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R Sivaprakasam, R Anuradha, R Bethunaickan, G Manokaran
We present an integrated therapeutic approach performed on a 37 year old female with giant lymphedema (Grade IV) due to lymphatic filariasis of 27 years duration. Our therapeutic approaches consisted of a basic foot care program for two weeks, followed by a course of oral penicillin for a week including conservative treatment with complete decongestive therapy (CDT) together with respiratory physiotherapy and walking exercises. In addition, advanced surgical techniques with supra-fascial excision of alternate lumps in three stages over an interval of ten days followed by a nodo-venal shunt resulted in reversing the stage IV lymphedema condition...
2018: Lymphology
L W Lai, R P Erickson, M Bernas, M H Witte
We performed whole exome sequencing in a family with FOXC2 mutation where the phenotype in one generation was strikingly more severe. Although there were 3 mutations shared by 2 fatal fetal hydrops cases and not the mildly affected mother, none of them were likely to be the cause of the marked phenotypic change.
2018: Lymphology
Y Suzuki, H Sakuma, S Yamazaki, J Ihara
We encountered a case in which we used a pedicled deep inferior epigastric perforator(DIEP) flap to repair a lymphatic leak. This case shows that such repairs can lead to the reconstruction of the lymphatic tract and prevent lymphatic leak recurrences. The present report describes a 45-year-old woman with ovarian cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy, and omentectomy. She presented with a pelvic lymphocele with lower-extremity swelling...
2018: Lymphology
L Roncati, A Manenti, T Pusiol, E Mataca, S Nosseir, F Piscioli, A Maiorana, G Barbolini
Modern immunohistochemical techniques allow a detailed study of the lymphatic system in many organs and areas of the body. We performed an in-depth study on lymphatic vessels of the ileal and colonic mesenteries, together with the greater omentum where they appear particularly numerous and mainly represented by capillaries interconnected among themselves and with lymph nodes. The capillary wall consists of a fine single sheath of endothelial cells wrapped around by a subtle collagen membrane and deprived of valves...
2018: Lymphology
M Cardone, F Cappellino, S Vincenzo, G Moneta, A Failla, M Iosa, B Monni, M R Fantegrossi, V Rubeghi, S Michelini
This study aimed to provide information on proprioception alterations in lymphedema-affected limbs. Blindfolded subjects sat at a table with their forearms positioned on paddles. The hinges of the paddles were aligned with the elbow joint and an electronic goniometer was positioned to measure the angle of the forearm. Paddles were moved by an electric servomotor with a slow angular speed that was barely appreciated by the subjects. Subjects were then asked to guess the position of the affected arm in comparison with the unaffected arm to study the position sense of the lymphedema-affected arm...
2018: Lymphology
S Dessalvi, G Villa, C C Campisi, C Campisi, F Boccardo
Lymphatic complications following great and small saphenous vein surgery show a varying and non-negligible incidence in the literature. We undertook this study to investigate a new protocol to reduce lymphatic injuries in patients undergoing venous surgery. Eighty-six patients with lower limb venous insufficiency and varices were treated. Lymphoscintigraphy was performed preoperatively in 65 of them and postoperatively in 19. Blue dye was used in all patients and blue lymph nodes and lymphatics were identified intra-operatively and preserved or used to perform multiple lymphatic-venous anastomoses (MLVA)...
2018: Lymphology
W L Olszewski
Counterpoint to the article: Peculiar Clinical Features of Cellulitis in Peripheral Lymphedema, K. Suehiro, et al. Lymphology Vol 51, No 2, pp 47-53.
2018: Lymphology
K Suehiro, N Morikage, K Ueda, M Samura, Y Takeuchi, T Nagase, T Mizoguchi, K Hamano
Although the occurrence of cellulitis in lymphedema (LE) is believed to be an infection-related event, many findings in its clinical course seem to suggest that it is unlikely to be an infection. Therefore, we tried to clarify the specific features of cellulitis in LE. In-hospital courses of cellulitis obtained from medical charts were reviewed in the patients with leg LE (LE; 24 patients, 72admissions), chronic venous insufficiency (CVI; 28 patients, 29 admissions), and leg cellulitis secondary to wound infection without underlying disease (N; 42 patients, 42 admissions)...
2018: Lymphology
A Atta, M Saber El Basiouny, S Mostafa Abass
Lymphedema is a chronic disease in which lymph accumulates under the subcutaneous tissue. The condition may be due to either congenital or acquired lymphatic system abnormalities. Genital lymphedema (scrotal lymphedema) has a high psychological and functional impact, and many surgical techniques have been tried in an attempt to improve function and cosmetic appearance. The aim of this study is to present our experience in treatment of a series of patients with scrotal lymphedema. Twenty patients suffering from moderate to severe scrotal lymphedema underwent treatment by using three flaps technique (2 inguinoscrotal flap and one perineoscrotal flap)...
2018: Lymphology
M Karafa, A Karafova, A Szuba
This study evaluated how different levels of pressure under inelastic multi-layer bandages affect the reduction of secondary arm lymphedema and patient comfort throughout therapy. Ninety-six women with lymphedema after breast cancer treatment were randomized into three groups of 32 patients depending on level of applied pressure in compression therapy: group I (control) at 21-30 mmHg; study groups II A at 31-40 mmHg and group II B at 41-60 mmHg. All patients were treated with complex decongestive therapy (CDT) and intermittent pneumatic compression (IPC) before compression...
2018: Lymphology
N Tanoue, L Moedano, M Witte, M Montague, A Lukefahr, M Bernas
Gorham-Stout disease - also known as "disappearing bone disease" is currently considered a single entity with varying clinical manifestations. We reviewed the existent literature from the earliest historic description(Jackson in 1838) and Gorham and Stout's original series of patients, multiple case reports and series since. After analyzing 212 reported cases, we identified 76 cases with details that recorded either a history of multifocal disease or an identifiable history of preceding trauma. From this review, we have defined two distinct Gorham-Stout entities - those characteristically associated with lymphangiomatosis [a form of GLA (generalized lymphangiomatosis) questionably distinguishable by bone biopsy and radiologic appearance] with multifocal distributed bone lesions, and those others, usually self-limited, first appearing after a traumatic event and always confined to a single bone or closely adjacent one...
2018: Lymphology
C Ives, L Gregg, C Trust, M Green
Traditionally lymphoscintigrams are taken after injection of peri-areolar Technetium-99m (Tc-99m) to quantify sentinel nodes before biopsy (SNB). However, recent research suggests that scintigraphy is not an essential adjunct. For service improvement, we stopped using lymphoscintigraphy so as to minimize delay to operating theater and reduce demand on the Nuclear Medicine Department. We audited early outcomes to ensure quality was maintained. 100 consecutive patients undergoing SNB with lymphoscintigrams were investigated...
2018: Lymphology
I Tzani, M Tsichlaki, E Zerva, G Papathanasiou, E Dimakakos
Lymphatic diseases, especially lymphedema, represent a serious problem in the health community. We investigated strategies and methods for physiotherapeutic rehabilitation of lymphedema by carrying out a comprehensive search of the Medline and Embase databases from 1990 to 2016 to identify relevant published studies, articles, and reviews. Approaches for conservative management of lymphedema include the following: manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, skin care, pneumatic compression, elevation of the extremities, thermal therapy, complete decongestive physiotherapy (CDT), taping, and aqua lymphatic therapy...
2018: Lymphology
Z Zhigeng, L Xin, Z Yanling, X Qiong, Z Zhaolin, C Lu, S Yaqian, L Cailing, W Shikun, T Hua
Although monocytes have previously been demonstrated to contribute to lymphatic vessel formation in vivo, monocyte transdifferentiation into lymphatic endothelial cells and the specific conditions required remain unclear. In this study, monocyte cultures isolated from human peripheral blood were stimulated to transdifferentiate into lymphatic endothelial cells under specific in vitro induction conditions. These results demonstrate primary isolates of CD14 (+) monocytes express low levels of lymphatic endothelial cell specific markers or pan-endothelial markers under routine culture conditions...
June 2017: Lymphology
G Szolnoky, A Ifeoluwa, M Tuczai, E Varga, M Varga, E Dosa-Racz, L Kemeny
Lipedema is a disproportional obesity featuring spontaneous or light pressure-induce pain and frequent hematoma formation due to even minor traumatic injuries. It is generally distinguished from general obesity primarily based on clinical hallmarks; however, this becomes difficult when appearing in a concomitant form (combination of obesity and lipedema). Our study group has recently demonstrated that lipedema-associated bruising is correlated with increased capillary fragility (CF) and also that CF could be significantly improved by complex decongestive physiotherapy (CDP)...
2017: Lymphology
I Teo, J Thompson, Y N Neo, S Lundie, D A Munnoch
Upper limb dominance is associated with increased limb volume, however there is a paucity of evidence if this is true for the lower limbs. This study investigated if there is a normative volume difference between the dominant and nondominant leg. Healthy volunteers between the ages of 18-40 years were recruited. Exclusion criteria included previous lower limb surgery, BMI >30, or pregnancy. An experienced lymphedema nurse specialist measured the circumference of each limb at 4 cm intervals from the malleolus to the groin...
2017: Lymphology
G Rocha, P Soares, I Azevedo, M J Baptista, J Casanova, C S Moura, H Guimaraes
Congenital pulmonary lymphangiectasia (CPL) and chylothorax (CC) are rare lymphatic developmental disorders. We report six clinical cases of CPL and CC that were admitted to our level III neonatal intensive care unit over the last 20 years. One case of unilateral CC was successfully treated with pleuro-amniotic shunt; three cases of bilateral CC were associated to lung hypoplasia, hydrops fetalis, and generalized lymphangiectasias; one case of CPL was associated with obstructive congenital heart defect; one case of unilateral CC was successfully treated with thoracocentesis and medium-chain triglyceride diet...
2017: Lymphology
K B Sreter, B Barisic, R W Light
Tuberous sclerosis complex (TSC) or Bourneville disease is a rare autosomal dominant neurocutaneous disorder that affects various organs. Pulmonary involvement in TSC may consist of lymphangioleiomyomatosis (LAM) and multifocal micronodular pneumocyte hyperplasia (MMPH), occurring together or alone. In patients with TSC-LAM, chylous pleural effusion (CPE) is a rare, though well-recognized, complication with an unpredictable clinical course. In refractory or persistent CPE, optimal management remains a clinical challenge...
2017: Lymphology
S Rajasekaram, R Anuradha, G Manokaran, R Bethunaickan
Filariasis is caused by thread-like nematode worms and is classified according to their presence in the vertebrate host. The lymphatic group includes Wuchereria bancrofti, Brugia malayi, and Brugia timori. Lymphatic filariasis, a mosquito-borne disease, has been one of the most prevalent diseases in tropical and subtropical countries and is accompanied by a number of pathological conditions. It is estimated that currently (after 13 years of the MDA programme) there are an estimated 67.88 million LF cases that include 36...
2017: Lymphology
N Gupta, K Wikenheiser-Brokamp, D Zander, R Balestra, A Selvaraju, K Niehaus, S Benzaquen
A 47-year old female was evaluated in our clinic for an incidental discovery of diffuse cystic lung disease on high-resolution computed tomography (CT) scan of the chest. There was no personal or family history of tuberous sclerosis complex (TSC), sicca symptoms, pneumothorax, or skin or renal tumors. Review of her chest CT scan showed bilateral, round, uniform, thin-walled cysts present in a diffuse distribution characteristic of lymphangioleiomyomatosis (LAM). CT scan of the abdomen and pelvis did not reveal angiomyolipomas, lymphangioleiomyomas, abnormal lymphadenopathy, or chylous fluid collections...
2017: Lymphology
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