Biomedical subjects
Publications and source records attributed to I M Kodolova.
One autopsy case of angiosarcoma of the testis tunica in a male of 60 is described. Histologically, the tumour corresponded to malignant haemangioendothelioma while electron microscopically areas having the structure of malignant haemangiopericytoma were also found.
Description is given of 11 patients with a severe form of protracted corticosteroid-dependent asthma. They died in status asthmaticus. Most of these patients had protracted status asthmaticus and cardiopulmonary failure. Pneumonia with toxic liver and kidney affection developed in some of them in parallel with glucocorticoid therapy. Long-term glucocorticoid treatment may give rise to vasculitis and thromboembolism of the pulmonary trunk. The principal disease can be aggravated by infection, administration of histoglobin, decrease in the dose of glucocorticosteroids or their discontinuation.
Principal stages in morphogenesis of peripheral lung cancer (PLC) were studied on operative specimens obtained from 200 PLC patients with majority tumors 0.5-3 cm in diameter. PLC was found to involve predominantly sites of preexisting cicatrices available in 93.1% of cases of small cancer. Essential in PLC onset may be Ghon's, Simon's and Aschoff-Pool focus cicatrices and tuberculomas recorded in 113 patients (70%). Pneumoconiosis- induced and postpneumonic cicatrices occurred in 42 (26%) and 6 (4%) patients, respectively. Dysplasia of small bronchi epithelium, bronchioles and alveoli found in cicatrices should be considered PLC precancer. The authors hold that cicatricial lesions in lung periphery are PLC risk factors.
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A case of a primary malignant mesenchymoma of the lung with elements of rhabdomyo-, leiomyo-, osteo-, fibro- and lipo-sarcoma is described. The tumor developed in a man of 58 with a long history of smoking, complaints of chest pains and cough with scanty sputum expectoration. The neoplastic process involved the upper lobe of the left lung and microscopically contained smooth muscle, endothelial, fibroblast-like cells, multinuclear giant cells resembling osteoclasts, strips of osteoid-like hyalinized connective tissue. Electron-microscopic examination revealed myoid-type cells with clusters of myofilaments and Z-type material, cells resembling fibroblasts, osteoclasts and lipocytes. It is suggested that there should be a common histogenesis of primary lung sarcomas arising from a stem cell precursor of mesenchymal origin in lung stroma, bronchial and vascular walls, pleura.
Morphological analysis of 90 observations with a clinical diagnosis of a small peripheral lung carcinoma is performed. The examination of an operation material confirmed diagnosis in 71 cases. Tuberculomas are found in 19 cases. The peripheral lung carcinoma was found to develop in 91.5% (65 cases) against the background of preexisting scars which in 73.8% (48 cases) had a post-tuberculosis and 26.2% (17) post-pneumonia origin. Scars were most frequently related to the healed forms of a focal secondary tuberculosis (30 cases) and sclerotic changes around tuberculomas (8). Post-tuberculosis scars provoking sclerosis and deformation of vessels, bronchi, bronchioles and alveoles with the development of an epithelial dysplasia, are one of the risk factors in the development of a peripheral lung carcinoma. The degradation and fibrinoid changes of a scar tissue infiltrated by a tumour and followed by destruction of scars are observed in peripheral lung carcinomas with a diameter more than 3 cm.
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Clinico-anatomic analysis of section and biopsy materials (skin, kidneys; synovial membranes of joints, lungs) was performed to study the effect of immunosuppressive and antiinflammatory therapy on the course and morphological manifestations of rheumatic diseases. In rheumatic fever, predominant involvement of valvular endocardium with flaccid asymptomatic course was observed with the lack of vasculitis and myocardial involvement, decreased fatality rate, a shift of fatality and morbility to middle age groups suggesting changes in the epidemiology of the disease and pathomorphosis of this nosological form. In systemic lupus erythematosus and rheumatoid arthritis, treatment of the disease positively affects its clinical, morphological, and immunological manifestations, i. e. partial pathomorphosis (nosomorphosis) occurs.
Morphological examinations in the lungs in patients with diabetes mellitus of different degrees of severity and duration (28 autopsy observations) were carried out. Diabetic microangiopathy in the lungs was found to involve the capillaries of alveolar septa and arterioles as well as pleural arterioles, and is manifested by plasmorrhagia, insudation, thickening of basal membranes and hyalinosis of the vessels. Moreover, intraseptal nodules, granulomas in small artery walls, focal proteinosis develop in the lungs followed by sclerosis of the microcirculatory bed vessels and centrilobular emphysema. All these comprise a favourable background for the development of pneumonias which, along with pulmonary-cardiac insufficiency are one of the most frequent causes of death of patients with diabetes mellitus.
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Based on the study of the materials of 13,000 autopsies made in 1962--1979 at the Pathology Department of the Chair of Pathological Anatomy of the I. M. Sechenov First Medical Institute, an increase in the rate of thromboembolic complications (TEC) was established predominantly in diseases of the cardiovascular system (atherosclerosis, hypertension, ischemic heart disease, rheumatic disease, protracted bacterial endocarditis). The analysis of 8157 autopsies with TEC revealed general regularities of changes in TEC structure in different diseases irrespective of their pathogenetic differences: predominance in the last two decades of venous thrombs, thromboemboly of the pulmonary artery and pulmonary infarction; prevalence of senescent and senile people among patients with TEC, and women among them (with the exception of protracted bacterial endocarditis).
The data from the literature and the authors' own studies on changes in the lungs in systemic diseases of the connective tissue with immune disorders: systemic lupus erythematosus, progressive systemic sclerosis, rheumatoid arthritis, and periarteriitis nodosum are presented. Changes in the lungs in the above diseases have some common features: damage of the microcirculatory bed, increased vascular permeability, impregnation with plasma of alveolar septae and vessel walls, cellular reactions, and septo-alveolar sclerosis. Specific features of each of the diseases under study were demonstrated. The time course of morphological changes in the lungs was followed in relation to the severity, duration, and form of the disease.
Examinations of the lung vessels in diabetes of various degrees of severity and duration revealed changes in the vessels similar to diabetic microangiopathy in other organs (kidneys, skin). Manifestations of diabetic microangiopathy in the lungs are most marked in arterioles and capillaries of the alveolar septae. Diabetic microangiopathy in the lungs is characterized by phenomena of plasmorrhagy and insudation, thickening of capillary basal membranes, sclerosis and hyalinosis of capillary and arteriola walls, and accumulation of alveolar macrophages resorbing metabolism products in alveolar lumen. Diabetic microangiopathy leads to the development of alveolar septae sclerosis and to centrilobular pulmonary emphysema. As compared with the involvement of the vessels in the kidneys and the skin, manifestations of diabetic microangiopathy in the lungs lag in their development and are less manifest.
Histological and immunohistochemical studies of 57 bioptic specimens of the mucosa of the main bronchi taken during an attack of bronchial asthma, and those of the lungs of 27 patients who had died on the attack, showed that in the course of the attack of bronchial asthma serous-desquamous allergic inflammation, which proceeded according to the type of hypersensitivity, of the immediate type, developed along the full length of the broncho-vascular barrier. It occurred under the effect of biologically active substances liberated in the reaction of the antigen with IgE. Immunochemically, there was detected luminescence of IgE on the basal membranes of the mucous glands, on the basal membranes of the mucosa, as well as in lymphoid, plasmic, and mast cells infiltrating the mucosa. In allergic inflammation in the bronchi there were noted drastic delatation and increased permeability of vessels of the microcirculatory bed, odema, migration of eosinophils, the mast-cell reaction with degranulation of mast cells, spasm of musculature, elevated permeability of the basal membrane, impregnation of the latter with plasmic protein with fibrin, hypersecretion and desquamation of the epithelium, hypersecretion of mucous glands. As a result of the inflammatory changes in the bronchial system disorders of the drainage function of the bronchi with obstruction of their lumens which were most pronounced in small bronchi and bronchioles, developed.
Opportunities of preservation of the lung at +4 degrees C and in association of this temperature with hyperbaric oxygenation during 2 and 24 hours with postponed autotransplantation have been studied. In 74 experiments on dogs postponed autotransplantation of the lung was performed, including 46--with preservation during 2 hours, and 28--with preservation during 24 hours. Based on the studies carried out, it was found that in preservation of the lung during 2 hours at +4 degrees C or in association of +4 degrees C and hyperbaric oxygenation the lung could be successfully employed for postponed autotransplantation. It is felt that there is no considerable difference between the results of experiments with postponed autotransplatation of the lung in preservation during 2 and 24 hours, depending on different conditions of preservation.
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