[Sudden maternal death in late pregnancy: congenital diaphragmatic defect causing prolapse of the intestine into the thoracic cavity (author's transl)]. / Plötzlicher mütterlicher Tod in der Spätschwangerschaft: Kongenitaler Zwerchfelldefekt als Ursache eines Eingeweideprolapses in die Thoraxhöhle.

Near the end of her first pregnancy, a 17-year-old patient developed sudden epigastric pain followed shortly afterwards by restlessness, paleness and respiratory distress. A diagnosis of pneumothorax was made from the chest radiogram. Shortly after this examination the patient died from cardiocirculatory failure. Autopsy revealed a congenital defect of the diaphragm with prolapse of abdominal organs into the thoracic cavity and displacement of the heart and mediastinum. The strangulated, gas-filled stomach was situated in the thoracic cavity and showed hemorrhagic erosions of the mucosa and a circumscribed mural defect which had obviously developed in the prefinal stage. This case as well as similar ones reported in the literature underline the necessity for a rapid diagnosis of unclear epigastric pain in late pregnancy. In the case of "diaphragmatic hernia" early surgery is indicated.

Intra- and extrarenal vascular changes in the acute renal failure of the rat caused by mercury chloride.

Histologic evidence of intrarenal vasomotor changes were observed in the rat in the course of acute renal failure caused by the injection of HgCl2. Male Wistar rats injected s.c. with 2.5 or 4.7 mg HgCl2 per kg b. wt. developed fibrinoid damage in the media segments of preglomerular renal vessels, mostly in the arcuate and interlobular arteries. The lesions were patchy and irregularly scattered throughout the kidneys. 24 h post-injection the lesions were very rare and of only mild degree, whereas they were fully developed and regularly seen 48 h post-injection. A high percentage of similar changes was found in certain extrarenal vascular areas especially in the mesentery and pancreas. The damaged vascular segments were usually dilated. The results of various thichrome stains and histochemical reactions suggested edema of vascular smooth muscle cells and imbibition of the media by blood plasma substances, sometimes reaching the degree of fibrinoid necrosis. These findings were confirmed by electron microscopy. The imbibition of the smooth muscle cells by blood plasma material was clearly evidenced by the demonstration of intracellular fibrin precipitations. In connection with the degeneration of smooth muscle cells, accumulations of crystal-like fibrin formations could often be shown. Subendothelial fibrin formations were not observed. 96 h after the 2.5 mg injection the changes were already regressing, but edema of the vascular wall and signs of disturbed vasotonia persisted for several days. The maximum of the vascular changes usually coincided with the maximum of azotemia and the formation of debris cylinders in the renal tubules. However, no clear relationship was recognizable in individual cases between vascular damage, extent of tubular necrosis and renal function. The pathogenesis of the vascular changes is obscure, but neurogenic factors, increased release of catecholamines and/or vasoactive agents of renal origin in connection with other factors might play a decisive role. Arterial hypertension was absent. It is assumed that the structural damage of the vascular media is mainly brought about by prolonged or recurring vasospasms, or by alternating spasm and vasodilatation with local ischemia and increased tension of the vascular wall in the dilated segments. The altered function and structure of the vascular wall might, to a certain extent, contribute to renal insufficiency.

Myelinated nerve fibers in the rat kidney. Light- and electron microscopic studies.

Thinly and richly myelinated nerve fibers in the rat kidney are demonstrated by light and electron microscopy. They run within the peripheral nerves in the periadventitia of the arteria rencularis and arteria arcuata and seem to end in the innermost renal cortex at the boundary to the renal medulla. Sporadically, a single myelinated fiber is found in this region, running near tubuli or in the neighbourhood of a glomerulus. No ganglion cells were seen within the renal parenchyma. The intrarenal medullated nerve fibers are assumed to be afferent. They sometimes showed reactive and degenerative changes in pathologically altered kidneys.

[Intraepithelial filament bundles of the adult human kidney. Studies by light and electron microscopy and by diffraction analysis (author's transl)]. / Licht-, elektronenmikroskopische und beugungsanalytische Untersuchungen an intraepithelialen Filamentbündeln in der Niere des erwachsenen Menschen

In studies of semi-thin sections of adult human kidney it is found that the structures formerly known as "Basalreifen" can be definitely related to basal cytoplasmic portions of the renal epithelium. Under the electron microscope they appear as bundles of filaments, usually having a width of 50-85 A. They are particularly well developed in the parietal layer of Bowman's capsule and are also present in the proximal and distal tubule where they are more abundant than in other parts of the nephron. The filament bundles proceed toward hemidesmosome-like structures at the basal border of the epithelia and sometimes contain dense bodies in the parietal capsular epithelium of the glomerulus; these bundles are probably responsible for local intra- and/or supravital protrusions of the cytoplasm. Findings in some diseased kidneys are also presented. Diffraction analysis of intrarenal vascular muscle cells and intraepithelial filament bundles gave comparable photographic records of the image structure spectrograms; it supports the assumption derived from the electron microscopic results that the intraepithelial filament bundles represent a contractile complex. However, the conclusiveness of image structure analysis in comparing the two biological objects is limited, as outlined in the discussion. With regard to renal function the significance of the intraepithelial filament bundles is still unclear. Periglomerular interstitial cells, which normally contain only narrow tracts of filaments in the periphery, had many of the characteristics of smooth muscle cells in a case of pyelonephritic renal cirrhosis. They are compared with myofibroblasts of a different origin.