[Forensic medical assessment of venous thromboembolic complications of mechanical injury of the lower limb after surgery]. / Sudebno-meditsinskaya otsenka venoznykh tromboembolicheskikh oslozhnenii mekhanicheskoi travmy nizhnei konechnosti posle operativnogo vmeshatel'stva.

In forensic medical practice, venous thromboembolic complications (VTEC) are relatively rare, due to hereditary and acquired factors. The issue of expert evaluation of the VTEC after the performed surgical intervention as an alleged defect in medical care causes discussion. The purpose of this publication is to demonstrate an expert case in the assessment of VTEC mechanical injury of the lower limb after surgery. The above case with the development of PATE after surgery clearly demonstrates the possibility of the appearance of a «medical case¼. The key to the correct expert assessment of the alleged defect of medical care during the forensic medical examination is not only a thorough and scrupulous study of medical documentation, but also a qualitatively performed forensic medical examination of the corpse.

[Long-term inflammatory and neoplastic reaction of prostate tissues during its transurethral infection with uropathogens: evaluation of the results of animal model study].

INTRODUCTION: There is no convincing evidence of the persistence of acute or the development of chronic bacterial-induced prostatic inflammation in the long term when infected with various titers of the uropathogen. Along with this, controversial data are presented on the relationship between post-infectious chronic inflammation and neoplastic changes in prostate tissues. OBJECTIVE: To carry out, based on the experimental data: 1) assessment of the degree of bacterial contamination and the severity of histological changes in prostate tissues on the 60th follow-up day in case of transurethral infection with various uropathogens in titers of 102,3,5 CFU/ml; 2) fundamental comparative analysis between the indicators of the inoculated test-titer and microbial load with the severity of histological changes in prostate tissues; 3) verification of neoplastic transformations in the prostate tissues during a long-term persistent bacterial-induced inflammatory process. MATERIALS AND METHODS: Animal studies were conducted using FELASA protocols. Laboratory animals: 14 New Zealand rabbits. Tested uropathogens: aerobes - E. coli, S. haemolyticus, anaerobes - P. niger. Titers: 102,3,5 CFU/ml. Uropathogen inoculation technique: topical transurethral. RANDOMIZATION: all laboratory animals were divided into 5 groups according to the uropathogen (4 experimental, 1 control). Follow-up period: 60 days. Sacrification and autopsy of the animals were performed on day 60. Biopsies were taken from various parts of the prostate, as well as from the bladder neck and the edge of the membranous urethra. Cultural, histological and immunohistochemical (expression of p53 and Ki-67) studies of prostate tissues were conducted. Statistical data processing was performed using the GraphPad Prism 9.0 program (GraphPad Software Inc., Graphpad Holdings LLC, San Diego, CA, USA) applying descriptive and non-parametric statistics. RESULTS: Two individuals infected with S. haemolyticus + P. niger had a lethal outcome. The contamination of prostate tissue was determined in all cases of infection. In 88.9% of the cases, an increase in tissue microbial load was determined compared to the initial titer. Multivariate analysis of culture study values revealed the presence of intragroup differences in prostate contamination only between infection with E. coli 103 CFU/ml and E. coli 105 CFU/ml (p=0.006), as well as intergroup differences between infection with E. coli 105 CFU/ml and P. niger 105 CFU/ml (p=0.013). The histological study revealed moderate proliferative inflammation after inoculation with 102,3,5 CFU/ml in the E. coli and S. haemolyticus groups. In the case of S. haemolyticus, it was more pronounced due to the presence of persistent alterative lesion foci; in the P. niger group, mild proliferative transformations were observed in prostate tissues in all cases. The immunohistochemical study of changes determined p53 expression (10.0%) in some areas of the glandular epithelium of prostate glands (but without a positive internal control) only in case of infection with E. coli 105 CFU/ml. Areas of glandular epithelium with Ki-67 expression ( less or equal 25.0%) were visualized in all tested groups, mainly at titers of 103 and 105 CFU/ml, but the severity of proliferative activity was not high (1+). There were no foci of prostate tissue with simultaneous nuclear activity of p53 and Ki-67. CONCLUSION: Proliferative inflammation of different intensity in prostate tissues was observed after sixty days. Its severity was mainly determined by the type of infecting agent (S. haemolyticus > E. coli > P. niger) and was not dependent on the inoculated titer and the subsequent microbial load of prostate tissues. No areas of neoplastic transformation of prostate tissues were reliably identified in the case of a bacterial-induced inflammatory process in the estimated follow-up period.

[Morphological and immunogistochemical characteristics of myocardial damage in miastenia].

The article presents a rare clinical case of a 45-year-old patient with generalized myasthenia with damages to the muscular apparatus of the extremities and the heart. A special feature of the case was myocardial damage evident as alterative-productive interstitial myocarditis with a peculiar immune phenotype of cell infiltrate, Cd3+, Cd4+, Cd8-, Cd68+. Furthermore, Cd68-expressing cells were presented by large macrophages with cytoplasmic granulation, which surrounded damaged cardiomyocytes. Around sites of cardiomyocyte alteration there were manifestations of neoangiogenesis with signs of Cd34 protein expression in thin-wall, capillary type blood vessels. These morphological and immunohistochemical changes in the myocardium supplement the concept of myasthenia morphogenesis.

[Morphological and Molecular-Biological Changes in the Coronary Arteries after Stenting].

This review addresses morphological changes in coronary arteries following stenting, which result from damage to the vascular wall. These changes include 1) formation of a thrombus in the site of intimal injury; 2) inflammation; 3) proliferation and migration of smooth muscle cells; 4) formation of extracellular matrix. Each of these pathological processes has specific morpho-biological features. The review shows the role of von Willebrand factor in development of early thrombosis after intimal injury, which provokes activation of the inflammatory response followed by proliferation of smooth muscle cell that synthetize the extracellular matrix. These cellular and intercellular changes are based on overexpression of TGF-ß1 protein, which facilitates modulation of various types of smooth muscle cells, including contractile and secretory ones. Issues of fine regulation of cellular and intercellular interactions by apoptosis, activation of mTOR signaling molecules, and microRNA are still understudied. Dynamic changes in drug-coated stents during development of neoatherosclerosis and late thrombosis remain not elucidated. Current reports show that initial mechanisms triggering pathological regenerative and hyperplastic processes that result in coronary restenosis in the area of implanted stents may form early (first hours or days) after stenting. Most studies were performed on experimental rather than on autopsy material, which does not allow fully unbiased interpretation of obtained data. Studying dynamics of morphological and molecular changes in coronary arteries after stenting, including on autopsy material, will allow one to express an opinion on the risk of postoperative thrombosis and restenosis.

[Cystoscopic and morphological features of chronic recurrent papillomavirus cystitis].

INTRODUCTION: Chronic recurrent cystitis (CRC) is a common disease in the female population and a serious medical problem. There are not enough data about etiology of this desiase and effective treatment. OBJECTIVE: To increase the accuracy of the differential diagnosis of bacterial and papillomavirus chronic recurrent cystitis. MATERIALS AND METHODS: Analysis of endoscopic and morphological diagnostic methods of 118 patients with CRC, which, depending on the etiological factor, were divided into two groups. Group I (n=65) patients with CRC of HPV etiology and Group II (n=53) - CRC of bacterial etiology (E. coli). All patients were examined according to the EAU and RSU recommendations, and an endoscopic examination of the bladder (cystoscopy) was additionally included, followed by morphological examination of biopsy specimen of the urinary bladder. RESULTS: The endoscopic picture of bacterial CRC usually is caused by hyperemia of the mucous membrane of the bladder, hyperemia and injection of vessels with the participation of (small-puncture/diapedesic) hemorrhages without signs of proliferative changes. The endoscopic picture in papillomavirus CRC in all patients presented by focal or diffuse, slightly elevated, exophytic, often polypoid formations of a whitish or whitish-gray color, usually localized in the Leto triangle. Morphological analysis of biopsy tissue of the urinary bladder in patients with bacterial cystitis in the mucous and submucous layer showed edema, thickening of the urothelium, capillary abundance, inflammatory infiltration, represented by lymphocytes, plasma cells and leukocytes, among which neutrophilic macrophage leukocytes were predominant. Morphological analysis of the bladder mucosa in all examined patients with signs of HPV-related lesions showed a thickening of the urothelium, squamous metaplasia of the urothelium, chronic inflammation, microcirculatory vascular reaction and edema. An important distinctive pathomorphological sign of HPV within urinary bladder was the presence of koilocytic transformation of urothelium cells due to the cytopathic effect of the virus. CONCLUSIONS: Papillomavirus CR has characterized by an infectious-inflammatory process in the bladder paries, with lymphocytic-plasmatic infiltration and coylocytic transformation of the urothelium.

[Forensic expert evaluation problems of early and late complications of interventional methods of treating coronary heart disease (systematic literature review)].

This article focuses on current concepts of ischemic heart disease, its interventional treatment, pathomorphology of early and late postoperative complications, and forensic aspects in evaluation of restenosis of a stented blood vessel.

[Are bacteriological and pathomorphological signs of bacterial prostatitis related between? (An experimental study)].

INTRODUCTION: In some cases, there is a dissociation between the severity of complaints, physical examination data, and levels of contamination of the biomaterial in the differential diagnosis of various categories of prostatitis (NIH-NIDDK, 1995). Patients note the presence of pronounced symptoms when verifying the threshold indicators of microbial load (104-105 CFU / ml) of prostate secretion or post-massage urine in a few observations. However, clinical manifestations and deviations in objective indicators are not so significant in some patients with higher titers of contamination. PURPOSE OF THE STUDY: To evaluate the relationship between the microbial load indices and the degree of pathomorphological changes in the prostate tissue during infection with the "reference" uropathogen E. coli in various titers under experimental conditions MATERIALS AND METHODS: Animal model was carried out using the FELASA protocols. Experimental individuals: 16 "New Zealand" rabbits, weight: 3580 [3480; 3695] (3300-4410), age: 25 [24; 26] (23-28) weeks. Uropathogen used: E. coli. Titers: 103 CFU / ml, 105 CFU / ml, 107 CFU / ml. Infection pathway: inoculation of the uropathogen was performed through urethra according to the modified technique of J.C. Nickel. Randomization: all lab animals were evenly divided into 4 groups of 4 animals, taking into account the initial titer of the uropathogen and the observation period - experimental groups 1 (103 CFU / ml), 2 (105 CFU / ml), 3 (107 CFU / ml); group 4 was control (Sol.NaCl 0.9%). Observation terms: 1, 3, 7 and 14 days, after which the animals were euthanized and dissected. 4 biopsies (1A-1D) for bacteriological (MacConkey agar - "HiMedia", India) and 2 biopsies (P1-P2) for morphological (Hematoxylin-eosin - "BlikMediklProduction", Russia; magn. 10x, 40x, 100x, 400x) studies were formed from various parts of the prostatic complex (prostate + proprostate + paraprostate). A three-point grading system was used for morphometric assessment of destructive changes in the prostate tissue in different groups. Analytical processing of the results was carried out using the software packages Microsoft 365 ("Microsoft", USA) and Statistica 10.2 ("StatSoft Inc.", USA) by methods of descriptive and nonparametric statistics. RESULTS: The maximum total absolute / median values of the seeding of biopsy specimens of the prostatic complex were revealed ( titer, 1A-1D) in group 1 and amounted to 76 lg CFU / ml / 5.00 [4.00; 5.25] lgCFU / ml, in group 2 defined as intermediate - 57 lgCFU / ml / 3.50 [3.00; 4.00] lgCFU / ml, and in group 3 were minimal - 48 lgCFU / ml / 3.00 [3.00; 3.25] lg CFU / ml according to the indicators of bacteriological research in the period from 1 to 14 days. Nevertheless, it was found that the cumulative maximum degree of histological changes in the prostate was recorded in group 2 ( p. - 84), in group 1 it was defined as intermediate ( p. - 68), and in group 3, it was the smallest ( p. - 64) according to the data of pathomorphological studies. When comparing daily changes in the seeding values and nominal indicators of inflammatory lesions in the prostate tissue, only in group 1, the trend graphs had a synchronous trend - an increase in microbial load led to the formation of more severe pathomorphological transformations on the day 7; in group 2, destructive changes were significant, and the rates of contamination, on the contrary, were minimal on the day 7; in group 3 a pronounced pathomorphological transformations in the tissues were noted on the day 3 and 7, but the microbial load of the tissues gradually decreased from the day 1. Also, differences in the increase in the "reactivity" of changes in the affected tissues were determined: in groups 1 and 3, a torpid reaction was revealed, accompanied by the development of moderate inflammatory changes on the day 1 and an "abrupt" increase in the intensity of destruction by the day 3; in group 2, in turn, a rapid reaction was determined, that characterized by the formation of a more pronounced destructive process already from the day 1. CONCLUSION: It was found that the parameters of contamination do not fully reflect the nature and severity of pathological changes in the prostate. Low titers of the uropathogen induce the development of an inflammatory process comparable in the severity of changes with that at higher concentrations. On the contrary, inoculation of obligate pathogenic titers does not always lead to a pronounced increase in microbial load but causes significant inflammatory changes in the prostate.

[Penile cavernous fibrosis: etiology, morphogenesis, erectile dysfunction].

Despite significant advances in andrology, the problem of penile cavernous fibrosis remains not fully understood. Many studies on the epidemiology of erectile dysfunction have been published, but consensus on the place and role of this pathology in the structure of sexual disorders has not yet been reached. The data obtained at different time intervals and in different geographical areas are strikingly different. Also, the role of organic disorders in the penis, including fibroplastic changes, in certain etiological factors has not been determined. In addition, the relationship between etiological factors and morphological changes in penile tissues is disputed due to the small amount of data obtained from the pathohistological study of human penis biopsies. This review is devoted to the systematization of epidemiological data and etiological factors of cavernous fibrosis, the definition of the relationship between them, the analysis of clinical and experimental studies, which study the relationship between the degree of severity of damaging agents and the formation of typical fibrogenic reactions.

[Forensic diagnosis of sudden death of young people based on morphological analysis of the cardiac conduction system]. / Sudebno-meditsinskaya diagnostika vnezapnoi smerti lits molodogo vozrasta na osnovanii morfologicheskogo analiza provodyashchei sistemy serdtsa.

The aim of study was to develop a comprehensive assessment of the central and peripheral parts of the nervous system with a determination of degree of severity of alterative changes in comparison with the condition of myocardial contractile apparatus. Own observations on modern methods of morphological study of the cardiac conduction system in the sudden death of young people are presented. Particular attention is paid to the technique of isolating and coloring the nervous structures of sympathetic and parasympathetic parts of the autonomic nervous system, including the medulla oblongata, sinus-atrial and atrial-ventricular nodes, atrioventricular bundle (the His bundle), Purkinje fibers. The features of morphological changes in the nerve structures of the heart, due to various etiological factors are highlighted.

[Renomedullary interstitial cell tumor: review of a rare clinical case].

Autopsy study of a 49-year-old patient demonstrates a rare kidney tumor that had a structure of a mesenchymal renomedullary interstitial tumor (RIO), which had specific characteristics. They include a predominance of the cellular component in the tumor, represented by cells with processes elements (fibroblasts, myofibroblasts), which were surrounded by collagen fibers of interstitium. Apparently, these cells can be involved in the regulation of renin and bicarbonates, the exchange of components of connective tissue (collagen fibers, proteoglycans) and hormones (estrogen, progesterone). Since these tumor cells regulate the synthesis and secretion of the substances, numerous clinical manifestations of RIO can be explained. Most likely, these include increased blood pressure, water-electrolyte disorders, hormonal disorders due to the presence of estrogen receptors, progesterone in the tumor tissue and metabolic disorders (diabetes mellitus). However, these assumptions require further clinical, morphological and immunohistochemical studies.

[Inguinal lymphadenitis due to invasion of Dirofilaria repens].

The paper presents the case of the right-sided inguinal inflammation of a lymph node as a result of invasion of Dirofilaria repens, the parasitic pathogen of subcutaneous dirofilariasis in animals of the canine family. The diagnosis was verified on the basis of the parallel application of morphological studies of cross sections of the nematode in histological samples and the molecular biological method polymerase chain reaction of scrapings of histological material. The localization of this helminth inside the cavities of the human body is extremely rare. Only isolated cases of atypical localization of D. repens are described: in the organs of the chest, cervical lymphatic node in the spermatic cord and epididymis, which led to pseudotumor formations that needed to be differentiated with neoplastic processes. This case is of great interest to experts of various fields (surgeons, oncologists, infectious disease specialists and pathologists), primarily in the differential diagnosis of malignant neoplasms of the lymphatic system.

[Experimental evaluation of inflammatory process in the prostate caused by transurethral transmission of uropathogen in low counts].

BACKGROUND: According to the literature, bacterial count of uropathogens isolated from expressed prostate secretion and urine which is sufficient for a diagnosis of bacterial prostatitis I and II categories, remains contradictory. Undoubtedly, the identification of microorganisms from affected organ in high titers indicates the presence of a relevant infectious-inflammatory process. In turn, there is no consensus on the development of bacterial prostatitis at lower titers of uropathogens. Thus, the aim of our study was to identify and compare the potential features of the development and occurrence of an infectious inflammatory process in the prostate during the reproduction of bacterial prostatitis in an animal model using a low titer of causative uropathogens. MATERIALS AND METHODS: A total of 16 "New Zealand" mature male rabbits aged 24+/-2 weeks old with weight of 3.5+/-0.3 kg were examined. Inoculation was performed via transurethral route, according to the developed experimental technique. E. coli was used as bacterial agent with a count of 1 x 103 CFU/ml, 1 x 105 CFU/ml and 1 x 107 CFU/ml. All animals were randomized into 4 groups of 4 individuals depending on the titer of the inoculated microorganisms (groups 1-3, respectively), group 4 - control (with inoculation by Sol. NaCl 0.9%). Sacrification and vivisection were performed on days 1, 3, 7 and 14 of the control days. Biopsy specimens from the lower urinary tract and internal genital organs of laboratory animals (bladder, urethra, prostatic complex - 6 biopsies #1A-1D, 2A, 2B) were evaluated morphologically and bacteriologically. Analytical evaluation of the experimental data was presented using descriptive statistical methods. RESULTS: In experimental groups (Groups 1-3), bacteriological examination of prostatic complex biopsies showed growth of microflora in all samples in titers of 101-107 CFU / ml. In group 1, the maximum concentration of uropathogen was observed on day 7, compared to day 1 in both groups 2 and 3. In all observed cases, the highest degree of bacterial contamination was noted in the biopsy specimens from paraprostatic tissues and distal part of the prostate, which was 4.0+/-1.7 lg CFU/ml and 3.5+/-1.9 lg CFU/ml, respectively, and the smallest in proximal prostatic loci (1C) and bladder neck (2B) - 3.0+/-1.2 lg COE / ml and 3.0+/-1.7 lg COE / ml, respectively. According to the morphological study, a relevant progression of the suppurative and destructive inflammation (with foci of colliquation necrosis) was identified in group 1 in the biopsies from the prostate with a maximum degree of changes on day 7 with subsequent formation of loose connective tissue proliferation areas by 14 days. This indicates the conversion of the inflammatory process to the chronic stage. These changes corresponded with the results of histopathological studies in groups 2 and 3 where higher titers of bacterial agent were used. In group 4 (control) the commensal flora was bacteriologically determined in the biopsies, but there were no signs of inflammation, according to the results of the morphological study. CONCLUSION: In experimental model, we found that E. coli 103 CFU / ml induces the development of a phasic inflammatory process in the structures of the prostatic complex. These processes resulted in the formation of irreversible proliferative changes. As a consequence, it shold be recommended to consider these signs of contamination when evaluating the results of bacteriological examination of expressed prostate secretion/urine samples during planning treatment strategy.

The Role of Smooth Myocytes and Macrophages in Development of Complicated Forms of Arterial Atherosclerosis.

PURPOSE: to conduct morphohistochemical and immunohistochemical study of arterial unstable atherosclerotic plaques for assessment of the state of smooth muscle cells (SMC) and macrophages. MATERIALS AND METHODS: The surgical material of the peripheral arteries (femoral, popliteal, external carotid) was obtained from 50 patients aged over 60 years, followed by morphohistochemical, immunohistochemical studies. RESULTS: Hyperplasia of secretory smooth muscle cells (SMC), and new formation of thin-walled capillary vessels was noted in unstable atherosclerotic plaques. Macrophagic infiltration was detected in the intima of arteries, in places of accumulation of foam cells. CONCLUSION: Unstable atherosclerotic plaque is a cellular-intercellular process with the participation of lipids, macrophages, and with predominance of SMC and newly formed vessels.

Morphoimmunohistochemical characteristics of synchronous bilateral breast cancer.

We performed a complex morphoimmunohistochemical study of synchronous bilateral breast cancer (diagnosed in 0.69% cases in women of the postproductive period after the age of 50). The molecular genetic characteristics of this cancer were detected and the algorithm of diagnostic studies was suggested. We have demonstrated that bilateral breast cancer was in 75% cases estrogen- and progesterone-positive, but androgen-negative. The HER-2/neu status of the tumor was negative in 75% cases, but expression of HER-2/neu was detected in the tumor of one mammary gland in 20% cases. Membrane expression of E-cadherin in infiltrative ductal cancer cells significantly decreased up to its complete disappearance with the decrease in tumor cell differentiation degree. The data provide new insight into prognostic value of the studied biomarkers and help to develop treatment protocol with consideration for the molecular biology of this group of tumors.

[Gastrointestinal stromal tumors].

The paper considers the current aspects of the morphology, immunohistochemistry, molecular biology of gastrointestinal stromal tumors (GIST). It describes the major signs of different histological types of GIST, which depend on the morphological, immunohistochemical types of interstitial cells of Cajal. Problems in the primary diagnosis and prognosis of GIST are discussed.

[Current idea of the morphogenetic features of liposarcomas].

The paper considers the current aspects of the morphology, immunohistochemistry, molecular biology of liposarcomas. Particular attention is given to the embryogenesis of liposarcomas and to problems in the immunohistochemical diagnosis of these neoplasms. There is evidence that TLS-CHOP is involved in the PNA processing of liposarcoma cells. Prospects for the diagnosis and treatment of malignant mesenchymal tumors are discussed.

[Pathomorphological characteristics of various portions of the aorta and pulmonary artery in coarctation in babies of the first month of life].

A total of 554 case and autopsy records were clinically and morphologically analyzed. There was aortic coarctation (AC) in 47 cases, including 32 cases in babies aged less than 1 month. Pathomorphologic changes in the aorta and pulmonary artery in AC are a dynamic process and reflect the signs of increased vascular permeability, damaged muscle elements, and formed minor vessels. It may be suggested that such changes reflect impaired vascular blood flow at the sites of AC, which should be kept in mind in the early diagnosis and prediction of complications.

[Dynamic of morphological changes of cerebral hematomas induced by arterial hypertension (analysis of surgical and autopsy materials)]. / Dinamika morfologicheskikh izmenenii vnutrimozgovykh gematom, voznikaiushchikh vsledstvie arterial'noi gipertenzii (analiz operatsionnogo i sektsionnogo materiala).

The pattern of morphological changes in blood clots, brain tissue and vessels of hypertensive hematomas (CH) was studied in 79 surgical and autopsy cases. Brain tissue compression degeneration of cells and fibers, edema were observed during the first 6 hours after the onset of hemorrhage. Necrosis and marked leukocyte infiltration appeared to progress gradually and reach maximum by the disease day 2-3. The degeneration manifested by formation of gliomesodermal capsule surrounding the haemorrhagic lesion from day 3 to 8. Dilatation of small cerebral vessels was followed by an increase in permeability and necrosis of vascular walls predominated within 24-72 hours after initial bleeding. It is suggested that the first 24 hours after CH onset are optimal for surgery.