[Castleman's disease]. / Morbus castleman.

A 17-year-old girl developed acute colicky periumbilical pain with haematuria. On examination a tightly elastic space-occupying lesion about 10 cm in diameter was palpable around the umbilicus. Erythrocyte sedimentation rate (ESR) was raised to 113 mm in the first hour. There was a microcytic anaemia (8.7 g/dl) and a positive Coombs test. Ultrasonography revealed a periumbilical space-occupying lesion of decreased echogenicity and left hydronephrosis. Computed tomography demonstrated a homogeneous noninfiltrative tumour, about 7 cm in diameter, with increased contrast medium concentration. The tumour, which was covered by peritoneum and well circumscribed, was excised from the base of the mesentery. Histologically it proved to have hyaline-sclerotic changes in the blood vessels and lymphoid and plasma cellular infiltrations, corresponding to a mixed form of Castleman's disease. In a second operation a left nephroureterectomy was performed. The kidney, the regional lymph nodes and the tissue which had caused the stenosis of the ureter all showed the same changes as the tumour. Postoperatively the ESR and the blood count became normal, but the Coombs test remained positive. During a subsequent pregnancy the ESR again rose. The patient has remained symptom-free for 38 months after the second operation.

Role of immunological factors in male infertility. Immunohistochemical and serological evidence.

Immunological deposits in the testis and circulating antibodies to spermatozoa are presented as a possible explanation for infertility in man. Testicular biopsy specimens from infertile patients (N = 52) as well as from fertile controls (N = 6) were analyzed immunohistochemically by using semithin sections. Immunoglobulin deposits were found in the testes of 21 patients. Antibody deposits were observed on the seminiferous tubule wall, on germ cells or in the interstitium. In two cases, the C3 complement component was detected on the tubular wall and in one case on atypical spermatogonia. Deposits of immunoglobulin class G were found most frequently, and were often attached to the seminiferous tubule wall. In addition, the occurrence of circulating antisperm antibodies in the sera of these patients was examined by a recently developed method, the immunobeads binding test. A significant number of patients with normal spermatogenesis had antibodies that exhibited a strong binding reaction to spermatozoa as observed by the immunobeads binding test. It is suggested that at least two different immunological mechanisms may be involved in pathological infertility: an immunoglobulin deposit, induced locally in the testis, in a manner specifically against the germ cells and the seminiferous tubular basement membrane, or in a manner nonspecifically against seminiferous tubular wall, and asystemically induced immunoglobulin production which is directed against spermatozoal antigens.

Mosaicism of dynein in spermatozoa and cilia and fibrous sheath aberrations in an infertile man.

Male patients displaying an immotile or almost immotile sperm population are the object of an interdisciplinary study concerning a ciliary mutant that induces the "Immotile-Cilia Syndrome". Development and function of both sperm flagella and cilia are normally affected because of disturbances of the 9 + 2-arrangement. During this program, clinical, physiological, genetical and ultrastructural investigations were done. The ultrastructure of immotile spermatozoa of an infertile man did not reveal inner and outer dynein arms. Lack of the ATPase dynein which is essential for movement of the 9 + 2-axoneme, is typical for the above syndrome. In addition, symmetry of the fibrous sheath of the spermatozoa was very abnormal. The pneumologist examined normal lung function, where the ultrastructure of the cilia of the nasal mucosa displayed the dynein arms. Analysis of family tree and chromosomes by the geneticist also gave a normal result. As revealed by this infertile patient it seems likely that expression of dynein must not be identical in both germ cells and somatic cells. Such variations are therefore regarded as additional forms of the "Immotile-Cilia syndrome". Asymmetric fibrous sheaths are thought to be a result of immotile spermatid flagella, leading to an abnormal arrangement of the accessory axonemal structures. Normal early spermatid flagella of man and rat show specific movements.

[Late complications of the intestine after radiotherapy of bladder carcinoma]. / Spätkomplikationen des Darmes nach Strahlenbehandlung des Blasencarcinoms

Immediate reactions of the intestines during or after radiotherapy of the pelvis are very common. Later complications requiring surgical intervention are seldom found. Out of 101 patients with bladder carcinomas, we observed 4 with severe irreversible intestinal changes. These had been operated and had received post-operative radiotherapy. On 3 patients a sigmoid stenosis had to be resected under the protection of a colostomy. On the fourth patient an ileovesical fistula was closed primary.

[Bladder substitution with continent ileum pouch experimental study on dogs (author's transl)]. / Blasenersatz durch ein kontinentes Ileumreservoir. Tierexperimentelle Studie an Hunden

Ileum conduit is a good method for supravesical diversion of urine. The disadvantage is, however, that it does not have a reservoir function. For the first time, in 1969 Kock had shown good results with a continent intra-abdominal ileum pouch for feces, and this gave us the idea to try a similar pouch for urine on 15 dogs. To make reservoirs of the small intestine was technically not simple and often led to complications. Urine continency could be attained by invagination of the small intestine. Primary and secondary reflux as well as stenoses of the ureter implantations led in 50% of the cases to ascending infections. Complications of urine reabsorption did not occur. Further studies of the continency, reflux and reabsorption problems indicate that a continent, intra-abdominal ileum pouch for urine will be possible.