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Pleural effusion and ascites in extrarenal lymphangiectasia causedby post-biopsy hematoma: A case report

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World Journal of Clinical Cases 2020年第24期8卷 6330-6336页

作者： Qiong-Zhen Lin Hui-En Wang Dong Wei Yun-Feng Bao Hang Li Tao Wang Department of Nephrology The Third Hospital of Hebei Medical UniversityShijiazhuang 050051Hebei ProvinceChina Department of Thoracic Surgery Hebei Provincial General HospitalShijiazhuang 050051Hebei ProvinceChina Department of Urology Hebei Provincial General HospitalShijiazhuang 050051Hebei ProvinceChina Department of Medical Imaging Hebei General HospitalShijiazhuang 050051Hebei ProvinceChina Department of Nephrology Peking Union Medical College HospitalBeijing 100045China Department of Nephrology The First Hospital of Hebei Medical UniversityShijiazhuang 050000Hebei ProvinceChina

BACKGROUNDThe renal system has a specific pleural effusion associated with it in the form of“urothorax”, a condition where obstructive uropathy or occlusion of thelymphatic ducts leads to extravasated fluids (urine or lymph) crossing thediaphragm via innate perforations or lymphatic channels. As a rare disorder thatmay cause pleural effusion, renal lymphangiectasia is a congenital or acquiredabnormality of the lymphatic system of the kidneys. As vaguely mentioned in areport from the American Journal of Kidney Diseases, this disorder can be causedby extrinsic compression of the kidney secondary to *** SUMMARYA 54-year-old man with biopsy-proven acute tubulointerstitial nephropathyexperienced bleeding 3 d post hoc, which, upon clinical detection, manifested as amassive perirenal hematoma on computed tomography (CT) scan withoutconcurrent pleural effusion. His situation was eventually stabilized byexpeditious management, including selective renal arterial embolization. Despite good hemodialysis adequacy and stringent volume control, a CT scan 1 mo laterfound further enlargement of the perirenal hematoma with heterogeneoushypodense fluid, left side pleural effusion and a small amount of ascites. Thesefluid collections showed a CT density of 3 Hounsfield units, and drained fluid ofthe pleural effusion revealed a dubiously light-colored transudate withlymphocytic predominance (> 80%). Similar results were found 3 mo later, duringwhich time the patient was free of pulmonary infection, cardiac dysfunction andovert hypoalbuminemia. After careful consideration and exclusion of otherpossible causative etiologies, we believed that the pleural effusion was due to theocclusion of renal lymphatic ducts by the compression of kidney parenchymaand, in the absence of typical dilation of the related ducts, considered our case asextrarenal lymphangiectasia in a broad *** such, our case highlighted a morbific passage between the kidney and thoraxunder an extrao

关键词： Urothorax Pleural effusion Perirenal hematoma Renal lymphangiectasia lymphatic drainage Case report

Role of mesenteric component in Crohn’s disease:A friend or foe?

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1536-1549页

作者： Yi Yin Zhen-Xing Zhu Zhun Li Yu-Sheng Chen Wei-Ming Zhu Department of General Surgery Jinling HospitalMedical School of Nanjing UniversityNanjing 210002Jiangsu ProvinceChina

Crohn’s disease(CD)is a complex and relapsing gastrointestinal disease with mesenteric *** mesenteric neural,vascular,and endocrine systems actively take part in the gut dysbiosis-adaptive immunity-mesentery-body axis,and this axis has been proven to be *** abnormalities of morphology and function of the mesenteric component are associated with intestinal inflammation and disease progress of CD via responses to afferent signals,neuropeptides,lymphatic drainage,adipokines,and functional *** hypertrophy of mesenteric adipose tissue plays important roles in the pathogenesis of CD by secreting large amounts of adipokines and representing a rich source of proinflammatory or profibrotic *** vascular alteration,including angiogenesis and lymphangiogenesis,is concomitant in the disease course of *** note,the enlarged and obstructed lymphatic vessels,which have been described in CD patients,are likely related to the early onset submucosa edema and being a cause of *** function of mesenteric lymphatics is influenced by endocrine of mesenteric nerves and ***,the structure of the mesenteric lymphatic vessels in hypertrophic mesenteric adipose tissue is mispatterned and ruptured,which can lead to lymph *** lymph factors can in turn stimulate adipose tissue to proliferate and effectively elicit an immune *** identification of the role of mesentery and the crosstalk between mesenteric tissues in intestinal inflammation may shed light on understanding the underlying mechanism of CD and help explore new therapeutic targets.

关键词： Crohn’s disease Mesenteric nerves Angiogenesis lymphatic drainage Mesenteric adipose tissue

Sentinel lymph node biopsy in renal malignancy: The past, present and future

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World Journal of Nephrology 2016年第2期5卷 182-188页

作者： Tharani Mahesan Alberto Coscione Ben Ayres Nick Watkin Department of Urology St George’s Hospital

Sentinel lymph node biopsy （SLNB） is now an establishedtechnique in penile and pelvic cancers, resulting in alower mortality and morbidity when compared withthe traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fuorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate *** the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.

关键词： Sentinel lymph node biopsy Dynamic sentinel node Renal malignancy Lymphoscintigraphy Near infra-red fuorescence Penile cancer lymphatic drainage

Consideration of the Self-Care Supporting Program Including Simple Exercise for Patients with Early Stages of Secondary Lower-Limb Lymphedema

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Health 2021年第3期13卷 238-252页

作者： Chitose Arakawa Chiharu Akazawa Sayoko Teraguchi Graduate School of Nursing Osaka Medical College Osaka Japan School of Human Nursing The University of Shiga Prefecture Shiga Japan Faculty of Nursing Osaka Medical College Osaka Japan

Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “

关键词： Secondary Lower-Limb Lymphedema Early Stages Self-Care Supporting Program lymphatic drainage Exercises