Edema and lymphedema
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
Lymphedema: Primary lymphedema is likely to be genetically inherited.5–7 Secondary lymphedema in the Northern hemisphere is most commonly due to cancer or its treatment.8 The skin pits with difficulty, has deep skin folds and changes very little with posture. The skin is pale and cool and in time will thicken - in the legs this makes it impossible to pick up a skin fold over the top of the second toe (Stemmer’s sign). Eventually warty tags can develop that can leak and become infected. In post breast cancer arm lymphedema the hand may be spared.9Acute inflammatory episodes are common in lymphedema and cause a diffuse warmth, redness and pain in the affected area. They are usually caused by streptococcal infection and will often respond to amoxicillin.10Classical cellulitis due to staphylococcal infection is uncommon in lymphedema. Lymphangiosarcoma is a rare complication.11–13
Yellow Nail Syndrome
Nilton Di Chiacchio, Antonella Tosti in Therapies for Nail Disorders, 2020
Often there is a spontaneous improvement of nail changes: more than 30% of patients according to Samman et al.,21 but only in 10% of cases according to a review of 70 patients in a publication by Norton.43 Nail abnormalities improve or regress when the respiratory diseases are successfully treated. YNS therapy includes treatments for associated diseases: bronchopulmonary hygiene (e.g., postural drainage, thoracic physiotherapy), inhaled steroids and antibiotics to control symptom exacerbations, and serial thoracentesis or pleurodesis for the control of pleural effluxion. Lymphedema can be managed in the majority of patients with a regimen consisting of the use of gradual pressure devices, exercises, bandages, manual lymphatic drainage, and possibly diuretics. In patients with paraneoplastic YNS, the nails often return to normal with tumor eradication. Three cases of YNS remission after tumor treatment have been described in the literature. In one case it is a breast cancer,44 another case of remission after the treatment of cholangiocarcinoma,45 and a case of healing after the resection of the larynx carcinoma.37 These cases indicate that the nail changes are reversible. A possible explanation of this tumor-healing regression phenomenon of YNS could be a direct involvement of the tumor of the lymphatic vessels, already deficient.44
Lymphoscintigraphy
Michael Ljungberg in Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
The most common pathological condition with obstruction of lymphatic pathways is called lymphedema. When lymph remains in tissues for some time it will cause progressive and chronic swelling, fat deposition, scarring, and immunosuppression [2]. Lymphedema is divided into two categories – primary (as a congenital disorder with absence of or deficiency of lymphatic vessels [3]) and secondary. Secondary lymphedema can be caused by infections, inflammatory diseases, trauma, or cancer treatments. It is a widespread condition, and about 120 million people in developing countries have lymphedema due to a parasitic infection known as lymphatic filariasis [4], and 10 million people in the Western world have it as a complication after previous cancer treatments, such as surgery or radiation therapy. Lymphedema commonly affects one of the arms or legs but can also be bilateral. In rare cases it can be presented by swelling of the genitals or chest. Lymphedema is incurable, but the right treatment can help reduce the swelling and pain. It can be treated conservatively by Complex Decongestive Therapy (CDT) or, in limited cases, by surgery (transplantation of lymph nodes and vessels, by-pass procedure or liposuction). CDT is initially performed by specially trained lymphedema therapists who will train patients to perform the treatment themselves. CDT consists of four components: (1) Manual lymphatic drainage, or a special massage technique that aims to stimulate an increased flow in the remaining lymphatic pathways; (2) compression therapy in the form of multi-layered bandaging; (3) dermatological skin care to prevent skin infection, and (4) physical training, with light exercises aimed at encouraging movement of the lymph fluid out of the limb.
Characterization of two distinct lipomas: a comparative analysis from surgical perspective
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Hak Chang, Seong Oh Park, Ung Sik Jin, Ki Yong Hong
The lymphatic system serves as a critical channel for the transport of interstitial fluid and immune cell migration [22]. Lymphatic insufficiency causes abnormal accumulation of lymphatic fluid known as lymphedema. An in vitro study demonstrated that supplementing lymphatic fluid to 3T3-L1 preadipocyte cell line promoted a robust adipogenic differentiation, indicating the presence of unknown potent stimulant(s) of adipogenesis in the lymphatic fluid [22]. Furthermore, in vivo studies of lymphedema using a mouse tail model showed that induced lymphatic fluid stasis caused fat deposition, inflammation and fibrosis through the upregulation of adipose-specific genes in a spatiotemporal manner [23]. Consequently, we postulated that direct or indirect stimulation by lymphatic retention can provide an adipogenic signal through the activation of ASCs. Our results showed that supplementation of ASCs culture with postoperatively drained serum promoted the proliferation of cells from non-encapsulated, but not from encapsulated lipomas. This suggested that ASCs response to changes in lymphatic microenvironment is lipoma-type-specific.
The application of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for assessment of the lymphatic system in reconstructive lymphaticovenular anastomosis surgery
Published in Expert Review of Medical Devices, 2021
Albert H. Chao, Steven A. Schulz, Stephen P. Povoski
Lymphedema is a chronic condition of pathological swelling or volume increase within tissues due to dysfunction of the lymphatic system, which results in retention of fluid, and in more advanced stages collagen formation and cellular proliferation of adipocytes and fibroblasts[5]. Primary lymphedema is caused by abnormal development of the lymphatic system. Secondary lymphedema is relatively more common and results from injury to a normally developed lymphatic system, such as due to infection, surgery, or radiation therapy. Symptoms of lymphedema include swelling, enlargement, heaviness, and pain in the affected tissues, as well as an increased propensity for soft tissue infections. These changes are responsible for the reduced quality of life and substantial morbidity experienced by patients with lymphedema.
An important tool in lymphedema management: validation of Turkish version of the lymphedema breast cancer questionnaire
Published in Disability and Rehabilitation, 2022
Hanife Doğan, Hanife Abakay, Ayşe Güç, Halit Karaca
In the diagnosis of lymphedema, the concepts of heaviness and swelling are especially focused on [9]. Each question in the LBCQ reflects a separate symptom. When looking at symptom percentages, patients with lymphedema reported higher rates of symptoms compared to those without lymphedema. In the literature, it has been reported that 10–60% of the patients experience at least one upper extremity problem (pain, numbness, tingling, stiffness, edema, weakness, or reduction in joint range) within a period of 6 months to 3 years after surgery [26]. In our study, the most common symptoms encountered by individuals with lymphedema were a heaviness, swelling, increased temperature, stiffness, and the development of fluid buildup. These results contribute to clinical and empirical studies regarding the symptoms researchers should focus on most in detecting lymphedema.
Related Knowledge Centers
- Edema
- Exercise
- Extracellular Fluid
- Manual Lymphatic Drainage
- Parasitic Disease
- Lymphatic System
- Immune System
- Infection
- Circulatory System
- Genetic Disorder