Introduction. Stagnant Ischemic Disease of soft tissues.
You may well be surprised that doctors who deal with pathologies of visceral organs, nervous system, osteogenesis and skin pay so little attention to muscles pathology (Trevell, Simmons, 1989). Muscles of a human body (there are about 700 of them) amount to 40% of its mass, and together with the connective tissue muscles amount to 90% of a human body. So, in actual fact, muscles are the biggest organ of a human body. However, up to the present moment they have no due attention of the specialists. Besides, the problem of pain and dysfunction of myofascial tissues is a pathology, which is faced by doctors all the time, but which is still not very clear and is often ignored by specialists.
At the same time, for example, coronary heart disease (CHD) - the pathology of heart - of this unique pump and a small organ, which weighs about 250-300 grams, is studied by quite a large group of specialists of different profile, including physiologists, biochemists, cardiologists, pharmacologists, pathologists, heart surgeons etc.
According to the present estimations of specialists, the frequency of diseases of locomotor system, if to compare with CHD, is widespread among the world population in approximately the same degree, and the former sometimes prevail. Every fourth person has heart diseases (Debeiki et al, 1998); at the same time almost every person has various pathologies of locomotor system.
Nowadays, clinical experimental studies reveal a lot of practical data that indicate important role of somatic musculature and connective tissue disorders in formation of viscerous pathology of the body. And on the contrary, there are a few evidences that show that visceral pathology influences the development of pathologic alterations in skeletal muscles and connective tissue. The collection of facts is an important evidence for the correlation of disorders found in soft tissues and their part in formation of pathology in a human body.
In this respect it seems quite reasonable and necessary to systematize and generalize the collected facts with the aim of the more clear idea about pathogenetic mechanisms of tissue trophic disorders developing in the body and the perfection of methods of their preventive care and treatment.
The existing conceptions concerning clinical pathology of tissues indicate the priority of disorders of tissular circulation of blood in development of tissue trophic disorders.
The major landmark in the study of the part of tissular pathology in development of many human diseases was the classical work of the outstanding French surgeon R.Lerish "The Principles of Physiological Surgery" (1961). The findings of his clinical experiments indicate that anatomical damages found in an organism are caused by nothing else but the changes in the local composition of blood and its derivatives. These local changes in the composition of tissue fluids (including hormones, mediators, and salts) determine and change the direction of growth and the function of local cellular elements with ensuing consequences, i.e. with definite anatomic changes in the structure of tissues and organs. All the cells of our organism are constantly relevant with the condition of the environment. The latter is dependent on the local condition of circulation of blood, which controls the composition of the local extracellular fluid. And a pathologically altered tissue or organ is the result of structural variations caused by the disorder in the composition of tissular environment with the following abnormal development of cells.
The human organism is constantly influenced by different stress factors (heat, cold, surge, variation of geomagnetic field, injuries, germs, fatigue, psychological stress etc.). Human life is considered by the author to be a chain of potentially pathological conditions which are usually overcome by the organism. Due to its own internal resources, the organism constantly corrects all kinds of insignificant but constant disorders ("microdamages") caused by the influence of the environment and inner feelings of a civilized person.
However, if the impact of environmental factors is too strong and the organism reacts too volcanically to them, then due to the genetous and acquired sensibility the organism starts feeling ill and these illnesses are just a stage in history of our lives. Occasional physical and moral commotions sometimes very severe and long-lasting sooner or later leave traces in our tissues ("chemical scarring" by G.Seliere), sensibilizing nervous system, and as a result, new occasional annoyances cause acute, fixed and difficult for restoration pathological reactions. As a result, within us and with our help a new person in physiological sense is created, for whom it's getting more and more difficult to cope with occasional vasomotor disorders caused by our everyday life. Thus, as a result of life perturbations, the human organism is ready for an illness.
To get the full picture of events happening inside of our tissues it is quite interesting to look at the classical presentation of vegetative life of connective tissue shown by R.Lerish. He wrote: "As it is indicated by surgical observations, connective tissue has its expressed physiological individuality and the presence of its own intensive vegetative life in it. So, connective tissue can in some cases morph into fibrous tissue, in other cases into lacunar, adipose tissue, into fibrogliomas and even morphs into cartilaginous or osseous tissue. They found out that connective tissue is not immobile, static formation, but the formation which is in continuous evolutionary dynamism and it is also influenced by a number of factors. Indeed, inflammatory processes proceed in it; and it also forms cicatrices filling the spaces as a result of surgical interferences.
In normal conditions of life of our organism connective tissue remains unchanged and sticks to the plan of our common architectural building. It plays a role of carcass through which juices of local meaning, nutrients and products of its metabolism are filtered. Being as if in drowsy state, connective tissue constantly regenerates, possesses incredible dynamism, thanks to which we succeed in growing fibroblasts even in laboratory conditions. It is important to know what makes this basic substance of this tissue develop in this or that way. For clinical medicine mechanisms that cause local proliferation of yellow fibres. Connective tissue does not grow itself, but together with vessels and forms vascular-connective integration. There is tophus and lipid deposition in it. It is considered to be common that these depositions are of mainly hematogenic imbibitional origin (imbibition - infiltration).
Individual qualities of connective tissue depend on the state of both local and common circulation of blood. Disorders of blood flow cause rarefaction of collagen and increase the number of fibrillar elements. Congestive and hydropic connective tissue can ossify even in the places where it doesn't happen in normal conditions, and local edema, as one of the conditions precedes the development of osseous tissue. As an example, we should mention such a fact that knitting in fractures is preceded with definitive local edema of tissues. If we only knew the mechanisms that regulate activity of connective tissue! Then, we would probably become the masters of the situation. We could either stop or impede slow dying of our sclerogenic organs".
R.Lerish comes to very important conclusions:
• The initial cause of many human diseases is in local changes of condition of tissues.
• The most of human diseases start with repeated local vascular and metabolic disorders caused by extreme and occasional excitations of sensible extracellular receptors. These changes can occur in a different way, but, in fact, all of them are similar to one another as their development is nearly always the same.
• The key to the problem of our diseases is in study and correction of local disorders in the vegetative life of tissues.
Discovered by the author, laws of reaction of local tissues and tissular environment in response to the impact of stress discover their substantiation in works of other researchers. For example, according to Lewis (1942), long-existing muscle spasm induces myogenetic ischemia due to the disorder of hemomicrocirculation. Developing at that acidosis of tissues and congestion of products of interstitial metabolism cause irritation of nociceptors with the formation of pain syndrome. Originally associated local disorders of tissular circulation of blood can lead to pathoanatomical changes in muscular tissue (Zaslavsky 1980). As a result of occurring at that tissue hypoxia, interstitial edema develops, which is the cause of forming of myofascial pain syndrome (Fassbender, 1981). Moreover, biologically active substances, accumulated in tissues, kinins in particular (Kallermeyer et al., 1968), which are algogenic substances, (Kassil, 1970; Zaslavsky, 1980), considerably intensify the course of pain syndrome. Besides that, accumulating within a long period of time biologically active substances may induce responsive inflammatory process (Khabirov, 1995). More than that, tissues with disturbed circulation of blood become the sources of cytokines, which, along with other mediators of inflammation when circulating with blood in elevated concentration, may induce local or systematic inflammatory response (Novikov et al, 2000). With the normal blood flow along microvessels, the concentration of such flogogenes is not enough for the induction of inflammatory process. It is clear that the disorder of microvasculature of tissues represents one of the first and necessary stages of appearance of inflammation. With the help of this, apparently, one can explain periodic flares of myofascial pain syndrome, evidences of virus infection and other pathologies that develop with venous lymphoid engorgement at the background.
The increase of congestive ischemic micro-circulate dislocations cause forming of syndrome of capillaceous trophic insufficiency (CTI). Developing syndrome of CTI, in its turn, induces disorder of function, in the basis of which there are structural changes (dystrophy, atrophy, proliferation of connective tissue). It favours the following aggravation and increase of different pathological disorders (Kaznacheev, Dzizinskiy, 1975). Morphologic medium of CTI appears to be deficit in the system of microcirculation of true capillars and their pathological transformation of deposit vessels. CTI of the system of microcirculation should be researched as one of the local evidences of general pathology because its progression is connected with a lot of local and common human diseases (Yarygin et al, 1996).
Long-lasting venous lymphoid stagnation in tissues results in increase of dispersion of proteins and fluid part of blood in intertissular space, and also results in interstitial edema and fibrin accumulation. Local tissular hypoxia initiates effuse of histamine and heparin with mast cells of connective tissue. At that, congestive protide assumes capillary structure, and as a result, fibroid degeneration appears (Drennan, 1951).
In recent years, the leading role of disorders of tissular circulation of blood in genesis of various diseases of locomotor system is proved with new evidences. For example, in a series of papers by V.S.Lobzin, N.M.Zhulev (1985); N.M. Zhulev et al (1999), which were held with the help of reographic and thermovisiographic examinations, they identified pathogenetic role of disturbances of venous circulation in the mechanisms of appearance of compression ischemic neuropathy, tunnel syndrome, spinal osteochondrosis. In the clinical picture of spinal osteochondrosis and neurological deficits, which are connected to it, and also many forms of visceral pathology, they study dislocations of tissular circulation as the dominant part (Proskurin, 1993).
The presented works give evidence for mainly ischemic genesis of many pathological conditions which develop in soft tissues.
In the light of matter mentioned above, it seems quite important to find out the principles of processes that precede the progression of such pathology, and how prevalent these processes might be among clinically healthy people. Prenosologic functional morphologic condition of tissues of healthy people is, undoubtedly, quite interesting from a clinical point of view but, unfortunately, such a condition is really hard to be detected. Such studies are rare and episodic. In medicine textbooks they pay too little attention to the study of pathology of skeletal muscles and connective tissue. In spite of the fact that it is retractive muscular tissue and connective tissular elements, which are connected to it, that are extremely subjected to damage as a result of daily activities and the influence of stress specialists usually concentrate on bones, joints, joint capsules and nerves (Trevell, Simmons, 1989; Mikhailichenko, 2003; Zharkov, 2003).
At the same time, the results of the author's clinical experiments and a few works of other researchers give us an opportunity to view about progressing pathological processes in tissues of healthy children, adults (including sportsmen) and also patients with well-marked clinical symptoms. These processes are latent, i.e. without clinical conspicuities. Such progression of pathological processes in an organism comes out in some non-specific and specific indicants of disorder of tissular microcirculation.