[Expression of c-erbB-2 and topoisomerase II alpha in relation to chemoresistance in ovarian cancer]. / Die Expression von c-erbB-2 und Topoisomerase IIalpha in Relation zur Zytostatikaresistenz beim Ovarialkarzinom.

In the present study, we examined die role of c-erbB-2 for chemoresistance in ovarian cancer. Overexpression of c-erbB-2 mRNA in tumor tissue was associated with a shorter survival of patients with primary ovarian cancer (P = 0.0001, N = 77) and was an independent prognostic factor in the proportional-hazard model (P = 0.035). A significant association between expression of c-erbB-2 mRNA und survival was obtained for the subgroup of patients who received a standard chemotherapy with carboplatin or cisplatin and cyclophosphamide (P = 0.0003). In addition, the application of a standard chemotherapy improved the survival of patients with relatively low c-erbB-2 expression (P = 0.013), but not of patients with overexpression of c-erbB-2 (P = 0.359). Expression of c-erbB-2 mRNA correlated with expression of topoisomerase IIalpha mRNA determined by a reverse semiquantitative PCR technique (P = 0.009), whereas expression of c-erbB-2 und topoisomerase IIbeta mRNA dit not correlate (P = 0.221). The data suggest that topoisomerase IIalpha, which correlates with c-erbB-2 expression, contributes to the resistance of c-erbB-2-overexpressing carcinomas.

Effectiveness of two fluoridation measures on erosion progression in human enamel and dentine in vitro.

The aim of the present study was to evaluate the effect of fluoride on the progression of erosive demineralisation in human enamel and dentine using a cyclic de- and remineralisation model in vitro. The mineral content expressed in micrometres was determined daily by longitudinal microradiography (LMR) and presented as cumulative mineral loss over 5 days. For erosive demineralisation, all samples were immersed in 0.05 M citric acid (pH 2.3) for 6x10 min/day and stored in a remineralisation solution. Fluoridation measures were performed as follows: group 1: control, no fluoridation; group 2: toothpaste fluoridation 3x5 min/daily (NaF, 0.15% F-); group 3: toothpaste fluoridation as group 2 and additionally application of a fluoride mouthrinse (Olaflur/SnF2, 0.025%F-) 3x5 min/daily and on days 1 and 3 gel fluoridation (Olaflur/NaF; 1.25% F-) for 1x5 min. After the first experimental day, no significant differences were found between the groups. However, after 5 days the erosive mineral loss values for enamel were 147.5+/-18.7 microm in the control group, 128.1+/-15.0 microm in group 2 (p< or =0.05) and 116.1+/-12.4 microm in group 3 (p< or =0.001). In dentine, the respective values were 136.7+/-16.4, 111.8+/-26.9 (p< or =0.001) and 60.3+/-17.8 (p< or =0.001). The intensive fluoridation significantly reduced erosion progression in enamel but had a more pronounced effect on dentine. The results suggest that subjects with erosive lesions should use an intensive fluoridation measure.

The presence of HPV DNA in cervical cancer: correlation with clinico-pathologic parameters and prognostic significance: 10 years experience at the Department of Obstetrics and Gynecology of the Mainz University.

The objective of this study was to assess whether the presence of human papillomavirus (HPV) DNA and/or several genotypes of HPV DNA in cervical cancer are correlated with several clinicopathologic parameters of well-defined prognostic significance and whether virologic parameters are predictors of long-term survival in cancer patients. Two hundred twenty three cases of cervical cancer patients included in this retrospective study underwent follow-up evaluation. Survival and cause of death were examined for 204 (91.4%) patients, with a mean follow-up time of 4.4 years. HPV DNA was detected using the highly sensitive polymerase chain reaction (PCR) method followed by HPV DNA sequencing for HPV genotyping. These results were correlated with well-defined clinicopathologic parameters and survival data. HPV DNA was detected by PCR in 150 of 193 (73.4%) tissue specimens of cervical cancer patients. DNA sequence analysis revealed the presence of HPV 16 (n = 68, 45.3%), HPV 18 (n = 49, 32.6%) and rare HPV types (n = 33, 22.1%). HPV genotypes correlated significantly with histologic tumor types, node status, tumor oxygenation, blood vessel invasion, and lymph space involvement. The presence of HPV DNA in cervical cancer as well as the genotype of HPV 16 could also be confirmed as significant prognostic factors in the univariate Cox regression analysis (RR 2.856, P < 0.003 resp. RR 3.444, P < 0.0001). In the multivariate analysis, however, HPV DNA status failed to be of prognostic relevance. Exclusively HPV 16 appears to have an independent impact on the overall survival in cervical patients (RR 3.653, P < 0.002). We conclude that the detection of HPV 16 genotype may play an important adjunct role in assessing prognosis of cervical cancer patients. The clinical impact of the presence of HPV DNA in primary tumors of uterine cervix remains to be investigated in further studies, and the exact mechanisms by which HPV influences the prognosis of cervical cancer patients have to be defined.

Human papillomavirus (HPV) DNA in primary cervical cancer and in cancer free pelvic lymph nodes--correlation with clinico-pathological parameters and prognostic significance.

OBJECTIVE: To assess whether the presence of human papilloma virus (HPV) DNA and/or several genotypes of HPV DNA in primary cervical cancer and cancer free pelvic lymph nodes are correlated with several clinicopathological parameters of well-defined prognostic significance and whether virological parameters are predictors of long-term survival in cancer patients. PATIENTS AND METHODS: 223 cases of cervical cancer patients included in this retrospective study underwent follow-up evaluation. Survival and cause of death were examined for 204 (91.4%) patients, with a mean follow-up time of 4.4 years. HPV DNA was detected using the high sensitive polymerase chain reaction (PCR) method followed by HPV DNA sequencing for HPV genotyping. These results were correlated with well-defined clinicopathological parameters and survival data. RESULTS: HPV DNA was detected by PCR in 150 of 203 (73.4%) tissue specimens of cervical cancer patients. DNA sequence analysis revealed the presence of HPV 16 (n = 68, 45.3%), HPV 18 (n = 49, 32.6%) and rare HPV types (n = 33, 22.1%). HPV genotypes correlated significantly with histological tumor types, node status, blood vessel invasion and lymph space involvement. The presence of HPV DNA in cervical cancer as well as the genotype of HPV 16 could also be confirmed as significant prognostic factors in the univariate Cox Regression Analysis (RR 2.856, p < 0.003 resp. RR 3.444, p < 0.0001). The presence of HPV DNA in cancer free pelvic lymph nodes was significantly correlated to the concomitant manifestation of pelvic lymph node metastases (RR 3.1, p < 0.0001). In the multivariate analysis, however, HPV DNA in primary tumor and in negative pelvic lymph nodes failed to be of prognostic relevance. Exclusively, HPV 16 appears to impact independently on the overall survival in cervical cancer patients (RR 3.653, p < 0.002). CONCLUSION: The detection of HPV 16 genotype may play an important adjunct role in assessing prognosis of cervical cancer patients. The clinical impact of the presence of HPV DNA in primary tumors and cancer free pelvic lymph nodes remains to be investigated in further studies. The exact mechanisms by which HPV influence the prognosis of cervical cancer patients have to be defined.

Analysis of high purity graphite and silicon carbide by direct solid sampling electrothermal atomic absorption spectrometry.

Solid sampling electrothermal atomic absorption spectrometry using the boat technique and a transversely heated graphite tube was applied to direct analysis of graphite and silicon carbide powders for 14 and 12 impurity elements, respectively. With graphite, for all analytes under investigation, a very effective in-situ analyte/matrix separation was achieved. That was the case also for analytes in silicon carbide requiring atomization temperatures below 2400 degrees C. At higher atomization temperatures, the decomposition products of silicon carbide give rise to significant background, which can still be corrected. Sample amounts of up to 4 mg graphite and 8 mg silicon carbide per analysis cycle were applied. For all analytes in both materials, limits of detection at the lower ng g(-1) and sub-ng g(-1) level were achieved, excluding arsenic for which they were 50 ng g(-1) and 23 ng g(-1) for graphite and silicon carbide, respectively. Quantification was performed using calibration curves measured with aqueous standard solutions. The accuracy was checked by comparison of the results with those obtained by instrumental neutron activation analysis and by other independent methods.

(A)symptomatic necrotizing arteritis of the female genital tract.

AIMS: The vasculitides represent a heterogenous set of disorders that differ in prognosis and response to therapy. Beside systemic vasculitides, the development of localized forms of arteritis is well known though uncommon and the etiopathogenesis is not yet definitely clear. METHODS: Patients with necrotizing arteritis of the female genital tract proven by histology are studied in a retrospective analysis. RESULTS: Three cases of necrotizing arteritis with histological features of panarteritis nodosa apparently confined to the female genital tract are presented. None of these patients had prior history of systemic vasculitis. The acute necrotizing vasculitis was confined only to the uterine cervix in two patients and involved all the internal genital organs in the third patient. The patients have been observed for up to 4 years without any therapy for these lesions and without any manifestation of systemic vasculitic progression. CONCLUSION: It is to speculate that focal arteritis of the female genital tract is a benign form of panarteritis nodosa or moreover a totally different entity with identical morphogenesis but possibly different pathogenesis. Furthermore it seems to be important to be aware of the specificity of focal arteritis in female genital tract as distinct from the generalized form to prevent unnecessary surgical or chemotherapeutical therapy for this lesion. The benign entity of local arteritis in the female genital tract is discussed in contrast to the severe prognosis of systemic panarteritis nodosa.

[Angiogenesis in cervical cancer]. / L'angiogenèse dans le cancer du col utérin.

Angiogenesis is a factor of spread and metastatization. This fact has been established for many malignancies, but the data concerning cervical cancer are rather conflicting. In a study including 42 patients affected by cervical cancer stages IB to IVA, the authors assess the mean capillary density and the correlations between this parameter and the other anatomoclinical parameters: the VEGF expression, tumoral oxygenation and the data obtained from dynamic MRI. The histologic assessment of the capillary density and the data obtained by dynamic MRI enable us at the same time to quantify the tumoral angiogenesis and establish the prognosis. The two methods could be used routinely as markers of prognosis. VGEF surely plays a role in angiogenesis linked with cervical cancer growth, but its regulation is not definitively clear at the moment. The impact of tumoral oxygenation (whose place as a prognostic marker is clearly established) on tumoral angiogenesis and vessels' permeability as well as its control is currently not clearly established. Further studies on larger populations are necessary.

Evaluation of DNA ploidy and degree of DNA abnormality in benign and malignant melanocytic lesions of the skin using video imaging.

BACKGROUND: Making a morphologic distinction between benign and malignant melanocytic tumors of the skin is frequently difficult, especially because "gray zones" between these lesions often exist. DNA image cytometry as an adjuvant method for the diagnosis and prognostic prediction of premalignant lesions and malignant tumors of many other organs is already well established. The aim of this study was to determine whether DNA image cytometry is helpful in distinguishing benign from malignant melanocytic lesions and whether cytometry would give valid information with which to predict the prognoses associated with malignant melanomas. METHODS: DNA image cytometry was performed on 127 benign and 58 primary maligant melanomas of the skin as well as 11 metastatic melanomas, using an enzymatic single cell solution according to a method described by Heiden et al. in Cytometry (1991;12:614-21). RESULTS: DNA aneuploidy was graded by DNA index (DI) and a 2c deviation index (2cDI). In contrast to benign melanocytic lesions (with 16% DNA aneuploidy), primary and metastatic malignant melanomas had significantly higher frequencies of DNA aneuploidy (86% and 73%, respectively). In the degree of DNA aneuploidy, significant differences between benign and malignant melanocytic tumors could be observed. The mean 2cDI of aneuploid benign lesions was 1.0, whereas the primary malignant melanomas had a mean 2cDI of 2.92 and the metastatic melanomas a mean of 6.9. The frequency of DNA aneuploidy increased with Breslow thickness. Twenty-one patients with primary malignant melanoma developed metastases. All metastasizing primary tumors were aneuploid and showed a significantly higher grade of DNA aneuploidy than nonmetastasizing malignant melanomas. Moreover, none of the diploid malignant melanomas developed metastases. CONCLUSIONS: This study reveals that DNA image cytometry is prognostically and diagnostically relevant to the evaluation of melanocytic lesions of the skin. Nevertheless, it cannot be relied on alone to provide enough information for a diagnosis.

Expression of tenascin in human cervical cancer--association of tenascin expression with clinicopathological parameters.

OBJECTIVE: Tenascin is an extracellular matrix glycoprotein, relevant for embryonal and fetal development, which is reexpressed in the stroma of benign and malignant tumors. Little is known about the molecular interaction of tenascin during neoplastic transformation and tumor progression in cervical cancer. METHOD: We studied the expression of tenascin in normal tissue of the cervix uteri, cervical carcinoma in situ, and invasive cervical carcinoma in paraffin sections by immunohistochemistry using a monoclonal antibody. Tenascin immunoreactivity was compared with various prognostic parameters. RESULTS: In normal cervical tissue (n = 5) and in cervical carcinoma in situ (n = 10) only vessel walls showed a weak tenascin cross-reactivity, whereas tenascin was not expressed in the epithelial layer or the underlying connective tissue. In invasive cervical carcinoma (n = 89) tenascin expression was markedly increased. In 84% (n = 75) of the cases examined a strong tenascin immunoreactivity was noted around and within the tumor cell nests. Sixteen percent (n = 14) of infiltrating cervical carcinomas showed no tenascin immunoreactivity. A definite correlation was found between weak or no tenascin expression and slight desmoplastic mesenchymal reactivity (n = 42/91%, P < 0.001), lymphatic space invasion (n = 54/81%, P < 0.001), and lymph node metastases (n = 30/77%, P < 0.05). Tenascin-positive patients had a significantly better prognosis than tenascin-negative patients (mean survival time of 56.5 +/- 4.1 months versus 31.9 +/- 5.6 months, P < 0.05). CONCLUSION: Based on these findings we discuss that the appearance of tenascin is an indicator of an adequate biological defense in cervical cancer patients. The tenascin staining may therefore be useful for detecting a subgroup of invasive cancer patients missing tenascin reactivity with alterations of stromal defense and a poorer prognosis.

[Value of clinically established MRI procedures concerning the pretherapeutic evaluation of maximal tumor diameter in primary or recurrent cervix cancer in relation to palpation findings and histopathologic whole mount specimens]. / Wertigkeit klinisch etablierter MRT-Verfahren hinsichtlich der prätherapeutischen Bestimmung des maximalen Tumordurchmessers beim primären und rezidivierten Zervixkarzinom im Vergleich zum Palpationsbefund und dem histopathologischen Grossflächenschnitt.

OBJECTIVE: The maximal tumor diameter of cervical cancer is one of the most important prognosis factors concerning patients' survival. The purpose of this study was to investigate the efficiency of different MRI-procedures in relation to clinical palpation concerning pretherapeutic tumor diameter assessment. MATERIAL AND METHODS: Thirty-one patients with biopsy proven primary cervical cancer and its recurrence (n = 10), respectively, underwent dynamic and conventional MRI before further treatment. The results of maximal tumor diameters were compared to palpatory findings and then correlated to the whole mount specimen as gold standard. RESULTS: The contrast-enhanced dynamic and T2-weighted MRI allows a significantly better (p < 0.05) assessment of maximal tumor diameter of cervical cancer than the conventional T1-weighted MRI. The T2-weighted MRI showed the highest correlation (r = 0.83) in respect to the whole mount specimen up to FIGO-IIB disease. The contrast-enhanced dynamic MRI and the palpation were characterized by the highest correlation coefficients of r = 0.77, r = 0.70 respectively, in advanced cervical cancer > FIGO-IIB disease. CONCLUSIONS: The MRI procedures offer no evident advantage in relation to clinical palpation to determine the maximal tumor diameter of cervical cancer or its recurrency and seems not to be indicated generally.

Tumor hypoxia in pelvic recurrences of cervical cancer.

We have previously demonstrated in primary cancer of the uterine cervix that tumor hypoxia, as determined polarographically, is strongly associated with clinical malignant progression of the disease. Having applied a similar methodological approach to investigate loco-regional relapses, we found a pronounced shift to more hypoxic oxygenation profiles in the recurrent tumors than in the primary tumors. Median pO2 values in 53 pelvic recurrences were significantly lower than the median pO2 values of 117 primary tumors of comparable sizes (7.1 +/- 1.1 mmHg vs. 12.1 +/- 1.0 mmHg, p = 0.0013). The differences in tumor oxygenation between primary and recurrent tumors mirrored the differences in the patients' 5-year survival probabilities. In the cohort of patients with pelvic relapses, median tumor pO2 < 4 mmHg indicated a significantly shorter median survival time as compared to median tumor pO2 > or = 4 mmHg. Our results further support our thesis that in cervical cancer, tumor hypoxia and clinical aggressiveness in terms of resistance to therapy and tumor dissemination, are interrelated.

A graphite furnace electrothermal vaporization system for inductively coupled plasma atomic emission spectrometry.

An improved graphite furnace electrothermal vaporization device equipped with an autosampler for inductively coupled plasma atomic emission spectrometry is presented. The transport losses of eight selected analytes in the individual segments of the device were determined by means of the radiotracer technique by applying amounts traced comparable to those to be determined in real samples. The results obtained from the radiotracer study were the basis for further improvement of the interface design, leading to considerable increase of the total transport efficiency, which finally was found to be between 26 (for Cr) and 57% (for Ga). The whole system consists of a graphite furnace vaporizer, a power supply, a gas flow box, and an autosampler with incorporated microbalance. The temperature program, gas flows, and autosampler functions are controlled by a data station which also provides the data acquisition and processing of the transient signals. The performance parameters of the developed system were evaluated using aqueous standard solutions. Absolute limits of detection for most analytes were between 0.1 and 1 ng, and for As, K, Ni and Pb, they were between 2 and 3.2 ng.

Association between tumor hypoxia and malignant progression in advanced cancer of the uterine cervix.

Experimental tumors contain a significant fraction of microregions that are chronically or transiently hypoxic. Experimental evidence showing that hypoxia (and subsequent reoxygenation) may have a profound impact on malignant progression and on responsiveness to therapy is growing. The clinical relevance of tumor oxygenation in human solid malignancies is under investigation. We have developed and validated a clinically applicable method for measurement of tumor oxygenation in locally advanced cancer of the uterine cervix using a computerized polarographic electrode system. Applying this procedure in patients with cervical cancers

[Intrafascial hysterectomy ("CISH" method; cervical intrafascial Semm hysterectomy)--can the risk of cervix stump carcinoma be calculated?]. / Die intrafaszial Hysterektomie ("CISH"-Methode) - Ist das Risiko eines Zervixstumpfkarzinoms kalkulierbar?

The incidence of the carcinoma of the cervical stump is reported in the literature between 0.1-3%. The operative treatment as well as the radiation therapy is more difficult and complicated in relation to the cervical malignancy of an "intact" uterus. On the other hand the supracervical uterus-amputation offers advantages versus the classical hysterectomy. So many endoscopic experienced groups prefer this operative technique. SEMM performs an additional stanza of the cervix and corpus in order to remove the cervical adenocells. This procedure was simulated with the help of an in vitro model to answer the question of facultative adenocells in the remaining cervix. 41 uteri and the resected stanzas were histologically examined. Adenocells could be detected in 68.3 % of the cervical hulls. The transformation zone could be resected totally in all cases. Taking into account these results we can conclude, that the combination of the supracervical hysterectomy with a cervix-corpus-stanza could reduce the risk of a cervical stump-carcinoma. Because of remaining adenocells in the cervical hull, this special carcinoma-risk can't be excluded after an interval of at least 20-25 years.

[Complications in HELLP syndrome due to peripartal hemostatic disorder]. / Komplikationen beim HELLP-Syndrom infolge einer peripartalen Hämostasestörung.

43 cases with severe preeclampsia with HELLP syndrome were observed out of 14890 deliveries from 1980 to 1993 in the Department of Obstetrics and Gynecology, University of Mainz. In 17 cases there were grave complications (14 renal failure: 3 patients requiring dialysis; 6 bleedings: abdominal wall hematoma in 5 patients after caesarean section, 1 rupture of the liver; 3 pulmonary complications; 9 cerebral complications: 7 eclamptic convulsions, 1 amaurosis caused by partial infarction of the posterior cerebral artery, 1 sinus venous thrombosis). The plasmatic blood-clotting factors were in the normal range, except for 2 cases. In 27 patients TAT and D-dimers were determined. In 17 of these 27 patients TAT and D-dimers increased up to extreme levels (TAT > 20 micrograms/l and D-dimers > 1000 micrograms/l). In 12 of these 17 patients, complications occurred during in the course of the disease (70%). On the other hand, only 3 out of 12 patients (30%) with a low activation of blood coagulation (TAT > 10 and < 20 micrograms/l; D-dimers > 800 and < 1000 microgram(s)/l) had shown complications. It is suggested that the early determination of TAT and D-dimers may help to avoid complications.

Hypoxia and Radiation Response in Human Tumors.

This study demonstrates by an updated analysis of an ongoing prospective study that tumor oxygenation, as measured with a validated standardized polarographic needle electrode method before treatment, powerfully predicts the prognosis of patients receiving radiotherapy for intermediate and advanced stage cancer of the uterine cervix. First evidence for a host component in tumor oxygenation based on a significant correlation between median pO(2) values determined in normal subcutaneous fatty tissue and in cervical cancer is also presented. Further investigations are necessary to clarify whether tumor hypoxia is just a marker of intrinsic tumor aggressiveness or whether the negative impact of tumor hypoxia on survival is related to radiobiological mechanisms caused by hypoxia per se, which may include (1) the reduced oxygen enhancement effect, (2) increased radioresistance due to expression of genes for cell cycle delay and stress proteins, and/or (3) accelerated tumor progression to more radioresistant and metastatic variants by increased genetic heterogeneity.

Tumor vascularity--a novel prognostic factor in advanced cervical carcinoma.

OBJECTIVE: In the search for the optimal treatment of advanced cervical cancer, the identification of valid prognostic factors obtainable without histopathologic investigation of the entire tumor and the locoregional lymph nodes is of paramount interest. Tumor microvessel density has recently been demonstrated to correlate strongly with disease aggressiveness in breast cancer and other malignancies. METHODS: We established a computerized image analysis system to quantify tumor microvascularity by using the closest-individual method, which determines the distribution of distances from random points within the tumor to the closest microvessel (DTCMV). Tumor microvascularity was assessed in paraffin sections of two cylindrical 2 x 20-mm core biopsies obtained transvaginally from the 12 and 6 o'clock positions of each tumor and then immunohistochemically stained for Factor VIII-related antigen. The oncologic relevance of tumor vascularity is studied in an open prospective trial. RESULTS: Tumor vascularity was quantified in 42 patients with cervical cancers > 3 cm in largest diameter, FIGO stages Ib-IVa. This new parameter representing pathophysiological tumor-host interactions was independent of various other patient and tumor characteristics, including age, FIGO stage, tumor size, differentiation, lymph node metastases and lymphatic space involvement. Thirty-nine patients were treated with curative intent either by primary surgery (n = 22) or radiation (n = 17). After a median observation time of 18 months (range 4-41 months), the patients with higher tumor vascularity (mean DTCMV < 83 microns) had significantly shorter disease-free (P = 0.025) and overall (P = 0.032) survival probabilities than patients with lower tumor vascularity (mean DTCMV > or = 83 microns). Cox regression analysis identified tumor vascularity as the strongest independent prognostic factor in this group of patients. CONCLUSIONS: The assessment of tumor microvascularity by computerized image analysis of defined tumor biopsies could become a novel means of predicting tumor aggressiveness in non-early cervical cancer.

Cytotoxicity of various crystalloid solutions to the endothelial cells of autologous grafts.

Harvesting and storage may influence the early failure of autologous grafts. We studied the endothelial layer of human saphenous veins (HSV) and bovine internal mammary arteries (BMA) after a two-hour storage period in comparison to vessel segments prepared immediately after harvesting. The storage solutions were 0.92% NaCl, 0.9% NaCL heparinized, Ringer's Lactate (RL), heparinized blood or Bretschneider's cardioplegic solution. To visualize the endothelial cell damage, specimens were stained with silver nitrate. The surface covered by morphologically intact endothelial cells was computed in percent. In a perfusion model using the carotid artery of rabbits, the increase of the permeability of the endothelium after two hours' perfusion was investigated (n = 5 each). In native HSV-segments 70.8 +/- 4.5% of the endothelium were found to be morphologically intact. The figures for stored grafts were: 14.7 +/- 4.4% (NaCl), 0.5 +/- 0.3% (hep. NaCl), 16.0 +/- 4.6% (RL), 37.2 +/- 5.3% (hep. blood) and 50.0 +/- 4.2% (Bretschneider). Comparable results were found with BMA specimens. BMA: 98.3 +/- 2.1% (native), 39.2 +/- 3.3% (NaCl), 8.4 +/- 3.5% (hep. NaCl), 11.2 +/- 4.8% (RL). 67.0 +/- 6.1% (hep. blood) and 78.1 +/- 4.7% (Bretschneider). In accordance with these results the increase of the permeability of the endothelial cell layer of the carotid artery of rabbits was significantly less after perfusion with Bretschneider's solution. The condition of the endothelial cells of autologous grafts at the time of implantation was found to be clearly dependent on the type of solutions used for perfusion and immersion. In comparison to all crystalloids studied in this series, Bretschneider's cardioplegic solution proved to be superior.

[Early and late damage in bypass vessels induced by crystalloid and cardioplegic solutions]. / Früh- und Spätschäden in Bypass-Gefässen induziert durch kristalloide und kardioplege Lösungen.

Veins and arteries grafted into the aorto-to-coronary position undergo degenerative processes, subintimal fibrous hyperplasia and diffuse atherosclerosis. We examined the influence of various crystalloid and cardioplegic solutions on the endothelium of human saphenous veins and internal mammary arteries, bovine internal mammary veins and arteries and rabbit carotid arteries, using light microscopy, TEM, SEM, immunological techniques and quantitative permeability measuring methods. Immersion or perfusion of vessel segments for various periods of time led to an ultrastructural endothelial cell damage, to an increased endothelial permeability for macromolecules, partly to an endothelial cell loss. Addition of high concentrations of heparin impaired this effect. Under influence of various solutions an increased plaque development under stimulation with atherogenic stimuli was observed.