[Myofascial chronic pelvic pain in women : A retrospective evaluation of the effects of specific diagnostics and therapy]. / Myofaszial bedingte chronische Unterbauchschmerzen bei Frauen : Eine retrospektive Auswertung der Auswirkungen einer spezifischen Diagnostik und Therapie.

BACKGROUND: The prevalence of chronic pelvic pain of 11.8% in the general population underlines the importance of this disease. However, the specific diagnostics and therapy of the muscles of this region are not yet part of the standard examination. The following study examines the effects of specific diagnostics and therapy on myofascial chronic pelvic pain. OBJECTIVES: The effectiveness of targeted diagnostics and multimodal therapy in the context of chronic pelvic pain and the need for a complementary drug adjustment. MATERIALS AND METHODS: This study retrospectively evaluated the data of 59 patients, who were referred to a pain center for treatment-resistant chronic pelvic pain in the period from January 2012 to April 2017. The pain needed to be clearly identified as myofascial. A previous minimum duration of pain as well as previous operations or other treatment procedures did not constitute exclusion criteria. Previous traumatization was a reason for exclusion. Therapy components included manual therapeutic treatment, training in self-stretching exercises, medication with the active ingredients flupirtine or methocarbamol, as well as relaxation procedures. Therapy was evaluated on the basis of the German Pain Questionnaire. RESULTS: After the treatment interval, the following statistically significant improvements were recorded: The average pain intensity decreased by 29.95 points (standard deviation [SD] = 20.61). General quality of life (Marburg questionnaire on habitual well-being, MFHW) increased by 1.1 points (SD = 0.73). The depression and anxiety assessment decreased by 2.56 (SD = 3.99) and 2.63 points (SD = 5.21) respectively. CONCLUSION: A multimodal therapy concept with a manual therapeutic treatment focus can lead to an improvement in pain symptoms and quality of life in patients with myofascial chronic pelvic pain after a treatment period of 120 days. Myofascial syndromes of urogenital muscles must be considered in the assessment of the cause of chronic pelvic pain.

Relationships between body temperatures and inflammation indicators under physiological and pathophysiological conditions in pigs exposed to systemic lipopolysaccharide and dietary deoxynivalenol.

We studied the constancy of the relationship between rectal and intraabdominal temperature as well as their linkage to inflammatory markers (leucocyte counts, kynurenine-to-tryptophan ratio (Kyn-Trp ratio), tumour necrosis factor alpha (TNF-α) in healthy and in pigs exposed to lipopolysaccharide (LPS) and/or deoxynivalenol (DON). Barrows (n = 44) were fed 4 weeks either a DON-contaminated (4.59 mg DON/kg feed) or a control (CON) diet and equipped with an intraabdominal temperature logger and a multicatheter system (V.portae hepatis, V.lienalis, Vv.jugulares) facilitating infusion of 0.9% NaCl (CON) or LPS (7.5 µg/kg BW) and simultaneous blood sampling. Body temperatures were measured and blood samples taken every 15 min for leucocyte counts, TNF-α and Kyn-Trp ratio. Combination of diet and infusion created six groups: CON_CONjug .-CONpor. , CON_CONjug. -LPSpor. , CON_LPSjug. -CONpor. , DON_CONjug. -CONpor. , DON_CONjug. -LPSpor. , DON_LPSjug. -CONpor. . The relationship between both temperatures was not uniform for all conditions. Linear regression revealed that an intraabdominal increase per 1°C increase in rectal temperature was ~25% higher in all LPS-infused pigs compared to NaCl-infusion, albeit diet and site of LPS infusion modified the magnitude of this difference. Inflammatory markers were only strongly present under LPS influence and showed a significant relationship with body temperatures. For example, leucocyte counts in clinically inconspicuous animals were only significantly correlated to core temperature in DON-fed pigs, but in all LPS-infused groups, irrespective of diet and temperature method. In conclusion, the gradient between body core and rectal temperature is constant in clinically inconspicuous pigs, but not under various pathophysiological conditions. In the latter, measurement of inflammatory markers seems to be a useful completion.

[Treatment of myofascial lumbar dorsal pain. Effective clinical diagnostics and therapy]. / Die Behandlung myofaszialer lumbaler Rückenschmerzen. Effektive Diagnostik und Therapie.

BACKROUND: Lumbar dorsal pain is a problem that must be taken seriously and is part of many people's everyday lives. Not only does it cause high costs for the health system, it also frequently leads to inability to work. The significance of the myofascial system is still not taken seriously enough in therapy and clinical diagnostics, when treating dorsal pain. In the following article, the effectiveness of specifically targeted therapy for myofascial pain is evaluated. METHODS: Included in the study were 44 patients referred for lumbar dorsal treatment-resistant pain to a practice specializing in pain therapy. Therapy focused on treatment of the affected muscle area with physiotherapy and the additional techniques of infiltrating trigger points, neural therapy, and general relaxation exercises. Medication was optimized according to the specific guidelines for the condition. The effect of therapy was evaluated using the German pain questionnaire (Deutsche Schmerzfragebogen). RESULTS: After the therapy phase, patients had a significantly lower intensity of pain, anxiety, and depression, as well as an increased quality of life. CONCLUSION: The results indicate that targeted treatment of muscles and fascia in patients with chronic back pain can lead to a reduction of pain symptoms. The consideration of the myofascial systems, particularly in relation to nonspecific back pain, could contribute to improving the treatment of pain and contribute to lowering costs.

Beyond the microcirculation: sequestration of infected red blood cells and reduced flow in large draining veins in experimental cerebral malaria.

Sequestration of infected red blood cells (iRBCs) in the microcirculation is a hallmark of cerebral malaria (CM) in post-mortem human brains. It remains controversial how this might be linked to the different disease manifestations, in particular brain swelling leading to brain herniation and death. The main hypotheses focus on iRBC-triggered inflammation and mechanical obstruction of blood flow. Here, we test these hypotheses using murine models of experimental CM (ECM), SPECT-imaging of radiolabeled iRBCs and cerebral perfusion, MR-angiography, q-PCR, and immunohistochemistry. We show that iRBC accumulation and reduced flow precede inflammation. Unexpectedly, we find that iRBCs accumulate not only in the microcirculation but also in large draining veins and sinuses, particularly at the rostral confluence. We identify two parallel venous streams from the superior sagittal sinus that open into the rostral rhinal veins and are partially connected to infected skull bone marrow. The flow in these vessels is reduced early, and the spatial patterns of pathology correspond to venous drainage territories. Our data suggest that venous efflux reductions downstream of the microcirculation are causally linked to ECM pathology, and that the different spatiotemporal patterns of edema development in mice and humans could be related to anatomical differences in venous anatomy.

Deoxynivalenol triggers the expression of IL-8-related signaling cascades and decreases protein biosynthesis in primary monocyte-derived cells.

Humans and their immune system are confronted with mold-contaminated food and/or mold-contaminated air in daily life and indoor activities. This results in metabolic stress and unspecific disease symptoms. Other studies provided evidence that exposure to mold is associated with the etiology of allergies. Deoxynivalenol (DON) is of great concern due to its frequent occurrence in toxically relevant concentrations. The exposure to this toxin is a permanent health risk for both humans and farm animals because DON cannot be significantly removed during standard milling and processing procedures. However, the direct effect on immunity or hematology is poorly defined because most investigations could not separate the effect of DON-contaminated feed intake. Due to the widespread distribution of DON after rapid absorption, it is not surprising that DON is known to affect the immune system. The immune system of the organism has one important function, to defend against the invasion of unknown substances/organisms. This study shows for the first time a synergistic effect of both-low physiological DON-doses in combination with low LPS-doses with the focus on the IL-8 expression on protein and RNA level. Both doses were found in vivo. IL-8 together with other anorectic cytokines like IL-1ß can affect the food intake and anorexia. We could also show that a calcium-response is not involved in the increased IL-8 production after acute DON stimulation with high or low concentrations.

Deoxynivalenol affects cell metabolism in vivo and inhibits protein synthesis in IPEC-1 cells.

Deoxynivalenol is present in forage crops in concentrations that endanger animal welfare but is also found in cereal-based food. The amphipathic nature of mycotoxins allows them to cross the cell membrane and interacts with different cell organelles such as mitochondria and ribosomes. In our study, we investigated the gene expression of several genes in vivo and in vitro that are related to the metabolism. We observed a significantly higher COX5B and MHCII expression in enterocytes of DON-fed pigs compared to CON-fed pigs and a marked increase in GAPDH and SLC7A11 in DON-fed pigs, but we could not confirm this in vitro in IPEC-1. In vitro, functional metabolic analyses were performed with a seahorse analyzer. A significant increase of non-mitochondrial respiration was observed in all DON-treatment groups (50-2000 ng/mL). The oxygen consumption of cells, which were cultured on membranes, was examined with a fiber-glass electrode. Here, we found significantly lower values for DON 200- and DON 2000-treatment group. The effect on ribosomes was investigated using biorthogonal non-canonical amino acid tagging (BONCAT) to tag newly synthesized proteins. A significantly reduced amount was found in almost all DON-treatment groups. Our findings clearly show that apical and basolateral DON-treatment of epithelial cell layer results in decreasing amounts of newly synthesized proteins. Furthermore, our study shows that DON affects enterocyte metabolism in vivo and in vitro.

Dietary fiber and its role in performance, welfare, and health of pigs.

Dietary fiber (DF) is receiving increasing attention, and its importance in pig nutrition is now acknowledged. Although DF for pigs was frowned upon for a long time because of reductions in energy intake and digestibility of other nutrients, it has become clear that feeding DF to pigs can affect their well-being and health. This review aims to summarize the state of knowledge of studies on DF in pigs, with an emphasis on the underlying mode of action, by considering research using DF in sows as well as suckling and weaned piglets, and fattening pigs. These studies indicate that DF can benefit the digestive tracts and the health of pigs, if certain conditions or restrictions are considered, such as concentration in the feed and fermentability. Besides the chemical composition and the impact on energy and nutrient digestibility, it is also necessary to evaluate the possible physical and physiologic effects on intestinal function and intestinal microbiota, to better understand the relation of DF to animal health and welfare. Future research should be designed to provide a better mechanistic understanding of the physiologic effects of DF in pigs.

Air-liquid interface cultures enhance the oxygen supply and trigger the structural and functional differentiation of intestinal porcine epithelial cells (IPEC).

The specific function of the epithelium as critical barrier between the intestinal lumen and the organism's internal microenvironment is reflected by permanent maintenance of intercellular junctions and cellular polarity. The intestinal epithelial cells are responsible for absorption of nutritional components, facing mechanical stress and a changing oxygen supplementation via blood stream. Oxygen itself can regulate the barrier and the absorptive function of the epithelium. Therefore, we compared the dish cell culture, the transwell-like membrane culture and the oxygen enriched air-liquid interface (ALI) culture. We demonstrated strong influence of the different culture conditions on morphology and function of intestinal porcine epithelial cell lines in vitro. ALI culture resulted in a significant increase in cell number, epithelial cell layer thickness and expression as well as apical localisation of the microvilli-associated protein villin. Remarkable similarities regarding the morphological parameters were observed between ALI cultures and intestinal epithelial cells in vivo. Furthermore, the functional analysis of protein uptake and degradation by the epithelial cells demonstrated the necessity of sufficient oxygen supply as achieved in ALI cultures. Our study is the first report providing marked evidence that optimised oxygen supply using ALI cultures directly affects the morphological differentiation and functional properties of intestinal epithelial cells in vitro.

M cells in Peyer's patches of the intestine.

M cells are specialized epithelial cells of the mucosa-associated lymphoid tissues. A characteristic of M cells is that they transport antigens from the lumen to cells of the immune system, thereby initiating an immune response or tolerance. Soluble macromolecules, small particles, and also entire microorganisms are transported by M cells. The interactions of these substances with the M cell surface, their transcytosis, and the role of associated lymphoid cells are reviewed in detail. The ultrastructure and several immuno- and lectin-histochemical properties of M cells vary according to species and location along the intestine. We present updated reports on these variations, on identification markers, and on the origin and differentiation of M cells. The immunological significance of M cells and their functional relationship to lymphocytes and antigenpresenting cells are critically reviewed. The current knowledge on M cells in mucosa-associated lymphoid tissues outside the gut is briefly outlined. Clinical implications for drug deliver, infection, and vaccine development are discussed.

Deoxynivalenol, but not E. coli lipopolysaccharide, changes the response pattern of intestinal porcine epithelial cells (IPEC-J2) according to its route of application.

The porcine intestinal epithelium is a primary target for mycotoxin deoxynivalenol (DON) and lipopolysaccharides (LPS). Although epithelial cells are exposed to these toxins mainly from the luminal-chyme compartment an exposure from the blood side resulting from systemic absorption cannot be excluded. Thus, we investigated the effect of DON and LPS, alone or combined, on porcine intestinal epithelial cells IPEC-J2 on a transcriptional, translational and functional level when administered either from apical or basolateral. IPEC-J2 cells were cultured on 12-well inserts in complete medium at 5% CO2 and 39°C and subjected to following treatments: control (CON), 2000 ng/mL DON, 1 µg/mL LPS or DON+LPS for 72 h, either from apical or basolateral. Transepithelial electrical resistance (TEER), protein and IL-8 content were measured and microarray analysis, qRT-PCR (IL-8, zonula occludens-1 ZO-1, ß-actin), Western Blot (ZO-1, ß-actin) and immunofluorescence (ZO-1) were performed. Data of at least three independent experiments were analysed with ANOVA and Dunnett's post hoc test. Basolateral DON resulted in significantly lower cell counts (p<0.05) with larger cells (p<0.01), whereas apical DON reduced total (p<0.001) and specific protein content (IL-8 content CON vs. DON: 2378 pg/3 mL vs. 991 pg/3 mL; p<0.001). Transcripts of ß-actin and ZO-1 were significantly upregulated in response to DON, irrespective of direction, whereas IL-8 mRNA remained unaffected. However, ZO-1 spatial distribution in the tight junction and its function (TEER) were detrimentally affected by basolateral DON only. In conclusion, direction of DON exposure affected IPEC-J2 differently on a translational and functional level, but was mainly inconsequential on a transcriptional level.

Regeneration of implanted splenic tissue in the rat: re-innervation is host age-dependent and necessary for tissue development.

The loss of spleen may lead to fatal bacterial infections. To prevent this, splenic autotransplantation has been performed in humans and experimental animals. However, there is still controversy about the protective function of this procedure. Since innervation plays an important role in splenic function, we investigated whether splenic regenerates are re-innervated, and whether this depends on the donor and host age. Splenic tissue (30 mg) was implanted into the greater omentum of either young (2 days) or old (12 months) rats, from either young or old syngeneic animals. After 3 months of regeneration, the weight of the regenerates was determined, PGP+ nerve fibers were revealed by immunohistology, and subdivided into nerve fibers of sympathetic (TH+, NPY+) or sensory (SP+, CGRP+) origin. In addition, proliferating (Ki-67 proliferation antigen+) and apoptotic cells (TUNEL technique+) were likewise investigated. No innervation of splenic regenerates was observed after implantation into old hosts, correlating with poorly developed splenic compartments. In contrast, almost normal re-innervation occurred in young hosts after implantation of both young and old splenic tissue. These regenerates showed well-developed splenic compartments and a normal number and tissue distribution of proliferating and apoptotic cells. However, after the implantation of young tissue, the final size of splenic regenerates was three times larger (140 +/- 30 vs. 40 +/- 10 mg). Thus, re-innervation of splenic implants is necessary for their subsequent development. It is determined by host age, whereas the final size of the splenic regenerates is regulated by donor age-dependent factors. This model is useful for studying both the process leading to initial innervation and the consequences of this innervation.

Quantification of B, T and null lymphocyte subpopulations in the blood and lymphoid organs of the pig.

Research on the pig's immune system is not only of general biological interest; the pig is also becoming more important as a large animal model in human biomedical research, e.g. as a donor for xeno-transplantation. With the increasing panel of monoclonal antibodies against porcine lymphocyte markers it is possible to gain more insight into the distribution and phenotype of lymphocyte subpopulations in the pig. In this study we investigated B cells (surface IgG: sIgG, sIgM and sIgA) and T cells (CD2, CD4, CD8, 8/1, MAC320) in the peripheral blood (pBL), thymus, spleen, tonsil, mesenteric and inguinal lymph nodes (mLN, iLN), jejunal and ileal Peyer's patches (jejPP, ilPP) in Göttingen minipigs. A flow cytometric technique was employed which enabled three color indirect immunofluorescence. B cell stained for surface IgG and surface IgA were found only in small percentages. Surface IgM positive cells were distributed at higher rates, with up to 24.9% in the iLN. Up to 64.2% of CD4+ and up to 73.1% of CD8+ cells were observed in the thymus. Most of the CD4+ cells were CD4/CD8 double positive cells. These cells were mostly triple positive in combination with CD2. A larger fraction of CD2- were CD8- which are taken to be NK cells. MAC320, a marker for a subtype of gamma/delta T cells, was predominantly found on cells in the pBL. The standardized flow cytometric technique produced comparable data on the distribution of major lymphocyte subpopulations in the blood and different lymphoid organs of the pig. The results provide a basis for future studies using the pig as animal model.

Jejunal and ileal Peyer's patches in pigs differ in their postnatal development.

The postnatal development of the jejunal and ileal Peyer's patches was studied before and after weaning in 1-, 1.5- and 2-month-old pigs. The follicles of the jejunal Peyer's patches grew with age and were two times longer and wider in specified pathogen-free and conventional pigs than in germ-free animals, thus indicating an influence of the living microbial antigens from the gut lumen. In germ-free pigs the size of the ileal Peyer's patch follicles increased between the 1st and 2nd month, whereas in the specified pathogen-free and conventional animals these follicles were comparable in size in all three age groups. In 1- to 1.5-month-old pigs the interfollicular area of jejunal Peyer's patches was wider (0.1 +/- 0.04 mm) than that of the ileal Peyer's patch (0.04 +/- 0.03 mm). Immunohistological studies showed that in germ-free pigs preferentially surface IgM+ but few IgA+ B cells were present in the follicles, domes and dome epithelia. In specified pathogen-free and conventional pigs the B cells expressed different levels of surface or cytoplasmic IgM or IgA. In all groups studied, more T cells were observed in the jejunal than in the ileal Peyer's patch. Here, few T lymphocytes were found because of the small interfollicular areas. Small numbers of Null cells were distributed in the interfollicular regions of all animals. The results show that living microbial antigens have a major influence on the jejunal and ileal Peyer's patches in pigs. The morphological differences between the two types of Peyer's patches are an indication that they develop differently during postnatal life. So far it remains unclear whether these morphological differences reflect a specific function of the pig's ileal Peyer's patch, such as the expansion of the genetically determined B cell repertoire as has been reported for sheep.

Postnatal development of lymphocyte subsets in different compartments of the small intestine of piglets.

In contrast to rodents, all compartments of the porcine small intestine contain lymphoid cells at birth. During the first few days of life maternal antibodies and leukocytes are taken up by the intestinal epithelium. The number of intraepithelial lymphocytes (IEL) increases by a factor of 12 from Day 1 to Day 60, but in germfree pigs only a minor increase is observed. Immediately after birth, low numbers of T cells are present in the small intestinal lamina propria (LP), and many of these express neither CD4 nor CD8 on their surface. This type of subset composition is still present in germfree pigs at an age of 1.5 months. The appearance of IgA+ and IgM+ lymphocytes in the LP differs. Many more of these B cells are found in the LP of the crypts than of the villi. The development of the discrete jejunal Peyer's patches (PP) differs from that of the continuous PP in the terminal ileum. The lymphocyte subset composition shows the most obvious differences between conventional and germfree piglets and between the jejunal and ileal PP at an age of 1.5 months. Several markers, e.g. for antigen-presenting cells, memory T cells, M cells in the domes of PP, have recently become available for the pig. These should now be applied in experiments on pigs in the early postnatal period to study the mechanisms of the development of tolerance and protective immune reactions.

Lymphocyte migration in the intestinal mucosa: entry, transit and emigration of lymphoid cells and the influence of antigen.

Lymphocyte migration is important to transport immunological information between the different compartments of the intestinal immune system. Large numbers of lymphocytes emigrate from the Peyer's patches and reach the blood circulation after expansion and maturation within the mesenteric lymph nodes. So far the frequency of antigen specific lymphocytes emigrating from the Peyer's patches after oral stimulation is not known. After mesenteric lymph node resection those cells emigrating from the intestinal wall are accessible by calculating the major intestinal lymph duct. The first antigen specific cells draining from the intestines are obviously not lymphocytes but dendritic cells, thus the antigen is rapidly trapped in the parenchyma of the lymph nodes in vivo. When lymphocytes were taken from intestinal lymph, labeled in vitro and retransfused, marked numbers of B-cells were re-detected in intestinal lymph. Later preferentially T-cells recirculated through the gut wall. After immigration into the intestinal lamina propria the lymphocytes may enter the space between epithelial cells, where they are present as intraepithelial lymphocytes. Lymphoid cells in the S-phase of the cell cycle have been detected in all compartments of the intestinal wall. Apoptosis is probably a further important mechanism for the regulation of intestinal immunity in removing cells reacting against harmless dietary antigens to maintain oral tolerance.

Contribution of serum IgA to intestinal lymph IgA, and vice versa, in minipigs.

Immune cells in pig gut lymph are rather well studied, but data on gut lymph immunoglobulins and their origin are nonexistent. Such data are important to understand the interplay between pig systemic and intestinal immunity as a basis for vaccination studies. In some species, gut lymph contributes much to plasma IgA, but apparently not in humans. To estimate the contributions of pig serum IgA to intestinal lymph IgA and vice versa, concentrations of IgA, IgG, IgM, albumin, haptoglobin, C3 and alpha 2-macroglobulin were measured by radial immunodiffusion in paired porcine intestinal lymph and serum samples. All proteins, except IgA, had lymph/serum ratios (< 1.0) inversely related to their size, depending on passive diffusion from serum. The mean lymph/serum ratio of IgA was 2.2 instead of an expected 0.50 or 0.65 (dimer or monomer, respectively), indicating that of the IgA in gut lymph, 22.7 or 29.5% came from serum, vs 77.3 or 70.5% from the intestine. Percentage of polymeric IgA, measured by gelfiltration and corrected radial immunodiffusion, was 64.3% in porcine mesenteric lymph and 47.3% in serum. As the pig plasma volume and daily gut lymph flow into circulation were known, it could be calculated that roughly 31% of the total plasma IgA originated daily from local intestinal synthesis, reaching blood via mesenteric lymph.

Many newly formed T lymphocytes leave the small intestinal mucosa via lymphatics.

The results show that 50% of the IgA+ and 25% of the IgM+ cells that leave the gut are newly formed BrdU+ cells. However, in absolute numbers the BrdU+Ig+ lymphocytes are the smaller cell pool in the afferent lymph, 2 to 3 times more newly formed T cells were observed. The function of this unexpectedly large pool of newly formed T lymphocytes in oral immunity or tolerance has to be clarified. In a recent study Dunkley and Husband reported that non-B cells play an important role for the localization of plasma cell precursors in the lamina propria of the mucosa. So far it is unknown where the pool of newly formed T and Ig+ lymphocytes comes from. Partially they are produced in the PP. However, they may have their origin in the lamina propria of the mucosa as well as in other organs of the body. Further studies are necessary to characterize the origin and the function of the large numbers of newly produced T lymphocytes in the intestinal lymph.

The pig as a model of developmental immunology.

There are many limitations to analyse the developing immune system in humans, thus there is need for experimental animal models to study the environmental influences during the ontogeny of the immune system. However risk assessment is difficult in using rodent models alone, especially as the intrauterine period of development is much shorter than that of humans. In addition to studies in dogs, the pig provides a variety of experimental approaches for developmental immunotoxicology. The gestation period is 115 days and the occurrence of the different lines of T and B lymphocytes in the blood and organs of the porcine embryo and fetus is well documented. Fetal porcine B cells represent a naive population developing without maternal idiotypic-antiidiotypic influences. The postnatal development is highly correlated to sufficient uptake of colostrum during the first 48 hours. Although many immunotoxicological experiments have been performed, there is a limited number of original publications about these studies. With the different strains of standard pigs and miniature pigs available and the rapid growing amount of immunological reagents, the pig represents an important experimental model for cost-effective studies in developmental immunotoxicology to analyse the risk of environmental hazards.

Evaluation of the medical curriculum: why, when, by whom and for whom should questionnaires be used.

The undergraduate medical curriculum has been modified or even totally reorganized in many countries in recent years, and there are plans to make departmental budgets and the salaries of university professors partially dependent on the outcome of teaching. Questionnaires are often used in such situations as a means of curriculum evaluation. Based on our own experience such evaluations should be done not only during and immediately after a course in the curriculum, but also at later time points, e.g., at the end of the undergraduate and also the postgraduate phase. The clinical relevance of lectures and courses can only be graded adequately after some years of clinical experience. Gross anatomy was graded top at all time points evaluated and reached higher levels of 'clinical relevance' than other typical preclinical and even clinical subjects. Efforts should be made to obtain a high response rate for representative results. After modifying parts of a course detailed questionnaires should also include space for students' suggestions. The results of such evaluations are not only relevant to the head of department as feedback on the individual lecturers but also important for the curriculum committee and the dean. Anatomists should utilize these evaluations to improve teaching.

Autotransplantation of lymph node fragments. Structure and function of regenerated tissue.

In pigs slices of autologous lymph nodes were implanted in the subcutaneous fat, under the muscular fascia or under the kidney capsule to study the regeneration of autotransplanted lymph node tissue. The regenerated nodules consisted of all the normal compartments found in lymph nodes and there was evidence that afferent lymphatics reached these nodules. Superficial inguinal lymph nodes regenerated more often and with a better structure than mesenteric lymph nodes. The sites under the kidney capsule and the fascia of muscles were found to be a less stimulating microenvironment for regeneration than the subcutaneous tissue. Regeneration of transplanted lymph node tissue was observed in pigs which had been operated on as young piglets or as adults. The regeneration of autotransplanted lymph node tissue might be a useful model for draining lymphedema, especially from the extremities.