1
|
Senger JLB, Kadle RL, Skoracki RJ. Current Concepts in the Management of Primary Lymphedema. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050894. [PMID: 37241126 DOI: 10.3390/medicina59050894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
Primary lymphedema is a heterogeneous group of conditions encompassing all lymphatic anomalies that result in lymphatic swelling. Primary lymphedema can be difficult to diagnose, and diagnosis is often delayed. As opposed to secondary lymphedema, primary lymphedema has an unpredictable disease course, often progressing more slowly. Primary lymphedema can be associated with various genetic syndromes or can be idiopathic. Diagnosis is often clinical, although imaging can be a helpful adjunct. The literature on treating primary lymphedema is limited, and treatment algorithms are largely based on practice patterns for secondary lymphedema. The mainstay of treatment focuses on complete decongestive therapy, including manual lymphatic drainage and compression therapy. For those who fail conservative treatment, surgical treatment can be an option. Microsurgical techniques have shown promise in primary lymphedema, with both lymphovenous bypass and vascularized lymph node transfers demonstrating improved clinical outcomes in a few studies.
Collapse
Affiliation(s)
- Jenna-Lynn B Senger
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
| | - Rohini L Kadle
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
| | - Roman J Skoracki
- Wexner Medical Center, Department of Plastic Surgery, Ohio State University, Columbus, OH 43210, USA
| |
Collapse
|
2
|
Kröger K, Schulz T, Santosa F, von Beckerath O, Gäbel G, Juntermanns B. Correlation between obesity and manual lymphatic drainage in Germany - a retrospective analysis from 2008 to 2016. VASA 2019; 49:115-120. [PMID: 31808380 DOI: 10.1024/0301-1526/a000822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Backgrounds: Costs for manual lymphatic drainage (MLD) paid by the Statutory Health Insurances (SHI) have increased disproportionately in Germany in the last decade. There is no obvious reason that this increase is due to an increasing number of patients with lymph edema. We therefore assume that there are large numbers of patients with obesity and obesity-associated dependency syndrome who drive the cost of MLD and did a retrospective analysis of the correlation between hospitalization rates for lymph edema and obesity and MLD prescription rates in outpatients. PATIENTS AND METHODS Roughly 90 % of the German population is insured by the Statutory Health Insurance. From its reports we extracted data regarding costs and numbers of MLD session prescribed annually. Hospitalization rates for lymph edema (codes I89.*, I97.2 and Q82.0) and for obesity (ICD E66.*) were provided by the Federal Statistical Office after a specific remote analyses. RESULTS In the years 2008 to 2016, the MLD prescriptions in the individual federal states increased by + 43.5 % in Berlin to + 109.3 % in Mecklenburg-Western Pomerania. Number of hospitalizations with the principal diagnosis (condition, which caused the admission) hereditary and postmastectomy lymph edema are low and decreased in most federal states. Number of hospitalizations with the additional diagnosis (conditions that coexist at the time of admission or develop subsequently) obesity increased with a range from + 4.8 % in Baden-Württemberg to + 86.4 % in Mecklenburg-Western Pomerania. The correlation between the increase in prescribed MLD in the individual federal state and the increase in hospitalization rates per 1000 inhabitants of cases with obesity is greater (R2 0.4696) than with lymph edema (R2 0.0987). CONCLUSIONS Our analysis is in line with the hypothesis that there is a correlation between the increasing prescription rate of MLD and the increasing burden of obesity in Germany.
Collapse
Affiliation(s)
- Knut Kröger
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Germany
| | - Tino Schulz
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Germany
| | - Frans Santosa
- Medical Faculty Universitas Pembangunan Nasional Veteran Jakarta, Indonesia
| | | | - Gabor Gäbel
- Department of Vascular Medicine, HELIOS Klinik Krefeld, Germany
| | | |
Collapse
|
3
|
Bolletta A, Di Taranto G, Chen SH, Elia R, Amorosi V, Chan JCY, Chen HC. Surgical treatment of Milroy disease. J Surg Oncol 2019; 121:175-181. [DOI: 10.1002/jso.25583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/21/2022]
Affiliation(s)
- A Bolletta
- Department of Plastic SurgeryChina Medical University Hospital Taichung Taiwan
- Department of Medical, Surgical, and Experimental SciencesPlastic Surgery Unit, University of SassariSassari Italy
| | - G Di Taranto
- Department of Plastic SurgeryChina Medical University Hospital Taichung Taiwan
- Department of Plastic and Reconstructive SurgerySapienza University of Rome, Umberto I University HospitalRome Italy
| | - SH Chen
- Department of Plastic SurgeryChang Gung Memorial HospitalTaipei Taiwan
| | - R Elia
- Department of Plastic SurgeryChina Medical University Hospital Taichung Taiwan
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ TransplantationUniversity of BariBari Italy
| | - V Amorosi
- Department of Plastic SurgeryChina Medical University Hospital Taichung Taiwan
- Plastic Surgery Unit, Sant'Andrea Hospital, School of Medicine and PsychologySapienza University of RomeRome Italy
| | - J CY Chan
- Department of Plastic SurgeryChina Medical University Hospital Taichung Taiwan
| | - HC Chen
- Department of Plastic SurgeryChina Medical University Hospital Taichung Taiwan
| |
Collapse
|
4
|
Dai T, Li B, He B, Yan L, Gu L, Liu X, Qi J, Li P, Zhou X. A novel mutation in the conserved sequence of vascular endothelial growth factor receptor 3 leads to primary lymphoedema. J Int Med Res 2018; 46:3162-3171. [PMID: 29896974 PMCID: PMC6134653 DOI: 10.1177/0300060518773264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objective To investigate whether lymphoedema in a Chinese family showed the hereditary and clinical characteristics of Milroy disease, an autosomal dominant form of congenital lymphoedema, typically characterized by chronic lower limb tissue swelling due to abnormal lymphatic vasculature development, and to perform mutational analyses of vascular endothelial growth factor receptor (VEGFR)3. Methods Individuals from a three-generation family affected by congenital lymphoedema were clinically assessed for Milroy disease. Mutation analysis of VEGFR3 was performed using DNA from family members and healthy controls. Results Out of 20 family members, eight were diagnosed with hereditary lymphoedema. Mutation analyses revealed a novel mutation site for c.3163 G>A, resulting in a p.1055D>N mutation in the second tyrosine kinase domain of VEGFR3, which was present in affected individuals only (absent in all unaffected family members and 130 healthy controls). Computed functional analyses showed the mutation may lead to structural alterations with a probability of 0.99999 of being disease causing. Conclusion A novel mutation associated with Milroy disease was identified in a Chinese family, expanding our knowledge of VEGFR3 gene function and providing a potential molecular target for treating hereditary lymphoedema.
Collapse
Affiliation(s)
- Ting Dai
- 1 GMU-GIBH Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, China
| | - Bohan Li
- 2 Department of Microsurgery, Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo He
- 2 Department of Microsurgery, Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liwei Yan
- 2 Department of Microsurgery, Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liqiang Gu
- 2 Department of Microsurgery, Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaolin Liu
- 2 Department of Microsurgery, Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Qi
- 2 Department of Microsurgery, Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ping Li
- 2 Department of Microsurgery, Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiang Zhou
- 2 Department of Microsurgery, Trauma and Hand Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
5
|
Facio MFW, Spessoto LCF, Gatti M, Ferraz Arruda PF, Ferraz Arruda JG, Antoniassi TS, Bogdan AP, Godoy MDFG, Godoy JMP, Facio FN. Clinical Treatment of Penile Fibrosis After Penoscrotal Lymphedema. Urol Case Rep 2017; 11:14-16. [PMID: 28083477 PMCID: PMC5220249 DOI: 10.1016/j.eucr.2016.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/06/2016] [Indexed: 01/27/2023] Open
Abstract
Genital lymphedema in men can affect the penis and/or scrotum, causing deformity and causing sexual limitations, social isolation, poor quality of life and recurrent subcutaneous infections due to difficulties in hygiene. There are few studies in the literature emphasizing the treatment of penile fibrosis after penoscrotal lymphedema. The purpose of this report is to describe a case of penile fibrosis treated using a new compression method.
Collapse
Affiliation(s)
| | | | - Marcio Gatti
- Medical School of São José do Rio Preto (FAMERP/FUNFARME), Brazil
| | | | | | | | - Ana Paula Bogdan
- Medical School of São José do Rio Preto (FAMERP/FUNFARME), Brazil
| | | | | | - Fernando Nestor Facio
- Medical School of São José do Rio Preto (FAMERP/FUNFARME), Brazil
- Corresponding author. Department of Urology, Medical School of São José do Rio Preto, Ave. Fernando C. Pires 3600, São José do Rio Preto, São Paulo, zip code 15015-040, Brazil. Fax: +55 17 3229 1777.Department of UrologyMedical School of São José do Rio PretoAve. Fernando C. Pires 3600São José do Rio PretoSão Paulozip code 15015-040Brazil
| |
Collapse
|
6
|
Fuchs S, Gat-Yablonski G, Shtaif B, Lazar L, Phillip M, Lebenthal Y. Vascular endothelial growth factor (VEGF) levels in short, GH treated children: a distinct pattern of VEGF-C in Noonan syndrome. J Endocrinol Invest 2015; 38:399-406. [PMID: 25344824 DOI: 10.1007/s40618-014-0194-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT Noonan syndrome (NS) is characterized by short stature and elevated risk of lymphedema. The mechanism underlying lymphedema may be mediated by vascular endothelial growth factors (VEGFs). OBJECTIVE To assess the effect of growth hormone (GH) treatment on plasma insulin-like growth factor (IGF)-1, VEGF-A and VEGF-C levels in patients with NS as compared to short GH-sufficient children. DESIGN Retrospective, comparative. SETTING Endocrinology department of a tertiary pediatric medical center. PATIENTS AND METHODS Plasma IGF-1, VEGF-A and VEGF-C levels were measured before and during GH treatment in 6 patients with NS and 18 age-matched short subjects (Turner, idiopathic short stature and small for gestational age). MAIN OUTCOME MEASURES Changes in plasma VEGF and IGF-1 levels. RESULTS Baseline IGF-1 SDS levels were slightly lower in NS patients compared with controls; IGF-1 response to GH therapy was markedly lower in NS patients compared with controls (p = 0.017). Mean baseline VEGF-A levels were similar in NS patients and controls whilst mean baseline VEGF-C levels were significantly lower in the NS group as compared with controls (p = 0.022). Plasma VEGF-A and VEGF-C levels did not significantly change during GH treatment in the study cohort. No correlation was found between VEGF-C levels and levels of IGF-1, VEGF-A and auxological parameters, either before or during GH administration. CONCLUSION Children with NS have a distinct growth factor profile including low basal VEGF-C and flattened IGF-1 response to GH. Further studies are needed to confirm our findings and to elucidate the interaction between VEGF-C levels and lymphedema.
Collapse
Affiliation(s)
- S Fuchs
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petah Tikva, Israel
- Department of Molecular Genetics, Weizmann Institute of Science, 76100, Rehovot, Israel
| | - G Gat-Yablonski
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petah Tikva, Israel
- Felsenstein Medical Research Center, 49100, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
| | - B Shtaif
- Felsenstein Medical Research Center, 49100, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
| | - L Lazar
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
| | - M Phillip
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petah Tikva, Israel
- Felsenstein Medical Research Center, 49100, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Y Lebenthal
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petah Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, 69978, Tel Aviv, Israel.
| |
Collapse
|
7
|
Torio-Padron N, Björn Stark G, Földi E, Simunovic F. Treatment of male genital lymphedema: An integrated concept. J Plast Reconstr Aesthet Surg 2015; 68:262-8. [DOI: 10.1016/j.bjps.2014.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 09/24/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
|
8
|
Drivdal M, Slagsvold CE, Aagenaes O, Kase BF. Hereditary Lymphedema, Characteristics, and Variations in 17 Adult Patients with Lymphedema Cholestasis Syndrome 1/Aagenaes Syndrome. Lymphat Res Biol 2014; 12:251-7. [DOI: 10.1089/lrb.2014.0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Monica Drivdal
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - Carl-Erik Slagsvold
- Department of Vascular Investigations, Oslo University Hospital, Oslo, Norway
| | | | - Bengt Frode Kase
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
9
|
Datar SA, Oishi PE, Gong W, Bennett SH, Sun CE, Johengen M, Maki J, Johnson RC, Raff GW, Fineman JR. Altered reactivity and nitric oxide signaling in the isolated thoracic duct from an ovine model of congenital heart disease with increased pulmonary blood flow. Am J Physiol Heart Circ Physiol 2014; 306:H954-62. [PMID: 24531811 DOI: 10.1152/ajpheart.00841.2013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We have previously shown decreased pulmonary lymph flow in our lamb model of chronically increased pulmonary blood flow, created by the in utero placement of an 8-mm aortopulmonary shunt. The purpose of this study was to test the hypothesis that abnormal lymphatic function in shunt lambs is due to impaired lymphatic endothelial nitric oxide (NO)-cGMP signaling resulting in increased lymphatic vascular constriction and/or impaired relaxation. Thoracic duct rings were isolated from 4-wk-old shunt (n = 7) and normal (n = 7) lambs to determine length-tension properties, vascular reactivity, and endothelial NO synthase protein. At baseline, shunt thoracic duct rings had 2.6-fold higher peak to peak tension and a 2-fold increase in the strength of contractions compared with normal rings (P < 0.05). In response to norepinephrine, shunt thoracic duct rings had a 2.4-fold increase in vascular tone compared with normal rings (P < 0.05) and impaired relaxation in response to the endothelium-dependent dilator acetylcholine (63% vs. 13%, P < 0.05). In vivo, inhaled NO (40 ppm) increased pulmonary lymph flow (normalized for resistance) ∼1.5-fold in both normal and shunt lambs (P < 0.05). Inhaled NO exposure increased bioavailable NO [nitrite/nitrate (NOx); ∼2.5-fold in normal lambs and ∼3.4-fold in shunt lambs] and cGMP (∼2.5-fold in both) in the pulmonary lymph effluent (P < 0.05). Chronic exposure to increased pulmonary blood flow is associated with pulmonary lymphatic endothelial injury that disrupts NO-cGMP signaling, leading to increased resting vasoconstriction, increased maximal strength of contraction, and impaired endothelium-dependent relaxation. Inhaled NO increases pulmonary lymph NOx and cGMP levels and pulmonary lymph flow in normal and shunt lambs. Therapies that augment NO-cGMP signaling within the lymphatic system may provide benefits, warranting further study.
Collapse
Affiliation(s)
- Sanjeev A Datar
- Department of Pediatrics, University of California, San Francisco, California
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Kesler CT, Liao S, Munn LL, Padera TP. Lymphatic vessels in health and disease. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2012. [PMID: 23209022 DOI: 10.1002/wsbm.1201] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The lymphatic vasculature plays vital roles in tissue fluid balance, immune defense, metabolism, and cancer metastasis. In adults, lymphatic vessel formation and remodeling occur primarily during inflammation, development of the corpus luteum, wound healing, and tumor growth. Unlike the blood circulation, where unidirectional flow is sustained by the pumping actions of the heart, pumping actions intrinsic to the lymphatic vessels themselves are important drivers of lymphatic flow. This review summarizes critical components that control lymphatic physiology.
Collapse
Affiliation(s)
- Cristina T Kesler
- E. L. Steele Laboratory, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | | | | | | |
Collapse
|
11
|
Datar SA, Johnson EG, Oishi PE, Johengen M, Tang E, Aramburo A, Barton J, Kuo HC, Bennett S, Xoinis K, Reel B, Kalkan G, Sajti E, Osorio O, Raff GW, Matthay MA, Fineman JR. Altered lymphatics in an ovine model of congenital heart disease with increased pulmonary blood flow. Am J Physiol Lung Cell Mol Physiol 2011; 302:L530-40. [PMID: 22207591 DOI: 10.1152/ajplung.00324.2011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abnormalities of the lymphatic circulation are well recognized in patients with congenital heart defects. However, it is not known how the associated abnormal blood flow patterns, such as increased pulmonary blood flow (PBF), might affect pulmonary lymphatic function and structure. Using well-established ovine models of acute and chronic increases in PBF, we cannulated the efferent lymphatic duct of the caudal mediastinal node and collected and analyzed lymph effluent from the lungs of lambs with acutely increased PBF (n = 6), chronically increased PBF (n = 6), and age-matched normal lambs (n = 8). When normalized to PBF, we found that lymph flow was unchanged following acute increases in PBF but decreased following chronic increases in PBF. The lymph:plasma protein ratio decreased with both acute and chronic increases in PBF. Lymph bioavailable nitric oxide increased following acute increases in PBF but decreased following chronic increases in PBF. In addition, we found perturbations in the transit kinetics of contrast material through the pleural lymphatics of lambs with chronic increases in PBF. Finally, there were structural changes in the pulmonary lymphatic system in lambs with chronic increases in PBF: lymphatics from these lambs were larger and more dilated, and there were alterations in the expression of vascular endothelial growth factor-C, lymphatic vessel endothelial hyaluronan receptor-1, and Angiopoietin-2, proteins known to be important for lymphatic growth, development, and remodeling. Taken together these data suggest that chronic increases in PBF lead to both functional and structural aberrations of lung lymphatics. These findings have important therapeutic implications that warrant further study.
Collapse
Affiliation(s)
- Sanjeev A Datar
- Department of Pediatrics, University of California, San Francisco, 94143-0106, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Lymphedema: a therapeutic approach in the treatment and rehabilitation of cancer patients. Am J Phys Med Rehabil 2011; 90:S69-75. [PMID: 21765266 DOI: 10.1097/phm.0b013e31820be160] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lymphedema therapy has gone by many names in the recent past, being referred to as complex decongestive therapy, complex physical therapy, or decongestive lymphatic therapy, among others. There are two phases of lymphedema treatment: the acute "intensive" phase and the maintenance phase. In the acute phase of treatment, the individual is typically wrapped with medical short-stretch compression bandages; receives a therapeutic exercise routine, skin care, and education; and undergoes manual lymphatic drainage by a specially trained physical therapist or healthcare professional. In the maintenance phase, the goals are for the individual to be able to wear a well-fitted appropriate gradient pressure garment during the day and compression bandaging (or a device that serves as an alternative to bandaging) at night, to maintain good skin care, to continue with therapeutic exercise, and to self-perform manual lymphatic drainage (or use a mechanical device that can perform manual lymphatic drainage) for the area of the body with impaired lymphatics. The effectiveness of the various components in each phase, as well as the motivation and compliance of the patient, differs. Further randomized trials are required to determine which component or combination of components in complex decongestive therapy works most effectively. It is recommended for patients not only to maintain physical activity for its many health benefits but also to facilitate muscle pumping to move lymphatic fluid throughout the body. Knowledge of some of the pathophysiologic mechanisms involved in the development of lymphedema is increasing, and it is possible that current modes of treatment of lymphedema will be augmented by molecular therapies in the future.
Collapse
|
13
|
Vaillant L, Tauveron V. Lymphœdèmes primaires des membres. Presse Med 2010; 39:1279-86. [DOI: 10.1016/j.lpm.2010.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 09/28/2010] [Indexed: 11/26/2022] Open
|
14
|
Zamir M, Moore JE, Fujioka H, Gaver DP. Biofluid mechanics of special organs and the issue of system control. Sixth International Bio-Fluid Mechanics Symposium and Workshop, March 28-30, 2008 Pasadena, California. Ann Biomed Eng 2010; 38:1204-15. [PMID: 20336840 PMCID: PMC2917121 DOI: 10.1007/s10439-010-9902-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the field of fluid flow within the human body, focus has been placed on the transportation of blood in the systemic circulation since the discovery of that system; but, other fluids and fluid flow phenomena pervade the body. Some of the most fascinating fluid flow phenomena within the human body involve fluids other than blood and a service other than transport--the lymphatic and pulmonary systems are two striking examples. While transport is still involved in both cases, this is not the only service which they provide and blood is not the only fluid involved. In both systems, filtration, extraction, enrichment, and in general some "treatment" of the fluid itself is the primary function. The study of the systemic circulation has also been conventionally limited to treating the system as if it were an open-loop system governed by the laws of fluid mechanics alone, independent of physiological controls and regulations. This implies that system failures can be explained fully in terms of the laws of fluid mechanics, which of course is not the case. In this paper we examine the clinical implications of these issues and of the special biofluid mechanics issues involved in the lymphatic and pulmonary systems.
Collapse
Affiliation(s)
- Mair Zamir
- Department of Applied Mathematics, The University of Western Ontario, London, ON, Canada.
| | | | | | | |
Collapse
|
15
|
|
16
|
Williams R. Drainage developers. J Biophys Biochem Cytol 2009. [PMCID: PMC2700398 DOI: 10.1083/jcb.1853if] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
17
|
Ji RC. Lymphatic endothelial cells, lymphedematous lymphangiogenesis, and molecular control of edema formation. Lymphat Res Biol 2009; 6:123-37. [PMID: 19093784 DOI: 10.1089/lrb.2008.1005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Lymphedema, defined as the abnormal accumulation of protein-rich fluid in soft tissues, results from the dysfunction of lymphatic system, an imbalance between lymph formation and its absorption into the initial lymphatics. Primary lymphedema occurs rarely on idiopathic or developmental abnormalities, especially hypoplasia or aplasia of lymphatics. Secondary lymphedema commonly develops when lymph transport is impaired due to lymphatic damage or resection of lymph nodes in surgery, infection, and radiation. Lymphatic endothelial cells (LECs) actively participate in the phenotypic consequences of a deranged lymphangiogenesis relating to tissue fluid accumulation in the pathogenesis of lymphedema. Recent insights into molecular genetic bases have shown an updated genotype-phenotype correlation between lymphangiogenesis, lymphatic function, and lymphedema. FOXC2, EphrinB2, VEGFR-3, VEGF-C, angiopoietin-2, Prox-1 and podoplanin have proved to be important factors of the genetic cascade linking to hereditary lymphedema, and embryonic and postnatal lymphatic development. FOXC2 may have a key role in regulating interactions between LECs and smooth muscle cells, and in the morphogenesis of lymphatic valves. Reduced VEGFR-3 tyrosine kinase activity and subsequent failure in transducing sufficient physiological VEGF-C/-D signals may affect LEC function and structure in the intercellular junctions and peri-lymphatic components. Identification of genetic markers in humans and animal models would facilitate the management of environmental factors influencing the expression and severity of lymphedema, and provide a basis for developing novel targeted therapies for the disease.
Collapse
Affiliation(s)
- Rui-Cheng Ji
- Department of Anatomy, Biology and Medicine, Oita University Faculty of Medicine, Oita 879-5593, Japan.
| |
Collapse
|
18
|
Verstraeten VLRM, Holnthoner W, van Steensel MAM, Veraart JCJM, Bladergroen RS, Heckman CA, Keskitalo S, Frank J, Alitalo K, van Geel M, Steijlen PM. Functional analysis of FLT4 mutations associated with Nonne-Milroy lymphedema. J Invest Dermatol 2008; 129:509-12. [PMID: 18719607 DOI: 10.1038/jid.2008.246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
19
|
Shin WS, Rockson SG. Animal models for the molecular and mechanistic study of lymphatic biology and disease. Ann N Y Acad Sci 2008; 1131:50-74. [PMID: 18519959 DOI: 10.1196/annals.1413.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The development of animal model systems for the study of the lymphatic system has resulted in an explosion of information regarding the mechanisms governing lymphatic development and the diseases associated with lymphatic dysfunction. Animal studies have led to a new molecular model of embryonic lymphatic vascular development, and have provided insight into the pathophysiology of both inherited and acquired lymphatic insufficiency. It has become apparent, however, that the importance of the lymphatic system to human disease extends, beyond its role in lymphedema, to many other diverse pathologic processes, including, very notably, inflammation and tumor lymphangiogenesis. Here, we have undertaken a systematic review of the models as they relate to molecular and functional characterization of the development, maturation, genetics, heritable and acquired diseases, and neoplastic implications of the lymphatic system. The translation of these advances into therapies for human diseases associated with lymphatic dysfunction will require the continued study of the lymphatic system through robust animal disease models that simulate their human counterparts.
Collapse
Affiliation(s)
- William S Shin
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | | |
Collapse
|
20
|
Hokari R, Kitagawa N, Watanabe C, Komoto S, Kurihara C, Okada Y, Kawaguchi A, Nagao S, Hibi T, Miura S. Changes in regulatory molecules for lymphangiogenesis in intestinal lymphangiectasia with enteric protein loss. J Gastroenterol Hepatol 2008; 23:e88-95. [PMID: 18005011 DOI: 10.1111/j.1440-1746.2007.05225.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Vascular endothelial growth factor receptor 3 (VEGFR3) and LYVE-1 are specifically expressed in the endothelium of the lymphatic systems. VEGF-C, D, FOXC2, Prox 1, and SOX18 are known to play central roles in lymphatic development. We investigated the expression of regulatory molecules for lymphangiogenesis in the duodenal mucosa of idiopathic intestinal lymphangiectasia. METHODS Biopsy samples were obtained from duodenal biopsies in patients with intestinal lymphangiectasia complicated with protein-losing from white spot lesions in which lymphangiectasia was histologically confirmed. Immunohistochemical analysis for VEGFR3 and LYVE-1 was performed. mRNA expression of VEGF-C, VEGF-D, VEGFR3, and transcription factors was determined by the quantitative reverse transcription-polymerase chain reaction method. RESULTS In the control mucosa, VEGFR3 was weakly expressed on the central lymphatic vessels in the lamina propria and LYVE-1 was expressed mainly on the lymphatic vessels in the submucosa. In intestinal lymphangiectasia, VEGFR3 and LYVE-1 expression levels were increased on the mucosal surface corresponding to widely dilated lymphatic vessels, while they were decreased in the deeper mucosa. mRNA expression study showed a significant increase in the expression level of VEGFR3 in lymphangiectasia, but the expression of VEGF-C and -D mRNA was significantly suppressed compared with that in controls despite the presence of lymphangiectasia. The mRNA expression levels of FOXC2 and SOX18 were also decreased, whereas Prox 1 was not altered. CONCLUSIONS There is an altered expression of regulatory molecules for lymphangiogenesis in the duodenal mucosa in these patients.
Collapse
Affiliation(s)
- Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Karpanen T, Alitalo K. Molecular biology and pathology of lymphangiogenesis. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2008; 3:367-97. [PMID: 18039141 DOI: 10.1146/annurev.pathmechdis.3.121806.151515] [Citation(s) in RCA: 265] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The lymphatic vasculature is essential for the maintenance of tissue fluid balance, immune surveillance, and adsorption fatty acids in the gut. The lymphatic vessels are also crucially involved in the pathogenesis of diseases such as tumor metastasis, lymphedema, and various inflammatory conditions. Attempts to control or treat these diseases have drawn a lot of interest to lymphatic vascular research during the past few years. Recently, several markers specific for lymphatic endothelium and models for lymphatic vascular research have been characterized, enabling great technical progress in lymphatic vascular biology, and many critical regulators of lymphatic vessel growth have been identified. Despite these significant achievements, our understanding of the lymphatic vessel development and pathogenesis is still rather limited. Several key questions remain to be resolved, including the relative contributions of different pathways targeting lymphatic vasculature, the molecular and cellular processes of lymphatic maturation, and the detailed mechanisms of tumor metastasis via the lymphatic system.
Collapse
Affiliation(s)
- Terhi Karpanen
- Molecular/Cancer Biology Laboratory and Ludwig Institute for Cancer Research, Biomedicum Helsinki and Haartman Institute, University of Helsinki and Helsinki University Central Hospital, FI-00014 Helsinki, Finland.
| | | |
Collapse
|
22
|
Abstract
The Forkhead family of transcription factors modulates a wide variety of cellular functions in cardiovascular tissues. In this review article, we discuss recent advances in our understanding of regulation provided by the forkhead factors in cardiac myocytes and vascular cells.
Collapse
Affiliation(s)
- Kyriakos N Papanicolaou
- Molecular Cardiology/Whitaker Cardiovascular Institute, Boston University School of Medicine, 715 Albany Street, W611, Boston, MA 02118, USA
| | | | | |
Collapse
|
23
|
Motegi SI, Tamura A, Okada E, Nagai Y, Ishikawa O. Successful Treatment with Lymphaticovenular Anastomosis for Secondary Skin Lesions of Chronic Lymphedema. Dermatology 2007; 215:147-51. [PMID: 17684378 DOI: 10.1159/000104267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 02/03/2007] [Indexed: 11/19/2022] Open
Abstract
The treatment of severe lymphedema is a difficult challenge. We performed lymphaticovenular anastomosis on two patients with secondary skin lesions of chronic lymphedema; one patient exhibited acquired lymphangioma circumscriptum of the vulva and the other presented elephantiasis nostras verrucosa of the lower leg. Both patients obtained a remarkable improvement in skin lesions and also in the reduction of lymphedema of the lower extremity. During a 6-month-follow-up period, constant reduction in the circumference of the lower extremities without exacerbation of skin lesions was achieved in both patients. Lymphaticovenular anastomosis is a useful surgical treatment for secondary lymphedema in the lower extremities. In addition, this surgical treatment is effective for secondary lesions of lymphedema, including acquired lymphangioma circumscriptum and elephantiasis nostras verrucosa.
Collapse
Affiliation(s)
- Sei-ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan.
| | | | | | | | | |
Collapse
|
24
|
Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations: Part I. J Am Acad Dermatol 2007; 56:353-70; quiz 371-4. [PMID: 17317485 DOI: 10.1016/j.jaad.2006.05.069] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 05/17/2006] [Accepted: 05/24/2006] [Indexed: 02/08/2023]
Abstract
UNLABELLED Cutaneous vascular malformations are rare disorders representing errors in vascular development. These lesions occur much less commonly but are often confused with the common infantile hemangioma. It is important to properly diagnose vascular malformations because of their distinct differences in morbidity, prognosis and treatment. Vascular malformations may be associated with underlying disease or systemic anomalies. Several of these syndromes are well defined and can often be distinguished on the basis of the flow characteristics of the associated vascular malformation. LEARNING OBJECTIVE At the completion of this learning activity, participants should have a better understanding of the different types of cutaneous vascular malformations. Because of the importance of proper diagnosis of these lesions, participants should also be better able to direct correct management and treatment.
Collapse
Affiliation(s)
- Maria C Garzon
- Department of Dermatology, Columbia University, New York 10032, USA.
| | | | | | | |
Collapse
|
25
|
Sharma R, Wang W, Rasmussen JC, Joshi A, Houston JP, Adams KE, Cameron A, Ke S, Kwon S, Mawad ME, Sevick-Muraca EM. Quantitative imaging of lymph function. Am J Physiol Heart Circ Physiol 2007; 292:H3109-18. [PMID: 17307997 DOI: 10.1152/ajpheart.01223.2006] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Functional lymphatic imaging was demonstrated in the abdomen and anterior hindlimb of anesthetized, intact Yorkshire swine by using near-infrared (NIR) fluorescence imaging following intradermal administration of 100-200 microl of 32 microM indocyanine green (ICG) and 64 microM hyaluronan NIR imaging conjugate to target the lymph vascular endothelial receptor (LYVE)-1 on the lymph endothelium. NIR fluorescence imaging employed illumination of 780 nm excitation light ( approximately 2 mW/cm(2)) and collection of 830 nm fluorescence generated from the imaging agents. Our results show the ability to image the immediate trafficking of ICG from the plexus, through the vessels and lymphangions, and to the superficial mammary, subiliac, and middle iliac lymph nodes, which were located as deep as 3 cm beneath the tissue surface. "Packets" of ICG-transited lymph vessels of 2-16 cm length propelled at frequencies of 0.5-3.3 pulses/min and velocities of 0.23-0.75 cm/s. Lymph propulsion was independent of respiration rate. In the case of the hyaluronan imaging agent, lymph propulsion was absent as the dye progressed immediately through the plexus and stained the lymph vessels and nodes. Lymph imaging required 5.0 and 11.9 microg of ICG and hyaluronan conjugate, respectively. Our results suggest that microgram quantities of NIR optical imaging agents and their conjugates have a potential to image lymph function in patients suffering from lymph-related disorders.
Collapse
Affiliation(s)
- Ruchi Sharma
- Division of Molecular Imaging, Department of Radiology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Stevenson DA, Pysher TJ, Ward RM, Carey JC. Familial congenital non-immune hydrops, chylothorax, and pulmonary lymphangiectasia. Am J Med Genet A 2006; 140:368-72. [PMID: 16419129 PMCID: PMC2568883 DOI: 10.1002/ajmg.a.31093] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Pulmonary lymphangiectasia is an uncommon congenital anomaly, and familial occurrence has rarely been reported. We report on two sibs with bilateral pleural effusion/chylothorax and hydrops who died neonatally. One sib required prenatal intrauterine hemithoracic drainage. Autopsy confirmed congenital pulmonary lymphangiectasia (CPL) histologically in the first case. Hydrops, characterized as subcutaneous edema and effusions in two or more body cavities, may be due to a variety of factors, but the co-occurrence of CPL in one of these sibs, although rare, supports the notion that chylothorax and hydrops may be caused by structural lesions of lymph channels. Although most cases of CPL are sporadic, the reported sibs support autosomal recessive inheritance, with intrafamilial variability of a lymphatic disorder on a genetic basis. Mutations in vascular endothelial growth factor receptor-3 (VEGFR3) in families with Milroy disease, mutations of FOXC2 in the lymphedema-distichiasis syndrome, and fatal chylothorax in alpha9-deficient mice are potential candidate genes.
Collapse
Affiliation(s)
- David A Stevenson
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah 84132, USA.
| | | | | | | |
Collapse
|
27
|
Abstract
The lymphatic vasculature forms a vessel network that drains interstitial fluid from tissues and returns it to the blood. Lymphatic vessels are also an essential part of the body's immune defence. They have an important role in the pathogenesis of several diseases, such as cancer, lymphoedema and various inflammatory conditions. Recent biological and technological developments in lymphatic vascular biology will lead to a better understanding and treatment of these diseases.
Collapse
Affiliation(s)
- Kari Alitalo
- Molecular/Cancer Biology Laboratory, Ludwig Institute for Cancer, Research, P.O.B. 63 (Haartmaninkatu 8), 00014 University of Helsinki, Finland.
| | | | | |
Collapse
|
28
|
Nagase T, Gonda K, Inoue K, Higashino T, Fukuda N, Gorai K, Mihara M, Nakanishi M, Koshima I. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol 2005; 10:304-10. [PMID: 16247656 DOI: 10.1007/s10147-005-0518-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Indexed: 11/30/2022]
Abstract
Although lymphedema in the extremities is a troublesome adverse effect following radical resection of various cancers, conventional therapies for lymphedema are not always satisfactory, and new breakthroughs are anticipated. With the introduction of supermicrosurgical techniques for the anastomosis of blood or lymphatic vessels less than 0.8 mm in diameter, we have developed a novel method of lymphaticovenular anastomosis for the treatment of primary as well as secondary lymphedema in the extremities. Here, we review the pathophysiological aspects of lymphedema, emphasizing the importance of smooth-muscle cell function in the affected lymphatic walls. We then describe the theoretical basis and detailed operative techniques of our lymphaticovenular anastomoses. Although technically demanding, especially for beginners, we believe that this method will become a new clinical standard for the treatment of lymphedema in the near future.
Collapse
Affiliation(s)
- Takashi Nagase
- Department of Plastic and Reconstructive Surgery, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Tokyo 113-8655, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Surgical methods have been widely used in the past to treat patients with congential lymphedema. There are only scant data in recent literature about the long-term outcome of these mostly historical methods. On the other hand, the subject is not only of interest to those concerned with the history of medicine but also may raise a couple of questions about treating such patients today. The authors report on a 77-year-old female patient with congential lymphedema with a 50-year follow-up after lymphedema resection and focus on practical problems of bandaging today.
Collapse
Affiliation(s)
- Birgit Heinig
- Department of Physiotherapy, Hospital Dresden-Friedrichstadt, Dresden, Germany
| | | |
Collapse
|
30
|
Nakano T, Nakashima Y, Yonemitsu Y, Sumiyoshi S, Chen YX, Akishima Y, Ishii T, Iida M, Sueishi K. Angiogenesis and lymphangiogenesis and expression of lymphangiogenic factors in the atherosclerotic intima of human coronary arteries☆. Hum Pathol 2005; 36:330-40. [PMID: 15891993 DOI: 10.1016/j.humpath.2005.01.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little information regarding the development of lymphangiogenesis in coronary atherosclerosis is available. We immunohistochemically investigated the correlation among intimal neovascularization (CD34 for angiogenesis and lymphatic vessel endothelial hyaluronan receptor-1 [LYVE-1] and podoplanin for lymphangiogenesis), the expression of lymphangiogenic factors (vascular endothelial growth factor [VEGF]-C and VEGF-D), and the progression of atherosclerosis using 169 sections of human coronary arteries from 23 autopsy cases. The more the atherosclerosis advanced, the more often the neointimas contained newly formed blood vessels ( P < .0001). Vascular endothelial growth factor-C was expressed mostly in foamy macrophages and in some smooth muscle cells, whereas VEGF-D was abundantly expressed in both. The number of VEGF-C-expressing cells, but not that of VEGF-D-expressing cells, was increased as the lesion advanced and the number of intimal blood vessels increased ( P < .01). Lymphatic vessels were rare in the atherosclerotic intima (LYVE-1 vs CD34 = 13 vs 3955 vessels) compared with the number seen in the adventitia (LYVE-1 vs CD34 = 360 vs 6921 vessels). The current study suggests that VEGF-C, but not VEGF-D, may contribute to plaque progression and be a regulator for angiogenesis rather than lymphangiogenesis in coronary atherosclerotic intimas. Imbalance of angiogenesis and lymphangiogenesis may be a factor contributing to sustained inflammatory reaction during human coronary atherogenesis.
Collapse
Affiliation(s)
- Toshiaki Nakano
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Streptococcus pyogenes Purpura Fulminans in a Child With Congenital Chylothorax. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2005. [DOI: 10.1097/01.idc.0000155841.57257.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Kim H, Dumont DJ. Molecular mechanisms in lymphangiogenesis: model systems and implications in human disease. Clin Genet 2003; 64:282-92. [PMID: 12974730 DOI: 10.1034/j.1399-0004.2003.00152.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The basic science and development of therapies targeting the blood vascular system has enjoyed much focus due to the knowledge of the molecular mechanisms behind its development and roles in disease. However, the closely associated lymphatic system, while also being responsible for a number of serious and debilitating diseases, has not garnered as much attention due to the lack of specific molecular markers, thereby limiting this field to no more than descriptive analysis. Within the past decade, great strides have been taken to identify a number of molecular signatures unique to the lymphatic system. To this end, the timeline for lymphatic development has now been redefined at the molecular level, and diseases associated with lymphatics now have a molecular basis. With this knowledge, the current modes of treatment for disease such as lymphedema, lymphangiomas, and metastatic progression can now be augmented with potential molecular therapies that have currently been tested in a number of animal models. Much like the therapeutics that have been associated with vasculogenesis and angiogenesis, manipulation of the molecular pathways that define lymphatic development may lead to better clinical outcomes associated with developmental defects and disease.
Collapse
Affiliation(s)
- H Kim
- Department of Medical Biophysics, Division of Molecular and Cellular Biology, University of Toronto, Sunnybrook & Women's College Health Sciences Center, Toronto, ON, Canada
| | | |
Collapse
|
33
|
Literature Watch. Lymphat Res Biol 2003. [DOI: 10.1089/153968503321642651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|