Compositional analysis of collagen from patients with diverse forms of osteogenesis imperfecta

Collagen was extracted by pepsin treatment from various tissues and skin fibroblasts of 23 patients belonging to different types of osteogenesis imperfecta (OI), and characterized by molecular sieve and ion exchange chromatography, gel electrophoresis, and amino acid analysis. We found an elevated collagen III/I ratio in the skin of one patient with OI type I but almost normal values in skin fibroblasts of two other patients of this OI type. Five patients with OI type II had a normal collagen III/I ratio in their skin and skin fibroblasts, but the degree of hydroxylation of lysine residues in collagen I and III from their skin, bone, calvarium, and noncalcified calvarial tissue was increased. Patients belonging to OI types II, III, and IV had also considerable amounts of collagen III in their long bones, while bone tissue from controls contained only type I collagen. The content of type V in calcified tissues was virtually the same in controls and patients.

[Meniscus transplantation--animal experiment study]

The possibility of repairing meniscus lesions by transplantation was studied in 30 sheep. Grafting of the meniscus was performed in 15 animals each either with lyophilised homologous menisci that had been sterilised by gamma rays, or with deep frozen homologous menisci. 27 menisci could be evaluated over a period of 48 weeks. Besides the clinical, microscopical and scanning electron microscopical evaluation, the grafts were also examined microangiographically and biomechanically. Both lyophilised and deep-freeze menisci are suitable for transplantation, but the processes of transformation of the grafts are significantly different: Whereas complete transformation takes place in the lyophilised transplant during the study period of 48 weeks, the deep-frozen transplant is accepted and heals without any remarkable transformation process to full function. Although the biomechanical stress tests yielded good stress tolerance for both types of transplants, the deep frozen homologous menisci appear to be more favourable with regard to possible clinical aspects since they do not undergo any transformation.

[Multilocular myositis ossificans--damage caused by excessive stress in performance sports?]

This is a report of a girl of 16 years of age who complained of pain in both legs after intensive competitive sports, the main event being the 800 m race. Radiologically visualised were periostal reactions and new periostal bone formations at the femur and lower leg. Diagnosis was extremely difficult due to generalised signs and symptoms, such as temperature, associated with inappetence and a "run-down" feeling, increase of alkaline phosphatase and liver enzyme levels and of the blood sedimentation rate. Differential diagnosis of heterotopic ossifications is dealt with in detail.

Systemic angioendotheliomatosis of the lung

Systemic angioendotheliomatosis is a very rare malignant disease characterized by intravascular neoplastic proliferation of reticuloendothelial cells. According to the clinical features three different types of prognostic value can be distinguished: Exclusive skin involvement; Progressive skin lesions disseminating to internal organs; Aggressive and lethal type affecting primarily internal organs. Until now about 60 cases of systemic angioendotheliomatosis have been reported in the literature. Here we describe the first well-documented case with almost isolated lung involvement. The presentation of morphologic and clinical signs and differential-diagnostic considerations are followed by a critical review of the literature.

[Postinflammatory pseudotumor of the lung in childhood]

A case of postinflammatory pseudotumor of the upper lobe of the right lung in a 5-year-old girl is reported who presented with recurrent feverish throat infections until the time of diagnosis. Right-sided pneumonectomy with partial resection of the v. cava and the carina was performed due to anatomical situs and the unclear dignity of the intraoperative frozen-section. The patient is in excellent condition 11 years following operation, her growth being entirely normal. At the example of this rare, benign, tumorous lung disease which is difficult to judge radiologically and which must be removed surgically for diagnostic an therapeutical reasons the problems are discussed.

Severe clostridium infection following perforation of the uterus in a patient with an ectopic pregnancy

Twenty-eight hours after CO2 insufflation and curettage in a 26 year old, haemolysis, jaundice and anuria developed. As an ectopic pregnancy was also suspected, a diagnostic laparoscopy was done and was followed by a hysterectomy and left salpingo-oophorectomy before Clostridium perfringens was grown on culture. The survival of the patient despite clostridial infection is probably due to immediate surgical treatment and intensive post-operative care.

Desquamative interstitial pneumonitis and alveolar lipoproteinosis: diagnostic difficulties and therapy problems with an infant

A desquamative, interstitial pneumonitis was diagnosed histologically in a 9-month-old boy who first became ill at the age of 5 weeks. The desquamative interstitial pneumonitis was associated with an acquired cytomegalovirus (CMV) infection. Despite treatment with corticoids, acyclovir and artificial ventilation, the patient died of pulmonary insufficiency at the age of 15 months. The autopsy revealed an alveolar lipoproteinosis.

[Primary dissection of the left coronary artery with rupture of the ventricle in a 27-year-old patient]

This report of a 27-year-old patient describes an extensive infarction of the anterior wall due to primary dissection of the left coronary artery in the absence of the circumflex artery followed by rupture of the left ventricle. In earlier reports an aortocoronary bypass operation was usually performed in similar situations. Although the final outcome was lethal, this case report shows recanalization by methods of "interventional cardiology" to be a potentially successful alternative which may be of value when bypass operation is not available or contraindicated, as in developing cardiogenic shock. This case report demonstrates an initially successful treatment, which after a stable interval was followed by a lethal complication, namely, rupture of the ventricle due to hemorrhagic infarction.

[Granulomatous gastritis of the antrum in generalized sarcoidosis]

A 42-year-old man had a 4 year history of sarcoidosis stage II (lung). In biopsied specimens of the antrum we found epithelioid granulomas caused by gastric involvement in sarcoidosis. Coincidentally we found a gastric ulcer which was later the source of gastric bleeding. The granulomas were located around this ulcer and also under intact mucosa. Therefore, in our opinion it was not the case that granulomatous gastritis caused the ulceration in a direct way. We saw a connection between hypercalcemia--often found in patients with sarcoidosis, as in our patient--and the gastric ulcer. Therapy was thus aimed at lowering the blood calcium concentration. Steroids were avoided at this time. The ulceration healed, although granulomatous gastritis continued.

Immunohistochemical study of granular cell tumours. Demonstration of neurone specific enolase, S 100 protein, laminin and alpha-1-antichymotrypsin

Nine granular cell tumours were investigated with poly- or monoclonal antisera to neurone specific enolase (NSE), glial enolase (GE), S 100 protein, alpha-1-antichymotrypsin, lysozyme, laminin, neurofilament (NF), glial fibrillary acidic protein (GFAP), brain creatine kinase (CK), different cytokeratins (Keratin Dako, PKK1), tissue polypeptide antigen (TPA), carcinoembryonic antigen (CEA), desmin, myoglobin and leukocyte common antigen (LCA), using immunoperoxidase-methods on formalin fixed paraffin embedded sections. While five tumours from adults show specific cytoplasmic staining for NSE and S 100, three congenital tumours, two from the gingiva and one from palatine, show only a weak reaction for NSE, reflecting a possible origin from mature and immature Schwann cells, respectively. However, one subcutaneous tumour from near the clavicule of a ten year old girl differs from the other eight tumours by its specific cytoplasmic staining for alpha-1-antichymotrypsin only, supporting the view that there are granular cell tumours of histiocytic origin. In addition, the five adult NSE-S100 tumours show strong laminin-immunostaining around the single small or syncytial granular cells, whereas pericellular laminin is not detectable in the histiocytic nor in the three congenital tumours. None of the tumours shows any staining for lysozyme, epithelial, muscular, leukocyte, neurofilament or glial antigens.

Fibromatosis hyalinica multiplex (juvenile hyalin fibromatosis). Light microscopic, electron microscopic, immunohistochemical, and biochemical findings

Fibromatosis hyalinica multiplex juvenilis (juvenile hyalin fibromatosis) is a very rare mesenchymal dysplasia, probably inherited as an autosomal-recessive trait. Two nonrelated cases are reported. Among the clinical features, the most impressive lesions are multiple slowly growing subcutaneous nodules, hypertrophic gingiva, flexural contractures with joint stiffness and radiolucent bone destructions. Light microscopic examination of the nodules reveals tumor-like deposits of an amorphous hyaline ground substance with delicate staining properties situated partly between cellular and vascular areas. Ultrastructural characteristics are cystic, dilated rough endoplasmatic reticulum and cystic Golgi vesicles which contain a fine fibrillar material that is also found in the ground substance. Immunohistochemical examination shows collagen type I and type III in the hyaline material, but not type II and type IV. Quantitative biochemical investigation reveals a normal ratio of collagen types I and III.

[The so-called nasal glioma]

A case of nasal "glioma" is presented. This tumor consists of congenital heterotopic glial tissue and represents an abnormal protrusion of brain substance (exencephalia).

[Pancreas head tumor in childhood]

In a 13 1/2-year-old girl free of symptoms and clinically healthy until the time of diagnosis a tumor in the head of the pancreas located paraduodenally, was removed using the Whipple technique. Histology revealed an apudome or carcinoid with endocrine activity. Because pancreatic tumors are rarely seen during childhood, and especially apudome and carcinoids are almost never diagnosed, this case presents the unique problems involved in diagnosis and therapy.