Superficial Lymphatic System Research Articles

The Importance of Ultrasonography in the Exploration of the Superficial Lymphatic System of Carnivores

The present study conducts on the basis of a topographical and anatomical systematization a characterization in terms of imaging of the superficial lymph nodes. Starting from the topographic anatomy of the superficial lymph nodes at carnivores, suitable for the tactile method of investigation, this study standardizes the imaging aspects of superficial lymph nodes, more specifically, their ultrasound anatomy. 7 female dogs of different breeds and ages, clinically healthy were assessed by ultrasound. Methods of investigation: two-dimensional ultrasound and in addition to this, color Doppler and power Doppler techniques. Ultrasound techniques were applied to 34 axillary, superficial inguinal and polipteus lymph nodes using an advanced ultrasound machine, equipped with small parts mode. Two-dimensional ultrasound images were obtained to quantify data on topography, size, shape, capsule node, ecostructure and echogenicity. Doppler techniques have revealed the presence and the characteristics of lymph circulation. The results obtained show that lymph nodes are essential structures which have to be assessed at any ultrasonographic examination, among other parenchymal organs. The most useful parameters for characterization are: the transverse with the longitudinal axis ratio, with a value below 0.5 indicating oval shape of examined lymph nodes and the ordered model, the radial distribution of the capsule toward the hilum of the blood vascularization.

Scintigraphic investigations of the superficial lymphatic system: quantitative differences between intradermal and subcutaneous injections

Both subcutaneous and intradermal injections are used for the scintigraphic investigations of the superficial lymphatic system. The qualitative differences between these types of injections are well known. This study quantified their differences in a group of volunteers. With the limbs at rest, activities in the axillary nodes (AxN) were recorded at 1, 20, 40, 60, 80 and 100 min after subcutaneous or intradermal injection of TC-labelled human serum albumin nanocolloids in the ventral middle part of each forearm of nine young, healthy, male volunteers and the results were compared. Expressed as per 10,000 of injected activity, activities recorded in the AxN were significantly higher (32.5 times as a mean value, ranging from 8.4 to 130.7 times) after intradermal injections than after subcutaneous injections (P<0.001 by using two-tailed Wilcoxon's signed-rank test). The mean AxN activity after intradermal injections was also apparently higher for the right limbs than for the left limbs, but when the paired t-test was used to compare the right with the left values of the nine volunteers, the comparison did not reach statistical significance (at T+100, 2P=0.087). When their handedness is taken into account, however, a level of statistical significance is reached (at T+100, 2P=0.025). This study quantifies the differences between subcutaneous and intradermal injections, but also shows, although on a limited number of volunteers, that handedness influences the results of the intradermal injections.

Superficial Lymphatic System of the Upper Torso: Preliminary Radiographic Results in Human Cadavers

Lymphoscintigraphy has become a routine examination for identifying the sentinel lymph node in various cancer patients. Despite increasing clinical information, the basic anatomy of the superficial lymphatic system of the upper torso has not been fully elucidated. Five female breasts, three anterior chest walls, and three forequarter specimens from fresh nine cadavers (two male and seven female) were used for this study. Our original radiographic method for delineating the lymphatics was applied. The course of the lymph vessels was traced from the x-ray films and color coded in accordance with their sentinel lymph node to define the lymph territories of the upper torso. In addition, cross-sectional studies were performed on the female breasts to demonstrate the three-dimensional pathway and connections of the lymphatic vessels. The lymphatic territories of the upper torso were divided by the midaxillary line. The anterior side drained into the external mammary or axillary vein lymph nodes and the posterior side drained into the scapular nodes. There was no significant difference between sexes. In most cases, one sentinel lymph node in the axilla notably covered a large lymph territory in both the upper arm and the upper torso. The authors have demonstrated by radiography and dissection the superficial lymphatics of the upper torso in male and female cadavers. The lymph vessels originating in the lower region of the upper torso have close spatial association with the breast tissue and seemed to play a key role in the breast lymph drainage.

Perforating Lymph Vessels in the Canine Torso: Direct Lymph Pathway from Skin to the Deep Lymphatics

Classic anatomical lymphatic mapping in humans is represented by four territories in the torso divided by the midline and horizontal line at the L2 level. Each territory drains into the ipsilateral axillary or inguinal lymph nodes. Recently, preoperative lymphoscintigraphy for staging breast cancer and malignant melanoma has become common in the clinical arena. It reveals an undescribed direct pathway from the skin of the loin to intraabdominal lymph nodes. The authors investigated the presence of such a lymphatic route using a dog model. The authors used seven greyhound dogs for this study. The caliber of their lymph vessels was similar to those of humans, and because of a lack of fat tissue under the integument, the vessels were identified easily. The authors applied their original radiographic technique using hydrogen peroxide and lead oxide for delineating the superficial lymphatic system. Lymphatic territories of the torso were classified with relation to their regional lymph nodes. The authors found perforating lymph vessels in the lumbar and gluteal regions. They originated from the skin, penetrated the abdominal wall, and then drained into paraaortic lymph nodes instead of the axillary and inguinal lymph nodes. They were always accompanied by blood vessels, especially perforating veins. The authors found perforating lymph vessels in a canine torso. They seem to be equivalent to the unexpected lymph pathways found in humans using lymphoscintigraphy.

PR19 THE SUPERFICIAL LYMPHATIC DRAINAGE OF THE HEAD AND NECK – AN ANATOMICAL STUDY AND CLINICAL IMPLICATIONS

Aims 1To re-evaluate the basic anatomy of the lymphatic vessel network in the head and neck region for diagnosis and treatment of lymphogenic cancer metastases. 2To compare the anatomy of the lymphatic system with the venous system. 3To investigate the possibility that extensive lymphatic-venous connections exist. Materials and Methods The lymphatic vessels in the scalp, face and neck of 5 (ten halves) fresh human cadavers were identified by using 6% hydrogen peroxide with and without India ink, then injecting the vessels with a lead oxide, milk powder and water mixture. The specimens were photographed, radiographed and analyzed. Results Radiographs and photographs show: 1The lymphatic pathway “patterns” found were different in each specimen, even each side of the same head showed considerable variation. 2The lymphatic pathways of the anterior neck lie in the tissue above the platysma and course horizontally and obliquely. This finding confirm those found using lymphoscintigraphy 3The discovery of lymphatic bypass routes confirms the lymphoscintigraphy findings that lymphatic drainage does not always go directly to the first tier lymph nodes. 4We were able to compare the anatomical relationship of the lymphatic and venous systems and demonstrate that a lymphatic-venous shunt does exist in the occipital region. Conclusion This study provides an anatomical picture of the superficial lymphatic system of the head and neck and will aid surgical management in the treatment of trauma, infection, lymphoedema and cancer.

Three case studies indicating the effectiveness of manual lymph drainage on patients with primary and secondary lymphedema using objective measuring tools

The superficial lymphatic system is divided into areas called lymphatic territories which are separated by watersheds. When the lymphatic system fails to remove its load either due to surgery, radiotherapy or some congenital malformation of it then the fluid (and the proteins and wastes contained within it) accumulates in that territory. Anastomotic connections exist across the watersheds and while they can work unaided, manual lymph drainage (MLD) can significantly help drainage across them into unaffected lymphatic territories. MLD also can help the movement of extracellular fluids into the lymph vessels and then along them. The purpose of the study is to examine the effectiveness of a manual technique in moving fluids and softening hardened tissues using three non-invasive examination tools. We examined the movement of fluids from the affected limbs of three lymphedema patients who underwent a standardized 45-min treatment using the Dr Vodder method of M L D. We chose a typical cross section of patients with either a primary leg, secondary leg or secondary arm lymphedema. The arm lymphedema patient was also measured for return of edema over a 30-min period after the conclusion of treatment and underwent a follow-up control measurement, 2 months later without treatment. The tools used were tonometry, multi-frequency bioelectrical impedance and perometry. All three evaluation tools indicated a movement of fluid to different and unblocked lymphatic territories as well as a softening of tissues in some of the affected limbs. Fluid movements were also detected in the contralateral, apparently normal limbs, even though they were not treated. MLD thus is an effective means of fluid clearance when it has accumulated as a consequence of a failure of the lymphatic system. It seems likely that MLD has a systemic effect on the lymphatic system and that it can improve flow from otherwise normal tissues. It is hypothesized that a series of treatments (as is the norm) would result in even more significant improvements. Crown Copyright r 2003 Published by Elsevier Science Ltd. All rights reserved.

Bicyclist's vulva: observational study * Commentary: Attitudes to women's bicycling have changed

# Bicyclist's vulva: observational study {#article-title-2} Many chronic injuries related to athletic bicycling are now recognised: cyclist's nipples,1 neuropathic syndromes,2 and skin problems caused by the saddle. We have seen...

Lymphatic regeneration following microvascular limb replantation: a qualitative and quantitative animal study.

Lymphatic regeneration following unilateral hindlimb autotransplantation was studied in 14 Lewis rats using Technetium-99 radiolabeled sulfur colloid (TC-99) lymphoscintigraphy and compared to the lymphatic pattern exhibited in four unoperated control rats. Control animals demonstrate a reproducible flow of lymph along the deep lymphatic system from the foot, draining into the ipsilateral inguinal nodes, and then up to the para-aortic nodes. Following replantation, lymphatic outflow from the replanted limb begins to occur within 3 to 6 days, reaching normal lymphatic clearance within 12 days. However, the pattern of lymphatic flow is ill-defined, relying on multiple small channels of the superficial lymphatic system. In contrast to controls, at 3 hr post TC-99 injection, lymphatic drainage in replanted rats is via the inguinal and axillary nodal regions bilaterally. This abnormal pattern persisted in the replanted animals for the duration of this study, 160 days. It is evident that lymphatic regeneration in this animal model is associated with a rapid return to normal levels of lymphatic clearance via collateral channels within the subcutaneous tissue. The rapidity with which lymphatic drainage is restored, and its localization within the subcutaneous tissue, can explain why replanted tissues and microvascular free flaps seldom develop lymphedema. In addition, the rat hindlimb replantation model may prove useful for studies of the general mechanisms and specific factors responsible for lymphangiogenesis.

Anatomie du système lymphatique du membre supérieur

The lymphatic system of the upper limb is studied according to its various networks: superficial, deep, axillary lymph nodes and anastomotic system. The most important superficial lymphatic system is described in the upper limb together with its applications for manual lymphatic drainage. The microstructure and function of the lymphatic system are studied. The pathophysiology and manual and microsurgical treatments of lymphoedema are not discussed in this article.

MANAGEMENT OF PARATRACHEAL LYMPH NODES IN RADICAL NECK DISSECTION

The cervical lymphatic system consists of : (1) the deep cervical lymphatic system along the jugular vein : (2) the superficial cervical lymphatic system along the accessory nerve : and (3) the paratracheal lymphatic system along the recurrent laryngeal nerve. The aim of the neck dissection is, as a matter of course, to excise completely these cervical nodes which already have had or may possibly come to have metastasis, for the removal of carcinoma.The routine technique of the neck dissection is the excision en bloc of the deep cervical and the superficial lymphatic nodes together with their adjacent tissues : the paratracheal lymphatic nodes seem not to be included in this range of excision. This is because of the lower incidence of metastasis in the paratracheal nodes. However, in some cases, it may be contract to the aim of neck dissection. Then, in what situations should the paratracheal nodes be excised? This problem is the main theme of the present paper.

Some relations of the lymphatic system to surgery of the mouth and jaws

1. 1. Some important relations of the lymphatic system to surgery of the mouth and jaws are presented in a brief, organized form. 2. 2. Lymphatic vessels are largely concerned with the absorption of insoluble interstitial particles by phagocytosis, colloid material, and extravascular protein material which is not normally taken up by blood capillaries. 3. 3. The walls of lymph capillaries are permeable to foreign substances of microscopic dimensions. 4. 4. Some factors determining and controlling the flow of lymph appear to be arterial and capillary blood pressure, gravity, kinetic movement, and intermittent massage. 5. 5. Blockage of lymphatic vessels produces a condition known as lymphedema; blockage may be produced by trauma, physical or chemical agents, infections, and inflammation. 6. 6. Lymph vessels have a high degree of regenerative power. 7. 7. It is believed that local lymphatic blockage as produced in acute surgical inflammation helps in isolating the lesion and protects the body from dissemination of the infection. 8. 8. It has been suggested that the lymphatic system plays an important role in maintaining the blood plasma level and aids in the process of rapid wound healing by reinforcement of plasma proteins which is necessary for the reparative process. 9. 9. The cellular content of lymph consists almost entirely of lymphocytes, and the lymphocytic content of the blood normally remains constant except for certain hourly fluctuations but does not remain in the blood stream for more than about twelve hours. 10. 10. The anatomy of the deep and superficial lymphatic system is presented as related to the mouth and jaws. 11. 11. Some common oral surgical causes of lymph node enlargement are presented with a view toward differential diagnosis of other camouflaging diseases.