Morphology and histochemistry of myogelosis.

Myogelosis is a common diagnosis in the case of chronic pain conditions, especially in the region of the pectoral girdle musculature, the glutei muscles, and the erector spinae muscle. Although such indurative areas continue to be palpable even on the cadaver, few studies concerning the morphological substrate of these areas have been undertaken. Selected biopsies as well as larger tissue samples were taken from 11 corpses and prepared for histological study. Following staining, the frozen sections were examined morphometrically. A histologically constant, significant morphological alteration was found in the areas of concern. The spaces between the individual muscle fibers of healthy muscle tissue appear relatively wide, the endomysium of the myogelotic area are clearly narrowed. Split fibers, ragged red fibers, Type II fiber atrophy, and fibers with a moth-eaten appearance have been detected. The morphometry shows considerable increase in thickness of the affected muscle fibers, suggestive of a pathological, local hypertrophy. The changes described may well represent a fixed condition, so that it should not be surprising that myogelosis therapy is difficult and protracted.

Intraperitoneal cholelithiasis after laparoscopic cholecystectomy--behavior of 'lost' concrements and their role in abscess formation.

UNLABELLED: In two experimental studies we sought preliminary information about the behavior of concrements lost in the peritoneal cavity during laparoscopic cholecystectomy. MATERIALS AND METHODS: In study 1, human gallstones were analyzed using X-ray diffraction, classified in three groups and examined with an ultramicroscope; then they were implanted in the peritoneal cavity of rats. After 8 weeks or 6 months, the animals were sacrificed and the concrements analyzed again as before. The tissues surrounding the calculi were also examined histologically. In study 2, human gallstones were examined with regard to bacterial contamination on the surface or in the middle of the calculi. The cholesterol content was analyzed, and the stones were divided into three groups and implantated in the rats as in the first study. After 8 weeks, the animals were sacrificed and areas with identifiable tissue reactions were examined histologically and microbiologically. RESULTS: The concrements lost their crystalline formation without any relation to their former cholesterol content, as shown by X-ray diffraction as well as ultramicroscopy. Mineralogically, these changes are a certain sign of structural dissolution. Cholesterol stones only caused abscess formations in association with gram-negative bowel germs. Sterile pigment concrements often led to a mesenchymal reaction such as granulomas. Contaminated pigment stones also resulted in extensive abscess formations.

Hepatotoxicity testing of atracurium and laudanosine in the isolated, perfused rat liver.

The pharmacokinetics of atracurium, which is degraded by Hofmann decomposition and ester hydrolysis, is not altered by impaired liver function. Atracurium should, therefore, be ideal for patients with heptic failure, and is now widely used in clinical practice. However, some studies reported considerable hepatotoxicity after atracurium, especially from its breakdown products--for example, leakage of lactate dehydrogenase (LDH) from isolated rat hepatocytes. Therefore, we have studied, in an isolated perfused rat liver model, biochemical and morphological changes after administration of either atracurium or its main metabolite, laudanosine. Despite using extremely high concentrations of these substances, we could not detect, biochemically (release of LDH or aspartate amino-transferase (AST)) or histologically, any signs of liver cell damage.

The differential diagnosis of primary peritoneal papillary tumors.

Primary tumors of the peritoneum are rare. Histological differentiation between papillary mesotheliomas, primary ovarian tumors, borderline tumors of the ovary with peritoneal deposits and primary peritoneal carcinoma may be difficult. The expression of vimentin, keratin, pankeratin, CEA, CA125, CA19-9, S100, B72.3 and BerEP4 was therefore investigated in twelve women with primary malignant peritoneal tumors, twelve women with pleural mesothelioma, eight women with serous ovarian carcinoma and four men with peritoneal mesothelioma. The marker pattern we used was no help in differentiating between metastatic ovarian carcinoma and primary peritoneal carcinomatosis. A combination of the markers S100, B72.3 and BerEP4 helped the distinction between mesotheliomas and the other malignancies. If two or all three markers are detectable, primary peritoneal carcinomatosis or metastatic ovarian carcinoma is the possible diagnosis. If none of the three markers are found, a diagnosis of mesothelioma is highly probable.

Comparison of HTK- and UW-solution for liver preservation tested in an orthotopic liver transplantation model in the pig.

The aim of this experimental study was to compare the preservation potency of University of Wisconsin (UW) and HTK (Bretschneider) solutions in an orthotopic liver transplantation (OLT) model in pigs. Livers were harvested using an in situ perfusion technique, where organs were flushed with the solution being tested, stored on ice--cold storage (CS)--for 2 or 24 h and then transplanted. Parameters monitored were liver enzymes in serum, hepatic water content, high energy phosphates, nuclear magnetic resonance (NMR) relaxation time T2, light microscopy and bile production. CS for 24 h is an extreme in pig liver preservation and is not compatible with animal survival. Biopsies showed drastic morphological changes and grafts did not produce bile in either group. (Bile production 2 h CS: HTK, 5.6 +/- 1.8 ml/h; UW, 4.7 +/- 2.3 ml/h) Enzyme release after reperfusion (deltaSGOT, deltaLDH) was higher in long-term preservation. Hepatic tissue water content significantly decreased during CS in UW preserved livers. Edema alter reperfusion (deltaH2O: HTK 24 h = +5.6%, UW 24 h = +4.8%) and regeneration capacity after reperfusion (UW 2 h = 63%, HTK 2 h = 55%, UW 24 h = 30%, HTK 24 h = 30%) were not significantly different. However, we did not observe major differences in preservation potency between the solutions tested. Differences were correlated, rather, with length 9 time of CS, than with the solution used. Therefore, HTK solution seemed to be a low potassium containing alternative to UW solution.

A practicable two-dimensional electrophoresis of urinary proteins as a useful tool in medical diagnosis.

Practical experience with a rapid two-dimensional electrophoresis technique for routine analysis of urinary proteins is discussed. The method consists of cellulose acetate electrophoresis in combination with sodium dodecyl sulfate (SDS) electrophoresis, performed together with Coomassie Blue gel staining on "PhastSystem". Over 400 analyses were performed within the time of two years. Most patients were from nephrological, urological and kidney-transplant departments. Some of them were from obstetric, pediatric or oncological departments. A systematic discussion and evaluation of the two-dimensional protein pattern with typical examples is outlined.

[Periarteritis nodosa of the gallbladder--2. Surgical case reports]. / Zur Wertigkeit des Befundes Panarteriitis nodosa an der Gallenblase--2 chirurgische Fallberichte.

P.n. of the gallbladder is discussed as isolated and systemic form according to the description and analysis of 2 cases. In the 1st case the disease remained restricted to the gallbladder and no further complications involving the vessel system appeared so far in the follow up (2 years). In the 2nd case the patient dies few days after the operation due to a systemic involvement. Literature survey reveals a nonuniform classification of angiitis. Nevertheless we have tried to assign (classify) to 2 above mentioned cases.

[The high autopsy rate in Vienna]. / Zur hohen Autopsierate in Wien.

In 1983 34% of all persons who died in the Republic of Austria were autopsied. We examined the frequency of postmortem examinations in the capital city, Vienna, between 1983 and 1987 in view of this high overall autopsy rate. The annual autopsy rate in all 9 pathology institutes and the department of legal medicine of the University of Vienna was on average 51 to 53%. There was a slight statistically verifiable decline in 1987. The reason for this high necropsy rate is that Austrian law permits the autopsies without the consent of next of kin if it appears indicated for medical, scientific or educational reasons; further more the fact, that the chairman of the department is at the same time the coroner for the hospital. A high autopsy rate is necessary to maintain a high standard of diagnostic accuracy even in modern medicine. The diagnoses were inaccurate or incomplete in 15% of all cases. The high autopsy rate is the basis for extremely accurate mortality and morbidity statistics and provides the basis for long range public health planning. Medical students develop an insight in disease patterns, which cannot be gained in any other way. The pathology departments of Vienna introduce a new city-wide computer-supported diagnostic file system, which will provide a baseline for comparative scientific studies.

[Systems theory in medicine and biology]. / Systemtheorie in der Medizin und Biologie.

We try to determinate, that systems theory has to be introduced into modern medicine. The biological roots as well as the cybernetic ones are outlined. Among various concepts about systems theory the evaluation by Riedl seems to be the most efficient to explain medical procedures. His basic informations refer to von Bertalanffy, the additional introduction of a 4-cause-principle, Aristoteles, permits the explanation of complex relations. The examples of tumor and inflammation are used to demonstrate the basic idea of the formal cause as well as the final cause. The latter should also become an important fact in the solution of other medical problems.

Differentiation of mononuclear blood cells into macrophages, fibroblasts and endothelial cells in thrombus organization.

The organization of thrombi and emboli may be performed exclusively by mononuclear blood cells which represent precursors of various mesenchymal cell types. Between the 10th and 20th day after the onset of blood clotting, mononuclear cells within the fibrinous matrix differentiate into (1) macrophages responsible for hematoclasia and hematophagocytosis, (2) endothelial cells lining autolytic slits in the fibrinous matrix and forming new capillaries, and (3) fibroblasts and even smooth muscle cells building up a young mesenchymal connective tissue.

Angiogenesis from mononuclear cells in thrombi.

In organizing thrombi angiogenesis is not dependent on invasion of vasa vasora from the vascular wall. Mononuclear cells of the monohistiocytic system are always present within the clotted blood and are capable of differentiation into various types of mesenchymal cells, including endothelial cells. At first autolytic slits and clefts appear in the fibrinous superficial areas of the thrombus. They are gradually lined by spindle-shaped "pre-endothelial" cells that already possess immunohistological properties of endothelial cells but still resemble primitive mesenchymal cells ultrastructurally. Later these cells gain connection with each other by pseudopodia, overlapping and interdigitation until the channels in the fibrinous matrix are covered by an uninterrupted layer of cells. These cells are now characterized ultrastructurally by the appearance of specific endothelial organelles (Weibel-Palade bodies). Circulation within these channels begins from the blood stream. In addition, angiogenesis by sprouting of vasa vasora from the vascular wall occurs in those areas of the thrombus in contact with the vessel wall. In blood vessels with on unimpaired intimal layer, angiogenesis by invasion of capillaries occurs at an earlier date than capillary formation by mononuclear cells.

[Is the tonisation of varicose veins due to elevated prostacyclin synthesis caused by dihydroergotamine?]. / Werden varikös veränderte Venen durch Dihydroergotamin über eine gesteigerte Prostacyclinsynthese tonisiert?

Prostacyclin is the most potent inhibitor of platelet aggregation and a very strong vasodilator. A few reports on a moderate vasoconstrictory response in certain vascular segments in various species have received less attention. We demonstrated recently that PGI2 dilates the arterial wall and has a constrictory effect on the venous wall. Normal and varicose human veins show a dose-dependent constrictory response to PGI2. Pretreatment of patients with 2.5 mg dihydroergotamine t.i.d. for 10 days increases venous PGI2 synthesis significantly. In vitro contractility response is identical in normal and varicose veins. Furthermore, no difference in contractility was registered in veins derived from treated and untreated patients. The significantly enhanced formation of PGI2 evoked by dihydroergotamine might be responsible for the tonisation of normal, healthy veins, as well as varicose veins.

Organisation of experimental thrombosis by blood cells. Evidence of the transformation of mononuclear cells into myofibroblasts and endothelial cells.

To clarify whether thrombus organisation was carried out by local cell activity or by elements of the circulating blood we developed an artificial prosthesis, made of an impermeable polyurethane material with an athrombogenic surface but with a central part consisting of a DACRON velour ring which was thrombogenic. We implanted these devices into the aorta of 10 sheep. In these animals, organisation of the central thrombus by local aortic cells could be excluded. After varying periods of time (2-84 days), the device was removed and the organized thrombus investigated by light and electron microscopy. From our investigations the organisation process with the development of mesenchymal cellular elements proceeded in 3 steps: The activation of the mononuclear macrophage system, the appearance of myofibroblastic cells and endothelial formation. The activation of the mononuclear macrophage system is probably induced by chemospecific products of metabolism arising from aging thrombotic material. Apart from mononuclear elements such as monocytes, macrophages, and giant cells we observed fibroblast-like and myofibroblast-like cells. The matrix contained collagen. Endothelium developed on the surface of the organizing thrombus. The final stage was characterized by the formation of a pseudovessel wall, which followed the pattern of the vascular model. Our findings support the hypothesis that a thrombus may be organized by cells derived from the circulating blood.