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Differences in normal structure and reaction to adjuvant between the costal and the visceral pleura.

Visceral and costal pleurae of the rabbit were studied by light and electron microscopy in the normal state, after India ink injection into the pleural cavity and in pleuritis induced by intrapleurally injected adjuvant. In normal rabbits, the mesothelial cells in the visceral pleura had more numerous microvilli and pinocytotic vesicles than in the costal pleura. The surface coat on the microvilli was much thicker in the former than in the latter. Intrapleurally injected India ink particles were phagocytosed by mesothelial cells and macrophages. The phagocytotic activity was more prominent on the costal side than on the visceral side. In rabbits with adjuvant induced pleuritis, the visceral pleura, but not the costal pleura, showed mushroom-like projections on the pleural surface which were composed of a fibrin mass mixed with phagocytotic macrophages and covered by proliferative mesothelial cells. These hitherto poorly known structures, which were formed, though less conspicuously, also after India ink administration, seemed to play an important role in the initial protection of the lung against foreign body invasions from the pleural cavity. With the progress of pleuritis, the mushroom-like projections changed into patchy granulation tissues which were well localized and did not exceed the elastic layer. In the costal pleura, apparently due to a poorer protective mechanism than in the visceral pleura, granulation tissue was formed much more extensively and diffusely. No signs of transformation of mesothelial cells into fibroblasts were recognized. Fat-containing cells closely resembling the Ito cells in the liver occurred in the submesothelial and subpleural layers of the visceral pleura.

Acid Phosphatase

Transport of water and solutes across sheep visceral pleura.

The fluid and solute transport properties of pleural tissue were studied using specimens of intact visceral pleura from adult sheep lungs. After thoracotomy, a shallow incision through the pleural surface permitted 10-cm2 by 10-micrometer pieces of visceral pleura free of lung parenchyma to be peeled off the lung surface. The pleura was then mounted as a planar sheet separating 2 reservoirs of Krebs-Ringer solution. Electrical potential and resistance, hydraulic water permeability, and diffusional permeability to water and several hydrophilic solutes were measured. The results showed that (1) no spontaneous voltage difference was present across the pleura; (2) electrical resistance (27.1 omega/cm2) was very low; (3) hydraulic water permeability was extremely high (1.64 X 10(-8) ml/dyne-s); and (4) diffusional permeability was high, varying from 5.24 X 10(-4) cm/s for water to 4 X 10(-5) cm/s for hemoglobin. Blue dextran (molecular weight, 2 X 10(6) daltons) did not cross the pleura in measurable quantities. We concluded that the isolated visceral pleura of the adult sheep is an extremely "leaky" tissue that probably does not actively transport salt and water. These findings are consistent with a passive model of pleural fluid formation and reabsorption, and suggest that the transport properties of normal pleural tissue are unlikely to be responsible for any differences in composition between interstitial and pleural fluids.

Animals

The preformed stomas connecting the pleural cavity and the lymphatics in the parietal pleura.

Lympatics in the parietal pleura and diaphragm of rabbits and mice formed lacunas, terminal dilatations of lymphatic channels, with cribriform laminas bordering the pleural space at one end and one-way valves on the other end. The laminas consisted of a coarse mesh of connective tissue fibers covered by mesothelial cells at one side and endothelial cells at the other. At the fenestrated portions of the meshwork the basal surfaces of the 2 lining cells were closely apposed and some preformed stomas were found bridging the pleural and lymphatic spaces. No such structures were found in the visceral pleura, but similar cribriform laminas were also present in human parietal pleura at autopsy. Intrapleurally injected carbon particles reached the lacunas faster than similarly injected chicken red blood cells in living rabbits. Carbon particles appeared to pass through the closely apposed lining cells as well as the stomas but not into the intact interstitial structures. These structural and functional findings supported the observation that large particles and cells in the pleural cavity are removed only through the lymphatics and only at specific sites in the parietal pleura.

Animals

[Peculiar capillary convolution of the parietal pleura. III. Electron microscopy studies].

By means of electron microscopy and ultrahistochemical research it has been attempted to detail the structure and explain the function of the pleural tufts of the parietal pleura present in the ventral mediastinum of dogs. This led to the discovery that the varions forms present for the surface-enlarging pleura protusions in actuality exhibit corresponding morphological characteristics. As a special formation of the serous lamina of parietal pleura, they are covered by an occasionally incomplete mesothel unit. The parenchyma of these organs is compinsed of a macrophage-rich outer border zone and of a vessel-canying central zone. The experimental in vivo application of cationized ferritin in the pleura-space clearly indicated a high resorptive metabolism of the mesothel and of the pluripotential mesenchym cells. The higher incidence of lymphoplasmatic cell-forms in the proximity of the central vessels along with leucocytic cell infiltrations fulfill an immunocellular and phagocytic function. The structure of the cell population of the pleural tufts partaking on the resorption of matter out of the pleural space has been discussed in detail. The in vivo application of a cationized ferritin solution for the purpose of studying these resorptive processes has been critically judged.

Animals

[Morphology of the microcirculatory bed of the lungs and visceral pleura in liver cirrhosis].

Morphological examinations of the microcirculatory bed of the lungs and pulmonary pleura in 30 fatal cases of cirrhosis of the liver revealed generalized involvement of the blood and lymph vessels. Most significant changes were found in venular and lymphomicrocirculatory parts of the pulmonary pleura as a manifestation of compensatory-adaptative processes directed at retention of the hemodynamic homeostasis of the pulmonary circulation. In the author's opinion, the most important factors causing reactions of the microcirculatory bed of the pulmonary pleura include venous hypervolemia of the pulmonary circulation followed by hypoxia. It is suggested that changes in the vessels of the microcirculatory bed of the lungs and pulmonary pleura in patients with cirrhosis of the liver are an important part of the compensatory-adaptative mechanisms; their disorders cause the development of the right ventricle insufficiency.

Adult

Postnatal development of the respiratory system of the opossum. II. Electron microscopy of the epithelium and pleura.

At birth, the opossum lung is remarkably primitive and consists of a system of branching airways that end in a number of terminal air chambers. From the newborn through the 10 cm stage of development the conducting portion of the lung predominates. The air chambers, which represent portions of the conducting system modified for respiration, are in a constant state of evolution since they are destined to become part of the expanding bronchial system. The airways are devoid of cilia and goblet cells at birth, and are lined by columnar epithelial cells which contain two types of cytoplasmic granules: an electron-dense form and a heterogeneous form. The latter exhibits an electron-dense core surrounded initially by a large halo of flocculent material. This type of granule is not seen beyond the 8 cm stage. The terminal air chambers of the newborn and later stages are lined type I and type II alveolocytes that appear identical to the alveolocytes lining alveoli in the adult. By the 2.5 cm stage, scattered cilia are present in the trachea and bronchi and bands of smooth muscle have differentiated in relation to bronchial epithelium and to proximal areas of the terminal chambers. Citiated cells are separated by ridges composed of light and dark cells which are without cilia and which contain scattered electron-dence granules. Throughout the postnatal period numerous alveolar macrophages and mast cells are noted in relation to the conducting system and pleura. Differentiation of the pleura also occurs during the postnatal period. In the newborn the pleura is simple squamous mesothelium. Later stages develop a thick connective tissue lamina between the pleural mesothelium and lung parenchyma. A large band of elastin is interposed between the mesothelium and underlying bundles of collagen.

Animals

Squamous-cell carcinoma of the pleura.

There are few reports of primary malignant tumours of the pleura other than mesothelioma. Reports of squamous-cell carcinoma of the pleura are especially rare. Epidermoid carcinoma of the pleura may occur in connection with persistent empyema drained by a pleurocutaneous fistula or long-standing extrapleural pneumothorax without fistula.

Adult

Biosynthesis of prostaglandin (PGI2) and 12L-hydroxy-5,8,10,14-eicosatetraenoic acid (HETE) by pericardium, pleura, peritoneum and aorta of the rabbit.

Prostacyclin generation by pericardium, pleura, peritoneum, aorta and dura mater of the rabbit was assessed as platelet aggregation inhibitory activity in platelet rich plasma. All tissues except the dura mater, were also incubated with labelled (1-14C) arachidonic acid and (1-14C) prostaglandin endoperoxide H2 and the various metabolites formed were identified radiochromatographically. Pericardium, pleura and peritoneum form substantially high amounts of prostacyclin and HETE indicating that these tissues contain both cyclo-oxygenase and prostacyclin-synthetase. They also show considerable lipoxygenase activity.

Animals

[Pathomorphology of the vascular bed of the lungs and pleura in the presence of hypervolemia of the pulmonary circulation].

Blood and lymphatic vessels of the lungs and the pleura in 23 infants aged below one year, who had died of congenital cardiac defects with hypervolemia of the lesser circulation (coarctation of the aorta, transposition of the major vessels, general arterial trunk in combination with septal defects, open arterial canal and other anomalies) and in 5 dogs with artificial anastomosis of Blalock (3), Cooley (I) and Pootts (I) were studied; In treatment of the materials various histological and histochemical methods, micropreparation and impregnation of total preparation according to Ranvier's and V. V; Kupriyanov's techniques were used. The results obtained showed that an excessive blood content of the lesser circulation was accompanied by onset in the vessels of the lungs and the pleura of various accomodative changes, which were particularly pronounced in the system of microcirculation. It was established that functional insufficiency of the adaptive mechanisms led to the "breakdown" of compensation, impairment of blood and lymph circulation in the terminal vascular bed of the lungs and to grave secondary alterations in the organ. It was shown that early correction of hypervolemia of the lesser circulation in the experiment brought about normalization of hemodynamics in the lungs and more or less full recovery of the structure of microvessels of the regional bed.

Child

[Benign tumors of the pleura].

The authors report a case of benign tumour of the pleura in a 74 year old woman. This is a pediculated tumour of the right base posteriorly above the diaphragm, the pleural nature of which was recognised before surgery and which, microscopically, proved to be a localized, benign mesothelioma of fibroblastic type. Benigh tumours of the pleura are rare but raise two interesting problems: that of their precise origin which is debated, and their prognosis; the possibility of relapse should be borne in mind.

Aged

[Biosynthesis of hyaluronic acid in parietal pleura of the rabbit (author's transl)].

The parietal pleura of rabbits was incubated with 14C-glucosamine. It was found that 14C-glucosamine was incorporated into the fraction of crude glycosaminoglycans. Then the crude glycosaminoglycans were fractionated by using specific mucopolysaccharide-lyases (hyaluronidase from streptomyces hyalurolytics, chondroitinase AC and chondroitinase ABC). As a result, evidence was obtained that hyaluronic acid was synthesized in parietal pleura and was released into the surroundings.

Animals

Localized fibrous "mesothelioma" of pleura (submesothelial fibroma): a clinicopathologic study of 18 cases.

Eighteen cases of solid fibrous tumors of the visceral pleura are studied. The series includes neoplasms of various sizes removed during the last 17 years at The Mount Sinai Hospital. Most tumors showed consistent gross and light microscopic features, such as encapsulation, preservation of pedicle, origin from visceral pleura, predominance of spindle cells with more or less hyalinized stroma, little or no pleomorphism or mitotic activity and no infiltration of the underlying lung. No sex predominance or relation to environmental pollutants was noted. Peak incidence was in the 6th decade of life. Total excision proved curative in all cases with no recurrences or complications. The cell of origin of this tumor appears to be a noncommitted mesenchymal cell present in the areolar tissue subjacent to the mesothelial lining.

Adult

Asbestos-related diseases of lung and pleura: clinical picture and illustrative cases.

Exposure to asbestos may occur in any of a large number of occupations, and the latent period from exposure to appearance of clinical or roentgenologic evidence of related disease of the lung or pleura, or both, may be more than 20 years. A complete occupational history is therefore of paramount importance in the detection of asbestos-related diseases. Illustrative cases highlight the features of benign and malignant diseases of the lung and pleura for which a causal relationship to asbestos exposure is probable or established.

Aged

Comparison of the diagnostic values of biopsies of the pleura and cytologic evaluation of pleural fluids.

Results of a comparison of the diagnostic efficacy of percutaneous needle biopsy of the parietal pleura with that of cytologic examination of pleural fluid sediment obtained concurrently from 166 patients with benign or cancerous pleural disorders are reported. Of 44 patients with confirmatory evidence of cancer involving the pleural surfaces, 43 had positive cytologic findings, whereas pleural biopsies were diagnostic in only 16 cases. Of a total of 122 patients with benign pleural diseases, cytology provided the diagnosis in two cases of eosinophilic pleurisy, and pleural biopsy contributed the diagnosis in four of ten cases of tuberculosis. The data indicate that percutaneous needle biopsy of the parietal pleura is less efficacious in the diagnosis of malignant pleural disease than is cytologic evaluation of the fluid sediment, whereas in the diagnosis of tuberculous pleurisy, pleural biopsy proved superior.

Adult

Efficacy of pleural needle biopsy and pleural fluid cytopathology in the diagnosis of malignant neoplasm involving the pleura.

A comparison was made of the efficacy of pleural needle biopsy and pleural-fluid cytopathology in the diagnosis of pleural tumor in a group of 271 patients. A malignant tumor involving the pleura was present in 95 cases. Needle biopsy alone provided a diagnosis of tumor in 53 instances, and cytopathologic preparations were diagnostic in 69 patients. A diagnosis was established on either the biopsy or cytopathology, or both, in 86 cases (90 percent). These results indicate the value of using both biopsy and fluid cytology in the evaluation of pleural effusion, which often is due to involvement of the pleura by malignant neoplasm.

Biopsy, Needle

[Functional morphology of the pleura (author's transl)].

Peculiarities of topography, structure and injuries are responsible for the pathomorphological behaviour of the pleura. Its characteristical macro- and microscopic alterations are correlated with the typical cytological findings of effusions. Additionally to the pleural reactions in acute inflammation, the postpleuritic functional disturbances of pleura and lung are reported.

Acute Disease

Antibody deposition in the pleura: a finding in drug-induced lupus.

Pleural tissues from a group of 36 consecutive patients comprised of 15 malignancies, 3 tuberculous, 2 rheumatoid arthritis, 3 procainamide-induced systemic lupus erythematosus (SLE) syndromes, 1 infectious mononucleosis, and 12 nonspecific pleural effusions undergoing needle biopsy were studied by immunofluorescent techniques for antibody deposition. Specific nuclear fluorescence was detected only in procainamide-induced SLE and was characterized by in vivo staining with either IgG, IgM, and in one case, also C3. C1q could not be detected. Two other patients who had antinuclear antibodies (ANA) in their peripheral blood did not have detectable in vivo antinuclear staining in their pleural tissue. The presence of in vivo fixation of ANA in the pleura may be of etiologic and diagnostic significance in procainamide-induced SLE syndrome.

Antibody Formation

Diagnostic reliability of needle biopsy of the parietal pleura. A review of 272 biopsies.

The clinical charts and histologic preparations from 245 patients who had pleural biopsies to evaluate pleural effusions of unknown etiology were reviewed. This represents an experience with 272 biopsies, as some patients underwent multiple biopsies. In 57 per cent of the cases of suspected or proven granulomatous disease involving the pleura, the pleural biopsy was positive. Similarly, in 48 per cent of the cases of suspected or proven pleural involvement by carcinoma, tumor was identified in the biopsy specimen. Only two false-positive diagnoses (one of granulomatous pleuritis and one of neoplastic disease) were made. The other 35 histologic diagnoses of granulomatous inflammation and 43 histologic diagnoses of carcinoma were verified. In this study, the authors found that the major limiting factor in establishing a diagnosis is the accuracy in random sampling of the parietal pleural surface. Thus, a negative pleural biopsy should not give the clinician a false sense of security.

Adolescent