From Big Medical Encyclopedia

COMMISSURES (synechia, singular; synonym: synechias, shvarta) — fibrous unions between the next bodies or surfaces.

Pages subdivide on inborn and acquired. Inborn S. are observed at malformations; their education is connected also with preservation in the postembryonal period of not reduced educations, napr, the vitelline and intestinal course. The acquired S. develop in the result of limited or diffusion inflammatory process in a serous or synovial membrane with the subsequent organization of exudate. In the beginning friable fibrinous S. are formed, to-rye are easily divided in the stupid way. In the subsequent exudate if it did not resolve, exposed organizations (see). Also S. in perigastriums at the organization of the streamed blood are formed. As a result of mechanical irritation of serous covers at the movement of bodies (a peristaltics of intestines, reduction of heart) mesothelial outgrowths («reactive structures») can form, to-rye further turn into fibrous Villages. Regarding cases there is a need to cause an union of serous leaves. In particular, in pulmonary surgery (pheumothorax, an empyema of a pleura, etc.) make an artificial obliteration of a pleural cavity for prevention of postoperative complications in the operational way (pneumopexy) or causing aseptic inflammatory reaction by means of chemical substances (caustic silver, ether, alcohol, etc.).

Macroscopically Pages represent tyazh, tapes, membranes or films of various thickness and length; they can be single, multiple, widespread and sometimes shroud all body or bodies, causing a partial or full obliteration of a serous cavity, leading to deformation and patol. to shift of bodies.

Histologically Pages are formed by mature fibrous fabric with a small number of neogenic elastic fibers. In the thickness of S. mixed vessels, quite often sinusoidny type, and sometimes the phenomena of an angiomatosis are found. The regenerating nerve fibrils from the next bodies grow into S. As a result of dystrophic processes S.'s hyalinosis is possible (see. Hyalinosis ). In some cases S. are exposed to calcification with metaplastig:esky growth of a bone tissue. As a result of these processes dense trudnorazdelimy Pages are formed. Plentiful adjournment of salts of calcium in S. of a pericardium leads to formation of a limy armor — a so-called armored heart (see. Pericardis ). At the organization of exudate in pleural cavities dense numerous unions obnaruyashvatsya often (see. Pleurisy ), the direction of collagenic bunches in to-rykh various, depending on S. Chast's mobility of such S. contains the layers of fatty tissue which are carrying out a role of depreciation devices. At an inflammation of a peritoneum widespread commissural process develops seldom. In some cases S.'s development can lead to development adhesive desease (see). Pages can support inflammatory process at encapsulation of exudate (interintestinal abscesses, a blocked pleuritis, peritonitis), to lead to development of an interstitial inflammation and subserous sclerosis in bodies.

Wedge, symptomatology, caused by commissures, depends on extent of development of commissural process and it is expressed in bigger or smaller disturbance of functions of bodies (see. Perigastritis , Perihepatitis , Periduodenitis , Pericardis , Peritonitis , Pericholecystitis , Pleurisy ).

Restriction of mobility of bodies, a pain syndrome, mechanical impassability quite often demand an operative measure. Physiotherapeutic treatment in some cases leads to involution

of S. Effektivnoye treatment the inflammatory processes leading to S.'s development, as a rule, prevents their development.

Bibliography: Baron M. A. Reactive structures of internal covers, L., 1949; The Multivolume guide to pathological anatomy, under the editorship of A. I. Strukov, t. 4, book 1, page 455, M., 1956, book 2, page 26, M., 1957.

G. M. Mogilevsky.