The 2011 PB Lymphological Award selection :
Clinical and genetic study of Italian families with primary lymphedema
Michelini S, Bertelli M, Cardone M, Cecchin S, Cestari M, Corda D, Leone A, Mander A, Ricci M
Role of Lymphoscintigraphy in primary prevention after breast cancer treatment
Venous bridges as an alternative option for lymphovenous shunts in paediatrics
Papendieck CM, Pozo P, Barbosa L
HIGHLIGHTS OF THE 34th ESL SCIENTIFIC MEETING IN NAPOLI AND NOMINEES FOR THE PB LYMPHOLOGICAL AWARDS 2008
The overall quality of the meeting was good.
We had a good surgical session with the main following points being achieved and/or questions being raised:
– In the upper limb edemas, the Lympho-Venous anastomosis are merely to be proposed to the stages 2 and 3 (Campisi et al).
– Brorson and colleagues presented their results with liposuction in lower limb edemas and confirmed the strict indications of such interventions.
– Their results seem to outline a shift in the overall cellular mass of the edematous limbs from being “liquid” towards one accumulation of fats in the pre-existing adipocytes and/or in other cells. The question remains to be solved and the mechanisms implied to be identified.
– On the another hand, the question of the importance of the deep lymphatic system in such situations was raised as well as the possibility in such case to associate to such liposuctions LVA or lymph vessel grafting (as proposed by Baumeister and colleagues to bridge the gap).
Belgrado and colleagues presented us interesting results about the variations of pressure and of temperature in patients or subjects wearing multi-layered bandagings. They demonstrated for instance that they resulted in one 4°Celsius increase of the skin temperature, a factor which might be implied in the therapeutic response to such bandagings. They also show us fascinating pictures of the skin temperatures obtained using infra-red technique analysis in patients with limbedemas. The work is in progress but this represents surely another way to study the edematous limbs.
In the same spirit, Leduc and colleagues presented the absence of influence of MLD on cardiac parameters as well as one interesting morphological approach for the formation of the axillary web syndrome.
With regard to more basic researchs, Lievens and colleagues and Bernas and colleagues also presented us two different animal models to study the effects of external irradiation on the lymphatic system regeneration after surgical interventions. The first group used mouses and a single vessel lymphatic cutting (the one linking the inguinal node to the axillary one in the animal). They confirmed their presentation in Prague that the (not severed) lymphatic vessels are radio-resistant and they showed that the lymphatic function was restored by lymphatic regeneration through the scar and/or by the development of lymphatico-lymphatic collateralisation pathways. The most surprising fact among their results was that the transport of radiolabeled colloids from the injected lower limb in the axillary nodes was increased when compared to normals, suggesting that there is a (temporary?) overall stimulation of the lymphatic function. On the other hand, Bernas and colleagues used rats as models and their surgical interventions at the root of the limbs was larger than the one performed by Lievens and colleagues. They also demonstrated the effect of Amifostine on the wound regeneration. The two models are interesting but different. For their part, Eliska and Eliskova studied the radial pressure in lymphatic vessels under manual lymphatic drainage.
With regard to clinical situations, Maccio and colleagues stressed the importance of teaching the physicians of the Emergency Units about the lymphangiological emergencies. On the other hand, Loskotova and Loskotova as well as Michelini and colleagues reminded us the muscular and articular involvements in lymphedemas.
Forner-Cordero and colleagues presented a very good multicenter work comparing in three randomised groups of patients the effects of three physiotherapeutic “regimens”. Although there may be a bias in their analysis, the most amusing conclusion was that Manual Lymphatic drainage adds nothing to pressotherapy and Multi Layered Bandagings. Unfortunately, because they were already nominated one year ago for the PB Lymphological Award, they could not be taken into account for the present meeting.
Finally, the three best and most interesting presentations were the following (and their authors are nominated for the PB Lymphological Awards 2008):
– Using immuno histological methods, Okada from Japan showed the different evolution of the veins and lymphatics with the mass of (in the epicardium of) hypertrophic hearts,
– Michelini and colleagues reported their first results with a vaccine in patients to prevent phlogistic complications in lymphedematous patients,
– Cestari and colleagues presented their results in the primary prevention of post-matectomy lymphedema using one algorithm defining patients at risk.