Fibrinous Membrane Research Articles

Editorial: Optimism in the control of atherosclerosis.

IF one were to characterize the prevailing view of atherosclerosis, its inevitability would generally be in the Death and Taxes category. Yet, over 120 years ago, Rokitansky1 proposed that this disorder resulted from the formation of an intimal, fibrinous membrane derived mainly from the blood. In the light of advances in the understanding of hemostasis, Duguid,2 nearly a century later, paraphrased Rokitansky with the hypothesis that these arterial lesions were the consequence of thrombotic deposits that provoked a vascular healing response. The thrombogenic concept of atherosclerosis is essentially optimistic in nature, particularly in the present period of rapid progress in . . .

Pre- and postoperative care in pulmonary surgery

0 PENING of the thorax, whether it involves an attack upon the Iungs, heart, aorta, esophagus or mediastinum, imposes specia1 probIems in the care of a patient if the surgeon is to insure safe conduct of the patient through the preoperative, operative and postoperative period. Correction of metaboIic disturbances, abnorma1 losses of fluids and eIectroIytes, and problems of intestina1 mobiIity and continuity are uncommon in thoracic surgery except in esophagea1 lesions; the prevention and treatment of shock is entirely comparabIe to that in genera1 surgery, recognizing that bIood Ioss is often more extensive in thoracic procedures; and the contro1 of infection and preservation of puImonary or cardiac function offer specia1 probIems in the postoperative management reIated to expansion of the remaining Iung and aItered cardiac compensation. PuImonary and esophagea1 surgery has passed through the initia1 phase of rapid growth and its technics are quite we11 standardized; new horizons are being vigorously expIored in cardiac and aortic surgery, empIoying new technics such as. hypothermia, by-pass of the circuIation, and others which are beyond the scope of a genera1 discussion. It is proposed to focus the attention of this paper on the genera1 probIems of care common to the majority of puImonary surgical procedures. Preservation of puImonary function and the prevention and treatment of infection are inseparabIe probIems in puImonary surgery. The rigidity of the chest waI1 imposed upon the Iung the necessity of fiIIing the thoracic space. FaiIure of the Iung to expand and HI compIetely the voIume of the thoracic cage permits the deveIopment of a “dead space” within the thorax, a space Iined on the outside by the rigid thoracic cage and on the inside by a tough fibrinous membrane. Such a “dead space” pre-

Pseudomembranous Enterocolitis: Clinicopathologic Study of Fourteen Cases in which the Disease was not Preceded by an Operation

Summary This report is based on a review of the clinical and pathologic findings in 14 cases of pseudomembranous enterocolitis in which the disease was not preceded by a recent operation on the abdomen. In the cases which previously have been reported in the literature the disease has occurred after an operation on the abdomen. The following pathologic conditions were associated with the pseudomembranous enterocolitis: obstruction of the large intestine in 5 cases, heart disease in 5 cases, and miscellaneous pathologic conditions in 4 cases. In 4 of the 5 cases of obstruction of the large intestine the cause of the obstruction was carcinoma. Severe infection was present in 3 of the 4 cases in the miscellaneous group. The most significant clinical features were the sudden onset of profound circulatory collapse which was resistant to the usual supportive measures, and the presence of watery diarrhea, abdominal distention with features suggestive of paralytic ileus, and abdominal pain. All but one of the patients were more than 50 years of age. At necropsy, segments or long stretches of the small and large intestine had a characteristic appearance. The mucosa was covered or replaced by a gray, loosely adherent wrinkled, fibrinous membrane which contained necrotic cellular debris, leukocytes and bacteria. The submucosa was markedly edematous and hyperemic. The muscular coat usually appeared normal, but partial necrosis of inflammation occasionally was present in this layer.

Radiation Necrosis

Mr. President—I should like to congratulate you and the Institute on promoting this discussion on radiation necrosis. It is a subject which is of the greatest importance to all of us, which has a voluminous literature, which has frequently, sometimes with justification and sometimes without, been the determining factor in the judgment of some of our colleagues on the value of radiotherapy; but it is a subject which we have been singularly shy in discussing in a meeting such as this. I was very pleased to see that you had arranged this meeting, but not so pleased when, in the regrettable absence of Mr. Stebbing, I was asked to take part, as I feel a heavy responsibility in speaking for the radiotherapists. There are two quite distinct clinical entities in radiation necrosis, early or acute necrosis, and late necrosis. The former may develop as an immediate sequel to irradiation, when instead of the normal sequence of events in a developing reaction—erythema followed by a fibrinous membrane on mucosal surfaces or erythema proceeding to dry and subsequent moist desquamation of a skin surface—there is early and intense œdema of the part, which may become purplish; there is extreme and continuous pain and the whole area becomes covered with a greyish yellow slough, which extends down into the subcutaneous tissues to a variable depth.

The Biological Significance of Fibrinous Radiomucositis of the Larynx

Since the first description of fibrinous radiomucositis of the oropharynx and larynx, the significance of this phenomenon has often been in the foreground of discussions but has never been definitely evaluated. Investigators have been inclined to believe that this reaction may be considered as a clinical test indicating radiobiological changes in the irradiated tumor. The time of appearance and the extent of fibrinous exudate formation are widely used as an indicator for the amount and distribution of radiation in the therapy of tumors of the oropharynx, nasopharynx, and larynx. It has been pointed out that the appearance of an extensive and confluent radiomucositis indicates that the dose necessary to destroy tumor cells has been reached. On the other hand, the necessity of the production of a confluent radiomucositis in order to achieve a favorable therapeutic result has been doubted. Borak emphasized that if the applied dose does not induce radiomucositis, or provokes only a mild degree thereof, regression of the tumor will be temporary and incomplete. As a rule, in such cases recurrence may be expected in about a year and permanent cure is the exception. I have studied a number of larynges (autopsy specimens) microscopically at or near the height of fibrinous radiomucositis. The epithelium is gone. The fibrin lies on what I take to be the old membrana propria. It also dips into the ducts of mucous glands, the acini of which are distended by basophilic material (retained secretion). Large amounts of fibrin are present in the subepithelial connective tissue and also in laryngeal muscles and in the perichondrium. This is a constant finding in the presence of clinically observed fibrinous mucositis and had persisted in one case for two months after the last irradiation. In cases in which fibrinous radiomucositis did not occur, only small amounts of fibrin or fibrinoid were noted in the connective tissue (4 specimens). Since standard irradiation technic was used, we must assume that the variation in degree of fibrinous exudate formation was due to constitutional differences prevailing in the tissues of the larynx itself. The larynx seems to react to irradiation in the same manner as it does to bacterial, chemical, or thermal influences. These, too, often induce the development of strong fibrinous pseudomembranes. At times, however, this reaction fails to occur, despite exposure to the same pathological stimuli. Microscopic examination conclusively shows that superficial and deep fibrinous exudation is not a reaction of tumor cells or tumor structures, as has been assumed. It is a reaction of connective tissues and blood vessels. As Lubarsch pointed out, development of fibrinous membranes always follows necrosis of epithelial cells. Hirschfeld believes, however, that the first step in the course of development of fibrinous membranes is fibrin exudate formation.

"The primary factor in thrombosis after injury to the blood-vessels"

No uniformity of opinion exists in regard to the essential processes leading to thrombosis. According to some authors thrombosis is essentially due to coagulation of plasma or of cells. Others hold that two factors enter: Agglutination and coagulation. Klemensiewicz and Gutschy expressed the opinion that the primary formation of a fibrinous membrane at the place of injury is necessary.We find the same diversity of views in regard to the so-called first coagulation of arthropod blood, which, as the author has already shown experimentally, is identical with thrombosis in that animal. That no explanation of thrombosis has found general recognition so far is due to the fact that microscopic examinations alone, based on staining reactions, are entirely inadequate for a decision of this question. Almost all previous work rests mainly on morphological investigation.Sahli's work, however, forms an exception. He found that after injection of leech extract into the circulation of a rabbit, thrombi no longer formed ...

A Discussion on Fibrinous Membranes within the Spinal Canal Occurring in General Paralysis

A Discussion on Fibrinous Membranes within the Spinal Canal Occurring in General Paralysis