[Morphological and ultrastructural changes in the rat kidney after experimental sepsis]. / Morfologicheskie i ultrastrukturnye izmeneniia kletok v pochkakh krys posle éksperimental'nogo sepsisa.

UNLABELLED: Experimental sepsis was investigated in 42 male white Wistar rats. The animals were divided into 7 equal groups. Suspended E. coli cells (2 x 10(7) per 100 g body weight) were injected into the tail vein in groups I-VI, group VII served as a control group. The rats were sacrificed with cervical dislocation at different times after injection: in 45 min (group I), 2 h (group II), 6 h (group III), 24 h (group IV), 48 h (group V), and 120 h (group VI). Samples of kidneys were taken and embedded in paraffin and EPON-812 for histological and electron microscopical evaluation, respectively. RESULTS: histological examination demonstrated that changes in kindeys started in 2 h after infection to achieve the maximum level in 24 h, showing thereafter a tendency to decrease. A significant tissue damage was first seen in the loop and distal tubules of nephrons, and then expanded to the proximal tubules. Electron microscope examination demonstrated that changes in podocytes and cytopodia could be distinctly differentiated in 2 h after infection and obviously increased in the course of the experiment. The podocytes were enlarged, the processes were expanded and adhered to each other. For that reason the number of filtration pores in the glomerular basal membrane decreased. The count of mesangial cells in the glomerulus was increased.

Dissemination of bacteria in multiple organs associated with apoptosis and macrophage activity in different stages of experimental sepsis.

BACKGROUND: Gram negative sepsis is reported to induce massive translocation of bacteria into tissues, which associates with decreased macrophage function and increased macrophage apoptosis. AIMS: The objective of this study was to detect the translocation of bacteria into different organs and to evaluate macrophage activity and the apoptosis of macrophages in the liver during different stages of sepsis and to correlate these parameters. MATERIAL: Wistar rats (n = 43) were inoculated intraperitoneally with an E. coli and divided into 5 groups, which were killed at different times. METHODS: Counts of translocated bacteria in tissues were evaluated by using morphological and bacteriological methods. Macrophage activity and apoptotic cells in the liver were studied by applying immunohistochemical methods. RESULTS: The counts of E. coli were the highest in the organs and blood 6 h after the onset of sepsis, being in correlation with the highest counts of apoptotic cells in the liver and the falling counts of activated macrophages. The counts of microbes show a new wave of elevation in tissues by 120th h. CONCLUSIONS: The massive penetration of bacteria, the depressed macrophage response in early sepsis following the increased rate of apoptotic macrophages, the different rate of bacterial multiplication in tissues and blood and the second wave of the multiplication of bacteria in tissues in late sepsis all refer to the significance of developing immune dysfunction.

Survival of patients with primary CNS tumours in Estonia.

We studied a population-based survey that included 1417 patients with a primary central nervous system (CNS) tumour diagnosed in Estonia between 1986 and 1996. Survival rates at 1 and 5 years and median survival by histology and patient's age at diagnosis were estimated. Median survival time for all tumours was 33.2 months and 1- and 5-year survival rates were 59.3 and 46.0%, respectively. In multivariate analysis, younger age, better clinical condition (i.e. a Karnofsky Performance Status (KPS) score of 60 and more) and tumour histology were all dependent prognostic factors for better survival. Risk of death was more than 8 times greater for glioblastoma (Risk Ratio (RR) 8.31) and approximately seven times greater for anaplastic astrocytoma (RR 7.22) and other gliomas (RR 5.74) compared with meningiomas. Comparing the first (1986-1989) and the third (1994-1996) time periods, statistically significant improvements in survival occurred for all tumours and astrocytomas. Declines in survival during the second period (1990-1993) were statistically significant for all the tumour groups, but the most striking decrease took place in patients with glioblastoma. Age-specific rates showed that the increase in survival was more evident for patients aged between 45 and 64 years.

Seizure disorders in patients with brain tumors.

The aim of this study was to analyze the clinical data of patients with epileptic seizures and diagnosed brain tumors. Analysis included 711 patients with primary and secondary brain tumors. 165 (23%) patients had experienced at least one seizure before tumor diagnosis. The mean time from the first epileptic seizure to tumor diagnosis was 16 months. The patient's age, location and pathology of tumor were associated with occurrence of seizures. Seizures were more common in patients aged 30-50 years. Tumors involving the frontal, frontoparietal, temporal and frontotemporal lobes were associated with occurrence of seizures. According to the histological diagnosis, patients with mixed gliomas (62%), oligodendrogliomas (53%) and astrocytomas (42%) experienced seizures most frequently.

Bacterial dissemination and the value of blood cultures in patients who die of septic shock.

The aim of this study was to determine whether blood cultures reflect real bacterial dissemination into the tissues of patients who die of septic shock. A total of 20 patients were divided into two groups with surgical (nine) and nonsurgical (11) sepsis. Blood cultures were taken and the adequacy of antibacterial therapy was assessed. Postmortem tissue samples of different organs were studied using light microscopy for the presence of bacteria. A semiquantitative measure, the contamination index, was applied. Despite negative blood cultures from 14 patients, bacteria were found in almost all of the organs examined from all of the patients. There was no difference in contamination index between patients who received adequate antibacterial therapy and those who did not. We conclude that septic shock is the manifestation of bacterial dissemination into the organs, and that blood cultures are of limited value in the diagnosis of sepsis, especially when they are taken during adequate antibacterial therapy.

Epidemiology of primary central nervous system tumors in Estonia.

During the period from 1986 to 1996, 1,665 cases of primary central nervous system (CNS) tumors were identified in the resident population of Estonia. Histological verification was available in 81% of the cases. Gliomas were more common in men, while meningiomas and neurinomas were more common in women. No significant difference was observed between the sexes for all primary CNS tumors. The age-specific incidence increased from the age of 30, reached a maximum in the age range of 50-69 years and declined in the elderly which may reflect under-diagnosis. The age-adjusted incidence rate for CNS tumors was 8.5/100,000 population. A comparison of our results with those of a previous study carried out in Estonia revealed a significant histology-specific increase in incidence in all age groups.

Translocation of indigenous microflora in an experimental model of sepsis.

Translocation of viable bacteria from gut to bloodstream and other sterile body sites during shock has been demonstrated in several experimental and clinical studies. The factors causing translocation and its incidence at different stages of shock are not known. The aim of the study was to evaluate the importance of several factors causing translocation of indigenous microflora in an experimental model of septic shock based on intraperitoneal Escherichia coli sepsis in rats. Counts of inoculated E. coli and translocated bacteria in different locations, gut morphology and haematological values were evaluated at different stages of sepsis. Sepsis developed in all animals and E. coli achieved the highest counts in blood 6 h after inoculation. Translocation was commonest at 6 and 12 h after inoculation. Frequently translocating bacteria were lactobacilli, bifidobacteria, bacteroides and peptostreptococci. In early sepsis, translocation was associated with high E. coli counts in blood, yet in late sepsis the opposite correlation was present. Low infiltration by neutrophils in the ileum and decreased mitotic activity in the colon were associated with a high translocation rate. In early sepsis, translocation was associated with low lymphocyte counts, but in late sepsis, with low neutrophil counts. Translocation of bacteria (including anaerobes) that colonise the gut in high counts takes place during sepsis. Putative influencing factors such as activity of the primary disease (bacterial counts in blood), gut morphology or haematological values seem to have different impacts on translocation, depending on the stage of the disease.

Tenascin expression patterns and cells of monocyte lineage: relationship in human gliomas.

Stromal extracellular matrix (ECM) components are thought to play an important role in regulating invasion of human gliomas. Macrophages and microglial cells may heavily influence the integrity of the extracellular compartment of gliomas, and the affected ECM may play a key role in regulating migratory activity of both tumor cells and macrophages/microglia. The aim of this investigation was to study immunohistochemically the expression patterns of four ECM components: fibronectin, laminin, collagen IV, and tenascin (TN) in human gliomas, with special attention to TN. Our main goal was to study the possible correlation between TN expression and macrophagic/microglial infiltration in gliomas. Altogether, 90 gliomas were studied. Tumors included 46 glioblastomas, 19 anaplastic gliomas, 22 low grade gliomas, and 3 pilocytic astrocytomas. Vascular TN prevailed in perinecrotic areas of glioblastomas, whereas interstitial TN was more often expressed distant from necrosis and in the ECM of anaplastic and low grade gliomas. Double staining with CD68 and anti-TN antibodies showed that macrophagic/microglial density was significantly higher in TN-positive areas of most of the glioblastomas and anaplastic gliomas, whereas microglial percentage from total number of CD68-positive cells was in most of the cases significantly higher in TN-negative areas. In addition, we saw a morphologically spatial correlation between higher densities of macrophagic/microglial infiltration and TN expression in perinecrotic areas in glioblastomas. Attachment of macrophages to TN-positive basement membrane zones of newly formed stromal blood vessels was evident. On the basis of our results, we conclude that TN may play a crucial role in regulating trafficking of cells of monocyte lineage in human gliomas.

Septic shock with disseminated microfoci in multiple organs in humans.

OBJECTIVE: Histological assessment of tissue damage and localisation of bacteria in autopsy materials of patients who died of septic shock. DESIGN: Prospective observational study. SETTING: General and paediatric intensive care units, Tartu University Hospitals and Institute of Anatomy, Tartu University. PATIENTS: 2 patients, who died of septic shock; 1 patient, who died of trauma. MEASUREMENTS AND RESULTS: Tissue samples of different organs (lungs, heart, spleen, pancreas, liver, adrenals, kidneys and brain) were studied for the presence of bacteria and for the local inflammatory reaction with light microscopy. Bacteria (cocci) were found in the capillaries and tissues of both septic shock patients, but not in the control patient. Capillary dilation, oedema, stasis and cell death, but no polymorphonuclear infiltration, were seen around the foci of bacterial invasion. CONCLUSIONS: Massive penetration of bacteria into all tissues without significant polymorphonuclear infiltration may take place in severe septic shock.

Respiratory failure in acute pancreatitis.

Marked respiratory insufficiency was established in 20 of 91 patients with acute pancreatitis. 16 of them died, 12 from uncontrollable hypoxaemia. At postmortem the most prominent finding was microatelectasis, the occurrence of which correlated highly with the serum amylase activity.