Eur J Plast Surg (1998) 21:55 © Springer-Verlag 1998 J. Bruna First experimental study of carbon dioxide digital subtraction lymphangiography Eur J Plast Surg (1997) 20:132-135 Direct lymphangiography using gas as a contrast agent is Recently, carbon dioxide was used in angiography - not a completely unknown procedure. We have termed arteriography and venography, and Dimakakos et al. have this procedure "pneumolymphography" generally and turned our attention to carbon dioxide digital subtraction "xeropneumolymphangiography" respectively because lymphangiography. The experimental study proved that the xeroradiography was used at that time. Our previous carbon dioxide digital subtraction lymphangiography clinical experience with this method was published only can demonstrate not only lymphatic vessels (pneumo- in monographs [1, 2] with demonstration of one of the lymphangiogram) but also lymph nodes (pneumolym- first xeropneumolymphangiograms  a long time ago. phadenogram). The method they describe is direct lym- At that time I used only a small amount of gas and oxygen phography or exact pneumolymphography. Their experi- and proved pneumolymphography to be sufficient but not mental study is interesting and I hope that the method will so accurate as direct lymphography with positive contrast be used in clinical practice in the near future. I agree with agent in demonstration of peripheral lymphatic vessels. the authors statement that more experimental studies will The experimental study of using carbon dioxide digital be required to permit its application in man. It is neces- and subtraction lymphangiography by Dimakakos et al. is sary to define more exact technical parameters including interesting and also exciting from a clinical point of view. the amount of carbon dioxide to be injected per extremity The study was very well done according to the interna- in different subjects, pressure and speed of safe carbon di- tional rules for experimental research and it is the first oxide application without damaging lymphatics. General- study as I know of which presents results with carbon di- ly pneumolymphography with carbon dioxide digital sub- oxide in combination with digital subtraction in imaging traction lymphography using a small amount of gas is a of the lymphatic system. safe method as we know from our experience with the The indications for lymphography declined during the air and oxygen pneumolymphography and from other ap- past 15 years with the advent and the sophistication of the plications of carbon dioxide in angiography. This was so-called new imaging methods - ultrasonography, com- proved at the Diagnostic Radiology Department of the puterized tomography and magnetic resonance imaging. University of Orange Free State in Bloemfontein last Direct lymphography is still useful and the most exact year. Finally, we highly recommend the continuation of method for visualization of lymphatic vessels, collateral clinical research on the application of carbon dioxide lymphatic circulation and lymph node pathology. Lym- pneumolymphography and to prove the real advantages phography lost favor in many institutions and diagnostic and disadvantages of carbon dioxide digital subtraction centers because of difficulty for many physicians to per- lymphography in comparison with direct and indirect pos- form it and because it was time consuming. The contrain- itive contrast lymphography. dication to direct lymphography with positive iodine con- trast in patients with iodine and polyvalent allergies can be overcome by pneumolymphography. References 1. Bruna J (1981) Xeroradiography of the lymphatic system. Acta J. Bruna (~3) University Carol Med, Prague, p 18 Department of Diagnostic Radiology, UFS 2. Bruna J (1984) Klincka xeroradiographie mizniho systemu P.O. Box 1095, Bloemfontein 9300, South Africa (Czech). Charles University, Prague, pp 22, 24
European Journal of Plastic Surgery – Springer Journals
Published: Jan 1, 1998
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