Biomedical subjects
S M Sekamova
Publications and source records attributed to S M Sekamova.
[Carcinoids of lungs].
The analysis of the results of the examination and treatment of 29 patients with carcinoids of the lungs has been carried out for 1984-1995. Peripheral carcinoids were detected in 59% of cases, of the tumor in the main and lobar bronchi was revealed in 41% of cases. The analysis showed that there are no symptoms, pathognomonic for carcinoids of the lungs; carcinoid syndrome was not detected in any patient. The examination (roentgenography and CT of the lungs, bronchoscopy) has not provided any objective, differential diagnostic criteria for carcinoids, cancer and benign tumors of the lungs. Morphological examination of the removed tumors allowed all the carcinoids to be divided in two types: typical (benign neuroendocrine tumor) and atypical (well differentiated neuroendocrine carcinoma). The final differentiation is possible only after conduction of thorough histological, electron microscopy and immunohistochemical examination. The principal method of carcinoids treatment is surgical one. The optimal surgical procedure is pneumonectomy or lobectomy with lymphadenectomy. Atypical resection of the lung without lymphadenectomy in peripheral location of the tumor is justified only in early stages of the disease and in cases of morphological verification of benign character of neuroendocrine tumor. Late results were followed up in 27 patients. In the group of patients with atypical carcinoids in terms of 6 to 12 months 3 patients died from progressing of the main disease. There were neither lethal outcomes nor signs of relapse of the disease in the group of patients with typical carcinoid. The terms of follow up were from 1 year to 12 years.
[Intercellular interactions in morphogenesis of initial lesions and sclerosis in interstitial lung diseases].
A total of 117 patients with pulmonary interstitial diseases (PID) were examined. The functional activity of alveolar macrophages was assayed in the lavage fluid and in lung tissue biopsy specimens from the generation of active oxygen forms, the secretion of tumor necrosis factor, fibronectin, expression of c-fos- and c-sis-oncoprotein. The stereotypic value for various PID was the development of alveolitis running in 2 stages: 1) early one, including exudative inflammation and 2) late one, involving sclerotic changes up to the formation of the honeycomb lung. This results in the block of the blood-air barrier and progression of respiratory failure and hypoxia in patients. The morphogenesis of fibrosing alveolitis is formed of alveolar septal damages caused by etiological agents of various nature, which is frequently unclear, by active forms of oxygen, lipid peroxidation products, proteases, tumor necrosis factor, which are produced by activated alveolar macrophages and polymorphonuclear leukocytes. The alveolar macrophage that secretes growth factors, c-fos- and c-sis-oncoproteins plays the key role in the progression of sclerotic changes. Lung cancer may develop at the end of fibrosing alveolitis at the stage of the honeycomb lung.
[Variants and stages in the course of idiopathic fibrosing alveolitis].
Clinicomorphological analysis covered 41 cases of idiopathic fibrosing alveolitis (IFA). The comparison of the degree of respiratory insufficiency, hypoxia, survival of the patients with cytogram of the bronchoalveolar lavage, morphological findings, generation of active oxygen forms by alveolar macrophages and leukocytes has provided evidence on an important role of alveolar macrophage in interstitial alveolitis and fibrosis in IFA. Three variants of chronic IFA are distinguished: aggressive, persistent and slowly progressive. The variants have different prognosis and need individual therapeutic approach.
[The clinico-morphological characteristics of interstitial lung diseases].
Electron microscopic and immunohistochemical methods were employed to study composition of collagens in extracellular matrix and quantify oncoproteins c-sis and c-fos. It was established that interstitial pulmonary diseases of various etiology are characterized at early stages by alveolitis with activation of alveolar macrophages, at late stages by interstitial fibrosis with accumulation of collagens type I, III, IV and V and epithelial dysplasia which is likely to initiate bronchioloalveolar cancer.
[Diagnostic criteria of pyloric helicobacter infection in peptic ulcer].
Helicobacter pylori (HP) in 41 patients (10 with stomach ulcer and 31 with duodenum ulcer) was found in gastro-biopsies from the stomach antrum before and after the treatment. The following methods to reveal HP were used: Giemsa staining, immunoperoxidase reaction with polyclonal monospecific antibodies against HP, urease rapid test. HP was also revealed in the blood serum by antibodies against HP by means of enzyme immunoassay. Electron microscopy was performed in 5 patients and bacteriologic study in 10 patients. Immunohistochemical method allows one to judge about real HP colonization of the gastric mucosa. Bacterioscopy with Giemsa staining gives good results but they are not true markers of HP presence this being explained by other methods. Serologic enzyme immunoassay gives an idea about the patient contamination, but not about HP eliminations as a result of treatment. Urease-test is adjuvant.
[The extracellular matrix of peripheral lung cancer in the scar and of pneumosclerosis of different origins (the immunohistochemistry and electron microscopy of the collagens)].
Collagen types and ultrastructural features of the stroma and scar extracellular matrix in the peripheral lung carcinoma, post-tuberculosis and post-pneumonia pneumosclerosis foci, fibrosing alveolitis interstitium were studied on the material of operational and transbronchial lung biopsies. It is established that by the collagen composition the scars in the peripheral carcinoma are identical to the pneumosclerosis foci and are distinguished from the carcinoma stroma by a higher concentration of type IV and V collagens (p less than 0.05). Accumulation of type III collagen in the lung carcinoma stroma reflects anaplasia of the tumour as the domination of type III collagen is characteristic of the embryonal tissue. The decrease of collagen type IV in the cancer stroma correlates with an increase of its malignancy. Pneumosclerosis in the fibrosing alveolitis is distinct from the focal forms of pneumosclerosis by a higher content of collagen I and a lower content of collagen V this being probably due to the character of sclerosis morphogenesis in this disease.
[Peripheral small cell carcinoma, atypical and typical lung carcinoids (morphologic features, cell oncogene expression, DNA histospectrophotometry)].
Morphogenetic and molecular-biological features of the lung peripheral tumours (small-cell carcinoma, atypical and typical carcinoid) were studied on the surgical material from 68 patients. Spectrum of histologic, histochemical, immunohistochemical (immunohistochemistry of oncoproteins c-fos, c-myc, c-ras, c-sis and c-src) methods, DNA histospectrophotometry by plug-method, electron microscopy, semithin section morphometry, statistical and correlation analysis were used. Small-cell carcinoma is shown to be a heterogeneous group of tumours that includes tumours with endocrine cell differentiation, endocrine and epidermoid and/or glandular, undifferentiated cell carcinoma. Lymphocyte-like carcinoma and intermediate cell carcinoma with endocrine cell differentiation are distinguished from other types of lung carcinoma by their low, sometimes diploid DNA content that does not correlate with its malignancy as well as by a low level of expression of cell oncogenes c-fos, c-ras, c-sis. Small-cell carcinoma with endocrine cell differentiation, atypical and typical lung carcinoids represent a unique histogenetic group of endocrine lung tumours that differ from each other by the degree of anaplasia.
[Kidney adenoma].
Morphological, electron microscopic, histospectrophotometric and morphometric (mean nuclear surface and ellipticity coefficient) studies of small cortical adenomas were performed. Surgical (kidneys removed because of renal cell carcinoma and shrinkage) and autopsy (atrophic kidney) materials were used. Total 142 adenomas were found in 93 out of 592 observations. The incidence of adenomas in kidneys with renal cell carcinoma was 12%, in contracted kidneys 19.2 and 19.44% (surgical and autopsy material). Electron microscopic examination was performed in 15 adenoma cases. Comparative quantitative DNA determination was performed in sections stained by Feulgen using plug-method on the microscope spectrum analyzers in 20 cases of adenoma and 15 cases of renal cell carcinoma identical histologically to adenocarcinoma. This combined study revealed the adenomas heterogeneity. Only part of them (well differentiated with diploid DNA-histograms and nuclei up to 32 mm2 may be referred to adenomas. All the others morphologically and morphometrically are close to adenocarcinomas. The type of DNA distribution and mean nuclear surface are most important for differential diagnosis between renal adenoma and carcinoma.
[Angiosarcoma of the testicular tunica].
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.
[Lung carcinosarcoma].
Lung carcinoma in a 72-year-old man smoker is described. Tumour, 12x8x8 sm in size, was located in the middle lobe of the right lung. Metastases were in the regional lymph nodes, soft tissue of the anterior abdominal wall, gastric mucosa and left adrenal. Epithelial component had signs of the undifferentiated carcinoma and adenocarcinoma, mesenchymal component consisted of leiomyosarcoma. Electron-microscopically, tumour cells with squamous, glandular, smooth muscle and fibroblastic features were found.
[Morphology of the thymus gland in children with myasthenia gravis].
Thymus excised from 68 patients suffering from juvenile myasthenia was subjected to histological, histochemical and electron microscopy studies. The changes in the thymus involved hyperplastic immune response in the form of lymphoid follicles with the germinal centers and focal plasmocytic infiltration. In myasthenia, the permanent characteristic of the thymus was activation of epithelial cells and Hassal bodies. A direct relationship was discovered between the efficacy of thymectomy and intensity of hyperplasia of the glandular lobules of the thymus. The lobule number of lymphoid follicles with the germinal centers did not affect the results of the surgical treatment of patients suffering from myasthenia.
[Campylobacter pylori and the reparative processes in peptic ulcer].
The paper deals with reparative potential of gastric and duodenal mucosa in ulcer in connection with the presence and quantity of Campylobacter pylori (CP) which is found practically in all patients not only with duodenal localization of ulcer but with mediogastric and pyloroantral localization as well. No correlation between the CP presence and CP mucosa colonization on the one hand and the type of reparative processes in the mucosa is found. The presence or the absence of CP as well as the degree of CP mucosal dissemination have no influence on the clinical course of the ulcer. Antiulcer treatment aiming at aggression factors (histamine H2-receptors blockers) and protective factors (enprostil) and lacking antibacterial activity improves the reparative processes but does not influence CP. Thus, CP is not etiological and probably is not a main pathogenetic factor in ulcer development. Its participation in the genesis of ulcer is possibly brought about under conditions of suppression of local protective mechanisms.
[Chronic gastroduodenitis in children and Campylobacter pylori].
Gastric biopsies from 90 children (from 5- to 15-year-old) with chronic gastroduodenitis were examined for Campylobacter pylori (CP) by bacteriological, histological (Giemsa stain, argentation by Warthin-Starry, acridine orange stain) and electron microscopical methods. CP is detected in 81.2% children. The degree of colonization was low or moderate. The increase of occurrence was noted with age and duration of disease. Persistence of CP went down with the increase of atrophic change in the gastric mucosa and duodenum, but there was no clear-cut correlation with the morphological variant of gastritis and the stage of disease. Colonization with CP is regarded as an important part in the pathogenesis of chronic gastroduodenitis in children.
[Aortic amyloidosis in elderly patients].
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[Features of senile cerebral amyloidosis].
It is established, on the basis of the autopsy material of I. M. Sechenov First Moscow Medical Institute for 1983-1987 (517 patients who died at the age of 40-89 years), that senile cerebral amyloidosis (SCA) is a local form of senile amyloidosis which occurs in 4.4% persons over 60 years of age. At the autopsy SCA is revealed in 21.4% cases, but the examination of the brain for amyloid increases the percent up to 78.6. Amyloid deposits are observed as senile plaques in the vessels of pia mater, plexus chorioideus and intracerebral vessels. Genetic factors in the SCA development can not be excluded.
[The morphology of mesenteric lymph nodes in Whipple's disease].
A patient aged 45 suffering from Whipple's disease is described. The disease has been diagnosed on the basis of morphologic examination of a biopsy specimen of the small intestine mesenteric lymph node. The patient had suffered from the disease for 14 years; during the last 6 months he developed symptoms of the malabsorption syndrome with diarrhea and steatorrhea. The lymph nodes contained numerous macrophages with PAS-positive glycoprotein granules in the cytoplasm, small cavities filled with lipids; electron microscopy has revealed bacillus-like bodies in the macrophages and outside the cells. After the disease has been diagnosed, the patient has been administered a course of tetracycline therapy, that resulted in an improvement of his status.
[Age-related amyloidosis of the pancreatic islets and diabetes mellitus].
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