Chronic oedema and lymphoedema: what is the difference?

Chronic oedema is a term that encompasses several causes that lead to oedema formation in any part of the body. This includes lymphoedema and its subcategories. Despite the assumption that these are different, there are more commonalities amongst them. This makes the transfer of knowledge and experience, from chronic oedema conditions to lymphoedema, and vice versa easier to achieve. However, this takes both time and support, to achieve the ultimate patient outcome of self-care, with generalist able to support this process and journey.

[Study on the heterogeneity of edema in severe preeclampsia]

OBJECTIVE

The aim of this study was to analysis the clinical edema forms and explore the heterogeneity of edema in severe preeclampsia (PE) .

METHOD

From February 2002 to February 2009, Peking University Third Hospital admitted with severe preeclampsia 228 cases who were enrolled in this study. The form is divided into no edema (A-type), pure interstitial edema (B-type), a simple cavity gap edema (C-type) and mixed interstitial edema that coexist with lacunar edema (D-type). Analysis and comparison of various types of edema in patients with different clinical manifestations of prenatal care models, laboratory parameters, the incidence of gestational age, complications and obstetric and perinatal outcomes, and analyze the relationship between different types of edema and albumins and the peak value of proteinuria.

RESULTS

Edema was seen in 86% (197/228) of all of cases. Compared the cases who have regular prenatal care with those who have irregular care, differences were statistically significant in edema type composition ratio (P < 0.01) and the incidence of serious complications (P < 0.01), and serum albumin levels (P < 0.01), but not in the peak value of proteinuria (P > 0.05); Compared early-onset PE and late-onset PE patients, differences were statistically significant in edema type composition ratio (P < 0.01) and peak value of proteinuria (P < 0.01), but not in serum albumin levels and the incidence of serious complications (P > 0.05). Comparison between the various types of edema, differences were statistically significant in serum albumin levels and peak value of proteinuria and incidence of serious complications and the gestational week at PE onset and the incidence of treatment preterm labor (P < 0.05).Occurrence of placental abruption, heart failure and HELLP syndrome had statistical significance in different types of edema(P < 0.05). The varying degrees of interstitial edema were correlated with serum albumin levels (r = -0.19, P < 0.05) and serious complication occurrence (r = -0.232, P < 0.05), but no correlation displayed with the peak value of urinary protein (P > 0.05).

CONCLUSIONS

The manifestations of edema were diverse in severe preeclampsia. The forms of edema were related to the PE onset of gestational age and serious complication involving in different organs.Strengthen prenatal care and early detection of edema may improve adverse obstetric outcomes.

[Clinical study of 48 cases of viper (Agkistrodon halys blomhoffii "Mamu shi") bite--Does the swelling at the first medical examination reflect the seriousness of the envenomation?]

We have evaluated 48 cases of viper (Agkistrodon halys blomhoffii "Mamushi") bite treated in our hospital from 2001 to 2005. Of all the patients, 21 were bitten in rice field/farm, 10 were in path, 9 were in yard and 8 were in other places. Most cases occurred between July and September. The most frequently bitten regions were fingers and toes. Because swelling reached its maximum at 1.1+/-0.5 day, it was difficult to judge the severity of Mamushi bite by the degree of swelling at the first examination. There was no significant relation between the grade classification of swelling and CPK values. Value of CPK became its peek at 2.0+/-1.1 days after bites. Some reports recommend giving antivenin judging from the grade classification. However we could not estimate the severity of Mamushi bite from the degree of swelling and CPK values at the first examination. The degree of swelling and CPK values at the first examination will not be an index to determine the choice of the treatment including use of the antivenin.

Muscle Edema: Classification, Mechanisms, and Interpretation

Muscle edema is commonly encountered in patients following extremity trauma. This article presents an overview of differential considerations in patients presenting with muscle edema, and while focusing on trauma outlines causes on the basis of mechanism, vasogenic, congestive, traumatic, and tumorigenic edema.

Poststroke hand swelling and oedema: prevalence and relationship with impairment and disability

OBJECTIVE

To examine the prevalence of swelling and oedema of the hand in stroke patients and relationships with impairments and disability.

DESIGN

Cross-sectional.

SETTING

Stroke unit at Rehabilitation Centre De Hoogstraat, The Netherlands.

SUBJECTS

Eighty-eight adult stroke patients who were admitted for clinical rehabilitation during one year (2000).

MEASUREMENTS AND METHODS

Assessment took place two weeks after admission to the rehabilitation centre. Degree of swelling was measured with a hand volumeter and oedema was defined as a volumeter score deviating more than two standard deviations from the expected score derived from population data. Further assessment included tonus (Modified Ashworth Score), sensibility, tactile inattention, carefulness, and motor function (Utrecht Arm/Hand Test). Arm disability was measured with Frenchay Arm Test and Nine-hole Peg Test.

RESULTS

Some degree of hand swelling was present in 72.7% and oedema in 33.0% of our patients. Swelling and oedema were significantly more often seen in patients with hypertonic fingers and impaired sensibility. Patients with hand oedema had significantly worse Frenchay Arm Test and Nine-hole Peg Test scores.

CONCLUSIONS

Swelling and oedema of the hand are common among stroke patients in clinical rehabilitation.

Scope and significance of non-uniform classification practices in breast cancer with non-inflammatory skin involvement: a clinicopathologic study and an international survey

BACKGROUND

The study evaluates the scope of non-uniform classification practices concerning breast carcinomas with non-inflammatory skin involvement.

PATIENTS AND METHODS

We compared the clinical course of patients with histologically proven non-inflammatory skin involvement: 119 (65.4%) with clinically obvious 'classical' skin changes (Group A) and 63 (34.6%) with no or only discreet changes (Group B). A questionnaire was circulated to pathology departments in 24 countries to assess the practice concerning the placement of skin- involved breast carcinomas in the TNM classification.

RESULTS

Patients in Group B showed a significantly better disease specific survival (P=0.0002). Eighty-six respondents (70.5%) of the survey preferred the 'histological view' and classified tumors with only histological proven skin involvement as T 4 b/stage IIIB. The opposing classification principle ('clinical view'), which dictates that T 4 b breast cancer is a clinical diagnosis and the classical signs must be present, was supported by 31 respondents (25.4%).

CONCLUSIONS

A large number of breast cancer patients with non-inflammatory skin involvement are only histologically proven and show, compared with cases exhibiting the classical clinical signs, significant differences in clinical course and prognosis. In general, both subsets were aggregated in one T category/stage (T 4 b/IIIB). This results in a considerable distortion of the reported statistical data.

[Pathogenesis of edema and its classification]

Pathogenesis of edema is in depth considered based on Starling's rule on capillary fluid dynamics. Edema can be divided into 4 types based on the mechanisms causing edema: increased capillary hydrostatic pressure, decreased plasma oncotic pressure, enhanced hydraulic permeability of capillary walls, and lymphatic obstruction. Each of the types can be further divided into generalized and local forms. Edema, defined as the expansion of interstitial fluid compartment, is initiated by imbalance of Starling forces across capillary walls between plasma and interstitium, but is maintained by enhanced sodium reabsorption from renal tubules.

Why and how post-mastectomy edema should be quantified in patients with breast cancer

In the present study, we advocate quantifying post-mastectomy edema in patients with breast cancer in millilitres and not in centimetre, contrarily to the usual routine practice. The water displacement and perimetric quantification methods exhibited both excellent reproducibility with an intraclass correlation coefficient > 0.99 and an accuracy coefficient < 0.3%.

A 1-year clinical report of a one-piece implant abutment

PURPOSE

Solid one-piece standard and conical abutments, which do not involve the external implant hex when seated, have been designed. The present clinical study represents a 1-year follow-up of the use of these abutments for anchorage of implant-supported fixed prostheses for oral rehabilitation of 36 completely and eight partially edentulous patients.

MATERIALS AND METHODS

After 1 year of loading, the implant-supported dentures were removed, and the seating of the 214 one-piece abutments was inspected clinically and radiographically.

RESULTS

After 1 year of loading, no loose abutments were observed. One complication was reported; it involved fracture of two abutment screws within the same fixed denture. Prosthesis mobility and gold screw loosening accompanied this complication. Ninety-one percent of the patients exhibited healthy gingiva, and 9% showed erythema/edema. No periimplantitis was identified.

CONCLUSION

The results of this study--healthy marginal tissue, a mean bone loss of 0.3+/-0.6 mm, and no abutment retightening 1 year after loading--support the use of the one-piece abutment design in implant-supported screw-retained restorations.

Osteonecrosis, transient osteoporosis, and transient bone marrow edema: current concepts

Osteonecrosis, transient osteoporosis, and transient bone marrow edema are closely related diseases that may have an overlapping clinical and radiographic presentation, thus creating difficulty in establishing a diagnosis. Close scrutiny of MR images may aid in distinguishing the pattern of osteonecrosis from other conditions, but in other cases careful clinical and radiologic follow up may be required. The pathogenesis, radiologic diagnosis, and clinical relevance of these conditions are described and reviewed in this article.

Albumin and colloid osmotic pressure implications for fluid resuscitation

This article reviews basic physiologic principles governing fluids in spaces. Starling's law is presented, and its interpolation into a dynamic clinical setting is discussed. These principles are further described through a case presentation.

[A method of evaluating the clinical course of edematous exophthalmos and pseudotumor of the orbit]

Study of the combinations of symptoms and signs contributing to the clinical picture of edematous exophthalmos (EE) and orbital pseudotumor (OP) has helped single out 14 classes, each of them reflecting the subjective or objective status of a patient. An 0 to 4 score rating inside each class permits ruling out this or that symptom (0 score) or assess its severity (1-2; 3-4 scores). These classes comprise patients' complaints, the status of the periorbital tissues, upper lid and bulbar conjunctiva, the degree of the eyeball protrusion, eye mobility and strabismus angle, and changes in the intraocular pressure and fundus oculi. Analysis of the symptoms markedness in scores for each of the 14 classes, carried out with due consideration for the process stage separately for EE and OP, has shown that the total score is under 6 in the initial stage of the disease and 17 in the decompensation stage. The score drastically rises in the far progressed stages of both EE and OP, being 23-29 in EE and 22-27 in OP. The authors emphasize that the suggested rating helps objectively assess the process stage in each case and thus choose the treatment strategy.

[A proposed classification of swollen legs]

The subject of enlarged legs is vast and complex. Up to now there has been no organic classification of the clinical picture involved. The basic problem is that of the criterion on which to base the classification. Literature on this subject has opted for the pathogenic criterion because it seems to facilitate the formulation of a classification which is of use to the doctor. One possibility would be to divide the syndrome into vascular and non-vascular swollen legs. The first group could in turn be separated into macro-circulating and micro-circulatory. The micro-circulatory forms can be primitive or secondary. Amongst the secondary micro-circulatory forms, two other groups can be singled out: secondary forms with local cause and secondary forms caused by organic pathology. However, there are clinical forms which are on the periphery of these different groups and these forms are subject to discussion regarding nosographic localization.

Diabetic macular edema. A review

Diabetic macular edema can be classified into a focal variety, characterized by focal leakage from microaneurysms, often with accumulation of extravascular lipoprotein in a circinate pattern around the focal leakage, and a diffuse variety, with diffuse leakage from retinal vessels often accompanied by cystoid macular changes. Laser photocoagulation is directed at microaneurysms for focal leakage and is applied in a grid pattern for diffuse leakage. Several prospective randomized clinical trials have shown that laser-treated eyes fare better than untreated eyes: there is a higher rate of modest visual improvement and a lower rate of visual deterioration in eyes treated with laser photocoagulation. In patients with diabetic macular edema, especially the diffuse variety, systemic factors also may play a pathogenic role. Fluid retention and hypertension due to cardiovascular and renal disease exacerbate retinal capillary leakage. Correction of systemic abnormalities (reduced blood pressure, diuresis) may reduce macular edema and should be included as part of the total management of patients with diabetic macular edema.

Endolymphatic hydrops. An overview and classification

Endolymphatic hydrops (EH) is a pathological condition which is the final common manifestation of a variety of otologic insults. In this paper we develop a classification which, on the basis of clinical and pathological data, distinguishes symptomatic and asymptomatic forms. Clinical case histories and temporal bone studies are presented to illustrate and substantiate this classification. The symptomatic form becomes evident by the hallmark symptoms of episodic vertigo and fluctuating hearing loss. The asymptomatic form is silent. Interconversion from one form to another may occur over time. Each of the forms can be subdivided, according to etiology, into embryopathic, acquired, and idiopathic types. The embryopathic type comprises those cases in which some noxious influence interferes with prenatal labyrinthine development. The acquired type includes those cases in which a documented insult, be it inflammatory or traumatic, is suffered by a previously normal labyrinth. The inflammation may be viral, bacterial, or spirochetal in nature, while the traumatic event may be either accidentally or surgically sustained. The idiopathic type includes cases in which the instigating event precipitating the EH is unknown. Menière's disease represents merely one example of the EH group of disorders, namely symptomatic idiopathic EH.

Patch testing in the rabbit using a modified human patch test method. Application of histological and visual assessement

A 5 h, semi-occlusive human patch test repeated daily for 5 days, was modified for use in the rabbit Using this method, the relative irritancy of three cosmetic samples of known human irritancy was determined in the rabbit. In addition, attention was paid to assessment methods and a detailed histological scoring system is described as well as two methods of visual assessment. In order to compare the effectiveness of these methods, the reaction to a series of concentrations of sodium lauryl sulphate was examined. All three assessment methods gave similar results and the merits of combining histological and visual assessment are discussed.