Lymphokinesia

7/30/2019 Lymphokinesia

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Disorder of

lymphokinesia in the

extremities


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Classification of diseases of lymph

system

Non-inflammatory diseases:

Lymphedema

Lymphangioma:

Capillary lymphangioma

cavernous lymphangioma

cystic lymphangioma

Inflammatory diseases:

lymphangitis

lymphadenitis

erysipelatous inflammation.


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Lymphedema

is a condition of increased mass of tissue

(skin, subcutaneous fat, connective tissue)

due to accumulation of fluid rich inproteins in the intercellular spaces and in

lymph viae, increased mass of keratinocytes,

fibroblasts, migrating immunocompetentcells and intercellular substance.


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Etiologicalclassification of

lymphedema

Primary:

aplasia of initial portion of lymph viae;

hypoplasia of lymph collectors;

atresia and agenesia of lymph collectors;

agenesia of lymph nodes; idiopathic fibrosis of inguinal lymph nodes.


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Etiologicalclassification of

lymphedema Secondary:

secondary congenital lymphedema - caused by loopsof the umbilical cord, amniotic constrictions, hair of

the foetus; malignant neoplasms;

iatrogenic lymphedema (after surgery or radiation

therapy);Trauma;

lymphangitis and lymphadenitis (bacterial, fungal, viral

or caused by chemical substances).


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Iatrogenic lymphedemadevelops due to

a diagnostic or therapeutic intervention

upon

treatment of malignant neoplasm accompanied by

lymphodissection;

reparative surgery on arteries accompanied bymassive damage of lymph collectors;

surgery for fascial bed syndrome;

intervention damaging lymph viae by medicalerror, for example after surgery for hernia,

varicose disease, excision of cellulocutaneous

flaps, on meniscus.


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Stages of lymphedema

latent, pre-clinical,

clinical stages:

stage I of lymphedema the welling is soft, a deep recessremains upon pressing it. Overnight the swelling

diminishes or goes away.

stage II - At this stage the swelling becomes dense due

to sclerotic changes; it does not leave a recess upon

compression. It is called irreversible because the edema

does not go down overnight.

Stage III is elephantiasis.


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Elephantiasis.


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The main signs of lymphedema are

as follows:

One extremity is affected in most cases. If bothextremities are affected, asymmetry of edema can benoted.

There are no pains.

In uncomplicated lymphedema ulcers do not develop.There is usually no change of colour in lymphedema.

Stemmers sign - the skin of dorsal phalangeal surface

thickens, it cannot be pinched (this is usually observedat stage II and III).

At advanced stages the skin thickens, deep folds withragged edge appear; hyperkeratosis and lichenification

are noted; multiple warts are possible.


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Indirect

lymphography Indirect lymphography

makes it possible to visualizelymph vessels of the skin.

Nonionic water solublecontrast agent is injectedsubcutaneously with aninfusion pump. The contrast

agent penetrates lymphvessels; lymph collectors canbe usually traced for 10-30centimeters. Due to back

flow of lymph the dilatedcutaneous lymph network iscontrasted. In proximalobstruction greatly dilatedlymph collectors are

visualized.


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Radionuclide lymphography

For functional appraisal of lymph system

quantitative isotope lymphography is used. This

method investigates the clearance of nuclear

tracer, the time of its penetration to lymph nodesand the amount of tracer absorbed. Besides,

lymph vessels and nodes of the investigated

body part are visualized.


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If the lymphedema is due to a malignant

process, the patient will display the

following:

fast augmentation of edema; bad pain;

edema worse on the thigh, and less pronounced

on the shin and foot; ulcers;

spacious lesions.


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Complicated lymphedema

In lymphedema the risk of mycosis

(dermatomycosis, onychomycosis) increases. If

interdigital spaces are affected, the risk of

erysipelas increases.

Erysipelas. This complication should be

differentiated from cancerous lymphangitis,

transitory aseptic dermatitis, thrombophlebitis.

The worst complication of lymphedema is

angiosarcoma (Stewart-Treves syndrome).


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Conservative treatment.

compression hosiery,

massage,

prolonged elevation of

the extremity, physiotherapy

(electrophoresis,

ultraviolet irradiation),

remedial gymnastics,

drug therapy.


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Drug therapy oflymphedema

1) tissue trophism (vitamins B, ascorbic acid,riboflavin);

2) peripheral circulation (No-spa, papaverine);

3) microcirculation (trental, solcoseryl, low-

molecular dextran);

4) angioprotectors (escusan);

5) vain and lymph tonics (troxevasin, detralex,

ginkor-fort); 6) anti-inflammatory drugs if indicated (ibuprofen,

voltaren and others);

7) drugs with hyaluronidase effect (lidase).


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Surgical treatment.

Two groups of surgical methods

can be distinguished: interventions aimed at improving lymph outflow

from the affected extremity;

removal of subcutaneous fat that has undergone

fibrous degradation.


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Removal of subcutaneous fat


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Lymphangioma

is a defect of development of

lymph vessels beginning in the

embryo and noticeale in early

childhood.


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Capillary lymphangioma

looks like smaller or bigger pale nodes with

vitreous humor. The skin in the area of

lymphangioma has an ornage-likeappearance. There are greater cavities in

some places, lined with endothelium and

containing lymph. Upon compressionlymphangioma collapses a bit.


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Cavernous lymphangioma

consists of irregular cavities lined with

endothelium and filled with lymph. It occurs on

shoulders and forearms; it can cause diffuse

disfiguring thickening of the extremity. The skinabove it is often red, thin, covered with

transparent vesicles. Going down the depth of

soft tissues, lymphangioma can affect musclesand bones. It grows slowly, collapse upon

compression and then refill with lymph again.


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Cystic lymphangioma

is a fluctuating elastic tumour

consisting of one or more cavities

filled with yellowish fluid. It islocalized in the armpit, more seldom

on the thigh or other portions of

extremities.

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Lymphokinesia