Twisting Tourniquet(©) Technique: introducing Schnogh, a novel device and its effectiveness in treating primary and secondary lymphedema of extremities.

Twisting Tourniquet(©) or in Thai "Schnogh" is a new invention for compression therapy of lymphedema. Twisting Tourniquet(©) Technique (TTT) is totally noninvasive for lymphedema management. After the amazing successful evidence in the first series of 28 patients, we have conducted preliminary studies in lymphedema clinics. It was found that the combination of gradually increasing constriction force by Schnogh until desired pressure was reached and maintained for 15 min, followed by a 5-min release, doing repeatedly this compression-decompression for at least 10 sessions a day, can generate acceptable results. The aim of the study was to evaluate the scientific effectiveness and establish a treatment protocol of TTT proposed as a therapeutic approach for clinical management of lymphedema. During 2006-2013, from over 3500 patients, 647 with primary/secondary lymphedema passed inclusion criteria, 307 for upper, and 340 for lower extremity. In the 5-day course of TTT, each day patients underwent 10 sessions of a 15-min compression followed by a 5-min decompression. Vegan diet was encouraged as an adjuvant therapy. Among lymphedema patients whose spectrum of edema severity ranged from mild to gigantic, TTT yielded an average volume reduction rate (VR) at 50.2% and 55.6%, making the average edema reduction volume attained at 463 and 1856 mL for upper and lower limb, respectively. The uniformed practice by Schnogh which supports a continual compression-decompression maneuver over 3.5 h daily for five consecutive days could induce an average VR at above half of the swelling in extremities of 647 patients. Schnogh is therefore effective in clinical management of lymphedema under TTT treatment of fibroblastic interstitium.

Microvascular dysfunction in hepatic ischemia-reperfusion injury in pigs.

Although hepatic ischemia-reperfusion (I/R) injury has been investigated for more than two decades, histopathological documentation is limited. As a result, three pig livers with I/R injury and three control livers were injected with colored media, cut into 14 segments, and examined by light microscopy together with microscopic map making. In livers with I/R injury, lobules were identified as being occluded or unoccluded. The proportion of the occluded lobules increased in a caudocephalic fashion, while that of the unoccluded lobules decreased (chi(2) for linear trend, P<0.0001). Especially in the occluded lobules, swollen hepatic plates displayed various forms of cellular distortion. Collapsed sinusoids containing leukocyte aggregation and shrunken central veins were observed together with reduced caliber of the contiguous sublobular veins. Portal vein constriction with loosening of the surrounding stroma suggestive of edema and hepatic artery dilation were also seen. Isolated arterioles and transintimal vasal outlets of the hepatic vein's vasa venarum were dilated and frequently observed. In conclusion, I/R injury affected the liver parenchyma, the microvasculature, and its surrounding stroma. The heterogeneous distribution of occluded and unoccluded lobules is suggested due to the difference of vascular structure in various liver segments. The constrictive/obstructive changes in the portosinusoidal-hepatic vascular profile suggest a definite increase in resistance at presinusoidal, sinusoidal, and proximal postsinusoidal levels, resulting in an expansion of the arterial shunt circulation.

Hepatic microvascular development in relation to the morphogenesis of hepatocellular plates in neonatal rats.

The development of hepatic microvascular heterogeneity after birth, and its temporal relationship to the development of parenchymal cell plates have received little attention. As a result, the morphogenesis of some of the parameters contributing to this heterogeneity in suckling and weaned rats was studied as a function of time between postpartum days 4 and 30 using in vivo light microscopic, electron microscopic, and immunocytochemical methods. During the early suckling period, the sinusoid network is highly anastomotic, with little evidence of zonation, and the parenchymal cell plates contain multiple cells and are irregularly arranged throughout the lobule. Sinusoidal endothelial fenestration is sparse at 4 days, but phagocytic Kupffer cell (KC) function already exists and exhibits zonal heterogeneity, with more cells located in the periportal zone. With increasing age, endothelial fenestrae increase and organize as sieve plates. Widened centrilobular radial sinusoids form through a loss ("drop-out") of intersinusoidal sinusoids (ISS). Concomitantly, the associated cell plates straighten and become one cell thick. Hepatocyte DNA synthesis and mitosis are higher in the periportal zone, which retains thickened cell plates and anastomotic sinusoids. The centrilobular sinusoids may widen to accommodate the increased volume of blood that results from the loss of ISS as well as the increased numbers of periportal sinusoids containing flow that feed these vessels. KC phagocytic activity increases during the suckling period concomitant with an increase of gut-derived endotoxin in the portal blood, which suggests that the KCs may be releasing mediators that affect sinusoid diameter, blood flow, endothelial fenestration, and perhaps parenchymal growth either directly or through the stimulation of growth factors.

Living-related liver transplantation: a Thai family's stressors and concerns.

This case study reviews the experience of a Thai family who traveled to Japan for living-related liver transplantation. The recipient experienced multiple problems after transplantation, which placed additional stress on the family. The cultural gap and language barrier resulted in a lack of understanding and often made it difficult for the medical team and family to communicate effectively. However, the use of interpreters helped to resolve these problems. This study shows that it is especially important for transplant coordinators and social workers to facilitate the collaboration and understanding between families and the medical team when cultural and language differences exist.