Zeitschrift fur Lymphologie. Journal of lymphology最新文献

Isolated extremity perfusion today is an undisputed alternative to amputation and a causal form of therapy for locally and regionally metastasising melanomas. In order to avoid the most serious complications such treatment should only be carried out at special centres. Milder side-effects such as early and late postoperative oedema respond well to drug regimes and manual lymphatic drainage.

The controversial question of the incidence and significance of varicoses and chronic venous insufficiency is analysed by a critical review of epidemiological studies. It is seen that many of the results which initially appear to diverge are attributable to different, in part unsatisfactory epidemiological methods; e.g. patient groups of different ages and sex, different interview and examination techniques in addition to, above all, different weighting of varicosis. Thus, studies in general practice showed that the prevalence for varicoses in women was four times that in men; CVI was, in fact, 15 times more frequent than in epidemiological studies. The different weighting of varicoses and chronic venous insufficiency may well be one of the major reasons for the absent "unité de doctrine".

In common with other organ systems in the body the immune system demonstrates functional disturbances which may lead to numerous immunological disorders with grave consequences for the health of the patient. Whenever the complex network of regulation and counter-regulation mechanisms within the defence system is impaired, by hereditary or acquired defects, immunological defect syndromes occur. One of the disorders that has been the object of intensive discussion in this context over the past few years is the acquired immune deficiency syndrome AIDS, a dangerous viral infection that mostly affects the T4 cells, whose helper and inductor function is absolutely essential for successful immunological defence. Furthermore, functional impairment of the antibody-producing plasma cells leads to the heterogeneous group of gammopathies which are characterized by an uncontrolled and excessive proliferation of structurally uniform antibody molecules in the blood. Overreactions of the immune system which wrongly attack endogenous tissue are accredited with causing the so-called auto-immune diseases. The clinical pictures within this group are exceptionally varied, and depend both on the self-antigen that the attack is aimed at as well as the erroneously triggered effector function that is affected. Whenever the immune system reacts disproportionately strongly against otherwise harmless foreign antigens, allergic clinical picture emerge.

Idiopathic oedema in women is due to a disturbance in capillary permeability with increased protein porosity. This leads to generalized pre- or mild oedema which, although it is frequently not recognizable clinically, gives rise to marked sensations of tension and heaviness with impaired physical performance. Diagnosis must exclude all other possible forms of oedema. However, not only oedema that presents in generalized forms must be considered. Optimum therapy consists of manual Vodder-Asdonk lymphatic drainage in conjunction with compression therapy. This results in a marked improvement. At present there is no known safe pharmaceutical treatment, diuretics are not indicated.

In an isotope lymphography study on 24 patients (38 legs), the influence of complete sclerosation therapy of trunk varicosis of the great and small saphenous veins according to Tournay is examined before and, on average, four weeks after treatment. The isotope lymphography parameter was defined as the ratio of the outflow from the foot to the influx to the groin area (quotient Q). The results showed no significant change in Q after treatment compared with the starting values. Thus, sclerosation therapy did not result in any impairment of lymphatic transport. In contrast, of the 9 patients (12 legs) treated by varicose exeresis who were referred for isotope lymphography there were 8 cases (i.e. 9 legs) of impaired lymphatic transport. However, this was a pre-selected patient group. Three further patients were examined by isotope lymphography after resection of a saphenous segment for arterial reconstruction. These revealed excessive lymphatic transport disturbances which were quantified for the first time. Vascular surgeons should include this complication in their explanatory talks with patients.

A technique for detecting initial lymphatics in excised human skin is reported. Excidates are carefully stretched. By subepidermal injection of a Berlin blue solution, dermal lymphatic networks can be imaged. The initial lymphatics can be clearly detected by light microscopy in semi-thin sections.

The factors that influence the risk of breast cancer are vitally important when collecting information on woman particularly at risk from cancer for screening and for advisory care in breast clinics. On the basis of the experience gathered over the last 150 years (since Rigoni-Stern in 1842), these should be divided up into I. confirmed (carcinoma of the breast, mastopathy with cytological atypia, women whose mother and sisters already had breast cancer), II. probable (childlessness, late first birth, miscarriage, early menarche and late menopause, overweight, elevated socio-economic status), and III. improbable risk factors (paranchyma samples according to Wolfe, the contraceptive pill, nicotine, coffee, alcohol and drugs).

Chronic venous insufficiency reveals both functional correlations with the lymphatic system of the limbs as well as pathological-anatomical. The functional correlation initially consists in an enhancement of function as a manifestation of a compensation mechanism of lymphatic drainage in relation to the insufficient venous system. Finally, if the lymphatics are themselves damaged in their further course, a safety valve insufficiency occurs with resulting lymphostasis. Apart from this participation, regional damages to the lymphatic fascicles play a role in chronic venous insufficiency in trophic disorders, as for example leg ulcer and atrophy. However, these are far less significant for the overall function of lymphatic drainage. As a role, they show a pronounced collateralization, and thus good possibilities of functional compensation. In particular indirect lymphography with water-soluble contrast medium is suitable as imaging technique in diagnostics with regard to the morphology. Isotope lymphography is suitable with regard to investigating the function of lymphatic drainage and for circumscribed local disorders. As native techniques, xeroradiography and computed tomography are very suitable to analyse tissue damage of the cutis and subcutis resulting from chronic venous insufficiency and from lymphostasis and to make indirect inferences from this with regard to the chronicity of this disease process.

Between may 1987 and may 1989, the case histories of 48 female patients with idiopathic oedema and of 5 female patients with diuretic-induced oedema were evaluated retrospectively at Dr. Asdonks' Feldbergklinik. Prior to and after the termination of the physical anti-oedemic treatment according to Asdonk, the volume of the limbs was determined. The extent of reduction in volume as reflected by lipophagia and decrease in oedema, as well as the regression of complaints were rated as a measure of therapeutic success. On discharge, all patients were free from complaints.

An immune reaction is a complex process. Nonspecific resistance is always induced besides specific humoral and cellular defense reactions. After binding to an antigen (antigen-antibody reaction) antibodies can activate complement. If the entire complement cascade occurs, for example at the surface of cells (bacteria), this leads to complement-induced lysis and to destruction of the antigen. Complement cleavage products which are formed during the activation of complement have biological activities. They can attract granulocytes, macrophages and lymphocytes chemotactically or induce and accelerate processes of phagocytosis. In consequence of the activation of T-lymphocytes sensitized T-cells are formed. T-helper-cells intensify both the humoral cellular immune response mediated by B-cells and the cellular immune response mediated by cytotoxic T-cells. They effect this by secretion of substances resembling hormones, the so-called lymphokines. Cytotoxic T-cells (killer cells) can kill their target cells directly. Immune reactions are regulated in multifarious ways. T-suppressor-cells slow down the immune reactions of B- and T-cells. The close interaction of the T-helper and T-suppressor-cells designated as "regulatory T-cells" ensures the functional equilibrium within the immune system.