Phlebolymphedema: is it a new concept?

Byung-Boong LEE, MD, PhD, FACS Professor of Surgery and Director, Center for the Lymphedema and Vascular Malformations, George Washington University, Washington DC, USA Abstract Venous and lymphatic systems are inseparable “dual” outflow systems with mutually complimentary function so that such mutual interdependence between these two systems causes a new condition to affect both systems simultaneously when one of the two systems should fail to provide sufficient compensation to the other system, known as “phlebolymphedema” (PLE): combined condition of chronic venous insufficiency (CVI)/chronic venous hypertension and chronic lymphatic insufficiency (CLI)/chronic lymphedema. PLE is, therefore, an unavoidable outcome of the joint failure…

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New diagnostic modalities in lymphedema

Sarah THOMIS University Hospitals Leuven, Belgium Abstract Introduction: Lymphedema is a chronic, progressive, and debilitating disease. An early and accurate diagnosis and treatment is very important to alter the normal progression of the disease. When lymphedema is diagnosed late, the options for treatment are diminished as fibrous tissue is formed. Until recently, lymphoscintigraphy was considered the gold-standard diagnostic technique; however, other new and renewed diagnostic tools have emerged. This article provides an overview of the available diagnostic tools based on the findings from a literature search. Methods: A literature search for each of the diagnostic tools was performed. Results: Diagnostic…

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Management of combined venous and lymphatic malformations

Management of combined venous and lymphatic malformations Raul MATTASSI, MD College of Applied Sciences, Director of the Department of Vascular Surgery and Center for Vascular Malformations, “Stefan Belov,” Clinical Institute Humanitas “Mater Domini,” Castellanza (Varese) Italy Abstract Vascular malformations are congenital vessel malformations that include one or more venous, lymphatic, or arteriovenous defects. Klippel-Trenaunay syndrome occurs when there is a combination of venous and lymphatic malformations in the limbs; however, the definition is still controversial. The 2013 international venous malformation consensus established that Klippel-Trenaunay syndrome is a combination of venous malformations that involve the whole limb and lymphatic malformations. Although,…

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Discovery of lymphatic filariasis during a humanitarian aid mission to Burkina Faso

André CORNU-THENARD Jean-Luc GILLET J Nathalie GRIMALDI Elizabeth CORNU-THENARD Nelly GILLET Hôpital Saint-Antoine Rue du Fbg Saint-Antoine 75012 Paris, France SUMMARY Lymphatic filariasis affects 120 million persons worldwide, a third of whom live in Africa. It is caused by threadlike parasitic worms transmitted to humans by the bite of mosquitoes which are vectors of the disease. One of the effects resulting from a mosquito bite affecting a lower limb is the occurrence of lymphedema. When the latter becomes massive, it is known as elephantiasis. The purpose of the December 2009 aid mission was to treat patients with this disease by…

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Tissue fluid pressure and flow in the subcutaneous tissue in lymphedema – hints for manual and pneumatic compression therapy

Waldemar L OLSZEWSKI1,2,3 Pradeep JAIN4 Govinda AMBUJAM4 Marzanna ZALESKA1 Marta CAKALA1 Tomasz GRADALSKI5 1. Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland 2. Department of Gastrointestinal and Transplantation Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland 3. Rikshospitalet / Norwegian Radium Hospital, Oslo, Norway 4. Indian Lymphology Centers, BHU Varanasi and TMC Thanjavur 5. Lymphedema Clinic St Lazarus Hospis, Krakow, Poland ABSTRACT Physiotherapy of lymphedema requires knowledge of: a) how high external pressures should be applied manually or set in compression devices in order generate tissue pressures high enough to move…

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Understanding the mechanisms of lymphangiogenesis: a hope for cancer therapy?

Jonathan P. SLEEMAN1,2 1. University of Heidelberg, Medical Faculty Mannheim, Ludolf-Krehl-Str. 13-17, D-68167 Mannheim, Germany. 2. Forschungszentrum Karlsruhe, Institut für Toxikologie und Genetik, Postfach 3640, D-76021 Karlsruhe, Germany. ABSTRACT The last fifteen years have witnessed a rapid deepening of our understanding of both the molecular biology of lymphatic vessels and the formation of new lymphatic vessels during lymphangiogenesis. Following the discovery that VEGFR-3, a transmembrane receptor tyrosine kinase, localizes to lymphatic vessels and can orchestrate lymphangiogenesis, the list of molecular regulators of lymphangiogenesis has continued to grow, and includes growth factors, cell surface proteins, and transcription factors. In addition, molecules…

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Anatomical distribution of tissue fluid and lymph in soft tissues of lower limbs in obstructive lymphedema—hints for physiotherapy

Waldemar LOLSZEWSKI1,2,3 Pradeep JAIN4 Govinda AMBUJAM4 Marzanna ZALESKA1 Marta CAKALA1 1. Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland 2. Department of Gastrointestinal and Transplantation Surgery, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland 3. Rikshospitalet / Norwegian Radium Hospital, Oslo, Norway 4. Indian Lymphology Centers, BHU Varanasi and TMC Thanjavur ABSTRACT Knowledge of the exact location of tissue fluid (TF) and stagnant lymph (L) in lymphedema is indispensable to rational physiotherapy and specifically defines where to apply external pressure and how much. We visualized the “TF&L” space in the skin and…

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Erysipelas and lymphedema

Loïc VAILLANT Skaraborg Université François Rabelais, Tours, France SUMMARY Erysipelas is a nonnecrotizing bacterial hypodermal cellulitis usually associated with streptococcal infection. It may be a mainly secondary complication of chronic lymphedema, and occurs in 20% to 30% of cases. The first presenting signs are sudden fever and shivering. The clinical feature is inflammatory plaque, which is often chronic and accompanied by fever. Inflammatory plaque is promoted by lymph stasis, and is marked by inflammatory episodes that often regress spontaneously. Erysipelas per se is mainly treated with antibiotics, and adjuvant therapies are not justified. The prevention of recurrence is primary. Since…

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Towards a better understanding of lymph circulation

Olivier STÜCKER*, Catherine PONS-HIMBERT*, and Elisabeth LAEMMEL** *CEROM **Université Paris 7 Paris, France SUMMARY The lymphatic system was for years considered an “accessory” system and was neglected in comparison with the vascular system, which appeared much more crucial. In the last decade, researchers have become interested in lymphatic function since many diseases seem to interact with it (cancer, inflammation, infection, auto-immunity). The lymphatic system is harder to study than its vascular counterpart as its vessels are ill-defined, almost invisible. Intravital microscopy alone correctly visualizes these structures, thus shedding light on their function and quantifying their movements. This paper focuses on…

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