RESUMO
BACKGROUND: Intestinal ischemia and reperfusion (I/R) is a documented cause of acute lung injury (ALI) and systemic inflammation. We previously reported that obstruction of thoracic lymphatic flow during intestinal I/R blunts pulmonary neutrophil recruitment and microvascular injury and decreases the systemic levels of tumor necrosis factor. Here, we consider the existence of a gut-lung axis promoting the induction of systemic inflammation, whereby drained intestinal lymph stimulates lung expression of adhesion molecules and matrix components and generation of inflammatory mediators. MATERIAL AND METHODS: Upon administration of anesthesia, male Wistar rats were subjected to occlusion of the superior mesenteric artery for 45 min, followed by 2 h of intestinal reperfusion (I/R); groups of rats were subjected to I/R with or without thoracic lymphatic duct ligation immediately before the procedure. The non-manipulated rats were used to investigate basal parameters. RESULTS: Obstruction of thoracic lymphatic flow before intestinal I/R decreased the ability of cultured lung tissue explants to release IL-1ß, IL-10, and VEGF. In contrast, lymphatic obstruction normalized the elevated lung expression of PECAM-1 caused by intestinal I/R. On the other hand, lung E-selectin expression was significantly reduced, whereas fibronectin expression and collagen synthesis were not affected. Lymph levels of LTB(4) and TXB(2) were found to be significantly increased. CONCLUSIONS: These data suggest that lymph factors drained from the intestine during ischemic trauma stimulate the lung to generate inflammatory mediators and alter the expression of adhesion molecules. Disturbances in lung homeostasis mediated by lymph might contribute to the spread of inflammatory processes, thereby accounting for the systemic inflammation induced by intestinal I/R.
Assuntos
Moléculas de Adesão Celular/metabolismo , Mediadores da Inflamação/metabolismo , Intestinos/irrigação sanguínea , Intestinos/fisiologia , Pulmão/metabolismo , Sistema Linfático/fisiologia , Traumatismo por Reperfusão/metabolismo , Animais , Eicosanoides/metabolismo , Interleucina-10/metabolismo , Interleucina-1beta/metabolismo , Ligadura , Sistema Linfático/cirurgia , Masculino , Modelos Animais , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo , Ratos , Ratos Wistar , Traumatismo por Reperfusão/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
OBJECTIVE: To evaluate postoperative lymphatic compensation in the upper limb after mastectomy with axillary dissection. SUBJECTS AND METHODS: Twenty-three patients who underwent lymphoscintigraphy before and 60 days after surgery were enrolled from September 2006 to June 2007, in Campinas, Brazil. Protocol examination consisted in static imaging of each upper limb in semi-flexion and thoracic imaging after 10 min and 1 and 2 hr after subcutaneous injection of 1 mCi (37 MBq) of 99mTc dextran into the dorsum of the hand. A comparative analysis was made of hepatic uptake of the radiopharmaceutical, velocity of axillary lymph node visualization (I, visible at 10 min; II, at 1 hr; III, at 2 hr; IV, not visible) and degree (intensity) of uptake (a, marked; b, moderate; c, mild; d, absent) before and 60 days after surgery. RESULTS: In the preoperative period, 3 (13%) patients were considered to have an optimal pattern (Ia) and 2 (9%) showed total involvement (IVd). Compared to velocity in the postoperative period, 9 (39%) patients showed no difference, 5 (22%) improved, 9 (39%) became worse, and one was considerably worse. Regarding the degree, 10 (43%) patients showed no difference, 9 (39%) became worse, and 4 (17%) improved. Regarding classification, 2 (9%) patients had an optimal lymphatic pattern (Ia) and 3 (13%) had total involvement (IVd). No patient presented decreased hepatic uptake after surgical treatment. CONCLUSIONS: The study found relevant changes in preoperative and postoperative lymphoscintigraphy, demonstrating the existence of functional differences in the lymphatic system of the upper limb. Alterations in lymphatic drainage pattern may already be perceived 60 days postoperatively, as can signs of lymphovenous anastomoses.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Excisão de Linfonodo/efeitos adversos , Sistema Linfático/fisiopatologia , Mastectomia/métodos , Recuperação de Função Fisiológica , Extremidade Superior , Adulto , Idoso , Axila , Brasil , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Sistema Linfático/cirurgia , Vasos Linfáticos/fisiopatologia , Linfedema/etiologia , Linfedema/fisiopatologia , Linfocintigrafia , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Risco , Resultado do Tratamento , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/fisiopatologiaRESUMO
Although the antiinflammatory and antiangiogenic properties of dexamethasone and acetylsalicylic acid have been studied extensively, their effects on lymphangiogenesis in regenerating tissues remain mostly unknown. We studied in rats the pharmacological modulation and the effect of a remote inflammatory stimulus on the lymphatic regeneration upon damage after a surgical procedure. A micronized purified flavonoid fraction bearing antiinflammatory and lymphagogue properties, was also used. An incisional wound and interruption of the afferent lymphatic vessels to the popliteal and axillary lymph nodes of adult rats were made in dorsal thigh and hypochondrium, respectively. The progress of lymphatic regeneration was evaluated 3, 7, 14 and 21 days after surgery. (99m)Tc-dextran lymphoscintigraphy and Evans blue dye uptake were used to evaluate the lymphatic flow and the kinetics of lymphatic regeneration. In control conditions, lymphatic regeneration took 14 days to be accomplished. In the presence of a remote inflammatory response, which conceivably yielded inflammatory mediators to the incised lymphatic vessels, that time was shortened to 7 days. In both conditions, lymphatic regeneration was inhibited by dexamethasone and acetylsalicylic acid and accelerated by the micronized purified flavonoid fraction. These findings indicate that lymphatic regeneration in an incisional wound may be significantly modulated by dexamethasone, aspirin and a micronized purified flavonoid fraction, and these results call our attention for the possibility to pharmacologically stimulate the recovery of a lymphatic failure due to a traumatic event, or to inhibit its function in order to limit the lymphatic spread of cytokines or neoplastic cells.
Assuntos
Anti-Inflamatórios/farmacologia , Aspirina/farmacologia , Dexametasona/farmacologia , Flavonoides/farmacologia , Linfangiogênese/efeitos dos fármacos , Sistema Linfático/efeitos dos fármacos , Regeneração/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Animais , Dextranos , Azul Evans , Indicadores e Reagentes , Inflamação/fisiopatologia , Sistema Linfático/fisiopatologia , Sistema Linfático/cirurgia , Linfocintigrafia , Masculino , Compostos de Organotecnécio , Compostos Radiofarmacêuticos , Ratos , Ratos Wistar , Fatores de TempoAssuntos
Humanos , Masculino , Feminino , Cirurgia Geral , Diagnóstico , Dermatopatias/cirurgia , Dermatopatias/diagnóstico , Pescoço/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Mama/cirurgia , Esôfago/cirurgia , Abdome/cirurgia , Doenças Cardiovasculares/cirurgia , Sistema Linfático/cirurgia , Pé Diabético/cirurgia , Mãos/cirurgiaRESUMO
O objetivo deste estudo é avaliar as lesöes linfáticas nos membros inferiores empacientes submetidos à cirurgia de varizes. Foi realizada linfocintilografia com trissulfito de antimônio marcado com Tecnécio (99m) em 20 membros no primeiro dia de pós-operatório. O extravasamento de contraste foi interpretado como evidência de lesão dos canais linfáticos. Nove membros tiveram a excisão simples de veias varicosas; onze pacientes tiveram além das exicisöes das veias varicosas, também safenectomia parcial ou total da veia sefena magna. Oito dos vinte membros estudados (40 'por cento') apresentaram lesöes à linfocintilografia. Evidências de lesöes linfáticas foram encontradas em 7 dos 11 membros safenectomizados (63,3 'por cento') e somente um dos 9 membros no grupo de excisão simples de veias varicosas (11,1 'por cento'). A diferença entre os grupos foi estatisticamente significante (p<0,05; teste de Fisher). Os autores concluem que a lesão linfática é comum em cirurgia de varizes, especialmente quando a safenectomia magna é realizada.
Assuntos
Sistema Linfático/cirurgia , Varizes Esofágicas e Gástricas/cirurgia , Incidência , Cuidados Pós-Operatórios , Fatores de Tempo , Resultado do TratamentoRESUMO
From March, 1987 to July 1990, 1,568 surgical procedures, were done at Oncological Gynecology Service; 206 of them (13.1%) were considered as "non-gynecological" surgical procedures; 182 (88.3%) were secondary to a malignity diagnosis, being the most frequent one ovarian carcinoma (54.4%). As to benign lesions, 11.7% caused "non gynecological" surgery, most frequent were severe pelvic adhesions, 41.6%, and severe endometriosis, 25%. "Non-gynecological" surgical procedure carried out most frequently was pelvic lymphadenectomy. Morbidity was 3.8%, and mortality, 0.48% due to acute myocardial infarction. The acceptance for oncologic gynecologist is justified in this series, based on survival and morbi-mortality, which permits the participation in a multidisciplinary team.
Assuntos
Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos Operatórios , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Neoplasias dos Genitais Femininos/epidemiologia , Humanos , Sistema Linfático/cirurgia , México/epidemiologia , Reoperação/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Sistema Urinário/cirurgiaRESUMO
This experimental study in dogs presents a new technique of microlympho-venous anastomosis to improve long-term patency rates and clinical results in lymphedema therapy. Technical points, such as an oval window on the wall of the vein and a few sutures piercing only two lymphatic layers, adventitia and media, outside the lumen for successful results are emphasized. Three methods for assessment of patency of anastomoses were used: (1) observation with operating microscope of dye transit across the anastomotic site; (2) lymphography, and (3) histopathologic examination. Of 23 dogs, five were used to perfect the technique, three died after operation, while the remaining 15 were divided into three groups of five dogs each. In the first group which were explored one month after surgery, all anastomoses were patent (100% patency). In the second group, explored three months after surgery, one anastomosis was obstructed and four were patent (80% patency). In the third group, explored six months after surgery, one anastomosis was obstructed and four were patent (80% patency). The results obtained with this technique and the occurrence of a similar physiological lympho-venous anastomosis suggest that end-to-side anastomosis may be the technique of choice.
Assuntos
Sistema Linfático/cirurgia , Microcirurgia/métodos , Anastomose Cirúrgica/métodos , Animais , Cães , Feminino , Linfedema/cirurgia , Linfografia , Masculino , Técnicas de Sutura , Grau de Desobstrução VascularRESUMO
Se presenta un estudio de 15 pacientes con trauma quirúrgico del sistema linfático. En la mayoría de los casos la duración de la linforrea fué de 10 a 22 días, lograndose buena evolución con tratamiento conservador. Se comentan las causas, manifestaciones clínicas y evolución, así como las medidas para evitar estas lesiones.