Two cases of symmetrical necrosis of the cortex of the kidneys associated with puerperal, eclampsia and suppression of urine / by R. Jardine and J.H. Teacher.

  • Jardine, Robert.
Date:
[1911?]
Catalogue details

Licence: In copyright

Credit: Two cases of symmetrical necrosis of the cortex of the kidneys associated with puerperal, eclampsia and suppression of urine / by R. Jardine and J.H. Teacher. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    The hemorrhagic patches in the great intestine were areas of somewhat superficial necrosis of the mucous membrane on the crests of the folds. The submucous connective tissue was thickened and the whole patch was intensely congested, and in some instances there had been considerable extravasation of blood. Thrombosis of the vessels was seen only in the necrotic centres. The larger vessels of the intestinal wall and those of the mesentery were packed with red blood corpuscles. Heart.—Sections were prepared at two levels transversely to the left ventricle, and a strip about two inches in length was taken longitudinally extending right to the apex. All three sections traversed the thrombus. One portion of the thrombus, situated about 3 cms. from the apex, had the appearance of a white globular thrombus such as is found in the auricular appendices in chronic cardiac disease. The rest, while of somewhat similar character, was much softer and more mixed with red blood. It was clearly, however, a slowly formed thrombus. To a considerable extent it lay in contact with the endocardium, but distinctly free from it. In other parts, however, the structures were completely incorporated, so that it was impossible to say where one ended and the other began. In many parts the edge of the thrombus showed a mixture of fibrin and connective tissue. The connective tissue was somewhat cellular and in places contained numerous wide capillaries distended with blood. Processes of the thrombus penetrated deeply into the muscle between the columnse carneae. In a few instances small thrombosed vessels were seen at some little depth in the heart wall, and throughout the fibrin-infiltrated tissue there were extravasations of blood. The larger branches of the coronary vessels showed no sign of disease. Some of the fibres of the myocardium next the thrombus showed degenerative changes, but there was nothing resembling infarction. It appears, therefore, that the thrombosis was not secondary to changes in the myocardium but was due, in all probability, to the stagnation of the circulation and other obscure conditions which lead to the formation of similar thrombi in various diseases. Kidney.—The condition of the kidney (Plate XXI. Fig. 2) was very similar to that in the first case, but the infarction of the cortex was more uniform in extent and character. There was practically no living tissue under the capsule, and the layer of necrotic tissue was very regular and uniform in thickness. It involved at least two-thirds of the cortex. The comparative amount of necrosis in the two specimens cannot be accurately estimated by reference to the draw- ings. In the first specimen most of the zone which appears only congested is really necrotic, and the condition is more nearly coextensive with that in No. 2 than would be inferred from the gross character of the organ. The degree of completeness of the necrosis in the infarcted area is very similar in the two cases. There is at most points a thin layer of living cortex between the necrotic tissue and the medulla. The margin of the necrosis is marked by a zone of intense congestion and the extravasation of blood. The vessels at the hilus of the kidney appeared to be normal. Careful dissection was made of branches as far as they could be traced, and neither thrombus nor embolus could be found. Microscopic examination showed further that the vessels at the junction of the cortex and medulla and the straight vessels of the pyramids were also free from thrombosis. The smaller arteries of the cortex presented a condition identical with that seen in the preceding specimen, being occupied by dense white amorphous thrombi. (Plate XXII. Figs. 3 and 4.) The extent of vessel occupied by this material varied somewhat. The thrombus commenced usually a little below the edge of the infarction. The size of the affected arteries varied from about 100 to 200 micromillimetres in diameter, most commonly nearer to the lower figure. Their walls were clearly muscular. There was very slight endarteritis.