Mutilation

MUTILATION (from Latin mutilare - to cut short, to shorten, to diminish), the separation of a part of a limb, a term used in cases where a more or less large distal segment of it (one or several finger phalanges, hand, foot, or an even larger part) undergoes necrosis and then spontaneously separates through demarcation inflammation. In most cases, this refers to the so-called dry gangrene (see), less frequently to some purulent process, and the causes for their occurrence can be very diverse and not always precisely determinable. Among the gangrenous processes that can lead to M., special mention should be made of: 1. Senile, or marantic gangrene (most often of the toes), observed in the elderly on the basis of vascular changes or severe marasmus, as well as generally in severe marantic conditions. 2. Gangrene developing during or after certain infectious diseases (pneumonia, abdominal and typhus, diphtheria, puerperal infection and some others), due to thrombosis of the small arteries of the limbs, which often occurs in places of toxic damage to the vascular walls (see Artery, as well as Mesarteritis). 3. The so-called spontaneous gangrene (gangraena spontanea, s. essentialis), developing not only in the elderly but also in people of middle and even young age (gangraena juvenilis) as a result of endarteritis or thromboarteritis of various, sometimes completely undeterminable origin. As the etiological basis of this process, syphilis, diabetes, chronic poisoning by nicotine or alcohol, hereditary or racial predisposition (predominant susceptibility of Jews), and finally a special disease of undetermined etiology described by Burger (Buerger) under the name thromboarteriitis productiva obliterans et thrombophlebitis productiva migrans are considered. In the cases of the last two categories, as well as in senile gangrene, the lower extremities are more often affected than the upper ones. 4. Raynaud's disease or symmetrical gangrene of the extremities. 5. Gangrene occurring in some severe cases of chronic ergot poisoning. 6. Gangrene of the toes (mostly IV and V) of the lower extremities, described as a special disease (mainly in African negroes) under the name ainhum (see Ainhum). 7. A special group consists of those mutilation processes in which the basis is the loss of sensitivity of the corresponding part of the body. This is most often observed in the anesthetic form of leprosy and in syringomyelia. Extremities that have lost sensitivity (especially hands) are extremely susceptible to all kinds of injuries leading to the development of various purulent processes, ulcers, etc. The latter, due to the usually existing trophic disorders, as well as due to the quite understandable inattentive attitude toward them by patients in case of insensitivity, often take a severe course and quickly penetrate to the bone, which, becoming involved in the process, necrotizes and then is rejected. Those cases of leprosy in which lepromatous granulations, developing in the bones of the extremities (e.g., phalanges), sometimes lead to the complete destruction of these bones, although incorrectly designated by some as lepra mutilans, however, have no relation to the actual process of M.

M. Skvortsov. MUTTENED SWELLING (Latin, intumescen-tia opaca) (synonyms: dull swelling, granular degeneration, parenchymatous degeneration), one of the most common types of protein degeneration (see Degeneration and Protein degeneration). It occurs predominantly in the cells of the parenchyma of organs (hence parenchymatous degeneration), e.g., in striated muscle fibers, especially of the heart, in liver cells, in the epithelium of the cortical layer of the kidneys, etc., expressing itself morphologically as some increase in the volume of the cell and the appearance in its protoplasm of small granules (hence granular degeneration), due to which the cell appears swollen and loses transparency, acquiring a cloudy appearance. The protein nature of the mentioned granules is evidenced by their ability to disappear upon the addition of weak acetic acid. As the intensity of the process increases, the nucleus also begins to change, first becoming pyknotic, and then gradually undergoing karyolysis. In the latter case, the cell dies, losing its contours and turning into an amorphous pile of fine-grained protein decay. Macroscopic examination of an organ in a state of M. S. mostly also allows one to clearly establish an increase in its volume (swelling), cloudiness, best seen on the surface of the section, which becomes not shiny as usual, but dull, resembling the surface of boiled meat. The similarity with the latter is further increased by the fact that the color of the tissue in M. S. due to compression of the capillaries by cells increased in volume becomes paler, grayish. When evaluating the described pictures in each specific case, it must be borne in mind that similar changes can also occur physiologically under the influence of enhanced cell function and postmortem as a result of cadaveric changes (coagulation of protein particles). In the latter case, only the increase in volume is absent. Among the pathological conditions causing M. S., first place is taken by various general intoxications of the body, mainly by bacterial toxins. Therefore, it is encountered exceptionally often in infectious diseases. Various circulatory disorders and the effect of high temperature are also of importance. M. S., as is evident from the fact that it is also observed physiologically, is a reversible process, and as long as there are no deep damages to the nucleus, it is possible to restore the normal structure of the cell upon elimination of harmful conditions. Changes morphologically corresponding to M. S. have repeatedly been obtained by various authors in vitro by immersing pieces or frozen sections from parenchymatous organs of healthy animals (liver, kidney, muscles, etc.) into so-called buffer mixtures. It was found that the phenomenon of M. S. is obtained only in an acidic environment (acidic swelling), starting from pH 6.2 and below. As for the essence of the process, the chemical transformations that occur in the cell during M. S. are not precisely known. According to some, it is not so much about the appearance of new protein particles as about the swelling and revelation of pre-existing granularities (chondriosomes) of the protoplasm. For this, they believe, on the one hand, the increase in the amount of water, and on the other, the relative decrease in the dry residue in the affected organs speak. According to another view (expressed as early as by Virchow, who first established both the term and the very concept of M. S.), the most characteristic chemical sign of M. S. is the increase in the amount of protein in the cell. Recent research (Hoppe-Seyler) shows that in the liver and kidneys in M. S. caused by various diseases, there is a significant increase in the absolute amount of both water and coagulable protein (as well as the entire dry residue), while the relative (to the weight of the organ) amount of all these components remains almost unchanged, and sometimes even decreases. The process that in German authors (A. Albrecht) received the difficult to translate into Russian name tropfige Entmischung (literally means droplet separation from mixture) stands extremely close to M. S. (perhaps even identical to it). It is also expressed by an increase in the water content in the cell and the appearance in it of the smallest particles or droplets of a substance that apparently was previously in solution or at least in such a close connection (mixture) with the protoplasm that it was indistinguishable. Some believe that this process develops under the influence of conditions created in M. S. of the cell; according to others, on the contrary, it precedes cloudy swelling, sometimes being as it were its initial stage. In any case, the boundaries between them are not clear, and the transition of one into the other is quite possible. Concerning the relation of cloudy swelling to vacuolar degeneration-see Vacuolar degeneration.