• Parasites, Hosts and Diseases
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• v.46 no.3
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• pp.119-125
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• 2008

Lymphatic filariasis, transmitted by mosquitoes is the commonest cause of lymphedema in endemic countries. Among 120 million infected people in 83 countries, up to 16 million have lymphedema. Microfilariae ingested by mosquitoes grow into infective larvae. These larvae entering humans after infected mosquito bites grow in the lymphatics to adult worms that cause damage to lymphatics resulting in dilatation of lymph vessels. This earliest pathology is demonstrated in adults as well as in children, by ultrasonography, lymphoscintigraphy and histopathology studies. Once established, this damage was thought to be irreversible. This lymphatic damage predisposes to bacterial infection that causes recurrent acute attacks of dermato-lymphangio-adenitis in the affected limbs. Bacteria, mainly streptococci gain entry into the lymphatics through 'entry lesions' in skin, like interdigital fungal infections, injuries, eczema or similar causes that disrupt integrity of skin. Attacks of dermato-lymphangio-adenitis aggravates lymphatic damage causing lymphedema, which gets worse with repeated acute attacks. Elephantiasis is a late manifestation of lymphatic filariasis, which apart from limbs may involve genitalia or breasts. Lymphedema management includes use of antifilarial drugs in early stages, treatment and prevention of acute attacks through 'limb-hygiene', antibiotics and antifungals where indicated, and physical measures to reduce the swelling. In selected cases surgery is helpful.

• Journal of Veterinary Clinics
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• v.35 no.6
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• pp.299-301
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• 2018

A 7-year-old intact female Shih-Tzu with chylothorax was presented. Percutaneous popliteal computed tomographic lymphangiography was performed to evaluate the thoracic duct and seek any potential cause of chylothorax. Despite two attempts, visualization of the thoracic duct failed and perianal subcutaneous computed tomographic lymphangiography with injection of iodinated, nonionic water-soluble contrast medium (0.6 ml/kg) was performed. A single branch of intact thoracic duct and dilated and tortuous lymphatics were detected. It was diagnosed as idiopathic chylothorax. Perianal subcutaneous lymphangiography is considered a less-invasive, easy and reliable method to visualize lymphatics in patients with chylothorax.

• Journal of Pharmaceutical Investigation
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• v.40 no.spc
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• pp.75-82
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• 2010

Specific diseases like cancer and acquired immune deficiency syndrome (AIDS) occur at various organs including lymphatics and spread through lymphatic system. Thus, if therapeutic agents for such diseases are more distributed or targeted to lymphatic system, we can obtain several advantages like reduction of systemic side effect and increase of efficacy. For these reasons, much interest has been focused on the nature of lymphatics and a lot of studies for lymphatic delivery of drugs have been carried out. Because lymphatics consist of single layer endothelium and have high permeability compared with blood capillaries, especially, the studies using nano-sized carriers have been performed. Polymeric nano-particle, liposome, and lipid-based vehicle have been adopted for lymphatic delivery as carriers. According to the administration route and the kind of carrier, the extent of lymphatic delivery efficiency of nano-sized carriers has been changed and influenced by several factors such as size, charge, hydrophobicity and surface feature of carrier. In this review, we summarized the key factors which affect lymphatic uptake and the major features of carriers for achieving the lymphatic delivery. Lymphatic delivery of drug using nano-sized carriers has many fold improved ability of lymphatic delivery compared with that of conventional dosage forms, but it has not shown whole lymph selectivity yet. Even though nano-sized carriers still have the potential and worth to study as lymphatic drug delivery technology as before, full understanding of delivery mechanism and influencing factors, and setting of pharmacokinetic model are required for more ideal lymphatic delivery of drug.

• Archives of Plastic Surgery
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• v.51 no.1
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• pp.130-134
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• 2024

Refractory chylous ascites can cause significant nutritional and immunologic morbidity, but no clear treatment has been established. This article introduces a case of a 22-year-old female patient with an underlying lymphatic anomaly who presented with refractory chylous ascites after laparoscopic adnexectomy for ovarian teratoma which aggravated after thoracic duct embolization. Ascites (>3,000 mL/d) had to be drained via a percutaneous catheter to relieve abdominal distention and consequent dyspnea, leading to significant cachexia and weight loss. Two sessions of hybrid lymphovenous anastomosis (LVA) surgery with intraoperative mesenteric lymphangiography guidance were performed to decompress the lymphatics. The first LVA was done between inferior mesenteric vein and left para-aortic enlarged lymphatics in a side-to-side manner. The daily drainage of chylous ascites significantly decreased to 130 mL/day immediately following surgery but increased 6 days later. An additional LVA was performed between right ovarian vein and enlarged lymphatics in aortocaval area in side-to-side and end-to-side manner. The chylous ascites resolved subsequently without any complications, and the patient was discharged after 2 weeks. The patient regained weight without ascites recurrence after 22 months of follow-up. This case shares a successful experience of treating refractory chylous ascites with lymphatic anomaly through LVA, reversing the patient's life-threatening weight loss. LVA was applied with a multidisciplinary approach using intraoperative mesenteric lipiodol, and results showed the possibility of expanding its use to challenging problems in the intraperitoneal cavity.

• Biotechnology and Bioprocess Engineering:BBE
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• v.10 no.6
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• pp.516-521
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• 2005

Drug delivery to the lymphatic system may be important in terms of the treatment with lymphatic involvement, such as tumor metastases and immunization. Especially, drug transport via the intestinal lymphatics after oral administration has been attracted lots of interests. The purpose of this study was to prepare cyclosporin A (CSA)-loaded liposomes, with different characteristics, and evaluate their mucoadhesivity. Three liposome preparations were formulated: cationic stearylamine liposomes (SA-Lip), anionic phosphatidylserine liposomes (PS-Lip), Polymer (chitosan)-coated liposomes (CS-Lip), and characterized. The liposome preparations were found to be spherical in shape, with PS-Lip being the smallest. The liposome preparations exhibited entrapment efficiencies in the order: PS-Lip $(52.5{\pm}2.9%)$ > SA-Lip $(48.8{\pm}3.3%)$ > CS-Lip $(41.7{\pm}4.2%)$. Finally, mucoadhesive tests were carried out using rat intestine, with SA-Lip (67%) showing the best adhesive rate of the three preparations (PS-Lip: 56%, CS-Lip: 61%). These results suggest that a positive charge on the surface of drug carriers may be an important factor for the intestinal drug delivery.

• Journal of Veterinary Clinics
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• v.19 no.4
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• pp.450-454
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• 2002

A five-year-old, female Great Dane dog with edema, localized trauma, mild pain, and lameness of the right hind limb was referred to the Veterinary Medical Teaching Hospital of Chungbuk National University. This dog had a history of mammary tumor excisions 6 months ago. Abnormal changes were not seen in the values of complete blood count and serum biochemical tests. But pedal direct lymphangiography using aqueous-based radiographic agent showed the obstructed lymph flow in right popliteal lymph node. Based on these observations, the dog was suspected as lymphedema resulted from lymph drainage flilure without any other possibilities of inflammation or other causes. Although recommended chemotherapy and physiotherapy had been applied for resolvinr presented problems for one month, there was no improvement on edema of damaged region and any other clinical signs. Therefore, the necropsy was performed after euthanasia under agreement of the owner of patient. In histopatholofical examination, the most characteristic lesions in the mass of femoral region were diffuse edema fibrosis and neoplastic cells in the lymphatics. Also, the neoplastic cells were very similar to those found in the tumor mass of mammary gland, which had diagnosed as fibrosing carcinoma. These facts suggested that the cause of obstructed lymph flow was the neoplasia in lymphatics of the right hind limb. With these results, a diagnosis of malignant lymphedema was made in this dog.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1057-1059
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• 1999

Lymphangioleiomyomatosis(LAM) is defined as an abnormal proliferation of smooth muscles in the lung tissue throughout lymphatics, vascular and bronchial structure. A 52-year-old postmenopausal woman was admitted to our hospital for recurrent pneumothorax. She was treated for medroxyprogesterone by LAM 1 month ago. We performed operation of pulmonary partial resection and pleurodesis. The patient is receiving continuous medroxyprogesterone and Leuplin administration, and currently, 6 months after the operation, is still showing good results.

• Journal of Chest Surgery
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• v.33 no.2
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• pp.193-194
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• 2000

A 45-year-old woman was diagnosed as having chylothorax after a mitral valve replacement for mitral stenosis. direct injury of lymphatics in thymus a ramification of thoracic duct was presumed to be responsibe for this complication. Four weeks of conservative treatment failed and surgical treatment was performed, We report a case of surgical treatment for chlyothorax after and open heart surgery.

• Archives of Plastic Surgery
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• v.48 no.3
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• pp.246-253
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• 2021

In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient's pathology, the treatment plan should be carefully decided and individualized. At the authors' institution, the treatment plan is made individually based on each patient's symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient's pathophysiology, optimal outcomes can be achieved. Depending on each patient's pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.1
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• pp.35-41
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• 2006

Purpose: A various find of radiotherapy treatment plans have been made to determine appropriate doses for breasts, chest walls and loco-regional lymphatics in the radiotherapy of breast cancers. The aim of this study was to evaluate the optimum radiotherapy plan technique method by analyzing dose distributions qualitatively and quantitatively. Materials and Methods: To evaluate the optimum breast cancer radiotherapy plan technique, the traditional method(two dimensional method) and computed tomography image are adopted to get breast volume, and they are compared with the three-dimensional conformal radiography (3DCRT) and the intensity modulated radiotherapy (IMRT). For this, the regions of interest (ROI) such as breasts, chest walls, loco-regional lymphatics and lungs were marked on the humanoid phantom, and the computed tomography(Volume, Siemens, USA) was conducted. Using the computed tomography image obtained, radiotherapy treatment plans (XiO 5.2.1, FOCUS, USA) were made and compared with the traditional methods by applying 3DCRT and IMRT. The comparison and analysis were made by analyzing and conducting radiation dose distribution and dose-volume histogram (DVH) based upon radiotherapy techniques (2D, 3DCRT, IMRT) and point doses for the regions of interest. Again, treatment efficiency was evaluated based upon time-labor. Results: It was found that the case of using 3DCRT plan techniques by getting breast volume is more useful than the traditional methods in terms of tumor delineation, beam direction and confirmation of field boundary. Conclusion: It was possible to present the optimum radiotherapy plan techniques through qualitative and quantitative analyses based upon radiotherapy plan techniques in case of breast cancer radiotherapy. However, further studies are required for the problems with patient setup reproducibility arising from the difficulties of planning target volume (PVT) and breast immobilization in case of three-dimensional radiotherapy planning.