Schnitte, Knoten und Netze – 100 Jahre Schweizerische Gesellschaft für Chirurgie

Vom Nobelpreis für die Schilddrüsenoperation zur Osteosynthese als weltweit praktizierter Technik: Die Chirurgie in der Schweiz der letzten einhundert Jahre kann als Erfolgsgeschichte gelesen werden. Der Sammelband zum 100-Jahr-Jubiläum der Schweizerischen Gesellschaft für Chirurgie geht tiefer und analysiert in vier medizinhistorischen Detailstudien die Hintergründe von medizinischen Erfolgen und organisatorischen Herausforderungen. Einige Reflexionen beleuchten zudem die heutige Chirurgie von der Ökonomisierung bis zur neueren Sakralisierung des von Chirurgen behandelten Körpers. Beiträge aus der chirurgischen Praxis skizzieren technisch-therapeutische Trends dieses Faches von der Organtransplantation bis zur «Schlüsselloch-Chirurgie».

Autonomic angiotensinergic fibres in the human heart with an efferent sympathetic cophenotype

AIM The autonomic innervation of the heart consists of sympathetic and parasympathetic nerve fibres, and fibres of the intrinsic ganglionated plexus with noradrenaline and acytylcholine as principal neurotransmitters. The fibres co-release neuropeptides to modulate intracardiac neurotransmission by specific presynaptic and postsynaptic receptors. The coexpression of angiotensin II in sympathetic fibres of the human heart and its role are not known so far. METHODS Autopsy specimens of human hearts were studied (n=3; ventricles). Using immunocytological methods, cryostat sections were stained by a murine monoclonal antibody (4B3) directed against angiotensin II and co-stained by polyclonal antibodies against tyrosine hydroxylase, a catecholaminergic marker. Visualisation of the antibodies was by confocal light microscopy or laser scanning microscopy. RESULTS Angiotensin II-positive autonomic fibres with and without a catecholaminergic cophenotype (hydroxylase-positive) were found in all parts of the human ventricles. In the epicardium, the fibres were grouped in larger bundles of up to 100 and more fibres. They followed the preformed anatomic septa and epicardial vessels towards the myocardium and endocardium where the bundles dissolved and the individual fibres spread between myocytes and within the endocardium. Generally, angiotensinergic fibres showed no synaptic enlargements or only a few if they were also catecholaminergic. The exclusively catechalominergic fibres were characterised by multiple beaded synapses. CONCLUSION The autonomic innervation of the human heart contains angiotensinergic fibres with a sympathetic efferent phenotype and exclusively angiotensinergic fibers representing probably afferents. Angiotensinergic neurotransmission may modulate intracardiac sympathetic and parasympathetic activity and thereby influence cardiac and circulatory function.