Lymphangitis : inflammation of a lymph vessel .

Lymphedema

Lymphatic system is a major part of the circulatory and immune system that transports lymph fluid from tissues to the blood stream. Lymph fluid contains white blood cells that protect the body against infections and help the body detoxify. When lymph fluid is not drained properly and starts to build and cause swelling, it is called Lymphedema. Any part of the body can be affected by Lymphedema, but it usually occurs in the arms, legs and very rarely it can occur on the neck, head, groin and genital areas.

Primary Lymphedema is congenital and is caused by the defective lymphatic system present during the birth. Sometimes primary Lymphedema, though present during the birth, may surface only after puberty.

Secondary Lymphedema is an acquired lymphedema due to infection, trauma, injury or cancer that has disturbed the lymphatic system. Apart from such conditions, radiation therapy and surgery involving lymph nodes also results in malfunction of lymphatic system giving rise to Lymphedema. Women who are treated for breast cancer are at high risk for Lymphedema. Breast cancer surgery normally involves removal of one or two lymph nodes and thus disturbs the pathway of the lymphatic system. Hence breast cancer patients should be watchful of any swelling under arms or around the breast region after the surgery.

Symptoms of Lymphedema

1. Pain and heaviness in the arms, legs, chest and breast.
2. Swelling in the arms and legs including fingers and toes.
3. Hardening and redness on the skin of the affected limbs.
4. Tingling sensation or pins and needles feeling in the arms and legs.
5. Sore feeling in elbow.
6. Trouble in wearing jackets, watches, bracelets and rings.
7. Difficulty in moving the limbs.
8. Discolored skin associated with rash.
9. Skin indentation after pressing the affected region.
10. Fever

Diagnosing Lymphedema

Doctor evaluates the patient through clinical examination and also checks family and medical history of the patient. He will also look for risk factors such as history of a cancer or a surgery. Doctor may also look for pitting by gently applying the pressure on the swelling. If skin indentation occurs, it needs to be examined further. Certain imaging tests like CT scan, MRI, Lymphoscintigraphy and ultrasonography may be carried on to confirm Lymphedema.

Lymphedema treatment

Treatment for Lymphedema depends upon the extent of progression and severity of the disease. However, the following methods are broadly followed to treat Lymphedema:

Manual lymph drainage: Manual lymph drainage is a massage technique that allows the flow of lymph from affected limb. This technique helps to heal the diseased portion, restore the health of the skin and also treat the infection.

Wrapping/Bandaging: Wrapping the arm or leg with layered bandage is the most effective way of treating Lymphedema. Lymph vessels lie below the skin and take the help of the muscles to drain the lymph. The bandage wrapped around the limb provides good support to the muscles and thus fluid is pumped out easily. Bandages should be wrapped tightly around the fingers and toes and loosened as you go up the arm.

Compression garments: Compression garments are specially designed garments and they work much the way as wraps do. These garments reduce the swelling and also prevent it from recurring. They help the muscles in pushing the lymph into lymph vessels by providing firm support. Compression garments should be picked up under professional guidance with utmost care as the proper fit is essential in treating the Lymphedema. Once purchased, they should be worn regularly and all day long for speedy results.

Exercise: Certain decongestive exercises increase the lymph flow and allow it to flow back into the blood stream. Exercise sets in the movement in muscles and thereby helps in draining the lymph fluid easily. The rate of lymph flow is 15 times higher during exercise when compared to the resting period. Thus, swelling eases faster with specified exercise regimen. Always take the help of the Lymphedema therapist before starting the exercises as not all types of exercises are suitable for Lymphedema patients.

Pneumatic compression: This is a new compression device that works towards reducing swelling rapidly. It is a plastic garment with electrical pumping unit which inflates with pumped air and thus applies pressure on the muscles. These muscles in turn work on the lymphatic flow and thus reduce the swelling.

Drugs: If the affected area is infected, doctor may prescribe antibiotics to control the infection. Painkillers are also administered to relieve the patient from pain.

Behcet's Syndrome

Turkish dermatologist, Hulusi Behcet (1889-1948) recognized and reported in 1937 symptoms of Behcet's syndrome. A dental infection is attributed as the etiology of the disease. The American Behcet's Disease Foundation (ABDA) was founded in 1978 with the objective to provide support to patients and family as well the caregivers. In the absence of a cure or a single test to definitely determine Behcet's syndrome or Behcet's disease, educate about the syndrome to seek prompt medical attention for treatment.

Morbus Behcet or Silk Road disease is the other name for Behcet Syndrome or disease. Month of May is Behcet's Awareness month and May 20th is Behcet's awareness day. The focus is on spreading awareness and stress the importance of self-help.

Behcet's syndrome facts

• Non-contagious
  
• Exact cause is unknown
  
• Genetic predisposition is high.
  
• Symptoms are similar to other disease of the digestive tract, Ulcerative Colitis and Crohn's Disease
  
• No single test to confirm diagnosis.
  
• No cure available.
  
• Disease affects different parts of the body.
  
• Men and women are equally prone but more severe in men.
  
• In the US, affects more women.
  
• More prevalent in Middle East, Mediterranean and Eastern Asia.
  
• Turkey has the highest prevalence.
  
• Leading cause of blindness in Japan.
  
• Most common among age group 20-30.
  
• Treatment requires more than one specialist.
  
• Continued, extensive research to explore possible genetic, bacterial and viral cause.
  
• Research is on to identify medicines to better treat Behcet's disease.

Behcet's syndrome – Autoimmune disease

There are over 14, 000 auto-immune diseases and 7000 plus are rare. Behcet's syndrome is rare. Autoimmune disease occurs when the body's immune system mistakenly attacks its own healthy tissues. Though the clinical feature of auto immunity is absent, Behcet's syndrome is classified as an autoimmune disease as it has various aspects related to autoimmune disease. Enhanced inflammatory response (inflammation of blood vessels) is one such aspect. Significant number of women as compared to men are more likely to be affected by autoimmune disease. Estrogen predisposes women to autoimmune disease.

Behcet's syndrome symptoms

The inflammation of blood vessels, particularly veins causes symptoms in many parts of the body. Swelling, redness, heat and pain are select features of an inflammation. Though Behcet's disease can affect any part of the body, involvement of the neurological system is known as neuro-Behcet's disease and is rated the most disabling complication of the disease. Not that common, neuro-Behcet's disease affects about 10 per cent of people with Behcet's disease.

The most common symptom of Behcet's syndrome is the regular occurrence of ulcers in the mouth and genitals. The symptoms are an off-shoot of inflammation of the eyes, skin, arteries, veins, joints, nervous and digestive systems and heart. Symptoms can be mild or severe. Symptoms can be noticed between ages 20-30 years.

Mouth ulcers: May look like normal mouth ulcers but are more painful and numerous in number. Ulcers develop in the tongue, lips, and gums and inside of the cheeks. Even if the ulcers heal within a couple of weeks, they recur.

Genital ulcers: In men, though genital ulcers can appear anywhere in the groin area, including the penis, it is more common on the scrotum. In women, the ulcers appear on the cervix (neck of the womb), vulva or vagina. The ulcers are usually painful and scars appear around the area.

Skin lesions: Resembling acne, pustular skin lesions can appear anywhere on the body. Erythema nodosum results in red, painful, tender lumps that can measure one to five centimeters. It is the result of inflammation in the fatty layer of the skin. It can appear on the legs and ankles but can also appear on the face, neck or arms. Erythema nodosum related to other disease heal without scars but if related to Behcet's disease, leaves the skin totally discolored.

Inflammation of the eyes: Sudden inflammation of the eyes is a common symptom of Behcet's syndrome. A group of connected tissues, uveal tract is inside the eye. This uveal tract gets inflamed. Uveitis as it is named can cause symptoms such as, painful red eyes, blurred vision and floaters (dots that move across the field of vision). With a possibility of permanent visual impairment, it is best to seek medical attention for appropriate treatment without any delay.

Skin sensitivity: Pathergy is a condition signifying sensitivity of the skin, particularly injury or irritation. Even a needle prick can lead to developing a large red lump in a day or two.

Gastrointestinal symptoms: Inflammation of the stomach and intestines causes symptoms such as loss of appetite, stomach pain, indigestion, diarrhea, feeling sick and vomiting. There is a possibility of damage to the bowel resulting in bleeding. Blood in stools suggests inflammation of the internal lining of the bowel.

Blood clots: Inflammation of the veins can lead to formation of blood clots or thrombosis.

Joint pain: Joint pain in ankles, wrists, knees, elbows and hips is common. Inflammation in the joint can cause swelling, redness and tenderness.

Brain: Meninges is the coverage of the brain. Inflammation of the brain or tissue that covers the brain (meninges) causes symptoms like headache, neck stiffness along with high body temperature. In severe cases, it can damage the nervous tissue and lead to extreme weakness or impaired function of the body.

Aneurysms: Aneurysms are outpouchings of blood vessel walls due to inflammation of arteries in the lungs. This can lead to massive lung hemorrhage. Symptoms include pain in the limbs, severe headache, feeling dizzy, and breathlessness, coughing up blood, confusion and loss of consciousness.

Inflammation of the nervous system: Inflammation of the central nervous system occurs in 5%-10% of reported cases. This is regarded as the most serious symptom. Typical symptoms include headache, double vision, loss of balance, seizures, partial paralysis on one side of the body, personality changes. Any of these are noticeable within the first five years of recognizing initial symptoms.

General symptoms: Experiencing extreme fatigue to the extent that it interrupts with everyday routine is a general symptom of Behcet's syndrome.

Behcet's Syndrome Causes

The exact cause remains unclear. Though regarded as an autoimmune disorder, it is unclear what triggers the autoimmune disorder. Other possible association is genetics. Certain ethnic groups or a family member with the disease increases chances of developing Behcet's syndrome. People with gene HLA B51, variations in other genes like IL10, IL23R-IL2RB2 increases the risk of developing the disease considerably. However, the condition does not have a clear pattern of incidence.

Risk factors identified include:

Age: Children and older adults can develop the condition. But men and women in the age group of 20-3 are more likely to be affected.

Location: People from countries in the Middle East and Far East, including Turkey, Iran, Japan and China are more likely to develop Behcet's syndrome.

Sex: The disease is more severe in men.

Genes: Having certain genes increases the risk of developing the syndrome.

Behcet's Syndrome Diagnosis

In the absence of a single test to diagnose Behcet's syndrome, doctors look out for symptoms. Blood tests or other laboratory tests are recommended to rule out other disease or illness. The criteria include:

Mouth sores: Mouth sores are very common. Many disorders are related to mouth sores. If the mouth sores recur every three months in 12 months, it is regarded as criteria for evaluating the disease.

Doctors look for two additional signs.

• Genital Sores
  
• Eye problems
  
• Skin sores
  
• Pathergy test

Behcet's Syndrome - time to seek help

Recognizing symptoms and relating the symptoms to Behcet's disease is essential. Note down symptoms being experienced and add related information that affects normal routine. Seek appointment with a doctor. If medical attention is delayed, the condition can worsen and lead to losing eye sight or a stroke. At the meeting, divulge family history and inform about medications for any other health issue or supplements being taken.

You are most likely to seek specialist help. Rheumatologist for arthritis, joint pain etc, Ophthalmologist for eye problems, gynecologist or an urologist for genital sores, dermatologist for skin issues, Gastroenterologist for digestive difficulties or neurologist for symptoms related to CNS (central nervous system).

Behcet's Syndrome Treatment

There is no cure for Behcet's syndrome. The treatment is aimed at alleviating the symptoms, reducing the frequency and intensity, put the disease into remission and prevent serious complications. Medicines for controlling the individual symptoms are prescribed. Some medicines are prescribed with other medicines to suppress the activity of immune system. Some medicines can have side effects too.

For the skin: gels, creams and ointment that contain a Corticosteroid to reduce the inflammation.

For mouth sores: Special mouth washes with Corticosteroid to reduce the pain and associated discomfort.

For the eyes: Eye drops with Corticosteroid to relieve pain and redness in the eye.

Coping with Behcet's syndrome

• Take ample rest in between flares.
  
• Pay attention to diet and exercise.
  
• Find support groups and connect.
  
• Login to American Behcet's Disease Association.
  
• Read message boards and engage in chat sessions.

Cervical Lymphadenitis

Cervical Lymphadenitis is inflammation in the lymph glands of the neck. This lymph gland enlargement is usually secondary to any viral or bacterial infections. This condition is often noticed with tonsillitis, pharyngitis or even dental infection. Cervical Lymphadenitis is commonly seen in children suffering from upper respiratory infection. Infections such as diphtheria, tuberculosis or wounds caused by cat-scratch disease or impetigo can bring on Cervical Lymphadenitis.

Symptoms of Cervical Lymphadenitis include pain and tenderness in the lymph glands of the neck. There might be cough, sore throat and fever. Often patients suffering from Cervical Lymphadenitis experience irritability and earache. In some cases, scalp infections or impetigo or dermatitis is noticed. Chest x-rays and skin tests are used to diagnose the cause for the swollen lymph nodes. The infected nodes are sometimes aspirated for further analysis. Biopsy might be done in some cases.

In most cases, Cervical Lymphadenitis does not need any treatment. Once the cause for the swollen lymph glands is identified, appropriate treatment is prescribed. Penicillin or dicloxacillin is often used.