[Adder bites--clinical picture, diagnosis and management]. / Kreuzotterbisse--Klinik, Diagnostik und Behandlung.

Adder bites are occasionally occurring envenoming emergencies. More than ten percent of the clinical courses are severe and even life-threatening. Children and elderly patients are over-represented in this group. Common symptoms comprise local edema, abdominal pain and vomiting, arterial hypotension and neurological disorders. First steps in the management are immobilization of the affected extremity, reassurance of the patient and application of analgetics. Anaphylaxis may occur and requires status adapted treatment. Persistent circulatory shock, protracted gastrointestinal or severe neurological symptoms, as well as rapidly progressing edema and airway obstruction are indications for antivenom treatment. Administration of antivenom results in prompt clinical improvement and in a significantly shorter hospital stay.

Medical thoracoscopy: hormone receptor content in pleural metastases due to breast cancer.

Pleural metastases are common in the course of breast cancer, but, to date, the role of oestrogen receptor (OR) and progesterone receptor (PgR) content in metastatic tissue has been poorly evaluated. A series of 50 consecutive patients with a history of breast cancer (median age 64 yrs, range 40-86 yrs), which presented with pleural effusion and therefore underwent medical thoracoscopy, was analysed. Metastatic pleural involvement was histologically confirmed in all patients. The hormone receptor status of the pleural metastases was investigated using the immunohistochemical method in 49 and the biochemical method in 31 cases. The immunohistochemical test was performed using monoclonal antibodies. Biochemical analysis was performed on specimens quick-frozen in liquid nitrogen. OR and PgR were measured with the dextran-coated charcoal assay and Scatchard analysis. Immunohistochemical analysis yielded 29 OR-positive and 25 PgR-positive cases and biochemical analysis yielded 16 OR-positive and four PgR-positive cases, sometimes discrepant to hormone status of the primary breast cancer. Using a semiquantitative immunoreactive score, there was a significant association between receptor positivity and survival, but only for PgR positivity. Immunohistochemical and biochemical detection of hormone receptors (oestrogen and progesterone) in pleural metastases of breast cancer is feasible based on medical thoracoscopy as the method of choice, by which sufficient specimens may be obtained. The receptor status may enable a decision on antihormonal treatment. Whether a positive receptor status in pleural metastatic tissue is associated with a better prognosis remains to be confirmed.

[Benign fibrous histiocytomas as a differential diagnosis in cavitary lung disease]. / Benignes fibröses Histiozytom als Differenzialdiagnose für eine kavernöse Lungenerkrankung. Kasuistik mit Literaturübersicht.

Benign fibrous histiocytomas (BFH) are uncommon pulmonary tumours. These lesions usually present as slow-growing, solid masses. We report the rare case of a young man with cavitary BFH. The 20-year-old patient, a non-invasive drug abuser, had suffered from hemoptysis for two months. The chest X-ray showed a solitary pulmonary nodule with a diameter of 2 cm in the left lower lobe with central cavitation. Fiberoptic bronchoscopy showed a normal bronchial system, biopsies were not diagnostic and no acid fast bacilli were found. Considering the patient's history and the cavitary process, a non-specific abscess was suspected and an antimicrobial treatment was started. Since no treatment effect was observed, biopsies from a second bronchoscopy were suspicious of a malignant mesenchymal tumour. Lower lobe resection with lymphadenectomy revealed a benign fibrous histiocytoma. This is--to our knowledge--the first reported case of a BFH presenting with cavitation.

The origins and consequences of public trust in government: a time series analysis.

The study of citizens' trust in the national government has been primarily individual-level, cross-sectional analysis. In the current research, we develop a quarterly time series measure of trust in the U.S. national government from 1980 to 1997 and conduct the first multivariate time series examination of public trust in government. We find that negative perceptions of the economy, scandals associated with Congress, and increasing public concern about crime each lead to declining public trust in government. Declining trust in government in turn leads to less positive evaluations of Congress and reduced support for government action to address a range of domestic policy concerns. These results provide new evidence of the influence of public concern about crime and the centrality of Congress in understanding public evaluations of the national government and new evidence of how declining levels of trust in government may influence elections and domestic policy making.

Carcinoid tumors of the lung: immuno- and ligandohistochemistry, analysis of integrated optical density, syntactic structure analysis, clinical data, and prognosis of patients treated surgically.

BACKGROUND: Analysis of potentially prognostic relevant factors of carcinoid tumors of the lung. METHODS: Clinical features, tumor size, and features derived from immuno- and ligandohistochemistry, cytometry and histometry, and survival have been analyzed in 82 potentially curatively resected carcinoid tumors of the lung. RESULTS: Patients with typical carcinoid tumors had a longer history of symptoms (13 vs. 8 months), fewer smoked (30% vs. 80%), and developed less frequently lymph node metastases (20% vs. 65%) compared to patients with atypical carcinoids. Statistically significant differences between both cell types have been observed in cytometric and histometric features, and binding of Lewis A trisaccharide (Lea). Prognosis is associated with the cell type, presence of lymph node metastases and heparin-binding lectin (HBL), certain cytometric and structural features, and binding of macrophage migration inhibitory factor (MIF) and beta-N-acetyl-D-galactosamine (beta-GalNAc). CONCLUSIONS: Complete lymph node dissection is necessary, data of cytometry, histometry, and ligandohistochemistry might eventually predict the course of the disease.

Twenty two year survival after incomplete resection of advanced adenoid cystic bronchogenic carcinoma.

In 1972, a 42 year old patient underwent thoracotomy for adenoid cystic carcinoma of the left main-stem bronchus. Pneumonectomy was performed, but the resection was not complete as the tumour had invaded the aortic and tracheal wall. The patient did not receive postoperative radiotherapy. In 1993, the patient was readmitted with severe respiratory insufficiency due to complete endobronchial tumour obstruction of the intermediate bronchus and extensive tumour growth in the mediastinum. Endobronchial laser treatment followed by stent implantation led to immediate symptomatic relief. The tumour then responded well to combined endobronchial and percutaneous radiotherapy. The patient died 7 months after readmission from ileus due to pancreatitis. We conclude that patients with advanced adenoid cystic carcinoma may profit from palliative surgery with respect not only to symptoms but also to duration of life.

Expression of adhesion molecules in peripheral pulmonary vessels from smokers and nonsmokers.

INTRODUCTION AND RATIONALE: An accumulation of intraalveolar cells, especially of macrophages and granulocytes, can be observed in smokers. Since adhesion molecules are involved in the process of cell accumulation, in this study we investigated the hypothesis that the expression of endothelial adhesion molecules on pulmonary vascular endothelial cells is different in smokers and nonsmokers. METHODS: We investigated lung biopsies from 26 patients who underwent thoracic surgery for localized malignancies (smokers: 15; nonsmokers: 11). Cryostat sections were stained by using immunohistochemistry (APAAP method) with antibodies against E- and P-selectin, the vascular adhesion molecule-1 (VCAM-1), and the intercellular adhesion molecule-1 (ICAM-1). The number of adhesion molecule-positive stained vessels was compared to the total number of vessels identified by the expression of von Willebrand's factor (vWF) and anti-CD31. RESULTS: The two groups investigated showed no differences in the expression of E-, and P-selectin and of VCAM-1. In contrast, the expression of ICAM-1 was significantly increased in smokers (median 25 vessels/section, CI95%: 19-31) compared to nonsmokers (median 16 vessels/section, CI95%: 9-21) (p = 0.030). In smoking subjects, we were also able to demonstrate a positive correlation between the duration of smoking expressed as pack years and the expression of ICAM-1 on pulmonary vessels (Spearman rank coefficient of correlation 0.857; p = 0.0002). CONCLUSION: The observed increased expression of ICAM-1 on pulmonary vascular endothelial cells in smokers compared to nonsmokers may be involved in the increased recruitment of inflammatory cells to the alveolar space of smokers.

[Primary pulmonary B-cell lymphoma of the MALT type]. / Primäre pulmonale B-Zell-Lymphome vom MALT-Typ.

The malignant B-cell lymphoma of the MALT-type shows significant differences from nodal lymphomas with respect to its biological, molecular genetic, and clinical properties. According to the proposal from the International Lymphoma Study Group for a Revised European-American Classification of Lymphoid Neoplasms, MALT-B-cell lymphomas have been defined as an extranodal subgroup of marginal zone B-cell lymphomas and may have lower and higher grade types. We have applied this classification to 24 cases of primary B-cell lymphomas of the lung. These tumors showed histopathologic features of low (n = 20) and/or high grade neoplasms (n = 4) recapitulating the structure of the acquired bronchus-associated lymphoid tissue (BALT). According to our experience, the diagnosis of BALT-type B-cell lymphoma, is both practically feasible and reproducible not only for surgical material but even for biopsy specimens.

Expert consultation by use of telepathology--the Heidelberg experiences.

The benefits and constraint using visual telecommunication in pathology (telepathology) are described based upon the experiences of the authors for more than 4 years. The experiences include first trials in visual telecommunication to analyze image quality, transfer rates, handling of commercially available equipment, and need for routinely diagnostic work followed by routinely expert consultations in frozen sections. A quality control study on diagnostic reliability of bronchial carcinomas was performed later, and the diagnosticly different cases were reclassified by a panel of pathologists using visual telecommunication. The latest experiences are based upon routinely expert consultations in morphologically difficult cases by ISDN-based telecommunication. As a result, image quality and transfer rates are sufficient to permit efficient expert contribution to diagnostically difficult cases in 30-50% of transmitted cases in both common telephone lines and ISDN connections. No influence of various staining procedures, immunohistology, or in situ hybridization on image quality or transfer rates were observed. The area of transmitted images is still too small, and the reliability of ISDN lines is still not sufficient for remote control service in Germany. The handling of commercially available equipment needs to be improved; however, as a general result, telepathology will probably improve the diagnostic quality and access in histopathology within the coming years.

Asymptomatic pulmonary involvement in 2 children with Niemann-Pick disease type B.

We present 2 cases of children with Niemann-Pick disease type B, and surprisingly with reticular lung infiltrations, although otherwise healthy in terms of pulmonary manifestation. Finding such reticular infiltrations should lead one to think of the possibility of metabolic storage disease.

Aids of telepathology in intra-operative histomorphological tumor diagnosis and classification.

Visual telecommunication (telepathology) was applied for expert consultation in intra-operative frozen sections and tumor classification of paraffin-embedded, poorly differentiated bronchial carcinoma. The Institute of Pathology, Hospital Baumgartnerhöhe, Vienna and the Department of Pathology, Thoraxklinik, Heidelberg transmitted histological images by use of commercially available computerized modems (VP 2000) and conventional telephone lines. The expert consultation of the frozen sections included the clinical history, macroscopic findings and problems of final judgement of the images. Additional useful information could be obtained in about 35% of cases, and comprised expansion of differential diagnosis, certainty of final diagnosis, and side findings, such as concurrent inflammation, sarcoid-like lesions, etc. The time required for intra-operative diagnosis was 6-10 min. Cases of the Austrian-German quality control study on lung cancer with divergent tumor classification were discussed by use of telepathology. A final congruent tumor diagnosis could be obtained in all divergent cases. The data indicate that telepathology can be successfully used for expert consultation of intra-operative frozen sections and panel discussions of difficult bronchial carcinoma cases.

Nucleolar organizer region-associated proteins in cancer cells. Quantitative investigations on gliomas, meningiomas, urinary bladder carcinomas and pleural lesions.

Using a modified silver staining technique, we investigated nucleolar organizer region-associated proteins (AgNORs) in paraffin sections of 156 neoplastic tissues and other lesions, including gliomas (n = 41), meningiomas (n = 20), urinary bladder carcinomas (n = 58), and neoplastic and reactive lesions of the mesothelium of the pleural cavity (n = 37). We found significant differences in the mean number and area of AgNORs per nucleus between nonanaplastic and anaplastic astrocytomas. In meningiomas AgNOR analysis may be useful to distinguish between mostly benign tumors (grade 1 tumors) and atypical ones. Urinary bladder carcinomas exhibited a statistically significant increase in both AgNOR number and area as the grade of malignancy increased. Diagnostically useful differences in the AgNOR configuration between inflammatory and neoplastic processes were found for mesothelial lesions. In general, a higher grade of malignancy correlated with an increase in the AgNOR number. This was accompanied by an increase in the total AgNOR area per nucleus, irrespective of whether the size of the individual AgNORs had changed.

Pulmonary schistosomiasis resembling acute pulmonary tuberculosis.

Pulmonary involvement of schistosomiasis is usually characterized by a miliary mottling or diffuse nodular infiltrates. In most cases, pulmonary involvement is associated with an apparent clinical involvement of other organs. This report describes a 35 yr old patient who developed a cavity, a parenchymatous infiltrate and hilar adenopathy in association with pulmonary schistosomiasis. Schistosoma eggs were demonstrated in transbronchial biopsies from the lung. Pulmonary involvement of schistosomiasis is reviewed and atypical features are discussed, which may lead to diagnostic difficulties, particularly compared to tuberculosis.

Gas chromatographic separation of diastereoisomeric amino acid derivatives on glass capillaries. THE USE OF PENTAFLUOROPROPIONYL-AMINO ACID (+)-3-METHYL-2-BUTYL ESTERS.

The separation of diastereoisomeric pentafluoropropionyl-D, L-amino acid (+)-3-methyl-2-butyl esters, including those derived from histidine, arginine and tryptophan, is achieved on glass capillaries. Separation factors of between 1.03 and 1.09 are observed for the derivatives of protein amino acids. The gas chromatographic separation of a mixture of common amino acids usually takes less than 1 h.

[A micro method for the determination of the configuration of histidine in peptides: evidence for partial racemization during peptide synthesis (author's transl)]. / Eine Mikromethode zur Konfigurationsbestimmung von Histidin in Peptiden Der Nachweis partieller Razemisierung bei der Peptidsynthese

A gas chromatographic method for the determination of small portions of D-histidine together with an excess of L-histidine (or vice versa) is described. Histidine is degraded to aspartic acid by reaction with ozone. The enantiomers are esterified with (+)-3-methyl-2-butanol. After N-trifluoroacetylation the volatile diastereoisomers are separated in glass capillaries coated with a chiral stationary phase and determined quantitatively. For precise evaluations the partial racemization during peptide hydrolysis must be accounted for. The method was applied to some histidine peptides and about 5% racemization was measured.

[The infarction of the right ventricle and the connections with coronary sclerosis and chronic cor pulmonale (author's transl)]. / Der Rechtsherzinfarkt und seine Beziehung zur Koronarsklerose und zum chronischen Cor pulmonale

The infarction of the right ventricle as a spatial and temporal mosaic-infarct and the lesions following it were investigated. Its frequency and its connections with the infarction of the left ventricle, coronary sclerosis and hypertrophy of the right ventricle as cor mitrale and cor pulmonale were reported, treated on 11 073 post-mortem examinations of adults separated in males and females. Three groups were divided: 1. isolated lesions of the right ventricle 2. separated lesions--spatially and/or temporally of the right and left ventricle 3. lesions overlapping from the left on the right ventricle. The infarct of the right ventricle respectively cicatrices were observed in 1.2%. The coronary sclerosis was detected in all cases, and specially the hypertrophy of the right ventricle as cor pulmonale or cor mitrale were important for the pathogenesis of right-cardiac infarcts. The pulmonary embolism was more frequent in isolated infarcts of the right ventricle.