Human postburn oedema measured with the impression method

The course of tissue swelling in human non-injured skin after burn injury was investigated with a non-invasive impression method that measures force and tissue fluid translocation during mechanical compression of the skin. Time-dependent changes in the fluid translocation and the interstitial-pressure related to impression force were measured on 11 occasions, during 3 weeks, in seven patients postburn. A mathematical model was fitted to the impression force curves and the parameters of the model depicted the time-dependent compartmental fluid shift in the postburn generalized oedema. Tissue fluid translocation increased significantly (P < 0.05) up to a maximum value after 6 days postburn and declined thereafter. This indicated a continuous increase in the generalized postburn oedema for the first 6 days postburn. Impression force at 3 weeks postburn was significantly lower (P < 0.001) as compared with the half-day postburn value, indicating an increased tissue pressure during the first days postburn. Parameter analysis indicated a flux of water-like fluid from the vasculature to the interstitial space during the first 6 days postburn. The spread of the values registered between different measurement sites was, however, large.

Breast carcinoma growth rate described by mammographic doubling time and S-phase fraction. Correlations to clinical and histopathologic factors in a screened population

BACKGROUND

In a retrospective study, correlations among mammographic doubling times (DT), clinicopathologic prognostic factors, and cytometric predictors were examined.

METHODS

One hundred fifty-eight patients with the possibility to calculate mammographic tumor DT were selected and the tumors were histologically reexamined and flow cytometric analysis for ploidy and S-phase fraction (SPF) was performed.

RESULTS

The tumors were Stage I in 68%, and 45% were detected by mammographic screening. DT ranged from 0.6 months to an indefinite time (median, 9.0 months). Short DT was significantly correlated to large tumor size (P = 0.01) and advanced pathologic tumor stage (P = 0.016), but there was no correlation between DT and histologic grade. Ploidy analysis indicated that there were 57% aneuploid and 7% tetraploid tumors. There was a significant overrepresentation of euploid tumors among tumors smaller than 10 mm (P = 0.02). Ploidy was correlated to histologic grade (P less than 0.001) and DT (P = 0.009). SPF was calculated in 122 cases. SPF correlated significantly with pathologic stage (P = 0.002), tumor size (P = 0.037), histologic grade (P = 0.001), the presence of axillary lymph node metastases (P = 0.046), DT (P = 0.02), and DNA ploidy (P less than 0.001). Compared with interval carcinoma, screening-detected carcinoma showed favorable characteristics concerning size, stage, DT, ploidy, and SPF but not regarding histologic grade and axillary lymph node metastases.

CONCLUSIONS

DT shows great variations. Factors related to tumor biology (i.e., DT, DNA ploidy, and SPF) are strongly correlated with one another, but they have no correlation with axillary lymph node metastases. Cancer detected by screening is discovered at an early stage and shows favorable characteristics concerning DT, ploidy, and SPF.

Mammographic growth rate, DNA ploidy, and S-phase fraction analysis in breast carcinoma. A prognostic evaluation in a screened population

BACKGROUND

The authors examined prognostic factors in 158 cases of breast carcinoma with known mammographic tumor volume doubling times (DT).

METHODS

The tumors were retrospectively reexamined histologically and flow cytometric analysis of DNA ploidy and S-phase fraction (SPF) was performed on archival paraffin-embedded material in each case. Life tables and Cox multivariate analyses were used for statistical evaluation of prognostic factors.

RESULTS

In univariate analysis of survival data, clinical and pathologic stage, histologic grade, the presence of axillary lymph node metastases, and SPF were significant prognostic predictors, but mammographic DT and DNA ploidy were not. SPF also contributed prognostic information in the subgroup of carcinoma cases detected by screening. In a Cox multivariate analysis, SPF, the presence of axillary lymph node metastases, and Stage II-III disease (as opposed to Stage I disease) were independent significant predictors of survival. In univariate analyses of distant disease-free survival, clinical and pathologic stage, tumor size, histologic grade, the presence of involved axillary nodes, DT, and SPF all were significant prognostic factors.

CONCLUSIONS

SPF, stage, and lymph node status were important prognostic factors in this patient material with predominantly small and node-negative breast carcinomas, whereas DNA ploidy and mammographic DT provided less prognostic information. The prognosis of carcinoma detected during screening did not differ significantly from that of breast carcinoma discovered otherwise in this selected patient group.

Self-reported prevalence of disability after subarachnoid haemorrhage, with special emphasis on return to leisure and work

The prevalences of motor and language impairments and of disabilities in activities of daily living (ADL), leisure and work were investigated in a consecutive series (n = 296) of long-term survivors of subarachnoid haemorrhage (SAH). Motor and language impairments were present in 17 and 20%, respectively. The majority reported independence in self-care (91%) and instrumental (80%) ADL, but among the self-care independent, 23% reported need of personal assistance. Leisure disability occurred in 48% and vocational disability in 40%. Hence, disabilities are more common after SAH than is indicated by occurrences of motor and language impairments. It is concluded that the discrepancy between the prevalences of impairments and of disabilities may be to a great extent caused by coping difficulties in relation to socio-demographic and geographic circumstances. The findings indicate a need for rehabilitative follow-up for virtually all SAH-patients.

Evaluation of the impression technique by measuring interstitial oedema in rat testis

The impression method for assessment of subcutaneous oedema was evaluated in a rat testis model where the testicular interstitial fluid volume was changed both artificially by infusion of rat plasma and pharmacologically by administration of human chorionic gonadotrophin. Both the integral value and the impression force value, as measured with the impression method, changed with infused volume, and changes as small as 16 microliters (approximately 7% of the total interstitial fluid volume in a testis) could be detected. Rats were treated with a single injection of 100 i.u. human chorionic gonadotrophin in order to induce changes in the volume of interstitial fluid in the testis. Both the integral value and the impression force value seemed to reveal information on testicular interstitial fluid volume in rats treated with human chorionic gonadotrophin that was similar to data revealed by measuring the actual fluid content in the testis. Interstitial fluid volume measured morphometrically in the contralateral testis in human chorionic gonadotrophin-treated rats was significantly correlated to the impression force value (r = 0.75) and the integral value (r = 0.52). This rat testis model proved to be an interesting experimental set-up for evaluation of the impression technique.

Impression technique for the assessment of oedema. Technical improvement and methodological evaluation of a new technique

A new instrument for the assessment of oedema based on the impression method is described. The measurement parameters are defined and the errors corresponding to the electrical and mechanical stability of the instrument are measured. The overall accuracy is calculated theoretically for the translocated volume. The accuracy and reproducibility are evaluated on plastic foam. The clinical procedure to measure oedema with this instrument is described. We show that the accuracy of the translocated volume parameter is very dependent on the overall stability of the instrument and that this instrument has an overall relative error of less than 7.3 per cent for a representative measurement. Experimental measurements on plastic foam show that the measurement parameters could be reproduced with standard deviations of less than 6 per cent and that the standard deviations for translocated volume are within the calculated overall relative error. Measurements on four patients with chronic oedema in an extremity show significantly different results on locations where pitting could be recognised compared to the contralateral nonoedematous extremity.

Lp(a) lipoprotein in patients with arterial insufficiency of the lower extremities

The serum concentration of Lp(a) lipoprotein was determined in 66 patients with peripheral arterial insufficiency of the lower extremities (PAI) and 164 controls. The mean level was higher among the patients than among the controls (236 +/- 248 vs. 129 +/- 159 mg/l, p = 0.01), and values above 300 mg/l were more common among the patients (22/66 vs. 21/164, p less than 0.001). The difference between the 26 female patients and the 94 female controls was statistically significant (280 +/- 268 vs. 118 +/- 141 mg/l, p less than 0.001), but not the difference between the 40 male patients and the 70 male controls (208 +/- 235 vs. 142 +/- 182 mg/l). A high Lp(a) lipoprotein level was not associated with a high LDL-cholesterol level, and there was no significant correlation between the serum levels of Lp(a) lipoprotein and triglycerides++, total cholesterol or HDL-cholesterol. The results indicate, that high Lp(a) lipoprotein levels may be a risk factor for PAI in women.

Static and flow cytometric DNA analysis compared to histologic prognostic factors in a cohort of stage T2 breast cancer

DNA analysis with static and flow cytometry was performed on archival smears and tissue sections in 99 patients with T2 breast cancer (Stage II). Tumour size, histologic grade and axillary node metastases were significant prognostic predictors. Static cytometry revealed 63% aneuploid tumours, and ploidy was significantly correlated to histologic grade and survival. DNA measurements obtained by static and flow cytometry were strongly correlated. According to flow cytometry 53% of the tumours were aneuploid. Flow cytometric DNA analysis correlated to histologic grade and survival and gave prognostic information among the lymph-node negative patients. Ploidy seems to be a significant, although not an independent prognostic indicator for T2 breast cancer.

Fibre loss and distribution in skeletal muscle from patients with severe peripheral arterial insufficiency

Cross-sections of whole calf muscles (m soleus and m gastrocnemius) were obtained from five previously clinically health individuals who had died accidentally (controls) and from amputated legs of five patients of similar age with severe peripheral arterial insufficiency. In the controls, but not in the patients, a characteristic distribution of different fibre types over the entire cross-sections was found, with a relative increase in number of (slow twitch) type 1 fibres in the central parts of both m soleus and m gastrocnemius. A pronounced neuromuscular pathomorphology was found in the patients, especially in m gastrocnemius. The findings suggested widespread damage to the fibres. There was also a lower total number of fibres in these ischaemic muscles; about 50% of the fibres of m gastrocnemius seemed to have disappeared. The results suggested that the relative inactivity as such may be responsible for some of the structural changes, above all the dedifferentiated distribution of different fibres over the cross-section. However, repeated acute and chronic subacute ischaemia may also cause, in the long term, irreparable damage and loss of many individual fibres. This may explain why muscles of patients with peripheral arterial insufficiency are also weaker, during single contractions. The lack of corresponding muscular atrophy in these patients seems to a large extent to be explained by an increase in connective tissue.

Ultrasonographic screening of the abdominal aorta among siblings of patients with abdominal aortic aneurysms

To evaluate the prevalence of abdominal aortic dilatations among asymptomatic brothers and sisters of patients with abdominal aortic aneurysms (AAAs), an ultrasonographic screening study was performed. One hundred and two siblings of patients operated on for AAAs at two Swedish hospitals were invited to attend, and 87 of them (35 men and 52 women) from 32 different families, accepted the invitation. Their median age was 63 years (range 39-82 years). Aortic dilatation was diagnosed in ten of the brothers (29 per cent) and three of the sisters (6 per cent). In ten cases (eight men and two women) there was a localized dilatation caudal to the coeliac axis, and in three a general dilatation of the abdominal aorta with the diameter at the coeliac axis greater than 29 mm. None of the aortic dilatations had been known before this study was performed. The conclusion is that the prevalence of asymptomatic aortic dilatations among brothers of patients with AAAs seems to be high and that this group should be selected for further screening studies.

Verbal memory function after subarachnoid haemorrhage determined by the localisation of the ruptured aneurysm

A total of 219 patients who had suffered from subarachnoid haemorrhage (SAH) were given a set of memory tests. The tests comprised immediate free recall (indexing long-term memory, LTM, and short-term memory, STM), final free recall (LTM) and final cued recall (LTM) of words as well as a digit-span test (an index of working memory, WM). STM was highly sensitive to brain damage caused by SAH whereas WM was not. Localisation of the ruptured aneurysm, angiographic vasospasm or mass effect did not have any selective influence on the SAH group's STM or WM. The final free recall test was the most sensitive measure of LTM whereas the LTM part of the immediate free recall test was the least sensitive. LTM impairment was most pronounced for patients with ruptured left anterior communicating artery aneurysms or for patients with angiographic vasospasm or mass effect. It is suggested that, in the SAH patients, a passive phonological short-term store is impaired, but the active maintenance rehearsal mechanism is intact. For patients with LTM dysfunction, deeper, more elaborate, active processing is disrupted, hindering efficient long-term storage.

Peripheral arterial insufficiency and the fine structure of the gastrocnemius muscle

A detailed light- and electron microscopical study was carried out on biopsies from m. gastrocnemius of 14 male individuals with intermittent claudication. The morphometric data obtained showed a large number of significant correlations with clinical and physical parameters. Practically all sections also showed morphological abnormalities, such as a fibre necrosis, regeneration, angular fibres, fibre type grouping and abundant connective tissue. Finally, there were significant differences in the muscle fine structure between those patients recommended physical training and those selected for surgery. The results clearly show that the structure of the muscle fibres is well adapted to the functional circumstances. They also show that widespread fibre damage do occur in intermittently ischaemic musculature, even if no signs of macroscopical tissue damage are found at routine clinical examination. Furthermore, although the clinical and physical data on patients selected for physical training and vascular surgery respectively, are very similar, there seems to be other factors that clinically influence the differentiation of the patients into these two groups. When evaluating effects of different treatments on these two groups of patients, it is thus important to take into account that there may be differences in morphology even before they are subjected to the different treatments.

High concentrations of Lp(a) lipoprotein in serum are common among patients with abdominal aortic aneurysms

The serum concentrations of Lp(a) lipoprotein was determined in 57 patients with abdominal aortic aneurysms (AAAs) and in 56 controls. Twentynine of the AAA-patients also suffered from other cardiovascular diseases and eleven had brothers and sisters with AAAs. Lp(a) was significantly higher among the AAA-patients than among the controls (22.3 +/- 24.3 vs 12.6 +/- 20.4 mg/dl, p less than 0.01). The 28 AAA-patients without other cardiovascular diseases had a somewhat higher Lp(a) in serum than the other AAA-patients, but this difference was not statistically significant (26.4 +/- 28.4 vs 18.5 +/- 19.3 mg/dl). The 11 AAA-patients with AAAs in the family didn't differ from the other AAA-patients concerning Lp(a) in serum. Several genetic markers were also studied, and the seven Kell-positive AAA-patients had a significantly lower Lp(a) in serum than the 47 Kell-negative AAA-patients (7.0 +/- 10.3 vs 25.7 +/- 25.2 mg/dl, p less than 0.05).

Prognostic factors in locally advanced breast cancer (T3, T4) with special reference to tumor cell DNA content

The prognostic value of DNA analysis was studied retrospectively in 91 patients with locally advanced breast cancer (T3, T4) and a follow-up time of 3-7 years. Tumor cell DNA analysis was performed by static cytometry on aspiration biopsy specimens in 42 cases and on tissue sections in 49 cases. The tumors were classified as euploid or aneuploid. Sixty-four percent of the tumors were aneuploid. DNA pattern correlated significantly to histologic grade and axillary perinodal growth and also to survival. DNA pattern, histologic grade and axillary node metastases correlated significantly to disease-free survival (DFS). In this series of patients with locally advanced breast cancer DNA determinations gave important prognostic information.

Bile-salt-stimulated lipase in human milk: evidence for its synthesis in the lactating mammary gland

Human milk contains many enzymes and other biologically active proteins. One of the enzymes, the bile salt-stimulated lipase, constitutes as much as 1% of the milk proteins. Its importance for efficient utilization of milk lipids by the breast-fed infant is now well established. However, whether the lipase protein is a product of protein synthesis within the mammary gland has up till now been an unanswered question. Using biopsy material from lactating human mammary gland we have now demonstrated that the enzyme is synthesized within the gland. This was done by immunoprecipitation of [35S]methionine-labelled protein from tissue pieces. By activity determination we could also determine the amount of enzyme stored in the gland. It was concluded that bile salt-stimulated lipase accounted for 1.3 micrograms/mg tissue protein. Finally, from this figure it could be calculated that about 10-15% of the total protein present in the tissue was milk protein.

Intracranial aneurysms and heredity

The occurrence of intracranial aneurysms (IAs) in the families of 579 consecutive patients with subarachnoid hemorrhage (SAH), of whom 485 had verified IAs, was studied retrospectively. IAs occurred in the families of 6.7% of the IA patients, but only 0.4% of their siblings had IAs. However, there were differences between the familial and nonfamilial IA patients, indicating that the familial patients are a specific small subpopulation of IA patients. The familial patients were younger, often had multiple aneurysms, and had aneurysms frequently located on arteries other than those in the nonfamilial group.

Genetic markers in patients with intracranial aneurysms

HLA antigens, blood group systems (ABO, Rh, MNSs, P, Kell, Lewis and Duffy) and serum group systems (Hp, Tf, Gc, Pi, Bf, C3 and C4) were studied in a series of patients with intracranial aneurysms. A significantly increased frequency of HLA antigen A28, a significantly decreased frequency of HLA antigen B40, and a significantly decreased frequency of complement factor C4 B2 was found among the patients when compared with controls from the same geographic area.

Familial aortic aneurysms: serum concentrations of triglyceride, cholesterol, HDL-cholesterol and (VLDL + LDL)-cholesterol

Patients with abdominal aortic aneurysms (AAAs) have been compared with healthy controls with respect to the serum concentrations of triglyceride, cholesterol, HDL-cholesterol and (VLDL + LDL)-cholesterol. The concentrations of triglyceride and (VLDL + LDL)-cholesterol in serum were higher in the patients than in the controls, while the concentration of HDL-cholesterol in serum was lower in the patients than in the controls. There was no statistically significant difference in the serum concentration of total cholesterol between the patients and the controls. Twelve patients had first degree relatives (brothers, sisters and/or parents) with AAAs and six patients had second degree relatives (cousins or brothers and sisters of the parents) with AAAs. There was no statistically significant difference between the patients who had first degree relatives with AAAs and the patients without AAAs in the family in the serum concentrations of triglyceride, cholesterol, HDL-cholesterol and (VLDL + LDL)-cholesterol.

Familial occurrence of abdominal aortic aneurysms

The occurrence of clinically diagnosed and ruptured abdominal aortic aneurysms (AAAs) in the family was studied retrospectively among 200 consecutive patients with AAAs treated at the Surgical Clinic, University Hospital of Umeå, in the north of Sweden, during the period 1965 to 1981. A standardized questionnaire was sent to the 89 patients who were still alive when the study was performed, and 87 patients answered it. In 14 of these families there was one blood relative with AAA, and in two families there were two blood relatives with AAAs, apart from the proband. In nine cases AAAs occurred among the 468 brothers and sisters of the probands (1.9%), and in five cases among cousins. Seven of the 204 deceased brothers and sisters (3.4%) had died of ruptured AAAs. No questionnaires were sent to the families of the 111 deceased patients, but at least 11 of these patients had AAAs in the family. Pedigrees of the families with aggregation of aneurysms are presented, and fortuitous familial aggregation or predisposition to the development of AAAs is discussed.

Blood groups and HLA antigens in patients with abdominal aortic aneurysms

Frequencies of blood groups (ABO, Rh, MNSs, P, Kell, Lewis and Duffy) and HLA antigens were studied in a series of patients from northern Sweden with abdominal aortic aneurysms. The following significant differences from the controls were found: a decreased frequency of the Rh-negative blood group and increased frequencies of the Kell-positive and MN blood groups. Previously reported associations with the ABO and Rh systems were not confirmed.

Morphometric analyses of human muscle fiber types

Fibers from the m. vastus lateralis of 10 middle-aged men were classified at ultrastructural level according to the appearance of the sarcomeric M-band. The Z-band widths had a two-peak distribution. One peak was due to type 1 fibers (mean 125 +/- 11 nm), the other to type 2 fibers. This latter could be separated into type 2A (101 +/- 9 nm) and type 2B (86 +/- 8 nm). About 83% of the fibers would have been correctly classified on the basis of the Z-band width alone. Mitochondrial volumes differed (type 1 5.6 +/- 0.8, 2A 4.0 +/- 0.8, and 2B 2.8 +/- 0.8%). However, only one third (37%) of the fibers would have been correctly classified if sorted according to this parameter. Mitochondrial volumes in the different fibers were correlated to mitochondrial enzymes, while fiber sizes and numbers were correlated to cytoplasmic variables. The correlations appeared mainly after a training program, suggesting that the relationships between structural and functional parameters are more obvious after adaptation to higher functional demands.

Z- and M-band appearance in different histochemically defined types of human skeletal muscle fibers

In order to define ultrastructural features, which alone or in combination with other features could be used to identify different types of fibers in human skeletal muscle, frozen biopsy specimens of m. tibialis anterior were serially sectioned. The thawed sections were prepared either for enzyme histochemistry or for electron microscopy. The same fiber was then identified in all serial sections and its ultrastructure examined under the electron microscope. A total of 75 fibers were included in this investigation. Specimens were also conventionally prepared for electron microscopy. Special interest was devoted to the appearance of the sarcomeric Z- and M-bands. In the same fiber, all myofibrils showed the same Z- as well as M-band structure. On the other hand, it was evident that these structures varied from one type of fiber to another in the same muscle and that their appearance were covariant to a great extent. Low level resolution of Type 1 fibers usually showed broad Z- and M-bands with five strong M-bridge lines. In Type 2A fibers intermediate Z-bands were observed. In the middle portion of the M-bands, three strong M-bridge lines were distinct while the two outer lines were relatively weak. Finally, Type 2B fibers usually appeared with narrow Z-bands. The three M-bridge lines in the middle were strong while the two outer ones were very weak, if seen at all. Discriminant analysis showed that about 70% of the fibers should have been correctly allocated on the basis of the Z-band width alone. When two independent observers classified the fibers on the basis of M-band appearance, more than 95% of the fibers were correctly classified. Thus, both the Z- and M-bands, alone or in combination, can be used as fiber type discriminators. However, the M-band structure proved to be more reliable than the Z-band width, and should therefore be used as the fiber type indicator when only one of these parameters is considered.

Intermittent claudication and muscle fiber fine structure: morphometric data on mitochondrial volumes

The mitochondrial volume densities (Vmit) of the different fiber types (type 1, type 2A, type 2B) were estimated in bilaterally obtained biopsies from 22 patients with unilateral intermittent claudication. These data, which were obtained from structurally intact fibers, were compared with clinical data from the same subject. In both the asymptomatic and symptomatic legs, Vmit 1 greater than Vmit 2A greater than Vmit 2B. Furthermore, Vmit 1 covariated with Vmit 2A and Vmit 2A with Vmit 2B in the asymptomatic legs (as in healthy subjects) but not in the symptomatic legs. Vmit 2 (mainly Vmit 2A) covariated with the age of the subjects in both legs. Vmit Tot was higher in the symptomatic legs than in the asymptomatic legs. This was mainly due to increase in the oxidative fibers, type 1 and type 2A. Usually, Vmit in the asymptomatic legs covariated significantly with the results of the functional tests (initial pain and maximum walking tolerance), while only Vmit 2A in the symptomatic legs showed such a correlation. However, the difference between the two legs concerning Vmit 1 was also correlated to the walking tolerance. Patients with high stenosis or occlusion showed higher Vmit Tot than did those with low obstacles. The results conclusively show that a fiber type-specific adaptation to ischemia occurs through an increase of mitochondrial content of oxidative fibers, which suggests that hypoxia may influence the control of synthesis or degradation of mitochondrial proteins.