Zeitschrift fur Lymphologie. Journal of lymphology最新文献

Eating habits, especially high-fat diets, is a topical subject that was also pointedly discussed by renowned authors at the international oncology convention in Hamburg this year. There is a continuing tendency for the incidence of breast cancer to be high in countries with high fat consumption. However, clinical comparative studies have not been able to definitely confirm any correlation between the two; probably because it is not possible to determine eating habits with a sufficient degree of reliability since these change during our lifetime. On the other hand, there is mounting evidence that overweight, rather than a high-fat diet as the result of consuming too many calories, presents the actual risk factor.

In 1900, the Hamburg surgeon P.H.M. Sudeck was the first to describe the clinical and radiological symptomatology of the disorder to which he later lent his name. He devoted his scientific career to this disorder, "acute inflammatory atrophy" of bone and soft-tissue as he called it. He elaborated the histology of the disorder with his students and advocated the pathogenic peripheral humoral theory. In later years seven further attempts to explain the pathogenesis were published. The present paper notes that this disorder, which can be divided into three distinct stages, is diagnosed mainly on the basis of clinical factors, above all in the early stage, and that x-rays in the early stages are difficult to differentiate from those of immobilisation osteoporosis since both disorders can manifest as patchy rare fraction and fibrous osteolysis in subchondral bone and old growth plates. Moreover, the author also notes that 10% of all Sudeck cases are not preceded by trauma; these must be understood as spontaneous Sudeck or as Sudeck after distant disturbances. A few sources also refer to Sudeck's dystrophy in the presence of lymphatic congestion. Another, special form of Sudeck's atrophy, is the shoulder-hand syndrome which, however, cannot always be differentiated precisely from rheumatic disorders or dystrophic contractures.

Tumour markers are substances stemming either from the tumour cell itself or the production of which is stimulated by the malignant growth. They are released into body fluids where they can be detected quantitatively with the aid of sensitive immunological methods. In addition to oncofetal antigens they include hormones, enzymes, isoenzymes as well as special proteins. The determination of markers by aid of monoclonal antibodies has led to an additional improvement in tumour diagnostics. Tumour markers are indubitably valuable preoperatively as prognostic parameters, and postoperatively for the follow-up and after-care. However, the tumour-associated substances so far in use are unsuitable for the early recognition of malignant processes.

Of the various forms of radiation injury resulting from irradiation several reactions are important in lymphology since they respond well to manual lymphatic drainage according to Vodder-Asdonk, to surgery or to fibrosis stretching. In acute and sub-acute radiation injury there is usually transient inflammatory swelling, e.g. in the extremities, and radiogenic oedema of the breast which reacts favourably to manual lymphatic drainage. Late sequelae such as ulcerating radiodermatitis and lymphatic oedema may be improved by manual lymphatic drainage or surgery as well as radiogenic fibrosis which is treated with intensive but careful stretching which may, in part, prevent further plexus injury.

Malignant lymphatic oedema is due to the obstruction of lymph tracts and lymph nodes by tumour cells. In addition to the necessary cancer therapy and the administration of analgesics physical oedema therapy is the single most effective form of relief which is most gratefully accepted by the patients. The only contraindication to manual lymphatic drainage is transient in the case of isolated local and regional metastatic spread which would still respond to treatment. Thereafter, and in all other conditions involving metastatic spread, there are no contraindications to physical oedema therapy.

In a comparative study 38 patients with secondary unilateral lymphatic oedema after mastectomy were investigated with regard to the efficacy of intermittent compression treatment using uni- or multichamber systems (Jobst and Lymph-a-mat respectively). Although both machines significantly reduce oedema, there is no difference between their reduction capacities.