3. Autopsy: definition of the concept, methodology, goals and objectives.

An autopsy (autopsy, section, necropsy) is a postmortem examination of a person in order to establish the changes caused by the disease and the causes of death. During the autopsy, human organs are examined and examined. To do this, the skull, chest and abdominal cavity are opened. All the results are recorded in the autopsy report.

Modern diagnostic methods make it possible today to accurately diagnose the disease. However, a post-mortem examination allows you to compare the results of an autopsy with the diagnosis established by a person during his lifetime. In addition, a clinical autopsy allows us to judge the degree of effectiveness of the treatment. Microscopic and chemical studies complement the autopsy materials. Thanks to the electron microscope, you can see the most insignificant changes in cells. It is also possible to perform a blood test that identifies various infections. Sometimes the results of a blood or tissue test are stored in a special archive in order to use this material for genetic or some other diagnosis many years later when more advanced methods become available.

Methods:

• The Abrikosov method (A.I. Abrikosov, 1875 – 1955, sov. pathologist) is a method of autopsy of a corpse, in which organs are extracted by complexes that make up anatomical and physiological systems (a complex of organs of the neck and chest; liver, stomach and duodenum; kidneys and urinary tract and genitals; brain and spinal cord).

• Leshka incision is a collar incision followed by opening of the diaphragm. It is used when it is necessary to save face.

• Fischer's method - (V. Fischer-Wasels, 1877-1941, German. pathologist) 1) a method of autopsy of a corpse, in which, in order to preserve the integrity of the skin of the anterior surface of the neck, a sectional incision is made from the side of the mastoid processes obliquely to the handle of the sternum; 2) a method of opening the brain, consisting in dissecting it with parallel incisions in the frontal plane.

• The method of opening the Shore - (G. V. Shore, 1872-1948, sov. pathologist; syn. the method of complete evisceration) is a method of autopsy of a corpse, in which the internal organs are extracted in a single complex.

4. Pathology of the cell nucleus, mitosis, chromosomal apparatus: classification, structural changes, examples of diseases.

Changes in the shape of the nucleus are an essential diagnostic sign: deformation of the nuclei by cytoplasmic inclusions in dystrophic processes, polymorphism of the nuclei in inflammation (granulomatosis) and tumor growth (cellular atypism).

The shape of the nucleus may also change due to the formation of multiple protrusions of the nucleus into the cytoplasm, which is due to an increase in the nuclear surface and indicates the synthetic activity of the nucleus with respect to nucleic acids and protein.

Changes in the number of nuclei in a cell can be represented by multinucleation, the appearance of a "satellite core" and nuclear-free. Multicore is possible with cell fusion. These are, for example, giant multinucleated cells of foreign bodies and Pirogov –Langhans, formed by the fusion of epithelioid cells. But the formation of multinucleated cells is also possible in mitotic disorders – nuclear division without subsequent division of the cytoplasm, which is observed after irradiation or administration of cytostatics, as well as with malignant growth.

Mitosis occupies a special place in the life cycle of a cell. With its help, the reproduction of cells is carried out, and therefore the transfer of their hereditary properties. The preparation of cells for mitosis consists of a number of sequential processes: DNA reproduction, doubling of cell mass, synthesis of protein components of chromosomes and mitotic apparatus, doubling of the cell center, energy accumulation for cytotomy. In the process of mitotic division, as is known, there are 4 main phases: prophase, metaphase, anaphase and telophase. The pathology of mitosis can be caused by various effects on the cell: ultraviolet and ionizing radiation, high temperature, chemicals, including carcinogens and mitotic poisons, etc. The number of pathological mitoses in tissue malignancy is high. In the pathology of mitosis, any of these phases may suffer. Guided by this, a classification of mitosis pathology was created [Alov I. A., 1972], according to which the following types of mitosis pathology are distinguished:

I. Chromosome damage:

1. cell retention in prophase;

2. violation of the spiralization and despiralization of chromosomes;

3. fragmentation of chromosomes;

4. formation of bridges between chromosomes in anaphase;

5. early separation of sister chromatids;

6. kinetochore damage.

II. Damage to the mitotic apparatus:

1. delayed development of mitosis in metaphase;

2. chromosome dispersal in metaphase;

3. three-group metaphase;

4. hollow metaphase;

5. multipole mitoses;

6. asymmetric mitoses;

7. monocentric mitoses;

8. K-mitoses.

III. Violation of cytotomy:

1. premature cytotomy;

2. delayed cytotomy;

3. absence of cytotomy.

Chromosomal aberrations are understood as changes in the structure of chromosomes caused by their breaks, followed by redistribution, loss or doubling of genetic material. They reflect different types of chromosome abnormalities. In humans, among the most common chromosomal aberrations, manifested by the development of deep pathology, there are anomalies concerning the number and structure of chromosomes. Abnormalities in the number of chromosomes can be expressed by the absence of one of a pair of homologous chromosomes (monosomy) or the appearance of an additional, third, chromosome (trisomy). Polyploidy and aneuploidy are less important for the development of chromosomal syndromes. Violations of the structure of chromosomes with a generally normal number of them in the karyotype include various types of their "breakdown": translocadia (exchange of segments between two non-homologous chromosomes), deletion (loss of a part of the chromosome), fragmentation, ring chromosomes, etc.

Chromosomal diseases caused by abnormalities in the number of individual chromosomes (trisomies and monosomies) can affect both autosomes and sex chromosomes. They are divided into somatic chromosome abnormalities (autosomes) and sex chromosome abnormalities (Barr bodies). At the same time, the nature of the chromosomal anomaly is taken into account – a violation of the number of individual chromosomes, the number of chromosomal sets or the structure of chromosomes. These criteria make it possible to identify complete or mosaic clinical forms of chromosomal diseases. Autosome monosomies (any chromosomes except the X and Y chromosomes) are incompatible with life. Autosomal trisomies are quite common in human pathology. They are most often represented by Patau syndrome (13th pair of chromosomes) and Edwards syndrome (18th pair), as well as Down's disease (21st pair). Chromosomal syndromes with trisomies of other pairs of autosomes are much less common. The monosomy of the sex X chromosome (genotype XO) is the basis of the Shereshevsky-Turner syndrome, the trisomy of the sex chromosomes (genotype XXY) is the basis of Kleinfelter syndrome. Chromosome number disorders in the form of tetra- or triploidy can be represented by both complete and mosaic forms of chromosomal diseases. Abnormalities in the structure of chromosomes give the largest group of chromosomal syndromes (more than 700 types), which, however, may be associated not only with chromosomal abnormalities, but also with other etiological factors.