[Tumor progression of diffuse median glioma with H3 K27 alteration from pilocytic astrocytoma to glioblastoma]. / Opukholevaya progressiya diffuznoi sredinnoi gliomy s al'teratsiei H3 K27 ot pilotsitarnoi astrotsitomy do glioblastomy.

In the latest revisions of the WHO Classification of CNS Tumors, carried out in 2016 and 2021, the traditional histogenetic classification of gliomas is rebuilt on a new molecular genetic basis, according to which diffuse midline glioma with alteration of histone H3 K27 is distinguished as a specific pediatric oncosyndrome. The rationale was the association of this feature of midline gliomas in children with a worse prognosis and the prospective possibilities of targeted therapy. A thematic review of the literature and our own observation of H3 K27M-positive glioma in the area of the right thalamus in a 6-year-old child, which initially had the appearance of pilocytic astrocytoma, recurred three times (within 1.5 years) and underwent tumor progression with anaplastic transformation into diffuse glioma of the glioblastoma type, are presented. The authors are inclined to believe that although the determination of the molecular genetic status of H3 K27 provides important information regarding the probable prognosis, at the same time there is no reason to doubt that histological verification should continue to be the basis of oncological diagnosis.

[Isolated sarcoidosis of the brain]. / Izolirovannyi sarkoidoz golovnogo mozga.

Sarcoidosis is a granulomatous multisystem disease of unclear etiology. Among the many local lesions of different localization, lesions of the central and peripheral nervous system (neurosarcoidosis) are distinguished as particularly unfavorable manifestations of the disease. Only in rare cases, neurosarcoidosis can manifest as isolated or primary. Biopsy remains the gold standard for the diagnosis of neurosarcoidosis. However, significant difficulties remain in verifying the diagnosis, especially with an isolated variant of the lesion A rare case of isolated neurosarcoidosis with a primary focus in the right hemisphere of the brain is described. The data of histological, histochemical and immunohistochemical examination of the surgical material are presented.

[Chordoma as a neurosurgical pathology]. / Khordoma kak neirokhirurgicheskaya patologiya.

OBJECTIVE: Assess the significance of chordoma as a neurosurgical pathology, taking into account the latest edition of the WHO classification of soft tissues and bone tumors (2020). MATERIAL AND METHODS: An analysis of 28 chordomas was carried out. All chordomas were histologically verified, including using immunohistochemical markers of notochordal differentiation (S100, EMA, keratin, brachiuria protein). RESULTS: Patients with chordomas accounted for 0.25% of the total number of neurosurgical patients. The vast majority (27) of chordomas had a cranio-vertebral localization. Sacral localization (S3-S5) of the tumor was detected in 1 patient. In 4 (15%) cases, operations were performed for the recurrence of chordoma. The tumors tended to grow into the structures of the skull, overgrown the vessels and nerves, and compress the adjacent brain structures. This was manifested by pain syndrome, neurological symptoms, impaired liquorodynamics. According to histopathological criteria, 27 (96%) cases of tumors were classified as conventional (usual) chordoma type, among them 7 corresponded to the chondroid subtype of the chordoma. In 1 case (4%), a dedifferentiated chordoma was detected. CONCLUSION: Chordoma, due to its axial localization, naturally involves adjacent structures of the nervous system, has clinically significant neuropathological manifestations, and often provides direct indications for a special neurosurgical approach. This requires its consideration not only as a bone, but also as a neurosurgical oncological pathology, along with other non-meningothelial (mesenchymal) tumors of the CNS.

A Model of Short Bowel Syndrome in Rodents in a Long-Term Experiment.

Simulation of short bowel syndrome (SBS) in experimental animals is of great interest for studies in translational medicine. The processes of intestinal adaptation are most often studied in rats aged 8-10 weeks with up to 70% resection the small bowel. In this case, the animals are euthanized in 2 weeks after the surgery; further development of the pathological process remains practically unexplored. In our experiment, a number of blood biochemical parameters and morphological signs of intestinal adaptation were assessed within 34 weeks after surgery. It was shown that after resection of 70% of the small bowel in rats (180±15 g), clinical symptoms are observed only during the first 2 weeks, however, the mortality in the group was observed throughout the entire period of the study in the absence of clear clinical signs. Morphological compensatory changes in the walls of the small intestine continued up to 34 weeks after resection, and their morphometry can be used to describe adaptation in the dynamics of the study.

[Tanatogenetic role of type 2 diabetes in neurosurgical patients]. / Tanatogeneticheskaia rol' sakharnogo diabeta 2-go tipa u neirokhirurgicheskikh bol'nykh.

The idea of diabetes in the aspects of its impact on the course of different diseases and tanatogenesis remains little investigated. OBJECTIVE: To define the tanatogenetic significance of 2 type diabetes in neurosurgical patients. SUBJECT AND METHODS: Forty-three patients aged 22-75 years, who had died after neurosurgery, were examined. Case histories and the time course of changes in blood glucose levels were analyzed. The manifestations of macroangiopathy were taken into account at autopsy; those of microangiopathy were considered at microscopy of the internal organs and tissues; Van Gieson and periodic acid-Schiff staining was additionally applied. The expression of insulin, glucagon, synaptophysin, S100 proteins, and neurofilament protein was found in the pancreas. The number and volume of islets and an insulin-to-glucagon ratio were morphometrically estimated. RESULTS: Type 2 diabetes mellitus was identified in 28 (65.1%) patients: 11 (25.6%), 8 (18.6%), and 9 (20.9%) with clinically obvious, subtle, and latent types, respectively; while it was as a background underlying disease in 3 (7.0%) patients. Among the immediate causes of death, there was a preponderance of local angiogenic complications (hemorrhages, infarctions, swelling, and displacement of the brain) (64%). Indurative pancreatitis was not inferior to cardiovascular diseases among complications and concomitant diseases and was detected in most diabetic patients (n=24, or 85.7%) and in 6 (a quarter) patients with acute pancreatic necrosis, which was the immediate cause of death in 2 cases. In the places of paravasal sclerosis, there was a reduction in the terminals of nerve fibers as a manifestation of diabetic neuropathy. CONCLUSION: Type 2 diabetes mellitus was much more frequently encountered in the most critically ill and dead neurosurgical patients than in the general population and was embodied in the pattern of immediate causes of death. Diabetic neuropathy with a reduction in the terminals of nerve fibers can serve as a substantial basis not only for vascular, but also for ductal dystonia and dyskinesia, which can become an important factor in the pathogenesis of chronic pancreatitis in patients with diabetes mellitus.

[Granulomatous inflammation in the bed of resected cerebral cavernoma in a child, caused by a hemostatic agent].

OBJECTIVE: The study presents a clinical observation of foreign body granuloma, which is rare productive inflammation, developed on treatment with a hemostatic material upon removal of cerebral cavernoma. MATERIAL AND METHODS: A 4-year-old boy operated on for left parietal lobe cavernoma was diagnosed with a mass lesion during a follow-up MRI examination 4 months after surgery. The patient was re-operated in connection with suspected abscess formation. The pathological tissue was subjected to the histological and immunohistochemical examination. RESULTS: Inflammation was accompanied by the formation of foreign body granulomas, and, in some areas, had immune nature with signs of focal destructive vasculitis, delayed maturation of the granulation tissue, and disturbance of the current organization and encapsulation processes. It is worth noting that granulomatous inflammation around a hemostatic material in the brain has no specific features during introscopy and mimics an abscess or tumor recurrence. CONCLUSION: The use of hemostatic materials upon resection of cerebral cavernous malformations may cause formation of granuloma mimicking disease relapse or abscess in the long term period. To prevent granulomatous inflammation, removal of a hemostatic material, if possible, from the surgical field is recommended when reliable hemostasis is achieved.

[Pathology of traumatic disease in wounded people]. / Patologicheskaia anatomiia travmaticheskoi bolezni u ranenykh.

The hemodynamic concept of TD pathogenesis and morphogenesis is based on the vascular response initiated by neuroendocrine mechanisms. Their effect in grave wounds is potentiated by blood loss, shock, endotoxicosis as well as inadequate therapy. Secondary damage to organs with clinical syndrome of their failure results from impaired correlation between the plasticity of histones and speed of microcirculatory alterations. Periodization of TD is suggested that takes into account its cyclicity and specificity of time distribution of therapeutic and diagnostic actions. Cerebral, pulmonary, renal, cardiac, gastro-intestinal and mixed forms of TD are distinguished.

[Thanatological analysis of traumatic disease]. / K tanatologicheskomu analizu travmaticheskoi bolezni.

The transition of trauma disease to the premortal period represents a qualitative leap of changing pathogenesis into thanatogenesis. Practically it means the appearance of such a condition of the patient which requires urgent measures of treatment directed to the correction of life-threatening alterations of homeostasis. The determination of some pathological process in the clinical picture of trauma disease as a possible direct cause of death presupposes the following prognosis of the type of the terminal condition, mechanism of death with the resulting conclusions concerning organization of curative measures.

[Morphologic characteristics of the changes in the thymus and spleen in alcoholism]. / Morfologicheskaia kharakteristika izmenenii vilochkovoi zhelezy i selezenki pri alkogolizme.

Morphological studies of the thymus and the spleen were made in 54 alcohol addicts and 53 cases of other death cause at the age from 25 to 65 yr. Alcoholism was found to induce the reduction in thymus size and the number of its lobes with a simultaneous decrease of lymphocyte content in them; in the lymphatic follicles of the spleen (in the presence of infectious processes) absence of bright multiplication centres and alkaline phosphatase activity in their mantle zone cells was noted. There appeared to be a statistically significant difference in the amount of the parenchyma in the thymus of alcoholics (p less than 0.017) compared to that of the control group 0.68 +/- 0.09 g and 1.33 +/- 0.21 g, respectively and this figure was almost 4-fold less, than the average age norms, 0.26 +/- 0.03 g; the quantitative content of the splenic pulp in alcoholics also had a statistically significant difference compared to the control group (P less than 0.001), 6.37 +/- 0.66 g vs. 12.59 +/- 0.98 g, respectively. The data obtained indicate the development of immunodeficiency states in alcoholism and basing on the changes occurring in the thymus and spleen they can be referred to a combined T- and B-cell form of immunodeficiency.

[Carcinoid-like ACTH-active thymus tumor with adrenal hyperplasia and the Itsenko-Cushing syndrome]. / Kartsinoidpodobnaia AKTG-aktivnaia opukhol' vilochkovoi zhelezy s giperplaziei nadpochechnikov i sindromom Itsenko-Kushinga.

Rare carcinoid-like ACTH-active tumour of the thymus in a woman of 40 is described. The tumour was of a solid-trabecular structure with rosette-like figures and consisted of spindle, polyhedral and roundish cells containing electron-dense granules of the neurosecretory type. Hormonal activity of the tumour was manifested in a pronounced hypercorticism with a marked adrenal hyperplasia, atrophy of sex organs and general virilization, skeletal muscle atrophy, osteoporosis, signs of diabetes mellitus, lipid hepatosis and other symptoms of a grave Itsenko-Cushing' syndrome followed by a fever. In spite of the absence of metastasis tumour was characterised by a rapid expansive growth with the compression of neck veins and venous stasis in both mediastinal organs and the tumour itself with the necrosis in its central parts. The cause of death was the thromboembolism of lung arteries from the thrombotic veins of the lower limbs.

[Anaerobic clostridial infection of surgical wounds]. / Anaerobnaia klostridial'naia infektsiia operatsionnykh ran.

Two cases of anaerobic clostridial infection in operative wounds of the anterior abdominal wall in women of 65 and 86 are presented. The infection developed by the second or third day following surgical intervention for small intestine ileus. Death occurred with septic shock manifestations 10-13 hours after the onset of the first clinical symptoms of infectious complications which were contributed to by late hospitalization of the patients, inadequate antibacterial treatment as well as age-dependent decrease of immunologic responsiveness. An increasing incidence of anaerobic operative wounds infection is noted.