Natural Treatment for Lymphedema Found

B7 Lymphedema Shoulder Immobility and Brachial Plexopathy

Lymphedema Arm edema or lymphedema in breast cancer patients is caused by an interruption ofthe normal filtration process that occurs between capillaries, interstitial tissue, and lymphatic vessels in the arm. Under normal circumstances, capillary pressures force fluid into the interstitium and reabsorption pressures pull most ofthe fluid back into the capillary at the venous side. The remainder of the filtered fluid and protein are removed by lymphatic vessels. Without the functioning lymphatic system, protein, cells and non-reabsorbed fluid remain in the interstitial tissue. The stasis of fluid in the subcutaneous tissues of the arm leads to increased weight and girth of the extremity. Patients with arm edema secondary to breast cancer therapy can experience difficulty performing skills at home or work because of functional impairment, psychological distress as a result of the change of body image, and chronic pain, leading to significantly reduced QOL.96'97'98 The primary treatment...

Morbidity Of Pelvic Lymphadenectomy

Several confounding factors complicate any evaluation of the morbidity of pelvic lymphadenectomy. First, the extent of the lymphatic dissection has differed between surgeons and over time as the technique has evolved. Second, pelvic lymphadenectomy can be performed in a number of ways (1) through a traditional lower midline incision (2) a mini-lap incision or (3) laparoscopically. These factors influence the overall complication rate, for example, the incidence of intraoperative neural and vascular injury, the rate of lymphocele formation and the extent of postoperative lymphedema. Ordinarily, pelvic lymphadenectomy is performed immediately before definitive treatment for prostate cancer, such as radical prostatectomy, or radioactive seed placement under the same anesthetic or external beam radiation within the perioperative period. For this reason, it can be difficult to differentiate complications attributable to the pelvic lymphadenectomy procedure from those related to the therapy...

Small Bowel Obstruction

Axr Bowel Obstruction Transition Point

Right inguinoscrotal fold (Fig. 1.67a). Because of the diagnostic limitations of plain films, cross-sectional methods are increasingly used. At US, dilated, fluid-filled small bowel loops are seen, which are recognized by the presence of the valvu-lae conniventes. The bowel wall may become edem-atous due to vascular and lymphatic obstruction, and ascites may be an accompanying feature of intestinal obstruction. In patients with mechanical bowel obstruction, hyperperistalsis with a to-and-fro motion of the bowel contents is often observed during real-time imaging. Once the obstruction becomes high-grade or complete, peristalsis may be absent (O'Malley and Wilson 2003). Peristals-ing fluid and air-filled loops of bowel or mesenteric fat passing down the canal into the scrotum can be readily identified in inguinal hernias (Fig. 1.67b). At US or CT a diagnosis of adhesion is assumed when there is no identifiable lesion at the transition zone between the dilated and the collapsed bowel...

Corradino Campisi General Clinical Aspects

Among peripheral lymphatic disorders, lymphedema represents a pathology with a relatively significant incidence worldwide. Lymphedema, from the etiopathogenetic point of view can be divided as primary or secondary. Primary lymphedema, also called idiopathic, has no clearly recognizable etiology, although triggering etiological factors can frequently be found. Lymphedemas with onset at birth (congenital) are included in this category and sometimes are hereditary-familial (Nonne-Milroy's disease), often associated with chromosomal abnormalities. Primary lymphedemas, depending on the time of their appearance, may have early or late onset, which can be triggered by little traumas, infections or surgery. Above all in females, predisposing factors are to be identified in alterations of their neurohormonal status (neuroendocrine lymphedemas). Primary lymphedemas can be related to general conditions of lymphatic and or lymphnodal dysplasia, hypoplasia or hyperplasia (with increased lymph...

Final Remarks and Future Applications

In the complex therapy for lymphedemas, the role to be played by surgery versus medical-physical conservative treatment can be easily defined.10 Combined physiotherapy is the treatment of choice for most lymphedemas. In nonresponsive cases Fig. 14.3. Primary leg lymphedema (a) in pediatrics. Microsurgical derivative lymphatic-venous drainage was performed at the inguino-crural region. Microsurgery allowed to obtain a rapid reduction of the edema at both sides (b). Fig. 14.3. Primary leg lymphedema (a) in pediatrics. Microsurgical derivative lymphatic-venous drainage was performed at the inguino-crural region. Microsurgery allowed to obtain a rapid reduction of the edema at both sides (b). With regard to prevention of secondary lymphedemas, finally, early diagnosis plays an important role as well as the selection of high-risk patients for the onset of lymphostatic disease after oncological lymphadenectomies, especially if associated with radiotherapy. In these cases, early microsurgery...

Clinical Manifestations

Can Filariasis Infect Scrotum

The clinical manifestations of lymphatic filariasis vary from one endemic area to another and also differ, to some extent, according to the species of the parasite that is involved (Partono, 1987). In parts of Africa such as Tanzania, the most common clinical form of the disease is hydrocele, while lymphedema and elephantiasis are much less common (Sasa, 1976). In other areas of the world such as India, both hydrocele and lymphedema are seen with almost equivalent frequency (Pani et al., 1991). Some forms of the disease, such as tropical pulmonary eosinophilia (TPE) and chyluria, are restricted in their distribution to certain parts of the world. For example, TPE has been reported most commonly from the Indian subcontinent, Brazil and Malaysia. Several studies have shown that there is a slight preponderance of females with chronic disease (when hydroceles are excluded) (Brabin, 1990). Other reports, especially from Ghana, indicate a male preponderance of the disease (Gyapong et al.,...

Midgut Volvulus

Chronic venous and lymphatic obstruction may also occur (Berdon 1995). Findings on abdominal radiographs in midgut volvulus are usually abnormal but nonspecific. Upper gastrointestinal examination (the study of choice in neonates) shows the typical corkscrew appearance of the proximal small bowel. However, in older patients with acute symptoms, US or CT are generally performed instead of a barium examination. Sonographically, an abnormal location of the mesenteric vein to the left or anterior to the corresponding artery can raise the suspicion of malrotation. When a volvulus occurs, twisting of the bowel loops around the mesenteric artery axis leads to the whirlpool sign (PRacROS 1992), best shown in Doppler color studies (PatiNO

Mastectomy continued

Wound infection, serosanguinous collection, haemorrhage, nerve injury (e.g. long thoracic nerve, thoracodorsal nerve, intercostobrachial nerve). Long-term Poor cosmetic result, lymphoedema to ipsilateral arm, shoulder stiffness, psychological problems, tumour recurrence.

Operative Treatment

At the end of the '60s, there were very few therapeutic solutions to the treatment of lymphedema. Only the most severe and advanced cases of elephantiasis were surgically treated, mainly in order to reduce the volume of lymphedematous limbs. The most popular surgical methods were those according to Charles (total resection of skin-lipid layers), Thompson (drainage with scarred subfascial skin flap), and Servelle (total surface lymphangectomy). Being highly destructive and invasive operations, they could not be recommended in less advanced or initial stages and even less so in children. Thus, for those patients resistant to conservative treatment, new and more suitable surgical solutions, aiming at correcting the mechanisms of lymphedema, that could shorten the duration of the disease, spare the patients frequent and long hospitalization, and allow them to go back to their family and work, were sought. As early as the '70s, Tosatti4 proposed a method of antigravitational ligation of...

Lymphatic Assessment

Based on medical history and objective examination, the time and conditions of onset, location, evolution, and extent, volume, and semiological features of lymphedema can be assessed and a differential diagnosis from phlebedema can be made. Lymphedema is hard to the touch, while venous edema is soft and has the typical fovea sign under finger compression. This difference above all depends on the stagnant lymph being an excellent pabulum for fibroblasts in the subcutaneous connective tissue, that mature more rapidly into fibrocytes, thus forming fibrosclerotic connective tissue. Lymphedema has a typically rhizomelic or columnar location, whereas the venous edema has an acromelic arrangement, except for phlegmasia dolens, caused by acute deep thrombophlebitis of the femoral-iliac region. Unlike phlebedema, lymphedema does not usually evolve into dystrophic-dyschromic skin lesions and ulcers. It is more likely to be complicated by acute reticular erysipeloid lymphangitis, caused by...

Fabrys disease

Although females are heterozygous, they are usually symptomatic and may be as severely affected as males. A skin rash (angiokeratoma) and pain in limbs (acro-paraesthesia) are early symptoms (under 10 years old). In late childhood, reduced sweating, abdominal symptoms and lymphoedema are characteristic. Renal failure, cardiac failure, stroke, epilepsy and CNS sensory organ involvement are later features. Life expectancy is 40-50 years for men and 50-65 years for most women.


Chronic manifestations of lymphatic filariasis include lymphedema, urogenital disease and adenopathy. Although antifilarial drug therapy is rarely, if ever, the 'definitive' treatment for these conditions, such treatment is indicated if the patient has evidence of active infection, e.g. detection of microfilaria or filarial antigen in the blood, or of the 'filaria dance sign' on ultrasound examination. Not infrequently, the inflammatory response secondary to treatment-induced death of the adult worm exacerbates manifestations of chronic disease. Lymphedema Data indicate that filarial elephantiasis and lymphedema of the leg may be partially reversible with a treatment regimen that emphasizes hygiene, prevention of secondary bacterial infections and physiotherapy. This regimen is similar to that now recommended for treatment of lymphedema in Europe, Australia, and the USA (Foldi et al, 1989 Kobayashi and Miller, 1987 Mortimer, 1990 Campisi, 1991 Casley-Smith and Casley-Smith, 1992...

The filariases

Brugia Malayi

Rapid mapping techniques have been developed as well as indirect methods, such as the use of key informants responding to self-administered questionnaires about the prevalence of hydrocele and lymphoedema and the use of mobile health workers to examine an established number of persons for lymphoedema and hydrocele, have been successfully employed to assess the endemicity of filariasis in Ghana and elsewhere. Community involvement could be enhanced by simultaneously providing symptomatic treatment for lymphoedema based on regular washing of skin with soap and water, limb elevation, topical application of antibiotics and antifungal creams (Plate 91). The delivery of drugs could be either through existing health services or community directed. Mathematical models could provide powerful tools for analysis, prediction and control strategies.