[Actual problems of the pathology of sepsis: 25 years in search of a consensus]. / Aktual'nye problemy patologii sepsisa: 25 let v poiskakh konsensusa.

In search of a consensus the authors give current materials on the pathobiology of sepsis, which concerns the definitions, classification, etiology, pathogenesis, and diagnosis of the disease on the basis of their own experience and the data available in the literature. The sepsis problem that is one of the most controversial and complex ones in pathobiology and medical practice has undergone a great very important 25-year stage of development to culminate in the adoption of clinical Sepsis-3 Consensus. International experts have proposed a new definition of sepsis, with an emphasis on the life-threatening condition and the presence of organ dysfunction that can be regarded as an analogous to organ damage. Systemic inflammatory response remains an essential sign of sepsis, but is not strictly specific. Instead of its previous four forms of sepsis, two forms of the disease (sepsis proper and septic shock) have been identified. The Consensus-proposed Sepsis-3 criteria for diagnosing sepsis continue to remain predominantly clinical laboratory ones, confirming the need for further clinicopathological and experimental morphological comparisons in order to achieve a complete understanding of the problem of sepsis between clinicians and pathologists.

[Clinical and epidemiological features of tuberculosis ostitis in BCG-vaccinated children].

There has been a drastic increase in the incidence of ostitis in children since 2001. Comparison of current tuberculous ostitis (n = 70) and primary pulmonary tuberculosis (n = 60) in infants revealed significant clinical and epidemiological differences. Molecular genetic methods identified BCG M. bovis strain DNA in 13 (46.4%) intraoperative samples and 4 samples of obtained cultures from bone destruction foci. Isolation of BCG cultures and/or verification of BCG M. ovis DNA from the bone lesion focus by polymerase chain reaction is a significant criterion for verification of the BCG etiology of ostitis having a morphological pattern of productive necrotic tuberculosis in children.

[Sepsis and the theory of systemic inflammatory reaction is an attempt of clinicomorphological consensus].

The authors propose to put the 1991 US Consensus Conference criteria for sepsis into practice and research methodology. This will be helpful in reaching the consensus in definitions.

Quantitative pathology of inhalational anthrax I: quantitative microscopic findings.

Forty-one cases of documented inhalational anthrax from the Sverdlovsk epidemic of 1979 traced to release of aerosols of Bacillus anthracis at a secret biologic-agent production facility were evaluated by semiquantitative histopathologic analysis of tissue concentrations of organisms, inflammation, hemorrhage, and other lesions in the mediastinum, mediastinal lymph nodes, bronchi, lungs, heart, spleen, liver, intestines, kidneys, adrenal glands, and central nervous system. These data were correlated with clinical, epidemiologic, and demographic data. The patients' courses, with a variable incubation period and short nonspecific course (4 days before hospitalization) with rapid demise (1 day of hospitalization before death), correlated with systemic bacterial infection and lesions. Bacillus anthracis were identified in all cases in which there was no antibiotic treatment or there was treatment for fewer than 21 hours. The lesions that were the most severe and apparently of longest duration were in the mediastinal lymph nodes and mediastinum. There and elsewhere, peripheral transudate surrounded fibrin-rich edema; necrosis of arteries and veins was the most likely source of large hemorrhages displacing tissue or infiltrating tissue, respectively; and apoptosis of lymphocytes was observed. Respiratory function was compromised by mediastinal expansion, large pleural effusions, and hematogenous and retrograde lymphatic vessel spread of B. anthracis to the lung with consequent pneumonia. The central nervous system and intestines manifested similar hematogenous spread, vasculitis, hemorrhages, and edema. These pathologic findings are consistent with previous experimental studies showing transport of inhaled spores to mediastinal lymph nodes, where germination and growth lead to local lesions and systemic spread, with resulting edema and cell death, owing to the effects of edema toxin and lethal toxin. The identification of the vascular lesions as a basis for the prominent hemorrhages is a novel observation for human inhalational anthrax.

PCR analysis of tissue samples from the 1979 Sverdlovsk anthrax victims: the presence of multiple Bacillus anthracis strains in different victims.

An outbreak of human anthrax occurred in Sverdlovsk, Union of Soviet Socialists Republic (now Ekaterinburg, Russia) in April 1979. Officials attributed this to consumption of contaminated meat, but Western governments believed it resulted from inhalation of spores accidentally released from a nearby military research facility. Tissue samples from 11 victims were obtained and methods of efficiently extracting high-quality total DNA from these samples were developed. Extracted DNA was analyzed by using PCR to determine whether it contained Bacillus anthracis-specific sequences. Double PCR using "nested primers" increased sensitivity of the assay significantly. Tissue samples from 11 persons who died during the epidemic were examined. Results demonstrated that the entire complement of B. anthracis toxin and capsular antigen genes required for pathogenicity were present in tissues from each of these victims. Tissue from a vaccination site contained primarily nucleic acids from a live vaccine, although traces of genes from the infecting organisms were also present. PCR analysis using primers that detect the vrrA gene variable region on the B. anthracis chromosome demonstrated that at least four of the five known strain categories defined by this region were present in the tissue samples. Only one category is found in a single B. anthracis strain.

Pathology of inhalational anthrax in 42 cases from the Sverdlovsk outbreak of 1979.

A large epidemic of anthrax that occurred in Sverdlovsk (now Ekaterinburg), Russia, in 1979 resulted in the deaths of many persons. A series of 42 necropsies, representing a majority of the fatalities from this outbreak, consistently revealed pathologic lesions diagnostic of inhalational anthrax, namely hemorrhagic necrosis of the thoracic lymph nodes in the lymphatic drainage of the lungs and hemorrhagic mediastinitis. Bacillus anthracis was recovered in bacterial cultures of 20 cases, and organisms were detected microscopically in the infected tissues of nearly all of the cases. A novel observation was primary focal hemorrhagic necrotizing pneumonia at the apparent portal of entry in 11 cases. Mesenteric lymphadenitis occurred in only 9 cases. This remarkably large series demonstrated the full range of effects of anthrax bacteremia and toxemia (edema especially adjacent to sites of extensive infection and pleural effusions) and hematogenously disseminated infection [hemorrhagic meningitis (21 cases) and multiple gastrointestinal submucosal hemorrhagic lesions (39 cases)].

[The causes of death in pulmonary tuberculosis patients living in the industrial areas of the Urals]. / Prichiny smerti bol'nykh tuberkulezom legkikh, prozhivaiushchikh v promyshlennykh raionakh Urala.

A comparative study of the causes of death of tuberculosis patients living in the industrial centres of the Ural for the period of 1953-1990 has shown that beginning in 1980's the frequency of progressive forms of tuberculosis increases, while the proportion of cardiopulmonary and chronic renal insufficiency as the cause of death diminishes (5.8 and 0.6%, respectively). Among those who died subjects of the able-bodied age and those with antisocial mode of life account for 40%. The middle-aged and elderly subjects (average age is 67 years) die mainly of silicotuberculosis among whom 40% die of cardiopulmonary insufficiency.

[Pathology of anthrax sepsis according to materials of the infectious outbreak in 1979 in Sverdlovsk (macroscopic changes)]. / Patologicheskaia anatomiia sibireiazvennogo sepsisa po materialam infektsionnoi vspyshki 1979g. v Sverdlovske (makroskopicheskie izmeneniia).

Obligatory findings in 42 postmortem observation of anthrax were hemorrhagic alterations of the intrathoracic lymph nodes and mediastinum. Hemorrhagic alterations in the respiratory organs, digestive tract, brain and meninges were also found macroscopically.

[Pathology of anthrax sepsis according to materials of the infectious outbreak in 1979 in Sverdlovsk (microscopic changes)]. / Patologicheskaia anatomiia sibireiazvennogo sepsisa po materialam infektsionnoi vspyshki 1979g v Sverdlovske (mikroskopicheskie izmeneniia).

Histologic studies of 42 cases of anthrax revealed that serous-hemorrhagic, hemorrhagic and hemorrhagic-necrotic inflammation was a substrate of macroscopic changes. Morphological characteristics of alterations in the respiratory organs, lymph nodes and mediastinum, digestive tract and liver, spleen, kidneys, brain and meninges are presented.

[Pathology of anthrax sepsis according to materials of the infectious outbreak in 1979 in Sverdlovsk (various aspects of morpho-, patho- and thanatogenesis)]. / Patologicheskaia anatomiia sibireiazvennogo sepsisa po materialam infektsionnoi vspyshki 1979 g. v Sverdlovske (nekotorye voprotsy morfo-, pato- i tanatogeneza.

Hemorrhagic lymphadenitis of the intrathoracic lymph nodes and mediastinitis are shown to be the primary septical focus, this indicating an inhalation route of the contamination with development of pulmonary anthrax. The alterations in the gastrointestinal tract and central nervous system are considered to be secondary resulting from lymphohematogenic generalization of the anthraxic sepsis. The attention is drawn to the morphological signs of the immunodepression and the inhibition of granulocytic reaction. It is noted that the epidemic outburst of the pulmonary anthrax is without analogs and its development may be the result only of a massive penetration of bacteria into the atmosphere.

[Prevalent disseminated form of bronchiolo-alveolar cancer]. / Rasprostranennaia disseminirovannaia forma bronkhioloal'veoliarnogo raka.

Three roentgenological variants of the course of the prevalent disseminated form of bronchoalveolar cancer were distinguished proceeding from the clinical and X-ray study: focal-disseminated (5 cases), focal-nodal (11) and focal-infiltrative (16). In the authors' opinion, the prevalent disseminated form of bronchoalveolar cancer is a terminal phase in the development of the more restricted forms of a tumour (nodal and pneumonia-like) which is formed by way of intrapulmonary aerogenic (bronchogenic) metastasis.

[Morphology of bronchiolo-alveolar cancer]. / Morfologiia bronkhioloal'veoliarnogo raka.

The criteria of the morphological diagnosis of bronchiolo-alveolar carcinoma are presented on the material of 140 cases. Three main histological types are distinguished: clear-cell, dark-cell, polymorphic-cell. Anatomical forms of tumour growth are also identified: nodular, pneumonia-like, disseminated.

[The diagnosis of bronchiolar-alveolar cancer]. / Diagnostika bronkhioloal'veoliarnogo raka.

Based on clinical and x-ray studies of 123 cases of bronchioloalveolar carcinoma (BAC) verified at the clinic of lung surgery during 1964-1988, three main x-ray anatomic forms of BAC were distinguished: nodular, pneumonia-like and mixed (disseminated). Each of the forms correlates with the appropriate x-ray variants, has a specific clinical picture, requires specific differential diagnosis. Optimal methods of obtaining material with a purpose of morphological verification of the diagnosis were delineated for each of the x-ray anatomic forms of BAC.

[Roentgeno-morphologic characteristics of the principal forms of pulmonary sequestration]. / Rentgenomorfologicheskaia kharakteristika osnovnykh form legochnoi sekvestratsii.

Basing on roentgeno-morphological correlations, three morphological types of pulmonary sequestration (PS) were singled out: intrapulmonary, intrapleural (peripulmonary) and extrapleural (mediastinal). PS signs on a skiagram can be of two types: spherical and cavitary. Reliable clinicoroentgenological diagnosis of PS is hardly possible and of hypothetical nature. Transthoracic puncture is the most effective and common diagnostic method.

[Roentgeno-morphologic forms of bronchioloalveolar cancer]. / Rentgenomorfologicheskie formy bronkhioloal'veoliarnogo raka.

The paper is concerned with the description of clinical, x-ray and morphological investigation of 123 bronchoalveolar cancer patients. Three types of this disease were defined: nodular (homogeneous and nonhomogeneous), pneumonia-like (infiltrative and infiltrative-nodular) and mixed (focal-disseminated, focal-nodular and focal-infiltrative). These types of bronchoalveolar cancer are most probably stages of the same tumor process. Clinical and x-ray signs of each type showed correlation with a morphological picture of a tumor. Shadow nonhomogeneity as one of the main x-ray signs of bronchoalveolar cancer was shown to be determined by the "alveolar" structure of a tumor, a tendency to the formation of small cavities, filled with viscous mucosa and air. Correct clinical and x-ray diagnosis in all types of bronchoalveolar cancer (before the use of the morphological methods) was established in 45.5% of the patients.