151
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Kilarski WW. Physiological Perspective on Therapies of Lymphatic Vessels. Adv Wound Care (New Rochelle) 2018; 7:189-208. [PMID: 29984111 PMCID: PMC6032671 DOI: 10.1089/wound.2017.0768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/26/2018] [Indexed: 12/16/2022] Open
Abstract
Significance: Growth of distinctive blood vessels of granulation tissue is a central step in the post-developmental tissue remodeling. Even though lymphangiogenesis is a part of the regeneration process, the significance of the controlled restoration of lymphatic vessels has only recently been recognized. Recent Advances: Identification of lymphatic markers and growth factors paved the way for the exploration of the roles of lymphatic vessels in health and disease. Emerging pro-lymphangiogenic therapies use vascular endothelial growth factor (VEGF)-C to combat fluid retention disorders such as lymphedema and to enhance the local healing process. Critical Issues: The relevance of recently identified lymphatic functions awaits verification by their association with pathologic conditions. Further, despite a century of research, the complete etiology of secondary lymphedema, a fluid retention disorder directly linked to the lymphatic function, is not understood. Finally, the specificity of pro-lymphangiogenic therapy depends on VEGF-C transfection efficiency, dose exposure, and the age of the subject, factors that are difficult to standardize in a heterogeneous human population. Future Directions: Further research should reveal the role of lymphatic circulation in internal organs and connect its impairment with human diseases. Pro-lymphangiogenic therapies that aim at the acceleration of tissue healing should focus on the controlled administration of VEGF-C to increase their capillary specificity, whereas regeneration of collecting vessels might benefit from balanced maturation and differentiation of pre-existing lymphatics. Unique features of pre-nodal lymphatics, fault tolerance and functional hyperplasia of capillaries, may find applications outreaching traditional pro-lymphangiogenic therapies, such as immunomodulation or enhancement of subcutaneous grafting.
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Affiliation(s)
- Witold W. Kilarski
- Institute for Molecular Engineering, The University of Chicago, Chicago, Illinois
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152
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Abstract
PURPOSE OF REVIEW The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions. RECENT FINDINGS The mainstay of current therapies for congenital and acquired lymphatic abnormalities has involved nonspecific medical management or surgical procedures to obstruct or divert lymphatic flow. With the development of dynamic contrast-enhanced magnetic resonance lymphangiography, image-directed percutaneous intervention may largely replace surgery. Because of new insights into the mechanisms that regulate lymphatic biology, pharmacologic inhibitors of mTOR and leukotriene B4 signaling are each in Phase II clinical trials to treat abnormal lymphatic structure and function, respectively. SUMMARY As our understanding of normal lymphatic biology continues to advance, we will be able to develop novel strategies to support and augment lymphatic function during critical illness and through convalescence.
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153
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Fernández Peñuela R, Pons Playa G, Casaní Arazo L, Masiá Ayala J. An Experimental Lymphedema Animal Model for Assessing the Results of Lymphovenous Anastomosis. Lymphat Res Biol 2018; 16:234-239. [DOI: 10.1089/lrb.2016.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Randolfo Fernández Peñuela
- Department of Plastic Surgery, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gemma Pons Playa
- Department of Plastic Surgery, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Casaní Arazo
- Catalan Institute of Cardiovascular Sciences, Hospital Santa Creu i Sant Pau, Pavilion of the Convent, Barcelona, Spain
| | - Jaume Masiá Ayala
- Department of Plastic Surgery, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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154
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Wong BW, Zecchin A, García-Caballero M, Carmeliet P. Emerging Concepts in Organ-Specific Lymphatic Vessels and Metabolic Regulation of Lymphatic Development. Dev Cell 2018; 45:289-301. [PMID: 29738709 DOI: 10.1016/j.devcel.2018.03.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/12/2017] [Accepted: 03/26/2018] [Indexed: 02/08/2023]
Abstract
The lymphatic system has been less well characterized than the blood vascular system; however, work in recent years has uncovered novel regulators and non-venous lineages that contribute to lymphatic formation in various organs. Further, the identification of organ-specific lymphatic beds underscores their potential interaction with organ development and function, and highlights the possibility of targeting these organ-specific lymphatics beds in disease. This review focuses on newly described metabolic and epigenetic regulators of lymphangiogenesis and the interplay between lymphatic development and function in a number of major organ systems.
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Affiliation(s)
- Brian W Wong
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, Leuven Cancer Institute, KU Leuven, Herestraat 49 - B912, Leuven 3000, Belgium; Laboratory of Angiogenesis and Vascular Metabolism, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven 3000, Belgium
| | - Annalisa Zecchin
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, Leuven Cancer Institute, KU Leuven, Herestraat 49 - B912, Leuven 3000, Belgium; Laboratory of Angiogenesis and Vascular Metabolism, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven 3000, Belgium
| | - Melissa García-Caballero
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, Leuven Cancer Institute, KU Leuven, Herestraat 49 - B912, Leuven 3000, Belgium; Laboratory of Angiogenesis and Vascular Metabolism, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven 3000, Belgium
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, Leuven Cancer Institute, KU Leuven, Herestraat 49 - B912, Leuven 3000, Belgium; Laboratory of Angiogenesis and Vascular Metabolism, VIB-KU Leuven Center for Cancer Biology, VIB, Leuven 3000, Belgium.
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155
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Ge Y, Li Y, Gong J, Zhu W. Mesenteric organ lymphatics and inflammatory bowel disease. Ann Anat 2018; 218:199-204. [PMID: 29723582 DOI: 10.1016/j.aanat.2018.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/14/2018] [Accepted: 03/01/2018] [Indexed: 12/20/2022]
Abstract
Inflammatory bowel disease (IBD) is a complex gastrointestinal disorder and its etiology is unclear yet. Current theory in IBD is focused on genetics, immunity and intestinal microbes. Emerging clinical evidence and experimental results suggest that morphologic abnormalities and dysfunction of mesenteric lymphatics may have potential roles in the pathogenesis and disease course of IBD. In this review, we summarize the findings of specific investigations of the lymphatics and explore its role in IBD.
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Affiliation(s)
- Yuanyuan Ge
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002 PR China
| | - Yi Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002 PR China.
| | - Jianfeng Gong
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002 PR China
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002 PR China
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156
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Hadamitzky C, Perić H, Theobald SJ, Gratz KF, Spohr H, Pabst R, Vogt PM. Effect of cryopreservation on lymph node fragment regeneration after autologous transplantation in the minipig model. Innov Surg Sci 2018; 3:139-146. [PMID: 31579777 PMCID: PMC6604575 DOI: 10.1515/iss-2018-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/10/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction Lymphoedema is a worldwide pandemic causing swelling of tissues due to dysfunctional transport of lymph fluid. Present management concepts are based in conservative palliation of symptoms through manual lymphatic drainage, use of compression garments, manual lymph drainage, exercise, and skin care. Nevertheless, some curative options as autologous lymph node transplantation were shown to reduce lymphoedema in selected cases. Lately, some concern has arisen due to reports of donor site morbidity. A possible solution could be the development of artificial lymph node scaffolds as niches of lymphatic regeneration. Engineering these scaffolds has included cryopreservation of lymph node stroma. However, the effects of cryopreservation on the regeneration capacities of these organs were unknown. Materials and methods Here, we used the minipig animal model to assess lymphatic regeneration processes after cryopreservation of autologous lymph nodes. Superficial inguinal lymph nodes were excised and conserved at -80°C for 1 month. Thereafter, lymph node fragments were transplanted in the subcutaneous tissue. Results Regeneration of the lymph nodes was assessed five months after transplantation. We show that lymph node fragment regeneration takes place in spite of former cryopreservation. Transplanted fragments presented typical histological appearance. Their draining capacity was documented by macroscopic transport of Berlin Blue dye as well as through SPECT-CT hybrid imaging. Discussion In conclusion, our results suggest that processes of cryopreservation can be used in the creation of artificial lymph node scaffolds without major impairment of lymph node fragments regeneration.
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Affiliation(s)
- Catarina Hadamitzky
- Practice for Lympho-Vascular Diseases Bahnhofstrasse 12, Hannover, Germany.,Catarina Hadamitzky and Hanes Perić contributed equally to the manuscript
| | - Hanes Perić
- myDent GmbH Tiergartenstrasse 114, 30559 Hannover, Germany.,Catarina Hadamitzky and Hanes Perić contributed equally to the manuscript
| | - Sebastian J Theobald
- Clinic of Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Hendrik Spohr
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Reinhard Pabst
- Institute of Immunomorphology, Hannover Medical School, Hannover, Germany
| | - Peter M Vogt
- Clinic of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
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157
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Todd M, Stubbs C, Pugh S. Mobiderm Autofit: an adjustable sleeve that enables patients to self-manage lymphoedema. Br J Community Nurs 2018; 23:S22-S28. [PMID: 29906197 DOI: 10.12968/bjcn.2018.23.sup4.s22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lymphoedema can result in debilitating physical and psychosocial morbidity and when combined with other chronic comorbidity, often requires holistic, specialist management that encompasses all the complex and compounding problems. Self-care is an integral component of any treatment strategy, however, the patient must be fully prepared and ongoing support should be provided. Self-care consists of managing the symptoms of lymphoedema but should include other fundamental aspects of healthy living, for example, maintaining a healthy weight and activity levels. To improve self-care, compression manufacturers have been instrumental in designing new ways of applying compression. Mobiderm Autofit armsleeves have been designed to improve the donning and wearing of compression sleeves in all patients. This product is especially useful for night-time wear and in the presence of fragile skin, or for those who only require reduced compression. The benefits of this garment are demonstrated in three case studies.
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Affiliation(s)
- Marie Todd
- Lymphoedema Clinical Nurse Specialist, Glasgow Specialist Lymphoedema Service, Scotland
| | - Charlotte Stubbs
- (case study author), Deputy Clinical Nurse Manager, Wolverhampton Lymphoedema Service, Compton Hospice
| | - Stacy Pugh
- (case study author), Lymphoedema Clinical Nurse Manager, Wolverhampton Lymphoedema Service, Compton Hospice; Honorary Lecturer, University of Wolverhampton; and trainer at Lymphoedema Training Academy
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158
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Jackson DG. Hyaluronan in the lymphatics: The key role of the hyaluronan receptor LYVE-1 in leucocyte trafficking. Matrix Biol 2018; 78-79:219-235. [PMID: 29425695 DOI: 10.1016/j.matbio.2018.02.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/25/2022]
Abstract
LYVE-1, a close relative of the leucocyte receptor, CD44, is the main receptor for hyaluronan (HA) in lymphatic vessel endothelium and a widely used marker for distinguishing between blood and lymphatic vessels. Enigmatic for many years because of its anomalous HA-binding characteristics, the function of LYVE-1 has just recently been identified as that of a lymphatic docking receptor for dendritic cells, selectively engaging with their surface HA glycocalyx to regulate entry to peripheral lymphatics and migration to downstream lymph nodes for immune activation. Furthermore, LYVE-1 mediates the trafficking of macrophages, and is also exploited by HA-encapsulated Group A streptococci for lymphatic invasion and host dissemination. Consistent with a role in lymphatic trafficking, the interaction of LYVE-1 with HA and its degradation products can also activate intracellular signalling pathways for endothelial junctional retraction and lymphatic endothelial proliferation. Here we outline the latest findings on the receptor in the context of its peculiar biochemical properties and speculate on how the interaction of LYVE-1 with different HA sizes and conformations might variably influence cell function as a consequence of avidity and receptor crosslinking. Finally, we evaluate evidence that LYVE-1 can also bind growth factors and associate with kinase-linked growth factor receptors and conclude on how the LYVE-1·HA axis may be exploited as a target to either block inflammation or tissue allograft rejection, or potentiate vaccine and drug delivery.
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Affiliation(s)
- David G Jackson
- University of Oxford, MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford OX3 9DS, UK.
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159
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Jones D, Meijer EFJ, Blatter C, Liao S, Pereira ER, Bouta EM, Jung K, Chin SM, Huang P, Munn LL, Vakoc BJ, Otto M, Padera TP. Methicillin-resistant Staphylococcus aureus causes sustained collecting lymphatic vessel dysfunction. Sci Transl Med 2018; 10:eaam7964. [PMID: 29343625 PMCID: PMC5953194 DOI: 10.1126/scitranslmed.aam7964] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/20/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of morbidity and mortality worldwide and is a frequent cause of skin and soft tissue infections (SSTIs). Lymphedema-fluid accumulation in tissue caused by impaired lymphatic vessel function-is a strong risk factor for SSTIs. SSTIs also frequently recur in patients and sometimes lead to acquired lymphedema. However, the mechanism of how SSTIs can be both the consequence and the cause of lymphatic vessel dysfunction is not known. Intravital imaging in mice revealed an acute reduction in both lymphatic vessel contractility and lymph flow after localized MRSA infection. Moreover, chronic lymphatic impairment is observed long after MRSA is cleared and inflammation is resolved. Associated with decreased collecting lymphatic vessel function was the loss and disorganization of lymphatic muscle cells (LMCs), which are critical for lymphatic contraction. In vitro, incubation with MRSA-conditioned supernatant led to LMC death. Proteomic analysis identified several accessory gene regulator (agr)-controlled MRSA exotoxins that contribute to LMC death. Infection with agr mutant MRSA resulted in sustained lymphatic function compared to animals infected with wild-type MRSA. Our findings suggest that agr is a promising target to preserve lymphatic vessel function and promote immunity during SSTIs.
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Affiliation(s)
- Dennis Jones
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Eelco F J Meijer
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Cedric Blatter
- Harvard Medical School, Boston, MA 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Shan Liao
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
| | - Ethel R Pereira
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Echoe M Bouta
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Keehoon Jung
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Shan Min Chin
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Peigen Huang
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Lance L Munn
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Benjamin J Vakoc
- Harvard Medical School, Boston, MA 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Michael Otto
- Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20814, USA
| | - Timothy P Padera
- Edwin L. Steele Laboratory, Department of Radiation Oncology, MGH Cancer Center, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA.
- Harvard Medical School, Boston, MA 02115, USA
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160
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Suehiro K, Morikage N, Ueda K, Samura M, Takeuchi Y, Nagase T, Mizoguchi T, Nakamura K, Hamano K. Venous hemodynamics assessed with air plethysmography in legs with lymphedema. Vasc Med 2018; 23:139-142. [PMID: 29325501 DOI: 10.1177/1358863x17745372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was conducted to identify specific abnormalities using the results from air plethysmography in legs with lymphedema. A routine air plethysmography exercise protocol was performed in 31 patients with unilateral leg lymphedema, and the results were compared with those of 53 patients with unilateral great saphenous vein reflux and 15 normal subjects. The venous filling index in legs with lymphedema (2.1 ± 1.2 mL/sec) was smaller than in legs with great saphenous vein reflux (6.4 ± 4.1 mL/sec, p < 0.05), but was not different from that in normal legs (1.9 ± 1.2 mL/sec). The ejection fraction was similar in all groups. The residual volume fraction in legs with lymphedema (35 ± 32%) was larger than that in normal subjects (13 ± 23%, p < 0.05), but was not significantly different from that in the contralateral leg of the lymphedema patients (32 ± 27%). In conclusion, we found no specific air plethysmography findings in uncomplicated lymphedema.
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Affiliation(s)
- Kotaro Suehiro
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Noriyasu Morikage
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Koshiro Ueda
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Makoto Samura
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Yuriko Takeuchi
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Takashi Nagase
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Takahiro Mizoguchi
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kaori Nakamura
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Division of Vascular Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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161
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Abstract
The supply of oxygen and nutrients to tissues is performed by the blood system, and involves a net leakage of fluid outward at the capillary level. One of the principal functions of the lymphatic system is to gather this fluid and return it to the blood system to maintain overall fluid balance. Fluid in the interstitial spaces is often at subatmospheric pressure, and the return points into the venous system are at pressures of approximately 20 cmH2O. This adverse pressure difference is overcome by the active pumping of collecting lymphatic vessels, which feature closely spaced one-way valves and contractile muscle cells in their walls. Passive vessel squeezing causes further pumping. The dynamics of lymphatic pumping have been investigated experimentally and mathematically, revealing complex behaviours indicating that the system performance is robust against minor perturbations in pressure and flow. More serious disruptions can lead to incurable swelling of tissues called lymphœdema.
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Affiliation(s)
- James E Moore
- Department of Bioengineering, Imperial College London
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162
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Abstract
The supply of oxygen and nutrients to tissues is performed by the blood system, and involves a net leakage of fluid outward at the capillary level. One of the principal functions of the lymphatic system is to gather this fluid and return it to the blood system to maintain overall fluid balance. Fluid in the interstitial spaces is often at subatmospheric pressure, and the return points into the venous system are at pressures of approximately 20 cmH2O. This adverse pressure difference is overcome by the active pumping of collecting lymphatic vessels, which feature closely spaced one-way valves and contractile muscle cells in their walls. Passive vessel squeezing causes further pumping. The dynamics of lymphatic pumping have been investigated experimentally and mathematically, revealing complex behaviours indicating that the system performance is robust against minor perturbations in pressure and flow. More serious disruptions can lead to incurable swelling of tissues called lymphœdema.
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Affiliation(s)
- James E Moore
- Department of Bioengineering, Imperial College London
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163
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Dierkes C, Scherzinger A, Kiefer F. Three-Dimensional Visualization of the Lymphatic Vasculature. Methods Mol Biol 2018; 1846:1-18. [PMID: 30242749 DOI: 10.1007/978-1-4939-8712-2_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Like the circulatory blood vessel system, the dendriform lymphatic vascular system forms a disseminated organ that is virtually indispensible for the function of most other organs. Formation and maintenance of the correct topology are essential for lymph vessel physiology and hence analysis of its three-dimensional architecture provides crucial functional information.Here we describe protocols for whole-mount immunostaining of the vessel systems in various mouse tissues, mouse fetuses, and human skin biopsies. The resulting samples are suited after flat mounting for confocal microscopy or after optical tissue clearing for light sheet microscopy. Both microscopic modalities use optical sectioning to generate image stacks from which the three-dimensional vessel structure can be digitally reconstructed. We introduce the open software package Voreen, developed at the University of Münster. Voreen has been adapted and extended for the interactive visualization of large multichannel image stacks on commodity hardware, allowing for a faithful digital representation of the spatial structure of the vessel systems in whole-mount stained tissue samples.
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Affiliation(s)
- Cathrin Dierkes
- Max Planck Institute for Molecular Biomedicine, Münster, Germany
| | - Aaron Scherzinger
- Department of Computer Science, University of Münster, Münster, Germany
| | - Friedemann Kiefer
- Max Planck Institute for Molecular Biomedicine, Münster, Germany. .,European Institute for Molecular Imaging (EIMI), University of Münster, Münster, Germany.
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164
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Petrova TV, Koh GY. Organ-specific lymphatic vasculature: From development to pathophysiology. J Exp Med 2017; 215:35-49. [PMID: 29242199 PMCID: PMC5748863 DOI: 10.1084/jem.20171868] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/11/2022] Open
Abstract
Recent discoveries of novel functions and diverse origins of lymphatic vessels have drastically changed our view of lymphatic vasculature. Traditionally regarded as passive conduits for fluid and immune cells, lymphatic vessels now emerge as active, tissue-specific players in major physiological and pathophysiological processes. Lymphatic vessels show remarkable plasticity and heterogeneity, reflecting their functional specialization to control the tissue microenvironment. Moreover, alternative developmental origins of lymphatic endothelial cells in some organs may contribute to the diversity of their functions in adult tissues. This review aims to summarize the most recent findings of organotypic differentiation of lymphatic endothelial cells in terms of their distinct (patho)physiological functions in skin, lymph nodes, small intestine, brain, and eye. We discuss recent advances in our understanding of the heterogeneity of lymphatic vessels with respect to the organ-specific functional and molecular specialization of lymphatic endothelium, such as the hybrid blood-lymphatic identity of Schlemm's canal, functions of intestinal lymphatics in dietary fat uptake, and discovery of meningeal lymphatic vasculature and perivascular brain lymphatic endothelial cells.
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Affiliation(s)
- Tatiana V Petrova
- Department of Fundamental Oncology, Ludwig Institute for Cancer Research, University of Lausanne, Epalinges, Switzerland .,Division of Experimental Pathology, Vaud University Hospital Center, University of Lausanne, Lausanne, Switzerland
| | - Gou Young Koh
- Center for Vascular Research, Institute for Basic Science, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea .,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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165
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Thomas M, Morgan K, Humphreys I, Jehu D, Jenkins L. Managing chronic oedema and wet legs in the community: a service evaluation. Nurs Stand 2017; 32:39-50. [PMID: 29119743 DOI: 10.7748/ns.2017.e10951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED Patients with chronic oedema and 'wet legs' are frequently seen in the community setting, with research indicating that more than half of community nurses' caseloads are patients with chronic oedema. However, a lack of nurse education and standardised care pathways for this condition has been identified. In June 2016, the Welsh Government supported the development of the On the Ground Education Project (OGEP), which aimed to raise community nurses' awareness and recognition of chronic oedema and wet legs, to improve the management of these conditions, and to support the efficient use of community nurses' time and resources. AIM To investigate the potential economic benefits of the OGEP and its effects on patients' quality of life. METHOD The OGEP was implemented between June 2016 and March 2017. During this time, 725 patients were assessed and chronic oedema was diagnosed in 426 (59%) of them. Of these, 100 patients were purposively recruited and 97 completed the pilot service evaluation. Data were collected observationally before and after the OGEP was implemented. Baseline measurements of resources, costs and outcomes were captured at the time the patients were initially identified and at a follow-up review three months later. The EQ-5D-5L tool was used to measure patients' health-related quality of life before and after the OGEP was implemented. Data were analysed using Microsoft Excel and SPSS Version 22. RESULTS Following implementation of the OGEP, there was a significant decrease in the number of district nurse home visits, (P=<0.001), GP surgery appointments (P=0.003) and episodes of cellulitis (P=<0.001). The EQ-5D-5L utility scores showed that patients' quality of life improved after the OGEP was implemented, from a baseline of 0.401 (SD 0.254) to 0.537 (SD 0.231) at the three-month follow-up review. CONCLUSION The OGEP may support the efficient use of community nurses' time and resources, reduce costs to the NHS, and improve the quality of life of patients with chronic oedema and wet legs.
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Affiliation(s)
- Melanie Thomas
- Wales, Lymphoedema Network Wales, Cimla Hospital, West Glamorgan, Wales
| | - Karen Morgan
- Lymphoedema Network Wales, Cimla Hospital, West Glamorgan, Wales
| | | | - Diane Jehu
- Lymphoedema Network Wales, Cimla Hospital, West Glamorgan, Wales
| | - Linda Jenkins
- Lymphoedema Network Wales, Cimla Hospital, West Glamorgan, Wales
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166
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Demiri E, Dionyssiou D, Tsimponis A, Goula OC, Mιlothridis P, Pavlidis L, Spyropoulou GA, Foroglou P. Donor-Site Lymphedema Following Lymph Node Transfer for Breast Cancer-Related Lymphedema: A Systematic Review of the Literature. Lymphat Res Biol 2017; 16:2-8. [PMID: 29087763 DOI: 10.1089/lrb.2017.0043] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Abstracts Background: Among current surgical options used for treating breast cancer-related lymphedema (BCRL), autologous lymph node transfer (ALNT) is shown to provide favorable results. However, postoperative donor-site lymphedema (DSL), following the lymphatic flap harvesting from the groin area, has already been reported. Our aim is to summarize the recent literature for evidence of DSL following an ALNT for BCRL. METHODS AND RESULTS A PubMed bibliographic search was performed for published studies evaluating donor-site complications following LNT in BCRL patients. We recorded demographic data of the patients, the type of flap used, the follow-up, the donor-site morbidity, and the diagnostic tests performed pre- and postoperatively. Statistical analysis was conducted to document any correlation between the incidence of DSL and the abovementioned recorded parameters. According to our results, 11 studies met the inclusion criteria. From a total of 189 patients, three cases with DSL of the lower limb were reported (1.6%). No statistically significant correlations were found. CONCLUSION ALNT has become increasingly popular and is considered an effective surgical option for treating BCRL of the upper limb. Although the incidence of postoperative DSL is low, insufficient data on patients' demographics, surgical details, and postoperative assessment do not allow extracting significant correlations. Meticulous technique of lymph node harvesting should be seriously considered to further minimize this infrequent but debilitating complication.
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Affiliation(s)
- Efterpi Demiri
- Department of Plastic Surgery, Faculty of Health Sciences, School of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Dimitrios Dionyssiou
- Department of Plastic Surgery, Faculty of Health Sciences, School of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Antonios Tsimponis
- Department of Plastic Surgery, Faculty of Health Sciences, School of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Olga Christina Goula
- Department of Plastic Surgery, Faculty of Health Sciences, School of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Panagiotis Mιlothridis
- Department of Plastic Surgery, Faculty of Health Sciences, School of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Leonidas Pavlidis
- Department of Plastic Surgery, Faculty of Health Sciences, School of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Georgia Alexandra Spyropoulou
- Department of Plastic Surgery, Faculty of Health Sciences, School of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Perikles Foroglou
- Department of Plastic Surgery, Faculty of Health Sciences, School of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
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167
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Abstract
The lymphatic system is essential for the maintenance of tissue fluid homeostasis, gastrointestinal lipid absorption, and immune trafficking. Whereas lymphatic regeneration occurs physiologically in wound healing and tissue repair, pathological lymphangiogenesis has been implicated in a number of chronic diseases such as lymphedema, atherosclerosis, and cancer. Insight into the regulatory mechanisms of lymphangiogenesis and the manner in which uncontrolled inflammation promotes lymphatic dysfunction is urgently needed to guide the development of novel therapeutics: These would be designed to reverse lymphatic dysfunction, either primary or acquired. Recent investigation has demonstrated the mechanistic role of leukotriene B4 (LTB4) in the molecular pathogenesis of lymphedema. LTB4, a product of the innate immune response, is a constituent of the eicosanoid inflammatory mediator family of molecules that promote both physiological and pathological inflammation. Here we provide an overview of lymphatic development, the pathophysiology of lymphedema, and the role of leukotrienes in lymphedema pathogenesis.
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Affiliation(s)
- Xinguo Jiang
- VA Palo Alto Health Care System, Palo Alto, California 94304, USA.,Stanford University School of Medicine, Stanford, California 94305, USA;
| | - Mark R Nicolls
- VA Palo Alto Health Care System, Palo Alto, California 94304, USA.,Stanford University School of Medicine, Stanford, California 94305, USA;
| | - Wen Tian
- VA Palo Alto Health Care System, Palo Alto, California 94304, USA.,Stanford University School of Medicine, Stanford, California 94305, USA;
| | - Stanley G Rockson
- Stanford University School of Medicine, Stanford, California 94305, USA;
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168
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Abstract
Lymphoedema management has evolved over many decades, but the core components of treatment remain largely unaltered, such as skin care, compression and self-lymphatic drainage. Near-infrared fluorescence lymphatic imaging (NIRFLI) offers an opportunity to enhance patient outcomes by evaluating and increasing the effectiveness of these treatment options. This is relevant when we consider the impact of this chronic condition and its endemic proportions ( Mortimer, 2014 ), while Moffatt et al (2017) suggests it is one of the biggest health risks in the Western world, due to the multiple causes, such as cancer, obesity and as a complication of an ageing population. The impact of the condition can be reduced through early identification and the risk-reduction strategies that NIRFLI can offer through greater understanding of its chronicity. The use of NIRFLI has also led to the development of a new manual lymphatic drainage technique to assist in the management of lymphoedema ( Belgrado et al, 2016 ). The aim of this article is to introduce and describe NIRFLI and its use within lymphoedema management. It will discuss use with early detection of lymphoedema and expand further, focusing on its use within the management of lymphoedema.
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Affiliation(s)
- Jane Wigg
- Clinical Consultant and Director, Lymphoedema Training Academy, and LymphVision Staffordshire
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169
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Trujillo AN, Katnik C, Cuevas J, Cha BJ, Taylor-Clark TE, Breslin JW. Modulation of mesenteric collecting lymphatic contractions by σ 1-receptor activation and nitric oxide production. Am J Physiol Heart Circ Physiol 2017; 313:H839-H853. [PMID: 28778917 PMCID: PMC5668603 DOI: 10.1152/ajpheart.00702.2016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
Recently, it has been reported that a σ-receptor antagonist could reduce inflammation-induced edema. Lymphatic vessels play an essential role in removing excess interstitial fluid. We tested the hypothesis that activation of σ-receptors would reduce or weaken collecting lymphatic contractions. We used isolated, cannulated rat mesenteric collecting lymphatic vessels to study contractions in response to the σ-receptor agonist afobazole in the absence and presence of different σ-receptor antagonists. We used RT-PCR and Western blot analysis to investigate whether these vessels express the σ1-receptor and immunofluorescence confocal microscopy to examine localization of the σ1-receptor in the collecting lymphatic wall. Using N-nitro-l-arginine methyl ester (l-NAME) pretreatment before afobazole in isolated lymphatics, we tested the role of nitric oxide (NO) signaling. Finally, we used 4-amino-5-methylamino-2',7'-difluorofluorescein diacetate fluorescence as an indicator to test whether afobazole increases NO release in cultured lymphatic endothelial cells. Our results show that afobazole (50-150 µM) elevated end-systolic diameter and generally reduced pump efficiency and that this response could be partially blocked by the σ1-receptor antagonists BD 1047 and BD 1063 but not by the σ2-receptor antagonist SM-21. σ1-Receptor mRNA and protein were detected in lysates from isolated rat mesenteric collecting lymphatics. Confocal images with anti-σ1-receptor antibody labeling suggested localization in the lymphatic endothelium. Blockade of NO synthases with l-NAME inhibited the effects of afobazole. Finally, afobazole elicited increases in NO production from cultured lymphatic endothelial cells. Our findings suggest that the σ1-receptor limits collecting lymphatic pumping through a NO-dependent mechanism.NEW & NOTEWORTHY Relatively little is known about the mechanisms that govern contractions of lymphatic vessels. σ1-Receptor activation has been shown to reduce the fractional pump flow of isolated rat mesenteric collecting lymphatics. The σ1-receptor was localized mainly in the endothelium, and blockade of nitric oxide synthase inhibited the effects of afobazole.
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Affiliation(s)
- Andrea N Trujillo
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Christopher Katnik
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Javier Cuevas
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Byeong Jake Cha
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Thomas E Taylor-Clark
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jerome W Breslin
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
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170
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Garmy-Susini B, Pizzinat N, Villeneuve N, Bril A, Brakenhielm E, Parini A. [Cardiac lymphatic system]. Med Sci (Paris) 2017; 33:765-770. [PMID: 28945567 DOI: 10.1051/medsci/20173308022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The lymphatic system is a network of vessels and lymphoid tissues that maintain tissue fluid homeostasis, transport intestinal fat, and regulate immune surveillance. Despite a large body of evidence showing the importance of lymphatic vessels in cardiovascular diseases, the role of cardiac lymphatics has not been extensively investigated. This review highlights the chronology of key discoveries in cardiac lymphatic development and function. In physiology, the cardiac lymphatic system dynamically regulates interstitial fluid drainage to the mediastinal lymph nodes to maintain homeostasis and prevent edema. After myocardial infarction, lymphatic vessels in the ischemic heart become dysfunctional and contribute to the development of chronic myocardial edema that aggravates cardiac fibrosis and dysfunction. Stimulation of cardiac lymphangiogenesis, based on the delivery of lymphangiogenic growth factors, such as VEGF-C, may represent a novel therapeutic strategy to improve cardiac function.
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Affiliation(s)
- Barbara Garmy-Susini
- Institut des maladies métaboliques et cardiovasculaires (I2MC), université de Toulouse, Inserm U1048, université Paul Sabatier, 1, avenue Jean Poulhès, 31432 Toulouse, France
| | - Nathalie Pizzinat
- Institut des maladies métaboliques et cardiovasculaires (I2MC), université de Toulouse, Inserm U1048, université Paul Sabatier, 1, avenue Jean Poulhès, 31432 Toulouse, France
| | | | - Antoine Bril
- Institut de recherches Servier, Suresnes, France
| | | | - Angelo Parini
- Institut des maladies métaboliques et cardiovasculaires (I2MC), université de Toulouse, Inserm U1048, université Paul Sabatier, 1, avenue Jean Poulhès, 31432 Toulouse, France
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171
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Affiliation(s)
- Jung Ho Lee
- Department of Plastic and Reconstructive Surgery, The Catholic University of Korea Bucheon St. Mary's Hospital, Seoul, Korea
| | - David W. Chang
- Section of Plastic and Reconstructive Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois
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172
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Hayes SC, Janda M, Ward LC, Reul-Hirche H, Steele ML, Carter J, Quinn M, Cornish B, Obermair A. Lymphedema following gynecological cancer: Results from a prospective, longitudinal cohort study on prevalence, incidence and risk factors. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.06.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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173
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Borri M, Gordon KD, Hughes JC, Scurr ED, Koh DM, Leach MO, Mortimer PS, Schmidt MA. Magnetic Resonance Imaging-Based Assessment of Breast Cancer-Related Lymphoedema Tissue Composition. Invest Radiol 2017; 52:554-561. [PMID: 28538023 PMCID: PMC5548500 DOI: 10.1097/rli.0000000000000386] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/04/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of this study was to propose a magnetic resonance imaging acquisition and analysis protocol that uses image segmentation to measure and depict fluid, fat, and muscle volumes in breast cancer-related lymphoedema (BCRL). This study also aims to compare affected and control (unaffected) arms of patients with diagnosed BCRL, providing an analysis of both the volume and the distribution of the different tissue components. MATERIALS AND METHODS The entire arm was imaged with a fluid-sensitive STIR and a 2-point 3-dimensional T1W gradient-echo-based Dixon sequences, acquired in sagittal orientation and covering the same imaging volume. An automated image postprocessing procedure was developed to simultaneously (1) contour the external volume of the arm and the muscle fascia, allowing separation of the epifacial and subfascial volumes; and to (2) separate the voxels belonging to the muscle, fat, and fluid components. The total, subfascial, epifascial, muscle (subfascial), fluid (epifascial), and fat (epifascial) volumes were measured in 13 patients with unilateral BCRL. Affected versus unaffected volumes were compared using a 2-tailed paired t test; a value of P < 0.05 was considered to be significant. Pearson correlation was used to investigate the linear relationship between fat and fluid excess volumes. The distribution of fluid, fat, and epifascial excess volumes (affected minus unaffected) along the arm was also evaluated using dedicated tissue composition maps. RESULTS Total arm, epifascial, epifascial fluid, and epifascial fat volumes were significantly different (P < 0.0005), with greater volume in the affected arms. The increase in epifascial volume (globally, 94% of the excess volume) constituted the bulk of the lymphoedematous swelling, with fat comprising the main component. The total fat excess volume summed over all patients was 2.1 times that of fluid. Furthermore, fat and fluid excess volumes were linearly correlated (Pearson r = 0.75), with the fat excess volume being greater than the fluid in 11 subjects. Differences in muscle compartment volume between affected and unaffected arms were not statistically significant, and contributed only 6% to the total excess volume. Considering the distribution of the different tissue excess volumes, fluid accumulated prevalently around the elbow, with substantial involvement of the upper arm in only 3 cases. Fat excess volume was generally greater in the upper arm; however, the relative increase in epifascial volume, which considers the total swelling relative to the original size of the arm, was in 9 cases maximal within the forearm. CONCLUSIONS Our measurements indicate that excess of fat within the epifascial layer was the main contributor to the swelling, even when a substantial accumulation of fluid was present. The proposed approach could be used to monitor how the internal components of BCRL evolve after presentation, to stratify patients for treatment, and to objectively assess treatment response. This methodology provides quantitative metrics not currently available during the standard clinical assessment of BCRL and shows potential for implementation in clinical practice.
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Affiliation(s)
- Marco Borri
- From the *Cancer Research UK Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research; †Cardiac and Vascular Sciences, St George's University of London; and ‡Skin Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kristiana D. Gordon
- From the *Cancer Research UK Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research; †Cardiac and Vascular Sciences, St George's University of London; and ‡Skin Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Julie C. Hughes
- From the *Cancer Research UK Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research; †Cardiac and Vascular Sciences, St George's University of London; and ‡Skin Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Erica D. Scurr
- From the *Cancer Research UK Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research; †Cardiac and Vascular Sciences, St George's University of London; and ‡Skin Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Dow-Mu Koh
- From the *Cancer Research UK Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research; †Cardiac and Vascular Sciences, St George's University of London; and ‡Skin Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Martin O. Leach
- From the *Cancer Research UK Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research; †Cardiac and Vascular Sciences, St George's University of London; and ‡Skin Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Peter S. Mortimer
- From the *Cancer Research UK Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research; †Cardiac and Vascular Sciences, St George's University of London; and ‡Skin Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Maria A. Schmidt
- From the *Cancer Research UK Cancer Imaging Centre, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research; †Cardiac and Vascular Sciences, St George's University of London; and ‡Skin Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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174
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Hägerling R, Drees D, Scherzinger A, Dierkes C, Martin-Almedina S, Butz S, Gordon K, Schäfers M, Hinrichs K, Ostergaard P, Vestweber D, Goerge T, Mansour S, Jiang X, Mortimer PS, Kiefer F. VIPAR, a quantitative approach to 3D histopathology applied to lymphatic malformations. JCI Insight 2017; 2:93424. [PMID: 28814672 PMCID: PMC5621876 DOI: 10.1172/jci.insight.93424] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/14/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lack of investigatory and diagnostic tools has been a major contributing factor to the failure to mechanistically understand lymphedema and other lymphatic disorders in order to develop effective drug and surgical therapies. One difficulty has been understanding the true changes in lymph vessel pathology from standard 2D tissue sections. METHODS VIPAR (volume information-based histopathological analysis by 3D reconstruction and data extraction), a light-sheet microscopy-based approach for the analysis of tissue biopsies, is based on digital reconstruction and visualization of microscopic image stacks. VIPAR allows semiautomated segmentation of the vasculature and subsequent nonbiased extraction of characteristic vessel shape and connectivity parameters. We applied VIPAR to analyze biopsies from healthy lymphedematous and lymphangiomatous skin. RESULTS Digital 3D reconstruction provided a directly visually interpretable, comprehensive representation of the lymphatic and blood vessels in the analyzed tissue volumes. The most conspicuous features were disrupted lymphatic vessels in lymphedematous skin and a hyperplasia (4.36-fold lymphatic vessel volume increase) in the lymphangiomatous skin. Both abnormalities were detected by the connectivity analysis based on extracted vessel shape and structure data. The quantitative evaluation of extracted data revealed a significant reduction of lymphatic segment length (51.3% and 54.2%) and straightness (89.2% and 83.7%) for lymphedematous and lymphangiomatous skin, respectively. Blood vessel length was significantly increased in the lymphangiomatous sample (239.3%). CONCLUSION VIPAR is a volume-based tissue reconstruction data extraction and analysis approach that successfully distinguished healthy from lymphedematous and lymphangiomatous skin. Its application is not limited to the vascular systems or skin. FUNDING Max Planck Society, DFG (SFB 656), and Cells-in-Motion Cluster of Excellence EXC 1003.
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Affiliation(s)
- René Hägerling
- Mammalian Cell Signaling Laboratory, Max Planck Institute for Molecular Biomedicine, Münster, Germany
| | - Dominik Drees
- Pattern Recognition and Image Analysis Group, Department of Computer Science, and
| | - Aaron Scherzinger
- Pattern Recognition and Image Analysis Group, Department of Computer Science, and
- Visualization and Computer Graphics Group, Department of Computer Science, University of Münster, Münster, Germany
| | - Cathrin Dierkes
- Mammalian Cell Signaling Laboratory, Max Planck Institute for Molecular Biomedicine, Münster, Germany
| | - Silvia Martin-Almedina
- Molecular and Clinical Sciences Institute, St. George’s University of London, London, United Kingdom
| | - Stefan Butz
- Department Vascular Cell Biology, Max Planck Institute for Molecular Biomedicine, Münster, Germany
| | - Kristiana Gordon
- Molecular and Clinical Sciences Institute, St. George’s University of London, London, United Kingdom
| | - Michael Schäfers
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
- DFG Cells-in-Motion Cluster of Excellence 1003, Münster, Germany
| | - Klaus Hinrichs
- Visualization and Computer Graphics Group, Department of Computer Science, University of Münster, Münster, Germany
- DFG Cells-in-Motion Cluster of Excellence 1003, Münster, Germany
| | - Pia Ostergaard
- Molecular and Clinical Sciences Institute, St. George’s University of London, London, United Kingdom
| | - Dietmar Vestweber
- Department Vascular Cell Biology, Max Planck Institute for Molecular Biomedicine, Münster, Germany
| | - Tobias Goerge
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - Sahar Mansour
- Molecular and Clinical Sciences Institute, St. George’s University of London, London, United Kingdom
| | - Xiaoyi Jiang
- Pattern Recognition and Image Analysis Group, Department of Computer Science, and
- DFG Cells-in-Motion Cluster of Excellence 1003, Münster, Germany
| | - Peter S. Mortimer
- Molecular and Clinical Sciences Institute, St. George’s University of London, London, United Kingdom
| | - Friedemann Kiefer
- Mammalian Cell Signaling Laboratory, Max Planck Institute for Molecular Biomedicine, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
- DFG Cells-in-Motion Cluster of Excellence 1003, Münster, Germany
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175
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Thomas MJ, Morgan K. The development of Lymphoedema Network Wales to improve care. ACTA ACUST UNITED AC 2017; 26:740-750. [DOI: 10.12968/bjon.2017.26.13.740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Melanie J Thomas
- National Clinical Lead for Lymphoedema in Wales, Lymphoedema Network Wales, Cimla Health and Social Care Centre, Neath
| | - Karen Morgan
- National Lymphoedema Education and Research Lead, Lymphoedema Network Wales, Cimla Health and Social Care Centre, Neath
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176
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Garza R, Skoracki R, Hock K, Povoski SP. A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies. BMC Cancer 2017; 17:468. [PMID: 28679373 PMCID: PMC5497342 DOI: 10.1186/s12885-017-3444-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
Secondary lymphedema of the upper and lower extremities related to prior oncologic therapies, including cancer surgeries, radiation therapy, and chemotherapy, is a major cause of long-term morbidity in cancer patients. For the upper extremities, it is most commonly associated with prior oncologic therapies for breast cancer, while for the lower extremities, it is most commonly associated with oncologic therapies for gynecologic cancers, urologic cancers, melanoma, and lymphoma. Both non-surgical and surgical management strategies have been developed and utilized, with the primary goal of all management strategies being volume reduction of the affected extremity, improvement in patient symptomology, and the reduction/elimination of resultant extremity-related morbidities, including recurrent infections. Surgical management strategies include: (i) ablative surgical methods (i.e., Charles procedure, suction-assisted lipectomy/liposuction) and (ii) physiologic surgical methods (i.e., lymphaticolymphatic bypass, lymphaticovenular anastomosis, vascularized lymph node transfer, vascularized omental flap transfer). While these surgical management strategies can result in dramatic improvement in extremity-related symptomology and improve quality of life for these cancer patients, many formidable challenges remain for successful management of secondary lymphedema. It is hopeful that ongoing clinical research efforts will ultimately lead to more complete and sustainable treatment strategies and perhaps a cure for secondary lymphedema and its devastating resultant morbidities.
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Affiliation(s)
- Ramon Garza
- PRMA Plastic Surgery, San Antonio, TX 78240 USA
| | - Roman Skoracki
- Department of Plastic Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Karen Hock
- Division of Oncology Rehabilitation Services, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Stephen P. Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
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177
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De Novo Upper Extremity Lymphedema After Elective Hand Surgery in Breast Cancer Survivors. Ann Plast Surg 2017; 79:24-27. [DOI: 10.1097/sap.0000000000000986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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178
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Dalal A, Eskin‐Schwartz M, Mimouni D, Ray S, Days W, Hodak E, Leibovici L, Paul M. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev 2017; 6:CD009758. [PMID: 28631307 PMCID: PMC6481501 DOI: 10.1002/14651858.cd009758.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Erysipelas and cellulitis (hereafter referred to as 'cellulitis') are common bacterial skin infections usually affecting the lower extremities. Despite their burden of morbidity, the evidence for different prevention strategies is unclear. OBJECTIVES To assess the beneficial and adverse effects of antibiotic prophylaxis or other prophylactic interventions for the prevention of recurrent episodes of cellulitis in adults aged over 16. SEARCH METHODS We searched the following databases up to June 2016: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS. We also searched five trials registry databases, and checked reference lists of included studies and reviews for further references to relevant randomised controlled trials (RCTs). We searched two sets of dermatology conference proceedings, and BIOSIS Previews. SELECTION CRITERIA Randomised controlled trials evaluating any therapy for the prevention of recurrent cellulitis. DATA COLLECTION AND ANALYSIS Two authors independently carried out study selection, data extraction, assessment of risks of bias, and analyses. Our primary prespecified outcome was recurrence of cellulitis when on treatment and after treatment. Our secondary outcomes included incidence rate, time to next episode, hospitalisation, quality of life, development of resistance to antibiotics, adverse reactions and mortality. MAIN RESULTS We included six trials, with a total of 573 evaluable participants, who were aged on average between 50 and 70. There were few previous episodes of cellulitis in those recruited to the trials, ranging between one and four episodes per study.Five of the six included trials assessed prevention with antibiotics in participants with cellulitis of the legs, and one assessed selenium in participants with cellulitis of the arms. Among the studies assessing antibiotics, one study evaluated oral erythromycin (n = 32) and four studies assessed penicillin (n = 481). Treatment duration varied from six to 18 months, and two studies continued to follow up participants after discontinuation of prophylaxis, with a follow-up period of up to one and a half to two years. Four studies were single-centre, and two were multicentre; they were conducted in five countries: the UK, Sweden, Tunisia, Israel, and Austria.Based on five trials, antibiotic prophylaxis (at the end of the treatment phase ('on prophylaxis')) decreased the risk of cellulitis recurrence by 69%, compared to no treatment or placebo (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.13 to 0.72; n = 513; P = 0.007), number needed to treat for an additional beneficial outcome (NNTB) six, (95% CI 5 to 15), and we rated the certainty of evidence for this outcome as moderate.Under prophylactic treatment and compared to no treatment or placebo, antibiotic prophylaxis reduced the incidence rate of cellulitis by 56% (RR 0.44, 95% CI 0.22 to 0.89; four studies; n = 473; P value = 0.02; moderate-certainty evidence) and significantly decreased the rate until the next episode of cellulitis (hazard ratio (HR) 0.51, 95% CI 0.34 to 0.78; three studies; n = 437; P = 0.002; moderate-certainty evidence).The protective effects of antibiotic did not last after prophylaxis had been stopped ('post-prophylaxis') for risk of cellulitis recurrence (RR 0.88, 95% CI 0.59 to 1.31; two studies; n = 287; P = 0.52), incidence rate of cellulitis (RR 0.94, 95% CI 0.65 to 1.36; two studies; n = 287; P = 0.74), and rate until next episode of cellulitis (HR 0.78, 95% CI 0.39 to 1.56; two studies; n = 287). Evidence was of low certainty.Effects are relevant mainly for people after at least two episodes of leg cellulitis occurring within a period up to three years.We found no significant differences in adverse effects or hospitalisation between antibiotic and no treatment or placebo; for adverse effects: RR 0.87, 95% CI 0.58 to 1.30; four studies; n = 469; P = 0.48; for hospitalisation: RR 0.77, 95% CI 0.37 to 1.57; three studies; n = 429; P = 0.47, with certainty of evidence rated low for these outcomes. The existing data did not allow us to fully explore its impact on length of hospital stay.The common adverse reactions were gastrointestinal symptoms, mainly nausea and diarrhoea; rash (severe cutaneous adverse reactions were not reported); and thrush. Three studies reported adverse effects that led to discontinuation of the assigned therapy. In one study (erythromycin), three participants reported abdominal pain and nausea, so their treatment was changed to penicillin. In another study, two participants treated with penicillin withdrew from treatment due to diarrhoea or nausea. In one study, around 10% of participants stopped treatment due to pain at the injection site (the active treatment group was given intramuscular injections of benzathine penicillin).None of the included studies assessed the development of antimicrobial resistance or quality-of-life measures.With regard to the risks of bias, two included studies were at low risk of bias and we judged three others as being at high risk of bias, mainly due to lack of blinding. AUTHORS' CONCLUSIONS In terms of recurrence, incidence, and time to next episode, antibiotic is probably an effective preventive treatment for recurrent cellulitis of the lower limbs in those under prophylactic treatment, compared with placebo or no treatment (moderate-certainty evidence). However, these preventive effects of antibiotics appear to diminish after they are discontinued (low-certainty evidence). Treatment with antibiotic does not trigger any serious adverse events, and those associated are minor, such as nausea and rash (low-certainty evidence). The evidence is limited to people with at least two past episodes of leg cellulitis within a time frame of up to three years, and none of the studies investigated other common interventions such as lymphoedema reduction methods or proper skin care. Larger, high-quality studies are warranted, including long-term follow-up and other prophylactic measures.
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Affiliation(s)
- Adam Dalal
- Beilinson Hospital, Rabin Medical CenterDepartment of Dermatology39 Jabotinski StreetPetah TikvaIsrael49100
- Tel Aviv UniversityThe Sackler School of MedicineTel AvivIsrael
| | - Marina Eskin‐Schwartz
- Beilinson Hospital, Rabin Medical CenterDepartment of Dermatology39 Jabotinski StreetPetah TikvaIsrael49100
- Tel Aviv UniversityThe Sackler School of MedicineTel AvivIsrael
| | - Daniel Mimouni
- Beilinson Hospital, Rabin Medical CenterDepartment of Dermatology39 Jabotinski StreetPetah TikvaIsrael49100
- Tel Aviv UniversityThe Sackler School of MedicineTel AvivIsrael
| | - Sujoy Ray
- St. John's Medical College and HospitalDepartment of PsychiatrySarjapur RoadBangaloreKarnatakaIndia560008
| | - Walford Days
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - Emmilia Hodak
- Beilinson Hospital, Rabin Medical CenterDepartment of Dermatology39 Jabotinski StreetPetah TikvaIsrael49100
- Tel Aviv UniversityThe Sackler School of MedicineTel AvivIsrael
| | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine EKaplan StreetPetah TikvaIsrael49100
| | - Mical Paul
- Rambam Health Care CampusDivision of Infectious DiseasesHa‐aliya 8 StHaifaIsrael33705
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179
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Affiliation(s)
- Marie Todd
- Lymphoedema CNS, Greater Glasgow and Clyde NHS
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180
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Abstract
This clinical review article on the combined use of JOBST FarrowWrap and Cutimed® Sorbion® Sachet XL uses a case study methodology to demonstrate how effective this approach is in managing superficial ulceration and/or lymphorrhea in the presence of chronic oedema and lymphoedema. The blend of these symptoms causes significant physical and psychosocial issues for patients and is highly labour and resource intensive. However, there is often inadequate treatment choice leading to protracted input by nurses and delayed or failed healing. Only by combining an effective exudate/lymphorrhea dressing choice with compression therapy, will there be a positive outcome and this will result in reducing nursing input, cost to the NHS, and enhance patient self-care.
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Affiliation(s)
- Marie Todd
- Lymphoedema Clinical Nurse Specialist, Specialist Lymphoedema Service, Glasgow
| | - Karen Lay-Flurrie
- Leg Ulcer Specialist Nurse, Community Leg Ulcer Clinic, Hertfordshire Community NHS Trust
| | - Janet Drake
- Leg Ulcer Support Nurse, Community Leg Ulcer Clinic, Hertfordshire Community NHS Trust
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181
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Alexakis C, Gordon K, Mellor R, Chong H, Mortimer P, Pollok R. Ano-genital Granulomatosis and Crohn's Disease: A Case Series of Males Presenting with Genital Lymphoedema. J Crohns Colitis 2017; 11:454-459. [PMID: 27683802 DOI: 10.1093/ecco-jcc/jjw173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Ano-genital granulomatosis is a rare chronic granulomatous condition of the skin that causes lymphoedema of the external genitalia. There is a reported association with Crohn's disease. Mechanisms of disease and optimal methods of treatment are poorly understood. METHODS A retrospective casenote review of 25 male patients with ano-genital granulomatosis presenting with genital lymphoedema was performed to determine the clinical and histopathological features of this condition and its relationship to intestinal Crohn's disease. RESULTS A combination of penile and scrotal oedema was reported at presentation in 80% of patients; 40% of patients had associated intestinal Crohn's disease. The average time from symptom onset to diagnosis was 52.7 months. Half of cutaneous biopsies contained non-caseating granulomas and 14% contained intralymphatic granulomas. In all, 72% of patients responded to oral steroids initially but recurrence was common. Complete or partial response was achieved in 60% of patients treated with azathioprine. Three of six patients responded to anti-tumour necrosis factor [TNF] therapy. A small proportion of patients required circumcision or de-bulking surgery for more debilitating disease. CONCLUSIONS Ano-genital granulomatosis is a rare condition that presents with genital lymphoedema, and there is frequently a protracted delay in diagnosis. There is a very strong association with intestinal Crohn's disease. Genital lymphoedema associated with gastrointestinal symptoms should prompt careful evaluation to exclude both ano-genital granulomatosis and Crohn's disease.
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Affiliation(s)
| | - Kristiana Gordon
- Department of Dermatology and Lymphoedema, St George's University Hospital, London, UK
| | - Russell Mellor
- Department of Dermatology and Lymphoedema, St George's University Hospital, London, UK
| | - Heung Chong
- Department of Cellular Pathology, St George's University Hospital, London, UK
| | - Peter Mortimer
- Department of Dermatology and Lymphoedema, St George's University Hospital, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospital, London, UK
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182
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Lindqvist E, Wedin M, Fredrikson M, Kjølhede P. Lymphedema after treatment for endometrial cancer − A review of prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2017; 211:112-121. [DOI: 10.1016/j.ejogrb.2017.02.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/19/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
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183
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Aldrich MB, Gross D, Morrow JR, Fife CE, Rasmussen JC. Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities, as assessed by near-infrared fluorescence lymphatic imaging. JOURNAL OF INNOVATIVE OPTICAL HEALTH SCIENCES 2017; 10:1650049. [PMID: 29104671 PMCID: PMC5665410 DOI: 10.1142/s1793545816500498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Previous studies have shown cost effectiveness and quality-of-life benefit of pneumatic compression therapy (PCT) for lymphedema. Insurers, such as the Centers for Medicare/Medicaid (CMS), however, desire visual proof that PCT moves lymph. Near-infrared fluorescence lymphatic imaging (NIRFLI) was used to visualize lymphatic anatomy and function in four subjects with primary and cancer treatment-related lymphedema (LE) of the lower extremities before, during, and after pneumatic compression therapy (PCT). Optically transparent and windowed PCT garments allowed visualization of lymph movement during single, one-hour PCT treatment sessions. Visualization revealed significant extravascular and lymphatic vascular movement of intradermally injected dye in all subjects. In one subject with sufficient patent lymphatic vessels to allow quantification of lymph pumping velocities and frequencies, these values were significantly increased during and after PCT as compared to pre-treatment values. Lymphatic contractile activity in patent lymphatic vessels occurred in concert with the sequential cycling of PCT. Direct visualization revealed increased lymphatic function, during and after PCT therapy, in all lymphedema-affected extremities. Further studies are warranted to assess the effects of PCT pressure and sequences on lymph uptake and movement.
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Affiliation(s)
- Melissa B. Aldrich
- Center for Molecular Imaging, The Brown Institute for Molecular Medicine, UTHealth, Houston, Texas
| | | | - John Rodney Morrow
- Center for Molecular Imaging, The Brown Institute for Molecular Medicine, UTHealth, Houston, Texas
| | - Caroline E. Fife
- CHI St. Luke’s Health, The Woodlands Hospital, The Woodlands, Texas
| | - John C. Rasmussen
- Center for Molecular Imaging, The Brown Institute for Molecular Medicine, UTHealth, Houston, Texas
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184
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Crescenzi R, Donahue PMC, Hartley KG, Desai AA, Scott AO, Braxton V, Mahany H, Lants SK, Donahue MJ. Lymphedema evaluation using noninvasive 3T MR lymphangiography. J Magn Reson Imaging 2017; 46:1349-1360. [PMID: 28245075 DOI: 10.1002/jmri.25670] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/30/2017] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To exploit the long 3.0T relaxation times and low flow velocity of lymphatic fluid to develop a noninvasive 3.0T lymphangiography sequence and evaluate its relevance in patients with lymphedema. MATERIALS AND METHODS A 3.0T turbo-spin-echo (TSE) pulse train with long echo time (TEeffective = 600 msec; shot-duration = 13.2 msec) and TSE-factor (TSE-factor = 90) was developed and signal evolution simulated. The method was evaluated in healthy adults (n = 11) and patients with unilateral breast cancer treatment-related lymphedema (BCRL; n = 25), with a subgroup (n = 5) of BCRL participants scanned before and after manual lymphatic drainage (MLD) therapy. Maximal lymphatic vessel cross-sectional area, signal-to-noise-ratio (SNR), and results from a five-point categorical scoring system were recorded. Nonparametric tests were applied to evaluate study parameter differences between controls and patients, as well as between affected and contralateral sides in patients (significance criteria: two-sided P < 0.05). RESULTS Patient volunteers demonstrated larger lymphatic cross-sectional areas in the affected (arm = 12.9 ± 6.3 mm2 ; torso = 17.2 ± 15.6 mm2 ) vs. contralateral (arm = 9.4 ± 3.9 mm2 ; torso = 9.1 ± 4.6 mm2 ) side; this difference was significant both for the arm (P = 0.014) and torso (P = 0.025). Affected (arm: P = 0.010; torso: P = 0.016) but not contralateral (arm: P = 0.42; torso: P = 0.71) vessel areas were significantly elevated compared with control values. Lymphatic cross-sectional areas reduced following MLD on the affected side (pre-MLD: arm = 8.8 ± 1.8 mm2 ; torso = 31.4 ± 26.0 mm2 ; post-MLD: arm = 6.6 ± 1.8 mm2 ; torso = 23.1 ± 24.3 mm2 ). This change was significant in the torso (P = 0.036). The categorical scoring was found to be less specific for detecting lateralizing disease compared to lymphatic-vessel areas. CONCLUSION A 3.0T lymphangiography sequence is proposed, which allows for upper extremity lymph stasis to be detected in ∼10 minutes without exogenous contrast agents. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1349-1360.
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Affiliation(s)
- Rachelle Crescenzi
- Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Paula M C Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Dayani Center for Health and Wellness, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Katherine G Hartley
- Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Aditi A Desai
- Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Allison O Scott
- Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Vaughn Braxton
- Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Helen Mahany
- Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sarah K Lants
- Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Manus J Donahue
- Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, USA
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185
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Cooper G. A wealth of information to apply to lymphoedema management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:200-202. [PMID: 28230433 DOI: 10.12968/bjon.2017.26.4.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Garry Cooper, Lecturer in Adult Nursing and Lymphoedema, Birmingham City University, considers how increasing knowledge in the field needs to be translated into effective, patient-focused services.
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186
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Affiliation(s)
- Garry Cooper
- Lecturer-Practitioner, Compton Hospice, MSc, BSc, DipHE
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187
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Betterman KL, Harvey NL. The lymphatic vasculature: development and role in shaping immunity. Immunol Rev 2016; 271:276-92. [PMID: 27088921 DOI: 10.1111/imr.12413] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The lymphatic vasculature is an integral component of the immune system. Lymphatic vessels are a key highway via which immune cells are trafficked, serving not simply as a passive route of transport, but to actively shape and coordinate immune responses. Reciprocally, immune cells provide signals that impact the growth, development, and activity of the lymphatic vasculature. In addition to immune cell trafficking, lymphatic vessels are crucial for fluid homeostasis and lipid absorption. The field of lymphatic vascular research is rapidly expanding, fuelled by rapidly advancing technology that has enabled the manipulation and imaging of lymphatic vessels, together with an increasing recognition of the involvement of lymphatic vessels in a myriad of human pathologies. In this review we provide an overview of the genetic pathways and cellular processes important for development and maturation of the lymphatic vasculature, discuss recent work revealing important roles for the lymphatic vasculature in directing immune cell traffic and coordinating immune responses and highlight the involvement of lymphatic vessels in a range of pathological settings.
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Affiliation(s)
- Kelly L Betterman
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia
| | - Natasha L Harvey
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
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188
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Miranda Garcés M, Pons G, Mirapeix R, Masià J. Intratissue lymphovenous communications in the mechanism of action of vascularized lymph node transfer. J Surg Oncol 2016; 115:27-31. [PMID: 27885675 DOI: 10.1002/jso.24413] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Vascularized lymph node transfer (VLNT) as a surgical treatment for cancer-related lymphedema has shown beneficial effects. The mechanism of action of this procedure involves lymphangiogenesis and lymphovenous communications (LVC) within the lymph nodes. We propose intratissue LVC as an additional element responsible for drainage of lymph to blood in the flap and examine this hypothesis in the current study. METHODS This prospective study determined the passage of lymph to the venous system via intratissue LVC in 26 free flaps used for breast reconstruction. We evaluated whether fluorescence was positive in the pedicle vein after increasing time intervals following intradermal injection of indocyanine green (ICG) dye into the flaps using near infra-red fluorescence lymphography. RESULTS We studied 26 free flaps, 22 deep inferior epigastric perforator (DIEP) flaps (84.6%), and 4 superior gluteal artery perforator (SGAP) flaps (15.4%). Fluorescence in the pedicle vein was positive in 22 of the 26 flaps (P = 0.000). The median time for fluorescence evaluation in the pedicle vein was 120 min. CONCLUSIONS Fluorescence in the pedicle vein after ICG intradermal injection indicates functional intratissue LVC in free flaps. J. Surg. Oncol. 2017;115:27-31. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- María Miranda Garcés
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau/Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gemma Pons
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau/Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rosa Mirapeix
- Department of Anatomy and Embriology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jaume Masià
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau/Universitat Autonoma de Barcelona, Barcelona, Spain
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189
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Frueh FS, Körbel C, Gassert L, Müller A, Gousopoulos E, Lindenblatt N, Giovanoli P, Laschke MW, Menger MD. High-resolution 3D volumetry versus conventional measuring techniques for the assessment of experimental lymphedema in the mouse hindlimb. Sci Rep 2016; 6:34673. [PMID: 27698469 PMCID: PMC5048170 DOI: 10.1038/srep34673] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/16/2016] [Indexed: 12/22/2022] Open
Abstract
Secondary lymphedema is a common complication of cancer treatment characterized by chronic limb swelling with interstitial inflammation. The rodent hindlimb is a widely used model for the evaluation of novel lymphedema treatments. However, the assessment of limb volume in small animals is challenging. Recently, high-resolution three-dimensional (3D) imaging modalities have been introduced for rodent limb volumetry. In the present study we evaluated the validity of microcomputed tomography (μCT), magnetic resonance imaging (MRI) and ultrasound in comparison to conventional measuring techniques. For this purpose, acute lymphedema was induced in the mouse hindlimb by a modified popliteal lymphadenectomy. The 4-week course of this type of lymphedema was first assessed in 6 animals. In additional 12 animals, limb volumes were analyzed by μCT, 9.4 T MRI and 30 MHz ultrasound as well as by planimetry, circumferential length and paw thickness measurements. Interobserver correlation was high for all modalities, in particular for μCT analysis (r = 0.975, p < 0.001). Importantly, caliper-measured paw thickness correlated well with μCT (r = 0.861), MRI (r = 0.821) and ultrasound (r = 0.800). Because the assessment of paw thickness represents a time- and cost-effective approach, it may be ideally suited for the quantification of rodent hindlimb lymphedema.
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Affiliation(s)
- Florian S Frueh
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany.,Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Christina Körbel
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Laura Gassert
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Andreas Müller
- Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Epameinondas Gousopoulos
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology, ETH Zurich, Zurich, Switzerland
| | - Nicole Lindenblatt
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Pietro Giovanoli
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Matthias W Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg/Saar, Germany
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190
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Lee N, Wigg J, Pugh S, Barclay J, Moore H. Lymphoedema management with the LymphFlow Advance pneumatic compression pump. Br J Community Nurs 2016; 21:S13-S19. [PMID: 27715144 DOI: 10.12968/bjcn.2016.21.sup10.s13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There are many intermittent pneumatic compression devices available for use in the management and adjunct treatment of lymphatic, venous and arterial disease. This article discusses the development of a new advanced pneumatic compression device, the LymphFlow Advance, which can perform focussed treatment on the lymphoedematous area using a variety of different cycles. Case studies with therapist and patient feedback are used to demonstrate the use of the LymphFlow Advance in the lymphoedema clinic, with a discussion of the evidence to underpin recommended treatment regimes.
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Affiliation(s)
| | - Jane Wigg
- Director, Lymphoedema Training Academy
| | - Stacy Pugh
- Lymphoedema Clinical Nurse Manager, Wolverhampton Lymphoedema Service
| | - Janet Barclay
- Lymphoedema Nurse Specialist, Dorset Lymphoedema Clinic
| | - Hayley Moore
- Macmillan Lymphoedema Nurse Specialist, Barnstaple Lymphoedema Service
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191
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Differentiation of functional venous insufficiency and leg lymphedema complicated by functional venous insufficiency using subcutaneous tissue ultrasonography. J Vasc Surg Venous Lymphat Disord 2016; 5:96-104. [PMID: 27987622 DOI: 10.1016/j.jvsv.2016.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/17/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To use subcutaneous ultrasonography to differentiate legs with edema because of obesity-related functional venous insufficiency (FVIob), immobility-related FVI (FVIim), secondary lymphedema (LE), LE complicated by obesity (LEob), and LE complicated by immobility (LEim). METHODS Ninety-nine legs with edema (16 FVIob, 32 FVIim, 22 LE, 9 LEob, and 20 LEim), and 10 normal legs were examined. Subcutaneous tissue ultrasonography was performed at eight points (medial, lateral, upper, lower, thigh, and calf) in each leg. Subcutaneous echogenicity (SEG) and subcutaneous echo-free space (SEFS) were assessed, and each graded as 0, 1, and 2 according to their severity. RESULTS In normal legs, SEG and SEFS were graded 0 in almost all parts of the leg. SEG was diffusely increased in FVIob, whereas SEG was increased in accordance with gravity in FVIim (upper medial thigh, 0.6 ± 0.5 vs lower medial calf, 1.2 ± 0.4; P < .001). In LE, SEG was increased in the medial side, particularly evident in upper thigh (upper medial thigh, 1.1 ± 0.4 vs upper lateral thigh, 0.6 ± 0.6; P < .01). SEFS was increased in accordance with gravity in all of these legs (FVIob: upper medial thigh, 0.2 ± 0.4 vs lower medial calf, 0.7 ± 0.8; P = .05; FVIim: upper medial thigh, 0.1 ± 0.2 vs lower medial calf, 1.3 ± 0.7; P < .0001; LE: upper medial thigh, 0.4 ± 0.7 vs lower medial calf, 0.9 ± 0.9; P < .05). The increases of SEG and SEFS in legs with LEob or LEim were diffuse and similar. As determined via stepwise logistic regression analyses, the increases in SEG in the upper medial thigh and SEFS in the lower medial thigh in LE cases, the increases in SEG in the upper lateral thigh and SEFS in the lower lateral thigh in cases with obesity-related leg edema (ie, FVIob and LEob), and the increase in SEFS in the lower lateral calf in cases with immobility-related leg edema (ie, FVIim and LEim) were determined to be significant factors to characterize each leg edema. CONCLUSIONS Differences in the extent and distribution of SEG and SEFS might help in differentiating LE from FVIob and FVIim, although assessment of LE complicated by obesity vs immobility remains difficult.
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192
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Gardenier JC, Hespe GE, Kataru RP, Savetsky IL, Torrisi JS, Nores GDG, Dayan JJ, Chang D, Zampell J, Martínez-Corral I, Ortega S, Mehrara BJ. Diphtheria toxin-mediated ablation of lymphatic endothelial cells results in progressive lymphedema. JCI Insight 2016; 1:e84095. [PMID: 27699240 DOI: 10.1172/jci.insight.84095] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Development of novel treatments for lymphedema has been limited by the fact that the pathophysiology of this disease is poorly understood. It remains unknown, for example, why limb swelling resulting from surgical injury resolves initially, but recurs in some cases months or years later. Finding answers for these basic questions has been hampered by the lack of adequate animal models. In the current study, we used Cre-lox mice that expressed the human diphtheria toxin receptor (DTR) driven by a lymphatic-specific promoter in order to noninvasively ablate the lymphatic system of the hind limb. Animals treated in this manner developed lymphedema that was indistinguishable from clinical lymphedema temporally, radiographically, and histologically. Using this model and clinical biopsy specimens, we show that the initial resolution of edema after injury is dependent on the formation of collateral capillary lymphatics and that this process is regulated by M2-polarized macrophages. In addition, we show that despite these initial improvements in lymphatic function, persistent accumulation of CD4+ cells inhibits lymphangiogenesis and promotes sclerosis of collecting lymphatics, resulting in late onset of edema and fibrosis. Our findings therefore provide strong evidence that inflammatory changes after lymphatic injury play a key role in the pathophysiology of lymphedema.
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Affiliation(s)
- Jason C Gardenier
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Geoffrey E Hespe
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Raghu P Kataru
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Ira L Savetsky
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Jeremy S Torrisi
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Gabriela D García Nores
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Joseph J Dayan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - David Chang
- Section of Plastic and Reconstructive Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA
| | - Jamie Zampell
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
| | - Inés Martínez-Corral
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - Sagrario Ortega
- Transgenic Mice Unit, Biotechnology Programme, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | - Babak J Mehrara
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York, USA
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193
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Sabine A, Saygili Demir C, Petrova TV. Endothelial Cell Responses to Biomechanical Forces in Lymphatic Vessels. Antioxid Redox Signal 2016; 25:451-65. [PMID: 27099026 DOI: 10.1089/ars.2016.6685] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SIGNIFICANCE Lymphatic vessels are important components of the cardiovascular and immune systems. They contribute both to the maintenance of normal homeostasis and to many pathological conditions, such as cancer and inflammation. The lymphatic vasculature is subjected to a variety of biomechanical forces, including fluid shear stress and vessel circumferential stretch. RECENT ADVANCES This review will discuss recent advances in our understanding of biomechanical forces in lymphatic vessels and their role in mammalian lymphatic vascular development and function. CRITICAL ISSUES We will highlight the importance of fluid shear stress generated by lymph flow in organizing the lymphatic vascular network. We will also describe how mutations in mechanosensitive genes lead to lymphatic vascular dysfunction. FUTURE DIRECTIONS Better understanding of how biomechanical and biochemical stimuli are perceived and interpreted by lymphatic endothelial cells is important for targeting regulation of lymphatic function in health and disease. Important remaining critical issues and future directions in the field will be discussed in this review. Antioxid. Redox Signal. 25, 451-465.
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Affiliation(s)
- Amélie Sabine
- 1 Ludwig Institute for Cancer Research, University of Lausanne Branch & Department of Fundamental Oncology, CHUV and University of Lausanne , Epalinges, Switzerland
| | - Cansaran Saygili Demir
- 1 Ludwig Institute for Cancer Research, University of Lausanne Branch & Department of Fundamental Oncology, CHUV and University of Lausanne , Epalinges, Switzerland
| | - Tatiana V Petrova
- 1 Ludwig Institute for Cancer Research, University of Lausanne Branch & Department of Fundamental Oncology, CHUV and University of Lausanne , Epalinges, Switzerland .,2 Division of Experimental Pathology, Institute of Pathology , CHUV, Lausanne, Switzerland .,3 Swiss Institute for Experimental Cancer Research , EPFL, Switzerland
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194
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Gray RJ, Worsley PR, Voegeli D, Bader DL. Monitoring contractile dermal lymphatic activity following uniaxial mechanical loading. Med Eng Phys 2016; 38:895-903. [DOI: 10.1016/j.medengphy.2016.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/18/2016] [Accepted: 04/23/2016] [Indexed: 11/25/2022]
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195
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Noble-Jones R. Using new research to improve treatment and management of lymphoedema. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:726. [PMID: 27409778 DOI: 10.12968/bjon.2016.25.13.726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rhian Noble-Jones
- Lymphoedema Specialist, University Teacher, University of Glasgow, outlines how new understanding of chronic oedema and lymphoedema offers potential for better management
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196
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In vivo label-free measurement of lymph flow velocity and volumetric flow rates using Doppler optical coherence tomography. Sci Rep 2016; 6:29035. [PMID: 27377852 PMCID: PMC4932526 DOI: 10.1038/srep29035] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/09/2016] [Indexed: 01/08/2023] Open
Abstract
Direct in vivo imaging of lymph flow is key to understanding lymphatic system function in normal and disease states. Optical microscopy techniques provide the resolution required for these measurements, but existing optical techniques for measuring lymph flow require complex protocols and provide limited temporal resolution. Here, we describe a Doppler optical coherence tomography platform that allows direct, label-free quantification of lymph velocity and volumetric flow rates. We overcome the challenge of very low scattering by employing a Doppler algorithm that operates on low signal-to-noise measurements. We show that this technique can measure lymph velocity at sufficiently high temporal resolution to resolve the dynamic pulsatile flow in collecting lymphatic vessels.
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197
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Vignes S. [Lymphedema: A diagnosis not easy but indispensable]. ACTA ACUST UNITED AC 2016; 41:235-7. [PMID: 27317269 DOI: 10.1016/j.jmv.2016.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/30/2016] [Indexed: 01/05/2023]
Affiliation(s)
- S Vignes
- Unité de lymphologie, centre de référence des maladies vasculaires rares (lymphœdèmes primaires), hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
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198
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Roth Flach RJ, Guo CA, Danai LV, Yawe JC, Gujja S, Edwards YJK, Czech MP. Endothelial Mitogen-Activated Protein Kinase Kinase Kinase Kinase 4 Is Critical for Lymphatic Vascular Development and Function. Mol Cell Biol 2016; 36:1740-9. [PMID: 27044870 PMCID: PMC4907094 DOI: 10.1128/mcb.01121-15] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 02/02/2016] [Accepted: 03/30/2016] [Indexed: 01/01/2023] Open
Abstract
The molecular mechanisms underlying lymphatic vascular development and function are not well understood. Recent studies have suggested a role for endothelial cell (EC) mitogen-activated protein kinase kinase kinase kinase 4 (Map4k4) in developmental angiogenesis and atherosclerosis. Here, we show that constitutive loss of EC Map4k4 in mice causes postnatal lethality due to chylothorax, suggesting that Map4k4 is required for normal lymphatic vascular function. Mice constitutively lacking EC Map4k4 displayed dilated lymphatic capillaries, insufficient lymphatic valves, and impaired lymphatic flow; furthermore, primary ECs derived from these animals displayed enhanced proliferation compared with controls. Yeast 2-hybrid analyses identified the Ras GTPase-activating protein Rasa1, a known regulator of lymphatic development and lymphatic endothelial cell fate, as a direct interacting partner for Map4k4. Map4k4 silencing in ECs enhanced basal Ras and extracellular signal-regulated kinase (Erk) activities, and primary ECs lacking Map4k4 displayed enhanced lymphatic EC marker expression. Taken together, these results reveal that EC Map4k4 is critical for lymphatic vascular development by regulating EC quiescence and lymphatic EC fate.
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Affiliation(s)
- Rachel J Roth Flach
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Chang-An Guo
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Laura V Danai
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Joseph C Yawe
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sharvari Gujja
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Yvonne J K Edwards
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Michael P Czech
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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199
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Prominent Lymphatic Vessel Hyperplasia with Progressive Dysfunction and Distinct Immune Cell Infiltration in Lymphedema. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:2193-2203. [PMID: 27315777 DOI: 10.1016/j.ajpath.2016.04.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/16/2016] [Accepted: 04/12/2016] [Indexed: 01/22/2023]
Abstract
Lymphedema is a common complication that occurs after breast cancer treatment in up to 30% of the patients undergoing surgical lymph node excision. It is associated with tissue swelling, fibrosis, increased risk of infection, and impaired wound healing. Despite the pronounced clinical manifestations of the disease, little is known about the morphological and functional characteristics of the lymphatic vasculature during the course of lymphedema progression. We used an experimental murine tail lymphedema model where sustained fluid stasis was generated on disruption of lymphatic flow, resulting in chronic edema formation with fibrosis and adipose tissue deposition. Morphological analysis of the lymphatic vessels revealed a dramatic expansion during the course of the disease, with active proliferation of lymphatic endothelial cells at the early stages of lymphedema. The lymphatic capillaries exhibited progressively impaired tracer filling and retrograde flow near the surgery site, whereas the collecting lymphatic vessels showed a gradually decreasing contraction amplitude with unchanged contraction frequency, leading to lymphatic contraction arrest at the later stages of the disease. Lymphedema onset was associated with pronounced infiltration by immune cells, predominantly Ly6G(+) and CD4(+) cells, which have been linked to impaired lymphatic vessel function.
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200
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Hadamitzky C, Zaitseva TS, Bazalova-Carter M, Paukshto MV, Hou L, Strassberg Z, Ferguson J, Matsuura Y, Dash R, Yang PC, Kretchetov S, Vogt PM, Rockson SG, Cooke JP, Huang NF. Aligned nanofibrillar collagen scaffolds - Guiding lymphangiogenesis for treatment of acquired lymphedema. Biomaterials 2016; 102:259-267. [PMID: 27348849 DOI: 10.1016/j.biomaterials.2016.05.040] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/24/2016] [Indexed: 12/18/2022]
Abstract
Secondary lymphedema is a common disorder associated with acquired functional impairment of the lymphatic system. The goal of this study was to evaluate the therapeutic efficacy of aligned nanofibrillar collagen scaffolds (BioBridge) positioned across the area of lymphatic obstruction in guiding lymphatic regeneration. In a porcine model of acquired lymphedema, animals were treated with BioBridge scaffolds, alone or in conjunction with autologous lymph node transfer as a source of endogenous lymphatic growth factor. They were compared with a surgical control group and a second control group in which the implanted BioBridge was supplemented with exogenous vascular endothelial growth factor-C (VEGF-C). Three months after implantation, immunofluorescence staining of lymphatic vessels demonstrated a significant increase in lymphatic collectors within close proximity to the scaffolds. To quantify the functional impact of scaffold implantation, bioimpedance was used as an early indicator of extracellular fluid accumulation. In comparison to the levels prior to implantation, the bioimpedance ratio was significantly improved only in the experimental BioBridge recipients with or without lymph node transfer, suggesting restoration of functional lymphatic drainage. These results further correlated with quantifiable lymphatic collectors, as visualized by contrast-enhanced computed tomography. They demonstrate the therapeutic potential of BioBridge scaffolds in secondary lymphedema.
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Affiliation(s)
- Catarina Hadamitzky
- Clinic of Plastic, Esthetic and Hand Surgery, Helios Clinic Hildesheim, Hildesheim 31135, Germany.,Clinic of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover 30625, Germany
| | | | - Magdalena Bazalova-Carter
- Department of Radiation Oncology, Stanford University, Stanford, California 94305, USA.,Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia V8P5C2, Canada
| | | | - Luqia Hou
- Stanford Cardiovascular Institute, Stanford University, Stanford, California 94305, USA.,Center for Tissue Regeneration, Repair and Restoration, Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA
| | - Zachary Strassberg
- Center for Tissue Regeneration, Repair and Restoration, Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA
| | | | - Yuka Matsuura
- Division of Cardiovascular Medicine, Stanford University, Stanford, California 94305, USA
| | - Rajesh Dash
- Division of Cardiovascular Medicine, Stanford University, Stanford, California 94305, USA
| | - Phillip C Yang
- Division of Cardiovascular Medicine, Stanford University, Stanford, California 94305, USA
| | | | - Peter M Vogt
- Clinic of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover 30625, Germany
| | - Stanley G Rockson
- Division of Cardiovascular Medicine, Stanford University, Stanford, California 94305, USA
| | - John P Cooke
- Division of Cardiovascular Medicine, Stanford University, Stanford, California 94305, USA.,Center for Cardiovascular Regeneration, Houston Methodist Research Institute, Houston, Texas 77030, USA
| | - Ngan F Huang
- Stanford Cardiovascular Institute, Stanford University, Stanford, California 94305, USA.,Center for Tissue Regeneration, Repair and Restoration, Veterans Affairs Palo Alto Health Care System, Palo Alto, California 94304, USA.,Department of Cardiothoracic Surgery, Stanford University, Stanford, California 94305, USA
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