[Papillary adenoma of type-II pneumocytes as a rare differential diagnosis of a solitary pulmonary nodule]. / Papilläres Adenom der Typ-II-Pneumozyten als seltene Differenzialdiagnose eines pulmonalen Rundherdes.

The case of a 66-year-old, asymptomatic patient with a papillary adenoma of type-II pneumocytes is reported. Following the coincidental radiologic finding of a solitary pulmonary nodule, the diagnosis could be established in a bronchoscopically obtained endobronchial biopsy. A resection of the involved segments S8-10 on the left side was performed. Papillary adenoma of type-II pneumocytes is a rare tumor, whose origin is suspected in progenitor cells of the bronchioloalveolar epithelium with the potential to differentiate towards type-II pneumocytes and clara cells. The tumor is regarded as benign, however, a malignant potential is not excluded by some authors.

Comparative histological and morphometrical studies into the relevance of intimal thickening to coronary sclerosis.

It was found by comparative histological and morphometrical studies, carried out on 125 human hearts of different age (20-90 years) and sex, that there exist critical limiting ranges of intima thickness and the intima/media relationship (IMR) for diffuse intimal thickening and the preatheroma phase of arteriosclerosis. Since furthermore a maximum and a minimum intima thickness as relating to diffuse intimal thickening could be determined, it is assumed that the location and formation of arteriosclerotic plaques is determined by the degree of so-called diffuse intimal thickening. It follows from these findings that postnatal intimal proliferation represents a potential prearteriosclerotic lesion of the intima, and that progressive intimal thickening supports the arteriosclerotic alteration of the intima, leading, through an extensive necrosis of the intima, to the atheroma phase.

Failure of foreign serum injections to induce immune vasculitis and to accelerate spontaneous or cholesterol-induced atherosclerosis in swine.

Experiments were conducted with domestic swine in an attempt to accelerate and/or modify spontaneous or cholesterol-induced atherosclerosis through immune complex-produced changes in the arterial wall. For the purpose of comparison, another experiment was carried out with rabbits. Swine differed completely from rabbits in that various experimental designs failed to produce immune complex arteritis and fibroproliferative arteriosclerosis. In addition, two foreign serum infusions (human plasma and horse serum on the 30th and 60th day, respectively, 350 mg/kg foreign protein/infusion/animal) did not produce a significant effect on spontaneous arteriosclerosis and cholesterol-induced atherosclerosis (4 months atherogenic diet) in the arterial system of swine. In the aortic trifurcation, however, it was found that antigen administration slightly enhanced cholesterol-dependent atherogenesis.

Exercises illustrating flow in porous media.

A set of physically based exercises is described for illustrating concepts and processes related to fluid movement in porous media. These exercises revolve around a permeameter that costs several dollars to construct and requires no external equipment and no electrical power to operate. The exercises can be used to illustrate concepts related to pressure and fluid statics, Darcy's equation for both gases and liquids, infiltration, and flow in layered media. Although the permeameter was originally developed as a teaching aid, it may also be useful in field applications as a tool to estimate air and hydraulic conductivity. Additional testing is recommended to further assess the accuracy of the results for field applications.

[Cellular and extracellular changes in the regression of experimentally-induced arteriosclerosis and their relevance for the regression of arteriosclerosis in humans]. / Zelluläre und extrazelluläre Veränderungen bei der Regression experimentell induzierter Arteriosklerose und ihre Relevanz zur Arterioskleroseregression beim Menschen.

In a survey the essential cellular and extracellular structural changes in the regression of experimentally induced changes of the arteries and their functional importance are discussed. All animal experiments show that early changes such as lipidosis and proliferation of the intima are totally reversible and more advanced atheroma-like stages of the experimental atherosclerosis are conditionally and incompletely reversible. The endothelial cell layer, the muscle cells of the plaques and the macrophages of the plaques with different time sequence and importance for the process of regression participate in the retrogression of induced plaques. With the removal of the atherogenic factor(s), in the animal experiment mainly hypercholesterolaemia and/or mechanical lesion of the vascular wall, the repair of the endothelial cell layer, the destruction and revival of the macrophages of the plaques, the elimination of intra- and extracellularly accumulated cholesterol esters in muscle cells and macrophages, the normalisation of the cell division rate and the fibrosynthesis of plaque muscle cells. On the many respects unclarified metabolic ways plaque muscle cells and macrophages participate in the absorption of extracellular matrix. The animal experimental, fairly optimistic results must not necessarily be valid also for man. In advanced stages of the atheroma of the aged man the basic conditions of reversibility, which are guaranteed in the animal experiment, are not given.

Mononuclear cell infiltration of the aortic intima in domestic swine.

The preparation of thick endothelial "häutchen" from microscopically lipid-free areas of the thoracic and abdominal aorta of 22 domestic pigs proved that there is a surprisingly frequent penetration of mononuclear blood cells into the subendothelial space. They are deposited on the intima in a diffuse or focal distribution as dense epi-, inter- and subendothelial cell infiltrates.

Hematogenic cell infiltration of the aortic intima in normal and hypercholesterolemic swine. Studies on en face endothelium-intima preparations.

The incidence of periendothelial (epi, inter- and subendothelial) round cells in en face endothelium-intima preparations and cross-sections of swine aortas was determined. The round cell count of Sudan-positive and -negative intimal areas of thoracic and abdominal aortas of animals fed an atherogenic diet was compared with Sudan-negative areas of animals on normal food. Furthermore, spontaneous lesions at the aortic trifurcation in swine and abdominal aortic segments of humans with different stages of arteriosclerosis were studied and the aorta endothelium of normal animals was examined with a scanning electron microscope. According to these studies, round cells (monocytes or lymphocytes occur in the subendothelium as a normal constituent of the aortic intima. They are increased in spontaneous lesions and more frequent in induced fatty streaks. In swine, they participate primarily in intracellular lipid storage in Sudan-positive intimal areas. Their function in normal intima and in low-lipid intimal thickening is unknown. Similar observations were made with regard to the human abdominal aorta.

[Role of inflammatory cellular infiltrates in the pathogenesis of human coronary arteriosclerosis (author's transl)]. / Die Bedeutung von entzündlichen Zellinfiltraten für die Pathogenese der Koronararteriosklerose des Menschen.

The ramus interventricularis anterior of the arteria coronaria cordis sinistra and the initial part of the arteria coronaria cordis dextra of 125 human patients aged between 20 and 90 years were studied for the occurrence and localisation of inflammatory cellular infiltrates in the vessel walls. A correlation between a pronounced inflammatory cellular infiltration and the presence and degree of severity of coronary arteriosclerosis was established. An inflammatory or immunpathologic cause of coronary arteriosclerosis is rejected. The highest incidence of inflammatory infiltrates was observed in the adventitia within the plaque area. Isolated macrophages were found to be present in all vessel wall layers and age groups.

Erythrocytophagocytosis by arterial smooth muscle cells in experimental atherosclerosis.

The morphological examination of advanced atherosclerosis caused by atherogenic diet in the coronary arteries and in the aorta abdominalis (trifurcation) of pigs showed plaque hemorrhage and signs of vascularisation. In these areas phagocytosis of erythrocytes could be observed. The cells involved in the phagocytic process vary considerably in size and shape but show common features of arterial smooth muscle cells. The modulation of smooth muscle cells is evident and progresses as the process of phagocytosis progresses. In early stages of erythrocyte engulfment the morphological characteristics which identify these cells as of smooth muscle origin are parts of surrounding basement membrane, caveolae intracellulares and myofilaments. The authors suggest, that under certain conditions arterial smooth muscle cells participate in phagocytic processes in the injured vessel wall as potential macrophages with lysosomal enzyme adaptation. Changes in extracellular surroundings and the actual situation of the vessel wall condition seem to play an important role in the induction of phagocytosis. Relations to vascularisation processes of the arterial plaques are evident.

[Modulation and proliferation of the vessel wall muscle cell and its importance for atherogenesis]. / Modulation und Proliferation der Gefäbetawandmuskelzelle und ihre Bedeutung für die Atherogenese.

Decisive for the progression of the arteriosclerosis is the increase of thickness of the intima, as it is shown by histological and morphometrical investigations on the human coronary arteries. A light-optic and electron-optic analysis of animal-experimental, induced and spontaneous proliferations of the intima has the result that the process of progression is maintained by structural and functional variants (modulations) of the myointimal cells. Under the influence of specific and unspecific stimulators they are able to proliferation and migration, abnormal fibre synthesis and lipid storage as well as to phagocytosis and formation of boundary surfaces. Most of the modulations described of the activated muscle cell are temporary adaptations to a changed micromilieu and they are reversible to contractile cells after decrease of the stimulation effect. Therefore it is assumed that in the early stages of the arteriosclerosis a progression phase is to be diagnosed light- and electron-optically essentially at the appearance of proliferation-active and synthesis-active modulations of the smooth muscle cell. An inactive, non-progressive thickening of the intima may be diagnosed by the proof of contractile muscle cells.

[Light and electron microscopic studies on spontaneous calcifying medial sclerosis of the rabbit (author's transl)]. / Lichtmikroskopische und elekronenoptische Untersuchungen zur spontanen kalzifizierenden Mediasklerose des Kanninchens

Of 223 histologically examined aortas of rabbits 24 showed spontaneous calcifying medial sclerosis. Spontaneous lesions found in the aorta of rabbits are histologically similar to those in other mammals and experimentally induced lesions following the action of vitamin D, adrenalin and orthostatic collaps as well as lesions of the arteriopathia calcificans infantum. Pathogenetically, it is reasonable to assume that primary media cell necrosis and secondary malregeneration of smooth muscle cells account for spontaneous medial sclerosis in the rabbit. Electron microscopical examination of the lesions showed the cells within the area of the lesions to represent forms of transformation of the smooth muscle cell.

[Cause and significance of increased endothelial permeability in the development of arteriosclerosis]. / Ursachen und Bedeutung der gesteigerten Endothelpermeabilität für die Entstehung der Arteriosklerose

The above survey described the physiological and pathological transport of molecules through the arterial endothelium. The barrier function of the endothelium can be interrupted by the humoral substances and such ones be longing to the vascular wall as well as by haemodynamic stress. With the intercellular junctions being opened by destruction or contraction of the endothelium, macromolecular plasma constituents get into the subendothelium where they are retained. By this retentive effect an increased endothelial permeability causes, even with physiological plasma-lipid concentrations, an accumulation of lipoproteins and other large plasma particles in the intima and upper media. The continuous plasma insudation consequently leads to the formation of an intimal regneration tissue, the intimal proliferation. Under the conditions of pathological plasma-lipid concentrations there is to be noticed an acceleration of regeneration processes. Though the new experimental results characterize the endothelial alteration as an initial process, the individual reaction of the vascular wall forms the biochemical and structural correlate of arteriosclerosis. From the results described it can be concluded that the inhibition of permeability disturbances and the involved proliferation processes of the arterial wall as well as the prevention of a hyperlipoproteinaemia are a causative therapeutical basis of prophylaxis and metaphylaxis of arteriosclerosis.

[Electron microscopic study on the "ghost bodies" in experimental arteriosclerotic lesions of the vascular wall (author's transl)]. / Zur Frage der "ghost bodies" bei experimenteller Gefässwandschädigung

QUESTION: Details on the origin and the pathogenesis of the so-called "ghost bodies" occurring in the arteries and arterioles following experimental lesions of the vascular wall were to be studied under peculiar experimental conditions (immunological injury and cholesterol diet in combination). MATERIAL AND METHODS: The experiments were carried out on 26 young rabbits of the same race and equal sex. They were selected from several test groups with experimentally induced arteriosclerosis. For challenge of immunological injury the animals were administered 3 intracutaneous injections of each 3 ml of horse serum at intervals of one week. Afterwards they received one or two intravenous injections of 2-3 ml of horse serum at weekly intervals. Immediately after the last injection the animals were sacrificed. A series of the animals were fed a cholesterol diet for some weeks after previous immunological injury (for details see WEIDENBACH and MASSMANN 1972). From a total of 26 animals always several sections of the aorta were investigated. 5 animals were used for controls. After decapitation of the animals the aortas were removed immediately and fixed in 2.5-3% glutaraldehyde for 2 hours. Afterwards they were postfixed in 1% osmium-Millonig solution for 1 hour. After 15 min the tissue samples were washed in Tyrode solution for 15 min, dehydrated in ascendent aceton grades and contrasted in blocks in the stage of 70% aceton. After embedding in Micropal the material was sectioned by an ultramicrotome OmU2 (Fa, Reichert, Wien) and investigated in electron microscopes of the types SEM 2-3 (100 kV) or KEM 1-2 (60 kV) (VEB Werk für Fernsehelektronik Berlin-Oberschöneweide). RESULTS: Basing on their observations the authors classify as ghost bodies all cytoplasmic protrusions and all constricted extracellular structures which are limited by a membrane and filled with prevailingly filamentous-granular material (figs. 1, 2, 3), occasionaly also including fragments of cell organelles (fig. 4). They develop from cytoplasmic protrusions or bulgings of the processes of smooth muscle cells (figs. 1 and 2). In these protrusions the cytoplasm of the smooth muscle cells is loosened and of filamentous-granular appearance (fig. 1). The cells themselves show all characteristics of a modified or activated smooth muscle cell: they are branched, the organelles display marked secretory-metabolic activity associated with partical loss of the contractile elements whereas degenerative changes of these cells are nearly completely absent. Frequently focal disorganization of the cell membrane with release of the content to extracellular regions can be observed which is locally associated with the development of fibrillar structures.--In the environment of the "ghost bodies" the formation of collagenous fibres is visible (fig. 3). Degenerative changes which point to transition to necrosis can only occasionally be observed...

[On some aspects of modern research of arteriosclerosis (author's transl)]. / Uber einige Aspekte der modernen Arterioskleroseforschung.

Atherogenesis is the result of interactions of factors originating from blood stream and the reaction of the arterial wall. Basing on this we have a pathogenetic trias: blood--lining membrane--arterial wall. Under these aspects some modern trends of experimental research are discussed. An example of blood-plasmatic injury is the hyperlipidaemia. The permeability of the lining endothelium regulates the infiltration and is influenced by several factors. The reactions of the modified smooth muscle cells in the arterial wall are the most important events in early atherogenesis. The metabolic decompensation of these cells is a main factor in the transition to advanced lesions. The efficiency of the cells is the preliminary condition for the reversibility of atherosclerotic lesions. Only early stages have some chances of regression; one must bear in mind this together with all therapeutical treatments.

Immune complex induced hematogenic cell infiltration of the aortic luminal border layer in rabbits. Light microscopic studies of surface preparations.

Interendothelial and subendothelial monocytes/macrophages are extremely rare in normal rabbit aortas compared with humans and swine, as has been shown by the present study and previous investigations of surface preparations. Light microscopy was used to study the development of immune complex-induced hematogenic macrophage infiltrations in 26 rabbits from the 4th to the 28th day after the last antigen administration. Of particular interest was the intensity, localization and duration of the hematogenic cell infiltrates with a view to establishing the role of immunological stimuli for subendothelial monocyte and lymphocyte accumulation. It was found that immune complex-induced hematogenic macrophage infiltrates are very short-lived and disappear after 20-28 days following immune complex deposition. They concentrate in the ostium regions of the thoracic and abdominal aorta and are subject to flow dynamics similar to those of cholesterol-induced sudanophile lipid deposition. Subendothelial macrophage infiltrates increase the permeability of the aorta for low-molecular but not for macromolecular plasma particles, do not affect the endothelial silver line picture and do not lead to lipid accumulation.

[Prostate carcinoma (PC)--an organ-related specific pathological neoplasm]. / Prostatakarzinom (PC)--eine organspezifische Neoplasie aus der Sicht der Pathologie.

The organ- and tumour-related specific characteristics of prostate carcinoma (PC) are presented in an overview under various aspects. It is the key for understanding pathological changes, including PC, to consider the subdivision of the prostate into anatomically and functionally distinguishable zones, especially the transitional zone (TZ) and the peripheral zone (PZ). The pseudoneoplastic hyperplasia of the TZ, combined with inflammatory consequences and age-related changes, forms a differential diagnostic challenge to both clinico-radiological diagnosis and macroscopic and microscopic examination. High-degree prostatic intra-epithelial neoplasia (PIN III) and atypical adenomatous hyperplasia (AAH) are presented as precursor lesions of PC with varying significance and assessment. Moreover, there are discussed the following characteristic features of PC: localisation types, focality, volume, progression, double-graduation according to Gleason, tumour stage, and prognosis. The most important prognosis factors of PC (category I) include the categories of the TNM system, such as stage, surgical marginal situation, degree and also the preoperative PSA level as a (poor) substitute for the tumour volume. Potential prognosis parameters (category II) show the tumour volume and the DNS ploidy, while there continues to exist a large number of non-established parameters (category III). The prognostic validity of the pathological examinations depends, on the one hand, on the tissue extent (needle biopsy, transurethral resection (TURP), so-called simple prostatectomy, radical prostatectomy (RPE)) and the prostate zones covered. On the other hand, the prognostic certainty also depends on the tumour-adequate macroscopic and microscopic assessment of an RPE that can only be a partial or complete handling in transversal large-area sections.

[Diseases of the sesamoid bone of the large toe]. / Erkrankungen an den Sesambeinen der Grosszehe.

One-hundred patients with anterior foot pain were examined by tangential sesamoid x-rays and some by bone scan. Degenerative changes were present at the sesamoid joint in thirty patients. In thirty-five the sesamoids had changed position relative to the first metatarsal bone, which in all cases could be attributed to metatarsus-primus-varus. Three fractures were found. They were differentiated from congenital partitions only by bone scan. Osteomalacia of the sesamoids was observed in two patients. Operative removal was necessary in only one of all patients.

[The relationship of the macrophage system to the blood vessel wall and atherogenesis]. / Beziehungen des Makrophagensystems zur Gefässwand und Atherogenese.

Monocytes/macrophages are physiological cellular components of the subendothelium of greater arteries as has been shown by our studies on endothelial/intimal preparations of 9 species, including man. Differentiation is possible between species rich (pig, man, sheep) or poor in macrophages (rabbit and other small laboratory animals) according to their density of subendothelial infiltration in the aorta. Morphological, histochemical, and ultrastructural results have shown that we are mainly dealing with metabolic quiescent, resident macrophages, their number being regulated by influences depending on endothelium and intima factors. We assume that in species rich in macrophages and in man, they have physiological functions for homoeostasis of border layer and intima. The most considerable signal for subendothelial macrophage accumulation in man, pig, and rabbit is intimal deposition of lipids, independent of experimental or spontaneous induction. Short-term or long-term hypercholesterolemia is not associated with increased adhesion and emigration of monocytes in unchanged intima at venous or arterial endothelial cells of pigs and rabbits. There is no evidence to intimal lipid infiltration being preceded by subendothelial macrophage invasion. Most studies on vessel border layer have suggested that in the early high-lipid phase of atherogenesis subendothelial macrophages participate in lipid metabolic clearance. But in conditions of metabolic activation they can be an atherogenic danger due to a whole range of secretory products stimulating recruitment of blood monocytes and lymphocytes, increasing the permeability of endothelium, altering the extracellular matrix components, and causing modulation of gen expression of vessel wall cells. Therefore, metabolic activation of the subendothelial macrophage system is a new, potentially atherogenic mechanism.