[New aspects of lymphedema].

Present knowledge on primary and secondary lymphedema of the extremities is reviewed. Conventional lymphography with contrast media requires surgical cannulation of pedal lymphatics and is indicated only in a few specific situations. Clinical findings, results of the patent blue test and possibly fluorescence microlymphography with fluorescent dextrans, indirect lymphography with iotasul, or isotope studies, suffice for correct diagnosis. In hereditary lymphedema present at birth (Milroy's disease) the lymphatic capillaries and precollectors are aplastic, whereas in sporadic lymphedema with postpubertal onset the large collectors are hypoplastic or aplastic. Conventional lymphography still yields the best results in differentiating between primary lymphedema with aplasia of the aorto-iliac collectors and a secondary form due to neoplastic disease. Combined physical therapy with tight bandages and stockings, massage and use of pneumatic devices for intermittent compression considerably reduces the edema and renders surgery unnecessary in most patients. Diuretics have a beneficial effect during early management, and benzopyrones for longterm treatment.