Zeitschrift fur Lymphologie. Journal of lymphology最新文献

In the Feldberg clinic Dr. Asdonk in St. Blasien we treat primary and secondary lymphedemas of the head with the "Manual lymphdrainage according to Vodder-Asdonk." Secondary lymphedemas are a result of cancer therapy or are caused of tumors or their metastases respectively. A successful therapy is possible at primary lymphedemas of head or lymphedemas following an inflammation or an injury. If the cancer increases unstoppable the so-called "malignant lymphedema" not always decreases. Nevertheless we should treat with manual lymphdrainage therapy because if we do it not the lymphedema increases also unstoppable and it means a disaster for the patient. The manual lymphdrainage therapy is the only treatment we can do. Diuretics are only an indication in the final phase of the malignant lymphedema of the head because they do not take away the protein out of the interstitial tissue and so the edema becomes all the more.

Edemas of the leg sometimes pose problems for diagnosis. Invasive procedures like lymphography or phlebography are either difficult to perform or might endanger the lymphatics. The value of magnetic resonance imaging was assessed in 20 patients with lymphedema, lipedema and phlebedema. Images of patients with lipedema showed homogenous enlarged subcutaneous tissue. In lymphedema a honeycomb pattern in the subcutaneous tissue was observed; in phlebedema there was an increase of fluid within the muscle. Magnetic resonance imaging is useful in differentiating lymphedema, lipedema or phlebedema.

Vitalmicroscopic findings confirm the existence of a "low resistance pathway" for the transinterstitial fluid movement from the pillaries to the initial lymphatics. One part of this prelymphatic system is represented by submicroscopical spaces along the connective tissue fibres between ground substance (high resistance pathway) and fibre surface. The other part is represented by a network of prelymphatic tissue channels which are open connected with the initial lymphatic system.

For reasons not yet known HIV infected patients in the final state of their aids disease often tend to develop Kaposi's sarcoma. These tumours result in secondary lymphatic edema which is found on both sides of the sarcoma up to the regional lymphatic nodes, transferred by the tumour cells. Depending on the state of the edema, a lymph drainage treatment is indicated palliatively; the patients can thus be relieved. A fundamental deterioration of the prognosis is not to be expected, the more as all patients are in the final state of this not yet curable disease. Differing from treatment of other lymphatic edema, it is of special importance to the therapist--apart from the difficult and specifically psychic burden--to pay attention to a protection from infection by gloves as a precaution for each single treatment.

The complete immobilisation of a limb alone can lead to the formation of oedema. Whereas the oedema secondary to inactivity induced by immobilisation is completely reversible, and will only lead to tissue damage in the longterm, neglect of oedema secondary to inactivity in the presence of central and peripheral paresis (apoplectic insult, paraplegia, damage to the plexus brachialis) may entail serious consequences due to the danger of tissue fibrosis. With paresis of an extremity, the lymphovenous return is impaired by two decisive factors: increased hydrostatic pressure in the distal limb segment, and absence of the muscle pump. In flaccid paresis, where there is low muscle tone and no muscle pump action, there is also a low venous tone and the resultant hydrostatic pressure is especially high. Venous stasis in the sub- and prefascial veins leads to increased protein loss from the venous limb of the capillaries and the venules. Compensation initially occurs in the prefascial lymph outflow region (latent oedema) which becomes decompensated if overloaded (visible oedema). Fibrosis of the subcutis and trophic skin changes are the result. In spastic paresis the regional subfascial lymphatic system responds with lymphangiospasm. Where the sympathetic innervation is interrupted (e.g. brachial plexus paralysis) there is passive hyperaemia of the terminal vessels with vascular dilatation and lymphangioparalysis. Insufficiency of the vascular walls results in an accumulation of protein in the tissues, which ultimately ends in fibrosis with ankylosis and shortening of the tendons and muscles. The early administration of complex physical decongestion therapy with manual lymphatic drainage can prevent this state.

The treatment of Sudeck's atrophy is not easy since there is a constant risk of relapse into the inflammatory stage. The earlier the diagnosis is established, the higher is the likelihood that treatment will be successful. As a rule, dystrophic lapses can be avoided by the use of prophylactic measures, even in patients at risk. Here, the cooperation with the pain therapist or anaesthesiologist is required. I am convinced that, by early infusion treatments or drug therapy for the sedation of sympathetic hyperexcitability, improvements in results can be achieved. It stands to reason that psychological guidance for the patient must be taken into due account.

Ultrasound generation is known now since about 150 years. Echo sounding has been used in first world war to fix the position of submarines, now we apply the echo sounding method in medical imaging to representate and to distinguish organs and tissue structures. This requires good knowledge about physical and technological properties in ultrasonics and about tissue interaction with ultrasound waves.

Indication for direct lymphography during the past forty years shows a downward tendency, mainly because of new alternative modern imaging methods. Nevertheless, in agreement with the actual literature it can be shown by own investigations with 8000 patients from 1964 to 1989 that one cannot give up lymphography totally. On principle lymphography is still carried out in case of testicular tumors, malignant lymphomas, unclear fever, lymphatic vessel injury and facultative in peripheric lymph edemas.

Oral contraceptive pills have been made available to women since the beginning of the 1960s. The pill (oral contraceptive pill, ovulation inhibitor) is the most sure of all contraceptive methods. With the beginning of applicating the pill, there had been fear of increasing breast cancer risk due to contained hormones. It is assumed that every third woman had ever taken oral contraceptive pills in her life. Yet, breast cancer incidence did not increase world-wide in an extent as would have been expected if the pill really were operating in a breast cancer promoting manner.