[A.V. Zinserling (Tsinzerling) school of infectious pathology: advances and prospects].

The paper analyzes the importance of infectious pathology today and discusses the main achievements of A.V. Zinserling (Tsinzerling) and his collaborators when having studied the pathologic anatomy of infectious diseases, primarily respiratory, intestinal, intrauterine ones. An indication is given to the significance of clinic and morphological comparisons, a problem of mixed infections. There is evidence that A.V. Zinserling's studies have opened the new area of science tissue microbiology in which some progress has been also achieved in recent years.

[Chronic course of influenza with extrapulmonary involvement]. / O khronicheskom techenii grippa s vnelegochnymi porazheniiami.

Results of the investigation of 265 placentas and 387 necropsies with the use of a wide spectrum of morphological, immunological and virological methods are presented. The existence of extrapulmonary damages, those of placenta (50 observations) and brain (17 observations), is shown. The variants of the influenza infection (persisting, chronic and manifesting) are discussed. The possibilities of a long-term survival of the infectious agent in the long-living brain and placental structures are considered. The proofs are presented showing the secretion by these organs of local factors of non-specific defense such as interferon.

[The characteristics of the pneumonias found in those who die in the postoperative period]. / Osobennosti pnevmonii, vyiavlennykh u umershikh v posleoperatsionnom periode.

A clinicomorphological examination of the respiratory organs has been conducted in 25 adults and 30 children who died after abdominal surgery. The authors compared the findings of light and immunofluorescent microscopy with laboratory and clinical evidence. Acute respiratory infections revealed in the examinees appeared of different etiology, many of them proved to be mixed. Viral and Mycoplasma infections were most prevalent and severe. Bacterial pneumonias occurred rarely, were clinically inapparent, often arose preoperatively. Weak aspiration indicated the absence of a direct relation between respiratory infections and disorders of bronchial drainage due to surgery performed.

[Basic unresolved problems of perinatal and pediatric pathology]. / Osnovnye nereshennye problemy perinatal'noi i detskoi patologii.

The autopsy of all spontaneous abortions, but not only of dead children is considered to be desirable to determine their diseases among which infections are frequent. The study of miscarriages lacking severe chronic pathology is important for obtaining reliable anthropometric data. The necessity of a rapid (within 1-2 days) examination of all placentas for determination of risk groups among mothers and children of purulent septic diseases as well as the causes of premature deliveries, asphyxia development and other disorders is discussed. Infections placentitis is frequently found when the placentas are carefully studied. The attention should be paid to frequently observed combined infections. Serious problem is careful investigation of syndromes (sudden infant death, infantile cerebral paralysis and others).

[Infectious toxic shock in generalized rotaviral infection in newborns]. / Infektsionno-toksicheskii shok pri generalizovannoi rotavirusnoi infektsii u novorozhdennykh.

The possibility of the rotavirus infection generalization, the course of which was complicated by the infectious toxic shock and disseminated intravascular coagulation syndrome as a cause of death of three newborns is shown for the first time. Etiology of the disease was established by electron microscopy, immunoenzymatic and immunofluorescent methods in the faeces, blood and postmortem material. The manifestations of giant cell metamorphosis not only in the intestine but also in the pia mater, kidneys, liver, lungs characteristic of RNA-viral infections indirectly confirmed the presence of viremia. Combination of rota- and respiratory syncytial viral infections made a pathologic process more severe with the development of necrotising enterocolitis, perforative serous peritonitis, intraabdominal hemorrhage.

[Status and perspectives of development of a pediatric pathology service in Saint Petersburg and the Leningrad region]. / Sostoianie i perspektivy razvitiia detskoi patologoanatomicheskoi sluzhby Sankt-Peterburga i Leningradskoi oblasti.

The structure, development and perspectives of the pathology service in St.-Petersburg and Leningrad Region are described. Preliminary data on the proportion of various diseases in children dying during perinatal period and miscarriages are presented, high incidence of intrauterine infections is indicated.

[Combined viral-mycoplasma placentitis]. / Sochetannye virusno-mikoplazmennye platsentity.

265 placentas were studied by means of light and fluorescent microscopy. 82 placentas showed combined infections induced by 2-5 agents (various viruses and mycoplasmas). Bacterial and fungal placentitis were excluded Manifestations depended on the infectious agents, their number and variants of their combination. Enhancement of vascular damage was observed in placentitis with participation of myxoviruses and herpes simplex virus. Enhancement of lymphoplasmacytic infiltration and sclerosis was typical for combined placentitis as well as alteration of antibody formation and interferon production. This reflects the gravity of the infection and its spread to the extra-placental membranes.

[Thymus mass in infants in the first year of life, who died as a result of sudden death syndrome]. / Massa timusa u detei pervogo goda zhizni, pogibshikh vsledstvie sindroma vnezapnoi smerti.

Thymus weight was studied in 117 infants of the first year of life who died a sudden death, in 195 breast-fed infants who died of various diseases and in 27 infants aged up to one year who died a violent death without disease symptoms. There was a great variability of the thymus weight in all the groups, although its values were statistically lower in the syndrome of sudden death whatever the method of comparison. No proof of the children thymomegaly in the syndrome of sudden death is found.

[Treatment and staining of smears and sections for detection of microorganisms]. / Obrabotka i okraska mazkov i srezov dlia vyiavleniia mikroorganizmov.

Detection of bacteria in smears and sections is necessary for a proper diagnosis of infectious diseases. Main methods of staining for a light- and luminescent microscopy and prescriptions of the dye preparation are presented.

[Intrauterine infections: frequency and diagnosis]. / Vnutriutrobnye infektsii (chastota i diagnostika).

Intrauterine infections occupy a considerable place in human pathology--a conclusion drawn on the basis of original and literature data. Herpetic, cytomegalic, mycoplasma and chlamydial infections are the most important among them. Intrauterine infections may be the cause of some diseases considered as somatic ones. The possibility of the pathology diagnosis of these disease not only on the basis of laboratory data but on the basis of characteristic structural changes of cells and tissues is shown.

[Cytological examination of urethral and endocervical smears in the diagnosis of infections]. / Tsitologicheskoe issledovanie mazkov iz uretry i édotserviksa dlia diagnostiki infektsii.

Cytologic studies of smears from 130 women suffering from various diseases, including 61 pregnant patients with gestoses, have shown structural changes of the cells in the smears from the endocervix and urethra, that permitted the diagnosis of Mycoplasma infection in 43.8% of patients, Chlamydia infection, 52.3%, and herpes simplex in 72.3% of patients; in 63.9% of patients these infections were combined. Cytologic studies may be useful in the tentative diagnosis of urogenital infections, including cases when it is necessary to elucidate the causes of unfavorable course of a previous pregnancy or when preterm babies are born.

[Use of the computer in the pathology department for improvement of the prophylactic medical examination and treatment of newborns and women]. / Ispol'zovanie EVM v rabote patologoanatomicheskogo otdeleniia dlia uluchsheniia dispanserizatsii i lecheniia novorozhdennykh i zhenshchin.

The practice of prognosis of the pathological conditions development in newborns on the basis of placenta examination and the evaluation of results by a computer is described. The same method was used for the determination of the risk groups among the women. The results of cytological diagnosis of some chronic infections on the basis of examination of endocervix and urethra smears are also presented. According to the authors the work performed helped in reducing the children mortality.

[Combined and mixed infections in human pathology]. / Sochetannye i smeshannye infektsii v patologii cheloveka.

The author' and his colleagues publications dealing with combined and/or mixed infections are summarized. It is pointed out that these pathological studies of current autopsy, surgical, biopsy and experimental materials were performed according to principles formulated by V. D. Zinserling (1892-1960) as early as in 1920-1930. The results obtained are compared to the facts revealed by V. D. Zinserling and his students 30 to 70 years ago. Rather high incidence of combined and mixed infections is outlined, various localizations of main lesions are described (lungs, brain, gastro-intestinal tract, tonsilla and other organs and tissues). Considerable influence that combined infections exert on each other is shown; it is brought about mainly by the change of the host. Some mechanisms are discussed: damage of local protective mechanisms, suppression or stimulation of immune mechanism, including interferonogenesis, and others.

[AIDS in children based on autopsy data from the Kalmyk ASSR]. / SPID u detei po sektsionnym materialam Kalmytskoi ASSR.

6 cases of HIV infection were revealed by enzyme immunoassay and immunoblotting among 144 children who had died in Elista. Another 5 children might have had HIV-infection but laboratory analyses either were lacking or gave doubtful results. Laboratory results were negative in 133 children. Similar severe changes of the lymphoid system typical for immunodeficiency were found in all children. These changes in HIV infection were characterized by lymphogenic generalized RNA infection. Complications (secondary diseases) in the form of DNA-virus infections (cytomegalia and herpes simplex), pneumocystosis and other viral and bacterial processes were observed in children of all groups. The disease was found mainly in Kalmyks. Blood examination of healthy Kalmyks revealed some differences in the form of significant decrease of the lysosomal cationic proteins content and the peroxydase activity of neutrophil leucocytes as compared to the same indexes obtained in Leningrad. There was also a tendency to the decrease of T-lymphocyte content. The children dying from immunodeficiencies lived mainly along the litoral of an ancient sea.

[Acute respiratory infections in children who have died and the role of the DIC syndrome in these diseases]. / Ostrye respiratornye infektsii u umershikh detei i rol' DVS-sindroma pri étikh zabolevaniiakh.

The results of several years study of the acute respiratory infections (ARI) (pneumonias) are summarized. Their high frequency in dying children is found (72% of autopsy cases in all Leningrad pediatric hospitals). Their etiology is usually complex: viral ARI were in 62.9%, bacterial--56.1%, mycoplasma--8.9%. Structural changes are described in some poorly known ARI (herpetic, cytomegalic, pneumocystic). The distribution of various ARI between hospitals and the etiology of children pneumonia in cases of the death at home (381 cases) or in hospitals (447 cases) are analysed when the autopsy was performed in the same pathology department with detail laboratory investigation. Pneumonias in these groups differed in the etiology and manifestations, first because of bacterial infections. In 114 children the incidence and manifestations of DIC syndrome were studied and this syndrome was shown to have a considerable importance in thanatogenesis particularly during first days of the disease and when the generalization of infections occurs.

[Criteria for the morphologic diagnosis of AIDS in autopsy material]. / O nektoroykh kriteriiakh morfologicheskoi diagnostikik SPIDa na sektsionnom materiale.

Our own lethal case of AIDS and the results of the study of other generalized viral infections, and literature data allow us to conclude that lymphoid system damage is the most characteristic feature of the disease. Hyperplasia of lymph nodes and the spleen occurs in the acute stage of the disease. Hyperplasia with subsequent desquamation of the sinus endothelium and alteration in dendritic reticular cells are found histologically. There is an accumulation in the sinuses of large cells with an abundant eosinophilic PAS-positive cytoplasm and a relatively clear nucleus, sometimes several nuclei are observed. Similar, in principle, changes as a manifestation of generalization, may occur in other organs, including alveolocytes and nephrothelium. All these changes suggest AIDS. The presence of immunodeficiency is confirmed by the unusually severe course of other infections, most frequently pneumocystosis.

[Chlamydiosis: diagnosis and role in human pathology]. / Khlamidiozy: Diagnostika, rol' v patologii cheloveka.

The paper presents the data reported in literature on the taxonomy of chlamydia, their tinctorial properties and modes of infection. It comes as evidence for the significance of urogenital chlamydiosis, including venereal lymphogranuloma. The morphological characteristics of the former abnormal condition are reported. Then the paper analyses intrauterine chlamydiosis and provides the results of the author's own investigations that suggest that its manifestations are largely similar to those of intrauterine mycoplasmosis. There is detailed information on respiratory chlamydiosis (ornithosis, psittacosis) and eye diseases (trachoma and paratrachoma). Finally, benign lymphoreticulosis (cat-scratch disease) is briefly reported too. Special emphasis is laid on extremely high incidence of chlamydiosis, in terms of laboratory and epidemiological data, and on little evidence for its structural changes. Nevertheless, the author considers that chlamydiosis may be suspected by the presence of basically homogeneous morphological changes in various diseases caused by different chlamydia, as evidenced by a light microscopy. This is especially important for a pediatric pathologist in his practice. Since even if the diagnosis is supposed to be established in a baby who has died in the perinatal period or upon examination of his/her afterbirth, the parents should undergo clinical and laboratory examinations followed by therapy as the need arises.

[Infectious placentitis, its effect on the fetus and infant development]. / Infektsionnye platsentity, ikh vliianie na plod i razvitie rebenka.

A random sample of 1000 placentae has been screened for infectious affections. Placentitis induced most commonly by Mycoplasma, herpetic and respiratory viruses was found in 213 of the examined placentae. Bacterial and mycotic involvement presented in 14 of cases. Immunofluorescence technique employed for the agents investigation revealed relevant agents and antigens as well as infection-specific structural rearrangement. There are also nonspecific organ alterations resulting in its insufficiency and having a high predictive value for the future developments. Placenta appeared capable of nonspecific protection against infection based on interferon production. Prognosis for genital-atrium infection proved most unfavorable.

[Herpetic infection (Herpes simplex]. / Gerpeticheskaia infektsiia (prostoi gerpes).

Structural manifestations of Herpesviridae infection, largely of herpes simplex, transmission and mode of entry were analysed and investigated by the authors on section material using light and immunofluorescent microscopy in combination with serological tests. In overall neonatal section material generalized herpetic infection was a frequent finding (4.7%). The lesions in type I and II herpes simplex were similar in manifestations. Structural evaluation of the viscera in prenatal and placental infections suggests affection of cells of epithelial origin with metamorphosis of the giant cells and a drastic increase of the nuclei exhibiting large inclusions rich in DNA. Alternative changes were more pronounced in the brain, while the destruction of the affected cells was more intensive in the lungs. Postnatal herpes simplex virus infection was also covered.