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At least 19 recordsLinked to original sources
PubMed1991

Evaluation of different surgical procedures in filarial lymphoedema of lower extremity.

Ninety-six cases of different stages of lymphoedema of inferior extremity were taken for study. Twenty-four patients with early lymphoedema (stage II) were subjected to lymphonodovenous shunt (LNVS) operation; 54 patients of late lymphoedema with skin changes (Stage IV) were subjected to Charles' operation and 18 patients with late lymphoedema without skin changes (stage III) were subjected either to Sistrunk's or Thompson's operation. All the results were studied, evaluated and compared. The cases subjected to LNVS operation had a rapid relief of lymphoedema in the early postoperative period followed by slow reduction. Patients subjected to Charles' operation had immediate volume and circumference reduction and take up of skin grafting was 84%. The cases subjected to Thompson's operation did not have satisfactory reduction in volume and circumference postoperatively. There were a few minor postoperative complications in all these procedure, infection being most notable in those who had undergone Charles' operation. It is concluded that while excisional surgery, such as Charles' operation becomes necessary for late stages of lymphoedema, which have progressed to elephantiasis, nodovenous shunt alone is sufficient to relieve early stages of lymphoedema due to filariasis.

Adolescent↗
PubMed1992

Modern treatment of lymphoedema. II. The benzopyrones.

The benzo-pyrones reduce all high-protein oedemas, including lymphoedema and elephantiasis, by increasing the numbers of macrophages and their normal proteolysis. Thus they remove the excess protein, and thereby the oedema which is caused by it. They also remove the stimulus it provides for chronic inflammation and fibrosis, and its action as a culture medium for bacteria. Coumarin (5,6 benzo-[alpha]-pyrone, 56 BaP) and oxerutins (HR, O(beta-hydroxy-ethyl)-rutosides) have been used in many clinical trials on a variety of high-protein oedemas. Four such trials are summarised here: on lymphoedema and elephantiasis (from many causes in Australia, and filaritic in India and China). The drugs reduced these much more slowly than adequate physical therapy, but they did reduce them. About half the excess volume was removed over six months in the Australian trials. In India and China similar rates were achieved with lymphoedema, but elephantiasis reduced at a slower rate. The benzo-pyrones convert a slowly worsening condition into a slowly improving one. No compression garments are necessary. In addition, the drugs considerably reduce the number of attacks of secondary acute infection, reduce the deformities of elephantiasis and considerably improve the patients' comfort and mobility. They may be taken orally, or applied topically, have very low toxicities and only few, minor side-effects. They are useful in many other forms of high-protein oedema, and improve the results of physical therapy for lymphoedema.

Administration, Cutaneous↗
PubMed1976

Lymph nodes and vessels in primary lymphoedema. Their relative importance in aetiology.

The classification of lymphoedemas is reviewed and the various primary lymphoedemas distinguished from the secondary. The early lymphographic studies of primary lymphoedemas (many of which arise from genetic factors) probably laid undue emphasis on changes in the lymphatic vessels. Oil contrast media in leter use in lymphography have given much information onchanges in the nodes. In 89% of patients reviewed both nodes and vessels were diseased and in the majority the changes were worse in the nodes. This suggests that in many patients with primary hypoplastic lymphoedema the pathological process has arisen first in the nodes.

Adolescent↗
PubMed1979

Microlymphatic surgery in management of lymphoedema of the upper limb.

Microlymphatic surgery is a recent addition to the range of surgical procedures for lymphoedema. Lymphaticovenous anastomosis is the most direct approach to the basic cause of obstructive lymphoedema bypassing the obstruction of the axilla or groin. With increased experience the overall results have improved and, in selective cases, segmental reduction is carried out either at the same operation or at a later date. Microlymphatic surgery in conjunction with segmental reduction of the upper arm is aesthetically and functionally most acceptable. The most significant effect of lymphaticovenous anastomosis in relieving the lymphoedema of the upper limb is over the dorsum of the hand and lower forearm. At least two, or more if possible, lymphaticovenous anastomoses are required for effectiveness of the procedure. Besides subjective and objective improvement in the lymphoedema there is significant reduction in frequency of cellulitis following lymphaticovenous anastomoses. The technique, along with the results and follow-up over 5 years is presented.

Arm↗
PubMed1976

Analysis of lymphoedema as first symptom of a neoplasm in a series of 650 patients with limb involvement.

In a series of 650 patients with lymphoedema of the extremities, a clinically suspected primary lymphoedema in 60 patients was found upon roentgenological examination to be secondary lymphoedema. After lymphography, tomography and in some cases selective supplementary angiographic examination, the causitive factor for almost all patients could be established and was confirmed after biopsy/operation and pathological-anatomical-anatomical examination. This is a very important finding, because a developing lymphoedema may be the first symptom of a malignant process characterized by tumour infiltration into the lymph nodes. It is exactly in these patients that lymphography may often give rise to unexpected amazing findings, which in certain cases may contribute to the possibility of starting effective treatment.

Extremities↗
PubMed1977

[Surgical treatment of lymphoedema (author's transl)].

Aetiology, pathogenesis, staging and the conservative and operative treatment of the lymphoedema are discussed. Only in 14 to 22% of all lymphoedema an operative treatment is required. Operative treatment is only indicated after the failure of conservative treatment. The latent (stage I) and the reversible (stage II) lymphoedema rarely demand an operation. Only the lymphovenous shunts or lymphadenovenous shunts may be indicated in stage II. In the irreversible lymphoedema (stage III) and in the elephantiasis (stage IV) the following operations have been developed: ligature of ectatic lymphtrunks, peripheral lymphovenous and lymphadenovenous shunts, skin-flap transplantations, free or pediculated transplantation of the greater omentum, lymphangioplastic operations (Thompson-operation) or excisional operations (Servelle-operation). The therapeutic principles of these operations are shown and late results are discussed.

Genital Diseases, Male↗
PubMed1979

Prostaglandins, rheumatoid arthritis, fibrin and lymphoedema.

Rheumatoid joint swelling is in part due to lymphoedema accompanying extravascular (E-V) deposition of fibrin. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin (ASA), phenylbutazone (PBZ) and indomethacin (INDO) which share the ability to inhibit prostaglandin synthetase fail to prevent fibrinous lymphoedema occurring in rabbit skin homografts in association with the presence of sensitised lymphocytes. The data highlight the need to define whether or not prostaglandins promote lymphocytic fibrinous lymphoedema.

Animals↗
PubMed1978

Lymphoedema of the rabbit ear following partial and complete lymphatic blockade; its effects on fibrotic development, enzyme types and their activity levels.

The dorsal surface of the rabbit ear was found to be a suitable place for the production of long-lasting lymphoedema. Its major tissues (skin and sub cutaneous) are those to which secondary lymphoedema is confined in clinical situations. After 32 weeks of partial lymphatic blockade total tissue activity levels of neutral proteinase and beta-glucuronidase were depressed while alkaline phosphatase was elevated. Subsequent complete lymphatic blockade for a further 5 weeks resulted in severe fibrosis of the s.c. tissues. The total tissue activity levels of 3 characteristic lysosomal macrophage hydrolases--acid protease, beta-glucuronidase and acid phosphatase--were significantly increased. There were strong correlations between the activity levels of these enzymes and the extent of fibrosis, increased fibrosis being characterized by higher activity levels. This, together with other evidence, suggested--as fibrosis became more severe--the total number of macrophages increased, but a high proportion of these were non-stimulated. Since these cells (when stimulated) are normally responsible for the lysis of collagen and removal of fibrotic tissue the impairment of their function as occurs in chronic lymphoedema results in further fibrosis and the continuation of the vicious circle.

Acid Phosphatase↗
PubMed1977

The influence of various benzo-pyrones on acid and neutral protease activity levels, the cells from which they may arise and their importance in the resolution of lymphoedema.

The availability of digestable material to a phagocyte determines not only the rapidity and completeness of digestion but the amount of lysosomal enzyme which reaches the extracellular compartment and the circulation. The measurement of enzyme activities in thermally injured limbs has shown the benzo-pyrones to enhance acid protease activity. There is much evidence to suggest this activity originates from macrophages which enter the thermally injured regions in great numbers. In this paper the administration of benzo-pyrones to animals with lymphoedema is reported to enhance neutral protease activity levels. This activity is not associated with mononuclear cells but with the neutrophils. Although additional histological work must be done to confirm the presence of neutrophils in lymphoedematous tissues there is evidence to suggest the increases in neutral protease levels arise from neutrophils and that in lymphoedema it is these cells which are acted upon by the benzo-pyrones. They then cause the removal of protein by enhancing its lysis either within the cells or in the extracellular compartment.

Animals↗
PubMed1992

Multi-frequency bioelectrical impedance augments the diagnosis and management of lymphoedema in post-mastectomy patients.

The value of multiple frequency bioelectric impedence analysis (MFBIA) in the monitoring and management of post-mastectomy lymphoedema of the arm was evaluated in 15 patients and controls. The technique was found to produce quantitative agreement with a clinical diagnosis of lymphoedema and with the currently-used measure (limb volume calculated from circumferential measurements) of limb size. The significance of this finding lies in MFBIA being diagnostically informative: it indicates when an observed change in limb volume is directly, albeit theoretically, attributable to accumulation of extracellular fluid. MFBIA potentially offers the means for earlier definitive diagnosis and more-accurate monitoring of extracellular fluid changes during and after treatment.

Adult↗
PubMed1992

Modern treatment of lymphoedema. I. Complex physical therapy: the first 200 Australian limbs.

Complex Physical Therapy (CPT) is discussed and its principles outlined. CPT involves: 1. skin care, 2. a special lymphatic massage, 3. compression bandaging and (later) garments, 4. special exercises which supplement the massage. CPT was used on 78 patients with postmastectomy lymphoedema (17 with Grade 1 and 61 with Grade 2). There were significant differences between the Grades. In the first four-week course the mean Grade 1 was reduced from 121% of normal to 107% (the mean change in the oedema was 103% of its initial value), and Grade 2 from 153% to 123% (with a mean change in oedema of 60%). All these were very highly significant. Over the next year there was a small, but very significant, decrease in the percentage of oedema. A further four-week course resulted in significant, and similar, reductions in the residual oedema. CPT was used to treat 128 lymphoedematous legs; 22 were Grade 1 lymphoedema, 84 were Grade 2 and 19 were elephantitic (Grade 3). After the first course of CPT the mean losses were: 1.1, 1.3 and 3.7 litres, respectively (all very significant). Over the next 11 months there were significant further reductions for all legs and in the amount of oedema of the unilateral legs. Some patients had a second course of CPT with similar reductions in the remaining oedema to that after the first course.

Arm↗
PubMedDate not supplied

Management of lymphoedema: a community-based approach.

Lymphoedema causes considerable physical, emotional and social problems. This article describes the establishment of a community lymphoedema service in one district health authority. The proposal won the Queen's Nursing Institute Innovation Award in 1991. A second article will review the first year of the clinical service.

Community Health Nursing↗
PubMed1992

Subcutaneous interstitial fluid pressure and arm volume in lymphoedema.

Interstitial fluid pressures were measured by the wick in needle method in the swollen and normal arms of 38 patients with lymphoedema resulting from treatment for breast cancer. The mean increase in arm volume, calculated from sequential circumferential measurements, was 33% (range 0.25 to 85.9). Subcutis interstitial fluid pressure in the swollen arm (2.0 cmH2O range -4.5 cmH2O to 6.8 cmH2O) was significantly greater (p < 0.001) than in the contralateral, non-swollen arm (-2.6 cmH2O range -11 cmH2O to 0 cmH2O). Interstitial fluid pressure in the oedematous arm did not correlate with the duration of the swelling (1-324 months), but did correlate with the increase in volume relative to the normal arm (r = 0.38, p < 0.05), the slope ('apparent compliance') being 28 ml.dl-1.cmH2O-1. The pressure-volume curve was less steep than the classic curve for acute oedema of dog limbs (Guyton, 1965). Vascular pressures were normal. The interstitial fluid pressures were not as high as those reported for lymphoedema of the lower extremity (mean 17.9 mmHg, Christensen et al., 1985). Nevertheless, the rise in interstitial fluid pressure by an average of 4.6 cmH2O constitutes a force opposing further microvascular fluid filtration and perhaps promoting fluid drainage out of the arm.

Adult↗
PubMed1978

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.

Animals↗
PubMedDate not supplied

[Experimental evidence for motoric rehabilitation in lymphoedema (author's transl)].

The authors distinguish three modalities of lymphtransport in lymphoedema. 1. Enhanced evacuation by existing lymphatics. 2. Enhanced evacuation by regenerated lymphatics. 3. Enhanced evacuation by lympho-lymphatic anastomoses. Experiments with 500 white mice indicate that the resorption of lymphoedema is increased by guided compression, although some manipulations must be performed with care, especially when regenerated lymphatics are present. The lymphatic flow in a limb is also enhanced by a special drainage technique at the proximal part of it. Likewise the lymph can be manipulated into the opposite limb by anastomotic channels after unilateral lymphadenectomy.

Animals↗
PubMed1979

A morphological assessment of macrophages attaching to subcutaneously implanted coverslips in dogs with chronic lymphoedema.

In an experimental model of chronic lymphoedema in the dog leg it has been shown that the presence of lymphoedema was associated with reduced numbers of macrophages found on subcutaneously implanted coverslips. Total numbers of mononuclear cells were not, however, significantly affected. When expressed as a percentage of the total mononuclear cells attached, the lymphoedematous limbs always had only half those of the corresponding normal limbs. Similarly, the percentage of macrophages with two or more pseudopods on the coverslips in the lymphoedematous limbs was only 1/3 of that for the same morphological criteria in normal limbs. However, when the macrophages with vacuoles were expressed as a percentage of the total macrophages, there was always a higher percentage in the lymphoedematous limbs compared with the corresponding normal ones.

Animals↗