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PubMed1996

Ultrastructural study on the plical epithelium of the bursa of Fabricius in chick embryos: influence of partial decerebration and hypophyseal allografts.

The bursa of Fabricius of 18 day normal and partially decerebrated chick embryos, and partially decerebrated embryos bearing a hypophyseal allograft was analysed by scanning and transmission electron microscopy, focusing on the ultrastructural characterisation of the plical epithelium. The plicae of the normal bursa consist of interfollicular (IFE) and follicle associated epithelium (FAE). The FAE is composed of typical polygonal cells and is supported by a layer of epithelial cells which appears as a continuation of the corticomedullary epithelium. Bordering cells lie between the FAE and IFE. The IFE is composed of 4 cell types: (1) undifferentiated, (2) goblet, at various stages of maturity, (3) prismatic, and (4) globular light cells. Partially decerebrated embryos showed a gross impairment of plical epithelium development and the complex of FAE and IFE cells was largely undifferentiated. Partially decerebrated embryos with a hypophyseal allograft displayed the same cellular types as observed in controls, thus indicating a restored differentiation of plical epithelium. These findings suggest that the hypophysis affects the differentiation of plical epithelium during ontogenesis.

Animals↗
PubMed1996

Isoforms of Na,K-ATPase in rat lens epithelium and fiber cells.

PURPOSE: The lens epithelium is thought to conduct Na-K transport for the entire lens cell mass. Lens fibers have a poor ion transport capacity. The authors tested whether different Na,K-ATPase polypeptides are expressed in the two cell types and whether both cells have the machinery needed for ongoing Na,K-ATPase expression as judged by the presence of mRNA for the Na,K-ATPase alpha subunit. METHODS: Membranes were isolated from adult rat lens epithelium or fibers, and Western blot experiments were conducted for Na,K-ATPase alpha 1, alpha 2, and alpha 3 polypeptides. Total RNA was isolated from adult rat lens epithelium or fiber cells, and Northern analysis was conducted for Na,K-ATPase alpha 1, alpha 2, and alpha 3 mRNA. Some experiments were conducted using fiber cells from neonatal (3-day-old) rat lenses. RESULTS: Multiple isoforms of Na,K-ATPase were detected in adult rat lens epithelium. Judged by Northern blot band intensity, mRNA for Na,K-ATPase alpha 1 and alpha 2 was more abundant than for alpha 3 mRNA. By Western blot, Na,K-ATPase alpha 1, alpha 2, and alpha 3 polypeptides were observed as sharp bands at 100 to 108 kDa. In fiber cells, only Na,K-ATPase alpha 1 immunoreactive polypeptide was detected. Judged by immunoblot density, the amount of alpha 1 polypeptide was similar in both epithelium and fiber cell material. However, Na,K-ATPase alpha subunit mRNA was not found in adult lens fibers. To test whether Na,K-ATPase synthesis takes place during fiber cell growth, Northern blot analysis was conducted with RNA from neonatal (3-day-old) lens fibers; Na,K-ATPase alpha 1 mRNA was clearly visible. CONCLUSIONS: Adult rat lens epithelium expresses more than one isoform of Na,K-ATPase catalytic subunit, whereas only the alpha 1 isoform can be detected in fiber cells. In adult rat lens fiber cells, the observation of alpha 1 polypeptide, but no alpha 1 mRNA, suggests that ongoing alpha 1 synthesis is low. Based on the detection of alpha 1 mRNA in neonatal lens fibers, Na,K-ATPase synthesis by lens fibers may be higher during cell elongation and growth.

Animals↗
PubMed1996

Regional differences in the distribution of catalase in the epithelium of the ocular lens.

Oxidative stress is thought to play a major role in cataract formation. The present experiments are aimed at gaining a better understanding of the systems that protect the lens from damage by reactive oxygen species. The aqueous humor normally contains hydrogen peroxide (H2O2), a compound capable of generating reactive oxygen species. The systems protecting the ocular lens from oxidative damage are primarily confined to the epithelium, a single layer of cells on the anterior side of the organ directly beneath the lens capsule. When cultured rabbit lenses were challenged with a single dose of 0.2 mM H2O2, cells in the peripheral region of the epithelium survived; those in the central region died. Here we investigate the histochemical and immunoperoxidase distributions of catalase, an enzyme which detoxifies H2O2, in cells from the peripheral and central regions of the epithelium on flat mount preparations of the epithelium. In a flat mount, the entire population of lens epithelial cells can be viewed on one preparation. The reaction product for catalase activity and its immunoperoxidase localization were more intense in peripheral epithelial cells than in cells throughout the central epithelium. Treatment of cultured lens epithelial cells or rabbit lenses with 3-aminotriazole or potassium cyanide, inhibitors of catalase, reduced or abolished the histochemical reaction product. Ultrastructural cytochemistry confirmed the presence of catalase in microperoxisomes of the epithelial cells from whole lenses. The decreased level of catalase throughout the central epithelium may account for the increased susceptibility of these cells to H2O2-induced cell death.

Animals↗
PubMed1998

Epidermal-growth-factor receptor correlates negatively with cell density in cervical squamous epithelium and is down-regulated in cancers of the human uterus.

The role of the epidermal-growth-factor receptor (EGFR) in cervical cancer is controversial, due to technical difficulties in localizing or in quantifying EGFR by homogenate assays or immunohistochemistry. Our autoradiographic approach, in combination with morphometry, allowed cell-type-specific quantification of EGFR, leading to the following observations: (i) In normal cervical epithelium, EGFR levels per cell were high in non-dividing squamous cells of the upper layers of normal epithelium, where a mitogenic function of these EGFRs can be excluded. (ii) In contrast to earlier findings in tissue homogenates, but consistent with our observation in normal cervical epithelium that cells of the proliferating strata (basal and parabasal cells) express intermediate and comparatively reduced levels of EGFR per cell, cervical cancers displayed a significant reduction both of specific EGF binding and of EGFR levels per cell as compared with normal epithelium. (iii) A significant negative correlation of cell density and EGFR number per cell was obtained. In normal cervical epithelium, cervical intra-epithelial neoplasia and invasive cervical cancer (p = 0.002). This negative correlation was most evident in normal epithelium, where large changes of cell density occur within one slide (p < 0.001). (iv) Specific EGF-binding was also significantly reduced in endometrial cancers when compared with normal endometrium. It is proposed that in uterine tissues low or intermediate levels of EGFR do not exclude their function as mediators of cell proliferation.

Autoradiography↗
PubMed1991

Auditory epithelial migration. III. Development of the stratified squamous epithelium of the tympanic membrane and external canal in the mouse.

The development of the stratified squamous epithelium of the tympanic membrane and external auditory canal was studied in serial sections of 124 mouse ears aged from 11 gestational days to 100 days. A fold developed from the edge of the fundus of the primary canal. It possessed two regions: firstly the meatal plate, which produced the pars tensa-covering epithelium (zone 2) and most of the deep ear canal epithelium (zone 3), and secondly the fundal extension plate, which grew from that part of the fundus not forming the meatal plate. The fundal extension plate gave rise to the pars flaccida-covering epithelium (zone 1) and also to the adjacent deep canal epithelium (zone 3). A difference from human development was that zone 3 in the mouse, in both the meatal plate- and the fundal extension plate-derived areas, formed adnexal structures. In the early development of the meatal plate, zone 3, at its tip, was swollen and actively mitotic and extended always for a short distance on to the zone 2 side. Zone 2, first perceived two days after zone 3, became progressively attenuated, and by the fourth day after its formation was a single thin layer. It is suggested that the proximal part of zone 3, situated in the mature ear around the periphery of the tympanic membrane, is a generation center for unidirectional outward flux of epithelium which terminates in the mouse at the first adnexal structure. It may cause the whole of zone 2 to move in the same direction by negative contact inhibition.

Animals↗
PubMed1978

Morphological and functional differentiation of the surface epithelium of the bursa Fabricii in chicken.

Morphological and functional differentiation of the mucosal surface epithelium of the bursa Fabricii was studied in White Leghorn chicken fetuses and newly hatched chickens. First signs of differentiation towards two types of epithelial cells appeared on the thirteenth day of incubation: The apical cells of the epithelial buds projected towards the lumen, and an increase in the number of Golgi regions was observed in the epithelial cells between the buds. On day 15 the follicle-associated epithelium contained small apically situated vacuoles, and large mucin granules appeared in the interfollicular surface epithelium. Towards the day of hatching both epithelial cell types were arranged to a monolayered or pseudostratified cylindrical epithelium. The follicle-associated epithelium had invaginations and small vacuoles in the apical cytoplasm, whereas the interfollicular surface epithelium had numerous microvilli on its apical surface and large mucin granules in the apical cytoplasm. In functional studies, endocytosis of colloidal carbon was demonstrated in four out of ten 19-day fetuses and in all chickens studied immediately after hatching.

Animals↗
PubMed1986

Effects of 30% intestinal resection on whole population cell kinetics of mouse intestinal epithelium.

The intestine remaining after resection undergoes a well known compensatory response. Crypts and villi grow in size, and the number of proliferating cells in a crypt increases. The crypt labeling index, however, is unchanged, which is thought to suggest that the growth fraction also remains unchanged and hence that the system is enlarged, but otherwise the new steady-state is similar to that of the controls. It is also generally accepted that no new crypts or villi are added to the adapting bowel. In this study we applied recently developed tools to study the response of the intestinal epithelium as a whole. Thus, the effects of 30% intestinal resection on whole population cell kinetics were determined by using flow cytometry, Coulter particle counting, and simple morphometric techniques. In addition to the classic response, we found an increase in the rate of crypt production, which was due mainly to a shorter crypt replication cycle. Thus, new crypts were produced at a faster rate in the resected animals than in the transected controls. This resulted in an expansion of the crypt cell population in the epithelium following resection. There was a corresponding expansion of the cycling cell population and thus an increase in the growth fraction of the resected epithelium. We conclude that for the crypt population, the classic story is correct with the exception that new crypts are added to the epithelium after resection. However, for the epithelium as a whole, the classic story is misleading as there appears to be an increase in the growth fraction of the epithelium after intestinal resection.

Animals↗
PubMed2001

Induction of bud formation of embryonic mouse tracheal epithelium by fibroblast growth factor plus transferrin in mesenchyme-free culture.

Embryonic mouse tracheal epithelium, which branches in an epithelial-mesenchymal recombination culture with bronchial mesenchyme, was cultured under mesenchyme-free conditions. When embedded in a basement-membrane-like matrix and cultured in a serum-free medium supplemented with fibroblast growth factor 1 (FGF1), the tracheal epithelium did not branch, whereas the bronchial epithelium underwent branching morphogenesis. When the medium was enriched with transferrin (Tf), bud formation was induced in the tracheal epithelium and some buds branched secondarily. FGF7 and FGF10, in cooperation with Tf, induced tracheal bud formation to the same extent as FGF1, although the optimum concentrations differed. A bromodeoxyuridine-labeling study comparing cultures with and without Tf showed no Tf-specific amplification of cell proliferation. A whole-mount in situ hybridization study of the expression of Bmp4 and Shh genes in explants of mesenchyme-free culture revealed that both genes were ubiquitously expressed and that expression did not correlate with bud formation. This expression pattern was different from the distally localized expression pattern observed in normal lung rudiments and in extratracheal buds induced by the recombined bronchial mesenchyme. These results suggest that both bronchial and tracheal bud formations were initiated without localized exposure of the epithelium to FGFs and were not accompanied by localized expression of Bmp4 and Shh in the epithelium.

Age Factors↗
PubMed2005

Neurogenesis, migration, and apoptosis in the vomeronasal epithelium of adult mice.

The location of neurogenesis and the direction of migration of neurons in the adult mouse vomeronasal organ is controversial. Cell division occurs at the center, and particularly, at the edges of the epithelium. Newly generated cells at the center of the epithelium participate in neurogenesis, however, it is unknown to what extent dividing cells at the edges participate in growth, become apoptotic or mature into neurons. Premitotic cells were labeled with bromodeoxyuridine (BrdU) in adult mice and animals allowed to survive for different postinjection periods. The terminal deoxynucleotidyl transferase-mediated biotinylated dUTP nick end-labeling (TUNEL) method was used to show the distribution of apoptotic cells. The vertical and horizontal position of BrdU-labeled cells was analyzed as a function of postinjection survival time. Vertical and horizontal migration of BrdU-labeled cells were detected. Cells in the central portions of the epithelium migrated vertically to become neurons as demonstrated by co-expression of olfactory marker protein. Cells at the edges migrated horizontally very slowly (less than 10% of the distance from the edge to the center of the epithelium per month), thus indicating that these cells participate in cell renewal exclusively in marginal regions. Neural turnover in the mouse vomeronasal epithelium, therefore appears to occur through a process of vertical migration. Data on the distribution of apoptotic cells indicate that a number of dividing cells throughout the epithelium, but particularly at the edges, die before becoming functional neurons. Accordingly, most dividing cells at the edges probably constitute a reservoir of stem cells dying before differentiation.

Animals↗
PubMed2005

Differential expression of matrix metalloproteinases and interleukin-8 during regeneration of human airway epithelium in vivo.

In many airway diseases, the airway epithelium is severely damaged and has to regenerate rapidly to restore its function. The regeneration process involves chronological steps of epithelial cell migration, proliferation, stratification, and differentiation. The present study has used an in vivo humanized airway xenograft model in nude mice that mimics the regeneration dynamics of human airway epithelium after severe injury, and human-specific molecular tools, to study the expression profiles of epithelial matrix metalloproteinases (MMPs)-7 and -9, of tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), and of the pro-inflammatory cytokine interleukin-8 (IL-8) during the different steps of human airway epithelium regeneration. It was found that during the cell migration and proliferation steps, airway epithelial cells expressed IL-8 at a high level, whereas airway epithelial pseudo-stratification and surface airway epithelial differentiation were associated with increased expression of MMPs and a progressive decrease in IL-8. Interestingly, immunohistochemical analysis revealed exclusive expression of MMPs at the apical part of the well-differentiated regenerated airway epithelium, and incubation of the regenerating epithelial cells with MMP inhibitors led to abnormal epithelial differentiation. These data provide new insight into the temporal expression of MMPs and IL-8 during the regeneration of airway epithelium and demonstrate the involvement of these factors during the different steps that lead to restoration of a well-differentiated and functional airway epithelium.

Animals↗
PubMed1997

ZO1 in corneal epithelium: association to the zonula occludens and adherens junctions.

The corneal epithelium, like other stratifying epithelium, does not present a well formed junctional complex as compared to that of simple epithelia. However, the resistance barrier of the corneal epithelium is to a great extent generated by zonula occludens (ZO, tight junction), which are formed between the cells of the apical-most strata. The tight junction provides a continuous seal around the apical aspect of adjoining epithelial cells, thereby preventing the free passage of molecules between adjacent epithelial cells (paracellular pathway). We have examined rabbit corneal epithelia with monoclonal antibody against the tight junction associated protein ZO1. With this antibody, we resolved two distinct patterns of ZO1 expression, one being the lateral boundary of the apical cell, which appeared as a true zonula around these cells. The second pattern of expression for ZO1 was at a set of punctate spots that correspond to the connection of the most apical portion of the basal corneal epithelial cells, with the above wing cells. En face, confocal analyses revealed that these areas consisted of 5-6 distinct spots per basal cell at or near the contact points with the immediate wing cells above. ImmunoEM revealed that the mid-epithelial accumulations of ZO1 were not tight junctions, but rather a form of adherens junction. The expression of ZO1 in the mid-epithelial level of the cornea is neither correlated with the presence of tight junction, nor with the established barrier functions. Interestingly, these junctions in the corneal epithelium also contain paxillin, a focal adhesion associated phosphoprotein which is a target of pp125 focal adhesion kinase, erbB-2 kinase and p21Obcr/abl oncogene. We postulated that the ZO1/paxillin adherens junction within stratified epithelium, such as the corneal epithelium, may function to reinforce attachments at the level of the basal cell to wing cell junction and be regulated by reversible phosphorylation. We speculate that the regulated phosphorylation of tyrosine residues on paxillin may perform a critical role in controlling epithelial cell-cell interactions as it does in cell-matrix adhesion.

Animals↗
PubMed2001

An expression profile of active genes in human conjunctival epithelium.

The purpose of this study was to describe the quantitatively and qualitatively genes expressed in in vivo human conjunctival epithelium. A cDNA library was created from human conjunctival epithelial cells obtained from 38 normal eyes by brush cytology. Poly A(+)RNA isolated from these cells was used as a template for cDNA synthesis by the vector-priming method. A 3'-directed cDNA library consisting of the cDNA moiety covering the poly A(+)RNA tail through the nearest Mbo I site was constructed and transformed into Escherichia coli. Inserts in 933 randomly chosen clones were sequenced. The resulting sequences were compared to determine frequency of appearance in the library, and to establish an expression profile of genes in the conjunctival epithelium. The sequences were sent to GenBank for gene identification. The result was an expression profile of active genes reflecting their relative abundance in the conjunctival epithelial mRNA population. The expression profile of human conjunctival epithelium showed that the most abundant gene transcript in human conjunctival epithelium was that for cytokeratin 13. Altogether 102 genes were found to be very active, including beta-2 microglobulin, lipocortin I and insulin-like growth factor binding protein-3. The gene expression profile of the conjunctival epithelium reflects the unique properties and functions of this tissue. Comparison of this expression profile with that obtained from corneal epithelium discloses clear differences and helps us better understand the physiology and pathophysiology of the ocular surface in humans.

Adult↗
PubMed2000

Abnormalities of cornified cell envelopes isolated from human papillomavirus type 11-infected genital epithelium.

Keratinocytes are the predominant cells in human skin. As keratinocytes differentiate, the nuclei are lost and the cornified cell envelope (CCE) develops, forming a covalently cross-linked, insoluble structure under the cell membrane. Layers of anuclear CCEs in the stratum corneum provide a barrier against water loss and mechanical damage and are a first line of immunologic defense. Infection of keratinocytes with human papillomaviruses (HPVs) induces proliferation and abnormalities including retention of nuclei in the stratum corneum and perinuclear halo formation. For effective transmission, HPV virions must be released from the CCE, a normally very durable structure. Therefore, it is likely that HPV infection affects the CCE in a manner that would facilitate virion release. To investigate the effects of HPV 11 infection on morphology and fragility, CCEs were purified from infected and uninfected epithelium. CCEs isolated from uninfected epithelium were smooth, cuboidal, and sonicated into long coiled structures. In contrast, CCEs from HPV 11-infected epithelium were irregular in size and shape, with rough edges, and sonicated into small fragments. In addition, the thickness of CCEs from HPV 11-infected tissue was 65% that of uninfected epithelium. Immunohistochemical analysis demonstrated that in contrast to uninfected epithelium, loricrin, the major component of the CCE, was abnormally distributed in the differentiated layers of HPV 11-infected epithelium. We conclude that in addition to the previously described epithelial abnormalities induced by HPV, the CCE is also affected by infection in ways that may facilitate transmission of virus from person to person.

Animals↗
PubMed1976

Further studies of the epithelium covering preovulatory rabbit follicles with special reference to lysosomal alterations.

The fine structure of the surface epithelium over preovulatory rabbit follicles was examined parallel with visualization of acid phosphatase at the electron microscopical level. Small enzyme positive vesicles were pinched off from the Golgi cisternae and similar vesicles fused and got incorporated into larger lysosomes of dense body type. Some lysosomes appeared in direct continuity with tubular enzyme positive structures. Other possible ways of increase of the lysosomal pool are indicated and discussed. As in previous studies a maximal accumulation of lysosomes was found in the apical epithelium at 8 h after an ovulatory dose of human chorionic gonadotrophin (HCG); thereafter a gradual loss of lysosomes ensued. Before the lysosomes disappeared from the surface epithelium they changed in character. They became more electron-lucent and revealed a fine-fibrillar matrix. Dense bodies deep in the cell interior appeared to communicate with each other and with the extracellular space below the surface epithelium. Openings were never seen towards the peritoneal cavity. tthe loss of lysosomal content from the apical surface epithelium before follicle rupture appeared in many respects similar to the histamine release process in mast cells. tthe findings support our working hypothesis that the surface epithelium over tgraafian follicles is an essential source of proteolytic enzymes and that these may be released extracellularly and actively contribute to the dissolution of the follicular apex before rupture.

Acid Phosphatase↗
PubMed1983

Discrimination of various epithelia by simple morphometric evaluation of the basal cell layer. A light microscopic analysis of pseudostratified, metaplastic and dysplastic nasal epithelium in nickel workers.

This study presents a simple morphometric method for objective classification of pseudostratified, various types of metaplastic, and dysplastic epithelium by evaluation of cellular features in the basal layer only. Fifty-four biopsy specimens were taken for diagnostic reasons from the nasal mucosa of nickel workers, and semithin toluidine-blue-stained sections were analysed. The most sensitive parameters in distinguishing between the various types of epithelium were: (i) the transverse nuclear diameter, (ii) the size of the nucleoli and (iii) the basal cell width expressed as an index weighted towards the cell profiles with the broadest attachment face on the basal lamina. A combination of these three parameters allows a clear separation between dysplastic, metaplastic and pseudostratified epithelium. The sequential increase in these parameters from pseudostratified epithelium through two histologically distinguishable stages of metaplasia (stratified cuboidal and mixed stratified cuboidal/stratified squamous epithelium) to fully developed squamous epithelium supports the concept that metaplasia develops gradually. The continuous increase in these parameters from metaplasia to dysplasia further suggests that metaplasia is a necessary step in the development of nasal epithelial dysplasia. This morphometric model appears especially useful in monitoring small sequential epithelial changes, and might also be used for evaluating other types of epithelia.

Biopsy↗
PubMed2004

The dynamics of precursor cells in the olfactory epithelium of juvenile and adult guinea pigs.

The dynamics of precursor cells in the olfactory epithelium of juvenile and adult guinea pigs were examined by immunohistochemical double staining using bromodeoxyuridine (BrdU), the neural cell adhesion molecule (N-CAM) and the protein gene product 9.5 (PGP9.5). Expression of apoptotic cells in the olfactory epithelium with the use of the TdT-mediated dUTP biotin nick end labeling (TUNEL) method was also observed. BrdU was given to healthy guinea pigs at the ages of 2 weeks and 6 months old. Tissue specimens were serially collected 1 h to 28 days after administration. BrdU-labeled cells were seen above the basal cell layer after 1 h and migrated to the middle layer of the olfactory epithelium, after 1 day in juveniles and 5 days in adults with expression of N-CAM. PGP9.5 was observed in BrdU-labeled cells after 5 days in juvenile guinea pigs and 7 days in adult. At 14 days after administration, BrdU-labeled cells in the epithelium appeared to decrease. However, a few of these cells were recognized above the basal cell layer after 28 days. The number and location of TUNEL-positive cells did not significantly differ between the juvenile and adult olfactory epithelium. Therefore, we conclude that the division speed from stem cells in juveniles is faster than that in adults, and apoptosis is unaffected by aging in the normal olfactory epithelium.

Age Factors↗
PubMed2001

Permeability of the proximal and distal rat colon crypt and surface epithelium to hydrophilic molecules.

Our knowledge of the epithelial permeability of different sections of the colon as well as of the surface and crypt epithelium is patchy and contradictory. Therefore, movement of radiolabelled urea, mannitol and Cr-EDTA between the lumen and the plasma of rats was studied, and expressed as clearance. In experiments studying movement from the lumen to the plasma, only the clearance of urea was significant. In experiments on the movement from plasma to the lumen, all three permeability probes exhibited significant clearance in the proximal colon, while in the distal colon the clearance of Cr-EDTA was not significant and the other clearance values were lower than in the proximal colon. Thus, the two methods are proposed to mainly reflect the permeability of two different parts of the epithelium, i.e. the surface and the crypt epithelium. Furthermore, it is proposed that the rat surface epithelium only allows passage of hydrophilic substances smaller than monosaccharides [radius below 0.35 nm (3.5 A] while the crypt epithelium, particularly in the proximal colon, is a heteroporous membrane of higher permeability containing pores corresponding to radii of >3.5-4.0 nm (35-40 A) and 0.4-0.5 nm (4-5 A). Moreover, the results indicate that in vivo luminal fluid solution has no access to the crypt epithelium, a conclusion strengthened by the observation that Evans-blue-labelled albumin and FITC-dextran 4000 do not seem to reach the crypt lumina.

Animals↗
PubMed2003

Prospective study of factors affecting postoperative pain and symptom persistence after stapled rectal mucosectomy for hemorrhoids: a need for preservation of squamous epithelium.

PURPOSE The purpose of the study was to determine the variables associated with postoperative pain and the clinical response of patients with uncomplicated hemorrhoidal disease treated with stapled rectal mucosectomy in the medium term. METHODS Patients with Grade II to IV, uncomplicated hemorrhoidal disease who underwent stapled rectal mucosectomy were prospectively included. The basal characteristics of the population were evaluated and level of stapling and placement of hemostatic suture determined. Histologically, the type of resected epithelium and presence of muscle fibers was evaluated. Postoperative pain was evaluated by means of a visual analog scale. Complications and clinical response were evaluated. RESULTS One hundred patients with a mean age of 43.9 years were included. Only columnar epithelium was resected in 48, transitional epithelium in 47, and squamous epithelium in 5 patients. Smooth muscle fragments were found in 55 patients, and, in 12 of these, fibers from the external muscular layer of rectum were also seen. Follow-up was 12.6 +/- 3.4 (range, 7-24) months. A total of 79 patients were completely asymptomatic at the end of follow-up. Resected squamous epithelium was associated with a higher postoperative pain level in the multivariate analysis (coefficient beta = 1.16 (95 percent confidence interval, 0.08-2.24); P = 0.035). CONCLUSIONS Rectal mucosectomy with stapler is an effective method for the treatment of uncomplicated prolapsing hemorrhoidal disease. Intensity of postoperative pain was associated with the type of resected epithelium. This suggests that low transection of hemorrhoids must be avoided.

Adult↗