The role of chlamydia in the pathogenesis of pulmonary emphysema. Electron microscopy and immunofluorescence reveal corresponding findings as in atherosclerosis.

Chlamydia pneumoniae has been detected in atherosclerotic plaques by various means. Chlamydiae are able to cause persistent infections. Serologically elevated antibody titers are found in severe chronic obstructive pulmonary disease. In atherosclerosis and pulmonary emphysema, inflammatory reactions can be seen by means of light microscopy. Specimens from patients with obliterative arteriosclerosis undergoing thrombendarteriectomy and with advanced emphysema undergoing lung volume reduction surgery were examined using scanning (SEM) and transmission (TEM) electron microscopy, and using immunofluorescence with monoclonal antibodies and antiserum against chlamydiae. SEM shows spherical bodies (SBs) with a diameter from 0.3 microm to 0.6 microm on the surface of the alveoli and bronchioles, as well as in atherosclerotic plaques. In atherosclerosis and emphysema, SBs reveal a double membrane, adherence to collagen fibers, tissue destruction, as well as intracellular and interstitial localization in TEM. They show in parts a densely packed central structure. SBs are seen both in alpha-1-antitrypsin deficiency emphysema and smoker's emphysema. Using immunofluorescence microscopy, spots are seen in corresponding distributions to the SBs. Morphological findings are typical for aberrant chlamydiae seen in persistent infections. Chronic infection and bacterial colonization associated with progressive disease seems to be relevant not only in atherosclerosis but also in pulmonary emphysema.

The role of subclavian-carotid transposition in surgery for supra-aortic occlusive disease.

From 1977 through 1985, 1043 patients underwent operation for supra-aortic occlusive disease. One hundred thirty-four of these patients (13%) with 146 lesions of the aortic arch branches (innominate, 25; subclavian, 103; and multiple, 10) had one or more symptoms of subclavian steal (78%), transient ischemic attacks (37%), arm ischemia (37%), and others (7%). However, according to results of a critical prospective neurologic examination, the classic steal syndrome appeared in only 13 patients (10%), vertebrobasilar insufficiency in 32 patients (24%), and hemispheric symptoms in 48 patients (36%). Symptomatic and/or significant internal carotid occlusive disease was present, ipsilateral in 28% and contralateral in 31% of the patients. Other supra-aortic vessels were involved in 49% of the patients. During the same period 192 patients with supra-aortic occlusive disease were treated without surgical intervention for various reasons. Fifty-five patients (27%) were completely asymptomatic except for the presence of reversed flow within the vertebral artery. The surgical approach in 138 operations was extrathoracic (ET) in 71% of patients (innominate artery, 2; subclavian artery, 95; and arch syndrome, 1) and transthoracic (TT) in 29% of patients (innominate artery, 23; subclavian artery, 8; and arch syndrome, 9). Generally, bypass procedures were preferred, but for 72 (71%) of the subclavian lesions subclavian-carotid transposition (SCT) was performed. Three patients had been referred for complications of previous carotid-subclavian bypass. The grafts were removed and vertebral and arm circulation restored by SCT. Carotid end-arterectomy was performed simultaneously (20%) or staged (3%) in 8% of the innominate procedures and 25% of the subclavian reconstructive procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thrombectomy with AV fistula in embolizing deep venous thrombosis--better therapeutic concepts]. / Thrombektomie mit AV-Fistel bei embolisierender tiefer Venenthrombose--das bessere Therapiekonzept.

From 1977 to March 1986 69 patients with embolizing deep vein thrombosis underwent thrombectomy plus av-fistula. The perioperative mortality rate was 7.2%, the rate of recurrent pulmonary embolism during follow up (28 +/- 24 months) 4.7% - all minor non-significant emboly-including those with an embolizing thrombosis of the contralateral deep venous system. In 62% preservation of valve competence was successful. As intracaval filter devices for prevention of recurrent pulmonary embolism have many severe complications, out of which the embolisation by the filter itself seems to be the most problematic, the first step of surgical management must be the removal of the embolizing source--thrombectomy plus routine av-fistula.

[Significance of magnesium, copper and zinc in medial femur neck fractures in the aged]. / Die Bedeutung von Magnesium, Kupfer und Zink bei der medialen Schenkelhalsfraktur des alten Menschen.

The medial fracture of the femur neck is mainly a fracture of the old man. It is well known, that often only minimal traumas are caused for the medial fracture of the femur neck. Osteoporosis alone is not the reason for fracture. A deficiency in trace elements especially for the old patients is often discussed, but there are no exact examinations yet. For this analysis the concentration magnesium, copper and zinc was performed from 10 patients which got a medial fracture of the femur neck. Bone-biopsy and blood was taken when an endoprothesis was implanted. We could find a decreased zinc concentration in all bones. The copper and magnesium concentration in bone was not significant depressed. Both elements have a great individual spread. There are no significant alterations in blood levels of magnesium, copper and zinc in patients with a medial fracture to normal population.

Myocardial oxygen consumption and regulation of coronary blood flow during stepped relief of the left ventricle.

In 25 calves an atrio-ventriculo-aortic bypass was performed and the metabolism and the regulation of coronary blood flow during stepped assistance of the left ventricle was studied. With mean aortic blood pressure kept constant stepped decrease in left ventricular pressure from 120 to 0 mmHg diminished myocardial oxygen consumption from 7.7 to 1.9 ml O2/min X 100 g. Increasing right ventricular pressure by banding the pulmonary artery with left ventricular pressure and mean aortic pressure kept constant the oxygen uptake of the left ventricle increased about 20.7 +/- 32.% when measured by Fick's principle but remained unchanged when calculated from hemodynamic parameters of the left ventricle (-1.5 +/- 3.5%). At constant coronary perfusion pressure coronary blood flow decreased when left ventricular pressure was reduced from 120 to 100 mmHg. Further decrease in left ventricular pressure to 0 mmHg showed no effect on coronary blood flow. Increasing heart rate from 152 +/- 9 to 208 +/- 8 b.p.m. enhanced myocardial oxygen uptake of the assisted heart about 59.0 +/- 11.4% while resistance to flow decreased about 40.4 +/- 2.8%. These results show that the metabolic regulation of coronary blood flow is still acting even in the assisted left heart.

The influence of zinc on bone healing in rats.

The importance and necessity of the trace element zinc for tissue restitution after injuries has been known for a long time. The influence of zinc on the healing of tibial fractures in rats is studied by daily administration of 0.6 mg zinc-dl-aspartate compared to a non-treated control group. There is a significant decrease of bone-zinc concentration after fracture. This decrease can be balanced out by zinc administration. There are no significant alterations in serum levels of zinc in both groups. Fracture healing is not affected. Zinc accumulates in bones.

[Studies on the immunologic behavior of standardized virus-induced rat tumor after cryosurgical and surgical treatment]. / Untersuchungen zum immunologischen Verhalten eines standardisierten virus-induzierten Rattentumors nach kryochirurgischer und chirurgischer Behandlung

The authors report on the behavior of a virus-induced tumor in the rat after cryosurgical and surgical treatment and re-implantation of different tumor suspensions. No specific "immune-cryothermic response" could be demonstrated. The principle of the lysis of the re-implantate lies in devitalizing the primary tumor.