Duct Lymph Research Articles

Treatment of an Inguinal Lymphatic Fistula with Indocyanine Green

<h3>Study Objective</h3> To address iatrogenic lymphocele after inguinal lymphadenectomy for vulvar cancer with a minimally invasive intervention, by localizing the disrupted lymphatic duct with real-time NIR/ICG fluorescent imaging. <h3>Design</h3> Narrated video footage. <h3>Setting</h3> Department of Gynecologic Oncology, Bern University Hospital. <h3>Patients or Participants</h3> Patient A underwent hemivulvectomy with homolateral inguinal sentinel lymphadenectomy for a squamous cell carcinoma of the right vulva, FIGO Ib. Two weeks later she reported a wound dehiscence in her right groin with abundant yellowish discharges, persisting over time and leading to a remarkable progression of the dehiscence. Patient B was seen after R1 resection of a relapsing FIGO II, already treated with combined chemoradiotherapy one year before. She underwent dorsal hemivulvectomy with bilateral inguinal lymphadenectomy, complete colpectomy and coverage of tissue defects with fascio-cutaneous flaps. Two weeks later she reported a closed inguinal lymphocele. We attempted a conservative treatment with antibiotics and needle aspirations, nevertheless a multibacterial infection occurred on the right side. <h3>Interventions</h3> By failing conservative measures, surgical correction of assumed lymphatic fistulas was called for in both cases. After debridement of the inguinal wound in local anesthesia, an intracutaneous injection of 2 ml ICG was carried out between the 1st and 2nd ipsilateral toe. <h3>Measurements and Main Results</h3> After 7 minutes a fluorescent effusion from the site of the fistula was identified in real-time NIR imaging, performed with an optic device (VITOM® ICG) installed on the operating table for the extracorporeal detection of the fluorescence produced by ICG. The disrupted lymphatic duct could be ligated. The absence of further fluorescent effusion confirmed the successful repair. The wound was closed and healed well in the follow-up. No recurrence or exacerbation of the lymphedema occurred. <h3>Conclusion</h3> Intraoperative NIR/ICG fluorescence lymphatic imaging with an exoscope enables a highly sensitive detection of lymphatic structures and a tailored curative intervention, with a safe toxicological profile and without radiation exposure.

The Antioxidant Impact of Supplementing High and Low doses of Ashwagandha Extract in Chronic Pancreatitis Induced Experimentally

The pancreas is part of the gastrointestinal system that lies in the upper abdomen behind the stomach. It is a mixed endocrine/exocrine gland enveloped by a thin layer of connective tissue. Connective tissue septa invade the gland, dividing it into lobules, serving as a support for tissue and providing a pathway for vasculature, nerve fibers, and lymphatic ducts. The pancreas lacks a complete fibrous capsule (Abozaid et al., 2020). The pancreas is composed of exocrine portion which comprises more than 95% of the pancreatic mass and it responsible for makes and secretes digestive enzymes into the intestine and endocrine portion (the islets) which makes and secretes hormones as (insulin, glucagon, somatostatin and pancreatic polypeptide) into the blood to control energy metabolism and storage throughout the body, it includes acinar and duct cells with associated connective tissue, vessels, and nerves.it comprise 1-2% of pancreatic mass Mederos et al (2021).

Elucidating a Potential Mechanism of Permeability Enhancer Sodium N-[8-(2-hydroxybenzoyl) amino] Caprylate in Rats: Evidence of Lymphatic Absorption of Cyanocobalamin using the Mesenteric Lymph Duct Cannulated Rat

Oral administration is the most popular and convenient route for drug delivery, yet the success of oral drug delivery is dependent on the ADME properties of the drug. Among those ADME properties, permeability is considered one of the key attributes for successful oral drug absorption. Hence, the utilization of permeability enhancers to improve drug oral absorption is an important area of research in drug delivery. A multitude of data suggests that sodium N-[8-(2-hydroxybenzoyl) amino] caprylate (SNAC) is an effective permeability enhancer. Despite its success, the mechanism of how SNAC works to enhance the oral absorption of compounds is poorly understood. To better understand how SNAC worked, we investigated the hypothesis of SNAC promotes lymphatic absorption of target compounds. In this study, cyanocobalamin was used as the model compound and mesenteric lymph duct cannulated rats were used to investigate its absorption with or without SNAC. The present study demonstrated that SNAC enhanced the lymphatic absorption of cyanocobalamin when the two were co-dosed in rats. Furthermore, levels of SNAC in lymph fluid and the systemic circulation were higher when co-dosed with cyanocobalamin.

Lymphatic Malformation Presenting as Recurrent Pleural Effusion and Ascites

Background: Chylothorax is defined as the accumulation of chyle in the pleural space and is characterized by elevated triglyceride content in pleural fluid &gt;110 mg/dl. Chylous ascites is the accumulation of chyle in peritoneal fluid characterized by triglyceride levels &gt;200 mg/dL. Causes can be traumatic or nontraumatic; portal or nonportal; and congenital or acquired (inflammatory, postoperative, malignant, or infectious). Lymph duct abnormalities are a rare cause of concurrent occurrence of chylothorax with chylous ascites. Clinical Description: We report a 4½-year-old girl who initially presented a fever and was diagnosed to have right-sided pleural effusion. Since no other focus was identified, she was treated as a case of tubercular pleural effusion, following which her symptoms settled transiently. She thereafter had a recurrence of her symptoms in association with ascites and was managed as a case of relapse of tuberculosis (TB) with category 2 anti-tubercular therapy. Since her symptoms did not resolve, she was referred to our hospital for further management. Management: Clinical reasoning based on history and examination coupled with investigations ruled out cardiac, renal, hepatic, malabsorption, or nutritional pathologies of recurrent effusions. TB was ruled out. A lymphatic malformation was suspected. Therapeutic cum diagnostic paracentesis was done in a fed state, which indicated a chylous nature by the milky appearance and suggestive cytology and biochemistry. Lymphoscintigraphy confirmed the presence of a lymphatic duct abnormality. The child was managed with diet modifications, following which she improved within a week. Conclusions: The approach to recurrent effusions without any focus should be logical and sequential, as described above, to exclude the aforementioned common conditions. If workup for TB is repeatedly negative other less likely causes should be considered.

MR-lymphangiography identifies lymphatic pathologies in patients with idiopathic recurrent cervical swelling.

BackgroundIdiopathic recurrent cervical swelling may be caused by lymphatic abnormalities.MethodsTen patients (9 females, mean age 51.2 ± 7) with idiopathic recurrent cervical swelling underwent MR‐lymphangiography (MRL). MR‐lymphangiograms were evaluated regarding lymphatic anatomy and flow. Individualized treatment was recommended according to MRL‐findings.Results8/10 patients presented with left‐sided, 2/10 with right‐sided swelling. Pathological lymph‐flow was identified in all cases: thoracic duct dilatation in patients with left‐sided and right lymphatic duct dilatation in right‐sided swelling, accessory thoracic lymphatics in 7/10 and reflux in 8/10 cases. In two cases, a lymphatic thrombus was identified.After treatment, symptoms resolved completely in 6/10 cases and partially in 1/10 cases. The remaining three patients have intermittent swellings but have no treatment wish.ConclusionIdiopathic recurrent cervical swelling can be caused by lymphatic anomalies. MRL displays impaired lymphatic drainage, lymphatic vessel dilatation, and chylolymphatic reflux as hallmarks of this condition and may aid in targeted treatment planning.

An effective method to reduce lymphatic drainage post-lateral cervical lymph node dissection of differentiated thyroid cancer: a retrospective analysis

BackgroundLymph or chyle leak (LL/CL) is severe complications after lateral cervical lymph node dissection (LLND), mainly due to iatrogenic injury of the lymphatic duct. Efficient and well-operated methods to reduce postoperative drainage are still lacking. This was a feasibility study to evaluate a new method of preventing LL/CL compared to conventional treatment.MethodWe retrospectively analyzed 20 consecutive patients who used the “pedicled omohyoid flap covering (POFC)” method during LLND from January 2019 to December 2021 in our center as an observation group. Another 20 consecutive patients used the conventional method during LLND in this period as a control group. The clinical and pathological features of the two groups were compared, and the related factors that affected postoperative lymphatic drainage were analyzed with Cox proportional hazards models.ResultsThe drainage volume per 24 h and the incidence of LL/CL in the control group were both higher than that in the observation group (all P < 0.05), and the number of lymph nodes dissected in the IV region > 10 and the use of the POFC method were the independent risk factors that significantly affected the incidence of LL/CL post LLND (all P < 0.05).ConclusionsPOFC is a safe and useful method for reducing drainage and preventing LL/CL post-LLND, especially for patients with heavy metastasis of the lymph nodes in the IV region.

Imaging Findings of Thoracic Lymphatic Abnormalities

The lymphatic system plays an important role in balancing fluid compartments in the body. It is disrupted by various disease processes in the thorax, including injury to the thoracic lymphatic duct after surgery, as well as malignancy and heart failure. Because of the small size of lymphatic vessels, imaging of the lymphatics is relatively difficult, and effective imaging methods are still being optimized and developed. The standard of reference for lymphatic imaging has been conventional lymphangiography for several decades. Other modalities such as CT, noncontrast or contrast-enhanced MRI, and lymphoscintigraphy can also demonstrate lymphatic abnormalities and help in treatment planning. Imaging findings associated with lymphatic abnormalities can be seen in the pulmonary parenchyma, pleural space, and mediastinum. In the pulmonary parenchyma, common findings include interlobular septal thickening as well as reversal of lymphatic flow with intravasation of contrast material into pulmonary lymphatics. In the pleural space, findings include chylous pleural effusion and occasionally nonchylous pleural effusion. In the mediastinum, thoracic duct leak, plexiform thoracic duct, lymphatic malformations, and lymphangiectasis may occur. Management of chylothorax includes conservative or medical treatment, surgery, and interventional radiology procedures. The authors discuss thoracic lymphatic anatomy, imaging manifestations of lymphatic abnormalities in the various anatomic compartments, and interventional radiology treatment of chylothorax. Radiologists should be familiar with these imaging findings for diagnosis and to help guide appropriate management. ©RSNA, 2022.

Influence of Intestinal Lymphatic Ligation on Pulmonary Injury in Rats with Severe Acute Pancreatitis.

The present study explored the mechanisms involved in intestinal lymphatic ligation in rats with severe acute pancreatitis (SAP). Male Sprague Dawley rats were randomly divided into 4 groups: saline group, saline+ligation group, SAP group, and SAP+ligation group. Rats in the SAP group were administered sodium taurocholate solution. Isolated mesenteric lymph duct ligation was administered to the saline+ligation and SAP+ligation groups. Endotoxin (ET), nitric oxide (NO), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), myeloperoxidase (MPO), and superoxide dismutase (SOD) were detected. Nuclear factor-κB (NF-κB) and intercellular cell adhesion molecule-1 (ICAM-1) proteins were observed. The mRNA of inducible nitric oxide synthase(iNOS) and Toll-like receptor 4 (TLR4) was detected by PCR. Pathomorphological analysis showed that necrosis was present in the lung of rats in the SAP group, but only mild lesions in the SAP+ligation group. ET, NO, TNF-α, and IL-1 in the serum and lung tissue were significantly decreased and MPO was increased in the SAP+ligation group as compared with the SAP group. However, MPO was increased. The expression of NF-κB and ICAM-1, either iNOS or TLR4, was upregulated in the SAP group, but downregulated in the SAP+ligation group. Intestinal lymph duct ligation prevented ET translocation, the release of inflammation factors, and inflammation injury. The intestinal lymph duct ligation could alleviate SAP-induced pulmonary injury by suppressing NF-κB activation in rats.

Axillary reverse mapping using near-infrared fluorescence imaging in invasive breast cancer (ARMONIC study)

BackgroundAxillary lymph node dissection (ALND) in patients with breast cancer has potential side effects, including upper-limb lymphedema. Axillary reverse mapping (ARM) is a technique that enables discrimination of the lymphatic drainage of the upper limb in the axillary lymph node basin from that of the breast. We aimed to evaluate ARM node identification by near-infrared (NIR) fluorescence imaging during total mastectomy with ALND and then to analyze potential predictive factors of ARM node involvement. MethodsThe study enrolled 119 patients diagnosed with invasive breast cancer with an indication for ALND. NIR imaging using indocyanine green dye was performed in 109 patients during standard ALND to identify ARM nodes and their corresponding lymphatic ducts. Results94.5% of patients had ARM nodes identified (95%CI = [88.4–98.0]). The ARM nodes were localized in zone D in 63.4% of cases. Metastatic axillary lymph nodes were found in 55% in the whole cohort, and 19.4% also had metastasis in ARM nodes. Two patients had metastatic ARM nodes but not in the remaining axillary lymph nodes. No serious adverse events were observed. Only the amount of mitosis was significantly associated with ARM node metastasis. ConclusionsARM by NIR fluorescence imaging could be a reliable technique to identify ARM nodes in real-time when ALND is performed. The clinical data compared with ARM node histological diagnosis showed only the amount of mitosis in the diagnostic biopsy is a potential predictive factor of ARM node involvement. Clinical trial registrationNCT02994225.

Liposomes are Poorly Absorbed via Lung Lymph After Inhaled Administration in Sheep.

Enhancing the delivery of therapeutic agents to the lung lymph, including drugs, transfection agents, vaccine antigens and vectors, has the potential to significantly improve the treatment and prevention of a range of lung-related illnesses. One way in which lymphatic delivery can be optimized is via the use of nanomaterial-based carriers, such as liposomes. After inhaled delivery however, there is conflicting information in the literature regarding whether nanomaterials can sufficiently access the lung lymphatics to have a therapeutic benefit, in large part due to a lack of reliable quantitative pharmacokinetic data. The aim of this work was to quantitatively evaluate the pulmonary lymphatic pharmacokinetics of a model nanomaterial-based drug delivery system (HSPC liposomes) in caudal mediastinal lymph duct cannulated sheep after nebulized administration to the lungs. Liposomes were labelled with 3H-phosphatidylcholine to facilitate evaluation of pharmacokinetics and biodistribution in biological samples. While nanomaterials administered to the lungs may access the lymphatics via direct absorption from the airways or after initial uptake by alveolar macrophages, only 0.3 and 0.001% of the 3H-lipid dose was recovered in lung lymph fluid and lymph cell pellets (containing immune cells) respectively over 5 days. This suggests limited lymphatic access of liposomes, despite apparent pulmonary bioavailability of the 3H-lipid being approximately 17%, likely a result of absorption of liberated 3H-lipid after breakdown of the liposome in the presence of lung surfactant. Similarly, biodistribution of 3H in the mediastinal lymph node was insignificant after 5 days. These data suggest that liposomes, that are normally absorbed via the lymphatics after interstitial administration, do not access the lung lymphatics after inhaled administration. Alternate approaches to maximize the lung lymphatic delivery of drugs and other therapeutics need to be identified.

Chylous ascites with lymphatic leakage localization: technical aspects and clinical applications.

BackgroundCarbon nanoparticle suspension (CNS) was applied to locate the lymphatic leakage in chylous ascites (CA). However, the flow speed and distance of the CNS were particularly decreased in the following two cases (patient 5 and 6). This study aimed to investigate and improve the flow speed and distance of the CNS via a rat model.MethodsSeven patients with CA were accepted for surgery in the past two years. Clinical data were recorded. Rats were divided into two groups to confirm the hypothesis regarding whether accepting milk or orally administered food before surgery was the key factor in CA surgery with CNS. The animals were divided into 2 groups: experimental group of 5 rats receiving fat emulsion injection (2 g/kg) 30 min before the operation and control group of 5 rats receiving saline. We analyzed flow speed and distance of the CNS in two groups of rats. The hypothesis established was that CNS movements pattern differ depending on the degree of capillary lymph duct filling. Finally, the late case reconfirmed the hypothesis again.ResultsIn animal experiments, the CNS in the preoperative high-fat feeding group moved faster and over a longer distance than that in the control group (0.51 ± 0.09 cm vs. 0.19 ± 0.10 cm, respectively; p < 0.05). Based on this, the CNS was applied to the seventh patient, who had been given a diet with a slightly higher fat content 3 days before the operation, and marked improvement with a complete cure was recorded.ConclusionsThe capillary lymph duct was beginning to swell after dietary intake. The dilation of the lymph vessel could make it easier for the CNS to move and reach the leakage.Supplementary informationThe online version contains supplementary material available at 10.1186/s12893-022-01619-7.

Cystic malformation (lymphangioma) of the thoracic lymphatic duct (peculiarities of clinical and radiological diagnosis, a brief review)

Introduction. The thoracic lymphatic duct in the upper half of the body collects lymph from the left lung, the left half of the heart, the walls of the left half of the chest, from the left upper limb and the left half of the neck and head. Therefore, the left-sided localization of the revealed pathological changes, with the involvement of the mediastinum and neck in the process at the same time, can be a sign of damage to the thoracic lymphatic duct (at the location), and therefore the key to a successful diagnosis of the disease. Aim. Demonstration of modern possibilities of clinical and radiological diagnosis of cystic malformation of the thoracic lymphatic duct (CMTLD). Results. In the literature, the pathology of the thoracic lymphatic duct is designated by two terms: “lymphangioma” and “cystic malformation of the thoracic lymphatic duct”. According to the generally accepted classification of vascular formations ISSVA (adopted at the 20th ISSVA conference in Melbourne in April 2014, last revised in May 2018), the term “lymphangioma” with regard to lymphatic malformations is considered obsolete, its use is recommended for true benign tumors of the lymphatic vessels. CMTLD – benign, extremely rare lymphovascular lesions resulting from embryological disorders (weakness of the duct wall and valve mechanism) in the development of the lymphatic system. The median prevalence is less than 1 % among all mediastinal cystic formations. Effective non-invasive diagnostics at the initial visit of the patient already at the outpatient stage deserves professional evaluation. We present the own clinical and radiological observation of a 26-year-old patient without any special clinical manifestations, in whom volumetric changes in the mediastinum on the left were detected during routine fluorography. The nature (X-ray semiotics) of preoperative imaging using computed tomography has been clarified. The revealed X-ray and pathoanatomical changes were compared. Conclusion. CMTLD – congenital lymphatic anomalies, more frequent and symptomatic in children. In older patients, acquired and asymptomatic CMTLD are most often diagnosed. The logistics of modern imaging technologies makes it possible to successfully diagnose such a rare disease as CMTLD already at the stage of the patient’s initial visit to the doctor.

Triglyceride-Mimetic Prodrugs of Buprenorphine Enhance Oral Bioavailability via Promotion of Lymphatic Transport.

Buprenorphine (BUP) is a potent opioid analgesic that is widely used for severe pain management and opioid replacement therapy. The oral bioavailability of BUP, however, is significantly limited by first-pass metabolism. Previous studies have shown that triglyceride (TG) mimetic prodrugs of the steroid hormone testosterone circumvent first-pass metabolism by directing drug transport through the intestinal lymphatics, bypassing the liver. The current study expanded this prodrug strategy to BUP. Here different self-immolative (SI) linkers were evaluated to conjugate BUP to the 2 position of the TG backbone via the phenol group on BUP. The SI linkers were designed to promote drug release in plasma. Lipolysis of the prodrug in the intestinal tract was examined via incubation with simulated intestinal fluid (SIF), and potential for parent drug liberation in the systemic circulation was evaluated via incubation in rat plasma. Lymphatic transport and bioavailability studies were subsequently conducted in mesenteric lymph duct or carotid artery-cannulated rats, respectively. TG prodrug derivatives were efficiently transported into the lymphatics (up to 45% of the dose in anaesthetised rats, vs. less than 0.1% for BUP). Incorporation of the SI linkers facilitated BUP release from the prodrugs in the plasma and in concert with high lymphatic transport led to a marked enhancement in oral bioavailability (up to 22-fold) compared to BUP alone. These data suggest the potential to develop an orally bioavailable BUP product which may have advantages with respect to patient preference when compared to current sublingual, transdermal patch or parenteral formulations.

Lymphedema After Axillary Lymph Node Dissection in Breast Cancer: Prevalence and Risk Factors-A Single-Center Retrospective Study.

Background: Lymphedema may develop when axillary lymph node dissection (ALND) injures and obstructs the lymph ducts in the upper limb. In patients with breast cancer, lymphedema is difficult to treat and can cause arm swelling, heaviness, and restricted movement. We aimed to identify the prevalence and risk factors for lymphedema after ALND in patients with breast cancer. Methods and Results: This retrospective study included 175 patients with breast cancer who underwent ALND in the Nagasaki University Hospital, Japan, between 2005 and 2018. Lymphedema was defined as symptomatic arm swelling with a >2-cm difference in the arm circumference between the affected and contralateral arms. Patients were divided into two groups according to the presence or absence of lymphedema. Surgical and pathological findings were compared between the two groups. Univariate and multivariate analyses were performed, including the chi-square test, Student's t-test, and logistic regression analysis. Lymphedema was prevalent in 20% of the study participants, and the mean time interval from surgery to development of lymphedema was 479 days. In the univariate analysis, a body mass index of >26 kg/m2, smoking, radiotherapy (RT), and dissection of >18 axillary lymph nodes (ALNs) significantly increased the risk of lymphedema. In the multivariate analysis, smoking, RT, and dissection of >18 ALNs significantly increased the risk of lymphedema. Conclusions: The prevalence of lymphedema in our study was 20%. Our findings suggest that smoking, RT, and dissection of >18 ALNs are risk factors for lymphedema. Aggressive and empiric ALND might be associated with axillary lymph duct damage.

Morphology and Ultrastructure of the Collecting Lymph Vessel, Lumbar Trunk and Thoracic Duct in the Rat

Objective: To determine morphological and ultrastructural details of the collecting lymph vessel, lumbar trunk and thoracic duct of the rat. Methods: Sixteen adult SD rats were utilized for the study. A small amount of 6% hydrogen peroxide was applied to find the lymph vessel in the dorsodistal hind-limb and sides of the abdominal aorta in the rat. Under a surgical microscope, the vessel was injected by Indian ink or a radiopaque mixture via a fine needle to locate sites of the collecting lymphatic vessel, lumbar trunk and thoracic duct. Vessels were then harvested for the histological and transmission electron microscopic examinations. Results: Diameters of the collecting lymph vessel, lumbar trunk and thoracic duct in the rat were diverse, small in the former and large in the latter. Containing multiple valves in the lumen, their walls were very thin and composed of three layers of tissue. Ultrastructures of the tunica intima and externa of these vessels were similar. A single layer of endothelium cells with a discontinuous basement membrane formed the tunica intima of the vessel. One or two discontinuous layers of smooth muscle cells was found in the tunica media of the collecting lymph vessel, one to three layers of smooth muscle cells in the lumbar trunk and three to five layers of smooth muscle cells in the thoracic duct. The tunica externa of the vessel was comprised by connective tissue (collagen fibrils) and fibroblasts. Conclusion: Morphological and ultrastructural details of the collecting lymph vessel, lymphatic trunk and duct in the rat have been demonstrated that may help for the purpose of further lymphatic vessels studies.

Embolic Agents: Coils.

Catheter-directed embolization is one of the cornerstones and defining procedures of interventional radiology. Armed with a plethora of agents and devices, interventionalists can acutely stop flow, usually of a blood vessel, to effectively treat pathologies from head to toe. The list of pathologies treatable by embolization is extensive and diverse, including life-threatening hemorrhage, aneurysms, lymphatic duct leaks, varices, pelvic congestion syndrome, benign prostatic hyperplasia, uterine fibroids, and cancer.

The digestion of diacylglycerol isomers by gastric and pancreatic lipases and its impact on the metabolic pathways for TAG re-synthesis in enterocytes

The specific activities of gastric and pancreatic lipases were measured using triacylglycerols (TAG) from rapeseed oil, purified 1,3-sn-DAG and 1,2(2,3)-sn-DAG produced from this oil, as well as a rapeseed oil enriched with 40% w/w DAG (DAGOIL). Gastric lipase was more active on 1,3-sn-DAG than on 1,2(2,3)-sn-DAG and TAG, whereas pancreatic lipase displayed a reverse selectivity with a higher activity on TAG than on DAG taken as initial substrates. However, in both cases, the highest activities were displayed on DAGOIL. These findings show that DAG mixed with TAG, such as in the course of digestion, is a better substrate for lipases than TAG. The same rapeseed oil acylglycerols were used to investigate intestinal fat absorption in rats with mesenteric lymph duct cannulation. The levels of TAG synthesized in the intestine and total fatty acid concentration in lymph were not different when the rats were fed identical amounts of rapeseed oil TAG, 1,2(2,3)-sn-DAG, 1,3-sn-DAG or DAGOIL. Since the lipolysis of 1,3-sn-DAG by digestive lipases leads to glycerol and not 2-sn-monoacylglycerol (2-sn-MAG) like TAG lipolysis, these results suggest that the re-synthesis of TAG in the enterocytes can entirely occur through the “glycerol-3-phosphate (G3P)” pathway, with the same efficiency as the 2-sn-MAG pathway predominantly involved in the intestinal fat absorption. These findings shed new light on the role played by DAG as intermediate lipolysis products. Depending on their structure, 1,2(2,3)-sn-DAG versus 1,3-sn-DAG, DAG may control the pathway (2-sn-MAG or G3P) by which TAG are re-synthesized in the enterocytes.

Immunity Correction by a Foot Method of the Body Systemic Mobilization

Physical rehabilitation, by the foot method of body systemic mobilization, is a new medical technology. In connection with the current global unstable infectious situation, the need arose again to return to the question of finding and developing a systematic approach of simple and generally available physical methods. Aim. Analyze and evaluate the effect of the method of systemic mobilization of the body with the foot on the immune system of the human body, in order to prevent and rehabilitate post-infectious conditions. Material and methods. The research was carried out in various climatic zones. The procedures were based on the techniques of the first, second and third orders, in the second and third age groups. The first group consisted of patients of the second age group (13-60 years old). The second study group was represented by the third age group (60 years +). Materials of the first age group (up to 13 years old) were not submitted to the analysis. The method of exposure stipulated only the canonical motion direction in the selected sessions, the session lasted within 40-70 minutes, every day, for 10-30 days, taking into account weight, age and chronic diseases. 237 male and female patients’ material was reviewed and analyzed. Results and discussion. The method of systemic mobilization of the body exposed to the foot showed more significant positive results in the second age group - 92.8% and less in the third – 78.6% . To achieve positive results, it took more procedures 4 ± 1.0 in a humid climate compared to a dry one. It has been approved that accelerated blood flow in the main and collateral vessels triggers the activity of the lymphatic system. In the primary lymphoid organs, the hematopoietic function is restored and increased, optimizing lymphopoiesis and the state of lymphodynamics. Techniques of the first order (level) restore the flow of lymph through the superficial lymphatic vessels, collecting and producing outflow of lymph from the skin, subcutaneous tissue, superficial fascia and the surface layer of muscle fibers.Techniques of the second order (level) affect the lymph flow of deep lymphatic vessels, collecting lymph from muscles, joints and bones, producing outflow from deeply located tissues, lymphatic vessels lying along the arteries and veins of the same name, actively anastomosing with a network of superficial lymphatic vessels. Techniques of the III order (level) promote lymph flow through the lymphatic capillaries, from intra- and extra-organ lymphatic vessels, trunks and ducts. These techniques create conditions for accelerating drainage in the thoracic duct, producing an “emptying” effect by a direct physical coercion on the vertebral column, penetrating deeply. Conclusion. This method has statistically confirmed studies that indicate its ability to significantly increase the speed of blood flow in the main and adjacent vessels. The method can be considered as having a positive effect on lymphodynamics, in particular on lymphatic capillaries emanating from intra- and extra organ lymphatic vessels, trunks and ducts. By increasing the transport function of the lymphatic vessels, providing a full blood supply (nutrition) to the primary organs of the lymphatic system, exerting a stimulating effect on the spirally oriented lymphangion myocytes, in a soft and carefully worked out way, the foot method of systemic body mobilization creates optimal conditions for the correction of the immune system. Thus, it is able to protect the internal environment of the human body from foreign agents.

Trans-cervical thoracic duct embolization for post-surgical left Chylothorax in a patient with multifocal lymphatic malformations

BackgroundMediastinal and abdominal lymphatic malformations may not be diagnosed until adulthood. Radiologic and pathologic diagnosis is often challenging due to the rarity of the lesion. Surgical excision of these lesions may be curative but lymphatic leak is a known complication. Lymphatic duct embolization may then be required to treat the leak.Case presentationWe describe a patient with post-surgical chylothorax where thoracic duct lymphangiography and embolization was performed by catheterizing the thoracic duct at the venous angle where it drains into the subclavian vein.ConclusionLymphatic duct embolization can be challenging in patients with lymphatic malformations. In these patients, if there is adequate visualization on ultrasound or fluoroscopy, terminal aspect of the thoracic duct can be accessed through the subclavian vein to perform the procedure.

Predictors of severity of lymphosclerosis in extremity lymphedema

BackgroundLymphovenous anastomosis (LVA) is an accepted method for treating lymphedema, and its efficacy could be greatly affected by the severity of lymphosclerosis. In the present study, we analyzed the intraoperative findings of lymphatic ducts in our patients who had undergone LVA to find predictive factors for the severity of lymphosclerosis. MethodsThe medical records of the patients who had undergone LVA for managing extremity lymphedema from September 2017 to December 2020 were reviewed. The severity of lymphosclerosis was evaluated intraoperatively under a surgical microscope and stratified using the NECST (normal, ectasia, contraction, sclerosis type) classification. Patient age, gender, body mass index (BMI), lymphoscintigraphy stage, and lymphatic duct locations were included for analysis. ResultsMultivariate linear regression analysis showed that location in a lower extremity (regression coefficient, −0.38; P = .03) and more advanced Taiwan lymphoscintigraphy stage (regression coefficient, 0.27; P < .001) were associated with more severe lymphosclerosis. In a subgroup analysis of lower extremity lymphedema, in addition to the Taiwan lymphoscintigraphy stage (regression coefficient, 0.24; P < .001), age (regression coefficient, 0.02; P = .001), and BMI (regression coefficient, 0.04; P = .005) were also associated with the severity of lymphosclerosis. ConclusionsThe severity of lymphosclerosis in extremity lymphedema correlated positively with the Taiwan lymphoscintigraphy stage and was more severe in lower limb lymphedema. In lower limb lymphedema, a higher BMI and older age also contributed to more severe lymphosclerosis.