Handicraft called kumihimo came from Japan. This is weaving cords using a simple device. Such cords were used by warriors to fasten armor, and by women to attach a bow to their belts.
Where in medieval Europe they used narrow strips of leather; in Japan they used silk braided cords.
To weave such products in Japan they used relatively large wooden machines, now they use small plastic disks.
You can make the discs yourself from thick cardboard.
You need to make triangular notches along the edge of the disk.
Usually they make 32. But the choice of quantity is yours.
Download the book :)
The art of kumihimo.rar
In English. The diagrams are clear.
http://files.gameworld.kz/va57yxmh3y.html
Jacqul Carey Creatibe Kumihimo - Creating Kumihimo
Description: A guide to weaving cords and belts using the Japanese kumihimo technique, allowing you to work on professional level.
More than 40 weaving patterns on 8 and 16 cords.
Full layout of patterns for color selection.
Ideas and advice.
http://files.gameworld.kz/5vyfprxnkv.html
Monkey Fist Knot
Knot
It was invented in the days of pirates, when a ship in distress needed to throw the saving end of a rope from another ship.
The pirates used a cannonball as a weight.
In order to secure the core, this knot was developed.
It was also used as a bladed weapon. A metal ball was woven inside the “fist”.
It is still used as a weapon to this day in various variations.
Eight-strand cord
Two types of cord can be woven on 8 threads.
A point knot is woven in the middle of the 4 threads, resulting in 8 ends (Fig. 23).
Weaving begins from left to right: the 1st thread is laid on the 2nd, the 2nd on the 3rd, etc., the last - the 8th - is pulled into the loop formed between the 1st and 2nd threads.
Repeating this weaving in one direction, a round cord is woven. Alternating direction:
one circle clockwise
the other is against it - you can weave an octagonal gaitan cord.
The second type of cord of 8 ends is woven on a base of thick rope.
4 threads are folded in half, tied with a knot “over the hand” and secured at the upper end of the warp, -
it turns out 8 ends of threads.
The threads are divided into 2 groups: 1 - 4th from the left, 5 - 8th thread from the right (Fig. 24).
The outermost thread on the left (1st) is placed behind the warp, brought under the 8th and 7th threads, then placed on the 6th and 5th. The outermost thread on the right (8th) is placed behind the warp, brought under the 2nd and 3rd and placed on the 4th and 1st threads.
So, alternating weaving techniques, the cord is braided to the required length.
Lotus cord
Place 2 crosswise and secure them in place.
You now have 4 ends:
lower (1st and 2nd),
upper (3rd and 4th).
Place the 1st end in a loop on the 2nd.
2nd end - on 1st and 3rd.
3rd end - to 2nd and 4th.
The 4th end is on the 3rd and pass under the 1st into the loop.
Tighten the knot by pulling all ends at the same time.
Continue weaving in the same direction
(from right to left, counterclockwise) and you will get a round twist cord.
Knots can be tied either clockwise or counterclockwise.
If you alternate these directions, you will get a cord with a square cross-section rather than a round one.
You can weave a “lotus” cord from threads of 4 different colors.
Mystic knot
IN Chinese"Pan Chang" means "endless".
One of the Eight Buddhist Symbols, Pan Chang symbolizes the mysteries of the Universe and is also known as the Mystic Knot.
It is believed to bring good luck.
The knot is quite complex, so study the pattern before you start weaving.
1. Take a thread 3m long. Pin it on the pillow in the middle, form a loop at each end (see Fig. 1, vertical hinges), stab.
2. Take the right end of the thread, make a long loop out of it and thread it through all the vertical loops that were formed in the previous step. The loop will pass through each of them according to the “under the thread - above the thread” pattern (see the same Fig. 1). Stab it. Now make another long loop from the same thread, pass it through the vertical loops, like the first, and pin it.
3. Now we take the left end and lead it along the top of the knot, wrapping around all the vertically running threads, except for the rightmost eye loop. In this case, the thread will pass first over the loops and then under them (see Fig. 2). We stab it. Once again we wind the same thread to the right (this creates a loop on the left) and repeat the same thing at the bottom of the knot.
4. Now you need to additionally pass the left end of the thread along the vertical of the knot (see Fig. 3).
The main principle to remember is:
when the thread goes up, it goes under 1 thread, over 3, again under 1, and again over 3 threads,
and when the thread goes down, it goes under 2, over 1, under 3, over 1 and under 1 thread.
Remember this sequence for yourself ("under one-above three-under one-above three-
and down-under two-over one-under three-over-under"), this will simplify things.
1 - 3 - 1 - 3 - 2 - 1 - 3 - 1 - 1
5. Gently tighten the knot using the outer loops and loose ends. All that remains is to equalize the size of the petals by pulling up the corresponding sections of the thread (go from the middle of the knot in turn in different directions).
Pathology of mitosis
Mitosis occupies a special place in the life cycle of a cell. With its help, cell reproduction is carried out, and hence the transfer of their hereditary properties. The preparation of cells for mitosis consists of a number of sequential processes: DNA reproduction, doubling of cell mass, synthesis of protein components of chromosomes and the mitotic apparatus, doubling of the cell center, accumulation of energy for cytotomy. In the process of mitotic division, as is known, there are 4 main phases: prophase, metaphase, anaphase and telophase.
With pathology of mitosis, any of these phases can suffer. Guided by this, it was created classification of pathology of mitosis (Alov I.A., 1972), according to which the following types of mitosis pathology are distinguished.
I. Damage to chromosomes: 1) delay of cells in prophase; 2) violation of spiralization and despiralization of chromosomes; 3) chromosome fragmentation; 4) formation of bridges between chromosomes in anaphase; 5) early separation of sister chromatids; 6) kinetochore damage.
II. Damage to the mitotic apparatus: 1) delay in the development of mitosis in metaphase; 2) dispersal of chromosomes in metaphase; 3) three-group metaphase; 4) hollow metaphase; 5) multipolar mitoses; 6) asymmetric mitoses; 7) monocentric mitoses; 8) K-mitoses.
III. Violation of cytotomy: 1) premature cytotomy; 2) delay in cytotomy; 3) absence of cytotomy.
The pathology of mitosis can be caused by various influences on the cell: ultraviolet and ionizing radiation, high temperature, chemicals, including carcinogens and mitotic poisons, etc. There is a large number of pathological mitoses during tissue malignancy (Fig. 8).
Rice. 8. Pathology of mitosis. Semi-thin section of tumor tissue. x1000
Chromosomal aberrations and chromosomal diseases
Chromosomal aberrations. Chromosome aberrations mean changes in the structure of chromosomes caused by their breaks, followed by redistribution, loss or duplication genetic material. They reflect different kinds chromosome abnormalities. In humans, among the most common chromosomal aberrations, manifested by the development of deep pathology, are anomalies relating to the number and structure of chromosomes. Violations number of chromosomes can be expressed by the absence of one of a pair of homologous chromosomes (monosomy) or the appearance of an additional third chromosome (trisomy). The total number of chromosomes in the karyotype in these cases differs from the modal number and is equal to 45 or 47. Polyploidy and aneuploidy are less important for the development of chromosomal syndromes. To violations chromosome structures with a generally normal number of them in the karyotype, they are classified as Various types their “breakdowns”: translocation (exchange of segments between two non-homologous chromosomes), deletion (loss of a part of a chromosome), fragmentation, ring chromosomes, etc.
The lecture notes presented to your attention are intended to prepare students of medical universities for passing exams. The book includes a course of lectures on pathological anatomy, is written in accessible language and will an indispensable assistant for those who want to quickly prepare for the exam and pass it successfully.
* * *
The given introductory fragment of the book General pathological anatomy: lecture notes for universities (G. P. Demkin) provided by our book partner - the company liters.
Lecture 1. Pathological anatomy
1. Objectives of pathological anatomy
4. Death and post-mortem changes, causes of death, thanatogenesis, clinical and biological death
5. Cadaveric changes, their differences from intravital pathological processes and significance for the diagnosis of the disease
1. Objectives of pathological anatomy
Pathological anatomy– the science of the occurrence and development of morphological changes in a sick body. It originated in an era when the study of painfully altered organs was carried out with the naked eye, i.e., using the same method used by anatomy, which studies the structure of a healthy organism.
Pathological anatomy is one of the most important disciplines in the system of veterinary education, in scientific and practical activities doctor She studies the structural, i.e., material basis of the disease. It is based on data from general biology, biochemistry, anatomy, histology, physiology and other sciences that study the general laws of life, metabolism, structure and functional functions of a healthy human and animal body in its interaction with the external environment.
Without knowing what morphological changes a disease causes in an animal’s body, it is impossible to have a correct understanding of its essence and mechanism of development, diagnosis and treatment.
The study of the structural basis of the disease is carried out in close connection with its clinical manifestations. Clinical and anatomical direction – distinguishing feature national pathological anatomy.
The study of the structural basis of the disease is carried out at different levels:
· the organismal level allows us to identify the disease of the entire organism in its manifestations, in the interrelation of all its organs and systems. From this level begins the study of a sick animal in clinics, a corpse in a dissection room or a cattle burial ground;
· the system level studies any system of organs and tissues (digestive system, etc.);
· the organ level allows you to determine changes in organs and tissues visible with the naked eye or under a microscope;
· tissue and cellular levels - these are the levels of studying altered tissues, cells and intercellular substance using a microscope;
· the subcellular level makes it possible to observe using an electron microscope changes in the ultrastructure of cells and intercellular substance, which in most cases were the first morphological manifestations of the disease;
· the molecular level of studying the disease is possible using complex methods studies involving electron microscopy, cytochemistry, autoradiography, immunohistochemistry.
Recognition of morphological changes at the organ and tissue levels is very difficult at the beginning of the disease, when these changes are insignificant. This is due to the fact that the disease began with changes in subcellular structures.
These levels of research make it possible to consider structural and functional disorders in their inextricable dialectical unity.
2. Objects of study and methods of pathological anatomy
Pathological anatomy deals with the study of structural disorders that arise at the very initial stages of the disease, during its development, up to the final and irreversible conditions or recovery. This is the morphogenesis of the disease.
Pathological anatomy studies deviations from the usual course of the disease, complications and outcomes of the disease, and necessarily reveals the causes, etiology, and pathogenesis.
Studying the etiology, pathogenesis, clinical picture, and morphology of the disease allows us to apply scientifically based measures for the treatment and prevention of the disease.
The results of observations in the clinic, studies of pathophysiology and pathological anatomy have shown that a healthy animal body has the ability to maintain a constant composition of the internal environment, a stable balance in response to external factors– homeostasis.
In case of illness, homeostasis is disrupted, vital activity proceeds differently than in a healthy body, which is manifested by the structural and functional disorders. Disease is the life of an organism in changed conditions of both the external and internal environment.
Pathological anatomy also studies changes in the body. Under the influence of drugs, they can be positive and negative, causing side effects. This is the pathology of therapy.
So, pathological anatomy covers a wide range of issues. She sets herself the task of giving a clear idea of the material essence of the disease.
Pathological anatomy strives to use new, more subtle structural levels and the most complete functional assessment of the altered structure at equal levels of its organization.
Pathological anatomy obtains material about structural disorders in diseases through autopsy of corpses, surgical operations, biopsies and experiments. In addition, in veterinary practice, for diagnostic or scientific purposes, forced slaughter of animals is carried out at different stages of the disease, which makes it possible to study the development of pathological processes and diseases at various stages. Great opportunity pathological examination of numerous carcasses and organs is performed in meat processing plants during the slaughter of animals.
In clinical and pathomorphological practice, biopsies are of particular importance, i.e. intravital removal of pieces of tissue and organs, carried out for scientific and diagnostic purposes.
Particularly important for elucidating the pathogenesis and morphogenesis of diseases is their reproduction in experiment. The experimental method makes it possible to create disease models for accurate and detailed study, as well as for testing the effectiveness of therapeutic and preventive drugs.
The possibilities of pathological anatomy have expanded significantly with the use of numerous histological, histochemical, autoradiographic, luminescent methods, etc.
Based on the objectives, pathological anatomy is placed in a special position: on the one hand, it is a theory of veterinary medicine, which, by revealing the material substrate of the disease, serves clinical practice; on the other hand, it is clinical morphology for establishing a diagnosis, serving the theory of veterinary medicine.
3. Short story development of pathological anatomy
The development of pathological anatomy as a science is inextricably linked with the dissection of human and animal corpses. According to literary sources in the 2nd century AD e. The Roman physician Galen dissected the corpses of animals, studying their anatomy, physiology, and described some pathological and anatomical changes. In the Middle Ages, due to religious beliefs, autopsies of human corpses were prohibited, which somewhat halted the development of pathological anatomy as a science.
In the 16th century in a number of countries Western Europe doctors were again given the right to perform autopsies on human corpses. This circumstance contributed to the further improvement of knowledge in the field of anatomy and the accumulation of pathological and anatomical materials for various diseases.
In the middle of the 18th century. The book of the Italian doctor Morgagni “On the localization and causes of diseases identified by the anatomist” was published, where the scattered pathological and anatomical data of his predecessors were systematized and his own experience was generalized. The book describes changes in organs in various diseases, which facilitated their diagnosis and contributed to the promotion of the role of pathological and anatomical research in establishing a diagnosis.
In the first half of the 19th century. in pathology, the humoral direction dominated, whose supporters saw the essence of the disease in changes in the blood and juices of the body. It was believed that first there was a qualitative disturbance of the blood and juices, followed by the rejection of “pathogenic matter” in the organs. This teaching was based on fantastic ideas.
The development of optical technology, normal anatomy and histology created the prerequisites for the emergence and development of cell theory (Virchow R., 1958). Pathological changes, observed in a particular disease, according to Virchow, is a simple sum of the disease state of the cells themselves. This is the metaphysical nature of R. Virchow’s teaching, since the idea of the integrity of the organism and its relationship with environment. However, Virchow's teaching served as a stimulus for deep scientific study diseases through pathological-anatomical, histological, clinical and experimental research.
In the second half of the 19th and early 20th centuries. In Germany, major pathologists Kip and Jost worked, authors of fundamental manuals on pathological anatomy. German pathologists conducted extensive research on equine infectious anemia, tuberculosis, foot and mouth disease, swine fever, etc.
The beginning of the development of domestic veterinary pathological anatomy dates back to the middle of the 19th century. The first veterinary pathologists were professors of the veterinary department of the St. Petersburg Medical-Surgical Academy I. I. Ravich and A. A. Raevsky.
WITH late XIX century, domestic pathological anatomy received its further development within the walls of the Kazan Veterinary Institute, where since 1899 the department was headed by Professor K. G. Bol. He is the author of a large number of works on general and specific pathological anatomy.
The research conducted by domestic scientists is of great scientific and practical importance. Row completed important research in the field of studying theoretical and practical issues pathologies of farm and commercial animals. These works made a valuable contribution to the development of veterinary science and animal husbandry.
4. Death and post-mortem changes
Death is the irreversible cessation of the vital functions of the body. This is the inevitable end of life, which occurs as a result of illness or violence.
The process of dying is called agony. Depending on the cause, the agony can be very brief or last up to several hours.
Distinguish clinical and biological death. Conventionally, the moment of clinical death is considered to be the cessation of cardiac activity. But after this, other organs and tissues with varying durations still retain vital activity: intestinal motility continues, gland secretion continues, and muscle excitability remains. After the cessation of all vital functions of the body, biological death occurs. Postmortem changes occur. Studying these changes is important for understanding the mechanism of death in various diseases.
For practical activities great importance have differences in morphological changes that occurred intravitally and postmortem. This helps to establish the correct diagnosis and is also important for forensic veterinary examination.
5. Cadaveric changes
· Cooling the corpse. Depending on the conditions, after various periods of time, the temperature of the corpse is equalized with the temperature of the external environment. At 18–20°C, the corpse cools by one degree every hour.
· Rigor mortis. 2–4 hours (sometimes earlier) after clinical death, smooth and striated muscles contract somewhat and become dense. The process begins with the jaw muscles, then spreads to the neck, forelimbs, chest, belly and hind limbs. The greatest degree of rigor is observed after 24 hours and persists for 1–2 days. Then the rigor disappears in the same sequence as it appears. Rigor of the heart muscle occurs 1–2 hours after death.
The mechanism of rigor mortis has not yet been sufficiently studied. But the importance of two factors has been clearly established. During the post-mortem breakdown of glycogen, a large amount of lactic acid is formed, which changes the chemistry of muscle fiber and promotes rigor. The amount of adenosine triphosphoric acid decreases, and this causes the loss of elastic properties of the muscles.
· Cadaveric spots arise due to changes in the state of the blood and its redistribution after death. As a result of post-mortem contraction of the arteries, a significant amount of blood passes into the veins and accumulates in the cavities of the right ventricle and atria. Post-mortem blood clotting occurs, but sometimes it remains liquid (depending on the cause of death). In death from asphyxia, blood does not clot. There are two stages in the development of cadaveric spots.
The first stage is the formation of cadaveric hypostases, which occur 3–5 hours after death. The blood, due to gravity, moves to the underlying parts of the body and seeps through the vessels and capillaries. Spots form, visible in the subcutaneous tissue after removing the skin, and in the internal organs - upon opening.
The second stage is hypostatic imbibition (impregnation).
In this case, interstitial fluid and lymph penetrate into the vessels, thinning the blood and increasing hemolysis. The diluted blood again seeps out of the vessels, first onto the underside of the corpse, and then everywhere. The spots have indistinct outlines, and when cut, it is not blood that flows out, but sanguineous tissue fluid (different from hemorrhages).
· Cadaveric decomposition and rotting. In dead organs and tissues, autolytic processes develop, called decomposition and caused by the action of the dead organism’s own enzymes. Tissue disintegration (or melting) occurs. These processes develop most early and intensively in organs rich in proteolytic enzymes (stomach, pancreas, liver).
Decomposition is then joined by rotting of the corpse, caused by the action of microorganisms that are constantly present in the body during life, especially in the intestines.
Rotting occurs first in the digestive organs, but then spreads to the entire body. During the putrefactive process, various gases are formed, mainly hydrogen sulfide, and very bad smell. Hydrogen sulfide reacts with hemoglobin to form iron sulfide. A dirty greenish color appears in the cadaveric spots. The soft tissues swell, soften and turn into a gray-green mass, often riddled with gas bubbles (cadaveric emphysema).
Putrefactive processes develop faster with more high temperature and higher environmental humidity.
№ 131 Melanocytic tumors: classification, morphological characteristics, features of metastasis, outcomes.
Noncellular nevus (pigmented nevus, mole). The mole is one of the most diverse, dynamic and biologically significant tumors of the skin. The name “noncellular nevus” is applied to any congenital or acquired tumor consisting of melanocytes. The most common (acquired) noncellular nevus is a small, tan, uniformly pigmented, firm papule that is typically less than 6 mm in diameter and has well-defined, rounded borders. There are a large number of clinical and histological types noncellular nevus.
Noncellular nevus is formed from melanocytes, which transform from single branched cells scattered among the basal keratinocytes into round or oval cells growing in groups or nests along the junction of the epidermis and dermis. The nuclei of nevus cells have rounded shape, are relatively monomorphic and contain not very noticeable nucleoli. Their mitotic activity is insignificant.
The superficial form of the tumor reflects the early stage of its development and is called borderline nevus . Gradually, most border nevi grow into the underlying dermis in the form of cell nests and strands (complex nevus) . In more mature neoplasms, these nests may already be completely isolated from the epidermis. This dermal(intradermal) nevus . Complex and dermal nevi tend to rise above the surface of the skin, unlike their borderline counterparts. The progressive growth of nevus cells from the zone of the dermatoepidermal junction into the underlying dermis is accompanied by a process called maturation. Despite not fully maturing, those nevus cells that are closer to the surface of the skin are larger in size and tend to produce melanin and form nests. More mature nevus cells, located deeper, are smaller in size. They grow in cords and synthesize little or no melanin. The most mature nevus cells can be found in the very core of the tumor, where they often acquire a spindle-shaped shape and grow in bunches, resembling nerve tissue. In these non-pigment-synthesizing, deep-seated nevus cells, similar to nerve structures, changes in enzyme activity are noted (progressive loss of tyrosinase activity and appearance of cholinesterase activity).
Rarer variants of noncellular nevus compared to those described are blue nevus And halo nevus .
Dysplastic nevus. VK birthmarks (dysplastic nevi) larger than other acquired moles: often their diameter exceeds 5 mm. These are flat macules, or plaques, that protrude slightly above the surface of the skin and have an uneven surface. As a rule, the degree of their pigmentation varies, and the edges have uneven contours,
Unlike freckles, dysplastic nevi appear on the surface of the skin, both exposed to sunlight and covered by clothing. These tumors are found in many family members who have a tendency to develop malignant melanomas (suffering from hereditary melanoma syndrome). Genetic analyzes carried out in such individuals revealed an autosomal dominant type of inheritance of dysplastic nevi. It has been suggested that a sensitive gene, which is localized on the short arm of the chromosome / near the locus, is involved in the hereditary transmission Rh. Dysplastic nevi can also occur as independent neoplasms not associated with hereditary melanoma syndrome; in this case, the risk of malignancy is low. Using serial studies of biopsy specimens, the transformation of dysplastic nevus into an early form of melanoma was traced clinically and histologically in some individuals. It turned out that it occurs over several weeks. However, most of these nevi are still stable (benign) neoplasms.
Dysplastic nevi are built from elements of a complex nevus that has architectural and cytological signs of abnormal growth. Intraepidermal nests of nevus cells are larger in size and often merge with each other. As part of this process, individual nevus cells begin to replace the keratinocytes of the basal layer, spreading along the dermatoepidermal junction. In this case, atypia of nevus cells is noted, manifested in the form of uneven, often angular contours and nuclear hyperchromasia. Changes also affect the superficial parts of the dermis. Rare lymphoid infiltrates, loss of melanin from collapsing nevus cells and its phagocytosis by dermal macrophages (melanin incontinence), as well as characteristic linear fibrosis of the reticular layer are found here.
Malignant melanoma. It is a relatively common disease that not long ago was considered almost exclusively fatal. In the vast majority of patients, melanoma occurs in the skin. In other localizations of this tumor, the mucous membranes of the mouth, genitals, anus and esophagus are affected. This tumor develops especially often in the choroid of the eye. Occasionally it is found in the membranes of the brain and the mucous membranes of the urinary and biliary tract.
An important role in emergence malignant melanoma skin plays sunlight. For example, in men it often develops on the upper back, and in women it often develops on the back and legs. People with lighter skin are more at risk of developing melanoma than those with dark skin. TO melanomagenic factors This applies not only to sunlight. The presence of a pre-existing nevus (especially a dysplastic one), hereditary factors, or even exposure to certain carcinogens all have important in the origin of neoplasms.
The earliest clinical manifestation malignant melanoma of the skin is itchy, and the most important symptom- change in color of pigmented lesion. Unlike the color of a benign (non-dysplastic) nevus, the pigmentation of melanomas varies significantly and appears in all possible shades of black, brown, red and gray. Sometimes there are areas of hypopigmentation that are white or flesh-colored. The borders of melanoma are unclear and the shape is not round, as with a noncellular nevus. They look like an irregular, twisted and not clearly defined line.
At the core interpretation of the structure Malignant melanoma is based on the concept of radial and vertical growth. Radial growth indicates the tendency of tumor cells to spread horizontally (growth) in the epidermal and superficial dermal layers. Such growth often takes a long period of time. During this process, melanoma cells do not yet exhibit the ability to metastasize. There is three varieties of radial growth melanoma: lentigo maligna, superficial spread, lentiginous lesions of the mucous membranes and extremities. They are determined by overall composition the growth and structure of tumor elements in the epidermal layer, as well as the biological behavior of melanoma. For example, lentigo maligna in the radial growth phase usually occurs on sun-damaged facial skin of older people; it can exist for several decades before suddenly metastasizing. Over time, radial growth changes to vertical. In the form of an expansively increasing mass, melanoma tissue rushes into the deeper layers of the dermis. In this mass, the cells remain at the stage of low differentiation and, as they spread into the reticular layer of the dermis, they acquire increasingly smaller sizes. In this case, based on the previous phase of flat and radial growth, the formation of tumor node. It is during this period that clones of tumor cells with metastatic potential are formed. The likelihood of metastasis can be predicted using simple measurement(in millimeters) depth of invasion, which is determined by the thickness of the vertical growth zone starting immediately below the granular layer of the epidermis.
As a rule, melanoma cells are much larger in size than nevus elements. They have large nuclei with irregular contours and marginally located (under the nuclear membrane) chromatin, as well as clearly defined eosinophilic nucleoli. These cells either form solid nests or grow in small groups or singly. All this occurs in all layers of the epidermis or dermis. As with other malignant tumors, it is important to note not only the degree of histological differentiation of tumor nests and complexes, but also the presence of melanin and the depth of invasion. Important prognostic indicators It is customary to consider the number of mitotic figures determined among tumor cells, the level of lymphocytic infiltration of the stroma and parenchymal complexes of the neoplasm.
Pathological anatomy is an integral part of pathology (from the Greek. pathos- disease), which is a broad field of biology and medicine that studies various aspects of disease. Pathological anatomy studies structural (material) basis of the disease. This study serves both medical theory and clinical practice, therefore pathological anatomy is scientific and applied discipline. The theoretical, scientific, significance of pathological anatomy is most fully revealed when studying the general patterns of development of cell pathology, pathological processes and diseases, i.e. general human pathology. General human pathology, primarily cell pathology and the morphology of general pathological processes, is the content of the course general pathological anatomy. The clinical, applied, significance of pathological anatomy lies in the study of the structural foundations of the entire variety of human diseases, the specifics of each disease, otherwise - in the creation anatomy of a sick person, or clinical anatomy. The course is dedicated to this section private pathological anatomy.
The study of general and specific pathological anatomy is inextricably linked, since general pathological processes in their various combinations are the content of both syndromes and human diseases. The study of the structural basis of syndromes and diseases is carried out in close connection with their clinical manifestations. Clinical and anatomical direction - this is a distinctive feature of domestic pathological anatomy.
In a disease, which should be considered as a violation of the normal vital functions of the body, as one of the forms of life, structural and functional changes are inextricably linked. There are no functional changes that are not caused by corresponding structural changes. Therefore, the study of pathological anatomy is based on principle of unity And structure pairing And functions.
When studying pathological processes and diseases, pathological anatomy is interested in the causes of their occurrence (etiology), development mechanisms (pathogenesis), the morphological basis of these mechanisms (morphogenesis), various outcomes of the disease, i.e. recovery and its mechanisms (sanogenesis), disability, complications, as well as death and death mechanisms (thanatogenesis). The task of pathological anatomy is also to develop the doctrine of diagnosis.
In recent years, pathological anatomy has paid special attention to the variability of diseases (pathomorphosis) and diseases arising in connection with the activities of a doctor (iatrogenics). Pathomorphosis - a broad concept that reflects, on the one hand, changes in the structure of morbidity and mortality associated with changes in human living conditions, i.e. changes in the general panorama of diseases, on the other hand, persistent changes in the clinical and morphological manifestations of a particular disease, but
zology - nosomorphosis, usually arising in connection with the use of medications (therapeutic pathomorphosis). Iatrogenesis (pathology of therapy), i.e. diseases and complications of diseases associated with medical manipulations (drug treatment, invasive diagnostic methods, surgical interventions) are very diverse and are often based on medical error. It should be noted that iatrogenicity has increased in recent decades.
Objects, methods and levels of research in pathological anatomy
Pathological anatomy obtains material for research during autopsies of corpses, surgical operations, biopsies and experiments.
At autopsies deceased - autopsy (from Greek autopsia- seeing with one’s own eyes) find both far-reaching changes that led the patient to death, and initial changes, which are often discovered only during microscopic examination. This made it possible to study the stages of development of many diseases. Organs and tissues taken at autopsy are studied using not only macroscopic, but also microscopic research methods. In this case, they mainly use light-optical examination, since cadaveric changes (autolysis) limit the use of more subtle methods of morphological analysis.
During the autopsy, the correctness of the clinical diagnosis is confirmed or a diagnostic error is revealed, the causes of death of the patient, the features of the course of the disease are established, the effectiveness of the use of medicinal drugs and diagnostic procedures is revealed, mortality and mortality statistics are developed, etc.
Operating material (removed organs and tissues) allows the pathologist to study the morphology of the disease at various stages of its development and use a variety of methods of morphological research.
Biopsy (from Greek bios- life and opsis- vision) - intravital tissue sampling for diagnostic purposes. The material obtained through biopsy is called biopsy. More than 100 years ago, as soon as the light microscope appeared, pathologists began to study biopsy material, supporting the clinical diagnosis with morphological examination. Currently, it is impossible to imagine a medical institution in which they would not resort to biopsies to clarify the diagnosis. In modern medical institutions A biopsy is performed in every third patient, and there is no organ or tissue that is not accessible to biopsy examination.
Not only the scope and methods of biopsy are expanding, but also the tasks that the clinic solves with its help. Through a biopsy, often repeated, the clinic receives objective data confirming
diagnosis, allowing one to judge the dynamics of the process, the nature of the course of the disease and prognosis, the feasibility of using and the effectiveness of a particular type of therapy, and the possible side effects of drugs. Thus, the pathologist, who came to be called clinical pathologist, becomes a full participant in diagnosis, therapeutic or surgical tactics and prognosis of the disease. Biopsies make it possible to study the most initial and subtle changes in cells and tissues using an electron microscope, histochemical, histoimmunochemical and enzymological methods, i.e. those initial changes in diseases, the clinical manifestations of which are still absent due to the consistency of compensatory-adaptive processes. In such cases, only the pathologist has the capabilities of early diagnosis. The same modern methods make it possible to give a functional assessment of structures changed during the disease, to gain an idea not only of the essence and pathogenesis of the developing process, but also of the degree of compensation for impaired functions. Thus, biopsy is now becoming one of the main objects of research in solving both practical and theoretical issues of pathological anatomy.
Experiment very important for elucidating the pathogenesis and morphogenesis of diseases. Although it is difficult to create an adequate model of human disease experimentally, models of many human diseases have been created and are being created; they help to better understand the pathogenesis and morphogenesis of diseases. Using models of human diseases, the effects of certain medications are studied and methods of surgical interventions are developed before they find clinical application. Thus, modern pathological anatomy has become clinical pathology.
The study of the structural basis of the disease is carried out at different levels: organismal, systemic, organ, tissue, cellular, subcellular, molecular.
Organismal level allows you to see the disease of an entire organism in its diverse manifestations, in the interconnection of all organs and systems.
System level- this is the level of study of any system of organs or tissues united by common functions (for example, the connective tissue system, blood system, digestive system, etc.).
Organ level allows you to detect changes in organs, which in some cases are clearly visible to the naked eye, in other cases, to detect them it is necessary to resort to microscopic examination.
Tissue and cellular levels- these are the levels of studying altered tissues, cells and intercellular substances using light-optical research methods.
Subcellular level allows you to observe using an electron microscope changes in cell ultrastructures and intercellular substance, which in most cases are the first morphological manifestations of the disease.
Molecular level studying the disease is possible using complex research methods involving electron microscopy, immunohistochemistry, cytochemistry, and autoradiography. As you can see, an in-depth morphological study of the disease requires the entire arsenal modern methods- from macroscopic to electron microscopic, histocytoenzymatic and immunohistochemical.
So, the tasks that pathological anatomy is currently solving put it in a special position among medical disciplines: on the one hand, it is medical theory, which, revealing the material substrate of the disease, serves directly clinical practice; on the other hand, this clinical morphology to establish a diagnosis, serving the theory of medicine. It should be emphasized once again that teaching pathological anatomy is based on the principles of unity and conjugation of structure and function How methodological basis the study of pathology in general, as well as clinical and anatomical direction of domestic pathological anatomy. The first principle allows us to see the connections of pathological anatomy with other theoretical disciplines and the need to know, first of all, anatomy, histology, physiology and biochemistry to understand the fundamentals of pathology. The second principle - clinical anatomical direction - proves the need for knowledge of pathological anatomy to study other clinical disciplines and the practical activities of a doctor, regardless of the future specialty.
Brief historical data
Pathological anatomy is an integral part of theoretical and practical medicine and has its roots in ancient times. As an independent discipline, it developed slowly due to the fact that autopsy of the bodies of the dead was prohibited for a long time. Only in the 16th century did they begin to accumulate materials on the pathological anatomy of diseases obtained from autopsies of corpses. In 1761, the work of the Italian anatomist G. Morgagni (1682-1771) “On the location and causes of diseases identified by the anatomist” was published, based on the results of 700 autopsies, some of which were performed by the author personally. He tried to establish a connection between the described morphological changes and the clinical manifestations of diseases. Thanks to Morgagni’s work, the dogmatism of old schools was broken, new medicine appeared, and the place of pathological anatomy among clinical disciplines was determined.
The works of the French morphologists M. Bichat (1771-1802), J. Corvisart (1755-1821) and J. Cruvelier (1791-1874), who created the world's first color atlas on pathological anatomy, were of great importance for the development of pathological anatomy. In the middle and late XVIII century in England, major studies by R. Bright (1789-1858) and A. Bayle (1799-1858) appeared, which made a great contribution to the development of pathological anatomy. Bayle was the first author of the most complete textbook on private
pathological anatomy, translated into Russian in 1826 by doctor I.A. Kostomarov.
In the 19th century, pathological anatomy had already gained a strong position in medicine. Departments of pathological anatomy were opened in Berlin, Paris, Vienna, Moscow, and St. Petersburg. Representative of the Viennese school K. Rokitansky (1804-1878) on the basis of a huge personal experience(30,000 autopsies over 40 years of dissection work) created one of the best manuals on pathological anatomy at that time. K. Rokitansky was the last representative of the dominant for centuries theories of human humoral pathology, which had no scientific basis.
The creation in 1855 by the German scientist R. Virchow (1821-1902) can be considered a turning point in the development of pathological anatomy and all medicine. theories of cellular pathology. Using the discovery of the cellular structure of organisms by Schleiden and Schwann, he showed that the material substrate of the disease is cells. Pathologists and clinicians around the world saw great progress in the cellular theory of pathology and widely used it as the scientific and methodological basis of medicine. However, cellular pathology alone proved impossible to explain the complexity of the pathological processes that occur during the disease. Cellular pathology began to be opposed to the doctrine of the neurohumoral and hormonal regulatory systems of the body - this is how functional direction in medicine. However, it did not negate the role of the cell in pathology. Currently, the cell and its constituent elements (ultrastructures) are approached as integral components of the whole organism, under the continuous influence and control of its neurohumoral and hormonal systems.
In the 20th century, pathological anatomy began to develop rapidly, involving biochemistry and biophysics, immunology and genetics, molecular biology, electronics and computer science in solving its problems. In many countries, institutes of pathology were created, fundamental manuals and journals on pathological anatomy appeared; International, European and national scientific societies of pathologists were created.
In our country, autopsies began to be performed for the first time in 1706, when medical hospital schools were organized by decree of Peter I. However, the first organizers of the medical service in Russia, N. Bidloo, I. Fischer, and P. Kondoidi, had to overcome the stubborn resistance of the clergy, who in every possible way prevented autopsies. Only after the opening of the Faculty of Medicine at Moscow University in 1755, autopsies began to be carried out quite regularly.
The first pathologists were the heads of clinics F.F. Keresturi, E.O. Mukhin, A.I. Over et al.
In 1849, on the initiative of the therapist Professor I.V. Varvinsky, the first department of pathological anatomy in Russia was opened at the Faculty of Medicine of Moscow University. The head of this department was his student A.I. Polunin (1820-1888), who is the founder of the Moscow school of pathologists and the founder of the clinical-anatomical direction in pathological anatomy. Over the 140-year existence of the Department of Pathological Anatomy at Moscow University, and since 1930 at the First Moscow Medical Institute, the tradition has been firmly maintained: the cathedral staff is passed from the hands of the teacher to the hands of the student. All seven heads of the department, being representatives of the same school, have successively replaced each other from 1849 to the present: A.I. Polunin, I.F. Klein, M.N. Nikiforov, V.I. Kedrovsky, A.I. Abrikosov, A.I. Strukov, V.V. Serov.
M.N. occupied a special place in the Moscow school of pathologists. Nikiforov (1858-1915), who headed the department of pathological anatomy at Moscow University from 1897 to 1915. He not only performed valuable work on pathological anatomy, but created one of the best textbooks and trained a large number of students who later headed departments of pathological anatomy in various cities Russia. The most talented student M.N. Nikiforova was A.I. Abrikosov, who headed the Department of Pathological Anatomy at Moscow University from 1920 to 1952 and laid the scientific and organizational foundations of pathological anatomy in the USSR. He is rightfully considered the founder of Soviet pathological anatomy. A.I. Abrikosov has carried out outstanding research on the initial manifestations of pulmonary tuberculosis, myoblast tumors, oral pathology, kidney pathology and many other issues. He wrote a textbook for students, which went through 9 editions, created a multi-volume manual on pathological anatomy for doctors, and trained a large number of students. A.I. Abrikosov was awarded the title of Hero Socialist Labor and State Prize laureate.
Prominent representatives of the Moscow school of pathologists are M.A. Skvortsov (1876-1963), who created the pathological anatomy of childhood diseases, and I.V. Davydovsky (1887-1968), known for his work on general pathology, infectious pathology, gerontology and combat trauma, and research on the philosophical foundations of biology and medicine. On his initiative, pathological anatomy began to be taught according to the nosological principle. I.V. Davydovsky was awarded the title of Hero of Socialist Labor and Lenin Prize laureate. Among the employees of the Department of Pathological Anatomy of the First Moscow Medical Institute - students of A.I. Abrikosov, a great contribution to the development of pathological anatomy was made by S.S. Weil (1898-1979), who later worked in Leningrad, V.T. Talalaev (1886-1947), N.A. Kraevsky (1905-1985).
The Department of Pathological Anatomy in St. Petersburg was created in 1859 on the initiative of N.I. Pirogov. Here is the glory of Russian pathological
anatomy was created by M.M. Rudnev (1837-1878), G.V. Shore (1872-1948), N.N. Anichkov (1885-1964), M.F. Glazunov (1896-1967), F.F. Sysoev (1875-1930), V.G. Garshin (1877-1956), V.D. Zinzerling (1891-1960). They trained a large number of students, many of whom headed departments at Leningrad medical institutes: A.N. Chistovich (1905-1970) - at the Military Medical Academy named after S.M. Kirova, M.A. Zakharyevskaya (1889-1977) - at the Leningrad Medical Institute named after I.P. Pavlova, P.V. Sipovsky (1906-1963) - at the State Institute for Advanced Training of Doctors named after. CM. Kirov.
In the second half of the 19th and early 20th centuries, departments of pathological anatomy were opened in medical institutes of Kazan, Kharkov, Kyiv, Tomsk, Odessa, Saratov, Perm and other cities. After October revolution departments of pathological anatomy were created in medical institutes of all union and autonomous republics, many regional centers of the RSFSR. Schools of pathologists grew up here, whose representatives developed and continue to develop Soviet pathological anatomy: M.P. Mirolyubov (1870-1947) and I.V. Toroptsev in Tomsk, I.F. Pozharisky (1875-1919) and Sh.I. Krinitsky (1884-1961) in Rostov-on-Don, N.M. Lyubimov (1852-1906) and I.P. Vasiliev (1879-1949) in Kazan, P.P. Zabolotnov (1858-1935) and A.M. Antonov (1900-1983) in Saratov, P.A. Kucherenko (1882-1936) and M.K. Dahl in Kyiv, N.F. Melnikov-Razvedenkov (1886-1937) and G.L. Derman (1890-1983) in Kharkov, etc.
During the years of Soviet power, pathologists launched scientific research in various areas of medicine, in particular infectious diseases. These works provided great assistance to Soviet healthcare in eliminating a number of infections (smallpox, plague, typhus, etc.). Subsequently, pathologists developed and continue to develop issues of early diagnosis of tumors; they pay much attention to the study of cardiovascular and many other diseases, issues of geographic and regional pathology. Experimental pathology is developing successfully.
Created in the country pathological service. Each hospital has a pathology department, headed by a pathologist. In large cities, central pathological laboratories have been created that organize the work of pathologists. All deaths in hospitals or clinics of medical institutes are subject to a pathological autopsy. It helps to establish the correctness of the clinical diagnosis, identify defects in the examination and treatment of the patient. To discuss medical errors identified during a pathological autopsy and develop measures to eliminate shortcomings in medical work, clinical and anatomical conferences. The materials of pathological conferences are summarized and contribute to the improvement of the qualifications of doctors, both clinicians and pathologists.
The work of pathologists is regulated by regulations and orders of the Ministry of Health of the Russian Federation and is controlled by the chief pathologist of the country.
Soviet pathologists are united by the All-Union scientific society, which regularly convenes all-Union conferences, plenums and congresses dedicated to topical issues pathological anatomy. A multi-volume manual on pathological anatomy has been created. Since 1935, the journal “Archive of Pathology” has been published. Its first editor was A.I. Abrikosov. Since 1976, the publication of the abstract journal “ General issues pathological anatomy".
