Microscopic investigation of villi from chorionic villous sampling.

The aim of the present study was to investigate the morphology of cytogenetically normal chorionic villi from chorionic villous sampling (CVS) specimens. This information can serve as a reference for morphological investigation of cytogenetically abnormal CVS specimens. We were also interested in any relationship between chorionic villous architecture and the outcome of pregnancy. In a reference group (n = 94, normal karyotype and ongoing pregnancies), we observed a considerable variation in villous diameter (range 116-377 microm) and vascular density (range 0.5-6.7 vessels/villus) and a high incidence of morphological criteria, classically mentioned in relation to chromosomal or other abnormalities, such as: fibrinoid deposition (74.5%), trophoblastic layer degeneration (3.2%) and abnormal proliferation (7.4%), avascular villi (54.2%), stromal oedema (55.3%), trophoblastic inclusions (23.4%) and fibrosis (23.4%). In the cytogenetic abnormal group (n = 10), neither the diameter nor the vascular density of the villi differed from the values observed in the reference group. In the reference group, we only observed a tendency for larger birthweights in relation to respectively larger and more vascularized villi. It is concluded that in CVS specimens, chorionic villous architecture and morphological criteria do not have any clinical relevance, neither do they have any important predictive value.

The distribution of non-Hodgkin's lymphoma in the lymphoid compartments of the human spleen.

In a series of 139 spleens involved by non-Hodgkin's lymphoma, we found that each type of lymphoma (as classified according to the Kiel classification) has a specific pattern of infiltration in the red and white pulp. Tumor infiltration in preexistent follicles was not a feature of B-cell lymphomas, but tumor nodules were found in the red pulp nonfiltering areas in cases of immunocytoma (small lymphocytic plasmacytoid) and centroblastic-centrocytic lymphoma (follicle center-cell lymphoma). B-chronic lymphocytic leukemia and centrocytic-centroblastic lymphoma were located along central arteries of T-cell areas. T-cell areas were infiltrated by B-prolymphocytic leukemia, immunocytoma, centrocytic lymphoma (lymphocytic lymphoma of intermediate differentiation), and T-cell lymphoma/leukemia. The red pulp showed diffuse involvement in leukemic cases. Additionally, there was pericapillary growth in all cases of low-grade B-cell lymphoma. The findings, which are related to the physiological counterparts of the lymphoma cells, contribute to our knowledge of the routes of circulation as well as the homing areas of lymphocytes in the human spleen.

Tubulointerstitial nephritis associated with pyrazinamide.

Modern antituberculous therapy consists of a combination of several drugs, some of which (e.g. rifampicin and streptomycin) may cause impairment of renal function. Pyrazinamide therapy has been associated with dose-dependent hepatotoxicity, hyperuricaemia, arthralgia and arthritis. The patient described in this report developed renal failure, fever, arthritis and arthralgia during administration of isoniazid, rifampicin, streptomycin and pyrazinamide. The renal biopsy showed tubulo-interstitial nephritis. After withdrawal of pyrazinamide, while continuing all other drugs, both renal function and histological findings improved which points to an association of renal failure with pyrazinamide.

Normal histology of the human spleen.

Like the lymph node, the human spleen is a highly compartimentalized organ. Each compartment has its own structure, cell population, and functions. These include the white pulp with T-cell areas and B-follicles, the non-filtering lymphoid areas of the red pulp, the border between red and white pulp (the perifollicular zone), the red pulp cord tissue and sinuses, and the perivascular rim. These structures are described and illustrated. In addition, we indicate how they relate to pathological alterations.

The spleen in Felty's syndrome: a histological, morphometrical, and immunohistochemical study.

A histological study employing morphometrical and immunohistochemical methods was performed in 3 spleens removed because of Felty's syndrome (FS). A comparison was made with control spleens and with spleens removed from patients with idiopathic thrombocytopenic purpura (ITP) or autoimmune hemolytic anemia (AIHA). In FS, the spleen is enlarged, mainly due to expansion of the red pulp. The sinuses are enlarged, too, and contain many macrophages. 2 of our specimens showed many hyperplastic germinal centers; the 3rd contained no germinal centers. Only in the former cases did splenectomy lead to an increase in the number of circulating granulocytes. Immunohistologically, FS spleens differed from the control, the ITP, and the AIHA spleens. The results have provided further evidence indicating that the pathogenesis of granulocytopenia in FS differs from that of autoimmune hematocytopenias, and have given rise to the hypothesis that, in FS, the spleen is the site of interaction between immune complexes and granulocytes.

Leucostasis, an underestimated cause of death in leukaemia.

Massive sludging of leukaemic cells in blood vessels is a frequent and often lethal complication of leukaemia. In a retrospective clinicopathological study on the causes of death in 52 patients with acute myeloid leukaemia and myeloproliferative disease, pulmonary leucostasis was found in 40% of the patients. In many of these patients the vessels of the heart, brain and testes were also involved. In search for signs and symptoms specific for leucostasis, the clinical records of the 21 patients with leucostasis (the study group) were compared to those of 20 patients without leucostasis (the control group). Dysfunction of the organs most affected by leucostasis, namely lungs, heart and brain, was found more often in the study group than in the controls, but the combination of unexplained fever with cardiopulmonary and/or central nervous system failure occurred almost exclusively and in half of the patients with leucostasis. Leucostasis occurs predominantly, but not exclusively, in patients with high leucocyte counts, and especially, but again not exclusively, when the leucocyte counts rise sharply.

Pulmonary leukostasis: radiologic-pathologic study.

The terminal chest radiographs of ten patients with pulmonary leukostasis were correlated with the autopsy findings. In six patients, no abnormalities attributable to leukostasis were seen on chest radiographs. In four patients, diffuse alveolar consolidations were caused by alveolar edema following leukostasis. Leukostasis should be considered in leukemia patients with severe dyspnea who have normal chest radiographs or diffuse alveolar edema.

A new method for diagnostic curettage.

A new device ('Abradul') for policlinical curettage was tested for reliability. The histology of the curettage obtained prior to hysterectomy was compared blindly to that of the surgical specimens in 61 patients. As a correlation of almost 100% was found, the results for this convenient and economical outpatient procedure are very promising. Routine screening for the patient at risk is now within reach.

Aware or non-aware. On the significance of awareness for the localization of the lesion responsible for homonymous hemianopia.

Some of the patients with homonymous hemianopia are unaware of any visual defect, whereas others perceive this defect more of less consciously. Analysis of the CT scans of 41 cases showed that patients who are partially or fully aware of the hemianopia have purely occipital lesions. The patients who were not aware of the visual defect were found to have larger and more anteriorly situated lesions. Parietal lesions or lesions interrupting the associative pathways to the primary or secondary visual association cortex are considered to be responsible for the lack of awareness of the defect.

Immunohistology of the human spleen: an inventory of the localization of lymphocyte subpopulations.

The immunohistochemistry of the cell population of the human spleen was studied. As controls, a strictly defined group of five specimens were used. This study stresses the need for the utmost care in this selection procedure. Using enzyme- and immuno-histochemistry the lymphocyte subpopulations were studied as to their localization in the several specific compartments in the red and white pulp. The findings were compared to those in idiopathic thrombocytopenic purpura, autoimmune haemolytic anaemia and Hodgkin's disease. In the controls a consistent pattern was found. There were specific changes in each of the disease groups consisting mainly of shifts between the compartments.

[Sperm analysis following vasectomy: when to perform a revasectomy?]. / Sperma-analyse na vasectomie: wanneer revasectomie?

PIP: On the basis of 4406 sperm analyses performed for check-up after vasectomy in 3150 men, a retrospective study was made of the question of what sperm control policy is recommended. Sperm tests after 10 ejaculations after operation revealed abolished fertility in almost 90% of the men, so that no further checks were indicated. When the first test shows more than 0.1 x 10 6 nonmotile spermatozoa/ml, continued check-ups are necessary until infertility has been proven. Motile spermatozoa during the first 6 months postvasectomy do not as a rule constitute a sign of recanalization but rather of the presence of a residue higher up in the urogenital tract. During this period, revasectomy therefore is not indicated. True recanalization occurs later and has been encountered only once among our 3150 patients. (author's)^ieng

The human spleen; a histological study in splenectomy specimens embedded in methylmethacrylate.

In a series of 316 surgically removed spleens, a histological and supportive immunohistological study was performed on methylmethacrylate sections. The structure of the human white and red pulp differs from the rat spleen in many respects, e.g. the human lacks the marginal sinus and the architecture of the periarteriolar lymph sheath seen in the rat. In man, the lymphoid compartment is in both white and red pulps. In the white pulp separate periarteriolar T-cell areas contain a large lymph-vessel plexus, which was reconstructed in serial sections. The circulation in the red pulp is discussed. The area between the red and white pulp, the perifollicular zone, is not the equivalent of the marginal sinus in the rat. Its anatomy in man suggests that it is an area formed from red pulp during the expansion of new follicles. The micro-anatomy was analysed in 119 controls. In cases of traumatic rupture the white pulp showed evidence of stimulation. A pathognomonic histological picture was not found in idiopathic thrombocytopenic purpura. In haemolytic anaemia the pulp cords were engorged by erythrocytes accompanied by a decreased B/T cell ratio in autoimmune haemolytic anaemia and by an increased B/T cell ratio in congenital spherocytosis.

The splenic red pulp; a histomorphometrical study in splenectomy specimens embedded in methylmethacrylate.

The anatomy and pathology of the splenic red pulp was studied in three-dimensional reconstructions of methylmethacrylate embedded blocks of tissue obtained after splenectomy, as well as by morphometrical analysis of a large number of specimens. The sinuses of the spleen form a plexus of anastomosing vessels with remarkable buds. Capillaries end as sheathed capillaries in the cord tissue, the 'filtering' area, but a large proportion of the red pulp cords appear to be 'non-filtering'. These might form part of the lymphatic compartment, which is separate from the white pulp and its extension along the capillaries. This area has not yet been described in man. The change in the volume and structure of the various components of the red pulp were studied in 60 controls and in cases of traumatic rupture, idiopathic thrombocytopenic purpura, aplastic anaemia, autoimmune haemolytic anaemia, congenital spherocytosis, splenic congestion, and Hodgkin's disease. Significant differences were found in the volume of filtering and non-filtering areas, the size of the sinus compartment, and the degree of vascularization; these differences were only partially expected, for instance in disorders with excessive erythrocyte sequestration. A decrease of the 'non-filtering' area in Hodgkin's disease might indicate an unknown aspect of this disease. In agreement with our previous paper on the amount of white pulp, spleens removed because of traumatic rupture and those incidentally removed during abdominal surgery may not be combined as a single control group, because of significant and probably functional differences in the composition also of the red pulp.

[A 2d malignancy of the kidney in a patient with Hodgkin disease following full remission]. / Ein zweites Malignom der Niere bei einem Patienten mit Morbus Hodgkin nach Vollremission.

A second case of a secondary kidney tumour following radio- and chemotherapy of Hodgkin's disease is presented. The radiological findings with a sarcomatoid hypernephroma are described.