ORCID Profile
0000-0003-2331-5251
Current Organisations
Monash Health
,
Royal Melbourne Hospital
,
Peter MacCallum Cancer Centre
,
University of Melbourne
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Publications
Divergent lymphatic drainage routes from the heel to the inguinal region: Anatomic study and clinical implications
Publisher: Mary Ann Liebert Inc
Date: 09-2014
Abstract: To determine routes of lymphatic drainage from the heel to the inguinal lymph nodes to assist in the clinical management of lower limb lymphatic disorders. Six lower limbs from three unembalmed human cadavers were studied. Under a surgical microscope, 6% hydrogen peroxide was used to detect lymphatic vessels on the medial and lateral sides of the heel. The lymphatic vessel on either side was then injected with a radio-opaque mixture. The lymphatic vessels were traced, photographed, and radiographed to demonstrate the lymphatic pathways from the heel to the inguinal lymph nodes. The final results were transferred to computer for digital image analysis. Two groups of lymph collecting vessels were identified. The medial group, arising from the skin between the medial malleolus and the Achilles tendon, coursed along the medial side of the leg and thigh to the inguinal lymph nodes. The lateral group, arising from the skin between the lateral malleolus and the Achilles tendon, coursed along the postero-lateral side of the leg to the popliteal fossa. Alternative routes were then identified from the popliteal fossa to the inguinal lymph nodes. The number, size, type, and distribution of lymph vessels and nodes were variable from person to person. Two different lymphatic routes from the heel to the inguinal lymph nodes have been described. This information upgrades current anatomical knowledge and the results will be of benefit for the clinical management of lower limb trauma and malignancy.
Superficial lymphatic drainage of the lower extremity: Anatomical study and clinical implications
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2013
68 Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography Maximum Standardized Uptake Value as a Predictor of Gleason Pattern 4 and Pathological Upgrading in Interme
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2022
Lymphatic drainage of the tongue and the soft palate
Publisher: Springer Science and Business Media LLC
Date: 08-04-2010
Modulation of immunity by lymphatic dysfunction in lymphedema
Publisher: Frontiers Media SA
Date: 29-01-2019
Radiologic characteristics of voice prostheses and the clinical significance of the missing valve
Publisher: AME Publishing Company
Date: 03-2020
The morphology of the human lymphatic vessels in the head and neck
Publisher: Wiley
Date: 20-08-2010
DOI: 10.1002/CA.21004
Abstract: Previously little has been written about the morphology of the human lymphatic vessels since Sappey (Sappey [1874] Anatomie, Physiologie, Pathologie des Vaisseaux Lymphatiques, Paris: Adrien Delahaye) over 100 years ago. There needs to be an accurate re-evaluation of scientific observations to aid clinical management. Forty-nine combinations of tissue from the head and neck of 20 unembalmed human cadavers were studied. Six percent hydrogen peroxide was used to find the vessels. They were injected with radio-opaque mixture, dissected, photographed, and radiographed. Final results were transferred to the computer for analysis. Different sized lymphatic valves were found in the precollecting and collecting lymph vessels, the lymphatic trunks, and ducts. The intervals between the valves were of various lengths. Diverse lymphatic ullae and erticula were seen in precollecting and collecting lymph vessels. Initial lymph vessels arose from the dermis, the galea, and the mucosal membrane. The vasculature of the direct and indirect precollecting and collecting lymph vessels, lymphatic trunks, and ducts was recorded. The morphology of the human lymphatic vessels in the head and neck has been described and recorded using radiographs and photographs.
Angiosomes of the brachial plexus: An anatomical study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2003
Lymphatic drainage of the external ear
Publisher: Wiley
Date: 05-0001
DOI: 10.1002/HED.21395
Abstract: Lymphoscintigraphy reveals inconsistencies in our knowledge of the lymphatic anatomy of the external ear. Fifteen external ears from 9 unembalmed human cadavers were studied. Six percent hydrogen peroxide was used to find the lymphatic vessels using a surgical microscope. They were injected with a radio-opaque mixture, dissected, photographed, and radiographed to demonstrate lymphatic vessels in the tissue. Final results were transferred to the computer for analysis. Four groups of lymph collecting vessels were found. The anterior branch, in all specimens, drained directly or indirectly (having merged with a vessel descending from the scalp) into the preauricular lymph nodes. The superior, middle, and inferior (lobule) branches drained to their multiple first tier lymph nodes. An accurate lymphatic map of the external ear is described to upgrade our anatomic knowledge. It will be of benefit for the clinical management of malignancies in this region.
Vascular Endothelial Growth Factor-d Modulates Caliber and Function of Initial Lymphatics in the Dermis
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1038/JID.2013.83
Abstract: The lymphatic vasculature is important for skin biology as it maintains dermal fluid homeostasis. However, the molecular determinants of the form and function of the lymphatic vasculature in skin are poorly understood. Here, we explore the role of vascular endothelial growth factor-d (Vegf-d), a lymphangiogenic glycoprotein, in determining the form and function of the dermal lymphatic network, using Vegf-d-deficient mice. Initial lymphatic vessels in adult Vegf-d-deficient mice were significantly smaller than wild-type but collecting lymphatics were unaltered. The uptake/transport of dextran in initial lymphatics of Vegf-d-deficient mice was far less efficient, indicating compromised function of these vessels. The role of Vegf-d in modulating initial lymphatics was further supported by delivery of Vegf-d in skin of wild-type mice, which promoted enlargement of these vessels. Vegf-d-deficient mice were subjected to cutaneous wounding to challenge lymphatic function: the resulting wound epithelium was highly edematous and thicker, reflecting inadequate lymphatic drainage. Unexpectedly, myofibroblasts were more abundant in Vegf-d-deficient wounds leading to faster wound closure, but resorption of granulation tissue was compromised suggesting poorer-quality healing. Our findings demonstrate that Vegf-d deficiency alters the caliber of initial lymphatics in the dermis leading to reduced functional capacity.
Training in the private sector: what works and how do we increase opportunities?
Publisher: Wiley
Date: 03-2009
DOI: 10.1111/J.1445-2197.2008.04830.X
Abstract: In Australia 61% of elective surgery takes place in private hospitals where current opportunities for surgical education and training (SET) are limited. The situation will shortly be compounded because of the large increase in local medical graduates, many of whom will aspire to be surgeons. How and where to train these extra surgeons to meet the expanding needs of the community must be addressed. Two models of private sector training are reviewed both of which involved combined training in both private and public sectors. Two second-year (SET 2) positions were created from one public hospital SET position by using the private sector for 3.5 days per week for 3 months of a 6-month rotation. The second model was applicable to post-fellowship training with a fairly even split between public and private sector responsibilities. In the first year, four registrars shared the two 6-month rotations for the SET 2 position. Trainees did the required minimum procedures (range 109-139) with primary operating targets of 20-25% (range 21-32%). The post-fellowship position in colorectal surgery was greatly enhanced by the private sector involvement with regard to operating experience as well as meeting part of the remuneration of the trainee. Successful models for training within the private sector in Australia can be found. To expand training in the private sector there will need to be a cultural shift in the perceptions of surgeons, patients, administrators, and trainees. Funding for posts may be available to those private hospitals that can meet the Royal Australasian College of Surgeons' accreditation standards for posts and hospitals.
Do magnetic resonance imaging abnormalities of the non-dominant wrist correlate with ulnar-sided wrist pain in elite tennis players?
Publisher: Springer Science and Business Media LLC
Date: 10-08-2020
DOI: 10.1007/S00256-019-03285-Y
Abstract: Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players that use the double-handed backhand technique. This study aimed to define the relationship between ulnar-sided wrist pain in symptomatic and asymptomatic elite tennis players, and the presence of abnormalities on magnetic resonance imaging (MRI). Fourteen symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls who did not play tennis, were analyzed prospectively, after undergoing MRI of their non-dominant wrist. Five anatomical regions were analyzed, thought to relate to ulnar-sided wrist pain. These consisted of the triangular fibrocartilage complex (TFCC), ulnar collateral ligament (UCL), extensor carpi ulnaris tendon (ECU), osseous-articular structures, and ganglia. Images were independently reviewed by two blinded musculoskeletal radiologists. Non-dominant, ulnar-sided, wrist pain in elite tennis players was not statistically significantly associated with an increased number of MRI abnormalities when compared with asymptomatic tennis players (p > 0.05). However, some evidence of statistical association was seen with an increased prevalence of ECU tendon abnormalities (OR = 8.0, 95% CI = (0.74, 20.00), p = 0.07). A statistically significant increase in MRI abnormalities of osseous structures (OR = 15.1, 95% CI = (1.56, 656.05), p = 0.02) and the dorsal radioulnar ligament (DRUL) (OR = 12.5, 95% CI = (2.15, 111.11), p = 0.03), was observed in symptomatic players compared with controls. Non-dominant, ulnar-sided, wrist pain in a subgroup of elite tennis players using a double-handed backhand technique is not associated with a statistically significant increased prevalence of MRI abnormalities when compared with asymptomatic tennis players, other than some evidence of statistical association with ECU tendon abnormalities. Therefore, significance of MRI abnormalities should be interpreted in the context of clinical findings.
Integrated clinical and genomic evaluation of guadecitabine (SGI-110) in peripheral T-cell lymphoma
Publisher: Springer Science and Business Media LLC
Date: 22-04-2022
DOI: 10.1038/S41375-022-01571-8
Abstract: Peripheral T-cell lymphoma (PTCL) is a rare, heterogenous malignancy with dismal outcomes at relapse. Hypomethylating agents (HMA) have an emerging role in PTCL, supported by shared mutations with myelodysplasia (MDS). Response rates to azacitidine in PTCL of follicular helper cell origin are promising. Guadecitabine is a decitabine analogue with efficacy in MDS. In this phase II, single-arm trial, PTCL patients received guadecitabine on days 1–5 of 28-day cycles. Primary end points were overall response rate (ORR) and safety. Translational sub-studies included cell free plasma DNA sequencing and functional genomic screening using an epigenetically-targeted CRISPR/Cas9 library to identify response predictors. Among 20 predominantly relapsed/refractory patients, the ORR was 40% (10% complete responses). Most frequent grade 3-4 adverse events were neutropenia and thrombocytopenia. At 10 months median follow-up, median progression free survival (PFS) and overall survival (OS) were 2.9 and 10.4 months respectively. RHOA G17V mutations associated with improved PFS (median 5.47 vs . 1.35 months Wilcoxon p = 0.02, Log-Rank p = 0.06). 4/7 patients with TP53 variants responded. Deletion of the histone methyltransferase SETD2 sensitised to HMA but TET2 deletion did not. Guadecitabine conveyed an acceptable ORR and toxicity profile decitabine analogues may provide a backbone for future combinatorial regimens co-targeting histone methyltransferases.
Radiologic Manifestations of Senile Lymph Nodes in the Popliteal Fossa
Publisher: Mary Ann Liebert Inc
Date: 03-2016
Abstract: To determine the radiologic manifestations of senile lymph nodes in the popliteal fossa for radiologic and clinical application. A total of six lower extremities from four unembalmed human cadavers were studied. Under a surgical microscope, 6% hydrogen peroxide was used to detect the lymphatic vessels commencing from the foot and leg. A 30-gauge needle was inserted into the vessels and injected with a radio-opaque lead oxide mixture. The specimens were radiographed and photographed to demonstrate the lymph nodes in the popliteal fossa. The final results were transferred to the computer for image analysis. An average of two lymph nodes (range 1 to 3) were found in the popliteal fossa of the lower extremity. They were ided into superficial and deep popliteal groups. The superficial group was located in the superficial layer of the popliteal fossa around the small saphenous vein (SSV). The deep group was close to the popliteal surface of the femur and always located next to the popliteal vein. All lymph nodes were transparent in appearance and contained coiled lymphatic tubules. The size and density of the tubules varied. The radiologic manifestations of senile lymph nodes in the popliteal fossa have been presented and discussed to upgrade our radiologic and anatomical knowledge. This will be of benefit for radiologic and clinical applications.
Alternative lymphatic drainage routes from the lateral heel to the inguinal lymph nodes: Anatomic study and clinical implications
Publisher: Wiley
Date: 20-01-2011
DOI: 10.1111/J.1445-2197.2010.05639.X
Abstract: The route of lymphatic drainage from the heel to the inguinal lymph nodes is required to be accurately evaluated for clinical needs. Seven lower limbs from four unembalmed human cadavers were studied. Under a surgical microscope, 6% hydrogen peroxide was used to detect the lymphatic vessel on the lateral side of the heel. The vessel was then injected with a radio-opaque lead oxide mixture. The vessel was traced, photographed and radiographed to demonstrate the lymphatic pathways from the lateral heel to the inguinal lymph nodes. The final results were transferred to the computer for image analysis. The lymph collecting vessel arising from the skin of the fossa between the lateral malleolus and the Achilles tendon ran along the posterolateral side of the leg, deep to the superficial fascia. From the popliteal fossa to the inguinal lymph nodes, three lymphatic routes were found: (i) via the superficial tissue of the medial side of the thigh (ii) running with the superficial femoral blood vessels (iii) running between the sciatic nerve and the profunda femoral vessels. The number and type of lymph nodes found in the popliteal fossa and femoral triangle were different from person to person. Actual and accurate lymphatic routes from the skin above the posterolateral heel to the inguinal lymph nodes have been described. This information upgrades our anatomical knowledge and the results will be of benefit for the clinical management of trauma and malignancies in the lower limb.
Related Organisations
Related Funding Activities
No related grants have been discovered for Sidney Levy.