Lymphatic Disturbances Research Articles

Preventive chemotherapy reverses covert, lymphatic-associated tissue change in young people with lymphatic filariasis in Myanmar.

ObjectivesThis longitudinal comparative study investigated the effect of preventive chemotherapy (PC) on covert tissue changes associated with lymphatic filariasis (LF) among young people living in an LF‐endemic area in Myanmar.MethodsTissue compressibility and extracellular free fluid in the lower limbs of people aged 10–21 years were measured using indurometry and bioimpedance spectroscopy (BIS). Baseline measures were taken in October 2014, annual mass drug administration (MDA) of PC was delivered in December, and in March 2015 further PC was offered to LF‐positive cases who had missed MDA. Follow‐up measures were taken in February and June 2015.ResultsA total of 50 antigen‐positive cases and 46 antigen‐negative controls were included. Self‐reported PC consumption was 60.1% during 2014 MDA and 66.2% overall. At second follow‐up, 24 of 34 cases and 27 of 43 controls had consumed PC. Significant and clinically relevant between‐group differences at baseline were not found post‐PC. Bayesian linear mixed models showed a significant change in indurometer scores at both calves for antigen‐positive cases who consumed any PC (dominant calf: −0.30 [95% CI −0.52, −0.07], P < 0.05 and non‐dominant calf: −0.35 [95% CI −0.58, −0.12], P < 0.01). Changes in antigen‐negative participants or those not consuming PC were not significant.ConclusionThis study is the first attempt to use simple field‐friendly tools to track fluid and tissue changes after treatment of asymptomatic people infected with LF. Results suggested that PC alone is sufficient to reverse covert lymphatic disturbance. Longer follow‐up of larger cohorts is required to confirm these improvements and whether they persist over time. These findings should prompt increased efforts to overcome low PC coverage, which misses many infected young people, particularly males, who are unaware of their infection status, unmotivated to take PC and at risk of developing lymphoedema. Indurometry and BIS should be considered in assessment of lymphatic filariasis‐related lymphedema.

Pseudotumor Cerebri and Glymphatic Dysfunction.

In contrast to virtually all organ systems of the body, the central nervous system was until recently believed to be devoid of a lymphatic system. The demonstration of a complex system of paravascular channels formed by the endfeet of astroglial cells ultimately draining into the venous sinuses has radically changed this idea. The system is subsidized by the recirculation of cerebrospinal fluid (CSF) through the brain parenchyma along paravascular spaces (PVSs) and by exchanges with the interstitial fluid (IF). Aquaporin-4 channels are the chief transporters of water through these compartments. This article hypothesizes that glymphatic dysfunction is a major pathogenetic mechanism underpinning idiopathic intracranial hypertension (IIH). The rationale for the hypothesis springs from MRI studies, which have shown many signs related to IIH without evidence of overproduction of CSF. We propose that diffuse retention of IF is a direct consequence of an imbalance of glymphatic flow. This imbalance, in turn, may result from an augmented flow from the arterial PVS into the IF, by impaired outflow of the IF into the paravenous spaces, or both. Our hypothesis is supported by the facts that (i) visual loss, one of the main complications of IIH, is secondary to the impaired drainage of the optic nerve, a nerve richly surrounded by water channels and with a long extracranial course in its meningeal sheath; (ii) there is a high association between IIH and obesity, a condition related to paravascular inflammation and lymphatic disturbance, and (iii) glymphatic dysfunction has been related to the deposition of β-amyloid in Alzheimer’s disease. We conclude that the concept of glymphatic dysfunction provides a new perspective for understanding the pathophysiology of IIH; it may likewise entice the development of novel therapeutic approaches aiming at enhancing the flow between the CSF, the glymphatic system, and the dural sinuses.

Comparative and Developmental Anatomy of Cardiac Lymphatics

The role of the cardiac lymphatic system has been recently appreciated since lymphatic disturbances take part in various heart pathologies. This review presents the current knowledge about normal anatomy and structure of lymphatics and their prenatal development for a better understanding of the proper functioning of this system in relation to coronary circulation. Lymphatics of the heart consist of terminal capillaries of various diameters, capillary plexuses that drain continuously subendocardial, myocardial, and subepicardial areas, and draining (collecting) vessels that lead the lymph out of the heart. There are interspecies differences in the distribution of lymphatic capillaries, especially near the valves, as well as differences in the routes and number of draining vessels. In some species, subendocardial areas contain fewer lymphatic capillaries as compared to subepicardial parts of the heart. In all species there is at least one collector vessel draining lymph from the subepicardial plexuses and running along the anterior interventricular septum under the left auricle and further along the pulmonary trunk outside the heart and terminating in the right venous angle. The second collector assumes a different route in various species. In most mammalian species the collectors run along major branches of coronary arteries, have valves and a discontinuous layer of smooth muscle cells.

Application of Ag-doped TiO2 nanoparticle prepared by photodeposition method for nitrate photocatalytic removal from aqueous solutions

Nitrate pollution in surface and groundwater resources is considered as an environmental challenge because of the potential risks of nitrate in diseases such as methemoglobinemia, lymphatic disturbances, and blood cancer. On the other hand, nanomaterials have been recently applied for the control of water pollutants. The objective of this research was to investigate the efficiency of silver-doped TiO2 nanoparticles prepared by photodeposition method under UV irradiation for nitrate removal. Ag-doped TiO2 nanomaterials (Ag/Ti = 0.1 at %) were characterized by scanning electron microscope-energy dispersive X ray, transmission electron microscope, X-ray diffraction, and BET and used in doses of 0.1, 0.4, 0.8, and 1.2 g/L. Three nitrate concentrations of 20, 50, and 100 mg/l were considered in the pH range of 5–9. The effect of Ag-doped TiO2 nanoparticles both in dark and with UV irradiation was studied. Nitrite and ammonia, as intermediates of photocatalytic degradation of nitrate, were detected by spectrophotometric method. Also, in the study, the effect of change in Ag percent doped on TiO2 under UV irradiation for nitrate removal was investigated. The effect of calcination temperature was surveyed on Ag-doped TiO2/UV process efficiency in nitrate removal from aqueous solutions. The optimum performance of nitrate removal (95.5%) was obtained with initial concentration of 100 mg/l and in acidic pH. Increase of Nanoparticle concentration up to 0.8 g/L, improved the removal efficiency, but 1.2 g/l of nanoparticles reduced the degradation efficiency. Maximum reduction performances without nanoparticles (with UV irradiation and in dark) were 32 and 23.3%, respectively. Optimal calcination temperature and optimal silver content doped on TiO2 was obtained at 400°C and 1%.

Lymphoscintigraphy in Angiomyomatous Hamartomas and Primary Lower Limb Lymphedema

Angiomyomatous hamartoma (AH) of the lymph node is a rare vascular benign disease of unknown etiology with a predisposition for the lymph nodes of the inguinal area. Only 18 cases have been described up to now in the literature and the disorder was reported to be associated with lymphedema or swelling of the ipsilateral limb in 4 patients. However, scintigraphic investigation of the lymphatic system in these patients was reported in only 2 cases. Five patients where the biopsy of inguinal nodes for suspected lymphadenitis led to the diagnosis of angiomyomatous hamartoma were investigated using lymphoscintigraphic techniques (1 girl aged 15; 1 boy aged 9 at the time of first biopsy and 11 at the time of the second one; and 3 men aged 30, 50, and 57). The operated limb was lymphedematous in 3 and 1 developed lymphedema after biopsy. The fifth patient developed a contralateral lymphedema after his second nodal biopsy. In all cases, lymphoscintigraphic investigation of the limbs showed extensive lymph node abnormalities on the operated side and in 4 cases on the opposite side. These observations support not only the hypothesis that lymphatic disturbance was involved in the pathogenesis of these tumors but also the proposition that lymphoscintigraphy should be performed in cases of inguinal lymphadenitis of unknown origin to diagnose the underlying situation of latent lymphedema.

Manejo nutricional e digestibilidade no quilotórax canino

O quilotórax corresponde ao acúmulo de fluido linfático em um ou em ambos os espaços pleurais, resultante do extravasamento de linfa do ducto torácico ou de uma de suas divisões principais. Este pode estar associado à ascite quilosa em pacientes com distúrbios linfáticos sistêmicos, como na linfangiectasia, em decorrência de defeitos no transporte linfático-venoso do quilo da cavidade torácica para a circulação sistêmica. A linfangiectasia intestinal é um distúrbio obstrutivo que envolve o sistema linfático do órgão e revela-se como a causa mais comum de enteropatias associadas à má absorção e perda de proteínas em cães. São apresentados no presente relato o controle clínico com o uso de dieta caseira com baixa gordura e a quantificação da função digestiva, por meio da determinação da digestibilidade do alimento, em um cão acometido por quilotórax secundário à linfangiectasia intestinal. A dieta caseira incluiu arroz, peito de frango, cenoura, carbonato de cálcio, levedura de cerveja, suplemento vitamínico e mineral e sal. O ensaio de digestibilidade foi conduzido pelo método de coleta total de fezes. A dieta caseira foi eficaz em interromper o acúmulo de efusão quilosa torácica, restabelecer as concentrações de proteína total e albumina e promover ganho de peso no paciente. Os resultados da digestibilidade demonstraram menor aproveitamento de todos os nutrientes no cão com linfangiectasia em relação ao controle sadio.

Advances in small animal mesentery models for in vivo flow cytometry, dynamic microscopy, and drug screening

Using animal mesentery with intravital optical microscopy is a well-established experimental model for studying blood and lymph microcirculation in vivo. Recent advances in cell biology and optical techniques provide the basis for extending this model for new applications, which should generate significantly improved experimental data. This review summarizes the achievements in this specific area, including in vivo label-free blood and lymph photothermal flow cytometry, super-sensitive fluorescence image cytometry, light scattering and speckle flow cytometry, microvessel dynamic microscopy, infrared (IR) angiography, and high-speed imaging of individual cells in fast flow. The capabilities of these techniques, using the rat mesentery model, were demonstrated in various studies; e.g., real-time quantitative detection of circulating and migrating individual blood and cancer cells, studies on vascular dynamics with a focus on lymphatics under normal conditions and under different interventions (e.g. lasers, drugs, nicotine), assessment of lymphatic disturbances from experimental lymphedema, monitoring cell traffic between blood and lymph systems, and high-speed imaging of cell transient deformability in flow. In particular, the obtained results demonstrated that individual cell transportation in living organisms depends on cell type (e.g., normal blood or leukemic cells), the cellos functional state (e.g., live, apoptotic, or necrotic), and the functional status of the organism. Possible future applications, including in vivo early diagnosis and prevention of disease, monitoring immune response and apoptosis, chemo- and radio-sensitivity tests, and drug screening, are also discussed.

Two Exercise Schemes in Postoperative Breast Cancer: Comparison of Effects on Shoulder Movement and Lymphatic Disturbance

We attempted to determine the best method of performing the exercises in rehabilitation after breast cancer surgery and their influence on postoperative complications. Currently, there are no guidelines for these exercises. The scope of this study was to evaluate the effect of two schemes of physiotherapy exercises (directed or free) on shoulder function and lymphatic disturbance in postoperative rehabilitation. Sixty women who underwent a modified radical mastectomy or quadrantectomy with axillary dissection were randomized into two groups. The physiotherapy technique used was kinesiotherapy. The directed group performed physiotherapy following a regimen of 19 exercises. The free group performed the exercises following the biomechanical physiological movements of the shoulder without a previously defined sequence or number of repetitions. The averages of the flexion, abduction and external rotational movements of the shoulder showed better recovery with statistical significance in the directed group compared to the free group. There was no significant difference between the groups in lymphatic disturbance. At the end of 42 days of follow-up, the movements of flexion, extension, abduction and external rotation of the shoulder were better rehabilitated in the directed group. The two schemes of exercises were not different with regard to lymphatic disturbance.

Morfo-anatomia de sementes de Dipteryx odorata (Aubl.) Will. (Fabaceae) como contribuição ao estudo Farmacognóstico de plantas da região Amazônica

Dipteryx odorata (Aubl.) Willd. (Fabaceae) é popularmente conhecida como cumaru. Suas sementes são utilizadas pela população, por seus efeitos terapêuticos, dados pela cumarina, hoje comercializada para distúrbios vasculares e linfáticos e pela produção de óleo. Realizou-se um estudo morfo-anatômico de sementes de seis indivíduos desta espécie através da caracterização morfológica, determinação do peso da matéria fresca e das dimensões de 100 sementes, além de cortes histológicos transversais e longitudinais, considerando-se o tegumento e o embrião. A semente é oblonga, levemente comprimida na região do hilo. O tegumento seminal apresenta cutícula delgada e lisa, macroesclereídeos, osteoesclereídeos, mesofilo interno e membrana basal. O embrião constitui-se de dois cotilédones e o eixo embrionário retilíneo, formado por plúmula, epicótilo e radícula.

Stasis papillomatosis. Clinical features, etiopathogenesis and radiological findings.

Stasis papillomatosis can be divided into localized and widespread forms. Ten patients with this disease are discussed with emphasis on their clinical and lymphoradiological findings. Using isotope lymphography we were able to find an overall lymphostasis in only four patients. In all patients, local lymphatic disturbances were detected by means of indirect lymphography with intradermal lymph cysts as the most specific sign. Local dermal lymphostasis seems to be the common final pathogenesis in spite of different etiologies (ie, primary lymphedema, chronic venous insufficiency, trauma recurrent erysipelas, and local lymphangiodysplasia of unknown origin). A maximum variant was seen, following en-bloc resection of subcutaneous tissue in a patient suffering from congenital lymphedema.

A CASE OF WUCHERERIASIS ON THE SPERMATIC CORD

As taken up in the preface the diagnosis of Wuchereriasis on the spermatic cord is easy to make when chyluria or elephantiasis appear simultaneously, or the occurrence of the characteristic fever access in the past and the presence of microfilaria in blood can be confirmed. But when we touch only an induration in the scrotum the differentiation of it from tuberculosis of the spermatic cord, varicocele, tumor of the spermatic cord, etc. Is very difficult and diagnosis should be made with caution. As for the genetic mechanism of the ailment concerned, as Shida and Fukuda, Nakamura and Ichimura have indicated, the Filaria bancro fti penetrates into the lymph vessel of spermatic cord and brings about a lymphatic circulatory disturbance with a mechanical lesion caused by worms, which results in the cystic dilatation of the local lymph vessel. As long as the lesion cannot be removed at the stadium, the canal dilatation seems to develop into a hypertrophy of the wall until inflammatory regressive degeneration is brought about.

Kaposi's sarcoma of the hard and soft palate: Report of a case with a five-year follow-up

1. 1. A case of multiple idiopathic hemorrhagic sarcoma of Kaposi of the hard and soft palate has been presented. 2. 2. Kaposi's sarcoma is usually systemic in nature, but it may be involved locally and independently in an unpredictable manner, involving the skin and internal organs with vascular and lymphatic disturbances, with a later fibrous hyperplasia. 3. 3. It is characterized further by a series of histologic patterns from which a definitive etiological picture is extremely vague. 4. 4. Surgery with wide excision is the treatment of choice when the lesions are single or few in number, but not involved systemically or complicated by metastases. However, when the lesions are many and confluent, x-radiation may prove beneficial. 5. 5. Immediate replacement of lost tissue with a prosthetic appliance builds morale, since speech and mastication are improved.

Researches on the Follicular Diseases of the Conjunctiva: Their Relation to the Laws of True Trachoma, its Etiology, and Unification of Conception

Follicular disease of the conjunctiva is classified as (1) simple follicular conjunctivitis; (2) miliary follicular conjunctivitis, or ophthalmia; (3) hyperplastic folliculomatous conjunctivitis or trachoma verum. The clinical and histological characteristics of each form of the disease are presented with numerous illustrative case reports. Four laws of trachoma are formulated. (1) There is no trachoma without follicles. (2) The trachoma follicle is a confluent follicle. (3) The folliculoma of trachoma can develop on the conjunctiva, as well as on the cornea. (4) True trachoma finally passes into spontaneous cicatrization or hyaline degeneration. The fourth law applies to every lymphadenoid tissue. Numerous parallel cases in families are described showing the hereditary tendency not only of trachoma but of accompanying evidences of lymphatic disturbances. The conclusion is drawn that trachoma is an endogenous, constitutional lymphadenoid disease of the conjunctiva and not an inflammatory lymphocytic infiltration in which follicles are accidental manifestations. From the University Ophthalmic Clinic of Sophia, Prof. Dr. C. Pascheff, director.