Zeitschrift fur Lymphologie. Journal of lymphology最新文献

Radiotherapy is a useful tool in the treatment of head and neck cancer either in an adjuvant or in a palliative setting. The tolerance doses of many tissues are near or even lower than the necessary therapeutic doses. Therefore some side effects of radiotherapy are unavoidable, others can be reduced if special technics are applied. Lymphedema of the head and neck is more often caused by radical surgery than by radiotherapy. If a combined modality treatment is used with surgery and radiotherapy, it results in an increased risk of lymphedema. If lymphedema results from radiotherapy it is caused by the late reaction of blood vessels and connective tissue within the irradiation field. Direct irradiation effects on lymphatic vessels are less important. Finally we stated four rules for the practical management of patients with visible lymphedema or the risk of developing an edema.

Three groups of patients (n: 10 each group) with extensive or massive secondary lymphedema of the arm were treated with different types of manual lymphatic drainage. The decrease of volume based on arm circumference was measured before and four weeks after treatment. The first group received one hour of manual lymph drainage twice a day ("Asdonk-standard"). The second group received a 90 minute and the third group only a single one hour treatment. Our result indicate that the therapeutic efficacy of the "Asdonk-standard" is superior to the other two forms of therapy. The improvement of lymphedema was much superior in this group and the treatment was more cost effective.

The pathophysiology and clinical presentation of myxedema is reviewed in this article. Myxedema represents the leading symptom in hypothyroidism but also occurs in a localized form in autoimmune hyperthyroidism. Even in subclinical cases of thyroid diseases may myxedema represent a valuable symptom in establishing the correct diagnosis. With adequate laboratory testing to ascertain the underlying disease, specific therapy can usually be initiated.

Therapy of first choice in chronic lymphedema is the complex physical drainage therapy. Complementary measures serve the prevention of erysipelas, the treatment of secondary tissue damage and additionally existing diseases in the lymphedematous area. Some measures of physical medicine and drugs are discussed. Antioxidative therapy as a new principle is presented. It is used to decrease secondary tissue damage by free radicals and to prevent possible damage far from the lymphedematous area.

The main problem in current lymph node imaging is the lack of reliable criteria for differential diagnosis between benign and malignant nodes, the main criterion being size. To reliably opacify all lymph nodes in the body, an intravenous contrast agent is therefore necessary. Two new contrast agents for MRI seem promising: lymphotropic iron oxides and Gadolinium DTPA-PGM. After intravenous administration these agents accumulate in phagocytic cells of normal lymph nodes but are excluded from nodes in which phagocytic activity is replaced. While iron oxides are already in clinical studies, GD-DTPA-PGM is in preclinical studies. Both agents seem to significantly improve the differential diagnosis between benign and malignant lymph nodes irrespective of size.

We report on a familial case of venous dysplasia of the deep veins characterized by clinical chronic venous insufficiency with subsequent lymphedema (phlebolymphedema). Successful therapy consists of physical therapy in the acute phase and was followed for over eight years with compression stockings.

Quality assurance in the field of lymphology is both necessary and possible. This applies not only to practising lymphologists, but also to standardization of lymphological diagnosis, the application of lymphatic drainage and to its practitioners, lymphatic drainage therapists.