Journals at the University of Arizona
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LYMPHATIC MICROANGIOPATHY: A COMPLICATION OF SEVERE CHRONIC VENOUS INCOMPETENCE (CVI)*
No full textThe lymphatic capillary network was visualized by fluorescence microlymphography (subepidermal in jection of 0.01 ml of FITC-dextran 150 000 under a fluorescence microscope) in the medial ankle re gion of 21 patients with chronic venous incompe tence (CVI) and of 15 healthy controls. In severe CVI leading to trophical changes of the skin lymphatic microangiopathy was detected. Obliterations of parts of the superficial capillary network, phenomena of cutaneous reflux and increased permeability of capillary fragments occurred. These findings con trast to primary lymphedema where the rete remains intact in most cases
CONVENTIONAL ROENTGEN DIAGNOSIS OF MEDIASTINAL LYMPHADENOPATHY. REVIEW ARTICLE (PART ONE)
No full textAlthough CT has significantly improved the imag ing of space occupying mediastinal processes, it cannot be the first diagnostic step for reasons of cost, capacity and radiation exposure. Therefore the conventional chest examination with biplane films, film tomography and esophagogram continues to be the basic roentgen procedure. The basis of the conventional studies is the analysis of the pleuro-mediastinal interfaces which re present the lateral mediastinal borders. This paper describes the roentgen-morphologic aspects of enlarged lymph nodes in the mediastinal compartments as far as they can be detected with conventional studies. The differential diagnoses are discussed and recognition of early and discrete lesions is particularly emphasized
LYMPHATIC AND TRANSCAPILLARY FORCES IN PATIENTS WITH EDEMA FOLLOWING OPERATION FOR LOWER LIMB ATHEROSCLEROSIS
No full textlntralymphatic end pressure and Starling pressures(interstitial fluid pressure (Pif), plasma and interstitialfluid colloid osmotic pressures (COPpl andCOPif)) were measured in leg subcutaneous tissuein 5 patients with local leg edema following femoropoplitealreconstruction for lower limb atherosclerosis.Superficial lymphatics were cannulated proximalto the ankle and the catheter was connectedto either syringes for determination of lymph flowand colloid osmotic pressure (COPI), or to a pressuretransducer for measurement of intralymphaticend pressure. Samples of interstitial fluid were collectedby implantation of nylon wicks and Pif wasmeasured by the "wick-in-needle" technique.In all patients normal end pressure waves with maximumvalues ranging between 30 and 40 mmHg wererecorded, indicating that the ischemia prior to surgeryhad not significantly affected the intrinsicmechanism for lymph propulsion. COPif of theoperated leg averaged 5.7 mmHg ± 1.0 which was0.9 mmHg ± 0.7 higher than the correspondingCOP1. This supports the theory of "preferentialchannels" between the capillaries and the lymphatics.There was a statistically significant correlation betweenlymph flow and estimated capillary pressure(reabsorption pressure) , capillary filtration coefficient,calf blood flow and Pif· According to thisstudy the capillary pressure should at least be 11mmHg before production of lymph occurs
CANINE THORACIC DUCT CANNULATION REVISITED
No full textThe knowledge of the physiopathologic aspects of lymph in certain pathologic thoracic states has increased, resulting in more thorcic duct oriented operations. Participation of the tho racic duct in the treatment of many clinical disorders, trauma, obstruction, tumors, portal hypertension, cirrhosis, pancreatitis, esophageal varices, immunologic depletion, bili ary atresia, and diagnostic purposes (1) has furthered its reawakening. It has become timely to review the cannulation procedure of the canine thoracic duct
THE PROBLEMS OF LYMPHATIC MICROSURGERY FOR LYMPHEDEMA
No full textThe problems of microsurgery for lymphedema consist of the discrepancy between the excellent technical possibilities, especially of microsurgical lympho-venous shunts and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Generally, the lymphatic surgeon considers the lymphatic system to be a canalicular system of drainage tubes, of lymph collectors. Bypassing a lymph block through peripheral lympho-venous shunts should therefore solve the problem of lymph stasis, present in each type of lymphedema. In chronic lymphedema however, not only the canalicular lymphatic system, but also the tissues, an integral part of the lymphatic system, are affected. In chronic lymphedema, canalicular repair, for reasons of quantitative lymph drainage, exceptionally only provides a "restitutio ad integrum" of the tissues, altered by lymph stasis
MAINTENANCE OF LONG-TERM THORACIC DUCT FISTULAS FOR THE ACHIEVEMENT OF IMMUNOSUPPRESSION IN MAN
No full textThe achievement of immunosuppression by thoracic duct lymph fistulas requires long-term drainage from one to three months. Manipulation of the immune system during profound lymphocyte depletion, un adulterated by the protean effects of pharmacologic agents, offers a unique opportunity to study and treat auto-immune disease and organ rejection phenomena. The protocol for thoracic duct cannulation and maintenance of long-term fistulas must be rigid ly observed for successful thoracic duct drainage. Surgical technique and important caveats are reviewed
PRENATAL DEVELOPMENT OF THE POST-CAPILLARY VENULES IN HUMAN LYMPHATIC TISSUE
No full textLymph nodes, Peyer's patches and tonsils from 19human fetuses or stillborn babies between 13 and 40weeks of pregnancy were collected, and their post-ca pillaryvenules (PCV) were subjected to direct mor·phometric measurements. The aims were to gain informationabout their development as well as about thecircumstances of lymphocyte recirculation during thefetal period.First PCV:s detectable in fetuses aged 15 weeks hada low endothelium (2 .3 to 3.2 1-1m), which increasesin heigth thereafter, up to 10.1 1-1m in full-term pregnancies.This increase was not directly related to gestationalage, however, but correlated most closelywith the state of supposed lymphocyte traffic, as definedon morphological grounds.The results suggest that active lymphocyte recirculationis established in fetal period, and because of ab senceof external antigenic stimuli it must be an inherentproperty of lymphocytes acquired by themduring the second trimester
Lymphatic Clearance of Radioactive Sulfur Colloid
No full textLymphatic clearance of radioactive sulfur colloid ismeasured in the hind limb of five mongrel dogs. Asolid state Si(Li) detector is placed onto the skin tocontinuously record activity over the site of subcutaneousinjection. Decrease in activity follows anexponential decay which is modeled as a dual decayoccurring from both the radioactive decay of thetra cer and the lymph clearance of the tagged sulfurco lloid. The calculated decay constants for lymphclearance flow per tissue volume result in a meanvalue of 0.233 ± 0.077 ml/ hr/ml which is consistentwith results of other investigators. Adjacent lymphnodes are monitored with a scintillation detector toshow that the colloid is absorbed by the lymph vessels.The carotid artery and liver are similarly monitoredto show that there is little or no capillary absorptionof the tagged colloid
LYMPHOGRAPHY FOR FEVER OF UNKNOWN ORIGIN-A REAPPRAISAL
No full textAmong the lymphograms of 25 F.U.O. patientswhose diagnoses were unknown after several weeksof detailed examinations, abnormalities were notedin 4. Of the 4 abnormal cases, 2 were finally diagnosedby superficial lymph nodes biopsies as havingmalignant lymphomas. The other 2 had no finaldiagnoses; though biopsies of enlarged superficiallymph nodes were performed, they showed onlyreactive hyperplasia. No exploratory laparotomywas performed among the 25 cases. We concludethat lymphography is not absolutely indicated inthe evaluation of F.U.O.
TISSUE CHANGES IN CHRONIC EXPERIMENTAL LYMPHOEDEMA IN DOGS
No full textChronic lymphoedema was experimentally inducedin the legs of dogs and studied with the electronmicroscope, including by quantitation. It was foundthat some cells (macrophages, fibroblast and, to alesser extent, lymphocytes) increased greatly innumber and relative volumes. Collagen (and fat cells)also greatly increased in relative volume. The lengthsof blood ve sets and initial lymphatics were muchgreater in the injured ti ssue. The number of smallves icles and vacuole rose greatly in both types ofvessels. Both also had many open endothelial junctions- although no doubt from different causes.It was concluded that, just as chronic inflammationis probably caused by excessive accumulations ofproteins, so chronic lymphoedema is probably aform of chronic inflammation