Zeitschrift fur Lymphologie. Journal of lymphology最新文献

In 1948, Stewart and Treves (158) described a lymphangiosarcoma on the edematous arm for the first time with reference to six cases involving arm edema after breast cancer operation. Since their publication, a further 313 cases have become known. In 1982, with communication of one case we published a statistical compilation comprising of 248 cases (Zeitschrift für Lymphologie VI, 1982, 51-66). A statistical compilation totalling 290 observations is now presented on the basis of further studies of the older literature supplemented by observations of the last six years including two of our own cases. So far, a total of 319 single observations has become known: 21 cases of Yap et al. (182), eight cases of Oshmianskaia et al. (123) and 290 cases in the statistical compilation we have drawn up and which is the basis of this publication. By histological investigation of the tissue material taken from a female patient within six weeks (exploratory excision, radical excision), detailed information could be obtained on the histological development of the Stewart-Treves-Syndrome (STS) from a preneoplasia to a mature lymphangiosarcoma. The second female patient is a relatively rare observation of an STS of fulminant course which remained restricted to the extremity, chest wall and neighboring parts of the back during the entire course.

Peripheral lymphedema can be induced experimentally by obliteration or destruction of the veins and/or lymphatics, extirpation of the lymph nodes and occlusion of lymphatics, circular incision of the soft tissues, experimentally induced thrombophlebitis and by simultaneous traumatization of the veins and lymphatics. Our own animal experiments were designed to provoke leg edema after ligation of the femoral vein and/or accompanying lymphatics below the inguinal ligament. In 23 animals, only one ligature of the femoral vein was applied, below the inguinal ligament and in 12 animals all accompanying lymphatics were ligated in addition. In all animals, the leg circumferences were measured in three precisely fixed positions before the experiments and daily for 22 days during the experiment. The greatest increase in circumference was found in the lower leg irrespective of the time of measurement. The peak increase of circumference was between the third and sixth day after the operation. Permanent lymph edema has not developed in any of the animals. At the latest after three weeks, the leg circumference has normalized. Additional ligation of the lymphatics merely led to a nonsignificant increase in circumference and to displacement of the maximum point by two to three days. Immediately after the operation, phlebographic and lymphographic control investigations were carried out in all animals.

Differential diagnosis of the various forms of edema certainly demands a wide range of experience. Up to 80% of cases can be diagnosed accurately on the basis of an exact case history and physical examination, a diagnosis which only needs to be confirmed by further tests. The rest of the cases require mechanical and laboratory tests which are, for the most part, very time consuming and costly.

At present, the role of prolactin has not yet been precisely determined both in the development and in the progression of benign and malignant diseases of the breast. Experimental investigations and data of the human receptor assay have clearly indicated the initial and promoting activity of prolactin in the genesis of breast tumors. However, the data published so far, which is in some cases highly contradictory, does not allow a positive appraisal on the correlation of the prolactin level and breast diseases in clinical research and experimental studies. The studies still to be carried out in human medicine with precise definition of the TRH-prolactin-target cell axis compared with the proof of the receptor radioimmunoassay in healthy and malignant breast tissue which has still not yet been provided might give rise to rather more clarity in this rather manifold problem.

By means of the orthograde application of Patent Blue Violet and Japanese ink, it was possible to demonstrate the cyclical changes in the uterine lymphatics of the pig. It was found that the lymphatic vessels in the endometrium were markedly dilated during oestrus. In the following phases of the cycle the lymphatics showed a reticulate pattern, which in the stage of preoestrus resembles that seen in oestrus. The transport of the dye into the lymphatics takes place extremely rapidly through the wall of the uterus and then into the mesometrium (serosa), where the lymphatics have a typically beaded appearance.

The results of experimental clinical and epidemiological studies published so far from 1896 until today on the connection between thyroid and breast diseases doubtless require critical examination, since these results are highly contradictory. Without being able to go into details of the sources of methodological errors and the highly heterogenous investigation material, two pathophysiological mechanisms can be discussed in the investigation of the interrelationship between the thyroid and the breast: 1. A low level of thyroid hormone might make the breast hypersensitive to prolactin, which might induce dysplasia or neoplasia of the mammary epithelium. In addition, there is the almost identical neurohumoral regulation of the hormones of the thyrotropic and lactotropic cells in the anterior pituitary. 2. Thyroid hormones have an effect on peripheral androgenic and estrogenic metabolism. The hyperthyroid state may cause an increase in the concentration of sex hormone-binding globulins, which might give rise to an alteration of the beneficial effect of sex hormones on the cellular levels. Compared to this, the iodine deficit might lead to neoplastic transformation of the mammary epithelium via the enhanced gonadotropin stimulation and the subsequent chronic hyperestrogenism. For better understanding of the always topical problem of the not yet completely elucidated correlation between thyroid function and breast diseases, a two-track procedure is appropriate: 1. Thyroid receptor assay on animal and human breast tumor tissue and 2. prospective clinical studies on a large scale.(ABSTRACT TRUNCATED AT 250 WORDS)

In the period from 1970 to 1986, 46 patients with non-Hodgkin's lymphoma were laparotomized and splenectomized at the Surgery Division, University of Göttingen. The operation was frequently carried out in advanced or generalized stages with a therapeutic indication and served for purely diagnostic purposes in only a proportion of the cases. The Kiel classification was chosen for the histology. Accordingly, hairy-cell leukemia (14 cases) and chronic lymphatic leukemia (12 cases) were the most frequent diagnoses, followed by LP immunocytoma and centroblastic-centrocytic lymphoma (seven cases each). In four out of the 20 clinical pictures which were not already generalized by definition, i.e. in 20% of the cases, exploratory laparotomy resulted in a change of stage (comprising two improvements and two deteriorations). The spleen was affected in 41 out of the 46 patients; in addition, lymphomatous infiltrations were found in six of the 12 liver biopsies taken and in 15 out of 17 lymph node preparations taken. The average spleen weight in the NHL patients (1,623 g) was markedly higher than in a reference group of Hodgkin patients (317 g). With critical establishment of the indication, exploratory laparotomy with splenectomy in histologically verified NHL and lymphography in the clinical staging are the most precise methods of investigation in graduated diagnosis of non-Hodgkin's lymphomas.