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[Anatomy and physiology of the lymphatic system].

The lymphatic capillaries, elements of the micro-circulatory unit, are formed within the interstitial tissue to which they are fixed. The convergence of the interstitial capillaries creates collectors which become increasingly large and valved. Distributed along the main vascular tracts for the deep network and along the subcutaneous for the superficial, anastomoses exist between the deep and superficial networks and others form in certain pathological conditions. It is the liquid impregnation of the interstitial tissue which triggers off the filling of the lymphatic vessel. Lymph progresses thanks to: the presence of valvules on the collectors, the arterial pulse, the muscular contractions, the pressure of adjoining tissues, and to thoracic aspiration. Nervous and hormonal phenomena are responsible for the formation and progression of the lymph.

Arteries↗

[A contribution to the pseudo-LE-syndrome. Investigations of the cardiovascular system, abdominal organs, lymphatic system and drug histories (author's transl)].

13 of 30 patients suffering from pseudo-LE-syndrome showed a usually reversible enlargement of the heart during the acute stage of the disease. In two patients carditis occurring in pseudo-LE-syndrome lead to congestive heart failure and an additional patient died in the acute stage of carditis. As opposed to Systemic Lupus Erythematosus hypertension did not occur in a higher frequency than normal. In five cases cardiac catheter examinations showed slight elevation of the end-diastolic pressure in the right ventricle, in two cases an abnormal high mean pressure in the right atrium and a systolic gradient at the pulmonic valve was found. -Scintigrams showed definite enlargement of the spleen and to a lesser degree enlargement of the liver was seen. Laparascopy showed multiple concretions after peritonitis. Lymphographic changes in the retroperitoneal lymph nodes and lymphatic ducts were not observed in contrast to rheumatic diseases. Drug histories in most cases discovered intake of Venopyronum dragees prior to onset of the disease. But recurrent attacks of the disease also occurred without further intake of the drug.

Adult↗

[Anatomy of the lymphatic system of the arm].

The lymphatic system of the upper limb is studied according to its various networks: superficial, deep, axillary lymph nodes and anastomotic system. The most important superficial lymphatic system is described in the upper limb together with its applications for manual lymphatic drainage. The microstructure and function of the lymphatic system are studied. The pathophysiology and manual and microsurgical treatments of lymphoedema are not discussed in this article.

Arm↗

Lymphatic system: morphofunctional considerations.

The lymphatic system, consisting of the lymph nodes and the lymphatic vessels as well as the spleen and various sites of lymphoid tissue, is deputed to important tasks: the immune response, the transport of lipids absorbed at the intestinal level and the reabsorption of water and other substances from the interstitial spaces; the lymph nodes in particular are involved in immunity and lymph filtration-depuration. Therefore, the knowledge of lymph node cellular architecture as well as of the structure and course of lymphatic vessels is of great importance. The pathologic processes that affect the lymphatic system can involve the canalicular and/or nodal part, resulting in patterns directly correlated with their respective function: lymphedema and lymphagitis on one hand, and disorders induced by accumulation, inflammation and tumors, on the other.

Humans↗

[The problem of the prognostic significance of perforations of the kidney hollow system and its vascular system; involvement of the lymphatic system and of surrounding organs in patients with hypernephroid kidney cancers].

On the basis of 51 patients with a hypernephroid renal carcinoma the prognostic importance of the size of the tumour, of the infraction into the renal hollow system, the invasion of lymphatic and vascular system as well as of the border of the organ after tumour nephrectomy and a 5-year observation time was discussed. While the isolated infraction into the hollow system was not relevant in smaller tumours, it implies an additional prognostically negative factor in advanced tumours. In the same measure the invasion of renal capsule or perihilary tissue resulted in a prognostically negative factor. Invasion of blood or lymphatic vessels proved to be very bad prognostically and resulted in a decrease of the survival rate of about 2/3. The prognostically worst hint was the simultaneous infraction into various systems with a decrease of the survival rate of more than 3/4.

Adenocarcinoma↗

Imaging of the lymphatic system: new horizons.

The lymphatic system is a complex network of lymph vessels, lymphatic organs and lymph nodes. Traditionally, imaging of the lymphatic system has been based on conventional imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI), whereby enlargement of lymph nodes is considered the primary diagnostic criterion for disease. This is particularly true in oncology, where nodal enlargement can be indicative of nodal metastases or lymphoma. CT and MRI on their own are, however, anatomical imaging methods. Newer imaging methods such as positron emission tomography (PET), dynamic contrast-enhanced MRI (DCE-MRI) and color Doppler ultrasound (CDUS) provide a functional assessment of node status. None of these techniques is capable of detecting flow within the lymphatics and, thus, several intra-lymphatic imaging methods have been developed. Direct lymphangiography is an all-but-extinct method of visualizing the lymphatic drainage from an extremity using oil-based iodine contrast agents. More recently, interstitially injected intra-lymphatic imaging, such as lymphoscintigraphy, has been used for lymphedema assessment and sentinel node detection. Nevertheless, radionuclide-based imaging has the disadvantage of poor resolution. This has lead to the development of novel systemic and interstitial imaging techniques which are minimally invasive and have the potential to provide both structural and functional information; this is a particular advantage for cancer imaging, where anatomical depiction alone often provides insufficient information. At present the respective role each modality plays remains to be determined. Indeed, multi-modal imaging may be more appropriate for certain lymphatic disorders. The field of lymphatic imaging is ever evolving, and technological advances, combined with the development of new contrast agents, continue to improve diagnostic accuracy.

Animals↗

Structure and function of the lymphatic system: an overview.

The lymphatic system is often overlooked, but is a vital part both of the circulation and the immune system. This article provides a basic overview of the structure and function of the lymphatic system as a grounding for understanding the development of chronic oedemas, notably lymphoedema.

Bandages↗

[Tests and imaging of the lymphatic system].

Methods for lymphatic imaging are numerous and can be roughly classified as anatomic or functional studies. Direct or indirect lymphographies provide useful informations in case of lymphostasis. Contrast lymphangiography is the only anatomical method giving precise informations either on lymphatic ducts or lymph nodes. Nevertheless this invasive method is no more indicated in cases of limb edemas. Indirect lymphographies study the spontaneous lymphatic drainage of inert particles injected into the dermis. The blue dye test is the most simple and the oldest indirect lymphography used in the positive diagnosis of a lymphostasis. It has been replaced with the indirect radionuclide lymphography which give more reliable informations. Fluorescence microlymphoangiography is an atraumatic method which permits the visualization of skin lymphatics. Indirect lymphangiography with contrast medium give reliable informations on the status of the initial lymphatics and is the best imaging method to differentiate between lipedema and lymphedema. Indirect radionuclide lymphoscintigraphy is a safe, non invasive and physiological method for the assessment of the limb lymphatic system used for morphological studies and objective measurement of the peripheral lymphatic function necessary to assess the lymphatic variation under therapy (decongestive physiotherapy, surgery, drugs).

Humans↗

[Diseases of the pulmonary lymphatic system in children].

Diseases of the lymphatic system in children include a group of exceptional conditions difficult to manage. The anatomy of lymphatic system is complex in the lung. Variable from one subject to another, its complex physiology plays an important role in air-blood exchanges occurring in the lung. In the pulmonary interstitium and in the pleura, the lymphatic system acts like an overflow valve capable of regulating variations in interstitial fluid. The presence or development of dysplasic lymphatics causes leakage, dilatation, and reflux of the lymph through incontinent valves leading to chylothorax and/or fluid overload in the pulmonary interstitium. Symptomatic care is usually proposed, based on a fat-free diet supplemented with light-chain triglycerides and liposoluble vitamins. Other therapeutic options can be proposed. Medical options include cytotoxic agents, somatostatin, and interferon-alpha. Surgery may also be useful, but an assessment of therapeutic efficacy is very difficult due to partial effects and the small number of cases studied.

Child↗

Structure function relationships in the lymphatic system and implications for cancer biology.

The lymphatic system, composed of lymphatic vessels, lymph, lymph nodes, and lymphocytes, is a distinctive vasculature (discontinuous basement membrane, open endothelial junctions, anchoring filaments, valves, and intrinsic contractility), different yet similar to the blood vasculature; an integral component of the plasma-tissue fluid-lymph circulation (the "blood-lymph loop"); and the center of the immunoregulatory network. Lymphatics are involved in diverse developmental, growth, repair, and pathologic processes both analogous to and distinct from those affecting the blood vasculature. Interference with the blood-lymph loop produces swelling [an imbalance between lymph formation (regulated by Starling's law of transcapillary fluid exchange) and lymph absorption], scarring, nutritional and immunodysregulatory disorders, as well as disturbances in lymph(hem)angiogenesis (lymphedema-angiodysplasia syndromes). The lymphatic system is also the stage on which key events during cancer development and progression are played out, and historically, also forms the basis for current evaluation, prognostication, and/or both operative and non-operative treatment of most cancers. Recent advances in molecular lymphology (e.g., discovery of lymphatic growth factors, endothelial receptors, transcription factors, genes, and highly specific immunohistochemical markers) and growing interest in lymphangiogenesis, combined with fresh insights and refined tools in clinical lymphology, including non-invasive lymphatic imaging, are opening up a window for translation to the clinical arena. Therefore, in cancer biology, attention to the multifaceted structure-function relationships within this vast, relatively unexplored system is long overdue.

Animals↗

Assessment of the cardiovascular and lymphatic systems.

Assessment of the cardiovascular and lymphatic systems first requires a complete signalment, history, and general physical examination. Further assessment of the cardiovascular system begins with evaluation of the cardiac borders through palpation and thoracic percussion. Complete cardiac auscultation requires careful evaluation of several parameters. The location, intensity, and character of normal heart sounds are first determined. This is followed by assessment of heart rate and rhythm. Finally, special attention should be placed on identifying abnormal heart sounds and describing them based on their location, intensity, duration, sound quality, and radiation. Assessment of the arterial, venous, and capillary systems provides additional information on the status of the cardiovascular system. Assessment of the lymphatic system primarily involves evaluation of external and palpable internal lymph nodes. Commonly palpable external lymph nodes include the intermandibular, parotid, retropharyngeal, superficial cervical, subiliac, mammary, and scrotal lymph nodes. Palpable internal abdominal lymph nodes include the iliofemoral lymph nodes and the iliosacral lymph center. Other lymph nodes that may be palpable include the renal, ruminal, and mesenteric lymph nodes. Lymph nodes should be evaluated for size, consistency, and tenderness.

Animals↗