[Changes in the urinary bladder caused by short-term permanent catheter insertion]. / Zmeny v mocovém mechýri po krátkodobém zavedení permanentního katétru.

BACKGROUND: Short-term urinary bladder drainage using a permanent Foley catheter is practised frequently in hospitals. The catheter usually hurts the bladder mucosa and submucosa to various degrees. The aim of this study was to show pathological changes observed during a time period of one to 30 days of catheter treatment. METHODS AND RESULTS: Samples for histological testing were taken from the posterior wall of the bladder of deceased patients. The posterior wall exhibited maximal injury. Same steps were done in 10 bladders of the deceased patients who had not been catheterised at all. There were 41 patients in the tested group, of an average age 70 years (22 men and 19 women). In microscopy the mucosa was oedematous, hyperaemic with ectatic vessels and haemorrhages. Polyps were also seen, some of them haemorrhagic. Polypous cystitis was revealed in 29 cases (70%), and various mucosal defects in 12 cases (29%). A predominance of fibroblasts was observed in the reactive stromal cells of the bladder wall. CONCLUSIONS: Polypous cystitis develops already in the first days after permanent catheter insertion. The recent polyps present an inflammation caused by mechanical injury. The number of reactive stromal cells increases only partly on the dependence on the duration of permanent catheter treatment. These are abundant in the polyps and where mucosal defects occur. The presence of these cells may also be influenced by spontaneous chronic inflammation or nodular prostate hyperplasia in men. The occurrence of eosinophilic leucocytes was not observed until 3 days after catheter insertion. We cannot see any relation between the reactive stroma cells and mastocytes or with eosinophils.

[Pneumatosis cystoides intestini caeci--a pseudotumor presented at autopsy]. / Pneumatosis cystoides intestini caeci-- pseudotumor zjistený pri pitve.

A large focus of cystic intestinal pneumatosis appeared as an accidental finding in a 59-year-old man suffering from obstructive lung disease, with cor pulmonale as the cause of death. The gas pseudocysts were found in the submucosa, muscularis propria and in the subserosal space. The pseudocysts were lined by flattened cells of connective tissue origin with presence of occasional macrophages. We believe that the lesion started by focal damage of the mucosal membrane, which was followed by penetration of stool particles with microbes into the submucosa. E. coli and Morganella morgani are the probable producers of the gas bullets.

[Emphysematous cystitis due to Clostridium perfringens--a localised infection in a man with generalized melanoma]. / Cystitis emphysematosa, zpusobená Clostridium perfringens--lokální infekce u nemocného s generalizovaným melanomem.

Emphysematous cystitis was found at autopsy of a 47-year-old man suffering from generalised malignant melanoma. Bacteriological cultures from the urinary bladder showed Escherichia coli, Klebsiella sp. and Clostridium perfringens type A, toxic strain. The histological examination revealed cystic dilatation of lymphatic vessels both in bladder mucosa and muscularis propria. There were multinucleated macrophages in the lining of some of these cystic spaces and a few Gram-positive rods inside their lumina. In the mucosal and submucosal connective tissue there were signs of chronic inflammation and, focally, small haemorrhages. We suppose that the gas production was due to the presence of Clostridium perfringens and believe that the infection of the urinary bladder occurred in relation to the repeated insertion of the catheter into the bladder of a patient with secondary immunosuppression. Emphysematous cystitis was, in our case, a localised clostridial infection without clinical and morphological signs of generalised septicaemia.

[Spindle cell and cuboidal renal cell carcinoma (loopoma). 10 case reports]. / Vretenobunecný a kuboidální renální karcinom (loopom). Popis 13 prípadu.

BACKGROUND: Current classification systems of neoplasms arising from renal parenchyma distinguish 5 categories of renal cell carcinoma (RCC), i.e. conventional RCC, papillary RCC, chromophobe RCC, collecting duct/medullary RCC and unclassified RCC. We present 13 cases of unusual and unclassified spindle and cuboidal renal cell carcinomas. METHODS AND RESULTS: The studied group consisted of 13 patients (7 men and 6 women). They ranged in age from 22 to 65 years (mean 57.3). Generally, the tumours were well circumscribed and confined to the kidney, whitish to grey on section with a diameter 4.5-13 cm (mean 8.6 cm). One patient was investigated for loin pain and nocturia. Three patients had staghorn nephrolithiasis and vague sonographic findings in renal parenchyma. In one patient the renal tumour was found when examined on follow-up examination for prostatic adenocarcinoma. None of our patients was known to have elevated levels of parathyroid hormone due to hyperplasia, adenoma or carcinoma of the parathyroid gland. Clinical follow-up of the patients ranged from 9 months to 8 years (mean 2.3 years). Microscopically, the tumours were composed of two main populations of cells: flattened, spindle cells with sparse cytoplasm and small cuboidal cells with clear to light eosinophilic cytoplasm. Eight patients are currently well without signs of recurrence or metastasis, one had metastasis in the regional lymph node at the time of nephrectomy, one died of unrelated cause, and three were lost to follow-up. CONCLUSIONS: We present 13 cases of unclassified RCC. Our cases were histologically, immunohistochemically and ultrastructurally similar to the hitherto reported case reports of this variant of RCC. It is obvious, that that variant of RCC should be recognised as a new subtype of RCC.

[Apoplexia uteri--a postmenopausal bleeding into atrophic endometrium during terminal stress]. / Apoplexia uteri--krvácení do atrofického endometria po menopauze pri terminálním stresu.

This is a detailed histological autopsy study of 47 cases of macroscopically recognisable flat intraendometrial haemorrhage into the atrophic lining of the uterine cavity. The average age of the studied women was 71 years. The majority of the deceased patients (61%) had suffered from various cardiovascular diseases or acute abdomen; the rest had disseminated carcinoma, chronic lung, kidney or liver diseases. The most common cause of death was cardiovascular failure (68%), followed by respiratory failure, cerebrovascular accident and renal or liver failure. We have observed serious vascular changes in other organs in 22 cases (46%), many of these affected the gastrointestinal tract. The histological examination has always showed congestion of the endometrium and myometrium. In 38 cases there was also marked haemorrhage into the endometrial stroma which occasionally extended into the myometrium. The intensity of the bleeding resembled a haemorrhagic infarction in several instances. The myometrial arteries exhibited a variable degree of atherosclerosis with narrowing of their lumen. In our opinion, apoplexia uteri is caused by the state of permanent hypoperfusion leading to passive hyperaemia, and it is related to the degree of the arterial stenosis.

[Comparative pathology of early stress-induced changes in the duodenal mucosa in laboratory rats and in humans]. / Srovnávací patologie casných stresových zmen duodenální sliznice u laboratorních potkanu a u cloveka.

BACKGROUND: Our presentation comprises results of two studies: The first was an experimental investigation of 60 Wistar-strain rats used in a toxicological study. The other part analysed stress changes in the duodenal mucosa in the human autopsy material. Both humans and rats had been exposed to stress and showed similar histological changes. METHODS AND RESULTS: In the rats the same duodenal lesions were present both in the test group and the control animals in the toxicological study. Lesions consisted of oedema of the duodenal villi and erosions in the tips of the villi. We believe that in the experimental group the stress was caused by restraining the animals by daily introduction of the gastric metallic tube, by taking blood from the retrobulbar plexus, and by anaesthesia. CONCLUSIONS: The autopsy study comprised 35 cases displaying congestion and macroscopically recognizable multifocal bleeding into the duodenal mucosal folds. The microscopic investigation revealed bleeding into the mucosal villi and small erosions. In some cases there were cuneiform mucosal infarcts extending into the submucosa. In the humans, severe cardiovascular diseases and circulatory disturbances represented the main causes of the stress. Local hypoxia and gastric juice acidity were involved in the pathogenesis of the duodenal mucosal changes.

[Non-ulcerous stress changes in the duodenal mucosa] ]. / Neulcerózní stresové zmeny sliznice duodena.

During autopsies on patients whose illnesses resulted in circulatory failure, we often observe irregular congestion and ecchymoses of duodenal mucosa with a maximum of changes on the tops of mucosal folds. A thorough histological examination of the duodenum of 35 such patients was made. In 28 cases apart from hyperemia, hemorrhage into tunica propria of the villi was found resembling the picture of minor hemorrhagic infarctions. Additionally, in 5 cases there were erosions present which resembled coagulation necrosis. Cuneiform infarctions penetrating into the submucosa were present in 3 cases. Changes described above appear as early manifestations of stress.

Spindle and cuboidal renal cell carcinoma, a tumour having frequent association with nephrolithiasis: report of 11 cases including a case with hybrid conventional renal cell carcinoma/ spindle and cuboidal renal cell carcinoma components.

AIMS: We present the largest series of an unclassified subtype of renal cell carcinoma, which seems to be a distinct morphological entity and which is sometimes designated as spindle and cuboidal renal cell carcinoma. METHODS AND RESULTS: Eleven cases of spindle and cuboidal renal cell carcinoma were found among 7000 primary renal cell tumours in Pilsen's routine and consultation files. The patients were five men and six women. They ranged in age from 22 to 65 years (mean 56.8). Microscopically, the tumours were composed of two main populations of cells. First, the preponderant type of cells was formed by flattened, spindle cells with sparse cytoplasm. The second cell type was a small cuboidal cell with clear to light eosinophilic cytoplasm. Spindle-shaped cells were arranged in a fascicular pattern often reminiscent of low-grade smooth muscle tumours. Solid areas of spindle cells were also present. Small cuboidal cells formed sparse tubular structures lined by a row of single cells. In addition to all previous published cases of spindle and cuboidal renal cell carcinoma we observed an association of nephrolithiasis in our cases. It was seen in 3/11 of our patients. A previously unreported feature is the occurrence of a conventional renal cell carcinoma component in one of our cases. Seven of our patients are currently well without signs of recurrence or metastasis, one had metastasis in a regional lymph node at the time of nephrectomy, one died of an unrelated condition, and two were lost to follow-up. CONCLUSIONS: We present 11 cases of spindle and cuboidal renal cell carcinoma, which is believed to be a distinctive morphological entity. Our cases were histologically, immunohistochemically and ultrastructurally similar to the previously reported cases of spindle and cuboidal renal cell carcinoma. In contrast to all previously reported cases of spindle and cuboidal renal cell carcinoma, we observed an association with nephrolithiasis in three of our cases; moreover, one of our tumours had a conventional renal cell carcinoma component and another revealed a metastatic focus in a regional lymph node. None of our patients died of the disease. This study confirms that spindle and cuboidal renal cell carcinoma has a low malignant potential.

[Hemorrhagic necrosis of the esophagus]. / Hemoragická nekróza jícnu.

A series of 25 necropsy patients aged 54-95 y. with hemorrhagic necrosis of the esophagus presented by black mucosa were studied. The discoloration was diffuse in most cases; less frequently there were black longitudinal streaks corresponding with mucosal folds. In 16 cases, the lesion affected the entire esophagus, in the remaining cases only the distal half to third of esophagus was affected. The changes ended abruptly at the cardia. Histologically, there was necrosis of the mucosa with focal involvement of muscularis mucosae. The necrotic tissue was usual densely infiltrated by leucocytes. The submucosa showed edema, fibrinorrhagy and slight hemorrhage. There were platelet thrombi in small mucosal and submucosal vessels. In only some cases, the infiltrate affected the entire muscularis propria. Gastrointestinal bleeding was noted in 8 cases. The esophageal lesion was preceded by circulation disorders, as shown in both the clinical course and in the autopsy findings. Local hypoperfusion, venous reflux, and gastroesophageal reflux appear as the principal pathogenetic factors.

[Haematoxylon campeachianum--the source of hematoxylin]. / Kreven obecná, dárce hematoxylinu.

A treatise based on literature data describing the tree Haematoxylon campeachianum. Its wood is the source of hematoxylin dye.

[Morphologic study of aneurysms of the thoracic aorta]. / Morfologické hodnocení výdutí hrudní aorty.

Aneurysm of thoracic aorta was found in 20 from 7175 autopsies (0.25%) of persons deceased at the age of more than 15 years. The aneurysm was localized in 4 cases, diffuse in 14 and combined in two cases. Its pathogenesis was related to medionecrosis in 6 cases, to chronic aortitis in 5 and to isthmic aortic coarctation in two cases. Left ventricle hypertrophy which was found in 17 cases was related to arterial hypertension in 10 cases but only twice to a diffuse aneurysm. The aneurysm was closely connected with the cause of death in 10 patients. In a control study of subsequent 100 autopsies the mean aortic circumference was 75 mm in men and 71 mm in women, 59 mm in patients under the age of 50 and 82 mm over the age of 71 years. Medionecrosis was found in 45 cases, mucodystrophy in 8 and chronic aortitis in two cases.

[Atherosclerotic aneurysms of the abdominal aorta]. / Aterosklerotické výdute brisní aorty.

Aneurysm of abdominal aorta was found in 58 cases (0.87 per cent) of a group of 6646 postmortems. The group comprised persons over 15, 45 males and 13 females. The highest frequency of aneurysms (36) was at the age 71 to 80. Rupture of the aneurysm occurred in 15 cases and vascular diseases represented a half part of other causes of death. All the aneurysms were atherosclerotic, in one case a combination with mucold dystrophy was found. Evidence of arterial hypertension was in 43 per cent of the analyzed cases. Histology was performed in 24 cases and proved a destruction of elastic structures in tunica media, fibrosis, loss of smooth muscle cells followed by substantial thinning of the vessel wall. Widening of adventicia was caused by increase of collagen fibres. Discussion concerned formal pathogenesis of the lesion.

[Extramedullary nodular plasmocytic lymphoma]. / Extramedulární uzlinový plazmocytární lymfom.

A plasmacytic lymphoma of the cervical nodes in a 71-year-old women spread also to the mediastinal nodes and after two years proved fatal. The authors did not detect a rise of monoclonal serum immunoglobulins nor did they detect their presence in the cytoplasm of tumour cells in the nodes subjected to biopsy. The lymphoma was preceded by a specific granulomatous inflammation of the skin and nodes persisting for four years.

[Generalized infection caused by coagulase-negative staphylococci]. / Celková infekce koaguláza negativními stafylokoky.

The pathogenicity of coagulase-negative staphylococci was shown in two patients--one died on bacterial endocarditis, the second was a diabetic woman after gastroectomy.