Dizionario

Dizionario

Although words like lymphocyte, lymph node, lymph, and lymphatic vessels are common in daily medical activities, Lymphology has always been considered as a sort of younger sister to Angiology or Phlebology. Also, apart from few pioneer physicians, it has never been investigated as a discreet, well identified area of research.

Therefore, the following “Dictionary” aims to be a sort of metaphorical “window” on the extensive and still poorly explored world of lymphatic diseases, as well as to provide some useful, basic information for a correct diagnosis of patients affected by lymphatic-lymph node disorders.

Questo “Dizionario” vuole, quindi, rappresentare una sorta di metaforica “finestra” sul vasto ed ancora poco inesplorato mondo della patologia linfatica e fornire utili elementi di conoscenza di base per una corretta diagnosi e gestione del paziente affetto da alterazioni del sistema linfatico-linfonoidale.

YELLOW NAIL, SYNDROME (YNS)

YNS (Yellow Nail Syndrome) is a rare disorder with unknown etiology and with chronic evolution. It is characterized by three fundamental clinical signs: yellow nails, primary (also called constitutional) lymphedema, and respiratory system dysfunctions. Nail anomalies, that are pathognomonic in YNS, are: decrease or total stop of nail growth, excessive nail curvature, lack of cuticle. These latter symptoms often are present much earlier (by months or years) than the other clinical signs. Systemic therapy with vitamin E has failed to prove effective in the long term, while therapy to control lymphedema is the same as the combined therapy employed in primary lymphedemas.

WELDING EFFECT

This effect is obtained with CO2 Laser beams on blood vessels with less than a millimeter gauge and on lymphatic vessels. When employed at very low power, it can seal tissues, thus replacing suture stitches (microsurgical laser-assisted anastomosis).
Figure: Surgical laser employed by us, also in lymphatic microsurgery, coupled with the operative microscope.

VOLUMETRY

One of the most objective and reliable methods to measure the extremities. The measurement device features a rigid cylinder filled with water, big enough to contain an extremity, and connected with a measuring system. Quite simply based on the physical principle of Archimedes, it measures – quickly and, most importantly during follow-up, in a reliable way – the volume of the affected limb, comparing it with the contralateral one.

VÖDDER METHOD

The first method of manual lymphatic drainage to be codified and used on a large scale. Dating back to the end of the ’30s, and revised according to more modern scientific know-how, it is still the most popular method employed by the “German School” of Professor Földi.

VITAL DYE

Literally, it is a dye that can be injected in vivo to identify some anatomic structures that would otherwise be difficult to detect. In lymphology, Blue Patent Violet (see BPV) is the most commonly employed vital dye.

VALSALVA MANOEUVRE

First described by Valsalva in 1704. It is performed by forcible exhalation lasting at least 10 seconds, keeping the glottis closed, after deep inhaling. This causes intrathoracic pressure to rise by 30-40 mmHg, with concurrent increase in endoabdominal pressure.

ULCER

Ulcer is the leak of either cutaneous or mucous substance involving the lining epithelium as well as the underlying connective tissue support (subcutaneous tissue and submucosal tunica). Typically, it does not heal spontaneously.

TURNER SYNDROME

Genetic disorder linked to the total absence of a sexual chromosome (kariotype 45,X : 50%) or mosaicism (45,X/46,XX : 25%) or to X- chromosome anomalies (46,XX : 25%), with the following clinical manifestations: primary amenorrhea, sexual infantilism, short stature, other associated congenital anomalies (including, in many cases, a primary lymphedema of the lower limbs).

THORACIC DUCT

The largest lymphatic vessel in the body (with a 5-8 mm gauge) and the most important pathway draining the lymph into the venous bloodstream. It originates from the confluence of the intestinal lymphatic trunk and right and left lymphatic lumbar trunks at the level of the first-second lumbar vertebra. In its initial portion, it may feature an ampulla-shaped dilation called chylous cyst or receptaculum chyli of Pecquet (see). After running posteriorly to the esophagus for about 35-45 cm, between the azygos vein (on the right) and the aorta (on the left), it empties into the left subclavian vein at the level of the homolateral subclavian-jugular angle. In its final portion, the thoracic duct runs to form an anterolateral, concave arch, branching out in different ways.

THOMSEN’S SYNDROME

Autosomal dominant myotonia congenital due to mutations in the chloride channel. It presents with a picture of widespread and progressive myotonia. As is often the case in neurological-muscular disorders, it can be associated with functional disuse lymphedema caused by muscular hypotonia.

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