Lymphology最新文献

Central lymphatic disorders of the lung have not received intense investigation. Lymphatic system physiology is presented in the context of historical developments and basic lung lymphatic anatomy is reviewed followed by emerging characteristics of primary and secondary pathophysiological disturbances of lymphatic involvement in a number of pulmonary diseases including Gorham-Stout disease, pulmonary edema and infections and inflammatory conditions including lymphangioleiomyomatosis (LAM). The future includes potential molecular targeting of lymphangiogenesis or lymphatic vessels for interventional occlusion. This article is an amalgamation of presentations at the 2023 ISL International Congress of Lymphology, Genoa, Italy in a special symposium on central and regional lymphatic system in health and disease and as part of a Special Symposium on the Lymphatic system of the Heart and Lung in Health and Disease at the 26th International Congress of Lymphology meeting held in Barcelona, Spain, September 2017, which has been updated to 2024.

Lymphatic anatomy of the abdomen is reviewed with focus on hepatic and mesenteric vessels in normal and pathologic conditions. Anatomy and pathophysiology is highlight using both specialized fluoroscopy and T2 Dynamic Contrast MR lymphangiography (DCMRL). Plastic bronchitis, chylothorax, protein losing enteropathy, and both cirrhosis and ascites due to hepatic lymphatics are highlighted. Presented at the 2023 ISL International Congress of Lymphology, Genoa, Italy in a special symposium on central and regional lymphatic system in health and disease.

Lymphatic flow disorders are reviewed, and a classification based on magnetic resonance lymphography findings outlined. Examples of successful interventional management based on this classification are provided. Presented at the 2023 ISL International Congress of Lymphology, Genoa, Italy in a special symposium on central and regional lymphatic system in health and disease.

Advances in lymphatic imaging for both diagnosis and intervention are reviewed, and specific examples given for protein-losing enteropathy, multi compartment lymphatic failure, congestive heart failure. Presented at the 2023 ISL International Congress of Lymphology, Genoa, Italy in a special symposium on central and regional lymphatic system in health and disease.

Multilayer compression bandaging (MLB) remains the primary treatment in lymphedema in association with manual lymphatic drainage. However, MLB can be contraindicated in patients with advanced lower extremity artery disease (LEAD). Presently, the prevalence of LEAD in lymphedema patients remains unknown. The goals of this study included i) to estimate the prevalence of LEAD, defined by toe-brachial index (TBI) less than 0.7, and ii) to measure the evolution of TBI after 30 min of MLB. A cross-sectional study was performed during a 3-month period on patients presenting with lower extremity lymphedema. Demographic data, basal TBI (T=0min) and TBI after 30 min of MLB at rest (T=30min) were recorded. Twenty-four patients with a total of 29 lymphedema limbs were included with a mean age of 62 years-old [Inter-quartile range (IQR) = 48 - 68] and 65.5% presenting with primary lymph-edema. Non-symptomatic LEAD, defined as TBI < 0.7, was found in 8 lymphedema limbs (27.6%). Advanced age, severe stages, and longer duration of lymphedema were associated with LEAD in univariate analysis. Median TBI increased significantly between T=0min and T=30min of MLB: 0.81 [IQR: 0.68 - 0.93] and 0.96 [IQR: 0.82 - 1.12] respectively (p= 0.004). Distal localization of lymphedema was associated with a decrease in TBI at T=30min in univariate analysis. Subclinical LEAD was found in over a quarter of lymphedema limbs and was more frequent in patients with advanced age, severe stages, and longer duration of lymphedema. Based on these findings, sub-clinical peripheral artery disease may be widely underestimated in lymphatic pathologies.

This study examined the effect of lymphedema self-care patient school education on patient functionality, quality of life, body value, and lymphedema volume in patients with lower extremity lymphedema. The study utilized a single-group quasi-experimental design. The study sample included 21 patients with primary and secondary lower extremity lymphedema. A multidisciplinary team created a face-to-face lymphedema self-care patient education program that lasted three weeks with four hours each week to enhance lymphedema self-care management. Data collected from participants prior to the program and then at third and sixth months via Lower Extremity Functional Scale (LEFS), Lymphedema Functionality, Disability and Quality of Life Scale in Lower Extremity Lymphedema (LYMPH-ICF-LL), Body Value Scale, and extremity volumes. The average age of the patients was 54.85±11.99 years and two-thirds had secondary lymphedema. A statistically significant difference was found in the mean scores of LEFS (p<0.001), LYMPH-ICF-LL total (p= 0.006) in the 3rd and 6th months after the completion of the program, and in the lymphedema volume change (p= 0.031) in the 6th month. It was found that the lymphedema self-care patient school improved functionality and quality of life in patients with lower extremity lymphedema and decreased lymphedema volume. This lymphedema self-care patient education pro-gram is a safe and effective educational method for self-care management in individuals with lower extremity lymphedema.

The physiologic sequelae of the atypical vasculature in patients with congenital heart disease can result in potentially fatal lymphatic complications, especially after corrective cardiac surgery. Transcatheter embolization of the thoracic duct or lymphatic collaterals can reduce morbidity and mortality in these patients. While typically performed transabdominally via an antegrade approach, retrograde embolization may be preferable in cases where this is not feasible, including in rare variants of thoracic duct anatomy. We present a case of a child with severe chylothorax after congenital cardiac surgery who was found to have thoracic lymphatic malformations and a plexiform thoracic duct variant who underwent successful embolization of the malformations.

Letter in response to article: Witt, M, A Ring: Handley's Thread Lymphangioplasty Vs. BioBridge^TM Collagen Matrix for Lymphedema Therapy-Old Wine in New Bottles? Lymphology 56 (2023) 110-120.

The purpose of this study is to investigate the relationship between reported symptoms, functional outcomes, and pain coping mechanisms in participants with lower limb lymph-edema. This research has been designed as cross-sectional. Participants' age, sex, height, weight, pain, tightness, and stiffness levels reported by the participants were documented with a 10 cm visual analogue scale. The Pain Coping Inventory scale has been used to evaluate coping strategies. Functional status was measured with timed-up-and-go test (TUGT), six-minute walk test (6MWT), and quadriceps muscle strength measurement with a hand-held dynamometer. The functional outcomes were also measured in a healthy control group. The difference in muscle strength in both lower extremities was evaluated using the t-test, and the correlations were assessed using the Spearman correlation test. Twenty-eight participants with lymphedema (PWL) and 23 controls were included in the study. Twenty-three of the PWL were female (82%). The mean age of the PWL was 54.43 ± 14.12, and the mean body mass index was 33.84 ± 6.17. There were no significant differences between the PWL and healthy controls regarding age and sex. The mean muscle strength of the affected lower extremity was 4.21 ± 1.10 kgs and was significantly lower compared to the contralateral lower extremity (6.10 ± 2.98 kgs) and control group (10.92 ± 1.25 kgs) (p<0.05 and p=0.007 respectively). In functional outcomes, TUGT was significantly worse in PWL when compared to the control group (11.17 ± 3.28 seconds vs 9.04 ± 1.33 seconds, p=0.004). A significant correlation was observed between the TUGT result and the level of tightness felt by the PWL (r= 0.43, p=0.02). There were significant correlations between pain coping strategies and patient reported symptoms. No correlations were found between coping strategies and functional measurements. Lymphedema disrupts the functional status of the participants, and these functional disruptions may be related to symptoms reported by the participants. The correlation between pain coping strategies and patient reported tightness may indicate that tightness may be more influential on coping with pain, but further research is needed to determine a cause-and-effect relationship.

Lymphadenopathy is associated with lymph node abnormal size or consistency due to many causes. We employed the deep convolutional neural network ResNet-34 to detect and classify CT images from patients with abdominal lymphadenopathy and healthy controls. We created a single database containing 1400 source CT images for patients with abdominal lymphadenopathy (n = 700) and healthy controls (n = 700). To train, test, and cross-validate the ResNet-34 classifier to detect specific lesions, we first resized and normalized all images. Then, we randomly divided the 1400 images into 88 groups of 16, and the classifier was trained to identify and label lesions using automatic volume delineation 3D reconstruction of target areas. The ResNet-34 had a diagnostic accuracy with receiver operating characteristic (ROC) curves of the true-positive rate versus the false-positive rate with the area under the curve (AUC) of 0.9957 and 1.00 for abdominal lymphadenopathy and healthy control CT images, respectively. This accuracy implied identical high sensitivity and specificity values of 99.57 % and 100% for the two groups. The added effect of ResNet-34 is a success rate of 99.57% and 100% for classifying random CT images of the two groups, with an overall accuracy of 99.79% in the testing subset for detecting and classifying lymph node lesions. Based on this high classification precision, we believe the output activation map of the final layer of the ResNet-34 is a powerful tool for the accurate diagnosis of lymph node lesions of abdominal lymphadenopathy from CT images.