Management of Conditions and Symptoms
Amy J. Litterini, Christopher M. Wilson in Physical Activity and Rehabilitation in Life-threatening Illness, 2021
The lymphatic system is responsible for (1) immune defense (e.g. removal of debris from the interstitium, production of lymphocytes, and protection from the spread of malignancy); (2) nutrition (e.g. intestinal lymph vessels absorb digested fats/lipoproteins); and (3) maintenance of fluid balance (i.e. filtration/reabsorption). An estimated 10% of the capillary ultrafiltrate is considered the lymph obligatory load which returns to the circulatory system via reabsorption by the lymphatic system.62Edema is the general term for swelling due to increased fluid collection in the interstitium; it is a visible and palpable sign of injury or a malfunctioning system, and is associated with different etiologies. In the body’s initial response to injury, acute edema results from a transfer of fluid (exudate) from the blood into tissue. Edema, which can be either generalized/diffuse or localized, can also result from immobilization, or it can be an initial symptom of an underlying disease such as CHF or other venous system disorders (see Chapter 8).62Lymphedema, considered a chronic condition, is the abnormal collection of protein-rich lymph fluid in the interstitium that, if left untreated, can cause chronic inflammation, fibrosis of the affected tissues, and/or wounds.
Grains
Christopher Cumo in Ancestral Diets and Nutrition, 2020
Another disease associated with corn is kwashiorkor, which Jamaican physician Cicely Delphine Williams (1893–1992) named in 1933.187 She noted the condition in Ghanaian children who ate little but corn. Investigators thereafter found kwashiorkor in Central America and Brazil’s corn consumers. Symptoms included edema, especially in the feet, ankles, and belly, where swelling was conspicuous. Victims suffered fatigue, weakness, diarrhea, sores on mucus membranes, fatty liver, peeling skin on legs and forearms, and irritability. Fatal when untreated, kwashiorkor retards growth and impairs the immune system. In 1952, the World Health Organization (WHO) blamed insufficient protein intake as the cause and noted kwashiorkor’s ubiquity among tropical and subtropical poor. Corn is not the lone culprit because the condition also afflicts cassava, rice, millet, and sorghum eaters.
Inflammation
George Feuer, Felix A. de la Iglesia in Molecular Biochemistry of Human Disease, 2020
Many immediate structural changes occur at the local site of damage within a short time after injury. In the inflamed tissue we can see dilatation of small blood vessels and capillaries. As a consequence, there is a significant influx of blood into the area, containing great numbers of erythrocytes and leukocytes. In the dilated blood vessel the blood flow becomes slower and leukocytes adhere along the vessel walls. The accumulation of red cells is manifested clinically as erythema. The inflammatory response appears in a diphasic increase of vascular permeability and shows intravascular and extravascular changes (Figure 1). The fastest reaction is vasodilatation causing the permeability to increase at the level of the vascular wall. Small molecules leak out together with plasma fluid and enter the extravascular space in increasing amounts. The abnormal accumulation of fluid leads to edema. The peak of this immediate response is at about 30 min and progresses to a latent phase after about 2 h. Within 2 to 4 h, the vascular permeability becomes more marked and another wave of fluid loss occurs causing severe edema formation. This fluid carries large molecules from the plasma into the surrounding tissue including fibrinogen, which is transformed to fibrin in the course of the clotting process. During the initial period, polymorphonuclear leukocytes start invading the injured area. Examples of polymorphs infiltration are shown in Plates 4 to 7.
Severe autoimmune hemolytic anemia complicating hereditary spherocytosis treated successfully with glucocorticoids and cyclosporine: a case report
Published in Hematology, 2023
Na Wang, Hongkai Lu, Linzhang Li, Ming Gong, Yongtong Cao
In November 2021, a 25-year-old woman developed moderate to severe edema with no obvious cause, especially in both lower limbs, accompanied by abdominal distension, weakness, heart palpitations, dyspnea, inability to lie down at night, and splenomegaly. On January 29th 2022, she was admitted to the Emergency Department of China–Japan Friendship Hospital with a fever of up to 39°C. The results of laboratory tests conducted on admission are provided in Table 1. A peripheral blood smear showed mature erythrocytes of variable size, heterogeneous erythrocytes, and a count of 2 nucleated erythrocytes per 100 leukocytes. Based on the patient's decreased hemoglobin level; elevated reticulocytes, lactate dehydrogenase, bilirubin, and indirect bilirubin levels; and direct anti-human globulin test (DAT) positivity [anti-immunoglobulin (IgG) 2+ and anti-C3d 1+; Table 1], the diagnosis of AIHA was considered. Tests performed to exclude infectious causes of the fever detected IgM antibodies against respiratory syncytial virus (RSV). It is worth noting that her platelet count decreased during the initial period of hospitalization (Table 1). This thrombocytopenia may have been mediated by immune-related factors and may have been due to the patient's hypersplenism.
Efficient bloodless mechanical thrombectomy for massive dural sinus thrombosis associated with COVID-19 using the 12-French Penumbra Lightning intelligent aspiration system
Published in Baylor University Medical Center Proceedings, 2023
Bradley Bernard, Taylor Maloney, Gregg Shalan, Mougnyan Cox, Ike Thacker
Cerebral venous thrombosis is a rare cause of stroke, most commonly affecting young women.1 The advent of the COVID-19 pandemic has resulted in an increase in reported cases of dural sinus thrombosis, with worsened outcomes for patients with both diseases.2 Venous obstruction can cause edema, potentially progressing to venous infarction and hemorrhage. Standard treatment includes parenteral anticoagulation and supportive care. Endovascular therapies can be considered in patients with an incomplete response to anticoagulation or in patients with poor prognostic factors, including progressive neurologic decline or new/worsening intracranial hemorrhage. Current guideline recommendations on endovascular therapy are unsettled, as there is little class I evidence on the most effective endovascular treatment modality, which includes catheter-delivered thrombolysis and thrombectomy.
The Effects of Synbiotic Supplementation on Serum Anti-Inflammatory Factors in the Survivors of Breast Cancer with Lymphedema following a Low Calorie Diet: A Randomized, Double-Blind, Clinical Trial
Published in Nutrition and Cancer, 2022
Ali Saneei Totmaj, Shahpar Haghighat, Shapour Jaberzadeh, Mehraban Navaei, Saeideh Vafa, Leila Janani, Hadi Emamat, Zahra Salehi, Maryam Izad, Mitra Zarrati
Reduction in excess arm edema volume after synbiotics supplementation is a new finding that has not been reported prior the present study. Reduction of arm edema volume occurred in both groups, but this reduction was only significant in the synbiotic group (%- 37.26 vs %- 20.75). However, in previous studies, the effect of weight loss has been shown to improve edema (14, 33, 34). The results of the present study unprecedentedly prove that receiving synbiotic supplement along with a weight-loss diet can significantly reduce the arm’s edema. Shaw et al. showed thata weight-loss diet lasting 12 weeks could significantly reduce the volume of edema (33). Obesity is a risk factor for the development and progression of lymphedema in BCSs (6, 12). Several mechanisms are proposed for this relationship, including a reduced muscle pump efficiency, excess fat deposits, and negative effects on lymphatic vessels in overweight or obese patients (35, 36).
Related Knowledge Centers
- Chronic Venous Insufficiency
- Deep Vein Thrombosis
- Hypoalbuminemia
- Kidney Failure
- Liver Disease
- Lymphedema
- Menstruation
- Tissue
- Angioedema
- Heart Failure