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1.
Kyobu Geka ; 74(11): 925-929, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34601475

RESUMO

A 74-year-old female with lung cancer underwent thoracoscopic right upper lobectomy. The patient was diagnosed chylothorax due to the milky drain effusion on postoperative day 1 (POD 1). Despite fasting management, chylothorax was not improved. Lymphangiography by inguinal lymph node puncture was performed on POD 4. The amount of drainage decreased on POD 6 and disappered by following pleurodesis. Early lymphangiography is recommended prior to surgical treatment for patients with chyle leakages who are unlikely to be cured by conservative treatment alone.


Assuntos
Quilotórax , Idoso , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/cirurgia , Feminino , Humanos , Linfonodos , Linfografia , Pleurodese , Punções
2.
Microsurgery ; 41(8): 762-771, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34617323

RESUMO

INTRODUCTION: The medical demand for lymphedema treatment is huge since the disease mechanism remains unclear, and management are difficult. Our purpose was to develop a reliable lymphedema model mimicking the clinical scenario and allows a microsurgical approach. MATERIALS AND METHODS: Male Lewis rats weighing 400 to 450 g were used to create lymphedema with groin and popliteal lymph node dissection and creation of 5 mm circumferential skin defect (n = 6). A skin incision was made and closed primarily for control group (n = 5). Evaluation included indocyanine green (ICG) lymphangiography 1 and 2 months postoperatively, volume difference between bilateral hindlimbs measured using micro-CT, and the skin was harvested for histological evaluation 2 months postoperatively. RESULTS: Larger volume differences present in the lymphedema group (17.50 ± 7.76 vs. 3.73 ± 2.66%, p < .05). ICG lymphangiography indicated dermal backflow only in the lymphedema group. Increased thickness of the epidermis was noted in lymphedema group (28.50 ± 12.61 µm vs. 15.10 ± 5.41 µm, p < .0001). More CD45+ (35.6 ± 26.68 vs. 2.8 ± 4.23 cells/high power field [HPF], p < .0001), CD3+ (38.39 ± 20.17 vs. 9.73 ± 8.62 cells/HPF, p < .0001), and CD4+ cell infiltration (11.7 ± 7.71 vs. 2.0 ± 2.67 cells/HPF, p < .0001) were observed in the lymphedema group. Collagen type I deposition was more in the lymphedema group (0.15 ± 0.06 vs. 0.07 ± 0.03, p < .0005). CONCLUSIONS: A rat lymphedema model was successfully established. The model can be applied in lymphedema related research.


Assuntos
Linfedema , Animais , Excisão de Linfonodo , Linfonodos , Linfedema/etiologia , Linfedema/cirurgia , Linfografia , Masculino , Ratos , Ratos Endogâmicos Lew
3.
Gan To Kagaku Ryoho ; 48(10): 1296-1298, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34657069

RESUMO

Chylothorax after esophagectomy is a relatively rare complication that can be difficult to manage. Here, we report a case of refractory chylothorax after surgery for esophageal cancer treated with lymphatic duct lipiodol imaging by inguinal lymph node puncture to confirm patency of the thoracic duct and thoracic duct ligation. A 71-year-old female with esophageal cancer(cT3N0M0)underwent video-assisted thoracoscopic esophagectomy with 2-field lymph node dissection, intrathoracic gastric tube reconstruction, and an enterostomy. A chylothorax appeared when we started enteral nutrition on the day after surgery. She became markedly dehydrated due to over 2,000 mL/day of drainage from the chest drain, and we managed her general condition in the ICU. We started octreotide acetate on postoperative day(POD)6 and etilefrine on POD 8, but neither was effective. Lymphatic duct lipiodol imaging by bilateral inguinal lymph node puncture was performed, and we confirmed leakage from the main thoracic duct. On POD 11, a thoracic duct ligation performed via a thoracotomy revealed that the volume of the chylothorax was remarkably decreased. The chest tube was removed on re-POD 12.


Assuntos
Quilotórax , Neoplasias Esofágicas , Idoso , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Feminino , Humanos , Linfografia , Complicações Pós-Operatórias/cirurgia , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/cirurgia
4.
Ann Ital Chir ; 92: 452-459, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524114

RESUMO

PURPOSE: The aim of this study is to compare two dynamic imaging modalities employed to study peripheral lymphatic system, Magnetic Resonance Lymphangiography (MRL) and Indocyanine Green Lymphangiography (ICGL), evaluating their role for planning lymphaticovenular anastomosis (LVA) or other surgical-nonsurgical treatments in patients with lymphedema of the extremities. MATERIALS AND METHODS: We conducted a retrospective study of 32 patients (26 women) with a mean age of 38 years (range 18-73) enrolled from January 2014 to December 2018; 20 out of 32 were affected by lower limb lymphedema with 6 cases of primary lymphedema; all of them had stage II disease. All the patient underwent ICGL and MRL within a month of one another, by injecting different contrast medium into interdigital web spaces. In each patient we rated the number of lymphatic vessels visualized, considering the wrist for the upper limb and the ankle for the lower limb. Student's t-test was applied. RESULTS: All patients completed both the diagnostic examinations without any significant complications. A statistically significant difference (p < 0.05) was found between the number of lymphatic vessels identified on the wrist/ankle (34 on ICGL vs 70 on MRL and 82 on ICGL vs 26 on MRL, considering affected and healthy limbs respectively). In particular, dermal backflow in advanced lymphedema seems to hinder lymphatic vessels detection on ICGL. Conversely, on healthy limbs, MRL hardly identifies lymphatics, because of their fast lymphatic flow and almost virtual lumen. CONCLUSIONS: Both MRL and ICGL are dynamic diagnostic modalities that permit an effective evaluation of lymphatic vessels anatomical and functional status in extremities lymphedema these diagnostic procedures may be considered complementary because they show different aspects of lymphatic system. KEY WORDS: Indocyanine green, MR lymphangiography.


Assuntos
Verde de Indocianina , Linfedema , Adolescente , Adulto , Idoso , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfografia , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Clin Imaging ; 80: 400-405, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34534773

RESUMO

PURPOSE: The purpose of the study is to determine if a combination of dermal thickening and subcutaneous fluid honeycombing on non-contrast MRI, termed the dermal rim sign (DRS), can be diagnostically analogous to dermal backflow seen on lymphoscintigraphy in patients with secondary upper extremity lymphedema. MATERIALS AND METHODS: Upper extremity MRI and lymphoscintigraphy were performed on patients referred to a multidisciplinary lymphedema clinic for suspicion of secondary lymphedema. Sensitivity, specificity, and positive and negative predictive values of DRS on MRI in detecting dermal backflow on lymphoscintigraphy and the correlation between DRS, Indocyanine Green (ICG) lymphography, bioimpedence L-Dex® ratio and MRI Lymphedema Staging were calculated. Weighted interobserver agreements on the presence and location of DRS on MRI were calculated. RESULTS: Of the 45 patients in the study, 91.1% (41/45) of patients had history of breast cancer. The average age was 58.4 ± 10.5 years, with a mean symptom duration of 4.7 ± 4.4 years. The mean BMI was 30.5 ± 7.0 kg/m2. Interobserver agreement on the presence and the extent of DRS on MRI was 0.93 [95% confidence-interval: 0.80-1]. DRS was present in 97% (32/33) of patients who demonstrated dermal backflow on lymphoscintigraphy. Sensitivity, specificity, PPV, and NPV of DRS were 96.6% [81.7%-99.9%], and 75.0% [47.6%-92.7%], 87.5% [74.9%-94.3%], and 92.3% [63.1%-98.8%]. DRS was associated with severity on ICG lymphography and bioimpedance (both p < 0.001). CONCLUSIONS: DRS on non-contrast MRI is highly predictive of dermal backflow and correlates with clinical measures of lymphedema severity. DRS may be used as an independent diagnostic biomarker to identify patients who would benefit from dedicated exams.


Assuntos
Linfedema , Idoso , Humanos , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Linfografia , Linfocintigrafia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Extremidade Superior
6.
Nihon Shokakibyo Gakkai Zasshi ; 118(8): 786-790, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34373398

RESUMO

An 80-year-old woman presented with acute abdominal pain and distention. A diagnosis of acute chylous peritonitis was made via contrast-enhanced computed tomography and abdominal paracentesis. She underwent ultrasound-guided intranodal lymphangiography with Lipiodol® (IL with Lipiodol), and her persistent abdominal pain was significantly reduced within a day. Moreover, her ascitic fluid showed marked improvement and paracentesis was no longer needed. Based on the findings of the study, IL with Lipiodol could be a promising minimally invasive approach in the treatment of acute chylous peritonitis.


Assuntos
Ascite Quilosa , Peritonite , Idoso de 80 Anos ou mais , Ascite Quilosa/diagnóstico por imagem , Ascite Quilosa/terapia , Óleo Etiodado , Feminino , Humanos , Linfografia , Peritonite/diagnóstico por imagem , Peritonite/etiologia , Peritonite/terapia , Ultrassonografia , Ultrassonografia de Intervenção
7.
Radiol Med ; 126(11): 1477-1486, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34379302

RESUMO

Cancer-related secondary lymphedema (LE) is a widespread issue, which markedly affects patients' quality of life. Its diagnosis is mainly clinical since there is no consensus on the best imaging technique that should be used to assess this pathology. Even if lymphedema treatment has been traditionally conservative and mainly based on compressive bandages and decongestive therapy, new surgical techniques are proving their effectiveness in the management of the disease and made proper assessment and characterization of lymphedema necessary. In this scenario, non-contrast magnetic resonance lymphography (NCMRL) is acquiring an increasing role, as a non-invasive imaging technique, useful for the analysis of LE. NCMRL is an effective tool in diagnosis confirmation, in providing information about the structural changes of the affected limbs, in grading this disorder, and provides a guide for LE management and treatment planning. This article aims to provide an overview of the literature regarding this examination, analyzing the acquisition technique, the interpretation of the imaging findings and their usefulness, the advantages and limits of this technique, to help the radiologist approach this relatively new investigation in cases of cancer-related LE.


Assuntos
Linfedema/diagnóstico por imagem , Linfografia/métodos , Imageamento por Ressonância Magnética , Humanos , Linfedema/etiologia , Imageamento por Ressonância Magnética/métodos , Neoplasias/complicações
8.
Rinsho Ketsueki ; 62(6): 554-559, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34219080

RESUMO

Chylothorax is a rare clinical sign in patients with diffuse large B-cell lymphoma (DLBCL), which is often challenging to manage and has a poor prognosis. We report the case of a 59-year-old woman who presented with right pleural effusion at the time of DLBCL diagnosis. Lymphadenopathy rapidly improved in response to chemotherapy. However, the pleural effusion progressed and was identified as chylothorax by thoracentesis. Because attempts to manage the condition with fasting and central venous nutrition were unsuccessful, we performed ultrasound-guided intranodal lipiodol lymphangiography from the inguinal lymph node. Although leak sites were not detected, the pleural effusion markedly improved on the day after the examination and resolved after 2 months. Lymphangiography is a minimally invasive examination with few complications. It contributes not only to the identification of leak sites but also to the improvement and resolution of chylothorax. Therefore, lymphangiography should be considered for refractory chylothorax that is unresponsive to chemotherapy or nutritional management.


Assuntos
Quilotórax , Linfoma Difuso de Grandes Células B , Derrame Pleural , Óleo Etiodado , Feminino , Humanos , Linfografia , Pessoa de Meia-Idade
10.
Microsurgery ; 41(5): 412-420, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34107100

RESUMO

BACKGROUND: Genital acquired lymphangiectasia (GAL) commonly recurs after simple resection. This study aimed to elucidate the efficacy of lymphaticovenous anastomosis (LVA) in the genital region or legs for preventing GAL recurrence after resection. METHODS: We retrospectively investigated 25 female patients who underwent GAL resection and LVA, lymphoscintigraphy, and indocyanine green (ICG) lymphography. Isotope or ICG was injected into the leg. Medicine accumulating in the genitals indicates lymphatic flow from the legs to the genitals (type 1). In some cases, we injected ICG into the anus to detect lymphatic flow from the anus to the genitals (type 2). Based on the findings, we selected LVA site (genital or leg). RESULTS: The mean patient age was 61.4 (range, 42-81) years. Seventeen patients underwent leg LVA only, while eight patients underwent genital LVA. The mean follow-up period was 285 (range, 87-365) days. GAL recurrence was observed in 10 patients (40.0%): three of eight (37.5%) who underwent genital LVA versus seven of 17 (41.2%) who underwent leg LVA. Among patients with type 2 lymphatic vessels, GAL recurrence was observed in two of six (33.3%) who underwent genital LVA versus five of nine (55.6%) who underwent leg LVA. CONCLUSION: Genital LVA prevented GAL recurrence in patients with type 2 lymphatic flow. Detecting the direction of lymphatic flow around GAL is essential to its successful treatment.


Assuntos
Vasos Linfáticos , Linfedema , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Feminino , Genitália , Humanos , Verde de Indocianina , Perna (Membro) , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/etiologia , Linfedema/prevenção & controle , Linfedema/cirurgia , Linfografia , Pessoa de Meia-Idade , Estudos Retrospectivos , Veias/cirurgia
11.
Zhonghua Wai Ke Za Zhi ; 59(6): 507-512, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34102736

RESUMO

Objective: To examine the clinical characteristics and abnormal reflux branches of primary isolated chylopericardium. Methods: Totally 43 patients with primary isolated chylopericardium at Department of Lymphatic Surgery, Affiliated Beijing Shijitan Hospital,Capital Medical University from June 2007 to January 2018 were recruited in this study. There were 21 males and 22 females, aging (23.0±15.9) years (range: 2 to 57 years). The levels of triglyceride, total cholesterol, total protein and albumin in pericardial effusion and blood were compared by paired-t test, and the characteristics of lymphatic system in direct lymphangiography and postoperative CT were analyzed. Results: Pericardial effusion was mainly milky white and monocytes, and 95.3%(41/43) were positive for Rivalta test. The level of triglyceride in pericardial effusion was significantly higher than that of blood ((9.67±5.11) mmol/L vs. (1.28±0.89) mmol/L, t=10.557, P<0.01), and the levels of total cholesterol ((2.19±0.52) mmol/L vs. (4.12±1.06) mmol/L, t=-3.732, P<0.01), total protein ((61.25±16.17) g/L vs. (68.26±8.30) g/L, t=-2.958, P=0.005) and albumin ((36.63±7.06) g/L vs. (42.32±4.73) g/L, t=-5.747, P<0.01) were significantly lower than that of blood. In the direct lymphangiography, the imaging of iliac and retroperitoneal lymphatics showed dilated or tortuous in 90.7% (39/43), the thoracoabdominal segment of thoracic duct showed dilation in 46.5% (20/43), and cervical thoracic duct imaging showed dilation in 44.2% (19/43) and stenosis in 55.8% (24/43). The image of lipiodol flowing into the vein showed obstruction at the venous angle. There were 60.5%(26/43) of the patients with lipiodol reflux through the bronchomediastinal trunk (type Ⅰ), 11.6%(5/43) with lipiodol diffusion to the pericardium through the abnormal pathway from the thoracic segment of the thoracic duct (type Ⅱ), while no communication pathway between the thoracic duct and the pericardial cavity (type Ⅲ) found in 27.9%(12/43). CT images obtained after the direct lymphangiography showed 34.9%(15/43) had abnormal distribution of lipiodol in pericardium, mediastinal lymph nodes and lung hilar lymph nodes, 46.5%(20/43) in mediastinal lymph nodes and lung hilar lymph nodes, 14.0%(6/43) only mediastinal lymph nodes, 4.6%(2/43) had no lipiodol in the above areas. Conclusions: Pericardial effusion compared with same period blood, has higher triglyceride, lower total cholesterol, total protein and albumin. The obstruction of the cervical segment of the thoracic duct and the formation of abnormal reflux branches would be corelative to primary isolated chylopericardium.


Assuntos
Derrame Pericárdico , Feminino , Humanos , Linfografia , Masculino , Pescoço , Derrame Pericárdico/diagnóstico por imagem , Estudos Retrospectivos , Ducto Torácico/diagnóstico por imagem
14.
AJR Am J Roentgenol ; 217(2): 433-438, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34106766

RESUMO

OBJECTIVE. The purpose of this study is to evaluate the safety and efficacy of intranodal lymphangiography (INL) with high-dose ethiodized oil in patients with postoperative refractory chylothorax. MATERIALS AND METHODS. A retrospective review of a cohort of 18 patients with refractory postoperative chylothorax seen between May 2015 and March 2019 was conducted. All patients underwent intranodal lymphangiography with high doses of ethiodized oil (mean, 75 mL; range, 40-140 mL). The following information was gathered from the institutional database: patient demographics, type of surgery, output volumes, interval between surgery and lymphangiography, imaging results, amount of ethiodized oil injected, clinical success, and time to resolution. RESULTS. Of the 18 patients, 11 (61%) had previously undergone thoracic duct ligation, and seven (39%) had not. A lymphatic leak was confirmed by lymphangiography in 12 of 18 patients (67%). A total of five patients underwent a second session of INL, which was successful in three of the patients (60%). Removal of all chest tubes was possible in 15 of 18 patients (83%) after a mean of 12 days (range, 1-25 days). Two patients had an anastomotic leak develop after esophagectomy and died with their chest tubes in situ. One patient underwent thoracic duct ligation after two failed INL procedures. No complications were recorded. CONCLUSION. INL with a high dose of injected ethiodized oil is a safe and effective procedure for the management of postsurgical refractory chylothorax, with chest tube removal in 83% of patients.


Assuntos
Quilotórax/diagnóstico por imagem , Quilotórax/terapia , Óleo Etiodado/uso terapêutico , Linfografia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
15.
Vet Radiol Ultrasound ; 62(5): 557-567, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34131988

RESUMO

Mammary gland neoplasms are predominant in dogs. However, sentinel lymph node (SLN) status assessment criteria have not been established for these cases. In this retrospective, secondary analysis, diagnostic case control study, CT images of 65 superficial inguinal SLNs were obtained before and 1, 3, 5, and 10 min after intravenous administration of contrast agent (iopamidol 370 mgI/mL). The presence and degree of postcontrast enhancement were assessed, by means of the median absolute density value and the maximum absolute density value at any time point in the center and in the periphery of each SLN measured in Hounsfield units (HU), before and after contrast agent administration. These values were compared with histopathological findings postsurgical excision. Receiver operating characteristic analysis was conducted. The absolute density values ranged widely at each time point and within each group of nodes (negative, positive, control group). At all time points, the median density value in the center and in the periphery was significantly higher in metastatic than in non-metastatic SLNs (P ≤ .014). Among the parameters tested, the median absolute density value measured in the periphery of the SLN 3 min after injection showed the highest sensitivity, specificity, and accuracy (AUC) (87.5%, 82.1%, and 92.1% respectively), with a cutoff value of 50.9 HU. The maximum absolute density value at any time point in the center and periphery of the SLNs was also significantly higher in metastatic SLNs compared to non-metastatic (P ≤ .001). With a cutoff value of 59.5 HU, the maximum absolute density value in the periphery of the SLN displayed high sensitivity and specificity (87.5% and 89.3%, respectively). The results of this study support the hypothesis that contrast enhanced CT imaging may aid in the assessment of SLN metastasis in dogs with mammary gland neoplasms.


Assuntos
Doenças do Cão , Linfonodo Sentinela , Animais , Estudos de Casos e Controles , Meios de Contraste , Doenças do Cão/diagnóstico por imagem , Cães , Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Linfografia , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/veterinária , Tomografia Computadorizada por Raios X/veterinária
16.
Intern Med ; 60(22): 3599-3603, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34092726

RESUMO

Yellow nail syndrome (YNS) is a rare disease comprising the clinical triad of yellow nail discoloration, pleural effusion, and lower limb lymphedema. We encountered a difficult-to-treat case of YNS in which the diagnosis was finally made based on intranodal lymphangiography. An 84-year-old man was admitted to our hospital with pleural effusion and yellow-green discoloration of the nails, accompanied by onychomycosis and limb lymphedema. Intranodal lymphangiography revealed a slow contrast flow and narrowing of the thoracic duct, suggesting lymphatic duct dysplasia and leading to the diagnosis of YNS.


Assuntos
Linfedema , Doenças da Unha , Derrame Pleural , Síndrome das Unhas Amareladas , Idoso de 80 Anos ou mais , Humanos , Linfedema/diagnóstico por imagem , Linfografia , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Ducto Torácico , Síndrome das Unhas Amareladas/diagnóstico , Síndrome das Unhas Amareladas/diagnóstico por imagem
18.
Medicine (Baltimore) ; 100(20): e25872, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011053

RESUMO

RATIONALE: Despite significant advances in microsurgical techniques, simultaneous release of transverse carpal ligament (TCL) and lymphovenous anastomosis (LVA) surgeries may be effective for treatment of carpal tunnel syndrome (CTS) and advanced-stage lymphedema. This case report describes the successful treatment of lymphedema with LVA in a patient with CTS and advanced-stage lymphedema. PATIENT CONCERNS: A 60-year-old female patient was referred to our lymphedema clinic with a 12-year history of chronic, acquired, right upper extremity lymphedema and CTS following right mastectomy and axillary lymph node dissection and adjuvant chemoradiotherapy for treating breast cancer. DIAGNOSIS: According to the indocyanine green lymphography, magnetic resonance lymphangiography, and electromyography, the patient was diagnosed with CTS and advanced-stage lymphedema (International Society of Lymphology late stage 2). INTERVENTION: Release of the TCL was performed first, followed by LVA at the wrist, forearm, and antecubital area. The right arm was compressed and elevated immediately postoperatively and postoperative compression bandage therapy with 35 to 40 mm Hg pressure was instituted following surgery. OUTCOMES: After 2 simultaneous surgeries, the patient had significant circumference and volume reduction of the right hand. The CTS and lymphedema symptoms have decreased following synchronous TCL release and LVA surgeries. LESSONS: Simultaneous LVA and release of the TCL may be effective and safe in patients with advanced lymphedema and CTS.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Linfedema/cirurgia , Complicações Pós-Operatórias/cirurgia , Anastomose Cirúrgica/métodos , Neoplasias da Mama/terapia , Síndrome do Túnel Carpal/etiologia , Doença Crônica/terapia , Feminino , Humanos , Verde de Indocianina/administração & dosagem , Excisão de Linfonodo/efeitos adversos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico , Linfedema/etiologia , Linfografia , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Extremidade Superior/irrigação sanguínea , Extremidade Superior/cirurgia , Veias/cirurgia
19.
Microsurgery ; 41(6): 574-578, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33991012

RESUMO

Patients presenting with chronic wounds in venous insufficiency often represent a challenge, like other conditions, like lymphatic impairment, may complicate the wound healing process. The purpose of this report is to highlight how the treatment of lymphatic impairment may be beneficial in patients affected by chronic ulcers with concomitant venous insufficiency. We present the case of a 78-year-old woman affected by chronic venous insufficiency (CVI) with long-lasting ulcers secondary to sclerosing agents treatment for varicose veins. The patient's condition was refractory to both conservative and surgical treatment. Since the patient also presented with severe lymphorrhea, with a significant amount of daily secretion, ICG-lymphography was performed subcutaneously, to visualize the pathway of lymphatic drainage and leakage. It also allowed marking on the skin the exact location of lymphatic vessels distally to the wound area. Hence, two lymphatico-venous anastomoses were performed between the two major collecting lymphatic vessels and two subcutaneous veins of adequate size. The postoperative course was uneventful and the procedure allowed for immediate resolution of lymphatic leakage and complete wound healing within 2 weeks with no recurrence in the follow-up time of 1.5 years. Based on the outcomes of this case, it is possible to consider the use of CVI treatment and lymphedema surgery as a combined approach to complicated cases of long-standing venous ulcers with lymphorrhea.


Assuntos
Vasos Linfáticos , Insuficiência Venosa , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfografia , Úlcera , Insuficiência Venosa/complicações , Insuficiência Venosa/cirurgia
20.
Clin J Gastroenterol ; 14(4): 969-974, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33974188

RESUMO

Chylothorax after esophagectomy is a serious complication that is associated with major morbidity due to dehydration and malnutrition. Reoperation with ligation of the thoracic duct is considered for patients with high-output chyle leaks that have failed conservative management. In this report, we present the treatment options for chylothorax after esophagectomy: inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization. A 74-year-old man with esophageal cancer had been operated with thoracoscopic esophagectomy. Six days after surgery, he presented with high-output chyle leaks. Conservative treatment did not result in a significant improvement. Inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization were performed 13 days after surgery and were technically and clinically successful. Inguinal intranodal lymphangiography and transvenous retrograde thoracic duct embolization are an effective treatment option, especially for patients after esophagectomy with reconstruction performed via the posterior mediastinal route, without the potential for damage the gastric tube and omentum.


Assuntos
Quilotórax , Embolização Terapêutica , Idoso , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/terapia , Esofagectomia/efeitos adversos , Humanos , Linfografia , Masculino , Complicações Pós-Operatórias , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/cirurgia
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