Pathological opening. G. P. Demkin General pathological anatomy: lecture notes for universities. A Brief History of the Development of Pathology

PATHOLOGICAL ANATOMY- biomedical science that studies the structural foundations of pathological processes. In P.'s tasks and. enters: identification morfol, changes of bodies, fabrics and cells at diseases, and also recovery processes; clarification of the causes, mechanisms and dynamics of these changes; comparison morfol, changes with results a wedge., biochemical. and patofiziol, researches. P.'s object of research and. is the material obtained during the autopsy of those who died from diseases, organs and tissues removed during surgical interventions and excised for diagnostic purposes, as well as material taken from the lab. animals subjected to various influences under experimental conditions. Solving the problems of etiology and pathogenesis, nosology and classification of diseases, P. a. contributes to the development of philosophical problems of medicine and general pathology, assists clinicians in recognizing diseases, monitoring the course of treatment, finds out the mechanism of complications and causes of death, analyzes diagnostic errors - is one of the important connecting links between theoretical and practical medicine.

P. a. usually divided into general and particular. General P. a. gives morfol, a characteristic patol, processes that have common patterns of development and common features, regardless of localization and conditions of their occurrence, for example, dystrophies, necrosis, circulatory disorders, hypertrophy, atrophy, inflammation, regeneration, tumors, immunity, as well as immune hypersensitivity reactions. Morfol, data on these processes are the basis of the general doctrine of the disease. Private P. a. studies morfol, bases and a pathogeny of separate nozol, forms.

The main method of research, to-ry uses P. a., is morfol, the method is observation with the naked eye and with the help of ch. arr. optical devices.

The current state of P. a. characterized by continuous expansion and deepening of its links with the clinic and experimental research. Development of the technique of surgical interventions, anesthesiology, resuscitation, transplantology, replenishment of the arsenal medicines changed the classical pictures of human diseases (see Pathomorphosis). The value of pathoanatomical autopsy has increased - its task is not only to establish the course of the disease and its complications, but also to explain, in combination with the data of intravital studies, the causes of inefficiency to treat. actions, unsuccessfulness of resuscitation, emergence inf. complications, etc. Particular importance is attached to clarifying the causes and nature of adverse effects on the course and outcome of the disease to lay down. events. The widespread use in the clinic of such non-invasive research methods as computed tomography, ultrasound diagnostics, etc., allows you to visually determine the focus patol, process, localization of the tumor and its metastases, detect blood clots, establish how thick the walls of the ventricles of the heart, etc .; this opens up great prospects for the development of intravital P. a. Special meaning got a biopsy (see) and cytologic research (see), to-rye are made with the diagnostic purpose, for control of the carried-out to lay down. measures, as well as to clarify the diagnosis and scope of surgical intervention during surgery. Thus, the traditional role of the pathologist, limited to his participation in the post-clinical (post-mortem) analysis of the disease, is increasingly being replaced by his role as a clinical morphologist.

The trend of differentiation of honey. disciplines is followed by the progressing differentiation of private P. and. with the advent of new chapters. It does development of the general P. and especially actual. as a synthetic science that allows a deep and comprehensive assessment of private facts. On the one hand, P. a. approaches the clinic, and on the other hand, it is organically intertwined with biochemistry and physiology due to the emergence of electron microscopic, histochemical, immunomorphological and other research methods. In changes in nuclear and cytoplasmic organelles, pathanatoms more and more confidently determine the structural basis for fluctuations in functions, cell activity and disturbances in its activity under the influence of pathogenic factors. In this regard, such research methods as electron-microscopic autoradiography are important, edges allow us to judge simultaneously the nature of biosynthetic processes, their intensity and localization inside the cell. P. a. becomes a system of knowledge about the structural basis of functions, activity of organs and violations of this structure. Modern P. and. characterized by an increased level of both qualitative * and quantitative analysis patol, processes (see Medical morphometry).

P.'s development and. occurs in the conditions of complex studying patol. process at all levels of the organization: the organismic level allows you to get an idea of ​​the general panorama of the disease, the role and participation of various organs and systems in it; the study of organ and tissue changes helps to clarify quality features and topography patol, processes in the damaged body; electron microscopy (see), histochemical research methods (see) and other methods reveal the essence of the changes occurring inside the cell, and allow them to be compared structurally and functionally with the results of biochemical, radioisotope and other studies. The lack of information about structural changes at one of the levels deprives the researcher of the opportunity to get a complete picture of the process under study.

As a result of experimental morphological studies carried out by A.I. Ignatovsky, N.N. Anichkov and S. S. Khalatov, the model of an atherosclerosis was for the first time created and bases of the doctrine about its patol, anatomy, a morphogenesis, a pathogeny are laid. Morfol, studies contributed to the formation of clinical and anatomical characteristics and the solution of issues of the pathogenesis of hypertension, symptomatic hypertensive conditions. An important role was played by morfol, researches in formation and development of the doctrine about coronary disease hearts, myocardial dystrophies, etc. For the development of a number * of issues of morphogenesis and pathogenesis of diseases of the cardiovascular system, the State Prizes of the USSR were awarded to A. I. Abrikosov and H. N. Anichkov (1944), A. N. Koltover (1971).

The development of neuropathology in the second half of the 19th century. was largely due to the improvement of gistol, technology and the possibility of microscopic examination nerve cells, nerve fibers and neuroglia. Neurohistological studies contributed to the formation of ideas about the structural foundations of nervous trophism. Complex microscopic and bacterial, studying patol, processes in lungs was a basis, on a cut modern, representations about patol, anatomy and a pathogeny of pneumonia, bronchitis, emphysema, an atelectasis and fluid lungs were formed. Ideas about defeats of kidneys were essentially developed on the basis of their microscopic studying at various inf. diseases, metabolic disorders, poisoning, etc. in combination with bacterial. and fiziol, researches.

Experimental gistol, researches were a basis for studying of structural changes of cells of glands of internal secretion and disturbances of mechanisms of formation and release of hormones at diseases. In the middle of the 20th century cells located in the mucous membrane and parenchyma of various internal organs, releasing biologically active substances and playing an important role in the regulation of body functions in normal and pathological conditions (see Argentaffin cells). Importance these data had, in particular, for expansion of ideas about funkts, morphology of bodies went. - kish. tract.

Thanks to the creation of decalcification methods, it became possible to microscopically study diseases of the skeletal system and its changes in somatic, endocrine diseases, certain malformations, etc. For the development of a number of problems in the pathology of the skeletal system, A. V. Rusakov and T. P. Vinogradova in 1967 was awarded the State Prize.

Due to technological progress in the 20th century. began fast development professional pathology (see). An important role in this belonged to pathoanatomical studies that contributed to the elucidation of the mechanisms of interaction harmful substances with cellular elements, features of compensatory-adaptive reactions of the body in response to the impact of prof. hazards.

New section of pathology and P. and. emerged in the 20th century. the doctrine about radiation defeats, in Krom the most perfect methods of the structural analysis found the application allowing to establish and track dynamics of damages of a kernel and cytoplasm.

Microscopic and histochemical, the study of connective tissue has expanded the idea of ​​its changes in various patol, processes, making it possible to single out a group of collagen diseases (see). For a series of works on the study of the pathomorphogenesis of rheumatic diseases, AI Strukov was awarded the Lenin Prize in 1974.

The doctrine of traumatic injuries and wound healing until the second half of the 19th century. based solely on macroscopic observations. In microscopic studies, the main patterns of the course of the wound process were established (its features in various organs and tissues, the relationship of various cellular elements at the stages of wound healing), a comparative structural analysis of the effectiveness of various treatment methods, etc. was presented. These data contributed to the development of the doctrine of combat injury (dynamics wound process, its complications, traumatic exhaustion, purulent-resorptive fever, etc.), laid down in the works of N. I. Pirogov. The most fundamental research that revived and developed the teachings of N. I. Pirogov belongs to I. V. Davydovsky: Krom was awarded the Lenin Prize in 1964 for the development of problems of general pathology, and in particular the wound process.

Great prospects for solving questions of the pathogenesis of human diseases are opened by further development of the problems of comparative pathology, widely deployed, for example, in Ying-those experimental pathology and therapy of the USSR Academy of Medical Sciences.

In the 20th century began to develop intensively P. and. diseases of children and newborns, taking into account the anatomical and functional characteristics of a growing organism.

In the first half of the 20th century received wide development biochemical, and fiziol. researches of a cell, results to-rykh laid the foundation of molecular biology (see). It was necessary to find out in which cell structures biochemical reactions take place, which organelles of the nucleus and cytoplasm, and how they provide specific cell functions. For the decision of these questions there was not enough research by means of biol, a microscope. The cell, retaining its significance as a single indivisible structural unit, could no longer serve as an object for further development of the question of the material basis of functions, disorders, since it was already “too big” for this. In the clinical and anatomical direction of research, a situation arose similar to that that developed in the middle of the 19th century, with the only difference that at that time it became necessary to have a structure smaller than an organ as an object of study, but now it is more miniature than a cell. And just like in the middle of the 19th century. this situation was eliminated by introducing microscopic research into medicine, in the 50s of the 20th century it was solved on the basis of ultramicroscopic research using an electron microscope. The most complex intracellular architecture was established, it was shown that the nucleus and cytoplasm consist from many specialized ultrastructures or organelles, each of which is responsible for a certain link in the work of the so-called intracellular conveyor, on which the processes that determine the function of the cell proceed in stages.These studies laid the foundation for the modern ultrastructural period in the development of P. a. A feature of this period is the complex use of electron microscopy and methods of histochemistry, autoradiography, immunomorphology, which made it possible to simultaneously carry out structural and functional analysis of intracellular changes. various diseases of a person, the dynamics of these changes, the patterns of restoration of cellular structures in the process of recovery, under the influence of modern methods treatment, etc. It turned out that under the influence of pathogenic influences in cell organelles, certain general pathological processes unfold, to-rye are observed in tissues and organs: edema, necrosis, regeneration, hyperplasia. In electron microscopic, histochemical, immunomorphol. researches new data on pathological anatomical changes of bodies at various diseases were received, to-rye allowed to find out many parties of a pathogeny and dynamics of development of the processes hidden from the researcher before. The study of human diseases at the ultrastructural level has approached the corresponding biochemical ones. research and thus molecular pathology.

Expression of communication P. and. with a wedge, medicine there was a dissecting business - the most important form of use of P.'s achievements and. in medical practice. In Russia, dissecting work began to develop in the first military hospitals (see Autopsy). Already during this period, great importance was attached to comparing the symptoms of the disease with the changes found at autopsy, which was reflected in the instructions and instructions compiled in 1754 by P. 3. Kondoidi, in which clinical and anatomical analysis was regarded as one of the most important factors in improving the quality of treatment. . work and improvement of medical art. An important role in P.'s development and. and prosectoral work was played by the opening of medical-surgical academies in St. Petersburg and Moscow / Great attention to the development of P. a. and prosectoral work were given by domestic clinicians I. V. Varvinsky, M. Ya. Mudroye, N. I. Pirogov, S. P. Botkin, G. A. Zakharyin and others.

In the state health care system created after the Great October Socialist Revolution, prosectoral work became a special service, which gradually acquired clear organizational forms. A significant role in this was played by the commission of dissectors at the Moscow City Department of Health (A. I. Abrikosov, I. V. Davydovsky, V. T. Talalaev) and the prosectoral sector of the pathoanatomical ob-va in Leningrad (G. V. Shor, S. S. Vail, V. G. Garshin, V. D. Tsinzerling). A lot of work on the organization of the pathoanatomical service was carried out in Rostov-on-Don (Sh. I. Krinitsky), Kiev (M. K. Dal), Kharkov (G. L. Derman), Minsk (I. T. Titov), ​​Kuibyshev ( N. F. Shlyapnikov), Smolensk (V. G. Molotkov) and other cities. Orders, regulations and instructions on organizing the work of pathoanatomical departments, comparing clinical and anatomical diagnoses, holding clinical and anatomical conferences, compiling pathoanatomical reports, etc. contributed to the improvement of dissecting work. A.I. Abrikosova (1948), S.S. Weill (1947), D. I. Golovin (1957), G. A. Merkulov (1956), A. V. Smolyannikov (1977) and others. Clinical and anatomical conferences initiated by I. V. Davydovsky (see .), which played an important role in improving the quality of diagnostic and treatment work.

During the years of the Great Patriotic War pathological anatomical service was improved in active army and rear hospitals. Organization of the Central Pathological Anatomical Laboratory (TsPAL) under the Main Military Sanitary Directorate of the Red Army, front-line, army pathoanatomical laboratories (PAL), pathoanatomical departments of large hospitals of the frontline state hospitals and evacuation hospitals of the People's Commissariat of Health of the USSR under the leadership of Ch. pathologist Soviet army(A. A. Vasiliev, M. F. Glazunov, N. A. Kraevsky) and Ch. the pathologist of Management of evacuation hospitals of People's Commissariat of Health of the USSR (IV Davydovsky) provided uniform interpretation patol. processes caused by combat trauma. Assistance was provided to the leadership of the medical service in improving the organization and improving the quality of honey. help. The scientific development of materials obtained by pathologists during the war years made it possible to study the cardinal issues of combat trauma and "wartime diseases", which were summarized in the multi-volume work "Experience of Soviet Medicine in the Great Patriotic War 1941-1945." and in a number of monographs by S. S. Vail (1943), A. P. Avtsyn (1946), I. V. Davydovsky (1950-1954), A. V. Smolyannikov (1960) and others. Unique material collected by military dissectors , stored in the Military Medical Museum in Leningrad. The experience of the pathoanatomical service during the Great Patriotic War contributed to its more harmonious organization in peacetime. In-t of the main pathologists of republics, territories, areas and large cities was created. TsPAL is included in Ying-that morphology of the person of the USSR Academy of Medical Sciences, to-ruyu the duty of the methodical center of pathoanatological service was assigned; one of the measures to improve it is the creation of joint pathoanatomical departments, which facilitated the systematization and scientific processing of sectional and biopsy material, expanded the possibility of using modern research methods.

P.'s problems and. until the 20s. 20th century developed Ch. arr. at the departments of P. a. honey. in-comrade, and in the future and laboratories of research institutes. In Russia, I laid down a number of pathoanatomical schools - Moscow, St. Petersburg, Kharkov, Kiev, Kazan, etc. The first department of P. a. . A. I. Polunin’s successors in the department were I. F. Klein, and then M. N. Nikiforov, the author of one of the first and most famous textbooks on P. a. A. I. Abrikosov, an outstanding scientist, one of the founders of Soviet P. a., the founder of a large school of pathologists, was a student of M. N. Nikiforov and his successor in the department. In the future, this department was headed by a student of A. I. Abrikosov - A. I. Strukov; since 1972 it has been occupied by a student of A. I. Strukov - V. V. Serov. Prominent representatives of the Moscow school of pathologists are I. V. Davydovsky, M. A. Skvortsov. A great contribution to the development of various areas of P. a. were introduced by representatives of the Moscow school G. D. Koritsky, Yu. M. Lazovsky, B. N. Mogilnitsky, I. F. Pozharisky, A. V. Rusakov, L. I. Smirnov, P. E. Snesarev, V. T. Talalaev, V. G. Shtefko, A. P. Avtsyn, T. P. Vinogradova, N. A. Kraevsky, N. K. Permyakov, Ya. L. Rapoport, D. S. Sarkisov, V. V. Serov and others.

Large domestic school P. and. is Leningrad (Petersburg). Since 1840, the course of autopsy at the Medico-Surgical Academy was led by N. I. Pirogov. In 1859, at his suggestion, the department of P. a. was opened, to-ruyu was headed by T. S. Illinsky. Since 1867, this department was headed by M. M. Rudnev, who is considered the founder of the St. Petersburg school of P. a. Later this department was headed by K. N. Vinogradov, H. N. Anichkov, A. N. Chistovich. A great contribution to the development of various problems of P. a. contributed by M. V. Voyno-Yasenets-cue, V. G. Garshin, M. F. Glazunov, K. P. Ulezko-Stroganova, B. JI. Tsinzerling, F. Ya. Chistovich, G. V. Shor, O. K. Khmelnitsky.

A big contribution to P.'s development and. also contributed by D. F. Lyambl, V. P. Krylov, N. F. Melnikov-Razvedenkov, G. N. Minkh, V. K. Vysokovich, A. I. Smirnova-Zamkova, I. V. Toroptsev, Yu. V. Gulkevich, I. I. Shirokogorov, V. K. Zhgenti.

The creation of pathoanatomical centers and laboratories at scientific research institutes contributed to the expansion of pathoanatomical research. The role of head institution in the field morfol, researches Ying t of human morphology of the USSR Academy of Medical Sciences organized in 1960 plays.

Significant development was received by P. and. in the countries of the socialist community: topical problems of pathology are being intensively developed, dissecting work is organized, and special journals are published. Close creative ties have been established between the pathologists of these countries and Soviet pathologists, and a wide exchange of experience is carried out in the form of scientific trips, participation in congresses, conferences, etc.

Abroad, a significant contribution to the development of P. a. introduced by I. Orth, Lubarsh (O. Lubarsch), R. Ressle, Weigert (K. Weigert), B. Fischer-Va-sels, Boret (M. Borst), L. Aschoff, K. Schmorl, Gerksheimer (G. Herxheimer), Gamperl (H. Hamperl), Weikselbaum (A. Weichselbaum), K. L. P. Masson, A. Polikar, F. Mallory, N. Foot and others.

An important role in an exchange of experience of scientific and organizational work of pathologists is played by the All-Union scientific about-in pathologists organized in 1947, a cut regularly holds congresses, plenums of board, conferences. In 1969 this about-in was included into the International council about-in pathologists. The main printed body, in which the results of the majority of pathoanatomical studies are published, is the journal "Archive of Pathology", founded in 1935 (originally, until 1946, it was called the "Archive of Pathological Anatomy and Pathological Physiology"). Since 1976, the VINITI monthly abstract journal “General Issues of Pathological Anatomy” has been published; The works of the Leningrad Scientific Society of Pathologists are published annually. The great experience of the work of Soviet pathologists is summarized in a multi-volume guide to pathological anatomy (1956-1964), founded by A. I. Abrikosov and completed by A. I. Strukov. For the first time, under the editorship of N. A. Kraevsky and A. V. Smolyannikov, a domestic manual on the pathoanatomical diagnosis of human tumors was created (1971). In 1975, an atlas of human tumors was published (D. I. Golovin).

P.'s teaching and. in honey. universities are conducted on the 3rd (general and private P. a.) and 5th (clinical P. a.) courses. In the USSR, unlike other countries, on the initiative of I. V. Davydovsky, the teaching of private P. a. is carried out not according to the organ, but according to the nosological principle. In addition to theoretical knowledge, students get acquainted with the basics of pathoanatomical techniques, documentation, clinical and anatomical analysis of autopsy results. Teaching methods P. a. are improved at f-takh of advanced training and at educational and methodological conferences. In 1979, P.'s textbook was published. (A. I. Strukov, V. V. Serov). Training on P. and. for departments of medical in-t, pathoanatomical offices, departments of research institutes are carried out through subordination, internship, residency and postgraduate studies. Great importance For further development P. a. and training of pathologists have departments of P. and. in-t of improvement of doctors and department of Central in-that of improvement of doctors; at these departments, pathologists receive primary specialization and undergo advanced training.

Bibliography:

Story- Abrikosov A. I. Pathological anatomy in the USSR (1917-1947), in the book: Achievements of owls. honey. science for XXX years, ed. H. N. Anichkova and others, p. 55, M., 1947; Andreev F. A. From the history of the Moscow school of pathologists, Arkh. patol., t. 11, c. 6, p. 28, 1949; Weil S. S. Essays on the development of pathological anatomy in Russia and the Soviet Union, Proceedings of the Military. honey. acad., vol. 1, p. 21, L., 1941; he, Original Russian textbooks of general pathology and pathological anatomy of the 70-80s of the last century, Arkh. patol., t. 12, c. 1, p. 100, 1950; Holstein N.I. Short story Department of Pathological Anatomy of the Military Medical Order of Lenin Academy. S. M. Kirova, L., 1960, bibliogr.; Dvizhkov P.P. and Strukov A. I. Pathological anatomy in the USSR for 40 years, Arkh. patol., t. 19, c. 10, p. 5, 1957; Deryabina V. L. Essays on the development of prosectoral work in Russia and the USSR, M., 1958; Korovin I. P. A brief historical sketch of the Department of Pathological Anatomy at the Military Medical (former Medical and Surgical) Academy, St. Petersburg, 1898; Mish.n ev O. D. and Ch e to a p e in and G. A., I. V. Davydovsky - the organizer of the Soviet pathoanatomical service, Arkh. patol., t. 39, No. 3, p. 78, 1977; The Development of Science at the Academy in 40 Years of Soviet Power, ed. A. N. Maksimenkova, p. 144, L., 1957; Sarkisov D. S. Prospects for the development of pathological anatomy at the present stage, Arkh. patol., t. 39, No. 8, p. 3, 1977; Serov V. V. 125 years of the Department of Pathological Anatomy of the I Moscow medical institute them. I. M. Sechenov (1849-1974), ibid., vol. 37, no. 1, p. 12, 1975; Strukov A. I., A. I. Abrikosov - organizer and first chairman of the Moscow Society of Pathologists, tamzhe, vol. 39, No. 1, p. 77, 1977; Strukov A. I. and B y l about S. A. A century since the founding of the Department of Pathological Anatomy of the First Moscow Order of Lenin Medical Institute (1849-1949), tamzhe, vol. I, century. 6, p. 3, 1949; Strukov A. I. et al. Pathological anatomy in the USSR for 50 years (1917-1967), ibid., t. 29, No. 10, p. 6, c. 11, p. 99, 1967* Strukov A. I. et al. 60 years of the Great October Socialist Revolution and the development of Soviet pathological anatomy, ibid., t. 39, No. 10, p. 3, c. I, s. 3, 1977; Chistovich Ya. I. History of the first medical schools in Russia, SPb., 1883; Klemperer P. Pathologic anatomy at the end of the eighteenth century, J. Mt Sinai Hosp., v. 24, p. 589, 1957, bibliogr.; LongE.R. A history of pathology, N. Y., 1965.

Textbooks, manuals, reference books- Abrikosov A. I. Private pathological anatomy, vol. 1-3, M.-L., 1938-1947; it, the Technique of pathoanatomical openings of corpses, M., 1948; Abrikosov A. I. and C tr to about in A. I. 'Pathological anatomy, part 1-2, M., 1961; Avtandilov GG Introduction to quantitative pathological morphology, M., 1980, bibliogr.; Avtsyn A. P. Introduction to geographic pathology, M., 1972, bibliogr.; Avtsyn A.P. and Sh and x l and m about in V. A. Ultrastructural bases of pathology of a cell, M., 1979, bibliogr.; Apatenko A. K. Epithelial tumors and malformations of the skin, M., 1973; about N e, Mesenchymal and neuroectodermal tumors and malformations of skin, M., 1977, bibliogr.; Weil S. S. Guide to the pathological and histological technique, L., 1947; Vinogradova T. P. Tumors of bones, M., 1973, bibliogr.; Golovin D. I. Atlas of human tumors, L., 1975; Davydovsky I. V. Pathological anatomy and pathogenesis of human diseases, vol. 1 - 2, M., 1956-1958; he, General pathology of the person, M., 1969; Ivanovskaya T. E. and Tsinzerling A. V. Pathological anatomy (childhood diseases), M., 1976; To at l e sh and G. S. Course of pathological anatomy, part 1-2, M.-L., 1930-1931; Course of General Pathological Anatomy, ed. A. N. Chistovich, L., 1970; Merkulov G. A. Course, pathological and histological equipment, L., 1969, bibliogr.; Multi-volume guide to pathological anatomy, ed. A. I. Strukova, vol. 1-9, M., 1956-1964; Permyakov N.K. Fundamentals of resuscitation pathology, M., 1979, bibliogr.; Guidelines for the pathoanatomical diagnosis of human tumors, ed. N. A. Kraevsky and A. V. Smolyannikov, M., "1976; Sarkisov D. S. Essays on the structural foundations of homeostasis, M., 1977, bibliogr.; Serov V. V. and Paukov V. S. Ultrastructural pathology , M., 1975; Skvortsov M. A. Pathological anatomy of the most important diseases of childhood, M., 1946; Smolyannikov A. V., Avtandilov G. G. and Uranova E. V. Principles of compiling a pathoanatomical diagnosis, M., 1977; Strukov A. I. and Beglaryan A. G. Pathological anatomy and pathogenesis of collagen diseases, M., 1963; Strukov A. I. and Serov V. V. Pathological anatomy, M., 1979; Cha Lisov I. A. and Khazanov A T. Guidelines for the pathoanatomical diagnosis of the most important infectious diseases cheloveka, L., 1980; Shor G. V. On the death of a person, L., 1925; Yaryg in H. E. and S erov V. V. Atlas of pathological histology, M., 1977; Allgemeine Pathology, hrsg. v. A. Hecht u. a., B., 1979; Bell E. T. Text-book of pathology, L., 1956; Buchner F. Allgemeine Pathologie und Atiologie, Miinchen, 1978; Electron microscopy in human medicine, ed. by J. V. Johannessen, N. Y. a. o., 1978; Evans R. W. Histological appearances of tumours, Edinburgh - L., 1966; Florey H. W. General pathology, L., 1970; Hamperl H. Lehrbuch der allgemeinen Pathologie und der pathologischen Anatomie, B. u. a., 1957; Handbuch der allgemeine Pathologie, hrsg. v. F. Buchner, Bd 1-11," B., 1955-1977; Handbuch der Histochemie, hrsg. v. W. Graumann u. K. Neumann, Bd 1-7, Stuttgart, 1958-1964; Handbuch der speziellen pathologischen Anatomie und Histologie, hrsg. v. F. Henke u. O. Lubarsch, Bd 1-13, B., 1924-1958; H e rb u t P. A. Pathology, L., 1955; , Jena, 1967, Bibliogr.; Kars-n e r H. T. Human pathology, Philadelphia-Montreal, 1955; Lehrbuch der speziellen Pathologie, hrsg. v. L. H. Kettler, Jena, 1976; Lehrbuch der speziellen pathologischen Anatomie, hrsg. v. E. Kaufmann, B., 1955-1969; L e t u 1 1 e M. Anatomie pathologique, vol. 1-3, P., 1931; Moreh e a d R. P. Human pathology, N. Y. a. o., 1965; Pathologische Anatomie, hrsg, v. L. Aschoff, Bd 1-2, Jena, 1936; Pathology, ed. by W. A. ​​D. Anderson, v. 1-2, St Louis, 1977; Rossle R. u. ApitzK. Atlas der pathologischen Anatomie, Stuttgart, 1951; Saphir O. Autopsy diagnosis and technic, N.Y., 1958; Spezielle pathologische Anatomie, hrsg. v. W. Doerr u. a., B. u. a., 1959-1976.

Periodicals- Archive of pathology, M., since 1946 (1935 -1941 - Archive of pathological anatomy and pathological physiology); Journal for normal and pathological histology, pharmacology and clinical medicine, St. Petersburg, 1870-1876; Abstract journal - General issues of pathological anatomy, M., since 1977; Acta morphologica Academiae Scientiarum Hungaricae, Budapest, since 1951; Acta pathologica Japonica, Tokyo, c 1951; Acta pathologica et microbiologica Scandinavica, Köbenhavn, c 1924; American Journal of Pathology, N. Y., c 1925; Annales d'anatoinie pathologique et d'anatomie normale n^dico-chirurgicale, P., c 1924; Archives of Pathology and Laboratory Medicine, Chicago, since 1926; Beitrage zur Pathologie, Stuttgart, since 1970 (1886-1969 - Beitrage zur pathologischen Anatomie und zur allgemeinen Pathologie); Ergebnisse der allgemeinen Pathologie und pathologischen Anatomie des Menschen und der Tiere, Miinchen, 1895-1962; Excerpta medica, Sect. V<- General Pathology and Pathological Anatomy, Amsterdam, с 1948; Human Pathology, Philadelphia, с 1970; Japanese Journal of Medical Sciences, Sect. 5 - Pathology, Tokyo, 1926-1944; Journal of Pathology, Edinburgh-L., с 1969 (1892- 1968 - Journal of Pathology and Bacteriology); Morfologia normala §i patologic£, Bucure§ti, 1957-1973; Proceedings of the New York Pathological Society, N. Y., 1896-1938; Virchows Archiv Abteilung A. Pathologische Anatomie, В., с 1968 (1847-1967 - Virchows Archiv fiir pathologische Anatomie und Physiologie uiid fiir klinische Medizin); Virchows Archiv Abteilung B. Zellpathologie, В., с 1968 (1847-1967 ,- Virchows Archiv fiir pathologische Anatomie und Physiologie und fiir klinische Medizin); Zentralblatt fiir allgemeine Pathologie und pathologische Anatomie, Jena, с 1895.

A. I. Strukov, A. V. Smolyannikov, D. S. Sarkisov.

HIGHER PROFESSIONAL EDUCATION

"PERM STATE MEDICAL ACADEMY

OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION»

DEPARTMENT OF PATHOLOGICAL ANATOMY WITH A SECTIONAL COURSE

GENERAL

PATHOLOGICAL

ANATOMY

Study guide for students

foreign branch

General pathological anatomy: Textbook for students of the medical faculty / G. G. Freind, A. N. Kryuchkov, T. B. Ponomareva and others; GOU VPO "PGMA of the Ministry of Health of Russia". - Perm, 2005. - 119 p.

The manual includes theoretical material on topics of general pathological anatomy and is intended for medical students.

FOREWORD

The textbook, created by the staff of the Department of Pathological Anatomy of the Perm Medical Academy, is intended primarily for students of the foreign department of medical and dental faculties. In accordance with the curriculum, the main general pathological processes are outlined: metabolic disorders (dystrophy), necrosis, blood and lymph circulation disorders, inflammation, immunopathological processes, adaptation and compensation, tumor growth.

Pathological anatomy is one of the main fundamental medical disciplines. For a long time, she used the knowledge gained from autopsy, but modern pathology is more focused on the needs of clinical practice: methods of pathological anatomy, primarily histological examination, are used for in vivo diagnosis of various pathological processes. Morphological diagnosis is of great importance in the choice of treatment tactics, determining the prognosis of the disease, primarily in oncology.

Head Department of Pathological Anatomy with a sectional course

Perm State Medical Academy,

Doctor of Medical Sciences G.G. Freund

Pathological anatomy (pathology): content, tasks and methods

The subject (content) of pathological anatomy. Pathological anatomy (pathology) studies the morphological manifestations of pathological processes in the human body at different levels (organ, tissue, cellular and subcellular).

Pathological anatomy consists of three main sections:

1. General pathological anatomy- the doctrine of typical pathological processes (metabolic disorders, blood and lymph circulation, inflammation, immunopathological processes, regeneration, atrophy, hypertrophy, tumor growth, necrosis, etc.).

2. Private(special) pathological anatomy studies the morphological manifestations of certain diseases (nosological forms), for example, tuberculosis, rheumatism, cirrhosis of the liver, etc.

3. Pathological practice- the doctrine of the organization of the pathoanatomical service and the practical activities of the pathologist (pathologist). The pathologist performs intravital and postmortem morphological diagnostics of pathological processes. Intravital morphological diagnostics is carried out on the material of biopsies and surgically removed organs or their parts. term biopsy(from the Greek βίος - life; όψις - vision, look, appearance; the literal translation of the term - “I look at the living”) is the taking of tissue from a patient for diagnostic purposes. The resulting material (usually a piece of tissue) is called biopsy. The study of the corpses of dead people is called autopsy(from the Greek αύτός - himself; όψις - sight, sight, view; the literal translation of the term is “I look myself”). The results of the morphological study are drawn up in the form of a pathoanatomical diagnosis (conclusion). The most important pathoanatomical diagnosis is in oncology.

Pathological human anatomy (medical pathological anatomy) makes extensive use of data obtained from pilot study pathological processes in laboratory animals.

Tasks of pathological anatomy. The main tasks of pathological anatomy are the following:

1. Identification etiology pathological processes, i.e. reasons ( causal genesis) and conditions for their development.

2. Study pathogenesis- the mechanism of development of pathological processes. In this case, the sequence of morphological changes is called morphogenesis. The term is used to denote the mechanism of recovery (reconvalescence). sanogenesis, and the mechanism of dying (death) - thanatogenesis.

3. Feature morphological picture diseases (macro- and micromorphological features).

4. Study complications And outcomes diseases.

5. Research pathomorphosis diseases, i.e. a persistent and regular change in the picture of the disease under the influence of living conditions or treatment.

6. Study iatrogenic- pathological processes that have developed as a result of diagnostic or therapeutic procedures.

7. Development of questions theories of diagnosis.

METHODS OF PATHOLOGICAL ANATOMY

The concept of morphological methods. feature morphological methods research in biology and medicine is the use of empirical information obtained directly when studying an object. In contrast, it is possible to study the properties of an object without directly perceiving it, but proceeding from the nature of secondary changes in the environment caused by the very existence of the object (such research methods are widely used in pathological physiology and clinical medicine). In other words, the morphological method is based on direct perception of the subject being studied, first of all, his visual characteristic(result observations).

Morphological methods, like any other scientific methods, are implemented in three stages:

1. Empirical stage- receiving primary information about the object from the sense organs. In pathological morphology, in addition to visual, tactile information is of great importance.

2. Theoretical stage– the stage of understanding the obtained empirical data and their systematization. This stage requires a wide erudition of the researcher, since the effectiveness of the perception of empirical information directly depends on the completeness of theoretical knowledge, which is expressed in the formula "We see what we know".

3. Stage of practical implementation– use of research results in practice. The results of morphological research in medicine are basis of diagnosis, which determines the important practical significance of the method.

descriptive method. Among morphological methods at the empirical stage, of particular importance is descriptive method (description method) is a method of fixing perceived information using verbal symbols (means of language as a sign system). A correct description of pathological changes is a kind of informational copy of the object of study. That is why it is necessary to strive to ensure that it is as complete and accurate as possible.

The method of describing macroobjects is used by almost all doctors of clinical specialties, which determines the need to study this method by students of all faculties. Most often, the method of describing macroobjects is used when a doctor detects changes in the integumentary tissues (skin and visible mucous membranes) during the examination of the patient. During surgical interventions, the visible changes in the internal organs, primarily those that are removed, the surgeon reflects in the protocol of the operation.

The main morphological methods include:

1. Macromorphological method- a method of studying biological structures without a significant increase in the object. A study using a magnifying glass with a small increase refers to the macromorphological method. The macromorphological method should not be called a macroscopic study, because the information received is not only visual.

2. micromorphological (microscopic) method- a method of morphological research, which uses devices (microscopes) that significantly increase the image of an object. Many variants of the microscopic method have been proposed, but the most widely used light microscopy (light-optical research).

Pathological anatomy is as ancient a science as surgery or therapy. Name "pathological anatomy" approved only from the middle of the eighteenth century. Before that, for a long time it was called "practical" or "medical" anatomy. The development of pathological anatomy by the middle of the twentieth century led in many countries to a new change in its name to "clinical pathology" which better reflects its important modern role in the intravital diagnosis of diseases, clinical and anatomical analysis of lethal outcomes based on autopsy materials, and the development of the theoretical foundations of medicine.

The history of pathological anatomy is conditionally divided intofour periods:

Iperiod- "anatomical" or "macroscopic"(from antiquity to the beginning of the 19th century),

IIperiod- "microscopic"(from the beginning of the 19th century to the 50s of the 20th century),

IIIperiod- "ultramicroscopic"(from the 50s to the 70s of the XX century),

IVperiod- modern, period"vital pathological anatomy" or"Pathological anatomy of a living person".

For many centuries, morphological knowledge about diseases did not stand out as an independent medical discipline.

First period history of the development of pathological anatomy ("anatomical" or "macroscopic")- the longest, heterogeneous and controversial. It has not been studied enough, although there is a lot of fragmentary information about a good knowledge of normal and pathological anatomy by priests and healers of various ancient civilizations (Ancient Egypt, Asia Minor, India, China, Ancient Greece and Rome, etc.), as well as medical scientists of the Middle Ages.

IN ancient Greece and Rome professional physicians appeared from the 12th century BC, medicine continued to develop in the Roman Empire and was accumulated, later partially lost, extensive material on normal and pathological human anatomy (known thanks to the works of Aristotle, Hippocrates and his followers, later - Celsus and Galen ), although the terms "anatomy" or "pathology" have not yet been used. The first anatomist is considered to be a student of Pythagoras, the physician Alcmene of Croton (500 BC), who is credited with the discovery of the optic nerve. Aristotle (born in 384 BC) for the first time in ancient medicine connected the manifestations of diseases with damage to specific organs, discovered the role of the heart.

With great benefit for the development of medicine, but within a short historical period, autopsies were carried out by scientists (Geraphilus, Erazistrat, etc.) of the Alexandrian school (300 AD). The works of the physician and anatomist gained worldwide fame and were relevant for many generations of doctors over the next 1000 years. Claudia Galena (K. Halen) (130 - 200 AD), who worked in the largest "scientific center" in the Mediterranean in those years - in Alexandria (Egypt) and wrote the first known textbook on human anatomy based on studies of corpses, mainly animals. With the help of experiments on animals, Galen first established the role of the central nervous system, the connection of mental activity with the brain. He also described the types of inflammation, tumors, the morphology of many diseases, summarizing the knowledge of physicians in Greece and Rome.

Such a term as "pathological anatomy" did not exist until the middle of the 18th century, morphological knowledge about the substrate of diseases was an integral part of medicine (the medical profession) as a whole or, in the 13th - 18th centuries in Europe, it was part of practical (medical) anatomy. Many morphological knowledge was repeatedly lost and accumulated again.

Until the beginning of the 13th century, autopsies were banned in Europe for religious reasons (only autopsies were allowed for the purpose of embalming corpses). Even the bull of Pope Boniface VIII of 1300, which forbade the dismemberment of corpses for long-distance transportation and burial, was widely misunderstood as a ban on autopsies and anatomical studies. For some time, autopsies were carried out in secret, and the scientists who performed them were persecuted. Only 250 years later, a bull of Pope Pius IV recommended an autopsy to determine the cause of death.

In 1242, Frederick II, King of Sicily and Italy, granted the School of Medicine in Bologna (Italy) the right to receive the corpses of two executed criminals a year for autopsies. In England, from 1300, a charter from King Henry VIII also granted the Barbers and Surgeons Association the right to perform autopsies on four executed criminals a year. Autopsies of the executed were allowed to be carried out in Vienna from 1403, in Prague - from 1600.

Thus, in the Middle Ages in Europe, autopsies were single and exceptional events. Their spread was also prevented by the absence of stationary medical institutions (although the first hospitals were organized in the ancient world). Professor at the University of Padua Berthelemy Montagnano (B. Montagnana) (born in 1460) became widely known for having performed 14 autopsies, which was an extremely large number for that time.

As you can see, the anatomical or macroscopic period in the history of pathological anatomy unites a variety of eras, but pathological anatomy, as an integral part of anatomy and surgery, began to develop intensively only in the 15th-17th centuries, thanks to the emergence of scientific biology, anatomy and physiology.

In the XIV-XVI centuries, anatomical studies of corpses, carried out by many European medical scientists and encyclopedists of the Renaissance, spread, a modern scientific approach to human anatomy and pathology began to take shape.

For example, Leonardo da Vinci(1452-1519) performed autopsies on more than 30 corpses to study human anatomy. Not only normal, but also pathological anatomy was developed Vesalius(1514-1564), the largest anatomist, his students Eustachius, Fallopius and Arantius.

paracelsus, professor at the University of Basel, surgeons A.Pare, V.Fabry, anatomist At.Harvey(who proposed the term "medical anatomy") and others actively promoted pathoanatomical studies of corpses. Autopsies were carried out, vessels were filled with various materials (paints, wax), the inventors of the syringe Jacobus Berengarus(1470-1550) and Reginière de Graaff (1641-1673).

J.Fernel (J. Fernel) (1497-1558) in his work "Pathology" - the first manual with such a name, summarized the materials of many autopsies, for the first time described appendicitis (not yet using this term), syphilitic aortic aneurysm, etc.

In the 17th century Carl Linnaeus, Marcello Malpighi(opening the capillaries) Mark Severin(described benign and malignant tumors), Silvius(described pulmonary tuberculosis), Yakov Wepfer(for the first time explaining the connection of apoplexy with cerebral hemorrhage), Glisson And Willis (Willisius) not only did post-mortem autopsies, but also pointed out their exceptional role in determining the causes of death of specific patients and the development of medicine in general. In the 17th century, museums of pathoanatomical preparations began to open in Europe.

Theophilus Bonet(Th.Bonet) (1620-1689), Swiss doctor , in 1676, he was one of the first to systematize the results of about 3000 autopsies, descriptions of which he collected in the literature starting from the time of Hippocrates, i.e. for 2000 years, and showed the existence of a relationship between morphological changes in organs and clinical manifestations of diseases.

A Dutch physician (anatomist, surgeon and forensic physician) made a great contribution to the development of scientific normal and pathological anatomy Frederic Ruysch(F. Ruysch) (1638-1731). F. Ruysch in the Guild of Surgeons of Amsterdam performed forensic and pathoanatomical autopsies, founded an anatomical museum, apparently one of the first in the world. It was he who presented his anatomical museum to Peter I, who, during his stay in Holland in 1689, even assisted Ruysch at autopsies.

By the end of the 17th - beginning of the 18th centuries, extensive materials of the results of pathological anatomical autopsies were accumulated, but it was not possible to generalize them for a long time.

First perioddevelopment of pathological anatomylike science actually began after the publication in 1761 of a 5-volume work by a professor at the universities of Bologna and Padua, a student of an anatomist and a practicing physician A. Valsalva - Giovanni Morgagni(G. Morgagni, 1682-1771) "On the location and causes of diseases identified by the anatomist."

J. Morgagni was the first to conduct clinical and anatomical comparisons based on the results of 700 postmortem autopsies, presented pathoanatomical descriptions of many diseases, and indicated the correct place of pathological anatomy among clinical disciplines.

Marie Bisha (M. Bishot) (1771-1802) and other French clinicians and naturalists of the 18th century - J. Corvisart (who revived the percussion method), R. Laennec (who invented auscultation) introduced pathological anatomy into clinical practice, proposed to study damage at the tissue level, created a classification of tissue types (connective , muscle, fat, bone, etc.). M. Bish's student F. Brousset created a doctrine that rejects the existence of diseases that do not have a material substrate.

Jean Cruvelier (J. cruvellier) (1771-1873), a student of G. Dupuytren, the first professor of pathological anatomy at the University of Paris, in 1829-1835. created and published the world's first color atlas of pathological anatomy.

The first period ended in 1842-1846. with the advent of the multi-volume "Guide to Particular Pathological Anatomy" by the founder of humoral pathology, a Czech scientist, professor of pathological anatomy at the University of Vienna Charles Rokitansky(K. Rokitansky, 1804-1878).

K. Rokitansky for the first time systematized and outlined a particular pathological anatomy according to the organ principle, presented changes in organs in accordance with the various stages of development of all the most important diseases known then, and for the first time used statistical methods in pathological anatomy. R. Virkhov called K. Rokitansky "Linnaeus of pathological anatomy".

K. Rokitansky was the first pathologist who was not directly involved in clinical activities, actively promoted the teaching of pathological anatomy and contributed to the opening of departments of pathological anatomy at European universities. However, although single microscopic (histological) descriptions were presented in his manual, their role was still small.

By this time, however, it became clear that with many severe disorders of organ function, it was not possible to reveal their macroscopic (anatomical) changes. It was this fact that subsequently formed the basis for the erroneous allocation of "functional" diseases, as, allegedly, without their structural expression. In addition, K. Rokitansky explained the origin and essence of pathological processes from the point of view of humoral ideas - the doctrine of "crashes" - dyscrasias (therefore, K. Rokitansky is considered the founder "humoral" pathology). However, later he adopted the ideas of R. Virchow's cellular pathology.

Second period history of pathological anatomy ("microscopic") is associated with the name of the founder of cellular (cellular) pathology, professor at the University of Berlin Rudolf Virchow(R. Virchov, 1821-1902) and with the publication in 1858 of his guide "Cellular Pathology". This period became possible thanks to the invention of the microscope and the approval in 1838-1839. cellular theory of the structure of organisms by Schleiden (1804-1881) and Schwann (1810-1882).

The main idea of ​​R. Virchow's work "Cellular Pathology" boiled down to the fact that all pathology is a pathology of cells. He was the first to describe and name such pathological processes as embolism, leukemia, amyloidosis, etc.

R. Virchow is the founder of the Department and Institute of Pathology in Berlin, the journal of pathological anatomy ("Virchow Archive"), the creator of the world-famous museum of macropreparations (more than 25,000 macropreparations). Cellular pathology, which was at one time the highest scientific achievement of medicine, had, however, serious shortcomings, for example, it considered the cells of the body as independent independent cells. This theory was subsequently significantly supplemented by ideas about humoral and nervous regulatory processes, intercellular interaction, etc.

The invention of the electron microscope made it possible in the 1950s to move on to the study of pathological processes at the ultrastructural level and laid the foundation for third period development of pathological anatomy - "ultramicroscopic".

Subsequently, immunomorphological, radiographic and others were added to the electron microscopic method of research, which made it possible to study the finest intracellular changes, brought pathological anatomy closer to molecular pathology, pathological physiology and biochemistry, genetics and immunology, put an end to the conditional division of diseases into “structural” and “functional ".

Since the 70s - 80s of the twentieth century, intravital morphological methods for studying organs, tissues and cells have become more important. By the end of the third period in the history of pathological anatomy, studies of biopsy material began to prevail over autopsies. Has come The fourth period development of pathological anatomy - the period of "lifetime pathological anatomy" or "pathological anatomy of a living person." It is no coincidence that in many countries the term "pathological anatomy" has given way to the name "clinical pathology". Pathological anatomical studies are performed using a wide range of morphological and molecular biological methods for studying biopsy material, which can be obtained from any organs and tissues, once or repeatedly, during the treatment of the disease. Fine-needle biopsies with subsequent cytological examination of the obtained material are promising. However, despite the development of new research methods, autopsies have not lost their significance.

In the clinic, other methods of intravital structural studies based on other physical principles have also been widely developed - types of nuclear magnetic resonance, computed tomography, ultrasonography, etc. Apparently, further development of these methods will bring them closer to pathological anatomy (clinical pathology) and lead to to the ability to study molecular, subcellular and cellular changes in a living organism without taking a biopsy and traumatizing tissues.

The above periodization of the history of pathological anatomy was first proposed by R. Virchow in his speech on the macroscopic and microscopic periods in the development of pathological anatomy in 1895 (“Morgagni and anatomical thought”). In the future, many domestic authors (A.I. Abrikosov, I.V. Davydovsky, D.S. Sarkisov) refined this periodization and continued to the present.

One of the main methods of research in pathological anatomy is an autopsy. With its help, the cause of death of the patient and the features of the course of the disease are established. Accurate statistics of mortality and lethality are being developed, the effectiveness of the use of certain therapeutic drugs and tools is being revealed. At autopsy, a far advanced stage of the disease is established, which led the sick animal to death. Paying attention to visible changes in systems and organs that seem not affected by pathological processes, one can get an idea of ​​the initial morphological manifestations of the disease. Similarly, early manifestations of tuberculosis and cancer have been studied in humans. Currently known changes that precede cancer, ie. precancerous processes.

Biopsy of tissue pieces plays a significant role in the study of pathological anatomy. These pieces, and sometimes whole organs, are removed from the body during surgical operations and are subjected to research. A biopsy is performed for diagnostic purposes to establish and confirm the diagnosis. Conducting it allows you to clarify the nature of the pathological process. What is inflammation or tumor? Currently, the technique of performing a biopsy has reached great perfection. Special needles have been created - trocars, with which you can extract pieces of the liver, kidneys, lungs, tumors, incl. brain tumors.

Another method used in pathology is the experimental method. It has found its application no less than in pathphysiological research. In an experiment, it is difficult to create a complete model of the disease, because its manifestation is associated not only with the influence of a pathogenic factor, but also with the influence of environmental conditions on the body and the resistance of the animal. Therefore, this diagnostic method is used less frequently than others.

Thus, pathological anatomy using autopsy data, biopsies obtained from patients, as well as based on the reproduction of disease models in the experiment and the use of modern research methods (electron microscopy, physiocontrast luminescence, histochemistry, histoimmunochemistry, and others) can get a fairly clear idea of ​​​​structural changes in tissues and organs in disease. To study their dynamics (morphogenesis), the mechanism of development (pathogenesis), as well as to establish the stages and phases of the course of the disease.

Summing up what has been said, it should be stated that each disease consists of a number of pathological processes that are its constituent elements.

To know the disease, it is necessary to have a clear idea of ​​these elements. The study of pathological processes and make up the course of general pathology. This includes information about signs of death, impaired general and local circulation, metabolic disorders, inflammation, morphology of immune processes, growth and development disorders, compensatory processes and tumors.

Historical stages in the development of pathology.

The development of pathology is closely connected with the autopsy of corpses. First, the autopsy was carried out in order to study the structure of the body of humans and animals. Several centuries before our era, on the orders of the Egyptian king Ptolemy, the corpses of the executed were placed at the disposal of doctors. However, later the autopsy of corpses ceased according to religious beliefs.

At the dawn of mankind, people wondered why disease occurs. The famous ancient Greek physician Hippocrates (460-372 BC) created humoral pathology. He believed that the human body contains blood, mucus, yellow and black bile. A person is healthy when they are in the right proportion of strength and quantity, and the mixture of them is perfect.

Disease occurs when the correct proportion is violated as a result of a lack or excess of one of them. This trend dominated medicine until the middle of the 19th century.

At the same time, the ancient Greek philosopher Democritus (460-370 BC) believed that there are atoms and voids. Atoms are eternal, indestructible, impenetrable. They differ in shape and position in the void. They move in different directions and all bodies are formed from them. The density of the arrangement of atoms, their movement and friction among themselves determine the normal or diseased state of the organism. This direction was called solidary pathology (solidus - dense).

And only after the appearance in 1761 of our era of the book of the Italian anatomist Morgani (1682-1771) "On the location and causes of diseases identified by the anatomist" pathology acquires the character of an independent discipline. In it, the author, using a large amount of material, showed the significance of morphological changes in diagnosis. The French morphologist Bicha (1771-1802) wrote that different tissues are affected in diseases, but to different degrees in different sufferings.

In the 19th century, the humoral theory was further developed in the works of the Austrian scientist Rokitansky, who saw the essence of the disease in a change in the blood and juices of the body (primary cause) on the basis of this, secondary changes in organs and tissues arise.

According to his teachings, in a diseased organism, first, qualitative changes in the blood and juices occur - dyscrasia of the body, followed by the deposition of "disease-causing material" in the organs. Rokitansky and his followers argued that each disease has its own type of blood and juice disorders. In their conclusions, they relied not on biochemical data and strictly verified factual material, but on fantastic ideas about the deterioration of blood and juices in the body.

The main provisions of the humoral theory of the middle of the 19th century clearly contradicted the large amount of factual material accumulated by science.

So in the XVII-XIX centuries in biology and medicine, a significant amount of experimental data on the structure and function of the body was accumulated. Visalius (1514-1564) laid the foundations of animal anatomy, the English physician Harvey (1578-1657) discovered blood circulation, the French scientist Descartes (1586-1656) gave a diagram of the reflex, the Italian naturalist Malpighi (1628-1694) described the capillaries and blood cells, the Italian scientist Morgagni (1682-1771) tried to connect the onset and development of the disease with anatomical changes in the organs in various diseases. The works of Morgagni, Bish and others formed the basis of the organ-localistic (anatomical) trend in pathology.

In 1839-1840. Schwann and others in the works "Microscopic studies on the correspondence in the structure and growth of animals and plants" for the first time formulated the basic provisions on the formation of cells and on the cellular structure of all organisms.

Further development of the anatomical direction was reflected in the cellular (or cellular) pathology of Virchow (1821-1902). In his theory, Virchow proceeded from the premise that in various diseases not only the organs as a whole change, but also the cells and tissues from which they are built. Therefore, he explained the disease only from the point of view of cell changes, and interpreted any process as a simple sum of structural changes in cells.

The basic principles of cellular pathology are as follows:

The disease is always the result of a change in cells - a violation of their vital functions. All pathology is cellular pathology.

No derivative formation of cells from an unorganized mass occurs. Cells are formed only by reproduction, which ensures the gradual development of normal organs and pathological abnormalities in the disease.

Disease is always a local process. With any disease, you can find an organ or part of an organ, i.e. "cell theory", which is captured by the pathological process.

Illness is nothing new compared to a healthy body. The differences are not qualitative, but only quantitative.

Virchow's cellular pathology expressed only the role of the cell in the pathology, but not the pathology of the cell itself. Cellular pathology played a positive role in the development of theoretical and practical medicine in the 19th century. At the same time, it was one-sided, mechanical, because. only local morphological changes were considered the causes of the disease, excluding the principles of the integrity of the organism and its interaction with the external environment. The denial of Virchow's provisions, which we perceive as an axiom, should not be attributed to the scientist's delusion, but to a lack of knowledge due to the poor technical equipment of researchers of that time.

The development of pathological anatomy was facilitated by the discovery by the French scientist L. Pasteur, the German R. Koch and other microbiologists of a number of microorganisms - the causative agents of infectious diseases, as well as the research of I. I. Mechnikov in the field of immunology and comparative pathology.

A significant role in the creation of the physiological trend in pathology belongs to the French scientist Claude Bernard (1813-1878). Bernard is considered one of the founders of comparative physiology and experimental pathology. He graduated from the University of Paris in 1839. Since 1854 - head of the department of general physiology at the University of Paris. The subject of his research was metabolic processes in the body. In 1853, Bernard discovered the vasomotor function of the sympathetic nervous system. His research in the field of external and internal secretion of glands, electrical phenomena in living tissues, the function of various nerves, the formation of bile by the liver, etc. were of great importance not only for the development of physiology, but also for other disciplines. Bernard believed that all phenomena of life are due to material causes, which are based on physical and chemical laws. But at the same time, according to Bernard, there are some unknown reasons that create life and dictate its laws.

Russian biology developed in its own original way. Back in 1860, I.M. Sechenov wrote that "Virchow's cell cytology, as a principle, is false." Sechenov's doctrine was developed by I.P. Pavlov. His views are reflected in issues of pathology and clinical medicine. Pavlov believed that the nervous system mobilizes and regulates the body's defenses during the development of the pathological process. The scientist confirmed his conclusions with significant factual material.

In Russia, pathology arose at the end of the 19th century. Alexander Fokht (1848-1930) was the founder of the Moscow School of Pathologists. He was the founder of experimental cardiology and clinical and experimental direction in pathology. In 1870 he graduated from the medical faculty of Moscow University. In 1891 he organized the Institute of General and Experimental Pathology.

Main works: on the study of the body's reactions to the influence of pathogenic factors, the role of nervous and humoral mechanisms of regulation of the function of the cardiovascular, endocrine-lymphatic and urinary systems in the pathological process. Focht developed experimental models of heart pathology and showed the importance of collateral circulation in closing various branches of the coronary arteries.

A number of outstanding scientists came out of this school: A.I. Talyantsev (1858-1929) - studied the pathology of the peripheral circulation, G.P. Sakharov (1873-1953) - solved the problems associated with endocrinology and allergies, F.A. Andreev (1879-1952) - dealt with issues of clinical death and V.V. Voronin - studied the processes associated with education.

In the cities of Kyiv and Odessa, general and experimental pathology was headed by V.V. Podvysotsky (1857-1913) author of a manual on general pathology. He studied the process of regeneration of glandular tissue and tumors. His students: I.T. Savchenko and L.A. Tarasevich studied immunology, body reactivity, endocrinology and inflammation.

Veterinary pathology was at the very beginning of its journey. Ravich Iosif Ippolitovich (1822-1875) is considered to be the founder of domestic general veterinary pathology as an independent discipline. In 1850 he graduated from the veterinary department of the St. Petersburg Medical and Surgical Academy. In 1856 he defended his dissertation and received a master's degree. Since 1859, he was Privatdozent of the Department of Zoophysiology and General Pathology of the Veterinary Department of the Academy. He owns over 50 works on physiology and pathology, epizootology and organization of veterinary business. I.I. Ravich was one of the first experimental veterinary pathologists. Among his scientific works are works on studying the effect of transection of the vagus nerve on digestion, and vasomotor - on blood circulation. Although the most famous books: “A course on the study of epidemic and contagious diseases of domestic animals”, “General catarrhs ​​and diphtheria”, “A guide to the study of the general pathology of domestic animals” were written on the basis of Virchow’s cytological theory, in his later works devoted to the infectious pathology of farm animals and recommendations for the fight against infectious diseases, Ravich already stood on positions close to understanding the mechanism of transmission of an infectious principle. His activities had a significant impact on the training of veterinarians in Russia in the 19th century.

Under his leadership, the veterinary department of the academy was transformed into an institute. In this regard, the training program for doctors was expanded and finalized.

Another outstanding pathologist of the late 19th and early 20th centuries was N.N. Marie (1858-1921). Working as the rector of the Novocherkassk Veterinary Institute, Marie had a significant impact on the development of animal pathology as an independent discipline. In addition to pathology, he was engaged in microbiology and meat science. His first guide to pathological anatomy contains provisions that are still guided today.

Domestic pathology was further developed within the walls of the Kazan Veterinary Institute. Here, since 1899, he headed the department K.G. Pain (1871-1959). He carried out a complete restructuring of the teaching discipline. Organized a new discipline: the course of pathological histology. He wrote a textbook for students "Fundamentals of the pathological anatomy of farm animals." This book was last reprinted in 1961 and is still one of the best teaching aids.

The baton of their teachers was picked up by K.I. Vertinsky, V.A. Naumov, V.Z. Chernyak, P.I. Kokurichev and others.

In our country, at the beginning of the 20th century, the departments of general pathology in medical and veterinary universities were transformed into departments of pathological physiology. In 1925, this name was officially assigned to pathphysiology. The organization of departments and the creation of a network of research institutes with experimental physiological departments, as well as the improvement and expansion of experimental methods, caused a wide development of research in pathphysiology.

Along with the old directions in pathphysiology, new schools arose. In Saratov, A.A. Bogomolets (1881-1946) created his own school. In 1906 he graduated from the Novorossiysk University in Odessa. From 1911 to 1925 he was a professor at Saratov University. From 1925 to 1930 - Professor of the Medical Faculty of Moscow University at the same time - Director of the Institute of Hematology and Blood Transfusion. From 1930 to 1946 he was director of the Institute of Experimental Biology and Pathology and the Institute of Clinical Physiology. His works are devoted to the most important issues of pathphysiology, endocrinology, the autonomic nervous system, the doctrine of the constitution and diathesis, oncology, physiology and pathology of connective tissue and longevity (gerantology). He developed a method of influencing the connective tissue with antireticular cytotoxic serum, which was used during the war to accelerate the processes of healing of fractures and damaged soft tissues. A.A. Bogomolets was the initiator and leader of the blood conservation work. Wrote "Guide to pathphysiology in 3 volumes".

After him, N.N. Sirotkin, A.D. Ado and others.

In the Leningrad Military Medical Academy, a school arose under the leadership of N.N. Anichkova (1885-1965), who studied the pathology of lipid-cholistyrin metabolism, the pathogenesis of atherosclerosis, the function of the reticuloendothelial system, hypoxia and other problems. V.Yu. London (Leningrad 1918-1939). At the same time, he used the original angiostomy technique. A.D. Speransky (1888-1961). In 1911 he graduated from the medical faculty of Kazan University. Since 1920, he worked as a professor at the Department of Operative Surgery and Topographic Anatomy at Irkutsk University. From 1923 to 1928 he was Pavlov's assistant and head of the experimental department of the Institute of General and Experimental Pathology. The main works of Speransky are devoted to the role of the nervous system in the origin and mechanisms of development, course and outcome of pathological processes of various nature, the methodology of pathology and experimental therapy.

The teachings of I.I. Pavlova (1849-1936). He took experimental research to a higher level. Pavlov believed that, considering the essence of the disease from the standpoint of the integrity of the body, one should simultaneously study the disorders that occur in this case in individual organs and tissues. In the development of the disease, he distinguished two sides, two kinds of phenomena: protective - physiological and actually destructive - pathological. Pavlov's teaching helps pathphysiologists to overcome the shortcomings of Virchow's cellular pathology, to take into account closer links with the clinical manifestations of the disease. His work in the field of physiology of the heart, digestion, higher nervous activity, methods: pancreatic fistula, Pavlovsky ventricle, the method of conditioned reflexes and others had a huge impact on the development of pathphysiology.

Currently, organizationally, veterinary pathologists of the country are an independent veterinary section of the All-Russian Society of Pathologists. Scientific, theoretical and methodological congresses and conferences are regularly held, at which important issues of the theory and practice of modern pathology are resolved.

GENERAL PATHOLOGICAL ANATOMY

THE DOCTRINE OF DEATH - THANATOLOGY*

Death (lat.mors, Greektanatos) as a biological concept is an irreversible cessation of metabolism and vital functions of the body. A decrease in the intensity of the metabolism and vital activity of the body to an almost complete suspension is called suspended animation (from the Greek. ana- back,bios- life). Death is the inevitable end of the natural life cycle of any organism. With the onset of death, a living organism turns into a dead body, or corpse (Greek. cadaver).

The life span of animals of different species is different and depends on the natural (phylogenetic, hereditary) features and conditions of existence. The human body is designed for 150-200 years of life, horses, camels live up to 40-45 years, and pigs - up to 27, cattle, carnivores - up to 20-25, small cattle - up to 15-20, crows, swans - up to 80-100, chickens, geese and ducks - up to 15-25 years.

Etiology of death.Natural or physiological deathof the body occurs in extreme old age as a result of its gradual wear and tear. There are various theories of aging and death. These include the theory of exhaustion of the genetic potential with a catastrophic accumulation of errors in the genetic code, the immunological theory and the theory of somatic mutations, the theory of autointoxication, the accumulation of free radicals and cross-linking of macromolecules, and, finally, the theory of neuroendocrine regulation disorders with a decrease in the efficiency of inductive synthesis of enzymes and the development of irreversible deviations in metabolism. Thus, aging and death are the final, programmed stage of development and differentiation (the stage of dyontogenesis).

However, higher animals die much earlier than their natural physiological lifespan due to disease, inability to obtain food, or external violence.

Death from exposure to pathogenic causes (exogenous or endogenous aggressive stimuli)- pathological(premature). She happensnon-violent Andviolent. Distinguish between non-violent ordinary death from diseases with a clinically pronounced manifestation and sudden (sudden) death without visible precursors of death, which occurred unexpectedly in apparently healthy animals (for example, from rupture of pathologically altered internal organs, heart attack, etc.). Violent death (unintentional or intentional) is observed as a result of such actions (unintentional or intentional) as slaughter or murder, death from various kinds of injuries (for example, work injury), accidents (transport accident, lightning discharges, etc.).

The process of death (thanatogenesis). Conventionally, it is divided into three periods: agony, clinical (reversible) and biological (irreversible) death.

Agony(from Greek.agon- struggle) - the process from the beginning of dying to clinical death - can last from a few seconds to a day or more. Clinical signs of agony are associated with a deep dysfunction of the medulla oblongata, uncoordinated work of homeostatic systems in the terminal period (arrhythmia, pulse fading, convulsions resembling a struggle, paralysis of sphincters). The senses of smell, taste, and last but not least, hearing are gradually lost.

clinical death characterized by a reversible cessation of vital body functions, respiratory and circulatory arrest. It is determined by the primary clinical signs of death: the last systole of the heart, the disappearance of unconditioned reflexes (determined by the pupil), the absence of encephalogram indicators. This extinction of the vital activity of the organism is reversible under normal conditions within 5-6 minutes (the time during which the cells of the cerebral cortex can remain viable without access to oxygen). At low temperatures, the time of experiencing the cerebral cortex increases to 30-40 minutes (the deadline for people to return to life when they are in cold water). In terminal conditions (agony, shock, blood loss, etc.) and clinical death, a complex of resuscitation (from Latin reanymatio - revival) measures is used to restore the work of the heart, lungs and brain, including artificial respiration, transplantation ( transplantation) of organs and implantation of an artificial heart. The basic patterns of dying and restoration of human vital functions (with experimental studies on animals) are studied by a special branch of medicine called resuscitation.

biological death- irreversible cessation of all vital functions of the body with the gradual death of cells, tissues, organs. After respiratory arrest and blood circulation, the nerve cells of the central nervous system are the first to die, and their ultrastructural elements are destroyed by autolysis. Then the cells of the endocrine and parenchymal organs (liver, kidneys) die off. In other organs and tissues (skin, heart, lungs, skeletal muscles, etc.), the process of death continues for several hours or even days, depending on the ambient temperature and the nature of the disease. During this time, despite the destruction of cell ultrastructures, the general structure of many organs and tissues is preserved, which makes it possible to determine the nature of intravital pathological changes and the causes of death during postmortem autopsy and anatomical examination.

Determining the causes of death is the responsibility of doctors, including pathologists and forensic experts. Distinguish between the main (determining) and immediate (proximate) causes of death. The main (determining) cause is the main (or main competing and combined) disease and other above-mentioned causes, which, by themselves or through a complication, cause the death of the animal. The immediate causes related to the mechanism of death (thanatogenesis) are associated with the cessation of the functions of the main organs that determine the vital activity of the organism. In accordance with the "vital triangle of Bish" these include: heart failure(morspersyncopem), paralysis of the respiratory center(morsperasphysyncopem) and general paralysis of the central nervous system (cessation of brain activity). In connection with the practice of resuscitation and organ transplantation, it has been established that the cessation of brain activity (“death” of the brain), which is determined by the absence of reflexes and negative encephalogram indicators, even with the functioning of the heart, lungs and other systems, is an indicator of death. From that moment on, the body is considered dead.

After the onset of biological death, secondary and tertiary post-mortem physical and chemical changes develop (the primary signs of death include symptoms of clinical death). Secondary signs of death are changes associated with circulatory arrest and cessation of metabolism: cooling of the corpse, rigor mortis, cadaveric drying, redistribution of blood, cadaveric spots. Tertiary signs appear in connection with cadaveric decomposition.

Corpse cooling(algorMortis). It develops in connection with the cessation of biological metabolism and the production of thermal energy. After the death of an animal, according to the second law of thermodynamics, the temperature of the corpse decreases relatively quickly in a certain sequence to the ambient temperature. But the evaporation of moisture from the surface of the corpse leads under normal conditions to its cooling by 2-3 ° C below the environment. First of all, the ears, skin, limbs, head are cooled, then the trunk and internal organs. The rate of cooling of the corpse depends on the ambient temperature, air humidity and speed of its movement, the weight and fatness of the dead animal (corpses of large animals cool more slowly), as well as the nature of the disease and the cause of death. At an external temperature of 18-20 ° C, the temperature of the corpse decreases for every hour on the first day by 1 ° C, on the second day - by 0.2 ° C.

If the causes of death are associated with overstimulation of the heat-regulating center of the brain and an increase in body temperature in infectious-toxic diseases (sepsis, anthrax, etc.), with a predominant lesion of the central nervous system, the presence of seizures (rabies, tetanus, brain injury, solar and thermal blows, electric shock, poisoning with strychnine and other poisons that excite the nervous system), the cooling of corpses slows down. In these cases, after clinical death, one can observe a short-term (in the first 15-20 minutes after death) increase in temperature (sometimes up to 42 ° C), and then a more rapid decrease in it (up to 2 ° C in 1 hour).

The cooling of the corpses of emaciated animals, young animals accelerates during bleeding. In a number of diseases, body temperature drops even before death occurs. For example, with eclampsia in cows before death, the temperature drops to 35 ° C, with jaundice - up to 32 ° C. At an external temperature of about 18 ° C, complete cooling occurs in the corpses of small animals (pigs, sheep, dogs) after about 1.5 -2 days, and for large ones (cattle, horses) - after 2-3 days.

The degree of cadaveric cooling is determined by touch, and if necessary, measured with a thermometer. Its definition makes it possible to judge the approximate time of death of the animal, which is of practical importance in forensic veterinary autopsies and serves as one of the diagnostic signs.

Rigor mortis(rigorMortis). This condition is expressed by post-mortem compaction of the skeletal, cardiac and eye muscles and, in connection with this, the immobility of the joints. In this case, the corpse is fixed in a certain position.

The etiology and mechanism of rigor rigor are associated with the unregulated course of biochemical reactions in muscle tissue immediately after the death of the animal. As a result of the lack of oxygen flow during the period of post-mortem muscle relaxation, aerobic glycolysis stops, but anaerobic glycolysis increases, glycogen breakdown occurs with the accumulation of lactic acid, resynthesis and breakdown of ATP and creatine-phosphoric acids (due to the development of autolytic processes and an increase in the permeability of membrane structures with the release of calcium ions and an increase in the ATPase activity of myosin), an increase in the concentration of hydrogen ions, a decrease in the hydrophilicity of muscle proteins, the formation of an actinomyosin complex, which is manifested by post-mortem contraction of muscle fibers and stiffness. With the cessation of this peculiar physico-chemical process, the muscles soften.

In the first hours after death, macroscopically, the muscles relax and become soft. Rigor mortis usually develops 2-5 hours after death and by the end of the day (20-24 hours) it covers all the muscles. Muscles become dense, decrease in volume, lose elasticity; joints are fixed in a state of immobility. Rigor mortis develops in a certain sequence: first, the muscles of the head, which fix the jaw in a stationary state, undergo rigor mortis, then the muscles of the neck, forelimbs, trunk, and hind limbs. Rigor mortis persists for up to 2-3 days, and then disappears in the same sequence in which it occurs, i.e., the chewing and other muscles of the head first become soft, then the neck, forelimbs, trunk and hind limbs. With the violent destruction of rigor mortis, it does not appear again.

Rigor mortis also affects the muscles of the internal organs. In the heart muscle, it can be expressed as early as 1-2 hours after death.

Microscopic examination revealed that the post-mortem contraction of muscle fibers proceeds unevenly and is characterized by compaction of their transverse striation in different parts of myofibrils with a simultaneous increase in longitudinal striation, a violation of the perpendicularity of the transverse striation to the longitudinal axis of the fiber.

As a result of the development of autolytic processes, J-discs decrease in size and disappear, myofibrils homogenize, destruction of the sarcoplasm occurs, otexarcosomes, partial release of lipids with their release into the Z-plates, chromatin moves under the nuclear membrane and exfoliation of the sarcolemma with destruction of its plasma membrane ( boundaries of sarcomeres disappear).

The onset time, duration and intensity of rigor mortis depend on the in vivo state of the organism, the nature of the disease, the causes of death and environmental conditions. Rigor is strongly pronounced and sets in quickly in the corpses of large animals with well-developed muscles, if death occurs during hard work, from severe blood loss, with convulsions (for example, with tetanus, rabies, poisoning with strychnine and other nerve poisons). With injuries and hemorrhages in the brain, the deadly effects of electricity, rapid rigor mortis of all muscles (cadaveric spasm) occurs. On the contrary, rigor mortis sets in slowly, is weakly expressed or does not occur in animals with poorly developed muscles and in newborn hypotrophics, emaciated or dead from sepsis (for example, anthrax, erysipelas, etc.), in those who have been ill for a long time. Dystrophically altered skeletal muscles and heart muscles are also subject to weak stiffness, or it does not occur at all. Low temperature and high humidity of the environment slow down the development of rigor mortis, high temperature and dry air accelerate its development and destruction.

In diagnostic terms, the speed and degree of development of rigor mortis allow us to judge the approximate time of death, possible causes, circumstances, and the environment in which death occurred (corpse posture).

Corpse desiccation. It is associated with the cessation of lifeprocesses in body and evaporation of moisture from the surface of the corpse. First of all, the drying of the mucous membranes and the skin is noted. The mucous membranes become dry, dense, brownish in color. With drying, clouding of the cornea is associated. Dry gray-brown spots appear on the skin, primarily on hairless areas, in places of maceration or damage to the epidermis.

Redistribution of blood. It occurs after death as a result of post-mortem contraction of the muscles of the heart and arteries. This removes blood from the heart. The heart, especially the left ventricle, becomes tight and constricted, the arteries almost empty, and the veins, capillaries, and often the right heart (with asphyxia) are overflowing with blood. A heart with dystrophic changes in the muscle does not undergo rigor mortis, or it is weakly expressed. In these cases, the heart remains relaxed, flabby, all its cavities are filled with blood. Then the blood, due to physical gravity, moves to the underlying parts of the body and organs.. With the development of hypostatic hyperemia in the veins and cavities of the right half of the heart, the blood coagulates due to post-mortem changes in its physical and chemical state. Post-mortem blood clots (cruor) are red or yellow, with a smooth surface, elastic consistency, moist (Fig. 1). They lie freely in the lumen of the vessel or cavity of the heart, which distinguishes them from intravital blood clots or thrombi. With a rapid onset of death, few blood clots are formed, they are dark red in color, with a slow onset, there are many of them, they are predominantly yellow-red or gray-yellow. When dying in a state of asphyxia, the blood in the corpse does not coagulate. Over time, cadaveric hemolysis occurs.

cadaveric spots(livorisMortis). Arise in connection with the redistribution and changes in the physico-chemical state of the blood in the corpse. They appear 1.5-3 hours after death and up to 8-12 hours are in two stages: hypostasis and imbibition. Hypostasis (from the Greek. hypo - at the bottom,stasis- stagnation) - accumulation of blood in the vessels of the underlying parts of the corpse and internal organs, therefore, external and internal hypostases are distinguished. At this stage, cadaveric spots are dark red in color with a bluish tint (in case of poisoning with carbon monoxide, bright red, and hydrogen sulfide - almost black), indistinctly outlined, turn pale when pressed, and drops of blood appear on the surface of the incision. When changing and put ia corpse spots can move. Internal hypostases are accompanied by effusion of bloody fluid into the serous cavities (cadaveric extravasation).

Cadaverous spots are well expressed in death from asphyxia, in plethoric animals and in other diseases with general venous congestion, when the blood does not coagulate. With anemia, exhaustion and after slaughter with exsanguination, hypostases are not formed.

The stage of imbibition (from lat.imbibitio- impregnation). It begins with the formation of late cadaveric spots after 8-18 hours or later - by the end of the first day after death, depending on the ambient temperature and the intensity of cadaveric decomposition. In connection with post-mortem hemolysis (erythrolysis), the sites of early cadaveric spots are impregnated with hemolyzed blood diffusing from the vessels. There are late cadaveric spots, or cadaveric imbibition. These spots have a pink-red color, do not change when pressed with a finger, a change in the position of the corpse does not cause them to move. In the future, cadaveric spots acquire a dirty green color due to the decomposition of the corpse.

Cadaveric spots can serve as a diagnostic sign of the disease, the absence of bleeding during slaughter in the agonal state, indicate the position of the corpse at the time of death. External cadaveric spots are detected on the surface of the skin. In animals with pigmented skin and thick hair, they are determined by the state of the subcutaneous tissue after skin removal. Cadaveric spots should be distinguished from intravital circulatory disorders (hyperemia, hemorrhages, etc.). (Hyperemia occurs not only in the underlying parts of the body and organs; hemorrhages are distinguished by clear outlines, swelling and the presence of blood clots.)

Corpse decomposition. Associated with the processes of autolysis and putrefaction of the corpse. Postmortem autolysis (from the Greek.autos - myself,lysis- dissolution), or self-dissolution, occurs under the influence of proteolytic and other hydrolytic enzymes of the cells of the organism itself, associated with ultrastructural elements - lysosomes, mitochondria, membranes of the endoplasmic reticulum - lamellar complex and intranuclear elements. This process develops immediately after the death of the animal, but not simultaneously in different organs and tissues, but as structural elements are destroyed. The rate and degree of development of cadaveric autolysis depend on the number and functional state of the corresponding organelles in the cells, the amount of proteolytic and other enzymes in the organs, the fatness of the animal, the nature of the disease and causes of death, the duration of the agonal period, and the ambient temperature. In the brain and spinal cord, glandular organs (liver, pancreas, kidneys, mucous membrane of the gastrointestinal tract, adrenal glands), it occurs faster. With autolysis, which is diffuse in nature, the volume of the organ and its cellular elements does not increase (in contrast to intravital granular dystrophy). Parenchymal organs are dull, grayish-red in section, with signs of diffuse decomposition.

Microscopically, autolytic processes cause a violation of the clarity of boundaries and the general pattern of cells, are manifested by dullness, destruction of lysosomes and other organelles of the cytoplasm and nucleus. First of all, parenchymal cells are destroyed, and then - the vessels and stroma of the organ.

Putrefactive enzymatic processes quickly (by the end of the first day) join the post-mortem autolysis in connection with the multiplication of putrefactive bacteria in the intestines, upper respiratory, urinary tract and other organs associated with the external environment, and their subsequent penetration into the blood of the entire corpse. As a result of putrefactive decay, cellular and tissue elements completely lose their structure.

During decay, chemical reactions caused by enzymes of microorganisms are accompanied by the formation of various organic acids, amines, salts, and foul-smelling gases (hydrogen sulfide, etc.). Hydrogen sulfide arising from cadaveric decomposition, when combined with blood hemoglobin, forms compounds (sulfhemoglobin, iron sulfide), giving the tissues in the places of cadaveric spots a gray-green color (cadaveric greens). Such spots primarily appear on the abdominal integument, in the intercostal spaces, on the skin in places of cadaveric imbibition. The formation and accumulation of gases (hydrogen sulfide, methane, ammonia, nitrogen, etc.) is accompanied by bloating of the abdominal cavity (cadaveric tympania), sometimes by rupture of organs, the formation of gas bubbles in organs, tissues and blood (cadaveric emphysema), but these post-mortem processes, unlike intravital tympania are not accompanied by a redistribution of blood in the organs.

Cadaveric decomposition develops especially rapidly if death occurs from septic diseases or asphyxia, if the process of decomposition and accumulation in the tissues of pyogenic and putrefactive microorganisms is observed during the life of the animal. At high external temperatures, rotting begins already in the first day. At the same time, the general drying of the corpse leads to its mummification. At external temperatures below 5 ° C and above 45 ° C, when a corpse freezes and is in peat bogs, in emaciated animals, when buried in dry sandy soil, decay slows down and may even be absent. In permafrost areas, the corpses of mammoths and other animals that died several millennia ago are found. The artificial preservation of corpses is called embalming, in which cadaveric decomposition is suspended.

Ultimately, as the corpse decomposes, the consistency of the organs becomes flabby, a foaming liquid appears and the organs turn into a fetid, dirty gray-green mass. At the end of decomposition, the organic matter of the corpse undergoes mineralization and turns into inorganic matter.

Non-cellular nevus (pigmented nevus, mole). A mole is one of the most diverse, dynamic and biologically significant skin tumors. The name "non-cellular nevus" is applied to any congenital or acquired tumor consisting of melanocytes. The most common (acquired) non-cellular nevus is a small, tan, uniformly pigmented, firm papule, typically less than 6 mm in diameter, with well-circumscribed, rounded borders. There are many clinical and histological types non-cellular nevus.

Non-cellular nevus is formed from melanocytes, which transform from single process cells scattered among basal keratinocytes to round or oval cells growing in groups or nests along the junction of the epidermis and dermis. The nuclei of nevus cells are rounded, relatively monomorphic, and contain inconspicuous nucleoli. Their mitotic activity is insignificant.

The superficial form of the tumor reflects the early stage of its development and is called borderline nevus . Gradually, most borderline nevi grow into the underlying dermis in the form of cell nests and strands. (compound nevus) . In more mature neoplasms, these nests may already be completely isolated from the epidermis. This dermal(intradermal) nevus . Compound and dermal nevi tend to be elevated above the skin surface, unlike their borderline counterparts. The progressive growth of nevus cells from the dermatoepidermal junction to the underlying dermis is accompanied by a process called ripening. Despite incomplete maturation, those nevus cells that are closer to the surface of the skin are larger, tend to produce melanin and form nests. More mature nevus cells, located deeper, are smaller. They grow in strands and synthesize little or no melanin. The most mature nevus cells can be found in the very core of the tumor, where they often become spindle-shaped and grow in bundles, resembling nervous tissue. In these non-pigmenting, deeply located nevus cells, similar to nerve structures, changes in enzyme activity (progressive loss of tyrosinase activity and the appearance of cholinesterase activity) are noted.

More rare variants of non-cellular nevus compared to those described are blue nevus And halo nevus .

Dysplastic nevus. Birthmarks VK (dysplastic nevi) larger than other acquired moles: often their diameter exceeds 5 mm. These are flat maculae, or plaques, protruding slightly above the surface of the skin and having an uneven surface. As a rule, the degree of their pigmentation varies, and the edges have uneven contours,

Unlike freckles, dysplastic nevi appear on the surface of the skin, both exposed to sunlight and closed clothing. These neoplasms are found in many family members who have a tendency to develop malignant melanomas (suffering from hereditary melanoma syndrome). Genetic analyzes that were performed in such individuals revealed an autosomal dominant pattern of inheritance for dysplastic nevi. It has been suggested that a sensitive gene, which is localized on the short arm of the chromosome / near the locus, is involved in the hereditary transmission Rh. Dysplastic nevi can also occur as independent neoplasms that are not associated with hereditary melanoma syndrome, in which case the risk of malignancy is low. With the help of a serial study of biopsy specimens, the transformation of a dysplastic nevus into an early form of melanoma was traced clinically and histologically in some individuals. It turned out that it occurs within a few weeks. However, most of these nevi are still stable (benign) neoplasms.

Dysplastic nevi built from the elements of a complex nevus, which has architectural and cytological signs of abnormal growth. Intraepidermal nests of nevus cells are larger and often merge with each other. Part of this process is that individual nevus cells begin to replace the basal layer keratinocytes, spreading along the dermatoepidermal junction. At the same time, atypia of nevus cells is noted, which manifests itself in the form of uneven, often angular contours and hyperchromasia of the nuclei. Changes also affect the superficial parts of the dermis. Here, rare lymphoid infiltrates, loss of melanin from the collapsing nevus cells and its phagocytosis by dermal macrophages (melanin incontinence), as well as a characteristic linear fibrosis of the reticular layer, are found.

Malignant melanoma. It is a relatively widespread disease that, not so long ago, was considered almost exclusively fatal. In the vast majority of patients, melanoma occurs in the skin. In other localizations of this tumor, the mucous membranes are affected: the oral cavity, genital organs, the anus and esophagus. Especially often this tumor develops in the choroid of the eye. Occasionally it is found in the membranes of the brain and mucous membranes of the urinary and biliary tract.

An important role in occurrence malignant melanoma skin plays sunlight. For example, in men it often develops on the upper back, while in women it often develops on the back and legs. Lighter-skinned people are more at risk of developing melanoma than dark-skinned people. TO melanomogenic factors It's not just sunlight. The presence of a preexisting nevus (especially a dysplastic one), hereditary factors, or even exposure to certain carcinogens are all important in the origin of neoplasms.

The earliest clinical manifestation malignant melanoma of the skin is itchy and the most important symptom- discoloration of the pigmented lesion. In contrast to the coloration of a benign (non-dysplastic) nevus, melanoma pigmentation varies significantly and appears in all sorts of shades of black, brown, red and gray. Sometimes there are areas of white or flesh-colored hypopigmentation. The boundaries of melanoma are indistinct, and the shape is not round, as in non-cellular nevus. They look like an irregular, twisted and not always clearly defined line.

At the core interpretation of the structure malignant melanoma lies the concept of radial and vertical growth. radial growth indicates the tendency of tumor cells to spread horizontally (growth) in the epidermal and superficial dermal layers. Such growth often takes a long time. During its melanoma cells do not yet show the ability to metastasize. There is three varieties of radial growth melanomas: malignant lentigo, surface spread, lentiginous lesions of the mucous membranes and extremities. They are determined by the general composition of growth and the structure of tumor elements in the epidermal layer, as well as by the biological behavior of melanoma. For example, lentigo maligna in the radial growth phase usually occurs on sun-damaged facial skin in older people; it can exist for several decades before suddenly metastasizing. Over time, the radial growth changes to vertical. In the form of an expansively increasing mass, melanoma tissue rushes into the deeper layers of the dermis. In this mass, cells remain at the stage of low differentiation and, as they spread into the reticular layer of the dermis, become smaller and smaller. At the same time, on the basis of the previous phase of flat and radial growth, the formation of tumor node. It is during this period that clones of tumor cells with metastatic potential are formed. The likelihood of metastasis can be predicted by a simple measurement (in millimeters) of the depth of invasion, which is determined by the thickness of the vertical growth zone starting just below the granular layer of the epidermis.

As a rule, melanoma cells are much larger than the elements of the nevus. They have large nuclei with irregular contours and marginally (under the nuclear membrane) located chromatin, as well as well-defined eosinophilic nucleoli. These cells either form solid nests or grow in small groups or singly. All this occurs in all layers of the epidermis or in the dermis. As with other malignant tumors, it is important to note not only the degree of histological differentiation of tumor nests and complexes, but also the presence of melanin and the depth of invasion. important predictive indicators it is customary to consider the number of mitotic figures detected among tumor cells, the level of lymphocytic infiltration of the stroma and parenchymal neoplasm complexes.