Brain lymphatic drainage system in fetus and newborn: Birth of a new era of exploration.
Authors: De Angelis LC, Witte MH, Bellini T, Bernas M, Boccardo F, Ramenghi LA, Bellini C Abstract A peculiar brain lymphatic drainage system has been recently fully recognized in animals and humans. It comprises different draining pathways, including the lymphatic system, the perivascular drainage pathway, and the cerebrospinal fluid (CSF) drainage routes. Although scant data are available about its function during the neonatal period, it may play a role in neonatal brain diseases. In this review, we focus on the actual knowledge of brain lymphatic drainage system, and we hypothesize potential implications of its ...
Source: Lymphology - May 29, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Adjunctive role of manual lymph drainage in the healing of venous ulcers: A comparative pilot study.
We examined whether CDP improves healing of venous leg ulcers and compared the efficacy of CDP with that of multilayered compression with short-stretch bandages. Eight patients (mean age: 64.8 years, mean ulcer area: 23.07 cm2, duration of ulcers: 25.37 months) were treated with a 5-day-course of CDP and 9 patients (mean age: 70.77 years, mean ulcer area: 21.47 cm2, duration of ulcers: 15.8 months) were included in a 10-day-course of CDP. Control goup consisted of 9 patients (mean age: 56.33 years, mean ulcer area: 13.87 cm2, duration of ulcers: 6.11 months) receiving multilayered compression. Wound surface measurement was...
Source: Lymphology - May 29, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Construct validity of functional status scores of patients with lymphedema.
Authors: Tidhar D, Deutscher D, Armer JM Abstract During treatment of lymphedema, routine use of patient-reported outcomes measures (PROMs) is recommended to monitor patient progress; however, the validity functional status (FS) PROMs in these patients is unknown. Our aims were to examine construct validity of the shoulder computerized adaptive testing (CAT) and the foot-and-ankle CAT, as a measure of FS for patients selecting the shoulder or the foot-and-ankle as their main body part affected by their lymphedema. We assessed the ability of the FS scores to distinguish between patient groups in clinically expected ...
Source: Lymphology - May 29, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Does initial routine use of a compression garment reduce the risk of lower limb lymphedema after gynecological cancer treatment? A randomized pilot study in an Asian institution and review of the literature.
Authors: Hnin YK, Ong LX, Tsai CC, Ong SS, Yee SG, Choo BA, Low JJ Abstract This is a randomized pilot study evaluating the effectiveness of customized compression garments (CG) in reducing the risk of lower limb lymphedema (LLL) in gynecological cancer patients. Patients who completed pelvic node dissection or radiation were routinely educated on reducing the risk of LLL by good skin care and manual lymphatic massage. After baseline lower limb volume perometry and clinical assessment, they were randomized to customized compression garment (CG) for 6 weeks (26 patients) or observation (30 patients). Both groups wer...
Source: Lymphology - May 29, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

In Memoriam Prof. Prof. h.c. Dr. med. Michael F ├Âldi, January 10, 1920 - October 20, 2018 "Father of Lymphology".
In Memoriam Prof. Prof. h.c. Dr. med. Michael Földi, January 10, 1920 - October 20, 2018 "Father of Lymphology". Lymphology. 2018;51(4):184-192 Authors: Piller N, Clodius L, Campisi C, Eliska O, Ohkuma M, Pissas A, Papendieck CM, Swedborg I, Ryan T, Witte MH Abstract In Memoriam: With deep sadness the world of Lymphology learned of the death of Prof. Prof. h.c. Dr. med. Michael Földi, a ground breaking pioneer of modern Lymphology. Words alone will never fully describe or capture the breadth and depth of Michael's contribution to our lymphatic knowledge and the legacy he has left fo...
Source: Lymphology - May 29, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Diagnostic accuracy of interlimb differences of ultrasonographic subcutaneous tissue thickness measurements in breast cancer-related arm lymphedema.
This study aimed to establish diagnostic accuracy of interlimb differences of ultrasonographic subcutaneous tissue thickness measurements in breast cancer-related arm lymphedema. We compared the truncated cone method by using circumference measurements and interlimb differences of ultrasonographic subcutaneous tissue thickness measurements to evaluate the diagnostic accuracy of interlimb differences of ultrasonographic subcutaneous tissue thickness measurements. Sensitivity, specificity, receiver-operating characteristic (ROC) curve, and area under the curve (AUC) were used. Analysis of ROC curves yielded area under the cu...
Source: Lymphology - May 25, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Early fetal hydropic changes are associated with moderate dilatation of the brain ventricular system: A clue to a possible link between cervical lymphatic engorgement and ventricular dilatation?
Authors: Paladini D, Donarini G, Conti A, Constanza De Angelis L, Witte MH, Genesio R, Bernas M, Bellini T, Boccardo F, Ramenghi LA, Bellini C Abstract The aim of this study is to assess whether early cervical lymphatic obstruction is associated with a sonographically detectable dilatation of the ventricular system in the 1st trimester of pregnancy. In particular, the objective is to assess whether fetuses with non-immune hydrops fetalis (NIHF), cystic hygroma, or enlarged nuchal translucency (NT) have a greater atrial width/biparietal diameter (AW/BPD) ratio than normal at time of the combined first trimester scre...
Source: Lymphology - May 25, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Impact of body fat and obesity on tissue dielectric constant (TDC) as a method to assess breast cancer treatment-related lymphedema (BCRL).
Authors: Mayrovitz H Abstract Obesity is linked to the risk of breast cancer and treatment-related lymphedema (BCRL). Thus, knowledge of how obesity, or more specifically total body fat percentage (TBF) and body mass index (BMI), affect measurements that are used to detect or track lymphedema is clinically important. Tissue dielectric constant (TDC) is one measure used to help characterize lymphedema features, detect its presence, and assess treatment-related changes. The goal of this research was to determine the extent to which TDC values depend on TBF and BMI. TDC was measured on both forearms (2.5mm depth) in 2...
Source: Lymphology - May 25, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Conservative management of chylous ascites after oncological surgery for peripheral neuroblastic tumors in pediatric patients.
Authors: Pio L, Boccardo F, Avanzini S, Paraboschi I, Granata C, Garaventa A, Dessalvi S, Martucciello G, Mattioli G Abstract Chylous ascites may complicate the postoperative course of abdominal surgery mainly due to the iatrogenic disruption of the lymphatic channels during extensive retroperitoneal dissection. Sparse data are available regarding treatment; however, in many cases a recommended first-line treatment approach is by way of enteral feeding, consisting of a formula high in medium-chain triglycerides (MCTs) together with a complete total parenteral nutrition teamed with somatostatin (or an equivalent). N...
Source: Lymphology - May 25, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Preliminary evidence of effectiveness of TECAR in lymphedema.
Authors: Cau N, Cimolin V, Aspesi V, Galli M, Postiglione F, Todisco A, Tacchini E, Darno D, Capodaglio P Abstract Lymphedema of the lower limbs often contributes to the mobility impairment of morbidly obese patients. Defining novel costeffective protocols is important for reducing treatment costs. The study aimed to assess if Capacitive and Resistive Energy Transfer (TECAR) can reduce edema and the minimum number of sessions needed to observe volume reduction. Forty-eight severely obese subjects (age range: 46-78 years; BMI>40 kg/m2) with bilateral lower limb lymphedema were divided into three groups undergoing...
Source: Lymphology - May 25, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

In Memoriam: John (Jack) B. Hay, PhD, December 24, 1942 - February 25, 2019, Lymphoimmunologist and Mentor Extraordinaire.
Authors: Young A, Johnston M Abstract In Memoriam: Dr. Jack Hay was an Emeritus Professor of the Department of Immunology and was Acting Chair (2000) and Undergraduate Program Coordinator (2006), as well serving in numerous roles during his distinguished academic and scientific career at the University of Toronto. PMID: 31119914 [PubMed - in process] (Source: Lymphology)
Source: Lymphology - May 25, 2019 Category: Internal Medicine Tags: Lymphology Source Type: research

Direct trans-cervical endolymphatic thoracic duct stent-graft for plastic bronchitis.
Authors: Majdalany BS, Khayat M, Sanogo ML, Saad WE, Khaja MS Abstract Plastic bronchitis is a poorly understood and uncommon diagnosis, arising from multiple etiologies. Traditional treatment consists of steroids and vasodilators, with thoracic duct embolization emerging as a new procedural therapy. Herein, abnormal lymphatic vessels were noted on lymphangiography in an adult patient with debilitating plastic bronchitis, but anterograde lymphatic access was not feasible due to the patient's morbid obesity and non-visualization of retroperitoneal lymphatics. After trans-venous thoracic duct access could not be esta...
Source: Lymphology - November 15, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Left ventricular rotational mechanics differ between lipedema and lymphedema: Insights from the three-dimensional speckle tracking echocardiographic MAGYAR-path study.
Authors: Nemes A, Kormanyos A, Domsik P, Kalapos A, Kemeny L, Forster T, Szolnoky G Abstract The present study aimed to assess LV rotational mechanics by three-dimensional speckle-tracking echocardiography (3DSTE) in lipedema (n=25), lymphedema (n=26) patient groups with age- and gender-matched healthy controls (n=54). 3 lipedema and 4 lymphedema patients were excluded due to insufficient image quality for 3DSTE analysis. LV apical rotation (9.61 ± 4.25 degree vs. 6.40 ± 2.63 degree, p
Source: Lymphology - November 15, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Secondary lymphedema after head and neck cancer therapy: A review.
Authors: Anand A, Balasubramanian D, Subramanian N, Murthy S, Limbachiya S, Iyer S, Thankappan K, Sharma M Abstract Secondary head and neck lymphedema (SHNL) is a chronic condition affecting patients who have undergone treatment for head and neck cancers. It results from the disruption of normal lymphatic flow by surgery and/or radiation. The incidence of secondary head and neck lymphedema varies anywhere between 12 and 54% of all patients treated for head and neck cancer, but it is still commonly under-diagnosed in routine clinical practice. In spite of awareness of this condition, treatment has been difficult as ...
Source: Lymphology - November 15, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Plantar lymphatic network.
Authors: Amore M, Bernardez R, Sgarbanti V, Romeo H Abstract 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 n...
Source: Lymphology - November 15, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Tissue dielectric constant ratios as a method to characterize truncal lymphedema.
Authors: Mayrovitz HN, Weingrad DN Abstract Truncal lymphedema is one possible complication of breast cancer treatment. It affects many women and is diagnosed based on symptoms and clinical assessment. Because changes occur late in the process, it is useful to have a quantitative assessment that is applied earlier to detect more subtle changes and quantitively assess treatment progress. Our goal was to describe a possible method to accomplish this via measurements of tissue dielectric constant (TDC). TDC was measured at lateral thorax, anterior forearm, and biceps in 120 women awaiting surgery for breast cancer. In...
Source: Lymphology - November 15, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Is lymphatic reconstitution possible after meshed skin grafting?
We report a case of lymphatic reconstitution across meshed, split-thickness skin graft performed for a patient with necrotizing fasciitis. The patient underwent extensive circumferential soft tissue debridement of the lower leg and resurfacing of the skin defect with meshed split-thickness skin graft. Indocyanine green fluorescence lymphography was performed 3 years after surgery and demonstrated that injected dye in the foot traveled across the skin graft and reached to the adjacent native skin in the proximal region. Our observation revealed that transferred split-thickness skin graft possessed some potential to allow fo...
Source: Lymphology - November 15, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

An overview of lymphatic filariasis lymphedema.
We examined the clinical manifestations of the disease, diagnosis, treatment, immune responses, and management including review of pharmaceutical agents against filariasis. Details on infection, safety profile, and status in clinical practices are also reported. PMID: 30248721 [PubMed] (Source: Lymphology)
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Successful factor XIII treatment of refractory chylothorax in tuberous sclerosis complex-associated lymphangioleiomyomatosis, multifocal multinodular pneumocyte hyperplasia and mediastinal lymphadenopathy.
This report suggests that the transglutaminase FXIII, a blood coagulation factor, may have an important clinical benefit in treating recurrent or thoracentesis-refractory CPE in TSC-LAM. To our knowledge, this is the first known case in the literature describing the successful treatment of CPE with FXIII in TSC-LAM. Because CPE is rare and there is currently no gold standard for its management, regardless of etiology, further research is warranted to investigate the potential clinical use of FXIII as an effective and safe treatment strategy in selected patients. PMID: 30248722 [PubMed] (Source: Lymphology)
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Congenital pulmonary lymphangiectasia and chylothorax - a case series.
We report six clinical cases of CPL and CC that were admitted to our level III neonatal intensive care unit over the last 20 years. One case of unilateral CC was successfully treated with pleuro-amniotic shunt; three cases of bilateral CC were associated to lung hypoplasia, hydrops fetalis, and generalized lymphangiectasias; one case of CPL was associated with obstructive congenital heart defect; one case of unilateral CC was successfully treated with thoracocentesis and medium-chain triglyceride diet. Mortality was high (66.6%). PMID: 30248723 [PubMed] (Source: Lymphology)
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Lower limb dominance and volume in healthy individuals.
This study investigated if there is a normative volume difference between the dominant and nondominant leg. Healthy volunteers between the ages of 18-40 years were recruited. Exclusion criteria included previous lower limb surgery, BMI>30, or pregnancy. An experienced lymphedema nurse specialist measured the circumference of each limb at 4 cm intervals from the malleolus to the groin. Measurements were used to calculate volume of each limb in milliliters. 100 (52 male, 48 female) participants met our inclusion criteria. 86% were right leg dominant and 14% left leg dominant. 93% demonstrated an average increased volume o...
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Measurement of capillary fragility: a useful tool to differentiate lipedema from obesity?
In this study, we measured CF in female subjects with lipedema (15) or non-complicated obesity (15) who were body mass index (BMI) and waist-to-hip ratio (WHR) matched. CF was evaluated with the vacuum suction method (VSM) using Parrot's angiosterrometer in both groups. Application of VSM resulted in a significantly higher number of petechiae in subjects with lipedema. Capillary fragility measurement appears to be a useful differential diagnostic tool between lipedema and obesity under these trial parameters. PMID: 30248725 [PubMed] (Source: Lymphology)
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Peculiar clinical features of cellulitis in peripheral lymphedema.
Authors: Suehiro K, Morikage N, Ueda K, Samura M, Takeuchi Y, Nagase T, Mizoguchi T, Hamano K Abstract Although the occurrence of cellulitis in lymphedema (LE) is believed to be an infection-related event, many findings in its clinical course seem to suggest that it is unlikely to be an infection. Therefore, we tried to clarify the specific features of cellulitis in LE. In-hospital courses of cellulitis obtained from medical charts were reviewed in the patients with leg LE (LE; 24 patients, 72admissions), chronic venous insufficiency (CVI; 28 patients, 29 admissions), and leg cellulitis secondary to wound infection...
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Cellulitis and bacteria in peripheral lymphedema.
Authors: Olszewski WL Abstract Counterpoint to the article: Peculiar Clinical Features of Cellulitis in Peripheral Lymphedema, K. Suehiro, et al. Lymphology Vol 51, No 2, pp 47-53. PMID: 30253455 [PubMed - in process] (Source: Lymphology)
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Decreasing and preventing lymphatic-injury-related complications in patients undergoing venous surgery: A new diagnostic and therapeutic protocol.
Authors: Dessalvi S, Villa G, Campisi CC, Campisi C, Boccardo F Abstract Lymphatic complications following great and small saphenous vein surgery show a varying and non-negligible incidence in the literature. We undertook this study to investigate a new protocol to reduce lymphatic injuries in patients undergoing venous surgery. Eighty-six patients with lower limb venous insufficiency and varices were treated. Lymphoscintigraphy was performed preoperatively in 65 of them and postoperatively in 19. Blue dye was used in all patients and blue lymph nodes and lymphatics were identified intra-operatively and preserved o...
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Proprioception sense in lymphedema affected upper limb.
This study aimed to provide information on proprioception alterations in lymphedema-affected limbs. Blindfolded subjects sat at a table with their forearms positioned on paddles. The hinges of the paddles were aligned with the elbow joint and an electronic goniometer was positioned to measure the angle of the forearm. Paddles were moved by an electric servomotor with a slow angular speed that was barely appreciated by the subjects. Subjects were then asked to guess the position of the affected arm in comparison with the unaffected arm to study the position sense of the lymphedema-affected arm. The study investigated 50 wom...
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Exploring the mesenteric lymphatic apparatus: A morphological and immunohistochemical investigation with clinical correlations.
Authors: Roncati L, Manenti A, Pusiol T, Mataca E, Nosseir S, Piscioli F, Maiorana A, Barbolini G Abstract Modern immunohistochemical techniques allow a detailed study of the lymphatic system in many organs and areas of the body. We performed an in-depth study on lymphatic vessels of the ileal and colonic mesenteries, together with the greater omentum where they appear particularly numerous and mainly represented by capillaries interconnected among themselves and with lymph nodes. The capillary wall consists of a fine single sheath of endothelial cells wrapped around by a subtle collagen membrane and deprived of va...
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Lymphatic tract reconstruction using a pedicled deep inferior epigastric perforator flap.
Authors: Suzuki Y, Sakuma H, Yamazaki S, Ihara J Abstract We encountered a case in which we used a pedicled deep inferior epigastric perforator(DIEP) flap to repair a lymphatic leak. This case shows that such repairs can lead to the reconstruction of the lymphatic tract and prevent lymphatic leak recurrences. The present report describes a 45-year-old woman with ovarian cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy, and omentectomy. She presented with a pelvic lymphocele with lower-extremity swelling. Lymphovenous anastomosis was performed an...
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

From childhood onset lymphedema to fatal fetal hydrops: Possible modifying genes for a FOXC2 mutation.
Authors: Lai LW, Erickson RP, Bernas M, Witte MH Abstract We performed whole exome sequencing in a family with FOXC2 mutation where the phenotype in one generation was strikingly more severe. Although there were 3 mutations shared by 2 fatal fetal hydrops cases and not the mildly affected mother, none of them were likely to be the cause of the marked phenotypic change. PMID: 30253460 [PubMed - in process] (Source: Lymphology)
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Successful multi-modal treatment of grade IV lymphedema in lymphatic filariasis: A case study.
We present an integrated therapeutic approach performed on a 37 year old female with giant lymphedema (Grade IV) due to lymphatic filariasis of 27 years duration. Our therapeutic approaches consisted of a basic foot care program for two weeks, followed by a course of oral penicillin for a week including conservative treatment with complete decongestive therapy (CDT) together with respiratory physiotherapy and walking exercises. In addition, advanced surgical techniques with supra-fascial excision of alternate lumps in three stages over an interval of ten days followed by a nodo-venal shunt resulted in reversing the stage I...
Source: Lymphology - September 27, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
Authors: Tzani I, Tsichlaki M, Zerva E, Papathanasiou G, Dimakakos E Abstract Lymphatic diseases, especially lymphedema, represent a serious problem in the health community. We investigated strategies and methods for physiotherapeutic rehabilitation of lymphedema by carrying out a comprehensive search of the Medline and Embase databases from 1990 to 2016 to identify relevant published studies, articles, and reviews. Approaches for conservative management of lymphedema include the following: manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, skin care, pneumatic compression, elevati...
Source: Lymphology - September 26, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Are pre-operative lymphoscintigrams needed for localization prior to sentinel node biopsy?: An audit to ensure safe practice and to provide another view.
Authors: Ives C, Gregg L, Trust C, Green M Abstract Traditionally lymphoscintigrams are taken after injection of peri-areolar Technetium-99m (Tc-99m) to quantify sentinel nodes before biopsy (SNB). However, recent research suggests that scintigraphy is not an essential adjunct. For service improvement, we stopped using lymphoscintigraphy so as to minimize delay to operating theater and reduce demand on the Nuclear Medicine Department. We audited early outcomes to ensure quality was maintained. 100 consecutive patients undergoing SNB with lymphoscintigrams were investigated. Lymphoscintigrams were reported by Consul...
Source: Lymphology - September 26, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Primary versus trauma-induced Gorham-Stout disease.
Authors: Tanoue N, Moedano L, Witte M, Montague M, Lukefahr A, Bernas M Abstract Gorham-Stout disease - also known as "disappearing bone disease" is currently considered a single entity with varying clinical manifestations. We reviewed the existent literature from the earliest historic description(Jackson in 1838) and Gorham and Stout's original series of patients, multiple case reports and series since. After analyzing 212 reported cases, we identified 76 cases with details that recorded either a history of multifocal disease or an identifiable history of preceding trauma. From this review, we have defin...
Source: Lymphology - September 26, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

The effect of different compression pressure in therapy of secondary upper extremity lymphedema in women after breast cancer surgery.
This study evaluated how different levels of pressure under inelastic multi-layer bandages affect the reduction of secondary arm lymphedema and patient comfort throughout therapy. Ninety-six women with lymphedema after breast cancer treatment were randomized into three groups of 32 patients depending on level of applied pressure in compression therapy: group I (control) at 21-30 mmHg; study groups II A at 31-40 mmHg and group II B at 41-60 mmHg. All patients were treated with complex decongestive therapy (CDT) and intermittent pneumatic compression (IPC) before compression. Fixed points of bilateral arms were measured at t...
Source: Lymphology - September 26, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Surgical treatment of scrotal lymphedema: modified surgical technique.
Authors: Atta A, Saber El Basiouny M, Mostafa Abass S Abstract Lymphedema is a chronic disease in which lymph accumulates under the subcutaneous tissue. The condition may be due to either congenital or acquired lymphatic system abnormalities. Genital lymphedema (scrotal lymphedema) has a high psychological and functional impact, and many surgical techniques have been tried in an attempt to improve function and cosmetic appearance. The aim of this study is to present our experience in treatment of a series of patients with scrotal lymphedema. Twenty patients suffering from moderate to severe scrotal lymphedema under...
Source: Lymphology - September 26, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Local Skin Cooling as an Aid to the Management of Patients with Breast Cancer Related Lymphedema and Fibrosis of the Arm or Breast.
Authors: Mayrovitz HN, Yzer JA Abstract Based on preliminary observations that topical cooling appeared to soften lymphedematous and fibrotic tissue, our goal was to systematically and quantitatively evaluate this effect. For this purpose, topical cooling was used as part of treatment of lymphedematous and fibrotic skin of women with breast cancer related lymphedema (BCRL) and localized fibrosis. Skin tissue hardness was assessed via the force required to indent skin to 4 mm (F4.0) and 1.3 mm (F1.3) and skin water was assessed by measurements of tissue dielectric constant (TDC). Measurements were done before coolin...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Neonatal Lymphedema from Thoracic Duct Obstruction Complicating Percutaneous Intravenous Central Catheterization.
Authors: Kylat RI, Kuo PH, Bedrick AD, Witte MH Abstract Percutaneous intravenous central catheter (PICC) complications are not common and generalized edema and anasarca in neonates as a complication of PICC malposition is even rarer. Documentation of the pathomechanisms of lymphedema in cases of severe anasarca in neonates is not often done. Here we document thoracic duct obstruction as the cause of lymphedema in a neonate with severe nonpitting generalized edema. Most PICC procedures should ideally be guided by point-of-care bedside ultrasound (US), and this precaution may prevent malposition of PICC lines althou...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Transdifferentiated Monocytes: a Novel Source of Lymphatic Endothelial-like Cells.
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 th...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Is Ultrasonography a Useful Method to Evaluate the Effectiveness of Complex Decongestive Therapy in Breast Cancer-related Lymphedema?
This study also demonstrated that the soft tissue thickness was higher in the affected arm and ultrasonographic findings were consistent with the other measurement methods (circumferences and limb volumes). Considering that ultrasound imaging is patient-friendly, non-invasive, and cost-effective, we recommend its more widespread use for evaluating treatment efficacy in BCRL. PMID: 30234245 [PubMed] (Source: Lymphology)
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Lymphatic Architecture of Suncus Murinus (House Musk Shrew) Palatum.
Authors: Hatakeyama S, Ando Y, Miura H, Satoh K, Fujimura A Abstract The 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 ...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Lymphangioleiomyomatosis and Gorham-Stout disease: Primary or secondary disorders of the lymphatic system?
Authors: Witte MH Abstract Lymphangioleimyomatosis and Gorham- Stout disease, rare disorders which share features of proliferating lymphatic vessels, predominantly in the lung in the former and bone in the latter, commonly manifest as progressive lung disease often associated with life-threatening complications of chylous reflux from central lymphatic obstruction/ leakage. This Lymphspiration-Editorial proposes that, rather than a secondary complication, lymphatic obstruction/ dysfunction is a much earlier or even the primary event in the pathogenesis of both disorders and that lymphostasis drives the cellular prol...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

The volume of postoperative drainage fluid as a potential early predictor of lymphedema after lymph node excision for metastatic melanoma.
Authors: Kretschmer L, Hellriegel S, Thoms KM, Schon MP, Al Ghazal P, Zapf A Abstract Lymphedema (LE) following lymph node dissection is a major problem for cancer patients, and radiation therapy, extended surgery, groin dissection, obesity, and older age are well-established risk factors of LE. We studied whether these risk factors are further associated with high volumes of postoperative drainage fluid after complete lymph node dissection (CLND) for melanoma metastases. Moreover, we examined whether a high amount of drainage fluid after sentinel lymph node biopsy (SLNB) can predict a high amount of drainage fluid...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Long-term follow-up of collateral pathways established after lymphadenectomy in rats.
In conclusion, the collateral pathway did not appear to be only for temporary use to compensate for drainage from the edematous limb but appears more stable as a component of a compensating lymphatic system. These new dilated vessels, although functional at this point, may still be susceptible to disturbance by further alteration to the lymph vessels. PMID: 30234249 [PubMed] (Source: Lymphology)
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Multi-modal imaging features and lympho-venous shunt for vaginal chylous fistula in lymphangioleiomyomatosis: Case report and review.
Authors: Huo M, Wang Z, Yue Y, Dong J, Wen Z, Xin J Abstract Vaginal chylous fistula is a very rare lymphatic disorder and lymphangioleiomyomatosis (LAM) is also a rare multisystemic disease. LAM with the development of a vaginal chylous fistula has rarely been reported. Here we report a case of vaginal chylous fistula accompanied with LAM. A 61-year-old woman occasionally experiencing milky vaginal discharge for the last 3 months underwent CT lymphangiography (CTL) after direct lymphangiography (DLG) and lymphoscintigraphy. DLG showed lymph flowing backwards toward the pelvic cavity. CTL revealed abnormal distribu...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

A new combined operative technique using crossed inguinal lymphatic rescue for pediatric patients with mixed lymphatic and venous malformations.
Authors: Papendieck C, Barbosa L, Amore M, Martinez Allende R, Mogollon G, Gomez Rueda S, Gomez M Abstract Truncular venous malformations and acquired functional or anatomical venous occlusions (or sub-occlusions) can be the cause of secondary lymphedema and even the cause of primary lymphedema when they are associated with lymphatic malformations (lymphangiodysplasia - LAD I, lymphadenodysplasia - LAD II, or a combination of both) in pediatric patients. This understanding recognizes the shared and successive embryogenesis of both systems. These conditions can exhibit hypertension in the venous pedicles intended fo...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Can obstructive intralymphatic granulomas be the cause of cheilitis granulomatosa?
We report 6 patients with ChG who clinically presented localized edema of the lips. Lip biopsy with pathomorphological and immunohistochemical examination was performed in all cases. We found discrete, non-necrotizing granulomas which were adjacent to numerous blood and lymphatic vessels. The lumen of lymphatic channels was dilated and was either empty or contained lymph and few macrophages or was completely occluded by nearby granulomas. All patients demonstrated a characteristic pattern of lymphangiectasia and perivascular lymphatic aggregates with evidence of non-necrotizing granulomas. None manifested intralymphatic gr...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Successful diagnosis of lymphangioleiomyomatosis with transbronchial lung cryobiopsy.
Authors: Gupta N, Wikenheiser-Brokamp K, Zander D, Balestra R, Selvaraju A, Niehaus K, Benzaquen S Abstract A 47-year old female was evaluated in our clinic for an incidental discovery of diffuse cystic lung disease on high-resolution computed tomography (CT) scan of the chest. There was no personal or family history of tuberous sclerosis complex (TSC), sicca symptoms, pneumothorax, or skin or renal tumors. Review of her chest CT scan showed bilateral, round, uniform, thin-walled cysts present in a diffuse distribution characteristic of lymphangioleiomyomatosis (LAM). CT scan of the abdomen and pelvis did not revea...
Source: Lymphology - September 23, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Lymphoscintigraphic Findings That Predict Favorable Outcome after Lymphaticovenous Anastomosis.
Authors: Chiewvit S, Kumnerdnakta S Abstract Radionuclide lymphoscintigraphy is an imaging technique used to radiologically evaluate the lymphatic system which can be utilized to evaluate signs of lymphatic obstruction that could be indication for lymphaticovenous anastomosis (LVA) operations. Our objective was to investigate and identify the radiographic signs in lymphoscinigraphy that predict favorable outcome after LVA. We retrospectively reviewed the medical charts of 80 patients with upper or lower-limb lymphedema who underwent initial lymphoscintigraphy before LVA during the 2011 to 2014 study period to evalu...
Source: Lymphology - September 22, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

A LYVE-1/CRSBP-1 Mutation in Inherited Primary Lymphedema.
Authors: Liu NF, Yu Z, Luo Y, Sun D Abstract Primary lymphedema is clinically and genetically heterogeneous with germline mutations identified in approximately 20 primary lymphedema genes. The lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1) gene, also known as cell-surface retention sequence binding protein-1 (CRSBP-1), encodes the major hyaluronan receptor in lymphatic endothelia and is one of the most specific lymphatic vessel markers. However, the role of this lymphatic endothelial specific protein in the development of the lymphatic system and lymphatic diseases remains unclear. Here, we report a mi...
Source: Lymphology - September 22, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research

Parental Experience of Prenatal Diagnosis of Lymphatic Malformation.
This study investigated parental experiences associated with prenatal diagnosis of LM. Parents of 5 children diagnosed prenatally with LM were recruited from the Vascular Anomalies Clinic at the Royal Childrens Hospital, Melbourne. Ten in-depth semistructured interviews were conducted with each parent separately to explore their experiences and views at the time of diagnosis and immediately after childbirth. Transcribed interviews were coded and thematically analyzed. Parents experienced prenatal diagnosis of LM as an unexpected and traumatic event. The lack of adequate information and clear care pathway created confusion ...
Source: Lymphology - September 22, 2018 Category: Internal Medicine Tags: Lymphology Source Type: research