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CLINICAL RELIABILITY AND THERAPEUTICAL INDICATIONS OF PRO-BNP IN LOWER LIMBS EDEMA
MICHELINI SANDRO, CARDONE MARCO, FIORENTINO ALESSANDRO, CAPPELLINO FRANCESCO, SAINATO VINCENZO, PERINELLI DONATELLA, MICHELINI SERENA
San Giovanni battista Hospital, Rome, Italy
Introduction: Edema of the lower limbs have multiple origins. In heart failure is frequently found, especially in elderly subjects (but also in young people in particular clinical conditions) edema bilateral and symmetrical of the lower limbs. The inability of an adequate response to the 'pre-load' by the heart, often is added, in these cases,to a further difficulty of peripheral lymphatic transport. The physical treatment, in these conditions, can trigger acute crisis of 'heart failure' if the intensity of the same is not 'calibrated' on the heart compliance.
Until recently, in this sense, an important predictive significance was attributed to cardiac ejection fraction (calculated during examination echocolordoppler); actually the real indicative factor of the cardiac compliance is the PRO-BNP, the value of which is indicative both from the functional point of view of the heart (with consequent indications for treatment with diuretic drugs and other drugs) and for the directions of physical treatment.
Materials and Methods: EF and PRO-BNP was tested in a group of 38 patients with bilateral edema of the lower limbs, of mixed genesis (17 females and 21 males, aged between 13 and 79 years, mean age 68 years).
Results: We found abnormalities in EF values in 15.5% in comparison to the considered normal values. The PRO-BNP values, on the contrary, appeared altered in 84.2% of the subjects examined. During the physical treatment of EF values remained essentially unchanged while the PRO-BNP rose up during the first sessions of about 45% (12-115%) to return to normal values at the end of treatment in 79% of subjects with baseline alterations.
Conclusions: The study shows the importance of the recognition of the PRO-BNP value in diagnostic and in the monitoring of the physical treatment in patients with bilateral lower extremity edema due to central and peripheral vascular problems.
STEWART-TREVES SYNDROME: THE MECHANISM OF THE ONCOGENESIS AND NATURE OF THE VASCULAR NEOPLASM
Takaoka City Municipal Hospital, Toyama Prefecture, Japan
Introduction: Stewart-Treves syndrome (STS) is a rare, but a life-threatening complication of lymphedema, consisting of vascular malignancies and long-standing chronic lymphedema. The first case of angiosarcoma arising secondary to lymphedema was reported by Lowenstein in 1906, and Stewart and Treves reported collective 6 cases of angiosarcoma in postmastectomy lymphedema in 1948.
Materials and Methods: Review of the literatures related to STS, and immunohistochemical study of the tumor tissue obtained from a case of STS (60 years old Japanese male) who suffered from primary lymphedema of the lower extremities.
OKADA E.
Results and Discussion: Regarding the tumor cells of the vascular malignancy observed in the case of STS, some of the tumor cells were CD34(+)/podoplanin(–) and others revealed CD34(–)/podoplanin(+). The vascular malignancies of STS have been called angiosarcoma, lymphangiosarcoma, or hemangiosarcoma depending on the literatures. Since, there are both types of tumor cells showing phenotypes for hemangiosarcoma and lymphangiosarcoma, the term angiosarcoma is thought to be appropriate to call the malignancy.
Regarding the process of the oncogenesis taking place in the syndrome, the local immunodeficiency caused by lymphedema has been regarded as the sole oncogenic factor. However, immune deficiency is thought to be a promoting factor for the oncogenesis, not an initiating. We reported that there is an increase in contents of lipid peroxide in the tissue of lymphedema. An increase in lipid peroxide is the evidence for generation of oxygen radicals. DNA-injury caused by oxygen radicals may play an initiating role in the process of the oncogenesis
Conclusions: The vascular malignancy in STS should be called angiosarcoma. Oncogenesis of the angiosarcoma in STS is thought to be initiated by the oxygen radicals and promoted by the local immunodeficiency.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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