1. Plast
Reconstr Surg. 2009 Aug;124(2):438-50.
Fibrosis is a key inhibitor of
lymphatic regeneration.
Avraham T, Clavin NW, Daluvoy SV, Fernandez J,
Soares MA, Cordeiro AP, Mehrara BJ.
Division of Plastic and
Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer
Center, New York, NY, USA.
BACKGROUND: Lymphedema is a
common debilitating sequela of lymph node dissection. Although
numerous clinical studies suggest that factors that lead to fibrosis
are associated with the development of
lymphedema, this relationship
has not been proven. The purpose of these experiments was therefore to
evaluate lymphatic regeneration in the setting of variable soft-tissue
fibrosis.
METHODS: A section of mouse tail skin including the capillary
and collecting lymphatics was excised.
Experimental animals (n = 20)
were treated with topical collagen type I gel and a moist dressing, whereas
control animals (n = 20) underwent excision followed by moist dressing
alone. Fibrosis, acute lymphedema,
lymphatic function, gene expression, lymphatic endothelial cell proliferation, and lymphatic fibrosis were
evaluated at various time points. RESULTS: Collagen gel
treatment significantly decreased fibrosis, with an
attendant
decrease in acute lymphedema and improved lymphatic function. Tails treated
with collagen gel
demonstrated greater numbers of lymphatic
vessels, more normal lymphatic architecture, and more
proliferating
lymphatic endothelial cells. These findings appeared to be independent of
vascular endothelial
growth factor C expression. Decreased fibrosis
was associated with a significant decrease in the expression
of extracellular matrix components. Finally, decreased soft-tissue fibrosis was associated with a significant
decrease in lymphatic fibrosis as
evidenced by the number of lymphatic endothelial cells that coexpressed
lymphatic and fibroblast markers. CONCLUSIONS: Soft-tissue fibrosis is
associated with impairment in
lymphatic regeneration and lymphatic
function. These defects occur as a consequence of impaired lymphatic
endothelial cell proliferation, abnormal lymphatic microarchitecture,
and lymphatic fibrosis. Inhibition of
fibrosis using a simple
topical dressing can markedly accelerate lymphatic repair and promote
regeneration
of normal capillary lymphatics.
PMID: 19644258
[PubMed - in process
---
2. Breast Cancer Res Treat. 2009 Jul
30. [Epub ahead of print]
Pain perception and detailed visual pain
mapping in breast cancer survivors.
Jud SM, Fasching PA, Maihöfner C,
Heusinger K, Loehberg CR, Hatko R, Rauh C, Bani H, Lux MP,
Beckmann
MW, Bani MR.
Department of Gynecology and Obstetrics, University Breast
Center for Franconia, Erlangen University
Hospital,
Universitaetsstrasse 21-23, 91054, Erlangen, Germany.
Chronic pain and
neural irritation after breast surgery and radiation are still relevant
sequelae of the
treatment. Pain quantification and localization in
patient groups are difficult to standardize. In order to
quantify
and localize pain in a group of breast cancer patients, a Java-based program
was developed to
visualize the frequency of pain in "pain maps." A
questionnaire with structured questions on the perception of
pain
included pictograms of a body to mark possible pain areas. A group of 343
breast cancer survivors
completed the questionnaires. The image
information was digitalized and processed using a Java applet.
Gray-scale summation pictures with numbers from "0," indicating black
(100% pain), to "255," indicating
white (0% pain), were generated.
The visualization of pain by creating pain maps revealed the location of
pain in breast cancer survivors on pictograms of the body. Analyzing
the total number of pixels, in which
pain was stated, made it
possible to compare pain areas in several subgroups, showing that patients
after
mastectomy versus breast-conserving therapy (3,011 vs. 2,224
pixels), and patients with lymphedema
versus patients without
lymphedema (3,010 vs. 2,239 pixels), have larger pain areas. This study
presents a
method of visualizing pain areas and assigning them to a
pictogram of the body in a sample of breast cancer
patients. The
method is easy to use and could help generate pain maps in several types of
disease.
PMID: 19641989 [PubMed - as supplied by
publisher
---
3. Am J Nurs. 2009 Aug;109(8):34-41; quiz
42.
Post-breast cancer lymphedema: part 2.
Fu MR, Ridner SH,
Armer J.
New York University College of Nursing, New York City, USA.
[email protected]
As breast cancer survivors often say, lymphedema is more
than just a swollen arm. A result of surgical or
radiologic breast
cancer treatment, it's an abnormal accumulation of lymph in the arm, shoulder,
breast, or
thoracic area that usually develops within three years
of a breast cancer diagnosis but can occur much later.
In Part 1
(July) the authors described the pathophysiology and diagnosis of lymphedema.
In Part 2 they
discuss current approaches to risk reduction,
treatment and management of the condition, and implications
for
nurses.
PMID: 19641404 [PubMed - in process
---
4. Ann
Acad Med Singapore. 2009 Jul;38(7):636-3.
Primary lymphoedema at an
unusual location triggered by nephrotic syndrome.
Tabel Y, Mungan I,
Sigirci A, Gungor S.
Department of Paediatrics, Faculty of Medicine,
Inonu University, Malatya, Turkey. yilmaztabel@yahoo.
com
INTRODUCTION: Lymphoedema results from impaired lymphatic
transport leading to the pathologic
accumulation of protein-rich
lymphatic fluid in the interstitial space, most commonly in the extremities.
Primary lymphoedema, a developmental abnormality of the lymphatic
system, may become evident later in
life when a triggering event
exceeds the capacity of normal lymphatic flow.
CLINICAL PICTURE: We
present a 3-year-old nephrotic syndrome patient with an unusual localisation
for primary lymphoedema.
TREATMENT AND OUTCOME: The patient
was treated with conservative approach and she was cured.
CONCLUSION: In this particular case, lymphoedema developed at an
unusual localisation, which has not
been recorded
before.
PMID: 19652856 [PubMed - in process
----
5. Int
Angiol. 2009 Aug;28(4):315-24.
The CEAP-L classification for lymphedemas
of the limbs: the Italian experience.
Gasbarro V, Michelini S, Antignani
PL, Tsolaki E, Ricci M, Allegra C.
Unit of Vascular and Endovascular
Surgery, Department of Surgical, Anesthesiological and Radiological
Sciences, Sant'Anna University Hospital, University of Ferrara,
Ferrara, Italy [email protected].
AIM: A method to classificate
lymphedema has been needed to gather all the important information on the
clinical evolution of the disease using a common language and an easy
clinical applicability.
METHODS: The proposal for a new classification
of the limb lymphedema was inspired by the C.E.A.P.
classification
for chronic venous insufficiency of the lower limb. The classification adopts
the acronym C.E.A.
P. by adding the letter L to underline the aspect
''lymphedema'' and is based on clinical data such as
extension of
lymphedema, presence of lymphangitis, leg ulcers and loss of functionality of
the limb and
instrumental criteria that permit to confirm and
precise diagnosis. The Clinical classification is based on the
most
objective sign in these patients, the edema which is subdivided into 5 classes
depending on the clinical
manifestations. The etiological aspect
considers 2 types of alterations of the lymphatic system: congenital and
acquired. The anatomic is aimed to locate the anatomical structures
involved. Pathophysiological conditions
are gathered into 5 groups:
agenesia or hypoplasia, hyperplasia, reflux, overload,
obstruction.
RESULTS: The classification has already been appraised
after 4 years of activity at the unit of Vascular and
Endovascular
Surgery of Ferrara, at the S. Giovanni Battista Hospital in Rome, at the
Umberto I Ancona
Hospital and at the S. Giovanni- Addolorata
Hospital in Rome.
CONCLUSIONS: The proposal for a new classification of
lymphedema C.E.A.P. L was developed in
order to categorize patients
with definite and objective marks, creating clinical reports with a common
vocabulary, clear to all clinicians, permitting to stage the disease,
evaluate treatment and finally obtain
epidemiological and
statistical data.
PMID: 19648876 [PubMed - in
process
-----
Breast. 2009 Aug 3. [Epub ahead of
print]
Axillary metastatic disease as presentation of occult or
contralateral breast cancer.
Lanitis S, Behranwala KA, Al-Mufti R,
Hadjiminas D.
St Mary's hospital, Praed street, Paddington, London W2
1NY, UK.
INTRODUCTION: Atypical axillary metastasis may arise from an
occult ipsilateral or contralateral breast
cancer or from primary
non-breast tumour. The treatment of this entity is challenging and presents
various
options. We present our experience with a brief review of
the literature.
RESULTS: A study of atypical axillary metastasis done at
St Mary's hospital, from 1998 to 2008, identified
six cases.
Radiological investigations and immunohistochemistry excluded non-breast
primary tumour. Three
patients had occult breast cancer on
presentation, two patients had previously treated contralateral breast
cancer and one patient developed a primary metachronous contralateral
breast cancer, which had a
completely different histological profile
from the involved lymph nodes on the same side. Axillary nodal
clearance was done for all patients except for the patient with
lymphoedema. Four patients were alive with
no evidence of disease
and two patients died of the disease at a median follow-up of 23
months.
CONCLUSION: Atypical axillary metastasis from ipsilateral occult
or contralateral breast cancer should be
treated with axillary node
clearance and further endocrine or chemotherapy. Radiation treatment or a
watchful policy to the ipsilateral breast should be validated by
further studies.
PMID: 19656680 [PubMed - as supplied by
publisher
-------------------------
Fukuoka Igaku Zasshi. 2009
Jun;100(6):235-41.
[The outcomes of program based on complex
decongestive physiotherapy for a patient with secondary
lymphedema
caused by infection on the leg][Article in Japanese]
Nakao F, Furutani
A, Yoshimura K, Hamano K, Kinoshita Y, Kawamoto R, Nakao H, Suzuki
S.
Department of Health Sciences, Faculty of Medical Sciences, Kyushu
University, 3-1-1 Maidashi, Higashi-
ku, Fukuoka 812-8582,
Japan.
Lymphedema is a chronic problem causing distress and loss of
functions throughout the lifespan. Complex
decongestive
physiotherapy (CDP) is in common use in developed countries but has only
recently been used
in Japan for people in outpatient settings. CDP
is a representative conservative treatment for lymphedema,
conducted by combining four kinds of physical therapies: skin care,
manual lymph drainage (MLD), bandage
and exercise. This research
project lead by a nurse is underway using CDP in an outpatient department. We
report a case of secondary lymphedema caused by infection
successfully treated by CDP. A 22-year-old
man suffered from
cellulitis of unknown origin when he was a high school student. After this
event, he had
been repeatedly admitted to hospital with infections
as a result of the lymphedema. He underwent MLD
once or twice
monthly and received health education for skin care, self-massage and exercise,
and was
advised to wear compression stockings. Within 7 months the
leg swelling had significantly reduced and his
feelings of malaise
and pain disappeared. Fourteen months later the circumferences of his knee and
ankle
had kept the sizes, and he has not re-entered hospital for
infections. For this man, CDP had a positive
outcome, as it has for
many others around the world. Our experience has found it very important to
establish
adequate support systems for such people in outpatient
and community settings. However, more research
and knowledge
sharing are required to understand the usefulness and effectiveness about this
program as a
primary treatment combined with health education in
community settings in Japan.
PMID: 19670806 [PubMed - in
process
-----------------------------------
Nat Med. 2009 Aug 9.
[Epub ahead of print]
Alternatively spliced vascular endothelial
growth factor receptor-2 is an essential endogenous inhibitor of
lymphatic vessel growth.
Albuquerque RJ, Hayashi T, Cho
WG, Kleinman ME, Dridi S, Takeda A, Baffi JZ, Yamada K, Kaneko H,
Green MG, Chappell J, Wilting J, Weich HA, Yamagami S, Amano S, Mizuki
N, Alexander JS, Peterson
ML, Brekken RA, Hirashima M, Capoor S,
Usui T, Ambati BK, Ambati J.
[1] Departments of Ophthalmology
& Visual Sciences, Lexington, Kentucky, USA. [2] Department of
Physiology, University of Kentucky, Lexington, Kentucky,
USA.
Disruption of the precise balance of positive and negative
molecular regulators of blood and lymphatic vessel
growth can lead
to myriad diseases. Although dozens of natural inhibitors of hemangiogenesis
have been
identified, an endogenous selective inhibitor of
lymphatic vessel growth has not to our knowledge been
previously
described. We report the existence of a splice variant of the gene encoding
vascular endothelial
growth factor receptor-2 (Vegfr-2) that
encodes a secreted form of the protein, designated soluble Vegfr-2
(sVegfr-2), that inhibits developmental and reparative lymphangiogenesis
by blocking Vegf-c function.
Tissue-specific loss of sVegfr-2 in
mice induced, at birth, spontaneous lymphatic invasion of the normally
alymphatic cornea and hyperplasia of skin lymphatics without affecting
blood vasculature. Administration of
sVegfr-2 inhibited
lymphangiogenesis but not hemangiogenesis induced by corneal suture injury or
transplantation, enhanced corneal allograft survival and suppressed
lymphangioma cellular proliferation.
Naturally occurring sVegfr-2
thus acts as a molecular uncoupler of blood and lymphatic vessels; modulation
of sVegfr-2 might have therapeutic effects in treating lymphatic
vascular malformations, transplantation
rejection and, potentially,
tumor lymphangiogenesis and lymphedema.
PMID: 19668192 [PubMed -
as supplied by publisher
-------------------------------------
1.
1: Integr Cancer Ther. 2009 Jun;8(2):123-9.
Feasibility trial of
electroacupuncture for aromatase inhibitor--related arthralgia in breast cancer
survivors.
Mao JJ, Bruner DW, Stricker C, Farrar JT, Xie SX, Bowman MA,
Pucci D, Han X, DeMichele A.
Department of Family Medicine and Community
Health, University of Pennsylvania Health System,
Philadelphia,
Pennsylvania 19104, USA
BACKGROUND: Arthralgia affects postmenopausal
women receiving aromatase inhibitors (AIs) for breast
cancer. Given
the existing evidence for electroacupuncture (EA) for treatment of
osteoarthritis in the general
population, this study aims to
establish the feasibility of studying EA for treating AI-related
arthralgia.
PATIENTS AND METHODS: Postmenopausal women with stage I-III
breast cancer who reported AI-
related arthralgia were enrolled in a
single-arm feasibility trial. EA was provided twice a week for 2 weeks
followed by 6 weekly treatments. The protocol was based on Chinese
medicine diagnosis of "Bi" syndrome
with electrostimulation of
needles around the painful joint(s). Pain severity of the modified Brief Pain
Inventory was used as the primary outcome. Joint stiffness, joint
interference, and Patient Global Impression
of Change (PGIC) were
secondary outcomes. Paired t tests were used for analysis.
RESULTS:
Twelve women were enrolled and all provided data for analysis. From baseline to
the end of
intervention, patients reported reduction in pain
severity (from 5.3 to 1.9), stiffness (from 6.9 to 2.4), and
joint
symptom interference (from 4.7 to 0.8), all P < .001; 11/12 considered joint
symptoms "very much
better" based on the PGIC. Subjects also
reported significant decrease in fatigue (from 4.4 to 1.9, P = .005)
and
anxiety (from 7.1 to 4.8, P = .01). No infection or development or worsening of
lymphedema was
observed.
CONCLUSION: Preliminary data
establish the feasibility of recruitment and acceptance as well as
promising preliminary safety and effectiveness. A randomized controlled
trial is warranted to establish the
efficacy of EA for AI-related
arthralgia in breast cancer survivors.
PMID: 19679620 [PubMed - in
process
---------------------------------
2. N Engl J Med. 2009 Aug
13;361(7):664-73.
Comment in: N Engl J Med. 2009 Aug
13;361(7):710-1.
Weight lifting in women with breast-cancer-related
lymphedema.
Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R,
Lewis-Grant L, Bryan CJ, Williams-Smith CT,
Greene QP.
Center
for Clinical Epidemiology and Biostatistics, University of Pennsylvania School
of Medicine,
Philadelphia, PA 19104, USA.
[email protected]
BACKGROUND: Weight lifting has generally been
proscribed for women with breast-cancer-related
lymphedema,
preventing them from obtaining the well-established health benefits of weight
lifting, including
increases in bone density.
METHODS: We
performed a randomized, controlled trial of twice-weekly progressive weight
lifting
involving 141 breast-cancer survivors with stable lymphedema
of the arm. The primary outcome was the
change in arm and hand
swelling at 1 year, as measured through displaced water volume of the affected
and
unaffected limbs. Secondary outcomes included the incidence of
exacerbations of lymphedema, number and
severity of lymphedema
symptoms, and muscle strength. Participants were required to wear a well-fitted
compression garment while weight lifting.
RESULTS: The
proportion of women who had an increase of 5% or more in limb swelling was
similar in the
weight-lifting group (11%) and the control group
(12%) (cumulative incidence ratio, 1.00; 95% confidence
interval,
0.88 to 1.13). As compared with the control group, the weight-lifting group had
greater
improvements in self-reported severity of lymphedema
symptoms (P=0.03) and upper- and lower-body
strength (P<0.001
for both comparisons) and a lower incidence of lymphedema exacerbations as
assessed
by a certified lymphedema specialist (14% vs. 29%,
P=0.04). There were no serious adverse events related
to the
intervention.
CONCLUSIONS: In breast-cancer survivors with lymphedema,
slowly progressive weight lifting had no
significant effect on limb
swelling and resulted in a decreased incidence of exacerbations of lymphedema,
reduced symptoms, and increased strength. (ClinicalTrials.gov
number, NCT00194363.) 2009
Massachusetts Medical
Society
PMID: 19675330 [PubMed - indexed for
MEDLINE
----------------------
1. Dev Cell. 2009
Aug;17(2):175-86.
Integrin-alpha9 is required for fibronectin matrix
assembly during lymphatic valve morphogenesis.
Bazigou E, Xie S, Chen C,
Weston A, Miura N, Sorokin L, Adams R, Muro AF, Sheppard D, Makinen
T.
Lymphatic Development Laboratory, Cancer Research UK London Research
Institute, 44 Lincoln's Inn
Fields, London WC2A 3PX,
UK.
Dysfunction of lymphatic valves underlies human lymphedema, yet the
process of valve morphogenesis is
poorly understood. Here, we show
that during embryogenesis, lymphatic valve leaflet formation is initiated
by upregulation of integrin-alpha9 expression and deposition of its
ligand fibronectin-EIIIA (FN-EIIIA) in
the extracellular matrix.
Endothelial cell-specific deletion of Itga9 (encoding integrin-alpha9) in mouse
embryos results in the development of rudimentary valve leaflets
characterized by disorganized FN matrix,
short cusps, and
retrograde lymphatic flow. Similar morphological and functional defects are
observed in
mice lacking the EIIIA domain of FN. Mechanistically, we
demonstrate that in primary human lymphatic
endothelial cells, the
integrin-alpha9-EIIIA interaction directly regulates FN fibril assembly, which
is essential
for the formation of the extracellular matrix core of
valve leaflets. Our findings reveal an important role for
integrin-alpha9 signaling during lymphatic valve morphogenesis and
implicate it as a candidate gene for
primary lymphedema caused by
valve defects.
PMID: 19686679 [PubMed - in
process
------------------
2. Nurs Stand. 2009 Jul
8-14;23(44):25.
A suitable case for treatment.
Mason
MC.
Chronic lymphoedema is a common condition but its treatment is often
overlooked.
PMID: 19685788 [PubMed - in process
-------
.
Ann Plast Surg. 2009 Sep;63(2):300-1.
Massive localized
lymphoedema.
Hutt J, Sturley W, Jemec B.
Department of Plastic
and Reconstructive Surgery, Chelsea and Westminster Hospital, London, United
Kingdom.
A case report of massive localized lymphoedema in a
morbidly obese 50-year-old woman and review of the
literature.
PMID: 19700959 [PubMed - in
process
-----
2. J Mal Vasc. 2009 Aug 18. [Epub ahead of
print]
[Adverse effects of compression in treatment of limb
lymphedema.][Article in French]
Vignes S, Arrault M.
Unité de
lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15,
rue Eugène-Millon, 75015 Paris,
France.
INTRODUCTION: Limb lymphedema, whether primary or secondary, is
a chronic disease. Compression
is the cornerstone of therapy and
includes multilayer low-stretch bandages and elastic garments.
Compression is usually well-tolerated. The aim of our study was to
identify all the different types of adverse
effects of
compression.
MATERIALS AND METHODS: Since January 2005, we have recorded
all adverse events occurring in
outpatients and inpatients
consulting in a single lymphology department, spontaneously reported by patient
during consultations or physical examinations, and noted the type of
compression material used.
RESULTS: Adverse effects were secondary to
poor choice of therapeutic material, excessive pressure or
contact
dermatitis. For the arms, an elastic garment stopping at the wrist can be
responsible for lymphedema
of the hand and fingers. Rubbing of
sleeve seams may cause pain and even ulcers between the thumb and
forefinger. Open-toed elastic stockings may exacerbate digital
lymphedema, leading to the formation of
oozing lymph vesicles.
Hyperpressure may cause severe pain localized to the first and fifth toes,
overlapping
toes, interdigital corns and/or ingrown toenails.
Silicone-banded soft-fit elastic garments may cause painful
phlyctena, urticaria or eczematiform lesions. Elastic bandages may
induce pain or purpuric lesions.
CONCLUSION: Compression can be
responsible for adverse effects, sometimes severe, requiring
treatment change or withdrawal. Further studies are needed to precisely
determine their frequency to
improve prescriptions and currently
available products.
PMID: 19695803 [PubMed - as supplied by
publisher
-----
3. Clin Rheumatol. 2009 Aug 20. [Epub ahead of
print]
Psoriatic arthritis and chronic lymphoedema: treatment efficacy
by adalimumab.
Tong D, Eather S, Manolios N.
Department of
Rheumatology, Westmead Hospital, Sydney, NSW, Australia,
2145,
Lymphoedema is a rare complication of psoriatic arthritis (PsA)
and inflammatory joint disease, with no
response noted to
disease-modifying drugs. However, reports are emerging of a beneficial effect
on
lymphoedema in patients treated with tumor necrosis factor-alpha
antagonists for PsA (Etanercept),
rheumatoid arthritis (Etanercept)
and ankylosing spondylitis (Infliximab). We describe a psoriatic arthritis
patient whose lymphoedema greatly improved following commencement of
adalimumab.
PMID: 19693641 [PubMed - as supplied by
publisher
-------
4. Ann Plast Surg. 2009
Sep;63(2):302-6.
Radical reduction of upper extremity lymphedema with
preservation of perforators.
Salgado CJ, Sassu P, Gharb BB, di
Spilimbergo SS, Mardini S, Chen HC.
Department of Plastic Surgery,
University Hospitals Cleveland/Case Western Reserve University,
Cleveland, Ohio, USA.
Excisional procedures have been
successfully utilized by different authors in multistage treatment of upper
extremity lymphedema. We have used microsurgical principles of
perforator flap surgery in order to develop
a one-stage procedure
that enables a radical reduction of the lymphedematous tissue with preservation
of
the vascular supply to the overlying skin.Between March 2000 and
February 2007, 11 patients affected by
late stage II lymphedema
underwent radical reduction of the affected tissues with preservation of
perforators. Perforator vessels from the radial and posterior
interosseous arteries were identified and
through medial and
lateral forearm incisions, skin flaps were raised off the underlying
lymphedematous tissue
and the affected tissue was removed off the
deep fascia. At a mean follow-up of 17.8 months the average
percentage reductions above and below the elbow, at the wrist, and the
hand were 15.1%, 20.7%, 0.5%,
and 3.6%, respectively. Statistical
analysis showed significant circumference reduction above and below the
elbow (P = 0.048 and 0.022, respectively) but not at the wrist and
hand. There were no cases of wound
breakdown, skin necrosis, or
cellulitis in the postoperative period. Four patients complained of mild
numbness confined to the vicinity of the surgical
incisions.Microvascular principles applied to the radical
excision
of the subcutaneous tissue seems to offer a new promising one-stage surgical
procedure in patients
affected by upper extremity lymphedema that
has failed conservative therapy.
PMID: 19692901 [PubMed - in
process
------
5. Clin Nucl Med. 2009
Sep;34(9):585-8.
Progression of clinically stable lymphedema on
lymphoscintigraphy.
Luongo JA, Scalcione LR, Katz DS, Yung
EY.
Department of Radiology, Winthrop-University Hospital, Mineola, NY
11501, USA.
Lymphedema is due to dysfunction in lymphatic transport, and
is divided into primary and secondary
subtypes. Primary lymphedema
is a congenital lymphatic abnormality or dysfunction whereas secondary
lymphedema is characterized by pathologic disruption or obstruction of a
previously-normal lymphatic
system. The stage of lymphedema is
determined clinically. Lymphoscintigraphy, however, may be used to
assess disease extent, for early detection of disease progression, and
can be used to direct therapy. We
report a case of a 56-year-old
woman with clinically stable lymphedema of 5 years, yet with
lymphoscintigraphy findings compatible with disease
progression.
PMID: 19692818 [PubMed - in process
6. J Urol.
2009 Aug 17. [Epub ahead of print]
A New Technique of Concealed Penis
Repair.
Sugita Y, Ueoka K, Tagkagi S, Hisamatsu E, Yoshino K, Tanikaze
S.
Urology, Kobe Children's Hospital (YS, ST, EH), Kobe,
Japan.
PURPOSE: Phimosis associated with concealed penis is not amenable
to ordinary circumcision. To our
knowledge we describe a new
technique to repair concealed penis.
MATERIALS AND METHODS: From
September 2003 to January 2008, 57 consecutive patients with
concealed penis were treated using our technique. Median age at surgery
was 33 months (range 7 months to
34 years). The technique consists
of 3 steps. Step 1 is a ventral incision to slit the narrow ring of the prepuce
and expose the glans. Step 2 is a circumferential skin incision made
between 2 edges of the ventral diamond-
shaped skin defect, followed
by midline incision of the dorsal inner prepuce to make 2 skin flaps connected
to the glans. Step 3 is skin coverage. Two skin flaps are brought
down and sutured together on the ventral
side of the penis. The
suture line between the penile shaft skin and the flap eventually becomes
elliptical.
Medical records were reviewed for voiding function, scar
formation, and replies from older patients and the
parents of
younger children about impressions of the surgical results.
RESULTS:
Median followup was 26 months. No patient had voiding problems. Lymphedema
persisted due
to suture line constriction in 2 patients who
underwent incision of the constriction. All older patients and the
parents of younger children were satisfied with the surgical
results.
CONCLUSIONS: Our new method is easy to design and perform to
correct concealed penis. It provides a
good cosmetic appearance and
seems to be applicable in all cases with deficient penile shaft
skin.
PMID: 19692094 [PubMed - as supplied by
publisher
----
1. Acta Oncol. 2009 Aug 27:1-8.\
Changes
in arm morbidities and health-related quality of life after breast cancer
surgery - a five-year follow-
up study.
Sagen A, Kåresen R,
Sandvik L, Risberg MA.
Department of Breast and Endocrine Surgery,
Ullevaal University Hospital, Oslo, Norway.
Background and purpose. Many
breast cancer survivors (BCS) suffer from long-term upper limb
morbidities after axillary node dissection. The purpose of this
five-year follow-up study was to describe
changes in long-term
upper limb morbidities, physical activity level, and Health-Related Quality of
Life
(HRQoL) and to find factors that predict HRQoL five years
after surgery. Patients and methods. This study
included 204 women
aged 55+/-10 years who had primary breast cancer surgery with axillary node
dissection. The subjects were examined for arm volumes and arm
lymphedema, arm pain, sensation of
heaviness, shoulder function,
physical activity level, and HRQoL, prior to surgery, and six months and five
years after surgery. The statistical analyses used included ANOVA
for repeated measures and multivariate
linear
regression.
Results. ALE (13%), pain (36%), and sensation of heaviness
(21%) in the upper limbs were present five
years after surgery. ALE
was the only morbidity that continued to increase over time. Several dimensions
of
HRQoL temporarily declined after surgery, but significantly
improved in the period from six months to five
years after surgery.
The significant predictive factors of HRQoL five years after surgery included
HRQoL
prior to surgery, physical activity level at leisure time
(both prior to and at six months after surgery), and
duration of
sick leave after surgery (in weeks). Conclusions. The overall HRQoL improved
significantly from
baseline to five years, despite the chronic arm
pain and increase in ALE. Three independent predictive
factors of
HRQoL were identified.
PMID: 19714526 [PubMed - as supplied by
publisher
------
2. Singapore Med J. 2009
Aug;50(8):781-4.
Tensor fascia lata flap reconstruction in groin
malignancy.
Agarwal AK, Gupta S, Bhattacharya N, Guha G, Agarwal
A.
Department of General Surgery, Medical College Kolkata, 73 West
Bengal, Kolkata 700072, India. \
INTRODUCTION: Block dissection of
inguinal lymph nodes is done in cases of malignant inguinal
lymphadenopathy, which requires the removal of skin where it is
involved, or elevation of the flaps which
have precarious blood
supply leading to necrosis. Thus, wound closure presents a big challenge. It
can be
done either by primary closure which is frequently
complicated by necrosis, or by split thickness skin graft
which is
complicated by rejection on radiotherapy. Another option is to cover the wound
by a vascularised
pedicled graft. This prospective study was
conducted after obtaining clearance from the ethical committee.
The
results were compared with the accepted complication rates of the
operation.
METHODS: We presented our experience of coverage of wounds
after block dissection of inguinal lymph
nodes for malignant
deposits in 15 patients (with median age of 46 years) by pedicled tensor fascia
lata thigh
flap.
RESULTS: The results following the surgery
were good. Healing was satisfactory in all 15 cases. There
were two
cases of marginal flap necrosis, and three cases developed lymphoedema which
was managed by
stockings. There were two cases of infection which
were settled by antibiotics. There were three cases of
loss of a
small area of skin graft at the donor site. There was no reported case of
recurrence in the inguinal
region.
CONCLUSION: This
technique of coverage of the defect after inguinal block dissection is easy
with
predictable good results.
-----
PMID: 19710976
[PubMed - in process
3. Eur J Cancer Care (Engl). 2009 Aug 25. [Epub
ahead of print]
Short- and long-term recovery of upper limb function
after axillary lymph node dissection.
Devoogdt N, VAN Kampen M,
Christiaens MR, Troosters T, Piot W, Beets N, Nys S, Gosselink
R.
Department of Physiotherapy - University Hospitals Leuven, Leuven,
Faculty of Kinesiology and
Rehabilitation Sciences - Katholieke
Universiteit Leuven, Leuven, and Department of Health Care Sciences
- University College of Antwerp, Antwerp.
All breast cancer
patients, suspected with lymph node invasion, need an axillary lymph node
dissection. This
study investigated the short- and long-term effects
of the treatment for breast cancer on shoulder mobility,
development of lymphoedema, pain and activities of daily living.
Patients who had a modified radical
mastectomy (33%) or a
breast-conserving procedure (67%) in combination with axillary lymph node
dissection were included. Shoulder mobility, lymphoedema, pain and
activities of daily living were evaluated
at 3 months and at 3.4
years after surgery. At long term, 31% of the patients experienced impaired
shoulder
mobility, 18% developed lymphoedema, 79% had pain and 51%
mentioned impaired daily activities.
Between 3 months and 3.4 years
after surgery, impaired shoulder mobility decreased from 57% to 31%.
The
incidence of lymphoedema increased from 4% to 18%. Patients experienced an
equal amount of pain
but fewer problems with daily activities. At
3.4 years, no significant differences between mastectomy and
breast-conserving procedure were found. In conclusion, at long term,
significant number of breast cancer
survivors still had impaired
shoulder mobility, developed lymphoedema, had pain and experienced difficulties
during daily activities. Shoulder mobility, pain and daily
activities evolved positively, while the incidence of
lymphoedema
increased.
PMID: 19708945 [PubMed - as supplied by
publisher
------
29 August 2009 - Predicting Cancer
Prognosis
Researchers led by Dr. Soheil Dadras at the Stanford
University Medical Center have developed a novel
methodology to
extract microRNAs from cancer tissues. The related report by Ma et al,
"Profiling and
discovery of novel miRNAs from formalin-fixed
paraffin-embedded melanoma and nodal specimens,"
appears in the
September 2009 issue of the Journal of Molecular Diagnostics.
Cancer
tissues from patients are often stored by a method that involves formalin
fixation and paraffin
embedding to retain morphological definition
for identification; however, this method frequently prevents
further molecular analysis of the tissue because of mRNA degradation.
Even so, these tissues contain high
numbers of microRNAs (miRNAs),
which are short enough (~22 nucleotides) to not be broken down
during the fixation process.
In this study, Dr. Dadras and
colleagues optimized a new protocol for extracting miRNAs from formalin-
fixed paraffin-embedded tissues. Using their new procedure, they
identified 17 new and 53 known miRNAs
from normal skin, melanoma,
and sentinel lymph nodes. These miRNAs were well-preserved in a 10-year-
old specimen. This new protocol, therefore, will allow for the
identification of novel miRNAs that may differ
in cancerous and
healthy tissue, even from long-preserved tissue, leading to better predictions
of disease
prognosis and treatment response.
Ma et al
suggest that their "cloning strategy has the advantage of not only discovering
novel and known
miRNA sequence identity but also providing an
estimate of relative expression level. … [This methodology
may
provide] a more robust strategy to obtain an accurate expression profile for
novel and/or previously
characterized small RNAs from clinically
defined [formalin-fixed paraffin-embedded] tumor specimens,
thereby
facilitating the discovery of 'oncomirs' as biomarkers."
Ma Z, Lui W-O,
Fire A, Dadras SS: Profiling and discovery of novel miRNAs from formalin-fixed
paraffin-
embedded melanoma and nodal specimens. J Mol Diagn 2009,
420-429
This work was supported in part by 2007 Dermatology Foundation
Dermatopathology Research Grant and
the department of Pathology
research funds at Stanford University Medical Center.
Source:
Angela
Colmone
American Journal of Pathology
-----
1. Ann Acad Med
Singapore. 2009 Aug;38(8):704-6.(pdf)
Patent blue dye in
lymphaticovenular anastomosis.
Yap YL, Lim J, Shim TW, Naidu S, Ong WC,
Lim TC.
Department of Surgery, Division of Plastic, Reconstructive and
Aesthetic Surgery, National University
Hospital,
Singapore.
INTRODUCTION: Lymphaticovenular anastomosis (LVA) has been
described as a treatment of chronic
lymphoedema. This microsurgical
technique is new and technically difficult. The small caliber and thin wall
lymphatic vessels are difficult to identify and easily destroyed during
the dissection.
MATERIALS AND METHODS: We describe a technique of
performing lymphaticovenular anastomosis
with patent blue dye
enhancement. Our patient is a 50-year-old lady who suffers from chronic
lymphoedema
of the upper limb after mastectomy and axillary
clearance for breast cancer 8 years ago.
RESULTS: Patent blue dye is
injected subdermally and is taken up readily by the draining lymphatic
channels. This allows for easy identification of their course. The
visualisation of the lumen of the lymphatic
vessel facilitates
microsurgical anastomosis. The patency of the anastomosis is also demonstrated
by the
dynamic pumping action of the lymphatic within the vessels.
CONCLUSION: Patent blue dye staining
during lymphaticovenular
anastomosis is a simple, effective and safe method for mapping suitable
subdermal
lymphatics, allowing for speedier dissection of the
lymphatic vessels intraoperatively. This technique also
helps in the
confirmation of the success of the lymphaticovenular
anastomosis.
PMID: 19736575 [PubMed - in
process
----
2. J Clin Pathol. 2009 Sep;62(9):808-11.
Massive localised lymphoedema: a clinicopathological study of
22 cases and review of the literature.
Manduch M, Oliveira AM,
Nascimento AG, Folpe AL.
Department of Laboratory Medicine and
Pathology, Mayo Clinic, Rochester, Minnesota 55905,
USA.
BACKGROUND: Massive localised lymphoedema (MLL) is a rare,
relatively recently described
pseudosarcoma most often occurring in
morbidly obese patients. AIM: To perform a retrospective review of
all cases diagnosed as MLL.
METHODS AND RESULTS:
Clinical information was obtained. 22 morbidly obese adults (mean patient
weight 186 kg) presented with unilateral, large soft tissue lesions of
longstanding duration. Most lesions
involved the thigh, but also
occurred in the posterior calf and lower leg. Clinically, most lesions were
regarded as representing benign processes, including pedunculated
lipoma, lymphocoele or recurrent
cellulites, although soft tissue
sarcoma was also suspected in two cases. Grossly, all masses showed
markedly thickened skin with a "cobblestone" appearance, and were
ill-defined, unencapsulated, lobulate,
and very large (mean size 31
cm, range 15-61.5 cm, mean weight 3386 g, range 1133-10,800 g).
Histologically, all 22 cases showed striking dermal fibrosis, expansion
of the fibrous septa between fat
lobules with increased numbers of
stromal fibroblasts, lymphatic proliferation and lymphangiectasia.
Multinucleated fibroblastic cells, marked vascular proliferation,
moderate stromal cellularity and fascicular
growth raised concern
among referring pathologists for atypical lipomatous tumour/well differentiated
liposarcoma, angiosarcoma, and a fibroblastic neoplasm such as
fibromatosis in 10, 2 and 1 case,
respectively.
CONCLUSION: The diagnosis of MLL continues to be challenging,
in particular for pathologists.
Awareness of this entity, clinical
correlation and gross pathological correlation are essential in the separation
of this distinctive pseudosarcoma from its various morphological
mimics.
PMID: 19734477 [PubMed - in
process
--------------------------
1. Plast Reconstr Surg. 2009
Sep;124(3):777-86.
Experimental assessment of autologous lymph node
transplantation as treatment of postsurgical lymphedema.
Tobbia D,
Semple J, Baker A, Dumont D, Johnston M.
Brain Sciences Program,
Department of Laboratory Medicine and Pathobiology, and Molecular and Cell
Biology, Sunnybrook Health Sciences Center, Toronto, Ontario,
Canada.
BACKGROUND: The authors' objective was to test whether the
transplantation of an autologous lymph
node into a nodal excision
site in sheep would restore lymphatic transport function and reduce the
magnitude
of postsurgical lymphedema.
METHODS: As a measure
of lymph transport, iodine-125 human serum albumin was injected into prenodal
vessels at 8 and 12 weeks after surgery, and plasma levels of the
protein were used to calculate the
transport rate of the tracer to
blood (percent injected per hour). Edema was quantified from the
circumferential measurement of the hind limbs.
RESULTS: The
transplantation of avascular lymph nodes at 8 (n = 6) and 12 weeks (n = 6)
produced
lymphatic function levels of 12.3 +/- 0.5 and 12.6 +/-
0.8, respectively. These values were significantly less
(p <
0.001) than those measured at similar times in the animals receiving sham
surgical procedures (16.6 +/-
0.7, n = 6; and 16.1 +/- 0.7, n = 6,
respectively). When vascularized transplants were performed, lymphatic
function was similar to the sham controls and significantly greater (p
< 0.001) than that of the avascular
group (8 weeks, 15.8 +/-
0.9, n = 8; 12 weeks, 15.7 +/- 1.0, n = 10). Lymph transport correlated
significantly with the health of the transplanted nodes (scaled with
histologic analysis) (p < 0.0001). The
vascularized node
transplants (n = 18) were associated with the greatest clinical improvement,
with the
magnitude of edema in these limbs exhibiting significantly
lower levels of edema (p = 0.039) than nontreated
limbs (n =
18).
CONCLUSIONS: The successful reimplantation of a lymph node into a
nodal excision site has the potential
to restore lymphatic function
and facilitate edema resolution. This result has important conceptual
implications
in the treatment of postsurgical lymphedema.
PMID: 19730296 [PubMed - in
process
------
2. Plast Reconstr Surg. 2009
Sep;124(3):737-51.
Perforator flaps: recent experience, current trends,
and future directions based on 3974 microsurgical breast
reconstructions.
Massey MF, Spiegel AJ, Levine JL, Craigie JE,
Kline RM, Khoobehi K, Erhard H, Greenspun DT, Allen
RJ Jr, Allen RJ
Sr; Group for the Advancement of Breast Reconstruction.
The Dr. Marga
Practice Group, 505 North Lake Shore Drive, Lake Point Tower Suite 214,
Chicago, IL
60611, USA. [email protected]
Perforator
flap breast reconstruction is an accepted surgical option for breast cancer
patients electing to
restore their body image after mastectomy.
Since the introduction of the deep inferior epigastric perforator
flap, microsurgical techniques have evolved to support a 99 percent
success rate for a variety of flaps with
donor sites that include
the abdomen, buttock, thigh, and trunk. Recent experience highlights the
perforator
flap as a proven solution for patients who have
experienced failed breast implant-based reconstructions or
those
requiring irradiation. Current trends suggest an application of these
techniques in patients previously
felt to be unacceptable surgical
candidates with a focus on safety, aesthetics, and increased sensitization.
Future challenges include the propagation of these reconstructive
techniques into the hands of future plastic
surgeons with a focus
on the development of septocutaneous flaps and vascularized lymph node
transfers for
the treatment of lymphedema.
PMID: 19730293
[PubMed - in process
-----
3. Clin Rheumatol. 2009 Sep 1.
[Epub ahead of print]
Lymphatic obstruction as a cause of extremity
edema in systemic lupus erythematosus.
Rajasekhar L, Habibi S, Sudhakar
P, Gumdal N.
Department of Rheumatology, Nizam's Institute of Medical
Sciences, Hyderabad, Andhra Pradesh, India,
500082
Systemic
lupus erythematosus (SLE) is a multisystem disease of autoimmune origin.
Lymphedema is a very
uncommon entity and has not been previously
documented in SLE. We report lymphatic obstruction
involving all
four limbs as a cause of extremity edema in a patient with SLE.
PMID:
19727913 [PubMed - as supplied by publisher
4. FASEB J. 2009 Sep 2.
[Epub ahead of print] Links
Lymphangiogenesis: in vitro and in vivo
models.
Bruyère F, Noë A.
Laboratory of Tumor and Development
Biology, Groupe Interdisciplinaire de Génoprotéomique Appliqué-
Cancer (GIGA-Cancer), University of Liège, Liège,
Belgium.
Lymphangiogenesis, the formation of new lymphatic vessels from
preexisting ones, is an important biological
process associated with
diverse pathologies, such as metastatic dissemination and graft rejection. In
addition, lymphatic hypoplasia characterizes lymphedema, usually a
progressive and lifelong condition for
which no curative treatment
exists. Much progress has been made in recent years in identifying molecules
specifically expressed on lymphatic vessels and in the setting up
of in vitro and in vivo models of
lymphangiogenesis. These new tools
rapidly provided an abundance of information on the mechanisms
underlying lymphatic development and the progression of diseases
associated with lymphatic dysfunction. In
this review, we describe
the common in vitro and in vivo models of lymphangiogenesis that have proven
suitable for investigating lymphatic biology and the interactions
occurring between lymphatic vessels and
other cells, such as immune
cells and cancer cells. Their rationales and limitations are discussed and
illustrated by the most informative findings obtained with
them.-Bruyère, F., Noël, A. Lymphangiogenesis: in
vitro and in vivo
models.
PMID: 19726757 [PubMed - as supplied by
publisher]
----
5. Lymphology. 2009
Jun;42(2):88-98.
Assessing lymphedema by tissue indentation force and
local tissue water.
Mayrovitz HN.
Department of Physiology,
College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale,
Florida 33328, USA.
Tissue water and mechanical property changes
accompany lymphedema, however the relationship between
these
changes, if any, is unclear. Local tissue water is quantifiable using the
tissue's dielectric constant
(TDC), but a non-gravity dependent
handheld clinical assessment tool to easily quantify corresponding local
tissue properties is not widely available. Herein such a tool is
described along with results obtained with it
and with TDC
measurements made in healthy legs and in lymphedematous legs before and after
one manual
lymphatic drainage (MLD) treatment. Using the handheld
device, tissue indentations to various depths could
be completed
and corresponding indentation forces (IF) recorded. Following tests in gels,
foams, and 24
healthy human legs to confirm linearity and
repeatability, IF and TDC were measured in 22 legs of 18
lymphedema
patients prior to and after one MLD treatment. Results showed that pre-MLD both
IF and
TDC were significantly (p < 0.001) greater in
lymphedematous legs compared to healthy legs and that both
IF and
TDC significantly (p < 0.001) decreased after MLD. However, no correlation
was found between
pretreatment IF and TDC nor between post-MLD
changes. Thus, measurements of local IF and tissue
water provide
useful but apparently independent information as to lymphedematous status and
its potential
change with therapy.
PMID: 19725274 [PubMed -
in process]
-----
6. Lymphology. 2009
Jun;42(2):85-7.
Hereditary palmoplantar keratoderma associated with
primary (congenital) lymphedema.
Ogunbiyi SO, Deguara J, Moss C, Burnand
KG.
Department of Academic Surgery, St Thomas' Hospital, London,
UK.
The palmoplantar keratodermas are a heterogenous group of hereditary
disorders of keratinization. They are
characterized by epidermal
thickening and a yellow waxy appearance of the palms and soles. Genetic
studies have linked various forms of palmoplantar keratoderma to markers
on chromosomes one, twelve,
and seventeen, and several genes have
been identified. Primary lymphedema is occasionally present at birth
(congenital
lymphedema or Milroy's disease), but more commonly develops at puberty
(lymphedema
praecox). Genetic studies have linked various autosomal
dominant forms of primary lymphedema (Milroy's
disease and
lymphedema distichiasis), to genes on chromosomes five and sixteen
respectively. We report a
case of palmoplantar keratoderma in a
child with congenital lymphedema. To our knowledge, this has not
been previously described and may represent a new phenotype for future
genetic study.
PMID: 19725273 [PubMed - in
process]
-----
7. Lymphology. 2009 Jun;42(2):51-60.
The
diagnosis and treatment of peripheral lymphedema. 2009 Concensus Document of
the International
Society of Lymphology.
International
Society of Lymphology.
PMID: 19725269 [PubMed - in
process
------
Lymphology. 2003 Jun;36(2):84-91.
The
diagnosis and treatment of peripheral lymphedema. Consensus document of the
International Society of
Lymphology.
International Society of
Lymphology.
This International Society of Lymphology (ISL) Consensus
Document is the current revision of the 1995
Document for the
evaluation and management of peripheral lymphedema. It is based upon
modifications
suggested and published following the 1997 XVI
International Congress of Lymphology (ICL) in Madrid,
Spain,
discussed at the 1999 XVII ICL in Chennai, India, considered at the 2000 (ISL)
Executive
Committee meeting in Hinterzarten, Germany, and derived
from integration of discussions and written
comments obtained during
and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL
Executive Committee meeting in Cordoba, Argentina. The document
attempts to amalgamate the broad
spectrum of protocols advocated
worldwide for the diagnosis and treatment of peripheral lymphedema into
a coordinated proclamation representing a "Consensus" of the
international community. The document is not
meant to override
individual clinical considerations for problematic patients nor to stifle
progress. It is also
not meant to be a legal formulation from which
variations define medical malpractice. The Society
understands that
in some clinics the method of treatment derives from national standards while
in others
access to medical equipment and supplies is limited and
therefore the suggested treatments are impractical.
We continue to
struggle to keep the document concise while balancing the need for depth and
details. With
these considerations in mind, we believe that this
version of the Consensus represents the best judgment of
the ISL
membership on how to approach patients with peripheral lymphedema as of 2003.
We anticipate
that the document will and should be challenged,
debated in the pages of Lymphology (e.g., as Letters to the
Editor), and ideally become a continued focal point for robust
discussion at local, national and international
conferences in
lymphology and related disciplines. We further anticipate as experience evolves
and new
ideas and technologies emerge that this "living document"
will undergo periodic revision and refinement.
PMID: 12926833 [PubMed -
indexed for MEDLINE
================================
1. Cancer
Res. 2009 Sep 1. [Epub ahead of print]
KDR Activating Mutations in Human
Angiosarcomas Are Sensitive to Specific Kinase Inhibitors.
Antonescu CR,
Yoshida A, Guo T, Chang NE, Zhang L, Agaram NP, Qin LX, Brennan MF, Singer S,
Maki RG.
Departments of Pathology, Epidemiology and
Biostatistics, Surgery, and Medicine, Memorial Sloan-
Kettering
Cancer, New York, New York.
Angiosarcomas (AS) represent a heterogeneous
group of malignant vascular tumors occurring not only in
different
anatomic locations but also in distinct clinical settings, such as radiation or
associated chronic
lymphedema. Although representing only 1% to 2%
of soft tissue sarcomas, vascular sarcomas provide
unique insight
into the general process of tumor angiogenesis. However, no molecular
candidates have been
identified to guide a specific therapeutic
intervention. By expression profiling, AS show distinct up-regulation
of
vascular-specific receptor tyrosine kinases, including TIE1, KDR, SNRK, TEK,
and FLT1. Full
sequencing of these five candidate genes identified
10% of patients harboring KDR mutations. A KDR-
positive genotype
was associated with strong KDR protein expression and was restricted to the
breast
anatomic site with or without prior exposure to radiation.
Transient transfection of KDR mutants into COS-
7 cells showed
ligand-independent activation of the kinase, which was inhibited by specific
KDR inhibitors.
These data provide a basis for the activity of
vascular endothelial growth factor receptor-directed therapy in
the
treatment of primary and radiation-induced AS. [Cancer Res
2009;69(18):7175-9].
PMID: 19723655 [PubMed - as supplied by
publisher]
-----
2. Orv Hetil. 2009 Sep
12;150(37):1731-8.
[Skin manifestations, treatment and rehabilitation in
overweight and obesity.][Article in Hungarian]
Wenczl E.
Fovárosi
Onkormányzat Egyesített Szent István és Szent László Kórház és Rendelointézet
Borgyógyászati
és Lymphológiai Rehabilitációs Osztály Budapest
Nagyvárad tér 1. 1095.
Overweight and obesity is a public health problem
in Hungary and in the Western world. It is important to
underline
that obesity is an illness and an important risk factor for several skin and
other diseases. An
overview of skin diseases caused or aggravated
by obesity (acanthosis nigricans, acrochordons, keratosis
pilaris,
hyperandrogenism, stria, adiposis dolorosa, lymphoedema, chronic venous
insufficiency, plantar
hyperkeratosis, lipoedema, skin infections,
acne inversa, psoriasis, tophi) helps us to look and see as well.
Look for the possibility of skin infections as it helps the early
diagnosis and to avoid complications. Draw
patients' attention to
the preventive importance of skin care. In case of an obese patient the usual
dosage of
most local and systemic drugs should be modified. It must
be kept in mind that obesity directly or indirectly
starts
unfavorable processes in almost all organ systems. Therefore, only a
multidisciplinary care may secure
treatment and rehabilitation of
obese patients. Dermatological and lymphological care is often part of the
rehabilitation.
PMID: 19723602 [PubMed - in
process
-----
1. Hum Mutat. 2009 Sep 16. [Epub ahead of
print]
Novel missense mutations in the FOXC2 gene alter transcriptional
activity.
van Steensel MA, Damstra RJ, Heitink M, Bladergroen RS,
Veraart J, Steijlen PM, van Geel M.
Departments of dermatology,
Maastricht University Medical Center, Maastricht, the
Netherlands.
Mutations in the FOXC2 gene that codes for a forkhead
transcription factor are associated with primary
lymphedema that
usually develops around puberty. Associated abnormalities include distichiasis
and, very
frequently, superficial and deep venous insufficiency.
Most mutations reported so far either truncate the
protein or are
missense mutations in the forkhead domain causing a loss of function. The
haplo-insufficient
state is associated with lymphatic hyperplasia
in mice as well as in humans. We analyzed the FOXC2 gene in
288
patients with primary lymphedema and found 11 pathogenic mutations, of which 9
are novel. Of those,
5 were novel missense mutations of which 4
were located outside of the forkhead domain. To examine their
pathogenic potential we performed a transactivation assay using a
luciferase reporter construct driven by
FOXC1 response elements. We
found that the mutations outside the forkhead domain cause a gain of
function
as measured by luciferase activity. Patient characteristics conform to previous
reports with the
exception of distichiasis, which was found in only
2 patients out of 11. FOXC2 mutations causing
lymphedema-distichiasis syndrome reported thus far result in
haplo-insufficiency and lead to lymphatic
hyperplasia. Our results
suggest that gain-of-function mutations may also cause lymphedema. One would
expect that in this case, lymphatic hypoplasia would be the
underlying abnormality. Patients with activating
mutations might
present with Meige disease. (c) 2009 Wiley-Liss, Inc.
PMID: 19760751
[PubMed - as supplied by publisher]
=====
2. Breast Cancer Res
Treat. 2009 Sep 17. [Epub ahead of print]
The efficacy of acupoint
stimulation for the management of therapy-related adverse events in patients
with
breast cancer: a systematic review.
Chao LF, Zhang AL,
Liu HE, Cheng MH, Lam HB, Lo SK.
School of Nursing, Chang Gung
University, Gueishan, Taoyuan, Taiwan, ROC.
The aim of the present study
was to scrutinize the evidence on the use of acupoint stimulation for managing
therapy-related adverse events in breast cancer. A comprehensive
search was conducted on eight English
and Chinese databases to
identify clinical trials designed to examine the efficacy of acupressure,
acupuncture, or acupoint stimulation (APS) for the management of
adverse events due to treatments of
breast cancer. Methodological
quality of the trials was assessed using a modified Jadad scale. Using pre-
determined keywords, 843 possibly relevant titles were identified.
Eventually 26 papers, 18 in English and
eight in Chinese, satisfied
the inclusion criteria and entered the quality assessment stage. The 26
articles were
published between 1999 and 2008. They assessed the
application of acupoint stimulation on six disparate
conditions
related to anticancer therapies including vasomotor syndrome,
chemotherapy-induced nausea and
vomiting, lymphedema,
post-operation pain, aromatase inhibitors-related joint pain and leukopenia.
Modalities of acupoint stimulation used included traditional
acupuncture, acupressure, electroacupuncture,
and the use of
magnetic device on acupuncture points. Overall, 23 trials (88%) reported
positive outcomes
on at least one of the conditions examined.
However, only nine trials (35%) were of high quality; they had a
modified Jadad score of 3 or above. Three high quality trials revealed
that acupoint stimulation on P6
(NeiGuang) was beneficial to
chemotherapy-induced nausea and vomiting. For other adverse events, the
quality of many of the trials identified was poor; no conclusive
remarks can be made. Very few minor
adverse events were observed,
and only in five trials. APS, in particular acupressure on the P6 acupoint,
appears beneficial in the management of chemotherapy-induced nausea and
vomiting, especially in the acute
phase. More well-designed trials
using rigorous methodology are required to evaluate the effectiveness of
acupoint stimulation interventions on managing other distress
symptoms.
PMID: 19760035 [PubMed - as supplied by
publisher]
----------------------
1: Breast Cancer Res Treat.
2009 Sep 22. [Epub ahead of print]
Changes in the Body Image and
Relationship Scale following a one-year strength training trial for breast
cancer survivors with or at risk for lymphedema.
Speck RM, Gross
CR, Hormes JM, Ahmed RL, Lytle LA, Hwang WT, Schmitz KH.
Center for
Clinical Epidemiology and Biostatistics, University of Pennsylvania School of
Medicine, 423
Guardian Drive, Blockley Hall, Philadelphia, PA,
19104-6021, USA.
The aim of this study was to evaluate the impact of a
twice-weekly strength training intervention on
perceptions of body
image in 234 breast cancer survivors (112 with lymphedema) who participated in
the
Physical Activity and Lymphedema (PAL) trial. The study
population included two hundred and thirty-four
women randomly
assigned to twice-weekly strength training or control group that completed the
32-item
Body Image and Relationships Scale (BIRS) at baseline and 12
months. Percent change in baseline to 12-
month BIRS total and
subscale scores, upper and lower body strength, and general quality of life
(QOL)
were compared by intervention status. A series of multiple
linear regression models including indicator
variables for
subgroups based on age, marital status, race, education, BMI, and strength
change were used
to examine differential intervention impact by
subgroup. Strength and QOL variables were assessed as
mediators of
the intervention effect on BIRS. Results: Baseline BIRS scores were similar
across intervention
and lymphedema status. Significantly greater
improvement in BIRS total score was observed from baseline
to 12
months in treatment vs.. control participants (12.0 vs. 2.0%; P < 0.0001). A
differential impact of the
intervention on the Strength and Health
subscale was observed for older women (>50 years old) in the
treatment group (P = 0.03). Significantly greater improvement was
observed in bench and leg press among
treatment group when compared
to control group participants, regardless of lymphedema. Observed
intervention effects were independent of observed strength and QOL
changes. Twice-weekly strength
training positively impacted
self-perceptions of appearance, health, physical strength, sexuality,
relationships,
and social functioning. Evidence suggests the
intervention was beneficial regardless of prior diagnosis of
lymphedema. Strength and QOL improvements did not mediate the observed
intervention effects.
PMID: 19771507 [PubMed - as supplied by
publisher
-----
1. Birth Defects Res C Embryo Today. 2009 Sep
11;87(3):222-231. [Epub ahead of print]
Lymphatic
development.
Butler MG, Isogai S, Weinstein BM.
Laboratory of
Molecular Genetics, National Institute of Child Health and Human Development,
National
Institutes of Health, Bethesda, Maryland 20892.
The
lymphatic system is essential for fluid homeostasis, immune responses, and fat
absorption, and is
involved in many pathological processes,
including tumor metastasis and lymphedema. Despite its
importance,
progress in understanding the origins and early development of this system has
been hampered
by lack of defining molecular markers and difficulties
in observing lymphatic cells in vivo and performing
genetic and
experimental manipulation of the lymphatic system. Recent identification of new
molecular
markers, new genes with important functional roles in
lymphatic development, and new experimental models
for studying
lymphangiogenesis has begun to yield important insights into the emergence and
assembly of this
important tissue. This review focuses on the
mechanisms regulating development of the lymphatic vasculature
during embryogenesis. Birth Defects Research (Part C) 87:222-231, 2009.
(c) 2009 Wiley-Liss, Inc.
PMID: 19750516 [PubMed - as supplied by
publisher]
=======
2. Indian J Cancer. 2009
Oct-Dec;46(4):337-9. Links
Mechanical lymphatic drainage in the
treatment of arm lymphedema.
Bordin NA, Guerreiro Godoy Mde F,
Pereira de Godoy JM.
Department of the Medicine School in Sao
Jose do Rio Preto-FAMERP, Brazil.
Exercising is one of the three
cornerstones in the treatment of lymphedema together with contention
mechanisms
and lymphatic drainage. The aim of the current study was to evaluate a new
method of
mechanic lymphatic drainage. Volumetric reductions were
evaluated after passive exercises in 25 patients
with arm
lymphedema resulting from breast cancer treatment. Their ages ranged between 42
and 86 years
old. All patients were submitted to one-hour sessions
using the RAGodoy(R) electromechanical apparatus
which performs
from 15 to 25 elbow bending and stretching exercises per minute. Volumetry,
using the
water displacement technique, was performed before and
after the sessions. The paired t-test was employed
for statistical
analysis with an alpha error of less than 5% being considered acceptable. The
reduction in
volume was significant (P-value < 0.001) with a
mean initial volume of 2026.4 and final volume of 1967.2
giving a
mean loss of 59.2 mL. The RAGodoy(R) apparatus was efficient to reduce the
volume of
lymphedematous arms and is an option for the treatment of
lymphedema.
PMID: 19749466 [PubMed - in
process]
------
1. Strahlenther Onkol. 2009 Oct;185(10):675-81.
Epub 2009 Oct 6.
Radiochemotherapy including cisplatin alone versus
cisplatin + 5-fluorouracil for locally advanced
unresectable stage
IV squamous cell carcinoma of the head and neck.
Tribius S, Kronemann S,
Kilic Y, Schroeder U, Hakim S, Schild SE, Rades D.
Department of
Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg,
Germany.
BACKGROUND AND PURPOSE: The optimal radiochemotherapy regimen
for advanced head-and-neck
cancer is still debated. This
nonrandomized study compares two cisplatin-based radiochemotherapy
regimens in 128 patients with locally advanced unresectable stage IV
squamous cell carcinoma of the head
and neck
(SCCHN).
PATIENTS AND METHODS: Concurrent chemotherapy consisted of
either two courses cisplatin (20
mg/m(2)/d1-5 + 29-33; n = 54) or
two courses cisplatin (20 mg/m(2)/d1-5 + 29-33) + 5-fluorouracil (5-
FU; 600 mg/m(2)/d1-5 + 29-33; n = 74).
RESULTS: At least one
grade 3 toxicity occurred in 25 of 54 patients (46%) receiving cisplatin alone
and in
52 of 74 patients (70%) receiving cisplatin + 5-FU. The
latter regimen was particularly associated with
increased rates of
mucositis (p = 0.027) and acute skin toxicity (p = 0.001). Seven of 54 (13%)
and 20 of
74 patients (27%) received only one chemotherapy course
due to treatment-related acute toxicity. Late
toxicity in terms of
xerostomia, neck fibrosis, skin toxicity, and lymphedema was not significantly
different.
The 2-year locoregional control rates were 67% after
cisplatin alone and 52% after cisplatin + 5-FU (p =
0.35). The
metastases-free survival rates were 79% and 69%, respectively (p = 0.65), and
the overall
survival rates 70% and 51%, respectively (p = 0.10). On
multivariate analysis, outcome was significantly
associated with
performance status, T-category, N-category, hemoglobin level prior to
radiotherapy, and
radiotherapy break > 1
week.
CONCLUSION: Two courses of fractionated cisplatin (20 mg/m(2)/day)
alone appear preferable, as this
regimen resulted in similar
outcome and late toxicity as two courses of cisplatin + 5-FU, but in
significantly
less acute toxicity.
PMID: 19806333 [PubMed -
in process
-----------------------
2. Ann Dermatol Venereol.
2009 Oct;136(10):756-8. Epub 2009 Jun 4.
[Puffy hand syndrome due to
drug addiction. Chronic Lymphoedema and long-term intravenous drug
addiction.][Article in French]
Messikh R, Pelletier F, Bizouard
N, Aubin F, Humbert P.
Service de dermatologie, CHU Saint-Jacques, 2,
place Saint-Jacques, 25030 Besançon cedex, France;
Inserm U645,
université de Franche-Comté, France.
PMID: 19801268 [PubMed - in
process
-------------------------------
3. Am J Surg. 2009
Oct;198(4):482-7.
Scientific Impact Award: Axillary reverse mapping
(ARM) to identify and protect lymphatics draining the
arm during
axillary lymphadenectomy.
Boneti C, Korourian S, Diaz Z, Santiago C,
Mumford S, Adkins L, Klimberg VS..
Division of Breast Surgical Oncology,
Department of Surgery, University of Arkansas for Medical Sciences,
Winthrop P. Rockefeller Cancer Institute, Little Rock, AR,
USA.
INTRODUCTION: The axillary reverse mapping (ARM) procedure
distinguishes lymphatics draining the
arm from those draining the
breast. The aim of this study was to assess the ability of ARM to identify and
preserve lymphatics draining the arm and the impact on
lymphedema.
METHODS: This study included 220 patients undergoing
sentinel lymph node (SLN) biopsy (SLNB) with
or without axillary
lymph node dissection (ALND) from May 2006 to September 2008. After SLN
localization with a radioactive tracer, blue dye was used to map ARM
lymphatics. Data were collected on
identification and variations in
lymphatic drainage, crossover rate, the incidence of metastases, and nodal
status.
RESULTS: Crossover (ARM = SLN) occurred in 6 patients
(2.8%). ARM lymphatics were near or in the
SLN field in 40.6% of
patients, placing it at risk for disruption during lymphadenectomy. ARM
lymphatics
juxtaposed to the hot SLNB (n = 12 [5.6%]) were
preserved. Fifteen ARM nodes were excised and were
negative even in
positive axillae. There were no cases of lymphedema at 6-month follow-up where
ARM
nodes were preserved.
CONCLUSION: Confluence of the arm
and breast drainage is rarely the SLN, and none of these nodes
contained metastases. Preserving the ARM nodes may translate into a
lower incidence of postoperative
lymphedema.
PMID: 19800452
[PubMed - in process
------------------------
4. Eur J Surg
Oncol. 2009 Oct 1. [Epub ahead of print]
Laparoscopic assisted radical
vaginal hysterectomy for cervical carcinoma: Morbidity and long-term follow-
up.
Mehra G, Weekes A, Vantrappen P, Visvanathan D, Jeyarajah
A.
Gynaecological Oncology Cancer Centre, St. Bartholomew's Hospital,
London, UK.
OBJECTIVES: To study the feasibility, morbidity and outcome
of cervical cancer patients treated with
laparoscopic assisted
radical vaginal hysterectomy (LARVH).
METHODS: The study group included
53 women with cervical cancer (stage-Ib). They included women
undergoing LARVH at the joint cancer-centres between 1994 and 2002.
Data was collected on operating-
time, nodal-yield, hospital-stay,
complications recurrence rate and survival rate. The group was followed up
until 2006.
RESULTS: Of 53 women who were selected for LARVH, in
2 women LARVH was abandoned when
nodes were positive at frozen
section. The median age was 42 years while the operating-time was 210min
with a nodal-yield of 23 and a hospital-stay of 5 days. Final histology
revealed 10 women with lympho-
vascular invasion, 1 nodal metastases
and invasion of parametrium/vagina in 2 women. 7 received adjuvant
radiotherapy. 3 had chemo-radiation. Complications included voiding
difficulty (6), urinary tract infection
(5), pyrexia (4),
haemorrhage (2), pain (1), port-site haematoma (1) and nerve injury (1). Late
complications included lymphoedema (4), urinary incontinence (4),
voiding-problems (2), lymphocyst (1),
venous-thrombosis (1) and
rectocele (1). The median follow-up was 41 months. 4 women had recurrence,
of which 3 women died. The five-year survival was
89%.
CONCLUSIONS: Vaginal radical hysterectomy with laparoscopic pelvic
lymphadenectomy is feasible and
safe with regards to mortality and
has low morbidity.
PMID: 19800194 [PubMed - as supplied by
publisher
------
1: Trans R Soc Trop Med Hyg. 2009 Sep 29. [Epub
ahead of print]
Quality of life in filarial lymphoedema patients in
Colombo, Sri Lanka.
Wijesinghe RS, Wickremasinghe AR.
Department
of Parasitology, Faculty of Medical Sciences, University of Sri
Jayawardenepura, Nugegoda,
Sri Lanka.
The quality of life
(QOL) was assessed in 141 filarial lymphoedema patients and 128 healthy people
in the
Colombo district of Sri Lanka. Information was gathered by
administering the validated translated version of
the WHO 100-item
QOL questionnaire (WHOQOL-100), which ascertains an individual's perception of
QOL in the physical, psychological, level of independence,
environmental and spiritual domains, as well as
the general QOL.
Healthy controls had a better QOL in all domains as well as in the overall
general QOL,
when compared to patients with lymphoedema. Several
facets such as pain and discomfort, sleep and rest,
activities of
daily living, dependence on medication and treatment, working capacity and
social support were
significantly affected by the acute
adenolymphangitis attack/s patients had suffered. The environmental and
spiritual domains were significantly affected by the maximum grade of
lymphoedema. The significant
difference in the QOL as perceived by
patients suffering from filarial lymphoedema and apparently healthy
individuals reiterates the importance of morbidity control in patients
already affected by filarial lymphoedema.
PMID: 19796782 [PubMed - as
supplied by publisher
------
1. Photomed Laser Surg. 2009
Oct 7. [Epub ahead of print]
The Effect of Laser Irradiation on
Proliferation of Human Breast Carcinoma, Melanoma, and Immortalized
Mammary Epithelial Cells.
Powell K, Low P, McDonnell PA, Laakso
EL, Ralph SJ.
1 School of Medical Science, Griffith University , Gold
Coast, Queensland, Australia .
Abstract Objective: This study compared
the effects of different doses (J/cm(2)) of laser phototherapy at
wavelengths of either 780, 830, or 904 nm on human breast carcinoma,
melanoma, and immortalized human
mammary epithelial cell lines in
vitro. In addition, we examined whether laser irradiation would malignantly
transform the murine fibroblast NIH3T3 cell line.
Background:
Laser phototherapy is used in the clinical treatment of breast cancer-related
lymphoedema,
despite limited safety information. This study
contributes to systematically developing guidelines for the safe
use of laser in breast cancer-related lymphoedema.
Methods:
Human breast adenocarcinoma (MCF-7), human breast ductal carcinoma with
melanomic
genotypic traits (MDA-MB-435S), and immortalized human
mammary epithelial (SVCT and Bre80hTERT)
cell lines were irradiated
with a single exposure of laser. MCF-7 cells were further irradiated with two
and
three exposures of each laser wavelength. Cell proliferation
was assessed 24 h after irradiation.
Results: Although certain doses of
laser increased MCF-7 cell proliferation, multiple exposures had either no
effect or showed negative dose response relationships. No sign of
malignant transformation of cells by laser
phototherapy was
detected under the conditions applied here. Conclusion: Before a definitive
conclusion can
be made regarding the safety of laser for breast
cancer-related lymphoedema, further in vivo research is
required.
PMID: 19811082 [PubMed - as supplied by
publisher]
------------
Breast Cancer. 2009 Sep 30. [Epub ahead of
print]
A multicentre cross-sectional study of arm lymphedema four or
more years after breast cancer treatment in
Iranian
patients.
Haddad P, Farzin M, Amouzegar-Hashemi F, Kalaghchi B,
Babazadeh S, Mirzaei HR, Mousavizadeh A,
Harirchi I, Rafat
J.
Department of Radiation Oncology, Cancer Institute, Tehran University
of Medical Sciences, P.O. Box
13145-158, Tehran, Iran,
[email protected].
BACKGROUND: We performed a cross-sectional
multicentre study to assess the prevalence of
lymphedema after
breast cancer treatment in Iran.
PATIENTS AND METHODS: All female breast
cancer patients who attended our follow-up clinics four or
more
years after their surgery with no sign of disease were asked to participate in
this study. Lymphedema
was defined as an increase of 10% in the
circumference of the arm on the involved side compared to the
opposite arm.
RESULTS: The total number of patients
participating in this study was 355. The prevalence of lymphedema
in the study patients was 17.5%, with the rate varying significantly
(between 4 and 21%) among the three
study centres (p = 0.007). The
mean number of months post surgery was larger for patients with
lymphedema (84 months) than for those without (79 months), though this
was not statistically significant (p >
0.1). The relationships
of various treatment factors and the education levels of the patients to the
presence of
lymphedema were also evaluated. None of the observed
differences were statistically significant aside from
those for the
type of surgery (mastectomy vs. conservative surgery, p = 0.055), treatment
with radiotherapy
(p = 0.099), and prescription of a supraclavicular
radiation field (p = 0.057), which were only just
significant.
CONCLUSION: The rate of lymphedema in our patients was
17.5%, ranging from 4 to 21% in different
study centres. Time post
surgery, treatment with radiotherapy and the technique used, and nodal
radiation
seem to be factors that are related to this large
variation.
PMID: 19789952 [PubMed - as supplied by
publisher]
------------------------
2. Breast Cancer. 2009 Sep
30. [Epub ahead of print]
Axillary reverse mapping for preventing
lymphedema in axillary lymph node dissection and/or sentinel lymph
node biopsy.
Noguchi M.
Department of Breast and
Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada, Ishikawa,
920-0293, Japan, [email protected].
PMID: 19789947
[PubMed - as supplied by publisher]
--------------------------
3.
Lymphat Res Biol. 2009;7(3):153-8.
Local Tissue Water in At-Risk and
Contralateral Forearms of Women with and without Breast Cancer
Treatment-Related Lymphedema.
Mayrovitz HN, Weingrad DN, Davey
S.
1 College of Medical Sciences, Health Professions Division, Nova
Southeastern University , Davie, Florida .
Abstract Background:
Quantitative measurements to help detect incipient or latent lymphedema in
patients at
risk for breast cancer treatment-related lymphedema
(BCRL) are potentially useful supplements to clinical
assessments.
Suitable measurements for routine use include arm volumes, arm bioimpedance,
and local
tissue water (LTW) determined from the tissue dielectric
constant (TDC). Because BCRL initially develops
in skin and
subcutis, measures that include whole arms may not be optimally sensitive for
detecting the
earliest changes. Thus, there is also a need for a
local measurement in which tissues most likely to
demonstrate early
lymphedematous changes can be more selectively assessed. The TDC method
satisfies
this criterion. Our goal was to use this method to
compare arm-to-arm differences in LTW within and
among women
grouped as healthy normal (HN), diagnosed with breast cancer (BC), but prior to
surgery
and established unilateral lymphedema (LE). Methods and
Results: LTW was determined on both anterior
forearms to a
measurement depth of 2.5 mm in 30 women of each group. TDC arm ratios were
determined
as dominant/nondominant for HN and BC,
at-risk/contralateral for BC, and lymphedematous/contralateral
for
LE. Results showed that TDC values for all arms except lymphedematous arms were
very similar and
insignificantly different with values among arms
(mean +/- SD) ranging from 24.9 +/- 3.8 to 25.7 +/- 3.8.
Arm ratios
did not differ between HC and BC whereas dominant/non-dominant arm ratios for
HN and BC
separately and combined (1.006 +/- 0.085) were
significantly less than the lymphedematous/contralateral
ratio of
the LE group (1.583 +/- 0.292). Conclusions: The findings indicate that LTW of
at-risk arms is not
affected by breast cancer and that lymphedema
does not significantly affect LTW of contralateral arms as
measured
with the TDC method. Further, based on the standard deviation of measured arm
ratios, an at-
risk/contralateral TDC ratio of 1.26 is suggested as a
possible threshold for detecting preclinical or latent
lymphedema.
PMID: 19778203 [PubMed - in
process
---------------------
4. Lymphat Res Biol.
2009;7(3):145-51.
Histological findings compared with magnetic resonance
and ultrasonographic imaging in irreversible
postmastectomy
lymphedema: a case study.
Tassenoy A, De Mey J, Stadnik T, De Ridder F,
Peeters E, Van Schuerbeek P, Wylock P, Van Eeckhout
GP, Verdonck K,
Lamote J, Baeyens L, Lievens P.
1 Department of Rehabilitation Research,
Free University Brussels , Brussels, Belgium .
Abstract Postmastectomy
edema is a current complication after axillary lymph node dissection in cases
of
breast cancer treatment. Staging is important in order to select
those patients who can benefit from complex
physical therapy (CPT).
Different imaging techniques can be used to evaluate the edema. Ultrasonography
(US) is a harmless, cheap, and easily applicable technique to
visualize the dermal and subcutaneous tissue,
but interpretation of
the obtained images is not always evident. The aim of this study was to compare
ultrasound images of irreversible edema with tissue histology,
magnetic resonance imaging (MRI) and
magnetic resonance
spectroscopy (MRS). Ultrasonographic images of the edematous dermis show an
homogeneous hypoechogenic dermal layer that appears on tissue histology
to be less compact, due to the
excess of fluid in the interstitium
separating the collagen fibres and making it more transparent on light
microscopy. MRI of the dermis gives a hyperintense signal, indicating
the presence of fluid. In the subcutis,
increase of the adipose
tissue could be observed on US, MRI, and tissue histology. In the case of
lymphedema, the area and perimeter of fat cells is significantly (p
< 0.05) increased. Hypoechogenic areas
near the muscle fascia are
registrated on US corresponding with epifascial fluid on MRI, and
hyperechogenic branches are embedded within the adipose tissue, on
tissue histology seen as large fibrotic
septa enclosing adipose
cells. MRI has a honeycomb picture corresponding with fluid bound to
fibrosis.
PMID: 19778202 [PubMed - in
process
---------------------
5. Rev Med Liege. 2009
Jul-Aug;64(7-8):409-13.
[Angiosarcoma consecutive to chronic
lymphoedema: a Stewart-Treves syndrome]
[Article in French]
Gonne E,
Collignon J, Kurth W, Thiry A, Henry F, Jerusalem G, Gennigens
C.
Université de Liège, Belgique.
The Stewart-Treves Syndrome is
defined as an angiosarcoma (very aggressive malignant tumor originating
from endothelial cells) appearing in a specific clinical setting. This
tumor develops in patients suffering from
chronic lymphedema of the
upper limb following mastectomy and axillary lymph node dissection for breast
cancer. The diagnosis relies on medical history, clinical
examination and a histological assesment (biopsy or
resection).
This syndrome represents a rare clinical entity. Unfortunately, the prognosis
is poor. A large
surgical resection is the treatment of choice if the patient is a candidate for a surgical resection with a curative
intent Radiotherapy is sometimes used as a palliative local treatment.
Chemotherapy is only used in more
advanced cases, not curable by
surgery alone.
PMID: 19777923 [PubMed - in process
----
1.
Acta Oncol. 2009 Oct 20. [Epub ahead of print]
Arm/shoulder problems in
breast cancer survivors are associated with reduced health and poorer physical
quality of life.
Nesvold IL, Fosså SD, Holm I, Naume B, Dahl
AA.
Department of Clinical Cancer Research, Oslo University Hospital,
Rikshospitalet, 0310 Oslo, Norway.
Abstract Background. Except for
lymphedema, the consequences of arm/shoulder problems (ASPs), at
long-term in breast cancer survivors (BCSs) have hardly been studied.
We examined demography, lifestyle,
quality of life (QoL) and somatic
morbidity in BCSs with and without ASPs. We also compared the
associations of restricted shoulder abduction and lymphedema with
QoL.
Methods. We used a cross-sectional case-control design. A sample of
256 BCSs all with lymph node
metastases were examined at a mean of
4.1 (SD 0.9) years post-surgery. Based on objective examinations
and self-rating the sample were separated into 81 BCSs (32%) with
definite ASP (ASP+ group) and 175
(68%) with minimal or no ASP
(ASP- group). The self-rating contained among other schedules the Short
Form-36 (SF-36) and the Kwan's arm/shoulder problem scale
(KAPS).
Results. In univariate analysis ASP+ was associated with not
being employed, having had mastectomy,
longer follow-up time,
radiotherapy to axilla, poorer self-rated health and physical condition,
minimal
physical activity, increased body mass index, regularly
intake of analgesics, and poorer physical QoL.
Multivariate
analysis showed that mastectomy, longer follow-up time, minimal physical
activity and poorer
physical QoL were associated with belonging to
ASP- group. All domains of the SF-36 were significantly
associated
with having impaired shoulder abduction (>/=25 degrees difference) while
none of the
associations with lymphedema were significant.
Discussion. In BCSs, at four years after treatment, having
ASP was
associated with mastectomy, minimal physical activity and poorer physical QoL.
Poor physical
QoL is strongly associated with reduced shoulder
abduction rather than with lymphedema.
PMID: 19842790 [PubMed - as
supplied by publisher]
-----------------------
2. Breast Cancer
Res Treat. 2009 Oct 20. [Epub ahead of print]
Axillary reverse mapping
for breast cancer.
Noguchi M.
Department of Breast and Endocrine
Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku 1-
1, Ishikawa, 920-0293, Japan, [email protected].
The
axillary reverse mapping (ARM) technique has been developed to map and preserve
arm lymphatic
drainage during axillary lymph node dissection (ALND)
and/or sentinel lymph node (SLN) biopsy, thereby
minimizing arm
lymphedema. However, several problems remain to be resolved in the practical
application
of this technique. This article presents a review of
current knowledge regarding ARM and discusses the
practical
applicability and relevance of this technique. Identification rates of ARM
nodes were insufficient
using blue dye. Although this was improved
using radioisotopes, radioisotopes alone do not permit visual
mapping of ARM lymphatics. Fluorescence imaging may be useful to
improve the identification rate of ARM
nodes and lymphatics. On the
other hand, the ARM nodes may be involved with metastatic foci in patients
with extensive axillary lymph node metastases. Moreover, the SLN
draining the breast may be the same as
the ARM node draining the
upper extremity in a minority of patients. These issues represent important
drawbacks of the ARM procedure. The success of ARM in reducing
lymphedema has not yet been
determined. Further studies are needed
before this can be accepted as a standard procedure in surgical
management of breast cancer.
PMID: 19842033 [PubMed - as
supplied by publisher
---------
1. Int J Neurosci.
2009;119(8):1105-1117.
Effects of Manual Lymph Drainage on Cardiac
Autonomic Tone in Healthy Subjects.
Kim SJ, Kwon OY, Yi
CH.
Department of Physical Therapy, Kangwon National University,
Kangwon-do, 245-711, Republic of
Korea.
This study was
designed to investigate the effects of manual lymph drainage on the cardiac
autonomic tone.
Thirty-two healthy male subjects were randomly
assigned to manual lymph drainage (MLD) (experimental)
and rest
(control) groups. Electrocardiogram (ECG) parameters were recorded with bipolar
electrocardiography using standard limb lead positions. The
pressure-pain threshold (PPT) was
quantitatively measured using an
algometer. Heart rate variability differed significantly between the
experimental
and control groups (p < 0.05), but the PPT in the upper trapezius muscle did
not (p > 0.05).
These findings indicate that the application of
MLD was effective in reducing the activity of the sympathetic
nervous system.
PMID: 19922342 [PubMed - as supplied by
publisher
------
1. 2009 Nov 18 - Subjective Assessment of
Pregnancy Impact on Primary Lower Limb Lymphedema.
Vignes S,
Arrault M, Porcher R.
Objective: To analyze subjective influence of
pregnancy on lower limb lymphedema.
Method: Cross-sectional study on 49
affected women was conducted in a single lymphology department
between January 2002 and December 2006. All women were asked whether
their lymphedema had
worsened during pregnancy.Results: Mean age at
lymphedema onset was 17 years, with no familial history
of
lymphedema. Lymphedema was unilateral for 30 women and bilateral for 19. Median
age at the first
delivery was 28 years. Eighteen women had only 1
pregnancy, 23 women had only 2, and 8 women had 3.
For the first
pregnancy, birth weight was 3.4 kg. Subjective lymphedema worsening was
reported by 5
women after the first pregnancy compared to 44 women
without worsening (P = ..006) and after 10 (11%)
of the 88
pregnancies (1 twin birth) involving 9 women. During the median 18 years since
the first
pregnancy, only a 14-year-old boy has developed bilateral
lymphedema.
Conclusion: Pregnancy did not significantly exacerbate
primary lower limb lymphedema.
PMID: 19926624 [PubMed - as supplied by
publisher
-----
2. 2009 Nov;9 - Topics of physiological and
pathophysiological functions of lymphatics.
Kawai Y, Ohhashi
T.
Department of Physiology, Shinshu University School of
Medicine, 3-1-1 Asahi, Matsumoto 390-8621,
Japan.
We
have reviewed physiological significance of rhythmical spontaneous contractions
of collecting lymphatics,
which play an important role in lymph
transport and seem to regulate lymph formation through changing the
pacemaker sites of the rhythmic contractions and conractile patterns of
lymphangions. Next, we reported
experimental findings that the wall
effective permeability of hydrophilic substances labelled with fluorescent
dyes was evaluated in an isolated cannulated rat single lymphatic using
a microscope system. With the
experimental evidence, we have
discussed physiological significance and crucial roles of the enrichment of
albumin in lymph through the wall of small lymphatics in regulation of
innate immunity. In addition, we have
described the mode of action
of recanalization of collecting lymphatics after excision of lymph node with
special reference to clinical treatment for surgical removal of
lymph nodes-mediated secondary lymphedema.
Finally, we have
addressed the possibility that primary tumor cells and/or metastatic carcinoma
cells
themselves release key chemical substances to develop
environment suitable for micro-metastasis in sentinel
lymph
node.
PMID: 19925407 [PubMed - in process
-----
3. 2009
Nov 18 - Longitudinal change of treatment-related upper limb dysfunction and
its impact on late
dysfunction in breast cancer survivors: A
prospective cohort study.
Yang EJ, Park WB, Seo KS, Kim SW, Heo CY, Lim
JY.
Department of Rehabilitation Medicine, Seoul National
University College of Medicine, Seoul National
University Bundang
Hospital, Gyeonggi-do, Republic of Korea.
BACKGROUND AND
OBJECTIVES: To investigate the prevalence of upper limb dysfunction (ULD)
and subtypes after breast cancer surgery and to identify factors
associated with late ULD.
METHODS: Among 191 enrolled patients, 191 were
evaluated at 3 months, 187 at 6 months, and 183 at
12 months after
surgery. Pain, shoulder range of motion, muscle strength, and arm circumference
were
assessed. Based on symptoms and physical examinations, the
types of ULD common after breast cancer
treatment were diagnosed
and categorized.
RESULTS: The prevalence of ULD after surgery were
24.6%, 20.9%, and 26..8% at 3, 6, and 12 months,
respectively. The
most common types of ULD were pectoralis tightness at 3 and 6 months and
lymphedema
at 12 months. Patients with pectoralis tightness or
lymphedema at 3 or 6 months showed a higher prevalence
of rotator
cuff disease at 12 months compared with those without early pectoralis
tightness or lymphedema.
CONCLUSIONS: The major post-operative ULD were
pectoralis tightness at 3 and 6 months and
lymphedema at 12 months.
Late ULD such as rotator cuff disease were associated with pectoral tightness
or
lymphedema at earlier stages. Diagnosis and treatment of ULD
should take place as soon as possible after
surgery. J. Surg.
Oncol. (c) 2009 Wiley-Liss, Inc.
PMID: 19924721 [PubMed - as supplied by
publisher
-----
4. 2009 Oct 12 - Selenium in oncology: from
chemistry to clinics.
Micke O, Schomburg L, Buentzel J, Kisters K,
Muecke R.
Department of Radiotherapy and Radiation Oncology,
Franziskus Hospital, Kiskerstrasse 26, D- 33615
Bielefeld,
Germany.
The essential trace element selenium, which is a
crucial cofactor in the most important endogenous
antioxidative
systems of the human body, is attracting more and more the attention of both
laypersons and
expert groups. The interest of oncologists mainly
focuses in the following clinical aspects: radioprotection of
normal tissues, radiosensitizing in malignant tumors, antiedematous
effect, prognostic impact of selenium, and
effects in primary and
secondary cancer prevention. Selenium is a constituent of the small group of
selenocysteine-containing selenoproteins and elicits important
structural and enzymatic functions. Selenium
deficiency has been
linked to increased infection risk and adverse mood states. It has been shown
to
possess cancer-preventive and cytoprotective activities in both
animal models and humans. It is well
established that Se has a key
role in redox regulation and antioxidant function, and hence in membrane
integrity, energy metabolism and protection against DNA damage. Recent
clinical trials have shown the
importance of selenium in clinical
oncology. Our own clinical study involving 48 patients suggest that
selenium has a positive effect on radiation-associated secondary
lymphedema in patients with limb edemas,
as well as in the head and
neck region, including endolaryngeal edema. Another randomized phase III study
of our group was performed to examine the cytoprotective properties
of selenium in radiation oncology. The
aim was to evaluate whether
sodium selenite is able to compensate a preexisting selenium deficiency and to
prevent radiation induced diarrhea in adjuvant radiotherapy for
pelvic gynecologic malignancies. Through this
study, the
significant benefits of sodium selenite supplementation with regards to
selenium deficiency and
radiotherapy induced diarrhea in patients
with cervical and uterine cancer has been shown for the first time in
a
prospective randomized trial. Survival data imply that supplementation with
selenium does not interfere
with the positive biological effects of
radiation treatment and might constitute a valuable adjuvant therapy
option
especially in marginally supplied individuals. More recently there were
emerging concerns coming up
from two large clinical prevention
trials (NPC, SELECT), that selenium increases the possible risk of
developing diabetes type II. Despite obvious flaws of both studies and
good counterarguments, a
controversial debate remains on the
possible advantage and risks of selenium in cancer prevention.
However, in the light of the recent clinical trials the potential
benefits of selenium supplementation in tumor
patients are
undeniable, even if further research is needed.
PMID: 19924043 [PubMed -
in process]
-----
1. Eur J Dermatol. 2009 Nov 17. [Epub
ahead of print]
Mushroom-like soft fibromas on chronic leg
lymphedema.
Nakamura S, Hashimoto Y, Nishi K, Takeda K, Takahashi H,
Mizumoto T, Iizuka H.
PMID: 19919910 [PubMed - as supplied by
publisher
------
2. Cases J. 2009 Sep
1;2:6887.
Lymphangiosarcoma of the arm presenting with lymphedema in a
woman 16 years after mastectomy: a case
report.
Sepah YJ,
Umer M, Qureshi A, Khan S.
Department of Surgery (Orthopedics), Aga Khan
University Medical College P.O. Box 3500, Karachi-
74800
Pakistan.
Lymphangiosarcoma following breast cancer is a relatively rare
entity, with around 300 cases so far
reported worldwide. Affecting
the long term survivors of breast cancer, lymphangiosarcoma (Stewart-
Traves
Syndrome) has a high mortality rate. Since lympedema following radical
mastectomy or axillary
clearance and radiotherapy seems to be the
main predisposing factor, further research regarding
modifications
in the surgical technique of axillary nodes dissection as well as the
development of new
chemotherapeutic agents effective in
lymphangiosarcoma are required.
PMID: 19918554 [PubMed - in
process
-----
3. Cancer Invest. 2009 Nov 16. [Epub ahead of
print]
Assessment of Breast Cancer-Related Arm
Lymphedema-Comparison of Physical Measurement Methods
and
Self-Report.
Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee
MJ, York S, Kilbreath SL.
Faculty of Health Sciences, University
of Sydney, Sydney, Australia1.
ABSTRACT
Purpose: To
determine the relationship between physical methods of measuring lymphedema and
self-
reported swelling, their reliability, and standard error of
measurement. Method: Lymphedema in each arm of
women with (n = 33)
and without (n = 18) unilateral arm lymphedema, secondary to breast cancer was
measured by self-report, bioimpedance spectroscopy (BIS),
perometer, and the truncated cone method.
Results: The physical
measurement tools were highly reliable (ICC((2,1)): 0.94 to 1.00) with high
concordance (r(c): 0.89 to 0.99). Selfreport correlatedmoderately with
physical measurements (r = 0.65 to
0.71) and was moderately reliable
(ICC((2,1)): 0.70).
Conclusions: Lymphedema assessment methods are
concordant and reliable but not interchangeable.
PMID: 19916749 [PubMed
- as supplied by publisher
-----
4. Urol Oncol. 2009 Nov 12.
[Epub ahead of print]
Diffuse lymphangiomatosis with genital
involvement-evaluation with magnetic resonance
lymphangiography.
Lohrmann C, Foeldi E, Langer
M.
Department of Radiology, University Hospital of Freiburg,
Freiburg, Germany.
OBJECTIVE: To assess, for the first time, the
morphology of the lymphatic system in patients with diffuse
lymphangiomatosis and genital involvement by magnetic resonance
lymphangiography (MRL).
MATERIALS AND METHODS: Ten patients with diffuse
lymphangiomatosis and genital involvement were
examined by MRL.
Three locations were examined: first, the lower leg and foot region; second,
the upper
leg and the knee region; and third, the pelvic with
retroperitoneal region. MR imaging was performed with a
1.5-T
system equipped with high-performance gradients. For MRL, a T1-weighted
3D-spoiled gradient-
echo and a T2-weighted 3D-TSE sequence were
used.
RESULTS: The size of the genital lymphangiomas, which were
revealed in all patients, varied between 6 and
85 mm. In 60% of the
patients, lymphangiomas were additionally detected at the level of the lower
legs, and
in 70% patients at the level of the upper leg.
Furthermore, lymphangiomas were seen in the inguinal and
retroperitoneal regions in 80%, and in the pelvic region and anterior
abdominal wall in 90% of the patients
examined. The genital
lymphangiomas feeding lymphatic vessels were detected in 80% of the patients in
the
anterior abdominal wall and in 90% of the patients in the
inguinal and pelvic regions; 90% of the patients
suffered
consecutively from a lymphedema of the lower extremities. All patients suffered
from recurrent
infections in the genital region; 80% of the
patients repeatedly experienced genital lymphorrhea due to
lympho-cutaneous fistulas and lymphcysts.
CONCLUSION: MRL is a
safe and accurate minimal-invasive imaging modality for the evaluation of the
lymphatic circulation in patients with diffuse lymphangiomatosis
and genital involvement. Because the site and
extent of the
lymphangiomas with their feeding lymphatic vessels are important prognostic
factors,
performing radiologic evaluation with a high resolution is
crucial for the therapeutic planning of patients.
PMID: 19914101 [PubMed
- as supplied by publisher
-----
5. Eur J Radiol. 2009 Nov 11.
[Epub ahead of print]
Assessment of the lymphatic system in
patients with diffuse lymphangiomatosis by magnetic resonance
imaging.
Lohrmann C, Foeldi E, Langer
M.
Department of Radiology, University Hospital of Freiburg,
Hugstetter Strasse 55, D-79106 Freiburg i. Br.,
Germany.
OBJECTIVE: To assess the lymphatic system in
patients with diffuse lymphangiomatosis by magnetic
resonance
imaging.
MATERIALS AND METHODS: 15 patients with diffuse
lymphangiomatosis were examined by magnetic
resonance imaging.
Three locations were examined: first, the lower leg and foot region; second,
the upper
leg and the knee region; and third, the pelvic with
retroperitoneal and abdominal region. For magnetic
resonance
lymphangiography a T1-weighted 3D spoiled gradient-echo and a T2-weighted
3D-TSE
sequence was used.
RESULTS: The size of the
genital lymphangiomas, which were revealed in all patients, varied between 5
and
83mm. In 47% of the patients lymphangiomas were detected at the
level of the lower legs, and in 87% of
the patients at the level of
the upper leg and retroperitoneum. Furthermore, lymphangiomas were seen in the
inguinal and pelvic region in 100% and intraabdominally in 40% of
the patients. The lymphangiomas
extended into the abdominal wall in
93% of the examined patients. A chylous pleural effusion was revealed
in
20% and a chylous ascites in 13% of patients. 93% of patients suffered due to
the diffuse
lymphangiomatous pathologies from a lymphedema of the
lower extremities, while a generalized
lymphedema of the trunk was
found in 87% of the patients.
CONCLUSION: Magnetic resonance
imaging is a safe and accurate minimal-invasive imaging modality for
the
evaluation of the lymphatic system in patients with diffuse lymphangiomatosis.
Since the localization and
extension of the lymphangiomas are
important prognostic factors, it is crucial to perform a safe radiologic
evaluation with a high resolution for the patient's therapeutic
planning.
PMID: 19913379 [PubMed - as supplied by
publisher
-----
6. Hum Genet. 2009 Nov 13. [Epub ahead of
print]
Linkage and sequence analysis indicate that CCBE1 is
mutated in recessively inherited generalised lymphatic
dysplasia.
Connell F, Kalidas K, Ostergaard P, Brice G,
Homfray T, Roberts L, Bunyan DJ, Mitton S, Mansour S,
Mortimer P,
Jeffery S; Lymphoedema Consortium.
Medical Genetics Unit,
Clinical Developmental Sciences, St George's University of London, Cranmer
Terrace, London, SW17 0RE, UK.
Generalised lymphatic
dysplasia (GLD) is characterised by extensive peripheral lymphoedema with
visceral
involvement. In some cases, it presents in utero with
hydrops fetalis. Autosomal dominant and recessive
inheritance has
been reported. A large, non-consanguineous family with three affected siblings
with
generalised lymphatic dysplasia is presented. One child died
aged 5 months, one spontaneously miscarried
at 17 weeks gestation,
and the third has survived with extensive lymphoedema. All three presented with
hydrops fetalis. There are seven other siblings who are clinically
unaffected. Linkage analysis produced two
loci on chromosome 18,
covering 22 Mb and containing 150 genes, one of which is CCBE1. A
homozygous cysteine to serine change in CCBE1 has been identified in the
proband, in a residue that is
conserved across species. High
density SNP analysis revealed homozygosity (a region of 900 kb) around
the locus for CCBE1 in all three affected cases. This indicates a
likely ancestral mutation that is common to
both parents; an
example of a homozygous mutation representing Identity by Descent (IBD) in this
pedigree.
Recent studies in zebrafish have shown this gene to be
required for lymphangiogenesis and venous sprouting
and are
therefore supportive of our findings. In view of the conserved nature of the
cysteine, the nature of
the amino acid change, the occurrence of a
homozygous region around the locus, the segregation within the
family, and the evidence from zebrafish, we propose that this mutation
is causative for the generalised
lymphatic dysplasia in this family,
and may be of relevance in cases of non-immune hydrops
fetalis.
PMID: 19911200 [PubMed - as supplied by
publisher
------
1. Cases J. 2009 Oct
24;2:165.
Nonclassical yellow nail syndrome in six-year-old girl: a case
report.
Cebeci F, Celebi M, Onsun N.
Department of
Dermatology, Vakif Gureba Training and Research Hospital, Istanbul,
Turkey.
INTRODUCTION: The yellow nail syndrome is usually
described as the combination of yellow nails with
lymphoedema and
often with respiratory manifestations such as pleural effusions, chronic
sinusitis and
bronchiectasis. The syndrome is most often seen in the
middle-aged individuals.
CASE PRESENTATION: We present a 6-year-old girl
with yellow nail syndrome having pansinusitis and
bronchiectasis.
CONCLUSION: The components comprising the
classical triad of yellow nail syndrome in children may not
necessarily be present altogether. Therefore, yellow nail syndrome
should be suspected in children having
only typical nail
changes.
PMID: 19946476 [PubMed - in process
----
2.
Aesthet Surg J. 2009 Nov-Dec;29(6):513-22.
Does thighplasty for
upper thigh laxity after massive weight loss require a vertical
incision?
Shermak MA, Mallalieu J, Chang
D.
Division of Plastic Surgery, Johns Hopkins Bayview Medical
Center, Baltimore, MD 21224, USA.
[email protected]
Comment in:
•Aesthet Surg J. 2009
Nov-Dec;29(6):522-3.
BACKGROUND: After massive weight loss (MWL), many
patients present with concerns about skin
excess and laxity. The
thigh is one of the more complex regions to address in MWL patients because of
the
differing degree, location, and quality of skin excess and fatty
tissue, as well as surgical risk factors.
OBJECTIVE: The authors
describe a technique called the anterior proximal extended (APEX) thighlift to
effectively treat upper thigh skin excess with a hidden scar while
also enhancing adjacent body regions.
METHODS: A review was performed of
97 MWL patients who underwent thighlift surgery between March
1998
and October 2007. Eighty-six women and 11 men, with average weight loss of 146
lb and average
body mass index (BMI) at contouring of 29.8, were
included in the study. The risk factors that were
assessed included
age, gender, medical conditions, tobacco use, BMI, weight of skin excised, and
surgery
performed. The outcomes that were assessed included wound
healing and lymphedema. Extended vertical
thighlift was performed
in 11 patients and anterior superior thighlift in 86 patients. RESULTS:
Complications
of thighlift included wound healing problems (n = 18;
18.6%); lymphedema (n = 8; 8.3%); cellulitis (n = 7;
7.2%); seroma
(n = 3; 3.1%); and bleeding (n = 1; 1%). On multivariate statistical analysis,
age and BMI
were found to impair healing in the entire thighlift
group. For patients with a BMI greater than or equal to 35,
the
odds ratio (OR) for a wound healing complication was 13.7 (P = .03).
Hypothyroidism was strongly
associated with lymphedema, with an OR
of 23 (P = .06). Extended thighlift trended toward lymphedema
(OR =
16.7; P = .08). CONCLUSIONS: Thighlift can be a satisfying procedure for both
the patient and
surgeon because it provides aesthetic improvement
in terms of skin excess and laxity. The APEX thighlift is a
new
technique that expands upon those previously described in the literature to
effectively treat upper thigh
laxity with a hidden scar after
MWL.
PMID: 19944997 [PubMed - in process
----
1.
Lymphology. 2009 Sep;42(3):146-7.
The diagnosis and treatment of
peripheral lymphedema.
Piller N, Carati C.
Comment
on:
•Lymphology. 2009 Jun;42(2):51-60.
PMID: 19938271 [PubMed - in
process]
-----
2. Nat Genet. 2009
Dec;41(12):1272-4.
Mutations in CCBE1 cause generalized lymph
vessel dysplasia in humans.
Alders M, Hogan BM, Gjini E, Salehi
F, Al-Gazali L, Hennekam EA, Holmberg EE, Mannens MM,
Mulder MF,
Offerhaus GJ, Prescott TE, Schroor EJ, Verheij JB, Witte M, Zwijnenburg PJ,
Vikkula M,
Schulte-Merker S, Hennekam RC.
Department
of Clinical Genetics, Academic Medical Centre, Amsterdam, The
Netherlands.
Lymphedema, lymphangiectasias, mental retardation and
unusual facial characteristics define the autosomal
recessive
Hennekam syndrome. Homozygosity mapping identified a critical chromosomal
region containing
CCBE1, the human ortholog of a gene essential for
lymphangiogenesis in zebrafish. Homozygous and
compound
heterozygous mutations in seven subjects paired with functional analysis in a
zebrafish model
identify CCBE1 as one of few genes causing primary
generalized lymph-vessel dysplasia in humans.
PMID: 19935664 [PubMed -
in process
-----
3. Plast Reconstr Surg. 2009
Oct;124(4):1186-95.
Management of "buried" penis in adulthood:
an overview.
Pestana IA, Greenfield JM, Walsh M, Donatucci CF,
Erdmann D.
Division of Plastic, Reconstructive, Maxillofacial,
and Oral Surgery, Department of Surgery, Duke
University Medical
Center, Durham, NC 27710, USA.
BACKGROUND: The condition of
"buried" penis may arise from several factors. Although the pediatric
form
is a rare congenital disorder, it may become an acquired condition in
adulthood, most commonly from
obesity, radical circumcision, or
penoscrotal lymphedema. As obesity has become a national epidemic, the
incidence of this phenomenon will inevitably increase. The purpose of
this article is to present current
strategies in the management of
this physically and psychologically debilitating condition.
METHODS: A
literature review of the surgical management of buried penis was obtained
mainly in the
plastic surgery and urology literature (PubMed), from
1977 to 2007.
RESULTS: Several risk factors were identified in adult
patients with buried penis, including morbid obesity
and diabetes
mellitus. Multiple techniques for release and reconstruction are described,
including primary
closure, Z-plasty, and skin resurfacing, all of
which may or may not include a lipectomy. Recent publications
focus
on resurfacing with split-thickness skin grafts and negative-pressure
dressings. These techniques have
been successful in terms of graft
survival and long-term cosmetic result.
CONCLUSIONS: Buried penis is an
unusual, difficult-to-treat condition that presents a unique challenge to
the plastic surgeon and the urologist. Predisposing factors such as
morbid obesity and diabetes mellitus are
becoming increasingly
prevalent, which suggests a potential increase in the incidence of this
condition.
Although no specific approach may be applicable to all
patients, a combination of various techniques may be
applied. In
complicated and severe cases, a split-thickness skin graft to the penile shaft,
reduction
scrotoplasty, suction-assisted lipectomy, and/or surgical
lipectomy, such as panniculectomy, may be
indicated. Therapy
adapted to the individual patient can result in high rates of successful
reconstruction with
acceptable cosmetic results.
PMID:
19935302 [PubMed - in process
-----
4. Lymphology. 2009
Sep;42(3):139-45.
Airplane travel and lymphedema: a case
study.
Ward LC, Battersby KJ, Kilbreath
SL.
School of Chemistry and Molecular Biosciences, University of
Queensland, Brisbane, Australia. l.ward@uq.
edu.au
A
single subject prospective study of the relationship between air travel and
lymphedema is reported. This
proof of concept study was aimed at
assessing the feasibility of using self-measured, inter-limb impedance
ratios as a quantitative measure of lymphedema immediately prior to and
following flying. The participant, a
breast cancer survivor with
lymphedema, measured whole arm impedance prior to and following air travel
on 20 occasions, varying in duration of between 1 and 9 h, over a
12-month period. Although the inter-arm
impedance ratio fluctuated
over this time, it generally increased and worsened following flying. Impedance
measurements were easily performed by the participant and could be
obtained as close to the start and
cessation of flying as is
practicably possible. These data, when associated with self-assessment of
lymphedema-related symptoms, could provide a comprehensive evidence
base for an assessment of the
risks associated with air travel and
the provision of appropriate advice to prospective travelers. Further
large-scale
studies are recommended.
PMID: 19927904 [PubMed - in
process
----
5. Lymphology. 2009
Sep;42(3):123-9.
The role of lymphoscintigraphy in the diagnosis
of lymphedema in Turner syndrome.
Bellini C, Di Battista E,
Boccardo F, Campisi C, Villa G, Taddei G, Traggiai C, Amisamo A, Perucchin PP,
Benfenati CS, Bonioli E, Lorini R.
Neuromuscular
Diseases Unit, Department of Pediatrics, University of Genoa, Genoa, Italy.
[email protected]
Lymphedema can be
present in patients affected by Turner syndrome (TS) with the dorsum of the
hands
and feet most commonly affected. This lymphedema results from
underdevelopment of the lymphatic system
before birth, and it
usually decreases during childhood. The aim of our study was to evaluate the
role of
lymphoscintigraphy as a diagnostic tool in patients with TS
to assess possible impairments in the lymphatic
system. Eighteen
patients with TS were karyotyped to confirm diagnosis and were evaluated by
lymphoscintigraphy. Lymphatic dysfunction was demonstrated in 15/18
patients. Lymphoscintigraphic
studies showed: 1) lymphatic
channels, 2) collateral lymphatic channels, 3) interrupted lymphatic
structures,
and 4) lymph nodes of the deep lymphatic system. Our
data demonstrate that lymphoscintigraphy should be
mandatory not
only in patients affected by Turner syndrome with signs of lymphatic dysplasia
but also in
those with minimal or absent signs of lymphatic
impairment in order to obtain a very early diagnosis and to
provide
substantial information for possible medical or surgical
treatment.
PMID: 19927901 [PubMed - in process
-----
6.
Lymphology. 2009 Sep;42(3):105-11.
Where do lymph and tissue
fluid accumulate in lymphedema of the lower limbs caused by obliteration of
lymphatic collectors?
Olszewski WL, Ambujam PJ, Zaleska
M, Cakala M.
Department of Surgical Research and
Transplantology, Medical Research Center, Polish Academy of
Sciences, Warsaw, Poland. [email protected]
Obliteration
of lymphatic collecting trunks of limbs by infective processes, trauma,
oncologic surgery and
irradiation bring about retention of lymph
and tissue fluid in tissues. Knowledge as to where excess lymph is
produced and accumulates as tissue fluid is indispensable for rational
physical therapy. So far, this
knowledge has been based on
lymphoscintigraphic, ultrasonographic and MR images. None of these
modalities provides distinct images of dilated lymphatics and fluid
expanded tissue spaces in dermis, subcutis
and muscles. Only
anatomical dissection and histological processing of biopsy material can
demonstrate the
remnants of the lymphatic network and the sites of
accumulation of mobile tissue fluid. We visualized and
calculated
the volume of the "tissue fluid and lymph" space in skin and subcutaneous
tissue of foot, calf, and
thigh in various stages of lymphedema,
using special coloring techniques in specimens obtained during
lymphatic microsurgical procedures or tissue debulking. When the
collecting trunks were obliterated, lymph
was present only in the
subepidermal lymphatics, while mobile tissue fluid accumulated in the
spontaneously
formed spaces in the subcutaneous tissue, around
small veins, and in the muscular fascia. Deformation of
subcutaneous tissue by free fluid led to formation of interconnecting
channels. In obstructive lymphedema
caused by obliteration of
collectors, lymph is present mainly in subepidermal lymphatics, and the bulk of
stagnant tissue fluid accumulates in subcutis between fibrous septa
and fat globules as well as above and
underneath muscular fascia.
These observations provide useful clues for designing pneumatic devices and
rational manual lymphatic massage to move stagnant tissue fluid toward
the non-swollen regions.
PMID: 19927899 [PubMed - in
process
-----
1. Pathophysiology. 2009 Nov 24. [Epub
ahead of print]
The role of lymphatic vessels in the heart.
Cui
Y.
Case Cardiovascular Research Institute, Department of
Medicine, Case Western Reserve University,
Cleveland, OH
44106-7290, United States; University Hospitals Harrington-McLaughlin Heart
& Vascular
Institute, University Hospitals Case Medical Center,
WRB 4-537, 2103 Cornell Road, Cleveland, OH
44106-7290, United
States.
Although cardiac lymphatic vessels have been described
for over three centuries, research progress on the
role of cardiac
lymphatic vessels in regulating cardiac physiology and their disturbances in
the pathogenesis
of cardiac disease has progressed very slowly,
largely due to technical challenges in developing both animal
models and cardiac lymphatic vascular imaging technologies. This review
summarizes evidence showing that
blocking cardiac lymph flow may
contribute to several forms of cardiac injury including cardiac
lymphedema, cardiac valvular deformation, coronary arterial injury,
conduction disturbances, myocardial
injury, and poor heart
performance in animal and human heart studies. Conversely, improving cardiac
lymph
flow may have beneficial effects on heart function after
heart attack (myocardial infarction). In addition, this
review
summarizes recent hypotheses about the forces generating cardiac lymph flow, in
which the role of
both the subepicardial and mid-myocardial
myocytes synchronized contractions causing lymph flow is
discussed.
Lastly, possible mechanisms of blood vessel injury caused by the failure of
perivascular lymphatic
remodeling are discussed.
PMID:
19942415 [PubMed - as supplied by publisher
--------
1. J Clin
Oncol. 2009 Oct 13. [Epub ahead of print]
Axillary Reverse Mapping to
Prevent Lymphedema After Breast Cancer Surgery: Defining the Limits of the
Concept.
Khan SA.
Robert H. Lurie Comprehensive Cancer
Center, Feinberg School of Medicine of Northwestern University,
Chicago, IL.
PMID: 19826108 [PubMed - as supplied by
publisher
--------
2. Parasite Immunol. 2009
Nov;31(11):664-72.
Filariasis and lymphoedema.
Pfarr KM, Debrah
AY, Specht S, Hoerauf A.
Institute for Medical Microbiology, Immunology
and Parasitology, University Hospital Bonn, Bonn,
Germany.
Among the causes of lymphoedema (LE), secondary LE due
to filariasis is the most prevalent. It affects only
a minority of
the 120 million people infected with the causative organisms of lymphatic
filariasis (LF),
Wuchereria bancrofti and Brugia malayi/timori, but
is clustered in families, indicating a genetic basis for
development of this pathology. The majority of infected individuals
develop filarial-specific
immunosuppression that starts even before
birth in cases where mothers are infected and is characterized by
regulatory T-cell responses and high levels of IgG4, thus tolerating
high parasite loads and microfilaraemia.
In contrast, individuals
with this pathology show stronger immune reactions biased towards Th1, Th2 and
probably also Th17. Importantly, as for the aberrant lymph vessel
development, innate immune responses
that are triggered by the
filarial antigen ultimately result in the activation of vascular endothelial
growth factors
(VEGF),
thus promoting lymph vessel hyperplasia
as a first step to lymphoedema development. Wolbachia
endosymbionts
are major inducers of these responses in vitro, and their depletion by
doxycycline in LF
patients reduces plasma VEGF and soluble
VEGF-receptor-3 levels to those seen in endemic normals
preceding
pathology improvement. The search for the immunogenetic basis for LE could lead
to the
identification of risk factors and thus, to prevention; and
has so far led to the identification of single-
nucleotide
polymorphisms (SNP) with potential functional relevance to VEGF, cytokine and
toll-like
receptor (TLR) genes. Hydrocele, a pathology with some
similarity to LE in which both lymph vessel dilation
and lymph
extravasation are shared sequelae, has been found to be strongly associated
with a VEGF-A
SNP known for upregulation of this
(lymph-)angiogenesis factor.
PMID: 19825106 [PubMed - in
process
---------------------------
3. Rev Port Cir Cardiotorac
Vasc. 2009 April- June;16(2):107-114.
[Lymphedema of the extremities: A
missed vascular pathology?]
[Article in Portuguese]
Pereira Albino
J.
Serviço de Cirurgia Vascular II do Centro Hospitalar Lisboa Norte,H.
Pulido Valente, Lisboa.
The diagnosis and treatment of lymphedemas of
the extremities, although relatively common in the western
countries, mainly in the area of oncology, are scarcely mentioned in
the international literature and in Portugal
very little work has
been devoted to this area. Nevertheless, they may cause severe functional and
aesthetic
disability, the main reason why decided to reassess its
pathology, with an emphasis on the clinical diagnosis
and medical
therapy. We stress the importance of oedema of the instep the value of the
Stemmer's sign in
the diagnosis, and the complete decongestive
physiotherapy in the management. When associated to the
pharmacological therapy and the correct use of elastic stockings, the
control of most of the cases can be
achieved. Surgical therapy is
reserved for rare cases and should be regarded as an adjuvant to intensive
medical therapy, which should accompany the patient throughout life
time.
PMID: 19823709 [PubMed - as supplied by
publisher
-------
4. J Pain Symptom Manage. 2009 Oct 9. [Epub
ahead of print]
Breast Cancer Survivors' Experiences of
Lymphedema-Related Symptoms.
Fu MR, Rosedale M.
New York
University College of Nursing, New York, NY, USA.
BACKGROUND: The
purpose of this study was to explore and describe breast cancer survivors'
lymphedema-related symptom experiences. As a serious chronic condition
from breast cancer treatment,
lymphedema or a syndrome of
persistent swelling and symptoms is caused by chronic accumulation of lymph
fluid in the interstitial spaces of the affected limb or surrounding
areas. Although significant prevalence of
ongoing multiple symptoms
have been reported, little is known about how survivors with lymphedema
perceive and respond to lymphedema-related symptoms in their daily
lives.
METHODS: This study used a descriptive phenomenological method.
Thirty-four participants were
recruited in the United States. Three
in-depth interviews were conducted with each participant; a total of
102
interviews were completed, audio taped, and transcribed. Interview transcripts
and field notes were the
data sources for this analysis, which was
part of three larger studies.
DATA ANALYSIS: Data were analyzed to
identify the essential themes within and across cases. Four
essential themes were revealed: living with perpetual discomfort,
confronting the unexpected, losing pre-
lymphedema being, and feeling
handicapped.
FINDINGS: Participants experienced multiple symptoms on a
daily basis. Distress was heightened when
women expected symptoms to
disappear, but instead, they remained as a "perpetual discomfort."
Moreover, distress was intensified when symptoms evoked unexpected
situations or when symptoms
elicited emotional responses powerful
enough to change perceived personal identity.
CONCLUSIONS: Findings
suggest that symptom distress may encompass temporal, situational, and
attributive dimensions. Prospective studies are needed to examine
lymphedema-related symptom distress in
terms of these dimensions so
that more specific interventions can be developed to target distress occurring
in
each dimension.
PMID: 19819668 [PubMed - as supplied by
publisher]
----
1. Br J Surg. 2009 Nov;96(11):1274-9.
Quality
of life after surgical reduction for severe primary lymphoedema of the limbs
and genitalia.
Ogunbiyi SO, Modarai B, Smith A, Burnand KG; London
Lymphoedema Consortium.
Academic Department of Surgery, St
Thomas' Hospital, Westminster Bridge Road, London,
UK.
BACKGROUND: The aim was to assess the quality of life (QoL)
of patients who had surgery for primary
lymphoedema.
METHODS: A QoL questionnaire was administered to
patients who had surgery between 1981 and 2003
(retrospective
group) and between 2003 and 2006 (prospective group).
RESULTS: The
response rate was 70.3 per cent (109 of 155 patients): 88 patients had limb
reduction (78,
retrospective; ten, prospective) and 21 had genital
reduction (13, retrospective; eight, prospective). Forty-
nine
patients (63 per cent) who had limb reduction studied retrospectively reported
satisfaction with the
procedure and most of these would opt for
surgery again. In the prospectively studied group, nine of ten
patients reported improved limbs, and seven would opt for surgery
again. Nineteen of 21 patients who had
genital reduction would
choose to have surgery again if needed (11 of the retrospectively assessed
group
and all of the prospective group). Patients' perception that
surgery was worthwhile was greater in both of the
prospectively
assessed groups (P = 0.013).
CONCLUSION: Surgery for severe lymphoedema
improved QoL at early assessment. This, however, may
not be
sustained. Genital reduction appeared to provide greater benefit than limb
reduction.
PMID: 19847880 [PubMed - in
process
-----------------------
2.
Afr J Paediatr
Surg. 2008 Jul-Dec;5(2):79-83.
Congenital constriction ring syndrome of
the limbs: A prospective study of 16 cases.
Adu EJ, Annan
C.
Department of Surgery, School of Medical Sciences, Kwame
Nkrumah University of Science and
Technology, Kumasi,
Ghana.
Background: The congenital constriction ring syndrome is
characterised by fibrous bands that encircle,
strangle and even
amputate parts of the foetus. It is a common condition amongst Ghanaian
patients, but
data on it is quite scanty.
Materials and
Methods: A prospective study of patients presenting at a plastic surgical
clinic in Ghana with
the characteristics of the congenital
constriction ring syndrome was undertaken. The patients were examined
clinically
and the findings recorded. An x-ray and clinical photograph of the affected
limbs was taken.
Treatment required several staged operations.
Surgical correction of the constriction ring was done by
excision
and Z-plasty to prevent or alleviate lymphoedema, separation of distally fused
digits and skin
grafting of defect.
Results: Sixteen patients
made up of 10 males and six females were seen. The age at presentation ranged
from nine days to 12 years with a mean age of 14.6 months.
Twenty-two limbs were affected, made up of
four right upper limbs,
six left upper limbs, seven right lower limbs and five left lower limbs. In the
upper limb
malformations involved 42 digits; in the lower limb
malformations involved 33 toes, one foot and five legs.
Four main
types of lesions were found: constriction rings, intrauterine amputations,
acrosyndactyly, and
simple syndactyly.
Conclusion:
Congenital constriction ring syndrome is of uncertain aetiology and could cause
morbidity in the
newborn. The syndrome and its complications are
amenable to corrective surgery with good results. Early
intervention is desirable for a successful outcome.
PMID:
19858673 [PubMed - in
process
----------------------------------
3. Ann Surg Oncol.
2009 Oct 27. [Epub ahead of print]
Predictive Factors of Response to
Decongestive Therapy in Patients with Breast-Cancer-Related
Lymphedema.
Forner-Cordero I, Muñoz-Langa J, Forner-Cordero A,
Demiguel-Jimeno JM.
Physical Medicine and Rehabilitation
Specialist, Hospital La Fe, Valencia, Spain,
[email protected].
BACKGROUND: Many studies have reported
the benefits of Decongestive treatment in patients with
breast-cancer-related lymphedema (BCRL) but few have study what are the
predictive factors of response.
METHODS: We performed a prospective,
multicenter controlled cohort study of 171 patients with BCRL
to
identify independent predictive factors of response to decongestive treatment
(CDT). Demographic data
and clinical and lymphedema characteristics
were collected prospectively. The end point was the
"percentage
reduction in excess volume (PREV)." Volumes were measured prior and at the end
of CDT.
Factors associated with response (PREV) were tested in
univariate and multivariate analyses using linear
regression
techniques.
RESULTS: Median age was 60.4 years (range 32-84); mean
lymphedema chronicity 4 years [95%
confidence interval (95% CI):
3.1-5.0]; mean baseline excess volume (EV) was 936 mL (95% CI: 846-
1026), and mean percentage EV was 35.3% (95% CI: 32.0-38.7); compliance
to bandages was good in
81.3% of patients. PREV was 71.7% (95% CI:
65.2-78.2). After univariate screening, 11 variables were
found to
be associated with PREV but only 4 variables were independent predictive
factors of response to
CDT in the multivariate analysis: Venous
insufficiency, percentage of EV (the higher the EV, the lower the
reduction with CDT); compliance to bandages (a good compliance improved
PREV in 25%), and treatment
in autumn (better results than during
the rest of the year).
CONCLUSIONS: This study shows that compliance to
bandages during CDT is one of the most important
predictors of
response. Moreover, data support the idea that more severe lymphedemas have a
worse
response to treatment, and it should be recommended in early
stages. The association between the season of
treatment and
response was also very strong, so weather conditions are an additional factor
that must be
taken into account in further studies..
PMID:
19859769 [PubMed - as supplied by
publisher
------------------------------------------
4. Oncology
(Williston Park). 2009 Feb;23(2 Suppl):34-8.
Lower extremity lymphedema
in a patient with melanoma.
Rubin KM, Kuhlman C.
Melanoma
Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts,
USA.
PMID: 19856587 [PubMed - in process
---
1.
Cancer. 2009 Oct 28. [Epub ahead of print]
Preoperative assessment
enables the early detection and successful treatment of
lymphedema.
Hayes S, Cornish B, Newman B..
Institute of Health
and Biomedical Innovation, School of Public Health, Queensland University of
Technology, Brisbane, Queensland, Australia.
PMID: 19877116
[PubMed - as supplied by publisher
---
2(a). Acta Oncol.
2009;48(8):1111-8.
Changes in arm morbidities and health-related quality
of life after breast cancer surgery - a five-year follow-
up
study.
Sagen A, Kåresen R, Sandvik L, Risberg MA.
Department of
Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway.
aase.sagen@uus.
no
BACKGROUND AND PURPOSE. Many breast cancer
survivors (BCS) suffer from long-term upper
limb morbidities after
axillary node dissection. The purpose of this five-year follow-up study was to
describe
changes in long-term upper limb morbidities, physical
activity level, and Health-Related Quality of Life
(HRQoL) and to
find factors that predict HRQoL five years after surgery.
PATIENTS AND
METHODS. This study included 204 women aged 55+/-10 years who had primary
breast cancer surgery with axillary node dissection. The subjects were
examined for arm volumes and arm
lymphedema, arm pain, sensation of
heaviness, shoulder function, physical activity level, and HRQoL, prior
to surgery, and six months and five years after surgery. The
statistical analyses used included ANOVA for
repeated measures and
multivariate linear regression.
RESULTS. ALE (13%), pain (36%), and
sensation of heaviness (21%) in the upper limbs were present five
years after surgery. ALE was the only morbidity that continued to
increase over time. Several dimensions of
HRQoL temporarily
declined after surgery, but significantly improved in the period from six
months to five
years after surgery. The significant predictive
factors of HRQoL five years after surgery included HRQoL
prior to
surgery, physical activity level at leisure time (both prior to and at six
months after surgery), and
duration of sick leave after surgery (in
weeks).
CONCLUSIONS. The overall HRQoL improved significantly from
baseline to five years, despite the
chronic arm pain and increase
in ALE. Three independent predictive factors of HRQoL were
identified.
PMID: 19863218 [PubMed - in process
---
2(b) Acta
Oncol. 2009 Aug 27:1-8. [Epub ahead of print]
Changes in arm morbidities
and health-related quality of life after breast cancer surgery - a five-year
follow-
up study.
Sagen A, Kåresen R, Sandvik L, Risberg
MA.
Department of Breast and Endocrine Surgery, Ullevaal University
Hospital, Oslo, Norway.
Background and purpose. Many breast cancer
survivors (BCS) suffer from long-term upper limb
morbidities after
axillary node dissection. The purpose of this five-year follow-up study was to
describe
changes in long-term upper limb morbidities, physical
activity level, and Health-Related Quality of Life
(HRQoL) and to
find factors that predict HRQoL five years after surgery.
Patients and
methods. This study included 204 women aged 55+/-10 years who had primary
breast cancer
surgery with axillary node dissection. The subjects
were examined for arm volumes and arm lymphedema,
arm pain,
sensation of heaviness, shoulder function, physical activity level, and HRQoL,
prior to surgery, and
six months and five years after surgery. The
statistical analyses used included ANOVA for repeated
measures and
multivariate linear regression.
Results. ALE (13%), pain (36%), and
sensation of heaviness (21%) in the upper limbs were present five
years after surgery. ALE was the only morbidity that continued to
increase over time. Several dimensions of
HRQoL temporarily
declined after surgery, but significantly improved in the period from six
months to five
years after surgery. The significant predictive
factors of HRQoL five years after surgery included HRQoL
prior to
surgery, physical activity level at leisure time (both prior to and at six
months after surgery), and
duration of sick leave after surgery (in
weeks).
Conclusions. The overall HRQoL improved significantly from
baseline to five years, despite the chronic arm
pain and increase
in ALE. Three independent predictive factors of HRQoL were
identified.
PMID: 19714526 [PubMed - as supplied by publisher
---
3(a). Acta Oncol. 2009;48(8):1102-10.
Physical
activity for the affected limb and arm lymphedema after breast cancer surgery.
A prospective,
randomized controlled trial with two years
follow-up.
Sagen A, Kåresen R, Risberg
MA.
Department of Breast and Endocrine Surgery, Oslo University
Hospital, Ullevaal, Norway. aase.sagen@uus.
no
BACKGROUND. The influence of physical activity on the
development of arm lymphedema (ALE) after
breast cancer surgery
with axillary node dissection has been debated. We evaluated the development of
ALE in two different rehabilitation programs: a no activity
restrictions (NAR) in daily living combined with a
moderate
resistance exercise program and an activity restrictions (AR) program combined
with a usual care
program. The risk factors associated with the
development of ALE 2 years after surgery were also
evaluated.
MATERIAL AND METHODS. Women (n = 204) with a
mean age of 55+/-10 years who had axillary
node dissection were
randomized into two different rehabilitation programs that lasted for 6 months:
NAR (n
= 104) or AR (n = 100). The primary outcomes were the
difference in arm volume between the affected
and control arms
(Voldiff, in ml) and the development of ALE. Baseline (before surgery) and
follow-up tests
were performed 3 months, 6 months, and 2 years
after surgery. Data were analyzed using ANCOVA and
regression
analysis.
RESULTS. Voldiff did not differ significantly between
the two treatment groups. Arm volume increased
significantly over
time in both the affected and the control arms. The development of ALE from
baseline to 2
years increased significantly in both groups (p <
0.001). The only risk factor for ALE was BMI > 25 kg/m
(2).
CONCLUSION. Patients that undergo breast cancer
surgery with axillary lymph node dissection should be
encouraged to
maintain physical activity in their daily lives without restrictions and
without fear of developing
ALE.
PMID: 19863217
[PubMed - in process
---
3(b) Acta Oncol. 2009 Jun 23:1-9. [Epub
ahead of print]
Physical activity for the affected limb and arm
lymphedema after breast cancer surgery. A prospective,
randomized
controlled trial with two years follow-up.
Sagen A, Kåresen R,
Risberg MA.
Department of Breast and Endocrine Surgery, Oslo
University Hospital, Ullevaal, Norway.
Background. The influence
of physical activity on the development of arm lymphedema (ALE) after breast
cancer surgery with axillary node dissection has been debated. We
evaluated the development of ALE in
two different rehabilitation
programs: a no activity restrictions (NAR) in daily living combined with a
moderate resistance exercise program and an activity restrictions (AR)
program combined with a usual care
program. The risk factors
associated with the development of ALE 2 years after surgery were also
evaluated.
Material and methods. Women (n=204) with a
mean age of 55+/-10 years who had axillary node dissection
were
randomized into two different rehabilitation programs that lasted for 6 months:
NAR (n=104) or AR
(n=100). The primary outcomes were the difference
in arm volume between the affected and control arms
(Voldiff, in
ml) and the development of ALE. Baseline (before surgery) and follow-up tests
were performed
3 months, 6 months, and 2 years after surgery. Data
were analyzed using ANCOVA and regression analysis.
Results.
Voldiff did not differ significantly between the two treatment groups. Arm
volume increased
significantly over time in both the affected and
the control arms. The development of ALE from baseline to 2
years
increased significantly in both groups (p<0.001). The only risk factor for
ALE was BMI > 25 kg/m(2).
Conclusion. Patients that undergo
breast cancer surgery with axillary lymph node dissection should be
encouraged to maintain physical activity in their daily lives without
restrictions and without fear of developing
ALE.
PMID: 19551531 [PubMed - as supplied by
publisher
-----
2(a). Acta Oncol.
2009;48(8):1111-8.
Changes in arm morbidities and health-related quality
of life after breast cancer surgery - a five-year follow-
up
study.
Sagen A, Kåresen R, Sandvik L, Risberg MA.
Department of
Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway.
aase.sagen@uus.
no
BACKGROUND AND PURPOSE. Many breast cancer
survivors (BCS) suffer from long-term upper
limb morbidities after
axillary node dissection. The purpose of this five-year follow-up study was to
describe
changes in long-term upper limb morbidities, physical
activity level, and Health-Related Quality of Life
(HRQoL) and to
find factors that predict HRQoL five years after surgery.
PATIENTS AND
METHODS. This study included 204 women aged 55+/-10 years who had primary
breast cancer surgery with axillary node dissection. The subjects were
examined for arm volumes and arm
lymphedema, arm pain, sensation of
heaviness, shoulder function, physical activity level, and HRQoL, prior
to surgery, and six months and five years after surgery. The
statistical analyses used included ANOVA for
repeated measures and
multivariate linear regression.
RESULTS. ALE (13%), pain (36%), and
sensation of heaviness (21%) in the upper limbs were present five
years after surgery. ALE was the only morbidity that continued to
increase over time. Several dimensions of
HRQoL temporarily declined
after surgery, but significantly improved in the period from six months to five
years after surgery. The significant predictive factors of HRQoL
five years after surgery included HRQoL
prior to surgery, physical
activity level at leisure time (both prior to and at six months after surgery),
and
duration of sick leave after surgery (in
weeks).
CONCLUSIONS. The overall HRQoL improved significantly from
baseline to five years, despite the
chronic arm pain and increase
in ALE. Three independent predictive factors of HRQoL were
identified.
PMID: 19863218 [PubMed - in process
2(b) Acta Oncol.
2009 Aug 27:1-8. [Epub ahead of print]
Changes in arm morbidities and
health-related quality of life after breast cancer surgery - a five-year
follow-
up study.
Sagen A, Kåresen R, Sandvik L, Risberg
MA.
Department of Breast and Endocrine Surgery, Ullevaal University
Hospital, Oslo, Norway.
Background and purpose. Many breast cancer
survivors (BCS) suffer from long-term upper limb
morbidities after
axillary node dissection. The purpose of this five-year follow-up study was to
describe
changes in long-term upper limb morbidities, physical
activity level, and Health-Related Quality of Life
(HRQoL) and to
find factors that predict HRQoL five years after surgery.
Patients and
methods. This study included 204 women aged 55+/-10 years who had primary
breast cancer
surgery with axillary node dissection. The subjects
were examined for arm volumes and arm lymphedema,
arm pain,
sensation of heaviness, shoulder function, physical activity level, and HRQoL,
prior to surgery, and
six months and five years after surgery. The
statistical analyses used included ANOVA for repeated
measures and
multivariate linear regression.
Results. ALE (13%), pain (36%), and
sensation of heaviness (21%) in the upper limbs were present five
years after surgery. ALE was the only morbidity that continued to
increase over time. Several dimensions of
HRQoL temporarily declined
after surgery, but significantly improved in the period from six months to five
years after surgery. The significant predictive factors of HRQoL
five years after surgery included HRQoL
prior to surgery, physical
activity level at leisure time (both prior to and at six months after surgery),
and
duration of sick leave after surgery (in
weeks).
Conclusions. The overall HRQoL improved significantly from
baseline to five years, despite the chronic arm
pain and increase
in ALE. Three independent predictive factors of HRQoL were
identified.
PMID: 19714526 [PubMed - as supplied by
publisher
3(a). Acta Oncol.
2009;48(8):1102-10.
Physical activity for the affected limb and
arm lymphedema after breast cancer surgery. A prospective,
randomized controlled trial with two years
follow-up.
Sagen A, Kåresen R, Risberg
MA.
Department of Breast and Endocrine Surgery, Oslo University
Hospital, Ullevaal, Norway. aase.sagen@uus.
no
BACKGROUND. The influence of physical activity on the
development of arm lymphedema (ALE) after
breast cancer surgery
with axillary node dissection has been debated. We evaluated the development of
ALE in two different rehabilitation programs: a no activity
restrictions (NAR) in daily living combined with a
moderate
resistance exercise program and an activity restrictions (AR) program combined
with a usual care
program. The risk factors associated with the
development of ALE 2 years after surgery were also
evaluated.
MATERIAL AND METHODS. Women (n = 204) with a
mean age of 55+/-10 years who had axillary
node dissection were
randomized into two different rehabilitation programs that lasted for 6 months:
NAR (n
= 104) or AR (n = 100). The primary outcomes were the
difference in arm volume between the affected
and control arms
(Voldiff, in ml) and the development of ALE. Baseline (before surgery) and
follow-up tests
were performed 3 months, 6 months, and 2 years
after surgery. Data were analyzed using ANCOVA and
regression
analysis.
RESULTS. Voldiff did not differ significantly between
the two treatment groups. Arm volume increased
significantly over
time in both the affected and the control arms. The development of ALE from
baseline to 2
years increased significantly in both groups (p <
0.001). The only risk factor for ALE was BMI > 25 kg/m
(2).
CONCLUSION. Patients that undergo breast cancer
surgery with axillary lymph node dissection should be
encouraged to
maintain physical activity in their daily lives without restrictions and
without fear of developing
ALE.
PMID: 19863217
[PubMed - in process
3(b) Acta Oncol. 2009 Jun 23:1-9. [Epub
ahead of print]
Physical activity for the affected limb and arm
lymphedema after breast cancer surgery. A prospective,
randomized
controlled trial with two years follow-up.
Sagen A, Kåresen R,
Risberg MA.
Department of Breast and Endocrine Surgery, Oslo
University Hospital, Ullevaal, Norway.
Background. The influence
of physical activity on the development of arm lymphedema (ALE) after breast
cancer surgery with axillary node dissection has been debated. We
evaluated the development of ALE in
two different rehabilitation
programs: a no activity restrictions (NAR) in daily living combined with a
moderate resistance exercise program and an activity restrictions (AR)
program combined with a usual care
program. The risk factors
associated with the development of ALE 2 years after surgery were also
evaluated.
Material and methods. Women (n=204) with a
mean age of 55+/-10 years who had axillary node dissection
were
randomized into two different rehabilitation programs that lasted for 6 months:
NAR (n=104) or AR
(n=100). The primary outcomes were the difference
in arm volume between the affected and control arms
(Voldiff, in
ml) and the development of ALE. Baseline (before surgery) and follow-up tests
were performed
3 months, 6 months, and 2 years after surgery. Data
were analyzed using ANCOVA and regression analysis.
Results.
Voldiff did not differ significantly between the two treatment groups. Arm
volume increased
significantly over time in both the affected and
the control arms. The development of ALE from baseline to 2
years
increased significantly in both groups (p<0.001). The only risk factor for
ALE was BMI > 25 kg/m(2).
Conclusion. Patients that undergo
breast cancer surgery with axillary lymph node dissection should be
encouraged to maintain physical activity in their daily lives without
restrictions and without fear of developing
ALE.
PMID: 19551531 [PubMed - as supplied by
publisher
----
1. Dermatol Online J. 2009 Aug
15;15(8):7.
Lymphedema praecox.
Rizzo C, Gruson LM, Wainwright
BD.
Department of Dermatology, New York University, USA.
A
57-year-old man presented with the post-pubertal onset of asymptomatic swelling
of the left arm and legs
that had been complicated by recurrent
bouts of cellulitis. The presentation and disease course are consistent
with lymphedema praecox, which is a subtype of primary lymphedema with
onset at puberty and a slowly
progressive course. The subtypes of
lymphedema, pathogenesis, and treatment are reviewed.
PMID: 19891915
[PubMed - in process
2. Breast J. 2009 Nov 2. [Epub ahead of
print]
Obesity is a Risk Factor for Developing Postoperative Lymphedema
in Breast Cancer Patients.
Helyer LK, Varnic M, Le LW, Leong W, McCready
D.
Department of Surgical Oncology, Princess Margaret Hospital,
University of Toronto, Toronto, Ontario,
Canada.
Lymphedema
(LE) is a well-known postoperative complication after axillary node dissection
(ALND).
Although, sentinel lymph node dissection (SLND) involves
more focused surgery and less disruption of the
axilla, early
reports show up to 13% of patients experience some symptoms of LE. The purpose
of this
study was to determine predictors of arm LE in our patients
under going SLND with or without an ALND.
One hundred and
thirty-seven breast cancer patients were treated at a comprehensive cancer
center.
Prospective measurement of arm volume was carried every 6
months from date of diagnosis. This data base
was retrospectively
reviewed for tumor stage, treatment, and subjective complaints of LE. Objective
LE
was defined as a change greater than 200 mL compared with the
control arm. Univariate and multivariate
analyses were performed.
Arm volume changes were measured over 24 months (median follow-up 20
months)
in 137 women: 82 stage I, 48 stage II, and 5 stage III; median age 56 years.
Breast-conserving
surgery was performed in 133 patients. All
patients underwent SLND for axillary staging and for 52 patients
this was the only axillary staging procedure. All node-positive
patients (31) and 54 node-negative patients
under went an immediate
completion ALND, the latter as part of a study protocol. At 24 months, 16
(11.6%) patients were found to have objective LE (>200 mL increase).
Patient age, tumor size, number of
nodes harvested, or adjuvant
chemotherapy was not found to be predictive of LE by univariate analysis. The
risk of developing postoperative LE was primarily and significantly
related to the patients' BMI (p = 0.003).
Multivariate analysis
revealed patients with a BMI >30 (obese) had an odds ratio of 2.93 (95% CI
1.03-
8.31) compared with those with a BMI of <25 of having LE.
Symptomatic LE (SLE), as defined by patient
complaints was recorded
in six of the above 16 patients, no SLE was recorded in patients without
objective
signs of edema. Univariate subgroup analysis compared the
symptomatic to the nonsymptomatic patients
and revealed the median
number of nodes removed was higher in the symptomatic patients (17 verses 9, p
=
0.045); however, these patients had a lower BMI (p = 0.0012). The
mean change in arm volume was not
significantly different between
the groups. SLE occurs in one third of patients with objective arm swelling
and most likely is multi-factorial in etiology. Although patients
undergoing SLN were recorded as having
objective LE, none reported
SLE. The development of LE within 2 years of surgery is associated with the
patient's BMI and this should be considered in preoperative
counseling.
PMID: 19889169 [PubMed - as supplied by
publisher
3. Dermatol Ther. 2009
Nov-Dec;22(6):475-90.
Filariasis: diagnosis and
treatment.
Mendoza N, Li A, Gill A, Tyring
S..
Universidad El Bosque, Bogotá, Colombia.
[email protected]
Filariasis is an infectious disease of the
lymphatics and subcutaneous tissues caused by nematodes or filariae.
Carried
by mosquito vectors, this disease causes millions of people to suffer from
lymphedema and
elephantiasis, characteristics of filariasis
infection. This disease can be diagnosed through the identification of
microfilariae in blood or skin samples, antigen detection, radiographic
imaging, or polymerase chain reaction.
Mass drug administration by
the World Health Organization has helped to diminish the incidence of
filariasis.
However, continued research on new drugs and
vaccinations will be needed to control and reduce the
microfilarial
levels in the human population.
PMID: 19889133 [PubMed - in
process
----
1. J Occup Rehabil. 2009 Nov 10. [Epub
ahead of print]
Factors Related to Return to Work by Women with Breast
Cancer in Northern France.
Fantoni SQ, Peugniez C, Duhamel A, Skrzypczak
J, Frimat P, Leroyer A.
Department of Occupational Medicine, CHRU Lille,
Université Lille 2, 1 Avenue Oscar Lambret, 59037,
Lille Cedex,
France, [email protected].
Introduction Earlier diagnosis and better
treatment have increased the survival rates of breast cancer
patients. This warrants research on return to work of cancer survivors,
especially about subjective factors
because they affect the mental
desire to return to work. Moreover, knowledge in this issue is very limited in
France. Objectives This study aims to explore the objective and
subjective factors that affect whether and
when women with breast
cancer return to work. Methods 379 women with breast cancer aged 18-60 years
who were working at the time of diagnosis responded to a 45 item
questionnaire. The questionnaire had
personal characteristics,
disease-related characteristics and work-related ones. Multivariate logistic
regressions were run to determine the association of these factors
and return to work and time until return to
work. Results During a
median follow-up of 36 months, 82.1% of the 379 women who had worked before
their diagnosis returned to work after a median sick leave of 10.8
months. Older age, lower educational
level, chemotherapy,
radiotherapy, lymphoedema, psychological or organizational self-perceived
constraints
related to their former job, and the lack of moral
support from work colleagues both limited and delayed
return to
work. Conclusion The resumption of work by women with breast cancer depends on
many
factors, not all of them medical. The self-perceived factors
must be considered: first to help support these
women during their
sick leave, while taking into account elements that may hinder early return to
work;
second to initiate a work resumption support process which
takes into account both the person and her
environment.
PMID:
19902340 [PubMed - as supplied by publisher
2. Ann Trop Med
Parasitol. 2009 Oct;103 Suppl 1:S41-51.
Lymphatic filariasis:
patients and the global elimination programme.
Mackenzie CD,
Lazarus WM, Mwakitalu ME, Mwingira U, Malecela MN.
Department of
Pathobiology and Diagnostic Investigation, Michigan State University, East
Lansing, MI
48824, USA. [email protected]
The defining
images of lymphatic filariasis are the horrendous disfigurements of
lymphoedema, elephantiasis
and hydrocele. These clinical
presentations, although obviously important and life changing, are not,
however, the only outcomes of this wide-spread filarial infection. The
other effects of the disease range from
severe, acute but
short-term bouts of sickness to psychological impairment, poverty and family
hardship. It
is important to support cases of the disease through
all means available, such as reparative hydrocelectomy,
hygiene
training and facilitation, and the provision of adequate chemotherapy. Although
only a minority of the
residents in any endemic community is
affected with the severe clinical manifestations of this parasitic
infection, these cases are central to, and important advocates for, the
current global effort to eliminate the
infection through mass drug
administrations (MDA). Their clinical improvement acts as an important catalyst
for the general population and encourages high compliance in the
MDA. This communication discusses the
central role that filariasis
patients have played in the Tanzania Lymphatic Filariasis Elimination Programme
to
date, and covers some of the clinical successes achieved in the
past 10 years. The abolition of the clinical
manifestations of
filarial infection remains the ultimate goal of the Global Programme to
Eliminate Lymphatic
Filariasis, and maintaining a focus on the
affected individuals and their clinical condition is vital to that
programme's overall success.
PMID: 19843397 [PubMed - in
process
3. Ann Trop Med Parasitol. 2009 Oct;103 Suppl
1:S5-10.
Ten years of managing the clinical manifestations and
disabilities of lymphatic filariasis.
Brantus
P.
Neglected Tropical Diseases, Health and Rehabilitation Unit,
Handicap International France, 14 Avenue
Berthelot, 69361 Lyon
Cedex 07, France. [email protected]
The aim of the Global
Programme to Eliminate Lymphatic Filariasis is to eradicate one of the world's
leading
causes of permanent and long-term disability, at least as a
public-health problem. The achievement of this
goal is based on the
interruption of the transmission of the causative parasites (so preventing new
cases) and,
as a 'second pillar', the prevention of disability in
those who are infected. The disability is associated with the
main
clinical manifestations of human infection with Wuchereria or Brugia spp. (i.e.
hydrocele, lymphoedema
and/or 'acute attacks'). The World Health
Organization and its partners have established strategies and
activities both for managing lymphoedema, through community home-based
care, and for increasing access
to surgery for hydrocele. Over the
last decade, there has been progress made in preventing the disability of
lymphatic filariasis, the monitoring and evaluation of such disability
and its control, and the integration of
disability prevention with
mass drug administrations and efforts to control other disabling diseases. That
progress and the challenges that remain in the prevention of the
morbidity and disability attributable to
lymphatic filariasis are
here reviewed.
PMID: 19843392 [PubMed - in process
4. J
Minim Invasive Gynecol. 2009 Nov-Dec;16(6):669-81.
Robotics and
gynecologic oncology: review of the literature.
Cho JE, Nezhat
FR.
Gynecologic Oncology Division, St. Luke's-Roosevelt Hospital
Center, New York, New York.
The objectives of this article were
to review the published scientific literature about robotics and its
application
to gynecologic oncology to date and to summarize findings of this advanced
computerenhanced
laparoscopic technique. Relevant sources were
identified by a search of PUBMED from January 1950 to
January 2009
using the key words Robot or Robotics and Cervical cancer, Endometrial cancer,
Gynecologic oncology, and Ovarian cancer. Appropriate case reports,
case series, retrospective studies,
prospective trials, and review
articles were selected. A total of 38 articles were identified on the subject,
and
27 were included in the study. The data for gynecologic cancer
show comparable results between robotic
and laparoscopic surgery
for estimated blood loss, operative time, length of hospital stay, and
complications.
Overall, there were more wound complications with
the laparotomy approach compared with laparoscopy
and
robotic-assisted laparoscopy. There were more lymphocysts, lymphoceles, and
lymphedema in the
robotic-assisted laparoscopic group compared with
the laparoscopy and laparotomy groups in patients with
cervical
cancer. Infectious and lung-related morbidity, postoperative ileus, and
bleeding or clot formation
were more commonly reported in the
laparotomy group compared with the other 2 cohorts in patients with
endometrial cancer. Computer-enhanced technology may enable more
surgeons to convert laparotomies to
laparoscopic surgery with its
associated benefits. It seems that in the hands of experienced laparoscopic
surgeons, final outcomes are the same with or without use of the robot.
There is good evidence that robotic
surgery facilitates laparoscopic
surgery, with equivalent if not better operative time and comparable surgical
outcomes, shorter hospital stay, and fewer major complications than
with surgeries using the laparotomy
approach.
PMID:
19896593 [PubMed - in process
----
1. Indian J Plast Surg.
2009 Jan-Jun;42(1):22-30.
Comparative results of non-operative
multi-modal therapy for filarial lymphoedema.
Gogia SB, Appavoo NC,
Mohan A, Kumar MB.
Sanwari Bai Surgical Centre, 28/31 Old Rajinder
Nagar, New Delhi - 110 060, India.
A comparative analysis of different
conservative modes of therapy for lymphoedema, largely of Filarial
origin, was conducted in a trial therapy unit in Chengalpattu, a
Filarial endemic district in Tamil Nadu.
Results were compared using
a single chambered intermittent pneumatic compression pump, heat therapy,
and interferential therapy machines. The results showed improvement of
limb size between 20% and 60% of
possible reduction (where 100%
would mean return of limb circumference to the same as that of the normal
side). Pneumatic compression therapy, when used alone, showed the best
results, which were significantly
better than all others whether
alone or in combination.
PMID: 19881016 [PubMed - in process
2.
Photomed Laser Surg. 2009 Oct;27(5):763-9.
Managing postmastectomy
lymphedema with low-level laser therapy.
Lau RW, Cheing
GL.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic
University, Hong Kong SAR, China.
OBJECTIVE: We aimed to investigate the
effects of low-level laser therapy (LLLT) in managing
postmastectomy
lymphedema.
BACKGROUND DATA: Postmastectomy lymphedema (PML) is a common
complication of breast cancer
treatment that causes various
symptoms, functional impairment, or even psychosocial morbidity. A
prospective, single-blinded, controlled clinical trial was conducted to
examine the effectiveness of LLLT on
managing PML.
METHODS:
Twenty-one women suffering from unilateral PML were randomly allocated to
receive either
12 sessions of LLLT in 4 wk (the laser group) or no
laser irradiation (the control group). Volumetry and
tonometry were
used to monitor arm volume and tissue resistance; the Disabilities of Arm,
Shoulder, and
Hand (DASH) questionnaire was used for measuring
subjective symptoms. Outcome measures were
assessed before and
after the treatment period and at the 4 wk follow-up.
RESULTS: Reduction
in arm volume and increase in tissue softening was found in the laser group
only. At
the follow-up session, significant between-group
differences (all p < 0.05) were found in arm volume and
tissue
resistance at the anterior torso and forearm region. The laser group had a 16%
reduction in the arm
volume at the end of the treatment period,
that dropped to 28% in the follow-up. Moreover, the laser group
demonstrated a cumulative increase from 15% to 33% in the tonometry
readings over the forearm and
anterior torso. The DASH score of the
laser group showed progressive improvement over time.
CONCLUSION: LLLT
was effective in the management of PML, and the effects were maintained to the
4
wk follow-up.
PMID: 19878027 [PubMed - in
process
-----------------------------
1. Breast J. 2009 Nov 24.
[Epub ahead of print]
Older Breast Cancer Survivors:
Factors Associated with Self-reported Symptoms of Persistent
Lymphedema Over 7 years of Follow-up.
Clough-Gorr
KM, Ganz PA, Silliman RA.
Geriatrics Section, Boston
University Schools of Medicine and Public Health, Boston,
Massachusetts.
Lymphedema of the arm is a common
complication of breast cancer with symptoms that can persist over
long periods of time. For older women (over 50% of breast cancer cases)
it means living with the potential
for long-term complications of
persistent lymphedema in conjunction with the common diseases and
disabilities of aging over survivorship. We identified women >/=65
years diagnosed with primary stage I-
IIIA breast cancer. Data were
collected over 7 years of follow-up from consenting patients' medical records
and telephone interviews. Data collected included self-reported
symptoms of persistent lymphedema, breast
cancer characteristics,
and selected sociodemographic and health-related characteristics. The overall
prevalence of symptoms of persistent lymphedema was 36% over 7 years
of follow-up. Having stage II or
III (OR = 1.77, 95% CI: 1.07-2.93)
breast cancer and having a BMI >30 (OR = 3.04, 95% CI: 1.69-
5.45) were statistically significantly predictive of symptoms of
persistent lymphedema. Women >/=80 years
were less likely to
report symptoms of persistent lymphedema when compared to younger women (OR =
0.44, 95% CI: 0.18-0.95). Women with symptoms of persistent
lymphedema consistently reported worse
general mental health and
physical function. Symptoms of persistent lymphedema were common in this
population of older breast cancer survivors and had a noticeable effect
on both physical function and general
mental health. Our findings
provide evidence of the impact of symptoms of persistent lymphedema on the
quality of survivorship of older women. Clinical and research efforts
focused on risk factors for symptoms of
persistent lymphedema in
older breast cancer survivors may lead to preventative and therapeutic measures
that help maintain their health and well-being over increasing
periods of survivorship.
PMID: 19968661 [PubMed - as
supplied by publisher
------
2. Hum Genet. 2009 Dec 5. [Epub ahead
of print]
Erratum to: Linkage and sequence analysis indicate that CCBE1
is mutated in recessively inherited
generalised lymphatic
dysplasia.
Connell F, Kalidas K, Ostergaard P, Brice G, Homfray T,
Roberts L, Bunyan DJ, Mitton S, Mansour S,
Mortimer P, Jeffery S;
Lymphoedema Consortium.
Medical Genetics Unit, Clinical
Developmental Sciences, St George's University of London, Cranmer
Terrace, London, SW17 0RE, UK.
PMID: 19967415 [PubMed
- as supplied by publisher
-----
3. J Cancer Surviv. 2009 Dec 6.
[Epub ahead of print]
The role of occupational upper
extremity use in breast cancer related upper extremity
lymphedema.
Tahan G, Johnson R, Mager L, Soran
A.
Department of Surgery, Surgical Oncology, Magee-Womens
Hospital of University of Pittsburgh,
Pittsburgh, PA, 15213,
USA.
BACKGROUND: Upper extremity (UE) use has been related
to breast cancer-related lymph edema
(BCRL). Our aim was to
evaluate severity of BCRL in different occupation groups, according to upper
extremity use.
METHODS: Fifty-five women with
BCRL were recruited. Group-1 (n = 21), with a mean age of 59,
included patients who worked continuously <30 min at a time and
</=8 h per day. Group-2 (n = 15), with a
mean age of 54, were
patients who worked continuously between 30 to 60 min at a time, and </=8 h
per
day. Group-3 (n = 19), who had a mean age of 51, included
patients who were working continuously for >1
h and >8 h per
day.
RESULTS: The age, operation type, infection
occurrence, radiotherapy status, and the operation on the side
of
the dominant hand were not statistically different between the groups. The
stage and grade of the BCRL
in group-3 were higher than the other
groups (both p < 0.001). The restriction of shoulder movements on
the operation side (p = 0.04) and shoulder physiotherapy need (p <
0.001) were the highest in group-3.
Arm pain (p = 0.004) and pain
medicine needs (p = 0.028) in group-1 were lower than the other
groups.
CONCLUSION: Group-3 had the worst BCRL clinical stage
and grade status and other breast cancer
treatment related
morbities. Occupations that require greater use of the upper extremities. At
present there is
a need for closer monitoring of patients with more
severe BCRL. Potential exacerbating and maintaining
factors of
functional limitations and pain need to considered so that clinical management
addresses these in
relation to daily use of the affected
UE
PMID: 19967411 [PubMed - as supplied by
publisher
------
3. Rev Lat Am Enfermagem. 2009
Sep-Oct;17(5):730-6.
Physiotherapy treatments for breast
cancer-related lymphedema: a literature review.
Leal NF, Carrara HH,
Vieira KF, Ferreira CH.
Faculdade de Medicina de Ribeirão
Preto, Universidade de São Paulo, Brazil.
Breast cancer is the second
most frequent cancer among women. Surgery is part of the therapeutic process
to prevent metastases, but it can also cause some complications,
including lymphedema. Physiotherapy
contributes to its treatment,
using different techniques that have been developed over the years. This
systematic literature review aims to present physiotherapy modalities
applied for lymphedema therapy. The
literature review was conducted
using textbooks and Lilacs, Pubmed and Scielo databases, from 1951 to
2009.
Physiotherapy resources used for lymphedema treatment include complex
decongestive therapy
(CDT), pneumatic compression (PC), high
voltage electrical stimulation (HVES) and laser therapy. The
analyzed literature shows that better results are obtained with
combined techniques. CDT is the most used
protocol, and its
association with PC has demonstrated efficacy. The new techniques HVES and
laser
present satisfactory results.
PMID: 19967225
[PubMed - in process
-----
5. Br J Nurs. 2009 Oct
8-21;18(18):1120-4.
Managing chronic oedema in the
morbidly obese patient.
Todd
M.
Lymphoedema Clinic, Greater Glasgow & Clyde NHS
Trust, Glasgow.
The obesity epidemic has become one of the
major challenges for health and social policy makers around
the
world. The increase in obesity is commensurate with the rise in associated
complications, including type
2 diabetes, cardiovascular disease
and some types of cancer (breast, colon, endometrium, prostrate, kidney
and gallbladder). There are also increased cost implications for health
services, welfare services and
employers. A crude estimate of
approximately 15000 patients attending a US clinic showed almost 75% of
morbidly obese patients have chronic oedema of the legs. An audit of
body mass index of patients attending
a specialist lymphoedema
clinic showed 36% were clinically obese and 23% were morbidly obese. This has
major implications for lymphoedema practitioners in terms of
allocating time and resources, and health and
safety issues relating
to providing a safe environment for both patients and practitioners. This
article
investigates the financial and health consequences of the
rising obesity problem and outlines some of the
strategies
implemented to halt this trend. The effects and management of chronic oedema in
the morbidly
obese patient are also
presented.
PMID: 19966731 [PubMed - in
process]
----
6. Pathophysiology. 2009 Dec 4. [Epub ahead of
print]
An interstitial hypothesis for breast cancer
related lymphoedema.
Bates
DO.
Microvascular Research Laboratories, Bristol Heart
Institute, Department of Physiology and Pharmacology,
School of
Veterinary Sciences, University of Bristol, Southwell Street, Bristol BS2 8EJ,
United Kingdom.
Breast cancer related lymphoedema (BCRL),
the chronically swollen arm of patients that have been treated
for
breast cancer, is no longer considered to be a result of lymphatic obstruction
as recent studies have
identified failing peripheral lymphatic
function as a principal contributing factor. The aetiology and
pathophysiology that results in this lymphatic failure is not clearly
understood, but it can occur with minimal
or even in some cases no
damage to the axillary lymph nodes, and evidence suggests that some patients
are
pre-disposed to develop the disease, and have poor lymphatic
function in their non-affected arms. It has
been shown that
interstitial forces such as hydrostatic pressure, and interstitial fluid
velocity, can regulate
both lymph flow, and lymph formation, and
there is good evidence that interstitial forces are dysregulated in
lymphoedema patients. Here I outline a hypothesis for how dysregulation
of interstitial parameters could
contribute to the generation of
breast cancer related lymphoedema, by combining disparate strands of
current
evidence on the molecular and physiological control of interstitial and lymph
flows. One mechanism
by which lymphoedema could be generated is
that a reduction in interstitial velocity results in increased
VEGF-C production, which in low flow conditions, instead of acting on
the lymphatics to increase pumping
and lymphangiogenesis, acts on
vasculature to increase fluid filtration. The resulting increase in
interstitial
pressure restores flow, but at the expense of
increased volume and hence oedema. The evidence supporting
the
hypothesis and possible tests of it are presented and
discussed.
PMID: 19963358 [PubMed - as supplied by
publisher
---------------------
1. J Reconstr Microsurg.. [Epub ahead
of print]
Comparison of Primary and Secondary Lower-Extremity Lymphedema
Treated with Supermicrosurgical
Lymphaticovenous Anastomosis and
Lymphaticovenous Implantation.
Demirtas Y, Ozturk N, Yapici O, Topalan
M.
Department of Plastic, Reconstructive and Aesthetic Surgery,
Ondokuz Mayis University Medical School,
Samsun,
Turkey.
Although some authors previously stated that
microlymphatic surgery does not have application to primary
lymphedema, opposite views are reported based on the observations that
the lymphatics were not
hypoplastic in majority of these patients
and microlymphatic surgery yielded significant improvement. The
aim
of this study was to compare the intraoperative findings and outcomes of
primary and secondary lower-
extremity lymphedema cases treated with
lymphaticovenous shunts. Between December 2006 and April
2009,
microlymphatic surgery was performed in 80 lower extremities with primary and
21 with secondary
lymphedema. These two groups of extremities are
compared according to the morphology of the lymphatic
vessels and
possibility of precise anastomoses, their response to the treatment, and final
outcomes based on
volumetric measurements during the follow-up
period. The morphology of the lymphatics in secondary
lymphedema
was more consistent, and at least one collector larger than 0.3 mm was
available for
anastomosis in 20 of 21 extremities. In the primary
lymphedema group, the lymphatics were smaller than 0.3
mm in 13 of
80 extremities. It was, therefore, possible to perform supermicrosurgical
lymphaticovenous
anastomosis in 84% of extremities with primary
lymphedema and 95% of extremities with secondary
lymphedema.
Reduction of the edema occurred earlier in the secondary lymphedema group, but
the mean
reduction in the edema volume was comparable between the
two groups. Microlymphatic surgery, although
more effective and
offered as the treatment of choice for secondary lymphedema, would also be a
valuable
and relevant treatment of primary lymphedema. © Thieme
Medical Publishers.
PMID: 20013596 [PubMed - as supplied by
publisher
----
2. PLoS Pathog. 2009
Dec;5(12):e1000688.
Lymphangiogenesis and lymphatic remodeling
induced by filarial parasites: implications for
pathogenesis.
Bennuru S, Nutman TB.
Laboratory of
Parasitic Diseases, National Institute of Allergy and Infectious Diseases,
National Institutes of
Health, Bethesda, Maryland, United States of
America.
Even in the absence of an adaptive immune system in murine
models, lymphatic dilatation and dysfunction
occur in filarial
infections, although severe irreversible lymphedema and elephantiasis appears
to require an
intact adaptive immune response in human infections.
To address how filarial parasites and their antigens
influence the
lymphatics directly, human lymphatic endothelial cells were exposed to filarial
antigens, live
parasites, or infected patient serum. Live filarial
parasites or filarial antigens induced both significant LEC
proliferation and differentiation into tube-like structures in vitro.
Moreover, serum from patently infected
(microfilaria positive)
patients and those with longstanding chronic lymphatic obstruction induced
significantly
increased LEC proliferation compared to sera from
uninfected individuals. Differentiation of LEC into tube-
like
networks was found to be associated with significantly increased levels of
matrix metalloproteases and
inhibition of their TIMP inhibitors
(Tissue inhibitors of matrix metalloproteases). Comparison of global gene
expression induced by live parasites in LEC to parasite-unexposed LEC
demonstrated that filarial parasites
altered the expression of those
genes involved in cellular organization and development as well as those
associated with junction adherence pathways that in turn decreased
trans-endothelial transport as assessed
by FITC-Dextran. The data
suggest that filarial parasites directly induce lymphangiogenesis and lymphatic
differentiation and provide insight into the mechanisms underlying
the pathology seen in lymphatic filariasis.
PMID: 20011114 [PubMed - in
process
----
3. Am J Pathol.. [Epub ahead of
print]
MYC High Level Gene Amplification Is a Distinctive
Feature of Angiosarcomas after Irradiation or Chronic
Lymphedema.
Manner J, Radlwimmer B, Hohenberger P,
Mössinger K, Küffer S, Sauer C, Belharazem D, Zettl A,
Coindre JM,
Hallermann C, Hartmann JT, Katenkamp D, Katenkamp K, Schöffski P, Sciot R,
Wozniak A,
Lichter P, Marx A, Ströbel P.
From the
Institute of Pathology,* University Medical Centre Mannheim, University of
Heidelberg, Germany;
the German Cancer Research Center (DKFZ),
Division of Molecular Genetics, Heidelberg, Germany; the
Department
of Surgery, Division of Surgical Oncology and Thoracic Surgery, University
Medical Centre
Mannheim, University of Heidelberg, Germany;
Pathology Viollier, Basle, Switzerland; the Department of
Pathology
and INSERM U916, Institut Bergonié and Laboratory of Pathology, University
Victor Ségalen,
Bordeaux, France; the Department of Dermatology,
Fachklinik Hornheide, Münster; the Department of
Medical
Oncology,** Medical Center II, Eberhard-Karls-University, Tuebingen, Germany;
the Institute of
Pathology, University of Jena, Germany; the
Department of General Medical Oncology, University Hospitals
Leuven, Leuven Cancer Institute, Catholic University Leuven, Leuven,
Belgium; and the Laboratory of
Morphology and Molecular Pathology,
Department of Pathology, University Hospital, Catholic University of
Leuven,
Belgium.
Angiosarcomas (AS) are rare vascular malignancies that
arise either de novo as primary tumors or
secondary to irradiation
or chronic lymphedema. The cytogenetics of angiosarcomas are poorly
characterized. We applied array-comparative genomic hybridization as a
screening method to identify
recurrent alterations in 22 cases.
Recurrent genetic alterations were identified only in secondary but not in
primary AS. The most frequent recurrent alterations were high level
amplifications on chromosome 8q24.21
(50%), followed by 10p12.33
(33%) and 5q35.3 (11%). Fluorescence in situ hybridization analysis in 28
primary and 33 secondary angiosarcomas (31 tumors secondary to
irradiation, 2 tumors secondary to
chronic lymphedema) confirmed
high level amplification of MYC on chromosome 8q24.21 as a recurrent
genetic
alteration found exclusively in 55% of AS secondary to irradiation or chronic
lymphedema, but not in
primary AS. Amplification of MYC did not
predispose to high grade morphology or increased cell turnover.
In
conclusion, despite their identical morphology, secondary AS are genetically
different from primary AS
and are characterized by a high frequency
of high level amplifications of MYC. This finding may have
implications both for the diagnosis and treatment of these
tumors.
PMID: 20008140 [PubMed - as supplied by
publisher
---
4. Surg Oncol.. [Epub ahead of
print]
Systematic review and meta-analysis of the used surgical
techniques to reduce leg lymphedema following
radical inguinal
nodes dissection.
Abbas S, Seitz M.
Hunter and
New England Health Area, Manning Hospital, 26 YORK Street, Taree, NSW 2430,
Australia.
BACKGROUND: Inguinal nodes dissection is associated
with high rates of morbidity, lymphedema in
particular is a chronic
disabling condition which is a common complication following this operation.
Prevention or minimization of this condition is an important aim
when considering this procedure. Many
technical modifications are
suggested for this purpose. This systematic review aims at assessing the
efficacy
of the available strategies to reduce the risk and severity
of leg lymphedema.
METHODS: For this review, MEDLINE and EMBASE were
searched to identify studies that reported
surgical strategies
designed to reduce complications of groin dissection and in particular leg
lymphedema.
Studies that reported outcome of long saphenous vein
sparing, fascia preserving dissection, microvascular
surgery,
sartorius transposition and omental pedicle flap were located. Data were
collected using predefined
inclusion and exclusion criteria. A
combined odds ratio was calculated combining studies suitable for meta-
analysis using the random effect model.
RESULTS: The search
result defined few studies that reported results of saphenous vein sparing
technique;
some of those studies were found suitable for
meta-analysis based on the Newcastle-Ottawa scale for non-
randomized
studies. The meta-analysis showed significant reduction of lymphedema (odds
ratio 0.24, 95%
CI 0.11-0.53) and other complications of inguinal
node dissection. There were no randomized studies to
address this
problem; there are also isolated studies that reported benefits of other
techniques but none of
them was suitable for
meta-analysis.
CONCLUSION: Meta-analysis of the reported studies on
sparing the long saphenous vein in inguinal nodes
dissection
suggests a reduced rate of lymphedema and other postoperative complications.
Other methods
that may be beneficial are fascia preserving
dissection, pedicled omental flap and microsurgery; however
sartorius transposition has not been shown to reduce the rate of
complications. Randomized controlled trials
are needed to prove the
benefits of various technical modifications.
PMID: 20005090 [PubMed - as
supplied by publisher
----
5. J Plast Reconstr Aesthet Surg..
[Epub ahead of print]
Surgical resection of vulva lymphoedema
circumscriptum.
Vignes S, Arrault M, Trévidic
P.
Department of Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène
Millon, 75015 Paris, France.
BACKGROUND: Lymphangioma
circumscriptum, a rare, benign disease that can be either congenital or
acquired, involves the deep dermis and subcutaneous
lymphatics.
OBJECTIVE: This study aims to analyse the efficacy of
surgical resection of vulva lymphangioma
circumscriptum
(VLC).
MATERIALS AND METHODS: Between January 2000 and December 2008,
eight consecutive women
referred to our centre and treated
surgically for VLC were included in the study. VLC was responsible for
recurrent lymph oozing in seven cases. All women were treated by the
same plastic surgeon specialising in
lymphatic
diseases.
RESULTS: The first surgery was performed after a median
interval of 5.4 years since VLC onset. The first
cutaneous resection
included the labia majora of all women and labia minora of five and clitoral
hood of four.
Five women experienced rapidly recurrent vesicles
associated with lymph oozing and underwent resection
again (once:
two women, twice: three women). The second resection was performed 4-6 months
after the
first, whereas the third took place 1-6 years after the
second. Five women had moderate and transitory post-
surgical lymph
oozing. After a median follow-up of 53 months after the last surgery, seven of
the eight
women were free from symptom.
CONCLUSION: Surgical
resection is an effective and well-tolerated therapy for VLC in most women.
Lesion recurrence is frequent but resection can be repeated several
times with no adverse effects.
PMID: 20004630 [PubMed - as supplied by
publisher
----
6. Adv Nurse Pract. 2009 Jun;17(6):29-30,
32.
Fluid transport gone wrong. An introduction to
lymphedema.
Ridner SH.
Vanderbilt University
School of Nursing, Nashville, USA.
PMID: 20000181 [PubMed - in
process
-----------------
1. Eur J Obstet Gynecol Reprod Biol. 2009
Dec 15. [Epub ahead of print]
Different physical treatment modalities
for lymphoedema developing after axillary lymph node dissection for
breast cancer: A review.
Devoogdt N, Van Kampen M, Geraerts I,
Coremans T, Christiaens MR.
Department Physiotherapy, University
Hospitals Leuven, Belgium; Faculty of Kinesiology and Rehabilitation
Sciences,
Katholieke Universiteit Leuven, Belgium; Department of Health Care Sciences,
University College
of Antwerp, Belgium.
The purpose
of this article is to provide a systematic review of Combined Physical Therapy,
Intermittent
Pneumatic Compression and arm elevation for the
treatment of lymphoedema secondary to an axillary
dissection for
breast cancer. Combined Physical Therapy starts with an intensive phase
consisting of skin
care, Manual Lymphatic Drainage, exercises and
bandaging and continues with a maintenance phase
consisting of skin
care, exercises, wearing a compression sleeve and Manual Lymphatic Drainage if
needed.
We have searched the following databases: PubMed/MEDLINE,
CINAHL, EMBASE, PEDro and
Cochrane. Only (pseudo-) randomised
controlled trials and non-randomised experimental trials investigating
the effectiveness of Combined Physical Therapy and its different parts,
of Intermittent Pneumatic
Compression and of arm elevation were
included. These physical treatments had to be applied to patients
with arm lymphoedema which developed after axillary dissection for
breast cancer. Ten randomised
controlled trials, one
pseudo-randomised controlled trial and four non-randomised experimental trials
were
found and analysed. Combined Physical Therapy can be
considered as an effective treatment modality for
lymphoedema.
Bandaging the arm is effective, whether its effectiveness is investigated on a
heterogeneous
group consisting of patients with upper and lower
limb lymphoedema from different causes. There is no
consensus on
the effectiveness of Manual Lymphatic Drainage. The effectiveness of skin care,
exercises,
wearing a compression sleeve and arm elevation is not
investigated by a controlled trial. Intermittent
Pneumatic
Compression is effective, but once the treatment is interrupted, the
lymphoedema volume
increases. In conclusion, Combined Physical
Therapy is an effective therapy for lymphoedema. However,
the
effectiveness of its different components remains uncertain. Furthermore,
high-quality studies are
warranted. The long-term effect of
Intermittent Pneumatic Compression and the effect of elevation on
lymphoedema are not yet proven. Copyright © 2009 Elsevier Ireland Ltd.
All rights reserved.
PMID: 20018422 [PubMed - as supplied by
publisher
----
2. South Med J. 2009
Dec;102(12):1257-9.
Palliation of malignant rectal obstruction
from invasive prostate cancer with multiple overlapping self-
expanding metal stents.
Smith AS, Cole M, Vega KJ, Munoz
JC.
Division of Gastroenterology, University of Florida College
of Medicine/Jacksonville, Jacksonville, FL
32207,
USA.
Self-expandable metal stents (SEMS) are used for colonic
neoplastic and extracolonic metastatic
obstruction relief. Limited
data exists on their use for locally invasive prostate cancer. We describe a
unique
approach using overlapping SEMS to alleviate a rectosigmoid
obstruction from locally invasive prostate
cancer. A patient with
locally advanced prostate cancer presented with obstipation and lymphedema.
Placement of overlapping rectosigmoid SEMS was performed, relieving the
visualized rectosigmoid
obstruction.
PMID: 20016435 [PubMed
- in process
----
3. Exerc Sport Sci Rev. 2010
Jan;38(1):17-24.
Balancing lymphedema risk: exercise versus
deconditioning for breast cancer survivors.
Schmitz
KH.
University of Pennsylvania School of Medicine, Abramson
Cancer Center, Philadelphia, 19104-6021,
United States.
[email protected]
Lymphedema, a common and feared
negative effect of breast cancer treatment, is generally described by
arm
swelling and dysfunction. Risk averse clinical recommendations guided survivors
to avoid the use of the
affected arm. This may lead to
deconditioning and, ironically, the very outcome women seek to avoid.
Recently
published studies run counter to these guidelines.
PMID: 20016295
[PubMed - in process
----
4. Exerc Sport Sci Rev. 2010
Jan;38(1):2.
Role of exercise in the prevention and management
of lymphedema after breast cancer.
Hayes
SC.
Queensland University of Technology,
Australia.
PMID: 20016292 [PubMed - in process
1.
Eur J Obstet Gynecol Reprod Biol. 2009 Dec 15. [Epub ahead of
print]
Different physical treatment modalities for lymphoedema
developing after axillary lymph node dissection for
breast cancer:
A review.
Devoogdt N, Van Kampen M, Geraerts I, Coremans T,
Christiaens MR.
Department Physiotherapy, University Hospitals
Leuven, Belgium; Faculty of Kinesiology and Rehabilitation
Sciences, Katholieke Universiteit Leuven, Belgium; Department of Health
Care Sciences, University College
of Antwerp,
Belgium.
The purpose of this article is to provide a systematic
review of Combined Physical Therapy, Intermittent
Pneumatic
Compression and arm elevation for the treatment of lymphoedema secondary to an
axillary
dissection for breast cancer. Combined Physical Therapy
starts with an intensive phase consisting of skin
care, Manual
Lymphatic Drainage, exercises and bandaging and continues with a maintenance
phase
consisting of skin care, exercises, wearing a compression
sleeve and Manual Lymphatic Drainage if needed.
We have searched
the following databases: PubMed/MEDLINE, CINAHL, EMBASE, PEDro and
Cochrane. Only (pseudo-) randomised controlled trials and non-randomised
experimental trials investigating
the effectiveness of Combined
Physical Therapy and its different parts, of Intermittent Pneumatic
Compression and of arm elevation were included. These physical
treatments had to be applied to patients
with arm lymphoedema which
developed after axillary dissection for breast cancer. Ten randomised
controlled
trials, one pseudo-randomised controlled trial and four non-randomised
experimental trials were
found and analysed. Combined Physical
Therapy can be considered as an effective treatment modality for
lymphoedema. Bandaging the arm is effective, whether its effectiveness
is investigated on a heterogeneous
group consisting of patients
with upper and lower limb lymphoedema from different causes. There is no
consensus on the effectiveness of Manual Lymphatic Drainage. The
effectiveness of skin care, exercises,
wearing a compression sleeve
and arm elevation is not investigated by a controlled trial. Intermittent
Pneumatic Compression is effective, but once the treatment is
interrupted, the lymphoedema volume
increases. In conclusion,
Combined Physical Therapy is an effective therapy for lymphoedema. However,
the effectiveness of its different components remains uncertain.
Furthermore, high-quality studies are
warranted. The long-term
effect of Intermittent Pneumatic Compression and the effect of elevation on
lymphoedema are not yet proven. Copyright © 2009 Elsevier Ireland Ltd.
All rights reserved.
PMID: 20018422 [PubMed - as supplied by
publisher
----
1. PLoS One. 2009 Dec
21;4(12):e8380.
Anti-inflammatory pharmacotherapy with
ketoprofen ameliorates experimental lymphatic vascular
insufficiency in mice.
Nakamura K, Radhakrishnan K, Wong
YM, Rockson SG.
Division of Cardiovascular Medicine, Stanford
University School of Medicine, Stanford, California,
USA.
BACKGROUND: Disruption of the lymphatic vasculature causes
edema, inflammation, and end-tissue
destruction. To assess the
therapeutic efficacy of systemic anti-inflammatory therapy in this disease, we
examined the impact of a nonsteroidal anti-inflammatory drug
(NSAID), ketoprofen, and of a soluble TNF-
alpha receptor (sTNF-R1)
upon tumor necrosis factor (TNF)-alpha activity in a mouse model of acquired
lymphedema.
METHODS AND FINDINGS: Lymphedema was induced by
microsurgical ablation of major lymphatic
conduits in the murine
tail. Untreated control mice with lymphedema developed significant edema and
extensive histopathological inflammation compared to sham surgical
controls. Short-term ketoprofen
treatment reduced tail edema and
normalized the histopathology while paradoxically increasing TNF-alpha
gene expression and cytokine levels. Conversely, sTNF-R1 treatment
increased tail volume, exacerbated
the histopathology, and
decreased TNF-alpha gene expression. Expression of vascular endothelial growth
factor-C (VEGF-C), which stimulates lymphangiogenesis, closely
correlated with TNF-alpha expression.
CONCLUSIONS: Ketoprofen therapy
reduces experimental post-surgical lymphedema, yet direct TNF-
alpha
inhibition does not. Reducing inflammation while preserving TNF-alpha activity
appears to optimize
the repair response. It is possible that the
observed favorable responses, at least in part, are mediated
through enhanced VEGF-C signaling.
PMID: 20027220 [PubMed - in
process
----
2. Vet Rec. 2009 Dec 26;165(25):758.
Therapy
for horses with chronic progressive lymphoedema.
Powell
H.
25A The Square, Alvechurch, Worcestershire B48
7LA.
PMID: 20023285 [PubMed - in process
----
3.
In Vivo. 2009 Nov-Dec;23(6):1017-20.
Incidence of arm
lymphoedema following sentinel node biopsy, axillary sampling and axillary
dissection in
patients with breast cancer.
Lumachi F,
Basso SM, Bonamini M, Marino F, Marzano B, Milan E, Waclaw BU, Chiara
GB.
University of Padua, School of Medicine, Department of
Surgical and Gastroenterological Sciences, Via
Giustiniani 2, 35128
Padova, Italy. [email protected].
The aim of this study was to
compare the incidence of lymphoedema after different treatments of the axilla
in
patients with breast cancer (BC). Medical records of 205 women
(median age 61 years, range 26-72
years) who underwent curative
surgery for primary BC were reviewed. According to the treatment of the
axilla, the study population was divided into four age- and
stage-matched groups of patients: Group A
(N=54 patients), sentinel
node biopsy (SLNB) alone; Group B (N=48 patients), SLNB followed by axillary
node (AN) sampling using ultrasound scissors (harmonic scalpel);
Group C (N=53 patients), AN dissection
using ultrasound scissors;
Group D (N=50 patients), traditional AN dissection. The median follow-up was
22 months (range 18-28 months). The intraoperative frozen section
of SLNB (Groups A and B) showed 32
out of 102 (31.4%) patients with
metastasis to AN, while final pathology showed AN metastases in 20, 17,
16 and 17 patients of groups A, B, C and D, respectively (p=NS). The
sensitivity of SLNB alone was 80%
and that of SLNB followed by AN
sampling was 95% (p=NS). At follow-up patients with lymphoedema
were 2 (3.7%), 2 (4.2%), 3 (5.6%) and 8 (16%) in groups A, B, C and D,
respectively (p=NS). In
conclusion, AN sampling is a sensitive and
low-morbidity procedure which, in conjunction with the use of
harmonic scalpel, may reduce the onset of arm lymphoedema.
PMID:
20023249 [PubMed - in process
-----------------------
Eur J Cancer
Care (Engl). 2009 Dec 17. [Epub ahead of print]
Cancer-related
secondary lymphoedema due to cutaneous lymphangitis carcinomatosa: clinical
presentations
and review of literature.
Damstra RJ,
Jagtman EA, Steijlen PM.
Nij Smellinghe Hospital, Department of
Dermatology and Phlebology and Lymphology, Compagnonsplein,
Drachten, the Netherlands.
DAMSTRA R.J., JAGTMAN E.A.
& STEIJLEN P.M. (2009) European Journal of Cancer Care Cancer-
related secondary lymphoedema due to cutaneous lymphangitis
carcinomatosa: clinical presentations and
review of literature
Lymphoedema is a clinical condition caused by impairment of the lymphatic
system,
leading to swelling of subcutaneous soft tissues. As a
result, accumulation of protein-rich interstitial fluid and
lymphstasis often causes additional swelling, fibrosis and adipose
tissue hypertrophy leading to progressive
morbidity and loss of
quality of life for the patient. Lymphoedema can be distinguished as primary or
secondary. Lymphoedema is a complication frequently encountered in
patients treated for cancer, especially
after lymphadenoectomy
and/or radiotherapy based on destruction of lymphatics. However, although
lymphatic impairment is sometimes caused by obstructive solid
metastasis, we present three cases of
secondary lymphoedema with
minor dermatological features without detectable solid metastasis. Sometimes
this type of lymphoedema is mistakenly called malignant lymphoedema.
All patients were previously treated
for cancer without clinical
signs of recurrence, presented with progressive lymphoedema and minor
dermatological
features of unknown origin. Clinical and histopathological examination of the
skin revealed
diffuse lymphangitis carcinomatosa, leading to
secondary lymphoedema and adjustment of the therapeutic
approach and
prognosis. We reviewed literature on these rare presentations of cancer
recurrence and
recommend, where appropriate, consulting a
dermatologist when discrete skin abnormalities are seen in
patients
with a history of cancer and developing lymphoedema.
PMID: 20030691
[PubMed - as supplied by publisher
----
1: Weight lifting in
women with breast-cancer-related lymphedema.
Authors: Schmitz KH, Ahmed RL,
Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-
Smith CT, Greene QP
Institution: Center for Clinical Epidemiology
and Biostatistics, University of Pennsylvania School of
Medicine,
Philadelphia, PA 19104, USA. [email protected]
Journal: N Engl J
Med. 2009 Aug 13;361(7):664-73.
2: Post-breast cancer lymphedema: part
2.
Authors: Fu MR, Ridner SH, Armer J
Institution: New York University
College of Nursing, New York City, USA. [email protected]
Journal: Am J Nurs.
2009 Aug;109(8):34-41; quiz 42.
3: Post-breast cancer. Lymphedema: part
1.
Authors: Fu MR, Ridner SH, Armer J
Institution: New York University
College of Nursing, New York City, USA. [email protected]
Journal: Am J Nurs.
2009 Jul;109(7):48-54; quiz 55.
4: The psycho-social impact of
lymphedema.
Authors: Ridner SH
Institution: Vanderbilt University School
of Nursing, Nashville, Tennessee 37240, USA. Sheila.
[email protected]
Journal: Lymphat Res Biol.
2009;7(2):109-12.
5: The standard of care for lymphedema: current
concepts and physiological considerations.
Authors: Mayrovitz
HN
Institution: College of Medical Sciences, Nova Southeastern University,
Ft. Lauderdale, FL 33328, USA.
[email protected]
Journal:
Lymphat Res Biol. 2009;7(2):101-8.
6: Prospective evaluation of a
prevention protocol for lymphedema following surgery for breast
cancer.
Authors: Boccardo FM, Ansaldi F, Bellini C, Accogli S, Taddei G,
Murdaca G, Campisi CC, Villa G,
Icardi G, Durando P, Puppo F,
Campisi C
Institution: Department of Surgery, Unit of Lymphatic Surgery and
Microsurgery, S. Martino Hospital,
University of Genoa, Italy.
[email protected]
Journal: Lymphology. 2009
Mar;42(1):1-9.
7: Suction-assisted lipectomy for treatment of
lower-extremity lymphedema.
Authors: Eryilmaz T, Kaya B, Ozmen S, Kandal
S
Institution: Department of Plastic, Reconstructive and Aesthetic Surgery,
Gazi University School of
Medicine, Ankara, Turkey.
[email protected]
Journal: Aesthetic Plast Surg. 2009 Jul;33(4):671-3.
Epub 2009 May 12.
8: Understanding the management of lymphoedema for
patients with advanced disease.
Authors: Honnor A
Institution: Loros
Hospice, Leicester, England. [email protected]
Journal: Int J Palliat
Nurs. 2009 Apr;15(4):162, 164, 166-9.
9: Understanding breast
cancer-related lymphoedema.
Authors: Bennett Britton TM, Purushotham
AD
Institution: Department of Research Oncology, King's College London,
Guy's & St. Thomas' NHS
Foundation Trust, London,
UK.
Journal: Surgeon. 2009 Apr;7(2):120-4.
10: Compression therapy in
breast cancer-related lymphedema: A randomized, controlled comparative
study of relation between volume and interface pressure
changes.
Authors: Damstra RJ, Partsch H
Institution: Department of
Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten,
The Netherlands. [email protected]
Journal: J Vasc Surg.
2009 May;49(5):1256-63.
11: Pole walking for patients with breast
cancer-related arm lymphedema.
Authors: Jonsson C, Johansson
K
Institution: Lymphedema Unit, Lund University Hospital, Lund, Sweden.
[email protected]
Journal: Physiother Theory Pract. 2009
Apr;25(3):165-73.
12: Recent advances in breast cancer-related
lymphedema of the arm: lymphatic pump failure and
predisposing
factors.
Authors: Stanton AW, Modi S, Mellor RH, Levick JR, Mortimer
PS
Institution: Division of Cardiac & Vascular Sciences, Dermatology, St
George's Hospital Medical School,
University of London, London,
United Kingdom.
Journal: Lymphat Res Biol. 2009;7(1):29-45.
13:
Breast cancer-related lymphoedema: risk factors and treatment.
Authors:
Harmer V
Institution: Breast Care Unit, St Mary's Hospital Campus, Imperial
College Healthcare, NHS Trust,
London, UK.
Journal: Br J Nurs.
2009 Feb 12-25;18(3):166-72.
14: Efficacy of pneumatic compression and
low-level laser therapy in the treatment of postmastectomy
lymphoedema: a randomized controlled trial.
Authors: Kozanoglu E,
Basaran S, Paydas S, Sarpel T
Institution: Department of Physical Medicine
and Rehabilitation, Faculty of Medicine, Cukurova University,
Adana, Turkey.
Journal: Clin Rehabil. 2009
Feb;23(2):117-24.
15: Lymphatic venous anastomosis (LVA) for treatment
of secondary arm lymphedema. A prospective
study of 11 LVA
procedures in 10 patients with breast cancer related lymphedema and a critical
review of
the literature.
Authors: Damstra RJ, Voesten HG, van
Schelven WD, van der Lei B
Institution: Department of Dermatology,
Phlebology and Lymphology, Nij Smellinghe Hospital,
Compagnonsplein
1, 9202 NN, Drachten, The Netherlands. [email protected]
Journal:
Breast Cancer Res Treat. 2009 Jan;113(2):199-206. Epub 2008 Feb 13.
1.
J Dermatol. 2009 Dec;36(12):646-8.
Basal cell carcinoma arising on a
chronic lymphedematous leg.
Ueno T, Futagami A, Mitsuishi T, Niimi Y,
Shimoda T, Kawana S.
Department of Cutaneous and Mucosal
Pathophysiology, Graduate School of Medicine, Nippon Medical
School, Tokyo, Japan. [email protected]
We describe
a case of an 82-year-old Japanese woman with basal cell carcinoma (BCC) on the
leg with
secondary chronic lymphedema due to treatment for uterine
cancer. Sparse tumor nests with remarkable
edema of the dermis in
the nodule appeared to be influenced by the chronic lymphedema. However, it
remains inconclusive whether or not the tumorigenesis of the BCC was
associated with chronic lymphedema
in this case.
PMID:
19958449 [PubMed - in process
2. Int J Gynecol Cancer. 2009
Dec;19(9):1649-54.
Lower-limb lymphedema and vulval cancer:
feasibility of prophylactic compression garments and validation
of
leg volume measurement.
Sawan S, Mugnai R, Lopes Ade B, Hughes
A, Edmondson RJ.
Academic Unit of Obstetrics and Gynaecology, St
Mary's Hospital, The University of Manchester,
Manchester, United
Kingdom.
OBJECTIVES: Leg lymphedema remains a significant health
problem after treatment of vulval cancer. This
pilot study explored
the feasibility of conducting a larger trial to investigate whether the early
use of
compression stockings is effective in preventing leg
lymphedema.
METHODS: Fourteen patients undergoing inguinofemoral
lymphadenectomy for vulval cancer were
randomized to either best
supportive care or best supportive care plus the use of graduated compression
stockings for 6 months.
RESULTS: Six of 7 patients in the
treatment group complied with the study protocol. The incidence of
clinically significant lymphedema was not different between both groups;
however, there was a greater
increase in mean leg volume in the
control group (953 vs 607 mL, P = 0.010). Furthermore, patients in the
treatment group showed better performance as judged by leg symptoms (P =
0.031, at 3 months) and
clinical examination (P = 0.039 at 4 weeks
and P = 0.004 at 6 months). There was no difference in the
incidence of groin wound dehiscence, infection, or lymphocyst
formation. We detected no difference
between both groups' scores
when using a validated quality-of-life questionnaire. Intraobserver and
interobserver variabilities of leg-volume measurement technique were
investigated using the principles of
repeatability and
reproducibility statistics. Intraobserver variability was estimated at 270 mL,
whereas
interobserver variability was 1000 mL.
CONCLUSIONS:
The prophylactic use of stockings in this population is feasible, and further
larger studies
are justified to investigate its role in reducing the
incidence of leg lymphedema. The design of these studies
should
take into account the observer-related variability in measuring leg volume or
consider alternative
methods.
PMID: 19955953 [PubMed - in
process
1. Plast Reconstr Surg. 2009 Aug;124(2):438-50.
Fibrosis is a
key inhibitor of lymphatic regeneration.
Avraham T, Clavin NW, Daluvoy SV, Fernandez J, Soares MA, Cordeiro AP,
Mehrara BJ.
Division of Plastic and Reconstructive Surgery, Department of Surgery,
Memorial Sloan-Kettering Cancer
Center, New York, NY, USA.
BACKGROUND: Lymphedema is a common debilitating sequela of lymph node
dissection. Although
numerous clinical studies suggest that factors that
lead to fibrosis are associated with the development of
lymphedema, this
relationship has not been proven. The purpose of these experiments was therefore
to
evaluate lymphatic regeneration in the setting of variable soft-tissue
fibrosis.
METHODS: A section of mouse tail skin including the capillary and collecting
lymphatics was excised.
Experimental animals (n = 20) were treated with
topical collagen type I gel and a moist dressing, whereas
control animals (n
= 20) underwent excision followed by moist dressing alone. Fibrosis, acute
lymphedema,
lymphatic function, gene expression, lymphatic endothelial cell
proliferation, and lymphatic fibrosis were
evaluated at various time points.
RESULTS: Collagen gel treatment significantly decreased fibrosis, with an
attendant decrease in acute lymphedema and improved lymphatic function.
Tails treated with collagen gel
demonstrated greater numbers of lymphatic
vessels, more normal lymphatic architecture, and more
proliferating lymphatic endothelial cells. These findings appeared to be independent of vascular endothelial
growth factor C expression. Decreased fibrosis was
associated with a significant decrease in the expression
of extracellular matrix components. Finally, decreased soft-tissue fibrosis was associated with a significant
decrease in lymphatic fibrosis as evidenced by the number of
lymphatic endothelial cells that coexpressed
lymphatic and fibroblast
markers. CONCLUSIONS: Soft-tissue fibrosis is associated with impairment in
lymphatic regeneration and lymphatic function. These defects occur as a
consequence of impaired lymphatic
endothelial cell proliferation, abnormal
lymphatic microarchitecture, and lymphatic fibrosis. Inhibition of
fibrosis
using a simple topical dressing can markedly accelerate lymphatic repair and
promote regeneration
of normal capillary lymphatics.
PMID: 19644258 [PubMed - in process
---
2. Breast Cancer Res Treat. 2009 Jul 30. [Epub ahead of
print]
Pain perception and detailed visual pain mapping in breast cancer
survivors.
Jud SM, Fasching PA, Maihöfner C, Heusinger K, Loehberg CR, Hatko R, Rauh C,
Bani H, Lux MP,
Beckmann MW, Bani MR.
Department of Gynecology and Obstetrics, University Breast Center for
Franconia, Erlangen University
Hospital, Universitaetsstrasse 21-23, 91054,
Erlangen, Germany.
Chronic pain and neural irritation after breast surgery and radiation are
still relevant sequelae of the
treatment. Pain quantification and
localization in patient groups are difficult to standardize. In order to
quantify and localize pain in a group of breast cancer patients, a
Java-based program was developed to
visualize the frequency of pain in "pain
maps." A questionnaire with structured questions on the perception of
pain
included pictograms of a body to mark possible pain areas. A group of 343 breast
cancer survivors
completed the questionnaires. The image information was
digitalized and processed using a Java applet.
Gray-scale summation pictures
with numbers from "0," indicating black (100% pain), to "255," indicating
white (0% pain), were generated. The visualization of pain by creating pain
maps revealed the location of
pain in breast cancer survivors on pictograms
of the body. Analyzing the total number of pixels, in which
pain was stated,
made it possible to compare pain areas in several subgroups, showing that
patients after
mastectomy versus breast-conserving therapy (3,011 vs. 2,224
pixels), and patients with lymphedema
versus patients without lymphedema
(3,010 vs. 2,239 pixels), have larger pain areas. This study presents a
method of visualizing pain areas and assigning them to a pictogram of the
body in a sample of breast cancer
patients. The method is easy to use and
could help generate pain maps in several types of disease.
PMID: 19641989 [PubMed - as supplied by publisher
---
3. Am J Nurs. 2009 Aug;109(8):34-41; quiz 42.
Post-breast cancer lymphedema: part 2.
Fu MR, Ridner SH, Armer J.
New York University College of Nursing, New York City, USA. [email protected]
As breast cancer survivors often say, lymphedema is more than just a swollen
arm. A result of surgical or
radiologic breast cancer treatment, it's an
abnormal accumulation of lymph in the arm, shoulder, breast, or
thoracic
area that usually develops within three years of a breast cancer diagnosis but
can occur much later.
In Part 1 (July) the authors described the
pathophysiology and diagnosis of lymphedema. In Part 2 they
discuss current
approaches to risk reduction, treatment and management of the condition, and
implications
for nurses.
PMID: 19641404 [PubMed - in process
---
4. Ann Acad Med Singapore. 2009 Jul;38(7):636-3.
Primary lymphoedema at an unusual location triggered by nephrotic
syndrome.
Tabel Y, Mungan I, Sigirci A, Gungor S.
Department of Paediatrics, Faculty of Medicine, Inonu University, Malatya,
Turkey. yilmaztabel@yahoo.
com
INTRODUCTION: Lymphoedema results from impaired lymphatic transport leading
to the pathologic
accumulation of protein-rich lymphatic fluid in the
interstitial space, most commonly in the extremities.
Primary lymphoedema, a
developmental abnormality of the lymphatic system, may become evident later in
life when a triggering event exceeds the capacity of normal lymphatic
flow.
CLINICAL PICTURE: We present a 3-year-old nephrotic syndrome patient with an
unusual localisation
for primary lymphoedema.
TREATMENT AND OUTCOME: The patient was treated with conservative approach and
she was cured.
CONCLUSION: In this particular case, lymphoedema developed at
an unusual localisation, which has not
been recorded before.
PMID: 19652856 [PubMed - in process
----
5. Int Angiol. 2009 Aug;28(4):315-24.
The CEAP-L classification for lymphedemas of the limbs: the Italian
experience.
Gasbarro V, Michelini S, Antignani PL, Tsolaki E, Ricci M, Allegra C.
Unit of Vascular and Endovascular Surgery, Department of Surgical,
Anesthesiological and Radiological
Sciences, Sant'Anna University Hospital,
University of Ferrara, Ferrara, Italy [email protected].
AIM: A method to classificate lymphedema has been needed to gather all the
important information on the
clinical evolution of the disease using a
common language and an easy clinical applicability.
METHODS: The proposal for a new classification of the limb lymphedema was
inspired by the C.E.A.P.
classification for chronic venous insufficiency of
the lower limb. The classification adopts the acronym C.E.A.
P. by adding the
letter L to underline the aspect ''lymphedema'' and is based on clinical data
such as
extension of lymphedema, presence of lymphangitis, leg ulcers and
loss of functionality of the limb and
instrumental criteria that permit to
confirm and precise diagnosis. The Clinical classification is based on the
most objective sign in these patients, the edema which is subdivided into 5
classes depending on the clinical
manifestations. The etiological aspect
considers 2 types of alterations of the lymphatic system: congenital and
acquired. The anatomic is aimed to locate the anatomical structures
involved. Pathophysiological conditions
are gathered into 5 groups: agenesia
or hypoplasia, hyperplasia, reflux, overload, obstruction.
RESULTS: The classification has already been appraised after 4 years of
activity at the unit of Vascular and
Endovascular Surgery of Ferrara, at the
S. Giovanni Battista Hospital in Rome, at the Umberto I Ancona
Hospital and
at the S. Giovanni- Addolorata Hospital in Rome.
CONCLUSIONS: The proposal for a new classification of lymphedema C.E.A.P. L
was developed in
order to categorize patients with definite and objective
marks, creating clinical reports with a common
vocabulary, clear to all
clinicians, permitting to stage the disease, evaluate treatment and finally
obtain
epidemiological and statistical data.
PMID: 19648876 [PubMed - in process
-----
Breast. 2009 Aug 3. [Epub ahead of print]
Axillary metastatic disease as presentation of occult or contralateral breast
cancer.
Lanitis S, Behranwala KA, Al-Mufti R, Hadjiminas D.
St Mary's hospital, Praed street, Paddington, London W2 1NY, UK.
INTRODUCTION: Atypical axillary metastasis may arise from an occult
ipsilateral or contralateral breast
cancer or from primary non-breast
tumour. The treatment of this entity is challenging and presents various
options. We present our experience with a brief review of the
literature.
RESULTS: A study of atypical axillary metastasis done at St Mary's hospital,
from 1998 to 2008, identified
six cases. Radiological investigations and
immunohistochemistry excluded non-breast primary tumour. Three
patients had
occult breast cancer on presentation, two patients had previously treated
contralateral breast
cancer and one patient developed a primary metachronous
contralateral breast cancer, which had a
completely different histological
profile from the involved lymph nodes on the same side. Axillary nodal
clearance was done for all patients except for the patient with lymphoedema.
Four patients were alive with
no evidence of disease and two patients died
of the disease at a median follow-up of 23 months.
CONCLUSION: Atypical axillary metastasis from ipsilateral occult or
contralateral breast cancer should be
treated with axillary node clearance
and further endocrine or chemotherapy. Radiation treatment or a
watchful
policy to the ipsilateral breast should be validated by further studies.
PMID: 19656680 [PubMed - as supplied by publisher
-------------------------
Fukuoka Igaku Zasshi. 2009 Jun;100(6):235-41.
[The outcomes of program based on complex decongestive physiotherapy for a
patient with secondary
lymphedema caused by infection on the leg][Article in
Japanese]
Nakao F, Furutani A, Yoshimura K, Hamano K, Kinoshita Y, Kawamoto R, Nakao H,
Suzuki S.
Department of Health Sciences, Faculty of Medical Sciences, Kyushu
University, 3-1-1 Maidashi, Higashi-
ku, Fukuoka 812-8582, Japan.
Lymphedema is a chronic problem causing distress and loss of functions
throughout the lifespan. Complex
decongestive physiotherapy (CDP) is in
common use in developed countries but has only recently been used
in Japan
for people in outpatient settings. CDP is a representative conservative
treatment for lymphedema,
conducted by combining four kinds of physical
therapies: skin care, manual lymph drainage (MLD), bandage
and exercise.
This research project lead by a nurse is underway using CDP in an outpatient
department. We
report a case of secondary lymphedema caused by infection
successfully treated by CDP. A 22-year-old
man suffered from cellulitis of
unknown origin when he was a high school student. After this event, he had
been repeatedly admitted to hospital with infections as a result of the
lymphedema. He underwent MLD
once or twice monthly and received health
education for skin care, self-massage and exercise, and was
advised to wear
compression stockings. Within 7 months the leg swelling had significantly
reduced and his
feelings of malaise and pain disappeared. Fourteen months
later the circumferences of his knee and ankle
had kept the sizes, and he
has not re-entered hospital for infections. For this man, CDP had a positive
outcome, as it has for many others around the world. Our experience has
found it very important to establish
adequate support systems for such
people in outpatient and community settings. However, more research
and
knowledge sharing are required to understand the usefulness and effectiveness
about this program as a
primary treatment combined with health education in
community settings in Japan.
PMID: 19670806 [PubMed - in process
-----------------------------------
Nat Med. 2009 Aug 9. [Epub ahead of print]
Alternatively spliced vascular endothelial growth factor receptor-2 is an
essential endogenous inhibitor of
lymphatic vessel growth.
Albuquerque RJ, Hayashi T, Cho WG, Kleinman ME, Dridi S, Takeda A, Baffi JZ,
Yamada K, Kaneko H,
Green MG, Chappell J, Wilting J, Weich HA, Yamagami S,
Amano S, Mizuki N, Alexander JS, Peterson
ML, Brekken RA, Hirashima M,
Capoor S, Usui T, Ambati BK, Ambati J.
[1] Departments of Ophthalmology & Visual Sciences, Lexington, Kentucky,
USA. [2] Department of
Physiology, University of Kentucky, Lexington,
Kentucky, USA.
Disruption of the precise balance of positive and negative molecular
regulators of blood and lymphatic vessel
growth can lead to myriad diseases.
Although dozens of natural inhibitors of hemangiogenesis have been
identified, an endogenous selective inhibitor of lymphatic vessel growth has
not to our knowledge been
previously described. We report the existence of a
splice variant of the gene encoding vascular endothelial
growth factor
receptor-2 (Vegfr-2) that encodes a secreted form of the protein, designated
soluble Vegfr-2
(sVegfr-2), that inhibits developmental and reparative
lymphangiogenesis by blocking Vegf-c function.
Tissue-specific loss of
sVegfr-2 in mice induced, at birth, spontaneous lymphatic invasion of the
normally
alymphatic cornea and hyperplasia of skin lymphatics without
affecting blood vasculature. Administration of
sVegfr-2 inhibited
lymphangiogenesis but not hemangiogenesis induced by corneal suture injury or
transplantation, enhanced corneal allograft survival and suppressed
lymphangioma cellular proliferation.
Naturally occurring sVegfr-2 thus acts
as a molecular uncoupler of blood and lymphatic vessels; modulation
of
sVegfr-2 might have therapeutic effects in treating lymphatic vascular
malformations, transplantation
rejection and, potentially, tumor
lymphangiogenesis and lymphedema.
PMID: 19668192 [PubMed - as supplied by publisher
-------------------------------------
1. 1: Integr Cancer Ther. 2009 Jun;8(2):123-9.
Feasibility trial of electroacupuncture for aromatase inhibitor--related
arthralgia in breast cancer survivors.
Mao JJ, Bruner DW, Stricker C, Farrar JT, Xie SX, Bowman MA, Pucci D, Han X,
DeMichele A.
Department of Family Medicine and Community Health, University of
Pennsylvania Health System,
Philadelphia, Pennsylvania 19104, USA
BACKGROUND: Arthralgia affects postmenopausal women receiving aromatase
inhibitors (AIs) for breast
cancer. Given the existing evidence for
electroacupuncture (EA) for treatment of osteoarthritis in the general
population, this study aims to establish the feasibility of studying EA for
treating AI-related arthralgia.
PATIENTS AND METHODS: Postmenopausal women with stage I-III breast cancer who
reported AI-
related arthralgia were enrolled in a single-arm feasibility
trial. EA was provided twice a week for 2 weeks
followed by 6 weekly
treatments. The protocol was based on Chinese medicine diagnosis of "Bi"
syndrome
with electrostimulation of needles around the painful joint(s).
Pain severity of the modified Brief Pain
Inventory was used as the primary
outcome. Joint stiffness, joint interference, and Patient Global Impression
of Change (PGIC) were secondary outcomes. Paired t tests were used for
analysis.
RESULTS: Twelve women were enrolled and all provided data for analysis. From
baseline to the end of
intervention, patients reported reduction in pain
severity (from 5.3 to 1.9), stiffness (from 6.9 to 2.4), and
joint symptom
interference (from 4.7 to 0.8), all P < .001; 11/12 considered joint symptoms
"very much
better" based on the PGIC. Subjects also reported significant
decrease in fatigue (from 4.4 to 1.9, P = .005)
and anxiety (from 7.1 to
4.8, P = .01). No infection or development or worsening of lymphedema was
observed.
CONCLUSION: Preliminary data establish the feasibility of recruitment and
acceptance as well as
promising preliminary safety and effectiveness. A
randomized controlled trial is warranted to establish the
efficacy of EA for
AI-related arthralgia in breast cancer survivors.
PMID: 19679620 [PubMed - in process
---------------------------------
2. N Engl J Med. 2009 Aug
13;361(7):664-73.
Comment in: N Engl J Med. 2009 Aug 13;361(7):710-1.
Weight lifting in women with breast-cancer-related lymphedema.
Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ,
Williams-Smith CT,
Greene QP.
Center for Clinical Epidemiology and
Biostatistics, University of Pennsylvania School of Medicine,
Philadelphia,
PA 19104, USA. [email protected]
BACKGROUND: Weight lifting has generally been proscribed for women with
breast-cancer-related
lymphedema, preventing them from obtaining the
well-established health benefits of weight lifting, including
increases in
bone density.
METHODS: We performed a randomized, controlled trial of twice-weekly
progressive weight lifting
involving 141 breast-cancer survivors with stable
lymphedema of the arm. The primary outcome was the
change in arm and hand
swelling at 1 year, as measured through displaced water volume of the affected
and
unaffected limbs. Secondary outcomes included the incidence of
exacerbations of lymphedema, number and
severity of lymphedema symptoms, and
muscle strength. Participants were required to wear a well-fitted
compression garment while weight lifting.
RESULTS: The proportion of women who had an increase of 5% or more in limb
swelling was similar in the
weight-lifting group (11%) and the control group
(12%) (cumulative incidence ratio, 1.00; 95% confidence
interval, 0.88 to
1.13). As compared with the control group, the weight-lifting group had greater
improvements in self-reported severity of lymphedema symptoms (P=0.03) and
upper- and lower-body
strength (P<0.001 for both comparisons) and a lower
incidence of lymphedema exacerbations as assessed
by a certified lymphedema
specialist (14% vs. 29%, P=0.04). There were no serious adverse events related
to the intervention.
CONCLUSIONS: In breast-cancer survivors with lymphedema, slowly progressive
weight lifting had no
significant effect on limb swelling and resulted in a
decreased incidence of exacerbations of lymphedema,
reduced symptoms, and
increased strength. (ClinicalTrials.gov number, NCT00194363.) 2009
Massachusetts Medical Society
PMID: 19675330 [PubMed - indexed for MEDLINE
----------------------
1. Dev Cell. 2009 Aug;17(2):175-86.
Integrin-alpha9 is required for fibronectin matrix assembly during lymphatic
valve morphogenesis.
Bazigou E, Xie S, Chen C, Weston A, Miura N, Sorokin L, Adams R, Muro AF,
Sheppard D, Makinen T.
Lymphatic Development Laboratory, Cancer Research UK London Research
Institute, 44 Lincoln's Inn
Fields, London WC2A 3PX, UK.
Dysfunction of lymphatic valves underlies human lymphedema, yet the process
of valve morphogenesis is
poorly understood. Here, we show that during
embryogenesis, lymphatic valve leaflet formation is initiated
by
upregulation of integrin-alpha9 expression and deposition of its ligand
fibronectin-EIIIA (FN-EIIIA) in
the extracellular matrix. Endothelial
cell-specific deletion of Itga9 (encoding integrin-alpha9) in mouse
embryos
results in the development of rudimentary valve leaflets characterized by
disorganized FN matrix,
short cusps, and retrograde lymphatic flow. Similar
morphological and functional defects are observed in
mice lacking the EIIIA
domain of FN. Mechanistically, we demonstrate that in primary human lymphatic
endothelial cells, the integrin-alpha9-EIIIA interaction directly regulates FN fibril assembly, which is essential
for the formation of the
extracellular matrix core of valve leaflets. Our findings reveal an important
role for
integrin-alpha9 signaling during lymphatic valve morphogenesis and
implicate it as a candidate gene for
primary lymphedema caused by valve
defects.
PMID: 19686679 [PubMed - in process
------------------
2. Nurs Stand. 2009 Jul 8-14;23(44):25.
A suitable case for treatment.
Mason MC.
Chronic lymphoedema is a common condition but its treatment is often
overlooked.
PMID: 19685788 [PubMed - in process
-------
. Ann Plast Surg. 2009 Sep;63(2):300-1.
Massive localized lymphoedema.
Hutt J, Sturley W, Jemec B.
Department of Plastic and Reconstructive Surgery, Chelsea and Westminster
Hospital, London, United
Kingdom.
A case report of massive localized lymphoedema in a morbidly obese
50-year-old woman and review of the
literature.
PMID: 19700959 [PubMed - in process
-----
2. J Mal Vasc. 2009 Aug 18. [Epub ahead of print]
[Adverse effects of compression in treatment of limb lymphedema.][Article in
French]
Vignes S, Arrault M.
Unité de lymphologie, centre national de référence
des maladies vasculaires rares, hôpital Cognacq-Jay, 15,
rue Eugène-Millon,
75015 Paris, France.
INTRODUCTION: Limb lymphedema, whether primary or secondary, is a chronic
disease. Compression
is the cornerstone of therapy and includes multilayer
low-stretch bandages and elastic garments.
Compression is usually
well-tolerated. The aim of our study was to identify all the different types of
adverse
effects of compression.
MATERIALS AND METHODS: Since January 2005, we have recorded all adverse
events occurring in
outpatients and inpatients consulting in a single
lymphology department, spontaneously reported by patient
during
consultations or physical examinations, and noted the type of compression
material used.
RESULTS: Adverse effects were secondary to poor choice of therapeutic
material, excessive pressure or
contact dermatitis. For the arms, an elastic
garment stopping at the wrist can be responsible for lymphedema
of the hand
and fingers. Rubbing of sleeve seams may cause pain and even ulcers between the
thumb and
forefinger. Open-toed elastic stockings may exacerbate digital
lymphedema, leading to the formation of
oozing lymph vesicles. Hyperpressure
may cause severe pain localized to the first and fifth toes, overlapping
toes, interdigital corns and/or ingrown toenails. Silicone-banded soft-fit
elastic garments may cause painful
phlyctena, urticaria or eczematiform
lesions. Elastic bandages may induce pain or purpuric lesions.
CONCLUSION: Compression can be responsible for adverse effects, sometimes
severe, requiring
treatment change or withdrawal. Further studies are needed
to precisely determine their frequency to
improve prescriptions and
currently available products.
PMID: 19695803 [PubMed - as supplied by publisher
-----
3. Clin Rheumatol. 2009 Aug 20. [Epub ahead of print]
Psoriatic arthritis and chronic lymphoedema: treatment efficacy by
adalimumab.
Tong D, Eather S, Manolios N.
Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia,
2145,
Lymphoedema is a rare complication of psoriatic arthritis (PsA) and
inflammatory joint disease, with no
response noted to disease-modifying
drugs. However, reports are emerging of a beneficial effect on
lymphoedema
in patients treated with tumor necrosis factor-alpha antagonists for PsA
(Etanercept),
rheumatoid arthritis (Etanercept) and ankylosing spondylitis
(Infliximab). We describe a psoriatic arthritis
patient whose lymphoedema
greatly improved following commencement of adalimumab.
PMID: 19693641 [PubMed - as supplied by publisher
-------
4. Ann Plast Surg. 2009 Sep;63(2):302-6.
Radical reduction of upper extremity lymphedema with preservation of
perforators.
Salgado CJ, Sassu P, Gharb BB, di Spilimbergo SS, Mardini S, Chen HC.
Department of Plastic Surgery, University Hospitals Cleveland/Case Western
Reserve University,
Cleveland, Ohio, USA.
Excisional procedures have been successfully utilized by different authors in
multistage treatment of upper
extremity lymphedema. We have used
microsurgical principles of perforator flap surgery in order to develop
a
one-stage procedure that enables a radical reduction of the lymphedematous
tissue with preservation of
the vascular supply to the overlying
skin.Between March 2000 and February 2007, 11 patients affected by
late
stage II lymphedema underwent radical reduction of the affected tissues with
preservation of
perforators. Perforator vessels from the radial and
posterior interosseous arteries were identified and
through medial and
lateral forearm incisions, skin flaps were raised off the underlying
lymphedematous tissue
and the affected tissue was removed off the deep
fascia. At a mean follow-up of 17.8 months the average
percentage reductions
above and below the elbow, at the wrist, and the hand were 15.1%, 20.7%, 0.5%,
and 3.6%, respectively. Statistical analysis showed significant
circumference reduction above and below the
elbow (P = 0.048 and 0.022,
respectively) but not at the wrist and hand. There were no cases of wound
breakdown, skin necrosis, or cellulitis in the postoperative period. Four
patients complained of mild
numbness confined to the vicinity of the
surgical incisions.Microvascular principles applied to the radical
excision
of the subcutaneous tissue seems to offer a new promising one-stage surgical
procedure in patients
affected by upper extremity lymphedema that has failed
conservative therapy.
PMID: 19692901 [PubMed - in process
------
5. Clin Nucl Med. 2009 Sep;34(9):585-8.
Progression of clinically stable lymphedema on lymphoscintigraphy.
Luongo JA, Scalcione LR, Katz DS, Yung EY.
Department of Radiology, Winthrop-University Hospital, Mineola, NY 11501,
USA.
Lymphedema is due to dysfunction in lymphatic transport, and is divided into
primary and secondary
subtypes. Primary lymphedema is a congenital lymphatic
abnormality or dysfunction whereas secondary
lymphedema is characterized by
pathologic disruption or obstruction of a previously-normal lymphatic
system. The stage of lymphedema is determined clinically.
Lymphoscintigraphy, however, may be used to
assess disease extent, for early
detection of disease progression, and can be used to direct therapy. We
report a case of a 56-year-old woman with clinically stable lymphedema of 5
years, yet with
lymphoscintigraphy findings compatible with disease
progression.
PMID: 19692818 [PubMed - in process
6. J Urol. 2009 Aug 17. [Epub ahead of print]
A New Technique of Concealed Penis Repair.
Sugita Y, Ueoka K, Tagkagi S, Hisamatsu E, Yoshino K, Tanikaze S.
Urology, Kobe Children's Hospital (YS, ST, EH), Kobe, Japan.
PURPOSE: Phimosis associated with concealed penis is not amenable to ordinary
circumcision. To our
knowledge we describe a new technique to repair
concealed penis.
MATERIALS AND METHODS: From September 2003 to January 2008, 57 consecutive
patients with
concealed penis were treated using our technique. Median age
at surgery was 33 months (range 7 months to
34 years). The technique consists of 3 steps. Step 1 is a ventral incision to slit the narrow ring of the prepuce
and expose the glans. Step 2 is a circumferential skin incision made
between 2 edges of the ventral diamond-
shaped skin defect, followed by
midline incision of the dorsal inner prepuce to make 2 skin flaps connected
to the glans. Step 3 is skin coverage. Two skin flaps are brought down and
sutured together on the ventral
side of the penis. The suture line between
the penile shaft skin and the flap eventually becomes elliptical.
Medical
records were reviewed for voiding function, scar formation, and replies from
older patients and the
parents of younger children about impressions of the
surgical results.
RESULTS: Median followup was 26 months. No patient had voiding problems.
Lymphedema persisted due
to suture line constriction in 2 patients who
underwent incision of the constriction. All older patients and the
parents
of younger children were satisfied with the surgical results.
CONCLUSIONS: Our new method is easy to design and perform to correct
concealed penis. It provides a
good cosmetic appearance and seems to be
applicable in all cases with deficient penile shaft skin.
PMID: 19692094 [PubMed - as supplied by publisher
----
1. Acta Oncol. 2009 Aug 27:1-8.\
Changes in arm morbidities and health-related quality of life after breast
cancer surgery - a five-year follow-
up study.
Sagen A, Kåresen R, Sandvik L, Risberg MA.
Department of Breast and Endocrine Surgery, Ullevaal University Hospital,
Oslo, Norway.
Background and purpose. Many breast cancer survivors (BCS) suffer from
long-term upper limb
morbidities after axillary node dissection. The purpose
of this five-year follow-up study was to describe
changes in long-term upper
limb morbidities, physical activity level, and Health-Related Quality of Life
(HRQoL) and to find factors that predict HRQoL five years after surgery.
Patients and methods. This study
included 204 women aged 55+/-10 years who
had primary breast cancer surgery with axillary node
dissection. The
subjects were examined for arm volumes and arm lymphedema, arm pain, sensation
of
heaviness, shoulder function, physical activity level, and HRQoL, prior
to surgery, and six months and five
years after surgery. The statistical
analyses used included ANOVA for repeated measures and multivariate
linear
regression.
Results. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper
limbs were present five
years after surgery. ALE was the only morbidity that
continued to increase over time. Several dimensions of
HRQoL temporarily
declined after surgery, but significantly improved in the period from six months
to five
years after surgery. The significant predictive factors of HRQoL
five years after surgery included HRQoL
prior to surgery, physical activity
level at leisure time (both prior to and at six months after surgery), and
duration of sick leave after surgery (in weeks). Conclusions. The overall
HRQoL improved significantly from
baseline to five years, despite the
chronic arm pain and increase in ALE. Three independent predictive
factors
of HRQoL were identified.
PMID: 19714526 [PubMed - as supplied by publisher
------
2. Singapore Med J. 2009 Aug;50(8):781-4.
Tensor fascia lata flap reconstruction in groin malignancy.
Agarwal AK, Gupta S, Bhattacharya N, Guha G, Agarwal A.
Department of General Surgery, Medical College Kolkata, 73 West Bengal,
Kolkata 700072, India. \
INTRODUCTION: Block dissection of inguinal lymph nodes is done in cases of
malignant inguinal
lymphadenopathy, which requires the removal of skin where
it is involved, or elevation of the flaps which
have precarious blood supply
leading to necrosis. Thus, wound closure presents a big challenge. It can be
done either by primary closure which is frequently complicated by necrosis,
or by split thickness skin graft
which is complicated by rejection on
radiotherapy. Another option is to cover the wound by a vascularised
pedicled graft. This prospective study was conducted after obtaining
clearance from the ethical committee.
The results were compared with the
accepted complication rates of the operation.
METHODS: We presented our experience of coverage of wounds after block
dissection of inguinal lymph
nodes for malignant deposits in 15 patients
(with median age of 46 years) by pedicled tensor fascia lata thigh
flap.
RESULTS: The results following the surgery were good. Healing was
satisfactory in all 15 cases. There
were two cases of marginal flap
necrosis, and three cases developed lymphoedema which was managed by
stockings. There were two cases of infection which were settled by
antibiotics. There were three cases of
loss of a small area of skin graft at
the donor site. There was no reported case of recurrence in the inguinal
region.
CONCLUSION: This technique of coverage of the defect after inguinal block
dissection is easy with
predictable good results.
-----
PMID: 19710976 [PubMed - in process
3. Eur J Cancer Care (Engl). 2009 Aug 25. [Epub ahead of
print]
Short- and long-term recovery of upper limb function after axillary lymph
node dissection.
Devoogdt N, VAN Kampen M, Christiaens MR, Troosters T, Piot W, Beets N, Nys
S, Gosselink R.
Department of Physiotherapy - University Hospitals Leuven, Leuven, Faculty of
Kinesiology and
Rehabilitation Sciences - Katholieke Universiteit Leuven,
Leuven, and Department of Health Care Sciences
- University College of
Antwerp, Antwerp.
All breast cancer patients, suspected with lymph node invasion, need an
axillary lymph node dissection. This
study investigated the short- and
long-term effects of the treatment for breast cancer on shoulder mobility,
development of lymphoedema, pain and activities of daily living. Patients
who had a modified radical
mastectomy (33%) or a breast-conserving procedure
(67%) in combination with axillary lymph node
dissection were included.
Shoulder mobility, lymphoedema, pain and activities of daily living were
evaluated
at 3 months and at 3.4 years after surgery. At long term, 31% of
the patients experienced impaired shoulder
mobility, 18% developed
lymphoedema, 79% had pain and 51% mentioned impaired daily activities.
Between 3 months and 3.4 years after surgery, impaired shoulder mobility
decreased from 57% to 31%.
The incidence of lymphoedema increased from 4% to
18%. Patients experienced an equal amount of pain
but fewer problems with
daily activities. At 3.4 years, no significant differences between mastectomy
and
breast-conserving procedure were found. In conclusion, at long term,
significant number of breast cancer
survivors still had impaired shoulder
mobility, developed lymphoedema, had pain and experienced difficulties
during daily activities. Shoulder mobility, pain and daily activities
evolved positively, while the incidence of
lymphoedema increased.
PMID: 19708945 [PubMed - as supplied by publisher
------
29 August 2009 - Predicting Cancer Prognosis
Researchers led by Dr. Soheil Dadras at the Stanford University Medical
Center have developed a novel
methodology to extract microRNAs from cancer
tissues. The related report by Ma et al, "Profiling and
discovery of novel
miRNAs from formalin-fixed paraffin-embedded melanoma and nodal specimens,"
appears in the September 2009 issue of the Journal of Molecular
Diagnostics.
Cancer tissues from patients are often stored by a method that involves
formalin fixation and paraffin
embedding to retain morphological definition
for identification; however, this method frequently prevents
further
molecular analysis of the tissue because of mRNA degradation. Even so, these
tissues contain high
numbers of microRNAs (miRNAs), which are short enough
(~22 nucleotides) to not be broken down
during the fixation process.
In this study, Dr. Dadras and colleagues optimized a new protocol for
extracting miRNAs from formalin-
fixed paraffin-embedded tissues. Using their
new procedure, they identified 17 new and 53 known miRNAs
from normal skin,
melanoma, and sentinel lymph nodes. These miRNAs were well-preserved in a
10-year-
old specimen. This new protocol, therefore, will allow for the
identification of novel miRNAs that may differ
in cancerous and healthy
tissue, even from long-preserved tissue, leading to better predictions of
disease
prognosis and treatment response.
Ma et al suggest that their "cloning strategy has the advantage of not only
discovering novel and known
miRNA sequence identity but also providing an
estimate of relative expression level. … [This methodology
may provide] a
more robust strategy to obtain an accurate expression profile for novel and/or
previously
characterized small RNAs from clinically defined [formalin-fixed
paraffin-embedded] tumor specimens,
thereby facilitating the discovery of
'oncomirs' as biomarkers."
Ma Z, Lui W-O, Fire A, Dadras SS: Profiling and discovery of novel miRNAs
from formalin-fixed paraffin-
embedded melanoma and nodal specimens. J Mol
Diagn 2009, 420-429
This work was supported in part by 2007 Dermatology Foundation
Dermatopathology Research Grant and
the department of Pathology research
funds at Stanford University Medical Center.
Source:
Angela Colmone
American Journal of Pathology
-----
1. Ann Acad Med Singapore. 2009 Aug;38(8):704-6.(pdf)
Patent blue dye in lymphaticovenular anastomosis.
Yap YL, Lim J, Shim TW, Naidu S, Ong WC, Lim TC.
Department of Surgery, Division of Plastic, Reconstructive and Aesthetic
Surgery, National University
Hospital, Singapore.
INTRODUCTION: Lymphaticovenular anastomosis (LVA) has been described as a
treatment of chronic
lymphoedema. This microsurgical technique is new and
technically difficult. The small caliber and thin wall
lymphatic vessels are
difficult to identify and easily destroyed during the dissection.
MATERIALS AND METHODS: We describe a technique of performing
lymphaticovenular anastomosis
with patent blue dye enhancement. Our patient
is a 50-year-old lady who suffers from chronic lymphoedema
of the upper limb
after mastectomy and axillary clearance for breast cancer 8 years ago.
RESULTS: Patent blue dye is injected subdermally and is taken up readily by
the draining lymphatic
channels. This allows for easy identification of
their course. The visualisation of the lumen of the lymphatic
vessel
facilitates microsurgical anastomosis. The patency of the anastomosis is also
demonstrated by the
dynamic pumping action of the lymphatic within the
vessels. CONCLUSION: Patent blue dye staining
during lymphaticovenular
anastomosis is a simple, effective and safe method for mapping suitable
subdermal
lymphatics, allowing for speedier dissection of the lymphatic
vessels intraoperatively. This technique also
helps in the confirmation of
the success of the lymphaticovenular anastomosis.
PMID: 19736575 [PubMed - in process
----
2. J Clin Pathol. 2009 Sep;62(9):808-11.
Massive localised lymphoedema: a clinicopathological study of 22 cases and
review of the literature.
Manduch M, Oliveira AM, Nascimento AG, Folpe AL.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester,
Minnesota 55905, USA.
BACKGROUND: Massive localised lymphoedema (MLL) is a rare, relatively
recently described
pseudosarcoma most often occurring in morbidly obese
patients. AIM: To perform a retrospective review of
all cases diagnosed as
MLL.
METHODS AND RESULTS: Clinical information was obtained. 22 morbidly obese
adults (mean patient
weight 186 kg) presented with unilateral, large soft
tissue lesions of longstanding duration. Most lesions
involved the thigh,
but also occurred in the posterior calf and lower leg. Clinically, most lesions
were
regarded as representing benign processes, including pedunculated
lipoma, lymphocoele or recurrent
cellulites, although soft tissue sarcoma
was also suspected in two cases. Grossly, all masses showed
markedly
thickened skin with a "cobblestone" appearance, and were ill-defined,
unencapsulated, lobulate,
and very large (mean size 31 cm, range 15-61.5 cm,
mean weight 3386 g, range 1133-10,800 g).
Histologically, all 22 cases
showed striking dermal fibrosis, expansion of the fibrous septa between fat
lobules with increased numbers of stromal fibroblasts, lymphatic
proliferation and lymphangiectasia.
Multinucleated fibroblastic cells,
marked vascular proliferation, moderate stromal cellularity and fascicular
growth raised concern among referring pathologists for atypical lipomatous
tumour/well differentiated
liposarcoma, angiosarcoma, and a fibroblastic
neoplasm such as fibromatosis in 10, 2 and 1 case,
respectively.
CONCLUSION: The diagnosis of MLL continues to be challenging, in particular
for pathologists.
Awareness of this entity, clinical correlation and gross
pathological correlation are essential in the separation
of this distinctive
pseudosarcoma from its various morphological mimics.
PMID: 19734477 [PubMed - in process
--------------------------
1. Plast Reconstr Surg. 2009 Sep;124(3):777-86.
Experimental assessment of autologous lymph node transplantation as treatment
of postsurgical lymphedema.
Tobbia D, Semple J, Baker A, Dumont D, Johnston M.
Brain Sciences Program, Department of Laboratory Medicine and Pathobiology,
and Molecular and Cell
Biology, Sunnybrook Health Sciences Center, Toronto,
Ontario, Canada.
BACKGROUND: The authors' objective was to test whether the transplantation of
an autologous lymph
node into a nodal excision site in sheep would restore
lymphatic transport function and reduce the magnitude
of postsurgical
lymphedema.
METHODS: As a measure of lymph transport, iodine-125 human serum albumin was
injected into prenodal
vessels at 8 and 12 weeks after surgery, and plasma
levels of the protein were used to calculate the
transport rate of the
tracer to blood (percent injected per hour). Edema was quantified from the
circumferential measurement of the hind limbs.
RESULTS: The transplantation of avascular lymph nodes at 8 (n = 6) and 12
weeks (n = 6) produced
lymphatic function levels of 12.3 +/- 0.5 and 12.6
+/- 0.8, respectively. These values were significantly less
(p < 0.001)
than those measured at similar times in the animals receiving sham surgical
procedures (16.6 +/-
0.7, n = 6; and 16.1 +/- 0.7, n = 6, respectively).
When vascularized transplants were performed, lymphatic
function was similar
to the sham controls and significantly greater (p < 0.001) than that of the
avascular
group (8 weeks, 15.8 +/- 0.9, n = 8; 12 weeks, 15.7 +/- 1.0, n =
10). Lymph transport correlated
significantly with the health of the
transplanted nodes (scaled with histologic analysis) (p < 0.0001). The
vascularized node transplants (n = 18) were associated with the greatest
clinical improvement, with the
magnitude of edema in these limbs exhibiting
significantly lower levels of edema (p = 0.039) than nontreated
limbs (n =
18).
CONCLUSIONS: The successful reimplantation of a lymph node into a nodal
excision site has the potential
to restore lymphatic function and facilitate
edema resolution. This result has important conceptual
implications in the
treatment of postsurgical lymphedema.
PMID: 19730296 [PubMed - in process
------
2. Plast Reconstr Surg. 2009 Sep;124(3):737-51.
Perforator flaps: recent experience, current trends, and future directions
based on 3974 microsurgical breast
reconstructions.
Massey MF, Spiegel AJ, Levine JL, Craigie JE, Kline RM, Khoobehi K, Erhard H,
Greenspun DT, Allen
RJ Jr, Allen RJ Sr; Group for the Advancement of Breast
Reconstruction.
The Dr. Marga Practice Group, 505 North Lake Shore Drive, Lake Point Tower
Suite 214, Chicago, IL
60611, USA. [email protected]
Perforator flap breast reconstruction is an accepted surgical option for
breast cancer patients electing to
restore their body image after
mastectomy. Since the introduction of the deep inferior epigastric perforator
flap, microsurgical techniques have evolved to support a 99 percent success
rate for a variety of flaps with
donor sites that include the abdomen,
buttock, thigh, and trunk. Recent experience highlights the perforator
flap
as a proven solution for patients who have experienced failed breast
implant-based reconstructions or
those requiring irradiation. Current trends
suggest an application of these techniques in patients previously
felt to be
unacceptable surgical candidates with a focus on safety, aesthetics, and
increased sensitization.
Future challenges include the propagation of these
reconstructive techniques into the hands of future plastic
surgeons with a
focus on the development of septocutaneous flaps and vascularized lymph node
transfers for
the treatment of lymphedema.
PMID: 19730293 [PubMed - in process
-----
3. Clin Rheumatol. 2009 Sep 1. [Epub ahead of print]
Lymphatic obstruction as a cause of extremity edema in systemic lupus
erythematosus.
Rajasekhar L, Habibi S, Sudhakar P, Gumdal N.
Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad,
Andhra Pradesh, India,
500082
Systemic lupus erythematosus (SLE) is a multisystem disease of autoimmune
origin. Lymphedema is a very
uncommon entity and has not been previously
documented in SLE. We report lymphatic obstruction
involving all four limbs
as a cause of extremity edema in a patient with SLE.
PMID: 19727913 [PubMed - as supplied by publisher
4. FASEB J. 2009 Sep 2. [Epub ahead of print] Links
Lymphangiogenesis: in vitro and in vivo models.
Bruyère F, Noë A.
Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de
Génoprotéomique Appliqué-
Cancer (GIGA-Cancer), University of Liège, Liège,
Belgium.
Lymphangiogenesis, the formation of new lymphatic vessels from preexisting
ones, is an important biological
process associated with diverse
pathologies, such as metastatic dissemination and graft rejection. In
addition, lymphatic hypoplasia characterizes lymphedema, usually a
progressive and lifelong condition for
which no curative treatment exists.
Much progress has been made in recent years in identifying molecules
specifically expressed on lymphatic vessels and in the setting up of in
vitro and in vivo models of
lymphangiogenesis. These new tools rapidly
provided an abundance of information on the mechanisms
underlying lymphatic
development and the progression of diseases associated with lymphatic
dysfunction. In
this review, we describe the common in vitro and in vivo
models of lymphangiogenesis that have proven
suitable for investigating
lymphatic biology and the interactions occurring between lymphatic vessels and
other cells, such as immune cells and cancer cells. Their rationales and
limitations are discussed and
illustrated by the most informative findings
obtained with them.-Bruyère, F., Noël, A. Lymphangiogenesis: in
vitro and in
vivo models.
PMID: 19726757 [PubMed - as supplied by publisher]
----
5. Lymphology. 2009 Jun;42(2):88-98.
Assessing lymphedema by tissue indentation force and local tissue water.
Mayrovitz HN.
Department of Physiology, College of Medical Sciences, Nova Southeastern
University, Ft. Lauderdale,
Florida 33328, USA.
Tissue water and mechanical property changes accompany lymphedema, however
the relationship between
these changes, if any, is unclear. Local tissue
water is quantifiable using the tissue's dielectric constant
(TDC), but a
non-gravity dependent handheld clinical assessment tool to easily quantify
corresponding local
tissue properties is not widely available. Herein such a
tool is described along with results obtained with it
and with TDC
measurements made in healthy legs and in lymphedematous legs before and after
one manual
lymphatic drainage (MLD) treatment. Using the handheld device,
tissue indentations to various depths could
be completed and corresponding
indentation forces (IF) recorded. Following tests in gels, foams, and 24
healthy human legs to confirm linearity and repeatability, IF and TDC were
measured in 22 legs of 18
lymphedema patients prior to and after one MLD
treatment. Results showed that pre-MLD both IF and
TDC were significantly (p
< 0.001) greater in lymphedematous legs compared to healthy legs and that
both
IF and TDC significantly (p < 0.001) decreased after MLD. However,
no correlation was found between
pretreatment IF and TDC nor between
post-MLD changes. Thus, measurements of local IF and tissue
water provide
useful but apparently independent information as to lymphedematous status and
its potential
change with therapy.
PMID: 19725274 [PubMed - in process]
-----
6. Lymphology. 2009 Jun;42(2):85-7.
Hereditary palmoplantar keratoderma associated with primary (congenital)
lymphedema.
Ogunbiyi SO, Deguara J, Moss C, Burnand KG.
Department of Academic Surgery, St Thomas' Hospital, London, UK.
The palmoplantar keratodermas are a heterogenous group of hereditary
disorders of keratinization. They are
characterized by epidermal thickening
and a yellow waxy appearance of the palms and soles. Genetic
studies have
linked various forms of palmoplantar keratoderma to markers on chromosomes one,
twelve,
and seventeen, and several genes have been identified. Primary
lymphedema is occasionally present at birth
(congenital lymphedema or
Milroy's disease), but more commonly develops at puberty (lymphedema
praecox). Genetic studies have linked various autosomal dominant forms of
primary lymphedema (Milroy's
disease and lymphedema distichiasis), to genes
on chromosomes five and sixteen respectively. We report a
case of
palmoplantar keratoderma in a child with congenital lymphedema. To our
knowledge, this has not
been previously described and may represent a new
phenotype for future genetic study.
PMID: 19725273 [PubMed - in process]
-----
7. Lymphology. 2009 Jun;42(2):51-60.
The diagnosis and treatment of peripheral lymphedema. 2009 Concensus Document
of the International
Society of Lymphology.
International Society of Lymphology.
PMID: 19725269 [PubMed - in process
------
Lymphology. 2003 Jun;36(2):84-91.
The diagnosis and treatment of peripheral lymphedema. Consensus document of
the International Society of
Lymphology.
International Society of Lymphology.
This International Society of Lymphology (ISL) Consensus Document is the
current revision of the 1995
Document for the evaluation and management of
peripheral lymphedema. It is based upon modifications
suggested and
published following the 1997 XVI International Congress of Lymphology (ICL) in
Madrid,
Spain, discussed at the 1999 XVII ICL in Chennai, India, considered
at the 2000 (ISL) Executive
Committee meeting in Hinterzarten, Germany, and
derived from integration of discussions and written
comments obtained during
and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL
Executive Committee meeting in Cordoba, Argentina. The document attempts to
amalgamate the broad
spectrum of protocols advocated worldwide for the
diagnosis and treatment of peripheral lymphedema into
a coordinated
proclamation representing a "Consensus" of the international community. The
document is not
meant to override individual clinical considerations for
problematic patients nor to stifle progress. It is also
not meant to be a
legal formulation from which variations define medical malpractice. The Society
understands that in some clinics the method of treatment derives from
national standards while in others
access to medical equipment and supplies
is limited and therefore the suggested treatments are impractical.
We
continue to struggle to keep the document concise while balancing the need for
depth and details. With
these considerations in mind, we believe that this
version of the Consensus represents the best judgment of
the ISL membership
on how to approach patients with peripheral lymphedema as of 2003. We anticipate
that the document will and should be challenged, debated in the pages of
Lymphology (e.g., as Letters to the
Editor), and ideally become a continued
focal point for robust discussion at local, national and international
conferences in lymphology and related disciplines. We further anticipate as
experience evolves and new
ideas and technologies emerge that this "living
document" will undergo periodic revision and refinement.
PMID: 12926833 [PubMed - indexed for MEDLINE
================================
1. Cancer Res. 2009 Sep 1. [Epub ahead of print]
KDR Activating Mutations in Human Angiosarcomas Are Sensitive to Specific
Kinase Inhibitors.
Antonescu CR, Yoshida A, Guo T, Chang NE, Zhang L, Agaram NP, Qin LX, Brennan
MF, Singer S,
Maki RG.
Departments of Pathology, Epidemiology and Biostatistics, Surgery, and
Medicine, Memorial Sloan-
Kettering Cancer, New York, New York.
Angiosarcomas (AS) represent a heterogeneous group of malignant vascular
tumors occurring not only in
different anatomic locations but also in
distinct clinical settings, such as radiation or associated chronic
lymphedema. Although representing only 1% to 2% of soft tissue sarcomas,
vascular sarcomas provide
unique insight into the general process of tumor
angiogenesis. However, no molecular candidates have been
identified to guide
a specific therapeutic intervention. By expression profiling, AS show distinct
up-regulation
of vascular-specific receptor tyrosine kinases, including
TIE1, KDR, SNRK, TEK, and FLT1. Full
sequencing of these five candidate
genes identified 10% of patients harboring KDR mutations. A KDR-
positive
genotype was associated with strong KDR protein expression and was restricted to
the breast
anatomic site with or without prior exposure to radiation.
Transient transfection of KDR mutants into COS-
7 cells showed
ligand-independent activation of the kinase, which was inhibited by specific KDR
inhibitors.
These data provide a basis for the activity of vascular
endothelial growth factor receptor-directed therapy in
the treatment of
primary and radiation-induced AS. [Cancer Res 2009;69(18):7175-9].
PMID: 19723655 [PubMed - as supplied by publisher]
-----
2. Orv Hetil. 2009 Sep 12;150(37):1731-8.
[Skin manifestations, treatment and rehabilitation in overweight and
obesity.][Article in Hungarian]
Wenczl E.
Fovárosi Onkormányzat Egyesített Szent István és Szent László Kórház és
Rendelointézet Borgyógyászati
és Lymphológiai Rehabilitációs Osztály
Budapest Nagyvárad tér 1. 1095.
Overweight and obesity is a public health problem in Hungary and in the
Western world. It is important to
underline that obesity is an illness and
an important risk factor for several skin and other diseases. An
overview of
skin diseases caused or aggravated by obesity (acanthosis nigricans,
acrochordons, keratosis
pilaris, hyperandrogenism, stria, adiposis dolorosa,
lymphoedema, chronic venous insufficiency, plantar
hyperkeratosis,
lipoedema, skin infections, acne inversa, psoriasis, tophi) helps us to look and
see as well.
Look for the possibility of skin infections as it helps the
early diagnosis and to avoid complications. Draw
patients' attention to the
preventive importance of skin care. In case of an obese patient the usual dosage
of
most local and systemic drugs should be modified. It must be kept in mind
that obesity directly or indirectly
starts unfavorable processes in almost
all organ systems. Therefore, only a multidisciplinary care may secure
treatment and rehabilitation of obese patients. Dermatological and
lymphological care is often part of the
rehabilitation.
PMID: 19723602 [PubMed - in process
-----
1. Hum Mutat. 2009 Sep 16. [Epub ahead of print]
Novel missense mutations in the FOXC2 gene alter transcriptional
activity.
van Steensel MA, Damstra RJ, Heitink M, Bladergroen RS, Veraart J, Steijlen
PM, van Geel M.
Departments of dermatology, Maastricht University Medical Center, Maastricht,
the Netherlands.
Mutations in the FOXC2 gene that codes for a forkhead transcription factor
are associated with primary
lymphedema that usually develops around puberty.
Associated abnormalities include distichiasis and, very
frequently,
superficial and deep venous insufficiency. Most mutations reported so far either
truncate the
protein or are missense mutations in the forkhead domain
causing a loss of function. The haplo-insufficient
state is associated with
lymphatic hyperplasia in mice as well as in humans. We analyzed the FOXC2 gene
in
288 patients with primary lymphedema and found 11 pathogenic mutations,
of which 9 are novel. Of those,
5 were novel missense mutations of which 4
were located outside of the forkhead domain. To examine their
pathogenic
potential we performed a transactivation assay using a luciferase reporter
construct driven by
FOXC1 response elements. We found that the mutations
outside the forkhead domain cause a gain of
function as measured by
luciferase activity. Patient characteristics conform to previous reports with
the
exception of distichiasis, which was found in only 2 patients out of 11.
FOXC2 mutations causing
lymphedema-distichiasis syndrome reported thus far
result in haplo-insufficiency and lead to lymphatic
hyperplasia. Our results
suggest that gain-of-function mutations may also cause lymphedema. One would
expect that in this case, lymphatic hypoplasia would be the underlying
abnormality. Patients with activating
mutations might present with Meige
disease. (c) 2009 Wiley-Liss, Inc.
PMID: 19760751 [PubMed - as supplied by publisher]
=====
2. Breast Cancer Res Treat. 2009 Sep 17. [Epub ahead
of print]
The efficacy of acupoint stimulation for the management of therapy-related
adverse events in patients with
breast cancer: a systematic review.
Chao LF, Zhang AL, Liu HE, Cheng MH, Lam HB, Lo SK.
School of Nursing, Chang Gung University, Gueishan, Taoyuan, Taiwan, ROC.
The aim of the present study was to scrutinize the evidence on the use of
acupoint stimulation for managing
therapy-related adverse events in breast
cancer. A comprehensive search was conducted on eight English
and Chinese
databases to identify clinical trials designed to examine the efficacy of
acupressure,
acupuncture, or acupoint stimulation (APS) for the management
of adverse events due to treatments of
breast cancer. Methodological quality
of the trials was assessed using a modified Jadad scale. Using
pre-
determined keywords, 843 possibly relevant titles were identified.
Eventually 26 papers, 18 in English and
eight in Chinese, satisfied the
inclusion criteria and entered the quality assessment stage. The 26 articles
were
published between 1999 and 2008. They assessed the application of
acupoint stimulation on six disparate
conditions related to anticancer
therapies including vasomotor syndrome, chemotherapy-induced nausea and
vomiting, lymphedema, post-operation pain, aromatase inhibitors-related
joint pain and leukopenia.
Modalities of acupoint stimulation used included
traditional acupuncture, acupressure, electroacupuncture,
and the use of
magnetic device on acupuncture points. Overall, 23 trials (88%) reported
positive outcomes
on at least one of the conditions examined. However, only
nine trials (35%) were of high quality; they had a
modified Jadad score of 3
or above. Three high quality trials revealed that acupoint stimulation on P6
(NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For
other adverse events, the
quality of many of the trials identified was poor;
no conclusive remarks can be made. Very few minor
adverse events were
observed, and only in five trials. APS, in particular acupressure on the P6
acupoint,
appears beneficial in the management of chemotherapy-induced
nausea and vomiting, especially in the acute
phase. More well-designed
trials using rigorous methodology are required to evaluate the effectiveness of
acupoint stimulation interventions on managing other distress symptoms.
PMID: 19760035 [PubMed - as supplied by publisher]
----------------------
1: Breast Cancer Res Treat. 2009 Sep 22. [Epub ahead of print]
Changes in the Body Image and Relationship Scale following a one-year
strength training trial for breast
cancer survivors with or at risk for
lymphedema.
Speck RM, Gross CR, Hormes JM, Ahmed RL, Lytle LA, Hwang WT, Schmitz KH.
Center for Clinical Epidemiology and Biostatistics, University of
Pennsylvania School of Medicine, 423
Guardian Drive, Blockley Hall,
Philadelphia, PA, 19104-6021, USA.
The aim of this study was to evaluate the impact of a twice-weekly strength
training intervention on
perceptions of body image in 234 breast cancer
survivors (112 with lymphedema) who participated in the
Physical Activity
and Lymphedema (PAL) trial. The study population included two hundred and
thirty-four
women randomly assigned to twice-weekly strength training or
control group that completed the 32-item
Body Image and Relationships Scale
(BIRS) at baseline and 12 months. Percent change in baseline to 12-
month
BIRS total and subscale scores, upper and lower body strength, and general
quality of life (QOL)
were compared by intervention status. A series of
multiple linear regression models including indicator
variables for
subgroups based on age, marital status, race, education, BMI, and strength
change were used
to examine differential intervention impact by subgroup.
Strength and QOL variables were assessed as
mediators of the intervention
effect on BIRS. Results: Baseline BIRS scores were similar across intervention
and lymphedema status. Significantly greater improvement in BIRS total score
was observed from baseline
to 12 months in treatment vs.. control
participants (12.0 vs. 2.0%; P < 0.0001). A differential impact of the
intervention on the Strength and Health subscale was observed for older
women (>50 years old) in the
treatment group (P = 0.03). Significantly
greater improvement was observed in bench and leg press among
treatment
group when compared to control group participants, regardless of lymphedema.
Observed
intervention effects were independent of observed strength and QOL
changes. Twice-weekly strength
training positively impacted self-perceptions
of appearance, health, physical strength, sexuality, relationships,
and
social functioning. Evidence suggests the intervention was beneficial regardless
of prior diagnosis of
lymphedema. Strength and QOL improvements did not
mediate the observed intervention effects.
PMID: 19771507 [PubMed - as supplied by publisher
-----
1. Birth Defects Res C Embryo Today. 2009 Sep 11;87(3):222-231. [Epub
ahead of print]
Lymphatic development.
Butler MG, Isogai S, Weinstein BM.
Laboratory of Molecular Genetics, National Institute of Child Health and
Human Development, National
Institutes of Health, Bethesda, Maryland
20892.
The lymphatic system is essential for fluid homeostasis, immune responses,
and fat absorption, and is
involved in many pathological processes,
including tumor metastasis and lymphedema. Despite its
importance, progress
in understanding the origins and early development of this system has been
hampered
by lack of defining molecular markers and difficulties in observing
lymphatic cells in vivo and performing
genetic and experimental manipulation
of the lymphatic system. Recent identification of new molecular
markers, new
genes with important functional roles in lymphatic development, and new
experimental models
for studying lymphangiogenesis has begun to yield
important insights into the emergence and assembly of this
important tissue.
This review focuses on the mechanisms regulating development of the lymphatic
vasculature
during embryogenesis. Birth Defects Research (Part C)
87:222-231, 2009. (c) 2009 Wiley-Liss, Inc.
PMID: 19750516 [PubMed - as supplied by publisher]
=======
2. Indian J Cancer. 2009 Oct-Dec;46(4):337-9. Links
Mechanical lymphatic drainage in the treatment of arm lymphedema.
Bordin NA, Guerreiro Godoy Mde F, Pereira de Godoy JM.
Department of the Medicine School in Sao Jose do Rio Preto-FAMERP,
Brazil.
Exercising is one of the three cornerstones in the treatment of lymphedema
together with contention
mechanisms and lymphatic drainage. The aim of the
current study was to evaluate a new method of
mechanic lymphatic drainage.
Volumetric reductions were evaluated after passive exercises in 25 patients
with arm lymphedema resulting from breast cancer treatment. Their ages
ranged between 42 and 86 years
old. All patients were submitted to one-hour
sessions using the RAGodoy(R) electromechanical apparatus
which performs
from 15 to 25 elbow bending and stretching exercises per minute. Volumetry,
using the
water displacement technique, was performed before and after the
sessions. The paired t-test was employed
for statistical analysis with an
alpha error of less than 5% being considered acceptable. The reduction in
volume was significant (P-value < 0.001) with a mean initial volume of
2026.4 and final volume of 1967.2
giving a mean loss of 59.2 mL. The
RAGodoy(R) apparatus was efficient to reduce the volume of
lymphedematous
arms and is an option for the treatment of lymphedema.
PMID: 19749466 [PubMed - in process]
------
1. Strahlenther Onkol. 2009 Oct;185(10):675-81. Epub 2009 Oct 6.
Radiochemotherapy including cisplatin alone versus cisplatin + 5-fluorouracil
for locally advanced
unresectable stage IV squamous cell carcinoma of the
head and neck.
Tribius S, Kronemann S, Kilic Y, Schroeder U, Hakim S, Schild SE, Rades
D.
Department of Radiation Oncology, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany.
BACKGROUND AND PURPOSE: The optimal radiochemotherapy regimen for advanced
head-and-neck
cancer is still debated. This nonrandomized study compares two
cisplatin-based radiochemotherapy
regimens in 128 patients with locally
advanced unresectable stage IV squamous cell carcinoma of the head
and neck
(SCCHN).
PATIENTS AND METHODS: Concurrent chemotherapy consisted of either two courses
cisplatin (20
mg/m(2)/d1-5 + 29-33; n = 54) or two courses cisplatin (20
mg/m(2)/d1-5 + 29-33) + 5-fluorouracil (5-
FU; 600 mg/m(2)/d1-5 + 29-33; n =
74).
RESULTS: At least one grade 3 toxicity occurred in 25 of 54 patients (46%)
receiving cisplatin alone and in
52 of 74 patients (70%) receiving cisplatin
+ 5-FU. The latter regimen was particularly associated with
increased rates
of mucositis (p = 0.027) and acute skin toxicity (p = 0.001). Seven of 54 (13%)
and 20 of
74 patients (27%) received only one chemotherapy course due to
treatment-related acute toxicity. Late
toxicity in terms of xerostomia, neck
fibrosis, skin toxicity, and lymphedema was not significantly different.
The
2-year locoregional control rates were 67% after cisplatin alone and 52% after
cisplatin + 5-FU (p =
0.35). The metastases-free survival rates were 79% and
69%, respectively (p = 0.65), and the overall
survival rates 70% and 51%,
respectively (p = 0.10). On multivariate analysis, outcome was significantly
associated with performance status, T-category, N-category, hemoglobin level
prior to radiotherapy, and
radiotherapy break > 1 week.
CONCLUSION: Two courses of fractionated cisplatin (20 mg/m(2)/day) alone
appear preferable, as this
regimen resulted in similar outcome and late
toxicity as two courses of cisplatin + 5-FU, but in significantly
less acute
toxicity.
PMID: 19806333 [PubMed - in process
-----------------------
2. Ann Dermatol Venereol. 2009 Oct;136(10):756-8. Epub 2009 Jun
4.
[Puffy hand syndrome due to drug addiction. Chronic Lymphoedema and long-term
intravenous drug
addiction.][Article in French]
Messikh R, Pelletier F, Bizouard N, Aubin F, Humbert P.
Service de dermatologie, CHU Saint-Jacques, 2, place Saint-Jacques, 25030
Besançon cedex, France;
Inserm U645, université de Franche-Comté,
France.
PMID: 19801268 [PubMed - in process
-------------------------------
3. Am J Surg. 2009 Oct;198(4):482-7.
Scientific Impact Award: Axillary reverse mapping (ARM) to identify and
protect lymphatics draining the
arm during axillary lymphadenectomy.
Boneti C, Korourian S, Diaz Z, Santiago C, Mumford S, Adkins L, Klimberg
VS..
Division of Breast Surgical Oncology, Department of Surgery, University of
Arkansas for Medical Sciences,
Winthrop P. Rockefeller Cancer Institute,
Little Rock, AR, USA.
INTRODUCTION: The axillary reverse mapping (ARM) procedure distinguishes
lymphatics draining the
arm from those draining the breast. The aim of this
study was to assess the ability of ARM to identify and
preserve lymphatics
draining the arm and the impact on lymphedema.
METHODS: This study included 220 patients undergoing sentinel lymph node
(SLN) biopsy (SLNB) with
or without axillary lymph node dissection (ALND)
from May 2006 to September 2008. After SLN
localization with a radioactive
tracer, blue dye was used to map ARM lymphatics. Data were collected on
identification and variations in lymphatic drainage, crossover rate, the
incidence of metastases, and nodal
status.
RESULTS: Crossover (ARM = SLN) occurred in 6 patients (2.8%). ARM lymphatics
were near or in the
SLN field in 40.6% of patients, placing it at risk for
disruption during lymphadenectomy. ARM lymphatics
juxtaposed to the hot SLNB
(n = 12 [5.6%]) were preserved. Fifteen ARM nodes were excised and were
negative even in positive axillae. There were no cases of lymphedema at
6-month follow-up where ARM
nodes were preserved.
CONCLUSION: Confluence of the arm and breast drainage is rarely the SLN, and
none of these nodes
contained metastases. Preserving the ARM nodes may
translate into a lower incidence of postoperative
lymphedema.
PMID: 19800452 [PubMed - in process
------------------------
4. Eur J Surg Oncol. 2009 Oct 1. [Epub ahead of print]
Laparoscopic assisted radical vaginal hysterectomy for cervical carcinoma:
Morbidity and long-term follow-
up.
Mehra G, Weekes A, Vantrappen P, Visvanathan D, Jeyarajah A.
Gynaecological Oncology Cancer Centre, St. Bartholomew's Hospital, London,
UK.
OBJECTIVES: To study the feasibility, morbidity and outcome of cervical
cancer patients treated with
laparoscopic assisted radical vaginal
hysterectomy (LARVH).
METHODS: The study group included 53 women with cervical cancer (stage-Ib).
They included women
undergoing LARVH at the joint cancer-centres between
1994 and 2002. Data was collected on operating-
time, nodal-yield,
hospital-stay, complications recurrence rate and survival rate. The group was
followed up
until 2006.
RESULTS: Of 53 women who were selected for LARVH, in 2 women LARVH was
abandoned when
nodes were positive at frozen section. The median age was 42
years while the operating-time was 210min
with a nodal-yield of 23 and a
hospital-stay of 5 days. Final histology revealed 10 women with
lympho-
vascular invasion, 1 nodal metastases and invasion of
parametrium/vagina in 2 women. 7 received adjuvant
radiotherapy. 3 had
chemo-radiation. Complications included voiding difficulty (6), urinary tract
infection
(5), pyrexia (4), haemorrhage (2), pain (1), port-site haematoma
(1) and nerve injury (1). Late
complications included lymphoedema (4),
urinary incontinence (4), voiding-problems (2), lymphocyst (1),
venous-thrombosis (1) and rectocele (1). The median follow-up was 41 months.
4 women had recurrence,
of which 3 women died. The five-year survival was
89%.
CONCLUSIONS: Vaginal radical hysterectomy with laparoscopic pelvic
lymphadenectomy is feasible and
safe with regards to mortality and has low
morbidity.
PMID: 19800194 [PubMed - as supplied by publisher
------
1: Trans R Soc Trop Med Hyg. 2009 Sep 29. [Epub ahead of print]
Quality of life in filarial lymphoedema patients in Colombo, Sri Lanka.
Wijesinghe RS, Wickremasinghe AR.
Department of Parasitology, Faculty of Medical Sciences, University of Sri
Jayawardenepura, Nugegoda,
Sri Lanka.
The quality of life (QOL) was assessed in 141 filarial lymphoedema patients
and 128 healthy people in the
Colombo district of Sri Lanka. Information was
gathered by administering the validated translated version of
the WHO
100-item QOL questionnaire (WHOQOL-100), which ascertains an individual's
perception of
QOL in the physical, psychological, level of independence,
environmental and spiritual domains, as well as
the general QOL. Healthy
controls had a better QOL in all domains as well as in the overall general QOL,
when compared to patients with lymphoedema. Several facets such as pain and
discomfort, sleep and rest,
activities of daily living, dependence on
medication and treatment, working capacity and social support were
significantly affected by the acute adenolymphangitis attack/s patients had
suffered. The environmental and
spiritual domains were significantly
affected by the maximum grade of lymphoedema. The significant
difference in
the QOL as perceived by patients suffering from filarial lymphoedema and
apparently healthy
individuals reiterates the importance of morbidity
control in patients already affected by filarial lymphoedema.
PMID: 19796782 [PubMed - as supplied by publisher
------
1. Photomed Laser Surg. 2009 Oct 7. [Epub ahead of
print]
The Effect of Laser Irradiation on Proliferation of Human Breast
Carcinoma, Melanoma, and Immortalized
Mammary Epithelial Cells.
Powell K, Low P, McDonnell PA, Laakso EL, Ralph SJ.
1 School of Medical Science, Griffith University , Gold Coast, Queensland,
Australia .
Abstract Objective: This study compared the effects of different doses
(J/cm(2)) of laser phototherapy at
wavelengths of either 780, 830, or 904 nm
on human breast carcinoma, melanoma, and immortalized human
mammary
epithelial cell lines in vitro. In addition, we examined whether laser
irradiation would malignantly
transform the murine fibroblast NIH3T3 cell
line.
Background: Laser phototherapy is used in the clinical treatment of breast
cancer-related lymphoedema,
despite limited safety information. This study
contributes to systematically developing guidelines for the safe
use of
laser in breast cancer-related lymphoedema.
Methods: Human breast adenocarcinoma (MCF-7), human breast ductal carcinoma
with melanomic
genotypic traits (MDA-MB-435S), and immortalized human
mammary epithelial (SVCT and Bre80hTERT)
cell lines were irradiated with a
single exposure of laser. MCF-7 cells were further irradiated with two and
three exposures of each laser wavelength. Cell proliferation was assessed 24
h after irradiation.
Results: Although certain doses of laser increased MCF-7 cell proliferation,
multiple exposures had either no
effect or showed negative dose response
relationships. No sign of malignant transformation of cells by laser
phototherapy was detected under the conditions applied here. Conclusion:
Before a definitive conclusion can
be made regarding the safety of laser for
breast cancer-related lymphoedema, further in vivo research is
required.
PMID: 19811082 [PubMed - as supplied by publisher]
------------
Breast Cancer. 2009 Sep 30. [Epub ahead of print]
A multicentre cross-sectional study of arm lymphedema four or more years
after breast cancer treatment in
Iranian patients.
Haddad P, Farzin M, Amouzegar-Hashemi F, Kalaghchi B, Babazadeh S, Mirzaei
HR, Mousavizadeh A,
Harirchi I, Rafat J.
Department of Radiation Oncology, Cancer Institute, Tehran University of
Medical Sciences, P.O. Box
13145-158, Tehran, Iran, [email protected].
BACKGROUND: We performed a cross-sectional multicentre study to assess the
prevalence of
lymphedema after breast cancer treatment in Iran.
PATIENTS AND METHODS: All female breast cancer patients who attended our
follow-up clinics four or
more years after their surgery with no sign of
disease were asked to participate in this study. Lymphedema
was defined as
an increase of 10% in the circumference of the arm on the involved side compared
to the
opposite arm.
RESULTS: The total number of patients participating in this study was 355.
The prevalence of lymphedema
in the study patients was 17.5%, with the rate
varying significantly (between 4 and 21%) among the three
study centres (p =
0.007). The mean number of months post surgery was larger for patients with
lymphedema (84 months) than for those without (79 months), though this was
not statistically significant (p >
0.1). The relationships of various
treatment factors and the education levels of the patients to the presence of
lymphedema were also evaluated. None of the observed differences were
statistically significant aside from
those for the type of surgery
(mastectomy vs. conservative surgery, p = 0.055), treatment with radiotherapy
(p = 0.099), and prescription of a supraclavicular radiation field (p =
0.057), which were only just significant.
CONCLUSION: The rate of lymphedema in our patients was 17.5%, ranging from 4
to 21% in different
study centres. Time post surgery, treatment with
radiotherapy and the technique used, and nodal radiation
seem to be factors
that are related to this large variation.
PMID: 19789952 [PubMed - as supplied by publisher]
------------------------
2. Breast Cancer. 2009 Sep 30. [Epub ahead of print]
Axillary reverse mapping for preventing lymphedema in axillary lymph node
dissection and/or sentinel lymph
node biopsy.
Noguchi M.
Department of Breast and Endocrine Surgery, Kanazawa Medical University
Hospital, Uchinada, Ishikawa,
920-0293, Japan, [email protected].
PMID: 19789947 [PubMed - as supplied by publisher]
--------------------------
3. Lymphat Res Biol. 2009;7(3):153-8.
Local Tissue Water in At-Risk and Contralateral Forearms of Women with and
without Breast Cancer
Treatment-Related Lymphedema.
Mayrovitz HN, Weingrad DN, Davey S.
1 College of Medical Sciences, Health Professions Division, Nova Southeastern
University , Davie, Florida .
Abstract Background: Quantitative measurements to help detect incipient or
latent lymphedema in patients at
risk for breast cancer treatment-related
lymphedema (BCRL) are potentially useful supplements to clinical
assessments. Suitable measurements for routine use include arm volumes, arm
bioimpedance, and local
tissue water (LTW) determined from the tissue
dielectric constant (TDC). Because BCRL initially develops
in skin and
subcutis, measures that include whole arms may not be optimally sensitive for
detecting the
earliest changes. Thus, there is also a need for a local
measurement in which tissues most likely to
demonstrate early lymphedematous
changes can be more selectively assessed. The TDC method satisfies
this
criterion. Our goal was to use this method to compare arm-to-arm differences in
LTW within and
among women grouped as healthy normal (HN), diagnosed with
breast cancer (BC), but prior to surgery
and established unilateral
lymphedema (LE). Methods and Results: LTW was determined on both anterior
forearms to a measurement depth of 2.5 mm in 30 women of each group. TDC arm
ratios were determined
as dominant/nondominant for HN and BC,
at-risk/contralateral for BC, and lymphedematous/contralateral
for LE.
Results showed that TDC values for all arms except lymphedematous arms were very
similar and
insignificantly different with values among arms (mean +/- SD)
ranging from 24.9 +/- 3.8 to 25.7 +/- 3.8.
Arm ratios did not differ between
HC and BC whereas dominant/non-dominant arm ratios for HN and BC
separately
and combined (1.006 +/- 0.085) were significantly less than the
lymphedematous/contralateral
ratio of the LE group (1.583 +/- 0.292).
Conclusions: The findings indicate that LTW of at-risk arms is not
affected
by breast cancer and that lymphedema does not significantly affect LTW of
contralateral arms as
measured with the TDC method. Further, based on the
standard deviation of measured arm ratios, an at-
risk/contralateral TDC
ratio of 1.26 is suggested as a possible threshold for detecting preclinical or
latent
lymphedema.
PMID: 19778203 [PubMed - in process
---------------------
4. Lymphat Res Biol. 2009;7(3):145-51.
Histological findings compared with magnetic resonance and ultrasonographic
imaging in irreversible
postmastectomy lymphedema: a case study.
Tassenoy A, De Mey J, Stadnik T, De Ridder F, Peeters E, Van Schuerbeek P,
Wylock P, Van Eeckhout
GP, Verdonck K, Lamote J, Baeyens L, Lievens P.
1 Department of Rehabilitation Research, Free University Brussels , Brussels,
Belgium .
Abstract Postmastectomy edema is a current complication after axillary lymph
node dissection in cases of
breast cancer treatment. Staging is important in
order to select those patients who can benefit from complex
physical therapy
(CPT). Different imaging techniques can be used to evaluate the edema.
Ultrasonography
(US) is a harmless, cheap, and easily applicable technique
to visualize the dermal and subcutaneous tissue,
but interpretation of the
obtained images is not always evident. The aim of this study was to compare
ultrasound images of irreversible edema with tissue histology, magnetic
resonance imaging (MRI) and
magnetic resonance spectroscopy (MRS).
Ultrasonographic images of the edematous dermis show an
homogeneous
hypoechogenic dermal layer that appears on tissue histology to be less compact,
due to the
excess of fluid in the interstitium separating the collagen
fibres and making it more transparent on light
microscopy. MRI of the dermis
gives a hyperintense signal, indicating the presence of fluid. In the subcutis,
increase of the adipose tissue could be observed on US, MRI, and tissue
histology. In the case of
lymphedema, the area and perimeter of fat cells is
significantly (p < 0.05) increased. Hypoechogenic areas
near the muscle
fascia are registrated on US corresponding with epifascial fluid on MRI, and
hyperechogenic branches are embedded within the adipose tissue, on tissue
histology seen as large fibrotic
septa enclosing adipose cells. MRI has a
honeycomb picture corresponding with fluid bound to fibrosis.
PMID: 19778202 [PubMed - in process
---------------------
5. Rev Med Liege. 2009 Jul-Aug;64(7-8):409-13.
[Angiosarcoma consecutive to chronic lymphoedema: a Stewart-Treves
syndrome]
[Article in French]
Gonne E, Collignon J, Kurth W, Thiry A, Henry F, Jerusalem G, Gennigens
C.
Université de Liège, Belgique.
The Stewart-Treves Syndrome is defined as an angiosarcoma (very aggressive
malignant tumor originating
from endothelial cells) appearing in a specific
clinical setting. This tumor develops in patients suffering from
chronic
lymphedema of the upper limb following mastectomy and axillary lymph node
dissection for breast
cancer. The diagnosis relies on medical history,
clinical examination and a histological assesment (biopsy or
resection).
This syndrome represents a rare clinical entity. Unfortunately, the prognosis is
poor. A large
surgical resection is the treatment of choice if the patient is a candidate for a surgical resection with a curative
intent Radiotherapy
is sometimes used as a palliative local treatment. Chemotherapy is only used in
more
advanced cases, not curable by surgery alone.
PMID: 19777923 [PubMed - in process
----
1. Acta Oncol. 2009 Oct 20. [Epub ahead of print]
Arm/shoulder problems in breast cancer survivors are associated with reduced
health and poorer physical
quality of life.
Nesvold IL, Fosså SD, Holm I, Naume B, Dahl AA.
Department of Clinical Cancer Research, Oslo University Hospital,
Rikshospitalet, 0310 Oslo, Norway.
Abstract Background. Except for lymphedema, the consequences of arm/shoulder
problems (ASPs), at
long-term in breast cancer survivors (BCSs) have hardly
been studied. We examined demography, lifestyle,
quality of life (QoL) and
somatic morbidity in BCSs with and without ASPs. We also compared the
associations of restricted shoulder abduction and lymphedema with QoL.
Methods. We used a cross-sectional case-control design. A sample of 256 BCSs
all with lymph node
metastases were examined at a mean of 4.1 (SD 0.9) years
post-surgery. Based on objective examinations
and self-rating the sample
were separated into 81 BCSs (32%) with definite ASP (ASP+ group) and 175
(68%) with minimal or no ASP (ASP- group). The self-rating contained among
other schedules the Short
Form-36 (SF-36) and the Kwan's arm/shoulder
problem scale (KAPS).
Results. In univariate analysis ASP+ was associated with not being employed,
having had mastectomy,
longer follow-up time, radiotherapy to axilla, poorer
self-rated health and physical condition, minimal
physical activity,
increased body mass index, regularly intake of analgesics, and poorer physical
QoL.
Multivariate analysis showed that mastectomy, longer follow-up time,
minimal physical activity and poorer
physical QoL were associated with
belonging to ASP- group. All domains of the SF-36 were significantly
associated with having impaired shoulder abduction (>/=25 degrees
difference) while none of the
associations with lymphedema were significant.
Discussion. In BCSs, at four years after treatment, having
ASP was
associated with mastectomy, minimal physical activity and poorer physical QoL.
Poor physical
QoL is strongly associated with reduced shoulder abduction
rather than with lymphedema.
PMID: 19842790 [PubMed - as supplied by publisher]
-----------------------
2. Breast Cancer Res Treat. 2009 Oct 20. [Epub ahead of
print]
Axillary reverse mapping for breast cancer.
Noguchi M.
Department of Breast and Endocrine Surgery, Kanazawa Medical University
Hospital, Uchinada-daigaku 1-
1, Ishikawa, 920-0293, Japan, [email protected].
The axillary reverse mapping (ARM) technique has been developed to map and
preserve arm lymphatic
drainage during axillary lymph node dissection (ALND)
and/or sentinel lymph node (SLN) biopsy, thereby
minimizing arm lymphedema.
However, several problems remain to be resolved in the practical application
of this technique. This article presents a review of current knowledge
regarding ARM and discusses the
practical applicability and relevance of
this technique. Identification rates of ARM nodes were insufficient
using
blue dye. Although this was improved using radioisotopes, radioisotopes alone do
not permit visual
mapping of ARM lymphatics. Fluorescence imaging may be
useful to improve the identification rate of ARM
nodes and lymphatics. On
the other hand, the ARM nodes may be involved with metastatic foci in patients
with extensive axillary lymph node metastases. Moreover, the SLN draining
the breast may be the same as
the ARM node draining the upper extremity in a
minority of patients. These issues represent important
drawbacks of the ARM
procedure. The success of ARM in reducing lymphedema has not yet been
determined. Further studies are needed before this can be accepted as a
standard procedure in surgical
management of breast cancer.
PMID: 19842033 [PubMed - as supplied by publisher
---------
1. Int J Neurosci. 2009;119(8):1105-1117.
Effects of Manual Lymph Drainage on Cardiac Autonomic Tone in Healthy
Subjects.
Kim SJ, Kwon OY, Yi CH.
Department of Physical Therapy, Kangwon National University, Kangwon-do,
245-711, Republic of
Korea.
This study was designed to investigate the effects of manual lymph drainage
on the cardiac autonomic tone.
Thirty-two healthy male subjects were
randomly assigned to manual lymph drainage (MLD) (experimental)
and rest
(control) groups. Electrocardiogram (ECG) parameters were recorded with bipolar
electrocardiography using standard limb lead positions. The pressure-pain
threshold (PPT) was
quantitatively measured using an algometer. Heart rate
variability differed significantly between the
experimental and control
groups (p < 0.05), but the PPT in the upper trapezius muscle did not (p >
0.05).
These findings indicate that the application of MLD was effective in
reducing the activity of the sympathetic
nervous system.
PMID: 19922342 [PubMed - as supplied by publisher
------
1. 2009 Nov 18 - Subjective Assessment of Pregnancy Impact on Primary
Lower Limb Lymphedema.
Vignes S, Arrault M, Porcher R.
Objective: To analyze subjective influence of pregnancy on lower limb
lymphedema.
Method: Cross-sectional study on 49 affected women was conducted in a single
lymphology department
between January 2002 and December 2006. All women were
asked whether their lymphedema had
worsened during pregnancy.Results: Mean
age at lymphedema onset was 17 years, with no familial history
of
lymphedema. Lymphedema was unilateral for 30 women and bilateral for 19. Median
age at the first
delivery was 28 years. Eighteen women had only 1 pregnancy,
23 women had only 2, and 8 women had 3.
For the first pregnancy, birth
weight was 3.4 kg. Subjective lymphedema worsening was reported by 5
women
after the first pregnancy compared to 44 women without worsening (P = ..006) and
after 10 (11%)
of the 88 pregnancies (1 twin birth) involving 9 women.
During the median 18 years since the first
pregnancy, only a 14-year-old boy
has developed bilateral lymphedema.
Conclusion: Pregnancy did not significantly exacerbate primary lower limb
lymphedema.
PMID: 19926624 [PubMed - as supplied by publisher
-----
2. 2009 Nov;9 - Topics of physiological and pathophysiological
functions of lymphatics.
Kawai Y, Ohhashi T.
Department of Physiology, Shinshu University School of Medicine, 3-1-1 Asahi,
Matsumoto 390-8621,
Japan.
We have reviewed physiological significance of rhythmical spontaneous
contractions of collecting lymphatics,
which play an important role in lymph
transport and seem to regulate lymph formation through changing the
pacemaker sites of the rhythmic contractions and conractile patterns of
lymphangions. Next, we reported
experimental findings that the wall
effective permeability of hydrophilic substances labelled with fluorescent
dyes was evaluated in an isolated cannulated rat single lymphatic using a
microscope system. With the
experimental evidence, we have discussed
physiological significance and crucial roles of the enrichment of
albumin in
lymph through the wall of small lymphatics in regulation of innate immunity. In
addition, we have
described the mode of action of recanalization of
collecting lymphatics after excision of lymph node with
special reference to
clinical treatment for surgical removal of lymph nodes-mediated secondary
lymphedema.
Finally, we have addressed the possibility that primary tumor
cells and/or metastatic carcinoma cells
themselves release key chemical
substances to develop environment suitable for micro-metastasis in sentinel
lymph node.
PMID: 19925407 [PubMed - in process
-----
3. 2009 Nov 18 - Longitudinal change of treatment-related upper limb
dysfunction and its impact on late
dysfunction in breast cancer survivors: A
prospective cohort study.
Yang EJ, Park WB, Seo KS, Kim SW, Heo CY, Lim JY.
Department of Rehabilitation Medicine, Seoul National University College of
Medicine, Seoul National
University Bundang Hospital, Gyeonggi-do, Republic
of Korea.
BACKGROUND AND OBJECTIVES: To investigate the prevalence of upper limb
dysfunction (ULD)
and subtypes after breast cancer surgery and to identify
factors associated with late ULD.
METHODS: Among 191 enrolled patients, 191 were evaluated at 3 months, 187 at
6 months, and 183 at
12 months after surgery. Pain, shoulder range of
motion, muscle strength, and arm circumference were
assessed. Based on
symptoms and physical examinations, the types of ULD common after breast cancer
treatment were diagnosed and categorized.
RESULTS: The prevalence of ULD after surgery were 24.6%, 20.9%, and 26..8% at
3, 6, and 12 months,
respectively. The most common types of ULD were
pectoralis tightness at 3 and 6 months and lymphedema
at 12 months. Patients
with pectoralis tightness or lymphedema at 3 or 6 months showed a higher
prevalence
of rotator cuff disease at 12 months compared with those without
early pectoralis tightness or lymphedema.
CONCLUSIONS: The major post-operative ULD were pectoralis tightness at 3 and
6 months and
lymphedema at 12 months. Late ULD such as rotator cuff disease
were associated with pectoral tightness or
lymphedema at earlier stages.
Diagnosis and treatment of ULD should take place as soon as possible after
surgery. J. Surg. Oncol. (c) 2009 Wiley-Liss, Inc.
PMID: 19924721 [PubMed - as supplied by publisher
-----
4. 2009 Oct 12 - Selenium in oncology: from chemistry to clinics.
Micke O, Schomburg L, Buentzel J, Kisters K, Muecke R.
Department of Radiotherapy and Radiation Oncology, Franziskus Hospital,
Kiskerstrasse 26, D- 33615
Bielefeld, Germany.
The essential trace element selenium, which is a crucial cofactor in the most
important endogenous
antioxidative systems of the human body, is attracting
more and more the attention of both laypersons and
expert groups. The
interest of oncologists mainly focuses in the following clinical aspects:
radioprotection of
normal tissues, radiosensitizing in malignant tumors,
antiedematous effect, prognostic impact of selenium, and
effects in primary
and secondary cancer prevention. Selenium is a constituent of the small group of
selenocysteine-containing selenoproteins and elicits important structural
and enzymatic functions. Selenium
deficiency has been linked to increased
infection risk and adverse mood states. It has been shown to
possess
cancer-preventive and cytoprotective activities in both animal models and
humans. It is well
established that Se has a key role in redox regulation
and antioxidant function, and hence in membrane
integrity, energy metabolism
and protection against DNA damage. Recent clinical trials have shown the
importance of selenium in clinical oncology. Our own clinical study
involving 48 patients suggest that
selenium has a positive effect on
radiation-associated secondary lymphedema in patients with limb edemas,
as
well as in the head and neck region, including endolaryngeal edema. Another
randomized phase III study
of our group was performed to examine the
cytoprotective properties of selenium in radiation oncology. The
aim was to
evaluate whether sodium selenite is able to compensate a preexisting selenium
deficiency and to
prevent radiation induced diarrhea in adjuvant
radiotherapy for pelvic gynecologic malignancies. Through this
study, the
significant benefits of sodium selenite supplementation with regards to selenium
deficiency and
radiotherapy induced diarrhea in patients with cervical and
uterine cancer has been shown for the first time in
a prospective randomized
trial. Survival data imply that supplementation with selenium does not interfere
with the positive biological effects of radiation treatment and might
constitute a valuable adjuvant therapy
option especially in marginally
supplied individuals. More recently there were emerging concerns coming up
from two large clinical prevention trials (NPC, SELECT), that selenium
increases the possible risk of
developing diabetes type II. Despite obvious
flaws of both studies and good counterarguments, a
controversial debate
remains on the possible advantage and risks of selenium in cancer prevention.
However, in the light of the recent clinical trials the potential benefits
of selenium supplementation in tumor
patients are undeniable, even if
further research is needed.
PMID: 19924043 [PubMed - in process]
-----
1. Eur J Dermatol. 2009 Nov 17. [Epub ahead of print]
Mushroom-like soft fibromas on chronic leg lymphedema.
Nakamura S, Hashimoto Y, Nishi K, Takeda K, Takahashi H, Mizumoto T, Iizuka
H.
PMID: 19919910 [PubMed - as supplied by publisher
------
2. Cases J. 2009 Sep 1;2:6887.
Lymphangiosarcoma of the arm presenting with lymphedema in a woman 16 years
after mastectomy: a case
report.
Sepah YJ, Umer M, Qureshi A, Khan S.
Department of Surgery (Orthopedics), Aga Khan University Medical College P.O.
Box 3500, Karachi-
74800 Pakistan.
Lymphangiosarcoma following breast cancer is a relatively rare entity, with
around 300 cases so far
reported worldwide. Affecting the long term
survivors of breast cancer, lymphangiosarcoma (Stewart-
Traves Syndrome) has
a high mortality rate. Since lympedema following radical mastectomy or axillary
clearance and radiotherapy seems to be the main predisposing factor, further
research regarding
modifications in the surgical technique of axillary nodes
dissection as well as the development of new
chemotherapeutic agents
effective in lymphangiosarcoma are required.
PMID: 19918554 [PubMed - in process
-----
3. Cancer Invest. 2009 Nov 16. [Epub ahead of print]
Assessment of Breast Cancer-Related Arm Lymphedema-Comparison of Physical
Measurement Methods
and Self-Report.
Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, Kilbreath
SL.
Faculty of Health Sciences, University of Sydney, Sydney, Australia1.
ABSTRACT
Purpose: To determine the relationship between physical methods of measuring
lymphedema and self-
reported swelling, their reliability, and standard error
of measurement. Method: Lymphedema in each arm of
women with (n = 33) and
without (n = 18) unilateral arm lymphedema, secondary to breast cancer was
measured by self-report, bioimpedance spectroscopy (BIS), perometer, and the
truncated cone method.
Results: The physical measurement tools were highly reliable (ICC((2,1)):
0.94 to 1.00) with high
concordance (r(c): 0.89 to 0.99). Selfreport
correlatedmoderately with physical measurements (r = 0.65 to
0.71) and was
moderately reliable (ICC((2,1)): 0.70).
Conclusions: Lymphedema assessment methods are concordant and reliable but
not interchangeable.
PMID: 19916749 [PubMed - as supplied by publisher
-----
4. Urol Oncol. 2009 Nov 12. [Epub ahead of print]
Diffuse lymphangiomatosis with genital involvement-evaluation with magnetic
resonance lymphangiography.
Lohrmann C, Foeldi E, Langer M.
Department of Radiology, University Hospital of Freiburg, Freiburg,
Germany.
OBJECTIVE: To assess, for the first time, the morphology of the lymphatic
system in patients with diffuse
lymphangiomatosis and genital involvement by
magnetic resonance lymphangiography (MRL).
MATERIALS AND METHODS: Ten patients with diffuse lymphangiomatosis and
genital involvement were
examined by MRL. Three locations were examined:
first, the lower leg and foot region; second, the upper
leg and the knee
region; and third, the pelvic with retroperitoneal region. MR imaging was
performed with a
1.5-T system equipped with high-performance gradients. For
MRL, a T1-weighted 3D-spoiled gradient-
echo and a T2-weighted 3D-TSE
sequence were used.
RESULTS: The size of the genital lymphangiomas, which were revealed in all
patients, varied between 6 and
85 mm. In 60% of the patients, lymphangiomas
were additionally detected at the level of the lower legs, and
in 70%
patients at the level of the upper leg. Furthermore, lymphangiomas were seen in
the inguinal and
retroperitoneal regions in 80%, and in the pelvic region
and anterior abdominal wall in 90% of the patients
examined. The genital
lymphangiomas feeding lymphatic vessels were detected in 80% of the patients in
the
anterior abdominal wall and in 90% of the patients in the inguinal and
pelvic regions; 90% of the patients
suffered consecutively from a lymphedema
of the lower extremities. All patients suffered from recurrent
infections in
the genital region; 80% of the patients repeatedly experienced genital
lymphorrhea due to
lympho-cutaneous fistulas and lymphcysts.
CONCLUSION: MRL is a safe and accurate minimal-invasive imaging modality for
the evaluation of the
lymphatic circulation in patients with diffuse
lymphangiomatosis and genital involvement. Because the site and
extent of
the lymphangiomas with their feeding lymphatic vessels are important prognostic
factors,
performing radiologic evaluation with a high resolution is crucial
for the therapeutic planning of patients.
PMID: 19914101 [PubMed - as supplied by publisher
-----
5. Eur J Radiol. 2009 Nov 11. [Epub ahead of print]
Assessment of the lymphatic system in patients with diffuse lymphangiomatosis
by magnetic resonance
imaging.
Lohrmann C, Foeldi E, Langer M.
Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse
55, D-79106 Freiburg i. Br.,
Germany.
OBJECTIVE: To assess the lymphatic system in patients with diffuse
lymphangiomatosis by magnetic
resonance imaging.
MATERIALS AND METHODS: 15 patients with diffuse lymphangiomatosis were
examined by magnetic
resonance imaging. Three locations were examined:
first, the lower leg and foot region; second, the upper
leg and the knee
region; and third, the pelvic with retroperitoneal and abdominal region. For
magnetic
resonance lymphangiography a T1-weighted 3D spoiled gradient-echo
and a T2-weighted 3D-TSE
sequence was used.
RESULTS: The size of the genital lymphangiomas, which were revealed in all
patients, varied between 5 and
83mm. In 47% of the patients lymphangiomas
were detected at the level of the lower legs, and in 87% of
the patients at
the level of the upper leg and retroperitoneum. Furthermore, lymphangiomas were
seen in the
inguinal and pelvic region in 100% and intraabdominally in 40%
of the patients. The lymphangiomas
extended into the abdominal wall in 93%
of the examined patients. A chylous pleural effusion was revealed
in 20% and
a chylous ascites in 13% of patients. 93% of patients suffered due to the
diffuse
lymphangiomatous pathologies from a lymphedema of the lower
extremities, while a generalized
lymphedema of the trunk was found in 87% of
the patients.
CONCLUSION: Magnetic resonance imaging is a safe and accurate
minimal-invasive imaging modality for
the evaluation of the lymphatic system
in patients with diffuse lymphangiomatosis. Since the localization and
extension of the lymphangiomas are important prognostic factors, it is
crucial to perform a safe radiologic
evaluation with a high resolution for
the patient's therapeutic planning.
PMID: 19913379 [PubMed - as supplied by publisher
-----
6. Hum Genet. 2009 Nov 13. [Epub ahead of print]
Linkage and sequence analysis indicate that CCBE1 is mutated in recessively
inherited generalised lymphatic
dysplasia.
Connell F, Kalidas K, Ostergaard P, Brice G, Homfray T, Roberts L, Bunyan DJ,
Mitton S, Mansour S,
Mortimer P, Jeffery S; Lymphoedema Consortium.
Medical Genetics Unit, Clinical Developmental Sciences, St George's
University of London, Cranmer
Terrace, London, SW17 0RE, UK.
Generalised lymphatic dysplasia (GLD) is characterised by extensive
peripheral lymphoedema with visceral
involvement. In some cases, it presents
in utero with hydrops fetalis. Autosomal dominant and recessive
inheritance
has been reported. A large, non-consanguineous family with three affected
siblings with
generalised lymphatic dysplasia is presented. One child died
aged 5 months, one spontaneously miscarried
at 17 weeks gestation, and the
third has survived with extensive lymphoedema. All three presented with
hydrops fetalis. There are seven other siblings who are clinically
unaffected. Linkage analysis produced two
loci on chromosome 18, covering 22
Mb and containing 150 genes, one of which is CCBE1. A
homozygous cysteine to
serine change in CCBE1 has been identified in the proband, in a residue that is
conserved across species. High density SNP analysis revealed homozygosity (a
region of 900 kb) around
the locus for CCBE1 in all three affected cases.
This indicates a likely ancestral mutation that is common to
both parents;
an example of a homozygous mutation representing Identity by Descent (IBD) in
this pedigree.
Recent studies in zebrafish have shown this gene to be
required for lymphangiogenesis and venous sprouting
and are therefore
supportive of our findings. In view of the conserved nature of the cysteine, the
nature of
the amino acid change, the occurrence of a homozygous region
around the locus, the segregation within the
family, and the evidence from
zebrafish, we propose that this mutation is causative for the generalised
lymphatic dysplasia in this family, and may be of relevance in cases of
non-immune hydrops fetalis.
PMID: 19911200 [PubMed - as supplied by publisher
------
1. Cases J. 2009 Oct 24;2:165.
Nonclassical yellow nail syndrome in six-year-old girl: a case report.
Cebeci F, Celebi M, Onsun N.
Department of Dermatology, Vakif Gureba Training and Research Hospital,
Istanbul, Turkey.
INTRODUCTION: The yellow nail syndrome is usually described as the
combination of yellow nails with
lymphoedema and often with respiratory
manifestations such as pleural effusions, chronic sinusitis and
bronchiectasis. The syndrome is most often seen in the middle-aged
individuals.
CASE PRESENTATION: We present a 6-year-old girl with yellow nail syndrome
having pansinusitis and
bronchiectasis.
CONCLUSION: The components comprising the classical triad of yellow nail
syndrome in children may not
necessarily be present altogether. Therefore,
yellow nail syndrome should be suspected in children having
only typical
nail changes.
PMID: 19946476 [PubMed - in process
----
2. Aesthet Surg J. 2009 Nov-Dec;29(6):513-22.
Does thighplasty for upper thigh laxity after massive weight loss require a
vertical incision?
Shermak MA, Mallalieu J, Chang D.
Division of Plastic Surgery, Johns Hopkins Bayview Medical Center, Baltimore,
MD 21224, USA.
[email protected]
Comment in:
•Aesthet Surg J. 2009 Nov-Dec;29(6):522-3.
BACKGROUND: After massive weight loss (MWL), many patients present with
concerns about skin
excess and laxity. The thigh is one of the more complex
regions to address in MWL patients because of the
differing degree,
location, and quality of skin excess and fatty tissue, as well as surgical risk
factors.
OBJECTIVE: The authors describe a technique called the anterior proximal
extended (APEX) thighlift to
effectively treat upper thigh skin excess with
a hidden scar while also enhancing adjacent body regions.
METHODS: A review was performed of 97 MWL patients who underwent thighlift
surgery between March
1998 and October 2007. Eighty-six women and 11 men,
with average weight loss of 146 lb and average
body mass index (BMI) at
contouring of 29.8, were included in the study. The risk factors that were
assessed included age, gender, medical conditions, tobacco use, BMI, weight
of skin excised, and surgery
performed. The outcomes that were assessed
included wound healing and lymphedema. Extended vertical
thighlift was
performed in 11 patients and anterior superior thighlift in 86 patients.
RESULTS: Complications
of thighlift included wound healing problems (n = 18;
18.6%); lymphedema (n = 8; 8.3%); cellulitis (n = 7;
7.2%); seroma (n = 3;
3.1%); and bleeding (n = 1; 1%). On multivariate statistical analysis, age and
BMI
were found to impair healing in the entire thighlift group. For patients
with a BMI greater than or equal to 35,
the odds ratio (OR) for a wound
healing complication was 13.7 (P = .03). Hypothyroidism was strongly
associated with lymphedema, with an OR of 23 (P = .06). Extended thighlift
trended toward lymphedema
(OR = 16.7; P = .08). CONCLUSIONS: Thighlift can
be a satisfying procedure for both the patient and
surgeon because it
provides aesthetic improvement in terms of skin excess and laxity. The APEX
thighlift is a
new technique that expands upon those previously described in
the literature to effectively treat upper thigh
laxity with a hidden scar
after MWL.
PMID: 19944997 [PubMed - in process
----
1. Lymphology. 2009 Sep;42(3):146-7.
The diagnosis and treatment of peripheral lymphedema.
Piller N, Carati C.
Comment on:
•Lymphology. 2009 Jun;42(2):51-60.
PMID: 19938271 [PubMed - in process]
-----
2. Nat Genet. 2009 Dec;41(12):1272-4.
Mutations in CCBE1 cause generalized lymph vessel dysplasia in humans.
Alders M, Hogan BM, Gjini E, Salehi F, Al-Gazali L, Hennekam EA, Holmberg EE,
Mannens MM,
Mulder MF, Offerhaus GJ, Prescott TE, Schroor EJ, Verheij JB,
Witte M, Zwijnenburg PJ, Vikkula M,
Schulte-Merker S, Hennekam RC.
Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The
Netherlands.
Lymphedema, lymphangiectasias, mental retardation and unusual facial
characteristics define the autosomal
recessive Hennekam syndrome.
Homozygosity mapping identified a critical chromosomal region containing
CCBE1, the human ortholog of a gene essential for lymphangiogenesis in
zebrafish. Homozygous and
compound heterozygous mutations in seven subjects
paired with functional analysis in a zebrafish model
identify CCBE1 as one
of few genes causing primary generalized lymph-vessel dysplasia in humans.
PMID: 19935664 [PubMed - in process
-----
3. Plast Reconstr Surg. 2009 Oct;124(4):1186-95.
Management of "buried" penis in adulthood: an overview.
Pestana IA, Greenfield JM, Walsh M, Donatucci CF, Erdmann D.
Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery,
Department of Surgery, Duke
University Medical Center, Durham, NC 27710,
USA.
BACKGROUND: The condition of "buried" penis may arise from several factors.
Although the pediatric
form is a rare congenital disorder, it may become an
acquired condition in adulthood, most commonly from
obesity, radical
circumcision, or penoscrotal lymphedema. As obesity has become a national
epidemic, the
incidence of this phenomenon will inevitably increase. The
purpose of this article is to present current
strategies in the management
of this physically and psychologically debilitating condition.
METHODS: A literature review of the surgical management of buried penis was
obtained mainly in the
plastic surgery and urology literature (PubMed), from
1977 to 2007.
RESULTS: Several risk factors were identified in adult patients with buried
penis, including morbid obesity
and diabetes mellitus. Multiple techniques
for release and reconstruction are described, including primary
closure,
Z-plasty, and skin resurfacing, all of which may or may not include a lipectomy.
Recent publications
focus on resurfacing with split-thickness skin grafts
and negative-pressure dressings. These techniques have
been successful in
terms of graft survival and long-term cosmetic result.
CONCLUSIONS: Buried penis is an unusual, difficult-to-treat condition that
presents a unique challenge to
the plastic surgeon and the urologist.
Predisposing factors such as morbid obesity and diabetes mellitus are
becoming increasingly prevalent, which suggests a potential increase in the
incidence of this condition.
Although no specific approach may be applicable
to all patients, a combination of various techniques may be
applied. In
complicated and severe cases, a split-thickness skin graft to the penile shaft,
reduction
scrotoplasty, suction-assisted lipectomy, and/or surgical
lipectomy, such as panniculectomy, may be
indicated. Therapy adapted to the
individual patient can result in high rates of successful reconstruction with
acceptable cosmetic results.
PMID: 19935302 [PubMed - in process
-----
4. Lymphology. 2009 Sep;42(3):139-45.
Airplane travel and lymphedema: a case study.
Ward LC, Battersby KJ, Kilbreath SL.
School of Chemistry and Molecular Biosciences, University of Queensland,
Brisbane, Australia. l.ward@uq.
edu.au
A single subject prospective study of the relationship between air travel and
lymphedema is reported. This
proof of concept study was aimed at assessing
the feasibility of using self-measured, inter-limb impedance
ratios as a
quantitative measure of lymphedema immediately prior to and following flying.
The participant, a
breast cancer survivor with lymphedema, measured whole
arm impedance prior to and following air travel
on 20 occasions, varying in
duration of between 1 and 9 h, over a 12-month period. Although the inter-arm
impedance ratio fluctuated over this time, it generally increased and
worsened following flying. Impedance
measurements were easily performed by
the participant and could be obtained as close to the start and
cessation of
flying as is practicably possible. These data, when associated with
self-assessment of
lymphedema-related symptoms, could provide a
comprehensive evidence base for an assessment of the
risks associated with
air travel and the provision of appropriate advice to prospective travelers.
Further
large-scale studies are recommended.
PMID: 19927904 [PubMed - in process
----
5. Lymphology. 2009 Sep;42(3):123-9.
The role of lymphoscintigraphy in the diagnosis of lymphedema in Turner
syndrome.
Bellini C, Di Battista E, Boccardo F, Campisi C, Villa G, Taddei G, Traggiai
C, Amisamo A, Perucchin PP,
Benfenati CS, Bonioli E, Lorini R.
Neuromuscular Diseases Unit, Department of Pediatrics, University of Genoa,
Genoa, Italy.
[email protected]
Lymphedema can be present in patients affected by Turner syndrome (TS) with
the dorsum of the hands
and feet most commonly affected. This lymphedema
results from underdevelopment of the lymphatic system
before birth, and it
usually decreases during childhood. The aim of our study was to evaluate the
role of
lymphoscintigraphy as a diagnostic tool in patients with TS to
assess possible impairments in the lymphatic
system. Eighteen patients with
TS were karyotyped to confirm diagnosis and were evaluated by
lymphoscintigraphy. Lymphatic dysfunction was demonstrated in 15/18
patients. Lymphoscintigraphic
studies showed: 1) lymphatic channels, 2)
collateral lymphatic channels, 3) interrupted lymphatic structures,
and 4)
lymph nodes of the deep lymphatic system. Our data demonstrate that
lymphoscintigraphy should be
mandatory not only in patients affected by
Turner syndrome with signs of lymphatic dysplasia but also in
those with
minimal or absent signs of lymphatic impairment in order to obtain a very early
diagnosis and to
provide substantial information for possible medical or
surgical treatment.
PMID: 19927901 [PubMed - in process
-----
6. Lymphology. 2009 Sep;42(3):105-11.
Where do lymph and tissue fluid accumulate in lymphedema of the lower limbs
caused by obliteration of
lymphatic collectors?
Olszewski WL, Ambujam PJ, Zaleska M, Cakala M.
Department of Surgical Research and Transplantology, Medical Research Center,
Polish Academy of
Sciences, Warsaw, Poland. [email protected]
Obliteration of lymphatic collecting trunks of limbs by infective processes,
trauma, oncologic surgery and
irradiation bring about retention of lymph and
tissue fluid in tissues. Knowledge as to where excess lymph is
produced and
accumulates as tissue fluid is indispensable for rational physical therapy. So
far, this
knowledge has been based on lymphoscintigraphic, ultrasonographic
and MR images. None of these
modalities provides distinct images of dilated
lymphatics and fluid expanded tissue spaces in dermis, subcutis
and muscles.
Only anatomical dissection and histological processing of biopsy material can
demonstrate the
remnants of the lymphatic network and the sites of
accumulation of mobile tissue fluid. We visualized and
calculated the volume
of the "tissue fluid and lymph" space in skin and subcutaneous tissue of foot,
calf, and
thigh in various stages of lymphedema, using special coloring
techniques in specimens obtained during
lymphatic microsurgical procedures
or tissue debulking. When the collecting trunks were obliterated, lymph
was
present only in the subepidermal lymphatics, while mobile tissue fluid
accumulated in the spontaneously
formed spaces in the subcutaneous tissue,
around small veins, and in the muscular fascia. Deformation of
subcutaneous
tissue by free fluid led to formation of interconnecting channels. In
obstructive lymphedema
caused by obliteration of collectors, lymph is
present mainly in subepidermal lymphatics, and the bulk of
stagnant tissue
fluid accumulates in subcutis between fibrous septa and fat globules as well as
above and
underneath muscular fascia. These observations provide useful
clues for designing pneumatic devices and
rational manual lymphatic massage
to move stagnant tissue fluid toward the non-swollen regions.
PMID: 19927899 [PubMed - in process
-----
1. Pathophysiology. 2009 Nov 24. [Epub ahead of print]
The role of lymphatic vessels in the heart.
Cui Y.
Case Cardiovascular Research Institute, Department of Medicine, Case Western
Reserve University,
Cleveland, OH 44106-7290, United States; University
Hospitals Harrington-McLaughlin Heart & Vascular
Institute, University
Hospitals Case Medical Center, WRB 4-537, 2103 Cornell Road, Cleveland, OH
44106-7290, United States.
Although cardiac lymphatic vessels have been described for over three
centuries, research progress on the
role of cardiac lymphatic vessels in
regulating cardiac physiology and their disturbances in the pathogenesis
of
cardiac disease has progressed very slowly, largely due to technical challenges
in developing both animal
models and cardiac lymphatic vascular imaging
technologies. This review summarizes evidence showing that
blocking cardiac
lymph flow may contribute to several forms of cardiac injury including cardiac
lymphedema, cardiac valvular deformation, coronary arterial injury,
conduction disturbances, myocardial
injury, and poor heart performance in
animal and human heart studies. Conversely, improving cardiac lymph
flow may
have beneficial effects on heart function after heart attack (myocardial
infarction). In addition, this
review summarizes recent hypotheses about the
forces generating cardiac lymph flow, in which the role of
both the
subepicardial and mid-myocardial myocytes synchronized contractions causing
lymph flow is
discussed. Lastly, possible mechanisms of blood vessel injury
caused by the failure of perivascular lymphatic
remodeling are
discussed.
PMID: 19942415 [PubMed - as supplied by publisher
--------
1. J Clin Oncol. 2009 Oct 13. [Epub ahead of print]
Axillary Reverse Mapping to Prevent Lymphedema After Breast Cancer Surgery:
Defining the Limits of the
Concept.
Khan SA.
Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine of
Northwestern University,
Chicago, IL.
PMID: 19826108 [PubMed - as supplied by publisher
--------
2. Parasite Immunol. 2009 Nov;31(11):664-72.
Filariasis and lymphoedema.
Pfarr KM, Debrah AY, Specht S, Hoerauf A.
Institute for Medical Microbiology, Immunology and Parasitology, University
Hospital Bonn, Bonn,
Germany.
Among the causes of lymphoedema (LE), secondary LE due to filariasis is the
most prevalent. It affects only
a minority of the 120 million people
infected with the causative organisms of lymphatic filariasis (LF),
Wuchereria bancrofti and Brugia malayi/timori, but is clustered in families,
indicating a genetic basis for
development of this pathology. The majority
of infected individuals develop filarial-specific
immunosuppression that
starts even before birth in cases where mothers are infected and is
characterized by
regulatory T-cell responses and high levels of IgG4, thus
tolerating high parasite loads and microfilaraemia.
In contrast, individuals
with this pathology show stronger immune reactions biased towards Th1, Th2 and
probably also Th17. Importantly, as for the aberrant lymph vessel
development, innate immune responses
that are triggered by the filarial
antigen ultimately result in the activation of vascular endothelial growth
factors
(VEGF),
thus promoting lymph vessel hyperplasia as a first step
to lymphoedema development. Wolbachia
endosymbionts are major inducers of
these responses in vitro, and their depletion by doxycycline in LF
patients
reduces plasma VEGF and soluble VEGF-receptor-3 levels to those seen in endemic
normals
preceding pathology improvement. The search for the immunogenetic
basis for LE could lead to the
identification of risk factors and thus, to
prevention; and has so far led to the identification of single-
nucleotide
polymorphisms (SNP) with potential functional relevance to VEGF, cytokine and
toll-like
receptor (TLR) genes. Hydrocele, a pathology with some similarity
to LE in which both lymph vessel dilation
and lymph extravasation are shared
sequelae, has been found to be strongly associated with a VEGF-A
SNP known
for upregulation of this (lymph-)angiogenesis factor.
PMID: 19825106 [PubMed - in process
---------------------------
3. Rev Port Cir Cardiotorac Vasc. 2009 April-
June;16(2):107-114.
[Lymphedema of the extremities: A missed vascular pathology?]
[Article in
Portuguese]
Pereira Albino J.
Serviço de Cirurgia Vascular II do Centro Hospitalar Lisboa Norte,H. Pulido
Valente, Lisboa.
The diagnosis and treatment of lymphedemas of the extremities, although
relatively common in the western
countries, mainly in the area of oncology,
are scarcely mentioned in the international literature and in Portugal
very
little work has been devoted to this area. Nevertheless, they may cause severe
functional and aesthetic
disability, the main reason why decided to reassess
its pathology, with an emphasis on the clinical diagnosis
and medical
therapy. We stress the importance of oedema of the instep the value of the
Stemmer's sign in
the diagnosis, and the complete decongestive physiotherapy
in the management. When associated to the
pharmacological therapy and the
correct use of elastic stockings, the control of most of the cases can be
achieved. Surgical therapy is reserved for rare cases and should be regarded
as an adjuvant to intensive
medical therapy, which should accompany the
patient throughout life time.
PMID: 19823709 [PubMed - as supplied by publisher
-------
4. J Pain Symptom Manage. 2009 Oct 9. [Epub ahead of print]
Breast Cancer Survivors' Experiences of Lymphedema-Related Symptoms.
Fu MR, Rosedale M.
New York University College of Nursing, New York, NY, USA.
BACKGROUND: The purpose of this study was to explore and describe breast
cancer survivors'
lymphedema-related symptom experiences. As a serious
chronic condition from breast cancer treatment,
lymphedema or a syndrome of
persistent swelling and symptoms is caused by chronic accumulation of lymph
fluid in the interstitial spaces of the affected limb or surrounding areas.
Although significant prevalence of
ongoing multiple symptoms have been
reported, little is known about how survivors with lymphedema
perceive and
respond to lymphedema-related symptoms in their daily lives.
METHODS: This study used a descriptive phenomenological method. Thirty-four
participants were
recruited in the United States. Three in-depth interviews
were conducted with each participant; a total of
102 interviews were
completed, audio taped, and transcribed. Interview transcripts and field notes
were the
data sources for this analysis, which was part of three larger
studies.
DATA ANALYSIS: Data were analyzed to identify the essential themes within and
across cases. Four
essential themes were revealed: living with perpetual
discomfort, confronting the unexpected, losing pre-
lymphedema being, and
feeling handicapped.
FINDINGS: Participants experienced multiple symptoms on a daily basis.
Distress was heightened when
women expected symptoms to disappear, but
instead, they remained as a "perpetual discomfort."
Moreover, distress was
intensified when symptoms evoked unexpected situations or when symptoms
elicited emotional responses powerful enough to change perceived personal
identity.
CONCLUSIONS: Findings suggest that symptom distress may encompass temporal,
situational, and
attributive dimensions. Prospective studies are needed to
examine lymphedema-related symptom distress in
terms of these dimensions so
that more specific interventions can be developed to target distress occurring
in
each dimension.
PMID: 19819668 [PubMed - as supplied by publisher]
----
1. Br J Surg. 2009 Nov;96(11):1274-9.
Quality of life after surgical
reduction for severe primary lymphoedema of the limbs and genitalia.
Ogunbiyi
SO, Modarai B, Smith A, Burnand KG; London Lymphoedema Consortium.
Academic Department of Surgery, St Thomas' Hospital, Westminster Bridge Road,
London, UK.
BACKGROUND: The aim was to assess the quality of life (QoL) of patients who
had surgery for primary
lymphoedema.
METHODS: A QoL questionnaire was administered to patients who had surgery
between 1981 and 2003
(retrospective group) and between 2003 and 2006
(prospective group).
RESULTS: The response rate was 70.3 per cent (109 of 155 patients): 88
patients had limb reduction (78,
retrospective; ten, prospective) and 21 had
genital reduction (13, retrospective; eight, prospective). Forty-
nine
patients (63 per cent) who had limb reduction studied retrospectively reported
satisfaction with the
procedure and most of these would opt for surgery
again. In the prospectively studied group, nine of ten
patients reported
improved limbs, and seven would opt for surgery again. Nineteen of 21 patients
who had
genital reduction would choose to have surgery again if needed (11
of the retrospectively assessed group
and all of the prospective group).
Patients' perception that surgery was worthwhile was greater in both of the
prospectively assessed groups (P = 0.013).
CONCLUSION: Surgery for severe lymphoedema improved QoL at early assessment.
This, however, may
not be sustained. Genital reduction appeared to provide
greater benefit than limb reduction.
PMID: 19847880 [PubMed - in process
-----------------------
2.
Afr J Paediatr Surg. 2008 Jul-Dec;5(2):79-83.
Congenital constriction ring syndrome of the limbs: A prospective study of 16
cases.
Adu EJ, Annan C.
Department of Surgery, School of Medical Sciences, Kwame Nkrumah University
of Science and
Technology, Kumasi, Ghana.
Background: The congenital constriction ring syndrome is characterised by
fibrous bands that encircle,
strangle and even amputate parts of the foetus.
It is a common condition amongst Ghanaian patients, but
data on it is quite
scanty.
Materials and Methods: A prospective study of patients presenting at a
plastic surgical clinic in Ghana with
the characteristics of the congenital
constriction ring syndrome was undertaken. The patients were examined
clinically and the findings recorded. An x-ray and clinical photograph of
the affected limbs was taken.
Treatment required several staged operations.
Surgical correction of the constriction ring was done by
excision and
Z-plasty to prevent or alleviate lymphoedema, separation of distally fused
digits and skin
grafting of defect.
Results: Sixteen patients made up of 10 males and six females were seen. The
age at presentation ranged
from nine days to 12 years with a mean age of
14.6 months. Twenty-two limbs were affected, made up of
four right upper
limbs, six left upper limbs, seven right lower limbs and five left lower limbs.
In the upper limb
malformations involved 42 digits; in the lower limb
malformations involved 33 toes, one foot and five legs.
Four main types of
lesions were found: constriction rings, intrauterine amputations,
acrosyndactyly, and
simple syndactyly.
Conclusion: Congenital constriction ring syndrome is of uncertain aetiology
and could cause morbidity in the
newborn. The syndrome and its complications
are amenable to corrective surgery with good results. Early
intervention is
desirable for a successful outcome.
PMID: 19858673 [PubMed - in process
----------------------------------
3. Ann Surg Oncol. 2009 Oct 27. [Epub ahead of print]
Predictive Factors of Response to Decongestive Therapy in Patients with
Breast-Cancer-Related
Lymphedema.
Forner-Cordero I, Muñoz-Langa J,
Forner-Cordero A, Demiguel-Jimeno JM.
Physical Medicine and Rehabilitation Specialist, Hospital La Fe, Valencia,
Spain, [email protected].
BACKGROUND: Many studies have reported the benefits of Decongestive treatment
in patients with
breast-cancer-related lymphedema (BCRL) but few have study
what are the predictive factors of response.
METHODS: We performed a prospective, multicenter controlled cohort study of
171 patients with BCRL
to identify independent predictive factors of
response to decongestive treatment (CDT). Demographic data
and clinical and
lymphedema characteristics were collected prospectively. The end point was the
"percentage reduction in excess volume (PREV)." Volumes were measured prior
and at the end of CDT.
Factors associated with response (PREV) were tested
in univariate and multivariate analyses using linear
regression
techniques.
RESULTS: Median age was 60.4 years (range 32-84); mean lymphedema chronicity
4 years [95%
confidence interval (95% CI): 3.1-5.0]; mean baseline excess
volume (EV) was 936 mL (95% CI: 846-
1026), and mean percentage EV was 35.3%
(95% CI: 32.0-38.7); compliance to bandages was good in
81.3% of patients.
PREV was 71.7% (95% CI: 65.2-78.2). After univariate screening, 11 variables
were
found to be associated with PREV but only 4 variables were independent
predictive factors of response to
CDT in the multivariate analysis: Venous
insufficiency, percentage of EV (the higher the EV, the lower the
reduction
with CDT); compliance to bandages (a good compliance improved PREV in 25%), and
treatment
in autumn (better results than during the rest of the year).
CONCLUSIONS: This study shows that compliance to bandages during CDT is one
of the most important
predictors of response. Moreover, data support the
idea that more severe lymphedemas have a worse
response to treatment, and it
should be recommended in early stages. The association between the season of
treatment and response was also very strong, so weather conditions are an
additional factor that must be
taken into account in further studies..
PMID: 19859769 [PubMed - as supplied by publisher
------------------------------------------
4. Oncology (Williston Park). 2009 Feb;23(2 Suppl):34-8.
Lower extremity lymphedema in a patient with melanoma.
Rubin KM, Kuhlman
C.
Melanoma Program, Massachusetts General Hospital Cancer Center, Boston,
Massachusetts, USA.
PMID: 19856587 [PubMed - in process
---
1. Cancer. 2009 Oct 28. [Epub ahead of print]
Preoperative assessment enables the early detection and successful treatment
of lymphedema.
Hayes S, Cornish B, Newman B..
Institute of Health and Biomedical Innovation, School of Public Health,
Queensland University of
Technology, Brisbane, Queensland, Australia.
PMID: 19877116 [PubMed - as supplied by publisher
---
2(a). Acta Oncol. 2009;48(8):1111-8.
Changes in arm morbidities and health-related quality of life after breast
cancer surgery - a five-year follow-
up study.
Sagen A, Kåresen R, Sandvik L, Risberg MA.
Department of Breast and Endocrine Surgery, Ullevaal University Hospital,
Oslo, Norway. aase.sagen@uus.
no
BACKGROUND AND PURPOSE. Many breast cancer survivors (BCS) suffer from
long-term upper
limb morbidities after axillary node dissection. The purpose
of this five-year follow-up study was to describe
changes in long-term upper
limb morbidities, physical activity level, and Health-Related Quality of Life
(HRQoL) and to find factors that predict HRQoL five years after surgery.
PATIENTS AND METHODS. This study included 204 women aged 55+/-10 years who
had primary
breast cancer surgery with axillary node dissection. The
subjects were examined for arm volumes and arm
lymphedema, arm pain,
sensation of heaviness, shoulder function, physical activity level, and HRQoL,
prior
to surgery, and six months and five years after surgery. The
statistical analyses used included ANOVA for
repeated measures and
multivariate linear regression.
RESULTS. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper
limbs were present five
years after surgery. ALE was the only morbidity that
continued to increase over time. Several dimensions of
HRQoL temporarily
declined after surgery, but significantly improved in the period from six months
to five
years after surgery. The significant predictive factors of HRQoL
five years after surgery included HRQoL
prior to surgery, physical activity
level at leisure time (both prior to and at six months after surgery), and
duration of sick leave after surgery (in weeks).
CONCLUSIONS. The overall HRQoL improved significantly from baseline to five
years, despite the
chronic arm pain and increase in ALE. Three independent
predictive factors of HRQoL were identified.
PMID: 19863218 [PubMed - in process
---
2(b) Acta Oncol. 2009 Aug 27:1-8. [Epub ahead of print]
Changes in arm morbidities and health-related quality of life after breast
cancer surgery - a five-year follow-
up study.
Sagen A, Kåresen R, Sandvik L, Risberg MA.
Department of Breast and Endocrine Surgery, Ullevaal University Hospital,
Oslo, Norway.
Background and purpose. Many breast cancer survivors (BCS) suffer from
long-term upper limb
morbidities after axillary node dissection. The purpose
of this five-year follow-up study was to describe
changes in long-term upper
limb morbidities, physical activity level, and Health-Related Quality of Life
(HRQoL) and to find factors that predict HRQoL five years after surgery.
Patients and methods. This study included 204 women aged 55+/-10 years who
had primary breast cancer
surgery with axillary node dissection. The
subjects were examined for arm volumes and arm lymphedema,
arm pain,
sensation of heaviness, shoulder function, physical activity level, and HRQoL,
prior to surgery, and
six months and five years after surgery. The
statistical analyses used included ANOVA for repeated
measures and
multivariate linear regression.
Results. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper
limbs were present five
years after surgery. ALE was the only morbidity that
continued to increase over time. Several dimensions of
HRQoL temporarily
declined after surgery, but significantly improved in the period from six months
to five
years after surgery. The significant predictive factors of HRQoL
five years after surgery included HRQoL
prior to surgery, physical activity
level at leisure time (both prior to and at six months after surgery), and
duration of sick leave after surgery (in weeks).
Conclusions. The overall HRQoL improved significantly from baseline to five
years, despite the chronic arm
pain and increase in ALE. Three independent
predictive factors of HRQoL were identified.
PMID: 19714526 [PubMed - as supplied by publisher
---
3(a). Acta Oncol. 2009;48(8):1102-10.
Physical activity for the affected limb and arm lymphedema after breast
cancer surgery. A prospective,
randomized controlled trial with two years
follow-up.
Sagen A, Kåresen R, Risberg MA.
Department of Breast and Endocrine Surgery, Oslo University Hospital,
Ullevaal, Norway. aase.sagen@uus.
no
BACKGROUND. The influence of physical activity on the development of arm
lymphedema (ALE) after
breast cancer surgery with axillary node dissection
has been debated. We evaluated the development of
ALE in two different
rehabilitation programs: a no activity restrictions (NAR) in daily living
combined with a
moderate resistance exercise program and an activity
restrictions (AR) program combined with a usual care
program. The risk
factors associated with the development of ALE 2 years after surgery were also
evaluated.
MATERIAL AND METHODS. Women (n = 204) with a mean age of 55+/-10 years who
had axillary
node dissection were randomized into two different
rehabilitation programs that lasted for 6 months: NAR (n
= 104) or AR (n =
100). The primary outcomes were the difference in arm volume between the
affected
and control arms (Voldiff, in ml) and the development of ALE.
Baseline (before surgery) and follow-up tests
were performed 3 months, 6
months, and 2 years after surgery. Data were analyzed using ANCOVA and
regression analysis.
RESULTS. Voldiff did not differ significantly between the two treatment
groups. Arm volume increased
significantly over time in both the affected
and the control arms. The development of ALE from baseline to 2
years
increased significantly in both groups (p < 0.001). The only risk factor for
ALE was BMI > 25 kg/m
(2).
CONCLUSION. Patients that undergo breast cancer surgery with axillary lymph
node dissection should be
encouraged to maintain physical activity in their
daily lives without restrictions and without fear of developing
ALE.
PMID: 19863217 [PubMed - in process
---
3(b) Acta Oncol. 2009 Jun 23:1-9. [Epub ahead of print]
Physical activity for the affected limb and arm lymphedema after breast
cancer surgery. A prospective,
randomized controlled trial with two years
follow-up.
Sagen A, Kåresen R, Risberg MA.
Department of Breast and Endocrine Surgery, Oslo University Hospital,
Ullevaal, Norway.
Background. The influence of physical activity on the development of arm
lymphedema (ALE) after breast
cancer surgery with axillary node dissection
has been debated. We evaluated the development of ALE in
two different
rehabilitation programs: a no activity restrictions (NAR) in daily living
combined with a
moderate resistance exercise program and an activity
restrictions (AR) program combined with a usual care
program. The risk
factors associated with the development of ALE 2 years after surgery were also
evaluated.
Material and methods. Women (n=204) with a mean age of 55+/-10 years who had
axillary node dissection
were randomized into two different rehabilitation
programs that lasted for 6 months: NAR (n=104) or AR
(n=100). The primary
outcomes were the difference in arm volume between the affected and control arms
(Voldiff, in ml) and the development of ALE. Baseline (before surgery) and
follow-up tests were performed
3 months, 6 months, and 2 years after
surgery. Data were analyzed using ANCOVA and regression analysis.
Results. Voldiff did not differ significantly between the two treatment
groups. Arm volume increased
significantly over time in both the affected
and the control arms. The development of ALE from baseline to 2
years
increased significantly in both groups (p<0.001). The only risk factor for
ALE was BMI > 25 kg/m(2).
Conclusion. Patients that undergo breast cancer surgery with axillary lymph
node dissection should be
encouraged to maintain physical activity in their
daily lives without restrictions and without fear of developing
ALE.
PMID: 19551531 [PubMed - as supplied by publisher
-----
2(a). Acta Oncol. 2009;48(8):1111-8.
Changes in arm morbidities and health-related quality of life after breast
cancer surgery - a five-year follow-
up study.
Sagen A, Kåresen R, Sandvik L, Risberg MA.
Department of Breast and Endocrine Surgery, Ullevaal University Hospital,
Oslo, Norway. aase.sagen@uus.
no
BACKGROUND AND PURPOSE. Many breast cancer survivors (BCS) suffer from
long-term upper
limb morbidities after axillary node dissection. The purpose
of this five-year follow-up study was to describe
changes in long-term upper
limb morbidities, physical activity level, and Health-Related Quality of Life
(HRQoL) and to find factors that predict HRQoL five years after surgery.
PATIENTS AND METHODS. This study included 204 women aged 55+/-10 years who
had primary
breast cancer surgery with axillary node dissection. The
subjects were examined for arm volumes and arm
lymphedema, arm pain,
sensation of heaviness, shoulder function, physical activity level, and HRQoL,
prior
to surgery, and six months and five years after surgery. The
statistical analyses used included ANOVA for
repeated measures and
multivariate linear regression.
RESULTS. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper
limbs were present five
years after surgery. ALE was the only morbidity that
continued to increase over time. Several dimensions of
HRQoL temporarily
declined after surgery, but significantly improved in the period from six months
to five
years after surgery. The significant predictive factors of HRQoL
five years after surgery included HRQoL
prior to surgery, physical activity
level at leisure time (both prior to and at six months after surgery), and
duration of sick leave after surgery (in weeks).
CONCLUSIONS. The overall HRQoL improved significantly from baseline to five
years, despite the
chronic arm pain and increase in ALE. Three independent
predictive factors of HRQoL were identified.
PMID: 19863218 [PubMed - in process
2(b) Acta Oncol. 2009 Aug 27:1-8. [Epub ahead of print]
Changes in arm morbidities and health-related quality of life after breast
cancer surgery - a five-year follow-
up study.
Sagen A, Kåresen R, Sandvik L, Risberg MA.
Department of Breast and Endocrine Surgery, Ullevaal University Hospital,
Oslo, Norway.
Background and purpose. Many breast cancer survivors (BCS) suffer from
long-term upper limb
morbidities after axillary node dissection. The purpose
of this five-year follow-up study was to describe
changes in long-term upper
limb morbidities, physical activity level, and Health-Related Quality of Life
(HRQoL) and to find factors that predict HRQoL five years after surgery.
Patients and methods. This study included 204 women aged 55+/-10 years who
had primary breast cancer
surgery with axillary node dissection. The
subjects were examined for arm volumes and arm lymphedema,
arm pain,
sensation of heaviness, shoulder function, physical activity level, and HRQoL,
prior to surgery, and
six months and five years after surgery. The
statistical analyses used included ANOVA for repeated
measures and
multivariate linear regression.
Results. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper
limbs were present five
years after surgery. ALE was the only morbidity that
continued to increase over time. Several dimensions of
HRQoL temporarily
declined after surgery, but significantly improved in the period from six months
to five
years after surgery. The significant predictive factors of HRQoL
five years after surgery included HRQoL
prior to surgery, physical activity
level at leisure time (both prior to and at six months after surgery), and
duration of sick leave after surgery (in weeks).
Conclusions. The overall HRQoL improved significantly from baseline to five
years, despite the chronic arm
pain and increase in ALE. Three independent
predictive factors of HRQoL were identified.
PMID: 19714526 [PubMed - as supplied by publisher
3(a). Acta Oncol. 2009;48(8):1102-10.
Physical activity for the affected limb and arm lymphedema after breast
cancer surgery. A prospective,
randomized controlled trial with two years
follow-up.
Sagen A, Kåresen R, Risberg MA.
Department of Breast and Endocrine Surgery, Oslo University Hospital,
Ullevaal, Norway. aase.sagen@uus.
no
BACKGROUND. The influence of physical activity on the development of arm
lymphedema (ALE) after
breast cancer surgery with axillary node dissection
has been debated. We evaluated the development of
ALE in two different
rehabilitation programs: a no activity restrictions (NAR) in daily living
combined with a
moderate resistance exercise program and an activity
restrictions (AR) program combined with a usual care
program. The risk
factors associated with the development of ALE 2 years after surgery were also
evaluated.
MATERIAL AND METHODS. Women (n = 204) with a mean age of 55+/-10 years who
had axillary
node dissection were randomized into two different
rehabilitation programs that lasted for 6 months: NAR (n
= 104) or AR (n =
100). The primary outcomes were the difference in arm volume between the
affected
and control arms (Voldiff, in ml) and the development of ALE.
Baseline (before surgery) and follow-up tests
were performed 3 months, 6
months, and 2 years after surgery. Data were analyzed using ANCOVA and
regression analysis.
RESULTS. Voldiff did not differ significantly between the two treatment
groups. Arm volume increased
significantly over time in both the affected
and the control arms. The development of ALE from baseline to 2
years
increased significantly in both groups (p < 0.001). The only risk factor for
ALE was BMI > 25 kg/m
(2).
CONCLUSION. Patients that undergo breast cancer surgery with axillary lymph
node dissection should be
encouraged to maintain physical activity in their
daily lives without restrictions and without fear of developing
ALE.
PMID: 19863217 [PubMed - in process
3(b) Acta Oncol. 2009 Jun 23:1-9. [Epub ahead of print]
Physical activity for the affected limb and arm lymphedema after breast
cancer surgery. A prospective,
randomized controlled trial with two years
follow-up.
Sagen A, Kåresen R, Risberg MA.
Department of Breast and Endocrine Surgery, Oslo University Hospital,
Ullevaal, Norway.
Background. The influence of physical activity on the development of arm
lymphedema (ALE) after breast
cancer surgery with axillary node dissection
has been debated. We evaluated the development of ALE in
two different
rehabilitation programs: a no activity restrictions (NAR) in daily living
combined with a
moderate resistance exercise program and an activity
restrictions (AR) program combined with a usual care
program. The risk
factors associated with the development of ALE 2 years after surgery were also
evaluated.
Material and methods. Women (n=204) with a mean age of 55+/-10 years who had
axillary node dissection
were randomized into two different rehabilitation
programs that lasted for 6 months: NAR (n=104) or AR
(n=100). The primary
outcomes were the difference in arm volume between the affected and control arms
(Voldiff, in ml) and the development of ALE. Baseline (before surgery) and
follow-up tests were performed
3 months, 6 months, and 2 years after
surgery. Data were analyzed using ANCOVA and regression analysis.
Results. Voldiff did not differ significantly between the two treatment
groups. Arm volume increased
significantly over time in both the affected
and the control arms. The development of ALE from baseline to 2
years
increased significantly in both groups (p<0.001). The only risk factor for
ALE was BMI > 25 kg/m(2).
Conclusion. Patients that undergo breast cancer surgery with axillary lymph
node dissection should be
encouraged to maintain physical activity in their
daily lives without restrictions and without fear of developing
ALE.
PMID: 19551531 [PubMed - as supplied by publisher
----
1. Dermatol Online J. 2009 Aug 15;15(8):7.
Lymphedema praecox.
Rizzo C, Gruson LM, Wainwright BD.
Department of Dermatology, New York University, USA.
A 57-year-old man presented with the post-pubertal onset of asymptomatic
swelling of the left arm and legs
that had been complicated by recurrent
bouts of cellulitis. The presentation and disease course are consistent
with
lymphedema praecox, which is a subtype of primary lymphedema with onset at
puberty and a slowly
progressive course. The subtypes of lymphedema,
pathogenesis, and treatment are reviewed.
PMID: 19891915 [PubMed - in process
2. Breast J. 2009 Nov 2. [Epub ahead of print]
Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast
Cancer Patients.
Helyer LK, Varnic M, Le LW, Leong W, McCready D.
Department of Surgical Oncology, Princess Margaret Hospital, University of
Toronto, Toronto, Ontario,
Canada.
Lymphedema (LE) is a well-known postoperative complication after axillary
node dissection (ALND).
Although, sentinel lymph node dissection (SLND)
involves more focused surgery and less disruption of the
axilla, early
reports show up to 13% of patients experience some symptoms of LE. The purpose
of this
study was to determine predictors of arm LE in our patients under
going SLND with or without an ALND.
One hundred and thirty-seven breast
cancer patients were treated at a comprehensive cancer center.
Prospective
measurement of arm volume was carried every 6 months from date of diagnosis.
This data base
was retrospectively reviewed for tumor stage, treatment, and
subjective complaints of LE. Objective LE
was defined as a change greater
than 200 mL compared with the control arm. Univariate and multivariate
analyses were performed. Arm volume changes were measured over 24 months
(median follow-up 20
months) in 137 women: 82 stage I, 48 stage II, and 5
stage III; median age 56 years. Breast-conserving
surgery was performed in
133 patients. All patients underwent SLND for axillary staging and for 52
patients
this was the only axillary staging procedure. All node-positive
patients (31) and 54 node-negative patients
under went an immediate
completion ALND, the latter as part of a study protocol. At 24 months, 16
(11.6%) patients were found to have objective LE (>200 mL increase).
Patient age, tumor size, number of
nodes harvested, or adjuvant chemotherapy
was not found to be predictive of LE by univariate analysis. The
risk of
developing postoperative LE was primarily and significantly related to the
patients' BMI (p = 0.003).
Multivariate analysis revealed patients with a
BMI >30 (obese) had an odds ratio of 2.93 (95% CI 1.03-
8.31) compared
with those with a BMI of <25 of having LE. Symptomatic LE (SLE), as defined
by patient
complaints was recorded in six of the above 16 patients, no SLE
was recorded in patients without objective
signs of edema. Univariate
subgroup analysis compared the symptomatic to the nonsymptomatic patients
and revealed the median number of nodes removed was higher in the
symptomatic patients (17 verses 9, p =
0.045); however, these patients had a
lower BMI (p = 0.0012). The mean change in arm volume was not
significantly
different between the groups. SLE occurs in one third of patients with objective
arm swelling
and most likely is multi-factorial in etiology. Although
patients undergoing SLN were recorded as having
objective LE, none reported
SLE. The development of LE within 2 years of surgery is associated with the
patient's BMI and this should be considered in preoperative counseling.
PMID: 19889169 [PubMed - as supplied by publisher
3. Dermatol Ther. 2009 Nov-Dec;22(6):475-90.
Filariasis: diagnosis and treatment.
Mendoza N, Li A, Gill A, Tyring S..
Universidad El Bosque, Bogotá, Colombia. [email protected]
Filariasis is an infectious disease of the lymphatics and subcutaneous
tissues caused by nematodes or filariae.
Carried by mosquito vectors, this
disease causes millions of people to suffer from lymphedema and
elephantiasis, characteristics of filariasis infection. This disease can be
diagnosed through the identification of
microfilariae in blood or skin
samples, antigen detection, radiographic imaging, or polymerase chain reaction.
Mass drug administration by the World Health Organization has helped to
diminish the incidence of filariasis.
However, continued research on new
drugs and vaccinations will be needed to control and reduce the
microfilarial levels in the human population.
PMID: 19889133 [PubMed - in process
----
1. J Occup Rehabil. 2009 Nov 10. [Epub ahead of print]
Factors Related to Return to Work by Women with Breast Cancer in Northern
France.
Fantoni SQ, Peugniez C, Duhamel A, Skrzypczak J, Frimat P, Leroyer A.
Department of Occupational Medicine, CHRU Lille, Université Lille 2, 1 Avenue
Oscar Lambret, 59037,
Lille Cedex, France, [email protected].
Introduction Earlier diagnosis and better treatment have increased the
survival rates of breast cancer
patients. This warrants research on return
to work of cancer survivors, especially about subjective factors
because
they affect the mental desire to return to work. Moreover, knowledge in this
issue is very limited in
France. Objectives This study aims to explore the
objective and subjective factors that affect whether and
when women with
breast cancer return to work. Methods 379 women with breast cancer aged 18-60
years
who were working at the time of diagnosis responded to a 45 item
questionnaire. The questionnaire had
personal characteristics,
disease-related characteristics and work-related ones. Multivariate logistic
regressions were run to determine the association of these factors and
return to work and time until return to
work. Results During a median
follow-up of 36 months, 82.1% of the 379 women who had worked before
their
diagnosis returned to work after a median sick leave of 10.8 months. Older age,
lower educational
level, chemotherapy, radiotherapy, lymphoedema,
psychological or organizational self-perceived constraints
related to their
former job, and the lack of moral support from work colleagues both limited and
delayed
return to work. Conclusion The resumption of work by women with
breast cancer depends on many
factors, not all of them medical. The
self-perceived factors must be considered: first to help support these
women
during their sick leave, while taking into account elements that may hinder
early return to work;
second to initiate a work resumption support process
which takes into account both the person and her
environment.
PMID: 19902340 [PubMed - as supplied by publisher
2. Ann Trop Med Parasitol. 2009 Oct;103 Suppl 1:S41-51.
Lymphatic filariasis: patients and the global elimination programme.
Mackenzie CD, Lazarus WM, Mwakitalu ME, Mwingira U, Malecela MN.
Department of Pathobiology and Diagnostic Investigation, Michigan State
University, East Lansing, MI
48824, USA. [email protected]
The defining images of lymphatic filariasis are the horrendous disfigurements
of lymphoedema, elephantiasis
and hydrocele. These clinical presentations,
although obviously important and life changing, are not,
however, the only
outcomes of this wide-spread filarial infection. The other effects of the
disease range from
severe, acute but short-term bouts of sickness to
psychological impairment, poverty and family hardship. It
is important to
support cases of the disease through all means available, such as reparative
hydrocelectomy,
hygiene training and facilitation, and the provision of
adequate chemotherapy. Although only a minority of the
residents in any
endemic community is affected with the severe clinical manifestations of this
parasitic
infection, these cases are central to, and important advocates
for, the current global effort to eliminate the
infection through mass drug
administrations (MDA). Their clinical improvement acts as an important catalyst
for the general population and encourages high compliance in the MDA. This
communication discusses the
central role that filariasis patients have
played in the Tanzania Lymphatic Filariasis Elimination Programme to
date,
and covers some of the clinical successes achieved in the past 10 years. The
abolition of the clinical
manifestations of filarial infection remains the
ultimate goal of the Global Programme to Eliminate Lymphatic
Filariasis, and
maintaining a focus on the affected individuals and their clinical condition is
vital to that
programme's overall success.
PMID: 19843397 [PubMed - in process
3. Ann Trop Med Parasitol. 2009 Oct;103 Suppl 1:S5-10.
Ten years of managing the clinical manifestations and disabilities of
lymphatic filariasis.
Brantus P.
Neglected Tropical Diseases, Health and Rehabilitation Unit, Handicap
International France, 14 Avenue
Berthelot, 69361 Lyon Cedex 07, France. [email protected]
The aim of the Global Programme to Eliminate Lymphatic Filariasis is to
eradicate one of the world's leading
causes of permanent and long-term
disability, at least as a public-health problem. The achievement of this
goal is based on the interruption of the transmission of the causative
parasites (so preventing new cases) and,
as a 'second pillar', the
prevention of disability in those who are infected. The disability is associated
with the
main clinical manifestations of human infection with Wuchereria or
Brugia spp. (i.e. hydrocele, lymphoedema
and/or 'acute attacks'). The World
Health Organization and its partners have established strategies and
activities both for managing lymphoedema, through community home-based care,
and for increasing access
to surgery for hydrocele. Over the last decade,
there has been progress made in preventing the disability of
lymphatic
filariasis, the monitoring and evaluation of such disability and its control,
and the integration of
disability prevention with mass drug administrations
and efforts to control other disabling diseases. That
progress and the
challenges that remain in the prevention of the morbidity and disability
attributable to
lymphatic filariasis are here reviewed.
PMID: 19843392 [PubMed - in process
4. J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):669-81.
Robotics and gynecologic oncology: review of the literature.
Cho JE, Nezhat FR.
Gynecologic Oncology Division, St. Luke's-Roosevelt Hospital Center, New
York, New York.
The objectives of this article were to review the published scientific
literature about robotics and its
application to gynecologic oncology to
date and to summarize findings of this advanced computerenhanced
laparoscopic technique. Relevant sources were identified by a search of
PUBMED from January 1950 to
January 2009 using the key words Robot or
Robotics and Cervical cancer, Endometrial cancer,
Gynecologic oncology, and
Ovarian cancer. Appropriate case reports, case series, retrospective studies,
prospective trials, and review articles were selected. A total of 38
articles were identified on the subject, and
27 were included in the study.
The data for gynecologic cancer show comparable results between robotic
and
laparoscopic surgery for estimated blood loss, operative time, length of
hospital stay, and complications.
Overall, there were more wound
complications with the laparotomy approach compared with laparoscopy
and
robotic-assisted laparoscopy. There were more lymphocysts, lymphoceles, and
lymphedema in the
robotic-assisted laparoscopic group compared with the
laparoscopy and laparotomy groups in patients with
cervical cancer.
Infectious and lung-related morbidity, postoperative ileus, and bleeding or clot
formation
were more commonly reported in the laparotomy group compared with
the other 2 cohorts in patients with
endometrial cancer. Computer-enhanced
technology may enable more surgeons to convert laparotomies to
laparoscopic
surgery with its associated benefits. It seems that in the hands of experienced
laparoscopic
surgeons, final outcomes are the same with or without use of
the robot. There is good evidence that robotic
surgery facilitates
laparoscopic surgery, with equivalent if not better operative time and
comparable surgical
outcomes, shorter hospital stay, and fewer major
complications than with surgeries using the laparotomy
approach.
PMID: 19896593 [PubMed - in process
----
1. Indian J Plast Surg. 2009 Jan-Jun;42(1):22-30.
Comparative results of non-operative multi-modal therapy for filarial
lymphoedema.
Gogia SB, Appavoo NC, Mohan A, Kumar MB.
Sanwari Bai Surgical Centre, 28/31 Old Rajinder Nagar, New Delhi - 110 060,
India.
A comparative analysis of different conservative modes of therapy for
lymphoedema, largely of Filarial
origin, was conducted in a trial therapy
unit in Chengalpattu, a Filarial endemic district in Tamil Nadu.
Results
were compared using a single chambered intermittent pneumatic compression pump,
heat therapy,
and interferential therapy machines. The results showed
improvement of limb size between 20% and 60% of
possible reduction (where
100% would mean return of limb circumference to the same as that of the normal
side). Pneumatic compression therapy, when used alone, showed the best
results, which were significantly
better than all others whether alone or in
combination.
PMID: 19881016 [PubMed - in process
2. Photomed Laser Surg. 2009 Oct;27(5):763-9.
Managing postmastectomy lymphedema with low-level laser therapy.
Lau RW, Cheing GL.
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University,
Hong Kong SAR, China.
OBJECTIVE: We aimed to investigate the effects of low-level laser therapy
(LLLT) in managing
postmastectomy lymphedema.
BACKGROUND DATA: Postmastectomy lymphedema (PML) is a common complication of
breast cancer
treatment that causes various symptoms, functional impairment,
or even psychosocial morbidity. A
prospective, single-blinded, controlled
clinical trial was conducted to examine the effectiveness of LLLT on
managing PML.
METHODS: Twenty-one women suffering from unilateral PML were randomly
allocated to receive either
12 sessions of LLLT in 4 wk (the laser group) or
no laser irradiation (the control group). Volumetry and
tonometry were used
to monitor arm volume and tissue resistance; the Disabilities of Arm, Shoulder,
and
Hand (DASH) questionnaire was used for measuring subjective symptoms.
Outcome measures were
assessed before and after the treatment period and at
the 4 wk follow-up.
RESULTS: Reduction in arm volume and increase in tissue softening was found
in the laser group only. At
the follow-up session, significant between-group
differences (all p < 0.05) were found in arm volume and
tissue resistance
at the anterior torso and forearm region. The laser group had a 16% reduction in
the arm
volume at the end of the treatment period, that dropped to 28% in
the follow-up. Moreover, the laser group
demonstrated a cumulative increase
from 15% to 33% in the tonometry readings over the forearm and
anterior
torso. The DASH score of the laser group showed progressive improvement over
time.
CONCLUSION: LLLT was effective in the management of PML, and the effects were
maintained to the 4
wk follow-up.
PMID: 19878027 [PubMed - in process
-----------------------------
1. Breast J. 2009 Nov 24. [Epub ahead of print]
Older Breast Cancer Survivors: Factors Associated with Self-reported Symptoms
of Persistent
Lymphedema Over 7 years of Follow-up.
Clough-Gorr KM, Ganz PA, Silliman RA.
Geriatrics Section, Boston University Schools of Medicine and Public
Health, Boston, Massachusetts.
Lymphedema of the arm is a common complication of breast cancer with
symptoms that can persist over
long periods of time. For older women (over
50% of breast cancer cases) it means living with the potential
for long-term
complications of persistent lymphedema in conjunction with the common diseases
and
disabilities of aging over survivorship. We identified women >/=65
years diagnosed with primary stage I-
IIIA breast cancer. Data were collected
over 7 years of follow-up from consenting patients' medical records
and
telephone interviews. Data collected included self-reported symptoms of
persistent lymphedema, breast
cancer characteristics, and selected
sociodemographic and health-related characteristics. The overall
prevalence
of symptoms of persistent lymphedema was 36% over 7 years of follow-up. Having
stage II or
III (OR = 1.77, 95% CI: 1.07-2.93) breast cancer and having a
BMI >30 (OR = 3.04, 95% CI: 1.69-
5.45) were statistically significantly
predictive of symptoms of persistent lymphedema. Women >/=80 years
were
less likely to report symptoms of persistent lymphedema when compared to younger
women (OR =
0.44, 95% CI: 0.18-0.95). Women with symptoms of persistent
lymphedema consistently reported worse
general mental health and physical
function. Symptoms of persistent lymphedema were common in this
population
of older breast cancer survivors and had a noticeable effect on both physical
function and general
mental health. Our findings provide evidence of the
impact of symptoms of persistent lymphedema on the
quality of survivorship
of older women. Clinical and research efforts focused on risk factors for
symptoms of
persistent lymphedema in older breast cancer survivors may lead
to preventative and therapeutic measures
that help maintain their health and
well-being over increasing periods of survivorship.
PMID: 19968661 [PubMed - as supplied by publisher
------
2. Hum Genet. 2009 Dec 5. [Epub ahead of print]
Erratum to: Linkage and sequence analysis indicate that CCBE1 is mutated in
recessively inherited
generalised lymphatic dysplasia.
Connell F, Kalidas K, Ostergaard P, Brice G, Homfray T, Roberts L, Bunyan
DJ, Mitton S, Mansour S,
Mortimer P, Jeffery S; Lymphoedema Consortium.
Medical Genetics Unit, Clinical Developmental Sciences, St George's
University of London, Cranmer
Terrace, London, SW17 0RE, UK.
PMID: 19967415 [PubMed - as supplied by publisher
-----
3. J Cancer Surviv. 2009 Dec 6. [Epub ahead of print]
The role of occupational upper extremity use in breast cancer related upper
extremity lymphedema.
Tahan G, Johnson R, Mager L, Soran A.
Department of Surgery, Surgical Oncology, Magee-Womens Hospital of
University of Pittsburgh,
Pittsburgh, PA, 15213, USA.
BACKGROUND: Upper extremity (UE) use has been related to breast
cancer-related lymph edema
(BCRL). Our aim was to evaluate severity of BCRL
in different occupation groups, according to upper
extremity use.
METHODS: Fifty-five women with BCRL were recruited. Group-1 (n = 21), with a
mean age of 59,
included patients who worked continuously <30 min at a
time and </=8 h per day. Group-2 (n = 15), with a
mean age of 54, were
patients who worked continuously between 30 to 60 min at a time, and </=8 h
per
day. Group-3 (n = 19), who had a mean age of 51, included patients who
were working continuously for >1
h and >8 h per day.
RESULTS: The age, operation type, infection occurrence, radiotherapy status,
and the operation on the side
of the dominant hand were not statistically
different between the groups. The stage and grade of the BCRL
in group-3
were higher than the other groups (both p < 0.001). The restriction of
shoulder movements on
the operation side (p = 0.04) and shoulder
physiotherapy need (p < 0.001) were the highest in group-3.
Arm pain (p =
0.004) and pain medicine needs (p = 0.028) in group-1 were lower than the other
groups.
CONCLUSION: Group-3 had the worst BCRL clinical stage and grade status and
other breast cancer
treatment related morbities. Occupations that require
greater use of the upper extremities. At present there is
a need for closer
monitoring of patients with more severe BCRL. Potential exacerbating and
maintaining
factors of functional limitations and pain need to considered so
that clinical management addresses these in
relation to daily use of the
affected UE
PMID: 19967411 [PubMed - as supplied by publisher
------
3. Rev Lat Am Enfermagem. 2009 Sep-Oct;17(5):730-6.
Physiotherapy treatments for breast cancer-related lymphedema: a
literature review.
Leal NF, Carrara HH, Vieira KF, Ferreira CH.
Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo,
Brazil.
Breast cancer is the second most frequent cancer among women. Surgery is part
of the therapeutic process
to prevent metastases, but it can also cause some
complications, including lymphedema. Physiotherapy
contributes to its
treatment, using different techniques that have been developed over the years.
This
systematic literature review aims to present physiotherapy modalities
applied for lymphedema therapy. The
literature review was conducted using
textbooks and Lilacs, Pubmed and Scielo databases, from 1951 to
2009.
Physiotherapy resources used for lymphedema treatment include complex
decongestive therapy
(CDT), pneumatic compression (PC), high voltage
electrical stimulation (HVES) and laser therapy. The
analyzed literature
shows that better results are obtained with combined techniques. CDT is the most
used
protocol, and its association with PC has demonstrated efficacy. The
new techniques HVES and laser
present satisfactory results.
PMID: 19967225 [PubMed - in process
-----
5. Br J Nurs. 2009 Oct 8-21;18(18):1120-4.
Managing chronic oedema in the morbidly obese patient.
Todd M.
Lymphoedema Clinic, Greater Glasgow & Clyde NHS Trust, Glasgow.
The obesity epidemic has become one of the major challenges for health
and social policy makers around
the world. The increase in obesity is
commensurate with the rise in associated complications, including type
2
diabetes, cardiovascular disease and some types of cancer (breast, colon,
endometrium, prostrate, kidney
and gallbladder). There are also increased
cost implications for health services, welfare services and
employers. A
crude estimate of approximately 15000 patients attending a US clinic showed
almost 75% of
morbidly obese patients have chronic oedema of the legs. An
audit of body mass index of patients attending
a specialist lymphoedema
clinic showed 36% were clinically obese and 23% were morbidly obese. This has
major implications for lymphoedema practitioners in terms of allocating time
and resources, and health and
safety issues relating to providing a safe
environment for both patients and practitioners. This article
investigates
the financial and health consequences of the rising obesity problem and outlines
some of the
strategies implemented to halt this trend. The effects and
management of chronic oedema in the morbidly
obese patient are also
presented.
PMID: 19966731 [PubMed - in process]
----
6. Pathophysiology. 2009 Dec 4. [Epub ahead of print]
An interstitial hypothesis for breast cancer related lymphoedema.
Bates DO.
Microvascular Research Laboratories, Bristol Heart Institute, Department
of Physiology and Pharmacology,
School of Veterinary Sciences, University of
Bristol, Southwell Street, Bristol BS2 8EJ, United Kingdom.
Breast cancer related lymphoedema (BCRL), the chronically swollen arm of
patients that have been treated
for breast cancer, is no longer considered
to be a result of lymphatic obstruction as recent studies have
identified
failing peripheral lymphatic function as a principal contributing factor. The
aetiology and
pathophysiology that results in this lymphatic failure is not
clearly understood, but it can occur with minimal
or even in some cases no
damage to the axillary lymph nodes, and evidence suggests that some patients are
pre-disposed to develop the disease, and have poor lymphatic function in
their non-affected arms. It has
been shown that interstitial forces such as
hydrostatic pressure, and interstitial fluid velocity, can regulate
both
lymph flow, and lymph formation, and there is good evidence that interstitial
forces are dysregulated in
lymphoedema patients. Here I outline a hypothesis
for how dysregulation of interstitial parameters could
contribute to the
generation of breast cancer related lymphoedema, by combining disparate strands
of
current evidence on the molecular and physiological control of
interstitial and lymph flows. One mechanism
by which lymphoedema could be
generated is that a reduction in interstitial velocity results in increased
VEGF-C production, which in low flow conditions, instead of acting on the
lymphatics to increase pumping
and lymphangiogenesis, acts on vasculature to
increase fluid filtration. The resulting increase in interstitial
pressure
restores flow, but at the expense of increased volume and hence oedema. The
evidence supporting
the hypothesis and possible tests of it are presented
and discussed.
PMID: 19963358 [PubMed - as supplied by
publisher
---------------------
1. J Reconstr Microsurg.. [Epub ahead of print]
Comparison of Primary and Secondary Lower-Extremity Lymphedema Treated with
Supermicrosurgical
Lymphaticovenous Anastomosis and Lymphaticovenous
Implantation.
Demirtas Y, Ozturk N, Yapici O, Topalan M.
Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis
University Medical School,
Samsun, Turkey.
Although some authors previously stated that microlymphatic surgery does not
have application to primary
lymphedema, opposite views are reported based on
the observations that the lymphatics were not
hypoplastic in majority of
these patients and microlymphatic surgery yielded significant improvement. The
aim of this study was to compare the intraoperative findings and outcomes of
primary and secondary lower-
extremity lymphedema cases treated with
lymphaticovenous shunts. Between December 2006 and April
2009,
microlymphatic surgery was performed in 80 lower extremities with primary and 21
with secondary
lymphedema. These two groups of extremities are compared
according to the morphology of the lymphatic
vessels and possibility of
precise anastomoses, their response to the treatment, and final outcomes based
on
volumetric measurements during the follow-up period. The morphology of
the lymphatics in secondary
lymphedema was more consistent, and at least one
collector larger than 0.3 mm was available for
anastomosis in 20 of 21
extremities. In the primary lymphedema group, the lymphatics were smaller than
0.3
mm in 13 of 80 extremities. It was, therefore, possible to perform
supermicrosurgical lymphaticovenous
anastomosis in 84% of extremities with
primary lymphedema and 95% of extremities with secondary
lymphedema.
Reduction of the edema occurred earlier in the secondary lymphedema group, but
the mean
reduction in the edema volume was comparable between the two
groups. Microlymphatic surgery, although
more effective and offered as the
treatment of choice for secondary lymphedema, would also be a valuable
and
relevant treatment of primary lymphedema. © Thieme Medical Publishers.
PMID: 20013596 [PubMed - as supplied by publisher
----
2. PLoS Pathog. 2009 Dec;5(12):e1000688.
Lymphangiogenesis and lymphatic remodeling induced by filarial parasites:
implications for pathogenesis.
Bennuru S, Nutman TB.
Laboratory of Parasitic Diseases, National Institute of Allergy and
Infectious Diseases, National Institutes of
Health, Bethesda, Maryland,
United States of America.
Even in the absence of an adaptive immune system in murine models, lymphatic
dilatation and dysfunction
occur in filarial infections, although severe
irreversible lymphedema and elephantiasis appears to require an
intact
adaptive immune response in human infections. To address how filarial parasites
and their antigens
influence the lymphatics directly, human lymphatic
endothelial cells were exposed to filarial antigens, live
parasites, or
infected patient serum. Live filarial parasites or filarial antigens induced
both significant LEC
proliferation and differentiation into tube-like
structures in vitro. Moreover, serum from patently infected
(microfilaria
positive) patients and those with longstanding chronic lymphatic obstruction
induced significantly
increased LEC proliferation compared to sera from
uninfected individuals. Differentiation of LEC into tube-
like networks was
found to be associated with significantly increased levels of matrix
metalloproteases and
inhibition of their TIMP inhibitors (Tissue inhibitors
of matrix metalloproteases). Comparison of global gene
expression induced by
live parasites in LEC to parasite-unexposed LEC demonstrated that filarial
parasites
altered the expression of those genes involved in cellular
organization and development as well as those
associated with junction
adherence pathways that in turn decreased trans-endothelial transport as
assessed
by FITC-Dextran. The data suggest that filarial parasites directly
induce lymphangiogenesis and lymphatic
differentiation and provide insight
into the mechanisms underlying the pathology seen in lymphatic filariasis.
PMID: 20011114 [PubMed - in process
----
3. Am J Pathol.. [Epub ahead of print]
MYC High Level Gene Amplification Is a Distinctive Feature of Angiosarcomas
after Irradiation or Chronic
Lymphedema.
Manner J, Radlwimmer B, Hohenberger P, Mössinger K, Küffer S, Sauer C,
Belharazem D, Zettl A,
Coindre JM, Hallermann C, Hartmann JT, Katenkamp D,
Katenkamp K, Schöffski P, Sciot R, Wozniak A,
Lichter P, Marx A, Ströbel
P.
From the Institute of Pathology,* University Medical Centre Mannheim,
University of Heidelberg, Germany;
the German Cancer Research Center (DKFZ),
Division of Molecular Genetics, Heidelberg, Germany; the
Department of
Surgery, Division of Surgical Oncology and Thoracic Surgery, University Medical
Centre
Mannheim, University of Heidelberg, Germany; Pathology Viollier,
Basle, Switzerland; the Department of
Pathology and INSERM U916, Institut
Bergonié and Laboratory of Pathology, University Victor Ségalen,
Bordeaux,
France; the Department of Dermatology, Fachklinik Hornheide, Münster; the
Department of
Medical Oncology,** Medical Center II,
Eberhard-Karls-University, Tuebingen, Germany; the Institute of
Pathology,
University of Jena, Germany; the Department of General Medical Oncology,
University Hospitals
Leuven, Leuven Cancer Institute, Catholic University
Leuven, Leuven, Belgium; and the Laboratory of
Morphology and Molecular
Pathology, Department of Pathology, University Hospital, Catholic University of
Leuven, Belgium.
Angiosarcomas (AS) are rare vascular malignancies that arise either de novo
as primary tumors or
secondary to irradiation or chronic lymphedema. The
cytogenetics of angiosarcomas are poorly
characterized. We applied
array-comparative genomic hybridization as a screening method to identify
recurrent alterations in 22 cases. Recurrent genetic alterations were
identified only in secondary but not in
primary AS. The most frequent
recurrent alterations were high level amplifications on chromosome 8q24.21
(50%), followed by 10p12.33 (33%) and 5q35.3 (11%). Fluorescence in situ
hybridization analysis in 28
primary and 33 secondary angiosarcomas (31
tumors secondary to irradiation, 2 tumors secondary to
chronic lymphedema)
confirmed high level amplification of MYC on chromosome 8q24.21 as a recurrent
genetic alteration found exclusively in 55% of AS secondary to irradiation
or chronic lymphedema, but not in
primary AS. Amplification of MYC did not
predispose to high grade morphology or increased cell turnover.
In
conclusion, despite their identical morphology, secondary AS are genetically
different from primary AS
and are characterized by a high frequency of high
level amplifications of MYC. This finding may have
implications both for the
diagnosis and treatment of these tumors.
PMID: 20008140 [PubMed - as supplied by publisher
---
4. Surg Oncol.. [Epub ahead of print]
Systematic review and meta-analysis of the used surgical techniques to reduce
leg lymphedema following
radical inguinal nodes dissection.
Abbas S, Seitz M.
Hunter and New England Health Area, Manning Hospital, 26 YORK Street, Taree,
NSW 2430, Australia.
BACKGROUND: Inguinal nodes dissection is associated with high rates of
morbidity, lymphedema in
particular is a chronic disabling condition which
is a common complication following this operation.
Prevention or
minimization of this condition is an important aim when considering this
procedure. Many
technical modifications are suggested for this purpose. This
systematic review aims at assessing the efficacy
of the available strategies
to reduce the risk and severity of leg lymphedema.
METHODS: For this review, MEDLINE and EMBASE were searched to identify
studies that reported
surgical strategies designed to reduce complications
of groin dissection and in particular leg lymphedema.
Studies that reported
outcome of long saphenous vein sparing, fascia preserving dissection,
microvascular
surgery, sartorius transposition and omental pedicle flap were
located. Data were collected using predefined
inclusion and exclusion
criteria. A combined odds ratio was calculated combining studies suitable for
meta-
analysis using the random effect model.
RESULTS: The search result defined few studies that reported results of
saphenous vein sparing technique;
some of those studies were found suitable
for meta-analysis based on the Newcastle-Ottawa scale for non-
randomized
studies. The meta-analysis showed significant reduction of lymphedema (odds
ratio 0.24, 95%
CI 0.11-0.53) and other complications of inguinal node
dissection. There were no randomized studies to
address this problem; there
are also isolated studies that reported benefits of other techniques but none of
them was suitable for meta-analysis.
CONCLUSION: Meta-analysis of the reported studies on sparing the long
saphenous vein in inguinal nodes
dissection suggests a reduced rate of
lymphedema and other postoperative complications. Other methods
that may be
beneficial are fascia preserving dissection, pedicled omental flap and
microsurgery; however
sartorius transposition has not been shown to reduce
the rate of complications. Randomized controlled trials
are needed to prove
the benefits of various technical modifications.
PMID: 20005090 [PubMed - as supplied by publisher
----
5. J Plast Reconstr Aesthet Surg.. [Epub ahead of print]
Surgical resection of vulva lymphoedema circumscriptum.
Vignes S, Arrault M, Trévidic P.
Department of Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015
Paris, France.
BACKGROUND: Lymphangioma circumscriptum, a rare, benign disease that can be
either congenital or
acquired, involves the deep dermis and subcutaneous
lymphatics.
OBJECTIVE: This study aims to analyse the efficacy of surgical resection of
vulva lymphangioma
circumscriptum (VLC).
MATERIALS AND METHODS: Between January 2000 and December 2008, eight
consecutive women
referred to our centre and treated surgically for VLC were
included in the study. VLC was responsible for
recurrent lymph oozing in
seven cases. All women were treated by the same plastic surgeon specialising in
lymphatic diseases.
RESULTS: The first surgery was performed after a median interval of 5.4 years
since VLC onset. The first
cutaneous resection included the labia majora of
all women and labia minora of five and clitoral hood of four.
Five women
experienced rapidly recurrent vesicles associated with lymph oozing and
underwent resection
again (once: two women, twice: three women). The second
resection was performed 4-6 months after the
first, whereas the third took
place 1-6 years after the second. Five women had moderate and transitory
post-
surgical lymph oozing. After a median follow-up of 53 months after the
last surgery, seven of the eight
women were free from symptom.
CONCLUSION: Surgical resection is an effective and well-tolerated therapy for
VLC in most women.
Lesion recurrence is frequent but resection can be
repeated several times with no adverse effects.
PMID: 20004630 [PubMed - as supplied by publisher
----
6. Adv Nurse Pract. 2009 Jun;17(6):29-30, 32.
Fluid transport gone wrong. An introduction to lymphedema.
Ridner SH.
Vanderbilt University School of Nursing, Nashville, USA.
PMID: 20000181 [PubMed - in process
-----------------
1. Eur J Obstet Gynecol Reprod Biol. 2009 Dec 15. [Epub ahead of
print]
Different physical treatment modalities for lymphoedema developing after
axillary lymph node dissection for
breast cancer: A review.
Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR.
Department Physiotherapy, University Hospitals Leuven, Belgium; Faculty of
Kinesiology and Rehabilitation
Sciences, Katholieke Universiteit Leuven,
Belgium; Department of Health Care Sciences, University College
of Antwerp,
Belgium.
The purpose of this article is to provide a systematic review of Combined
Physical Therapy, Intermittent
Pneumatic Compression and arm elevation for
the treatment of lymphoedema secondary to an axillary
dissection for breast
cancer. Combined Physical Therapy starts with an intensive phase consisting of
skin
care, Manual Lymphatic Drainage, exercises and bandaging and continues
with a maintenance phase
consisting of skin care, exercises, wearing a
compression sleeve and Manual Lymphatic Drainage if needed.
We have searched
the following databases: PubMed/MEDLINE, CINAHL, EMBASE, PEDro and
Cochrane.
Only (pseudo-) randomised controlled trials and non-randomised experimental
trials investigating
the effectiveness of Combined Physical Therapy and its
different parts, of Intermittent Pneumatic
Compression and of arm elevation
were included. These physical treatments had to be applied to patients
with
arm lymphoedema which developed after axillary dissection for breast cancer. Ten
randomised
controlled trials, one pseudo-randomised controlled trial and
four non-randomised experimental trials were
found and analysed. Combined
Physical Therapy can be considered as an effective treatment modality for
lymphoedema. Bandaging the arm is effective, whether its effectiveness is
investigated on a heterogeneous
group consisting of patients with upper and
lower limb lymphoedema from different causes. There is no
consensus on the
effectiveness of Manual Lymphatic Drainage. The effectiveness of skin care,
exercises,
wearing a compression sleeve and arm elevation is not
investigated by a controlled trial. Intermittent
Pneumatic Compression is
effective, but once the treatment is interrupted, the lymphoedema volume
increases. In conclusion, Combined Physical Therapy is an effective therapy
for lymphoedema. However,
the effectiveness of its different components
remains uncertain. Furthermore, high-quality studies are
warranted. The
long-term effect of Intermittent Pneumatic Compression and the effect of
elevation on
lymphoedema are not yet proven. Copyright © 2009 Elsevier
Ireland Ltd. All rights reserved.
PMID: 20018422 [PubMed - as supplied by publisher
----
2. South Med J. 2009 Dec;102(12):1257-9.
Palliation of malignant rectal obstruction from invasive prostate cancer with
multiple overlapping self-
expanding metal stents.
Smith AS, Cole M, Vega KJ, Munoz JC.
Division of Gastroenterology, University of Florida College of
Medicine/Jacksonville, Jacksonville, FL
32207, USA.
Self-expandable metal stents (SEMS) are used for colonic neoplastic and
extracolonic metastatic
obstruction relief. Limited data exists on their use
for locally invasive prostate cancer. We describe a unique
approach using
overlapping SEMS to alleviate a rectosigmoid obstruction from locally invasive
prostate
cancer. A patient with locally advanced prostate cancer presented
with obstipation and lymphedema.
Placement of overlapping rectosigmoid SEMS
was performed, relieving the visualized rectosigmoid
obstruction.
PMID: 20016435 [PubMed - in process
----
3. Exerc Sport Sci Rev. 2010 Jan;38(1):17-24.
Balancing lymphedema risk: exercise versus deconditioning for breast cancer
survivors.
Schmitz KH.
University of Pennsylvania School of Medicine, Abramson Cancer Center,
Philadelphia, 19104-6021,
United States. [email protected]
Lymphedema, a common and feared negative effect of breast cancer treatment,
is generally described by
arm swelling and dysfunction. Risk averse clinical
recommendations guided survivors to avoid the use of the
affected arm. This
may lead to deconditioning and, ironically, the very outcome women seek to
avoid.
Recently published studies run counter to these guidelines.
PMID: 20016295 [PubMed - in process
----
4. Exerc Sport Sci Rev. 2010 Jan;38(1):2.
Role of exercise in the prevention and management of lymphedema after breast
cancer.
Hayes SC.
Queensland University of Technology, Australia.
PMID: 20016292 [PubMed - in process
1. Eur J Obstet Gynecol Reprod Biol. 2009 Dec 15. [Epub ahead of
print]
Different physical treatment modalities for lymphoedema developing after
axillary lymph node dissection for
breast cancer: A review.
Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR.
Department Physiotherapy, University Hospitals Leuven, Belgium; Faculty of
Kinesiology and Rehabilitation
Sciences, Katholieke Universiteit Leuven,
Belgium; Department of Health Care Sciences, University College
of Antwerp,
Belgium.
The purpose of this article is to provide a systematic review of Combined
Physical Therapy, Intermittent
Pneumatic Compression and arm elevation for
the treatment of lymphoedema secondary to an axillary
dissection for breast
cancer. Combined Physical Therapy starts with an intensive phase consisting of
skin
care, Manual Lymphatic Drainage, exercises and bandaging and continues
with a maintenance phase
consisting of skin care, exercises, wearing a
compression sleeve and Manual Lymphatic Drainage if needed.
We have searched
the following databases: PubMed/MEDLINE, CINAHL, EMBASE, PEDro and
Cochrane.
Only (pseudo-) randomised controlled trials and non-randomised experimental
trials investigating
the effectiveness of Combined Physical Therapy and its
different parts, of Intermittent Pneumatic
Compression and of arm elevation
were included. These physical treatments had to be applied to patients
with
arm lymphoedema which developed after axillary dissection for breast cancer. Ten
randomised
controlled trials, one pseudo-randomised controlled trial and
four non-randomised experimental trials were
found and analysed. Combined
Physical Therapy can be considered as an effective treatment modality for
lymphoedema. Bandaging the arm is effective, whether its effectiveness is
investigated on a heterogeneous
group consisting of patients with upper and
lower limb lymphoedema from different causes. There is no
consensus on the
effectiveness of Manual Lymphatic Drainage. The effectiveness of skin care,
exercises,
wearing a compression sleeve and arm elevation is not
investigated by a controlled trial. Intermittent
Pneumatic Compression is
effective, but once the treatment is interrupted, the lymphoedema volume
increases. In conclusion, Combined Physical Therapy is an effective therapy
for lymphoedema. However,
the effectiveness of its different components
remains uncertain. Furthermore, high-quality studies are
warranted. The
long-term effect of Intermittent Pneumatic Compression and the effect of
elevation on
lymphoedema are not yet proven. Copyright © 2009 Elsevier
Ireland Ltd. All rights reserved.
PMID: 20018422 [PubMed - as supplied by publisher
----
1. PLoS One. 2009 Dec 21;4(12):e8380.
Anti-inflammatory pharmacotherapy with ketoprofen ameliorates experimental
lymphatic vascular
insufficiency in mice.
Nakamura K, Radhakrishnan K, Wong YM, Rockson SG.
Division of Cardiovascular Medicine, Stanford University School of Medicine,
Stanford, California, USA.
BACKGROUND: Disruption of the lymphatic vasculature causes edema,
inflammation, and end-tissue
destruction. To assess the therapeutic efficacy
of systemic anti-inflammatory therapy in this disease, we
examined the
impact of a nonsteroidal anti-inflammatory drug (NSAID), ketoprofen, and of a
soluble TNF-
alpha receptor (sTNF-R1) upon tumor necrosis factor (TNF)-alpha
activity in a mouse model of acquired
lymphedema.
METHODS AND FINDINGS: Lymphedema was induced by microsurgical ablation of
major lymphatic
conduits in the murine tail. Untreated control mice with
lymphedema developed significant edema and
extensive histopathological
inflammation compared to sham surgical controls. Short-term ketoprofen
treatment reduced tail edema and normalized the histopathology while
paradoxically increasing TNF-alpha
gene expression and cytokine levels.
Conversely, sTNF-R1 treatment increased tail volume, exacerbated
the
histopathology, and decreased TNF-alpha gene expression. Expression of vascular
endothelial growth
factor-C (VEGF-C), which stimulates lymphangiogenesis,
closely correlated with TNF-alpha expression.
CONCLUSIONS: Ketoprofen therapy reduces experimental post-surgical
lymphedema, yet direct TNF-
alpha inhibition does not. Reducing inflammation
while preserving TNF-alpha activity appears to optimize
the repair response.
It is possible that the observed favorable responses, at least in part, are
mediated
through enhanced VEGF-C signaling.
PMID: 20027220 [PubMed - in process
----
2. Vet Rec. 2009 Dec 26;165(25):758.
Therapy for horses with chronic progressive lymphoedema.
Powell H.
25A The Square, Alvechurch, Worcestershire B48 7LA.
PMID: 20023285 [PubMed - in process
----
3. In Vivo. 2009 Nov-Dec;23(6):1017-20.
Incidence of arm lymphoedema following sentinel node biopsy, axillary
sampling and axillary dissection in
patients with breast cancer.
Lumachi F, Basso SM, Bonamini M, Marino F, Marzano B, Milan E, Waclaw BU,
Chiara GB.
University of Padua, School of Medicine, Department of Surgical and
Gastroenterological Sciences, Via
Giustiniani 2, 35128 Padova, Italy. [email protected].
The aim of this study was to compare the incidence of lymphoedema after
different treatments of the axilla in
patients with breast cancer (BC).
Medical records of 205 women (median age 61 years, range 26-72
years) who
underwent curative surgery for primary BC were reviewed. According to the
treatment of the
axilla, the study population was divided into four age- and
stage-matched groups of patients: Group A
(N=54 patients), sentinel node
biopsy (SLNB) alone; Group B (N=48 patients), SLNB followed by axillary
node
(AN) sampling using ultrasound scissors (harmonic scalpel); Group C (N=53
patients), AN dissection
using ultrasound scissors; Group D (N=50 patients),
traditional AN dissection. The median follow-up was
22 months (range 18-28
months). The intraoperative frozen section of SLNB (Groups A and B) showed 32
out of 102 (31.4%) patients with metastasis to AN, while final pathology
showed AN metastases in 20, 17,
16 and 17 patients of groups A, B, C and D,
respectively (p=NS). The sensitivity of SLNB alone was 80%
and that of SLNB
followed by AN sampling was 95% (p=NS). At follow-up patients with lymphoedema
were 2 (3.7%), 2 (4.2%), 3 (5.6%) and 8 (16%) in groups A, B, C and D,
respectively (p=NS). In
conclusion, AN sampling is a sensitive and
low-morbidity procedure which, in conjunction with the use of
harmonic
scalpel, may reduce the onset of arm lymphoedema.
PMID: 20023249 [PubMed - in process
-----------------------
Eur J Cancer Care (Engl). 2009 Dec 17. [Epub ahead of print]
Cancer-related secondary lymphoedema due to cutaneous lymphangitis
carcinomatosa: clinical presentations
and review of literature.
Damstra RJ, Jagtman EA, Steijlen PM.
Nij Smellinghe Hospital, Department of Dermatology and Phlebology and
Lymphology, Compagnonsplein,
Drachten, the Netherlands.
DAMSTRA R.J., JAGTMAN E.A. & STEIJLEN P.M. (2009) European Journal of
Cancer Care Cancer-
related secondary lymphoedema due to cutaneous
lymphangitis carcinomatosa: clinical presentations and
review of literature
Lymphoedema is a clinical condition caused by impairment of the lymphatic
system,
leading to swelling of subcutaneous soft tissues. As a result,
accumulation of protein-rich interstitial fluid and
lymphstasis often causes
additional swelling, fibrosis and adipose tissue hypertrophy leading to
progressive
morbidity and loss of quality of life for the patient.
Lymphoedema can be distinguished as primary or
secondary. Lymphoedema is a
complication frequently encountered in patients treated for cancer, especially
after lymphadenoectomy and/or radiotherapy based on destruction of
lymphatics. However, although
lymphatic impairment is sometimes caused by
obstructive solid metastasis, we present three cases of
secondary
lymphoedema with minor dermatological features without detectable solid
metastasis. Sometimes
this type of lymphoedema is mistakenly called
malignant lymphoedema. All patients were previously treated
for cancer
without clinical signs of recurrence, presented with progressive lymphoedema and
minor
dermatological features of unknown origin. Clinical and
histopathological examination of the skin revealed
diffuse lymphangitis
carcinomatosa, leading to secondary lymphoedema and adjustment of the
therapeutic
approach and prognosis. We reviewed literature on these rare
presentations of cancer recurrence and
recommend, where appropriate,
consulting a dermatologist when discrete skin abnormalities are seen in
patients with a history of cancer and developing lymphoedema.
PMID: 20030691 [PubMed - as supplied by publisher
----
1: Weight lifting in women with breast-cancer-related lymphedema.
Authors:
Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ,
Williams-
Smith CT, Greene QP
Institution: Center for Clinical
Epidemiology and Biostatistics, University of Pennsylvania School of
Medicine, Philadelphia, PA 19104, USA. [email protected]
Journal:
N Engl J Med. 2009 Aug 13;361(7):664-73.
2: Post-breast cancer lymphedema: part 2.
Authors: Fu MR, Ridner SH, Armer
J
Institution: New York University College of Nursing, New York City, USA. [email protected]
Journal: Am J Nurs. 2009
Aug;109(8):34-41; quiz 42.
3: Post-breast cancer. Lymphedema: part 1.
Authors: Fu MR, Ridner SH,
Armer J
Institution: New York University College of Nursing, New York City,
USA. [email protected]
Journal: Am J Nurs. 2009
Jul;109(7):48-54; quiz 55.
4: The psycho-social impact of lymphedema.
Authors: Ridner
SH
Institution: Vanderbilt University School of Nursing, Nashville, Tennessee
37240, USA. Sheila.
[email protected]
Journal:
Lymphat Res Biol. 2009;7(2):109-12.
5: The standard of care for lymphedema: current concepts and physiological
considerations.
Authors: Mayrovitz HN
Institution: College of Medical
Sciences, Nova Southeastern University, Ft. Lauderdale, FL 33328, USA.
[email protected]
Journal: Lymphat Res
Biol. 2009;7(2):101-8.
6: Prospective evaluation of a prevention protocol for lymphedema following
surgery for breast cancer.
Authors: Boccardo FM, Ansaldi F, Bellini C,
Accogli S, Taddei G, Murdaca G, Campisi CC, Villa G,
Icardi G, Durando P,
Puppo F, Campisi C
Institution: Department of Surgery, Unit of Lymphatic
Surgery and Microsurgery, S. Martino Hospital,
University of Genoa, Italy.
[email protected]
Journal:
Lymphology. 2009 Mar;42(1):1-9.
7: Suction-assisted lipectomy for treatment of lower-extremity
lymphedema.
Authors: Eryilmaz T, Kaya B, Ozmen S, Kandal S
Institution:
Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University
School of
Medicine, Ankara, Turkey. [email protected]
Journal: Aesthetic
Plast Surg. 2009 Jul;33(4):671-3. Epub 2009 May 12.
8: Understanding the management of lymphoedema for patients with advanced
disease.
Authors: Honnor A
Institution: Loros Hospice, Leicester, England.
[email protected]
Journal:
Int J Palliat Nurs. 2009 Apr;15(4):162, 164, 166-9.
9: Understanding breast cancer-related lymphoedema.
Authors: Bennett
Britton TM, Purushotham AD
Institution: Department of Research Oncology,
King's College London, Guy's & St. Thomas' NHS
Foundation Trust, London,
UK.
Journal: Surgeon. 2009 Apr;7(2):120-4.
10: Compression therapy in breast cancer-related lymphedema: A randomized,
controlled comparative
study of relation between volume and interface
pressure changes.
Authors: Damstra RJ, Partsch H
Institution: Department
of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten,
The Netherlands. [email protected]
Journal:
J Vasc Surg. 2009 May;49(5):1256-63.
11: Pole walking for patients with breast cancer-related arm
lymphedema.
Authors: Jonsson C, Johansson K
Institution: Lymphedema Unit,
Lund University Hospital, Lund, Sweden. [email protected]
Journal:
Physiother Theory Pract. 2009 Apr;25(3):165-73.
12: Recent advances in breast cancer-related lymphedema of the arm: lymphatic
pump failure and
predisposing factors.
Authors: Stanton AW, Modi S,
Mellor RH, Levick JR, Mortimer PS
Institution: Division of Cardiac &
Vascular Sciences, Dermatology, St George's Hospital Medical School,
University of London, London, United Kingdom.
Journal: Lymphat Res Biol.
2009;7(1):29-45.
13: Breast cancer-related lymphoedema: risk factors and
treatment.
Authors: Harmer V
Institution: Breast Care Unit, St Mary's
Hospital Campus, Imperial College Healthcare, NHS Trust,
London,
UK.
Journal: Br J Nurs. 2009 Feb 12-25;18(3):166-72.
14: Efficacy of pneumatic compression and low-level laser therapy in the
treatment of postmastectomy
lymphoedema: a randomized controlled
trial.
Authors: Kozanoglu E, Basaran S, Paydas S, Sarpel T
Institution:
Department of Physical Medicine and Rehabilitation, Faculty of Medicine,
Cukurova University,
Adana, Turkey.
Journal: Clin Rehabil. 2009
Feb;23(2):117-24.
15: Lymphatic venous anastomosis (LVA) for treatment of secondary arm
lymphedema. A prospective
study of 11 LVA procedures in 10 patients with
breast cancer related lymphedema and a critical review of
the
literature.
Authors: Damstra RJ, Voesten HG, van Schelven WD, van der Lei
B
Institution: Department of Dermatology, Phlebology and Lymphology, Nij
Smellinghe Hospital,
Compagnonsplein 1, 9202 NN, Drachten, The Netherlands.
[email protected]
Journal:
Breast Cancer Res Treat. 2009 Jan;113(2):199-206. Epub 2008 Feb 13.
1. J Dermatol. 2009 Dec;36(12):646-8.
Basal cell carcinoma arising on a chronic lymphedematous leg.
Ueno T, Futagami A, Mitsuishi T, Niimi Y, Shimoda T, Kawana S.
Department of Cutaneous and Mucosal Pathophysiology, Graduate School of
Medicine, Nippon Medical
School, Tokyo, Japan. [email protected]
We describe a case of an 82-year-old Japanese woman with basal cell carcinoma
(BCC) on the leg with
secondary chronic lymphedema due to treatment for
uterine cancer. Sparse tumor nests with remarkable
edema of the dermis in
the nodule appeared to be influenced by the chronic lymphedema. However, it
remains inconclusive whether or not the tumorigenesis of the BCC was
associated with chronic lymphedema
in this case.
PMID: 19958449 [PubMed - in process
2. Int J Gynecol Cancer. 2009 Dec;19(9):1649-54.
Lower-limb lymphedema and vulval cancer: feasibility of prophylactic
compression garments and validation
of leg volume measurement.
Sawan S, Mugnai R, Lopes Ade B, Hughes A, Edmondson RJ.
Academic Unit of Obstetrics and Gynaecology, St Mary's Hospital, The
University of Manchester,
Manchester, United Kingdom.
OBJECTIVES: Leg lymphedema remains a significant health problem after
treatment of vulval cancer. This
pilot study explored the feasibility of
conducting a larger trial to investigate whether the early use of
compression stockings is effective in preventing leg lymphedema.
METHODS: Fourteen patients undergoing inguinofemoral lymphadenectomy for
vulval cancer were
randomized to either best supportive care or best
supportive care plus the use of graduated compression
stockings for 6
months.
RESULTS: Six of 7 patients in the treatment group complied with the study
protocol. The incidence of
clinically significant lymphedema was not
different between both groups; however, there was a greater
increase in mean
leg volume in the control group (953 vs 607 mL, P = 0.010). Furthermore,
patients in the
treatment group showed better performance as judged by leg
symptoms (P = 0.031, at 3 months) and
clinical examination (P = 0.039 at 4
weeks and P = 0.004 at 6 months). There was no difference in the
incidence
of groin wound dehiscence, infection, or lymphocyst formation. We detected no
difference
between both groups' scores when using a validated
quality-of-life questionnaire. Intraobserver and
interobserver variabilities
of leg-volume measurement technique were investigated using the principles of
repeatability and reproducibility statistics. Intraobserver variability was
estimated at 270 mL, whereas
interobserver variability was 1000 mL.
CONCLUSIONS: The prophylactic use of stockings in this population is
feasible, and further larger studies
are justified to investigate its role
in reducing the incidence of leg lymphedema. The design of these studies
should take into account the observer-related variability in measuring leg
volume or consider alternative
methods.
PMID: 19955953 [PubMed - in process