Biomedical subjects
C L Witte
Publications and source records attributed to C L Witte.
Diagnostic and interventional imaging of lymphatic disorders.
During the past several years, technological innovations in nuclear diagnostics and computer imaging have rekindled enthusiasm for visualising the lymphatic system in peripheral lymphoedema and related disorders of lymph flow. Isotope lymphography or lymphangioscintigraphy has now largely replaced conventional (direct) oil-contrast lymphography for evaluating lymphatic dysplasia as it is much simpler, safe, repeatable, and provides both structural and functional detail of the lymphatic system. Magnetic resonance imaging (MRI), alone or in combination with superparamagnetic contrast agents (lymphangiomagnetograms) or fat subtraction (suppression) has the potential to yield further dividends in understanding a variety of enigmatic oedematous states including lymphoedema. Other imaging techniques of promise include ultrasonography (primarily for filariasis), fluorescent microangiolymphography, and intradermal brominated fluorocarbon (primarily for lymph nodes). Not only can these readily non-invasive imaging techniques be used to monitor and document the efficacy of treatments designed to remedy defective lymph transport and function, but in certain conditions (e.g., chylous reflux syndrome), they can be employed to obliterate incompetent lymphangiectatic/lymphangiomatous truncal elements through sclerosis using percutaneous computer-guided catheters.
Refinement of a rodent model of peripheral lymphedema.
A reliable, inexpensive experimental counterpart of peripheral lymphedema has been notoriously difficult to reproduce thereby stifling basic and clinical research into this frustrating clinical condition. Accordingly, in 45 adult Wistar-Fuzzy rats, we attempted to produce sustained hindlimb lymphedema by either groin nodal/lymphatic microsurgical ablation (S) (guided by visual blue dye lymphography) or limited field-groin irradiation (R) alone (4500 rads) or combined S followed by R or R followed by S with an additional non-manipulated group serving as controls. Observations were made for 30-100 days thereafter. Hindlimb volumes were determined serially using the truncated cone formula based on multiple circumferential measurements at standardized intervals along the affected hindlimb and the findings compared with similar measurements in the contralateral non-manipulated hindlimb. In randomly selected rats from each group, lymphatic drainage was assessed by lymphangioscintigraphy (LAS), soft tissue swelling by magnetic resonance imaging (MRI), and edema fluid total protein content by refractometry. Whereas S or R alone produced only transient or mild hindlimb edema without associated morbidity or mortality, S-R or R-S induced moderate to severe sustained protein-rich hindlimb lymphedema associated with 9-13% early mortality and notable late local limb morbidity. Lymphatic obstruction was documented by sustained maintenance of increased hindlimb volume, subcutaneous fluid accumulation (MRI), and impaired lymphatic drainage (LAS). This reproducible rodent model of secondary lymphedema reliably simulates a stable clinical condition for a window of up to 100 days and should thereby facilitate standardized testing of therapeutic/preventive protocols and basic research into lymphatic dynamics in secondary lymphedema.
Lymphangitis and refractory lymphedema after treatment with topical cantharidin.
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A novel type of adhering junction in an epithelioid tumorigenic rat cell culture line.
Two major types of plaque-bearing adhering junctions are commonly distinguished: the actin microfilament-anchoring adhaerens junctions (AJs) and the desmosomes anchoring intermediate-sized filaments (IFs). Both types of junction usually possess the common plaque protein, plakoglobin, whereas the other plaque proteins and the transmembrane cadherins are mutually exclusive. For example, AJs contain E-, N-, or P-cadherin in combination with alpha- and beta-catenin, vinculin and alpha-actinin, whereas in desmosomes, desmogleins and desmocollins are associated with desmoplakin and one or several of the plakophilins (PP1-3). Here we describe a novel type of adhering junction comprising proteins of both AJs and desmosomes and the tight junction (TJ) plaque protein, ZO-1, in a newly established, liver-derived tumorigenic rat cell line (RMEC-1). By immunofluorescence microscopy, cell-cell contacts are characterized by mostly continuous-appearing lines which are usually resolved by electron microscopy as extended arrays of closely spaced small plaque subunits. These plaque-covered regions are positive for plakoglobin, alpha- and beta-catenin, the arm-repeat protein p120, vinculin, desmoplakin and protein ZO-1. They are positive for E-cadherin in cultures early on in passaging, but tend to turn negative for all known cadherins in densely grown cultures. On immunoblotting SDS-PAGE-separated proteins from dense-grown cell monolayers, "pan-cadherin" antibodies have reacted with a band at approximately 140 kDa, identified as N-cadherin by peptide fingerprinting of the immunoprecipitated protein, which for reasons not yet clear is modified or masked in immunolocalization experiments. The exact histological derivation of RMEC-1 cells is not known. However, the observations of several endothelial markers and the fact that all cells are rich in IFs containing vimentin and/or desmin, while only subpopulations also reveal IFs containing CKs 8 and 18, is suggestive of a mesenchymal, probably endothelial origin. We discuss the molecular relationship of this novel type of extended junction with other types of adhering junctions.
A forgotten woman professor and lymphologist.
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ISL Consensus Document revisited: suggested modifications (summarized from discussions at the 16th ICL, Madrid, Spain, September 1997 and the Interim ISL Executive Committee meeting).
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Phenotypic and genotypic heterogeneity in familial Milroy lymphedema.
Familial Milroy lymphedema (ML) is classified as an autosomal dominant disorder characterized by peripheral edema of the lower extremities at birth or in early childhood. The variety of phenotypes are not well described, and the genomic location and functional expression of the gene or genes underlying this and related familial lymphedema syndromes remain largely unknown. In this collaborative study between the University of Arizona and the University of São Paulo, we collected clinical pedigrees on 6 ML families, carried out clinical examination of affected and unaffected individuals, and, in representative affected members of two of the families performed dynamic lymphangioscintigraphy (LAS) of the lower and upper limbs to delineate further the ML lymphangiodysplastic phenotype. To localize the gene for ML, we conducted a genome-wide search in 4 of the families using 387 polymorphic dinucleotide-repeat markers at approximate 10 cM spacing in 54 subjects (affected, unaffected bloodline relatives, and spouses). In all 6 families (86 subjects), we specifically examined the suggested linkage to the vascular endothelial growth factor (VEGF)-C receptor (Flt4) gene localized to the chromosome region 5q34-q35. The findings provide evidence for a spectrum of ML clinical and LAS phenotypes and also suggest ML locus heterogeneity.
Lymphangiogenesis: mechanisms, significance and clinical implications.
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On the causation of edema: a lymphologic perspective.
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On tumor (and other) lymphangiogenesis.
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Enlargement of splenic implants.
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Disorders of lymph flow.
Disturbances in blood capillary exchange of fluid, macromolecules, and cells across intact and abnormal microvessels and deranged lymphatic transport are integral, interacting components in disorders of tissue swelling. Lymphedema or low-output failure of the lymph circulation is often indolent for many years before lymphatic insufficiency (failure) and tissue swelling emerge and persist. Superimposed occult or overt infection (lymphangitis) are probably major contributors to progressive limb deformity (elephantiasis). Long-standing lymphedema is characterized by trapping in the skin and subcutaneous tissue of fluid, extravasated plasma proteins, and other macromolecules: impaired immune cell trafficking; abnormal processing of autologous and foreign antigens; heightened susceptibility to superimposed infection; local immunodysregulation; defective lymphatic (lymphangion) propulsion from an imbalance of mediators regulating vasomotion; soft-tissue overgrowth; scarring and hypertrophy; and exuberant angiogenesis occasionally culminating in vascular tumors (Fig. 8). In contrast to the blood circulation, where flow depends primarily on the propulsive force of the myocardium, lymph propulsion depends predominately on intrinsic truncal contraction, a phylogenetic vestige of amphibian lymph hearts. Whereas venous "plasma" flows rapidly (2-3 l/min) against low vascular resistance, lymph flows slowly (1-2 ml/min) against high vascular resistance. On occasion, impaired transport of intestinal lymph may be associated with reflux and accumulation and leakage of intestinal chyle in a swollen leg. Although the term "lymphedema" is usually reserved for extremity swelling, the pathogenesis of a wide variety of visceral disorders also may be traceable to defective tissue fluid and macromolecular circulation and impaired cell trafficking of lymphocytes and macrophages. Thus, lymph stasis, with impaired tissue fluid flow, underlies or complicates an indolent subclinical course with a long latent period and sporadic episodes of lymphangitis, which culminates in intense scarring. Examples are pulmonary fibrosis (e.g., pneumoconiosis), regional enteritis, retroperitoneal fibrosis, and perhaps chronic pancreatitis and cirrhosis of the liver. Transdifferentiation and ultimately transformation of endothelial and other vascular accessory cells during lymph stasis also may be pivotal to a wide range of dysplastic and neoplastic vascular disorders, including Stewart-Treves angiosarcoma, AIDS-associated Kaposi's sarcoma, and lymphangitic metastatic carcinomatosis. Lymphscintigraphy has now replaced conventional lymphography as the procedure of choice to corroborate the diagnosis of peripheral lymphedema, whereas MR imaging using paramagnetic and superparamagnetic contrast agents has the potential to yield huge dividends in furthering understanding of a variety of enigmatic edematous states, including lymphedema. Not only are better explanations and insights into swelling disorders likely to be forthcoming, but, equally important, these new, safe, noninvasive imaging techniques can and should be used to monitor the evolution and document the efficacy of commonly advocated operations and nonoperative remedies for defective lymph transport and function.
Is vagotomy and gastrectomy still justified for gastroduodenal ulcer?
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Percutaneous sclerotherapy of lymphangiomas.
PURPOSE: The authors report their experience with percutaneous image-guided sclerotherapy for treatment of unresectable lymphangiomas. MATERIALS AND METHODS: Five patients with unresectable lymphangiomas of the pelvis (n = 2), neck (n = 1), abdomen (n = 1), or leg (n = 1) were treated at two medical centers with sclerotherapy, with use of doxycycline as the sclerosant. Computed tomography was used to guide the procedures, with supplemental lymphoscintigraphy, ultrasound, and magnetic resonance imaging used as needed. RESULTS: Symptomatic relief of lymphedema, lymphorrhea, or a decrease in size of lymphatic pools was achieved, to varying degrees, in the five patients. Follow-up is ongoing, and further sclerotherapy may be indicated as the clinical course dictates. CONCLUSION: Percutaneous sclerotherapy with doxycycline is safe and appears effective for palliative treatment of unresectable lymphangiomas on the basis of our initial clinical experience.
Kaposi's sarcoma, vascular permeability, and scientific integrity.
On March 13, 1992, Nakamura et al published an article in the journal Science reporting that sulfated polysaccharide peptidoglycan (SP-PG) inhibited the growth and vascular hyperpermeability characteristics of Kaposi's sarcoma-related cells and lesions in nude mice. While examining their key composite Fig 3, A through E, and related Table 2, we were surprised by several photographic features and other irregularities in the figures, which we explored further through a series of experiments. We were unable to confirm some of the pivotal findings. We communicated our concerns to Science but our letter was rejected. After submission of additional analysis, the matter was reopened by Science, but again our correspondence was rejected. Despite extensive review, the salient points raised in our initial correspondence remain unanswered or only tangentially addressed. The original conclusions by Nakamura et al are still not only highly dubious, but the validity of the peer review process and self-correcting nature of scientific inquiry are also called into question.