Magnetic resonance lymphangiography: Establishing normal.

BACKGROUND: Despite an increased interest in visualizing the lymphatic vessels with magnetic resonance lymphangiography (MRL), little literature is available describing their appearance in nonlymphedematous individuals. To determine lymphatic abnormalities, an understanding of how healthy lymphatic vessels appear and behave needs to be established. Therefore, in this study, MRL of individuals without a history of lymphatic disease was performed. METHODS: A total of 25 individuals (15 women) underwent MRL of their lower limbs using a 3.0 T Philips magnetic resonance imaging scanner (Philips Medical Systems). The first nine participants were recruited to establish the concentration of gadolinium-based contrast agent (GBCA) to administer, with the remainder imaged before and after interdigital forefoot GBCA injections at the optimized dose. Outcomes, including lymphatic vessel diameter, tortuosity, and frequency of drainage via particular drainage routes, were recorded. RESULTS: Healthy lymphatic vessels following the anteromedial pathway were routinely observed in post-contrast T1-weighted images (average tortuosity, 1.09 ± 0.03), with an average of 2.16 ± 0.93 lymphatic vessels with a diameter of 2.47 ± 0.50 mm crossing the anterior ankle. In six limbs, vessels following the anterolateral pathways were observed. No vessels traversing the posterior of the legs were seen. In a subset of 10 vessels, the lymphatic signal, measured at the ankle, peaked 29 minutes, 50 seconds ± 9 minutes, 29 seconds after GBCA administration. No lymphatic vessels were observed in T2-weighted images. CONCLUSIONS: Contrast-enhanced MRL reliably depicts the lymphatic vessels in the legs of healthy controls. Following interdigital contrast injection, anteromedial drainage appears dominant. Quantitative measures related to lymphatic vessel size, tortuosity, and drainage rate are readily obtainable and could be beneficial for detecting even subtle lymphatic impairment.

Investigation of clinical characteristics and genome associations in the 'UK Lipoedema' cohort.

Lipoedema is a chronic adipose tissue disorder mainly affecting women, causing excess subcutaneous fat deposition on the lower limbs with pain and tenderness. There is often a family history of lipoedema, suggesting a genetic origin, but the contribution of genetics is currently unclear. A tightly phenotyped cohort of 200 lipoedema patients was recruited from two UK specialist clinics. Objective clinical characteristics and measures of quality of life data were obtained. In an attempt to understand the genetic architecture of the disease better, genome-wide single nucleotide polymorphism (SNP) genotype data were obtained, and a genome wide association study (GWAS) was performed on 130 of the recruits. The analysis revealed genetic loci suggestively associated with the lipoedema phenotype, with further support provided by an independent cohort taken from the 100,000 Genomes Project. The top SNP rs1409440 (ORmeta ≈ 2.01, Pmeta ≈ 4 x 10-6) is located upstream of LHFPL6, which is thought to be involved with lipoma formation. Exactly how this relates to lipoedema is not yet understood. This first GWAS of a UK lipoedema cohort has identified genetic regions of suggestive association with the disease. Further replication of these findings in different populations is warranted.

Prevalence of gastrointestinal symptoms among ambulatory HIV patients and a control population.

BACKGROUND: The gastrointestinal tract is a common site of involvement in HIV-infected patients. Gastrointestinal symptoms are common in the general population and are associated with decreased quality of life. METHODS: Ambulatory consecutive HIV-infected patients and consecutive healthy blood donors seen in Jamaica were studied. A 19-item questionnaire of GI symptoms was administered. RESULTS: There were 196 respondents. Among 99 HIV patients, the mean number of symptoms was 2.9 and in 97 controls 3.3 (p=0.091). Dysphagia and odynophagia were present in 8.1% of HIV patients and 3.1% of the controls (p=0.129). Belching was present in 59.6% of HIV patients and in 96.8% of controls (p≤0.001). In the control group, 44.3% had heartburn compared to 29.3% of HIV patients. Within the preceding year, 26.3% of HIV participants and 12.4% of controls sought medical attention for their GI symptoms (p=0.001). GI symptomatology was directly related to immune status in the HIV group as patients with a CD4 count of less than 200 cells/µL reported up to 6 GI symptoms, those with CD4 of 201-350 cells/µL had 3 symptoms, and patients with CD4 greater than 351 cells/µL had 1 symptom. Pain on swallowing, and vomiting were significantly more common in patients with CD4 <350 cells/µL than in controls. CONCLUSIONS: GI symptoms were common in HIV patients and controls. In HIV patients symptoms were directly related to CD4 count. Pain on swallowing and vomiting were significantly more common in patients with CD4 <350 cells/µL than in controls.