Abstract:
:Disturbances in blood capillary exchange of fluid, macromolecules, and cells across intact and abnormal microvessels and deranged lymphatic transport are integral, interacting components in disorders of tissue swelling. Lymphedema or low-output failure of the lymph circulation is often indolent for many years before lymphatic insufficiency (failure) and tissue swelling emerge and persist. Superimposed occult or overt infection (lymphangitis) are probably major contributors to progressive limb deformity (elephantiasis). Long-standing lymphedema is characterized by trapping in the skin and subcutaneous tissue of fluid, extravasated plasma proteins, and other macromolecules: impaired immune cell trafficking; abnormal processing of autologous and foreign antigens; heightened susceptibility to superimposed infection; local immunodysregulation; defective lymphatic (lymphangion) propulsion from an imbalance of mediators regulating vasomotion; soft-tissue overgrowth; scarring and hypertrophy; and exuberant angiogenesis occasionally culminating in vascular tumors (Fig. 8). In contrast to the blood circulation, where flow depends primarily on the propulsive force of the myocardium, lymph propulsion depends predominately on intrinsic truncal contraction, a phylogenetic vestige of amphibian lymph hearts. Whereas venous "plasma" flows rapidly (2-3 l/min) against low vascular resistance, lymph flows slowly (1-2 ml/min) against high vascular resistance. On occasion, impaired transport of intestinal lymph may be associated with reflux and accumulation and leakage of intestinal chyle in a swollen leg. Although the term "lymphedema" is usually reserved for extremity swelling, the pathogenesis of a wide variety of visceral disorders also may be traceable to defective tissue fluid and macromolecular circulation and impaired cell trafficking of lymphocytes and macrophages. Thus, lymph stasis, with impaired tissue fluid flow, underlies or complicates an indolent subclinical course with a long latent period and sporadic episodes of lymphangitis, which culminates in intense scarring. Examples are pulmonary fibrosis (e.g., pneumoconiosis), regional enteritis, retroperitoneal fibrosis, and perhaps chronic pancreatitis and cirrhosis of the liver. Transdifferentiation and ultimately transformation of endothelial and other vascular accessory cells during lymph stasis also may be pivotal to a wide range of dysplastic and neoplastic vascular disorders, including Stewart-Treves angiosarcoma, AIDS-associated Kaposi's sarcoma, and lymphangitic metastatic carcinomatosis. Lymphscintigraphy has now replaced conventional lymphography as the procedure of choice to corroborate the diagnosis of peripheral lymphedema, whereas MR imaging using paramagnetic and superparamagnetic contrast agents has the potential to yield huge dividends in furthering understanding of a variety of enigmatic edematous states, including lymphedema. Not only are better explanations and insights into swelling disorders likely to be forthcoming, but, equally important, these new, safe, noninvasive imaging techniques can and should be used to monitor the evolution and document the efficacy of commonly advocated operations and nonoperative remedies for defective lymph transport and function.
journal_name
Acad Radioljournal_title
Academic radiologyauthors
Witte CL,Witte MHdoi
10.1016/s1076-6332(05)80193-xsubject
Has Abstractpub_date
1995-04-01 00:00:00pages
324-34issue
4eissn
1076-6332issn
1878-4046journal_volume
2pub_type
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journal_title:Academic radiology
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journal_title:Academic radiology
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journal_title:Academic radiology
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journal_title:Academic radiology
pub_type: 杂志文章
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更新日期:2019-01-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2005.10.025
更新日期:2006-05-01 00:00:00
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journal_title:Academic radiology
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更新日期:2012-11-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2018.11.015
更新日期:2019-10-01 00:00:00
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pub_type: 临床试验,杂志文章
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更新日期:2007-06-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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更新日期:2010-03-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章,评审
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更新日期:2019-03-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2020.10.026
更新日期:2020-11-11 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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更新日期:2020-03-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2018.03.023
更新日期:2019-01-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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更新日期:1998-06-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2010.04.015
更新日期:2010-09-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2010.04.025
更新日期:2010-09-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2016.06.004
更新日期:2016-10-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2015-12-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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journal_title:Academic radiology
pub_type: 杂志文章
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更新日期:2000-12-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2012.05.013
更新日期:2012-10-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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更新日期:1999-02-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2020.08.021
更新日期:2020-09-21 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
doi:10.1016/j.acra.2009.03.016
更新日期:2009-09-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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更新日期:2000-05-01 00:00:00
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journal_title:Academic radiology
pub_type: 杂志文章
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更新日期:2020-05-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2006-07-01 00:00:00
abstract::At our institution, we have developed a remediation team of strong, focused experts who help us with struggling learners in making the diagnosis and then coaching on their milestone deficits. It is key for all program directors to recognize struggling residents because early recognition and intervention gives the resi...
journal_title:Academic radiology
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更新日期:2017-06-01 00:00:00