Lymphatic Outflow Research Articles

Clinical and diagnostic evaluation of the effectiveness of treatment of optic neuropathy in patients with edematous endocrine ophthalmopathy

The aim: to conduct a clinical and diagnostic evaluation of the effectiveness of the administration of a complex of drugs in the region of hemolymphocirculation in optical neuropathy in patients with edematous form of endocrine ophthalmopathy.Materials and methods. The results of diagnosis and treatment of 31 patients (61 eyes) with optical neuropathy on the background of edematous exophthalmos in endocrine ophthalmopathy were analyzed. To identify hidden forms of optical neuropathy, such studies were prescribed as computer microperimetry on a confocal infrared ophthalmoscope, a complex of electroretinographic studies: registration of maximum ERG, oscillatory potentials. Latent forms of optical neuropathy were detected in 22 cases. In 9 cases, there were obvious forms of optical neuropathy. All patients underwent a 10-day course of intensive complex treatment, consisting of injections into the region of hemolymphocirculation (projection of the pterygoid fossa) No. 6–8 (No. 3–4 on each side) with an interval of 24 hours of a drug mixture, the formulation of which included Lidocaine 20 mg, Dexazone 4 mg, Hemase 3000 UNITS, Dalargin 1 mg.Results. In all patients, there was a pronounced positive dynamics in the form of a significant (from 0.6 to 1.0) increase in visual acuity, a decrease in exophthalmos from (2.0 to 3.0 mm), an increase in color and contrast sensitivity.Conclusions. Due to the violation of venous and lymphatic outflow due to thickening of extraocular muscles and retrobulbar fiber, injections into the hemolymphocirculation region (projection of the pterygoid fossa) of drugs with a wide range of decongestant and metabolic effects are justified, effective and safe.

Myocardial Edema Provides a Link Between Pulmonary Arterial Hypertension and Pericardial Effusion.

Myocardial Edema Provides a Link Between Pulmonary Arterial Hypertension and Pericardial Effusion.

Abstract ES8-1: Options for reducing risk for lymphedema when ALND/regional nodal XRT are needed

Abstract Upper extremity lymphedema following axillary lymph node harvest or radiation therapy, can be extremely debilitating and symptomatic in breast cancer patients, and significantly reduces quality of life. In recent years, surgical procedures to reduce the development and progression of lymphedema have become more prevalent. These surgical procedures carry the aim of restoring lymphatic flow in the extremity following disruption of native channels. The most common procedures include vascularized lymph node transfer (VLNT) to the axilla, and lymphaticovenous bypass (LV bypass). The goal of both procedures is to restore flow, and reduce symptoms (infections, cellulitis, and reduced range of motion). VLNT involves harvest and transfer of autologous lymph node packets from a separate area of the body (most frequently the groin or supraclavicular region), and placement into the involved axilla, followed by microsurgical revascularization of the lymph nodes. Through cell signaling, this allows development of new lymphatic channel pathways, and resumption of drainage. LV bypass involves localized microsurgical anastomosis of lymphatic channels in the downstream affected extremity, directly to superficial veins in their vicinity. This allows lymphatic channels, proximal to the site of obstruction, to still drain their collected lymphatic fluid, directly into the systemic venous circulation in the extremity. In most cases, multiple LV bypass anastomoses are performed, to enhance lymphatic outflow. Due to the safety and efficacy of both procedures, they continue to be incorporated more frequently and routinely as part of breast reconstruction treatment plans. Citation Format: H Sbitany. Options for reducing risk for lymphedema when ALND/regional nodal XRT are needed [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr ES8-1.

Лимфомиозот — биорегуляционный подход в терапии детских заболеваний

Детский организм чрезвычайно восприимчив к действию различных возбудителей, токсинов, химических веществ, а также психических стрессов [1]. Возросшая антигенная нагрузка на детский организм в современных экологических, экономических и социальных условиях изменила течение многих заболеваний. Прежде всего к таким негативным моментам в здоровье детей в настоящее время следует отнести высокую частоту сочетанной патологии ряда органов и систем, увеличение случаев диагностики аллергических состояний, распространение заболеваний, в основе которых лежит острый или хронический эндотоксикоз [2]. Поэтому очень важно направить терапевтические и профилактические усилия педиатров на минимизацию воздействия отрицательных эндогенных факторов на организм ребенка [1]. В данной публикации представлен обзор клинических работ, демонстрирующих опыт клинического применения комплексного биорегуляционного препарата Лимфомиозот немецкой компании «Биологише Хайльмиттель Хеель ГмбХ» (далее — «Хеель») при распространенных заболеваниях в детском возрасте [3–5]. Лимфомиозот — базовый дренажный комплексный биорегуляционный препарат, улучшающий отток лимфы из тканей и органов, оказывающий дезинтоксикационное и противовоспалительное действие, что создает условия для оптимизации течения воспаления и полного его завершения. Лимфомиозот обладает благоприятным профилем безопасности и хорошей переносимостью [1, 2, 6–15]. Разрешен к применению с рождения.

Lymphatic self-massage for enhancing immunity during a pandemic

The article is devoted to the problem of improving immunity during the COVID-19 pandemic and the related effect of lymphatic self-massage.The article analyzes the general concepts of the lymphatic system and its functions, as well as lymphatic self-massage and its effect on cardiovascular and lymphatic systems.It is noted that the lymph flow stimulation through movements activates and normalizes the most important body functions. Using Skype, the authors surveyed medical students about knowledge on benefits and techniques of lymphatic selfmassage.Further, a master class was held on the technique of lymphatic self-massage. The authors studied the awareness of students about the benefits of lymphatic selfmassage, revealed a tendency to chronic diseases and assessed the benefits after the procedure.Based on the data obtained, it was revealed that viral infections, namely COVID-19, provoke one of the most common diseases — autoimmune thyroiditis. So, 64% of the respondents noted about it.Using lymphatic self-massage, the manifestations of this pathology decreases, the facial muscles relax and the blood and lymph outflow improves.Thus, there is an undoubted benefit of lymphatic self-massage for the prevention of diseases with immune involvement, including COVID-19.

Challenging Visualization of Sentinel Lymph Nodes in Upper Urinary Tract Urothelial Carcinoma.

Purpose: The purpose of this study was to assess the possibility of detecting sentinel lymph nodes (SLNs) and to perform analysis of lymphatic outflow in patients with suspicion of upper tract urothelial carcinoma (UTUC) with the use of a radioisotope-based technique. Methods: During 2018–2021, a prospective study was conducted on 19 patients with the suspicion of UTUC and for whom diagnostic ureterorenoscopy (URS) was planned. Technetium-99m (99mTc) nanocolloid radioactive tracer injection and a tumor biopsy were performed for staging procedures. Three-dimensional (3D) reconstruction and fusion of images were performed for better localization of lymph nodes (LNs). Detection of SLNs and the analysis of the radiotracer outflow was conducted with the use of single-photon emission-computed tomography/computed tomography (SPECT/CT) lymphangiography. Results: The mean age of the patients was 73.4 years; 7 (36%) were male. Pathological staging from the biopsy was T0—8 (42%), Ta—7 (36%), T1—4 (21%). SLNs were detected in two of 19 cases (10%). In one patient a single SLN (5.3%) was visualized, and in another case (5.3%), multiple (double) radioactive lymph nodes were visualized. In 17 out of the 19 (89.5%) cases, no lymphatic outflow was observed, and out of these five cases (26.3%) of gravitational leakage of injected radiotracer to the retroperitoneal space was noted. Conclusions: We demonstrated that detection of SLNs in the upper urinary tract is possible yet challenging. Radiotracer injection in the upper urinary tract during ureterorenoscopy is difficult to perform, and the expected result of injection is unsatisfactory. Lymphatic outflow from the tumor site to the first LNs in our studied group of patients is visible in 10.5% of cases. SPECT/CT lymphangiography in cases of UTUC may provide valuable information about a patient’s individual anatomy of the lymphatic system and the position of the first lymph nodes draining lymph with potential metastatic cells from the tumor.

Structural Confirmation of Lymphatic Outflow from Subconjunctival Blebs of Live Human Subjects.

PurposeTo uncover the mechanism of subconjunctival outflow in humans.DesignCross-sectional study.ParticipantsFifteen patients receiving subconjunctival anesthesia before intravitreal injection for routine clinical care.MethodsAnterior segment (AS) OCT was performed in patients with various instances of conjunctival edema or subconjunctival fluid. Other patients received a subconjunctival mixture of 0.005% indocyanine green and 2% lidocaine. After subconjunctival injection of the tracer and anesthetic mixture, blebs and associated outflow pathways were imaged angiographically and the time for appearance was recorded. The pattern and structure of outflow pathways were studied using AS OCT. Angiographic and AS OCT results were compared with trabecular and conventional outflow imaging, which demonstrates veins.Main Outcome MeasuresOcular surface lymphangiography and AS OCT images.ResultsAnterior segment OCT of the conjunctiva in a normal eye demonstrated thin nonedematous conjunctiva with absent intraconjunctival lumens or subconjunctival fluid. Patients with a history of trabeculectomy, subconjunctival drug injection, or chemosis demonstrated thickened conjunctiva and intraconjunctival luminal pathways that contained valve-like structures. Tracer-based studies in patients demonstrated blebs with irregular subconjunctival bleb-related outflow patterns that arose in a time-dependent fashion. These angiographic pathways were luminal on OCT, sausage shaped, and contained intraluminal valve-like structures. This was in contrast to trabecular and conventional outflow imaging, where pathways were classically Y-shaped, of even caliber, and lacked valve-like structures.ConclusionsOutflow pathways were seen in patients with conjunctival edema and after subconjunctival tracer injection. These pathways were lymphatic based on pattern and structural study. Better understanding of bleb-related lymphatic outflow may lead to improved bleb-requiring glaucoma surgeries and subconjunctival drug delivery.

Иммуногистохимическая идентификация лимфатического оттока в фильтрационных подушках после непроникающей глубокой склерэктомии (НГСЭ)

Relevance. One of the conditions for the functional outflow pathways' formation after filtering glaucoma surgeries is the uniform moisture absorption from the filtering blebs, which is provided by the blood and, possibly, lymphatic vessels of the conjunctiva. Purpose. To conduct a structural and molecular assessment of filtering blebs in patients with open-angle glaucoma (OAG) after non-penetrating deep sclerectomy (NPDS) according to OCT data, as well as ultrastructural and immunohistochemical studies. Material and methods. A clinical study of 12 patients with primary open-angle glaucoma (POAG) after NPDS was conducted. In the long-term postoperative period (12–18 months), the level of intraocular pressure (IOP) was determined, the structure of the filtering blebs using biomicroscopy and OCT of the anterior segment of the eye was evaluated, the immunohistochemical study of the filtering blebs' tissue for the expression of podoplanin and ultrastructural analysis of the samples obtained using a laser confocal microscope LSM 710 (Zeiss) was performed. In 8 cases (group 1), these were non-functional scarred filtering blebs, IOP 24.12± 2.24 mm Hg, in 4 cases (group 2) – functional filtering blebs, IOP 15.31± 4.08 mm Hg. Results. During the immunohistochemical examination of the first group patients' conjunctival samples, no vessels with characteristics of the lymphatic system were detected in any case. In each sample of the second group patients' filtering blebs, from 5 to 7 vessels with different variants of podoplanin expression were determined. Conclusion. The aqueous outflow entering the subconjunctival space through the newly created outflow pathway during glaucoma surgery is carried out at the expense of conjunctival lymphatic structures, the condition of which to a certain extent determines the success or failure of the surgery. Key words: non-penetrating deep sclerectomy; open-angle glaucoma; lymphatic outflow; filtering blebs

Lymphatic complications after harvesting venous conduits in coronary artery bypass grafting surgery

Complications associated with the disorders of lymphatic outflow in the lower extremities are common in cardiovascular surgery involving the isolation of venous conduits and interventions on the femoral vessels. Despite the relatively low frequency, treatment of these complications requires significant efforts and does not always yield the expected results whereas timely diagnosis of lymphatic drainage disorders is often difficult. This becomes the reason for repeated hospitalizations, surgical interventions, long hospital stays, and disabilities. However, the problem of lymphatic complications is still not getting enough attention. This article discusses the pathogenesis, predictors of lymphatic complications, and the options and approaches to their treatment and diagnosis.

Лімфодренаж — основа біорегуляційного підходу в терапії дитячих захворювань

Дитячий організм надзвичайно сприйнятливий до дії різних збудників, токсинів, хімічних речовин, а також психічних стресів [1]. У сучасних екологічних, економічних та соціальних умовах зросле антигенне навантаження змінило перебіг багатьох захворювань у дiтей. Перш за все до таких негативних моментів у здоров’ї дітей зараз слід віднести збільшення випадків діагностики алергічних та атопічних станів, поширення захворювань, в основі яких лежить гострий або хронічний ендотоксикоз, високу частоту поєднаної патології [2]. У зв’язку з цим важливим патогенетичним моментом терапевтичних і профілактичних зусиль педіатрів є мінімізація негативного впливу ендотоксикозу на організм дитини та підвищення ефективності лікування різних захворювань [1]. У публікації подано огляд клінічних робіт, що демонструють досвід клінічного застосування відомого в педіатричному середовищі комплексного біорегуляційного препарату Лімфоміозот при поширених захворюваннях у дитячому віці [3–5]. Лімфоміозот — базовий дренажний комплексний біорегуляційний препарат, який поліпшує відток лімфи iз тканин та органів, чинить дезинтоксикаційну та імунокоригуючу дію, що створює умови для оптимізації перебігу запалення та повного його завершення. Лімфоміозот має сприятливий профіль безпеки та добру переносимiсть [1, 2, 6–15]. Препарат у формі крапель дозволений до застосування з народження, розчин для ін’єкцій — з 6 років.

Povidon-iodine applied for the treatment of chylothorax in children

Introduction. The aim of this study is to demonstrate the experience of non-surgical treatment of congenital and acquired chylothorax in children using povidone-iodine.Material and methods. The study presents results of treatment of 10 patients with chylothorax who had chemical pleurodesis with povidone-iodine. The study covered a time period from 2016 to 2020. The congenital character of the disease was registered in 2 patients, the acquired one - in 8 patients. The main indication for surgery was ineffective conservative therapy, including the withdrawal of feeding and the administration of preparation Octreotide. The procedure consisted of intrapleural injection of 4% povidone-iodine solution into the pleural cavity with the calculated dose of 1 ml/kg and solution exposure for 4 hours. Results. The interpleural administration of povidone-iodine was effective in all patients. Complications of chemical pleurodesis were observed in 2 patients and were associated with pulmonary edema on the injection side. Lymph outflow was stopped on average in 4 days. There was one adverse episode which developed because of the lung malformation incompatible with life. Conclusions. Intrapleural administration of povidone-iodine is an effective treatment of chylothorax in children.

Radioiodine-resistant metastases of well-differentiated thyroid cancer, analysis of tumor characteristics and primary surgical intervention

The aim of this article is to assess the initial status, characteristics of the tumor process and initial surgical treatment in patients with well-differentiated thyroid carcinomas who subsequently showed resistance to 131I therapy, comparing with the control group of patients who achieved a positive effect of 131I therapy. Materials and methods. In total, 156 cases of well-differentiated thyroid cancer were analyzed. The control group consisted of 189 patients who showed complete responses to treatment of metastases after 131I therapy and the confirmed relapse-free period. The patients were operated and followed up in the Department of Endocrine Gland Surgery of SI “V. P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine” between 1990 and 2019. Results. Based on our study, in the group of radioiodine-resistant metastases, there was a 3.1:1.0 predominance of women over men; whereas in the control group, this ratio was 1.4:1.0. It was noted that resistance to radioactive iodine in patients under 20 years of age was 4 times significantly lower (10.26 %) comparing with the radiosensitive group (41.90 %). In the age group of 41–60 years, radioiodine resistance was 6.5 times higher than that in the comparison group (39.10 % and 6.35 %), and in the age group over 61 years – 11 times (11.54 % and 1.05 %). The impact analysis of radiation exposure on the radioiodine refractoriness occurrence revealed that among patients living in radiation-contaminated areas of Ukraine in 1986 following the Chornobyl accident, there were no significant differences in the development of resistance to radioactive iodine (resistance to 131I – 51.92 % (n = 81), treatment response 131I – 64.02 % (n = 121)). These differences may be due to the younger age of patients affected by radiation and better sensitivity to radioiodine compared to the main group patients. The maximum number of radioiodine-resistant observations was in the intermediate risk group (71.15 %; n = 111). Worth noting is the significant number of radioiodine-resistant metastases in the group where their absence was initially diagnosed (11.53 %; n = 18) and in the group where the proper assessment of lymph collectors was not performed (29.49 %; n = 46). Radioiodine resistance was significantly more common (33.97 %; n = 53) in observations where the prophylactic central dissection was not performed. Conclusions. The main risk factors in the development of radioiodine-resistant metastases were the age of patients older than 40 years, the limited primary surgery on regional lymphatic collectors of the neck, tumor aggressiveness. Careful pre- and intraoperative assessment of regional collectors of the lymph outflow, preventive central neck dissection and extensive therapeutic dissections can reduce the risk of residual and radioiodine-resistant metastases. Timely diagnosis of metastases can improve the results of primary surgical treatment for patients with differentiated thyroid carcinoma and reduce the incidence of radioiodine resistance.

Possibilities of the indocyanine green dye application for evaluation of peculiarities of lymph outflow and metastasizing of colorectal cancer

Objective. Studying of velocity of prevalence of luminescent dye indocyanine green along lymphatic vessels in the large bowel surgery.
 Materials and methods. Estimation of procedure for coloring of tumoral substrate and lymphatic vessels while performance of oncological operations was conducted. We performed laparoscopic resection of sigmoid colon in 7 patients, suffering tumors, and anterior rectal resection in 5 patients, having tumors of upper ampullary part of rectum, using indocyanine green dye.
 Results. In Group I, consisting of 7 patients, surgical technique of no touch manipulations on the tumor before transection of feeding vessels (NTIT–operations) was applied, and in Group II, consisting of 5 patients, the tumor mobilization was done primarily. Application of indocyanine green dye helped a lot to establish localization and prevalence of the process in rectum.
 Conclusion. Application of fluorescent dye indocyanine green on tumoral substrate before doing ligation of feeding vessels raises possibility of the complication occurrence, consisting of the cancer cells dissemination in abdominal cavity. While performing laparoscopic procedures in resection of the large bowel tumors it is expedient to ligate the feeding vessels primarily, with secondary manipulation– to dissect and mobilize the tumoral substrate.

Оптическая нейропатия и отечный экзофтальм. Новые подходы к лечению

Purpose. To study the clinical effectiveness of the administration of complex therapy of drugs to the hemolymphocirculatory organ (pterygopalatine fossa) in edematous exophthalmos in patients with endocrine ophthalmopathy complicated by optical neuropathy. Material and methods. The analysis of the results of treatment of 31 patients (62 eyes) with edematous exophthalmos on the background of endocrine ophthalmopathy complicated by optical neuropathy, who applied for help in the Novosibirsk branch of "MNTC "Eye Microsurgery". All patients were prescribed a 10-day course of intensive complex treatment, consisting of injections into the region of hemolymphocirculation (pterygeal fossa) No. 6 (No. 3 on each side) with an interval of 24 hours of a drug mixture, the formulation of which included Lidocaine 20 mg, Dexazone 4 mg, Hemase 3000 units, Dalargin 1 mg, with additional administration of antioxidants, neuroprotectors, vitamins and keratoprotectors. Results. By the end of treatment, all patients had a pronounced positive trend in the form of a significant (from 0.6 to 1.0) increase in visual acuity, a decrease in exophthalmos (from 2,0 to 3,0 mm), and an increase in color and contrast sensitivity. Conclusions. Due to the violation of venous and lymphatic outflow due to the thickening of extraocular muscles and retrobulbar fiber, injection of drugs with a wide range of decongestant and metabolic effects into the hemolymphocirculation region (pterygeal fossa) is justified and effective. Key words: endocrine ophthalmopathy, optical neuropathy, complex therapy.

Application of pantohematogen dry for treatment of discirculatory disorders in chronic prostatitis (experimental and clinical study)

PURPOSE: To study in experiment and in clinical conditions the effectiveness of the preparation pantogematogen dry, obtained from the blood of a maral, for the correction of dyscirculatory disorders in the prostate gland.
 MATERIALS AND METHODS: The experimental and morphological part of the work was performed on 90 male Wistar rats with local venous congestion in the small pelvis due to ligation of the internal iliac veins. Animals of the main group (n = 30) underwent enteral correction with dry pantohematogen (in a daily dose of 10 mg per 100 g of animal weight) starting from the 7th day after modeling the disease, the course was 14 days. The rats of the 2nd group (n = 30) after modeling of venous stasis were not treated. Group 3 consisted of intact animals. During the clinical phase of the study, 61 patients with chronic congestive prostatitis were treated. All patients received standard therapy, and patients in the treatment group (n = 30) additionally received highly dispersed aerosol transrectal irrigation with an aqueous solution of pantohematogen, daily, for a course of 10 procedures.
 RESULTS AND DISCUSSION: Morphological examination of the prostate gland of laboratory animals with experimental discirculatory prostatitis and its subsequent enteral correction with panthematogen dry indicated significant differences compared with animals of the 2nd group. A tendency towards restoration of the normal structure of the prostate, its metabolism, regional and organ blood and lymph outflow, improvement of the drainage-detoxification and transport activity of its regional lymph nodes was noted. In the clinical part of the study, the effectiveness of the use of pantogematogen in patients with chronic congestive prostatitis was shown. At the end of the course of treatment in patients of the 1st group, the disappearance of pain (in 72.4% of cases) and dysuric (in 86.2% of cases) syndromes was observed, and in the rest a decrease in their intensity. According to the TRUS of the prostate in patients of the 1st group, after treatment in 52% of cases, a decrease in the volume of the prostate was noted.
 CONCLUSIONS: The results of an experimental clinical study indicate the prospects for the inclusion of pantogematogen in the complex therapy of patients with chronic congestive prostatitis.

Tertiary lymphoid organs drive disrupted gut to lymph node communication through association with collecting lymphatic vessels

Abstract The concept that impaired lymphatic flow during the progression of Crohn’s disease, a major form of inflammatory bowel disease, emerged decades ago, but remains unresolved. In Crohn’s disease, tertiary lymphoid organs (TLOs) are associated with collecting lymphatic vessels (CLVs) of the mesentery that govern lymph outflow from the intestine. Whether TLOs affect lymph transport is unknown. In the TNFDARE mouse model of Crohn’s-like ileitis, TLOs formed at valve regions which supported lymphangiogenic outgrowths to the TLOs. Photoconversion approaches to study cell trafficking indicated that TLOs received immune cells traveling from the intestine but scarcely allowed their egress, effectively trapping DCs, B, and T cells. Using adoptive transfer of microbiota-dependent TCR we found reduced overall Tregs differentiation and their presence shifted from the lymph nodes to TLOs, altering intestinal-induced responses. Strikingly, although anti-TNF therapy dampens gut inflammation, TLO are refractory the therapy. Moreover, passage of soluble fluorescent tracer through TLO-rich CLVs was also impeded, indicating transport defects were intrinsic to the CLVs. Indeed, lymph flow diverted at TLO to neighboring CLV branches, where dysfunctional valves allowed lymph return to the gut wall, accompanied by lymph leakage at the TLOs. Culturing lymphatic endothelial cells with TNF demonstrate that the cytokine alone can reduce key genes found in lymphatic valves. These data indicate that TNF disrupts lymphatic valve maintenance pathways, promoting formation of mesenteric TLOs that broadly impair lymph transit of molecules and cells from the intestine, impairing immune surveillance of the mucosal barrier, altering homeostasis.

Інноваційна методика навчання студентів-початківців технічному удару гри в настільний теніс під час занять з фізичного виховання

As the overall life expectancy and aging of society increase, the number of diseases, disabilities and mortality increases, which creates a serious medical and social problem. Therefore, the search for effective and safe for the body ways to reduce biological age and slow down the aging process. Physical activity can compensate for the effects of aging on self-efficacy. Massage in its effect on the body is close to physical activity, improves well-being, blood circulation, metabolism, lymph outflow and tissue drainage. It is an more effective and practically safe method of therapy than drugs. Massage has significant preventive potential and is one of the promising non-drug means of reducing biological age and prevention of premature aging. The purpose of the work. Evaluate the effectiveness of using different types of massage to reduce biological age in relatively healthy people from 30 to 69 years. Research methods. The study involved 78 people (67 women and 11 men), who were divided into three groups. A course of massage of 10 procedures every other day of the neck area and thoracic back was performed in order to prevent premature aging and reduce biological age. Cryomassage was performed with the help of cryopackets, and vacuum massage was performed on a Cerri device (Italy). The control group included patients who did not receive massage. Before and after therapy, a number of indicators were determined – biomarkers of aging and biological age. Results of work. Cryomassage and vacuum massage have been shown to effectively improve a number of biomarkers of aging: lower systolic, diastolic and pulse blood pressure, increase lung vital capacity and expiratory respiration time, improve balance, improve self-esteem and improve self-esteem. Conclusions. Both types of neck massage contribute to the reduction of biological age and prevention of premature aging in the studied patients, in contrast to the control group.

Transcoelomic and Lympho-Hematogenous Dissemination of Endometrioid Heterotopias – the Mechanism of Extragenital Endometriosis Formation

Endometriosis nowadays still a disease with an undisclosed pathogenesis. This article demonstrates and explains the possibility of different variants of dissemination of endometrioid cells in the body with the formation of foci of extragenital endometriosis in organs and tissues remote from the pelvis, complementing and confirming the theory of utero-peritoneal reflux in the development of endometriosis as the most reasonable. Endometrioid heterotopias have a more developed lymphatic network compared to the normal endometrium due to active lymphangiogenesis, and, having a tendency to invasive growth, endometrioid heterotopia is a source of endometrioid cells spreading along the direction of lymph outflow from the most typical locations (pelvic organs) with damage to the inguinal and pelvic lymph nodes. Lymphatic dissemination in adenomyosis is observed in every fourth patient, which requires revision of the surgery protocol with excision of regional lymph nodes to prevent relapses. The presence of cases of pulmonary endometriosis and endometrioid liver cysts makes hematogenic dissemination of endometriosis from the primary source in the pelvic region obvious. The most frequent localizations of endometrioid heterotopias are located near the corresponding venous plexuses of the small pelvis, the outflow from which occurs mainly through the inferior vena cava, without anatomical obstacles for hematogenic dissemination of endometrioid cells with subsequent lung damage. For liver involment, it is likely that endometriosis in the distal parts of the colon is important, the venous outflow from which is directed to the portal vein system. Endometriosis of the diaphragm – is an example transcoelomic spread with predominant location on the right dome of the diaphragm, as the right subphrenic space communicates with the pelvic cavity through the right lateral channel, which justifies the possibility of such involments of the diaphragme in context of the theory of uteroperitoneal reflux.Thus, the theory of menstrual regurgitation and the theory of hemato-lymphatic dissemination are components of a single pathogenetic model of the distribution of endometrioid cells in the body.

Radionuclide-guided sentinel lymph node mapping in urachal cancer.

Urachal cancer gives metastases through the lymph nodes (LNs). No lymphadenectomy scheme in the case of this cancer exist, yet it is proposed as a staging procedure. An assessment of lymphatic outflow from the tumor site with the use of single-photon emission computed tomography/computed tomography (SPECT/CT) lymphangiography is possible for staging purposes. To perform the mapping of the LNs draining the lymph from urachal cancer with the use of radioisotope-based technique and to propose the lymphadenectomy template in case of urachal cancer. A prospective study was conducted in 5 patients with urachal cancer. The 99m-technetium (Tc-99m)-nanocolloid was injected during a cystoscopy prior to the surgery. Lymphangiography was performed using SPECT/CT. A radioactive LNs analysis with the use of a hand-held gamma-ray detection probe was conducted during the surgery and the sentinel lymph node (SLN) biopsy procedure was performed. An additional lymphadenectomy containing the lymphatic basin of identified radioactive LNs was performed. In all cases lymphatic outflow from the urachal tumor to the LNs was present. Preoperative SPECT/CT allowed detecting the activity of the radiotracer in the common iliac region in all the studied patients. In 3 cases, bilateral lymphatic outflow, and in 2 cases, unilateral lymphatic outflow was observed. All preoperatively visualized LNs were found and excised with the use of a gamma-ray detection probe during a lymphadenectomy. In all cases, SLNs did not contain metastases. Mapping of the LNs draining the lymph from urachal cancer with the use of radiotracer is possible. Lymphatic outflow in the case of this cancer can be both unilateral and bilateral. No recommendations about the extension of lymphadenectomy are proposed. We recommend individual assessment and treatment based on additional knowledge about lymphatic outflow. This allows for minimally invasive yet targeted treatment as an SLN basin lymphadenectomy.

The option of surgery for gastric stump cancer in patients who have previously undergone pancreaticoduodenectomy

Gastric stump cancer is a carcinoma which forms no earlier than 5years after surgery for benign disease. The incidence ranges from 2.4 to 5% among patients with stomach cancer. Previous operations lead to the emergence of an adhesive process in the abdominal cavity, changes in the anatomy and topography of the abdominal organs, as well as the development of new ways of lymph outflow. These factors lead to the re-surgery becomes technically more complicated and requires high professional training from the surgeon. Of particular surgical interest is the issue of restoration of the digestive tract, which directly depends on the nature and volume of the previous surgery. In this paper, the authors describe cases of surgical treatment of gastric stump cancer in two patients, who had previously undergone pancreaticoduodenectomy.