Comparative morphology of the hepatic and coronary artery walls. Part I. Differences in the distribution and intensity of non-atherosclerotic intimal thickening and atherosclerosis.

We compared the morphology of the hepatic artery intima which is free of atherosclerosis, with that of the typically atherosclerosis-prone coronary artery. The study group comprised material collected from 116 autopsies. Subjects were aged between 1 month and 90 years. Specimens were collected from grossly normal arterial segments. An already known fact was confirmed: the presence and remarkable intensity of non-atherosclerotic intimal thickening in the coronary arteries since the beginning of life. On the contrary, hepatic artery intimal thickening was incidental during the first 4 decades of life and regular later on. During all the decades intimal thickness was decreased in the hepatic artery in comparison to the coronary artery. Initial atherosclerosis was noted during the 4th decade of life in the coronary artery and during the 8th and 9th decades in the hepatic artery. Intimal thickness was always lower in women compared to men. These findings reveal a positive correlation between the intensity of intimal hyperplasia and the incidence of atherosclerosis. The intimal pattern is of limited value in the determination of an unidentified subject age who underwent an autopsy. The thickness of the hepatic artery intima, which surpasses 200 microns indicates that the subject is at least 40 years of age, while initial atherosclerosis--the 8th or 9th decades of life.

Comparative morphology of the hepatic and coronary artery walls. Part II. The relation between the internal elastic membrane, non-atherosclerotic intimal thickening and atherosclerosis.

Evident difference in the occurrence of atherosclerosis between hepatic and coronary arteries justifies the search for local preconditions of this disease. In this study we compared the internal elastic membrane morphology of both arteries. It appeared to be mono- or polylinear (laminar) and continuous in the hepatic artery. This was in contrast to its fragmentation in the coronary artery since the beginning of life. Thus, the condition of the internal elastic membrane may play an important role in the development of non-atherosclerotic intimal thickening. Continuous elastica could make the migration of medial myocytes into the intima more difficult (hepatic artery). On the other hand, fragmented coronary artery elastica seems to facilitate this migration. In turn, intimal thickening is less or more advanced, respectively.

Comparative morphology of the hepatic and coronary artery walls. Part III. The insignificance of medial morphologic features in the determination of an autopsied unidentified subjects age.

Since hepatic arteries are free of atherosclerosis any possible wall structure change may be attributed to age. We determined the media of hepatic and coronary arteries in view of this assumption. We measured its thickness and myocytic density (per 1 mm2 of cross-section) from specimens collected from autopsied subjects, aged up to 90 years. The media gradually thickens with age, although values noted during particular decades remain statistically insignificant. The myocytic density (in 1 mm2) was almost constant throughout life. The latter observation is incompatible, in comparison with data reported by other authors (diminution was expected).

Light and electron microscopic picture of atherosclerotic plaque in stable and unstable angina.

By presenting this series of 127 cases of coronary atherectomy the authors join the workers who study morphological differences between the atherosclerotic plaques in stable and unstable angina. Routine staining of formalin-fixed, paraffin-embedded material was completed by the detection of T lymphocytes, macrophages, mast cells, smooth myocytes and grown-in capillaries using monoclonal antibodies (DAKO), as well as by the immunofluorescent demonstration of fibrinogen in the plaques. The plaques derived from patients with unstable angina showed a higher incidence of mast cells (significant) and macrophages (insignificant). These cells render the plaque more susceptible to rupture or fissuring. There was also significantly more frequent and quantitatively more abundant permeation of the plaque by fibrinogen that raises the chance of thrombosis. These findings support the view that unstable angina correlates with the phenomena that favour the rupture of the plaque and thrombosis. Electron microscopy has not been used so far to study coronary atherosclerotic plaques. This material includes 15 plaques from stable and 18 plaques from unstable angina. A cover of fibrin and blood platelets is a regular formation on the surface and in the superficial layer of the plaque from unstable angina. It contributes to the "thrombotic proneness" of the coronary artery. These plaques also show abundant elastic fibres. This pattern corresponds to myo-elastic intimal hyperplasia ("intimal thickening") where the production of intimal elastin constitutes an essential phenomenon. Intimal thickening is interpreted as a preatherosclerotic event. The presence of elastin reflects an early stage of the development of the plaque. The plaque from stable angina shows abundant collagen fibres, which aggravate the lesion.

Restoration of the continuity of dog ureter after resection of its 5 cm middle segment.

OBJECTIVE: To evaluate the restoration of the ureter of the dog after resection of a 5 cm-long middle segment. MATERIALS AND METHODS: Eight dogs underwent resection of the middle segment of the ureter, after which a 6-8 F Bard ureteric stent modelling catheter was inserted into both remaining portions of the ureter for 3 months. One month after removal of the stent the animals were killed and their ureters examined both grossly and microscopically. Paraffin-embedded sections were subjected to microscopic and immunohistochemical studies. RESULTS: The continuity of the ureter was restored but the reconstructed segment was narrowed to a variable extent. The wall of the ureter was lined by normal urothelium but consisted of fibrous connective tissue which failed to produce a regular coat. The reconstructed segment showed no smooth muscle cells (negative staining with azan and a negative reaction with monoclonal antibodies against desmin). A few smooth myocytes were found only at the border with intact portions of the ureter. CONCLUSIONS: The surgical procedure resulted in the restoration of ureteric continuity by repair and not by regeneration of its wall.

[Correlation among clinical and histopathologic criteria in selection of donors for orthotopic liver transplantation]. / Korelacja miedzy kryteriami klinicznymi a histopatologicznymi w doborze dawców w ortotopowym przeszczepie watroby.

The aim of this work is to present the correlation between the initial microscopic pattern of the liver graft and clinical and laboratory findings. In the Department of General Surgery and Liver Diseases 6 specimens were taken from 4 livers destined for planned liver transplantations. They were taken from the organ rinsed in UW solution, processed and stained extemporaneously. Quick HE staining was performed in some cases. Two livers were qualified for transplantation although they showed negligible histopathological changes. In one of these cases there was a clinical and pathological disagreement. The results of histological examination were crucial in qualification of the liver for grafting. One organ was disqualified because of negative clinical and pathological findings, while two other livers were disqualified after clinical examination. We resigned from the transplantation of liver of the last donor, who exhibited unsatisfactory clinical tests in spite of good pathological results.

[Giant cell arteritis--presentation of 3 cases]. / Olbrzymiokomórkowe zapalenie Tetnicy skroniowej--omówienie 3 przypadków.

Three patients with giant cell arteritis (GCA) observed recently in our department are described. One of them demonstrated clinical picture of polymyalgia rheumatica, the other two presented with clinical symptoms of GCA. This presentation seems to be very helpful for correct diagnosis in cases with difficult recognition.

[A case of Whipple's disease]. / Przypadek choroby Whipple'a.

We present 66 year old man with symptoms of malabsorption syndrome. The correct diagnosis of Whipple's disease was made difficult by the radiological picture of the jejunum tumor with subocclusion. It was the cause of the diagnosis of carcinoid tumor of the small intestine: the laparotomy was performed. The histological picture was typical for Whipple's disease. The skin changes seen in our patient were similar like in carcinoid syndrome, pellagra and Whipple's disease.

[Ruptured aneurysm of the abdominal aorta into the duodenum as a cause of hemorrhage from the digestive tract]. / Pekniety tetniak aorty brzusznej do dwunastnicy przyczyna krwotoku z przewodu pokarmowego.

An extremely rare cause of bleeding from the digestive tract is presented which was a rupture of abdominal aorta aneurysm into duodenal lumen. On the basis of history data, clinical picture and gastroscopy, bleeding from gastric ulcer was diagnosed. The actual cause of bleeding was established during autopsy, not confirming at the same time the presence of gastric ulcer.

[Anatomic study of the direct vascular connection between the adrenal gland and kidney in humans]. / Badania anatomiczne nad bezposrednim polaczeniem naczyniowym miedzy nadnerczem i nerka u czlowieka.

The study was performed on 16 specimens containing adrenal gland and kidney obtained at route autopsy. The mixture of gelatin and india ink was injected into adrenal artery, through the catheter. In all specimens vessels leaving adrenal gland and entering cortex of kidney were found. Therefore, we conclude that alike other species also in humans, the adrenal-renal mirabile does exist.

[Renal biopsy in the aged]. / Biopsja nerki u osób w wieku podeszlym.

Pathological findings in urinalysis in the aged persons are usually thought to be caused by pathologic processes other than glomerulopathy. Histological evaluation of renal tissue in older patients is extremely difficult due to coexistence of involuntary changes-hyalinosis, increase in mesangial matrix content, and vascular changes. The aim of the study was to evaluate frequency of glomerulonephritis, both primary and secondary in persons older than 60. In this group, as compared to the younger people the secondary glomerulonephritis was more frequent, amyloidosis and vasculitis nodosa being the most frequent. In primary glomerulonephritis mesangiocapillary type dominate, quite often some tendency to hyalinization could be observed. Renal biopsy is useful as a diagnostic tool in both the aged and young. It should be performed regardless the patients age.

Relation between cardiovascular pathologic conditions and malignant tumours as seen by pathologist. II. Myocardial infarct and coronary atherosclerosis in the population suffering from malignant neoplasm as seen by pathologist.

In the autopsy material of 2932 men and 3051 women the frequency of fresh myocardial infarct and the severity of coronary atherosclerosis were highly significantly lower in the population suffering from malignancies than in that free of cancer. Lower frequency of myocardial infarct seems to result from lower severity of coronary atherosclerosis. The incidence rate of myocardial infarct was also significantly lower in the cancer--bearing group when both compared populations showed identical, severe (grade 4) coronary atherosclerosis. This observation seems to indicate lesser contribution of coronary spasm in cancerous population and justifies the discussion of possible significance of EDRF (endothelium-derived relaxing factor) and catecholamines.

Relation between cardiovascular pathologic conditions and malignant tumours as seen by pathologist. I. Frequency of malignant neoplasms in the population with myocardial hypertrophy as seen by pathologist.

Relatively low co-existence of malignant neoplasms and chronic cardiovascular disease was documented in this work the emphasis being put on the conditions running with myocardial hypertrophy. The percentage of malignancy in the total autopsy material of 5821 men and 6849 women was 27.8 and 23.0 resp., and in the subgroup with heart weight 300-400 g, 36.8 and 31.0 resp. This percentage was significantly lower in separated subgroups of: a. arterial hypertension, 6.6 and 10.2, b. cardio-pulmonary syndrome, 23.0 and 18.5, c. healed myocardial infarct accompanied by myocardial hypertrophy, 13.3 and 11.7, d. acquired valvar deformity, 15.3 and 10.1. The subgroup of heart weight 150-250 g showed 57.2% and 46.6% of cases with malignancy while that of cardiac weight over 600 g-7.4% and 5.7%. In the subgroup of normal right-(2-3 mm) and left-ventricular (10-12 mm) wall thickness corresponding percentage equalled 29.4 and 30.1, in the subgroup of right-ventricular wall thickness over 6 mm--14.4 and 8.8, and in that of left-ventricular wall thickness over 18 mm--12.5 and 9.4. Scanty available information suggests some antimitotic activity of catecholamines believed to condition that of chalones. Catecholamines are also attributed with the stimulation of myocardial hypertrophy. The correlation of our findings with assumptions mentioned above seem to justify a hypothesis, or only a possibility, that compensatory mechanisms active in the cardiovascular diseases create an unfavourable background for the development of neoplasm.