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31.07.2014, 00:44 | |
Резюме УДК 617.764.6-002-053.1-089.819.2 Украинский медицинский центр детской офтальмологии и микрохирургии глаза НДСЛ «Охматдет» МОЗ Украины (Киев) National Children's Specialized Hospital "Okhmatdyt" MOH of Ukraine, Center for Pediatric Ophthalmology and eye microsurgery (Kiev)
barinof@ua.fm
Viscoelastic preparations based on methyl cellulose are widely used in medicine for production of pharmacological preparations, in ophthalmology it's derivatives are used for tear film substitutes. For lacrimal system polymer substances as viscoelastic solutions (derivatives of methyl cellulose), oxypropylmethyl cellulose and polyvinyl spiritus, added as a thickener for a contrast substance during x-ray examination have been already used. Although the authors haven't brought data about influence of this widely used viscoelastic solution on lacrimal epithelium and about duration of its staying in lacrimal system. Such characteristic as ability of maintenance of a certain volume during a certain period of time with fixation to endothelium in the eye cavity led to a presumption that same characteristic should be performed also in nasolacrimal duct cavity. Protecting layer on epithelium of nasolacrimal duct may protect from adhering of the opposite walls after bouginage, thus preventing recurrent dacriocystitis. Aim of the research. To study reaction of tissues and adhesion of viscoelastic solution on an epithelium plast of lacrimal system on different levels in experiment, and to define duration of it's staying in lacrimal system with the following argumented using for treatment of recurrent dacriocystitis in children. Material and methods. Excision of organ complexes has been performed under control of surgical microscope "Leica ICC50HD". During the work 20 organ complexes of 10 rats has been excised (in all the cases organ complexes have been excised from both sides). Intraperitoneal anesthesia has been used during surgeries, 0,2 ml of Sodium Tiopental and 0,4 ml of 0,1% solution of propofol. The coarse of the experiment was the following. To control and determine peculiarities of lacrimal system structure 4 organ complexes of 2 rats have been excised after standard bouginage and dilation of lacrimal canalicules with #00 probe. The other 8 rats had dilation of superior and inferior lacrimal canalicules with probe #00 done with the following introduction of viscoelastic solution "Cellugel", stained with methylene blue (volume 0,15-0,2ml) from both sides, where preparations were experimental and excised by 3 organ complexes during the next 3 days. All the animals used in the experiment were alive until the moment of the end of their participation in the experiment. Euthanasia of the animal in the planned termed has been performed by overdosing of 5% tiopental solution. The excised tissues have been fixed on a firm base with narrow needles considering organotopics and pointing localizing of the beginning of lacrimal canalicules and entrance into medium and inferior nasal duct. To perform hystological exams the tissues were introduced into formaldehyde with the volume part of 10% for fixation with the following shading into paraffin. 6mkm slices, stained with hematoxylin and eosin were performed in longitudinal way following coarse of lacrimal canalicules and perpendicularly to the axis. Results of the examination and discussion. Hystological analysis of the obtained control preparations showed that both lacrimal canalicules of the rodents merge into a tube which than opens into a lacrimal sack (our own data is agreed with the literature). Mucous of the canalicules is covered with multilayer simple nosquamous epithelium. Base membrane of the mucous is made of elements of fibroplasic raw, thin collagen and elastic fibers which are situated circularly by 6-12 layers. During the first day of examination filling of lacrimal sack has been found with the level of examining solution. Histologic examination showed tense adhesion of viscoelastic solution with epithelium of lacrimal duct on the level of lacrimal sack and haven't shown any signs of functional tension of the epitheliocytes. This gives an opportunity to almost surely presume that none of pathological changes can be seen afterwards. On the second day of examination partial filling of lacrimal duct of a white rat with the stained viscoelastic solution with the presence of adhesion on the unchanged epithelium plast has been registered. No hemorrhage and vessel dilation in the submucous layer or desquamation of epithelium plast cells, in the areas of contact with viscoelastic solution cellular elements testifying inflammation were absent. Histologic picture of lacrimal duct and surrounding tissues epithelium is comparable to control results of the experiment animal. The examination held on the third day showed presence of the remains of the stained viscoelastic solution in the epithelium plast of nasolacrimal duct with the main volume of the introduced substance on the level of entrance into nasal cavity. Entrance into nasal cavity on the level of the anterior parts or medial and inferior nasal turbinate is covered with multilayer squamous epithelium unlike lacrimal duct of a white rat having multilayer nonsquamous cover. Though this peculiarity hasn't impacted adhesive properties of viscoelastic solution. Conclusion 1. During the experiment it has been found that viscoelastic solution has a tense adhesion to squamous epithelium of lacrimal system of a white rat, without desquamation and functional tension of epitheliocytes of nasolacrimal duct, hemorrhage or vessel dilation in submucous zone, cellular elements, testifying inflammation in areas of contact with examining solution during 3 days. 2. Therefore taking into consideration theoretic data and results of own experiment examination, we may tell that a way of treatment of recurrent dacriocystitis using viscoelastic solution to separate the opposite surfaces of nasolacrimal duct is actual and pathogenetically approved. Литература
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