Zeitschrift fur Lymphologie. Journal of lymphology最新文献

The lymphatic system has been demonstrated by means of special microscopic investigations, using morphologically comprehensive resorption procedures. References has been made to the literature which gives an account of the available knowledge about the lymphatic system and the scientific concepts produced in the course of the centuries. After going into the fundamental morphological principles of parenteral resorption and resorption in the bovine uterus, a description is given of the transport of the vital dyes patent blue violet and Japanese ink, which was followed microscopically in the lymphatic system. A further phenomenon emerges with the concept of persorption, where the particles are in the micron range and have also been identified microscopically in the pathways of the lymphatic system.

In the present paper, 66 Studies on exploratory laparotomy with splenectomy in Hodgkin's lymphoma from Western Europe and the USA are presented in tables. This statistical compilation on 7183 laparotomies shows that the spleen was involved in 39.9% (2685 out of 6900 cases investigated), the liver in only 7.7% (446 out of 5789) and the abdominal lymph nodes were involved in 30.3% (1389 out of 4578) of the cases. Altogether, laparotomy with splenectomy led to a change in staging in 33% of the patients (1892 out of 5745). In the period from 1970 to 1986, 123 patients with Hodgkin's lymphoma were laparotomized (and also splenectomied apart from one exception) at the Surgical Division, University of Göttingen. The patients comprised 52 cases in the context of primary staging and 71 cases in the context of secondary staging. In 43 cases (35.2%) the spleen was affected, in seven cases (5.7%) the liver was affected, and there was combination with spleen involvement in each case. Infiltration of abdominal lymph nodes was shown in 38.2% (26/68). Exploratory laparotomy led to a change in stage in 46 cases (37.1%) comprising 28 improvements and 18 deteriorations. Before laparotomy, 15 patients were in stage I, 29 in stage II, 44 in stage III and 21 in stage IV. After pathological staging, 14 were in stage I, 40 were in stage II, 47 were in stage II and 19 were in stage IV. Out of the 14 patients who could not be assigned to any stage before the operation, 11 could be definitively staged afterwards. In addition, lymphography was performed in 103 patients, liver and spleen scintigraphy in 51 patients, sonography in 30 patients and computer tomography in 22 patients. In the re-examination of the lymph node situation in the retroperitoneal space, lymphography attained a specificity of 48% and a sensitivity of 71.4% with a positive prediction precision of 35.7% and a negative prediction precision of 88.8%.

Experience and results are reported on the basis of more than 380 lymphographic investigations in patients with a malignant testicular tumor. In 61% of these patients, there was suspicion of a metastatic infiltration of the retroperitoneal lymph nodes. In 75 patients, histological checking of the lymphographic finding was possible on the basis of a retroperitoneal lymphadenectomy. Lymphography was shown to have a precision of 81%. Lymphography is obligatory as a complement to other techniques of investigation such as sonography and computer tomography in patients with malignant testicular tumor, since the greatest diagnostic information can be expected from combined application of all three methods.

Intolerance reactions of the skin in which a decision is made on allergic and toxic genesis have increased in significance in recent years. Whereas antibodies blocking bacterial or viral antigens are formed in the normergic immune reaction, nonblocking antibodies to animal, plant or chemical heterologous substances are formed in an allergy as a result of an misdirected immunological reaction. Sensitization is favored by a) large structure and protein affinity of the allergen, b) irritation of the affected part of the skin by fungi or chemicals and c) genetic predisposition. Depending on the clinical manifestation, a distinction is made between inhaled allergens (bronchial asthma, hay fever), allergens ingested with the food (food allergy) and allergens which have come in contact with the skin (immediate reaction - urticaria, late reaction - contact eczema). Intolerance reactions of the skin which can be ruled out as the cause of an allergy are designated as toxic. Acute toxic reactions are based on violent or intensively physical (heat, cold, radiation), chemical (acids, alkalis, heavy metal salts, oils, solvents) or microbial damage to the skin (infection by fungi, bacteria, viruses). The degenerative eczema as the most important form of chronic toxic intolerance reaction arises by weak but continuously acting longterm mechanical or chemical exposures.