Intensive investigation in management of Hodgkin's disease.
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Ninety-eight patients with clinically localised Hodgkin's disease underwent laparotomy and splenectomy to determine the extent of microscopic spread. In 68 patients the procedure was carried out for untreated disease apparently confined above the diaphragm. Abdominal disease cannot be confidently excluded on the basis of non-invasive investigation at presentation. Clinical assessment of splenic disease was unreliable unless gross splenomegaly was present. Pedal lymphography was accurate in assessing para-aortic and iliac disease but of no value in assessing other intra-abdominal lymph node involvement, including that of the mesenteric lymph node. Trephine bone marrow biopsy findings were normal in all patients before surgery, and only one patient was found to have diseased bone marrow by Stryker-saw biopsy at operation. Liver disease was identified at operation in nine patients, some of whom were asymptomatic with clinically undetectable splenic and nodal disease. Detailed clinical staging failed to detect disease in one-third of patients who underwent laparotomy. These studies show that if radiotherapy is to remain the treatment of choice for disease truly localised to lymph nodes a detailed staging procedure, including laparotomy and splenectomy, remains essential. The value of this potentially curative treatment is considerably diminished in the patient who has been inadequately staged. (+info)
Return of lymphatic function after flap transfer for acute lymphedema.
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OBJECTIVE: The goals of this work were to develop animal models of lymphedema and tissue flap transfer, and to observe physiologic changes in lymphatic function that occur in these models over time, both systemically with lymphoscintigraphy (LS) and locally using fluorescence microlymphangiography (FM). SUMMARY BACKGROUND DATA: Although lymphedema has been managed by a combination of medical and surgical approaches, no effective long-term cure exists. Surgical attempts aimed at reconnecting impaired lymphatic channels or bypassing obstructed areas have failed. METHODS: The tails of rats (A groups) and mice (B groups) were used because of their different features. Lymphedema was created by ligation of the lymphatics at the tail base and quantified by diameter measurements there. In the experimental group, rectus abdominis myocutaneous flap was transferred across the ligation. In addition to the ligation (A1 and B1) and ligation + flap (A2 and B2) groups, three control groups were included: sham flap with ligation (B4), sham flap alone (B5), and normal (A3 and B3) animals. Observations were made at weekly time points for lymphatic function and continuity. RESULTS: Lymphedema was successfully created in the mouse ligation groups (B1 and B4) and sustained for the entire length of observation (up to 14 weeks). Lymphatic continuity was restored in those animals with transferred flaps across the ligation site (A2 and B2), as seen both by LS and FM. Sham flaps did not visibly affect lymphatic function nor did they cause any visible swelling in the tail. CONCLUSIONS: Acute lymphedema developing after ligation of tail lymphatics in mice can be prevented by myocutaneous flap transfer. Restored lymphatic continuity and function were demonstrable using lymphoscintigraphy and fluorescence microlymphangiography. (+info)
Lymphographic studies in acute lymphogranuloma venereum infection.
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Lymphography, a radiological method of demonstrating lymphatic channels and nodes, has been used to investigate three cases of acute bubonic lymphogranuloma venereum (LGV). There is general agreement that LGV has a predilection for lymphatic channels and lymph nodes. However, very little is known of the extent of lymph node involvement in the early bubonic stage and whether there is merely a lymphangitis or complete lymphatic obstruction. The present study was undertaken to determine the lymphographic appearance in acute bubonic LGV, the extent of lymphatic node involvement in early LGV, and the usefulness of the procedure in the management of LGV patients. The buboes were not outlined by this procedure. The vessel phase of the lymphogram appeared normal, while the nodal phase showed a gradient of pathological involvement from the inguinal region lessening towards the lumbar nodes. The main drawbacks of lymphography in LGV are the difficulty of visualizing the lymphatics in the negroid skin and the lack of diagnostic criteria for inflammatory diseases of the lymphatic system. The lymphographic findings in LGV as described here may be regarded as typical of LGV but cannot be accepted as specific for LGV with a high degree of confidence. It is suggested that the procedure could be used for monitoring patients with the severe and late sequelae of LGV infection. (+info)
Lymphatic microangiopathy of the skin in systemic sclerosis.
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METHODS: The cutaneous capillary lymphatic system in patients with systemic sclerosis was investigated using fluorescence microlymphography. The distal upper limbs of 16 healthy controls (mean age 62.3+/-13.1 yr) and 16 patients with systemic sclerosis (mean age 58.9+/-13.6 yr) were examined and the following parameters were evaluated: (a) single lymphatic capillaries; (b) lymphatic capillary network and cutaneous backflow; (c) extension of the stained lymphatics; (d) diameter of single lymphatic capillaries. RESULTS: At the finger level, lymphatic capillaries were lacking in five patients, while they were present in all controls (P < 0.05). Extension of the stained lymphatics was increased in 11 patients (8.1+/-6.0 mm) compared to the 16 healthy controls (2.0+/-1.2 mm) (P < 0.0001). Cutaneous backflow was observed in three patients (P < 0.05). At the hand level, lymphatic network extension was significantly different between patients (3.8+/-2.4 mm) and controls (1.2+/-0.8 mm) (P < 0.01); however, no significant differences were found at the forearm level. CONCLUSION: Lesional skin in patients with systemic sclerosis exhibits evidence of lymphatic microangiopathy. (+info)
Nodal volume reduction after concurrent chemo- and radiotherapy: correlation between initial CT and histopathologic findings.
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BACKGROUND AND PURPOSE: The role of concurrent chemoradiation for treatment of head and neck squamous cell carcinoma is expanding. We sought to evaluate the CT appearance of diseased and normal cervical lymph nodes before and after concurrent chemoradiation and to correlate lymph node volume reduction as revealed by CT with histopathologic findings of resected nodes. METHODS: Using concurrent chemoradiation, we treated seven patients with locally advanced head and neck squamous cell carcinoma. Our chemotherapeutic regimen consisted of cisplatin (100 mg/m2 body surface area administered on days 1 through 4 and 29 through 32) and 5-fluorouracil (1000 mg/m2 body surface area, administered on days 1 through 4 and 29 through 32). Radiotherapy was administered twice per day on dosing days 1 through 42 to a total dose of 7200 cGy to the primary tumor and 6000 cGy to the involved lymph nodes. Pre- and post-treatment CT scans were used to calculate lymph node volumes for all CT-positive (size criteria or extracapsular spread or both) diseased nodes (n = 19) and one normal node per patient (n = 7). Volume reduction was determined by CT results and correlated with the histopathologic findings of resected nodes. RESULTS: Average volume reduction (+/- standard error of the mean) for the 19 diseased nodes was 91%+/-4% and for the seven normal nodes was 55%+/-21% (P < .02, two-sided t test). Fifteen of 19 of the diseased lymph nodes showed extracapsular spread before treatment and none of 19 after treatment. The histopathologic findings of resected nodes included persistent tumor in one of the 19 diseased lymph nodes. Six of seven patients remained alive and disease-free, with an average follow-up duration of 24 months. CONCLUSION: Nodal volume reduction of greater than 90% was associated with eradication of tumor as assessed by histopathologic analysis of resected nodes. Serial CT scans obtained both before and after concurrent chemoradiation may be useful for predicting which patients will benefit from adjuvant surgical therapy. (+info)
Absence of functional lymphatics within a murine sarcoma: a molecular and functional evaluation.
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Despite a clinically recognized association between the lymphatics and metastasis, the biology of tumor-lymphatic interaction is not clearly understood. We report here that functional lymphatic capillaries are absent from the interior of a solid tumor, despite the presence within the tumor of the lymphangiogenic molecule vascular endothelial growth factor (VEGF)-C and endothelial cells bearing its receptor, VEGF receptor 3. Functional lymphatics, enlarged and VEGF receptor 3 positive, were detected in some tumors only at the tumor periphery (within 100 microm of the interface with normal tissue). We conclude that although lymphangiogenic factors are present, formation of functional lymphatic vessels is prevented, possibly due to collapse by the solid stress exerted by growing cancer cells. (+info)
Non-Hodgkin's lymphomata: clinical and immunological data in relation to histology.
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Two hundred and forty-four previously untreated patients seen since 1964 in the department of haematology at Saint-Louis hospital were analysed. Clinical data included results of initial work-up and prognosis evaluated by survival rate matched with principal variables: age, sex, histopathology, staging, incidence of clinical and biological systemic symptoms. Immunological data included results of systematic studies made in each category of non-Hodgkin's lymphomata. Hyperbasophilic lymphoma, a special group recently characterized, is discussed. (+info)
A clinicopathological study of stages I and II non-Hodgkin's lymphomata using the Lukes-Collins classification.
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A series of 226 patients with Stages I and II non-Hodgkin's lymphomata, treated with intensive irradiation to the involved regions, were studied using the Lukes-Collins classification. A statistically significant difference was found in the length of survival of patients with the follicular and the diffuse types of lymphoma. A difference in survival was also observed among those with the 3 subtypes of follicular lymphomata. The extent to which the follicular pattern could be recognized and whether or not lymphoma cells were confined to the follicular structures likewise had a bearing upon the survival of patients with follicular lymphomata. In this series, no significant difference in survival was found between the histological types of diffuse lymphoma. The relationship of the methods of staging to survival in this series, and the findings at staging laparotomy in other series suggest that the lymphangiogram is less valuable for detecting intra-abdominal disease in the non-Hodgkin's lymphomata than in Hodgkin's disease, probably because of the high incidence of involvement of mesenteric lymph nodes in the non-Hodgkin's lymphomata. (+info)