Lymphology最新文献

A woman in her 70s with a 20-year history of postoperative edema and repeated cellulitis after surgery and chemotherapy for ovarian cancer presented with pain, redness, and swelling in her left lower leg. She was admitted with dehydration, disorientation, and elevated inflammation. After antibiotic treatment, redness of the lower extremities gradually improved. However, the patient complained of severe back pain after 10 days of treatment. Computed tomography (CT) revealed an abscess of the right pisiform muscle and patient was diagnosed with pyomyositis of the piriformis muscle. On hospital day 18, CT-guided percutaneous drainage of the abscess was performed. At the 6-month follow-up, there was no recurrence of the abscess. It is difficult to diagnose pyomyositis of the piriformis muscle via physical examination. This extremely rare case involves pyomyositis of the piriformis muscle as a result of cellulitis due to lymphedema. If antibiotic treatment for cellulitis in a patient with lymphedema is unsuccessful and severe pain persists, early imaging diagnosis should be considered.

The aim of this pilot randomized con-trolled trial (RCT) was to assess the feasibility of a moderate intensity cycling intervention in persons with lower limb lymphedema (LLL) and to explore its potential benefits. Thirty-three participants were included for an 8-week intervention of home-based exercise and randomized to an intervention group (IG) with cycling 3-5 times a week, 30-60 minutes, or to a control group (CG). Feasibility was assessed by recruitment and retention rates, adherence to training protocol, and adverse events. Potential benefits were physical fitness (submaximal bicycle ergometer test), volume, local tissue water, impedance of extracellular fluid, lymphedema-related disability (Lymph-ICF-LL) and health-related quality of life (Lymphedema Quality of Life Inventory). Assessments were performed at baseline and after 8 weeks. Non-parametric analyses were used. Twenty-seven participants (IG=16; CG=11), median age 63 years and time with LLL 9 years, completed the trial. Retention to group allocation was 82%, training protocol adherence was 81% and only one adverse event occurred. Significant between-group improvement was found for lymphedema-related disability favoring the IG. Within-group improvements regarding physical fitness, local tissue water and health-related quality of life were found in the IG, but not in the CG. In conclusion, this study shows that moderate intensity cycling is feasible with potential benefits in functioning and health-related quality of life for persons with chronic LLL.

Near infrared fluorescence imaging (NIRFI) with Indocyanine Green (ICG) has been shown to detect lymph leakages and pat-terns in patients with complete axillary lymph node dissection (CALND) for breast cancer. However, ICG has also been demonstrated to have toxic effects in the ophthalmological field and limited data (in animal and human studies) suggest that it can alter functioning of the lymphatic system. The current study investigates pre-operative (Pre) and per-operative (Per) ICG administration and the volumes (V) of liquids collected in drains (Vd) and/or punctures (needle aspiration) (Vp) after breast cancer surgery. Fifty-five patients had one subcutaneous ICG injection in the ipsilateral hand either the day before (group Pre; n = 26) or the day of the surgery (group Per: n = 29). Vd, Vp and Vt (=Vd+Vp) were compared. The two groups did not differ statistically. We observed a statistical tendency (p=0.07) to find lower fluid volumes, overall (Vt) and in aspirations (Vp), when ICG was injected the day before the operation (Pre) compared with the same day (Per). When no fluorescence (no lymph leakage from the arm) was detected in the fluid collections, Vd and Vt were statisti-cally significantly lower in the pre-op group and in the whole group but not in the per-op one. Our correlation results add additional evidence to suggest that ICG may have a causative effect on the lymphatic system depending on the duration of its exposure as observed in the ophthalmological field. Although further study is needed to confirm, lymphologists, angiologists, lymphatic surgeons, vascular surgeons, and others who are using ICG for their NIRFLI evaluations should be aware of possible risks and complications associated with this procedure for use in patients with lymphedema.

The lymphatic system, a complex physiological network of lymphatic organs and vessels, is essential for maintaining fluid homeostasis. Dysfunction of lymphatic system can lead to lymphedema, a pathology characterized by the accumulation of interstitial fluid in peripheral tissues. This study aimed to identify novel genetic variants in genes within the RAS/ MAPK pathway and assess their potential association with lymphedema onset. We conducted a retrospective analysis of the genetic and clinical data from 408 patients diagnosed with primary lymphedema. These patients were previously tested using a next-generation sequencing panel that included 28 diagnostic genes and 71 candidate genes. The analysis revealed five genetic variants in the genes LZTR1, RAF1 and MAP2K1. Among the identified variants, four of them have never been reported in the literature. In silico analysis and molecular modelling supported the possible pathogenicity of one missense variant in RAF1 (c.1344T>G; p.Ile448Met), which could affect protein activation by phosphorylation. The results of this study highlight the genes involved in the RAS/MAPK signaling pathway as potential diagnostic targets for primary lymphedema.

This case series highlights potential systemic effects of lymphaticovenular anastomosis (LVA) with conventional treatment in patients with primary lymphedema of the lower limb, with a particular focus on its implications for cerebral lymphatic function. We present two cases in which LVA performed on a lower limb led to interesting systemic improvements extending beyond the treated regions, including alleviation of preoperative cognitive symptoms. The first case involves a 37-year-old woman with diffuse body swelling, including facial edema. LVA in her left leg resulted not only in re-duction of swelling but also in marked improvement in speech and mentation. The second case describes a 62-year-old woman who, following LVA in her right leg, experienced resolution of limb and facial edema, relief of oropharyngeal symptoms, and improvement in cognitive function. Although these cranial improvements were not objectively assessed due to lack of measurement before the LVAs, they were subjectively perceived by the patients post-operatively. These reports indicate the systemic nature of primary lymphedema and interestingly suggest that peripheral lymphatic surgery and treatment may positively influence cerebral lymphatic dynamics.

Recurrence is a major challenge in treatment of lymphatic malformations (LMs) world-wide. The objectives of the current study were to investigate risk factors associated with LM recurrence and to compare effectiveness of surgical and endovascular treatments. A multi-center 10-year retrospective chart review was conducted on all consecutive patients treated for LMs from 2009 to 2019. Data collected included post-treatment size, symptoms, and recurrence. Stepwise multiple regression analysis was used to identify risk factors and to compare treatment modalities. A total of 13 patients with 20 treatment cases were included. No significant difference was observed in size reduction and symptom alleviation between the treatment groups. Resection showed the highest recurrence rate of 36.4% (p=0.04) and lymphaticovenular anastomosis (LVA) presented excel-lent results in post-treatment size, symptoms, and recurrence despite lack of statistical significance. Microcystic type of LMs was identified as an independent risk factor for recurrence. Both surgery and sclerotherapy are effective in improving size and symptoms of LMs. This data will help physicians and patients choose the optimal treatment and potentially predict progression.

Lymphangiosarcoma is a rare, malignant angiosarcoma that primarily develops in limbs with chronic lymphedema and presents with dermal lesions. Due to a 5-year survival rate of 22.4%, early detection and treatment are critical for improving prognosis. This study assessed physiotherapists' skills in recognizing suspicious dermal lesions in lymphedema patients with a focus on lymphangiosarcoma. An 11-question online survey was created using Google Forms that included academic training, practical experience, frequency of lymphatic treatments, ability to recognize suspicious dermal lesions, referral frequency to specialists, and opinions on specific training needs. The study was conducted from 9 February to 30 March, 2024 and it targeted Italian physiotherapists who manage patients with lymphedema. Responses were received from 170 physiotherapists. Only 12.9% had university education on dermal lesions in lymphedema patients, while 70.6% had postgraduate training. Additionally, 57.6% felt unable to recognize lymphangiosarcoma. Postgraduate education was correlated with the ability to recognize the pathology (p=0.047). Clinical experience and frequency of lymphatic treatments was associated with recognition and reporting of suspected cases (p<0.05). Findings suggest the need for increased awareness and specialized training among physiotherapists to improve early detection and treatment of lymphangiosarcoma in lymphedema patients. Enhanced postgraduate education and clinical experience may lead to better patient outcomes.

Understanding lymphatic anatomy of the upper extremity is necessary for treatment of upper extremity lymphedema (UEL). This study aimed to clarify the watershed of upper arm lymphosomes using fluorescent lymphography with multi-site injection of indocyanine green (ICG). Limbs contralateral to breast cancer treatment side of breast cancer survivors were included to evaluate upper arm lymphosomes. 0.1ml of ICG was injected intra-dermally at these 3 points in the mid-lateral upper arm: at the level of one (U1), two (U2), and three quarters (U3) from the lateral edge of the acromion to the lateral epicondyle of the humerus. Fluorescent images were obtained to determine the upper arm lymphatic pathway patterns. An injection site with multiple lymphatic pathways was evaluated as a watershed point. A total of twenty-one limbs were included. The lymphatic pathways from the U1/ U2/ U3 were anteromedial patterns in 20/13/6 (95.2%/90.5%/28.6%), and posterolateral pat-terns in 3/13/19 (14.3%/61.9%/90.5%), respectively. Both patterns were identified in 2/12/5 (9.5%/57.1%/23.8%), and no pattern in 0/1/1 (0%/4.8%/4.8%). Based on study results, the true watershed was determined as an approximate line from the posterolateral side of the lateral edge of the acromion to the anteromedial side of the lateral epicondyle of the humerus rather than a mid-arm line.

Mounting evidence implicates brain lymphatic drainage in the pathogenesis of Alzheimer's disease and other dementias. Several recent basic and clinical science discoveries have suggested the impact of lymphatic therapy to stimulate lymph flow in the head and neck including improvement in cognition. Manual lymphatic drainage has potential as a simple inexpensive way to promote brain lymph drainage and is worthy of a well-designed clinical trial to evaluate its potential as a primary or adjunctive treatment of Alzheimer's disease at this time.

This study explored differences in morphology and distribution of myocardial lymphatic drainage ducts in patients with dilated cardiomyopathy (DCM), ischemic cardiomyopathy (ICM), and hypertrophic cardiomyopathy (HCM) in end-stage heart failure to reveal the relationship between the morphological distribution characteristics of myocardial lymphatic drainage ducts and different etiologies and these disease courses. Hearts of 24 patients (transplant recipients) who underwent heart transplantation and 1 normal heart were collected. Myocardial tissue from the anterior wall of the ventricle was taken and quickly frozen. Immunohistochemical and Western blotting techniques were used to detect the expression of LYVE-1, Podoplanin, and VEGFR-3 in cardiac tissue. Ink injection, immunohistochemical staining, and immunofluorescence double labeling techniques were used to detect the co-localization of three antibodies in hu-man heart tissue. Masson staining was used to observe the distribution and content of collagen fibers in the heart tissue of transplant recipients. Compared with the normal group, expression levels of LYVE-1 (p<0.05) and VEGFR-3 (p<0.001) in the DCM group were significantly increased. Expression level of LYVE-1 (p<0.05) was significantly increased in the ICM and HCM groups, but there was no significant change in the expression level of VEGFR-3. The expression level of Podoplanin in the normal group was higher than that in the heart failure groups, but the protein ex-pression results were the opposite. The expression levels of LYVE-1 and VEGFR-3 in the DCM and ICM groups showed an increasing trend with the progression of the disease, while the expression levels of Podoplanin showed a decreasing trend. The immunofluorescence results showed that on larger lymphatic vessels, LYVE-1 and VEGFR-3 were expressed on the inner side of the lymphatic lumen, while Podoplanin was expressed on the outer side, and there was co-localization between the two layers. Masson's staining results showed that the degree of myocardial fibrosis in the DCM group (p<0.01) and HCM group (p<0.001) increased, while there was no significant change in the ICM group (p<0.05). Positive expression intensity of LYVE-1, Podoplanin, and VEGFR-3 does not have a consistent quantitative relationship with different types of heart failure and the duration of the disease. The expression of three biomarkers confirms that DCM, ICM, and HCM have increased lymphatic vessel architecture compared to normal hearts, and the number of lymphatic vessels increases with prolongation of disease course.