Quantitative and qualitative differences between benign and malignant mesothelial cells in pleural fluid.

Quantitative as well as qualitative cellular parameters were investigated in 20 cases of reactive mesothelial proliferations and 40 cases of primary pleural mesotheliomas. The two groups showed statistically significant differences in the nuclear areas, cytoplasmic areas and standard deviations. In the mesotheliomas, the mean nuclear area and the mean cytoplasmic area were larger than in the reactive proliferations. Nine cases could not be properly classified with these quantitative parameters alone. Qualitative analysis revealed highly characteristic features in the mesotheliomas. Morula formation as well as irregular and coarse reticular chromatin patterns were strongly indicative of mesothelioma. The location and shape of the nucleus and the type and amount of cytoplasmic vacuolization gave additional information for distinguishing between the two groups.

Discrimination between primary pleural and primary peritoneal mesotheliomas by morphometry and analysis of the vacuolization pattern of the exfoliated mesothelial cells.

Cells exfoliated from primary pleural mesotheliomas differ significantly from those from primary peritoneal tumors. In a quantitative study, it was shown that the pleural cells have larger nuclei, a more pronounced anisokaryosis and a higher nuclear-cytoplasmic ratio and, therefore, appear more malignant than the peritoneal cells, which have abundant cytoplasma and small nuclei. The differences in quantitative parameters were due to a more extensive vacuolization and consequent cytoplasmic distension, combined with nuclear compression in the case of peritoneal mesotheliomas. The morphometric parameters and the vacuolization patterns of cell populations in cases with both pleural and peritoneal involvement correlated with the data of the primary tumor regardless of the fluid in which the cells were found. This finding indicates the transcoelomic metastatic properties of malignant mesothelioma.

[Therapy of chronic fibrosing alveolitis (author's transl)]. / Therapie der chronischen fibrosierenden Alveolitis.

The treatment with steroids, spironolactone, immunosuppressive drugs and D-Penicillamin is studied in 25 patients suffering from fibrosing alveolitis. A clinical improvement and an improvement of vital-capacity and total-capacity is seen, but no change in atrerial blood gas tensions.

[Pulmonary embolism in the elderly patient (author's transl)]. / Die Lungenembolie im Alter.

Pulmonary embolism has a high incidence in old patients and is often not recognized. In most cases the embolism is of unknown origin, although the deep venous system of the lower extremities is involved in almost 95%. The diagnostic procedure consists of evaluation of clinical symptoms and findings. ECG and chest X-ray are often not conclusive. Confirmation of the diagnosis is possible by ventilation-perfusion scanning of the lung. Pulmonary angiography is of no value in the elderly patient, because of the lack of consequences. Besides local therapy of a thrombosis, therapy consists of administration of heparin, while oral anticoagulation should be used only with precaution. The efficacy of platelet aggregation inhibiting substances remains to be determined. The main point are prophylactic measures in patients with risk factors or in high risk situation.