[Primary generalized AL amyloidosis]. / Pervichnyi generalizovannyi AL-amiloidoz.

The paper describes an autopsy observation of a 71-year-old male with primary generalized AL amyloidosis lasting about 4 months after its manifestation to the onset of death from hepatic and renal failure. Total damage to the liver and spleen, as well as amyloid deposits in the kidneys, adrenal glands, and pancreas were noted.

[Microscopic polyangiitis]. / Mikroskopicheskii poliangiit.

The paper describes an autopsy case of a 69-year-old woman with microscopic polyangiitis lasting about 1.5 months despite intensive treatment. She had generalized productive vasculitis, extracapillary productive glomerulonephritis, adult respiratory distress syndrome with focal pneumonia, isolated lung atelectasis, splenic infarction, and toe and finger gangrene. Morphological differences from those of granulomatosis with polyangiitis and Churg-Strauss syndrome are presented.

[Combined application of modern endoscopic techniques in the detection of precancerous and malignant lesions of larynx]. / Kombinirovannoe primenenie sovremennykh éndoskopicheskikh metodov v diagnostike predraka i raka gortani.

INTRODUCTION: Early detection of malignant laryngeal tumors is crucial but still challenging. And 5-year survival rate depends on a stage of revealing. The aim of the study - assessment of the effectiveness of combined application of narrow band imaging and contact endoscopy in visualization of neoangiogenesis. MATERIAL AND METHODS: 102 patients were included in this study. All the patients were evaluated by means of narrow band imaging and contact endoscopy. RESULTS: Combined application of narrow band imaging and contact endoscopy gained a high level of effectiveness: accuracy - 93.9%, sensitivity - 96%, specificity - 93.4%, positive predictive value - 94.3%, negative predictive value - 93.4%. CONCLUSION: Combined application of narrow band imaging and contact endoscopy may contribute to early detection of malignant laryngeal tumors.

[Features of the development of latent autoimmune diabetes in adults (LADA)]. / Osobennosti razvitiia latentnogo diabeta vzroslykh (LADA).

The study of the sociomedical problems of diabetes mellitus led to the discovery of latent autoimmune diabetes in adults (LADA), a special form of the disease. The slow onset of the disease, the clinical signs of type 2 diabetes mellitus concurrent with the autoantibody pancreatic ß-cell destruction mechanism that is characteristic of type 1 diabetes. Genetic factors play an important role in the genesis of the disease. Insulitis concurrent with intact or hypertrophic islets of the gland originally develops morphologically. Subsequently, the phenomena of islet atrophy and sclerosis are progressive. The disease is typical for young people (generally those aged 25-35 years) with normal body mass index, low blood C-peptide levels, with antibodies against ß-cells, primarily to glutamate decarboxylase, being detected. Insulin preparations should be used to treat these patients.

[The disciplines of choice in the teaching of pathoanatomy]. / Distsipliny po vyboru v prepodavanii patologicheskoi anatomii.

The changes caused by scientific and technological progress have required that the pedagogical process should be substantially restructured. This is solved to a large extent by the discipline of choice (electives). Free choice and contact with leading experts on the topic of interest to a particular student increase the quality of teaching and the level of its theoretical and practical training.

[Interconnection of the angiopathy and neuropathy development mechanism at patients with type II pancreatic diabetes].

In the article we summarized literature data, covered genesis of angiopathy and neuropathy at patients with type II diabetes. In the genesis of disease different metabolic, immune, hypoxic, genetic and others factors, caused affection of arteries, microcirculation and the peripheral nervous system, play an important role. Increasing changes of the great and minute vessels are interconnected with diabetic neuropathy

[Primary amyloidosis with predominant involvement of the heart and gastrointestinal tract].

The paper describes a postmortem observation of primary cardiovascular AL-amyloidosis first diagnosed by rectal biopsy in a 71-year-old woman. Death occurred due to chronic cardiovascular insufficiency 6 months after disease manifestation.

[The mechanisms responsible for the development of diabetic nephroangiopathy].

Metabolic, hemodynamic, blood rheological, hormonal, immune, age- and other related mechanisms are involved in the development of nephroangiopathy in types 1 and 2 diabetes mellitus. The initial increase in glomerular filtration rapidly gives way to progressive sclerosis and hyalinosis of glomeruli and afferent and efferent arterioles. These changes can be arrested only in early stages of diabetic nephroangiopathy.

[Diagnostics of microcirculatory disorders in patients with diabetes mellitus type 2 and ischemic heart disease]. / Diagnostika mikrotsirkuliatornykh narushenii y bol'hykh sakharnym diabetom tipa 2 i ishemicheskoi bolezn'iu serdtsa.

Skin biopsy is the most significant method for diagnosis of microcirculatory disorders in diabetes mellitus of type 2 (DM2) and ischemic heart disease (IHD). This method provides earlier detection of microcirculatory changes which is essential for prophylaxis of life-threatening vascular complications and early treatment. 29 IHD and DM2 patients were examined. In the period of DM compensation and stable angina these patients underwent incision biopsy. Morphological preparations were studied histologically and immunohistochemically. The data obtained allowed estimation of the mean time of development of diabetic microangiopathy (MAP) in these patients. The results show that in combination of DM2 and IHD microcirculatory disorders in skin biopsies develop later than in DM2 without IHD; MAP progression correlates with DM duration; clinical compensation of patients with IHD and DM2 depresses progression of DMA. A method of choice in diagnosis of microcirculatory disorders in DM patients is skin biopsy.

[Mechanisms of development of diabetic macroangiopathy]. / Mekhanizmy razvitiia diabeticheskoi makroangiopatii.

Pieces of the aorta and heart coronary arteries taken at autopsy of 100 patients who had died of insulin-dependent and non-insulin-dependent diabetes mellitus were studied histologically and immunohistologically. Atherosclerosis was more pronounced in diabetes mellitus patients than in patients with normal glycemic indices. Atherosclerosis was most severe in non-insulin-dependent diabetes. Diabetic microangiopathy of the vasa vasorum of large arteries promotes development of atherosclerosis.

[Immunomorphological study of diabetic microangiopathy]. / Immunologicheskoe izuchenie diabeticheskoi mikroangiopatii.

Femoral skin biopsies of 300 patients with insulin-dependent and non-insulin-dependent diabetes were studied immunomorphologically and the results were compared to the level of immunoglobulins in the blood serum. It is found that IgG, beta-lipoproteins, complement were registered in the arterioles and capillary walls in diabetic microangiopathy more frequently than in healthy persons. The conclusion is made that in development of diabetic microangiopathy, in both types of diabetes, immune (immunocomplex) mechanisms that damage vascular wall are involved.

[Dynamic morphologic follow-up of diabetic microangiopathy]. / Dinamicheskoe morfologicheskoe nabliudenie za razvitiem diabeticheskoi mikroangiopatii.

Skin thigh biopsies were regularly taken in 186 patients with insulin-dependent and non-insulin-dependent diabetes. Progression of diabetic microangiopathy was found in spite of hypoglycemic treatment. Development of lesions of microvessels was somewhat inhibited only by angioprotectors (ticlid, dyamicron, dipiridamol).

[Pathogenetic aspects of chronic inflammation]. / Patogeneticheskie aspekty khronicheskogo vospaleniia.

Chronic inflammation (CI) was studied immunologically and immunomorphologically on biopsy and surgical material: interstitial pulmonary diseases, chronic inflammatory processes of the uteri and ovaries, decubitus in the spinal cord damage, trophic ulcers of the limbs, osteomyelitis, chronic abscesses of soft tissues, coccygeal cysts and chronic paraproctitis. The following parameters determine the development of CI: persistence of the damaging agent, immunological insufficiency, mechanisms of autoimmunization, progression of CI according to the principle of vicious circle. CI looses its biological usefulness as a compensatory-adaptive reaction.

[Immunomorphologic characteristics of bedsores]. / Immunomorfologicheskaia kharakteristika prolezhnei.

Biopsies and blood of 36 patients with bedsores developing due to spinal cord trauma were studied. Pronounced alterations in the blood content of IgA, IgM, IgG, a significant increase in circulating immune complexes (CIC) content and a decrease of neutrophil leukocyte chemotactic activity were found. The authors conclude that an immune system dysfunction occurs in patients with bedsores as well as secondary immune deficiency and immunoglobulin and CIC deposition in the granulation tissue vessels. Development of chronic vasculitis, obliteration and reduction of vessels, hypoxia and metabolic disturbances in the wound edges, formation of deficient fibroblasts synthesizing collagen type III which does not facilitate skin epithelium maturation, all these changes result in a chronic course of the wound and almost complete lack of healing.

[The effect of antiaggregants on the course of diabetic microangiopathy]. / Vliianie antiagregantov na techenie diabeticheskoi mikroangiopatii.

As shown by conjunctival biomicroscopy, 6-month administration of ticlid and gliclazide induced a statistically significant increase in the frequency of less severe microcirculatory disturbances compared to conventional hypoglycemic therapy. The drugs also restricted plasmatic impregnation and cell proliferation in skin biopsy microvascular wall. Following 2-year antiaggregation treatment (gliclazide, trental, dipiridomol) 48.9% of diabetes mellitus patients achieved regression of morphological manifestations of diabetic microangiopathy, 16.2% stabilization against 34.9% of progressive disease cases. Conventional sugar-reducing therapy fails to stop diabetic microangiopathy progression in 73.4-93.3% of the diabetics.

Analysis of association of peptic ulcer and essential hypertension from the standpoint of the problem of concomitant pathology. A possible role of vascular factor in the genesis of ulcer formation.

Patients with association of peptic ulcer and essential hypertension were found to form a heterogeneous group. Examination of this patients' group made it possible to distinguish certain clinical variants of such an association. Patients who first developed essential hypertension and then peptic ulcer were established to have a severe pattern of essential hypertension, unmarked and little symptomatic clinical picture of peptic ulcer, to be characterized by proneness to the complicated disease course. These features together with vascular lesions identified in the gastric submucosal layer, running their course as hypertonic microangiopathies permit attribution of the indicated ulcerations to the group of symptomatic gastroduodenal ulcers. In cases of association of peptic ulcer and essential hypertension, hemiton that suppresses the processes of gastric secretion was found to be the drug of choice.

[Mechanisms of lesions of nasal mucosa microcirculation in allergic rhinitis]. / O mekhanizmakh povrezhdeniia mikrotsirkuliatornogo rusla slizistoi obolochki polosti nosa pri allergicheskom rinite.

Morphological study of tissue of the mucous membrane of the nasal cavity in 36 patients which was removed in the process of surgical treatment showed a marked disorder of microcirculation. Immunoluminescent studies revealed fixed globulins and a complement in the vascular wall.

[The efficacy of the antiaggregants ticlid and diabeton in correcting chronic intravascular microcoagulation of the blood in diabetic patients]. / Effektivnost' antiagregantov--tiklida i diabetona v korrektsii khronicheskogo vnutrisosudistogo mikrosvertyvaniia krovi u bol'nykh sakharnym diabetom.

Hemocoagulation was examined in 477 diabetes mellitus patients. Whatever the disease type, severity, duration and the intensity of microvascular complications, diabetes mellitus was discovered to be marked by the development of chronic intravascular blood microcoagulation associated with primary hyperactivation of the platelet component of hemostasis. The use of the new antiaggregation agents tiklid and diabeton allows an appreciable decrease of the activity of platelet microthrombus formation whereas the administration of the common sugar-reducing antidiabetic therapy favours the maintenance of its high level.

[Morphogenesis of diabetic microangiopathy]. / Morfogenez diabeticheskoi mikroangiopatii.

Skin biopsies from 40 patients 17 to 75 years old with type I and II diabetes mellitus were studied morphologically. The formation of diabetic microangiopathy starts with the damage of endotheliocytes, vascular permeability disturbance, activation of pericytes and smooth muscle elements with subsequent thickening of basal membranes and capillary and arteriole hyalinosis, these lesions being directly related to the duration of diabetes. Diabetic microangiopathy is a manifestation of the disease and its morphology is similar in both type I and II diabetes.