Sonography of subcutaneous tissue cannot determine causes of lower limb edema

VASA ◽  
2015 ◽  
Vol 44 (2) ◽  
pp. 122-128 ◽  
Author(s):  
Mandy Becker ◽  
Tom Schilling ◽  
Olga von Beckerath ◽  
Knut Kröger
Keyword(s):  
Clinical Diagnosis ◽  
Lower Limb ◽  
Subcutaneous Tissue ◽  
Hepatic Disease ◽  
Clinical Use ◽  
Single Image ◽  
Heart Insufficiency ◽  
Chronic Hepatic Disease ◽  
Limb Edema ◽  
Venous Disorders

Background: To clarify the clinical use of sonography for differentiation of edema we tried to answer the question whether a group of doctors can differentiate lymphedema from cardiac, hepatic or venous edema just by analysing sonographic images of the edema. Patients and methods: 38 (70 ± 12 years, 22 (58 %) females) patients with lower limb edema were recruited according the clinical diagnosis: 10 (26 %) lymphedema, 16 (42 %) heart insufficiency, 6 (16 %) venous disorders, 6 (16 %) chronic hepatic disease. Edema was depicted sonographically at the most affected leg in a standardised way at distal and proximal calf. 38 sets of images were anonymised and send to 5 experienced doctors. They were asked whether they can see criteria for lymphedema: 1. anechoic gaps, 2. horizontal gaps and 3. echoic rims. Results: Accepting an edema as lymphedema if only one doctor sees at least one of the three criteria for lymphatic edema on each single image all edema would be classified as lymphatic. Accepting lymphedema only if all doctors see at least one of the three criteria on the distal image of the same patient 80 % of the patients supposed to have lymphedema are classified as such, but also the majority of cardiac, venous and hepatic edema. Accepting lymphedema only if all doctors see all three criteria on the distal image of the same patients no edema would be classified as lymphatic. In addition we separated patients by Stemmers’ sign in those with positive and negative sign. The interpretation of the images was not different between both groups. Conclusions: Our analysis shows that it is not possible to differentiate lymphedema from other lower limb edema sonographically.

scholarly journals Target Therapies for NASH/NAFLD: From the Molecular Aspect to the Pharmacological and Surgical Alternatives

2021 ◽  
Vol 11 (6) ◽  
pp. 499
Author(s):  
Michele Finotti ◽  
Maurizio Romano ◽  
Pasquale Auricchio ◽  
Michele Scopelliti ◽  
Marco Brizzolari ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Fatty Liver Disease ◽  
Hepatic Disease ◽  
Lifestyle Modifications ◽  
Alcoholic Fatty Liver ◽  
Target Therapies ◽  
Chronic Hepatic Disease ◽  
The Impact ◽  
Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease represents an increasing cause of chronic hepatic disease in recent years. This condition usually arises in patients with multiple comorbidities, the so-called metabolic syndrome. The therapeutic options are multiple, ranging from lifestyle modifications, pharmacological options, to liver transplantation in selected cases. The choice of the most beneficial one and their interactions can be challenging. It is mandatory to stratify the patients according to the severity of their disease to tailor the available treatments. In our contribution, we review the most recent pharmacological target therapies, the role of bariatric surgery, and the impact of liver transplantation on the NAFLD outcome.

Influences of lower limb edema on daily lives of elderly individuals in an elderly day care center

2020 ◽  
Author(s):  
Sayumi Tsuchiya ◽  
Takuto Sawazaki ◽  
Shuji Osawa ◽  
Makoto Fujiu ◽  
Mayumi Okuwa ◽  
...  
Keyword(s):  
Lower Limb ◽  
Day Care ◽  
Care Center ◽  
Daily Lives ◽  
Day Care Center ◽  
Elderly Individuals ◽  
Limb Edema

scholarly journals Morbidity of Inguinofemoral Lymphadenectomy in Vulval Cancer

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
A. A. Soliman ◽  
M. Heubner ◽  
R. Kimmig ◽  
P. Wimberger
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Local Complications ◽  
Wound Breakdown ◽  
Vulval Cancer ◽  
Significant Difference ◽  
Limb Edema ◽  
Short And Long Term ◽  
Inguinofemoral Lymphadenectomy

Background. The aim of this study is to detect possible risk factors for development of short- and long-term local complications after inguinofemoral lymphadenectomy for vulval cancer.Methods. This retrospective cohort study included 34 vulval cancer patients that received inguinofemoral lymphadenectomy. The detected complications were wound cellulitis, wound seroma formation, wound breakdown, wound infection, and limb lymphoedema. Followup of the patient ran up to 84 months after surgery.Results. Within a total of 64 inguinofemoral lymphadenectomies, 24% of the inguinal wounds were affected with cellulitis, 13% developed a seroma, 10% suffered wound breakdown, 5% showed lower limb edema within a month of the operation, and 21.4% showed lower limb edema during the long-term followup. No significant correlation could be found between saphenous vein ligation and the development of any of the local complications. The 3-year survival rate in our cohort was 89.3%.Conclusions. Local complications after inguino-femoral lymphadenectomy are still very high, with no single pre-, intra-, or postoperative factor that could be incriminated. Saphenous vein sparing provided no significant difference in decreasing the rate of local complications. More trials should be done to study the sentinel lymph node detection technique.

scholarly journals Influence of prevalent occupational position during working day on occupational lower limb edema

2015 ◽  
Vol 14 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Cleusa Ema Quilici Belczak ◽  
José Maria Pereira Godoy ◽  
Amélia Cristina Seidel ◽  
Rubiana Neves Ramos ◽  
Sergio Quilici Belczak ◽  
...  
Keyword(s):  
Lower Limb ◽  
Skin Color ◽  
Correlation Coefficients ◽  
Cumulative Effect ◽  
Study Groups ◽  
Lower Limbs ◽  
Volume Increase ◽  
Occupational Position ◽  
Limb Edema ◽  
Working Day

BACKGROUND: The lower limb edema observed in normal people at the end of their working days can vary in intensity and frequency depending on the predominant working positions required to perform different jobs.OBJECTIVES: To compare lower limb volumes of volunteers allocated to three study groups, depending on the predominant positions in which they work.METHODS: Volumetric assessments were conducted of both lower limbs of 51 people free from vascular disease, allocated to three groups of 17 individuals each by predominant working position: sitting, static standing or alternating between the two. Volumes were measured at the start and at the end of the working day and the differences in volumes were calculated for each group. Means and frequencies were compared using appropriate inferential statistics and correlation coefficients were calculated.RESULTS: The groups were homogenous in terms of sex distribution, age, skin color and BMI. The volumetric data from measurements taken before starting work revealed significant differences between all three groups. Volunteers who predominantly worked sitting down had largest volumes, followed by those who remained standing for long periods and then those who varied between these positions. The frequency of lower limb volume increase > 100 mL was significantly higher in the group of people who worked sitting down and maintained this position for long periods.CONCLUSIONS: Postural edema is more common among people who work sitting down for long periods, among whom it appears that there is a cumulative effect from the position, since they exhibit larger lower limb volumes at the start of the day.

scholarly journals Clinical Use of a Wearable Lower Limb Support Device for Surgeries Involving Long Periods of Standing

2018 ◽  
Vol 20 (3) ◽  
pp. 121-125 ◽  
Author(s):  
Hiroshi Kawahira ◽  
Ryoichi Nakamura ◽  
Yoshihiro Shimomura ◽  
Takashi Oshiro ◽  
Shinichi Okazumi
Keyword(s):  
Lower Limb ◽  
Clinical Use ◽  
Support Device

scholarly journals The effects of the combination of angiotensin-converting enzyme inhibitor and diuretic on the lower limb venous circulation in men with hypertension and chronic venous disorders

2020 ◽  
Vol 25 (3) ◽  
pp. 3545
Author(s):  
S. V. Letyagina ◽  
V. M. Baev ◽  
S. A. Shmeleva ◽  
T. Yu. Agafonova
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Flow Velocity ◽  
Antihypertensive Therapy ◽  
Lower Limb ◽  
Ace Inhibitor ◽  
Venous Pressure ◽  
Uncontrolled Hypertension ◽  
Converting Enzyme ◽  
Venous Circulation ◽  
Venous Disorders

Aim. To study the effects of angiotensin converting enzyme (ACE) inhibitor and diuretic combination on the lower limb venous circulation in men with hypertension (HTN) and chronic venous disorders (CVD).Material and methods. The study included 37 men with uncontrolled hypertension at the age of 46 (40-49) years, which were divided into two groups: 20 patients with objective signs of CVD (CEAP criteria) and 17 patients without CVD. During hospitalization, all participants received antihypertensive therapy with a combination of ACE inhibitor and diuretic. Vein Doppler ultrasound at rest was performed on the day of hospitalization and after 14 days. The diameter and the area of vein lumen, flow velocity and peripheral venous pressure (PVP) were recorded. Mann-Whitney and Wilcoxon tests were used for statistical analysis.Results. Initially, patients with CVD had higher values of PBP (by 26%), diameter and area of the vein lumen (53%) and flow velocity (by 14%) than in patients without CVD. As a result of therapy, in the group of patients with HTN and without CVD, systolic (SBP) and diastolic blood pressure (DBP) decreased to the target levels, PVP decreased by 13%, vein diameter increased by 27%, blood flow velocity decreased by 15%. Therapy in patients with CVD led to the normalization of SBP, DBP, and a decrease in PVP and flow velocity by 31% and 33%, respectively. No significant changes in the diameter and cross-sectional area of lower limb veins were noted.Conclusion. The obtained data showed that 14-day antihypertensive therapy with ACE inhibitor and diuretic in patients with HTN and CVD, unlike patients with HTN and without CVD, did not led to vein dilation, but was associated with flow velocity and PVP decrease. By therapy’s end, most of venous hemodynamic parameters, including PVP, were identical in the studied groups.

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

Angiology ◽  
1993 ◽  
Vol 44 (6) ◽  
pp. 464-470 ◽  
Author(s):  
P. Bräutigam ◽  
W. Vanscheidt ◽  
E. Földi ◽  
T. Krause ◽  
E. Moser
Keyword(s):  
Lower Limb ◽  
Limb Edema

scholarly journals Videocapillaroscopy of the Oral Mucosa in Patients with Diabetic Foot: Possible Diagnostic Role of Microangiopathic Damage?

2020 ◽  
Vol 9 (11) ◽  
pp. 3641
Author(s):  
Giuseppe A. Scardina ◽  
Giovanni Guercio ◽  
Cesare F. Valenti ◽  
Domenico Tegolo ◽  
Pietro Messina
Keyword(s):  
Clinical Diagnosis ◽  
Oral Mucosa ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Average Length ◽  
T Test ◽  
Control Group ◽  
Anova Test ◽  
Diagnostic Role

Introduction: Diabetic foot represents one of the most serious and expensive complications of diabetes and is subject to a high percentage of amputations that are almost always preceded by ulcers ascribable to neuropathy and/or vasculopathy. Videocapillaroscopy (VCS) can be a valuable aid in order to uncover morpho-structural anomalies in the vascular bed, both at the level of the oral mucosa and at the level of the terminal vessels of the lower limb. Materials and methods: Sixty subjects divided into 4 groups were enrolled: 15 healthy subjects; 15 patients with diabetes for more than 10 years without ulcerative foot lesions; 15 patients with neuropathic diabetic foot (clinical diagnosis, MDNS); 15 patients with ischemic diabetic foot (clinical diagnosis, ABI, lower limb doppler). A complete videocapillaroscopic mapping of the oral mucosa was carried out on each patient. The areas investigated were: labial mucosa, the retro-commissural region of the buccal mucosa, and the vestibular masticatory mucosa (II and V sextant). Results: The analysis of the morphological and densitometric characteristics of the capillaries revealed the following: a significant reduction in capillary density in neuropathic (mean ± SD 7.32 ± 2.1) and ischemic patients (mean ± SD 4.32 ± 3.2) compared to the control group of patients (both diabetic mean ± SD 12.98 ± 3.1 and healthy mean ± SD 19.04 ± 3.16) (ANOVA test and Bonferroni t test p < 0.05); a reduction in the average length of the capillaries and a significant increase in tortuosity (ANOVA test and Bonferroni t test p < 0.05). In the neuropathic patients, a recurrent capillaroscopic pattern that we defined as “sun” was found, with capillaries arranged radially around an avascular area. Conclusions: The data obtained from this preliminary study suggest a potential diagnostic role of oral capillaroscopy in the early and subclinical identification of microangiopathic damage in patients with diabetic foot.

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