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The feasibility of using still images sent via the Internet for remote neuropathological consultation was examined. We assessed the diagnostic agreement between three groups of neuropathologists and a reference laboratory. All groups independently evaluated pictorial data exchanged by e-mail or ftp server. In the group of benign meningothelial meningioma agreement was reached in 100%, 100%, 92% of cases. In three cases of malignant meningioma agreement was achieved in 100%, 33%, 33% of cases, and in ten cases of atypical meningioma agreement was achieved in 50%, 30%, 40% of cases. Average concordance for all three groups was 83.33%, 54.33%, 57.67%. Our experiment showed that there were no discrepancies in the typical cases of benign meningothelial meningiomas. Disagreement related to the grade II and III lesions i.e. atypical and malignant meningioma. Atypical as well as malignant meningioma seems to need more direct discussion to achieve consensus. The main problem was the subjectivity of the local pathologist who overstated the informational content of the images, and an insufficient number of pictures. This may be prevented in the future by employment of dynamic teleneuropathology using a very high-resolution camera.

Glomerular and interstitial expression of tenascin was examined by an indirect immunoperoxidase method in renal biopsy specimens from 27 patients with mesangial proliferative (IgA-negative) glomerulonephritis (MesProGN). Histologically normal samples of kidney tissue (n = 10) obtained from patients with renal trauma were used as controls. In patients with MesProGN, expression of tenascin in glomeruli and interstitium was significantly higher as compared with controls. Tenascin was present in mesangial regions and particularly in areas with interstitial damage. Our results confirm that tenascin is present in normal renal tissue and show a strongly positive correlation between glomerular tenascin expression and surface of mesangial areas and between interstitial expression of tenascin and the relative interstitial cortical volume in patients with MesProGN. In addition, there was a significant correlation between intensity of glomerular and interstitial tenascin staining and serum creatinine levels. Our data indicate that tenascin accumulates in glomeruli and interstitium in patients with MesProGN. Therefore, immunohistochemical staining of tenascin may be a useful marker of progression of the disease in this type of glomerulonephritis.

HLA-DR antigen expression in tumour cells was investigated in 68 laryngeal carcinomas. The tissue sections were studied by a morphometric method using a computer image analysis system. Although the highest number of HLA-DR-positive cells was observed in the groups with the lowest clinical stage, these differences did not reach statistical significance. Analysis of survival showed a significantly different survival time of patients classified as HLA-DR positive (10% and more HLA-DR+tumour cells) compared to those classified as HLA-DR negative. There were no significant differences in survival times between patients with glottic and extraglottic cancers, or between patients with various grades of histological malignancy.

Chordoma is a relatively rare neoplasm originating from the remnants of the embryonic notochord. We analysed 24 cases of chordoma. The patients were divided into groups depending on the localisation. We analysed the results of different methods of therapy: surgical treatment, radiation therapy and combined surgical and radiological treatment. The results were compared with the data from the references.

Fourteen renal biopsy specimens from patients with mesangiocapillary glomerulonephritis type I (MCGN-I), for whom both light and electron microscopies as well as immunofluorescence microscopy and full clinical data were available, were examined quantitatively. As a control, 10 biopsy specimens of the kidney from patients with minimal change disease (MCD) were used. Morphometric investigations were performed by a computer image analysis system to investigate whether myofibroblasts have a role in tubulointerstitial fibrosis in MCGN-I and, in particular, to examine the relationship between alpha-SMA expression and interstitial infiltrates. The morphometric study revealed that in MCGN-I patients the mean values for the expression of alpha-SMA, interstitial volume, CD68+, CD45RB+, CD43+ and CD20+ cells were significantly increased, as compared with a control group. In the MCGN-I group, there were significant positive correlations between the interstitial expression of alpha-SMA and the interstitial volume as well as CD68+ and CD45RB+ cells. The correlations between the interstitial expression of alpha-SMA and CD43+ as well as CD20+ cells were positive, but without statistical significance. In conclusion, our study suggests that interstitial a-SMA positive cells play a role in the development of interstitial fibrosis in MCGN-I. The significant correlation between the interstitial expression of alpha-SMA and interstitial CD68+ cells may identify monocytes/macrophages as important mediators in the process of inducing the myofibroblast phenotype in resting fibroblasts.

The authors reported the accumulation of osmiophilic myelin-like bodies typical for Fabry's disease in the rebiopsied 19-year-old woman clinically presenting with intermittent mild microhematuria and trace proteinuria. The light microscopy examination of the first kidney biopsy specimen (10 years ago) showed the presence of vacuolated cells in glomeruli, but electron microscopy study was not performed. The family history was negative for renal diseases. A biochemical enzymatic assay for alpha-galactosidase A was not performed. It is concluded that electron microscopy examination of kidney biopsy specimen is important for the investigation of storage diseases.

Twelve renal biopsy specimens from patients with idiopathic diffuse IgA nephropathy (IgAN) and 13 from patients with primary proliferative mesangial non IgA glomerulonephritis (PMGN) for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available were examined and quantitatively compared. Morphometric investigations performed by means of a computer image analysis system were undertaken to compare the deposit area per mesangial area in IgAN and PMGN, as well as to study whether this parameter could correlate with the intensity of the glomerular infiltrates of monocytes/macrophages and with hematuria. The results showed that the mean values of the deposit area per mesangial area were significantly increased in IgAN patients in comparison with PMGN group. There were strong positive correlations between the area of the mesangial deposits and the mean number of the glomerular CD 68 positive cells in both IgAN and PMGN groups. Correlations between the area of the mesangial deposits and hematuria were also positive, but only in IgAN patients this relationship reached statistical significance. In conclusion, the present study pointed out that the deposit area per mesangial area was significantly increased in IgAN if compared with PMGN. Moreover, the results suggest that lack of fast catabolism of the mesangial deposits in IgAN may depend on the small number of monocytes/macrophages in the glomeruli. Positive correlations between deposit area per mesangial area and hematuria are not clear and need further investigations.

The expression of the intercellular adhesion molecule-1 (ICAM-1), infiltrating cells positive for its ligand leucocyte adhesion molecule-1(LFA-1), and the markers of total leucocytes (CD45RB), T cells (CD45RO), and monocytes/macrophages (CD68) were examined by an indirect immunoperoxidase method on renal biopsy specimens from 20 patients with mesangial proliferative glomerulonephritis-IgA negative (MesProGN) and 20 with IgA nephropathy (IgAN). Histologically, normal portions of the kidney tissue (n = 15) obtained from patients with renal trauma or renal tumours were used as controls. The expression of ICAM-1 was evident and extended in mesangium, on endothelial cells of peritubular capillaries, interstitial cells, several infiltrating immune cells and on tubular epithelial cells, particularly on atrophic tubuli in renal biopsies of MesProGN and IgAN. In both types of glomerulopathies a significant increase in the number of glomerular and interstitial LFA-1-positive cells correlated positively with the expression of ICAM-1. The number of glomerular and interstitial LFA-1-positive cells correlated positively with the number of monocytes/macrophages in glomeruli and interstitium. The strong correlation between expression of ICAM-1 and LFA-1 and between LFA-1-positive cells and immune cells makes these adhesion molecules useful markers of activity and suggest that they are involved in recruitment of leucocytes in the studied types of proliferative glomerulopathies.

HLA DR antigen expression in tumor cells and lymphocytic infiltrates at the tumour periphery were investigated in 68 laryngeal carcinomas. The tissue sections were studied by a quantitative method using computer image analysis system. The highest number of CD45RO+ cells was observed in the groups of the lowest clinical stage. There were statistically significant differences between the groups in the number of T cells, whereas no differences were found in HLA DR+ cancer cell number, B cell number or mitosis count. Statistical analysis revealed a significant correlation between T-cell number at the periphery of the tumour and the number of cancer cells showing HLA DR expression. The results of the analysis, using Cox proportional hazard model with selected factors, showed that only HLA DR expression in cancer cells had a significant effect on survival, whereas the number of CD45RO+ and CD20+ cells, histological grade and mitosis count did not contribute further to prognostic information. To our knowledge, this is the first time that HLA DR expression and its correlation with lymphocytic infiltration have been shown by a quantitative method in laryngeal cancer.

Apoptosis plays an important role in the recovery from glomerulonephritis. Moreover, aberrant apoptosis seems to contribute to lupus nephritis. This study compared the intensity of apoptosis in lupus and non-lupus mesangiocapillary glomerulonephritis. We used an in situ cell death detection kit, POD, which detects single cell apoptosis in formalin-fixed renal tissue. Our material comprised 13 renal biopsy specimens from patients with lupus mesangiocapillary glomerulonephritis (SLE-N IV), 11 renal tissues from patients with non-lupus mesangiocapillary type I glomerulonephritis (MCGN) and 8 normal kidney samples. We checked the correlations between intraglomerular apoptotic cells and the total number of intraglomerular cells, the relationship between tubulointerstitial apoptotic cells and the relative interstitial cortical volume. The population of intraglomerular apoptotic cells was lower in tissues from SLE-N IV patients than patients with MCGN. In MCGN the intensity of apoptosis in glomeruli correlated significantly with the number of total glomerular cells. Tubulointerstitial apoptotic cells were infrequent in the kidney samples from patients with SLE-N IV and in the normal kidney. In the renal interstitium and tubuli the number of apoptotic cells did not correlate with the relative interstitial cortical volume in kidney tissue in patients with MCGN. In the biopsies from patients with SLE-N IV there was an inverse correlation between tubulointerstitial apoptotic cells and the relative interstitial cortical volume, so a low number of apoptotic tubulointerstitial cells was associated with fibrosis in the renal interstitium. The results illustrate the differences in the intensity of apoptosis in lupus and non-lupus glomerulonephritis. The low number of apoptotic cells in renal tissue from patients with SLE-N IV suggests regulation of apoptosis may be altered in the mechanisms of glomerular and tubulointerstitial damage in lupus nephritis, although the reduced apoptosis may simply be due to smaller numbers of cells in fibrotic areas.

Fifty cervical samples from women with mild, moderate and severe dysplasia and with preinvasive and invasive cancer were stained according to AgNOR method and examined quantitatively. Morphometric investigation were performed by means of a computer image analysis system to evaluate whether number of AgNORs per nucleus, number of AgNORs per 1 micron 2 of nuclear area, nuclear area and nuclear outline may be helpful in morphological differentiation of examined lesions. The morphometric evaluation revealed that the number of AgNORs and nuclear area increased from group of mild dysplasia to invasive cancer. Nuclear outline increased as well, but there were less significant differences. The numbers of AgNORs per 1 micron 2 of nuclear area were different in all groups, these differences were not significant. Our results confirmed that the number of AgNORs per nucleus and nuclear area may constitute a helpful tool to support subjective differential diagnostics. These parameters may be especially useful in doubtful cases, when sample is small or inflammatory changes superimposed as well as in cytological examination.

Fifteen renal biopsy specimens from patients with idiopathic diffuse IgA nephropathy (IgAN) and twelve from patients with Schoenlein-Henoch nephritis (SHN) for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available were examined and compared quantitatively. Morphometric investigations were performed by means of a computer image analysis system to evaluate whether morphometric analysis could confirm morphological similarity between IgAN and SHN as well as to study whether glomerular parameters could correlate with hematuria in these glomerulopathies. The morphometric study did not reveal noticeable differences between groups and the mean values of total glomerular area, total glomerular cells per total glomerular area, total glomerular cells per unit of glomerular area, mesangium (% of total glomerular area) and relative interstitial volume were similar in IgAN and SHN. Moreover, there were significant positive correlations between glomerular mesangium (% of total glomerular area) and hematuria in both IgAN and SHN groups. The correlations between other glomerular parameters and hematuria were weak and did not reach statistical significance.

15 renal biopsy specimens from patients with mesangial proliferative glomerulopathy (MPGN), 15 from patients with IgA nephropathy (IgAN), and 15 from patients with mesangiocapillary glomerulopathy type I (MCGN-I), for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available, were examined and compared with 15 normal controls. Morphometric investigations were performed by means of a computer image analysis system to evaluate quantitatively the glomerular deposition of PAS positive material in these glomerulopathies, as well as to assay whether this parameter could correlate with the renal function. The morphometric study demonstrated that the mean values of glomerular deposition of PAS positive material (% of total glomerular area) were similar in MPGN, IgAN, and MCGN-I. Although correlations between glomerular deposition of PAS positive material and serum creatinine tended to be positive in MPGN, IgAN and MCGN-I, they were weak and not significant. Thus, the present study could not confirm earlier suggestions concerning a significant correlation between these parameters.

IgA nephropathy (IgAN) is considered as a disease of young men under 30 years of age, and is relatively uncommon in the elderly. It is thought, that the disease appears to have a more unfavourable prognosis in the elderly. The aim of the study was to evaluate the clinical and histological presentation of IgAN in patients under 45 (group I, n = 31, mean age = 28.3) and over 45 years of age (group II, n = 11, mean age = 48.6). Time between onset and diagnosis of IgAN was similar in both groups. Proteinuria/ 24 hand hypertension were significantly higher, gross hematuria was significantly lower in the older patients at the time of renal biopsy. Light microscope findings showed that severity of tubulointerstitial lesions, as well as glomerular sclerosis were more common in patients over 50 years of age, but mesangial proliferation in the younger ones. The study pointed out that factors that carry a poor prognosis, i.e. proteinuria, high blood pressure, tubulointerstitial damage were more commonly present in older patients. Prolonged follow-up is necessary to confirm this trend.

It is postulated that programmed cell death via apoptosis may be critical for successful remodelling of glomeruli after inflammation injury. Recently, several methods of analysis of apoptotic cells have been developed, most of them based on the detection of DNA degradation. To determine whether apoptosis is present in renal tissue we compared 36 renal biopsy specimens in patients with various types of glomerulonephritis with 8 samples of the normal kidney using the In situ Cell Death Detection kit, POD, which detects single cell apoptosis in formalin-fixed tissue. In addition, we tried to correlate apoptosis with the type of renal injury. The apoptotic cells were scored using a computerized digital image analyzer. There were greater numbers of glomerular apoptotic cells in IgA nephropathy (IgA-N) compared with the normal kidney, minimal change nephrotic syndrome (MCNS) and mesangial proliferative glomerulonephritis (Mes-Pro-GN). In proliferative types of glomerulonephritis the intensity of apoptosis in glomeruli correlated significantly with the total number of glomerular cells. The relationship between apoptotic cells in glomeruli and degree of proteinuria showed statistical significance only in patients with Mes-Pro-GN. There was no difference in the number of interstitial and tubular apoptotic cells between all studied groups. Our data suggest the possibility of altered regulation in apoptotic mode of cell death in mechanisms of glomerular damage.

The pathogenetic mechanism of nasal polyps remains unknown, although polyps seem to be an expression of chronic nasal inflammation of both allergic and nonallergic origin. The goal of our study was to compare the distribution mast cells and eosinophils (cells traditionally associated with allergic inflammation) in nasal polyps from well defined atopic and nonatopic patients, using advanced morphometric analysis system. Nasal polyps were removed during routine nasal polypectomy performed in 17 atopic and 19 nonatopic patients. Parafin sections of nasal polyps were stained with haematoxilin/eosin, chromotrope R2 or toluidine blue, and light microscopy, assisted with computerized picture analysis system, was used to count the number of cells in the superficial and stromal layer of the mucosa. Regardless of the presence or absence of atopy, eosinophils were predominant cells in the polyps, and both eosinophils and mast cells were more abundant in the superficial layer than in the stromal layer of the mucosa. The density of eosinophils in both layers and mast cells in the stromal layer was similar in atopic and nonatopic patients. Only the density of mast cells in the superficial layer of the mucosa was slightly higher (p < 0.005 in atopic compared to nonatopic patients): In both groups of patients a significant correlation between the number of mast cells and eosinophils in the superficial layer of the polyp mucosa was found (r = 0.84; p < 0.001). Our study demonstrates that eosinophils and mast cells are abundant in nasal polyps from both atopic and nonatopic patients and that mast cells seem to be more superficially distributed in atopic compared to nonatopic patients.

We examined quantitatively 11 renal biopsy specimens from patients with class Va WHO lupus membranous glomerulopathy (LMGN) and 16 from patients with primary (nonlupus) membranous glomerulopathy (NLMGN) for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available and compared these specimens with six cases of normal controls. In LMGN, subepithelial deposits resembled those seen in stage III of membranous glomerulopathy (MGN) according to the scheme proposed by Churg's group, i.e., for the present study only advanced cases of NLMGN (stage III according to this scheme) were selected. The electron micrographs were scanned in Primax flatbed A4 scanner and morphometric investigations were then performed by means of a computer image analysis system to compare glomerular basement membrane (GBM) thickness and the electron-microscopic density of the deposits in LMGN and NLMGN as well as to study whether these parameters could correlate with the clinical data. The study revealed that in LMGN the GBM thickness and the electron-microscopic density of the deposits were significantly increased in comparison with NLMGN. It should also be noted that both in LMGN and NLMGN groups the degree of proteinuria was closely correlated with the density of the deposits, but not with the GBM thickness. Moreover, no correlations were found between serum creatinine and the GBM thickness as well as between serum creatinine and the density of the deposits in these groups. In conclusion, the present data confirm that in LMGN and NLMGN proteinuria mainly depends on density of the subepithelial deposits. Furthermore, in cases with especially high density of these deposits systemic lupus erythematosus (SLE) should be taken into consideration, even if this etiology was not clinically suggested at the time of biopsy.

Twelve patients with primary diffuse IgA nephropathy (IgAN) aged under 45 years (IgAN < 45), and eleven patients with this glomerulopathy aged over 45 years (IgAN > 45) for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available were examined quantitatively and compared with fifteen normal controls. Morphometric investigations were performed by means of a computer image analysis system to characterize quantitatively IgAN in patients over and below 45 years of age as well as to study whether changes in quantitatively analyzed glomeruli could correlate with hematuria, which is thought as the main renal symptom in this glomerulopathy. The study revealed that the mean values of total glomerular cells per total glomerular area, total glomerular cells per unit of glomerular area, mesangium (% of total glomerular area) and relative interstitial volume were in both IgAN < 45 and IgAN > 45 groups increased in comparison with normal controls, most of them significantly. The comparison of these parameters between IgAN < 45 and IgAN > 45 groups showed that the mean values of total glomerular cells per total glomerular area and total glomerular cells per unit of glomerular area were significantly greater in IgAN < 45 group, but relative interstitial volume was significantly increased in IgAN > 45 patients. Moreover, there were significant positive correlations between total glomerular cells per unit of glomerular area and hematuria, but not between glomerular mesangium (% of total glomerular area) and hematuria in both IgAN < 45 and IgAN > 45 groups. In conclusion, we found evident quantitative differences between glomerular and interstitial parameters in younger and elderly patients. Although close relationship was observed between glomerular hypercellularity and the degree of hematuria in both younger and elder patients, this association is not clear and its pathogenesis remains to be shown.

Fifteen renal biopsy specimens from patients with idiopathic mesangiocapillary glomerulonephritis type III (MCGN-III) and fifteen from patients with primary membranous glomerulopathy (MGN) for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available were examined quantitatively and compared with six normal controls. Morphometric investigations of electron micrographs were performed by means of a computer image analysis system to compare glomerular basement membrane (GBM) thickness and the electron-microscopic density of the deposits in MCGN-III and MGN as well as to study whether these parameters could correlate with the clinical data. The study revealed that GBM thickness and the electron-microscopic density of the deposits were significantly-increased in MGN in comparison with MCGN-III. It should be also noted that the degree of proteinuria was closely correlated with the density of the deposits in both MCGN-III and MGN groups. While the present morphometric analysis of glomerular ultrastructure has not yet elucidated the nature of hematuria in MCGN-III and MGN, our results suggest the location rather than the density of the deposits may play a role in the process.

The authors report on a group of 3 patients who have developed restricted knee extension following acl reconstruction using central one-third of the patellar tendon as an autogenous graft. A fibrous nodule, varying in size from 15 to 20 mm, occupying the intercondylar notch and presenting mechanical block to full extension was found at arthroscopy. Removal of the nodule resulted in improved extension to about minus 3 degrees after surgery and 0 degrees at 6 weeks follow-up. No complications occurred. Histologically, the nodule consisted of focally hyalinized fibrous tissue.

Amyloidosis is a heterogeneous group of disorders characterised by extracellular deposition of abnormal protein fibrils which are derived from different proteins in different forms of the disease. Almost all patients with amyloidosis have renal disorders. Distinguishing type of amyloidosis is important for therapeutic and investigative purposes. The different types of amyloid fibril proteins can be evaluated by immunohistochemistry, but not by routine histochemical techniques. On the basis of immunohistochemical studies two groups of amyloidosis were distinguished. In all cases, whatever the type, P component was detected, while none of the biopsies revealed transthyretin. The immunoperoxidase technique has the advantage of being able to detect amyloid in formalin-fixed paraffin embedded tissues and remains the simplest and very specific method for identifying amyloid fibril proteins.

Seventeen kidney autopsy tissue sections from patients with cirrhosis of the liver were quantitatively examined and compared with fifteen cases of normal controls. The study was limited only to cases with normal renal function and without macroscopic renal changes. Morphometric investigations were performed by means of a computer image analysis system. The study revealed that total glomerular area, total number of glomerular cells per total glomerular area, mesangium (percentage of total glomerular area), and number of sclerotic glomeruli (percentage of total glomeruli) were significantly increased in cirrhotic patients. There was no significant increase in relative interstitial volume and in total glomerular cell per unit of glomerular area in comparison with controls. The results indicate that, despite the lack of renal clinical and laboratory manifestation, cirrhosis of the liver can be accompanied by a variety of glomerular disorders. These abnormalities consist of an enlargement of the glomeruli, an increase in glomerular cellularity proportional to the increase in glomerular size, thickening in mesangial matrix, and increased glomerulo-sclerotic lesions.

Fifteen renal biopsy specimens from patients with idiopathic diffuse IgAN for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available were quantitatively examined and compared with fifteen cases of normal controls. Morphometric investigations were performed by means of a computer image analysis system to evaluate whether morphometric analysis may be helpful in morphologic diagnosis of IgAN and to study whether serum creatinine and changes in quantitatively analyzed glomeruli could correlate with the interstitial fibrosis. The study revealed that total glomerular area, total number of glomerular cells per total glomerular area, and total glomerular cells per unit of glomerular area as well as relative interstitial volume were increased in IgAN in comparison with normal glomeruli, most of them significantly. Moreover, there were significant positive correlations between the width of the cortical interstitium and serum creatinine level as well as between the width of the cortical interstitium and glomerular changes. Although these findings suggest that in IgAN both glomerular and interstitial lesions are involved in the renal prognosis, the authors conclude that a morphometric analysis does not lend itself to establish such causal associations. It was noted that morphometric methods supported by image analysis system cannot be used instead of light microscopy, electron microscopy, and immunohistochemistry, but they can be helpful in precise evaluation of both glomerular and interstitial lesions, which are commonly known as histologic risk factors in primary glomerular diseases.

The authors evaluated, using computer image analysis system, 15 renal biopsy specimens from patients with MCD and 15 from patients with FSGS. As a control group 5 biopsy and 10 autopsy renal specimens were used. These studies revealed, that in MCD glomeruli showed proliferative changes unrecognizable by light microscopy. In FSGS glomeruli without sclerotic changes were larger than in controls and showed glomerular cells proliferation (per unit of glomerular area) similar to MCD. FSGS in comparison with MCD showed larger glomeruli and prominent interstitial fibrosis. These observations appeared to be helpful in distinguishing MCD and recent forms of FSGS. There were no correlations between relative interstitial volume and glomerular changes in MCD as well as in FSGS. The authors concluded, that histomorphometry can't be used instead of morphological examinations of renal biopsy specimens, but it gives objective informations about progression of the illness and may be useful in differential diagnosis of selected cases of MCD and FSGS.

Fifteen renal biopsy specimens from adult patients with minimal change disease (MCD) and fifteen with idiopathic focal segmental glomerulosclerosis (FSGS) for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available were examined quantitatively. As a control 6 biopsy and 9 autopsy specimens of the normal kidneys were used. Morphometric investigations were performed by means of a computer image analysis system to evaluate whether morphometric analysis may be helpful in morphological differential diagnosis of MCD and FSGS in adults as well as to study whether serum creatinine and changes in quantitatively analyzed glomeruli could correlate with the interstitial fibrosis. The morphometric comparisons of the glomeruli and renal interstitial tissue in patients with FSGS, MCD and controls revealed that the mean values of total glomerular area, total glomerular cells per total glomerular area, total glomerular cells per unit of glomerular area, mesangium (% of total glomerular area) and relative interstitial volume were increased in both MCD and FSGS patients in comparison with normal controls, most of them significantly in FSGS group. Furthermore, in FSGS the mean values of total glomerular area, total glomerular cells per total glomerular area and relative interstitial volume were significantly higher than those of the minimal lesion group. In FSGS there were significant positive correlations between interstitial volume and serum creatinine (r = 0.64, p < 0.005), between interstitial volume and glomerular mesangium (r = 0.75, p < 0.002) and between total glomerular area and serum creatinine (r = 0.54, p < 0.05). However, correlation between interstitial volume and total glomerular cells per unit of glomerular area, similarly like all correlations in MCD, was weak and not significant (r = 0.49, p-NS). Our morphometric data confirm that glomerular hypertrophy and the extent of interstitial fibrosis may be a valuable predictor of unfavorable evolution of FSGS as well as may be helpful in the differential diagnosis of MCD and FSGS in the elderly. We suggest, that quantitative analysis of these parameters is extremely useful in early cases of FSGS when sclerotic changes involve rather juxtamedullary glomeruli and can be misdiagnosed with MCD by light and electron microscopy.

Glomerular and interstitial leukocyte infiltrates were studied by indirect immunoperoxidaze technique using monoclonal antibodies against all leukocytes, pan-T lymphocytes, helper/inducer CD4 cells, suppressor/cytotoxic CD8 cells, pan-B lymphocytes, monocytes/macrophages and polymorphs in 23 renal biopsy samples obtained from children with minimal change disease (MCD). The cases were classified on the basis of light, electron microscopy and immunofluorescence. Nephrotic syndrome was steroid-sensitive in 15 patients (group I) and steroid-resistant in 8 subjects (group II). Both groups did not differ in the type or number of glomerular immune cells, quantified as immunopositive cells per glomerular cross section. Intraglomerular cellular infiltrates were mainly constituted of monocytes/macrophages; among T lymphocytes T helper/inducer cells predominated over T cytotoxic/suppressor cells. Enumeration of interstitial immune cells showed significantly higher number of all leukocytes and T lymphocytes, quantified as immunopositive cells/mm2, in steroid-resistant group. T helper/inducer cells predominated over T cytotoxic/suppressor cells in the renal interstitium in steroid-responsive and in steroid-resistant MCD. The leukocyte infiltrates did not correlate with a degree of proteinuria at the tine of biopsy and with the renal cortical interstitial volume in both studied groups. Our data suggest, that steroid resistance in minimal change nephropathy in children seems to be related to interstitial T lymphocytes.

Twenty renal biopsy specimens from patients with idiopathic diffuse membranous glomerulonephritis (MGN), for whom both light and electron microscopy as well as immunofluorescence microscopy and full clinical data were available, were examined quantitatively and compared with fifteen cases of normal controls. Morphometric investigations were performed by means of a computer image analysis system to evaluate whether morphometric analysis may be helpful in morphological diagnosis of MGN, and to study whether serum creatinine and changes in quantitatively analysed glomeruli could correlate with the interstitial fibrosis. The study revealed that total glomerular area, total number of glomerular cells per total glomerular area, and total glomerular cells per unit of glomerular area as well as relative interstitial volume were significantly increased in MGN in comparison with normal glomeruli. Moreover, there was significant positive correlation between the width of the cortical interstitium and serum creatinine level but not between the width of the cortical interstitium and glomerular changes. These findings suggest, that in MGN mainly interstitial lesions are involved in the renal prognosis and they are not related to the severity of glomerular changes. The authors conclude, that although morphometric methods supported by image analysis system cannot be used instead of light microscopy, electron microscopy and immunohistochemistry, they may be helpful in every-day diagnostic procedures of early stages of MGN.

Glomerular and interstitial leukocyte subpopulations were analyzed in renal biopsies from 20 patients with proliferative mesangial glomerulonephritis (PMGN) and from 20 patients with IgA nephropathy (IgAGN), by immunoperoxidase techniques with monoclonal antibodies. Few; intraglomerular leukocytes were seen, the majority of them belonging to the monocyte/macrophage phenotype. T-cells and monocyte/macrophages constituted the predominant infiltrating cell type in the interstitium. Significant differences were found in the numbers of intraglomerular macrophages between PMGN and IgAGN, and in the numbers of T-cells between IgAGN and control group. Rang Spearman Correlations showed proteinuria values in PMGN to be closely dependent on density of intraglomerular infiltrates and the number of macrophages. Hematuria values in IgAGN were closely dependent on the number of intraglomerular macrophages. Interstitial macrophages and T-cells were well correlated with the degree of interstitial damage and the serum creatinine level in PMGN and in IgAGN. No association was found between intraglomerular cells and serum creatinine level, and between interstitial cells and proteinuria values, as well hematuria values at the time of biopsy. These findings suggest that mononuclear cells may play a role in the pathogenesis of PMGN and IgAGN, and that cellular immune mechanisms may be important determinants of the severity of histological lesions and the degree of renal function.

Glomerular lesions have been reported to occur in association with a wide variety of malignancies, particularly carcinomas and lymphomas. Patients with the neoplastic diseases are exposed to continuous antigenemia, which stimulates antibody production and forms circulating immune complexes. Membranous nephropathy appears to be the most common glomerular lesion in patients with solid tumors, and minimal change glomerulopathy is another major form of glomerular disease associated with lymphomas, particularly with Hodgkin's disease. Three cases of nephropathy associated with anaplastic oat cell bronchial carcinoma, gastric adenocarcinoma and Hodgkin's disease were studied histologically, ultrastructurally and by immunofluorescence. The diagnosis of glomerulopathy preceded the diagnosis of malignant disease. All three patients were admitted to hospital because of nephrotic syndrome. The paraneoplastic glomerulopathies were histologically identical to that of idiopathic membranous glomerulonephritis and minimal change glomerulonephritis. Adult patients over the age of 50-60 with nephrotic syndrome caused by glomerulonephritis, especially by membranous nephropathy, should be screened for cancer.

Fifty three vaginal smears, classified to the III Papanicolaou group, were verified with Bethesda system. It was found that this system eliminates qualitatively erroneous preparations, increasing reliability of diagnosis, and facilitating precise description of cytological diagnosis. Advantages of Bethesda system justify its prompt introduction to the practice and abandon Papanicolaou classification.

The authors analysed 60 cases of IgA nephropathy diagnosed in biopsy specimens with light microscope examination, immunofluorescence, and electron microscope in 37 patients. It was found that the course of disease was rather mild in the majority of patients and did not accompany renal failure. Examination in light microscope enabled to find disseminated glomerular and mesangial lesions whereas immunofluorescence--potent, granular fluorescence of IgA in mesangium, and sometimes in the walls of vascular loops. Electron microscopic examination revealed dense deposits localized in mesangium and sometimes subendothelially. It is stressed that the diagnosis of IgA nephropathy is possible after exclusion of all pathologies producing IgA deposits in mesangium.

The clinico-morphological studies were carried out in 20 patients with mesangiocapillary glomerulonephritis. The kidney specimens were obtained twice in each patient in intervals 1-10 years. At the first biopsy 6 patients had nephrotic syndrome, 6 prominent proteinuria and the other slight proteinuria. Hematuria was noted in all patients. Hypertension was observed in 7 patients and increased serum creatinine (< 1.5 mg%) in 6. Pathomorphological study showed at the time of first biopsy MCGN type I in 17 cases, MCGN type II in 2 and type III in 1. At rebiopsy the clinical improvement was noted only in 4 patients, 7 had worse clinical data and in 9 cases there were no changes in reference to the first biopsy. Progression of morphological changes was the most common histopathological finding at the time of rebiopsy, but there was no correlation to clinical data. Our investigations point out, that the histological evaluation shouldn't be the only one prognostic indicator in MCGN.

The authors reevaluated 21 renal biopsy specimens from patients with rheumatoid arthritis (RA) and clinical symptoms of glomerulopathy. The patients were divided into three groups: in the I group they were treated with nonsteroid antiinflammatory drugs, in the II one with gold and in the III group with D-penicillamine. Pathomorphological study based on light microscopy, immunohistochemistry and electron microscopy showed that forms of primary renal involvement (group I) and secondary renal involvement (group II and III) in patients with rheumatoid arthritis were very similar to the types of glomerulonephritis not related to RA. The authors pointed out, that in the most cases immunohistochemistry revealed immunoglobulins (IgG,IgA,IgM,C3) and electron microscopy investigations showed deposits in various parts of the glomeruli. This observations support opinions, that immune complex mechanism takes a great role in pathogenesis of glomerulopathy in RA.

Renal biopsies collected from 18 patients with the symptoms of nephropathy accompanying systemic lupus erythematosus-diagnosed and clinically confirmed according to the accepted criteria-were examined histologically. Morphological examinations revealed mesangiocapillary glomerular nephritis in 11 patients, mesangial proliferative glomerular nephritis in 6 patients, and focal proliferative glomerular nephritis in 1 patients. Morphological examination was widened by calculation of process activity (AI) and chronicity (CI). Despite diagnosed diffuse glomerular nephritis, the prognosis was rather good in the majority of patients. To the group of "increased risk" only 5 patients were classified. No correlation between clinical symptoms, renal involvement and AI and CI values was found.

Two cases of large intestine endometriosis are presented. The disease was diagnosed during histological examination of samples taken during surgery. Clinically one case was diagnosed as Crohn's disease, while the second as cancer of the large intestine. The authors suggest, that an extent of surgery for, tumours of the large intestine should be carefully planned, specially if the tissue specimen was not examined histologically earlier.

The clinical and morphological analysis is reported of the changes evolving in 12 cases of mesangial proliferative glomerulonephritis based on repeated biopsies carried out at intervals from 1 to 7 years. Clinical findings at the time of the first biopsy included in 2 cases nephrotic syndrome, and in the remaining cases proteinuria ranging from 0.3 to 2/1000. In all cases erythrocytes in urine were present ranging from 4-6 to 50-100 erythrocytes per field of vision. Hypertension was found in 4 cases, and increased serum creatinine level in 1 patient. At the time of repeated biopsy in 11 cases clinical evidence of improvement was noted with decreased proteinuria anderythrocytes in urine. In 1 case worsening was found and several months later signs of renal failure developed which led to death. The morphological examinations demonstrated in the first biopsies mesangial proliferative glomerulonephritis. In second biopsies these findings were confirmed. In 1 case with unfavourable outcome the changes became more pronounced, and in the remaining ones no significant differences were noted in relation to the first biopsy which evidenced lack of a close correlation between the clinical condition and the morphological state of the kidneys.

Histological examination was done of 103 fallopian tubes removed surgically due to tubal pregnancy. The examinations were done for finding the causes of abnormal nidation of the fertilized ovum. Sections were taken semiserially. The most frequent change (54.3% of cases) was presence of chronic inflammation with infiltrations composed of lymphocytes and plasma cells, and adhesions between the mucosal folds. Foci of decidual transformation in tubal wall were found in 13.6%, diverticula in 9.7%, and foci of tubal endometriosis in only 2.9% of cases. It is postulated that histological diagnosis should include, besides information on the presence of fertilized ovum, also a description of associated lesions which could be responsible for abnormal nidation.

The experiment was carried out on 65 white male Wistar rats and 65 white male Swiss mice poisoned with thallium sulfate in doses 30-40 mg/kg body weight. The animals were sacrificed in the 4, 8, 24, 48th hours of experiment and their kidneys were submitted to light and an electron microscopic examination. Protein level in urine and urea level in blood serum of the rats were determined. With the light microscope necrosis of epithelium of Henle loops, hydropic degeneration, swelling and focal necrosis of epithelium of proximal convoluted tubules, and stromal oedema were seen. An electron microscopic study pointed out swelling and degenerative changes in the mitochondria, loss of microvilli in many cells, dilatation of endoplasmic reticulum and decrease of electron density of basement membranes. Urea level in blood serum and protein level in urine increased.