Biomedical subjects
Publications and source records attributed to M Oehmichen.
Demonstration of nonspecific acid alpha-naphthyl acetate esterase activity is a simple and practical method for classifying mononuclear cells in the cerebrospinal fluid. In addition to mononuclear phagocytes, T lymphocytes may also be characterized.
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In a review, the methods and value of CSF cytology as routine diagnostic investigation should be described summarily. Among the various methods of cell concentration, the sedimentation method permits the best cytological differentiation of the cells of the cerebrospinal fluid. Both neuro-immunological processes and unspecific irritation processes (e. g. subarachnoid hemorrhage, traumata), brain tumors and metastases can be differentiated. For prognostic and therapeutic questions, cytology of the CSF is sometimes the method of choice, as for instance in questions of CNS involvement in hemoblastoses. The spectrum of diagnostic possibilities recommends the cytology of CSF as a routine method in all neurological, internal medical and pediatric clinics.
Following intracerebral injection of labeled erythrocytes, lymphocytes and/or peritoneal macrophages, cervical and inguinal lymph nodes were subjected to histologic examination. Labeled cells of all cell types were found in the cervical lymph nodes, but they were not observed in the inguinal lymph nodes. No labeled cells were demonstrated in the lymph nodes following intravenous injection of cell suspensions. It is assumed that an efflux of cells occurs in the perineural spaces of the exiting nerve fibers. The anatomic relationships were discussed.
Radioactively labeled macrophages were injected intracerebrally in order to acquire additional criteria for the identity of certain intracerebral cell types with cells of the monocyte-macrophage series. The intracerebral distribution of the labeled cells, their reactive ability following silver impregnation, and the formation of processes were considered as indications for ameboid motility. The localization, reactive ability, and structure of the cells were similar to that found in cells inside the brain which are considered to be monocyte derivatives, i.e., intraventricular cells such as epiplexus cells and supraependymal cells, progressive microglia, free subarachnoidal cells, and perivascular cells of intracerebral vessels. A survival time of 2 months was assumed for the cells since isolated, intracerebrally administered, peritoneal macrophages can still be demonstrated inside the subarachnoid space 2 months after the injection.
While it is certain that reactive microglia (phagocytes in damaged brain tissue) originate from monocytes, the derivation of resting microglia (argentophilic cells in undamaged brain tissue) is not clear. In order to examine a possible lymphocytic and/or monocytic origin for resting microglia, cryostat sections of presumably normal human brain tissue were treated with anti-lymphocyte, anti-monocyte and anti-beta 2-microglobulin sera and then stained with the immunoperoxidase technique. No positive reaction was obtained. It must be concluded that resting microglia are not derived from mononuclear blood cells.
A modification of the Weil and Davenport (1933) silver carbonate method for microglia impregnation is described. Formalin-dextran-CaCl2 solution was used as a fixation solution. The technique is simple, reproducible and improved. The staining method includes the demonstration of as well resting as progressive microglia.
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Eosinophilic granulocytes in the CSF were observed in 94 of approximately 10,000 qualitative cytologic preparations. Those cases of eosinophilia which occurred in the context of a parasitic disease or a puncture-related hemorrhage were excluded. CSF eosinophilia exceeding 1% was found in 57.5% of the cases and 5% in 23.5%. Increased cell counts were observed in 67.7% of the cases; elevated CSF protein values, in 68% to 73%; blood eosinophils, in 10.4%. There was no reason to suspect a relationship between these findings and the number of eosinophils in the CSF.--Fifty-two percent of the cases involved inflammatory diseases of the nervous system; the 18 cases of abacterial inflammation of unknown etiology were particularly striking. In the remaining cases, eosinophils were found in conjunction with cerebral ischemia and hemorrhage, with tumors, and in a relatively high percentage of children (21%). The frequency of occurrence with drained or undrained hydrocephalus was striking. A review of the pathophysiological function of eosinophils indicated that revived or corpuscular antigens were present in all cases of CSF eosinophilia in which an eosinophilic reaction was induced. Nothing can be said at this time, however, concerning the classification of the antigens.
Various methods of CSF cell differentiation are discussed. These methods provide additional information regarding the origin and, therefore, the types of pathological alterations occurring in the leptomeninges. They include the application of immunological and cytochemical markers to differentiate and identify B and T lymphocytes as well as cells from the monocyte-macrophage series and precursor cells of polymorphnuclear leukocytes. Application of these methods to CSF cells and the differentiation of CSF cells from 16 patients with inflammatory or neoplastic alterations were discussed. B cell or T cell type lymphocytes predominate with multiple sclerosis, T lymphocytes with tubercular meningitis. Varying quantities of B and T lymphocytes are found with viral meningitis. In one case the tumor cells of a reticulum cell sarcoma were identified in the CSF as T cells; in one case of plasmacytoma, tumor cells in the CSF were identified as B lymphocytes. In selected cases of leukemic or carcinomatous infiltration of the meninges and of medulloblastoma, CSF cells did not react to treatment with immunological markers.
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The case of a 65 year-old female with an immunoblastic sarcoma of T cell type (reticulosarcoma) is reported. Post mortem tumor cell infiltrations with the typically histomorphological criteria of an immunoblastic sarcoma were found in the uterus, bone marrow and leptomeninges. With the aid of immunological markers the T cell type of this malignant lymphoma was diagnosed intra vitam on the basis of CSF cells. Until now, only one case of an immunoblastic sarcoma of the T cell type has been described in the literature.
Comparable histologic alterations of intramural nervous tissue were reported in various diseases of the small and large intestine. In 6 cases, an intestinal obstruction was present which led to secondary intramural inflammation. The obstruction was induced by the spastic segment in Hirschsprung's disease (3 cases), by rectal atresia (2 cases) and by postoperative ischemic damage to the intestinal wall (1 case). In 4 other patients, the inflammation was predominant. The diseases considered were necrotizing enterocolitis (1 case), membranous enteritis (1 case) and Crohn's disease (2 cases). On the one hand, inflammatory infiltration composed primarily of lymphocytes was observed histologically in various degrees proximal to the obstruction in all cases. On the other, comparable alterations were found in splittering of nerve fibers and deterioration of nerve cells (degenerative alterations) in the plexus myentericus as well as hyperplasia and hyperchromasia of ganglion cells. Schwann cell proliferation and fibrosis in nerve fibers (reactive alterations). Until now such alterations were only observed in Chagas' disease and in ulcerative colitis, especially complicated by toxic megacolon. It is suspected that the neurodegenerative alterations in these diseases are toxically induced.
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In order to examine the possible haematogenous origin of phagocytes in anterograde and retrograde degeneration, rabbit peritoneal macrophages were labeled in vitro with 3H-DFP and injected intravenously into host animals. Four or five days prior to the injection, the facial nerve was avulsed and the sciatic nerve ligated in five recipients. The animals were killed 24 h after the injection of the macrophages. Labeled cells were found in that part of the sciatic nerve which was mechanically damaged and in the liver and spleen but not in areas with retrograde or Wallerian degeneration. The possible interpretation of these findings is discussed.