Classification of myositis. Correlations between morphological and clinical classifications of inflammatory muscle disease

Insufficient clinical data given to pathologists often hamper the differentiation of inflammatory muscle diseases. Thus we proved the value of a classification based only upon morphological criteria. Among 160 biopsies with myositic pattern (4.9% of a series of 3264 muscle biopsies) we could distinguish the following groups: Interstitial inflammation with only few fibre necroses (17.6%), predominance of fibre necroses with few inflammatory infiltrates (38.1%), small vessel vasculitis (20.0%), arteritis (13.1%), granulomatous myositis (8.8%) and polymorphonuclear leukocytic infiltrates (2.6%). This classification is compared with the used clinical diagnoses. Some special morphological aspects (histometric and immunocytologic examinations, tissue calcification, inclusion bodies, neurogenic atrophies) are analysed and so are some clinical peculiarities (e.g. malignoma-association, differentiation of mixed connective tissue syndrome, drug-induced reactions). The diagnostic value of purely morphologic criteria is restricted. For better diagnostic work a great number of clinical informations is required. Nevertheless, certain morphological patterns give important directions, e.g. to occult malignoma.     

Experimental evaluation of a phakic anterior chamber implant in a primate model. Part II. Pathology.

Anterior chamber intraocular lenses were implanted in 50 phakic primate eyes and followed by serial histopathology for two years. Significant observations included corneal endothelial alterations, haptic erosion into and encapsulation by peripheral iris and ciliary body, and chronic low grade inflammation.     

Mitochondrial myopathies with necrotizing encephalopathy of the Leigh type

Two patients with mitochondrial encephalomyopathy (MEP) serve to emphasize the variability of this group of diseases. Cerebral insults, mitochondrial cardiopathy, relapsing ileus, cerebral angioma, ataxia, and myoclonic seizures characterized the first case of an adult man with similar diseases in his family, interpreted as transitional form between mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and myoclonus epilepsy associated with ragged red fibers (MERRF). The second patient, a floppy infant with cardiomyopathy and myoclonism, statomotoric and mental retardation showed combined defects in mitochondrial respiratory chain at NADH-CoQ reductase and cytochrome c oxidase and a deficiency of carnitine. In both patients neuropathologically criteria of Leigh's syndrome could be demonstrated in the cerebral cortex, in case 2 also clinically. The classificatory problems of the relationships between KSS, MELAS, MERRF, Leigh's as well as Alpers' syndromes are discussed.     

Inhibition by MIF-I of alpha-MSH induced increase of intraocular pressure and miosis in rabbits

The effects of intracameral (i.c.) administration of MIF-I on the ocular response to alpha-MSH were tested in rabbits. In confirmation of previous studies, i.c. alpha-MSH significantly increased intraocular pressure (IOP) and reduced pupillary diameter (PD). Concomitant administration of alpha-MSH and MIF-I antagonized both the IOP increase and miosis induced by alpha-MSH. Aqueous humor (AH) dynamics studies revealed that alpha-MSH increases IOP, possibly, by decreasing AH outflow. The decreased AH outflow induced by alpha-MSH was antagonized by concurrent administration of MIF-I and alpha-MSH. MIF-I did not affect IOP or PD when administered alone. These results add more support for a role of alpha-MSH in ocular function, and suggest that the ocular response to alpha-MSH may be subject to inhibitory control by MIF-I.     

Encephalomyelitis and demyelinating diseases in patients with extracerebral malignant tumors

We examined central nervous system (CNS) lesions in 456 patients with primary extracerebral malignant tumors. Inflammatory reactions caused by viral (progressive multifocal leukoencephalopathy (PML), herpes zoster varicella), fungal, or bacterial infections could be demonstrated in 20 patients. In a further 19 patients, the brain tissue showed lymphocyte infiltrates of unknown etiology and, in four of these, autopsy revealed probable paraneoplastic, non-bacterial, endocarditis as a possible explanation for the local inflammatory reaction. The frequency of thrombophlebitis, non-arteriosclerotic thrombosis and arteritis was significantly higher than in a control group of 2052 tumor-free patients. Focal spongiform-axonopathic lesions (24 cases) as well as diffuse leukoencephalopathy (11 cases) were interpreted as probably being at least in part paraneoplastic because the same alterations could also be observed in patients who had never undergone cytostatic or radiation therapy. The possible pathogenetic conditions are discussed and a classification of these tumor-accompanying, but not always tumor-dependent, lesions suggested.