Particle clearance from the canine pleural space into thoracic lymph nodes: an experimental study.

We instilled tungsten powder (CaWO4) into the pleural space of the dog and studied the kinetics and distribution of particle translocation from the pleural space to the thoracic lymph nodes over 1-7 days. We found that the transport of tungsten particles to regional lymph nodes was present at day 1, and reached its peak at day 3. In situ detection of tungsten by elemental particle analysis of lymph node sections by scanning electron microscopy complemented by light microscopy and X-ray analysis allowed precise mapping of the marker in the thoracic nodes. The first lymph nodes to become tungsten-laden was the parasternal group (day 1-3). From day 3 to 7 tungsten inclusions decreased in these parasternal nodes while moderately increasing in the remaining intrathoracic lymph nodes. Retrocardiac pleural folds containing numerous "milky spots" also accumulated prominent amounts of tungsten early after intrapleural injection of CaWO4. These data indicate that 1) particle translocation from the pleural space to regional lymph nodes is a rapid process and is first directed to the parasternal lymph nodal subgroup; 2) particle dissemination to virtually all other lymph nodes within the thorax follows thereafter; 3) retrocardiac pleural folds contribute to the clearance of particles from the pleural space.     

T and B lymphocytes of the regional lymph nodes in patients with carcinoma of uterine cervix.

A comparative study of the peripheral blood and the regional lymph nodes lymphocyte subpopulations at 25 patients with carcinoma of uterine cervix was carried out by non-immune rosettes and immunofluorescence methods. The lymph nodes of ten women not affected with any disease, but operated on the occasion of the traumas were investigated as a control. The patients had a significant reduction of the relative amount of T cells and increase of number of B cells in their lymph nodes as compared with the control group. A significant variability of immune indices of the regional lymph nodes as compared to those of peripheral blood was shown. It was pointed out that the presence of the metastases in the regional lymph nodes is one of the possible reasons of this phenomena. The possible significance of the results is discussed.     

Types of reaction in the regional lymph nodes in non-metastatic and minute-metastatic carcinoma of the uterine cervix.

The authors studied tissue reactions in the regional lymph nodes of 68 patients with an invasive cancer of the uterine cervix at stage I and II of neoplastic disease. Two basic types of the lymph nodes reactions have been distinguished. In the first type of changes a reactive hyperplasia of sinusoidal histiocytosis predominated, as well as distinct activation of lymphocyte production within the follicles and numerous aggregates of plasmacytoid cells within the medullary cords. The second type of reaction was characterised by fibroplastic reaction causing constriction and block of capsular lymphatic and blood vessels, the pseudotransformation into hemolymph node and hematoxyphilic atrophy of lymphoreticular tissue. The authors' observations indicate that in case with the predominance of the second type reaction within regional lymph nodes arise favourable conditions for the production of distant metastases.     

Visceral leishmaniasis. Persistence of parasites in lymph nodes after clinical cure

Visceral leishmaniasis (VL) is generally associated with severe immunodeficiency (AIDS; renal, liver, and heart transplantations; haemopoietic malignancies). More rarely it can be related to an immunotolerence status such as pregnancy. Various observations report the development of leishmaniasis several months or even years after exposure to the parasite. Relapses occur rarely in patients not known to be immunocompromised, but are common after incomplete treatment. They are frequent in patients with Leishmania/HIV co-infection. Asymptomatic phases and relapses suggest that parasite can exist in the tissues for a long time before and/or after clinical onset of the disease.The mechanisms of onset of clinical leishmaniasis following exposure and infestation are highly relevant to understanding the pathology of the disease. The survival of Leishmania parasite between infection and disease or after cure is a very important issue for clinicians and epidemiologists. We describe two cases of VL occurring in a patient with lymphoma and in a pregnant woman. In both cases, parasites remained present in the lymph nodes after clinical cure.     

Sonographic detection of perihepatic lymph nodes: technique and clinical value

Sonographic detection of perihepatic lymphadenopathy by transabdominal ultrasound is helpful in the diagnosis of acute and chronic liver disease but differentiation between benign inflammatory and malignant disease is not possible. The diagnostic value of perihepatic lymphadenopathy has been evaluated in patients with chronic hepatitis C and primary biliary cirrhosis. In patients with chronic hepatitis C enlargement of perihepatic lymph nodes is associated with viremia and is predictive for the presence of severe inflammatory activity with and without cirrhosis. In retrospective studies it could be shown that patients with chronic hepatitis C without response to antiviral therapy do not normalize the size of perihepatic lymph nodes. Future prospective studies have to evaluate whether successful antiviral therapy together with histological improvement will be reflected in an decline of perihepatic lymph node size. In patients with primary biliary cirrhosis the total perihepatic lymph node volume reflect histological stages, i.e. larger lymph nodes are observed in more advanced disease. The mechanism of portal lymphadenopathy in patients with acute and chronic liver disease is unknown. Viral, bacterial infections, and immunological causes are potential etiopathological factors in periportal lympadenopathy. Malignant causes of perihepatic lymphadenopathy have also to be considered.     

Distribution of solitary lymph nodes in primary gastric cancer： A retrospective study and clinical implications

AIM To investigate the distribution pathway of metastatic lymph nodes in gastric carcinoma as a foundation for rational lymphadenectomy.METHODS We investigated 173 cases with solitary or single station metastatic lymph nodes (LN) from among 2476 gastric carcinoma patients. The location of metastatic LN, histological type and growth patterns were analyzed retrospectively.RESULTS Of 88 solitary node metastases cases, 65 were limited to perigastric nodes (N1), while 23 showed skipping metastasis. Among 8 tumors in the upper third stomach, 3 involved right paracardial LN (station number No.1), and one in the greater curvature was found in No.1. In the 28 middle third stomach tumors, 10were found in LN of the lesser curvature (No.3) and 6 in LN of the left gastric artery (No.7); 5 of the 20 cases on the lesser curvature spread to No.7, while 2 of the 8 on the greater curvature metastasized to LN of the spleen hilum (No.10). Of 52 lower third stomach tumors, 13 involved in No.3 and 19 were detected in inferior pyloric LN (No.6); 9 of the 29 cases along the lesser curvature were involved in No.6.CONCLUSION Transversal and skipping metastases of sentinel lymph nodes (SLN) are notable, and rational lymphadenectomy should, therefore, be performed.     

CT features of intrapulmonary lymph nodes:a comparative study with pathology

正Objective To explore the CT features and pathology of intrapulmonary lymph nodes (IPLNs), so as to improve the understanding and diagnosis of IPLNs.Meth-o dsA total of 38 patients (49 IPLNs) confirmed by the surgery and pathology were retrospectively analyzed, including 21 males and 17 females with a mean age of(56±8) years. All the patients underwent MSCT scan and 1. 0 mm thin layer reconstruction before surgery.Double-blind method was used to analyze CT signs and the corresponding histopathological changes were compared.Results(1) Location:all IPLNs were located     

Experimental opacification of mediastinal lymph nodes by intraperitoneal injection of an iodinated fatty emulsion.

Absorption and lymphatic drainage of several lipiodol emulsions injected intraperitoneally have been studied in the rabbit and rat. Good opacification of the lymphatic channels and mediastinal lymph nodes is obtained in several hours with fine emulsions and in several days with coarse emulsions. The tolerance is related to dose, and the peritoneal reaction was moderate with the low doses, similar to that caused by the administration of physiologic saline alone. Computerized tomography in detecting low contrasts attained with small doses could render this method of indirect lymphography possible in man.     

Anatomic study of the lymph nodes of the mesorectum

PURPOSE: Lymph node involvement is the most important prognostic factor when staging patients with colorectal cancer. The probability of detecting metastasis grows with the number of nodes examined. However, the number of nodes found in surgical specimens varies substantially. We have therefore determined the number and distribution of lymph nodes in the mesorectum by cadaveric dissection. METHODS: Twenty formalin-fixed cadaveric pelvises were dissected (13 males). The search for lymph nodes was performed in a systematic way, from the division of the superior rectal artery following the smallest visible branches to the level of the anorectal ring. RESULTS: A total of 168 lymph nodes were found in 20 mesorectal blocks, with a mean (standard deviation) number per specimen of 8.4 (4.45). Lymph node size ranged from 2 to 10 mm. Distribution of lymph nodes in mesorectum was as follows: 120 nodes (71.4 percent) were found around the branches of the superior rectal artery proximal to the peritoneal reflection, and 48 nodes (28.6 percent) were found distal to the peritoneal reflection. Fourteen specimens (70 percent) had lymph nodes at the division of the superior rectal artery. CONCLUSIONS: The mean number of lymph nodes found in the mesorectum distal to the superior rectal artery division was 8.4. Most of these lymph nodes were proximal to the peritoneal reflection. The range found in the number of lymph nodes per case should be considered for use in the formulation of guidelines in anatomicopathologic studies of surgical specimens obtained after mesorectal excision.Poster presentation at the XVI Congreso Latinoamericano de Coloproctología, Santiago, Chile, October 28 to 30, 1999.     

Time course and distribution of tungsten-laden macrophages in the hilar lymph nodes of the dog lung after experimental instillation of calcium tungstate into the left apical bronchus

We sprayed a tungsten powder (CaWO4) into the airway of a single lobe (left apical) of the dog lung in order to study: (a) the kinetics of particle translocation from the bronchoalveolar lining to hilar lymph nodes, and (b) the sorting in lung lymph nodes of inhaled microcrystals. We found that the transport of the tungsten particles to the regional lymph node takes at least 24 hours and reaches its peak at day 7. In situ detection of tungsten by elemental particle analysis of lymph node sections by scanning electron microscopy allowed precise mapping of the marker in the node; the method was complemented by light microscopy and thin-section electron microscopy of the same nodes. Virtually all of the lymph node tungsten was located inside macrophages. The first tungsten-positive macrophages seen in the regional lymph nodes (day 1 to day 3) were restricted to the subcapsular space. This was followed by massive filling of the same sinus and of the narrow interfollicular areas by the particle-laden macrophages (day 3 to day 7). The even distribution of the tungsten-bearing phagocytes found in these anatomical regions of the node indicated that the subcapsular area in the dog was a continuous domain rather than the segmented region observed in nodes of common laboratory animals such as the rat. By day 7 after tungsten instillation, a moderate number of tungsten-positive macrophages was also detected in the paracortical region of the node. Finally, the presence of tungsten-bearing macrophages was extended to the outer lymph node medulla (day 7 to day 14); here, the macrophages were located in association with cords of plasmacytes and showed interdigitations with these lymphocytes. Only minimal amounts of tungsten were detected inside lymphoid follicles in association with dendritic cells. Some of the tungsten initially deposited in the airway of the apical left lung lobe was detected in contralateral hilar lymph nodes. We conclude that: (i) particle translocation from the alveolus to regional lymph nodes is a slow process that is mediated by pulmonary macrophages, in agreement with the findings of Harmsen et al Science 230:1277, 1985); (ii) in the lymph node, particle-bearing macrophages are sorted through narrow interfollicular sinuses into the outer medulla where they interact extensively with plasma cells; (iii) the migrating macrophages cannot penetrate the follicular domains of the node; minute quantities of exogenous particles may, nevertheless, be transferred from macrophages to follicular dendritic cells; and (iv) contralateral drainage may be a feature of the lymphatic system in the lung.     

Peripheral subpleural intrapulmonary lymph nodes. Apropos of a clinical case and an anatomical case

The authors report the case of a round, peripheral radiographic opacity ("coin lesion" of English-language authors) which after surgical excision was found to be an intrapulmonary lymph node. In an anatomical study on the lymphatic drainage of pulmonary segments in adults, a similar lesion was found among 483 injected segments. A review of the literature yielded 27 similar cases which are described in detail. These lymph nodes are probably more frequent than is generally believed, as shown by an experimental radiolymphographic study. Such clinical findings will no doubt be rendered more numerous by the improved sensitivity of new medical imaging techniques. Despite hypotheses put forward by the authors, the presence of these lymph nodes, which seem to be acquired by the adult lung, has not yet been explained.     

Acute gluteal abscess following intramuscular chloroquine injection: a clinical and experimental study

This prospective study contains clinical and experimental parts. In the clinical study, 125 patients given intramuscular chloroquine for malaria were followed for 2 months in order to detect local injection site complications. Adequate local antiseptic conditions were ensured before giving the injection. Twenty-three patients (18.4%) had minimal local reaction in the form of redness, induration and/or a lump. No pyogenic abscess was noted in contrast to a previous report. In the second part of the study, an experimental animal (Green monkey) was given either chloroquine phosphate, Ampiclox or normal saline intramuscularly. The injection site was later biopsied and histologically examined. Intramuscular chloroquine was found to cause severe inflammatory reactions and muscle necrosis, whereas other injections had very minimal local effects. It is concluded that intramuscular chloroquine causes muscle necrosis which may lead to acute pyogenic abscess if minimal contamination takes place.