Journals at the University of Arizona
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PECULIAR CLINICAL FEATURES OF CELLULITIS IN PERIPHERAL LYMPHEDEMA
No full textAlthough the occurrence of cellulitis in lymphedema (LE) is believed to be an infection-related event, many findings in its clinical course seem to suggest that it is unlikely to be an infection. Therefore, we tried to clarify the specific features of cellulitis in LE. In-hospital courses of cellulitis obtained from medical charts were reviewed in the patients with leg LE (LE; 24 patients, 72 admissions), chronic venous insufficiency (CVI; 28 patients, 29 admissions), and leg cellulitis secondary to wound infection without underlying disease (N; 42 patients, 42 admissions). The patients with LE complained of less local pain (peak numerical scale; LE: 1.4 ± 1.7, CVI: 4.1 ± 2.5, N: 3.2 ± 2.0, p 0.0001), showed an abnormally higher peak procalcitonin level (LE: 33.8 ± 34.8 (N = 7), CVI: 2.9 ± 5.8 (N = 8), N: 0.4 ± 0.6 (N = 10), p 0.05), and required fewer antibiotics (LE: 1.1 ± 0.3, CVI: 1.8 ± 0.9, N: 1.5 ± 0.9, p 0.0001). These findings suggested that the occurrence of cellulitis in LE seems unlikely to be an infection-related type of cellulitis similar to that found in CV
SECONDARY LYMPHEDEMA AFTER HEAD AND NECK CANCER THERAPY: A REVIEW
No full textSecondary head and neck lymphedema (SHNL) is a chronic condition affecting patients who have undergone treatment for head and neck cancers. It results from the disruption of normal lymphatic flow by surgery and/or radiation. The incidence of secondary head and neck lymphedema varies anywhere between 12 and 54% of all patients treated for head and neck cancer, but it is still commonly under-diagnosed in routine clinical practice. In spite of awareness of this condition, treatment has been difficult as definitive staging, diagnostic, and assessment tools are still under development. This review article is aimed at looking at the evidence, standards of management, and deficiencies in current literature related to SHNL to optimize management of these patients and improve their quality of life
PLANTAR LYMPHATIC NETWORK
No full textAnatomical descriptions of the lymphatic system of the foot remain imprecise. In the present report, we aim to elucidate the anatomical lymphatic plantar network in order to improve current clinical practice on the foot. Lower limbs from a total of 25 human cadavers, 4 amputated limbs, and 8 term fetuses were studied. All cadavers were subjected to injection procedures, formalized, immersed in a solution of hydrogen peroxide, and finally dissected. On 6 of the fetal samples, the diaphanization Spatelholz technique was followed. The superficial lymphatic network of the sole is morphologically divided into three plexuses: anterior, medium, and posterior, with the medium differing from the rest. The anterior plexus presents lymphatic vessels forming scarce polygonal figures of considerable size that converge towards the medial edge to constitute ascending trunks. The middle plexus is characterized by the presence of transverse interconnected trunks that extend from one edge to the other of the sole. The posterior plexus presents polygonal figures of smaller size and greater number than the anterior plexus and forms ascending trunks that are directed to the dorsal surface of the foot. These observations demonstrate that the plantar lymphatic network display important differences among the caliber of the lymphatic vessels as well as in the communication and morphological shape of their plexus. Finally, a comparative distribution and organization between the lymphatic and the venous networks was also examined
Linkages Between Riparian Characteristics, Ungulate Grazing, and Geomorphology and Nutrient Cycling in Montane Grassland Streams
No full textCatchment characteristics and disturbances control the conditions and processes found in stream ecosystems. We examined nutrient cycling linkages between riparian soils and adjacent streams and the impacts of the removal of ungulate grazing on these ecosystems and processes at six grazing exclosure sites in the Valles Caldera National Preserve, NM, USA. The exclusion of native and domestic ungulate grazers for 3 yr significantly increased the riparian aboveground biomass of standing vegetation (2736155 in grazed vs. 4006 178 g .m2 in exclosures) and litter (58675 in grazed vs. 1106 76 g .m2 in exclosures) (P¼0.003 and 0.006, respectively). Except for an increase in total soil phosphorous (P) at three of the six sites, soil nutrient values were minimally affected by grazing after five growing seasons. Within the six sites studied, no connection was found between 0–15-cm depth soils, which were P-limited based on stoichiometric ratios, and stream nutrient availability or limitation, which were nitrogen limited. Stream geomorphology was not significantly altered by 5 yr of grazing exclusion. Theelimination of grazing suppressed instream nutrient processing with significantly longer NH4 uptake lengths (P¼0.003). These results suggest the exclusion of ungulate grazing impacts terrestrial characteristics (increased standing vegetative biomass) that are linked to ecosystem services provided by adjacent aquatic ecosystems (reduced N-uptake). Management plans should carefully balance the positive effect of grazing on stream nutrient processing and retention reported here with the welldocumented grazing-related loss of other ecosystem services such as decreased fish and aquatic invertebrate habitat and effects on water-quality parameters such as turbidity and water temperature
Emerging Student Learning Networks: Self-Directed Learning in an Eighth-Grade Life Science Classroom
No full textAlthough self-directed learning environments are common in higher education and online learning environments, they are uncommon in secondary educational settings. This mixed-method action research study, in which the author/researcher was also the teacher, reports on the design and implementation of a self-directed learning environment for eighth-grade life science students. This study investigated the impact of this type of learning environment on the behavior and achievement of students. The findings demonstrated an increase in self-regulatory behaviors, higher performance on a state-mandated final exam, and the development of complex and robust student learning networks. Implications for teaching and learning practices and suggestions for further research are discussed.DOI:10.2458/azu_itet_v6i2_ardit
The Construction of Spanish Masculine Identities from 1898-1936
No full textThe construction of masculine identities by different institutions in Spain in the years leading up to the Spanish Civil War
SUCCESSFUL FACTOR XIII TREATMENT OF REFRACTORY CHYLOTHORAX IN TUBEROUS SCLEROSIS COMPLEX-ASSOCIATED LYMPHANGIOLEIOMYOMATOSIS, MULTIFOCAL MULTINODULAR PNEUMOCYTE HYPERPLASIA AND MEDIASTINAL LYMPHADENOPATHY
No full textTuberous sclerosis complex (TSC) or Bourneville disease is a rare autosomal dominant neurocutaneous disorder that affects various organs. Pulmonary involvement in TSC may consist of lymphangioleiomyomatosis (LAM) and multifocal micronodular pneumocyte hyperplasia (MMPH), occurring together or alone. In patients with TSC-LAM, chylous pleural effusion (CPE) is a rare, though well-recognized, complication with an unpredictable clinical course. In refractory or persistent CPE, optimal management remains a clinical challenge. We report the unique case of a 29-year-old Caucasian female, neversmoker, with definite TSC since infancy, characterized by seizures, facial angiofibromas (“adenoma sebaceum”), bilateral renal angiomyolipomas, hepatic angiomyolipomas, subcortical/cortical tubers, and subependymal nodules. At 27 years old, due to bleeding from the renal angiomyolipomas, she underwent nephrectomy, first of the right, and then a year and 9 months later, of the left kidney. She was hemodialysis dependent for the next five years until cadaveric kidney transplantation. The medical history was also remarkable for recurrent exudative lymphocytic PE despite repeated therapeutic thoracenteses, with firstpresentation at 23.5 years of age. Chylothorax was initially diagnosed at 24 years and 8 months old (PE triglycerides 4.53 mmol/L), and reconfirmed at age 29 (PE triglycerides 12.46-15.30 mmol/L). Computerized tomography scan of the thorax showed a large encapsulated PE in the left lung field, multiple thin walled cysts (≤ 5 mm in diameter) in the lung parenchyma bilaterally, and mediastinal lymphadenopathy – all prominent features of LAM – as well as nodular pulmonary lesions (≤ 3 mm in diameter) consistent with MMPH. Given the persistent nature of the CPE, a five-day course of recombinant human factorXIII (FXIII) was administered intravenously. The chylothorax completely resolved within three months. There has been no recurrence of CPE on follow-up chest X-rays (i.e., total follow-up period of 53 months). This report suggests that the transglutaminase FXIII, a blood coagulation factor, may have an important clinical benefit in treating recurrent or thoracentesis-refractory CPE in TSC-LAM. To our knowledge, this is the first known case in the literature describing the successful treatment of CPE with FXIII in TSC-LAM. Because CPE is rare and there is currently no gold standard for its management, regardless of etiology, further research is warranted to investigate the potential clinical use of FXIII as an effective and safe treatment strategy in selected patients