Human lymphatic pumping measured in healthy and lymphoedematous arms by lymphatic congestion lymphoscintigraphy
Identifieur interne : 002728 ( Pmc/Curation ); précédent : 002727; suivant : 002729Human lymphatic pumping measured in healthy and lymphoedematous arms by lymphatic congestion lymphoscintigraphy
Auteurs : S. Modi [Royaume-Uni] ; A W B. Stanton [Royaume-Uni] ; W E Svensson [Royaume-Uni] ; A M Peters [Royaume-Uni] ; P S Mortimer [Royaume-Uni] ; J R Levick [Royaume-Uni]Source :
- The Journal of Physiology [ 0022-3751 ] ; 2007.
Abstract
Axillary surgery for breast cancer partially obstructs lymph outflow from the arm, chronically raising the lymphatic smooth muscle afterload. This may lead to pump failure, as in hypertensive cardiac failure, and could explain features of breast cancer treatment-related lymphoedema (BCRL) such as its delayed onset. A new method was developed to measure human lymphatic contractility non-invasively and test the hypothesis of contractile impairment. 99mTc-human IgG (Tc-HIG), injected into the hand dermis, drained into the arm lymphatic system which was imaged using a gamma-camera. Lymph transit time from hand to axilla,
Url:
DOI: 10.1113/jphysiol.2007.130401
PubMed: 17569739
PubMed Central: 2277237
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<series><title level="j">The Journal of Physiology</title>
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<front><div type="abstract" xml:lang="en"><p>Axillary surgery for breast cancer partially obstructs lymph outflow from the arm, chronically raising the lymphatic smooth muscle afterload. This may lead to pump failure, as in hypertensive cardiac failure, and could explain features of breast cancer treatment-related lymphoedema (BCRL) such as its delayed onset. A new method was developed to measure human lymphatic contractility non-invasively and test the hypothesis of contractile impairment. <sup>99m</sup>
Tc-human IgG (Tc-HIG), injected into the hand dermis, drained into the arm lymphatic system which was imaged using a gamma-camera. Lymph transit time from hand to axilla, <italic>t</italic>
<sub>transit</sub>
, was 9.6 ± 7.2 min (mean ±<sc>s.d.</sc>
) (velocity 8.9 cm min<sup>−1</sup>
) in seven normal subjects. To assess lymphatic contractility, a sphygmomanometer cuff around the upper arm was inflated to 60 mmHg (<italic>P</italic>
<sub>cuff</sub>
) before <sup>99m</sup>
Tc-HIG injection and maintained for >> <italic>t</italic>
<sub>transit</sub>
. When <italic>P</italic>
<sub>cuff</sub>
exceeded the maximum pressure generated by the lymphatic pump (<italic>P</italic>
<sub>pump</sub>
), radiolabelled lymph was held up at the distal cuff border. <italic>P</italic>
<sub>cuff</sub>
was then lowered in 10 mmHg steps until <sup>99m</sup>
Tc-HIG began to flow under the cuff to the axilla, indicating <italic>P</italic>
<sub>pump</sub>
≥<italic>P</italic>
<sub>cuff</sub>
. In 16 normal subjects <italic>P</italic>
<sub>pump</sub>
was 39 ± 14 mmHg. <italic>P</italic>
<sub>pump</sub>
was 38% lower in 16 women with BCRL, namely 24 ± 19 mmHg (<italic>P</italic>
= 0.014, Student's unpaired <italic>t</italic>
test), and correlated negatively with the degree of swelling (12–56%). Blood radiolabel accumulation proved an unreliable measure of lymphatic pump function. Lymphatic congestion lymphoscintigraphy thus provided a quantitative measure of human lymphatic contractility without surgical cut-down, and the results supported the hypothesis of lymphatic pump failure in BCRL.</p>
</div>
</front>
</TEI>
<pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Physiol</journal-id>
<journal-id journal-id-type="publisher-id">tjp</journal-id>
<journal-title>The Journal of Physiology</journal-title>
<issn pub-type="ppub">0022-3751</issn>
<issn pub-type="epub">1469-7793</issn>
<publisher><publisher-name>Blackwell Science Inc</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">17569739</article-id>
<article-id pub-id-type="pmc">2277237</article-id>
<article-id pub-id-type="doi">10.1113/jphysiol.2007.130401</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Cardiovascular</subject>
</subj-group>
</article-categories>
<title-group><article-title>Human lymphatic pumping measured in healthy and lymphoedematous arms by lymphatic congestion lymphoscintigraphy</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Modi</surname>
<given-names>S</given-names>
</name>
<xref ref-type="aff" rid="au1">1</xref>
<xref ref-type="aff" rid="au3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Stanton</surname>
<given-names>A W B</given-names>
</name>
<xref ref-type="aff" rid="au1">1</xref>
<xref ref-type="aff" rid="au3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Svensson</surname>
<given-names>W E</given-names>
</name>
<xref ref-type="aff" rid="au3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Peters</surname>
<given-names>A M</given-names>
</name>
<xref ref-type="aff" rid="au4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mortimer</surname>
<given-names>P S</given-names>
</name>
<xref ref-type="aff" rid="au1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Levick</surname>
<given-names>J R</given-names>
</name>
<xref ref-type="aff" rid="au2">2</xref>
</contrib>
<aff id="au1"><label>1</label>
<institution>Cardiac and Vascular Sciences (Dermatology), University of London</institution>
<addr-line>London SW17 0RE, UK</addr-line>
</aff>
<aff id="au2"><label>2</label>
<institution>Basic Medical Sciences (Physiology), St George's Hospital Medical School, University of London</institution>
<addr-line>London SW17 0RE, UK</addr-line>
</aff>
<aff id="au3"><label>3</label>
<institution>Nuclear Medicine, Hammersmith Hospital</institution>
<addr-line>London W12 0HS, UK</addr-line>
</aff>
<aff id="au4"><label>4</label>
<institution>Nuclear Medicine, Royal Sussex County Hospital</institution>
<addr-line>Brighton BN2 5BE, UK</addr-line>
</aff>
</contrib-group>
<author-notes><corresp id="cor1"><bold>Corresponding author</bold>
A. W. B. Stanton: St George's Hospital Medical School, University of London, Cranmer Terrace, London SW17 0RE, UK. Email: <email>astanton@sgul.ac.uk</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><day>15</day>
<month>8</month>
<year>2007</year>
</pub-date>
<pub-date pub-type="epub"><day>14</day>
<month>6</month>
<year>2007</year>
</pub-date>
<volume>583</volume>
<issue>Pt 1</issue>
<fpage>271</fpage>
<lpage>285</lpage>
<history><date date-type="received"><day>13</day>
<month>2</month>
<year>2007</year>
</date>
<date date-type="accepted"><day>10</day>
<month>6</month>
<year>2007</year>
</date>
</history>
<copyright-statement>© 2007 The Authors. Journal compilation © 2007 The Physiological Society</copyright-statement>
<copyright-year>2007</copyright-year>
<abstract><p>Axillary surgery for breast cancer partially obstructs lymph outflow from the arm, chronically raising the lymphatic smooth muscle afterload. This may lead to pump failure, as in hypertensive cardiac failure, and could explain features of breast cancer treatment-related lymphoedema (BCRL) such as its delayed onset. A new method was developed to measure human lymphatic contractility non-invasively and test the hypothesis of contractile impairment. <sup>99m</sup>
Tc-human IgG (Tc-HIG), injected into the hand dermis, drained into the arm lymphatic system which was imaged using a gamma-camera. Lymph transit time from hand to axilla, <italic>t</italic>
<sub>transit</sub>
, was 9.6 ± 7.2 min (mean ±<sc>s.d.</sc>
) (velocity 8.9 cm min<sup>−1</sup>
) in seven normal subjects. To assess lymphatic contractility, a sphygmomanometer cuff around the upper arm was inflated to 60 mmHg (<italic>P</italic>
<sub>cuff</sub>
) before <sup>99m</sup>
Tc-HIG injection and maintained for >> <italic>t</italic>
<sub>transit</sub>
. When <italic>P</italic>
<sub>cuff</sub>
exceeded the maximum pressure generated by the lymphatic pump (<italic>P</italic>
<sub>pump</sub>
), radiolabelled lymph was held up at the distal cuff border. <italic>P</italic>
<sub>cuff</sub>
was then lowered in 10 mmHg steps until <sup>99m</sup>
Tc-HIG began to flow under the cuff to the axilla, indicating <italic>P</italic>
<sub>pump</sub>
≥<italic>P</italic>
<sub>cuff</sub>
. In 16 normal subjects <italic>P</italic>
<sub>pump</sub>
was 39 ± 14 mmHg. <italic>P</italic>
<sub>pump</sub>
was 38% lower in 16 women with BCRL, namely 24 ± 19 mmHg (<italic>P</italic>
= 0.014, Student's unpaired <italic>t</italic>
test), and correlated negatively with the degree of swelling (12–56%). Blood radiolabel accumulation proved an unreliable measure of lymphatic pump function. Lymphatic congestion lymphoscintigraphy thus provided a quantitative measure of human lymphatic contractility without surgical cut-down, and the results supported the hypothesis of lymphatic pump failure in BCRL.</p>
</abstract>
</article-meta>
</front>
</pmc>
</record>
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