Pub Date : 1977-05-01DOI: 10.1177/153857447701100303
C L Witte, M H White, A E Dumont
The partition of extracellular fluid between plasma and tissue is determined by the balance of hydrostatic and oncotic pressure gradients across capillary membranes, and a filtration coefficient reflecting the surface area and permeability of filtering capillaries. Normally, a small excess of tissue fluid forms, enters lymphatics and returns to the bloodstream. In health, lymph formation and lymph absorption are exactly in balance and tissues are edema free’ (Figure 1). When lymphatic channels, however, are congenitally absent, or become obstructed or obliterated plasma that normally escapes from the bloodstream accumulates in tissues or body cavities as protein-rich edema fluid. This phenomenon is referred to as &dquo;lymphedema&dquo; and is characterized by a decreased rate of lymph absorption or &dquo;low output failure&dquo; of the lymph circulation’ (Figure 2). On the other hand, when lymph formation is increased to the point where it overwhelms the capacity of the lymphatic absorptive apparatus, albeit a nondiseased one, edema and/or effusion also result’ (Figure 3). This other form of &dquo;lymphedema&dquo; characterized by excess lymph formation or &dquo;high output failure&dquo; of the lymph circulation forms the basis of this report.
{"title":"High flow failure of the lymph circulation.","authors":"C L Witte, M H White, A E Dumont","doi":"10.1177/153857447701100303","DOIUrl":"https://doi.org/10.1177/153857447701100303","url":null,"abstract":"The partition of extracellular fluid between plasma and tissue is determined by the balance of hydrostatic and oncotic pressure gradients across capillary membranes, and a filtration coefficient reflecting the surface area and permeability of filtering capillaries. Normally, a small excess of tissue fluid forms, enters lymphatics and returns to the bloodstream. In health, lymph formation and lymph absorption are exactly in balance and tissues are edema free’ (Figure 1). When lymphatic channels, however, are congenitally absent, or become obstructed or obliterated plasma that normally escapes from the bloodstream accumulates in tissues or body cavities as protein-rich edema fluid. This phenomenon is referred to as &dquo;lymphedema&dquo; and is characterized by a decreased rate of lymph absorption or &dquo;low output failure&dquo; of the lymph circulation’ (Figure 2). On the other hand, when lymph formation is increased to the point where it overwhelms the capacity of the lymphatic absorptive apparatus, albeit a nondiseased one, edema and/or effusion also result’ (Figure 3). This other form of &dquo;lymphedema&dquo; characterized by excess lymph formation or &dquo;high output failure&dquo; of the lymph circulation forms the basis of this report.","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 3","pages":"130-51"},"PeriodicalIF":0.0,"publicationDate":"1977-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11566781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-05-01DOI: 10.1177/153857447701100304
D B van Wyck, D O Lucas
success hinges upon amalgamating diverse forces expeditiously, and maintaining intact lines of supply and communication. In biological warfare, the needs for immune defense are met by the blood-lymph loop (Figure 1), wherein local immune forces are constantly replenished by the bloodstream, and tissue sites are linked to systemic immune centers via lymphatics. Thus, when antigen invades tissue spaces and parenchymal cells, inflammation ensues and capillary permeability increases. As plasma pours in, antigens are swept up into lymphatics, filtered within lymph nodes, engulfed by macrophages, and processed for lymphocyte activation. &dquo;Messenger&dquo; lymphocytes then migrate from nodes through efferent lymphatics to the bloodstream, summoning reinforcements from the central lymphoid tissue. In the central
{"title":"Immune function in disorders of the lymph circulation.","authors":"D B van Wyck, D O Lucas","doi":"10.1177/153857447701100304","DOIUrl":"https://doi.org/10.1177/153857447701100304","url":null,"abstract":"success hinges upon amalgamating diverse forces expeditiously, and maintaining intact lines of supply and communication. In biological warfare, the needs for immune defense are met by the blood-lymph loop (Figure 1), wherein local immune forces are constantly replenished by the bloodstream, and tissue sites are linked to systemic immune centers via lymphatics. Thus, when antigen invades tissue spaces and parenchymal cells, inflammation ensues and capillary permeability increases. As plasma pours in, antigens are swept up into lymphatics, filtered within lymph nodes, engulfed by macrophages, and processed for lymphocyte activation. &dquo;Messenger&dquo; lymphocytes then migrate from nodes through efferent lymphatics to the bloodstream, summoning reinforcements from the central lymphoid tissue. In the central","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 3","pages":"152-9"},"PeriodicalIF":0.0,"publicationDate":"1977-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11819139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-05-01DOI: 10.1177/153857447701100305
T Ditchek
Using a technique that has changed very little from the original, a cut down is performed over a vital blue stained lymphatic usually on the dorsum of the foot or hand. With slow injection over approximately one hour, opacification of, in the lower extremity, fore-leg, thigh, pelvic, including inguinal, external, and common iliac chains and paralumbar, including paracaval and para-aortic lymphatic chains is achieved. Contrast continues through the cisterna chyli into the thoracic duct and usually into the left subclavian vein. Arm lymphograms opacity analagous extremity vessels, but fill only axillary and supraclavicular lymphatic structures. The contrast material is usually cleared from the lymphatic channels in 24 hours, entering the nodes, but normal variations are frequent, with residual contrast material sometimes persisting in channels for up to several days. Some of the earliest uses of Lymphangiography were in the evaluation of Primary Lymphedema and in lymphographic classification into patterns of Aplasia, Hypoplasia, and &dquo;Dermal Backflow alone&dquo;.2 The lymphangiogram of a 19 year old female (Figure 1) with Lymphedema Praecox demonstrates the marked hypoplasia of subdermal lymphatics in the foreleg and thigh seen in this condition. Note the abrupt transition (Figure 2) to a normal appearing lymphatic chain proximal to the inguinal ligament, which is characteristic of this type of hypoplasia. Congenital lymphedema of the Aplastic type is seen in this 7 year old male (Figure 3) with a history of an edematous limb since six months of age (no significant difference in leg length was present). Note the absence of any significant subdermal lymphatic network, with all lymph carried by both fine and more dilated dermal lymphatic channels. Films at 24 and 48 hours
{"title":"Radiologic examination of the lymphatic circulation.","authors":"T Ditchek","doi":"10.1177/153857447701100305","DOIUrl":"https://doi.org/10.1177/153857447701100305","url":null,"abstract":"Using a technique that has changed very little from the original, a cut down is performed over a vital blue stained lymphatic usually on the dorsum of the foot or hand. With slow injection over approximately one hour, opacification of, in the lower extremity, fore-leg, thigh, pelvic, including inguinal, external, and common iliac chains and paralumbar, including paracaval and para-aortic lymphatic chains is achieved. Contrast continues through the cisterna chyli into the thoracic duct and usually into the left subclavian vein. Arm lymphograms opacity analagous extremity vessels, but fill only axillary and supraclavicular lymphatic structures. The contrast material is usually cleared from the lymphatic channels in 24 hours, entering the nodes, but normal variations are frequent, with residual contrast material sometimes persisting in channels for up to several days. Some of the earliest uses of Lymphangiography were in the evaluation of Primary Lymphedema and in lymphographic classification into patterns of Aplasia, Hypoplasia, and &dquo;Dermal Backflow alone&dquo;.2 The lymphangiogram of a 19 year old female (Figure 1) with Lymphedema Praecox demonstrates the marked hypoplasia of subdermal lymphatics in the foreleg and thigh seen in this condition. Note the abrupt transition (Figure 2) to a normal appearing lymphatic chain proximal to the inguinal ligament, which is characteristic of this type of hypoplasia. Congenital lymphedema of the Aplastic type is seen in this 7 year old male (Figure 3) with a history of an edematous limb since six months of age (no significant difference in leg length was present). Note the absence of any significant subdermal lymphatic network, with all lymph carried by both fine and more dilated dermal lymphatic channels. Films at 24 and 48 hours","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 3","pages":"160-75"},"PeriodicalIF":0.0,"publicationDate":"1977-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100305","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11819141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-05-01DOI: 10.1177/153857447701100308
M D Kerstein, L Licalzi
The burgeoning field of lymphatic research, and the applications of surgical and microsurgical techniques to the problem of lymphedema have been briefly reviewed. The chronicity of this symptom complex and the relative sparsity of cases in developed countries make controlled clinical trials of treatment unfeasable and comparisons of present regimens difficult. However, continued investigation will undoubtedly be fruitful.
{"title":"Microvascular procedures in the management of lymphedema.","authors":"M D Kerstein, L Licalzi","doi":"10.1177/153857447701100308","DOIUrl":"https://doi.org/10.1177/153857447701100308","url":null,"abstract":"<p><p>The burgeoning field of lymphatic research, and the applications of surgical and microsurgical techniques to the problem of lymphedema have been briefly reviewed. The chronicity of this symptom complex and the relative sparsity of cases in developed countries make controlled clinical trials of treatment unfeasable and comparisons of present regimens difficult. However, continued investigation will undoubtedly be fruitful.</p>","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 3","pages":"188-95"},"PeriodicalIF":0.0,"publicationDate":"1977-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11819143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-05-01DOI: 10.1177/153857447701100302
M H Witte, D Hanto, C L Witte
On the evolutionary scale the tissue fluid or lymph circulation long antedates the blood vascular system. In one form or another-whether as a single giant coelom or as an intricate network of thin-walled channelsa distinct tissue fluid circulation can be consistently identified in all vertebrate or invertebrate animal-life. In a general sense, this circulation helps maintain water balance and tissue turgor, influences food gathering and the absorption and distribution of nutriments, disposes of wastes, and aids in respiration, locomotion, defense and even occasionally in reproduction.’ I
{"title":"Clinical and experimental techniques to study the lymphatic system.","authors":"M H Witte, D Hanto, C L Witte","doi":"10.1177/153857447701100302","DOIUrl":"https://doi.org/10.1177/153857447701100302","url":null,"abstract":"On the evolutionary scale the tissue fluid or lymph circulation long antedates the blood vascular system. In one form or another-whether as a single giant coelom or as an intricate network of thin-walled channelsa distinct tissue fluid circulation can be consistently identified in all vertebrate or invertebrate animal-life. In a general sense, this circulation helps maintain water balance and tissue turgor, influences food gathering and the absorption and distribution of nutriments, disposes of wastes, and aids in respiration, locomotion, defense and even occasionally in reproduction.’ I","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 3","pages":"120-9"},"PeriodicalIF":0.0,"publicationDate":"1977-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11819235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-05-01DOI: 10.1177/153857447701100306
C M Chavez
Despite recent advances in the treatment of lymphedema, a satisfactory and uniformly effective method for its control has not yet been developed. Surgical and nonsurgical modalities in treatment have been employed for many years without uniform success or, at best, only partially successful. Lymphedema may occur as a transient or a permanent phenomenon. As far as the transient lymphedema is concerned, the problem is simple and requires no radical or complicated treatment because once the etiology is corrected resolution of the lymph stasis will follow. We are, however, more concerned with the permanent type of lymphedema. Two main forms may be observed; on one hand is the congenital malformation of the lymphatic
{"title":"Understanding the therapeutic approaches to lymphedema.","authors":"C M Chavez","doi":"10.1177/153857447701100306","DOIUrl":"https://doi.org/10.1177/153857447701100306","url":null,"abstract":"Despite recent advances in the treatment of lymphedema, a satisfactory and uniformly effective method for its control has not yet been developed. Surgical and nonsurgical modalities in treatment have been employed for many years without uniform success or, at best, only partially successful. Lymphedema may occur as a transient or a permanent phenomenon. As far as the transient lymphedema is concerned, the problem is simple and requires no radical or complicated treatment because once the etiology is corrected resolution of the lymph stasis will follow. We are, however, more concerned with the permanent type of lymphedema. Two main forms may be observed; on one hand is the congenital malformation of the lymphatic","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 3","pages":"176-81"},"PeriodicalIF":0.0,"publicationDate":"1977-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11566783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-05-01DOI: 10.1177/153857447701100301
S A Threefoot
Unfortunately, one cannot present as precise a discussion on the hydrodynamics of the lymphatic system as one can on the blood vascular system. The contents and physical characteristics of lymph from the extremities and from each organ differ and are different from those of thoracic duct lymph. The data on the anatomy, contents measurements of pressures and rates of flows of the lymphatic system are not as consistent or as predictable as those of the blood circulation. Difficulties in methodology are at least in part responsible.
{"title":"Disordered lymph flow--an overview.","authors":"S A Threefoot","doi":"10.1177/153857447701100301","DOIUrl":"https://doi.org/10.1177/153857447701100301","url":null,"abstract":"Unfortunately, one cannot present as precise a discussion on the hydrodynamics of the lymphatic system as one can on the blood vascular system. The contents and physical characteristics of lymph from the extremities and from each organ differ and are different from those of thoracic duct lymph. The data on the anatomy, contents measurements of pressures and rates of flows of the lymphatic system are not as consistent or as predictable as those of the blood circulation. Difficulties in methodology are at least in part responsible.","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 3","pages":"115-9"},"PeriodicalIF":0.0,"publicationDate":"1977-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11819232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-05-01DOI: 10.1177/153857447701100307
P L Schnur
The clinical picture of lymphedema and its classification have been briefly reviewed with a discussion of surgical treatment both historical and current. It has been pointed out that the primary mode of treatment of congenital or secondary lymphedema of the extremities is intensive medical therapy and that surgical intervention is warranted in only rare and unusual circumstances. The gamut of surgical procedures attempted have been reviewed and it is this author's contention that the only procedure of limited, worthwhile value is a combination of the Kondoleon and the Thompson procedures. The Kondoleon phase of the procedure debulks the extremity in stages and removes the deep fascia. The Thompson form of the procedure advances a deepithelialized dermal flap into the deep lymphatical venous system. It has not been conclusively proven whether this dermal flap is of significant physiologic benefit, but I feel it is worth adding this to the Kondoleon procedure so that in time, we will have an opportunity to evaluate the value of this phase of the procedure.
{"title":"Surgical treatment of lymphedema--a reappraisal.","authors":"P L Schnur","doi":"10.1177/153857447701100307","DOIUrl":"https://doi.org/10.1177/153857447701100307","url":null,"abstract":"<p><p>The clinical picture of lymphedema and its classification have been briefly reviewed with a discussion of surgical treatment both historical and current. It has been pointed out that the primary mode of treatment of congenital or secondary lymphedema of the extremities is intensive medical therapy and that surgical intervention is warranted in only rare and unusual circumstances. The gamut of surgical procedures attempted have been reviewed and it is this author's contention that the only procedure of limited, worthwhile value is a combination of the Kondoleon and the Thompson procedures. The Kondoleon phase of the procedure debulks the extremity in stages and removes the deep fascia. The Thompson form of the procedure advances a deepithelialized dermal flap into the deep lymphatical venous system. It has not been conclusively proven whether this dermal flap is of significant physiologic benefit, but I feel it is worth adding this to the Kondoleon procedure so that in time, we will have an opportunity to evaluate the value of this phase of the procedure.</p>","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 3","pages":"182-7"},"PeriodicalIF":0.0,"publicationDate":"1977-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11566787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-03-01DOI: 10.1177/153857447701100201
W F Barker
Although a review of other surgical procedures would now have only historical value, there are 3 areas of effort where more direct effort has yielded some useful results. All of these have either fallen into disuse or were never commonly used because better drug therapies were meanwhile developed. Those procedures were: (1) Thoracolumbar sympathectomy and/or splanchnicectomy, (2) Adrenalectomy: total or subtotal, with or without sympathectomy, and (3) Chronic stimulation of carotid sinus nerve. ,
{"title":"The surgical treatment of hypertension.","authors":"W F Barker","doi":"10.1177/153857447701100201","DOIUrl":"https://doi.org/10.1177/153857447701100201","url":null,"abstract":"Although a review of other surgical procedures would now have only historical value, there are 3 areas of effort where more direct effort has yielded some useful results. All of these have either fallen into disuse or were never commonly used because better drug therapies were meanwhile developed. Those procedures were: (1) Thoracolumbar sympathectomy and/or splanchnicectomy, (2) Adrenalectomy: total or subtotal, with or without sympathectomy, and (3) Chronic stimulation of carotid sinus nerve. ,","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 2","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"1977-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100201","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11818280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1977-03-01DOI: 10.1177/153857447701100205
F Villagra, J J Rufilanchas, G Tellez, J M Maroñas, A Iglesias, D F Aymerich
Patients with coarctation of the aorta undergo operation with low mortality risk in most medical centers. However, some patients do not survive operation or die early in the follow up period. We review our experience in 85 operated patients with coarctation of the aorta. Three expired during hospitalization and all had severe associated anomalies, specially those of the aortic valve. Another three patients died early in the follow up period due to
{"title":"Early and late death of surgically treated patients with coarctation of the aorta.","authors":"F Villagra, J J Rufilanchas, G Tellez, J M Maroñas, A Iglesias, D F Aymerich","doi":"10.1177/153857447701100205","DOIUrl":"https://doi.org/10.1177/153857447701100205","url":null,"abstract":"Patients with coarctation of the aorta undergo operation with low mortality risk in most medical centers. However, some patients do not survive operation or die early in the follow up period. We review our experience in 85 operated patients with coarctation of the aorta. Three expired during hospitalization and all had severe associated anomalies, specially those of the aortic valve. Another three patients died early in the follow up period due to","PeriodicalId":76789,"journal":{"name":"Vascular surgery","volume":"11 2","pages":"63-7"},"PeriodicalIF":0.0,"publicationDate":"1977-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/153857447701100205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"11522048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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