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Despite the large arsenal of diagnostic methods for studying the lymphatic system, there are isolated works on its morpho-functional state in chronic venous insufluciency. The purpose of the study was to study the anatomical and physiological state of the surface lymphatic system of the lower extremities in persons with different clinical classes of chronic vein diseases using fluorescence lifography. The study was conducted in 105 patients divided into six groups according to the clinical class of chronic diseases of the veins of the lower extremities according to the CEAP classiffication. We used fluorescent lymphography using sodium fluorescein to study the anatomical and functional capabilities of the lymphotone. The study revealed that morphofunctional changes in superficial lymphatic vessels in chronic lower extremity vein diseases depend on venous system decompensation. With an increase in the clinical class of chronic diseases of the veins of the lower extremities, the rate of lymph flow through the superficial lymphatic vessels is statistically significantly reduced. At the same time, the antegrade lymph cell is completely absent in С5-С6, with the appearance of retrograde outflow and discharge of the lymph into the deep lymph vessels. Thus, the progression of chronic venous insufficiency leads to proportional progression of morphofunctional changes in the superficial lymphatic system, which leads to the formation of lymphovenous insufficiency.

Purpose of the study. To provide prevention of early and treatment of late postoperative lymphorrhea in patients with oncolog­ical profile using fluorescent lymphography, photodynamic, radiation and endolymphatic lymphostatic therapy.Patients and methods. In the process, the results of treatment of 2 groups of patients were evaluated. Group I (main group) — 310 people — were patients with localized malignant tumors, who underwent elective surgical treatment and to whom were applied developed measures for the prevention of early and treatment of late postoperative lym­phorrhea using fluorescent lymphography (168 people), photodynamic (68 people), radiation (48 people) and endo­lymphatic lymphostatic therapy (26 people). Group II (control group) — 310 people — who underwent elective surgical treatment of tumor diseases of similar localization using standard measures for the treatment of postoperative lym­phorrhea (punctures, pressure dressings, etc.). The groups were comparable by sex, age, nosology and the volume of surgical interventions.Results. We estimated the volume and duration of lymphorrhea by the amount of allocated to the drainage and evacuated puncture lymph. In the control group, the average lympho-loss in the hospital was 59.6 ml, at the outpatient stage — 15.8 ml. Of the 310 patients in the control group, postoperative complications were identified in 29 (9.4%) patients: wound suppuration (11), abscesses (4), pleural empyema (2), thromboembolism (3), adhesive disease (6), pyelonephritis (2) and myocardial infarc­tion (1). Initial lymphorrhea, more than 100 ml per day, was present in 27 (93%) of these patients.Lymphorrhea in the main group in the hospital was 32.7 ml, and at the outpatient stage — 8.1 ml. Complications in the main group were detected in 13 (4.2%) patients: wound suppuration, anastomotic failure and fistula — 3, abscesses — 1, thrombo­embolism — 1, bleeding from duodenal ulcer — 1, adhesive disease — 7.After the application of the proposed measures for the prevention and treatment of lymphorrhea in the main group, the dura­tion and volume of lymphorrhea decreased almost twice, as did the frequency of postoperative complications.Conclusion. Prolonged lymphorrhea leads to an increase in the incidence of postoperative complications. Fluorescent lymphog­raphy, photodynamic therapy, radiation therapy and endolymphatic lymphostatic therapy, taking into account indications and contraindications to each of these methods, can be used for the diagnosis, prevention and treatment of postoperative lymphatic lesions. An individual approach to the prevention of postoperative lymphorrhea leads to a decrease in its volume and duration, a decrease in the frequency of postoperative complications, a reduction in the patient’s stay in hospital and at the outpatient stage and allows for the timely start of special treatment in cancer patients.

Objective: To study diagnostic value of fluorescence lymphography for sentinel lymph node biopsy in breast cancer., Material and Methods: The study enrolled 25 patients with breast cancer T1-2N0-1M0 between March 2023 and July 2023. Eight ones underwent neoadjuvant chemotherapy. In 3 patients, morphologically verified metastases cN1 in axillary lymph nodes regressed after treatment. After sentinel lymph node biopsy, all patients underwent standard axillary lymphadenectomy. Subareolar injection of indocyanine green 1 ml (5 mg/ml) was performed immediately before surgery. Fluorescence imaging was performed using the MARS system., Results: Detection rate was 100%. Mean number of sentinel lymph nodes was 2. Metastatic lesions of sentinel lymph nodes were observed in 6 patients (24%) with micro-metastases in 2 cases. In 50% of cases, metastatic lesion did not extend beyond sentinel lymph nodes. False negative result was obtained in 1 (4%) patient. Mean number of metastases was 1.8 (max 3 in one patient)., Conclusion: Sentinel lymph node biopsy with fluorescence lymphography is a sensitive method. The advantages of this technique are visualization of subcutaneous lymphatic vessels and skin incision for access to sentinel lymph nodes, as well as visualization of sentinel lymph nodes after skin incision.

Objective: To develop a method for analysis of lymphatic drainage pathways from the lobe of the lung affected by non-small cell lung cancer (NSCLC) using infrared fluorescence., Material and Methods: A study enrolled patients with NSCLC who underwent anatomic resection of the lung with systematic lymph node dissection and preliminary intraoperative peritumoral injection of indocyanine green conjugate with human albumin. Registration of fluorescence in regional lymph nodes (LN) was carried out immediately after excision of specimen using the FLUM-808 instrumental system., Results: Infrared fluorescence was observed in 117 hilar and mediastinal lymph nodes from 43 patients (2.7 nodes per a patient). Comparison of localization of fluorescent LN with localization of tumor in various lobes established significant variability of lymphatic drainage pathways., Conclusion: The developed method of infrared fluorescent evaluation of lymphatic drainage in patients with NSCLC confirms the necessity of systematic lymph node dissection for adequate staging.

The paper describes properties of clinical visualization approaches which are applied for detection of sentinel lymph nodes in patients suffering from oral cavity squamous cell cancer. Diagnostic efficiency results and technological features of different imaging techniques are discussed.

The present review of the literature data highlights modern approaches to and major trends in diagnostics and conservative treatment of lymphedema of the lower extremities based on the generalized world experience. Patients with lymphedema of the lower extremities comprise a "difficult to manage" group because the disease is characterized by steady progression and marked refractoriness to various conservative therapeutic modalities creating problems for both the patient and the attending physician. Modern methods for the diagnosis of lymphedema are discussed with special reference to noninvasive and minimally invasive techniques (such as lymphoscintiography, computed tomography, MRT, laser Doppler flowmetry, etc.). During the last 20 years, combined conservative therapy has been considered as the method of choice for the management of different stages and forms of lymphedema of the lower extremities in foreign clinics. The basis of conservative therapy is constituted by manual lymph drainage (MLD), compression bandages using short-stretch materials, physical exercises, and skin care (using the method of M. Foldi). Also reviewed are the main physiobalneotherapeutic methods traditionally widely applied for the treatment of lymphedema of the lower extremities in this country. Original methods for the same purpose developed by the authors are described including modifications of cryotherapy, pulsed matrix laserotherapy, hydro- and balneotherapy. Mechanisms of their therapeutic action on the main pathogenetic factors responsible for the development of lymphedema (with special reference to lymph transport and formation) are discussed. The principles of combined application of physiotherapeutic methods for the rehabilitative treatment of patients presenting with lymphedema of the lower extremities are briefly substantiated. Special emphasis is laid on their influence on major components of the pathological process.

The study has established that during a progressive tuberculous process, immunological changes appear as significant increased proinflammatory cytokine production that leads to progressive destructive processes in the lung parenchymal lesion areas. Inclusion of lymphotrophic chemoimmunotherapy with roncoleukin into the complex therapy of patients with progressive pulmonary tuberculosis permits the optimization of the results of treatment in patients with progressive pulmonary tuberculosis due to the target delivery of antituberculous and immunoactive agents.

The author revises the contents and limits of the anatomic CEAP classification. For this purpose 84 patients with different types of trophic disorders of the lower limbs were examined with the aid of the author's technique of functional lymphography and lymphoscintigraphy. Impairment of drainage and transport function of the lymphatic capillaries was established from the ulcer edge at the level of the outgoing (from skin to collector) and collecting (from foot to regional nodes) capillaries. A close relationship was discovered between secondary changes in the lymphatic bed and the severity of trophic disorders. In groups with dilated and stenosed vessels, there were subgroups of patients with preserved function of lympangions. The data obtained evidence that lymphovenous insufficiency beyond the area of trophic disorders is more pronounced than in the focus itself. This may play a decisive role in the choice of the treatment modality as dependent on the condition of the drainage pathways. To refine the diagnosis in patients showing disease progression, with failed treatment of trophic ulcers including ulcerous defects, the author suggests that A category may be divided into two subgroups: Av for characterization of different veins and Al for lymphatic vessels of varying levels: S (skin), (Tissue) and Lnd (lymph nodes). The use of additional criteria for the diagnosis substantially improves the characteristics of the international CAAP classification.

The paper describes the results of examination carried out by the Sankt-Peterburg school of lymphologists, pertaining to the structure, physiological properties and function of lymphangions responsible for active lymph transport. The problems of the pathogenesis, diagnosis and treatment of lymphedema of the lower extremities used in clinical practice are reviewed from the standpoint of the new theory. The data obtained as a result of the clinico-morphofunctional studies allowed to delineate the stages of lymphedema as dependent on the degree of lymphocytic structure and function integrity. Based on the aforesaid the new approaches to the diagnosis and selection of the treatment methods for lymphedema of the lower extremities have been formulated.

Complex analysis of the methods of early diagnostics and tactics of surgery treatment of 340 professional flyers with various forms of nodal thyroid diseases in the 5-yr period (1996-2002) showed effectiveness of a specialized diagnostic program including USI-controlled biopsy, in reliable estimate of structural changes of nodal thyroid formations already at early phases of disease in the majority of patients (83.2%). Organ-preserving and economical operations for removal of benign thyroid knottings led to recovery and professional rehabilitation of 90.3% of the patient-pilots.

The examination of 539 patients with varicose disease was fulfilled with the help of ultrasonic (dopplerography, angioscanning), rentgenological (phlebography, lymphography), functional (rheovasography, photoplethysmography) methods. Two forms of venous hypertension were established: superficial and deep. Hemodynamic disorders in patients with the superficial form result from the formation of isolated blood refluxes in the superficial, perforant and profound veins. In patients with this form the muscular-venous pump has mild disturbance and is clinically manifested as a slowly progressing course of the disease. The basis for the development of the deep form is a severe valve incompetence of the profound veins with the formation of associated blood refluxes in all the elements of the muscular-venous pump. The latter completely looses its function which leads to a rapid lympho-venous decompensation.

Injection hepatography (IH) was made in 278 patients with cholestasis to study the drainage function of the liver. In 208 cases. IH was performed as a test during percutaneous transhepatic cholangiography (PTHC). The hepatic lymph pathways were imaged in 167 (60%) patients. Images of the biliary tract were obtained in 245 (88.1%) patients with cholestasis, it being not dilated in 34 (12.2%) patients. The fact that hepatolymphography may be performed during PTHC as an independent test permits verification of hepatic lymph circulatory disorders that are an index of the rate of inflammation in the organ.

The authors describe the method of endoscopic gastroduodenal lymphography with opacification and its results obtained after treatment of 79 patients with peptic ulcers. The method of diagnosing penetrating ulcers is thought to be highly informative and reliable. It should not be followed by repeated roentgenological examinations, so it decreases the X-ray load both on the patients and on medical personnel and allows the optimal methods of treatment of patients with chronic gastroduodenal ulcers to be chosen.

Transcutaneous transhepatic lymphography was conducted in 116 patients with hepatic cirrhosis 127 times in total to study up the type of plasma flow. An inguinal nodulolymphography was performed additionally in several patients. Peripheral type of the plasma flow with the lymphatic vessels net arrangement on periphery of hepar was revealed in 46 patients, the lymphatic ducts blockade on the level of lig. gastroduodenalis, LI-LII vertebral bodies, forming the cisterns--in 24 and without them--in 7 thoracic duct blockade close to its outfall--in 48, and in 11 of them--extended type of the duct outfall. The choice of operative procedure--hepatic extraperitonealization, intraperitoneal and peripheral lymphovenous anastomosis conduction--was accomplished according to the type of the plasma flow present.

Experience in the diagnosis and treatment of nodular forms of thyroid carcinoma is generalized. Among 4,601 patients who underwent operation for nodular goiter 338 (7.3%) were found to have carcinoma. Aspiration biopsy was widely used in establishing the diagnosis and chromothyrolymphography during the operation. The method of operative treatment consists in extrafascial resection of the thyroid gland and subsequent substitution therapy with thyroidine or thyrotoxine.

The paper deals with the results of X-ray lymphographic and morphological studies of the peripheral lymphatic system in 82 patients with various stages of chronic lower extremity arterial insufficiency. Destructive and sclerotic changes in lymphatic vessels, inguinal lymph nodes, and impairments in lymph flow whose severity was in proportion to the stage of chronic ischemia were detected. The associated immune, barrier-filtration and transport dysfunctions called for their adequate correction. In patients with Stages II and III ischemia, direct controlled endolymphatic therapy promotes the improvement of tissue lymphatic drainage and hemocirculation in the diseased extremity and recovery of immune homeostasis in the region.

In vivo indirect electrolymphoroentgenography was conducted to study the reaction of lymphatics during prolonged compression syndrome (PCS). The studies were made on white rats, Wistar-line, males. It was found out that the early period of clinical course of PCS was characterized by lymphostasis. The intermediate period of PCS corresponds to the stage of the collateral lymphokinesis. At the edge of intermediate and late period of PCS the electrolymphoroentgenogram shows the removal of lymphostasis and recovery of main lymphokinesis.

Regional lymphatic bed in local application of mineral sorbent SUMS-2p in 80 white noninbred rats with experimental generalized purulent peritonitis is studied with the use of indirect intravital lympho-roentgenography. The correlation between lympho-dynamics and generalized purulent peritonitis stage was observed. It is shown that the peritoneo-sorption with the mineral sorbent SUMS-2p led to early restoration of lympho-drainage.

A study was made of the potentialities of lymphography using a new radiopaque medium chromethiotrast (a solution of harmless fat-soluble anthraquinone dyes fixed with ethiotrast). The agent is intended for combined x-ray and visual investigation of the lymphatic system. Lymphograms of 76 patients (with Hodgkin's disease, prostatic cancer, cancer of the female organs, breast, bladder, rectal cancer, and secondary limb lymphedema) were analyzed. Chromethiotrast is easily administered in the lymphatic bed ensuring a good contrast density of the lymphatic vessels permitting the detection of their structure. Chromethiotrast is quickly discharged from the lymphatic system, causing no marked side-effects provided all precautions necessary for the administration of iodobutyric radiopaque media, are taken.

Three clinical cases with the mediastinal form of Brill-Symmers disease are discussed. The variants of its symptomatology and course are described. The methods of diagnosis and surgical tactics are dealt with. Operative treatment of mediastinal giant follicular lymphoma in the stage of a benign course is the method of choice. The late-term results (of up to 20 years) were studied in 2 of the 3 patients.

Computed tomography (CT) findings were compared with operative ones for 50 patients with esophageal and proximal gastric cancer. In diagnosis of metastases to the upper abdominal and retroperitoneal lymph nodes ST sensitivity reached 93.3%, specificity 85% and accuracy 90.3%. The best diagnostic results were obtained in detection of metastases to the nodes of the celiac trunk branch and paraaortal fat (94.2%). Lower CT resolution appeared in diagnosis of perigastric node metastatic involvement in the primary tumor location in the proximal stomach.

Intraoperative color lymphosialography was carried out in 56 patients with benign tumors of the parotid salivary gland. A characteristic staining of the gland distinguishing it from the tumor was seen during surgery in all the cases. Peripheral branches of the facial nerve were well seen too. Employment of this technique has helped reduce by half the number of x-ray contrast examinations and resulted in a lower incidence (only 5 percent) of postoperative complications.

The diagnostic effectiveness of ultrasound and lymphographic investigations was assessed in 89 rectal cancer patients. Lymphography was shown to be a more informative method as it permitted the detection of metastases in 6 patients in whom USI results were negative, metastatic involvement in 2 patients, specifying the type of pathological changes of the enlarged lymph nodes in 14 patients. In a normal lymphographic picture metastatic involvement was detected in 37 cases using echography. More extended metastatic spreading was found on USI (as compared to lymphography) in one patient. The combined use of echography and lymphography improved the diagnosis of rectal cancer lymphogenous metastases.

In 62 dogs, presenting a model of the renal autotransplantation into the pelvis on the iliac vessels, a comparative estimation of morpho-functional state of the transplanted organ has been performed at a spontaneous (control) and surgical (experiment) restoration of the lymphatic outflow pathways during the postoperative period from 1 day up to 6 years. Three periods of morpho-functional restoration of the transplant renal tissue have been revealed: I (period of decreased functional activity) lasts in the control from 1 up to 14 days, in the experiment--up to 7 days after the operation; II (period of restoration of the functional activity) lasts in the control from 14 up to 90 days, in the experiment--from 7 up to 30 days after the operation; III (steady functioning of the renal transplant) begins in the control on the 90th day, in the experiment--on the 30th day after the operation and lasts up to the end of the observations. Such signs as lymphostasis and certain disturbances of oxidation-reduction and physical-chemical processes in the renal tissue are specific features. Time of normalization of the processes mentioned and degree of their manifestation depend on spontaneous or surgical restoration of the lymphatic outflow pathways. The surgical relymphatization of the renal transplant contributes to a more rapid and complete restoration of its morphofunctional state in comparison to a traditional method of the kidney transplantation.

In 243 mongrel female dogs anatomy, topography of the pelvic lymph nodes (LN), composition and frequency of their revealing have been studied. By means of roentgenological and morphological methods in 100% of cases, lateral, iliac and hypogastric LN are revealed. In 94% sacral and in 87.3% medial iliac left, as well as anorectal LN (88.6%) are detected most often. Obturative (20.4%--left and 27.3%--right), subpiriform (15.3%), suprapiriform (3.3%) and lumbar caudal (8%) LN occur less often. Inconstantly LN are predominantly revealed in the left side. When the constant LN are of small size, medial iliac, sacral and anorectal nodes are always discovered. In this case anorectal and lumbar caudal LN are revealed without obturative ones, and the latter--without medial iliac, which in their turn are found without sacral LN. Volumetric values of the constant and inconstant LN are in direct dependence with each other. When the volume of the constant LN increases, the volume of the inconstant LN also increased, demonstrating a definite tendency to decreasing amount of the latter. Caudal lumbar LN are revealed in 8% (12 cases in 150), therefore, peripheral lymph with a dye, and to the same extent an ascending infection and cells of malignant neoplasms directly get into the lymphatic lumbar trunk.

On the basis of the experience with treatment of more than 500 patients with sigmoid and rectal cancer, the informative value of the instrumental methods of investigation used for more precise definition of a stage of the disease is analysed. A scheme for rational examination of the patients is suggested.

Preoperative X-ray computerized tomography (CT) was performed in 60 patients with carcinoma of the esophagus at the All-Union Oncology Research Centre, USSR AMS in 1986-1989. The method is evaluated on the basis of comparison with the operative findings in determining the depth of invasion of the esophageal wall and adjoining structures by the tumor, metastatic involvement of the lymph nodes below the diaphragm, and metastases in the liver. Informativeness of X-ray CT proved to be highest in patients in whom the tumor had not spread beyond the esophageal wall. It was established that the method possesses high resolving possibilities in identification of enlarged lymph nodes in the abdominal cavity. Small metastases in the liver, measuring 0.5 to 2 cm in diameter, cannot be revealed by the method in some cases. The data gained by means of X-ray CT allows tactics of the surgical intervention to be determined and the late-term results to be predicted.

X-ray features, frequency and mode of spreading of metastases from ovarian dysgerminoma were studied. The role of lymphography in choosing treatment modality in this clinical setting is outlined. The authors consider lymphography to be mandatory in examining patients suffering ovarian dysgerminoma.

Endolymphatic infusions of a 10 percent solution of dibunol in iodolipol or chromolymphotrast were given for prevention of lymphogenic dissemination of rectal cancer. Certain changes in X-ray pattern of lymphogenic metastases developed due to prolonged intravascular retention of the contrast agent. Under such conditions metastatic lesions took the form of collateral lymph flow development and enlargement and deformation of lymph nodes. The diagnostic value of lymphography appears to be still higher when several symptoms of metastatic involvement of the lymphatic system are in evidence.

The results of examination of 79 patients of whom 25 were thyroid cancer patients, showed that electroroentgenothyrolymphoscans made it possible to judge with a sufficient degree of significance of the size, site and function of the intrathyroid lymph nodes of which some were "hidden" because of their small size on routine scans. This method can be successfully used for differential diagnosis of different thyroid diseases including tumors alongside with other morphological methods.

Proceeding from an analysis of the clinical and x-ray findings on 333 bladder cancer patients the frequency of lymphogenic metastatic spread was determined with relation to a degree of local extent of disease: T1 and T2--no metastases; T3a--metastases in 11.5%; T3b--in 30.3%; T4a--in 36.4%; T4b--in 50% of the cases. Metastases were mainly detected in the external inguinal lymph nodes. The lumbar lymph node involvement was always combined with tumorous changes in the pelvic lymphatic plexuses. Indications to lymphography with relation to a primary tumor spread (T3a, T3b and T4a) were defined. The authors determined the role of x-ray monitoring and repeated lymphography for the detection of metastases and a study of their regression caused by therapeutic measures.