Path. Res. Pract. 186,821-822 (1990)
8th Congress of USSR Pathologists N. M. Anichkov and V. Tumanov Department of Pathology, Leningrad, Institute of Medicine and Hygiene, Leningrad, USSR
The regular all-Union forum of USSR pathologists took place in Tbilisi from the 17th to the 20th of October 1989. Six years had passed since the last (Tashkent) congress, and the topic considered was inflammatory diseases of the lungs and immunodeficient conditions. 450 delegates and guests from all our republics and from abroad were present. Academician D. S. Sarkisov (Moscow), President of the board of the all-Union Society of pathologists opened the Congress with a report "On the state and perspectives of development of pathology in the USSR". He emphasized that an increase of the role of miroscopic diagnosis during life had been registered all over the country. Data showing an increase of the number of biopsies from 9.6 to 26 million within 10 years were presented. At the same time considerable difficulties were noted in the replacement of personnel and the technical outfitting of hospital pathological departments and laboratories. Due to the fact that graduates of medical institutes at present rarely take up pathology, intake is low. Only around 600 pathologists are under the age of 33 (70% of them work at hospitals, the rest in the Departments of Medical Institutes and scientific laboratories). Considerable attention was devoted to the problems of teaching and organization of scientific investigations. The speaker generalized on the experience of 30 recently established regional pathological centres, working in the majority of cases on a self-financed and administrative basis similar to institutes of pathology. He remarked on the achievements and drawbacks of their centralized work. The first plenary session and a number of satellite symposia and poster presentations were devoted to modern problems of the pathology and pathogenesis of pneumonia. N. K. Permyakov et al. (Moscow) presented the results of a complex morphological and bacteriological investigation of 5209 observations, 202 of which pertained to lobar pneumonia and the rest to focal pneumonias of varied extent. In 92% of the patients the pneumonias presented as a complication of primary disease, in relationship to vascular, oncological, or surgical illness. It was emphasized that the growing significance of streptostaphylococcal and Gram-negative flora is often a result of hospital infection. The speakers also showed an atypical course of lobar pneumonia which is not accompanied by pronounced hyperthermia not only proved difficulties in © 1990 by Gustav Fischer Verlag, Stuttgart
diagnosis but also was accompanied by undiagnosed complications. A. V. Zinserling et al. presented a data analysis on paediatric pathology in Leningrad for 1977-1986. Acute laryngotracheobronchitis and pneumonias were observed in 72-79% of autopsies. Bacterial lesions were noted in 56.1%, mycoplasmic in 8.9%, candidia in 2.0%, and pneumocystis in 0.3%. The reasons for the high frequency of chlamydiosis remained unknown. A separate investigation on a group of children with the syndrome of sudden death characterised by acute respiratory infection might represent singular organism reactivity in cases of thymomegalia, hypoplasia of the adrenal glands, and unstable regulation of the cardiovascular system. There were no explanations for various differences in the frequency of disseminated intravascular coagulation syndrom of different etiology; the spread and extent of the process in the respiratory system were not established. T. N. Kopyeva (Moscow) distinguished the morphological variants of obstructive and non-obstructive forms of chronic bronchitis: catarrhal, granulating, destructive and, also, peribronchitis. Various speakers commented on chronic pneumonia in cases of chronic bronchitis and bronchiectasis and in non-specific chronic lung lesions. V. S. Paukov et al. (Moscow) presented comprehensive data on interstitial lung diseases (ILD) of known and unknown pathology. They distinguished over 20 forms of sarcoidosis, histocytosis X, the Goodpasture syndrome, allergic vasculites, venous occlusive disease, Wipple's disease, cryptogenic fibrous alveolitis and other changes that occur in rheumatic processes. Three stages of ILD morphogenesis were distinguished: 1) alveolitis, 2) desintegration of alveolar structures with interstitial fibrosis, 3) blockage of capillary blood flow with disturbances of pulmonary gas exchange at the level of the blood/gas barrier. Diffuse and granulomatous ILD and the mechanisms of intracellular integration and cooperation in cases of these diseases were characterized in detail. A comprehensive report on "Pneumonia, pneumonitis, alveolitis (problems of terminology, pathomorphology, and morphogenesis)" was presented by A. G. Bobkov (Leningrad) and H. Eckert (Berlin-Buch). Other speakers dwelt upon new data concerning the typing of etiological factors in pneumonia and on the immunological and other transitional mechanisms converting acute inflammatory processes into chronic ones. 0344-0338/90/0186-0821 $3 .50/0
822 . N. M. Anichkov and V. Tumanov
The second plenary session, as well as several satellite symposia and poster presentations were devoted to the morphology of immunodeficient conditions. T. E. Ivanovskaya (Moscow) presented information on 4 observations of congenital immunodeficiency syndrome in data including 5667 autopsies in children. The author concluded that "primary" immunodeficiency as such does not exist, since in some cases it is determined by the presence of the pathological genes in the gametes of the parents while in others it is aquired intratubally under the influence of environmental factors, such as viruses. It was suggested that a group of unclassified congenital immunodeficiencies should be formed, including pneumonia in congenital thymomegalia, symptoms of dyschromism, immaturity of the immune system (not corresponding to age), and premature fatty transformation of the thymus. The data of S. A. Zairatyants et al. (Moscow) on thymomegalia as a syndrome of congenital (primary) immunodeficiency is in conformity with the latter suggestion. The presentation of A. P. Avstin et al. (Moscow) on 3 sectional observations of AIDS arose considerable interest among hospital pathologists. The speakers illustrated the changes in the organs at autopsy in detail; one of the patients died of generalized Kaposi sarcoma, the second of pneumocytis pneumonia, and the third committed suicide. In other reports and discussions it was noted that the problems of secondary (acquired) immunodeficiences have been insufficiently elaborated, regardless of their important role in the pathology of man. Changes in the organs of immunity in aging and tumor growth on a background of immunodeficiency, and problems of the classification of granulocytic, macrophage and other neoplasms were also discussed. A number of guests at the Congress from European countries presented reports. D. Ferluga (Yugoslavia) made a report on nephritis in cases of lupus erythematosus; G. Plank (Czechoslovakia) on changes at hypotrophy of the newborn; K. Lapis (Hungary) on DNA-content shift in elements of changed vascular system of the liver; J. Stejskal (Czechoslovakia) on family histocytosis; A. Kulig (Poland) on cytological diagnostics of mammary gland tumours in aspirates; H. David (GDR) on the problem of organellopathies; W. Janisch (GDR) and S. Dushkova (Czechoslovakia) on immunohistochemical peculiarities of poorly differentiated tumours of the brain and hypophysis. A "round table" discussion was organized on the last day of the Congress. Attention was paid to the problems of classification of disease. N. M. Anichkov and B. A. Zus (Leningrad), touching upon the building up of diagnoses, criticized the tendency to a deformation of diagnostic formulations for the sake of statistics. They gave examples of unscientific utilization of such a diagnostic category as "combined disease", and also the confusion produced by such categories as "basic disease" and "complication". Having shown how badly hospital pathologists distinguish and diagnose diabetic glomerulosclerosis with secondary
hypertension and what harm they bring about in medical care and statistical recording of disease, the authors demonstrated the erroneous tendency of distinguishing hypertensive complications as the basic nosologic form. Other reports contained a considerable amount of criticism of the international classification of diseases effective up to date; and suggestions were made on restricting the reporting of certain syndromes in basic nosologic forms. Time does not permit us to give an adequate review of the materials and data presented at the Congress. The participants of the Congress received the Proceedings in which summaries of 203 reports were published. The editorial board of the journal "Arkhiv patologii" reported on their work. It was said, in particular, that during the last 5 years 250 scientific papers out of 1700 presented for publication were rejected; the rest were published and deposited. The Journal experiences economic difficulties, because publication is expensive and the circulation is about 5 thousand copies. The editorial board is planning to change the size of the journal. As usual, a number of organizational questions were decided. The Congress elected the Presidium of the Board of the All-Union Society of Pathologists by ballot. The following professors were elected: D. S. Sarkisov (Chairman), G. G. Avtandilov, A. P. Avstin (all Moscow), N. M. Anichkov (Leningrad), U. A. Gabuniya, T. I. Dekanosidze (both Tbilisi), I. A. Kazantseva (Moscow), A. F. Kisilyeva (Kiev), V. S. Paukov, N. K. Permyakov, V. V. Serov, A. V. Smolyannikov, Yu. N. Solovyev (all Moscow), S. A. Stepanov (Saratov), V. P. Tumanov (Moscow), O. K. Khmelnitsky, A. V. Zinserling (both Leningrad), E. D. Cherstvoi (Minsk), A. M. Shabanov (Kalinin), V. P. Shiskov, R. D. Stern (Moscow). Addendum According to the data of Human Morphology Research Institute of the USSR Academy of Medical Sciences in 1989 5928 pathologists worked in the USSR. Of this number 4380 pathologists worked in hospital departments and 1548 at the Institutes (chairs) of Pathology and Research Laboratories. At the same time there was a considerable amount of vacancies partly occupied by doctors of other specialities in many hospitals. Annually over 480 thousand autopsies are performed at present, however, approximately 70% of deceased undergo a post-morten examination. Over 13 million of histological studies of surgical material plus over 12660 thousand biopsy examinations are performed every year. But only about 8.3 histological studies are done per 10 thousand surgical interventions of diverse profiles including "small surgery". It should be noted that the statistic account of histological studies in the Soviet Union is carried out by the number of studied specimens.
Received March 13, 1990· Accepted March 14, 1990
Key words: USSR pathologists' congress - Inflammatory diseases - Lung diseases - Immunodeficient conditions Prof. Dr. N. M. Anichkov, Department of Pathology, Leningrad Institute of Medicine and Hygiene, Piskarjovsky pr., 47, Leningrad, 195067, USSR
8th Congress of USSR Pathologists N. M. Anichkov and V. Tumanov Department of Pathology, Leningrad, Institute of Medicine and Hygiene, Leningrad, USSR
The regular all-Union forum of USSR pathologists took place in Tbilisi from the 17th to the 20th of October 1989. Six years had passed since the last (Tashkent) congress, and the topic considered was inflammatory diseases of the lungs and immunodeficient conditions. 450 delegates and guests from all our republics and from abroad were present. Academician D. S. Sarkisov (Moscow), President of the board of the all-Union Society of pathologists opened the Congress with a report "On the state and perspectives of development of pathology in the USSR". He emphasized that an increase of the role of miroscopic diagnosis during life had been registered all over the country. Data showing an increase of the number of biopsies from 9.6 to 26 million within 10 years were presented. At the same time considerable difficulties were noted in the replacement of personnel and the technical outfitting of hospital pathological departments and laboratories. Due to the fact that graduates of medical institutes at present rarely take up pathology, intake is low. Only around 600 pathologists are under the age of 33 (70% of them work at hospitals, the rest in the Departments of Medical Institutes and scientific laboratories). Considerable attention was devoted to the problems of teaching and organization of scientific investigations. The speaker generalized on the experience of 30 recently established regional pathological centres, working in the majority of cases on a self-financed and administrative basis similar to institutes of pathology. He remarked on the achievements and drawbacks of their centralized work. The first plenary session and a number of satellite symposia and poster presentations were devoted to modern problems of the pathology and pathogenesis of pneumonia. N. K. Permyakov et al. (Moscow) presented the results of a complex morphological and bacteriological investigation of 5209 observations, 202 of which pertained to lobar pneumonia and the rest to focal pneumonias of varied extent. In 92% of the patients the pneumonias presented as a complication of primary disease, in relationship to vascular, oncological, or surgical illness. It was emphasized that the growing significance of streptostaphylococcal and Gram-negative flora is often a result of hospital infection. The speakers also showed an atypical course of lobar pneumonia which is not accompanied by pronounced hyperthermia not only proved difficulties in © 1990 by Gustav Fischer Verlag, Stuttgart
diagnosis but also was accompanied by undiagnosed complications. A. V. Zinserling et al. presented a data analysis on paediatric pathology in Leningrad for 1977-1986. Acute laryngotracheobronchitis and pneumonias were observed in 72-79% of autopsies. Bacterial lesions were noted in 56.1%, mycoplasmic in 8.9%, candidia in 2.0%, and pneumocystis in 0.3%. The reasons for the high frequency of chlamydiosis remained unknown. A separate investigation on a group of children with the syndrome of sudden death characterised by acute respiratory infection might represent singular organism reactivity in cases of thymomegalia, hypoplasia of the adrenal glands, and unstable regulation of the cardiovascular system. There were no explanations for various differences in the frequency of disseminated intravascular coagulation syndrom of different etiology; the spread and extent of the process in the respiratory system were not established. T. N. Kopyeva (Moscow) distinguished the morphological variants of obstructive and non-obstructive forms of chronic bronchitis: catarrhal, granulating, destructive and, also, peribronchitis. Various speakers commented on chronic pneumonia in cases of chronic bronchitis and bronchiectasis and in non-specific chronic lung lesions. V. S. Paukov et al. (Moscow) presented comprehensive data on interstitial lung diseases (ILD) of known and unknown pathology. They distinguished over 20 forms of sarcoidosis, histocytosis X, the Goodpasture syndrome, allergic vasculites, venous occlusive disease, Wipple's disease, cryptogenic fibrous alveolitis and other changes that occur in rheumatic processes. Three stages of ILD morphogenesis were distinguished: 1) alveolitis, 2) desintegration of alveolar structures with interstitial fibrosis, 3) blockage of capillary blood flow with disturbances of pulmonary gas exchange at the level of the blood/gas barrier. Diffuse and granulomatous ILD and the mechanisms of intracellular integration and cooperation in cases of these diseases were characterized in detail. A comprehensive report on "Pneumonia, pneumonitis, alveolitis (problems of terminology, pathomorphology, and morphogenesis)" was presented by A. G. Bobkov (Leningrad) and H. Eckert (Berlin-Buch). Other speakers dwelt upon new data concerning the typing of etiological factors in pneumonia and on the immunological and other transitional mechanisms converting acute inflammatory processes into chronic ones. 0344-0338/90/0186-0821 $3 .50/0
822 . N. M. Anichkov and V. Tumanov
The second plenary session, as well as several satellite symposia and poster presentations were devoted to the morphology of immunodeficient conditions. T. E. Ivanovskaya (Moscow) presented information on 4 observations of congenital immunodeficiency syndrome in data including 5667 autopsies in children. The author concluded that "primary" immunodeficiency as such does not exist, since in some cases it is determined by the presence of the pathological genes in the gametes of the parents while in others it is aquired intratubally under the influence of environmental factors, such as viruses. It was suggested that a group of unclassified congenital immunodeficiencies should be formed, including pneumonia in congenital thymomegalia, symptoms of dyschromism, immaturity of the immune system (not corresponding to age), and premature fatty transformation of the thymus. The data of S. A. Zairatyants et al. (Moscow) on thymomegalia as a syndrome of congenital (primary) immunodeficiency is in conformity with the latter suggestion. The presentation of A. P. Avstin et al. (Moscow) on 3 sectional observations of AIDS arose considerable interest among hospital pathologists. The speakers illustrated the changes in the organs at autopsy in detail; one of the patients died of generalized Kaposi sarcoma, the second of pneumocytis pneumonia, and the third committed suicide. In other reports and discussions it was noted that the problems of secondary (acquired) immunodeficiences have been insufficiently elaborated, regardless of their important role in the pathology of man. Changes in the organs of immunity in aging and tumor growth on a background of immunodeficiency, and problems of the classification of granulocytic, macrophage and other neoplasms were also discussed. A number of guests at the Congress from European countries presented reports. D. Ferluga (Yugoslavia) made a report on nephritis in cases of lupus erythematosus; G. Plank (Czechoslovakia) on changes at hypotrophy of the newborn; K. Lapis (Hungary) on DNA-content shift in elements of changed vascular system of the liver; J. Stejskal (Czechoslovakia) on family histocytosis; A. Kulig (Poland) on cytological diagnostics of mammary gland tumours in aspirates; H. David (GDR) on the problem of organellopathies; W. Janisch (GDR) and S. Dushkova (Czechoslovakia) on immunohistochemical peculiarities of poorly differentiated tumours of the brain and hypophysis. A "round table" discussion was organized on the last day of the Congress. Attention was paid to the problems of classification of disease. N. M. Anichkov and B. A. Zus (Leningrad), touching upon the building up of diagnoses, criticized the tendency to a deformation of diagnostic formulations for the sake of statistics. They gave examples of unscientific utilization of such a diagnostic category as "combined disease", and also the confusion produced by such categories as "basic disease" and "complication". Having shown how badly hospital pathologists distinguish and diagnose diabetic glomerulosclerosis with secondary
hypertension and what harm they bring about in medical care and statistical recording of disease, the authors demonstrated the erroneous tendency of distinguishing hypertensive complications as the basic nosologic form. Other reports contained a considerable amount of criticism of the international classification of diseases effective up to date; and suggestions were made on restricting the reporting of certain syndromes in basic nosologic forms. Time does not permit us to give an adequate review of the materials and data presented at the Congress. The participants of the Congress received the Proceedings in which summaries of 203 reports were published. The editorial board of the journal "Arkhiv patologii" reported on their work. It was said, in particular, that during the last 5 years 250 scientific papers out of 1700 presented for publication were rejected; the rest were published and deposited. The Journal experiences economic difficulties, because publication is expensive and the circulation is about 5 thousand copies. The editorial board is planning to change the size of the journal. As usual, a number of organizational questions were decided. The Congress elected the Presidium of the Board of the All-Union Society of Pathologists by ballot. The following professors were elected: D. S. Sarkisov (Chairman), G. G. Avtandilov, A. P. Avstin (all Moscow), N. M. Anichkov (Leningrad), U. A. Gabuniya, T. I. Dekanosidze (both Tbilisi), I. A. Kazantseva (Moscow), A. F. Kisilyeva (Kiev), V. S. Paukov, N. K. Permyakov, V. V. Serov, A. V. Smolyannikov, Yu. N. Solovyev (all Moscow), S. A. Stepanov (Saratov), V. P. Tumanov (Moscow), O. K. Khmelnitsky, A. V. Zinserling (both Leningrad), E. D. Cherstvoi (Minsk), A. M. Shabanov (Kalinin), V. P. Shiskov, R. D. Stern (Moscow). Addendum According to the data of Human Morphology Research Institute of the USSR Academy of Medical Sciences in 1989 5928 pathologists worked in the USSR. Of this number 4380 pathologists worked in hospital departments and 1548 at the Institutes (chairs) of Pathology and Research Laboratories. At the same time there was a considerable amount of vacancies partly occupied by doctors of other specialities in many hospitals. Annually over 480 thousand autopsies are performed at present, however, approximately 70% of deceased undergo a post-morten examination. Over 13 million of histological studies of surgical material plus over 12660 thousand biopsy examinations are performed every year. But only about 8.3 histological studies are done per 10 thousand surgical interventions of diverse profiles including "small surgery". It should be noted that the statistic account of histological studies in the Soviet Union is carried out by the number of studied specimens.
Received March 13, 1990· Accepted March 14, 1990
Key words: USSR pathologists' congress - Inflammatory diseases - Lung diseases - Immunodeficient conditions Prof. Dr. N. M. Anichkov, Department of Pathology, Leningrad Institute of Medicine and Hygiene, Piskarjovsky pr., 47, Leningrad, 195067, USSR
