Biomedical subjects
M Földi
Publications and source records attributed to M Földi.
On nonoperative management of chronic lymphedema.
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The lymphedema chaos: a lancet.
Pathophysiology of lymphedema is not an enigma. It is caused by a low-output failure of the lymph vascular system in combination with an inadequate scavenging of stagnating plasma protein by macrophages. Axillary venous diseases alone never cause chronic postmastectomy edema. In the diagnosis of lymphedema, invasive methods (i.e., direct lymphography and venography) are not only unnecessary but are potentially harmful and do not give any information of therapeutic relevance. Lymphedema of the limbs without reflux of lymph or chyle is not a surgical disease. It can be treated successfully by the skillful application of specific physiotherapeutic measures free of any side effect. The results of this therapy can be maintained if the patient's compliance is good.
[Insufficiency of the cervical lymph vessel system; lymphostatic encephalopathy and retinopathy following cervical block dissection].
There are no lymphatic vessels in the CNS, in the retina and in the optic disk. In spite of this, however, cervical lymphostasis will result in lymphostatic encephalopathy and ophthalmopathy.
Conservative treatment of lymphoedema of the limbs.
Management of Lymphoedema is extremely variable in the medical profession, ranging from aggressive diagnostic procedures, which may aggravate the disease (lymphography by oily contrast mediums) in combination with therapeutic nihilism to precipitous operations. Scattered between these two contraversial extreme positions are quite a number of various conservative methods - some of which being in conflict with the anatomy and physiology of the lymph vascular system and the pathology of Lymphoedema. Lymphoedema, if left untreated, or is treated inadequately, may lead to invalidity and to death if Stewart-Treves Syndrome develops. Unnecessary surgery may have disastrous consequences. The paper describes how Lymphoedema can be treated with success, free of any side effects, by complex physiotherapy.
[Problems of lymphangiology in oral medicine and orthodontics].
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[Anatomic basis for the treatment of lymphedema].
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[Adipositas, lipedema and lymphostasis].
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[Lymphedema: How should lymphedema not be treated? Operative treatment of lymphedema].
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Morphologic findings in lymph nodes after occlusion of their efferent lymphatic vessels and veins.
Cervical lymph nodes of rabbits were congested for 24 hours, 7 days, and 14 days by occlusion of the nodal veins, efferent lymphatics, or both. The lymph nodes were examined by histologic and morphometric methods, and the results were compared with findings in control nodes. The present study demonstrated that the vascular sinus transformation (VST), observed first in human lymph nodes, is reproducible experimentally. Complete occlusion of both the veins and lymphatics led to a marked increase in volume of the nodes and often to total necrosis of their parenchyma. Incomplete occlusion of the veins combined with complete occlusion of the lymphatics or complete occlusion of the lymphatics alone resulted in VST as early as 7 days after the operation. In the first stage of VST, proliferation of the subendothelial tissue accompanied by proliferation of blood capillaries was noted. The proliferation started from the capsular side of the marginal sinus and from the trabecular side of the intermediate sinuses. Subsequently, the sinuses transformed into a framework of channels resembling blood capillaries. Without occlusion of the efferent lymphatics, VST did not develop. Complete or incomplete occlusion of the veins combined with complete occlusion of the lymphatics resulted in a pronounced thickening of the capsule, sclerosis of the medullary sinuses, depletion of lymphocytes in the nodal parenchyma, and cavernous dilation of the medullary sinuses. After occlusion of the lymphatics alone these changes were less extensive. Occlusion of veins alone caused only moderate thickening of the capsule and slight sclerosis of nodal parenchyma, but no VST. Total necrosis of the parenchyma occurred only after combined complete occlusion of nodal veins and lymphatics.
[Lymphedema of the arm after mastectomy].
Every arm lymphoedema requires treatment. The method of the first option is the conservative complex "physical decongestion therapy". Although the early establishment of a lympho-venous shunt is theoretically justified, this operation is still in an experimental stage. Other operative procedures, like for example, that proposed by Thompson, should only be considered when a "physical decongestion therapy", carried out in an adequate manner, has failed. The author has certainly not yet encountered such a case. A strong word of caution must be given against adventurous operative techniques, as, e.g., venolysis, or the implantation of various threads.
A fine structural study of the tissue channels' numbers and dimensions in normal and lymphoedematous tissues.
The numbers and effective radii were estimated for the tissue channels in the intersitial tissue of rats in the cerebral cortex and the facial subcutaneous tissue. Normal animals and some with acute (3 days) abd chronic (12 months) lymphoedema were used. It was found that the numbers and sizes of the channels corresponded well to those obtained by other techniques, however it was possible that in the oedematous animals the largest channels may have been artefactually counted as a number of smaller ones, thus reducing the hydraulic conductivity calculated. It is unlikely that this error was important for the normal tissue. In acute lymphoedema the numbers of both the small and the larger channels increased markedly, as did the radii of the largest channels. In chronic lymphoedema the numbers of the smaller channels fell to some extent. It was noted that, especially in lymphoedema and especially in the brain, there were many extra channels in the basement membrane regions of the capillaries. It is concluded that this new technique will be of considerable use in investigating the tissue channels in human patients since it can be applied to biopsy specimens.
The effects of chronic cervical lymphostasis on regions drained by lymphatics and by prelymphatics.
Chronic cervical lymphostasis was induced in cats. The effects in regions directly drained by lymphatics (facial skin and retrobulbar tissue), and in regions primarily drained by prelymphatics (cerebral cortex, retina, papilla, iris, choroid and Circle of Willis) were studied ophthalmoscopically and electron microscopically. It was found that in all regions there was considerable oedema, increases in protein concentration and excess collagen, together with increased numbers of macrophages. The lymphatics, where these existed, had many open junctions: both these vessels and the prelymphatics were very dilated, with considerable increases in protein concentration.
A fine structural study of the removal of the effectiveness of benzo-pyrone treatment of lymphoedema by the destruction of the macrophages by silica.
Macroscopical, light microscopical and electronmicroscopical observations were made of the diaphragm, skin and brain of rats, some of which were treated with intraperitoneal silica for 8 days (after being given it i.v. for 2 days). The diaphragms showed a most remarkable increase in fibroblast activity and fibrosis beneath the peritoneal mesothelium (which was disintegrating). Deep to this there were many disintegrating macrophages, and much oedema and increased protein concentration. Ligation of the cervical lymphatics produced the usual changes of lymphoedema in the skin and brain. This was greatly reduced in the animals treated with a mixture of benzo-pyrones. However, in those animals also treated with silica, the benzo-pyrones had no effect on the amount of oedema or of protein. In all the animals except those treated with silica, lymphoedema was accompanied by considerable numbers of macrophages entering the affected tissues; in those treated with silica, these numbers were greatly reduced.