Report on 25° Congress of International Society of Lymphology

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Foto-San-FranciscoA very special Congress and participated one in San Francisco, coinciding with the 50th anniversary of the founding of the Scientific Society International. In fact, at the opening session the Secretary General of the company, the US Marylis Witte, recalled all the Presidents who have succeeded up to the present, and each of these (obviously living) have expressed their views on their experience and on its hinges on which corporate activity has been established in the past period. The first session ended with the statement / invitation / encouragement of Witte, in future generations, to keep walking ‘shoulders’ of the ‘giants’ who have made the same corporate history so far..

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The second session involved the aspects of genetics and molecular biology. With the moderation of the writer and American Erickson attended eminent world experts, such Hennekam (the discoverer of the lymph-dysplastic syndrome (involving over limbs also lacteals intestinal and lung) that bears his name. Vikkula spoke of genetic mutations induced by family genes and VEGFR3 KIF11, Keeley  spoke of lymphedema in Turner syndrome and the writer who has made a general framework, based on the experiences of the Italian study group, about the current global knowledge in genetics lymphedema. In particular, two findings have emerged that have most impressed the audience (the result of extensive discussion): 1) the germ sporadic forms (those in which the mutation is found in the blood of individuals with lymphedema do not show a family history of disease, for which the same mutation occurred immediately after the meeting of the two gametes, male and female, but before the first cell replications) have a 50% chance to become ‘family’, that is to be transmitted to descendants (unlike to what was believed up to now); this means that the forms of primary lymphedema are increasing in the world population. 2) in one case among those we studied, having found a genetic mutation of the gene CCBE1 in his blood (not sufficient alone to cause disease), also found in the affected tissue, it proceeded to the study, by biopsy, also of tissue itself and this has revealed the presence of a mutation of the gene FOXC2 present only in cells of the tissue lymphedematous and not in the blood; in these cases, the mutation is transmitted to descendants and may not become a family being ‘sporadic-somatic and germ). In future it will be necessary to increase this type of study to better understand the ‘negativity’ of tests performed in the blood of many symptomatic patients ‘sporadic’ and ‘non-family’ who, though similar to the test described above, there never will transmit the disease to future generations . All those present were very much interested in following this course of study and are waiting for the publication of our research.

Another interesting speech was made by Nobel Laureate Francoise Barré-Sinoussi who held a reading on the state of HIV infection, pointing out that in many cases you are getting good results on the arrest (sequestration) of virus replication resulting in blocking of the disease (AIDS).

They then succeeded in presentations Campisi, Boccardo, Brorson, Papendieck, Olszewski, Masia and Yamamoto who highlighted the progress, each with its own technique, which provides the contribution of surgery in the therapeutic approach to the disease overall. Everyone, also stressed the importance of the combined approach in the management of a disease that must be managed throughout the life of the patient.

For the imaging session the Chinese Ningfei Liu reiterated the importance of magnetic Linfangiorisonanza (still little and badly practiced in our country) for the definition of individual clinical pictures. Many authors (including Yamamoto and Belgrado) confirmed the growing role that it’s taking the videoscopia after subcutaneous injection of  green indocyanine, to define the course of the great lymphatic collectors of individual districts and stop the outflow of lymph same.

A group of American study has therefore emphasized the relevance of the physical decongestive treatment , combined with remedies ‘botanical’ (alpha and gamma benzopyrones), emphasizing the hepatotoxicity of coumarin at therapeutic doses. Recalling an article published in 1999 on ‘New England Journal’ the writer pointed out that coumarin with hepatotoxic effect is concise and, in Europe, at least fifteen years, is used coumarin natural that, in common therapeutic doses, has not absolutely proven hepatotoxicity.

Leon Stanley (one of the three co-chairs of the Congress, along with Marylis Witte and Saskia Thiadens), of San Francisco, then spoke of the ability of metastasis of certain cancers (melanoma in particular) via the lymphatic system; a risk but also a potential seen that the obliged transit through lymph nodes and the consequent meeting with the T lymphocytes of the organism to the tumor cells may also (as fortunately happens in many cases) determine the neutralization. Even in this respect much it depends on the ability of each specific immune-competent body.

In the session ‘Development of the lymphatic system and pediatric diseases’ Papendieck and others have pointed out as being overweight in childhood contributes to the onset of lymphatic insufficiency. This is a theme, echoed by other authors to describe the problems related to being overweight in adulthood. Endogenous insulin resistance, in fact, related to high doses of the same serum and changes in concentration of leptin, promote lymphatic stasis and even the onset of lipoedema. On the latter topic it happened to the writer to moderate (among others) a specific session. The ideas expressed by the various speakers have just confirmed, however, the main concepts that are known on the subject: familiar, exclusive onset in women and the age of puberty, poor response to physical treatments and dietary principles and standards of living. German Stulz has also emphasized the fact of the higher incidence of ‘depression to the suicide attempts’ between patients carriers of this disease (perhaps exaggerating a bit’ the theme!). For my specific question addressed to all the speakers on the broad therapeutic (with reference to the RF, the shockwave and to mesotherapy, it is mentioned vibratory energy and an American group quoted a text, for sale ‘on line ‘on the website: http: //www.lymphnotes.com/pub.php/id/20/, entitled’ Living well with Lymphoedema ‘in that there would be answers to all the questions that arise on both patients and health professionals, including dietary principles).

Two sessions were devoted to Training and Education. These participated, in particular, by representatives dell’ILF (International Lymphoedema Framework), including Piller and Keeley, and the president of the Lymphoedema Framework, Amer. An interesting proposal involved the training of the operators. It ‘was a questionnaire (which we should use, perhaps revised, too) to define the skills of individual health professionals working in the area; in particular, the main questions are: 1) how long exercises in the specific area of lymphology? 2) How many patients he visited / treated in the last twelve months? 3) How many Meetings / Training courses in Lymphology has participated in the last twelve months? 4) What scientific articles read on the subject of particular interest in the last twelve months in Literature? 5) What is your opinion of these items?

A space has also been dedicated to bringing the ‘Consensus Document’ of the Company; in particular we have been received the following proposals: 1) inclusion of a recommendation on taking charge of patients according to the case history, with the possibility of outpatient treatment, to DH and, when necessary (Fragility social need for portability or medical monitoring in 24 hours), inpatient. 2) Among the diagnostic tests it was also recommended the use of videoscopia after inoculation of green indocyanine . 3) It’s advisable  that you start to use, even in this field of vascular disease, Telemedicine.

The Congress opened with a session on corporate activities retrospective of the past 50 years; It closed with a session looking to the future activities of the same company, which is freedom of action left to the individual participants. Personally, in addition to remember that next month I will go to Algeria to present a report on the primary and secondary lymphedema in the Congress of the Algerian Company of vascular disease (also very interested in developing this branch of vascular disease: a door that opens onto the ‘ Africa, so far a ‘taboo’ for most of the international scientific societies), I pointed out that even today millions and millions of people await the right answers to their health needs, as part of their public health systems or private; so far in most cases this does not happen (I’m looking forward to receiving, in this regard, a comprehensive description of the rights of health of the patient with lymphedema who resides in Germany by fellow Stulz who presented a nice job with the provocative title : ‘can a patient with lymphedema get admitted to hospital after admission itself a substantial improvement of his physical ability and quality of life?‘). We, as an international scientific society, we have a duty to intervene at the highest level to improve this situation and we can do it with an instrument, the Consensus Document, which we particularly ‘cure’ and ‘spread’ in this sense, as much as possible.

The Congress ended with the General Assembly of the Society that, in the voting, expressed, however, with unanimous consent, my Society  next Presidency. A pleasure to be with all those who in our country are fighting for the rights of such people, to whom I have personally dedicated the title with the same conviction to give even more energy, and at the highest levels, in view of ongoing research the best solutions to many problems for which patients rightly expect appropriate answers.

The International Society of Lymphology has also dedicated a website for all the answers, even practices that an ‘interested in the work’ (doctor, physiotherapist, nurse, patient and other) arises on a daily basis; the site is: http://question.curiosityforall.org/Lymph * (Editor’s note the link will be active soon)

Dr. Sandro Michelini
Elect President of International Society of Lymphology
San Francisco 12 Settembre 2015