ABSTRACT
Objective:To investigate the diagnosis of malignancy with upper limb lymphedema as the initial sign and symptoms.Methods:Clinical data of 6 patients with malignant lymphedema admitted at the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, from May 2007, to Dec 2018 were retrospectively analyzed.Results:The age of these 6 patients ranged from 50 to 78 years. The time from the occurrence of lymphedema to the diagnosis of malignant tumors ranged from 1 month to 15 years. Limb swelling occurred in all 6 cases. Local lymphadenopathy occurred in 4 cases and limb paresthesia occurred in 2 cases. Pathological diagnosis showed that the tumor originated from epithelial tissue in 3 cases, mesenchymal tissue in 2 cases and lymphatic system in 1 case. Pathological diagnosis showed that the tumor originated from epithelial tissue in 3 cases, mesenchymal tissue in 2 cases and lymphatic system in 1 case.Conclusions:To avoid delays in the diagnosis and therapy of malignant lymphedema, physicians should actively look for signs or symptoms of lymphedema during the follow-up period and promptly manage patients developing problems.
ABSTRACT
Objective:To investigate the clinical features, diagnosis, treatment and prognosis of adult cervical lymphangioma.Methods:Twenty-five cases of adult cervical lymphangioma admitted at Department of Lymphatic Surgery of Beijing Shijitan Hospital from Feb 2017 to Jun 2020 were retrospectively analyzed.Results:Among the 25 cases,there were 5 males and 20 females, aged from 18 to 58 years. Radionuclide lymphoscintigraphy performed in 25 cases, increased radioactivity in the neck tumor area was seen in 8 cases; Direct lymphangiography performed in 17 cases,outlet obstruction of cervical thoracic duct was found in 14 cases. Twenty one cases were treated by operation and followed up for 6-47 months. No recurrence was found; 4 cases abandoned surgery, 1 case was lost to follow-up, and the other 3 cases were followed up for 16-48 months with tumor progresses.Conclusions:Adult cervical lymphangioma is lymphangiomalformation disease. Total resection of the tumor and avoiding damage to the thoracic duct is the key for successful management.
ABSTRACT
Objective:To evaluate peritoneovenous shunt for treatment of refractory chylous ascites.Methods:The clinical data of 40 patients with refractory chylous ascites treated by peritoneovenous shunt procedure at Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from May 2008 to Aug 2020 were retrospectively analyzed.Results:Patients'postoperative weight [(57.8±13.2) kg] was significantly lower than that of preoperative weight [(65.9±13.1) kg]. Postoperative abdominal circumference significantly reduced [(82.0±9.8) cm vs. (94.3±10.8) cm]. Average postoperative 24-hour urine output was significantly higher than that before operation [2 250 (1 650, 3 300) ml vs. 750 (500, 1 000) ml]. Platelet count and fibrinogen decreased after operation; prothrombin time (PT) prolonged; the change of time of activated partial thromboplastin (APTT) was not statistically significant ( P=0.506). Postoperative aspartate aminotransferase (AST), urea, and creatinine decreased; whereas alanine aminotransferase (ALT) ( P=0.154), total protein ( P=0.350), and albumin ( P=0.113) remained unchanged. 35 patients got follow-up, 29 deceased. The survival time with tube was 16 (7,37) months; 6 cases survived, the survival time with tube was 28 (6,124) months. Conclusions:Peritoneovenous shunt is a palliative surgery improving the quality of life of patients with refractory chylous ascites.
ABSTRACT
Objective:To explore the clinical features of Stewart-Treves syndrome in postoperative patients of breast cancer.Methods:The clinical data of 11 patients with Stewart-Treves syndrome after breast cancer surgery in Beijing Shijitan Hospital from Aug 2008 to Sep 2016 were retrospectively analyzed.Results:All the 11 patients were female , age ranging from 44 to 78 years.The main clinical manifestations included multiple skin and subcutaneous nodules , scattered red or purplish red rashes in the lymphedematous upper limbs, and sometimes in the chest wall. MRI showed multiple short T2 signal soft tissue nodules in skin and subcutaneous soft tissue. Histopathology showed heterogeneous endothelial cell-derived malignant tumor. Immunohistochemical staining showed positive CD31, CD34 and D2-40. These 11 patients had skin and subcutaneous tumor excision and biopsy, 4 had shoulder amputation, 4 received postoperative adjuvant chemo plus or radiotherapy. As of Feb 2020, 1 patient was alive, 9 died and 1 lost follow-up.Conclusions:Stewart-Treves syndrome is a rare complication of breast cancer, with poor prognosis and high mortality.
ABSTRACT
Objective:To study the clinical effect of liposuction combined with lymphatico-venous anastomosis for treatment of breast cancer-related lymphedema(BCRL).Methods:From Nov 2015 to Nov 2017, 111 patients with BCRL admitted to the Department of Lymphatic Surgery at Beijing Shijitan Hospital were enrolled. The rank-sum test was used for statistical analysis. The frequencies of erysipelas episodes before and after combined surgeries were compared.Results:The mean upper limb circumference significantly decreased at 7 days[0.2 cm (-0.8, 1.1)], at follow-up[0.2 cm(-0.4, 1.0)]compared with that of preoperation[5.0 cm(4.1, 6.9)]( P<0.05). The mean upper limb volume significantly decreased at day 7[26 ml(-120, 155)], at follow-up[37 ml(-66, 165)]compared with preoperation[786 ml(632, 1 200)]( P<0.05). The incidence of erysipelas of the affected limbs significantly decreased after treatment. Furthermore, the softness and the feeling of heaviness of the affected limbs significantly improved after the combined procedures(all P<0.05). Conclusion:Liposuction combined with lymphatico-venous anastomosis is an effective method for the treatment of breast cancer-related lymphedema.
ABSTRACT
Objective@#To investigate the imaging features and etiology of lymphatic trunk in primary facial lymphedema.@*Methods@#26 patients with primary facial lymphedema patients (F/M, 13/13, ages 21.8 ± 13.9 years old) were recruited from January 2015 to October 2017 in this study, with 32 sides facial lymphedema reported, including 6 right facial lymphedema, 14 left facial lymphedema, and 6 bilateral facial lymphedema. And all the patient data and imaging were retrospective analysis to summarize the MR imaging features of thoracic duct and right lymphatic duct, meanwhile compared with surgical results.@*Results@#For all 26 patients, MR imaging result in thoracic duct manifests 32 lymphatic duct, including 20 thoracic duct and 12 right lymphatic duct. The imaging features demonstrate two typical findings: dilated(13 cases) and slim(7 cases) demonstrations. While for right lymphatic duct, the MR result included three types: dilated(6 cases), slim(4 cases) and no sign of manifestations(2 cases). In surgery, the thoracic duct in cervical segment demonstrated abnormal structures, including capsulated by fibrous tissues in peripheral area(30 sides), surrounded by internal jugular vein sheath(11 sides), external pressed by venae cervicalis transversa(5 sides) and lymphatic trunk dysplasia(2 sides).@*Conclusions@#MR thoracic duct and right lymphatic duct imaging can be used as an effective diagnostic imaging method for primary facial lymphedema, and the structural anomaly of the upper cervical catheter and the right lymphatic catheter may be one of the pathogenic factors of primary facial lymphedema.
ABSTRACT
Objective@#To investigate outcome and clinical value of liposuction in primary lymphedema of lower extremities.@*Methods@#Thirty patients with primary lymphedema in unilateral lower extremity were recruited in this study from July 2016 to August 2017 in Beijing Shijitan Hospital. There were 13 male and 17 female patients, with the average age of (36±16.3) years. All the patients were underwent liposuction. The volume of hemorrhage and lipid, operation time and the volume changes of affected extremity were recorded. The subjective evaluation of the patients were also proceed. The patients were divided into different groups according to gender, stage and erysipelas history.@*Results@#Total lipid volume is 900-3 900 ml. The hemorrhage volume is 160-1 100 ml during liposuction. The ipsilateral-contralateral percent volume of lower extremity was decreased immediately after surgery (6.6%±10.0%, t=7.050, P=0.000), and 3 months postoperatively (12.2%±10.7%, t=5.365, P=0.000), when compared with preoperative (31.4%±16.4%). However, the percent volume was increased 3 months after surgery, compared to immediately postoperative measurements (t=-2.088, P=0.041). Female patients had more lipid volume and higher liposuction rate than males, whereas male patients show more affected extremities volume before, after and in 3-month follow-up. The hemorrhage volume was also higher in male than female patients. Patients with erysipelas had higher volume of hemorrhage, with lower lipid volume and liposuction rate. Stage Ⅱpatients show higher lipid volume and liposuction rate than stage Ⅲ patients in operation, with lower hemorrhage and affected extremity volume changes in before, after and 3-month follow-up. In subjective assessment, the experienced heaviness and fatigue was alleviated in all patients, while the pain and tightness was increased.@*Conclusions@#Liposuction is an effective therapy for primary lymphedema in lower extremity. It is necessary to combine with other therapies to improve lymph circulation. Patients′ gender, stage and the history of erysipelas are the main influencing factors of operation difficulty and prognosis.
ABSTRACT
Objective To investigate the clinical value of lymphangiography in the diagnosis and treatment of cervical chylous fistula.Methods The clinical data of 7 patients with chylous fistula at Department of Lymph Surgery,Capital Medical University Affiliated Beijing Shijitan Hospital from Jul 2010 to Aug 2015 was retrospectively analyzed.Lymphangiography was performed to investigate the site of fistula and condition of thoracic duct.Results There were 1 male and 6 female patients aging from 22 to 59 years.All patients underwent lymphangiography successfully with dynamic imaging clearly,which accurately showed the location of the leakage and the anatomy of the thoracic duct.There was compensatory branch or trunk drainage in 2 cases which underwent successful conservative treatment,the other 5 cases with leak ＞ 500 ml a day without clear compensatory branch underwent surgical treatment and were cured with no major complications.Conclusion Lymphangiography not only clearly locates the leakage and anatomical relationship of the thoracic duct,but also guides the choice of treatment and precise surgery,avoiding the secondary injury.
ABSTRACT
Objective@#To study the clinical effects of liposuction combined with lymphatico-venous anastomosis for treatment of secondary lymphedema of the lower limbs.@*Methods@#A retrospective analysis was performed for 49 patients who had undergone liposuction combined with lymphatico-venous anastomosis to treat secondary lymphedema of the lower limbs at Department of Lymph Surgery, Beijing Shijitan Hospital from November 2013 to February 2015.All patients were female aging from 31 to 70 years with median age of (52±10)years.All patients had history of pelvic surgery.There were 32 cases with cervical carcinoma, 11 cases with endometrial cancer, 1 case with ovarian cancer who accepted radical hysterectomy, 2 cases with benign tumor who accepted resection, 2 cases accepted inguinal lymph node dissection, 1 case with rectal cancer accepted radical resection.There were 30 cases with history of radiation therapy and 23 cases with history of erysipelas recurrent((2.1±3.9)/year). The limb swelling degree in preoperative and postoperative patients was explored using one-way analysis of variance with replicate measures and paired sample t-test. Meanwhile the incidence of lymphogenous infection was used as an evaluation of operation efficacy.@*Results@#The mean lower limb circumference difference at 7 days, 6 months and 12 months was (0.17±1.36)cm, (1.25±1.62)cm and(1.58±1.56)cm, respectively, which was significantly decreased compared with preoperative((4.92±2.16)cm) (t=-5.712, -5.777, -5.765; all P<0.01). The mean lower limb volume difference at 7 days, 6 months and 12 months was (522±799)ml, (726±973)ml and (889±895)ml, respectively, which was significantly decreased compared with preoperative((2 729±1 335) ml)(t=-5.905, -6.093, -5.777; all P<0.01). The incidence of erysipelas was 0.0(0.0, 0.0)/6 months within 6 months after operation and 0.0(0.0, 0.0)/6 months within 6-12 months after operation, which was significantly lower than that before operation(0.0(0.0, 2.0)/year). The feeling of tightness and heaviness of the limb was significantly improved compared with preoperative.@*Conclusion@#Liposuction combined with lymphatico-venous anastomosis is an effective method for the treatment of secondary lymphedema of the lower limbs.
ABSTRACT
Objective:To evaluate clinical significance of change of serum thyroid hormone level in patients with ST elevation myocardial infarction (STEMI) and old myocardial infarction (OMI) .Methods :Clinical data of 52 STE‐MI patients (STEMI group) and 48 OMI patients (OMI group) hospitalized in our department of cardiology were retrospectively analyzed .Automatic chemiluminescent analyzer was used to quantitatively measure thyroid hormone levels in two groups .Results:Compared with OMI group ,there were significant reductions in serum levels of free triiodothyronine [FT3 ,(4.45 ± 1.09) pmol/L vs .(3.03 ± 0.14) pmol/L] ,free thyroxine [FT4 ,(18.53 ± 3.89) pmol/L vs .(11.83 ± 0.53) pmol/L] and thyrotropic‐stimulating hormone [TSH ,(1.85 ± 1.04)μIU/L vs .(0.26 ± 0.13)μIU/L] in STEMI group ,P<0.01 all .Conclusion:Thyroid hormone levels of STEMI patients are significant‐ly higher than those of OMI patients , serum thyroid hormone levels may reflect severity of coronary vessel lesions in patients with myocardial infarction.
ABSTRACT
Objective:To explore the Chlamydia pneumoniae (Cpn) immunoglobulin (Ig) G positive rate , inflamma‐tory factors and blood lipid levels in patients with coronary heart disease (CHD) .Methods :A total of 50 CHD patients hospitalized in our hospital were selected as CHD group ,and 33 non‐CHD patients visited to outpatient clinic in same period were regarded as non‐CHD control group .Blood lipid ,inflammatory factor levels ,and positive rate of Cpn IgG were compared between two groups .Results :Compared with non‐CHD control group ,there were significant rise in levels of TC [ (3.96 ± 1.07) mmol/L vs .(4.75 ± 1.33) mmol/L] ,TG [ (1.05 ± 0.42) mmol/L vs .(1.67 ± 0.82) mmol/L] and LDL‐C [ (2.12 ± 0.47) mmol/L vs .(2.88 ± 0.86) mmol/L] , P < 0.05 all ;significant rise in levels of inflammatory factor :C reactive protein [CRP ,(3.85 ± 0.87) mg/L vs .(5.80 ± 1.60) mg/L] ,interleukin‐ 6 [IL‐6 ,(6.50 ± 1.53) mg/L vs .(15.80 ± 7.62) mg/L] and tumor necrosis factor‐α [TNF‐α ,(5.50 ± 1.60) mg/L vs .(16.10 ± 2.20) mg/L] in CHD group , P < 0.05 all ;positive rate of serum Cpn IgG in CHD group was significantly higher than that of non‐CHD control group (78.0% vs .21.2% ,P < 0.05) .Conclusion : In present study ,positive rate of serum Cpn IgG ,inflammatory factor and blood lipid levels significantly rise in CHD patients ; Chlamydia pneumoniae infection and dyslipidemia may have a synergistic effect ,cause occurrence and development of CHD in common .
ABSTRACT
Objective:To compare therapeutic effect and safety between atorvastatin and simvastatin treating angina pectoris of coronary heart disease (CHD).Methods:A total of 150 patients with chronic stable angina pectoris (SAP)of CHD were selected and randomly and equally divided into atorvastatin group and simvastatin group accord-ing to number table method.Changes of angina pectoris attack frequency,duration,degree of pain,nitroglycerin dosage and blood lipids were compared between two groups before and after treatment.All patients were followed up six months.Results:Compared with before treatment,there were significant reductions in angina pectoris attack frequency,duration,pain degree and nitroglycerin dosage after treatment 12 weeks in two groups,P0.05 all). Compared with before treatment,there were significant reductions in serum levels of total cholesterol [ (5.62 ± 0.54)mmol/L vs.(3.68±0.41)mmol/L,(5.78±0.56)mmol/L vs.(3.33±0.43)mmol/L],triglyceride [(2.30 ±0.42)mmol/L vs.(1.62±0.34)mmol/L,(2.35±0.41)mmol/L vs.(1.68±0.69)mmol/L]and low density lipoprotein cholesterol [(3.56±1.22)mmol/L vs.(2.76±0.83)mmol/L,(3.48±1.21)mmol/L vs.(2.43± 0.72)mmol/L],and significant increase in level of high density lipoprotein cholesterol [(1.32±0.35)mmol/L vs. (1.58±0.34)mmol/L,(1.30±0.46)mmol/L vs.(1.60±0.45)mmol/L]in atorvastatin group and simvastatin group after treatment (P0.05);there was no significant difference in incidence rate of cardiovascular events (28.00% vs.25.33%,P>0.05)between two groups during follow-up.Conclusion:Both atorvastatin and simvasta-tin can effectively regulate the state of high blood lipid,and possess good effect and safety for angina pectoris of coronary heart disease.
ABSTRACT
Objective To summarize the clinical characteristics of liver cirrhosis complicated with chylous ascites.Methods From July,2007 to November,2012,patients diagnosed as liver cirrhosis complicated with chylous ascites were retrospectively analyzed.Analyze the etiology,liver function,ascites,imaging examination,treatment options and progonsis of these patients.Differences in measurement data were compared with U test.Results A total of 34 cases were enrolled,male 27 cases and female seven cases,average age (51.7±12.5) years old.Hepatitis B (20/34,58.8％) was the most common etiology of liver cirrhosis.Child-Pugh grading was grade B (26 cases) and C (eight cases).The appearance of aseites of 17 cases was chylous and the serm-ascites albumin gradient (SAAG) was 18.8 (2.6 to 32.5) g/L.The SAAG of 27 cases (84.4％) was no less than 11.0 g/L.The ascites triglyceride (TG) level was 2.94 (0.26 to 16.75) mmol/L,the TG of 27 cases (84.4％) was no less than 1.25 mmol/L.The level of TG (2.66(0.26 to 16.75) mmol/L) of patients with SAAG over 11.0 g/L was significantly lower than that of SAAG lower than 11 g/L (7.07(2.26 to 15.67) mmol/L,U=24.00,P=0.02).The lymphatic scintigraphy indicated that imaging agent leaked into peritoneal cavity in 29 cases (85.3 ％).Direct lymphangiography revealed lymphatic vessel structure abnormality in 15 cases (60 ％).Twelve patients received conservative treatment and four patients were effective,13 patients accepted peritoneal-venous shunting and 12 patients were effective,11 patients with microsurgical treatrnent and seven patients were effective.Conclusions Lymphatic struture is a possible cause of cirrhosis patients with chylous ascites.The characteristics of chylous ascites in cirrhosis patients are still the same as the characteristics of portal hypertension ascites.The SAAG remarkably increases,and the the level of SAAG probably depends on TG level.Lymphoscintigraphy has great value on the determination of the presence of ascites.And the direct lymphangiography could help to reveal lymphatic vessel structure abnormality.
ABSTRACT
Objective To investigate the incidence,diagnosis,treatment and prognosis of abnormal lymphatic vessels in intestinal lymphangiectasia (IL) patients complicated by portal vein hypertension.Methods General information,clinical manifestations,laboratory tests,endoscopy and pathological examination,the results of direct and nuclide lymphangiography,treatment and prognosis of seven IL patients complicated by portal vein hypertension were retrospective analyzed.Results Among seven IL patients complicated by portal vein hypertension,there were five cases with abnormal lymphatic vessels and two cases were merely secondary to portal vein hypertension.The main symptoms were edema,abdominal distension and diarrhea.The results of laboratory tests mainly were lymphocytopenia (0.3× 109 to 1.7 × 109/L),hypoalbuminemia (16.0 to 27.8g/L) and hypoglobulinemia (13.2 to 17.7 g/L).Under endoscope,mucosal edema,chronic inflammatory reaction,intestinal villi spot and patched white nodular changes and polyp-like changes appeared.For treatment,the low-fat with medium-chain triglyceride diet and symptomatic support was the basic treatment.The condition could be relieved by surgical remission of abnormal lymphatic vessels or partial small-bowel resection.If the etiological factors could not be removed,the therapeutic effect was poor in the patients merely secondary to portal vein hypertension.Conclusion The suspicious IL patients complicated by portal vein hypertension need further examination to explore whether abnormal lymphatic vessels existed,and to provide evidence for surgical intervention.
ABSTRACT
Objective To evaluate the diagnosis and therapy of intestinal lymphangiectasia.Methods In this study 15 patients were admitted in our hospital during recent 7 years.Clinical manifestations included hypoalbuminemia,symmetrical edema,emaciation,diarrhea and lymphopenia.Lymphangiography,lympanscintigraphy and biopsy were performed for diagnosis.Therapy conducted included conservative therapy,low-fat and medium-chain triglycerides(MCT)diet,albumin infusions,diuretics,total parenteral nutrition and octreotide.Surgical therapy ineluded thoracic duct-vein anastomasis and segmental resection.Results In this group 8 patients receiving conservative therapy were followed-up from 1.5 to 7 years(average 2.5 years).Symptoms were alleviated in 6 patients.Seven patients underwent operative therapy,among them,4 patients received thoracic duct-exterior jugular vein anastomasis and followed-up from 1 to 5 years,with symptoms mitigated in 2 patients.3 patients underwent local intestinal resection,follow-up from 1 to 3 years found one patient was cured,one was improved,and 1 patient died 3 months afterthe operation. Conclusion Intestinal lymphangiectasia is rather rare and there was no definite and effective therapy.
ABSTRACT
<p><b>OBJECTIVE</b>To discuss the diagnosis and therapy of chylous reflux and external chylous fistula.</p><p><b>METHODS</b>All of 6 patients were diagnosed with direct lymphagiography, lymphscintigraphy. Among them, 2 patients received CT after direct lymphagiography. Retroperitoneal lymphangiectomy plus lymph-vein shunting was performed in 5 patients, and retroperitoneal lymphangiectomy in 1 patient.</p><p><b>RESULTS</b>The 6 patients were followed up from 6 months to 6 years. In 5 patients, chylous cysts disappeared and chylous fistula closed, and in 1 patient, chylous fistula didn't cicatrize, and chyle still leak out from the scrotum.</p><p><b>CONCLUSIONS</b>Retroperitoneal lymphangiectomy plus lymph-vein shunting has curative effect on chylous external fistula of the lower extremity and genitalia, but it has the chance to not obstruct all paths of chylous reflex.</p>