[Insurance expert assessment of traumatic Achilles tendon rupture. A case report]

Achilles tendon ruptures are among of the most frequent tendon ruptures. Usually middle aged men with infrequent sports activity are involved. In most cases histopathology reveals degenerative changes within the tendon. Unusual rupture location and physical signs of trauma should lead one to consider a traumatic origin of the rupture. Traumatic origin can be confirmed by the accident history and physical signs as well as with the histopathology of the rupture site and possibly a tissue section far away the rupture site. This information can be helpful in insurance inquiries.

Interferon therapy, but not busulfan restores normal-sized megakaryopoiesis in CML--a comparative histo- and immunomorphometric study

To assess possible alterations of megakaryocytes associated with interferon (IFN) and busulfan (BU) therapy of Ph(1+)-CML, an immunohistochemical and morphometric study was performed on trephine biopsies of the bone marrow taken before and at varying intervals during treatment. For the identification of megakaryopoiesis and its endoreduplicative activity the monoclonal antibodies CD61 (anti-platelet glycoprotein IIIa) and PC10 raised against proliferating cell nuclear antigen (PCNA) were used. We compared 60 specimens from 20 patients following IFN alpha-2b administration (in combination with IFN gamma in seven patients) with 57 specimens from 22 patients after monotherapy with BU. A close correlation with clinical follow-up studies revealed that in the IFN-treated group the prevalence of atypical micro-megakaryocytes, usually characterizing CML, was conspicuously reduced in repeatedly taken bone marrow samples. Initially, even an increase in size which was levelled to normal values during maintenance therapy was observed. These features were most prominently expressed in the 13 patients with a complete hematologic and/or partial cytogenetic response. Associated with this phenomenon was a significant enhancement of the PCNA-labelling index which indicated a stimulation of endoreduplicative (endomitotic) activity necessary for achieving normal size and ploidy. In the second group of patients treated by BU these changes were absent. For this reason, our findings are in keeping with the assumption that during IFN treatment, there is at least partial recovery and expansion of a putative normal (Ph1-) megakaryopoiesis. In conclusion, megakaryocyte morphology, i.e. normalization in size, is thought to be a useful indicator to evaluate the response to IFN in CML patients.

Clinical and histological features retain their prognostic impact under interferon therapy of CML: a pilot study

In 55 patients with Ph1+ CML under interferon (IFN) monotherapy, an immunohistochemical and morphometric study on pretreatment bone marrow biopsies was performed to evaluate the prognostic impact of clinical as well as histological disease features. For identification of megakaryocytes we used the PAS stain and CD61 to calculate the subfraction of precursors (pro- and megakaryoblasts). Demonstration of macrophages and their different subsets was carried out by PG-M1 (CD68) and the GSA-1 lectin. The erythroid precursors were stained by Ret40f (anti-glycophorin C). Density of argyrophilic (reticulin plus collagen) fibers was determined by applying Gomori's silver impregnation method. Clinical variables like state of hematological response to IFN administration, age, spleen and liver size, myeloblasts plus promyelocytes, basophils as well as basophils and eosinophils exerted a predictive capacity by univariate statistical analysis. However, when entering these factors into previously published risk models, i.e., the so-called Sokal score and its modifications, to assess subgroups with different survival patterns or relative risk groups, a clear-cut discrimination was not feasible. Bone marrow features of prognostic value consisted of megakaryocytes and their precursors, fibers, and pro- and erythroblasts. Only when including histological variables into a formerly reported Cox model, could a significant separation of patients into the different categories or relative risk groups be computated. In conclusion, the present data emphasize the prognostic impact of histological parameters to be considered in all clinical trials on CML.

Quantification of thymic innervation in juvenile and aged rats

Thymic innervation has been quantified using silver impregnation and light microscopy on 5 juvenile and 5 aged rats. There is an increase in innervation density of the thymus with age, exceeding the reduction of thymic volume due to involution. The density of innervation correlates inversely with thymic volume. From previous studies, we conclude that thymic innervation is confined to the extraparenchymal compartment. Ultrastructural morphometry shows this compartment to maintain its volume during involution of the remaining thymic tissue. Related only to the extraparenchymal compartment, the innervation increases by a factor two with age.

Thymic innervation in the rat: a light and electron microscopical study

The innervation of the rat thymus was studied by light and electron microscopy in juvenile and aged rats. By light microscopy numerous fine nerves were found in the connective tissue septa penetrating between the thymic lobules. These septa were clearly delineated in the juvenile animals, but indistinct in the aged rats, thus creating the spurious impression that thymic parenchyma contains nerves. In the aged animals the nerves are thicker, tortuous, and more branched than in juvenile animals. Electron microscopy confirms the light microscopic observations: no nerves were found within the thymic parenchyma. The thymic capsule and larger connective tissue septa contain bundles of myelinated and unmyelinated axons, surrounded by a perineural sheath. Within the extraparenchymal compartment, which is greatly enlarged in aged animals, efferent and sensory nerves, devoid of perineurium, were found to contact mainly reticular cells, and in rare instances plasma cells and lymphocytes. The majority of axonal varicosities are not closely related to cellular elements, and, in general, vesicles are relatively infrequent. The possible functional significance of these observations is discussed.