Clinical

LYMPHOEDE
symposium
MA
on

Sponsors

MERIDIAN ENTERPRISES PVT. LTD.

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Hundreds of miles of desolate,

monotonous , burnt-up steppe
cannot induce such deep
depression ;
as one man when he sits and talks
. and one does not know when he
will go Anton

Chekov

LYMPHOEDEMA

LYMPHATIC
SYSTEM

LYMPHATIC
SYSTEM

Studies on
Lymphoedema
Univ.

of Texas ; Memorial Hermann

Centre; Houston

The

Lymphoedema Assoc. of
Australia,
Univ. of Adelaide, South Australia
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Oedemas

Excess fluid in tissues

Excess production
Poor drainage
Both

Low prot. oedemas

early venous, cardiac, renal, nutritional

High prot. oedemas

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Why?
Different

pathogenesis
Colloidal osmotic pressure is
greater
Prot has deleterious effects
edema, chr. Inflammation, excess
fibrosis, sec. infection, pain
Drug therapy is different
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Side effects
Acute
Chronic
Pain
Immobility
Poor wd. Healing Fibrosis
Injury
Sec. infection
Loss of self esteem
Depression

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Lymphoedema
Primary
Idiopathic
Av malformation
Hemangioma
Lymphangioma
Lymphoedema
praecos
Lymphoedema
tarda

Secondary
Surgery for Ca.
Radiotherapy
Accidental injuries
Trauma(scarring)
Filariasis
Chr. Venous
Insufficiency
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Rx
Frustrating,

long standing and

unsatisfactory
Conventional / unconventional
Non medical lines of Rx
Pt compliance
poor,
not very readily available,
cost factor,
socio-economic factors.
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Rx
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CPT
HYGIENE

& TOPICAL SKIN PRODUCTS

MANUAL LYMPH DRINAGE
MLD
BANDAGING & COMPRESSION
REMEDIAL EXERCISES & ELEVATION

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DRUGS

DIPODEM
COUMARIN
( 5,6 Benzo Alpha Pyrone)

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Dipodem
Increase the no. of macrophages present

Increases the proteolytic activity of

macrophages
Stimulates macrophage activity
Improves pumping by the lymphatics

Lysis of excess proteins Decreases coll. Osm. Pr.

Decreases sec. bact./fungal infection
Decreases chr. Inflammation / fibrosis
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dipodem

Acute
Burns, crush injuries
Surgical trauma
Sports injuries, industrial injuries, strains
Infections ( cellulitis, diab. foot)
Lymphoedema, elephantiasis

Chronic
Chr. Venous insufficiency
Ulcers
Haemorrhoids

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Case
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Case 1
M/38,

casual labourer, Mankhurd

H/o

: pain & Swelling (Rt.) leg X 4 days

: tenderness in (Rt.) groin X 2 days
: Fever
X 2 days
No h/o trauma
No h/o major illnesses /
surgery/ hospitalistion

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Case 1

Vitals

stable
Febrile T=101
Swelling ++ (rt) leg
Cellulitis / Oedema
Streaks of inflamed subcut veins~
lymphangitis
Tenderness in (rt) groin / lnpathy
Clin Impression:
Acute Lymphangitis ~ Filarial
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Case 1

CBC HB: 9.8 TC: 16,800 P68 L25 E6

M1
ESR 22
SGPT/SGOT/Creat : 34 / 42/ 0.8
PS
Normal
Urine Normal
? Venous Doppler
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Case 1 - Rx
Antibiotic Amoxy-Clav 1000mg b.d.
Analgesic Antiiflammatory Diclo-para
Serratiopeptidase (10mg) tds
T. Hetrazan (100mg) tds
T. Dipodem (200mg) bd
Supportive measures
: rest, limb elevation
:Gly-MgSo4 soaks, F.U.

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THANK YOU

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