Abstracts LymphForsch 2/2011

Diagnostic imaging of the lymphatic system : a historical perspective

H. Weissleder, LymphForsch 2011; 16 (2):60-67

Summary
Imaging methods can be considered as an integral part of the investigation of the lymphatic system. At the beginning, water-soluble and oily iodinated contrast agents, and fluorescent as well as radioactive substances were used for the diagnosis of lymph vessels/node diseases. A combination of the oily contrast agent and radioactive phosphorus (P32) also allowed a therapeutic use in cases of malignant lymph node alterations.

The introduction of non-invasive cross-sectional image methods has resulted in the eighties to a change of the diagnostic strategy.
Indications, interpretation and the practical value of “direct and indirect lymphography, lymphoscintigraphic function test, contrast-enhanced
MRI lymphography, LSN-MRI lymphography, and indocyanine green fluorescence lymphography (ICGFL)“ for daily use are described. The ICGFL
seems also suitable to use as pre-operative lymph node identification in the context of a sentinel lymph node biopsy. The application of lymphotropic superparamagnetic nanoparticles (LSN) into the lymphatic diagnostics (LSN-MRI lymphography) has led to a significant improvement in the staging of malignant tumors. The lymphotropic iron oxide, now present in the third generation, are better tolerated than existing developments and also suitable for intravenous bolus injections. Intravital microscopy, a method of molecular imaging, allows to observe living cells in vivo („Cell Tracking“). For lymphology the importance of the method lies in the possibility:
1. To study lymphatic vessels, cell biology and physiology of the lymphatic system. 2. Experimental studies using fluorescent proteins allow new insights regarding the cellular behavior.

Keywords: Imaging methods, conventional lymphography, lymphoscintigraphic function test, indocyanine green fluorescence lympho-graphy, MRI-Imaging, intravital microcopy
Lymph vessel transplantation connecting

Lymph vessel transplantation connecting transplants to regional lymph nodes for treatment of lymphedema

J. Wallmichrath, R. G. H. Baumeister, R. Giunta, A. Frick, LymphForsch 2011; 16 (2):68-71

Summary
The microsurgical therapy of obstructive lymphedema includes lymph vessel transplantation. To this end, lymphatic vessels (collectors) are used to bypass areas of obstruction and to restore lymphatic continuity. The transplants are usually anastomosed to the regional lymph nodes proximally to the obstruction with microsurgical lympho-lymphatic anasto- moses. In some cases, the surgery is complicated by an insufficient
number and/or quality of existing recipient lymphatic vessels. Here, a new and promising technical alternative involves connecting the transplant to the capsule of a local lymph node. A technical advantage of this procedure is the possibility to connect several lymphatic vessels of various diameters to the lymph node with the uninterrupted suture technique. We report about our experimental and clinical experience with these microsurgical lympho-lympho- nodular anastomoses.

Keywords: Lymphedema, microsurgery, lymph vessel transplantation, lymph node

A consideration of the cost-effectiveness in the treatment of lymphedema reduction

A. Gattwinkel, LymphForsch 2011; 16 (2):72-76

Summary
Three examples that can be frequently observed in practice are used to demonstrate the relationship between various amounts of costs and the resulting benefits in lymphedema therapy employing complete physical decongestive therapy (CDT):
1. In phase 1 (decongestive therapy), manual lymph drainage (MLD) is performed two to three times a week. However, in many cases bandaging
is not prescribed. Instead, a medi- cal compression garment is prescribed. Here, while costs are incurred, it is highly doubtful whether therapy will be successful.
2. The patient receives the correct prescriptions. Phase 1 of the therapy is performed as prescribed. In phase 2 (preservation therapy), however, the compression garment is not properly measured (for example, too early, wrong quality). In this case, costs are incurred, but benefits are not ideal.
3. CDT is properly performed in both phases. During therapy, the physician, the therapist, the medical supply store and the claims processor at
the insurance company work together in close collaboration. Despite the costs, which are also considerable, the cost- benefit ratio is ideal.

Keywords: complete physical decongestive therapy, manual lymph drainage, medical compression bandage, medical compression garment, flat-knitted, circular-knitted

Lymphatic networks – the golden key for outpatient care of lymphedema

O.Gültig1, H. Pritschow2, LymphForsch 2011;16 (2):78-80

Summary
Already in the mid-eighties of the last century, it became evident that the oedema- reducing phase of Combined Decongestive Therapy (CDT) was
rarely carried out on an out-patient basis. The lack of lymph-competent medical prescriptions and the fact that, at that time, medical supply
stores were not generally trained in lymphology severely limited the therapeutic possibilities for lymphology therapists providing treatment. Only
the intro- duction of specific curricular training courses for physicians with their own practices from the year 2000 onwards (under the patronage of the DGL, the German Society of Lymphology) and the growing willingness of providers in this sector (medical supply stores) to undergo training allowed the development to today’s figure of more than 60 lymphology networks in Germany. Here, therapy is conducted with a high level of efficiency under the aspects of quality and economics. The extended training of all the professional groups involved in successful CDT, and the professional evaluation of these processes, is the next focus of the endeavours to further improve the out-patient lymphological care (OLC).

Keywords: Oedema-reduction, CDT, curricular professional training for physicians, quality economics, out-patient lymphological care, extended training, evaluation