Advances in treatment of lymphedema with supraclavicular vascularized lymph node transfer / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of supraclavicular vascularized lymph node transfer (VLNT).@*METHODS@#The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized.@*RESULTS@#The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction.@*CONCLUSION@#There are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.

Linfedema: actualización en el diagnóstico y tratamiento quirúrgico / Lymphedema: update in diagnosis and surgical treatment

El linfedema es la acumulación de fluido rico en proteínas en el intersticio, secundario a anomalías en el sistema de transporte linfático. En países desarrollados se relaciona más frecuentemente al tratamiento quirúrgico del cáncer. El diagnóstico clínico y a través de técnicas de imágenes es fundamental para evaluar el estado funcional del sistema linfático. Los objetivos principales en el manejo del linfedema son limitar la morbilidad del paciente, mejorar la funcionalidad y la calidad de vida. El tratamiento quirúrgico es una alternativa cuando las medidas conservadoras ya no son suficientes. Existen procedimientos que buscan prevenir el desarrollo del linfedema y técnicas que incluye procedimientos fisiológicos (reconstructivos) y resectivos que se utilizan cuando el linfedema ya está establecido. El éxito depende de una buena elección de los pacientes y la realización de un tratamiento individualizado. A continuación se presenta una revisión en cuanto a las últimas estrategias diagnósticas y actualización en las técnicas quirúrgicas con énfasis en el tratamiento microquirúrgico.

Lymphedema is the accumulation of protein-rich fluid in the interstitium, secondary to abnormalities in the lymphatic transport system. In developed countries it is more often related to surgical treatment of cancer. The clinical diagnosis and through imaging techniques is fundamental to evaluate the functional status of the lymphatic system. The main objectives in managing lymphedema are to limit patient morbidity, improve functionality and quality of life. Surgical treatment is an option when conservative measures are no longer sufficient. There are procedures that seek to prevent the development of lymphedema, and techniques that include physiological (reconstructive) and resective procedures that are used when lymphedema is already established. Success depends on a good selection of patients and the completion of an individualized treatment. The following is a review article of the latest diagnostic strategies and update in surgical techniques with emphasis on microsurgical treatment.

Vascularização arterial e venosa do linfonodo poplíteo em cães / Arterial and venous vasculature of popliteo lymph nodes in dogs

O linfonodo poplíteo nos cães situa-se, à direita e à esquerda em um espaço designado fossa poplítea, no terço distal dos músculos bíceps femoral, lateralmente e semitendinoso, medialmente, projetando-sena altura da face caudal das articulações femoro tibial e femoro patelar(articulação do joelho). Neste estudo foram utilizados vinte e cinco cães, machos e fêmeas adultos, procedentes do canil municipal de Araçatuba, São Paulo, cujas capturas foram efetuadas pela defesa sanitária animal desta cidade. Os vasos arteriais destinados a esta estrutura derivam sempre, de ambos os lados, da artéria femoral caudal distal e variam de 10 a 1, com maior freqüência de 2 (7 vezes,28%) à direita e de 6 a 2 igualmente com maior freqüência de 2 (8 vezes, 32%). Tão logo tem-se ainda à direita 5 e 6 ramos (3 vezes,12%), 1, 7 e 10 (1 vez, 4%). Relativamente às veias derivadas deste linfonodo, convergem sempre para a veia safena lateral, estes vasos oscilam entre 9 e 2, com maior freqüência de 3 (9 vezes, 3,6%), à direita e de 12 a 2, com maior freqüência de 3 (10 vezes, 40%) à esquerda. Assim, os demais ramos oriundos da linfonodo poplíteo direito e que se inserem na veia supracitada são em número de 2 e 5 (5 vezes,20%), 4 e 6 (2 vezes, 8%) e 8 e 9 (1 vez, 4%). Não obstante, ao lado esquerdo verifica-se em número de 2 ramos (6 vezes, 24%), 4 (4vezes, 16%), 6 (3 vezes, 12%) e finalizando 9 e 12 ramos (1 vez, 4%). O tamanho do linfonodo poplíteo em cães soropositivos para Leishmaniose Visceral pode encontrar-se entre 7,8 x 3,8 x 6,1 a 50,0 x 20,7 x 28,5 , em mm, sendo a média 26,18 x 10,5 x 15,97 mm para o direito e 26,98 x 11,14 x 15,25 mm para o esquerdo (referente as medidas dorso-ventral, latero-lateral e crânio-caudal, respectivamente).

Poplíteo lympho nodes in the dogs is placed, to the right and the left in popliteo an appointed space fossa, in distal part of the muscles femoral biceps, laterally and semi-tendinous, medially, projecting in the height of the face volume of the joint to femoro tibial e femoro patellar (joint of the knee). In this study twenty and five dogs, males and females adult, originating the Araçatuba municipal kennel had been used whose captures had been effected by the animal sanitary defense of this city. The arterial vessels destined to this structure always derive, of both the sides, the femoral artery distal volume and vary of 10 the 1, more frequently of 2 (7 times, 28%) to the right and of 6 the 2, equally more frequently of 2 (8 times, 32%). So soon as one has still to right 5 and 6 branches (3 times, 12%), 1, 7 and 10 (1 time, 4%). Relatively to the veins derived from this lympho nodes, always converges to the lateral safena vein, these vessels oscillates between 9 and 2, more frequently of 3 (6 times,24%), to the right and of 12 the 2, more frequently of 3 (10 times, 40%) to the left. Thus, others deriving branches of popliteo lympho nodes right and that if they insert in the above-mentioned vein are in number of 2 and 5 (5 times, 20%), 4 and 6 (2 times, 8%) and 8 and 9 (1 time,4%). In spite of, to the left side it is examined in number de 2 branches(6 times, 24%), 4 (4 times, 16%), 6 (3 times, 12%) and finishing 9 and 12 branches (1 time, 4%). The size of popliteo lympho node in seropositive dogs for Visceral Leishmaniasis can meets enters 7,8 x 3,8 x 6,1 a 50,0 x20,7 x 28,5 , in mm, being average 26,18 x 10,5 x 15,97 mm for right and 26,98 x 11,14 x 15,25 mm for left (concerning the measures dorso ventral, latero-lateral and cranial-caudal, respectively).

FNAC in a case of NHL presenting initially as nodal infarction.

Lymph node infarction is rare and can occur in either nonneoplastic or neoplastic conditions. Fine needle aspiration cytology (FNAC) of infarction preceding lymphoma has not been described earlier. A 26-year-old male, was referred to the cytology laboratory for FNAC of bilateral axillary lymph nodes. FNA smears showed uniform looking ghost cells. There were no viable cells. A biopsy was advised which also showed extensive coagulative necrosis. Five weeks later, right cervical lymph nodes also appeared and FNA smears showed discrete monomorphic population of immature lymphoid cells. A cytologic diagnosis of infarction in a case of non-Hodgkin's lymphoma (NHL) was made and subsequently confirmed by histopathologic examination. Our case indicates that such cases should be followed up closely and repeated aspirations should be done to prevent a delayed diagnosis of lymphoma.

Contribuição ao estudo da influência da radiação ionizante pré-operatória sobre a marcação do linfonodo sentinela do reto com azul patente: estudo experimental em ratos / Contribution to the study of the influence of preoperative ionizing radiation on the identification of the sentinel lymph node with patent blue: an experimental in rats

A radiação ionizante prévia promove alterações actínicas em tecidos peritumorais,o que poderia influenciar a demarcação do linfonodo sentinela.O presente estudo desenvolveu modelo experimental para demarcação do linfonodo sentinela do reto do rato e para definição da dose de radiação (curva de calibração).O objetivo foi avaliar a influência da radiação ionizante pré-operatória sobre a marcação, com corante azul patente, do linfonodo sentinela do reto de ratos.A amostra foi constituída por 40 ratos machos Wistar e dividida em 2 grupos:Grupo 1(controle não irradiado;n=20) e Grupo 2(irradiado com 1200cGy e demarcado 2 dias após;n=20).Foi observado aumento linear do tempo de coloração do linfonodo no Grupo 2.Concluindo,a irradiação pré-operatória não influiu na demarcação do linfonodo sentinela do reto do rato / Previous ionizing radiation induces actinic alterations in peritumoral tissues and thus might influence the localization of the sentinel lymph node.The present study developed an experimental model for the localization of the sentinel lymph node of the rectum of the rat and for the definition of the dose of radiation (calibration curve).The objective was to evaluate the influence of preoperative ionizing radiation on the staining of a patent blue dye in the sentinel lymph node of the rectum in rats.The sample was composed of 40 male Wistar rats and was divided in two groups: Group 1( non-irradiated control; n = 20 ) and Group 2( irradiated with 1200cGy and stained 2 days afterwards; n = 20).It was observed a linear increase in the time for the staining of the lymph in Group 2.In conclusion, preoperative irradiation did not influence the staining of the sentinel lymph node of the rectum in rats...

Vascular transformation of sinuses in lymph nodes associated with myelodysplastic syndrome--a case report.

We describe a case of plexiform variant of vascular transformation of lymph nodes sinuses in association with myelodysplastic syndrome. The patient had repeated bacterial infections and terminal fungal infection and dies after a protracted illness of seven years.

Significance of serum immunoglobulin levels in conglomeration with trans-sternal phlebography in the phlebography management of breast cancer.

The study was conducted on 63 patients with breast lump and twenty normal healthy females. In benign breast disease, a significant (P < 0.001) rise in serum IgA, significant (P < 0.001) decrease in IgG and no change in IgM levels was seen before operation. A significant decrease (P < 0.001) in serum IgA and significant increase in IgG and IgM was observed post operatively. In carcinoma breast, a significant (P < 0.001) elevation in IgA, IgG and IgM levels was found pre-operatively with a concomitant decrease in serum IgA and IgG and increase in serum IgM levels, post operatively. Trans-sternal phlebography (TSP) carried out with 95.23% success has revealed significant (P < 0.001) change in the staging of carcinoma breast. The increased levels of serum immunoglobulins associated with the patients of carcinoma breast with metastasis has led to conclude that these levels, if punctuated with TSP findings can lead to better assessment of the staging of carcinoma breast and thereby its management.

Lymphnode infarction and lymphoma.

Lymphnode infarction is seen in two sets of situations viz. spontaneous banal infarction of non-neoplastic nodes, and in association with lymphoma. It needs to be differentiated from other causes of lymphnode as a phenomenon occurring synchronous with and occasionally preceding diagnosis of lymphoma is significant.