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Biomedical subjects

M A Konerding

Publications and source records attributed to M A Konerding.

At least 37 records · Page 2Linked to original sources

[Rectal carcinoma. Optimizing therapy by knowledge of anatomy with special reference to the mesorectum].

The connective tissue spaces of the pelvis and pelvic floor originate from an urogenital and perirectal mesenchymal cell complex, which can be clearly discerned. In the adult, the final compartments, which arise from these distinct tissue complexes, are still functionally separated. The perirectal tissue gives rise to the rectal fascia or rectal adventitia, also known as mesorectum. The connective tissue space between rectal and parietal pelvic fascia can be dissected as a plane free of vessels and nerves. Surgical dissection along this plane with complete mesorectum excision results in reliable excision of all relevant lymphatic pathways with extensive preservation of continence and sexual function.

Adult↗

Liposuction-assisted nerve-sparing extended radical hysterectomy: oncologic rationale, surgical anatomy, and feasibility study.

OBJECTIVE: Our purpose was to improve the therapeutic index of radical hysterectomy by extending the resection of parametrial tissue without further impairing pelvic autonomic nerve functions. STUDY DESIGN: We studied the topographic anatomy of the parametrial tissue with high-resolution magnetic resonance imaging and by dissection of fresh human cadavers. We then performed a clinical feasibility study of the liposuction-assisted nerve-sparing extended radical hysterectomy. RESULTS: Magnetic resonance imaging demonstrated that the perispinous adipose tissue is retained after type III radical hysterectomy and is a frequent site of tumor recurrence. The perispinous adipose tissue contains the pelvic plexus, the pelvic splanchnic nerves, small blood vessels, and lymphatic tissue. We developed the liposuction-assisted nerve-sparing extended radical hysterectomy and applied it to seven consecutive patients with cervical or vaginal cancer. No intraoperative or postoperative complications occurred. Postoperative magnetic resonance imaging assured us that perispinous adipose tissue was cleared in all cases. A metastatic lymph node was found in the perispinous adipose tissue removed by liposuction from one patient. Suprapubic cystostomies could be removed after a median period of 12 days. CONCLUSION: The nerve-sparing removal of perispinous adipose tissue by liposuction is a feasible addition to wide en bloc parametrectomy in anatomically defined planes.

Adipose Tissue↗

The vascular architecture of the chick chorioallantoic membrane: sequential quantitative evaluation using corrosion casting.

Microvascular corrosion casting was used for evaluating qualitatively and quantitatively angiogenesis in the chick chorioallantoic membrane (CAM). Series of CAMs from day 8 to 18 were examined. The density of plexus capillaries increases rapidly until day 10 and then remains constant. The vessels connected to the plexus (first order vessels) increase in number and length between days 10 and 12. The vessels initiating from first-order vessels (second order) also increase in number but remain nearly the same in lengths and diameters. Compared to previous studies using stereomicroscopy, significant differences in vessel numbers and lengths exist, which can be explained by the low resolution and magnification resulting in too low vascular densities of the pre- and post-capillaries. The third-order vessels increase in number until day 12 when they reach a plateau, whereas higher-order vessels increase in number. These results give an insight into the vascular development of this organ, and provide the basis for assessing the targets and effects of angiogenic or antiagiogenic agents.

Journal Article↗

Impact of fibroblast growth factor-2 on tumor microvascular architecture. A tridimensional morphometric study.

Three cell clones originated by transfection of human endometrial adenocarcinoma HEC-1-B cells with fibroblast growth factor-2 (FGF-2) cDNA and characterized by a different capacity to produce and secrete the growth factor were transplanted subcutaneously in nude mice. Corrosion casting of the tumor microvasculature of xenografts produced by injection of 2 x 10(6) or 10 x 10(6) FGF-2-B9 cells (which produce and secrete significant amounts of FGF-2), 10 x 10(6) FGF-2-A8 cells (which produce comparable amounts of FGF-2 but do not secrete it), or 10 x 10(6) control FGF-2-B8 cells (which produce only trace amounts of FGF-2) was performed after 14 days of growth. Interbranching distances, intervascular distances, branching angles, and vessel diameters were then determined using tridimensional stereo pairs of the casted tumor vascularity. When transplanted at the same concentration, FGF-2-B9 cells grew faster in nude mice compared with FGF-2-A8 and FGF-2-B8 clones. The total amount of new vessel formation was far higher in FGF-2-B9 tumors than in FGF-2-B8 or FGF-2-A8 tumors. Also, vessel courses were more irregular and blind-ending vessels and evasates were more frequent in FGF-2-B9 tumors. Moreover, FGF-2-B9 tumor microvasculature was characterized by a wider average vascular diameter and by an extreme variability of the diameter of each individual vessel along its course between two ramifications. No statistical differences were observed when the distribution curves of the values of intervascular distances, interbranching distances, and branching angles of the microvessel network were compared among the different experimental groups. The distinctive features of the microvasculature of FGF-2-B9 tumors were retained, at least in part, in the smaller lesions produced by injection of a limited number of cells. The data indicate that FGF-2 production and release confer to FGF-2-B9 cells the ability to stimulate the formation of new blood vessels with distinctive architectural features. Neovascularization of FGF-2-B9 lesions parallels the faster rate of growth of the neoplastic parenchyma. This does not affect the overall architecture of the microvessel network that appears to be primed by characteristics of the HEC-1-B tumor cell line and/or by the microenvironment of the host. To our knowledge, this work represents the first attempt to define the influence of a single, defined growth factor on the tridimensional tumor vascular pattern.

Adenocarcinoma↗

Impact of particulate contamination in crystalloid cardioplegic solutions: studies by scanning and transmission electron microscopy.

The amount of particulate matter present in Bretschneider's cardioplegic solution (HTK) was assessed by laser-mediated particle counting. Permissible levels of contaminant particles with a distribution of diameters between 0.2 and 20 microns were found. A significant further increase in the particle count was observed when the fluid was administered for clinical use, which resulted in the additional release of particles from, for example, the infusion kit, which included an in-line filter with pores of 270 microns. Filtration of the HTK solution by a terminal inline filter (0.2 micron) significantly reduced the number of particles. In order to determine the chemical composition and the potential hazards of the particulate material we used scanning electron microscopy in combination with energy dispersive X-ray analysis and transmission electron microscopy to examine specimens taken from heart tissue obtained from Göttinger minipigs after cardioplegia and from humans undergoing mitral valve replacement after cardioplegia and reperfusion. Particles of various diameters were found either to be plugging coronary capillaries, to be adherent to the endothelial layer, or to be engulfed by polymorphonuclear (PMN) granulocytes, which appeared to be activated. Some of the PMN granulocytes were apparent in the endothelial layer. It is recommended, therefore, that a terminal in-line filter (0.2 micron) should be routinely used.

Animals↗

The vascular anatomy of the inner anterior abdominal wall with special reference to the transversus and rectus abdominis musculoperitoneal (TRAMP) composite flap for vaginal reconstruction.

This study was designed to clarify the vascularization of the inner anterior abdominal wall with respect to the novel transversus and rectus abdominis musculoperitoneal (TRAMP) flap, which was introduced recently for vaginal reconstruction. A series of human cadavers was injected with a lead oxide-gelatine mixture by means of the deep inferior epigastric artery and subsequently dissected and examined by radiography. In all cases we found that the blood supply of the entire rectus abdominis muscle from the symphysis to the costal arch and that of the medial 10 to 15 cm of the transversus abdominis muscle, as well as the underlying peritoneum, was provided by several branches of the deep inferior epigastric artery. "Choke" arteries to the superior epigastric artery and also to the intercostal arteries (X, XI, and XII) have been shown to be common features. From the anatomic point of view, these observations offer the possibility of mobilizing large parts of the transversus abdominis muscle together with the rectus abdominis muscle for reconstructive surgery.

Abdominal Muscles↗

Impact of the incubation medium on the endothelium of autologous vein grafts: damage scoring by scanning electron microscopy.

The aim of this study was to examine the influence of different incubation media on the morphology of the endothelium of great saphenous vein grafts and establish a suitable scoring system for the evaluation of damage caused by these media. Fifty specimens of saphenous veins from ten patients during elective aorto-coronary bypass surgery were used. Ten specimens served as controls; the others were assigned to test groups and exposed to heparinized whole blood, Bretschneider's HTK, human albumin or Ringer's solution. Specimens exposed to heparinized blood showed only slight morphological alterations, whereas the other three mediums caused severe damage. Thus, heparinized blood seems to be most suitable as a rinsing and incubation medium. A widely accepted scoring system for the quantification of endothelial damage caused by the incubation media did not adequately reflect the morphology alterations in the cytoskeleton and membrane topology. The proposed scoring system, which is based on endothelial cell separation, endothelial cell loss, amount of deposits, endothelial cell surface homogeneity, in addition to the frequency of spikes and blebs, seems to be suitable for characterizing differences in endothelial morphology.

Adult↗

[Myoperitoneal composite flaps: a new surgical principle for vaginal reconstruction].

In spite of the development of various techniques for the formation of a neovagina, the longterm results are often disappointing, especially if the simpler methods (dilation, ectopic pouch formation, epithelium transfer) have been applied. The more complex surgical techniques such as musculo/fasciocutaneous and colon flaps are associated with a significant risk of severe complications. For certain operative situations necessitating vaginal reconstruction, adequate procedures are still missing. Based on surgico-anatomic investigation of the vascular territories of the myoperitoneal anterior abdominal wall, we introduce the use of myoperitoneal composite flaps from the deep inferior epigastric artery angiosome as a novel surgical principle for vaginal reconstruction and report on the experience with the first two patients.

Adenocarcinoma↗

Does lung contusion affect both the traumatized and the noninjured lung parenchyma? A morphological and morphometric study in the pig.

Isolated unilateral lung contusion (LC) was induced in 12 pigs to determine the pathophysiological role of LC in the high mortality after multiple injury. The Horovitz quotient, pulmonary vascular resistance, mean pulmonary artery pressure, mixed venous oxygen consumption, inspiratory pressure and compliance were significantly decreased in the LC group as compared to controls. The number of polymorphonuclear granulocytes, the microvascular permeability of albumine and the Wilhelmy balance as determined by bronchoalveolar lavage were significantly increased after lung contusion. As indicators of a systemic reaction we found elevated plasma levels of the terminal complement complex and decreased levels of the complement factor 3a after LC. The morphological assessment revealed changes such as those encountered during the early phase of adult respiratory distress syndrome, with granulocyte sticking, endothelial cell adhesion and transendothelial diapedesis. Morphometric analysis demonstrated a significant decrease in alveolar diameter in both the injured and the contralateral lung due to impaired surfactant surface activity. A distinct increase in septal diameter, related to edema and caused by increased microvascular permeability, was found in the injured lungs. These findings emphasize that LC leads to a generalized impairment of the entire lung, which may lead to progressive lung failure.

Albumins↗

A simple and accurate method for 3-D measurements in microcorrosion casts illustrated with tumour vascularization.

Microvascular corrosion casting is an established method to investigate vascular patterns of nearly all organs. Trying to evaluate these specimens quantitatively using native scanning electron microscope (SEM) pictures always implied a big error, because the information of depth cannot be taken into account. However, SEM stereo pairs allow for exact measurements. Tumour microcorrosion casts were used to demonstrate the feasibility of this 3-D quantification method. The information of depth was calculated for each measuring point using the parallax. From the resulting coordinates the intervascular distances, the interbranching distances as well as the interbranching angles were determined. We found significant differences between all investigated tumours. Reproducibility tests and tests for the greatest error possibilities resulted in a maximum deviation of 2.5% to be expected. Consequently this method is suitable for all application ranges of microvascular corrosion casting as a quantitative determination method.

Animals↗

Microvascular corrosion casting in the study of tumor vascularity: a review.

Tumor blood flow is dependent on the structure and three-dimensional (3-D) architecture of the vascular network. The latter can be best studied by scanning electron microscopy of microvascular corrosion casts. However, literature reviews show that nearly all studies using this technique render comparisons of different tumors more difficult since they are mainly based on descriptive terms that might lead to misunderstandings. Qualitative comparisons of 13 experimental and 3 human primary tumors of different origin show a high degree of similarity in the vasculature. Quantitative analysis of these casts reveals similar ranges of parameters such as diameters, intervascular and interbranching distances. Diameters of vessels with capillary wall structure range from 6 micron m to 55 micron m in the human primary tumors (renal clear cell carcinoma, basalioma), and from 5 micron m to 80 micron m in xenografted tumors (sarcomas, colon carcinoma). Intervascular distances in the human primary tumors range from 2 micron m to 52 micron m, and from 11 micron m to 105 micron m in the xenografts. Interbranching distances range from 34 micron m to 258 micron m in the former, and from 11 micron m to 160 micron m in the latter. Both qualitative and quantitative analyses of tumor microvascular corrosion casts enable pathophysiological conclusions to be drawn and contribute to a better understanding of tumor vascularity.

Animals↗

Endothelial damage of the venous graft in CABG. Influence of solutions used for storage and rinsing on endothelial function.

A significant proportion of early graft occlusions after aortocoronary revascularization using autologous saphenous vein grafts (SVG) are due to mechanical and/or metabolic or biochemical endothelial lesions. The morphological examination of the endothelium, usually carried out using light microscopy or by various types of scanning electron microscopy (SEM), does not give any indication of the functioning of the endothelium (E). Functionally intact E is capable of producing endothelium-derived relaxing factor (EDRF); a practicable in vitro test is the relaxation of pre-contracted vein segments (VS) in response to acetylcholine (ACh) application. To study the effect of the solution used to rinse and store the SVG between removal and implantation on the functional characteristics of the E, we performed in vitro tests on macroscopically intact VS removed from the saphenous vein of 30 male patients who underwent elective CABG surgery. Isolated VS rings were incubated for 60 min in heparinized whole blood (HWB), Bretschneider's cardioplegic solution (HTK), human albumin solution (HAS), or Ringer's solution (RS) and compared with the results obtained immediately after the removal of untreated control samples (C) taken from the same patients. After equilibration in carbogen aerated Krebs-Henseleit solution and precontraction by 3 x 10(-7) M noradrenaline (NE), relaxation induced by 10(-6) M ACh was measured. Only the samples stored in HWB (13.4 +/- 0.4 mN) showed similar maximal contractions with NE to those in the control group (14.4 +/- 0.5 mN), i.e. all those segments which showed both contractions with NE and relaxation with ACh.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholine↗

Vascular patterns of tumors: scanning and transmission electron microscopic studies on human xenografts.

The tumor vascular system plays a significant role both in tumor growth and metastasis as well as in therapy. However, there are comparatively few papers dealing with the morphology and architecture of tumor vascularity. This is inconceivable insofar as structural and architectural parameters determine tumor blood flow. Therefore, the vascular system of eight human tumor lines transplanted onto 121 thymus-aplastic nude mice was studied with light, scanning and transmission electron microscopy as well as microvascular corrosion casting. All tumors show a connective tissue-like capsule with a dense plexus of vessels forming a "vascular envelope". Particularly in early stages, these vessels follow a tortuous course with glomeruloidal arrangement and numerous indications of angiogenic activity. In the tumor centre regular arteries and veins are never to be seen. Instead, all vessels show a capillary wall construction with variations in height and electron densities of the endothelial cells. Changes in vessel diameter, lack of vascular hierarchy, blind ends as well as irregular sinusoidal systems originating from and draining to veins are common features. The vascular densities vary considerably within single tumors. Based on the vascular architecture and wall construction, necroses may occur even in areas with intervascular distances of only 15 microns. No significant differences in vascular architecture of the various cell lines could be observed.

Animals↗

[The effect of topical heparin on histamine-induced wheals. A double-blind study].

Since it is difficult to demonstrate the effectiveness of heparin-containing ointments in the treatment of thrombophlebitis under clinical conditions, a double-blind experimental trial was performed in 18 volunteers. To produce a reproducible inflammation, ten drops of a histamine solution containing 10 mg histamine/100 ml, were applied to an area measuring 4 x 7 cm2 on both forearms of each test subject. Under each drop, the skin was pricked five times. Ten minutes after induction of inflammation, one forearm of each subject was treated in a double-blind randomized manner with an ointment containing heparin (50,000 IU heparin/100 g), the other arm being treated with the heparin-free ointment base. As a criterion of the effectiveness of the ointment, the course of the temperature of the forearms was measured using thermography. Ten minutes after application of the histamine solution, the temperature increased by a mean of about 3 degrees centigrade. After 30 minutes' treatment with heparin-containing ointment, the temperature then decreased by 1.77 degrees C, while that of the forearms treated with heparin-free ointment base decreased by only 1.14 degrees C. The difference was statistically significant (p less than 0.001). Sixty minutes after treatment the differences were still significant at p = 0.012. This study thus demonstrates the effectiveness of heparin-containing ointment in the treatment of histamine-induced inflammation.

Administration, Topical↗

Scanning electron microscopy of corrosion casting in medicine.

The aims of this review are: 1. to provide a bibliography of the publications that have used the corrosion casting technique; 2. to describe the advantages and limitations of the methodology; 3. to illustrate possible applications in the field of medicine, and 4. to highlight the significance of this method in the teaching of medical students. Thus, this paper is primarily focused on the scanning electron microscopical examination of vascular corrosion casts. The unsurpassed three-dimensionality of the corrosion casting technique compared to any other means stands out in particular. This can be especially useful when complex vascular-anatomical relationships are present. This applies not only to the portrayal of the modes of branching and varying vascular densities but also to regulatory arrangements, such as sphincters and arteriovenous anastomoses. Between 1966 and 1990, a total of 549 publications were found in the Medline literature data bank, containing the key words "corrosion casting", "microvascular cast", or "vascular cast" (as of August, 1990). Of those publications, most dealt with applications to experimental animals. By contrast, only 142 reports were mainly or partially concerned with human investigational material. The normal vascular system of nearly all organs, insofar as this is of direct medical relevance, has been largely resolved. In our opinion, one of the most important potential applications of the corrosion casting technique lies in the investigation of gastrointestinal, renal or hepatic ailments, which coincide with the reconstruction or rarefication of the vascular bed, e.g., in ulcers, ileitis terminalis, colitis ulcerosa, cirrhosis or glomerulonephritis.

Animals↗

The vascular architecture of human xenotransplanted tumors: histological, morphometrical, and ultrastructural studies.

This study was designed to examine the vascular system of human xenotransplanted tumors on nude mice with different complementary morphometrical and morphological methods. The vascular system shows a chaotic arrangement. There is an extreme heterogeneity in the vascular distribution and density. Large avascular regions could be identified in several non-necrotic tumors. There was no clear difference in the vascular density between the center and the periphery of the tumors, nor was there any zonal correlation for the distribution of the necrosis. With three-dimensional corrosion casts it could be demonstrated that clusters of vessels were directly beneath areas almost free of vessels. In the center, vessels often form a sinusoidal system with numerous blind ends without clearly discernible endothelial cells. Numerous irregular tumor-cell-lined sinusoids are visible next to endothelial-lined vessels with transmission electron microscopy. With scanning electron microscopy it could be demonstrated that large-calibre endotheliazed vessels were found in the direct vicinity or in the center of non-viable zones. Even large-calibre vessels have a capillary wall structure. Sometimes, a basement membrane cannot be observed at all or only incompletely. There are numerous indications of vascular discontinuities and leaks with a widespread intercellular occurrence of blood cells.

Animals↗

The vasculature of xenotransplanted human melanomas and sarcomas. 3. Morphometric studies.

Morphometric measurements of xenotransplanted tumors allowed the evaluation of vascular distribution and density. The correlation between these two parameters and the amount of necrosis could be determined. A wide range of vascular densities between different tumors was measured. This extreme heterogeneity of vascular distribution and density was seen in the center as well as in the periphery of single tumors. Large avascular regions were identified in several tumors that were not necrotic. The distribution of the necrosis showed no zonal correlation, either. No correlation was observed between the density of vessels and the amount of necrosis.

Animals↗