[Possibilities of fluorescence videomicroscopy in vascular diagnosis].
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Biomedical subjects
Publications and source records attributed to G Isenring.
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Four patients with hereditary lymphedema present at birth (Milroy's disease) have been studied by fluorescence microlymphography (1, 7). The videomicroscopy technique failed to visualize any lymphatic capillary in the edematous part of their legs. In sporadic primary lymphedema with late manifestation, however, a well developed superficial capillary network is detected (1, 6). Three family members without lymphedema had normal microlymphatics. Milroy's disease, at least in the family presented, is characterized by aplasia or extreme hypoplasia of both lymphatic capillaries and collectors whereas in the usual sporadic form of primary lymphedema aplasia or hypoplasia is confined to the larger trunks.
Fluorescence microlymphography, a virtually atraumatic procedure, makes it possible to visualize the superficial network of skin lymphatic microvessels. 0.01 ml of 25% solution of FITC-dextran 150,000 were injected into the subepidermal layer using a steel microneedle (outer diameter 0,2 mm) connected to a microsyringe. The region above the medial ankle was examined by microlymphography in 15 healthy volunteers and 24 patients with primary lymphedema. The mean maximal propagation of the fluorescent dye in the lymphatic network, measured from the original deposit, was significantly lower (p lower than 0.001) in healthy volunteers (7.8 +/- 2.6 mm) than in patients with primary lymphedema (22.1 +/- 13.1 mm). Cutaneous reflux phenomena were demonstrated in 20% of the patients. The number of visualized precollectors was lower in patients with primary lymphedema. No significant differences were found between the mean diameters of meshes and of lymphatic capillaries in healthy volunteers and patients. However, definitely enlarged lymphatic vessels were observed in two patients with congenital lymphedema.
The lymphatic capillary network was visualized by fluorescence microlymphography (subepidermal injection of 0.01 ml of FITC-dextran 150000 under a fluorescence microscope) in the medial ankle region of 21 patients with chronic venous incompetence (CVI) and of 15 healthy controls. In severe CVI leading to trophical changes of the skin lymphatic microangiopathy was detected. Obliterations of parts of the superficial capillary network, phenomena of cutaneous reflux and increased permeability of capillary fragments occurred. These findings contrast to primary lymphedema where the rete remains intact in most cases.
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