ANAPA

ANAPA, a seaside climatic health station on the Black Sea coast (of the Black Sea Region, North Caucasus Krai), on an elevated cape jutting into the sea. A resort of national significance, it is under the administration of the North Caucasus Krai Executive Committee. In terms of climate, Anapa is similar to the eastern part of the Crimean coast. Average annual temperature +12.1°C, summers +22.4°C, autumns +12.9°C, winters +2.3°C, and springs +10.6°C. Small amount of precipitation: 91 mm in summer, up to 480 mm per year. Summers are mild, not hot, relative humidity - 76%. - Medical facilities: polyclinic, X-ray department, mud therapy clinic, chemical-bacteriological laboratory, and malaria station. Therapeutic mud is extracted from Chumurskoye Lake (47₂ km from the mud therapy clinic). "Golden Beach" - width 50-100 m, length 15 km; the seabed gradually deepens along the entire length of the beach. - Treatment methods of the resort: 1) heliotherapy - from May 1 to October 1, 2) sea bathing - from June 1 to October 1 (sea temperature in June +18°C, July +23°C, August +22°C), 3) mud therapy - from June 15 to October 1, 4) grape therapy - from August 20 to October 1. - Main indications: 1) bone tuberculosis, 2) tuberculosis of lymph nodes, 3) rickets, 4) essential anemias and anemias after infections, 5) various neuralgias, 6) chronic rheumatism. - Contraindications: 1) pulmonary tuberculosis in all stages, 2) organic heart defects and severe arteriosclerosis, 3) chronic intestinal diseases in early childhood. - Transportation: from Novorossiysk 45 kilometers by steamer; from Tonnelya Station 30 kilometers by automobile or horse.

K. Smirenkin. ANAPLASIA (from Greek ana-back and plasis-formation) - a term introduced into pathology by Hansemann in 1893 to denote such a change in cells which consists in the loss of cell differentiation, i.e., their specific morphological and functional properties, and at the same time in the acquisition of the ability to exist independently. Initially, Hansemann assumed that anaplasia is a physiological phenomenon occurring in every developing organism, in which, along with the processes of blastogenesis, expressed in the progressive development and differentiation of cells, anaplasia also occurs, i.e., a phenomenon of the opposite order. Later, Hansemann abandoned the assumption of physiological anaplasia and limited the application of this concept only in relation to the origin of tumors. According to Hansemann's theory, tumors arise because and in those cases when, during cell multiplication, anaplastic cells arise, i.e., cells that lose the ability to differentiate and at the same time acquire the ability to exist independently; the cause of such anaplasia, according to Hansemann, is the improper division of multiplying cells, manifested in the form of asymmetric mitoses. Thus, according to Hansemann, asymmetric division of multiplying cells is the basis for the appearance of anaplastic cells, from which tumors develop. This theory was later developed in more detail by Boveri. Hansemann's view raised objections and at present should be considered rejected on the basis of the facts that, first, asymmetric mitoses often occur without any subsequent anaplasia and tumor development, and second, very malignant tumors, for example, carcinomas, can be observed without clearly expressed anaplasia of cells. Generally, it can be thought that anaplasia is a result, not a cause, of rapid tumor growth. Thus, if anaplasia of cells is no longer recognized as the cause of tumors, on the other hand, Hansemann's term to this day is retained in pathology to denote various cases when tissue is formed that is less mature and developed, less differentiated than the normal tissue of a given type. This most often occurs in tumors, especially rapidly growing, malignant ones, the cells of which have completely lost differentiation; such tumors can be called anaplastic (for example, anaplastic carcinoma, consisting of small undifferentiated epithelial cells arranged in a solid mass in the spaces). Similarly, in the doctrine of metaplasia (see), it is customary to speak of anaplastic metaplasia when, through multiplication, new tissue is formed that stands in terms of development and differentiation below the pre-existing tissue. In the aforementioned cases, when the matter is limited to a judgment about the external appearance of the tissue, the process refers to morphological anaplasia. In addition, some researchers are inclined to speak of biological anaplasia, implying by this the peculiar biological properties of tumor cells, consisting in the loss of their functions and the direction of all their energy toward multiplication. Finally, the concept of chemical and physico-chemical anaplasia (see below) is also proposed in relation to tumors. G. E. Koritsky also retains the term anaplasia in his "Experience in Transformative Cellular Pathology," giving it, however, his own original interpretation ("multiplication of cells with a change in their form beyond the genus") and dividing anaplasia into normal, granulomatous, and blastomatous. It should also be noted that the use of the term "anaplasia" in all the above senses is not generally accepted; some (Lubarsch) consider it generally unnecessary; others find it etymologically incorrect and propose to replace it with another, for example, the term proposed by Beneke - cataplasia, or the designation of Ribbert - "Ruckschlag" = setback, which essentially imply the same thing, i.e., the loss of cell differentiation.

A. Abrikosov. A. chemical and physico-chemical, denoting the peculiarities of the chemical process and physico-chemical properties that characterize tumor tissue. Chemical A. concerns the carbohydrate, lipid, protein, and mineral metabolism in the tumor, which may be, as a consequence of these, a series of metabolic disturbances in the entire organism of the tumor carrier. The best studied are the disturbances of carbohydrate metabolism, mainly thanks to the research of Warburg and his school. According to the nature of carbohydrate metabolism, Warburg divides all tissues into 4 types: 1. In the normal adult resting cell, oxidative processes prevail, i.e., respiration. The breakdown of sugar proceeds slowly and only under anaerobic conditions. 2. Embryonic cells are characterized by vigorous oxidation and vigorous glycolysis only in an anaerobic environment. 3. Malignant neoplasm differs by vigorous glycolysis and, which is especially important, by glycolysis under aerobic conditions, with relatively slow respiration. 4. Cells of benign neoplasms are characterized by weak oxidation with somewhat enhanced glycolysis. The glycolytic power of a tumor is 100 times greater than that of blood and 200 times greater than that of resting muscle. In one hour, a malignant tumor produces lactic acid in an amount equal to 8% of its weight. Whereas in embryonic tissue, due to high oxidation, the ratio of splitting energy to oxidation energy is somewhat less than one, in a benign tumor it approaches one, in a malignant tumor it reaches incredibly high figures, rising to 3-4; according to Warburg, oxygen starvation kills cells incapable of anaerobiosis, while cells with high adaptability in carbohydrate metabolism turn malignant. This position forms the basis of Warburg's theory of the etiology of neoplasms. In other cases, the oxidative capacity of the tumor does not lag behind the norm, but then its splitting capacity is sharply increased. For example, rat cancer, having the same gas exchange as healthy rat epithelium, in 6-10 hours breaks down an amount of sugar equal to its weight. The indicator of sugar splitting energy is the content of lactic acid in the tissues. All cells, breaking down sugar, produce lactic acid, but only in case of insufficient oxygen supply (e.g., during intense muscular work, venous stagnation) does the excess acid enter the blood. In the blood flowing from the tumor, there is always an increase in lactic acid, reaching 46 mg%. In the tumor itself, the lactic acid content is 61 mg% higher than in the blood flowing to it. According to Minami, the production of lactic acid by rat cancer is 15 times greater than its production by the liver; interestingly, fructose is fermented by the tumor with the same speed and ease as glucose. In endurance to low O₂ pressure and in the predominance of the fermentation process, the tumor cell approaches the yeast cell. Data concerning the lipid metabolism of the tumor and the carrier organism are rather indefinite. The predominance of analytical processes over synthetic processes, characteristic of the tumor, is confirmed by Zerner's indication of increased nucleic metabolism, as well as by de Bruyne's data speaking of the particular liveliness of tumor autolysis. The extreme inconsistency of clinical and experimental data speaking of changes in the mineral composition and metabolism of the tumor and the carrier organism argues against the importance of these changes in the process of the origin and growth of malignant neoplasm. The transition of a normal body cell into a tumor cell is accompanied by a series of changes in its physico-chemical properties (A. physico-chemical), which include osmotic pressure in the cell and in the growth medium, the dispersity of tissue colloids and their stability against precipitation, surface tension, resistance to electric current, the actual reaction of the cell contents and the growth medium. Unfortunately, it is very difficult to determine whether these changes are causes or consequences of tumor growth. Taking into account the hypomineralization of the tumor, its osmotic pressure can be considered lowered. Guérin considers the basis of the cancerous process the increase in the dispersity of cell colloids in the tumor that he found, which, with the constancy of surface energy, due to the increase in the internal surface of the cell, leads to a decrease in surface tension. The importance of the decrease in surface tension as a factor of malignant growth is emphasized by the low surface tension of the serum of cancer patients and the surface activity of carcinogenic substances, such as tar and aniline. Surface-active substances, for example, tributyrin, increase the susceptibility of mice to cancer transplantation (Bauer). Bauer and Lastnitski explain the different frequency of cancer metastasis to organs by the difference in surface tension: thus, the lymph glands, which are a place of very frequent formation of secondary cancer nodes, have a surface tension 25% lower than the spleen, where metastases are observed extremely rarely. The resistance to electric current of tumor cells, according to Waterman, is lowered. Kles and Coulon connect the beginning of malignant growth with an increase in the iso-electric point of the tissue from which the cancer develops: when transplanting a tumor into a muscle, whose iso-electric point had been previously raised by aseptic inflammation, they obtained an increase in the percentage of engraftment. Conversely, artificial lowering of the iso-electric point prevents the engraftment of the transplant. Research on the actual reaction of tumor tissue and body fluids of the carrier organism did not lead to definite results. Not only in the animal organism, but also in plants, tumor growth is also associated with a change in the actual reaction of the juices. Theoretically, the role of changes in the physico-chemical state and physico-chemical reactions in the process of the origin and development of the tumor seems undeniable; unfortunately, the question of the physico-chemical A. of the cell, deserving of very great attention, turns out to be developed much less than the question of chemical anaplasia.