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16SCANNING ELECTRONIC MICROSCOPY OF SPERMATIC VEINS
AT VARICOCELE Shamsiev A.M.1, Kodirov N.D.2, Baybekov I.M.3, Shamsiev J.A.4,
Igamova S.S.5
1Shamsiyev Azamat Muxitdinovich - Professor;
2Kodirov Nizom Daminovich - Assistant, DEPARTMENT OF PEDIATRIC SURGERY, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND;
3Baybekov Iskandar Mukhamedovich - Professor, Head of the Laboratory, LABORATORY OF PATHOLOGICAL ANATOMY, RSCS NAMED AFTER ACAD. V. VAHIDOV, TASHKENT;
4Shamsiyev Jamshid Azamatovich - Professor, Head of the Department, DEPARTMENT OF PEDIATRIC SURGERY, POSTGRADUATE MEDICAL FACULTY;
5Igamova Saodat Suratovna - Assistant, DEPARTMENT OF NEUROLOGY AND NEUROSURGERY, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Varicocele - pathological expansion and tortuosity of the scrotum. The term varicocele refers primarily to the expansion and tortuosity of the components of the venous plexus draining the testicles [2, 4, 7].
It occurs in 15-20% of adult men and up to 40% of non-sexually mature boys. [1, 4, 6]. This pathology is more often observed on the left side of the scrotum and may be the cause of a decrease in testicular (sexual) function [5, 11]. There are several theories of the etiology of this dysfunction [3, 10]. The main thing is the anatomical features of the venous plexus, including the angle of the admission of the testicular vein into the left renal vein, which determine the functional insufficiency of the venous valves at the juncture of the testicular and renal vein [8, 9].
Varicocele shows structural changes in all shells. In the middle shell, there is hypertrophy of the muscle elements and intermuscular connective tissue. In those places where the inner shell has changes in the form of plaques, the middle shell is especially strongly rarefied. In the groinlike plexus, in the areas of contact of the walls of the vessels with each other, there is a strong development of longitudinal-muscular elements [1, 4]. Morphological method - one of the most objective in assessing the condition of varicose veins and convoluted veins in varicocele. Knowledge of the morphological status of varicose veins of the scrotum can serve as a determining factor in the choice of the method of surgical intervention. However, there is a small number of studies of structural changes in v. spermaticus in varicocele. Studies of the same structure of veins in varicocele with the help of scanning electron microscopy (SEM) were practically not carried out. This is the definitive goal of this work.
The purpose of the study is to study, using SEM, the peculiarities of the veins in varicocele.
Material and methods of research. To study varicose veins, their fragments were obtained during operative excision of persons aged 15 to 20 years. Samples were fixed in a 10-12% solution of neutral formalin. After appropriate processing, the pieces were poured into paraffin and sections 5-7 ^m thick were prepared. A general morphological picture was studied on sections stained with hematoxylin and eosin. The study and photographing of the preparations was carried out with the help of the Axioscope (Carl Zeiss) microscope with a digital camera ProgRess, CapturePro 2.6, coupled with a Pentium IV computer. For SEM, the preparations, after fixing in 2.5% glutaraldehyde solution on phosphate buffer, were
subjected to dehydration in alcohol-acetone, then dried by a critical point in the HCP-2 apparatus and sputtered with gold in an IB-2 apparatus. The scan was performed in a Hitachi S-405A microscope (Japan). Photographing was carried out from the monitor screen using a Canon digital camera
Computer processing of the received video data was carried out with the help of Windows Professional applications on the Pentium IV computer.
Research results. With light-optical studies in the veins, all three shells are clearly distinguishable: tunica intima, t. media, t. adventitia. A characteristic feature of these is the close contact of the walls of the vessels that form the indicated cord (Fig. 1).
Fig. 1. The fusion of the walls of the veins of the thrombus plexus is enlightened. 10*10
Another peculiarity of the plexus veins is the rather narrow, partly collapsed lumens, the longitudinal dimensions of which sometimes several times exceed the dimensions of the diameter. In the lumen of the veins, blood convolutions and mixed blood clots are often detected, which are often intimately intertwined with intima. (Fig. 1, 2).
Fig. 2. The lumen of the vein. Inner surface with fine folds, interlacing of smooth muscle fibers t.
Media. SEM *100
SEM veins of the lobate plexiform plexus venous plexus of the spermatic strand showed that the most developed layer is t. media.
T. intima in the veins examined is rather polymorphic. Along with small folds lined with flattened endothelial cells (Fig 3, 4), there are areas lined with higher endothelial cells of cubic and even prismatic shape. (Fig. 3).
Fig. 3. Wavy surface of the intima with furrows and grooves. SEM-1000
Fig. 4. Endothelial cells of inner surface ofprismatic form. SEM *400
In t. media smooth-muscular and, in part, connective tissue fibers quite chaotically intertwining with each other, still have a distinct circular arrangement.
The main relief of the inner surface of the veins is determined by large folds and ridges, on the surface of which smaller folds are formed. The latter, as noted above, are lined with endothelium (Fig. 5).
Fig. 5. Large crests of the internal surface with clusters of uniform elements of blood. SEM *400
One of the characteristic features of the inner surface of the intima is the accumulation in the deep furrows of blood cells, mainly red blood cells and fibrin strands. Erythrocytes and other blood cells can be located on the surface of the endothelial lining, but more often they are defined in areas where the endothelium is desquamated (Fig. 6).
Fig. 6. Accumulations of strands offibrin and blood cells in the indentations of the inner surface.
SEM-1500
With large increases, it is seen that among the red blood cells located on the inner surface of the vessels, in areas as lined with the endothelium, and, more often, without lining, along with discocytes - (normal form of erythrocytes) there are many pathological forms. Among pathological forms, echinocytes dominate - red blood cells with numerous processes.
Accumulations of erythrocytes and other blood cells with strands of fibrin represent the initial stage of the formation of thrombus.
SEM studies have shown numerous clumps on the luminal surface of erythrocytes and other blood cells with strands of fibrin, which may be the precursor of the formation of thrombi. Moreover, these deposits can be located on the holistic endothelial lining, but are more often found in deendotelized areas.
Among the clusters of formed elements of blood, erythrocytes predominate, and their pathological forms are echinocytes.
Identified features should be considered when performing surgical treatment varicocele.
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