31. Where do the collectors of the lateral upper arm territory drain? In the United States, it is estimated that approximately 2 million people have primary lymphedema. Lymphatic intrinsic contractility (Lymphangiomotoricity): The Lymph "Rhythm" Elements of the lymphatic system include lymph capillaries (or initial lymphatics), with no real valves or proper muscular units, which carry fluid from interstitial spaces (interstitial fluid) to pre- collectors. Eight hundred and four practitioners were included in the study (trained: 393; untrained: 411). When the lymph volume increases, what happens to lymphangiomotricity? Reversible lymphedema: early accumulation of protein-rich fluid, elevation reduces swelling; tissue pits on pressure. significantly more correct mappings (correct answers = 245) Segments between two valves in a lymph collector are called lymph angions. When it is not flowing we experience swelling, fluid retention, congestion, bloating, and achy pain. , Because of the axillary dissection, drainage from the ipsilateral lymph vessels may be impaired. As with many other professional manual approaches, without previous specific training it may understandably seem impossible to assess these components of the lymph circulation, and discriminate between different skin signals. J Am Osteopath Assoc 105: 457-464. As an indispensable follow up study, fluorescent micro lymphangiography, or novel ultrasound, needs to be used to confirm these results. Lymphedema is a chronic, incurable condition that is characterized by an abnormal collection of fluid owing to an anatomic alteration of the lymphatic system. in individual subjects mapped by palpation, must further test Unauthorized use of these marks is strictly prohibited. Edema that presents with cording as its underlying cause must be treated concurrently with the cording. Any individual who undergoes axillary, breast, or chest surgery is considered to be at risk for the development of lymphedema in the trunk quadrant and upper extremity of the affected side. It thickens What structures form the medial femoral triangle where the inguinal lymph nodes are located? A surrounding fiber net of anchoring filaments, arranged around the lymph capillaries, enables these vessels to stay open at the junction between the overlapping cells even under high tissue pressure ( Fig. Lung biopsy showing infiltration of lymphatic tissue. A healthy lymphatic system is generally able to prevent or decrease the amount of acute edema. Federal government websites often end in .gov or .mil. To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation. As the condition progresses, protein continues to accumulate, forming a network of fibrosclerotic tissue. Accessed 2 Jun. Drainage - MLD increases lymphangiomotoricity ( the contraction rate of the lymph vessel) which decreases transit stretch time (the time it takes for nutrients to reach the cell) MLD creates Thixotropy in the loose connective tissue ( ability to go from a gel to a liquid state and back) when the tissue is mor sol (liquid) the nutrient reaches . What are the names of the four bundles in the hand? colloid osmotic pressure of the plasma (COPpl), blood pressure in arteries is ____ than blood capillary pressure, precapillary sphincter is innervated by ____. Disclaimer. age) were not collected, but in the relatively large sample of the untrained group, for example, we dont know if additional information would have made a difference in their initial lymphatic examination of the foot. what is a contraindication for abdominal techniques? where does the 3 chains of the lateral cervical triangle drain? MLM is a recent advance in manual therapy, According to numerous studies, the threshold of human mechanoreceptors for different mechanical stimulus is astonishingly small, on the order of a micrometer. Introduction. -Caused: Protein-rich interstitial volume overload, secondary to lymph drainage failure. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Therapists Management of Carpal Tunnel Syndrome: A Practical Approach, Therapists Management of Peripheral Nerve Injury, on Management of Upper Extremity Lymphedema, Rehabilitation of the Hand and Upper Extremity. Spontaneously irreversible lymphedema: proteins stimulate fibroblast formation; connective and scar tissue proliferate; minimal pitting even with moderate swelling. This is recognized as lymphedema or lymphostatic edema. Attendees were only checked for basic pathological clinical signs, such as clinical lymphedema, redness, pathological appearance of the skin, fibrosis, as well as any subjectiveself-reported signs, such as pain, tenderness, etc., and a medical history of lymphedema. MLM is a gentle, non-invasive method by which trained manual therapists - using only their hands declare being able to identify the specific direction of the superficial or deep lymphatic circulation on an affected or unaffected area of the body. what is the common cause of lymphedema in the World? 41 Miyaoka et al. These areas were not graded because: 1) the direction of the arrows changes in these areas, and 2) the heel and the ball of the foot can be the two areas with the thickest epidermis in the feet. I have been trained to assess the lymph flow by palpation: Yes___No___, 2. Furthermore, there is no similar artery or vein mapping on the sole of the foot. what is the force of proteins in the blood to hold water called? The https:// ensures that you are connecting to the This study examines the feasibility of manual lymphatic palpation. FOIA These pathways correlate with known physiologic lymphatic maps of the area, and no other known structures. 64-2 ). A Lymphatic Safety Factor. Between the axillary and inguinal lymph nodes, on the front of the body. Background: Trained practitioners claim to identify the 8600 Rockville Pike The nonoperated side of thorax is the area draining lymph from the defective, postlymphadenectomy side. The editorial Tracking system facilitates a user friendly article submission, review and publication. Inflammation of lymphatic vessels, usually caused by virulent organisms, often STREPTOCOCCI (see STREPTOCOCCUS ). Radial, Ulnar, Mesothenar, and Descending. For Johansson and Vallbo, the Pacinian corpuscles, and rapidly adapting Meissner's corpuscles, had the lowest thresholds of all human mechanoreceptors, with medians of 9.2 and 13.8 micrometers.34 Mountcastle determined that Pacinian corpuscles are capable of sensing vibrations, associated with slip and texture, which can be less than a micrometer in amplitude. where are the perforating collectors located? what is an absolute contraindication for compression treatment? It is reasonable to consider the possibility that, with training, selective attention/palpation may allow discernment of lymph flow, just as a listener can select the sound of a single instrument in a symphony. In the interstitial fluid, the pressure is always negative under physiological conditions and becomes positive when increased proteins are present. 2023. all collectors in forearm converge and bottleneck at ____. The contraction of smooth muscle in each angion (called lymphangiomotoricity) generates the propulsive force of lymph flow along the lymph vessel. Some swelling may be a mixture of both edema and lymphedema, as occurs when the functional reserve of the lymphatic system is exceeded and the lymph transport capacity is compromised. Which skin areas do the superficial Inguinal lymph nodes drain? The .gov means its official. Bruising reduction. There is no obvious rhythm ever described in these structures, which can be mechanically felt at a distance on the skin. Patient education about the signs and symptoms of lymphedema as well as proper management and protection of the limb at risk should be implemented. Internal organs, ovaries, testicles, and prostate. Human mechanoreceptors are exquisitely sensitive. Lymphangiomotoricity (flow of the lymph) Lymph collects in angions (between two valves) Smooth muscle and respiratory pumps force lymph forward Aided by function of the one-way semilunar valves Ultimately lymph fluid empties into venous system Lymph collects Interstitial fluid Single angion Angion contracts Valve opens Valve . the efferent vessels of the ancillary lymph nodes converge to form which structure? Created by dnrusso Terms in this set (88) Lymphedema definition a build up of lymph fluid in the fatty tissues just under the skin What are characteristics of lymphedema? MLM is a component of Lymph Drainage Therapy (LDT)/Osteopathic Lymphatic Technique (OLT) a hands-on modality developed by Bruno Chikly, MD, DO, inspired by the traditional work of osteopaths CE Miller (1920), FP Millard and Emil Vodder. what/where does the collectors of the ventromedial bundle form? The diagnosis of lymphedema is made in most cases by patient history, systems review, inspection, palpation, and a few select noninvasive tests such as volume or girth measurement. Conclusion: Trained practitioners, but not untrained between axillary lymph nodes crossing sagittal watershed. Edema reduction. drains muscle/tendons, drains joints, inner organ drains. Inflammation of the lymphatic vessels. How much fluid returns to the right venous angle in 24 hours? in humans. It may be difficult for a manual practitioner to guess, or assume, which pathway will be taken by the lymph flow. Specific manual techniques for the lymphatic system have been used by osteopaths since the end of the 19th century.1,2 Emil Vodder, PhD in Philosophy and manual therapist, and his wife, developed an innovative approach to manually enhance lymph flow throughout the body. Depictions of the lymphotome of other regions, such as the legs, arms, back, and trunk are common (Figures 2 and 3). Secondary lymphedema is usually unilateral; however, it may present in both limbs. Pain management as pressure of lymph fluid decreases around nerves, pain and discomfort are relieved and require less pain medication. Lymph collectors have valves, spaced every 6 to 20mm. 49-51. The propulsion directs the lymph fluid into regional and central lymph nodes to be filtered ( Fig. Fluid accumulation in the tissues is an ideal medium for pathogen growth, and cellulitis and venous-type ulceration (particularly of the lower extremities) can be a common occurrence for patients with lymphedema. Students enrolled in LDT/OLT level 2 seminars. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. What are the names of the two upper arm territories? First, it provides significant immune function by protecting the body from disease and infection via production, maintenance, and distribution of lymphocytes. At the first sign of edema, management techniques should be initiated. Similarly, for the trained group, testing was performed after their first 3 days of training in manual mapping technique (MLM), (practitioners did not yet have extended practice of their mapping skills.). lymph pathway as it leaves deep inguinal lymph via efferent lymph vessels, pelvic nodes->lumbar nodes->lumbar trunks->cisterna chyli->thoracic duct->left venous angle. what is the segment of lymph collector between proximal and distal pair of valves? {Lack of lymphatic regeneration increased risk of lymphedema. However, there are some possible anatomical variations in healthy individuals. There is no known easily palpable slow arterial pulse in this area. upper quadrant of trunk, upper extremities. Functional reserve of the lymphatic system. what forms the medial femoral triangle where the inguinal lymph nodes are located? Mild postoperative edema and subtle changes in tissue are expected and often transient, resolving with the healing of the surgical site and lymphatic regeneration. Secondary lymphedema etiologies include inflammation, infection, radiation therapy, surgery, filariasis (parasitic infection), trauma, iatrogenic alterations, artificial self-induced lymphedema, benign or malignant tumor growth, and chronic venous insufficiency. Human lymph collectors are approximately 100 to 600 microns in diameter, and consist primarily of chains of muscular units called lymphangions, bordered by two-leaflet bicuspid valves. Gastrointestinal Trunk -> Cisterna Chyli -> Thoracic Duct -> Left Venous Angle. Lymphatic vessels, absorbing surrounding interstitial fluid, possess a physiological rhythm similar to the one used by these practitioners. Sometimes the etiology of edema is uncertain, and there is no clear clinical distinction between lymphedema and other types of edema. The untrained group was comprised of manual therapists students who randomly registered in an introductory lymph class (LDT level 1). In an experimental study on rats and sheep we demonstrated by means of light reflexion rheography and laser doppler fluxmetry that manual lymphatic drainage therapy causes vessel narrowing followed by increased blood flow in the arterioles, capillaries and venulae of the skin as well as in peripheral arteries and an increased lymph flow in lymphatic collectors. 4. -4 major mechanisms: increase blood capillary pressure, decreased plasma protein concentration, increased blood . Europe PMC is an archive of life sciences journal literature. These data only suggest, at this point, that these arrows may representlymph-interstitial flow. Nevertheless, this would not make the lymphatic flow readily palpable. What is the largest lymph trunk in the body? Manual therapy, including gentle passive ROM of the shoulder with elbow and wrist extension and mild skin traction, can be followed by the appropriate edema techniques. . (The image above is a copyrighted product of Association for the Advancement of Wound Care [. What happens to the lymph fluid as it passes through the lymph nodes? In manual therapy practice, fascia pulls are usually felt as straight lines (collagen fibers). Specific arrows were drawn by the 245 practitioners that had correct answers, matching the known general pattern of the superficial lymphatic circulation of the foot. A number of abnormalities can be found in subclinical lymphedema, including hyper pressure in the lymphatic microcirculation, measured by fluorescence microlymphography and dermal backflow. Today, manual therapists, including DOs, PTs, OTs, nurses, and other practitioners use Combined Decongestive Physiotherapy (CDP) for lymphedema. It shows that trained practitioners are able to provide maps of the soles of the feet of healthy volunteers. Relaxation, reduces stress, increase flexibility, improve posture, improve blood circulation, endorphine release to improve mood, flush out metabolic byproducts, increase range of motion, support healthy immunity, increase nutrient supply to muscles increases energy improve sleep, relieve headaches, Reduces the sympathetic nervous system creating a calming relaxation affect, overriding the nociceptors by stimulating mechanoreceptors reducing pain, increases lymphangiomotoricity, decreasing transit stretch to help facilitate lymph flow, opening areas, utilizing and activating collateral pathways, this not only helps drain fluid, but increases activity of lymphocytes in nodes, increases cellular debris from tissues and increasing immunity. 2.During the session to allow the therapist to determine whether the most appropriate work area has been selected, and if the lymph flow has been efficiently and non-invasively rerouted by the hands-on manoeuvres (Figures 4 and 5). axilla, inguinals, etc.) However, once chemotherapy is concluded, the edema can resolve with continued treatment. lymphedema is always unilateral, if bilateral it is usually ____? Complete decongestive therapy is a two-phase intervention for lymphedema that is noninvasive, highly effective, and cost-effective that can reduce and maintain limb size. 28, Lymphatic vessels are located initially just under the dermo- epidermic junction, making them potentially relatively easy to palpate. government site. what is the term when the diameter of collectors is larger than normal, resulting in an insufficient valvular system? 42-46 The sole of the foot has two main territories, the lateral half of the sole of the foot drains laterally, and the medial half drains medially. (Post surgical lymphatic massage is important when considering that stagnating lymph fluid can become infectious material and warrant artificial drain insertionwhich is painful, costly and time consuming). At the site of fluid entry, we find, in initial lymphatics, oak leaf-shapedendothelial cells with overlapping flaps; the openings are about 2 microns in size.12 Pre-collectors slowly acquire valves. what happens to lymph fluid as it passes through lymph nodes? where are superficial collectors located? The etiology of lymphedema is currently classified into two major categories: primary and secondary lymphedema. Research Article - (2015) Volume 23, Issue 1. A positive IFP can be reduced a) by compression therapy b) by manual lymphatic drainage c) most effective by the combination of a) and. between axillary and inguinal lymph nodes, on front of body. The interstitial- lymphatic system seems a plausible hypothesis for the arrows described by the trained practitioners that had a correct answer. Shoulder flexion with the elbow extended becomes increasingly difficult because of tightness of the cords. Which part of the nervous system innervates the lymph collectors? 64-5 ). Reduces the sympathetic nervous system creating a calming relaxation affect, overriding the nociceptors by stimulating mechanoreceptors reducing pain, increases lymphangiomotoricity, decreasing transit stretch to help facilitate lymph flow, opening areas, utilizing and activating collateral pathways, this not only helps drain fluid, but increase. lymphangitis. They were given forms, and chose freely whether to fill in the forms (or not). All of the above healthy volunteer, a region never previously studied. One third of patients who undergo mastectomy (with lymph node resection) secondary to breast cancer develop secondary lymphedema of the upper extremity (the reported incidence varies depending on study parameters). Appropriate identification and intervention of this disease can improve functional and aesthetic outcomes and patient quality of life. Bethesda, MD 20894, Web Policies Lymphatic intrinsic contractility (Lymphangiomotoricity): The Lymph "Rhythm" Elements of the lymphatic system include lymph capillaries (or initial lymphatics), with no real valves or proper muscular units, which carry fluid from interstitial spaces (interstitial fluid) to pre- collectors. Lymphangiomotoricity is described as being generated by pacemaker activity, creating rapid synchronized phasic contractions with rhythmic contractility/peristalsis. Journal of lymphology, In the lymphangiomotor system, during manual lymph drainage (ML) there is an increase of lymphatic pressure, a decrease of the amplitude and an increase in frequency and hypertensive lymph stasis in too intensive ML. This edema frequently presents during the first 3 months postoperatively but can appear with the same signs and symptoms years later and usually corresponds to some traumatic irritation of the sclerosed lymphatic vessels, such as a quick stretch of the arm or an attempt to lift something that is too heavy. the superficial lymphatic system is located ____ the fascia. Quality in Primary Care received 2951 citations as per Google Scholar report. what anastomoses are used in lymphedema treatment? In this hypothetical model, one characteristic the practitioner needs to palpate is the effect of the diameter change created by lymphatic contraction, and transmitted to the skin by the anchoring filaments.24 To get a quantitative idea of these lymphatic signals we need to identify the diameter change during the lymphatic diastole/systole cycle. A positive IFP can be reduced a) by compression therapy b) by manual lymphatic drainage c) most effective by the combination of a) and b) Since the IFP increases again after discontinuation of one of these therapies, compression therapy is indispensable as chronic treatment. It increases What is the main function of the lymph nodes? Please enable it to take advantage of the complete set of features! This makes it quite easy to differentiate fascia pull from lymphatics rhythm, as a practitioner would just need to change position (tension) of the area to differentiate fascia from lymph. The lateral cervical triangle consists of which lymph nodes? What are the watersheds we utilize during treatment? the rate of contraction used by the lymphangion to transport the lymph fluid. In the interstitial fluid, the pressure is always negative under physiological conditions and becomes positive when increased proteins are present. Anterior axillo-axillary (AAA)Posterior axillo-axillary (PAA)Axillo-inguinal/Inguinal-axillary (AI/IA)Anterior inter-inguinal (AII). Secondary lymphedema is caused by some identifiable insult to the lymphatic system. The sole of the foot is one of the most difficult areas for palpating lymph flow, because it has a thick epidermic layer. {ALND seroma. The frequency of contraction of lymph angions at rest is 6 to 10 contractions per minute. Eighty-seven percent of all cases of primary lymphedema occur in females, and the lower extremities are more often involved than other body parts. Practitioners in the control group were excluded if they had previous training in palpation of lymph flow. Acta Physiol Acad Sci Hung. LYMF. 2,7 Manual Lymphatic Mapping (MLM) could be used to refine manual lymphatic assessment and treatment, or as an element of the manual component of CDP. Without previous specific training, it is understandable that it may seem impossible to assess these components of the lymph circulation. On the extremities territories are called. In the lymphangiomotor system, during manual lymph drainage (ML) there is an increase of lymphatic pressure, a decrease of the amplitude and an increase in frequency and hypertensive lymph stasis in too intensive ML. Brainscape helps you realize your greatest personal and professional ambitions through strong habits and hyper-efficient studying. sympathetic branch of autonomic nervous system, percentage of water that becomes lymphatic load ____, initial lymph capillaries cover body surface to form ___, rate of lymph anions contract is referred as____, anions under normal conditions contract ___times per minute. Results: Trained practitioners (n=393) provided Definitions.net. What does lymphangiopathy mean? Which lymph nodes do the collectors in the anterior intercostals spaces drain to? Szegvari made another observation in 1963, and made lymphangiographic observation of lymphatic contractions in humans, of about 4-5/min.21 Since the initial objective quantification of human lymph vessels by Olszewski (1979, 1980, 1982), there have been a few hundred studies on both animals and humans measuring lymphangiomotoricity in vivo and in vitro.16,22, Most recent studies show that these intrinsic lymph pumps generate lymph flow via the coordinated rapid strong contractions of their smooth muscular units.18 Numerous researches corroborate these data. However, this area was the most appropriateand honest choice. 13-16 Lymphangions work much like the bodys heart pacemakers, contracting regularly throughout the lymphatic system (Lymphangiomotoricity), and moving lymph in peristaltic waves.17,18 From the tunica media to the tunica externa, these muscular units have extensive autonomic nervous system innervation.19, The first descriptions of intrinsic contractility in human lymphatics were done by Kinmonth and Taylor in 1956.20 They mentioned that these contractions, independent of respiration, have a rhythm of approximately 4-6/min. Fibrosis of the initial lymphatic vessels and collectors leads to a failure of the endothelial junctions to close and valvular dysfunction in the deeper collecting vessels. Web. STANDS4 LLC, 2023. Written by Margaret Latham, MA, PT, DPT, CLT-LANA, ALM, MLD-PS In their book High Definition Body Sculpting, Doctors Hoyos and Prendergast recommend manual lymph drainage (MLD) in the Vodder style beginning on post-op day 3 as part of the CARE (Cosmetic Active Recovery) System of Postoperative Care. which lymph nodes does the ventromedial bundle drain? Fluorescence microlymphography: diagnostic potential in lymphedema and basis for the measurement of lymphatic pressure and flow velocity. What are the two bundles of the lower leg? how much fluid returns to right venous angle in 24 hours, how much fluid returns to the left venous angle in 24 hours. CDP is one of thenon-invasive treatments of choice for lymphedema, and is recognized and reimbursed by a growing number of national insurance companies.3-6 CDP consists of many components, including hands-on, manual lymph drainage therapy (MLDT), skin care, external compressions, etc. practitioners, mapped pedal flow by palpation, consistent with The classification system is used for unilateral limb involvement and is based on circumferential limb measurements. Any increase in fluid in the compromised area can tip the balance in favor of an edematous condition. Preliminary communication. When treated early and appropriately, cording-related edema usually resolves. A healthy lymphatic system is generally able to prevent or decrease the amount of acute edema. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. initial lymph capillaries, precollections, lymph collecter. specific direction of superficial or deep lymphatic circulation Each practitioner was asked to write on a form, provided to them in class, what they considered, through touch, to be the directions oflymphatic-interstitial flow in the sole of the right foot of a healthy volunteer. which lymph nodes does the dorsolateral bundle drain? For example, in cases of post mastectomy upper-extremitylymphedema, lymph flow has some 20 alternate pathways to choose between for rerouting to an unaffected lymph territory. Lymphology 40: 52-62. lymphangiomotoricity General Effects of MLD 1) increase in lymph production (See next) 2) increased lymphangiomotoricity by stimulating smooth musculature 3) reverse of lymph flow 4) increase in venous return 5) soothing 6) Analgesic General Effects of MLD Why is an increase in lymph production a "good" effect of MLD? There are several limitations to this study. Described as little lymphatic hearts, the contractility of lymphangions was initially objectively evaluated in humans by Olszewski. Lymphangiomotoricity is natural rhythmic pulsing of the lymph vessels. Risk of lymphedema in palpation of lymph collector are called lymph angions at rest is 6 20mm! Practitioner to guess, or assume, which pathway will be taken by the lymph have! Palpation, must further test Unauthorized use of these marks is strictly prohibited always under. All of the area, and no other known structures would not make the lymphatic flow palpable... 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Percent of all cases of primary lymphedema realize your greatest personal and professional ambitions through strong habits and hyper-efficient.. Is concluded, the contractility of lymphangions was initially objectively evaluated in by. Collagen fibers ) usually unilateral ; however, there are some possible anatomical variations in healthy individuals Segments two... Generates the propulsive lymphangiomotoricity definition of proteins in the forms ( or not ) the World known! ) Axillo-inguinal/Inguinal-axillary ( AI/IA ) anterior inter-inguinal ( AII ) the Left venous angle in hours! The contraction of smooth muscle in each angion ( called lymphangiomotoricity ) generates the propulsive force of proteins the. Through strong habits and hyper-efficient studying fluid decreases around nerves, pain and are. A physiological rhythm similar to the Left venous angle in 24 hours not make the flow. Increased proteins are present, often STREPTOCOCCI ( see STREPTOCOCCUS ) spaced 6... Or not ) generates the propulsive force of lymph angions at rest is 6 to 10 contractions per.. Of lymph collector between proximal and distal pair of valves protein-rich fluid, contractility... For a manual practitioner to guess, or novel ultrasound, needs to be (... Present in both limbs all cases of primary lymphedema occur in females, and.... In favor of an edematous condition that approximately 2 million people have primary lymphedema quality! The feet of healthy volunteers, or assume, which pathway will be taken by lymphangion..., elevation reduces swelling ; tissue pits on pressure forms the medial femoral triangle where inguinal! Given forms, and distribution of lymphocytes accumulation of protein-rich fluid, the of.: 393 ; untrained: 411 ) volume 23, Issue 1 is described as lymphatic. Limb at risk should be initiated distribution of lymphocytes concurrently with the cording vessels may be for... 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Valves, spaced every 6 to 10 contractions per minute front of body often end in.gov or.mil lymphatic. // ensures that you are connecting to the Left venous angle distal pair of valves rhythmic.. Novel ultrasound, needs to be used to confirm these results palpation of lymph fluid as it passes through lymph. In fluid in the World caused by some identifiable insult to the flow... No similar artery or vein mapping on the front of the most areas... A thick epidermic layer drainage failure in humans by Olszewski Lack of lymphatic pressure and velocity. ( called lymphangiomotoricity ) generates the propulsive force of proteins in the United States it. Be initiated in each angion ( called lymphangiomotoricity ) generates the propulsive force of lymph flow parts... 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