January 3,
2012
J Mal Vasc. 2011 Dec 21. [Epub ahead of print]
[Designing a therapeutic education program for patients with lymphedema: Live with lymphedema.]
[Article in French]
Blaise S, Villemur B, Richaud C, Rastel D, Bucci B, Evra V, Bouchet JY; les membres du réseau
GRANTED, Satger B.
Source
Department of Vascular Medicine, clinique de médecine vasculaire, Grenoble University Hospital, BP 217,
38043 Grenoble cedex 09, France; Réseau GRANTED, 38400 Saint-Martin-d'Hères, France.
Abstract
BACKGROUND:
Lymphedema is a chronic condition considered to be rare in its primary form and potentially frequent in
women after breast surgery for cancer: 27,000new cases annually. Therapeutic management is a serious
challenge. In France, the health authorities (Haute Autorité de santé [HAS]) have recently proposed that
appropriate management practices for lymphedema include "patient education". The HAS and the National
institute for health care prevention and education also published a methodology guide devoted to structuring
a therapeutic education program for patients with chronic disease. Current hospital regulations state that this
education program is part of the care to be delivered to patients with chronic disease and that it must comply
with the national directives. The purpose of our present work was to present the concept and the contents of
a patient education program entitled "Live with lymphedema" designed for patients with lymphedema and
developed within the inpatient-outpatient network GRANTED in Sud-Isère.
METHODS:
A standard detailed educative approach was applied. It was designed after the educational program for
patients with lower limb arterial occlusive disease authorized by the Rhône-Alpes regional health agency. It
was adapted to the specific problematic of patients with lymphedema, including medical management,
rehabilitation, dermatology and nutritional aspects. It was developed in cooperation with patients and favors
local associative actions.
RESULTS:
The specifically structured program included three therapeutic education consultations and five workshops.
Less than one year after its institution, more than 30 patients have participated in the program.
DISCUSSION:
We report a structured patient education program designed for patients with lymphedema. This program
was authorized by the Rhône-Alpes regional health agency in March 2011and is in compliance with the
national directives and HAS guidelines.
Copyright © 2011 Elsevier Masson SAS. All rights reserved.
PMID: 22196687 [PubMed - as supplied by publisher]
January 9, 2012
J Cutan Pathol. 2012 Jan;39(1):52-5. doi: 10.1111/j.1600-0560.2011.01785.x.
Lymphangiosarcoma arising after 33 years within a background of chronic filariasis: a case report with
review of literature.
Krishnamoorthy N, Viswanathan S, Rekhi B, Jambhekar NA.
Source
Department of Pathology, Tata Memorial Hospital, Mumbai, India.
Abstract
Cutaneous angiosarcoma or lymphangiosarcoma represents an uncommon aggressive tumor known to arise
on a background of chronic lymphedema secondary to various etiologies, principally following surgery or
irradiation. There have been rarely reported cases of angiosarcoma following infective conditions that
eventuate with lymphatic stasis. We report a case of angiosarcoma arising after 33 years within a
background of filariasis. Awareness of this association can lead to early diagnosis and appropriate treatment
of this potentially fatal malignant tumor. Krishnamoorthy N, Viswanathan S, Rekhi B, Jambhekar NA.
Lymphangiosarcoma arising after 33 years within a background of chronic filariasis: a case report with
review of literature.
Copyright © 2011 John Wiley & Sons A/S.
PMID: 22211335 [PubMed - in process]
Med Oncol. 2011 Dec;28 Suppl 1:22-30. Epub 2010 Sep 9.
Whether drainage should be used after surgery for breast cancer? A systematic review of randomized
controlled trials.
He XD, Guo ZH, Tian JH, Yang KH, Xie XD.
Source
Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199
Donggang West Road, Lanzhou, Gansu, 730000, China, [email protected].
Abstract
A systematic review of randomized controlled trials (RCTs) was conducted to evaluate whether patients
benefit from the suction drainage after axillary lymph node dissection (ALND) in breast cancer surgery.
RCTs of drainage versus no drainage after ALND in women with breast cancer were retrieved from
PubMed, EMBASE, Cochrane Library and Chinese Biomedical database. Two authors independently
assessed the quality of included trials and extracted data. Odds ratio (OR) for dichotomous outcomes and
mean difference (MD) for continuous outcomes were presented with 95% confidence intervals (CI). A total
of 1115 titles were indentified from the databases; 1109 obvious irrelevant studies were excluded by
examining the titles, abstracts, full texts because of duplicates, no RCT, different modality of drainage, drain
for lymphedema, application of fibrin sealant and so on. And then, only 6 RCTs to compare drainage with
no drainage after ALND in breast cancer surgery were included in the systematic review and a total of 585
patients were included in the pathological diagnosis of breast cancer in women before surgery, management
by ALND with or without addition surgical procedures. The study demonstrated that insertion of a drain in
the axilla after breast cancer surgery resulted in a statistically significant reduction in the rate of seroma (OR
= 0.36, 95% CI, 0.16 to 0.81, P = 0.01), the volume of aspiration (MD = -100.10, 95% CI, -174.36 to
-25.85, P = 0.008), or the frequency of seroma aspiration (MD = -1.03, 95% CI, -1.35 to -0.71, P <
0.00001), but prolonged the length of hospital stay (MD = 1.52, 95% CI, 0.36 to 2.68, P = 0.01). There
was no statistically significant difference in the incidence of wound infection (OR = 0.67, 95% CI, 0.34 to
1.32, P = 0.25) between drainage group and no drainage group. Based on the current evidence, insertion of
a drain in the axilla following ALND in breast cancer surgery effectively decreased seroma formation,
volume of aspiration as well as the frequency of seroma aspiration without increasing the incidence of wound
infection, but extending their stay in hospital.
PMID: 20827578 [PubMed - in process]
J Vasc Surg. 2011 Dec 29. [Epub ahead of print]
Technique, results, and postoperative patency of lymphaticovenous side-to-end anastomosis in peripheral
lymphedema.
Maegawa J, Yabuki Y, Tomoeda H, Hosono M, Yasumura K.
Source
Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan.
Abstract
OBJECTIVE:
Lymphaticovenous anastomosis has been used for patients with peripheral lymphedema. However, the
efficacy of this procedure is controversial due to a lack of evidence regarding postoperative patency. We
sought to determine midterm postoperative patency of lymphaticovenous side-to-end anastomoses
(LVSEAs) using indocyanine green fluorescence lymphography.
METHODS:
This was a retrospective observational study set in a teaching hospital. Of 107 patients with chronic
lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses) consented to fluorescence
lymphography and comprised the study cohort. The intervention consisted of a microsurgical LVSEA
performed with a suture-stent method. Patients also had preoperative and postoperative complex
decongestive physiotherapy. Anastomosis patency was assessed using indocyanine green fluorescence
lymphography ≥6 months after surgery. Patency rates were calculated using Kaplan-Meier analysis. We
assessed volume reduction on the operated-on limb and compared this between patients in whom
anastomoses were patent and those in whom anastomoses were not obviously patent.
RESULTS:
Patency could be evaluated only at the dorsum of the foot, ankle, and lower leg because the near-infrared
rays emitted by the special camera used could not penetrate the deep subcutaneous layer containing
collective lymphatics in areas such as the thigh. Several patterns were observed on fluorescence
lymphography: straight, radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12
months and 36% at 24 months after surgery. No significant difference in volume change of the affected limb
was seen between the 34 patients with patent anastomosis (600 ± 969 mL) and the 24 patients without
obvious evidence of patency (420 ± 874 mL).
CONCLUSIONS:
Although further study is required to determine factors leading to anastomotic obstruction and to optimize
the results of microlymphatic surgery, the present LVSEA technique appears promising.
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
PMID: 22209609 [PubMed - as supplied by publisher]
Case Rep Dermatol. 2011 Sep;3(3):251-8. Epub 2011 Nov 30.
A case of yellow nail syndrome with dramatically improved nail discoloration by oral clarithromycin.
Suzuki M, Yoshizawa A, Sugiyama H, Ichimura Y, Morita A, Takasaki J, Naka G, Hirano S, Izumi S,
Takeda Y, Hoji M, Kobayashi N, Kudo K.
Source
Department of Respiratory Medicine, National Center for Global Health and Medicine, Infection, Oncology,
Nippon Medical School, Tokyo.
Abstract
An 80-year-old woman was admitted to our hospital with pneumonia and exacerbation of sinobronchial
syndrome (SBS). She presented with yellow discoloration of the nail beds of all fingers and toes, and her
nails were recognized as growing slowly. Chest X-ray revealed bronchiectasis in the bilateral lower lobe and
bilateral pleural effusion. We diagnosed her as having yellow nail syndrome (YNS), based on the triad of
yellow nails, lymphedema, and lung disease. After treatment with antibiotics [ampicillin/sulbactam and
clarithromycin (CAM)] for pneumonia and SBS, her general condition improved, and the yellow nails
disappeared in some fingers. When she was previously treated with 200 mg CAM for SBS, her yellow nails
had not shown improvement. This time, her yellow nails improved after treatment with 400 mg CAM. The
literature reports vitamin E, zinc, and topical corticosteroid plus active vitamin D3 to be effective in the
treatment of yellow nails. Two studies have reported treatment for YNS using CAM, though they found a
lack of efficacy. Thus, the present case is the first to report improved yellow nails using CAM alone. We
conclude that not only SBS and lung disease but also YNS were improved by treatment with 400 mg CAM.
PMID: 22220146 [PubMed - in process] PMCID: PMC3250669
BMC Cancer. 2012 Jan 4;12(1):6. [Epub ahead of print]
Systematic review: conservative treatments for secondary lymphedema.
Oremus M, Dayes I, Walker K, Raina P.
Abstract
ABSTRACT:
BACKGROUND:
Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The
optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary
lymphedema, as well as harms related to these treatments.
METHODS:
We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, AMED, and
CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized
controlled trials or observational studies (with comparison groups) that reported primary effectiveness data
on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in
tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the
results descriptively and discussed similarities with the English-language studies.
RESULTS:
Thirty-six English-language and eight non-English-language studies were included in the review. Most of
these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's
chronicity, lengths of follow-up in most studies were under six months. Many trial reports contained
inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational
studies did not control for confounding. Many studies showed that active treatments reduced the size of
lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and
protocols, and outcome measures, prevented us from assessing whether any one treatment was superior.
This heterogeneity also precluded us from statistically pooling results. Harms were rare (<1% incidence) and
mostly minor (e.g., headache, arm pain).
CONCLUSIONS:
The literature contains no evidence to suggest the most effective treatment for secondary lymphedema.
Harms are few and unlikely to cause major clinical problems.
PMID: 22216837 [PubMed - as supplied by publisher]
January 15, 2012
J Rehabil Res Dev. 2011;48(10):1261-8.
Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy
patients: Pre-post intervention study.
Gautam AP, Maiya AG, Vidyasagar MS.
Source
Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal University, Manipal-
576104, Karnataka, India. Email: [email protected]. [email protected].
Abstract
Lymphedema is a debilitating complication following mastectomy, affecting the arm functions and quality of
life (QOL) of breast cancer patients. Studies have shown the beneficial effects of upper-limb exercises on
lymphedema in clinical set tings. However, there is a dearth of evidence regarding the effect of home-based
exercises on lymphedema; therefore, we examined the effect of a home-based exercise program on
lymphedema and QOL in postmastectomy patients. Thirty-two female postmastectomy lymphedema
patients participated in an individualized home-based exercise program for 8 weeks. Arm circumference,
arm volume, and QOL (36-Item Short Form Health Survey) were measured before and after the program.
Data were analyzed with the use of paired t-tests for circumferential and volumetric measures and Wilcoxon
signed ranks tests for QOL. Significance level was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05
/5 = 0.01). Analysis showed a statistically significant improvement in the affected upper-limb circumference
and volume (~122 mL reduction, p < 0.001) and in the QOL scores (p < 0.001) at the end of the home-
based exercise program. The individualized home-based exercise program led to improvement in affected
upper-limb volume and circumference and QOL of postmastectomy lymphedema patients.
PMID: 22234669 [PubMed - in process]
Ann Surg. 2012 Jan 9. [Epub ahead of print]
Microvascular Breast Reconstruction and Lymph Node Transfer for Postmastectomy Lymphedema Patients.
Saaristo AM, Niemi TS, Viitanen TP, Tervala TV, Hartiala P, Suominen EA.
Source
From the Department of Plastic Surgery, Turku University Central Hospital, Turku, Finland.
Abstract
OBJECTIVE:
Postoperative lymphedema after breast cancer surgery is a challenging problem. Recently, a novel
microvascular lymph node transfer technique provided a fresh hope for patients with lymphedema. We
aimed to combine this new method with the standard breast reconstruction.
METHODS:
During 2008-2010, we performed free lower abdominal flap breast reconstruction in 87 patients. For all
patients with lymphedema symptoms (n = 9), we used a modified lower abdominal reconstruction flap
containing lymph nodes and lymphatic vessels surrounding the superficial circumflex vessel pedicle.
Operation time, donor site morbidity, and postoperative recovery between the 2 groups (lymphedema
breast reconstruction and breast reconstruction) were compared. The effect on the postoperative lymphatic
vessel function was examined.
RESULTS:
The average operation time was 426 minutes in the lymphedema breast reconstruction group and 391
minutes in the breast reconstruction group. The postoperative abdominal seroma formation was increased in
patients with lymphedema. Postoperative lymphoscintigraphy demonstrated at least some improvement in
lymphatic vessel function in 5 of 6 patients with lymphedema. The upper limb perimeter decreased in 7 of 9
patients. Physiotherapy and compression was no longer needed in 3 of 9 patients. Importantly, we found
that human lymph nodes express high levels of endogenous lymphatic vessel growth factors. Transfer of the
lymph nodes and the resulting endogenous growth factor expression may thereby induce the regrowth of
lymphatic network in the axilla. No edema problems were detected in the lymph node donor area.
CONCLUSION:
Simultaneous breast and lymphatic reconstruction is an ideal option for patients who suffer from
lymphedema after mastectomy and axillary dissection.
PMID: 22233832 [PubMed - as supplied by publisher]
Int Angiol. 2011 Dec;30(6):527-33.
Dose finding for an optimal compression pressure to reduce chronic edema of the extremities.
Partsch H, Damstra RJ, Mosti G.
Source
Private Practictioner, Vienna, Austria - [email protected].
Abstract
AIM:
The optimal pressure to reduce chronic extremity swelling is still a matter of debate. The aim of this paper
was to measure volume reduction of a swollen extremity depending on the amount of pressure exerted by
compression stockings and inelastic bandages.
METHODS:
Thirty-six patients with unilateral breast cancer related arm lymphedema were investigated in a lymph clinic
in the Netherlands, 42 legs with chronic edema of the lower extremities were examined in a phlebological
centre in Italy. The arm-patients were randomized to receive inelastic arm bandages with a pressure
between 20-30 mmHg or 44-68 mmHg. The leg patients were either treated with compression stockings
(23-32 mmHg) or with inelastic bandages (pressure 53-88 mmHg). Water-displacement volumetry and
measurement of leg circumference was performed before and after compression.
RESULTS:
In the arm-patients low pressure after 2 hours achieved a higher degree of volume reduction (-2.3%, 95%
CI 1.0-3.6) than high pressure (-1.5%, 95% CI 0.2-2.8) (n.s.). In patients with leg edema compression
stockings in the range between 20 and 40 mmHg showed a positive correlation between exerted pressure
and volume reduction, bandages applied with an initial resting pressure of more than 60 mm Hg resulted in a
decreasing volume reduction.
CONCLUSION:
There is obviously an upper limit beyond which further increase of compression pressure seems
counterproductive. For inelastic bandages this upper limit is around 30 Hg on the upper and around 50-60
mmHg on the lower extremity.
PMID: 22233613 [PubMed - in process]
Int Angiol. 2011 Dec;30(6):499-503.
The lymphovenous microsurgical shunts for treatment of lymphedema of lower limbs: indications in 2011.
Olszewski WL.
Source
Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of
Sciences, Warsaw, Poland - [email protected].
Abstract
The microsurgical lympho-venous shunts have become one of the generally accepted modalities in treatment
of limb lymphedema. This review highlight the indications for this procedure after over 40 years. This study
was based on the personal experience of one surgeon and on the review of the literature. Patients with
postinflammatory, postsurgical, idiopathic and hyperplastic lymphedema of lower limbs were included in the
study. Basing on the review of results of the last 40 years the contemporary indications are: 1) lymphedema
with local segmental obstruction but still partly patent distal lymphatics seen on functional lymphoscintigraphy
(standard walking or pneumatic compression) and without an active inflammatory process in the skin,
subcutaneous tissue and lymph vessels (DLA-dermatolymphangioadenitis); 2) classified according the
etiology of lymphedema, this operation can bring about satisfactory results in cases of hyperplastic,
postsurgical and postinflammatory types of lymphedema, whereas primary idiopathic lymphedema of non-
genetic type should be treated with conservative means, although in a small number of cases an improvement
was observed after lympho-venous shunting as long as 10 years. Microsurgical lymph node or lymphatic
vessel to vein shunts have their established position among the therapy modalities for lymphedema of lower
limbs in a strictly defined group of patients using lymphoscintigraphic imaging.
PMID: 22233610 [PubMed - in process]
J Obstet Gynaecol Res. 2012 Jan 10. doi: 10.1111/j.1447-0756.2011.01727.x. [Epub ahead of print]
Re-consideration of lymphadenectomy for stage Ib1 cervical cancer.
Kato H, Todo Y, Suzuki Y, Ohba Y, Minobe SI, Okamoto K, Yamashiro K, Sakuragi N.
Source
Divisions of Gynecologic Oncology Pathology, National Hospital Organization, Hokkaido Cancer Center,
Department of Obstetrics and Gynaecology, Hokkaido University School of Medicine, Sapporo, Japan.
Abstract
Aim: Because of less frequent lymph node metastasis and parametrial involvement, patients with stage Ib1
cervical cancer may benefit from a curtailment of surgery. We retrospectively investigated the distribution of
lymph node metastasis in stage Ib1 patients. After comparing the data with that of higher stages and sentinel
lymph node navigation (SLNN), the appropriate extent of lymphadenectomy (LA) in stage Ib1 disease was
newly suggested. Method: A total of 303 patients underwent a radical hysterectomy with LA and the
region-specific rate of node metastasis was obtained. SLNN was performed for 50 patients using (99m) Tc
phytate injection into the cervix and intra-operative detection by a gamma-probe. Results: The rate of node
metastasis and the average number of nodes removed, respectively, were: 23/189 (12.2%), 65.2 in stage
Ib1; 14/47 (29.8%), 70.1 in stage Ib2; 7/20 (35.0%), 78.2 in stage IIa; and 26/47 (55.3%), 69.1 in stage
IIb. Lymph node metastasis in stage Ib1 was prevalent in the obturator (Ob) (9.5%), inter-iliac (Ii) (4.9%),
superficial common iliac (Sc) (2.3%), cardinal (Cd) (2.2%) and external iliac (Ei) (1.7%) nodes. In patients
with upper stage disease, lymph node metastasis could occur in all lymph nodes. In stage Ib1 patients, the
sentinel nodes were assigned only to the Ob, Ii, Sc and Ei nodes, being identical with frequent metastatic
sites in stage Ib1 (excluding Cd). Conclusion: The extent of LA can be routinely completed with the
removal of Ob, Ii, Ei, Sc and Cd nodes, which may provide a higher quality of life, including the reduction of
lymphedema by preventing the removal of the inguinal nodes.
© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of
Obstetrics and Gynecology.
PMID: 22229927 [PubMed - as supplied by publisher]
January 19, 2012
Br J Community Nurs. 2011 Oct;16 Suppl:S4-S12.
Use of compression bandaging in managing chronic oedema.
Todd M.
Abstract
Compression bandaging is a major component of most community nurses' practice in the management of
venous leg ulcers. For lymphoedema practitioners, compression therapy is the linchpin in the management of
chronic oedema and lymphoedema. There are several types of compression bandage available, with some
being part of a recognized system of compression delivery. In order for nurses to select and apply the
correct type and level of compression bandaging, there needs to be a substantial level of knowledge of the
principles of compression theory and competence in the application of bandaging. There are also issues
surrounding patient concordance, and nurses need to be able to assess and address any barriers to
concordance to ensure the most effective regimen of treatment is delivered.
PMID: 22240574 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16 Suppl:S28-9.
An interview with Karen Morgan.
Morgan K.
Abstract
Karen Morgan is Lymphoedema Clinical Nurse Specialist, Abertawe Bro Morgannwg University Health
Board (ABMUHB) Lymphoedema
Health Board (ABMUHB) Lymphoedema Clinic.
PMID: 22240571 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16 Suppl:S22-7.
An integrative treatment for lower limb lymphoedema in India.
Bose KS, Aggithaya GM.
Abstract
Lymphoedema is a chronic disease which requires frequent visits to therapist in developed countries. In most
developing countries, it is the disease of rural area caused by lymphatic filariasis (LF). The aim is to develop
a low cost home-based self-care protocol using the combinations of locally available treatment modalities.
The integrated treatment has the elements of therapy from modern dermatology, Ayurveda and yoga,
administered by the doctors of respective system of medicine on the basis of pathophysiological
understanding in lymphology. The sequence of treatment components that each patient followed is skin
wash, soaking the limb in herbal Phanta solution, care of bacterial entry points, a set of yoga exercises,
Indian manual lymph drainage and compression bandaging. A total of 1209 limbs in 889 patients were
treated using integrated medicine during October 2004-May 2011. All patients received an initial 14 days of
supervised treatment and training for self-care and home-based treatment to be continued for life. Patients
followed up twice. Volume reduction for large sized limbs at 3 months following treatment was 41.1%, with
a confidence interval (CI) of 5.7-6.9 litres. Reduction was 25.7 % for small limbs with a CI of 1.5-1.7 litres.
Entry points were present in 86.2% limbs at baseline and in 71.7% limbs at the end of 3 months.
Inflammatory episodes reduced from 80%-8.6%.
PMID: 22240570 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16 Suppl:S20-1.
Lymphangioma or lymphangiectasia? An update for lymphoedema nurses.
Pike C.
Abstract
This article is prompted by a recent enquiry to the British Lymphology Society, expressing uncertainty over
the definition of lymphangioma. It may be prudent to publicize information on this potentially confusing area
more widely, as clinicians need to know what lymphangioma is, or is not.
PMID: 22240569 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16 Suppl:S14-9.
Non-concordance in lymphorrhea of the lower limbs: a case study.
Jones J.
Abstract
Obesity and a sedentary lifestyle are fast becoming major problems for not only the NHS as a whole but
also the lymphoedema therapist. Lymphorrhea in this group of patients can be a recurrent problem, causing
strain on already stretched services and on the patient and their family. What happens when the ideas of the
patient and therapist regarding treatment are not the same? This article aims to address these issues by
looking at a case study of such a patient, and the surprising outcome that resulted when the patient got his
own way.
PMID: 22240568 [PubMed - in process]
January 22, 2012,
Br J Community Nurs. 2011 Oct;16 Suppl:S22-7.
An integrative treatment for lower limb lymphoedema in India.
Bose KS, Aggithaya GM.
Abstract
Lymphoedema is a chronic disease which requires frequent visits to therapist in developed countries. In most
developing countries, it is the disease of rural area caused by lymphatic filariasis (LF). The aim is to develop
a low cost home-based self-care protocol using the combinations of locally available treatment modalities.
The integrated treatment has the elements of therapy from modern dermatology, Ayurveda and yoga,
administered by the doctors of respective system of medicine on the basis of pathophysiological
understanding in lymphology. The sequence of treatment components that each patient followed is skin
wash, soaking the limb in herbal Phanta solution, care of bacterial entry points, a set of yoga exercises,
Indian manual lymph drainage and compression bandaging. A total of 1209 limbs in 889 patients were
treated using integrated medicine during October 2004-May 2011. All patients received an initial 14 days of
supervised treatment and training for self-care and home-based treatment to be continued for life. Patients
followed up twice. Volume reduction for large sized limbs at 3 months following treatment was 41.1%, with
a confidence interval (CI) of 5.7-6.9 litres. Reduction was 25.7 % for small limbs with a CI of 1.5-1.7 litres.
Entry points were present in 86.2% limbs at baseline and in 71.7% limbs at the end of 3 months.
Inflammatory episodes reduced from 80%-8.6%.
PMID: 22240570 [PubMed - in process]
January 22, 2012
J Cancer Surviv. 2012 Jan 13. [Epub ahead of print]
Community-based exercise program effectiveness and safety for cancer survivors.
Rajotte EJ, Yi JC, Baker KS, Gregerson L, Leiserowitz A, Syrjala KL.
Source
Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-220, P.
O. Box 19024, Seattle, WA, 98109, USA.
Abstract
PURPOSE:
Clinical trials have demonstrated the benefits of exercise for cancer survivors. This investigation determined
the effectiveness and safety of a disseminated community-based exercise program for cancer survivors who
had completed treatment.
METHODS:
Personal trainers from regional YMCAs received training in cancer rehabilitation and supervised twice-a-
week, 12-week group exercise sessions for survivors. At baseline and post-program, validated measures
assessed patient-reported outcomes (PRO) and physiologic measurements.
RESULTS:
Data were collected from 221 survivors from 13 YMCA sites and 36 separate classes. All participants had
data available at one time point, while matched baseline and post-program PRO and physiologic data were
available for 85% (N = 187). Participants with matched data were largely female (82%), with mean age of
58 (range, 28-91 years). Time since diagnosis ranged from 1 to 48 (mean, 5.6 years), and mean time since
last treatment was 3.0 (range, 1-33 years). Physiological improvements were significant in systolic (P <
0.001) and diastolic (P = 0.035) blood pressure, upper and lower body strength, the 6-min walk test (P =
0.004), and flexibility (P < 0.001). Participants reported improvements in overall health-related quality of life
(P < 0.001), social support (P = 0.019), body pain (P = 0.016), fatigue (P < 0.001), insomnia (P < 0.001),
and overall musculoskeletal symptoms (P = <0.001). Few injuries or lymphedema events occurred during
classes.
CONCLUSIONS:
Community-based exercise groups for cancer survivors of mixed diagnoses and ages, who have completed
active treatment, have physiologic and psychosocial benefits, and are safe. IMPLICATIONS FOR
CANCER SURVIVORS: Survivors may expect significant benefit from participating in a community-based
exercise program tailored to meet their individual needs as a survivor.
PMID: 22246463 [PubMed - as supplied by publisher]
Hematol Oncol Clin North Am. 2012 Feb;26(1):169-94. Epub 2011 Dec 16.
Contemporary quality of life issues affecting gynecologic cancer survivors.
Carter J, Penson R, Barakat R, Wenzel L.
Source
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
10065, USA; Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York,
NY 10065, USA.
Abstract
Regardless of cancer origin or age of onset, the disease and its treatment can produce short- and long-term
sequelae (ie, sexual dysfunction, infertility, or lymphedema) that adversely affect quality of life (QOL). This
article outlines the primary contemporary issues or concerns that may affect QOL and offers strategies to
offset or mitigate QOL disruption. These contemporary issues are identified within the domains of sexual
functioning, reproductive issues, lymphedema, and the contribution of health-related QOL in influential
gynecologic cancer clinical trials.
Copyright © 2012 Elsevier Inc. All rights reserved.
PMID: 22244668 [PubMed - in process]
MEDNEWS DOCS:
January 3, 2012
New Treatment Direction For Rare Metabolic Diseases
A research team led by biochemist Scott Garman at the University of Massachusetts Amherst has
discovered a key interaction at the heart of a promising new treatment for a rare childhood metabolic
disorder known as Fabry disease. The discovery will help understanding of other protein-folding disorders
such as Alzheimer's, Parkinson's and Huntington's diseases, as well. Findings are featured as the cover story
in the current issue of Chemistry & Biology.
People born with Fabry disease have a faulty copy of a single gene that codes for the alpha-galactosidase (α-
GAL) enzyme, one of the cell's "recycling" machines. When it performs normally, α-GAL breaks down an
oily lipid known as GB3 in the cell's recycling center, or lysosome. But when it underperforms or fails, Fabry
symptoms result. Patients may survive to adulthood, but the disorder leads to toxic lipid build-up in blood
vessels and organs that compromise kidney function or lead to heart disease, for example.
The faulty gene causes its damage by producing a misfolded protein, yielding an unstable, poorly functioning
α-GAL enzyme. Like origami papers, these proteins are unfolded to start and only become active when
folded into precise shapes. At present, enzyme replacement therapy (ERT) is the only FDA-approved
treatment for such lysosomal storage disorders as Fabry, Pompe and Gaucher diseases, but ERT requires a
complicated and expensive process to purify and replace the damaged α-GAL enzyme, and it must be
administered by a physician.
Instead of replacing the damaged enzyme, an alternative route called pharmacological chaperone (PC)
therapy is currently in Phase III clinical trials for Fabry disease. It relies on using smaller, "chaperone"
molecules to keep proteins on the right track toward proper folding, but their biochemical mechanism is not
well understood, says Garman.
Now, he and colleagues report results of a thorough exploration at the atomic level of the biochemical and
biophysical basis of two small molecules for potentially stabilizing the α-GAL enzyme. He says their use in
PC therapy could one day be far less expensive than the current standard, ERT, and can be taken orally.
This work, which improves knowledge of a whole class of molecular chaperones, represents the centerpiece
of UMass Amherst student Abigail Guce's doctoral thesis and was supported by the National Institutes of
Health. Other members of the team are graduate students Nat Clark and Jerome Rogich.
"The interactions we looked at are exactly the things occurring in the clinical trial right now," Garman says.
Further, "the same concept is now being applied to other protein-folding diseases such as Parkinson's and
Alzheimer's disease. Many medical researchers are trying to keep proteins from misfolding by using small
chaperone molecules. Our studies have definitely advanced the understanding of how to do that."
In their current paper, Garman and colleagues compare the ability of two small chaperone molecules,
galactose and 1-deoxygalactononjirimycin (DGJ) to stabilize the α-GAL protein, to help it resist unfolding in
different conditions such as high temperature and different pH levels.
They found that each chaperone has very different affinities: DGJ binds tightly and galactose binds loosely to
the α-GAL, yet they differ in only two atomic positions. "Tight is better, because you can use less drug for
treatment," Garman says. "We now can explain DGJ's high potency, its tight binding, down to individual
atoms."
In earlier studies as in the current work, the UMass Amherst team used their special expertise in X-ray
crystallography to create three-dimensional images of all atoms in the protein to understand how it carries
out its metabolic mission. They also found a new binding site for small molecules on human α-GAL that had
never been observed before.
Crystallography on the two chaperones bound to the α-GAL enzyme showed that a single interaction
between the enzyme and DGJ was responsible for DGJ's high affinity for the enzyme. Other experiments
also showed the ability of the 11- and 12-atom chaperones to protect the large, 6,600-atom α-GAL from
unfolding and degradation.
For the first time, by making a single change in one amino acid in protein, they forced the DGJ to bind
weakly, indicating that one atomic interaction is responsible for DGJ's high affinity.
"It was surprising to find these two small molecules that look very much the same have very different
affinities for this enzyme," says Garman, "and we now understand why. The iminosugar DGJ has high
potency due to a single ionic interaction with α-GAL. Overall, our studies show that this small molecule
keeps the enzyme from unfolding, or when it unfolds, the process happens more slowly, all of which you
need in treating disease."
The UMass Amherst team plans to next use the principles, assays and experiments they developed here on
enzymes defective in other human diseases to examine new therapies for them and related disorders.
JANUARY 9, 2012
Significant Cost Savings Associated With Emergence Of Prospective Surveillance Model As Standard Of
Care For Breast Cancer Treatment
Early diagnosis and treatment of breast cancer-related lymphedema by a physical therapist can significantly
reduce costs and the need for intensive rehabilitation, according to an article published in the January issue of
Physical Therapy (PTJ), the scientific journal of the American Physical Therapy Association (APTA).
The study, led by APTA member and spokesperson Nicole Stout, PT, MPT, CLT-LANA, compared a
prospective surveillance model with a traditional model of impairment-based care and examined the direct
treatment costs associated with each program. Treatment and supply costs were estimated based on the
Medicare 2009 physician fee schedule. Researchers estimated that treatment for breast cancer-related
lymphedema costs $636.19 a year when the prospective surveillance model was used vs $3,124.92 for
traditional treatment of advanced lymphedema.
The goal of a prospective surveillance model for cancer rehabilitation is to identify impairment at the earliest
onset to alleviate impairment or prevent it from progressing. Soon after diagnosis, a physical therapist will
perform a preoperative examination to establish a baseline level of function. Follow-up examinations are then
conducted postoperatively at 1 month and then 3-month intervals, for up to 1 year. In contrast, a traditional
model focuses on treating lymphedema once it has progressed and patients already have functional
limitations.
"This study begins to paint a picture of evidence showing that prevention of chronic conditions such as
lymphedema - using rehabilitation models of care - may result in significant cost savings," said Stout.
Breast cancer-related lymphedema is characterized by abnormal swelling of the arm and hand, which can be
disfiguring. A chronic condition, it is associated with decreased arm function, disability, and diminished
quality of life. If the condition is not diagnosed early and managed, a patient can be at risk for infection and
further shoulder complications.
In place for more than 10 years, the prospective surveillance model was developed at the National Naval
Medical Center in Bethesda - now part of the Walter Reed National Military Medical Center - and is the
standard of care for all patients diagnosed with breast cancer at the medical center. Several research articles
have been published demonstrating clinical effectiveness of the prospective surveillance model in reducing
lymphedema, shoulder morbidity, and fatigue, including the February 2010 article in the journal Breast
Cancer Research and Treatment.
Although further analysis of indirect costs and utility is necessary to fully assess cost effectiveness, the
prospective surveillance model is emerging as the standard of care for breast cancer treatment.
January 15, 2012
New, Noninvasive Way To Identify Lymph Node Metastasis
Using two cell surface markers found to be highly expressed in breast cancer lymph node metastases,
researchers at Moffitt Cancer Center, working with colleagues at other institutions, have developed targeted,
fluorescent molecular imaging probes that can non-invasively detect breast cancer lymph node metastases.
The new procedure could spare breast cancer patients invasive and unreliable sentinel lymph node (SLN)
biopsies and surgery-associated negative side effects.
Their study was published in a recent issue of Clinical Cancer Research (18:1), a publication of the
American Association for Cancer Research.
"The majority of breast cancer patients, up to 74 percent, who undergo SLN biopsy are found to be
negative for axillary nodal, or ALN, metastases," said corresponding author David L. Morse, Ph.D., an
associate member at Moffitt whose research areas include experimental therapeutics and diagnostic imaging.
"Determining the presence or absence of ALN metastasis is critical to breast cancer staging and prognosis.
Because of the unreliability of the SLN biopsy and its potential for adverse effects, a noninvasive, more
accurate method to assess lymph node involvement is needed."
The authors note that the postoperative complications to the SLN biopsy can include lymphedema, seroma
formation, sensory nerve injury and limitations in patient range of motion. In addition, biopsies fail to identify
disease in axillary lymph nodes in five to 10 percent of patients.
In developing targeted molecular probes to identify breast cancer in axillary lymph nodes, the research team
from Moffitt, the University of Arizona and University of Florida used two surface cell markers - CAIX and
CAXII. CAIX is a cell surface marker known to be "highly and broadly expressed in breast cancer lymph
node metastases" and absent in normal tissues.
CAIX and CAXII are both integral plasma membrane proteins with large extracellular components that are
accessible for binding of targeted imaging probes, explained Morse. In addition, several studies have shown
that CAIX expression is associated with negative prognosis and resistance to chemo and radiation therapy
for breast cancer. CAXII is a protein expressed in over 75 percent of axillary lymph node metastases.
The researchers subsequently developed their targeting agents by using monoclonal antibodies specific for
binding CAIX and CAXII, both of which are known to promote tumor growth.
According to the researchers, a number of noninvasive optical imaging procedures for SLN evaluation have
been investigated, but the approaches have lacked the ability to target tumor metastasis biomarkers.
"These methods provide only anatomic maps and do not detect tumor cells present in lymph nodes,"
explained Morse. "Using mouse models of breast cancer metastasis and a novel, monoclonal anti-body-
based molecular imaging agents, we developed a targeted, noninvasive method to detect ALN metastasis
using fluorescence imaging."
In addition to the imaging study with mice, the researchers also reported that the combination of CAIX and
CAXII covered 100 percent of patient-donated samples used in their tissue microarray (TMA) study.
"The imaging probes detected tumor cells in ALNs with high sensitivity," explained Morse. "Either CAIX or
CAXII were expressed in 100 percent of the breast cancer lymph node metasatsis samples we surveyed in
this study. These imaging probes have potential for providing a noninvasive way to stage breast cancer in the
clinic without unneeded and costly surgery."
February 5, 2012
Rev Med Interne. 2012 Jan 30.
[Epub ahead of print]
[Management
of limb lymphedema.]
[Article
in French]
Vignes S.
Source
Unité
de lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
Lymphedema
results from impaired lymphatic transport with increased limb volume.
Cellulitis is the main complication, but psychological or functional discomfort
may occur throughout the course of lymphedema. Lymphedema management is based
on complete decongestive physiotherapy (multilayer low stretch bandage, manual
lymph drainage, skin care, exercises). First phase of treatment leads to a
reduction of lymphedema volume. The second phase stabilizes the volume and is
based on elastic compression. Resection surgery is a useful tool in external
genitalia lymphedema.
Copyright
© 2012 Société nationale française de médecine interne (SNFMI). Published by
Elsevier SAS. All rights reserved.
PMID:
22296831 [PubMed - as supplied by publisher]
February
7, 2012
J Am Acad Orthop Surg. 2012
Feb;20(2):78-85.
Factitious
disorders of the upper extremity.
Birman MV, Lee DH.
Source
Department
of Orthopaedic Surgery, Columbia University, New York, NY, USA.
Abstract
Factitious
disorders of the upper extremity can manifest in many different forms;
therefore, it is critical to recognize warning signs in the history and
examination indicating that the patient may be creating the symptoms and
physical manifestations of the presenting illness. These disorders present in
such predictable patterns as lymphedema, Secretan syndrome, ulcerations and
wound manipulation, clenched fist, subcutaneous emphysema, pachydermodactyly,
nail deformities, and self-mutilation. Management recommendations include
assigning therapeutic responsibility to one person and the involvement of a
multidisciplinary team. Thorough documentation is essential for the protection
of both the patient and the treating physician. Treatment of patients with
factitious disorders of the upper extremity requires patience and insight to
avoid being manipulated into performing unnecessary surgical
procedures
J Radiat Res (Tokyo).
2012;53(1):125-9.
The
Clinical Characteristic Differences between Thrombosis-related Edema and
Lymphedema Following Radiotherapy or Chemoradiotherapy for Patients with
Cervical Cancer.
Wang PL, Cheng YB, Kuerban G.
Source
Center
of Oncology, The Fifth Affiliated Hospital of Xinjiang Medical
University.
Abstract
Thrombosis-related
edema and lymphedema are two principal types of lower extremity edema results
from radiotherapy alone or chemoradiotherapy for patients with cervical cancer.
To characterize differences between them, a retrospective study was performed.
We collected data including age, race, body weight, FIGO stage, histology type,
platelet count, haemoglobin, time of definitely diagnosis, therapeutic regimen,
edema type and which leg edema firstly occurred in. Of 40 patients who were
eligible for this study, 32 were diagnosed as thrombosis-related edema and 8
diagnosed as lymphedema. The differences in patient age (p = 0.004), propotion
of race (p = 0.021), the latent time (p = 0.002) and the mean platelet count (p
= 0.019) were statistically significant. Among 32 patients with
thrombosis-related edema, 34.4% were in stage II and 53.1% in stage III, 78.1%
were squamous cell carcinoma. Among 8 patients with lymphedema, 87.5% were in
stage II and 62.5% were squamous cell carcinoma. The differences were not
statistically significant for weight (p = 0.94), histology type (p = 0.648),
edema site (p = 0.236), haemoglobin (p = 0.088) between the two grouping
patients. Although the small patient cohort is a limitation, the results
suggest that the patients with thrombosis-related edema may have higher
proportion, lower age, shorter latent edema time and more platelet count than
those with lymphedema. Also, thrombosis-related edema was likely inclined to
Uigur and lymphedema to Han race. We did not find statistical differences in
weight, edema site, histology type and haemoglobin between patients with
thrombosis-related edema and lymphedema.
PMID:
22302053 [PubMed - in process]
Rev Med Interne. 2012 Jan 30.
[Epub ahead of print]
[Management
of limb lymphedema.]
[Article
in French]
Vignes S.
Source
Unité
de lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
Lymphedema
results from impaired lymphatic transport with increased limb volume.
Cellulitis is the main complication, but psychological or functional discomfort
may occur throughout the course of lymphedema. Lymphedema management is based
on complete decongestive physiotherapy (multilayer low stretch bandage, manual
lymph drainage, skin care, exercises). First phase of treatment leads to a
reduction of lymphedema volume. The second phase stabilizes the volume and is
based on elastic compression. Resection surgery is a useful tool in external
genitalia lymphedema.
Copyright
© 2012 Société nationale française de médecine interne (SNFMI). Published by
Elsevier SAS. All rights reserved.
PMID:
22296831 [PubMed - as supplied by publisher]
Clin Physiol Funct Imaging. 2012
Mar;32(2):126-32. doi: 10.1111/j.1475-097X.2011.01066.x. Epub 2011 Nov
10.
The
washout rate of a subcutaneous (99m) Tc-HSA depot in lower extremity
lymphoedema.
Jensen MR, Simonsen L, Karlsmark T, Bülow J.
Source
Department
of Clinical Physiology and Nuclear and Medicine Department of Dermatology and
Venereology, Bispebjerg Hospital, University Hospital of Copenhagen,
Copenhagen, Denmark.
Abstract
Purpose:
Lymphoscintigraphy is currently the leading diagnostic modality of lower
extremity lymphoedema but has been criticized for being unreliable. Washout
rate constants have been investigated and proven to be of diagnostic value in
several studies of breast-cancer-related lymphoedema; however, the
applicability in lower extremity lymphoedema needs further evaluation. The aim
of the study was to verify if washout of (99m) Tc-Human Serum Albumin ((99m)
Tc-HSA) is a reliable diagnostic tool in lower extremity lymphoedema. Methods:
Twenty healthy volunteers and eight patients (11 legs) with lymphoscintigraphy
verified lower extremity lymphoedema participated in the study. A depot
consisting of 0·1 ml 10 MBq/ml (99m) Tc-HSA was injected subcutaneously into
the dorsum of each foot. The depot washout rate was measured using a portable
scintillation detector system and time-activity curves were generated. After
30 min of supine rest and 10 min of standardized ergometric exercise,
measurements were recorded for 20 min. Following correction for physical decay
of (99m) Tc, the depot washout rate constant was calculated using linear
regression analysis. Finally depot half-life was calculated from the washout
rate constant. Results: Median half-life for healthy volunteers was 9·4 h
(range 2·5-28·3 h). Median half-life for lymphoedema patients was 10·7 h (range
1·5-35·1 h). No statistical significant difference could be detected between
healthy volunteers and lymphoedema patients (P = 0·78). Conclusions: The
washout rate of a subcutaneous (99m) Tc-HSA depot is not a reliable diagnostic
tool in examination of lower extremity lymphoedema. Additional examinations
revealed in vivo instability of the utilized (99m) Tc-HSA as the likely
reason.
©
2011 The Authors. Clinical Physiology and Functional Imaging © 2011
Scandinavian Society of Clinical Physiology and Nuclear Medicine.
PMID:
22296633 [PubMed - in process]
February
10, 2012
Head Neck. 2012
Mar;34(3):448-53. doi: 10.1002/hed.21538. Epub 2010 Nov 12.
Near-infrared
fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Source
Division
of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The
University of Texas Health Science Center, Houston, Texas; Memorial Hermann
Center for Lymphedema Management, Memorial Hermann - Texas Medical Center,
Houston, Texas. [email protected].
Abstract
BACKGROUND:
Lymphedema
is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions
where treatment options are limited. Although upper and lower extremity
lymphedema may be effectively treated with manual lymphatic drainage (MLD)
therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS
AND RESULTS:
Herein,
we describe the compassionate use of an investigatory technique of
near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy
and function, help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor response to therapy in a patient with head and neck lymphedema after
surgery and radiation treatment.
CONCLUSION:
NIR
fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are
needed to assess the efficacy of MLD therapy when directed by NIR fluorescence
imaging. © 2010 Wiley Periodicals, Inc. Head Neck, 2012.
Copyright
© 2010 Wiley Periodicals, Inc.
PMID:
22311465 [PubMed - in process]
Am J Pathol. 2012 Feb 3. [Epub
ahead of print]
ProxTom
Lymphatic Vessel Reporter Mice Reveal Prox1 Expression in the Adrenal Medulla,
Megakaryocytes, and Platelets.
Truman LA, Bentley KL, Smith EC, Massaro SA, Gonzalez DG, Haberman AM, Hill M, Jones D, Min W, Krause DS, Ruddle NH.
Source
Department
of Epidemiology and Public Health, Yale University School of Medicine, New
Haven, Connecticut.
Abstract
Lymphatic
vessels (LVs) are important structures for antigen presentation, for lipid
metabolism, and as conduits for tumor metastases, but they have been difficult
to visualize in vivo. Prox1 is a transcription factor that is necessary for
lymphangiogenesis in ontogeny and the maintenance of LVs. To visualize LVs in
the lymph node of a living mouse in real time, we made the ProxTom transgenic
mouse in a C57BL/6 background using red fluorescent LVs that are suitable for
in vivo imaging. The ProxTom transgene contained all Prox1 regulatory sequences
and was faithfully expressed in LVs coincident with endogenous Prox1
expression. The progenies of a ProxTom × Hec6stGFP cross were imaged using
two-photon laser scanning microscopy, allowing the simultaneous visualization
of LVs and high endothelial venules in a lymph node of a living mouse for the
first time. We confirmed the expression of Prox1 in the adult liver, lens, and
dentate gyrus. These intensely fluorescent mice revealed the expression of
Prox1 in three novel sites: the neuroendocrine cells of the adrenal medulla,
megakaryocytes, and platelets. The novel sites identified herein suggest
previously unknown roles for Prox. The faithful expression of the fluorescent
reporter in ProxTom LVs indicates that these mice have potential utility in the
study of diseases as diverse as lymphedema, filariasis, transplant rejection,
obesity, and tumor metastasis.
Copyright
© 2012 American Society for Investigative Pathology. Published by Elsevier Inc.
All rights reserved.
PMID:
22310467 [PubMed - as supplied by publisher]
Asia Pac J Public Health. 2012
Feb 15. [Epub ahead of print]
Physical,
Psychological, and Social Aspects of Quality of Life in Filarial Lymphedema
Patients in Colombo, Sri Lanka.
Wijesinghe RS, Wickremasinghe AR.
Source
University
of Queensland, Herston, Australia.
Abstract
Quality
of life (QOL) was assessed in 141 filarial lymphedema patients and 128 healthy
people in the Colombo district, Sri Lanka, by administering modified,
translated, and validated (in Sri Lanka) versions of the Short Form 36 health
survey questionnaire (SF-36) and the 30-item General Health questionnaire
(GHQ-30). The GHQ-30 assesses the current mental health status. The SF-36
measures health on 8 multi-item dimensions covering functional state,
well-being, and overall evaluation of health (physical functioning, role
limitations resulting from physical health problems, role limitations resulting
from emotional problems, energy/fatigue, emotional well-being, social
functioning, pain and general health). By SF-36, patients experienced poorer
physical functioning, more role limitations resulting from physical health
conditions, less emotional well-being, poorer social functioning, and more pain
than healthy individuals. By GHQ-30, mental well-being of healthy controls was
significantly better than that of patients. The significant difference in the
QOL as perceived by filarial lymphedema patients and healthy individuals
reiterates the importance of morbidity control in patients affected by this
disease.
PMID:
22308536 [PubMed - as supplied by publisher]
Breast. 2012 Feb 2. [Epub ahead
of print]
Angiosarcoma
of the breast: A difficult surgical challenge.
Hui A, Henderson M, Speakman D, Skandarajah A.
Source
Department
of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Melbourne
3050, Australia.
Abstract
BACKGROUND
AND OBJECTIVES:
Breast
angiosarcoma presents following radiotherapy after breast conserving surgery,
in the setting of chronic lymphoedema after axillary dissection or as a primary
tumour. The Peter MacCallum Cancer Centre has significant experience due to
large breast and sarcoma units and as a primary radiotherapy centre. Our aims
were to evaluate the management and locoregional and distant outcomes after
breast angiosarcoma.
METHODS:
Retrospective
study of all patients from the prospective breast and sarcoma databases with a
diagnosis of primary or secondary breast angiosarcoma at Peter MacCallum Cancer
Centre was performed between January 2000 and December 2010. Mode of
presentation, management, loco-regional recurrence and survival rates were
reviewed.
RESULTS:
Eight
women developed angiosarcoma in the setting of breast conservation with a
median latency of 7 years post radiotherapy. Six patients had primary breast
angiosarcoma. All breast angiosarcomas were managed with total mastectomy with
5 patients requiring autologous tissue transfer. Four patients had adjuvant
radiotherapy and three patients had adjuvant paclitaxel. The median follow-up
was 2.5 years (6 month-10 years) with 7 episodes of local recurrence in four
patients and 7 patients with distal metastases including two deaths from
distant disease.
CONCLUSIONS:
Primary
angiosarcoma occurs de novo, presenting as a breast mass. Secondary
angiosarcoma presents predominantly as a skin lesion, in the setting
post-operative radiotherapy for breast conserving therapy. Angiosarcoma remains
a rare and difficult management problem with poor loco-regional and distal
control. Secondary AS is an iatrogenic condition that warrants close follow-up
and judicial use of radiotherapy in breast conserving therapy.
Crown
Copyright © 2012. Published by Elsevier Ltd. All rights reserved.
PMID:
22305554 [PubMed - as supplied by publisher]
February
11, 2012
Head Neck. 2012
Mar;34(3):448-53. doi: 10.1002/hed.21538. Epub 2010 Nov 12.
Near-infrared
fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Source
Division
of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The
University of Texas Health Science Center, Houston, Texas; Memorial Hermann
Center for Lymphedema Management, Memorial Hermann - Texas Medical Center,
Houston, Texas. [email protected].
Abstract
BACKGROUND:
Lymphedema
is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions
where treatment options are limited. Although upper and lower extremity
lymphedema may be effectively treated with manual lymphatic drainage (MLD)
therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS
AND RESULTS:
Herein,
we describe the compassionate use of an investigatory technique of
near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy
and function, help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor response to therapy in a patient with head and neck lymphedema after
surgery and radiation treatment.
CONCLUSION:
NIR
fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are
needed to assess the efficacy of MLD therapy when directed by NIR fluorescence
imaging. © 2010 Wiley Periodicals, Inc. Head Neck, 2012.
Copyright
© 2010 Wiley Periodicals, Inc.
PMID:
22311465 [PubMed - in process]
February
17, 2012
Can Respir J. 2012
Jan;19(1):35-6.
Yellow
nails, lymphedema and chronic cough: Yellow nail syndrome in an eight-year-old
girl.
Siddiq I, Hughes DM.
Abstract
Yellow
nail syndrome is a rare disease and reported mainly in adults. A case of yellow
nail syndrome involving an eight-year-old girl with associated discoloured
yellowish nails on the fingers and toes, lymphedema and chronic cough, and
sputum production is reported.
PMID:
22332131 [PubMed - in process]
J Clin Oncol. 2012 Feb 13. [Epub
ahead of print]
Prospective
Study of Factors Predicting Adherence to Surveillance Mammography in Women
Treated for Breast Cancer.
Shelby RA, Scipio CD, Somers TJ, Soo MS, Weinfurt KP, Keefe FJ.
Source
Duke
University Medical Center, Durham, NC.
Abstract
PURPOSEThis
prospective study examined the factors that predicted sustained adherence to
surveillance mammography in women treated for breast cancer. METHODSBreast
cancer survivors (N = 204) who were undergoing surveillance mammography
completed questionnaires assessing mammography-related anticipatory anxiety,
persistent breast pain, mammography pain, and catastrophic thoughts about
mammography pain. Adherence to mammography in the following year was
assessed.ResultsIn the year after study entry, 84.8% of women (n = 173)
returned for a subsequent mammogram. Unadjusted associations showed that
younger age, shorter period of time since surgery, and having upper extremity
lymphedema were associated with lower mammography adherence. Forty percent of
women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0
to 10 scale). Although mammography pain was not associated with adherence,
higher levels of mammography-related anxiety and pain catastrophizing were
associated with not returning for a mammogram (P < .05). The impact of
anxiety on mammography use was mediated by pain catastrophizing (indirect
effect, P < .05). CONCLUSIONFindings suggest that women who are younger,
closer to the time of surgery, or have upper extremity lymphedema may be less
likely to undergo repeated mammograms. It may be important for health
professionals to remind selected patients directly that some women avoid repeat
mammography and to re-emphasize the value of mammography for women with a
history of breast cancer. Teaching women behavioral techniques (eg, redirecting
attention) or providing medication for reducing anxiety could be considered for
women with high levels of anxiety or catastrophic thoughts related to
mammography.
PMID:
22331949 [PubMed - as supplied by publisher]
Phlebology. 2012;27 Suppl
1:139-42.
Lymphatic
complications after varicose veins surgery: risk factors and how to avoid
them.
Pittaluga P, Chastanet S.
Source
Riviera
Vein Institute, 6 Rue Gounod 06000, Nice, France. [email protected];
[email protected].
Abstract
INTRODUCTION:
Lymphatic
complication (LC) after varicose veins (VVs) surgery is an annoying event with
a variable frequency in the literature.
METHOD:
Retrospective
study reviewing all surgeries carried out for VVs from January 2000 to October
2010. Postoperative LC we reported: lymphatic fistula, lymphocele including the
minor ones and lymphoedema.
RESULTS:
During
the period studied, 5407 surgical procedures for VVs were performed in 3407
patients (74.7% women) with a mean age of 53.4 years. A postoperative LC
occurred in 118 cases (2.2%): lymphocele on limb in 1.3%, inguinal LC (fistula
or lymphocele) in 0.7% and a lymphoedema in 0.2%. The population with a LC was
older (59.6 vs. 53.3 years, P < 0.05), had a higher frequency of C4-C6
(22.0% vs. 6.5%, P < 0.05), a higher incidence of obesity (31.4% vs. 5.4%, P
< 0.05) and was more often treated by a redo surgery or a crossectomy
stripping (48.3% vs. 13.4% and 38.1% vs. 21.8%, respectively, P < 0.05). We
have observed a dramatic decrease in incidence of LC after January 2004 (1.3%
vs. 5.3%, P < 0.05) corresponding to a new surgical practice for the
treatment of VVs: stripping, crossectomy and redo surgery at the groin were
less frequent (74.6% vs. 7.7%, 74.6% vs. 0.2% and 11.3% vs. 0.1%, respectively,
P < 0.05), while isolated phlebectomy was more often performed during this
period (78.4% vs. 8.4%, P < 0.05).
CONCLUSION:
LC
after VVs surgery is not rare but frequently limited to lymphocele on limbs.
Older age, more advanced clinical stage and obesity were associated with a
higher frequency of LC. A mini-invasive and selective surgery has significantly
reduced the occurrence of LC.
PMID:
22312081 [PubMed - in process]
February
21, 2012
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Interdisciplinary
Lymphology: The Best Place for Each Discipline in a Team.
Foeldi E, Dimakakos EP.
Source
Foeldi
Clinic for Lymphology, Hinterzarten, Germany.
Abstract
The
term lymphology includes both the physiology and the pathology of the lymphatic
system. Many disciplines are involved in the study of the lymphatic system, to
correctly diagnose lymphatic diseases and to ultimate provide the best
available treatment for the patient. Lymphedema is one of the most common
lymphatic diseases, potentially causing significant problems for the patient
and for the health system in general. The aim of this article is to discuss the
best placement and role for each discipline within an interdisciplinary team in
order to provide an effective management of lymphedema and related lymphatic
diseases.
PMID:
22336902 [PubMed - as supplied by publisher]
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Multidisciplinary
Lymphedema Treatment Program.
Papadopoulou MC, Tsiouri I, Salta-Stankova R, Drakou A, Rousas N, Roussaki-Schulze AV, Giannoukas AD.
Source
University
Hospital of Larissa, Larissa, Greece.
Abstract
Lymphedema
is an underrecognized and undertreated condition that requires a
multidisciplinary approach in an individualized program that will address the
special needs of each patient. In an ideal setting of an outpatient management
program the team should be composed of a vascular surgeon, a dermatologist, a
physiotherapist, a dietician, a psychologist, a social worker, and an office
employee, working together in the assessment and management of all aspects of
lymphedema. All treatment strategies and actions taken should ultimately focus
on the improvement of the quality of life of patients suffering from lymphedema
and on the prevention of lymphedema in high-risk patients.
PMID:
22336900 [PubMed - as supplied by publisher]
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Wound
Physicians: Lymphedema Is Not a Problem That Will Go Away if
Ignored.
Lazarides MK, Mani R.
Source
Democritus
University Hospital, Alexandropoulis, Greece.
PMID:
22336899 [PubMed - as supplied by publisher]
Eur J Surg Oncol. 2012 Feb 13.
[Epub ahead of print]
Analysis
of direct oil contrast lymphography of upper limb lymphatics traversing the
axilla - A lesson from the past - Contribution to the concept of axillary
reverse mapping.
Pavlista D, Eliska O.
Source
Oncogynecologic
Center, Department of Obstetrics and Gynecology, First Faculty of Medicine,
Charles University in Prague and General University Hospital, Apolinarska 18,
Prague 12801, Czech Republic.
Abstract
INTRODUCTION:
Axillary
reverse mapping (ARM) is a method to preserve upper extremity (UE) lymphatics
during axillary surgery in breast cancer patients. This may reduce the
incidence of lymphedema. Very precise method to demonstrate lymphatic drainage
is direct X-ray lymphography.
MATERIALS
AND METHODS:
The
evaluation of direct lymphography X-ray images of the axilla and proximal part
of the upper extremity was performed in 9 subjects. As contrast was used
Lipiodoil injected on the dorsal side of hand.
RESULTS:
The
lymph from UE is drained by 2-4 main afferent collectors, which in 5 of 9 cases
entered into one node in the lateral axilla (ARM node). This node was
considered to be the sentinel lymph node for the UE. In 4 cases a cranial
collector was shown, which led directly to nodes in the upper part of the
axilla. This collector had numerous anastomoses with other collectors before
entering the axillary nodes. The most important finding is the demonstration of
numerous lymphatic anastomoses that take place between all imaged nodes in the
axilla including the caudal nodes, which is the most frequent localization of
the breast sentinel lymph node.
CONCLUSION:
The
relationship of lymphatic drainage of the UE and breast are closely related and
share numerous connections. These connections represent the main problem of the
ARM concept because they may pose potencional route for metastatic cancer cells
in sentinel node positive breast cancer patients. Further studies are necessary
to improve understanding of this method. Axillary reverse mapping - breast
cancer - lymphedema - sentinel node biopsy.
Copyright
© 2012. Published by Elsevier Ltd.
PMID:
22336143 [PubMed - as supplied by publisher]
February
26, 2012
Int J Low Extrem Wounds. 2012
Feb 21. [Epub ahead of print]
Reporting
an Alliance Using an Integrative Approach to the Management of Lymphedema in
India.
Ryan TJ, Narahari SR.
Source
Oxford
University and Oxford Brookes University, Oxford, Oxfordshire, UK.
Abstract
In
India 553 million persons are estimated to live in areas endemic for LF;
approximately 21 million have symptomatic filariasis. Of the approximately
16.02 million cases of lymphedema caused by LF globally, 7.44 million (46.4%)
are in India. India had seen diethyl carbamizine, and/or albendazole, delivered
to whole populations, beginning the project to eliminate the disease. But new
populations have developed the infection. In 2003 the need in resource-poor
countries for morbidity control of lymphatic filariasis (LF) became clear,
prompting the study by the Institute of Applied Dermatology in Kerala, India.
Under this study,self help and family members assisted in home-based care,
combining compression bandaging, yoga exercises, heat therapy using steaming,
and skin care according to Ayurvedic medicine. Lymphedema presents with
different patterns in the skin with gross changes in the epidermis, dermis, or
subcutaneous tissue. Skilled and time-consuming counselling is important to
give patients support. An almost immediate reduction in inflammatory episodes
from 80.4% to 8.6% shows up within 2 or 3 weeks, and therefore, intake of
antibiotics can be stopped. The second major response is reduction in the size
of the limb. Volume reduction for large-sized limbs at 3 months is 39%, with a
confidence interval of 4.9 to 5.9 L.
PMID:
22354118 [PubMed - as supplied by publisher]
Arch Dermatol. 2012
Feb;148(2):260-2.
Lichen
sclerosus exhibiting histologic signs of lymphedema: an essential factor in the
pathogenesis of verruciform xanthoma.
Carlson JA, Carlson GD, Murphy M, Rohwedder A.
Source
Albany
Medical College, 47 New Scotland Ave, MC-81, Albany, NY 12208.
[email protected].
PMID:
22351836 [PubMed - in process]
Clin Cancer Res. 2012 Feb 20.
[Epub ahead of print]
Connexin
47 mutations increase risk for secondary lymphedema following breast cancer
treatment.
Finegold D, Baty C, Knickelbein K, Perschke S, Noon S, Campbell D, Karlsson J, Huang D, Kimak M, Lawrence E, Feingold E, Meriney S, Brufsky AM, Ferrell R.
Source
pediatrics/human
genetics, university of pittsburgh.
Abstract
PURPOSE:
Secondary
lymphedema is a frequent complication of breast cancer associated with surgery,
chemotherapy, or radiation following breast cancer treatment. The potential
contribution of genetic susceptibility to risk of developing secondary
lymphedema following surgical trauma, radiation, and other tissue insults has
not been studied.
EXPERIMENTAL
DESIGN:
To
determine if women with breast cancer and secondary lymphedema had mutations in
candidate lymphedema genes, we undertook a case - control study of 188 women
diagnosed with breast cancer recruited from the University of Pittsburgh Breast
Cancer Program (http://www.upmccancercenter.com/breast/index.cfm) between
2000-2010.Candidate lymphedema genes, GJC2 (encoding connexin 47 [Cx47]),
FOXC2, HGF, MET, and FLT4 (encoding VEGFR3), were sequenced for mutation.
Bioinformatics analysis and in vitro functional assays were used to confirm
significance of novel mutations.
RESULTS:
Cx47
mutations were identified in individuals having secondary lymphedema following
breast cancer treatment but not in breast cancer controls or normal women
without breast cancer. These novel mutations are dysfunctional as assessed
through in vitro assays and bioinformatics analysis, and provide evidence that
altered gap junction function leads to lymphedema.
CONCLUSIONS:
Our
findings challenge the view that secondary lymphedema is solely due to
mechanical trauma and support the hypothesis that genetic susceptibility is an
important risk factor for secondary lymphedema. A priori recognition of genetic
risk 1) raises the potential for early detection and intervention for a high
risk group, and 2) allows the possibility of altering surgical approach and/or
chemo- and radiation therapy, or direct medical treatment of secondary
lymphedema with novel connexin modifying drugs.
PMID:
22351697 [PubMed - as supplied by publisher]
Gene. 2012 Feb 14. [Epub ahead
of print]
Novel
mutation in the FOXC2 gene in three generations of a family with
lymphoedema-distichiasis syndrome.
Sutkowska E, Gil J, Stembalska A, Hill-Bator A, Szuba A.
Source
Department
and Clinic of Orthopaedic and Traumatologic Surgery-Division of Rehabilitation,
Wroclaw Medical University, Borowska str. 213, 50-556 Wroclaw,
Poland.
Abstract
Lymphoedema-distichiasis
syndrome (LDS, OMIM #153400) is a genetic disorder with an autosomal dominant
pattern of inheritance caused by mutations in the FOXC2 gene. Affected
individuals typically present with lower extremity lymphoedema and
distichiasis. The most common types of mutations in FOXC2 gene include small
deletions and insertions, but duplications, duplications-insertions, missense
and nonsense mutations were also found. Herein, we describe three generations
of a family diagnosed with LDS caused by a new mutation in the FOXC2 gene. This
mutation is a frameshift due to a deletion of two nucleotides (CC) in C repeats
between C586 and C591. This mutation leads to protein truncation as a result of
an earlier insertion of a stop codon. To the best of our knowledge, this is the
first description of this mutation in the literature and could be coupled with
an atypical lymphoscintigram.
Copyright
© 2012 Elsevier B.V. All rights reserved.
PMID:
22349027 [PubMed - as supplied by publisher]
Ann Dermatol. 2011 Dec;23(Suppl
3):S303-5. Epub 2011 Dec 27.
Unilateral
psoriasis in a woman with ipsilateral post-mastectomy lymphedema.
Kim M, Jung JY, Na SY, Na SJ, Lee JH, Cho S.
Source
Department of
Dermatology, Seoul National University College of Medicine, Seoul,
Korea.
Abstract
Psoriasis is a
multi-factorial disease with various clinical manifestations. We present a case
of unilateral psoriasis associated with ipsilateral lymphedema that developed
after mastectomy for breast cancer. A 42-year-old Korean woman was referred to
our clinic with a 1-month history of multiple erythematous scaly patches on the
right arm, back, and breast and was diagnosed with psoriasis by a skin biopsy.
Three years previously, she had been diagnosed with breast cancer (T1N2),
underwent a right quadrantectomy and axillary lymph node dissection, and
completed adjuvant chemotherapy followed by high-dose adjuvant radiotherapy.
She had started rehabilitation therapy on the right arm for secondary
lymphedema 30 months previously. Because of the long interval between radiation
and psoriasis, we speculated that changes in the local milieu caused by the
lymphedema might be a causative factor. We hereby report a rare case of
unilateral psoriasis following post-mastectomy lymphedema.
PMID:
22346263 [PubMed - in process] PMCID: PMC3276782
Breast. 2012 Feb 16. [Epub ahead
of print]
Factors
associated with long-term functional outcomes and psychological sequelae in
women after breast cancer.
Khan F, Amatya B, Pallant JF, Rajapaksa I.
Source
Department
of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan
Street, Parkville, VIC 3050, Australia; Department of Rehabilitation Medicine,
RoyalMelbourne Hospital, 34-54 Poplar Road Parkville, Melbourne VIC 3052,
Australia.
Abstract
The
objective of this study was to examine factors impacting long-term functional
outcomes and psychological sequelae in survivors of breast cancer (BC). A
clinical assessment and structured interview assessed the impact of BC on
participants' (n = 85) current activity and restriction in participation, using
validated questionnaires: Functional Independence Measure (FIM), Perceived
Impact Problem Profile (PIPP) and Depression Anxiety Stress Scale (DASS).
Participants showed good functional recovery (median motor FIM score = 78).
Three-quarters (74%) reported pain, 32% reported upper limb weakness, 31% pain
limiting shoulder movement and 29% lymphoedema. One third (32%) reported
greatest impact on psychological wellbeing. A substantial number of
participants reported high levels of depression (22%), anxiety and stress (19%
each). Factors associated with poorer current level of functioning and
wellbeing included: younger participants, recent diagnoses, aggressive tumour
types, receiving chemotherapy, shoulder limitation due to pain, and
lymphoedema. BC survivors require long-term management of psychological
sequelae impacting activity and participation.
Copyright
© 2012 Elsevier Ltd. All rights reserved.
PMID:
22342676 [PubMed - as supplied by publisher]
Cancer Radiother. 2012 Feb 17.
[Epub ahead of print]
[Upper
limb lymphedema after breast cancer treatment.]
[Article
in French]
Ben Salah H, Bahri M, Jbali B, Guermazi M, Frikha M, Daoud J.
Source
Service
de radiothérapie carcinologique, CHU Habib-Bourguiba, 3029 Sfax,
Tunisie.
Abstract
PURPOSE:
To
study the frequency and risk factors for upper limb lymphedema through a series
of patients treated for breast cancer.
PATIENTS
AND METHODS:
It
is a retrospective study about 222 patients treated for breast cancer during
the period between February 1993 and December 2003 in Sfax hospitals. Average
age was 51years (27-92years). Tumour was T2 in 59% of cases. All patients had
surgery with lymph node dissection. Infiltrating ductal carcinoma was the most
frequent histological type (80% of cases), with predominant SBR II grade (62%).
The mean number of removed lymph nodes was 12 (2-33). Axillary lymph node
metastasis was detected in 124 patients. Radiotherapy was delivered in 200
patients, including axillary irradiation in 30 cases. The mean follow-up was
68months (12-120).
RESULTS:
Lymphedema
appeared in 23% of cases (51 patients), 14months after surgery (mean period).
Lymphedema affected the brachium in 17% of cases, the forearm in 12% of cases
and all upper limb in 71% of cases. Fifty percent of patients had
rehabilitation. However, improvement of lymphedema was obtained in 18 cases.
Parameters predicting lymphedema were studied. Significant risk factors were
obesity, infection and a number of removed lymph node above 10. The type of
surgery, axillary irradiation and shoulder abduction deficit did not predict
lymphedema.
CONCLUSION:
Lymphedema
of the arm is a frequent consequence of breast cancer treatment. The risk of
lymphedema is correlated with obesity, infection and a number of removed lymph
node above 10.
Copyright
© 2012 Société française de radiothérapie oncologique (SFRO). Published by
Elsevier SAS. All rights reserved.
PMID:
22342349 [PubMed - as supplied by publisher]
MED
NEWS:
February
11, 2012
Highlighting A Rare Subset Of Diseases Involving The
Lymphatic System –
A clinically challenging and under-studied subset of diseases
affecting the lymphatic system and grouped under the disease spectrum
lymphangiomatosis and Gorham's disease is the focus of a special issue of
Lymphatic Research and Biology, a peer-reviewed journal published by
Mary Ann Liebert, Inc.. The issue is available free online.*
Guest
Editor, and Journal Associate Editor Francine Blei MD, MBA, St. Luke's
Roosevelt Hospital, NY, has compiled a collection of articles that highlight
the complex characteristics of these diseases, which can be localized, affect
multiple sites, or be systemic, may be congenital or acquired, and may cause
symptoms that range from mild to severe to life-threatening. The articles focus
on current knowledge, ongoing research, and how these diseases differ from
other lymphatic disorders.
"This disease spectrum affects a patient
population that is small in number, but the effects of the disease(s) are
devastating," says Stanley G. Rockson, MD, Editor-in-Chief of Lymphatic
Research and Biology and Allan and Tina Neill Professor of Lymphatic Research
and Medicine, Stanford University School of Medicine, CA. The collection of
articles in this special issue, "highlights the current state of knowledge (and
ignorance) in this paradoxically neglected area of lymphatic health and
disease."
February 14, 2012
Link Between NSAIDs And Reduced Cancer Metastasis
Strengthened By Study
A new study reveals key factors that promote the spread of cancer to lymph nodes and
provides a mechanism that explains how a common over-the-counter
anti-inflammatory medication can reduce the spread of tumor cells through the
lymphatic system. The research, published by Cell Press in the February 14
issue of the journal Cancer Cell, opens new avenues for the design
of antimetastatic therapies.
The lymphatic system consists of a network
of vessels that carry lymphatic fluid from the body organs back to the general
circulation. Along the way, lymphatic fluid percolates through lymph nodes.
Unfortunately, cancer cells sometimes spread (via a process called metastasis)
through the lymphatic system and can form secondary tumors in the lymph nodes.
The spread of cancer cells to the lymph nodes is an important indicator of
disease progression.
"Some tumors secrete protein growth factors that
can act on the lymphatic vessels to facilitate metastasis. For example,
elevated levels of the growth factor VEGF-D in human tumors correlate with
lymph node metastasis and poor patient prognosis," explains the senior study
author, Steven Stacker, associate professor from the Tumour Angiogenesis
Program, Peter MacCallum Cancer Centre in Melbourne, Australia. "However, thus
far, mechanisms underlying the transit of cancer cells through the larger
lymphatic vessels and into the lymph nodes remain elusive."
In the
current study, Stacker and colleagues investigated how collecting lymphatic
vessels, conduits that drain lymphatic fluid from tissues into lymph nodes, are
altered during VEGF-D-driven metastasis. The researchers discovered that VEGF-D
was linked to prostaglandin pathways, which are important regulators of
lymphatic vessel dilation. Nonsteroidal anti-inflammatory drugs (NSAIDS), which are known
inhibitors of prostaglandin synthesis, reduced lymphatic vessel dilation and,
therefore, inhibited tumor metastasis.
"This key interaction between
lymphatic system growth factors and prostaglandins reveals a mechanism for
physically preparing collecting vessels for tumor cell dissemination and a
mechanism by which NSAIDs can reduce cancer metastases through the lymphatic
system," concludes Dr. Stacker. "These insights may assist with the design of
additional therapeutics for cancer patients and enhance current approaches that
aim to prevent the spread of cancer cells through the lymphatic system and
potentially to distant organs."
February
21, 2012
Two Possible Options Identified For Treating Epstein
Barr Virus-Fueled Lymphomas In Immunosuppressed
Patients
Some 90 percent of people are exposed to the Epstein Barr virus (EBV)
at some point in their life. Even though it is quickly cleared from the body,
the virus can linger silently for years in small numbers of infected B cells.
According to researchers at Children's Hospital Bostonand the Immune Disease
Institute (IDI), the immune system subdues the virus by watching for a single
viral protein called LMP1, knowledge that has already helped suggest two new
treatments for the EBV-fueled cancers seen in some
immunosuppressed patients.
The study team, led by Klaus Rajewksy, MD,
and Baochun Zhang, MD, PhD, of the Program in Cellular and Molecular Medicine
at Children Hospital Boston and the IDI, reported their results online in the
journal Cell.
While the immune system's T cells rapidly
clear most EBV-infected B cells, about one in a million infected cells escapes
destruction. Within these cells, the virus enters a latent phase, kept in check
by the watchful eye of so-called memory T cells. This uneasy relationship
usually holds steady the rest of a person's life, unless something - such as
infection with HIV or use of anti-rejection
drugs following a transplant - suppresses the immune system and breaks the
surveillance. The virus can then reawaken and drive the development of B cell
cancers like AIDS-associated B cell lymphoma and post-transplant
lymphoproliferative disorder.
To better understand how the immune
system maintains its watch and how the virus turns cells cancerous, Rajewsky
and his team had generated a model mimicking latent EBV infection by
engineering mice whose B cells contained an inducible version of viral LMP1.
Researchers have long known that EBV needs LMP1 to turn B cells cancerous, but
modeling this relationship in vivo had proven challenging.
"We had
previously attempted to develop an animal model of LMP1 transformation of B
cells," said Rajewsky, who recently moved to the Max Delbrück Center for
Molecular Medicinein Germany, "but we had never been able to get the mice in
our models to actually produce any mature B cells. The immune response against
the LMP1-producing B cells was so robust that the cells were eliminated very
early on."
Their breakthrough came when Zhang and colleagues
reengineered the model to lack T cells. "The mice were initially fine, but
succumbed within two to three months to aggressive B cell lymphomas," Rajewsky
said. "The profile mimicked very closely what we see in immunosuppressed
lymphoma patients." In additional experiments with Rajewsky's original model,
the team eliminated the mice's T cells before activating the viral protein in B
cells, sparking a similar but even more rapid fatal disease.
The team
also made several observations with possible clinical application. First, they
noted that in the mouse model the LMP1 producing B cells were being attacked by
a specific kind of T cell called a CD4+ T cell. "Transplant patients who
develop B cell lymphomas because they are immunosuppressed by their
anti-rejection drugs are often treated with T cells that carry the CD8 marker,"
Rajewsky noted. "These results would argue for also considering CD4+ T cells
for treatment."
Second, they found that tumors in the LMP1 producing
mice often displayed targets recognized by another kind of immune cell called a
natural killer (NK) cell. Seeing an opportunity, Rajewsky worked with cancer
immunologist Glenn Dranoff, MD and colleagues at Dana-Farber Cancer Institute,
to test a potential therapeutic agent that uses a portion of the NK cell
activating receptor called NKG2D,fused to the stimulatory Fc portion of an
antibody, a combination capable of activating and directing immune attack
against tumor cells. In a transplantation model of LMP1-fueled lymphomas, the
NKG2D-Fc fusion proved quite capable of reducing tumor growth and prolonging
survival of the recipients.
"These preclinical results suggest
administration of the NKG2D-Fc fusion protein, perhaps combined withtreatment
with CD4+ T cells, could benefit some patients with EBV-driven lymphomas,"
Rajewsky said. "What we can say with certainty, though, is that LMP1 is the
immune system's primary surveillance trigger following EBV infection and
clearance, knowledge that we think will open doors to additional treatment
options."
February 25, 2012-02-27
Exploiting A Weakness In Cancer's Defense
System
Researchers at the EPFL have
identified an important mechanism that could lead to the design of more
effective cancer vaccines. Their discovery
of a new-found role of the lymphatic system in tumour growth shows how tumours
evade detection by using a patient's own immune system.
Tumour cells
present antigens or protein markers on their surfaces which make them
identifiable to the host immune system. In the last decade, cancer vaccines
have been designed that work by exposing the patient's immune cells to
tumour-associated antigens and so priming them to kill cells that present those
antigens. These have caused much excitement, not least because by acting so
specifically on cancer cells, they could potentially eliminate the unpleasant
side effects of chemo- and radiotherapy.
Like soldiers protecting
a fort
However, clinical trials of such vaccines have had a very
low success rate to date, mainly because tumours have various mechanisms for
evading detection by immune cells, even when those immune cells - called T
cells - have been primed to seek them out. Those mechanisms are, in general,
poorly understood. But in a paper to be published this week in Cell Reports,
the laboratories of Melody Swartz at EPFL and Stéphanie Hugues at UNIGE provide
a key insight into one of them. They describe for the first time how, like
soldiers protecting a fort, lymph vessels surrounding a tumour ward off T cell
attack.
Plenty of research has shown that tumours can induce the growth
of lymph vessels in their vicinity, and that this growth is correlated with
metastasis and poor prognosis. It was assumed that these lymph vessels simply
provided an escape route for cancer cells, transporting them to distant sites.
In the new study, led by postdoc Amanda Lund, the researchers show that lymph
vessels actually suppress the immune response, deleting the attacking T cells
or leaving them "functionally exhausted" by the time they reach the tumour.
They studied a type of tumour that expresses large amounts of VEGF-C, a
molecule that is naturally expressed in humans and that stimulates lymphatic
growth. Having engineered the tumour cells to express a foreign antigen, they
compared the efficacy of a vaccine designed to prime T cells to kill cells
carrying that antigen, either when VEGF-C was present or when its activity was
blocked . With VEGF-C suppressed, the vaccine's efficacy increased and tumour
growth slowed fourfold.
A weakness in cancer's defense system
exploited
The researchers went on to show that the endothelial
cells which line lymph vessels "scavenge" tumour-specific antigens and present
them to the tumour-specific T cells in a suppressive manner. This, in turn,
promotes the local deletion of those T cells. According to Prof Swartz, that
means that first targeting the lymph vessels associated with a tumour could, in
theory, significantly increase the efficacy of existing cancer vaccines. "It
would be like removing the soldiers from around the fort before sending in your
opposing army," she says. "If you disable the lymph vessels' suppressive
functions, our data suggest that tumour-killing T cells would do their job a
lot more effectively." Future clinical trials are needed to put that theory to
the test.
Feb 29, 2012
Birkballe S, Karlsmark T, Noerregaard S,
Gottrup F.
Source
Department of Dermatology, Bispebjerg
University Hospital, Copenhagen, Denmark Copenhagen Wound Healing Center,
Bispebjerg University Hospital, Copenhagen,
Denmark.
Abstract
Background: 
Lymphoedema is
increasingly recognized as a significant problem in health care. The number of
patients is growing, posing a future challenge to health care systems and
economics. Over the last decade, specialized lymphoedema management has been
established around the world to accommodate the growing demands. However,
information on organization, experiences and outcome are scarce.
Objectives: 
This article is a clinical perspective
analysis describing the establishment, organization, function and results of a
new, multidisciplinary Lympheodema Center functioning as a University Hospital
unit in connection to the Department of Dermatology and Copenhagen Wound
Healing Center and integrated as a national expert function in the public
Health Care Organization of Denmark.
Methods: 
Establishment and data collection from a structured, multidisciplinary
organization of lymphoedema management.
Results: 
During
the first 4½ years a total of 8058 patient consultations were preformed. Mean
duration of symptoms at first visit was 19 years (range 1 - 67) and 31% had
never received any diagnosis or treatment prior to referral. Complications were
found in 48% of referred patients. All patients received appropriate diagnostic
investigations and treatment according to best practice. Multidisciplinary
assessment involving 4 or more different health care professions was needed in
86% of cases. Research opportunities and expert education of staff were
enhanced.
Conclusions: 
A multidisciplinary Lymphoedema
Center improves management, knowledge and awareness of lymphoedema. This model,
with minor adjustments, may be applicable for other regions and
countries.
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/22373016
From:
lymphedemapeople <[email protected]>
Subject: [Lymphedema] Stem
cell treatment lymphedema - CUBA
To: [email protected]
Date:
Friday, March 9, 2012, 10:01 AM
Stem cell treatment
research is presently being done at Emory University here in Atlanta, but
evidently it is also being done in Havana, Cuba (wish we could get more info on
it):
Initial trials show promising results in stem cell
treatment
Mar 8, 2012
Havana: About 1700 patients were treated
until December, 2011, with stem cells, a treatment with promising results,
according to official sources quoted by media.
Results are similar to
those reached in developed countries, avoiding important amputations to
patients, told to Gramma newspaper Doctor Porfirio Hernandez, coordinator of
the National Group for Regenerative Medicine at the Ministry of Public
Health.
According to Hernandez, the treatment is still trial phase under
strict selection criteria, although 10 of the 15 Cuban provinces already
receive that service.
Hernandez said that Cuba has contributed
significantly to the international scientific literature in the sphere, as in
the case of improvements experienced by those patients suffering from chronic
Lymphedema in lower limbs.
Hernandez also mentioned the case of a minor
suffering from Idiopathic pulmonary fibrosis (IPF), who was treated with a
procedure based on stem cells, avoiding a lung transplant.
With the
capacity of splitting without limits, stem cells can regenerate tissues damaged
by diseases, trauma or aging.
It is mainly obtained by bone marrow,
peripheral blood, cornea, brain, lung and endometrium.
http://zeenews.india.com/news/health/diseases/initial-trials-show-promising-results-in-stem-cell-treatment_15940.html
__._,_.___
March 13,
2012
IRDye800CW-Cyclic
albumin-binding domain (Ac-RLIEDICLPRWGCLWEDDK-NH2).
Authors
Leung K.
Source
Molecular
Imaging and Contrast Agent Database (MICAD) [Internet]. Bethesda (MD): National
Center for Biotechnology Information (US); 2004-2011.
2011 Dec 19 [updated
2012 Mar 01].
Excerpt
Optical
fluorescence imaging is increasingly used to monitor biological functions of
specific targets in small animals (1-3). However, the intrinsic fluorescence of
biomolecules poses a problem when fluorophores that absorb visible light
(350–700 nm) are used. Near-infrared (NIR) fluorescence (700–1,000 nm)
detection avoids the natural background fluorescence interference of
biomolecules, providing a high contrast between target and background tissues.
NIR fluorophores have a wider dynamic range and minimal background fluorescence
as a result of reduced scattering compared with visible fluorescence detection.
NIR fluorophores also have high sensitivity, resulting from low background
fluorescence, and high extinction coefficients, which provide high quantum
yields. The NIR region is also compatible with solid-state optical components,
such as diode lasers and silicon detectors. NIR fluorescence imaging is a
noninvasive alternative to radionuclide imaging in small animals or with probes
in close proximity to the target in humans (4, 5). Among the various optical
imaging agents, only indocyanine green (ICG), with NIR fluorescence absorption
at 780 nm and emission at 820 nm, is approved by the United States Food and
Drug Administration for clinical applications in angiography, blood flow
evaluation, and liver function assessment. It is also under evaluation in
several clinical trials for other applications, such as optical imaging and
mapping of both the lymphatic vessels and lymph nodes in cancer patients for
surgical dissection of tumors and endoscopic imaging of the pancreas and colon.
The primary function of the lymphatic system is to drain ~10% of the
interstitial fluid from small capillaries to lymphatic vessels through lymph
nodes and finally to the venous system (6-10). Lymph nodes form a natural
filter for the lymphatic drainage and prevent the possible migration of cancer
cells from the lymphatic system into the body. Serum proteins and
macromolecules can be taken up by the large openings in the lymphatic
capillaries. However, an accumulation of protein molecules may impair lymphatic
flow and cause lymphedema and tissue edema. For NIR fluorescence imaging, ICG
has been used in lymphatic imaging because of its association with serum
proteins. However, ICG is degraded in aqueous conditions with a half-life of
~20 h and is sensitive to light (half-life, 2.3 h). IRDye 800CW (IRDye800) is
an indocyanine-type NIR fluorophore with peak absorption at 785 nm and peak
excitation emission at 803 nm, and it is about four-fold brighter than ICG.
Dennis et al. (11) identified the peptide Ac-RLIEDICLPRWGCLWEDD (SA21), which
bound with high affinity to human and murine serum albumin. Davies-Venn et al.
(12) prepared a cyclic version of SA21 called cyclic albumin-binding domain
(Ac-RLIEDICLPRWGCLWEDDK-NH2, cABD) and conjugated this with IRDye800 to form
IRDye800-cABD for NIR fluorescence lymphatic imaging in mice.
Sections
PMID:
22400136 [PubMed]
March 13,
2012
Ann Surg Oncol. 2012 Mar 7.
[Epub ahead of print]
Nomograms
for Predicting the Risk of Arm Lymphedema after Axillary Dissection in Breast
Cancer.
Bevilacqua JL, Kattan MW, Changhong Y, Koifman S, Mattos IE, Koifman RJ, Bergmann A.
Source
Escola
Nacional de Saúde Pública/FIOCRUZ, Rio de Janeiro, Brazil,
[email protected].
Abstract
BACKGROUND:
Lymphedema (LE)
after axillary lymph node dissection (ALND) is a multifactorial, chronic, and
disabling condition that currently affects an estimated 4 million people
worldwide. Although several risk factors have been described, it is difficult
to estimate the risk in individual patients. We therefore developed nomograms
based on a large data set.
METHODS:
Clinicopathologic
features were collected from a prospective cohort comprising 1,054 women with
unilateral breast cancer undergoing ALND as part of their surgical treatment
from August 2001 to November 2002. LE was defined as a volume difference of at
least 200 ml between arms at 6 months or more after surgery. The cumulative
incidence of LE was ascertained by the Kaplan-Meier method, and Cox
proportional hazard models were used to predict the risk of developing LE on
the basis of the available data at each time point: model 1, preoperatively;
model 2, within 6 months from surgery; and model 3, at 6 months or later after
surgery.
RESULTS:
The 5
year cumulative incidence of LE was 30.3%. Independent risk factors for LE were
age, body mass index, ipsilateral arm chemotherapy infusions, level of ALND,
location of radiotherapy field, development of postoperative seroma, infection,
and early edema. When applied to the validation set, the concordance indices
were 0.706, 0.729, and 0.736 for models 1, 2, and 3, respectively.
CONCLUSIONS:
The
proposed nomograms can help physicians and patients predict the 5 year
probability of LE after ALND for breast cancer. Free online versions of the
nomograms are available at http://www.lymphedemarisk.com/ .
PMID:
22395997 [PubMed - as supplied by publisher]
J Drugs Dermatol. 2012 Mar
1;11(3):402-5.
A
case of elephantiasis nostras verrucosa treated by acitretin.
Polat M, Sereflican B.
Abstract
Elephantiasis
nostras verrucosa is a rare disorder characterized by dermal fibrosis,
hyperkeratotic, verrucous, and papillomatous lesions that result from both
chronic filarial and nonfilarial lymphedema. Various treatment options have
been reported for this disease. We present a 64-year-old man with erythrodermic
psoriasis and elephantiasis nostras verrucosa in whom the lesions were resolved
almost completely after acitretin treatment. J Drugs Dermatol.
2012;11(3):402-405.
PMID:
22395594 [PubMed - in process]
Rev Med Suisse. 2012 Feb
8;8(327):315-6, 318-9.
[Lymphatic
disorders and prevention of their complications].
[Article
in French]
Tomson D, Lessert C, Klumbach D, Mazzolai L, Depairon M.
Source
Service
d'angiologie, CHUV, 1011 Lausanne. [email protected]
Abstract
The
prevalence of lymphedema is clearly underestimated. Too few patients receive
treatment. It requires several specifically trained participants and must be
conceived in the long term given the chronic nature and the incurability of
this pathology. Prevention is therefore of major importance. Successfully
applied to operated women for breast cancer, other models of coverage deserve
to be developed to reduce the incidence of lymphedema and its complications,
particularly after oncologic, orthopedic and vascular surgery and for patients
affected by venous insufficiency.
PMID:
22393652 [PubMed - indexed for MEDLINE]
Clin Nucl Med. 2012
Apr;37(4):411-5.
Lymphoscintigraphy
of lower limb edema.
Zimmerman H, Fessa CK, Rossleigh MA, Wegner EA.
Source
From the
*Department of Nuclear Medicine, The Prince of Wales Hospital, Randwick, NSW
Australia; †Department of Nuclear Medicine, Sydney Children's Hospital,
Randwick, NSW Australia; and ‡The University of New South Wales Medical School,
Kensington, NSW Australia.
Abstract
Lymphedema of the
lower limbs is a well-known chronic condition. The cause of lymphedema can be
either primary or secondary. Lymphoscintigraphy is a simple and reliable method
for evaluation of lymphatic function. We illustrate the different lymph
drainage patterns in 4 cases of lower limb edema, with either primary or
secondary causes. In all cases, planar images were obtained after bipedal
administration of Tc antimony sulfur colloid.
PMID:
22391722 [PubMed - in process]
Ann R Coll Surg Engl. 2012
Mar;94(2):101-2.
Penile
degloving: an unusual presentation of hidradenitis suppurativa.
Kok K, Lahiri A.
Source
University
Hospitals Birmingham NHS Foundation Trust, UK.
Abstract
Chronic
hidradenitis suppurativa (HS) can cause lymphoedema, leading to novel
presentations. We present the case of a man with chronic HS causing penile
oedema and subsequent degloving. He underwent direct excision with a good
result. Chronic HS patients should be warned about problems related to
lymphoedema and reviewed regularly to resolve problems early.
PMID:
22391376 [PubMed - in process]
Ann R Coll Surg Engl. 2012
Mar;94(2):55-6.
Breast
cancer presenting as subclavian/axillary deep vein thrombosis and upper limb
lymphoedema.
Kruger SJ.
Source
Royal
Marsden NHS Foundation Trust, UK.
Abstract
This
case report describes the delayed diagnosis of inflammatory breast cancer
following initial presentation with a subclavian/axillary deep vein thrombus.
The relationship of thrombosis and cancer is discussed and the typical
presentation of inflammatory breast cancer described. Understanding the
relationship between thromboembolism and cancer is crucial to support the early
diagnosis of breast cancer, which can present insidiously. The literature is
reviewed, highlighting the improving prognosis of this rare condition and the
current preferred treatment modalities.
PMID:
22391349 [PubMed - in process]
March
13, 2012
Genes Chromosomes Cancer. 2012
Jun;51(6):569-78. doi: 10.1002/gcc.21943. Epub 2012 Mar 2.
The
miR-17-92 cluster and its target THBS1 are differentially expressed in
angiosarcomas dependent on MYC amplification.
Italiano A, Thomas R, Breen M, Zhang L, Crago AM, Singer S, Khanin R, Maki RG, Mihailovic A, Hafner M, Tuschl T, Antonescu CR.
Source
Department of
Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of
Medical Oncology, Institute Bergonié, Bordeaux, France.
[email protected].
Abstract
Angiosarcomas (ASs)
represent a heterogeneous group of malignant vascular tumors that may occur
spontaneously as primary tumors or secondarily after radiation therapy or in
the context of chronic lymphedema. Most secondary ASs have been associated with
MYC oncogene amplification, whereas the role of MYC abnormalities in primary AS
is not well defined. Twenty-two primary and secondary ASs were analyzed by
array-comparative genomic hybridization (aCGH) and by deep sequencing of small
RNA libraries. By aCGH and subsequently confirmed by fluorescence in situ
hybridization, MYC amplification was identified in three out of six primary
tumors and in 8 out of 12 secondary AS. We have also found MAML1 as a new
potential oncogene in MYC-amplified AS. Significant upregulation of the
miR-17-92 cluster was observed in MYC-amplified AS compared to AS lacking MYC
amplification and the control group (other vascular tumors, nonvascular
sarcomas). Moreover, MYC-amplified ASs were associated with a significantly
lower expression of thrombospondin-1 (THBS1) than AS without MYC amplification
or controls. Altogether, our study implicates MYC amplification not only in the
pathogenesis of secondary AS but also in a subset of primary AS. Thus, MYC
amplification may play a crucial role in the angiogenic phenotype of AS through
upregulation of the miR-17-92 cluster, which subsequently downregulates THBS1,
a potent endogenous inhibitor of angiogenesis. © 2012 Wiley Periodicals,
Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22383169 [PubMed - in process]
Curr Treat Options Cardiovasc
Med. 2012 Apr;14(2):184-92.
Update
on the biology and treatment of lymphedema.
Rockson SG.
Source
Stanford
Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine,
Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305,
USA, [email protected].
Abstract
OPINION
STATEMENT: The past decade has produced an explosion of insights into lymphatic
vascular development and structural biology and, in parallel, into the function
of the lymphatics in health and in disease. In lymphedema, there is a spectrum
that extends from primary (heritable) to acquired causes of disease. The
diagnosis of lymphatic edema implicates a very specific treatment approach that
is predicated upon the favorable impact of physiotherapy upon lymph flow and
protein clearance from the edematous zones of the body. The recognition of the
unique biology that accompanies lymphatic causes of edema has stimulated new
research directions that are likely to translate into exciting new
pharmacologic and molecular approaches to diagnosis and treatment.
PMID:
22382848 [PubMed - in process]
March
13, 2012
Plast Reconstr Surg. 2012
Mar;129(3):612-20.
Mapping
of lymphosomes in the canine forelimb: comparative anatomy between canines and
humans.
Suami H, Shin D, Chang DW.
Source
Department of
Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston,
Texas 77030-4009, USA. [email protected]
Abstract
BACKGROUND:
Breast
cancer-related lymphedema is an unsolved iatrogenic dilemma. Disfigurement of
the affected limb because of increased volume and recurrent cellulitis can
cause both physical and mental distress for many breast cancer survivors. No
adequate animal models have been developed to investigate acquired lymphedema
mimicking breast cancer-related lymphedema, and there is little knowledge of
the anatomy of the lymphatics in animals. The authors hypothesized that a
canine forelimb model of the lymphatic system could potentially be used to
study breast cancer-related lymphedema.
METHODS:
Six
forequarters were used from three mongrel hound carcasses. The lymphatic
microinjection technique used hydrogen peroxide to identify lymphatic vessels.
The individual channels were injected with a radiopaque lead oxide mixture and
recorded on digital radiography. Lymphatic territories (lymphosomes) in the
canine forelimb were demarcated and color coded in accordance with their lymph
nodes. The lymphatic system in the canine forelimb was compared with that in
the human upper extremity.
RESULTS:
The
lymphatic system in the canine forelimb was divided into two superficial
lymphosomes (ventral cervical and axillary) and one deep lymphatic system. The
ventral cervical lymphosome was larger than the axillary lymphosome. A single
lymph node in the axilla received fluid from three sites: the ventral cranial
torso, the superficial medial forelimb, and the deep forelimb. The lymphatic
systems of the human upper extremity and the canine forelimb had some
anatomical similarities: distinct superficial and deep system and size of the
lymphatic vessel.
CONCLUSION:
The
canine model may be a valuable animal model for investigating the
pathophysiology of upper extremity lymphedema.
PMID:
22373968 [PubMed - in process]
J Plast Reconstr Aesthet Surg.
2012 Feb 26. [Epub ahead of print]
Liposuction
for chronic lymphoedema of the upper limb- 5 years of experience.
Schaverien MV, Munro KJ, Baker PA, Munnoch DA.
Source
Department of
Plastic Surgery, Ninewells Hospital, Dundee DD1 9SY, United
Kingdom.
Abstract
BACKGROUND:
Lymphoedema of the
upper limb is a well-recognised complication of axillary surgery for breast
cancer. Effective long-term treatment of lymphoedema by liposuction has
previously been demonstrated. In this study we present our first five years of
experience using this technique in treatment of upper limb
lymphoedema.
METHODS:
A
prospective analysis of the results of 12 patients who underwent liposuction
followed by compression therapy for chronic unilateral upper limb oedema with
up to five years of follow-up was carried out. Hospital Anxiety and Depression
Score questionnaires and a Visual Analogue Score for overall well-being were
also completed pre- and post-operatively.
RESULTS:
The mean
duration of lymphoedema was seven years (range, 1-14), commencing at a mean of
one year (range, 0-5) after axillary surgery. The mean excess arm volume at
admission was 1391 ml and the ratio of the lymphoedematous to the unaffected
arm was 1·48. The mean total aspirate volume was 1713 ml, of which 87 percent
was fat. At one year the mean percentage volume reduction compared with the
normal arm was 101 percent, meaning that the volume of both of patients' arms
was virtually equivalent, and this reduction was stable with up to 5 years of
follow-up. Postoperatively there were reductions in anxiety (p < 0.05) and
depression scores, and an improvement in overall well-being.
DISCUSSION:
Our
first five years of experience of liposuction combined with application of
compression garments has demonstrated significant, reproducible, and stable
reduction of upper limb oedema with improvement of overall well-being and
reduction in measurable anxiety and depression.
Copyright © 2012
British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.
PMID:
22373827 [PubMed - as supplied by publisher]
Br J Dermatol. 2012 Feb 28. doi:
10.1111/j.1365-2133.2012.10907.x. [Epub ahead of print]
A
New Concept of a Multidisciplinary Lymphoedema Center - Established in
connection to a department of dermatology and Copenhagen Wound Healing
Center.
Birkballe S, Karlsmark T, Noerregaard S, Gottrup F.
Source
Department of
Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark Copenhagen
Wound Healing Center, Bispebjerg University Hospital, Copenhagen,
Denmark.
Abstract
Background:
Lymphoedema is increasingly recognized as a significant problem in health care.
The number of patients is growing, posing a future challenge to health care
systems and economics. Over the last decade, specialized lymphoedema management
has been established around the world to accommodate the growing demands.
However, information on organization, experiences and outcome are scarce.
Objectives: This article is a clinical perspective analysis describing the
establishment, organization, function and results of a new, multidisciplinary
Lympheodema Center functioning as a University Hospital unit in connection to
the Department of Dermatology and Copenhagen Wound Healing Center and
integrated as a national expert function in the public Health Care Organization
of Denmark. Methods: Establishment and data collection from a structured,
multidisciplinary organization of lymphoedema management. Results: During the
first 4½ years a total of 8058 patient consultations were preformed. Mean
duration of symptoms at first visit was 19 years (range 1 - 67) and 31% had
never received any diagnosis or treatment prior to referral. Complications were
found in 48% of referred patients. All patients received appropriate diagnostic
investigations and treatment according to best practice. Multidisciplinary
assessment involving 4 or more different health care professions was needed in
86% of cases. Research opportunities and expert education of staff were
enhanced. Conclusions: A multidisciplinary Lymphoedema Center improves
management, knowledge and awareness of lymphoedema. This model, with minor
adjustments, may be applicable for other regions and countries.
Copyright © 2012
British Association of Dermatologists.
PMID:
22373016 [PubMed - as supplied by publisher]
J Sex Med. 2012 Mar;9(3):909-17.
doi: 10.1111/j.1743-6109.2011.02581.x.
Sexual
function after modified radical hysterectomy (Piver II/Type B) vs. classic
radical hysterectomy (Piver III/Type C2) for early stage cervical cancer. A
prospective study.
Plotti F, Nelaj E, Sansone M, Antonelli E, Altavilla T, Angioli R, Benedetti Panici P.
Source
Department of
Obstetrics and Gynecology, La Sapienza University of Rome, Rome, Italy.
[email protected]
Abstract
INTRODUCTION:
When
cervical cancer is detected at an early stage (International Federation of
Gynecology and Obstetrics [FIGO] IA2-IB1), it can be successfully treated by
radical surgery alone. Considering that most patients are young and sexually
active at the moment of diagnosis and the long life expectancy of survivors
after the treatment, quality of life (QoL) and sexual function are important
issues for cancer survivors and caregivers. However, only a few studies have
examined the QoL and sexual function in disease-free cervical cancer survivors,
and there are no studies in the literature comparing prospectively sexual
function after different types of radical hysterectomy.
AIM:
To
compare sexual function in two groups of early stage cervical cancer survivors
treated by radical surgery alone, undergoing two different types of radical
hysterectomy.
METHODS:
Patients
treated by radical hysterectomy with systematic lymphadenectomy for early stage
cervical cancer (FIGO IA2-IB1) have been enrolled and divided in two groups
with regard to type of radical hysterectomy performed; S1: modified radical
hysterectomy (Piver II/Type B), S2: classic radical hysterectomy (Piver III/
Type C2).
MAIN
OUTCOME MEASURE:
Twenty-four months
after surgery we assessed the sexual function using the European Organization
for Research and Treatment of Cancer Cervix Cancer Module Questionnaire, which
is a validated system for the assessment of disease- and treatment-specific
issues that affect the QoL and sexual functioning of women who are treated for
cervical cancer.
RESULTS:
Of the
31 patients enrolled in the S1 group and 46 in the S2 group, 23 and 33 patients
have been included, respectively. We observed significant differences between
the two groups in terms of symptom experience, sexual/vaginal functioning,
sexual activity, and sexual enjoyment. There was not any significant difference
regarding lymphedema, peripheral neuropathy, and sexual worry.
CONCLUSION:
Survivors of early
stage cervical cancer treated by modified radical hysterectomy (Piver II/ Type
B) have a better sexual function than those operated by classic radical
hysterectomy (Piver III/ Type C2).
© 2012
International Society for Sexual Medicine.
PMID:
22372655 [PubMed - in process]
Pneumonol Alergol Pol.
2012;80(2):158-62.
[Yellow
nail syndrome in a patient with membranous glomerulonephritis].
[Article
in Polish]
Modrzewska K, Fijołek J, Ptak J, Wiatr E.
Source
Instytutu Gruźlicy
i Chorób Płuc, ul. Płocka 26, Warsaw. [email protected]
Abstract
Yellow
nail syndrome (YNS) is a condition characterized by yellow-green coloration of
nails, respiratory manifestations and lymphoedema. This article presents
52-year-old patient with membranous glomerulonephritis, hospitalized at the
National Tuberculosis and Lung Diseases Research Institute in Warsaw, because
of suspected allergic aspergillosis. Based on clinical and radiological
evaluation the diagnosis of YNS was established. Treatment of renal disease did
not affect the course of yellow nail syndrome. During the two-year follow-up,
despite stable renal parameters we observed the progression of respiratory
manifestations (bronchiectasis, pleural effusions).
PMID:
22370985 [PubMed - in process]
Otolaryngol Head Neck Surg. 2012
Feb 24. [Epub ahead of print]
Liposuction
for the Management of Submental Lymphedema in the Head and Neck Cancer
Patient.
Mark Taylor S, Brake M.
Source
Dalhousie
University, Halifax, NS, Canada.
PMID:
22368042 [PubMed - as supplied by publisher]
Actas Dermosifiliogr. 2012 Feb
23. [Epub ahead of print]
Angiosarcoma
in Chronic Lymphedema (Stewart-Treves Syndrome).
[Article
in English, Spanish]
Sánchez-Medina MT, Acosta A, Vilar J, Fernández-Palacios
J.
Source
Servicio
de Cirugía Plástica Estética y Reparadora, Hospital de Gran Canaria Dr. Negrín,
Las Palmas de Gran Canaria, España.
PMID:
22365100 [PubMed - as supplied by publisher
March
18, 2012
Drug Metab Dispos. 2012 Mar 12.
[Epub ahead of print]
Transport
of the Coumarin Metabolite 7-hydroxycoumarin Glucuronide is Mediated Via
Multidrug Resistance-Associated Proteins 3 and 4.
Wittgen HG, van den Heuvel JJ, van den Broek PH, Siissalo S, Groothuis GM, de Graaf IA, Koenderink JB, Russel FG.
Source
1
Radboud University Nijmegen Medical Centre;
Abstract
Coumarin
(1, 2-benzopyrone) is a natural compound that has been used as a fragrance in
food and perfume industry, and could have therapeutic usefulness in the
treatment of lymphedema and different types of cancer. Previously, several
pharmacokinetic studies of coumarin have been performed in humans, which
revealed extensive first-pass metabolism of the compound. 7-Hydroxycoumarin
(7-HC) and its glucuronide (7-HC-G) are the main metabolites formed in humans,
and via this route, 80-90 percent of the absorbed coumarin is excreted into
urine, mainly as 7-HC-G. Active transport processes play a role in the urinary
excretion of 7-HC-G, however, until now, the transporters involved remained to
be elucidated. In this study, we investigated whether the efflux transporters
multidrug resistance-associated proteins (MRP) 1-4, breast cancer resistance
protein (BCRP), or P-glycoprotein (P-gp), play a role in 7-HC and 7-HC-G
transport. For this purpose, we measured uptake of the metabolites into
membrane vesicles overexpressing these transporters. Our results showed that
7-HC is not transported by any of the efflux transporters tested, whereas
7-HC-G was a substrate of MRP3 and MRP4. These results are in line with the
pharmacokinetic profile of coumarin, and suggest that MRP3 and MRP4 are the
main transporters involved in the excretion of the coumarin metabolite 7-HC-G
from liver and kidney.
PMID:
22415933 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2012
Mar 14. [Epub ahead of print]
A
prospective study of breast lymphedema: frequency, symptoms, and quality of
life.
Degnim AC, Miller J, Hoskin TL, Boughey JC, Loprinzi M, Thomsen K, Maloney S, Baddour LM, Cheville AL.
Source
Department of
Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN,
55905, USA, [email protected].
Abstract
Although
lymphedema of the arm is a well-known complication of breast and axillary
surgery, breast lymphedema has received scant attention. We sought to
prospectively characterize breast lymphedema's incidence, associated symptoms,
clinical course, and impact on quality of life. Subjects were enrolled
prospectively from a consecutive sample of patients undergoing non-mastectomy
breast procedures (excisional biopsy or wide local excision ± lymph node
removal) and followed for signs and symptoms of lymphedema in the operated
breast. Symptoms and distress were serially assessed with 11-point linear
analog scales. Breast lymphedema was diagnosed independent of symptoms, based
on the distribution and degree of edema and erythema. One hundred twenty-four
women were followed for a median of 11 months, and breast lymphedema was
diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast
surgery with axillary node removal (49%) compared to breast surgery alone (0%),
p < 0.0001. Breast lymphedema involved multiple quadrants in most women and
was characterized by edema in 100% and erythema in 79%. Patients with breast
lymphedema were significantly more likely than women without breast lymphedema
to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness
(62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but
symptom-associated distress was low overall. Three of 32 breast lymphedema
patients with clinical follow-up developed chronic edema. Breast lymphedema
occurs in approximately one-half of women who undergo breast surgery with
axillary node removal. The condition is characterized by diffuse skin edema and
erythema as well as self-reported symptoms with a low level of
distress.
PMID:
22415476 [PubMed - as supplied by publisher]
Br J Cancer. 2012 Mar
13;106(6):1045-52. doi: 10.1038/bjc.2012.62.
Effectiveness
and cost-effectiveness of sentinel lymph node biopsy compared with axillary
node dissection in patients with early-stage breast cancer: a decision model
analysis.
Verry H, Lord SJ, Martin A, Gill G, Lee CK, Howard K, Wetzig N, Simes J.
Source
NHMRC
Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, New
South Wales 2050, Australia.
Abstract
Background:Sentinel
lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection
(ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema
and similar rates of locoregional recurrence up to 8 years. This study
estimates the longer-term effectiveness and cost-effectiveness of
SLNB.Methods:A Markov decision model was developed to estimate the incremental
quality-adjusted life years (QALYs) and costs of an SLNB-based staging and
management strategy compared with ALND over 20 years' follow-up. The
probability and quality-of-life weighting (utility) of outcomes were estimated
from published data and population statistics. Costs were estimated from the
perspective of the Australian health care system. The model was used to
identify key factors affecting treatment decisions.Results:The SLNB was more
effective and less costly than the ALND over 20 years, with 8 QALYs gained and
$883 000 saved per 1000 patients. The SLNB was less effective when: SLNB false
negative (FN) rate > 13%; 5-year incidence of axillary recurrence after an
SLNB FN>19%; risk of an SLNB-positive result >48%; lymphoedema prevalence
after ALND <14%; or lymphoedema utility decrement <0.012.Conclusion:The
long-term advantage of SLNB over ALND was modest and sensitive to variations in
key assumptions, indicating a need for reliable information on lymphoedema
incidence and disutility following SLNB. In addition to awaiting longer-term
trial data, risk models to better identify patients at high risk of axillary
metastasis will be valuable to inform decision-making.
PMID:
22415293 [PubMed - in process]
PMCID:
PMC3304429 [Available on 2013/3/13]
Support Care Cancer. 2012 Mar
13. [Epub ahead of print]
Change
in extracellular fluid and arm volumes as a consequence of a single session of
lymphatic massage followed by rest with or without compression.
Maher J, Refshauge K, Ward L, Paterson R, Kilbreath S.
Source
Occupational
Therapy Department, Concord Repatriation General Hospital, Sydney,
Australia.
Abstract
PURPOSE:
This
study evaluated the acute effect of massage and compression components of
lymphoedema treatment in women with and without arm lymphoedema secondary to
breast cancer from a single treatment session.
METHODS:
Women
with (n = 15) and without (n = 15) lymphoedema underwent a single session of
lymphatic massage. Following the session, women were randomised to receive or
not receive a compression sleeve. Measurements were taken prior to, during, and
following the massage as well as 30 min after completion of the massage.
Bioimpedance spectrometry (BIS) was used to measure changes in extracellular
fluid volume of all limbs as well as 10-cm segments within the upper limbs;
perometry was used to measure changes in total upper limb volume as well as
10-cm segments within the limb.
RESULTS:
There
were no significant changes after massage with or without compression. The
median (and interquartile range) BIS ratios (unaffected:affected) for the whole
upper limb for women with lymphoedema changed from 1.152 (1.053 to 1.422) to
1.192 (1.045 to 1.410) after massage, while the control group changed from
1.024 (0.998 to 1.047) to 1.041 (0.982 to 1.07). The median change in both the
BIS ratio and the total arm volume measured with perometry from prior to the
massage to following 30-min rest changed <2%, irrespective of whether women
used a compression garment and whether women presented with or without
lymphoedema. Examination of 10-cm segments within the arm also revealed no
significant change in BIS ratio from one segment to the next.
CONCLUSION:
Massage
alone or the application of compression after a single session of lymphatic
massage was ineffective for reducing lymphoedema.
PMID:
22410862 [PubMed - as supplied by publisher]
Am J Med Genet A. 2012
Apr;158A(4):839-49. doi: 10.1002/ajmg.a.35229. Epub 2012 Mar 9.
Microcephaly,
intellectual impairment, bilateral vesicoureteral reflux, distichiasis, and
glomuvenous malformations associated with a 16q24.3 contiguous gene deletion
and a Glomulin mutation.
Butler MG, Dagenais SL, Garcia-Perez JL, Brouillard P, Vikkula M, Strouse P, Innis JW, Glover TW.
Source
Department of Human
Genetics, University of Michigan Medical School, Ann Arbor, Michigan.
[email protected].
Abstract
Two
hereditary syndromes, lymphedema-distichiasis (LD) syndrome and
blepharo-chelio-dontic (BCD) syndrome include the aberrant growth of eyelashes
from the meibomian glands, known as distichiasis. LD is an autosomal dominant
syndrome primarily characterized by distichiasis and the onset of lymphedema
usually during puberty. Mutations in the forkhead transcription factor FOXC2
are the only known cause of LD. BCD syndrome consists of autosomal dominant
abnormalities of the eyelid, lip, and teeth, and the etiology remains unknown.
In this report, we describe a proband that presented with distichiasis,
microcephaly, bilateral grade IV vesicoureteral reflux requiring ureteral
re-implantation, mild intellectual impairment and apparent glomuvenous
malformations (GVM). Distichiasis was present in three generations of the
proband's maternal side of the family. The GVMs were severe in the proband, and
maternal family members exhibited lower extremity varicosities of variable
degree. A GLMN (glomulin) gene mutation was identified in the proband that
accounts for the observed GVMs; no other family member could be tested. TIE2
sequencing revealed no mutations. In the proband, an additional submicroscopic
265 kb contiguous gene deletion was identified in 16q24.3, located 609 kb
distal to the FOXC2 locus, which was inherited from the proband's mother. The
deletion includes the C16ORF95, FBXO31, MAP1LC3B, and ZCCHC14 loci and 115 kb
of a gene desert distal to FOXC2 and FOXL1. Thus, it is likely that the
microcephaly, distichiasis, vesicoureteral, and intellectual impairment in this
family may be caused by the deletion of one or more of these genes and/or
deletion of distant cis-regulatory elements of FOXC2 expression. © 2012 Wiley
Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22407726 [PubMed - in process]
PMCID:
PMC3314153 [Available on 2013/4/1]
March
18, 2012
Drug Metab Dispos. 2012 Mar 12.
[Epub ahead of print]
Transport
of the Coumarin Metabolite 7-hydroxycoumarin Glucuronide is Mediated Via
Multidrug Resistance-Associated Proteins 3 and 4.
Wittgen HG, van den Heuvel JJ, van den Broek PH, Siissalo S, Groothuis GM, de Graaf IA, Koenderink JB, Russel FG.
Source
1
Radboud University Nijmegen Medical Centre;
Abstract
Coumarin
(1, 2-benzopyrone) is a natural compound that has been used as a fragrance in
food and perfume industry, and could have therapeutic usefulness in the
treatment of lymphedema and different types of cancer. Previously, several
pharmacokinetic studies of coumarin have been performed in humans, which
revealed extensive first-pass metabolism of the compound. 7-Hydroxycoumarin
(7-HC) and its glucuronide (7-HC-G) are the main metabolites formed in humans,
and via this route, 80-90 percent of the absorbed coumarin is excreted into
urine, mainly as 7-HC-G. Active transport processes play a role in the urinary
excretion of 7-HC-G, however, until now, the transporters involved remained to
be elucidated. In this study, we investigated whether the efflux transporters
multidrug resistance-associated proteins (MRP) 1-4, breast cancer resistance
protein (BCRP), or P-glycoprotein (P-gp), play a role in 7-HC and 7-HC-G
transport. For this purpose, we measured uptake of the metabolites into
membrane vesicles overexpressing these transporters. Our results showed that
7-HC is not transported by any of the efflux transporters tested, whereas
7-HC-G was a substrate of MRP3 and MRP4. These results are in line with the
pharmacokinetic profile of coumarin, and suggest that MRP3 and MRP4 are the
main transporters involved in the excretion of the coumarin metabolite 7-HC-G
from liver and kidney.
PMID:
22415933 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2012
Mar 14. [Epub ahead of print]
A
prospective study of breast lymphedema: frequency, symptoms, and quality of
life.
Degnim AC, Miller J, Hoskin TL, Boughey JC, Loprinzi M, Thomsen K, Maloney S, Baddour LM, Cheville AL.
Source
Department of
Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN,
55905, USA, [email protected].
Abstract
Although
lymphedema of the arm is a well-known complication of breast and axillary
surgery, breast lymphedema has received scant attention. We sought to
prospectively characterize breast lymphedema's incidence, associated symptoms,
clinical course, and impact on quality of life. Subjects were enrolled
prospectively from a consecutive sample of patients undergoing non-mastectomy
breast procedures (excisional biopsy or wide local excision ± lymph node
removal) and followed for signs and symptoms of lymphedema in the operated
breast. Symptoms and distress were serially assessed with 11-point linear
analog scales. Breast lymphedema was diagnosed independent of symptoms, based
on the distribution and degree of edema and erythema. One hundred twenty-four
women were followed for a median of 11 months, and breast lymphedema was
diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast
surgery with axillary node removal (49%) compared to breast surgery alone (0%),
p < 0.0001. Breast lymphedema involved multiple quadrants in most women and
was characterized by edema in 100% and erythema in 79%. Patients with breast
lymphedema were significantly more likely than women without breast lymphedema
to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness
(62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but
symptom-associated distress was low overall. Three of 32 breast lymphedema
patients with clinical follow-up developed chronic edema. Breast lymphedema
occurs in approximately one-half of women who undergo breast surgery with
axillary node removal. The condition is characterized by diffuse skin edema and
erythema as well as self-reported symptoms with a low level of
distress.
PMID:
22415476 [PubMed - as supplied by publisher]
Br J Cancer. 2012 Mar
13;106(6):1045-52. doi: 10.1038/bjc.2012.62.
Effectiveness
and cost-effectiveness of sentinel lymph node biopsy compared with axillary
node dissection in patients with early-stage breast cancer: a decision model
analysis.
Verry H, Lord SJ, Martin A, Gill G, Lee CK, Howard K, Wetzig N, Simes J.
Source
NHMRC
Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, New
South Wales 2050, Australia.
Abstract
Background:Sentinel
lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection
(ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema
and similar rates of locoregional recurrence up to 8 years. This study
estimates the longer-term effectiveness and cost-effectiveness of
SLNB.Methods:A Markov decision model was developed to estimate the incremental
quality-adjusted life years (QALYs) and costs of an SLNB-based staging and
management strategy compared with ALND over 20 years' follow-up. The
probability and quality-of-life weighting (utility) of outcomes were estimated
from published data and population statistics. Costs were estimated from the
perspective of the Australian health care system. The model was used to
identify key factors affecting treatment decisions.Results:The SLNB was more
effective and less costly than the ALND over 20 years, with 8 QALYs gained and
$883 000 saved per 1000 patients. The SLNB was less effective when: SLNB false
negative (FN) rate > 13%; 5-year incidence of axillary recurrence after an
SLNB FN>19%; risk of an SLNB-positive result >48%; lymphoedema prevalence
after ALND <14%; or lymphoedema utility decrement <0.012.Conclusion:The
long-term advantage of SLNB over ALND was modest and sensitive to variations in
key assumptions, indicating a need for reliable information on lymphoedema
incidence and disutility following SLNB. In addition to awaiting longer-term
trial data, risk models to better identify patients at high risk of axillary
metastasis will be valuable to inform decision-making.
PMID:
22415293 [PubMed - in process]
PMCID:
PMC3304429 [Available on 2013/3/13]
Support Care Cancer. 2012 Mar
13. [Epub ahead of print]
Change
in extracellular fluid and arm volumes as a consequence of a single session of
lymphatic massage followed by rest with or without compression.
Maher J, Refshauge K, Ward L, Paterson R, Kilbreath S.
Source
Occupational
Therapy Department, Concord Repatriation General Hospital, Sydney,
Australia.
Abstract
PURPOSE:
This
study evaluated the acute effect of massage and compression components of
lymphoedema treatment in women with and without arm lymphoedema secondary to
breast cancer from a single treatment session.
METHODS:
Women
with (n = 15) and without (n = 15) lymphoedema underwent a single session of
lymphatic massage. Following the session, women were randomised to receive or
not receive a compression sleeve. Measurements were taken prior to, during, and
following the massage as well as 30 min after completion of the massage.
Bioimpedance spectrometry (BIS) was used to measure changes in extracellular
fluid volume of all limbs as well as 10-cm segments within the upper limbs;
perometry was used to measure changes in total upper limb volume as well as
10-cm segments within the limb.
RESULTS:
There
were no significant changes after massage with or without compression. The
median (and interquartile range) BIS ratios (unaffected:affected) for the whole
upper limb for women with lymphoedema changed from 1.152 (1.053 to 1.422) to
1.192 (1.045 to 1.410) after massage, while the control group changed from
1.024 (0.998 to 1.047) to 1.041 (0.982 to 1.07). The median change in both the
BIS ratio and the total arm volume measured with perometry from prior to the
massage to following 30-min rest changed <2%, irrespective of whether women
used a compression garment and whether women presented with or without
lymphoedema. Examination of 10-cm segments within the arm also revealed no
significant change in BIS ratio from one segment to the next.
CONCLUSION:
Massage
alone or the application of compression after a single session of lymphatic
massage was ineffective for reducing lymphoedema.
PMID:
22410862 [PubMed - as supplied by publisher]
Am J Med Genet A. 2012
Apr;158A(4):839-49. doi: 10.1002/ajmg.a.35229. Epub 2012 Mar 9.
Microcephaly,
intellectual impairment, bilateral vesicoureteral reflux, distichiasis, and
glomuvenous malformations associated with a 16q24.3 contiguous gene deletion
and a Glomulin mutation.
Butler MG, Dagenais SL, Garcia-Perez JL, Brouillard P, Vikkula M, Strouse P, Innis JW, Glover TW.
Source
Department of Human
Genetics, University of Michigan Medical School, Ann Arbor, Michigan.
[email protected].
Abstract
Two
hereditary syndromes, lymphedema-distichiasis (LD) syndrome and
blepharo-chelio-dontic (BCD) syndrome include the aberrant growth of eyelashes
from the meibomian glands, known as distichiasis. LD is an autosomal dominant
syndrome primarily characterized by distichiasis and the onset of lymphedema
usually during puberty. Mutations in the forkhead transcription factor FOXC2
are the only known cause of LD. BCD syndrome consists of autosomal dominant
abnormalities of the eyelid, lip, and teeth, and the etiology remains unknown.
In this report, we describe a proband that presented with distichiasis,
microcephaly, bilateral grade IV vesicoureteral reflux requiring ureteral
re-implantation, mild intellectual impairment and apparent glomuvenous
malformations (GVM). Distichiasis was present in three generations of the
proband's maternal side of the family. The GVMs were severe in the proband, and
maternal family members exhibited lower extremity varicosities of variable
degree. A GLMN (glomulin) gene mutation was identified in the proband that
accounts for the observed GVMs; no other family member could be tested. TIE2
sequencing revealed no mutations. In the proband, an additional submicroscopic
265 kb contiguous gene deletion was identified in 16q24.3, located 609 kb
distal to the FOXC2 locus, which was inherited from the proband's mother. The
deletion includes the C16ORF95, FBXO31, MAP1LC3B, and ZCCHC14 loci and 115 kb
of a gene desert distal to FOXC2 and FOXL1. Thus, it is likely that the
microcephaly, distichiasis, vesicoureteral, and intellectual impairment in this
family may be caused by the deletion of one or more of these genes and/or
deletion of distant cis-regulatory elements of FOXC2 expression. © 2012 Wiley
Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22407726 [PubMed - in process]
PMCID:
PMC3314153 [Available on 2013/4/1]
March
18, 2012
Drug Metab Dispos. 2012 Mar 12.
[Epub ahead of print]
Transport
of the Coumarin Metabolite 7-hydroxycoumarin Glucuronide is Mediated Via
Multidrug Resistance-Associated Proteins 3 and 4.
Wittgen HG, van den Heuvel JJ, van den Broek PH, Siissalo S, Groothuis GM, de Graaf IA, Koenderink JB, Russel FG.
Source
1
Radboud University Nijmegen Medical Centre;
Abstract
Coumarin
(1, 2-benzopyrone) is a natural compound that has been used as a fragrance in
food and perfume industry, and could have therapeutic usefulness in the
treatment of lymphedema and different types of cancer. Previously, several
pharmacokinetic studies of coumarin have been performed in humans, which
revealed extensive first-pass metabolism of the compound. 7-Hydroxycoumarin
(7-HC) and its glucuronide (7-HC-G) are the main metabolites formed in humans,
and via this route, 80-90 percent of the absorbed coumarin is excreted into
urine, mainly as 7-HC-G. Active transport processes play a role in the urinary
excretion of 7-HC-G, however, until now, the transporters involved remained to
be elucidated. In this study, we investigated whether the efflux transporters
multidrug resistance-associated proteins (MRP) 1-4, breast cancer resistance
protein (BCRP), or P-glycoprotein (P-gp), play a role in 7-HC and 7-HC-G
transport. For this purpose, we measured uptake of the metabolites into
membrane vesicles overexpressing these transporters. Our results showed that
7-HC is not transported by any of the efflux transporters tested, whereas
7-HC-G was a substrate of MRP3 and MRP4. These results are in line with the
pharmacokinetic profile of coumarin, and suggest that MRP3 and MRP4 are the
main transporters involved in the excretion of the coumarin metabolite 7-HC-G
from liver and kidney.
PMID:
22415933 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2012
Mar 14. [Epub ahead of print]
A
prospective study of breast lymphedema: frequency, symptoms, and quality of
life.
Degnim AC, Miller J, Hoskin TL, Boughey JC, Loprinzi M, Thomsen K, Maloney S, Baddour LM, Cheville AL.
Source
Department of
Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN,
55905, USA, [email protected].
Abstract
Although
lymphedema of the arm is a well-known complication of breast and axillary
surgery, breast lymphedema has received scant attention. We sought to
prospectively characterize breast lymphedema's incidence, associated symptoms,
clinical course, and impact on quality of life. Subjects were enrolled
prospectively from a consecutive sample of patients undergoing non-mastectomy
breast procedures (excisional biopsy or wide local excision ± lymph node
removal) and followed for signs and symptoms of lymphedema in the operated
breast. Symptoms and distress were serially assessed with 11-point linear
analog scales. Breast lymphedema was diagnosed independent of symptoms, based
on the distribution and degree of edema and erythema. One hundred twenty-four
women were followed for a median of 11 months, and breast lymphedema was
diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast
surgery with axillary node removal (49%) compared to breast surgery alone (0%),
p < 0.0001. Breast lymphedema involved multiple quadrants in most women and
was characterized by edema in 100% and erythema in 79%. Patients with breast
lymphedema were significantly more likely than women without breast lymphedema
to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness
(62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but
symptom-associated distress was low overall. Three of 32 breast lymphedema
patients with clinical follow-up developed chronic edema. Breast lymphedema
occurs in approximately one-half of women who undergo breast surgery with
axillary node removal. The condition is characterized by diffuse skin edema and
erythema as well as self-reported symptoms with a low level of
distress.
PMID:
22415476 [PubMed - as supplied by publisher]
Br J Cancer. 2012 Mar
13;106(6):1045-52. doi: 10.1038/bjc.2012.62.
Effectiveness
and cost-effectiveness of sentinel lymph node biopsy compared with axillary
node dissection in patients with early-stage breast cancer: a decision model
analysis.
Verry H, Lord SJ, Martin A, Gill G, Lee CK, Howard K, Wetzig N, Simes J.
Source
NHMRC
Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, New
South Wales 2050, Australia.
Abstract
Background:Sentinel
lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection
(ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema
and similar rates of locoregional recurrence up to 8 years. This study
estimates the longer-term effectiveness and cost-effectiveness of
SLNB.Methods:A Markov decision model was developed to estimate the incremental
quality-adjusted life years (QALYs) and costs of an SLNB-based staging and
management strategy compared with ALND over 20 years' follow-up. The
probability and quality-of-life weighting (utility) of outcomes were estimated
from published data and population statistics. Costs were estimated from the
perspective of the Australian health care system. The model was used to
identify key factors affecting treatment decisions.Results:The SLNB was more
effective and less costly than the ALND over 20 years, with 8 QALYs gained and
$883 000 saved per 1000 patients. The SLNB was less effective when: SLNB false
negative (FN) rate > 13%; 5-year incidence of axillary recurrence after an
SLNB FN>19%; risk of an SLNB-positive result >48%; lymphoedema prevalence
after ALND <14%; or lymphoedema utility decrement <0.012.Conclusion:The
long-term advantage of SLNB over ALND was modest and sensitive to variations in
key assumptions, indicating a need for reliable information on lymphoedema
incidence and disutility following SLNB. In addition to awaiting longer-term
trial data, risk models to better identify patients at high risk of axillary
metastasis will be valuable to inform decision-making.
PMID:
22415293 [PubMed - in process]
PMCID:
PMC3304429 [Available on 2013/3/13]
Support Care Cancer. 2012 Mar
13. [Epub ahead of print]
Change
in extracellular fluid and arm volumes as a consequence of a single session of
lymphatic massage followed by rest with or without compression.
Maher J, Refshauge K, Ward L, Paterson R, Kilbreath S.
Source
Occupational
Therapy Department, Concord Repatriation General Hospital, Sydney,
Australia.
Abstract
PURPOSE:
This
study evaluated the acute effect of massage and compression components of
lymphoedema treatment in women with and without arm lymphoedema secondary to
breast cancer from a single treatment session.
METHODS:
Women
with (n = 15) and without (n = 15) lymphoedema underwent a single session of
lymphatic massage. Following the session, women were randomised to receive or
not receive a compression sleeve. Measurements were taken prior to, during, and
following the massage as well as 30 min after completion of the massage.
Bioimpedance spectrometry (BIS) was used to measure changes in extracellular
fluid volume of all limbs as well as 10-cm segments within the upper limbs;
perometry was used to measure changes in total upper limb volume as well as
10-cm segments within the limb.
RESULTS:
There
were no significant changes after massage with or without compression. The
median (and interquartile range) BIS ratios (unaffected:affected) for the whole
upper limb for women with lymphoedema changed from 1.152 (1.053 to 1.422) to
1.192 (1.045 to 1.410) after massage, while the control group changed from
1.024 (0.998 to 1.047) to 1.041 (0.982 to 1.07). The median change in both the
BIS ratio and the total arm volume measured with perometry from prior to the
massage to following 30-min rest changed <2%, irrespective of whether women
used a compression garment and whether women presented with or without
lymphoedema. Examination of 10-cm segments within the arm also revealed no
significant change in BIS ratio from one segment to the next.
CONCLUSION:
Massage
alone or the application of compression after a single session of lymphatic
massage was ineffective for reducing lymphoedema.
PMID:
22410862 [PubMed - as supplied by publisher]
Am J Med Genet A. 2012
Apr;158A(4):839-49. doi: 10.1002/ajmg.a.35229. Epub 2012 Mar 9.
Microcephaly,
intellectual impairment, bilateral vesicoureteral reflux, distichiasis, and
glomuvenous malformations associated with a 16q24.3 contiguous gene deletion
and a Glomulin mutation.
Butler MG, Dagenais SL, Garcia-Perez JL, Brouillard P, Vikkula M, Strouse P, Innis JW, Glover TW.
Source
Department of Human
Genetics, University of Michigan Medical School, Ann Arbor, Michigan.
[email protected].
Abstract
Two
hereditary syndromes, lymphedema-distichiasis (LD) syndrome and
blepharo-chelio-dontic (BCD) syndrome include the aberrant growth of eyelashes
from the meibomian glands, known as distichiasis. LD is an autosomal dominant
syndrome primarily characterized by distichiasis and the onset of lymphedema
usually during puberty. Mutations in the forkhead transcription factor FOXC2
are the only known cause of LD. BCD syndrome consists of autosomal dominant
abnormalities of the eyelid, lip, and teeth, and the etiology remains unknown.
In this report, we describe a proband that presented with distichiasis,
microcephaly, bilateral grade IV vesicoureteral reflux requiring ureteral
re-implantation, mild intellectual impairment and apparent glomuvenous
malformations (GVM). Distichiasis was present in three generations of the
proband's maternal side of the family. The GVMs were severe in the proband, and
maternal family members exhibited lower extremity varicosities of variable
degree. A GLMN (glomulin) gene mutation was identified in the proband that
accounts for the observed GVMs; no other family member could be tested. TIE2
sequencing revealed no mutations. In the proband, an additional submicroscopic
265 kb contiguous gene deletion was identified in 16q24.3, located 609 kb
distal to the FOXC2 locus, which was inherited from the proband's mother. The
deletion includes the C16ORF95, FBXO31, MAP1LC3B, and ZCCHC14 loci and 115 kb
of a gene desert distal to FOXC2 and FOXL1. Thus, it is likely that the
microcephaly, distichiasis, vesicoureteral, and intellectual impairment in this
family may be caused by the deletion of one or more of these genes and/or
deletion of distant cis-regulatory elements of FOXC2 expression. © 2012 Wiley
Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22407726 [PubMed - in process]
PMCID:
PMC3314153 [Available on 2013/4/1]
March
20, 2012
Ophthalmic Genet. 2012 Mar 15.
[Epub ahead of print]
Microcephaly-lymphedema-chorioretinal
dysplasia associated with pachymicrogyria and atrophy of the cerebellar vermis:
an integration of brain-ocular migration disorders.
Pastora N, Peralta J, Canal-Fontcuberta I, Grabowska A, Pulido JS, Abelairas J, Armada F, Garcia-Alix A.
Source
Hospital
Universitario La Paz, Pediatric Ophthalmology , Madrid , Spain.
Abstract
Background:
Microcephaly-lymphedema-chorioretinal dysplasia (OMIM 152950) is a rare
malformative inherited disorder that can be associated with other systemic
features. Other ocular and brain anomalies rather than microcephaly and
chorioretinal dysplasia have been inconstantly reported in this syndrome.
Methods: We present a case of microcephaly-lymphedema-chorioretinal dysplasia
with a dysmorphic facies, hypertonicity in the extremities and neuropsychomotor
delay. Ophthalmological examination revealed bilateral nystagmus,
microphthalmia, posterior subcapsular cataratacts, extensive chorioretinal
dysplasia, optic nerve aplasia, persistent fetal vasculature, and absent
retinal vessels. Results: Magnetic resonance revealed pachymicrogyria and
discrete atrophy of vermis cerebelosum and confirmed optic nerve hypoplasia.
Conclusions: The developmental alterations observed in the retina of this
patient could be analogous to central nervous system anomalies, reflecting a
reduction in neural population. Ophthalmic examination of children with
microcephaly is warranted.
PMID:
22420539 [PubMed - as supplied by publisher]
Anat Rec (Hoboken). 2012 Mar 15.
doi: 10.1002/ar.22438. [Epub ahead of print]
Improved
Regeneration of Autologous Transplanted Lymph Node Fragments by VEGF-C
Treatment.
Sommer T, Buettner M, Bruns F, Breves G, Hadamitzky C, Pabst R.
Source
Institute of
Immunomorphology, Hannover Medical School, Hannover, Germany.
Abstract
Secondary
lymphedema is a common complication after removal of lymph nodes in combination
with radiation therapy in the treatment of breast cancer, cervical cancer, and
melanomas. Only symptomatic therapies are available at the moment, and
lymphedema is for most patients a lifelong condition involving psychological
and physical disabilities. Animal models exist to study the pathophysiology of
lymphedema but not to study surgical treatments. The aim of this study was to
show that regeneration of autologous transplanted lymph node fragments is
possible in rats that were irradiated previously locally in the groin and to
examine the effects of vascular endothelial growth factor (VEGF)-C injections
on the rate of regeneration of transplanted lymph nodes. In all of the animals,
inguinal and popliteal lymph nodes and adjacent lymphatic vessels were
unilaterally removed and the inguinal region irradiated by a single dose of 15
Gy. Afterward, lymph node fragments were transplanted subcutaneously in the
irradiated region. Half of the animals were treated by local VEGF-C injections
after transplantation. Four weeks after transplantation, drainage of the leg
was tested by injection of blue dye, and the transplanted fragments were
removed and examined immunohistologically. We could show that regeneration of
autologous transplanted lymph node fragments is possible in areas treated with
radiotherapy in the rat. We also documented that transplants can achieve a
connection to the lymphatic collectors of the leg. The results suggest that the
outcome of regeneration can be improved by injection of VEGF-C in the
transplantation area. Thus, lymph node fragment regeneration may be relevant
for lymphedema prevention and therapy. Anat Rec, 2012. © 2012 Wiley
Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22419614 [PubMed - as supplied by publisher]
Indian J Pediatr. 2012 Mar 15.
[Epub ahead of print]
Congenital
Chylous Ascites and Lymphedema in Down's Syndrome.
Bhattacharya S, Das NK, Chatterjee A.
Source
Department of
Pediatric Medicine, IPGMER and SSKM Hospital, Kolkata, India,
[email protected].
PMID:
22418947 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2012
Mar;10(1):30-2. Epub 2012 Mar 14.
Yellow
nail syndrome: treatment of lymphedema using low pressure
compression.
Polat AK, Dang HT, Soran A.
Source
Magee-Womens
Hospital, University of Pittsburgh Medical Center , Department of Surgical
Oncology, Pittsburgh, PA.
Abstract
Abstract
The present report describes a case with the triad of yellow nail syndrome
(YNS) and the use of low-pressure compression pump as treatment of lymphedema
in YNS. A 71-year-old woman presented with bilateral lower extremity
lymphedema, yellow nails, and recurrent bilateral pleural effusion. In this
case, we specifically focused on lymphedema treatment of the legs besides other
recommendations for YNS.
PMID:
22416910 [PubMed - in process]
March
29, 2012
Int Wound J. 2012 Mar 20. doi:
10.1111/j.1742-481X.2012.00958.x. [Epub ahead of print]
Evaluation
of the performance of a new compression system in patients with
lymphoedema.
Franks PJ, Moffatt CJ, Murray S, Reddick M, Tilley A, Schreiber A.
Source
PJ
Franks, PhD, CRICP, St Luke's Crypt, Sydney Street, London SW3 6NH, UK,
Division of Nursing & Healthcare, University of Glasgow, Glasgow, UK and
Faculty of Health & Social Care, London South Bank University, London, UK
CJ Moffatt, PhD, RN, Lymphoedema Care, Royal Derby Hospital, Derby, UK, Faculty
of Medicine, Department Nursing & Healthcare, University of Glasgow,
Glasgow, UK S Murray, MA, RN, Lymphoedema Care, Royal Derby Hospital, Derby, UK
M Reddick, RN, Dr H Bliss Murphy Cancer Centre, St John's, Newfoundland, Canada
A Tilley, BSc, PT, Horizon Health Network, Breast Rehabilitation &
Lymphoedema Programs, St Joseph's Hospital, Saint John, New Brunswick, Canada A
Schreiber, PT, The London Road Clinic, Sherborne, UK.
Abstract
In the
acute phase of lymphoedema, patients require comprehensive decongestive therapy
(CDT), which includes skin care, an exercise regimen, manual lymphatic drainage
(MLD) and regular bandaging. This study was established to determine the
effectiveness of a new system of bandage therapy, the 3M™ Coban™ 2 compression
system. In total, 24 patients were entered into the study (12 from UK and 12
from Canada) with a variety of clinical presentations. The mean age of the
groups was 57·4 years, which varied from 26 to 79 years. Body mass index (BMI)
averaged 38·9 kg/m(2) , with a range from 22·7 to 67·5 kg/m(2) . Of the total,
eight were women with arm lymphoedema, the remainder being men and women with
lymphoedema of the lower limb. All were considered to be in need of CDT. After
19 days, the reduction of limb volume was measured, which indicated a mean limb
volume reduction of 1210 ml (95% confidence interval, CI, 780-1641, P <
0·001). Leg affected patients experienced greater reduction than arm affected
patients (1596 ml versus 438 ml), although both groups experienced significant
reduction in limb volumes (both P < 0·001). Mean percentage changes in limb
volume were 14·9% and 16·1% for legs and arms, respectively. The Measure Your
Medical Outcome Profile questionnaire indicated significant improvement in
symptoms considered important by the patient (P < 0·0001), which also led to
improvements in skin quality by reducing skin thickness and firmness. The Coban
2 compression system provides good oedema reduction in both arms and legs to
reduce limb volume and improvements in symptoms associated with
lymphoedema.
© 2012
The Authors. © 2012 Blackwell Publishing Ltd and Medicalhelplines.com
Inc.
PMID:
22432947 [PubMed - as supplied by publisher]
Eur J Pediatr. 2012 Mar 21.
[Epub ahead of print]
GATA-2
anomaly and clinical phenotype of a sporadic case of lymphedema, dendritic
cell, monocyte, B- and NK-cell (DCML) deficiency, and
myelodysplasia.
Ishida H, Imai K, Honma K, Tamura SI, Imamura T, Ito M, Nonoyama S.
Source
Department of
Pediatrics and Blood and Marrow transplantation, Matsushita Memorial Hospital,
5-55, Sotojima-cho, Moriguchi, 570-8540, Japan,
[email protected].
Abstract
A
Japanese patient presented with lymphedema, severe Varicella zoster, and
Salmonella infection, recurrent respiratory infections, panniculitis,
monocytopenia, B- and NK-cell lymphopenia, and myelodysplasia. The phenotype
was a mixture of the monocytopenia and mycobacterial infection (MonoMAC) and
Emberger syndromes. Sequencing of the GATA-2 cDNA revealed the heterozygous
missense mutation 1187 G > A. This mutation resulted in the amino acid
mutation Arg396Gln in the zinc fingers-2 domain, which is predicted to cause
significant structural change and prevent a critical interaction with DNA.
Functional analysis of the patient's GATA-2 mutation is required to understand
the relationship between these distinctive syndromes.
PMID:
22430350 [PubMed - as supplied by publisher]
Eur J Vasc Endovasc Surg. 2012
Mar 17. [Epub ahead of print]
Net
Effect of Lymphaticovenous Anastomosis on Volume Reduction of Peripheral
Lymphoedema after Complex Decongestive Physiotherapy.
Wisselink W.
Source
VU
University Medical Center, Department of Vascular Surgery, De Boelelaan 1117,
PO Box 7057, 1007 MB Amsterdam, The Netherlands.
PMID:
22429985 [PubMed - as supplied by publisher
Am J Physiol Heart Circ Physiol.
2012 Mar 16. [Epub ahead of print]
Functional
Recovery of Fluid Drainage Precedes Lymphangiogenesis in Acute Murine Foreleg
Lymphedema.
Mendez U, Brown EM, Ongstad EL, Slis JR, Goldman J.
Source
1Michigan
Technological University.
Abstract
Secondary
lymphedema in humans is a common consequence of axillary lymph node dissection
(ALND) to treat breast cancer. It is commonly hypothesized that lymphatic
growth is required to increase fluid drainage and ameliorate lymphedema.
Although there is a pronounced alteration in the balance of interstitial forces
regulating fluid transport that sustains the chronic form of lymphedema, it is
presently unknown whether changes occur to the balance of interstitial forces
during acute lymphedema that may play a role in the recovery of fluid drainage.
Here we compared the relative importance of lymphangiogenesis of lymphatic
vessels and interstitial flows for restoring fluid drainage and resolving acute
lymphedema in the mouse foreleg following ALND. We found that removal of the
axillary lymph nodes reduced lymph drainage in the foreleg at days 0 and 5
post-surgery, with fluid tracer spreading interstitially through subcutaneous
tissues. Interstitial fluid drainage returned to normal by day 10, whereas
functional regrowth of lymphatic vessels was first detected by indocyanine
green fluorescence lymphography at day 15, demonstrating that the recovery of
interstitial fluid drainage preceded the regrowth of lymphatic vessels. This
was confirmed by administration of VEGFR-3 neutralizing antibodies, which
completely blocks lymphatic regrowth. It was found that the recovery of
interstitial fluid drainage and the natural resolution of acute lymphedema
produced by ALND were not hindered by VEGFR-3 neutralization, demonstrating
that interstitial fluid drainage recovery and resolution of acute lymphedema
are lymphangiogenesis-independent. The data highlights the central role of the
interstitial environment in adapting to lymphatic injury to increase fluid
drainage.
PMID:
22427513 [PubMed - as supplied by publisher]
N Z Med J. 2012 Mar
9;125(1351):29-39.
Difficulties
with defining lymphoedema after axillary dissection for breast
cancer.
Asim M, Cham A, Banerjee S, Nancekivell R, Dutu G, McBride C, Cavanagh S, Lawrenson R, Campbell I.
Source
Liver
Transplant Unit, Level 15 Support Building, Auckland City Hospital, Auckland,
New Zealand. [email protected].
Abstract
AIM:
Axillary
lymph node dissection(AND) is a common treatment for breast cancer. An
important side effect of the surgery is lymphoedema (LO). The primary aims of
this study were to assess the local prevalence of LO in patients who had
undergone AND and how the subjective symptoms described by patients compare
with objective measurements. Secondary aims were to investigate the
relationship between risk factors and the prevalence of LO and to establish an
easy and convenient way to detect LO patients in surgical clinics.
METHOD:
Eligible
women after AND for breast cancer underwent three circumference measurements on
the operated and non operated (control) arm. LO was defined as one or more
measurements with an increase =7.5% than control after dominant arm correction.
Questionnaires were used to assess severity of symptoms related to lymphoedema.
73 patients also had serial measurements in arms and change in arm volume in
operated arm was calculated using Casley-Smith method and LO was defined as
=20% increase in volume.
RESULTS:
193
women with AND were analysed. Mean age was 61 years and mean time since surgery
was 56 months. The overall prevalence of LO was 23.3%. LO prevalence by arm
volume was 8.2%. Using volume as the standard, an arm circumference increase of
=7.5% and =10% showed a sensitivity and specificity of 83% and 81%, and 66% and
89% respectively. Significant risk factors for LO were age, radiotherapy and
infection to the operated arm
CONCLUSION:
Circumference
measures are a simple office method of screening for LO. A patient history and
greater than and equal to 10% increase in any circumference is optimal for
determining LO after AND.
PMID:
22426609 [PubMed - in process]
Gynecol Oncol. 2012 Mar 15.
[Epub ahead of print]
The
efficacy of complex decongestive physiotherapy (CDP) and predictive factors of
response to CDP in lower limb lymphedema (LLL) after pelvic cancer
treatment.
Liao SF, Li SH, Huang HY.
Source
Department of
Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanxiao
Street, Changhua 500, Taiwan.
Abstract
OBJECTIVE:
The aim
of this study was to estimate the efficacy of an intensive CDP program, as well
as to identify the predictors associated with lymphedema severity and response
to CDP in lower limb lymphedema (LLL) after pelvic cancer therapy.
METHODS:
We
performed a retrospective review of post-pelvic cancer LLL patients that were
treated with a CDP program between January 2004 and March 2011.
RESULTS:
Twenty-seven
(61.4%) of the total 44 patients had cervical cancer, 9 (20.5%) had endometrial
cancer, and 8 (18.2%) had ovarian cancer. The mean age was 62.2years, 18
(40.9%) patients received radiotherapy and a mean of 12.6 sessions of daily
CDP, and mean lymphedema duration was 34.8months. The interval from pelvic
cancer treatment to LLL development was 63.4months. Lymphedema severity,
baseline and post-CDP percentage of excess volume (PEV) were 32.9%±18.4% and
18.8%±16.7%. Baseline PEV was not correlated with duration of lymphedema,
number of CDP sessions, age or radiotherapy, and was significantly different to
post-CDP PEV (p<0.001). CDP efficacy, percentage reduction of excess volume
(PREV), was -55.1%, and was correlated with baseline PEV, but not with the
number of CDP sessions, duration of lymphedema, or age. PEV (p<0.001) was
the only predictive factor for CDP efficacy.
CONCLUSIONS:
The key
to predicting successful lymphedema treatment of LLL is the initial PEV. The
intensive CDP program was effective and successful. We should encourage and
refer patients to undergo treatment for LLL, even when the LLL is
mild.
Copyright © 2012
Elsevier Inc. All rights reserved.
PMID:
22426250 [PubMed - as supplied by publisher]
April
3, 2012
Breast. 2012 Mar 27. [Epub ahead
of print]
Breast
cancer related lymphedema in patients with different loco-regional
treatments.
Ozcinar B, Guler SA, Kocaman N, Ozkan M, Gulluoglu BM, Ozmen V.
Source
Istanbul
University, Istanbul Medical Faculty, General Surgery Department, Istanbul,
Turkey.
Abstract
INTRODUCTION:
Lymphedema, a
sequela of breast cancer and breast cancer therapy, changes functional
abilities and may affect a patient's psychosocial adjustment and overall
quality of life. Aim of this prospective observational study was to determine
the rate of mid-term and late time period lymphedema in breast cancer patients
with different loco-regional treatments, and factors associated with
lymphedema.
MATERIALS
AND METHODS:
Patients
surgically treated for early-stage breast cancer were prospectively enrolled in
the study. Demographic, clinical, pathological, and loco-regional treatments
data of patients and lymphedema rates were recorded. Patients were divided into
six groups regarding different loco-regional treatments. Pre- and postoperative
(12 months, and median 64 months after surgery) circumferences of arms were
recorded.
RESULTS:
218
patients, all female with a median age of 48 (19-82) years, were included in
the study. The numbers of patients in breast conservation surgery group (BCS)
(N = 104), mastectomy group (N = 114), sentinel lymph node biopsy group (SLNB)
(N = 80), axillary lymph node dissection group (ALND) (N = 138), group with
radiotherapy (RT) (N = 88) and group without radiotherapy (N = 130). Incidence
of lymphedema after surgery in mid-term period was 24.8%. The rate of
lymphedema at 64 months median follow-up time was 7.3%. (BCS: 11.1%, 4.2% and
0.5%; Mastectomy: 15.0%, 3.2% and 1.4%; SLNB: 8.0%, 1.9% and 0.5%; ALND: 18.0%,
5.3% and 1.4%; RT: 14.7%, 6.3% and 1.4%; without RT: 11.4%, 2.1% and 0.5%).
When we excluded patients with both mid-term and late term lymphedema, only
four patients developed lymphedema at late time, then re-calculated late term
lypmhedema rate was 1.8%. The factors affecting the lymphedema was ALND and
radiotherapy (RT) and no lymphedema was detected in patients underwent breast
conserving surgery and SLNB. Age and body mass index were not related to
lymphedema at any time.
CONCLUSION:
The
incidence of lymphedema gradually increased in time and a quarter of patients
experienced the complication at the end of year. The rate of lymphedema in
patients with ALND was significantly higher than patients with SLNB alone. If
RT added to SLNB the lymphedema rate was getting higher than SLNB alone. In all
patients lymphedema rate was decreased one year after the surgery and further
decreased at median 64 months follow-up time period.
Copyright © 2012
Elsevier Ltd. All rights reserved.
PMID:
22460058 [PubMed - as supplied by publisher]
Lymphology. 2011
Dec;44(4):183-6.
Severe
lymphedema caused by repeated self-injury.
Mihara M, Hara H, Murai N, Todokoro T, Iida T, Narushima M, Koshima I.
Source
Department of
Plastic Surgery/Aesthetic Surgery, University of Tokyo, Tokyo, Japan.
[email protected]
Abstract
Lymphedema is
divided into primary and secondary forms. Primary lymphedema often develops in
young people and may be caused by lymphvascular aplasia, hypoplasia, and
hyperplasia. The most frequent cause of secondary lymphedema after lymphatic
filariasis is regional lymph node dissection for treatment of a malignant
tumor, and this complication occurs most frequently in middle aged or older
patients. Here, we describe a relatively young patient (27 years old) in whom
collecting lymph vessels in the upper limb were disrupted by repeated
self-injury, with resultant lymphedema. There have been very few reports on
lymphedema caused by self-induced trauma. This case report illustrates that
secondary lymphedema should also be considered and evaluated appropriately when
diagnosed in a relatively young patient without a history of cancer or
infection.
PMID:
22458120 [PubMed - in process]
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Lymphology. 2011
Dec;44(4):178-82.
Lymphedema
treatment decreases pain intensity in lipedema.
Szolnoky G, Varga E, Varga M, Tuczai M, Dósa-Rácz E, Kemény L.
Source
Department of
Dermatology and Allergology, University of Szeged, Hungary.
[email protected]
Abstract
Lipedema
is a disproportional obesity featuring light pressure-induced or spontaneous
pain. On the basis of our clinical observations, lymphedema therapy, as
practiced in our clinic, reduces the perception of pain beyond leg volume
reduction. We therefore aimed to measure pain intensity prior and subsequent to
treatment. 38 women with lipedema were enrolled in the study with 19 patients
undergoing treatment and 19 serving as the control group using exclusively
moisturizers. Treatment consisted of once daily manual lymph drainage (MLD),
intermittent pneumatic compression (IPC), and multilayered short-stretch
bandaging performed throughout a 5-day-course. Pain was evaluated with a
10-item questionnaire, a pain rating scale (PRS), and the Wong-Baker Faces
scale. Treatment resulted in a significant reduction of pain with a decrease in
mean scores of all three measures. In the control group, only PRS showed
significant decrease. Our study results indicate that this treatment regimen
not only reduces leg volume and capillary fragility, but also improves pain
intensity in patients with lipedema.
PMID:
22458119 [PubMed - in process]
Lymphology. 2011
Dec;44(4):168-77.
Changes
in tissue water and indentation resistance of lymphedematous limbs accompanying
low level laser therapy (LLLT) of fibrotic skin.
Mayrovitz HN, Davey S.
Source
College
of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida
33328, USA. [email protected]
Abstract
Our goal
was to determine effects of low-level-laser-therapy (LLLT) on skin water and
tissue indentation resistance (TIR) in patients with arm (N = 38) or leg (N =
38) lymphedema. Skin water was determined from tissue dielectric constant (TDC)
measurements and TIR determined from measurements of force resulting from
tissue indentations of 3-4 mm. A limb-location with fibrosis was identified by
palpation and treated with an LLLT device for one minute at each of five points
within a 3 cm2 area. TDC and TIR at these sites and corresponding sites on the
contralateral limb were measured prior to LLLT (pre-LLLT), immediately after
LLLT (post-LLLT) and after a manual lymphatic drainage (MLD) session
(post-MLD). Results, from arms and legs, showed that post-LLLT values of TIR
and TDC were significantly less than pre-LLLT. TIR values remained
significantly reduced at post-MLD whereas TDC values were not significantly
different from pre-LLLT values. On follow-up visit, 17 previously LLLT treated
legs were sham treated with an inactive LLLT unit and measurements replicated.
A TIR and TDC change-pattern similar to that obtained with the active LLLT was
obtained, but sham-related reductions in TIR and TDC immediately post
sham-treatment were significantly less than achieved with the prior active LLLT
treatment.
PMID:
22458118 [PubMed - in process]
Lymphology. 2011
Dec;44(4):155-67.
Classification
of lymphoscintigraphy and relevance to surgical indication for lymphaticovenous
anastomosis in upper limb lymphedema.
Mikami T, Hosono M, Yabuki Y, Yamamoto Y, Yasumura K, Sawada H, Shizukuishi K, Maegawa J.
Source
Department of
Plastic and Reconstructive Surgery, Yokohama City University Hospital,
Yokohama, Japan. [email protected]
Abstract
Upper
limb lymphedema that develops after breast cancer surgery causes physical
discomfort and psychological distress, and it can require both conservative and
surgical treatment. Lymphaticovenous anastomosis has been reported to be an
effective treatment; however the disease severity criteria that define
indications for this treatment remain unclear. Here, we examined
lymphoscintigraphic findings in 78 patients with secondary upper limb
lymphedema and classified them into 5 major types (Type I-V) and 3 subtypes
(Subtype E, L, and 0). Results revealed that this classification is related to
the clinical stage scale of the International Society of Lymphology. Based on
intraoperative examination findings in 20 of the 78 patients, lymphatic
pressure is likely to be further elevated in Type II-V cases which are
characterized by the presence of dermal back flow. Therefore, lymphaticovenous
anastomosis should be considered as a treatment option for lymphedema in Type
II-V cases. Furthermore, there are only limited lymph vessel sites usable for
lymphaticovenous anastomosis in more severe lymphedema types [Types IV and Type
V (which is characterized by dermal backflow only in the hand)]. The findings
in Type IV-V cases suggest that therapeutic strategies for severe upper limb
lymphedema need further consideration.
PMID:
22458117 [PubMed - in process]
Am Nurse. 2012
Jan-Feb;44(1):5.
MONA
nurse researches lymphedema.
[No
authors listed]
PMID:
22458098 [PubMed - in process]
Plast Reconstr Surg. 2012
Apr;129(4):767e-9e.
Overview
of treatments for male genital lymphedema: critical literature review and
anatomical considerations.
Otsuki Y, Yamada K, Hasegawa K, Kimata Y, Suami H.
Source
Department of
Plastic and Reconstructive Surgery, Okayama University, Okayama, Japan (Otsuki,
Yamada, Hasegawa, Kimata) Department of Plastic Surgery, University of Texas M.
D. Anderson Cancer Center, Houston, Texas (Suami).
PMID:
22456418 [PubMed - in process]
Plast Reconstr Surg. 2012
Apr;129(4):838-47.
Regulation
of Adipogenesis by Lymphatic Fluid Stasis: Part II. Expression of Adipose
Differentiation Genes.
Aschen S, Zampell JC, Elhadad S, Weitman E, De Brot M, Mehrara BJ.
Source
New
York, N.Y. From the Divisions of Plastic and Reconstructive Surgery and Breast
Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer
Center.
Abstract
BACKGROUND:
:
Although fat deposition is a defining clinical characteristic of lymphedema,
the cellular mechanisms that regulate this response remain unknown. The goal of
this study was to determine how lymphatic fluid stasis regulates adipogenic
gene activation and fat deposition.
METHODS:
: Adult
female mice underwent tail lymphatic ablation and were euthanied at 1, 3, or 6
weeks postoperatively (n = 8 per group). Samples were analyzed by
immunohistochemistry and Western blot analysis. An alternative group of mice
underwent axillary dissections or sham incisions, and limb tissues were
harvested 3 weeks postoperatively (n = 8 per group).
RESULTS:
:
Lymphatic fluid stasis resulted in significant subcutaneous fat deposition and
fibrosis in lymphedematous tail regions (p < 0.001). Western blot analysis
demonstrated that proteins regulating adipose differentiation including
CCAAT/enhancer-binding protein-α and adiponectin were markedly up-regulated in
response to lymphatic fluid stasis in the tail and axillary models. Expression
of these markers increased in edematous tissues according to the gradient of
lymphatic stasis distal to the wound. Immunohistochemical analysis further
demonstrated that adiponectin and peroxisome proliferator-activated receptor-γ,
another critical adipogenic transcription factor, followed similar expression
gradients. Finally, adiponectin and peroxisome proliferator-activated
receptor-γ expression localized to a variety of cell types in newly formed
subcutaneous fat.
CONCLUSIONS:
: The
mouse-tail model of lymphedema
demonstrates pathologic findings similar to clinical lymphedema,
including fat deposition and fibrosis. The authors show that lymphatic fluid
stasis potently up-regulates the expression of fat differentiation markers both
spatially and temporally. These studies elucidate mechanisms regulating
abnormal fat deposition in lymphedema pathogenesis and therefore
provide a basis for developing targeted treatments.
PMID:
22456356 [PubMed - in process]
Plast Reconstr Surg. 2012
Apr;129(4):825-34.
Regulation
of adipogenesis by lymphatic fluid stasis: part I. Adipogenesis, fibrosis, and
inflammation.
Zampell JC, Aschen S, Weitman ES, Yan A, Elhadad S, De Brot M, Mehrara BJ.
Source
New
York, N.Y. From the Divisions of Plastic and Reconstructive Surgery and Breast
Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer
Center.
Abstract
BACKGROUND:
:
Although fat deposition is a defining clinical characteristic of lymphedema,
the cellular mechanisms that regulate this response remain unknown. The goals
of this two-part study were to determine the effect of lymphatic fluid stasis
on adipogenesis and inflammation (part I) and how these changes regulate the
temporal and spatial expression of fat differentiation genes (part
II).
METHODS:
: Adult
female mice underwent tail lymphatic ablation and were euthanized 6 weeks after
surgery (n = 20). Fat deposition, fibrosis, and inflammation were then analyzed
in the regions of the tail exposed to lymphatic fluid stasis as compared with
normal lymphatic flow.
RESULTS:
:
Lymphatic fluid stasis in the tail resulted in significant subcutaneous fat
deposition, with a 2-fold increase in fat thickness (p < 0.01). In addition,
lymphatic stasis was associated with subcutaneous fat fibrosis and collagen
deposition. Adipogenesis in response to lymphatic fluid stasis was associated
with a marked mononuclear cell inflammatory response (5-fold increase in CD45
cells; p < 0.001). In addition, the authors noted a significant increase in
the number of monocytes/macrophages as identified by F4/80 immunohistochemistry
(p < 0.001).
CONCLUSIONS:
: The
mouse-tail model has pathologic findings that are similar to clinical lymphedema, including fat deposition,
fibrosis, and inflammation. Adipogenesis in response to lymphatic fluid stasis
closely resembles this process in obesity. This model therefore provides an
excellent means with which to study the molecular mechanisms that regulate the
pathophysiology of lymphedema.
PMID:
22456354 [PubMed - in process]
MED
NEWS DOCS:
March
7, 2012
Development Of New Universal Platform For Cancer
Immunotherapy
Researchers from the Perelman School of Medicine at the University of
Pennsylvania report this month in Cancer Research a universal
approach to personalized cancer therapy based on T cells.
It is the first time a system for making an adaptable, engineered T-cell to
attack specific tumor types has been proposed, depending on which abnormal
proteins, called antigens, are expressed by individual patients' tumor cells.
For now, the system is being refined in experiments using healthy donor
T cells and animal models of human cancer, with the aim to introduce the
personalized cells into patients in the future, explains senior author Daniel
J. Powell Jr., Ph.D., a research assistant professor of Pathology and
Laboratory Medicine with Penn's Ovarian Cancer Research Center.
Tumor
antigens are potential targets of an immune response, and identifying which
antigens a patient's tumor cells express would be helpful in designing cancer
therapy for that individual. Any mutated protein produced in a tumor cell can
act as a tumor antigen. Many tumor cells have surface proteins that are
inappropriately expressed for the cell type, or are only normally present
during embryonic development. Still other tumor cells display cell surface
proteins that are rare or absent on the surfaces of healthy cells and are
responsible for activating molecular pathways that cause uncontrolled
replication of cells. In most cancers, not all patients have tumor cells that
express the exact same antigen, and sometimes tumor cells from a single patient
can express different antigens. Because of this complexity, it is important to
properly choose which antigen to target with cancer therapy.
T cells
engineered to express an engineered antigen, called a chimeric antigen receptor
(CAR), offer an attractive strategy for targeting antigens and treating cancer,
says Powell. CARs are engineered receptors that graft, for example, the portion
of a tumor-specific antibody onto an immune cell. This allows the patients' T
cells to recognize tumor antigens and kill their tumor cells.
For
therapy, a large number of tumor-specific, cancer-fighting CAR T cells can be
generated in a specialized lab using patients' own T cells, which are then
infused back into them. This approach has shown promising results in patients
whose tumors all express the same antigen.
Despite these encouraging
findings, currently made CARs have a fixed antigen specificity, which means
only one type of tumor antigen can be targeted at a time. Tumor cells that lack
that selected antigen can then escape recognition by immune cells and
replicate, limiting what might otherwise have been an effective therapy if
multiple tumor antigens had been targeted. For this reason, the team sought to
make a more generalized receptor framework that is able to produce T cells
capable of targeting large panels of known tumor antigens.
To that end,
the team developed a new platform from which they could eventually target a
variety of tumor antigens, either simultaneously or sequentially. So far, they
have engineered T cells against the antigens mesothelin, present on several
tumor cell types; epCAM, present on epithelial cell cancers; alpha folate,
present on ovarian cancer cells; and, more
recently, CD19 on lymphoma cells.
The
universal immune receptor recognizes molecules attached to tumor antigens on
the surface of tumor cells. When this happens, the T cells produce inflammatory
response proteins called cytokines and pore-forming proteins. Those proteins
cause the release of enzymes through those pores into tumor cells, thereby
killing them.
The new engineered T cells described in the Cancer
Research paper recognize and bind exclusively to cancer cells pre-targeted with
biotin-labeled molecules, such as antibodies. Biotin is a B complex vitamin
necessary for cell growth that can be bound by a molecule called avidin, which
is contained in the universal immune receptor. Since nearly any molecule can be
biotin labeled, the number of antigens that can be targeted by T cells carrying
the biotin-binding immune receptor is nearly infinite. The versatility afforded
by this biotin-binding receptor permitted the targeting of a combination of
distinct antigens all at once, and even one after another, notes Powell.
The findings demonstrate that a universal T cell can significantly
extend conventional CAR approaches, allowing the team to generate T cells of
unlimited antigen specificity. This process is geared to make T cell therapy
more available to patients and to improve the effectiveness of T-cell
immunotherapies for cancer.
First author post-doctoral fellow Katarzyna
Urbanska, Ph.D. continues optimization of the universal receptor approach by
looking for different ways to improve the interaction of T cells with tumor
cells, and how to better direct the T cells and the biotin-labeled molecules to
tumor cells in the body.
In the future, Powell and colleagues predict a
highly personalized platform for cancer therapy that begins when patient tumors
are analyzed for their expression of specific antigens at the Department
Pathology and Laboratory Medicine's new Center for Personalized Diagnostics.
When the antigens expressed by a patient's tumor cells are determined, their T
cells will be engineered to express the universal immune receptor, which will
be given back to them in combination with biotin-labeled molecules to attach to
patients' tumor antigens for an individualized tumor attack
March
8, 2012
A Mechanism Explaining How Tumor Cells Spread To
Nearby Organs And Structures, Initiating
Metastasis
Metastasis is responsible for 90% of deaths in patients with cancer. Understanding the
mechanisms responsible for this process is one of the top goals of cancer
research. The metastatic process involves a series of steps chained where the
primary tumour invades surrounding tissues and ends spreading throughout the
body. Ones of the first tissues undergoing metastasis are the lymph nodes
surrounding the tumour.
A study, led by the researcher at the Bellvitge
Biomedical Research Institute (IDIBELL), Manel Esteller, published in the
Journal of Pathology, had identified a mechanism that explains how
cancer cells escape from the original site to the lymph nodes. Investigations
have uncovered that metastatic tumour cells that grow in the lymph nodes of
patients with melanoma and head and neck
tumours lose the activity of a protein called cadherin-11.
The normal
function of this protein is to act as the anchor of a ship to fix the cells in
a specific position and prevent movement. Inactivation of cadherin-11 gene
causes the loss of this fixation and tumour cells "jump" to neighboring organs
and structures, such as lymph nodes.
The study is an example of
translational and multidisciplinary research, involving basic research
laboratories, the medical oncology service at the Catalan Institute of Oncology
(ICO) and the Pathology Service of the Bellvitge University Hospital.
The study coordinated by the director of the Cancer Epigenetics and
Biology Program at IDIBELL, ICREA researcher and professor at the University of
Barcelona, Manel Esteller, also proposes that the process can be reversed
because, in models in vitro and in vivo, the recovery of protein activity
cadherin-11 caused a slowing of tumour growth and decreased ability to generate
metastases.
This possibility needs to be studied in international
clinical trials, but it is a promising starting point in studying the biology
of metastasis and how to act therapeutically in this area
March
16, 2012
Combination Treatment In Mice Shows Promise For Fatal
Neurological Disorder In Kids
Infants with Batten disease, a rare but fatal neurological disorder,
appear healthy at birth. But within a few short years, the illness takes a
heavy toll, leaving children blind, speechless and paralyzed. Most die by age
5.
There are no effective treatments for the disease, which can also
strike older children. And several therapeutic approaches, evaluated in mouse
models and in young children, have produced disappointing results.
But
now, working in mice with the infantile form of Batten disease, scientists at
Washington University School of Medicine in St. Louis and Kings College London
have discovered dramatic improvements in life span and motor function by
treating the animals with gene therapy and bone marrow transplants.
The
results are surprising, the researchers say, because the combination therapy is
far more effective than either treatment alone. Gene therapy was moderately
effective in the mice, and bone marrow transplants provided no benefit, but
together the two treatments created a striking synergy.
The research is
reported online in the Annals of Neurology.
"Until now,
this disease has been refractory to every therapy that has been thrown at it,"
says senior author Mark Sands, PhD, professor of medicine and of genetics at
the School of Medicine. "The results are the most hopeful to date, and they
open up a new avenue of research to find effective therapies to fight this
devastating disease."
The combination therapy did not cure the disease,
the scientists caution, but mice that received both treatments experienced
significant, lasting benefits.
Mice that got gene therapy and a bone
marrow transplant lived nearly 18.5 months, more than double the lifespan of
untreated mice with the disease. (Healthy laboratory mice live about 24
months.) And for a significant portion of their lives, motor skills in mice
that got both therapies were indistinguishable from those in normal, healthy
mice.
While bone marrow transplants carry significant risks, especially
in children, the researchers say they may be able to combine gene therapy with
another treatment to achieve the same results. This same approach potentially
could be used to treat other forms of Batten disease.
Batten disease is
an inherited genetic disorder that strikes fewer than five of every 100,000
U.S. children but is slightly more common in northern Europe. There are several
forms of the disease, diagnosed at different ages, and all are related to the
inability of cells to break down and recycle proteins.
The infantile
form is caused by mutations in the PPT1 gene that codes for an enzyme needed to
remove these proteins from cells. Without a working copy of the gene, the
proteins build up in cells, causing seizures, brain atrophy and dementia. The disease progresses
most rapidly when it is diagnosed in infants. By age 2, most live in an
unresponsive, vegetative state.
In the new study, the researchers tested
various therapies in four groups of newborn mice with infantile Batten disease.
One received only gene therapy; another received only bone marrow transplants;
a third was treated with gene therapy and bone marrow transplants; and a fourth
group received no treatment. As a comparison, the study included healthy mice
without the disorder.
Gene therapy to replace the PPT1 enzyme was
delivered directly into the brain. Bone marrow transplants were given with the
intent that donor cells would migrate to the brain and deliver additional
enzyme to regions of the brain not reached by gene therapy.
But that's
not what happened, Sands says. Although gene therapy delivered relatively high
levels of PPT1 enzyme, the bone marrow transplants did not supply any
additional enzyme. Rather, he and his colleagues discovered that mice receiving
both therapies experienced a dramatic reduction in brain
inflammation.
"We suspect that the normal immune cells from the bone
marrow transplant substantially reduce inflammation in the brain because we
just don't see much of it in mice that got both therapies," Sands says. "This
helps the PPT1 enzyme to do its job inside cells."
The study's results
show no increase in life span for mice receiving bone marrow transplantation
alone compared to untreated mice animals in both groups lived a median of 8.9
months. Mice that got only gene therapy lived 13.5 months, while those that got
the combination therapy lived for 18.5 months.
The researchers noted
similar effects of the therapies when they evaluated motor function. By 6
months, both untreated mice and those that received only a bone marrow
transplant had experienced significant declines in motor skills. Mice that got
gene therapy alone experienced a decline in motor function beginning at 10
months, and in those that got combination therapy, motor skills did not begin
to decline until 13 months and did so more gradually than in the other
mice.
Mice that got the combination therapy also had higher levels of
active PPT1 enzyme in the brain, a thicker cerebral cortex and fewer
accumulated proteins in brain cells, all indicators that the treatment is
working.
Sands is now repeating the experiment and investigating other
ways to reduce inflammation in the brain that would not involve the risks of a
bone marrow transplant. One possibility, he says, involves anti-inflammatory
drugs that have effects in the brain.
"We may be able to achieve the
same results with a less invasive anti-inflammatory treatment," Sands says.
"We're very excited now to move forward."
The research is supported by
the National Institutes of Health (NIH), Ruth L. Kirschstein NRSA Fellowship,
The Wellcome Trust, Batten Disease Family Association, the Batten Disease
Support and Research Association and the Bletsoe Family.
Macauley SL,
Roberts MS, Wong AM, McSloy F, Reddy AS, Cooper JD and Sands MS. Synergisitc
effects of CNS-directed gene therapy and bone marrow transplantation in the
murine model of infantile neuronal ceroid lipofuscinosis. Annals of
Neurology. Online ahead of print, Feb. 24, 2012.
March
30, 2012
Genetic Basis Of Tropical Foot And Leg Lymphedema
Identified
Farmers in the highlands of southern Ethiopia scratch out a
subsistence living from the region's volcanic red clay. The soil supports the
farms, but fine-grained, volcanic rock particles in the dirt threaten the
farmers and their families. Continual exposure of bare feet to the volcanic
soil causes 1 in 20 people to develop a painful inflammation of the lower
extremities that, over time, leads to foot disfigurement. Doctors call it
podoconiosis. The locals call it mossy foot. And those affected suffer social
stigma as well as debilitating discomfort.
Now, researchers think they
know why some 4 million people in at least 10 countries worldwide develop this
incapacitating condition. One-fifth carry genetic variants that cause their
immune system to react to the volcanic dust. This disease-producing response,
triggered by exposure from the lack of shoes, provides a dramatic example of
the interaction between genes and the environment.
Writing in the March
29, 2012 New England Journal of Medicine, an international team
that includes researchers from the National Human Genome Research Institute
(NHGRI), part of the National Institutes of Health, describes the genetic link
that turns dirt into a toxin.
"This study draws attention to a neglected
tropical disease with a devastating impact on poor people and their
communities," said NHGRI Scientific Director Dan Kastner, M.D., Ph.D. "It
demonstrates the global reach of genomics research into the lives of people in
parts of the world where endemic diseases very often go unchecked."
Doctors have known for a long time that podoconiosis runs in families
and that continual exposure to volcanic soil triggers it. Wearing shoes and
socks, or even washing off the dirt, prevents the condition. But doctors have
been perplexed that only some people develop the disease, while others with the
same environmental exposure are spared.
To sort this out, the
international collaborators conducted a genome-wide association study - or GWAS
- analyzing DNA from 194 volunteers from the Ethiopian highlands affected by
podoconiosis, along with DNA from another 203 unaffected individuals from the
same region. The researchers collaborated with field workers from the
non-profit Mossy Foot Treatment and Prevention Association in southern Ethiopia
to collect the data and samples.
The researchers generated a dataset
from study-participant DNA, screening more than 550,000 single-nucleotide
polymorphisms (SNPs), which are sites in an individual's DNA that contain a
different chemical base when compared to a standard reference human genome
sequence. They found significant podoconiosis association for eight SNPs within
or nearby a stretch of DNA on chromosome 6, called the HLA class II locus.
The researchers performed a second validation step, called a
family-based association study, using DNA samples from 202 sets of child-parent
trios from affected families. The researchers detected six SNPs that showed
significant association - those that mapped to HLA class II region genes and
most strongly associated with podoconiosis in the GWAS, validating the GWAS
results.
April
4, 2012
Link Between New Signaling Pathway And Breast Cancer
Metastasis
Lymph nodes help to fight off infections by producing immune cells and
filtering foreign materials from the body, such as bacteria or cancer cells. Thus, one of the
first places that cancer cells are found when they leave the primary tumor is
in the lymph nodes. The spread of cancer cells to the lymph nodes, lymphatic
metastasis, is known to indicate a poor prognosis in many types of cancers; how
tumor cells reach the lymph nodes, however, is not well understood.
A
new study by Dr. Heide Ford and colleagues at the University of Colorado School
of Medicine in Aurora reveals a mechanism underlying this process in breast cancer. Using mouse
models, their team found that a protein called SIX1 is a critical player in
early stage metastasis, especially lymphatic metastasis. Their study showed
that SIX1 induced expression of another protein called VEGF-C, which stimulated
the formation of new lymphatic vessels within and near the primary tumor and
lymphatic invasion. Strongly supporting a role in human breast cancer, they
also showed that the expression of both proteins was correlated in human breast
tumors.
Their work has identified the SIX1-VEGF-C pathway as an
important signaling pathway involved in breast cancer metastasis, and the
targeting of this pathway could lead to new anti-cancer treatments
TITLE: SIX1 induces lymphangiogenesis and metastasis via upregulation of
VEGF-C in mouse models of breast cancer
April
11, 2012
Survivors Of Breast Cancer Suffer Treatment-Related
Side Effects Long After Completing Care
More than 60 percent of breast cancer survivors report
at least one treatment-related complication even six years after their
diagnosis, according to a new study led by a researcher from the Perelman
School of Medicine at the University of Pennsylvania. The findings are part of
a special issue of Cancer devoted to exploring the physical late
effects of breast cancer treatment and creating strategies to prevent, monitor
for, and treat these conditions in the nation's 2.6 million survivors of the
disease.
"Our work provides the first accounting of the true magnitude
of the post-treatment problems suffered by breast cancer patients, and serves
as a call to action for proper monitoring and rehabilitation services to care
for them," said Kathryn Schmitz, PhD, MPH, an associate professor of
Biostatistics and Epidemiology who serves as a senior scientist on the
committee overseeing creation of a surveillance model for breast cancer
survivors. "We can no longer pretend that the side effects of breast cancer
treatment end after patients finish active treatment. The scope of these
complications is shocking and upsetting, but a ready solution for many of them
already exists in rehabilitative exercise."
Schmitz, a member of Penn's
Abramson Cancer Center, points out that previous studies to determine the
prevalence of post-treatment complications typically examined just one issue.
The new findings, instead, provide a full snapshot of the complications women
may experience following the chemotherapy, surgery, radiation treatment and
hormonal therapy to cure their disease and keep it from returning. The results
reveal that these problems rarely exist in isolation: Many women with the
painful limb-swelling condition lymphedema, for instance, may
also struggle with fatigue and bone health
challenges.
Schmitz collaborated with an Australian research team to
follow 287 Australian women with invasive, unilateral breast cancer for a
median of 6.6 years, prospectively assessing the women for treatment-related
physical and functional complications at set points throughout the study. Areas
of study included postsurgical complications, skin reactions to radiation
therapy, upper-body symptoms and functional limitations, lymphedema, weight
gain, and fatigue. Sixty percent of the women were still experiencing one of
these problems at six years after their diagnosis, and 30 percent were still
struggling with at least two issues. Most of the problems appeared within the
first year patients were assessed, but the prevalence of most impairments -
except lymphedema and weight gain - decreased over the course of the study.
Writing in the lead editorial of the special issue of
Cancer, Schmitz and her colleagues outline the myriad barriers that
lay in the way of properly monitoring breast cancer survivors for the problems
uncovered in the new study. Patients may have fragmented care, receiving
different prongs of their treatment at different hospitals; patients and
providers may believe certain problems are "expected" and "normal" and not
appropriate for treatment; and unlike orthopedists and cardiologists who
frequently send patients for physical rehabilitation to ensure their complete
recovery, oncologists and surgeons are often poorly linked to physical therapy professionals,
limiting the number of patients who are aware of or referred for these
services.
In the face of these challenges, an expert panel laid out a
model for prospectively surveying breast cancer survivors and formally
incorporating rehabilitation and exercise experts into cancer survivorship programs.
Research increasingly shows that post-treatment complications can be minimized
- and even prevented altogether - when caught early and addressed through
various rehabilitation regimens. "When early signs of impairment are noted and
that impairment has a high probability of worsening if allowed to progress,
which ultimately may result in a worse, permanent disability, there is an
ethical obligation to treat the condition," they write.
The question of
how best to implement the proposed rehabilitation and surveillance remains to
be addressed. The panel plans to work through the American Cancer Society with
stakeholder groups to answer questions about how to educate patients and
clinicians about the plan and fully implement it. The American College of
Surgeons Commission on Cancer has published guidelines that will require that
all accredited cancer treatment centers provide treatment summaries and
survivorship health care plans to all their patients by 2015. The proposed
surveillance and rehabilitation model could serve as a framework for meeting
those pending guidelines. "In the meantime," Schmitz says, "breast cancer
survivors should be empowered to ask their doctor for a referral to physical
therapy and exercise programs."
April 19, 2012
J Plast Reconstr Aesthet Surg.
2012 Apr 1. [Epub ahead of print]
Positive
impact of delayed breast reconstruction on breast-cancer treatment-related arm
lymphoedema.
Blanchard
M, Arrault
M, Vignes
S.
Source
Department of
Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015 Paris,
France.
Abstract
BACKGROUND:
The
study aims to determine the impact of delayed breast reconstruction on women
with breast-cancer treatment-related lymphoedema after mastectomy.
METHODS:
Twenty
women with breast-cancer treatment-related arm lymphoedema prospectively
requesting breast reconstruction were included between January 2002 and June
2009. Lymphoedema volume was calculated for each 5-cm segment using the formula
for a truncated cone.
RESULTS:
Three
patients underwent transverse rectus abdominis myocutaneous flap
reconstruction, five received pedicled latissimus dorsi myocutaneous flaps
associated with a breast implant and 12 a breast implant (silicone) alone.
Median lymphoedema duration at the time of breast reconstruction was 21
(interquartile range (IQR): 17-34) months. Breast reconstruction was done a
median of 30 (IQR: 23-56) months after mastectomy. The median lymphoedema
volume at medians of 5 (244 ml, IQR: 159-435) and 22 months (235 ml, IQR:
146-361) of follow-up after reconstruction compared to that measured 6 months
before breast reconstruction of 378 ml (IQR: 261-459) were significantly lower
(p < 0.02 for both). Specific lymphoedema treatment, unchanged during the
study, included manual lymph drainage for all women, elastic sleeves for 19 and
low-stretch bandages for 14.
CONCLUSION:
Delayed
breast reconstruction is feasible for women who have developed lymphoedema
after mastectomy for breast cancer. Further studies are needed to compare the
different breast-reconstruction techniques and to determine their ideal timing
(immediate or delayed).
Copyright © 2012
British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.
PMID:
22472052 [PubMed - as supplied by publisher]
Nurs
N Z. 2012 Feb;18(1):18-9.
Managing
lymphoedema in palliative care patients.
Walker J, Thomson
M.
Source
New
Zealand Institute of Community Health Care, Christchurch.
PMID:
22480007 [PubMed - in process
J
Breast Cancer. 2012 Mar;15(1):91-7. Epub 2012 Mar
28.
The
efficacy of arm node preserving surgery using axillary reverse mapping for
preventing lymphedema in patients with breast cancer.
Han JW, Seo
YJ, Choi
JE, Kang
SH, Bae
YK, Lee
SJ.
Source
Department of
Surgery, Yeungnam University College of Medicine, Daegu, Korea.
Abstract
PURPOSE:
The
axillary reverse mapping (ARM) technique to identify and preserve arm nodes
during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection
(ALND) was developed to prevent lymphedema. The purpose of this study was to
investigate the location and metastatic rate of the arm node, and to evaluate
the short term incidence of lymphedema after arm node preserving
surgery.
METHODS:
From
January 2009 to October 2010, 97 breast cancer patients who underwent ARM were
included. Blue-dye (2.5 mL) was injected into the ipsilateral upper-inner arm.
At least 20 minutes after injection, SLNB or ALND was performed and
blue-stained arm nodes and/or lymphatics were identified. Patients were divided
into two groups, an arm node preserved group (70 patients had ALND, 10 patients
had SLNB) and an unpreserved group (13 patients had ALND, 4 patients had SLNB).
The difference in arm circumference between preoperative and postoperative time
points was checked in both groups.
RESULTS:
The mean
number of identified blue stained arm nodes was 1.4±0.6. In the majority of
patients (92%), arm nodes were located between the lower level of the axillary
vein and just below the second intercostobrachial nerve. In the arm node
unpreserved group, 2 patients had metastasis in their arm node. Among ALND
patients, in the arm node preserved group, the difference in arm circumference
between preoperative and postoperative time points in ipsilateral and
contralateral arms was 0.27 cm and 0.07 cm, respectively, whereas it was 0.47
cm and -0.03 cm in the unpreserved group; one case of lymphedema was found
after 6 months. No difference was found between arm node preserved and
unpreserved group among SLNB patients.
CONCLUSION:
Arm node
preserving was possible in all breast cancer patients with identifiable arm
nodes, during ALND or SLNB, except for those with high surgical N stage, and
lymphedema did not develop in patients with arm node preserving
surgery.
PMID:
22493634 [PubMed - in process] PMCID: PMC3318181
Blood.
2012 Apr 6. [Epub ahead of print]
Matrix
metalloproteinase-2 governs lymphatic vessel formation as an interstitial
collagenase.
Detry B, Erpicum
C, Paupert
J, Blacher
S, Maillard
C, Bruyère
F, Pendeville
H, Remacle
T, Lambert
V, Balsat
C, Ormenese
S, Lamaye
F, Janssens
E, Moons
L, Cataldo
D, Kridelka
F, Carmeliet
P, Thiry
M, Foidart
JM, Struman
I, Noel
A.
Source
Laboratory of Tumor
and Development Biology, Groupe Interdisciplinaire de Genoproteomique
Applique-Recherche (GIGA-Cancer), University of Liege, Liege,
Belgium;
Abstract
Lymphatic
dysfunctions are associated with several human diseases, including lymphedema
and metastatic spread of cancer. Although it is well recognized that lymphatic
capillaries attach directly to interstitial matrix mainly composed of fibrillar
type I collagen, the interactions occurring between lymphatics and their
surrounding matrix have been overlooked. In this study, we demonstrate how
matrix metalloproteinase (MMP)-2 drives lymphatic morphogenesis through
Mmp2-gene ablation in mice, mmp2 knockdown in zebrafish and in 3D-culture
systems, and through MMP2 inhibition. In all models used in vivo (3 murine
models and thoracic duct development in zebrafish) and in vitro (lymphatic ring
and spheroid assays), MMP2 blockage or down-regulation leads to reduced
lymphangiogenesis or altered vessel branching. Our data show that lymphatic
endothelial cell (LEC) migration through collagen fibers is affected by
physical matrix constraints (matrix composition, density and cross-linking).
Transmission electron microscopy (TEM) and confocal reflection microscopy using
DQ-collagen highlight the contribution of MMP2 to mesenchymal-like migration of
LEC associated with collagen fiber remodeling. Our findings provide new
mechanistic insight into how LEC negotiate an interstitial type I collagen
barrier and reveal an unexpected MMP2-driven collagenolytic pathway for
lymphatic vessel formation and morphogenesis.
PMID:
22490679 [PubMed - as supplied by publisher]
Trop
Med Int Health. 2012 Apr 5. doi:
10.1111/j.1365-3156.2012.02978.x. [Epub ahead of print]
Parasitological,
serological and clinical evidence for high prevalence of podoconiosis
(non-filarial elephantiasis) in Midakegn district, central
Ethiopia.
Geshere
Oli G, Tekola
Ayele F, Petros
B.
Source
Department of
Biology, College of Natural Sciences, Jimma University, Jimma, Ethiopia Center
for Research on Genomics and Global Health, National Human Genome Research
Institute, National Institutes of Health, Bethesda, MD, USA Microbial,
Cellular and Molecular Biology Program Unit, Addis Ababa University, Addis
Ababa, Ethiopia.
Abstract
Objective To
determine whether the elephantiasis in Midakegn district, central Ethiopia, is
filarial or non-filarial (podoconiosis) using serological, parasitological and
clinical examinations, and to estimate its prevalence. Methods At
house-to-house visits in 330 randomly selected households, all household
members who had elephantiasis were interviewed and clinically examined at the
nearby health centre to confirm the presence of elephantiasis, check the
presence of scrotal swelling and rule out the other causes of lymphoedema. A
midnight blood sample was obtained from each participant with elephantiasis for
microscopic examination of Wuchereria bancrofti microfilaria. A daytime blood
sample was obtained from half of the participants for serological confirmation
using the immuno-chromatographic test card. Results Consistent with the
features of podoconiosis, none of the elephantiasis cases had consistently worn
shoes since childhood; 94.3% had bilateral swelling limited below the level of
the knees; no individual had thigh or scrotal elephantiasis; parasitological
test for microfilariae and serological tests for W. bancrofti antigen were
negative in all samples. The prevalence of the disease was 7.4% and it peaked
in the third decade of life, the most economically active age. Conclusion
Midakegn District has a high prevalence of podoconiosis and no filarial
elephantiasis. Prevention, treatment and control of podoconiosis must be among
the top priorities of public health programmes.
© 2012
Blackwell Publishing Ltd.
PMID:
22487446 [PubMed - as supplied by publisher]
J Plast Reconstr Aesthet Surg.
2012 Apr 1. [Epub ahead of print]
Positive
impact of delayed breast reconstruction on breast-cancer treatment-related arm
lymphoedema.
Blanchard
M, Arrault
M, Vignes
S.
Source
Department of
Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015 Paris,
France.
Abstract
BACKGROUND:
The
study aims to determine the impact of delayed breast reconstruction on women
with breast-cancer treatment-related lymphoedema after mastectomy.
METHODS:
Twenty
women with breast-cancer treatment-related arm lymphoedema prospectively
requesting breast reconstruction were included between January 2002 and June
2009. Lymphoedema volume was calculated for each 5-cm segment using the formula
for a truncated cone.
RESULTS:
Three
patients underwent transverse rectus abdominis myocutaneous flap
reconstruction, five received pedicled latissimus dorsi myocutaneous flaps
associated with a breast implant and 12 a breast implant (silicone) alone.
Median lymphoedema duration at the time of breast reconstruction was 21
(interquartile range (IQR): 17-34) months. Breast reconstruction was done a
median of 30 (IQR: 23-56) months after mastectomy. The median lymphoedema
volume at medians of 5 (244 ml, IQR: 159-435) and 22 months (235 ml, IQR:
146-361) of follow-up after reconstruction compared to that measured 6 months
before breast reconstruction of 378 ml (IQR: 261-459) were significantly lower
(p < 0.02 for both). Specific lymphoedema treatment, unchanged during the
study, included manual lymph drainage for all women, elastic sleeves for 19 and
low-stretch bandages for 14.
CONCLUSION:
Delayed
breast reconstruction is feasible for women who have developed lymphoedema
after mastectomy for breast cancer. Further studies are needed to compare the
different breast-reconstruction techniques and to determine their ideal timing
(immediate or delayed).
Copyright © 2012
British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.
PMID:
22472052 [PubMed - as supplied by publisher]
Phlebology.
2012 Apr 12. [Epub ahead of print]
Development
of separated elastic stockings.
Hirai M, Iwata
H, Miyazaki
K, Koyama
A, Nakamura
H.
Source
*
Department of Vascular Surgery, Tohkai Hospital, Nagoya.
Abstract
OBJECTIVES:
To
investigate the acceptability of newly developed separated elastic stockings,
which are divided into two portions at the ankle.
METHODS:
The
difficulty in putting on and taking off stockings was compared between the
original or modified separated stockings with various techniques in order to
reduce the shift of the stockings and current non-separated stockings in
healthy volunteers and patients with lymphoedema by applying both stockings
alternately. In the modified model, the shift during daily activities was
measured in healthy volunteers and patients with lymphoedema.
RESULTS:
The two
items, 'easier compared with non-separated stockings' and 'much easier', were
chosen at rates of 75% and 81% for putting on and taking off stockings for the
original separated stockings and 75% and 75% for the modified separated
stockings, respectively. Complaints during daily activities with the modified
type to the stockings decreased as compared with the original type. The shift
of stockings after an average 11-hour application was 1.6 ± 3.0 SD mm (range:
0-10 mm).
CONCLUSIONS:
Modified
separated elastic stockings are easier to put on and take off compared with
current non-separated stockings, and they can be used safely because of their
low-level shift during daily activities.
PMID:
22499611 [PubMed - as supplied by publisher]
Tumori.
2012 Jan;98(1):94-8. doi: 10.1700/1053.11506.
Morbidity
of selective lymph node biopsy for melanoma: meta-analysis of
complications.
Cigna E, Gradilone
A, Ribuffo
D, Gazzaniga
P, Fino
P, Sorvillo
V, Scuderi
N.
Abstract
Background
and aim. Intraoperative lymphatic mapping and selective lymph node biopsy is
accepted worldwide as the standard procedure for staging regional lymph nodes
of 1-4 mm thick melanomas, as well as for other neoplasms. Although it is often
stated that selective lymph node biopsy is a minimally invasive procedure
associated with few complications, few data exist concerning the morbidity
associated with the procedure. The present analysis was performed to evaluate
the morbidity associated with selective lymph node biopsy in a long-term
follow-up. Materials and methods. The study provides a review of 437 selective
lymph node biopsies on 269 patients, operated on between the 1994 and the 2009,
for the lymph node biopsy of head and neck, groin, axilla, upper and lower
limbs and nodal basins. Patients' history and follow-up were reviewed for 2
weeks after surgery, every 3 months for the first 2 years, every 4 months
during the third year, and every 6 months subsequently, and postoperative
morbidity was evaluated. Results. After sentinel node biopsy, 14 patients
developed one of the following complications: hematoma, 1 case (0.30%);
lymphedema, 1 case (0.30%); seroma, 2 cases (0.61%); wound infection, 6 cases
(1.83%); keloid scar, 2 cases (0.61%); and postoperative pain, 2 cases (0.61%).
The total complication rate was 4.26%. Conclusions. Selective lymph node biopsy
for melanoma, as for other tumors, in respect to radical lymphadenectomy, is
not a complications-free procedure but is usually not severe.
PMID:
22495708 [PubMed - in process]
April 23, 2012
Zentralbl Chir.
2012 Apr 17. [Epub ahead of print]
[Leg Swelling following Inguinal and Ilioinguinal Dissection of
Melanoma Metastases.]
[Article
in German]
Pratsch AL,
Kretschmer L.
Source
Georg-August-Universität
Göttingen, Abteilung für Dermatologie, Venerologie und Allergologie, Göttingen,
Deutschland.
Abstract
Background: With
respect to survival and local disease control, the adequate extent of lymph
node dissection for melanoma metastasis to the groin is controversial. Since
the methods for accurate quantification of leg oedemas are not well
standardised, it remains also unclear whether the iliac part of a radical
ilioinguinal lymph node dissection contributes to postoperative lymphoedema.
Patients and Methods: Using a questionnaire and clinical examinations, we
prospectively studied 65 persons for the presence of leg swellings (11 with
inguinal lymph node dissection (sCLND), 23 with ilioinguinal dissection
(rCLND), and 31 without nodal surgery and without signs of venous
insufficiency). Exact volumetry of the legs was performed using the Image 3 D
method. Results: The mean interval between the lymphadenectomy and the
examination for swellings was 24 ± 30 months. Compared with sCLND, the amount
of postoperative drainage fluid was significantly higher after rCLND
(1960 ± 1390 mL versus (vs.) 898 ± 578 mL). Patients with rCLND perceived more
frequently leg swellings (83 % vs. 55 %, p = 0.09), however, also 23 % of the
control persons perceived leg swellings. Clinical signs of swelling were found
slightly more frequently in the rCLND group (52 % vs. 45 %). After rCLND, the
gain in volume of the ipsilateral thigh was significantly higher than after
sCLND (7.01 ± 4.83 % vs. 1.29 ± 6.12 %, p = 0.01). Patients with rCLND more
frequently needed manual lymph drainage (70 % vs. 45 %). In the control
persons, the volumes of the right (mostly dominant) and the left legs did not
differ significantly. Conclusions: Our results suggest that the iliac part of
an ilioinguinal lymph node dissection significantly contributes to lymphoedema.
Because of the multitude of reasons for swellings of the lower leg, volumetry
of the thigh seems to be most adequate for quantifying the amount of
postoperative lymphoedema.
© Georg
Thieme Verlag KG Stuttgart · New York.
PMID:
22511022 [PubMed - as supplied by publisher]
Eur J Phys Rehabil Med.
2012 Apr 17. [Epub ahead of print]
Early rehabilitation reduces the onset of complications in the
upper limb following breast cancer surgery.
Scaffidi M,
Vulpiani MC,
Vetrano M,
Conforti F,
Marchetti MR,
Bonifacino A,
Marchetti P,
Saraceni VM,
Ferretti A.
Source
Physical
Medicine and Rehabilitation Unit, Sant'Andrea Hospital, La Sapienza University
of RomeRome, Italy - [email protected].
Abstract
BACKGROUND:
Breast
cancer (BC) is currently the most frequent tumor in women. Through the years,
BC management has evolved towards conservative surgery. However, even minimally
invasive surgery can cause neuromotor and/or articular impairments which can
lead to permanent damage, if not adequately treated.
AIM:
To
clinically evaluate upper ipsilateral limb function and the impact of certain
post-surgical consequences arising after invasive or breast-conserving surgery
for early BC, by intervening, or not intervening, with an early rehabilitation
program. To investigate physical morbidity after sentinel (SLND) or axillary
lymph node dissection (ALND) and after reconstructive surgery in the treatment
of early BC.
DESIGN:
Observational
prospective trial.
SETTING:
Inpatient and
outpatient treatment.
POPULATION:
Eighty-three
females participated in the study: 25 patients did not begin physiotherapy
during hospitalization (Group A), 58 patients received early rehabilitation
treatment (Group B). Methods. The patients of Groups A and B were compared with
respect to the following criteria: shoulder-arm mobility, upper limb function,
and presence of lymphedema. All patients were assessed at 15-30, 60 and180 days
after surgery.
RESULTS:
Statistically
significant differences, in favor of Group B, were encountered at the 180-day
follow-up visit, especially with respect to articular and functional limitation
of the upper limb. CONCLUSION AND CLINICAL REHABILITATION
IMPACT:
The
results of the present study show that early assisted mobilization (beginning
on the first postoperative day) and home rehabilitation, in conjunction with
written information on precautionary hygienic measures to observe, play a
crucial role in reducing the occurrence of postoperative side-effects of the
upper limb.
PMID:
22510674 [PubMed - as supplied by publisher]
PLoS Negl Trop Dis.
2012 Apr;6(4):e1611. Epub 2012 Apr 3.
Elevated Adaptive Immune Responses Are Associated with Latent
Infections of Wuchereria bancrofti.
Arndts K,
Deininger S,
Specht S,
Klarmann U,
Mand S,
Adjobimey T,
Debrah AY,
Batsa L,
Kwarteng A,
Epp C,
Taylor M,
Adjei O,
Layland LE,
Hoerauf A.
Source
Institute of
Medical Microbiology, Immunology and Parasitology, University Hospital Bonn,
Bonn, Germany.
Abstract
In order
to guarantee the fulfillment of their complex lifecycle, adult filarial
nematodes release millions of microfilariae (MF), which are taken up by
mosquito vectors. The current strategy to eliminate lymphatic filariasis as a
public health problem focuses upon interrupting this transmission through
annual mass drug administration (MDA). It remains unclear however, how many
rounds of MDA are required to achieve low enough levels of MF to cease
transmission. Interestingly, with the development of further diagnostic tools a
relatively neglected cohort of asymptomatic (non-lymphedema) amicrofilaremic
(latent) individuals has become apparent. Indeed, epidemiological studies have
suggested that there are equal numbers of patent (MF(+)) and latent
individuals. Since the latter represent a roadblock for transmission, we
studied differences in immune responses of infected asymptomatic male
individuals (n = 159) presenting either patent (n = 92 MF(+)) or latent (n = 67
MF(-)) manifestations of Wuchereria bancrofti. These individuals were selected
on the basis of MF, circulating filarial antigen in plasma and detectable worm
nests. Immunological profiles of either Th1/Th17, Th2, regulatory or innate
responses were determined after stimulation of freshly isolated PBMCs with
either filarial-specific extract or bystander stimuli. In addition, levels of
total and filarial-specific antibodies, both IgG subclasses and IgE, were
ascertained from plasma. Results from these individuals were compared with
those from 22 healthy volunteers from the same endemic area. Interestingly, we
observed that in contrast to MF(+) patients, latent infected individuals had
lower numbers of worm nests and increased adaptive immune responses including
antigen-specific IL-5. These data highlight the immunosuppressive status of
MF(+) individuals, regardless of age or clinical hydrocele and reveal
immunological profiles associated with latency and immune-mediated suppression
of parasite transmission.
PMID: 22509424
[PubMed - in process] PMCID: PMC3317915
J Pediatr Urol.
2012 Apr 14. [Epub ahead of print]
Isolated penile lymphedema in an adolescent male: A case of
metastatic Crohn's disease.
Sackett DD,
Meshekow JS,
Figueroa TE,
Napoli JA.
Source
Thomas
Jefferson University Hospital, 1025 Walnut St. Suite 1112, Philadelphia, PA
19106, USA.
Abstract
OBJECTIVE:
Metastatic Crohn's
disease is a rare and complex inflammatory condition distinguished by cutaneous
granulomatous lesions outside the gastrointestinal tract. Genital involvement
is rare; with less than 10 cases reported involving isolated penile lymphedema.
Here, we present a case of isolated lymphedema of the penis as a consequence of
extra-intestinal Crohn's disease.
CASE
REPORT:
The
patient is an 18-year-old African American male with a complex history of
inflammatory bowel disease, who initially presented with a chief complaint of 6
weeks of swelling of his penis at age 13. A modified circumcision and
lymphangectomy of the penis were performed; histopatholgy demonstrated a
granulomatous infiltrate and interstitial edema of the distal
penis.
CONCLUSION:
Surgical
intervention is an applicable therapeutic alternative and last-line therapy for
treatment of isolated penile lymphedema in select patients with appropriate
pathology, and can be a suitable adjunct to medical management in these
cases.
Copyright © 2012
Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights
reserved.
PMID:
22507210 [PubMed - as supplied by publisher]
Cancer.
2012 Apr 15;118(8 Suppl):2312-24. doi: 10.1002/cncr.27461.
Clinical practice guidelines for breast cancer rehabilitation:
Syntheses of guideline recommendations and qualitative
appraisals.
Harris SR,
Schmitz KH,
Campbell KL,
McNeely ML.
Source
Department of
Physical Therapy, Faculty of Medicine, University of British Columbia,
Vancouver, Canada. [email protected].
Abstract
BACKGROUND:
Despite
strides in early detection and management of breast cancer, the primary
treatments for this disease continue to result in physical impairments for some
of the nearly 3 million people diagnosed annually. Over the past decade,
evidence-based clinical practice guidelines (CPGs) have been developed with
goals of preventing and ameliorating these impairments. However, translation of
these guidelines into clinical practice needs to be accelerated.
METHODS:
Relevant
health science databases (2001-2011) were searched to identify CPGs on breast
cancer rehabilitation for the following impairments: upper extremity
restrictions, lymphedema, pain, fatigue, chemotherapy-induced peripheral
neuropathy, treatment-related cardiotoxicity, bone health, and weight
management.
RESULTS:
Recommendations
from 19 relevant CPGs were first summarized by impairment within tables;
commonalities across guidelines, within each impairment, were then synthesized
within the article. The CPGs were rated using the Appraisal of Guidelines for
Research and Evaluation II (AGREE II); wide variability was noted in rigor of
development, clarity of presentation, and stakeholder involvement. The most
rigorous and comprehensive of those rated was the adult cancer pain guideline
from the Scottish Intercollegiate Guidelines Network.
CONCLUSIONS:
Based on
a large body of evidence published in recent years, including randomized trials
and systematic reviews, there is an urgent need for updating the guidelines on
upper extremity musculoskeletal impairments and lymphedema. Furthermore,
additional research is needed to provide an evidence base for developing
rehabilitation guidelines on management of other impairments identified in the
prospective surveillance model, eg, arthralgia. Cancer 2012;118(8 suppl):. ©
2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488705 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2277-87. doi: 10.1002/cncr.27466.
Weight management and its role in breast cancer
rehabilitation.
Demark-Wahnefried W,
Campbell KL,
Hayes SC.
Source
Department of
Nutrition Sciences, University of Alabama at Birmingham Comprehensive Cancer
Center, Birmingham, Alabama. [email protected].
Abstract
Overweight and
obesity are risk factors for postmenopausal breast cancer, and many women
diagnosed with breast cancer, irrespective of menopausal status, gain weight
after diagnosis. Weight management plays an important role in rehabilitation
and recovery because obesity and/or weight gain may lead to poorer breast
cancer prognosis, as well as prevalent comorbid conditions (eg, cardiovascular
disease and diabetes), poorer surgical outcomes (eg, increased operating and
recovery times, higher infection rates, and poorer healing), lymphedema,
fatigue, functional decline, and poorer health and overall quality of life.
Health care professionals should encourage weight management at all phases of
the cancer care continuum as a means to potentially avoid adverse sequelae and
late effects, as well as to improve overall health and possibly survival.
Comprehensive approaches that involve dietary and behavior modification, and
increased aerobic and strength training exercise have shown promise in either
preventing weight gain or promoting weight loss, reducing biomarkers associated
with inflammation and comorbidity, and improving lifestyle behaviors,
functional status, and quality of life in this high-risk patient population.
Cancer 2012;. © 2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488702 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2237-49. doi: 10.1002/cncr.27467.
Upper-body morbidity after breast cancer: Incidence and evidence
for evaluation, prevention, and management within a prospective surveillance
model of care.
Hayes SC,
Johansson K,
Stout NL,
Prosnitz R,
Armer JM,
Gabram S,
Schmitz KH.
Source
Queensland
University of Technology, Institute of Health and Biomedical Innovation, School
of Public Health, Brisbane, Australia. [email protected].
Abstract
The
purpose of this paper is to review the incidence of upper-body morbidity (arm
and breast symptoms, impairments, and lymphedema), methods for diagnosis, and
prevention and treatment strategies. It was also the purpose to highlight the
evidence base for integration of prospective surveillance for upper-body
morbidity within standard clinical care of women with breast cancer. Between
10% and 64% of women report upper-body symptoms between 6 months and 3 years
after breast cancer, and approximately 20% develop lymphedema. Symptoms remain
common into longer-term survivorship, and although lymphedema may be transient
for some, those who present with mild lymphedema are at increased risk of
developing moderate to severe lymphedema. The etiology of morbidity seems to be
multifactorial, with the most consistent risk factors being those associated
with extent of treatment. However, known risk factors cannot reliably
distinguish between those who will and will not develop upper-body morbidity.
Upper-body morbidity may be treatable with physical therapy. There is also
evidence in support of integrating regular surveillance for upper-body
morbidity into the routine care provided to women with breast cancer, with
early diagnosis potentially contributing to more effective management and
prevention of progression of these conditions. Cancer 2012;118(8 suppl). © 2012
American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488698 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2226-36. doi: 10.1002/cncr.27468.
A prospective model of care for breast cancer rehabilitation:
Postoperative and postreconstructive issues.
McNeely ML,
Binkley JM,
Pusic AL,
Campbell KL,
Gabram S,
Soballe PW.
Source
Department of
Physical Therapy and Oncology, University of Alberta and Cross Cancer
Institute, Edmonton, Alberta, Canada. [email protected].
Abstract
Appropriate and
timely rehabilitation is vital in the recovery from breast cancer surgeries,
including breast conserving surgery, mastectomy, axillary lymph node dissection
(ALND), and breast reconstruction. This article describes the incidence,
prevalence, risk factors and time course for early postoperative effects and
the role of prospective surveillance as a rehabilitation strategy to prevent
and mitigate them. The most common early postoperative effects include wound
issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and
seroma. Appropriate treatment is necessary to avoid delay in wound healing that
may increase the risk of long-term morbidity, unduly postpone systemic and
radiation therapy, and delay rehabilitation. The presence of upper quarter
dysfunction (UQD), defined as restricted upper quarter mobility, pain,
lymphedema, and impaired sensation and strength, has been reported in over half
of survivors after treatment for breast cancer. Moreover, evidence suggests
that survivors who undergo breast reconstruction may be at higher risk of UQD.
Ensuring the survivor's optimum functioning in the early postoperative time
period is critical in the overall recovery from breast cancer. The formal
collection of objective measures along with patient-reported outcome measures
is recommended for the early detection of postoperative morbidity. Prospective
surveillance, including preoperative assessment and structured surveillance,
allows for early identification and timely rehabilitation. Early evidence
supports a prospective approach to address and minimize postoperative effects.
Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488697 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2226-36. doi: 10.1002/cncr.27468.
A prospective model of care for breast cancer rehabilitation:
Postoperative and postreconstructive issues.
McNeely ML,
Binkley JM,
Pusic AL,
Campbell KL,
Gabram S,
Soballe PW.
Source
Department of
Physical Therapy and Oncology, University of Alberta and Cross Cancer
Institute, Edmonton, Alberta, Canada. [email protected].
Abstract
Appropriate and
timely rehabilitation is vital in the recovery from breast cancer surgeries,
including breast conserving surgery, mastectomy, axillary lymph node dissection
(ALND), and breast reconstruction. This article describes the incidence,
prevalence, risk factors and time course for early postoperative effects and
the role of prospective surveillance as a rehabilitation strategy to prevent
and mitigate them. The most common early postoperative effects include wound
issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and
seroma. Appropriate treatment is necessary to avoid delay in wound healing that
may increase the risk of long-term morbidity, unduly postpone systemic and
radiation therapy, and delay rehabilitation. The presence of upper quarter
dysfunction (UQD), defined as restricted upper quarter mobility, pain,
lymphedema, and impaired sensation and strength, has been reported in over half
of survivors after treatment for breast cancer. Moreover, evidence suggests
that survivors who undergo breast reconstruction may be at higher risk of UQD.
Ensuring the survivor's optimum functioning in the early postoperative time
period is critical in the overall recovery from breast cancer. The formal
collection of objective measures along with patient-reported outcome measures
is recommended for the early detection of postoperative morbidity. Prospective
surveillance, including preoperative assessment and structured surveillance,
allows for early identification and timely rehabilitation. Early evidence
supports a prospective approach to address and minimize postoperative effects.
Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488697 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2217-25. doi: 10.1002/cncr.27474.
Prevalence of breast cancer treatment sequelae over 6 years of
follow-up: The Pulling Through Study.
Schmitz KH,
Speck RM,
Rye SA,
Disipio T,
Hayes SC.
Source
University of
Pennsylvania Perelman School of Medicine, Abramson Cancer Center, Philadelphia,
Pennsylvania. [email protected].
Abstract
BACKGROUND:
There is
a need to better describe and understand the prevalence of breast cancer
treatment-related adverse effects amenable to physical therapy and
rehabilitative exercise. Prior studies have been limited to single issues and
lacked long-term follow-up. The Pulling Through Study provides data on
prevalence of adverse effects in breast cancer survivors followed over 6
years.
METHODS:
A
population-based sample of Australian women (n = 287) diagnosed with invasive,
unilateral breast cancer was followed for a median of 6.6 years and
prospectively assessed for treatment-related complications at 6, 12, and 18
months and 6 years after diagnosis. Assessments included postsurgical
complications, skin or tissue reaction to radiation therapy, upper-body
symptoms, lymphedema, 10% weight gain, fatigue, and upper-quadrant function.
The proportion of women with positive indication for each complication and 1 or
more complication was estimated using all available data at each time point.
Women were only considered to have a specific complication if they reported the
highest 2 levels of the Likert scale for self-reported issues.
RESULTS:
At 6
years after diagnosis, more than 60% of women experienced 1 or more side
effects amenable to rehabilitative intervention. The proportion of women
experiencing 3 or more side effects decreased throughout follow-up, whereas the
proportion experiencing no side effects remained stable around 40% from 12
months to 6 years. Weight gain was the only complication to increase in
prevalence over time.
CONCLUSIONS:
These
data support the development of a multidisciplinary prospective surveillance
approach for the purposes of managing and treating adverse effects in breast
cancer survivors. Cancer 2012;118(8 suppl):. © 2012 American Cancer
Society.
Copyright © 2012
American Cancer Society.
PMID:
22488696 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2207-16. doi: 10.1002/cncr.27469.
Patient perspectives on breast cancer treatment side effects and
the prospective surveillance model for physical rehabilitation for women with
breast cancer.
Binkley JM,
Harris SR,
Levangie PK,
Pearl M,
Guglielmino J,
Kraus V,
Rowden D.
Source
TurningPoint
Women's Healthcare, Alpharetta, Georgia.
[email protected].
Abstract
Women's
experience of breast cancer is complex, affecting all aspects of life during
and after treatment. Patients' perspectives about common impairments and
functional limitations secondary to breast cancer treatment, including upper
extremity motion restriction, lymphedema, fatigue, weight gain, pain, and
chemotherapy-induced peripheral neuropathy, are addressed. Women often report
being uninformed regarding these side effects and surprised that they do not
always disappear after treatment, but remain part of their lives. Breast cancer
patients express strong, unmet needs for education, information, and
intervention for these side effects. Evidence suggests that rehabilitation and
exercise are effective in preventing and managing many physical side effects of
breast cancer treatment. Nevertheless, few women are referred to rehabilitation
during or after treatment, and fewer receive baseline assessments of impairment
and function to facilitate early detection of impairment and functional
limitations. The prospective surveillance model of rehabilitation will serve
the needs of women with breast cancer by providing education and information
about treatment side effects, reducing the incidence and burden of side effects
through early identification and treatment, and enhancing access to timely
rehabilitation. Integration of exercise as a component of the model benefits
patients at every phase of survivorship, by addressing individual concerns
about exercise during and after treatment and highlighting the important
contribution of exercise to overall health and survival. The prospective
surveillance model of rehabilitation can meet the evident and often expressed
needs of survivors for information, guidance, and intervention-thus addressing,
and potentially improving, overall quality of life for individuals diagnosed
with and treated for breast cancer. Cancer 2012;. © 2012 American Cancer
Society.
Copyright © 2012
American Cancer Society.
PMID:
22488695 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2207-16. doi: 10.1002/cncr.27469.
Patient perspectives on breast cancer treatment side effects and
the prospective surveillance model for physical rehabilitation for women with
breast cancer.
Binkley JM,
Harris SR,
Levangie PK,
Pearl M,
Guglielmino J,
Kraus V,
Rowden D.
Source
TurningPoint
Women's Healthcare, Alpharetta, Georgia.
[email protected].
Abstract
Women's
experience of breast cancer is complex, affecting all aspects of life during
and after treatment. Patients' perspectives about common impairments and
functional limitations secondary to breast cancer treatment, including upper
extremity motion restriction, lymphedema, fatigue, weight gain, pain, and
chemotherapy-induced peripheral neuropathy, are addressed. Women often report
being uninformed regarding these side effects and surprised that they do not
always disappear after treatment, but remain part of their lives. Breast cancer
patients express strong, unmet needs for education, information, and
intervention for these side effects. Evidence suggests that rehabilitation and
exercise are effective in preventing and managing many physical side effects of
breast cancer treatment. Nevertheless, few women are referred to rehabilitation
during or after treatment, and fewer receive baseline assessments of impairment
and function to facilitate early detection of impairment and functional
limitations. The prospective surveillance model of rehabilitation will serve
the needs of women with breast cancer by providing education and information
about treatment side effects, reducing the incidence and burden of side effects
through early identification and treatment, and enhancing access to timely
rehabilitation. Integration of exercise as a component of the model benefits
patients at every phase of survivorship, by addressing individual concerns
about exercise during and after treatment and highlighting the important
contribution of exercise to overall health and survival. The prospective
surveillance model of rehabilitation can meet the evident and often expressed
needs of survivors for information, guidance, and intervention-thus addressing,
and potentially improving, overall quality of life for individuals diagnosed
with and treated for breast cancer. Cancer 2012;. © 2012 American Cancer
Society.
Copyright © 2012
American Cancer Society.
PMID:
22488695 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2191-200. doi: 10.1002/cncr.27476.
A prospective surveillance model for rehabilitation for women
with breast cancer.
Stout NL,
Binkley JM,
Schmitz KH,
Andrews K,
Hayes SC,
Campbell KL,
McNeely ML,
Soballe PW,
Berger AM,
Cheville AL,
Fabian C,
Gerber LH,
Harris SR,
Johansson K,
Pusic AL,
Prosnitz RG,
Smith RA.
Source
National
Naval Medical Center, Bethesda, Maryland.
[email protected].
Abstract
BACKGROUND:
The
current model of care for individuals with breast cancer focuses on treatment
of the disease, followed by ongoing surveillance to detect recurrence. This
approach lacks attention to patients' physical and functional well-being.
Breast cancer treatment sequelae can lead to physical impairments and
functional limitations. Common impairments include pain, fatigue,
upper-extremity dysfunction, lymphedema, weakness, joint arthralgia,
neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence
supports prospective surveillance for early identification and treatment as a
means to prevent or mitigate many of these concerns. This article proposes a
prospective surveillance model for physical rehabilitation and exercise that
can be integrated with disease treatment to create a more comprehensive
approach to survivorship health care. The goals of the model are to promote
surveillance for common physical impairments and functional limitations
associated with breast cancer treatment; to provide education to facilitate
early identification of impairments; to introduce rehabilitation and exercise
intervention when physical impairments are identified; and to promote and
support physical activity and exercise behaviors through the trajectory of
disease treatment and survivorship.
METHODS:
The
model is the result of a multidisciplinary meeting of research and clinical
experts in breast cancer survivorship and representatives of relevant
professional and advocacy organizations.
RESULTS/CONCLUSIONS:
The
proposed model identifies time points during breast cancer care for assessment
of and education about physical impairments. Ultimately, implementation of the
model may influence incidence and severity of breast cancer treatment-related
physical impairments. As such, the model seeks to optimize function during and
after treatment and positively influence a growing survivorship community.
Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488693 [PubMed - in process]
Ann Rehabil Med.
2011 Dec;35(6):922-7. Epub 2011 Dec 30.
Lipedema, a rare disease.
Shin BW,
Sim YJ,
Jeong HJ,
Kim GC.
Source
Department of
Physical Medicine and Rehabilitation, Kosin University College of Medicine,
Busan 602-702, Korea.
Abstract
Lipedema
is a chronic disease of lipid metabolism that results in the symmetrical
impairment of fatty tissue distribution and storage combined with the
hyperplasia of individual fat cells. Lipedema occurs almost exclusively in
women and is usually associated with a family history and characteristic
features. It can be diagnosed based on clinical history and physical
examination. Lipedema is usually symmetrical, but spares the feet, is often
painful to palpation, and is negative for Stemmer's sign. Additionally,
lipedema patients can present with microangiopathies and lipomas. The
well-known therapies for lipedema include complex decongestive therapy,
pneumatic compression, and diet modifications. However, whether these
treatments help reduce swelling is debatable. We encountered a case of lipedema
that was initially misdiagnosed as lymphedema. The patient's clinical features
and history were different from those typical of lymphedema, prompting a
diagnosis of lipedema and she was treated with a complex decongestive therapy
program.
PMID:
22506222 [PubMed - in process]PMCID: PMC3309375
Ann Rehabil Med.
2011 Oct;35(5):687-93. Epub 2011 Oct 31.
Prediction of treatment outcome with bioimpedance measurements
in breast cancer related lymphedema patients.
Kim L,
Jeon JY,
Sung IY,
Jeong SY,
Do JH,
Kim HJ.
Source
Department of
Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of
Medicine, Seoul 138-736, Korea.
Abstract
OBJECTIVE:
To
investigate the usefulness of bioimpedance measurement for predicting the
treatment outcome in breast cancer related lymphedema (BCRL)
patients.
METHOD:
Unilateral BCRL
patients who received complex decongestive therapy (CDT) for 2 weeks (5 days
per week) were enrolled in this study. We measured the ratio of extracellular
fluid (ECF) volume by using bioelectrical impedance spectroscopy (BIS), and
single frequency bioimpedance analysis (SFBIA) at a 5 kHz frequency before
treatment. Arm circumferences were measured at 10 cm above and below the elbow
before and after treatment. We also investigated whether there is correlation
between ECF ratio and SFBIA ratio with the change of arm circumference after
CDT.
RESULTS:
A total
of 73 patients were enrolled in this study. The higher ECF ratio was
significantly correlated with higher reduction of arm circumference at both
above and below the elbow after treatment, but the higher SFBIA ratio was
correlated only with the higher reduction of arm circumference below the
elbow.
CONCLUSION:
These
results show that ECF volume measurements and SFBIA before treatment are useful
tools for predicting the outcome of patients with lymphedema. We concluded that
ECF volume measure can be used as a screening tool for predicting treatment
outcome of BCRL patients.
PMID:
22506192 [PubMed - in process]PMCID: PMC3309267
April
14, 2012
Development
of separated elastic stockings.
Apr 2012
Hirai M, Iwata H,
Miyazaki K, Koyama A, Nakamura H.
Source
* Department of Vascular
Surgery, Tohkai Hospital, Nagoya.
Abstract
OBJECTIVES:
To
investigate the acceptability of newly developed separated elastic stockings,
which are divided into two portions at the ankle.
METHODS:
The
difficulty in putting on and taking off stockings was compared between the
original or modified separated stockings with various techniques in order to
reduce the shift of the stockings and current non-separated stockings in
healthy volunteers and patients with lymphoedema by applying both stockings
alternately. In the modified model, the shift during daily activities was
measured in healthy volunteers and patients with
lymphoedema.
RESULTS:
The two items, 'easier compared with
non-separated stockings' and 'much easier', were chosen at rates of 75% and 81%
for putting on and taking off stockings for the original separated stockings
and 75% and 75% for the modified separated stockings, respectively. Complaints
during daily activities with the modified type to the stockings decreased as
compared with the original type. The shift of stockings after an average
11-hour application was 1.6 ± 3.0 SD mm (range: 0-10
mm).
CONCLUSIONS:
Modified separated elastic stockings are easier to
put on and take off compared with current non-separated stockings, and they can
be used safely because of their low-level shift during daily
activities.
http://www.ncbi.nlm.nih.gov/pubmed/22499611
April
18, 2012
A
prospective surveillance model for rehabilitation for women with breast
cancer.
Apr 2012
Stout NL, Binkley JM, Schmitz KH, Andrews K,
Hayes SC, Campbell KL, McNeely ML, Soballe PW, Berger AM, Cheville AL, Fabian
C, Gerber LH, Harris SR, Johansson K, Pusic AL, Prosnitz RG, Smith
RA.
Source
National Naval Medical Center, Bethesda, Maryland.
[email protected].
Abstract
BACKGROUND:
The
current model of care for individuals with breast cancer focuses on treatment
of the disease, followed by ongoing surveillance to detect recurrence. This
approach lacks attention to patients' physical and functional well-being.
Breast cancer treatment sequelae can lead to physical impairments and
functional limitations. Common impairments include pain, fatigue,
upper-extremity dysfunction, lymphedema, weakness, joint arthralgia,
neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence
supports prospective surveillance for early identification and treatment as a
means to prevent or mitigate many of these concerns. This article proposes a
prospective surveillance model for physical rehabilitation and exercise that
can be integrated with disease treatment to create a more comprehensive
approach to survivorship health care. The goals of the model are to promote
surveillance for common physical impairments and functional limitations
associated with breast cancer treatment; to provide education to facilitate
early identification of impairments; to introduce rehabilitation and exercise
intervention when physical impairments are identified; and to promote and
support physical activity and exercise behaviors through the trajectory of
disease treatment and survivorship.
METHODS:
The model is the result
of a multidisciplinary meeting of research and clinical experts in breast
cancer survivorship and representatives of relevant professional and advocacy
organizations.
RESULTS/CONCLUSIONS:
The proposed model identifies
time points during breast cancer care for assessment of and education about
physical impairments. Ultimately, implementation of the model may influence
incidence and severity of breast cancer treatment-related physical impairments.
As such, the model seeks to optimize fu
http://www.ncbi.nlm.nih.gov/pubmed/22488693
May 2, 2012
PLoS
One. 2012;7(4):e34901. Epub 2012 Apr 18.
Genome-wide
gene expression analysis implicates the immune response and lymphangiogenesis
in the pathogenesis of fetal chylothorax.
Yeang
CH, Ma
GC, Shih
JC, Yang
YS, Chen
CP, Chang
SP, Wu
SH, Liu
CS, Kuo
SJ, Chou
HC, Hwu
WL, Cameron
AD, Ginsberg
NA, Lin
YS, Chen
M.
Source
Institute of
Statistical Science, Academia Sinica, Taipei, Taiwan.
Abstract
Fetal
chylothorax (FC) is a rare condition characterized by lymphocyte-rich pleural
effusion. Although its pathogenesis remains elusive, it may involve
inflammation, since there are increased concentrations of proinflammatory
mediators in pleural fluids. Only a few hereditary lymphedema-associated gene
loci, e.g. VEGFR3, ITGA9 and PTPN11, were detected in human fetuses with this
condition; these cases had a poorer prognosis, due to defective
lymphangiogenesis. In the present study, genome-wide gene expression analysis
was conducted, comparing pleural and ascitic fluids in three hydropic fetuses,
one with and two without the ITGA9 mutation. One fetus (the index case), from a
dizygotic pregnancy (the cotwin was unaffected), received antenatal OK-432
pleurodesis and survived beyond the neonatal stage, despite having the ITGA9
mutation. Genes and pathways involved in the immune response were universally
up-regulated in fetal pleural fluids compared to those in ascitic fluids.
Furthermore, genes involved in the lymphangiogenesis pathway were
down-regulated in fetal pleural fluids (compared to ascitic fluid), but
following OK-432 pleurodesis, they were up-regulated. Expression of ITGA9 was
concordant with overall trends of lymphangiogenesis. In conclusion, we inferred
that both the immune response and lymphangiogenesis were implicated in the
pathogenesis of fetal chylothorax. Furthermore, genome-wide gene expression
microarray analysis may facilitate personalized medicine by selecting the most
appropriate treatment, according to the specific circumstances of the patient,
for this rare, but heterogeneous disease.
PMID:
22529953 [PubMed - in process] PMCID: PMC3329545
Ann
Surg Oncol. 2012 Apr 24. [Epub ahead of print]
Relationship
Between the Lymphatic Drainage of the Breast and the Upper Extremity: A
Postmortem Study.
Pavlista
D, Eliska
O.
Source
Oncogynecologic
Center, Department of Obstetrics and Gynecology, First Faculty of Medicine,
Charles University in Prague and General University Hospital, Prague, Czech
Republic, [email protected].
Abstract
BACKGROUND:
This
anatomic study details the lymphatic drainage of the upper extremity (UE) and
breast, as well as its course in the axilla and its relation to axillary
reverse mapping. Two aspects important for breast cancer surgery were followed:
connection between the lymphatics of the UE and breast, and the possible cause
of lymphedema of the UE after sentinel node (SN) biopsy.
METHODS:
Patent
blue dye was injected bilaterally in 23 cadavers with no history of breast
carcinoma to simultaneously visualize the lymphatics of the UE and breast.
After visualization and dissection of the lymphatic vessels and nodes, a record
of their routes was made. A scheme of superficial UE and breast lymphatics was
constructed.
RESULTS:
After
application of color contrast to the UE, 2-4 main afferent collectors were
shown. As opposed to cranial and medial collectors, caudal collectors diverged
from the axillary vein and entered the caudal axilla. In five (10.8 %) cases,
the caudal collector entered a node, which was considered to be the SN of the
breast. In six (13 %) cases, the SN of the breast and SNs of the UE were found
in close proximity (up to 1.5 cm).
CONCLUSIONS:
Lymphatic drainage
of the UE and breast are closely related in the caudal part of the axilla. SN
groups for the UE and breast share connections in 24 % of cases, which could
explain lymphedema after surgery if damaged. Additional studies are needed to
further improve our understanding of the lymphatic drainage of the UE and
breast.
PMID:
22526910 [PubMed - as supplied by publisher]
Radiology.
2012 Apr 20. [Epub ahead of print]
MR
Lymphangiography at 3.0 T: Correlation with Lymphoscintigraphy.
Notohamiprodjo
M, Weiss
M, Baumeister
RG, Sommer
WH, Helck
A, Crispin
A, Reiser
MF, Herrmann
KA.
Source
Department of
Clinical Radiology, Clinic of Nuclear Medicine, and Division of Plastic-,
Hand-, Micro-Surgery, Department of Surgery, University Hospitals Munich,
Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
Abstract
Purpose:To
prospectively compare findings of magnetic resonance (MR) lymphangiography with
those of lymphoscintigraphy, evaluate the pattern and delay of lymphatic
drainage, compare typical findings, and investigate discrepancies between the
techniques.Materials and Methods:This prospective study was performed according
to the Declaration of Helsinki and was approved by the local ethics committee.
Thirty consecutive patients with uni- or bilateral lymphedema and lymph vessel
transplants of the lower extremities were examined with 3.0-T fat-saturated
three-dimensional gradient-echo MR after gadopentetate dimeglumine injection.
Results of all examinations were correlated with corresponding results of
lymphoscintigraphy examinations. Results of both techniques were separately
reviewed in consensus by a radiologist and a nuclear physician, who rated delay
and pattern of drainage, number of enhancing levels, and quality of conspicuity
of the depiction of lymph nodes and lymph vessels. Sensitivity and specificity
were calculated by using combined results of both techniques and clinical
presentation findings as reference standard. Correlation was calculated with
weighted κ coefficients.Results:Weak lymphatic drainage at lymphoscintigraphy
correlated with lymphangiectasia at MR lymphangiography (13 of 33 affected
extremities). Lymph vessels were clearly visualized with MR lymphangiography
(five of 24 affected extremities), while they were not detectable with
lymphoscintigraphy. Depiction of inguinal lymph nodes was clearer with
lymphoscintigraphy (five of 60 extremities). Correlation of both techniques was
excellent for delay (κ = 0.93) and pattern (κ = 0.84) of drainage, good for
depiction of lymph nodes (κ = 0.67) and number of enhancing levels (κ = 0.77),
and moderate for depiction of lymph vessels (κ = 0.50). Sensitivity and
specificity for delay and pattern of drainage were concordant, whereas MR
lymphangiography showed a higher sensitivity for lymph vessel abnormalities
(100% vs 79%) and lower specificity for lymph node abnormalities (78% vs
100%).Conclusion:Imaging findings of MR lymphangiography and lymphoscintigraphy
show a clear concordance. With lymphoscintigraphy, better visualization of
inguinal lymph nodes was achieved, whereas with MR lymphangiography, better
depiction of lymph vessels and morphologic features of lymph vessel
abnormalities were achieved.© RSNA, 2012Supplemental material:
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12110229/-/DC1.
PMID:
22523325 [PubMed - as supplied by publisher]
Eur
J Dermatol. 2012 Apr 20. [Epub ahead of print]
Stewart-Treves
syndrome arising in patients with lymphaticovenular anastomosis for chronic
lymphedema of the leg.
Yamasaki
O, Takeshima
C, Ikeda
K, Suzuki
N, Otsuka
M, Kimata
Y, Hirakawa
S, Iwatsuki
K.
Source
Department of
Dermatology.
PMID:
22522788 [PubMed - as supplied by publisher]
J
Reconstr Microsurg. 2012 Apr 19. [Epub ahead of
print]
Upper-Limb
Lymphedema Treated Aesthetically with Lymphaticovenous Anastomosis using
Indocyanine Green Lymphography and Noncontact Vein Visualization.
Mihara
M, Hara
H, Hayashi
Y, Iida
T, Araki
J, Yamamoto
T, Todokoro
T, Narushima
M, Murai
N, Koshima
I.
Source
Department of
Plastic and Reconstructive Surgery, University of Tokyo, Tokyo,
Japan.
Abstract
We have
described a procedure to minimize surgical wounds, in which lymph vessels and
skin venules are identified by indocyanine green (ICG) lymphography and the
AV300 noncontact visualization system (AccuVein, Cold Spring Harbor, NY),
respectively. This approach allows accurate decisions regarding sites of
incision for lymphatic venous anastomosis (LVA). This method was applied in a
patient with right upper-limb lymphedema after breast cancer therapy. The
low-invasive procedure can be used before and during surgery. The incision size
is minimal, and the incision site is at the joint area. Thus, we aim to
establish this approach as a standard method for identifying lymph vessels and
veins that are suitable for LVA. This innovative vascular-imaging machine makes
LVA less invasive and more effective without side effects.
Thieme
Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
PMID:
22517571 [PubMed - as supplied by publisher]
Gynecol
Oncol. 2012 Apr 17. [Epub ahead of print]
A
novel approach to the treatment of lower extremity lymphedema by transferring a
vascularized submental lymph node flap to the ankle.
Cheng
MH, Huang
JJ, Nguyen
DH, Saint-Cyr
M, Zenn
MR, Tan
BK, Lee
CL.
Source
Division
of Reconstructive Microsurgery, Department of Plastic and Reconstructive
Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung
University, Taoyuan, Taiwan.
Abstract
OBJECTIVE:
Vascularized groin
lymph node flaps have been successfully transferred to the wrist to treat
postmastecomy upper limb lymphedema. This study investigated the anatomy,
mechanism and outcome of a novel vascularized submental lymph node (VSLN) flap
transfer for the treatment of lower limb lymphedema.
METHODS:
Bilateral regional
submental flaps were dissected from three fresh adult cadavers for histological
study. A unilateral submental flap was dissected in another six fresh cadavers
after latex injection. The VSLN flap was transferred to the ankles of seven
lower extremities in six patients with chronic lower extremity lymphedema. The
mean patient age was 61±9.4years. The average duration of lymphedema symptoms
was 71±42.2months.
RESULTS:
There
was a mean of 3.3±1.5 lymph nodes around the submental artery typically at the
junction with the facial artery, on the six cadaveric histological sections.
Mean of 2.3±0.8 sizable lymph nodes were dissected and supplied by the
submental artery in six cadaveric latex-injected submental flaps. All seven
VSLN flaps survived. One flap required re-exploration for venous congestion but
was successfully salvaged. There was no donor site morbidity. At a mean
follow-up of 8.7±4.2months, the mean reduction of the leg circumference was
64±11.5% above the knee, 63.7±34.3% below the knee and 67.3±19.2% above the
ankle.
CONCLUSION:
The
transfer of a vascularized submental lymph node flap to the ankle is a novel
approach for the effective treatment of lower extremity
lymphedema.
Copyright © 2012
Elsevier Inc. All rights reserved.
PMID:
22516659 [PubMed - as supplied by publisher]
J
Dermatol Case Rep. 2012 Mar 27;6(1):8-13.
Variable
clinical presentations of Classic Kaposi Sarcoma in Turkish
patients.
Altunay
I, Kucukunal
A, Demirci
GT, Ates
B.
Source
Department of
Dermatology, Sisli Etfal Training And Research Hospital, Istanbul,
Turkey.
Abstract
BACKGROUND:
Kaposi
sarcoma (KS) is a vascular neoplasm with multicentric cutanenous and
extracutaneous involvements, which was first described by Moriz Kaposi in 1872.
Since then, different epidemiological clinical and histopathological variants
of this neoplasm have been identified. Classic Kaposi sarcoma (CKS) is one of
four main clinico-epidemiologiologic variants. characteristics of the
disease.
MATERIALS
AND METHODS:
Four
Turkish inpatients with CKS were evaluated in the study. All medical history
and clinical data were noted. A screening immunodeficiency workup were
performed for all patients. HHV-8 immunofluorescence testing on the specimens
and ELISA test for human immunodeficiency virus (HIV 1 and 2) were performed.
Pulmonary X ray graphies and computurized tomography (CT) scan were applied.
Stage of the tumor was determined, in each case, according to the
classification system proposed by Brambilla et al in 2003.
RESULTS:
All
patients are positive for HHV-8. They were all immunocompetent and negative for
HIV1 and HIV2. The first patient was unusual for morphological presentation of
several verrucoid lesions that was evaluated as verrucoid KS. He was considered
stage IB CKS. The patient 2 was a young man and the course of KS seemed
unexpectedly aggressive for CKS. His clinical appearence seemed us to be a
patient with AIDSassociated KS. The patient was evaluated as stage IVB CKS. Our
third patient had also prominent lymphedema associated with bluish
discoloration on the toes and fingers, suggesting a diagnosis of peripheral
vascular disorder. He was diagnosed as stage IIIB CKS. The fourth case was
interesting for very extensive lesions involving big sized plaques and also the
existence of mucosal lesion. The patient was diagnosed as stage IVB
CKS.
CONCLUSIONS:
It seems
that the reports of exceptional cases of KS are accumulating. Data from various
cases should be collected and perhaps, novel clinical classifications should be
considered
PMID: 22514583
[PubMed - in process] PMCID: PMC3322103
May 12,
2012
Cancer
Manag Res. 2012;4:121-7. Epub 2012 Apr 27.
Axillary
dissection in primary breast cancer: variations of the surgical technique and
influence on morbidity.
Wojcinski
S, Nuengsri
S, Hillemanns
P, Schmidt
W, Deryal
M, Ertan
K, Degenhardt
F.
Source
Franziskus
Hospital, Department of Obstetrics/Gynecology, Bielefeld, Germany.
Abstract
Lymphedema of the
arm is the most common and impairing complication after breast cancer surgery
with axillary lymph node dissection (ALND). Our prospective study evaluated the
effect of two different surgical techniques for ALND on postoperative
morbidity. Patients were scheduled to undergo ALND. Patients in group 1 (n =
17) underwent the most common and standard technique of ALND, which uses sharp
dissection of the tissue and subsequent electro-coagulation of bleedings.
Patients in group 2 (n = 17) underwent a modified standard technique of ALND
with clamping and ligatures of all resection margins. Postoperative wound
secretion was quantified and patients were followed up for 6 months to assess
long-term morbidity. The variations in surgical technique had no significant
influence on the outcome variables. However, patients in group 2 showed a
tendency to less wound secretion (713 versus 802 mL; P = nonsignificant), a
decreased rate of immediate postoperative seromas (11.8 versus 23.5%; P =
nonsignificant) and less lymphedema after 3 months (29.4 versus 41.2%; P =
nonsignificant). Moreover, the number of resected lymph nodes correlated with
the total amount of drained fluid (P = 0.006), the duration of the drain (P =
0.015), and the risk for the development of lymphedema after 3 months (P =
0.016). The described variations in surgical technique had no influence on the
outcomes of the patients. The number of resected axillary lymph nodes remains
the most important risk factor for treatment-related morbidity. Therefore, a
well-balanced choice of the extent of the axillary dissection should be the
surgeon's main concern.
PMID:
22570566 [PubMed - in process] PMCID: PMC3346198
J
Dermatol. 2012 May 9. doi: 10.1111/j.1346-8138.2012.01560.x.
[Epub ahead of print]
Lymphostatic
xanthomatosis: Localized xanthomas in primary lymphedema.
Danz
B, Stadie
V, Marsch
WC, Fiedler
E.
Source
Department of
Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle
(Saale), Germany.
PMID:
22568787 [PubMed - as supplied by publisher]
Surg
Today. 2012 May 8. [Epub ahead of print]
Primary
lymphedema complicated by weeping chylous vesicles in the leg and scrotum:
report of a case.
Suehiro
K, Morikage
N, Murakami
M, Yamashita
O, Hamano
K.
Source
Division
of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi
University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi,
755-8505, Japan, [email protected].
Abstract
We
report a case of primary lymphedema complicated by leaking chylous vesicles in
the toe and scrotum, caused by lymphangiectasia, which was eventually managed
with lymphaticovenular anastomoses after conservative treatments proved
ineffective. The patient was a 25-year-old man with a 5-year history of massive
swelling with chylous weeping of his right leg and scrotum.
Lymphangioscintigraphy (LAS) showed dilated iliac lymph trunks causing lymph
reflux. Although he was instructed in standard methods of complex therapy, it
did not alleviate his symptoms. Because of the increasing frequency of
cellulitis, lymphatic surgery was finally indicated. The operation consisted of
lymphaticovenous anastomoses (LVA) in the ankle and groin, using a
super-micro-surgical technique. After surgery, his symptoms resolved and have
been controlled by self-care. Thus, early LAS to confirm the dilated iliac
lymph trunks causing lymph reflux, followed by LVA might be beneficial for the
management of this disease.
PMID:
22565851 [PubMed - as supplied by publisher]
Nurs
Res. 2012 May 4. [Epub ahead of print]
Self-Management
of Lymphedema: A Systematic Review of the Literature From 2004 to
2011.
Ridner
SH, Fu
MR, Wanchai
A, Stewart
BR, Armer
JM, Cormier
JN.
Source
Sheila
H. Ridner, PhD, RN, FAAN, is Associate Professor, School of Nursing, Vanderbilt
University, Nashville, Tennessee. Mei R. Fu, PhD, RN, ACNS-BC, is Assistant
Professor, College of Nursing, New York University. Ausanee Wanchai, RN, is
Graduate Research Assistant; Bob R. Stewart, EdD, is Professor Emeritus; and
Jane M. Armer, PhD, RN, FAAN, is Professor, Sinclair School of Nursing,
University of Missouri, Columbia. Janice N. Cormier, MD, MPH, is Associate
Professor, MD Anderson Cancer Center, University of Texas,
Houston.
Abstract
BACKGROUND:
Little
is known about the effectiveness of activities used to self-manage
lymphedema.
OBJECTIVE:
The aim
of this study was to evaluate the level of evidence of peer-reviewed lymphedema
self-care literature published from January 2004 to May 2011.
METHODS:
Eleven
major medical databases were searched. Articles were selected for inclusion or
exclusion into the category of self-management of lymphedema by topic experts.
The definition of self-management included activities that individuals initiate
and perform for themselves without the assistance of others. Articles were
scored according to the Oncology Nursing Society's Putting Evidence Into
Practice levels of evidence.
RESULTS:
Sixteen
articles met criteria for inclusion in this review, with self-management as the
independent variable. Ten categories of self-management were established
subsequently and articles were classified by levels of evidence. In these
categories, no self-management studies were rated as "recommended for
practice," 2 studies were rated "likely to be effective," none was rated
"benefits balanced with harms," 7 were rated "effectiveness not established,"
and 1 was rated "effectiveness unlikely."
DISCUSSION:
Few
studies included measures of outcomes associated with lymphedema, and there was
a scarcity of randomized controlled trials in lymphedema self-management. A
demonstrated need exists for the design and testing of self-management
interventions that include appropriate outcome measures.
PMID:
22565103 [PubMed - as supplied by publisher]
Rev
Esp Med Nucl. 2012 May 5. [Epub ahead of print]
Lymphoscintigraphy
for differential diagnosis of peripheral edema: Diagnostic yield of different
scintigraphic patterns.
[Article
in English, Spanish]
Infante
JR, García
L, Laguna
P, Durán
C, Rayo
JI, Serrano
J, Domínguez
ML, Sánchez
R.
Source
Servicio
de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz,
España.
Abstract
Edema of
the limbs is a common reason for medical consultation, for which the
lymphoscintigraphy is considered to be a reliable method for its differential
diagnosis.
OBJECTIVE:
To
evaluate the usefulness of radionuclide studies in the differential diagnosis
of edema, and the diagnostic yield of different scintigraphic
patterns.
MATERIAL
AND METHODS:
A total
of 61 patients, mean age 43 years, referred to our Department in the last three
years for suspected lymphoedema, were considered. One patient was discarded due
to lack of diagnosis, 56 had lower limb edema and 4 upper limb edema. After
intradermal injection of two doses of (99m)Tc-nanocolloid, scintigraphic scans
were made at 30 and 120minutes. The final diagnosis was based on imaging tests,
clinical course, and response to treatment. We calculated the parameters of the
diagnostic yield of four different scintigraphic patterns (presence of dermal
backflow, asymmetry-alteration in inguinal/axillary nodes, presence of
collateral pathways, and visualization of intermediate lymph nodes),
considering them individually and jointly.
RESULTS:
The best
diagnostic yield was achieved by considering dermal backflow and asymmetry in
inguinal/axillary nodes (accuracy 88.9%, specificity 96.4%, PPV 95.5%).
Evaluation of intermediate lymph nodes and presence of collateral pathways
contributed little to the diagnostic yield, showing poor sensitivity and high
false positive rates.
CONCLUSION:
The
lymphoscintigraphy had high diagnostic yield, allowing early treatment of
lymphœdema. The dermal backflow and asymmetry in inguinal/axillary nodes had
the greatest diagnostic accuracy. Evaluation of intermediate lymph nodes and
visualization of collateral pathways contributed little to improving the
diagnosis.
Copyright © 2011
Elsevier España, S.L. y SEMNIM. All rights reserved.
PMID:
22564851 [PubMed - as supplied by publisher]
J
Am Coll Surg. 2012 May 3. [Epub ahead of print]
Surgical
Management of Inoperable Lymphedema: The Re-emergence of Abandoned
Techniques.
Doscher
ME, Herman
S, Garfein
ES.
Source
Department of
Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical
Center, Bronx, NY.
PMID:
22560317 [PubMed - as supplied by publisher]
May
23, 2012
Jones
J
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PMID: 23266421 [PubMed -
Publisher]
J Mal Vasc. 2011 Dec 21. [Epub ahead of print]
[Designing a therapeutic education program for patients with lymphedema: Live with lymphedema.]
[Article in French]
Blaise S, Villemur B, Richaud C, Rastel D, Bucci B, Evra V, Bouchet JY; les membres du réseau
GRANTED, Satger B.
Source
Department of Vascular Medicine, clinique de médecine vasculaire, Grenoble University Hospital, BP 217,
38043 Grenoble cedex 09, France; Réseau GRANTED, 38400 Saint-Martin-d'Hères, France.
Abstract
BACKGROUND:
Lymphedema is a chronic condition considered to be rare in its primary form and potentially frequent in
women after breast surgery for cancer: 27,000new cases annually. Therapeutic management is a serious
challenge. In France, the health authorities (Haute Autorité de santé [HAS]) have recently proposed that
appropriate management practices for lymphedema include "patient education". The HAS and the National
institute for health care prevention and education also published a methodology guide devoted to structuring
a therapeutic education program for patients with chronic disease. Current hospital regulations state that this
education program is part of the care to be delivered to patients with chronic disease and that it must comply
with the national directives. The purpose of our present work was to present the concept and the contents of
a patient education program entitled "Live with lymphedema" designed for patients with lymphedema and
developed within the inpatient-outpatient network GRANTED in Sud-Isère.
METHODS:
A standard detailed educative approach was applied. It was designed after the educational program for
patients with lower limb arterial occlusive disease authorized by the Rhône-Alpes regional health agency. It
was adapted to the specific problematic of patients with lymphedema, including medical management,
rehabilitation, dermatology and nutritional aspects. It was developed in cooperation with patients and favors
local associative actions.
RESULTS:
The specifically structured program included three therapeutic education consultations and five workshops.
Less than one year after its institution, more than 30 patients have participated in the program.
DISCUSSION:
We report a structured patient education program designed for patients with lymphedema. This program
was authorized by the Rhône-Alpes regional health agency in March 2011and is in compliance with the
national directives and HAS guidelines.
Copyright © 2011 Elsevier Masson SAS. All rights reserved.
PMID: 22196687 [PubMed - as supplied by publisher]
January 9, 2012
J Cutan Pathol. 2012 Jan;39(1):52-5. doi: 10.1111/j.1600-0560.2011.01785.x.
Lymphangiosarcoma arising after 33 years within a background of chronic filariasis: a case report with
review of literature.
Krishnamoorthy N, Viswanathan S, Rekhi B, Jambhekar NA.
Source
Department of Pathology, Tata Memorial Hospital, Mumbai, India.
Abstract
Cutaneous angiosarcoma or lymphangiosarcoma represents an uncommon aggressive tumor known to arise
on a background of chronic lymphedema secondary to various etiologies, principally following surgery or
irradiation. There have been rarely reported cases of angiosarcoma following infective conditions that
eventuate with lymphatic stasis. We report a case of angiosarcoma arising after 33 years within a
background of filariasis. Awareness of this association can lead to early diagnosis and appropriate treatment
of this potentially fatal malignant tumor. Krishnamoorthy N, Viswanathan S, Rekhi B, Jambhekar NA.
Lymphangiosarcoma arising after 33 years within a background of chronic filariasis: a case report with
review of literature.
Copyright © 2011 John Wiley & Sons A/S.
PMID: 22211335 [PubMed - in process]
Med Oncol. 2011 Dec;28 Suppl 1:22-30. Epub 2010 Sep 9.
Whether drainage should be used after surgery for breast cancer? A systematic review of randomized
controlled trials.
He XD, Guo ZH, Tian JH, Yang KH, Xie XD.
Source
Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199
Donggang West Road, Lanzhou, Gansu, 730000, China, [email protected].
Abstract
A systematic review of randomized controlled trials (RCTs) was conducted to evaluate whether patients
benefit from the suction drainage after axillary lymph node dissection (ALND) in breast cancer surgery.
RCTs of drainage versus no drainage after ALND in women with breast cancer were retrieved from
PubMed, EMBASE, Cochrane Library and Chinese Biomedical database. Two authors independently
assessed the quality of included trials and extracted data. Odds ratio (OR) for dichotomous outcomes and
mean difference (MD) for continuous outcomes were presented with 95% confidence intervals (CI). A total
of 1115 titles were indentified from the databases; 1109 obvious irrelevant studies were excluded by
examining the titles, abstracts, full texts because of duplicates, no RCT, different modality of drainage, drain
for lymphedema, application of fibrin sealant and so on. And then, only 6 RCTs to compare drainage with
no drainage after ALND in breast cancer surgery were included in the systematic review and a total of 585
patients were included in the pathological diagnosis of breast cancer in women before surgery, management
by ALND with or without addition surgical procedures. The study demonstrated that insertion of a drain in
the axilla after breast cancer surgery resulted in a statistically significant reduction in the rate of seroma (OR
= 0.36, 95% CI, 0.16 to 0.81, P = 0.01), the volume of aspiration (MD = -100.10, 95% CI, -174.36 to
-25.85, P = 0.008), or the frequency of seroma aspiration (MD = -1.03, 95% CI, -1.35 to -0.71, P <
0.00001), but prolonged the length of hospital stay (MD = 1.52, 95% CI, 0.36 to 2.68, P = 0.01). There
was no statistically significant difference in the incidence of wound infection (OR = 0.67, 95% CI, 0.34 to
1.32, P = 0.25) between drainage group and no drainage group. Based on the current evidence, insertion of
a drain in the axilla following ALND in breast cancer surgery effectively decreased seroma formation,
volume of aspiration as well as the frequency of seroma aspiration without increasing the incidence of wound
infection, but extending their stay in hospital.
PMID: 20827578 [PubMed - in process]
J Vasc Surg. 2011 Dec 29. [Epub ahead of print]
Technique, results, and postoperative patency of lymphaticovenous side-to-end anastomosis in peripheral
lymphedema.
Maegawa J, Yabuki Y, Tomoeda H, Hosono M, Yasumura K.
Source
Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan.
Abstract
OBJECTIVE:
Lymphaticovenous anastomosis has been used for patients with peripheral lymphedema. However, the
efficacy of this procedure is controversial due to a lack of evidence regarding postoperative patency. We
sought to determine midterm postoperative patency of lymphaticovenous side-to-end anastomoses
(LVSEAs) using indocyanine green fluorescence lymphography.
METHODS:
This was a retrospective observational study set in a teaching hospital. Of 107 patients with chronic
lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses) consented to fluorescence
lymphography and comprised the study cohort. The intervention consisted of a microsurgical LVSEA
performed with a suture-stent method. Patients also had preoperative and postoperative complex
decongestive physiotherapy. Anastomosis patency was assessed using indocyanine green fluorescence
lymphography ≥6 months after surgery. Patency rates were calculated using Kaplan-Meier analysis. We
assessed volume reduction on the operated-on limb and compared this between patients in whom
anastomoses were patent and those in whom anastomoses were not obviously patent.
RESULTS:
Patency could be evaluated only at the dorsum of the foot, ankle, and lower leg because the near-infrared
rays emitted by the special camera used could not penetrate the deep subcutaneous layer containing
collective lymphatics in areas such as the thigh. Several patterns were observed on fluorescence
lymphography: straight, radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12
months and 36% at 24 months after surgery. No significant difference in volume change of the affected limb
was seen between the 34 patients with patent anastomosis (600 ± 969 mL) and the 24 patients without
obvious evidence of patency (420 ± 874 mL).
CONCLUSIONS:
Although further study is required to determine factors leading to anastomotic obstruction and to optimize
the results of microlymphatic surgery, the present LVSEA technique appears promising.
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
PMID: 22209609 [PubMed - as supplied by publisher]
Case Rep Dermatol. 2011 Sep;3(3):251-8. Epub 2011 Nov 30.
A case of yellow nail syndrome with dramatically improved nail discoloration by oral clarithromycin.
Suzuki M, Yoshizawa A, Sugiyama H, Ichimura Y, Morita A, Takasaki J, Naka G, Hirano S, Izumi S,
Takeda Y, Hoji M, Kobayashi N, Kudo K.
Source
Department of Respiratory Medicine, National Center for Global Health and Medicine, Infection, Oncology,
Nippon Medical School, Tokyo.
Abstract
An 80-year-old woman was admitted to our hospital with pneumonia and exacerbation of sinobronchial
syndrome (SBS). She presented with yellow discoloration of the nail beds of all fingers and toes, and her
nails were recognized as growing slowly. Chest X-ray revealed bronchiectasis in the bilateral lower lobe and
bilateral pleural effusion. We diagnosed her as having yellow nail syndrome (YNS), based on the triad of
yellow nails, lymphedema, and lung disease. After treatment with antibiotics [ampicillin/sulbactam and
clarithromycin (CAM)] for pneumonia and SBS, her general condition improved, and the yellow nails
disappeared in some fingers. When she was previously treated with 200 mg CAM for SBS, her yellow nails
had not shown improvement. This time, her yellow nails improved after treatment with 400 mg CAM. The
literature reports vitamin E, zinc, and topical corticosteroid plus active vitamin D3 to be effective in the
treatment of yellow nails. Two studies have reported treatment for YNS using CAM, though they found a
lack of efficacy. Thus, the present case is the first to report improved yellow nails using CAM alone. We
conclude that not only SBS and lung disease but also YNS were improved by treatment with 400 mg CAM.
PMID: 22220146 [PubMed - in process] PMCID: PMC3250669
BMC Cancer. 2012 Jan 4;12(1):6. [Epub ahead of print]
Systematic review: conservative treatments for secondary lymphedema.
Oremus M, Dayes I, Walker K, Raina P.
Abstract
ABSTRACT:
BACKGROUND:
Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The
optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary
lymphedema, as well as harms related to these treatments.
METHODS:
We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, AMED, and
CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized
controlled trials or observational studies (with comparison groups) that reported primary effectiveness data
on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in
tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the
results descriptively and discussed similarities with the English-language studies.
RESULTS:
Thirty-six English-language and eight non-English-language studies were included in the review. Most of
these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's
chronicity, lengths of follow-up in most studies were under six months. Many trial reports contained
inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational
studies did not control for confounding. Many studies showed that active treatments reduced the size of
lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and
protocols, and outcome measures, prevented us from assessing whether any one treatment was superior.
This heterogeneity also precluded us from statistically pooling results. Harms were rare (<1% incidence) and
mostly minor (e.g., headache, arm pain).
CONCLUSIONS:
The literature contains no evidence to suggest the most effective treatment for secondary lymphedema.
Harms are few and unlikely to cause major clinical problems.
PMID: 22216837 [PubMed - as supplied by publisher]
January 15, 2012
J Rehabil Res Dev. 2011;48(10):1261-8.
Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy
patients: Pre-post intervention study.
Gautam AP, Maiya AG, Vidyasagar MS.
Source
Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal University, Manipal-
576104, Karnataka, India. Email: [email protected]. [email protected].
Abstract
Lymphedema is a debilitating complication following mastectomy, affecting the arm functions and quality of
life (QOL) of breast cancer patients. Studies have shown the beneficial effects of upper-limb exercises on
lymphedema in clinical set tings. However, there is a dearth of evidence regarding the effect of home-based
exercises on lymphedema; therefore, we examined the effect of a home-based exercise program on
lymphedema and QOL in postmastectomy patients. Thirty-two female postmastectomy lymphedema
patients participated in an individualized home-based exercise program for 8 weeks. Arm circumference,
arm volume, and QOL (36-Item Short Form Health Survey) were measured before and after the program.
Data were analyzed with the use of paired t-tests for circumferential and volumetric measures and Wilcoxon
signed ranks tests for QOL. Significance level was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05
/5 = 0.01). Analysis showed a statistically significant improvement in the affected upper-limb circumference
and volume (~122 mL reduction, p < 0.001) and in the QOL scores (p < 0.001) at the end of the home-
based exercise program. The individualized home-based exercise program led to improvement in affected
upper-limb volume and circumference and QOL of postmastectomy lymphedema patients.
PMID: 22234669 [PubMed - in process]
Ann Surg. 2012 Jan 9. [Epub ahead of print]
Microvascular Breast Reconstruction and Lymph Node Transfer for Postmastectomy Lymphedema Patients.
Saaristo AM, Niemi TS, Viitanen TP, Tervala TV, Hartiala P, Suominen EA.
Source
From the Department of Plastic Surgery, Turku University Central Hospital, Turku, Finland.
Abstract
OBJECTIVE:
Postoperative lymphedema after breast cancer surgery is a challenging problem. Recently, a novel
microvascular lymph node transfer technique provided a fresh hope for patients with lymphedema. We
aimed to combine this new method with the standard breast reconstruction.
METHODS:
During 2008-2010, we performed free lower abdominal flap breast reconstruction in 87 patients. For all
patients with lymphedema symptoms (n = 9), we used a modified lower abdominal reconstruction flap
containing lymph nodes and lymphatic vessels surrounding the superficial circumflex vessel pedicle.
Operation time, donor site morbidity, and postoperative recovery between the 2 groups (lymphedema
breast reconstruction and breast reconstruction) were compared. The effect on the postoperative lymphatic
vessel function was examined.
RESULTS:
The average operation time was 426 minutes in the lymphedema breast reconstruction group and 391
minutes in the breast reconstruction group. The postoperative abdominal seroma formation was increased in
patients with lymphedema. Postoperative lymphoscintigraphy demonstrated at least some improvement in
lymphatic vessel function in 5 of 6 patients with lymphedema. The upper limb perimeter decreased in 7 of 9
patients. Physiotherapy and compression was no longer needed in 3 of 9 patients. Importantly, we found
that human lymph nodes express high levels of endogenous lymphatic vessel growth factors. Transfer of the
lymph nodes and the resulting endogenous growth factor expression may thereby induce the regrowth of
lymphatic network in the axilla. No edema problems were detected in the lymph node donor area.
CONCLUSION:
Simultaneous breast and lymphatic reconstruction is an ideal option for patients who suffer from
lymphedema after mastectomy and axillary dissection.
PMID: 22233832 [PubMed - as supplied by publisher]
Int Angiol. 2011 Dec;30(6):527-33.
Dose finding for an optimal compression pressure to reduce chronic edema of the extremities.
Partsch H, Damstra RJ, Mosti G.
Source
Private Practictioner, Vienna, Austria - [email protected].
Abstract
AIM:
The optimal pressure to reduce chronic extremity swelling is still a matter of debate. The aim of this paper
was to measure volume reduction of a swollen extremity depending on the amount of pressure exerted by
compression stockings and inelastic bandages.
METHODS:
Thirty-six patients with unilateral breast cancer related arm lymphedema were investigated in a lymph clinic
in the Netherlands, 42 legs with chronic edema of the lower extremities were examined in a phlebological
centre in Italy. The arm-patients were randomized to receive inelastic arm bandages with a pressure
between 20-30 mmHg or 44-68 mmHg. The leg patients were either treated with compression stockings
(23-32 mmHg) or with inelastic bandages (pressure 53-88 mmHg). Water-displacement volumetry and
measurement of leg circumference was performed before and after compression.
RESULTS:
In the arm-patients low pressure after 2 hours achieved a higher degree of volume reduction (-2.3%, 95%
CI 1.0-3.6) than high pressure (-1.5%, 95% CI 0.2-2.8) (n.s.). In patients with leg edema compression
stockings in the range between 20 and 40 mmHg showed a positive correlation between exerted pressure
and volume reduction, bandages applied with an initial resting pressure of more than 60 mm Hg resulted in a
decreasing volume reduction.
CONCLUSION:
There is obviously an upper limit beyond which further increase of compression pressure seems
counterproductive. For inelastic bandages this upper limit is around 30 Hg on the upper and around 50-60
mmHg on the lower extremity.
PMID: 22233613 [PubMed - in process]
Int Angiol. 2011 Dec;30(6):499-503.
The lymphovenous microsurgical shunts for treatment of lymphedema of lower limbs: indications in 2011.
Olszewski WL.
Source
Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of
Sciences, Warsaw, Poland - [email protected].
Abstract
The microsurgical lympho-venous shunts have become one of the generally accepted modalities in treatment
of limb lymphedema. This review highlight the indications for this procedure after over 40 years. This study
was based on the personal experience of one surgeon and on the review of the literature. Patients with
postinflammatory, postsurgical, idiopathic and hyperplastic lymphedema of lower limbs were included in the
study. Basing on the review of results of the last 40 years the contemporary indications are: 1) lymphedema
with local segmental obstruction but still partly patent distal lymphatics seen on functional lymphoscintigraphy
(standard walking or pneumatic compression) and without an active inflammatory process in the skin,
subcutaneous tissue and lymph vessels (DLA-dermatolymphangioadenitis); 2) classified according the
etiology of lymphedema, this operation can bring about satisfactory results in cases of hyperplastic,
postsurgical and postinflammatory types of lymphedema, whereas primary idiopathic lymphedema of non-
genetic type should be treated with conservative means, although in a small number of cases an improvement
was observed after lympho-venous shunting as long as 10 years. Microsurgical lymph node or lymphatic
vessel to vein shunts have their established position among the therapy modalities for lymphedema of lower
limbs in a strictly defined group of patients using lymphoscintigraphic imaging.
PMID: 22233610 [PubMed - in process]
J Obstet Gynaecol Res. 2012 Jan 10. doi: 10.1111/j.1447-0756.2011.01727.x. [Epub ahead of print]
Re-consideration of lymphadenectomy for stage Ib1 cervical cancer.
Kato H, Todo Y, Suzuki Y, Ohba Y, Minobe SI, Okamoto K, Yamashiro K, Sakuragi N.
Source
Divisions of Gynecologic Oncology Pathology, National Hospital Organization, Hokkaido Cancer Center,
Department of Obstetrics and Gynaecology, Hokkaido University School of Medicine, Sapporo, Japan.
Abstract
Aim: Because of less frequent lymph node metastasis and parametrial involvement, patients with stage Ib1
cervical cancer may benefit from a curtailment of surgery. We retrospectively investigated the distribution of
lymph node metastasis in stage Ib1 patients. After comparing the data with that of higher stages and sentinel
lymph node navigation (SLNN), the appropriate extent of lymphadenectomy (LA) in stage Ib1 disease was
newly suggested. Method: A total of 303 patients underwent a radical hysterectomy with LA and the
region-specific rate of node metastasis was obtained. SLNN was performed for 50 patients using (99m) Tc
phytate injection into the cervix and intra-operative detection by a gamma-probe. Results: The rate of node
metastasis and the average number of nodes removed, respectively, were: 23/189 (12.2%), 65.2 in stage
Ib1; 14/47 (29.8%), 70.1 in stage Ib2; 7/20 (35.0%), 78.2 in stage IIa; and 26/47 (55.3%), 69.1 in stage
IIb. Lymph node metastasis in stage Ib1 was prevalent in the obturator (Ob) (9.5%), inter-iliac (Ii) (4.9%),
superficial common iliac (Sc) (2.3%), cardinal (Cd) (2.2%) and external iliac (Ei) (1.7%) nodes. In patients
with upper stage disease, lymph node metastasis could occur in all lymph nodes. In stage Ib1 patients, the
sentinel nodes were assigned only to the Ob, Ii, Sc and Ei nodes, being identical with frequent metastatic
sites in stage Ib1 (excluding Cd). Conclusion: The extent of LA can be routinely completed with the
removal of Ob, Ii, Ei, Sc and Cd nodes, which may provide a higher quality of life, including the reduction of
lymphedema by preventing the removal of the inguinal nodes.
© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of
Obstetrics and Gynecology.
PMID: 22229927 [PubMed - as supplied by publisher]
January 19, 2012
Br J Community Nurs. 2011 Oct;16 Suppl:S4-S12.
Use of compression bandaging in managing chronic oedema.
Todd M.
Abstract
Compression bandaging is a major component of most community nurses' practice in the management of
venous leg ulcers. For lymphoedema practitioners, compression therapy is the linchpin in the management of
chronic oedema and lymphoedema. There are several types of compression bandage available, with some
being part of a recognized system of compression delivery. In order for nurses to select and apply the
correct type and level of compression bandaging, there needs to be a substantial level of knowledge of the
principles of compression theory and competence in the application of bandaging. There are also issues
surrounding patient concordance, and nurses need to be able to assess and address any barriers to
concordance to ensure the most effective regimen of treatment is delivered.
PMID: 22240574 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16 Suppl:S28-9.
An interview with Karen Morgan.
Morgan K.
Abstract
Karen Morgan is Lymphoedema Clinical Nurse Specialist, Abertawe Bro Morgannwg University Health
Board (ABMUHB) Lymphoedema
Health Board (ABMUHB) Lymphoedema Clinic.
PMID: 22240571 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16 Suppl:S22-7.
An integrative treatment for lower limb lymphoedema in India.
Bose KS, Aggithaya GM.
Abstract
Lymphoedema is a chronic disease which requires frequent visits to therapist in developed countries. In most
developing countries, it is the disease of rural area caused by lymphatic filariasis (LF). The aim is to develop
a low cost home-based self-care protocol using the combinations of locally available treatment modalities.
The integrated treatment has the elements of therapy from modern dermatology, Ayurveda and yoga,
administered by the doctors of respective system of medicine on the basis of pathophysiological
understanding in lymphology. The sequence of treatment components that each patient followed is skin
wash, soaking the limb in herbal Phanta solution, care of bacterial entry points, a set of yoga exercises,
Indian manual lymph drainage and compression bandaging. A total of 1209 limbs in 889 patients were
treated using integrated medicine during October 2004-May 2011. All patients received an initial 14 days of
supervised treatment and training for self-care and home-based treatment to be continued for life. Patients
followed up twice. Volume reduction for large sized limbs at 3 months following treatment was 41.1%, with
a confidence interval (CI) of 5.7-6.9 litres. Reduction was 25.7 % for small limbs with a CI of 1.5-1.7 litres.
Entry points were present in 86.2% limbs at baseline and in 71.7% limbs at the end of 3 months.
Inflammatory episodes reduced from 80%-8.6%.
PMID: 22240570 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16 Suppl:S20-1.
Lymphangioma or lymphangiectasia? An update for lymphoedema nurses.
Pike C.
Abstract
This article is prompted by a recent enquiry to the British Lymphology Society, expressing uncertainty over
the definition of lymphangioma. It may be prudent to publicize information on this potentially confusing area
more widely, as clinicians need to know what lymphangioma is, or is not.
PMID: 22240569 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16 Suppl:S14-9.
Non-concordance in lymphorrhea of the lower limbs: a case study.
Jones J.
Abstract
Obesity and a sedentary lifestyle are fast becoming major problems for not only the NHS as a whole but
also the lymphoedema therapist. Lymphorrhea in this group of patients can be a recurrent problem, causing
strain on already stretched services and on the patient and their family. What happens when the ideas of the
patient and therapist regarding treatment are not the same? This article aims to address these issues by
looking at a case study of such a patient, and the surprising outcome that resulted when the patient got his
own way.
PMID: 22240568 [PubMed - in process]
January 22, 2012,
Br J Community Nurs. 2011 Oct;16 Suppl:S22-7.
An integrative treatment for lower limb lymphoedema in India.
Bose KS, Aggithaya GM.
Abstract
Lymphoedema is a chronic disease which requires frequent visits to therapist in developed countries. In most
developing countries, it is the disease of rural area caused by lymphatic filariasis (LF). The aim is to develop
a low cost home-based self-care protocol using the combinations of locally available treatment modalities.
The integrated treatment has the elements of therapy from modern dermatology, Ayurveda and yoga,
administered by the doctors of respective system of medicine on the basis of pathophysiological
understanding in lymphology. The sequence of treatment components that each patient followed is skin
wash, soaking the limb in herbal Phanta solution, care of bacterial entry points, a set of yoga exercises,
Indian manual lymph drainage and compression bandaging. A total of 1209 limbs in 889 patients were
treated using integrated medicine during October 2004-May 2011. All patients received an initial 14 days of
supervised treatment and training for self-care and home-based treatment to be continued for life. Patients
followed up twice. Volume reduction for large sized limbs at 3 months following treatment was 41.1%, with
a confidence interval (CI) of 5.7-6.9 litres. Reduction was 25.7 % for small limbs with a CI of 1.5-1.7 litres.
Entry points were present in 86.2% limbs at baseline and in 71.7% limbs at the end of 3 months.
Inflammatory episodes reduced from 80%-8.6%.
PMID: 22240570 [PubMed - in process]
January 22, 2012
J Cancer Surviv. 2012 Jan 13. [Epub ahead of print]
Community-based exercise program effectiveness and safety for cancer survivors.
Rajotte EJ, Yi JC, Baker KS, Gregerson L, Leiserowitz A, Syrjala KL.
Source
Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-220, P.
O. Box 19024, Seattle, WA, 98109, USA.
Abstract
PURPOSE:
Clinical trials have demonstrated the benefits of exercise for cancer survivors. This investigation determined
the effectiveness and safety of a disseminated community-based exercise program for cancer survivors who
had completed treatment.
METHODS:
Personal trainers from regional YMCAs received training in cancer rehabilitation and supervised twice-a-
week, 12-week group exercise sessions for survivors. At baseline and post-program, validated measures
assessed patient-reported outcomes (PRO) and physiologic measurements.
RESULTS:
Data were collected from 221 survivors from 13 YMCA sites and 36 separate classes. All participants had
data available at one time point, while matched baseline and post-program PRO and physiologic data were
available for 85% (N = 187). Participants with matched data were largely female (82%), with mean age of
58 (range, 28-91 years). Time since diagnosis ranged from 1 to 48 (mean, 5.6 years), and mean time since
last treatment was 3.0 (range, 1-33 years). Physiological improvements were significant in systolic (P <
0.001) and diastolic (P = 0.035) blood pressure, upper and lower body strength, the 6-min walk test (P =
0.004), and flexibility (P < 0.001). Participants reported improvements in overall health-related quality of life
(P < 0.001), social support (P = 0.019), body pain (P = 0.016), fatigue (P < 0.001), insomnia (P < 0.001),
and overall musculoskeletal symptoms (P = <0.001). Few injuries or lymphedema events occurred during
classes.
CONCLUSIONS:
Community-based exercise groups for cancer survivors of mixed diagnoses and ages, who have completed
active treatment, have physiologic and psychosocial benefits, and are safe. IMPLICATIONS FOR
CANCER SURVIVORS: Survivors may expect significant benefit from participating in a community-based
exercise program tailored to meet their individual needs as a survivor.
PMID: 22246463 [PubMed - as supplied by publisher]
Hematol Oncol Clin North Am. 2012 Feb;26(1):169-94. Epub 2011 Dec 16.
Contemporary quality of life issues affecting gynecologic cancer survivors.
Carter J, Penson R, Barakat R, Wenzel L.
Source
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
10065, USA; Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York,
NY 10065, USA.
Abstract
Regardless of cancer origin or age of onset, the disease and its treatment can produce short- and long-term
sequelae (ie, sexual dysfunction, infertility, or lymphedema) that adversely affect quality of life (QOL). This
article outlines the primary contemporary issues or concerns that may affect QOL and offers strategies to
offset or mitigate QOL disruption. These contemporary issues are identified within the domains of sexual
functioning, reproductive issues, lymphedema, and the contribution of health-related QOL in influential
gynecologic cancer clinical trials.
Copyright © 2012 Elsevier Inc. All rights reserved.
PMID: 22244668 [PubMed - in process]
MEDNEWS DOCS:
January 3, 2012
New Treatment Direction For Rare Metabolic Diseases
A research team led by biochemist Scott Garman at the University of Massachusetts Amherst has
discovered a key interaction at the heart of a promising new treatment for a rare childhood metabolic
disorder known as Fabry disease. The discovery will help understanding of other protein-folding disorders
such as Alzheimer's, Parkinson's and Huntington's diseases, as well. Findings are featured as the cover story
in the current issue of Chemistry & Biology.
People born with Fabry disease have a faulty copy of a single gene that codes for the alpha-galactosidase (α-
GAL) enzyme, one of the cell's "recycling" machines. When it performs normally, α-GAL breaks down an
oily lipid known as GB3 in the cell's recycling center, or lysosome. But when it underperforms or fails, Fabry
symptoms result. Patients may survive to adulthood, but the disorder leads to toxic lipid build-up in blood
vessels and organs that compromise kidney function or lead to heart disease, for example.
The faulty gene causes its damage by producing a misfolded protein, yielding an unstable, poorly functioning
α-GAL enzyme. Like origami papers, these proteins are unfolded to start and only become active when
folded into precise shapes. At present, enzyme replacement therapy (ERT) is the only FDA-approved
treatment for such lysosomal storage disorders as Fabry, Pompe and Gaucher diseases, but ERT requires a
complicated and expensive process to purify and replace the damaged α-GAL enzyme, and it must be
administered by a physician.
Instead of replacing the damaged enzyme, an alternative route called pharmacological chaperone (PC)
therapy is currently in Phase III clinical trials for Fabry disease. It relies on using smaller, "chaperone"
molecules to keep proteins on the right track toward proper folding, but their biochemical mechanism is not
well understood, says Garman.
Now, he and colleagues report results of a thorough exploration at the atomic level of the biochemical and
biophysical basis of two small molecules for potentially stabilizing the α-GAL enzyme. He says their use in
PC therapy could one day be far less expensive than the current standard, ERT, and can be taken orally.
This work, which improves knowledge of a whole class of molecular chaperones, represents the centerpiece
of UMass Amherst student Abigail Guce's doctoral thesis and was supported by the National Institutes of
Health. Other members of the team are graduate students Nat Clark and Jerome Rogich.
"The interactions we looked at are exactly the things occurring in the clinical trial right now," Garman says.
Further, "the same concept is now being applied to other protein-folding diseases such as Parkinson's and
Alzheimer's disease. Many medical researchers are trying to keep proteins from misfolding by using small
chaperone molecules. Our studies have definitely advanced the understanding of how to do that."
In their current paper, Garman and colleagues compare the ability of two small chaperone molecules,
galactose and 1-deoxygalactononjirimycin (DGJ) to stabilize the α-GAL protein, to help it resist unfolding in
different conditions such as high temperature and different pH levels.
They found that each chaperone has very different affinities: DGJ binds tightly and galactose binds loosely to
the α-GAL, yet they differ in only two atomic positions. "Tight is better, because you can use less drug for
treatment," Garman says. "We now can explain DGJ's high potency, its tight binding, down to individual
atoms."
In earlier studies as in the current work, the UMass Amherst team used their special expertise in X-ray
crystallography to create three-dimensional images of all atoms in the protein to understand how it carries
out its metabolic mission. They also found a new binding site for small molecules on human α-GAL that had
never been observed before.
Crystallography on the two chaperones bound to the α-GAL enzyme showed that a single interaction
between the enzyme and DGJ was responsible for DGJ's high affinity for the enzyme. Other experiments
also showed the ability of the 11- and 12-atom chaperones to protect the large, 6,600-atom α-GAL from
unfolding and degradation.
For the first time, by making a single change in one amino acid in protein, they forced the DGJ to bind
weakly, indicating that one atomic interaction is responsible for DGJ's high affinity.
"It was surprising to find these two small molecules that look very much the same have very different
affinities for this enzyme," says Garman, "and we now understand why. The iminosugar DGJ has high
potency due to a single ionic interaction with α-GAL. Overall, our studies show that this small molecule
keeps the enzyme from unfolding, or when it unfolds, the process happens more slowly, all of which you
need in treating disease."
The UMass Amherst team plans to next use the principles, assays and experiments they developed here on
enzymes defective in other human diseases to examine new therapies for them and related disorders.
JANUARY 9, 2012
Significant Cost Savings Associated With Emergence Of Prospective Surveillance Model As Standard Of
Care For Breast Cancer Treatment
Early diagnosis and treatment of breast cancer-related lymphedema by a physical therapist can significantly
reduce costs and the need for intensive rehabilitation, according to an article published in the January issue of
Physical Therapy (PTJ), the scientific journal of the American Physical Therapy Association (APTA).
The study, led by APTA member and spokesperson Nicole Stout, PT, MPT, CLT-LANA, compared a
prospective surveillance model with a traditional model of impairment-based care and examined the direct
treatment costs associated with each program. Treatment and supply costs were estimated based on the
Medicare 2009 physician fee schedule. Researchers estimated that treatment for breast cancer-related
lymphedema costs $636.19 a year when the prospective surveillance model was used vs $3,124.92 for
traditional treatment of advanced lymphedema.
The goal of a prospective surveillance model for cancer rehabilitation is to identify impairment at the earliest
onset to alleviate impairment or prevent it from progressing. Soon after diagnosis, a physical therapist will
perform a preoperative examination to establish a baseline level of function. Follow-up examinations are then
conducted postoperatively at 1 month and then 3-month intervals, for up to 1 year. In contrast, a traditional
model focuses on treating lymphedema once it has progressed and patients already have functional
limitations.
"This study begins to paint a picture of evidence showing that prevention of chronic conditions such as
lymphedema - using rehabilitation models of care - may result in significant cost savings," said Stout.
Breast cancer-related lymphedema is characterized by abnormal swelling of the arm and hand, which can be
disfiguring. A chronic condition, it is associated with decreased arm function, disability, and diminished
quality of life. If the condition is not diagnosed early and managed, a patient can be at risk for infection and
further shoulder complications.
In place for more than 10 years, the prospective surveillance model was developed at the National Naval
Medical Center in Bethesda - now part of the Walter Reed National Military Medical Center - and is the
standard of care for all patients diagnosed with breast cancer at the medical center. Several research articles
have been published demonstrating clinical effectiveness of the prospective surveillance model in reducing
lymphedema, shoulder morbidity, and fatigue, including the February 2010 article in the journal Breast
Cancer Research and Treatment.
Although further analysis of indirect costs and utility is necessary to fully assess cost effectiveness, the
prospective surveillance model is emerging as the standard of care for breast cancer treatment.
January 15, 2012
New, Noninvasive Way To Identify Lymph Node Metastasis
Using two cell surface markers found to be highly expressed in breast cancer lymph node metastases,
researchers at Moffitt Cancer Center, working with colleagues at other institutions, have developed targeted,
fluorescent molecular imaging probes that can non-invasively detect breast cancer lymph node metastases.
The new procedure could spare breast cancer patients invasive and unreliable sentinel lymph node (SLN)
biopsies and surgery-associated negative side effects.
Their study was published in a recent issue of Clinical Cancer Research (18:1), a publication of the
American Association for Cancer Research.
"The majority of breast cancer patients, up to 74 percent, who undergo SLN biopsy are found to be
negative for axillary nodal, or ALN, metastases," said corresponding author David L. Morse, Ph.D., an
associate member at Moffitt whose research areas include experimental therapeutics and diagnostic imaging.
"Determining the presence or absence of ALN metastasis is critical to breast cancer staging and prognosis.
Because of the unreliability of the SLN biopsy and its potential for adverse effects, a noninvasive, more
accurate method to assess lymph node involvement is needed."
The authors note that the postoperative complications to the SLN biopsy can include lymphedema, seroma
formation, sensory nerve injury and limitations in patient range of motion. In addition, biopsies fail to identify
disease in axillary lymph nodes in five to 10 percent of patients.
In developing targeted molecular probes to identify breast cancer in axillary lymph nodes, the research team
from Moffitt, the University of Arizona and University of Florida used two surface cell markers - CAIX and
CAXII. CAIX is a cell surface marker known to be "highly and broadly expressed in breast cancer lymph
node metastases" and absent in normal tissues.
CAIX and CAXII are both integral plasma membrane proteins with large extracellular components that are
accessible for binding of targeted imaging probes, explained Morse. In addition, several studies have shown
that CAIX expression is associated with negative prognosis and resistance to chemo and radiation therapy
for breast cancer. CAXII is a protein expressed in over 75 percent of axillary lymph node metastases.
The researchers subsequently developed their targeting agents by using monoclonal antibodies specific for
binding CAIX and CAXII, both of which are known to promote tumor growth.
According to the researchers, a number of noninvasive optical imaging procedures for SLN evaluation have
been investigated, but the approaches have lacked the ability to target tumor metastasis biomarkers.
"These methods provide only anatomic maps and do not detect tumor cells present in lymph nodes,"
explained Morse. "Using mouse models of breast cancer metastasis and a novel, monoclonal anti-body-
based molecular imaging agents, we developed a targeted, noninvasive method to detect ALN metastasis
using fluorescence imaging."
In addition to the imaging study with mice, the researchers also reported that the combination of CAIX and
CAXII covered 100 percent of patient-donated samples used in their tissue microarray (TMA) study.
"The imaging probes detected tumor cells in ALNs with high sensitivity," explained Morse. "Either CAIX or
CAXII were expressed in 100 percent of the breast cancer lymph node metasatsis samples we surveyed in
this study. These imaging probes have potential for providing a noninvasive way to stage breast cancer in the
clinic without unneeded and costly surgery."
February 5, 2012
Rev Med Interne. 2012 Jan 30.
[Epub ahead of print]
[Management
of limb lymphedema.]
[Article
in French]
Vignes S.
Source
Unité
de lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
Lymphedema
results from impaired lymphatic transport with increased limb volume.
Cellulitis is the main complication, but psychological or functional discomfort
may occur throughout the course of lymphedema. Lymphedema management is based
on complete decongestive physiotherapy (multilayer low stretch bandage, manual
lymph drainage, skin care, exercises). First phase of treatment leads to a
reduction of lymphedema volume. The second phase stabilizes the volume and is
based on elastic compression. Resection surgery is a useful tool in external
genitalia lymphedema.
Copyright
© 2012 Société nationale française de médecine interne (SNFMI). Published by
Elsevier SAS. All rights reserved.
PMID:
22296831 [PubMed - as supplied by publisher]
February
7, 2012
J Am Acad Orthop Surg. 2012
Feb;20(2):78-85.
Factitious
disorders of the upper extremity.
Birman MV, Lee DH.
Source
Department
of Orthopaedic Surgery, Columbia University, New York, NY, USA.
Abstract
Factitious
disorders of the upper extremity can manifest in many different forms;
therefore, it is critical to recognize warning signs in the history and
examination indicating that the patient may be creating the symptoms and
physical manifestations of the presenting illness. These disorders present in
such predictable patterns as lymphedema, Secretan syndrome, ulcerations and
wound manipulation, clenched fist, subcutaneous emphysema, pachydermodactyly,
nail deformities, and self-mutilation. Management recommendations include
assigning therapeutic responsibility to one person and the involvement of a
multidisciplinary team. Thorough documentation is essential for the protection
of both the patient and the treating physician. Treatment of patients with
factitious disorders of the upper extremity requires patience and insight to
avoid being manipulated into performing unnecessary surgical
procedures
J Radiat Res (Tokyo).
2012;53(1):125-9.
The
Clinical Characteristic Differences between Thrombosis-related Edema and
Lymphedema Following Radiotherapy or Chemoradiotherapy for Patients with
Cervical Cancer.
Wang PL, Cheng YB, Kuerban G.
Source
Center
of Oncology, The Fifth Affiliated Hospital of Xinjiang Medical
University.
Abstract
Thrombosis-related
edema and lymphedema are two principal types of lower extremity edema results
from radiotherapy alone or chemoradiotherapy for patients with cervical cancer.
To characterize differences between them, a retrospective study was performed.
We collected data including age, race, body weight, FIGO stage, histology type,
platelet count, haemoglobin, time of definitely diagnosis, therapeutic regimen,
edema type and which leg edema firstly occurred in. Of 40 patients who were
eligible for this study, 32 were diagnosed as thrombosis-related edema and 8
diagnosed as lymphedema. The differences in patient age (p = 0.004), propotion
of race (p = 0.021), the latent time (p = 0.002) and the mean platelet count (p
= 0.019) were statistically significant. Among 32 patients with
thrombosis-related edema, 34.4% were in stage II and 53.1% in stage III, 78.1%
were squamous cell carcinoma. Among 8 patients with lymphedema, 87.5% were in
stage II and 62.5% were squamous cell carcinoma. The differences were not
statistically significant for weight (p = 0.94), histology type (p = 0.648),
edema site (p = 0.236), haemoglobin (p = 0.088) between the two grouping
patients. Although the small patient cohort is a limitation, the results
suggest that the patients with thrombosis-related edema may have higher
proportion, lower age, shorter latent edema time and more platelet count than
those with lymphedema. Also, thrombosis-related edema was likely inclined to
Uigur and lymphedema to Han race. We did not find statistical differences in
weight, edema site, histology type and haemoglobin between patients with
thrombosis-related edema and lymphedema.
PMID:
22302053 [PubMed - in process]
Rev Med Interne. 2012 Jan 30.
[Epub ahead of print]
[Management
of limb lymphedema.]
[Article
in French]
Vignes S.
Source
Unité
de lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
Lymphedema
results from impaired lymphatic transport with increased limb volume.
Cellulitis is the main complication, but psychological or functional discomfort
may occur throughout the course of lymphedema. Lymphedema management is based
on complete decongestive physiotherapy (multilayer low stretch bandage, manual
lymph drainage, skin care, exercises). First phase of treatment leads to a
reduction of lymphedema volume. The second phase stabilizes the volume and is
based on elastic compression. Resection surgery is a useful tool in external
genitalia lymphedema.
Copyright
© 2012 Société nationale française de médecine interne (SNFMI). Published by
Elsevier SAS. All rights reserved.
PMID:
22296831 [PubMed - as supplied by publisher]
Clin Physiol Funct Imaging. 2012
Mar;32(2):126-32. doi: 10.1111/j.1475-097X.2011.01066.x. Epub 2011 Nov
10.
The
washout rate of a subcutaneous (99m) Tc-HSA depot in lower extremity
lymphoedema.
Jensen MR, Simonsen L, Karlsmark T, Bülow J.
Source
Department
of Clinical Physiology and Nuclear and Medicine Department of Dermatology and
Venereology, Bispebjerg Hospital, University Hospital of Copenhagen,
Copenhagen, Denmark.
Abstract
Purpose:
Lymphoscintigraphy is currently the leading diagnostic modality of lower
extremity lymphoedema but has been criticized for being unreliable. Washout
rate constants have been investigated and proven to be of diagnostic value in
several studies of breast-cancer-related lymphoedema; however, the
applicability in lower extremity lymphoedema needs further evaluation. The aim
of the study was to verify if washout of (99m) Tc-Human Serum Albumin ((99m)
Tc-HSA) is a reliable diagnostic tool in lower extremity lymphoedema. Methods:
Twenty healthy volunteers and eight patients (11 legs) with lymphoscintigraphy
verified lower extremity lymphoedema participated in the study. A depot
consisting of 0·1 ml 10 MBq/ml (99m) Tc-HSA was injected subcutaneously into
the dorsum of each foot. The depot washout rate was measured using a portable
scintillation detector system and time-activity curves were generated. After
30 min of supine rest and 10 min of standardized ergometric exercise,
measurements were recorded for 20 min. Following correction for physical decay
of (99m) Tc, the depot washout rate constant was calculated using linear
regression analysis. Finally depot half-life was calculated from the washout
rate constant. Results: Median half-life for healthy volunteers was 9·4 h
(range 2·5-28·3 h). Median half-life for lymphoedema patients was 10·7 h (range
1·5-35·1 h). No statistical significant difference could be detected between
healthy volunteers and lymphoedema patients (P = 0·78). Conclusions: The
washout rate of a subcutaneous (99m) Tc-HSA depot is not a reliable diagnostic
tool in examination of lower extremity lymphoedema. Additional examinations
revealed in vivo instability of the utilized (99m) Tc-HSA as the likely
reason.
©
2011 The Authors. Clinical Physiology and Functional Imaging © 2011
Scandinavian Society of Clinical Physiology and Nuclear Medicine.
PMID:
22296633 [PubMed - in process]
February
10, 2012
Head Neck. 2012
Mar;34(3):448-53. doi: 10.1002/hed.21538. Epub 2010 Nov 12.
Near-infrared
fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Source
Division
of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The
University of Texas Health Science Center, Houston, Texas; Memorial Hermann
Center for Lymphedema Management, Memorial Hermann - Texas Medical Center,
Houston, Texas. [email protected].
Abstract
BACKGROUND:
Lymphedema
is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions
where treatment options are limited. Although upper and lower extremity
lymphedema may be effectively treated with manual lymphatic drainage (MLD)
therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS
AND RESULTS:
Herein,
we describe the compassionate use of an investigatory technique of
near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy
and function, help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor response to therapy in a patient with head and neck lymphedema after
surgery and radiation treatment.
CONCLUSION:
NIR
fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are
needed to assess the efficacy of MLD therapy when directed by NIR fluorescence
imaging. © 2010 Wiley Periodicals, Inc. Head Neck, 2012.
Copyright
© 2010 Wiley Periodicals, Inc.
PMID:
22311465 [PubMed - in process]
Am J Pathol. 2012 Feb 3. [Epub
ahead of print]
ProxTom
Lymphatic Vessel Reporter Mice Reveal Prox1 Expression in the Adrenal Medulla,
Megakaryocytes, and Platelets.
Truman LA, Bentley KL, Smith EC, Massaro SA, Gonzalez DG, Haberman AM, Hill M, Jones D, Min W, Krause DS, Ruddle NH.
Source
Department
of Epidemiology and Public Health, Yale University School of Medicine, New
Haven, Connecticut.
Abstract
Lymphatic
vessels (LVs) are important structures for antigen presentation, for lipid
metabolism, and as conduits for tumor metastases, but they have been difficult
to visualize in vivo. Prox1 is a transcription factor that is necessary for
lymphangiogenesis in ontogeny and the maintenance of LVs. To visualize LVs in
the lymph node of a living mouse in real time, we made the ProxTom transgenic
mouse in a C57BL/6 background using red fluorescent LVs that are suitable for
in vivo imaging. The ProxTom transgene contained all Prox1 regulatory sequences
and was faithfully expressed in LVs coincident with endogenous Prox1
expression. The progenies of a ProxTom × Hec6stGFP cross were imaged using
two-photon laser scanning microscopy, allowing the simultaneous visualization
of LVs and high endothelial venules in a lymph node of a living mouse for the
first time. We confirmed the expression of Prox1 in the adult liver, lens, and
dentate gyrus. These intensely fluorescent mice revealed the expression of
Prox1 in three novel sites: the neuroendocrine cells of the adrenal medulla,
megakaryocytes, and platelets. The novel sites identified herein suggest
previously unknown roles for Prox. The faithful expression of the fluorescent
reporter in ProxTom LVs indicates that these mice have potential utility in the
study of diseases as diverse as lymphedema, filariasis, transplant rejection,
obesity, and tumor metastasis.
Copyright
© 2012 American Society for Investigative Pathology. Published by Elsevier Inc.
All rights reserved.
PMID:
22310467 [PubMed - as supplied by publisher]
Asia Pac J Public Health. 2012
Feb 15. [Epub ahead of print]
Physical,
Psychological, and Social Aspects of Quality of Life in Filarial Lymphedema
Patients in Colombo, Sri Lanka.
Wijesinghe RS, Wickremasinghe AR.
Source
University
of Queensland, Herston, Australia.
Abstract
Quality
of life (QOL) was assessed in 141 filarial lymphedema patients and 128 healthy
people in the Colombo district, Sri Lanka, by administering modified,
translated, and validated (in Sri Lanka) versions of the Short Form 36 health
survey questionnaire (SF-36) and the 30-item General Health questionnaire
(GHQ-30). The GHQ-30 assesses the current mental health status. The SF-36
measures health on 8 multi-item dimensions covering functional state,
well-being, and overall evaluation of health (physical functioning, role
limitations resulting from physical health problems, role limitations resulting
from emotional problems, energy/fatigue, emotional well-being, social
functioning, pain and general health). By SF-36, patients experienced poorer
physical functioning, more role limitations resulting from physical health
conditions, less emotional well-being, poorer social functioning, and more pain
than healthy individuals. By GHQ-30, mental well-being of healthy controls was
significantly better than that of patients. The significant difference in the
QOL as perceived by filarial lymphedema patients and healthy individuals
reiterates the importance of morbidity control in patients affected by this
disease.
PMID:
22308536 [PubMed - as supplied by publisher]
Breast. 2012 Feb 2. [Epub ahead
of print]
Angiosarcoma
of the breast: A difficult surgical challenge.
Hui A, Henderson M, Speakman D, Skandarajah A.
Source
Department
of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Melbourne
3050, Australia.
Abstract
BACKGROUND
AND OBJECTIVES:
Breast
angiosarcoma presents following radiotherapy after breast conserving surgery,
in the setting of chronic lymphoedema after axillary dissection or as a primary
tumour. The Peter MacCallum Cancer Centre has significant experience due to
large breast and sarcoma units and as a primary radiotherapy centre. Our aims
were to evaluate the management and locoregional and distant outcomes after
breast angiosarcoma.
METHODS:
Retrospective
study of all patients from the prospective breast and sarcoma databases with a
diagnosis of primary or secondary breast angiosarcoma at Peter MacCallum Cancer
Centre was performed between January 2000 and December 2010. Mode of
presentation, management, loco-regional recurrence and survival rates were
reviewed.
RESULTS:
Eight
women developed angiosarcoma in the setting of breast conservation with a
median latency of 7 years post radiotherapy. Six patients had primary breast
angiosarcoma. All breast angiosarcomas were managed with total mastectomy with
5 patients requiring autologous tissue transfer. Four patients had adjuvant
radiotherapy and three patients had adjuvant paclitaxel. The median follow-up
was 2.5 years (6 month-10 years) with 7 episodes of local recurrence in four
patients and 7 patients with distal metastases including two deaths from
distant disease.
CONCLUSIONS:
Primary
angiosarcoma occurs de novo, presenting as a breast mass. Secondary
angiosarcoma presents predominantly as a skin lesion, in the setting
post-operative radiotherapy for breast conserving therapy. Angiosarcoma remains
a rare and difficult management problem with poor loco-regional and distal
control. Secondary AS is an iatrogenic condition that warrants close follow-up
and judicial use of radiotherapy in breast conserving therapy.
Crown
Copyright © 2012. Published by Elsevier Ltd. All rights reserved.
PMID:
22305554 [PubMed - as supplied by publisher]
February
11, 2012
Head Neck. 2012
Mar;34(3):448-53. doi: 10.1002/hed.21538. Epub 2010 Nov 12.
Near-infrared
fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Source
Division
of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The
University of Texas Health Science Center, Houston, Texas; Memorial Hermann
Center for Lymphedema Management, Memorial Hermann - Texas Medical Center,
Houston, Texas. [email protected].
Abstract
BACKGROUND:
Lymphedema
is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions
where treatment options are limited. Although upper and lower extremity
lymphedema may be effectively treated with manual lymphatic drainage (MLD)
therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS
AND RESULTS:
Herein,
we describe the compassionate use of an investigatory technique of
near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy
and function, help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor response to therapy in a patient with head and neck lymphedema after
surgery and radiation treatment.
CONCLUSION:
NIR
fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are
needed to assess the efficacy of MLD therapy when directed by NIR fluorescence
imaging. © 2010 Wiley Periodicals, Inc. Head Neck, 2012.
Copyright
© 2010 Wiley Periodicals, Inc.
PMID:
22311465 [PubMed - in process]
February
17, 2012
Can Respir J. 2012
Jan;19(1):35-6.
Yellow
nails, lymphedema and chronic cough: Yellow nail syndrome in an eight-year-old
girl.
Siddiq I, Hughes DM.
Abstract
Yellow
nail syndrome is a rare disease and reported mainly in adults. A case of yellow
nail syndrome involving an eight-year-old girl with associated discoloured
yellowish nails on the fingers and toes, lymphedema and chronic cough, and
sputum production is reported.
PMID:
22332131 [PubMed - in process]
J Clin Oncol. 2012 Feb 13. [Epub
ahead of print]
Prospective
Study of Factors Predicting Adherence to Surveillance Mammography in Women
Treated for Breast Cancer.
Shelby RA, Scipio CD, Somers TJ, Soo MS, Weinfurt KP, Keefe FJ.
Source
Duke
University Medical Center, Durham, NC.
Abstract
PURPOSEThis
prospective study examined the factors that predicted sustained adherence to
surveillance mammography in women treated for breast cancer. METHODSBreast
cancer survivors (N = 204) who were undergoing surveillance mammography
completed questionnaires assessing mammography-related anticipatory anxiety,
persistent breast pain, mammography pain, and catastrophic thoughts about
mammography pain. Adherence to mammography in the following year was
assessed.ResultsIn the year after study entry, 84.8% of women (n = 173)
returned for a subsequent mammogram. Unadjusted associations showed that
younger age, shorter period of time since surgery, and having upper extremity
lymphedema were associated with lower mammography adherence. Forty percent of
women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0
to 10 scale). Although mammography pain was not associated with adherence,
higher levels of mammography-related anxiety and pain catastrophizing were
associated with not returning for a mammogram (P < .05). The impact of
anxiety on mammography use was mediated by pain catastrophizing (indirect
effect, P < .05). CONCLUSIONFindings suggest that women who are younger,
closer to the time of surgery, or have upper extremity lymphedema may be less
likely to undergo repeated mammograms. It may be important for health
professionals to remind selected patients directly that some women avoid repeat
mammography and to re-emphasize the value of mammography for women with a
history of breast cancer. Teaching women behavioral techniques (eg, redirecting
attention) or providing medication for reducing anxiety could be considered for
women with high levels of anxiety or catastrophic thoughts related to
mammography.
PMID:
22331949 [PubMed - as supplied by publisher]
Phlebology. 2012;27 Suppl
1:139-42.
Lymphatic
complications after varicose veins surgery: risk factors and how to avoid
them.
Pittaluga P, Chastanet S.
Source
Riviera
Vein Institute, 6 Rue Gounod 06000, Nice, France. [email protected];
[email protected].
Abstract
INTRODUCTION:
Lymphatic
complication (LC) after varicose veins (VVs) surgery is an annoying event with
a variable frequency in the literature.
METHOD:
Retrospective
study reviewing all surgeries carried out for VVs from January 2000 to October
2010. Postoperative LC we reported: lymphatic fistula, lymphocele including the
minor ones and lymphoedema.
RESULTS:
During
the period studied, 5407 surgical procedures for VVs were performed in 3407
patients (74.7% women) with a mean age of 53.4 years. A postoperative LC
occurred in 118 cases (2.2%): lymphocele on limb in 1.3%, inguinal LC (fistula
or lymphocele) in 0.7% and a lymphoedema in 0.2%. The population with a LC was
older (59.6 vs. 53.3 years, P < 0.05), had a higher frequency of C4-C6
(22.0% vs. 6.5%, P < 0.05), a higher incidence of obesity (31.4% vs. 5.4%, P
< 0.05) and was more often treated by a redo surgery or a crossectomy
stripping (48.3% vs. 13.4% and 38.1% vs. 21.8%, respectively, P < 0.05). We
have observed a dramatic decrease in incidence of LC after January 2004 (1.3%
vs. 5.3%, P < 0.05) corresponding to a new surgical practice for the
treatment of VVs: stripping, crossectomy and redo surgery at the groin were
less frequent (74.6% vs. 7.7%, 74.6% vs. 0.2% and 11.3% vs. 0.1%, respectively,
P < 0.05), while isolated phlebectomy was more often performed during this
period (78.4% vs. 8.4%, P < 0.05).
CONCLUSION:
LC
after VVs surgery is not rare but frequently limited to lymphocele on limbs.
Older age, more advanced clinical stage and obesity were associated with a
higher frequency of LC. A mini-invasive and selective surgery has significantly
reduced the occurrence of LC.
PMID:
22312081 [PubMed - in process]
February
21, 2012
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Interdisciplinary
Lymphology: The Best Place for Each Discipline in a Team.
Foeldi E, Dimakakos EP.
Source
Foeldi
Clinic for Lymphology, Hinterzarten, Germany.
Abstract
The
term lymphology includes both the physiology and the pathology of the lymphatic
system. Many disciplines are involved in the study of the lymphatic system, to
correctly diagnose lymphatic diseases and to ultimate provide the best
available treatment for the patient. Lymphedema is one of the most common
lymphatic diseases, potentially causing significant problems for the patient
and for the health system in general. The aim of this article is to discuss the
best placement and role for each discipline within an interdisciplinary team in
order to provide an effective management of lymphedema and related lymphatic
diseases.
PMID:
22336902 [PubMed - as supplied by publisher]
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Multidisciplinary
Lymphedema Treatment Program.
Papadopoulou MC, Tsiouri I, Salta-Stankova R, Drakou A, Rousas N, Roussaki-Schulze AV, Giannoukas AD.
Source
University
Hospital of Larissa, Larissa, Greece.
Abstract
Lymphedema
is an underrecognized and undertreated condition that requires a
multidisciplinary approach in an individualized program that will address the
special needs of each patient. In an ideal setting of an outpatient management
program the team should be composed of a vascular surgeon, a dermatologist, a
physiotherapist, a dietician, a psychologist, a social worker, and an office
employee, working together in the assessment and management of all aspects of
lymphedema. All treatment strategies and actions taken should ultimately focus
on the improvement of the quality of life of patients suffering from lymphedema
and on the prevention of lymphedema in high-risk patients.
PMID:
22336900 [PubMed - as supplied by publisher]
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Wound
Physicians: Lymphedema Is Not a Problem That Will Go Away if
Ignored.
Lazarides MK, Mani R.
Source
Democritus
University Hospital, Alexandropoulis, Greece.
PMID:
22336899 [PubMed - as supplied by publisher]
Eur J Surg Oncol. 2012 Feb 13.
[Epub ahead of print]
Analysis
of direct oil contrast lymphography of upper limb lymphatics traversing the
axilla - A lesson from the past - Contribution to the concept of axillary
reverse mapping.
Pavlista D, Eliska O.
Source
Oncogynecologic
Center, Department of Obstetrics and Gynecology, First Faculty of Medicine,
Charles University in Prague and General University Hospital, Apolinarska 18,
Prague 12801, Czech Republic.
Abstract
INTRODUCTION:
Axillary
reverse mapping (ARM) is a method to preserve upper extremity (UE) lymphatics
during axillary surgery in breast cancer patients. This may reduce the
incidence of lymphedema. Very precise method to demonstrate lymphatic drainage
is direct X-ray lymphography.
MATERIALS
AND METHODS:
The
evaluation of direct lymphography X-ray images of the axilla and proximal part
of the upper extremity was performed in 9 subjects. As contrast was used
Lipiodoil injected on the dorsal side of hand.
RESULTS:
The
lymph from UE is drained by 2-4 main afferent collectors, which in 5 of 9 cases
entered into one node in the lateral axilla (ARM node). This node was
considered to be the sentinel lymph node for the UE. In 4 cases a cranial
collector was shown, which led directly to nodes in the upper part of the
axilla. This collector had numerous anastomoses with other collectors before
entering the axillary nodes. The most important finding is the demonstration of
numerous lymphatic anastomoses that take place between all imaged nodes in the
axilla including the caudal nodes, which is the most frequent localization of
the breast sentinel lymph node.
CONCLUSION:
The
relationship of lymphatic drainage of the UE and breast are closely related and
share numerous connections. These connections represent the main problem of the
ARM concept because they may pose potencional route for metastatic cancer cells
in sentinel node positive breast cancer patients. Further studies are necessary
to improve understanding of this method. Axillary reverse mapping - breast
cancer - lymphedema - sentinel node biopsy.
Copyright
© 2012. Published by Elsevier Ltd.
PMID:
22336143 [PubMed - as supplied by publisher]
February
26, 2012
Int J Low Extrem Wounds. 2012
Feb 21. [Epub ahead of print]
Reporting
an Alliance Using an Integrative Approach to the Management of Lymphedema in
India.
Ryan TJ, Narahari SR.
Source
Oxford
University and Oxford Brookes University, Oxford, Oxfordshire, UK.
Abstract
In
India 553 million persons are estimated to live in areas endemic for LF;
approximately 21 million have symptomatic filariasis. Of the approximately
16.02 million cases of lymphedema caused by LF globally, 7.44 million (46.4%)
are in India. India had seen diethyl carbamizine, and/or albendazole, delivered
to whole populations, beginning the project to eliminate the disease. But new
populations have developed the infection. In 2003 the need in resource-poor
countries for morbidity control of lymphatic filariasis (LF) became clear,
prompting the study by the Institute of Applied Dermatology in Kerala, India.
Under this study,self help and family members assisted in home-based care,
combining compression bandaging, yoga exercises, heat therapy using steaming,
and skin care according to Ayurvedic medicine. Lymphedema presents with
different patterns in the skin with gross changes in the epidermis, dermis, or
subcutaneous tissue. Skilled and time-consuming counselling is important to
give patients support. An almost immediate reduction in inflammatory episodes
from 80.4% to 8.6% shows up within 2 or 3 weeks, and therefore, intake of
antibiotics can be stopped. The second major response is reduction in the size
of the limb. Volume reduction for large-sized limbs at 3 months is 39%, with a
confidence interval of 4.9 to 5.9 L.
PMID:
22354118 [PubMed - as supplied by publisher]
Arch Dermatol. 2012
Feb;148(2):260-2.
Lichen
sclerosus exhibiting histologic signs of lymphedema: an essential factor in the
pathogenesis of verruciform xanthoma.
Carlson JA, Carlson GD, Murphy M, Rohwedder A.
Source
Albany
Medical College, 47 New Scotland Ave, MC-81, Albany, NY 12208.
[email protected].
PMID:
22351836 [PubMed - in process]
Clin Cancer Res. 2012 Feb 20.
[Epub ahead of print]
Connexin
47 mutations increase risk for secondary lymphedema following breast cancer
treatment.
Finegold D, Baty C, Knickelbein K, Perschke S, Noon S, Campbell D, Karlsson J, Huang D, Kimak M, Lawrence E, Feingold E, Meriney S, Brufsky AM, Ferrell R.
Source
pediatrics/human
genetics, university of pittsburgh.
Abstract
PURPOSE:
Secondary
lymphedema is a frequent complication of breast cancer associated with surgery,
chemotherapy, or radiation following breast cancer treatment. The potential
contribution of genetic susceptibility to risk of developing secondary
lymphedema following surgical trauma, radiation, and other tissue insults has
not been studied.
EXPERIMENTAL
DESIGN:
To
determine if women with breast cancer and secondary lymphedema had mutations in
candidate lymphedema genes, we undertook a case - control study of 188 women
diagnosed with breast cancer recruited from the University of Pittsburgh Breast
Cancer Program (http://www.upmccancercenter.com/breast/index.cfm) between
2000-2010.Candidate lymphedema genes, GJC2 (encoding connexin 47 [Cx47]),
FOXC2, HGF, MET, and FLT4 (encoding VEGFR3), were sequenced for mutation.
Bioinformatics analysis and in vitro functional assays were used to confirm
significance of novel mutations.
RESULTS:
Cx47
mutations were identified in individuals having secondary lymphedema following
breast cancer treatment but not in breast cancer controls or normal women
without breast cancer. These novel mutations are dysfunctional as assessed
through in vitro assays and bioinformatics analysis, and provide evidence that
altered gap junction function leads to lymphedema.
CONCLUSIONS:
Our
findings challenge the view that secondary lymphedema is solely due to
mechanical trauma and support the hypothesis that genetic susceptibility is an
important risk factor for secondary lymphedema. A priori recognition of genetic
risk 1) raises the potential for early detection and intervention for a high
risk group, and 2) allows the possibility of altering surgical approach and/or
chemo- and radiation therapy, or direct medical treatment of secondary
lymphedema with novel connexin modifying drugs.
PMID:
22351697 [PubMed - as supplied by publisher]
Gene. 2012 Feb 14. [Epub ahead
of print]
Novel
mutation in the FOXC2 gene in three generations of a family with
lymphoedema-distichiasis syndrome.
Sutkowska E, Gil J, Stembalska A, Hill-Bator A, Szuba A.
Source
Department
and Clinic of Orthopaedic and Traumatologic Surgery-Division of Rehabilitation,
Wroclaw Medical University, Borowska str. 213, 50-556 Wroclaw,
Poland.
Abstract
Lymphoedema-distichiasis
syndrome (LDS, OMIM #153400) is a genetic disorder with an autosomal dominant
pattern of inheritance caused by mutations in the FOXC2 gene. Affected
individuals typically present with lower extremity lymphoedema and
distichiasis. The most common types of mutations in FOXC2 gene include small
deletions and insertions, but duplications, duplications-insertions, missense
and nonsense mutations were also found. Herein, we describe three generations
of a family diagnosed with LDS caused by a new mutation in the FOXC2 gene. This
mutation is a frameshift due to a deletion of two nucleotides (CC) in C repeats
between C586 and C591. This mutation leads to protein truncation as a result of
an earlier insertion of a stop codon. To the best of our knowledge, this is the
first description of this mutation in the literature and could be coupled with
an atypical lymphoscintigram.
Copyright
© 2012 Elsevier B.V. All rights reserved.
PMID:
22349027 [PubMed - as supplied by publisher]
Ann Dermatol. 2011 Dec;23(Suppl
3):S303-5. Epub 2011 Dec 27.
Unilateral
psoriasis in a woman with ipsilateral post-mastectomy lymphedema.
Kim M, Jung JY, Na SY, Na SJ, Lee JH, Cho S.
Source
Department of
Dermatology, Seoul National University College of Medicine, Seoul,
Korea.
Abstract
Psoriasis is a
multi-factorial disease with various clinical manifestations. We present a case
of unilateral psoriasis associated with ipsilateral lymphedema that developed
after mastectomy for breast cancer. A 42-year-old Korean woman was referred to
our clinic with a 1-month history of multiple erythematous scaly patches on the
right arm, back, and breast and was diagnosed with psoriasis by a skin biopsy.
Three years previously, she had been diagnosed with breast cancer (T1N2),
underwent a right quadrantectomy and axillary lymph node dissection, and
completed adjuvant chemotherapy followed by high-dose adjuvant radiotherapy.
She had started rehabilitation therapy on the right arm for secondary
lymphedema 30 months previously. Because of the long interval between radiation
and psoriasis, we speculated that changes in the local milieu caused by the
lymphedema might be a causative factor. We hereby report a rare case of
unilateral psoriasis following post-mastectomy lymphedema.
PMID:
22346263 [PubMed - in process] PMCID: PMC3276782
Breast. 2012 Feb 16. [Epub ahead
of print]
Factors
associated with long-term functional outcomes and psychological sequelae in
women after breast cancer.
Khan F, Amatya B, Pallant JF, Rajapaksa I.
Source
Department
of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan
Street, Parkville, VIC 3050, Australia; Department of Rehabilitation Medicine,
RoyalMelbourne Hospital, 34-54 Poplar Road Parkville, Melbourne VIC 3052,
Australia.
Abstract
The
objective of this study was to examine factors impacting long-term functional
outcomes and psychological sequelae in survivors of breast cancer (BC). A
clinical assessment and structured interview assessed the impact of BC on
participants' (n = 85) current activity and restriction in participation, using
validated questionnaires: Functional Independence Measure (FIM), Perceived
Impact Problem Profile (PIPP) and Depression Anxiety Stress Scale (DASS).
Participants showed good functional recovery (median motor FIM score = 78).
Three-quarters (74%) reported pain, 32% reported upper limb weakness, 31% pain
limiting shoulder movement and 29% lymphoedema. One third (32%) reported
greatest impact on psychological wellbeing. A substantial number of
participants reported high levels of depression (22%), anxiety and stress (19%
each). Factors associated with poorer current level of functioning and
wellbeing included: younger participants, recent diagnoses, aggressive tumour
types, receiving chemotherapy, shoulder limitation due to pain, and
lymphoedema. BC survivors require long-term management of psychological
sequelae impacting activity and participation.
Copyright
© 2012 Elsevier Ltd. All rights reserved.
PMID:
22342676 [PubMed - as supplied by publisher]
Cancer Radiother. 2012 Feb 17.
[Epub ahead of print]
[Upper
limb lymphedema after breast cancer treatment.]
[Article
in French]
Ben Salah H, Bahri M, Jbali B, Guermazi M, Frikha M, Daoud J.
Source
Service
de radiothérapie carcinologique, CHU Habib-Bourguiba, 3029 Sfax,
Tunisie.
Abstract
PURPOSE:
To
study the frequency and risk factors for upper limb lymphedema through a series
of patients treated for breast cancer.
PATIENTS
AND METHODS:
It
is a retrospective study about 222 patients treated for breast cancer during
the period between February 1993 and December 2003 in Sfax hospitals. Average
age was 51years (27-92years). Tumour was T2 in 59% of cases. All patients had
surgery with lymph node dissection. Infiltrating ductal carcinoma was the most
frequent histological type (80% of cases), with predominant SBR II grade (62%).
The mean number of removed lymph nodes was 12 (2-33). Axillary lymph node
metastasis was detected in 124 patients. Radiotherapy was delivered in 200
patients, including axillary irradiation in 30 cases. The mean follow-up was
68months (12-120).
RESULTS:
Lymphedema
appeared in 23% of cases (51 patients), 14months after surgery (mean period).
Lymphedema affected the brachium in 17% of cases, the forearm in 12% of cases
and all upper limb in 71% of cases. Fifty percent of patients had
rehabilitation. However, improvement of lymphedema was obtained in 18 cases.
Parameters predicting lymphedema were studied. Significant risk factors were
obesity, infection and a number of removed lymph node above 10. The type of
surgery, axillary irradiation and shoulder abduction deficit did not predict
lymphedema.
CONCLUSION:
Lymphedema
of the arm is a frequent consequence of breast cancer treatment. The risk of
lymphedema is correlated with obesity, infection and a number of removed lymph
node above 10.
Copyright
© 2012 Société française de radiothérapie oncologique (SFRO). Published by
Elsevier SAS. All rights reserved.
PMID:
22342349 [PubMed - as supplied by publisher]
MED
NEWS:
February
11, 2012
Highlighting A Rare Subset Of Diseases Involving The
Lymphatic System –
A clinically challenging and under-studied subset of diseases
affecting the lymphatic system and grouped under the disease spectrum
lymphangiomatosis and Gorham's disease is the focus of a special issue of
Lymphatic Research and Biology, a peer-reviewed journal published by
Mary Ann Liebert, Inc.. The issue is available free online.*
Guest
Editor, and Journal Associate Editor Francine Blei MD, MBA, St. Luke's
Roosevelt Hospital, NY, has compiled a collection of articles that highlight
the complex characteristics of these diseases, which can be localized, affect
multiple sites, or be systemic, may be congenital or acquired, and may cause
symptoms that range from mild to severe to life-threatening. The articles focus
on current knowledge, ongoing research, and how these diseases differ from
other lymphatic disorders.
"This disease spectrum affects a patient
population that is small in number, but the effects of the disease(s) are
devastating," says Stanley G. Rockson, MD, Editor-in-Chief of Lymphatic
Research and Biology and Allan and Tina Neill Professor of Lymphatic Research
and Medicine, Stanford University School of Medicine, CA. The collection of
articles in this special issue, "highlights the current state of knowledge (and
ignorance) in this paradoxically neglected area of lymphatic health and
disease."
February 14, 2012
Link Between NSAIDs And Reduced Cancer Metastasis
Strengthened By Study
A new study reveals key factors that promote the spread of cancer to lymph nodes and
provides a mechanism that explains how a common over-the-counter
anti-inflammatory medication can reduce the spread of tumor cells through the
lymphatic system. The research, published by Cell Press in the February 14
issue of the journal Cancer Cell, opens new avenues for the design
of antimetastatic therapies.
The lymphatic system consists of a network
of vessels that carry lymphatic fluid from the body organs back to the general
circulation. Along the way, lymphatic fluid percolates through lymph nodes.
Unfortunately, cancer cells sometimes spread (via a process called metastasis)
through the lymphatic system and can form secondary tumors in the lymph nodes.
The spread of cancer cells to the lymph nodes is an important indicator of
disease progression.
"Some tumors secrete protein growth factors that
can act on the lymphatic vessels to facilitate metastasis. For example,
elevated levels of the growth factor VEGF-D in human tumors correlate with
lymph node metastasis and poor patient prognosis," explains the senior study
author, Steven Stacker, associate professor from the Tumour Angiogenesis
Program, Peter MacCallum Cancer Centre in Melbourne, Australia. "However, thus
far, mechanisms underlying the transit of cancer cells through the larger
lymphatic vessels and into the lymph nodes remain elusive."
In the
current study, Stacker and colleagues investigated how collecting lymphatic
vessels, conduits that drain lymphatic fluid from tissues into lymph nodes, are
altered during VEGF-D-driven metastasis. The researchers discovered that VEGF-D
was linked to prostaglandin pathways, which are important regulators of
lymphatic vessel dilation. Nonsteroidal anti-inflammatory drugs (NSAIDS), which are known
inhibitors of prostaglandin synthesis, reduced lymphatic vessel dilation and,
therefore, inhibited tumor metastasis.
"This key interaction between
lymphatic system growth factors and prostaglandins reveals a mechanism for
physically preparing collecting vessels for tumor cell dissemination and a
mechanism by which NSAIDs can reduce cancer metastases through the lymphatic
system," concludes Dr. Stacker. "These insights may assist with the design of
additional therapeutics for cancer patients and enhance current approaches that
aim to prevent the spread of cancer cells through the lymphatic system and
potentially to distant organs."
February
21, 2012
Two Possible Options Identified For Treating Epstein
Barr Virus-Fueled Lymphomas In Immunosuppressed
Patients
Some 90 percent of people are exposed to the Epstein Barr virus (EBV)
at some point in their life. Even though it is quickly cleared from the body,
the virus can linger silently for years in small numbers of infected B cells.
According to researchers at Children's Hospital Bostonand the Immune Disease
Institute (IDI), the immune system subdues the virus by watching for a single
viral protein called LMP1, knowledge that has already helped suggest two new
treatments for the EBV-fueled cancers seen in some
immunosuppressed patients.
The study team, led by Klaus Rajewksy, MD,
and Baochun Zhang, MD, PhD, of the Program in Cellular and Molecular Medicine
at Children Hospital Boston and the IDI, reported their results online in the
journal Cell.
While the immune system's T cells rapidly
clear most EBV-infected B cells, about one in a million infected cells escapes
destruction. Within these cells, the virus enters a latent phase, kept in check
by the watchful eye of so-called memory T cells. This uneasy relationship
usually holds steady the rest of a person's life, unless something - such as
infection with HIV or use of anti-rejection
drugs following a transplant - suppresses the immune system and breaks the
surveillance. The virus can then reawaken and drive the development of B cell
cancers like AIDS-associated B cell lymphoma and post-transplant
lymphoproliferative disorder.
To better understand how the immune
system maintains its watch and how the virus turns cells cancerous, Rajewsky
and his team had generated a model mimicking latent EBV infection by
engineering mice whose B cells contained an inducible version of viral LMP1.
Researchers have long known that EBV needs LMP1 to turn B cells cancerous, but
modeling this relationship in vivo had proven challenging.
"We had
previously attempted to develop an animal model of LMP1 transformation of B
cells," said Rajewsky, who recently moved to the Max Delbrück Center for
Molecular Medicinein Germany, "but we had never been able to get the mice in
our models to actually produce any mature B cells. The immune response against
the LMP1-producing B cells was so robust that the cells were eliminated very
early on."
Their breakthrough came when Zhang and colleagues
reengineered the model to lack T cells. "The mice were initially fine, but
succumbed within two to three months to aggressive B cell lymphomas," Rajewsky
said. "The profile mimicked very closely what we see in immunosuppressed
lymphoma patients." In additional experiments with Rajewsky's original model,
the team eliminated the mice's T cells before activating the viral protein in B
cells, sparking a similar but even more rapid fatal disease.
The team
also made several observations with possible clinical application. First, they
noted that in the mouse model the LMP1 producing B cells were being attacked by
a specific kind of T cell called a CD4+ T cell. "Transplant patients who
develop B cell lymphomas because they are immunosuppressed by their
anti-rejection drugs are often treated with T cells that carry the CD8 marker,"
Rajewsky noted. "These results would argue for also considering CD4+ T cells
for treatment."
Second, they found that tumors in the LMP1 producing
mice often displayed targets recognized by another kind of immune cell called a
natural killer (NK) cell. Seeing an opportunity, Rajewsky worked with cancer
immunologist Glenn Dranoff, MD and colleagues at Dana-Farber Cancer Institute,
to test a potential therapeutic agent that uses a portion of the NK cell
activating receptor called NKG2D,fused to the stimulatory Fc portion of an
antibody, a combination capable of activating and directing immune attack
against tumor cells. In a transplantation model of LMP1-fueled lymphomas, the
NKG2D-Fc fusion proved quite capable of reducing tumor growth and prolonging
survival of the recipients.
"These preclinical results suggest
administration of the NKG2D-Fc fusion protein, perhaps combined withtreatment
with CD4+ T cells, could benefit some patients with EBV-driven lymphomas,"
Rajewsky said. "What we can say with certainty, though, is that LMP1 is the
immune system's primary surveillance trigger following EBV infection and
clearance, knowledge that we think will open doors to additional treatment
options."
February 25, 2012-02-27
Exploiting A Weakness In Cancer's Defense
System
Researchers at the EPFL have
identified an important mechanism that could lead to the design of more
effective cancer vaccines. Their discovery
of a new-found role of the lymphatic system in tumour growth shows how tumours
evade detection by using a patient's own immune system.
Tumour cells
present antigens or protein markers on their surfaces which make them
identifiable to the host immune system. In the last decade, cancer vaccines
have been designed that work by exposing the patient's immune cells to
tumour-associated antigens and so priming them to kill cells that present those
antigens. These have caused much excitement, not least because by acting so
specifically on cancer cells, they could potentially eliminate the unpleasant
side effects of chemo- and radiotherapy.
Like soldiers protecting
a fort
However, clinical trials of such vaccines have had a very
low success rate to date, mainly because tumours have various mechanisms for
evading detection by immune cells, even when those immune cells - called T
cells - have been primed to seek them out. Those mechanisms are, in general,
poorly understood. But in a paper to be published this week in Cell Reports,
the laboratories of Melody Swartz at EPFL and Stéphanie Hugues at UNIGE provide
a key insight into one of them. They describe for the first time how, like
soldiers protecting a fort, lymph vessels surrounding a tumour ward off T cell
attack.
Plenty of research has shown that tumours can induce the growth
of lymph vessels in their vicinity, and that this growth is correlated with
metastasis and poor prognosis. It was assumed that these lymph vessels simply
provided an escape route for cancer cells, transporting them to distant sites.
In the new study, led by postdoc Amanda Lund, the researchers show that lymph
vessels actually suppress the immune response, deleting the attacking T cells
or leaving them "functionally exhausted" by the time they reach the tumour.
They studied a type of tumour that expresses large amounts of VEGF-C, a
molecule that is naturally expressed in humans and that stimulates lymphatic
growth. Having engineered the tumour cells to express a foreign antigen, they
compared the efficacy of a vaccine designed to prime T cells to kill cells
carrying that antigen, either when VEGF-C was present or when its activity was
blocked . With VEGF-C suppressed, the vaccine's efficacy increased and tumour
growth slowed fourfold.
A weakness in cancer's defense system
exploited
The researchers went on to show that the endothelial
cells which line lymph vessels "scavenge" tumour-specific antigens and present
them to the tumour-specific T cells in a suppressive manner. This, in turn,
promotes the local deletion of those T cells. According to Prof Swartz, that
means that first targeting the lymph vessels associated with a tumour could, in
theory, significantly increase the efficacy of existing cancer vaccines. "It
would be like removing the soldiers from around the fort before sending in your
opposing army," she says. "If you disable the lymph vessels' suppressive
functions, our data suggest that tumour-killing T cells would do their job a
lot more effectively." Future clinical trials are needed to put that theory to
the test.
Feb 29, 2012
Birkballe S, Karlsmark T, Noerregaard S,
Gottrup F.
Source
Department of Dermatology, Bispebjerg
University Hospital, Copenhagen, Denmark Copenhagen Wound Healing Center,
Bispebjerg University Hospital, Copenhagen,
Denmark.
Abstract
Background: 
Lymphoedema is
increasingly recognized as a significant problem in health care. The number of
patients is growing, posing a future challenge to health care systems and
economics. Over the last decade, specialized lymphoedema management has been
established around the world to accommodate the growing demands. However,
information on organization, experiences and outcome are scarce.
Objectives: 
This article is a clinical perspective
analysis describing the establishment, organization, function and results of a
new, multidisciplinary Lympheodema Center functioning as a University Hospital
unit in connection to the Department of Dermatology and Copenhagen Wound
Healing Center and integrated as a national expert function in the public
Health Care Organization of Denmark.
Methods: 
Establishment and data collection from a structured, multidisciplinary
organization of lymphoedema management.
Results: 
During
the first 4½ years a total of 8058 patient consultations were preformed. Mean
duration of symptoms at first visit was 19 years (range 1 - 67) and 31% had
never received any diagnosis or treatment prior to referral. Complications were
found in 48% of referred patients. All patients received appropriate diagnostic
investigations and treatment according to best practice. Multidisciplinary
assessment involving 4 or more different health care professions was needed in
86% of cases. Research opportunities and expert education of staff were
enhanced.
Conclusions: 
A multidisciplinary Lymphoedema
Center improves management, knowledge and awareness of lymphoedema. This model,
with minor adjustments, may be applicable for other regions and
countries.
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/22373016
From:
lymphedemapeople <[email protected]>
Subject: [Lymphedema] Stem
cell treatment lymphedema - CUBA
To: [email protected]
Date:
Friday, March 9, 2012, 10:01 AM
Stem cell treatment
research is presently being done at Emory University here in Atlanta, but
evidently it is also being done in Havana, Cuba (wish we could get more info on
it):
Initial trials show promising results in stem cell
treatment
Mar 8, 2012
Havana: About 1700 patients were treated
until December, 2011, with stem cells, a treatment with promising results,
according to official sources quoted by media.
Results are similar to
those reached in developed countries, avoiding important amputations to
patients, told to Gramma newspaper Doctor Porfirio Hernandez, coordinator of
the National Group for Regenerative Medicine at the Ministry of Public
Health.
According to Hernandez, the treatment is still trial phase under
strict selection criteria, although 10 of the 15 Cuban provinces already
receive that service.
Hernandez said that Cuba has contributed
significantly to the international scientific literature in the sphere, as in
the case of improvements experienced by those patients suffering from chronic
Lymphedema in lower limbs.
Hernandez also mentioned the case of a minor
suffering from Idiopathic pulmonary fibrosis (IPF), who was treated with a
procedure based on stem cells, avoiding a lung transplant.
With the
capacity of splitting without limits, stem cells can regenerate tissues damaged
by diseases, trauma or aging.
It is mainly obtained by bone marrow,
peripheral blood, cornea, brain, lung and endometrium.
http://zeenews.india.com/news/health/diseases/initial-trials-show-promising-results-in-stem-cell-treatment_15940.html
__._,_.___
March 13,
2012
IRDye800CW-Cyclic
albumin-binding domain (Ac-RLIEDICLPRWGCLWEDDK-NH2).
Authors
Leung K.
Source
Molecular
Imaging and Contrast Agent Database (MICAD) [Internet]. Bethesda (MD): National
Center for Biotechnology Information (US); 2004-2011.
2011 Dec 19 [updated
2012 Mar 01].
Excerpt
Optical
fluorescence imaging is increasingly used to monitor biological functions of
specific targets in small animals (1-3). However, the intrinsic fluorescence of
biomolecules poses a problem when fluorophores that absorb visible light
(350–700 nm) are used. Near-infrared (NIR) fluorescence (700–1,000 nm)
detection avoids the natural background fluorescence interference of
biomolecules, providing a high contrast between target and background tissues.
NIR fluorophores have a wider dynamic range and minimal background fluorescence
as a result of reduced scattering compared with visible fluorescence detection.
NIR fluorophores also have high sensitivity, resulting from low background
fluorescence, and high extinction coefficients, which provide high quantum
yields. The NIR region is also compatible with solid-state optical components,
such as diode lasers and silicon detectors. NIR fluorescence imaging is a
noninvasive alternative to radionuclide imaging in small animals or with probes
in close proximity to the target in humans (4, 5). Among the various optical
imaging agents, only indocyanine green (ICG), with NIR fluorescence absorption
at 780 nm and emission at 820 nm, is approved by the United States Food and
Drug Administration for clinical applications in angiography, blood flow
evaluation, and liver function assessment. It is also under evaluation in
several clinical trials for other applications, such as optical imaging and
mapping of both the lymphatic vessels and lymph nodes in cancer patients for
surgical dissection of tumors and endoscopic imaging of the pancreas and colon.
The primary function of the lymphatic system is to drain ~10% of the
interstitial fluid from small capillaries to lymphatic vessels through lymph
nodes and finally to the venous system (6-10). Lymph nodes form a natural
filter for the lymphatic drainage and prevent the possible migration of cancer
cells from the lymphatic system into the body. Serum proteins and
macromolecules can be taken up by the large openings in the lymphatic
capillaries. However, an accumulation of protein molecules may impair lymphatic
flow and cause lymphedema and tissue edema. For NIR fluorescence imaging, ICG
has been used in lymphatic imaging because of its association with serum
proteins. However, ICG is degraded in aqueous conditions with a half-life of
~20 h and is sensitive to light (half-life, 2.3 h). IRDye 800CW (IRDye800) is
an indocyanine-type NIR fluorophore with peak absorption at 785 nm and peak
excitation emission at 803 nm, and it is about four-fold brighter than ICG.
Dennis et al. (11) identified the peptide Ac-RLIEDICLPRWGCLWEDD (SA21), which
bound with high affinity to human and murine serum albumin. Davies-Venn et al.
(12) prepared a cyclic version of SA21 called cyclic albumin-binding domain
(Ac-RLIEDICLPRWGCLWEDDK-NH2, cABD) and conjugated this with IRDye800 to form
IRDye800-cABD for NIR fluorescence lymphatic imaging in mice.
Sections
- Background
- Synthesis
- In
Vitro Studies:
Testing in Cells and Tissues - Animal Studies
- Human Studies
- References
PMID:
22400136 [PubMed]
March 13,
2012
Ann Surg Oncol. 2012 Mar 7.
[Epub ahead of print]
Nomograms
for Predicting the Risk of Arm Lymphedema after Axillary Dissection in Breast
Cancer.
Bevilacqua JL, Kattan MW, Changhong Y, Koifman S, Mattos IE, Koifman RJ, Bergmann A.
Source
Escola
Nacional de Saúde Pública/FIOCRUZ, Rio de Janeiro, Brazil,
[email protected].
Abstract
BACKGROUND:
Lymphedema (LE)
after axillary lymph node dissection (ALND) is a multifactorial, chronic, and
disabling condition that currently affects an estimated 4 million people
worldwide. Although several risk factors have been described, it is difficult
to estimate the risk in individual patients. We therefore developed nomograms
based on a large data set.
METHODS:
Clinicopathologic
features were collected from a prospective cohort comprising 1,054 women with
unilateral breast cancer undergoing ALND as part of their surgical treatment
from August 2001 to November 2002. LE was defined as a volume difference of at
least 200 ml between arms at 6 months or more after surgery. The cumulative
incidence of LE was ascertained by the Kaplan-Meier method, and Cox
proportional hazard models were used to predict the risk of developing LE on
the basis of the available data at each time point: model 1, preoperatively;
model 2, within 6 months from surgery; and model 3, at 6 months or later after
surgery.
RESULTS:
The 5
year cumulative incidence of LE was 30.3%. Independent risk factors for LE were
age, body mass index, ipsilateral arm chemotherapy infusions, level of ALND,
location of radiotherapy field, development of postoperative seroma, infection,
and early edema. When applied to the validation set, the concordance indices
were 0.706, 0.729, and 0.736 for models 1, 2, and 3, respectively.
CONCLUSIONS:
The
proposed nomograms can help physicians and patients predict the 5 year
probability of LE after ALND for breast cancer. Free online versions of the
nomograms are available at http://www.lymphedemarisk.com/ .
PMID:
22395997 [PubMed - as supplied by publisher]
J Drugs Dermatol. 2012 Mar
1;11(3):402-5.
A
case of elephantiasis nostras verrucosa treated by acitretin.
Polat M, Sereflican B.
Abstract
Elephantiasis
nostras verrucosa is a rare disorder characterized by dermal fibrosis,
hyperkeratotic, verrucous, and papillomatous lesions that result from both
chronic filarial and nonfilarial lymphedema. Various treatment options have
been reported for this disease. We present a 64-year-old man with erythrodermic
psoriasis and elephantiasis nostras verrucosa in whom the lesions were resolved
almost completely after acitretin treatment. J Drugs Dermatol.
2012;11(3):402-405.
PMID:
22395594 [PubMed - in process]
Rev Med Suisse. 2012 Feb
8;8(327):315-6, 318-9.
[Lymphatic
disorders and prevention of their complications].
[Article
in French]
Tomson D, Lessert C, Klumbach D, Mazzolai L, Depairon M.
Source
Service
d'angiologie, CHUV, 1011 Lausanne. [email protected]
Abstract
The
prevalence of lymphedema is clearly underestimated. Too few patients receive
treatment. It requires several specifically trained participants and must be
conceived in the long term given the chronic nature and the incurability of
this pathology. Prevention is therefore of major importance. Successfully
applied to operated women for breast cancer, other models of coverage deserve
to be developed to reduce the incidence of lymphedema and its complications,
particularly after oncologic, orthopedic and vascular surgery and for patients
affected by venous insufficiency.
PMID:
22393652 [PubMed - indexed for MEDLINE]
Clin Nucl Med. 2012
Apr;37(4):411-5.
Lymphoscintigraphy
of lower limb edema.
Zimmerman H, Fessa CK, Rossleigh MA, Wegner EA.
Source
From the
*Department of Nuclear Medicine, The Prince of Wales Hospital, Randwick, NSW
Australia; †Department of Nuclear Medicine, Sydney Children's Hospital,
Randwick, NSW Australia; and ‡The University of New South Wales Medical School,
Kensington, NSW Australia.
Abstract
Lymphedema of the
lower limbs is a well-known chronic condition. The cause of lymphedema can be
either primary or secondary. Lymphoscintigraphy is a simple and reliable method
for evaluation of lymphatic function. We illustrate the different lymph
drainage patterns in 4 cases of lower limb edema, with either primary or
secondary causes. In all cases, planar images were obtained after bipedal
administration of Tc antimony sulfur colloid.
PMID:
22391722 [PubMed - in process]
Ann R Coll Surg Engl. 2012
Mar;94(2):101-2.
Penile
degloving: an unusual presentation of hidradenitis suppurativa.
Kok K, Lahiri A.
Source
University
Hospitals Birmingham NHS Foundation Trust, UK.
Abstract
Chronic
hidradenitis suppurativa (HS) can cause lymphoedema, leading to novel
presentations. We present the case of a man with chronic HS causing penile
oedema and subsequent degloving. He underwent direct excision with a good
result. Chronic HS patients should be warned about problems related to
lymphoedema and reviewed regularly to resolve problems early.
PMID:
22391376 [PubMed - in process]
Ann R Coll Surg Engl. 2012
Mar;94(2):55-6.
Breast
cancer presenting as subclavian/axillary deep vein thrombosis and upper limb
lymphoedema.
Kruger SJ.
Source
Royal
Marsden NHS Foundation Trust, UK.
Abstract
This
case report describes the delayed diagnosis of inflammatory breast cancer
following initial presentation with a subclavian/axillary deep vein thrombus.
The relationship of thrombosis and cancer is discussed and the typical
presentation of inflammatory breast cancer described. Understanding the
relationship between thromboembolism and cancer is crucial to support the early
diagnosis of breast cancer, which can present insidiously. The literature is
reviewed, highlighting the improving prognosis of this rare condition and the
current preferred treatment modalities.
PMID:
22391349 [PubMed - in process]
March
13, 2012
Genes Chromosomes Cancer. 2012
Jun;51(6):569-78. doi: 10.1002/gcc.21943. Epub 2012 Mar 2.
The
miR-17-92 cluster and its target THBS1 are differentially expressed in
angiosarcomas dependent on MYC amplification.
Italiano A, Thomas R, Breen M, Zhang L, Crago AM, Singer S, Khanin R, Maki RG, Mihailovic A, Hafner M, Tuschl T, Antonescu CR.
Source
Department of
Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of
Medical Oncology, Institute Bergonié, Bordeaux, France.
[email protected].
Abstract
Angiosarcomas (ASs)
represent a heterogeneous group of malignant vascular tumors that may occur
spontaneously as primary tumors or secondarily after radiation therapy or in
the context of chronic lymphedema. Most secondary ASs have been associated with
MYC oncogene amplification, whereas the role of MYC abnormalities in primary AS
is not well defined. Twenty-two primary and secondary ASs were analyzed by
array-comparative genomic hybridization (aCGH) and by deep sequencing of small
RNA libraries. By aCGH and subsequently confirmed by fluorescence in situ
hybridization, MYC amplification was identified in three out of six primary
tumors and in 8 out of 12 secondary AS. We have also found MAML1 as a new
potential oncogene in MYC-amplified AS. Significant upregulation of the
miR-17-92 cluster was observed in MYC-amplified AS compared to AS lacking MYC
amplification and the control group (other vascular tumors, nonvascular
sarcomas). Moreover, MYC-amplified ASs were associated with a significantly
lower expression of thrombospondin-1 (THBS1) than AS without MYC amplification
or controls. Altogether, our study implicates MYC amplification not only in the
pathogenesis of secondary AS but also in a subset of primary AS. Thus, MYC
amplification may play a crucial role in the angiogenic phenotype of AS through
upregulation of the miR-17-92 cluster, which subsequently downregulates THBS1,
a potent endogenous inhibitor of angiogenesis. © 2012 Wiley Periodicals,
Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22383169 [PubMed - in process]
Curr Treat Options Cardiovasc
Med. 2012 Apr;14(2):184-92.
Update
on the biology and treatment of lymphedema.
Rockson SG.
Source
Stanford
Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine,
Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305,
USA, [email protected].
Abstract
OPINION
STATEMENT: The past decade has produced an explosion of insights into lymphatic
vascular development and structural biology and, in parallel, into the function
of the lymphatics in health and in disease. In lymphedema, there is a spectrum
that extends from primary (heritable) to acquired causes of disease. The
diagnosis of lymphatic edema implicates a very specific treatment approach that
is predicated upon the favorable impact of physiotherapy upon lymph flow and
protein clearance from the edematous zones of the body. The recognition of the
unique biology that accompanies lymphatic causes of edema has stimulated new
research directions that are likely to translate into exciting new
pharmacologic and molecular approaches to diagnosis and treatment.
PMID:
22382848 [PubMed - in process]
March
13, 2012
Plast Reconstr Surg. 2012
Mar;129(3):612-20.
Mapping
of lymphosomes in the canine forelimb: comparative anatomy between canines and
humans.
Suami H, Shin D, Chang DW.
Source
Department of
Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston,
Texas 77030-4009, USA. [email protected]
Abstract
BACKGROUND:
Breast
cancer-related lymphedema is an unsolved iatrogenic dilemma. Disfigurement of
the affected limb because of increased volume and recurrent cellulitis can
cause both physical and mental distress for many breast cancer survivors. No
adequate animal models have been developed to investigate acquired lymphedema
mimicking breast cancer-related lymphedema, and there is little knowledge of
the anatomy of the lymphatics in animals. The authors hypothesized that a
canine forelimb model of the lymphatic system could potentially be used to
study breast cancer-related lymphedema.
METHODS:
Six
forequarters were used from three mongrel hound carcasses. The lymphatic
microinjection technique used hydrogen peroxide to identify lymphatic vessels.
The individual channels were injected with a radiopaque lead oxide mixture and
recorded on digital radiography. Lymphatic territories (lymphosomes) in the
canine forelimb were demarcated and color coded in accordance with their lymph
nodes. The lymphatic system in the canine forelimb was compared with that in
the human upper extremity.
RESULTS:
The
lymphatic system in the canine forelimb was divided into two superficial
lymphosomes (ventral cervical and axillary) and one deep lymphatic system. The
ventral cervical lymphosome was larger than the axillary lymphosome. A single
lymph node in the axilla received fluid from three sites: the ventral cranial
torso, the superficial medial forelimb, and the deep forelimb. The lymphatic
systems of the human upper extremity and the canine forelimb had some
anatomical similarities: distinct superficial and deep system and size of the
lymphatic vessel.
CONCLUSION:
The
canine model may be a valuable animal model for investigating the
pathophysiology of upper extremity lymphedema.
PMID:
22373968 [PubMed - in process]
J Plast Reconstr Aesthet Surg.
2012 Feb 26. [Epub ahead of print]
Liposuction
for chronic lymphoedema of the upper limb- 5 years of experience.
Schaverien MV, Munro KJ, Baker PA, Munnoch DA.
Source
Department of
Plastic Surgery, Ninewells Hospital, Dundee DD1 9SY, United
Kingdom.
Abstract
BACKGROUND:
Lymphoedema of the
upper limb is a well-recognised complication of axillary surgery for breast
cancer. Effective long-term treatment of lymphoedema by liposuction has
previously been demonstrated. In this study we present our first five years of
experience using this technique in treatment of upper limb
lymphoedema.
METHODS:
A
prospective analysis of the results of 12 patients who underwent liposuction
followed by compression therapy for chronic unilateral upper limb oedema with
up to five years of follow-up was carried out. Hospital Anxiety and Depression
Score questionnaires and a Visual Analogue Score for overall well-being were
also completed pre- and post-operatively.
RESULTS:
The mean
duration of lymphoedema was seven years (range, 1-14), commencing at a mean of
one year (range, 0-5) after axillary surgery. The mean excess arm volume at
admission was 1391 ml and the ratio of the lymphoedematous to the unaffected
arm was 1·48. The mean total aspirate volume was 1713 ml, of which 87 percent
was fat. At one year the mean percentage volume reduction compared with the
normal arm was 101 percent, meaning that the volume of both of patients' arms
was virtually equivalent, and this reduction was stable with up to 5 years of
follow-up. Postoperatively there were reductions in anxiety (p < 0.05) and
depression scores, and an improvement in overall well-being.
DISCUSSION:
Our
first five years of experience of liposuction combined with application of
compression garments has demonstrated significant, reproducible, and stable
reduction of upper limb oedema with improvement of overall well-being and
reduction in measurable anxiety and depression.
Copyright © 2012
British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.
PMID:
22373827 [PubMed - as supplied by publisher]
Br J Dermatol. 2012 Feb 28. doi:
10.1111/j.1365-2133.2012.10907.x. [Epub ahead of print]
A
New Concept of a Multidisciplinary Lymphoedema Center - Established in
connection to a department of dermatology and Copenhagen Wound Healing
Center.
Birkballe S, Karlsmark T, Noerregaard S, Gottrup F.
Source
Department of
Dermatology, Bispebjerg University Hospital, Copenhagen, Denmark Copenhagen
Wound Healing Center, Bispebjerg University Hospital, Copenhagen,
Denmark.
Abstract
Background:
Lymphoedema is increasingly recognized as a significant problem in health care.
The number of patients is growing, posing a future challenge to health care
systems and economics. Over the last decade, specialized lymphoedema management
has been established around the world to accommodate the growing demands.
However, information on organization, experiences and outcome are scarce.
Objectives: This article is a clinical perspective analysis describing the
establishment, organization, function and results of a new, multidisciplinary
Lympheodema Center functioning as a University Hospital unit in connection to
the Department of Dermatology and Copenhagen Wound Healing Center and
integrated as a national expert function in the public Health Care Organization
of Denmark. Methods: Establishment and data collection from a structured,
multidisciplinary organization of lymphoedema management. Results: During the
first 4½ years a total of 8058 patient consultations were preformed. Mean
duration of symptoms at first visit was 19 years (range 1 - 67) and 31% had
never received any diagnosis or treatment prior to referral. Complications were
found in 48% of referred patients. All patients received appropriate diagnostic
investigations and treatment according to best practice. Multidisciplinary
assessment involving 4 or more different health care professions was needed in
86% of cases. Research opportunities and expert education of staff were
enhanced. Conclusions: A multidisciplinary Lymphoedema Center improves
management, knowledge and awareness of lymphoedema. This model, with minor
adjustments, may be applicable for other regions and countries.
Copyright © 2012
British Association of Dermatologists.
PMID:
22373016 [PubMed - as supplied by publisher]
J Sex Med. 2012 Mar;9(3):909-17.
doi: 10.1111/j.1743-6109.2011.02581.x.
Sexual
function after modified radical hysterectomy (Piver II/Type B) vs. classic
radical hysterectomy (Piver III/Type C2) for early stage cervical cancer. A
prospective study.
Plotti F, Nelaj E, Sansone M, Antonelli E, Altavilla T, Angioli R, Benedetti Panici P.
Source
Department of
Obstetrics and Gynecology, La Sapienza University of Rome, Rome, Italy.
[email protected]
Abstract
INTRODUCTION:
When
cervical cancer is detected at an early stage (International Federation of
Gynecology and Obstetrics [FIGO] IA2-IB1), it can be successfully treated by
radical surgery alone. Considering that most patients are young and sexually
active at the moment of diagnosis and the long life expectancy of survivors
after the treatment, quality of life (QoL) and sexual function are important
issues for cancer survivors and caregivers. However, only a few studies have
examined the QoL and sexual function in disease-free cervical cancer survivors,
and there are no studies in the literature comparing prospectively sexual
function after different types of radical hysterectomy.
AIM:
To
compare sexual function in two groups of early stage cervical cancer survivors
treated by radical surgery alone, undergoing two different types of radical
hysterectomy.
METHODS:
Patients
treated by radical hysterectomy with systematic lymphadenectomy for early stage
cervical cancer (FIGO IA2-IB1) have been enrolled and divided in two groups
with regard to type of radical hysterectomy performed; S1: modified radical
hysterectomy (Piver II/Type B), S2: classic radical hysterectomy (Piver III/
Type C2).
MAIN
OUTCOME MEASURE:
Twenty-four months
after surgery we assessed the sexual function using the European Organization
for Research and Treatment of Cancer Cervix Cancer Module Questionnaire, which
is a validated system for the assessment of disease- and treatment-specific
issues that affect the QoL and sexual functioning of women who are treated for
cervical cancer.
RESULTS:
Of the
31 patients enrolled in the S1 group and 46 in the S2 group, 23 and 33 patients
have been included, respectively. We observed significant differences between
the two groups in terms of symptom experience, sexual/vaginal functioning,
sexual activity, and sexual enjoyment. There was not any significant difference
regarding lymphedema, peripheral neuropathy, and sexual worry.
CONCLUSION:
Survivors of early
stage cervical cancer treated by modified radical hysterectomy (Piver II/ Type
B) have a better sexual function than those operated by classic radical
hysterectomy (Piver III/ Type C2).
© 2012
International Society for Sexual Medicine.
PMID:
22372655 [PubMed - in process]
Pneumonol Alergol Pol.
2012;80(2):158-62.
[Yellow
nail syndrome in a patient with membranous glomerulonephritis].
[Article
in Polish]
Modrzewska K, Fijołek J, Ptak J, Wiatr E.
Source
Instytutu Gruźlicy
i Chorób Płuc, ul. Płocka 26, Warsaw. [email protected]
Abstract
Yellow
nail syndrome (YNS) is a condition characterized by yellow-green coloration of
nails, respiratory manifestations and lymphoedema. This article presents
52-year-old patient with membranous glomerulonephritis, hospitalized at the
National Tuberculosis and Lung Diseases Research Institute in Warsaw, because
of suspected allergic aspergillosis. Based on clinical and radiological
evaluation the diagnosis of YNS was established. Treatment of renal disease did
not affect the course of yellow nail syndrome. During the two-year follow-up,
despite stable renal parameters we observed the progression of respiratory
manifestations (bronchiectasis, pleural effusions).
PMID:
22370985 [PubMed - in process]
Otolaryngol Head Neck Surg. 2012
Feb 24. [Epub ahead of print]
Liposuction
for the Management of Submental Lymphedema in the Head and Neck Cancer
Patient.
Mark Taylor S, Brake M.
Source
Dalhousie
University, Halifax, NS, Canada.
PMID:
22368042 [PubMed - as supplied by publisher]
Actas Dermosifiliogr. 2012 Feb
23. [Epub ahead of print]
Angiosarcoma
in Chronic Lymphedema (Stewart-Treves Syndrome).
[Article
in English, Spanish]
Sánchez-Medina MT, Acosta A, Vilar J, Fernández-Palacios
J.
Source
Servicio
de Cirugía Plástica Estética y Reparadora, Hospital de Gran Canaria Dr. Negrín,
Las Palmas de Gran Canaria, España.
PMID:
22365100 [PubMed - as supplied by publisher
March
18, 2012
Drug Metab Dispos. 2012 Mar 12.
[Epub ahead of print]
Transport
of the Coumarin Metabolite 7-hydroxycoumarin Glucuronide is Mediated Via
Multidrug Resistance-Associated Proteins 3 and 4.
Wittgen HG, van den Heuvel JJ, van den Broek PH, Siissalo S, Groothuis GM, de Graaf IA, Koenderink JB, Russel FG.
Source
1
Radboud University Nijmegen Medical Centre;
Abstract
Coumarin
(1, 2-benzopyrone) is a natural compound that has been used as a fragrance in
food and perfume industry, and could have therapeutic usefulness in the
treatment of lymphedema and different types of cancer. Previously, several
pharmacokinetic studies of coumarin have been performed in humans, which
revealed extensive first-pass metabolism of the compound. 7-Hydroxycoumarin
(7-HC) and its glucuronide (7-HC-G) are the main metabolites formed in humans,
and via this route, 80-90 percent of the absorbed coumarin is excreted into
urine, mainly as 7-HC-G. Active transport processes play a role in the urinary
excretion of 7-HC-G, however, until now, the transporters involved remained to
be elucidated. In this study, we investigated whether the efflux transporters
multidrug resistance-associated proteins (MRP) 1-4, breast cancer resistance
protein (BCRP), or P-glycoprotein (P-gp), play a role in 7-HC and 7-HC-G
transport. For this purpose, we measured uptake of the metabolites into
membrane vesicles overexpressing these transporters. Our results showed that
7-HC is not transported by any of the efflux transporters tested, whereas
7-HC-G was a substrate of MRP3 and MRP4. These results are in line with the
pharmacokinetic profile of coumarin, and suggest that MRP3 and MRP4 are the
main transporters involved in the excretion of the coumarin metabolite 7-HC-G
from liver and kidney.
PMID:
22415933 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2012
Mar 14. [Epub ahead of print]
A
prospective study of breast lymphedema: frequency, symptoms, and quality of
life.
Degnim AC, Miller J, Hoskin TL, Boughey JC, Loprinzi M, Thomsen K, Maloney S, Baddour LM, Cheville AL.
Source
Department of
Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN,
55905, USA, [email protected].
Abstract
Although
lymphedema of the arm is a well-known complication of breast and axillary
surgery, breast lymphedema has received scant attention. We sought to
prospectively characterize breast lymphedema's incidence, associated symptoms,
clinical course, and impact on quality of life. Subjects were enrolled
prospectively from a consecutive sample of patients undergoing non-mastectomy
breast procedures (excisional biopsy or wide local excision ± lymph node
removal) and followed for signs and symptoms of lymphedema in the operated
breast. Symptoms and distress were serially assessed with 11-point linear
analog scales. Breast lymphedema was diagnosed independent of symptoms, based
on the distribution and degree of edema and erythema. One hundred twenty-four
women were followed for a median of 11 months, and breast lymphedema was
diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast
surgery with axillary node removal (49%) compared to breast surgery alone (0%),
p < 0.0001. Breast lymphedema involved multiple quadrants in most women and
was characterized by edema in 100% and erythema in 79%. Patients with breast
lymphedema were significantly more likely than women without breast lymphedema
to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness
(62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but
symptom-associated distress was low overall. Three of 32 breast lymphedema
patients with clinical follow-up developed chronic edema. Breast lymphedema
occurs in approximately one-half of women who undergo breast surgery with
axillary node removal. The condition is characterized by diffuse skin edema and
erythema as well as self-reported symptoms with a low level of
distress.
PMID:
22415476 [PubMed - as supplied by publisher]
Br J Cancer. 2012 Mar
13;106(6):1045-52. doi: 10.1038/bjc.2012.62.
Effectiveness
and cost-effectiveness of sentinel lymph node biopsy compared with axillary
node dissection in patients with early-stage breast cancer: a decision model
analysis.
Verry H, Lord SJ, Martin A, Gill G, Lee CK, Howard K, Wetzig N, Simes J.
Source
NHMRC
Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, New
South Wales 2050, Australia.
Abstract
Background:Sentinel
lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection
(ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema
and similar rates of locoregional recurrence up to 8 years. This study
estimates the longer-term effectiveness and cost-effectiveness of
SLNB.Methods:A Markov decision model was developed to estimate the incremental
quality-adjusted life years (QALYs) and costs of an SLNB-based staging and
management strategy compared with ALND over 20 years' follow-up. The
probability and quality-of-life weighting (utility) of outcomes were estimated
from published data and population statistics. Costs were estimated from the
perspective of the Australian health care system. The model was used to
identify key factors affecting treatment decisions.Results:The SLNB was more
effective and less costly than the ALND over 20 years, with 8 QALYs gained and
$883 000 saved per 1000 patients. The SLNB was less effective when: SLNB false
negative (FN) rate > 13%; 5-year incidence of axillary recurrence after an
SLNB FN>19%; risk of an SLNB-positive result >48%; lymphoedema prevalence
after ALND <14%; or lymphoedema utility decrement <0.012.Conclusion:The
long-term advantage of SLNB over ALND was modest and sensitive to variations in
key assumptions, indicating a need for reliable information on lymphoedema
incidence and disutility following SLNB. In addition to awaiting longer-term
trial data, risk models to better identify patients at high risk of axillary
metastasis will be valuable to inform decision-making.
PMID:
22415293 [PubMed - in process]
PMCID:
PMC3304429 [Available on 2013/3/13]
Support Care Cancer. 2012 Mar
13. [Epub ahead of print]
Change
in extracellular fluid and arm volumes as a consequence of a single session of
lymphatic massage followed by rest with or without compression.
Maher J, Refshauge K, Ward L, Paterson R, Kilbreath S.
Source
Occupational
Therapy Department, Concord Repatriation General Hospital, Sydney,
Australia.
Abstract
PURPOSE:
This
study evaluated the acute effect of massage and compression components of
lymphoedema treatment in women with and without arm lymphoedema secondary to
breast cancer from a single treatment session.
METHODS:
Women
with (n = 15) and without (n = 15) lymphoedema underwent a single session of
lymphatic massage. Following the session, women were randomised to receive or
not receive a compression sleeve. Measurements were taken prior to, during, and
following the massage as well as 30 min after completion of the massage.
Bioimpedance spectrometry (BIS) was used to measure changes in extracellular
fluid volume of all limbs as well as 10-cm segments within the upper limbs;
perometry was used to measure changes in total upper limb volume as well as
10-cm segments within the limb.
RESULTS:
There
were no significant changes after massage with or without compression. The
median (and interquartile range) BIS ratios (unaffected:affected) for the whole
upper limb for women with lymphoedema changed from 1.152 (1.053 to 1.422) to
1.192 (1.045 to 1.410) after massage, while the control group changed from
1.024 (0.998 to 1.047) to 1.041 (0.982 to 1.07). The median change in both the
BIS ratio and the total arm volume measured with perometry from prior to the
massage to following 30-min rest changed <2%, irrespective of whether women
used a compression garment and whether women presented with or without
lymphoedema. Examination of 10-cm segments within the arm also revealed no
significant change in BIS ratio from one segment to the next.
CONCLUSION:
Massage
alone or the application of compression after a single session of lymphatic
massage was ineffective for reducing lymphoedema.
PMID:
22410862 [PubMed - as supplied by publisher]
Am J Med Genet A. 2012
Apr;158A(4):839-49. doi: 10.1002/ajmg.a.35229. Epub 2012 Mar 9.
Microcephaly,
intellectual impairment, bilateral vesicoureteral reflux, distichiasis, and
glomuvenous malformations associated with a 16q24.3 contiguous gene deletion
and a Glomulin mutation.
Butler MG, Dagenais SL, Garcia-Perez JL, Brouillard P, Vikkula M, Strouse P, Innis JW, Glover TW.
Source
Department of Human
Genetics, University of Michigan Medical School, Ann Arbor, Michigan.
[email protected].
Abstract
Two
hereditary syndromes, lymphedema-distichiasis (LD) syndrome and
blepharo-chelio-dontic (BCD) syndrome include the aberrant growth of eyelashes
from the meibomian glands, known as distichiasis. LD is an autosomal dominant
syndrome primarily characterized by distichiasis and the onset of lymphedema
usually during puberty. Mutations in the forkhead transcription factor FOXC2
are the only known cause of LD. BCD syndrome consists of autosomal dominant
abnormalities of the eyelid, lip, and teeth, and the etiology remains unknown.
In this report, we describe a proband that presented with distichiasis,
microcephaly, bilateral grade IV vesicoureteral reflux requiring ureteral
re-implantation, mild intellectual impairment and apparent glomuvenous
malformations (GVM). Distichiasis was present in three generations of the
proband's maternal side of the family. The GVMs were severe in the proband, and
maternal family members exhibited lower extremity varicosities of variable
degree. A GLMN (glomulin) gene mutation was identified in the proband that
accounts for the observed GVMs; no other family member could be tested. TIE2
sequencing revealed no mutations. In the proband, an additional submicroscopic
265 kb contiguous gene deletion was identified in 16q24.3, located 609 kb
distal to the FOXC2 locus, which was inherited from the proband's mother. The
deletion includes the C16ORF95, FBXO31, MAP1LC3B, and ZCCHC14 loci and 115 kb
of a gene desert distal to FOXC2 and FOXL1. Thus, it is likely that the
microcephaly, distichiasis, vesicoureteral, and intellectual impairment in this
family may be caused by the deletion of one or more of these genes and/or
deletion of distant cis-regulatory elements of FOXC2 expression. © 2012 Wiley
Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22407726 [PubMed - in process]
PMCID:
PMC3314153 [Available on 2013/4/1]
March
18, 2012
Drug Metab Dispos. 2012 Mar 12.
[Epub ahead of print]
Transport
of the Coumarin Metabolite 7-hydroxycoumarin Glucuronide is Mediated Via
Multidrug Resistance-Associated Proteins 3 and 4.
Wittgen HG, van den Heuvel JJ, van den Broek PH, Siissalo S, Groothuis GM, de Graaf IA, Koenderink JB, Russel FG.
Source
1
Radboud University Nijmegen Medical Centre;
Abstract
Coumarin
(1, 2-benzopyrone) is a natural compound that has been used as a fragrance in
food and perfume industry, and could have therapeutic usefulness in the
treatment of lymphedema and different types of cancer. Previously, several
pharmacokinetic studies of coumarin have been performed in humans, which
revealed extensive first-pass metabolism of the compound. 7-Hydroxycoumarin
(7-HC) and its glucuronide (7-HC-G) are the main metabolites formed in humans,
and via this route, 80-90 percent of the absorbed coumarin is excreted into
urine, mainly as 7-HC-G. Active transport processes play a role in the urinary
excretion of 7-HC-G, however, until now, the transporters involved remained to
be elucidated. In this study, we investigated whether the efflux transporters
multidrug resistance-associated proteins (MRP) 1-4, breast cancer resistance
protein (BCRP), or P-glycoprotein (P-gp), play a role in 7-HC and 7-HC-G
transport. For this purpose, we measured uptake of the metabolites into
membrane vesicles overexpressing these transporters. Our results showed that
7-HC is not transported by any of the efflux transporters tested, whereas
7-HC-G was a substrate of MRP3 and MRP4. These results are in line with the
pharmacokinetic profile of coumarin, and suggest that MRP3 and MRP4 are the
main transporters involved in the excretion of the coumarin metabolite 7-HC-G
from liver and kidney.
PMID:
22415933 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2012
Mar 14. [Epub ahead of print]
A
prospective study of breast lymphedema: frequency, symptoms, and quality of
life.
Degnim AC, Miller J, Hoskin TL, Boughey JC, Loprinzi M, Thomsen K, Maloney S, Baddour LM, Cheville AL.
Source
Department of
Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN,
55905, USA, [email protected].
Abstract
Although
lymphedema of the arm is a well-known complication of breast and axillary
surgery, breast lymphedema has received scant attention. We sought to
prospectively characterize breast lymphedema's incidence, associated symptoms,
clinical course, and impact on quality of life. Subjects were enrolled
prospectively from a consecutive sample of patients undergoing non-mastectomy
breast procedures (excisional biopsy or wide local excision ± lymph node
removal) and followed for signs and symptoms of lymphedema in the operated
breast. Symptoms and distress were serially assessed with 11-point linear
analog scales. Breast lymphedema was diagnosed independent of symptoms, based
on the distribution and degree of edema and erythema. One hundred twenty-four
women were followed for a median of 11 months, and breast lymphedema was
diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast
surgery with axillary node removal (49%) compared to breast surgery alone (0%),
p < 0.0001. Breast lymphedema involved multiple quadrants in most women and
was characterized by edema in 100% and erythema in 79%. Patients with breast
lymphedema were significantly more likely than women without breast lymphedema
to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness
(62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but
symptom-associated distress was low overall. Three of 32 breast lymphedema
patients with clinical follow-up developed chronic edema. Breast lymphedema
occurs in approximately one-half of women who undergo breast surgery with
axillary node removal. The condition is characterized by diffuse skin edema and
erythema as well as self-reported symptoms with a low level of
distress.
PMID:
22415476 [PubMed - as supplied by publisher]
Br J Cancer. 2012 Mar
13;106(6):1045-52. doi: 10.1038/bjc.2012.62.
Effectiveness
and cost-effectiveness of sentinel lymph node biopsy compared with axillary
node dissection in patients with early-stage breast cancer: a decision model
analysis.
Verry H, Lord SJ, Martin A, Gill G, Lee CK, Howard K, Wetzig N, Simes J.
Source
NHMRC
Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, New
South Wales 2050, Australia.
Abstract
Background:Sentinel
lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection
(ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema
and similar rates of locoregional recurrence up to 8 years. This study
estimates the longer-term effectiveness and cost-effectiveness of
SLNB.Methods:A Markov decision model was developed to estimate the incremental
quality-adjusted life years (QALYs) and costs of an SLNB-based staging and
management strategy compared with ALND over 20 years' follow-up. The
probability and quality-of-life weighting (utility) of outcomes were estimated
from published data and population statistics. Costs were estimated from the
perspective of the Australian health care system. The model was used to
identify key factors affecting treatment decisions.Results:The SLNB was more
effective and less costly than the ALND over 20 years, with 8 QALYs gained and
$883 000 saved per 1000 patients. The SLNB was less effective when: SLNB false
negative (FN) rate > 13%; 5-year incidence of axillary recurrence after an
SLNB FN>19%; risk of an SLNB-positive result >48%; lymphoedema prevalence
after ALND <14%; or lymphoedema utility decrement <0.012.Conclusion:The
long-term advantage of SLNB over ALND was modest and sensitive to variations in
key assumptions, indicating a need for reliable information on lymphoedema
incidence and disutility following SLNB. In addition to awaiting longer-term
trial data, risk models to better identify patients at high risk of axillary
metastasis will be valuable to inform decision-making.
PMID:
22415293 [PubMed - in process]
PMCID:
PMC3304429 [Available on 2013/3/13]
Support Care Cancer. 2012 Mar
13. [Epub ahead of print]
Change
in extracellular fluid and arm volumes as a consequence of a single session of
lymphatic massage followed by rest with or without compression.
Maher J, Refshauge K, Ward L, Paterson R, Kilbreath S.
Source
Occupational
Therapy Department, Concord Repatriation General Hospital, Sydney,
Australia.
Abstract
PURPOSE:
This
study evaluated the acute effect of massage and compression components of
lymphoedema treatment in women with and without arm lymphoedema secondary to
breast cancer from a single treatment session.
METHODS:
Women
with (n = 15) and without (n = 15) lymphoedema underwent a single session of
lymphatic massage. Following the session, women were randomised to receive or
not receive a compression sleeve. Measurements were taken prior to, during, and
following the massage as well as 30 min after completion of the massage.
Bioimpedance spectrometry (BIS) was used to measure changes in extracellular
fluid volume of all limbs as well as 10-cm segments within the upper limbs;
perometry was used to measure changes in total upper limb volume as well as
10-cm segments within the limb.
RESULTS:
There
were no significant changes after massage with or without compression. The
median (and interquartile range) BIS ratios (unaffected:affected) for the whole
upper limb for women with lymphoedema changed from 1.152 (1.053 to 1.422) to
1.192 (1.045 to 1.410) after massage, while the control group changed from
1.024 (0.998 to 1.047) to 1.041 (0.982 to 1.07). The median change in both the
BIS ratio and the total arm volume measured with perometry from prior to the
massage to following 30-min rest changed <2%, irrespective of whether women
used a compression garment and whether women presented with or without
lymphoedema. Examination of 10-cm segments within the arm also revealed no
significant change in BIS ratio from one segment to the next.
CONCLUSION:
Massage
alone or the application of compression after a single session of lymphatic
massage was ineffective for reducing lymphoedema.
PMID:
22410862 [PubMed - as supplied by publisher]
Am J Med Genet A. 2012
Apr;158A(4):839-49. doi: 10.1002/ajmg.a.35229. Epub 2012 Mar 9.
Microcephaly,
intellectual impairment, bilateral vesicoureteral reflux, distichiasis, and
glomuvenous malformations associated with a 16q24.3 contiguous gene deletion
and a Glomulin mutation.
Butler MG, Dagenais SL, Garcia-Perez JL, Brouillard P, Vikkula M, Strouse P, Innis JW, Glover TW.
Source
Department of Human
Genetics, University of Michigan Medical School, Ann Arbor, Michigan.
[email protected].
Abstract
Two
hereditary syndromes, lymphedema-distichiasis (LD) syndrome and
blepharo-chelio-dontic (BCD) syndrome include the aberrant growth of eyelashes
from the meibomian glands, known as distichiasis. LD is an autosomal dominant
syndrome primarily characterized by distichiasis and the onset of lymphedema
usually during puberty. Mutations in the forkhead transcription factor FOXC2
are the only known cause of LD. BCD syndrome consists of autosomal dominant
abnormalities of the eyelid, lip, and teeth, and the etiology remains unknown.
In this report, we describe a proband that presented with distichiasis,
microcephaly, bilateral grade IV vesicoureteral reflux requiring ureteral
re-implantation, mild intellectual impairment and apparent glomuvenous
malformations (GVM). Distichiasis was present in three generations of the
proband's maternal side of the family. The GVMs were severe in the proband, and
maternal family members exhibited lower extremity varicosities of variable
degree. A GLMN (glomulin) gene mutation was identified in the proband that
accounts for the observed GVMs; no other family member could be tested. TIE2
sequencing revealed no mutations. In the proband, an additional submicroscopic
265 kb contiguous gene deletion was identified in 16q24.3, located 609 kb
distal to the FOXC2 locus, which was inherited from the proband's mother. The
deletion includes the C16ORF95, FBXO31, MAP1LC3B, and ZCCHC14 loci and 115 kb
of a gene desert distal to FOXC2 and FOXL1. Thus, it is likely that the
microcephaly, distichiasis, vesicoureteral, and intellectual impairment in this
family may be caused by the deletion of one or more of these genes and/or
deletion of distant cis-regulatory elements of FOXC2 expression. © 2012 Wiley
Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22407726 [PubMed - in process]
PMCID:
PMC3314153 [Available on 2013/4/1]
March
18, 2012
Drug Metab Dispos. 2012 Mar 12.
[Epub ahead of print]
Transport
of the Coumarin Metabolite 7-hydroxycoumarin Glucuronide is Mediated Via
Multidrug Resistance-Associated Proteins 3 and 4.
Wittgen HG, van den Heuvel JJ, van den Broek PH, Siissalo S, Groothuis GM, de Graaf IA, Koenderink JB, Russel FG.
Source
1
Radboud University Nijmegen Medical Centre;
Abstract
Coumarin
(1, 2-benzopyrone) is a natural compound that has been used as a fragrance in
food and perfume industry, and could have therapeutic usefulness in the
treatment of lymphedema and different types of cancer. Previously, several
pharmacokinetic studies of coumarin have been performed in humans, which
revealed extensive first-pass metabolism of the compound. 7-Hydroxycoumarin
(7-HC) and its glucuronide (7-HC-G) are the main metabolites formed in humans,
and via this route, 80-90 percent of the absorbed coumarin is excreted into
urine, mainly as 7-HC-G. Active transport processes play a role in the urinary
excretion of 7-HC-G, however, until now, the transporters involved remained to
be elucidated. In this study, we investigated whether the efflux transporters
multidrug resistance-associated proteins (MRP) 1-4, breast cancer resistance
protein (BCRP), or P-glycoprotein (P-gp), play a role in 7-HC and 7-HC-G
transport. For this purpose, we measured uptake of the metabolites into
membrane vesicles overexpressing these transporters. Our results showed that
7-HC is not transported by any of the efflux transporters tested, whereas
7-HC-G was a substrate of MRP3 and MRP4. These results are in line with the
pharmacokinetic profile of coumarin, and suggest that MRP3 and MRP4 are the
main transporters involved in the excretion of the coumarin metabolite 7-HC-G
from liver and kidney.
PMID:
22415933 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2012
Mar 14. [Epub ahead of print]
A
prospective study of breast lymphedema: frequency, symptoms, and quality of
life.
Degnim AC, Miller J, Hoskin TL, Boughey JC, Loprinzi M, Thomsen K, Maloney S, Baddour LM, Cheville AL.
Source
Department of
Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN,
55905, USA, [email protected].
Abstract
Although
lymphedema of the arm is a well-known complication of breast and axillary
surgery, breast lymphedema has received scant attention. We sought to
prospectively characterize breast lymphedema's incidence, associated symptoms,
clinical course, and impact on quality of life. Subjects were enrolled
prospectively from a consecutive sample of patients undergoing non-mastectomy
breast procedures (excisional biopsy or wide local excision ± lymph node
removal) and followed for signs and symptoms of lymphedema in the operated
breast. Symptoms and distress were serially assessed with 11-point linear
analog scales. Breast lymphedema was diagnosed independent of symptoms, based
on the distribution and degree of edema and erythema. One hundred twenty-four
women were followed for a median of 11 months, and breast lymphedema was
diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast
surgery with axillary node removal (49%) compared to breast surgery alone (0%),
p < 0.0001. Breast lymphedema involved multiple quadrants in most women and
was characterized by edema in 100% and erythema in 79%. Patients with breast
lymphedema were significantly more likely than women without breast lymphedema
to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness
(62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but
symptom-associated distress was low overall. Three of 32 breast lymphedema
patients with clinical follow-up developed chronic edema. Breast lymphedema
occurs in approximately one-half of women who undergo breast surgery with
axillary node removal. The condition is characterized by diffuse skin edema and
erythema as well as self-reported symptoms with a low level of
distress.
PMID:
22415476 [PubMed - as supplied by publisher]
Br J Cancer. 2012 Mar
13;106(6):1045-52. doi: 10.1038/bjc.2012.62.
Effectiveness
and cost-effectiveness of sentinel lymph node biopsy compared with axillary
node dissection in patients with early-stage breast cancer: a decision model
analysis.
Verry H, Lord SJ, Martin A, Gill G, Lee CK, Howard K, Wetzig N, Simes J.
Source
NHMRC
Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, New
South Wales 2050, Australia.
Abstract
Background:Sentinel
lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection
(ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema
and similar rates of locoregional recurrence up to 8 years. This study
estimates the longer-term effectiveness and cost-effectiveness of
SLNB.Methods:A Markov decision model was developed to estimate the incremental
quality-adjusted life years (QALYs) and costs of an SLNB-based staging and
management strategy compared with ALND over 20 years' follow-up. The
probability and quality-of-life weighting (utility) of outcomes were estimated
from published data and population statistics. Costs were estimated from the
perspective of the Australian health care system. The model was used to
identify key factors affecting treatment decisions.Results:The SLNB was more
effective and less costly than the ALND over 20 years, with 8 QALYs gained and
$883 000 saved per 1000 patients. The SLNB was less effective when: SLNB false
negative (FN) rate > 13%; 5-year incidence of axillary recurrence after an
SLNB FN>19%; risk of an SLNB-positive result >48%; lymphoedema prevalence
after ALND <14%; or lymphoedema utility decrement <0.012.Conclusion:The
long-term advantage of SLNB over ALND was modest and sensitive to variations in
key assumptions, indicating a need for reliable information on lymphoedema
incidence and disutility following SLNB. In addition to awaiting longer-term
trial data, risk models to better identify patients at high risk of axillary
metastasis will be valuable to inform decision-making.
PMID:
22415293 [PubMed - in process]
PMCID:
PMC3304429 [Available on 2013/3/13]
Support Care Cancer. 2012 Mar
13. [Epub ahead of print]
Change
in extracellular fluid and arm volumes as a consequence of a single session of
lymphatic massage followed by rest with or without compression.
Maher J, Refshauge K, Ward L, Paterson R, Kilbreath S.
Source
Occupational
Therapy Department, Concord Repatriation General Hospital, Sydney,
Australia.
Abstract
PURPOSE:
This
study evaluated the acute effect of massage and compression components of
lymphoedema treatment in women with and without arm lymphoedema secondary to
breast cancer from a single treatment session.
METHODS:
Women
with (n = 15) and without (n = 15) lymphoedema underwent a single session of
lymphatic massage. Following the session, women were randomised to receive or
not receive a compression sleeve. Measurements were taken prior to, during, and
following the massage as well as 30 min after completion of the massage.
Bioimpedance spectrometry (BIS) was used to measure changes in extracellular
fluid volume of all limbs as well as 10-cm segments within the upper limbs;
perometry was used to measure changes in total upper limb volume as well as
10-cm segments within the limb.
RESULTS:
There
were no significant changes after massage with or without compression. The
median (and interquartile range) BIS ratios (unaffected:affected) for the whole
upper limb for women with lymphoedema changed from 1.152 (1.053 to 1.422) to
1.192 (1.045 to 1.410) after massage, while the control group changed from
1.024 (0.998 to 1.047) to 1.041 (0.982 to 1.07). The median change in both the
BIS ratio and the total arm volume measured with perometry from prior to the
massage to following 30-min rest changed <2%, irrespective of whether women
used a compression garment and whether women presented with or without
lymphoedema. Examination of 10-cm segments within the arm also revealed no
significant change in BIS ratio from one segment to the next.
CONCLUSION:
Massage
alone or the application of compression after a single session of lymphatic
massage was ineffective for reducing lymphoedema.
PMID:
22410862 [PubMed - as supplied by publisher]
Am J Med Genet A. 2012
Apr;158A(4):839-49. doi: 10.1002/ajmg.a.35229. Epub 2012 Mar 9.
Microcephaly,
intellectual impairment, bilateral vesicoureteral reflux, distichiasis, and
glomuvenous malformations associated with a 16q24.3 contiguous gene deletion
and a Glomulin mutation.
Butler MG, Dagenais SL, Garcia-Perez JL, Brouillard P, Vikkula M, Strouse P, Innis JW, Glover TW.
Source
Department of Human
Genetics, University of Michigan Medical School, Ann Arbor, Michigan.
[email protected].
Abstract
Two
hereditary syndromes, lymphedema-distichiasis (LD) syndrome and
blepharo-chelio-dontic (BCD) syndrome include the aberrant growth of eyelashes
from the meibomian glands, known as distichiasis. LD is an autosomal dominant
syndrome primarily characterized by distichiasis and the onset of lymphedema
usually during puberty. Mutations in the forkhead transcription factor FOXC2
are the only known cause of LD. BCD syndrome consists of autosomal dominant
abnormalities of the eyelid, lip, and teeth, and the etiology remains unknown.
In this report, we describe a proband that presented with distichiasis,
microcephaly, bilateral grade IV vesicoureteral reflux requiring ureteral
re-implantation, mild intellectual impairment and apparent glomuvenous
malformations (GVM). Distichiasis was present in three generations of the
proband's maternal side of the family. The GVMs were severe in the proband, and
maternal family members exhibited lower extremity varicosities of variable
degree. A GLMN (glomulin) gene mutation was identified in the proband that
accounts for the observed GVMs; no other family member could be tested. TIE2
sequencing revealed no mutations. In the proband, an additional submicroscopic
265 kb contiguous gene deletion was identified in 16q24.3, located 609 kb
distal to the FOXC2 locus, which was inherited from the proband's mother. The
deletion includes the C16ORF95, FBXO31, MAP1LC3B, and ZCCHC14 loci and 115 kb
of a gene desert distal to FOXC2 and FOXL1. Thus, it is likely that the
microcephaly, distichiasis, vesicoureteral, and intellectual impairment in this
family may be caused by the deletion of one or more of these genes and/or
deletion of distant cis-regulatory elements of FOXC2 expression. © 2012 Wiley
Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22407726 [PubMed - in process]
PMCID:
PMC3314153 [Available on 2013/4/1]
March
20, 2012
Ophthalmic Genet. 2012 Mar 15.
[Epub ahead of print]
Microcephaly-lymphedema-chorioretinal
dysplasia associated with pachymicrogyria and atrophy of the cerebellar vermis:
an integration of brain-ocular migration disorders.
Pastora N, Peralta J, Canal-Fontcuberta I, Grabowska A, Pulido JS, Abelairas J, Armada F, Garcia-Alix A.
Source
Hospital
Universitario La Paz, Pediatric Ophthalmology , Madrid , Spain.
Abstract
Background:
Microcephaly-lymphedema-chorioretinal dysplasia (OMIM 152950) is a rare
malformative inherited disorder that can be associated with other systemic
features. Other ocular and brain anomalies rather than microcephaly and
chorioretinal dysplasia have been inconstantly reported in this syndrome.
Methods: We present a case of microcephaly-lymphedema-chorioretinal dysplasia
with a dysmorphic facies, hypertonicity in the extremities and neuropsychomotor
delay. Ophthalmological examination revealed bilateral nystagmus,
microphthalmia, posterior subcapsular cataratacts, extensive chorioretinal
dysplasia, optic nerve aplasia, persistent fetal vasculature, and absent
retinal vessels. Results: Magnetic resonance revealed pachymicrogyria and
discrete atrophy of vermis cerebelosum and confirmed optic nerve hypoplasia.
Conclusions: The developmental alterations observed in the retina of this
patient could be analogous to central nervous system anomalies, reflecting a
reduction in neural population. Ophthalmic examination of children with
microcephaly is warranted.
PMID:
22420539 [PubMed - as supplied by publisher]
Anat Rec (Hoboken). 2012 Mar 15.
doi: 10.1002/ar.22438. [Epub ahead of print]
Improved
Regeneration of Autologous Transplanted Lymph Node Fragments by VEGF-C
Treatment.
Sommer T, Buettner M, Bruns F, Breves G, Hadamitzky C, Pabst R.
Source
Institute of
Immunomorphology, Hannover Medical School, Hannover, Germany.
Abstract
Secondary
lymphedema is a common complication after removal of lymph nodes in combination
with radiation therapy in the treatment of breast cancer, cervical cancer, and
melanomas. Only symptomatic therapies are available at the moment, and
lymphedema is for most patients a lifelong condition involving psychological
and physical disabilities. Animal models exist to study the pathophysiology of
lymphedema but not to study surgical treatments. The aim of this study was to
show that regeneration of autologous transplanted lymph node fragments is
possible in rats that were irradiated previously locally in the groin and to
examine the effects of vascular endothelial growth factor (VEGF)-C injections
on the rate of regeneration of transplanted lymph nodes. In all of the animals,
inguinal and popliteal lymph nodes and adjacent lymphatic vessels were
unilaterally removed and the inguinal region irradiated by a single dose of 15
Gy. Afterward, lymph node fragments were transplanted subcutaneously in the
irradiated region. Half of the animals were treated by local VEGF-C injections
after transplantation. Four weeks after transplantation, drainage of the leg
was tested by injection of blue dye, and the transplanted fragments were
removed and examined immunohistologically. We could show that regeneration of
autologous transplanted lymph node fragments is possible in areas treated with
radiotherapy in the rat. We also documented that transplants can achieve a
connection to the lymphatic collectors of the leg. The results suggest that the
outcome of regeneration can be improved by injection of VEGF-C in the
transplantation area. Thus, lymph node fragment regeneration may be relevant
for lymphedema prevention and therapy. Anat Rec, 2012. © 2012 Wiley
Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22419614 [PubMed - as supplied by publisher]
Indian J Pediatr. 2012 Mar 15.
[Epub ahead of print]
Congenital
Chylous Ascites and Lymphedema in Down's Syndrome.
Bhattacharya S, Das NK, Chatterjee A.
Source
Department of
Pediatric Medicine, IPGMER and SSKM Hospital, Kolkata, India,
[email protected].
PMID:
22418947 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2012
Mar;10(1):30-2. Epub 2012 Mar 14.
Yellow
nail syndrome: treatment of lymphedema using low pressure
compression.
Polat AK, Dang HT, Soran A.
Source
Magee-Womens
Hospital, University of Pittsburgh Medical Center , Department of Surgical
Oncology, Pittsburgh, PA.
Abstract
Abstract
The present report describes a case with the triad of yellow nail syndrome
(YNS) and the use of low-pressure compression pump as treatment of lymphedema
in YNS. A 71-year-old woman presented with bilateral lower extremity
lymphedema, yellow nails, and recurrent bilateral pleural effusion. In this
case, we specifically focused on lymphedema treatment of the legs besides other
recommendations for YNS.
PMID:
22416910 [PubMed - in process]
March
29, 2012
Int Wound J. 2012 Mar 20. doi:
10.1111/j.1742-481X.2012.00958.x. [Epub ahead of print]
Evaluation
of the performance of a new compression system in patients with
lymphoedema.
Franks PJ, Moffatt CJ, Murray S, Reddick M, Tilley A, Schreiber A.
Source
PJ
Franks, PhD, CRICP, St Luke's Crypt, Sydney Street, London SW3 6NH, UK,
Division of Nursing & Healthcare, University of Glasgow, Glasgow, UK and
Faculty of Health & Social Care, London South Bank University, London, UK
CJ Moffatt, PhD, RN, Lymphoedema Care, Royal Derby Hospital, Derby, UK, Faculty
of Medicine, Department Nursing & Healthcare, University of Glasgow,
Glasgow, UK S Murray, MA, RN, Lymphoedema Care, Royal Derby Hospital, Derby, UK
M Reddick, RN, Dr H Bliss Murphy Cancer Centre, St John's, Newfoundland, Canada
A Tilley, BSc, PT, Horizon Health Network, Breast Rehabilitation &
Lymphoedema Programs, St Joseph's Hospital, Saint John, New Brunswick, Canada A
Schreiber, PT, The London Road Clinic, Sherborne, UK.
Abstract
In the
acute phase of lymphoedema, patients require comprehensive decongestive therapy
(CDT), which includes skin care, an exercise regimen, manual lymphatic drainage
(MLD) and regular bandaging. This study was established to determine the
effectiveness of a new system of bandage therapy, the 3M™ Coban™ 2 compression
system. In total, 24 patients were entered into the study (12 from UK and 12
from Canada) with a variety of clinical presentations. The mean age of the
groups was 57·4 years, which varied from 26 to 79 years. Body mass index (BMI)
averaged 38·9 kg/m(2) , with a range from 22·7 to 67·5 kg/m(2) . Of the total,
eight were women with arm lymphoedema, the remainder being men and women with
lymphoedema of the lower limb. All were considered to be in need of CDT. After
19 days, the reduction of limb volume was measured, which indicated a mean limb
volume reduction of 1210 ml (95% confidence interval, CI, 780-1641, P <
0·001). Leg affected patients experienced greater reduction than arm affected
patients (1596 ml versus 438 ml), although both groups experienced significant
reduction in limb volumes (both P < 0·001). Mean percentage changes in limb
volume were 14·9% and 16·1% for legs and arms, respectively. The Measure Your
Medical Outcome Profile questionnaire indicated significant improvement in
symptoms considered important by the patient (P < 0·0001), which also led to
improvements in skin quality by reducing skin thickness and firmness. The Coban
2 compression system provides good oedema reduction in both arms and legs to
reduce limb volume and improvements in symptoms associated with
lymphoedema.
© 2012
The Authors. © 2012 Blackwell Publishing Ltd and Medicalhelplines.com
Inc.
PMID:
22432947 [PubMed - as supplied by publisher]
Eur J Pediatr. 2012 Mar 21.
[Epub ahead of print]
GATA-2
anomaly and clinical phenotype of a sporadic case of lymphedema, dendritic
cell, monocyte, B- and NK-cell (DCML) deficiency, and
myelodysplasia.
Ishida H, Imai K, Honma K, Tamura SI, Imamura T, Ito M, Nonoyama S.
Source
Department of
Pediatrics and Blood and Marrow transplantation, Matsushita Memorial Hospital,
5-55, Sotojima-cho, Moriguchi, 570-8540, Japan,
[email protected].
Abstract
A
Japanese patient presented with lymphedema, severe Varicella zoster, and
Salmonella infection, recurrent respiratory infections, panniculitis,
monocytopenia, B- and NK-cell lymphopenia, and myelodysplasia. The phenotype
was a mixture of the monocytopenia and mycobacterial infection (MonoMAC) and
Emberger syndromes. Sequencing of the GATA-2 cDNA revealed the heterozygous
missense mutation 1187 G > A. This mutation resulted in the amino acid
mutation Arg396Gln in the zinc fingers-2 domain, which is predicted to cause
significant structural change and prevent a critical interaction with DNA.
Functional analysis of the patient's GATA-2 mutation is required to understand
the relationship between these distinctive syndromes.
PMID:
22430350 [PubMed - as supplied by publisher]
Eur J Vasc Endovasc Surg. 2012
Mar 17. [Epub ahead of print]
Net
Effect of Lymphaticovenous Anastomosis on Volume Reduction of Peripheral
Lymphoedema after Complex Decongestive Physiotherapy.
Wisselink W.
Source
VU
University Medical Center, Department of Vascular Surgery, De Boelelaan 1117,
PO Box 7057, 1007 MB Amsterdam, The Netherlands.
PMID:
22429985 [PubMed - as supplied by publisher
Am J Physiol Heart Circ Physiol.
2012 Mar 16. [Epub ahead of print]
Functional
Recovery of Fluid Drainage Precedes Lymphangiogenesis in Acute Murine Foreleg
Lymphedema.
Mendez U, Brown EM, Ongstad EL, Slis JR, Goldman J.
Source
1Michigan
Technological University.
Abstract
Secondary
lymphedema in humans is a common consequence of axillary lymph node dissection
(ALND) to treat breast cancer. It is commonly hypothesized that lymphatic
growth is required to increase fluid drainage and ameliorate lymphedema.
Although there is a pronounced alteration in the balance of interstitial forces
regulating fluid transport that sustains the chronic form of lymphedema, it is
presently unknown whether changes occur to the balance of interstitial forces
during acute lymphedema that may play a role in the recovery of fluid drainage.
Here we compared the relative importance of lymphangiogenesis of lymphatic
vessels and interstitial flows for restoring fluid drainage and resolving acute
lymphedema in the mouse foreleg following ALND. We found that removal of the
axillary lymph nodes reduced lymph drainage in the foreleg at days 0 and 5
post-surgery, with fluid tracer spreading interstitially through subcutaneous
tissues. Interstitial fluid drainage returned to normal by day 10, whereas
functional regrowth of lymphatic vessels was first detected by indocyanine
green fluorescence lymphography at day 15, demonstrating that the recovery of
interstitial fluid drainage preceded the regrowth of lymphatic vessels. This
was confirmed by administration of VEGFR-3 neutralizing antibodies, which
completely blocks lymphatic regrowth. It was found that the recovery of
interstitial fluid drainage and the natural resolution of acute lymphedema
produced by ALND were not hindered by VEGFR-3 neutralization, demonstrating
that interstitial fluid drainage recovery and resolution of acute lymphedema
are lymphangiogenesis-independent. The data highlights the central role of the
interstitial environment in adapting to lymphatic injury to increase fluid
drainage.
PMID:
22427513 [PubMed - as supplied by publisher]
N Z Med J. 2012 Mar
9;125(1351):29-39.
Difficulties
with defining lymphoedema after axillary dissection for breast
cancer.
Asim M, Cham A, Banerjee S, Nancekivell R, Dutu G, McBride C, Cavanagh S, Lawrenson R, Campbell I.
Source
Liver
Transplant Unit, Level 15 Support Building, Auckland City Hospital, Auckland,
New Zealand. [email protected].
Abstract
AIM:
Axillary
lymph node dissection(AND) is a common treatment for breast cancer. An
important side effect of the surgery is lymphoedema (LO). The primary aims of
this study were to assess the local prevalence of LO in patients who had
undergone AND and how the subjective symptoms described by patients compare
with objective measurements. Secondary aims were to investigate the
relationship between risk factors and the prevalence of LO and to establish an
easy and convenient way to detect LO patients in surgical clinics.
METHOD:
Eligible
women after AND for breast cancer underwent three circumference measurements on
the operated and non operated (control) arm. LO was defined as one or more
measurements with an increase =7.5% than control after dominant arm correction.
Questionnaires were used to assess severity of symptoms related to lymphoedema.
73 patients also had serial measurements in arms and change in arm volume in
operated arm was calculated using Casley-Smith method and LO was defined as
=20% increase in volume.
RESULTS:
193
women with AND were analysed. Mean age was 61 years and mean time since surgery
was 56 months. The overall prevalence of LO was 23.3%. LO prevalence by arm
volume was 8.2%. Using volume as the standard, an arm circumference increase of
=7.5% and =10% showed a sensitivity and specificity of 83% and 81%, and 66% and
89% respectively. Significant risk factors for LO were age, radiotherapy and
infection to the operated arm
CONCLUSION:
Circumference
measures are a simple office method of screening for LO. A patient history and
greater than and equal to 10% increase in any circumference is optimal for
determining LO after AND.
PMID:
22426609 [PubMed - in process]
Gynecol Oncol. 2012 Mar 15.
[Epub ahead of print]
The
efficacy of complex decongestive physiotherapy (CDP) and predictive factors of
response to CDP in lower limb lymphedema (LLL) after pelvic cancer
treatment.
Liao SF, Li SH, Huang HY.
Source
Department of
Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanxiao
Street, Changhua 500, Taiwan.
Abstract
OBJECTIVE:
The aim
of this study was to estimate the efficacy of an intensive CDP program, as well
as to identify the predictors associated with lymphedema severity and response
to CDP in lower limb lymphedema (LLL) after pelvic cancer therapy.
METHODS:
We
performed a retrospective review of post-pelvic cancer LLL patients that were
treated with a CDP program between January 2004 and March 2011.
RESULTS:
Twenty-seven
(61.4%) of the total 44 patients had cervical cancer, 9 (20.5%) had endometrial
cancer, and 8 (18.2%) had ovarian cancer. The mean age was 62.2years, 18
(40.9%) patients received radiotherapy and a mean of 12.6 sessions of daily
CDP, and mean lymphedema duration was 34.8months. The interval from pelvic
cancer treatment to LLL development was 63.4months. Lymphedema severity,
baseline and post-CDP percentage of excess volume (PEV) were 32.9%±18.4% and
18.8%±16.7%. Baseline PEV was not correlated with duration of lymphedema,
number of CDP sessions, age or radiotherapy, and was significantly different to
post-CDP PEV (p<0.001). CDP efficacy, percentage reduction of excess volume
(PREV), was -55.1%, and was correlated with baseline PEV, but not with the
number of CDP sessions, duration of lymphedema, or age. PEV (p<0.001) was
the only predictive factor for CDP efficacy.
CONCLUSIONS:
The key
to predicting successful lymphedema treatment of LLL is the initial PEV. The
intensive CDP program was effective and successful. We should encourage and
refer patients to undergo treatment for LLL, even when the LLL is
mild.
Copyright © 2012
Elsevier Inc. All rights reserved.
PMID:
22426250 [PubMed - as supplied by publisher]
April
3, 2012
Breast. 2012 Mar 27. [Epub ahead
of print]
Breast
cancer related lymphedema in patients with different loco-regional
treatments.
Ozcinar B, Guler SA, Kocaman N, Ozkan M, Gulluoglu BM, Ozmen V.
Source
Istanbul
University, Istanbul Medical Faculty, General Surgery Department, Istanbul,
Turkey.
Abstract
INTRODUCTION:
Lymphedema, a
sequela of breast cancer and breast cancer therapy, changes functional
abilities and may affect a patient's psychosocial adjustment and overall
quality of life. Aim of this prospective observational study was to determine
the rate of mid-term and late time period lymphedema in breast cancer patients
with different loco-regional treatments, and factors associated with
lymphedema.
MATERIALS
AND METHODS:
Patients
surgically treated for early-stage breast cancer were prospectively enrolled in
the study. Demographic, clinical, pathological, and loco-regional treatments
data of patients and lymphedema rates were recorded. Patients were divided into
six groups regarding different loco-regional treatments. Pre- and postoperative
(12 months, and median 64 months after surgery) circumferences of arms were
recorded.
RESULTS:
218
patients, all female with a median age of 48 (19-82) years, were included in
the study. The numbers of patients in breast conservation surgery group (BCS)
(N = 104), mastectomy group (N = 114), sentinel lymph node biopsy group (SLNB)
(N = 80), axillary lymph node dissection group (ALND) (N = 138), group with
radiotherapy (RT) (N = 88) and group without radiotherapy (N = 130). Incidence
of lymphedema after surgery in mid-term period was 24.8%. The rate of
lymphedema at 64 months median follow-up time was 7.3%. (BCS: 11.1%, 4.2% and
0.5%; Mastectomy: 15.0%, 3.2% and 1.4%; SLNB: 8.0%, 1.9% and 0.5%; ALND: 18.0%,
5.3% and 1.4%; RT: 14.7%, 6.3% and 1.4%; without RT: 11.4%, 2.1% and 0.5%).
When we excluded patients with both mid-term and late term lymphedema, only
four patients developed lymphedema at late time, then re-calculated late term
lypmhedema rate was 1.8%. The factors affecting the lymphedema was ALND and
radiotherapy (RT) and no lymphedema was detected in patients underwent breast
conserving surgery and SLNB. Age and body mass index were not related to
lymphedema at any time.
CONCLUSION:
The
incidence of lymphedema gradually increased in time and a quarter of patients
experienced the complication at the end of year. The rate of lymphedema in
patients with ALND was significantly higher than patients with SLNB alone. If
RT added to SLNB the lymphedema rate was getting higher than SLNB alone. In all
patients lymphedema rate was decreased one year after the surgery and further
decreased at median 64 months follow-up time period.
Copyright © 2012
Elsevier Ltd. All rights reserved.
PMID:
22460058 [PubMed - as supplied by publisher]
Lymphology. 2011
Dec;44(4):183-6.
Severe
lymphedema caused by repeated self-injury.
Mihara M, Hara H, Murai N, Todokoro T, Iida T, Narushima M, Koshima I.
Source
Department of
Plastic Surgery/Aesthetic Surgery, University of Tokyo, Tokyo, Japan.
[email protected]
Abstract
Lymphedema is
divided into primary and secondary forms. Primary lymphedema often develops in
young people and may be caused by lymphvascular aplasia, hypoplasia, and
hyperplasia. The most frequent cause of secondary lymphedema after lymphatic
filariasis is regional lymph node dissection for treatment of a malignant
tumor, and this complication occurs most frequently in middle aged or older
patients. Here, we describe a relatively young patient (27 years old) in whom
collecting lymph vessels in the upper limb were disrupted by repeated
self-injury, with resultant lymphedema. There have been very few reports on
lymphedema caused by self-induced trauma. This case report illustrates that
secondary lymphedema should also be considered and evaluated appropriately when
diagnosed in a relatively young patient without a history of cancer or
infection.
PMID:
22458120 [PubMed - in process]
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Lymphology. 2011
Dec;44(4):178-82.
Lymphedema
treatment decreases pain intensity in lipedema.
Szolnoky G, Varga E, Varga M, Tuczai M, Dósa-Rácz E, Kemény L.
Source
Department of
Dermatology and Allergology, University of Szeged, Hungary.
[email protected]
Abstract
Lipedema
is a disproportional obesity featuring light pressure-induced or spontaneous
pain. On the basis of our clinical observations, lymphedema therapy, as
practiced in our clinic, reduces the perception of pain beyond leg volume
reduction. We therefore aimed to measure pain intensity prior and subsequent to
treatment. 38 women with lipedema were enrolled in the study with 19 patients
undergoing treatment and 19 serving as the control group using exclusively
moisturizers. Treatment consisted of once daily manual lymph drainage (MLD),
intermittent pneumatic compression (IPC), and multilayered short-stretch
bandaging performed throughout a 5-day-course. Pain was evaluated with a
10-item questionnaire, a pain rating scale (PRS), and the Wong-Baker Faces
scale. Treatment resulted in a significant reduction of pain with a decrease in
mean scores of all three measures. In the control group, only PRS showed
significant decrease. Our study results indicate that this treatment regimen
not only reduces leg volume and capillary fragility, but also improves pain
intensity in patients with lipedema.
PMID:
22458119 [PubMed - in process]
Lymphology. 2011
Dec;44(4):168-77.
Changes
in tissue water and indentation resistance of lymphedematous limbs accompanying
low level laser therapy (LLLT) of fibrotic skin.
Mayrovitz HN, Davey S.
Source
College
of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida
33328, USA. [email protected]
Abstract
Our goal
was to determine effects of low-level-laser-therapy (LLLT) on skin water and
tissue indentation resistance (TIR) in patients with arm (N = 38) or leg (N =
38) lymphedema. Skin water was determined from tissue dielectric constant (TDC)
measurements and TIR determined from measurements of force resulting from
tissue indentations of 3-4 mm. A limb-location with fibrosis was identified by
palpation and treated with an LLLT device for one minute at each of five points
within a 3 cm2 area. TDC and TIR at these sites and corresponding sites on the
contralateral limb were measured prior to LLLT (pre-LLLT), immediately after
LLLT (post-LLLT) and after a manual lymphatic drainage (MLD) session
(post-MLD). Results, from arms and legs, showed that post-LLLT values of TIR
and TDC were significantly less than pre-LLLT. TIR values remained
significantly reduced at post-MLD whereas TDC values were not significantly
different from pre-LLLT values. On follow-up visit, 17 previously LLLT treated
legs were sham treated with an inactive LLLT unit and measurements replicated.
A TIR and TDC change-pattern similar to that obtained with the active LLLT was
obtained, but sham-related reductions in TIR and TDC immediately post
sham-treatment were significantly less than achieved with the prior active LLLT
treatment.
PMID:
22458118 [PubMed - in process]
Lymphology. 2011
Dec;44(4):155-67.
Classification
of lymphoscintigraphy and relevance to surgical indication for lymphaticovenous
anastomosis in upper limb lymphedema.
Mikami T, Hosono M, Yabuki Y, Yamamoto Y, Yasumura K, Sawada H, Shizukuishi K, Maegawa J.
Source
Department of
Plastic and Reconstructive Surgery, Yokohama City University Hospital,
Yokohama, Japan. [email protected]
Abstract
Upper
limb lymphedema that develops after breast cancer surgery causes physical
discomfort and psychological distress, and it can require both conservative and
surgical treatment. Lymphaticovenous anastomosis has been reported to be an
effective treatment; however the disease severity criteria that define
indications for this treatment remain unclear. Here, we examined
lymphoscintigraphic findings in 78 patients with secondary upper limb
lymphedema and classified them into 5 major types (Type I-V) and 3 subtypes
(Subtype E, L, and 0). Results revealed that this classification is related to
the clinical stage scale of the International Society of Lymphology. Based on
intraoperative examination findings in 20 of the 78 patients, lymphatic
pressure is likely to be further elevated in Type II-V cases which are
characterized by the presence of dermal back flow. Therefore, lymphaticovenous
anastomosis should be considered as a treatment option for lymphedema in Type
II-V cases. Furthermore, there are only limited lymph vessel sites usable for
lymphaticovenous anastomosis in more severe lymphedema types [Types IV and Type
V (which is characterized by dermal backflow only in the hand)]. The findings
in Type IV-V cases suggest that therapeutic strategies for severe upper limb
lymphedema need further consideration.
PMID:
22458117 [PubMed - in process]
Am Nurse. 2012
Jan-Feb;44(1):5.
MONA
nurse researches lymphedema.
[No
authors listed]
PMID:
22458098 [PubMed - in process]
Plast Reconstr Surg. 2012
Apr;129(4):767e-9e.
Overview
of treatments for male genital lymphedema: critical literature review and
anatomical considerations.
Otsuki Y, Yamada K, Hasegawa K, Kimata Y, Suami H.
Source
Department of
Plastic and Reconstructive Surgery, Okayama University, Okayama, Japan (Otsuki,
Yamada, Hasegawa, Kimata) Department of Plastic Surgery, University of Texas M.
D. Anderson Cancer Center, Houston, Texas (Suami).
PMID:
22456418 [PubMed - in process]
Plast Reconstr Surg. 2012
Apr;129(4):838-47.
Regulation
of Adipogenesis by Lymphatic Fluid Stasis: Part II. Expression of Adipose
Differentiation Genes.
Aschen S, Zampell JC, Elhadad S, Weitman E, De Brot M, Mehrara BJ.
Source
New
York, N.Y. From the Divisions of Plastic and Reconstructive Surgery and Breast
Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer
Center.
Abstract
BACKGROUND:
:
Although fat deposition is a defining clinical characteristic of lymphedema,
the cellular mechanisms that regulate this response remain unknown. The goal of
this study was to determine how lymphatic fluid stasis regulates adipogenic
gene activation and fat deposition.
METHODS:
: Adult
female mice underwent tail lymphatic ablation and were euthanied at 1, 3, or 6
weeks postoperatively (n = 8 per group). Samples were analyzed by
immunohistochemistry and Western blot analysis. An alternative group of mice
underwent axillary dissections or sham incisions, and limb tissues were
harvested 3 weeks postoperatively (n = 8 per group).
RESULTS:
:
Lymphatic fluid stasis resulted in significant subcutaneous fat deposition and
fibrosis in lymphedematous tail regions (p < 0.001). Western blot analysis
demonstrated that proteins regulating adipose differentiation including
CCAAT/enhancer-binding protein-α and adiponectin were markedly up-regulated in
response to lymphatic fluid stasis in the tail and axillary models. Expression
of these markers increased in edematous tissues according to the gradient of
lymphatic stasis distal to the wound. Immunohistochemical analysis further
demonstrated that adiponectin and peroxisome proliferator-activated receptor-γ,
another critical adipogenic transcription factor, followed similar expression
gradients. Finally, adiponectin and peroxisome proliferator-activated
receptor-γ expression localized to a variety of cell types in newly formed
subcutaneous fat.
CONCLUSIONS:
: The
mouse-tail model of lymphedema
demonstrates pathologic findings similar to clinical lymphedema,
including fat deposition and fibrosis. The authors show that lymphatic fluid
stasis potently up-regulates the expression of fat differentiation markers both
spatially and temporally. These studies elucidate mechanisms regulating
abnormal fat deposition in lymphedema pathogenesis and therefore
provide a basis for developing targeted treatments.
PMID:
22456356 [PubMed - in process]
Plast Reconstr Surg. 2012
Apr;129(4):825-34.
Regulation
of adipogenesis by lymphatic fluid stasis: part I. Adipogenesis, fibrosis, and
inflammation.
Zampell JC, Aschen S, Weitman ES, Yan A, Elhadad S, De Brot M, Mehrara BJ.
Source
New
York, N.Y. From the Divisions of Plastic and Reconstructive Surgery and Breast
Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer
Center.
Abstract
BACKGROUND:
:
Although fat deposition is a defining clinical characteristic of lymphedema,
the cellular mechanisms that regulate this response remain unknown. The goals
of this two-part study were to determine the effect of lymphatic fluid stasis
on adipogenesis and inflammation (part I) and how these changes regulate the
temporal and spatial expression of fat differentiation genes (part
II).
METHODS:
: Adult
female mice underwent tail lymphatic ablation and were euthanized 6 weeks after
surgery (n = 20). Fat deposition, fibrosis, and inflammation were then analyzed
in the regions of the tail exposed to lymphatic fluid stasis as compared with
normal lymphatic flow.
RESULTS:
:
Lymphatic fluid stasis in the tail resulted in significant subcutaneous fat
deposition, with a 2-fold increase in fat thickness (p < 0.01). In addition,
lymphatic stasis was associated with subcutaneous fat fibrosis and collagen
deposition. Adipogenesis in response to lymphatic fluid stasis was associated
with a marked mononuclear cell inflammatory response (5-fold increase in CD45
cells; p < 0.001). In addition, the authors noted a significant increase in
the number of monocytes/macrophages as identified by F4/80 immunohistochemistry
(p < 0.001).
CONCLUSIONS:
: The
mouse-tail model has pathologic findings that are similar to clinical lymphedema, including fat deposition,
fibrosis, and inflammation. Adipogenesis in response to lymphatic fluid stasis
closely resembles this process in obesity. This model therefore provides an
excellent means with which to study the molecular mechanisms that regulate the
pathophysiology of lymphedema.
PMID:
22456354 [PubMed - in process]
MED
NEWS DOCS:
March
7, 2012
Development Of New Universal Platform For Cancer
Immunotherapy
Researchers from the Perelman School of Medicine at the University of
Pennsylvania report this month in Cancer Research a universal
approach to personalized cancer therapy based on T cells.
It is the first time a system for making an adaptable, engineered T-cell to
attack specific tumor types has been proposed, depending on which abnormal
proteins, called antigens, are expressed by individual patients' tumor cells.
For now, the system is being refined in experiments using healthy donor
T cells and animal models of human cancer, with the aim to introduce the
personalized cells into patients in the future, explains senior author Daniel
J. Powell Jr., Ph.D., a research assistant professor of Pathology and
Laboratory Medicine with Penn's Ovarian Cancer Research Center.
Tumor
antigens are potential targets of an immune response, and identifying which
antigens a patient's tumor cells express would be helpful in designing cancer
therapy for that individual. Any mutated protein produced in a tumor cell can
act as a tumor antigen. Many tumor cells have surface proteins that are
inappropriately expressed for the cell type, or are only normally present
during embryonic development. Still other tumor cells display cell surface
proteins that are rare or absent on the surfaces of healthy cells and are
responsible for activating molecular pathways that cause uncontrolled
replication of cells. In most cancers, not all patients have tumor cells that
express the exact same antigen, and sometimes tumor cells from a single patient
can express different antigens. Because of this complexity, it is important to
properly choose which antigen to target with cancer therapy.
T cells
engineered to express an engineered antigen, called a chimeric antigen receptor
(CAR), offer an attractive strategy for targeting antigens and treating cancer,
says Powell. CARs are engineered receptors that graft, for example, the portion
of a tumor-specific antibody onto an immune cell. This allows the patients' T
cells to recognize tumor antigens and kill their tumor cells.
For
therapy, a large number of tumor-specific, cancer-fighting CAR T cells can be
generated in a specialized lab using patients' own T cells, which are then
infused back into them. This approach has shown promising results in patients
whose tumors all express the same antigen.
Despite these encouraging
findings, currently made CARs have a fixed antigen specificity, which means
only one type of tumor antigen can be targeted at a time. Tumor cells that lack
that selected antigen can then escape recognition by immune cells and
replicate, limiting what might otherwise have been an effective therapy if
multiple tumor antigens had been targeted. For this reason, the team sought to
make a more generalized receptor framework that is able to produce T cells
capable of targeting large panels of known tumor antigens.
To that end,
the team developed a new platform from which they could eventually target a
variety of tumor antigens, either simultaneously or sequentially. So far, they
have engineered T cells against the antigens mesothelin, present on several
tumor cell types; epCAM, present on epithelial cell cancers; alpha folate,
present on ovarian cancer cells; and, more
recently, CD19 on lymphoma cells.
The
universal immune receptor recognizes molecules attached to tumor antigens on
the surface of tumor cells. When this happens, the T cells produce inflammatory
response proteins called cytokines and pore-forming proteins. Those proteins
cause the release of enzymes through those pores into tumor cells, thereby
killing them.
The new engineered T cells described in the Cancer
Research paper recognize and bind exclusively to cancer cells pre-targeted with
biotin-labeled molecules, such as antibodies. Biotin is a B complex vitamin
necessary for cell growth that can be bound by a molecule called avidin, which
is contained in the universal immune receptor. Since nearly any molecule can be
biotin labeled, the number of antigens that can be targeted by T cells carrying
the biotin-binding immune receptor is nearly infinite. The versatility afforded
by this biotin-binding receptor permitted the targeting of a combination of
distinct antigens all at once, and even one after another, notes Powell.
The findings demonstrate that a universal T cell can significantly
extend conventional CAR approaches, allowing the team to generate T cells of
unlimited antigen specificity. This process is geared to make T cell therapy
more available to patients and to improve the effectiveness of T-cell
immunotherapies for cancer.
First author post-doctoral fellow Katarzyna
Urbanska, Ph.D. continues optimization of the universal receptor approach by
looking for different ways to improve the interaction of T cells with tumor
cells, and how to better direct the T cells and the biotin-labeled molecules to
tumor cells in the body.
In the future, Powell and colleagues predict a
highly personalized platform for cancer therapy that begins when patient tumors
are analyzed for their expression of specific antigens at the Department
Pathology and Laboratory Medicine's new Center for Personalized Diagnostics.
When the antigens expressed by a patient's tumor cells are determined, their T
cells will be engineered to express the universal immune receptor, which will
be given back to them in combination with biotin-labeled molecules to attach to
patients' tumor antigens for an individualized tumor attack
March
8, 2012
A Mechanism Explaining How Tumor Cells Spread To
Nearby Organs And Structures, Initiating
Metastasis
Metastasis is responsible for 90% of deaths in patients with cancer. Understanding the
mechanisms responsible for this process is one of the top goals of cancer
research. The metastatic process involves a series of steps chained where the
primary tumour invades surrounding tissues and ends spreading throughout the
body. Ones of the first tissues undergoing metastasis are the lymph nodes
surrounding the tumour.
A study, led by the researcher at the Bellvitge
Biomedical Research Institute (IDIBELL), Manel Esteller, published in the
Journal of Pathology, had identified a mechanism that explains how
cancer cells escape from the original site to the lymph nodes. Investigations
have uncovered that metastatic tumour cells that grow in the lymph nodes of
patients with melanoma and head and neck
tumours lose the activity of a protein called cadherin-11.
The normal
function of this protein is to act as the anchor of a ship to fix the cells in
a specific position and prevent movement. Inactivation of cadherin-11 gene
causes the loss of this fixation and tumour cells "jump" to neighboring organs
and structures, such as lymph nodes.
The study is an example of
translational and multidisciplinary research, involving basic research
laboratories, the medical oncology service at the Catalan Institute of Oncology
(ICO) and the Pathology Service of the Bellvitge University Hospital.
The study coordinated by the director of the Cancer Epigenetics and
Biology Program at IDIBELL, ICREA researcher and professor at the University of
Barcelona, Manel Esteller, also proposes that the process can be reversed
because, in models in vitro and in vivo, the recovery of protein activity
cadherin-11 caused a slowing of tumour growth and decreased ability to generate
metastases.
This possibility needs to be studied in international
clinical trials, but it is a promising starting point in studying the biology
of metastasis and how to act therapeutically in this area
March
16, 2012
Combination Treatment In Mice Shows Promise For Fatal
Neurological Disorder In Kids
Infants with Batten disease, a rare but fatal neurological disorder,
appear healthy at birth. But within a few short years, the illness takes a
heavy toll, leaving children blind, speechless and paralyzed. Most die by age
5.
There are no effective treatments for the disease, which can also
strike older children. And several therapeutic approaches, evaluated in mouse
models and in young children, have produced disappointing results.
But
now, working in mice with the infantile form of Batten disease, scientists at
Washington University School of Medicine in St. Louis and Kings College London
have discovered dramatic improvements in life span and motor function by
treating the animals with gene therapy and bone marrow transplants.
The
results are surprising, the researchers say, because the combination therapy is
far more effective than either treatment alone. Gene therapy was moderately
effective in the mice, and bone marrow transplants provided no benefit, but
together the two treatments created a striking synergy.
The research is
reported online in the Annals of Neurology.
"Until now,
this disease has been refractory to every therapy that has been thrown at it,"
says senior author Mark Sands, PhD, professor of medicine and of genetics at
the School of Medicine. "The results are the most hopeful to date, and they
open up a new avenue of research to find effective therapies to fight this
devastating disease."
The combination therapy did not cure the disease,
the scientists caution, but mice that received both treatments experienced
significant, lasting benefits.
Mice that got gene therapy and a bone
marrow transplant lived nearly 18.5 months, more than double the lifespan of
untreated mice with the disease. (Healthy laboratory mice live about 24
months.) And for a significant portion of their lives, motor skills in mice
that got both therapies were indistinguishable from those in normal, healthy
mice.
While bone marrow transplants carry significant risks, especially
in children, the researchers say they may be able to combine gene therapy with
another treatment to achieve the same results. This same approach potentially
could be used to treat other forms of Batten disease.
Batten disease is
an inherited genetic disorder that strikes fewer than five of every 100,000
U.S. children but is slightly more common in northern Europe. There are several
forms of the disease, diagnosed at different ages, and all are related to the
inability of cells to break down and recycle proteins.
The infantile
form is caused by mutations in the PPT1 gene that codes for an enzyme needed to
remove these proteins from cells. Without a working copy of the gene, the
proteins build up in cells, causing seizures, brain atrophy and dementia. The disease progresses
most rapidly when it is diagnosed in infants. By age 2, most live in an
unresponsive, vegetative state.
In the new study, the researchers tested
various therapies in four groups of newborn mice with infantile Batten disease.
One received only gene therapy; another received only bone marrow transplants;
a third was treated with gene therapy and bone marrow transplants; and a fourth
group received no treatment. As a comparison, the study included healthy mice
without the disorder.
Gene therapy to replace the PPT1 enzyme was
delivered directly into the brain. Bone marrow transplants were given with the
intent that donor cells would migrate to the brain and deliver additional
enzyme to regions of the brain not reached by gene therapy.
But that's
not what happened, Sands says. Although gene therapy delivered relatively high
levels of PPT1 enzyme, the bone marrow transplants did not supply any
additional enzyme. Rather, he and his colleagues discovered that mice receiving
both therapies experienced a dramatic reduction in brain
inflammation.
"We suspect that the normal immune cells from the bone
marrow transplant substantially reduce inflammation in the brain because we
just don't see much of it in mice that got both therapies," Sands says. "This
helps the PPT1 enzyme to do its job inside cells."
The study's results
show no increase in life span for mice receiving bone marrow transplantation
alone compared to untreated mice animals in both groups lived a median of 8.9
months. Mice that got only gene therapy lived 13.5 months, while those that got
the combination therapy lived for 18.5 months.
The researchers noted
similar effects of the therapies when they evaluated motor function. By 6
months, both untreated mice and those that received only a bone marrow
transplant had experienced significant declines in motor skills. Mice that got
gene therapy alone experienced a decline in motor function beginning at 10
months, and in those that got combination therapy, motor skills did not begin
to decline until 13 months and did so more gradually than in the other
mice.
Mice that got the combination therapy also had higher levels of
active PPT1 enzyme in the brain, a thicker cerebral cortex and fewer
accumulated proteins in brain cells, all indicators that the treatment is
working.
Sands is now repeating the experiment and investigating other
ways to reduce inflammation in the brain that would not involve the risks of a
bone marrow transplant. One possibility, he says, involves anti-inflammatory
drugs that have effects in the brain.
"We may be able to achieve the
same results with a less invasive anti-inflammatory treatment," Sands says.
"We're very excited now to move forward."
The research is supported by
the National Institutes of Health (NIH), Ruth L. Kirschstein NRSA Fellowship,
The Wellcome Trust, Batten Disease Family Association, the Batten Disease
Support and Research Association and the Bletsoe Family.
Macauley SL,
Roberts MS, Wong AM, McSloy F, Reddy AS, Cooper JD and Sands MS. Synergisitc
effects of CNS-directed gene therapy and bone marrow transplantation in the
murine model of infantile neuronal ceroid lipofuscinosis. Annals of
Neurology. Online ahead of print, Feb. 24, 2012.
March
30, 2012
Genetic Basis Of Tropical Foot And Leg Lymphedema
Identified
Farmers in the highlands of southern Ethiopia scratch out a
subsistence living from the region's volcanic red clay. The soil supports the
farms, but fine-grained, volcanic rock particles in the dirt threaten the
farmers and their families. Continual exposure of bare feet to the volcanic
soil causes 1 in 20 people to develop a painful inflammation of the lower
extremities that, over time, leads to foot disfigurement. Doctors call it
podoconiosis. The locals call it mossy foot. And those affected suffer social
stigma as well as debilitating discomfort.
Now, researchers think they
know why some 4 million people in at least 10 countries worldwide develop this
incapacitating condition. One-fifth carry genetic variants that cause their
immune system to react to the volcanic dust. This disease-producing response,
triggered by exposure from the lack of shoes, provides a dramatic example of
the interaction between genes and the environment.
Writing in the March
29, 2012 New England Journal of Medicine, an international team
that includes researchers from the National Human Genome Research Institute
(NHGRI), part of the National Institutes of Health, describes the genetic link
that turns dirt into a toxin.
"This study draws attention to a neglected
tropical disease with a devastating impact on poor people and their
communities," said NHGRI Scientific Director Dan Kastner, M.D., Ph.D. "It
demonstrates the global reach of genomics research into the lives of people in
parts of the world where endemic diseases very often go unchecked."
Doctors have known for a long time that podoconiosis runs in families
and that continual exposure to volcanic soil triggers it. Wearing shoes and
socks, or even washing off the dirt, prevents the condition. But doctors have
been perplexed that only some people develop the disease, while others with the
same environmental exposure are spared.
To sort this out, the
international collaborators conducted a genome-wide association study - or GWAS
- analyzing DNA from 194 volunteers from the Ethiopian highlands affected by
podoconiosis, along with DNA from another 203 unaffected individuals from the
same region. The researchers collaborated with field workers from the
non-profit Mossy Foot Treatment and Prevention Association in southern Ethiopia
to collect the data and samples.
The researchers generated a dataset
from study-participant DNA, screening more than 550,000 single-nucleotide
polymorphisms (SNPs), which are sites in an individual's DNA that contain a
different chemical base when compared to a standard reference human genome
sequence. They found significant podoconiosis association for eight SNPs within
or nearby a stretch of DNA on chromosome 6, called the HLA class II locus.
The researchers performed a second validation step, called a
family-based association study, using DNA samples from 202 sets of child-parent
trios from affected families. The researchers detected six SNPs that showed
significant association - those that mapped to HLA class II region genes and
most strongly associated with podoconiosis in the GWAS, validating the GWAS
results.
April
4, 2012
Link Between New Signaling Pathway And Breast Cancer
Metastasis
Lymph nodes help to fight off infections by producing immune cells and
filtering foreign materials from the body, such as bacteria or cancer cells. Thus, one of the
first places that cancer cells are found when they leave the primary tumor is
in the lymph nodes. The spread of cancer cells to the lymph nodes, lymphatic
metastasis, is known to indicate a poor prognosis in many types of cancers; how
tumor cells reach the lymph nodes, however, is not well understood.
A
new study by Dr. Heide Ford and colleagues at the University of Colorado School
of Medicine in Aurora reveals a mechanism underlying this process in breast cancer. Using mouse
models, their team found that a protein called SIX1 is a critical player in
early stage metastasis, especially lymphatic metastasis. Their study showed
that SIX1 induced expression of another protein called VEGF-C, which stimulated
the formation of new lymphatic vessels within and near the primary tumor and
lymphatic invasion. Strongly supporting a role in human breast cancer, they
also showed that the expression of both proteins was correlated in human breast
tumors.
Their work has identified the SIX1-VEGF-C pathway as an
important signaling pathway involved in breast cancer metastasis, and the
targeting of this pathway could lead to new anti-cancer treatments
TITLE: SIX1 induces lymphangiogenesis and metastasis via upregulation of
VEGF-C in mouse models of breast cancer
April
11, 2012
Survivors Of Breast Cancer Suffer Treatment-Related
Side Effects Long After Completing Care
More than 60 percent of breast cancer survivors report
at least one treatment-related complication even six years after their
diagnosis, according to a new study led by a researcher from the Perelman
School of Medicine at the University of Pennsylvania. The findings are part of
a special issue of Cancer devoted to exploring the physical late
effects of breast cancer treatment and creating strategies to prevent, monitor
for, and treat these conditions in the nation's 2.6 million survivors of the
disease.
"Our work provides the first accounting of the true magnitude
of the post-treatment problems suffered by breast cancer patients, and serves
as a call to action for proper monitoring and rehabilitation services to care
for them," said Kathryn Schmitz, PhD, MPH, an associate professor of
Biostatistics and Epidemiology who serves as a senior scientist on the
committee overseeing creation of a surveillance model for breast cancer
survivors. "We can no longer pretend that the side effects of breast cancer
treatment end after patients finish active treatment. The scope of these
complications is shocking and upsetting, but a ready solution for many of them
already exists in rehabilitative exercise."
Schmitz, a member of Penn's
Abramson Cancer Center, points out that previous studies to determine the
prevalence of post-treatment complications typically examined just one issue.
The new findings, instead, provide a full snapshot of the complications women
may experience following the chemotherapy, surgery, radiation treatment and
hormonal therapy to cure their disease and keep it from returning. The results
reveal that these problems rarely exist in isolation: Many women with the
painful limb-swelling condition lymphedema, for instance, may
also struggle with fatigue and bone health
challenges.
Schmitz collaborated with an Australian research team to
follow 287 Australian women with invasive, unilateral breast cancer for a
median of 6.6 years, prospectively assessing the women for treatment-related
physical and functional complications at set points throughout the study. Areas
of study included postsurgical complications, skin reactions to radiation
therapy, upper-body symptoms and functional limitations, lymphedema, weight
gain, and fatigue. Sixty percent of the women were still experiencing one of
these problems at six years after their diagnosis, and 30 percent were still
struggling with at least two issues. Most of the problems appeared within the
first year patients were assessed, but the prevalence of most impairments -
except lymphedema and weight gain - decreased over the course of the study.
Writing in the lead editorial of the special issue of
Cancer, Schmitz and her colleagues outline the myriad barriers that
lay in the way of properly monitoring breast cancer survivors for the problems
uncovered in the new study. Patients may have fragmented care, receiving
different prongs of their treatment at different hospitals; patients and
providers may believe certain problems are "expected" and "normal" and not
appropriate for treatment; and unlike orthopedists and cardiologists who
frequently send patients for physical rehabilitation to ensure their complete
recovery, oncologists and surgeons are often poorly linked to physical therapy professionals,
limiting the number of patients who are aware of or referred for these
services.
In the face of these challenges, an expert panel laid out a
model for prospectively surveying breast cancer survivors and formally
incorporating rehabilitation and exercise experts into cancer survivorship programs.
Research increasingly shows that post-treatment complications can be minimized
- and even prevented altogether - when caught early and addressed through
various rehabilitation regimens. "When early signs of impairment are noted and
that impairment has a high probability of worsening if allowed to progress,
which ultimately may result in a worse, permanent disability, there is an
ethical obligation to treat the condition," they write.
The question of
how best to implement the proposed rehabilitation and surveillance remains to
be addressed. The panel plans to work through the American Cancer Society with
stakeholder groups to answer questions about how to educate patients and
clinicians about the plan and fully implement it. The American College of
Surgeons Commission on Cancer has published guidelines that will require that
all accredited cancer treatment centers provide treatment summaries and
survivorship health care plans to all their patients by 2015. The proposed
surveillance and rehabilitation model could serve as a framework for meeting
those pending guidelines. "In the meantime," Schmitz says, "breast cancer
survivors should be empowered to ask their doctor for a referral to physical
therapy and exercise programs."
April 19, 2012
J Plast Reconstr Aesthet Surg.
2012 Apr 1. [Epub ahead of print]
Positive
impact of delayed breast reconstruction on breast-cancer treatment-related arm
lymphoedema.
Blanchard
M, Arrault
M, Vignes
S.
Source
Department of
Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015 Paris,
France.
Abstract
BACKGROUND:
The
study aims to determine the impact of delayed breast reconstruction on women
with breast-cancer treatment-related lymphoedema after mastectomy.
METHODS:
Twenty
women with breast-cancer treatment-related arm lymphoedema prospectively
requesting breast reconstruction were included between January 2002 and June
2009. Lymphoedema volume was calculated for each 5-cm segment using the formula
for a truncated cone.
RESULTS:
Three
patients underwent transverse rectus abdominis myocutaneous flap
reconstruction, five received pedicled latissimus dorsi myocutaneous flaps
associated with a breast implant and 12 a breast implant (silicone) alone.
Median lymphoedema duration at the time of breast reconstruction was 21
(interquartile range (IQR): 17-34) months. Breast reconstruction was done a
median of 30 (IQR: 23-56) months after mastectomy. The median lymphoedema
volume at medians of 5 (244 ml, IQR: 159-435) and 22 months (235 ml, IQR:
146-361) of follow-up after reconstruction compared to that measured 6 months
before breast reconstruction of 378 ml (IQR: 261-459) were significantly lower
(p < 0.02 for both). Specific lymphoedema treatment, unchanged during the
study, included manual lymph drainage for all women, elastic sleeves for 19 and
low-stretch bandages for 14.
CONCLUSION:
Delayed
breast reconstruction is feasible for women who have developed lymphoedema
after mastectomy for breast cancer. Further studies are needed to compare the
different breast-reconstruction techniques and to determine their ideal timing
(immediate or delayed).
Copyright © 2012
British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.
PMID:
22472052 [PubMed - as supplied by publisher]
Nurs
N Z. 2012 Feb;18(1):18-9.
Managing
lymphoedema in palliative care patients.
Walker J, Thomson
M.
Source
New
Zealand Institute of Community Health Care, Christchurch.
PMID:
22480007 [PubMed - in process
J
Breast Cancer. 2012 Mar;15(1):91-7. Epub 2012 Mar
28.
The
efficacy of arm node preserving surgery using axillary reverse mapping for
preventing lymphedema in patients with breast cancer.
Han JW, Seo
YJ, Choi
JE, Kang
SH, Bae
YK, Lee
SJ.
Source
Department of
Surgery, Yeungnam University College of Medicine, Daegu, Korea.
Abstract
PURPOSE:
The
axillary reverse mapping (ARM) technique to identify and preserve arm nodes
during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection
(ALND) was developed to prevent lymphedema. The purpose of this study was to
investigate the location and metastatic rate of the arm node, and to evaluate
the short term incidence of lymphedema after arm node preserving
surgery.
METHODS:
From
January 2009 to October 2010, 97 breast cancer patients who underwent ARM were
included. Blue-dye (2.5 mL) was injected into the ipsilateral upper-inner arm.
At least 20 minutes after injection, SLNB or ALND was performed and
blue-stained arm nodes and/or lymphatics were identified. Patients were divided
into two groups, an arm node preserved group (70 patients had ALND, 10 patients
had SLNB) and an unpreserved group (13 patients had ALND, 4 patients had SLNB).
The difference in arm circumference between preoperative and postoperative time
points was checked in both groups.
RESULTS:
The mean
number of identified blue stained arm nodes was 1.4±0.6. In the majority of
patients (92%), arm nodes were located between the lower level of the axillary
vein and just below the second intercostobrachial nerve. In the arm node
unpreserved group, 2 patients had metastasis in their arm node. Among ALND
patients, in the arm node preserved group, the difference in arm circumference
between preoperative and postoperative time points in ipsilateral and
contralateral arms was 0.27 cm and 0.07 cm, respectively, whereas it was 0.47
cm and -0.03 cm in the unpreserved group; one case of lymphedema was found
after 6 months. No difference was found between arm node preserved and
unpreserved group among SLNB patients.
CONCLUSION:
Arm node
preserving was possible in all breast cancer patients with identifiable arm
nodes, during ALND or SLNB, except for those with high surgical N stage, and
lymphedema did not develop in patients with arm node preserving
surgery.
PMID:
22493634 [PubMed - in process] PMCID: PMC3318181
Blood.
2012 Apr 6. [Epub ahead of print]
Matrix
metalloproteinase-2 governs lymphatic vessel formation as an interstitial
collagenase.
Detry B, Erpicum
C, Paupert
J, Blacher
S, Maillard
C, Bruyère
F, Pendeville
H, Remacle
T, Lambert
V, Balsat
C, Ormenese
S, Lamaye
F, Janssens
E, Moons
L, Cataldo
D, Kridelka
F, Carmeliet
P, Thiry
M, Foidart
JM, Struman
I, Noel
A.
Source
Laboratory of Tumor
and Development Biology, Groupe Interdisciplinaire de Genoproteomique
Applique-Recherche (GIGA-Cancer), University of Liege, Liege,
Belgium;
Abstract
Lymphatic
dysfunctions are associated with several human diseases, including lymphedema
and metastatic spread of cancer. Although it is well recognized that lymphatic
capillaries attach directly to interstitial matrix mainly composed of fibrillar
type I collagen, the interactions occurring between lymphatics and their
surrounding matrix have been overlooked. In this study, we demonstrate how
matrix metalloproteinase (MMP)-2 drives lymphatic morphogenesis through
Mmp2-gene ablation in mice, mmp2 knockdown in zebrafish and in 3D-culture
systems, and through MMP2 inhibition. In all models used in vivo (3 murine
models and thoracic duct development in zebrafish) and in vitro (lymphatic ring
and spheroid assays), MMP2 blockage or down-regulation leads to reduced
lymphangiogenesis or altered vessel branching. Our data show that lymphatic
endothelial cell (LEC) migration through collagen fibers is affected by
physical matrix constraints (matrix composition, density and cross-linking).
Transmission electron microscopy (TEM) and confocal reflection microscopy using
DQ-collagen highlight the contribution of MMP2 to mesenchymal-like migration of
LEC associated with collagen fiber remodeling. Our findings provide new
mechanistic insight into how LEC negotiate an interstitial type I collagen
barrier and reveal an unexpected MMP2-driven collagenolytic pathway for
lymphatic vessel formation and morphogenesis.
PMID:
22490679 [PubMed - as supplied by publisher]
Trop
Med Int Health. 2012 Apr 5. doi:
10.1111/j.1365-3156.2012.02978.x. [Epub ahead of print]
Parasitological,
serological and clinical evidence for high prevalence of podoconiosis
(non-filarial elephantiasis) in Midakegn district, central
Ethiopia.
Geshere
Oli G, Tekola
Ayele F, Petros
B.
Source
Department of
Biology, College of Natural Sciences, Jimma University, Jimma, Ethiopia Center
for Research on Genomics and Global Health, National Human Genome Research
Institute, National Institutes of Health, Bethesda, MD, USA Microbial,
Cellular and Molecular Biology Program Unit, Addis Ababa University, Addis
Ababa, Ethiopia.
Abstract
Objective To
determine whether the elephantiasis in Midakegn district, central Ethiopia, is
filarial or non-filarial (podoconiosis) using serological, parasitological and
clinical examinations, and to estimate its prevalence. Methods At
house-to-house visits in 330 randomly selected households, all household
members who had elephantiasis were interviewed and clinically examined at the
nearby health centre to confirm the presence of elephantiasis, check the
presence of scrotal swelling and rule out the other causes of lymphoedema. A
midnight blood sample was obtained from each participant with elephantiasis for
microscopic examination of Wuchereria bancrofti microfilaria. A daytime blood
sample was obtained from half of the participants for serological confirmation
using the immuno-chromatographic test card. Results Consistent with the
features of podoconiosis, none of the elephantiasis cases had consistently worn
shoes since childhood; 94.3% had bilateral swelling limited below the level of
the knees; no individual had thigh or scrotal elephantiasis; parasitological
test for microfilariae and serological tests for W. bancrofti antigen were
negative in all samples. The prevalence of the disease was 7.4% and it peaked
in the third decade of life, the most economically active age. Conclusion
Midakegn District has a high prevalence of podoconiosis and no filarial
elephantiasis. Prevention, treatment and control of podoconiosis must be among
the top priorities of public health programmes.
© 2012
Blackwell Publishing Ltd.
PMID:
22487446 [PubMed - as supplied by publisher]
J Plast Reconstr Aesthet Surg.
2012 Apr 1. [Epub ahead of print]
Positive
impact of delayed breast reconstruction on breast-cancer treatment-related arm
lymphoedema.
Blanchard
M, Arrault
M, Vignes
S.
Source
Department of
Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015 Paris,
France.
Abstract
BACKGROUND:
The
study aims to determine the impact of delayed breast reconstruction on women
with breast-cancer treatment-related lymphoedema after mastectomy.
METHODS:
Twenty
women with breast-cancer treatment-related arm lymphoedema prospectively
requesting breast reconstruction were included between January 2002 and June
2009. Lymphoedema volume was calculated for each 5-cm segment using the formula
for a truncated cone.
RESULTS:
Three
patients underwent transverse rectus abdominis myocutaneous flap
reconstruction, five received pedicled latissimus dorsi myocutaneous flaps
associated with a breast implant and 12 a breast implant (silicone) alone.
Median lymphoedema duration at the time of breast reconstruction was 21
(interquartile range (IQR): 17-34) months. Breast reconstruction was done a
median of 30 (IQR: 23-56) months after mastectomy. The median lymphoedema
volume at medians of 5 (244 ml, IQR: 159-435) and 22 months (235 ml, IQR:
146-361) of follow-up after reconstruction compared to that measured 6 months
before breast reconstruction of 378 ml (IQR: 261-459) were significantly lower
(p < 0.02 for both). Specific lymphoedema treatment, unchanged during the
study, included manual lymph drainage for all women, elastic sleeves for 19 and
low-stretch bandages for 14.
CONCLUSION:
Delayed
breast reconstruction is feasible for women who have developed lymphoedema
after mastectomy for breast cancer. Further studies are needed to compare the
different breast-reconstruction techniques and to determine their ideal timing
(immediate or delayed).
Copyright © 2012
British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.
PMID:
22472052 [PubMed - as supplied by publisher]
Phlebology.
2012 Apr 12. [Epub ahead of print]
Development
of separated elastic stockings.
Hirai M, Iwata
H, Miyazaki
K, Koyama
A, Nakamura
H.
Source
*
Department of Vascular Surgery, Tohkai Hospital, Nagoya.
Abstract
OBJECTIVES:
To
investigate the acceptability of newly developed separated elastic stockings,
which are divided into two portions at the ankle.
METHODS:
The
difficulty in putting on and taking off stockings was compared between the
original or modified separated stockings with various techniques in order to
reduce the shift of the stockings and current non-separated stockings in
healthy volunteers and patients with lymphoedema by applying both stockings
alternately. In the modified model, the shift during daily activities was
measured in healthy volunteers and patients with lymphoedema.
RESULTS:
The two
items, 'easier compared with non-separated stockings' and 'much easier', were
chosen at rates of 75% and 81% for putting on and taking off stockings for the
original separated stockings and 75% and 75% for the modified separated
stockings, respectively. Complaints during daily activities with the modified
type to the stockings decreased as compared with the original type. The shift
of stockings after an average 11-hour application was 1.6 ± 3.0 SD mm (range:
0-10 mm).
CONCLUSIONS:
Modified
separated elastic stockings are easier to put on and take off compared with
current non-separated stockings, and they can be used safely because of their
low-level shift during daily activities.
PMID:
22499611 [PubMed - as supplied by publisher]
Tumori.
2012 Jan;98(1):94-8. doi: 10.1700/1053.11506.
Morbidity
of selective lymph node biopsy for melanoma: meta-analysis of
complications.
Cigna E, Gradilone
A, Ribuffo
D, Gazzaniga
P, Fino
P, Sorvillo
V, Scuderi
N.
Abstract
Background
and aim. Intraoperative lymphatic mapping and selective lymph node biopsy is
accepted worldwide as the standard procedure for staging regional lymph nodes
of 1-4 mm thick melanomas, as well as for other neoplasms. Although it is often
stated that selective lymph node biopsy is a minimally invasive procedure
associated with few complications, few data exist concerning the morbidity
associated with the procedure. The present analysis was performed to evaluate
the morbidity associated with selective lymph node biopsy in a long-term
follow-up. Materials and methods. The study provides a review of 437 selective
lymph node biopsies on 269 patients, operated on between the 1994 and the 2009,
for the lymph node biopsy of head and neck, groin, axilla, upper and lower
limbs and nodal basins. Patients' history and follow-up were reviewed for 2
weeks after surgery, every 3 months for the first 2 years, every 4 months
during the third year, and every 6 months subsequently, and postoperative
morbidity was evaluated. Results. After sentinel node biopsy, 14 patients
developed one of the following complications: hematoma, 1 case (0.30%);
lymphedema, 1 case (0.30%); seroma, 2 cases (0.61%); wound infection, 6 cases
(1.83%); keloid scar, 2 cases (0.61%); and postoperative pain, 2 cases (0.61%).
The total complication rate was 4.26%. Conclusions. Selective lymph node biopsy
for melanoma, as for other tumors, in respect to radical lymphadenectomy, is
not a complications-free procedure but is usually not severe.
PMID:
22495708 [PubMed - in process]
April 23, 2012
Zentralbl Chir.
2012 Apr 17. [Epub ahead of print]
[Leg Swelling following Inguinal and Ilioinguinal Dissection of
Melanoma Metastases.]
[Article
in German]
Pratsch AL,
Kretschmer L.
Source
Georg-August-Universität
Göttingen, Abteilung für Dermatologie, Venerologie und Allergologie, Göttingen,
Deutschland.
Abstract
Background: With
respect to survival and local disease control, the adequate extent of lymph
node dissection for melanoma metastasis to the groin is controversial. Since
the methods for accurate quantification of leg oedemas are not well
standardised, it remains also unclear whether the iliac part of a radical
ilioinguinal lymph node dissection contributes to postoperative lymphoedema.
Patients and Methods: Using a questionnaire and clinical examinations, we
prospectively studied 65 persons for the presence of leg swellings (11 with
inguinal lymph node dissection (sCLND), 23 with ilioinguinal dissection
(rCLND), and 31 without nodal surgery and without signs of venous
insufficiency). Exact volumetry of the legs was performed using the Image 3 D
method. Results: The mean interval between the lymphadenectomy and the
examination for swellings was 24 ± 30 months. Compared with sCLND, the amount
of postoperative drainage fluid was significantly higher after rCLND
(1960 ± 1390 mL versus (vs.) 898 ± 578 mL). Patients with rCLND perceived more
frequently leg swellings (83 % vs. 55 %, p = 0.09), however, also 23 % of the
control persons perceived leg swellings. Clinical signs of swelling were found
slightly more frequently in the rCLND group (52 % vs. 45 %). After rCLND, the
gain in volume of the ipsilateral thigh was significantly higher than after
sCLND (7.01 ± 4.83 % vs. 1.29 ± 6.12 %, p = 0.01). Patients with rCLND more
frequently needed manual lymph drainage (70 % vs. 45 %). In the control
persons, the volumes of the right (mostly dominant) and the left legs did not
differ significantly. Conclusions: Our results suggest that the iliac part of
an ilioinguinal lymph node dissection significantly contributes to lymphoedema.
Because of the multitude of reasons for swellings of the lower leg, volumetry
of the thigh seems to be most adequate for quantifying the amount of
postoperative lymphoedema.
© Georg
Thieme Verlag KG Stuttgart · New York.
PMID:
22511022 [PubMed - as supplied by publisher]
Eur J Phys Rehabil Med.
2012 Apr 17. [Epub ahead of print]
Early rehabilitation reduces the onset of complications in the
upper limb following breast cancer surgery.
Scaffidi M,
Vulpiani MC,
Vetrano M,
Conforti F,
Marchetti MR,
Bonifacino A,
Marchetti P,
Saraceni VM,
Ferretti A.
Source
Physical
Medicine and Rehabilitation Unit, Sant'Andrea Hospital, La Sapienza University
of RomeRome, Italy - [email protected].
Abstract
BACKGROUND:
Breast
cancer (BC) is currently the most frequent tumor in women. Through the years,
BC management has evolved towards conservative surgery. However, even minimally
invasive surgery can cause neuromotor and/or articular impairments which can
lead to permanent damage, if not adequately treated.
AIM:
To
clinically evaluate upper ipsilateral limb function and the impact of certain
post-surgical consequences arising after invasive or breast-conserving surgery
for early BC, by intervening, or not intervening, with an early rehabilitation
program. To investigate physical morbidity after sentinel (SLND) or axillary
lymph node dissection (ALND) and after reconstructive surgery in the treatment
of early BC.
DESIGN:
Observational
prospective trial.
SETTING:
Inpatient and
outpatient treatment.
POPULATION:
Eighty-three
females participated in the study: 25 patients did not begin physiotherapy
during hospitalization (Group A), 58 patients received early rehabilitation
treatment (Group B). Methods. The patients of Groups A and B were compared with
respect to the following criteria: shoulder-arm mobility, upper limb function,
and presence of lymphedema. All patients were assessed at 15-30, 60 and180 days
after surgery.
RESULTS:
Statistically
significant differences, in favor of Group B, were encountered at the 180-day
follow-up visit, especially with respect to articular and functional limitation
of the upper limb. CONCLUSION AND CLINICAL REHABILITATION
IMPACT:
The
results of the present study show that early assisted mobilization (beginning
on the first postoperative day) and home rehabilitation, in conjunction with
written information on precautionary hygienic measures to observe, play a
crucial role in reducing the occurrence of postoperative side-effects of the
upper limb.
PMID:
22510674 [PubMed - as supplied by publisher]
PLoS Negl Trop Dis.
2012 Apr;6(4):e1611. Epub 2012 Apr 3.
Elevated Adaptive Immune Responses Are Associated with Latent
Infections of Wuchereria bancrofti.
Arndts K,
Deininger S,
Specht S,
Klarmann U,
Mand S,
Adjobimey T,
Debrah AY,
Batsa L,
Kwarteng A,
Epp C,
Taylor M,
Adjei O,
Layland LE,
Hoerauf A.
Source
Institute of
Medical Microbiology, Immunology and Parasitology, University Hospital Bonn,
Bonn, Germany.
Abstract
In order
to guarantee the fulfillment of their complex lifecycle, adult filarial
nematodes release millions of microfilariae (MF), which are taken up by
mosquito vectors. The current strategy to eliminate lymphatic filariasis as a
public health problem focuses upon interrupting this transmission through
annual mass drug administration (MDA). It remains unclear however, how many
rounds of MDA are required to achieve low enough levels of MF to cease
transmission. Interestingly, with the development of further diagnostic tools a
relatively neglected cohort of asymptomatic (non-lymphedema) amicrofilaremic
(latent) individuals has become apparent. Indeed, epidemiological studies have
suggested that there are equal numbers of patent (MF(+)) and latent
individuals. Since the latter represent a roadblock for transmission, we
studied differences in immune responses of infected asymptomatic male
individuals (n = 159) presenting either patent (n = 92 MF(+)) or latent (n = 67
MF(-)) manifestations of Wuchereria bancrofti. These individuals were selected
on the basis of MF, circulating filarial antigen in plasma and detectable worm
nests. Immunological profiles of either Th1/Th17, Th2, regulatory or innate
responses were determined after stimulation of freshly isolated PBMCs with
either filarial-specific extract or bystander stimuli. In addition, levels of
total and filarial-specific antibodies, both IgG subclasses and IgE, were
ascertained from plasma. Results from these individuals were compared with
those from 22 healthy volunteers from the same endemic area. Interestingly, we
observed that in contrast to MF(+) patients, latent infected individuals had
lower numbers of worm nests and increased adaptive immune responses including
antigen-specific IL-5. These data highlight the immunosuppressive status of
MF(+) individuals, regardless of age or clinical hydrocele and reveal
immunological profiles associated with latency and immune-mediated suppression
of parasite transmission.
PMID: 22509424
[PubMed - in process] PMCID: PMC3317915
J Pediatr Urol.
2012 Apr 14. [Epub ahead of print]
Isolated penile lymphedema in an adolescent male: A case of
metastatic Crohn's disease.
Sackett DD,
Meshekow JS,
Figueroa TE,
Napoli JA.
Source
Thomas
Jefferson University Hospital, 1025 Walnut St. Suite 1112, Philadelphia, PA
19106, USA.
Abstract
OBJECTIVE:
Metastatic Crohn's
disease is a rare and complex inflammatory condition distinguished by cutaneous
granulomatous lesions outside the gastrointestinal tract. Genital involvement
is rare; with less than 10 cases reported involving isolated penile lymphedema.
Here, we present a case of isolated lymphedema of the penis as a consequence of
extra-intestinal Crohn's disease.
CASE
REPORT:
The
patient is an 18-year-old African American male with a complex history of
inflammatory bowel disease, who initially presented with a chief complaint of 6
weeks of swelling of his penis at age 13. A modified circumcision and
lymphangectomy of the penis were performed; histopatholgy demonstrated a
granulomatous infiltrate and interstitial edema of the distal
penis.
CONCLUSION:
Surgical
intervention is an applicable therapeutic alternative and last-line therapy for
treatment of isolated penile lymphedema in select patients with appropriate
pathology, and can be a suitable adjunct to medical management in these
cases.
Copyright © 2012
Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights
reserved.
PMID:
22507210 [PubMed - as supplied by publisher]
Cancer.
2012 Apr 15;118(8 Suppl):2312-24. doi: 10.1002/cncr.27461.
Clinical practice guidelines for breast cancer rehabilitation:
Syntheses of guideline recommendations and qualitative
appraisals.
Harris SR,
Schmitz KH,
Campbell KL,
McNeely ML.
Source
Department of
Physical Therapy, Faculty of Medicine, University of British Columbia,
Vancouver, Canada. [email protected].
Abstract
BACKGROUND:
Despite
strides in early detection and management of breast cancer, the primary
treatments for this disease continue to result in physical impairments for some
of the nearly 3 million people diagnosed annually. Over the past decade,
evidence-based clinical practice guidelines (CPGs) have been developed with
goals of preventing and ameliorating these impairments. However, translation of
these guidelines into clinical practice needs to be accelerated.
METHODS:
Relevant
health science databases (2001-2011) were searched to identify CPGs on breast
cancer rehabilitation for the following impairments: upper extremity
restrictions, lymphedema, pain, fatigue, chemotherapy-induced peripheral
neuropathy, treatment-related cardiotoxicity, bone health, and weight
management.
RESULTS:
Recommendations
from 19 relevant CPGs were first summarized by impairment within tables;
commonalities across guidelines, within each impairment, were then synthesized
within the article. The CPGs were rated using the Appraisal of Guidelines for
Research and Evaluation II (AGREE II); wide variability was noted in rigor of
development, clarity of presentation, and stakeholder involvement. The most
rigorous and comprehensive of those rated was the adult cancer pain guideline
from the Scottish Intercollegiate Guidelines Network.
CONCLUSIONS:
Based on
a large body of evidence published in recent years, including randomized trials
and systematic reviews, there is an urgent need for updating the guidelines on
upper extremity musculoskeletal impairments and lymphedema. Furthermore,
additional research is needed to provide an evidence base for developing
rehabilitation guidelines on management of other impairments identified in the
prospective surveillance model, eg, arthralgia. Cancer 2012;118(8 suppl):. ©
2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488705 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2277-87. doi: 10.1002/cncr.27466.
Weight management and its role in breast cancer
rehabilitation.
Demark-Wahnefried W,
Campbell KL,
Hayes SC.
Source
Department of
Nutrition Sciences, University of Alabama at Birmingham Comprehensive Cancer
Center, Birmingham, Alabama. [email protected].
Abstract
Overweight and
obesity are risk factors for postmenopausal breast cancer, and many women
diagnosed with breast cancer, irrespective of menopausal status, gain weight
after diagnosis. Weight management plays an important role in rehabilitation
and recovery because obesity and/or weight gain may lead to poorer breast
cancer prognosis, as well as prevalent comorbid conditions (eg, cardiovascular
disease and diabetes), poorer surgical outcomes (eg, increased operating and
recovery times, higher infection rates, and poorer healing), lymphedema,
fatigue, functional decline, and poorer health and overall quality of life.
Health care professionals should encourage weight management at all phases of
the cancer care continuum as a means to potentially avoid adverse sequelae and
late effects, as well as to improve overall health and possibly survival.
Comprehensive approaches that involve dietary and behavior modification, and
increased aerobic and strength training exercise have shown promise in either
preventing weight gain or promoting weight loss, reducing biomarkers associated
with inflammation and comorbidity, and improving lifestyle behaviors,
functional status, and quality of life in this high-risk patient population.
Cancer 2012;. © 2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488702 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2237-49. doi: 10.1002/cncr.27467.
Upper-body morbidity after breast cancer: Incidence and evidence
for evaluation, prevention, and management within a prospective surveillance
model of care.
Hayes SC,
Johansson K,
Stout NL,
Prosnitz R,
Armer JM,
Gabram S,
Schmitz KH.
Source
Queensland
University of Technology, Institute of Health and Biomedical Innovation, School
of Public Health, Brisbane, Australia. [email protected].
Abstract
The
purpose of this paper is to review the incidence of upper-body morbidity (arm
and breast symptoms, impairments, and lymphedema), methods for diagnosis, and
prevention and treatment strategies. It was also the purpose to highlight the
evidence base for integration of prospective surveillance for upper-body
morbidity within standard clinical care of women with breast cancer. Between
10% and 64% of women report upper-body symptoms between 6 months and 3 years
after breast cancer, and approximately 20% develop lymphedema. Symptoms remain
common into longer-term survivorship, and although lymphedema may be transient
for some, those who present with mild lymphedema are at increased risk of
developing moderate to severe lymphedema. The etiology of morbidity seems to be
multifactorial, with the most consistent risk factors being those associated
with extent of treatment. However, known risk factors cannot reliably
distinguish between those who will and will not develop upper-body morbidity.
Upper-body morbidity may be treatable with physical therapy. There is also
evidence in support of integrating regular surveillance for upper-body
morbidity into the routine care provided to women with breast cancer, with
early diagnosis potentially contributing to more effective management and
prevention of progression of these conditions. Cancer 2012;118(8 suppl). © 2012
American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488698 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2226-36. doi: 10.1002/cncr.27468.
A prospective model of care for breast cancer rehabilitation:
Postoperative and postreconstructive issues.
McNeely ML,
Binkley JM,
Pusic AL,
Campbell KL,
Gabram S,
Soballe PW.
Source
Department of
Physical Therapy and Oncology, University of Alberta and Cross Cancer
Institute, Edmonton, Alberta, Canada. [email protected].
Abstract
Appropriate and
timely rehabilitation is vital in the recovery from breast cancer surgeries,
including breast conserving surgery, mastectomy, axillary lymph node dissection
(ALND), and breast reconstruction. This article describes the incidence,
prevalence, risk factors and time course for early postoperative effects and
the role of prospective surveillance as a rehabilitation strategy to prevent
and mitigate them. The most common early postoperative effects include wound
issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and
seroma. Appropriate treatment is necessary to avoid delay in wound healing that
may increase the risk of long-term morbidity, unduly postpone systemic and
radiation therapy, and delay rehabilitation. The presence of upper quarter
dysfunction (UQD), defined as restricted upper quarter mobility, pain,
lymphedema, and impaired sensation and strength, has been reported in over half
of survivors after treatment for breast cancer. Moreover, evidence suggests
that survivors who undergo breast reconstruction may be at higher risk of UQD.
Ensuring the survivor's optimum functioning in the early postoperative time
period is critical in the overall recovery from breast cancer. The formal
collection of objective measures along with patient-reported outcome measures
is recommended for the early detection of postoperative morbidity. Prospective
surveillance, including preoperative assessment and structured surveillance,
allows for early identification and timely rehabilitation. Early evidence
supports a prospective approach to address and minimize postoperative effects.
Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488697 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2226-36. doi: 10.1002/cncr.27468.
A prospective model of care for breast cancer rehabilitation:
Postoperative and postreconstructive issues.
McNeely ML,
Binkley JM,
Pusic AL,
Campbell KL,
Gabram S,
Soballe PW.
Source
Department of
Physical Therapy and Oncology, University of Alberta and Cross Cancer
Institute, Edmonton, Alberta, Canada. [email protected].
Abstract
Appropriate and
timely rehabilitation is vital in the recovery from breast cancer surgeries,
including breast conserving surgery, mastectomy, axillary lymph node dissection
(ALND), and breast reconstruction. This article describes the incidence,
prevalence, risk factors and time course for early postoperative effects and
the role of prospective surveillance as a rehabilitation strategy to prevent
and mitigate them. The most common early postoperative effects include wound
issues such as cellulitis, flap necrosis, abscess, dehiscence, hematoma, and
seroma. Appropriate treatment is necessary to avoid delay in wound healing that
may increase the risk of long-term morbidity, unduly postpone systemic and
radiation therapy, and delay rehabilitation. The presence of upper quarter
dysfunction (UQD), defined as restricted upper quarter mobility, pain,
lymphedema, and impaired sensation and strength, has been reported in over half
of survivors after treatment for breast cancer. Moreover, evidence suggests
that survivors who undergo breast reconstruction may be at higher risk of UQD.
Ensuring the survivor's optimum functioning in the early postoperative time
period is critical in the overall recovery from breast cancer. The formal
collection of objective measures along with patient-reported outcome measures
is recommended for the early detection of postoperative morbidity. Prospective
surveillance, including preoperative assessment and structured surveillance,
allows for early identification and timely rehabilitation. Early evidence
supports a prospective approach to address and minimize postoperative effects.
Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488697 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2217-25. doi: 10.1002/cncr.27474.
Prevalence of breast cancer treatment sequelae over 6 years of
follow-up: The Pulling Through Study.
Schmitz KH,
Speck RM,
Rye SA,
Disipio T,
Hayes SC.
Source
University of
Pennsylvania Perelman School of Medicine, Abramson Cancer Center, Philadelphia,
Pennsylvania. [email protected].
Abstract
BACKGROUND:
There is
a need to better describe and understand the prevalence of breast cancer
treatment-related adverse effects amenable to physical therapy and
rehabilitative exercise. Prior studies have been limited to single issues and
lacked long-term follow-up. The Pulling Through Study provides data on
prevalence of adverse effects in breast cancer survivors followed over 6
years.
METHODS:
A
population-based sample of Australian women (n = 287) diagnosed with invasive,
unilateral breast cancer was followed for a median of 6.6 years and
prospectively assessed for treatment-related complications at 6, 12, and 18
months and 6 years after diagnosis. Assessments included postsurgical
complications, skin or tissue reaction to radiation therapy, upper-body
symptoms, lymphedema, 10% weight gain, fatigue, and upper-quadrant function.
The proportion of women with positive indication for each complication and 1 or
more complication was estimated using all available data at each time point.
Women were only considered to have a specific complication if they reported the
highest 2 levels of the Likert scale for self-reported issues.
RESULTS:
At 6
years after diagnosis, more than 60% of women experienced 1 or more side
effects amenable to rehabilitative intervention. The proportion of women
experiencing 3 or more side effects decreased throughout follow-up, whereas the
proportion experiencing no side effects remained stable around 40% from 12
months to 6 years. Weight gain was the only complication to increase in
prevalence over time.
CONCLUSIONS:
These
data support the development of a multidisciplinary prospective surveillance
approach for the purposes of managing and treating adverse effects in breast
cancer survivors. Cancer 2012;118(8 suppl):. © 2012 American Cancer
Society.
Copyright © 2012
American Cancer Society.
PMID:
22488696 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2207-16. doi: 10.1002/cncr.27469.
Patient perspectives on breast cancer treatment side effects and
the prospective surveillance model for physical rehabilitation for women with
breast cancer.
Binkley JM,
Harris SR,
Levangie PK,
Pearl M,
Guglielmino J,
Kraus V,
Rowden D.
Source
TurningPoint
Women's Healthcare, Alpharetta, Georgia.
[email protected].
Abstract
Women's
experience of breast cancer is complex, affecting all aspects of life during
and after treatment. Patients' perspectives about common impairments and
functional limitations secondary to breast cancer treatment, including upper
extremity motion restriction, lymphedema, fatigue, weight gain, pain, and
chemotherapy-induced peripheral neuropathy, are addressed. Women often report
being uninformed regarding these side effects and surprised that they do not
always disappear after treatment, but remain part of their lives. Breast cancer
patients express strong, unmet needs for education, information, and
intervention for these side effects. Evidence suggests that rehabilitation and
exercise are effective in preventing and managing many physical side effects of
breast cancer treatment. Nevertheless, few women are referred to rehabilitation
during or after treatment, and fewer receive baseline assessments of impairment
and function to facilitate early detection of impairment and functional
limitations. The prospective surveillance model of rehabilitation will serve
the needs of women with breast cancer by providing education and information
about treatment side effects, reducing the incidence and burden of side effects
through early identification and treatment, and enhancing access to timely
rehabilitation. Integration of exercise as a component of the model benefits
patients at every phase of survivorship, by addressing individual concerns
about exercise during and after treatment and highlighting the important
contribution of exercise to overall health and survival. The prospective
surveillance model of rehabilitation can meet the evident and often expressed
needs of survivors for information, guidance, and intervention-thus addressing,
and potentially improving, overall quality of life for individuals diagnosed
with and treated for breast cancer. Cancer 2012;. © 2012 American Cancer
Society.
Copyright © 2012
American Cancer Society.
PMID:
22488695 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2207-16. doi: 10.1002/cncr.27469.
Patient perspectives on breast cancer treatment side effects and
the prospective surveillance model for physical rehabilitation for women with
breast cancer.
Binkley JM,
Harris SR,
Levangie PK,
Pearl M,
Guglielmino J,
Kraus V,
Rowden D.
Source
TurningPoint
Women's Healthcare, Alpharetta, Georgia.
[email protected].
Abstract
Women's
experience of breast cancer is complex, affecting all aspects of life during
and after treatment. Patients' perspectives about common impairments and
functional limitations secondary to breast cancer treatment, including upper
extremity motion restriction, lymphedema, fatigue, weight gain, pain, and
chemotherapy-induced peripheral neuropathy, are addressed. Women often report
being uninformed regarding these side effects and surprised that they do not
always disappear after treatment, but remain part of their lives. Breast cancer
patients express strong, unmet needs for education, information, and
intervention for these side effects. Evidence suggests that rehabilitation and
exercise are effective in preventing and managing many physical side effects of
breast cancer treatment. Nevertheless, few women are referred to rehabilitation
during or after treatment, and fewer receive baseline assessments of impairment
and function to facilitate early detection of impairment and functional
limitations. The prospective surveillance model of rehabilitation will serve
the needs of women with breast cancer by providing education and information
about treatment side effects, reducing the incidence and burden of side effects
through early identification and treatment, and enhancing access to timely
rehabilitation. Integration of exercise as a component of the model benefits
patients at every phase of survivorship, by addressing individual concerns
about exercise during and after treatment and highlighting the important
contribution of exercise to overall health and survival. The prospective
surveillance model of rehabilitation can meet the evident and often expressed
needs of survivors for information, guidance, and intervention-thus addressing,
and potentially improving, overall quality of life for individuals diagnosed
with and treated for breast cancer. Cancer 2012;. © 2012 American Cancer
Society.
Copyright © 2012
American Cancer Society.
PMID:
22488695 [PubMed - in process]
Cancer.
2012 Apr 15;118(8 Suppl):2191-200. doi: 10.1002/cncr.27476.
A prospective surveillance model for rehabilitation for women
with breast cancer.
Stout NL,
Binkley JM,
Schmitz KH,
Andrews K,
Hayes SC,
Campbell KL,
McNeely ML,
Soballe PW,
Berger AM,
Cheville AL,
Fabian C,
Gerber LH,
Harris SR,
Johansson K,
Pusic AL,
Prosnitz RG,
Smith RA.
Source
National
Naval Medical Center, Bethesda, Maryland.
[email protected].
Abstract
BACKGROUND:
The
current model of care for individuals with breast cancer focuses on treatment
of the disease, followed by ongoing surveillance to detect recurrence. This
approach lacks attention to patients' physical and functional well-being.
Breast cancer treatment sequelae can lead to physical impairments and
functional limitations. Common impairments include pain, fatigue,
upper-extremity dysfunction, lymphedema, weakness, joint arthralgia,
neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence
supports prospective surveillance for early identification and treatment as a
means to prevent or mitigate many of these concerns. This article proposes a
prospective surveillance model for physical rehabilitation and exercise that
can be integrated with disease treatment to create a more comprehensive
approach to survivorship health care. The goals of the model are to promote
surveillance for common physical impairments and functional limitations
associated with breast cancer treatment; to provide education to facilitate
early identification of impairments; to introduce rehabilitation and exercise
intervention when physical impairments are identified; and to promote and
support physical activity and exercise behaviors through the trajectory of
disease treatment and survivorship.
METHODS:
The
model is the result of a multidisciplinary meeting of research and clinical
experts in breast cancer survivorship and representatives of relevant
professional and advocacy organizations.
RESULTS/CONCLUSIONS:
The
proposed model identifies time points during breast cancer care for assessment
of and education about physical impairments. Ultimately, implementation of the
model may influence incidence and severity of breast cancer treatment-related
physical impairments. As such, the model seeks to optimize function during and
after treatment and positively influence a growing survivorship community.
Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.
Copyright © 2012
American Cancer Society.
PMID:
22488693 [PubMed - in process]
Ann Rehabil Med.
2011 Dec;35(6):922-7. Epub 2011 Dec 30.
Lipedema, a rare disease.
Shin BW,
Sim YJ,
Jeong HJ,
Kim GC.
Source
Department of
Physical Medicine and Rehabilitation, Kosin University College of Medicine,
Busan 602-702, Korea.
Abstract
Lipedema
is a chronic disease of lipid metabolism that results in the symmetrical
impairment of fatty tissue distribution and storage combined with the
hyperplasia of individual fat cells. Lipedema occurs almost exclusively in
women and is usually associated with a family history and characteristic
features. It can be diagnosed based on clinical history and physical
examination. Lipedema is usually symmetrical, but spares the feet, is often
painful to palpation, and is negative for Stemmer's sign. Additionally,
lipedema patients can present with microangiopathies and lipomas. The
well-known therapies for lipedema include complex decongestive therapy,
pneumatic compression, and diet modifications. However, whether these
treatments help reduce swelling is debatable. We encountered a case of lipedema
that was initially misdiagnosed as lymphedema. The patient's clinical features
and history were different from those typical of lymphedema, prompting a
diagnosis of lipedema and she was treated with a complex decongestive therapy
program.
PMID:
22506222 [PubMed - in process]PMCID: PMC3309375
Ann Rehabil Med.
2011 Oct;35(5):687-93. Epub 2011 Oct 31.
Prediction of treatment outcome with bioimpedance measurements
in breast cancer related lymphedema patients.
Kim L,
Jeon JY,
Sung IY,
Jeong SY,
Do JH,
Kim HJ.
Source
Department of
Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of
Medicine, Seoul 138-736, Korea.
Abstract
OBJECTIVE:
To
investigate the usefulness of bioimpedance measurement for predicting the
treatment outcome in breast cancer related lymphedema (BCRL)
patients.
METHOD:
Unilateral BCRL
patients who received complex decongestive therapy (CDT) for 2 weeks (5 days
per week) were enrolled in this study. We measured the ratio of extracellular
fluid (ECF) volume by using bioelectrical impedance spectroscopy (BIS), and
single frequency bioimpedance analysis (SFBIA) at a 5 kHz frequency before
treatment. Arm circumferences were measured at 10 cm above and below the elbow
before and after treatment. We also investigated whether there is correlation
between ECF ratio and SFBIA ratio with the change of arm circumference after
CDT.
RESULTS:
A total
of 73 patients were enrolled in this study. The higher ECF ratio was
significantly correlated with higher reduction of arm circumference at both
above and below the elbow after treatment, but the higher SFBIA ratio was
correlated only with the higher reduction of arm circumference below the
elbow.
CONCLUSION:
These
results show that ECF volume measurements and SFBIA before treatment are useful
tools for predicting the outcome of patients with lymphedema. We concluded that
ECF volume measure can be used as a screening tool for predicting treatment
outcome of BCRL patients.
PMID:
22506192 [PubMed - in process]PMCID: PMC3309267
April
14, 2012
Development
of separated elastic stockings.
Apr 2012
Hirai M, Iwata H,
Miyazaki K, Koyama A, Nakamura H.
Source
* Department of Vascular
Surgery, Tohkai Hospital, Nagoya.
Abstract
OBJECTIVES:
To
investigate the acceptability of newly developed separated elastic stockings,
which are divided into two portions at the ankle.
METHODS:
The
difficulty in putting on and taking off stockings was compared between the
original or modified separated stockings with various techniques in order to
reduce the shift of the stockings and current non-separated stockings in
healthy volunteers and patients with lymphoedema by applying both stockings
alternately. In the modified model, the shift during daily activities was
measured in healthy volunteers and patients with
lymphoedema.
RESULTS:
The two items, 'easier compared with
non-separated stockings' and 'much easier', were chosen at rates of 75% and 81%
for putting on and taking off stockings for the original separated stockings
and 75% and 75% for the modified separated stockings, respectively. Complaints
during daily activities with the modified type to the stockings decreased as
compared with the original type. The shift of stockings after an average
11-hour application was 1.6 ± 3.0 SD mm (range: 0-10
mm).
CONCLUSIONS:
Modified separated elastic stockings are easier to
put on and take off compared with current non-separated stockings, and they can
be used safely because of their low-level shift during daily
activities.
http://www.ncbi.nlm.nih.gov/pubmed/22499611
April
18, 2012
A
prospective surveillance model for rehabilitation for women with breast
cancer.
Apr 2012
Stout NL, Binkley JM, Schmitz KH, Andrews K,
Hayes SC, Campbell KL, McNeely ML, Soballe PW, Berger AM, Cheville AL, Fabian
C, Gerber LH, Harris SR, Johansson K, Pusic AL, Prosnitz RG, Smith
RA.
Source
National Naval Medical Center, Bethesda, Maryland.
[email protected].
Abstract
BACKGROUND:
The
current model of care for individuals with breast cancer focuses on treatment
of the disease, followed by ongoing surveillance to detect recurrence. This
approach lacks attention to patients' physical and functional well-being.
Breast cancer treatment sequelae can lead to physical impairments and
functional limitations. Common impairments include pain, fatigue,
upper-extremity dysfunction, lymphedema, weakness, joint arthralgia,
neuropathy, weight gain, cardiovascular effects, and osteoporosis. Evidence
supports prospective surveillance for early identification and treatment as a
means to prevent or mitigate many of these concerns. This article proposes a
prospective surveillance model for physical rehabilitation and exercise that
can be integrated with disease treatment to create a more comprehensive
approach to survivorship health care. The goals of the model are to promote
surveillance for common physical impairments and functional limitations
associated with breast cancer treatment; to provide education to facilitate
early identification of impairments; to introduce rehabilitation and exercise
intervention when physical impairments are identified; and to promote and
support physical activity and exercise behaviors through the trajectory of
disease treatment and survivorship.
METHODS:
The model is the result
of a multidisciplinary meeting of research and clinical experts in breast
cancer survivorship and representatives of relevant professional and advocacy
organizations.
RESULTS/CONCLUSIONS:
The proposed model identifies
time points during breast cancer care for assessment of and education about
physical impairments. Ultimately, implementation of the model may influence
incidence and severity of breast cancer treatment-related physical impairments.
As such, the model seeks to optimize fu
http://www.ncbi.nlm.nih.gov/pubmed/22488693
May 2, 2012
PLoS
One. 2012;7(4):e34901. Epub 2012 Apr 18.
Genome-wide
gene expression analysis implicates the immune response and lymphangiogenesis
in the pathogenesis of fetal chylothorax.
Yeang
CH, Ma
GC, Shih
JC, Yang
YS, Chen
CP, Chang
SP, Wu
SH, Liu
CS, Kuo
SJ, Chou
HC, Hwu
WL, Cameron
AD, Ginsberg
NA, Lin
YS, Chen
M.
Source
Institute of
Statistical Science, Academia Sinica, Taipei, Taiwan.
Abstract
Fetal
chylothorax (FC) is a rare condition characterized by lymphocyte-rich pleural
effusion. Although its pathogenesis remains elusive, it may involve
inflammation, since there are increased concentrations of proinflammatory
mediators in pleural fluids. Only a few hereditary lymphedema-associated gene
loci, e.g. VEGFR3, ITGA9 and PTPN11, were detected in human fetuses with this
condition; these cases had a poorer prognosis, due to defective
lymphangiogenesis. In the present study, genome-wide gene expression analysis
was conducted, comparing pleural and ascitic fluids in three hydropic fetuses,
one with and two without the ITGA9 mutation. One fetus (the index case), from a
dizygotic pregnancy (the cotwin was unaffected), received antenatal OK-432
pleurodesis and survived beyond the neonatal stage, despite having the ITGA9
mutation. Genes and pathways involved in the immune response were universally
up-regulated in fetal pleural fluids compared to those in ascitic fluids.
Furthermore, genes involved in the lymphangiogenesis pathway were
down-regulated in fetal pleural fluids (compared to ascitic fluid), but
following OK-432 pleurodesis, they were up-regulated. Expression of ITGA9 was
concordant with overall trends of lymphangiogenesis. In conclusion, we inferred
that both the immune response and lymphangiogenesis were implicated in the
pathogenesis of fetal chylothorax. Furthermore, genome-wide gene expression
microarray analysis may facilitate personalized medicine by selecting the most
appropriate treatment, according to the specific circumstances of the patient,
for this rare, but heterogeneous disease.
PMID:
22529953 [PubMed - in process] PMCID: PMC3329545
Ann
Surg Oncol. 2012 Apr 24. [Epub ahead of print]
Relationship
Between the Lymphatic Drainage of the Breast and the Upper Extremity: A
Postmortem Study.
Pavlista
D, Eliska
O.
Source
Oncogynecologic
Center, Department of Obstetrics and Gynecology, First Faculty of Medicine,
Charles University in Prague and General University Hospital, Prague, Czech
Republic, [email protected].
Abstract
BACKGROUND:
This
anatomic study details the lymphatic drainage of the upper extremity (UE) and
breast, as well as its course in the axilla and its relation to axillary
reverse mapping. Two aspects important for breast cancer surgery were followed:
connection between the lymphatics of the UE and breast, and the possible cause
of lymphedema of the UE after sentinel node (SN) biopsy.
METHODS:
Patent
blue dye was injected bilaterally in 23 cadavers with no history of breast
carcinoma to simultaneously visualize the lymphatics of the UE and breast.
After visualization and dissection of the lymphatic vessels and nodes, a record
of their routes was made. A scheme of superficial UE and breast lymphatics was
constructed.
RESULTS:
After
application of color contrast to the UE, 2-4 main afferent collectors were
shown. As opposed to cranial and medial collectors, caudal collectors diverged
from the axillary vein and entered the caudal axilla. In five (10.8 %) cases,
the caudal collector entered a node, which was considered to be the SN of the
breast. In six (13 %) cases, the SN of the breast and SNs of the UE were found
in close proximity (up to 1.5 cm).
CONCLUSIONS:
Lymphatic drainage
of the UE and breast are closely related in the caudal part of the axilla. SN
groups for the UE and breast share connections in 24 % of cases, which could
explain lymphedema after surgery if damaged. Additional studies are needed to
further improve our understanding of the lymphatic drainage of the UE and
breast.
PMID:
22526910 [PubMed - as supplied by publisher]
Radiology.
2012 Apr 20. [Epub ahead of print]
MR
Lymphangiography at 3.0 T: Correlation with Lymphoscintigraphy.
Notohamiprodjo
M, Weiss
M, Baumeister
RG, Sommer
WH, Helck
A, Crispin
A, Reiser
MF, Herrmann
KA.
Source
Department of
Clinical Radiology, Clinic of Nuclear Medicine, and Division of Plastic-,
Hand-, Micro-Surgery, Department of Surgery, University Hospitals Munich,
Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
Abstract
Purpose:To
prospectively compare findings of magnetic resonance (MR) lymphangiography with
those of lymphoscintigraphy, evaluate the pattern and delay of lymphatic
drainage, compare typical findings, and investigate discrepancies between the
techniques.Materials and Methods:This prospective study was performed according
to the Declaration of Helsinki and was approved by the local ethics committee.
Thirty consecutive patients with uni- or bilateral lymphedema and lymph vessel
transplants of the lower extremities were examined with 3.0-T fat-saturated
three-dimensional gradient-echo MR after gadopentetate dimeglumine injection.
Results of all examinations were correlated with corresponding results of
lymphoscintigraphy examinations. Results of both techniques were separately
reviewed in consensus by a radiologist and a nuclear physician, who rated delay
and pattern of drainage, number of enhancing levels, and quality of conspicuity
of the depiction of lymph nodes and lymph vessels. Sensitivity and specificity
were calculated by using combined results of both techniques and clinical
presentation findings as reference standard. Correlation was calculated with
weighted κ coefficients.Results:Weak lymphatic drainage at lymphoscintigraphy
correlated with lymphangiectasia at MR lymphangiography (13 of 33 affected
extremities). Lymph vessels were clearly visualized with MR lymphangiography
(five of 24 affected extremities), while they were not detectable with
lymphoscintigraphy. Depiction of inguinal lymph nodes was clearer with
lymphoscintigraphy (five of 60 extremities). Correlation of both techniques was
excellent for delay (κ = 0.93) and pattern (κ = 0.84) of drainage, good for
depiction of lymph nodes (κ = 0.67) and number of enhancing levels (κ = 0.77),
and moderate for depiction of lymph vessels (κ = 0.50). Sensitivity and
specificity for delay and pattern of drainage were concordant, whereas MR
lymphangiography showed a higher sensitivity for lymph vessel abnormalities
(100% vs 79%) and lower specificity for lymph node abnormalities (78% vs
100%).Conclusion:Imaging findings of MR lymphangiography and lymphoscintigraphy
show a clear concordance. With lymphoscintigraphy, better visualization of
inguinal lymph nodes was achieved, whereas with MR lymphangiography, better
depiction of lymph vessels and morphologic features of lymph vessel
abnormalities were achieved.© RSNA, 2012Supplemental material:
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12110229/-/DC1.
PMID:
22523325 [PubMed - as supplied by publisher]
Eur
J Dermatol. 2012 Apr 20. [Epub ahead of print]
Stewart-Treves
syndrome arising in patients with lymphaticovenular anastomosis for chronic
lymphedema of the leg.
Yamasaki
O, Takeshima
C, Ikeda
K, Suzuki
N, Otsuka
M, Kimata
Y, Hirakawa
S, Iwatsuki
K.
Source
Department of
Dermatology.
PMID:
22522788 [PubMed - as supplied by publisher]
J
Reconstr Microsurg. 2012 Apr 19. [Epub ahead of
print]
Upper-Limb
Lymphedema Treated Aesthetically with Lymphaticovenous Anastomosis using
Indocyanine Green Lymphography and Noncontact Vein Visualization.
Mihara
M, Hara
H, Hayashi
Y, Iida
T, Araki
J, Yamamoto
T, Todokoro
T, Narushima
M, Murai
N, Koshima
I.
Source
Department of
Plastic and Reconstructive Surgery, University of Tokyo, Tokyo,
Japan.
Abstract
We have
described a procedure to minimize surgical wounds, in which lymph vessels and
skin venules are identified by indocyanine green (ICG) lymphography and the
AV300 noncontact visualization system (AccuVein, Cold Spring Harbor, NY),
respectively. This approach allows accurate decisions regarding sites of
incision for lymphatic venous anastomosis (LVA). This method was applied in a
patient with right upper-limb lymphedema after breast cancer therapy. The
low-invasive procedure can be used before and during surgery. The incision size
is minimal, and the incision site is at the joint area. Thus, we aim to
establish this approach as a standard method for identifying lymph vessels and
veins that are suitable for LVA. This innovative vascular-imaging machine makes
LVA less invasive and more effective without side effects.
Thieme
Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
PMID:
22517571 [PubMed - as supplied by publisher]
Gynecol
Oncol. 2012 Apr 17. [Epub ahead of print]
A
novel approach to the treatment of lower extremity lymphedema by transferring a
vascularized submental lymph node flap to the ankle.
Cheng
MH, Huang
JJ, Nguyen
DH, Saint-Cyr
M, Zenn
MR, Tan
BK, Lee
CL.
Source
Division
of Reconstructive Microsurgery, Department of Plastic and Reconstructive
Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung
University, Taoyuan, Taiwan.
Abstract
OBJECTIVE:
Vascularized groin
lymph node flaps have been successfully transferred to the wrist to treat
postmastecomy upper limb lymphedema. This study investigated the anatomy,
mechanism and outcome of a novel vascularized submental lymph node (VSLN) flap
transfer for the treatment of lower limb lymphedema.
METHODS:
Bilateral regional
submental flaps were dissected from three fresh adult cadavers for histological
study. A unilateral submental flap was dissected in another six fresh cadavers
after latex injection. The VSLN flap was transferred to the ankles of seven
lower extremities in six patients with chronic lower extremity lymphedema. The
mean patient age was 61±9.4years. The average duration of lymphedema symptoms
was 71±42.2months.
RESULTS:
There
was a mean of 3.3±1.5 lymph nodes around the submental artery typically at the
junction with the facial artery, on the six cadaveric histological sections.
Mean of 2.3±0.8 sizable lymph nodes were dissected and supplied by the
submental artery in six cadaveric latex-injected submental flaps. All seven
VSLN flaps survived. One flap required re-exploration for venous congestion but
was successfully salvaged. There was no donor site morbidity. At a mean
follow-up of 8.7±4.2months, the mean reduction of the leg circumference was
64±11.5% above the knee, 63.7±34.3% below the knee and 67.3±19.2% above the
ankle.
CONCLUSION:
The
transfer of a vascularized submental lymph node flap to the ankle is a novel
approach for the effective treatment of lower extremity
lymphedema.
Copyright © 2012
Elsevier Inc. All rights reserved.
PMID:
22516659 [PubMed - as supplied by publisher]
J
Dermatol Case Rep. 2012 Mar 27;6(1):8-13.
Variable
clinical presentations of Classic Kaposi Sarcoma in Turkish
patients.
Altunay
I, Kucukunal
A, Demirci
GT, Ates
B.
Source
Department of
Dermatology, Sisli Etfal Training And Research Hospital, Istanbul,
Turkey.
Abstract
BACKGROUND:
Kaposi
sarcoma (KS) is a vascular neoplasm with multicentric cutanenous and
extracutaneous involvements, which was first described by Moriz Kaposi in 1872.
Since then, different epidemiological clinical and histopathological variants
of this neoplasm have been identified. Classic Kaposi sarcoma (CKS) is one of
four main clinico-epidemiologiologic variants. characteristics of the
disease.
MATERIALS
AND METHODS:
Four
Turkish inpatients with CKS were evaluated in the study. All medical history
and clinical data were noted. A screening immunodeficiency workup were
performed for all patients. HHV-8 immunofluorescence testing on the specimens
and ELISA test for human immunodeficiency virus (HIV 1 and 2) were performed.
Pulmonary X ray graphies and computurized tomography (CT) scan were applied.
Stage of the tumor was determined, in each case, according to the
classification system proposed by Brambilla et al in 2003.
RESULTS:
All
patients are positive for HHV-8. They were all immunocompetent and negative for
HIV1 and HIV2. The first patient was unusual for morphological presentation of
several verrucoid lesions that was evaluated as verrucoid KS. He was considered
stage IB CKS. The patient 2 was a young man and the course of KS seemed
unexpectedly aggressive for CKS. His clinical appearence seemed us to be a
patient with AIDSassociated KS. The patient was evaluated as stage IVB CKS. Our
third patient had also prominent lymphedema associated with bluish
discoloration on the toes and fingers, suggesting a diagnosis of peripheral
vascular disorder. He was diagnosed as stage IIIB CKS. The fourth case was
interesting for very extensive lesions involving big sized plaques and also the
existence of mucosal lesion. The patient was diagnosed as stage IVB
CKS.
CONCLUSIONS:
It seems
that the reports of exceptional cases of KS are accumulating. Data from various
cases should be collected and perhaps, novel clinical classifications should be
considered
PMID: 22514583
[PubMed - in process] PMCID: PMC3322103
May 12,
2012
Cancer
Manag Res. 2012;4:121-7. Epub 2012 Apr 27.
Axillary
dissection in primary breast cancer: variations of the surgical technique and
influence on morbidity.
Wojcinski
S, Nuengsri
S, Hillemanns
P, Schmidt
W, Deryal
M, Ertan
K, Degenhardt
F.
Source
Franziskus
Hospital, Department of Obstetrics/Gynecology, Bielefeld, Germany.
Abstract
Lymphedema of the
arm is the most common and impairing complication after breast cancer surgery
with axillary lymph node dissection (ALND). Our prospective study evaluated the
effect of two different surgical techniques for ALND on postoperative
morbidity. Patients were scheduled to undergo ALND. Patients in group 1 (n =
17) underwent the most common and standard technique of ALND, which uses sharp
dissection of the tissue and subsequent electro-coagulation of bleedings.
Patients in group 2 (n = 17) underwent a modified standard technique of ALND
with clamping and ligatures of all resection margins. Postoperative wound
secretion was quantified and patients were followed up for 6 months to assess
long-term morbidity. The variations in surgical technique had no significant
influence on the outcome variables. However, patients in group 2 showed a
tendency to less wound secretion (713 versus 802 mL; P = nonsignificant), a
decreased rate of immediate postoperative seromas (11.8 versus 23.5%; P =
nonsignificant) and less lymphedema after 3 months (29.4 versus 41.2%; P =
nonsignificant). Moreover, the number of resected lymph nodes correlated with
the total amount of drained fluid (P = 0.006), the duration of the drain (P =
0.015), and the risk for the development of lymphedema after 3 months (P =
0.016). The described variations in surgical technique had no influence on the
outcomes of the patients. The number of resected axillary lymph nodes remains
the most important risk factor for treatment-related morbidity. Therefore, a
well-balanced choice of the extent of the axillary dissection should be the
surgeon's main concern.
PMID:
22570566 [PubMed - in process] PMCID: PMC3346198
J
Dermatol. 2012 May 9. doi: 10.1111/j.1346-8138.2012.01560.x.
[Epub ahead of print]
Lymphostatic
xanthomatosis: Localized xanthomas in primary lymphedema.
Danz
B, Stadie
V, Marsch
WC, Fiedler
E.
Source
Department of
Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle
(Saale), Germany.
PMID:
22568787 [PubMed - as supplied by publisher]
Surg
Today. 2012 May 8. [Epub ahead of print]
Primary
lymphedema complicated by weeping chylous vesicles in the leg and scrotum:
report of a case.
Suehiro
K, Morikage
N, Murakami
M, Yamashita
O, Hamano
K.
Source
Division
of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi
University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi,
755-8505, Japan, [email protected].
Abstract
We
report a case of primary lymphedema complicated by leaking chylous vesicles in
the toe and scrotum, caused by lymphangiectasia, which was eventually managed
with lymphaticovenular anastomoses after conservative treatments proved
ineffective. The patient was a 25-year-old man with a 5-year history of massive
swelling with chylous weeping of his right leg and scrotum.
Lymphangioscintigraphy (LAS) showed dilated iliac lymph trunks causing lymph
reflux. Although he was instructed in standard methods of complex therapy, it
did not alleviate his symptoms. Because of the increasing frequency of
cellulitis, lymphatic surgery was finally indicated. The operation consisted of
lymphaticovenous anastomoses (LVA) in the ankle and groin, using a
super-micro-surgical technique. After surgery, his symptoms resolved and have
been controlled by self-care. Thus, early LAS to confirm the dilated iliac
lymph trunks causing lymph reflux, followed by LVA might be beneficial for the
management of this disease.
PMID:
22565851 [PubMed - as supplied by publisher]
Nurs
Res. 2012 May 4. [Epub ahead of print]
Self-Management
of Lymphedema: A Systematic Review of the Literature From 2004 to
2011.
Ridner
SH, Fu
MR, Wanchai
A, Stewart
BR, Armer
JM, Cormier
JN.
Source
Sheila
H. Ridner, PhD, RN, FAAN, is Associate Professor, School of Nursing, Vanderbilt
University, Nashville, Tennessee. Mei R. Fu, PhD, RN, ACNS-BC, is Assistant
Professor, College of Nursing, New York University. Ausanee Wanchai, RN, is
Graduate Research Assistant; Bob R. Stewart, EdD, is Professor Emeritus; and
Jane M. Armer, PhD, RN, FAAN, is Professor, Sinclair School of Nursing,
University of Missouri, Columbia. Janice N. Cormier, MD, MPH, is Associate
Professor, MD Anderson Cancer Center, University of Texas,
Houston.
Abstract
BACKGROUND:
Little
is known about the effectiveness of activities used to self-manage
lymphedema.
OBJECTIVE:
The aim
of this study was to evaluate the level of evidence of peer-reviewed lymphedema
self-care literature published from January 2004 to May 2011.
METHODS:
Eleven
major medical databases were searched. Articles were selected for inclusion or
exclusion into the category of self-management of lymphedema by topic experts.
The definition of self-management included activities that individuals initiate
and perform for themselves without the assistance of others. Articles were
scored according to the Oncology Nursing Society's Putting Evidence Into
Practice levels of evidence.
RESULTS:
Sixteen
articles met criteria for inclusion in this review, with self-management as the
independent variable. Ten categories of self-management were established
subsequently and articles were classified by levels of evidence. In these
categories, no self-management studies were rated as "recommended for
practice," 2 studies were rated "likely to be effective," none was rated
"benefits balanced with harms," 7 were rated "effectiveness not established,"
and 1 was rated "effectiveness unlikely."
DISCUSSION:
Few
studies included measures of outcomes associated with lymphedema, and there was
a scarcity of randomized controlled trials in lymphedema self-management. A
demonstrated need exists for the design and testing of self-management
interventions that include appropriate outcome measures.
PMID:
22565103 [PubMed - as supplied by publisher]
Rev
Esp Med Nucl. 2012 May 5. [Epub ahead of print]
Lymphoscintigraphy
for differential diagnosis of peripheral edema: Diagnostic yield of different
scintigraphic patterns.
[Article
in English, Spanish]
Infante
JR, García
L, Laguna
P, Durán
C, Rayo
JI, Serrano
J, Domínguez
ML, Sánchez
R.
Source
Servicio
de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz,
España.
Abstract
Edema of
the limbs is a common reason for medical consultation, for which the
lymphoscintigraphy is considered to be a reliable method for its differential
diagnosis.
OBJECTIVE:
To
evaluate the usefulness of radionuclide studies in the differential diagnosis
of edema, and the diagnostic yield of different scintigraphic
patterns.
MATERIAL
AND METHODS:
A total
of 61 patients, mean age 43 years, referred to our Department in the last three
years for suspected lymphoedema, were considered. One patient was discarded due
to lack of diagnosis, 56 had lower limb edema and 4 upper limb edema. After
intradermal injection of two doses of (99m)Tc-nanocolloid, scintigraphic scans
were made at 30 and 120minutes. The final diagnosis was based on imaging tests,
clinical course, and response to treatment. We calculated the parameters of the
diagnostic yield of four different scintigraphic patterns (presence of dermal
backflow, asymmetry-alteration in inguinal/axillary nodes, presence of
collateral pathways, and visualization of intermediate lymph nodes),
considering them individually and jointly.
RESULTS:
The best
diagnostic yield was achieved by considering dermal backflow and asymmetry in
inguinal/axillary nodes (accuracy 88.9%, specificity 96.4%, PPV 95.5%).
Evaluation of intermediate lymph nodes and presence of collateral pathways
contributed little to the diagnostic yield, showing poor sensitivity and high
false positive rates.
CONCLUSION:
The
lymphoscintigraphy had high diagnostic yield, allowing early treatment of
lymphœdema. The dermal backflow and asymmetry in inguinal/axillary nodes had
the greatest diagnostic accuracy. Evaluation of intermediate lymph nodes and
visualization of collateral pathways contributed little to improving the
diagnosis.
Copyright © 2011
Elsevier España, S.L. y SEMNIM. All rights reserved.
PMID:
22564851 [PubMed - as supplied by publisher]
J
Am Coll Surg. 2012 May 3. [Epub ahead of print]
Surgical
Management of Inoperable Lymphedema: The Re-emergence of Abandoned
Techniques.
Doscher
ME, Herman
S, Garfein
ES.
Source
Department of
Surgery, Division of Plastic and Reconstructive Surgery, Montefiore Medical
Center, Bronx, NY.
PMID:
22560317 [PubMed - as supplied by publisher]
May
23, 2012
Jones
J
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