Search Results (37)

Background and Objectives: Lymphedema is one of the most important morbid complications of modified radical mastectomy (MRM) surgery. It can cause limb movement restriction and psychosocial deformities in some patients. This study aimed to determine and compare the physiological and pathological changes that develop in the axillary venous structures in patients who underwent axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). Materials and Methods: Patients diagnosed with breast cancer who underwent MRM and breast-conserving surgery (BCS) plus SLNB between 2017 and 2022 were retrospectively examined. The patients’ operation side and contralateral axillary vein diameter and the difference between them, axillary vein flow rate and the difference between them, axillary vein wall thickness and the difference between them, severity of lymphedema, extremity joint restriction examination, and the Nottingham Health Profile (NHP) data were recorded. The relationship of these parameters with the lymph node dissection width and radiotherapy was analyzed. Results: Fifty-eight patients in total were included in the study. In the distribution of lymphedema and lymphedema severity according to ALND groups, there is a statistically significant difference (p < 0.001). A statistically significant difference was determined in the distribution of the difference in the axillary vein blood flow rate and axillary vein diameter difference between the two arms according to the lymph node dissection groups. In the distribution of physical therapy and rehabilitation scales according to the lymph node dissection groups, a significant difference was found in the disabilities of the arm, shoulder, and hand (DASH), shoulder flexion restriction variables, and NHP sleep variables (all p < 0.001). Conclusions: This study demonstrated that ALND leads to more pronounced physiological and pathological changes in axillary venous structures—including increased vein wall thickness, altered flow rates, and diameter differences—compared to SLNB combined with breast-conserving surgery. These changes may be attributed to lymphovenous disruption and postoperative edema. Furthermore, radiotherapy appears to contribute to these changes, though to a lesser extent than ALND. Therefore, SLNB followed by radiotherapy may be preferable in eligible patients to reduce postoperative complications such as lymphedema, joint restriction, and sleep disturbances. Full article

This study investigates the virulence properties and pathogenetic characteristics of the Kazakhstani strain of LSDV (LSDV KZ-Kostanay-2018) in indigenous cattle under controlled conditions. Twelve non-breed cattle were inoculated intradermally and monitored for clinical, pathological, and immunological responses. Clinical signs, including fever, skin nodules, and lymphadenopathy, emerged as early as day 5 post-infection (pi), with peak severity observed between days 11 and 14. Rapid seroconversion was observed, with 100% of animals showing virus-neutralizing antibodies by day 13. Pathological findings revealed extensive necrosis, thrombosis, and edema, with pronounced damage in the spleen, lungs, and lymph nodes. Histological analyses identified widespread destructive changes in the dermis and systemic tissues, consistent with highly aggressive disease progression. Viral genome and replication were confirmed in blood, skin nodules, and lymph nodes, with peak viral loads between days 11 and 14 pi. These results align with findings in Russian cattle infected with the Saratov/2017 strain but demonstrate more rapid symptom onset and severe pathology, suggesting strain-specific virulence. These findings contribute to a deeper understanding of LSDV pathogenesis and underscore the importance of regional adaptations in disease management. Full article

(1) Background: The IL-36 cytokines have been identified as key contributors to pustular psoriasis, and their inhibitor is already in clinical use. However, few studies have explored them in atopic dermatitis. (2) Methods: The role of IL-36α was investigated in various atopic dermatitis models using wild-type, keratin 14-specific IL-33 transgenic, IL-18 transgenic, caspase-1 transgenic, and caspase-1 transgenic mice with IL-17AF deletion, reflecting diverse aspects of human skin inflammation. IL-36α was administered subcutaneously in five doses on alternate days across the five strains to examine cellular infiltration patterns and cytokine expression levels. (3) Results: The skin phenotype was exacerbated, accompanied by worsening edema and skin thickness in all mouse groups upon IL-36α administration. An increase in infiltrating cells was observed among innate immune cells, while lymphocyte counts, including T cells and innate lymphoid cells, did not rise. Additionally, anti-inflammatory cytokines were induced simultaneously with inflammatory cytokines and downstream cytokines of IL-36α as well. Infiltrating lymphocytes in the skin displayed a distinct Type 2 cytokine-dominant profile for innate lymphoid cells and a Type 3 cytokine-dominant profile for T helper cells and γδ T cells, contrasting with the Type 1-dominant cell profile in draining lymph nodes. Type 1, Type 2, and Type 3 cytokine dominance patterns were not affected by the administration of IL-36α. (4) Conclusions: IL-36α triggers inflammatory responses in atopic dermatitis by activating innate immunity. The infiltrating lymphocytes in the skin have different cytokine production profiles between innate lymphoid cells and T cells, as well as different patterns of cytokine production in their draining lymph nodes. Full article

Background and Objectives: This study aimed to evaluate the imaging characteristics of computed tomography (CT) for diagnosing and assessing cellulitis in patients with leg swelling. Materials and Methods: Overall, 1545 patients who underwent CT for leg swelling were retrospectively analyzed. Among them, 174 were diagnosed with cellulitis based on clinical findings, laboratory tests indicating inflammation, and their response to antibiotics. Patients with previous follow-up CT scans, negative CT findings, or alternative diagnoses were excluded (n = 1123). Two radiologists independently assessed the CT images while blinded to other clinical data, resolving discrepancies through consensus. Results: Among 174 patients with cellulitis, 112 were men, and 62 were women, with a mean age of 64.1 ± 15.8 years. The patients were categorized into two groups based on the affected region: Group I (thigh or lower leg, n = 130) and Group II (foot involvement only, n = 44). The qualitative CT features analyzed included skin thickening (83.9%), subcutaneous edema (94.8%), early venous return (82.8%), lymph node pathological findings (72.4%), and prominent lymph node enhancement (79.3%). Group I demonstrated significantly higher rates of skin thickening, subcutaneous edema, and early venous return than Group II. Pairwise analysis of CT findings revealed significant associations between skin thickening and subcutaneous edema, skin thickening and early venous return on MIP, and early venous return on MIP and lymph node pathology. Conclusions: CT provides valuable diagnostic features of cellulitis in patients with leg swelling. Skin thickening, subcutaneous edema, early venous return, and lymph node abnormalities are key findings in the diagnosis of cellulitis. Full article

Background/Objectives: To investigate the association between MRI features of primary breast cancers with axillary status, aiming to identify possible imaging biomarkers. Methods: Patients diagnosed with breast cancer between 2021 and 2023 in our clinic were retrospectively evaluated, and those that presented as mass lesions on preoperative MRI examinations (n: 123) were included in the study. Patients with and without metastatic axillary lymph nodes (mALN) were compared in terms of breast density, background parenchymal enhancement, tumor size, location in the breast, distance from the skin, patient age, presence of edema, multiple foci, histopathological type and molecular subtype of tumors. In multifocal/multicentric cases, the largest lesion was taken into consideration. Prepectoral and subcutaneous edema were considered diffuse edema, while perilesional edema was considered focal edema. MannWhitney U/Student-t test, Chi- square/Fischer Exact tests and logistic regression analysis were used for statistical analyses as appropriate. Results: Axilla was positive in 88 patients. There was a statistically significant difference in terms of edema, age, molecular subtype, Ki-67 index, number of lesions, tumor size, and laterality between the two groups (p < 0.05). Univariate logistic regression analysis showed that all included variables were statistically significant (p < 0.05). Multivariate logistic regression analysis revealed that presence of edema (OR: 2.46 CI; 1.11–5.48, p = 0.027) and multiple lesions (OR: 1.86 CI; 1.01–3.43, p = 0.046) were significantly associated with mALN. There was no significant difference between peritumoral edema and diffuse edema. Conclusions: Our study showed a statistically significant relationship between the axillary status and the presence of edema and multiple tumoral lesions on MRI. These findings have a potential to serve as prognostic imaging biomarkers for predicting the presence of mALN. Further studies with larger case series are needed to support our findings. Full article

Background and Clinical Significance: Breast cancer-related lymphedema (BCRL) is a chronic condition affecting up to 20% of breast cancer survivors. Manual lymphatic drainage (MLD) has traditionally included techniques to redirect lymph flow toward alternative pathways when axillary drainage is impaired. However, emerging imaging techniques suggest that most lymph continues to drain toward the ipsilateral axilla, and this has led to the widespread uptake of treatment protocols that exclude traditional redirecting movements, even in cases where personalized imaging is unavailable. Case Presentation: This case report describes a woman with BCRL affecting the right arm and hand who underwent 3 years of conservative lymphedema therapy, including MLD and self-massage techniques that incorporated traditional redirection strategies. Pre-operative indocyanine green (ICG) lymphography, performed after prolonged conservative treatment, confirmed the presence of an open alternative drainage pathway bypassing the axilla and demonstrated dermal flow along the redirected pathways towards a previously described “radial” pathway. These findings suggest that targeted manual therapy may have reinforced or optimized this compensatory route. Conclusions: This case highlights the potential risk of relying on a single form of assessment and generalized cohort imaging studies to guide individualized MLD protocols. In the absence of personal imaging, prematurely abandoning traditional redirection techniques may limit opportunities to establish functional alternative pathways, particularly in early edema in patients who have this anatomical variation. ICG lymphography provides valuable insight into compensatory lymphatic drainage. However, until imaging protocols are standardized and individual imaging is widely accessible, retaining traditional MLD techniques for newly diagnosed BCRL may be crucial for optimizing treatment outcomes. Future research should explore the long-term impact of manual therapy on alternative pathway development and function. Full article

Background: The therapeutic efficacy of extended lymph node dissection (ePLND) for intermediate- and high-risk (IR/HR) prostate cancer remains controversial. This study evaluated whether PLND improved biochemical recurrence (BCR) rates in patients with prostate cancer undergoing robotic-assisted radical prostatectomy (RARP) using a propensity matching method with cases from two facilities. Methods: The study included 1002 patients with IR/HR disease who underwent RARP at two facilities with equivalent surgical techniques and hospital size but different ePLND policies for IR/HR between July 2012 and November 2022. We compared perioperative outcomes, complications, and biochemical recurrence-free survival (bRFS) between the centers. Results: After propensity matching, 221 and 124 cases, each at intermediate and high risk, respectively, were compared. Except for age, preoperative clinicopathological variables did not differ significantly between the matched ePLND and non-PLND groups. A median of 18 lymph nodes were assessed in the dissection group. The 3-year bRFS rates did not differ significantly between ePLND and non-PLND among intermediate-risk and high-risk patients. The dissection group had significantly longer operative times and more complications associated with ePLND, including lower extremity edema, pelvic hematoma, and neuropathy. A multivariable Cox regression analysis performed after propensity adjustment identified initial prostate-specific antigens, pathological tumor stage (high-risk only), and positive surgical margins as independent prognostic factors for bRFS while ePLND was not significant. Conclusions: These results suggest that ePLND may not be necessary in intermediate- to high-risk PCa patients undergoing RARP, although further study with a longer follow-up is required. Full article

Background and Objectives: Angioedema is a non-pitting edema of the submucosal layer which can be acquired or inherited and usually presents with hives. Intestinal angioedema is rare and can mimic other acute gastrointestinal disorders. It is typically associated with a lack or dysfunction of C1-inhibitor, with a small number of cases having normal C1-inhibitor function. We present a rare case of chronic recurrent intestinal angioedema in a patient with normal C1-inhibitor function who did not respond to icatibant therapy. Case presentation: A 56-year-old woman presented with 3 days of abdominal pain, nausea, vomiting, and diarrhea. She denied a history of allergies and reported a 30-year history of similar episodes requiring hospitalization. Initial evaluation demonstrated normal C4 and C1 esterase inhibitor function with negative gastrointestinal bacterial and viral panel. A CT of the abdomen and pelvis demonstrated acute diffuse bowel thickening and prominent mesenteric lymph nodes. MRI demonstrated inflammation of the small and large bowel. EGD and colonoscopy findings were normal. She was diagnosed with intestinal angioedema and started on icatibant without significant improvement. Her symptoms resolved after 3 days of supportive therapy and resolution of inflammation was noted on imaging. She was discharged home with allergy and immunology follow-up. Conclusions: Intestinal angioedema is under-recognized and presentation can overlap with other pathologies of the GI tract. Extensive work up is needed during the first episode of an attack and complement levels should be checked in all patients. Appropriate classification is important as it dictates therapy. However, ambiguous cases like ours sometimes cannot be classified into any specific category. Full article

Appendiceal intussusception is a rare condition characterized by the invagination of the appendix into the base of the cecum. In some cases, this condition can lead to obstruction, ischemia, and perforation. It is more common in elderly patients, particularly women, and is often associated with the presence of a lesion, benign or malignant, acting as a “lead point.” This case report details the emergency management of a 54-year-old female patient with severe abdominal pain, nausea, and vomiting. The physical examination was unremarkable, as were the laboratory tests. However, ultrasound revealed a small amount of fluid in the pelvis, leading to further investigation with a CT scan which showed appendiceal intussusception with significant wall edema, fluid in the surrounding fatty tissue, and reactive lymph nodes. The patient then underwent an operation that confirmed an intussuscepted appendix showing signs of ischemia. Histopathology showed the presence of an endometrioma acting as the “lead point”. This case report showcases the crucial role of diagnostic imaging, which is superior to clinical examination and laboratory tests when diagnosing these patients. Diagnostic imaging, coupled with careful differential diagnosis, is vital to distinguishing benign conditions from malignancy and ensuring timely and appropriate intervention. Early diagnosis and surgical intervention are essential to prevent life-threatening complications such as gangrene and perforation and exclude malignancy in adult patients. Full article

The anti-inflammatory, antiviral, and anti-cancer properties, as well as the mechanism of action of cyclo-[Pro-Pro-β³-HoPhe-Phe-] tetrapeptide (denoted as 4B8M), were recently described. The aim of this work was to synthesize and evaluate the immunosuppressive actions of the stereochemical variants of 4B8M by sequential substitution of L-amino acids by D-amino acids (a series of peptides denoted as P01–P07) using parent 4B8M as a reference compound. In addition, diverse available bioinformatics tools using machine learning and artificial intelligence were tested to find the bio-pharmacokinetic and polypharmacological attributes of analyzed stereomers. All peptides were non-toxic to human peripheral blood mononuclear cells (PBMCs) and only cyclo-[D-Pro-Pro-β³-HoPhe-Phe-] peptide (P03) was capable of inhibiting mitogen-induced PBMC proliferation. The peptides inhibited the lipopolysaccharide (LPS)-induced production of tumor necrosis factor-alpha (TNF-α) to various degrees, with P04 (cyclo-[Pro-Pro-D-β³-HoPhe-Phe-]) and P03 being the most potent. For further in vivo studies, P03 was selected because it had the combined properties of inhibiting cell proliferation and TNF-α production. P03 demonstrated a comparable ability to 4B8M in the inhibition of auricle edema and lymph node cell number and in the normalization of a distorted blood cell composition in contact sensitivity to the oxazolone mouse model. In the mouse model of carrageenan-induced inflammation of the air pouch, P03 exhibited a similar inhibition of the cell number in the air pouches as 4B8M, but its inhibitory effects on the percentage of neutrophils and eosinophils in the air pouches and blood, as well as on mastocyte degranulation in the air pouches, were stronger in comparison to 4B8M. Lastly, in a mouse model of dextran sulfate-induced colitis, similar effects to 4B8M regarding thymocyte number restoration and normalization of the blood cell pictures by P03 were observed. In summary, depending on either experimental findings or in silico predictions, P03 demonstrated comparable, or even better, anti-inflammatory and bio-pharmacokinetic properties to 4B8M and may be considered as a potential therapeutic. The possibility of P00 and P03 identification by circular dichroism measurements was tested by quantum-chemical calculations. Full article

Background: The aim of this study is to examine the outcomes of an accelerated fractionated irradiation for N0 glottic carcinoma. Methods: In this retrospective analysis, 29 patients with N0 glottic carcinoma treated by radiation therapy were enrolled. Thirteen patients had T1a disease, six had T1b disease, and ten had T2 disease. A fractional dose of 2.1 Gy was administered to seven patients. The total doses were 65.1 and 67.2 Gy in four and three patients, respectively. A fractional dose of 2.25 Gy was administered to 22 patients. The total doses were 63 and 67.5 Gy in 21 patients and 1 patient with T2 disease, respectively. Additionally, 13 patients underwent the use of TS-1 (80–100 mg per day). Results: The median follow-up period was 33 months, and the 3-year local control rate was 95.6%. No patient had a lymph node or distant recurrence. As acute adverse events, grades 2 and 3 dermatitis were observed in 18 patients and 1 patient, and grades 2 and 3 mucositis were observed in 15 patients and 1 patient. As a late adverse event, one patient required tracheotomy because of laryngeal edema occurring. Conclusions: Accelerated fractionated irradiation may be an option in the radiation therapy of N0 glottic carcinoma because of its ability to shorten the treatment time. Full article

In traditional Korean medicines, Magnolia officinalis is commonly included for the remedy of atopic dermatitis, and magnolol is a major constituent of Magnolia officinalis. Its pharmacological effects include anti-inflammatory, hepatoprotective, and antioxidant effects. Using BALB/c mice repeatedly exposed to 1-chloro-2,4-dinitrobenzene (DNCB), magnolol was evaluated in atopic dermatitis-like lesions. Administration of magnolol (10 mg/kg, intraperitoneal injection) markedly relieved the skin lesion severity including cracking, edema, erythema, and excoriation, and significantly inhibited the increase in IgE levels in the peripheral blood. A DNCB-induced increase in mast cell accumulation in atopic dermatitis skin lesions was reversed by magnolol administration, as well as a rise in expression levels of pro-inflammatory Th2/Th17/Th1 cytokines’ (IL-4, IL-13, IL-17A, IFN-γ, IL-12A, TARC, IL-8, and IL-6) mRNAs in the lymph nodes and skin (n = 5 per group). In lymph nodes, magnolol reversed DNCB’s increase in CD4⁺RORγt⁺ Th17 cell fraction and decrease in CD4⁺FoxP3⁺ regulatory T cell fraction. The results also showed that magnolol suppressed T cell differentiation into Th17 and Th2 cells, but not Th1 cells. Magnolol suppresses atopic dermatitis-like responses in the lymph nodes and skin, suggesting that it may be feasible to use it as a treatment for atopic dermatitis through its suppression of Th2/Th17 differentiation. Full article

Background: While rare, penoscrotal lymphedema (PL) is accompanied with devastating effects on the quality of life of patients. Moreover, especially for patients with excessive (giant) PL, no standardized curative treatment has been defined. This article therefore retrospectively evaluates the authors’ surgical treatment approach for giant PL, which includes resection alone or in combination with a free vascularized lymph node transfer (VLNT). Methods: A total of ten patients met the inclusion criteria. One patient dropped out of the study before therapy commenced. Eight of the nine remaining patients presented with end-stage (giant) PL. One patient presented with manifest pitting edema. All patients were treated with penoscrotal resection and reconstruction. Additionally, five patients received VLNT into the groin or scrotum. Results: The extent of the lymphedema was specified with a treatment-oriented classification system. The median follow-up was 49.0 months. No patient showed a recurrence. Patients who received VLNT into the scrotum displayed a significantly improved lymphatic transport of the scrotum. Conclusions: Advanced PL should be treated in a standardized surgical fashion as suggested by our proposed algorithm. VLNT from the lateral thoracic region into the scrotum must be considered. If treated correctly, surgical intervention of end-stage PL leads to good results with a low recurrence rate. Full article

Lymphedema is often complicated by chronic inflammation, leading to fibrosis, fat deposition, and inhibition of lymphangiogenesis. This study aimed to verify whether lymphedema itself or together with commensal bacterial flora infection contributes to the severity of local inflammation. Edema was induced by interruption of the lymph flow in the rat’s hind limb. Immune cell infiltrates were examined by flow cytometry and immunohistochemistry. Nine-day edema alone did not affect immune cell content in the skin but resulted in a decrease in CD4⁺ T helper lymphocytes and monocytes in the draining popliteal lymph nodes. In turn, local saprophytic Staphylococcus epidermidis infection of the edematous limb resulted in dense infiltrates of CD68⁺ macrophages and monocytes, MHC class II antigen-presenting cells, CD90⁺ stem cells, thymocytes, and immature B cells in the skin, accompanied by a simultaneous reduction in density of CD4⁺ T helper lymphocytes and monocytes, OX62⁺ dendritic cells, CD68⁺ macrophages and monocytes, HiS48⁺ granulocytes, CD90⁺ stem cells, thymocytes, and immature B cells in the draining popliteal lymph nodes. These results indicate that the combination of edema and saprophytic bacteria infection induces severe inflammation in the peripheral tissues and results in a delay of antibacterial protection processes in neighboring lymphatic organs. Full article

Lymphedema is a progressive condition. Its therapy aims to reduce edema, prevent its progression, and provide psychosocial aid. Nonsurgical treatment in advanced stages is mostly insufficient. Therefore—in many cases—surgical procedures, such as to restore lymph flow or excise lymphedema tissues, are the only ways to improve patients’ quality of life. Imaging modalities: Lymphoscintigraphy (LS), near-infrared fluorescent (NIRF) imaging—also termed indocyanine green (ICG) lymphography (ICG-L)—ultrasonography (US), magnetic resonance lymphangiography (MRL), computed tomography (CT), photoacoustic imaging (PAI), and optical coherence tomography (OCT) are standardized techniques, which can be utilized in lymphedema diagnosis, staging, treatment, and follow-up. Conclusions: The combined use of these imaging modalities and self-assessment questionnaires deliver objective parameters for choosing the most suitable surgical therapy and achieving the best possible postoperative outcome. Full article