[From the teacher's letters (30 years since the death of Sh. I. Krinitskiĭ)].
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Biomedical subjects
Publications and source records attributed to A V Smol'iannikov.
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The authors presented the current conception of iatrogenesis in wide interpretation consistent with The International Classification of the Diseases and Causes of Death (the IX revision). The tendencies in iatrogenesis determination are analysed. Soviet and foreign literature data published on iatrogenic variants, frequency rate, problems for pathologists, classification, medical-pathological and social aspects are delineated.
In reviewing briefly the changes that have taken place during the past decade (1977-86) in the theory and practice of pathology and, in the theory and practice of pathology and, more particularly, in the Pathology Service within the overall Soviet Health care system, it should be noted first of all that this period has been productive with regard to both the practical work of the pathology departments in hospitals and the research activities of scientific institutions. Pathology is gaining importance as a basic biomedical discipline. Considerable successes have been scored in fundamental research not only by the central scientific institutions but also by laboratories for morphologic research and departments of pathology at educational establishments in most of the Union Republics. Many of such laboratories and departments are well equipped and conduct work at a high technological and methodological level in areas of high priority. The number of interdisciplinary research projects has increased. A series of monographs has been published, devoted to various aspects of methodology on medicine, to the relationship between form and function, or to a critique of erroneous theories. Scientific cooperation with pathologists of other Socialist countries has been expanding, as has the participation of Soviet pathologists at international congresses, symposia, and other meetings. An important achievement has been the establishment of a network of pathology departments of hospitals and of pathologic service bureaus. There is little doubt that these bureaus which have so far been set up on a pilot basis, will become an important component of the Pathology Service on which this will rely for research progress and for keeping abreast of technological developments. They are also called upon to promote better services in rural areas. The construction of new buildings for hospital pathology departments has been expanded, but the rate and magnitude of this activity cannot yet be regarded as satisfactory. Over the past decade, pathology laboratories at hospitals have become important diagnostic centers indispensable for accurate diagnosis of many diseases through examination of biopsy specimens, and they are now better equipped than before, although the improvements have been less spectacular than expected. The quality of postmortem and clinicopathologic analysis has improved. A notable event was the session of the Collegium of the USSR Ministry of Health devoted to the Pathology Service development.(ABSTRACT TRUNCATED AT 400 WORDS)
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Problems of morphological features and nature of dysplasia and its role in blastomogenesis are discussed. It is pointed out that the term "dysplasia" is used in modern pathology to designate various processes including disembryogenetic, adaptive-hyperplastic and pretumourous ones. The necessity of a uniform interpretation of this term is underlined, its definition is given and it is suggested to distinguish between metaplastic processes and dysplasia. An important role of advanced dysplasia as a precancerous process is shown; due to this it should serve as one of the most important criteria for the formation of groups of increased cancer risk. As the problem of dysplasia is a biological one it can be solved only on the basis of fundamental multidisciplinary research; this may help in the unveiling essence of processes of malignization.
Problems of training of clinical pathologists in the Soviet Union are reviewed. A 11-cycle program delivered at 8 chairs of the Central Institute for Advanced Medical Training and State Institutes for Postgraduate Medical Education embraces all kinds of training and advanced training of the specialists. The teaching schedule is based on a standard program providing necessary extent of up-to-date knowledge on pathologic anatomy and professional skills. The efficacy of field cycles is discussed. The improvement of certification procedure is believed to be necessary.
A number of organizational measures directed to the improvement of pathoanatomic service has been put forward for the discussion. In particular, it is advised to generalize regularly all the autopsy findings according to a unified form, which will be of the greatest scientific and practical importance. The authors necessitate increasing the number of autopsies in cases of death at home. Measures to improve the quality of investigating the biopsy and surgical material are recommended, as well as methods of monitoring this work. The major principles in appointing the Chief regional pathoanatomist are discussed.
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History of the rise of the pathology service in the system of the military-medical service of the Red Army is described and the arguments in favour of its necessity in the fighting troops are presented. The characterization of the goals of such a service is given, notably: an evaluation of the work of the military-medical establishments on the basis of a summarized clinico-anatomical analysis of pathology data, this allowing the heads of the military-medical service a rapid elimination of organizational and therapeutic-diagnostic defects of various stages of medical evacuation and improvement of the activity of the therapeutic evacuation centres; establishing the causes of death of the persons wounded or struck in the battles and evaluating the significance of the type, time, volume and shortcomings of the treatment in the fatal issue; studying the pathology of the war trauma, regeneration, the pathogenesis of infectious complications and influence on their development and course of the treatment, etc. The organizational structure of the service, its branches (front and army laboratories of pathology, department of pathology of big hospitals) working under the guidance of the Central Laboratory of Pathology (CLP), is described. The documents which were the basis of the work of these laboratories are characterized. An important merit of M.F. Glazunov and N. A. Krayevsky--chiefs of the CLP--in the organization and guidance, both practical and scientific, is noted. The main results of the activity of the service are briefly characterized.
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The question on the necessity of intensification of efforts of older generation scientists, those working at medical and research institutes, scientific pathology societies in the preparation and education of young scientific staff is raised. Some criteria for the evaluation of such a preparation and educational principle based on the deep study by young scientists of The Marxist-Leninist philosophy, formation of the communist mentality are discussed. The responsibility of leading pathologists of the country and the importance of such work is pointed out as those who are young to-day will have to put forward pathology at the XXI century.
The normal skin and adipose subcutaneous tissue, desmoid fibroma, lipomas with varying proliferative activity, fibrosarcoma, malignant fibrous histiocytoma, epithelioid leiomyoma are studied by means of electron microscopy and electron microscopical radioautography. It was found that the walls of the smallest vessels contain cells which are the source of a permanent physiological renewal of a different type of the connective tissue. In proportion to differentiation and gradual removal of these cells from the vascular wall their proliferative and metabolic activity is more and more decreasing. Thus, the vessels represent not only the transport-nutritive system but the central generative structure of the connective tissue as well. Pluripotential mesenchymal cell of the vascular wall which under physiological conditions is differentiating in the direction of fibro-, angio-, lipo- or osteogenesis, due to the influence of oncogenic factors gives rise to the development of benign and malignant tumours of fibrous, vascular (angiomas), smooth muscle, adipose and bone structure. This can be most demonstratively checked using electron-radioautography of tumourlike conditions and relatively slow growing tumours.