Comparative morphology of the hepatic and coronary artery walls. Part III. The insignificance of medial morphologic features in the determination of an autopsied unidentified subjects age

Since hepatic arteries are free of atherosclerosis any possible wall structure change may be attributed to age. We determined the media of hepatic and coronary arteries in view of this assumption. We measured its thickness and myocytic density (per 1 mm2 of cross-section) from specimens collected from autopsied subjects, aged up to 90 years. The media gradually thickens with age, although values noted during particular decades remain statistically insignificant. The myocytic density (in 1 mm2) was almost constant throughout life. The latter observation is incompatible, in comparison with data reported by other authors (diminution was expected).

Comparative morphology of the hepatic and coronary artery walls. Part II. The relation between the internal elastic membrane, non-atherosclerotic intimal thickening and atherosclerosis

Evident difference in the occurrence of atherosclerosis between hepatic and coronary arteries justifies the search for local preconditions of this disease. In this study we compared the internal elastic membrane morphology of both arteries. It appeared to be mono- or polylinear (laminar) and continuous in the hepatic artery. This was in contrast to its fragmentation in the coronary artery since the beginning of life. Thus, the condition of the internal elastic membrane may play an important role in the development of non-atherosclerotic intimal thickening. Continuous elastica could make the migration of medial myocytes into the intima more difficult (hepatic artery). On the other hand, fragmented coronary artery elastica seems to facilitate this migration. In turn, intimal thickening is less or more advanced, respectively.

Comparative morphology of the hepatic and coronary artery walls. Part I. Differences in the distribution and intensity of non-atherosclerotic intimal thickening and atherosclerosis

We compared the morphology of the hepatic artery intima which is free of atherosclerosis, with that of the typically atherosclerosis-prone coronary artery. The study group comprised material collected from 116 autopsies. Subjects were aged between 1 month and 90 years. Specimens were collected from grossly normal arterial segments. An already known fact was confirmed: the presence and remarkable intensity of non-atherosclerotic intimal thickening in the coronary arteries since the beginning of life. On the contrary, hepatic artery intimal thickening was incidental during the first 4 decades of life and regular later on. During all the decades intimal thickness was decreased in the hepatic artery in comparison to the coronary artery. Initial atherosclerosis was noted during the 4th decade of life in the coronary artery and during the 8th and 9th decades in the hepatic artery. Intimal thickness was always lower in women compared to men. These findings reveal a positive correlation between the intensity of intimal hyperplasia and the incidence of atherosclerosis. The intimal pattern is of limited value in the determination of an unidentified subject age who underwent an autopsy. The thickness of the hepatic artery intima, which surpasses 200 microns indicates that the subject is at least 40 years of age, while initial atherosclerosis--the 8th or 9th decades of life.

Light and electron microscopic picture of atherosclerotic plaque in stable and unstable angina

By presenting this series of 127 cases of coronary atherectomy the authors join the workers who study morphological differences between the atherosclerotic plaques in stable and unstable angina. Routine staining of formalin-fixed, paraffin-embedded material was completed by the detection of T lymphocytes, macrophages, mast cells, smooth myocytes and grown-in capillaries using monoclonal antibodies (DAKO), as well as by the immunofluorescent demonstration of fibrinogen in the plaques. The plaques derived from patients with unstable angina showed a higher incidence of mast cells (significant) and macrophages (insignificant). These cells render the plaque more susceptible to rupture or fissuring. There was also significantly more frequent and quantitatively more abundant permeation of the plaque by fibrinogen that raises the chance of thrombosis. These findings support the view that unstable angina correlates with the phenomena that favour the rupture of the plaque and thrombosis. Electron microscopy has not been used so far to study coronary atherosclerotic plaques. This material includes 15 plaques from stable and 18 plaques from unstable angina. A cover of fibrin and blood platelets is a regular formation on the surface and in the superficial layer of the plaque from unstable angina. It contributes to the "thrombotic proneness" of the coronary artery. These plaques also show abundant elastic fibres. This pattern corresponds to myo-elastic intimal hyperplasia ("intimal thickening") where the production of intimal elastin constitutes an essential phenomenon. Intimal thickening is interpreted as a preatherosclerotic event. The presence of elastin reflects an early stage of the development of the plaque. The plaque from stable angina shows abundant collagen fibres, which aggravate the lesion.

[Correlation among clinical and histopathologic criteria in selection of donors for orthotopic liver transplantation]

The aim of this work is to present the correlation between the initial microscopic pattern of the liver graft and clinical and laboratory findings. In the Department of General Surgery and Liver Diseases 6 specimens were taken from 4 livers destined for planned liver transplantations. They were taken from the organ rinsed in UW solution, processed and stained extemporaneously. Quick HE staining was performed in some cases. Two livers were qualified for transplantation although they showed negligible histopathological changes. In one of these cases there was a clinical and pathological disagreement. The results of histological examination were crucial in qualification of the liver for grafting. One organ was disqualified because of negative clinical and pathological findings, while two other livers were disqualified after clinical examination. We resigned from the transplantation of liver of the last donor, who exhibited unsatisfactory clinical tests in spite of good pathological results.

[A case of Whipple's disease]

We present 66 year old man with symptoms of malabsorption syndrome. The correct diagnosis of Whipple's disease was made difficult by the radiological picture of the jejunum tumor with subocclusion. It was the cause of the diagnosis of carcinoid tumor of the small intestine: the laparotomy was performed. The histological picture was typical for Whipple's disease. The skin changes seen in our patient were similar like in carcinoid syndrome, pellagra and Whipple's disease.

[Giant cell arteritis--presentation of 3 cases]

Three patients with giant cell arteritis (GCA) observed recently in our department are described. One of them demonstrated clinical picture of polymyalgia rheumatica, the other two presented with clinical symptoms of GCA. This presentation seems to be very helpful for correct diagnosis in cases with difficult recognition.

[Ruptured aneurysm of the abdominal aorta into the duodenum as a cause of hemorrhage from the digestive tract]

An extremely rare cause of bleeding from the digestive tract is presented which was a rupture of abdominal aorta aneurysm into duodenal lumen. On the basis of history data, clinical picture and gastroscopy, bleeding from gastric ulcer was diagnosed. The actual cause of bleeding was established during autopsy, not confirming at the same time the presence of gastric ulcer.

[Anatomic study of the direct vascular connection between the adrenal gland and kidney in humans]

The study was performed on 16 specimens containing adrenal gland and kidney obtained at route autopsy. The mixture of gelatin and india ink was injected into adrenal artery, through the catheter. In all specimens vessels leaving adrenal gland and entering cortex of kidney were found. Therefore, we conclude that alike other species also in humans, the adrenal-renal mirabile does exist.

[Renal biopsy in the aged]

Pathological findings in urinalysis in the aged persons are usually thought to be caused by pathologic processes other than glomerulopathy. Histological evaluation of renal tissue in older patients is extremely difficult due to coexistence of involuntary changes-hyalinosis, increase in mesangial matrix content, and vascular changes. The aim of the study was to evaluate frequency of glomerulonephritis, both primary and secondary in persons older than 60. In this group, as compared to the younger people the secondary glomerulonephritis was more frequent, amyloidosis and vasculitis nodosa being the most frequent. In primary glomerulonephritis mesangiocapillary type dominate, quite often some tendency to hyalinization could be observed. Renal biopsy is useful as a diagnostic tool in both the aged and young. It should be performed regardless the patients age.

Influence of renal denervation on urine concentration in awake and anaesthetized dogs

The role of renal nerves in urine concentration was studied in clearance experiments with unilaterally renal-denervated dogs prepared by surgical bladder division. Urine concentration was assessed under conditions of: (1) stimulation of ADH release by dehydration or barbiturate anaesthesia; (2) mannitol diuresis, and (3) isotonic saline diuresis. Differences in TcH2O/GFR between the intact and denervated kidney were not significant in any of the experimental groups. However, in dehydrated conscious dogs Uosm of the intact kidney (939 +/- 58 mmol/kg H2O) was significantly higher (P less than 0.05) than that of the denervated organ (806 +/- 51 mmol/kg H2O). In the intact kidney the medullary content of total solutes and sodium per kg wet tissue was 684 +/- 26 mmol and 208 +/- 12 mmol, respectively. This was significantly higher (P less than 0.005) than corresponding values of 581 +/- 23 mmol and 171 +/- 14 mmol per kg wet tissue measured in the denervated organ. We suggest that a slight impairment of urine concentration (lower Uosm) in the denervated kidney of conscious dogs may depend on decreased medullary hypertonicity.

Squamous metaplasia of the lung alveolar epithelium in mice after influenza virus infection

Metaplasia of the lung alveolar epithelium was observed in mice challenged with influenza virus after previous infection, and in mice repeatedly infected. Immunological factors are suggested to contribute to the development of the process.

Glomerular foam cells in kidney allograft

Foam cells are occasionally encountered in renal glomeruli in cases of nephrotic syndrome, however, they were not described so far in renal allografts. The authors found the glomerular foam cells in a cadaveric kidney transplant which survived 7 months after transplantation in a 35-year-old man. Electron microscopy revealed the mesangial cells to be loaded with lipids in this case. The formation of the glomerular foam cells is generally referred to hyperlipidemia, but its cause remains obscure in the presented case.

Renal glomerular and tubular lesions in rabbits treated with uranyl nitrate

Renal injury and regeneration was followed light--and electron microscopically in rabbits treated with uranyl nitrate. The presence and importance of glomerular lesions is noteworthy.

Some serum biochemical changes associated with chloroform-induced renal tubular necrosis in mice

The chloroform--induced renal tubular necrosis is associated with the rise of serum urea, creatinine and potassium. The highest values, observed 24 hours after chloroform administration, are respectively: 75 mg% (norm 32 mg%), 1.75 mg% (norm 0.25 mg%), 6.1 mEq/1 (norm 4.4 mEq/1). They gradually decreased with the progress of renal regeneration. These transient, rather little biochemical deviations justify the good conditions and eventual survival of chloroform-poisoned mice. The contribution of possible glomerular lesions to the disturbed renal function is taken into consideration.

Comparison of the role of testosterone and methyltestosterone in developing chloroform-induced renal tubular necrosis in mice

The presence of testosterone is a prerequisite for the development of chloroform-induced renal tubular necrosis in mice. The purpose of this study was to check whether methyltestosterone exerts the same influence. Castrated males and females were treated with one of these compounds: those treated with testosterone developed renal tubular necrosis after chloroform injection, those which received methyltestosterone were free of this lesion.

Clinical and morphological correlations in mesangial glomerulonephritis in children

The present series comprises 36 cases of mesangial glomerulonephritis in children aged from six months to 14 years. On the basis of morphological criteria, types with considerable and slight mesangial proliferation were distinguished. Slight mesangial proliferation was more typical of younger children. Clinically they showed more often the nephrotic syndrome (sometimes difficult to differentiate from lipoid nephrosis). Older children developed mesangial proliferation rather of greater intensity: renal insufficiency and erythruria predominated in this group.

Studies on the cumulation of the toxic effect of indomethacin

The cumulative toxicity of alpha and gamma forms of crystalline indomethacin was studied on Wistar rats treated with these compounds in increasing doses for 24--32 days. The toxic effect of alpha and gamma forms is significantly cumulative. When administration of indomethacin is many times repeated doses 3--4 times lower than those applied once are sufficient to cause death. Indomethacin causes ulcers of small intestinal and cecal mucosa, with perforation. The alpha and gamma crystalline forms of indomethacin did not differ in the degree of cumulation of the toxic effect and intensity of morphological lesions.