Basophils Trigger Fibroblast Activation in Cardiac Allograft Fibrosis Development.

Fibrosis is a major component of chronic cardiac allograft rejection. Although several cell types are able to produce collagen, resident (donor-derived) fibroblasts are mainly responsible for excessive production of extracellular matrix proteins. It is currently unclear which cells regulate production of connective tissue elements in allograft fibrosis and how basophils, as potential producers of profibrotic cytokines, are involved this process. We studied this question in a fully MHC-mismatched model of heart transplantation with transient depletion of CD4(+) T cells to largely prevent acute rejection. The model is characterized by myocardial infiltration of leukocytes and development of interstitial fibrosis and allograft vasculopathy. Using depletion of basophils, IL-4-deficient recipients and IL-4 receptor-deficient grafts, we showed that basophils and IL-4 play crucial roles in activation of fibroblasts and development of fibrotic organ remodeling. In the absence of CD4(+) T cells, basophils are the predominant source of IL-4 in the graft and contribute to expansion of myofibroblasts, interstitial deposition of collagen and development of allograft vasculopathy. Our results indicated that basophils trigger the production of various connective tissue elements by myofibroblasts. Basophil-derived IL-4 may be an attractive target for treatment of chronic allograft rejection.

Anomalous origin of the left thyrocervical trunk as a cause of residual pain after myocardial revascularization with internal mammary artery.

A patient with successful implantation of an internal mammary artery graft in the left anterior descending coronary artery complained of residual but different anginal pain after operation. Ischemia was demonstrated during a manual stress test. Angiography revealed anomalous origin of the thyrocervical trunk from the internal mammary artery. Angina and ischemia disappeared after the trunk was ligated.

Evidence for posttranscriptional stimulation of monoclonal antibody secretion by L-glutamine during slow hybridoma growth.

The addition of 5-40 mM L-glutamine to batch cultures of a murine hybridoma following the cessation of rapid growth significantly stimulated monoclonal antibody (mAb) synthesis and secretion per cell. Stimulation of mAb secretion following the cessation of rapid growth was also observed in response to addition of mitochondrial intermediates of glutamate oxidation and was not found to be the result of release of transiently stored mAb. Less than 1% of the secreted mAb was detected by ELISA in isolated hybridoma lysosomes. This stimulation was posttranscriptional and not the result of enhancement of levels of mAb mRNAs or stabilization of heavy (H) or light (L) chain encoding message. Sub-inhibitory levels of lysosomotrophic weak bases stimulated release of lysosomal contents but did not result in release of intact or partially degraded mAb. Inhibition of aspartic proteinase activity secreted by the hybridoma did not enhance mAb secretion even though a high level of mAb degrading proteinase activity was continuously secreted during both rapid and slow growth. These responses indicate that during slow growth, the addition of L-glutamine increases the availability of cellular ATP generated by mitochondrial respiration which stimulates some posttranscriptional step in the pathway of mAb secretion such as the rate of H or L chain translation, chain assembly, interorganelle transport or vesicular transport from the Golgi to the cell membrane.

Effect of phosphate deficiency on pulp alkaline phosphatase and Ca2+-, Mg2+-ATPase activity in rats.

Phosphate deficiency imposed on weanling rats for two wk resulted in a 40% increase in alkaline phosphatase activity of incisor pulp, without a significant change in Ca2+-, Mg2+-ATPase activity. The results are consistent with a separate identity for the two enzymes, but their physiological roles remain obscure.

Assessment of stenoses in coronary angioplasty. Inter- and intraobserver variability.

Three observers twice assessed coronary artery lesions of 10 patients in three oblique views using the films obtained before, immediately after, and six months after percutaneous transluminal coronary angioplasty. In order to improve accuracy of the interpretation, the stenoses were traced from the cine projector and the diameters measured with a calibrated magnifying glass. Interobserver and intraobserver variability of the commonly used method assessing only the projection showing the most severe stenosis was compared to that of a method assessing the mean of three projections. The interobserver coefficients of variation were 7.0% for using the one projection showing the most severe stenosis and 6.4% for using the mean of three projections (not significant). The intraobserver coefficient of variation was significantly reduced from 16.0 to 10.5% (P less than 0.0001) by using the mean of three projections. The assessment of three projections instead of one justifies the additional time needed by significantly increasing assessment reliability which is of great importance in evaluating and comparing anatomical results of percutaneous transluminal coronary angioplasty.

1.5 T MRI, CT, ultrasonography and scintigraphy in hyperparathyroidism.

The enlarged parathyroid glands of twenty-four patients with primary, and 5 with tertiary, hyperparathyroidism were prospectively studied with MRI, CT, ultrasonography and subtraction scintigraphy prior to surgery. Sensitivities in a prospective study were 63, 60, 53 and 44% for the primary, and 71, 67, 44 and 11% for the tertiary, disease form. On MRI, diseased parathyroids showed the "typical" behaviour of tumours with high signal intensity on T2-weighted and low signal intensity in T1-weighted images. On CT, the lesions were hypodense and on US hypoechoic relative to the thyroid. Retrospective analysis of MRI and CT images yielded sensitivities of 87 and 85%, respectively.

A comparison of bone loss from different skeletal sites during acute calcium deficiency in mice.

Severe Ca deficiency was produced by the combined stresses of a Ca-deficient diet and lactation in female mice. Alveolar bone loss was assessed by changes in alveolar crest height and in quantity of supporting trabecular bone. Changes in the femur were measured by changes in mineral content and in the cross-sectional area of the midshaft region, and in vertebrae by changes in mineral content. A similar decrease in bone was observed in all sites during progression of Ca deficiency with a similar increase during recovery. Maximum bone loss amounted to more than 50 per cent. Alveolar bone loss was characterized by a reduction in trabecular bone without loss of alveolar crest height.

[Bi-ventricular endo-myocardial fibrosis (author's transl)]. / Biventrikuläre Endomyokardfibrose.

Bi-ventricular endo-mycardial fibrosis was diagnosed in two European women. Clinically there was severe cardiac insufficiency in the presence of only moderate radiological cardiac enlargement. Haemodynamically there was restricted filling, but otherwise normal systolic ventricular function. The diagnosis depended on the angio-cardiographic demonstration of a small, globular left ventricular chamber with a tubular narrowed right ventricle with a thickened wall, particularly at the apex. In one patient the endo-myocardial fibrosis was also demonstrated by echocardiography.

Clip stenosis--a hazard of incorrectly prepared saphenous vein bypass grafts to coronary arteries.

During the routine review of control follow-up cinéangiograms taken of patients after aorto-coronary bypass grafting, the authors noted a number of vein graft stenoses of varying severity. All stenoses were in the segment of vein away from the aortic or coronary anastomoses, but were clearly at the site of a steel clip used to occlude side branches during preparation of the vein graft. The incidence was too high to be related to chance, and in some cases the intrusion of the clip upon the lumen was obvious. Suggestions are made to eliminate the occurrence of this iatrogenic stenosis.

[Coronary angiography in constrictive pericarditis (author's transl)]. / Koronarangiographische Befunde bei Pericarditis constrictiva.

Normally, systolic movement of the coronary arteries results in, 1) shortening in length, thereby increasing tortuosity, and 2) movement of the arteries towards each other. In ten patients with constrictive pericarditis, several sections of the vessels were fixed. Vascular fixation was also observed in nine out of ten patients after aorto-coronary bypass operations, but only in right ventricular branches. Decreased movement of the coronary arteries was found in occasional cases of congestive cardiomyopathy with large ventricles and reduced ejection fractions, and sometimes in akinesia of the myocardium, due to coronary sclerosis. Fixation of several coronary branches can therefore contribute to the diagnosis of constrictive pericarditis.

[Vascular dilatations in the coronary angiogram]. / Gefässerweiterungen im Koronarangiogramm.

Amongst 166 patients with aneurysms, ectasia or megaloarteries shown on coronary angiograms, 86.1% had dilated vessels as part of generalised coronary sclerosis (usually in patients with three-vessel disease). In 9%, dilatation was of iatrogenic origin and in 4.8% it was idiopathic. One patient had Marfan's syndrome. Amongst 9 000 patients, there were eight with megalo-arteries without stenosis; six of these had atypical angina and three suffered an infarct. Patients with definite dilatation of the coronary artery and stagnation of contrast flow required treatment.

[Computerized tomography and sonography in the diagnosis of recurrent colorectal tumors]. / Computertomographie (CT) und Sonographie (US) in der Rezidivdiagnostik kolorektaler Tumoren.

CT and ultrasound of the abdomen were retrospectively evaluated in 44 patients operated on colorectal cancers (18 colon, 26 rectal carcinomas) in detecting a recurrence suspected on biochemical, endoscopic or clinical grounds. CT is superior to ultrasound in detecting a recurrence (metastases of liver and lymph nodes, local recurrence, intra-abdominal recurrence of another localisation). CT is recommended as a routine examination in the follow-up of patients operated on colorectal cancers.

[Heart luxation following pneumonectomy]. / Herzluxation nach Pneumonektomie.

A herniation (with torsion) of the heart trough a dehiscent pericardial suture was observed on the second postoperative day after right-sided pneumonectomy, when shock symptoms developed. Chest x-ray was diagnostic and lead to rethoracotomy with successful reposition of the heart.--Another case showed an atypical bulge of the heart contour after pneumonectomy with partial pericardial resection. It was caused by pericardial fat, sutured on the defect for occlusion.

[Coronary fistulae (author's transl)]. / Beitrag zur Kenntnis der Koronarfisteln

Three patients with coronary fistulae are described, including one patient with a rare coronary-pulmonary double fistula. The clinical features, diagnostic aspects and radiological signs are reviewed.

[Echinococcus of the heart. Infundibular pulmonary stenosis due to a large solitary cyst of the ventricular septum (author's transl)]. / Beitrag zur Echinokokkuserkrankung des Herzens. Infundubuläre Pulomnalstenose durch grosse solitäre Zyste im Ventrikelseptum

An echinococcus cyst in the ventricular septum is described, which produced an infundibular pulmonary stenosis. Following angiography, surgical intervention could be accurately planned and proved successful. The incidence, course, radiological features and diagnosis of cardiac echinococcus are reviewed.

[Cranial and caudal projections for coronary angiography (author's transl)]. / Kraniale und kaudale Projektionen bei der Koronarangiographie.

Cranial and caudal projections are a simple method for improving the diagnosis of coronary stenoses. In 20 cases out of 100 unselected coronary angiograms, the cranial projection showed stenoses to be more severe than had been demonstrated by the standard projection, or revealed them for the first time.

[Unusual radiological findings after surgically treated constrictive pericarditis]. / Ungewöhnliche radiologische Befunde bei operierter Pericarditis constrictiva.

The radiological findings in three patients who had had surgery for constrictive pericarditis are reported: 1. acute myocardial dilatation after pericardectomy for constrictive pericarditis, with good restitution of ventricular function; 2. abnormal ventricular appearances after pericardial resection during childhood; 3. diastolic prolapse of the cardiac apex after fenestration of the pericardium.

[Extrapancreatic organ manifestations of pancreatic pseudocysts]. / Extrapankreatische Organmanifestationen von Pankreaspseudozysten.

Hepatosplenomegaly is seldom caused by cystic tumefactions. 4 cases are presented, in which pseudocysts of the pancreas invaded and enlarged the spleen or liver.

[Aneurysm of the membranous septum. Angiocardiographic study]. / Das Aneurysma des Septum membranaceum. Eine angiokardiographische Studie.

Amongst 9000 patients on whom angiocardiograms had been carried out, a membranous septum aneurysm (MSA) was found in 47. In nine patients out of 27 the MSA could be demonstrated by sonography. The most common abnormalities accompanying this lesion were disturbances in rhythm and conduction (in 29 patients), ventricular septal defect in 29 and aortic insufficiency in 14. Complications included bacterial endocarditis in five patients (three with aortic insufficiency and two with sepsis lenta), aortic insufficiency (which was not of rheumatic or bacterial origin in three patients with conduction defects) and thirteen patients with abnormalities of cardiac rhythm with small VSDs.

[Large solitary aneurysm of the left coronary artery. Plain films and angiography (author's transl)]. / Grosses solitäres Aneurysma der linken Koronararterie Thoraxröntgenbild und Angiographie

The diagnosis of coronary aneurysms has for a long time been made at autopsy. After a general review of coronary artery aneurysms, a large aneurysm of the circumflex branch of the left coronary is described; this was diagnosed by selective coronary angiography and successfully treated by surgery. The results are compared with six other reported cases of pre-operatively diagnosed coronary artery aneurysms. Since complications, such as rupture, embolisation or infarction, are common in large coronary aneurysms, early diagnosis is desirable. An abnormal bulge of the cardiac contour or circular calcification within or at the edge of the cardiac shadow may be suggestive of the diagnosis.