The Importance of the Subfascial Lymphatics in the Diagnosis of Lower Limb Edema: Investigations with Semiquantitative Lymphoscintigraphy

Bräutigam, Peter; Vanscheidt, Wolfgang; Földi, E.; Krause, Thomas; Moser, E.

doi:10.1177/000331979304400606

Cited by 37 publications

(32 citation statements)

References 2 publications

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“…This approach yields high numbers of T cells, and assessment of T cell responses in the SIN has been more sensitive than assessing those responses in PBMC [28]. There has been limited prior experience mapping lymphatic drainage from muscle [41,42]. The present study is, to our knowledge, the first to test whether i.m.…”

Section: Discussionmentioning

confidence: 99%

A randomized pilot trial testing the safety and immunologic effects of a MAGE-A3 protein plus AS15 immunostimulant administered into muscle or into dermal/subcutaneous sites

Slingluff

Petroni

Olson

et al. 2015

Cancer Immunol Immunother

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Introduction Methods to induce T cell responses to protein vaccines have not been optimized. The immunostimulant AS15 has been administered with the recombinant MAGE-A3 protein (recMAGE-A3) i.m. but not i.d. or s.c. This study tests hypotheses that the i.d./s.c. route is safe and will increase CD4+ and CD8+ T cell responses to MAGE-A3. Patients and Methods Twenty-five patients with resected stage IIB-IV MAGE-A3+ melanoma were randomized to immunization with recMAGE-A3 combined with AS15 immunostimulant (MAGE-A3 immunotherapeutic) either i.m. (Group A, n=13), or i.d./s.c. (Group B, n=12). Adverse events were recorded. Ab responses to MAGE-A3 were measured by ELISA. T cell responses to overlapping MAGE-A3 peptides were assessed in PBMC and a sentinel immunized node (SIN) after 1 in vitro stimulation with recMAGE-A3, by IFNγ ELISPOT assay and by flow cytometry for multifunctional (TNFα/IFNγ) responses. Results Both routes of immunization were well tolerated without treatment-related grade 3 adverse events. All patients had durable Ab responses. For all 25 patients, the T cell response rate by ELISPOT assay was 30% in SIN (7/23) but only 4% (1/25) in PBMC. By flow cytometry, multifunctional CD8+ T cell responses were identified in 1 patient in each group; multifunctional CD4+ T cell response rates for Groups A and B, respectively, were 31% and 64% in SIN, and 31% and 50% in PBMC. Conclusion The MAGE-A3 immunotherapeutic was well tolerated after i.d./s.c. administration, with trends to higher CD4+ T cell response rates than with i.m. administration. This study supports further study of AS15 by i.d./s.c. administration.

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Section: Discussionmentioning

confidence: 99%

A randomized pilot trial testing the safety and immunologic effects of a MAGE-A3 protein plus AS15 immunostimulant administered into muscle or into dermal/subcutaneous sites

Slingluff

Petroni

Olson

et al. 2015

Cancer Immunol Immunother

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“…In pure lipoedema, there is no change or only small changes in lymph transport (37). At an early stage before the occurrence of high-volume insufficiency, elevated lymph node uptake values can be measured with lymphoscintigraphy (38).…”

Section: Aetiologymentioning

confidence: 99%

Treatment of lipoedema using liposuction

Rapprich¹,

Baum²,

Kaak³

et al. 2015

Phlebologie

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SummaryBackground: Lipedema is a painful, genetically induced, abnormal deposition of subcutaneous fat in the extremities of women. The pathogenesis is unknown. Also unknown is the number of women affected in Germany. This study presents the epidemiology of the disease. There are currently two treatment options available: Complex physical decongestive therapy and liposuction. Liposuction is the only method that removes fat permanently. An additional study proves its effectiveness and highlights its vital role as part of a comprehensive treatment concept. Patients and methods: As part of the epidemiological research, all patients of a general practioner were examined for leg problems. The liposuction study included the preand postoperative examination of 85 patients, which was carried out using a questionnaire. Results: Lipedema were diagnosed in 5 % of all patients of the GP practice. In all 85 pa-

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“…Die Diskrepanz der geringeren sub-im Vergleich zur epifaszialen Mitreaktion im Sinne einer Hochvolumeninsuffizienz kann darin liegen, daß die interstitielle Flüßigkeitsvermeh-rung vom subfaszialen Lymphgefäßsy-stem schlechter toleriert wird und dadurch früher die Lymphtransportkapazität abnimmt als im epifaszialen Kompartiment. Hierfür könnten ähn-liche Mechanismen wie beim primä-ren Lymphödem verantwortlich sein, die dann zu einer Art subklinischem Kompartmentsyndrom führen könn-ten [5,6].…”

Section: Die Mitreaktion Des Lymphsystems Beim Primär Nicht Lymphödemunclassified

“…Subfaszial weisen alle Patienten einen massiv reduzierten Lymphtransport auf [5]. Zu diesem Ergebnis kamen auch Lofferer [13] und Tiedjen [21].…”

Section: Die Mitreaktion Des Lymphsystems Beim Primär Nicht Lymphödemunclassified

Die Beteiligung des Lymphgefäßsystems beim primär nichtlymphogenen Ödem des Beines

Bräutigam

Vanscheidt

Földi³

et al. 1997

Der Hautarzt

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Two-compartment lymphoscintigraphy was developed to examine the sub- and epifascial lymphatics of the leg. Digital images were evaluated visually and semiquantitatively by calculating the uptake of activity within the lymph nodes. The data from patient groups with four different types of leg edema were compared with those of the control group to prove the involvement of the lymphatics in the non-lymphatic edema. The cyclic idiopathic edema demonstrated an accelerated transport of the lymph consistent with a high volume insufficiency. In phlebedema the high volume insufficiency was epifascially so distinct, that it could be detected scintigraphically. In post thrombotic syndrome the transport of the lymph was reduced dramatically corresponding to a safety valve insufficiency. Epifascially however, an accelerated lymph flow was observed due to compensatory mechanisms. The lipedema did not show any scintigraphic abnormalities. These results show that two-compartment lymphoscintigraphy can detect alterations in lymphatic function secondary to non-lymphogenic leg edema. The lymphatic function is changed according to the underlying pathophysiology which may be facilitate the differential diagnosis of such a leg edema.

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The Importance of the Subfascial Lymphatics in the Diagnosis of Lower Limb Edema: Investigations with Semiquantitative Lymphoscintigraphy

Cited by 37 publications

References 2 publications

A randomized pilot trial testing the safety and immunologic effects of a MAGE-A3 protein plus AS15 immunostimulant administered into muscle or into dermal/subcutaneous sites

A randomized pilot trial testing the safety and immunologic effects of a MAGE-A3 protein plus AS15 immunostimulant administered into muscle or into dermal/subcutaneous sites

Treatment of lipoedema using liposuction

Die Beteiligung des Lymphgefäßsystems beim primär nichtlymphogenen Ödem des Beines

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