Ultrastructural studies of an open lung biopsy of a patient who had lymphoid interstitial pneumon... more Ultrastructural studies of an open lung biopsy of a patient who had lymphoid interstitial pneumonia, Sjögren's syndrome, and a highly elevated level of immunoglobulin M in the serum disclosed the presence in bronchiolar epithelium of numerous round electron-dense particles 70-120 nm in diameter. These were closely reminiscent of the oncogenic type-A viral particles associated with tumors of laboratory and wild mice. In the inflammatory infiltrate the morphology of some small lymphocytes was suggestive of germinative activity, although no germinal centers were found. Plasma cells, which were numerous in the vicinity of the bronchiolar epithelium, contained varying amounts of electron-dense material, probably immunoglobulin, which was also deposited in the irregulary thickened epithelial basal lamina. The observations support the theory that viral infection may be the stimulus to the immunologic abnormalities observed in patients with lymphoid interstitial pneumonia and Sjögren's syndrome.
A series of 446 patients with lung cancer were followed for 5 yr or until death to find out wheth... more A series of 446 patients with lung cancer were followed for 5 yr or until death to find out whether the mode of detection of the cancer affected their prognosis. The patients were divided into 2 groups. Group A: patients whose cancer was diagnosed in mass radiography, or some other health examination, or in an examination for another disease. Group B: patients who had consulted a doctor on account of their symptoms. Of the patients in Group A, 50% were alive 1 yr after diagnosis and 5% after 5 yr. The corresponding figures in Group B were 24% and 4%. In 127 patients, an abnormal shadow could already be seen in roentgenograms taken 6 months or more before diagnosis. These patients survived longer than the others, 9% being alive 5 yr after diagnosis. The results do not suggest that roentgenologic screening improves the prognosis for lung cancer.
The role of glucose-6-phosphatase (G6Pase) in postreceptional glucose handling in non-insulin dep... more The role of glucose-6-phosphatase (G6Pase) in postreceptional glucose handling in non-insulin dependent diabetics ( NIDDs ) was in investigated by comparing the enzyme values in diagnostic liver biopsy samples with fasting blood glucose (BG), immunoreactive insulin (IRI) and plasma antipyrine half-life (T/2). The NIDDs , treated with sulphonylureas, had elevated serum aminotransferase and alkaline phosphatase values associated with fatty liver with or without fibrosis. G6Pase activity was reduced in the NIDDs compared with subjects who had undergone gallstone surgery (p less than 0.001), insulin dependent diabetics (p less than 0.001), and age- and sex-matched non-diabetics (p less than 0.001). G6Pase was inversely related to BG and antipyrine T/2, but not to IRI or conventional liver function tests. Therapy with phenobarbital and medroxyprogesterone acetate, known inducers, increased G6Pase activity, shortened antipyrine T/2, reduced BG and did not alter IRI, in four NIDDs . Low liver G6Pase activity in NIDDs may hence be one factor underlying the impaired glycemic control.
Three consecutive head nurses developed liver injury after years of handling cytostatic drugs. Th... more Three consecutive head nurses developed liver injury after years of handling cytostatic drugs. They had neurological symptoms associated with elevated serum alanine amino-transferase (ALAT) and alkaline phosphatase (ALP) levels. Liver histology showed portal hepatitis with piecemeal necrosis in one of them, the others had hepatic fibrosis and fat accumulation. The subjects' livers were metabolically active as reflected by adaptive and toxic changes in cellular ultrastructure. After withdrawal of the drugs, serum ALAT and ALP values fluctuated between normal and 2-3 times elevated. Follow-up biopsies demonstrated an increase in collagen fibres and a decrease in microsomal enzyme activity, as reflected by arylhydrocarbon hydroxylase activity in vitro. The findings suggest that handling of cytostatic drugs may insidiously damage the liver, which, with time, seems to lead to irreversible fibrosis.
The hepatic injury developing during occupational exposure to chemicals was investigated in 23 ma... more The hepatic injury developing during occupational exposure to chemicals was investigated in 23 male patients, aged 23-49 years, by comparing case histories, liver function tests, hepatic microsomal enzyme activities in vivo and in vitro with histology. The subjects, 15 chemical industry workers and 8 painters, had disturbed liver tests after years of exposure to solvents, paints and lacquers. Characteristic for the patients was a 2-4-fold increase in serum aminotransferases associated with normal liver or reactive hepatitis with or without fatty liver. All patients, except subjects with fatty change, had metabolically active liver which was reflected as adaptive and toxic changes in cellular ultrastructure. The biochemical liver tests normalized within 3-6 weeks after cessation of the exposure. The findings demonstrate that occupational exposure to chemical solvents may insidiously damage the liver. The injury is detectable by biochemical, metabolic and histological investigations in the early phase.
usually has been arbitrarily based upon survival time or the duration of symptoms without histolo... more usually has been arbitrarily based upon survival time or the duration of symptoms without histological evidence and without clear distinction between chronic, subacute, and recurring spontaneously reducing forms.'j2 Chronic intussusception has been described as being incompletely obstructing and easily reducible, as causing minimal damage to intestine and mesentery, as being uncommon during infancy, as not frequently being preceded by acute enteritis, and as often being secondary to a causative lesion such as a polyp, tumor, or Meckel's diverticulum. About 3% of intussusceptions in infants are thought to be chronic.3 Because the symptoms in these cases differ from those in acute intussusception, delay in diagnosis and treatment may ensue.
The accuracy of radiography of excised air-inflated lungs in assessing pulmonary emphysema at nec... more The accuracy of radiography of excised air-inflated lungs in assessing pulmonary emphysema at necropsy was evaluated in a series of 107 adults who had died in hospital by reading the radiographs and examining the pathological specimens independently. The radiographic and pathological assessments of the severity of emphysema correlated significantly (r = 0.87, p less than 0.0001). Mild emphysema was recognised radiographically in 88.7% and moderate in 94.9% of the lungs. One of 16 normal lungs (6.3%) was radiographically diagnosed as showing mild emphysema. Six out of 53 lungs (11.3%) with mild emphysema were radiographically assessed as normal. The correct radiographic recognition of the type of emphysema was possible in 86% of lungs with mild and 97.4% with moderate centrilobular emphysema and in 81.8% and 87.5% respectively of the lungs with mild and moderate paracicatricial emphysema, but in only 25.0% and 28.6% of the lungs with mild and moderate panlobular emphysema. Radiograph...
Acta pathologica, microbiologica, et immunologica Scandinavica. Section A, Pathology, 1982
Karttunen, T., Autio-Harmainen, H. & Sutinen, S. Capillarosclerosis of the urinary tract associat... more Karttunen, T., Autio-Harmainen, H. & Sutinen, S. Capillarosclerosis of the urinary tract associated with the use of paracetamol and cyclophosphamide. Acta path. microbiol. immunol. scand. Sect. A, 90:
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 1985
Pi phenotypes, determined post mortem by isoelectric focusing and immunofixation, emphysema, asse... more Pi phenotypes, determined post mortem by isoelectric focusing and immunofixation, emphysema, assessed from inflation fixed specimens and smoking history were correlated in 186 hospital necropsies. It was possible to determine Pi phenotype in 98.4% of the specimens. Phenotype M occurred in 87.5%, MZ in a 8.1%, MS in 2.1% and FM in 0.5%. An expected association was found between smoking and emphysema but not between the Pi phenotypes and emphysema. Thus, while smoking is a major aetiological factor, the Pi MZ heterozygous state does not seem to predispose to structural emphysema. However, the small number of cases did not allow an estimation of the risk of smoking in Pi MZ heterozygous persons compared to those with the normal Pi phenotype.
A 46-year-old woman suffering from rheumatoid arthritis developed numerous round opacities at the... more A 46-year-old woman suffering from rheumatoid arthritis developed numerous round opacities at the apex of the right lung 11 years after an exposure to dolomite . Resected lung showed discrete nodules, 0.8-2 cm in diameter, with central necrosis surrounded by palisading fibroblasts and a prominent inflammatory zone. A large number of birefringent dust particles were seen in the necrotic centres and around the nodules. By electron microscopy the particles were dense, mostly elongated and lamellar, varying from 0.005 to 3 microns in width, and from 0.1 to 6.5 microns in length. Energy dispersive x-ray microanalysis of the dust particles gave elemental spectra with high spikes of silicon, aluminium and potassium, and minimal magnesium, calcium, iron and titanium. According to chemical analysis, the original dolomite consisted almost entirely of magnesium and calcium carbonates and only of traces of silicon, aluminium and potassium. Apparently the human organism can better eliminate calcium and magnesium carbonates than silicon, aluminium and potassium.
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 1983
subtypes or grading of pulmonary adenocarcinoma. A histochemical and electron microscopic study. ... more subtypes or grading of pulmonary adenocarcinoma. A histochemical and electron microscopic study. Acta path. microbiol. immunol. s a n d . Sect. A.
Virchows Archiv A Pathological Anatomy and Histopathology, 1985
We analysed statistically the association of emphysema, determined on inflation fixed specimens, ... more We analysed statistically the association of emphysema, determined on inflation fixed specimens, with the weights of the body and heart, and of the cardiac ventricles, weighed separately, in 170 male and 86 female adult autopsies. The cases were grouped according to the cause of death into cardiovascular, cancer and other deaths. In men the body weight was inversely proportional to the severity of emphysema, but no association existed between the body weight and the cause of death. In male cardiovascular deaths the total heart weight, total ventricular weight and the weight of the left ventricle with the septum were also inversely proportional to the severity of emphysema while this was not true in the other deaths. In male cardiovascular deaths a decrease, and in the other deaths an increase, of the weight of the free wall of the right ventricle was associated with an increasing severity of emphysema. In all male deaths, however, the left to right ratio decreased with an increasing severity of emphysema. Thus, pulmonary emphysema is associated both with a general atrophy, including the myocardium, and a mainly relative right ventricular hypertrophy. An absolute right ventricular hypertrophy, however, seems to accompany emphysema only in the absence of other major cardiovascular diseases.
An unusual case of a benign cartilagenous tumour of the temporomandibular joint is presented. The... more An unusual case of a benign cartilagenous tumour of the temporomandibular joint is presented. The difficulties encountered in histological diagnosis, the benign behaviour of the tumour and the need for restraint in treatment are emphasized.
We describe seven typhoidal tularemia patients without ulcers or lymphadenopathy, who underwent d... more We describe seven typhoidal tularemia patients without ulcers or lymphadenopathy, who underwent diagnostic bronchoscopy. Four patients had had obvious airborne exposure to F. tularensis during farming activities, and the remaining three had respiratory symptoms also. Bronchoscopical findings were pathological in all cases, varying from local to diffuse haemorrhagic inflammation; in one case a granulomatous tumour was seen. Early histopathological changes in three biopsies consisted of haemorrhagic oedema progressing to a non-specific inflammatory reaction, which could still be found 45 days after the onset of symptoms. Granulomatous inflammation, indistinguishable from tuberculosis or sarcoidosis, was seen in four biopsies from two patients, three to seven months after the onset. Most patients had radiographic hilar enlargement. We conclude that transmission of typhoid tularemia usually occurs through inhalation leading to bronchial changes, which correspond skin ulcerations in ulcero-glandular tularemia, the hilar enlargement corresponding to the lymph node component. We emphasize that usage of the term 'typhoidal' tularemia should be discontinued. Instead, tularemia transmitted through inhalation should be called pulmonary or respiratory.
A case of pulmonary vascular occlusive disease: comparison of post-mortem radiography and histolo... more A case of pulmonary vascular occlusive disease: comparison of post-mortem radiography and histology A case of rapidly progressing fatal pulmonary hypertension in a nine-year-old boy showing histological narrowing and occlusion of pulmonary veins and arteries is described. Post-mortem radiography of the air-inflated, excised lung without use of additional contrast media nicely demonstrated the vascular lesions.
Ultrastructural studies of an open lung biopsy of a patient who had lymphoid interstitial pneumon... more Ultrastructural studies of an open lung biopsy of a patient who had lymphoid interstitial pneumonia, Sjögren's syndrome, and a highly elevated level of immunoglobulin M in the serum disclosed the presence in bronchiolar epithelium of numerous round electron-dense particles 70-120 nm in diameter. These were closely reminiscent of the oncogenic type-A viral particles associated with tumors of laboratory and wild mice. In the inflammatory infiltrate the morphology of some small lymphocytes was suggestive of germinative activity, although no germinal centers were found. Plasma cells, which were numerous in the vicinity of the bronchiolar epithelium, contained varying amounts of electron-dense material, probably immunoglobulin, which was also deposited in the irregulary thickened epithelial basal lamina. The observations support the theory that viral infection may be the stimulus to the immunologic abnormalities observed in patients with lymphoid interstitial pneumonia and Sjögren's syndrome.
A series of 446 patients with lung cancer were followed for 5 yr or until death to find out wheth... more A series of 446 patients with lung cancer were followed for 5 yr or until death to find out whether the mode of detection of the cancer affected their prognosis. The patients were divided into 2 groups. Group A: patients whose cancer was diagnosed in mass radiography, or some other health examination, or in an examination for another disease. Group B: patients who had consulted a doctor on account of their symptoms. Of the patients in Group A, 50% were alive 1 yr after diagnosis and 5% after 5 yr. The corresponding figures in Group B were 24% and 4%. In 127 patients, an abnormal shadow could already be seen in roentgenograms taken 6 months or more before diagnosis. These patients survived longer than the others, 9% being alive 5 yr after diagnosis. The results do not suggest that roentgenologic screening improves the prognosis for lung cancer.
The role of glucose-6-phosphatase (G6Pase) in postreceptional glucose handling in non-insulin dep... more The role of glucose-6-phosphatase (G6Pase) in postreceptional glucose handling in non-insulin dependent diabetics ( NIDDs ) was in investigated by comparing the enzyme values in diagnostic liver biopsy samples with fasting blood glucose (BG), immunoreactive insulin (IRI) and plasma antipyrine half-life (T/2). The NIDDs , treated with sulphonylureas, had elevated serum aminotransferase and alkaline phosphatase values associated with fatty liver with or without fibrosis. G6Pase activity was reduced in the NIDDs compared with subjects who had undergone gallstone surgery (p less than 0.001), insulin dependent diabetics (p less than 0.001), and age- and sex-matched non-diabetics (p less than 0.001). G6Pase was inversely related to BG and antipyrine T/2, but not to IRI or conventional liver function tests. Therapy with phenobarbital and medroxyprogesterone acetate, known inducers, increased G6Pase activity, shortened antipyrine T/2, reduced BG and did not alter IRI, in four NIDDs . Low liver G6Pase activity in NIDDs may hence be one factor underlying the impaired glycemic control.
Three consecutive head nurses developed liver injury after years of handling cytostatic drugs. Th... more Three consecutive head nurses developed liver injury after years of handling cytostatic drugs. They had neurological symptoms associated with elevated serum alanine amino-transferase (ALAT) and alkaline phosphatase (ALP) levels. Liver histology showed portal hepatitis with piecemeal necrosis in one of them, the others had hepatic fibrosis and fat accumulation. The subjects' livers were metabolically active as reflected by adaptive and toxic changes in cellular ultrastructure. After withdrawal of the drugs, serum ALAT and ALP values fluctuated between normal and 2-3 times elevated. Follow-up biopsies demonstrated an increase in collagen fibres and a decrease in microsomal enzyme activity, as reflected by arylhydrocarbon hydroxylase activity in vitro. The findings suggest that handling of cytostatic drugs may insidiously damage the liver, which, with time, seems to lead to irreversible fibrosis.
The hepatic injury developing during occupational exposure to chemicals was investigated in 23 ma... more The hepatic injury developing during occupational exposure to chemicals was investigated in 23 male patients, aged 23-49 years, by comparing case histories, liver function tests, hepatic microsomal enzyme activities in vivo and in vitro with histology. The subjects, 15 chemical industry workers and 8 painters, had disturbed liver tests after years of exposure to solvents, paints and lacquers. Characteristic for the patients was a 2-4-fold increase in serum aminotransferases associated with normal liver or reactive hepatitis with or without fatty liver. All patients, except subjects with fatty change, had metabolically active liver which was reflected as adaptive and toxic changes in cellular ultrastructure. The biochemical liver tests normalized within 3-6 weeks after cessation of the exposure. The findings demonstrate that occupational exposure to chemical solvents may insidiously damage the liver. The injury is detectable by biochemical, metabolic and histological investigations in the early phase.
usually has been arbitrarily based upon survival time or the duration of symptoms without histolo... more usually has been arbitrarily based upon survival time or the duration of symptoms without histological evidence and without clear distinction between chronic, subacute, and recurring spontaneously reducing forms.'j2 Chronic intussusception has been described as being incompletely obstructing and easily reducible, as causing minimal damage to intestine and mesentery, as being uncommon during infancy, as not frequently being preceded by acute enteritis, and as often being secondary to a causative lesion such as a polyp, tumor, or Meckel's diverticulum. About 3% of intussusceptions in infants are thought to be chronic.3 Because the symptoms in these cases differ from those in acute intussusception, delay in diagnosis and treatment may ensue.
The accuracy of radiography of excised air-inflated lungs in assessing pulmonary emphysema at nec... more The accuracy of radiography of excised air-inflated lungs in assessing pulmonary emphysema at necropsy was evaluated in a series of 107 adults who had died in hospital by reading the radiographs and examining the pathological specimens independently. The radiographic and pathological assessments of the severity of emphysema correlated significantly (r = 0.87, p less than 0.0001). Mild emphysema was recognised radiographically in 88.7% and moderate in 94.9% of the lungs. One of 16 normal lungs (6.3%) was radiographically diagnosed as showing mild emphysema. Six out of 53 lungs (11.3%) with mild emphysema were radiographically assessed as normal. The correct radiographic recognition of the type of emphysema was possible in 86% of lungs with mild and 97.4% with moderate centrilobular emphysema and in 81.8% and 87.5% respectively of the lungs with mild and moderate paracicatricial emphysema, but in only 25.0% and 28.6% of the lungs with mild and moderate panlobular emphysema. Radiograph...
Acta pathologica, microbiologica, et immunologica Scandinavica. Section A, Pathology, 1982
Karttunen, T., Autio-Harmainen, H. & Sutinen, S. Capillarosclerosis of the urinary tract associat... more Karttunen, T., Autio-Harmainen, H. & Sutinen, S. Capillarosclerosis of the urinary tract associated with the use of paracetamol and cyclophosphamide. Acta path. microbiol. immunol. scand. Sect. A, 90:
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 1985
Pi phenotypes, determined post mortem by isoelectric focusing and immunofixation, emphysema, asse... more Pi phenotypes, determined post mortem by isoelectric focusing and immunofixation, emphysema, assessed from inflation fixed specimens and smoking history were correlated in 186 hospital necropsies. It was possible to determine Pi phenotype in 98.4% of the specimens. Phenotype M occurred in 87.5%, MZ in a 8.1%, MS in 2.1% and FM in 0.5%. An expected association was found between smoking and emphysema but not between the Pi phenotypes and emphysema. Thus, while smoking is a major aetiological factor, the Pi MZ heterozygous state does not seem to predispose to structural emphysema. However, the small number of cases did not allow an estimation of the risk of smoking in Pi MZ heterozygous persons compared to those with the normal Pi phenotype.
A 46-year-old woman suffering from rheumatoid arthritis developed numerous round opacities at the... more A 46-year-old woman suffering from rheumatoid arthritis developed numerous round opacities at the apex of the right lung 11 years after an exposure to dolomite . Resected lung showed discrete nodules, 0.8-2 cm in diameter, with central necrosis surrounded by palisading fibroblasts and a prominent inflammatory zone. A large number of birefringent dust particles were seen in the necrotic centres and around the nodules. By electron microscopy the particles were dense, mostly elongated and lamellar, varying from 0.005 to 3 microns in width, and from 0.1 to 6.5 microns in length. Energy dispersive x-ray microanalysis of the dust particles gave elemental spectra with high spikes of silicon, aluminium and potassium, and minimal magnesium, calcium, iron and titanium. According to chemical analysis, the original dolomite consisted almost entirely of magnesium and calcium carbonates and only of traces of silicon, aluminium and potassium. Apparently the human organism can better eliminate calcium and magnesium carbonates than silicon, aluminium and potassium.
Acta Pathologica Microbiologica Scandinavica Series A :Pathology, 1983
subtypes or grading of pulmonary adenocarcinoma. A histochemical and electron microscopic study. ... more subtypes or grading of pulmonary adenocarcinoma. A histochemical and electron microscopic study. Acta path. microbiol. immunol. s a n d . Sect. A.
Virchows Archiv A Pathological Anatomy and Histopathology, 1985
We analysed statistically the association of emphysema, determined on inflation fixed specimens, ... more We analysed statistically the association of emphysema, determined on inflation fixed specimens, with the weights of the body and heart, and of the cardiac ventricles, weighed separately, in 170 male and 86 female adult autopsies. The cases were grouped according to the cause of death into cardiovascular, cancer and other deaths. In men the body weight was inversely proportional to the severity of emphysema, but no association existed between the body weight and the cause of death. In male cardiovascular deaths the total heart weight, total ventricular weight and the weight of the left ventricle with the septum were also inversely proportional to the severity of emphysema while this was not true in the other deaths. In male cardiovascular deaths a decrease, and in the other deaths an increase, of the weight of the free wall of the right ventricle was associated with an increasing severity of emphysema. In all male deaths, however, the left to right ratio decreased with an increasing severity of emphysema. Thus, pulmonary emphysema is associated both with a general atrophy, including the myocardium, and a mainly relative right ventricular hypertrophy. An absolute right ventricular hypertrophy, however, seems to accompany emphysema only in the absence of other major cardiovascular diseases.
An unusual case of a benign cartilagenous tumour of the temporomandibular joint is presented. The... more An unusual case of a benign cartilagenous tumour of the temporomandibular joint is presented. The difficulties encountered in histological diagnosis, the benign behaviour of the tumour and the need for restraint in treatment are emphasized.
We describe seven typhoidal tularemia patients without ulcers or lymphadenopathy, who underwent d... more We describe seven typhoidal tularemia patients without ulcers or lymphadenopathy, who underwent diagnostic bronchoscopy. Four patients had had obvious airborne exposure to F. tularensis during farming activities, and the remaining three had respiratory symptoms also. Bronchoscopical findings were pathological in all cases, varying from local to diffuse haemorrhagic inflammation; in one case a granulomatous tumour was seen. Early histopathological changes in three biopsies consisted of haemorrhagic oedema progressing to a non-specific inflammatory reaction, which could still be found 45 days after the onset of symptoms. Granulomatous inflammation, indistinguishable from tuberculosis or sarcoidosis, was seen in four biopsies from two patients, three to seven months after the onset. Most patients had radiographic hilar enlargement. We conclude that transmission of typhoid tularemia usually occurs through inhalation leading to bronchial changes, which correspond skin ulcerations in ulcero-glandular tularemia, the hilar enlargement corresponding to the lymph node component. We emphasize that usage of the term 'typhoidal' tularemia should be discontinued. Instead, tularemia transmitted through inhalation should be called pulmonary or respiratory.
A case of pulmonary vascular occlusive disease: comparison of post-mortem radiography and histolo... more A case of pulmonary vascular occlusive disease: comparison of post-mortem radiography and histology A case of rapidly progressing fatal pulmonary hypertension in a nine-year-old boy showing histological narrowing and occlusion of pulmonary veins and arteries is described. Post-mortem radiography of the air-inflated, excised lung without use of additional contrast media nicely demonstrated the vascular lesions.
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