[Double balloon enteroscopy. First surgical experience]. / Doppelballonenteroskopie in der Chirurgie. Ein erster Erfahrungsbericht.

INTRODUCTION: In Germany double balloon enteroscopy (DBE) has been used for about 4 years in diagnostics of the small intestine. Testing for the first time its value in daily surgical practice, we analyzed retrospectively the results of all DBE examinations from December 2004 to September 2006. MATERIAL AND METHODS: During the study period 106 enteroscopies were performed on 75 patients (42 males, 33 females, age 16-84 years). The approach was oral in 75 cases and anal in 31. Most indications were recurrent middle gastrointestinal bleeding. RESULTS: Complete small intestine inspection could be performed completely orally in seven of 106 examinations; and in most cases a combined oral/anal approach was required. Total endoscopy was completed in 21.3% of the patients studied. Pathologies were detected in 41 examinations (54.7%). These included 11 patients with angiodysplasias (14.7%) successfully treated with argon plasma coagulation (APC) and seven patients with small intestinal polyps (9.3%) that could be removed endoscopically. Further findings included diverticulum (6.7%), changes related to Crohn's disease (4.0%), small intestinal tumors (4.0%), extraluminar disorders (2.6%), stenoses (1.3%), and others (8.0%). Secondary diagnoses included colonic/rectal lesions in 5.3% of cases and pathologies of the stomach or esophagus in 4.0%. One patient had severe complications from a perforation following polypectomy. Therapies followed in 40.0% of all patients examined. Surgical interventions were indicated in six of 75 patients (8.0%), specifically five small intestinal resections and one bypass operation due to an infiltrating pancreas carcinoma. Endoscopic interventions were used in 25.3% of patients and medical treatment in 10.7%. CONCLUSION: With adequate indication, DBE shows very high diagnostic value. Immediate endoscopic therapy is possible in most cases, a considerable advantage over previous methods. Surgery was indicated for 8.0% of those examined in our study group, whereas the literature until now describes surgical indication rates of up to 22%.

[Heterotopic pancreas in the gallbladder. Diagnosis, therapy, and course of a rare developmental anomaly of the pancreas]. / Heterotopes Pankreasgewebe in der Gallenblase. Diagnostik, Therapie und Verlauf einer seltenen Entwicklungsanomalie der Bauchspeicheldrüse.

Ectopic pancreas is a rare entity but the second most prevalent pancreatic anomaly. Heterotopic pancreas is defined as the presence of pancreatic tissue without any anatomic or vascular continuity with the main body of the pancreas. Its aetiology is not clearly established. In 1916, Poppi published for the first time evidence of heterotopic pancreas in the gallbladder. A review of the literature up to the present showed only 28 more cases worldwide of ectopic pancreas in the gallbladder. Aberrant pancreas is incidentally discovered in 2% of autopsies and has been estimated to occur once in every 500 upper abdominal explorations. Ninety per cent of ectopic pancreas is found in the stomach, duodenum, and jejunum. Mostly it is asymptomatic and benign. For this reason, therapy is indicated only in patients with symptoms such as pyloric obstruction, bleeding, and malignant transformation. Surgical resection or endoscopic mucosal resection as a newer method are recommended.

Functional thrombin receptor PAR1 in primary cultures of human glioblastoma cells.

In this study we investigated primary cultures obtained from two glioblastomas surgically removed from a 64-year-old man and a 50-year-old woman, respectively. The presence of the tethered ligand thrombin receptor PAR1 (protease-activated receptor 1) in these cells was demonstrated at the level of receptor binding by using immunofluorescence studies with the monoclonal anti-PAR1 antibody Mab 31-2. Stimulation of human glioblastoma cells both with alpha-thrombin and the thrombin receptor activating peptide TRAP-6 resulted in a series of [Ca+]i spikes as shown by confocal laser fluorescence microscopy with fluo-3 as calcium sensitive fluorescence indicator. This effect was completely blocked with the thrombin receptor antagonist peptide T1. Our results demonstrate functional thrombin receptors (PAR1) in primary cultures of human glioblastomas for the first time.

Modulation of expression of intermediate filaments during the development of established rat liver cell lines.

A number of clear epithelial-like cell lines were established from the liver of fetal and neonatal rats. The intermediate filaments of these cells were investigated using polyclonal prekeratin antisera, monoclonal antibodies against a cytokeratin subfamily and vimentin by means of the indirect immunofluorescence technique and SDS-PAGE analysis. Changes in the expression of cytokeratin filaments were found during the evolution of permanent cell lines. Cells positively stained for cytokeratins could be seen near to other cells which were negative. In early passages (up to the 40th) nearly all cells were strongly stained by the different keratin antibodies. During the following subcultivation the pattern of staining considerably changed. In FRL and NP-RL cell lines keratin-negative cells could already be observed in the early passages, rapidly increasing in the later passages. Compared to this, vimentin-staining of all cells remained constant in its morphological expression. The keratin filaments were seen in thick fiber bundles arranged particularly in the perinuclear ring as well as in finer networks throughout the cytoplasm. Every cell in the established lines showed their very individual staining pattern. The vimentin filaments extended to the whole cytoplasm up to the cell margin. Our observations demonstrate the variability of the system of keratin filaments in established epithelial-like liver cells under cultural conditions.

[Intermediate filaments in cells of hyaline cartilage]. / Intermediärfilamente in den Zellen des hyalinen Knorpels.

After different fixation procedures great numbers of bundles of intermediate cytofilaments, 10 nm in thickness, could be detected in electron micrographs of chondrocytes from Processus xiphoideus of the rat, from the articular cartilage of the rabbit and from chondrocyte cultures from the articular cartilage of the rabbit. By means of the indirect immunofluorescence technique with monoclonal antibodies they could be clearly defined as vimentin.

Metastasis induction by incomplete tumor resection. A new metastasis model using inoculation sarcomas in adult nude mice after long-term cultivation of sarcoma cells.

In searching an animal model to study metastasis formation we used cultured cells of experimental rhabdomyosarcomas and their inoculation tumors in adult nude mice. Supplementing earlier observations (Katenkamp et al. 1987) we found that long-term cultured sarcoma cells induce tumors in adult nude mice which do not metastasize spontaneously but produce lung metastases after repeated incomplete tumor removal. Possible factors and mechanisms responsible for metastasis emergence are discussed. The metastasis model introduced may be apt to study cellular changes at cytogenetic and molecular biological level that occur during tumor progression and metastatic dissemination.

Immunohistochemical localization of cytochrome P450 1A1 in precision-cut rat liver slices after in vitro exposure to beta-naphthoflavone.

Mono- and polyclonal antibodies have been used to study the localization and distribution of cytochrome P450 1A1 (CYP1A1) in cultured precision-cut liver slices with various immunohistochemical methods. Neither in non-incubated slices nor in slices incubated in the absence of beta-naphthoflavone (BNF) for 24 hrs was CYP1A1 immunohistochemically detectable. After incubation in the presence of BNF (25 microM), however, CYP1A1 was well visible in parenchymal and biliary epithelial cells. CYP1A1 was not evenly distributed, but was localized predominantly in hepatocyte layers near the surfaces of the slices. This distribution could be due to the preferential uptake of BNF by outer cell layers or due to functional changes of inner cells. Together with results obtained with other methods (e.g. RT-PCR) this investigation also demonstrates that precision-cut liver slices are a useful tool for the detection of in vitro induction of CYP1A1.

[The system of intermediate filaments in the cells of the epitheloid line RL 19. An electron microscopy study]. / Das System von Intermediärfilamenten in den Zellen der epitheloiden Linie RL 19. Eine elektronenmikroskopische Studie.

The occurrence and distribution of intermediate-sized filaments (100 A filaments) in an established epitheloid cell line RL 19 originally derived from rat liver was described by use of ultrathin sections tangentially and crossly to the cell substrate. The epithel-like cells showed in the cytoplasm a highly developed system of intermediate-sized filaments. The intermediate-sized filaments are either individually traversing in different directions or are grouped to loosely arranged bundles randomly running wavy-like through the whole cytoplasm. The bundles of highly variable thickness (20 to 40 filaments) are branched or are uniting and assembled to a three-dimensional network. The nucleus and Golgi-system are surrounding by a large ring of densely packed intermediate-sized filaments. Occasionally parallel running single filaments are associated to electron dense aggregates.

Experimental tumors with features of malignant histiocytomas. Morphological studies on neoplasms produced by inoculation of an established macrophage-like cell line (WEHI-3).

Soft tissue malignant histiocytomas are thought to be a histologic variant of malignant fibrous histiocytomas. By means of an established macrophage-like cell line (WEHI-3) we produced experimental tumors with light microscopic features of malignant histiocytomas. In spite of repeated subculturing of WEHI-3 cells and their derivatives the 6 tumor generations received by cell transplantations were remarkably constant in regard of their light and electron microscopic morphology. This was in contrast to preceding experiments with an established fibrosarcoma cell line. Electron microscopically they were never to be identified in the histiocytoma-like tumors so that these neoplasms could virtually not be considered as members of the malignant fibrous histiocytoma group. Our results support the idea that malignant fibrous histiocytomas and malignant histiocytomas of the soft tissues arise from undifferentiated mesenchymal cells and emphasize that monocyte-derived histiocytic tumors may appear as soft tissue histiocytomas although they are more related to malignant histiocytosis.

Persistence of Acholeplasma laidlawii in an established cell line RL 19. 1. Host-parasite morphology.

The cell-parasite relationship of epitheloid cells from the established liver cell line RL 19 persistently infected with Acholeplasma laidlawii was studied by transmission electron microscopy and scanning electron microscopy. The predominantly filamentous, branched A. laidlawii were arranged horizontally on the cell surface between microvilli at the cell margin. The cell adhesion, spreading, growth pattern and cell surface shape were not altered in relation to uninfected cultures of the same cell line.

Morphogenesis of cell-to-substratum adhesion and spreading on Ni-Cr-alloys. A scanning electron microscopic study.

A scanning electron microscopy (SEM) analysis has been performed on the adhesion, spreading and growth pattern of fibroblastoid and epitheloid cells on Ni-Cr-alloys as compared to glass substrates. The attachment is initiated by filipodial contact of monolayer cells with the glass as well as alloys, and subsequent radial spreading occurs by the gradual peripheral extension of the broad lamellipodium followed by a general cell flattening. When cultured under identical conditions monolayer cells reach confluence at the same time on glass and alloy surfaces, respectively. The results show that the fibroblastoid and epitheloid cells form stable contacts between the cell surface and the alloy in the same manner in which the cells adhere to the surface of glass. The cells migrated and proliferated on the surface of alloys and covered the surface of the substratum.

Toxicity evaluation of water soluble substances of dental materials by means of cell population in vitro.

The paper describes a method of evaluation of the biocompatibility of dental restorative materials with a monolayer cell culture system. Semisolid and solid materials were eluted under physiological conditions. The cell monolayer was exposed to the eluates. The method enables the recognition of toxic ingredients and thus their elimination by the producer of these materials as well as the comparison of the cytotoxicity of newly developed materials with conventional ones.

In vitro characteristics of two established hepatoma cell lines.

The in vitro behaviours of a fibroblast-like (DENA-RH 13) and an epithelial-like (DENA-RH 13A) cell line, derived from a chemically induced hepatocarcinoma of rat are described. The DENA-RH 13A can be maintained and studied either in monolayer as a transplantable solid tumor or in fluid-suspension culture as ascites tumor in Wistar rats. The cytomorphology and growth pattern of the clones of the cell lines are described. While DENA-RH 13 cells produced undifferentiated tumors with mainly sarcoma-like structures in allogeneic hosts the epithelial-like cell line (DENA-RH 13A) grew in a carcinoma-like pattern in animals.

[Comparative studies on the cytotoxic effect of composite filling materials and silicate cement]. / Vergleichende Untersuchungen der zytotoxischen Wirkung von Composite-Füllungsmaterial und Silikatzement

The biologic compatibility of two composite materials (Cosmic, Epstic) based on Bowen's resin and two silicate cements (Frontasil, Silicap) and theirs components were assessed in cell culture. The compounds eluated from the material specimens under physiological conditions affected monolayer cultures of rat fibroblasts and rat epithelial cells (linr RL-19). Silicate cement eluate brings about death of cells due to high concentration of H-ions. Neutralized eluate of freshly prepared Cosmic, Estic and Frontasil caused the same cell damage which was less pronounced following Silicap eluate. The toxicity was markedly reduced following use of an eluate material which had a setting time of 24 hours. After the 2nd and 3rd elution of same specimen the cytoxicity was noticeably weakened, however, it was still demonstrable. The patterns of injury were different following composite material and silicate cement. All tested components soluted in Eagle medium have an irritating effect on the cultivated cells.

Growth inhibition and morphological changes caused by indomethacin in fibroblasts in vitro.

In a definite range of concentrations indomethacin inhibits the multiplication of fibroblasts in vitro without influencing their viability. The effect of lethal doses of indomethacin on the fine structure of normal and transformed fibroblasts was investigated by light and electron microscopy. The cells grown in flat monolayers became roundish and, varying in sequence, small zeiotic blebs were bulging at the external cell membrane. Beside coarse vesicular transformation of the endoplasmatic reticulum and extension of the perinuclear spaces ballooning of the mitochondria occurred. After breaking up of the vesicles of the endoplasmatic reticulum loosening of the cytoplasmic ground substance associated with enlargement of the hyaline plasma margins was observed in further progress of the experiment. The internal structures of the mitochondria were completely disorganized. In the ultrastructure of the fibroblasts altered by lethal doses of indomethacin no specific sites of drug action could be identified.

[Tissue compatiblity of stomatologic materials in cell cultures]. / Bestimmung der Gewebsverträglichkeit stomatologischer Werkstoffe an Zellkulturen

The paper contains results of investigations on the suitability of cell cultures for biological testing of soluble substances from dental cements and their components. The preparation of the specimens as well as the elution process are described. Furthermore the culture system of cell populations in vitro and representative biological parameters are reported.

[Comparative in vitro study on cellular reactions to soluble components of EBA and phosphate cement]. / Vergleichende in vitro-Studie zellulärer Reaktionen auf lösliche Bestandteile von EBA- und Phosphat-Zement

While the eluate of EBA cement does not have any toxic effect on the cell populations, the cells are noticeably damaged by the pH-corrected eluate of freshly mixed phosphate cement. Comparison between the cellular reaction to eluates and the solubility of the cements shows that the toxic effect is not a priori dependent on the composition of the material, but on the degree of dissolution which is primarily determined by the environment and the mixture ratio. The solutions of cement powder do not have any irritating effect on the cultivated cells. However, due to its content of eugenol, the EBA cement fluid solved in a considerably weaker concentration in the culture medium than the phosphate cement fluid damages the cells to such an extent that they die.

Experimental tumors with features of malignant fibrous histiocytomas. Light microscopic and electron microscopic investigations on tumors produced by cell transplantation of an established fibrosarcoma cell line.

An established fibrosarcoma cell line (RFS) derived from a cadmium induced fibrosarcoma of rat and RFS-cells in different subcultures produced tumors in nude mice and baby rats which showed characteristics of fibrosarcoma, malignant fibrous histiocytoma and completely undifferentiated sarcoma. After thorough examination of cells in culture and in experimental tumors by light microscopic and electron microscopic methods that conclusion has been drawn that malignant fibrous histiocytoma can develop from fibrosarcoma. By this the assumption that malignant fibrous histiocytomas derive from tissue histiocytes is questioned. After the discussion of the general unspecifity of the storiform growth pattern and the cytology of malignant fibrous histiocytomas the idea is presented that many defined malignant soft tissue tumors inclusively fibrosarcomas may pass a phase which should morphologically be diagnosed as malignant fibrous histiocytoma. Conceding the practical value of this diagnosis we emphasize that the concept of the entity "malignant fibrous histiocytoma" should be critically reevaluated because of the probable heterogeneity of this tumor group.

Growth of fibroblasts and epithelioid cells on a new machinable bioactive glass ceramic in comparison with non-reactive materials.

In this study scanning electron microscopy (SEM) was used to investigate the substrate attachment, cell spreading and growth properties of fibroblasts and epithelioid cells on a newly developed machinable bioactive glass ceramic. The morphogenetic reactions of cell cultured on bioactive ceramic were compared with those of identical cells cultured on non-reactive glass and vitreous carbon. The adhesion, subsequent spreading and the growth appearance of fibroblasts and epithelioid cells on the surface of machinable glass ceramics are similar to those on nonreactive materials. Our findings concerning the behaviour of cell populations in vitro on the surface of a new machinable glass ceramic allow the conclusion that this implant material is adhesive for cells and biocompatible.