Abstracts LymphForsch 1/2013

Studying step frequency during exertion on a treadmill as recorded by functional lymphoscintigraphy of the lower extremities

W. J. Brauer, V. S. Brauer, LymphForsch 2013,17(1)6-9

Summary

Purpose: Standardized exercise is an essential component of functional lymphoscintigraphic tests. However, when standardized exercise is elicited with the help of a treadmill ergometer, different step frequencies are observed. The purpose of this study was to measure the num- ber of steps within a given time period and to determine a standardized step frequency for ’walking on the treadmill’ and for ’free walking’. In a second study, we investigated the ability of test persons to adjust their walking on a treadmill ergometer to a fixed pulse frequency.

Methods: For the first part of the study, a standardized protocol was used to examine the lymphoscintigraphy of the lower extremities while patients walked on a treadmill ergome- ter (289 patients, 4 km/h). The number of steps within a given time period (30 min) was determined with a step counter, and the variability of step numbers was investigated in relation to sex, body size and body mass index (BMI). In the second part of the study, we used a metronome to investigate the influence of a fixed pulse frequency on the variability of the step frequency in 170 patients.

Results: In the first part of the study, the number of steps within 30 min ranged between 2105 and 4249; the median was 3331. Step frequency did not correlate with body size, BMI or sex. In the second part of the study, the previously determined median was then applied as fixed step frequency. The variance of step frequency in the second part of the study was significantly lower than in the first part of the study.

Conclusions: The results indicate that a standardized walking speed of 4 km/h leads to considerable variance in the number of steps per given time period. This variance can be reduced when patients walk with a standardized step frequency. Therefore, standardized exercise using a treadmill ergometer or monitored ’free walking’ should be performed with both standardized velocity and step frequency.

Keywords: lymphedema, lymphoscintigraphy, lymphoscintigraphic function test

Studies on patient quality of life after lymphatic vessel transplantation

R. G. H. Baumeister, S. Springer, M. Koller, A. Frick, LymphForsch 2013,17(1)10-12

Summary
Quality-of-life assessment studies are becoming more significant for the evaluation of treat- ment procedures. In this cross-sectional study, 212 patients were investigated with respect to changes in their quality of life after reconstruction of a discontinuous lymphovascular system by means of autologous lymphatic collector transplantation. All patients had under- gone at least six months of complete physical decongestive therapy with a mean duration of edema treatment of seven years. A modified standardized questionnaire that examined the physical and psychological status of the patients was used to assess quality of life. The results document a significant improvement in the quality of life of patients with arm and leg lymphedema, both psychologically and physically. The improved lymphatic outflow provided by the lymphatic vascular bypasses is most likely responsible for the reduction in volume, increase in mobility and, to a great extent, the elimination of the need to wear compression garments.

Keywords: lymphedema, lymphatic vessel transplantation, quality of life, lymph, lymphatic vessel

A third case of congenital analbuminemia combined with lipedema

W. Schmeller, D. Hartwig, LymphForsch 2013,17(1)13-15

Summary
In the last issue of LymphForsch, we reported about two Turkish sisters with the rare disease congenital analbuminemia combined with lipedema. In this article, we present the third case from of 52 cases in the international literature to date. All of our patients were born near Kayseri, Turkey (Eastern Anatolia). It is known that congenital analbuminemia is a genetic disorder caused by the “Kayseri mutation” in most cases.

Keywords: analbuminemia, lipedema, Kayseri mutation

Stewart-Treves syndrome associated with secondary arm lymph- edema nine years after invasive ductal carcinoma

A. Bennewitz , D. Langner , J. Schönlebe , B. Heinig , A. Koch , U. Wollina, LymphForsch 2013,17(1)16-18

Summary
Chronic lymphedema of the arm is a possible complication after curative breast cancer treatment. In rare cases, Stewart-Treves angiosarcoma develops in the chronically lymph- edematous arm. We report on a 54-year-old woman who presented with lymphedema- associated Stewart-Treves syndrome. Diagnostic and therapeutic issues are discussed.

Keywords: breast cancer, chronic lymphedema of the arm, Stewart-Treves syndrome, angiosarcoma

Lymphatic and rheumatic disorders

M. Uhlemann, T. Kupka, H. Uhlemann, LymphForsch 2013,17(1)21-24

Summary
Lymphatic and rheumatic diseases are closely associated in terms of their pathophysiology and symptoms. The cardinal symptoms of both disorders are edema, inflammation and reduced lymphangiomotor activity, which clearly demonstrates the advantage of close rheumatological-angiological cooperation. Physical therapy, in particular complete physical decongestive therapy, is highly significant for alleviating the symptoms and enhancing the prognosis of the disorders. Therefore, the application of manual lymphatic drainage at an early stage in patients presenting with rheumatic edema should be an integral component of the long-term therapy concept.

Keywords: lymphatic insufficiency, inflammation, edema, rheumatic disease and etio- pathogenetic associations, manual lymph drainage

The role of lymphological aspects in vascular surgery

I. Flessenkämper, LymphForsch 2013,17(1)25-29

Summary
The consequences of vascular procedures for lymphatic structures are often neglected. The case of an exacerbated inguinal lymphatic fistula that ended in an infrarenal aortic exchange is used to demonstrate the importance of lymphological aspects of vascular surgery. The typical lymphatic sequelae of vascular operations, such as lymphatic fistulas, lymphoceles and postsurgical lymphedema, are discussed in the context of venous and arterial procedures. Current therapeutic options include conservative treatment such as manual lymph drainage and compression therapy. Treatment of lymph fistulas include sclerotherapy, radiotherapy, vacuum therapy and surgery.

Keywords: lymphatic fistula, vascular procedure, stent graft infection, therapeutic options, complication

The lymphangiogenic growth factors VEGF-C and VEGF-D

Part 1: Basic principles and embryonic development

R. Krebs , M. Jeltsch, LymphForsch 2013,17(1)30-37

Summary
VEGF-C and VEGF-D are the two central signaling molecules that stimulate the develop- ment and growth of the lymphatic system. Both belong to the vascular endothelial growth factor (VEGF) protein family, which plays important roles in the growth of blood vessels (angiogenesis) and lymphatic vessels (lymphangiogenesis). In mammals, the VEGF family comprises five members: VEGF-A, PlGF, VEGF-B, VEGF-C and VEGF-D. The family was named after VEGF-A, the first member to be discovered. VEGF-C and VEGF-D form a subgroup within this family in terms of function and structure. Their distinctive biosynthesis differen- tiates them from the other VEGFs: they are produced as inactive precursors and need to be activated by proteolytic removal of their long N- and C-terminal propeptides. Unlike the other VEGFs, VEGF-C and VEGF-D are direct stimulators of lymphatic vessel growth. They exert their lymphangiogenic function via VEGF receptor 3, which is expressed in the adult organism almost exclusively on lymphatic endothelial cells. In this review, we provide an overview of the VEGF protein family and their receptors. We focus on the lymphangiogenic VEGF-C and VEGF-D, discussing their biosynthesis and their role in embryonic lymphangio- genesis.

Keywords: VEGF-C, VEGF-D, growth factors, lymphangiogenesis

Regulation of hemangiogenesis and lymphangiogenesis by activators and inhibitors of the vascular endothelial growth factor (VEGF) family

J. Becker, LymphForsch 2013,17(1)38-44

Summary
The vascular endothelial growth factor (VEGF) family of ligands and receptors is the most prominent regulator of development, regeneration and maintenance of functional blood and lymphatic vessels. This system of effectors and inhibitors ensures that the appropriate amount of blood and lymphatic vessels is formed at the right time, the right place and the right dimension, and that new vessels are formed from pre-existing ones. While this system is tightly regulated in healthy individuals, disorganization of the system can cause or pro- mote the progression of diseases. Detailed knowledge of the molecules and their interre- lationships is a prerequisite for treating such diseases appropriately. The increasing know- ledge of the functions and interactions of the VEGF-family ligands and receptors, along with the discovery of new molecular variants, provide new insight into the regulation of angiogenesis and help to identify new targets and drugs that may be suitable for improving current therapeutic regimens.

June 26, 2013

Keywords: hemangiogenesis, lymphangiogenesis, VEGF, NRP, soluble receptors