Nils H. Sternby

Histologic features of the temporomandibular joint disk and posterior disk attachment: Comparison of symptom-free persons with normally positioned disks and patients with internal derangement☆

To gain further knowledge about the differences between normal and pathologic anatomy of the temporomandibular joint disk, we examined histologically disks obtained at autopsy from 10 symptom-free persons and compared our findings with observations involving 17 surgically removed disks. The surgical patients had internal derangement and severe long-standing temporomandibular joint pain and dysfunction. The normal disks were biconcave, whereas the surgically removed disks were deformed and thicker than the normal disks. Chondrocytes (4 joints), a surface layer of proliferative connective tissue (4 joints), vessels (2 joints), and splitting (4 joints) were seen in the surgical specimens but not in the normal specimens. The surgical specimens also showed higher maximal density of fibroblasts and vessels. It was concluded that surgically removed temporomandibular joint disks demonstrated several histologic alterations that were not seen in normal disks. These characteristics may serve as the basis for development of a histologic grading of pathologic conditions of the temporomandibular joint disk and the posterior disk attachment.

Trousseau’s syndrome – what is the evidence? A population-based autopsy study

Despite numerous studies documenting the association between cancer and venous thromboembolism (VTE), the reason for the excessive risk in certain cancers remains obscure. No large-scale studies have yet investigated the independent effects of cancer type, site and growth pattern. Between 1970 and 1982, 23,796 standardised autopsies were performed, representing 84% of all in-hospital deaths in an urban Swedish population. The relationship between cancer and PE was evaluated with logistic regression. The overall PE prevalence was 23%, and 10% of the population had a fatal PE. Forty-two per cent of pancreatic cancer patients had PE (OR 2.55; 95% CI 2.10-3.09) (p<0.001); gall bladder, gastric, colorectal and pulmonary adenocarcinomas were similarly independently associated with PE. In comparison with squamous cell lung cancer, patients with pulmonary adenocarcinoma had 1.65 times higher odds for PE (95% CI 1.20-2.29). Adenocarcinoma and metastatic cancer were independently associated with PE risk (OR 1.27; 95% CI 1.16-1.40; p<0.001, and OR 1.10;95% CI 1.01-1.20; p=0.024, respectively) but when controlling for cancer type and spread, pancreatic cancer was still associated with an OR of 2.10 (95% CI 1.71-2.58) of PE (p<0.001). We conclude that the risk of PE in cancer patients depends not only on the cancer site and spread but also on the histological type. The excess independent risk in pancreatic cancer is intriguing and should warrant further research.

Pathology of Centenarians. I. The Cardiovascular System and Lungs

The cardiovascular and lung lesions in 23 centenarians (7 males and 16 females) were examined pathologically. The heart showed varied degrees of hypertrophy, and myocardial fibrosis was present in 15 of the 23 patients. Coronary arteriosclerosis was noted coincidentally. In addition to these findings, amyloid deposition was seen in the hearts of 8 patients. Generalized atherosclerosis of the arterial tree was severe to moderate in all cases. Bronchopneumonia was present in 15 of the 23 patients, and fresh or old thromboembolism in 8. There was a tendency toward emphysema and chronic bronchitis in the structure of the lung. The frequent occurrence of myocardial fibrosis and bronchopneumonia was characteristic in the series. It was significant that cardiac amyloid deposition was noted in these cases.

Atherosclerosis in the hypercholesterolemic hare: Comparison of coronary artery lesions induced by dietary cholesterol in the hare and the rabbit

Atherosclerotic lesions in coronary arteries were compared in 10 hybrid hares and 14 rabbits after induction of hypercholesterolemia, using a cholesterol-enriched diet. All proximal portions of hare coronary arteries contained intimal lesions, often with severe luminal stenosis. These lesions were characterized by the presence of foam cells, smooth muscle cells, and areas of atheronecrosis. Foam cells were also found focally in the media. As part of the intimal changes, iron deposition was present in 65% and calcification was present in 32.5% of proximal segments examined. The proportion of segments with intimal lesions and the intima/media cross-sectional area ratios (I/M ratios) were greatest in proximal segments with stepwise decreases in the mid and distal segments. As area of myocardial infarction was present in one hare. In contrast, 46.5% of proximal segments of rabbit coronary arteries had no intimal lesions and those lesions present had no calcium or iron deposition. No infarction was observed in rabbit hearts. The proportion of segments with lesions and the mean I/M ratios were significantly greater in the hare than the rabbit, with proximal and mid coronary segments showing the most marked differences. The hare appears to develop coronary artery lesions more like those seen in man, with high grade, proximal stenoses occurring uniformly in hypercholesterolemic animals. In contrast, the atherosclerosis developing in rabbit coronary arteries is less uniform and includes involvement of intramyocardial arterioles. The hare offers several advantages as a model of human atherosclerosis.

Arthroscopic diagnosis of perforation and adhesions of the temporomandibular joint: Correlation with postmortem morphology

Arthoscopy was performed in the upper joint compartment of 28 temporomandibular joints in 16 fresh cadavers to investigate the accuracy of arthroscopic diagnoses of perforation and adhesion. Subsequent dissections revealed that only three of nine perforations were seen arthroscopically and that three of four joints with adhesions were arthroscopically diagnosed. There was no overdiagnosis of perforation or adhesions. Intra-articular hyperplastic soft tissue formation (crab meat) was arthroscopically seen in ten joints (36%) and was with only two exceptions associated with either a perforation or adhesions. Histologically, the adhesion and the hyperplastic soft tissue consisted of fibrous connective tissue with collagen fibers and fibroblasts. It was concluded that a positive arthroscopic diagnosis of adhesion or perforation is reliable whereas a negative diagnosis of perforation is not reliable.

Pathology of centenarians. II. Urogenital and digestive systems.

ABSTRACT: The urogenital and digestive systems in 23 centenarians (7 males and 16 females) were examined pathologically. In the urogenital system, macroscopic scar formation, chronic pyelonephritis and arterio‐ and arteriolosclerosis of the kidney usually were pronounced. Six instances of prostatic glandular hyperplasia were demonstrated, and three of these were associated with well‐differentiated adenocarcinoma. The testis, ovary and uterus usually showed a strong tendency toward atrophic changes. In the digestive system, senile atrophy of the liver and formation of colonic diverticula were noted. In this series of aged subjects, malignant lesions of the gastrointestinal tract were rare. It is also noteworthy that the unsuspected lesion of massive gastrointestinal hemorrhage associated with the various observed disorders might have been the cause of death in some of these centenarians.

High condylar shave of the temporomandibular joint with preservation of the articular soft tissue cover: an experimental study on rabbits.

The high condylar shave has the disadvantage of removing the articular soft tissue cover together with the underlying condylar bone. In an attempt to overcome this disadvantage, we elevated the articular soft tissue cover, shaved the condylar head, and replaced the articular soft tissue cover in its original position in nine adult rabbit temporomandibular joints. On the contralateral joints, the same amount of bone was shaved together with the articular soft tissue cover. The rabbits were killed after 3 months, and the condyles were macroscopically and histologically evaluated. All condyles were covered with an articular soft tissue layer in the area operated on. This surface was smoother when the articular soft tissue cover was preserved. Histologically, the subarticular layer of cartilage cells was continuous in the joints with preservation of the articular soft tissue cover but was frequently interrupted in the joints where this cover was removed. The incision made in the posterior part of the articular surface for elevating the articular soft tissue cover frequently caused a deformity of the condyle and an interruption of the subarticular layer of cartilage. The results suggest that preservation of the articular soft tissue cover on the mandibular condyle might be one way to improve the postoperative morphology after high condylar shave. The technique in its present state has obvious drawbacks and should be further refined before it is considered for clinical application.

Cholesterol-induced atherosclerosis. Clonal characteristics of arterial lesions in the hybrid hare.

Utilizing the observation that a majority of human atherosclerotic fibrous plaques show monoclonal characteristics, we carried out this study to determine the clonal characteristics of cholesterol-induced atherosclerosis in the hybrid hare. If this is a valid model for human atherosclerosis, the lesions produced in the aorta should be monoclonal. Glucose-6-phosphate dehydrogenase (G-6-PD) was used as an X-linked cellular marker in the female hybrid hare (Lepus timidus × Lepus europaeus), which is heterozygous for electrophoretically separable isoenzymes of G-6-PD. Hares were fed cholesterol over either a 6-month ora l 6-month period, and the easily dissectable lesions in the aorta and common iliac arteries were assayed for isoenzyme activity at these times. Of the 93 lesions assayed, all had polyclonal characteristics except a single monoclonal lesion found in an animal fed cholesterol over a 16-month period. Hares fed over the 16-month period showed lesions with isoenzyme patterns having a significantly higher contribution of L. timidus isoenzyme than those found in underlying media. This suggested that a selection of cells with the L. timidus X-chromosome had taken place, but the degree of this selection was not great enough to allow any of the lesions to be defined as monoclonal.

An experimental study of gastric stump carcinoma in Wistar rats

The risk of gastric stump carcinoma is increased 15–20 years after gastric resection for benign disease. Reflux of duodenal juice, bacterial overgrowth and formation of N‐nitroso compounds are possible etiological factors. There is a geographical variation in the incidence of gastric cancer, possibly explained by differences in food intake. Experimentally it is possible to induce gastric stump carcinoma in rats without the addition of exogenous carcinogens. The aim of this study was: 1) to find the incidence of gastric careinoma in rats subjected to BII resection and followed for 10 months, and 2) to examine if acetic acid, a common dietary factor, could influence the development of gastric carcinoma. Amongst BII‐operated male Wistar rats, infiltrating carcinoma was found in 5/20 on a normal diet and in 5/24 exposed to acetic acid (NS). Benign mucosal changes were seen in 12/20 and 16/24 respectively (NS). With the exception of a profound inflammation in one sham‐operated animal, no mucosal pathological changes were found in 24 sham‐operated and 24 control animals where no operation was performed.

Osteoplasty of the mandibular condyle with preservation of the articular soft tissue cover: Comparison of fibrin sealant and sutures for fixation of the articular soft tissue cover in rabbits☆

Fibrin sealant and sutures were compared for fixation of the articular soft tissue cover after it had been raised in association with osteoplasty of the mandibular condyle. Nine adult rabbits were operated on bilaterally with the use of fibrin sealant on one joint and sutures on the other joint. The rabbits were killed after 3 months. Macroscopic and histologic evaluations of the condyles did not reveal any appreciable differences between the two techniques. Fibrin sealant was, however, technically easier to apply than the sutures. It was concluded that fibrin sealant might be an alternative to sutures for fixation of the articular soft tissue cover after it has been raised in association with osteoplasty of the mandibular condyle.