Pathomorphosis

Pathomorphosis - resistant changing clinical and morphological patterns of various diseases.
Causes of pathomorphosis complex and diverse. It is assumed the possible role of the natural evolution of the disease (natural pathomorphosis) due to the evolution of pathogenic properties of the pathogen. However, the most significant and authoritative role of active preventive and treatment measures, especially antibiotic therapy. Modern active chemotherapy, hormonotherapy , distort the picture of the disease, depriving its typical features. It is therapeutically due pathomorphosis, dramatically changed not only the picture of many diseases, but also morbidity.
Sharply changed not only the overall morbidity and mortality, but also during and pathology of individual diseases. Virtually disappeared some children's infectious diseases. Scarlet fever, diphtheria have become rare diseases.
Changed the incidence of infectious diseases of adults. Lobar pneumonia, gave earlier greater mortality, has become a rare disease, like typhoid fever, typhus , and other diseases. At the same time, the increase in life expectancy has led to an increase in the number of patients dying from cardiovascular diseases, malignant tumors. Increased number of various forms of allergic diseases, the occurrence of which some important side effect of drugs, use of antibiotics, vaccines (see Allergy).
All this changed the General panorama of disease occurred pathomorphosis all nosological systems that better be described as "mesomorphs".
Example nepomorpha within specific groups of diseases can be the change of relations in the frequency of different forms of cancer. A few decades ago lung cancer was a rare disease, it takes the second place after gastric cancer.
Pathomorphosis in the narrow sense refers to changing clinical-morphological patterns of specific diseases. Pathomorphosis of scarlet fever is manifested not only by the rarity of the disease, but also the fact that she now been mild, with no severe complications (purulent otitis, jade and other). Under the influence of antibiotics lobar pneumonia as if dropped and very early start the processes resolution, decreased the number of pulmonary and extra-pulmonary complications.
The achievements in TB control and application of new medical preparations happened pathomorphosis of this disease. For example, acute - tuberculous meningitis, miliary tuberculosis, etc. that were previously considered fatal, now take a chronic course, and in some cases comes clinically cured. Increased number of patients with pulmonary heart and amyloidosis (see).
In connection with vaccination mortality of children from tuberculosis has become very low. However, there are antibiotic resistant forms of mycobacteria, which can be allocated to patients, creating epidemic danger.
Over the past 30 years occurred pathomorphosis protracted septic endocarditis, formerly diseases, inevitably leading to death.
Treatment with massive doses of penicillin leads to the elimination of the septic process valves, but contributes to the deformation of valves, resulting in 2-3 years may come death from heart failure.
Phenomena disease variability to be considered in medical practice in the diagnosis of disease, the course and the symptoms have changed. They changed and epidemiological activities (for example, duration of isolation of the sick with scarlet fever).

Pathomorphosis (from the Greek. pathos is a disease and morphosis - formation) is a persistent change in the total incidence, as well as anatomical-clinical forms of specific diseases under the influence of various environmental factors. The concept of pathomorphosis in the sense introduced Gallahan (W. Hellpach, 1929) to characterize changes in the clinical symptoms and pathology of syphilis under the influence of active chemotherapy. The concept of pathomorphosis is an amendment to the established in the public and private pathology view about known stabilization forms of diseases.
Epidemiology and honey. statistics say big changes that have occurred in the overall morbidity and mortality and clinical-anatomical picture individual diseases. Changes in overall morbidity and mortality occurred under the influence of changes of environmental factors (see Ecology), social conditions, and also as a result of mass sanitary, preventive and therapeutic measures. Especially acute infectious diseases, many of which are almost eliminated by carrying out a state scale series of events, including specific serum-vaccinal prevention, etc. Dramatically reduced child mortality from infectious diseases. Therefore, the concept of disease variability and include changes in the epidemiology of infectious diseases. Changed and the individual character of epidemic outbreaks, resulting epidemiologists, especially foreign ones, are willing to use the concept of P. for replacement of the obsolete concept of "genius epidemicus". At the same time in total morbidity and mortality dramatically increased role of atherosclerosis (General and organ) and malignant neoplasms, which is associated with increased life expectancy in most countries. In connection with this pathology old age (geriatric pathology) and gerontology attract special attention.
Changes in the overall morbidity caused recently by the spread of diseases previously or not seen at all, or encountered very rarely. We are talking mainly about diseases viral nature, not previously known due to the fact that for large periods and conditions (geographical, social and other) for contact between infectious agent in its natural foci and man (see Natural focality). Radiation injuries, the former for a long period of professional disease mainly radiologists, since the entry of humanity in the age of atomic energy and outer space exploration has entered nosological system as statistically recorded value. In the category of pathomorphosis, however, do not include diseases that existed long ago, but not identified correctly in the absence of reliable data on etiology and pathogenesis.
The most striking forms of the disease variability is due in the postwar years active chemotherapy, including antibiotic therapy, and active anti-infection prevention activities. The most important section of Peterhof is therapeutically due to P. the Most rich in this type of Petrograd area of infectious diseases. Prime examples of this on, are scarlet fever and lobar pneumonia. In 1928-1932, the structure of mortality from acute infections on scarlet fever fell about 22%; in some epidemic mortality of this disease reached 50%. At present, the epidemic of scarlet fever virtually disappeared, and deaths from it are exceptionally rare, approaching zero. P. scarlet fever is caused by a number of factors. One of them (probably the most significant is the sharp decline under the influence of chemotherapy complicating purulent processes. Other, less real factor is "spontaneous" pathomorphosis of scarlet fever, because in the 20th century there has been an overall reduction in the severity, and outcome of scarlet fever outside provable connection with preventive measures. The reasons for such spontaneous P. hypothetically (mutations of the pathogen, the changed reactivity organisms).
Pronounced P. lobar pneumonia was reflected not only in mortality in this disease, but also on the morbidity. In the pre-war period lobar pneumonia was one of the first places in the incidence and overall mortality (3%), and the mortality rate reached 20% and above. With the introduction of effective chemotherapy not only death from lobar pneumonia was the casuistry, but the incidence is insignificant place in medical statistics. In accordance with this changed the clinical and pathologic anatomy of lobar pneumonia. Its classical forms almost disappeared from protectorship practice due to the change of phase of the nature of the process. Pathomorphosis of diphtheria is expressed not only by the reduction of morbidity and mortality, but also shifting the centre of gravity of the current and pathology of the respiratory tract on the heart.
Example therapeutically due pastels can be used protracted septic endocarditis. Under intensive treatment of its antibiotic nature of valvular lesions sharply differs from the classical forms prepozna-ulcerative endocarditis; there are phenomena sharp sclerosis and calcification of the valves valves with their disfigurement, aneurysms, and so on, The same is observed in spontaneous healing of this endocarditis, which is, according to some, in 3% of cases of this disease.
Chemotherapy has made a dramatic change in the pathology of tuberculosis. Pathomorphosis of this disease is manifested in the reduction and manifestations of exudative form; typical became fibro-cavernous tuberculosis with the cleansing of the cavern, the walls of which non-specific productive processes prevail over specific. The lengthening of life of TB patients has led to the increase of mortality from cardio-respiratory failure due pneumosclerosis, as well as increased General of amyloidosis. P. meningitis under the influence of late or non-radical chemotherapy, prolonging life, but not curing the patient, is the development adhesive processes in shells and sclerosis of meningeal vessels.
Chemotherapy and hormone therapy of malignant neoplasms has made a number of changes in their pathology (for example, pathomorphosis of prostate cancer in the treatment of estrogen drugs), and the General structure of morbidity malignant neoplasms recently significantly changed the sharp increase bronchus and lung cancer.
Currently, became known phenomenon therapeutically due to P. in the treatment of psychosis modern psychopharmacological agents.
The variety and prevalence of phenomena P. requires careful study of them to use the appropriate data in health care. Extremely important knowledge P. in individual pathology, as it changes, sometimes substantial, in the symptomatology of the disease, hindering the recognition of both the disease and its complications and require special diagnostic techniques.
External manifestation treatment-caused disease variability can be effaced clinical symptoms with unexpected formidable development and the fatal outcome of disease, especially when purulent surgical diseases.
In postmortem practice phenomena P. often more difficult to identify the process and postmortem diagnosis, especially in cases when under the influence of therapy shift morphological paintings toward characterizing another illness ("phenocopy"). These circumstances necessitated making in postmortem diagnosis additional characteristics of the main disease, the picture of which there are changes, indicating an incomplete recovery. In these cases began to write: "protracted septic endocarditis treated with antibiotics", "prostate cancer treated with sinestrola", etc. Should be encouraged to standardise and avoid enumeration applied medical use in protectorship practice is more common and unified identification in the form of an Addendum to the diagnosis of the main disease of the following words: "... with symptoms treatment-caused disease variability, including prolonged septic endocarditis with symptoms treatment-caused disease variability"; "prostate cancer patients with symptoms of therapeutic pathomorphosis', and so on).