RESUMEN
OBJECTIVE: We evaluated whether superficial lymphatic anatomy and functional lymph node drainage are symmetric between the right and left upper extremities of healthy female volunteers, and if handedness is associated with symmetry of superficial lymphatic anatomy. BACKGROUND: Symmetry of lymphatic anatomy has been assumed historically. This assumption of individual anatomic symmetry is being utilized clinically and in research without validation. METHODS: 36 normal female volunteers underwent bilateral indocyanine green (ICG) lymphography and lymphoscintigraphy of the upper extremities. Eight collecting vessel pathways of each upper extremity were mapped on ICG lymphography. 13 lymph node groups were visualized on lymphoscintigraphy. Symmetry of lymphatic anatomy and functional drainage were established by comparing the right and left extremities of each participant. Hand dominance was assessed by hand grip strength on a hand dynamometer. RESULTS: Among the 36 participants, 10 (28%) showed symmetry of all eight upper extremity lymphatic pathways with ICG. However, only 1 (3%) participant demonstrated complete symmetry amongst the 13 lymph node groups. Total symmetry of lymphatic channels was observed on ICG in seven (39%) participants with hand dominance and three (17%) participants without hand dominance (X2 = 2.215, P = 0.137). CONCLUSION: Lymphatic anatomy and functional drainage of the upper extremities are not consistently symmetric. Functional nodal drainage as demonstrated by lymphoscintigraphy shows less symmetry than anatomic studies of lymphatic channels using ICG. Symmetric lymphatic anatomy does not appear to correlate with hand dominance. These findings challenge the prevailing assumption of left-right lymphatic symmetry.
RESUMEN
Pediatric burns are life-threatening injuries due to the acute injury and secondary complications. In acute-phase burns, hypovolemia and vasoconstriction cause renal impairment. Sepsis and multiorgan failure compound the problem resulting in morbidity and mortality. This paper outlines 5 years' experience using hemofiltration in major pediatric burns, and a review of the current literature. Retrospective patient data collection was undertaken identifying relevant pediatric burns undergoing Continuous Veno-Venous Hemofiltration. Data were analyzed to identify demographics, indication, duration of therapy, and outcomes. A systematic review was also performed using PRISMA principles. PubMed, Science Direct, and OVID databases were explored and relevant papers were included. From January 2015 to December 2019, hemofiltration was utilized in five cases. Age range 3 to 15 years (mean: 12), four males/one female, and mean weight 56 kg (12-125 kg). TBSA 21% to 61% (mean: 37.6%), mechanism of injury was scald-60%, flame-40%. Overall survival was 100%. Three patients were filtered for a brief period during the first 24 hours to correct metabolic acidosis and control temperature. Two patients required prolonged therapy. All patients recovered without further long-term renal support. A total of 3814 papers were identified for systematic review. Three were considered relevant for inclusion. This paper reflects the benefits of hemofiltration in the management of severe pediatric burns. Renal replacement therapy is useful in managing metabolic acidosis, temperature control, and renal failure. The current literature supports judicious use on a patient-by-patient basis. Given the lack of evidence in the literature, further studies are required to establish guidelines for the use of hemofiltration in pediatric burns.