[Thromboangiitis obliterans (Buerger's disease): state of the art]. / Obliteriruyushchii trombangiit (bolezn' Byurgera): sovremennoe sostoyanie problemy.

Thromboangiitis obliterans (Buerger's disease) is systemic vasculitis with predominant development of thrombotic occlusions of small-to-medium diameter arteries of distal portions of both upper and lower limbs. A distinctive feature of Buerger's disease from other vasculitides is the involvement of the venous bed into the pathological process in the form of migrating thrombophlebitis. The disease is encountered more often in young adult males, predominantly tobacco smokers. The clinical pattern is presented by symptoms of increasing insufficiency of blood supply of tissues of extremities. The diagnosis is made by means of ruling out other vascular diseases (atherosclerosis, diabetes mellitus, systemic diseases of connective tissue, hypercoagulation conditions) based on clinical and laboratory findings, as well as modern methods of visualization, including multislice spiral computed tomographic angiography. Of special importance is a pathomorphological examination aimed at detecting the signs specific for Buerger's disease: arteries showing intimal hyperplasia (from stenosis to complete obliteration according to the capillary angiomatosis type, vascular "recalibration", obliteration of lumens by thrombi, lack of calcification of the tunica media; venous alterations are presented by panphlebitis with intimal hyperplasia, and occlusion with thrombi. Treatment is aimed at eliminating the aetiological stimulus (i. e, smoking), improving blood circulation by means of regular, dosed physical exercises, and administration of anti-ischaemic agents (analogues of prostaglandins, calcium channel antagonists, antiaggregants and anticoagulants). Failure of conservative treatment failed should be followed by making a decision to perform revascularization (endovascular interventions, bypass reconstructive operations, arterialization of the venous blood flow of the foot, resection of the posterior tibial veins, transplantation of the greater omentum onto the crus).

[Pathological deformation of the carotid arteries].

The literature on the etiology, pathogenesis, clinical manifestations and pathology, basic approaches to the treatment of congenital and acquired pathological deformation of the internal carotid artery has been analyzed. The review discusses the possible risk factors and diseases that lead to the development of pathological deformations as well as existing hypotheses of pathogenesis. Open and unresolved issues of the etiology and pathogenesis of this disease are identified. The disputable issues on the emergence and development of vascular deformations in children, young people and elderly are discussed. The authors posit a hypothesis that congenital and acquired pathological deformations are different diseases which differ by etiology, pathogenesis, clinical and pathomorphological picture, prognosis, approaches to diagnosis and treatment; the relationship between them has not been proved.

[Morphological pathology of vessels in granulomatosis with polyangiitis (Wegener's disease)].

OBJECTIVE: to investigate the incidence of injuries in different vascular beds and the morphopathological changes in vessels in granulomatosis with polyangiitis. MATERIAL AND METHODS: The morphopathological features of vascular injuries were investigated in 11 dead patients aged 16--74 years with granulomatosis with polyangiitis. RESULTS: Proliferative and destructive angiitis with predominant involvement of microcirculatory vessels and with development of necrosis-prone granulomas in their walls and perivascularly was established to underlie the clinical manifestations of granulomatosis with polyangiitis. The most typical localization of the pathologic process is the vessels of the upper respiratory tract, lungs, and kidneys. Cardiopulmonary and renal failures are causes of death in the majority of cases. It should be noted that the vessels of the heart, liver, and gastrointestinal tract are frequently involved in the pathological process. Vascular changes in these organs determine the clinical features of granulomatosis with polyangiitis and lead to a number of fatal complications. CONCLUSION: Granulomatosis with polyangiitis is a systemic disease with polymorphism of clinical manifestations, which requires in-depth analysis based on current precision patient examination methods, including a histopathological study.

[Marfan syndrome: clinical and pathomorphological restructurings after surgical treatment of aortic aneurysm].

The authors examined the state of patients suffering from Marfan syndrome (MS) who endured operation for ascending aorta aneurysm with replacement of the ascending aorta and aortic valve (Bentall operation), studying alterations of the skeleton, face, heart and eyes, as well as pathomorphological restructurings in the aortic wall. The study was carried out 7.0 ± 4.2 years after the operation. We examined a total of 39 patients with MS - 27 (69.2%) men and 12 (30.8%) women aged from 22 to 70 years old (average age - 42.1 ± 13.4 years). All patients were operated on for dissecting aneurysm of the ascending aorta accompanied by a considerable degree of aortic valve insufficiency or aortic ostium stenosis. The mean diameter of the aorta at the level of the sinuses of Valsalva amounted to 7.0 ± 1.3 cm (minimal - 5.0 cm, maximal - 12.0 cm), the Z-score prior to operation was 12.7 ± 6.5. The time form making the diagnosis of MS to surgical intervention for aortic aneurysm amounted to 9.6 ± 5.9 years. The condition after operative treatment in all patients was satisfactory, with the haemodynamic indices stable: systolic AP - 133.5 ± 19.1 mm Hg, diastolic AP 85.1 ± 12.9 mm Hg, heart rate 74.8 ± 7.2 bpm. The average systemic score for the symptoms and tests of MS patients amounted to 8.2 ± 3.3 points. Pathohistological alterations of the aorta in patients with Marfan syndrome consisted in pronounced restructuring of the wall with deep irreversible alternative changes. The pathological process extended in the middle aortic layer all alone the length, but not only in the portions of rupture and dissection. The main pathomorphological signs in MS were as follows: focal accumulations of mucoid substances, dystrophic alterations of smooth-muscle cells, ribbon-like anuclear zones, formation of cystlike cavities, alterations of elastic fibres - fragmentation, hyperelastosis, multiplication, thinning and straightening, zones of elastolysis.

[Myocardial infarction at the age under 50: influence of occupational xenobiotics (analysis of chemical elements in hair of patients)].

X-ray and fluorescence analysis covered elemental composition of hair in 39 patients with myocardial infarction and 23 healthy individuals. The highest "chemical pollution" was seen in myocardial infarction patients whose occupations are associated with xenobiotics exposure. Hair of those patients contain reliably high amounts of iron, copper, manganese, chromium, cadmium, lead, strontium, rubidium, potassium, bromium and clorine. Nearly two thirds of those patients had potassium and strontium levels considerably exceeding maximally allowable values. Reliably higher levels of some chemical elements in myocardial infarction patients vs. controls could be a proof of direct cause-effect relationships between xenobiotics influence and coronary affection in individuals aged under 50, especially subjected to regular risk factors.

[Is atherosclerosis a specific arterial lesion or a "unified" group definition? Search for the causes of arteriosclerosis: an ecologic conception].

The term "atherosclerosis" is erroneously used for the definition of different types of arteriosclerosis, each of them has not only its characteristic structural signs, but also its specific causes and the mechanisms of its development. Particularly, young subjects are observed to mainly have lipid-free arterial intimal lesion with formed myofibrous, fibrous hyalinized plaques, and circular or focal myoelastic intimal hyperplasia. This type of atherosclerosis more commonly occurs in those who are occupationally exposed to xenobiotics. The establishment of the actual cause of each type of arteriosclerosis will open up fresh opportunities for the prevention of the diseases that are responsible for high morbidity and disability rates in the past decades.

[Gsell-Erdheim syndrome: main pathomorphological alterations]. / Sindrom Gzelia-Erdkheima: osnovnye patomorfologicheskie izmeneniia.

24 cases of Gsell-Erdheim syndrome observed in 1999-2001 have been analysed. There were 20 men (83.4%) and 4 women (16.6%) aged 22-69 years. Six men (25%) died at the age under 50 years. At necropsies the following characteristic variants of stratification were observed: a total damage with stratification of the aorta at all length or, less often, local damage. Destruction of an elastic skeleton of the media is the basis of aorta stratification: zones free of the nuclei, foci of elastolysis (medianecrosis), thinning, dyschromia and fragmentation of elastic fibers, focal hyperelastosis. The pathological process involves all the aortic length not only the area of aneurysm and rupture. Manifestations of variable severity of the same process were seen in different parts of the aortic wall.

[Aortic dissecting aneurysms: clinical masks, differential diagnosis]. / Rasslaivaiushchie anevrizmy aorty: klinicheskie maski, osobennosti differentsial'noi diagnostiki.

101 necropsies of aortic dissection (AD) made in 1991-2000 have been analysed. Among the deceased men prevailed (76.3%), 23(22.8%) of them were under 50 years of age. An accurate intravital diagnosis was made only in 40.6 patients. The most common clinical masks were the following: coronary, valvular, vascular, gastrointestinal, pulmonary, thromboembolic, mediastinal, cerebral, renal and anemic. Most often AD masks as acute myocardial infarction. The knowledge of encountered clinical masks of AD promoted improvement of early AD diagnosis to correct AD surgically and reduce lethality.

[Lead--an etiologic factor in vascular disease: main evidence (lecture)]. / Svinets--étiologicheskii faktor porazheniia sosudov: osnovnye dokazatel'stva.

Review of the literature showing that lead is one of the most potent etiological stimuli in the development of the characteristic vascular pathology (vasculitis, atherosclerosis, arteriosclerosis, arterial hypertension). The attempt is made to summarise sparse data on the routes and mechanisms of the lead vascular damage pathogenesis.

[Ecologic pathology and ecologic nosology: a new trend in medicine]. / Ekologicheskaia patologiia i ékologicheskaia nozologiia: novoe napravlenie v meditsine.

The necessity of the study of technogenic stimuli effects on humans resulting in ecological pathology and ecological nosology is emphasized. Clinicomorphological aspects of latent health disturbances, their structural basis (ecological pathology), i.e. qualitative and quantitative spectrum of initial alterations in the subcellular structures and cells are considered. The examples of ecological diseases produced by specific chemical stimuli are presented. It is suggested to name ecological diseases with terms at the basis of which are etiological stimuli. As illustration statistical data are provided (clinical and pathological) on the role of occupational xenobiotics in the onset of coronary heart disease at young age and its sequelae.

Pathogenesis and morphogenesis of microcirculatory disorders in myocardial infarction. Clinical and ultrastructural examination.

Major advances in the understanding of myocardial infarction (MI) have been made on animal models of ischemia and infarction. We performed ultrastructural examinations of the hearts of 36 patients who died during the acute phase of MI. Tissue for investigation was obtained by express necropsy immediately after death at the clinic. All components of the microcirculatory system of the heart were damaged during the acute phase of MI. Coronary thrombosis led to arteriolar spasm and intravascular blood coagulation in the vicinity of the damaged artery. Microvessels reduction in ischemic, necrotic, and near-infarct zones was caused by endothelial cell injury and rheological disturbances. Thrombocytes played a decisive role in thrombus formation and arteriolar constriction. Leukocytes nearly always impaired the microhemodynamics in ischemic zones due to their size and rigidity. Microcirculatory disorders seemed to precede myocardial cell injury and death.

[The Lvov school of clinical pathologists]. / L'vivs'ka shkola klinichnykh patolohiv.

The story of pathology in Lviv can be briefly summarized in two stages, the first one beginning with 1785 when the University of Lviv medical faculty was organized, the second stage dating back to 1896 when the Medical Institute of Lviv and the department of pathology were found. In 1896 the first autopsy was performed at the pathology department of the Medical Institute of Lviv. Beginning with 1901 the Institute has been conducting postmortal, histological and microbiological investigations; since 1923 they have been obtaining biopsies and operative material, in 1955 histochemistry division was organized, and in 1967 electronic microscopy was first applied to studies and has become accepted practice since then. The beginning of the pathology scientific school in Lviv dates back to the end of the 19th century. It is possible to make out four principal periods of activity at the second stage of the department's development, viz., those between 1896 and 1920, 1920 and 1941, 1945 and 1965, and from 1966 up to the present day. Each of these was approximately of 20 years' duration. During the first period, A. Obzhut and Z. Dmokhovs'kyi, eminent pathologists, showed themselves first-rate lenders, the main fields of their activity having been creation of text-books for students, organization of the department's macro-museum, study into inflammation. During the second period it was V. Novits'kyi who came to the fore having devoted himself to study of infections diseases, carcinogenesis, problems of goitre; and also known for publication of a three-volume text-book on pathologic anatomy. During the third period the department was headed by M.V. Voino-Iasenets'kyi and Ie.I. Pal'chevs'kyi who distinguished themselves in the study of infectious diseases and endemic pathology. At present, D. Zerbino is in charge of the department of pathology. His principal lines of scientific activity are those of environmental and cardiovascular pathology.

[Thrombosis and embolism as paraneoplastic syndrome]. / Trombozy i émbolii kak paraneoplasticheskii sindrom.

Arterial and venous thrombotic occlusions, migrating thrombophlebitis, pulmonary artery branches embolism, abacterial thrombotic endocarditis, paradoxal hemorrhages, thrombotic microangiography arising in patients with various malignant tumours are understood under hemostasiologic paraneoplastic syndrome. The following factors are at the basis of paraneoplasia pathogenesis: 1) procoagulants synthesis by tumour cells, namely tissue factor and activators of blood coagulation factor X; 2) procoagulant activity of tumour-associated macrophages and their activity in the extra- and intravascular conversion of fibrinogen into fibrin; 3) damage of vascular endothelium by tumour cells and cytokines, for example necrotizing factor of tumours; 4) multifactorial enhancement of thrombocyte aggregational properties. According to the current concepts, such neoplastic phenomena as metastasizing, uncontrolled growth, escaping from immunological control, secondary tumour changes are viewed through the disturbances of hemostasiologic balance.

[Biopsy: its history, current and future outlook]. / Biopsiia: istoriia, sovremennost', perspektivy.

The term "biopsy" was introduced into medical terminology in 1879 by Ernest Besnier. The first diagnostic biopsy in Russia was performed in 1875 by M. M. Rudnev. It is possible to make out three stages in more than 100 year history of the method development: an occasional use of histologic procedure involving living organs and tissues accessible for observation and study (approximately until the late 19th century); restricted application of biopsy (until the mid-20th century); present stage at which the method is widely adopted and its use is general and total (with respect to human organism) not only in oncology but practically in all clinical specialties. Kinds of biopsy, excisional and incisional, are discussed as are problems of hazardousness that arise in excising body tissue for analysis in a biopsy, difficulties the pathoanatomist is faced with in interpreting histopathological preparations, reasons for faulty interpretation or failure to account for the findings, sources of error, future developments and applications. Techniques designed for getting biopsies from the heart and lungs are described, along with their diagnostic potentialities.

[Spectrographic study of the hair]. / Spektrohrafichne doslidzhennia volossia.

Estimation of microelemental composition of hairs and method of its determination are presented in the article. Two dozens of microelements were established to be present in hairs. Some samples contained vanadium, tin, and bismuth. This may be connected with unfavourable ecological influence. About a quarter of samples revealed presence of nickel, chrome and manganese., Barium and strontium were found in a half of the cases. Lead did not manifested in the most part of the samples. It may be ousted by other elements or accumulated in other organs. Calcium, aluminum, copper, iron, titan, lantan and zinc were common. Thus, study of microelemental composition of hairs may provide information on the state of metabolism and influence of environment on the body.

[The pathomorphological variants of changes in the aortic and arterial intimae: their terminology and nature]. / Patomorfolohichni varianty zmin intymy aorty ta arterii: terminolohiia i sut'.

Results of the complex study of extra- and intracranial arteries, arteries of lower limbs and aorta at various levels are presented. Autopsy material was obtained from young (aged below 44) patients who died of ischemic heart disease, cerebrovascular pathology, circulatory disorders of lower extremities. Attempt was made to summarize data about various lesions of inner arterial membrane: circular and focal musculo-elastic hyperplasia of hyalinized plaques, plaques poor on lipids, protein deposits on intima. Unification, different arterial lesions by the term "atherosclerotic plaque" prevents from detection of subtle morphogenetic mechanisms, metabolic and immunomorphological peculiarities of arterial wall.

[Myxoma of the heart: aspects of its histogenesis]. / Miksoma sertsia: deiaki aspekty histohenezu.

15 cases of heart myxomas are presented. Their origin from remains of embryonal mesenchymal tissue is hypothesized. Predominant localization at the foramen ovale area, where remains of embryonal tissue can be found, and peculiarities of histological structure resembling embryonal mesenchyma may be proofs of the hypothesis. Microscopic structure of myxomas is homogeneous: branching cells of histiocytic origin amidst basophilic or eosinophilic stroma presented by myxoid tissue, capillaries and vessels of various gauges at different stages of functional activity (shut-down, compressed, dilated, filled with erythrocytes).