RECOVERY (synonym reconvalescence) — the active process arising from the moment of a disease and representing a complex of the composite reactions of an organism directed to recovery and compensation of disturbances, i.e. normalization of functions and relationship of an organism with the environment at the new level.
It is inseparable from a disease century, edges it is always characterized by unity of two opposite phenomena: actually pathological disturbances and adaptive reactions recovering and compensating these disturbances (see. Disease ). These phenomena should not be considered as independently proceeding in an organism. E.g., the inflammatory reaction always arising in response to damage of fabrics, on the one hand, is the adaptive reaction developed in the course of evolution and providing healing of the arisen defect of the damaged fabrics, i.e. recovery; on the other hand, disturbance of functions of bodies at an inflammation can entail serious consequences. Even such mechanism of an inflammation as phagocytal reaction (see. Phagocytosis ), can promote not only elimination of microorganisms, but also spread of an infection in an organism (e.g., at tuberculosis). The same dual character has also a number of fabric reactions (e.g., a hypertrophy of body) or such general reaction as fever (see). In the concept «disease» mechanisms of a disease and recovery integrally combine.
Ways and mechanisms B. in each separate case are various, however there are general patterns. V.'s process is characterized bystry (e.g., in an emergency) or, more often, gradual neutralization, elimination of a pathogenic factor or increase in limit of sensibility to it in an organism, recovery processes (regeneration, etc.), the compensatory and adaptive reactions which are expressed in change of a metabolism in cells, body tissues, and also functional and restructuring in all organism.
In specific cases mechanisms B. can be very individual, in particular depending on a variety of mechanisms of a disease. E.g., V.'s process at various infectious diseases, though has common features, proceeds variously depending on a type of the activator and features of a pathogeny of a disease. At the same disease of V. can proceed differently that depends on age, sex and the previous life of the patient and as a result it is characterized by individual reactivity of an organism (see). Century of an organism is controlled by its regulatory systems, first of all nervous and endocrine.
In V.'s processes reserve opportunities of an organism have essential value. Heart, e.g., at the raised loading easily doubles number of reductions that leads to increase in arterial pressure upon 30 — 40%. It is known also that at switching off of the most part of pulmonary fabric life activity of an organism can significantly not be broken. The arterial blood contains by three and a half times bigger amount of oxygen, than is used by body tissues. Function of a stomach, small or large intestine is easily compensated even if at a resection their considerable part is removed. Function of hemopoietic system during removal of a spleen is usually compensated. Normal function of kidneys on condition of preservation 2/3 of their weights as in normal conditions only a part of nephrons is in an active state is possible.
In the course of V. at the person the known role is played by social factors with their powerful impact on all its activity, directing a complex of reactions of V. to this or that party.
Mechanisms B. can be divided into three types of reactions, to-rye often characterize
stages B. 1. Defense reactions of an organism, to-rye in usual conditions of life provide resistance to various pathogenic factors and continue to work with bigger or smaller intensity already in the period of a predisease and in the onset of the illness. Thanks to action of defense reactions at a meeting of an organism with pathogenic factors (if pathogenic action insufficiently intensively or quickly) the disease can not develop or stop at the beginning (see. Defense reactions of an organism ). At infectious diseases depending on properties of a microorganism (their virulence) and a damage rate, and also expressivenesses protective (nonspecific mechanisms of immunity) and compensatory reactions can develop clinically expressed forms of a disease, asymptomatic, erased or various on weight. A training to any extreme influences of the environment and a rational way of life stimulate defense reactions of an organism, optimal conditions for sale
of mechanisms B. 2 are created. The mechanisms B. operating in stage of latency and especially in the period of the expressed picture of a disease. Here join defense reactions recovery and compensatory processes (see), development to-rykh in various degree fills the broken functions. The outcome of a disease depends on a ratio of depth of pathological disturbances and expressiveness of recovery and compensatory reactions. Compensation of hemodynamic disturbances at a stenosis of the mouth of an aorta owing to the developing compensatory hypertrophy of a left ventricle, etc.
3 can be an example such mekhaniz m. The late mechanisms providing compensation of organic frustration and final recovery of functions. The resorption of the destroyed fabrics, processes of removal of decomposition products by phagocytosis, and also processes of substitution of fabric damage by an angenesis concern to them. On such type V. at diseases proceeds, to-rykh the inflammation is the cornerstone.
The important role in implementation of a number of protective and adaptive reactions on V.'s course, especially at infectious diseases, belongs to reticuloendothelial system (see). The microorganisms getting to internal environment of an organism activate reticuloendothelial system, cells a cut participate in formation of inflammatory reaction of an organism in the course of what the center of an infection is isolated. Activation of reticuloendothelial system leads to transformation of polyblasts and histiocytes in macrophages, to-rye actively participate (along with leukocytes of blood) in reactions of phagocytosis; the reticular macrophages which are in limf nodes and a spleen, absorb microorganisms. The essential role in the course of V. at the cellular level is carried out by lymphocytes and fibroblasts. The special role of lymphocytes in development of antibodies is now convincingly shown. Antibody formation is important in V.'s processes; the maximum antiserum capacity is usually observed at the very beginning of Century. Favorable disease is characterized by the increasing dominance of processes of V. over the processes characterizing a disease.
Distinguish bystry and slow Century. At nek-ry infectious diseases of V. sometimes comes after sharp short-term deterioration in a disease (see Crisis). Depending on features of a disease and extent of inclusion of all complex of protective and recovery mechanisms distinguish full and incomplete Century.
Absolute recovery (restitutio ad integrum) it is characterized by lack of the residual phenomena of a disease and the maximum recovery of working ability of the person. Return of fabrics to a reference functional state it is impossible to identify with full V. all organism as whole. Sometimes in addition and now consider full V. return to the initial, taking place prior to the beginning of a disease condition of an organism. In this regard in use there is a concept «involution of pathological process» as V. Eto's synonym the defined full V. is reflection of formalistic, metaphysical approach to definition of mechanisms of a disease and V. Klinicheski there is no return of an organism to initial (to a disease) to a state. It is always qualitative other state which is characterized by certain features of life activity of the organism which transferred a disease.
At incomplete recovery (partial) there are residual phenomena of a disease, napr, after an organic disease of c. the N of page or the expressed traumatic damage of nek-ry parts of a body though compensated in a varying degree. One of incomplete V.'s options is life activity of an organism in the conditions of so-called replacement therapy (e.g., at a rational insulin therapy of patients with a diabetes mellitus). At infectious diseases in some cases V. with formation of an immunitas non sterilisans and a condition of a carriage of bacilli is possible (see. Carriage of contagiums ). At incomplete V. activity of bodies, systems and all organism in general cannot provide optimum adaptation of an organism to the environment; working ability of the person at the same time can be limited.
As a result of V. there is relative or, whenever possible, full stabilization internal environment of an organism (see); the metabolism is recovered, membrane permeability in cells is normalized, distribution of water and electrolytes, biochemical and biophysical indicators are recovered.
Clinical observation and studying loudspeakers B. as a method of a research of process of recovery were considerably enriched with modern means of studying of pathological human physiology. At the same time methods, use are used to-rykh does not break functions of an organism and at the same time gives the chance of a long continuous research, simultaneous registration of various processes for clarification of natural bonds between separate mechanisms B. However even the most careful clinical observation not always allows to get into essence of process deeply.
Pilot study on animals gives the chance to study processes of recovery and compensation of the broken functions (after artificially caused damage or a disease) or to find out various mechanisms B. by means of experimental therapy.
For this purpose creation of pilot models, the most adequate is necessary for diseases of the person. Methods of mathematical modeling, biophysical models, etc. are applied. Using model of a disease, the researcher obtains new data on a disease (see. Model of a disease , experimental). Considering similarity and distinctions of a disease of animals and diseases of the person, it is possible to study features of adaptation of an organism to the environment, its defense, compensatory and recovery reactions, V.'s features in age and comparative aspect. The comparative and pathological aspect of V. gained special development thanks to classical researches of I. I. Mechnikov on phagocytosis.
Mechanisms B. at the person are most perfect. It is established that adaptive processes take place the initial stages of the formation in early age and therefore are unevenly expressed in different systems. E.g., function of a respiratory organs is finally improved after the birth of the child that creates premises for a disease of pneumonia. Protective and compensatory mechanisms at the child are not perfect yet, however at early children's age, e.g., compensation of the broken functions of a nervous system is carried out quicker and more stoutly, than at adults.
The processes defining V. is compensation of pathological frustration and recovery of the broken functions. From all-biological positions both of these processes are expression of adaptation of an organism to the environment in the conditions of a disease. It should be noted difficulties of differentiation of process of compensation of the functions broken at a disease from adaptive reaction of an organism.
In usual (normal) living conditions is always available, according to P. K. Anokhin (1962), «continuous impact of the rejecting factors» on an organism, influence to-rykh at once is removed protective and compensatory processes. The extraordinary irritants causing morbid condition at the same time stimulate adaptive mechanisms, to-rye took place and in normal conditions (see. Adaptive reactions ). Integration of functions of an organism is constantly carried out at the different levels: molecular, cellular, organ, system. The systems of an organism supporting a homeostasis in normal conditions and recovering it during a disease function on the basis of the principle of self-control (see. Homeostasis ). At the level of a cell and more high levels of integration of an organism recovery of functions also turns on the mechanisms operating by the principle of self-control. At the same time it is known that at a disease, e.g., parenchymatous cells can perish and be replaced in the course of V. with connecting fabric. At the same time there is an inclusion of various adaptive reactions (e.g., processes of a hyperplasia, a hypertrophy) that testifies to considerable compensatory opportunities of an organism, to-rye on the expressiveness can be various. Than pathological process is heavier, especially high requirements are imposed to compensatory mechanisms for compensation and recovery of the broken functions. It is necessary to consider relativity of compensation at the same time. Due to insufficiently full compensation in an organism the so-called weak point is created — locus minoris resistentiae (see). At the same time overcooling, physical. tension, other extreme conditions, and also aging of an organism can cause a palindromia (see. Recurrence ).
Recovery processes often have various local humoral reactions which are carried out by physiologically active agents in the basis. There is a feedforward of many defense and adaptive reactions with reflex activity of a nervous system. During the drawing identical on localization and weight of damages by an animal, to-rye are at the different levels of phylogenetic development, there are disturbances, various on weight; than the organization of a brain and a nervous system is higher, it is heavier than subjects of an effect of damage, however compensatory opportunities are more various and reliable. It is connected with turning on of reflex mechanisms (including conditioned reflexes) in implementation of adaptive reactions. Specific features of compensatory reactions of an organism can be connected with typological features of a nervous system. However the features of cortical processes (in particular, force them) characterizing type of a nervous system not always define degree biol, fitness or resistance of an organism to adverse factors of the environment, so and extent of compensatory processes. In an experiment it is shown that in nek-ry conditions animals with weak type of a nervous system can be steadier, than animals with strong type, owing to emergence at the first guarding braking.
Many data on a possibility of psychotherapeutic influence on nervous, mental and even somatopathies are saved up. The last validates representation, a cut the Russian doctors, about essential value of mentality of the person in mechanisms B put forward long ago. Still N. I. Pirogov noted bystry V. wounded at successful approach of army. According to Ishshekuts (V. of Issekutz), method of use of so-called empty tablets (placebo) it was possible to prevent headaches, attacks of seasickness, went. - kish. frustration, neurosises in 24 — 59% of cases; this method was effective also at a hypertension and angina pectoris — in 17 — 18,4% of cases.
I. P. Pavlov's school drafted the major provision about biol, value of braking in c. N of page (see. Braking ). Guarding value of braking is of special interest in clinic; it reduces a susceptibility of an organism to usual irritants (as at a normal dream) or to extraordinary irritants (as at ultraboundary braking) that provides active recovery of a functional condition of nervous cells.
However the fact that braking in many cases can be guarding for cells of the highest departments of c. and. the page, does not mean that this state always shall promote elimination of pathological process on the periphery since on the periphery the disorders of functions of bodies and fabrics which do not have a direct bearing on disturbances of century can take place and. In these cases immersion in a long dream (especially artificial, medicamentous) can negatively influence the course of a disease since an active, active condition of the highest departments of c. the N of page usually plays a crucial role in the course of Century.
The fact that novocainic blockade according to Vishnevsky was repaid as a medical method, demonstrates that V. can be connected with interruption of a way of a pathological afferentation from the center of damage to fabrics.
The endocrine system is important in mechanisms B. Works of G. Selye and other scientists showed that in mechanisms of development nonspecific adaptation syndrome (see), characterizing stress (see), an essential role is played by reaction of system a hypophysis — bark of adrenal glands.
In recovery reactions of an organism the angenesis and bodies has paramount value (see. Regeneration , in pathology). Thanks to new data there was an opportunity to present these processes in other plan, than it was known earlier. It is established, e.g., that regeneration of skin represents not chaotic process of growth of fabrics, and the special adaptive mechanism directed to bystry closing of wound defect. The possibility of stimulation of regeneration processes in those fabrics was established, to-rye normal differ in weak regeneration (bones, muscles and other high-differentiated fabrics). For more complete regeneration with success temporary prostheses (frameworks) were used; they facilitate a possibility of regeneration of fabric and create conditions for functioning of body. Organ and tissue transplantation is widely applied (see. Transplantation ). Particularly important so-called replaceable regeneration became; with its help replacement of a transplant by tissues of the recipient is carried out that promotes recovery of defect.
In the course of recovery of functions the important place is taken by a regeneration and compensatory hypertrophy of body. Understand recovery of weight or mass of body on condition of its form remaining broken (after damage) as a regeneration hypertrophy. A basis of such recovery of bodies is the hypertrophy and a hyperplasia of cells at the expense of a hypertrophy of intracellular ultrastructures, is more rare — regenerations of structural elements of body (see. Vicarious processes). Recovery processes on such type are characteristic of a number of internals. The compensatory (vicarious) hypertrophy arising in one of pair bodies after damage or removal of another is close to these processes.
Many damages are replaced with connective tissue hem (see). At the same time an essential role is played by fibroblasts, specific property to-rykh is synthesis of the collagen bearing function of a mechanical support of fabrics that plays an essential role in healing of fabrics after damage.
Treatment of a disease shall provide, in addition to elimination of a cause of illness, strengthening of defense and adaptive, compensatory and recovery reactions, the prevention of a recurrence, a decompensation and death, elimination or simplification of effects of damages of bodies and fabrics. Effective methods of increase in compensatory opportunities of an organism are created during surgeries and in the postoperative period (the managed breath, artificial circulation, a hypothermia, electric cardiac activation, new pharmacological means, etc.) * There are unlimited ways of improvement of adaptive and compensatory reactions during big surgeries (e.g., creation of the homeostatic cybernetic systems which are automatically changing, as necessary, of function of an organism by to lay down. influences during operations, etc.).
At the people who just recovered or those, at to-rykh V.'s process it is close to end, all are especially expressed adaptive, including immune, processes, working capacity is recovered, there is desire to work.
Assumes return of the person to usual professional activity century. At incomplete V. employment, i.e. providing the work corresponding to the changed state of health is shown. Return of the person who had a disease to work is called rehabilitation (see). Rest, switching off from usual, especially unfavorable, living and working conditions, sometimes a climatotherapy are very important factors promoting Century.
Bibliography: Anokhin P. K. General principles of formation of defensors of an organism, Vestn. USSR Academy of Medical Sciences, No. 4, page 16, 1962; The Multivolume guide to pathological physiology, under the editorship of H. N. Si-rotinina, t. 1, page 195, M., 1966, bibliogr.; Sketches on a problem of regeneration, under the editorship of N. A. Krayevsky and L. D. Liozner, M., 1966; Pathological physiology of extreme states, under the editorship of P. D. Guo-rizontova and H. N. Sirotinina, page 7, M., 1973, bibliogr.; Chernukh A. M. Regulatory mechanisms and processes of a disease and recovery at various levels of integration of an organism, the Stalemate. fiziol, and Eksperim, rubbed., t. 13, No. 2, page 3, 1972, bibliogr.
A. M. Chernukh.