Studies in fat necrosis / by H. Gideon Wells.

  • Harry Gideon Wells
Date:
1903
Catalogue details

Licence: In copyright

Credit: Studies in fat necrosis / by H. Gideon Wells. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    by a ligature tied tightly about the base of the cot. In this way necrosis was pro- duced in the fat, presumably without injury to any enzyme it might contain, without disturbing its chemical equilibrium, and without the influence of outside factors. Within three days the pieces sloughed off at the point of ligation and were found loose in the abdominal cavity, containing a soft and brownish fat. Sections of this fat showed it to be totally necrotic, with opaque, thick fibrils of connective tissue, and with but a few abnormal nuclei surviving. The fat cells were completely empty in stained and hardened sections, and there was no resemblance whatever to fat necrosis. Frozen sections stained by Sudan III showed that the fat was still present in the fat cells, staining well, apparently in a perfectly unchanged condition. The part played by fatty acids in the necrosis was studied by placing lumps of sterilized palmitic acid and stearic acid in the subcutaneous fat tissue, and in a fold of the omentum in contact with fat tissue, where it was retained by a suture that formed a pocket. After two and four days the pieces with the surrounding tissue were taken out and hardened in formalin. Miscroscopic examination showed that the lumps of fatty acids had acted like perfectly inert foreign bodies, causing no changes but proliferation and a slight leucocytic infiltration of the tissues immediately adjacent. ACTION OP PANCREATIN POST MORTEM AND IN VITRO Not infrequently at autopsy necrosis of the fat immediately about the pancreas, and more particularly the fat lying between the lobules of the gland, has been observed (Chiari).15 At times cellular reaction has established the vital nature of the fat necrosis, but in other cases the necrosis is more diffuse and without cellular reaction, suggesting a change in the fat of post-mortem origin, quite analogous to the common self-digestion of the gland. After death the digestion of the gland destroys its con- sistence to such an extent as readily to permit of the escape of its fluids beyond its confines, and the question of the possibility of this pancreatic fluid producing fat necrosis after death becomes of interest. If fat necrosis is simply the reaction of fat tissue to certain enzymes, it is reasonable to expect pancreatic extracts to cause the process after death, or even in vitro, if the temperature is kept favorable for enzyme action. The following experiments were performed: EXPERIMENTS IN VITRO Pieces of fat omentum were placed in a 1 per cent. Na2C03 solution containing pancreatin, and kept at body temperature in the incubator. At intervals portions were placed in formalin and examined histologically, both in frozen and imbedded sections. It was found that within half an hour the cells on the surface had lost their staining entirely, and the membrane sur- rounding the fat cells had assumed an increased affinity for eosin and had become thickened. The appearance was exactly similar to the change seen in fat tissue in the earliest stages of fat necrosis (see subsequent description) before the necrosed fat cells become filled with the characteristic opaque material. The changes that follow from longer exposure simply consist of a loss of nuclear stain throughout the fat tissue, and later an entire loss of even the connective tissue structure. '5 Zeitschrift fur Heilkunde, Vol. XVIII (1898). 213
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