A Controlled Comparison between Manual Lymphatic Mapping of Plantar Lymph flow and Standard Physiologic Maps Using Lymph Drainage Therapy / Osteopathic Lymphatic Technique

2016 ◽  
pp. 105-116
Author(s):  
Bruno Chikly ◽  
Jörgen Quaghebeur ◽  
Walter Witryol
Keyword(s):  
Lymphatic Mapping ◽  
Lymph Flow ◽  
Lymph Drainage

Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema

2001 ◽  
Vol 101 (2) ◽  
pp. 131-140 ◽  
Author(s):  
A. W. B. STANTON ◽  
W. E. SVENSSON ◽  
R. H. MELLOR ◽  
A. M. PETERS ◽  
J. R. LEVICK ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regional Differences ◽  
Removal Rate ◽  
Lymphatic Drainage ◽  
Lymph Flow ◽  
Lymph Drainage ◽  
Lymphatic Function ◽  
Γ Radiation ◽  
Image Width ◽  
Proximal Forearm

Recent research indicates that the pathophysiology of breast-cancer-related lymphoedema (BCRL) is more complex than simple axillary lymphatic obstruction as a result of the cancer treatment. Uneven distribution of swelling (involvement of the mid-arm region is common, but the hand is often spared) is puzzling. Our aim was to test the hypothesis that local differences in lymphatic drainage contribute to the regionality of the oedema. Using lymphoscintigraphy, we measured the removal rate constant, k (representing local lymph flow per unit distribution volume, VD), for 99mTc-labelled human immunoglobulin G in the oedematous proximal forearm, and in the hand (finger web) in women in whom the hand was unaffected. Tracer was injected subcutaneously, and the depot plus the rest of the arm was monitored with a γ-radiation camera for up to 6 h. VD was assessed from image width. Contralateral arms served as controls. k was 25% lower in oedematous forearm tissue than in the control arm (BCRL, -0.070±0.026%·min-1; control, -0.093±0.028%·min-1; mean±S.D.; P = 0.012) and VD was greater. In the non-oedematous hand of the BCRL arm, k was 18% higher than in the control hand (BCRL, -0.110±0.027%·min-1; control, -0.095±0.028%·min-1; P = 0.057) and 59% higher than forearm k on the BCRL side (P = 0.0014). VD did not differ between the hands. Images of the BCRL arm following hand injection showed diffuse activity in the superficial tissues, sometimes extending almost to the shoulder. A possible interpretation is that the hand is spared in some patients because local lymph flow is increased and diverted along collateral dermal routes. The results support the hypothesis that regional differences in surviving lymphatic function contribute to the distribution of swelling.

Chronic peripheral oedema and lymphoedema

2010 ◽  
pp. 3083-3092
Author(s):  
Peter S. Mortimer
Keyword(s):  
Heart Failure ◽  
Filtration Rate ◽  
Interstitial Fluid ◽  
Lymph Flow ◽  
Peripheral Oedema ◽  
Main Process ◽  
Lymph Drainage ◽  
Fluid Filtration

Lymph transport, not venous reabsorption, is the main process responsible for interstitial fluid drainage. All peripheral oedema is either absolute or relative lymph drainage failure. Oedema develops when the microvascular filtration rate exceeds lymph drainage for a sufficient period, either because the filtration rate is high or because lymph flow is low, or a combination of the two. Lymphoedema is strictly peripheral oedema due solely to a failure of lymph drainage. Most peripheral oedema arises from microvascular fluid filtration overwhelming lymph drainage, e.g. heart failure, but lymphoedema supervenes as lymph function declines if high filtration is sustained....

Quantitation of Lymphatic Drainage of the Peritoneal Cavity in Sheep: Comparison of Direct Cannulation Techniques with Indirect Methods to Estimate L Ymph Flow

1993 ◽  
Vol 13 (4) ◽  
pp. 270-279 ◽  
Author(s):  
Lisa Tran ◽  
Helen Rodela ◽  
John B. Hay ◽  
Dimitrios Oreopoulos ◽  
Miles G. Johnston
Keyword(s):  
Peritoneal Cavity ◽  
Lymphatic Drainage ◽  
Lymph Flow ◽  
Lymph Drainage ◽  
Flow Rates ◽  
Drainage Fluid ◽  
Peritoneal Drainage ◽  
Ultrafiltration Failure ◽  
Lymph Duct ◽  
The Right

Objective It has been suggested that lymphatics may contribute to ultrafiltration failure in patients on continuous ambulatory peritoneal dialysis (CAPD) byabsorbing dialysate and ultrafiltrate from the peritoneal cavity. In most studies lymphatic drainage has been estimated from the disappearance of an instilled tracer from the peritoneal cavity or estimated from the appearance of an intraperitoneally administered tracer in the bloodstream. However, in sheep it is possible to cannulate several of the relevant lymphatics that drain the peritoneal cavity and assess lymph drainage parameters directly. The purpose of this study was to estimate lymph drainage from the peritoneal cavity in sheep using the disappearance of tracer from the cavity and the appearance of intraperitoneally instilled tracer in the bloodstream and to compare these results with those obtained from our previous studies using cannulation techniques. Design Experiments were performed in anesthetized and nonanesthetized animals. Volumes of 50 mL/kg of Dianeal 4.25% containing 25 μCi of 1251-albumin were infused into the peritoneal cavity. Results In anesthetized sheep the calculated peritoneal lymph drainage from monitoring the disappearance of tracer from the peritoneal cavity over 6 hours was 1.873±0.364 mL/kg/hour. Monitoring the appearance of tracer in the blood gave significantly lower peritoneal lymph flow rates of 1.094±0.241 mL/kg/hour. Directly measured lymph flow rates from our earlier publication were lower still and ranged from 0.156±0.028 -0.265±0.049 mL/hour/kg, depending on how we estimated the right lymph duct contribution to peritoneal drainage, since we could not cannulate this vessel. We repeated these experiments in conscious sheep. The value for lymph flow estimated from the disappearance of tracer from the peritoneal cavity was 2.398±0.617 mL/hour/kg and from the appearance of tracer in the blood, 1.424±0.113 mL/ hour/kg. The1ymph flow rates monitored from indwelling lymphatic catheters ranged from 1.021 ±0.186 -1.523±0.213 mL/hour/kg (again, depending on our estimates for the right lymph duct). Conclusions Lymph flow rates measured from indwelling lymphatic catheters provided the most conservative values for lymphatic drainage of the peritoneal cavity under dialysis conditions. Estimates of lymphatic drainage based on the appearance of tracer in the blood gave values that were on average higher. The method using the disappearance of tracer from the cavity to estimate lymph flows overestimated peritoneal lymph drainage. Fluid was lost from the peritoneal cavity, and the estimated proportion of liquid lost through lymphatic drainage depended on the technique used to measure lymph flow rates.

Pathogenesis of Tumor Recurrences on the Tracheostoma in Patients Laryngectomised for Carcinoma

1967 ◽  
Vol 53 (4) ◽  
pp. 299-313 ◽  
Author(s):  
Roberto Molinari ◽  
Italo Milanesi
Keyword(s):  
Defense Mechanisms ◽  
Healing Process ◽  
Drainage System ◽  
Normal Direction ◽  
Lymph Flow ◽  
High Rate ◽  
Lymph Drainage ◽  
Neoplastic Cells ◽  
Subglottic Region

Of 519 patients subjected to total laryngectomy for cancer 14 had a recurrence of the tumor on the tracheostoma. The various possible pathogenetic mechanisms are reviewed critically in the light of this material. Non-radicality of the operation seems to be the most probable, in view of the peculiar lymph spread of neoplastic cells. The lymph drainage system of the larynx is described, with special reference to the crossing of the lymphatic networks at the level of the subglottic region. Although the normal direction of the lymph flow of this region is almost entirely upward, several anatomic and pathologic alterations can stop these pathways and reverse the lymph flow, in which case some of the lymph reaches the vessels of the tracheal network. When the trachea is divided during laryngectomy or when tracheotomy is performed, neoplastic cells spread out of the severed vessels and are imprisoned by the suture of the tracheostoma and the healing process. They thus elude the biological defense mechanisms (which may be present also in the lymph nodes) and so a tumor forms on the new site. This interpretation is supported by the high rate of recurrence on the tracheostoma (17.5%) after long-term use of a tracheostomy tube, especially in cases of tumor of the subglottic region or of the glottis.

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

1989 ◽  
Vol 256 (4) ◽  
pp. R867-R874
Author(s):  
G. J. Valenzuela ◽  
C. W. Hewitt ◽  
G. C. Kramer ◽  
Y. Do ◽  
W. A. Hseuh
Keyword(s):  
Arterial Pressure ◽  
Plasma Protein ◽  
Thoracic Duct ◽  
Protein Concentration ◽  
Lymph Flow ◽  
Escape Rate ◽  
Thoracic Duct Lymph ◽  
Lymph Drainage ◽  
Plasma Protein Concentration ◽  
Duct Lymph

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)

Reduced Lymphatic Drainage of Dialysate from the Peritoneal Cavity during Acute Peritonitis in Sheep

1996 ◽  
Vol 16 (2) ◽  
pp. 163-171 ◽  
Author(s):  
Helen Rodela ◽  
Zheng-Yi Yuan ◽  
John B. Hay ◽  
Dimitrios G. Oreopoulos ◽  
Miles G. Johnston
Keyword(s):  
Peritoneal Cavity ◽  
Thoracic Duct ◽  
Mediastinal Lymph Node ◽  
Lymphatic Drainage ◽  
Lymph Flow ◽  
Lymph Drainage ◽  
Total Recovery ◽  
Acute Peritonitis ◽  
Conscious Sheep ◽  
The Right

Objectives The purpose of this study was to investigate the effects of acute peritonitis on lymphatic drainage of the peritoneal cavity in conscious sheep Design Peritonitis was induced with the addition of 1% casein or 1% albumin to the dialysis solution. Thirty sheep (5 groups of 6) were used in this study. One group received 50 mL/kg intraperitoneal infusions of Dianeal 4.25% (486 mOsm/L); a second group received 1% casein-DianeaI4.25% (493 mOsm/L); a third group received 1% albumin-Dianeal 4.25% (487 mOsm/L). In the fourth and fifth groups (controls and casein-injected) lymph was collected from the caudal mediastinal lymph node and the thoracic duct, both of which are involved in the lymphatic drainage of the peritoneal cavity (peritonitis induced with casein). 1251-human serum albumin (25 μCi) was added to the dialysate as the lymph flow marker. Lymph drainage was estimated from (1) the appearance of the intraperitoneally administered tracer in the blood; (2) the disappearance of the tracer from the peritoneal cavity; and (3) the recovery of tracer in lymph. Results In noncannulated animals the cumulative volume removed by lymphatics over 6 hours (based on tracer recovery in blood) was 10.5 ±1.0 mL/kg in control animals versus 5.0 ± 0.6 mL/kg and 8.6 ± 1.2 mL/kg in casein and albumin-infused sheep, respectively. The suggestion of decreased lymph drainage in peritonitis was supported by the cannulation experiments. While the cumulative fluid removed from the peritoneal cavity over 6 hours in caudal lymph was unaffected by peritonitis (3.8 ± 0.4 mL/kg in controls vs 3.6 ± 0.5 mL/kg in casein injected animals), peritonitis reduced flow into the thoracic duct from 3.0 ± 0.3 to 1.1 ± 0.3 mL/kg. The sum of the volume removed in lymph in the cannulated preparations was 6.8 ± 0.4 mL/kg in controls versus 4.7 ± 0.5 mL/kg in the peritonitis group. The total volume removed from the cavity (including an estimate of flow based on the residual recovery of tracer in blood) was reduced from 12.6 ±1.4 in controls to 7.8 ± 0.6 mL/kg in the peritonitis sheep. In contrast, estimates of lymph drainage based on the disappearance of tracer from the peritoneal cavity suggested that lymph drainage increased (from 16.6 ±1.6 mL/kg in controls to 17.8 ±1.5 mL/kg and 25.5 ±1.7 mL/kg in the casein and albumin groups, respectively, in noncannulated animals and from 15.3 ± 1.4 mL/kg in controls to 25.0 ± 1.7 mL/kg in the cannulated group). In both noncannulated and cannulated sheep the total recovery of tracer was less in the peritonitis groups. Conclusions These studies demonstrated that lymph drainage of the peritoneal space was decreased in a casein peritonitis model. The decrease in lymph drainage is most obvious in the visceral pathway leading to the thoracic duct; however, diaphragmatic drainage into the right lymph duct may also be inhibited. The disappearance of tracer from the peritoneal cavity was elevated during peritonitis. Tracer disappearance has been used to estimate lymph drainage, but this approach suggested, incorrectly, that lymph flow had increased.

scholarly journals Posterior lymph heart pressure and rate and lymph flow in the toad Bufo marinus in response to hydrated and dehydrated conditions

1992 ◽  
Vol 169 (1) ◽  
pp. 207-220 ◽  
Author(s):  
J. M. Jones ◽  
L. A. Wentzell ◽  
D. P. Toews
Keyword(s):  
Heart Rate ◽  
Systolic Pressure ◽  
Lymph Flow ◽  
Bufo Marinus ◽  
Lymph Drainage ◽  
Constant Measurement ◽  
Lymph Heart ◽  
The Mean ◽  
Toad Bufo ◽  
New Surgical Technique

Posterior lymph heart pressure, rate and flow were measured in chronically cannulated Bufo marinus during normal hydrated and dehydrated conditions. A new surgical technique was developed which allowed direct and constant measurement of the functioning of the posterior lymph hearts with minimal disruption to normal lymph drainage. The mean intra-lymph-heart systolic pressure was 2.29 +/− 0.12 kPa for hydrated animals at rest, decreasing to 1.01 +/− 0.10 kPa after 24 h of dehydration. Similarly, lymph heart rate, which was 48.2 +/− 1.7 beats min-1 under hydrated conditions, decreased to 31.8 +/− 4.6 beats min-1 after 18 h of dehydration. Lymph flow decreased almost to zero during dehydration from a hydrated rate of 1.11 +/− 0.04 ml h-1 100 g-1. This is the first study to measure directly and to correlate these variables in an amphibian and to show specifically that pressure, rate and lymph flow are significantly reduced during periods of dehydration.

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