Documente Academic
Documente Profesional
Documente Cultură
April 2014
fisamment. Cela s'explique par le faible dveloppement des
infrastructures touristiques, par des investissements insuffisants, par l'absence des mcanismes efficaces de la motivation du petit et du moyen business, par une insuffisamment
haute qualit du service et par d'autres raisons.
Analysant l'exprience trangre tudie on peut proposer certaines variantes de l'amlioration de la situation du
tourisme en rgion de Rostov.
Par exemple, d'aprs l'exprience du Mexique il est possible de mettre en oeuvre les programmes rgionaux et nationaux du dveloppement du tourisme qui contribueront
amliorer l'image de la rgion sur les marchs touristiques
nationaux ainsi qu' internationaux.
Other
143
Rfrences:
1.
2.
3.
For example, hypoplastic dysplasia was diagnosed as a principal renal condition in 8 from 34 patients aged 954 years
with nephrotic syndrome and histologically minimal glomerular changes[6]. At the same time, Alport syndrome was not
mentioned among 4440 cases, diagnosed by renal biopsy at
the same institution, overviewed in[8]. The concept of hypoplastic dysplasia as a special form of nephropathy[4], discussed with clinicians performing biopsies, could have interfered with the diagnosis of Alport syndrome, having certain
ultrastructural features in common with hypoplastic dysplasia as per[46]. Differential diagnosis of hypoplastic dysplasia with Alport syndrome was not mentioned in[46].
Note that Alport syndrome has significant genetic implications. Moreover, indications for renal and pancreatic biopsies applied by the same authors in research[9,10] should be
questioned, considering the questionable morphological descriptions partly cited above. Today, the same authors apply
the term hypoplastic dysplasia to the glomerular changes in
congenital hydronephrosis and other congenital renal conditions (where intra-operative excision renal biopsies have
been collected), interpreting them as inborn nephropathy reportedly affecting a majority of glomeruli[1113]. It
144
. 4 (63) . , 2014 .
Fig. 1. Glomerulus with singular capillary loops () and freely lying podocytes () x1100[4].
Fig. 2. Congenital nephropathy, case 1. a absence of capillary loops in a glomerulus (K), compact arrangement of
undifferentiated cells. Methylene blue-azure II-fuchsin stain. x400; podocytes () with large, pale, eccentrically
located nuclei; large endothelial cells () bulging into the capillary lumen x3200; fragments of disorderly arranged
membrane-like material (MB), a cell with excrescences of cytoplasm () x20800
The same researchers collected 60 pancreatic excision biopsies 5x5 mm in size[16] in the course of pancreatic blood
shunting into the systemic blood flow in insulin-dependent
diabetics.[3] From 1986 through 1994, 409 of such procedures were performed in type 1 diabetic patients by this
Other
145
Fig. 3. Glomerulus with a singular capillary loop (), abundance of freely lying cells (CK), x1500
and among the cells of the inter-acinar ducts[28,29], glomerulonephritis and mesangiolysis as consecutive stages
of diabetic glomerulosclerosis[10], frequent mesangial interposition with displacement of mesangial cells to the peripheral capillary loops and formation of double-contour glomerular basement membranes[10,30], which is partly at
variance with usual morphological descriptions[3135].
In particular, glomerulonephritis, if detected in diabetic patients, has been interpreted as a superimposed condition or
a complication[34,35]. Collection of renal biopsies from diabetic patients for research was planned in advance[36].
In conclusion, the purpose of this paper was to remind
that, performing renal or pancreatic biopsy, the risk-tobenefit ratio should be kept as low as possible[14]. In particular, pancreatic biopsy is associated with risks[1,32,37].
Quality of morphological examination should be taken into
account in determining indications to renal and pancreatic biopsies in each particular case. Finally, in the author's
opinion based on the literature overview, indications to the
pancreatic blood shunting into the systemic blood flow in
diabetics have not been sufficiently elaborated, which can
pertain also to angiographic procedures involving catheterization of renal and splenic veins as well as arteriography
described in[3].
References:
1.
Krogvold L, Edwin B, Buanes T, et al. Pancreatic biopsy by minimal tail resection in live adult patients at the onset of
type 1 diabetes: experiences from the DiViD study. Diabetologia. 2014, V 57, p. 8413.
146
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
. 4 (63) . , 2014 .
Imagawa A, Hanafusa T, Tamura S, et al. Pancreatic biopsy as a procedure for detecting in situ autoimmune
phenomena in type 1 diabetes: close correlation between serological markers and histological evidence of cellular
autoimmunity. Diabetes. 2001, V 50, p. 126973.
Galperin EI1, Diuzheva TG, Petrovsky PF, et al. Results of pancreatic blood shunting into the systemic blood flow in
insulin-dependent diabetics. HPB Surg. 1996, V 9, p. 1917.
Severgina ES, Pal'tsev MA. Hypoplastic dysplasia as one of the forms of nephropathy. Arkh Patol. 1989, V 51, N 10,
p. 5863.
Varshavskii VA1, Proskurneva EP, Gasanov AB, et al. Subdivision of certain morphological variants of chronic
glomerulonephritis. Arkh Patol. 1999, V 61, N 5, p. 406.
Severgina ES. Ultrastructural heterogeneity of minimal changes in the kidney glomeruli, detected by light optics.
Arkh Patol. 1991, V 53, N 2, p. 538.
Jargin SV. The concept of hypoplastic renal dysplasia can interfere with the diagnosis of Alport syndrome. CMAJ,
February 14, 2014; http://www.cmaj.ca/content/102/4/396. citation/reply#cmaj_el_716893
Dzhanaliev BR, Varshavskii VA, Laurinavichus AA. Primary glomerulopathies: incidence, dynamics and clinical
manifestations of morphological variants. Arkh Patol. 2002, V 64, N 2, p. 325.
Severgina ES, Diuzheva TG. Morphologic and functional changers in B-cells and vessels of the islands of Langerhans
in patients with insulin-dependent diabetes mellitus. Arkh Patol. 1996, V 58, N 5, p. 407.
Severgina ES, Ponomarev AB, Diuzheva TG, et al. Diabetic glomerulonephritis the first stage of diabetic
glomerulopathy. Arkh Patol. 1994, V 56, N 4, p. 4450.
Severgina LO, Leonova LV, Severgina ES, et al. Coupling between the hemodynamic parameters and the
morphological changes in the kidney in children with congenital hydronephrosis. Arkh Patol. 2011, V 73, N 2, p.
147.
Leonova LV, Severgina ES, Popova OP, et al. Transforming growth factor as a marker beta of nephrogenetic
disturbance in congenital obstructive uropathies. Arkh Patol. 2007, V 69, N 4, p. 358.
Cheskis AL, Severgina ES, Leonova LV, Ostapko MS. Status and development of the kidney after surgical treatment
of hydronephrosis in children. Urologiia. 2002, N 4, p. 3943.
Jargin SV. Renal biopsy research with implications for therapy of glomerulonephritis. Curr Drug ther. 2012, V 7, p.
2637.
Jargin SV. Chernobyl-related bladder lesions: new interpretation required. J Interdiscipl Histopathol. 2014;
doi:10.5455/jihp. 20140127124925
Severgina ES. Morphology and pathogenesis of insulin-dependent diabetes mellitus. Habilitation thesis.
I.M.Sechenov Medical Academy, Moscow, 1995. (Russian)
Siplivyi VA, Beresnev AV. The late results of deportalization of the pancreatic blood flow in patients with type-1
diabetes mellitus. Klin Khir. 1998, N 11, p. 912.
Nikonenko AS, Kovalev AA, Zavgorodnii SN, Volkova NA. Surgical treatment of insulin-dependent diabetes mellitus
and its complications. Khirurgiia. 1996, N 2, p. 813.
Shraer TI, Rozina NS. Late results of pancreatic blood outflow deportalization and its significance in the combined
modality treatment of diabetes mellitus. Probl Endokrinol. 1992, V 38, N 5, p. 4952.
Torgunakov SA, Torgunakov AP. Possible causes of thrombus-related hazard of a distal splenorenal venous
anastomosis. Angiol Sosud Khir. 2010, V 16, N 4, p. 1848.
Torgunakov AP. Renoportal venous anasomosis. Kemerovo Medical Institute, 1992. (Russian)
Ivanov PA, Golikov PP, Shcherbiuk AN, et al. Characteristics of the postoperative period in diabetes mellitus type 1
in patients with distal splenorenal anastomosis. SovMed. 1990, N 2, p. 179.
Gal'perin EI, Shraer TI, Diuzheva TG, et al. Experimental basis and initial clinical experience with the surgical
treatment of diabetes mellitus. Khirurgiia. 1987, N 2, p. 6470.
Gal'perin EI, Diuzheva TG, Kuzovlev NF, et al. Surgical correction of metabolism in diabetes mellitus. Khirurgiia.
1988, N 9, p. 611.
Putintsev AM, Shraer TI, Sergeev VN, et al. Variants of surgical management for severe arterial hypertension
combined with type 2 diabetes mellitus. Angiol Sosud Khir. 2010, V 16, N 2, p. 1205.
Gal'perin EI, Kuzovlev NF, Diuzheva TG, Aleksandrovskaia TN. Approaches to surgical treatment of diabetes
mellitus (experimental study). Khirurgiia. 1983, N 1, p. 1320.
Williams G, Pickup JC. Handbook of diabetes. 2nd edition. Blackwell Science, Oxford, 1999.
Severgina ES, Diuzheva TG, Razgulina LE, Stakheev IB. Is localization of B-cells in the acini a normal condition or
the sign of compensatory process in insulin-dependent diabetes mellitus? Arkh Patol. 1992, V 54, N 12, p. 1823.
Severgina E, Dyuzheva T, PaltsevM.Acinar B-cells in pancreas in insulin-dependent diabetic patients. The right to
exist. Pathol Res Pract. 1993, V 189, N 3, p. 2989.
Other
147
30. Severgina ES, Ponomarev AB, Diuzheva TG, et al. Diabetic glomerulosclerosis a prolonged stage of diabetic
glomerulopathy. Arkh Patol. 1994, V 56, N 4, p. 505.
31. RosaiJ.Rosai and Ackerman's surgical pathology. Mosby, Edinburgh, 2004.
32. Spencer J, PeakmanM.Post-mortem analysis of islet pathology in type 1 diabetes illuminates the life and death of
the beta cell. Clin Exp Immunol. 2009, V 155, p. 1257.
33. Richardson SJ, Morgan NG, Foulis AK Pancreatic Pathology in Type 1 Diabetes Mellitus. Endocr Pathol. 2014; doi:
10.1007/s1202201492978
34. Dizdar O, Kahraman S, Gentoy G, et al. Membranoproliferative glomerulonephritis associated with type 1 diabetes
mellitus and Hashimoto's thyroiditis. Nephrol Dial Transplant. 2004, V 19, p. 9889.
35. Hironaka K1, Makino H, Ikeda S, et al. Nondiabetic renal disease complicating diabetic nephropathy. J Diabet
Complications. 1991, V 5, p. 1489.
36. Severgina ES, Ponomarev AB. Patho- and morphogenesis of diabetes mellitus and early diabetic nephropathy. Arkh
Patol. 1988, V 50, N 4, p. 805.
37. Atkinson MA. Pancreatic biopsies in type 1 diabetes: revisiting the myth of Pandora's box. Diabetologia. 2014, V 57,
p. 6569.