Biomedical subjects
Publications and source records attributed to W Schlake.
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Five cases of granulomatous orchitis are reported and the literature is reviewed. The clinical features, pathology and treatment of this rare disease are discussed. In four cases the clinical features were chronic, while one patient had an acute course. The average age of the five patients was 31 years. In all cases we found only one testes was affected. In two cases the affected testis was removed, and in the remaining three cases only partial orchiectomy was performed.
The diagnosis of Jakob-Creutzfeld disease was made in two women (aged 59 and 76 years) whose course was marked by rapidly progressing signs of dementia, myoclonus and rhythmic bi- and tri-phasic steep waves in the EEG. The diagnoses were confirmed neuropathologically at autopsy. Since the disease is transmissible, precautions must be taken if the disease is suspected: wearing of disposable gloves, disinfection of instruments by one-hour autoclaving at 121 degrees C, disinfection of potentially contaminated surfaces with 5% sodium hypochlorite, and avoidance of skin cuts or punctures by instruments or syringes.
Nowadays the resected stomach is considered to be in a precancerous state in the broader sense. Until now there have been no systematic, histoautoradiographic investigations concerning the proliferative kinetics of the resected stomach in the region of anastomosed mucosa sections. Histoautoradiographic investigations should give an answer to the following questions: 1. In which way do the proliferative kinetics of gastric mucosa in the part of the anastomosis change with increasing postoperative interval? 2. Is there a result of variations in the proliferative kinetics of the anastomotic distant mucosa of the fundus? To find an answer to these questions, 75 Wistar-rats out of 231 operated rats (Billroth's 1st principle) were selected for histoautographic analysis. The laboratory animals were killed at fixed points of time in a postoperative interval of 104 weeks of experiment and the gastrointestinal preparations were worked up and interpreted for the histoautographic analysis. During the postoperative period the 3H-labelling-indices showed a characteristic course in the part of the gastric anastomosis. After a continuous increase of the 3H-labelling indices up to the fourfold of standard values two years after the operation there was a slight decrease of the proliferative activity. But it still remained twice the normal value. In addition, extended displacements and decompositions of gastric anastomosis mucosa could be observed. However, the proliferative activity in the anastomotid distant mucosa remained unchanged. A cell proliferation of gastric anastomosis increasing considerably and demonstrated in our experiment has to be considered as promotion factor of cancer development. Anastomotic carcinomas developing during the total experiment give evidence for this.
In a postoperative interval of 104 weeks' experience with 75 Wistar rats resected according to Billroth's 1st principle, the fourfold of standard of proliferative activity in addition to extended displacements and decompositions could be demonstrated. During 104 weeks of experience 8 animals developed in the anastomosed mucosa section adenomatous cystic glandular proliferations, 5 animals anastomotic polypi, 16 animals dysplastic gland areas and 10 animals showed anastomotic carcinomas. For these pathologic-anatomically outlined changes cellular proliferation was analysed by histoautoradiographic methods in parts of highest mitotic activity. The results were interpreted in dependence on their postoperative interval. In all pathologic-anatomical changes sources of strongest labelling could be found in the periphery. As most serious complication rats in experiment developed carcinoma in the anastomosed parts of mucosa. The peripheral sections of the carcinoma, so-called "front of invasion", showed regions of highest mitotic activity. Analysis of histoautoradiographic investigation in pathologic-anatomical change revealed modified proliferation kinetics in the sense of highly increased cell proliferation rates, which refer to the important role of the anastomotic region in the resected stomach.
The results of the occlusion of renal tumors by two different materials-Ethibloc (n = 26) and absolute alcohol (n = 72) are being compared. The kidneys were occluded under equal clinical conditions. The clinical symptoms following embolisation are fewer in the group of alcohol embolized patients than in the group with Ethibloc. On the capillary level, the histological reaction to alcohol corresponds to a histotoxic alteration. This reaction goes beyond the reactive inflammation of the tissue observed after Ethibloc. This intensified reaction of the tissue after alcohol application partially explains the advantage of a fractionated application of alcohol during tumor embolisation.
We report on two brothers and an unrelated girl with congenital muscular dystrophy (CMD), brain malformation and ocular changes (strabismus, myopia, glaucoma, cataracts, retinal dystrophy). Correlations with the inherited autosomal recessive syndromes of CMD, including the Fukuyama-type CMD with CNS malformation, and the Muscle, Eye and Brain Disease published by Santavuori are discussed.
The cytogenesis of giant cell tumors of bone was studied in 6 cases by combined electron microscopical, histochemical and autoradiographical investigations. Electron microscopy identified two different types of mononuclear stromal cells: fibroblast-like cells with spindly shape and numerous membranes of the granular ER occur together with macrophages bearing many large lysosomes and a prominent Golgi apparatus. Enzyme histochemical results reflect the same diversity: One portion of mononuclear cells exhibits strong alpha-naphthyl acetate esterase (ANAE) activity, known as a marker for cells of the mononuclear phagocyte system, while the other, fibroblast-like cell type is ANAE negative. Tumor giant cells contain numerous membranes of granular ER, mitochondria, and a few isolated lysosomes. They lack the typical brush border of osteoclasts. Moderate to strong ANAE activity of these giant cells reflects their belonging to the mononuclear phagocyte system. Consequently, the giant cell tumor of bone consists of two different cell types, i.e. fibroblast-like cells and cells of the mononuclear phagocyte system, and so is appraised as a fibrohistiocytic tumor. A new inference from our autoradiographic findings is that tritiated thymidine is incorporated only by mononuclear cells, but not by giant cells. Electron microscopical autoradiography demonstrated that among the mononuclear cells, only fibroblasts are found to proliferate, but not macrophages. Thus, the giant cell tumor of bone is seen as a neoplasm of fibroblastic cells with a strong reactive infiltration of cells from the mononuclear phagocyte system.
Fourty-four patients with angiographically verified malignant renal tumors underwent a complete or selective embolisation of the affected kidney with absolute alcohol. The occlusion is effected by slow infusion of absolute alcohol. The technique is supported by animal experiments. The quantity of alcohol applied is measured by its intracorporal spread. The method of slow infusion is compared to other published embolisation techniques using absolute alcohol. This method allows an individual application of the vascular occlusion of the tumor supplying and the normal tissue supplying vessels, depending on size and localisation of the tumor, and further clinical data.
Twelve osteosarcomas treated according to the COSS 80 protocol (preoperative chemotherapy, resection) were studied by light and electron microscopic, histochemical, and autoradiographic methods. Evidence of regressive and necrotic changes was found in many tumor cells, but the alterations were unspecific. Viable tumor cells of high malignancy were also observed regularly, often at the S phase. As the tumor regression continued, a strong reaction of the mononuclear phagocyte system was manifested by the presence of macrophages and giant cells.
An ideal classification of malignant tumors should imply not only the histogenesis of the tumor and adequate reproducibility of its specific characteristics by other investigators, but also an exact definition of the stages of tumor development to facilitate prognostic prediction. The present paper proposes a classification of gastric carcinoma with emphasis on the initial stages of malignant transformation. The classification is based on the analysis of early invasive gastric cancer observed in biopsy material from the Institute of Pathology of Münster University. Since 1974, all cases of severe dysplasia or early gastric cancer were selected from a total of 200,000 gastric biopsies and more than 1500 gastric resections, and subjected to special work-up. In analogy to Clark's classification of malignant melanoma (Clark et al., 1969) the proposed classification defines consecutive stages of development in gastric carcinoma with special regard on the maximum depth of invasion and vertical thickness of the tumor, together with its histologic type and the predominant direction of tumor spread.
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In a female patient with histiologically ensured histiocytosis X, cell cultures modified according to NEZELOF were performed in methylcellulosis and Eagle's medium. From the 5th to the 15th day of incubation the cells were daily observed natively through a normal microscope and taken for histochemical examinations and for checking their capacity of phagocytosis. Two cell types could be distinguished: spindle-shaped fibroblasts as well as round cells of changing form and size, the alpha-naphthylacetate esterase response of which proved to be positive. The round cells can partly be regarded as HK cells, whereas giant cells could be predominantly observed during the second week. A phagocytosis of iron chips and human erythrocytes loaded with antibodies could be revealed in both types. HK cells represented mature macrophages, from which giant cells developed under in vitro conditions. There is still not explanation as to the local and immunological factors characterizing the clinical picture of histiocytosis X.
Aortas with coarctation (isthmus stenosis) are obviously an ideal model to investigate pressure dependent changes of the aorta, as one can compare the proximal region (high pressure) with the distal region (low pressure). 7 aortas of patients aged from 2 months to 54 years were investigated. The concentrations of Na, Mg, P, S, C1, K, and Ca were determined by electronprobe microanalysis. Ca and P are constituent parts of the developing mineral and are mainly discussed. The Ca/P ratio (by weight) is about 0.3 in the unmineralized and about 2 in the mineralized tissue. Mineralization is demonstrated by a parallel increase of Ca, P, and the Ca/P ratio. Enrichments of Ca and P are found above all in a subintimal band. Usually they occur proximally and distally, but are much more pronounced proximally. Even in the aorta of a 2 month old infant enrichments were found proximally, but not distally. Thus mineral deposits occur very early in regions of hypertension. The differences between the proximal and distal region may demonstrate the influence of blood pressure on vascular mineralization. The mineralization starts in small compartments, which increase in size and number in the process of mineralization. Mineralized regions could often be localized by cathodoluminescence. But to demonstrate and localize the initial mineral deposits and to quantify element contents, electronprobe microanalysis became indispensable.
Aortas with isthmus stenosis (coarctation) can be regarded as a model for those changes of the vessel wall, that depend on blood pressure, as one can compare the proximal region (high pressure) with the distal one (low pressure). The Na, Mg, P, S, Cl, K, and Ca content of the vessel walls of 5 patients (age: 2 months to 34 years) were determined by electron probe microanalysis. We have used cryostat sections and measured the element concentrations from the lumen to the outer media. In this paper we discuss especially the measurements of Ca and P, as the mineral being deposited in the vessel wall, e.g. in arteriosclerosis, contains Ca and P. Up to 18 years Ca and P enrichments are found only in a subintimal band parallel to the lumen. The proximal region of the aorta of a 34 years old patient, however, demonstrated Ca and P enrichments in the whole media with a high peak in the subintimal band. The enrichments are proximally always higher than distally. Only in the distal region of the 2 months old infant no Ca or P enrichments were found, but they appeared proximally. Thus high blood pressure causes an enrichment of Ca and P in a subintimal band very rapidly and promotes the mineralization of the vessel wall. The quantitative electron probe microanalysis demonstrated these pathological alterations.
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The case of a 41 year old patient with primary adenocarcinoma of bartholin's gland is reported. The adenocarcinoma was a cylindroma. A radical vulvectomy without post-operative radiation was performed. In the world literature around 200 cases of carcinoma of bartholin's gland are reported. The problems of diagnosis, microscopic classifications and adequate therapy and prognosis are discussed. Carcinoma of bartholin's gland is often recognized late. A cytologic smear for cancer in the treatment of inflammatory diseases of bartholin's gland is indicated. The five cases of carcinoma of bartholin's gland during pregnancy were treated by Caesarean section and thereafter radical vulvectomy. The left bartholin's gland is much more often the site, of the carcinoma that the right. Concomittant carcinoma of both bartholin's gland has as yet not been reported.
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