Abstracts LymphForsch 2/2010

Isolation of Bipotent Endothelial Precursor Cells from Lungs of Adult Mice

A. Buttler, J. Schniedermann, H. A. Weich und J. Wilting

Summary
Endothelial precursor cells (EPCs) of adult animals and humans have already been described to give rise to blood vessels. While EPCs have been isolated from bone marrow, peripheral blood and vascular walls, the development of EPCs into lymphatic vessels has not been described yet. In this study, we isolated EPCs from lungs of adult mice and performed immunohistological analyses. Furthermore, we investigated the potency of EPCs to differentiate in vitro and in vivo. The CD31/PECAM-1-positive EPCs isolated with the help of Dynabeads possessed a high proliferative capacity and could be amplified for more than 30 passages. Besides CD31, the cells expressed typical endothelial markers such as ESAM, eNOS and VE-cadherin but also showed expression of specific lymphendothelial markers such as LYVE-1, podoplanin, and PROX1. In addition, the EPCs possessed the capacity to form blood as well as lymphatic vessels in vivo. In single-cell culture, EPCs developed clones that expressed both blood and lymphatic endothelial markers. We provide evidence for the existence of EPCs in the lungs of adult mice with high proliferative and angiogenic potential, and commitment for both blood and lymphatic vessels. Our results point to a common progenitor for blood and lymphatic endothelial cells in the lung.

Keywords: endothelial precursor cells, mouse, lung, blood endothelium, lymphatic endothelium, lymphangiogenesis

Erysipelas and the Immune System

A. Schmolke

Summary
Patients with edema tend to develop recurrent erysipelas, a streptococcal infection of the skin. Mediators of inflammation provoke edema, which leads to increased susceptibility to infection: an apparent vicious circle. Immune cell trafficking occurs via the lymphatic vessels, lymph stasis caused by edema is followed by immunostasis. Although each infection further aggravates the edema there is evidence for a causative primary role of edema in the increased susceptibility to infection.

Keywords: erysipelas, edema, dendritic cells, T cells, immunity

Long-term Results Following Liposuction in Lipedema

A. Schmeller, M. Hüppe, I. Meier-Vollrath

Summary
A prospective single-center study with mail questionnaire – in most cases combined with clinical controls – was carried out in 112 patients with lipedema after a period from 8 months to nearly 7 years following liposuction in tumescent local anesthesia.
With regard to morphology (body shape), patients showed reductions of fat volume in circumscribed areas resulting in normalization of body proportions. With regard to complaints, there was pronounced and clinically relevant improvement in spontaneous pain, pain upon pressure, edema, hematomas and restriction of movement; in addition the self-assessment concerning cosmetic appearance changed for the better and there was improvement in quality of life. Statistical analyses of all examined items and of a summary item (impairment) demonstrated that the success of liposuction was not dependent on the women’s age; however, patients with more severe disease (stage II and III) showed better improvement compared to patients in stage I. The success was similar after a period of both one year and nearly seven years. When performed by experienced surgeons, liposuction is a successful and effective method with very few complications. As a result, less conservative treatment (decongestive therapy, compression garments) is needed postoperatively.

Keywords: liposuction, lipedema, follow-up study, complaints, impairment.

Results of a Retrospective Study on the Effect of Manual Lymph Drainage

A. Lee-Schultze

Summary
A retrospective study looked at 51 patients with secondary unilateral lymphedema treated with complete combined decongestive physical therapy including manual lymph drainage (MLD). The post-therapy reduction in limb volume was significant on the directly treated edematous side (with or without compression therapy) and on the non-edematous untreated side. These results appear to indicate that:
1. MLD is able to reduce lymphedema independent of compression therapy 2. MLD may have a systemic effect on lymphangiomotoricity. 

Keywords: manual lymph drainage, lymphedema, compression therapy

Bandages for the Soul: How Can Clinical Psychological Support for Emotionally Stressed Patients Help in Lymphedema Rehabilitation Treatment?

A. Flaggl, M. Melcher, W. Döller

Summary
This survey was conducted on 310 patients at the Center for Lymphology at the State Hospital of Wolfsberg, Austria. The extent of the psychological strain (SCL-90-R) and the physical stress (GBB-34) were measured at the beginning of the medical rehabilitation, at the end of rehabilitation and after a seven-month follow-up period. At the outset of the rehabilitation, about one-third of the patients (35.2 %), experienced psychological stress requiring psychological treatment. Compared to the group of patients without psychological stress, these patients have a statistically significantly higher level of physical stress. Some of the patients with severe emotional stress required psychological support in addition to the complete physical decongestive therapy. Patients with emotional stress who received psychological support in addition to complete physical decongestive therapy achieve statistically significantly better treatment results. This difference between the groups is not only apparent at the end of the rehabilitation, but becomes more striking toward the end of the follow-up period. Severely emotionally stressed patients who receive psychological support obtain better mental health. In addition, the difference in the reduction in physical stress as compared to patients who undergo complete physical decongestive therapy exclusively is statistically significant.

Keywords: lymphedema, psychological strain, physical discomfort, rehabilitation, psychological support

Lymphological Acute Treatment Center – An Innovative Treatment Concept

A. R. Lulay

Summary
Clinical lymphology takes place nearly exclusively at rehabilitation centers. The following review presents a new approach to treatment of patients with severe lymphedema. The excellent results were observed in 200 cases within a single year. The patients had either acute or severe comorbidities or had not responded to out-patient therapy. They underwent a stringent treatment concept on an in-patient basis in fewer than two weeks.

Keywords: clinical lymphology, results of the clinical complete physical decongestive therapy, acute lymphedema treatment center

Side-effects, Complications and Problems Associated with Outpatient Lymphedema Treatment

O. Gültig

Summary
Close cooperation between the physician with advanced lymphology training, the experienced lymphology therapist and the competent medical supply store is the golden key to successful realization of the decongestion and maintenance phase of the combined physical decongestive therapy (CDT) in out-patient treatment. As in a specialized lymphology clinic, the patient is involved in the treatment process from the very beginning. Problems in out-patient treatment are nearly always professional challenges for which solutions can be found.

Keywords: lymphology networks, problems, challenges