Plantar lymphatic network.

Anatomical 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.

Kinesio Taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial.

QUESTION: Does Kinesio Taping reduce swelling in athletes who have suffered an acute, lateral ankle sprain? DESIGN: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment. PARTICIPANTS: Thirty-six athletes who participated regularly in one of seven different sports modalities and suffered an acute ankle sprain. INTERVENTION: The experimental group received Kinesio Taping application for 3 days, which was designed to treat swelling. The control group received an inert Kinesio Taping application. OUTCOME MEASURES: For the comparison between groups, the swelling was measured via volumetry, perimetry, relative volumetry and two analyses of the difference in volume and perimetry between ankles of each participant. Data were collected immediately after the 3 days of intervention and at follow-up, which was 15 days post intervention. RESULTS: At 3 days after intervention, there were no differences between groups for swelling in volumetry (MD -2 ml, 95% CI -28 to 32); perimetry (MD 0.2 cm, 95% CI -0.6 to 1.0); relative volumetry (MD 0.0 cm, 95% CI -0.1 to 0.1); and the other analyses. At day 15 follow-up, there were no significant between-group differences in outcomes. CONCLUSION: The application of Kinesio Taping, with the aim of stimulating the lymphatic system, is ineffective in decreasing acute swelling after an ankle sprain in athletes. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials, RBR-32sctf.

Central nervous system: a modified immune surveillance circuit?

Immune surveillance in the central nervous system (CNS) was considered impossible because: (i) the brain parenchyma is separated from the blood circulation by the blood-brain barrier (BBB); (ii) the brain lacks lymphatic drainage and (iii) the brain displays low major histocompatibility complex class II (MHCII) expression. In this context, the BBB prevents entry of immune molecules and effector cells to the CNS. The absence of lymphatic vessels avoids CNS antigens from reaching the lymph nodes for lymphocyte presentation and activation. Finally, the low MHCII expression hinders effective antigen presentation and re-activation of T cells for a competent immune response. All these factors limit the effectiveness of the afferent and efferent arms necessary to carry out immune surveillance. Nevertheless, recent evidence supports that CNS is monitored by the immune system through a modified surveillance circuit; this work reviews these findings.

Intestinal lymph-borne factors induce lung release of inflammatory mediators and expression of adhesion molecules after an intestinal ischemic insult.

BACKGROUND: Intestinal ischemia and reperfusion (I/R) is a documented cause of acute lung injury (ALI) and systemic inflammation. We previously reported that obstruction of thoracic lymphatic flow during intestinal I/R blunts pulmonary neutrophil recruitment and microvascular injury and decreases the systemic levels of tumor necrosis factor. Here, we consider the existence of a gut-lung axis promoting the induction of systemic inflammation, whereby drained intestinal lymph stimulates lung expression of adhesion molecules and matrix components and generation of inflammatory mediators. MATERIAL AND METHODS: Upon administration of anesthesia, male Wistar rats were subjected to occlusion of the superior mesenteric artery for 45 min, followed by 2 h of intestinal reperfusion (I/R); groups of rats were subjected to I/R with or without thoracic lymphatic duct ligation immediately before the procedure. The non-manipulated rats were used to investigate basal parameters. RESULTS: Obstruction of thoracic lymphatic flow before intestinal I/R decreased the ability of cultured lung tissue explants to release IL-1ß, IL-10, and VEGF. In contrast, lymphatic obstruction normalized the elevated lung expression of PECAM-1 caused by intestinal I/R. On the other hand, lung E-selectin expression was significantly reduced, whereas fibronectin expression and collagen synthesis were not affected. Lymph levels of LTB(4) and TXB(2) were found to be significantly increased. CONCLUSIONS: These data suggest that lymph factors drained from the intestine during ischemic trauma stimulate the lung to generate inflammatory mediators and alter the expression of adhesion molecules. Disturbances in lung homeostasis mediated by lymph might contribute to the spread of inflammatory processes, thereby accounting for the systemic inflammation induced by intestinal I/R.

Lymphoscintigraphic appraisal of the lower limbs after liposuction.

BACKGROUND: The trauma resulting from liposuction damages the subcutaneous cellular tissue and subsequently the lymphatic structures. In turn, this damage can reduce lymphatic drainage, which may or may not appear clinically as some degree of edema. OBJECTIVE: It is possible to evaluate the function of the lymphatic system using lymphoscintigraphy. We conducted a study to evaluate the lymphatic system using this technique both before and after liposuction of the lower limbs. METHODS: The study included seven women ranging from 18 to 42 years of age, all of whom were diagnosed with lipodystrophy solely in the lateral and medial regions of the upper third of the thighs. This study was conducted in three stages: preoperative lymphoscintigraphy, liposuction, and postoperative lymphoscintigraphy three months postoperatively. The Wilcoxon signed-rank test was used for the statistical analysis of the results. RESULTS: A comparison of values for the average time of the radiopharmaceutical acquisition curve and clearance in the areas of lymphoscintigraphic interest both before and three months after liposuction did not reveal significant results. CONCLUSIONS: A comparison of preoperative and postoperative lymphoscintigraphic findings showed no significant damage to the lymphatic system associated with liposuction of the lower limbs.

[Cancer lymphangiogenesis and its role in metastasic dissemination]. / Linfangiogénesis en el cáncer y su papel en la diseminación metastásica.

It is well-known that there are different tumor-type-dependent metastatic patterns. For example, in carcinomas metastatic spread is preferentially via the lymphatic system by which they reach regional lymph nodes through pre-existent afferent lymph vessels and/or newly formed lymph capillaries; while in sarcomas the favored pathway is through bloodvessels. These metastatic patterns have been used for many years by clinicians and surgeons for staging and tumor resection, particularly in the case of breast cancer. Recently this knowledge has been applied to detection and resection of sentinel lymph nodes. The lymphatic system drains the interstitial fluid from tissues and reincorporates it into the blood flow; in addition, it forms part of the host's immune defense and in pathological conditions, induces different types of lymph edema and participates in tumor invasion and metastasis. Although, the study of lymphangiogenesis was stagnated for several decades, it was not until a few years ago that biomolecular mechanisms were discovered and many specific markers are now in use to study the process of tumor dissemination and metastasis. There is a tendency to utilize molecular knowledge in clinical settings for grading and estimating prognostic significance of tumors as well as to develop specific therapeutic strategies.

Linfangiogénesis en el cáncer y su papel en la diseminación metastásica / Cancer lymphangiogenesis and its role in metastasic dissemination

Es bien sabido que existen diferentes patrones de metástasis dependiendo del tipo tumoral. Por ejemplo, la diseminación metastásica de los carcinomas es vía linfática preferencialmente, las células neoplásicas llegan a los ganglios linfáticos regionales a través de vasos linfáticos aferentes preexistentes o capilares linfáticos de nueva formación; en cambio, en los sarcomas la vía principal es a través de los vasos sanguíneos. Estos patrones metastásicos han sido utilizados durante muchos años por los clínicos y cirujanos para la etapificación y resección tumoral, particularmente en cáncer de mama. Recientemente este conocimiento ha sido aplicado para la detección y resección del ganglio centinela. El sistema linfático drena el líquido intersticial de los tejidos y lo reincorpora al sistema sanguíneo; además, forma parte de la defensa inmune del huésped y en condiciones patológicas induce diferentes tipos de linfedema y participa en la invasión y metástasis. El estudio de la linfangiogénesis permaneció aletargado por muchas décadas y no es sino hasta los últimos años que se han descrito mecanismos biomoleculares y marcadores específicos, los cuales actualmente se están utilizando para estudiar el proceso de diseminación tumoral y metástasis. Existe una tendencia hacia la aplicación clínica de este conocimiento molecular en la clínica para estimar el significado pronóstico de los tumores, así como para desarrollar estrategias terapéuticas específicas.

It is well-known that there are different tumor-type-dependent metastatic patterns. For example, in carcinomas metastatic spread is preferentially via the lymphatic system by which they reach regional lymph nodes through pre-existent afferent lymph vessels and/or newly formed lymph capillaries; while in sarcomas the favored pathway is through bloodvessels. These metastatic patterns have been used for many years by clinicians and surgeons for staging and tumor resection, particularly in the case of breast cancer. Recently this knowledge has been applied to detection and resection of sentinel lymph nodes. The lymphatic system drains the interstitial fluid from tissues and reincorporates it into the blood flow; in addition, it forms part of the host's immune defense and in pathological conditions, induces different types of lymph edema and participates in tumor invasion and metastasis. Although, the study of lymphangiogenesis was stagnated for several decades, it was not until a few years ago that biomolecular mechanisms were discovered and many specific markers are now in use to study the process of tumor dissemination and metastasis. There is a tendency to utilize molecular knowledge in clinical settings for grading and estimating prognostic significance of tumors as well as to develop specific therapeutic strategies.

99mTc-labeled dextran for mammary lymphoscintigraphy in dogs.

Lymphoscintigraphy is the technique of choice for sentinel lymph node detection in women with early breast cancer, but there is limited information evaluating the value of this technique in animals. We investigated mammary lymphatic drainage in 25 young female mongrel dogs by intramammary injection of 18.5 MBq of 99mTc-dextran (70,000 Da). Lymph node anatomical referencing was obtained using an external marker, bone scintigraphy, or scintiscanning the body contour. Cranial and caudal thoracic mammary glands drained into the cranial sternal lymph node and axillary lymph center. The cranial thoracic mammary gland also drained into the superficial cervical lymph node in two of five animals. The cranial abdominal gland was drained by the axillary lymph center. The caudal abdominal mammary gland was drained by the superficial inguinal lymph node in all animals and simultaneously by medial iliac lymph nodes in four of five animals. In one dog, this mammary gland was also drained by the mediastinal and the superficial cervical lymph nodes. The inguinal mammary gland was drained by superficial inguinal lymph nodes and simultaneously via the medial iliac lymph node in one animal. Lymphatic communications between lymph nodes were identified in 11 of 25 (44%) animals. 99mTc-dextran mammary lymphoscintigraphy was easy and rapid to perform and may provide valuable information for further studies.

Linfedema / Lymphedema

Ha sido estimado (WHO) que un 3 por ciento de la población mundial convive y padece un linfedema, entre los grados o estadios subclínico y la elefantiasis extrema. ¿Qué es el linfedema y cuál es su etiopatogenia? ¿Es un signo, un síntoma, una enfermedad? No hay duda de que el linfedema más frecuente aparece por una parasitosis. Las filariasis. Una obstrucción por una causal extrínseca del sistema linfático. Múltiples son las causas que reproducen esta situación, y el resultado, con consenso, se denomina linfedema secundario. Por oposición y no necesariamente por consenso, aparece el término linfedema primario, obstrucción funcional o anatómico por una causal intrínseca del sistema congénito, seguramente geneticamente condicionado. El término linfedema idiopático (gr) (espontáneo, de causa desconocida) aparece como una opción para definir el tema. En la medida que sea conocida la causa el termino idiopático no tiene sentido. Hoy son conocidas la mayoría de las causas pero no por qué se desencadenan. Si así fuera, todos los linfedemas tendrían tratamiento específico. Frente a una cascada de opinión y terminología se deben ordenar estos conceptos como ejercicio semántico para lograr un lenguaje común en un tema de alto impacto médico y psicosocial.

Linfedema / Lymphedema

Ha sido estimado (WHO) que un 3 por ciento de la población mundial convive y padece un linfedema, entre los grados o estadios subclínico y la elefantiasis extrema. ¿Qué es el linfedema y cuál es su etiopatogenia? ¿Es un signo, un síntoma, una enfermedad? No hay duda de que el linfedema más frecuente aparece por una parasitosis. Las filariasis. Una obstrucción por una causal extrínseca del sistema linfático. Múltiples son las causas que reproducen esta situación, y el resultado, con consenso, se denomina linfedema secundario. Por oposición y no necesariamente por consenso, aparece el término linfedema primario, obstrucción funcional o anatómico por una causal intrínseca del sistema congénito, seguramente geneticamente condicionado. El término linfedema idiopático (gr) (espontáneo, de causa desconocida) aparece como una opción para definir el tema. En la medida que sea conocida la causa el termino idiopático no tiene sentido. Hoy son conocidas la mayoría de las causas pero no por qué se desencadenan. Si así fuera, todos los linfedemas tendrían tratamiento específico. Frente a una cascada de opinión y terminología se deben ordenar estos conceptos como ejercicio semántico para lograr un lenguaje común en un tema de alto impacto médico y psicosocial. (AU)

Linfedema / Lymphedema

Ha sido estimado (WHO) que un 3 por ciento de la población mundial convive y padece un linfedema, entre los grados o estadios subclínico y la elefantiasis extrema. ¿Qué es el linfedema y cuál es su etiopatogenia? ¿Es un signo, un síntoma, una enfermedad? No hay duda de que el linfedema más frecuente aparece por una parasitosis. Las filariasis. Una obstrucción por una causal extrínseca del sistema linfático. Múltiples son las causas que reproducen esta situación, y el resultado, con consenso, se denomina linfedema secundario. Por oposición y no necesariamente por consenso, aparece el término linfedema primario, obstrucción funcional o anatómico por una causal intrínseca del sistema congénito, seguramente geneticamente condicionado. El término linfedema idiopático (gr) (espontáneo, de causa desconocida) aparece como una opción para definir el tema. En la medida que sea conocida la causa el termino idiopático no tiene sentido. Hoy son conocidas la mayoría de las causas pero no por qué se desencadenan. Si así fuera, todos los linfedemas tendrían tratamiento específico. Frente a una cascada de opinión y terminología se deben ordenar estos conceptos como ejercicio semántico para lograr un lenguaje común en un tema de alto impacto médico y psicosocial. (AU)

Visualização linfocintigráfica da desembocadura do ducto torácico / Lymphoscintigraphic visualization of the thoracic duct confluence

OBJETIVO: Avaliar a sensibilidade da linfocintigrafia intersticial na visualização da desembocadura do ducto torácico. MÉTODO: Foram analisados 535 exames linfocintigráficos realizados no Serviço de Medicina Nuclear do Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), no período de 1993 a 1999. Todas as linfocintigrafias foram realizadas através da injeção subcutânea, no primeiro espaço interdigital de cada pé, de 1 ml da solução de Dextran 500 marcado com Tecnécio-99 metaestável. RESULTADOS: A desembocadura do ducto torácico foi visualizada em 424 pacientes, que representam 79,3 por cento das linfocintigrafias realizadas. Na avaliação por sexo, a desembocadura do ducto torácico foi visualizada em 191 pacientes do sexo feminino, representando 77 por cento dos casos. Nos pacientes do sexo masculino, a desembocadura foi visualizada em 233 casos (80,9 por cento). CONCLUSÃO: O presente estudo confirma a importância da linfocintigrafia como método de escolha na avaliação da circulação linfática e demonstra que esse exame apresenta uma alta sensibilidade para a visualização da desembocadura do ducto torácico.

Lymphatic drainage on healthy and neoplasic mammary glands in female dogs: can it really be altered?

The purpose of this research was to study the mammary lymphatic drainage under a macroscopic and mesoscopic view, comparing the vascular pattern of healthy and neoplasic mammary glands injected with drawing ink alcoholic and fluorescein solutions, in 46 mongrel female dogs. The results pointed out that the thoracic gland is drained by the axillary lymph centre, but in mammary neoplasia either superficial cervical or ventral thoracic lymph centres can be involved. Cranial and caudal abdominal glands may be drained by the axillary, inguinofemoral and popliteal lymph centres. However, the popliteal drainage is specific for the healthy caudal abdominal mammary gland. The inguinal gland can be drained by both inguinofemoral and popliteal lymph centres in both neoplasic and healthy conditions. Regarding the mammary lymphatic communications, this research demonstrated that neoplasic glands present more types of anastomosis (40.9%), than healthy glands (33.33%), and an increase in contralateral anastomosis (50%) compared with healthy ones (33%). Given the data, the mammary neoplasia can change the lymphatic drainage pattern in terms of lymph centres and vascular arborization, thus forming new drainage channels and recruiting a larger number of lymph nodes. Lastly, some comments were made about the severity of a specific neoplasic mammary gland and conditions to be considered before making a decision in terms of the most adequate operative procedure, and suggestions for further investigations.

Reciprocal influences between ambulatorial peritoneal dialysis and pulmonary function.

The aim of this study was to verify if dialysis solution volumes used in patients on continuous ambulatory peritoneal dialysis (CAPD) interfere with pulmonary function and if the pulmonary volumes interfere with the lymphatic absorption of the peritoneal cavity. We submitted 10 CAPD patients with a mean age of 48 +/- 18 years and on CAPD for 35 +/- 27 months to the following evaluations: first, measurement of the lymphatic absorption from the peritoneal cavity; second, measurement of the hydrostatic intraperitoneal pressure; and third, expirometry with the peritoneal cavity full of dialysis solution and empty. There were no differences between the expirometry results obtained with the peritoneal cavity full and empty of dialysis solution, and the results were in accordance with the prediction for this population. The values did not correlate with the peritoneal lymphatic absorption of the peritoneal cavity. The cumulative lymphatic absorption of the peritoneal cavity after 4 h dialysis solution permanence was 197 +/- 93 ml, and the hydrostatic intraperitoneal pressure was 13.9 +/- 2.8 column centimeters of water. Neither of these correlated with pulmonary volumes. In conclusion, CAPD did not interfere with the pulmonary function, nor did the pulmonary function influence the lymphatic absorption of the peritoneal cavity of these patients.

Absorçäo de líquido de irrigaçäo na ressecçäo transuretral da próstata em cäes / Irrigating fluid absorption during transurethral resection of the prostate in dogs

Trinta e dois cäes submetidos a entubaçäo do ducto torácico e cateterismo bilateral dos ureteres, foram divididos em 3 grupos: A- 4 cäes inoculados com RISA 131 I ou EDTA 51 Cr por via intravenosa ou peri-prostática; B- controle de 8 cäes submetidos a irrigaçäo vesical e prostática com 8 litros de glicina a 1,2 por cento contendo os marcadores radioativos; C- 8 cäes manejados como em B mas sujeitos à RTU da próstata. Os cäes foram acompanhados por 5 horas. A absorçäo de líquido de irrigaçäo foi calculada pelos métodos volumétrico e radioisotópico. Em 5 horas, 97 por cento da RISA 131 I inoculada via intravenosa permanecia neste espaço enquanto apenas 4,6 por cento da injetada no espaço peri-prostático penetrou no compartimento vascular. Para o EDTA 51 Cr, 63,6 por cento da massa inoculada no espaço peri-prostático foi recuperada na urina após 5 horas. O método volumétrico mostrou absorçäo média de 22,7 ml no grupo B e 276 ml no C, e o radioisotópico de 6,3 ml e 165,4 ml, respectivamente. O modelo experimental tem similaridades com o ser humano

A technique for chronically recording the EKG of the lymph hearts in the toad Bufo arenarum (Hensel).

A simple technique for recording the EKG of the posterior lymphatic hearts of the toad Bufo arenarum (Hensel) in free moving unanesthetized specimens is described. This technique permits long term chronic recordings in varied physiological and behavioral conditions whereas it overcomes some of the technical difficulties encountered in obtaining reliable recordings.

A technique for chronically recording the EKG of the lymph hearts in the toad Bufo arenarum (Hensel)

A simple technique for recording the EKG of the posterior lymphatic hearts of the toad Bufo arenarum (Hensel) in free moving unanesthetized specimens is described. This technique permits long term chronic recordings in varied physiological and behavioral conditions whereas it overcomes some of the technical difficulties encountered in obtaining reliable recordings.

A technique for chronically recording the EKG of the lymph hearts in the toad Bufo arenarum (Hensel)

A simple technique for recording the EKG of the posterior lymphatic hearts of the toad Bufo arenarum (Hensel) in free moving unanesthetized specimens is described. This technique permits long term chronic recordings in varied physiological and behavioral conditions whereas it overcomes some of the technical difficulties encountered in obtaining reliable recordings.(AU)