Obstruction Of Lymphatic Flow Research Articles

Acute Chyloperitoneum with Small Bowel Volvulus: Case Series and Systematic Review of the Literature.

Introduction: Chyloperitoneum arises from lymph leakage into the abdominal cavity, leading to an accumulation of milky fluid rich in triglycerides. Diagnosis can be challenging, and mortality rates vary depending on the underlying cause, with intestinal volvulus being just one potential acute cause. Despite its rarity, our case series highlights chyloperitoneum associated with non-ischemic small bowel volvulus. The aims of our study include assessing the incidence of this association and evaluating diagnostic and therapeutic approaches. Material and Methods: We present two cases of acute abdominal peritonitis with suspected small bowel volvulus identified via contrast-enhanced computed tomography (CT). Emergency laparotomy revealed milky-free fluid and bowel volvulus. Additionally, we conducted a systematic review up to 31 October 2023, identifying 15 previously reported cases of small bowel volvulus and chyloperitoneum in adults (via the PRISMA scheme). Conclusions: Clarifying the etiopathogenetic mechanism of chyloperitoneum requires specific diagnostic tools. Magnetic resonance imaging (MRI) may be useful in non-emergency situations, while contrast-enhanced CT is employed in emergencies. Although small bowel volvulus infrequently causes chyloperitoneum, prompt treatment is necessary. The volvulus determines lymphatic flow obstruction at the base of the mesentery, with exudation and chyle accumulation in the abdominal cavity. Derotation of the volvulus alone may resolve chyloperitoneum without intestinal ischemia.

Patient-specific surgical options for breast cancer-related lymphedema: technical tips.

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient’s pathology, the treatment plan should be carefully decided and individualized. At the authors’ institution, the treatment plan is made individually based on each patient’s symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient’s pathophysiology, optimal outcomes can be achieved. Depending on each patient’s pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

Bicavitary effusion in a horse with multicentric lymphoma

SummaryA 14‐year‐old Quarter Horse gelding presented for a 2‐week history of increased respiratory rate, fever and weight loss. The referring veterinarian performed an ultrasonographic examination on the farm and considered a differential diagnosis of pleuritis and pleuropneumonia. On presentation, transtracheal wash showed suppurative septic inflammation with bacteria within macrophages. Thoracic ultrasonography showed increased hypoechoic fluid in the pleural and peritoneal cavities. Cytologic analysis of pleural and peritoneal fluids revealed lymphorrhagic effusion with atypical lymphocytes, suggestive of a lymphatic flow obstruction or lymphoma. Treatment consisted of drainage of the pleural fluid, anti‐inflammatory agents, fluid therapy and antimicrobial therapy. Continued fluid accumulation in the thoracic cavity, tachypnoea, lack of response to pain medication and progressive lethargy resulted in the horse being subjected to euthanasia. At necropsy, bicavitary effusion was confirmed and histopathological diagnosis of multicentric lymphoma was made. Horses presenting with pleural effusion should also be evaluated for peritoneal effusion, as bicavitary effusion may indicate noninflammatory conditions such as neoplasia.

Pre-collecting lymphatic vessels form detours following obstruction of lymphatic flow and function as collecting lymphatic vessels

Previously, we showed that lymphatic vessels (LVs) formed detours after lymphatic obstruction, contributing to preventing lymphedema. In this study, we developed detours using lymphatic ligation in mice and we identified the detours histologically. Under anesthesia, both hindlimbs in mice were subcutaneously injected with Evans blue dye to detect LVs. We tied the right collecting LV on the abdomen that passes through the inguinal lymph node (LN) at two points. The right and left sides comprised the operation and sham operation sides, respectively. Lymphography was performed to investigate the lymph flow after lymphatic ligation until day 30, using a near-infrared fluorescence imaging system. Anti-podoplanin antibody and 5-ethynyl-2'-deoxyuridine (EdU) were used to detect LVs and lymphangiogenesis. Within 30 days, detours had developed in 62.5% of the mice. Detours observed between two ligation sites were enlarged and irregular in shape. Podoplanin+ LVs, which were located in the subcutaneous tissue of the upper panniculus carnosus muscle, connected to collecting LVs at the upper portion from the cranial ligation site and at the lower portion from the caudal ligation site. EdU+ cells were not observed in these detours. The sham operation side showed normal lymph flow and did not show enlarged pre-collecting LVs until day 30. Detours after lymphatic ligation were formed not by lymphangiogenesis but through an enlargement of pre-collecting LVs that functioned as collecting LVs after lymphatic ligation. Further studies are required to explore the developmental mechanism of the lymphatic detour for treatment and effective care of lymphedema in humans.

331 Lymphatic flow blockade amplifies inflammation in imiquimod-induced psoriasis-like skin lesions

The lymphatic transport has important roles in coordinating local immune responses. The biological effects on tissue inflammation following lymphatic flow obstruction in vivo, however, are not fully understood. In this study, to further investigate the in vivo role of lymphatic system in skin inflammation, we induced psoriasis-like inflammation on mouse back skin or ear with topical application of imiquimod (IMQ), using k-cyclin transgenic (kCYC+/-) mice, which demonstrate severe lymphatic dysfunction. kCYC+/- mice showed severe clinical scores and enhanced ear swelling to IMQ treatment compared with wild-type littermates. Immunohistochemistry showed increased epidermal thickness. On the other hand, mRNA expression levels of inflammatory cytokines including IFN-γ, TNF-α, and IL-17A, in IMQ-treated skin were comparable between kCYC+/- mice and wild-type mice. Interestingly, western blot analyses revealed that protein expression levels of IFN-γ, TNF-α, IL-17A, IL-22, and IL-23 were significantly upregulated in IMQ-treated skin of kCYC+/- mice compared to wild-type mice. Consistently, phosphorylation of STAT3, which can be induced by IL-17 and IL-22 and associated with epidermal hyperplasia, was also augmented in epidermal keratinocytes in IMQ-treated skin of kCYC+/- mice. These results suggest that lymphatic dysfunction in kCYC+/- mice caused accumulation of inflammatory cytokine proteins without upregulation of mRNA expressions, resulting in exacerbation of IMQ-induced psoriasis-like skin inflammation. The findings add insight into the clinical problem of inflammatory dermatitis that commonly occurs in humans with peripheral edema of the lower legs.

Proximal ligation after the side-to-end anastomosis recovery technique for lymphaticovenous anastomosis.

BackgroundLymphaticovenous anastomosis is an important surgical treatment for lymphedema, with lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous end-to-end anastomosis being the most frequently performed procedures. However, LVSEA can cause lymphatic flow obstruction because of regurgitation and tension in the anastomosis. In this study, we introduce a novel and simple procedure to overcome this problem.MethodsThirty-five female patients with lower extremity lymphedema who underwent lymphaticovenous anastomosis at our hospital were included in this study. Eighty-five LVSEA procedures were performed, of which 12 resulted in insufficient venous blood flow. For these 12 anastomoses, the proximal lymphatic vessel underwent clipping after the anastomotic procedure and the venous inflow was monitored. Subsequently, the proximal ligation after side-to-end anastomosis recovery (PLASTER) technique, which involves ligating the proximal side of the lymphatic vessel, was applied. A postoperative evaluation was performed using indocyanine green 6 months after surgery.ResultsDespite the clipping procedure, three of the 12 anastomoses still showed poor venous inflow. Therefore, it was not possible to apply the PLASTER technique in those cases. Among the nine remaining anastomoses in which the PLASTER technique was applied, three (33%) were patent.ConclusionsOur findings show that achieving patent anastomosis is challenging when postoperative venous inflow is poor. We achieved good results by performing proximal ligation after LVSEA. Thus, the PLASTER technique is a particularly useful recovery technique when LVSEA does not result in good run-off.

Pleural Effusions and Pneumothoraces.

1. Katherine Cashen, DO* 2. Tara L. Petersen, MD† 1. *Department of Pediatrics, Children's Hospital of Michigan/Wayne State University School of Medicine, Detroit, MI 2. †Division of Critical Care, Department of Pediatrics, The Children’s Hospital of Wisconsin/The Medical College of Wisconsin, Milwaukee, WI * Abbreviations: BTS: : British Thoracic Society CHF: : congestive heart failure CT: : computed tomography VATS: : video-assisted thoracoscopic surgery 1. Clinicians should be aware of the causes and clinical presentation of pleural effusions and pneumothoraces. 2. Clinicians should understand the current role of diagnostic tests, imaging modalities, and timing of minimally invasive treatments. After completing this article, readers should be able to: 1. Describe the pathogenesis of pleural fluid accumulation. 2. Identify the most likely causes of pleural effusion and pneumothorax. 3. Understand the basic clinical presentation, diagnostic tests, and management of pleural effusions and pneumothoraces. 4. Differentiate between transudative and exudative pleural effusions. 5. Understand the natural history of spontaneous pneumothorax. The pleural space is created by the parietal and visceral pleura that line the chest wall and the lung surface, respectively. Normally, only a small amount (0.3 mL/kg) of hypotonic fluid is present within the pleural space due to homeostatic balances in physiologic fluid production and absorption. Various infectious and noninfectious processes can lead to pathologic filling of the pleural space with fluid (effusion) or air (pneumothorax). Such pathologic changes create a true space that can interfere with normal lung mechanics and, in severe cases, cardiac function. Although much less common in pediatric than adult populations, pleural effusions and pneumothoraces in both groups can lead to substantial complications, resulting in significant morbidity and mortality if unrecognized or untreated. Overall, the cause of pleural effusions and pneumothoraces differs in children compared to adults. In adults, congestive heart failure (CHF) and malignancy account for a substantial number of pleural effusions, but these are uncommon causes in children. Infectious pleural effusions in the setting of pneumonia (parapneumonic effusions) remain the most common cause of effusions in both children and adults. Unlike the adult population, children experience spontaneous …

Massive localized lymphedema of the mons: the pi-cut technique

Massive localized lymphedema (MLL) is a form of secondary lymphedema caused by obstruction of lymphatic flow seen in morbidly obese patients. Common areas for the large mass include the abdomen, suprapubic region, scrotum, and thigh. Skin changes and the sheer size cause significant morbidity. Described as a benign lymphoproliferative overgrowth, MLL if left untreated can progress to angiosarcoma. The key to resection is minimizing blood loss and the key to reconstruction is to reconstruct utilizing the principles of vulvar esthetic subunits. For hemostasis, a tourniquet is used around the base of the mass and infiltration with wetting solution is injected. Reconstruction with the “pi-cut” technique, so named because of its resemblance to the mathematical symbol of pi, allows closure along the vulvar esthetic subunits. To illustrate our surgical technique, we present a case of MLL of the mons veneris in a 53-year-old woman with a BMI (body mass index) of 78 kg/m2. The specimen weighed approximately 17.5 kg, the heaviest MLL of the mons veneris described in the literature. Our resection technique and pi-cut closure technique allowed for minimal blood loss and postoperative morbidity and an esthetic closure respecting the vulvar esthetic subunits. MLL of the mons veneris can be successfully and safely resected with an esthetic result using our technique.

Massive Localized Lymphedema Revisited

Massive localized lymphedema (MLL) is a rising and potentially fatal complication of the obesity epidemic. Described as a benign lymphoproliferative overgrowth of obese patients, MLL is a form of secondary lymphedema, caused by the obstruction of lymphatic flow, with characteristic clinical and histological presentation. Patients have a large mass with classic skin changes often accompanied by lymphatic weeping that require complex reconstruction. Although oftentimes benign, if left untreated, MLL can progress to angiosarcoma, further supporting the need for more research into MLL and its sequelae. We present a unique case of MLL of the mons pubis in a 52-year-old man with a body mass index of 75.7 kg/m. The literature was comprehensively reviewed with a total of 65 cases of MLL being described, 9 of which resulted in angiosarcoma (10.3% of all cases), 6 of which resulted in death (9.2% of all cases). We found a female predominance of 1.24 to 1, an average weight of 183 kg, and a 48.5% majority of cases in the thigh.

Lymphatic Dysfunction Impairs Antigen-Specific Immunization, but Augments Tissue Swelling Following Contact with Allergens

The lymph transports tissue-resident dendritic cells (DCs) to regional lymph nodes (LNs), having important roles in immune function. The biological effects on tissue inflammation following lymphatic flow obstruction in vivo, however, are not fully known. In this study, we investigated the role of the lymphatic system in contact hypersensitivity (CHS) responses using k-cyclin transgenic (kCYC(+/-)) mice, which demonstrate severe lymphatic dysfunction. kCYC(+/-) mice showed enhanced ear swelling to both DNFB and FITC, as well as stronger irritant responses to croton oil compared with wild-type littermates. Consistently, challenged ears of kCYC(+/-) mice exhibited massive infiltrates of inflammatory cells. In contrast, DC migration to regional LNs, drainage of cell-free antigen to LNs, antigen-specific IFN-γ production, and lymphocyte proliferation were impaired during the sensitization phase of CHS in kCYC(+/-) mice. Transfer experiments using lymphocytes from sensitized mice and real-time PCR analysis of cytokine expression using challenged ear revealed that ear swelling was enhanced because of impaired lymphatic flow. Collectively, we conclude that insufficient lymphatic drainage augments apparent inflammation to topically applied allergens and irritants. The findings add insight into the clinical problem of allergic and irritant contact dermatitis that commonly occurs in humans with peripheral edema of the lower legs.

Abdominal chyloma: Computed tomography findings

Chyloma is a rare clinical entity that occurs secondary to obstruction of lymphatic flow or leakage from lymphangiectatic vessels, which can be secondary to surgery. Herein, we present the computed tomography findings of this challenging diagnosis in an abdominal chyloma patient with left adrenalectomy.

Lymphatic flow obstruction by tumor demonstrated using real-time fluorescence navigation

The Journal of DermatologyVolume 39, Issue 8 p. 745-748 LETTERS TO THE EDITOR Lymphatic flow obstruction by tumor demonstrated using real-time fluorescence navigation Taishi KIM, Taishi KIM Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorMasao FUJIWARA, Masao FUJIWARA Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorTakeshi NAGATA, Takeshi NAGATA Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorHidekazu FUKAMIZU, Hidekazu FUKAMIZU Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author Taishi KIM, Taishi KIM Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorMasao FUJIWARA, Masao FUJIWARA Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorTakeshi NAGATA, Takeshi NAGATA Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorHidekazu FUKAMIZU, Hidekazu FUKAMIZU Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this author First published: 02 October 2011 https://doi.org/10.1111/j.1346-8138.2011.01386.xCitations: 1 Masao Fujiwara, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan. Email: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume39, Issue8August 2012Pages 745-748 RelatedInformation

Effect of cardiac lymph flow obstruction on cardiac collagen synthesis and interstitial fibrosis

The effect of chronic cardiac lymphatic obstruction on the myocardial synthesis of collagen type I and III was investigated in a rabbit model. In the lymphatic obstruction group (n=16), plasma C-terminal propeptide type I procollagen (PICP) and N-terminal propeptide type III procollagen (PIIINP) were elevated at 7, 14 and 30 days after the operation (p<0.05). The elevated PICP and PIIINP returned to the pre-operation values 60 days after the operation. The myocardial expression of collagen type I and III mRNA were also enhanced in the lymphatic flow obstruction group. Plasma PICP, PIIINP and myocardial collagen type I and III mRNA remained unchanged in the control group (n=16). We concluded that chronic obstruction of cardiac lymph flow leads to enhanced myocardial collagen synthesis in rabbits. The enhanced collagen synthesis starts within seven days after lymphatic obstruction and subsides after 60 days.

Clinicopathologic Study of Conjunctivochalasis

To clarify the structural features of conjunctivochalasis histopathologically. A biopsy of redundant conjunctiva from the same anatomic location of 44 +/- 7.5 years (mean +/- SD, 50.87 years), underwent conjunctivoplasty (termed tear meniscus reconstruction). In all 44 cases, histologic examination disclosed normal conjunctival epithelium and negligible inflammation and lymphocyte infiltration; 39 patients manifested microscopic lymphangiectasia. Elastica van Gieson staining demonstrated elastic fiber fragmentation and sparsely assembled collagen fibers in all 44 cases. There was no discernible difference between specimens from patients with and without complications including tear-deficient dry eye, meibomian gland dysfunction, and clinically observable lymphangiectasia and/or pinguecula. Based on our histopathologic findings, we hypothesize that mechanical forces between the lower lid and conjunctiva gradually interfered with lymphatic flow. Chronic, prolonged mechanical obstruction of lymphatic flow may result in lymphatic dilation and eventually give rise to clinical conjunctivochalasis.

Severe gestational edema

Lower extremity edema is an almost universal finding in late pregnancy, occurring secondary to increased venous pressure in the legs, obstruction of lymphatic flow, and reduced plasma colloid osmotic pressure. 1 Varney describes gestational edema as the development of an excessive accumulation of fluid in the tissues without coexisting hypertension or proteinuria. 2 Midwives are familiar with this common condition in an otherwise uncomplicated pregnancy and are comfortable reassuring clients that lower extremity edema is non-pathologic. The patient with severe lower extremity edema, however, presents the provider with a clinical challenge. Is the presenting symptom a sign of an underlying disease process, or simply a normal physiologic process with extreme manifestation/expression? Lower extremity edema that rises to include the labia presents an intrapartum challenge of managing tissue integrity during the birth. A case of severe gestational edema is reported. Discussion explores broader considerations in differential diagnosis and management.

Management of Malignant Pleural Effusions

Malignant pleural effusions (MPEs) are a common complication of advanced malignancies, particularly lung and breast cancer. They are caused by a variety of mechanisms including tumor obstruction of lymphatic flow, spread of malignant cells via the systemic circulation, and tumor invasion of the pulmonary arterioles. Therapy is determined by tumor histology, stage of malignancy, and a careful assessment of a patient's performance status and comorbid diseases. A number of approaches have been used to treat patients with MPE ranging from thoracentesis to pleurectomy. Tube thoracostomy drainage followed by application of a sclerosing agent is the most common strategy. Effective sclerosing agents include quinacrine, talc, bleomycin, tetracycline and Corynebacterium parvum. Results from a recent multicenter randomized trial suggest that bleomycin may be superior in terms of control of effusion at 30 days. Further randomized studies are ongoing to determine the optimal method of draining the pleural space and the most effective sclerosing agent. Thoracoscopy using video-assisted techniques is a promising new approach to MPEs both for diagnosis and treatment. The application of biological agents such as interleukin-2, the interferons, and novel chemotherapeutic agents are experimental approaches that are under investigation.

Cystic Lymphangioma of the Spleen

Splenic cysts are uncommon, with fewer than 600 cases reported in the world literature. This report concerns a case of cystic lymphangioma of the spleen, consisting of a large splenic cyst with associated multiple, small, subcapsular cysts and lymphangiectasia. The cysts are lined by endothelium, and they conform to the characteristics of dilated lymphatic channels. Lymphangioma of the spleen is thought to arise from congenital obstruction of lymphatic flow, with subsequent dilatation of lymphatic channels. The diagnosis and treatment of splenic cysts are discussed and a new classification of splenic cysts is proposed.

Omental Transposition in the Control of Chronic Lymphedema

Chronic lymphedema of an extremity has persisted over the years as an unsolved surgical problem. The multiple operations that have been attempted for this condition indicate a continued search for an ideal procedure. Lymphedema appears to be the result of lymphatic flow obstruction in association with varying degrees of venous blockage.¹Successful treatment of lymphedema would therefore require the introduction of new lymphatic and venous channels into an involved extremity in order to bypass the area of lymphatic and venous obstruction. A new one-stage operation has been devised whereby the omentum, with its rich lymphatic and vascular supply, is used to bridge discontinuity in the lymphatic system of a lymphedematous extremity. In order to test the technical feasibility of mobilizing the omentum for long distances, ten dogs had their omentum fashioned into a pedicle graft with preservation of the gastroepiploic arcade. The length of the omentum was extended so

Biochemical studies of the ascitic fluid in hepatic cirrhosis.

scITic FLVlD appears frequently in the course of cirrhosis of the liver. Th is complicat ion is generally considered to be present in 50-80 per cent of cases of cirrhosis and is found most often in cirrhosis of the "at rophic type." Numerous etiologic factors have been suggested to explain the pathogenesis of ascites in cirrhotic patients. T h e principal ones are felt to be: portal hypertension, 1 hypoa lbuminemia , 2 alterations of electrolyte metabolism (secondary hyperaldosteronism),.~ alterations in the metabol ism of ant idiuret ic hormone, 4 and obstruction of lymphat ic flow. ~ Each of these factors may play a par t in the product ion of ascites, but it is not possible, in practice, to conclude which is the principal one. Biochemical studies of the ascitic fluid of cirrhotic subjects demonstrate it to be poor in proteins and to behave like a transudate. 6, 7 In comparative electrophoretic studies of serum and ascitic fluid in patients with hepatic cirrhosis, it has been found that the protein fractions of each are alike qualitatively. 8, 9 A recent paper 1° has emphasized the quant i ta t ive relationships between the protein fractions of ascitic fluid and those of serum. These relationships may be helpful in distinguishing between the various types of ascites. Unti l recently most studies have been concerned with these prote in relationships; however, few workers have studied other components of ascitic fluid. 11, 12 In the investigation to be described in this article, we studied protein, bi l irubin, inorganic phosphorus, and alkaline phosphatase in ascitic fluid in cirrhotic patients and a t tempted to establish a correlation between them and their respective serum values, hoping thereby to obtain a bet ter unders tanding of the nature of the ascitic fluid formed.