[Myocardial infarction and acute coronary syndrome: definitions, classification, and diagnostic criteria].

The review gives the definitions and classification of and diagnostic criteria for myocardial infarction and acute coronary syndrome in accordance with the "The third universal definition of myocardial infarction" adopted in 2012 (Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, 2012). It also discusses the clinical and morphological comparisons of and the problems in the differential diagnosis of myocardial infarction as a nosological entity within coronary heart disease with other coronarogenic and non-coronarogenic necroses of the myocardium.

[The present views of chronic obstructive pulmonary disease and the senile lung].

The gross postmortem diagnosis of chronic obstructive pulmonary disease (COPD) and its differential diagnosis with senile lungs on autopsy specimens are much difficult if clinical, X-ray, and functional findings are absent. The diagnosis of COPD is now possible only if medical history and clinical data, external respiratory function, and disease severity are considered and compared with the gross and microscopic autopsy pattern, by obligatorily evaluating the state of collagen and elastic fibers. Taking into account the current definition and essence of COPD, it is expedient to reconsider existing stereotypes in the postmortem diagnosis of this disease, by focusing our efforts on the study of its morphologic substrate, patho-, and morphogenesis.

[Correlation of salivary and genital glands].

Based on the experimental data correlation of parotids and genital glands in 24 male rabbits 1.5 months after testectomy (full testectomy, unilateral partial resection and bilateral partial resection) was found out. The findings included hyperplasia, parenchyma atrophy, stromal and periductal sclerosis of the parotids. In the majority of cases in adjacent lymphatic notes hyperplasia of B-zones and devastation of T-zones may also be seen, confirming autoimmune reaction after genital glands injury.

[Pathologic anatomy of Barrett's esophagus].

It is most substantiated to define Barrett's esophagus as intestinal metaplasia of esophageal cardiac mucosa irrespective of its association with the endoscopically detected esophageogastric junction, which develops as a result of gastroesophageal reflux. There is a need for further investigations of the specific features of the cardiac-type mucosa. During endoscopic study, it is important to be alert when identifying short and ultrashort Barrett's esophagus and to sample sufficient biopsy material. A pathologist must differentiate three major types of the cylindrical epithelium of the esophagus: cardiac, acid-producing cardiac, and intestinal metaplasia, by diagnosing Barrett's esophagus in the latter case. Patients with the esophageal cardiac mucosa should be referred to as a risk group for its development.

[State of the colon after cholecystectomy].

Study of the colon was carried out in patients with cholelithiasis after cholecystectomy. Estimated clinical symptoms, the mucous membrane status by the results of the histological, morphometric methods, computed ploidometry and immunomorphology of colon biopsy specimens. Mucosal atrophy, the buildup of sclerotic processes and proliferative activity of colonocytes was significantly more frequent in patients with cholecystectomy in history, than in patients with cholelithiasis and the control group. Most of the examined patients have disorders of the colon microbiocenosis. Use of domestic liquid synbiotic complexes Normoflorin L and B allowed to hold a successful correction of disbiosis.

[Acute gastroduodenal erosions and ulcers in coronary heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease].

A total of 4684 autopsies made at Moscow multidisciplinary hospitals in 2002-2008 were studied to reveal the incidence and morphological features of acute gastroduodenal erosions and ulcers in coronary heart disease (CHD), cerebrovascular disease (CVD), and chronic obstructive pulmonary disease (COPD). Cases with combined, background, and concomitant diseases that could be independent causes of gastroduodenal lesions were excluded. Patients older than 60 years with infarctions of the myocardium or brain, a concurrence of CHD, CVD, and COPD, and various diseases with chronic heart failure syndrome, particularly in the presence of arterial hypertension and diabetes mellitus should be referred to as a risk group for acute gastroduodenal erosions and ulcers and their induced hemorrhages.

[Pathological anatomy in A/H1N1 influenza].

Forty autopsy cases died from A/H1N1 influenza in Moscow, the Moscow Region, and Chita were analyzed. Major changes were found to develop in the trachea and lung. The lung showed the pattern of exudative and proliferative stages of diffuse alveolar lesion. In addition, the signs of viremia-associated infectious-toxic shock, as suggested by pronounced changes in the brain, kidneys, liver, spleen, adrenals, and lymph nodes were revealed. Bacterial bronchopneumonia was detected only in 20% of cases.

[Pathomorphology of the lung in severe influenza A/H1N1].

Thirty-five autopsy cases of influenza A/HIN1 in Moscow were analyzed. Primary pathological changes were found in the trachea and lung. The lung showed a pattern of the exudative and proliferative stages of diffuse alveolar damage. In addition, there were signs of infectious-toxic shock associated with viremia, as suggested by pronounced changes in the brain, kidneys, liver, spleen, adrenals, and lymph nodes. Bacterial bronchopneumonia was detected in only 20% of cases.

[Molecular biological features of ectopic and eutopic endometrium in genital endometriosis].

The molecular biological features of the eutopic and ectopic endometrium were studied in 46 patients with adenomyosis, 44 with endometrioid cysts in the ovaries, and 34 with disseminated mixed forms of genital endometriosis. Reproductive-aged patients with the eutopic endometrium in a proliferation phase with hyperplastic or inflammatory changes were selected. Ten samples of the endometrium in a phase proliferation, which had been obtained at medicolegal autopsy of women without reproductive disorders, were studied as a control group. Both the glandular and stromal components of the ectopic and eutopic endometrium in different forms of endometriosis were shown to differ from the intact endometrium in their molecular biological features (the expression of Ki-67, Bcl-2, Bax, vascular endothelial growth factor, transforming growth factor-beta1, matrix metalloproteinases 2 and 10, matrix metalloproteinase-2 inhibitor, the enzyme cytochrome P450 aromatase.

[Acute erosive gastropathies].

There is a rise in the rates of acute erosive gastropathies in patients with cardiovascular and other somatic diseases. The role of acute erosive gastropathy-induced hemorrhages in the tanatogenesis of these diseases is underestimated; the problems of their prevention, diagnosis, and treatment remained unsolved. Many factors, mainly acute or chronic ischemia of the gastroduodenal mucosa, as well as its age-related involution, Helicobacter pylori infection, reflux gastritis, multiple organ dysfunction, drug-induced damage, etc., which are implicated in the pathogenesis of acute erosive gastropathies in patients with cardiovascular and other somatic diseases, are summarized.

[The morphology of the immune system in opiomania, cannabism, and polynarcotism].

The organs of the immune system were morphologically and immunohistochemically studied in chronic opiomania (n = 219), cannabism (n = 22), and polynarcotism (n = 69) after excluding HIV-infected patients. In opiomania, immune disorders were identified in 98.6% of cases. These immune disorders differ according to their stage and characterize by the inversion of the T-helper/T-suppressor index, the reductions in the proliferative activity of lymphocytes and the production of immunoglobulins, atrophy of the thymus and T zones, and, in 37.4% of cases, persistent follicular hyperplasia of B zones with the impaired architectonics of lymphoid follicles. It is a cause of generalized lymphadenopathy and splenomegaly, which are similar to those observed in HIV infection. Infection with hepatitis B and C viruses enhances thymus and T-zone atrophy, but B-tone hyperplasia particularly in the lymph nodes of the hepatic hilum and spleen. In cannabism, the morphological signs of immunodeficiency were revealed only in 13.6% of the dead and there was no inversion of the T-helper/T-suppressor index. In polynarcotism, the involvement of immune organs is most severe and similar to that seen in opiomania.

[Matters of identifying the categories of discrepancy between diagnoses as a part of the problem of organizing the clinical expert work of a postmortem service].

Whether the categories of a discrepancy between diagnoses should not be identified, which has been put by I. A. Kazantseva, is supported by the Society of Pathologists. The ranking of diagnostic discrepancies has been already subject to criticism in a number of standard guidance publications. However, this matter is a part of the unsolved problem of the clinical expert work of a postmortem service. Many regions have elaborated and approved their own principles of its organization. The standards of the Russian Agency are the most important achievement in assuring orderliness of its work. The problem requires further initiatives of the Russian Society of Pathologists and its close interaction with the Ministry of Health and Social Development in approving the relevant normative documents as soon as possible.

[Benign prostate hyperplasia as an age-related problem].

The incidence of genitourological diseases is greater that that of circulatory disorders, benign prostate hyperplasia (BPH) is the commonest urological disease in the elderly and senile males. According to the results of the authors' clinicomorphological study, BPH has been detectable in 69% of the males who died at the age of above 60 years. BPH frequently occurs in patients with arterial hypertension, diabetes mellitus, coronary heart disease, and metabolic syndrome, which necessitates a search for the commonness of causes or mechanisms of development of these diseases. The most important complication of BPH is acute urinary retention. Its major causes in therapeutic clinic are recurrent chronic prostatitis, decompensation of circulatory insufficiency, and emergencies generally resulting from alcohol abuse. As this takes place, the worst prognosis is observed in elderly patients with the complicated comorbid status, particularly in the presence of chronic alcohol intoxication. Patients with BPH are at high and surgical treatment-unassociated risks for pulmonary arterial thromboembolism (PATE). In these patients, the causes of PATE are pelvic deep vein thromboses whose incidence in clinical practice is underestimated.

[Formulation and coding of a postmortem diagnosis by using the ICD-10 in blood circulation disorders].

The paper presents the rules of formulation and coding of a postmortem diagnosis in blood circulatory diseases in accordance with the requirements of the ICD-10 and the standards of morbid anatomy service, which have been approved by the Federal Agency for Health Care and Social Development of the Russian Federation.

[Cytochrome P-450 aromatase expression in the ectopic and eutopic endometrium in endometriosis].

An immunoperoxidase test was used to reveal the expression of cytochrome P-450 aromatase in the eutopic and ectopic endometrium of 14 patients with ovarian endometriosis and 26 with adenomyosis, whose age ranged from 21 to 47 years (38+/-2.0 years). Five endometrial samples taken at autopsy from the women who had died from injuries at ages of 32 to 47 years and who had no uterine or ovarian abnormities served as the control. Control observations revealed no aromatase expression by endometrial epithelial and stromal cells. Aromatase expression in the eutopic endometrium was found in patients with ovarian endometriosis and adenomysis in 80 and 58% of cases, respectively; while that in the ectopic endothelium was in all cases in both groups. In external genital endometriosis, the sensitivity and specificity of the test were 75 and 100%, respectively. In the glandular and stromal epithelium of both the ectopic and eutopic endometrium, aromatase expression increased with the higher extent of endometriosis.

[Immunomorphological characteristics and criteria for predicting gastrointestinal stromal tumors].

The study of 36 cases of gastrointestinal stromal tumors (GIST) (n = 26 of the stomach and n = 10 of the duodenum, small bowel, and rectum) indicated that among the clinical symptoms, there were prevalent abdominal pains and gastrointestinal bleeding. Local invasion and metastases were detected in 11 patients. According to the risk of aggressiveness, 1 tumor presented a very low risk; 5, a low risk; 14, a moderate risk; and 16 a high risk. All GISTs with mucosal infiltration were in high and moderate risk groups. The expression of p27 did not depend on that of other markers, the sizes of a tumor, its histological type, and affinity to this or that risk group. There was a statistically significant difference in the expression of Ki-67 in the groups of low (1.7%) and high (10.3%) risks.

[Clinical and morphological characteristics of gastrointestinal stromal tumors].

GIST are stromal tumors and the gastrointestinal tract (GIT) and some other organs of spindle-cell or epithelioid-cell structure expressing CD117 (C-kit, KIT), as well as those at different rates and in different combinations, CD34, smooth muscle and/or neurogenic differentiation antigens. It should be taken into account that CD117 are also expressed by melanomas, vascular, and some other tumors. The c-kit gene mutations leading to the expression and autoactivation of the tyrosine kinase receptor KIT underlie the oncogenesis of GIST, which results in enhanced proliferative activity and inhibited apoptosis. This is supported by successful chemotherapy for GIST with a KIT receptor inhibitor. The histogenesis of GIST is associated with GIT somatic stem, the Cajal cell precursors. Many GISTs behave like sarcomas and they are characterized by an infiltrating growth, hematogenic (mainly into the liver) and implantational (along the peritoneum) cancer spread. There are opinions that all such neoplasms are potentially malignany and small-sized GISTs are benign and have the minimum mitotic activity.

[Detection rates of various serotypes of human papilloma virus in atypical glandular hyperplasia and adenocarcinoma of the endometrium and their immunomorphological features in virus-positive cases].

Various virus serotypes were found in 35.3% of cases and their detection rate frequency reducing with age. They were detectable in 35.3 -52.9% of cases of atypical glandular hyperplasia, highly and moderately differentiated adenocarcinoma of the endometrium and only in 17.6% of cases of poorly differentiated adenocarcinomas. Serotypes 58 and 51 were nearly twice more frequently, but serotypes 18 and 52 were not observed. Immunomorphologically virus-positive observations were characterized by pronounced infiltration with T-helper and T-suppressor/killer cells. The endometrium and tumors showed an increased significant proliferative activity (Ki-67 expression) and reduced expression of receptors to progesterone and, to a lesser degree, to estrogen in 47-83% of virus-positive cases. Expression of growth factors did not greatly differ.

[Prospects for using combined three-dimensional injection of gel transplants with autologous and allogenic cell cultures in reproductive medicine].

A combined cellular transplant for injection has been designed, by using lowly differentiated stromal fat tissue cells obtained from Wistar rats and it preserved biological and physical properties after passing through a small-diameter injection needle (an insulin syringe). A morphological study of the results of its transplantation into paraurethral tissues in 28 female rats showed that the transplant cells, autologous ones in particular, activated the proliferation of local connective tissue cell populations and retained their viability and proliferative and synthetic activities up 20 days or more. At the end of the experiment (on days 27-35), marked focal connective tissue enlargement at the site of injection of both allo- and autografts results in the narrowing of the urethral lumen. The injection implantation of combined allo- and autografts opens up new avenues for the treatment of pathological processes of the reproductive and urinary tracts.