Zeitschrift fur Lymphologie. Journal of lymphology最新文献

Edema caused by surreptitious self-mutilation leads to special diagnostic and therapeutic problems because the causal psychic illness is not immediately obvious or appears insignificant due to the diagnosis of edema and the frequent desire of the patients for invasive measures. The quickest clarification is achieved by contacting an experienced lymphologist, who can often classify the swelling as artificial edema at a glance. In order to avoid any secondary damage arising from the edema, it should be reduced as quickly as possible by referring the patient to a lymphological clinic for therapy. Thus, invasive diagnostics would certainly be avoided, and the patient's desire for invasive procedures circumvented by conservative therapy. A psychiatric/psychosomatic specialist must be consulted. Cooperation between patient, physicians in practice and hospital should be established as early as possible. In difficult cases, the patient should be referred to a psychiatric hospital. Even for the experienced lymphologist, cases in which Sudeck's disease in the congested extremity has to be taken into account and the compliance of the patient is restricted present particular problems.

Malignant melanoma of the skin has become a real problem due to the increasing number of cases. No other tumor is induced by long term UV-radiation of the skin. Excision of the primary tumor is the treatment of choice in this disease. Before excision of the tumor lymphoscintigraphy is the first choice in diagnosis to demonstrate the draining lymph vessels and lymph node groups of an malignant melanoma for later operation. This work current the status quo of lymphoscintigraphy in malignant melanoma of the trunk.

Early terms of lymphostasis in lipedema can be detected with lymphoscintigraphy. A normal examination almost certainly excludes a lymphatic component. Indirect lymphography is only used to rule out morphological abnormalities of lymph vessels. If a lymphoscintigraphic study is normal indirect lymphography is not indicated.

Manual lymphatic drainage was virtually unknown in the former German Democratic Republic, and its method was deliberately not published for several reasons. However, patients with lymphedema heard of this therapy and some examples illustrate how patients benefitted from it. Soon lymphatic drainage was better known amongst therapists than doctors. Current efforts are underway to integrate this therapy into a coherent treatment plan. Lymphologically oriented hospitals, private care physicians, therapists and the German Society of Lymphology should cooperate closely cooperating to achieve this goal.

Report of a 55-year-old-male patient with most serious anasarca caused by insufficiency right heart. The reason of the heart failure was probably rheumatic carditis caused by streptococcal infections which followed recurrent erysipelas both legs with phleblymphedema. The necessity of consistent antibiotic treatment of the erysipelas, that's the only possibility to avoid more difficult secondary complications like this case of rheumatic carditis showed. The treatment of insufficiency heart was followed by physical decongestive therapy of the phleblymphedema of the legs. After a treatment period of 12 weeks a water loss of 112 kg and reduction of abdominal circumference from 250 cm to 150 cm could be achieved.

The "Lipedema" or "Fatedema" is conditioned by a slight mechanical obstruction of the small lymphatic vessels by the increasing pressure of the growing fat tissue. This lymphostasis in a normal lymphatic vessel system arises only with women and always symmetrically and conducts to typical complaints. Therapeutically, apart from loss in weight, only lymph drainage therapy is in a position to remove the complaints of edema.

It is told the course of a disease of a 44-year old woman who got a gigantic lymphedema of the arm within 5 years after a treatment caused by breast cancer 10 years ago. There are described the psychical and social consequences and there are also analyzed reasons how such an extreme lymphedema of the arm could be possible. An incessant success of the treatment could only be achieved by a combination of plastic operation to reduce the tissue and consistent use of physical therapy of edema according to Asdonk, a combination of manual lymph-drainage therapy according to Vodder-Asdonk and compression treatment.

As overall conclusions from this study, and the two preceding comparable trials in which TcPO2 was measured in patients with (8) and without (7) stockings, we propose that: All patients with symptoms and oedema of CVI should be advised to wear suitable compressive stockings (this study); if they do wear stockings, then additional benefit may be derived from treatment with HR (8); for patients who are reluctant to wear stockings, for a variety of reasons, or in whom stockings may be contraindicated (e.g. mixed arterio-venous disease), then HR is an acceptable alternative (7 and this study).