Venous and lymphatic reasons for edema--the swollen leg from the angiologist's point of view

Venous and lymphatic reasons for edema--the swollen leg from the angiologist's point of view

Friedli S,
Mahler F.

Abteilung fur Angiologie, Inselspital, Bern. sandra.friedli@insel.ch

Peripheral edema develop as a consequence of imbalance in the processes of filtration, resorption and lymphatic transport in the capillary bed. Venous hypertension and impaired lymphatic function belong to the most important underlying pathomechanisms. Chronic venous insufficiency as a result of valve degeneration as well as venous obstruction in acute deep thrombosis lead to venous hypertension and to an increase of filtration pressure. As venous diseases are frequent, they are one of the most reasons for a swollen leg in clinical everyday life.

Primary and secondary disturbances of the lymphatic system are another important reason for interstitial liquid retention. Although there are about 140 millions of people suffering from lymphedema worldwide, the disease is still underdiagnosed.

PMID: 15605455 [PubMed - indexed for MEDLINE]

Pseudophakic Corneal Edema: A Review of Mechanisms and Treatments.

Pseudophakic Corneal Edema: A Review of Mechanisms and Treatments.
Cornea. 2006 Oct;25

Narayanan R,
Gaster RN,
Kenney MC.

From the *LV Prasad Eye Institute, Banjara Hills, Hyderabad, India, and the daggerDepartment of Ophthalmology, Veterans Affairs Medical Center, Long Beach, CA.

PURPOSE:

To review the pathological mechanisms and treatments for pseudophakic corneal edema (PCE), one of the most common indications for penetrating keratoplasty.

METHODS:

The literature was examined for the molecular biology associated with PCE and for the surgical and medical treatments for this disorder.

RESULTS:

The incidence of PCE has recently been decreasing because of improved surgical instrumentation, including improvements in intraocular lens designs that cause less trauma to the corneal endothelium. Extracellular matrix and growth factor abnormalities occur in PCE corneas and recently, the role of aquaporins, which are involved in the regulation of fluid movement across cells, has been investigated.

CONCLUSIONS:

Although newer treatment options have been suggested, penetrating keratoplasty still remains the most definitive treatment and has the highest success rate.

Wolters Kluwer Health

Lasix

Lasixfurosemide (fur OH se mide)

Lasix, Lo-Aqua

What is the most important information I should know about Lasix?

Do not use Lasix if you are unable to urinate.

Before using Lasix, tell your doctor if you have kidney disease, liver disease, gout, lupus, diabetes, or an allergy to sulfa drugs.

To be sure Lasix is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. It is important that you not miss any scheduled visits to your doctor.

Lasix will make you urinate more often and you may get dehydrated easily. Follow your doctor's instructions about using potassium supplements or getting enough salt and potassium in your diet.

Avoid becoming dehydrated. Follow your doctor's instructions about the type and amount of liquids you should drink while you are taking Lasix.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

What is Lasix?

Lasix is a loop diuretic (water pill) that prevents your body from absorbing too much salt, allowing the salt to instead be passed in your urine.

Lasix treats fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome. Lasix is also used to treat high blood pressure (hypertension).

Lasix may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before taking Lasix?

Do not use Lasix if you are unable to urinate.

Before using Lasix, tell your doctor if you have:

kidney disease;

liver disease;

gout;

lupus;

diabetes; or

an allergy to sulfa drugs.

If you have any of these conditions, you may not be able to use Lasix, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Lasix can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Lasix?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Lasix will make you urinate more often and you may get dehydrated easily. Follow your doctor's instructions about using potassium supplements or getting enough salt and potassium in your diet.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. It is important that you not miss any scheduled visits to your doctor.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

Store this medication at room temperature away from heat, light, and moisture.

What happens if I miss a dose?

Lasix is sometimes used only once, so you may not be on a dosing schedule. If you are using the medication regularly, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and wait until your next regularly scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of Lasix. Symptoms of a Lasix overdose may include ringing in your ears, loss of appetite, weakness, dizziness, confusion, feeling light-headed, or fainting.

What should I avoid while taking Lasix?

Avoid becoming dehydrated. Follow your doctor's instructions about the type and amount of liquids you should drink while you are taking Lasix.

Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Lasix can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun.
What are the possible side effects of Lasix

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using Lasix and call your doctor at once if you have any of these serious side effects:

dry mouth, thirst, nausea, vomiting;

feeling weak, drowsy, restless, or light-headed;

fast or uneven heartbeat;

muscle pain or weakness;

urinating less than usual or not at all;

easy bruising or bleeding, unusual weakness;

a red, blistering, peeling skin rash;

hearing loss; or

nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Continue taking Lasix and talk with your doctor if you have any of these less serious side effects:

diarrhea, constipation, or stomach pain;

headache;

numbness, burning, pain, or tingly feeling;

dizziness; or

blurred vision.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Lasix?

If you take sucralfate (Carafate), take it at least 2 hours before or after you take Lasix.

Before taking this medication, tell your doctor if you are using any of the following drugs:

lithium;

digoxin (Lanoxin);

steroids (prednisone and others);

ethacrynic acid (Edecrin);

diet pills or cold medicine;

other blood pressure medications;

amikacin (Amikin), gentamicin (Garamycin), netilmicin (Netromycin), streptomycin, tobramycin (Nebcin, Tobi);

salicylates such as aspirin, Disalcid, Doan's Pills, Dolobid, Salflex, Tricosal, and others; or

indomethacin.

If you are using any of these drugs, you may not be able to use Lasix, or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect Lasix. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has additional information about Lasix written for health professionals that you may read

Drugs.com

Hand Edema Related to Drug Addiction

Hand Edema Related to Drug Addiction

Puffy hand syndrome due to drug addiction: a case-control study of the pathogenesis

Authors: Andresz, Valérie1; Marcantoni, Nicolas1; Binder, Florence2; Velten, Michel2; Alt, Martine3; Weber, Jean-Christophe4; Stephan, Dominique

Source: Addiction, Volume 101, Number 9, September 2006, pp. 1347-1351(5) Publisher: Blackwell Publishing

Abstract: We studied the pathogenesis of puffy hand syndrome of intravenous drug use. We hypothesized that injections of high-dose sublingual buprenorphine, instead of the recommended sublingual administration, could play an important role in lymphatic obstruction and destruction. Design and participants  We set up a case-control study in substitution centres, recruiting intravenous drug addicts with and without puffy hands, respectively. The subjects were asked to answer anonymously a questionnaire of 40 items comprising social and demographic status, history of illicit drugs use, buprenorphine misuse and injection practices.

Findings: We included 33 cases and 33 controls, mean age of 32 years. They were past heroin users, mainly methadone-substituted. In multivariate analysis, sex (women) injections in the hands injections in the feet and the absence of tourniquet were significant risk factors for puffy hand syndrome. In 69.7% of the cases and 59.4% of the controls, respectively, there was a high-dose sublingual buprenorphine misuse, although it appeared not to be a significant risk factor for puffy hand syndrome.

Conclusions: Injection practices are likely to cause puffy hands syndrome, but buprenorphine misuse should not be considered as a significant risk factor. However, intravenous drug users must still be warned of local and systemic complications of intravenous drug misuse. Keywords: Buprenorphine; intravenous drug use; puffy hand syndrome

Document Type: Research article DOI: 10.1111/j.1360-0443.2006.01521.x

Affiliations: 1: Hypertension Maladies vasculaires Pharmacologie clinique, Hôpitaux Universitaires, 2: Laboratoire d'épidémiologie et de Santé publique EA 1801, Faculté de Médecine, 3: Centre de Pharmacovigilance 4: and Médecine interne A, Hôpitaux Universitaires, Université Louis Pasteur, Strasbourg, France

Article

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Puffy hand in long-term intravenous drug users

Mal Vasc. 2004 Oct;29(4):201-4. Simonnet N, Marcantoni N, Simonnet L, Griffon C, Chakfe N, Wertheimer J, Stephan D. Service d'Hypertension Arterielle et Maladies Vasculaires, Hopitaux universitaires de Strasbourg, BP 426, 67091 Strasbourg.

Narcotic addiction may induce systemic and local complications. Intravenous injections of drugs can cause venous thrombosis, and septic or embolic complications. The puffy hand sign is a more uncommon complication of hard-core injection addicts. Three long-term intravenous drug users, two males, one female, mean age 30.6 years (26-37) presented puffy hands. These patients had been drug addicts for four to twelve years (mean duration 7.3 years) and had stopped heroin injections for 3-5 years (mean 4.6), participating in a buprenorphine substitution program. The edema appeared several years after drug cessation (1.5-5, mean 2.3). Typically the puffiness was bilateral, the hands swollen from the proximal segments of the fingers to the wrist. In one patient, the edema was localized both in the hands and in the feet. The edema was not pitting and unaffected by elevation. Duplex ultrasound examination of the extremities was normal. Lymphangiography performed in one patient was consistent with deep lymphatic destruction. Puffy hand syndrome appears to be the end result of lymphatic obstruction. Repeated injections of drugs in or outside the veins destroy the lymphatics. Buprenorphine may play an important role in the puffy hand sign. Although it is supposed to be administered orally, many drug addicts use it as an i.v. solution. Because buprenorphine is poorly soluble, it causes lymphatic obstruction. This type of hand for which no therapy exists must be differentiated from deep palmar space infection with dorsal edema which requires incision and drainage.

Article

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Puffy hand syndrome in drug addiction treated by low-stretch bandages

Arrault M, Vignes S. Unite de Lymphologie, Hopital Cognacq-Jay, 15, rue Eugene Miron, 75015 Paris.

BACKGROUND: Puffy hand syndrome is a complication of intravenous drug abuse, which has no current available treatment. Arm and forearm edema are voluminous and cause functional and aesthetic disturbances. We report two cases successfully treated by low-stretch bandages.

OBSERVATIONS: A 40-year-old man and a 34-year-old woman, both intravenous drug users, with puffy hand syndrome were hospitalized for 11 days. Treatment included daily multilayer bandaging. Lymphedema volumes calculated by utilizing the formula for a truncated cone decreased by 16% on the left side and 12% on the right side for the first patient and 31 and 17% for the second. Hand circumference decreased 4.3 cm on the left side and 3.2 cm on the right side in case 1, and 2.5 cm and 1.9 cm respectively for case 2. The patients were taught self-bandaging techniques during their hospital stays. Elastic gloves were fitted at the end of treatment. Reduction of lymphedema volume remained stable after 18 months in one patient while for the second patient further treatment and hospitalization were required due to poor compliance.

DISCUSSION:

The pathogenesis of this edema is probably multifactorial: venous, lymphatic insufficiency and the direct toxicity of injected drugs. Lymphedema treatment currently consists of low-stretch bandaging and wearing elastic garments, which is effective in decreasing the volume of puffy hand syndrome.

Article

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Hand Edema and Acrocyanosis: "Puffy Hand Syndrome"

For 2 years, a 27-year-old woman had chronic swelling of both hands associated with recurrent cyanotic digital erythema. On examination, all fingers had stable swelling and erythema with a few superficial telangiectases (Figure 1 and Figure 2). An initial diagnosis of atypical Raynaud syndrome with edematous scleroderma was made. Her case was evaluated for systemic scleroderma with antinuclear antibody titer, ribonucleoprotein, antitopoisomerase, centromere, SSA, SSB, and Sm antibody titers, and the findings were negative. The rest of the clinical examination, which included the musculoskeletal, cardiac, digestive, and respiratory systems, was unremarkable. Findings from the examination were negative for human immunodeficiency virus but positive for hepatitis C virus. When these findings were presented to her, she revealed a history of drug addiction that involved injection of narcotic drugs in the dorsal aspect of both hands but that had ceased 3 years previously.

Article