[Erysipelas and lymphedema]. / Erysipel und Lymphödem.

The most common complication of lymphedema is erysipelas (Saint Anthony's fire). The protein-rich lymph is such an excellent medium for the growth of bacteria that the risk of erysipelas developing is as high in the most severe forms of lymphedema as 50% compared with only 1/1000 in the general population. Treatment requires the use of antibiotics. Of importance for prophylaxis is the rigorous disinfection of minor injuries that provide a portal for bacteria, usually streptococci, and the physical edema therapy described by Asdonk comprising manual lymph drainage and compression.

[Outcome of various inpatient lymph drainage procedures]. / Ergebnisse unterschiedlicher stationärer Lymphdrainagebehandlung.

Three groups of patients (n: 10 each group) with extensive or massive secondary lymphedema of the arm were treated with different types of manual lymphatic drainage. The decrease of volume based on arm circumference was measured before and four weeks after treatment. The first group received one hour of manual lymph drainage twice a day ("Asdonk-standard"). The second group received a 90 minute and the third group only a single one hour treatment. Our result indicate that the therapeutic efficacy of the "Asdonk-standard" is superior to the other two forms of therapy. The improvement of lymphedema was much superior in this group and the treatment was more cost effective.

[Value of functional lymphoscintigraphy and indirect lymphangiography in lipedema syndrome]. / Aussagewert der Funktions-Lymphszintigraphie und indirekten Lymphangiographie beim Lipödem-Syndrom.

Early terms of lymphostasis in lipedema can be detected with lymphoscintigraphy. A normal examination almost certainly excludes a lymphatic component. Indirect lymphography is only used to rule out morphological abnormalities of lymph vessels. If a lymphoscintigraphic study is normal indirect lymphography is not indicated.

[Quality assurance in lymphology]. / Qualitätssicherung in der Lymphologie.

Quality assurance in the field of lymphology is both necessary and possible. This applies not only to practising lymphologists, but also to standardization of lymphological diagnosis, the application of lymphatic drainage and to its practitioners, lymphatic drainage therapists.

[Lipedema]. / Das Lipödem.

The "Lipedema" or "Fatedema" is conditioned by a slight mechanical obstruction of the small lymphatic vessels by the increasing pressure of the growing fat tissue. This lymphostasis in a normal lymphatic vessel system arises only with women and always symmetrically and conducts to typical complaints. Therapeutically, apart from loss in weight, only lymph drainage therapy is in a position to remove the complaints of edema.

[Measuring and documentation of edema]. / Messung und Dokumentation von Odemen.

Measuring and documentation of peripheral edemas should be carried out consistently both in ambulant and in hospital treatment. It's technical easy and can be done as measuring of circumference or of volume. This documentation is important both for the doctors and the physiotherapists and the patients too.

[Pain in patients with edema]. / Schmerzen bei Odempatienten.

Most of the edemas can lead to feelings or even pains of tension and tend different strong to this symptoms according to their genesis and degree of strength. These troubles can be improved or can disappear completely by an edema treatment, either by medicinal therapy or lymph drainage therapy. In cases of bursting pains because of malignant edemas analgesics are regular necessary. Differential diagnostic we must also think to other reasons of pains in association from pain and edema, if they will not get better by an edema therapy. In cases of edemas who can only be treated by lymph drainage therapy the indication for this treatment is given at the latest, when pains begin.

[Complications in lymphedema]. / Komplikationen bei Lymphödemen.

Lymphodemas need treatment not only for the complaints they cause but also for their possible complications. Either complaints and complications can be eliminated or at least decreased by consistent physical therapy of edemas according to Asdonk.

[Significance of radiogenic damage for lymphology]. / Die Bedeutung radiogener Schädigungen für die Lymphologie.

Of the various forms of radiation injury resulting from irradiation several reactions are important in lymphology since they respond well to manual lymphatic drainage according to Vodder-Asdonk, to surgery or to fibrosis stretching. In acute and sub-acute radiation injury there is usually transient inflammatory swelling, e.g. in the extremities, and radiogenic oedema of the breast which reacts favourably to manual lymphatic drainage. Late sequelae such as ulcerating radiodermatitis and lymphatic oedema may be improved by manual lymphatic drainage or surgery as well as radiogenic fibrosis which is treated with intensive but careful stretching which may, in part, prevent further plexus injury.

[Malignant lymphedema]. / Das maligne Lymphödem.

Malignant lymphatic oedema is due to the obstruction of lymph tracts and lymph nodes by tumour cells. In addition to the necessary cancer therapy and the administration of analgesics physical oedema therapy is the single most effective form of relief which is most gratefully accepted by the patients. The only contraindication to manual lymphatic drainage is transient in the case of isolated local and regional metastatic spread which would still respond to treatment. Thereafter, and in all other conditions involving metastatic spread, there are no contraindications to physical oedema therapy.

[Idiopathic and diuretic-induced edema]. / Idiopathisches und Diuretika-induziertes Odem.

Between may 1987 and may 1989, the case histories of 48 female patients with idiopathic oedema and of 5 female patients with diuretic-induced oedema were evaluated retrospectively at Dr. Asdonks' Feldbergklinik. Prior to and after the termination of the physical anti-oedemic treatment according to Asdonk, the volume of the limbs was determined. The extent of reduction in volume as reflected by lipophagia and decrease in oedema, as well as the regression of complaints were rated as a measure of therapeutic success. On discharge, all patients were free from complaints.

[Idiopathic edema in the female]. / Das idiopathische Odem der Frau.

Idiopathic oedema in women is due to a disturbance in capillary permeability with increased protein porosity. This leads to generalized pre- or mild oedema which, although it is frequently not recognizable clinically, gives rise to marked sensations of tension and heaviness with impaired physical performance. Diagnosis must exclude all other possible forms of oedema. However, not only oedema that presents in generalized forms must be considered. Optimum therapy consists of manual Vodder-Asdonk lymphatic drainage in conjunction with compression therapy. This results in a marked improvement. At present there is no known safe pharmaceutical treatment, diuretics are not indicated.

[Differential diagnosis of edemas]. / Differentialdiagnose der Odeme.

Differential diagnosis of the various forms of edema certainly demands a wide range of experience. Up to 80% of cases can be diagnosed accurately on the basis of an exact case history and physical examination, a diagnosis which only needs to be confirmed by further tests. The rest of the cases require mechanical and laboratory tests which are, for the most part, very time consuming and costly.

[Treatment of edema with special reference to lymph drainage therapy]. / Behandlung von Odemen unter besonderer Berücksichtigung der Lymphdrainagetherapie.

Depending on its genesis, edema must be treated by medication or diet. Simultaneous application of lymph drainage may be beneficial in some cases, especially in combined edema. In some kinds of edema, in particular lymphedema, only therapeutic lymph drainage introduced into medicine by Asdonk can attain an improvement in combination with compression stockings, since there is no drug which acts on the lymphatic system. The use of digitalis and diuretics is not justified in lymphedema. Surgical techniques have not been completely convincing so far.