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PubMed1996

Enterostatin efflux in cat intestinal lymph: relation to lymph flow, hyaluronan, and fat absorption.

The question addressed in this study was whether enterostatin, the pancreatic procolipase activation peptide, modulates intestinal hyaluronan turnover via lymph. In anesthetized cats, segments of ileum were surgically isolated from the proximal and distal gut, the draining lymphatic was cannulated, and the segment was autoperfused in situ. In several groups, concentrations of immunoreactive enterostatin in lymph were compared with that in plasma at baseline and elevated lymph flow and in the absence and presence of fat absorption. The baseline ratio of lymph enterostatin to that in plasma (L/P) in the absence of fat absorption was 1.44 +/- 0.29 compared with 4.93 +/- 0.42 after cream feeding (P < 0.05). In a separate group, when the intestinal lumen was perfused for 2 h with a mixture of oleic acid and taurocholate, enterostatin L/P doubled compared with baseline. At high lymph flows, enterostatin concentrations fell in all groups, resulting in an L/P of 0.47 +/- 0.09 (P < 0.05) in the absence of fat absorption, 0.77 +/- 0.35 after oleic acid, and 1.26 +/- 0.13 in the cream-fed group. These changes correlate with the pattern of hyaluronan efflux from the ileum into lymph after fat absorption [R.K. Reed, M.I Townsley, V.H. Pitts, T.C. Laurent, and A.E. Taylor. Am. J. Physiol, 263 (Gastrointest. Liver Physiol. 26): G6-G11, 1992] However, in separate groups when enterostatin was introduced into ileum, either as a close intra-arterial bolus or via the intestinal lumen, there were no resultant changes in efflux of hyaluronan from the intestine into lymph. In conclusion, despite the fact that delivery of pancreatic exocrine secretions to the ileal lumen was blocked in this model, enterostatin concentration in lymph increased after fat absorption. Nonetheless, it seems clear that enterostatin does not modify intestinal hyaluronan turnover.

Animals↗
PubMed1989

Effects of sustained lymph drainage on cardiovascular function and thoracic duct lymph in sheep.

We studied the effect of lowering the plasma protein concentration on the cardiovascular function and thoracic duct lymph in awake adult sheep. Hypoproteinemia was induced in seven nonpregnant, splenectomized sheep by drainage of the thoracic duct lymph over a 5-day period. The plasma protein went from a mean of 6.4 +/- 0.2 (SE) to 4.9 +/- 0.2 g/dl on day 5, and the lymph-to-plasma protein concentration ratio decreased from 0.74 +/- 0.01 on day 1 to 0.48 +/- 0.04 on day 5. The percentage composition of the protein fractions in plasma and lymph remained unchanged. Lymph flow was 1.79 +/- 0.37 and 1.28 +/- 0.10 ml/min for days 1 and 5, respectively. Renin concentration in plasma increased 50-fold by day 5. Arterial pressure fell from 102.9 +/- 5.4 to 72.7 +/- 4.4 mmHg by day 5. Mean hematocrit was 28.9 +/- 1.7 at day 1, which was not significantly different than 24.6 +/- 2.9 at day 5 and indicated that the plasma volume did not decrease. Body weight also did not change significantly. There was a decrease in the transcapillary protein escape rate, determined as the thoracic lymph flow rate multiplied the lymph protein concentration, that suggests adaptations in the microcirculation to decrease vascular-to-interstitial protein transfer during hypoproteinemia. Hypoproteinemic animals also demonstrated greater vascular retention of a fluid volume challenge. In conclusion, the sheep adaptations to sustained hypoproteinemia produced by lymph drainage were a significant decrease in arterial pressure, large increases in vascular compliance and renin concentration, and reduced transcapillary escape rate of protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

99mTc-Evans blue dye for mapping contiguous lymph node sequences and discriminating the sentinel lymph node in an ovine model.

BACKGROUND: The aim of this study was to investigate the potential of (99m)Tc-Evans blue for discriminating the sentinel lymph node in multitiered lymph node sequences by using an ovine model. (99m)Tc-Evans blue is an agent that has both radioactive and color signals in a single dose. Previous studies in smaller animal models suggested that this agent could have advantages over the dual-injection technique of radiocolloid/blue dye. METHODS: Doses of (99m)Tc-Evans blue ( approximately 21 MBq) containing Evans blue dye (approximately 4 mg) were administered to the hind limbs or fore limbs of sheep to map the lymphatic drainage patterns, validate its ability to identify the sentinel lymph node, and examine the reproducibility of the technique. The study protocol was repeated with (99m)Tc-antimony trisulfide colloid and Patent Blue V dye. After the operative exposure, lymph nodes were identified with the gamma probe and then excised and analyzed for radioactivity (percentage of injected dose) and blue color. RESULTS: After the administration of (99m)Tc-Evans blue, all lymph nodes harvested (35 of 35) in either short chains or long basins were hot and blue. The sentinel lymph nodes concentrated more radioactivity than the second-tier nodes to the extent of 2:1 to 215:1. For radiocolloid/Patent Blue V, the ratios were lower, at 2:1 to 3:1. CONCLUSIONS: (99m)Tc-Evans blue was found to better discriminate the sentinel lymph node than (99m)Tc-antimony trisulfide colloid/Patent Blue V in variable multitier lymph node anatomy, and it is an agent that promises to have positive clinical applications.

Animals↗
PubMed2005

Ontogeny of the antigen-reactive lymph follicle-forming capacity of the popliteal lymph node in neonatal mice.

The ontogenetic development of the reactive lymph follicle-forming capacity of the popliteal lymph node was investigated immunohistochemically in young mice which had received a single injection of hemocyanin (KLH) in a rear footpad at a predetermined age (between 1 and 21 days). The mice were sacrificed at various intervals after injection. In non-stimulated young mice, primary lymph follicles first appeared in the popliteal node at 11 days of age. When KLH was given to 7-day-old or older mice, each draining popliteal node showed a marked increase in B lymphocytes in the extrafollicular zone 3 days after injection and produced a number of "new" lymph follicles outside the pre-existing follicles over the next few days. In mice injected at 2-4 days of age, these nodes showed an increase in B lymphocytes in the outer cortex and had produced several lymph follicles by 8 days of age. The number of lymph follicles produced by each node tended to increase in line with age at injection. These results indicate that neonatal popliteal nodes become able to produce lymph follicles in response to exogenous antigens some time before ontogenetically developing follicles appear. The formation of new lymph follicles observed in draining popliteal nodes after KLH injection at an early postnatal age is discussed in relation to the ontogenetic development of stromal cells (precursors of follicular dendritic cells) that are capable of interacting with B lymphocytes and the extent of B lymphocyte influx into the node induced by KLH stimulation.

Aging↗
PubMed2000

[Lymph scintigraphy and pre- and intraoperative gamma probe measurements for localization of sentinel lymph nodes (SLN) in breast cancer].

UNLABELLED: Aim of this study was to prove the clinical value of nuclear medicine procedures to detect the sentinel lymph node (SLN) for SLN biopsy. METHODS: In 132 patients with breast cancer we performed lymph scintigraphy of the breast as well as both pre- and intraoperative gamma probe measurements correlating the results with the findings of histopathology. RESULTS: SLN were detectable in 62 of 110 patients according to a sensitivity of 56% when scanning was performed only at 1-2 h p.i. while the sensitivity increased to 86% (19 of 22 pts.) if sequential images were acquired up to 2 h p.i. One or more SLN were identified by a hand-held gamma probe transcutaneously prior to surgery in 96% (113 of 118 pts.) of the patients who showed up with no clinically suspected lymph node metastases. Intraoperatively, in additionally 2 patients the SLN could be found resulting in a sensitivity of 97% (115 of 118 pts.). In only 3 patients with clinically no tumor spread to axillary lymph nodes no SLN could be identified by the probe. Skip lesions, i.e. lymph node metastases in patients with tumor-free SLN, occurred in 2 cases: due to SLN biopsy in these patients lymph node staging was false negative compared to conventional staging by means of axillary lymph node dissection. CONCLUSION: The results demonstrate a high preoperative detection rate of SLN in patients with breast cancer using lymph scintigraphy and gamma probe measurements. Thus, nuclear medicine is capable of providing the basic requirements for SLN biopsy in the daily routine.

Adult↗
PubMed1976

Studies on lymph humoral factor. Evidence for a lymphocytopoietic factor in rat thoracic duct lymph.

Normal rats were injected with the partially purified material extracted from the thoracic duct lymph which was collected from normal syngeneic rats. The cellular changes in the peripheral lymphoid tissues and thymus were examined cytologically and histologically. The intravenous injection of the lymph extract into normal syngeneic rats resulted in increase in weight of lymphoid tissues. Histologically, a massive proliferation of large pyroninophilic lymphoid cells and an increase in mitotic index was detected predominantly in the thymus-dependent areas and thymic cortex. In spleens from rats injected with lymph extract, the marginal zone bridging channel was shown as one route for the translocation or mobilization of newly borne lymphoid cells to the venous circulation. Similar lymphocytopoietic activity, but to a lesser extent than lymph extract, was also detected in lymph plasma, serum and serum extract. The lymph extract was shown to be non-immunogenic in syngeneic rats. It is suggested that the effects of the lymph extract on lymphoid cell proliferation are due to the presence of a lymphocytopoietic factor in body fluid, particularly in the lymph.

Animals↗
PubMed1975

[Regional neck lymph nodes and primary tumors. 2. The reactive neck lymph node lesion].

Topographic classification of lymphatic nodes with reactive changes and with metastasis makes evident, that the regional lymph nodes have not only changes, caused by inflammation but also by growth of tumor. Thus, the lymph nodes are accomodation of defense and in the second place as an accommodation of discharge. The regional lymph nodes respond independent of the extent of the primary tumor. The regional metastasis are nearly always localized in the center of lymph nodes with reactiv changes. Lymph nodes with follicular lymphatic hyperplasia are situated in the immediate environment of the metastasis. Lymph nodes with sinus-reaction are extended before the metastasis, in direction of lymph discharge. By super imposed projection of the results of histological evaluation of cervical glands with metastasis in the neck, one obtains to some extent an impression of the defense activity by the lymph nodes at the time of the operation.

Head and Neck Neoplasms↗
PubMed1992

Lymph, lymph glands, and homeostasis.

Under aerobic conditions every respiring cell in the human body normally consumes oxygen to burn food and produce stoichiometric quantities of water which dissolves carbon dioxide and less soluble cell products. The effluent water and solutes appear in the form of lymph in the interstices between cells. The lymph effluent from all respiring cells flows to become the circulating lymph and blood plasma which coordinately sustain a steady state of homeostasis throughout the internal milieu. As a result, every living cell served by the vascular system has equal opportunity to partake of water and solutes emanating from or absorbed by remaining cells. Solute quantities available depend on cell location, regional plasma flow, local vascular permeability, molecular size, configuration, solubility and concentration, as well as avid cell receptors. Proportional to oxygen consumption, organized lymph glands develop in environments of relatively high oxygen tension around regional arteries to filter and process lymph coming from regional cells, and to produce effluent lymph rich in soluble globulins extruded by local mononuclear cells (especially macrophages, plasmacytes, lymphocytes), along with suspended small cytoplasm-poor lymphocytes. In turn, such dissolved globulins and remarkably motile small lymphocytes help feed, regulate growth and provide immunity to remaining cells. The lymph effluent from lymph glands and residua from capillary filtrates, along with newly absorbed solvent water, join the blood circulation during pulmonary inspiration in volumes proportional to the volume of air inspired with each breath.

Animals↗
PubMed2004

[Effects of radiation therapy for paraaortic lymph node involvement and recurrent lymph node metastases from gastric cancer].

Effects of radiation therapy for lymph node metastases from gastric cancer were retrospectively analyzed. The radiation sites were residual paraaortic lymph node involvement and postoperative recurrent lymph node metastases in 10 patients. The size of lymph node swelling was decreased in 6 (60%) patients after radiation therapy using liniac. Complaints due to lymph node metastases such as pain and edema of extremities were voiced by 7 patients. These complaints were eventually relieved or disappeared in all 7 patients. There were no severe adverse effects during radiation therapy, and 7 patients (70%) could shift to home care. One-year and 3-year survival rates were 20 and 10%, respectively. Radiation therapy for lymph node metastases from gastric cancer was chiefly effective in relieving complaints. Although it is unclear whether radiation therapy can improve the survival rate, these results suggest that radiation therapy could be one of the most useful locoregional therapies for paraaortic lymph node involvement and recurrent lymph node metastases from gastric cancer.

Aged↗
PubMed1987

Lymph drainage originating from the lower esophagus and gastric cardia as measured by radioisotope uptake in the regional lymph nodes following lymphoscintigraphy.

Lymph drainage originating from the lower esophagus and gastric cardia was determined using uptake of radioisotope (RI) in the regional lymph nodes in 19 patients with primary cancer at these sites. On the day prior to operation, 99m Tc colloid solution was injected submucosally in the distal esophagus or gastric cardia during endoscopy. The regional lymph nodes were removed at operation and RI uptake of individual nodes was measured in a well-type scintillation counter. Uptake was expressed as the amount per nodal weight. After radioactive colloid was injected into the lower esophagus, high RI uptake was common in both the mid-mediastinal and abdominal nodes, suggesting that lymph originating from the lower esophagus drains in both a superior and inferior direction. On the other hand, after radioactive colloid was injected into the gastric cardia, high RI uptake was never demonstrated in mediastinal lymph nodes suggesting that direct mediastinal lymph flow from the gastric cardia is rare. These results support clinical observations on the distribution of lymph nodal metastases in patients with lower esophageal and gastric cardia malignancies. As a diagnostic tool for lymph nodal metastases, however, lymphoscintigraphy is unreliable.

Abdomen↗
PubMed2003

Lymph node status and survival in cutaneous malignant melanoma--sentinel lymph node biopsy impact.

AIM: The survival benefit of sentinel lymph node biopsy (SLB) with lymphadenectomy for microscopic melanoma metastases to regional lymph nodes (SLND) is uncertain. The aim of the study was to analyse the factors influencing clinical outcome (overall survival (OS) and disease free survival (DFS)) of patients undergone lymph node dissection (LND) as result of positive sentinel lymph node disease (SLND) or as consequence of clinically detected metastases (CLND). PATIENTS AND METHODS: This was a single-institution retrospective analysis of survival data of 350 consecutive, prospectively collected, melanoma patients who underwent radical LND in 1995-2001. One hundred and forty-five patients underwent SLND and 205 underwent CLND. RESULTS: The median OS and DFS times of the entire group of melanoma patients, computed from the date of primary lesion excision, were 46.3 months and 26.5 months (5-year OS ratio 41.8% and 5-year DFS ratio 31.5%). The factors which correlated with poor OS by multivariate analysis were: primary tumour Breslow thickness >4 mm (p=0.001), extracapsular extension of lymph node metastases (p=0.004), male sex (p=0.001) and metastases to more than one regional lymph node (p=0.04). The negative factors for DFS were: nodal extracapsular invasion (p=0.00002) and primary tumour Breslow thickness >4 mm (p=0.004). There were no significant differences in OS and DFS between SLND and CLND groups, when calculated from the date of primary tumour excision. However, if OS and DFS were estimated from the date of LND, the SLND group demonstrated significantly better survival in comparison with CLND. CONCLUSION: The study demonstrates no survival benefit from SLB with subsequent radical regional LND in malignant melanoma patients with lymph node metastases.

Analysis of Variance↗
PubMedDate not supplied

Lymph node metastasis and lymph vascular space invasion in microinvasive squamous cell carcinoma of the uterine cervix.

The objective of this study was to determine whether the depth of invasion was related to lymph vascular space invasion (LVSI) and lymph node metastasis and whether there was a correlation between LVSI and lymph node metastasis in stage IA cervical cancer. The medical records, including surgical notes and pathologic reports, of 202 patients with microinvasive squamous cell carcinoma of the uterine cervix were reviewed retrospectively. There was a positive correlation between the depth of invasion and the LVSI, and the incidence of lymph node metastasis was slightly higher than those reported hitherto for stage IA1 cervical cancer, especially in the depth of invasion of 1-3 mm group. However, among four patients with lymph node metastasis, only two patients had positive LVSI. There was no definite correlation between LVSI and lymph node metastasis. LVSI could not identify the patients with high risk for lymph node metastasis.

Adult↗
PubMed2005

[Lymph vascularity and lymph node metastases on PET and PET-CT: immunohistological and clinical observations].

Sarcomatous malignancies only rarely develop regional lymph node metastases: about 2.7% of our evaluated cases. In this paper we provide evidence supporting a new hypothesis that two entirely separate lymph vascular systems exist in humans. One system (LGS I) exists in close proximity to the epithelium and drains into regional lymph nodes. Only sarcomas that originate in the epithelium or its immediate proximity are able to form regional lymph node metastases. The vast majority of sarcomatous malignancies (97.4% of cases) do not give rise to lymph node metastases, since they originate in proximity to a second, more deeply localized lymph node system (LGS II) in the mesenchymally derived tissues of the body. This second system has no connection to regional lymph nodes. Supporting evidence is provided by experience in the operative treatment of extremity lymphedema, PET-CT examinations, radionuclear lymphography, and scientific investigations using antibodies specifically directed at the elements of the lymph vascular system.

Epithelium↗
PubMed2000

Predicting sentinel and residual lymph node basin disease after sentinel lymph node biopsy for melanoma.

BACKGROUND: The selection of patients for sentinel lymph node biopsy (SNB) and selective lymphadenectomy for histologically positive sentinel lymph nodes (SLND) are areas of debate. The authors of the current study attempted to identify predictors of metastases to the sentinel and residual nonsentinel lymph nodes in patients with melanoma. METHODS: The Indiana University Interdisciplinary Melanoma Program computerized database was queried to identify all patients who underwent SNB for clinically localized cutaneous melanoma. Demographic, surgical, and histopathologic data were recorded. Univariate and multivariate logistic regression analyses were performed to identify associations with SNB and nonsentinel lymph node positivity. Classification tree and logistic procedures were performed to identify the ideal tumor thickness cutpoint at which to perform SNB. RESULTS: Two hundred seventy-five SNB procedures were performed to stage 348 regional lymph node basins for occult metastases from melanoma. Of the 275 melanomas, 54 (19.6%) had a positive SNB, as did 58 of 348 basins (16.7%). Classification and logistic regression analysis identified a Breslow depth of 1.25 mm to be the most significant cutpoint for SNB positivity (odds ratio 8. 8:1; P = 0.0001). By multivariate analyses, a Breslow thickness cutpoint >/= 1.25 mm (P = 0.0002), ulceration (P = 0.005), and high mitotic index (> 5 mitoses/high-power field; P = 0.04) were significant predictors of SNB results. SLND was performed in 53 SNB positive patients, 15 of whom (28.3%) had at least 1 additional positive lymph node. SLND positivity was noted across a wide range of primary tumor characteristics and was associated significantly with multiple positive SN, but not with any other variable. SNB result correlated significantly with disease free and overall survival. CONCLUSIONS: Patients with a Breslow tumor thickness >/= 1. 25 mm, ulceration, and high mitotic index are most likely to have positive SNB results. SLND is recommended for all patients after positive SNB because it is difficult to identify patients with residual lymph node disease.

Adolescent↗
PubMed1987

Pathways of lymph flow through superficial inguinal lymph nodes in the pig.

The pig lymph node has an unusual structure in that tissue containing lymph nodules generally occupies a central position. Our aim was to describe the lymphatic pathways through this node. We studied the structure of these pathways with light and electron microscopy, made casts of lymphatic vessels and sinuses with Microfil, and studied the distribution within the node of subcutaneously injected carbon particles. Most afferent lymphatics penetrate deeply within the node, where they give off several branches to peritrabecular sinuses that ramify through centrally located nodular tissue. However, where an afferent lymphatic enters the node there is a subcapsular sinus over an area of nodular tissue that occupies a conventional superficial position. Some lymph reaches this sinus from the central peritrabecular sinuses, but there can also be direct communications between this sinus and the afferent lymphatic. After flowing through sinuses in nodular tissue, lymph enters tissue that is analogous to medullary tissue in other species. This tissue is of two types, one consisting mainly of a diffuse network of reticular cells around spaces up to 10-12 microns across, and one that more closely resembles conventional medullary tissue. Lymph then flows to collecting ducts, which lack valves, and then to efferent lymphatics. Our findings do not support suggestions that a purely physical obstruction of lymphocytes in the lymph node accounts for the dearth of lymphocytes in efferent lymph of pigs.

Animals↗
PubMed2004

Should decisions on internal mammary lymph node irradiation be based on current lymphoscintigraphy techniques for sentinel lymph node identification?

BACKGROUND: Treatment of internal mammary lymph node (IMN) metastases remains controversial because of the difficulty in predicting involvement, potential treatment-related morbidity, and questionable efficacy. Lymphoscintigraphy with sentinel lymph node biopsy offers a means to identify occult involvement of IMN, allowing appropriate patient selection for IMN treatment. METHODS: The authors retrospectively reviewed 262 lymphoscintigraphies (LS) of 248 patients treated at the University of Florida (Gainesville, FL) between 1998 and 2002. Tumor characteristics were assessed for their value in predicting IMN drainage and their association with IMN radiation. RESULTS: Lymph flow to the IMN was documented with LS in 23 of 262 tumor specimens (9%). Flow to the IMN was not correlated with any of the five factors: tumor location, tumor size, lymphovascular invasion, pathologic lymph node status, and laterality of the involved breast (right vs. left breast). Identification of IMN flow increased from 5.7% to 10.1% with the use of a deep injection technique. IMN radiotherapy was used more frequently in patients with larger tumors (15 of 188 in Tis/T1 vs. 31 of 70 in T2-T4; P<0.0001) and positive lymph nodes (17 of 91 in lymph node-negative patients vs. 28 of 66 in lymph node-positive patients; P<0.0001). In patients with T2N0 tumors (n=32), IMN radiotherapy was used more frequently with medial tumors (5 of 11 [45%]) than with lateral tumors (4 of 21 [19%]). CONCLUSIONS: The incidence of flow to the IMN documented with the current LS technique was low compared with other LS and extended radical mastectomy series. Histopathologic information was obtained for the sentinel IMN when IMN flow was identified on the LS. In the absence of histopathologic information, treatment decisions should continue to be based on clinical factors known to be correlated with occult IMN involvement.

Adult↗
PubMed1991

Response of efferent lymph and popliteal lymph node to epidermal infection of sheep with orf virus.

Functional and phenotypic changes in the cell populations were monitored in the popliteal efferent lymph of sheep following experimental epidermal infection with orf virus. In another group of sheep, cells from the popliteal lymph node draining the site of infection were similarly monitored and compared with the cells from contralateral popliteal and mesenteric lymph nodes. All sheep showed serological evidence of previous exposure to orf virus. Following infection, anti-orf antibody titres rose and efferent lymphocyte and blast cell output increased. Interferon-like activity was detected in efferent lymph early after orf virus but not mock infection. Lymphocytes from the draining popliteal lymph node showed antigen-specific lymphoproliferation on Days 3-7 while cells in the efferent lymph demonstrated proliferative activity on Days 4-6. The requirement for exogenous antigen-presenting cells in the culture of efferent lymphocytes varied between individual sheep. The culture supernatant from proliferating lymph node cells contained interferon-like activity but no anti-orf antibodies, the reverse of that from cultured efferent lymphocytes, perhaps indicating a different reactive T cell population. During the course of the experiment there was an increase in the percentage of efferent lymphocytes expressing MHC Class II antigens and surface immunoglobulins, the latter being recorded as a double peak. The short-term nature of the local T cell response may in part explain the incompleteness of immunity to orf virus in sheep.

Animals↗
PubMed2004

Failure in the detection of the sentinel lymph node with a combined technique of radioactive tracer and blue dye in a patient with cancer of the vulva and a single positive lymph node.

BACKGROUND: In early stage vulvar cancer, the sentinel lymph node procedure with a radioactive tracer appears to be a promising new diagnostic tool to predict lymph node status. No detection failures have been published so far in vulvar cancer. We recently experienced failure in the detection of the sentinel lymph node in a patient with a positive lymph node. CASE: A 75-year-old patient with a clinical T2N0M0 squamous cell carcinoma replacing the clitoris underwent a sentinel node procedure. A sentinel node was detected only at one groin. An exploration of the other groin showed a positive lymph node totally replaced by tumor. CONCLUSION: In the case we present, stasis of the lymph flow might be the leading cause of the failure of the sentinel lymph node procedure.

Aged↗