Search

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.

In isolated sections of mesenteric lymphatic vessels, the constrictory responses to transmural electrical stimulation were studied. Inhibition of the spontaneous rhythm occurring primarily at low frequencies was revealed as well as the inhibition following the excitatory effect of high--frequency stimulation. Analysis of the transmural inhibition showed the latter to occur as the result of activation of adrenergic nervous plexus and to be fulfilled by the beta--adrenoreceptors.

In rats, catecholamines were found to increase the rate of the muscles spontaneous rhythmic contractions while the alpha- and beta-blocking agents suppressed them. The spontaneous contractions were blocked in the uncalunm medium. Rhythmic electrical stimulation evoked contracture-like responses the uncalunm of which depended on the strength, frequency, and duration of the stimulation. In spontaneoulsy active preparations, single electrical stimuli evoked contractions according to the "all or nothing" rule. The membrane potential magnitude varied within the limits of 25-37 mV, and action potentials were related to the contractions. The data obtained suggest that the functional unit of conduction of spontaneous or evoked excitation waves is represented by a group of smooth muscle cells within a single lymphangion.

A combined clinico-morpho-physiologic investigation was conducted in 98 patients with primary and secondary lymphatic edema. All patients underwent lymphography by means of electron and light microscopy; biopsy specimens obtained from a lymphatic vessel at lymphography were investigated histologically, and contractility records were made. Pronounced disorders were demonstrated in the lymphatic vessels and their myocytes. New rational schedules of pathogenetic treatment for lymphedema of the lower limbs are outlined on the basis of the reported findings.