Peroxidatic activities of human alveolar macrophages in some pulmonary granulomatous disorders.
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Biomedical subjects
Publications and source records attributed to P Soler.
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Various congenital systemic arteriovenous fistulas have been described. An unusual case of congenital systemic arteriovenous fistula arising from the descending aorta and draining separately into the superior vena cava, the azygos vein, and the innominate vein is reported. Clinically, this case simulated a patent ductus arteriosus. To our knowledge, this particular anomaly has not been described before.
It was reported earlier that in the lungs of individuals with idiopathic pulmonary fibrosis, many cells lining small air spaces have intimate associations with underlying interstitial cells. The present study confirms and extends these previous observations by describing changes seen in a different patient group. Light microscopy of lung biopsy tissue showed thickened alveolar walls with infiltrates of mixed inflammatory cells. There were undefined associations between interstitial cells and cuboidal and attenuated epithelial cells lining smaller air spaces. Electron microscopy demonstrated that cytoplasmic processes from the lining cells protruded through discontinuities in underlying basement membranes, and that intimate connections between lining cells and interstitial cells frequently were present. In addition, some of the cells lining air spaces had few microvilli, rare pinocytotic vesicles, and did not lie on basement membranes. These cells were mesenchymal-like in appearance and were clearly associated with interstitial cells and connective tissue. Similar pulmonary lesions were observed in mice that received a single intraperitoneal injection of butylated hydroxytoluene and were exposed subsequently to 70% oxygen for 6 days. Our findings suggest that communication between a regenerating epithelium and the underlying mesenchyme is an integral step for ongoing alveolar repair.
Langerhans' cells were found in lung biopsies in one of nine control patients and in 20 of 160 patients with fibrotic lung disorders, including 13 of 56 patients with idiopathic pulmonary fibrosis, two of nine patients with collagen vascular diseases, two of seven patients with hypersensitivity pneumonitis, and each of three patients with end stage fibrosis of uncertain cause. Langerhans' cells were not found in any of the 41 patients with sarcoidosis, the 35 patients with interstitial lung diseases associated with inhalation of inorganic dusts, the seven patients with pulmonary lymphangioleiomyomatosis, or the two patients with chronic eosinophilic pneumonia. In the control patient, Langerhans' cells were found between epithelial cells in bronchioles. In patients with fibrotic lung disorders, Langerhans' cells were found in the epithelial layer of bronchioles and alveoli containing proliferating epithelial cells, i.e., either cuboidal epithelial cells of bronchiolar origin or type II alveolar epithelial cells. Severe fibrosis or squamous metaplasia were not prerequisites for the presence of Langerhans' cells. The motility of Langerhans' cells apparently was restricted, as they were not found in the air spaces in any of the biopsies, and they were not recovered from bronchoalveolar lavage fluid of any of the 97 patients studied, even though some of these patients had relatively numerous Langerhans' cells in lung biopsies. These observations are in sharp contrast to those in pulmonary histiocytosis X, in which histiocytosis X cells (HX cells) occur in granulomas, in alveolar interstitium, and between epithelial cells of the lower respiratory system. HX cells also migrate into air spaces, as shown by their occurrence in bronchoalveolar lavage fluid. The HX bodies in HX cells are morphologically similar to Langerhans' cell granules, but are more numerous and pleomorphic. HX cells are considered to be reactive or activated Langerhans' cells.
Ultrastructural studies of lung and lymph nodes biopsies from twelve patients with sarcoidosis were performed. They consistently demonstrated junctional complexes between consistently demonstrated junctional complexes between granulomatous cells issued from the mononuclear phagocyte system. These inter-cellular contacts have a desmosome-like appearance but differ in some of their structural aspects. The role of these complexes appearing between cells of monocytic origin remains to be defined.
The respiratory effects of low levels of SO2 alone or associated with NO or NO2 were studied in rats exposed for periods of one day to thirteen weeks. Control rats were exposed to ambient air. Both control and treated rats appeared similarly active and grew uniformly. Erythrocytic variables (hemoglobin, hematocrit, red cell counts, 2,3-DPG, glucose, lactate, methemoglobin) and oxyhemoglobin dissociation curves were determined at different times throughout exposure to the gaseous mixture. Blood variables of the exposed rats were not significantly different from those of controls, and hemoglobin affinity was not modified. Bronchiolar and tracheal epithelia were studied by scanning (TEM) to detect a possible loss of cilia. The alveolar walls were investigated by Light Microscopy and TEM after each period of exposure. No striking changes were observed in rat lung structures under Light Microscopy or TEM. Bronchiolar and tracheal epithelia were normally ciliated. No synergistic effects were produced by either SO2 + NO or SO2 + NO2.
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Fibreoptic broncho-alveolar lavage was used in four patients; the diagnosis of histiocytosis X had been established by lung biopsy in three and was suggested on clinical grounds in the remaining patient. Characteristic cells with an ultrastructural cytoplasmic marker (X body) were found in the washes of all four patients. In the patient without biopsy confirmation, the findings in the broncho-aleolar washes supplied the corroborating evidence for the diagnosis. From this preliminary study the technique seems able to provide a diagnosis in pulmonary histiocytosis X without the need for an open lung biopsy.
Three cases of pulmonary lymphangiomyomatosis are described, with emphasis on the ultrastructural changes. The clinicopathologic features corresponded to those previously described. Each patient was a female in the reproductive years; breathlessness and recurrent pneumothoraces were the predominant clinical features. Histologically, the lungs showed a focal interstitial infiltrate of short, spindle-shaped mononuclear cells compatible with primitive smooth muscle, which was associated with irregular emphysema and hemosiderosis. Electron microscopy confirmed the smooth muscle nature of the pulmonary infiltrate and showed the presence of cells intermediate between smooth muscle and fibroblasts. Abnormalities were also noted in the pulmonary connective tissue that are possibly related to the fragility of the lung in this condition.
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Following the intravenous injection of complete Freund's adjuvant, changes in the rat lung were studied with the electron microscope. Interstitial granulomas were produced and whereas on light microscopy these appeared to consist mainly of epitheloid cells, electron microscopy showed that the granulomas were largely made up of macrophages. Epithelioid cells were in fact few in number, atypical in appearance and limited to the periphery of some granulomas. Fenestrated capillaries were also found at the edge of the granulomas. The alveolar macrophages were increased in number and size but marked cytoplasmic vacuolation and a paucity of lysosomes are consistent with our previous suggestion that the phagocytic and migratory properties of these cells are weakened or inhibited. Alterations were found in both types of alveolar epithelial cell with the appearance of intermediate cell forms.
One hundred and fourteen pulmonary biopsies were performed to diagnose diffuse pulmonary diseases. Diagnosis was made in 98% of cases. Biopsy requires very methodic rules for the sampling and its utilization. These rules are reported.
A morphological study permitted us to show that the epithelioid cell is an active cell, the characteristic vesicles of which seem to be linked to the presence of a glycoprotein substance which passes through the Golgi apparatus and becomes accumlated in the lysosomes owing to their richness in acid phosphatase. A fraction of this substance may be secreted into the extra-cellular medium, without it being possible to determine its precise nature and whether this function is carried out only by this cell.
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