Dizionario

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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.

MOTOR REHABILITATION

When taking care of lymphedema patients, it should not be forgotten that patients with severe lymphedemas of the limbs often have concurrent muscular-skeletal impairments, partly due to the lack of use of the limb, but, above all, to its weight which, in some cases, may be more than double that of a healthy limb, thus causing major repercussions on bone-tendon structures. For example, scapulohumeral periarthritis is a typical condition in secondary lymphedema patients of the upper limb. Figure: Some examples of physical exercises in patients with limb lymphedema.

MILROY DISEASE

Eponym sometimes used to identify congenital (neonatal lymphedema) proper with heredo-familial basis. Figure: Congenital lymphedema of the upper and lower extremities.

MICROSURGICAL ARMAMENTARIUM

Together with the operative microscope, it includes all surgical instruments that are key to a microsurgeon. They are not simply miniature reproductions of standard surgical instruments, but they have been duly designed and adjusted to meet different needs: for example, their tips must be very thin in order to handle highly fragile structures, they have to be used in very small spaces, and have no reflecting surfaces. Further, they must have the right ergonomic features to be extremely easy to hold and handle.

MICROLYMPHOGRAPHY

Contrast-based imaging technique, by which FICT-dextran (150,000 dalton p.m.) is injected into the sub-epidermal layer, in order to display lymphatic capillary and precollector (see) structures in the skin of all body districts and examine their morphology, average diameter, intralymphatic pressure, and any changes with breathing. Despite some interesting results attained, this imaging technique has not yet become common clinical practice.

MESOTHERAPY

This therapeutic method is quite common in aesthetic medicine. By means of multi-injectors fitted with ultra-thin, jagged, no more than 5 mm long needles, various types of pharmaceutical substances are injected into sub-dermal tissues. Its therapeutical goal is to inject substances that can reduce the fibrotic component of suprafascial tissues, thus enhancing microcirculation fluid exchange. In lymphology, in particular, it is only applied in patients with both lipedema and Edematous-Fibrosclerotic Panniculopathy (EFP, see), most commonly in the gluteal region and the hips. Since it is a relatively invasive treatment, and considering the poor outcome in patients with fibrosis due to chronic lymphatic stasis, it should not be used indiscriminately.

MEIGE’S SYNDROME

This eponym is sometimes used to identify primary, early onset (before 35 years of age) lymphedema.

MECHANICAL LYMPHATIC INSUFFICIENCY

This condition is brought about when the functional capacity of the lymphatic circulation system decreases and cannot cope any longer with a normal or only slightly higher lymphatic load. Figure: Chart illustrating the “mechanical lymphatic insufficiency” condition.

MECHANICAL LYMPHATIC DRAINAGE

Lymphatic drainage obtained with mechanical equipment. There are several types of equipment available on the market, which promote lymphatic drainage according to different mechanisms. The most common ones employ alternate pneumatic systems, which, by raising skin pressure in a sequential way in the various districts and along a caudo-cranial direction, enhance the centripetal flow of the lymph in lymphedematous limbs toward the major lymphatic structures of the trunk. The main action of this method is to drain the liquid component of the edema, with only an indirect impact on the fibrotic and protein component of the lymphatic edema.

MASTECTOMY

Surgical removal of a breast. It may be partial, such as in the case of quadrantectomies, or total, and is performed in patients (the great majority of them women) affected by tumors involving the mammary gland. This type of surgery is associated with concurrent loco-regional lymphadenectomy and radiation therapy, and is one of the main causes of secondary lymphedema. Figures: Lymphedemas of the right upper limb secondary to breast surgery.

MANUAL LYMPHATIC DRAINAGE

Lymphatic drainage obtained with manual manoeuvres. Today, there are several techniques available, among them the most popular ones are lymphatic drainage according to Földi-Vödder and the one according to A. Leduc. By means of several codified manoeuvres, the lymph is drained by pushing it towards residual outflow pathways, and, at the same time, by activating the peristaltic action of lymphangions, namely the functional unit of lymphatic vessels. According to recent studies, unlike mechanical drainage, which mostly acts on the lymph liquid component, manual drainage has a higher effect on protein content, thus also decreasing the fibrous component, which is a main feature of chronic lymphedema.

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