The average concentration of albumin in the lymph is about 40% of that present in the blood of the same individual; lymphatic calcium has an average concentration of about 70% of blood; the leukocytes present in the lymphatic fluid are about one third of those present in the blood, almost all lymphocytes; other electrolytes, such as potassium, on the other hand, have coincident concentrations. Experience gained with the study of the composition of the Lymph in postoperative Lymphoceles, also combined with the detection of the qualitative and quantitative modifications of the Lymph before and after pharmacological and physical rehabilitation treatment (including chemical mediators of inflammation).
A somatic genetic mutation (i.e. present only in the cells of the lymphedema site and not in the blood cells) which causes primary lymphedema in individuals, unlike the germline mutation itself (i.e. also present in blood cells) is not transmitted to the offspring.
Post-traumatic lymphedema must always be investigated, both for clinical management and prognostic purposes, with a lymphoscintigraphic examination which must exclude congenital predisposition to chronic edema (caused by the trauma itself and not reversible).
These are some of the news that the participants in the Advanced University Training Course on ‘Rehabilitation of the patient with Lymphedema’ heard on the first day dedicated to the Event which opened on 4 September 2020 in the new Didactic Pole of the ‘La Sapienza’ University of Rome based in the S. Andrea Hospital.
It was exciting to inaugurate the new premises with topics entirely dedicated to Lymphedema and to capture the interest, participation and particular attention of the learners (from various Italian regions) and the satisfaction of the organizers, Professor Vulpiani (Head of the School of Specialization in Physical and Rehabilitative Medicine of the University ‘La Sapienza’ – Polo S. Andrea) and his close collaborator Professor Mario Vetrano.
With the inevitable compliance with the rules imposed for the prevention of contagion from COVID SARS2 and despite the difficulties related to checks, self-certifications and observance of distances, after a few ‘technical’ postponements the Course has seen its natural ‘take-off’ with the topics exposed (anatomy and physiology of the lymphatic system, genetic aspects, composition of the lymph and its modifications, nature and functions of the interstitial matrix which performs its functions as a real ‘biological network’ between the cells and the vascular-nervous structures keep them alive, syndromic lymphedema and clinical aspects related to the lymphoscintigraphic examination), transmitted with the usual enthusiasm by the writer who, despite the passing of the years, always has a very strong desire to share the experiences of a mainly dedicated professional life to these issues and a serene discussion on the same with other passionate ‘experts’.
Saturday 5 September was the turn of Marina Cestari to whom I personally recommended (even if the statement was obviously superfluous) to speak only about her own clinical experience. Which he did, even judging by the intense participation of the learners with continuous questions for further information, in an excellent and natural way.
This is needed in this as in other fields in a time of ‘obscurantism of medieval significance’ towards professional qualification and what was once considered the triumph of the clinic. The desire to know professional experiences ‘lived’ on large numbers is becoming, in fact, a real ‘need’ in a world which, due to the increasingly ‘virtual’ characteristics of participation, is seeking a return to the best forms of teaching which, at least in the field of medicine, they have contributed to building the enormous knowledge base from which the current generations are benefiting, and with them the patients who are being treated.
Today the administrator on duty of a health company aims to manage patients who are less and less complex and who present the least possible risk from the point of view of potential conflict and any legal disputes. We hope that such courses will awaken the interest in taking care of even complex patients and that the ‘clinical challenge’ can be taken up again, with due serenity by every healthcare worker, appropriately supported and shared by the administrators on duty. .
With the hope that such initiatives can grow numerically and really contribute to the improvement of the quality of care, we thank the university colleagues who accepted our request and allowed us to realize this event which, we hope, can be repeated, perhaps even further expanded.
Good Course to all participants and best wishes to patients who will then be managed clinically by them.
Sandro Michelini
Rome 5 September 2020
