Malignes Histiocytom der Haut mit multivesiculärer Vacuolisierung

Zusammenfassung Bei einem 47 jährigen Patienten entwickelten sich am rechten Bein mehrere rasch wachsende Tumoren von distal nach proximal. Histologisch und elektronenmikroskopisch zeigten die Tumorzellen morphologische Besonderheiten, die für ihre histiocytäre Provenienz sprechen. Auffallend war die große Anzahl polymorpher cytoplasmatischer Membranstrukturen und großer Vacuolen, die massenhaft kleine Vesikel enthielten. Diese Strukturen werden als transformierte multivesiculäre Körper gedeutet; ihre Entstehung vollzieht sich im Rahmen einer bizarr übersteigerten Membranaktivierung einer malignen Zellrasse. Bemerkenswert ist die rasche und völlige Remission durch Radiotherapie.

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Multivesicular vacuolization in malignant histiocytoma of the skin

Summary A 47-year-old patient developed several rapidly growing tumours in his right leg. Histologic and electron microscopic examination revealed morphological characteristics suggesting the histiocytic origin of the tumour cells. An important finding was the striking number of pleomorphic membraneous inclusions and large vacuoles containing numerous small vesicles. These cytoplasmic inclusions are interpreted as transformed multivesicular bodies. Their formation may be an expression of an increased and bizarre membraneous activity of a malignant cell race. Radiotherapy resulted in a remarkably rapid and complete remission.

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Auszugsweise vorgetragen beim 4th European Meeting on Electron Microscopy Applied on Cutaneous Pathology, Heidelberg, 6. und 7. Mai 1977: Multivesicular Vacuolization in Malignant Histiocytoma.     

Progressive-ratio performance maintained by drug infusions: Comparison of cocaine,diethylpropion, chlorphentermine,and fenfluramine

Cocaine, diethylpropion, chlorphentermine, and fenfluramine were compared on a drug-maintained progressive-ratio procedure in baboons. Intravenous infusions of drug were contingent on completion of a fixed-ratio response requirement (fixed number of lever-press responses) with a 3-h time-out period following each infusion. Prior to testing each dose of drug, stable self-infusion performance was first established with 0.4 mg/kg cocaine when the fixed-ratio requirement was 160. Subsequently, a test dose of drug was substituted for the standard dose of cocaine. If the dose of drug maintained a criterion level of self-infusion performance (six or more infusions per day for 2 days), the ratio requirement was systematically increased every day until the breaking point at which the self-infusion performance fell below a criterion level (one or zero infusionsper day). Fenfluramine did not maintain criterion self-infusion performance at any dose tested (0.02–5.0 mg/kg). The dose ranges of the other drugs that maintained maximum breaking points were 1.0–5.6 mg/kg for chlorphentermine, 1.0–3.0 mg/kg for diethylpropion, and 0.1–0.4 mg/kg for cocaine. Within-animal comparison of the maximum breaking points indicated that cocaine maintained the highest breaking points, followed in order by diethylpropion, chlorphentermine, and fenfluramine. The rank ordering of these drugs with the breaking point measure corresponds well with both the results of other animal experiments on measurement of reinforcing efficacy of these drugs and with the clinical information about the human subjective effects and abuse of these drugs.     

The role of cavitational activity in fragmentation processes by lithotripters

The role of cavitation during shock wave exposure was poorly understood until now. Cavitational activity produces severe damage to nearby surfaces due to multiple high-speed liquid jets resulting from bubble collapse. These jet impacts can be made visible by microscopy. For investigating the presence of cavitational processes by shock waves outside and even inside of targets, we have performed the following experiments. Natural gallstones and artificial targets were examined microscopically with regard to the effects of shock pulses. Scanning electron and light microscopical investigations revealed regularly typical and uniform microjet impacts within the fissures and split lines. Since these experiments are the continuation of high-speed films of 10,000 frames/s of shock wave actions on targets, it is most likely that the shock wave produces at first split lines through the stone. Then liquid occupies these cracks. But the following shock waves create within these liquid-filled fissures cavitation and, therefore, cause the disintegration of the targets. It now becomes understandable why biliary lithotripsy is less effective than renal lithotripsy: bile fluid is a high-viscous liquid and, therefore, hinders the disintegration of stones more than low-viscous urine. Intervals between the application of shock waves in biliary lithotripsy, therefore, should improve the treatment results.     

DNA repair in human bronchial epithelial cells

The purpose of this investigation was to compare the responseof human cell types (bronchial epithelial cells and fibroblastsand skin fibroblasts) to various DNA damaging agents. Repairof DNA single strand breaks (SSB) induced by 5 krads of X-raywas similar for all cell types; 90% of the DNA SSB were rejoinedwithin one hour. During excision repair of DNA damage from u.v.-radiation,the frequencies of DNA SSB as estimated by the alkaline elutiontechnique, were similar in all cell types. Repair replicationas measured by BND cellulose chromatography was also similarin epithelial and fibroblastic cells after u.v.-irradiation.Similar levels of SSB were also observed in epithelial and fibroblasticcells after exposure to chemical carcinogens: 7,12-dimethylbenz[a]anthracene;benzo[a]pyrene diol epoxidle (BPDE); or N-methyl-N-nitro-N-nitrosoguanidine.Significant repair replication of BPDE-induced DNA damage wasdetected in both bronchial epithelial and fibroblastic cells,although the level in fibroblasts was 40% of that in epithelialcells. The pulmonary carcinogen asbestos did not damage DNA.DNA-protein crosslinks induced by formaldehyde were rapidlyremoved in bronchial cells. Further, epithelial and fibroblasticcells, which were incubated with formaldehyde and the polymeraseinhibitor combination of cytosine arabinoside and hydroxyurea,accumulated DNA SSB at approximately equal frequencies. Theseresults should provide a useful background for further investigationsof the response of human bronchial cells to various DNA damagingagents.     

A pathological classification of pleomorphic adenoma of the salivary glands (author's transl)]

Pleomorphic adenomas of the salivary glands show, despite their pleomorphism, certain histological characteristics. These are based onthe differentiation of the epithelial cell and the amount and nature of the stroma. A systematic histological analysis of 310 pleomorphic adenomas of the parotid gland resulted in the following findings and classification. 1. The most frequent epithelial cell forms were salivary duct and myoepithelial cells (75-90%) seen as epidermoid cell groups (75%). Rarer forms of differentiation were striated duct cells (5%), keratinised squamous epithelium (2,5%), oncocytes (1%), basal cells (1%), and sebaceous gland cells or goblet cells (less than 1%). 2. A myxomatous stroma represented the prototype of stromal differentiation (80%). A chondroid stroma was found in 10% of cases examined and a mixed mucochondroid stroma in 3%. Further differentiation included hyaline stroma (25%) and fibrous stroma (15%) especially in the older tumour or after irradiation. Rarely was a fascicular (0,5%) or osseous (1%) stromal change found. 3. Four subgroups of pleomorphic adenoma can be classified from consideration of the epithelial and stromal changes. Subgroup 1 (30,5%) is the classical pleomorphic adenoma with a stroma content of 30-50%; subgroup 2 (55%) has a stroma content of 80%; subgroup 3 (9%) has a poor stroma content of 20-30% or less and an epitaelial differentiation similar to subgroup 1; and subgroup 4 has also a poor stroma content (6%) with a relatively monomorphic epithelial structure. 4. Recurrences (13,5%) were seen more in stroma-rich pleomorphic adenomas than in stroma-poor tumours. 5. On the basis of cytological differentiation, pleomorphic adenomas develop from indifferent tissue adjacent to salivary intercalated or striated ducts.     

Beurteilung von Schweregrad und Verlauf der chronischen posttraumatischen Osteomyelitis

Zusammenfassung Anhand der anamnestischen Daten von 50 Patienten mit chronischer posttraumatischer Osteomyelitis wird eine Punktebewertung zur Beurteilung des Schweregrades der Erkrankung entwickelt, die neben der Gesamtdauer der Erkrankung den prozentualen Anteil der stationären Behandlung sowie die Anzahl der chirurgischen Eingriffe berücksichtigt. Zur Objektivierung des klinischen Verlaufes wird eine zweite Skala (München-Murnau-Skala) vorgestellt, welche die äußeren Wundverhältnisse, die röntgenologischen Befunde sowie die Blutkörperchensenkungsgeschwindigkeit erfaßt. Anhand einer Autovaccinetherapie bei 18 Patienten wird die Objektivierung des Therapieerfolges mit Hilfe dieser Skala gezeigt.

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Scoring system for evaluation of severity and progress of chronic posttraumatic osteomyelitis

Summary From the anamnestic data of 50 patients suffering from chronic posttraumatic osteomyelitis a severity scoring system was developed, based on the duration of the disease, the time of hospitalization and the number of surgical interventions. The clinical course of 18 patients, undergoing an auto-vaccination treatment, was registered by another scoring system (Munich-Murnau-Scale) regarding wound morphology, bone radiology and erythrocyte sedimentation rate.

     

Detoxifikation polytoxikomaner Patienten mit Buprenorphin Auswirkungen auf Affektivität, Angst und Entzugssymptomaik

We used an open-labeled, 21-day inpatient detoxification treatment to compare the short-term effects of a 10-day buprenorphine plus 19-day carbamazepine regimen (n = 15) to a 14-day oxazepam plus 19-day carbamazepine regimen (n = 12) during rapid detoxification from opioids and other abused drugs. Somatic and psychopathological changes were assessed using the following rating scales: ASI, HAMD, SCL-90-R, and SOWS. Eighteen of 27 patients (67%) completed the study. Four dropouts (27%) were treated with buprenorphine/carbamazepine (BPN/CBZ) and the other five dropouts (42%) were treated with oxazepam/carbamazepine (OXA/CBZ). Repeated measures analysis of variance showed that SOWS scores were significantly less pronounced with BPN-CBZ than with OXA/CBZ. On the first day of admission, no significant difference in HAMD scores was detected (BPN/CBZ 11.6, BPN/CBZ 1.0). On day 14, HAMD was significantly less pronounced in BPN/CBZ (3.0) than in OXA/CBZ (6.1). BPN/CBZ showed a significant improvement in the ASI score on days 7 and 14 compared with OXA/CBZ. Three of nine items of the SCL-90-R showed a trend toward less pronounced outcome in BPN-CBZ. No severe side effects occurred during treatment in either group. The buprenorphine/carbamazepine regimen provided significantly more effective relief from affect disturbances and withdrawal syndromes than the oxazepam/carbamazepine regimen. The pharmacological basis of these effects of buprenorphine (kappa-antagonism activity,mu-agonism activity) are discussed.     

The impact of hormone replacement therapy on quality of life and willingness to pay

Objective To measure the gain in quality of life due to hormone replacement therapy for women with mild and severe menopausal symptoms.
Design Prospective study where data on quality of life and willingness to pay were collected by interview.
Setting Department of Gynaecology at Sodertalje Hospital near Stockholm.
Participants One hundred and four women aged 45 to 65 years treated for menopausal symptoms for at least one month.
Methods Quality oflife was measured by the time tradeoff and rating scale methods. The willingness to pay for hormone replacement therapy was investigated using the contingent valuation method.
Main outcome measures The quality adjusted life year weight measured with the rating scale and time tradeoff methods, and willingness to pay.
Results The increase in the quality adjusted life year weight due to hormone replacement therapy for women with mild symptoms was 0.26 according to the rating scale method and 0.18 according to the time tradeoff method. For women with severe symptoms the quality adjusted life year weight increased by 0.50 according to the rating scale method and by 0.42 according to the time tradeoff method. The mean willingness to pay for hormone replacement therapy per month was 2300 Swedish krone for women with mild symptoms and 4800 Swedish krone for women with severe symptoms (£1 = 10.3 Swedish krone).
Conclusions Hormone replacement therapy leads to a major improvement in quality of life for women with menopausal symptoms. Both for women with mild and severe menopausal symptoms the willingness to pay for the treatment also greatly exceeds the costs, indicating that hormone replacement therapy is economically beneficial for women with menopausal symptoms.     

Reiter's syndrome following intravesical BCG immunotherapy

A 71 year old woman developed conjunctivitis, asymmetrical oligoarthritis, and cystitis (Reiter's syndrome) secondary to intravesical BCG treatment for transitional cell carcinoma of the bladder. She received oral prednisolone, izoniazid, and pyridoxine and made a full recovery. Increasing use of BCG as immunotherapy will lead to an increase in the incidence of BCG associated reactive arthritis. Prompt recognition and early diagnosis will facilitate treatment and recovery.