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Lymphology 10 (1977) 54-61 © Georg Thieme Verlag Stuttgart The Anatomy Qf Vessels in Relation to Function

F. Huth, D. Bernhardt Pathologic Institute, University of Dlisseldorf (Chairman: Prof. Dr. H. Meessen)

The essential functions of the lymphatic sys­ -Natucci and Zaccharini 1949; Rusznyak, tem are to pi~k up large molecules, particles Foldi and Szabo 1957; Hankiss 1959; Aiello and excess fluid and to transport them from et al. 1960; Tormene et al. 1965; Csillik and the peripheral connective to the venous Foldi 1967; Huth et al. 1970; Foldi 1971; system. Within normal tissue most of the Stroobandt et al. 1976; Lie et al 1976; lymphatics are collapsed, (Fig. la). They can, Huth et al. 1974, 1976). Oemer et a1. (1972) therefore, hardly be differentiated light micro­ modified the method of blocking the lymph scopically from blood or from outflow by interrupting the thoracic duct. septal connective tissue. Various techniques The possibility of huge dilation of the lym­ have been used to visualize the lymph vessels phatics is different from the limited dilatation within organs and extremities. Retrograde in­ rate of the blood capillaries (Fig. 2a). Electron jection of air, indian ink, differ~nt proteins microscopy demonstrates that additional and dyes, silver nitrate, mercur}r, ferritin, properties of lymph· capillaries exist in con­ acrylic resins etc., often lead td ruptures of trast to blood capillaries ( Casley-8mith 1965, the thinwalled and vulnerable lYmphatics, 1967, 1910;Burke and Leak 1965, 1970; there by causing interstitial dye bxtravasates Huth 1967, 1968; Huth et al. 1970). The to be falsely interpreted as lymphatics ( Wutzer thickness of the lymphatic can 1834, Most 1908, Bartels 19091 Baum 1928, vary from 0.1 /l to several micra. In contrast Grau 1943, Jancso et al. 1952,fMori 1963, to blood capillaries, the lymphatic endotheliwn Mori et al. 1964, Leak and Burke 1966t is not enveloped in a continous basal lamina Viragh et al. 1966, Bergstrom ~d Werner or (Figs. 1, 2a, b, c; d). Similar to 1966, Kuprianov 1969, Casley-Smith 1969, blood vascular endothelium, it contains mito­ Gerteis 1972). Injection of lyniph-specific chondria, lysosomes, free ribosomes, a scant dyes such as patent blue as weti as different endoplasmic reticulum, fine intracytoplasmic tracer techniques demonstrate ~ectorallymph

I muscular fllarnents, and sometimes numerous vascular branches but never the complete microvesicles. The endothelial processes link lymph drainage of tissue or organs. Application to each other multiformally: Apposed of hydrogen peroxide demonst~tes the l~ph membranes can be held together by maculae vessels below mesothelial surfaces; total occludentes or adherentes (Fig. 3b). Some­ lymphangiography of an orgart was not pos­ times the cellular margins are connected by sible with this method (Magnus i922, 1923, interdigitations (Fig. 3a); in other areas, a Hass 1936, Johnson and Blak~ 1966; John-

1 close apposition without special cellular pro­ son 1969). 1 trusions dominates. A specific structure of In 1939 Kaiserling and Soostrizeyer found a lymph capillaries is represented by the over­ way out of this methodologicil problem by lap of endothelial cell processes. The gaps be­ blocking the lymph flow of w?- organ like the. tween the overlapping cell processes can separate up to several micra so that complete kidney. This procedure leads ~o a lymphostasts with dilatation of the lymph vascular branches cells from the interstitium can readily pass (Fig. 1b) up to their endings which the patent junction (Fig. 2b). The ~atency ~of thus can be seen light microsCopically. Other the junctions is influenced by another specific investigators used this method with success in structure: Leak and Burke (1968) were able· various organs (Romualdi et al. 1946, 1947; to demonstrate fme anchoring ftlaments

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emanating from the outer surface of the lymphatic endothelium and extending into the interstitium with its thicker collagen fibrils (Fig. 3b). The overlap of endothelial cells with the possibility of extensive patency and the anchoring fllaments maintain the removal of interstitial fluids and corpuscular substances and/or large molecules. Increased interstitial hydrostatic pressure will expand the interstitial space, hereby drawing the collagen fibrils. In this way the intercellular clefts are opened by pulling the :filaments attached to the endothelial wall. This adap­ tive mechanism of lymphatics in response to altered hydrostatic and osmotic interstitial pressure has been proven not only in sub­ cutaneous connective tissue (Casley-Smith 1967, Leak 1972) but also in other organs such as the kidney, the liver, and the (Huth 1968; Huth·et a!. 1970, 1976; Lie et al. 1976; Stroobandt et al. 19176). Kalima and Kalima (1975) demonstrated different gaps between the overlapping endothelial processes of mesenteric lymphatics. They referred to them as perilymphatic channels. They thought the channels played a signifi­ cant role in the uptake of liquids or sub­ stances into the lymphatics. We saw compar­ able structures in organ lymphatics (Fig. 2d). Casley-Smith used the term prelymphatic for all interstitial spaces which are finally drain- ed by lymphatic vessels. The trel)1endous dilatation rate of the lymphatics caiu1ot be Fig la Nearly collapsed lymph capillary of the heart musCle. x 19.120 completely explained by the special connections. 1 b Dilated lymph collecting vessel with valves with­ of the endothelial cellular processes. A further in the renal hilus, following experimental lympho­ extending capacity such as an intensive fold­ stasis of the kidney. ing of the lymphatic endothelium within non­ 22 x, v. Giesen altered organs or tissues exists (Fig. 2f). In addition, the numerous cellular protrusions of lymphatic endothelial cells (Fig. 1a) must overlapping cell processes together thus clos­ be regarded as a structural reserve for dilation ing the junctions. At this point one could since they disappear during dilation. It was speculate that the peripheral lymph drainage Casley-Smith (1967), Foldi (1972), and Leak system functions adequately until the endo­ (1972) who differentiated between L'1e spe­ thelial junctions are pulled too far apart and cial manner of transpoting fluids, proteins, lymph fluid can again escape. and lipids via draining iymph vessels and the Uptake of particles and fluids into lymphatics characteristic submicroscopical structures. from the interstitium can also occur across Increased interstitial pressure leads to opening the endothelium within multiple vesicles of the endothelial junctions while higher pres­ (Fig. 3b). The transcellular passage has been sure inside the vascular lumen presses the elucidated by experiments with different parti- Permission granted for single print for individual use. Reproduction not permitted without permission of Journal LYMPHOLOGY. 56 F. Huth, D. Bernhardt

Fig. 2a Dilated lymph capillary between blood capillaries of myocardium. x 3. 75 0 2 b Open junction between two endothelial processes of a lymph capillary. x 13.800 2c Dilated lymph capillaries with endothelial siderosomes, following venous congestion. x 4 000 2d Dilated lymph capillary with splitting of an endothelial cell, forming a perilymphatic channel (above). X 3.675 2e "Confluence" of several lymphatics at the inner surface of the chylous cisterna. x 230 2f Top view of lymph vascular endothelium with intensive folding of the endothelial cells. x 600

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b

c Fig. 3a Interdigitation of two endothelial processes in the lymph capillary wall. x 29.500 3b Part ly transversa lly, partly ta ngentially sectioned lymph capillary with intensive microvesiculation of the endothelium beside the adjacent co llagen fibrils and finer filaments. Zonula occludens formed by two endothelial cell processes at the right below. 44.250 x 3c Parasitic Iymphangiosis (onchocercosis). HE, 60 x cles and substances (Casley-Smich 1964, 1965, scopy and scanning electron microscopy, it 1968; Leak and Burke 1966, 1968). The has been proven that funnel-like valvular further transport of lymph following its re­ structures dominate (Lauweryns 1971 ). Blood sorption is maintained by valves which can vessels, i.e. of comparable size, do not alieady be observed in smaller lytnph-collecting contain valves. The existence of valves, there­ vessels like those of the epicardium or the fore, support the identification of medium­ hilar lymph vessels of different organs sized lymph vessels. Within the lymph-col­ (Fig. 1b ). Lymph vascular valves differ in lecting vessels, not only the valves but also a size and shape. With the aid of stereomicro- special wall structure helps to propel the

Permission granted for single print for individual use. Reproduction not permitted without permission of Journal LYMPHOLOGY. 58 F. Huth, D. Bernhardt lymp~ centripetally. Lymph propulSion by valves in cases without carditis have been cor­ rythmic contractions has been dembnstrated related with lymphostatic conditions (Kline experimentally in vivo and in vitro ~y Florey 1964, Miller et al. 1960-70, Goldberg 1968, (1927), Smith (1949), Horstmann ~1951, Bullon and Ruth 1972). Pulmonary lympho­ 1959), Webb and Starzl (1953), Mislin (1961, stasis with interstitial fibrosis has been de­ 1963, 1976), Kinmonth et al. {1963), Schipp monstrated after obliteration of lymph vessels and Schiifer {1969), Yoffey and Courtice in pneumoconiosis as well as primary fibrosis (1970). The contractability of a lYIPph vas~u­ of the (Meessen 1949, Vanek 1954, lar segment between two valves wi$ autonom­ Sztibo 1960). ous nerval stimulation enables functional ad­ Lymphostatic alterations with lymphangiectasia aptation to the amount of lymph by the and enteral protein loss are increasingly being number of contractions. Another control detected with the aid of modem methods of mechanism for lymph transport is provided investigation. The importance of lymphatic by the wall structure of the chylouS cisterna. vascular drainage of the cirrhotic liver and The lymph vessels running into the jchylous consequently, the dynamic insufficiency of cisterna take a helical course wi~ the the great lymph trunks in liver cirrhosis with cisternal wall. This structural property makes

1 ascites as well as their interdependence have it possible to compress the entering lymph been clarified in the paSt ten years (Baggen­ vessels during the filling phase of the cisterna. stoss and Cain 1957; Baggenstoss 1960; In addition the cisternal lymph vess,els have Dumont et al. 1960-1969; De Benedetti et valvular folds at their orifices which can block al. 1965; Ludwig et al. 1968; CL. and MH. the afferent vessels during the filling phase Witte et al. 1968, 1969, Beltz et al. 1969; (Fig. 2e) (Lenz and Ruth 1976). I Borchard et al. 1972). Transport of lymph within the lymph trunks, The special architecture of the peripheral especially in the thoracic duct, is facilitated lymphatics in lymph nodes and spleen as well by the elastic and muscular wall components, as their role in the spread of blastoma cells by their well-developed valvular ap~aratus, has been elucidated by combined scanning and and probably by the pulsation of the adjacent transmission electron microscopy. For the . Adrenergic nerves have been demon-, urinary tract, chyluria, for instance following strated ·in close contact to muscle c~lls of the fl.lariasis impressively illustrates the possible thoracic duct wall (Wenze/1912). Afmal importance of this drainage system (Fig. 3c). regulative mechanism for the lymph flow to the venous system is represented by; the A connection between general diseases such as ductal orifice at the venous angle with its widespread tumorous processes and the lympho­ individual variability and its speciallductal static symptoms caused by them often remains branching at the venous angle as well as by occult. The lymphovenous pressure gradient its special valvular apparatus. The importanceI and/or the shunt of the fluid into the venous of these structures has ·been emphasized by system can be influenced by generalized factors endoscopic fmdings (Seeliger 1973, 1974). such as venous congestion in heart failure or venous thrombosis. An oedema resulting from The lymphatic vascular wall structu~es and such factors can just barely be correlated their alterations considerably influe*ce the with lymphostasis. pathological changes in the interstit~um of almost every organ. Only a few exrupples are The sequence of organic diseases involving mentioned in the context of this article. Brain specific lymph vascular structures ought to be tissue which does not have its own lymphatic researched further. Finally, attention should vascular system, can be split by lymphostatic be drawn to the fact that the diagnosis of oedema as has been shown experimentally and lymphangiomata over against hemangiomata after human pharyngitis, sinusitis, n~ck dis­ often depends on the evidence of specific section, etc. (Foldi et al. 1962, 196f.). Inter­ lymphvascular features such as valves within stitial cardiac fibrosis and sclerosis qf the heart smaller vascular lumina. Permission granted for single print for individual use. Reproduction not permitted without permission of Journal LYMPHOLOGY. The Anatomy of Lymph Vessels in Relation to Function 59

In summary, the morphology of the lymph Cas/ey-Smith, J.R.: The structure of large lymphatics: vessels not only determines the function of How this determines their permeabilities and this drainage system but also influences its their ability to transport lymph. Lymphology 2 (1969) 15-25 pathologic reactions. · Casley-Smith, J.R.: How the over­ comes the inadequacies of the blood system. In: References Progress in Lymphology II. Ed.: Viamonte et al. 51-54, Thieme, Stuttgart 1970 Aiello, R.J., J.F. Enquist, E. Jkezono, B.S. Levowitz: Cremer, H., N. MUller, H. Bechtelsheimer: Morpho­ An experimental study of the role of hepatic logische Untersuchungen an Leber und Diinn­ lymph in the production of ascites. Surg: Gynecol. darm sowie lipidchemische Untersuchungen im Obstet. 11 (1960) 77-81 Serum nach Unterbindung des Ductus thoracicus Baggenstoss, A.B., J.C. Cain: The hepatic hilar bei Ratten. Virchows Arch. AbtL A, 355 (1972) lymphatics of man; their relation to ascites. New 309-322 EngL J. Med. 256 (1957) 531-53~ Csillik, B., M. Foldi: Experimental Jymphostasis: Baggenstoss, A.B.: The relationship of the hepatic Histochemistry and ultrastructure. Experientia hilar lymph vessels of man to ascites. Arch. De SuppL 14, pp. 159-168 Birkhauser, Basel 1967 Vecchi 31 (1960) 11-19 I Dumont, A.E., J.H. MulholltJnd: Flow rate and com­ Bartels, P.: Das Lymphgefai\system. In: Bardeleben: position of thoracic duct lymph in patients with Handb. Anat. III. 4, 231-233. Fischer lena 1909 cirrhosis. New Engl. J. Med. 263 (1960) 471-474 Baum,H.: Das Lymphgefai\system deS Pferdes. Dumont, A.E., J.H. MulholltJnd: Effects of thoracic Springer, Berlin 1928 duct to esophagus shunt in dogs with congestive Becher, H., E. Fischer: Weitere Erfolge mit der heart failure. Comparison with f'mdings in hepatic Methode der selbsttiitigen Luftfilll~ Anat. cirrhosis. New Engl. J. Med. 269 (1963) 949-952 Anz. 76 (1933) 340-348 Dumont, A.E.: Liver lymph: a critical component Beltz, L., ·G. Esser, M. Grenzmann: Zur Lymph­ of hepatic cirrhosis. In: Ch. G. Child: The liver dynamik bei der portalen Hypert~nsion. Fort~chr. and portal hypertension. Vol I (1964) 176-188 Rontgenstr. 111 (1969) 1-21 1 Dumont, A.E., J.H. MulholltJnd: Hepatic lymph in De Benedetti, M.J., Ph. W. Wright, M.J. Orloff: cirrhosis. In: Progress in liver diseases. VoL II, Dynamics of liver lymph and blood flow in ex­ pp. 427-441. Grune +Stratton, New York-London perimental liver disease and ascites. Surgical 1965 Forum 16 (1965) 274-276 Dumont, A.E., M.H. Witte: Significance of excess Borchard, F., H. Borchard, F. Huth: Beitrag zur lymph in the thoracic duct in patients with lymphvasculiiren Sklerose des Ductus thoracicus. hepatic cirrhosis. Amer. J. Surg. 112 (1966) Beitr. Path. Anat. 146 (1972) 145,-161 401-406 Bullon, A., F. Huth: Fine structure .o.f lymphatics Dumont, A.E., A. Martelli: X-ray opacification of in the myocardium. Lymphology 5 (1972) 42-48 hepatic lymph nodes following intravenous in­ Bergstrom, K., B. Werner: Proteins iO: human jection of tantalum dust. Lymphology 2 (1969) thoracic duct lymph. Acta chir. sdand. 131· 91-95 (1966) 413-422 . ' Florey, H.: Observations on the contractility of Burke, J.F., L. V. Leak: Ultrastructure of lymphatic lacteals. Part I. J. Physiol. 62 (1927) 267-272 capillaries during the inflammatory response. J. Florey, H.: Observations on the contractility of CelL BioL 27 (1965) abstr. 129A-130A lacteals. Part II. J. PhysioL 63 (1927) 1-18 Burke, J.F., L. V. Leak: Lymphatic C

Foldi, M.: Erkrankungen des Lymphgefai\systems. lymphatics in regard to intestinal absorption. 'G. Witzstrock, Baden-Baden, Briissell971 Abstr. Intern. Congr. LymplioL Buenos-Aires, ·Gerteis, W.: DarstellUrigsmethoden des Lymphgefai­ Rio de Janeiro 1975, pp. 101-103 systems und praktische Lytrtphographie. In: Kinmonth, J.B., E.P. Sharpey-Schafer, G.W. Taylor: Handb. AUg. Path. 111/6, pp~ 595-636. Springer,: Spontaneous contractions of lymphatic vessels Berlin, Heidelberg, New Yotk 1972 in man. Lancet 1 (1963) 1425 Goldberg, G.M.: The involvement of the endocardium Kline, LK.: The relationship between human endo­ as related to subendocardial lymphatics. Amer. · cardial fibroelastosis and obstruction of the J. Path. 52 (1968) 69a cardiac lymphatics. Circulation 30 (1964) 728- Grau, H.: Das Lymphgefai\system. In:· Ellenberger­ 735 Baum: Handb. VergL Anat d. Haustiere 18. Anfl. Kuprianov, V. V.: Some features of the initial lym­ Berlin 1943 phatic vessels in their interrelation with blood Hankiss, J.: KollodiumeinhUUung der Leber zur vessels. Acta anat (Basel) 73 (1969) 69-80 Untersuchung des Lymphkr~islaufs der Leber­ Lauweryns, J.M.: Stereomicroscopic funnel-like kapsel Zschr. Ges. Inn. Med. 14 (1959) 1018 architecture of pulmonary lymphatic valves. Bass, H.: Die Architektur der Il.ymphgef~e der Lymphology 4 (1971) 125-132 Leberkapsel in ihren BeziehUngen zur Bindege­ Leak, L. V., J.F. ·Burke: The passage of electron­ websstruktur und Fliissigkeitsstromung. Virchows opaque tracers across the lymphatic capillary

Arch. 297 (1936) 384-403 I wall In: Electron Microscopy, Vol. II Biology; Horstmann, E.: Ober die funktionelle Struktur der pp. 731-732. Maruzen Co. Ltd., Tokyo 1966 mesenterialen Lymphgeflii\e, MorphoL Jahrb. Leak, L. V., J.F. Burke: Fine structure of the lym­ 91 (1951) 483-510 phatic capillary and the adjoining connective Horstmann, E.: Beobachtungen zur Motorik der tissue area. Amer. J. Anat. 118 (1966) 785-809 Lymphgeflii\e. Pfliigers Arch. ges. Physiol 269 Leak, L. V.: The fme structure and function of the (1959) 511-519 lymphatic vascular system. In: Handb. Allg. Hudack, S.S. P.D. McMaster: The lymphatic partici­ Pathol 111/6, pp. 149-196. Springer, Berlin­ pation in human cutaneous phenomena. J. exp. Heidelberg - New York 1972 Med. 57 (1933) 751-774 Lenz, W., F. Huth: Lichtoptische und rasterelektro­ Huth,·F.: Disk. in: Progress in Lymphology. p. 411 nenmikroskopische Untersuchungen zur Wand­ Thieme Stuttgart 1967 struktur der Cisterna chyli des Menschen. Acta Huth, F.: Beitriige zur Orthologie und Pathologie anat 96 (1976) 259-269 der Lymphgeflii\e der Nieren. Beitr. Path. Anat. Lie, T.S., W. Nohl, H. Nakano, H. Ebata, F. Ruth: 136 (1968) 341-412 Beeinflussung einer Cholestase durch eine Lympho­ Huth, F., A. Wilde, H.J. Schulten, S. Berger: stase der Leber. Folia Angiol. 24 (1976) 59-62 · Morphologische Beitrage zut Pathophysiologie Lie, T.S., W. Nohl, H. Nakano, H. Ebata, F. Huth: des Lymphgefai\systems de~ Leber. Virchows Lymphostatische Hepatopathie. Folia Angiol Arch. Abt A, 351 (1970) ~1-67 24 (1976) 52-58 Huth, F.: Allgemeine Patholog~e des Lymphgeflii\­ Ludwig, J., P. Linhart, A.B. Baggenstoss: Hepatic systems. In: Handb. Allg. Pathol. Bd. 111/6, pp. lymph drainage in cirrhosis and congestive heart 457-578. Springer, Berlin- Heidelberg- New York failure. Arch. Pathol 86 (1968) 551-562 1972 Ludwig, J., P. Linhart: Lymphvarizen bei Leber­ Huth, F.: Morphologische Aspekte des Lymphgef~ zirrhose und Stauungsleber. Verb. Dtsch. Ges. systems der Leber. Leber, Magen, Darm 4 Pathol 52 (1968) 563-567 (1974) 262-273 Magnus, G.: Darstellung der Lymphwurzeln von Huth, F., T.S. Lie, W. Nohl, P.l Hiilzer, H. Nakano: serosen Hauten und ihre. Bedeutung fiir die Morphologische Befunde an den Lebern von Pathologie. Arch. Klin. Chir. 121 (1922) 128-130 Hunden nach experimentellfr Lymphostase, Meessen, H.: Ober Lungenzirrhose. Beitr. path. Anat- Cholestase sowie Lymphostase plus Cholestase 110 (1949) 1-14 mit und ohne Behandlung durch subkutane In­ Miller, A.J., R. Pick, L.N. Katz: Lymphatics of the jektionen von Cumarin-Troxerutin. Folia Angiol myocardial pathology produced by chronic 24 (1976) 39-51 cardiac lymphatic obstruction in the dog. Circ. Johnson, R.A., T.M. Blake: Lymphatics of the heart. Res. 8 (1960) 941-947 Circulation 33 (1966) 13 7-142 Miller, A.J., if Pick, L.N. Katz: Lymphatics of the Johnson, R.A.: The lymphatic ,system of the heart mitral valve of the dog. Circ. Res. 9 ( 1961) 1005- Lymphology 2 (1969) 95-1p8 1009 Jossifow, G.M.: Das Lymphge~system des Men­ Miller, A.J., R. Pick, L.N. Katz: Studies on the effect of chronic impairment of cardiac lymph flow in schen. Fischer, Jena 1930 I Kaiserling, H., T. Soostmeyo: Die Bedeutung des the dog. In: Progress in Lymphology. pp 369-3 70. NierenlymphgefliL\systems ~r die Nierenfunktion. Thieme, Stuttgart 1967 . Wiener Klin. Wschr. 52 (1939) 1113-1117 Miller, A.J.: Some observations concerning pericardial Kalima, T.V., S.H. Kalima: The significance of ultra­ effusions and their relationship to the venous and structural details in blood capillaries and initial lymphatic circulation of the heart. Lymphology 2 (1970) 76-78 Permission granted for single print for individual use. Reproduction not permitted without permission of Journal LYMPHOLOGY. I The Anatomy of Lymph Vessels in Relation to Function 61

I Mislin, H.: Zur Funktionsanalyse def Lymphgefafl­ Seeliger, K.: Direkte intravaskuliire fibroskopische motorik. Rev. suisse Zool 68 (1961) 228-238 Lymphoskopie und Ductus thoracicus-Kaniilierung. Mislin, H.: Experimenteller Nachwe's der autochtonen Folia Angiol. XXI (1973) 287-296 Automatik der Lymphgef~e. Experientia 1 7 Seeliger, K.: Vasculiire Endoskopie der Ductus thoraci­ (1961> 29-3o . I cus-Einmiindung im linken Venenwinkel. Folia Mislin, H.: Zur Funktionsanalyse de8 Elektrolymph­ Angiol. Suppl Vol III (1974) 117-118 angiogramms (ELG) bei MesenteriaJgef~en von Smith, R.O.: Lymphatic contractility: A possible Meerschweinchen. Verb. Dtsch. Ges. Zool intrinsic mechanism of lymphatic vessels for pp. 543-549. Leipziger Acad. Vetlagsanstalt transport of lymph. J. exp. Med. 90 (1949) 497-

Geest & Portzig KG 1963 I . ··- 509 Misl~n. H.: Active contractility of thb lymphangion _ Stroobandt, R., W. Lenz, G. Jacobs, E. Wiebringhaus, and coordination of lymphangiob chains. Experi- F. Huth, L. Van Der Hauwart: X-ray, light- and

entia 32 (1976) 820-822 I electron microscopic investigations of the cardiac Mori, K.: MOiphological obseiVation on the passage lymph vascular system. Folia Angiol. 24 (1976) of substances through the walls Qf blood and 63-71 lymphatic vessels. Acta path. japJ 13 (1963) Szabo, G.: Die Bedeutung des LympbgefaBsystems in

2o8-2o9 I der Physiologie und Pathologie. Med. Klin. 55 Mori, K., S. Yamada, R. Ohori, M. Takada, T. Naito: (1960) 974-977 Observations in vivo on the extravasation of Tormene, A., 0. Zangrando, R. Millini G. Fazzini: various dye fluids from the blood vessels into the Contribution to the study of the lymphatic connective tissue. Okajimas Foli~ anat jap. 39 circulation in organs. Note 1: The renal lymphatics..

(1964) 277-299 i Ural int. 20 (1965) 305-318 Most, A.: Untersuchungen iiber die Lymphbahnen Vanek, J.: Interstitielle nichteitrige Pneumonie. Zen­ an der oberen Thoraxapertur und am Brustkorb. tralbl Pathol 92 (1954) 405-416 Arch. Anat Physiol 1 (1908) 1-30 Viragh, s:, M. Papp, L Toro, l Rusznyak: Cutaneous Natucci, G., C. Zaccarini: Risultati gperimentali e lymphatic capillaries in dextran- induced oedema sequele determinate dalla ligat~ dei linfatici of the rat Brit J. exp. Path. 4 7 (1966) 563-567 all'ilo delrene. Riv. Anat Path. 2 (1949) 639-658 Webb, R.C., T.E. Starzl: The effect of Romualdi, G., 0. Linoli: Le alteraziJni delle strutture pulsation on lyntph pressure in large lymphatics. glomerulari nelle nefrosi umano esperimentali ed Bull. Johns Hopk. Hasp. 93 (1953) 401-407 illoro significate nella genesi della alterazioni Wutzer, C. W.: Einmiindung des Ductus thoracicus in tubulari a gocce jalines. Arch. De1 Vecchi 8 (1946) die Vena azygos. Arch. Anat. Physiol. (1834)

577-622 I 311-318 Romualdi, G., M. Monaci: La nefrosi consecutiva a Wenzel, J.: Nonnale Anatomie des Lymphgefcii\systems. linfostasi sperimentale e Ia nefro~i da tossici esogeni In: Handb. Allg. Pathol. Bd. 111/6 pp. 89.;.1~8. nell rene in linfostasi Arch. De ~ecchi 9 (194 7) Springer, Berlin- Heidelberg:.... New York 1972

987-1002 I Witte, C.L., M.H. Witt~ A.E. Dumont, J. Frist, W.R. Romualdi, G., M. Monaci: Le modificazioni della Cole: Lymph protein in hepatic cirrhosis and funzione dei rene in corso di linfbstasi in animali experimental hepatic and portal venous hypertension nonnali e nella ipertrofica vicaria!nte. Arch. De Ann. Surg. 168 (1968) 567-577

Vecchi 9 (1947) 973-986 I Witte, M.H., A.E. Dumont, W.R. Cole, C.L. Witte, Rusinyak,l, M. Foldi, G. Szabo: Ppysiologie und K. Kintner: Lymph circulation in hepatic cirrhosis: Pathologie des Lymphkreislaufs. !Fischer, Jena effect of portocaval shunt. Ann. Int. Med. 70 1 (1969) 303-310 Sch~::. R., A. Schafer: ElektroneJikroskopische Witte, M.H., C.L. Witte: Influence of mechanical Untersuchungen zur Chylusbildttng und Funktion factors on ascites fonnation in hepatic cirrhosis. der Lymphwege in der Darmwatid des Saugers. Lymphology 2 (1969) 89-91 Zool Anz. SuppL Bd 33, Verb. ZooL Ges. Yoffey, J.M., F. C. Courtice: Lymphatics, lymph and the lymphomyeloid complex. London, Acad. PP· 407-415 (1969> I

I Press. 1970 I

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I . F. Huth, Patholog. rnstitut, Univ. Dusseldorf. Moorenstr. 5, 4000 DUsseldorf

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