[Arthropathy in hemochromatosis]. / Arthropathie bei Hämochromatose.

Early diagnosis of hemochromatosis may prevent the numerous risks of iron overload. One of the most common early manifestations of this disease is arthropathy. The clinical and radiologic findings of hemochromatosis arthropathy are discussed. Diagnosis is suggested by simple laboratory tests and confirmed by liver biopsy with measurement of hepatic iron content. Treatment includes the removal of the excess body iron by phlebotomy. Unfortunately, symptoms of arthropathy tend to be resistant to phlebotomy.

The sublingua and tongue of Tupaia (Scandentia, Mammalia): a scanning electron microscope study.

The surface morphology of the tongue and the sublingua in Tupaia belangeri was examined both under the dissection microscope and with the scanning electron microscope. Shape and structural differentiation of the sublingua and the anterior ventral part of the tongue are described. Special types of papillae were found on the lingual segment of the keel, along the serrated edges of the sublingua, and at the apex linguae. The findings are discussed with respect to the special conformation of the oral cavity of Tupaia and in relation to the evolutionary and functional significance of the tongue and the sublingua in this species.

[Movement therapy. With special reference to functional disorders of the locomotor system]. / Bewegungstherapie. Mit besonderer Berücksichtigung funktioneller Störungen des Bewegungssystems.

Physical therapy by movements is of importance in several medical fields, in particular in rehabilitation. A great variety of possibilities for treatment by exercises and manual therapy exists. In a first part we outline a useful and problem-oriented nomenclature derived from actual applications of physical therapy by movements based on various concepts. The bases and applications of functional therapy by movements, by training or manipulative procedures as well as other therapeutic means are presented. The therapeutic climate and the relation between doctor and physiotherapist are briefly explored. In a second part we present the most important traditional concepts of treatment by movements in a more detailed way.

Analysis of glycosaminoglycans in human serum after oral administration of chondroitin sulfate.

Chondroitin sulfate was administered orally to six healthy volunteers, six patients with rheumatoid arthritis and six patients with osteoarthritis. Blood was collected at intervals before and after treatment and the glycosaminoglycan concentration was analyzed in serum using a sensitive assay based on the metachromatic reaction with 1,9-dimethylmethylene blue. The glycosaminoglycan concentration in serum before and after ingestion of chondroitin sulfate was statistically unchanged in all of the subjects studied. We suggest that chondroprotection by orally administered chondroitin sulfate is a biologically and pharmacologically unfounded theory. Any possible benefit to osteoarthritic patients after ingestion of chondroitin sulfate should be sought at the gastrointestinal rather than at the plasmatic or articular cartilage level.

Failure of MR imaging to detect reflex sympathetic dystrophy of the extremities.

Reflex sympathetic dystrophy of the extremities is a disease with a wide spectrum of clinical manifestations. It is characterized by pain, hyperthermia, and cutaneous changes and has been linked to an abnormality of regional blood flow. The disease is associated with previous injury or trauma including surgery, but also has been found in association with myocardial infarctions and tumors. The final diagnosis can be made only on the basis of the clinical course, which is characterized either by regression without sequel or the appearance of aponeurotic and tendinous retractions including bony sclerosis in the affected region occurring over many months to years. The literature and our own results show that MR imaging has high sensitivity for diagnosing transient osteoporosis of the hip, which is generally thought to be a form of reflex sympathetic dystrophy. Therefore we investigated the usefulness of MR imaging for diagnosing sympathetic dystrophy of the extremities. Twenty-five patients underwent T1- and T2-weighted MR imaging of the affected body region. They were selected on the basis of the initial clinical findings and positive findings on scintigraphy, which is known to be a sensitive, but not very specific, imaging method for sympathetic dystrophy. The final diagnosis was established on the basis of the clinical course in 17 of the 25 patients. In 10 of these, findings on MR images were completely normal, in six the MR images showed only nonspecific soft-tissue changes or bone marrow sclerosis, and in one patient they showed changes in bone marrow signal. Of the remaining eight patients without a final diagnosis of sympathetic dystrophy, MR showed soft-tissue or bone marrow alterations in six. MR imaging appears to be of little value in establishing the diagnosis of sympathetic dystrophy, but it may improve diagnostic specificity when used in conjunction with scintigraphy.

[Comparative anatomic studies of the tongue of Pan troglodytes (Blumenbach, 1799) and other primates. I. The chimpanzee tongue]. / Vergleichend-anatomische Untersuchungen an den Zungen von Pan troglodytes (Blumenbach, 1799) und weiteren Primates. Teil I: Befunde an der Schimpansenzunge.

This study was carried out on a comprehensive collection of tongues of Pan troglodytes. Material of tongues of Tupaia glis, Microcebus murinus, Chirogaleus major, Lemur catta, Galago crassicaudatus, Cebus apella, and Macaca mulatta were used for comparison of the different stages of the development of the papilla foliata. The tongue of Pan exhibits longitudinal growth correlated with the growth of length of the jaws and individual age. A typical foramen caecum as it occurs in man was gross anatomically not recognizable. Seldom a small circular depression appeared in the midline close to the papilla circumvallata centralis which could be the remnant of the foramen caecum. There is a remarkable accumulation of papillae filiformes and fungiformes at the apex linguae; the same seems to be true for other genera of primates. It is self-explanatory that the accumulation of papillae makes the tip of the tongue a particularly sensitive area; this has been found to be true even in man. One specimen of the prenatal age just before term was studied. It exhibited remarkably elongated, thread-like papillae, their function is unknown as yet. They are no longer present in a newborn specimen of 4 d of age. In the aboral part of the dorsum linguae, a special kind of papillae occur; they are flat lobes which carry moderately elongated, tiny processes at their free margin. The function of these papillae is unknown; taste buds are absent.

[Comparative anatomy of the tongue of Pan troglodytes (Blumenbach, 1799) and other primates. II. Findings in other primates]. / Vergleichend-anatomische Untersuchungen an den Zungen von Pan troglodytes (Blumenbach, 1799) und weiteren Primates. Teil II: Befunde an anderen Primaten.

This 2nd part of our studies shows that the papilla foliata is fully developed in Pan, Cebus, and Macaca; in Prosimians the papilla foliata is well developed in Lemur and Chirogaleus. In Galago crassicaudatus, this papilla is missing. Among 3 individuals of Microcebus, the papilla foliata was differently developed: in 2 cases, the tongue exhibited only 2 on both sides and a very low folia. Taste buds were found in the epithelium of only one side of each folium. In the 3rd case, the folia of the papilla were developed only on one side of the tongue, whereas, on the other side, a typical papilla was missing. Instead of the papilla, the tongue of the same animal exhibited a hillock-like structure; it is a gustatory hillock which exhibited many taste buds. There were 3 gustatory hillocks in all of the specimens of Tupaia glis; they are situated on both sides of the tongue.

Lightmicroscopical investigations of the sublingua of Microcebus murinus (Cheirogaleidae, Lemuriformes) with remarks on the phylogenetic relations of the tree shrews (Scandentia) to primates.

The sublingua of Microcebus murinus was studied gross anatomically and light microscopically. The apex of the sublingua ends in two lobe-like projections separated by a distinct median cleft. The lobes exhibit at their oral, free margin tiny processes, but no "comb"-like specializations of intensely keratinized mucosa. At the ventral surface of the sublingua three longitudinally oriented keels or ridges are found; the mucosa of the keels is strongly keratinized, so that these structures maximize the rigidity of the undertongue. In none of the specimens examined was any trace of sublingual cartilage found; in the sublingua of Cheirogaleus (only one individual examined), the nearest relative of Microcebus, cartilage was also absent. The absence of sublingual cartilage and the incidental, irregular occurrence of cartilaginous elements in the sublingua of Tarsius and Tupaia indicate that the sublingual cartilaginous skeleton is not a derivative of the hyoid arch. It is a newly developed supporting structure which does not regularly occur. A sublingua occurs only in prosimians and Tarsius; whether the fimbria linguae of the Hominoidea is the homologue of a sublingua is still disputable. The exclusive occurrence of a sublingua in prosimians and Tarsius indicates a phylogenetic relationship between these two groups and Tupaia. The "Tupaia-problem" concerns the origin of primates and from this point it derives its general importance. At present we are far from a final solution; a definite answer cannot be expected before sufficient fossil records are available which document conclusively the historical paths of the origin of primates.

Notes on the typology of the skull of the Myrmecophagidae (Mammalia, Edentata).

The skulls of Myrmecophaga, Tamandua, and Cyclopes are klinorhynch; the upper jaw is situated rostral to the neurocranium and to a varying degree ventral to the plane of the median basis cranii. The median part of the base of the neurocranium is the structure to which the anatomical modifications in the median plane are referred. The kyphosis, which determines the situation of the upper jaw, is prebasically located either within the upper jaw (Myrmecophaga, Tamandua) or at its basis (Cyclopes).

Preliminary electron microscopic observations on ependymal cells in the caudal segment of the filum terminale and the ampulla caudalis of Macaca fascicularis and Cercopithecus griseoviridis (primates, Cercopithecidae).

In a previous paper, the concept of the terminal organ (TO) of the subcommissural complex was forwarded. Functionally this complex is a neuro (glio-) hemal organ which serves to discharge the Reissner's secretory material into the systemic circulation. The TO is characterized by structural specializations that make feasible the discharge and chemical decomposition of the secretory material stowed in the massa caudalis (MC). The TO is probably not only the ampulla caudalis (AC); it may comprise even parts of the filum terminale next to the AC. The boundary of the TO is uncertain as yet. It cannot be precluded that the AC, which itself varies in shape and size, is just a receptaculum massae caudalis. The material of the MC escapes from the AC either through apertures of the wall of the AC or of the filum terminale (Neuropori caudalis, slit-shaped gaps). It is also likely that the secretory material becomes chemically decomposed in the AC and is intra- (trans-) cellularly discharged. In this connexion, certain ependymal cells may be of significance. These cells exhibit large, tongue-shaped central projections (temporarily developed?) which bear a considerable number of long microvilli. The significance of these cells probably lies in the enlargement of the cell surface bathing in the CSF which contains the MC. These cells are most abundant in the area of the TO; single, isolated cells of the same type occur in other areas of the ependyma of some primates. This would indicate that the TO does not contain special types of cells not found in other parts of the ependyma, but that the TO differs from other ependymal regions in the density of peculiar cell types.

The terminal organ of the subcommissural complex of chordates: definition and perspectives.

The subcommissural organ (SCO) exhibits anatomical characteristics of an endocrine organ: The secretion is released either into the blood (hypendymal capillaries) or the CSF of the 3rd ventricle; excretory ducts are absent; the active secretory activity of the ependymal cells can be regulated by humorally transmitted messages or by neural input. The rate of production of the Reissner's fibre (RF) by the SCO is rather fast, and the secretory material is stored in the ampulla caudalis (AC) and must be continuously discharged accordingly. Structures jointly involved in depletion of the AC and the decomposition and removal of the massa caudalis (MC) are collectively called the terminal organ (TO). The TO of the SCO-complex is formed by an assemblage of different structures in the caudal segment of the spinal cord (neurogenic part) and in the tissues (non-neurogenic part) which encompass this part of the cord. The different parts of the TO are characterized, even at the cellular level, by specializations which support the discharge as well as the dissolution of the material of the MC. The RF may be a detoxicator for the CSF, but also a carrier of hormonally active substances. In this case the TO is a site of release of hormones. The function of the entire complex is still under discussion, particularly its role in endocrine integration.

Observations on the discharge of the secretion from ependymal cells of the subcommissural organ (SCO) of some South American primates.

The secretion of the subcommissural organ (SCO) is synthesized in the intrinsic cells of that structure, a neuroendocrine gland. The organelles involved in the synthesis of this secretion are rough-surfaced endoplasmic reticulum (RER) and the Golgi apparatus. It is still uncertain whether and to what extent the latter participates in the synthesis. In highly active secretory ependymal cells of the SCO, the Golgi apparatus exhibits distinct signs of intense activity. This suggests that the Golgi apparatus is involved in the preparation of the secretion, even if this is difficult to prove electron microscopically. The secretion is discharged from the optical part of the SCO-cells into the cerebrospinal fluid (CSF) of the IIIrd ventricle, where Reissner's fibre is formed. Different phases of release of the content of the secretory granula into the IIIrd ventricle are described; our findings are in agreement with previously published observations. In 2 cases delicately granulated and moderately electron-dense material was found in circumscriptly dilated vaults of the intercellular spaces. Release of secretory material into intercellular spaces appears to be possible, but is evidently infrequent. Regular occurrence of a basal (peripheral) discharge into the hypendymal capillaries is not unanimously agreed upon as yet. In this paper, a passage of granula is described from the cytoplasm of the end feet of SCO cells through the walls of the capillaries into the systemic circulation. This provides structural evidence that secretory material synthesized in the SCO is released into the capillaries. These observations must ultimately be confirmed with the aid of ultracytochemical methods, particularly using labelled material.

Casual light microscopic observations on the intracommissural elements (ICE) of the subcommissural complex in some primates.

OKSCHE (1969) described secretory processes in glial cells of the canine subcommissural complex which form strands crossing directly from the hypendyma to the membrana limitans gliae superficialis; these observations were corroborated by STERBA et al. (1982). According to OKSCHE (1969) the secretory material is discharged into the blood vessels of the pia mater; empty vesicles are found in widened leptomeningeal spaces. Structural elements of the subcommissural complex situated in the commissura caudalis, but which are actually not intrinsic elements of the latter, should be called "Intercommissural elements" (ICE); they traverse radially the commissura caudalis (nerves, glial cells, blood vessels), thus causing the striped appearance of the commissure in sagittal section. The striation depends on different elements (nerves, astroglia), which can be demonstrated by different techniques. The strands originate out of cone-like projections of the hypendyma which contain numerous cells having the appearance of ependymal cells of the SCO sunk into the hypendyma. The strands consist of bipolar astroglia, which develop the endfeet forming the membrana limitans gliae superficialis.

Observations on organized areas of the endoplasmic reticulum, mitochondria, and ribosomes in ependymal cells of the subcommissural organ of Cebus, Saimiri and Callicebus (Platyrrhina, Primates).

The endoplasmic reticulum, the distribution of ribosomes attached to its membranes and the topographic relation of mitochondria have been studied in ependymal cells of the subcommissural organ of Cebus, Saimiri, and Callicebus. Occasionally, these organelles appear to be distinctly organized in restricted areas. They may be either irregularly arranged, formed into stacks, or organized into individualized corpuscules. The constituents of these organized areas are the same. Topographic relations with the GOLGI apparatus which would indicate a close interaction between these organelles, were not observed. The assemblage of substructures known to be involved in the synthesis of secretions of the subcommissural organ indicates a specific function of those areas.

Preliminary electronmicroscopical observations on the ampulla caudalis and the discharge of the material of Reissner's fibre into the capillary system of the terminal part of the tail of Ammocoetes (Agnathi).

The discharge of the material of the Reissner's fibre (RF) and the massa caudalis (MC) into the "meningeal spaces" has until now not been studied in detail and with the aid of the electron-microscope. It was generally assumed that the material of the MC disintegrates in the "meningeal spaces", but the nature and function of those spaces have not been established. The CNS of Ammocoetes ist encompassed by the meninx primitiva, which is the meningeal tissue of the lower vertebrates; the meninx does not differentiate during ontogeny into the pia mater and the arachnoides. In contrast, the meninx primitiva of mammals is the anlage in the ontogenetical sense of the leptomeninges in adult individuals. The results presented in this paper are valid for Ammocoetes only; Petromyzon and Myxine must be studied anew from a perspective which may be the result of our study. Of particular interest would be an anatomical analysis of these caudalmost structures of the CNS (Ampulla caudalis [AC], MC, neuropori, lacunae etc.) in Branchiostoma. The diameter of the RF of Ammocoetes is approximately 1.7 micron; this is not different from the diameter of the RF in adult individuals. In the AC the RF divides into several smaller fibres which eventually disintegrate and form the amorphous MC. In sagittal sections, the fibrillary structure of the RF is distinct. In cross sections the small fibres may appear as globules. The terminal part of the RF is very often coiled. The ependyma of the caudal part of the canalis centralis (CC) ist not remarkable; liquor contacting neurons are frequently found with their dendrites touching the RF. Liquor contacting neurons are never found in the ependyma of the AC. The ependymal cells of the dorsal part of the AC possess neither kinocilia or microvilli. The disappearance of these organelles begins in the dorsal part of the caudalmost segment of the CC. Most surprising is the distribution of the attachment devices which are probably desmosomes. In the ependyma of the caudal part of the spinal cord the attachment devices are typically situated; in the ependyma of the AC these devices are absent. We use the general term "attachment devices" until the nature of these devices has been clearly determined. In the caudalmost part of the spinal cord as well as in the AC, the intercellular spaces between the ependymal cells communicate, forming a 3-dimensional labyrinth. If there are no attachment devices between the proximal parts of the ependymal cells, the intercellular spaces may provide a passageway between the CC and the loose tissue of the meninx primitiva.(ABSTRACT TRUNCATED AT 400 WORDS)

Capillary sclerosis of the urinary tract and analgesic nephropathy.

Morphology, frequency and significance of capillary sclerosis (CS) in the ureter and electron microscopic findings in early papillary necrosis are described. CS of the urinary tract is characterized by a thickening of the basement membrane of capillaries lying just underneath the urothelium. The basement membrane changes can be demonstrated by PAS, Sudan stain and autofluorescence with equal reliability. By electron microscopy the thickened basement membranes exhibit a tree ring like pattern permeated by lipid vacuoles. CS is most often present in the renal pelvis and the ureter and only in particularly severe cases also in the urinary bladder. The most severe CS is found in the proximal and middle third of the ureter. In a prospective autopsy study CS was found in 3.5% of autopsies of adults and in 83% of clinically recognized phenacetin abusers. Since there is no association with other renal or metabolic diseases, CS can be considered as specific for phenacetin abuse. This finding is further substantiated by a significant correlation between the degree of severity of capillary sclerosis and the daily dose of phenacetin in grams. In about half of the patients with known analgesic abuse but without CS, possible causes for the lack of CS can be identified, of which the most important is regression of CS after stopping the abuse. Electron microscopic studies of early papillary necrosis show the same BM changes as in the ureter in peritubular capillaries, loops of Henle and similar BM alterations in the collecting ducts. The morphologic findings in the ureter and in the renal papilla suggest that CS in papillary necrosis are the consequence of a toxic damage of endothelial and in the kidney of endothelial and epithelial cells.

Energy and protein consumption in patients with senile dementia.

Demented elderly patients unable to eat independently and often refusing food are threatened by malnutrition. Therefore, we determined in 6 female patients aged 74-100 with senile dementia the average daily food consumption within a 3-week period by the exact weighing methods on six occasions. The average daily energy intake was 7,364 kJ (carbohydrates 3,300, fat 3,030, and protein 1,034 kJ). Acceptance of food was best at breakfast; during lunch and dinner all patients refused nutrients in two-thirds of the meals. During the observation period the subjects remained in a steady state (weight, serum albumin). It is concluded that spontaneous nutrient intake is sufficient in stable conditions. In times of increased energy needs the observed eating habits may lead to malnutrition.