Biomedical subjects
Publications and source records attributed to P Stömmer.
Myiasis is a rare disease in Europe and the USA; it is defined by the development of parasitic, mostly tropical maggots in the human body. They are best identified by the pattern of their terminal spiracles and the shape of their stigmal plates. In spite of the size of the larvae of Cordylobia anthropophaga, there is only low-grade inflammation; the clinical course is benign.
Ten cases of the rare solid and cystic pancreatic tumors are presented. All except one occurred in young women (mean age, 25 +/- 9.2 years). The large neoplasms were evenly distributed across the pancreas; in one case, metastasis occurred; all other cases were free from disease after complete resection. Histologic hallmarks of solid and cystic neoplasms were papillary growth, large intracytoplasmic granules, and immunoreactivity with alpha 1-antitrypsin, alpha 1-antichymotrypsin, phospholipase A2, and neuroendocrine markers (neuron-specific enolase [NSE], synaptophysin). This suggests both endocrine as well as exocrine differentiation.
For many years a 52-year-old patient suffering from duodenal ulcer had taken a silver-containing preparation, the total quantity of silver ingested in this manner amounting to about 35 g. 18 years after the first manifestation of duodenal ulcer a dermatologist diagnosed argyria and confirmed this by biopsy. After acute coronary failure with marked nicotine abuse autopsy revealed granulated deposits of silver in the corium, particularly on elastic fibres, at the sweat glands, sebaceous glands and hair follicles. There were no deposits in the epidermis. Dense silver deposits were also seen in the walls of most of the blood vessels, in the basal membranes of the renal glomeruli, of the choroid plexus and of the seminiferous tubules, as well as in the portal fields. Definite intracellular deposits occurred in macrophages only. The metal was found only rarely in epithelial basal membranes. Generalised argyria does not entail any pathological implications and is considered to be intractable.
This paper reports on the new combined examination of peroral transpapillary fine-caliber endoscopy (miniscope 0.5 mm in diameter) with mini-biopsy of the pancreatic duct in 10 patients and 19 surgical pancreas resection preparations. With this technique, endoscopic-retrograde inspection of the whole length of the pancreatic duct is possible without the need for papillotomy. In the case of pancreatic duct changes due to carcinoma of the pancreas, and chronic pancreatitis, the ductal lesions can be inspected. Furthermore, with the aid of a new mini-biopsy forceps (1.5 mm in diameter), material for histological evaluation can be much more efficiently obtained than was normally possible with conventional biopsy forceps (2.2 mm). This new endoscopic-bioptic technique promises to improve the diagnostic reliability in pancreatic duct lesions requiring clarification.
A special variety of pancreatic cancer is characterized by a predominant intraductal proliferation with a low-grade proliferation rate. Immunohistochemical peculiarities and the lack of lymph node metastases despite an extended tumor, distinguish it from usual ductal pancreatic carcinoma. Adenocarcinoma of the pancreas with a predominant intraductal component is proposed for its classification.
Phospholipase A2 is an enzyme which is produced in acinar cells, and persists even in regressive states of chronic pancreatitis, when the production of other enzymes diminishes. We therefore tested this enzyme as a marker of acinar descent in various pancreatic tumors. This enzyme could be seen in 50% of the acinar-cell carcinomas, in 60% of solid and papillary pancreatic tumors, and in 50% of microglandular carcinomas. Ductal cancers and isletcell cancers were negative. In contrast to other markers of acinar matrix (amylase, antitrypsin), phospholipase A2 gave fewer false-positive or false-negative results.
Phospholipase A2, injected as a bolus into the jugular vein of adult male Wistar rats was investigated with respect to its action upon lung morphology and blood- plasma- histamine. In comparison with the injection of saline, phospholipase A2 causes hyperemia of the lungs, sequestration of granulocytes and intraalveolar pulmonary edema; the histamine level is increased to the sixfold. Pretreatment of the animals with indomethacin diminishes the toxic effect of phospholipase A2 upon the lungs and the histamine level.
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Newly developed endoscopes make it possible to inspect the major papilla, the pancreatic and choledochal ducts without previous papillotomy. First results of this new method in surgical specimens and patients are presented. Ductal dilatations, and irregularities as well as secretion plugs and calcifications are characteristic phenomenons of chronic pancreatitis; the diagnosis of a malignant pancreatic tumour can be made by observing an irregular compression of the pancreatic duct and the infiltration of its wall. Perhaps by this method precursors of ductal pancreatic cancer will be recognized. We assume that ERCP will be supported by this method.
In two males with AIDS, aged 26 and 39 years, who had disseminated Kaposi's sarcoma, massive pericardial effusion with tamponade (confirmed by echocardiography) developed in the final stages. Multiple pericardial taps, of up to two litres, of serous fluid yielded no malignant cells or pathogens cytologically or microbiologically. At autopsy the finding was of cytomegalovirus and cryptococcus septicaemia, respectively, and generalized Kaposi's sarcoma with infiltration of the heart along the great vessels and subepicardially along the coronary vessels. The pericardial sac was distended balloon-like with 800 ml sanguinous fluid (in both cases). Histological examination did not demonstrate cytomegalic inclusion bodies or fungal granulomas in cardiac tissue. The pericardial effusion was probably due to tumour spread in the lymph channels and along the vasa vasorum.
This report describes a newly available endoscopic system, the purpose of which is to inspect the common bile duct, gallbladder, cystic duct and the pancreatic duct with the aid of retrograde endoscopy. A miniscope examination of the gallbladder was carried out in eight out of ten autopsy specimens, and the entire pancreatic duct was inspected in nine out of ten specimens after successful transpapillary catheterisation. The procedure described in this paper opens up a new diagnostic and therapeutic approach to the gallbladder, biliary tree and the pancreatic duct.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Pulmonary damage in acute tryptic pancreatitis is frequently a main contributory factor in death. Morphology shows a toxic pneumonosis with a course in stages. Various pathogenetic mechanisms may contribute towards its occurrence. Similar to the acute tryptic pancreatitis in the pancreas proper the pancreatitis-induced adult respiratory distress syndrome (ARDS) is probably not caused by a single enzyme or its reaction products but by a summation effect, i.e. the "concert of pancreatic enzymes".
The acute abdominal form of Wilsons's disease was observed in three female patients aged 17, 18 and 30 years. Clinically uncharacteristic general symptoms and jaundice were dominant. Chemical pathology showed high bilirubin values with predominance of direct bilirubin, signs of hepatic and renal insufficiency and haemolytic anaemia. There were no neurologic symptoms and the Kayser-Fleischer ring was absent. Coeruloplasmin in blood was normal, copper concentration in blood and urine was clearly increased. Diagnosis of Wilsons's disease could only be established at post mortem by quantitative copper estimation in liver tissue. The patients succumbed 1--4 weeks after onset of symptoms through hepatic failure.