Olivier Leduc

Scintigraphic investigations of the superficial lymphatic system: quantitative differences between intradermal and subcutaneous injections.

Rationale and objectivesBoth subcutaneous and intradermal injections are used for the scintigraphic investigations of the superficial lymphatic system. The qualitative differences between these types of injections are well known. This study quantified their differences in a group of volunteers. MethodsWith the limbs at rest, activities in the axillary nodes (AxN) were recorded at 1, 20, 40, 60, 80 and 100 min after subcutaneous or intradermal injection of 99mTC-labelled human serum albumin nanocolloids in the ventral middle part of each forearm of nine young, healthy, male volunteers and the results were compared. ResultsExpressed as per 10 000 of injected activity, activities recorded in the AxN were significantly higher (32.5 times as a mean value, ranging from 8.4 to 130.7 times) after intradermal injections than after subcutaneous injections (P<0.001 by using two-tailed Wilcoxons signed-rank test). The mean AxN activity after intradermal injections was also apparently higher for the right limbs than for the left limbs, but when the paired t-test was used to compare the right with the left values of the nine volunteers, the comparison did not reach statistical significance (at T+100, 2P=0.087). When their handedness is taken into account, however, a level of statistical significance is reached (at T+100, 2P=0.025). ConclusionThis study quantifies the differences between subcutaneous and intradermal injections, but also shows, although on a limited number of volunteers, that handedness influences the results of the intradermal injections.

Are there hemodynamic implications related to an axillary arch

The axillary arch (AA) has been thoroughly studied and described as a supernumerary muscle, present unilaterally or bilaterally. This study aims to provide an in vivo demonstration of the influence of an AA on vascular, biometrical, and hemodynamic parameters. Two‐hundred thirty‐nine subjects with a mean age of 21.3 ± 2.7 years participated in this study. After visual screening by two independent experts, 20 subjects (8.4%) presented with an AA unilaterally (n = 12) or bilaterally (n = 8). An echo‐Doppler examination of the vena and arteria axillaris was performed to measure blood flow, velocity of circulating elements, and blood vessel diameter in different positions of the arm (abduction: 45°, 90°, 90° combined with exorotation ‘ER’, 120°). The arteria axillaris parameters, measured in the test (n = 9; six women, three men) and control group (n = 11; six women, five men), were equivalent for all tested positions. The axillary vein parameters, compared to variations within the groups, revealed no significant differences. However, when comparing variation between groups, significant differences were found for (i) diameter in 90° abduction + ER and 120° abduction; (ii) velocity in 90° and 120° abduction. Blood flow demonstrated no significant difference between groups in any of the positions. The results of this study indicate that there is no functional vascular implication of the AA in the test samples. This study also questions the interpretation of some hypotheses regarding the AA and entrapment syndromes. Clin. Anat. 24:964–967, 2011.

Lymphatic Drainage to the Paravertebral Lymph Nodes in Breast Cancer Patients

INTRODUCTION Aberrant, altered, or blocked lymphatic drainage may contribute to the high recurrence rate of breast cancer. Thus, an efficient evaluation of lymphatic drainage from the breasts and/or upper limbs is essential in the management of lymphedema and in ipsilateral primary or contralateral recurrent breast cancer patients. There are very few reports of lymphatic drainage to the paravertebral lymph nodes in patients with a lymphedema after breast cancer surgery with or without reconstruction. METHODS We used lymphoscintigraphy to examine lymphatic drainage in a case series. RESULTS We observed five patients with upper limb and/or mammary lymphedema (after breast cancer surgery with or without reconstruction) who had lymphatic drainage from the upper limb or breast to the posterior intercostal and/or paravertebral lymph nodes. One patient also presented with nodal relapse at the time of our investigation. CONCLUSIONS The cases from this study demonstrate the unusual, and mostly unrecognized, lymphatic drainage pathways toward lymph nodes, which may be at risk for further evolution of breast cancer.

Chemotherapy port related lymphedema after axillary lymph node dissection

UNLABELLED The Mascagni lymphatic pathway comprises superficial channels along the clavicle that drain upper extremity lymph. A 65 year-old woman with recurrent left breast cancer presented with a non-functioning chemotherapy port in the right deltopectoral groove. She had undergone right mastectomy with axillary lymph node dissection (ALND). After port removal and wound closure she developed right upper extremity lymphedema. Patients who have undergone ALND may depend solely on this pathway for upper extremity lymphatic drainage. LEVEL OF EVIDENCE level V.

Manual Lymph Drainage (Leduc Method)

The International Society of Lymphology has published a consensus for edema treatment since 1995.1 Some countries have elaborated a more locally adapted consensus.2,3 Nevertheless, the basic techniques mentioned in the different proposals are the same: manual lymphatic massage (or manual lymphatic drainage [MLD]), intermittent sequential pneumatic compression therapy (ISPT), and multilayer bandages (MLB).