William E. Ehrich

A frequent obstructive anomaly of the mouth of the left common iliac vein

Abstract This study of the opening of the left common iliac vein into the inferior vena cava is based on the examination of 412 bodies: 97 stillborn babies and infants up to 10 months old, 28 children from 1 to 9 years of age, 23 adolescents from 10 to 19 years of age, and 264 adults up to 90 years of age. The width of the opening first increased rapidly with increasing age, and later more slowly. The curve reached its peak during the seventh decade. A valve was found to be normally present in the newborn at the lower pole of the opening, but it appeared to be worn off in an ever greater percentage as age progressed, and more so in obstructed than in normal openings. This observation seems to be significant with regard to the cause of varices of the lower extremities, which have often been explained as a result of venous valvular insufficiency. Obstruction of the orifice in the 399 cases analyzed was observed in 95 instances (23.8 per cent), with a possibility of 16 more instances in the stillborn and infants. It was less common in children and babies (4.7 per cent), although, if the 16 doubtful cases are included, the percentage rises to 17.3 per cent. In those over 10 years of age, it was found 89 times (33.8 per cent). It occurred with equal frequency in males and females, and in whites and Negroes. According to location and other criteria, the obstructions could be divided into five groups (Figs. 3 and 4). The most common site of obstruction was the upper pole of the orifice, where two-thirds of all obstructions were found. Concerning the pathogenesis of the obstructions, few, if any, were thought to be caused by faulty development, per se. They appeared to be acquired during the growth period, rarely before birth, and rarely after adolescence. As to the mechanism involved, it was observed that the obstructions occurred at a point where the right iliac artery crosses and exerts pressure on the vein. This pressure conceivably interferes with the proper development of the opening into the vena cava or causes an injury resulting in organization and fibrosis. In a small number of cases the obstructions could be shown to be organized thrombi. The clinical significance of the obstructions is apparent from the greater frequency of thrombosis in the left than in the right leg. This preponderance could be confirmed in our material, as well as in an analysis of 1,000 consecutive autopsies from one of our hospitals.

Agglutination of Bacteria by Lymphoid Cells in Vitro.

Summary It has been demonstrated that certain lymphoid cells of antibody forming lymph nodes agglutinate on their surface in vitro the bacteria with which the animals were immunized. The agglutinating cells which could be identified belonged to the plasma cell series, whereas typical small lymphocytes failed to show the phenomenon. These observations seem to show that it is the plasma cell rather than the lymphocyte which elaborates agglutinins.

THE ROLE OF THE LYMPHOCYTE IN THE CIRCULATION OF THE LYMPH

The circulation of the lymph begins with the filtration of plasma through the blood capillaries. Though most of the filtrate is reabsorbed into the blood, some is left behind in the tissues. The latter is carried off by the lymph vessels, which soon enter into lymph nodes. Lymph, apparently, never reaches the thoracic duct without having passed through a t least one lymph node. The number of lymph nodes in the human body may be estimated a t between 500 and 1000.” 44 The total weight of these nodes is believed to amount to about 1% of the total body weight.13 It is well known that herbivora have considerably more lymphatic tissue than carnivora. They also have more circulating lymphocytes (TABLE 1 ) . While passing through a lymph node, the lymph is considerably modified. There is retention, in the node, of red cells, leukocytes, bacteria, and other corpuscular matter that may be contained in the peripheral lymph,t there is addition to the lymph of lymphocytes originating, as is generally believed, within the lymphatic tissue. While peripheral lymph of various species normally contains from 500 to 2000 leukocytes per cu. mm., 4 to 18% of which may be granulocytes and monocyte~,’~ intermediate lymph cont,ains from 5,000 to 20,000 leukocytes per cu. mm. After stimulation with antigen, intermediate lymph of rabbits may contaie as many as 50,000 to 70,000 per cu. mm., of which 99% may be lymphocytesz0 (TABLE 1) . The rise in the number of lymphocytes in the lymph, while it is passing through a lymph node, cannot be explained by reabsorption of water in the nodes, because the protein contained in the lymph, peripheral and central to nodes, is identical in amount. In fact, “if the blood

Teratoid parasites of the mouth (episphenoids, epipalati [epurani], epignathi)

Abstract The teratoid parasites of the mouth show all transitions from dermoids (hairy polyps) through teratomas (unorganized derivatives of all three germinal layers) to incompletely developed twins (sometimes affixed to the autosite by an umbilical cord). Most oral parasites are attached to the sphenoid bone (episphenoids) ; some are affixed to the palate (epipalati or epurani) ; a few are bound to the jaw (epignathi). The episphenoids mostly grow into the pharynx and mouth; in a considerable number of cases they develop into the cranium (encranii) ; in rare cases they extend into both directions. A case of the latter variety has been described in this paper. It has been shown that the intraoral and intracranial portions of these parasites are connected with one another through the area of the craniopharyngeal canal. Since many encranii spring from the region of the pituitary gland, and most oral parasites arise at or near the sphenoid bone, and since almost all encranii, episphenoids, epipalati, and epignathi develop at or near the midline, it appears that all these parasites have a common pathogenesis. As the higher-developed parasites, like the one reported here, show the same axial orientation as their autosites, it suggests itself that they are asymmetrical double monsters rather than teratomas due to dislocation of germ tissue.

Heparin and Heparinocytes in Elephantiasis Scroti.

Summary and Conclusions Microscopic examination of a human scrotum amputated because of elephantiasis showed numerous heparinocytes around lymph and blood vessels. One hundred and twenty-six mg of purified heparin per kg of wet tissue was obtained. Based on the purified material, the scrotum contained at least 16,380 I.U. of activity per kg of fresh tissue. These findings are further evidence that mast cells are sources of heparin. They also explain the absence of thrombosis in elephantiasis.

Effects of Cortisone, Hyaluronidase, Desoxycorticosterone, and Artisone on Experimental Serum Disease in Rabbits:

Conclusions Cortisone in doses of 4 mg twice daily depressed the Arthus reaction in the skin and completely prevented arteritis and carditis in 8 of 9 rabbits treated with horse serum. Glomerular nephritis, on the other hand, was not prevented. The zona fasciculata of the adrenals was atrophied. The mortality rate was highest among the animals receiving cortisone. Hyaluronidase in doses of 6000 T.R.U. per kg depressed the Arthus reaction in the skin and diminished glomerular nephritis, but enhanced arteritis and carditis. These observations may be explained by the ability of hyaluronidase to weaken ground substance barriers, thereby diverting antigen and antibody from the kidneys to the general vascular bed. DCA and Artisone in the doses used had no remarkable effect on the histological manifestations of serum disease, but DCA caused a depression of the Arthus reaction in the skin possibly through its hyaluronidase-like effect upon the ground substance. It appears that serum disease is an excellent experimental tool for comparing the total efficacy of cortisone-like drugs after preliminary screening for their anti-permeability action on ground substance.

Effect of Hyaluronidase on Experimental Hypercholesterolemia in Rabbits and Rats and Atheromatosis in Rabbits

Summary 1. Subcutaneous or intravenous injection of hyaluronidase depressed hypercholesterolemia in rabbits and rats. 2. Intraperitoneal injection of hyaluronic acid prevented hypercholesterolemia in nephrotic rats. 3. Hyaluronidase facilitated general lipidoses and aggravated atheromatosis in rabbits. 4. The advisability of indiscriminately lowering the blood cholesterol level in hypercholes-terolemics is questioned. 5. The antihyper-cholesterolemic effect of hyaluronidase was abolished when specific antibodies to the enzyme developed. 6. Endogenous experimental hypercholesterolemia in rabbits does not depend on the presence of the adrenals.

Effects of salicylates and other drugs on experimental serum disease

Abstract 1.1. Massive doses of sodium salicylate in rabbits were found to prolong the prothrombin time (Dicumarol effect) and to cause a reduction in thymus weight (toxic effect). In some rabbits with experimental serum disease, it also caused a decrease in the precipitin titers and a depression of the immediate mesenchymal reactions in heart, lungs, and spleen which are believed to be instrumental in antibody production. Allergic arteritis on the other hand was not depressed. 2.2. Dicumarol in effective doses prolonged the prothrombin time and interfered with precipitin titration both in vivo and in vitro. It did not, however, decrease thymus weight, the immediate mesenchymal reactions, or allergic arteritis. As the precipitin reaction was depressed in vitro, the diminished yield in precipitin is interpreted as caused by direct interference with the precipitin reaction. 3.3. Colchicine used for its known toxic effect on lymphoid tissue caused a marked decrease in thymus weight, the immediate mesenchymal reactions, and the precipitin titers. It also abolished the allergic arteritis which is believed to be an antigen-antibody reaction. 4.4. These observations seem to show that the efficacy of massive salicylate therapy in hypersensitive diseases is a complex one. It appears to be conditioned in part by its anticoagulant effect (Dicumarol effect) and depressing effect upon the antibody forming lymphoid cells (toxic effect). The former action enhances, the latter depresses the occurrence of an Arthus phenomenon.

Dynamik der Reizbeantwortung

Wenn ich der ehrenvollen Einladung Ihres Vorstandes folgend nach Wiesbaden gekommen bin, um den heutigen „Reiztag“ mit einem Referat uber die Entzundung einzuleiten, so tat ich das schon deshalb gerne, weil ich mich darauf freute, alte Freunde und vertraute Statten wiederzusehen. Vor allem aber lag mir daran, bei Ihnen fur eine Richtung in der Pathologie zu werben, wie sie in Deutschland besonders durch Franz Buchner vertreten wird. Die moderne Pathologie ist nicht langer eine pathologische Morphologie. Sie ist vielmehr eine pathologische Biologie. Hiermit soll naturlich nicht gesagt sein, das die Morphologie keine wissenschaftliche Bedeutung hat. Im Gegenteil, sie ist genau so wissenschaftlich wie die Physik oder Chemie. Ich meine nur, das alle diese Forschungsrichtungen im Grunde nur Methoden sind. Fur die Erforschung biologischer Vorgange kann aber, wie Buchner so treffend bemerkt hat, „nicht die Methode die Absteckung der Grenzen bestimmen, sondern allein der Gegenstand“.

Blood Histamine, Leukocytes and Platelets in Experimental Serum Disease in Rabbits

Conclusions It appears that in rabbits histamine is linked via the histamine containing platelets with blood coagulation, and this is connected via heparin with the heparin producing basophiles. All these elements are involved in serum disease. The first injection of serum is followed by a rise in histamine and platelets, the second by a drop in these elements. The destruction of the white cell layer following reinjection calls forth an outpouring of heparin which in turn is followed by basophilia in the blood. Only the changes following reinjection can be regarded as allergic. Neohetramine was found to effect only the primary reactions following the first administration of serum. It suppressed the rise in blood histamine and the proteinuria observed during the first week following the first injection, and also impeded the primary mesenchymal reactions in lungs and heart which are believed to be instrumental in antibody formation. There are reasons to believe that this was not a specific antihistaminic effect, but that it was due to a non-specific action of the drug upon the permeability of tissue membranes possibly via the hyaluronidasehyaluronic acid mechanism.