Pathologia
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Published By Zaporozhye State Medical University

2310-1237, 2306-8027

Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 346-351
Author(s):  
I. I. Yakovtsova ◽  
V. M. Cheverda ◽  
O. V. Dolhaia ◽  
A. S. Yakymenko ◽  
I. V. Ivakhno

Colorectal cancer (CRC) is the second leading cause of mortality among cancers after malignant tumors of respiratory system. One of the most significant prognostic features of CRC is tumor budding (TB), which isn’t widely implemented in clinical practice. The aim of this research: to find the prognostic criteria of recurrence and lethal outcome of CRR IIA and IIIB stages (рТ3N0-2M0), the ratio of tumors with certain differentiation in groups of research was taken equal. Material and methods. The group I was formed from primary CRC without recurrences. The main relapse-free survival time was 5 years (62.5 ± 16.5 months). The ІІ group – primary CRC with recurrences; ІІА – with recurrences during 5 years from the moment when the tumor was removed, without fatal outcome; ІІВ – with recurrences and lethal outcome from genera­lization of tumor process during 5 years from the moment when the tumor was removed. The microslides of CRC were made by using the standard methods. Results. TB was identified in 46.66 % (28/60) of CRC рТ3N0-2M0. The direct relationship between tumor grade and presence of TB was found (Р < 0.05), but TB didn’t define differentiation of the CRC. There was a statistically significant relationship between TB and metastatic spreading of CRC to regional lymph nodes (Р < 0.001). Metastasis was associated with 3 stage of TB, absence of metastasis was typical for CRC without TB. The tendency was found in a larger number of cases of the CRC with TB 3 stage among recurring CRC compared with CRC without recurrence, mainly due to the ІІВ group of the research. Inverse correlation between TB stage and time of recurrence appearance was found (Р < 0.05). TB in central tumor sites was followed by presence and higher stage of TB in peripheral tumor sites (Р < 0.05), that can be taken into account during biopsies of CRC. Conclusions. TB is a prognostic criterion of metastasis and time of recurrence appearance for CRC рТ3N0-2M0, which is mostly typical for tumors in patients with recurrences and lethal outcome at the taken equal ratio of tumors by differen­tiation.


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 328-339
Author(s):  
A. A. Zhyvetska-Denysova ◽  
I. I. Vorobiova ◽  
N. Ya. Skrypchenko ◽  
S. M. Tolkach ◽  
S. M. Razdaibedin ◽  
...  

Successful implantation involves a high degree of development of spiral arteries, combined with high proliferative activity, which ensures the formation of a healthy placenta, full uterine-placental circulation, and the birth of a healthy child. The placenta is the unique organ of the biological monitoring, the mirror of pregnancy. Identification of placental markers of miscarriage is a promising direction for preventing reproductive losses. The aim of the work is to identify the markers of miscarriage and premature labor in the structures of the chorion and placenta. Materials and methods. The main group included tissue samples of the 22 chorions and 64 placentas after termination of current pregnancy from women with a history of reproductive losses. The control group included tissue samples of the 20 chorions after artificial abortion and 20 placentas after physiological pregnancy and birth. The placenta was examined according to the protocol (form No. 013-1/0). The expressions of VEGF, CD31/PECAM1, CD105/Endoglin/TGFβ 1/3 Receptor, Bcl-2α Ab-1, TNF-α, CD45/T200/LCA, CD56/NCAM1 were studied in the structures of chorion and placenta by immunohistochemistry. Results. Based on histological and immuno-histochemical study of chorion and placenta samples in women with reproductive history and termination of the current pregnancy, it was established that embryo-endometrial dysfunction is the cause of miscarriage in the first trimester, and inflammation is the precondition of preterm birth; markers of miscarriage and premature labor in the structures of the chorion and placenta have been identified. Conclusions. The markers of miscarriage are pathomorphological changes in endometrium and chorion combined with high expression of TNF-α and NK-CD56, low expression of CD31/PECAM1, negative expression of VEGF to indicate a violation of cytotrophoblast invasions. The markers of inflammation and premature labor are structural and functional changes of placenta in combination with moderate expression of TNF-α in syncytium, high expression of NK-CD56 in villous stroma, high expression of CD45/T200/LCA in the decidual membrane.


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 340-345
Author(s):  
N. V. Danilevska

Here we expand the existing knowledge about disorders associated with the COVID-19-related pandemic and quarantine. We show that the COVID-19-related pandemic and quarantine can reduce the combat effectiveness of the military, provoking a deterioration in the health of combatants and requires hospitalization. Aim. Investigate the impact of the COVID-19 pandemic and quarantine on the health of Ukrainian combatants. Material and methods. A study was conducted between March 12, 2020 and May 22, 2020 at the Department of Psychiatry, Psychotherapy, General and Medical Psychology, Narcology, and Sexology in Zaporizhzhia State Medical University and Zaporizhzhia military hospital (Ukraine). All combatants who were hospitalized during this period were examined. We analyzed medical records, anamnestic data, and performed psychopathological and psychological examinations of all patients. Results. In 56 % of combatants hospitalized during high quarantine measures, the cause of health disorders is negative COVID-19 pandemic and quarantine-related thoughts that provoke stress. These stressful thoughts associated with the COVID-19 pandemic and quarantine provoke the development of hypertensive emergency (57 % vs 18 %), anxiety syndrome (29 %), dissociative [conversion] disorder (7 %), and exacerbate the negative effects of pre-pandemic diseases, namely, hypertension (43 % vs 27 %), somatoform autonomic dysfunction of the cardiovascular system (29 %), panic disorder [episodic paroxysmal anxiety] (7 %), adjustment disorders (7 %), post-traumatic stress disorder (7 %). Conclusions. Preventive measures need to be developed and applied to combatants to prevent their deteriorating health due to the effects of the COVID-19 pandemic and quarantine stress


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 295-302
Author(s):  
T. V. Shulyatnikova ◽  
V. O. Tumaskyi

Pathophysiology of sepsis-associated encephalopathy (SAE) is linked to blood-brain barrier breakdown, neuroinflammation and neurotransmitter imbalance in the brain. Astroglia, the most abundant cell population within the brain, plays the critical role in control of all kinds of homeostatic processes, thereby regulating the adaptive reactions of the brain to various challenges. Astroglia are highly heterogenous across the brain regions, therefore, damaging factors stimulate heterogenous astroglial reactivity and response in different brain regions. The aim of this study was determining immunohistochemical features of GFAP expression in various brain regions in the model of rodent experimental sepsis. Materials and methods. The experiment was performed in Wistar rats: control group of 5 sham-operated rats and the main group of 20 rats subjected to cecum ligation and puncture (CLP) procedure. The immunohistochemical study of GFAP expression in the sensorimotor cortex, subcortical white matter, hippocampal, thalamic and caudate nucleus/putamen regions was performed from 20 to 48 hours of the postoperative period. Results. Starting from the 12th hour after CLP, animals began display progressive increase in signs of periorbital exudation, piloerection, fever-/hypothermia, diarrhea, social isolation, lethargy, and respiratory impairment. In the period of 20–38 hours, 9 animals showed expressed previously listed symptoms and were euthanized (CLP-B – lethal group), 11 rats survived until 48 hours of the experiment (CLP-A – survived group). In the lethal group, starting from 20 to 38 hours after the CLP procedure, a significant (relative to control) regionally-specific dynamic increase in the level of GFAP expression was observed in the brain: in the cortex – by 465 %, in the subcortical white matter – by 198 %, in the hippocampus – by 250 %, from the 23rd hour – in the caudate nucleus/putamen by 18 %. In the thalamus, no significant changes in the level of GFAP expression were observed. In the cortex and hippocampus of survived animals, 48 h after CLP, higher values of GFAP expression were observed comparing to the group of non-survived animals. Conclusions. Under conditions of the experimental SAE, an early dynamic increase in the astroglial reactivity was observed in the cortex, hippocampus, white matter, and caudate nucleus/putamen of the brain with the most significant increase of indicators in the cortex and hippocampus, which potentially indicates relatively more vulnerable areas of the brain to damaging factors, as well as places of the most active intercellular interaction in the condition of systemic inflammation. Higher values of GFAP expression in the cortex and hippocampus of survived animals at 48 hours of the experiment, compared with indicators of non-survived group, indicate increased astroglial reactivity in these brain regions at the noted time period, accompanied by relatively more favorable clinical course of the disease.  


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 303-310
Author(s):  
S. M. Koval ◽  
I. O. Snihurska ◽  
K. O. Yushko ◽  
O. V. Mysnychenko ◽  
V. Yu. Halchynska

The aim of this work was to study the features of the composition of the gut microbiota (GM) in patients with arterial hypertension (AH), which occurs against the background of abdominal obesity (AO). Materials and methods. The paper presents the data on examination of 70 patients with AH of 2–3 degrees (46 patients with AO and 24 patients without obesity – with normal body weight (NBW)). The control group included 20 apparently healthy individuals with NBW. The patients underwent detailed standard clinical, laboratory and instrumental examination. Determination of the quantitative composition of GM was carried out by the method of polymerase chain reaction with hybridization-fluorescence detection of results in real time using the test system “COLONOFLOR-16 (biocenosis)” (“ALFA-LAB”). In this work, a statistical analysis of the obtained data was carried out using standard methods and Microsoft Excel 17.0. Results. A significant change in the composition of GM were found in patients with AH, which proceeds against the background of AO, in comparison with apparently healthy individuals and with patients with AH without obesity (with NBW). In the group of AH patients with the presence of AO, significant decrease in the number of Lactobacillus spp., Bifidobacterium spp., Faecalibacterium prausnitzii and Аkkermansia muciniphila was found in comparison with apparently healthy individuals. The number of Faecalibacterium prausnitzii and Аkkermansia muciniphila in these patients was also significantly lower than in hypertensive patients with NBW. At the same time, the ratio of Bacteroides fragilis/Faecalibacterium prausnitzii was significantly higher than in the control group and the group of hypertensive patients without obesity – with NBW. Conclusions. The results of the study indicate a possible role for the deficiency of such representatives of GM as Lactobacillus spp., Bifidobacterium spp., Faecalibacterium prausnitzii and Аkkermansia muciniphila and an increase in the ratio of Bacteroides fragilis/Faecalibacterium prausnitzii in the pathogenesis of AH, which occurs against the background of AO.


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 365-370
Author(s):  
I. V. Shop ◽  
Ye. О. Holubkina ◽  
T. M. Tykhonova ◽  
T. A. Derienko ◽  
O. V. Al-Trawneh

The association of atrial fibrillation (AF) with complete atrioventricular block (CAVB) is a common clinical feature in elderly patients. It is characterized by the loss of specific symptoms of AF (palpitations, intermissions); in the first place may come CAVB symptoms: dizziness, Morgagni–Adams–Stokes (MAS) attacks. Aim. The article objective is to illustrate the dynamic changes in the course of AF with the development of CAVB on the example of a clinical case and to discuss the difficulties in timely diagnosis and therapy correction. Case presentation. A 75-year-old male was diagnosed with a rapid ventricular response form of AF. The onset of CAVB caused the transition from rapid ventricular response form of AF to slow ventricular response form, which was initially accompanied by a subjective improvement in the patient’s condition. As the disease progressed, the patient’s condition worsened due to the development of MAS attacks. The elderly patients with a permanent form of AF require constant cardiac monitoring by an experienced specialist who has appropriate vigilance in management of patients with arrhythmias, awareness about possible concomitant conduction disorders. This provides comprehensive cardiac support, including timely pacemaker implantation which gives more options for AF symptoms monitoring and heart rate control, has a positive modifying effect on drug therapy. Conclusions. Changes in the clinical picture of AF after development of CAVB can lead to late diagnosis of CAVB, inadequate therapy and untimely pacemaker implantation, as a consequence, to progression of concomitant pathology and the development of life-threatening complications, as in our clinical case.


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 321-327
Author(s):  
A. I. Denysenko ◽  
V. I. Chernii

It is important to study changes in metabolism in patients with secondary hyperparathyroidism (SHPT) during parathyroid surgical interventions (PTSI), as well as to search for ways to correct them. Aim. To study metabolism in patients with SHPT with PTSI and assess the possibilities of its correction. Materials and methods. The study was prospective, not randomized. We studied 135 patients with SHPT with end-stage chronic renal failure who underwent PTSI (72 men and 63 women, aged from 19 to 73 years). Preoperative risk ASA III–IV. General anesthesia using the inhalation anesthetic sevoflurane and the narcotic analgesic fentanyl in low-flow mechanical ventilation. Operational monitoring was complemented by the use of indirect calorimetry. In group I (n = 70), the metabolic rate (MR) and basal metabolism rate (BMR) were determined against the background of standard intensive therapy. In group II (n = 65) – target metabolic rate (TMR) and the metabolic disorders (MD) were additionally determined, and intensive therapy was supplemented with glucocorticoids. Results. The baseline MR in both groups were low, close to BMR. The MR of patients in group I remained low during the entire PTSI (P < 0.05). In group II, from the stage of removal of the parathyroid glands, a steady increase in the MR, with a significant excess of the baseline MR and BMR (P < 0.05), was noted. TMR decreased while exceeding the MR. Group II patients woke up and were transferred to the ward faster compared to group I, and nausea and vomiting were 2.5 times less frequent (9.2 % in group II, 22.9 % in group I). 12 hours after PTSI, feeling of pain, according to the VAS scale, was lower than in group I (P < 0.05). During the day after PTSI, the indicators of the acid-base state of the venous blood of both groups did not change significantly, and the level of ionized calcium decreased (P < 0.05), which required additional intravenous administration of 10 % calcium gluconate. Conclusions. Perioperative energy monitoring makes it safer to carry out PTSI in patients with SHPT. Additional definition of the TMR and the MD allows for more efficient construction of intensive therapy.  


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 311-320
Author(s):  
M. V. Nikolaiev

Aim. Determination of biliary reflux in patients with morbid obesity after a single-anastomotic gastric bypass operation performed in the clinic's modification and according to the classical Roux-en-Y gastric bypass technique. Development of diagnostic criteria for biliary reflux Materials and methods. The results of treatment of 36 patients with morbid obesity who underwent bypass surgery were studied. The patients are divided into two groups. Clinically modified laparoscopic monoanastomotic gastric bypass surgery was performed in 25 patients (main group). The control group included 11 patients after the standard technique of Roux-en-Y laparoscopic gastric bypass. Inclusion criteria were: persons of both sexes aged 18-60 years with morbid obesity and a body mass index of 40 or more, as well as 35 or more in the presence of comorbid diseases (type 2 diabetes mellitus, arterial hypertension, dyslipidemia, sleep apnea syndrome). In both groups, impedance pH measurements were performed in the postoperative period. Statistical processing was performed using the Statistica 13.0 software package using parametric and nonparametric statistical methods.  Results: Clinical manifestations of the enterogastric biliary reflex were found in both groups; in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. The analysis of daily pH-metry in the studied groups showed that in the esophagus the time with pH <4 in the main group 2.83 (1.55; 3.95)% 3.00 (2.30; 3.50)% in the control group, time with pH 4-6.9 (physiological for the esophagus) 92.40 (90.65; 94.20)% and 94.10 (89.80; 95.50)%, respectively, time with pH> 7 (weak alkaline) was 4.80 (3.45; 5.85)% and in the control group 2.90 (1.20; 7.20)%. There was no statistically significant difference in these indicators (p> 0.05). Conclusions. Monoanastomotic gastric bypass surgery in the modification of the clinic has the same positive properties as the Rouen-Wye technique, allowing you to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone mini-gastric bypass surgery require a thorough examination with fibrogastroscopy in combination with pH impedance measurement at least 1 time per year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stomach stump. The level of quality of life of patients after surgery in the control group and the main group does not significantly differ, as evidenced by the results of the questionnaire survey using the GERG Q questionnaire, which indicates the effectiveness of the methodology of laparoscopic monoanastomotic gastric bypass surgery modified in the clinic. Key words: morbid obesity, gastric bypass surgery, surgical treatment, mini-gastric bypass, biliary reflux.


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 269-277
Author(s):  
O. V. Riabokon ◽  
L. M. Tumanska ◽  
V. V. Cherkaskyi ◽  
Yu. Yu. Riabokon

The aim of the work – to conduct clinical and pathomorphological analysis of deaths from COVID-19 in 2020. Materials and methods. We analyzed 41 case histories and results of pathological-anatomical examination of patients who were died of COVID-19 during 2020. Results. The lethal outcome of COVID-19 disease was recorded at day 22 (16; 27) of the disease. Among the dead, there is a high percentage of men (73.2 %), early old age and middle old age patients (75.6 %) with comorbid pathology (92.7 %). Early lung damage with COVID-19 in the deceased was determined by pronounced interstitial and interstitial-alveolar edema, the presence of erythrocyte stasis in the pulmonary microvessels, blood clots and hypoperfusion leukocyte stasis, as well as the presence of erythrocytes in the alveoli. Bilateral polysegmental subtotal viral pneumonia in 90.2 % of dead patients was characterized by significant edema and thickening of the alveolar walls with their moderate infiltration by lymphocytes, focal peribronchial and perivascular inflammatory polymorphonuclear infiltration, multiple and small exfoliated alveolar epithelium (87.8 %), as well as metaplasia of a few alveolocytes preserved on the luminal surface of the alveoli (82.9 %). Every tenth person who died of COVID-19 had signs of secondary bacterial microflora. In 85.4 % of patients who died on day 22–27 of the disease focal or sublobar pneumofibrosis was diagnosed. In those who died due to COVID-19, multiorgan failure was characterized by focal necrosis of the renal tubular epithelium (73.2 %), focal lymphocytic-leukocyte infiltration (12.2 %) and renal microvascular thrombosis (17.1 %), focal centro-lobular necrosis (90.2 %) and focal lymphocytic-leukocyte infiltration of lobes (7.3 %) of the liver. Thrombotic complications were confirmed in 22.0 % of deceased patients: ischemic cerebral infarction, transmural myocardial infarction, pulmonary embolism, deep vein thrombosis of the lower extremities under the pathology. These thrombotic complications were not diagnosed during life in all patients. The majority of deaths due to COVID-19 had morphological signs of chronic cardiovascular pathology. Ischemic heart disease and hypertension during the life of patients were not diagnosed in all cases. Conclusions. Early lung damage in COVID-19 in the deceased was determined by pronounced interstitial-alveolar edema, blood clots and leukocyte stasis in microvessels, less often – the presence of “hyaline membranes”. In 90.2 % of the dead patients bilateral polysegmental subtotal pneumonia with edema and lymphocytic infiltration of the pulmonary interstitium, inflammatory peribronchial and perivascular focal polymorphonuclear infiltrates, foci of atelectasis and dyscryphaseses was found. In 9.7 % of patients bilateral subtotal viral-bacterial fibrinous-purulent bronchopneumonia developed. In those who died on the 22nd–27th day of the disease focal pneumofibrosis was determined. Pathomorphologically, thrombotic complications, which were not diagnosed in all patients during their lifetime, were confirmed in 22.0 % of deceased patients. Most deaths from COVID-19 had morphological signs of chronic cardiovascular disease.


Pathologia ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 286-294
Author(s):  
Ya. V. Kolesnyk ◽  
T. O. Briukhanova ◽  
M. Yu. Sliepchenko ◽  
O. A. Nakonechna ◽  
O. H. Sorokina

The article presents the results of our own studies. The aim was to determine the structural and functional status of blood lymphocytes in patients with acute and prolonged course of infectious mononucleosis (IM) in children. Materials and methods. 102 children were under clinical and laboratory-instrumental supervision, the children were divided into groups: group 1 – 65 children with IM with an acute course of the disease; group 2 – 37 children with a prolonged course of the disease. All children underwent standard clinical laboratory and instrumental laboratory examinations. The diagnosis of IM was confirmed by PCR (detection of EBV DNA in the blood) and ELISA (anti-EBV IgM and IgG). Research results. In the study of the structural state of the cytoplasmic membrane of the lymphocytes in the blood of patients with MI in the onset of the disease, it was found that the average values of penetration rate of the electron paramagnetic resonance of spin probes (PR EPR s. p.) in children of both groups were significantly higher than normal (P < 0.001). There are also differences between groups of patients. In this case, the value of PR EPR s. p. in patients with a prolonged course by 15.8 % exceeded those in patients with acute IM (P < 0.001). According to the rate of microviscosity of the intracellular content (MV IC), its values were reduced compared with the control – by 22.1 % (P < 0.001) in patients with acute course of the disease and by 25.1 % – with a prolonged course of IM). In addition, in patients with a prolonged course of the disease, the values were 9 % lower than in the group with acute infectious mononucleosis. When considering immunological parameters, it was found that the indicators of the T-immune system for patients with a prolonged course of the disease in comparison with the alternative group was characterized by a decrease in the content of CD3 <50 % (respectively in 51.3 % and 26.2 % of patients; P < 0.05); CD4 <31 % (62.1 % and 32.4 %, respectively; P < 0.05) and CD8 <15 % (37.8 % and 10.8 %, respectively; P < 0.01). With regard to the cytokine profile, the level of IL-1 <20.0 pg/ml was determined 3.5 times more often in patients with a prolonged course of the disease compared to the acute course (64.8 % and 18.5 % of patients, respectively); TNFα <20.0 pg/ml 1.9 times more often (48.6 % and 24.6 %, respectively) and a very high (>30.1 pg/ml) level of IL4 in 40.5 % and 20 %). From the B-system of immunity in patients with a prolonged course of IM in comparison with the acute course increased content of CD22 was more often determined, as well as low levels of IgA, IgM <1.1 g/l and IgG <10.0 g/l. Conclusions. According to the results of observations, the pathogenetic role of the violation of the structural organization of blood lymphocytes in the formation of IM is established. It was found that these disorders in the form of increased permeability of their cytoplasmic membrane and reduced viscoelastic properties of their intracellular environment are more pronounced with a prolonged course of the disease, which is a factor in the prolongation of the disease. It is determined that the indicators of cellular and humoral parts of the immune system affect the course of IM. During formation of an acute course of IM in children already in the acute period of a disease activation of both cellular and humoral links of immunity, which is shown in the form of increase in relative content of CD3+, CD4+, CD8+ and CD22+ and levels of immunoglobulins M, A, is noted. For the prolonged course of the disease depression of T-cell immunity in the form of a decrease in the relative content of CD3+, CD4+ and CD8+ lymphocytes and an increase in CD22+, as well as inhibition of antibody genesis are characteristic. It was found that the variant of IM depends on the type of reaction of T-helper clones, namely – in the initial period of manifestation of IM with its acute course there is activation of T1 and T2 helper response, which manifests itself in a significant increase in IL-1, TNFα and moderate IL-4. Prolonged course of the disease is formed against the background of weak activation of pro-inflammatory interleukins (IL-1, TNFα) and significant – anti-inflammatory IL-4.  


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