[Cardiotoxic effect of the tocolytic agent fenoterol (partusisten) in the neonate (author's transl)]

Forty-two children of mothers treated with beta-adrenergic drugs were investigated cardiologically during a period of 3 1/2 years. Eleven neonates were seen to suffer from severe toxic myocardiopathy associated with heart failure. The mothers had in part been given excessive fenoterol doses for 13 weeks on the average. One child died of regressive myocardial alterations as confirmed by autopsy. Suspicion of toxic myocardiopathy was suggested in another 16 children. Related to the very large number of mothers treated with tocolytic agents, fenoterol-induced myocardiopathy so far appears to be rare. In agreement with other reports, however, our observations suggest the possibility of severe, even perilous myocardial damage. Therefore, the indication and dosage of fenoterol should be subjected to more rigid criteria than so far applied.

[Angiographic and morphological findings in testis tumors (author's transl)]

The arterial supply of testicular tumors is compared to that of normal testes. Data were collected from comparative angiographic and morphologic studies of 21 surgical and autopsy specimens. The arterial vascularization of seminomas is rather poorly developed, newly formed vessels show only minor differences of caliber. Non-seminomatous testicular tumors show a strongly irregular pattern of arterial branching with bends, variations of caliber, irregular contours, completely avascular areas, and extravasation of contrast medium. Depending on the size of tumors, the original testicular arteries are displaced and compressed more or less strongly. Angiographic findings are correlated with morphologic finding. The relevance of different patterns of vascularization for therapeutic considerations is discussed.

Activity of isoenzyme A and N-acetyl-beta-glucosaminidase in fibrotic liver tissue

Isoenzymes of N-acetyl-beta-glucosaminidase were separated in the supernatant of 72 homogenized normal and fibrotic human liver. Patterns of isoenzymes were obtained by electrofocusing in thin layers of polyacrylamide gel. The activity of mesenchymal reaction in the liver tissue was determined by histological examination. The distribution of N-acetyl-beta-glucosaminidase isoenzymes was compared with the mesenchymal activity in the liver tissue. The results show a good correlation of isoenzyme A activity with mesenchymal activity.

Rupture of the aortic wall with compression of bronchial arteries

A case of closed traumatic rupture of the aortic wall with compression of the bronchial arteries is described. No comparable case has been reported in the literature so far. The effect on pulmonary perfusion and gas exchange is demonstrated. The compression, displacement and transportation of the bronchial arteries (vasa privata) is shown is postmortem angiography.

[Problems in the histological classification of bronchial carcinomas]

Different histological classifications of pulmonary tumors, proposed and adopted over the last five decades, are briefly reviewed. Referring to the revised Histological Classification of Lung Tumors that was edited by an international committee of lung pathologists for WHO in 1977, different histologic types of bronchus carcinoma are presented in separate groups. Squamous carcinoma, small cell carcinoma, adenocarcinoma, and large cell carcinoma are differentiated in supra- and subgroups. Specific problems arising in the classification of mixed or combined tumors manifesting coexistence of different histologic growth types in the same tumor, are discussed in detail.

Dendriform pulmonary ossification

Four cases of dendriform pulmonary ossification are reported from postmortem roentgenography of isolated lungs. All showed pathoanatomical evidence of chronic fibrosing, mostly interstitial, rarely intraalveolar pneumonia, besides the typical manifestations of dendriform pulmonary ossification. Microscopy revealed fluid transition from proliferating, interstitially increased connective tissue to fully developed osseous structures. These dendriform structures can be seen in some analogy to the structural pattern of interstitial, bronchovascular as well as septal connective tissue; however, actual topographical correlation between bone structures and blood or lymph vessels could not be safely determined. Our observations suggest that dendriform pulmonary ossification may be interpreted as a rare complication, or special manifestation, of chronic fibrosing interstitial inflammation of the lung.

[Tissue artefacts by the use of overheated forceps for paraffin embedding (author's transl)]

Histologic work-up of tissue specimens, especially from endoscopic biopsies, requires the use of fine forceps for orientation and dressing in fluid paraffin during the embedding procedure. These forceps are usually preheated over an open flame. If, however, smaller tissue particles are handled with overheated forceps, arteficial alterations may occur which are apt to hamper or falsify the histologic evaluation of the prepared section. Some typical tissue artefacts due to the handling with overheated forceps, are demonstrated with slides from liver biopsies. Recent experiences with an auxiliary instrument for paraffin embedding (Histostat of Vogel, designed by Ciplea) are reported. The forceps are kept at stable temperatures by immersion in fluid paraffin during the embedding procedure, thus excluding almost completely the risk of tissue artefacts by handling with overheated forceps.

Smoking habits and their relationship to precancerous lesions of the larynx

Histologic findings in vocal cord specimens of 148 male autopsy cases (ages 15--91) were compared to a retrospective anamnesis of smoking habits. The relative frequency of normal squamous epithelium is 83.3% in nonsmokers, gradually decreasing from 56.3% in light to 45.8% in moderate, and finally 30.6% in heavy smokers. Ex-smokers were found to return to approximately the level of light smokers (54.2%). Precancerous lesions (dysplasia and carcinoma in situ) and carcinoma were found at lowest rates in non-smokers (4.2%) rising accordingly from 12.5% in light to 22.9% in moderate, and to 47.2% in heavy smokers, and returning to the level of light smokers (12.5%) in ex-smokers. Rates of relative frequency were rather similar, if less drastic, for hyperplastic and parakeratotic or keratinizing epithelial changes. The evaluation of lifetime tobacco consumption correlated to histologic findings in individual cases revealed an analogous pattern. Results suggest a very clear relationship between changes of vocal cord epithelia, and the quantities of tobacco consumed over a lifetime. They provide additional arguments in favor of the term "dysplasia" which, currently used to define precancerous lesions in various organs, may be suitably adopted for the morphological classification of precancerous changes of vocal cord epithelium.

Radiological and histological findings of the lacrimal passages of newborns

By means of postmortem dacryocystograms and photomicrographs of histological slides, the topography and morphology of the lacrimal passages in premature and mature newborn infants are demonstrated. Because of the bends in the course of the lower tear duct, a percentage of probings will fail to effect satisfactory perforation of Hasner's membrane. In most cases the soft texture of this membrane requires no more than syringing under pressure using a hollow probe.

[Preneoplasms of the bronchial system in smokers and nonsmokers (author's transl)]

Parallel to the rapidly rising frequency of bronchial carcinoma with almost 27,000 deaths in 1978, preneoplasms of the bronchial system are now almost daily observations for the pathologist. The question of cancerous prestages of the bronchial mucosa is closely coupled with the histogenesis of malignant neoplasms. Besides epithelial anomalies such as basal cell hyperplasia and squamous epithelial metaplasias, precancerous epithelial dysplasias of Grades I to III and carcinoma in situ must be differentiated. According to the results of extensive histological investigation connections between smoking, smoking habits and carcinogenic constituents in the condensate of cigarettes on the one hand and both frequency and severity of preneoplastic and neoplastic changes in the bronchial system on the other are well known.

[Clinical symptoms and morphology of ischemic proctitis (author's transl)]

Obliterating arteriosclerotic lesions of pelvic vessels may induce inflammation and fibrosis of the rectum and subsequently ischemic proctitis. This may lead to damage of the sphincter muscle and to complete incontinence. Clinical symptoms are pain and bloody stools, as in ischemic colitis. The combination of periproctitis and perianal necrosis may be misinterpreted as anal fistulas. An anus praeter sigmoideus is to be recommended for palliation. A case report of this particular disease is given including clinical, angiographic and morphological data.

[Boeck's disease with spinal involvement and retroperitoneal fibrosis]

Sarcoidosis (Morbus Boeck) is a frequently found disease of the reticulohistiocytic system. Etiology and pathogenesis were mostly unknown until today. Histologic study of sarcoidosis shown granuloma with epitheloid cells similar to tuberculosis, often with hyalinization but without cheesy necrosis. The disease mostly starts with a mediastinal and cervical lymphadenopathy. Radiographically, the disease shows three typical stages when spreading to the lungs. Bone involvement in lymphomas, especially vertebral involvement, is found to be rare. A case with an additional retroperitoneal fibrosis is reported from our own hospital.

Fatal pneumopathy after cytostatic treatment for leukemia in children

Two cases of fatal pneumopathy during cytostatic therapy for acute lymphatic leukemia of childhood, are reported with pathoanatomical lung findings and general clinical features. Histology revealed massed atypical epithelial proliferation in the bronchiolar terminal pathways (tumourlets) with multinucleated polymorphic giant cells beside pulmonary fibrosis. As causative factors for pulmonary chages hypersensitivity reactions, direct toxicity, or pharmacologic effects are discussed. Formal pathogenesis is explained by an impairment of endothelial cells in alveolar capillaries followed by permeability disorders and interstitial edema with disturbed perfusion. Disseminated intravasal microthrombi are frequent. Restitution to integrity appears possible only under favorable conditions. If the exsudative turns into the proliferative phase, intraalveolar and interstitial pulmonary fibrosis may develop with atypical epithelial proliferations. The prognosis of cytostatics-induced pneumopathies depends essentially on the time when it is diagnosied.

[Surgical management of incontinence in rectal constipation (author's transl)]

In rectal constipation chronic filling of the rectum with feces will cause continuous rectal dilatation, a permanent stimulus for defecation and finally rectal incontinence. Reduction of rectal volume and perfect continence may be achieved in these cases by surgical removal of part of the elongated colon; thus surgery may have its place as an alternative to medical treatment of this disease. Patients with rectal constipation do not have an aganglionic segment of the colon, as is the case in Hirschsprung's disease; the dilated part of the colon is characterized on the contrary by hypertrophic intestinal wall.

[Angiopathy in a case of primary oxalosis combined with familial spherocytosis (author's transl)]

An 18-year-old female with primary oxalosis, seen first when she was in advanced renal failure, developed a severe necrotizing angiopathy which began after a rapid decrease in renal function requiring chronic dialysis. Because of the severe angiopathy the preliminary diagnosis of an acute autoimmune vasculitis had been made. The correct diagnosis was revealed by renal biopsy and a renal transplantation performed. Soon after severe oxalosis led to failure of the renal transplant and death. The patient had also had familial spherocytosis, inherited from her father, while the oxalosis had been inherited from her mother. It is suggested that early transplantation at the onset of renal failure, as long as the blood oxalate level is still tolerably low, may give better results than have so far been reported.

Anatomy of the naso-lacrimal duct in new-borns: therapeutic considerations

The topography and morphology of the lacrimal ducts in newborn infants was demonstrated by means of post mortem dacryocystograms and microphotograms of histologic slides. Because of bends in the course of the lower tear duct, a percentage of probings will fail to effect satisfactory perforation of the Hasner membrane. In most cases, the soft texture of this membrane requires no more than syringing under pressure, using a hollow probe as described by Bangerter (1953).

Bronchial arteries in various stages of bronchogenic carcinoma

The vascularization of growing and regressing bronchogenic carcinomas was analyzed by comparison of postmortem angiographic and histologic investigations of bronchial arteries in 20 autopsy lungs with bronchogenic carcinoma. Vascular findings in bronchial arteriograms range from correct orientation of proliferating vessels to convoluted patterns of vascular growth during the early phases of tumor growth. Later spotty or smudgy extravasation may be seen in necrotic tumor areas, and increased vascular anastomoses appear between the nutritive and functional pulmonary circulations. Characteristic findings in angiography may be correlated, to a certain extent, with size and histologic type of the tumors. Our findings emphasize the role of nutritive pulmonary vessels in the vascularization of bronchogenic carcinoma at different stages of its development.

[Bronchial arteries in interstitial pulmonary fibrosis (author's transl)]

6 autopsy lungs with interstitial pulmonary fibrosis were subjected to comparative angiographical and morphological investigations of bronchial arteries. During the final stage of interstitial pulmonary fibrosis, bronchial arteries were increased in number, and so were their anastomoses with pulmonary arteries. Extensive formation of broncho-pulmoary anastomosis as well as proliferation and formation of new bronchial arteries, is associated with interstitial chronic inflammation and fibrosis in the lung. The findings explain functional interconnections between the vessels of the systemic and the pulmonary circulations by direct artery-to-artery anastomoses, with a negative influence on pulmonary hypertension.

[Heart trauma caused by central venous catheter (author's transl)]

Four cases of extensive traumatic lesions of the right atrium induced by central venous catheter, are reported. In one case there was beginning in the other complete perforation of the right atrium. Such lesions can be caused by horizontal fixation of the intracardiac portion of a catheter due to wall-adherent thrombi; catheters held near the coronary sinus by a so-called Chiari net; or by coiling of the catheter within the atrium. Central venous catheters often cause endothelial lesions and thrombotic changes in the veins near the heart. Possible trauma to the right atrium, which could provoke fatal complications (e. g. haemopericardium or arrhythmias) must, therefore, be given special attention.

Structural alterations of the lung in anthracosilicosis--automatic quantitation with an image-analysing computer

A morphometric method of assessing anthracosilicotic alterations in lung structure was studied in 4 patients. The introduced model and a special technique for preparation permit the evaluation of anthracosilicotic dust deposits, secondary emphysema, and intact residual parenchyma by means of an image-analysing computer. This method appears particularly suitable for investigating and correlating morphology to clinical data, because the parameter 'intact residual parenchyma' can be reproduced in a short time with sufficient accuracy by random samples.

[Dissecting arterial disease of the renal vessels as a cause of hypertension]

With modern specific diagnostic studies like isotope renography, angiotensin-infusion-test, peripheral venous renin assay, comparative assays of the renin activity in the individual renal veins, and angiography the renal and renovascular causes for hypertension become more and more significant. When it has been shown that the hypertension is caused by a constriction of the renal arteries, instant operative therapy is indicated. The rare case of a dissectioning arteriopathy of the renal arterial wall causing hypertonia is described.

[The radiological anatomy of the tear ducts in neonates (author's transl)]

This position and relationship to the facial skeleton of the tear ducts in neonates were studies during 25 post mortem examinations by injection of contrast material into them and the findings were correlated with microscopic appearances. This produced the following results: in more than 50% cases there was unilateral or bilateral narrowing of the distal end of the duct due to persistence of Hasner's membrane. The ration of length of the tear duct and the ductus in neonates is 1:2 (adults 1:3). The proximal portions of the ducts between the saccus and the ductus show multiple transverse mucosal folds. There are several more or less acute curves in both planes. The examination indicates that in the treatment of neonatal dachryostenosis it is necessary to use a combination of dilatation and pressure injections.

[Development of idiopathic dacryostenosis (clinical and pathologico-anatomical findings)]

The authors describe microsurgical appearances of tear-sac and nasal mucous membranes from 45 patients suffering from dacryostenosis without clinically manifest nose or sinus conditions. In addition the observations of Henle (1865), that described the continuation of expandible conchal mucous membrane up to the lower part of the tear duct were controlled. The observations gave the following results: 1. In all cases of dacryostenosis there was a past history of more or less severe acute or chronic inflammation of the nasal and tear-duct mucous membrane. 2. The submucose of the ductus naso-lacrimalis surrounded by bone contains arterioles with sphincters and cavernous vessel complexes which can cause swelling up to displacement of the canal lumen, according to the blood flow. The results support the hypothesis of the authors that "idiopathic" dacryostenosis is caused by ascending inflammations from the region of the nose and sinus cavities, which can be clinically quite inconspicuous.

[Platelet morphology and physical stress (author's transl)]

The morphology of thrombocytes of 45 volunteers in varying conditions of training was analysed under physical stress. The probands were divided in three groups of 15 each. Group X (aged 20-26 years) had occasional gymnastics training. Group Y (aged 44-52 years) was without any physical training, and Group Z consisted of athletes (aged 22-25 years) in good training condition. By means of the platelet aggregation test (PAT), thrombocyte changes were classified in 5 stages: solitary stage (I), accumulation stage (II), degranulation stage (III), fibrin forming stage (IV), irreversible aggregation stage (V). The probands were subjected to ergometer stress in exact dosage. With the exception of the athletes, all blood smears showed a decrease in stage I (solitary), and considerable increase in stages II-V. 5, 30, or 60 min after stress, the return of irreversible aggregates (PAT V), of platelet changes in the fibrin-forming stage (PAT IV), and in the degranulation stage (PAT III), was markedly delayed in Group Y (untrained older persons) when compared with the group of well-trained athletes. The observation may offer an explanation for some cases of acute thrombotic cardiac death among trained athletes. On the other hand, it may prove the better adaptation of the thrombocytic system during physical stress when athletes are in good physical condition.

[Pulmonary perfusion in embolism of pulmonar arteries without pulmonary infarction (author's transl)]

Six autopsy lungs with embolism of the pulmonary arteries but without infarction, were subjected to comparative angiographic and morphologic examination of bronchial arteries. In pulmonary embolism without hemorrhagic infarction the disconnected vascular bed of pulmonary arteries can be demonstrated distally of the obstructive thrombo-embolism and with a noncapillary contrast medium. The vascular bed appears in intrapulmonal, precapillary, bronchopulmonal anastoses. The results of the investigation explain an intravital sufficient subsidiary circulation in the pulmonary areas separated from the normal circulation of pulmonary arteries. An extended subsidiary development of bronchial arteries in reaction to previous chronic pulmonary disease would help, according to our findings in postmortem lung angiographies, to support the circulation after embolism of pulmonary arteries.

[Fatal thrombo-embolism after central-vein catheterisation (author's transl)]

Ten cases of fatal thromboembolism after central venous catheterisation were found among the autopsies of one year. The immediate causes of death were protracted pulmonary embolism (n = 8), cerebral embolism with defect of ventricular septum (n = 1), and central regulatory disturbance following complete thrombotic occlusion of the jugular veins (n = 1). The sources of the fatal embolisms were found in thrombi in the superior vena cava, the innominate veins or subclavian veins. The relation of these thrombi to catheter-dependent lesions in the venous walls was beyond doubt. The catheters had been left in position for periods of 2 to 56 days. In 40 further autopsies with different causes of death, catheter-dependent mural lesions of varying extent were found in the venous system near the heart. Local thrombi were identified after catheterisation of not more than 24 hours. Macroscopic and microscopic appearance of these thrombi was characterised by a groove-like structure corresponding to the apposition of thrombi around the plastic catheter.

Structural analysis of pulmonary vascular changes in a case of infantile calcifying arteriopathy

In a well documented case of ACI, the pulmonary vessels were subjected to light microscopy, radiography, electron microscopy and X-ray microanalysis. The analysis of calcified foci in the walls of large and medium pulmonary arteries demonstrated a marked correlation between the deposits of calcium and phosphorus and the number of elastic fibers. The interpretation of our observations is in favour of a congenital defect of elastic fiber formation in the vascular walls, followed by calcification. Massive accumulation of calcium in the vascular walls was associated with tissue destruction, fragmentation of fibers and formation of irregular calcified foci which provoked a foreign-body reaction.

[Plasmocytoma of the orbit (author's transl)]

After a survey of the clinical picture of plasmcytoma including histological, internal and radiological findings the special aspects of affections of the orbit are described and demonstrated by four own cases since 1955. The authors propose the differentiation between plasmocytomas with bony erosive changes, solitary or multiple, and extrameudllary myeloma for theapeutical and prognostical reasons. The extramedullary myeloma of the orbit has a better prognosis and should be treated by local excision of the tumor with following radiation (CO-60). In case of bony erosive changes the extension of the tumor has to be considered, in case of multiple involvement of the body the radiation should be prefered as a palliative treatment in combination with chemotherapy.

[Endoscopic-radiological demonstration of the gastrointestinal lymph nodes and lymph vessels]

Using an intragastric contrast medium (Lipiodol) the paragastric lymph nodes of 23 patients were lymphangiographed prior to laparotomy. The patients suffered from gastric or duodenal ulcers (15 cases), postresectional ulcers (3 cases), or gastric carcinoma (5 cases). The surgically resected material was examined by radiological and histological techniques. The following results were obtained: 1. After application of the contrast medium the paragastric lymph nodes could firstly be seen 5 hours later and even after 7 days and more. 2. The radiographs presented typical storage phenomena with granular or clod-like structures as an equivalent of the inflammatory lymph node alterations. Histologically a marked sinus catarrh with lipid laden reticulum cells and multinuclear giant cells of the foreign body types was observed. 3. In gastric carcinoma characteristic storage defects up to complete destruction of the lymph nodes were found as a roentgenological equivalent of lymph nodes metastases. In addition there were occasionally abnormal courses of the lymphatic vessels with variations in diameter and bizarre storage formations. 4. The described method provides a helpful tool in the diagnosis of gastric lesions. No side effects have been observed.

Morphological and biochemical findings in a case of mucopolysaccharidosis type III A (Sanfilippo's disease type A)

Morphological and biochemical autopsy findings of a 12 year old girl with mucopolysaccharidosis type III (Sanfilippo's syndrome). The clinically suspected diagnosis was biochemically ascertained before the patients death. The autopsy findings obtained by biochemical and by light and electron microscopic investigations of different organs are compared with the results of other authors.