Clinical pathomorphology

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The possibility of clinical pathomorphology expanded through the use of electron-microscopic investigation methods biopsy material, especially in patients with inactive (I degree) or latent rheumatic heart disease.
According to P. Y. Aldiyarova (1977), when revmocardit and ears, and in the ventricle myocardium at the electron microscopic level we find microcirculatory disturbances in the form of frequent microhemorrhages, extravasation, thickening of the basement membrane, swelling of cytoplasm and destruction of organelles endothelial cells of blood and lymphatic capillaries, destruction of the collagen fibrils in the walls of arteries and veins. There is also a breakdown of the collagen fibrils on periodycznie argyrophile microfibers with the loss of their orderliness, partial collapse to grained debris. Significant ultrastructural dystrophic changes in muscle cells (myocytes); they are primarily functional structures. Particularly noteworthy is the fact that with minimal activity of rheumatic heart disease along with pathological processes simultaneously observed regeneration of functional structures of myocytes, the prevailing when the subsidence of the rheumatic process.
One might think that the possibility of clinical morphology are not limited study of the tissues of the heart. For example, Cohen et al. (1971) revealed pathological changes in tissues of the kidneysobtained in percutaneous biopsy of the kidneys, in 17 of the 26 patients with acute rheumatic fever (children and adults). They were mostly change the type or focal alopecia acute glomerulonephritis, similar to those found in various infectious diseases. The possibility of chronic glomerulonephritis rheumatism justifies histological examination to clarify the essence of the process in the kidneys.
Often rheumatism in active phase and symptoms of heart failure is increased liver. Apparently, one should agree with the opinion of A. A. Likhachev (1970), not found in biopsy of the liver in 98 patients nor in the stroma of the liver or in vessels characteristic processes disorganization of connective tissue and granulomatous reactions, i.e. rheumatic hepatitis that rheumatism indications for biopsy of the liver should be strictly limited.
Biopsy material lung was studied mainly with the purpose of examining the morphology of the lung (second) barrier (I. K. Esipova and others, 1959, and others). The detected changes relate mainly small branches of the pulmonary artery, which develop compensatory-adaptive processes type milestone with outcomes in milestiibas. At the same time actually rheumatic hemorrhagic pneumonia, pulmonary hemo-siders need further study.
Finally, to determine the activity of rheumatic process can be a useful study of the mediastinal lymph nodes, since the dependence of the intensity ploskokletochnom reaction from the activity of rheumatic process (J. of L. Rapoport in. A. Ishchenko, 1960, A. S. Kaplansky, 1961; A. I. Strukov, A. G. Beglaryan, 1963), and the skin in connection with the identified parallelism in changes of connective tissue, skin and heart with active rheumatoid arthritis (VP Slyusarchuk, 1975).
It should be noted that the in vivo study first of all the heart tissue obtained during operations, helps to clarify the degree of activity of rheumatic heart disease and direction of the process, in particular to identify the correlation of processes of damage and adaptation, and to predict the prognosis of the disease in General, including the results of the operation.