DEFINITION OF PATHOLOGICAL CHANGES 108 Table 4.1, The mean diameter and proportion af various fibre types in normal adule musete pro} f Type | ‘Type 2A Type 28 Male Female Male Female Male Female rage diameter of filbres (1) 6t 53 69 52, 62 42 AN pr Percentage of fibres im total 36 39 24 29 40 32. In children the problem is somewhat different. In normal biopsies the | wean diameters of the type.) and type 2 fibres differ by not more than 12 per cent of the value of the largest diameter of the largest fibre type. The variability, coefficient is again fess than 250. A graph showing the normal f values of the fibre size in childhood is illustrated in, Fig. 4.52 ATROPHY AND HYPERTROPHY FACTORS Atrophy and hypertrophy factors are calculated from the histograms of m the muscle fibres and are an expression of the number of abnormally small E ot large fibres in the biopsy (Brooke and Engel, 1969b). Nearly all the fibres #: in the normal histogram are between 40 and 80 diameter in the male and © to 70 yt in the female. if we first consider the abnormally small fibres, let us suppose that there area few fibres in the 30 to 40 yt range in a certain histogram from a male B biopsy. These fibres would have fess significance than the same number of fibres in the range of £0 to 20 j, or than a Jarger number of fibres in the same {Mt 40 jt) range. This may be taken into account by multiplying the number fof fibres in the histogram with a diameter between 30 and 40 pt by one, the aumber of fibres with. a diameter between 20 and 30 4 by two, the number B of those from 10 to 20 1 by three, and the number in the group less than {0 p {by four, These products are then added together and divided by the total mumber of fibres in the histogram to put the result on a proportional basis. ‘The resulting number is then multiplied by 1000 and this is the ‘atrophy factor. A hypertrophy factor may be similarly derived to express the pro- portion of fibres larger than, 80 js in the male. A diagrammatic calculation FP from a histogram is shown. in Fig, 4.53. In addition to making the calculations for the muscle biopsy as a whole, one can alse consider each fibre type separately. Thus, for each histochemical fibre type there are two mumbers: bie atrophy and hypertrophy factors (abbreviated A-H factors). The histo f, gram for a given biopsy may then be expressed as a series of four numbers for BAL HI, A2, H2 (atrophy and hypertrophy of type I and type 2 fibres respectively). If fibre subtypes are considered, there wili be six numbers, B. thos Al, HI, A2A, H2A, A2B, H2B. In the female we use the limits 30 to Fy and not 40 to 80 ut in order to calculate atrophy and hypertrophy factors ina similar way (Table 4.2).2 MUSCLE BIOPSY: A MODERN APPROACH CALCULATION OF A~H FACTC tb 40 60 80 10 te) Totai No of Fibers 2156 ad -4 ~ Foster = Tee H~ Factor 122 jon of atrophy (A) and hypertrophy (Ht) factors from « histogram of fibre sives in a muscle biopsy. (Reproduced, with permission, from Brooke and Engel, 1955 surotagy (Minneapolis), 19, 378-393.) This statistical approach, although somewhat laborious, is particulurly useful in detecting the presence of atrophy or hypertrophy that may not be apparent on routine inspection of a muscle biopsy, and for demonstrating the presence of selective atrophy of one fibre type in association with hyper trophy of anet type Table . Upper fimits for she value of atrophy and inypertropiy factors for normal adult mate anid female nusetes Type | ‘Type 2A and 28 Atrophy Hypertrophy Awophy Hypertrophy 150 300) 150 300) e 100, 20) £50 150 Male 150 150 iso 400 Female 100 4 200 150