Herbal treatment for Lymphatic Obstruction

Lymphedema in the Head Neck Area

Interstitial lymphedema develop in most patients with head-neck tumors after surgery, chemotherapy, and radiation therapy. Patients developing endolaryngeal edema under these conditions require effective therapy if tracheostomy is to be avoided. The treatment of such patients with sodium selenite (selenase) was found to be helpful, as evidenced by the results of a recent clinical study (83). Of 30 such patients 20 developed endolaryn-geal edema on average four weeks after radiotherapy, accompanied by breathing difficulties and whistling noises during respiration. In 16 of the 20 patients with endolaryngeal edema sodium se-lenite (orally, 3 x 200 g Se day) effected a significant reduction of the edema over a period of eight weeks. Of the 30 patients, 12 were also treated with proteolytic enzymes, but this treatment proved effective in only two individuals. In 13 of 20 patients, tracheostomy was not necessary of the seven tracheostomies that had to be performed in the remaining...

Lymphedema of the

Secondary lymphedema develop in cancer patients after surgical interventions and radiation therapy. Due to removal of lymph nodes and diminished functioning of the lymphatic passages excess lymph accumulates in the affected extremity. The diminished oxygen supply may trigger the invasion of polymorphous neutrophilic leukocytes and the production of reactive oxygen radical species, resulting in inflammatory reactions and ultimately progressive degenerative changes in the affected extremity. The administration of sodium selenite (selenase), in some cases even after single oral dose of 800 g selenium, causes spontaneous volume reductions of the affected extremity and has anti-inflammatory effects selenite supplementation in addition diminished the serum levels of 2-hydroxynonenal and malondialdehyde, two parameters of lipid peroxidation (78-80). Selenite in addition increased the contractility of the lymphatic vessels, improved the effect of manual de-congestion therapies by about 15...

Electrocardiogram ECG

As a consequence to cardiac lymphatic obstruction, alterations have been reported in ECG resembling those observed in myocardial hypoxemia or in grave anoxemia .97 Similarly, elevated ST- and negative T-segments have been described in dogs.98 These pathological changes were attributed to the myocardial dilatation by the edema. Furthermore, cardiac arrhythmias have been reported similar to those found in sick sinus syndrome in man.87 Other investigators, however, did not observe changes in ECG following interruption of the cardiac lymph drainage.99100

Organization of Sport Groups

Some of the newcomers have pre-existing experience in sports and may indicate that they would like to get to know their body afresh, and that they want to return to the same kind of sport or sports group after an introductory period of strengthening. This is not a problem if the type of sport does not adversely affect the altered physical status of the patient. (For example, a breast cancer patient should not take part in sports that may aggravate brachial lymphedema.) Some types of sport such as gymnastics, water gymnastics, longdistance running, or swimming can usually be taken up again without difficulties or problems. It is not advisable to engage in types of sport that entail prolonged and unforeseeable periods of strain, such as handball, basketball, volleyball, and martial arts, especially when they are conducted in a competitive manner.

Management in Custody

The health care professional managing the detainee should clean and dress open wounds as soon as possible to prevent the spread of infection. It may also be appropriate to start a course of antibiotics if there is abscess formation or signs of cellulites and or the detainee is systemically unwell. However, infections can often be low grade because the skin, venous, and lymphatic systems have been damaged by repeated penetration of the skin. In these cases, signs include lymphedema, swollen lymph glands, and darkly pigmented skin over the area. Fever may or may not be present, but septicemia is uncommon unless the individual is immunocompromised (e.g., HIV positive). Co-Amoxiclav is the preferred treatment of choice because it covers the majority of staphylococci, streptococci, and anerobes (the dose depends on the degree of infection).

Biological Warfare Agents

Axial magnetic resonance image (MRI) with intravenous gadolinium contrast enhancement of the arm of a patient with cutaneous anthrax that demonstrates massive lymphedema and enhancement of the subcutaneous fat in the lateral compartment. (Courtesy of Carlos R. Gimenez, M.D., Professor of Radiology, LSU School of Medicine, New Orleans, LA.)

Adaptive Immunity to Parasites

Adaptive immune responses to parasites can also contribute to tissue injury. Some parasites and their products induce granulomatous responses with concomitant fibrosis. Schistosoma mansoni eggs deposited in the liver stimulate CD4+ T cells, which in turn activate macrophages and induce DTH reactions. DTH reactions result in the formation of granulomas around the eggs an unusual feature of these granulomas, especially in mice, is their association with TH2 responses. (Granulomas are generally induced by TH1 responses against persistent antigens see Chapter 18.) Such TH2-induced granulomas may result from the process of alternative macrophage activation that is induced by IL-4 and IL-13 (see Chapter 10). The granulomas serve to contain the schistosome eggs, but severe fibrosis associated with this chronic cellmediated immune response leads to cirrhosis, disruption of venous blood flow in the liver, and portal hypertension. In lymphatic filariasis, lodging of the parasites in lymphatic...

Histopathology

Impaired cardiac lymph drainage inevitably causes myocardial edema as demonstrated by an increase in water content.34,85 Histological changes include interstitial edema, swelling of myofibrils, myofibrillar derangement, and mitochondrial injury.14,77,87'89 Additionally, there were described subendocardial and myocardial focal hemorrhages following cardiac lymphatic obstruction.89,90 But these were observed only occasionally and have not been confirmed in other studies.77,91 It is conceivable that the ultrastructural changes following insufficient cardiac lymph drainage reduce myocardial performance. Chronic interstitial edema is well known to cause interstitial fibrosis.92 Accordingly, the left ventricular myocardial collagen concentration was significantly higher in dogs with chronic myocardial edema in response to pulmonary artery banding (see below) than in normal dogs.34 With prolonged cardiac lymphatic obstruction, thickening of the endocardium with increased The coronary...

Coronary Blood Flow

Cardiac lymphatic obstruction may be assumed to interfere with myocardial blood flow due to an increase in interstitial pressure, which then enhances coronary flow resistance. Indeed, when cardiac lymphatic outflow pressure was elevated so that lymph flow was abolished, interstitial fluid pressure rose from 15.0-27.5 mm Hg.37 Baseline coronary blood flow, however, was not significantly affected following cardiac lymphatic obstruction, whereas reactive hyperemia and adenosine induced vasodilation were reduced.95 96 Obviously, blood flow to the edematous myocardium was maintained on the expense of the coronary flow reserve. Consequently, an increased myocardial oxygen demand should not be met adequately by a rise in blood flow and myocardial ischemia would result.

Cardiac Performance

One of the earlier investigations on the functional importance of intact cardiac lymphatic drainage studied the cardiac output following cardiac lymphatic obstruction in isolated rat hearts.88 Cardiac output decreased by 33 within 90 min in the lymphostatic hearts, whereas it remained stable in hearts with freely draining lymph. The reduction in cardiac function following lymphatic obstruction was not related to coronary perfusion, which was not different in lymph obstructed and control hearts and did not change during the experiment. 86. Ludwig LL, Schertel ER, Pratt JW, McClure DE, Ying AJ, Heck CF, Myerowitz PD. Impairment of left ventricular function by acute cardiac lymphatic obstruction. Cardiovasc Res 1997 33 164-171. 89. Sun SC, Lie JT. Cardiac lymphatic obstruction ultrastructure of acute-phase myocardial injury in dogs. Mayo Clin Proc 1977, 52 785-792. 92. Witte CL, Witte MH, Dumont AE. Pathophysiology of chronic edema, lymphedema, and fibrosis. In Edema. Edts. Staub NC,...

Winter Sports

Tight, constrictive clothing should be avoided in order to prevent lymphedema of the arm. Backpacks are only suitable when they are not too heavily packed and have comfortable, broad straps. Since hypothermia can also promote the development of lymphedema, special safety measures should be met to avoid these complications.

Tularemia

Coronal magnetic resonance image (MRI) with intravenous gadolinium contrast enhancement of the arm of a patient with cutaneous anthrax that demonstrates massive lymphedema and enhancement of the subcutaneous fat in the lateral compartment. (Courtesy of Carlos R. Gimenez, M.D., Professor of Radiology, LSU School of Medicine, New Orleans, LA.)

Plague

Axial magnetic resonance image (MRI) with intravenous gadolinium contrast enhancement of the arm of a patient with cutaneous anthrax that demonstrates massive lymphedema and enhancement of the subcutaneous fat in the lateral compartment. (Courtesy of Carlos R. Gimenez, M.D., Professor of Radiology, LSU School of Medicine, New Orleans, LA.) FIGURE 24.3 Cutaneous Anthrax 2. Coronal magnetic resonance image (MRI) with intravenous gadolinium contrast enhancement of the arm of a patient with cutaneous anthrax that demonstrates massive lymphedema and enhancement of the subcutaneous fat in the lateral compartment. (Courtesy of Carlos R. Gimenez, M.D., Professor of Radiology, LSU School of Medicine, New Orleans, LA.)