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Posts Tagged ‘Physical Medicine Institute Margarita Correa MD’

Indocyanine green (ICG) Lymphography

In ICGLymphography, ICGscan, Indocyanine green, Lymphatic mapping, Lymphedema Advances, Lymphedema Clinic, Lymphedema Doctor, Lymphedema Physician, Lymphedema Therapy, Lymphedema Treatment on March 9, 2018 at 12:55 am

Indocyanine green (ICG) lymphography is a scan of the superficial lymphatics,helps define lymphatic dysfunction and delineate individualized lymphedema treatment. This study also helps visualize lymphedema in the asymptomatic limb. Superficial lymphatics accounts for 70% of the lymphatic system.

Indocyanine green (ICG) is a contrast that fluoresces in the near infrared range and therefore needs a special camera to be seen after injection. Low dose ICG injected into the subcutaneous tissue has been used to map lymphatics; this is known as ICG lymphography. The ICG binds to a protein called albumin, which is taken up into the lymphatics, and transported within the lymph fluid. In this way, the function of the lymphatics can be assessed.

We offer an initial consultation and ICG scan and if found with lymphedema an appropriate treatment plan is discussed.

In case ICG scan is normal in the presence of a swollen leg or arm, differential diagnosis for edema cause(s) is made.

In case of primary and secondary lymphedema, ICG scan will help define individual characteristics and pattern of lymph flow that with help customize decongestive therapy.

Higher risks for lymphedema development in cancer includes lymph nodes removal and/or radiation. After completion of cancer treatment, ICG scan can detect early signs of lymphedema and initiate preventive measures and/or treatment.

Procedure: After cleaning the skin with antiseptic, topical anesthetic is applied to numb injection site(s); and local anesthesia can be injected at injection site to numb and reduce pain. A tiny dose of ICG is injected subcutaneously, typically 0.1 ml (0.25 mg – 0.5 mg) per injection site, from 2 to 3 sites in the web space between fingers or toes in the affected arm or leg.

After a period of time from minutes to hour(s) the infrared camera scans the affected area and a black and white image is displayed on a video screen.

In normally functioning lymphatics, ICG is quickly taken up by the lymphatic system. The dye is rapidly transported in normal linear channels to the groin or armpit. Slow transport of dye indicates that the lymphatics have suffered secondary changes.

Benefits: The purpose of this test is to visualize the flow of the superficial lymphatics and areas of abnormalities such as dermal backflow. In addition important information regarding the function of the lymphatics can be gained from assessing the speed of lymphatic transport up the affected limb. The test aids in individualizing lymphedema treatment to improve effectiveness.

Precautions: ICG lymphography is a safe technique. Allergic reactions to ICG are very rare in general. The package insert states it contains ‘no more than 5% of sodium iodide’ ~ mainly used as a preservative.

Contraindication: Patients allergic to iodide, iodine and/or shellfish.

Side Effects: There is a theoretical risk of introducing infection by giving injections into the limb affected by lymphedema but this is unlikely as sterile needles and antiseptic skin preparation are used routinely. Other side effects may include allergic reaction, bruising, hematoma, temporary numbness, burning sensation at the injection site, and temporary local green coloration or discoloration of the skin.

Furthermore, ICG lymphography does not involve exposure to radiation.

Local anesthetic is routinely used in order to minimize the pain of ICG injection.

The dye has a green color and may leave a small green patch on the skin at the foot or hand lasting for a few days usually 3 – 7 days following the test.

After ICG lymphography, you can resume normal activities straight away, for example, it is fine for you to drive yourself home.

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References:

1. Yamamoto T, etal. The earliest finding of indocyanine green lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow stage and concept of subclinical lymphedema. Plast Reconstr Surg.2011 Oct;128(4):314e-321e.

2. Yamamoto T, etal. Indocyanine Green Lymphography Findings in Primary Leg Lymphedema. Eur J Vasc Endovasc Surg.2015 Jan;49(1):95-102.

3. Yamamoto T, etal. Dynamic Indocyanine Green (ICG) lymphography for breast cancer-related arm lymphedema. Ann Plast Surg.2014 Dec;73(6):706-9.

4. Mihara M, etal. Indocyanine green lymphography is superior to lymphoscintigraphy in imaging diagnosis of secondary lymphedema of the lower limbs. J Vasc Surg Venous Lymphat Disord.2013 Apr;1(2):194-201.

5. Mihara M, etal. Indocyanine green (ICG) lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs. PLoS One. 2012;7(6):e38182.

6. Aldrich MB, etal. Concentration of indocyanine green does not significantly influence lymphatic function as assessed by near-infrared imaging. Lymphat Res Biol.2012 Mar;10(1):20-4.

7. Yamamoto T, etal. Indocyanine green lymphography for evaluation of genital lymphedema in secondary lower extremity lymphedema patients. J Vasc Surg Venous Lymphat Disord.2013 Oct;1(4):400-405.

8. Ietto G, etal. Real-time Intraoperative Fluorescent Lymphography: A New Technique for Lymphatic Sparing Surgery. Transplant Proc. 2016 Nov;48(9):3073-3078.

Physical Medicine Institute Orlando  352-404-6959

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Margarita Correa MD Google Map Orlando Office

In Alternative Medicine, Bowel & Bladder Dysfunction, Cancer Rehabilitation, doctor, Electromyography, EMG & NCS, FL, Health, Lymphedema, Lymphedema Clinic, Lymphedema Doctor, Lymphedema Physician, Lymphedema Rehabilitation, Lymphedema Therapy, Lymphedema Treatment, Manual Lymph Drainage, Manual Therapy, Massage, Medical, Nerve Conduction Studies, Pain Medicine, Pediatric Physical Medicine and Rehabilitation, Pediatric Rehabilitation Medicine, Pediatric Therapy, Physiatrist, Physical Medicine and Rehabilitation on June 19, 2011 at 1:47 pm

Margarita Correa MD.

2902 N Orange Ave, Suite 205, Orlando, FL 32804

Phone (407) 237-0069 ‎

Fax (352) 404-6960

http://www.physmedi.com

http://www.lymphedemaphysmedi.com

http://www.lymphdoc.com

http://www.pedrehabphysmedi.com

 

Margarita Correa , Electromyography & NCS – Margarita Correa MD, Orlando, FL – Physiatrist

In doctor, Electromyography, EMG & NCS, Medical, Nerve Conduction Studies, Physiatrist, Physical Medicine and Rehabilitation on May 7, 2011 at 3:41 pm

Margarita Correa , Electromyography & NCS – Margarita Correa MD, Orlando, FL – Physiatrist.

Contact Us @ pedrehabphysmedi.com

In doctor, Health, Pediatric Physical Medicine and Rehabilitation, Pediatric Rehabilitation Medicine, Pediatric Therapy on April 24, 2011 at 10:03 pm

Contact Us @ pedrehabphysmedi.com.

Request an appointment is available, is easy to use!

Electromyography (EMG) & Nerve Conduction Studies (NCS)

In doctor, Electromyography, EMG & NCS, Medical, Nerve Conduction Studies, Physiatrist, Physical Medicine and Rehabilitation on April 16, 2011 at 1:21 am

Electromyography (EMG) & Nerve Conduction Studies (NCS): a test that helps in diagnosis of conditions related to nerves, muscles, neuromuscular junction and motor neuron.

General Indications for EMG & NCS:
numbness, tingling, burning sensation or
pain, radicular pain, limb pain, muscle
weakness and/or atrophy, fasciculations.

  • Facial nerve palsy
  • Carpal & Cubital tunnel syndrome
  • Tarsal tunnel syndrome
  • Nerve Injuries
  • Peripheral neuropathy
  • Radiculopathies
  • Congenital and acquired neuropathies
  • Myopathies, muscular dystrophy
  • Neuromuscular junction disorders
  • Motor neuron diseases

The EMG & NCS usually takes about 1 hour to be performed and the report is provided to the referring physician or provider in 24 to 48 hours.

BOTOX injections are performed either EMG or nerve stimulation guided. The botulinum toxin when injected relaxes the muscle to reduce muscle tone and spasticity, improve function of the extremity or neck and decrease pain. The benefit of the BOTOX injection usually last up to 4-5 months depending on the condition treated and is found to be beneficial is repeated.

Special considerations:
EMGs are often avoided or done with great caution on individuals who are receiving anticoagulants (warfarin) due to risk of local bleeding. Depending on each individual case your doctor may stop the warfarin 3 days before the study and re-assume immediately after.

EMGs are generally not problematic for persons with pacemakers, but nerve conduction studies requiring stimulation near pacemakers should be avoided.

Do not apply body or hand lotion, this will make difficult for the superficial electrodes to adhere to the skin.

Margarita Correa MD / Physical Medicine Institute Office @ Winter Park, FL open Friday 04/15/11 – accepting patients

In Alternative Medicine, Bowel & Bladder Dysfunction, Cancer Rehabilitation, Electromyography, EMG & NCS, Health, Lymphedema, Lymphedema Doctor, Lymphedema Physician, Lymphedema Rehabilitation, Lymphedema Therapy, Lymphedema Treatment, Manual Lymph Drainage, Manual Therapy, Massage, Medical, Nerve Conduction Studies, Pain Medicine, Pediatric Physical Medicine and Rehabilitation, Pediatric Rehabilitation Medicine, Pediatric Therapy, Physiatrist, Physical Medicine and Rehabilitation on March 12, 2011 at 3:42 pm

Margarita Correa MD / Physical Medicine Institute @ Winter Park Office Opening on Friday, April 15, 2011 – Accepting Patients.

Medical services: Physical Medicine and Rehabilitation, Physical Therapy, Manual Therapy, Therapeutic Massage, Manual Lymph Drainage, Lymphedema Therapy, Cancer Rehabilitation Program, Electrodiagnostic Medicine (EMG & NCS), Comprehensive Physical Rehabilitation Management…

For additional information or making appointments call (352) 404-6959, alternate phone (407) 237-0069

We accept most health insurances.

Location:

2902 N Orange Ave

Suite 205

Orlando, FL 32804

Manual Lymph Drainage

http://www.physmedi.com

http://www.lymphedemaphysmedi.com

http://www.lymphdoc.com

Open House Physical Medicine Institute @ Winter Park Thursday May 5, 2011; 5:00pm – 7:00pm

In Bowel & Bladder Dysfunction, Cancer Rehabilitation, Electromyography, EMG & NCS, Health, Lymphedema, Lymphedema Doctor, Lymphedema Physician, Lymphedema Rehabilitation, Lymphedema Therapy, Lymphedema Treatment, Medical, Nerve Conduction Studies, Pediatric Physical Medicine and Rehabilitation, Pediatric Rehabilitation Medicine, Pediatric Therapy, Physiatrist, Physical Medicine and Rehabilitation on February 18, 2011 at 1:06 am

Margarita Correa MD announces the opening of a new private practice @ Winter Park, open house @ 2902 N Orange Ave, Ste 205 Orlando, FL 32804   RSVP (352) 404-6959   physmedi@physmedi.com

http://www.lymphedemaphysmedi.com

http://www.lymphdoc.com

http://www.physmedi.com

http://www.lymphrehab.com

Cancer Rehabilitation Program – products and services from Physical Medicine Institute @ Winter Park

In Bowel & Bladder Dysfunction, Cancer Rehabilitation, Electromyography, EMG & NCS, Health, Lymphedema, Lymphedema Doctor, Lymphedema Physician, Lymphedema Rehabilitation, Lymphedema Therapy, Lymphedema Treatment, Medical, Nerve Conduction Studies, Pain Medicine, Physiatrist, Physical Medicine and Rehabilitation on February 5, 2011 at 5:43 pm

Cancer Rehabilitation Program – products and services from Physical Medicine Institute @ Winter Park.