Biomedical subjects
Publications and source records attributed to F Gloor.
The authors report a case of an oesophageal cancer limited to the mucosa and the submucosa. This case is interesting because of its long history for more than 18 months, the difficulty of fiberoptic diagnosis and the diagnostic value of rigid instruments completed via vital staining by o-toluidine.
9 cases of "thorotrast kidney" after retrograde pyelography with reflux are presented. In 6 patients carcinoma of the renal pelvis developed 47--31 years after thorotrast pyelography. Because of this high rate of carcinoma induction, thorotrast kidney must be classified as a precancerous condition with high-rate tumor manifestation. Thorotrast kidney is diagnosed on X-ray by very opaque linear densities following the calices and pyelon. Early ureteronephrectomy is the treatment of choice in unilateral thorotrast kidneys. If uretero-nephrectomy is not possible, the patient should be followed up regularly with urinary cytologic examinations for early detection of malignancy.
Biochemical tests (serum calcium, inorganic phosphate and alkaline phosphatase), as well as clinical, radiological, scanning and histological investigations were undertaken in 24 patients in chronic renal failure. The frequency with which the diagnosis of renal osteopathy could be made depended in the method of investigation, the biochemical findings proving to be completely unreliable. There were positive radiological signs in ten patients and clinical signs in 12, predominantly in the progressive stages of osteopathy. A positive scan was obtained in 23 patients, typical histological bone changes in an equal number. Since it correlates so well with the histological findings, bone scan is suitable particularly in the early diagnosis of osteopathy. Since this test is easily performed and hardly stresses the patient, it should routinely be the initial one for the diagnosis of renal osteopathy.
5 cases of cantharidin intoxication are reported. 4 patients had used cantharidin as an aphrodisiac and one to induce abortion. All presented with urinary tract symptoms. Four patients had gross hematuria. In one case non-oliguric renal failure occurred, with increase of plasma creatinine to 5.6 mg/100 ml. renal biopsy was performed in 2 cases. On light and electron microscopy glomerula showed only minimal changes such as podocyte swelling. The tubuli were markedly altered, with luminal enlargement, intraluminal cell debris, flattening and shrinking of the epithelial cells and distortion of brush borders. Whereas all 5 patients recovered completely, some deaths due to cantharidin poisoning have been reported in the literature. Since cantharidin is markedly toxic, its use in humans should be strongly discouraged.
Biochemical tests (serum calcium, inorganic phosphate and alkaline phosphatase), as well as clinical, radiological, scanning and histological investigations were undertaken in 24 patients in chronic renal failure. The frequency with which the diagnosis of renal osteopathy could be made depended in the method of investigation, the biochemical findings proving to be completely unreliable. There were positive radiological signs in ten patients and clinical signs in 12, predominantly in the progressive stages of osteopathy. A positive scan was obtained in 23 patients, typical histological bone changes in an equal number. Since it correlates so well with the histological findings, bone scan is suitable particularly in the early diagnosis of osteopathy. Since this test is easily performed and hardly stresses the patient, it should routinely be the initial one for the diagnosis of renal osteopathy.
A 19-year-old patient was treated who developed a life-threatening pulmonary insufficiency after having suffered from a flu-like illness for 13 days. Lung biopsy revealed an early stage of idiopathic pulmonary fibrosis. Chemotherapy by prednisone alone proved ineffective. A combination of prednisone and massive doses of cyclophosphamide and vincristine, however, was effective in halting the rapid progression of the disease. The patient recovered gradually; the results of the pulmonary function tests were close to normal 2 weeks after the onset of therapy. Lung biopsy showed normal lung histology 7 months later. The patient has had no complaints at all for more than 3 years after the episode so that we may assume that he recovered fully.
Morphological diagnosis and differential diagnosis of pyelonephritis are discussed particularily considering macroscopic features. A special form with radiological significance is ncrotizing "emphysematous" pyelonephritis. Chronic non-obstructive pyelonephritis is rarer than formerly thought if strict morphological criteria are applied. It should be differentiated from nephropathy caused by analgetics. In analgesic nephropathy bilateral papillary necrosis is the earliest and most characteristic alteration. Differentiation between chronic pyelonephritis and analgesic nephropathy is possible in most cases but may be difficult if analgesic nephropathy is complicated by bacterial infection. A classification of "unilateral small kidney" is presented. Unilateral acquired "renal shrinkage" should be differentiated from congenital "unilateral hypoplasia". It remains to be discussed whether the so-called "Ask-Upmark-Kidney" is a malformation or the result of chronic pyelonephritis.
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Systematic microbiological research and correlation of the histopathological findings obtained from random autopsies revealed 23 hitherto undetected clostridial infections including 11 cases of gas gangrene, 4 of septicemia, 3 of bacteremia, and 5 other clostridial infections. The knowledge gained from this study led to clinical diagnosis of several cases of gas gangrene which were confirmed bacteriologically and histologically. Of 8 hospital patients who were thus diagnosed in this surgical clinic, 7 recovered, including a case of gas gangrene of the abdominal wall. The problem in gas gangrene is timely clinical diagnosis. Little is known about gas edema illnesses which are not traumatically conditioned. Recognition of the local and general symptoms (local, violent, yet inappropriate pain in the wound, "unexplained" postoperative secondary bleeding, appearance of tachycardia wholly unrelated to the patient's temperature, sudden shock, rapid deterioration of patient's general condition, jaundice and rise in CPK) makes it possible to diagnose postoperative gas edema in time. 77 infections with isolation of clostridia, seen in 76 patients, are reported. On the basis of clinical and histopathological criteria they have been classified as follows: 22 cases with gas gangrene (clostridial myonecrosis), 16 cases with anaerobic cellulitis, 20 wound infections, 8 cases of septicemia, 5 of bacteriemia, 1 of tetanus, and 5 other clostridial infections.
The role of the pathologist in breast cancer is discussed from the practical viewpoint. For primary diagnosis surgical biopsy is preferred. Of prognostic significance are the size of the tumor and the number of regional lymph nodes affected. The different histological patterns have little prognostic bearing, with the exception of some rare special types such as medullary or mucinous carcinomas. Histological and/or cytological "grading" is too time-consuming for practical purposes. The pathologist is confronted with new problems by non-palpable "minimal breast cancer" detected by mass screening methods. The solution to these problems requires close interdisiplinary cooperation. In In the broad field of cystic diseases of the breast there is a need for a better histological definition of what constitutes a true premalignant lesion. Finally, the problems of multicentric and bilateral breast cancers are mentioned.
The Z-line, the transitional zone from oesophageal to gastric mucosa, is a clearly defined point of reference. Selective forceps biopsies were obtained from the Z-line, just below it from the cardia and 1-3 cm above it from the oesophagus, in 79 patients with an age average of 47 1/2 years. A comparison was made between endoscopic and histological findings, on the one hand, and symptoms on the other. Moderately severe inflammatory changes correlated positively with only minor endoscopic changes of the Z-line: patients of this group had significantly more symptoms of reflux than those with a normal line. Exact endoscopy, complemented by histological examination, can discover reflux oesphagitis in its early stages, although endoscopically and histologically the delineation from normal is difficult.
In Schweizerische Medizinische Wochenschrift 106, 894-897 (1976) an article was published on a kinship with hereditary "minor adenomatous polyposis" of the colon with a higher than expected incidence of carcinoma of the stomach. Evidence for a genetic relationship between this family (Sch.) and another branch with an isolated case (Sch. E.) of familial polyposis of the gastrointestinal tract was found. The patient Sch. E. is presented here. The polyposis of this patient is phenotypically identical with that found in the classical familial polyposis of the colon, but also exhibits features of "minor adenomatous polyposis". A systematic clinical-endoscopic examination of ten members of the patient's family produced no further cases of gastrointestinal polyposis of carcinomata. In the case of Sch. E., therefore, a spontaneous mutation is postulated. A new classification of the various types of colonic polyposis is suggested.
A 28 year old patient complained of sensory disturbances and pain in the right upper arm during pregnancy. During the 32nd week of her pregnancy, a large painful mass developed in the flexor muscles which, radiographically, showed some calcification. A diagnosis of a parosseous sarcoma was made; biopsy, however, indicated a diagnosis of non-traumatic myositis ossificans. Since the histological appearances of active myositis may be vary difficult to distinguish from a juxtacortical sarcoma, a right brachial angiogram and scintiscan were obtained. The angiographic and scintigraphic findings were erroneously considered to suggest malignancy. Following delivery, the tumour was removed. Futher histology confirmed the diagnosis of localised, non-traumatic myositis ossificans. The value of radiology, biopsy, angiography and scintigraphy are discussed with reference to our experience.
Selected examples are cited to show that, even today, autopsy can provide the clinician with essential information. The most important task of clinical autopsy is analysis of the individual case and correlation between clinical and autopsy findings. The discrepancies that may arise here are illustrated by cases of endocarditis. Spontaneous or therapeutic alterations of disease forms can only be established by autopsy, as is exemplified by indigenous systemic mycoses. The part autopsy can play in the analysis of new disease entities is illustrated in the case of analgesic nephropathy. From this it emerges that autopsy serves not only to establich terminal states but also the early stages. The example of malignant tumors which eluded clinical diagnosis is cited to demonstrate the value of autopsy statistics. In conclusion, an appeal is made for more intensive cooperation between clinician and pathologist and wider use of modern methods in the evaluation of autopsies.
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The study reports cytological findings in 63 cases of radio- and/or oestrogen-treated carcinoma of the prostate. The different effects of therapy on the tumor cells in the cytological smear are described and discussed. An evaluation of the results, depending on the type of therapy, showed, that radio-treated tumors, due to the rapid and strong sclerosis of connective tissue, were less suitable for aspiration biopsy than hormone-treated tumors. Further, we were able to show that the effect of therapy in well-differentiated tumors is better than in poorly differentiated tumors. Cytological examination of treated prostate carcinoma is a simple method, quickly carried out, repeatable several times, and of high diagnostic value. Aspiration biopsy is most of all indicated for follow-up of the less well-differentiated and the hormone-treated carcinomas.