[Psoriatic arthritis and heart disease].
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Biomedical subjects
Publications and source records attributed to L V Kakturskiĭ.
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Literature on the various manifestations of the selenium deficiency in humans and animals is presented. Mechanisms of the biological effects of selenium brought about by glutathione peroxidase are considered. Biogeochemical anomalies, parenteral nutrition, malabsorption syndromes as conditions for the development of hyposelenosis are characterized as well as their manifestations (white-muscular disease, myopathies, cardiomyopathies, Keshan disease, Kashin-Beck disease). Selenium deficiency facilitates the development of the ischemic heart disease, myocardium infarction, certain types of malignancy and so on. The attention is drawn to the link of the selenium deficiency with imbalance of other trace elements.
Informative value of non-specific histopathological myocardial changes was determined on the material of 31 autopsy cases of a sudden coronary death (SCD) and comparison of two groups: 18 observations of violent death and 17 observations of an acute alcoholic intoxication. Informative value was assessed using Kullback's criterion. Large- and small-focal cardiosclerosis and cardiomyocyte hyperthrophy were of a high informative value for SCD. Sclerosis of the intramural arteries, congestion on venas and capillaries, muscle fiber fragmentation had an informative value for SCD versus a violent death, and haemorrhages for SCD versus an alcoholic group. Cardiomyocyte vacuolisation and wavelike deformation of muscle fibers were of a low informative value. Cardiomyocyte atrophy and lymphohistiocytic infiltration were informative for SCD when compared to a violent death and for an alcoholic group when compared to SCD. Endothelial proliferation of the microcirculation vessels, myolysis, sludge-phenomenon, lypofuscinosis, stromal lipomatosis were of informative value for the alcoholic group and not for SCD.
Analysis of current data indicates that one of the important and unsolved problems in the concept of sudden cardiac death is the question on the trigger mechanisms of the ventricular fibrillation which is the most frequent cause of heart failure in the sudden death of patients with coronary heart disease. It can be assumed that the spread, with the circulating blood, in the myocardial tissue of the arythmogenic substances formed in the hypoxic areas of the ischemized heart muscle or as an effect of catecholamines favour the fibrillation. Penetration of the arythmogenic substances into the circulation is due to the blood circulation remaining in the ischemic zone or the reperfusion of the ischemic tissue. Amphiphilic lysophosphoglycerides, cAMP, free fatty acids, lipid peroxidation products, some forms of prostaglandins may play a role of arythmogenic substances.
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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.
The epidemiology, risk factors, pathological anatomy, and pathogenesis of sudden cardiac death are characterized on the grounds of literature data and the results of the authors own study. The main attention was focused on sudden death in ischemic heart disease. Information on acute and chronic morphological changes in the coronary arteries of the heart, the myocardium, and the conducting system is given. The pathogenic importance of myocardial ischemia, local metabolic damages, and microcirculatory disorders in the heart muscle is discussed. It is indicated that the principal role in thanatogenesis is played by the electrical instability of the myocardium and disorders of cardiac rhythm caused to a definite measure by the structural and functional changes in the conducting system of the heart.
The paper describes a method for determining the correlation of the frequency indices grouped in the conjugation tables. The main stages involve the calculation of Pirson's criterion, determination of confidential probability of the correlation coefficient by comparison of the calculated Pirson's criterion with the standard values, and calculation of the correlation coefficient. The latter may vary within 0-1 and characterizes the correlation strength.
Bloodfilling of myocardial capillaries was determined morphometrically on the material of 12 autopsy observations of sudden coronary death (patients of 42-60 years) and 6 control observations of sudden death (subjects of 40-51 years), and these data were compared with the degree of stenosis of coronary arteries of the heart. Almost two-fold decrease of bloodfilling in sudden death was found alongside with marked increase of uneven pattern of bloodfilling. Bloodfilling was particularly decreased in the basal parts of the left ventricle and in the interventricular septum. Blood supply in much better in the apical parts of the left ventricle and the right ventricle. A trend for reverse correlation between the blood supply of the capillaries and the degree of stenosis of coronary arteries was observed.
Hearts of 12 patients with ischemic heart disease at the age of 42--60 years who had died suddenly were examined. The control consisted of 6 autopsy observations of violent death. A strong positive correlation between the degree of coronary arteries stenosis and the size of focal myocardial lesions was revealed in ischemic heart disease. No similar regularities were found in the controls. The size of myocardial lesions in the control group was minimal.
The paper describes the main principles of morphometry and its concepts and characterizes the potentials of the morphometric methods. Statistical sampling and conditions of preserving its representative character are dealt with. The implications of some concepts of variation statistics are analysed: mean values, variability indices, confidence intervals, thresholds of confidence probability, criteria of significance, regularities of the distribution of frequencies of sampling elements. The main rules of the factor, correlation, regression, dispersion, and information analysis are described. Attention is drawn to the insufficient use of morphometry potentials. It is stated that morphometric description should not overshadow the specific features of the structures under study.
The paper deals with some aspects of the dialectics of structure and function relationships in biological objects normally and pathologically. Idealistic and metaphysical concepts of the structure-function relationships (morphological idealism, holism, physiological idealism, functionalism) are critisized, and historical premises of these concepts are characterized. The principle of indissoluble unity and interconnection of changes in structure and function is emphasized, while the thesis of the primacy of function in the shaping of the form and the concept of functional diseases are rejected. Much attention is paid to the methodological principles of the study of structure and function based on the systemic approach to the investigation of biological objects from the point of view of structural levels and integratism. The groundlessness of the principles of reductionism and organicism in the solution of this problem is indicated. The connection of the concepts of structure and function with categories and laws of materialistic dialectics is dwelt on.
For assessment of diagnostic significance of nonspecific morphological signs the authors suggest to apply calculation of their informativeness according to Kullback's formula. This qualitatively characterizes the degree of difference of crossed signs in differentiating diseases. An initial value is frequency of occurrence of a sign or a degree of its manifestation determined by a relative frequency index according to histometry findings. Calculation of informativeness may be applied only with respect to statistically significant differing aspects. The value of the informativeness index corresponds to diagnostic significance of a sign. The recommended objective method broadens the sphere of application of diagnostic biopsy and may facilitate putting into practice of pathological anatomy of methods of computer diagnosis.
Vessels of the microcirculatory bed of the heart in myocardial infarction were studied on the basis of the material of 21 section observations using histological, histochemical methods and the technique of impregnation of films of the epicardium developed by V. V. Kupriyanov. In the ischemic stage in the zone of ischemia and in perifocal areas there were noted signs of increased vascular permeability and impairment of hemodynamics: plethora of the venous department of the microcirculatory system, stasis of the blood in capillaries, spasm and paresis of vessels of the microcirculation. In the necrotic stage in the zone of necrosis there were observed destruction of vessels of the microcirculatory bed; in the peri-infarction zone--drastic plethora of veins, venules and capillaries, higher vascular permeability, leucostasis, leucopedesis, perivascular cellular infiltrates, destruction of vessels of the microcirculatory bed, dilatation of lymphatic vessels; in the intact zone--venous plethora and elevated permeability. In cases of shocks and collapses in vessels of the microcirculatory bed of the heart beyond the zone of necrosis aggregations of erythrocytes were found. In the reparative stage newly formed vessels in the granulation tissue were observed; In the post-infarction scars sinusoid vascular cavities and arteries of the closing type were noted.
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