Abstracts LymphForsch 1/2017

– full text in German –

Treating patients with edema at a specialized clinic: Experiences from a rehabilitation hospital

W. Schneider, S. Tobisch, R. Reintjes, K. Schönweiß, A. Kassen
LymphForsch 21 (1) 2017;6-12

Within the scope of a historical cohort study, we reveiwed the charts of 154 in-patients with edema (14.9 % primary, 33.1 % secondary lymphedema, 53.2 % lipedema) between the ages of 30 and 60 treated in 2008 at a specialized clinic. During their stay, 19.4 % of patients were fitted with compression garments for the first time. For 95.8% of the patients who had already undergone compression therapy in the past, the compression garments were modified based on the patient’s particular needs (e.g. compression knee-high stockings combined with knee-length pantyhose instead of pantyhose). Changes in compression garments during an in-patient stay indicate the need for individualized compression therapy in order to achieve long-term therapy success. 

Keywords: edema, compression therapy, improvement of Treatment
E-mail: schneider@lymphklinik.com

Ultrastructural and immunohistological studies of human lymphatic collectors

A. Sperling1 *, V. Hasselhof1 *, P. Ströbel2 , J. Becker1 , K. Buttler1 , T. Aung3 , G. Felmerer4 , J. Wilting1
LymphForsch 21 (1) 2017;13-20

Lymphatic collectors fulfill important functions for centripetal lymph transport. With the
exception of the thoracic duct, lymphatic collectors have mainly been studied in animals,but rarely in humans. We studied small pieces of healthy lymphatic collectors isolated fromthe hypodermis of the thigh from 22 patients undergoing autologous collector transplantationinto the axillary region for the treatment of arm lymphedema. The diameter of collectors varied from 1 to 1.8 mm. Their tunica media was either made up almost exclusively of smooth muscle cells (SMCs), or was weaker with a high amount of CD34-positive fibrocytes intermingled between SMCs. The lumen was lined by lymphatic endothelial cells, which are positive for CD31, Prox1, vimentin, CCBE1 and β-catenin. By means of transmission electron microscopy (TEM), we observed dark and light SMCs in the tunica media, as well as bundles of type-I collagen filaments, elastic fibers, and cells with characteristics of interstitial Cajal-like cell (ICLCs). These are positive for vimentin und PDGFRα and possess long, thin cellular processes, which are often immediately opposed to rivet-like junctions of SMCs. The junctions contain numerous caveolae, which are known as Ca2+ storage sites. ICLCs are most likely pacemaker cells for the autonomous contractility of collectors.

Keywords: Lymphatic endothelial cell, lymphatic collector, interstitial Cajal-like cell, smooth muscle cell, vimentin, CCBE1, β-catenin, Prox-1
E-mail: joerg.wilting@med.uni-goettingen.de

Plastic surgical treatment of facial lymphedema

G. Felmerer, J. Ernst, E. Klingelhöfer
LymphForsch 21 (1) 2017;21-26

The surgical treatment of facial lymphedema has not been systematically described to date and is generally considered not to be effective in the head and neck region. The present study presents different treatment options with respect to cause and analyzes the results of eight patients. Lymph vessel transplantation as described by Baumeister was used for localizable lymphatic blockade (n=3) or direct excision (n=2) for localized edema. A complication of the excisions was an ectropium that could be remedied by a corrective intervention. Six patients achieved permanent edema clearance. In two cases edema recurred. Two other patients with tumor diseases did not undergo surgery, but are presented here in order to outline the contraindications for surgical treatment. In selected cases, causeadapted plastic surgical treatment can be successful and may be an alternative to combined physical decongestive therapy (CDT) in patients with severe facial lymphedema.

Keywords: lymphedema, surgery, facial edema, microsurgery
E-mail: gunther.felmerer@med.uni-goettingen.de

Lymphangiogenesis research in the eye: What's the point?

T. Clahsen, D. Hos, C. Cursiefen
LymphForsch 21 (1) 2017;27-39

Lymphatic vessels are typically found in nearly all vascularized tissues of the body. The tasks of the lymphatic system are to return tissue fluid and proteins into the blood circulation and maintain the body's immunity. For a long time it was thought that the eye, with the exception of the conjunctiva, is free of lymphatic vessels. With the identification of specific lymphatic endothelial markers such as podoplanin or LYVE-1, the existence of lymphatic vessels in association with various eye diseases has now been proven. Lymphatic vessels have been detected in the limbus, the lacrimal gland and the extraocular muscles. In the course of inflammatory processes or in association with (malignant) tumors, secondary lymphangiogenesis may also occur in the normally avascular cornea and the ciliary body. Furthermore, lymphangiogenesis in the eye seems to be important for mediating rejection reactions after corneal transplantation, as well as for the emergence of dry eye, allergic reactions, or lymphogenic tumor metastasis. To date, however, while angiogenesis inhibitors have made their way into clinical application in the treatment of various eye diseases, inhibitors for lymphangiogenesis have not. Thus a better understanding of lymphangiogenesis in the eye could open up new therapeutic possibilities for preventing vision loss in several eye diseases. The newly founded DFG (German Research Council) Research Unit FOR 2240 at the University of Cologne's Department of Opthalmology (www.for2240.de) is investigating the pathogenesis and underlying mechanisms of inflammatory diseases of the eye with lymphangiogenesis involvement in order to develop novel and innovative therapeutic strategies.

Keywords: lymphatic vessel, eye, modulators, lymphangiogenesis, eye diseases
E-mail: claus.cursiefen@uk-koeln.de
› www.for2240.de

What causes pain in lipedema?

E. Brenner
LymphForsch 21 (1) 2017;40-47

Pain is an important criterion for diagnosing lipedema. This pain, however, has not been properly investigated or characterized in the literature, and in most cases, authors have settled for putting forward hypotheses. Comparison of these hypotheses with actual findings, if even available, it becomes obvious that many of these hypotheses cannot be correct. Hardly any of the tangible results seem to provide a solid basis for explaining lipedema- related pain. When examining lipedema-related pain reported in the pain literature, it becomes increasingly evident that dynamic mechanical allodynia, with Aβ-fibers and probably tactile C (CT)-fibers, is involved. It is in principle possible to stimulate CT-fibers by manual lymphatic drainage (MLD), and this may explain the method's analgesic effects. Conversely however, this pain-relieving effect via CT-fibers seems to exclude the involvement of small fiber neuropathy (SFN), and thus any direct nerve damage as the cause of pain in lipedema.

Keywords: lipedema, pain, allodynia, hyperalgesia, Aβ-fibers, CT-fibers
E-mail: erich.brenner@i-med.ac.at