Fritz K. Beller

Ultrastructural comparison of endometriotic implants and eutopic endometrium

Ultrastructural features of endometriotic implants suggest an incomplete response to the prevalent hormonal milieu. The cyclic changes, especially in the secretory phase, appear to depend more on the morphologic differentiation of the ectopic implants than on the hormonal stimulus. The endometriotic tissue encompassed a wide range of morphologic development from poorly to highly differentiated glands. Variations occurred from gland to gland and even within the same gland. Complete proliferative development was found only in some of the patients and full secretory transformation was absent in all. The incomplete morphologic response to cyclic hormonal changes may explain the frequent failure of endocrine therapy.

Kidney transplantation from anencephalic donors.

3 observations: transplantations de reins de 3 fœtus anencephaliques chez 2 enfants et chez un adulte (completement HLA-identique et avec reactions croisees negatives). Resultats tres satisfaisants

Consumptive coagulopathy associated with intra-amniotic infusion of hypertonic salt.

Abstract A coagulation defect was observed in 3 patients with hemorrhage after abortion induced by the intra-amniotic infusion of hypertonic NaCl. This observation resulted in a study of the coagulation system in 25 patients during the abortion program. A decrease in platelet number, fibrinogen concentration, and factor V activity as well as an increase in fibrinolysis breakdown products was observed in nearly all patients. It developed in different degrees, most pronounced at the time of abortion. Fibrin monomers were observed 24 hours after the salt infusion. Plasninogen, alpha-2 macroglobulin and antithrombin III values remained unchanged. Neither a reduction in urinary output nor an increase in plasma hemoglobin was observed. This suggests that glomerular fibrin deposition does not occur. The syndrome is therefore, best characterized as a consumptive coagulopathy. The decreased coagulation factors return to normal without treatment after the expulsion of the fetus. The development of a consumptive coagulopathy associated with termination of pregnancy by the intra-amniotic infusion of hypertonic salt may explain the hemorrhagic syndrome reported in the literature and provide evidence for an unwanted pathophysiologic development.

Blood coagulation and fibrinolytic enzyme studies during cyclic and continuous application of progestational agents

Abstract In 10 volunteers two different oral progestational agents and one placebo were employed for three cycles. Blood was taken on 9 different days during each cycle and subjected to blood coagulation and fibrinolytic enzyme studies. The statistical evaluation did not reveal any changes. However, when patients were taking progestational agents in continuous high doses for treatment of endometriosis an increase in Factor VII, fibrinogen, and plasminogen was illicited. It is assumed that increase in coagulable proteins due to steroids is a dose-time response problem.

Disseminated intravascular coagulation during the continuous infusion of endotoxin in rabbits

Endotoxinemia was produced in rabbits by a continuous intravenous infusion of endotoxin (30 to 50 βg per kilogram per hour) for 8 to 14 hours. Disseminated intravascular coagulation occurred 6 to 14 hours after the onset of the infusion. Fibrin deposition was observed in decreasing order of frequency in kidney, liver, lung, and spleen. Approximately 50 per cent of the treated animals revealed focal glomerular necrosis. The extent of glomerular fibrin deposition was correlated to the occurrence of focal glomerular necrosis. In one group of animals allowed to survive lysis of glomerular fibrin deposition was demonstrated in kidney sections. Hemodynamic studies revealed a rise in central venous pressure during the experiment. The parameters of pH, pCO 2 , serum lactate, and base excess indicated a steady state of metabolic acidosis during the infusion. Renal function revealed a polyuric phase with disturbed medullary function preceding renal failure.

Biochemical identification of the mucus of pseudomyxoma peritonei as the basis for mucolytic treatment

Two cases of pseudomyxoma peritonei are presented. The gelatinous mucus was biochemically analyzed. The mucus contained approximately 98% protein and 2% to 5% carbohydrate per unit of dry weight. The predominant carbohydrate components were galactose and mannosamine. The mucus also had thromboplastic activity. Because of these findings, dextran sulfate, at concentrations between 2% and 10%, was instilled into the abdominal cavity and caused lysis of the mucus.

Septicemia during pregnancy: A study in different species of experimental animals

When Escherichia coli B6 lipopolysaccharide, 0.2 mg/kg of body weight, was infused into nonpregnant minipigs during a 5-hour period, the animals died after 12 to 16 hours as a result of endotoxic shock. When the same infusion was given to six pregnant minipigs at term, these animals died after only 3 1/2 hours. The decrease in the number of white blood cells, the number of platelets, hematocrit, and clotting factors was not significantly different between the two groups. The acid-base status, however, indicated a much more pronounced metabolic acidosis in the pregnant animals than in the nonpregnant controls. In the pregnant minipigs heart rate, cardiac output, mean arterial pressure, and total peripheral resistance indicated cardiovascular collapse, and the multiple wire, platinum surface electrode revealed a drastic reduction in uterine tissue oxygenation in the pregnant animals. The data support the hypothesis that pregnant animals at term are more susceptible to the harmful effects of lipopolysaccharide. Early death in the pregnant minipigs, however, was not associated with disseminated intravascular coagulation as it is in smaller animals (rat, rabbit, and hamster).

The Fibrinolytic Enzyme System in Cervical Mucus

A clinical study was undertaken to assess the fibrinolytic enzyme system in cervical mucus in relation to the different stages of the menstrual cycle. Samples of cervical mucus from 8 women in the reproductive stage were taken on different days of the cycle and tested for components of the fibrinolytic system. The testing procedure is explained and the results graphed. Activator was found to disappear from the mucus for 2 days pre- and post-ovulation. Heating and freezing the mucus did not destroy the fibrinolytic activity. Testing was conducted for the presence of such other agents as proactivator, plasmin, and plasminogen in the mucus.

Bilateral breast cancer: The frequency of undiagnosed cancers

The risk of developing cancer in the contralateral breast is five to seven times the risk of cancer occurrence for the normal female population. In patients in 365 consecutive operations, 15 frankly invasive cancers and four metastatic lesions were found in the contralateral breast as well as an additional 28 lesions in situ, totaling 13%. An additional 30% of the patients had severe dysplasia with an unknown potential for becoming cancerous. Only less than one third of the cancers in the contralateral breast were symptomatic (by palpation or mammography or both) but not recognized at the time of primary treatment. The majority of lesions in the contralateral breast are due to a second primary growth, and only a minority is metastatic. The results of 203 bilateral operations consisting of a modified subcutaneous mastectomy with axillary lymph node dissection and radiation are presented; this cosmetically acceptable procedure reduces the number of cancers in the contralateral breast to an incidence of 1% to 2%.

Surgical complications and follow-up evaluation of 163 patients with subcutaneous mastectomy

One hundred sixty three prophylactic subcutaneous mastectomies were performed during a six-year period in high-risk situations. All cases were evaluated for immediate surgical complications and followed up for at least five years. The postoperative complications following subcutaneous mastectomy with and without simultaneous reduction of skin were hematoma, infection, necrosis of the nipple area, pain, and impaired sensitivity. The most significant long-term complication was moderate to severe capsule formation. Despite these problems most women were satisfied with the procedure which was performed because of their increased risk of breast cancer.One hundred sixty three prophylactic subcutaneous mastectomies were performed during a six-year period in high-risk situations. All cases were evaluated for immediate surgical complications and followed up for at least five years. The postoperative complications following subcutaneous mastectomy with and without simultaneous reduction of skin were hematoma, infection, necrosis of the nipple area, pain, and impaired sensitivity. The most significant long-term complication was moderate to severe capsule formation. Despite these problems most women were satisfied with the procedure which was performed because of their increased risk of breast cancer.