[The shock lung syndrome in agranulocytosis patients].
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Biomedical subjects
Publications and source records attributed to U Bleyl.
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Cell injury can result in cell death with sufficient intensity and prolongation of various noxae. Cell death exhibits specific local characteristics but is generally monomorphic. Since a cell cannot be considered as an individual unit, knowledge of the interactions among various cells and their systems provides the basis for effective cell and organ protection. In the case of cell or organ injury which threatens to generalize, with far-reaching consequences for the entire organism, the following therapeutic measures should be considered: timely intervention in the disturbed prostaglandin metabolism; activation of the RES; for example, substitution of opsonins; minimizing of the secondary invasion of enterogenic toxins.
All cases of the Regional Cancer Registry, North Baden who developed a gastro-intestinal cancer during the period 1975-1980 were re-examined according to the following parameters: tumor volume, pT stage, pN stage, grading. In the period considered, 8424 cases out of 14,061 cases with histologically proven gastrointestinal cancer could be grouped according to the pT stage. Most of the cases were operated at the pT2 or pT3 stage. Remarkable differences in the different tumor localizations were obtained. Stomach carcinoma had the highest percentage of the pT4 stage (36.2%), rectum carcinoma the lowest (7%). In all primaries a close coherence of tumor volume and pT stage was noted. Carcinoma at the pT1 stage measured 20 cm3 on average, those at the pT4 stage 170 cm3. No coherence of staging and age of the patients could be obtained. Younger patients showed a higher percentage of undifferentiated carcinoma than older patients. Survival data could not be obtained due to the data protection law.
Population-based data of malignomas of the gastro-intestinal tract were evaluated from the regional cancer registry North-Baden for the period of 1971-1980. The age standardized incidence of oesophagus carcinomas shows a steady level of 4.5/100,000 (males) and 0.5/100,000 (females); the age standardized incidence of stomach carcinomas increased from 1971 to 1974, then shows a decline for both males and females, where the colon carcinomas show an increase of 80% for the same time period, also the cancer of the small intestines and of the rectum, increased slightly. Compared to data of other cancer registries the world standardized incidence of rectum carcinomas is of the same level as the data from the cancer registry of Bas-Rhin and is with an incidence of 25.8/100,000 males; 16.2/100,000 females above the incidence of all other cancer registries. The post-operative TNM-stage differs for the different primary topographies. Especially patients with colon carcinomas were operated when the carcinoma was in an advanced stage, patients with rectum carcinomas were operated at a less advanced stage. Male patients with an oesophagus carcinoma showed in a significant percentage an advanced smoking and alcohol consumption, compared to patients suffering from stomach, colon or rectum carcinomas. The specialized organisation of the cancer registry shows a high efficiency due to the requirements of the public health system, and is very useful in the evaluation of descriptive and analytic population-based cancer data.
Cystic diseases of the adrenal glands, which were thought to be rare, are being found more frequently nowadays by means of sonography and computer tomography. Our experience of fifteen cases is reported; of these, ten were confirmed at operation. Contrary to expectations based on the relevant literature, only one of the operated cases proved to be an endothelial cyst of lymphangiomatous origin. All other patients had pseudo-cysts of the adrenals. These are due to bleeding into a normal or tumour-containing gland. About one quarter of the pseudo cysts showed circular calcification on the plain films, although the incidence of this is given as 8-15% in the literature. The cystic nature of these lesions can be readily demonstrated by ultrasound or CT. The latter also provided information concerning the wall of the cyst and of the remaining adrenal tissue. An aspiration biopsy of the cyst can be carried out under ultrasound or CT control; cytological examination will confirm the benign nature of the lesion. A benign lesion without symptoms requires no further diagnostic or therapeutic measures. If there is hypertension, as may occur with a cystic phäeochromocytoma or lymphangioma, angiography is still indicated. Hormone assays are possible following catheterisation of the vena cava combined with adrenal phlebography. The origin and extent of a malignant pseudo-cyst can be demonstrated by arteriography, if this information is lacking following CT.
A severe shock is produced in 18 mongrel dogs by standardized bone trauma and haemorrhagic shock. Impairment of microcirculation is demonstrated by acidosis, reduced oxygen uptake and disseminated intravascular coagulation (DIC). Further, a specific increase in pulmonary vascular resistance--independent of the reduction in blood flow--is evoked, concomitantly with the occurrence of microthrombi, oedema and haemorrhage in lung tissue. Pretreatment with heparin inhibits disseminated intravascular coagulation and reduces impairment of microcirculation and the consecutive damage of intestinal organs. However increase of pulmonary vascular resistance is unchanged and pulmonary haemorrhage is pronounced. Therefore heparin pretreatment enhances pulmonary histologic impairment after trauma and haemorrhagic shock.
Uremic pneumonitis is included in the "adult respiratory distress syndrome". Diffuse alveolo-capillary damage, interstitial and intraalveolar edema, widespread atelectases, alveolar haemorrhages and pulmonary hyaline membranes are characteristic but not pathognomonic findings in uremic pneumonitits. Investigations showed that uremic pneumonitis results from diffuse permeability disorders of the alveolo-capillary permeability combined with an intrarenal or generalized consumption of coagulation factors, and a subsequent state of hypercoagulability. A comparative morphological and clinical analysis of 66 autopsy cases with severe uremia showed that neither the intensity of the urea retention nor the intensity of the creatinine retention correlate with the morphologic symptoms of uremic pneumonitis. Uremia may induce the basic alveolocapillary damage and the subsequent plasmatic leakage into the alveoli and alveolar ducts but uremia has obviously no influence on the simultaneous formation of pulmonary hyaline membranes and intraalveolar bleedings. Hyaline membranes and intraalveolar bleedings are the entire equivalents of the immediate procoagulative activity of the underlying diseases.
Sepsis and non-septic shock in pregnancy show characteristic modifications which are caused a) by physiologic changes in hemostasis primarily in the third trimester of pregnancy, b) by etiologic distinctions of shock regarded as pregnancy-specific, c) by hemodynamic changes in the circulation during pregnancy, d) by the ability of the healthy, young organism to compensate adequately. In the dead fetus syndrome and in non-septic shock, i.e., in amnionic fluid embolism and in abruptio placentae, the clinical picture is often governed by marked secundary fibrinolysis. Retroplacental hematoma, the characteristic feature of premature placental separation, remains controversial as either the cause or sequela of the hemostatic disorder. Etiologic, pathogenetic, and morphologic similarities exist between septic abortion, chorioamnionitis, and puerperal sepsis, but the varying response of the maternal organism during the course of pregnancy leads to different clinical and morphologic pictures. Due to a decrease in fibrinolytic activity as a consequence of pregnancy, the hypercoagulability state in a septic endotoxic shock predisposes the kidneys to bilateral renal cortical necrosis, principally in the amnion infection syndrome.
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Germ-free and conventional rats were fed cholesterol or normal pellets and part of both groups were immunized repeatedly with horseradish peroxidase (HRP). Four days after the last injections all the rats were killed, aortas removed and prepared for immunocytology and chemical analysis. Free peroxidase was not detected in the arterial wall and in all immunized rats only faint staining of free anti-HRP antibodies occurred in the intima. In contrast there was a consistent deposition of HRP-anti-HRP antibody complexes in the inner two thirds of the arterial wall in all HRP-immunized animals. Immunization and cholesterol feeding increased the cholesterol content of the aorta and produced early lesions, whereas cholesterol feeding or immunization alone was less effective.
In states of plasmic hypercoagulability and consumption coagulopathy ethanol favours the non-enzymatic polymerization of circulating soluble fibrinogen fibrin monomer complexes (FFMC) in vitro. The ethanol-gelation test of Godal and Abildgaard makes use of this phenomenon, called paracoagulation. The present studies show that it is also possible to visualize soluble FFMC by means of ethanol-gelation. In the electron microscope, FFMC, polymerized non-enzymatically by ethanol in the spleen, are characterized by plump or slender mycelioid fibrillar precipitates that show a uniform rhythmic transverse striation, a period-coincidental filamentary arrangement and an average periodicity of 23 nm. The ultrastructure demonstrates these ethanol-induced filaments to be in vitro-polymerized fibrin monomer derivatives. Paracoagulation with ethanol allows the identification of soluble FFMC in the tissue prior to the formation of highly polymerized fibrin-rich microthrombi, the established equivalents of the DIC-syndrome. The electron microscope studies also show the existence of a second type of fibrillary structure in the tissue polymerized by ethanol. This second type lacks the characteristic periodicity of fibrin and the period-coincidental arrangement of the filamentary structures, but is characterized by closely packed or chain-like aligned, irregularly sized spherical bodies. There is some evidence that these spherical bodies in vitro represent non-enzymatically polymerized complexes of fibrin monomers and fibrin degradation products (FDP), the equivalent of a limited local or generalized fibrinolysis in vivo.
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Twenty mongrel dogs are subjected to a standardized traumatic hemorrhagic shock. After reinfusion of the dogs' own blood the animals are continuously observed for the 72 hr. Deterioration of general hemodynamics and activation of intravascular coagulation is more pronounced in the nonsurviving animals. Correspondingly, histologic alterations particularly of the liver and intestine are more marked in the nonsurvivors. Increase of partial thromboplastin time and long-lasting increase of the prothrombin time (Quick) appear to be early signs of a fatal prognosis.
In a group of 70 premature and newborn infants, treated with artificial ventilation, 24.3% developed bronchopulmonary dysplasia (BPD). Only in a very few cases did the typical radiological stages, as described by Northway, succeed each other in a chronological order. It is impossible to differentiate BPD stage I or II from RDS stage III and IV without a knowledge of the clinical course and of the duration of artificial ventilation. The lower the gestational age, the more severe and earlier do the radiological and histological changes occur. The radiological differential diagnosis of BPD includes Wilson-Mikity-syndrome, congenital pulmonary lymphangiectasia, neonatal tuberculosis, cystic fibrosis and Hamman-Rich-syndrome.
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