• 제목/요약/키워드: Superficial lymphatic system

검색결과 6건 처리시간 0.02초

Three-dimensional analysis of dermal backflow in cancer-related lymphedema using photoacoustic lymphangiography

  • Oh, Anna;Kajita, Hiroki;Imanishi, Nobuaki;Sakuma, Hisashi;Takatsume, Yoshifumi;Okabe, Keisuke;Aiso, Sadakazu;Kishi, Kazuo
    • Archives of Plastic Surgery
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    • 제49권1호
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    • pp.99-107
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    • 2022
  • Background Dermal backflow (DBF), which refers to lymphatic reflux due to lymphatic valve insufficiency, is a diagnostic finding in lymphedema. However, the three-dimensional structure of DBF remains unknown. Photoacoustic lymphangiography (PAL) is a new technique that enables the visualization of the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and can provide three-dimensional images of superficial lymphatic vessels and the venous system. This study reports the use of PAL to visualize DBF structures in the extremities of patients with lymphedema after cancer surgery. Methods Patients with a clinical or lymphographic diagnosis of lymphedema who previously underwent surgery for cancer at one of two participating hospitals were included in this study. PAL was performed using the PAI-05 system. ICG was administered subcutaneously in the affected hand or foot, and ICG fluorescence lymphography was performed using a near-infrared camera system prior to PAL. Results Between April 2018 and January 2019, 21 patients were enrolled and examined using PAL. The DBF was composed of dense, interconnecting, three-dimensional lymphatic vessels. It was classified into three patterns according to the composition of the lymphatic vessels: a linear structure of lymphatic collectors (pattern 1), a network of lymphatic capillaries and lymphatic collectors in an underlying layer (pattern 2), and lymphatic capillaries and precollectors with no lymphatic collectors (pattern 3). Conclusions PAL showed the structure of DBF more precisely than ICG fluorescence lymphography. The use of PAL to visualize DBF assists in understanding the pathophysiology and assessing the severity of cancer-related lymphedema.

Evolution of Anatomical Studies on the Arterial, Venous, and Lymphatic System in Plastic Surgery

  • Soo Jin Woo;Hee Tae Koo;Seong Oh Park;Hiroo Suami;Hak Chang
    • Archives of Plastic Surgery
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    • 제49권6호
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    • pp.773-781
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    • 2022
  • Anatomies of the vascular and lymphatic systems have been vital research topics in reconstructive surgery. Harvey was a pioneer who provided the earliest descriptions of the cutaneous vasculature in the 17th century. The concept of vascular territories of the skin was first described by Manchot. The radiographic injection method in cadavers was developed by Salman, who defined more than 80 vascular territories. The arterial system has been thoroughly investigated with the development of regional and free flaps. The concept of axial and random pattern flaps was introduced by McGregor and Morgan. Manchot's vascular territories were refined by Taylor and Palmer as the angiosome concept. Detailed information about the venous circulation is essential for reconstructive surgeries. The concept of intrinsic and extrinsic venocutaneous vascular systems was introduced by Nakajima and led to the development of the venoadipofascial flap. The importance of venous augmentation in flap survival was emphasized by Chang. The lymphatic system was discovered much later than the arterial and venous systems. Aselli was credited for discovering the lacteal vessels in the 17th century; mercury was popularly used as a contrast agent to distinguish lymphatic vessels for the next three centuries. A radiographic method in cadavers was developed by Suami. Lymphatic imaging devices are constantly upgrading, and photoacoustic imaging was recently introduced for three-dimensional visualization of architecture of superficial layers of the lymphatic and venous systems.

부인과 암 이후 이차적인 다리 림프 부종 환자에게 적용한 림프흡수 마사지의 효과 (Effects of Manual Lymph Drainage on Patients with Secondary Lymphedema of Legs After Gynecologic Cancer)

  • 정성관;이승병
    • 대한정형도수물리치료학회지
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    • 제22권2호
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    • pp.35-39
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    • 2016
  • Background: The superficial lymphatic system is divided into areas called lymphatic territories which are separated by watersheds. When the lymphatic system fails to remove its load either due to surgery, radiotherapy or some congenital malformation of it then the fluid and the proteins and wastes contained within it accumulates in that territory. Anastomotic connections exist across the watersheds and while they can work unaided manual lymph drainage (MLD) can significantly help drainage across them into unaffected lymphatic territories. The purpose of the study is to examine the effectiveness of a manual technique in moving fluids and softening hardened tissues using a tape measure and Patient-Specific Functional Scale. Methods: We examined the movement of fluids from the affected limbs of lymphedema patients who underwent a standardized 30-min treatment using the Dr. Vodder method of MLD. We chose a typical cross section of patients with secondary leg or secondary arm lymphedema. The lymphedema patient was also measured after the conclusion of treatment and underwent a follow-up control measurement, within 8 weeks. Both evaluation tools indicated a movement of fluid to different and unblocked lymphatic territories as well as a softening of tissues in some of the affected limbs. Results: MLD is an effective means of fluid clearance when it accumulates as a consequence of a failure of the lymphatic system. It seems likely that MLD has a systemic effect on the lymphatic system and that it can improve flow from otherwise normal tissues. Conclusions: It is hypothesized that a series of treatments would result in even more significant improvements.

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Photoacoustic lymphangiography before and after lymphaticovenular anastomosis

  • Oh, Anna;Kajita, Hiroki;Matoba, Eri;Okabe, Keisuke;Sakuma, Hisashi;Imanishi, Nobuaki;Takatsume, Yoshifumi;Kono, Hikaru;Asao, Yasufumi;Yagi, Takayuki;Aiso, Sadakazu;Kishi, Kazuo
    • Archives of Plastic Surgery
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    • 제48권3호
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    • pp.323-328
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    • 2021
  • Background Lymphaticovenular anastomosis (LVA) is a minimally invasive surgical procedure used to treat lymphedema. Volumetric measurements and quality-of-life assessments are often performed to assess the effectiveness of LVA, but there is no method that provides information regarding postoperative morphological changes in lymphatic vessels and veins after LVA. Photoacoustic lymphangiography (PAL) is an optical imaging technique that visualizes the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and provides three-dimensional images of superficial lymphatic vessels and the venous system simultaneously. In this study, we performed PAL in lymphedema patients before and after LVA and compared the images to evaluate the effect of LVA. Methods PAL was performed using the PAI-05 system in three patients (one man, two women) with lymphedema, including one primary case and two secondary cases, before LVA. ICG fluorescence lymphography was performed in all cases before PAL. Follow-up PAL was performed between 5 days and 5 months after LVA. Results PAL enabled the simultaneous visualization of clear lymphatic vessels that could not be accurately seen with ICG fluorescence lymphography and veins. We were also able to observe and analyze morphological changes such as the width and the number of lymphatic vessels and veins during the follow-up PAL after LVA. Conclusions By comparing preoperative and postoperative PAL images, it was possible to analyze the morphological changes in lymphatic vessels and veins that occurred after LVA. Our study suggests that PAL would be useful when assessing the effect of LVA surgery.

한국산 미꾸리 Misgumus anguillicaudatus (Pisces, Cobitidae) 피부 구조 및 조직화학적 특징 (Structure and Histochemistry of Skin of Mud Loach, Misgurnus anguillicaudatus (Pisces, Cobitidae), from Korea)

  • 박종영;김익수
    • 한국어류학회지
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    • 제11권2호
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    • pp.109-116
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    • 1999
  • 한국산 미꾸리 Misgurnus anguillicaudatus의 피부 구조 및 조직화학적 특정을 조사하기 위해 등, 측면, 복부, 머리부분의 피부를 조사하였다. 미꾸리의 epidermis는 elongated mucous cell과 club cell의 2개의 gland로 구성되었으며 두께는 아주 두꺼웠다. mucous cell은 acid mucopolysaccharides의 물질을 분비하였으나 club cell은 mucopolysaccharides에 어떠한 반응도 보이지 않았다. 표피의 기저층은 림파구를 가지는 lymphocytic space가 발달하였으며 기저막과 상피세포사이에 배모양의 감각세포인 pit organ이 존재하였다. Dermis의 stratum laxum에는 acid mucopolysaccharides를 나타내는 부분(a definite area)이 존재하며, 이러한 물질은 비늘에도 분포하고 있다. 작은 비늘이 dermis속에 파 묻혀 있으나 머리부분에는 없다. 또한 많은 양의 모세혈관들이 기저막 바로 아래에 존재하였다. 피부의 이러한 특징들은 미꾸리가 공기를 이용하는 피부호흡과 밀접한 관계가 있다.

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림프절의 자기공명영상의 특징: 가토에서 T1과 T2 강조영상의 비교 (Magnetic resonance imaging characteristic of lymph nodes: Comparison of T1 and T2 weighted image in normal rabbits)

  • 이기창;최민철;최호정;윤정희;최승홍;문우경;정진욱
    • 대한수의학회지
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    • 제44권2호
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    • pp.311-315
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    • 2004
  • The detection of lymph node metastasis is an important step in tumor staging and is significant for therapy planning. It has been challenged to yield an appropriate image with diagnostic methods such as Magnetic Resonance (MR) and Computed Tomography (CT). Though CT has been used widely and accessed easily to show internal organs, it can hardly provide difference between lymph node and adjacent vessel or fat tissue. It has been well established that MR can reveal the subtle discrepancy within soft tissue. This study investigated the suitability of MR lymph node imaging without contrast enhancement by comparison of T1-weighted image (T1WI) and T2- weighted image (T2WI) in ten normal rabbits. According to the pulse sequence optimized from preliminary study, T1-weighted spin-echo (repetition time/echo time=400/12 ms) and T-2 weighted fast spin-echo (repetition time/echo time=3500/84 ms) images covering the hind limbs and pelvic region were acquired at 1.5 T. Two radiologists scrupulously evaluated the MR images in consensus. And signal intensity of lymph nodes was compared with that of adjacent fat. Statistical analysis showed that T1-weighted coronal image visualized the lymph nodes (iliac, superficial inguinal and popliteal lymph nodes) quickly and consistently rather than T2-weighted one. Conclusively, T1WI for evaluation of lymph nodes is moderately better than T2WI and appears to have potential for quick and sufficient mapping of the lymph nodes. In addition, this normal MR image of lymph nodes could be applied to further study for the evaluation of lymphatic system in abscess and tumor bearing animal model.