Biomedical subjects
Publications and source records attributed to J M Vetters.
A 70 year old man is described in whom the presence of a cryoglobulin caused a number of unusual laboratory features which were not recognized as being due to a cryoglobulin initially. Pseudoleucocytosis has been recognized in the past. However, the intracytoplasmic inclusion bodies have only rarely been described. The curious appearance of the ESR has not previously been described.
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A 39 year-old patient with cholangiocarcinoma and pre-existing ulcerative colitis was successfully treated by orthotopic liver transplantation. He was given low doses of prednisone and azathioprine and survived for more than 9 months, dying with tumour metastases, thrombosis of the inferior vena cava and an intra-abdominal abscess. At autopsy the homograft showed little evidence of rejection. Preoperatively the patient had septicemia. Removal of his liver was difficult. The discrepancy between donor and recipient in size of blood vessels and the presence of two hepatic arteries in the donor caused problems during the vascular anastomoses. During the operation cardiac arrest occurred. Postoperatively there were several medical and surgical problems, including intraperitoneal and gastrointestinal hemorrhage, paralysis of the right dome of the diaphragm, sinus bradycardia, massive diuresis, peroneal nerve palsy, and one major and three minor episodes of rejection, which were reversed by giving pulse doses of methylprednisolone intravenously.
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An electron microscopic study of a variety of skin diseases has demonstrated microtubular 'inclusions' in vascular endothelium in bullous pemphigoid for the first time. The 'inclusions' are similar to those originally reported in lupus erythematosus by Fresco (1968) and presently being detected in an increasing number and variety of pathological processes.
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Fifty-four thymus glands removed surgically from patients with myasthenia gravis were examined using an accurate morphometric technique and the data compared with the response to thymectomy. There is a tendency for patients with relatively unreactive thymus glands to obtain a better result from thymectomy but this is not statistically significant.
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The epithelial cells of the Hassall's corpuscles in 11 human thymus glands (nine cases of myasthenia gravis and two glands from patients undergoing surgical correction of congenital heart disease) have been examined by electron microscopy. In every instance the epithelial cells have the cytoplasmic organelle complex necessary for ;export'-type secretory activity and in addition contain large numbers of membrane-limited small spheroidal secretion granules.Hassall's corpuscles are avascular anatomical units and a pericorpuscular zone, at least 50 mum broad, is also without blood vessels. It is therefore suggested that the secretory product(s) of the corpuscular epithelial cells has a purely intrathymic function.
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An epidermoid type of thymoma from an asymptomatic 39-year-old male subject is described. Electron microscopy demonstrated endocrine type secretory granules within the tumour cells, and a minority of these granules resembled normal human pancreatic alpha cell granules. Fine structural evidence for endocrine secretory activity in a primary thymic tumour has not been previously described. There are few fine structural reports of primary thymic tumours in man and to our knowledge these do not include certain features of the case described here.