Joint occurrence of collagen mRNA containing cells and macrophages in human atherosclerotic vessels.

Cells with enhanced levels of collagen type I and III mRNA were identified and localized in frozen tissue sections from samples of human atherosclerotic renal and common iliac arteries by in situ hybridization using complementary 35S-labeled RNA probes. Serial sections were immunohistochemically stained for smooth muscle cells, monocytes, and differentiated macrophages. In the fibromuscular intima and in the fibrous plaques, cells with enhanced transcriptional activity were located mainly in the vicinity of differentiated macrophages. In three patients, lack of enhanced transcriptional activity in a proliferated intima was connected with complete absence of macrophages, thus indicating a quiescent stage of atherosclerosis. Immunohistochemical staining of serial sections for smooth muscle cells (SMC) revealed the presence of this cell type throughout the proliferated intima in atherosclerotic arteries including those areas in which enhanced collagen mRNAs were detected. The present results support the idea that macrophages play an important role in the activation of collagen synthesis in SMC of atherosclerotic vessel walls.

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo.

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.

[Late metastasis of an extragonadal Leydig cell tumor]. / Spät-Metastasierung eines extragonadalen Leydig-Zelltumors.

The case of a 36-year-old patient who underwent extirpation of a Leydig cell tumor of the epididymis is presented. Five years later a retroperitoneal mass was removed, which was found to be a metastatic Leydig cell carcinoma. The literature conrains reports of only 32 cases of metastatic Leydig cell tumors, all of which had originated in the testis and not extragonadally. The symptoms, treatment and prognosis are discussed with reference to the literature.

[Clinical aspects of hypophyseal metastases]. / Klinik der hypophysären Metastasierungen.

Metastatic tumors within the pituitary gland are rare. The incidence--reported by series of autopsies--differs from 1.8-12% of metastatic tumors. Most of the primary tumors are breast cancers, followed by cancers of the gastro-intestinal system. Only 20% of these metastases are clinically diagnosed. Diabetes insipidus is the main symptom, correlating with the greater incidence of metastatic lesions in the posterior lobe. The unusual features of a reported case are discussed. In this case the dysfunction of cranial nerves passing the sella turcica led to the diagnosis. Therapy with Flutamid initiated a remission. Survival of 18 months is remarkably long.

The applications of the BrdUrd-technique for the estimation of cycling S-phase cells in human renal cell carcinoma.

After testing the BrdUrd technique on experimental tumour cell lines, we applied the technique to human renal cell carcinoma in vitro. We compared the results with the data acquired after FCM analysis and 3H-thymidine treatment. In contrast to BrdUrd the 3H-thymidine uptake seemed to be limited in suspended cells. FCM data represented the DNA distribution of cells. BrdUrd labelling on the other hand detected DNA synthesizing cells. Only both methods in parallel were able to discriminate between proliferating cells and resting cells with an S-phase equivalent DNA content.

Preoperative renal tumor embolization. A useful procedure?

The medical reports of 113 patients operated upon for renal tumors were retrospectively reviewed to assess the value of preoperative embolization. Coils or ethanol were used preoperatively in 55 patients while 58 patients underwent nephrectomy without embolization. The tumors were staged according to the TNM and the Robson staging classification. T1 and T2 tumors as well as T3 and T4 tumors were grouped together for statistical evaluation. There was no significant difference in intraoperative blood loss, operation time and survival rate between patients undergoing preoperative embolization and those who had only nephrectomy. Duration of hospital stay was always longer in the preoperatively embolized group. Preoperative embolization of renal tumors neither improved the patients' outcome nor reduced the surgical risk. Robson's classification, stage III/IV, did not show any significant differences for embolized patients or for those nephrectomized without embolization.

[Clinical experience using polyurethane ureter endoprostheses and studies of the incrustation tendency]. / Klinische Erfahrungen mit Ureterendoprothesen aus Polyurethan und Untersuchungen zur Inkrustationstendenz.

The advantages of internal urinary drainage by using ureteral splints have often been discussed during the last years. Using this technique in our clinic for 17 years nearly 2000 ureteral splints have been applied in 650 patients. Since 1978, in 164 patients ureteral splints made of polyurethane (PUR) were used. The indications are listed. The complication-rate is very low. Ureteral splints which had been removed after varying periods were examined by scanning electron microscopy. Results of these studies are shown.

[Vesico-uterine fistula]. / Vesiko-uterine Fisteln.

The incidence of vesico-uterine fistulas is very low; they can develop from normal delivery, malignant tumors, inflammations and iatrogenic lesions. The increased number of cesarean sections during the past years should also be considered. Two patients are presented. Symptoms, diagnostic and therapy are discussed.

[Studies of the cell kinetics of human malignant testicular tumors]. / Zellkinetische Untersuchungen menschlicher maligner Hodentumoren.

The cellular DNA-content of 75 malignant testicular germ-cell tumours was determined by flow cytometry. The results are: Aneuploidy is a certain tumour marker in 95% of germ-cell tumours. The DNA-indices range from 2 c (diploid) to 6 c with a modal value around 3 c. 23% of germ-cell tumours are multiclonal. The S-phase percentage is higher than those of the most other solid tumours investigated so far and is 25.5% in seminomas and 35% in non-seminomatous germ-cell tumours. Further investigations of a greater number of tissues will show the importance of DNA-contents measurement by flow cytometry for the prognosis of testicular tumours, representing an addition to histopathology.

[Spermatogenesis in old age--nuclear DNA determination by flow cytophotometry in testicular samples of older men for the quantification of spermatogenesis]. / Untersuchungen zur Spermatogenese im Alter--Impulszytophotometrische Zellkern-DNS-Bestimmungen von Hodenproben alter Männer zur Quantifizierung der Spermatogenese.

The flow cytometric determination of the nuclear DNA content of testicular samples permits a fast and reliable quantification of spermatogenesis. 70 testicular samples from men over 50 years of age were analysed with this method. 60% of the samples showed a distinct reduction of spermatogenesis. Only three men showed a nonreduced spermatogenesis in both testes. Comparing the results of the measurements of both testes, in nearly half of the testes pairs a reduction of the germ cell number below two thirds of the better side was striking. In one patient, a Leydig cell tumor was detected by chance by an aneuploidy.

DNA-analysis of human testicular samples by cytofluorometry.

Germ cells in human testicular samples have been estimated by histology and quantitated by flow cytometry. There is an excellent relationship between the two techniques. These samples were classified histologically as "normal", "reduced number of germ cells" or "no germ cells". A definition of "normalcy" as determined by flow cytometry as having at least 38% of the cells in the haploid state, is proposed. Testicular samples from prepubertal boys with infiltrating leukemic cells often show an increase in the percentage of S-phase cells indicating the presence of tumor. These results indicate the value of flow cytometry in the identification of reproductive and neoplastic disorders.

Priapism: a three-phase concept of management according to aetiology and prognosis.

Priapism is a persistent, painful erection of the penis unassociated with sexual stimulation or desire, and detumescence does not occur following ejaculation. Prolonged pathological erections may occur and it is only when they are painful that the term priapism should be used. The erection is limited to the corpora cavernosa. Although the syndrome was named after Priapos, the mythical Greek god of fertility, impotence persists in one half of patients treated for priapism. The disease is rare; the literature consists mainly of case reports and comprehensive reviews are seldom found. Permanent sequelae cause a psychological and physical handicap and justify the present review, which is based upon recent literature as well as personal clinical experience of 15 patients. We have reviewed 170 reports describing 1400 cases of priapism and have based the analysis upon the 230 single case reports found in the literature.

Urolithiasis in a patient ingesting pure silica: a scanning electron microscopy study.

A patient who repeatedly produced urinary calculi, had consumed about 3 g of cristobalite (SiO2) per day for many years. Investigations using scanning electron microscopy revealed minute particles containing silicon in the core of the stone as well as in urine sediment. A mechanism similar to that proposed for the effect of silicon-containing drugs against gastric ulcer, may play a role in this formation of silicon-containing urinary stones.

Flow cytometric analysis of the maldescended testis.

Flow cytometric measurements of the cellular DNA contents of 16 testicular biopsies of 15 patients with maldescended testes were performed. 2 patients were children. 11 patients of pubescent or adult age had no haploid germ cells in the tissue of their maldescended testis. One patient with a testis mobilis had about a normal percentage of haploid germ cells. In one patient a malignant tumor was detected unexpectedly by an aneuploid stem line at 2.2 c. Flow cytometric analysis of human testicular biopsy material is an easy and a fast way to quantify the function of spermatogenesis and detect malignancies.

[Urologic complications in Crohn disease]. / Urologische Komplikationen beim Morbus Crohn.

The main urological complications of Crohn's disease are: vesico-intestinal fistula, ureteral obstruction, formation of urinary calculi and amyloidosis of the kidney. In the course of their illness nearly 4 to 10 per cent of patients with Crohn's disease suffer from these complications. The frequency of vesico-intestinal fistula is nearly 4 per cent; with great fluctuations, the frequency of ureteral obstruction is specified by 6 per cent. 10 per cent of all patients with Crohn's disease will suffer from secondary amyloidosis. In most cases the kidney is the organ of manifestation. In 5 per cent the formation of urinary calculi is complicating Crohn's disease. The specific complications are demonstrated in symptoms, diagnostic and therapy.

[Urologic complications in 200 patients with Crohn disease]. / Urologische Komplikationen bei 200 Patienten mit Morbus Crohn.

The main urological complications of Crohn's disease are: vesico-intestinal fistula, ureteral obstruction, formation of urinary calculi and amyloidosis of the kidney. 200 patients suffering from Crohn's disease who had been treated in- or outpatient between 1973 and 1982 have been examined concerning urological complications. The frequency of complications was 14,5 per cent. Twenty patients developed fistulae, eleven had ureteral obstructions, two patients suffered from calculi and two from amyloidosis of the kidney. Due to this frequency a special urological diagnostic program is mandatory. A sonogram of the kidney and an i.v. urography should be made in case of pathological sonogram. This is as necessary as the control of kidney function and diagnosis of the urine. These specific urological complications are demonstrated in symptoms, diagnosis and therapy.

[Urologic complications following vascular prosthetic interventions in the aortofemoral area]. / Urologische Komplikationen nach gefässprothetischen Eingriffen im aorto-femoralen Bereich.

After vascular graft surgery within the pelvic area, urological complications occur in about ten percent of the patients. Overlooking 310 cases, four patients suffered from ureteral lesions and 21 patients had ureteral obstructions. Possible causes for ureteral obstructions are positioning of the ureter between vessel and prosthesis, hematoma, lymphoma, anastomotic aneurysm, prosthesis infection, Morbus Ormond as well as trophical lesions of the ureter wall. Use of ureteral splint could prevent surgical intervention in many cases. Application of prophylactic pre-operative splinting is recommended in case of large aneurysm, previously injured kidney and single kidney.

Scanning electron microscopy of urinary calculi--some peculiarities.

Within the scope of the investigation of more than 1,500 urinary calculi by scanning electron microscopy (SEM), some peculiarities arose concerning secondary phase transitions and morphology of some of the crystalline phases present. There is evidence for a phase transition from Ca-oxalate dihydrate to the monohydrate form in oxalate rich stones. This is characterized by a transitional zone, in which often relatively large monocrystals of newly formed whewellite are found, sticking within weddellite crystals with typical dissolution signs. We conclude that the phase transformation is regulated by dissolution and recrystallization. In mixed uric acid / uric acid dihydrate stones, occasionally parallel growth of apparently two different kinds of crystals upon each other can be observed, which possibly are uric acid crystals grown epitaxially on uric acid dihydrate. A few nearly pure whewellite stones with little Ca-phosphate at the central core show tubules which obviously had been part of a calcified renal papilla and so had been acting as a nidus for stone formation. Bacterial footprints as well as calcified bacteria have only been found in apatite containing stones of patients with urinary tract infections by Escherichia coli. These bacteria are likely responsible for the origin of these footprints.