Yarovenko G.V.

Lymphedema is a slowly and steadily progressive chronic disease. Nine million people in the world suffer with lymphatic edemas of the extremities without correlation with venous pathology. The effectiveness of the drain function of the lymphatic system of extremities doesn-t depend on only of lymphatic vessels, but also on anatomy-function condition of lymphatic nodules. We studied the patients - inguinal lymphatic nodules with different degrees of the first and the second chronic lymphostasis of low extremities morphologically. During the morphology research it was marked, that the capsule was 7,9%, the lymphatic tissue was 30,2% and the fat or the fibrous tissue was 59,2%. By the cells composition in the lymphatic node numerical reduction of genuine cells of the lymphatic tissue and cells of the phagocytic line descended. The data we-ve got confirm irreversible changes the inguinal lymphatic nodules with the chronic lymphatic insufficiency of low extremities. The processes of the sclerosis and atrophy lymphatic tissue develop in the nodules which lead to breach of their function. With a view to search new ways of correction lymphatic flow-out we created a model of lymphatic edema to extremities of experimental animals (white rats) by introoperation ablation of inguinal lymphatic nodules. The increase of the peripheral of edema in the operated extremity of the groups of white rats took place 21 days, and then the stability of the edema came. The confirmation of the edema in the operation extremity realized with a few methods: by measuring of the extremity in the upper third hip, by volumetry, by the test of MacClura and Oldrich, by ultrasonic research of the inguinal region, by the contrast of the lymphatic collector with methylene blue. Removed lymphatic nodules were the basis for getting the culture of poorly differentiated stromal cells. Experimental animals were divided into three groups. To the animals of the first group (45) the culture poorly differentiated stromal cells was injected into the inguinal region of operated leg. To the animals of the second group (8) the culture of fibroblasts was injected and to the animals of the third group (8) 0,9% physiological solution was injected. During the transplantation of the culture poorly differentiated stromal cells into the inguinal region of the experimental animals by test of MacClura and Oldrich the resorption of the skin papule in the shin increased and composed 7% by 30 day, 14,7% by 60 day and 17,6% by 102 day. In the hip the resorption of the skin papule prolonged in 8,4%, 16% and 21,5% accordingly. It was also fixed the of reduction the edema in the operated extremity of animals in 32% by 30 day, in 87% by 60 day and by 102 day the edema completely cut short. During ultrasonic research of the inguinal region of the operated extremity of the first group animals neogenic tissue, friable, with echopositive center, around which hypoechogene fillet was rendered, was discovered. In the tissue solitary streaming signals were assisted. The structure composition of the tissue conforms to the texture of the lymphatic nodules as in a sound extremity. Microscopical morphological research confirmed the presence of the lymphatic nodules in the inguinal region. After the injection of methylene blue the colored vessels and lymphatic sinuses defined in the paracortical layer of lymphatic nodules. According to the data of autoradiography in the lymphatic nodules represented by lymphocytes accumulation of the marks H3 timedin was marked. According to the studied criteria somatical condition of the experimental animals we confirmed the absence of negative effect to the organism of the culture poorly differentiated stromal cells in the period from the moment of injection to 1,5 years, the full life cycle of animals. So, the use of poorly differentiated stromal cells in the treatment of patients with lymphatic edema of low extremities is expedient and must be directed to creation of new ways of lymphatic flow-out, to the formation of which they cooperate

1. Вылков И.Н. Патология лимфатических узлов. - София, 1980.
2. Зербино Д.Д. Хроническая недостаточность лимфатической системы - патоморфологические феномены. - Тезисы материалов 1 съезда лимфологов России, Москва, 2003, c. 34.
3. Коненков В.И., Бородин Ю.И. Клеточные аспекты лимфологии. - Тезисы II съезда лимфологов России, Санкт-Петербург, 2005, c. 150 - 152.
4. Нурмухаметова Б.Н., Омарбекова Ф.С., Ажахме­това А.З. Особенности строения лимфатических узлов различных локализаций. - Тезисы материалов научной конференции «Проблемы экспериментальной, клинической и профилактической лимфологии», Новосибирск, 2002, с. 281-283.
5. Петренко В.М. Лимфатический узел как сложный, комплексный лимфангион. - Тезисы II съезда лимфологов России, Санкт-Петербург, 2005, c. 229 - 230.
6. Поташов Л.В., Бубнова Н.А., Орлов Р.С. и др. Хирургическая лимфология. - Санкт-Петер­бург, 2002.
7. Феоник О.В., Бубнова Н.А., Борисова Р.П. и др. Лимфовенозная недостаточность и пути ее коррекции. - Тезисы III международного хирургического конгресса, Москва, 2008, с. 303.
8. Шиманко А.И., Дибиров М.Д., Соломатин С.А. и др. Принципы диагностики и комплексного лечения вторичной лимфедемы конечностей. - Вестник лимфологии, 2005, №1, с.32 - 35.
9. Drayton D.L. et al.Lymphoid organ development: from ontogeny to neogenesis. - Nat. Immunol., 2006, vol. 7, pp. 344 - 353.
10. Logan V. Incidence and prevalence of lym­phoedema: a literature review. - J. Clin. Nurs., 1995, vol. 4, pp. 213 - 219.
11. Mortimer P.S. Pathophysiology of Lymphedema. - Proceedings of the 16^th International Congress of Lymphology, 1997, pp. 1 - 4.
12. Takeshi Watanabe et al. Artifisial lymph node transplanted into mice. - Journal of Clinical Investigation, 2007, doi:10.1172/JCI30379
13. von Andrian U.H., Mempel T.R. Homing and cellular traffic in lymph nodes. - Nat. Rev. Immunol., 2003, vol. 3, pp. 867 - 878.