Clinical pathomorphology

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In recent years, has become increasingly important clinical pathomorphology, based on studying the affected tissue obtained by biopsy or surgery. Its achievements are certainly expand the diagnostic capabilities of the Clinician. Currently, clinical morphology has occupied a strong position in rheumatology in the study deleted during commissurotomy or prosthetic valves ears fibrillation and valves, biopsy of the heart muscle, lungs and mediastinal lymph nodes are performed for certain indications during the operation. Therefore, we will focus on the pathomorphology of these tissues from the point of view of its significance in evaluating the activity and direction of the rheumatic process, postoperative prognosis. General questions pathomorphology of rheumatic fever are detailed in the monographs A. I. Strukova and A. G. Beglaryan (1963), N. N. Grisman (TC), we will mention only the main provisions. The essence of tissue changes rheumatism studied Century, Talalaeva (1929). He showed that granuloma rheumatoid called ashoff-talalaevsky, caused alterative-exudative changes of connective tissue (disorganization) and ends sclerosis. Later it was proved that the disorganization of the connective tissue is a dynamic process that passes 4 stages: muhidnova swelling, fibrinogen changes, granulomatous reactions and sclerosis (A. I. Strukov, Century, Orel, 1957; Century, Orel, 1958; A. I. Strukov, 1971, and others).
Of great importance for the understanding of the clinical picture of rheumatic heart disease had also work M. A. Skvortsova (1937), who described nonspecific inflammation in stroma attack, similar to the famous giperergicakie reaction in the joints and serosa rheumatism.
Summarizing the literature data, N. N. Grisman (1971) described the following tissue reactions observed in the heart and blood vessels in rheumatoid arthritis: 1) the processes of disorganization of connective tissue, including molignee swelling, fibrinogene changes glycemy the breakdown of collagen; 2) non-specific exudative-proliferative response, the most striking inflammation endo-, myo - and pericardial; 3) ashoff-talalaevsky granuloma; 4) vessels affection manifested as fibrinogenum changes in the connective tissue of the vascular wall, and the development of productive vasculitis with outcomes in multiple sclerosis; 5) diverse pathology muscle fibers (hypertrophy, atrophy, dystrophy, foci necrobiosis); 6) the final stage as a result of the above changes - sclerosis and hyalinosis.
For the Clinician have the most value data N. N. Gritsman about a certain correlation of the described changes with the clinical activity of the rheumatic process.
Molignee swelling is most evident when the maximum (III degree) activity and is characterized by gamma-metachromatic at colouring toluidine-blue, swelling and razvlecheniem connective tissue. It is based on the depolymerization of the basic substance with the accumulation mainly acid mucopolysaccharides. Among cellular elements are found in a small amount of fat and mocowanie cells, private lymphocytes and histiocytes. Molignee swelling was observed in all the structures of the heart: the wall surface and valve endocardium, myocardium, including in the left atrial appendage. Noteworthy reversibility of the pathological changes at this stage, which implies the ability to completely reverse the development process in patients with rheumatism.
Deeper, II, stage disorganization of connective tissue - fibrinogene changes. They are observed at all degrees of activity of rheumatic process in all the structures of the heart, but most often in the endocardium, 3 times less in stroma attack and rarely in the epicardium, mainly in children with III degree of activity of rheumatism. Fibrinogene changes occur processes disorganization of collagen fibers - their swelling, merge among themselves with the formation of homogeneous unstructured field. The composition of fibrinoid heterogeneous and depends on what plasma components happened soaking collagen - plasma proteins (fibrinoid fibrin or fibrin (fibrinoid with fibrin).