Greek term pathos. - Suffering - was born back in ancient times and initially reflected the purely subjective experiences of a person, for some reason experiencing suffering. Gradually, this term began to denote the disease. And the science examining the manifestations of the altered or disturbed vital activity of the body was called "Pathology".
Pathology is an extensive area of \u200b\u200bbiology and medicine, which studies various aspects of the disease.
Pathological anatomy of a person is an integral part of the pathology, a branch of medicine that focuses on structural (morphological) changes in the body for diseases, for the causes of the disease, on the effects of disease on the body, on the mechanisms of development of the pathogenic process. At the same time, pathological anatomy necessarily associates these changes with clinical manifestations of the disease and therefore the main direction of its development is clinical and anatomical.
Pathological anatomy is a bridge between basic biological sciences and practical medicine. It studies changes in the structure and functions that arise as a result of damage or congenital disorders.
Pathological anatomy includes two large sections: general and private human pathology.
General pathological anatomy studies structural and functional changes that occur in cells and tissues under direct influence of pathogens or as a result of the development of the response of the body on them.
It includes two main sections: the doctrine of the causes of (etiology) of human diseases and the basic laws of their occurrence and development (pathogenesis).
The causes of the disease are various pathogenic factors, primarily the effects of the external environment. These factors can lead to the development of the disease or directly, or change the internal properties of the organism (chromosomal aberrations, gene mutations), which, in turn, are persistently fixed, can play a leading role in the development of the disease. No less important in the development of the disease is the degree of severity of protective and compensatory-adaptive (adaptation) mechanisms.
Along with structural changes, biochemical and physiological (functional), united by a general concept - pathogenesis occur. The term "pathogenesis" is used to refer:
q teachings on general laws of development, flow and outcome of the disease;
q mechanism for the development of a specific illness or pathological process.
Under the influence of a wide variety of reasons in the body, qualitatively similar general and local changes may develop, including circulatory disorders, alterational changes, inflammation, compensatory and adaptive processes, tissue growth disorders (tumors). All these changes are studied in the first section - the general pathology of a person.
At the same time, the degree of severity of these changes and their ratio in each case differ significantly as it determines the morphological and clinical manifestations of individual diseases. These differences are the subject of studying the private pathological anatomy or pathological anatomy of diseases.
Death as a biological concept (biological death) is an expression of an irreversible cessation of the life of the body. With the onset of death, a person turns into a dead body, a corpse (Cadaver). From a legal point of view in most countries, the body is considered to be dead when the full and irreversible cessation of the brain activity occurs. But at the same time a large number of cells and tissues in a legally dead organism remain viable for some time after death. If the body is subjected to hypothermia, in which the need for oxygen is sharply reduced, the process of cell death and tissues can be significantly detained. These organs and tissues make up the main source for transplantation.
Distinguish the following types of death:
1) Natural ("physiological" death), which really does not exist;
2) pathological (premature) death due to the disease;
3) violent death (murder, suicide, injury, etc.).
The subject of studying pathological anatomy is death due to the disease, which usually occurs relatively slowly, passing a number of stages. Along with this, there is a sudden, for minutes and even a minute, the occurrence of death, but still with quite pronounced clinical and morphological manifestations of the disease. In this case, the term sustainable death is used. However, the unexpected occurrence of death is also possible against the background of visible clinical well-being and minimal or even absent morphological manifestations of the disease. Such a state is found in breast-age and it is denoted by the term syndrome of sudden death.
After death in a certain sequence, posthumous changes arise. These include:
- rigor mortis;
- redistribution of blood;
- capor spots;
- drowy drying;
- corpse decomposition.
Knowledge of the mechanisms and the rate of development of these signs allows specialists to determine the time of death.
Cooling the corpse is associated with termination after the death of developing heat and subsequent leveling of temperature with the environment.
The corpse stuff is consigned to the muscle seal as a result of the disappearance of adenosineryphosphoric acid and the accumulation of lactic acid. The corpse stuffing is most strongly pronounced in people with well-developed muscles and in cases where death has come for cramps.
The redistribution of blood is expressed in the overflow of the veins and in reducing the blood flow of the arteries. In the cavities of the heart and blood vessels it is possible to form posthumous boroughs of blood. The number of them is maximally with a slow occasion of death and the minimum - with quick. When death in the state of asphyxia, blood is not coagulated, with time hemolysis occurs.
Podpny stains are due to the redistribution of blood, flowing it under the influence of gravity in the following parts of the body. These red-purple body hypostasis are pale with pressure (as opposed to hemorrhages). However, in a later dates for the diffusion of blood plasma, painted lysed hemoglobin, into the surrounding tissues, stains become more pale and do not disappear when pressing.
Corpse drying arises as a result of moisture evaporation from the body surface. It begins with drying the cornea, which is manifested by its clouding in areas corresponding to the open eye gap. The mucousse becomes dry, brown-colored. The same spots resembling parchment appear in the skin, primarily in the injuries of the epidermis.
The body decomposition is due to autolysis and rotten corpse. Posthumous autolysis occurs under the action of intracellular hydrolytic (lysosomal) enzymes. Posthumous autolysis quickly join the rotational processes caused by bacterial flora. They start off the intestine. Such a decomposition is accompanied by a strong grinding smell. In the case of gas formation by multiplying bacteria, the gas is inflated by the affected tissues and organs that acquire a foamy appearance (body emphysema).
Objects and research methods:
The objects of studying pathological anatomy are:
¨ corpses of persons who are dead from diseases, and in wartime - and from the battle injury;
¨ Tissues taken from living persons in surgical interventions and punctures (here referred to the studies of the material taken with the diagnostic goal - diagnostic biopsy, as well as the study of operational material in order to verify and clarify the clinical diagnosis);
¨ Tissues taken from animals with an experimentally induced pathological process.
Methods for studying pathological anatomy can be divided into two groups: basic and additional.
The main morphological methods of research include:
Macroscopic (inspection and study by the naked eye);
Microscopic.
Additional methods of research are chemical (histochemistry, immunohistochemistry, etc.), physical (estate, x-ray, x-ray analysis, ultrasound, etc.), biological (bacteriological, hematological techniques, tissue culture method, etc.).
Autopsy (autopsy of the dead)
The word "autopsy" means translated "Watch someone." The autopsy value is great and they are used for:
Scientific and educational process. It is thanks to the openings that the morphological substrate and the dynamics of the development of most diseases were revealed, the prerequisites for modern classifications of diseases were created;
Quality control of diagnosis and treatment;
Learning students and clinicians;
Identifying infectious diseases and carrying out relevant sanitary and epidemiological measures;
Tanatogenesis definitions: In cases of detection of signs of violent death, the autopsy acquires the importance of forensic medical;
Detection and study for the first time identified diseases.
Microscopy
The light microscopy has limitations: with an increase in more than 1200, the effect of refractive deformation for light waves of different lengths is manifested, as a result of which the image loses clarity and becomes blurry.
Electronic microscopy.
Three main types of electron microscopy distinguish:
- Transmission
- Scanning
- Analytical electron microscopy.
Immunohistochemistry
The value of immunohistochemistry is that it is based on strictly specific reactions between the diagnostic antibodies and their complementary antigens. In an immunohistochemical study, the tissue is usually treated with antibodies to the antigen, who want to identify it. Then the fabric is treated with antibodies to diagnostic antibodies. These antibodies contain either dye or enzyme, which can then be easily detected.
With this technology, you can define:
v hormones;
v receptors;
v cell adhesion molecules;
v protein matrix connective tissue;
v plasma proteins;
v Onclofetal antigens;
v enzymes;
v components of the cytoskeleton;
v leukocyte antigens;
v immunoglobulin components (various light and heavy chains, secretory components and J-chains);
v oncogens and their derivatives;
v nuclear proliferation genes;
v A large number of infectious agents, including bacteria, viruses, simplest and mushrooms.
Histochemistry
Histochemical studies are used to determine in the tissues of various substances. In fact, the usual color of hematoxylin and eosin is also a histochemical method. Currently, a huge amount of dyes are developed, specifically staining various components included in the cells: enzymes, various classes of fats, proteins and glycoproteins, metals, carbohydrates. For example: painting according to the van-Gizon method on collagen fibers, alzian blue on acidic glycosaminoglycans, impregnation of silver nitrate salts using the Gamori method to reticular fibers, etc.
Material for research Pathological anatomy receives when opening corpses, surgical operations, biopsy and experiment.
When opening the dead corpses - autopsy (from Greek. AutoPsia - a vision of their own eyes) find both far-sighted changes that led patients to death and initial changes that detect more often during microscopic examination. This made it possible to study the stages of the development of many diseases. Organs and tissues taken on autopsies are studied using not only macroscopic, but also microscopic research methods. At the same time, they use mainly light-optical studies, since the body changes (autolysis) limit the use of more subtle methods of morphological analysis.
During the opening, the correctness of the clinical diagnosis is confirmed or the diagnostic error is detected, the causes of the patient's death, the features of the course of the disease, the effectiveness of the use of therapeutic drugs, diagnostic manipulations is revealed, the statis of mortality and mortality is being developed, etc.
Operational material (remote organs and tissues) allows the pathologist to study the morphology of the disease at various stages of its development and use the various methods of morphological research.
Biopsy(from Greek. BIOS - Life and Opsis - Vision) - Lifting tissue with a diagnostic purpose. The material obtained by biopsy is called biopsy. More than 100 years ago, as soon as the light microscope appeared, the pathologists began to study the biopsy material, reinforcing a clinical diagnosis of morphological research. Currently, a medical institution cannot be submitted, in which they would not be resorted to biopsies to clarify the diagnosis. In modern medical institutions, biopsy is produced by each third patient, and there is no such organ, such tissue that would not be available to biopsy research.
Not only the volume and methods of biopsy are expanding, but also the tasks that the clinic solves it. Through a biopsy, often re-clinic, the clinic receives objective data confirming the diagnosis to judge the dynamics of the process, the nature of the course of the disease and the forecast, the feasibility of the use and effectiveness of one or another type of therapy, about the possible side effect of drugs. Thus, the pathologist, which began to be called a clinical pathologist, becomes a full participant in the diagnosis, therapeutic or surgical tactics and disease prediction. Biopsy gives you the opportunity to study the most initial and subtle changes in cells and tissues using an electron microscope, histochemical, histoimmunochemical and enzymological methods, that is, those initial changes in diseases whose clinical manifestations are still missing due to the viability of compensatory-adaptive processes. In such cases, only the pathologist has the possibilities of early diagnosis. The same modern methods allow to provide a functional estimate of the structures changed in case of disease, to obtain a representation not only about the essence and pathogenesis of the developing process, but also on the degree of compensation of disturbed functions. Thus, biopsytat is currently becoming one of the main objects of research in solving both practical and theoretical issues of pathological anatomy.
The experiment is very important to clarify pathogenesis and morphogenesis of diseases. Although in the experiment it is difficult to create an adequate model of a person's disease, the models of many human diseases are created and created, they help to deeper the pathogenesis and morphogenesis of diseases. On the models of human diseases, the action of certain drugs is being studied, the methods of operational interventions are developing before they find clinical use. Thus, modern pathological anatomy has become clinical pathology.
The study of the structural bases of the disease is carried out at different levels: organized, systemic, organ, fabric, cellular, subcell, molecular.
- Organizable levelallows you to see the disease of the holistic organism in its diverse manifestations, in the relationship of all organs and systems.
- System level- This is the level of studying any system of organs or tissues, combined with the generality of functions (for example, connective tissue systems, blood system, digestive system, etc.).
- Organ levelallows you to detect changes in organs, which in some cases are well visible to the naked eye, in other cases it is necessary to resort to microscopic examination.
- Fabric and cellular levels- These are the levels of study of altered tissues, cells and an intercellular substance using light-optical research methods.
- Subcell levelit allows you to observe with the help of an electron microscope change of ultrastructures of cells and an intercellular substance, which in most cases are the first morphological manifestations of the disease.
- Molecular levelthe study of the disease is possible using integrated research methods with the involvement of electron microscopy, immunohistochemistry, cytochemistry, radioautographics. As can be seen, an in-depth morphological study of the disease requires the entire arsenal of modern methods - from macroscopic to electron microscopic, histocytoenzimatic and immunohistochemical.
So, the tasks that are currently the pathological anatomy put it among medical disciplines in a special position: on the one hand, this is the theory of medicine, which, revealing the material substrate of the disease, serves directly clinical practice; On the other hand, it is a clinical morphology to establish a diagnosis that serves the theory of medicine. It should be emphasized once again that the training of pathological anatomy is based on the principles of unity and conjugacy of the structure and functionas a methodological basis for studying pathology in general, as well as clinical and anatomical direction of domestic pathological anatomy.The first principle allows you to see the links of pathological anatomy with other theoretical disciplines and the need for knowledge primarily anatomy, histology, physiology and biochemistry for knowledge of the foundations of pathology. The second principle is the clinical and anatomical direction - proves the need for knowledge of pathological anatomy to study other clinical disciplines and practical activities of the doctor regardless of the future specialty.
Clinical Biomechanics of Podium Bones
During phase flexia PDM. podium bone makes the movement of outdoor rotation. At the same time, the rear parts of large horns are diverted down the book, Kepened and Knab. Thus, the lift bone is revealed. The body descends, slightly turning the stop.
During phase extension PDM. subject bone makes the movement of internal rotation. At the same time, the rear parts of large horns converge up, for the stop and knutrice. Podium bone is thus closed. The body of the bone rises, slightly turning the kleon.
1. Novoseltsev S.V. Introduction to osteopathy. Crane diagnostics and correction techniques. St. Petersburg, LLC "Publishing Foliant", 2007. - 344 C.: IL.
2. Caporossi R., Peyralade F. Traite Pratique D`osteopatique Cranienne. S.i.O. Paris, ED. D`Verlaque, 1992.
3. Liem T. CraniosaCral Osteopathy. Principles and Practice. ELSEVIER, 2004. - 706 p.
4. Magoun H.I. Osteopathy In The Cranial Field, 3 Rd ED., 1976. - PP.5, 165.
5. Retzlaff E.W., Mitchell F.L., Jr. The Cranium and Its Sutures, Berlin, Springer Verlag, 1987.
6. SUTHERLAND W.G. Contributions of the Thougoht. - IDAHO: SUTHERLAND CRANIAL TEACHING FOUNDATION, 1967. - P. 90-92.
Introduction
Anatomy and clinical biomechanics of the bones of the skull. General
Palpator landmarks skull
Anatomy and clinical biomechanics of the occipital bone
Anatomy and clinical biomechanics of wedge-shaped bone
Anatomy and clinical biomechanics of temporal bones
Anatomy and clinical biomechanics of parietal bones
Anatomy and clinical biomechanics of the frontal bone
Anatomy and clinical biomechanics of lattice bone
Anatomy and clinical biomechanics of the upper jaw
Anatomy and clinical biomechanics of zicky bone
Anatomy and clinical teachnik biomechanics
Anatomy and clinical biomechanics sky bones
Anatomy and clinical biomechanics of the lower jaw
Anatomy and clinical biomechanics of sub-speaking bones
Pathological anatomy gets material on structural disorders
Diseases with the help of opening corpses, surgical operation, biopsy
and experiment.
When opening the corpses (autopsy-from Greek. AutoPsia - Vision
own eyes) dead from various diseases confirmed
clinical diagnosis vulnence or diagnostic error is detected,
The cause of the death of the patient, the features of the course of the disease,
is the effectiveness of the use of therapeutic drugs, tools,
Working statistics for mortality and mortality, etc. At the opening of
go as far as far as the changes that led the patient to death,
so the initial changes that detect more often with micro
Skopic study. That is how all stages were studied.
The development of tuberculosis, currently well-known doctors. By-
Once studied early manifestations of such a disease like cancer,
Revealed changes preceding its development, i.e. the precancer
processes.
Organs and tissues taken on autopsy are studied using not only ma-
Croskopic, but also microscopic research methods. At the same time
reproduced mainly by a light-optical study, since
Changes (autolysis) limit the use of thinner methods of morpho
logical analysis.
Operational material allows the pathologist to study
morphology of the disease at various stages of its development and use when
This is a variety of morphological research methods.
Biopsy (from Greek. BIOS - Life and Opsis - Vision) - Lifting Taking
Fabrics and microscopic examination with a diagnostic purpose. Already bo
Leu 100 years ago, as soon as the light microscope appeared, pathologists
Began to study the biopsy material - biopsy. Thus
way they supported a clinical diagnosis of morphological research
. Over time, the use of tissue biopsy available for research
Doves expanded. Currently, it is impossible to present therapeutic institutions
The railway in which they would not be resorted to biopsies to clarify the diagnosis.
In modern medical institutions, biopsy is produced to each third
Mu patient.
Until recently, biopsy was used mainly to diagnose
Packs of tumors and urgent solving further medicinal tactics, result
Tatti research biopsy was interested in most often surgeons and dermatology
gov. Over the past 30 years, the picture has changed dramatically. Medical equipment
Created special needles with which you can carry out the so-called
puncture biopsies of different organs (liver, kidneys, lungs, heart, bone
Brain, synovial shells, lymph nodes, spleen, head
Brain), as well as devices for the production of endobiopsy (bronchi, stomach, ki-
Schaine, etc.).
Currently, not only biopsy is improved, but also expands
The task, which with its help solves the clinic. By biopsy,
Rarely repeated, the clinic receives objective data confirming
diagnosis to judge the process dynamics, the nature of the flow of disease
nor and forecast, the feasibility of using and the effectiveness of this or
A different type of therapy, about the possible side effect of drugs. So
zoom, the pathologist becomes a full participant in the diagnosis,
Rapeutic or surgical tactics and disease forecasting.
Biopsy make it possible to explore the most initial and subtle changes
cells and tissues using an electron microscope, biochemical, histo-
Chemical, histoimmunochemical and enzymological methods. It's known
cheat that with the help of modern methods of morphological research
You can identify those initial changes in diseases, clinical manifestations
which are still missing due to the consistency of compensatory
processes. In such cases, only the pathologist has
opportunities early diagnosis. The same modern methods of cyto- and
Stochemistry, immunohistochemistry, radioautography, especially in combination with
throne microscopy, allow you to give a functional assessment of the changed
in case of disease structures, to obtain a submission not only about the essence and PATO
The genesis of the developing process, but also on the degree of compensation for disturbed
functions. Thus, biopsytat is currently becoming one of
new research objects in solving both practical and theoretical
There are problems of pathological anatomy.
Experiment is very important to clarify pathogenesis and morphogenesis
Diseases. The experimental method found particularly widespread use.
in pathological physiology, to a lesser extent - in the pathological anatom
Mia. However, the latter uses an experiment in order to trace
All phases of the development of the disease.
In the experiment it is difficult to create an adequate model of human disease, so
as his diseases are closely related not only with the effects of the pathogenic factor,
But also by the special working conditions and life. Some diseases such as rheum
TIM, meet only in humans, and still attempts to reproduce them
Animals did not give the desired results. However, the model of many
human pains are created and created, they help deeper to understand the PATO
Genesis and morphogenesis of diseases. On the models of human diseases, they study
These or other drugs are developing methods
Operational interventions before they find clinical use.
Thus, modern pathological anatomy is experiencing a period
Modernization, it became clinical pathology.
Tasks that are currently pathological anatomy
They have it among medical disciplines in a special position: on the one hand -
This is the theory of medicine, which, revealing the material substrate
The clinical practice serves directly clinical practice; On the other - it is
Clinical morphology to establish a diagnosis that serves
Waria medicine.
Purpose of classes: Examine the content of the subject of pathological anatomy, tasks and basic research methods. Consider the morphogenesis of the main structural changes in both individual tissues and organs and in the whole body during death and posthumous changes. Assimate the causes, morphology, the functional importance and the outcome of necrosis and apoptosis, find out the patterns of development of these processes.
As a result of the study, students should:
Know:
Terms used in the studied section of pathology;
Direct causes and mechanisms underlying necrosis and apoptosis;
Basic structural changes that develop in tissues and organs with necrosis, apoptosis, after the onset of biological death.
The value of pathological changes in tissues and their clinical manifestations.
Be able to:
Diagnose on macroscopic and microscopic levels various clinical and morphological forms of necrosis;
Conduct clinical and anatomical comparisons when analyzing the above pathological processes;
To be familiar with:
With major, including new scientific achievements in the study of ultrastructural, molecular changes in tissues in the development of necrosis and apoptosis.
Pathological anatomy Learning structural changes arising in the patient's body. It is divided into theoretical and practical parts. Structure of pathological anatomy: general part, private pathological anatomy and clinical morphology. The general part studies common pathological processes, the patterns of their occurrence in organs and tissues in various diseases. Pathological processes include: necrosis, circulatory disruption, inflammation, compensatory inflammatory processes, tumors, dystrophy, cell pathology. Private pathological anatomy studies material substrate disease, i.e. It is the subject of nosology. Nosology (the doctrine of the disease) provides for knowledge: etiology, pathogenesis, manifestations and nomenclature of diseases, their variability, as well as constructing the diagnosis, principles of treatment and prevention.
Tasks of pathological anatomy:
Study of the etiology of the disease (causes and conditions of the disease);
Study of the pathogenesis of the disease (mechanism of development);
Study of morphology of the disease, i.e. structural changes in the body, tissues;
Study of morphogenesis of the disease, i.e. diagnostic structural changes;
Study of the pathomorphosis of the disease (a resistant change in the cell and morphological manifestations of the disease under the influence of drugs - drug metamorphosis, as well as under the influence of the conditions of the external environment - natural metamorphosis);
The study of the complications of diseases, pathological processes that are not mandatory manifestations of the disease, but arise and worsen it, often leading to a fatal outcome;
Study of the outcome of the disease;
Study of tanatogenesis (death mechanism);
Evaluation of the functioning and condition of damaged organs.
Objects of study of pathological anatomy:
Body material;
Material taken in the life of the patient (biopsy) to diagnose and determine the forecast of the disease;
Experimental material.
Methods of study of the pathologist:
1) light microscopy with the use of special dyes;
2) electron microscopy;
3) luminescent microscopy;
5) immunohistochemistry.
Research levels: organism, organisal, systemic, tissue, cellular, subjective and molecular.
Apoptosis - This is a natural, programmed cell death in general or its part. It is found in physiological conditions - it is natural aging (death of red blood cells, T- and in lymphocytes), with physiological atrophy (atrophy of the fork gland, germ glands, leather). Apoptosis may occur in pathological reactions (during the regression period), under the action of medicinal and pathogenic factors.
Apoptosis mechanism: - Condensation of the kernel;
Condensation and sealing of internal organelle;
Fragmentation of cells with the formation of apoptotic taurus. These are small structures having fragments of eosinophilic cytoplasm with kernel residues. Then they are captured by phagocytes, macrophages, parenchyma and stroma cells. There is no inflammation.
For modern medicine, a constant search for the most objective material criteria for diagnosis and knowledge of the essence of the disease is characteristic. Among these criteria, morphological acquires exceptional importance as the most reliable.
Modern pathological anatomy widely uses other biomedical disciplines, summarizing the actual data of biochemical, morphological, genetic, pathophysiological and other studies in order to establish patterns of work of one or another organ and system under various diseases.
The scope of the application of morphological analysis in the clinic is constantly expanding due to the ever-increasing surgical activity and progress of medical equipment, as well as in connection with the improvement of the methodological capabilities of morphology. Improving medical instruments has led to the fact that there are practically no such areas of the human body that would be unavailable for a doctor. At the same time, endoscopy acquires particular importance for improving the clinical morphology, which allows the clinician to engage in morphological study of the disease at the macroscopic (organ) level. Endoscopic studies also serve as biopsy targets, with the help of which the pathologist receives material for morphological research and becomes a full-fledged participant in solving the issues of diagnosis, therapeutic or surgical tactics and disease prediction.
Tubesstudied by the pathologist, can be divided into three groups: (Fig. 7)
1) Cultural Material
2) substrates derived from patients with their lives (organs, tissues and their parts, cells and their parts, secretion products, liquids)
3) experimental material.
Methodical foundations of pathological anatomy: (Fig. 8)
Macroscopic study
Histological examination
Cytological research
Immunohistochemical research
Methods of molecular biology
Research chromosomes
Electronic microscopy.
Pattern material. Traditionally, the organs and tissues of the dead corpses: are the subject of study in the course of pathologists of autopsies (autopsies, sections) of those who died from diseases. Cases of death that occurred not from diseases, but as a result of crimes, catastrophes, accidents or unclear reasons, examine judicial medicines.
Opening. Despite the fact that in recent years in all countries, the number of openings is steadily declining, the pathological study remains one of the main methods of scientific knowledge of the disease. The source of autopsy is the establishment of the final diagnosis and causes of the patient's death. The history of the disease is delivered to the pathological department and all the existing medical records. Before opening the pathologist, it is obliged to study all this, and then invite to the autopsy attending physicians. The correctness or error in the clinical diagnosis, the effectiveness of treatment is estimated. There are criteria for evaluating the discrepancies of clinical and pathologist diagnoses, as well as the classification of the causes of discrepancies. Clinicians must make sure that those findings confirm or refute their ideas about the processes and changes that occurred in the body during the life of the patient. The results of autopsy by the pathologist lies in the protocol of opening, and the causes of the patient's death indicates a death certificate, which then issues the deceased relatives.
Another purpose of the opening is the mutual enrichment of the scientific and practical experience of clinicians and pathologists. The value of the sectional work of the pathologist consists not only in the control of the quality of therapeutic and diagnostic activities of clinicians (this control is complicated and carried out not only by pathologists), but also in the accumulation of statistical and scientific and practical data on diseases and pathological processes.
If the sectional work is organized highlyofessional and adequately equipped with methodologically, then its fulfillment is very expensive. This has become one of the reasons for a significant reduction in the number of hospital autopsies in a number of industrialized countries.
Material taken in the life of the patient. A much greater volume in the work of the pathologist occupies a microscopic study of the material obtained with the diagnostic goal during the lifetime of the patient. Most often, such a material comes from the operating clinicians: surgeons, gynecologists, urologists, otorhinolaryngologists, ophthalmologists, etc. The diagnostic role of the pathologist is great here, and its conclusion is often determined by the wording of the clinical diagnosis.
Histological research. This study is subjected operational and biopsy materials.The pathologist requires histological confirmation (clarification) of the diagnosis. In both cases, immediate fixation of remote fabrics is important. Even a very long content of remote pieces or substrates in air, in water or salt solution can lead to irreversible, artificially caused changes in the material, which will make it difficult or eliminate the setting of the right histological diagnosis.
Stages of manufacturing histological preparations: (Fig. 9)
Fixation (10% rr formalin, ethyl alcohol)
Flushing (flowing tap water)
Dehydration (alcohi increasing concentration)
Removal of alcohol (chloroform, xylene, toluene)
Impression and fill (paraffin)
Production of paraffin blocks
Production of paraffin slices on the microtome and placing them on the slide
Deparafining (xylene alcohol-distilled water)
Coloring
Dehydration and enlightenment of sections (xylene, toluene)
Conclusion in the resin under the coating glass (Canadian Balsam) (Fig.10-19)
For urgent biopsyconducted often during extensive surgical interventions, in order to quickly obtain a histological diagnosis, the tissue is frozen and cut on a cryostate Ile and freezing microtome. The diagnosis is made in 20-30 minutes.
For normal diagnostics, universal histological color of sections are widely used. hematoxiline and Eusic. (Fig.20)
Very often used color picrofuxin by van Gizon Electively, i.e. Collage fibers of connective tissue in red color, while other structures becomes yellow or greenish yellow. (Fig.21) There are also many histological paintings to identify certain components of tissue or pathological substrates.
Cytological research. It is carried out on stars made from the contents of hollow or tubular organs, as well as drug prints, punctures and aspirates (aspiration punctures, suused syringe). More active interference is the scraping from the walls of the organs. The cytological material is fixed, usually, right on the slide glass, often during color. The most popular color of Azur-Eosin. (Fig.22.23)
Immunohistochemical study. With some pathological conditions, especially tumors, it is difficult and even impossible to determine the type of fabric or its origin (histogenesis) with the help of histo or cytological colors. Meanwhile, such verification is important for diagnosis and forecasting. Therefore, the immunohistochemical method. Under it, solutions with antibodies to the artificial antigens are applied to histo or cytological drugs: tumor, viral, microbial, autoantignenes, etc. Immunofluorescence is most often used in the study of sections prepared in a cryostat or on a freezing microtome, as well as in the study of cytological drugs. (Fig.24.25) Immunoperoxidase method is even more common. There are several variants of the specified method. Two of them are most often used: peroxidase-antipexidase (dad-method), and the Avidin-biotin complex method (ABC method). (Fig.26.27)
Methods of molecular biology.Molecular biology methods are used in well-equipped pathological departments for privatiable diagnostics: flow cytometry and hybridization technique in situ,i.e. in place, on histological cut. The first method is necessary for a quantitative analysis of DNA content in tumor cells. Hybridization in situ It is used mainly in three areas of pathology: for identifying germs or viruses in tissues or liquids; To study the genome under its congenital disorders; When diagnosing tumors, in particular, to recognize viral antigens. Most often the main hybridization method in situ will be applied - polymerase chain reaction(PCR).
Research chromosomes . In many modern pathological departments, a chromosomal analysis is carried out to determine deviations in the genetic apparatus (genome) of cells having a congenital or acquired character.
This analysis is of particular importance in recognition and study of tumors, various options for which are accompanied by quite specific marker restructuring or chromosome aberrations. (Fig.28) Chromosomal analysis refers to economically expensive methods and therefore applied infrequently.
Electronic microscopy. During the diagnostic studies on the material taken during the lifetime of the patient, electron microscopy is often used: transmission (in a passing beam, like light-optical microscopy) and scanning (removing surface relief). (Fig.29)
Experimental material. Exploring the fabrics taken during his lifetime or after the death of a sick person, the pathologist observes changes at the time of tissue withdrawal. What happened before and could be after - it remains unknown. Experiment with a sufficient amount of laboratory animals (white mice, white rats, guinea pigs, rabbits, dogs, monkeys, etc.) allows you to simulate and study diseases and pathological processes at any stage of their development.
The study of the structural foundations of the disease is carried out at different levels:
organiser, systemic, organ, fabric, cellular, subcelet, mole
Cool. (Fig. 30)
Organizable levelallows you to see a disease of a holistic organism
In its diverse manifestations, in the relationship of all organs and systems.
System level- this is the level of studying any system of organs
or tissues combined by the generality of functions (for example, the system of connecting
tissue tissue, blood system, digestive system, etc.).
Organ levelallows you to detect changes to organs that
In some cases there are well visible naked eyes, in others
Cases for their detection must be resorted to microscopic
Research.
Fabric and cellular levels- these are levels of learning changed tissues,
cells and intercellular substances using light-optical methods
Doves.
Subcell levelallows you to observe with electronic
microscope changes of ultrastructures of cell and intercellular substance that
ryy in most cases are the first morphological manifestations
Diseases.
Molecular levelthe study of the disease is possible when used
integrated research methods with electron microscopy involvement,
immunohistochemistry, cytochemistry, radioautography. As can be seen, in-depthorn
Fologistic research of the disease requires the entire arsenal of modern methods
Dov - from macroscopic to electron microscopic, histocytoenzy
Matic and immunohistochemical.
So, the tasks that are currently pathological anatomy
put it among medical disciplines in a special position: on the one hand -
this is the theory of medicine, which, revealing the material substrate of diseases
nor serves directly clinical practice; On the other hand, it is a clinical morphology to establish a diagnosis that serves the theory of medicine. It should be emphasized once again that the training of pathological anatomy is based on the principles of unity and conjugacy of the structure and function scatter
a crimson-based study of pathology in general, as well as clinical and anatomical
whom the directions of domestic pathological anatomy .
First principle
allows you to see the links of pathological anatomy with other theoretical disciplines and the need for knowledge primarily anatomy, histology,
Physiology and biochemistry for knowledge of the foundations of pathology. The second principle is
Niko-anatomical direction - proves the need for knowledge of pathology
Gycical anatomy to study other clinical disciplines and practical
Doctor's activities regardless of future specialty.
