From Big Medical Encyclopedia

NOSOLOGY (grech, nosos a disease + logos the doctrine) — the doctrine about a disease including biological and medical bases of diseases, and also questions of their etiology, a pathogeny, the nomenclature and classification. According to N. allocate nozol. units, or forms, i.e. this or that specific disease with a combination of symptoms, typical for it (see. Symptom ) and the functional and morphological changes which are their cornerstone, and also certain etiology (see) and pathogeny (see). It developed N as a result of long historical process of gradual allocation of the specific diseases caused by the different reasons and differing on mechanisms of development, an organopathology and a wedge, a picture. More and more deep knowledge of their essence was provided by progress of private medicobiological disciplines — microbiology, patol. physiology, biochemistry, etc.

At any diseases (see) the complete organism is surprised, however, as a rule, it is possible to reveal the leading link — preferential defeat of this or that body, system of bodies. Complexity and variety of bonds between bodies, a large number of the reasons, ways and mechanisms of fabric defeats make objective premises for allocation nozol, forms, to-rykh contain St. 20 thousand Nozol, the form includes the most essential kliniko-anatomic symptoms of a disease which are its cornerstone, the cause and effect relations, etiological, pathogenetic, funktsio-nalno-morphological factors.

Except nozol, forms, exist syndromes (see) — standard groups of the symptoms revealing coherence of bodies, change of function to-rykh at pathology are reflected by disturbance of a homeostasis and is often directed to its recovery. The concept «syndrome» reflects this or that party of a pathogeny nozol, forms without its etiology. A part of syndromes include in structure nozol. forms, others represent independent categories. Often syndromes in different diseases are similar or are even identical that, according to I. V. Davydovsky, speaks differentiating and integrating laws of a pathogeny. The differentiating law of a pathogeny is based that action same etiol, a factor in different conditions is shown differently and leads to development of various syndromes, and in some cases and diseases. The integrating law of a pathogeny is that different etiol, factors can put the mechanisms causing identical syndromes in action; e.g., the syndrome of stenocardia can arise at action of a number of koronarogenny and nekoronarogenny factors.

Representation about nozol, forms and syndromes is not stable since reflects the level of development of medical science, first of all knowledge of an etiology and a pathogeny of diseases. In process of accumulation of this knowledge there is an association of syndromes or their complexes in nozol, a form, and also allocation of syndromes, to-rye then can be included in other nozol, forms. Lack of data on an etiology and a pathogeny of a number of diseases complicates allocation nozol, forms. In similar cases are based on the kliniko-anatomic characteristic of process.

During a disease there can be factors changing the kliniko-anatomic characteristic nozol, forms, its current and an outcome. The difficult complex of influences causing results pathomorphism (see) diseases or change of the cause and effect relations with development against the background of an initial disease new nozol, forms. In this regard there is a problem of multiple and so-called second diseases exerting considerable impact on N. Eto's keeping is connected, on the one hand, with increase in average life expectancy of the population, and with another — with progress of medicine, as a result to-rogo earlier incurable diseases recover, but can leave the serious consequences which are the reason of a new disease. The diseases resulting from an adverse effect also belong to the same category to lay down. actions. It is established that multiple diseases are combined among themselves on the basis of constitutional features of an organism or are connected with the fact that one disease as if opens the road another, reducing resistance and changing reactivity of an organism of the patient. Distinguish from multiple diseases coordinate, developing at the same time, as if jointly, and subordinated, arising consistently. At joint development of diseases summing of effect of their action, weighting or, on the contrary, easier course of several diseases or one of them is possible. Among persons of advanced and senile age the number of people with multiple diseases increases, and at the age of St. 70 years, according to Franke (H. Franke, 1960), only one disease is found only in 1% of cases. At the subordinated diseases after an initial disease the second disease develops; e.g., stomach ulcer can arise at cirrhosis as a result of the increased content of gastrin and its slowed-down destruction in a liver, and also simultaneous increase in development of corticosteroids adrenal glands that leads to decrease in secretion of mucin a mucous membrane of a stomach and reduces its resistance to action of a gastric juice. Example of genetically caused second disease is emergence on the basis of a pigmental xeroderma of a carcinoma cutaneum. The second disease can be connected also with predisposition of this or that body owing to, e.g., inborn malformation. Defects of immune system, napr, at a diabetes mellitus, diseases of the hemopoietic system, can form a basis of emergence inf. diseases.

The second diseases can result from also adverse effect of the medical and diagnostic actions which became an origin of a new complex of changes, naira, a dumping syndrome after a resection of a stomach, aplastic anemia at radiation therapy of tumors, an adhesive desease after abdominal organs operations, etc. Unlike naturally developing second diseases such «diseases from treatment» are pathogenetic not connected with the being available disease and are new nozol, a form. The question about nozol, entities of the processes which are sharply arising and leading to death connected with an operative measure, an anesthesia, diagnostic manipulations, administration of medicines, etc. became especially debatable. The treatment patol, the processes resulting from inadequate reaction of an organism to administration of medicines is also difficult (an acute anaphylaxis, etc.). Such reactions regard, as well as mentioned above patol, processes, as the second diseases as in similar cases the hidden readiness of an organism for heavy reactions to adequate influences is involuntarily shown.

Classification of diseases (see. Nomenclature and classification of diseases ) is under construction on the basis of the leading signs characterizing nozol, forms. The main thing among them is the etiology in all variety of its external and internal factors. However this sign can be not always the basis for classification since the etiology of many diseases is not found out. The international classification of diseases and causes of death is based on a number of signs — etiological, pathogenetic, organopatologichesky. It is considered at statement of clinical and anatomic diagnoses and is the obligatory document for the countries entering into WHO.

Bibliography: Davydovsky I. V. Problems of a modern nosology, Vestn, sovr, medical, No. 4, page 205, No. 6, page 350, No. 7, page 423, 1927; it, Medical errors, Owls. medical, No. 3, page 3, 1941; it e, Questions of localization and an organopathology in the light of Sechenov's doctrine — Pavlova — Vvedensky, M., 1954; Petlenko V. P., Strukov A. I. and Khmelnytsky O. K. A determinism and the theory of causality in pathology, M., 1978, bibliogr.; Tsaregorodtsev G. I., Krotkov E. A. and Bogolyubov V. M. About a concept of a nosological form of a disease, Rubbed. arkh., t. 48, No. 1, page 55, 1976; Curtius F. Individuum und Krankheit, B., 1959; Hamperl H. t)ber die «zweite Krankheit», Miinch. med. Wschr., S. 213, 1967.

A. V. Smolyannikov.