Journals at the University of Arizona
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LYMPHSCINTIGRAPHY IN PERIPHERAL LYMPHEDEMA USING TECHNETIUM-LABELLED HUMAN SERUM ALBUMIN: NORMAL AND ABNORMAL PATTERNS
No full textLymphscintigraphy using Tc-99m human serum albumin (HSA) was examined in 23 patients with peripheral leg lymphedema. Each was injected intradermally with one mCi in the medial web space bilaterally. Images of the lower pelvis and both thighs were obtained within five minutes after injection using an extralargefield view camera GE 500A with low energy all purpose collimator interfaced with G.E. Star computer. These images were acquired in dynamic byte mode, 128 x 128 matrix size, every minute for 40 minutes. Delayed images for this region and of both legs were also taken at 90 minutes and time activity curves from comparable regions of interest over the inguinal area bilaterally were generated. Three patterns emerged: 1-normal lymph flow (12 patients) characterized by symmetrical or nearly symmetrical early appearance of lymphatics (medial bands) with visualization of inguinal and pelvic lymph nodes in both early and delayed images. Time activity curves showed step ladder rise, in "pulses" every three to four minutes. 2-enhanced lymph flow pattern (6 patients) was characterized by rapid movement of radiolabelled albumin throughdilated lymphatics, occasionally with subcutaneous pooling, and both larger and more numerous inguinal and pelvic nodes on the lymphedematous side. 3-obstructed lymph flow (5 patients) was characterized by subcutaneouspooling, absent lymphatics, (medial bands) and flat, time activity curve on the lymphedematous side (only background activity) and absent inguinal and pelvic nodes. On delayed images, where lymphatic obstruction was incomplete there was delayed appearance of inguinal pelvic nodes which were fewer and smaller compared to the nonedematous side. Intradermal injection of Tc-99m HSA is a useful technique to examine peripheral lymph dynamics in patients with chronic lymphedema of the legs. The procedure is safe, reliable, readily interpretable and may be repeated
ABNORMAL FIBRINOLYSIS: THE CAUSE OF LIPODERMATOSCLEROSIS OR "CHRONIC CELLULITIS" IN PATIENTS WITH PRIMARY LYMPHEDEMA
No full textBlood fibrinolytic activity was measured in 20patients with primary lymphedema, ten without andten with skin changes usually attributed to "chroniccellulitis". The patients with abnormal skin showedreduced fibrinolytic activity, a finding previouslydescribed in patients with chronic venous disease andlipodermatosclerosis. It is postulated that changes of"chronic cellulitis" are identical to lipodermatosclerosisand are produced by a similarmechanism, namely reduced fibrinolysis
EFECTS OF ACETYLCHOLINE ON PERIPHERAL VASCULAR PROTEIN PERMEABILITY
No full textIt is common practice to assume that when avasodilator such as acetylcholine (ACh) produces adecrease in lymph/plasma protein ratio (R) whilelymph flow (L) increases, permeability-surface areaproduct (PS) and reflection coefficient (a) are unchanged.However, if PS and a are unaltered by astimulus that increases L, then a decreased R can beassociated with an elevated, constant, or reduced aand PS. To test what the effect of ACh, a "purevasodilator," is in the hindquarters of the anesthetizeddog, we infused 127 micrograms ACh min·1 into the abdominalaorta of 6 female mongrel dogs while collectinglumbar trunk lymph in order to measure L andR. a and PS were computed by the method of fluctuationsover 15 min collections. The rise or decreasein LR was well correlated with L (r=.951) as expected,but was much less than predicted if a and PShad been unaltered during ACh infusion. Computationsindicated that a rose with ACh approximately34% (P = .0007) and PS rose 54% (P = .042)above control. This can be interpreted as a decreasein the radial dimension of the protein transport channelsand an increase in the number of such channelsper unit area, with both changes induced either byaltered capillary anatomy or redistribution in aheteroporous system. Such an analysis seems compatiblewith the results of other studies in a variety oftissues which indicate that ACh tightens membraneseither directly or through an effect mediated byreduced arterial pressure
TRANSDIFFERENTIATED MONOCYTES: A NOVEL SOURCE OF LYMPHATIC ENDOTHELIAL-LIKE CELLS
No full textAlthough monocytes have previously been demonstrated to contribute to lymphatic vessel formation in vivo, monocyte transdifferentiation into lymphatic endothelial cells and the specific conditions required remain unclear. In this study, monocyte cultures isolated from human peripheral blood were stimulated to transdifferentiate into lymphatic endothelial cells under specific in vitro induction conditions. These results demonstrate primary isolates of CD14 (+) monocytes express low levels of lymphatic endothelial cell specific markers or pan-endothelial markers under routine culture conditions. Using fibronectin (FN) coated flasks and EGM-2 supplemented culture medium, monocytes were induced to express lymphatic endothelial markers Prox-1, VEGFR-3, LYVE-1, Podoplanin, and pan-endothelial markers vWF, CD144, and VEGFR-2. Furthermore, using the FN/EGM-2/lipopolysaccharide (LPS) culture conditions, monocytes displayed dramatically increased expressions of Prox-1, VEGFR-3, Podoplanin, LYVE-1 and vWF, while the expression of CD144 and VEGFR-2 sharply decreased. In addition, VEGF-C secretion by monocytes exposed to fibronectin coated plates with EGM-2 medium with FN/EGM-2/LPS in vitro was significantly increased over levels seen in routine culture conditions. These findings demonstrate that monocytes can be induced to undergo transdifferentiation becoming more lymphatic endothelial-like cells and increase their VEGF-C production in an FN/EGM-2/LPS environment
LYMPHATIC ARCHITECTURE OF SUNCUS MURINUS (HOUSE MUSK SHREW) PALATUM
No full textThe architecture of craniocervical lymphatic vessels in rodents has been examined previously. In the present study, we evaluated the distribution of collecting lymphatic vessels in the palate of Suncus, which is known to retain the prototype of placental mammals and is more similar to humans in terms of jaw bone morphology when compared with rodents. Three-dimensional reconstructed images of the Suncus palatum revealed that the collecting lymphatic vessels were connected to each other via smaller branches, and ran in an antero-posterior direction in the periosteum. The vessels entered the pair of posterior palatine foramina located near the fourth premolar or the first molar bilaterally, coursed through the posterior palatine canals, and reached the pterygopalatine fossa positioned posteriorly in the palate. The collecting lymphatic vessels changed directions from medial to superior to lateral while wrapping around arteries during their course, perhaps to enable the smooth transition from the palate to the deep cervical node. Inefficient lymphatic flow in humans is attributed to the superior location of the pterygopalatine fossa in the palate when compared with its location in the Suncus
ULTRASTRUCTURAL AND ELECTROPHYSIOLOGIC CHANGES OF EXPERIMENTAL ACUTE CARDIAC LYMPHOSTASIS
No full textExperimental impairment of cardiac lymph flow indogs produced histologic and electrophysiologicchanges in the heart . Interstitial edema, lipid swellingof myofibrils, dilatation of lymph vessels. andfibrinoid degeneration of small coronary arteries occurredin and near the sinus node and the atrioventricularconduction system . On electrical stimulationof the heart, significant shortening of the atrial andventricular effective refractory periods, increases inthe sinus node recovery time and in the atrioventri·cular conduction time, and ventricular extrasystolesand ventricular fibrillation were observed. Many ofthese EKG changes are similar to those observed insick sinus syndrome in man. An attempt was madeto create dynamic lymphatic insufficiency by rapidelectrical stimulation of the heart. E KG abnormalitiesobserved in these cases could be prevented byintravenous injection of calcium dobesilate