s-5682 and Lymphedema

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Clinical Trials as Topic; Diosmin; Double-Blind Method; Drug Combinations; Female; Flavonoids; Hemorrhoids; Hesperidin; Humans; Lymphedema; Male; Middle Aged; Placebos; Platelet Aggregation Inhibitors; Pregnancy; Thrombophlebitis; Time Factors

Microangiopathy of chronic venous insufficiency is characterized by elongated, dilated and coiled skin capillaries, which are surrounded by an enlarged pericapillary space (halo). Reduction of capillary number and even areas devoid of microvessels (atrophie blanche) are common in severe chronic venous insufficiency associated with focal microvascular ischaemia (decreased transcutaneous oxygen tension). The superficial network of skin lymphatic capillaries is obliterated in part. Oedema formation results from increased permeability of blood capillaries (enhanced transcapillary diffusion of sodium fluorescein) and deficient lymphatic drainage of interstitial fluid.

Topics: Diosmin; Drug Combinations; Flavonoids; Hesperidin; Humans; Lymphatic System; Lymphedema; Microcirculation; Microscopy, Fluorescence; Microscopy, Video; Skin; Venous Insufficiency

To assess the activity of a purified, micronized, flavonoidic fraction (Dios; Daflon 500 mg*) on upper limb lymphedema occurring after breast cancer therapy, a monocenter, randomized, double-blind, parallel group vs placebo (Plac) trial was carried out. One hundred and four women with lymphedema were included; 94 completed the study (46 Dios, 48 Plac). A subset of 24 patients with more severe lymphedema (10 Dios, 14 Plac) was subjected to a separate analysis. Treatment consisting of Dios or Plac was given two tablets daily over a six-month period. A radionuclide lymphoscintigraphy using technetium-99m was performed at inclusion and at the end of the treatment. The upper limb volume was measured every two months. In the overall population the evolution of parameters was not different between Dios and Plac. In the 24 patients with a more severe lymphedema, the lymphoscintigraphic parameters (m +/- sd) were as follows: lymphatic migration speed was significantly improved by Dios in comparison with Plac (delta Speed cm/minute: 0.84 +/- 0.6 vs 0.14 +/- 0.26, P = 0.005). The half-life of the colloidal compound was significantly improved over time in the Dios group (delta half-life = 10.3 +/- 13.07 minute, P = 0.034) but not in the Plac group (delta half-life = 0.53 +/- 15.51 minute, P = 0.086). The change over time of colloidal clearance was close to significance in the Dios group (delta clearance microL/minute: 2.18 +/- 3.10, P = 0.054) but not in the Plac group (0.11 +/- 2.26, P = 0.86). No significant difference was found for evolution of lymphedema volume, despite a tendency in favor of Dios. This can be related to wide distribution of volume values and small numbers of patients. In conclusion, these results suggest a beneficial therapeutic activity of Dios at the usual dose of two tablets/day in patients affected with more severe lymphedema. The clear improvement of the lymphatic speed illustrates its known lymphokinetic activity. Further studies with a higher dosage could confirm the beneficial activity of this drug in secondary lymphedema.

Topics: Aged; Breast Neoplasms; Diosmin; Double-Blind Method; Drug Combinations; Female; Flavonoids; Hesperidin; Humans; Lymphedema; Middle Aged

The paper describes the results of examination carried out by the Sankt-Peterburg school of lymphologists, pertaining to the structure, physiological properties and function of lymphangions responsible for active lymph transport. The problems of the pathogenesis, diagnosis and treatment of lymphedema of the lower extremities used in clinical practice are reviewed from the standpoint of the new theory. The data obtained as a result of the clinico-morphofunctional studies allowed to delineate the stages of lymphedema as dependent on the degree of lymphocytic structure and function integrity. Based on the aforesaid the new approaches to the diagnosis and selection of the treatment methods for lymphedema of the lower extremities have been formulated.

Topics: Animals; Biopsy; Diosmin; Drug Combinations; Electric Stimulation Therapy; Hesperidin; Humans; Leg; Lymphatic System; Lymphatic Vessels; Lymphedema; Lymphography