A report from Mulhouse (written by Martin Wald)

 
 
 

Summary of the session IX – Free communications

Chairmen: Martin Wald, Corrado Campisi, Nele Adriaenssens, Karin Johansson, Yesim Bakar

This section lasted 90 minutes and included 11 lectures and discussion. A noticeable and very positive fact was the high participation of young lymphologists both among the lecturers and the auditorium. The lectures focused on the following basic topics:

  • Lymphatic system imaging
  • Measurement of the affected limb volume and the Tissue Dielectric Constant (TDC)
  • Results of various physical therapeutic approaches in patients with lymphoedema
  • lmportance of the long-term penicillin administration in the prevention of inflammatory complications of lymphedema
  • The medium- and long-term results of lympho-venous anastomoses Assessment of the quality-of-life of patients with lymphoedema.

The lectures and rich discussion confirmed that:

  • Lymphoscintigraphy is the gold standard investigation to objectify lymphatic insufficiency. In case of a discrepancy between the clinìcal findìng and the result of lymphoscintigraphy of the superficial lymphatic system, lymphoscintigraphy of the deep system should be performed.
  • ICG fluorescence lymphography is a suitable method to prove the movements of the lymph in tissues orto prove the patency of
    lympho-venous anastomoses in real time. lt can be also used to visualise assess various physical techniques used in the treatment of lymphedema.
  • TDC measurement could be a suitable non-invasive and rapid method to complement standard procedures in early diagnosis of lymphatic insufficiency in arm lymphoedema in breast cancer patients.
  • Individual ways to measure oedema should be judged not only in terms of the time needed but also in terms of reliability. Experiences of each single centre play a crucial role.
  • Complex Decongestive Therapy is consìdered the gold standard in the treatment of oedema caused by lymphatic insufficiency. Nevertheless, it can be also effectively used in oedema of venous or mixed etiology.
  • Prophylaxis of inflammatory complications of the lymphoedematous tìssue associated with “dormant” bacteria can be effective considering the minimum toxicity of penicillins. Each recurrence of dermato-lymphangìo-adenitis leads to oedema progression and soft tìssue fibrotization.
  • Questionnaires (e.g. SF-36) and their quality and reliability should be a part of evaluation of the quality of care and the quality of life of the patients. Questionnaires should continue to be improved.