LARGE POST-SURGICAL ARM
This expression in the past was often referred to define secondary lymphedema of the upper limbs, following axillary lymphadenectomy, which, in the majority of cases, is performed in association with mastectomy for breast cancer treatment.
A specific diagnostic tool taking advantage of the combination between laser technology and Doppler physical principle. With this imaging technique, blood microcirculation can be accurately investigated, and alterations, including lymphedema, due to specific disorders, can be detected. It is still scarcely used in daily clinical practice and only in some specialist Centres with state-of-the art technology for microcirculation investigations and research.
Laser therapy is a very common therapeutic method in lymphology. It is employed either alone or in combination with the operative microscope. CO2 Laser is the most common device, which is by now routinely employed also in simple out-patient facilities for the treatment of lymphostatic verrucosis, post-surgical lymphorrheas, and phlebostatic ulcers. It is successfully used in the operating room, for its “welding” effect, typical of the laser, in the treatment of acquired and congenital lymph-chylorrheas, lymphoceles, and lymphangiodysplasias.
Figure: CO2 Laser used in our Centre.
Physical method for manual lymphatic drainage, proposed and applied by the Belgian A. Leduc.
Viscous, liposoluble fluid used as a radio-opaque contrast medium during lymphographies. Owing to its chemical-physical features and the relative fragility of lymphatic collectors, it is injected with mechanical injectors that ensure constant pressure and velocity throughout the injection.
The lymph is a fluid, mostly with watery appearance, which derives from the interstitium and is absorbed by the “initial lymphatics”. It differs from the other body fluids for its high concentration in proteins and macromolecules. It has various functions, some of them still not yet clear. It plays a key role particularly in the transport of macromolecular materials, which could not be otherwise drained through blood circulation. It is also key in linking up lymph node structures and peripheral tissues, thus ensuring an adequate cell-mediated immune response. For more detailed information on lymph physical-chemical features, see a physiology text book.
Inflammation of one or more lymph nodes. It may be acute, subacute, and chronic.
Disorder affecting lymph node structures.
Also called lymphatic varices, they are a sign of lymphatic stasis caused by a full or partial obstacle to regular lymph flow. They feature acquired dilatations of lymphatic vessels. They differ from lymphangiomas, in that the latter ones are already observed at neonatal age.
With the conventional CT scan, only lymphadenomegalies can be clearly displayed, while lymphatic structures as a whole are not detectable. Therefore, it is routinely employed only for oncological staging. However, if associated with lymphografy, according to Kinmonth method, e.g. with injection of radio-opaque liposoluble contrast medium in the lymph circulation, also lymphatic-lymph node structures can be clearly displayed. In this way, spiral CT scan advantages are combined with those – namely resolution and accuracy – offered by this more specific imaging technique.