Clonality, Growth and Spread of Cancer
Jeremy R. Jass in Understanding Pathology, 2020
Once cancer cells penetrate into the lumen (central cavity) of a vessel they can travel large distances with relative ease (Willis, 1952). Two types of vessel may be invaded: lymphatics and veins. One function of the lymphatic system is to prevent tissue swelling by draining excess fluid from the spaces between cells, returning it to the blood. The passage of fluid is interrupted by the presence of lymph nodes, whose principal function is to monitor invasion by micro-organisms and mount an appropriate immune response. Cancer cells may be trapped in lymph nodes, where they form secondary deposits. Eventually some cells will break away and continue along the lymphatic chain, spreading from node to node. It is for this reason that cancer surgery removes not only the main tumour but also the draining lymph nodes which may have succeeded in limiting the extent of spread. Once cancer has spread to lymph nodes, the chances of cure are reduced. By setting up colonies in lymph nodes the cancer has indicated it is capable of metastasis.
Inflammation
George Feuer, Felix A. de la Iglesia in Molecular Biochemistry of Human Disease, 2020
Following a mild lesion caused by bacteria, chemicals, or heat, the lymphatics dilate and open junctions are established between endothelial cells with subsequent increased permeability to blood cells and macromolecules. These changes are associated with the effects of edema fluid affecting anchoring filaments attached to the lymphatic wall.65 Inflammation causes a 10- to 20-fold increase in lymph flow and raises the protein concentration from 1 to 2 g/dl to 5g or more as a result of increased accumulation of proteins and cell debris in the interstitial tissue due to proteolytic enzyme activity. The lymphatics contain many enzymes which originated from injured tissue. Large molecules produced by enzyme action also increase the osmolarity of the interstitial fluid, particularly following bacterial injury or bums. In the case of thermal lesion, lymphatic drainage reaches a maximum in the first hour.384
Lymphoscintigraphy, lymphangiography, magnetic resonance imaging
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
The sentinel lymph node is the first lymph node that filters lymph draining from the tumor site. Lymphatic drainage varies greatly in each individual. Lymphoscintigraphy maps the drainage pattern in each patient. The Tc-fSC particles injected adjacent to the tumor site are trapped in the sentinel node. Pre-operative lymphoscintigraphy is valuable for identifying lymphatic drainage and sentinel node location. A hand-held γ-probe is then used intra-operatively to identify the lymph nodes where radioactivity has accumulated. Tracer injections in the dermis, subcutaneous tissue, and peri-tumor locations have all been used with reasonable results. Most reports have agreed that a combination of radioactive tracer with a visible dye (isosulfan blue) yields the best results. Investigators have reported the identification of a sentinel node in well over 90% of patients. The utility and long-term impact of sentinel node mapping and examination in the management of melanoma and breast cancer are well established, but are beyond the scope of this chapter.20–23
The eye area as the most difficult area of activity for esthetic treatment
Published in Journal of Dermatological Treatment, 2022
Anna Kołodziejczak, Helena Rotsztejn
In order to reduce swelling, blood flow should be stimulated with the use of manual massage, lymphatic drainage or endermology. It should be remembered that lymphatic stasis from the lateral part should be drain into the parotid nodes and from the medial part into the submandibular. Carboxytherapy can be used for chronic but not disease-related edema. Fat bags and fat tissue hernia are localized in the lower parts – below the orbital bone, and therefore more treatment techniques can be used. In such cases, the following techniques can be used: carboxytherapy, radiofrequency (preferably with partial vacuum), microneedle radiofrequency, HIFU/IFUS, endermology, and injection lipolysis (Kybella – deoxycholic acid). Body fat reduction therapies will be effective if the changes are resulting from excess body fat but without the accompanying skin and muscle laxity. Microsuction – excess fat and edema in the subdermal plane is suctioned with the use of a small-caliber liposuction cannula (2.3 or 3.0 mm) until the bulge is no longer palpable or visible (2,4,6).
Physical therapy in patients with systemic sclerosis: physical therapists’ perspectives on current delivery and educational needs
Published in Scandinavian Journal of Rheumatology, 2022
SIE Liem, NM van Leeuwen, TPM Vliet Vlieland, GMW Boerrigter, CHM van den Ende, LAJ de Pundert, MR Schriemer, J Spierings, MC Vonk, JK de Vries-Bouwstra
With respect to the content of physical therapy, our finding that exercise therapy was one of the most frequently used treatment modalities is in line with one German study (8). Our study adds to these results with a more detailed description of the treatment modalities employed. Moreover, in our study, the physical therapists were the source of information, whereas the German study was based on physician reports. We found that half of the physical therapists performed massage, but we did not specify the type of massage. The study by Belz et al (8) only looked at one type of massage, manual lymphatic drainage, making it difficult to compare these proportions. Importantly, in our study, SSc-specific exercises, including hand and mouth exercises, were employed less frequently than aerobic or muscle strengthening exercises. The extent to which these exercises could have been included in the home exercises given to the SSc patients remains to be explored. Yet, the current provision of hand and mouth exercises seems relatively low as, in general, approximately one-third of SSc patients experience difficulties with mouth opening, and at least half of the patients have limited hand function (18, 19). This difference could probably be explained by a combination of a lack of information in the referral, a lack of patients’, physicians’, and physical therapists’ awareness of the possibility, and/or a lack of knowledge.
Lung ultrasound-guided therapeutic thoracentesis in refractory congestive heart failure
Published in Acta Cardiologica, 2020
Aleksandar Lazarevic, Milan Dobric, Boris Goronja, Dijana Trninic, Svetozar Krivokuca, Jelena Jovanic, Eugenio Picano
The pleural cavity fluid is a dynamic variable since the parietal pleura continuously secretes small amounts of 20–30 mL of fluid daily, which is reabsorbed by the visceral pleura and lymphatic drainage [9]. The lymphatics have the capacity to reabsorb 20 times more fluid than is formed normally, and a pleural effusion develops when there is an excess pleural fluid formation or when there is decreased fluid removal from the lymphatics. In heart failure, the hemodynamic mechanism underlying pleural effusion is an increased right [10] or left atrial pressure [11,12]. Together with lung interstitium, pleural space acts as a sump for excess lung water [13]. The increased transudation exceeds the compensatory reserve of lymphatic drainage. When the amount of pleural effusion is moderate-to-severe, therapeutic thoracentesis improves ventilatory exchanges and corrects hypoxaemia at least partially, that may explain the immediate symptomatic relief [14]. In addition, therapeutic thoracentesis relieves the constrictive physiology of heart filling and low cardiac output which is frequently associated with massive pleural effusion [15,16]. Therapeutic thoracentesis therefore immediately improves symptoms and may restore a better lung function and myocardial performance, interrupting the vicious circle of increased pleural pressures, reduced lymphatic drainage, constrictive cardiac physiology, reduced lung ventilation and impaired tissue oxygenation leading to backward heart failure, increased pulmonary wedge and systemic venous pressures eventually worsening pleural effusion.