Search

Objective: To study the features of the clinic and treatment of children with infringement of the appendix in inguinal hernias in children., Material and Methods: We observed 12 children with the localization of the appendix in the right inguinal hernia. Four of them had an infringement of the appendix: two with inguinal hernia, two with sliding inguinal and femoral hernias. To verify the diagnosis, we used clinical and laboratory examinations of children with restrained inguinal hernia, ultrasound and Doppler examination of the groin and scrotum, X-ray, morphological examination of surgical materials. 4 clinical observations are presented., Results and Discussion: Difficulties in diagnosing acute appendicitis in case of infringement of the appendix in inguinal hernias in children are associated with an atypical clinical picture, which proceeds under the mask of OZO. Testicular infarction was found in 2 children with strangulated inguinal hernia and necrosis of the appendix. Combined surgery with abdominal and herniatomical access for sliding restrained hernias in 2 children made it possible to perform a radical operation and avoid severe postoperative complications., Conclusions: 1. Infringement of the appendix in inguinal hernias in children is rare. 2. The clinical picture of the restrained appendix in the hernial sac proceeds under the mask of OZJ. 3. Operative access in the groin area when the appendix is infringed in the hernial sac is the operation of choice. 4. In case of infringement of the appendix with sliding hernias (inguinal and femoral), the operation of choice can be abdominal and herniatomical approaches.

The effect of citoflavin and neoton preparations on the migration activity of neutrophil granulocytes under action of mitogen-induced immunocompetent blood cells, Peyer's patches, spleen and inguinal lymph was studied on a group of 55 male chinchilla rabbits with experimental model of widespread purulent peritonitis. It is established that the regulating action of immunocompetent cells on the migration of neutrophil leukocytes under the conditions of widespread purulent peritonitis is stable and widespread process, which is observed within 5 days of the postoperative period. The use of citoflavin and neoton during the postoperative period produces correction of the activity of immunocompetent cells, changing their properties in regulation of the migratory activity of neutrophil granulocytes. The effect is characteristic of both preparations and it is observed in all investigated organs, being manifested to a greater degree in immunocompetent cells of peripheral blood and Peyer's patches. Metabolic preparation citoflavin exhibits a more pronounced immunotropic action in comparison to neoton, which contains creatine phosphate.

Color Doppler mapping (CDM) of the regional lymph nodes was performed in 152 patients with primary skin melanoma without clinically determined regional and distant metastases. The patients were divided into 2 groups. The first group included 52 patients in whom biopsy was fulfilled after sonography and CDM of the regional lymph nodes. The second group (control) included 100 patients. After sonography and CDM biopsy of the lymph nodes was not fulfilled. Using CDM of the regional lymph nodes in the preoperative period allowed unjustified lymphadenectomies in patients with skin melanoma to be avoided. An algorithm of preoperative diagnosis of the degree of regional spreading of skin melanoma was developed which will give better results of treatment. The method of color Doppler mapping was first used for the detection of micrometastases of the tumor in the regional lymph system.

Data are presented on radiochemotherapy (1-4 cycles of combined therapy+total (TI) or subtotal (STI) irradiation of lymph nodes) given to 120 patients, with stage III Hodgkin's disease, whose ileoinguinal lymph nodes were intact. Analysis of overall survival of patients with stage III Hodgkin's disease showed that 87% of STI patients survived for 10-years as compared with 73% in TI (p=0.07). What is most important is that 10-year relapse-free survival in STI patients (92%) was significantly higher than that in TI (75%) (p=0.01).

Two groups of dogs, one of which (14 animals) was a control one, and the other (10 animals) received the maximum loads in the form of running on the treadmill at the 15 km/hr speed, have been investigated. After the load the inquinal lymphatic node was extracted from the animals under the thiopental anaesthesia. The results of the lymphoid tissue morphometric analysis have demonstrated that the higher meanings of the reticular fibrae volumetric density in the cerebral substance were observed in animals with a high level of the working capacity (the time of running). The small lymphocyte population density ratio coefficient in the paracortical zone to the same value in germinative centres (K) was 2.25. The low meanings of the reticular fibrae volumetric density in the germinative centres are revealed in dogs with a low level of the working capacity. The K was 1.59. In animals of this subgroup the cells, manifesting the phosphatase activity, are observed in great number in the medullar bands, which is corresponded with high meanings of the product of reaction of to alcaline phosphatase.

The inguinal lymph nodes of patients with primary lymphedema of lower extremities were investigated by light microscopy. It was found that sclerotization of regional lymph nodes can begin with both cortical and medullary parenchyma. Different stages of this process in lymph nodes were distinguished. These stages depend on the duration of the illness and the zone of organ where the first signs of sclerotization were observed. Small islands of lymphoid parenchyma were found in even well advanced sclerosis lymph nodes, and this allows to assume possibility of full regeneration of all structure of these organs when lymph circulation is normalized.

The authors have operated 24 patients to repair total and subtotal defects of penile integuments due to oleogranuloma. They have performed a total of 13 transplantations of axial island cellolocutaneous inguinal flaps basing on the external pudendal, superficial epigastric or superficial circumflex iliac arteries; 3 transplantations of free axial inguinal grafts; 2 transplantations of free axial grafts from the forearm on the radial artery. Microvascular anastomoses with the recipient zone vessels were formed. 8 two-stage Reich operations were conducted. Postoperative dynamic monitoring (skin thermometry, oxygen polarography, Doppler ultrasound scanning of the vessels) of the graft has found more favourable vascular reactions in the axial flaps vs. scrotal ones. Effective contralateral grafting was performed in a patient with the transplant necrosis on the superficial epigastric artery.

Single physical load (fifty minutes long swimming with further increase) causes destructive changes in the immune system organs, demonstrated on the cellular level--increase of perinuclear space, appearance of vacuoles in the cell cytoplasm and destruction of mitochondria cysts. Five weeks long preliminary training of the animals with six times a week use of continuously increasing physical loads contributed in appearance of lymphocytes with altered shape of the nucleus: great number of mitochondria, many with destructed cysts was found. Besides, cells with signs of destruction were demonstrated. The use of the same volume physical load for a more long time during the training and correction of the diet with vegetable products, containing biologically active substances helped to prevent unfavorable changes on the cellular level.

The authors describe ecological and epidemiological features of body, head and pubic louse pediculosis among servicemen and its epidemiological and hygienic significance. The article shows the possible routes of proliferation of lice in military contingency. There are practical recommendations for the army physician on execution of preventive measures and disinfection, as well as most effective and simple methods of lice extermination on the man's body, underwear, uniform, linen and dwelling. The article discusses various variants of insecticide application in different situations, and describes new antipediculous insecticides.

The inguinal lymph nodes (ILN) of 35 mature dogs were studied. Single individually dosed physical load causes destructive changes in ILN both on cell (widening of the perinuclear region, appearance of the great amount of vacuoles in cytoplasm, destruction of the mitochondria christal, rupture of the nuclear membrane) and tissue level (increase of the number of degeneratively changed cells, decrease of the number of the medium lymphocyte). Activity of succinate and lactate-dehydro-genases and alcaline phosphatase increases, with irregular distribution of the reaction products in the ILN section. Systematic training of the animals with such loads not only prevents unfavourable changes in ILN but also results in the increase of the proportion of blast cells, number of cells with the mitotic figures, appearance of the great amount of the lymph nodules with germinal centres. Enzyme activities in ILN of these animals were lower and had an even distribution of reaction products.

Operations were performed on 242 patients (49 out of 110 children and 193 out of 220 adults) with nonorganic new growths of the true pelvis. Nine surgical approaches were used: transperitoneal (89 patients), transperitoneal-unguinal-femoral (2), extraperitoneal (48), transgluteal-transsacral (23), parasacral (14), transuterine (4), interlabial (2), perineal (16), combined (44). The transperitoneal approach was used most frequently--in 52.0% of patients (taking into account the combined approach), more often in children than in adults, and more often in males than in females. The choice of the approach was mostly guided by the location and size of the new growth in the true pelvis.

The article analyses modern methods for the restoration of of defects in the metacarpal bones, based on microsurgical techniques. A case is described in which a new method for one-stage reconstruction of the hand in combined traumatic defect in the first and second metacarpal bones and an extensive defect in the soft tissues on the back of the hand was used. The hand was reconstructed by means of a vascularized complex autograft on a common vascular pedicle which included two separate fragments of the scapula and a fascial flap of the scapular region. With the application of the described method successful functional rehabilitation of the injured hand was achieved in a short period. A good cosmetic effect of the plastic repair was also noted.

The general structure and cell composition of the inguinal lymph nodes has been analysed at a direct endolymphatic antibiotic therapy, performed with the aim of prophylaxis of suppurative complications, when surgical interventions are performed in the vessels of the lower extremities. Morphokinetics of the lymph nodes depends on duration of the endolymphatic therapy. During early terms it reflects an increase in transport function of the regional inguinal lymph nodes, during late terms it reflects an increase in their immune role. In the lymph nodes, situating on the contralateral side, an analogous reaction is revealed; this appears to demonstrate presence of well developed collaterals between lymph vessels of the lower extremities.

Morphometric analysis was used to study the architectonics of hyperplastic regional lymph nodes in malignant melanoma patients as offset by normal condition. Specific volume relationships between all basic structures of the organ were established practically in all study groups. The specific features established should be continued at morphologic examination of lymph nodes for skin melanoma diagnosis.

Skin and mucosal lesions are described in a 40-year-old man who suffered from HIV infection in the stage of secondary diseases. The diagnosis was supported by demonstration of antibodies to HIV in the immune blotting test. The clinical manifestations were reduced to steady fever, generalized lymphadenopathy, pyoderma vegetans and chancriform pyoderma, candidiasis of the oral cavity, and seborrheic dermatitis, HIV infection was diagnosed 4 years after the appearance of pyoderma which initially was amenable by external antibacterial agents and then became resistant to them. Eruptions of pyoderma vegetans simulating wide condylomas were located in inguinal folds, on the internal surface of the thighs and scrotum; the chancriform focus was located in the internal preputial layer. The treatment with azothymidine combined with antibacterial and antimycotic agents led to the improvement of the patient's general status and to the reduction of local lesions. However, on recommendations of an unknown witch doctor who started treating him with the aid of reflexotherapy, phytotherapy and bioenergetic actions the patient stopped receiving the treatment prescribed and did not report for control examinations. After 5 months he died of brain edema.

It was shown that intralymphatic+ inguinal administration of gentamicin provided its high concentrations in central lymph, blood and ++para-aortic lymph nodes and increased the antibiotic levels in the abdominal organs 2.33 to 6.66 times as compared with its intramuscular administration while lymphotropic retroperitoneal administration of gentamicin provided more prolonged maintenance of the antibiotic therapeutic concentrations in lymph of the thoracic lymphatic duct, central blood, ++para-aortic lymph nodes and the abdominal organs in comparison to its intramuscular administration. Intralymphatic+ inguinal administration of drugs providing the highest concentrations in all the organs of the abdominal cavity and the ways of the infection penetration is useful in therapy of severe inflammatory diseases of the abdominal organs inclined to generalization and lymphotropic retroperitoneal administration of drugs is useful in therapy of less severe purulent inflammatory processes in the abdominal cavity.

In 54 patients with pyoinflammatory processes in the urogenital system, the efficacy of endolymphatic antibiotic therapy was investigated after surgical interventions into these organs along with administration of antibiotics just into the inguinal lymph node. To administer antibiotics, separation and drainage of the inguinal lymph node were conducted concurrently with surgical interventions in 26 patients for pyoinflammatory processes in the epididymis, prostate, and kidneys. In the other group (n-28), the inguinal lymph node was drained on days 4 to 5 of postoperative interventions due to the progression of an acute infectious inflammation in the affected organs and wounds. The efficacy of endolymphatic antibiotic therapy was evaluated by using clinical, laboratory, cytochemical, and immunological criteria. The drainage of inguinal lymph nodes in combination with aminoglycoside and cephalosporin antibiotics given in the postoperative period proved to be a safe and effective mode of treatment of pyoinflammatory processes in urogenital organs and wounds.

Mycetoma is a variety of deep mycoses. The endemic centres are situated in the countries with tropic or subtropic climate. In diagnosis, the important place belongs to microbiological, histological and roentgenological investigations. Surgical treatment supposes the radical removal of a pathological focus in aiming at preservation of the weight-bearing surface of an extremity. In intact skin, the subcutaneous incision of the mycous infiltrate is performed. The extensive soft tissue defects, especially at the region of joints, require primary or secondary autodermoplasty. The medicamentous treatment of fungal mycetomas is ineffective. The positive effect of Ketocanazole (Nizoral) before the operation was noted.

The dynamic of cellular reactions demonstrates certain changes in functional activity of all structures of the node during pregnancy. A similar trend of processes in the iliac (regional for the uterus) and mesenteric lymph nodes has been defined. At early stages of pregnancy, lymph nodule are the most active, this is demonstrated as an increasing portion of lymphoblasts, macrophages and dividing cells. During this period, cell composition of the cortical plateau is relatively stable. For the paracortical zone of the mesenteric lymph nodes a rather significant decrease in the portion of middle lymphocytes and reticular cells is characteristic. There is not any significant change in the relative amount of the cells in the same functional zone of the iliac lymph nodes during the same period of pregnancy. The medullar cords demonstrate an increasing number of blast forms and young plasmocytes. However, as the pregnancy develops, the structure of the paracortical zone undergoes an essential change--progressively increases the portion of lymphoblasts and large lymphocytes. The blastic reaction in the mesenteric lymph nodes is proved to depend, to some extent, on that in the iliac lymph nodes of the same animal. Mature plasma cells become the dominating cellular element in the medullary cords. At the end of the pregnancy a relative amount of the reticular cells increases in all structural zones of the node.

By means of incubation of slices in 2% solution of glyoxylic acid distribution of adrenergic fibers in the rabbit lymph nodes and in the thoracic lymphatic duct has been studied. Adrenergic fibers get into parenchyma of the lymph nodes via two ways. The first--the perivascular, when the nervous fibers make a plexus and get into the node along the blood vessels, the second--diffuse nervous fibers get together with trabecules in between the lymphoid nodules. The distribution density of the adrenergic fibers is not the same in different groups of the lymph nodes. In the lumbar nodes it is the highest. In the lymph nodes of the cervical part the density of the sympathetic fibers is, as a rule, lower than in the lumbar, but higher than in the axillary nodes. The lowest density of th adrenergic fibers is in the mesenteric, superficial inguinal lymph nodes and in the lymph nodes, situating near the thoracic part of the aorta. In the lymphatic duct wall small amount of adrenergic fibers are revealed, they form a plexus, predominantly in the cranial part.

The report deals with an evaluation of the data on 107 cases of squamous cell carcinoma of the rectum. 63 patients (58.8%) had proctological diseases in their case histories. Anal carcinoma is being misdiagnosed at out-patient hospitals as some other proctologic lesion in 34.9%. This fact points to the staff's lack of knowledge of the clinical picture of squamous cell carcinoma of the rectum. Abdominal-perineal extirpation of the rectum was the most frequent procedure used in the treatment of squamous cell carcinoma.

Development of pregnancy results in a systemic reaction of the immunogenetic organs: the structure of both the central (thymus) and peripheral lymphoid organs (lymph nodes) undergoes certain changes, beginning from its earliest stages (preimplantation period). Unidirection of the processes in the iliac (that are regional for the uterus) and mesenteric lymph nodes is stated. The reconstruction of the node occurs according to the reaction type at tissue allotransplantation, when hypertrophy of the thymus-dependent zone comes forward. During the period of the greatest manifestations of these alterations, however (the second half of pregnancy) the migration process of lymphocytes from blood into the lymph node is significantly inhibited. This is essentially clear in the iliac lymph nodes. The reconstruction of the thymus is in general similar with phenomena of accidental involution. However, accumulation of thymocytes in the medulla demonstrates blocking of their discharge into the blood stream. The disturbed processes of recirculation of result in incompleteness of the immune response at pregnancy and, perhaps, are included into the protective mechanisms of the offspring reproduction.

The method of accelerated plasty with an inguinal flap was used for treatment of 13 patients with electric burns and frostbites of the IV degree. The 2nd step of the non-free skin plasty was performed 5 days (120 hours) after the first operation which was possible following a special training--a periodical, with increasing duration of the compression of the flap feeding pedicle which was started next day after the first step of the plasty.

Owing to the method for making total plane preparations of the capsule after A. V. Borisov, it is possible not only to prove presence of myocytes in the capsule and in the trabeculae of the inguinal lymph nodes in the man and rat, but to open out general regularities of their distribution and orientation. In the capsule areas, corresponding to the places, where the lymph nodules are adjacent to (zone A), the number of myocytes is the least. They are oriented in various directions and are in close contact with each other (fascicular-reticulate principle of distribution of myocytes). In the capsule areas, surrounding A zones (named B zones) the myocytes are situated in tight layers and have circulatory orientation. At the place where the afferent lymphatic vessel gets into the capsule, precapsular lymphangion makes an infundibular dilatation and its myocytes along the sloping spiral get into the capsule, where they are arranged circulatory and form a muscular "constrictor". While studying ultrastructure of myocytes in the rat inguinal lymph nodes, it has been found out that their structure is typical for the smooth muscle cells. There are numerous myo-myocytic contacts of nexus type, that unite the myocytes of the node into a single functional complex.

Applying histological and morphometric methods, construction and cell composition of the inguinal lymph nodes have been studied in 125 white rats subjected to a daily dynamic (swimming) and static (hanging on a pole) loading. It has been demonstrated that the structural and cell composition changes of the lymph nodes depend but slightly on the character of the loading (dynamic or static), but rather essentially vary in the animals differently adapted to the loading. When adaptation is satisfactory, the rats gain in weight, in their lymph nodes the areas occupied by the connective tissue elements grow smaller, while the part of the cortical substance increases, with increasing number in them of follicles having light centres. As to the cell composition in the lymph node of these animals, a characteristic feature is an increasing amount of large and middle lymphocytes, lymphoblasts, plasmic cells and mitoses, that demonstrate an accelerated activity of the organism's immunological reactions. When adaptation to the physical loading is insufficient--exophtalmus, brown rings around the eyes appear, with a successive motor excitation. These animals poorly gain in weight, the number of lymphoblasts and large lymphocytes in the light follicular centres of their lymph nodes decreases, as well as the number of plasmic cells in the myelin cords; that demonstrates unsatisfactory immune processes.

The amount of plasma cells is connected with intensity of humoral immunological reactions. In people died an accidental death, the amount of immature plasma cells is the least in the axillary and the greatest--in the mesenteric nodes, especially in the thymus-independent zone. The amount of lymphoblasts and large lymphocytes, reflecting intensity of the humoral and cellular immune reactions, is also the greatest in the mesenteric lymph nodes, both in the thymus-dependent and in the thymus-independent zone. In all probability, the intensity of the immunological processes is minimal in the axillary, it is middle in the iliac and cervical and it is maximal in the mesenteric lymph nodes. In each case it is probably connected with peculiarities of antigenic composition of the lymph inflow. The mesenteric lymph nodes are on the way of the foreign protein getting into the intestine. This is evidently reflected by the highest content of immature plasma cells, lymphoblasts and large lymphocytes in them.

Histology and ultrastructure of sebaceous glands of the integumental inguinal gland of the hare were studied during the periods of low and high reproductive activity (in winter and in spring breeding season). It was established that the glands were functioning continually (cells in acini of all the animals used contained numerous secretory granules). The expansion of agranular endoplasmic reticulum and Golgi complex in secretory cells of sexually active animals, especially of males, shows an increased intensity of gland secretory process during the breeding season.