Linfoma em cão da raça cane corso: relato de caso / Lymphoma in a cane corso dog: case report / Linfoma en un perro cane corso: relato de un caso

Os linfócitos são células de defesa do organismo que funcionam como barreira contra infecções e células cancerígenas, elas circulam pelo sistema linfático e estão presentes por todo o organismo do animal, podem se proliferar de forma maligna, caracterizando o linfoma. Acometem em sua maioria, cães de raças de grande porte, animais de meia idade e idosos. Sendo uma doença de etiologia desconhecida, vários fatores podem contribuir para sua evolução, como deficiências autoimunes, bem como hábitos alimentares ao longo da vida do animal, ou até por predisposição genética. O presente relato de caso, tem o objetivo de mostrar a evolução gradual da doença, quais sinais clínicos o animal poderá apresentar, e como os exames laboratoriais podem nos auxiliar em seu diagnóstico.(AU)

The lymphocytes are defense cells of the body that act as a barrier against infection and cancer cells, they circulate through the lymphatic system and are present throughout the animal's body, and can proliferate in a malignant way, characterizing the lymphoma. They mostly affect large breed dogs, middle-aged and elderly animals. Being a disease of unknown etiology, several factors may contribute to its evolution, such as autoimmune deficiencies, as well as food habits throughout the animal's life, or even genetic predisposition. The present case report has the objective of showing the gradual evolution of the disease, which clinical signs the animal may present, and how laboratory tests can help us in its diagnosis.(AU)

Los linfocitos son células de defensa del organismo que actúan como barrera contra infecciones y células cancerígenas, circulan por el sistema linfático y están presentes en todo el organismo del animal, pudiendo proliferar de forma maligna, caracterizando el linfoma. Afectan sobre todo a perros de razas grandes, animales de mediana edad y ancianos. Siendo una enfermedad de etiología desconocida, varios factores pueden contribuir a su evolución, como deficiencias autoinmunes, así como hábitos alimentarios a lo largo de la vida del animal, o incluso predisposición genética. El presente caso clínico tiene como objetivo mostrar la evolución gradual de la enfermedad, qué signos clínicos puede presentar el animal y cómo las pruebas de laboratorio pueden ayudarnos en su diagnóstico.(AU)

Research progress in the cardiac lymphatic system and myocardial repair after myocardial infarction / 中南大学学报(医学版)

The lymphatic system of the heart plays an important role in the repair process after myocardial injury and may regulate normal tissue homeostasis and natural regeneration via maintaining fluid homeostasis and controlling the inflammatory response. The lymphatic system in the heart is activated after myocardial injury and is involved in the scarring process of the heart. Recent studies on the lymphatic system and myocardial repair of the heart have developed rapidly, and the mechanisms for lymphangiogenesis and lymphatic endothelial cell secretion have been elucidated by different animal models. A deep understanding of the structural, molecular, and functional characteristics of the lymphatic system of the heart can help develop therapies that target the lymphatic system in the heart. Summarizing the progress in studies on targets related to myocardial repair and the cardiac lymphatic system is helpful to provide potential new targets and strategies for myocardial repair therapy after myocardial infarction.

Outcomes of Chylothorax Nonoperative Management After Cardiothoracic Surgery: A Systematic Review and Meta-Analysis

ABSTRACT Introduction: Chylothorax after thoracic surgery is a severe complication with high morbidity and mortality rate of 0.10 (95% confidence interval [CI] 0.06 - 0.02). There is no agreement on whether nonoperative treatment or early reoperation should be the initial intervention. This systematic review and meta-analysis aimed to evaluate the outcomes of the conservative approach to treat chyle leakage after cardiothoracic surgeries. Methods: A systematic review was conducted in PubMed®, Embase, Cochrane Library Central, and LILACS (Biblioteca Virtual em Saúde) databases; a manual search of references was also done. The inclusion criteria were patients who underwent cardiothoracic surgery, patients who received any nonoperative treatment (e.g., total parenteral nutrition, low-fat diet, medium chain triglycerides), and studies that evaluated chylothorax resolution, length of hospital stay, postoperative complications, infection, morbidity, and mortality. Central Message Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates. Results: Twenty-two articles were selected. Pulmonary complications, infections, and arrhythmia were the most common complications after surgical procedures. The incidence of chylothorax in cardiothoracic surgery was 1.8% (95% CI 1.7 - 2%). The mean time of maintenance of the chest tube was 16.08 days (95% CI 12.54 - 19.63), and the length of hospital stay was 23.74 days (95% CI 16.08 - 31.42) in patients with chylothorax receiving nonoperative treatment. Among patients that received conservative treatment, the morbidity event was 0.40 (95% CI 0.23 - 0.59), and reoperation rate was 0.37 (95% CI 0.27 - 0.49). Mortality rate was 0.10 (95% CI 0.06 - 0.02). Conclusion: Nonoperative treatment for chylothorax after cardiothoracic procedures has significant hospital stay, morbidity, mortality, and reoperation rates.

Malformaciones linfáticas abdominales en una población pediátrica: experiencia en un centro de referencia de Medellín, Colombia / Abdominal lymphatic malformations in a pediatric population: Experience in a referral center in Medellín, Colombia

Introducción. Los linfangiomas son anormalidades benignas del sistema linfático, que corresponden a dilataciones quísticas de estos vasos y se localizan especialmente en el cuello. Solo el 10 % de todas estas malformaciones se encuentran en el abdomen y presentan síntomas variables de acuerdo al tamaño y su ubicación especifica, siendo el dolor abdominal el principal síntoma. Métodos. Se presentan cinco pacientes pediátricos con malformaciones linfáticas abdominales. Se describen su cuadro clínico, localización, tratamiento y la experiencia en el manejo de dicha patología en un hospital de referencia. Resultados. Los métodos más apropiados para hacer una aproximación diagnóstica son la ecografía, la tomografía computarizada y la resonancia nuclear magnética. Dentro de las opciones descritas para el tratamiento están la farmacológica, la escleroterapia y la resección quirúrgica, tanto por vía abierta como por laparoscopia. Conclusión. Existe una variedad de métodos para realizar la resección de los linfangiomas abdominales, pero la cirugía sigue siendo la más efectiva, especialmente cuando se cuenta con la laparoscopia como una herramienta terapéutica.

Introduction. Lymphangiomas are benign abnormalities of the lymphatic system, which correspond to cystic dilations of these vessels and are located especially in the neck. Only 10% of all these malformations are found in the abdomen and present variable symptoms according to size and their specific location, with abdominal pain being the main symptom. Methods. Five pediatric patients with abdominal lymphatic malformations are presented. Their clinical presentation, location, treatment and experience in the management of this pathology in a referral hospital are described. Results. The most appropriate methods to make a diagnostic approach are ultrasound, computed tomography and magnetic resonance imaging. Among the options described for treatment are pharmacological, sclerotherapy and surgical resection, both open and laparoscopic. Conclusion. There are a variety of methods for resecting abdominal lymphangiomas, but surgery remains the most effective, especially when laparoscopy is used as a therapeutic tool.

Chinese Herbal Medicine Adjusting Brain Microenvironment via Mediating Central Nervous System Lymphatic Drainage in Alzheimer's Disease / 中国结合医学杂志

Due to its complex pathogenesis and lack of effective therapeutic methods, Alzheimer's disease (AD) has become a severe public health problem worldwide. Recent studies have discovered the function of central nervous system lymphatic drainage, which provides a new strategy for the treatment of AD. Chinese herbal medicine (CHM) has been considered as a cure for AD for hundreds of years in China, and its effect on scavenging β-amyloid protein in the brain of AD patients has been confirmed. In this review, the mechanism of central nervous system lymphatic drainage and the regulatory functions of CHM on correlation factors were briefly summarized. The advances in our understanding regarding the treatment of AD via regulating the central lymphatic system with CHM will promote the clinical application of CHM in AD patients and the discovery of new therapeutic drugs.

The process in research of anatomy of brain lymphatic system and the relationship between it and Alzheimer's disease / 中华显微外科杂志

Conventional wisdom holds that the central nervous system (CNS) does not have lymphatic vessels or lymphatic circulation, and it lacks lymphatic pathways to clear brain metabolites. However, with the development of study in intracranial clearance, it has been discovered that there are lymphatic systems in CNS, including glymphatic pathway and it meningeal lymphatic vessels. It further reveals the exchange system between cerebrospinal fluid (CSF) and interstitial fluid (ISF). It also closely relates to the development of neurodegenerative diseases, age-related changes of brain, traumatic brain injury, circulatory diseases and tumors. In the past 10 years, the research in CNS has been a hot spot in life sciences. This article aims to explain the research progress from the aspects of the discovery of glymphatic system, anatomical structure and function, and relationship with Alzheimer's disease (AD).

Dysfunction of lymphatic system and early Parkinson′s disease / 中华神经科杂志

Lymphatic system is the transportation way of cerebrospinal fluid and brain interstitial fluid exchange. And this system is a central nervous drainage system which plays an important role in drainaging and discharging of metabolic waste in the brain. The function of this system can be evaluated indirectly by the perivascular space on magnetic resonance imaging. Parkinson′s disease is a common neurodegenerative disorder. It may be helpful to control the progression of the disease if the changes of perivascular space can be dynamically observed in the early or even prodromal stage of the disease. This article reviews the relationship between lymphatic system disfunction and early stage of Parkinson′s disease.

Terapia complexa descongestiva no tratamento de linfedema pós-mastectomia / Descongestive complex therapy in the treatment of lymphedema after mastectomy

Introdução: O linfedema é a complicação mais frequente no pós-operatório do câncer de mama. Objetivo: Identificar a efetividade do uso da Terapia Complexa Descongestiva (TCD) na redução do volume e no tratamento intensivo do linfedema em pacientes submetidas ao procedimento cirúrgico com esvaziamento axilar devido ao câncer de mama. Métodos: Trata-se de uma revisão sistemática, para o qual foram consultados os bancos de dados Bireme e Pubmed, utilizando artigos científicos em português e inglês de revistas indexadas nas bases de dados Medline, Scielo, Lilacs, Register of Controlled Trials (Cochrane Central) e Physiotherapy Evidence Database (PEDro), publicados entre os anos de 2004 e 2019. Para a construção do trabalho foram incluídos estudos que estivessem disponíveis na íntegra, que a população alvo fosse composta por mulheres submetidas ao procedimento cirúrgico devido ao câncer de mama, com esvaziamento axilar, que apresentassem linfedema e que incluíssem em seus tratamentos, um protocolo fisioterapêutico de TCD. Também de forma independente, foi avaliada a qualidade metodológica dos estudos selecionados com a Escala de Qualidade de JADAD. Resultados: Atualmente, o padrão-ouro dentre as principais técnicas fisioterapêuticas utilizadas para o tratamento do linfedema é a TCD, a qual é composta por drenagem linfática manual, cuidados com a pele e unhas, bandagem de compressão e exercícios terapêuticos. Conclusão: A TCD é considerada o método mais utilizado e eficiente na redução do volume e no tratamento intensivo do linfedema pósmastectomia. (AU)

Introduction: The lymphedema is the most common postoperative complication of breast cancer. Objective: The present study aims to identify the effectiveness of the use of Complex Decongestive Therapy (CDT) in reducing volume and intensive treatment of lymphedema in patients undergoing axillary emptying due to breast cancer. Methods: This was a systematic review, for which Bireme and Pubmed databases were consulted, using scientific articles in Portuguese and English from journals indexed in Medline, Scielo, Lilacs, Register of Controlled Trials (Cochrane Central) databases and Physiotherapy Evidence Database (PEDro), all of them published between the years 2004 to 2019. For the construction of this study, we included articles available in full, with a target population consisting of women undergoing the surgical procedure due to breast cancer, with axillary emptying, who presented lymphedema and who included in their treatments a physical therapy protocol of CDT. Also, independently, the methodological quality of the studies selected was evaluated using the JADAD Quality Scale. Results: Currently, the gold standard among the main physiotherapeutic techniques used for the treatment of lymphedema is CDT, which consists of manual lymphatic drainage, skin and nail care, compression bandaging and therapeutic exercises. Conclusion: The CDT is considered the most used and efficient method for volume reduction and intensive treatment of post-mastectomy lymphedema. (AU)

Contribution of an instructional module for lymph node evaluation: An experiment / Contribuição de um módulo instrucional para avaliação de linfonodos: um experimento / Contribución de un módulo instruccional para la evaluación de ganglios linfáticos: experimento

Objective: to evaluate the contribution of an instructional module identifying the number and characteristics of lymph nodes by undergraduate nursing students. Method: an experimental, randomized, controlled and masked study using an instructional module for intervention. The 68 students who made up the control group or the experimental group performed the prototype lymph node palpation in the initial and final phases, following the free registration of the characteristics and number of these structures. Between the phases, the instructional module (palpation prototype and a registration guide instrument) was applied to the experimental group. Descriptive statistics and mixed linear regression were used for analysis. Results: the experimental group showed greater accuracy (p<0.05) in the evaluation of the size, consistency, mobility and coalescence of the lymph nodes in the final phase when compared to the control; it also showed more chances to correctly evaluate the consistency ( OR 45,26; 95% CI<7,74>‡<264.54> p<0.0001), mobility (OR 55.95; CI 95% 12.45 - 251.60; p<0.0001) and size (OR 25.64; CI 95% 3.92 - 160.2; p=0.0002) of the lymph nodes. Conclusion: the results reinforce the contribution of the instructional module to increase the knowledge of nursing students about the evaluation of lymph nodes.

Objetivo: avaliar a contribuição de um módulo instrucional para a identificação do número e das características de linfonodos por estudantes de graduação em enfermagem. Método: estudo experimental, aleatorizado, controlado e mascarado utilizando para intervenção um módulo instrucional. Os 68 estudantes que compuseram o grupo controle ou o grupo experimento realizaram nas fases inicial e final a palpação dos linfonodos em protótipo, seguindo-se o registro livre das características e número dessas estruturas. Ao grupo experimento foi aplicado, entre as fases, o módulo instrucional (protótipo de palpação e um instrumento-guia de registro). Para análise empregou-se estatística descritiva e regressão linear mista. Resultados: o grupo experimento apresentou maior acerto (p<0,05) na avaliação do tamanho, consistência, mobilidade e coalescência dos linfonodos na fase final quando comparado ao controle; ainda, apresentou mais chances de avaliar corretamente a consistência (OR 45,26; IC 95% 7,74 - 264,54; p<0,0001), mobilidade (OR 55,95; IC 95% 12,45 - 251,60; p<0,0001) e tamanho (OR 25,64; IC 95% 3,92 - 160,62; p=0,0002) dos linfonodos. Conclusão: os resultados reforçam a contribuição do módulo instrucional para o aumento do conhecimento de estudantes de enfermagem sobre a avaliação de linfonodos.

Objetivo: evaluar la contribución de un módulo instruccional a la identificación del número y características de ganglios linfáticos por estudiantes de pregrado de enfermería. Método: estudio experimental, aleatorizado, controlado y enmascarado mediante intervención de un módulo instruccional. Los 68 estudiantes que integraron el grupo control o el grupo experimental realizaron en las fases inicial y final la palpación de los ganglios linfáticos en prototipo, tras el registro libre de las características y número de estas estructuras. El módulo instruccional (prototipo de palpación y un instrumento-guía de registro) se aplicó al grupo de Experimental. Para el análisis, se utilizó estadística descriptiva y regresión lineal mixta. Resultados: el grupo Experimental mostró mayor acierto (p<0,05) en la evaluación del tamaño, consistencia, movilidad y coalescencia de los ganglios linfáticos en la fase final en comparación con el control; aun así, presentó más probabilidad de evaluar correctamente la consistencia (OR 45,26; IC del 95% 7,74 - 264,54; p<0,0001), la movilidad (OR 55,95; IC del 95% 12,45 - 251, 60; p<0,0001) y tamaño (OR 25,64; IC 95% 3,92 - 160,62; p=0,0002) de los ganglios linfáticos. Conclusión: los resultados refuerzan el aporte del módulo instruccional para el incremento del conocimiento de los estudiantes de enfermería sobre la evaluación de ganglios linfáticos.

Nanostructured lipid carrier containing hydroxymethylnitrofurazone: preparation, characterization and in vitro and in vivo evaluation of leishmanicidal activity / Carreador lipídico nanoestruturado contendo hidroximetilnitrofural: preparação, caracterização físico-química e avaliação in vitro e in vivo da atividade leishmanicida

Leishmaniasis, a neglected tropical disease (NTD), is a set of diseases caused by obligatory parasitic protozoa of the genus Leishmania. And it has cutaneous and visceral eishmaniasis as its main forms. Treatment includes pentavalent antimonials. These drugs have several disadvantages, such as the need for parenteral administration, use of high dosages, long duration of treatment, severe toxicity, resistance and variable efficacy. The candidate for hydroxymethylnitrofural drug (NFOH), a prodrug derived from nitrofural, showed high activity in cell cultures infected with Trypanosoma cruzi and less toxicity when compared to nitrofural. Due to its low solubility in water and reduced bioavailability, NFOH has failed the in vivo efficacy tests. Nanostructured drug delivery systems have the potential to overcome these challenges due to their evident advantages: greater therapeutic efficacy, less toxicity, modified drug release and increased gastrointestinal absorption of drugs with low water solubility. The objective of this project will be the preparation and evaluation of the physicochemical characteristics of a nanostructured lipid carrier containing hydroxymethylnitrofural (NLC-NFOH). The NFOH showed the highest solubility in Miglyol® 840 among the tested liquid lipids. For solid lipids, Gelucire® 50/13 and Precirol® ATO5 proved to be more suitable for the solubilization of NFOH. The optimized NLC-NFOH consisted of these three lipids. These lipids were selected using a quick Technobis Crystal 16TM methodology, microscopy and DSC. Different lipid selection tools provided scientific knowledge relevant to the development of NLC. The NLC-NFOH had an average z of 198.6 ± 5.4 nm, a PDI of 0.11 ± 0.01 and a zeta potential of -13.7 ± 0.7 mV. This study allowed a design space development approach of the first NLC-NFOH with the potential to treat leishmaniasis orally. The development of a sensitive bioanalytical method using HPLC and evaluation of some analytical figures of merit for the validation allowed the quantification of NFOH and NF. The bioanalytical method for analysis of NFOH and NF use Zorbax SB-C18, 5µm, (4.6x250mm) HPLC column. The mobile phase was consisted of acetonitrile:water (20:80 v/v) with flow rate of 1.2 ml/min, at UV detection of 370 nm. The linearity of NFOH and NF was found in the range 0.0253.0 µg/ml with a correlation coefficient of r > 0.98. The precision was 2.44 to 13.77% for NFOH and 2.61 to 18.42%; the accuracy was 2.66 to 14.28% for NFOH and 2.09 to 19.06% for NF. The method showed to be suitable for effectively evaluation of NFOH is serum. NLC-NFOH (2.8 mg/kg) was administered to animals by gavage, and the blocking flow of the chylomicrons model was performed with an intraperitoneal injection of cycloheximide. The presence of NFOH in serum was evaluated with and without cycloheximide. The cytotoxicity assay of NLC-NFOH and blank-NLC showed more than 90% viable cells at the maximum concentration used (2560 µM). NFOH and NF were detected at 1h after the gavage of DMSO-NFOH or NLC-NFOH, without the pretreatment with cycloheximide. The concentration found for DMSO-NFOH and NLC-NFOH were 0.0316 and 0.0291 µg/mL, respectively. The NLC presented the NFOH absorption by the lymphatic system, demonstrated by blocking chylomicrons flow

A leishmaniose, uma doença tropical negligenciada (DTN), é um conjunto de doenças causadas por protozoários parasitas obrigatórios do gênero Leishmania. E tem como formas principais a leishmaniose cutânea e visceral. O tratamento inclui antimoniais pentavalentes. Esses fármacos apresentam várias desvantagens, como necessidade de administração parenteral, uso de altas dosagens, longa duração do tratamento, toxicidade grave, resistência e eficácia variável. O candidato ao fármaco hidroximetilnitrofural (NFOH), um pró-fármaco derivado do nitrofural, apresentou alta atividade em culturas de células infectadas pelo Trypanosoma cruzi e menor toxicidade quando comparado ao nitrofural. Devido à sua baixa solubilidade em água e biodisponibilidade reduzida, o NFOH falhou nos testes de eficácia in vivo. Os sistemas nanoestruturados de liberação de fármacos têm potencial para superar esses desafios devido às suas vantagens evidentes: maior eficácia terapêutica, menor toxicidade, liberação modificada do fármaco e aumento da absorção gastrointestinal de fármacos com baixa solubilidade em água. O objetivo deste projeto será a preparação e avaliação das características físico-químicas de um carreador lipídico nanoestruturado contendo hidroximetilnitrofural (NLC-NFOH). O NFOH apresentou a maior solubilidade no Miglyol® 840 entre os lipídios líquidos testados. Para lipídios sólidos, Gelucire® 50/13 e Precirol® ATO5 se mostraram mais adequados para a solubilização de NFOH. O NLC-NFOH otimizado consistiu desses três lipídios. Esses lipídios foram selecionados usando Technobis Crystal 16TM, microscopia e DSC. Diferentes ferramentas de seleção de lipídios forneceram conhecimento científico relevante para o desenvolvimento de NLC. O NLC-NFOH teve z-average de 198,6 ± 5,4 nm, PDI de 0,11 ± 0,01 e potencial zeta de -13,7 ± 0,7 mV. Este estudo permitiu o desenvolvimento por abordagem de Design Space do primeiro NLC-NFOH com potencial para tratar a leishmaniose por via oral. O desenvolvimento de um VIII método bioanalítico sensível utilizando HPLC e a avaliação de algumas figuras analíticas de mérito para a validação permitiram a quantificação de NFOH e NF em soro. O método bioanalítico para análise de NFOH e NF usou coluna de HPLC Zorbax SB-C18, 5 µm, (4,6 x 250 mm). A fase móvel foi constituída por acetonitrila: água (20:80 v / v) com vazão de 1,2 ml / min, com detecção no UV de 370 nm. A linearidade de NFOH e NF foi encontrada na faixa de 0,0253,0 µg / ml com um coeficiente de correlação de r> 0,98. A precisão foi de 2,44 a 13,77% para NFOH e 2,61 a 18,42%; a precisão foi de 2,66 a 14,28% para NFOH e 2,09 a 19,06% para NF. O método mostrou-se adequado para avaliação efetiva do NFOH no soro. NLC-NFOH (2,8 mg / kg) foi administrado aos animais por gavagem, e o modelo de bloqueio do fluxo de quilomícrons foi realizado com injeção intraperitoneal de cicloheximida. A presença de NFOH no soro foi avaliada com e sem cicloheximida. O ensaio de citotoxicidade de NLC-NFOH e brancoNLC mostrou mais de 90% de células viáveis na concentração máxima utilizada (2560 µM). NFOH e NF foram detectados 1h após a gavagem de DMSO-NFOH ou NLC-NFOH, sem o pré-tratamento com cicloheximida. As concentrações encontradas para DMSO-NFOH e NLC-NFOH foram 0,0316 e 0,0291 µg / mL, respectivamente. O NLC apresentou a absorção do NFOH pelo sistema linfático, demonstrada pelo bloqueio do fluxo dos quilomícrons

Advances of Angiopoietin-Tie axis in vascular and lymphatic system-related diseases / 生物工程学报

Endothelial cells that form the inner layers of both blood and lymphatic vessels are important components of the vascular system and are involved in the pathogenesis of vascular and lymphatic diseases. Angiopoietin (Ang)-Tie axis in endothelial cells is the second endothelium-specific ligand-receptor signaling system necessary for embryonic cardiovascular and lymphatic development in addition to the vascular endothelial growth factor receptor pathway. The Ang-Tie axis also maintains vascular homeostasis by regulating postnatal angiogenesis, vessel remodeling, vascular permeability, and inflammation. Therefore, the dysfunction of this system leads to many vascular and lymphatic diseases. In light of the recent advances on the role of the Ang-Tie axis in vascular and lymphatic system-related diseases, this review summarizes the functions of the Ang-Tie axis in inflammation-induced vascular permeability, vascular remodeling, ocular angiogenesis, shear stress response, atherosclerosis, tumor angiogenesis, and metastasis. Moreover, this review summarizes the relevant therapeutic antibodies, recombinant proteins, and small molecular drugs associated with the Ang-Tie axis.

Cystic lymphangioma of abdominal wall in an adult: a rare site

Cystic lymphangiomas are rare, congenital, benign lesions occurring early in life, mainly in the head, neck, and oral cavity, rarely occur in abdominal wall and its discovery in adult is also very rare. It is due to aberrant proliferation of lymphatic vessels resulting from abnormal development of the lymphatic system. These are soft, variable in size and shape and tend to grow extensively if not surgically excised. These are multilocular cysts filled with clear or yellow lymph fluid, sometime mixed with blood. The present case report describes a case of cystic lymphangioma of right lower abdominal wall in a 36 years old male and its clinical, ultrasonographic, CECT, and histopathological correlation.

Contribuição de um módulo instrucional no desenvolvimento de habilidades de avaliação de linfonodos: um experimento / Contribution of an instructional module in the development of lymph node assessment skills: an experiment

A coleta de dados por meio da anamnese e do exame físico é etapa indispensável para a implementação do Processo de Enfermagem; para realização do exame físico empregam-se as técnicas de inspeção, palpação, percussão e ausculta, que permitem confirmar padrões de normalidade ou a presença de alterações. É de interesse, neste estudo, o exame dos linfonodos, componentes que podem, a partir de suas alterações, nortear a terapêutica e as ações de enfermagem a serem executadas. Tais estruturas são avaliadas pelas técnicas de inspeção e palpação, além da anamnese. Considerando a necessidade de criação de estratégias cada vez mais interativas, baseadas na proposta da aprendizagem experiencial, este estudo experimental, randomizado, controlado e mascarado tem como objetivo avaliar a contribuição de um Módulo Instrucional na aquisição de conhecimentos sobre a avaliação de características de linfonodos, por estudantes de enfermagem. A intervenção educativa foi composta pela utilização de um módulo instrucional, formado por um protótipo de palpação e um instrumento-guia de registro. Participaram do estudo 68 estudantes dos cursos de graduação em enfermagem de uma instituição pública paulista que estavam cursando a disciplina de semiologia e semiotécnica. Em ambos os grupos (experimento e controle) foi realizada inicialmente a palpação dos linfonodos em um protótipo (A) seguindo-se o registro livre das características e número das estruturas avaliadas. O grupo controle seguiu para avaliação final, similar à inicial, em outro protótipo (C) utilizando o instrumento de registro livre. O grupo experimento foi submetido à intervenção educativa, que consistiu no manejo do módulo instrucional (protótipo B e instrumento-guia de registro dos dados) e, após, realizou a avaliação final, similar à do grupo controle. Após a avaliação final, o grupo controle foi apresentado à intervenção educativa. Por último, em ambos os grupos, os estudantes registraram sua opinião sobre a atividade educativa realizada. Utilizou-se para análise os registros realizados nas fases inicial e final; os dados foram categorizados e, para avaliar idade, curso e sexo, utilizou-se frequência, média, mediana e desvio-padrão; para verificar a interação entre os acertos das variáveis pelos grupos nos tempos, optou-se pelo modelo de regressão linear mista. A análise de interação entre os grupos permite concluir que o grupo experimento apresentou significativa diferença com relação ao grupo controle no acerto de tamanho (p <= 0,0001), consistência (p <= 0,0001), mobilidade (p <= 0,0001) e coalescência (p = 0,0021). Ainda, os estudantes avaliaram positivamente a atividade, destacando sua capacidade de relacionar a teoria com a prática, sua facilidade e boa representação da realidade. Os resultados positivos do grupo experimento, bem como a aceitação referida pelo público-alvo reforçam a utilização do módulo instrucional como estratégia de ensino complementar às aulas de semiologia e semiotécnica no ensino da avaliação de características de linfonodos

The data colleta through anamnesis and physical examination is an indispensable step for the implementation of the Nursing Process; to perform the physical examination are used the techniques of inspection, palpation, percussion and auscultation, which allow to confirm patterns of normality or the presence of changes. It is of interest, in this study, the examination of the lymph nodes, components that can, from their alterations, guide the therapeutics and the nursing actions to be performed. Such structures are evaluated by the techniques of inspection and palpation, in addition to anamnesis. Considering the need to create increasingly interactive strategies based on the proposal of experiential learning, this experimental, randomized, controlled and double blind study aims to evaluate the contribution of an Instructional Module in the acquisition of knowledge about the evaluation of lymph node characteristics, by nursing students. The educational intervention was composed by the use of an instructional module, formed by a prototype of palpation and a guide instrument of registration. The participants of the study were 68 undergraduate nursing students from a public institution in São Paulo who were attending the discipline of semiology and semitechnical. In both groups (experiment and control) the palpation of the lymph nodes was initially performed in a prototype (A) followed by the free registration of the characteristics and number of the structures evaluated. The control group followed for final evaluation, similar to the initial one, in another prototype (C) using the free registry instrument. The experimental group was submitted to the educational intervention, which consisted in the management of the instructional module (prototype B and instrument guide of data recording) and, afterwards, made the final evaluation, similar to that of the control group. After the final evaluation, the control group was presented to the educational intervention. Finally, in both groups, the students recorded their opinion about the educational activity performed. We used for analysis the records made in the initial and final phases; the data were categorized and, to evaluate age, course and sex, we used frequency, mean, median and standard deviation; to verify the interaction between the correctness of the variables by the groups in the times, we opted for the mixed linear regression model. The analysis of interaction between the groups allows to conclude that the experiment group presented a significant difference in relation to the control group in the variables size of the lymph node (P <= 0.0001), consistency (p <= 0.0001), mobility (p <= 0.0001) and coalescence (p = 0.0021). Still, the students positively evaluated the activity, highlighting their ability to relate theory to practice, its easy and good representation of reality. The positive results of the experiment group as well as the acceptance reported by the target public reinforce the use of the instructional module as a complementary teaching strategy to the semiology and semi-technical classes in teaching the evaluation of lymph node characteristics

Aplicação da drenagem linfática eletrônica em edemas de membros inferiores / Application of electronic lymphatic drainage in lower limb edema

O objetivo deste estudo foi verificar os efeitos do Drenagem Linfática Eletrônica (DLE) em edemas de membros inferiores (MMII). A metodologia contou com 2 voluntários do gênero feminino com idade entre 21 e 25 anos, apresentando edemas nos MMII, os quais foram medidos por meio da fita métrica. O aparelho utilizado para realização deste estudo foi o Ciclus®. Foram realizadas as sessões de drenagem linfática eletrônica nos MMII, uma vez por semana, totalizando 10 sessões com duração de 50 minutos cada. Pode-se concluir neste estudo de caso que após a aplicação do aparelho de drenagem linfática eletrônica, houve uma redução significativa nos membros inferiores nos dois participantes do estudo. Porém é necessário realizações de mais estudos práticos com maiores números de participantes e principalmente no que se diz respeito a parâmetros e colocação dos eletrodos. (AU)

The aim of this study was to demonstrate the increase of lymphatic and venous return using electronic lymphatic drainage. The methodology included two female volunteers 20 to 30 years old, with edema of the lower limbs, measured with a metric tape. The equipment used for this study was the Ciclus®. The Electronic lymphatic drainage sessions were performed in the lower limbs once a week, totalling 10 sessions with 50 minutes each. We observed after the application of the electronic lymphatic drainage device a significant reduction in the lower limbs in the two participants. However, it is necessary to carry out more practical studies with larger numbers of participants and especially with regard to parameters and placement of the electrodes. (AU)

Estudo comparativo entre drenagem linfática manual e endermoterapia no edema de membros inferiores / Comparative study between manual lymphatic drainage and endermotherapy in the edema of lower limbs

O edema é uma das disfunções associadas ao sistema linfático caracterizado pelo acúmulo de líquido no espaço intersticial. Para a redução e melhora deste problema existe diversas técnicas que possuem como objetivo estimular o sistema linfático aumentando sua capacidade de absorção e circulação da linfa por entre seus vasos até a corrente sanguínea, de modo manual ou eletrônico, como o caso da drenagem linfática manual e da endermoterapia. O presente estudo teve como objetivo verificar se a endermoterapia como drenagem linfática eletrônica possui os mesmo efeitos que a drenagem linfática manual na redução do edema de membros inferiores. Devido ao seu caráter experimental qualitativo pertinente ao tema escolhido, optou-se por um estudo de caso. Este estudo contou com um voluntário do sexo feminino, com idade de 25 anos, apresentando edema nos membros inferiores. Após avaliação feita por anamnese, perimetria e exame físico, foram realizadas 10 sessões de drenagem linfática manual no membro direito e no membro esquerdo drenagem linfática eletrônica por meio do aparelho de endermoterapia Beauty Dermo Vacuoterapia® da marca HTM, para comparação de ambas as técnicas. As sessões foram realizadas duas vezes na semana em um período de 30 dias. Os resultados obtidos mostraram que houve diminuição de 0,5 cm no membro que recebeu a drenagem linfática manual, enquanto aquele que recebeu a técnica de drenagem linfática eletrônica com aparelho de endermoterapia um total de 5,5 cm, além da melhora no aspecto da pele ocasionado pelos efeitos secundários do aparelho. Com o estudo pode-se concluir que a endermoterapia usada como drenagem linfática eletrônica obteve melhores resultados que a drenagem linfática manual, na redução do edema nos membros inferiores, contudo são necessárias novas pesquisas com um grupo maior de indivíduos para melhores resultados. (AU)

Edema is one of the dysfunctions associated with the lymphatic system characterized by the accumulation of fluid in the interstitial space. To reduce and improve this problem, there are several techniques that aim to stimulate the lymphatic system by increasing its capacity for absorption and circulation of lymph through its vessels into the bloodstream, either manually or electronically, such as manual lymphatic drainage and endermotherapy. This study aimed to verify if the endermotherapy as electronic lymphatic drainage has the same effects as manual lymphatic drainage in the reduction of lower limb edema. This case study had a female volunteer, aged 25 years, presenting edema in the lower limbs. After anamnesis, perimetry and physical examination, 10 sessions of manual lymphatic drainage were performed on the right limb and left lymphatic drainage using the HTM brand Beauty Dermo Vacuoterapia® endermoterapia, for comparison of both techniques. The sessions were held twice a week over a period of 30 days. The results showed that there was a decrease of 0.5 cm in the limb that received manual lymphatic drainage, while the one who received the electronic lymphatic drainage technique with an endermotherapy device, a total of 5.5 cm, besides the improvement in the appearance of the skin caused by the side effects of the appliance. We concluded that the endermotherapy used as electronic lymphatic drainage obtained better results than manual lymphatic drainage, in the reduction of the edema in the lower limbs, however, new studies are necessary with a larger group of individuals for better results. (AU)

Fisioterapia vascular no tratamento da doença venosa crônica / Vascular physiotherapy in treatment of chronic venous disease

A aplicação da fisioterapia vascular através dos exercícios terapêuticos e da drenagem linfática manual (DLM) na Doença Venosa Crônica (DVC) contribui para a minimização das alterações vasculares, com melhora do retorno venoso, diminuindo a estase sanguínea e contribuindo para a melhora do quadro clínico.ObjetivoVerificar a eficácia da fisioterapia vascular no tratamento da DVC.MétodosEstudo-piloto prospectivo longitudinal, que avaliou dez pacientes com DVC, com classificação CEAP (1-5), que responderam aos questionários de qualidade de vida (QV) SF-36 e AVVQ, sendo submetidos a pletismografia a água e goniometria dos membros inferiores. Finalizada a avaliação inicial, receberam tratamento fisioterapêutico vascular, com exercícios terapêuticos e DLM, em dez sessões de 60 minutos. Após tratamento, foram novamente avaliadas pela aplicação dos questionários iniciais e realização dos métodos de mensuração volumétrica e de amplitude de movimento articular (ADM).ResultadosPacientes do gênero feminino, com idade média de 43,1 anos. Nas atividades de vida prática (AVPs), a posição predominante foi ortostatismo prolongado. Na classificação CEAP, a maioria das pacientes apresentou C3 e apenas 10% delas eram C2. Nos questionamentos sobre suas principais queixas, relataram sensação de peso e cansaço nos membros, dor nas pernas, prurido e edema. Após as sessões de fisioterapia vascular, todas as pacientes encontravam-se sem queixas. A ADM e a QV apresentaram melhora significativa após intervenção da fisioterapia vascular.ConclusãoA fisioterapia vascular contribui para o controle do quadro clínico da DVC, melhorando edema e ADM, e favorecendo a melhora da QV dos acometidos pela doença.

In chronic venous disease (CVD), vascular physiotherapy in the form of therapeutic exercises and manual lymph drainage (MLD) contributes to reducing vascular disorders, with improved venous return, reduced venous stasis and improved clinical status.ObjectiveTo investigate the efficacy of vascular physiotherapy in treatment of CVD.MethodsA prospective, longitudinal pilot study that assessed ten patients with CVD, with CEAP classifications from 1 to 5. Patients were administered the SF-36 and AVVQ quality of life questionnaires and underwent water plethysmography and goniometry of the lower limbs. After initial assessments they were given ten 60-minute sessions of vascular physiotherapy consisting of therapeutic exercises and MLD. After treatment they were once more assessed using the same questionnaires and methods for volumetric measurement and assessment of joint movement amplitude (JMA).ResultsThe patients were all female, with a mean age of 43.1 years. Their predominant positions during practical activities of life was prolonged and orthostatic. The majority of the patients had a CEAP classification of C3 and just 10% were C2. When questioned about their principal complaints, they reported feelings of heaviness and tiredness in their limbs, pain in their legs, itching and swelling. After the vascular physiotherapy sessions all patients were free from complaints. Both JMA and quality of life improved significantly after the intervention with vascular physiotherapy.ConclusionsVascular physiotherapy contributed to controlling the clinical manifestations of CVD, improving edema and JMA, and promoting improved quality of life for patients.

Lymphatic compensation during the postoperative period after breast cancer treatment with axillary dissection / Compensações linfáticas no pós-operatório de câncer de mama com dissecção axilar

Lymphedema secondary to breast cancer causes physical and psychological morbidity and compromises quality of life. The objective of this literature review was to study lymphatic compensation after surgery for breast cancer and the factors that influence this process, with a view to understanding the etiopathogenesis of lymphedema. Articles indexed on Pubmed published from 1985 to 2012 were reviewed. According to the literature, lymphangiogenesis reduces damage to lymph vessels; there is little evidence that Vascular Endothelial Growth Factor is elevated in women with lymphedema; lymphovenous communications can be observed 60 days after surgery; women without lymphedema have acquired alternative mechanisms for removal of proteins from the interstitial space; and active exercise stimulates lymphatic and venous pumping. Health professionals should teach these patients about the risk factors for lymphedema. The effects of lymphangiogenesis, proteolysis and lymphovenous communications on development of lymphedema should be studied, since these events are intimately related.

Linfedema secundário ao câncer de mama resulta em morbidade física e psicológica, e compromete a qualidade de vida. O objetivo desta revisão da literatura foi estudar as compensações linfáticas após cirurgia para câncer de mama e os fatores que interferem neste processo, visando a compreender a etiopatogenia do linfedema. Foram incluídos artigos publicados de 1985 a 2012, da base de dados Pubmed. Segundo a literatura, a linfangiogênese reduz danos nos vasos linfáticos; há pouca evidência de que o fator de crescimento vascular endotelial linfático é aumentado nas mulheres com linfedema; anastomoses linfovenosas são observadas 60 dias após a cirurgia; mulheres sem linfedema adquiriram mecanismos alternativos para remoção das proteínas do interstício, e exercício ativo estimula bombeamento linfático e venoso. Orientações dos fatores de risco para linfedema devem ser empregadas por profissionais da saúde. O efeito de linfangiogênese, proteólise e anastomoses linfovenosas sobre o desenvolvimento do linfedema deve ser estudado, pois são eventos intimamente relacionados.

Adult Cystic Hygroma– A Rare Entity

Objective Lymphangiomas (Cystic Hygromas) are rare congenital malformations commonly seen in children. Its occurrence in adults is uncommon with very scarce reports in the literature. It mainly occurs in infants or children younger than 2 years of age. We report this case to emphasise the need to consider cystic hygroma in differential diagnosis of neck masses in adults. Case Reports A 50-year-old female presented with a swelling over the antero– lateral aspect of neck of size 8´6 cm since last 4 years, which was not associated with pain, discharge, discolouration or sudden increase in size. Conclusion The awareness of occurrence of cystic lymphangio main adults is important for its proper management, which includescomplete surgical removal, to prevent recurrence.

Detection of lymphatic biomarker D2-40 in human trabecular meshwork / 中华实验眼科杂志

Background The pathological basis of human primary open angle glaucoma mainly is the degeneration of trabecular meshwork and Schlemm canal.As the outflow pathway of aqueous humor, the tissue origin and characteristics of trabecular meshwork remain less clear.Studying the characteristics of trabecular meshwork may contribute a new thought to the treatment of primary open angle glaucoma.Objective This study was to explore the histological property of trabecular meshwork by detecting the expression of D2-40, a lymphatic biomarker,and CD31,CD34 and smooth muscle actin (SMA), some vascular endothelial biomarkers.Methods Twenty specimens of adult eyeballs were collected from Zhongshan Ophthalmic Center of Sun Yat-sen University,including l0 eyeballs from accident death donors,3 enucleated eyeballs due to posterior segment of choroidal malignant melanoma and 7 orbital exenterated eyeballs.The series ocular meridian sections with the thickness of 4 μm were prepared for the haematoxylin-eosin staining.Immunohistochemistry was employed to detect the expression of D2-40,CD31 ,CD34 and SMA in trabecular meshwork and Schlemm canal.Results Intact structure of chamber angle was observed under the optical microscope by haematoxylin-eosin staining.Human trabecular meshwork tissue was presented with meshlike structure,while Schlemm canal showed the lumen structure.No abnormal substance and periphery synechia were found.D2-40 was strongly expressed in the trabecular meshwork endothelial cells with staining score for 3 points, but CD31, CD34 and SMA were negatively expressed.In contrast, CD31, CD34 and SMA rather than D2-40 were positively expressed in the Schlemm canal.In addition, CD31 and CD34 were also positively expressed in the vascular endothelial cells around the trabecular meshwork.Conclusions The trabecular meshwork expresses lymphatic biomarker rather than vascular biomarkers.This result indicates that trabecular meshwork of human eyes is lymphatic vessel-like tissue.