Cyclic Edema Research Articles

Long term use of metformin in idiopathic cyclic edema, report of thirteen cases and review of the literature

IntroductionIdiopathic cyclic edema (ICE) is a rare cause of edema. To date, there is no standard of care. The physiopathology of ICE could be explained by an impairment of capillary permeability. In 1995, a study demonstrated the efficacy of metformin on symptoms and capillary permeability. We evaluated ICE-patients who were treated with metformin in our department. MethodsWe retrospectively included patients diagnosed for ICE between January 1997 and October 2013. ICE was diagnosed in the presence of edema after excluding other etiologies. LANDIS test was used to support ICE diagnosis in all patients. The absence of edema at follow-up was considered as complete response (CR), partial decreased was considered as partial response (PR). Adverse events were recorded. ResultsThirteen patients have accepted to use metformin. The median treatment duration was 28.5 months [8–167] and the median follow-up of treated patients was 40.5 months [14–167]. CR was reached in 10 patients (77%), and PR in 2 patients (15%). Two patients reported side-effects as diarrheas and one of them stopped the treatment due to mild diarrhea. ConclusionWe report the interest and tolerance of the long-term use of metformin in ICE. No severe adverse events were noticed. A prospective study is needed to confirm the efficacy of metformin in ICE-patients.

Adenomyosis of the Extrapelvic Portion of the Round Ligament

Abstract Background: Adenomyosis is a disease of the uterus characterized by invasion of endometrial cells within the myometrium. Adenomyosis is typically confined to the uterus, with no distant localizations. This article reports on a case of adenomyosis of the distal extrapelvic portion of the round ligament. Case: The patient, a 49-year-old woman, had previously undergone surgery for pelvic endometriosis. This prior surgery included removal of uterus, fallopian tubes, and a portion of the sigmorectal intestine. She then presented with a nodule on the right side of her pubis. The nodule was close to the upper part of her right labia majora. She was experiencing cyclic pain, nodule enlargement, and edema on the right side of her pubis. The entire round ligament, from the internal inguinal canal to its distal end above the pubis, was removed. Histology testing revealed that the distal nodule was a myomalike neoformation containing endometrial tissue; this was definable as adenomyosis. Results: After the s...

Evaluation of the Prevalence of Concomitant Idiopathic Cyclic Edema and Cellulite

The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema. Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema. Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.

Remission of hypnic headache associated with idiopathic cyclic edema with the use of aminaphtone.

Headache is one of the chief complaints among patients visiting primary care physicians. The aim of the current study is to report on a case of daily intermittent headaches in a patient with idiopathic cyclic edema. Over three years the patient suffered from headaches that started and improved at specific times. They began at about 5 to 6 o’clock in the morning and spontaneously disappeared 3 to 4 hours after getting up and thus were directly associated to sleep. The patient complained of generalized edema and had weight differences of about two kilograms between 7 a.m. and 5 p.m. A hypothesis of idiopathic cyclic edema was reached and the patient was prescribed aminaphtone which cured the headaches within two days after initiating treatment.

Gemcitabine-induced Chronic Systemic Capillary Leak Syndrome: A Life-threatening Disease

Systemic capillary leakage syndrome (SCLS) is a process associated with capillary membrane hyper-permeability due to endothelial damage. It manifests by generalised oedema, anasarca, acute respiratory distress syndrome, hypovolaemia and shock. Fever precedes the oedema in 30% of cases, and rhabdomyolysis due to severe muscular oedema can take place. The pathogenesis is not clear, but it is thought that various inflammatory cytokines are involved in the process. A scintigraphic study with labelled albumin shows increased vascular permeability, massive extravasation of intravascular fluid and albumin retention in the interstitial space [ 1 Clarkson B. Thompson D. Horwith M. Luckey H. Cyclical edema and shock due to increased capillary permeability. Am J Med. 1960; 29: 193-216 Abstract Full Text PDF PubMed Scopus (275) Google Scholar ].

Case 30: Hypereosinophilia

A young man presented with systemic symptoms and marked eosinophilia. Subsequently cyclical weight gain and edema contributed to a diagnosis.

Black's medical dictionary

This dictionary defines and explains a wide range of terms and concepts in use in medicine and closely related fields. The new edition is up-to-date with current theory and practice, with many new topics and revised sections to cover recent medical developments. New topics included are Bowen's disease, adulteration of food, cluster headaches and cyclical oedema of women. Recent developments in dentistry, ophthalmology, psychiatry, dermatology and diseases of the ear are also covered.

Vascular Hyperpermeability in Nephrotic Edema

Background/Aim: There is increasing evidence that hypoalbuminemia and the inability of the renal distal tubule to excrete salt are not the only factors responsible for nephrotic edema. We tested the possibility that vascular hyperpermeability also plays a role in the pathophysiology of nephrotic edema in human primary glomerulonephritis. Methods: We investigated the capillary permeability by means of a standardized test using albumin labelled with technetium (^99mTc-albumin) in 20 healthy adults and in 101 nephrotic adult patients comprising 60 patients with idiopathic nephrotic syndrome (INS; minimal-change nephropathy and segmental glomerulosclerosis), 32 with idiopathic membranous nephropathy (IMN) and 9 patients with idiopathic type I membranoproliferative glomerulonephritis (MPGN). The patients and healthy controls were also compared with a group of women (n = 25) with idiopathic cyclic edema, a disease in which an increase in capillary permeability plays a pivotal role. The capillary permeability measured by the Landis isotope test is normal in edematous patients with cardiac and renal impairment unrelated to glomerular disease, cirrhosis, hypothyroidism, lymphatic obstruction and diuretic abuse. As values were not normally distributed, nonparametric analysis of variance was used (Kruskal-Wallis test), and patient groups were compared with healthy controls and with women with idiopathic cyclic edema by means of the two-tailed nonparametric Mann-Whitney test. The effects of high-dose steroids and Ginkgo biloba extract (Tanakan^®; an agent able to improve capillary permeability) were analyzed by means of the two-tailed nonparametric Wilcoxon test. Results: The capillary permeability was significantly increased (Mann-Whitney test) in each glomerular disease group compared with the healthy controls. ^99mTc-albumin extravasation values (%; median and range in parentheses were the following: healthy controls 0 (0–8.4); idiopathic cyclic edema patients 11.5 (8–24), p < 0.001; INS 20 (0–50), p < 0.0001; IMN 12.5 (0–40), p < 0.001, and MPGN 10 (0–40), p < 0.05. An increase in capillary permeability exceeding the upper limit of control values ( >8% of ^99mTc-albumin extravasation) was observed in 88% of INS, in 53% of IMN and in 44% of MPGN patients. The increase in capillary permeability (%) was greater in idiopathic nephrotic patients than in idiopathic cyclic edema patients (p < 0.005, Mann-Whitney test) and was markedly reduced in nephrotic patients receiving high-dose steroids (n = 8) [before 25 (8–40); after 0 (0–25), p < 0.005 (Wilcoxon’s test)] and high doses of G. biloba extract (n = 16) [before 30 (8–50); after 2.5 (0–20, p < 0.0005 (Wilcoxon’s test)]. Conclusions: We conclude that capillary permeability is severely altered in most of the nephrotic patients with primary glomerulonephritis. These results strongly suggest that the capillary hyperpermeability plays a role in the pathophysiology of nephrotic edema in primary glomerular disease, especially in INS. We postulate that this widespread abnormality in capillary permeability is related to the release of vascular permeability factor and other cytokines by immune cells.

Clinical efficacy of micronized purified flavonoid fraction (MPFF) in edema.

Swelling is one of the most frequent complaints of patients in daily clinical practice; leg edema is its objective confirmation. It can be associated with several diseases. Micronized purified flavonoid fraction (MPFF) is a phlebotropic drug commonly used to treat the signs and symptoms associated with chronic venous insufficiency (CVI). It has confirmed its clinical efficacy in different groups of patients suffering from edema: idiopathic cyclic edema, CVI-associated edema, postmastectomy lymphedema and might be beneficial in some of drug-induced edema. In a double-blind, placebo-controlled, randomized study including 30 outpatients suffering from idiopathic cyclic edema syndrome, MPFF 1000 mg/day for 6 weeks, normalized the capillary permeability, assessed by the Landis isotope test, in 3 out of 4 patients (p=0.01). The decrease in capillary hyperpermeability led to a clinically significant decrease in weight and edema. In 200 patients with functional or organic venous insufficiency of the lower limbs, a double-blind, placebo-controlled, randomized study with MPFF 1000 mg/day for 2 months provided strong evidence of a marked improvement in symptoms and signs. A significant reduction in supramalleolar edema (assessed by circumference measurement) was observed, whatever the origin of CVI: functional or organic. MPFF efficacy was also demonstrated in another randomized, multicenter controlled trial in 320 patients suffering from chronic venous insufficiency. In this study, a significant decrease in circumference of the most affected leg was observed after 2 months of treatment (p<0.001), whatever the schedule of administration of MPFF (1000 mg once daily or bid). The benefit of MPFF on edema has been further confirmed by the volometer technique (opto-electronic measuring system) which was performed in a population of 30 patients suffering from CVI and treated by MPFF 1000 mg/day over a 6-week period. The mean volume of the more affected lower leg decreased significantly after a 6-week period of treatment, correlating to a significant improvement in clinical symptoms. MPFF has been also tested on another type of edema, upper limb lymphedema secondary to mastectomy, during a double-blind, placebo-controlled, randomized study in 104 patients. MPFF 1000 mg/day improved all lymphoscintigraphic parameters such as half-life and clearance of the labelled colloid. With regard to evolution of lymphedema volume, a tendency in favor of MPFF was observed in the subgroup of patients with more severe lymphedema. Based on its action on capillary hyperpermeability, MPFF has been used with attractive results when combined with classic treatment for a pilot study carried out in patients with advanced breast cancer (n=21) or ovarian carcinoma (n=3), treated with docetaxel, which causes severe edema as a side effect, even when associated with corticoids. Further trials are under way to assess the possible benefit of MPFF in such patients. These results in different types of edema confirm that, by acting on all parameters involved in edema, veins, lymphatics, and microcirculation, MPFF represents a drug of choice for treating CVI-associated edema.

Leg edema

Leg edema is a troublesome condition for many women, and it can be associated with local or systemic disorders. Although there may be normal cyclic edema secondary to hormonal changes, this complaint should be evaluated properly so that a treatable underlying disorder will not be over-looked. An understanding of the normal physiology of the leg vasculature and a knowledge of the common causes of edema will allow the physician to appropriately address this complaint. A thorough history and physical examination, along with appropriate diagnostic tests, permit accurate diagnosis. Subsequent treatment or referral can then be prescribed.

The Effects of Metformin on the Capillary Permeability to Albumin in Women Patients with Cyclic Edema

An experimental work has suggested the efficacy of metformin, an oral antidiabetic agent, on capillary permeability. This agent has been tested in 10 women patients with cyclic edema, 7 of them being obese. The capillary permeability to albumin studied by an isotope test derived from Landis's method was initially increased. After a mean of six-weeks of treatment the albumin retention and an index demonstrating the interstitial protein elimination through the lymph route were significantly improved. Concomitantly, the swelling feelings were reduced in 8 cases and the lower limb edema had decreased or disappeared in 8 of 9 patients who initially presented these symptoms. The effects of metformin are beneficial and have been observed to be independent of glycemic change. The results suggest a special effect of this agent on the microcirculation. Nevertheless, a controlled study is required.

Elevated Serum Levels of lnterleukin-5 in Patients With the Syndrome of Episodic Angioedema and Eosinophilia

The syndrome of episodic angioedema and eosinophilia is characterized by cyclic edema, marked peripheral blood eosinophilia, and eosinophil degranulation in the dermis. Using a sensitive immunoenzymetric method, we measured serum interleukin (IL)-5 levels in four patients with this syndrome. We also determined the percentage of activated T cells in the peripheral blood of a new patient before and during an attack. In the patient presented, IL-5 levels peaked several days before maximal eosinophilia and then declined. This patient's lymphocytes showed an increased percentage, 28% (normal 2% to 3%), of activated T cells staining for both CD3 and HLA-DR 10 days before maximal eosinophilia, but no increase at the time of peak eosinophilia. In serum from three previously reported cases, elevated serum IL-5 levels were found during attacks. After glucocorticoid administration, IL-5 levels became undetectable in three of the four patients. Production of IL-5 is likely an important determinant of the pathophysiology of this syndrome.

Elevated serum levels of interleukin-5 in patients with the syndrome of episodic angioedema and eosinophilia

The syndrome of episodic angioedema and eosinophilia is characterized by cyclic edema, marked peripheral blood eosinophilia, and eosinophil degranulation in the dermis. Using a sensitive immunoenzymetric method, we measured serum interleukin (IL)-5 levels in four patients with this syndrome. We also determined the percentage of activated T cells in the peripheral blood of a new patient before and during an attack. In the patient presented, IL-5 levels peaked several days before maximal eosinophilia and then declined. This patient's lymphocytes showed an increased percentage, 28% (normal 2% to 3%), of activated T cells staining for both CD3 and HLA-DR 10 days before maximal eosinophilia, but no increase at the time of peak eosinophilia. In serum from three previously reported cases, elevated serum IL-5 levels were found during attacks. After glucocorticoid administration, IL-5 levels became undetectable in three of the four patients. Production of IL-5 is likely an important determinant of the pathophysiology of this syndrome.

Idiopathic oedema: non-drug treatment first

Idiopathic oedema or fluid retention syndrome occurs mainly in post pubertal women. Also known as cyclical oedema, it appears to be more commonly recognised than when we last discussed it,1 and has recently been described in a few prepubertal children.2 Patients with the syndrome retain abnormal amounts of salt and water while standing, in response to an excessive orthostatic fall in plasma volume.3 Their symptoms are frequently attributed to neuroticism, allergy or varicose veins, and incorrectly managed with excessive doses of diuretics.4 When should oedema be regarded as ‘idiopathic’, and how should it be managed?

Cyclical Edema in a Patient with Hypothalamic Disorders and Chronic Glomerulonephritis: Arginine Vasopressin-Dependent Atrial Natriuretic Hormone Release.

A 28-year-old woman had hypothalamic disorders (amenorrhea, obesity, psychiatric abnormalities, polydipsia and fever) and chronic glomerulonephritis. She also suffered from general edema associated with cyclical oliguria and polyuria. Her body weight and plasma osmolality increased during the oliguria phase lasting 2 to 8 days and decreased after paroxysmal polyuria accompanied by the natriuresis. These episodes occurred repeatedly, regardless of the treatment with or without diuretics. The release of arginine vasopressin in response to increased plasma osmolality was exaggerated, but changes in plasma volume did not affect arginine vasopressin release. Plasma atrial natriuretic hormone increased in response to a rise in plasma arginine vasopressin and plasma volume during the oliguria phase, thereby resulting in the diuresis and natriuresis. The renin-angiotensin-aldosterone system was secondarily activated by body fluid depletion and diuretics, and this might play an additive role in general swelling. Plasma gonadal hormones did not change to explain the edema. The mechanism of this cyclical edema remains unknown, but it is likely that hypothalamic dysfunction related to psychiatric abnormalities may exaggerate arginine vasopressin release, and enhanced renal sympathetic activity may cause retention of Na and water, and the increase in atrial natriuretic hormone release responding to the plasma volume expansion may bring about the diuresis and natriuresis.

Osmoregulation of vasopressin secretion and thirst in cyclical oedema.

Osmoregulation of vasopressin release and thirst was studied in the mid-follicular and mid-luteal phases of the menstrual cycle of five patients with cyclical oedema defined by peripheral oedema and weight gain (greater than 3.0 kg) manifest in two consecutive luteal phases. Results are compared to those already obtained in eight healthy women. In the patients, basal plasma osmolality in the mid-luteal phase was significantly lower than in the mid-follicular periods (patients, 283 +/- 1, 287 +/- 1 mOsmol/kg, respectively, mean +/- SEM, P less than 0.05; controls, 282 +/- 1, 286 +/- 1 mOsmol/kg, respectively, P less than 0.05). Plasma osmolality (pOsm) and plasma arginine vasopressin (pAVP) were measured during hypertonic (850 mmol/l) saline infusion in both phases of the cycle; linear regression analyses of these data gave the following mean regression equations, (i) mid-follicular, pAVP = 0.55 (pOsm - 285), r = 0.94 and (ii) mid-luteal, pAVP = 0.42 (pOsm - 281), r = 0.93. The abscissal intercept was significantly different (P less than 0.025). Osmotic threshold for severe thirst onset was lower in the mid-luteal phase compared to the mid-follicular value (296 +/- 1, 299 +/- 1 mOsmol/kg, respectively, P less than 0.01). Basal data and results of thirst onset and theoretical threshold for vasopressin release in response to osmotic stimulation obtained in the patients were similar to healthy control women. We conclude that osmoregulation in cyclical oedema is normal.

Increased Numbers of Erythrocyte Sodium Pumps in Idiopathic (Cyclical) Oedema

Increased Numbers of Erythrocyte Sodium Pumps in Idiopathic (Cyclical) Oedema

The Effects of Nomifensine in Cyclical Oedema

The Effects of Nomifensine in Cyclical Oedema

Prolactin Response to Pergolide in Cyclical Oedema

Prolactin Response to Pergolide in Cyclical Oedema

Prolactin Response to Pergolide in Cyclical Oedema

Prolactin Response to Pergolide in Cyclical Oedema