Showing papers by "Stanley G. Rockson published in 1998"

Lymphedema: classification, diagnosis and therapy:

Abstract: This review presents the diagnostic features, the pathophysiology and the available therapies for lymphedema. This disease is often able to be diagnosed by its characteristic clinic- cal presentation, yet, in some cases, ancillary tests might be necessary to establish the diag- nosis, particularly in the early stages of the disease and in edemas of mixed etiology. These diagnostic modalities are also useful in clinical studies. Available modalities include isotopic lymphoscintigraphy, indirect and direct lymphography, magnetic resonance imaging, computed tomography and ultrasonography. Lymphedema may be primary or secondary to the presence of other diseases and/or to the consequences of sur- gery. Primary lymphedema may occur at any phase of life but it most commonly appears at puberty. Secondary lymphedema is encountered more often. The most prevalent worldwide cause of lymphedema is filariasis, which is particularly common in south-east Asia. In the USA, postsurgical lymphedema of the extremity prevails. Complications of chronic limb lymphedema include recurrent cellulitis and lymphangiosarcoma. Most patients are treated conservatively, by means of various forms of compression therapy, including complex physical therapy, pneumatic pumps and compressive garments. Volume reducing surgery is performed rarely. Lymphatic microsurgery is still in an experimental stage, although a few centers consistently report favorable outcomes.

Workgroup III: Diagnosis and management of lymphedema

Abstract: Stanley G. Rockson, M.D. (Co-Chair) Linda T. Miller, P.T. (Co-Chair) Ruby Senie, Ph.D. (Rapporteur) Michael J. Brennan, M.D.* Judith R. Casley-Smith, M.D., Ph.D.* Ethel Földi, M.D.* Michael Földi, M.D.* Gail L. Gamble, M.D.* Renato G. Kasseroller, M.D.* Albert Leduc, Ph.D.* Robert Lerner, M.D.* Peter S. Mortimer, M.D.* Sandra A. Norman, Ph.D.* Chester L. Plotkin, M.D.* Margaret E. Rinehart-Ayres, Ph.D., P.T.* Arnold L. Walder, M.D., Ph.D.*

Myocardial ischemia and infarction due to multiple coronary‐cameral fistulae: Two case reports and review of the literature

Abstract: The functional significance of coronary-cameral fistulae, and the effect of these arterial anomalies upon effective coronary blood flow, continue to be debated. Two cases of coronary cameral fistulae, each of which illustrates the likelihood of an ischemic substrate, are herein presented, along with a review of the relevant literature regarding this disorder.

Images in vascular medicine: Lymphoscintigraphy in congenital lymphedema

Abstract: Slight degrees of congenital lymphedema are not infrequently reported in the pediatric population. These findings probably reflect a normal developmental variation in the regression of lymphedema that is postulated to be present in all fetuses.1,2 However, more severe degrees of lymphedema in childhood are much less common, and frequently reflect the impact of infection, trauma, neoplasia and radiation.3 Severe congenital lymphedema is most often ascribable to heritable syndromes of genetic origin, such as Nonne–Milroy disease, lymphedema with microcephaly,6,7 Noonan syndrome,8,9 Ullrich Turner syndrome,10 lymphedema-hypoparathyroidism syndrome11 and the more recently described Hennekam syndrome.12 Most of these syndromes display an autosomal dominant pattern of inheritance. Many of the associated somatic defects, such as hypertelorism, ear anomalies, epicanthal folds and retrognathia, might conceivably be explained by lymphatic hypoplasia as a consequence of intrauterine lymphedema. In many such patients, the identification of heritable syndromes depends heavily on the accurate diagnosis of congenital lymphedema. While this can often be accomplished with routine physical assessment, at times the findings of indirect radionuclide lymphoscintigraphy can provide valuable confirmatory evidence. The figure depicts the lymphoscintigraphic findings in a 13-year-old female with severe, congenital lymphedema and associated developmental defects. The study demonstrates extensive stasis of the radionuclide within the cutaneous structures of the lower extremities (‘dermal backflow’) and the popliteal lymph nodes are distinctly delineated with radionuclide uptake. The latter finding suggests lymphatic transport via the deep lymphatic system;14 both findings are characteristic of lymphatic insufficiency and lymphostasis.