[Papillary adenoma of type-II pneumocytes as a rare differential diagnosis of a solitary pulmonary nodule]. / Papilläres Adenom der Typ-II-Pneumozyten als seltene Differenzialdiagnose eines pulmonalen Rundherdes.

The case of a 66-year-old, asymptomatic patient with a papillary adenoma of type-II pneumocytes is reported. Following the coincidental radiologic finding of a solitary pulmonary nodule, the diagnosis could be established in a bronchoscopically obtained endobronchial biopsy. A resection of the involved segments S8-10 on the left side was performed. Papillary adenoma of type-II pneumocytes is a rare tumor, whose origin is suspected in progenitor cells of the bronchioloalveolar epithelium with the potential to differentiate towards type-II pneumocytes and clara cells. The tumor is regarded as benign, however, a malignant potential is not excluded by some authors.

[Prostate carcinoma (PC)--an organ-related specific pathological neoplasm]. / Prostatakarzinom (PC)--eine organspezifische Neoplasie aus der Sicht der Pathologie.

The organ- and tumour-related specific characteristics of prostate carcinoma (PC) are presented in an overview under various aspects. It is the key for understanding pathological changes, including PC, to consider the subdivision of the prostate into anatomically and functionally distinguishable zones, especially the transitional zone (TZ) and the peripheral zone (PZ). The pseudoneoplastic hyperplasia of the TZ, combined with inflammatory consequences and age-related changes, forms a differential diagnostic challenge to both clinico-radiological diagnosis and macroscopic and microscopic examination. High-degree prostatic intra-epithelial neoplasia (PIN III) and atypical adenomatous hyperplasia (AAH) are presented as precursor lesions of PC with varying significance and assessment. Moreover, there are discussed the following characteristic features of PC: localisation types, focality, volume, progression, double-graduation according to Gleason, tumour stage, and prognosis. The most important prognosis factors of PC (category I) include the categories of the TNM system, such as stage, surgical marginal situation, degree and also the preoperative PSA level as a (poor) substitute for the tumour volume. Potential prognosis parameters (category II) show the tumour volume and the DNS ploidy, while there continues to exist a large number of non-established parameters (category III). The prognostic validity of the pathological examinations depends, on the one hand, on the tissue extent (needle biopsy, transurethral resection (TURP), so-called simple prostatectomy, radical prostatectomy (RPE)) and the prostate zones covered. On the other hand, the prognostic certainty also depends on the tumour-adequate macroscopic and microscopic assessment of an RPE that can only be a partial or complete handling in transversal large-area sections.

[MR imaging of prostate cancer]. / MR-Tomographie des Prostatakarzinoms.

PURPOSE: Accurate diagnosis and staging of prostate cancer (PC) is developing into an important health care issue in light of the high incidence of PC and the improvements in stage-adapted therapy. The purpose of this paper is to provide an overview on the current role of MR imaging and MR spectroscopy in the diagnosis and staging of PC. MATERIAL AND METHODS: Pertinent literature was searched and evaluated to collect information on current clinical indications, study techniques, diagnostic value, and limitations of magnetic resonance imaging and spectroscopy. RESULTS: Major indications for MR imaging of patients with suspected PC are to define tumor location before biopsy when clinical or TRUS findings are inconclusive, and to provide accurate staging of histologically proven PC to ascertain effective therapy. Current MR imaging techniques for the evaluation of PC include multiplanar high-resolution T2-weighted FSE and T1-weighted SE sequences using combined endorectal and phased-array coils. Using these techniques, the reported accuracy of MR imaging for the diagnosis of extracapsular tumor extension ranges between 82 and 88% with sensitivities between 80 and 95%, and specificities between 82 and 93%. Typical MR findings of PC in different stages of disease, as well as diagnostic problems, such as chronic prostatitis, biopsy-related hemorrhage and therapy-related changes of prostatic tissue are discussed. In addition, the current perspectives and limitations of MR spectroscopy in PC are summarized. CONCLUSIONS: Current MR imaging techniques provide important diagnostic information in the pretherapeutic workup of PC including a high staging accuracy, and is superior to TRUS.

Exercises illustrating flow in porous media.

A set of physically based exercises is described for illustrating concepts and processes related to fluid movement in porous media. These exercises revolve around a permeameter that costs several dollars to construct and requires no external equipment and no electrical power to operate. The exercises can be used to illustrate concepts related to pressure and fluid statics, Darcy's equation for both gases and liquids, infiltration, and flow in layered media. Although the permeameter was originally developed as a teaching aid, it may also be useful in field applications as a tool to estimate air and hydraulic conductivity. Additional testing is recommended to further assess the accuracy of the results for field applications.

Retroperitoneal ectopic neural mass: "abdominal brain"--presentation of two cases and proposal of classification of paraneuraxial neural ectopia.

An encapsulated mass of brain tissue was found in the retroperitoneum of a fetus of gestational week 15 and a boy of age 3 years. The masses possessed fibrous tissue that bound them to the spine and intraspinal connective tissue, respectively, but there was no evidence of direct continuity of the ectopic brain tissue with the normal central nervous system. There was no dysraphism. In our fetal case, possible Foix-Alajouanine anomaly was additionally found. The ectopic neural tissue in the retroperitoneal region may be termed "abdominal brain." In the literature, an identical state has been described in the head (paracranial region) but there are no other records of the paraspinal region. Despite the different locations of the masses (head/paracranial or retroperitoneum/paraspinal), these ectopic brain masses should belong to the same disorder spectrum of the paraneuraxial neural ectopia, a new concept.

[Trans-sternal cervico-mediastinal primary tumor resection and lymphadenectomy in thyroid gland cancer]. / Die transsternale zervikomediastinale Primärtumorresektion und Lymphadenektomie beim Schilddrüsenkarzinom.

Thyroid carcinoma may invade the mediastinum by direct extension of the primary tumor or metastases to the paratracheal or retroclavicular-parajugular lymph nodes. From 1975 to 1991 in 47 out of 622 thyroid cancer patients (7.6%) [14 papillary (PTC), 5 follicular (FTC), 16 medullary (MTC) and 12 undifferentiated carcinoma (UTC)] transsternal tumor resection has been performed. Four patients (UTC three, MTC one) deceased 7, 8, 35, and 41 days after resection of the primary tumor due to cardiac or tumor disease, and in one patient because of acute arteriotracheal haemorrhage after external irradiation; no patient deceased after transsternal resection as a result of cervicomediastinal lymphadenectomy. At the time of primary operation 80% of patients showed an advanced tumor stage (greater than pT3). In 34% of patients (PTC 64%, FTC 40%, MTC 13%, UTC 25%) no tumor recurrence was observed neither by imaging nor by biochemical methods. In 18 patients a transsternal microdissection of all four cervicomediastinal lymph node compartments has been performed. Histological analyses of excised and tumor involved lymph nodes revealed in 9 patients unilateral cervical and mediastinal and in 9 patients bilateral cervical and mediastinal lymph node metastases. In the case of unilateral cervicomediastinal lymph node metastases 2 out of 2 patients with papillary and 2 out of 6 patients with medullary thyroid carcinoma could be cured surgically. In the case of bilateral cervicomediastinal lymph node metastases 3 out of 4 patients with papillary thyroid carcinoma, but no other thyroid cancer patient were free of disease. In conclusion, main indications for transsternal cervicomediastinal resection in thyroid carcinoma are (1) primary tumors extending to the upper mediastinum, but without lymph node metastases, and (2) thyroid carcinomas with unilateral cervicomediastinal lymph node metastases. In the case of bilateral cervicomediastinal lymph node metastases probable only papillary thyroid carcinomas are supposed to be curable by transsternal multicompartmentectomy.

[Diseases of the sesamoid bone of the large toe]. / Erkrankungen an den Sesambeinen der Grosszehe.

One-hundred patients with anterior foot pain were examined by tangential sesamoid x-rays and some by bone scan. Degenerative changes were present at the sesamoid joint in thirty patients. In thirty-five the sesamoids had changed position relative to the first metatarsal bone, which in all cases could be attributed to metatarsus-primus-varus. Three fractures were found. They were differentiated from congenital partitions only by bone scan. Osteomalacia of the sesamoids was observed in two patients. Operative removal was necessary in only one of all patients.

[The relationship of the macrophage system to the blood vessel wall and atherogenesis]. / Beziehungen des Makrophagensystems zur Gefässwand und Atherogenese.

Monocytes/macrophages are physiological cellular components of the subendothelium of greater arteries as has been shown by our studies on endothelial/intimal preparations of 9 species, including man. Differentiation is possible between species rich (pig, man, sheep) or poor in macrophages (rabbit and other small laboratory animals) according to their density of subendothelial infiltration in the aorta. Morphological, histochemical, and ultrastructural results have shown that we are mainly dealing with metabolic quiescent, resident macrophages, their number being regulated by influences depending on endothelium and intima factors. We assume that in species rich in macrophages and in man, they have physiological functions for homoeostasis of border layer and intima. The most considerable signal for subendothelial macrophage accumulation in man, pig, and rabbit is intimal deposition of lipids, independent of experimental or spontaneous induction. Short-term or long-term hypercholesterolemia is not associated with increased adhesion and emigration of monocytes in unchanged intima at venous or arterial endothelial cells of pigs and rabbits. There is no evidence to intimal lipid infiltration being preceded by subendothelial macrophage invasion. Most studies on vessel border layer have suggested that in the early high-lipid phase of atherogenesis subendothelial macrophages participate in lipid metabolic clearance. But in conditions of metabolic activation they can be an atherogenic danger due to a whole range of secretory products stimulating recruitment of blood monocytes and lymphocytes, increasing the permeability of endothelium, altering the extracellular matrix components, and causing modulation of gen expression of vessel wall cells. Therefore, metabolic activation of the subendothelial macrophage system is a new, potentially atherogenic mechanism.

Histoautoradiographic detection of 3H-thymidine and 3H-proline in the vascular wall of domestic swine in experimental atherosclerosis. Is there an effect of saturated/unsaturated fatty acids in high cholesterol diet?

In vitro labeling of arterial wall samples from domestic swine with tritiated thymidine or proline was used to establish the effect of unsaturated (sunflower oil) or saturated (beef tallow) fatty acids in the presence of enteral cholesterol on DNA and collagen synthesis. Histoautoradiography of samples incubated in vitro gives labeling patterns and indices comparable to in vivo labeling. Preliminary results show that these nutrient fats do not differ in their effect on the DNA and collagen synthesis of vascular wall cells both in the presence and absence of intimal changes.

The influence of dietary low and high unsaturated fats and cholesterol on the fatty acid pattern of serum and aortic cholesteryl esters and the lipid deposits of pig aorta.

16 three-month-old female pigs were divided into 3 groups. 6 animals received a semi-synthetic diet containing 15% sunflower oil (g/100 g food) and 1.25% cholesterol (SF group). In 6 animals the sunflower oil was replaced by beef tallow (BT group). 4 control animals 1.5% sunflower oil and without cholesterol. The serum cholesterol levels of the SF group rose moderately, those of the BT group moderately or highly. The relative lipid infiltrated intima area (LIA) and the cholesteryl ester (CE) content of aortas were generally lower in the SF group than in the BT group in comparison to the serum cholesterol levels. The dietary fatty acid pattern determined the fatty acid composition of CE in the serum and extracellular lipid of the aortic lesions. With regard to the intracellular changes of fatty acid pattern of CE (decrease in dienoic acid, predominantly linoleic acid, and increase in monoenoic acids, predominantly oleic acid, and in trienoic acids and higher unsaturated fatty acids), there were important differences between the 2 dietary groups. The dienoic acid content of CE decreased intracellularly from 61% to 30.5%, at the most, in the SF group, and then stopped. In the BT group only 26-35% dienoic acid was available from the extracellular CE and was reduced intracellularly to 9% at the most. In the SF group the intracellular increase in monoenoic acid content of CE was related to the decrease in dienoic acid content. In the BT group this was true only for some lipid deposits of the aorta; in other lesions the monoenoic acid content remained nearly constant or even decreased with decrease in linoleic acid whereas the increase in trienoic acid content was especially high suggesting that an unphysiological trienoic acid (20:3 delta 5, 8, 11), originating from oleic acid, was formed in greater amounts. Our findings point to the development of an essential fatty acid deficiency in the foam cells of aortic lesions in the BT group which may result in an unfavorable influence on the cholesterol clearance from the cells and the arterial wall.

Immune complex induced hematogenic cell infiltration of the aortic luminal border layer in rabbits. Light microscopic studies of surface preparations.

Interendothelial and subendothelial monocytes/macrophages are extremely rare in normal rabbit aortas compared with humans and swine, as has been shown by the present study and previous investigations of surface preparations. Light microscopy was used to study the development of immune complex-induced hematogenic macrophage infiltrations in 26 rabbits from the 4th to the 28th day after the last antigen administration. Of particular interest was the intensity, localization and duration of the hematogenic cell infiltrates with a view to establishing the role of immunological stimuli for subendothelial monocyte and lymphocyte accumulation. It was found that immune complex-induced hematogenic macrophage infiltrates are very short-lived and disappear after 20-28 days following immune complex deposition. They concentrate in the ostium regions of the thoracic and abdominal aorta and are subject to flow dynamics similar to those of cholesterol-induced sudanophile lipid deposition. Subendothelial macrophage infiltrates increase the permeability of the aorta for low-molecular but not for macromolecular plasma particles, do not affect the endothelial silver line picture and do not lead to lipid accumulation.

Failure of foreign serum injections to induce immune vasculitis and to accelerate spontaneous or cholesterol-induced atherosclerosis in swine.

Experiments were conducted with domestic swine in an attempt to accelerate and/or modify spontaneous or cholesterol-induced atherosclerosis through immune complex-produced changes in the arterial wall. For the purpose of comparison, another experiment was carried out with rabbits. Swine differed completely from rabbits in that various experimental designs failed to produce immune complex arteritis and fibroproliferative arteriosclerosis. In addition, two foreign serum infusions (human plasma and horse serum on the 30th and 60th day, respectively, 350 mg/kg foreign protein/infusion/animal) did not produce a significant effect on spontaneous arteriosclerosis and cholesterol-induced atherosclerosis (4 months atherogenic diet) in the arterial system of swine. In the aortic trifurcation, however, it was found that antigen administration slightly enhanced cholesterol-dependent atherogenesis.

[Cellular and extracellular changes in the regression of experimentally-induced arteriosclerosis and their relevance for the regression of arteriosclerosis in humans]. / Zelluläre und extrazelluläre Veränderungen bei der Regression experimentell induzierter Arteriosklerose und ihre Relevanz zur Arterioskleroseregression beim Menschen.

In a survey the essential cellular and extracellular structural changes in the regression of experimentally induced changes of the arteries and their functional importance are discussed. All animal experiments show that early changes such as lipidosis and proliferation of the intima are totally reversible and more advanced atheroma-like stages of the experimental atherosclerosis are conditionally and incompletely reversible. The endothelial cell layer, the muscle cells of the plaques and the macrophages of the plaques with different time sequence and importance for the process of regression participate in the retrogression of induced plaques. With the removal of the atherogenic factor(s), in the animal experiment mainly hypercholesterolaemia and/or mechanical lesion of the vascular wall, the repair of the endothelial cell layer, the destruction and revival of the macrophages of the plaques, the elimination of intra- and extracellularly accumulated cholesterol esters in muscle cells and macrophages, the normalisation of the cell division rate and the fibrosynthesis of plaque muscle cells. On the many respects unclarified metabolic ways plaque muscle cells and macrophages participate in the absorption of extracellular matrix. The animal experimental, fairly optimistic results must not necessarily be valid also for man. In advanced stages of the atheroma of the aged man the basic conditions of reversibility, which are guaranteed in the animal experiment, are not given.

Hematogenic cell infiltration of the aortic intima in normal and hypercholesterolemic swine. Studies on en face endothelium-intima preparations.

The incidence of periendothelial (epi, inter- and subendothelial) round cells in en face endothelium-intima preparations and cross-sections of swine aortas was determined. The round cell count of Sudan-positive and -negative intimal areas of thoracic and abdominal aortas of animals fed an atherogenic diet was compared with Sudan-negative areas of animals on normal food. Furthermore, spontaneous lesions at the aortic trifurcation in swine and abdominal aortic segments of humans with different stages of arteriosclerosis were studied and the aorta endothelium of normal animals was examined with a scanning electron microscope. According to these studies, round cells (monocytes or lymphocytes occur in the subendothelium as a normal constituent of the aortic intima. They are increased in spontaneous lesions and more frequent in induced fatty streaks. In swine, they participate primarily in intracellular lipid storage in Sudan-positive intimal areas. Their function in normal intima and in low-lipid intimal thickening is unknown. Similar observations were made with regard to the human abdominal aorta.

Mononuclear cell infiltration of the aortic intima in domestic swine.

The preparation of thick endothelial "häutchen" from microscopically lipid-free areas of the thoracic and abdominal aorta of 22 domestic pigs proved that there is a surprisingly frequent penetration of mononuclear blood cells into the subendothelial space. They are deposited on the intima in a diffuse or focal distribution as dense epi-, inter- and subendothelial cell infiltrates.

[Modulation and proliferation of the vessel wall muscle cell and its importance for atherogenesis]. / Modulation und Proliferation der Gefäbetawandmuskelzelle und ihre Bedeutung für die Atherogenese.

Decisive for the progression of the arteriosclerosis is the increase of thickness of the intima, as it is shown by histological and morphometrical investigations on the human coronary arteries. A light-optic and electron-optic analysis of animal-experimental, induced and spontaneous proliferations of the intima has the result that the process of progression is maintained by structural and functional variants (modulations) of the myointimal cells. Under the influence of specific and unspecific stimulators they are able to proliferation and migration, abnormal fibre synthesis and lipid storage as well as to phagocytosis and formation of boundary surfaces. Most of the modulations described of the activated muscle cell are temporary adaptations to a changed micromilieu and they are reversible to contractile cells after decrease of the stimulation effect. Therefore it is assumed that in the early stages of the arteriosclerosis a progression phase is to be diagnosed light- and electron-optically essentially at the appearance of proliferation-active and synthesis-active modulations of the smooth muscle cell. An inactive, non-progressive thickening of the intima may be diagnosed by the proof of contractile muscle cells.

[Progression and regression of diet-induced arterial changes in the domestic pig]. / Progression und Regression der diätinduzierten Arterienveränderungen des Hausscheines.

Under atherogenic diet in the pig changes of the intima developed in predisposed places of the arteries which have close relations to the atherogenesis in man. 4 months after the end of a 4-month atherogenic diet no decisive regression of lipid infiltrates could be established in spontaneous thickenings of the intima, however, signs of a lipid mobilisation.