[Problems of agreement between clinical and autopsy diagnoses. Reply to the comments of Schneider and coworkers].
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Autopsy↗
Biomedical subjects
F Vollmar
Publications and source records attributed to F Vollmar.
[Problems of agreement of clinical and autopsy diagnoses].
Results obtained from autopsy are parameters of importance to efficacy of diagnosis and therapy. To enable better overseeability of higher numbers of cases, the necessary congruence between clinical and postmortem diagnoses should be consistently settled on the basis of identical criteria used by clinicians and pathologists. Aspects relating to the problem are discussed in some detail, and suggestions are made on how to formulate final evaluations in postmortem reports.
Autopsy↗
[Ectopic pregnancy--still a challenge in gynecology. A contribution to diagnosis and therapy].
The diagnostic and therapeutic management in 80 cases with ectopic pregnancy is analysed. Only in 36 cases (45%) there was an accordance of installation diagnosis with the intraoperative status. 44 patients (55%) were suspicious to suffer from acute pelvic inflammatory disease, abortion or irregular uterine bleedings. Only in 28 cases (35%) the clinical symptomatology was so characteristic for ectopic pregnancy that operation had been performed without any other diagnostic procedures. In 34 cases (43%) a laparoscopy was necessary to get the correct diagnosis. In all the other 18 patients (22%) the indication for operation was made by punction of the cul-de-sac, curettage, and/or ultrasound. Because of an increased blood loss more than 500 ml an intra- or postoperative blood transfusion was necessary in about 1/3 of all treated patients. In 32% it was possible to preserve the fallopian tube. The corresponding operative procedure consisted of salpingotomy and manual expression of tubal pregnancy. Local vasoconstrictive acting substances are recommended. If there are hints at an ectopic pregnancy by histologic examination of tissue got by curettage quick and well-organized management is necessary to use the possibility of conservative operation-procedures. Histologic examination of all abortion tissue is requested.
Adolescent↗
[Postpartum curettage--is it always indicated?].
Within five years (1982-1986) there were in the Dept. Obstet. Gynec., Main Hospital of Suhl 382 curettements after 7,462 term deriveries (greater than 37. week of pregnancy). This is a frequency of 5.2%. Only in 25% there was a histologic confirmation of placental tissue. Discussion about possibilities to reduce the frequency of such curettements post partum without neglecting necessary interferences.
Chorionic Villi↗
[Myocardial infarction without coronary artery changes].
Since 1972 6 patients (4 males and 2 females) at the age from 18 to 44 years with myocardial infarctions could be observed whose coronary system in the subsequent coronarographic examinations proved to be unconspicuous. The diagnosis of the infarction was anamnestically, laboratory-chemically, electrocardiographically and partly scintigraphically ascertained. Issuing from features of infarction and pseudoinfarction, respectively, in the ECG other differential-diagnostically important cardiac and extracardiac causes could be excluded. In comparison to patients with coronary sclerosis typical symptomatology could not be delimited. Peculiarities of the clinical picture are the juvenile age, the in most cases short or lacking angina pectoris anamnesis, the frequent lack of factors of risk and the inclination to disturbances of rhythm. Up to now a satisfying etiologic clarification could not be rendered. The relevance of the different possibilities of the disturbed equilibrium between O2-offer and -need concerning the clinical course of our patients is discussed. Here on the side of the O2-offer the spasm of the big and small vessel and the disease of the small vessels are regarded as decisive factors of the development of the infarction, where as the coronary embolism with subsequent lysis is less to be taken into consideration. Other pathogenetic mechanisms, such as the pathologic Hb-O2-dissociation and the metabolic changes influencing the O2-need must be included into the causal chain of this presumably polyetiologic process. Prognostic and therapeutic aspects which closely correlate with the etiologic explanation are discussed.
Adult↗
Barrett-esophagus following total gastrectomy. A contribution to it's pathogenesis.
We have undertaken esophagoscopy 1/2 to 17 1/2 years after surgery in 20 patients with a total gastrectomy and an esophago-jejunal anastomosis. In 5 cases we found a complete columnar lining of the distal esophagus (Barrett-esophagus). 2 other cases showed a multilocular columnar epithelium. One case with a Barrett-esophagus had endoscopy before surgery, and it could be proved that the columnar lining developed after surgery. We suspect that it was the same in the remaining cases. All examined patients, except one, showed an erosive esophagitis of varying severity. These observations support the current view that the columnar lined esophagus is usually an acquired one. The pathogenesis is not completely clear, but reflux of digestive juices destroying the squamous epithelium and impairing healing is the condition for columnar lining. The observations on patients with total gastrectomy prove that it must not necessarily be gastric juice. The very urgent question of the origin of columnar lining cannot be answered at present.
Adult↗
[Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases. 8th communication: Relationship of coronary atherosclerosis and myocardial infarction (author's transl)].
The autopsy reports of the Pathological Institute Erfurt of the period from 1.1.1951 until 31.12.1969 were scored for cases of coronary atherosclerosis and myocardial infarction and analysed concerning frequency and distribution of age and sex, resp. In 89.05 per cent (2131 cases) of all myocardial infarctions a coronary sclerosis was present. Males suffered significantly more frequent from these forms of ischaemic heart disease. During the period of nineteen years a significant increase of the coronary atherosclerosis in combination with a myocardial infarction was observed. This is due to the more frequent occurrence of severe forms. The increase of the frequency of the myocardial infarctions and of the weak and moderately coronary sclerosis particularly concerns the younger age groups. Callous infarcts were more frequent than fresh and relapsing ones.
Adolescent↗
[Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases. 9th communication: relationship of coronary thrombosis and myocardial infarction (author's transl)].
The autopsy reports of the Pathological Institute Erfurt of the period from 1.1.1951 until 31.12.1969 were scored for cases of myocardial infarction and coronary thrombosis. Among 2,393 morphologically analysed myocardial infarctions 454 coronary thromboses (18.97 per cent) were found. Males were significantly more affected than females. Fresh infarcts showed significantly more thromboses than callous infarcts. We found fresh and occluding vessel thromboses more frequently in fresh infarctions. The analysis of age distribution yielded an increase of the rate of thrombosis in cases with myocardial infarction. On the other hand, the frequency of infarctions in cases with a coronary thrombosis was decreasing. It is suggested that the risk for infarctions is larger in younger people with coronary thrombosis than in older ones. No infarctions were detected in 165 cases of thrombosis. Preferably this group includes those cases in which the patients deceased within 6 to 8 hours and, therefore, the infarction was not morphologically detectable.
Adult↗
[Clinico-endoscopic problems in malignant changes of the gastric stump].
The authors give a report on occasional difficulties concerning the radiological and endoscopic clarification of the malignant changes at the gastric stump after treatment of resection. Four relevant cases are stated and explained. The endoscopy (glass fibre gastroscopy) together with the biopsy is at present the most reliable method for the diagnosis of the pathological processes in the remaining part of the stomach. A regular endoscopic and radiological control of patients with gastric resection is desirable.
Female↗
[Paraneoplastic hypoglycemia due to malignant histiocytoma (Doege-Potter syndrome) (author's transl)].
A case report is given on a male patient who was 52 years old when he died. 9 years ago a nephrectomy was performed because of a densely-packed mesenchymal tumor of the adipose tissue of the pelvis renalis. 7 years after the surgical intervention he suffered from several hypoglycemic crises. An operation was performed, and 2 large tumor nodes were removed from the greater omentum. A retroperitoneal relapse was inoperable. Nevertheless, the disorder of the carbohydrate metabolism disappeared after the operation. At the autopsy, one year later, a large retroperitoneal tumor with metastases in the lymph nodes was found. The neoplastic growth was classified as a malignant histiocytoma, and the hyperglycemia was taken as a paraneoplastic syndrome (Doege-Potter).
Histiocytoma, Benign Fibrous↗
[Myocardial infarctions without stenosing artery selerosis of thrombosis ofthe coronary arteries (author's transl)].
At autopsies between 1951 and 1969, 246 of 2393 cases with myocardial infarctions and heart muscle scars showed no thrombi and no artery sclerosis to be worth mentioning. The 7 comprehensive morphologically investigated observations of a second case group were discovered in a prospective study from 1970 to 1973. This study included 255 cases with myocardial infarctions or heart muscle scars. Comparatively to the investigations with sclerosis of the coronary arteries, myocardial infarctions without occlusive coronary disease were stated more frequent in woman than in men. Furthermore, more young people were affected from these infarctions. In 3 of 7 cases without sclerosis or thrombosis of the coronary arteries the infarctions were located more frequent subendocardial that in these cases with coronary sclerosis or thrombosis. Respectively to the size the 246 infarctions of the first group, they did not differ from those taken in a respecting group of 2147 cardiac infarctions with stenosing processes of the coronary arteries. Infarctions without sclerosis or thrombosis of the coronary arteries were located more frequently in the ventricular septum and in the wall of the right ventricle. For these infarctions a coincidenceof several, separate not relevant factors in supposed to be the cause. Theinfarctions without stenosing processes of the coronary arteries occupy insome respects an exceptional position, but on principle they do not differ in the morphological findings from the other myocardial infarctions.
Adult↗
[Methods of induction of a coronary thrombosis by means of direct current in the closed dog and dwarf swine thorax].
Coronary thrombosis is a perilous disease. Animal experiments may contribute to investigate its pathogenesis and treatment. The development of an experimental model of coronary thrombosis on closed thorax is important. In this report the methodics of such model is entered into, pointing at its dangers and possible complications.
Animals↗
[Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases. VII. Communication: Complications in myocardial infarctions (author's transl)].
2393 cases of myocardial infarctions autopsied during the period from 1.1. 1951 until 31. 12. 1969 in our Institute were scored for aneurysm and rupture of the cardiac wall as well as for partietal thrombosis and endocardial fibrosis, and analysed concerning frequency and distribution of sex. Aneurysm of the ventricle walls was present in 23.94 per cent of myocardial infarctions. Most of the aneurysms were found in the posterior wall of the left ventricle. Callous infarctions showed more aneurysms than fresh myocardial lesions. A rupture was present in 31.82 per cent of acute aneurysms and in 4.53 per cent of old aneurysms. Parietal thromboses we found in 13.92 per cent of all infarctions. In 14.21 per cent of all myocardial infarctions endocardial fibroses were present. Parietal thromboses and endocardial fibroses were significantly most frequent in infarctions of the right ventricle.
Acute Disease↗
[Coronary thrombosis in the viewpoint of experimental research].
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Coronary Disease↗
[Coronary atherosclerosis, coronary thrombosis and myocardial in autopsy cases. Statistical studies. 3rd communication: relationship of coronary atherosclerosis of other arteries (author's transl)].
28978 autopsy reports of young (after the 14th year of age) and adult patients autopsied during the period of 1.1 1951 until 31. 12. 1969 were scored for atherosclerotic changes of the aorta and other arteries. The association of changes of these vessels and coronary sclerosis was studied. All groups of atherosclerotic changes showed an increase during the observation period. The cases with sclerotic changes of the aorta and the other arteries also showed an increase, especially those in combination with severe coronary sclerosis. 6.15 per cent of all cases showed a coronary sclerosis without further lesions of other vessels. Corresponding to the results of other authors we observed that in cases of atherosclerotic changes of several arteries mostly a atherosclerosis of all other vessels has to be taken into account.
Adolescent↗
[Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases. 4th communication: coronary thrombosis (author's transl)].
28978 cases of young (after the 14th year of age) and adult patients autopsied during the period from 1.1 1951 until 31. 12. 1969 in our Institute were scored for coronary thrombosis and analysed concerning frequency and distribution of age and sex, resp. In this material the evidence of morphological changes was proved by longitudinal dissection of the coronary vessels. We analysed the age of thrombi, the localization and the grading of coronary vessels occlusions. Coronary thrombi were found in 2,31 per cent of all autopsies (2,81 per cent in males,1,31 per cent in females). Coronary thromboses showed an increase during the observation period. These thrombi were found more frequently in younger patients. Most of the thrombi (62,20 per cent) were localized in the Arteria coronaria sinistra, 37,80 per cent we found in the Arteria coronaria dextra. Fresh thrombi (57,51 per cent) and those being in organization (42,49 per cent) were not significantly different. Obturating thromboses showed an increase. The numbers of non-obturating thromboses decreased during the observation period. Our findings correspond to similar results published in literature.
Adolescent↗
[Coronary artherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases (author's transl)].
The autopsy reports of the Pathological Institute Erfurt of the period from 1.1. 1951 untile 31.12. 1969 were scored for cases of coronary sclerosis and coronary thrombosis and analysed concerning frequency and distribution of age and sex, resp. In 3.97 per cent of all autopsies (4.93 per cent of men, 2.62 per cent of women) a coronary sclerosis was present in combination with a coronary thrombosis. Coronary thrombi appeared more frequent in severe coronary sclerosis (8.96%) than in weak or moderately severe coronary sclerosis (1.39%). Males suffered significantly more frequent from these forms of icaemic heart disease. Coronary thrombi were found more frequently in the left coronary artery (2.46%) than in the right coronary (1.51%). This difference was significant. Non obturating thromboses were more frequent than obturating ones and those being in organization were rarer than fresh thromboses. In all cases a decrease of the relative frequency of the coronary thrombosis with increasing age in men and women is detected.
Adolescent↗
[Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases (author's transl)].
The autopsy reports of the Pathological Institute Erfurt of the period from 1. 1. 1951 until 31. 12. 1969 were scored for cases of myocardial infarction which were analyed concerning frequency and distribution of age, and sex, resp. The informations were transferred to punched cards and processed with electronic data equipment. In 8.26 per cent of all autopsies (males 10.32 per cent, femals 5.78 per cent) a myocardial infarction was present. During the period of nineteen years a significant increase of the myocardial infarctions was observed. Callous infarcts were more frequent than fresh and relapsing. Most of the infarcts were found in the posterior wall of the left ventricle.
Adolescent↗