Biomedical subjects
Publications and source records attributed to H J Rumpelt.
The broncho-alveolar lavage from an 18-year-old girl with proven histiocytosis X of the lung has been cocultivated with Staphylococcus aureus. Electron microscopy revealed that the bacteria adhere to the membrane of HX cells and become ingested afterwards.
32 forceps biopsies were performed in 30 patients with obstructive jaundice during percutaneous transhepatic biliary drainage procedures. In one patient an adequate specimen could not be obtained. In 25 of the remaining 31 cases diagnosis was confirmed histologically (malignant tumours: n = 22, benign stricture: n = 3). In 6 patients false-negative results were obtained. Transluminal biopsy is an easily performed adjunct to percutaneous transhepatic diagnostic interventions with minimal additional discomfort for the patient. In many cases percutaneous needle biopsy can be avoided. Forceps biopsy enables nonoperative histological diagnosis of small carcinomas of the bile ducts.
Bellini duct carcinomas have recently been identified as a new entity in the spectrum of renal cell carcinomas and 10 cases have now been reported. The present paper adds detailed clinical and morphological data on six new cases. In addition, immunohistological and electronmicroscopical results support the origin of these tumours from the renal collecting ducts, especially the papillary ducts (Bellini ducts). A set of immunohistological reactions, including reactions to cytokeratins 13 and 19, vimentin and UEA-1 was found to facilitate the differential diagnosis of Bellini duct carcinomas from other renal cell carcinomas and infiltrating urothelial carcinomas of renal pelvis.
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After a controversial phase of nomenclature (including--among others--the terms "hypernephroma" and "hypernephroid carcinoma") a cytomorphologically defined subtyping of renal cell tumours (adenomas, carcinomas, oncocytomas) is offered, based on new electron microscopical and histochemical observations. These data are in part supported by cytogenetical findings reported in the literature. Phenotypical/histogenetical relations to different parts or cell types, respectively, of the nephron-collecting duct system could be demonstrated. Chromophobe cell carcinoma and oncocytoma exhibit features of the intercalated cells.
Pneumonia was diagnosed radiologically in three patients (43, 54 and 58 years old, respectively), presenting with temperatures between 39 degrees and 40 degrees C, cough and weight loss. These signs persisted for 6, 7 and 13 weeks, respectively, but the pathogens could not be cultivated. Lung function analysis showed partial respiratory insufficiency with extensive restrictive impairment of ventilation. Samples of lung tissue were obtained in all three cases and histology revealed fibrosing alveolitis. In two patients serology yielded antibody titres of 1:512 and in one patient of 1:128, against Legionella pneumophila. Treatment with 1 g erythromycin three times daily was unsuccessful. Therefore, the patients were given prednisone at an initial dosage of 50-100 mg which was subsequently reduced. Lung function normalised during this treatment course, radiological findings and antibody titres receded. Hence, treatment with corticosteroids should be attempted if there is an urgent suspicion of fibrosing alveolitis caused by Legionella pneumophila, after having excluded a florid infectious pneumonia and after failure of erythromycin treatment.
A young male patient (NYHA III) presented with a severe pulmonary artery bifurcation stenosis of unknown origin. He underwent successful radical resection and endarterectomy of abundant endoluminal and perivascular inflammatory tissue. Surgery was performed with extracorporeal circulation (ECC) without transection of the aorta and the pulmonary artery bifurcation was enlarged with a patch. Right ventricular to peripheral pulmonary artery pressure gradient fell from 80 mmHg preoperatively to 25 mmHg 18 months postoperatively. The patient is fully rehabilitated and working (NYHA I). Histological examination confirmed Takayasu's arteritis as the underlying disease and medium-term follow-up angiography showed an almost normal pulmonary artery bifurcation. We conclude that the radical surgical approach is a valuable palliation in this disease.
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The elimination of Staphylococcus aureus (S. a.) and Pseudomonas aeruginosa (P. a.) by pulmonary neutrophilic granulocytes was investigated in vitro. The elimination rate of P. a. is appreciably smaller than that of S. a.. The reason for this is apparently a reduced degree of phagocytosis of P. a. in consequence of the slight adherence to the granulocyte membrane. The liberation of oxidants differs only to a negligible degree.
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Glomerular crescents are accumulations of proliferating cells in Bowman's capsule and develop as a consequence of glomerular capillary wall ruptures. The severity of crescentic lesion (% glomeruli affected) and crescent size (segmental vs global) are correlated: the higher the percentage of crescentic glomeruli, the more of them are global ones. Several age stages can be differentiated: cellular, fibrocellular, and fibrous crescents. Cellular crescents are mainly composed of epithelial cells derived from the visceral and parietal epithelium, while macrophages and granulocytes are intermingled in widely varying numbers. Crescents can appear in most forms of glomerulonephritis (gn). High percentages of crescents (more than 50%) may be associated 1. with glomerulonephritides of other definition (especially postinfectious gn, mesangial-proliferative gn, IgA-nephritis, membranoproliferative gn, LE-nephritis, Schönlein-Henoch nephritis, cryoglobulinemia) and 2. are the substantial alteration in intra-extracapillary proliferative gn (IEKPGN). Among the latter three forms can be distinguished. a) Anti-glomerular-basement membrane-nephritis and Goodpasture syndrome, respectively (28% of cases), M. Wegener and other vasculitides (8%), and c) idiopathic IEKPGN (63%). Immunohistologic results (IgG, A, M; complement C3, C4) in idiopathic IEKPGN are positive in 53% of cases, but when only cases with initial crescents are evaluated merely 10% are positive, thus secondary trapping of components of humoral immune reaction may be involved. The appearance of crescents generally has a negative influence on prognosis. In cases with more than 80% crescents terminal renal failure occurs in most cases. 50-80% crescents mostly result in compensated renal insufficiency, but less than 50% crescents may be present without elevation of serum creatinine concentration.
This paper reports on 32 chromophobe cell renal carcinomas observed in 697 renal cell cancers (RCC) of adults (peak in the sixth decade of life). The chromophobe cell-type differs from other types of RCC macroscopically, the cut-surface being predominantly of grey-beige colour. Histologically, there are two variants: one is the typical (light) variant (n = 22) and the other is eosinophilic (n = 10). Both variants have in common (a) reaction of the cytoplasm with Hale's acid iron colloid; (b) electron microscopic detection of cytoplasmic microvesicles (150-300 nm), frequently with 'inner vesicles', and (c) low glycogen content in comparison with the clear cell carcinoma. Immunocytochemical investigations on the intermediate filaments show a positive reaction for cytokeratins No. 18 (uniformly) and Nos. 7 and 19 (to varying extents) for both variants, whereas vimentin was not found in any of these carcinomas, in contrast to the clear-cell type. The cytomorphological grading revealed predominantly G II tumours. A lymph node metastasis was found in one patient. On the basis of the mortality curves determined, the prognosis for patients with chromophobe cell carcinomas is more favourable than that of the clear-cell type. In terms of differential diagnosis, on the one hand, the typical (light) variant of the chromophobe cell RCC must be delimited from the clear-cell RCC, and on the other hand, the eosinophilic variant must be distinguished from the chromophilic or 'granular' RCC. Microscopic, histological, histochemical, electron microscopic, and intermediate filament analysis results document that the chromophobe cell type of RCC is a distinct entity. The implications for the nomenclature of RCC, especially with regard to the 'granular' type, are discussed.
The fine structural details of how leukocytes appear in the lumen of tubules and the localization of bacteria in the tubulo-interstitial space were studied by light and electronmicroscopy in renal cortical biopsy specimens from three patients with acute pyelonephritis. The cells of interstitial infiltrates infiltrated and sometimes disrupted the cortical collecting tubules preferentially, while inflammatory infiltration of the proximal and distal convoluted tubules occurred more rarely. Since the emigration of tubular wall-localized individual leukocytes into the lumen was not observed even in long series of thin sections, focal inflammatory disruption of the uriniferous ducts was considered to be the morphological basis of the intratubular accumulation of leukocytes. The structural simplicity of the collecting tubular cells is suggested to be the reason for their preferential involvement in the drainage of the interstitial suppuration, although a role for specific carbohydrate receptors cannot be excluded. The bacteria were usually found within the neutrophilic granulocytes and macrophages of the interstitial infiltrates, and within and among the cells of leukocyte casts. Additionally, pure bacterial colonies were noticed in the lumen of a few collecting tubules. The problem of the adherence of the bacteria to the surface of the tubular cells is discussed.
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Autopsy findings in a patient with cardiac tamponade following percutaneous transluminal coronary angioplasty (PTCA) are reported. Angiography during PTCA demonstrated coronary dissection without extravasation of contrast medium at the site of angioplasty. Histologic examination of the dilated coronary segment revealed longitudinal splitting of intima and media as well as circumferential subintimal and submedial dissection. Hemorrhage into plaque, intima, media, adventitia and dissection lumina was found. Disruption of the adventitia was not present. Cardiac tamponade may occur transadventitially without complete disruption of the coronary artery and without extravasation of contrast medium.
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The histopathological grading exerted a significant influence on prognosis in patients with colonic carcinoma. More than half of the well differentiated tumors were found in early stage pT1-3 N0 M0 compared to 25% of the G2- and 10% of the G3-tumors. The percentage of incurable cases in G2-tumors was twice as high and in G3-tumors three times as high as in patients with well differentiated carcinomas. The recurrence rate increased significantly with decreasing tumor differentiation from 21% to 51%. Despite the correlation with tumor stage the histopathological grading could be established as an independent prognostic variable and had an influence on the recurrence rate especially within tumor stage pT1-3 N0 M0.