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PubMed1990

[Status of lymphatic vessels, lymph flow and lymph toxicity in patients with obliterating arterial diseases of the lower extremities].

The condition of the lymph vessels, the lymph flow, and the toxicity of peripheral lymph were studied in 46 patients with obliterating diseases of the arteries of the lower limbs. The results of the study showed the severity of the destructive changes in the peripheral lymphatic system to be directly dependent on the severity of the arterial ischemia of the limb. Block of the lymphatic system, deceleration of the lymph flow, and changes in the lymph vessels themselves lead to deterioration of the tissue drainage function and intensification of regional endotoxicosis. In view of which correction of the peripheral lymphatic system should be included in the complex of measures for the treatment of patients with obliterating diseases of the lower limb arteries.

Adult↗
PubMed1999

Congenital hypothyroidism and nonimmune hydrops fetalis: associated?

Hydrops fetalis (HF) consists of an abnormal accumulation of fluid in two or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema. Almost all observed cases of HF are of the nonimmune type, the causes of which remain undetermined in 15% of patients. We report a newborn infant with nonimmune hydrops fetalis (NIHF) and congenital hypothyroidism. The infant's mother was healthy and there were no malformations of the placenta or umbilical cord. The infant did not show any structural abnormalities of his central nervous, cardiovascular, gastrointestinal, or urinary tract systems, and there was no evidence of anemia, infectious disease, or inborn error of metabolism. An immune-based process was unlikely, because the blood group of the mother and infant was A-positive and results of an indirect Coombs test in the mother and a direct Coombs test in the infant were negative. The patient's condition gradually improved with mechanical ventilation, repeated thoracocentesis, and total parenteral nutrition. By day 5 of age the skin edema, pericardial effusion, and ascites disappeared, but accumulation of significant amounts of chylous pleural fluid persisted. Because of lethargy, FT4 and thyroid-stimulating hormone levels were obtained and showed hypothyroidism. Thyroid hormone supplementation was then started, and within 4 days the infant became more vigorous and was weaned from mechanical ventilation. After 7 days, the chylothorax resolved completely as the serum thyroxine level normalized. No reaccumulation of pleural effusion was noticed. The infant started to gain weight and was discharged from the hospital at 35 days of age. A possible pathophysiologic association between congenital hypothyroidism and NIHF is discussed. NIHF may be caused by lymphatic congestion attributable to an impairment of lymphatic flow and a delayed return of lymph to the vascular compartment. There could be a possibility that because of thyroid hormone deficiency in this patient, there was reduced adrenergic stimulation of the lymphatic system. This could result in a sluggish flow of the lymph with engorgement of the lymphatic system, leakage of lymph into the pleura and the interstitial spaces, and the production of chylothorax with NIHF. Animal studies demonstrate a direct relationship between lymph flow rate or lung liquid clearance and adrenergic receptor activity in the lymphatic system. These observations support our hypothesis that deficient adrenergic activity in congenital hypothyroidism might lead to chylothorax with NIHF in the fetus. We speculate that thyroid hormone may play a role in the regulation of adrenergic receptors in the lymphatic system and lungs, thus modulating both the lymphatic flow rate and lung liquid clearance, and facilitating the resolution of chylothorax. Examination of thyroid functions should be included in the investigation of fetuses and neonates with NIHF of an obscure origin.

Congenital Hypothyroidism↗
PubMed1989

Lymphatic transport of salicylates in dogs.

1. Pharmacokinetic parameters were determined for acetylsalicylic acid (ASA) and salicylic acid (SA) in plasma and lymph following the intravenous or oral administration of a water-soluble preparation of lysine-acetylsalicylic acid to dogs. 2. By both routes of administration, ASA but not SA, tended to be deposited in lymph, as indicated by the ratio between the area under the concentration-time curve constructed for the parent compound and its metabolite in lymph and plasma. 3. A reduced conversion of ASA to SA by esterases in lymph, and lymphatic absorption of ASA following the oral administration might be factors responsible for the accumulation of the compound in the lymphatic system. 4. It is suggested that the lymphatic system might serve as a temporary reservoir compartment for ASA.

Administration, Oral↗
PubMed1981

The problems of lymphatic microsurgery for lymphedema.

The problems of microsurgery for lymphedema consist of the discrepancy between the excellent technical possibilities, especially of microsurgical lympho-venous shunts and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Generally, the lymphatic surgeon considers the lymphatic system to be a canalicular system of drainage tubes, of lymph collectors. Bypassing a lymph block through peripheral lympho-venous shunts should therefore solve the problem of lymphstasis, present in each type of lymphedema. In chronic lymphedema however, not only the canalicular lymphatic system, but also the tissues, and integral part of the lymphatic system, are affected. In chronic lymphedema, canalicular repair, for reasons of quantitative lymph drainage, exceptionally only provides a "restitutio ad integrum" of the tissues, altered by lymph stasis.

Animals↗
PubMed1977

Irregular cervical dissemination of tumours of the maxillo-facial region.

In nearly 90% of lymphatic disseminations, metastasis of carcinomata of the oral cavity follows the normal regional anatomy of the efferent lymphatic system, and usually manifests itself in three homolateral filtering groups. More than 90% of lymphatic metastases occur in the first year following diagnosis of the primary tumour. Such a sequence may be regarded as "regular" metastasis. Anatomical variations and metastasis-induced or therapy-induced blockage of the efferent lymphatic system can change the pattern of metastasis to "irregular". The present studies are specially directed towards recurrence of metastasis, lymphangiosis blastomatosa, the so-called late metastasis as well as the problem of branchiogenic carcinoma. The explanation of clinical aspects has been substantiated with topographic-anatomical and histological findings as well as experience gained in lymphography and lymphoscintigraphy of the cervical lymphatic system.

Carcinoma↗
PubMed2006

Pulmonary vascular endothelial growth factor-C in development and lung injury in preterm infants.

RATIONALE: In mice, vascular endothelial growth factor-C (VEGF-C) plays an important role in development of the lymphatic system and in pathogenesis of pulmonary inflammation. Its role in development of the lymphatic system in human lung and in lung injury in newborns remains unclear. OBJECTIVES: We studied the role of VEGF-C in developing human lung, and in acute and chronic lung injury in preterm infants. METHODS: Included in the immunohistochemistry study were 10 fetuses, 15 control neonates without primary lung disease, 15 preterm infants with respiratory distress syndrome, and 8 infants with bronchopulmonary dysplasia. Tracheal aspirate fluid samples of intubated very-low-birth-weight infants during Postnatal Weeks 1-5 were analyzed with ELISA. RESULTS: Bronchiolar staining for VEGF-C was observed in all 48 samples. Alveolar epithelial staining was seen in most fetuses (8/10). In addition, staining was observed in alveolar macrophages in bronchopulmonary dysplasia (4/8), and late respiratory distress syndrome (2/7). VEGF receptor-3 (VEGFR-3) staining was observed in lymphatic endothelium adjacent to vascular endothelium. VEGF-C was expressed consistently in tracheal aspirate fluid, being highest during the first 2 postnatal days. Antenatal administration of glucocorticoids was associated with higher VEGF-C in tracheal aspirate fluid. CONCLUSIONS: The pattern of pulmonary VEGF-C and VEGFR-3 protein expression and consistent VEGF-C protein appearance in tracheal aspirate fluid in human preterm infants indicate a role for VEGF-C in the physiologic development of the lymphatic system of the lung.

Bronchi↗
PubMed2002

The role of lymphatic transport in enhancing oral protein and peptide drug delivery.

The gastrointestinal lymphatic system is a specific transport pathway through which dietary lipids, fat-soluble vitamins, and water-insoluble peptide-type molecules (e.g., cyclosporine A) can gain access to the systemic circulation. Drugs transported by way of the gastrointestinal lymphatic system bypass the liver and avoid potential hepatic first-pass metabolism. Lymphatic delivery of immunomodulatory and low therapeutic index protein and peptide drugs used in the treatment of cancer cell metastases and HIV presents an opportunity to maximize therapeutic benefit while minimizing general systemic drug exposure. Furthermore, lymphatic drug transport may promote drug incorporation into the body's lipid-handling system, thus offering the potential to manipulate drug distribution and residence time within the body. This review article will discuss the potential utilization of lymphatic transport in enhancing the oral absorption of protein- and peptide-like drugs.

Administration, Oral↗
PubMed2004

The presence of myofibroblasts, smooth muscle cells and elastic fibers in the lymphatic collectors of horses.

Horses are highly susceptible to lymphedema. Knowledge of the morphological components of lymphatic collectors is therefore essential to understanding the function of the lymphatic system. A better knowledge of the lymphatic system allows the development of more effective treatments against lymphedema. The composition of hypodermal and deep lymphatic collectors was investigated with immunohistochemical staining, using antibodies against proteins of the collector walls from the skin in the hind limbs of 10 healthy horses. Lymphatic collectors can be subdivided into passive (elastic fibers) and active (smooth muscle cells and myofibroblasts) components. The presence of myofibroblasts in equine lymphatic collectors has not previously been described. The high concentration of myofibroblasts, especially in the dermal collectors, suggests their possible importance in lymph flow. Myofibroblasts may act as pacemaker cells for the contraction of smooth muscle cells and probably play a role in the proliferation of smooth muscle cells during training, as there appears to be correlation between the percentage of smooth muscle cells in equine lymphatic collectors and level of physical fitness. The response of the lymphatics to stimulation may allow effective treatment of lymphedema without using pharmacological drugs. The high percentage of elastic fibers (approximately 45% in equine lymphatic collectors) indicates the importance of passive components within the lymph flow.

Animals↗