Messages 4144-4221

Digest Pagina 1 di 65

Messages in vasculab group. Page 1 of 1.

Group: vasculab Message: 4144 From: Waldemar L. Olszewski Date: 06/02/2011 Subject: Re: MEVc Course Group: vasculab Message: 4145 From: MUDr. Andrej Džupina Date: 06/02/2011 Subject: Re: MEVc Course Group: vasculab Message: 4147 From: Dr.D.Eckert Date: 07/02/2011 Subject: Re: MEVc Course Group: vasculab Message: 4150 From: Giancarlo Bracale Date: 09/02/2011 Subject: Re: MEVc Course Group: vasculab Message: 4153 From: bblee Date: 10/02/2011 Subject: Re: MEVc Course Group: vasculab Message: 4157 From: Nada Theivacumar Date: 10/02/2011 Subject: Re: MEVc Course Group: vasculab Message: 4158 From: Dr.D.Eckert Date: 10/02/2011 Subject: Re: MEVc Course Group: vasculab Message: 4159 From: Nick Morrison Date: 10/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4160 From: bblee Date: 10/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4161 From: [email protected] Date: 11/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4162 From: Albert Adrien RAMELET Date: 11/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4163 From: Pier Luigi Antignani Date: 11/02/2011 Subject: R: [vasculab] Lymphatic Group: vasculab Message: 4164 From: Dr.D.Eckert Date: 11/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4165 From: bblee Date: 11/02/2011

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2 ... 30/ 04/ 2017 Digest Pagina 2 di 65

Subject: Re: Lymphatic Group: vasculab Message: 4166 From: bblee Date: 11/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4167 From: [email protected] Date: 12/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4168 From: Hirai Date: 12/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4170 From: [email protected] Date: 12/02/2011 Subject: R: [vasculab] Lymphatic Group: vasculab Message: 4172 From: mauroand Date: 12/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4173 From: Dr.D.Eckert Date: 13/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4175 From: Julio Ferreira Date: 13/02/2011 Subject: Re: R: [vasculab] Lymphatic Group: vasculab Message: 4176 From: bblee Date: 13/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4177 From: bblee Date: 13/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4178 From: jane wigg Date: 13/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4179 From: Horst Rieger Date: 13/02/2011 Subject: Re: R: [vasculab] Lymphatic Group: vasculab Message: 4180 From: Armer, Jane Date: 13/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4181 From: [email protected] Date: 13/02/2011 Subject: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4182 From: [email protected] Date: 14/02/2011 Subject: R: Rif: RE: RE: [vasculab] Lymphatic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 3 di 65

Group: vasculab Message: 4183 From: Alessandro Pieri Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4184 From: bblee Date: 14/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4185 From: bblee Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4186 From: bblee Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4187 From: Leonardo Corcos Date: 14/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4188 From: [email protected] Date: 14/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4189 From: Alberto Caggiati Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4190 From: Hugo Partsch Date: 14/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4191 From: bblee Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4192 From: bblee Date: 14/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4193 From: [email protected] Date: 15/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4194 From: claude franceschi Date: 15/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4195 From: [email protected] Date: 15/02/2011 Subject: Rif: Re: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4196 From: Alberto Caggiati Date: 15/02/2011 Subject: Lymphatic failure and CEAP Group: vasculab Message: 4197 From: Ermes Pasqual Date: 15/02/2011

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 4 di 65

Subject: Ogg:Phlebolyphedema term Group: vasculab Message: 4198 From: Hugo Partsch Date: 15/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4199 From: Waldemar L. Olszewski Date: 15/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4200 From: bblee Date: 15/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4201 From: [email protected] Date: 15/02/2011 Subject: R: Re: [vasculab] Lymphatic failure and CEAP Group: vasculab Message: 4202 From: Alessandro Pieri Date: 16/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4203 From: claude franceschi Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4204 From: Robert A Weiss Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4205 From: bblee Date: 16/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4206 From: bblee Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4207 From: bblee Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4208 From: bblee Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4209 From: bblee Date: 16/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4210 From: sur2 Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4211 From: [email protected] Date: 16/02/2011 Subject: R: [vasculab] Lymphatic failure and CEAP

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 5 di 65

Group: vasculab Message: 4212 From: Alfred Bollinger Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4213 From: Foeldiklinik Hinterzarten Date: 16/02/2011 Subject: Lymphatic Group: vasculab Message: 4214 From: bblee Date: 17/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4215 From: bblee Date: 17/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4216 From: Alfred Bollinger Date: 17/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4217 From: bblee Date: 17/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4218 From: Prof. Corradino Campisi Date: 17/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4219 From: Waldemar L. Olszewski Date: 19/02/2011 Subject: Re: Lymphatic Group: vasculab Message: 4220 From: [email protected] Date: 19/02/2011 Subject: Re: Lymphatic failure and CEAP Group: vasculab Message: 4221 From: bblee Date: 20/02/2011 Subject: Re: Lymphatic

Group: vasculab Message: 4144 From: Waldemar L. Olszewski Date: 06/02/2011 Subject: Re: MEVc Course Waldemar L Olszewski MD, Warsaw Â Dear Colleagues, Â

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 6 di 65

The VASCULAB is most active in the field of phlebology. Fantastic accomplishments. However, there is something lacking. This is information and discussion on the lymphatic system. Both the venous and lymphatic circulation in parallel return fluid to the blood circulation, one would not exist without the other. Lymphology is developing fast and can not exists without phlebology. I propose to create a subchapter of VASCULABÂ devoted to pathophysiology, diagnosis and therapy of diseases of the lymphatic system. More than 300 million people around the world affected (WHO data). I organize a congress of the European Society for Lymphology, June 3-4,2011, Warsaw, PolandÂ www.ESL2011.info It could be a good start for creating the phlebolymphological family. Â Â Waldemar L Olszewski MD Professor of Surgery frm President of the International Society for Lymphology 2011/2/6 [email protected]

Group: vasculab Message: 4145 From: MUDr. Andrej Džupina Date: 06/02/2011 Subject: Re: MEVc Course Dear Profesor Olszewski, I am so happy and aggre with you. Lymphology is most important parf of flebology, or this two systems must bez workink in cooperation . You propose is wery good. Best regards a.dÅ¾upina Bardejov Slovakia Group: vasculab Message: 4147 From: Dr.D.Eckert Date: 07/02/2011 Subject: Re: MEVc Course I finde, itÂ´s a very good idear! Thank You for it!

Dr. Daniela Eckert/Hagenow-Germany

Group: vasculab Message: 4150 From: Giancarlo Bracale Date: 09/02/2011

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 7 di 65

Subject: Re: MEVc Course I too agree with you sincerely yours Giancarlo Bracale, MD Professor of Vascula Surgery Chief Dept. Vascular and Endovascular Surgery Director of Post-Graduated School of Vascular Surgery University Federico II of Naples Group: vasculab Message: 4153 From: bblee Date: 10/02/2011 Subject: Re: MEVc Course Couldn't agree more with Professor Olszewski.

Such feeling is now shared from the both sides of the Atlantic.

Indeed, American Venous Forum at the helm leading the venous field decided to dedicate one separate/independent symposium only for the lymphedema for the first time through upcoming annual meeting in San Diego in late February- I invited Drs. Peter Gloviczki of Mayo and Stanley Rockson of Stanford as the speaker to appeal to the main stream of American venous specialists through this opportunity.

The IUP Consensus 2009 for the Phlebology Training Curriculum- it will be published soon- embraced all the lymphatic disorders including the lymphedema. And also Phlebology Curriculum organized by American Board of Phlebology took one more step to include Phlebolymphedema (PLE) to represent the combined condition of the CVI and CLI properly.

So I uphold Prof. Olszewski's claim: "the time is right!"

All the best,

B. B. (Byung-Boong) Lee, MD, PhD, FACS

Professor of Surgery and Director, Center for Vein, Lymphatics and Vascular Malformations, George Washington University, Washington DC, USA

Clinical Professor of Surgery, Georgetown University, Washington DC, USA

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 8 di 65

Clinical Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Visiting Professor of Surgery, Johns Hopkins University School of Medicine, U.S.A.

From: [email protected] [mailto: [email protected] ] On Behalf Of Giancarlo Bracale Sent: Wednesday, February 09, 2011 10:57 AM To: [email protected] Subject: Re: [vasculab] MEVc Course Group: vasculab Message: 4157 From: Nada Theivacumar Date: 10/02/2011 Subject: Re: MEVc Course It is my pleasure to agree with Prof Olszewski's suggestion. Lymphatic disease is an ignored segment of phlebology. Yes, let's focus some attention on this. Well done everybody. Kind regards Nada Selva Theivacumar Vascular SpR, canterbury Hospital. UK.

Sent from my iPhone

Group: vasculab Message: 4158 From: Dr.D.Eckert Date: 10/02/2011 Subject: Re: MEVc Course ï»¿ Dear Colleagues,

may be I could help You in the Lymphatic subjects, if You are interestid on it, because IÂ´m working in "Lymphologie" since 2000 and in my owne lympholgic dispensary since 2004, in Germany.

Kind regards,

Dr. Daniela Eckert/Hagenow-Germany

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 9 di 65

Group: vasculab Message: 4159 From: Nick Morrison Date: 10/02/2011 Subject: Re: Lymphatic To All, I am also very happy to see the increased interest in Lymphology subjects. The American College of Phlebology has included discussions and symposia on lymphology during each of its annual congresses over the past several years and will continue to do so in the future. Because of the significant association of phlebolymphedema and lymphedema seen on a daily basis in most phlebology practices, this is a discussion that is certainly coming into its own, and rightfully so. The ACP is very supportive of this effort and will be sure Lymphology has a place of importance in the program of the 2013 UIP World Congress in Boston. Best regards, Nick Morrison, MD Organizing Chair, UIP 2013

Group: vasculab Message: 4160 From: bblee Date: 10/02/2011 Subject: Re: Lymphatic Attachments :

Dear All,

I forgot to mention on such critical role of ACP played to bring the lymphedema into the main stream of the phlebologists here in the U.S. through years.

And no doubt ACP will continue to advocate it under Nick's leadership.

Indeed, Nick has been giving unlimited support to this critical issue through years and he will do more through 2013 IUP World Congress in Boston.

All the best,

BB Lee

From: [email protected] [mailto:[email protected]] On Behalf Of Nick Morrison Sent: Thursday, February 10, 2011 11:46 AM

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 10 di 65

To: [email protected] Subject: Re: [vasculab] Lymphatic

To All, I am also very happy to see the increased interest in Lymphology subjects. The American College of Phlebology has included discussions and symposia on lymphology during each of its annual congresses over the past several years and will continue to do so in the future. Because of the significant association of phlebolymphedema and lymphedema seen on a daily basis in most phlebology practices, this is a discussion that is certainly coming into its own, and rightfully so. The ACP is very supportive of this effort and will be sure Lymphology has a place of importance in the program of the 2013 UIP World Congress in Boston. Best regards, Nick Morrison, MD Organizing Chair, UIP 2013

Group: vasculab Message: 4161 From: [email protected] Date: 11/02/2011 Subject: Re: Lymphatic Dear Doctor Lee, I just reda your message.

When is this course scheduled in San Diego, please? Thank you for letting me know. Have a wonderful day. All the best, Anne-Marie Vaillant-Newma

My e mail address has changed.

For future correspondence, please write to me at:

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 11 di 65

[email protected]

-----Original Message----- From: bblee < [email protected] To: [email protected] Sent: Wed, Feb 9, 2011 3:17 pm Subject: RE: [vasculab] MEVc Course Group: vasculab Message: 4162 From: Albert Adrien RAMELET Date: 11/02/2011 Subject: Re: Lymphatic Great Thanks! Best regards aa

Dr Albert Adrien RAMELET 2 Place Benjamin-Constant CH-1003 Lausanne +41 21 312 60 60 +41 21 320 40 90 www.ramelet-dr.ch [email protected]

Le 10 fÃ©vr. 11 Ã 17:45, Nick Morrison a Ã©crit :

Group: vasculab Message: 4163 From: Pier Luigi Antignani Date: 11/02/2011 Subject: R: [vasculab] Lymphatic Attachments :

I agree you about the main role of lymphatic system in the vascular diseases moreover in phlebological conditions. If you think to edema, we well know that it is dependent to efficacy of lymphatic system as compensatory mechanism and when the lymphatic system doesnâ€™t work the edema increases.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 12 di 65

We work in Italy from many years both in the management and treatment of lymphatic dysplasias and primary and secondary lymphoedema.

In our national congress we often organize some session on this toipics.

All the best

PLA

prof. Pier Luigi Antignani

via Germanico 211

00192 Roma

[email protected]

Da: [email protected] [mailto:[email protected]] Per conto di bblee Inviato: giovedÃ¬ 10 febbraio 2011 20.22 A: [email protected] Oggetto: RE: [vasculab] Lymphatic

Dear All,

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 13 di 65

I forgot to mention on such critical role of ACP played to bring the lymphedema into the main stream of the phlebologists here in the U.S. through years.

And no doubt ACP will continue to advocate it under Nick's leadership.

Indeed, Nick has been giving unlimited support to this critical issue through years and he will do more through 2013 IUP World Congress in Boston.

All the best,

BB Lee

From: [email protected] [mailto:[email protected]] On Behalf Of Nick Morrison Sent: Thursday, February 10, 2011 11:46 AM To: [email protected] Subject: Re: [vasculab] Lymphatic

--- On Thu, 2/10/11, Dr.D.Eckert < [email protected] wrote:

From: Dr.D.Eckert < [email protected] Subject: Re: [vasculab] MEVc Course To: [email protected] Date: Thursday, February 10, 2011, 6:35 AM

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 14 di 65

Group: vasculab Message: 4164 From: Dr.D.Eckert Date: 11/02/2011 Subject: Re: Lymphatic ï»¿ Dear Mr. Morrison! Pleas sent me all informations about the UIP World Congress 2013 in Boston. Thank You very mutch for.

Dr. Daniela Eckert "GefÃ¤ÃŸzentrum Hagenow" Germany e-mail: [email protected]

Group: vasculab Message: 4165 From: bblee Date: 11/02/2011 Subject: Re: Lymphatic Dear Anne-Marie

Delighted to hear from you.

This is NOT a course but Luncheon Symposium for 90 minutes dedicated only to the Lymphedema; I was invited to organize for upcoming Annual Meeting in San Diego on March 26th 12:00 noon through 1:30 PM.

Through years, AVF (American Venous Forum) allocated very limited time for the lymphedema as a part of other course/symposium but never gave 1 & 1/2 hour separate session only for the lymphedema issue.

So I invited TWO most respectful and influential colleagues in this field, Peter Gloviczki of Mayo for the surgical issue and Stan Rockson of Stanford for the Medical Issue following my general overview to lead their way.

All the best,

P.S. Thanks for your new e-mail address.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 15 di 65

From: [email protected] [mailto: [email protected] ] On Behalf Of [email protected] Sent: Thursday, February 10, 2011 3:08 PM To: [email protected] Subject: Re: [vasculab] Lymphatic Group: vasculab Message: 4166 From: bblee Date: 11/02/2011 Subject: Re: Lymphatic Dear Prof. Antignani

Thanks for your information on Italian front.

Indeed, we still consider Professor Edmundo Malan's pioneering work in the field of vascular malformation/angiodysplasia as a landmark contribution so that it is NOT a surprising news at all to hear from Italian group on such leading concept to combine the venous and lymphatic disorders.

Here in this side of the Atlantic, we barely start to accept this new approach, and a new phlebology curriculum Dr. Steve Zimmet is currently organizing in behalf of American Board of Phlebology for the training included 'phlebolymphedema' as a separate independent subject.

All the best,

BB Lee

From: [email protected] [mailto: [email protected] ] On Behalf Of Pier Luigi Antignani Sent: Friday, February 11, 2011 3:54 AM To: [email protected] Subject: R: [vasculab] Lymphatic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 16 di 65

We work in Italy from many years both in the management and treatment of lymphatic dysplasias and primary and secondary lymphoedema.

In our national congress we often organize some session on this toipics.

All the best

PLA Group: vasculab Message: 4167 From: [email protected] Date: 12/02/2011 Subject: Re: Lymphatic Dear Dr. Lee, Thank you very much for this information. All the best, Anne-Marie Vaillant-Newman Sent on the SprintÂ® Now Network from my BlackBerryÂ®

-----Original Message----- From: "bblee" < [email protected] Sender: [email protected] Date: Fri, 11 Feb 2011 15:06:20 To: < [email protected] Reply-To: [email protected] Subject: RE: [vasculab] Lymphatic Group: vasculab Message: 4168 From: Hirai Date: 12/02/2011 Subject: Re: Lymphatic Dear all,

I am a Japanese vascular surgeon and phlebologist. In Japan also lymphedema is a very major matter of concern for its prevention and treatment. We also treat many patients with lymphedema and present our papers in our national congress. However, as you know, the evidence is very few in treatment and prevention for lymphedema. Manual lymph drainage is effective for treatment or prevention of cancer-related lymphedema? Even if so, how about self-lymph drainage in the absence of therapist in outpatients clinic? What kind of compression therapy is selected, compression pressure, type, stiffnessãƒ»ãƒ»? Can patients with lymphedema apply the bandages by themselves with precise compression manner? What kind of exercise under compression is recommended and inhibited in outpatients? Do all patients with lymphedema always need the therapy for

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 17 di 65

lymphedema (prognosis of lymphedema)? How acts the venous system in lymphedema?Â Etc. ãƒ»ãƒ» We can read many literatures in the world, but we do not know the concrete treatment and prevention for each patient.

I hope phlebologists and lymphologists in the world can discuss about these topics. Even if the evidence is few, we may obtain the useful judging materials from the discussion. I hope to learn many from them, which are useful in clinical practice.

All the best

Masafumi Hirai, MD

Department of Vascular Surgery

Tohkai Hospital.

e-mail: [email protected]

Group: vasculab Message: 4170 From: [email protected] Date: 12/02/2011 Subject: R: [vasculab] Lymphatic Dear All

I agree with your suggestion about Lymphedema and Phledema . I demonstrated with Bartolo in human and vivo with the videocapillaroscopy and measuring the intralymphatic pressure and interstitial pressure , that the chronici edema in CVD is always a phlebolymphedema. If you like I can send you this video and results. I have not the e-mail address of Nick Morrison, please inform him.

All the best

Claudio Allegra

Da: [email protected] [mailto:[email protected]] Per conto di bblee Inviato: giovedÃ¬ 10 febbraio 2011 20.22

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 18 di 65

A: [email protected] Oggetto: RE: [vasculab] Lymphatic

Dear All,

I forgot to mention on such critical role of ACP played to bring the lymphedema into the main stream of the phlebologists here in the U.S. through years.

And no doubt ACP will continue to advocate it under Nick's leadership.

Indeed, Nick has been giving unlimited support to this critical issue through years and he will do more through 2013 IUP World Congress in Boston.

All the best,

BB Lee

From: [email protected] [mailto:[email protected]] On Behalf Of Nick Morrison Sent: Thursday, February 10, 2011 11:46 AM To: [email protected] Subject: Re: [vasculab] Lymphatic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 19 di 65

Best regards, Nick Morrison, MD Organizing Chair, UIP 2013

--- On Thu, 2/10/11, Dr.D.Eckert < [email protected] wrote:

From: Dr.D.Eckert < [email protected] Subject: Re: [vasculab] MEVc Course To: [email protected] Date: Thursday, February 10, 2011, 6:35 AM Group: vasculab Message: 4172 From: mauroand Date: 12/02/2011 Subject: Re: Lymphatic Dear BB and all.

IÂ´m just learning from all our Vasculab friends in phleblogical issues. Through all these years, phlebological concepts coming from Europe have been most helpful in clinical practice and last congress in Monaco was really striking in scientific achievements in such important field. Lymphology has seen a remarkable growing in its importance during the last few years and we owe a lot to the continuous efforts BBLee has offered us for such a long time.Â I just hope our next meeting to bring te deserved space to the lymphatics so we can all profit from all our lymphological members. Congratulations to Vasculab to permit and acknowledge the lymphatics into this ever intriguing phlebological discussion. My best wishes, Mauro Andrade Past president ISL

Em 11/02/2011 18:21, bblee < [email protected]

Dear Prof. Antignani

Thanks for your information on Italian front.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 20 di 65

group on such leading concept to combine the venous and lymphatic disorders.

All the best,

BB Lee

From: [email protected] [mailto:[email protected]] On Behalf Of Pier Luigi Antignani Sent: Friday, February 11 , 2011 3:54 AM To: [email protected] Subject: R: [vasculab] Lymphatic

We work in Italy from many years both in the management and treatment of lymphatic dysplasias and primary and secondary lymphoedema.

In our national congress we often organize some session on this toipics.

All the best

PLA

Group: vasculab Message: 4173 From: Dr.D.Eckert Date: 13/02/2011 Subject: Re: Lymphatic Dear Mr. Allegra!

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 21 di 65

I would like to have the video and the results You mean! It would be gteat! Thank You very mutch for!

Dr. Daniela Eckert Hagenow/Germany

Group: vasculab Message: 4175 From: Julio Ferreira Date: 13/02/2011 Subject: Re: R: [vasculab] Lymphatic Dear Prof Allegra I'll really appreciate if you send also for me a copy. Kind regards Julio

Sent by my iPhone 3G Dr Julio H G Ferreira [email protected] http://www.ibf.med.b

Group: vasculab Message: 4176 From: bblee Date: 13/02/2011 Subject: Re: Lymphatic Dear All,

We are eager to share such critical evidence on the inseparable CVI and CLI(Chronic lymphatic insufficiency) established by Prof. Allegra with the colleagues through years.

Indeed, Prof. Allegra kindly provided one separate chapter on this issue based on his work with fluorescent microlymphagiography to Lymphedema Compendium which will be soon to be published.

We do look forward to learning more in this issue from him through Vasculab.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 22 di 65

All the best,

From: [email protected] [mailto: [email protected] ] Sent: Saturday, February 12, 2011 1:06 PM To: [email protected] ; BB Lee PhDr (BB Lee PhDr) Subject: R: [vasculab] Lymphatic Group: vasculab Message: 4177 From: bblee Date: 13/02/2011 Subject: Re: Lymphatic Dear All

Delighted to know such influential leader in lymphology like Prof. Andrade of Sao Paolo showing his interest to support our effort for match making between two big groups of the phlebology and lymphology through Vasculab.

Indeed, Prof. Andrade led UIP Consensus (2009) in primary lymphedema with us giving a critical support to convince the phlebologists on inseparable relationship with the lymphatic disorder as de facto leader/scholar in the lymphology field as past president of ISL.

I am eager to welcome Prof. Andrade to chip in to this grassroots' movement(?) to lead other lymphology senior colleagues to join to a free chat(?) through Vasculab with their cousin phlebologists without any pressure.

All the best,

BB Lee

George Washington University

P.S. We, Georgetown University Vascular Surgery Division team moved altogether to George Washington University here in Washington DC from Jan 2011 and consolidated both programs to organize the best team of vascular surgery in Nation's Capital

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 23 di 65

based on George Washington University now. And I will continue to serve as Director of newly organizing Center for Vein, Lymphatics and Vascular Malformations with this new team for worldwide services.

From: [email protected] [mailto: [email protected] ] On Behalf Of mauroand Sent: Saturday, February 12, 2011 1:14 PM To: [email protected] Subject: Re: RE: [vasculab] Lymphatic Group: vasculab Message: 4178 From: jane wigg Date: 13/02/2011 Subject: Re: Lymphatic Dear Sir, I would love to have the results. As a practitioner, I also lecture on chronic/lymphoedema and would like to be able to use this information with your consent. I teach a lymphoedema degree at Wolverhampton university in the UK and at the Royal Marsden Hospital. My training school is Leduc UK (the UK School for the Leduc method). May thanks Jane Wigg

Group: vasculab Message: 4179 From: Horst Rieger Date: 13/02/2011 Subject: Re: R: [vasculab] Lymphatic Hallo Claudio,

Do you remember me â€“ Horst Rieger â€“?

As you probably know I have retired since nearly 7 years ans I am no longer active in scientific medicine.

Two times a week I work as a practitioner associated with the university of Cologne together with a cardiologist and a pneumologist. It runs really good.

My question: who is actually the president of the Italian Society of Angiology and Vascular Medicine. Details later. With warm regards and hoping you are well

Prof. Horst Rieger

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 24 di 65

From: [email protected] Sent: Saturday, February 12, 2011 7:06 PM To: [email protected] ; BB Lee PhDr (BB Lee PhDr) Subject: R: [vasculab] Lymphatic

Dear All

All the best

Claudio Allegra

Da: [email protected] [mailto:[email protected]] Per conto di bblee Inviato: giovedÃ¬ 10 febbraio 2011 20.22 A: [email protected] Oggetto: RE: [vasculab] Lymphatic

Dear All,

I forgot to mention on such critical role of ACP played to bring the lymphedema into the main stream of the phlebologists here in the U.S. through years.

And no doubt ACP will continue to advocate it under Nick's leadership.

Indeed, Nick has been giving unlimited support to this critical issue through years and he will do more through 2013 IUP World Congress in Boston.

All the best,

BB Lee

From: [email protected] [mailto:[email protected]] On Behalf Of Nick Morrison Sent: Thursday, February 10, 2011 11:46 AM To: [email protected] Subject: Re: [vasculab] Lymphatic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 25 di 65

--- On Thu, 2/10/11, Dr.D.Eckert < mailto:ticap%40t-online.de wrote:

From: Dr.D.Eckert < mailto:ticap%40t-online.de Re: [vasculab] MEVc Course To: mailto:vasculab%40yahoogroups.com Date: Thursday, February 10, 2011, 6:35 AM Group: vasculab Message: 4180 From: Armer, Jane Date: 13/02/2011 Subject: Re: Lymphatic I would also be very interested to see the video on phlebolymphedema. My best, Jane M. Armer, PhD, RN, FAAN Professor, Sinclair School of Nursing Director, Nursing Research, Ellis Fischel Cancer Center Director, American Lymphedema Framework Project Phone 573-882-0287

______From: jane wigg < [email protected] Sent: Sunday, February 13, 2011 2:49 PM To: [email protected] < [email protected] Subject: Re: [vasculab] Lymphatic Group: vasculab Message: 4181 From: [email protected] Date: 13/02/2011 Subject: Rif: RE: RE: [vasculab] Lymphatic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 26 di 65

Dear All, the fact that phlebedema is always intermingled with lymphedema and viceversa looks to fill everybody with enthusiasm. An historical question: who firstly introduced the concept and term of phlebolymphedema? AT the best of my "mnemonic power", they were Attilio Cavezzi and Sandro Michelini which wrote a very exhaustive book entitled "Phlebolymphedema" since 1997. Did someone published the term phlebolymphedema before them? Alberto Caggiati Group: vasculab Message: 4182 From: [email protected] Date: 14/02/2011 Subject: R: Rif: RE: RE: [vasculab] Lymphatic Dear Alberto,

tracing my history, I find:

SEMEIOTICA ULTRASUONOGRAFICA DELLE ALTERAZIONI LINFATICHE NELL'ARTO INFERIORE. (Ultrasound Semiotics of Lymphatic Disorders of the Lower Limb)

Fausto Passariello, Raffaele Carbone, Antonella Mancini SOCIETA' ITALIANA OPERATORI C.H.I.V.A. - Sede NAPOLI 02

MINERVA ANGIOLOGICA Aprile Giugno 1991 , Vol. 16, Suppl. 1 al N. 2, pp. 453-457

An HTML (italian) version is available on line at

http://web.tiscali.it/afunc/chivaref/passarie/linfo.htm

Sorry for the Italian language.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 27 di 65

Both the cited article and Cavezzi/Michelini's book are in Italian.

Though not a book, my article has 2 important requisites:

1. It introduced in Italy the ultrasound investigation of the lymphatic limb. I say in Italy because I learned it in France in 1987, working with the wonderful team of Claude Franceschi. 2. It was the first publicationwhere the hypothesis of mixed phlebo- lymphatic pictures was formulated. In the same article there is also the description of the lymphatic-venous intersection, with some details on the possible physiopathology.

Regards

Fausto Passariello

----Messaggio originale---- Da: [email protected] Data: 13/02/2011 22.19 A:

Supera i limiti: raddoppia la velocitÃ da 10 a 20 Mega! Risparmia con Tutto Incluso: telefono + adsl 20 mega a soli 29,95 â‚¬ al mese per due anni! SCONTO DI 240 EURO! http://abbonati.tiscali.it/telefono-adsl/prodotti/tc/tuttoincluso/?WT.mc_id=01fw

Group: vasculab Message: 4183 From: Alessandro Pieri Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Dear all

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 28 di 65

I would like to spend some words about edema: C3 ceap is indeed mistifying about edema because it is not only espression of CVI but of many diseases. The clinical pattern of lymphedema is quite different because of Stemmer sign and of it's clinical history. Echography cannot distinguish the reasons of edema because the pattern is always the same . It is obviuos that in any case venous insufficiency transfers to lymph as a collateral pathway but venous insufficiency may be related to heart failure, pulmonary hypertension, protein deficit, muscular failure , chronic limb ischemia and so on. The result is always interstitial patency indipendetely from the first cause. So I think that the term phebolymphedema has no clinical meaning because it is obvious and only espression of a physiological transfer.

alessandro pieri

Inviato da iPad pieri alessandro

Il giorno 13/feb/2011, alle ore 22.19, [email protected] ha scritto:

Group: vasculab Message: 4184 From: bblee Date: 14/02/2011 Subject: Re: Lymphatic Correct, Alberto.

BB Lee

From: [email protected] [mailto: [email protected] ] On Behalf Of [email protected] Sent: Sunday, February 13, 2011 4:20 PM To: [email protected]

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 29 di 65

Cc: [email protected] Subject: Rif: RE: RE: [vasculab] Lymphatic Group: vasculab Message: 4185 From: bblee Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Dear Fausto,

As Alberto mentioned, the term of "phlebolymphedema" has been officially(?) used by Cavezzi and Michelini as the title of their monograph in 1998.

But before those mixed condition was officially christened to the 'phlebolymphedema' by Attilio and Sandro, this unique condition has already been fully accepted among the vascular malformation specialists for more than two decades along the management of Klippel Trenaunay Syndrome. More specifically, such combined form of the venous and lymphatic malformation to cause 'primary phlebolymphedema' was classified to the hemolymphatic malformation' since 1988 following the Hamburg workshop.

Indeed, for almost two decades, we adopted similar principle of CHIVA to the KTS patients with the phlebolymphedema leg ulcer for more logical management of the CVI by the marginal/lateral embryonic vein combined with the CLI by the LM.

Hence we invited Paolo Zamboni and Claudio Franceschi to write one subchapter of the phlebolymphedema to imply his unique principle for the phlebolymphedema - Attilio wrote for the secondary phlebolymphedema- in Lymphedema Compendium soon to be published.

Warm regards,

From: [email protected] [mailto: [email protected] ] On Behalf Of [email protected] Sent: Sunday, February 13, 2011 7:09 PM To: [email protected] Subject: R: Rif: RE: RE: [vasculab] Lymphatic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 30 di 65

Dear Alberto,

tracing my history, I find:

SEMEIOTICA ULTRASUONOGRAFICA DELLE ALTERAZIONI LINFATICHE NELL'ARTO INFERIORE.

(Ultrasound Semiotics of Lymphatic Disorders of the Lower Limb)

Fausto Passariello, Raffaele Carbone, Antonella Mancini

SOCIETA' ITALIANA OPERATORI C.H.I.V.A. - Sede NAPOLI 02

MINERVA ANGIOLOGICA

Aprile Giugno 1991, Vol. 16, Suppl. 1 al N. 2, pp. 453-457

An HTML (italian) version is available on line at

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 31 di 65

http://web.tiscali.it/afunc/chivaref/passarie/linfo.htm

Sorry for the Italian language.

Both the cited article and Cavezzi/Michelini's book are in Italian. Group: vasculab Message: 4186 From: bblee Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Dear Professor Pieri

We have a different view as well as prospect from what you claim.

We have a compelled reason to claim the phlebolymphedema as an independent issue from either CVI or CLI/lymphedma, based on our experience with the 'primary' phlebolymphedema among the hemolymphatic malformation-combined form of the venous and lymphatic malformation- patient.

Indeed, we learned such striking difference between the 'primary' and 'secondary' phlebolymphedema not only on their management but also the prognosis.

As you correctly pointed out there are so many different causes/pathogeneses of the CVI as well as CLI. But clinically, not all the CVI causes CLI and visa versa even among the primary phlebolymphedema.

I wonder how many phlebologists believed the CVI will precipitate the CLI before Seshadri Raju and Peter Neglen proved this secondary PLE based on their experience with the iliac vein trhmbosis/stenosis?

Anyhow, Before we adopted the term of 'phlebolymphedema' for the official (?) use, especially before the UIP Consensus (2009) for

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 32 di 65

the phlebolymphedema, we did make quite a soul search to make sure it will be timely and legitimate claim to bring to the main stream of the phlebology.

And new training curriculum for the phlebology led by Dr. Steve Zimmet of American Board of Phlebology also adopted this PLE as well.

Respectfully,

BB Lee

Professor of Vascular Surgery, George Washington University.

From: [email protected] [mailto: [email protected] ] On Behalf Of Alessandro Pieri Sent: Sunday, February 13, 2011 6:42 PM To: [email protected] Subject: Re: Rif: RE: RE: [vasculab] Lymphatic

Dear all

I would like to spend some words about edema: Group: vasculab Message: 4187 From: Leonardo Corcos Date: 14/02/2011 Subject: Re: Lymphatic Dearest Alberto and all, I would like to remind you that in 1986 Prof. I. Donini and many of us founded the Italian Society of Phlebolymphology. Why ? Please visit the web and search for www.SIFL.it .

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 33 di 65

Leonardo Corcos

Group: vasculab Message: 4188 From: [email protected] Date: 14/02/2011 Subject: Re: Lymphatic Dear all: I am so surprised to find so many people interested in phlebolymphedema! It's great! In Spain we need to improve the knowlegde about all these patologies, as patients with lower limb lymphedema are diagnosed a mean of 13 years after the onset of the symptoms. Can I have the video? Kind regards, Isabel

Isabel Forner-Cordero, MD, PhD. Lymphedema Unit, Univeristy Hospital La Fe. Valencia, SPAIN. [email protected]

Group: vasculab Message: 4189 From: Alberto Caggiati Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic ï»¿ Dear Sandro, Dear All, initial lymphatics and venuale are not to be considered to work like simple " communicating vessels " and interstitial pressure is not the only regulator of fluid shifting between initial lymphatics and venulae. In fact, not all what enters lymphatics can enter also into venules and vicerversa. Not all interstitial fluid produced by venous stasis can be drained by initial lymphatics, and so on. From the histological point of view, it was well described that no damage of lymphatics occurs in C3 legs, and that lymphatics damaging (dilation, thrombosis, etc) occurs only in advanced C4b legs (lipodermatosclerosis). All this probably means that lymphatic drainage is not a mere subsidiary of the venous one. ALberto.

Group: vasculab Message: 4190 From: Hugo Partsch Date: 14/02/2011 Subject: Re: Lymphatic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 34 di 65

Dear Alberto, as far I know it was Henrik van der Molen who introduced the term "chronic venous insufficiency" (Ãœber die chronische venÃ¶se Insuffizienz. Verhandlungen der Deutschen Gesellschaft fÃ¼r Venenerkrankungen. Schattauer, Stuttgart 1957, pp41-59) and I still remember that he also preached the term "chronic lymphatico-venous insufficiency", especially in connection with the postthrombotic syndrome. This is also quoted by H. Haid as a "personal communication (1972)" in his book Venenerkrankungen , 5th edition , G. Thieme 1985, p 250 and may have been influenced by our scintigraphic demonstration of a disturbed subfascial lymphatic drainage in patients with possthrombotic syndrome . (Haid H, Lofferer O, Mostbeck A, Partsch H.[Lymph kinetics in the postthrombotic syndrome under compression bandages. Med Klin. 1968. May 10;63(19): 754-7]

In the report from the 3rd International Congress of Phlebology in Amsterdam 1968 (Ed HR van der Molen, J. van Limborgh, W. Boersma, Ã‰dition Stenvert Zoon, Apeldoorn, NL) there is a whole bunch of papers dealing with the involvement of veins and lymphatics in chronic oedema, at that time mainly demostrated by phlebography and lymphography. It was the merit of Attilio Cavezzi togeter with Sandro Michelini to use the term Phlebolymphoedema for an entity which today is frequently called "chronic oedema" as the title of a remarkable book containig numerous impressive clinical examples (edizioni PR 1998). Kind regards, Hugo Partsch

[email protected] Group: vasculab Message: 4191 From: bblee Date: 14/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Thanks, Alberto.

One question!

How much this anatomical/histological status would have a clinical significance on current CEAP classification? Is it meaningful to link with clinical status?

Regards,

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 35 di 65

From: [email protected] [mailto: [email protected] ] On Behalf Of Alberto Caggiati Sent: Monday, February 14, 2011 10:32 AM To: [email protected] Subject: Re: Rif: RE: RE: [vasculab] Lymphatic

Dear Sandro, Dear All,

initial lymphatics and venuale are not to be considered to work like simple "communicating vessels" and interstitial pressure is not the only regulator of fluid shifting between initial lymphatics and venulae. In fact, not all what enters lymphatics can enter also into venules and vicerversa. Not all interstitial fluid produced by venous stasis can be drained by initial lymphatics, and so on.

From the histological point of view, it was well described that no damage of lymphatics occurs in C3 legs, and that lymphatics damaging (dilation, thrombosis, etc) occurs only in advanced C4b legs (lipodermatosclerosis).

All this probably means that lymphatic drainage is not a mere subsidiary of the venous one.

ALberto. Group: vasculab Message: 4192 From: bblee Date: 14/02/2011 Subject: Re: Lymphatic Hugo,

Delighted to hear such invaluable historical background especially in German speaking society.

So such concept has been documented way back in 1957.

Fantastic!

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 36 di 65

Warm regards,

From: [email protected] [mailto: [email protected] ] On Behalf Of Hugo Partsch Sent: Monday, February 14, 2011 3:47 PM To: [email protected] Subject: Re: RE: RE: [vasculab] Lymphatic

Dear Alberto, as far I know it was Henrik van der Molen who introduced the term "chronic venous insufficiency" Group: vasculab Message: 4193 From: [email protected] Date: 15/02/2011 Subject: Re: Lymphatic Attachments :

Dear All,

Chronic venous insufficiency (CVI) has been around a long time certainly long before Henrik van der Molen used the term in 1957. (see below).

If fact it goes well back in time to easily 1500 BC and as far back as 4000 BC. . Insufficient varicose veins are recorded in antiquity on the Ebers' Papyrus scribed during Egyptâ€™s Pharaoh Amenhotepâ€™s rule dated 1550 BC. The papyrus details serpentine dilatations involving the lower limbs.

Here is a part of the relevant section of the Papyrus:

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 37 di 65

Here is an etching of that time - translation of the hieroglyphics above, showing women applying salves to patients with CVI leg ulcers.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 38 di 65

It was further described by Asclepius and is observable on a votive dated 1200 BC In this votive the large leg and the distended vein are obvious. Dr. Amynos scribed clear varicosities and an enlarged leg carried by Asclepius the "God of Medicine" on the Acropolis Tablet in the 4 th century BC.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 39 di 65

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 40 di 65

In fact varicose vein records can be discovered back to at least 4,000 BC.

Some relevant history might be useful: Lest we not forget what we have learned in the past.

As the great writer Mark Twain once said, "history might not repeat itself but it does tend to rhyme."

All of these physicians recognized that when supine the veins went away whereas while standing they bulged and were obviously affected by gravity. But Newton did not appear until the 1600s, so they were unaware of the gravity effects on fluids in blood vessels with refluxing valves. It was perhaps an unexplained observation during these early times.

Hippocrates between 460â€“377 BC noted that standing aggravated lower limb ulcers. There are credible reports he cauterized varicose veins with hot irons and was the first to link refluxing varicose veins and ulcers. It could be claimed that Dr. Hippocrates was the first surgeon to complete an early derivative of minimally invasive endovenous vein ablation surgery but with no anesthetic of any sort. Ouch!

Around the time of Christ, Aurelius Cornelius Celsius (53 B.C.- 7 A.D.) described varicose vein excision in detail. He performed staggered incisions, cauterized the vein ends and removed the then possible amount of vessels; this amounts to an ancient forerunner of the staggered incisions and venous avulsions (microphlebotomy) used today in certain venous surgeries.

More than 100 years later, Claudius Galenus (130-200 A.D.) stripped dilated veins between two ligations with a hook and applied wine to the wounds. He figured out alcohol was a good antiseptic. And what was left over, well it made a good beverage. Thus the invention of surgical venous ligation is attributed to Galenus.

In 199 AD the great physician by then revered as Galen of Pergamum re-described varicose veins with greater precision.

The world soon after entered the dark ages of semi continuous war, death, religious and royal persecution and pestilence and scientific stagnation for nearly two millennia, meanwhile many died. Fearful, then untreatable diseases such as: typhus, plague, syphilis, tuberculosis, dysentery, pneumonia, malaria, measles, diphtheria, infection etc were on the rise and took a grim toll on humanity since in those dark days antibiotics or vaccines had not been invented. One problem was Hippocratesâ€™ Corpus â€“ a vast edifice of work spanning 34 volumes with 60 parts - the last entries of which were written in 150 BC. Since Hippocrates died in 377 BC it is clear he did not write the entire Corpus. But the Middle Ages used the Corpus as dictum and all disease was ascribed to imbalances of Hippocratesâ€™ Four Humors: earth, air, fire, and water. The essential concept was that the corpus identified manâ€™s four humors as black bile, blood, yellow bile, and phlegm. All of these humors had to be perfectly balanced at all times and had to possess an infinitely adaptable pattern to fit with: the seasons, the wind, the elements, and in due course the Evangelists. Any imbalances caused disease. Clearly, these incorrect dictates held back medicine for nearly two millennia.

Things improved somewhat in 1525 when Ambrose ParÃ© concerned about violating the Corpus, described compression bandages from the foot to the knee for managing weeping skin ulcers of the ankle.

In 1585 Fabrice d'Acquapendente was the first to publish a description of venous valves.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 41 di 65

Almost a hundred years later the great mathematician Sir Isaac Newton published his gravity theories around 1666 and following that, physicians began to understand the effect gravity had on veins, vein valves which had failed and their disorders.

In 1676, Dr. Wiseman aware of Newtonâ€™s thunderous gravity postulates, invented the first supportive stockings made of leather and nearly two hundred years later in 1854; Viennaâ€™s famous Dr. Unna described a venous supportive boot, which now carries his name, â€œthe Unna Bootâ€ widely prescribed today in the conservative management of venous stasis ulcers. It is probable the last Tudor King of England, the obese Henry Vlll had chronic venous insufficiency since he was known to have venous stasis ankle ulcers and wore ParÃ© style bandages for years preceding his death in 1547.

In 1682 Dr. Zollikofer (Switzerland) was the first recorded physician to use sclerotherapy for chronically insufficient varicose veins. Though not detailed he is said to have used an acid - in those days that would most likely be carbolic acid. That would likely work very well. But it might sclerose the entire patient.

The Swedish scientist Anders Celsius also recommended the use of banding for leg ulcers. He was a scientist who not only invented the temperature scale we know, but he studied carefully the effect of pressure. He was right.

Chronic venous insufficiency has been recognized and described for thousands of years.

John Opie MD.

In a message dated 2/14/2011 2:49:05 P.M. US Mountain Standard Time, [email protected] writes: Group: vasculab Message: 4194 From: claude franceschi Date: 15/02/2011 Subject: Re: Lymphatic Dear all, Since venous physipathology is still controversial and In order to avoid any misunderstanding,Â who would be so kind as to answer the following questions: 1/ Is Phlebolymphoedema supposed to be a mix of lymphatic and venous edema.Â 2/ Association or Â inter-causality? Pathophysiologic experimental evidences? Theoretical model? experimental data? 3/ Clinical assessment: mix of venous and venous signs? More? less? 4/ Instrumental assessment? US, Lymphogram? Other? 5/ Histological evidences: which?Â Thank you very much

2011/2/14 Hugo Partsch

Group: vasculab Message: 4195 From: [email protected] Date: 15/02/2011 Subject: Rif: Re: RE: RE: [vasculab] Lymphatic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 42 di 65

Dear Hugo, and All thanks for he fascinating historical review on phlebo-lymphedema. Unfortunately, most of what described by not-English speaking phlebologists from mid 20th Century did not diffused worldwide, even due to the absence of Internet. If we could read what our fathers wrote, probably we could make better researches. Thanks again to Hugo Alberto

------

ï»¿ Dear BB, you overestimate my scientific capacity. I believe lymphatic impairment accompanies severe skin changes but I have no experience in how to demonstrate it. Attached just a few contributions from the German-language phlebological and lymphological schools which partially reply to Claude questions, too. I believe in them, since other Authors do not demonstrate the contrary.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 43 di 65

In 1982, Bolliger wrote: The lymphatic capillary network was visualized by fluorescence microlymphography ... In severe CVI leading to trophical changes of the skin lymphatic microangiopathy was detected. Obliterations of parts of the superficial capillary network, phenomena of cutaneous reflux and increased permeability of capillary fragments occurred. These findings contrast to primary lymphedema where the rete remains intact in most cases (Lymphology 1982; 15: 60-5).

In 1993 Franzeck wrote:In severe stages of CVI, the lymphatic capillary network at the medial ankle area is destroyed, and the remaining lymphatic capillary fragments have an increased permeability to FITC-dextran with a molecular weight of 150,000. These findings demonstrate a special lymphatic microangiopathy in CVI, suggesting an additional lymphatic component in the edema formation (Yale J Biol Med 1993;66:37-46)

Leu, 1995 wrote about lymphatics and CVI:

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 44 di 65

Group: vasculab Message: 4197 From: Ermes Pasqual Date: 15/02/2011 Subject: Ogg:Phlebolyphedema term It is o.k. to move the issue of lynphedema from semantics field to phisiopathologic field.By the way I remember "Il Sistem Linfatico nella pratica clinica"Battezzati-Donini printed in Italy 1967 by Piccin Editore on page 203.Thanks Ermes Pasqual.

Group: vasculab Message: 4198 From: Hugo Partsch Date: 15/02/2011

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 45 di 65

Subject: Re: Lymphatic failure and CEAP Dear Alberto, Your knowledge of literature is amazing. Just one tiny point: You probably mean Alfred BOLLINGER from Zurich who is still very active as a novelist (-and not the late Alfred Bolliger who was the presÃdent of the Swiss Phlebological Society.) As a report from an International meeting we have published a booklet: Bollinger A, Partsch H, Wolfe JHN. The Initial Lymphatics. G. Thieme , 1984 , in which we described " dermal lymphangiopathy" in C3- C6 patients by microlymphangiography and by indirect lymphography. Best regards, Hugo

Prof. Dr. Hugo Partsch Baumeistergasse 85 A 1160 Wien Austria Tel. 00431 4855853 FAX 00431 4800304 [email protected] Group: vasculab Message: 4199 From: Waldemar L. Olszewski Date: 15/02/2011 Subject: Re: Lymphatic failure and CEAP Attachments :

Dear All,

1. Chronic venous insufficiency( CVI) Â WITHOUT skin changes is characterized by high hydrostatic pressure, subsequently increased capillary filtration pressure in all tissues and in effect Â higher than normal tissue fluid/lymph (TF/L) formation. Â This increased TF/L volume.is transported away by lymphatics. Consequently, lymph flow in collecting vessels becomes accelerates. On lymphoscintigraphy the tracer is eliminated much faster than in normal conditions. It reachesÂ in an upright position without movementsÂ the inguinal lymph nodes in 10-15 minutes, with Â normal values of 20-30 minutes, . 2. ChronicÂ venous insufficiency WITH skin changes (skin induration, pigmentation etc) is characterized by decreased number of lymphatic capillaries in the subepidermal plexus. The main collectors are not affected until it comes to formation of an ulcer. The lymphoscintigraphic picture is not much different from that of non-complicated CVI.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 46 di 65

3. Once ulcer forms and is accompanied by adjacent skin inflammation, collecting vessels dilate, the inguinal and sometimes iliac lymph nodes swell. This can be observed on lymphoscintigrams for months or years. This also means that there is a continuous inflammatory process affecting limb immune system. 4.In course of time, especially in cases with non-healing ulcers, we see on lymphoscintigrams fragmentation of lymphatic pathways and decrease in size and change to moth-bitten shape of lymph nodes. This is the phase of impaired TF/L transport and lymphatic stasis (edema) superimposes upon venous edema. I have studied these events using lymphangiography and now lymphoscintigraphy as well as local color lymphography and of course histology with specific staining of lymphatics with anti LYVE1 antigen specific for lymphatic endothelial cells and lymph node bacteriology Together, CVI is followed by increased TF/L formation and flow sometimes surpassing the transport capacity of collecting lymphatics. Damage to lymphatics at subepidermal level and collectors is observed in very late stages only. Venous ulcer evoke local immune reaction reflected for long periods in the regional lymph nodes. The most fascinating is the lymph node reaction to the ulcer even when the bacteriological culture is negative. We now carry out a project on the local autoimmune reaction to the non-healing ulcer.

Greetings Waldemar L Olszewski.Â l 2011/2/15 Alberto Caggiati

Good medical history review!

Enjoyed very much.

BB Lee

From: [email protected] [mailto: [email protected] ] On Behalf Of [email protected]

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 47 di 65

Sent: Monday, February 14, 2011 6:52 PM To: [email protected] Subject: Re: [vasculab] Lymphatic

Dear All,

Chronic venous insufficiency (CVI) has been around a long time certainly long before Henrik van der Molen used the term in 1957. (see below).

John Opie MD. Group: vasculab Message: 4201 From: [email protected] Date: 15/02/2011 Subject: R: Re: [vasculab] Lymphatic failure and CEAP Attachments :

Dear Prof Olszewski,

what a fascinating series of experimental results !!!

I thank you very much for having started this interesting discussion.

Fausto Passariello Vasculab Moderator

Supera i limiti: raddoppia la velocitÃ da 10 a 20 Mega! Risparmia con Tutto Incluso: telefono + adsl 20 mega a soli 29,95 â‚¬ al mese per due anni! SCONTO DI 240 EURO!

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 48 di 65

http://abbonati.tiscali.it/telefono-adsl/prodotti/tc/tuttoincluso/?WT.mc_id=01fw

Group: vasculab Message: 4202 From: Alessandro Pieri Date: 16/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Dear Professor Lee, Your remarks are, as usually, correct but I fear the abuse of the term PLE. Lipodermatosclerosis following dvt or superficial venous insufficiency are obviuos but do not appear in all the cases. Perhaps chronic sub clinical lymphoedema is underlying in those cases. As an example we can consider the clinical reply to Calcium antagonists: only in a percent of cases there is a lymphoedema reversed by their discontinuation. May be that they would be considered as a mean to predict chronic sub clinical lymphatic insufficiency ?

I think that a correct definition of PLE is still missed.

Thank for Your observation Alessandro pieri

Inviato da iPad pieri alessandro

Il giorno 14/feb/2011, alle ore 04.54, "bblee" < [email protected] Group: vasculab Message: 4203 From: claude franceschi Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Pr Waldemar L. Olszewski , congratulations for such a rational model based on experimental findings. I'm sure it could be a very good basis for discussion and further studies! Cordialement

2011/2/15 < [email protected] Group: vasculab Message: 4204 From: Robert A Weiss Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 49 di 65

Thank you Dr. Olszewiski for your logical and scientific summary. It seems like the lymphatic system helps to purge or transport fluid formation regardless of etiology and so becomes intricately involved with chronic venous insufficiency . Thanks for your scholarly explanation. And thanks to Dr. Partsch for the elegant, erudite and elucidating history of lymphedema. Thanks to all for their academic contributions. It is really instructive for me to follow this discussion group with the worldÃ¢Â€Â™s venous and lymphatic experts weighing in with their opinions. Cheers to all,

Robert A. Weiss, MD Associate Professor, Johns Hopkins U School of Medicine Director, MD Laser Skin & Vein Institute 54 Scott Adam Road Hunt Valley (Baltimore), MD 21030 | O 410-666-3960 | F 410-666-0203

[email protected]

From: [email protected] [mailto: [email protected] ] On Behalf Of Waldemar L. Olszewski Sent: Tuesday, February 15, 2011 9:29 AM To: [email protected] Subject: Re: [vasculab] Lymphatic failure and CEAP Group: vasculab Message: 4205 From: bblee Date: 16/02/2011 Subject: Re: Lymphatic Dear Claudio

We do have a plenty of information on various issues you raised as below among the Primary Phlebolymphedema (PLE) caused by Hemolymphatic Malformation as a clinical manifestation of Klippel Trenaunay Syndrome.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 50 di 65

But not many colleagues especially among the phlebologists are interested in this unique issue of 'primary' PLE, so that this format wouldn't be proper to spend too much time.

Warm regards,

P.S. New Lymphedema Compendium dedicated one independent chapter for the PLE including your elegant pathophysiology review besides both primary as well as secondary type and the PLE-induced ulcers, soon to be published.

From: [email protected] [mailto: [email protected] ] On Behalf Of claude franceschi Sent: Monday, February 14, 2011 7:26 PM To: [email protected] Subject: Re: RE: RE: [vasculab] Lymphatic

Dear all,

Since venous physipathology is still controversial and In order to avoid any misunderstanding, who would be so kind as to answer the following questions:

1/ Is Phlebolymphoedema supposed to be a mix of lymphatic and venous edema.

2/ Association or inter-causality? Pathophysiologic experimental evidences?

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 51 di 65

Theoretical model? experimental data?

3/ Clinical assessment: mix of venous and venous signs? More? less?

4/ Instrumental assessment? US, Lymphogram? Other?

5/ Histological evidences: which?

Thank you very much Group: vasculab Message: 4206 From: bblee Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Dear Alberto

Thanks for such interesting article you kindly share with us.

Professor Bollinger- he is still active as before when I met him in Bern 2 years ago- initiated this intradermal lymphatic system appraisal with fluorescent microlymphangiography although Claudio Allegra brought it to main stream of the lymphology to teach us.

Indeed, it reminds me that we once tried ultrasonographic assessment of transdermal lymphatic circulation with 20 MHz transducer which Dutch group provided to the dermatologists as a 'dermal scan'. But soon abandoned due to too sensitive to interpret such delicate intradermal findings and furthermore, we also learned that the fluorescent microlymphangiography is more accurate than the US study.

Anyhow, Dr. Newton de Barros of U Sao Paolo published a beautiful PLE ulcer study with the lymphoscintigraphy lately to bring new attention on the secondary PLE to the phlebologists (Venous-lymphatic disease: lymphoscintigraphic abnormalities in venous ulcers: J Vasc Bras. 2009;8(1):33-42). And Phlebology -editor: Steven Zimmet- will soon publish one very intersting paper of iatrogenic lymphedema following the GSV stripping this year, bringing another whistle blow on such neglected link between the venous and lymphatic system.

All the best,

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 52 di 65

BB Lee

From: [email protected] [mailto: [email protected] ] On Behalf Of Alberto Caggiati Sent: Tuesday, February 15, 2011 4:59 AM To: [email protected] Subject: [vasculab] Lymphatic failure and CEAP

Ã¯Â»Â¿

Dear BB,

you overestimate my scientific capacity. I believe lymphatic impairment accompanies severe skin changes but I have no experience in how to demonstrate it. Group: vasculab Message: 4207 From: bblee Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Hugo,

Good to know more about this microlymphangiography you were involved way before we committed to the dermascan in 1994.

What was the major difference on the microlymphangiography findings among the C3 and C6, then?

Is this Alfred Bollinger the same gentleman Iris Baumgartner of Bern University studied?

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 53 di 65

Because, we still have a raw data of the dermal scan on C2 through C5, using US with 20 MHz we failed to interpret. Perhaps, we could get a chance to compare them, I hope.

Regards,

From: [email protected] [mailto: [email protected] ] On Behalf Of Hugo Partsch Sent: Tuesday, February 15, 2011 9:10 AM To: [email protected] Subject: Re: [vasculab] Lymphatic failure and CEAP

Dear Alberto, Your knowledge of literature is amazing. Just one tiny point: You probably mean Alfred BOLLINGER from Zurich who is still very active as a novelist (-and not the late Alfred Bolliger who was the presÃdent of the Swiss Phlebological Society.) Group: vasculab Message: 4208 From: bblee Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Great review, Waldemar.

So you think the current quality of ordinary lymphoscintigraphy using filtered sulfur colloid - do NOT mean antimony sulfur colloid- could define the progress/change of the dermal lymph flow/system?

Fascinating!

I had an access to a few unique data of the LSG findings related to the venous ulcer from Brazilian/Sao Paolo group lately. But the

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 54 di 65

quality was so poor that only gross stagnation/dermal backflow was identifiable.

Regards,

BB Lee

From: [email protected] [mailto: [email protected] ] On Behalf Of Waldemar L. Olszewski Sent: Tuesday, February 15, 2011 9:29 AM To: [email protected] Subject: Re: [vasculab] Lymphatic failure and CEAP Group: vasculab Message: 4209 From: bblee Date: 16/02/2011 Subject: Re: Rif: RE: RE: [vasculab] Lymphatic Dear Alberto

I am a plain vascular surgeon with very limited knowledge in basic pathophysiology but recently we felt more necessity of the bird's eye view on such mixed/combined condition of the CVI and CLI so that we adopted this relatively new term of PLE from European colleagues for our own use in this side of the Atlantic.

So we simply decided to define any clinical condition of CVI + CLI to the PLE and for one step further, we are currently classifying the PLE to primary and secondary PLE depending upon its etiology/pathogenesis.

Indeed, we carefully tried to bring up this PLE through UIP Consensus (2009) with fair response so that we decided to allocate one separate chapter for the PLE related four subchapters to newly organizing Lymphedema Compendium soon to be published.

Anyhow, Seshadri Raju's group of U Mississippi has very good data of secondary PLE although there are not many good papers to identify the secondary PLE initially started as CVI but subsequently complicated with the secondary CLI. Lately, Sao Paolo group shared quite convincing data of secondary PLE as I mentioned through previous communication.

But, such mixed condition of the CVI and CLI has been well known to the vascular malformation specialists through years, which we defined as primary PLE lately.

So there is no precondition of lipodermatosclerosis or post-thrombotic condition to be defined as either primary or secondary PLE in

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 55 di 65

our current view.

Hope we are not terribly wrong!

Regards,

BB Lee

From: [email protected] [mailto: [email protected] ] On Behalf Of Alessandro Pieri Sent: Tuesday, February 15, 2011 5:23 PM To: [email protected] Cc: < [email protected] Subject: Re: Rif: RE: RE: [vasculab] Lymphatic

Dear Professor Lee,

Your remarks are, as usually, correct but I fear the abuse of the term PLE. Group: vasculab Message: 4210 From: sur2 Date: 16/02/2011 Subject: Re: Lymphatic failure and CEAP Dear All, It has been intersting to follow the discussions on phlebo-lymphology. Since a visit by Prof.Neil Piller and teamfrom Australia to our institute in Novemebr 2010 we have been using techniques taught and seen significant changes in limb girth and ulcer healing. Dr.Edwin Stephen Vascular Surgery Department Christian Medical College, Vellore India Group: vasculab Message: 4211 From: [email protected] Date: 16/02/2011 Subject: R: [vasculab] Lymphatic failure and CEAP ï»¿ Dear B.B. and Hugo Alfred Bollinger is retired many years ago and actually he spend 10 months of the year in Stromboli Island. He worked in Zurich University in cardiology Group: vasculab Message: 4212 From: Alfred Bollinger Date: 16/02/2011

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 56 di 65

Subject: Re: Lymphatic failure and CEAP Attachments :

ï»¿ Dear Doctor Lee

since I am no more active in medical science - it was a great pleasure to know you and to listen to your excellent presentation in Bern with Iris Baumgartner -, participation in discussions has become very rare for me. However, hearing the kind comments of my old friend Hugo Partsch I make an exception. Hugo is the one who introduced indirect lymphography with contrast media. So we had a common meeting on the subject, Hugo showing the small lyphatics, we the really initial ones.

Indeed, fluorescence microlymphography for depicting lymphatic capillaries was introduced by myself and my group. I join you the list of publications we have made on that topic, the first one, that appeared in Circulation, is the introduction of the technique, that is easier to perform then has been stated. With the help of a machine built by bioingeneers in San Diego (Marcos Intaglietta), we succeeded afterwards to measure intralymphatic capillary pressure. In lymphedema there is lypmphatic hypertension.

We also have worked in microangiopathy of chronic venous incompetence. In this condition we often find spots of

Wishing you still a great discussion

Alfred Bollinger

Group: vasculab Message: 4213 From: Foeldiklinik Hinterzarten Date: 16/02/2011 Subject: Lymphatic Dear All,

I am delighted that Prof. Olszewski mentioned the importance of the lymphatic drainage system in venous diseases. I am a clinical lymphologist working in internal medicine. At our specialist clinic for lymphology we treat 5000 patients with lymphedema per year, and have done for the past 30 years. There is a broad spectrum of lymphological diseases, with regards to both the age of the patient and also the kind of damage to the lymph vascular system. Analysis of the statistics of this high number of patients, tells us that the frequency of occurrence of phlebolymphedema is at 6%. When we analyse the causes of lymphedema of the legs,

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 57 di 65

the prevalence of lymphedema due to subfascial chronic venous insufficiency (with or without ulcers) is at 22%. That means that 78 persons of the patients with leg lymphedemas donâ€™t have venous diseases.

I would like to ask the colleaques dealing with the venous diseases how high is the per cent of phlebolymphedema in suprafascial CVI and in subfascial CVI?

Prof. Etelka Foeldi, MD Medical Director Foeldiclini, Clinic for Lymphology Hinterzarten/Germany

-- mailto: [email protected] Group: vasculab Message: 4214 From: bblee Date: 17/02/2011 Subject: Re: Lymphatic failure and CEAP Dear Professor Bollinger

Delighted to hear from you directly and thanks for your kind explanation including all hidden(?) stories behind.

As Hugo mentioned, I was a bit confused with other gentleman with same name so that I failed to tribute to your pioneering work in this unique filed when you came to our CVM symposium.

Indeed, it was a great honor and privilege for me to have you to come to Bern to listen to my humble lectures on the vascular malformations.

More than two decades ago, based on our limited experiment with high MHz- 18 through 22- of the ultrasonography, we found enormous potential of fluorescent microlymphangiography to assess intradermal lymphatic circulation especially on postthrombotic

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 58 di 65

venous stasis ulcer. So we are lucky to have such world experts, Hugo Partsch, Claudio Allegra, and you, in this field to chip in to ease many itching points through the Vasculab.

All the best,

B. B. (Byung-Boong) Lee, MD, PhD, FACS

Professor of Surgery and Director, Center for Vein, Lymphatics and Vascular Malformations, George Washington University, Washington DC, USA

Clinical(Emeritus) Professor of Surgery, Georgetown University, Washington DC, USA

Clinical Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

Visiting Professor of Surgery, Johns Hopkins University School of Medicine, U.S.A.

From: [email protected] [mailto: [email protected] ] On Behalf Of Alfred Bollinger Sent: Wednesday, February 16, 2011 4:38 AM To: [email protected] Cc: Partsch Hugo Subject: Re: [vasculab] Lymphatic failure and CEAP

Ã¯Â»Â¿

Dear Doctor Lee

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 59 di 65

common meeting on the subject, Hugo showing the small lyphatics, we the really initial ones.

We also have worked in microangiopathy of chronic venous incompetence. In this condition we often find spots of

Alfred Bollinger Group: vasculab Message: 4215 From: bblee Date: 17/02/2011 Subject: Re: Lymphatic Dear Etelka Quite interesting data! How many percentage of these population belongs to the primary lymphedema? It is amazing that 22% of the whole lymphedema population of yours has a combined condition of the venous disorder/subfascial CVI, which is much higher than we generally believe.

Our data - John Bergan was the peer reviewer- analysis of the first group of 1,000 lymphedema (L) patients - 700 secondary & 300 primary- has shown combined CVI in less than 5% among the secondary L (N=34), and a bit more than 10% among the primary L(N=31) as a mixed condition with the VM-related venous disorder (e.g. marginal vein with no valves, deep vein dysplasia, absence of the iliac vein, etc). Could you tell me why your data show such high percentage of the venous disorder/CVI comparing to ours? Are they all secondary L? How many of them belongs to the primary? You do not seem to consider the L with subfascial CVI as a phlebolymphedema. Then, which kind of the patients do you classify to the phlebolymphedema?

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 60 di 65

We appreciate you to share further information in this regard with us. Best, BB Lee P.S. Indirect answer to your question on suprafascial(=epifascial) CVI is the majority of the primary PLE with the marginal/lateral embryonic/sciatic vein belongs to this group: 7% in our data.

-----Original Message----- From: [email protected] [mailto: [email protected] ] On Behalf Of Foeldiklinik Hinterzarten Sent: Wednesday, February 16, 2011 8:44 AM To: [email protected] Subject: [vasculab] Lymphatic

Dear All,

I would like to ask the colleaques dealing with the venous diseases

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 61 di 65

how high is the per cent of phlebolymphedema in suprafascial CVI and in subfascial CVI?

Prof. Etelka Foeldi, MD Medical Director Foeldiclini, Clinic for Lymphology Hinterzarten/Germany

-- mailto: [email protected]

------

======The Vasculab Activities http://web.tiscali.it/vasculab/vasculab/vasculab_activities.htm ======The WHAT-MD Survey is On Line at the address http://web.tiscali.it/vasculab/what_md/what_md_survey.htm ======The SVT Survey Results are On Line at the address http://web.tiscali.it/vasculab/svt/svtsurvey.xml ======The MEV-c Course http://web.tiscali.it/vasculab/mev-c/progr_en.doc ======

To unsubscribe send an empty message to the address:

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 62 di 65

[email protected] Per annullare l'iscrizione a questo gruppo, manda una mail vuota all'indirizzo: [email protected] ======Link utili di Yahoo! Gruppi Group: vasculab Message: 4216 From: Alfred Bollinger Date: 17/02/2011 Subject: Re: Lymphatic failure and CEAP ï»¿ Dear Byung-Boong (may I write like that? I am Alfred)

thanks a lot for your kind mail! I also saw now the mail of Claudio Allegra. But please, I do not spend more than 1-2 months on Stromboli (I have written a photo and text book on it) and was not working in Cardiology, but founding the Zurich Angiology Division. Now I am professor emeritus of Angiology at the Zurich University.

I wish you all the best again, both personally and for your work!

Alfred

Group: vasculab Message: 4217 From: bblee Date: 17/02/2011 Subject: Re: Lymphatic failure and CEAP Attachments :

Thank you very much, Alfred,

Truly,

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 63 di 65

From: [email protected] [mailto:[email protected]] On Behalf Of Alfred Bollinger Sent: Thursday, February 17, 2011 5:27 AM To: [email protected] Subject: Re: [vasculab] Lymphatic failure and CEAP

ï»¿

Dear Byung-Boong

(may I write like that? I am Alfred)

I wish you all the best again, both personally and for your work!

Alfred

Group: vasculab Message: 4218 From: Prof. Corradino Campisi Date: 17/02/2011 Subject: Re: Lymphatic ï»¿ Dear friends and Colleagues, I would like to contribute to your increasing interest in Lymphology, underlyining the effective role of modern surgical procedures in this field, according to the most recent evidence.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 64 di 65

I remain at your complete disposal for any futher detail.

Best regards, Prof.Corradino Campisi,MD,PhD Full Professor of Surgery, Past President and Chairman Dept.of Surgery, University Hospital ,San Martino Operative Unit of Lymphatic Surgery, Genoa,Italy

Group: vasculab Message: 4219 From: Waldemar L. Olszewski Date: 19/02/2011 Subject: Re: Lymphatic Dear All,

It is so nice to see that I ignited so much interest in lymphology just with one letter. This means this theoretical and clinical discipline is receiving its momentum. With respect to the incidence rate of phlebo-lymphatic changes the percentage is around 5-10% but may be higher in some places. The most important is the primary diagnosis of venous insufficiency (varicous veins, posththrombophlebitic synrome, posttraumatic, antipregnacy pills etc). Depending on the etiology of the damage of the venous system we can expect lower or higher incidence rate of the lymphatic insufficiency. The overall statistics are not very infomative.

Regards

Waldemar L Olszewski

2011/2/17, bblee < [email protected] Group: vasculab Message: 4220 From: [email protected] Date: 19/02/2011 Subject: Re: Lymphatic failure and CEAP

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017 Digest Pagina 65 di 65

Dear Prof. Olszewski

I have recently suggested ( http://www.ncbi.nlm.nih.gov/pubmed/20224526) that venous ulcerations develop primarily due to an (auto)immune reaction, which is initiated by venous stasis. Thus, your findings on the behavior of lymph nodes may be in line with this hypothesis.

Marian Simka Group: vasculab Message: 4221 From: bblee Date: 20/02/2011 Subject: Re: Lymphatic Couldn't agree more, Waldemar. Thanks, BB Lee

-----Original Message----- From: [email protected] [mailto: [email protected] ] On Behalf Of Waldemar L. Olszewski Sent: Saturday, February 19, 2011 8:20 AM To: [email protected] Subject: Re: [vasculab] Lymphatic

Dear All,

It is so nice to see that I ignited so much interest in lymphology just with one letter.

file:///H:/xsl -fo/fop -2.0/jtavr/jtavr01/jtavr012/JTAVR000017 -PassarielloF/Phlebolymphedema%20Feb%206 -20,%202011%20 -%20 ©%2... 30/ 04/ 2017