1. Br J Community Nurs. 2009 Oct;14(10):S9-12, 14.
Tackling obesity as part of a lymphoedema management programme.
Stigant A.
NHS Cumbria. [email protected]
PMID: 19966696 [PubMed - indexed for MEDLINE]
-----------
2. Br J Community Nurs. 2009 Oct;14(10):S28-30.
Lymphoedema is part of who I am.
Summerhill L.
PMID: 19966693 [PubMed - indexed for MEDLINE]
----------------------
3. Br J Community Nurs. 2009 Oct;14(10):S20, 22-3.
Manual handling in lymphoedema: the importance of getting it right.
Pike C.
British Lymphology Society. [email protected]
PMID: 19966691 [PubMed - indexed for MEDLINE]
---------------------------
4. Br J Community Nurs. 2009 Oct;14(10):S15-6, 18-9.
Breast cancer-related lymphoedema: implications for primary care.
Harmer V.
St.Mary's Hospital, Imperial College Healthcare NHS Trust, London. [email protected]
------------------
PMID: 19966690 [PubMed - indexed for MEDLINE]
-----------------
1. Am J Clin Oncol. 2010 Jan 15. [Epub ahead of print]
The Role of Chemo-Radiotherapy in the Management of Locally Advanced
Carcinoma of the Vulva: Single
Institutional Experience and Review of
Literature.
Tans L, Ansink AC, van Rooij PH, Kleijnen C, Mens JW.
From the *Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer
Center, Rotterdam,
The Netherlands; daggerDepartment of Gynecological
Oncology, Erasmus MC-Daniel den Hoed Cancer
Center, Rotterdam, The
Netherlands; and double daggerDepartment of Radiation Oncology, University
Medical Center Utrecht, Utrecht, The Netherlands.
OBJECTIVE:: To retrospectively investigate the outcome and toxicity of
concurrent chemo-radiotherapy in
the treatment of locally advanced vulvar
cancer (LAVC).
PATIENTS AND METHODS:: Between 1996 and 2007, 28 consecutive patients with
LAVC were
treated with chemoradiation (20 primary tumors and 8 loco-regional
recurrences). Treatment consists of 2
separate courses of external-beam
radiotherapy (40 Gy-2 weeks split-20 Gy). During each course of
radiotherapy, 5-fluorouracil (1000 mg/m /d), was given as a continuous intravenous infusion over the first 4
days, and mitomycin-C (10 mg/m on day
1), as a bolus intravenous injection. Outcome measures were
rates of complete and partial response, loco-regional control, progression-free survival, overall survival,
and toxicity.
RESULTS:: The median follow-up was 42 months and the median age of patients
was 68 years. Twenty
patients (72%) achieved complete remission, 4 patients
(14%) partial remission, for an overall response
rate of 86%. Four patients
(14%) had progressive disease directly after chemo-radiotherapy. The actuarial
rates of loco-regional control, progression-free survival and overall
survival at 4 years were 75%, 71%,
and 65%, respectively. There was no
treatment break for acute toxicity. Vulvar desquamation was the main
acute
treatment-related side effect (93%). Three patients developed transient grade 2
neutropenia or
thrombocytopenia. Mild skin fibrosis and atrophy (n = 6,
21%), radiation ulcer (n = 4, 14%, in one patient
treatment was needed),
telangectasia (n = 3, 11%), and lymphoedema (n = 2, 7%) were the most common
late toxicity of chemoradiation.
CONCLUSION:: These data support the use of concurrent chemoradiotherapy as an
effective alternative
to primary ultra-radical surgery to treat LAVC with an
acceptable toxicity profile.
PMID: 20087157 [PubMed - as supplied by publisher]
------------------------
2.
J Postgrad Med. 2009 Oct-Dec;55(4):270-1.
Yellow nail syndrome following thoracic surgery: A new association?
Banta DP, Dandamudi N, Parekh HJ, Anholm JD.
Loma Linda University Medical Center, VA Loma Linda Healthcare System, Loma
Linda, California,
USA.
An 80-year-old man presented with the characteristic triad of yellow nail
syndrome (chronic respiratory
disorders, primary lymphedema and yellow
nails) in association with coronary artery bypass graft surgery.
Treatment
with mechanical pleurodesis and vitamin E resulted in near complete resolution
of the yellow
nails, pleural effusions, and lower extremity edema. The
etiology of the yellow nail syndrome has been
described as an anatomical or
functional lymphatic abnormality. Several conditions have previously been
described as associated with this disease. This is the first report of the
association of this syndrome with
thoracic surgery.
PMID: 20083874 [PubMed - in process]
-------------------------
3. Int J Palliat Nurs. 2009 Oct;15(10):474, 476-80.
Understanding lymphoedema in advanced disease in a palliative care
setting.
Todd M.
Specialist Lymphoedema Clinic, Glasgow, UK. [email protected]
Lymphoedema in the palliative patient can be very distressing and
uncomfortable, and managing this
symptom is often difficult and labour
intensive. Using a humanistic approach, the practitioner can holistically
and sensitively assess the patient's needs and problems and develop a
management strategy that ensures
these needs are addressed. This requires a
high level of skill in assessment, communication, collaborative
working, and
symptom management. The four basic principles of lymphoedema management are
compression, massage, skin care and exercise. These principles are modified
and applied on an individual
patient basis through the support and
collaboration of the team involved in each patient's care.
PMID: 20081719 [PubMed - in process]
---------------
4. J Wound Care. 2010 Jan;19(1):15-7.
Using VAC to facilitate healing of traumatic wounds in patients with chronic
lymphoedema.
Wollina U, Hansel G, Krönert C, Heinig B.
Healing of traumatic injuries in patients with chronic lymphoedema is often
delayed. This article describes
how topical negative pressure was used to
promote healing in two such cases. It also eliminated pain and
prevented
re-infection.
PMID: 20081569 [PubMed - in process]
----------------
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007585.
Lymphadenectomy for the management of endometrial cancer.
May K, Bryant A, Dickinson HO, Kehoe S, Morrison J.
Nuffield Department of Obstetrics and Gynaecology, University of Oxford,
Women's Centre, John
Radcliffe Hospital, Oxford, UK, OX3 9DU.
BACKGROUND: Endometrial carcinoma is the most common gynaecological cancer in
western Europe
and North America. Lymph node metastases can be found in
approximately 10% of women who clinically
have cancer confined to the womb
prior to surgery and removal of all pelvic and para-aortic lymph nodes
(lymphadenectomy) is widely advocated. Pelvic and para-aortic
lymphadenectomy is part of the FIGO
staging system for endometrial cancer.
This recommendation is based on non-randomised controlled trials
(RCTs) data
that suggested improvement in survival following pelvic and para-aortic
lymphadenectomy.
However, treatment of pelvic lymph nodes may not confer a
direct therapeutic benefit, other than allocating
women to poorer prognosis
groups. Furthermore, a systematic review and meta-analysis of RCTs of
routine adjuvant radiotherapy to treat possible lymph node metastases in
women with early-stage
endometrial cancer, did not find a survival
advantage. Surgical removal of pelvic and para-aortic lymph
nodes has
serious potential short and long-term sequelae and most women will not have
positive lymph
nodes. It is therefore important to establish the clinical
value of a treatment with known morbidity.
OBJECTIVES: To evaluate the effectiveness and safety of lymphadenectomy for
the management of
endometrial cancer.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL)
Issue 2, 2009. Cochrane Gynaecological Cancer Review Group
Trials Register, MEDLINE (1966 to June
2009), Embase (1966 to June 2009). We
also searched registers of clinical trials, abstracts of scientific
meetings, reference lists of included studies and contacted experts in the
field.
SELECTION CRITERIA: RCTs and quasi-RCTs that compared lymphadenectomy with no
lymphadenectomy, in adult women diagnosed with endometrial cancer.
DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted
data and
assessed risk of bias. Hazard ratios (HRs) for overall and
progression-free survival and risk ratios (RRs)
comparing adverse events in
women who received lymphadenectomy or no lymphadenectomy were
pooled in
random effects meta-analyses.
MAIN RESULTS: Two RCTs met the inclusion criteria; they randomised 1945
women, and reported HRs
for survival, adjusted for prognostic factors, based
on 1851 women.Meta-analysis indicated no significant
difference in overall
and recurrence-free survival between women who received lymphadenectomy and
those who received no lymphadenectomy (pooled HR = 1.07, 95% CI: 0.81 to
1.43 and HR = 1.23, 95%
CI: 0.96 to 1.58 for overall and recurrence-free
survival respectively).We found no statistically significant
difference in
risk of direct surgical morbidity between women who received lymphadenectomy and
those
who received no lymphadenectomy. However, women who received
lymphadenectomy had a significantly
higher risk of surgically related
systemic morbidity and lymphoedema/lymphocyst formation than those who
had
no lymphadenectomy (RR = 3.72, 95% CI: 1.04 to 13.27 and RR = 8.39, 95% CI:
4.06, 17.33 for
risk of surgically related systemic morbidity and
lymphoedema/lymphocyst formation respectively).
AUTHORS' CONCLUSIONS: We found no evidence that lymphadenectomy decreases the
risk of death
or disease recurrence compared with no lymphadenectomy in
women with presumed stage I disease. The
evidence on serious adverse events
suggests that women who receive lymphadenectomy are more likely to
experience surgically related systemic morbidity or lymphoedema/lymphocyst
formation.
PMID: 20091639 [PubMed - in process]
----------------
2. Ann Oncol. 2010 Jan 20. [Epub ahead of print]
Eccrine porocarcinoma presenting with scrotal lymphedema: a case report and
review of systemic
treatment.
Perez-Garcia J, Morales R, Valverde CM, Rodon J, Suarez C, Semidey ME,
Garcia-Patos V, Bartralot
R, Serra M, Carles J.
Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona,
Spain.
PMID: 20089564 [PubMed - as supplied by publisher
-----------------------
3. Zhongguo Zhen Jiu. 2009 Dec;29(12):998-1000.
[Observation on 27 elderly women in britain with lymphedema syndrome treated
by acupuncture combined
with medicine] [Article in Chinese]
Yang XH, Liu H, Chai JH, Zhao XC.
Department of Acupuncture and Moxibustion, Jingmen Hospital of TCM, Jingmen
448000, China.
[email protected]
OBJECTIVE: To observe clinical effect of acupuncture combined with medicine
therapy for elderly women
in Britain with lymphedema syndrome.
METHODS: Twenty-seven cases were classified according to syndrome
differentiation of TCM into cold
congealing and dampness obstruction type
(11 cases), qi-blood stagnation type (12 cases) and downward
attack of
damp-heat type (4 cases). They were treated with acupuncture at main points
Zusanli (ST 36),
Yanglingquan (GB 34), Yinglingquan (SP 9), Sanyinjiao (SP
6), Taichong (LR 3), Fenglong (ST 40),
Xuehai (SP 10), Fengshi (GB 31), Futu
(ST 32), Liangqiu (ST 34), Weizhong (BL 40), etc., twice each
week and oral
administration of modified Duhuojisheng Decoction, Huangqiwuwu Decoction and
Simiao
San Decoction, respectively, meanwhile washing the affected limb with
again decoction of remaining gruffs
one medicament each day. They were
treated for 12 weeks.
RESULTS: Twelve cases were clinically cured, accounting for 44.4%, 14 cases
were effective, accounting
for 51.9%; and 1 case was ineffective, accounting
for 3.7%.
CONCLUSION: Acupuncture combined with medicine has a good therapeutic effect
on lymphedema
syndrome.
PMID: 20088421 [PubMed - in process]
------------------
1. Mamm Genome. 2009 Dec 29. [Epub ahead of print]
Whole-genome scan identifies quantitative trait loci for chronic pastern
dermatitis in German draft horses.
Mittmann EH, Mömke S, Distl O.
Institute of Animal Breeding and Genetics, University of Veterinary Medicine
Hannover, Bünteweg 17p,
30559, Hannover, Germany.
Chronic pastern dermatitis (CPD), also known as chronic progressive
lymphedema (CPL), is a skin
disease that affects draft horses. This disease
causes painful lower-leg swelling, nodule formation, and skin
ulceration,
interfering with movement. The aim of this whole-genome scan was to identify
quantitative trait
loci (QTL) for CPD in German draft horses. We recorded
clinical data for CPD in 917 German draft
horses and collected blood samples
from these horses. Of these 917 horses, 31 paternal half-sib families
comprising 378 horses from the breeds Rhenish German, Schleswig,
Saxon-Thuringian, and South German
were chosen for genotyping. Each half-sib
family was constituted by only one draft horse breed.
Genotyping was done
for 318 polymorphic microsatellites evenly distributed on all equine autosomes
and
the X chromosome with a mean distance of 7.5 Mb. An across-breed
multipoint linkage analysis revealed
chromosome-wide significant QTL on
horse chromosomes (ECA) 1, 9, 16, and 17. Analyses by breed
confirmed the
QTL on ECA1 in South German and the QTL on ECA9, 16, and 17 in Saxon-Thuringian
draft horses. For the Rhenish German and Schleswig draft horses, additional
QTL on ECA4 and 10 and
for the South German draft horses an additional QTL
on ECA7 were found. This is the first whole-genome
scan for CPD in draft
horses and it is an important step toward the identification of candidate
genes.
PMID: 20039044 [PubMed - as supplied by publisher]
--------------------
2. Work. 2009;34(3):285-96.
The impact of breast cancer among Canadian women: disability and
productivity.
Quinlan E, Thomas-MacLean R, Hack T, Kwan W, Miedema B, Tatemichi S, Towers
A, Tilley A.
University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N5A5. [email protected]
Each year over 20,000 Canadian women are diagnosed with breast cancer. Many
breast cancer survivors
anticipate a considerable number of years of
potential participation in the paid labour market, therefore, the
link
between breast cancer survivorship and productivity deserves serious
consideration. The hypothesis
guiding this study is that arm morbidities
such as lymphedema, pain, and range of motion limitations are
important
explanatory variables in survivors' loss of productivity. The study draws from a
larger longitudinal
research project involving over 600 breast cancer
survivors in four geographical locations across Canada.
The study's regression results indicate that, after adjusting for fatigue, breast cancer stage, and geographical
location, survivors with range of motion limitations
and arm pain are more than two and half times as likely
to lose some
productivity capacity as compared to counterparts with no arm morbidity. The
findings make
a compelling argument for the necessity of adequate
rehabilitation programs delivered at crucial times in
breast cancer
survivors' recovery. The study's unexpected finding that geographical location
is a highly
significant predictor of changes in productivity among breast
cancer survivors is interpreted as a factor of
the regulatory framework
governing employment relationships in the four different jurisdictions.
PMID: 20037243 [PubMed - in process
-----------------
1. Clin Exp Dermatol. 2009 Dec;34(8):e931-3.
Localized bullous pemphigoid in a patient with primary lymphoedema tarda.
Perez A, Clements SE, Benton E, Robson A, Bhogal B, Stefanato CM, McGibbon
D.
St John's Institute of Dermatology, St Thomas' Hospital, London, UK. [email protected]
We report a case of localized bullous pemphigoid (BP) in a woman patient with
primary lymphoedema
tarda. There is only one previous case reported of
localized pemphigoid in an area of lymphoedema, this
being of the
cicatricial variant. Slow circulation in the lymphatic vessels, increased
capillary permeability
with preferential localization of antibodies in the
area, and potential cleavage of the epidermal junction due
to increased
hydrostatic pressure leading to autoimmunity, have all been advocated as
possible pathogenic
mechanisms. Nevertheless, we consider that the mechanism
by which localized pemphigoid arises on
lymphoedema remains elusive, based
on a previous case of generalized BP sparing an area of postsurgical
lymphoedema.
PMID: 20055870 [PubMed - in process
----------------------
2. Clin Exp Dermatol. 2009 Dec;34(8):e696-8. Epub 2009 Jul 3.
Elephantiasis nostras verrucosa in a patient with systemic sclerosis.
Chatterjee S, Karai LJ.
Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic, 9500
Euclid Avenue/Desk
A50, Cleveland, OH 44195, USA. [email protected]
Elephantiasis nostras verrucosa (ENV) is an unusual skin condition
characterized by dermal fibrosis and
hyperkeratotic verrucous lesions
resulting from chronic nonfilarial lymphoedema. The condition is similar to
'elephantiasis tropica', in which elephantiasis develops secondary to
filariasis. Lymphatic obstruction can be
primary or due to various causes
such as surgery, tumour, radiation, congestive heart failure or obesity.
Recurrent attacks of cellulitis lead to further impairment of lymphatic
drainage, causing permanent swelling,
dermal fibrosis and epidermal
thickening. We report a case of a 56-year-old man with systemic sclerosis
(SS), who presented with painful lesions on both legs, consistent with ENV.
He developed extensive,
fungating, papillomatous lesions on the skin of the
legs, toes and dorsa of the feet over a period of 3 years.
Histology
revealed dense dermal fibrosis, oedema of the papillary dermis and extensive
pseudo-epitheliomatous changes. To our knowledge, this is the first report
of ENV in which SS was
considered to be the primary cause for the impairment
of lymphatic flow.
PMID: 20055839 [PubMed - in process
-----------------------------
3. Breast Cancer Res Treat. 2010 Jan 7. [Epub ahead of print]
Pre-operative assessment enables early diagnosis and recovery of shoulder
function in patients with breast
cancer.
Springer BA, Levy E, McGarvey C, Pfalzer LA, Stout NL, Gerber LH, Soballe PW,
Danoff J.
Proponency Office for Rehabilitation and Reintegration, Office of the Surgeon
General, 5109 Leesburg
Pike, Suite 684, Falls Church, VA, 22041-3258, USA,
[email protected].
In order to determine the extent and time course of upper limb impairment and
dysfunction in women being
treated for breast cancer (BC), and followed
prospectively, a novel physical therapy surveillance model
post-treatment
was used. Subjects included adult women with newly diagnosed, untreated,
unilateral, Stage
I to III BC, and normal physiological and biomechanical
shoulder function. Subjects were excluded if they
had a previous history of
BC, or prior injury or surgery of the affected upper limb. Measurements included
body weight, shoulder ranges of motion (ROM), manual muscle tests, pain
levels, upper limb volume, and
an upper limb disability questionnaire
(ULDQ). Measurements were taken at baseline (pre-surgery), and 1,
3-6, and
12 months post-surgery. All subjects received pre-operative education and
exercise instruction
and specific physical therapy (PT) protocol after
surgery including ROM and strengthening exercises. All
measures of function
were significantly reduced 1 month post-surgery, but most recovered to baseline
levels by 1-year post-surgery. Some subjects developed signs of lymphedema
3-12 months post-surgery,
but this did not compromise function. Shoulder
abduction, flexion, and external rotation, but not internal
rotation ROM,
were associated with the ULDQ. Most women in this cohort undergoing surgery for
BC
who receive PT intervention may expect a return to baseline ROM and
strength by 3 months. Those who
do not reach baseline, often continue to
improve and reach their pre-operative levels by 1-year
post-surgery.
Lymphedema develops independently of shoulder function 3-12 months post-surgery,
necessitating continued monitoring. A prospective physical therapy model of
surveillance allows for
detection of early and later onset of impairment
following surgery for BC in this specific cohort of patients.
PMID: 20054643 [PubMed - as supplied by publisher
-------------------------
4. Hernia. 2010 Jan 7. [Epub ahead of print]
Abdominoscrotal hydrocele in a 9-month old infant.
Blevrakis E, Anyfantakis DI, Sakellaris G.
Department of Pediatric Surgery, University General Hospital of Heraklion,
Crete, Greece.
Abdominoscrotal hydrocele represents an uncommon condition, especially in
childhood, resulting from the
communication of a large scrotal hydrocele
with the abdominal cavity through the inguinal canal. The
disorder has been
associated with a variety of pathological entities such as hydronephrosis,
lymphedema,
and malignancy of the tunica vaginalis. Diagnosis is made by
physical examination and confirmed by
abdominal ultrasound scan. Surgical
correction, although complex, remains the optimal therapeutic option.
The
present article reports the case of a 9-month infant from Greece with
abdominoscrotal hydrocele.
Regardless of rarity, the disorder should be
included in the differential diagnosis of scrotal and abdominal
masses, as
early diagnosis and surgical intervention may prevent the development of
potential
complications. The difficulty in establishing a preoperative
diagnosis highlights the necessity for a physician
to have a high level of
familiarity with abdominoscrotal hydrocele and its possible complications.
Awareness
of this abnormality will ensure its prompt recognition and optimal
management.
PMID: 20054596 [PubMed - as supplied by publisher]
----------------------
1. J Mal Vasc. 2009 Nov;34(5):314-22.
[Limb lymphedema: Diagnosis, explorations, complications][Article in
French]
Vignes S, Coupé M, Baulieu F, Vaillant L; Groupe Recommandations de la
Société Française de
Lymphologie.
Unité de lymphologie, hôpital Cognacq-Jay, Centre national de référence des
maladies vasculaires rares,
15, rue Eugène-Millon,75015 Paris, France.
Lymphedema results from impaired lymphatic transport with increased limb
volume. Primary and secondary
forms can be distinguished. Secondary
lymphedema of the upper limb is the most frequent in France. A
2-cm
difference on any segment of the limb confirms the diagnosis of lymphedema.
Calculated lymphedema
volume using the formula for a truncated cone is
required to assess the efficacy of treatment and to monitor
follow-up.
Primary lymphedema is sporadic but rarely familial. Lymphoscintigraphy is useful
in the primary
form to evaluate precisely lymphatic function of the two
limbs. Erysipelas is the main complication,but
psychological or functional
discomfort may occur throughout the course of lymphedema. Lipedema is the
main differential diagnosis, defined as an abnormal accumulation of fat from
hip to ankle and occurs almost
exclusively in obese women.
PMID: 20050179 [PubMed - in process
----------------------
2. Plast Reconstr Surg. 2010 Jan;125(1):19-23.
Breast reconstruction and lymphedema.
Chang DW, Kim S.
Department of Plastic Surgery, University of Texas M. D. Anderson Cancer
Center, Houston, Texas
77030-4009, USA. [email protected]
BACKGROUND: The authors conducted this study to determine the following: Does
delayed breast
reconstruction that requires surgical dissection in the
previously operated on and/or irradiated axilla lead to
a higher incidence
of lymphedema? In patients who have developed lymphedema following mastectomy,
does delayed breast reconstruction with autologous flap reduce the severity
of the lymphedema?
METHODS: Four hundred eighty-two consecutive delayed autologous breast
reconstructions performed at
the authors' institution were evaluated. The
authors evaluated the effects of flap choice, recipient vessel
choice,
previous radiotherapy, and previous axillary node dissection on lymphedema
development after
breast reconstruction. The authors also evaluated the
effect of autologous breast reconstruction on the
status of the preexisting
lymphedema.
RESULTS: Four hundred forty-four delayed breast reconstructions were
performed using 394 free flaps
and 50 latissimus dorsi flaps in patients
with no lymphedema. Lymphedema developed in 16 cases (3.6
percent). The type
of flap, the site of recipient vessel, previous radiotherapy, and previous
axillary node
dissection did not have a significant effect on the incidence
of lymphedema after breast reconstruction.
Breast reconstructions were
performed in 38 patients who already had lymphedema: nine (23.7 percent)
demonstrated significant improvement, and none demonstrated worsening of
lymphedema after breast
reconstruction.
CONCLUSIONS: The incidence of lymphedema following delayed autologous breast
reconstruction is
low, and the use of thoracodorsal vessels or a latissimus
dorsi flap, even in patients with previous axillary
node dissection or
irradiation, was not associated with a significantly higher risk of developing
lymphedema.
In patients who developed lymphedema following mastectomy,
delayed autologous breast reconstruction
may help reduce the severity of
lymphedema.
PMID: 20048582 [PubMed - in process
--------------------
1. Oncol Nurs Forum. 2010 Jan;37(1):85-91.
Patient perceptions of arm care and exercise advice after breast cancer
surgery.
Lee TS, Kilbreath SL, Sullivan G, Refshauge KM, Beith JM.
Royal North Shore Hospital, Sydney, Australia. [email protected]
PURPOSE/OBJECTIVES: To describe in greater detail women's experiences
receiving advice about arm
care and exercise after breast cancer treatment.
DESIGN: Cross-sectional survey.
SETTING: Three hospitals in Sydney, Australia.
SAMPLE: 175 patients with breast cancer recruited 6-15 months after their
surgery.
METHODS: Patients completed a survey about their perceptions of arm activity
after breast cancer and
were asked to respond to an open-ended question
about their experience receiving advice about arm care
and exercise.
Comments from 48 women (27%) who volunteered responses were collated and
categorized.
MAIN RESEARCH VARIABLES: Patients' experience with arm care and exercise
advice after breast
cancer surgery.
FINDINGS: Topics raised by respondents included perceptions of inadequate and
conflicting advice, lack
of acknowledgment of women's concerns about upper
limb impairments, an unsupported search for
information about upper limb
impairments, fear of lymphedema, women's demand for follow-up
physiotherapy,
and some positive experiences with supportive care.
CONCLUSIONS: Upper limb impairments are problematic for some breast cancer
survivors, and these
concerns are not always taken seriously by health
professionals. To date, standardized advice is provided
that does not meet
the needs and expectations of a cohort of women after breast cancer surgery.
IMPLICATIONS FOR NURSING: Health professionals could better address patients'
concerns about
upper limb impairments by providing accurate advice relevant
to the surgery.
PMID: 20044343 [PubMed - in process
----------------------
2. Oncol Nurs Forum. 2010 Jan;37(1):E28-33.
Confronting the unexpected: temporal, situational, and attributive dimensions
of distressing symptom
experience for breast cancer survivors.
Rosedale M, Fu MR.
College of Nursing, New York University, New York City, USA. [email protected]
PURPOSE/OBJECTIVES: To describe women's unexpected and distressing symptom
experiences after
breast cancer treatment.
RESEARCH APPROACH: Qualitative and descriptive.Setting: Depending upon their
preference,
participants were interviewed in their homes or in a private
office space in a nearby library.
PARTICIPANTS: Purposive sample of 13 women 1-18 years after breast cancer
treatment.
METHODOLOGIC APPROACH: Secondary analysis of phenomenologic data (constant
comparative
method).
MAIN RESEARCH VARIABLES: Breast cancer symptom distress, ongoing symptoms,
and unexpected
experiences.
FINDINGS: Women described experiences of unexpected and distressing symptoms
in the years following
breast cancer treatment. Symptoms included pain, loss
of energy, impaired limb movement, cognitive
disturbance, changed sexual
experience, and lymphedema. Four central themes were derived: living with
lingering symptoms, confronting unexpected situations, losing precancer
being, and feeling like a has-been.
Distress intensified when women expected
symptoms to disappear but symptoms persisted instead.
Increased distress
also was associated with sudden and unexpected situations or when symptoms
elicited
feelings of loss about precancer being and feelings of being a has
been. Findings suggest that symptom
distress has temporal, situational, and
attributive dimensions.
CONCLUSIONS: Breast cancer survivors' perceptions of ongoing and unexpected
symptoms have
important influences on quality of life. Understanding
temporal, situational, and attributive dimensions of
symptom distress
empowers nurses and healthcare professionals to help breast cancer survivors
prepare
for subsequent ongoing or unexpected experiences in the years after
breast cancer treatment.
INTERPRETATION: Follow-up care for breast cancer survivors should foster
dialogue about ways that
symptoms might emerge and that unexpected
situations might occur. Prospective studies are needed to
examine symptom
distress in terms of temporal, situational, and attributive dimensions and
explore the
relationship between symptom distress and psychological distress
after breast cancer treatment.
PMID: 20044329 [PubMed - in process
----------------
1. J Man Manip Ther. 2009;17(3):e80-9.
Systematic review of efficacy for manual lymphatic drainage techniques in
sports medicine and
rehabilitation: an evidence-based practice approach.
Vairo GL, Miller SJ, McBrier NM, Buckley WE.
Manual therapists question integrating manual lymphatic drainage techniques
(MLDTs) into conventional
treatments for athletic injuries due to the
scarcity of literature concerning musculoskeletal applications and
established orthopaedic clinical practice guidelines. The purpose of this
systematic review is to provide
manual therapy clinicians with pertinent
information regarding progression of MLDTs as well as to critique
the
evidence for efficacy of this method in sports medicine. We surveyed
English-language publications
from 1998 to 2008 by searching PubMed, PEDro,
CINAHL, the Cochrane Library, and SPORTDiscus
databases using the terms
lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage,
and lymphatic pump techniques. We selected articles investigating the
effects of MLDTs on orthopaedic
and athletic injury outcomes. Nine articles
met inclusion criteria, of which 3 were randomized controlled
trials (RCTs).
We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences
in
experimental design, data could not be collapsed for meta-analysis.
Animal model experiments reinforce
theoretical principles for application of
MLDTs. When combined with concomitant musculoskeletal
therapy, pilot and
case studies demonstrate MLDT effectiveness. The best evidence suggests that
efficacy
of MLDT in sports medicine and rehabilitation is specific to
resolution of enzyme serum levels associated
with acute skeletal muscle cell
damage as well as reduction of edema following acute ankle joint sprain and
radial wrist fracture. Currently, there is limited high-ranking evidence
available. Well-designed RCTs
assessing outcome variables following
implementation of MLDTs in treating athletic injuries may provide
conclusive
evidence for establishing applicable clinical practice guidelines in sports
medicine and
rehabilitation.
PMID: 20046617 [PubMed - in process
------------------
1. Gynecol Obstet Invest. 2010 Jan 12;69(3):212-216. [Epub ahead of
print]
Vulvar Lymphoedematous Pseudotumours Mistaken for Aggressive Angiomyxoma:
Report of Two Cases.
D'Antonio A, Caleo A, Boscaino A, Mossetti G, Iannantuoni N.
Unit of Pathologic Anatomy, A.U.O. San Giovanni di Dio e Ruggi d'Aragona,
Salerno, Italy.
Background: We describe 2 cases of vulvar pseudotumour due to lymphatic
obstruction with chronic
lymphoedema of unknown cause that presented as a
solitary mass that mimicked aggressive angiomyxoma.
Material and Methods:
Both patients presented with a vulvar mass without medical history of trauma,
surgery in the anogenital region or skin diseases. One patient was
overweight (BMI = 26). Both surgically
resected vulvar specimens were
represented by a polypoid mass with a soft and a gelatinous cut surface.
Results: Histologically, the presence of an abundant oedematous stroma with
spindle-shaped cells and
numerous thin-walled small-to-medium vessels may be
confused with an aggressive angiomyxoma. The
diagnostic key was represented
by the massive oedema, rather than myxoid stroma, with the presence of
dilated, tortuous lymphatic channels (some surrounded by clusters of
lymphocytes) in the dermis.
Conclusion: The recognition of these lesions is
important because they may be the cause of problems in
differential
diagnosis and therapeutic management. In fact, such lesions can be mistaken from
both the
clinical and histological perspective as a primitive tumour of the
vulva-like aggressive angiomyxoma.
However, these lesions are not true
neoplasms and are likely due to lymphatic obstruction with
lymphoedema. A
simple surgical excision with vulvoplasty is curative. Copyright © 2010 S.
Karger AG,
Basel.
PMID: 20068325 [PubMed - as supplied by publisher
-----------------
2. BMJ. 2010 Jan 12;340:b5396. doi: 10.1136/bmj.b5396.
Effectiveness of early physiotherapy to prevent lymphoedema after surgery for
breast cancer: randomised,
single blinded, clinical trial.
Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, Prieto Merino D, Mayoral
del Moral O, Cerezo
Téllez E, Minayo Mogollón E.
Physiotherapy Department, School of Physiotherapy, Alcalá de Henares
University, E-28871 Alcalá de
Henares, Madrid, Spain. [email protected]
OBJECTIVE: To determine the effectiveness of early physiotherapy in reducing
the risk of secondary
lymphoedema after surgery for breast cancer.
DESIGN: Randomised, single blinded, clinical trial.
SETTING: University hospital in Alcalá de Henares, Madrid, Spain.
PARTICIPANTS: 120 women who had breast surgery involving dissection of
axillary lymph nodes
between May 2005 and June 2007.
INTERVENTION: The early physiotherapy group was treated by a physiotherapist
with a physiotherapy
programme including manual lymph drainage, massage of
scar tissue, and progressive active and action
assisted shoulder exercises.
This group also received an educational strategy. The control group received
the educational strategy only.
MAIN OUTCOME MEASURE: Incidence of clinically significant secondary
lymphoedema (>2 cm
increase in arm circumference measured at two adjacent
points compared with the non-affected arm).
RESULTS: 116 women completed the
one year follow-up. Of these, 18 developed secondary
lymphoedema (16%): 14
in the control group (25%) and four in the intervention group (7%). The
difference was significant (P=0.01); risk ratio 0.28 (95% confidence
interval 0.10 to 0.79). A survival
analysis showed a significant difference,
with secondary lymphoedema being diagnosed four times earlier in
the control
group than in the intervention group (intervention/control, hazard ratio 0.26,
95% confidence
interval 0.09 to 0.79).
CONCLUSION: Early physiotherapy could be an effective intervention in the
prevention of secondary
lymphoedema in women for at least one year after
surgery for breast cancer involving dissection of axillary
lymph nodes.
TRIAL REGISTRATION: Current controlled trials ISRCTN95870846.
PMID: 20068255 [PubMed - in process
----------------------
3. BMJ. 2010 Jan 12;340:b5235. doi: 10.1136/bmj.b5235.
Prevention of lymphoedema after axillary surgery for breast cancer.
Cheville A.
PMID: 20068254 [PubMed - in process]
-------------------------
4. Physiother Theory Pract. 2010 Jan;26(1):62-8.
Physical therapy management of primary lymphedema in the lower extremities: A
case report.
Greene R, Fowler R.
Howard University, Washington, DC, USA. [email protected]
Lymphedema is the tissue fluid accumulation that arises as a consequence of
impaired lymphatic drainage.
Lymphedema can result from either congenital
(primary) or acquired (secondary) anomalies. Primary
lymphedema affects 1-2
million people in the United States. Women are more affected by this disorder
than men. The management of lymphedema by physical therapists usually
includes a combination of skin
care, external pressure, isotonic exercise,
and massage. This case report describes the course of treatment
for a
24-year-old female with stages 2 and 3 primary lymphedema. The goals of physical
therapy
intervention were as follows: 1) to reduce total limb girth
circumference for both lower extremities; 2) to
improve skin texture; 3) to
promote independence with skin care to reduce the risk of infection; and 4) to
facilitate independence with self-management. Following intervention, the
patient met and exceeded all
goals to decrease limb circumference. She had
minimal fibrosis in the lower extremities, and she exhibited
no signs and/or
symptoms of infection. Decongestive lymphedema therapy was effective in treating
this
patient with primary lymphedema of the lower extremities. Continuous
maintenance is required to ensure
that the patient's limb size continues to
reduce.
PMID: 20067355 [PubMed - in process]
-------------------------
5. Support Care Cancer. 2010 Jan 12. [Epub ahead of print]
Retrospective trial of complete decongestive physical therapy for lower
extremity secondary lymphedema
in melanoma patients.
Carmeli E, Bartoletti R.
Tel Aviv University, Tel Aviv, Israel, [email protected].
BACKGROUND: Melanoma is a malignant tumour of melanocytes, which are found
predominantly in
skin, and at least 10-45% of patients develop secondary
lymphedema (SL).
PURPOSE: This study seeks to investigate if individual's lymphatic system can
benefit from complete
decongestive physical therapy (CDPT) 1 year after
discharge from CDPT and consequently endorsing a
better quality of life.
METHODS: Male and female(n = 12) melanoma survivors 1-4 years post diagnosis
with unilateral SL.
Questionnaire and limb measurements were used to asses
retrospective outcomes. RESULTS: A significant
improvements (p < 0.05)
has been in the categories of localisation, staging, disability and symptoms of
SL.
CONCLUSIONS: CDPT provides relief in signs and symptoms for patients with SL
following groyne
dissection.
PMID: 20066550 [PubMed - as supplied by publisher]
----------------------
6. J Surg Oncol. 2010 Jan 8. [Epub ahead of print]
Axillary reverse mapping with indocyanine fluorescence imaging in patients
with breast cancer.
Noguchi M, Yokoi M, Nakano Y.
Department of Breast and Endocrine Surgery, Kanazawa Medical University
Hospital, Uchinada-daigaku,
Japan.
BACKGROUND: The ARM technique was proposed to prevent arm lymphedema after
ALND and/or
SLN biopsy. However, several problems remain to be resolved in
the practical application of this technique.
METHODS: The fluorescent ARM nodes and/or lymphatics were identified using a
fluorescence imaging
system with subdermal injection of indocyanine green
into the upper limb. ALND was performed in patients
with clinically involved
nodes, and the ARM nodes were separately removed during ALND. SLN biopsy
was
performed in patients with clinically uninvolved nodes. If SLN was positive,
ALND was performed
with removal of ARM nodes. Otherwise, identified ARM
nodes were preserved unless they were the same
as SLN.
RESULTS: ARM nodes and/or lymphatics were identified in 7 (88%) of 8 patients
who underwent
ALND, whereas they were identified in 9 (75%) of 12 patients
who underwent SLN biopsy alone. ARM
nodes were involved with tumors in 3
(43%) of the former patients, and SLN was the same as the ARM
node in 2
(14%) of 14 patients who underwent SLN biopsy.
CONCLUSIONS: Fluorescence imaging was sensitive for identification of ARM
nodes and/or lymphatics.
However, further studies are needed before efforts
to preserve these nodes can be safely implemented.
PMID: 20063370 [PubMed - as supplied by publisher]
-------------------
7. Cases J. 2009 Dec 22;2:9377.
Challenges of cellulitis in a lymphedematous extremity: a case report.
Connor MP, Gamelli R.
Loyola University of Chicago, Stritch School of Medicine, 2160 South First
Ave, Maywood IL, 60153,
USA.
INTRODUCTION: Lymphedema is a relatively common phenomenon. It is important
that clinicians
appreciate the relative risks imposed by this condition.
While for some it may only represent a flaw in
appearance, this condition
can potentially have fatal consequences. Our case reports on the challenges of
cellulitis in a lymphedematous extremity that progressed to septic
shock.
CASE PRESENTATION: A 37-year-old Hispanic male was transferred to the Burn
Unit from an outside
hospital for wound care of an extremely severe case of
cellulitis. He suffered massive lymphedema of his
lower extremity, with
innumerable nodules and chronic skin changes. After 3 days of cellulitis, he was
in
critical condition and required intubation and vasopressors. With intense
wound care and systemic
antibiotics, he gradually recovered and was
discharged in 16 days with his cellulitis resolved and ambulating
independently.
CONCLUSION: Our case highlights the special care and attention that chronic
lymphedema deserves.
These patients can exhibit marked disfigurement and
physical disability affecting them on both social and
physical levels. They
also are at great medical risk, as cellulitis almost cost our patient his life.
Evidence
indicates that lymphedema, no matter the etiology, is susceptible
to cellulitis with both great propensity and
virulence. Physicians should be
aware of the great risk of lymphedema, strive to prevent deterioration and
complications, and be prepared to educate and closely monitor these
patients.
PMID: 20062550 [PubMed - in process]
-----------------
1. BMJ. 2010 Jan 12;340:b5396. doi: 10.1136/bmj.b5396.
Effectiveness of early physiotherapy to prevent lymphoedema after surgery for
breast cancer: randomised,
single blinded, clinical trial.
Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, Prieto Merino D, Mayoral
del Moral O, Cerezo
Téllez E, Minayo Mogollón E.
Physiotherapy Department, School of Physiotherapy, Alcalá de Henares
University, E-28871 Alcalá de
Henares, Madrid, Spain. [email protected]
OBJECTIVE: To determine the effectiveness of early physiotherapy in reducing
the risk of secondary
lymphoedema after surgery for breast cancer. DESIGN:
Randomised, single blinded, clinical trial.
SETTING: University hospital in Alcalá de Henares, Madrid, Spain.
PARTICIPANTS: 120 women who had breast surgery involving dissection of
axillary lymph nodes
between May 2005 and June 2007.
INTERVENTION: The early physiotherapy group was treated by a physiotherapist
with a physiotherapy
programme including manual lymph drainage, massage of
scar tissue, and progressive active and action
assisted shoulder exercises.
This group also received an educational strategy. The control group received
the educational strategy only.
MAIN OUTCOME MEASURE: Incidence of clinically significant secondary
lymphoedema (>2 cm
increase in arm circumference measured at two adjacent
points compared with the non-affected arm).
RESULTS: 116 women completed the one year follow-up. Of these, 18 developed
secondary
lymphoedema (16%): 14 in the control group (25%) and four in the
intervention group (7%). The
difference was significant (P=0.01); risk ratio
0.28 (95% confidence interval 0.10 to 0.79). A survival
analysis showed a
significant difference, with secondary lymphoedema being diagnosed four times
earlier in
the control group than in the intervention group
(intervention/control, hazard ratio 0.26, 95% confidence
interval 0.09 to
0.79).
CONCLUSION: Early physiotherapy could be an effective intervention in the
prevention of secondary
lymphoedema in women for at least one year after
surgery for breast cancer involving dissection of axillary
lymph nodes.
TRIAL REGISTRATION: Current controlled trials ISRCTN95870846.
PMID: 20068255 [PubMed - in process]
-----
1. Br J Surg. 2010 Jan 25. [Epub ahead of print]
Comparison of radionuclide lymphoscintigraphy and dynamic magnetic resonance
lymphangiography for
investigating extremity lymphoedema.
Liu NF, Lu Q, Liu PA, Wu XF, Wang BS.
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's
Hospital, China.
BACKGROUND:: Lymphoscintigraphy is widely used to image the lymphatic system.
The aim of this
study was to compare lymphoscintigraphy and dynamic magnetic
resonance lymphangiography (MRL) in
the investigation of extremity
lymphoedema.
METHODS:: Sixteen patients with primary extremity lymphoedema and two with
Klippel-Trenaunay
syndrome with lymphoedema were examined by
lymphoscintigraphy using the tracer (99)Tc-labelled
dextran, and by MRL
using gadobenate dimeglumine as contrast agent. Morphological abnormalities and
functional state of the lymphatic systems of affected limbs were compared
between the two imaging
methods.
RESULTS:: Lymphatic vessels were imaged in 14 of 18 limbs with lymphoedema
using MRL, compared
with one of 18 using lymphoscintigraphy. MRL detected
the inguinal nodes in 16 of 17 patients, whereas
lymphoscintigraphy revealed
inguinal nodes in only nine. MRL revealed more precise information about
structural and functional abnormalities of lymph vessels and nodes than
lymphoscintigraphy by real-time
measurement of lymph flow in vessels and
nodes.
CONCLUSION:: Dynamic MRL was more sensitive and accurate than
lymphoscintigraphy in the
detection of anatomical and functional
abnormalities in the lymphatic system in patients with extremity
lymphoedema. Copyright (c) 2010 British Journal of Surgery Society Ltd.
Published by John Wiley &
Sons, Ltd.
PMID: 20101589 [PubMed - as supplied by publisher]
2. Acta Oncol. 2010;49(2):166-73.
Arm lymphoedema in a cohort of breast cancer survivors 10 years after
diagnosis.
Johansson K, Branje E.
Department of Health Science, Lund University, S-221 00 Lund, Sweden.
INTRODUCTION: Arm lymphoedema is a frequent complication after breast cancer
treatment. Early
diagnosis and treatment is considered important for
successful management of breast cancer related arm
lymphoedema (BCRL). The
purpose was to identify BCRL incidence, time of onset,
progression/regression and associated factors 10 years after breast cancer
diagnosis.
MATERIAL AND METHODS: Two hundred and ninety two patients treated with
axillary node dissection
and radiotherapy were included in this
retrospective study. A total of 111 diagnosed with BCRL (incidence
38.7%).
Of these women 98 were followed for up to 10 years after BCRL diagnosis. Forty
consecutive
patients registered with no BCRL were included in the control
group. BCRL was defined as an increase in
arm volume difference >or=5%
and an increased thickness of subcutis. Follow-up was performed twice a
year, including assessment of lymphoedema relative volume (LRV) by water
displacement method and
compression treatment. Additional intensive
treatment was given if LRV increased by more than 5% since
the previous
visit or exceeded 20% in total.
RESULTS: Mean LRV was 8.1 +/-3.6% at diagnosis and 9.0+/-6.7% at last
follow-up measurement
(mean 48.9+/-39.2 months) with no significant
difference. There was no difference in progression of LRV
between groups
with early versus late diagnosis (within or after 12 months postoperatively),
small
(5-<10%) versus large (>or=10%) LRV at time of diagnosis, or
regular (at least twice a year) versus
non-regular treatment. More BCRL
patients with large LRV at diagnosis (15.8%), exceeded LRV
>or=20% during
follow-up time, than patients with small LRV at diagnosis (10.1%).
CONCLUSION: BCRL can be identified at an early stage both in regard to time
of diagnosis after
operation and to edema volume, and that edema volume can
be kept at a low level for at least 10 years.
Small LRV at time of diagnosis
appears to be more important for minimizing the progression of LRV than
time
of diagnosis after operation.
PMID: 20100154 [PubMed - in process]
3. Psychooncology. 2010 Jan 22. [Epub ahead of print]
Predictors of arm morbidity following breast cancer surgery.
Hack TF, Kwan WB, Thomas-Maclean RL, Towers A, Miedema B, Tilley A, Chateau
D.
Faculty of Nursing, University of Manitoba, Winnipeg, MB, Canada.
Objective: Arm morbidity post-breast cancer surgery is increasingly being
recognized as a chronic problem
for some women following breast cancer
surgery. The purpose of this study was to examine demographic,
disease, and
treatment-related predictors of a comprehensive array of chronic arm morbidity
(pain,
lymphedema, functional disability, and range of motion) post-breast
cancer surgery.
Methods: Women (n=316) with a non-metastatic primary diagnosis of breast
cancer were accrued from
cancer centers in four Canadian cities. Patients
completed a clinical assessment and measures of arm
morbidity at 6-12 months
post-breast cancer surgery. The independent variables in the MANOVA to
predict arm morbidity included: Lymph node management type, number of
axillary nodes dissected, type of
surgery, disease stage, presence of
post-operative infection, radiation to the axilla, body mass index (BMI),
assessment time post-surgery, education, and partner status.
Results: Pain was significantly predicted by axillary lymph node management,
lack of a partner, and
post-operative infection; lymphedema by axillary
lymph node management, number of axillary nodes
dissected, radiation to the
axilla, and having a modified radical mastectomy; functional disability by
post-operative infection and high BMI; and restricted external rotation by
axillary lymph node management,
low educational attainment, and advanced
disease.
Conclusion: Comprehensive behavioral management and rehabilitation programs
are needed to treat arm
morbidity following breast cancer surgery. These
programs should address the full scope of symptoms and
associated
psychosocial and functional sequelae. Copyright (c) 2010 John Wiley & Sons,
Ltd.
PMID: 20099254 [PubMed - as supplied by publisher]
4. J Dtsch Dermatol Ges. 2010 Jan;8(1):7-14
Podoconiosis - non-filarial geochemical elephantiasis - a neglected tropical
disease?
[Article in English, German]
Nenoff P, Simon JC, Muylowa GK, Davey G.
Laboratorium für medizinische Mikrobiologie, Mölbis, Germany. [email protected]
Podoconiosis or mossy foot is a form of non-filarial lymphedema. This
geochemical elephantiasis is a
disabling condition caused by the passage of
microparticles of silica and aluminum silicates through the skin
of people
walking barefoot in areas with a high content of soil of volcanic origin.
Podoconiosis is
widespread in tropical Africa, Central America and North
India, yet it remains a neglected and
under-researched condition. The
disabling effects of podoconiosis cause great hardship to patients. It
adversely affects the economic (reduced productivity and absenteeism),
social (marriage, education, etc.)
and psychological (social stigma)
well-being of those affected. Podoconiosis can be prevented; the main
primary preventive measure is protective footwear. Secondary measures
include a strict hygiene regimen
and compression therapy, which can reverse
initial lesions. Tertiary approaches include surgical
management, such as
shaving operations to reduce hyperplastic and verrucous elephantiasis.
PMID: 20096054 [PubMed - in process]
----
07 January 2010 - Leukemia Vaccine Appears To Mop Up Cancer Cells Gleevec
Leaves Behind
Preliminary investigations by US researchers suggest that a vaccine made with
leukemia cells appears able
to reduce or wipe out the last few cancer cells
that are left behind in some patients with chronic myeloid
leukemia (CML)
who are taking the drug Gleevec (Imatinib mesylate). However, the researchers
said the
results are tentative and there could be other reasons for this
apparent success.
The pilot study, which was funded by the National Institutes of Health, is
the work of a team led by Dr
Hyam Levitsky, professor of oncology, medicine
and urology at the Johns Hopkins Kimmel Cancer Center
in Baltimore,
Maryland, and appears in the 1 January issue of the journal Clinical Cancer
Research.
Gleevec, marketed by Novartis as Gleevec in the US and Glivec in Europe and
Australia, is one of the first
targeted cancer drugs to succeed in patients
with CML. It destroys most of the cancer cells, but for many
patients a few
cells remain that can be detected with sensitive molecular tests.
These remaining cells can cause the cancer to return, said the researchers,
and especially when they come
off the Gleevec.
The researchers explained that most patients with CML have to stay on Gleevec
for most of their lives and
90 per cent of them achieve remisson, but about
10 to 15 per cent can't tolerate it in the long term.
Lead author Dr B Douglas Smith, associate professor of oncology at the Johns
Hopkins Kimmel Cancer
Center, told the press that:
"Often patients have low blood cell counts, fluid retention, significant
nausea and other gastrointestinal
problems."
Secondary therapies, including the drugs dasatinib and nilotinib, also have
many side effects, he said, adding
that another common side effect with
Gleevec is fatigue:
"Patients often tell me that they feel about 80 to 90 percent of what they
should, and over time, this may
have a big impact on their quality of life,"
he added.
Gleevec also can't be taken by pregnant women, and since one third of CML
patients tend to be in their
20s and 30s, many patients on the drug would
like to come off it because they want to have children.
Levitsky said that the ability to get patients off Gleevec would be a great
advance, and if this vaccine is
successful, that goal would be reached.
For the study, Levitsky and colleagues used a vaccine made from CML
cells.
The vaccine is made by first irradiating the CML cells to stop them being
cancerous, then altering their
genetic make up so they produce an immune
system stimulator known as GM-CSF
(granulocyte-macrophage colony-stimulating
factor, a substance that helps make more white blood cells of
particular
types).
The treated CML cells also carry antigens that are specific to CML and prime
the immune system to target
and destroy any circulating CML cells.
The researchers treated 19 CML patients with the vaccine: all the patients
had measurable levels of CML
cells, even though they had taken Gleevec for
more than 12 months. They administered the vaccine on four
occasions, three
weeks apart, with 10 skin injections each time.
They then followed up the patients after a median (mid-range) period of 6
years, at which point they found
that the remaining cancer cells had gone
down in 13 patients, of whom 12 also reached their lowest
measured level of
residual cancer cells at this point and of these seven had CML levels that were
completely undetectable.
However, the researchers were cautious to point out the limitations of the
study: there was a limited number
of patients, and there were no comparisons
with other therapies. They said they could not be sure that it
was the
vaccine that caused the CML levels to drop.
Levitsky told the media that more research was needed to confirm these
findings, and that:
"We want to get rid of every last cancer cell in the body, and using cancer
vaccines may be a good way to
mop up residual disease."
Levitsky and colleagues are now testing the patients' blood to identify
exactly which antigens are stimulating
the immune system so they can tailor
the vaccine for further investigations that examine the immune
response in
more detail.
They said during this pilot study the patients showed few side effects from
the trial vaccine, these included
pain at the injection site, swelling,
occasional muscle ache and mild fever.
"K562/GM-CSF Immunotherapy Reduces Tumor Burden in Chronic Myeloid Leukemia
Patients with
Residual Disease on Imatinib Mesylate."
B. Douglas Smith,
Yvette L. Kasamon, Jeanne Kowalski, Christopher Gocke, Kathleen Murphy, Carole
B. Miller, Elizabeth Garrett-Mayer, Hua-Ling Tsai, Lu Qin, Christina Chia,
Barbara Biedrzycki, Thomas
C. Harding, Guang Haun Tu, Richard Jones, Kristen
Hege, and Hyam I. Levitsky.
Clin Cancer Res January 1, 2010
16:338-347.
DOI:10.1158/1078-0432.CCR-09-2046
Source: Johns Hopkins Medical Institutions, NCI Dictionary of cancer
terms.
Written by: Catharine Paddock, PhD
2.
31 December 2009 - Morbidity Of Open Retroperitoneal Lymph Node Dissection
For Testicular Cancer:
Contemporary Perioperative Data
UroToday.com - Ours is a retrospective review of patients who underwent open
retroperitoneal lymph
node dissection between 2001-2008.
We identified perioperative data for patients who underwent primary (P-RPLND)
versus
post-chemotherapy RPLND (PC-RPLND) and found mean blood loss,
operative duration and hospital
stay to be significantly less for the former
group (P<0.05). A majority of the patients had high risk features
at
orchiectomy consisting of 146 (76%) embryonal carcinoma and 83 (44%) having
lymphovascular
invasion. Not surprisingly, more clinical stage I (CS I)
patients underwent primary versus PC-RPLND
(55% vs. 38%) and the converse
for clinical stage II (CSII) disease (45% vs. 62%). Overall, there were
18
(9%) complications with 7 (7%) and 11 (12%) in the primary and PC-RPLND groups,
respectively. All
of these complications consisted pain, ileus, and chylous
ascites except one patient who had an
intraoperative aortic injury. There
were no peri-operative deaths.
This contemporary data should be considered when comparing open versus
laparoscopic RPLND
(L-RPLND). Although L-RPLND has become an established
alternative for management of CS I patients,
more research is needed in
patients with high-risk features and/or post-chemotherapy treated patients. The
minimal morbidity of patients undergoing open RPLND by a dedicated tertiary
center has been described
in this contemporary group of patients and should
be considered when comparing open to L-RPLND.
Written by Stephen B. Williams, MD, et al. as part of Beyond the Abstract on
UroToday.com. This
initiative offers a method of publishing for the
professional urology community. Authors are given an
opportunity to expand
on the circumstances, limitations, etc., of their research by referencing the
published
abstract.
UroToday - the only urology website with original content written by global
urology key opinion leaders
actively engaged in clinical practice. To access
the latest urology news releases from UroToday, go to:
www.urotoday.com
------------------
1. Oper Orthop Traumatol. 2009 Dec;21(6):545-56.
The surgical treatment of chronic extension deficits of the knee] [Article in
German]
Freiling D, Lobenhoffer P.
Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus
Henriettenstiftung Hannover,
Hannover, Germany. [email protected]
OBJECTIVE : Restoration of full knee extension in patients with chronic
extension deficits, especially in
posttraumatic and postoperative cases.
INDICATIONS : Chronic knee extension deficits of more than 10 degrees .
CONTRAINDICATIONS : Local intraarticular problems caused by cyclops syndrome,
graft hypertrophy
or graft impingement after anterior cruciate ligament
reconstruction (notch impingement). These patients
should be treated with
arthroscopic procedures. Spastic flexion contracture. Noncompliant patients.
Acute
or chronic infections. Poor soft-tissue conditions on site of
surgery.
SURGICAL TECHNIQUE : If necessary, arthroscopy before arthrolysis to assure
that the extension
deficit is not caused by a local problem (cyclops,
osteophytes, graft hypertrophy or graft impingement after
anterior cruciate
ligament reconstruction). Anterior skin incision at the medial border of the
patellar
ligament. Resection of Hoffa's fat pad, which is extremely fibrotic
in almost all cases. Second skin incision
at the posteromedial side of the
knee joint. Incision of the medial retinaculum between the posterior border
of the medial collateral ligament and the posterior oblique ligament.
Posteromedial arthrotomy between the
distal part of the tendon of the
adductor magnus muscle and the posterior horn of the medial meniscus.
Release of all adhesions in the posterior recess of the knee joint. Complete
release of the posterior joint
capsule from the femoral shaft.
POSTOPERATIVE MANAGEMENT : Immobilization for 48 h after surgery in full
extension (no knee
motion allowed in the first 48 h). For 48 h after surgery
only short walks to the bathroom are allowed.
Special dynamic extension
brace (Dynasplint((R)), CDS((R)) Forte, Albrecht company, Stephanskirchen,
Germany) for 4-6 weeks after surgery 6-8 h per day. Painkillers following
WHO (World Health
Organization) protocol. Manual lymph drainage and electric
muscle stimulation help to decrease pain and
swelling. Physiotherapy twice
daily starting at the 2nd postoperative day. No flexion exercises for the first
7
days after surgery. 15 kg partial weight bearing for 4-6 weeks. Daily
physiotherapy is recommended after
discharge. RESULTS : 121 patients
underwent anterior and posterior arthrolysis between 1990 and 2000.
86 of
these patients could be included in this study. The average follow-up was 4.6
years (1-10 years). The
extension deficit before surgery averaged 20 degrees
compared with the opposite side. At follow-up, the
average extension had
increased by 17 degrees , no patient had more than 5 degrees of flexion
contracture.
The Lysholm Score was 84 postoperatively. The Tegner Activity
Scale increased from 1.9 to 4.0 after
arthrolysis. In the AOSSM Subjective
Outcome Score, 35 patients showed excellent and 60 good results.
14 patients
were satisfied after surgery and nine were not. Three patients required revision
surgery (two
synovial fistulas, one hematoma).
PMID: 20087716 [PubMed - in process]
. Breast Cancer Res
Treat. 2010 Feb 24. [Epub ahead of print]
Effect of air travel on lymphedema risk in women with history of breast
cancer.
Kilbreath SL, Ward LC, Lane K, McNeely M, Dylke ES, Refshauge KM, McKenzie D,
Lee MJ,
Peddle C, Battersby KJ.
Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW,
1825, Australia,
[email protected].
To assess the impact of air travel on swelling of the 'at risk' arm of women
treated for breast cancer.
Women treated for breast cancer from Canada (n =
60) and from within Australia (n = 12) attending a
dragon boat regatta in
Queensland, Australia participated. Women were measured within 2 weeks prior
to their flight, on arrival in Queensland and, for 40 women travelling from
Canada, measured again 6
weeks following return to Canada. Changes to
extracellular fluid were measured using a single-frequency
bioimpedance
device (BIA). Each arm was measured separately using a standardized protocol to
obtain
the inter-limb impedance ratio. An increase in the ratio indicates
accumulated fluid. Information regarding
medical management of participants'
breast cancer, use of compression garment and history of exercise
were also
obtained. For most women (95%), air travel did not adversely affect the
impedance ratio. The
BIA ratio of long-haul travellers was 1.007 +/- 0.065
prior to the flight and 1.006 +/- 0.087 following the
flight. The ratio of
short-haul travellers was 0.994 +/- 0.033 and following the flight was 1.001 +/-
0.038.
Air travel did not cause significant change in BIA ratio in the
'at-risk' arm for the majority of breast cancer
survivors who participated
in dragon boat racing. Further research is required to determine whether these
findings are generalizable to the population of women who have been treated
for breast cancer.
PMID: 20180016 [PubMed - as supplied by publisher]
2. Cell. 2010 Feb 19;140(4):460-76.
Lymphangiogenesis: Molecular mechanisms and future promise.
Tammela T, Alitalo K.
Molecular/Cancer Biology Laboratory and Haartman Institute, University of
Helsinki, Finland.
The growth of lymphatic vessels (lymphangiogenesis) is actively involved in a
number of pathological
processes including tissue inflammation and tumor
dissemination but is insufficient in patients suffering from
lymphedema, a
debilitating condition characterized by chronic tissue edema and impaired
immunity. The
recent explosion of knowledge on the molecular mechanisms
governing lymphangiogenesis provides new
possibilities to treat these
diseases. 2010 Elsevier Inc. All rights reserved.
PMID: 20178740 [PubMed - in process]
3. Eur J Vasc Endovasc Surg. 2010 Feb 20. [Epub ahead of print]
Primary Lymphoedema and Lymphatic Malformation: Are they the Two Sides of the
Same Coin?
Lee BB, Villavicencio JL.
Division of Vascular Surgery, Georgetown University School of Medicine,
Washington, DC 20007,
USA; Georgetown University Hospital, 4th floor PHC,
3800 Reservoir Road NW, Washington, DC
20007, USA.
OBJECTIVES: To clear the confusion regarding the relationship between the
'primary lymphoedema' and
(truncular) lymphatic malformation (LM); the
latter is one of congenital vascular malformations.
MATERIALS & METHODS: A literature review was carried out on the primary
lymphoedema either
existing as an independent LM lesion or as a component of
the Klippel-Trenaunay syndrome.
RESULTS: The review was able to provide a contemporary guide/conclusion on
the definition and
classification, clinical evaluation and clinical
management regarding conservative (physical) therapy,
reconstructive
surgical therapy and ablative/excisional surgical therapy, for the primary
lymphoedema as
an LM.
CONCLUSIONS: Primary lymphoedema can be considered as 'congenital' since its
majority represents
a clinical manifestation of the truncular type of LM
arising during the later stages of lymphangiogenesis.
Such embryological
staging information of the LM is critical for proper management of the primary
lymphoedema when it exists with other congenital vascular malformations
(Klippel-Trenaunay syndrome).
2. Basic non-invasive to minimally invasive
tests will provide an adequate diagnosis and lead to the
correct
multidisciplinary, specifically targeted and sequenced treatment strategy. 3.
The mainstay of
current management of the primary lymphoedema/truncular LM
is complex decongestive therapy; and the
reconstructive as well as ablative
surgical therapy remain adjunctive therapies at best. Copyright © 2010
European Society for Vascular Surgery. Published by Elsevier Ltd. All rights
reserved.
PMID: 20176496 [PubMed - as supplied by publisher]
4. Clin Nutr. 2010 Feb 17. [Epub ahead of print]
Do patients with lymphoedema cholestasis syndrome 1/Aagenaes syndrome need
dietary counselling
outside cholestatic episodes?
Drivdal M, Løken EB, Hagve TA, Bergstad I, Aagenæs O.
Regional Department of Eating Disorders, Division of Psychiatry, Building
37A, Oslo University Hospital,
Ullevaal, N-0407 Oslo, Norway.
BACKGROUND&AIMS: Patients with lymphoedema cholestasis syndrome
1/Aagenaes Syndrome
need a fat reduced diet when cholestatic. We wanted to
assess the need for dietary counselling outside
cholestatic episodes, and
hypothetized that no counselling was needed.
METHODS: Fifteen patients above 10 years of age without symptoms of
cholestasis were compared
with a sex and age matched control group. Diet
from a four-day weighed record and blood samples were
compared between the
two groups and with general Norwegian recommendations.
RESULTS: The patients had a similar diet to the healthy controls, except for
statistically significant lower
intake of energy from total fat (p=0.04) and
saturated fat (0.02), and fish (0.05). The patients met the
dietary
recommendations for macronutrients, except for saturated fat, monounsaturated
fat, refined sugar
and fibre. Supplements were needed to meet the
micronutrient recommendations. Patients had a
significantly lower serum
level of alpha-tocopherol (0.01) compared with the control group, and the
serum 25-OH D level was below reference ranges.
CONCLUSIONS: The patients would benefit from counselling on fat quality,
carbohydrates including
fibre intake, and individual needs for vitamins D
and E. To secure serum 25-OH D and alpha-tocopherol
levels within reference
ranges, regular examinations to determine the need for supplementary vitamins D
and E are recommended.
Copyright © 2009 Elsevier Ltd and European Society for Clinical Nutrition and
Metabolism. All rights
reserved.
PMID: 20170991 [PubMed - as supplied by publisher]
----------------------
1. Microsurgery. 2010 Mar 2. [Epub ahead of print]
Prevention of lymphatic injuries in surgery.
Francesco B, Corrado C, Giuseppe M, Emanuela B, Chiara B, Francesco P,
Corradino C.
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San
Martino Hospital, University
of Genoa, Italy.
BACKGROUND:: The problem of prevention of lymphatic injuries in surgery is
extremely important if
we think about the frequency of both early
complications such as lymphorrhea, lymphocele, wound
dehiscence, and
infections and late complications such as lymphangites and lymphedema. Nowadays,
it is
possible to identify risk patients and prevent these lesions or treat
them at an early stage. This article helps
to demonstrate how it is
important to integrate diagnostic and clinical findings to better understand how
to
properly identify risk patients for lymphatic injuries and, therefore,
when it is useful and proper to do
prevention.
METHODS:: Authors report their experiences in the prevention and treatment of
lymphatic injuries after
surgical operations and trauma. After an accurate
diagnostic approach, prevention is based on different
technical procedures
among which microsurgical procedures. It is very important to follow-up the
patient
not only clinically but also by lymphoscintigraphy.
RESULTS AND CONCLUSIONS:: It was identified a protocol of prevention of
secondary limb
lymphedema that included, from the diagnostic point of view,
lymphoscintigraphy and, as concerns
therapy, it also recognized a role to
early microsurgery. It is necessary to accurately follow-up the patient
who
has undergone an operation at risk for the appearance of lymphatic complications
and, even better,
to assess clinically and by lymphoscintigraphy the patient
before surgical operation. (c) 2010 Wiley-Liss,
Inc. Microsurgery, 2010.
PMID: 20198663 [PubMed - as supplied by publisher]
2. Horm Res Paediatr. 2010;73(3):210-214. Epub 2010 Mar 3.
Tall Stature and Gonadal Dysgenesis in a Non-Mosaic Girl 45,X.
Fernandez R, Pasaro E.
Department of Psychobiology, University of A Coruña, Campus Elviña, A Coruña,
Spain.
Turner's syndrome, also known as 'monosomy X', is a genetic disorder that
occurs in 1/2,500 female
births and is hypothesized to result from
haploinsufficiency of certain genes expressed from both sex
chromosomes that
escape X inactivation. While the classic karyotype related to Turner's syndrome
is 45,
X, the majority of those affected actually have a mosaic chromosomal
complement, most often with a
second normal cell line (46,XX). The resulting
phenotype is variable and related to the underlying
chromosomal pattern, but
it is characterized by three cardinal features: short stature (around 100%),
ovarian failure (>90%) and congenital lymphedema (>80%). In this paper
we report a molecular and
cytogenetic investigation of a 26-year-old female
with non-mosaic 45,X karyotype, who has a stature of
170 cm without GH
treatment, and whose only apparent Turner feature is gonadal dysgenesis. The
only
possible explanation for the absence of Turner phenotype is the hidden
mosaicism combined with an
untreated gonadal dysgenesis. Our results support
the theory that significant ascertainment bias exists in
our understanding
of Turner's syndrome. Copyright © 2010 S. Karger AG, Basel.
PMID: 20197675 [PubMed - as supplied by publisher]
3. Plast Reconstr Surg. 2010 Mar;125(3):935-43.
The intravascular stenting method for treatment of extremity lymphedema with
multiconfiguration
lymphaticovenous anastomoses.
Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS.
Tokyo, Japan; and Baltimore, Md. From the Department of Plastic and
Reconstructive Surgery, Tokyo
University School of Medicine, and the
Division of Plastic, Reconstructive, and Maxillofacial Surgery,
Johns
Hopkins Hospital.
BACKGROUND:: In secondary extremity lymphedema, normal antegrade lymphatic
flow is disrupted by
the disease state. Attempts to capture aberrant
retrograde lymphatic flow by means of microsurgical
lymphaticovenous
anastomoses have been hindered because of technical limitations. The authors
applied
the intravascular stenting method to the surgical correction of
extremity lymphedema to generate
multiconfiguration lymphaticovenous
anastomoses capable of decompressing both proximal and distal
lymphatic
flow.
METHODS:: Lymphatic channels were detected using indocyanine green injection
and infrared scope
imaging. Sites felt to be adequate for lymphaticovenous
anastomosis were accessed through 2-cm skin
incisions under local
anesthesia. Using the intravascular stenting method, the authors performed a
total of
39 lymphaticovenous anastomoses (15 flow-through, 11 end-to-end,
eight end-to-side, two double end-
to-end, two end-to-end/end-to-side, and
one pi-type) on both the proximal and distal ends of lymphatic
channels in
14 female patients with upper (n = 2) and lower (n = 12) extremity
lymphedema.
RESULTS:: At an average follow-up of 8.9 months, average limb girth decreased
3.6 cm (range, 1.5 to 7
cm) or 11.3 percent (range, 4 to 33 percent). There
was a greater reduction in cross-sectional area with
increasing number of
lymphaticovenous anastomoses per limb.
CONCLUSIONS:: The intravascular stenting method facilitated
multiconfiguration lymphaticovenous
anastomoses capable of decompressing
both antegrade and retrograde lymphatic flow. This approach
resulted in
durable reduction of both upper and lower extremity lymphedema. As
multiconfiguration
lymphaticovenous anastomoses are now technically
feasible, the influence of the number of
lymphaticovenous anastomoses and
the effectiveness of specific lymphaticovenous anastomosis
configurations
for the treatment of lymphedema deserves further study.
PMID: 20195120 [PubMed - in process]
4. Am J Med. 2010 Mar;123(3):e3-4.
Nocturia: an uncommon presentation of lower-limb lymphedema.
Cagnati P, Colombo BM, Gulli R, Russo R, Puppo F, Boccardo F,
Campisi C, Murdaca G.
PMID: 20193816 [PubMed - in process]
5. An Bras Dermatol. 2009 Dec;84(6):659-62. published Feb 2010.
[Yellow nail syndrome: case report]
[Article in Portuguese]
Machado RF, Rosa DJ, Leite CC, Martins Neto MP, Gamonai A.
Universidade Federal de Juiz de Fora, MG, Brasil. [email protected]
The yellow nail syndrome is a rare disease, in which there is a triad of
lymphedema, pleural effusion and
slow-growing dystrophic yellow nails. Many
associations have already been described; among them,
chronic respiratory
tract diseases, autoimmune disorders, malignancies and immunodeficiency
conditions.
Only one third of cases in the literature show all findings. The
case reported next is an example of the
classical triad.
PMID: 20191179 [PubMed - in process]
----------------------
1. Ann Plast Surg. 2010 Mar 11. [Epub ahead of print]
Preservation of Toes in Advanced Lymphedema: An Important Step in the Control
of Infection.
Karonidis A, Chen HC.
From the Department of Plastic Surgery, E-Da Hospital/I-Shou University,
Yan-Chau Shiang, Kaohsiung
County, Taiwan, Republic of China.
ABSTRACT:: In advanced lymphedema, the most important goal of treatment is
the control or
eradication of infection. Toes are the major cause of
infection mainly due to lack of space at the webs.
The fibrosis of the soft
tissue with impaired circulation of the toes certainly contribute to infection
of the
toes, foot, and even proximal to the leg.Between 2004 and 2008, 20
patients with severe lymphedema
and fibrosis of lower limbs were treated
with Charles' procedure and included in this study. The toes were
preserved.
Excisional therapy is the only choice to decrease the lymphatic load and control
the infection.
The toes can be preserved if there is only swelling without
previous cellulites or verrucous hyperkeratosis
and neither deformity nor
osteomyelitis of the toes. The surgical technique to treat the toes includes (1)
excision of the soft tissue at the dorsum of the toes with preservation of
the extensor tendon and its
paratenon, to facilitate the take of skin graft,
and (2) preservation of skin flaps at the web spaces. This
avoids
contracture at the web spaces and crowding of the toes, improves foot hygiene,
and hence
prevents infection.Proper aesthetic and functional results were
obtained in all patients and 18 of 20
patients have been free of recurrent
infection at 3-years follow-up.In the treatment of advanced
lymphedema of
the lower extremity, the toes are the major determinant of future infection
after surgery.
For preservation of toes, careful selection of patients and
correct surgical procedure are essential for
success.
PMID: 20224333 [PubMed - as supplied by publisher]
2. Lymphology. 2009 Dec;42(4):188-94.
Intermittent pneumatic compression acts synergistically with manual lymphatic
drainage in complex
decongestive physiotherapy for breast cancer
treatment-related lymphedema.
Szolnoky G, Lakatos B, Keskeny T, Varga E, Varga M, Dobozy A, Kemény L.
Department of Dermatology and Allergology, University of Szeged, Szeged,
Hungary. szolnoky@dermall.
hu
The application of intermittent pneumatic compression (IPC) as a part of
complex decongestive
physiotherapy (CDP) remains controversial. The aim of
this study was to investigate whether the
combination of IPC with manual
lymph drainage (MLD) could improve CDP treatment outcomes in
women with
secondary lymphedema after breast cancer treatment. A randomized study was
undertaken
with 13 subjects receiving MLD (60 min) and 14 receiving MLD (30
min) plus IPC (30 min) followed by
standardized components of CDP including
multilayered compression bandaging, physical exercise, and
skin care 10
times in a 2-week-period. Efficacy of treatment was evaluated by limb volume
reduction and
a subjective symptom questionnaire at end of the treatment,
and one and two months after beginning
treatment. The two groups had similar
demographic and clinical characteristics. Mean reductions in limb
volumes
for each group at the end of therapy, and at one and two months were 7.93% and
3.06%,
9.02% and 2.9%, and 9.62% and 3.6%, respectively (p < 0.05 from
baseline for each group and also
between groups at each measurement).
Although a significant decrease in the subjective symptom survey
was found
for both groups compared to baseline, no significant difference between the
groups was found
at any time point. The application of IPC with MLD provides
a synergistic enhancement of the effect of
CDP in arm volume reduction.
PMID: 20218087 [PubMed - in process]
3. Lymphology. 2009 Dec;42(4):176-81.
Axillary web syndrome: nature and localization.
Leduc O, Sichere M, Moreau A, Rigolet J, Tinlot A, Darc S, Wilputte F,
Strapart J, Parijs T, Clément
A, Snoeck T, Pastouret F, Leduc A.
Haute Ecole P.H. Spaak, Département de Kinésithérapie, Unité de
Lympho-Phlébologie, Bruxelles,
Belgique. [email protected]
Axillary Web Syndrome (AWS) is a complication that can arise in patients
following treatment for breast
cancer. It is also known variously as
syndrome of the axillary cords, syndrome of the axillary adhesion,
and
cording lymphedema. The exact origin, presentation, course, and treatment of AWS
is still largely
undefined. Because so little is known about AWS, we
undertook a case series study consisting of 15
women who had undergone
breast cancer surgery and presented with AWS. All subjects received a
clinical examination which included body size determination and detailed
measurements of the size and
location of the cords. The cords were found to
originate from the axilla, continue on the medial aspect of
the arm up to
the epitrochlea region, then to the anteromedian aspect of the forearm, and
finally reaching
the base of the thumb. The cords averaged approximately 44%
of the limb length. Correlation of the cord
location with anatomical studies
shows that in fact this path follows the specific course taken by the
antero-radial pedicle which arises at the anterior aspect of the elbow from
the brachial medial pedicule to
anastomose in the axilla at the level of the
lateral thoracic chain nodes. Although our series is small, the
correspondence between the physical findings and the anatomical studies
strongly supports the notion that
the cords are lymphatic in origin.
PMID: 20218085 [PubMed - in process]
4. Lymphology. 2009 Dec;42(4):152-60.
Lymphedema-distichiasis syndrome without FOXC2 mutation: evidence for
chromosome 16 duplication
upstream of FOXC2.
Witte MH, Erickson RP, Khalil M, Dellinger M, Bernas M, Grogan T, Nitta H,
Feng J, Duggan D, Witte
CL.
Department of Surgery, University of Arizona College of Medicine, Tucson, AZ
85724-5200, USA.
[email protected]
A patient with the classical phenotype of Lymphedema-Distichiasis syndrome
(OMIM 153400) is
described who showed no mutations in the sequence of FOXC2.
Accordingly, a Gene Chip 250k array
analysis was undertaken with dense SNP
genotyping of the genomic region surrounding the FOXC2
locus on Chromosome
16 followed by copy number evaluation by real time PCR. The latter assay
showed evidence of a duplicated region 5' of FOXC2 that could be causative
for the patient's striking
phenotype, which included both distichiasis and a
hyperplastic refluxing lymphatic vascular and lymph
node phenotype
associated with pubertal onset lymphedema, scoliosis and strabismus.
PMID: 20218083 [PubMed - in process]
1. Dermatology. 2010 Mar 20. [Epub ahead of print]
Leg Ulceration in Rheumatoid Arthritis - An Underreported Multicausal
Complication with Considerable
Morbidity: Analysis of Thirty-Six Patients
and Review of the Literature.
Seitz CS, Berens N, Bröcker EB, Trautmann A.
Departments of Dermatology, Venereology and Allergology, University of
Würzburg, Würzburg,
Germany.
Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease
which may present with extra-
articular symptoms, including cutaneous
manifestations. Ulcerated rheumatoid nodules, necrotic vasculitic
lesions
and pyoderma gangrenosum are fairly characteristic and well-recognized causes of
skin ulcers in
RA. However, most RA patients develop leg ulcers due to other
pathophysiological factors posing a
diagnostic and therapeutic challenge and
leading to considerable morbidity.
Methods: A retrospective chart analysis of all patients with RA and leg
ulcers hospitalized at our
Dermatology Department between January 1998 and
March 2008 was performed to evaluate risk
factors and identify underlying
conditions that predispose RA patients to the development of leg ulcers.
Results: A total of 36 patients with RA and leg ulcers were identified. Three
patients presented with
necrotizing vasculitis and 2 with pyoderma
gangrenosum. Chronic venous insufficiency was diagnosed as
the underlying
cause of leg ulcers in 8 patients, peripheral arterial disease in 4 patients,
and combined
arterial and venous malfunction in 3 patients. Five patients
suffered from pressure ulcers. Interestingly, in
11 patients (31%) other
underlying causes besides constricted mobility followed by secondary
lymphedema could not be identified, and these ulcers were classified as
'inactivity leg ulcers'.
Conclusions: The majority of leg ulcers in patients with RA are due to
underlying venous/arterial
malfunction while vasculitic or traumatic ulcers
are less common. Additionally, we identified a relevant
subgroup of patients
with 'inactivity ulcers' due to impaired mobility and consecutive lymphedema.
Morphology and localization of ulcerations as well as duplex sonography
provide the most important
clues for accurate diagnosis, ensuring adequate
treatment. Copyright © 2010 S. Karger AG, Basel.
PMID: 20332595 [PubMed - as supplied by publisher]
1. Microsurgery. 2010 Mar 16. [Epub ahead of print]
Microsurgery for lymphedema: Clinical research and long-term results.
Campisi C, Bellini C, Campisi C, Accogli S, Bonioli E, Boccardo F.
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San
Martino Hospital, University
of Genoa, Italy.
Objectives: To report the wide clinical experience and the research studies
in the microsurgical treatment
of peripheral lymphedema.
Methods: More than 1800 patients with peripheral lymphedema have been treated
with microsurgical
techniques. Derivative lymphatic microvascular procedures
recognize today its most exemplary
application in multiple lymphatic-venous
anastomoses (LVA). In case of associated venous disease
reconstructive
lymphatic microsurgery techniques have been developed. Objective assessment was
undertaken by water volumetry and lymphoscintigraphy.
Results: Subjective improvement was noted in 87% of patients. Objectively,
volume changes showed a
significant improvement in 83%, with an average
reduction of 67% of the excess volume. Of those
patients followed-up, 85%
have been able to discontinue the use of conservative measures, with an
average follow-up of more than 10 years and average reduction in excess
volume of 69%. There was a
87% reduction in the incidence of cellulitis
after microsurgery.
Conclusions: Microsurgical LVA have a place in the treatment of peripheral
lymphedema, and should be
the therapy of choice in patients who are not
sufficiently responsive to nonsurgical treatment. (c) 2010
Wiley-Liss, Inc.
Microsurgery, 2010.
PMID: 20235160 [PubMed - as supplied by publisher]
2. Cancer Res. 2010 Mar 16. [Epub ahead of print]
Imaging of Human Lymph Nodes Using Optical Coherence Tomography: Potential
for Staging Cancer.
McLaughlin RA, Scolaro L, Robbins P, Hamza S, Saunders C, Sampson DD.
Authors' Affiliations: Optical + Biomedical Engineering Laboratory, School of
Electrical, Electronic, and
Computer Engineering and School of Surgery,
University of Western Australia, Crawley, Western
Australia, Australia; and
PathWest, QEII Medical Centre and Sir Charles Gairdner Hospital, Nedlands,
Western Australia, Australia.
Histologic assessment is the gold standard technique for the identification
of metastatic involvement of
lymph nodes in malignant disease, but can only
be performed ex vivo and often results in the unnecessary
excision of
healthy lymph nodes, leading to complications such as lymphedema. Optical
coherence
tomography (OCT) is a high-resolution, near-IR imaging modality
capable of visualizing microscopic
features within tissue. OCT has the
potential to provide in vivo assessment of tissue involvement by
cancer. In
this morphologic study, we show the capability of OCT to image nodal
microarchitecture
through an assessment of fresh, unstained ex vivo lymph
node samples. Examples include both benign
human axillary lymph nodes and
nodes containing metastatic breast carcinoma. Through accurate
correlation
with the histologic gold standard, OCT is shown to enable differentiation of
lymph node tissue
from surrounding adipose tissue, reveal nodal structures
such as germinal centers and intranodal vessels,
and show both diffuse and
well circumscribed patterns of metastatic node involvement. Cancer Res;
70
(7); 2579-84.
PMID: 20233873 [PubMed - as supplied by publisher]
3. Arch Dermatol. 2010 Mar;146(3):337-42.
Large nodular plaque on leg in the setting of chronic lymphedema--quiz case.
Angiosarcoma in the setting
of familial lymphedema.
Cronin H, Mowad C, Ferringer T.
Geisinger Medical Center, Danville, Pennsylvania, USA.
PMID: 20231513 [PubMed - in process]
1. Lymphology. 2009 Dec;42(4):188-94.Published March 2010
Intermittent pneumatic compression acts synergistically with manual lymphatic
drainage in complex
decongestive physiotherapy for breast cancer
treatment-related lymphedema.
Szolnoky G, Lakatos B, Keskeny T, Varga E, Varga M, Dobozy A, Kemény L.
Department of Dermatology and Allergology, University of Szeged, Szeged,
Hungary. szolnoky@dermall.
hu
The application of intermittent pneumatic compression (IPC) as a part of
complex decongestive
physiotherapy (CDP) remains controversial. The aim of
this study was to investigate whether the
combination of IPC with manual
lymph drainage (MLD) could improve CDP treatment outcomes in
women with
secondary lymphedema after breast cancer treatment. A randomized study was
undertaken
with 13 subjects receiving MLD (60 min) and 14 receiving MLD (30
min) plus IPC (30 min) followed by
standardized components of CDP including
multilayered compression bandaging, physical exercise, and
skin care 10
times in a 2-week-period. Efficacy of treatment was evaluated by limb volume
reduction and
a subjective symptom questionnaire at end of the treatment,
and one and two months after beginning
treatment. The two groups had similar
demographic and clinical characteristics. Mean reductions in limb
volumes
for each group at the end of therapy, and at one and two months were 7.93% and
3.06%,
9.02% and 2.9%, and 9.62% and 3.6%, respectively (p < 0.05 from
baseline for each group and also
between groups at each measurement).
Although a significant decrease in the subjective symptom survey
was found
for both groups compared to baseline, no significant difference between the
groups was found
at any time point. The application of IPC with MLD provides
a synergistic enhancement of the effect of
CDP in arm volume reduction.
PMID: 20218087 [PubMed - in process]
1. Nucl Med Commun. 2010 Mar 2. [Epub ahead of print]
Intradermal lymphoscintigraphy at rest and after exercise: a new technique
for the functional assessment of
the lymphatic system in patients with
lymphoedema.
Tartaglione G, Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C,
Paone G, Bernabucci V,
Bartoletti R, Marchetti P, Marzola MC, Naji M,
Rubello D.
aUnit of Nuclear Medicine, Cristo Re Hospital bUnit of Medical and
Dermatologic Oncology cUnit of
Oncological Rehabilitation, Istituto
Dermopatico dell'Immacolata, IDI-IRCCS dUnit of Medical
Oncology,
Sant'Andrea Hospital, Rome eDepartment of Nuclear Medicine, PET Centre,
Radiology,
Medical Physics, Santa Maria della Misericordia Hospital, Rovigo,
Italy fDepartment of Nuclear
Medicine, Hammersmith Hospital, London, UK.
AIM: The aim of this study was to evaluate the effect of implementing a new
technique, intradermal
injection lymphoscintigraphy, at rest and after
muscular exercise on the functional assessment of the
lymphatic system in a
group of patients with delayed or absent lymph drainage.
METHODS: We selected 44 patients (32 women and 12 men; 15 of 44 with upper
limb and 29 of 44
with lower limb lymphoedema). Thirty of 44 patients had
bilateral limb lymphoedema and 14 of 44 had
unilateral disease; 14
contralateral normal limbs were used as controls. Twenty-three patients had
secondary lymphoedema after lymphadenectomy and the remaining 21 had
idiopathic lymphoedema.
Each of the 44 patients was injected with 50 MBq
(0.3-0.4 ml) of Tc-albumin-nanocolloid, which was
administered intradermally
at the first interdigital space of the affected limb. Two planar static scans
were
performed using a low-energy general-purpose collimator (acquisition
matrix 128x128, anterior and
posterior views for 5 min), and in which
drainage was slow or absent, patients were asked to walk or
exercise for 2
min. A postexercise scan was then performed to monitor and record the tracer
pathway
and the tracer appearance time (TAT) in the inguinal or axillary
lymph nodes.
RESULTS: The postexercise scans showed that (i) 21 limbs (15 lower and six
upper limbs) had
accelerated tracer drainage and tracer uptake in the
inguinal and/or axillary lymph nodes. Two-thirds of
these showed lymph
stagnation points; (ii) 27 limbs had collateral lymph drainage pathways; (iii)
in 11
limbs, there was lymph drainage into the deeper lymphatic channels,
with unusual uptake in the popliteal
or antecubital lymph nodes; (iv) six
limbs had dermal backflow; (v) three limbs did not show lymph
drainage
(TAT=not applicable). TAT=15+/-3 min, ranging from 12 to 32 min in limbs with
lymphoedema
versus 5+/-2 min, ranging from 1 to 12 min in the contralateral
normal limbs (P<0.001).
CONCLUSION: Intradermal injection lymphoscintigraphy gives a better imaging
of the lymph drainage
pathways in a shorter time, including cases with
advanced lymphoedema. In some patients with
lymphoedema, a 2-min exercise
can accelerate tracer drainage, showing several compensatory
mechanisms of
lymph drainage. The effect of the exercise technique on TAT and
lymphoscintigraphy
findings could result in a more accurate functional
assessment of lymphoedema patients.
PMID: 20215978 [PubMed - as supplied by publisher]
2. J Neurol Phys Ther. 2010 Mar;34(1):41-9.
Rehabilitation postfacial reanimation surgery after removal of acoustic
neuroma: a case study.
Wilson CM, Ronan SL.
Department of Physical and Occupational Therapy (C.M.W.), William Beaumont
Hospital, Troy,
Michigan; Department of Physical Therapy (C.M.W.), School of
Health Sciences, Oakland University in
Rochester, Michigan; and Department
of Physical Therapy (S.R.), New York Medical College, School
of Public
Health, Valhalla, New York.
BACKGROUND AND PURPOSE:: Facial paralysis can have a significant negative
impact on an
individual's social, physical, and emotional well-being;
however, little information has been reported on the
efficacy of physical
therapy interventions for this condition. The purpose of this case study was to
describe the details of a physical therapy evaluation and intervention for a
patient who underwent facial
muscle transfer after resection of acoustic
neuroma.
CASE DESCRIPTION:: A 29-year-old woman underwent left-sided facial
reanimation surgery, which
included transplantation of the temporalis muscle
and platysma muscle to the corner of the mouth.
INTERVENTION:: The patient received 30 sessions of physical therapy that
included electrical
stimulation, biofeedback, lymphatic drainage, home
exercises and facial stretching, and scar management.
OUTCOMES:: The patient exhibited an improvement in the Composite score of the
Sunnybrook Facial
Grading System from 17 to 41. She was able to regain
function of the left side of her face with gains in
expressions of smiling,
frowning, and puckering, but symmetry was not completely restored. The patient
had chronic difficulty with left-sided lymphedema, requiring frequent manual
lymphatic drainage.
DISCUSSION:: Data from this case study suggest that physical therapy
management improves functional
outcomes for individuals with postoperative
changes in facial motor function from facial reanimation
surgery. Further
research is required to explore factors that influence the rate and extent of
recovery
derived from physical therapy interventions.
PMID: 20212367 [PubMed - in process]
3. Zhonghua Zheng Xing Wai Ke Za Zhi. 2009 Nov;25(6):433-6.
[Interstitial high-resolution MR lymphangiography in patients with lower
extremity lymphedema][Article in
Chinese]
Ren YQ, Lu Q, Cao WG.
Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of
Medicine, Shanghai 200011,
China.
OBJECTIVE: To assess the feasibility of interstitial magnetic resonance
lymphangiography (IMRL) with
intracutaneous injection of gadobenate
dimeglumine--a commercially available, non-ionic, extracellular
paramagnetic
contrast agent.
METHODS: We studied 10 patients with lower extremity lymphedema. A mixture of
7.5 ml gadobenate
dimeglumine and 0.5 ml 2% lidocaine were evenly subdivided
into 8 portions and injected
intracutaneously into each web space of both
feet. For IMRL, a 3D fast spoiled gradient-recalled echo
T1-weighted images
with a fat saturation technique (T1 high resolution isotropic volume excitation,
THRIVE) was performed.
RESULTS: The beaded appearance of lymphatic vessels extending from the
injection site were detected
in 11 of 12 lower legs and the best delineation
of lymphatic vessels was present at 15-30 minutes after
injection. In 6 of
12 affected thighs, lymphatic vessels could be also visualized with the
strongest
enhancement at 45 minutes.
CONCLUSION: IMRL is a safe and technically feasible new method which can
effectively visualize the
pathological lymphatic vessels in lower extremity
lymphedema.
PMID: 20209934 [PubMed - in process]
Large Nodular Plaque on Leg in the Setting of Chronic
Lymphedema—Diagnosis
Arch Dermatol.2010; 146: 337-342.
1. Pediatr Dermatol. 2010 Jan 1;27(1):58-61.
Lymphatic compression by sclerotic patches of morphea: an original mechanism
of lymphedema in a child.
Samimi M, Maruani A, Machet MC, Baulieu F, Machet L, Lorette G.
University François Rabelais, Tours, France.
Lymphedema in children is mostly primary, due to lymphatic hypoplasia.
Secondary lymphedema is
caused by lymphatic injury or obstruction. We report
the case of a child that developed a lymphedema of
the left upper and lower
extremities, with a simultaneous onset of ipsilateral hemicorporal morphea. We
concluded that lymphatic obstruction was due to sclerosis from morphea. This
is a unique, rarely reported
mechanism of lymphedema. Lymphoscintigraphy
revealed attenuated lymphatic flow in the left upper and
lower limbs.
Systemic corticosteroids were associated with slow improvement in the sclerotic
patches.
We simultaneously noticed an improvement in the lymphedema of
limbs. Repeat lymphoscintigraphy
revealed dramatically improved lymphatic
function. This case suggests that at least in some cases
lymphedema may be
caused by morphea.
PMID: 20199412 [PubMed - in process]
1. Am J Med Genet A. 2010 Mar;152A(3):737-40.
c. 595-596 insC of FOXC2 underlies lymphedema, distichiasis, ptosis,
ankyloglossia, and Robin
sequence in a Thai patient.
Tanpaiboon P, Kantaputra P, Wejathikul K, Piyamongkol W.
Faculty of Medicine, Department of Pediatrics, Chiang Mai University, Chiang
Mai, Thailand.
[email protected]
Lymphedema-distichiasis syndrome is a rare primary lymphedema inherited as an
autosomal dominant
disorder. The characteristic features consist of late
onset-lymphedema and distichiasis together with other
occasionally seen
features including varicose vein, cleft palate, ptosis, and congenital heart
diseases.
FOXC2 is the gene found to be associated with this syndrome. We
report here the first Thai patient who
has characteristic features of this
syndrome and the infrequently described features including
ankyloglossia,
and Robin sequence which consists of glossoptosis, cleft palate, and
micrognathia.
Mutation analysis of FOXC2 revealed c. 595-596 insC. (c) 2010
Wiley-Liss, Inc.
PMID: 20186799 [PubMed - in process]
2. Cases J. 2009 Mar 23;2:6625.
Pneumatic compression devices for in-home management of lymphedema: two case
reports.
[No authors listed]
ABSTRACT : The two patients in this case series had experienced long-term
difficulty controlling
lymphedema at home. Both patients had used numerous
home therapies, including older-generation
intermittent pneumatic
compression devices, without success. The Flexitouch(R) system, an advanced
pneumatic device, was prescribed to assist them with in-home efforts by
providing therapy to their
affected limbs in addition to the lower trunk
area for the patient with lymphedema of the lower extremity;
and the trunk,
chest wall, and shoulder areas for the patient with lymphedema of the upper
extremity.
Both patients achieved successful home maintenance of lymphedema,
as judged by limb volume, clinical
observations, and subjective patient
impressions, after incorporating the Flexitouch(R) system. Neither
patient
experienced the deleterious effects (worsening genital edema; fibrotic cuff
development) that they
had experienced with the older-generation
intermittent pneumatic compression devices they had
previously used.
Incorporating the Flexitouch(R) system as part of maintenance may improve
success for
lymphedema patients who have previously struggled with in-home
management.
PMID: 20184680 [PubMed - in process]
3. J Lymphoedema. 2009 Apr 1;4(1):14-18.
30-MONTH POST-BREAST CANCER TREATMENT LYMPHOEDEMA.
Armer JM, Stewart BR, Shook RP.
Jane M Armer, Professor, Sinclair School of Nursing (SSON), Director, Nursing
Research, Ellis Fischel
Cancer Center; Bob R Stewart, Professor Emeritus,
College of Education, Adjunct Clinical Professor,
SSON; Robin P Shook,
Project Development Specialist, Lymphedema Research Project, SSON,
University of Missouri, Columbia, USA.
BACKGROUND: Quantification of lymphoedema (LE) has been problematic, and the
reported
incidence of LE varies greatly among women treated with surgery and
radiation for breast cancer. AIMS:
This study aims to describe LE occurrence
over time among breast cancer survivors using four diagnostic
criteria based
on three measurement techniques.
METHODS: Limb volume and symptom assessment data were followed after surgery
every three months
for 12 months, then every six months for 30 months. Limb
volume changes (LVC) were measured by
circumferences and by perometry, and
by symptom experience via interview. Standard survival analysis
methods
identified when the criteria indicating LE were met.
RESULTS: Trends in LE occurrence are reported for data from 211 participants.
At 30 months post-
treatment, LE incidence ranged from 41-91%, with 2cm being
the highest estimation method and self-
reported signs and symtoms (SS) the
lowest.
CONCLUSIONS: This 30-month analysis supports the previous 12-month analysis
in finding the 2cm
criteria as the most liberal definition of LE.
Self-reporting of heaviness and swelling, along with 10%
LVC, represented
the most conservative definitions (41% and 45%, respectively).
PMID: 20182653 [PubMed]
4. J Altern Complement Med. 2010 Feb;16(2):145-9.
An integrative treatment for lower limb lymphedema (elephantiasis).
Narahari SR, Aggithaya MG, Prasanna KS, Bose KS.
Department of Ayurveda, Kasaragod, Kerala, India.
PMID: 20180687 [PubMed - in process]
1. Circ Res. 2010 Feb 4. [Epub ahead of print]
Transmural Flow Modulates Cell and Fluid Transport Functions of Lymphatic
Endothelium.
Miteva DO, Rutkowski JM, Dixon JB, Kilarski W, Shields JD, Swartz MA.
Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne,
Switzerland.
Rationale: Lymphatic transport of peripheral interstitial fluid and dendritic cells (DCs) is important for both
adaptive immunity and maintenance of
tolerance to self-antigens. Lymphatic drainage can change rapidly
and
dramatically on tissue injury or inflammation, and therefore increased fluid
flow may serve as an
important early cue for inflammation; however, the
effects of transmural flow on lymphatic function are
unknown.
Objective: Here we tested the hypothesis that lymph drainage regulates the
fluid and cell transport
functions of lymphatic endothelium.
Methods and Results: Using in vitro and in vivo models, we demonstrated that
lymphatic endothelium is
sensitive to low levels of transmural flow.
Basal-to-luminal flow (0.1 and 1 mum/sec) increased lymphatic
permeability,
dextran transport, and aquaporin-2 expression, as well as DC transmigration into
lymphatics. The latter was associated with increased lymphatic expression of
the DC homing chemokine
CCL21 and the adhesion molecules intercellular
adhesion molecule-1 and endothelial selectin. In addition,
transmural flow
induced delocalization and downregulation of vascular endothelial cadherin and
PECAM-
1 (platelet/endothelial cell adhesion molecule-1). Flow-enhanced DC
transmigration could be reversed by
blocking CCR7, intercellular adhesion
molecule-1, or endothelial selectin. In an experimental model of
lymphedema,
where lymphatic drainage is greatly reduced or absent, lymphatic endothelial
expression of
CCL21 was nearly absent.
Conclusions: These findings introduce transmural flow as an important
regulator of lymphatic endothelial
function and suggest that flow might
serve as an early inflammatory signal for lymphatics, causing them to
regulate transport functions to facilitate the delivery of soluble antigens
and DCs to lymph nodes.
PMID: 20133901 [PubMed - as supplied by publisher]
2. Am J Occup Ther. 2010 Jan-Feb;64(1):59-72.
Randomized controlled trial of the Breast Cancer Recovery Program for women
with breast cancer-
related lymphedema.
McClure MK, McClure RJ, Day R, Brufsky AM.
Magee-Women's Research Institute, Pittsburgh, PA, USA.
Evidence-based exercise and relaxation recommendations for people with breast
cancer-related
lymphedema (BCRL) are needed. We report a randomized
controlled study of one program, designed to
achieve synergistic
improvements in physical and emotional BCRL symptoms. People in the treatment
group received an exercise and relaxation program, The Breast Cancer
Recovery Program (N=16). The
control participants (N=16) continued with
health professionals' recommendations. Participants were
tested at entry,
2.5 weeks, 5 weeks, and 3 months. Treatment group participants, compared with
control
participants, demonstrated significant treatment effects for
improved bioimpedance z, arm flexibility,
quality of life, mood at 3 months,
and weight loss. Adherence was high for this safe and effective
program,
which improved lymphedema physical and emotional symptoms.
PMID: 20131565 [PubMed - in process]
------------------------------
1. Angiology. 2010 Feb 10. [Epub ahead of print]
Epidemiological Data and Comorbidities of 428 Patients Hospitalized With
Erysipelas.
Pereira de Godoy JM, Massari PG, Rosinha MY, Brandão RM, Foroni Casas AL.
The aim of this study was to evaluate the epidemiological data and the main
comorbidities of patients with
erysipelas admitted to a tertiary hospital.
All patients admitted due to erysipelas during the period from
1999 to 2008
were included in a prospective and cross-sectional study. The Fisher exact test
and logistic
regression were used for statistical analysis. A total of 428
individuals were hospitalized with 41
rehospitalizations; 51.17% of the
patients were women, the mean age was 58.6 years. The main
comorbidities
were hypertension (51.6%), diabetes mellitus (41.6%), chronic venous
insufficiency
(36.2%), other cardiovascular diseases (33.2%) including
angina, peripheral arterial insufficiency, acute
myocardial infarction, and
strokes, obesity (12.1%), chronic renal failure (6.8%), neoplasms (4.9%),
cirrhosis (4.9%), chronic lymphedema (4.2%), and leg ulcers (2.6%).
Erysipelas is a seasonal disease
that affects adults and the elderly people,
has a repetitive nature, and is associated with comorbidities.
PMID: 20147345 [PubMed - as supplied by publisher]
------------------------------
1. Lymphat Res Biol. 2009 Dec;7(4):239-45.
Topography of
accumulation of stagnant lymph and tissue fluid in soft tissues of human
lymphedematous
lower limbs.
Olszewski WL, Jain P, Ambujam G, Zaleska M, Cakala M.
1 Department of Surgical Research and Transplantology, Medical Research
Center , Polish Academy of
Sciences, Warsaw, Poland .
Abstract Background: The knowledge of where does excess tissue fluid
accumulate in obstructive
lymphedema is indispensable for rational physical
therapy. However, it has so far been limited to that
obtained from
lymphoscintigraphic, ultrasonographic, and MR images. None of these modalities
provide
composite pictures of dilated lymphatics and expanded tissue space
in dermis, subcutis, and muscles. So
far, only anatomical dissection and
histological processing of biopsy material can visualize the tissue
lymphatic network and the sites of accumulation of the excess of mobile
tissue fluid.
Methods and Results: We visualized the "tissue fluid and lymph" space in skin
and subcutaneous tissue of
foot, calf, and thigh in various stages of
lymphedema in specimens obtained during lymphatic microsurgical
procedures
or tissue debulking, using special staining techniques. The volume of
accumulated fluid was
calculated from the densitometric data of stained
tissue sections. We found that lymph was present only in
the subepidermal
lymphatics, whereas the collecting trunks were obliterated in most cases. Mobile
tissue
fluid accumulated in the spontaneously formed spaces in the
subcutaneous tissue, around small veins and
above and underneath muscular
fascia. Deformation of subcutaneous tissue by free fluid led to formation
of
interconnecting channels. The volume of subcutaneous free fluid ranged around
50% of total tissue
volume and there were no significant differences in
various stages of lymphedema. This could be
explained by the presence of
thick layers of subcutaneous fat tissue even in the most advanced stage of
lymphedema.
Conclusions: In lymphedema caused by obliteration of collecting trunks, lymph
is present only in the
subepidermal lymphatics, whereas the bulk of stagnant
tissue fluid accumulates in the subcutaneous tissue
and above and beneath
muscular fascia. These findings should be useful for designing pneumatic devices
for limb massage as well as for rational manual lymphatic drainage in terms
of sites of massage and level
of applied external pressures.
PMID: 20143923 [PubMed - in process]
---------------------------
1. Lymphat Res Biol. 2009 Dec;7(4):239-45.
Topography of accumulation of stagnant lymph and tissue fluid in soft tissues
of human lymphedematous
lower limbs.
Olszewski WL, Jain P, Ambujam G, Zaleska M, Cakala M.
1 Department of Surgical Research and Transplantology, Medical Research
Center , Polish Academy of
Sciences, Warsaw, Poland .
Abstract Background: The knowledge of where does excess tissue fluid
accumulate in obstructive
lymphedema is indispensable for rational physical
therapy. However, it has so far been limited to that
obtained from
lymphoscintigraphic, ultrasonographic, and MR images. None of these modalities
provide
composite pictures of dilated lymphatics and expanded tissue space
in dermis, subcutis, and muscles. So
far, only anatomical dissection and
histological processing of biopsy material can visualize the tissue
lymphatic network and the sites of accumulation of the excess of mobile
tissue fluid.
Methods and Results: We visualized the "tissue fluid and lymph" space in skin
and subcutaneous tissue of
foot, calf, and thigh in various stages of
lymphedema in specimens obtained during lymphatic microsurgical
procedures
or tissue debulking, using special staining techniques. The volume of
accumulated fluid was
calculated from the densitometric data of stained
tissue sections. We found that lymph was present only in
the subepidermal
lymphatics, whereas the collecting trunks were obliterated in most cases. Mobile
tissue
fluid accumulated in the spontaneously formed spaces in the
subcutaneous tissue, around small veins and
above and underneath muscular
fascia. Deformation of subcutaneous tissue by free fluid led to formation
of
interconnecting channels. The volume of subcutaneous free fluid ranged around
50% of total tissue
volume and there were no significant differences in
various stages of lymphedema. This could be
explained by the presence of
thick layers of subcutaneous fat tissue even in the most advanced stage of
lymphedema.
Conclusions: In lymphedema caused by obliteration of collecting trunks, lymph
is present only in the
subepidermal lymphatics, whereas the bulk of stagnant
tissue fluid accumulates in the subcutaneous tissue
and above and beneath
muscular fascia. These findings should be useful for designing pneumatic devices
for limb massage as well as for rational manual lymphatic drainage in terms
of sites of massage and level
of applied external pressures.
PMID: 20143923 [PubMed - in process]
2. Lymphat Res Biol. 2009 Dec;7(4):215-9.
Lymphatics in human lymphatic filariasis: in vitro models of parasite-induced
lymphatic remodeling.
Bennuru S, Nutman TB.
Laboratory of Parasitic Diseases, National Institute of Allergy and
Infectious Diseases , Bethesda,
Maryland.
Abstract Lymphatic filariasis characterized by the dysfunction of the
lymphatics can lead to severe (and
often) irreversible lymphedema and
elephantiasis. Decades of research in the field shows that the
establishment
of the adult parasites in the lymphatics triggers a cascade of events that
ultimately results in
tissue scarring and fibrosis. In this minireview, we
focus on the studies addressing the mechanisms
underlying the
parasite-induced lymphatic dilatation that suggests parasite-induced lymphatic
remodeling
and lymphangiogenesis may be the prelude towards developing
chronic and irreversible filarial pathology.
PMID: 20143920 [PubMed - in process
3. Lymphat Res Biol. 2009 Dec;7(4):205-14.
New approaches to lymphatic imaging.
Lucarelli RT, Ogawa M, Kosaka N, Turkbey B, Kobayashi H, Choyke PL.
Molecular Imaging Program, National Cancer Institute , Bethesda,
Maryland.
Abstract Accurate imaging of the lymphatic system can aid in cancer staging,
optimize surgical procedures
to reduce lymphedema, and may one day be a
means of delivering intralymphatic therapy. The Sentinel
Lymph Node (SLN)
concept has been pivotal in driving new imaging techniques. Metastasis to a SLN
is
a critical indicator of advanced disease. However, presently, few tools
are available for imaging the
lymphatics, and even fewer are available for
locating the SLN for biopsy. Recently, new macromolecular
agents, including
gadolinium-labeled dendrimers, fluorescent quantum dots, and
fluorescently-labeled
immunoglobins, have been used to image the lymphatics
and SLN with MRI and optical techniques, and
new fluorescent nanoparticles
such as upconverting nanocrystals are potential future agents. Additionally,
multi-modality probes combining two modalities such as optical/MR dendrimers
have been designed to
provide both preoperative imaging, and intraoperative
guidance during lymph node resections. These
probes can map the lymphatic
system for maximal therapeutic benefit while minimizing complications such
as lymphedema. Advances in the understanding of the molecular mechanisms of
lymphangiogenesis and
lymphatic spread of tumors offer the opportunity for
more targeted imaging of the lymphatic system.
Additionally, these imaging
agents could be used as powerful research tools for tracking immunological
cells and monitoring the immune response as well as providing the means to
deliver lymphatic-targeted
therapies. The future holds great promise for the
translation of these methods to the clinic.
PMID: 20143919 [PubMed - in process]
4. Ann Surg Oncol. 2010 Feb 6. [Epub ahead of print]
The Effect of Providing Information about Lymphedema on the Cognitive and
Symptom Outcomes of
Breast Cancer Survivors.
Fu MR, Chen CM, Haber J, Guth AA, Axelrod D.
College of Nursing, New York University, New York, NY, USA, [email protected].
BACKGROUND: Despite recent advances in breast cancer treatment, breast cancer
related
lymphedema (BCRL) continues to be a significant problem for many
survivors. Some BCRL risk factors
may be largely unavoidable, such as
mastectomy, axillary lymph node dissection (ALND), or radiation
therapy.
Potentially avoidable risk factors unrelated to breast cancer treatment include
minor upper
extremity infections, injury or trauma to the arm, overuse of
the limb, and air travel. This study investigates
how providing information
about BCRL affects the cognitive and symptomatic outcome of breast cancer
survivors.
METHODS: Data were collected from 136 breast cancer survivors using a
Demographic and Medical
Information interview instrument, a Lymphedema
Education Status interview instrument, a Knowledge
Test for cognitive
outcome, and the Lymphedema and Breast Cancer Questionnaire for symptom
outcome. Data analysis included descriptive statistics, t tests, chi-square
(chi(2)) tests, and regression.
RESULTS: BCRL information was given to 57% of subjects during treatment. The
mean number of
lymphedema-related symptoms was 3 symptoms. Patients who
received information reported significantly
fewer symptoms and scored
significantly higher in the knowledge test. After controlling for confounding
factors, patient education remains an additional predictor of BCRL outcome.
Significantly fewer women
who received information about BCRL reported
swelling, heaviness, impaired shoulder mobility, seroma
formation, and
breast swelling.
CONCLUSIONS: Breast cancer survivors who received information about BCRL had
significantly
reduced symptoms and increased knowledge about BCRL. In
clinical practice, breast cancer survivors
should be engaged in supportive
dialogues so they can be educated about ways to reduce their risk of
developing BCRL.
PMID: 20140528 [PubMed - as supplied by publisher]
1. Cancer. 2010 Mar 24. [Epub ahead of print]
A phase I study to assess the feasibility and oncologic safety of axillary
reverse mapping in breast cancer
patients.
Bedrosian I, Babiera GV, Mittendorf EA, Kuerer HM, Pantoja L, Hunt KK,
Krishnamurthy S, Meric-
Bernstam F.
Department of Surgical Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston
Texas.
BACKGROUND:: Axillary reverse mapping (ARM) is a novel technique to preserve
upper extremity
lymphatics that may reduce the incidence of lymphedema after
axillary lymph node dissection. Early
reports have suggested that ARM lymph
nodes do not contain metastatic disease from breast cancer;
however, these
studies were conducted in early stage patients with low likelihood of lymph node
metastasis. This study reported a phase 1 trial conducted in patients with
cytologically documented
axillary metastasis undergoing axillary lymph node
dissection to determine the feasibility and oncologic
safety of ARM.
METHODS:: Thirty patients, 23 (77%) of whom received preoperative therapy
(chemotherapy in 22
patients and hormonal therapy in 1 patient), were
enrolled. Blue dye was injected in the upper inner
ipsilateral arm. The
presence of blue lymphatics was noted, and blue lymph nodes were sent separately
for pathologic evaluation.
RESULTS:: The average time between blue dye injection and axillary exposure
was 35 minutes (range,
15-60 minutes). Blue lymphatics were identified in 21
patients (70%) and blue lymph nodes in 15 patients
(50%). The median number
of ARM lymph nodes was 1 (range, 0-3 lymph nodes) and the median
number of
axillary lymph nodes was 26 (range, 6-47 lymph nodes). Axillary metastases were
noted in
60% (18 of 30) of patients. Of 11 patients who had axillary
metastasis and at least 1 ARM lymph node
identified, 2 (18%) had metastasis
to the ARM lymph node.
CONCLUSIONS:: ARM appears to be a feasible technique with which to identify
upper arm lymphatics
during axillary surgery. However, the high prevalence
of disease involving ARM lymph nodes in this small
cohort suggested that
preservation of these lymphatics is not oncologically safe in women with
documented axillary lymph node metastasis from breast cancer. Cancer 2010.
(c) 2010 American
Cancer Society.
PMID: 20336790 [PubMed - as supplied by publisher]
2. Ann Surg Oncol. 2010 Mar 25. [Epub ahead of print]
Prospective Assessment of Postoperative Complications and Associated Costs
Following Inguinal Lymph
Node Dissection (ILND) in Melanoma Patients.
Chang SB, Askew RL, Xing Y, Weaver S, Gershenwald JE, Lee JE, Royal R, Lucci
A, Ross MI,
Cormier JN.
Department of Surgical Oncology, University of Texas M. D. Anderson Cancer
Center, Houston, TX,
USA.
BACKGROUND: We prospectively assessed the incidence, risk factors, and costs
associated with
wound complications and lymphedema in melanoma patients
undergoing inguinal lymph node dissection
(ILND).
MATERIALS AND METHODS: A total of 53 melanoma patients were accrued to 2
trials (June 2005
to July 2008) that included prospective evaluations of
postoperative complications; 30-day wound
complications included infection,
seroma, and/or dehiscence. There were 20 patients who underwent limb
volume
measurement and completed a 19-item lymphedema symptom assessment questionnaire
preoperatively and 3 months postoperatively. A multivariate analysis was
performed to evaluate potential
risk factors for complications. A
microcosting analysis was also performed to evaluate the direct costs
associated with wound complications.
RESULTS: The 30-day wound complications were noted in 77.4% of patients. A
BMI >/= 30 (n = 28)
increased the risk for wound complications (odds
ratio [OR] = 11.4, 95% confidence interval [95%CI]
1.6-78.5, P = .01), while
advanced nodal disease approached significance (OR = 9.0, 95%CI: 0.79-
103.1,
P = .08). Other risk factors, including diabetes, smoking, and the addition of a
deep pelvic
(iliac/obturator) dissection to ILND, were not significant. Of
20 patients, 9 (45%) developed limb volume
change (LVC) >/=5% at 3
months, with associated mean symptom scores of 6.1 versus 4.6 for those
without LVC. Costs for patients with wound complications were significantly
higher than for those without
wound complications.
CONCLUSIONS: Postoperative wound complications and early onset lymphedema
occur frequently
following ILND for melanoma. Obesity is an adverse risk
factor for 30-day wound complications that can
significantly increase
postoperative costs, as is likely the case for advanced disease. Risk reduction
practices and novel treatment approaches are needed to reduce postoperative
morbidity.
PMID: 20336388 [PubMed - as supplied by publisher]
1. J Clin Nurs. 2010 Mar 16. [Epub ahead of print]
After axillary surgery for breast cancer - is it safe to take blood samples
or give intravenous infusions?
Winge C, Mattiasson AC, Schultz I.
Authors:Charlotte Winge, RN, Division of Surgery, Department of Clinical
Sciences, Karolinska Institute
at Danderyd Hospital; Anne-Cathrine
Mattiasson, RNT, Professor, Division of Surgery, Department of
Clinical
Sciences, Karolinska Institute at Danderyd Hospital and Sophiahemmet University
College;
Inkeri Schultz, MD, PhD, Department of Clinical Sciences,
Karolinska Institute at Danderyd Hospital and
Department of Plastic and
Reconstructive Surgery, Karolinska University Hospital, Stockholm, Sweden.
Aim. To investigate the occurrence of complications after a needle puncture
or intravenous injection in the
ipsilateral arm of women who have undergone
axillary lymph node clearance for breast cancer.
Background. After axillary lymph node clearance in patients with breast
cancer, some women experience
lymphoedema and recurrent infections. To
reduce the risk of these postoperative complications, most
women are advised
to not have intravenous infusions in, or blood samples taken from, the arm in
the
operated side. Very little published data are available regarding the
incidence of lymphoedema after
intravenous procedures under clean conditions
in the hospital setting. This study set out to investigate the
occurrence of
complications after a needle puncture or intravenous injection in the
ipsilateral arm of
women who have undergone axillary lymph node clearance
for breast cancer is therefore important.
Design. Descriptive. Methods. Self-reported questionnaire. Results. Most of
the reported complications
were minor, including itching, bruises and
vomiting at the time of the intravenous procedure. The most
serious
complication was infection in one patient needing antibiotic treatment and
subsequent arm swelling.
Conclusions. This study indicates that if a blood sample is taken or
intravenous injection is given
according to the current Swedish guidelines
for health care professionals, there should be a very low risk
of
complications. Relevance to clinical practice. If intravenous procedures are
performed without any
disadvantage in the arm of the operated side in women
who have undergone axillary surgery, the clinical
problem of finding a
proper vein and the psychological concern of the women can be reduced.
PMID: 20345831 [PubMed - as supplied by publisher]
1. Am J Med Genet A. 2010 Apr;152A(4):970-6.
Lipedema: an inherited condition.
Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S, Mortimer
PS.
Department of Cardiac and Vascular Sciences, St. George's, University of
London, London, UK.
[email protected]
Abstract
Lipedema is a condition characterized by swelling and enlargement of the
lower limbs due to abnormal
deposition of subcutaneous fat. Lipedema is an
under-recognized condition, often misdiagnosed as
lymphedema or dismissed as
simple obesity. We present a series of pedigrees and propose that
lipedema
is a genetic condition with either X-linked dominant inheritance or more likely,
autosomal
dominant inheritance with sex limitation. Lipedema appears to be a
condition almost exclusively affecting
females, presumably
estrogen-requiring as it usually manifests at puberty. Lipedema is an entity
distinct
from obesity, but may be wrongly diagnosed as primary obesity, due
to clinical overlap. The phenotype
suggests a condition distinct from
obesity and associated with pain, tenderness, and easy bruising in
affected
areas. (c) 2010 Wiley-Liss, Inc.
PMID: 20358611 [PubMed - in process]
---
1. J Cancer Surviv. 2010 Apr 7. [Epub ahead of print]
Upper extremity impairments in women with or without lymphedema following
breast cancer treatment.
Smoot B, Wong J, Cooper B, Wanek L, Topp K, Byl N, Dodd M.
Department of Physical Therapy and Rehabilitation Science, University of
California San Francisco, San
Francisco, CA, USA, [email protected].
Abstract
INTRODUCTION: Breast-cancer-related lymphedema affects
approximately 25% of breast cancer
(BC) survivors and may impact use of the
upper limb during activity. The purpose of this study is to
compare upper
extremity (UE) impairment and activity between women with and without lymphedema
after BC treatment.
METHODS: 144 women post BC treatment completed demographic, symptom, and
Disability of
Arm-Shoulder-Hand (DASH) questionnaires. Objective measures
included Purdue pegboard,
finger-tapper, Semmes-Weinstein monofilaments,
vibration perception threshold, strength, range of
motion (ROM), and
volume.
RESULTS: Women with lymphedema had more lymph nodes removed (p < .001),
more UE symptoms
(p < .001), higher BMI (p = .041), and higher DASH
scores (greater limitation) (p < .001). For all
participants there was
less strength (elbow flexion, wrist flexion, grip), less shoulder ROM, and
decreased sensation at the medial upper arm (p < .05) in the affected UE.
These differences were
greater in women with lymphedema, particularly in
shoulder abduction ROM (p < .05). Women with
lymphedema had bilaterally
less elbow flexion strength and shoulder ROM (p < .05). Past diagnosis of
lymphedema, grip strength, shoulder abduction ROM, and number of
comorbidities contributed to the
variance in DASH scores (R (2) of 0.463, p
< .001).
IMPLICATIONS FOR CANCER SURVIVORS: UE impairments are found in women
following
treatment for BC. Women with lymphedema have greater UE impairment
and limitation in activities than
women without. Many of these impairments
are amenable to prevention measures or treatment, so early
detection by
health care providers is essential.
PMID: 20373044 [PubMed - as supplied by
publisher]
2. Support Care Cancer. 2010 Apr 6. [Epub ahead of print]
Can ICF model for patients with breast-cancer-related lymphedema predict
quality of life?
Tsauo JY, Hung HC, Tsai HJ, Huang CS.
--------------------
1: Ridner SH, Dietrich MS, Kidd N RelatedArticles
Breast cancer
treatment-related lymphedema self-care: Education, practices, symptoms, and
quality of
life.
Support Care Cancer. 2010 Apr 15.
PMID: 20393753
[PubMed - Publisher]
School and Graduate Institute of Physical Therapy, College of Medicine,
National Taiwan University,
Taipei, Taiwan.
Abstract
GOAL OF WORK: The aim of the study was to investigate if the
International Classification of
Functioning, Disability and Health (ICF)
model with clinical data from patients with
breast-cancer-related lymphedema
can predict their health-related quality of life (HRQL).
MATERIALS AND METHODS: Sixty-one patients with breast-cancer-related
lymphedema were
recruited. Data were collected from records, including age,
type(s) of surgery, number of dissected
lymph nodes and history of
radiotherapy and/or chemotherapy, duration of lymphedema, and duration
between surgery and enrollment. Excessive arm volume, average arm symptom,
function of upper
extremity (U/E), and HRQL were assessed four times during
and after patients' treatment of
lymphedema.
RESULTS: The ICF model accounted for 20.5% to 55.6% variance in each domain
of HRQL. Activity
and participation reflected by U/E function were the most
important factor, significantly predicting every
domain of HRQL. Among
measured impairments, average arm symptom was found to be most
correlated
with U/E function (r = 0.590, P < 0.05).
CONCLUSION: The ICF model consisting of clinical measures for patients with
breast-cancer-related
lymphedema can predict their HRQL. Activity and
participation were the most important component.
Arm symptoms rather than
arm volume significantly correlated with U/E function. This might suggest that
reducing arm symptoms is relatively more important while treating patients
with breast-cancer-related
lymphedema.
PMID: 20372972 [PubMed - as supplied by publisher]
3. Indian J Plast Surg. 2009 Jul;42(2):248-50.
Lymphangiectasis of lower limb: A rare challenging case.
Bhattacharya V, Mishra B, Barooah PS, Chaudhuri GR, Bhattacharya S.
Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu
University, Varanasi - 221
005, U.P, India.
Abstract
Lymphangiectasis usually occurs in the viscera. Involvement of
the lower limb is very rare. It is difficult to
establish the diagnosis
without detailed investigations. Clinical features are peculiar and may mimic
lymphoedema of different origins which needs to be ruled out. Contrary to
the expectation, the
post-operative result is excellent in the long-term
follow-up.
PMID: 20368868 [PubMed - in process]
4. J Clin Invest. 2010 Apr 1. pii: 40101. doi: 10.1172/JCI40101. [Epub
ahead of print]
Direct transcriptional regulation of neuropilin-2 by COUP-TFII modulates
multiple steps in murine
lymphatic vessel development.
Lin FJ, Chen X, Qin J, Hong YK, Tsai MJ, Tsai SY.
Abstract
The lymphatic system plays a key role in tissue fluid
homeostasis. Lymphatic dysfunction contributes to
the pathogenesis of many
human diseases, including lymphedema and tumor metastasis. However, the
mechanisms regulating lymphangiogenesis remain largely unknown. Here, we
show that COUP-TFII
(also known as Nr2f2), an orphan member of the nuclear
receptor superfamily, mediates both
developmental and pathological
lymphangiogenesis in mice. Conditional ablation of COUP-TFII at an
early
embryonic stage resulted in failed formation of pre-lymphatic ECs (pre-LECs) and
lymphatic
vessels. COUP-TFII deficiency at a late developmental stage
resulted in loss of LEC identity, gain of
blood EC fate, and impaired
lymphatic vessel sprouting. siRNA-mediated downregulation of
COUP-TFII in
cultured primary human LECs demonstrated that the maintenance of lymphatic
identity
and VEGF-C-induced lymphangiogenic activity, including cell
proliferation and migration, are
COUP-TFII-dependent and cell-autonomous
processes. COUP-TFII enhanced the
pro-lymphangiogenic actions of VEGF-C, at
least in part by directly stimulating expression of
neuropilin-2, a
coreceptor for VEGF-C. In addition, COUP-TFII inactivation in a mammary gland
mouse tumor model resulted in inhibition of tumor lymphangiogenesis,
suggesting that COUP-TFII also
regulates neo-lymphangiogenesis in the adult.
Thus, COUP-TFII is a critical factor that controls
lymphangiogenesis in
embryonic development and tumorigenesis in adults.
PMID: 20364082 [PubMed - as supplied by publisher
----
1. PLoS Negl Trop Dis. 2010 Apr 20;4(4):e668.
Feasibility and effectiveness of basic lymphedema management in Leogane,
Haiti, an area endemic for
bancroftian filariasis.
Addiss DG, Louis-Charles J, Roberts J, Leconte F, Wendt JM, Milord MD, Lammie
PJ, Dreyer G.
Division of Parasitic Diseases, National Center for Infectious Diseases, U.S.
Centers for Disease
Control and Prevention, Atlanta, Georgia, United States
of America. [email protected]
Abstract
BACKGROUND: Approximately 14 million persons living in areas
endemic for lymphatic filariasis have
lymphedema of the leg. Clinical
studies indicate that repeated episodes of bacterial acute
dermatolymphangioadenitis (ADLA) lead to progression of lymphedema and that
basic lymphedema
management, which emphasizes hygiene, skin care, exercise,
and leg elevation, can reduce ADLA
frequency. However, few studies have
prospectively evaluated the effectiveness of basic lymphedema
management or
assessed the role of compressive bandaging for lymphedema in resource-poor
settings.
METHODOLOGY/PRINCIPAL FINDINGS: Between 1995 and 1998, we prospectively
monitored
ADLA incidence and leg volume in 175 persons with lymphedema of
the leg who enrolled in a
lymphedema clinic in Leogane, Haiti, an area
endemic for Wuchereria bancrofti. During the first phase of
the study, when
a major focus of the program was to reduce leg volume using compression
bandages,
ADLA incidence was 1.56 episodes per person-year. After March
1997, when hygiene and skin care
were systematically emphasized and
bandaging discouraged, ADLA incidence decreased to 0.48
episodes per
person-year (P<0.0001). ADLA incidence was significantly associated with leg
volume,
stage of lymphedema, illiteracy, and use of compression bandages.
Leg volume decreased in 78% of
patients; over the entire study period, this
reduction was statistically significant only for legs with stage 2
lymphedema (P = 0.01).
CONCLUSIONS/SIGNIFICANCE: Basic lymphedema management, which emphasized
hygiene and
self-care, was associated with a 69% reduction in ADLA
incidence. Use of compression bandages in
this setting was associated with
an increased risk of ADLA. Basic lymphedema management is feasible
and
effective in resource-limited areas that are endemic for lymphatic
filariasis.
PMID: 20422031 [PubMed - in process]PMCID: PMC2857874
2. Support Care Cancer. 2010 Apr 25. [Epub ahead of print]
Longitudinal changes in sexual problems related to cancer treatment in Korean
breast cancer survivors: a
prospective cohort study.
Yang EJ, Kim SW, Heo CY, Lim JY.
Int J Med Sci. 2010 Apr 15;7(2):68-71.
Godoy & Godoy technique in the treatment of lymphedema for
under-privileged populations.
de Godoy JM, de Godoy Mde F.
Stricto-Sensu and Lato-Sensu of Course in Medicine of Medical School in São
José do Rio Preto- SP
(FAMERP), Brazil. [email protected]
Abstract
The aim of this paper is to report new options in the treatment
of lymphedema for under-privileged
populations. Several articles and books
have been published reporting recent advances and
contributions. A new
technique of manual lymph drainage, mechanisms of compression, development of
active and passive exercising apparatuses and the adaptation of
myolymphokinetic activities have been
developed for the treatment of
lymphedema. This novel approach can be adapted for the treatment of
lymphedema in mass.
PMID: 20428336 [PubMed - in process]
Department of Rehabilitation Medicine, Seoul National University College of
Medicine, Seoul National
University Bundang Hospital, 300 Gumi-dong
Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707,
Republic of Korea.
Abstract
PURPOSE: The aims of the study were to investigate longitudinal
changes in multiple domains of
problems with sexual functioning in Korean
breast cancer survivors in the first year after surgery for
breast cancer
and to determine which factor(s), including upper limb dysfunction, may
influence sexual
problems.
METHODS: Women diagnosed with breast cancer (n = 191) were initially assessed
at baseline before
surgery and completed follow-ups at 3, 6, and 12 months
after surgery. Survey items included sexual
interest, sexual activity,
satisfaction with sex life, feeling sexually attractive, body image, medical
history,
symptoms, upper limb dysfunction, and sociodemographics.
RESULTS: The prevalence of sexually active women was 39.2% at 3 months, which
increased to
48.2% at 6 months, and 50% at 12 months after surgery. Compared
with pretreatment levels,
considerably more women reported moderate or
severe problems with sexual interest and sexual activity
at 3, 6, and 12
months after surgery. Chemotherapy was related to sexual problems only early
after
treatment, and surgical procedure (extensive vs. conservative) had no
significant effect on sexual
problems. Low perceived sexual attractiveness
in 3 months after surgery was related to greater overall
sexual problems.
Lymphedema was significantly related to sexual disinterest at all stages of
follow-up
and to sexual satisfaction at the 6 month follow-up after
adjusting for other predicting factors.
CONCLUSIONS: Although sexual activity gradually improved during the first
year, more women
reported moderate or severe problems with sexual interest
and activity over time. Upper limb
dysfunction, such as that caused by
lymphedema, is a significant factor that may interfere with sexual
functioning in breast cancer survivors.
PMID: 20419495 [PubMed - as supplied by publisher]
3. J Indian Assoc Pediatr Surg. 2009 Oct;14(4):230-1.
Saxophone penis due to primary lymphoedema.
Jain VK, Singh S, Garge S, Negi A.
Department of Surgery, SAIMS, Indore, India.
Abstract
Congenital lymphoedema is a rare disorder that may result in
disfiguring edema of the male genitalia. The
treatment of persistent
lymphoedema is surgical and consists of meticulous excision of all subcutaneous
layers of the affected skin, combined with reconstruction of the penis and
or scrotum.
PMID: 20419030 [PubMed - in process]PMCID: PMC2858891
4. Indian J Orthop. 2010 Apr;44(2):198-201.
One-stage release of congenital constriction band in lower limb from new born
to 3 years.
Das SP, Sahoo P, Mohanty R, Das S.
Swami Vivekananda National Institute of Rehabilitation Training and Research,
Olatpur, Bairoi, Cuttack,
Orissa-754 010, India.
Abstract
BACKGROUND: Congenital constriction band is the most common cause
of terminal congenital
malformation of a limb and lymphoedema. Superficial
bands do not need any treatment, but deeper
bands are managed with excision
and Z-plasty. The circumferential bands are released in two to three
stages
to prevent vascular compromise. The purpose of this study was to present the
outcome of
one-stage release.
MATERIALS AND METHODS: Nineteen children, 12 boys and 7 girls, with 24
congenital
constriction bands constituted the clinical material. The mean
age at presentation was 57 days (range 12
hours to 3 years) Band was
unilateral in 14 and bilateral in five limbs. In unilateral cases, right side
was
involved in nine cases and left side in five. The constriction band is
seen at the junction of middle and
distal third. The patients having
constriction bands in lower limbs and age less than 3 years were included
in
the study. One stage circumferential release of congenital constriction band was
performed. Our
youngest patient was operated at the age of six months. Club
feet, (n=8) and lymphedema (n=7) were
associated anomalies. Club feet and
band were released in one stage in three limbs. The results were
evaluated
by criteria described by Joseph Upton and Cissy Tan.
RESULTS: There were 18
excellent, six satisfactory results. No wound problem occurred. No vascular
compromise was noted during or after the procedure. On follow-up, distal
swelling reduced.
CONCLUSIONS: One-stage circumferential release of
congenital constriction band in lower limbs with
or without lymphodema is a
safe and easy procedure.
PMID: 20419008 [PubMed - in process]PMCID: PMC2856396
1. SADJ. 2010 Feb;65(1):14, 16-8.
Facial lymphoedema as an indicator of terminal disease in oral HIV-associated
Kaposi sarcoma.
Feller L, Khammissa RA, Wood NH, Jose RJ, Lemmer J.
Department of Periodontology and Oral Medicine, School of Oral Health
Sciences, University of
Limpopo, Medunsa Campus, South Africa. [email protected]
Abstract
Rapidly progressive facial lymphoedema developing concurrently
with, or immediately after rapid
enlargment of oral Kaposi sarcoma (KS) in
HIV-seropositive highly active antiretroviral treatment
(HAART)-naïve
subjects, foretokens death. We present here an unusual case of HIV-KS in an
11-year-old HIV-seropositive HAART-naïve boy. Our patient's KS disease had
had a fulminant course
characterised by rapidly progressing oral HIV-KS,
resorption of the mandibular alveolar bone process
beneath some of the
HIV-KS lesions, and rapidly progressive facial lymphoedema. He died 3 weeks
after the onset of facial lymphoedema.
PMID: 20411797 [PubMed - in process]
2. Hell J Nucl Med. 2010 Jan-Apr;13(1):6-10.
Diagnostic application of lymphoscintigraphy in the management of
lymphoedema.
Sadeghi R, Kazemzadeh G, Keshtgar M.
Nuclear Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract
Lymphoedema (LOE) is an under-diagnosed condition which can cause
severe incapacitating swelling of
the extremities. Misdiagno sis and/or
delayed diagnosis are common and the goal of further evaluation is
to
confirm the cause and determine the type and site of lymphatic obstruction.
Lymphoscintigraphy
(LSG) is a minimally invasive way of evaluation of the
lymphatic system and can be used in the
management of the LOE patients.
However, many aspects of this useful diagnostic procedure are not
fully
explained in the med ical literature. In this article we briefly explain the
etiology and pathophysiology
of LOE. Methodology and applications of LSG for
the evaluation of this disease are extensively
reviewed.
PMID: 20411162 [PubMed - in process
3. Dermatol Online J. 2010 Apr 15;16(4):4.
Papillary intralymphatic angioendothelioma of the thigh: A case report and
review of the literature.
Ward KA, Ecker PM, White RR, Melnik TE, Gulbahce EH, Wilke MS, Sangueza
OP.
University of Minnesota, USA.
Abstract
The term angiosarcoma, encompasses several neoplasms, all of
which exhibit a malignant process
derived from endothelial cells of the
vessels. The most common form of angiosarcoma is highly
aggressive, often
fatal, and usually affects the head and neck region of elderly white men. Other
low-grade forms of angiosarcoma, including papillary intralymphatic
angioendothelioma, also known as
Dabska tumor, are less invasive, affect a
wider age range, and offer a better prognosis. There are several
predisposing factors that increase the risk of angiosarcoma and include
chronic lymphedema of the
extremities, preexisting vascular lesions, and
prior radiation, often as therapy for other malignancies. We
report an
unusual case of a very small, low-grade angiosarcoma on the thigh of an adult
female with no
known predisposing risk factors.
PMID: 20409411 [PubMed - in process]
4. Int Wound J. 2010 Feb;7(1):14-26.
The experience of children and families with lymphoedema--a journey within a
journey.
Moffatt CJ, Murray SG.
University of Glasgow, Glasgow, UK. [email protected]
Abstract
This paper reports on a study in the UK that explored the
experience of children suffering with
Lymphoedema and that of their
families. Qualitative data was collected from 20 children between the
ages
of 6 and 18 and their respective parents. Single, semi-structured interviews
were used in which
children and their parents were asked to share how
lymphoedema impacted on their family life. Children
were asked about their
school experience, their dreams and their aspirations. Three categories emerged.
Firstly, the negotiation of the health care system. Themes included correct
diagnosis, finding robust
information and reaching a knowledgeable expert.
The second category explored the complex role of the
parents as advocates.
Themes within this category included the dilemmas of parenting and the
increasing
challenges as children reached adolescence. The final category
involved the impact on the family unit.
The first theme concerned the
integration of lymphoedema into daily activities and the intrusion on family
time. The second explored the impact on siblings and the final theme the
changing dilemmas as children
moved through the stages of childhood and
faced adulthood.
PMID: 20409247 [PubMed - in process]
5. Br J Dermatol. 2010 Apr 16. [Epub ahead of print]
High resolution cutaneous ultrasonography to differentiate lipoedema from
lymphoedema.
Naouri M, Samimi M, Atlan M, Perrodeau E, Vallin C, Zakine G, Vaillant L,
Machet L.
Université François Rabelais de Tours; UMR, Inserm U930, CNRS ERL 3106;
Inserm CIC 202,
Department of Dermatology, Department of Plastic Surgery,
Department of Radiology, CHRU de
Tours; France.
Abstract
Summary Introduction. Lipoedema is an accumulation of fat
abnormally distributed in the lower limbs,
and lymphoedema is edema caused
by a deficiency of the lymphatic system. High-resolution ultrasound
operating at 20 MHz makes it possible to characterise dermal oedema. The
purpose of our study was to
demonstrate that high-resolution ultrasound
imaging of the skin was able to differentiate lipoedema from
lymphoedema.
Patients and method. Sixteen patients with lymphoedema (22 legs), 8 patients
with
lipoedema (16 legs) and 8 controls (16 legs) were included. Patients
with lipolymphoedema were
excluded. Ultrasound examinations were carried out
with a real time high resolution ultrasound device on
3 different sites for
each lower limb. The images were then anonymized and examined by an independent
dermatologist who was blind to the clinical diagnosis. A new series of
images was examined by 3
dermatologists to check inter-observer agreement.
Results. A significant difference in dermal thickness
was observed between
lymphoedema and lipoedema patients and lymphoedema patients and controls.
No
significant difference in dermal thickness was shown between lipoedema and
controls at the thigh or
ankle. Dermal hypoechogenicity was evidenced on at
least one of the three sites in 100% of
lymphoedema patients, 12.5% of
lipoedema patients and 6.25% of controls. Hypoechogenicity affected
the
entire dermis in all cases of lymphoedema except one. In cases of lipoedema and
controls,
hypoechogenicity was only localized at the ankle and prevailed in
the upper dermis. The expert
diagnosed all lower limbs with lymphoedema. No
cases of lipoedema were diagnosed as lymphoedema.
Exact inter-observer
agreement was excellent (0.98). Conclusions. High-resolution cutaneous
ultrasonography makes it possible to differentiate lymphoedema from
lipoedema. Obtaining a reliable
diagnosis through high resolution cutaneous
ultrasonography might be valuable to improve the treatment
of lipoedema and
lymphoedema.
PMID: 20408836 [PubMed - as supplied by publisher]
. Int J Med Sci. 2010 Apr 15;7(2):68-71.
Godoy & Godoy technique in the treatment of lymphedema for
under-privileged populations.
de Godoy JM, de Godoy Mde F.
Stricto-Sensu and Lato-Sensu of Course in Medicine of Medical School in São
José do Rio Preto-
SP (FAMERP), Brazil. [email protected]
Abstract
The aim of this paper is to report new options in the treatment
of lymphedema for under-privileged
populations. Several articles and books
have been published reporting recent advances and
contributions. A new
technique of manual lymph drainage, mechanisms of compression, development
of active and passive exercising apparatuses and the adaptation of
myolymphokinetic activities have
been developed for the treatment of
lymphedema. This novel approach can be adapted for the
treatment of
lymphedema in mass.
PMID: 20428336 [PubMed - in process]PMCID: PMC2860639
2. Contrib Nephrol. 2010;164:227-36. Epub 2010 Apr 20.
Fluid assessment and management in the emergency department.
Di Somma S, Gori CS, Grandi T, Risicato MG, Salvatori E.
Sant'Andrea Hospital, Second Faculty Medical School, "La Sapienza" University
of Rome, Rome,
Italy.
Abstract
Evaluation of hydration state or water homeostasis is an
important component in the assessment and
treatment of critically ill
patients in the emergency department (ED). The main purpose of ED
physicians
is to immediately distinguish between normal hydrated, dehydrated and
hyperhydrated
states. Fluid depletion may result from renal losses and
extrarenal losses (from the GI tract,
respiratory system, skin, fever,
sepsis, third space accumulations). Total body fluid increase can
result
from heart failure, kidney disease, liver disease, malignant lymphoedema or
thyroid disease. In
patients with fluid overload due to acute heart failure,
diuretics should be given when there is
evidence of systemic volume
overload, in a dose up-titrated according to renal function, systolic
blood
pressure, and history of chronic diuretic use. The bioelectrical impedance
vector analysis
(BIVA) is a noninvasive technique to estimate body mass and
water composition by bioelectrical
impedance measurements, resistance and
reactance. In patients with hyperhydration state due to
heart failure, some
authors showed that reactance is strongly related to BNP values and the NYHA
functional classes. Other authors found a correlation between impedance and
central venous pressure
in critically ill patients. We have been analyzing
the hydration state at admission to the ED, 24, 72 h
after admission and at
discharge, and found a significant and indirectly proportional correlation
between BIVA hydration and the Caval index at the time of presentation to
the ED and 24 and 72 h
after hospital admission. Moreover, at admission we
found an inverse relationship between BIVA
hydration and reduced urine
output that became directly proportional at 72 h. This confirms the good
response to diuretic therapy with the shift of fluids from interstitial
spaces.
Copyright (c) 64\C S. Karger AG, Basel.
PMID: 20428007 [PubMed - in process]
3. Womens Health (Lond Engl). 2010 May;6(3):399-406.
Breast cancer and lymphedema: a current overview for the healthcare
provider.
Rourke LL, Hunt KK, Cormier JN.
University of Texas, MD Anderson Cancer Center, Department of Surgical
Oncology, Houston, TX
77030, USA. [email protected]
Abstract
Lymphedema is a troublesome condition faced by many breast cancer
survivors today. Since
lymphedema represents a debilitating and progressive
problem that is feared by most breast cancer
patients and their providers,
an up-to-date understanding is necessary in order to better diagnose,
treat
and manage these patients. The etiology of lymphedema is multifactorial and
poorly understood.
Although lymphedema is not clearly defined within the
medical community, there are several
diagnostic tools available to the
clinician, of which the most widely accepted in the clinical setting are
the
arm circumference measurements. Misinformation has recently been conveyed
regarding activity
recommendations for those patients afflicted with
lymphedema. These recent events highlight the
critical importance of
education, heightened awareness and dedicated future cooperative research in
order to favorably impact on lymphedema care and the quality of life for
those living with
lymphedema.
PMID: 20426606 [PubMed - in process]
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Mar;26(2):103-6.
[The pathological characteristics and clinical significances of maturational
change of port-wine stain]
[Article in Chinese]
Wang W, Lin XX, Ma G, Li W, Hu XJ, Jin YB, Chen H, Yang C, Wang W.
Department of Plastic and Reconstructive Surgery, Ninth People's Hospital,
Shanghai Jiaotong
University, Shanghai 200011, China. [email protected]
Abstract
OBJECTIVE: In this study histologic observations were presented
to elucidate the possible
mechanism of maturational change of port-wine
stain(PWS).
METHODS: Normal PWS(3 cases) , thicken PWS (11 cases) and nodular PWS (9
cases) were
included to present histologic observations.
RESULTS: Normal PWS, only shows mild dilated, thin-walled vessels within
superficial dermis.
Thicken PWS, shows further dilated vessels and sebaceous
gland throughout dermis and superficial
subcutaneous fat. Nodular PWS can be
divided into three groups. I Similar to thicken PWS, shows
further dilated
vessels and sebaceous gland throughout dermis and superficial subcutaneous fat.
II
Shows Large number of dilated vessels, honeycombin and less vascular
mesenchymall. III Tenacious
texture shows mild dilated vessels, diffused
collagen, mesenchymal rarefactin, lymphocyte infiltration
and lymphedema
change.
CONCLUSIONS: Histologic examination revealed not only the expected vascular
abnormalities, but
also a number of widely distributed hamartomatous changes
in thicken and nodular PWS. The
complex hamartomatous changes suggest a
genetically determined, multilineage developmental field
defect in the
pathogenesis of PWS.
PMID: 20540312 [PubMed - in process]
1. J Vector Borne Dis. 2010 Jun;47(2):91-6.
Bancroftian filariasis among the Mbembe people of Cross River state,
Nigeria.
Okon OE, Iboh CI, Opara KN.
Department of Zoology & Environmental Biology, University of Calabar,
Calabar, Nigeria.
Abstract
BACKGROUND & OBJECTIVE: Bancroftian filariasis is a major
public health and socioeconomic
problems in the humid tropical and
subtropical regions of the world. A study was undertaken to
investigate the
status of the disease in some rural communities of Cross River State, Nigeria,
with a
view to enriching the epidemiological baseline data of the disease in
Nigeria.
METHODS: A total of 897 Mbembe people living in six major villages of Obubra
Local
Government Area of Cross River State, Nigeria were examined between
December 2008 and June
2009 for lymphatic filariasis due to Wuchereria
bancrofti.
RESULTS: Out of the 897 persons examined, 139 (15.5%) were positive for
microfilariae in their
blood smear. Infection varied significantly among
villages (p <0.05) but was not sex-specific (p >0.
05). The overall
mean microfilarial density among the total population was 9.9 mf/50 microl. The
occurrence of microfilaria in the peripheral blood of the infected persons
was neither age nor sex
specific (p >0.05). The most important clinical
manifestations were hydrocele (9.7%) and
lymphoedema (2.3%). Overall disease
prevalence was (6.8%).
CONCLUSION: Government effort on the Community Directed Treatment with
Ivermectin (CDTI)
project should be complimented with albendazole
distribution to the endemic communities.
Environmental sanitation should
also be intensified to eliminate the breeding sites of the mosquito
vectors.
PMID: 20539046 [PubMed - in process]
2. J Surg Res. 2010 Apr 18. [Epub ahead of print]
Treatment of Post-Mastectomy Lymphedema with Laser Therapy: Double Blind
Placebo Control
Randomized Study.
Ahmed Omar MT, El Morsy AM, Abd-El-Gayed Ebid A.
Faculty of Physical Therapy, Cairo, Egypt. Member of International Panel of
Advisory Board for
Indian Journal of Physiotherapy and Occupational
Therapy.
Abstract
BACKGROUND: In post-mastectomy patients, lymphedema has the
potential to become a
permanent progressive condition and become extremely
resistant to treatment. Thus, it can results in
function impairment and
decrease quality of life. The aim of this study was to evaluate the effect of
low level laser therapy (LLLT) on limb volume, shoulder mobility, and hand
grip strength.
MATERIAL AND METHODS: Fifty women with breast cancer-related lymphedema were
enrolled
in a double-blind, placebo controlled trial. Patients were randomly
assigned to active laser (n = 25)
and placebo (n = 25) groups and received
irradiation with Ga-As laser device that had wavelength of
904 nm, power of
5 mW, and spot size of 0.2 cm(2) over the axillary and arm areas, three times a
week for 12 wk. The total energy applied at each point was 300 mjoules over
seven points, giving a
dosage of 1.5 joules/cm(2) in the active group. The
placebo group received placebo therapy in
which the laser had been disabled
without affecting its apparent function. Limb circumference,
shoulder
mobility, and grip strength were measured before treatment and at 4, 8, and 12
wk.
RESULTS: The two groups had similar parameters at baseline. The reduction of
limb volume tended
to decline in both groups. The trend being more
significantly pronounced in active LLLT group than
placebo at 8 and 12 wk,
respectively (P < 0.05). Goniometric data for shoulder mobility and hand
grip strength were statistically significance for LLLT group than for
placebo.
CONCLUSION: Laser treatment was found to be effective in reducing the limb
volume, increase
shoulder mobility, and hand grip strength in approximately
93% of patients with postmastectomy
lymphedema. Copyright © 2010 Elsevier
Inc. All rights reserved.
PMID: 20538293 [PubMed - as supplied by publisher]
3. Lancet Oncol. 2010 May 25. [Epub ahead of print]
Angiosarcoma.
Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ.
Academic Unit of Surgical Oncology, School of Medicine and Biomedical
Sciences, University of
Sheffield, Sheffield, UK.
Abstract
Angiosarcomas are rare soft-tissue sarcomas of endothelial cell
origin that have a poor prognosis.
They can arise anywhere in the body, most
commonly presenting as cutaneous disease in elderly
white men, involving the
head and neck and particularly the scalp. They can be caused by therapeutic
radiation or chronic lymphoedema and hence secondary breast angiosarcomas
are an important
subgroup. Recent work has sought to establish the molecular
biology of angiosarcomas and identify
specific targets for treatment.
Interest is now focused on trials of vascular-targeted drugs, which are
showing promise in the control of angiosarcomas. In this review we discuss
angiosarcoma and its
current management, with a focus on clinical trials
investigating the treatment of advanced disease.
Copyright © 2010 Elsevier
Ltd. All rights reserved.
PMID: 20537949 [PubMed - as supplied by publisher]
4. Am J Hum Genet. 2010 Jun 11;86(6):943-8. Epub 2010 May 27.
GJC2 missense mutations cause human lymphedema.
Ferrell RE, Baty CJ, Kimak MA, Karlsson JM, Lawrence EC, Franke-Snyder M,
Meriney SD,
Feingold E, Finegold DN.
Department of Human Genetics, Graduate School of Public Health, University of
Pittsburgh,
Pittsburgh, PA 15261, USA.
Abstract
Lymphedema is the clinical manifestation of defects in lymphatic
structure or function. Mutations
identified in genes regulating lymphatic
development result in inherited lymphedema. No mutations
have yet been
identified in genes mediating lymphatic function that result in inherited
lymphedema.
Survey microarray studies comparing lymphatic and blood
endothelial cells identified expression of
several connexins in lymphatic
endothelial cells. Additionally, gap junctions are implicated in
maintaining
lymphatic flow. By sequencing GJA1, GJA4, and GJC2 in a group of families with
dominantly inherited lymphedema, we identified six probands with unique
missense mutations in
GJC2 (encoding connexin [Cx] 47). Two larger families
cosegregate lymphedema and GJC2
mutation (LOD score = 6.5). We hypothesize
that missense mutations in GJC2 alter gap junction
function and disrupt
lymphatic flow. Until now, GJC2 mutations were only thought to cause
dysmyelination, with primary expression of Cx47 limited to the central
nervous system. The
identification of GJC2 mutations as a cause of primary
lymphedema raises the possibility of novel
gap-junction-modifying agents as
potential therapy for some forms of lymphedema. Copyright 2010
The American
Society of Human Genetics. Published by Elsevier Inc. All rights reserved.
PMID: 20537300 [PubMed - in process]
5. Microcirculation. 2010 May;17(4):281-96.
Lymphatic dysfunction, not aplasia, underlies milroy disease.
Mellor RH, Hubert CE, Stanton AW, Tate N, Akhras V, Smith A, Burnand KG,
Jeffery S, Mäkinen
T, Levick JR, Mortimer PS.
Cardiac & Vascular Sciences (Dermatology), St George's Hospital Medical
School, University of
London, London, UK.
Abstract
OBJECTIVE: Milroy disease is an inherited autosomal dominant
lymphoedema caused by mutations
in the gene for vascular endothelial growth
factor receptor-3 (VEGFR-3, also known as FLT4). The
phenotype has to date
been ascribed to lymphatic aplasia. We further investigated the structural and
functional defects underlying the phenotype in humans.
METHODS: The skin of the swollen foot and the non-swollen forearm was
examined by (i)
fluorescence microlymphangiography, to quantify functional
initial lymphatic density in vivo; and (ii)
podoplanin and LYVE-1
immunohistochemistry of biopsies, to quantify structural lymphatic density.
Leg vein function was assessed by colour Doppler duplex ultrasound.
RESULTS: Milroy patients exhibited profound (86-91%) functional failure of
the initial lymphatics in
the foot; the forearm was unimpaired. Dermal
lymphatics were present in biopsies but density was
reduced by 51-61% (foot)
and 26-33% (forearm). Saphenous venous reflux was present in 9/10
individuals with VEGFR3 mutations, including two carriers.
CONCLUSION: We propose that VEGFR3 mutations in humans cause lymphoedema
through a
failure of tissue protein and fluid absorption. This is due to a
profound functional failure of initial
lymphatics and is not explained by
microlymphatic hypoplasia alone. The superficial venous valve
reflux
indicates the dual role of VEGFR-3 in lymphatic and venous development.
PMID: 20536741 [PubMed - in process]
6. Genet Med. 2010 Jun 8. [Epub ahead of print]
Spinal extradural arachnoid cysts in lymphedema-distichiasis syndrome.
Sánchez-Carpintero R, Dominguez P, Núñez MT, Patiño-García A.
From the 1Department of Pediatrics, Pediatric Neurology Unit; 2Department of
Radiology,
Neuroradiology Unit; and 3Department of Pediatrics, Laboratory of
Pediatrics, University Clinic of
Navarra, Pamplona, Spain.
Abstract
PURPOSE:: Lymphedema-distichiasis syndrome is characterized by
the presence of lower limb
lymphedema and supernumerary eyelashes arising
from the Meibomian glands. Spinal extradural
arachnoid cysts have been
observed in some families but their true frequency is unknown. The aim of
this study is to determine the frequency of spinal extradural arachnoid
cysts in lymphedema
distichiasis syndrome.
METHODS:: We collected clinical information from all 45 living members of a
complete family of 48
members and performed molecular analysis of the FOXC2
gene in 30 individuals. We obtained
spinal magnetic resonance imaging from
all family members with a FOXC2 gene mutation.
RESULTS:: Twelve family
members carried a mutation in the FOXC2 gene and had clinical features
of
lymphedema-distichiasis syndrome. Of these, 58% (seven individuals) had
extradural arachnoid
cysts.
DISCUSSION:: We suggest that a follow-up protocol for lymphedema-distichiasis
syndrome
families should include spinal magnetic resonance imaging for all
affected members so that the timing
of surgery for removal of these cysts
can be optimized.
PMID: 20535019 [PubMed - as supplied by publisher]
7. Ugeskr Laeger. 2010 Jun 7;172(23):1765-6.
[Recurrent post surgical cellulitis of the breast][Article in Danish]
Thoning JM, Thormann H.
Svendborg Sygehus, Medicinsk Afdeling, Odense Universitetshospital, 5230
Odense, Denmark.
[email protected]
Abstract
Differentiation between infectious and non-infectious cellulitis
is a frequent clinical issue. Often, there
is no proven portal of entry for
infection and it is difficult to obtain a positive culture. Two case
stories
with recurrence of postoperative cellulitis are presented. Lymphoedema, often
seen post
surgery, is itself inflammatory and may cause inflammatory
cellulitis. In recurrent cases of cellulitis
without any effect of
antibiotic treatment, inflammatory cellulitis should be considered.
PMID: 20534207 [PubMed - in process]
June 6, 1010 - This is Now Considered a Critical Piece of Cancer
Treatment -
The research of Dr. Kathryn Schmitz, which had already research reversed
decades of cautionary
exercise advice given to breast cancer patients with
lymphedema, led an expert panel to developed
the new recommendations.
According to Eurekalert:
"Cancer patients and survivors should strive to get the same 150 minutes per
week of moderate-
intensity aerobic exercise that is recommended for the
general public ... Though the evidence
indicates that most types of physical
activity -- from swimming to yoga to strength training -- are
beneficial for
cancer patients, clinicians should tailor exercise recommendations to individual
patients".
Sources: Science Daily June 1, 2010
Dr. Mercola's Comments:
As little as a decade ago, it was common for physicians to advise their heart
attack patients to avoid
exercise for fear that they could stress out their
heart and trigger a second attack.
Now, it's common knowledge that exercise is a phenomenal way to strengthen
your heart after a
heart attack as well as lessen your risk of further
problems, and regular exercise is routinely
recommended to heart
patients.
For cancer patients, this trend is still in the beginning stages, with many
practitioners advising their
patients to avoid exercise during and after
cancer treatment. But increasing evidence is showing that
this outdated
advice is actually causing cancer patients harm, as regular exercise can lead to
a
number of health improvements for cancer patients, including:
· Better aerobic fitness
· Increased muscular
strength
· Improved quality of
life
· Less fatigue
Exercise Improves Cancer Survival
I've written a lot about how exercise can help to reduce your risk of cancer
in the first place, but
does it do any good if you're already fighting
cancer? Yes … a lot.
Harvard Medical School researchers found patients who exercise moderately --
3-5 hours a week
-- reduce their odds of dying from breast cancer by about
half as compared to sedentary women. In
fact, any amount of weekly exercise
increased a patient's odds of surviving breast cancer. This
benefit also
remained constant regardless of whether women were diagnosed early on or after
their
cancer had spread.
Patients receiving the biggest boost from exercise were those most sensitive
to estrogen, the most
common form of breast cancer. (Previous research has
shown exercise lowers estrogen levels, which
can fuel the growth of breast
cancer cells.)
Think about it. If just three to five hours of walking per week can so
drastically improve your
chances of surviving a hormone-responsive breast
cancer tumor, imagine what a few more hours a
week of exercise could do for
you.
If you're male, be aware that athletes have lower levels of circulating
testosterone than non-athletes,
and similar to the association between
estrogen levels and breast cancer in women, testosterone is
known to
influence the development of prostate cancer in men.
Physical activity can reduce your risk and boost your chances of recovery if
you have cancer.
Exercise is a Potent Cancer Fighter
Cancer thrives on sugar, but regular exercise reduces your insulin levels,
which creates a low sugar
environment that discourages the growth and spread
of cancer cells. Controlling your insulin levels is
one of the most powerful
steps you can take to reduce your cancer risk and help keep it from
returning.
Physically active adults experience about half the incidence of colon cancer
as their sedentary
counterparts. Exercise has a beneficial influence on
insulin, prostaglandins and bile acids, all of which
are thought to
encourage the growth and spread of cancer cells in your colon. Exercise also
improves
bowel transit time, which means your body's waste is spending less
time in contact with the mucosal
lining of your colon.
Exercise also improves the circulation of immune cells in your blood. The job
of these cells is to
neutralize pathogens throughout your body.
The better these cells circulate, the more efficient your immune system is at
locating and defending
against viruses and diseases, including cancer,
trying to attack your body.
It's also been suggested that apoptosis (programmed cell death) is triggered
by exercise, causing
cancer cells to die. So you can see why a regular
exercise program is important not only during any
treatment you're receiving
but also afterward as well.
Exercise Tips for Cancer Patients
I would also strongly recommend that you read the lead article in today's
newsletter that reviews
some of the newest insights on how to optimize your
exercise program and actually reduce your
exercise time and improve your
benefits.
You will need to tailor your exercise routine to your individual scenario,
taking into account your
stamina and current health. Often, you will be able
to take part in a regular exercise program -- one
that involves a variety of
exercises like strength training, core-building, stretching, aerobic and
anaerobic -- with very little changes necessary.
However, you may find that you need to exercise at a lower intensity or for
shorter durations at
times. Always listen to your body and if you feel you
need a break, take time to rest. Even exercising
for a few minutes a day is
better than not exercising at all, and you'll likely find that your stamina
increases and you're able to complete more challenging workouts with each
passing day.
In the event you are suffering from a very weakened immune system, you may
want to exercise in
your home instead of visiting a public gym. But remember
that exercise will ultimately help to boost
your immune system, so it's very
important to continue with your program.
June 21, 2010 - Indian River County health notes for June 22 -
VNA screenings
The Visiting Nurse Association of the Treasure Coast is offering the
following no-cost blood
pressure and blood glucose screenings in June
June 22, (BP/BS) 9-11 a.m. Staples, 1191 U.S. 1, Vero Beach.
June 28, (BP/BS) 8:30-10 a.m. Sebastian Gym & Fitness, 345 Sebastian
Blvd., Sebastian.
For morning blood sugar tests, you should fast after midnight on the evening
before the screening.
For more information about health screenings or other
VNA services, call (772) 567-5551 or visit
www.vnatc.com.
Balancing hormones
A free workshop, “Balancing Hormones Safely and Naturally,” will be presented
6 p.m. Tuesday,
June 22, at Alternative Medicine Family Care Center, 3408
Aviation Blvd., Vero Beach.
The workshop addresses non-drug solutions to the hormone-related concerns of
women 0f all ages
including thyroid problems, hot flashes, fatigue, night
sweats, irregular cycle, headaches, trouble
sleeping, abnormal cramping,
depression and anxiety.
To R.S.V.P., call (772) 778-8877. Visit www.amfcc.info for more information on
alternative
medicine.
Digestive disorders
A free workshop on digestive disorders will be presented 6-7 p.m. Thursday,
June 24, at Alternative
Medicine Family Care Center, 3408 Aviation Blvd.,
Vero Beach.
This workshop will teach alternative approaches to preventing and relieving
common digestive
disorders including acid reflux, hiatal hernia, gas,
bloating, irritable bowel, diarrhea, stomach cramps,
Crohn’s Disease and
constipation.
Call (772) 778-8877 to R.S.V.P. For more info, visit www.amfcc.info.
Balance screenings
Sunshine Physical Therapy Clinic will be at the Walgreens on 17th Avenue and
U.S. 1 in Vero
Beach 10 a.m.-noon Wednesday, June 30, to do balance
screenings. For more information, call the
clinic at (772) 562-6877.
Blood pressure screenings
Blood pressure screenings are offered 10-11:30 a.m. the third Tuesday of
every month as Oxygen
Plus, 2360 U.S. 1, Vero Beach. For more information,
call (772) 569-0232 or write oxygen-
[email protected].
Wellness program
A free wellness presentation to raise antioxidant levels, improve immune
system functions and reduce
DNA damage will be offered at the Institute of
Colorectal Health & Wellness, 1255 37th St., Suite
B, Vero Beach, 7 p.m.
Thursdays.
R.S.V.P. at (772) 778-4773 or [email protected].
Walkers, wheelchairs
Veterans of Foreign Wars Post 3918, Vero Beach, has walkers, wheelchairs,
crutches, portable
commodes and motor scooters, available free for anybody
who needs them. For information, call the
Post 3918 office at (772) 567-8487
and leave your name and number.
Quit smoking
Free quit smoking now classes (all forms of tobacco) are offered to all
county residents 18 and older
at the Indian River County Health Department,
1900 27th St., Vero Beach.
Call (561) 640-3620 for dates and times. This is a community health promotion
program offered by
Everglades Area Health Education Center.
Mental health
The Mental Health Association has opened a walk-in center to provide people
in crisis immediate
access to help. Death in the family, domestic abuse,
depression, anxiety, parenting issues —
whatever the difficulty, MHA’s
therapists stand ready to assist. If you are interested in donating to
the
MHA or if you need help for yourself or your loved ones, call (772)
569-9788.
Health talk show
If you have missed any of Indian River Medical Center’s Health Talk TV
segments that air on
WWCI-TV Channel 10, you can now go to the hospital’s
Web site, www.irmc.cc. Under “Health
Resources” at the top of the home page, choose to watch any or all segments
from the first four
shows.
To view on YouTube, go to www.youtube.com and type “Indian River Medical
Center” in the
search box.
The show, hosted by Kim Beckett, wife of Dr. Clark W. Beckett, IRMC vascular
surgeon, features
the latest in health news and medical advances. The series
airs on Channel 10 on alternate Mondays
and Wednesdays at 4, 7 and 11
p.m.
E-mail questions, comments and suggested topics to [email protected].
Fitness camp
In partnership with the Club at Spine & Sport Institute, CityFit Outdoor
Fitness Camp is hosting
Brown Bag boot camps from noon to 12:50 p.m.
Tuesdays and Thursdays on 36th Street in Vero
Beach.
The camps are designed with a holistic approach to health and include
workouts, workshops and
field trips focused on smarter shopping and menu
planning..
The cost is $250 for six weeks. Call Jill at (772) 713-7938 or e-mail [email protected] to
reserve a spot.
Macular Degeneration
Free initial eye screenings are available at Diabetes Eye and Macular
Degeneration Institute for
patients who are diabetic or age 50 and older.
Call (772) 770-1577 to schedule an appointment at
93 Royal Palm Pointe, Vero
Beach.
Florida Eye Institute
Florida Eye Institute will begin free initial vision and glaucoma screenings
from 9 to 11 a.m. Fridays
at 2750 Indian River Blvd. in Vero Beach. Call
(772) 569-9500 or visit www.fleye.com for
more
information.
Monnett Eye Center
Monnett Eye Center provides free vision, glaucoma and hearing screenings from
9 a.m. to 2 p.m.
Tuesdays at the clinic, 14410 U.S. 1 in Sebastian. Monnett
Eye Center also provides local
businesses with free vision, glaucoma and
hearing screenings for their employees. For more
information and
appointments, call (772) 589-8111.
Aesthetic medicine
Find out what’s new in aesthetic medicine at a free informational seminar
presented by Ferdinand
Becker M.D., F.A.C.S. and Barry Boyd, M.D. 10-11 a.m.
Friday, June 25, at Advanced Facial
Cosmetic and Laser Surgery Center, 5070
N. State Road A1A, Vero Beach. Topics include
surgical and nonsurgical
cosmetic procedures such as dermal fillers, Zerona, fractional laser
resurfacing and photorejuvenation, as well as aesthetic surgery for the face
and body, including
facelifts and eyelid surgery, breast surgery, tummy
tucks and liposuction. The seminar is free, but
reservations are required.
Call (772) 234-3700.
Lymphedema therapy
Sunshine Physical Therapy Clinic, 1705 17th Ave., Vero Beach, now offers
lymphedema therapy
among its regular services. Michelle Dorfman is certified
in treating anyone with lymphedema of the
upper extremity. If you have had a
mastectomy, lumpectomy radiation treatment, lymph node
removal, other
surgeries or infections to the limbs, you may be at risk for developing
lymphedema.
For information, call (772) 562-6877.
June 22, 2010 - Dragonboat gets grant –
Prince George Northbreast Passage Dragon Boat team has received a grant for
$2,000 for the
upcoming season. The grant was part of a $50,000 Canadian
Breast Cancer Foundation grant
allotted to 22 B.C. Dragon Boat breast cancer
survivor teams for 2010.
The grant was created to celebrate the fact women can lead healthy and active
lives after breast
cancer. This region has supported the teams since 1997.
The Dragon Boat movement for breast
cancer survivors began in 1996 as the
result of a ground breaking study led by Dr. Don McKenzie ,
professor of
sports medicine at the University of British Columbia. He set out to investigate
the link
between upper body exercise and the development of lymphedema in
women with breast cancer.
Lymphedema is the swelling some women experience due to accumulation of fluid
in the arm and
chest after removal of lymph nodes for the treatment of
breast cancer.
In his study, 24 women, all with a history of breast cancer, volunteered for
the research project and
began training as dragon boaters. McKenzie found
that despite rigorous repetitive upper-body
exercises – which dragon boating
requires – no new cases of lymphemdema occurred and none of
the existing
cases progressed.
Women who participated showed a marked improvement in both physical and
mental health. From
this initial project in Vancouver, an international
movement of breast cancer survivor Dragon boat
teams has evolved.
Balance a touch away - Jerrilyn Zavada - 06/24/2010
An oasis of peace sits relatively untapped in downtown Streator.
Body/Mind/Spirit, owned by Amy Ryan of Streator, offers massage and
lymphedema therapy and
Reiki, among other services to provide a balance
between body and spirit.
Ryan is a graduate of the Illinois Valley Community College massage therapy
program. She practiced
locally for seven years, before going into private
practice.
"I love what I do and I love helping people," Ryan said. "I believe I have a
gift and I want to share it."
Ryan's philosophy in providing the services is simple. She provides massage
techniques tailored to
individual needs.
"A few simple changes can bring more balance into a busy lifestyle and you
can enjoy a higher, more
vibrant state of health," she said. "Blending the
wise ways of the East with dynamic ways of the West
is the necessary step
that would bring us closer to manifesting health and inner peace."
Ryan offers competitive prices for 30-minute, one-hour and 90-minute massage
sessions. She offers
discounts to senior citizens.
"A lot of them are on fixed incomes and it's so wonderful for them," she
said.
June 25, 2010 - Pulling together - Joey Coleman -
They paddle the west harbour every Saturday morning. Forty women in two
boats, determined to
paddle the fastest dragon boat in the world. Like all
athletes, they're focused on the next race -- the
next big challenge.
What makes these athletes different is their biggest challenge is behind
them. They're breast cancer
survivors.
The team formed 13 years ago after an article in Chatelaine about the debate
over upper body
exercise for women with breast cancer. Two decades ago, it
was believed this activity increased the
risk of lymphedema.
But a study by Dr. Don McKenzie of the University of British Columbia proved
conventional
wisdom was wrong.
Dragon boating is physically demanding and a challenge for even the most
healthy person.
"A lot of people believe it's canoeing and canoeing is a nice easy stroke,"
said Kathy Levy, a
founding member and now a coach with the team.
"A lot of our ladies, including me, did not do a lot of physical activity.
Now, all of the sudden, we
have triceps, biceps and calf muscles," said
coach Ann Fowbes Arndt.
They practise at Macassa Bay Yacht Club two days a week and on other days do
water aerobics,
marathon training, spinning, cross-training and even
boxing.
Two weekends ago, they won an international breast cancer survivors dragon
boat festival, beating
72 other international teams.
Husbands get involved, too, sometimes treating team members to breakfast when
they come off the
water.
"A couple years back, they had a race and they had to pull off a good time,"
said Jim Martin, whose
wife, Loraine, is on the team.
"I said if you can do this, I'll cook breakfast ... waffles and ice cream
with shaved chocolate,
strawberries cut into hearts."
Since then, he has been part of the shore team preparing breakfast following
each victory.
Racing, and the mental preparation involved, helps the paddlers think about
something other than
cancer, but it's never far from their thoughts.
"It's always in the back of your head that one day it may come back to bite
you," said Levy. "We
have lost three members already this year. It's
hard."
Team member Rae Puttock listened by cellphone from her bed as the team won in
Peterborough.
She died the next day.
"She was always a part of everything we were doing right up to the day before
she died," said Levy.
"You don't leave the team because you've retired or
you've been traded."
Levy and Fowbes Arndt say the losses increase their determination.
"We gather strength from the girls we've lost. It makes us paddle harder for
each of them. They're
with us on the boat."
June 24, 2010 - Decongestive Physiotherapy Helps Patients with Painful Leg
Swelling -
Source: Wolters Kluwer Health: Lippincott Williams &
Wilkins
Combination Approach Benefits Patients with Chronic Venous Insufficiency or
Lymphedema,
Reports Topics in Geriatric Rehabilitation
Newswise — For patients with painful swelling of the legs caused by chronic
venous insufficiency
(CVI), a combination treatment approach called
"complete decongestive physiotherapy" improves
symptoms, walking ability,
and quality of life, reports a study in Topics in Geriatric Rehabilitation.
The journal is published by Lippincott Williams & Wilkins, a part of
Wolters Kluwer Health, a
leading provider of information and business
intelligence for students, professionals, and institutions in
medicine,
nursing, allied health, and pharmacy.
Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce
leg swelling and
pain in patients with CVI, according to the new study, led
by Yesim Bakar, Ph.D., P.T., of Abant
Izzet Baysal University in Bolu,
Turkey. Another paper in the same issue of TGR shows similar
benefits of CDP
in a patient with lymphatic obstruction (lymphedema) related to the skin
condition
psoriasis.
Complete Decongestive Physiotherapy Brings Good Results
Dr Bakar and coauthors evaluated the effects of CDP in 62 older adults
(average age 65 years) with
CVI. Patients with CVI have poor blood flow in
the veins of the leg, leading to fluid buildup. This
results in painful
swelling, making it difficult for patients to walk and perform other activities.
Usually
only one leg is affected.
All patients were treated using the CDP approach, which combines four types
of physical therapy
treatments:
• Manual lymph drainage—massage to promote drainage of the lymph
nodes.
• Skin care—moisturizers and other treatments for skin changes caused
by poor circulation.
• Compression—bandages are applied to prevent fluid from
reaccumulating.
• Exercise—simple leg exercises to improve blood flow and leg
motion.
For the first month, patients met with a physical therapist five days a week
for treatment. They also
received education in performing each of the four
types of therapy for themselves. The goal was to
keep fluid buildup under
control through lifelong, daily self-care.
The CDP treatment program dramatically reduced leg swelling—on average, fluid
buildup in the
affected leg decreased by the equivalent of nearly half a
liter. Pain was also decreased, from an
average score of 67 to 18 on a
100-point scale. Patients had improved walking ability, less pain
when
walking, and improved ability to perform daily activities. The authors believe
that including
exercise in the treatment program was a key factor in
improving walking ability.
Dr. Bakar is also a co-author of the other paper, which reports on the use of
CDP in a woman with
lymphedema related to the chronic skin condition
psoriasis. In patients with lymphedema, obstruction
of the lymph nodes
causes similar symptoms of leg pain and swelling. In both the short and long
term,
CDP brought significant improvement in pain, swelling, and
activity.
In recent years, CDP has become an accepted approach to treatment for
lymphedema. Although not
a cure, CDP incorporates several physical therapy
techniques that can help keep fluid buildup, leg
swelling, and pain under
control.
The new studies are the first to evaluate the fully integrated CDP
approach—including daily home
maintenance therapy—in patients with CVI and
psoriasis-related lymphedema. "CDP is a time-
consuming process for patients
and physiotherapists," Dr. Bakar and colleagues write. "However, it
is
widely used and an effective treatment for patients with lymphedema." The new
results suggest that
this combination physical therapy approach could also
be very helpful for patients with leg pain and
swelling caused by CVI.
About Topics in Geriatric Rehabilitation
Topics in Geriatric Rehabilitation is a peer-reviewed quarterly
publication that presents clinical, basic,
and applied research, as well as
theoretic information, consolidated into a clinically relevant form.
TGR is
a leading resource for the healthcare professional practicing in the area of
geriatric
rehabilitation. TGR provides useful treatment information written
by and for specialists in all aspects
of geriatric care. Each issue focuses
on a specific topic, providing best practices and dependable
hands-on tips
and techniques.
Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international
publisher for healthcare professionals
and students with nearly 300
periodicals and 1,500 books in more than 100 disciplines publishing
under
the LWW brand, as well as content-based sites and online corporate and customer
services.
LWW is part of Wolters Kluwer Health, a leading provider of information and
business intelligence
for students, professionals and institutions in
medicine, nursing, allied health and pharmacy. Major
brands include
traditional publishers of medical and drug reference tools and textbooks, such
as
Lippincott Williams & Wilkins and Facts & Comparisons®; and
electronic information providers,
such as Ovid®, UpToDate®, Medi-Span® and
ProVation® Medical.
Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global
information services
company. Professionals in the areas of legal, business,
tax, accounting, finance, audit, risk,
compliance, and healthcare rely on
Wolters Kluwer’s leading, information-enabled tools and
solutions to manage
their business efficiently, deliver results to their clients, and succeed in an
ever
more dynamic world.
Wolters Kluwer has 2009 annual revenues of €3.4 billion ($4.8 billion),
employs approximately
19,300 people worldwide, and maintains operations in
over 40 countries across Europe, North
America, Asia Pacific, and Latin
America. Wolters Kluwer is headquartered in Alphen aan den Rijn,
the
Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included
in the AEX
and Euronext 100 indices.
June 19, 2010 - Post-surgery lymphedema often goes untreated -
Massage technique can help reduce hand swelling
Lymphedema is a physical and emotional problem for many post-surgery cancer
patients, "and all
too often not diagnosed," says Canadian lymphedema expert
Dr. Anna Towers.
"People go to emergency with a skin infection or ulcer and they are treated
for that, but not for the
underlying cause, which is severe swelling
lymphedema," says the McGill University professor.
She visited Victoria recently to talk about lymphedema, a fluid-retention
condition that can affect
anyone who has had radiation or surgery involving
lymph nodes.
Towers is founding chairwoman of the newly formed Canadian Lymphedema
Framework, which
seeks to raise the profile and treatment of this
condition.
Lymph is a fluid, found between the body's cells, that is carried by the
lymphatic system through
nodes. Unlike blood, it has no central pump, but
moves due to muscle action. Under ideal conditions,
the fluid feeds cells
and carries away excess waste and cancer cells, says the palliative care
physician.
But when damaged, the system doesn't drain well and any inflammation causes
even more to build
up. "We're doing a large Canadian study now
following women who've had breast cancer. We're
only halfway through; the
study goes from 2005 to 2015, and already we're showing 17 per cent
have
lymphedema. "It can appear immediately after treatment or years later,
after an injury - a
suntan, an infection from an insect sting, even air
travel," Towers says. "Inflammation exacerbates the
problem."
Untreated, lymphedema can lead to disability, loss of function, job loss and
early death.
Forty per cent of patients with the condition develop complications ranging
from infection to blood
clots, says Towers, associate professor in McGill's
oncology department and former director of its
palliative care division. She
is advocating across the country for better research, care and medical
coverage.
About 25,000 new cases occur in B.C. every year, mostly following surgeries
for breast, prostate,
colorectal, gynecological or melanoma cancers. (The
condition can also be genetic.)
Once lymphedema develops, the preferred treatment is hands-on, decongestive
massage to softly
guide lymph in the right direction, to reduce swelling and
improve function. A compression garment
or bandage is worn for
maintenance.
Robert Harris operates the Dr. Vodder clinic here, which trains therapists in
the massage. "It's very
light, gentle, rhythmic, and stimulates the lymph
vessels to pump," he says. "Patients love it," and
frequent massage can
bring a limb down 40 to 50 per cent in a month, which also lowers infection
risk.
"The therapy is life-changing but its success depends on how soon it
happens." One hour costs about
$85. The medical services plan picks up $23,
while some extended-health plans pay more.
A 60-year-old woman, who asked not to be identified, had a recent lumpectomy
and developed
swelling in her hand, arm and breast. "It was like an
overfilled balloon. I couldn't close my fist, get
my rings off. But after
about six treatments the therapist got my breast draining and my hand
working.
"I tried to get physio at the cancer clinic, but was told it would be up to
six week. I didn't want to
wait because it was getting bigger and bigger.
This therapy is wonderful."
Combined decongestive therapist Beth Atkinson took the Dr. Vodder lymph
drainage course and
works at Vitality Treatment Centre in Oak Bay, with
others trained in the specialty. There are eight in
the city. "We
cover seven days a week, because when a person comes in with a severe problem,
there's an intense phase before maintenance can begin. We might see them
three, four times a week,
for three weeks. "A patient might have a leg
that weighs twice what's normal. Even after massage,
there's tremendous
difference. People get off the table and say: Wow, I can bend my knee.' (Excess
water is eliminated through waste.)" She adds lymph drainage is useful
for other inflammatory
conditions, too, and patients can learn to do it
themselves.
Towers says the therapy should be covered by provincial medical plans, but
blamed lack of
leadership. Health policy favours prevention and treatment -
"as it should" - but that leaves less for
followup care, she says.
Because the treatment is not pharmacological, "we don't have the benefit of
pharmaceutical firms' resources to help advocate." In addition, many
problems appear years after the
cancer management ends.
The B.C. Cancer Agency recommends patients contact the Dr. Vodder school - www.vodderschool.
com or at 250-598-9862
for combined decongestive therapy. It's not available in hospitals, which
use compression pumps instead.
June 25, 2010 - Cancer centers revitalize survivors - By Helena Oliviero
-
For almost five months, Priscilla Tomlinson’s life revolved around regular
trips to the basement of
Piedmont Hospital. There, on every third Tuesday,
she underwent chemotherapy sessions lasting
almost eight hours to battle
ovarian cancer.
After each session, she went into her backyard and lit a bouquet of dried
sage, letting it waft over her
like incense. Two days later, a flu-like wave
would smash her to her core. Slowly, she would begin
to feel better. And
then it was time for the next Tuesday chemo date at Piedmont.
Then suddenly, in January 2007, her cancer treatments were done. She would
require checkups and
medication, but she was no longer a cancer patient.
Yet, moving forward was difficult, and she found herself returning to
Piedmont, again and again. But
no longer to the basement. Now she takes the
elevator to the 7th floor, to Piedmont’s Cancer
Wellness Center.
There, Tomlinson takes African drumming classes. She molds clay into pinch
pots. She jots down
her thoughts in an “expressive arts room.” She
participates in food demonstrations. She meditates
and meets with
therapists.
Tomlinson is among a growing number of cancer patients who are looking to
cancer centers for help
in making the transition to life as a survivor. And
more cancer centers are offering post-treatment
options.
Yoga, massage therapy and mind-body studios are becoming mainstream as
medical facilities extend
the traditional boundaries of health care. It
allows them to maintain relationships with the patients, as
well as meet
patient demands for more complementary and alternative approaches to
wellness.
“It helps me deal with the anxiety of scans and helps me stay in the
present,” said Tomlinson, 70,
who lives in Decatur. “It helps me from not
running stories in my mind thinking of all of the bad things
that can
happen. This helps me live my life.”
Seeking help
Cancer survivors are living longer and healthier lives. The chance of
surviving most cancer has been
steadily rising. For example, the 5-year
survival rate for breast cancer is now 90 percent, up from 75
percent in the
mid-to-late 1970s, according to the National Cancer Institute.
Still, fighting a deadly disease can leave survivors feeling battered and
confused, and struggling to find
their way. From soreness and scars to being
emotionally shaken, survivors often need help grappling
with everything from
depression and fatigue to body image concerns and relationship woes.
At the same time, Americans overall are increasingly looking outside
traditional medicine for their
health care needs.
About a third of Americans are using at least one form of what’s referred to
as “complementary or
alternative medicine.”
When megavitamins and prayer are included in this definition, the percentage
rises to 62 percent,
according to the National Institutes of Health.
Americans spend $34 billion annually in out-of-pocket
expenses on
complementary and alternative approaches, according to a 2009 analysis by the
Centers for Disease Control and Prevention.
Several smaller studies of cancer patients suggest many of them are seeking
alternative care. A study
published in the 2000 issue of the Journal of
Oncology found 69 percent of 453 cancer patients
turned to some aspect of
alternative care as part of their cancer treatment. A more recent study
published in a December 2004 issue of the Journal found 88 percent of 102
cancer patients enrolled
in a research study turned to CAM therapy, which
can include vitamins or minerals and acupuncture.
Filling a void
Dr. Perry Ballard, an oncologist at Piedmont since 1987, said he used to be
skeptical of
nontraditional care but now embraces its role in helping a
person get better.
“Life is never the same after you have cancer, and it goes beyond having the
most cutting-edge
therapies,” said Ballard. “You have to heal yourself
psychologically and spiritually. We are learning
more and more about the
mind-body connection.”
As a doctor seeing as many as 25 patients a day, Ballard said he hears a wide
range of emotional
aches and pains: a young woman who’s been prematurely
thrust into menopause because of a
mastectomy; a man losing sexual function;
young singles wondering if they will ever get married.
Complementary care, he said, helps fill the void of what traditional medicine
can do. And patients
addressing emotional and physical needs are better
patients — they are more likely to keep
appointments and stay on top of
their treatments.
Erika Baube, a licensed social worker at Georgia Cancer Specialists, said the
majority of her clients
seek counseling after they complete treatment.
During the treatment stage, patients are intently focused on doctors’
appointments, chemotherapy
and other all-consuming medical needs. Once that
intense routine ends, many emotions bubble up.
“There’s this emotional letdown at the end of treatment,” said Baube. “They
have been so focused
on getting through the treatment, and then it’s, ‘Now
what?’ They are finally allowing themselves to
feel the fear.”
Feeling up to par
After surgery and undergoing several rounds of radiation in 2007, Alice
Stubblefield turned to
Turning Point in Alpharetta, a nonprofit resource for
women with breast cancer offering physical
therapy, massage, counseling and
other services.
Stubblefield couldn’t shake lingering soreness and lymphedema, an
accumulation of fluid that
sometimes builds up and causes swelling after
cancer treatment. She also worried about her body
image, concerned about her
husband’s reaction to the mastectomy.
“I know my husband is here for me and still loves me, but the women there
helped me work through
the process and really accept myself,” said
Stubblefield.
Going to Turning Point also encouraged her to set goals. Among them: To play
golf with her husband
again.
For the longest time after her cancer, she had no interest in picking up a
set of clubs. Over time, her
outlook on life brightened. She and her husband
are golfing together again.
“Not only do you want to do more things, but it’s not the end of the world,”
she said. ‘What do I do
now?’
For Ned Crystal, who is 36, launching a new support group helped re-energize
him after his cancer
treatments. “We have been going through this
ritual of doctors and restrictive diet and you have this
moment of clarity
that gets clouded again.
What is a normal life and what do I do now? How do I go through a transition
of getting back to the
grindstone of work?” said Crystal, who was diagnosed
with sarcoma, a rare form of cancer
developing in the soft tissues of the
body, after suffering a knee injury three years ago. “They are
calling me a survivor and saying I am in the clear now. ... It’s frightening
and it’s unnerving” said
Crystal, who lives in Smyrna with his wife.
Crystal, who underwent treatment at Emory University’s Winship Cancer Center,
joined a steering
committee to help design a new program for cancer
survivors, including a peer-to-peer program
matching newly diagnosed cancer
patients with survivors. He’s also founded a new sarcoma support
group,
believed to be the first in Atlanta.
“According to the statistics, there is a 95 percent chance I’m not going to
make it five years. You can
fold up the tent and go home or make a
difference. ... For me, getting involved has renewed my
passion.” ‘I really needed this’
On a recent afternoon, Priscilla Tomlinson closes her eyes and taps on an
African drum. Then her
eyes spring open and she begins pounding
the instrument — boom, boom, boom! She releases
nervous energy. She releases
anxiety.
All of the participants in this class are cancer survivors. The chemotherapy,
the radiation, the surgery
is behind them. Yet, they all wrestle with the
fear it may one day return.
Harriet Sims, 40, is among those in this class. Dripping in sweat and
tearful, she smiles. Sims was
diagnosed two years ago with multiple myeloma,
a blood cancer. She underwent a stem-cell
treatment a year and a half ago.
She will get a follow-up biopsy during the coming days to see if the
cancer
has been kept at bay, “I can’t tell you how much I needed this,”
said Sims. “I come here
and it makes me feel good.”
Tomlinson gives her a hug.
As the class comes to a close, they sing together: “I’m a tower of strength
within and without, I am a
tower of strength within. All my fears slip away,
slip away, all my fears slip away.”
June 25, 2010 - CDP treatment can reduce pain and swelling in CVI patients
-
For patients with painful swelling of the legs caused by chronic venous
insufficiency (CVI), a
combination treatment approach called "complete
decongestive physiotherapy" improves symptoms,
walking ability, and quality
of life, reports a study in Topics in Geriatric Rehabilitation. The journal is
published by Lippincott Williams & Wilkins, a part of Wolters Kluwer
Health, a leading provider of
information and business intelligence for
students, professionals, and institutions in medicine, nursing,
allied
health, and pharmacy.
Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce
leg swelling and
pain in patients with CVI, according to the new study, led
by Yesim Bakar, Ph.D., P.T., of Abant
Izzet Baysal University in Bolu,
Turkey. Another paper in the same issue of TGR shows similar
benefits of CDP
in a patient with lymphatic obstruction (lymphedema) related to the skin
condition
psoriasis.
Complete Decongestive Physiotherapy Brings Good Results
Dr Bakar and coauthors evaluated the effects of CDP in 62 older adults
(average age 65 years) with
CVI. Patients with CVI have poor blood flow in
the veins of the leg, leading to fluid buildup. This
results in painful
swelling, making it difficult for patients to walk and perform other activities.
Usually
only one leg is affected.
All patients were treated using the CDP approach, which combines four types
of physical therapy
treatments:
•Manual lymph drainage—massage to promote drainage of the lymph
nodes.
•Skin care—moisturizers and other treatments for skin changes caused
by poor circulation.
•Compression—bandages are applied to prevent fluid from
reaccumulating.
•Exercise—simple leg exercises to improve blood flow and leg
motion.
For the first month, patients met with a physical therapist five days a week
for treatment. They also
received education in performing each of the four
types of therapy for themselves. The goal was to
keep fluid buildup under
control through lifelong, daily self-care.
The CDP treatment program dramatically reduced leg swelling—on average, fluid
buildup in the
affected leg decreased by the equivalent of nearly half a
liter. Pain was also decreased, from an
average score of 67 to 18 on a
100-point scale. Patients had improved walking ability, less pain
when
walking, and improved ability to perform daily activities. The authors believe
that including
exercise in the treatment program was a key factor in
improving walking ability.
Dr. Bakar is also a co-author of the other paper, which reports on the use of
CDP in a woman with
lymphedema related to the chronic skin condition
psoriasis. In patients with lymphedema, obstruction
of the lymph nodes
causes similar symptoms of leg pain and swelling. In both the short and long
term,
CDP brought significant improvement in pain, swelling, and
activity.
In recent years, CDP has become an accepted approach to treatment for
lymphedema. Although not
a cure, CDP incorporates several physical therapy
techniques that can help keep fluid buildup, leg
swelling, and pain under
control.
The new studies are the first to evaluate the fully integrated CDP
approach—including daily home
maintenance therapy—in patients with CVI and
psoriasis-related lymphedema. "CDP is a time-
consuming process for patients
and physiotherapists," Dr. Bakar and colleagues write. "However, it
is
widely used and an effective treatment for patients with lymphedema." The new
results suggest that
this combination physical therapy approach could also
be very helpful for patients with leg pain and
swelling caused by CVI.
June 26, 2010 - This is Now Considered a Critical Piece of Cancer
Treatment…-
The research of Dr. Kathryn Schmitz, which had already research reversed
decades of cautionary
exercise advice given to breast cancer patients with
lymphedema, led an expert panel to developed
the new recommendations.
According to Eurekalert:
"Cancer patients and survivors should strive to get the same 150 minutes per
week of moderate-
intensity aerobic exercise that is recommended for the
general public ... Though the evidence
indicates that most types of physical
activity -- from swimming to yoga to strength training -- are
beneficial for
cancer patients, clinicians should tailor exercise recommendations to individual
patients".
Sources: Science Daily June 1, 2010
Dr. Mercola's Comments:
As little as a decade ago, it was common for physicians to advise their heart
attack patients to avoid
exercise for fear that they could stress out their
heart and trigger a second attack.
Now, it's common knowledge that exercise is a phenomenal way to strengthen
your heart after a
heart attack as well as lessen your risk of further
problems, and regular exercise is routinely
recommended to heart
patients.
For cancer patients, this trend is still in the beginning stages, with many
practitioners advising their
patients to avoid exercise during and after
cancer treatment. But increasing evidence is showing that
this outdated
advice is actually causing cancer patients harm, as regular exercise can lead to
a
number of health improvements for cancer patients, including:
· Better aerobic fitness
· Increased muscular
strength
· Improved quality of
life
· Less fatigue
Exercise Improves Cancer Survival
I've written a lot about how exercise can help to reduce your risk of cancer
in the first place, but
does it do any good if you're already fighting
cancer? Yes … a lot.
Harvard Medical School researchers found patients who exercise moderately --
3-5 hours a week
-- reduce their odds of dying from breast cancer by about
half as compared to sedentary women. In
fact, any amount of weekly exercise
increased a patient's odds of surviving breast cancer. This
benefit also
remained constant regardless of whether women were diagnosed early on or after
their
cancer had spread.
Patients receiving the biggest boost from exercise were those most sensitive
to estrogen, the most
common form of breast cancer. (Previous research has
shown exercise lowers estrogen levels, which
can fuel the growth of breast
cancer cells.)
Think about it. If just three to five hours of walking per week can so
drastically improve your
chances of surviving a hormone-responsive breast
cancer tumor, imagine what a few more hours a
week of exercise could do for
you.
If you're male, be aware that athletes have lower levels of circulating
testosterone than non-athletes,
and similar to the association between
estrogen levels and breast cancer in women, testosterone is
known to
influence the development of prostate cancer in men.
Physical activity can reduce your risk and boost your chances of recovery if
you have cancer.
Exercise is a Potent Cancer Fighter
Cancer thrives on sugar, but regular exercise reduces your insulin levels,
which creates a low sugar
environment that discourages the growth and spread
of cancer cells. Controlling your insulin levels is
one of the most powerful
steps you can take to reduce your cancer risk and help keep it from
returning.
Physically active adults experience about half the incidence of colon cancer
as their sedentary
counterparts. Exercise has a beneficial influence on
insulin, prostaglandins and bile acids, all of which
are thought to
encourage the growth and spread of cancer cells in your colon. Exercise also
improves
bowel transit time, which means your body's waste is spending less
time in contact with the mucosal
lining of your colon.
Exercise also improves the circulation of immune cells in your blood. The job
of these cells is to
neutralize pathogens throughout your body.
The better these cells circulate, the more efficient your immune system is at
locating and defending
against viruses and diseases, including cancer,
trying to attack your body.
It's also been suggested that apoptosis (programmed cell death) is triggered
by exercise, causing
cancer cells to die. So you can see why a regular
exercise program is important not only during any
treatment you're receiving
but also afterward as well.
Exercise Tips for Cancer Patients
I would also strongly recommend that you read the lead article in today's
newsletter that reviews
some of the newest insights on how to optimize your
exercise program and actually reduce your
exercise time and improve your
benefits.
You will need to tailor your exercise routine to your individual scenario,
taking into account your
stamina and current health. Often, you will be able
to take part in a regular exercise program -- one
that involves a variety of
exercises like strength training, core-building, stretching, aerobic and
anaerobic -- with very little changes necessary.
However, you may find that you need to exercise at a lower intensity or for
shorter durations at
times. Always listen to your body and if you feel you
need a break, take time to rest. Even exercising
for a few minutes a day is
better than not exercising at all, and you'll likely find that your stamina
increases and you're able to complete more challenging workouts with each
passing day.
In the event you are suffering from a very weakened immune system, you may
want to exercise in
your home instead of visiting a public gym. But remember
that exercise will ultimately help to boost
your immune system, so it's very
important to continue with your program.
June 28, 2010 - HFM offers programming for cancer patients - Lakeshore health
briefs -
MANITOWOC — The Holy Family Memorial Wellness Center is offering individual
programming
for cancer patients.
Among the benefits: reduced pain and fatigue associated with cancer and
treatments; prevention,
identification and management of lymphedema;
increased treatment tolerance; and return to pre-
treatment levels of
strength and fitness.
Wellness Center coordinator Melissa Sperbeck, recently certified as a cancer
exercise specialist, will
meet with patients for a free consultation and
discuss individual programming unique to each client
and illness. Funding
for program participation is available through the Carol Rose Wester Fund.
For information, or to schedule a free consultation, call Sperbeck at (920)
320-4620.
Personal yoga instruction offered
MANITOWOC — The Holy Family Memorial Wellness Center is offering personal
yoga instruction.
Wellness Center yoga instructor Corinne Knab has more than 30 years of yoga
experience, and will
be studying this summer to earn certification as a yoga
therapist.
Each session will begin with an assessment of how the individual is feeling,
both physically and
emotionally. Based on the assessment, Knab will
determine which breathing practices, poses and
meditation techniques to lead
the participant through.
For information, call (920) 320-4600.
HFM Laboratory receives reaccreditation
MANITOWOC — Holy Family Memorial Laboratory has been awarded
reaccreditation by the
Accreditation Committee of the College of American
Pathologists (CAP), based on the results of a
recent onsite inspection. The
reaccreditation includes the laboratories at Holy Family Memorial
Medical
Center, Woodland Clinic and Harbor Town Campus.
The CAP Laboratory Accreditation Program, started in the early 1960s, is
recognized by the federal
government as being equal to, or more strict than
the government's own inspection program, an
HFM news release said.
During the CAP accreditation process, inspectors examine the laboratory's
records and quality of
procedures for the previous two years. Inspectors
also examine laboratory staff qualifications, as well
as the laboratory's
equipment, facilities, safety program and record, in addition to the overall
management of the lab.
HFM offers free classes, screenings
MANITOWOC — Holy Family Memorial's Health Resource Center, 2300 Western
Ave., offers
the following:
A free, one-hour class on the basics of how to search the Internet for health
information is open to
the public on a one-on-one basis by appointment
between 8 a.m. to 4 p.m. Monday through Friday.
To make an appointment, call
(920) 320-2519.
A variety of health related books, videos and DVDs , a computer with Internet
access,
knowledgeable staff and information on HFM physicians, programs and
services is available to the
public during the above hours.
Free blood pressure screenings will be offered from 1 to 3 p.m. July 6 and 20
and from 9 to 11 a.m.
July 8 and 22. Walk-ins are welcome.
A cholesterol and blood sugar screening will be offered from 6:30 to 10 a.m.
July 15. To schedule an
appointment, call (920) 320-6777.
June 28th, 2010 - More exercise prescribed for cancer survivors, even
before they finish therapy –
WASHINGTON - New guidelines urge cancer survivors to exercise more, even,
difficult as it may
sound, those who have not yet finished their
treatment.
There Is growing evidence that physical activity improves quality of life and
eases some cancer-
related fatigue. More, it can help fend off a serious
decline in physical function that can last long after
therapy is
finished.
Consider: In one year, women who needed chemotherapy for their breast cancer
can see a swapping
of muscle for fat that is equivalent to 10 years of
normal aging, says Dr. Wendy Demark-Wahnefried
of the University of Alabama
at Birmingham.
In other words, a 45-year-old may find herself with the fatter, weaker body
type of a 55-year-old.
Scientists have long advised that being overweight and sedentary increases
the risk for various
cancers. Among the nearly 12 million U.S. cancer
survivors, there are hints — although not yet proof
— that people who are
more active may lower risk of a recurrence. Like everyone who ages, the
longer cancer survivors live, the higher their risk for heart disease that
exercise definitely fights.
The American College of Sports Medicine convened a panel of cancer and
exercise specialists to
evaluate the evidence. Guidelines issued this month
advise cancer survivors to aim for the same
amount of exercise as
recommended for the average person: about 2½ hours a week.
Patients still in treatment may not feel up to that much, the guidelines
acknowledge, but should avoid
inactivity on their good days.
"You don't have to be Lance Armstrong," stresses Dr. Julia Rowland of the
National Cancer
Institute, speaking from a survivorship meeting this month
that highlighted exercise research. "Walk
the dog, play a little golf."
But how much exercise is needed? And what kind? Innovative new studies are
under way to start
answering those questions, including:
—Oregon Health and Science University is training prostate cancer survivors
to exercise with their
wives. The study will enrol 66 couples, comparing
those given twice-a-week muscle-strengthening
exercises with pairs who do
not get active.
Researchers think exercising together may help both partners stick with it.
They also are testing
whether the shared activity improves both physical
functioning and eases the strain that cancer puts
on the caregiver and the
marriage.
"It has the potential to have not just physical benefits but emotional
benefits, too," says lead
researcher Dr. Kerri Winters-Stone.
—Demark-Wahnefried led a recent study of 641 overweight breast cancer
survivors that found at-
home exercises with some muscle-strengthening, plus
a better diet, could slow physical decline.
—Duke University is recruiting 160 lung cancer patients to test whether
three-times-a-week aerobic
exercise, strength training or both could improve
their fitness after surgery. Lung cancer has long
been thought beyond the
reach of exercise benefits because it so often is diagnosed at late stages.
Duke's Dr. Lee Jones notes that thousands who are caught in time to remove
the lung tumour do
survive about five years, and he suspects that fitness,
measured by how well their bodies use oxygen,
plays a role.
People with cancer usually get less active as symptoms or treatments make
them feel lousy. Plus,
certain therapies can weaken muscles, bones, even the
heart. Not that long ago, doctors advised
taking it easy.
Not anymore: Be as active as you are able, says Dr. Kathryn Schmitz of the
University of
Pennsylvania, lead author of the new guidelines.
"Absolutely it's as simple as getting up off the couch
and walking," she
says.
Exercise programs are beginning to target cancer survivors, like Livestrong
at the YMCA, a
partnership with cycling great and cancer survivor
Armstrong's foundation. The American College of
Sports Medicine now
certifies fitness trainers who specialize in cancer survivors.
Still, anyone starting more vigorous activity for the first time or who has
particular risks, like the
painful arm swelling called lymphedema that some
breast cancer survivors experience, may need
more specialized exercise
advice, Schmitz says. They should discuss physical therapy with their
oncologist, she advises. For example, Schmitz led a major study that
found careful weight training
can protect against lymphedema, reversing
years of advice to coddle the at-risk arm. But the
average
fitness trainer does not know how to offer that special training safely, she
cautions.
Mary Lou Galantino of Wilmington, Delaware, is a physical therapist who
specializes in cancer care
and kept exercising when her own breast cancer
was diagnosed at the University of Pennsylvania in
2003. Then 42, she says
she was on the treadmill within 24 hours of each chemo session, to stay fit
enough to care for her two preschoolers. "You can feel more energy"
with the right exercise, says
Galantino, a physical therapy professor at the
Richard Stockton College of New Jersey. "I was
giving my body up to the
surgeons and chemo, but I could take my body back through yoga and
aerobic
exercise."
June 29, 2010 - Recurrent furunculosis as a cause of isolated penile
lymphedema: a case report - Ali
AlshahamSuneet Sood -
IntroductionIsolated lymphedema of the penis is extremely rare: combined
involvement of the
scrotum and penis is the norm. Furunculosis as a cause is
not, to our knowledge, previously reported.
We present a case of isolated penile lymphedema that responded to excision of
lymphedematous
tissue and reconstruction with flaps.Case presentationA
32-year-old Arab man presented with a
three-year history of a gradually
increasing, painless penile swelling. Our patient's main complaint was
non-erectile sexual dysfunction.
The swelling was preceded by at least three prior episodes of severe
furunculosis at the penile root.
He had no other contributory past medical
or family history.
On examination there was gross penile enlargement, maximally at the mid
shaft, associated with
thickened skin at the sites of prior furunculosis.
The glans and scrotum were normal.
Both testes were palpable. Serology for filariasis, and urinary tract
ultrasound and computed
tomography scan were normal.
The clinical diagnosis was lymphedema following recurrent penile
furunculosis. At operation the
lymphedematous tissues were removed.
Closure of the penile shaft was accomplished by bilateral advancement of
flaps from both ends of the
penis. He resumed normal sexual activity one
month after surgery.
At 12 months, he had a good cosmetic result, with no signs of recurrence.
Conclusions: Furunculosis at the penile root may result in lymphedema
confined to the penile shaft,
sparing the scrotum. Excision of abnormal
tissue and cover with a skin flap gave excellent cosmetic
results, and
allowed satisfactory sexual activity.
June 29, 2010 - What's the Big Idea? Inaugural Conference Aims to Find out -
By Joan Delaney -
Just as the G8 and G20 summits have wound up in Ontario, a conference of a
very different kind is
being planned on the other side of the country in
Victoria.
Called IdeaWave, the aim of conference is to bring innovative thinkers
together to brainstorm a wide
range of issues, from sewage treatment and
drug prohibition to health and public transit.
The two-day conference will feature 50 short talks on any topic the speaker
desires, giving critical
thinkers from the Pacific Northwest a forum to
explore issues that affect both their immediate region
and further
afield.
“There’s a lot of critical thinkers out there who are meeting regularly,
talking about ideas informally,
and so I just thought, ‘What would it take
to get all of those people together in a room?’ To me,
having 200 critical
thinkers in a room is quite exciting,” says event organizer Kris Constable.
Constable believes his conference is the first ever to keep the talks to 10
minutes with no limit on the
subject matter. Established ideas conferences
that take place annually in Vancouver and California
cost between $3,000 and
$7,000 to participate, he adds.
“I, like most North Americans, can’t afford to attend such a thing. So this
is kind of my answer to
that. I'm going to make this the first approachable
ideas conference ever. We've got both speakers
and attendees coming from
Washington State and all over B.C.”
Limiting the talks to 10 minutes keeps them from becoming boring and “cuts
right to the meat” of the
topic, he says.
“It separates the wheat from the chaff essentially. You've got 10 minutes to
make sure that you’ve
clearly articulated your idea in the best way that you
can. With 10 minutes you're concentrating your
talk to be as effective as
possible.”
Frank Heidt, a chief executive officer with a company in Seattle, will talk
about expanding on the
idea of transforming abandoned shipping containers
into housing. There are about three million
unused shipping containers in
the Pacific Rim because it’s cheaper for companies to leave them there
than
return them to their country of origin empty or partially filled, according to
Heidt.
His talk will be about using these shipping containers as lending libraries
of hand tools, enabling
people in developing countries to “build their own
future.”
Margaret Pulton, a nurse from B.C., will explore using technology to create
clothing as a treatment
for Lymphedema, while Clem Persaud, a professor of
biotechnology, will devote his 10 minutes to
how we can positively impact
our lives by influencing the expression of our genes.
As well as airing their ideas, there will also be a chance for both speakers
and attendees to mingle
and network.
“If your idea’s good enough that other people are excited, they're going to
go ahead and talk to you
and hopefully get a few people helping you make
your idea happen,” says Constable.
“These are the people who are kind of the thinkers and the doers in one.”
Being still a few shy of the required 50 speakers, Constable is looking for
more people to submit
their proposals. The conference will take place July
10 and 11 at the Ambrosia Centre in downtown
Victoria.
June 29, 2010 - Community-based education strengthens campaign for
elimination of lymphatic
filariasis - Joseph Quimby
Community-based lymphatic filariasis education in Orissa State, India,
increased treatment
compliance from around 50% to up to 90%, according to a
study published June 29 in the open-
access journal PLoS Neglected Tropical
Diseases. In their study, researchers from the U.S. Centers
for Disease
Control and Prevention, in partnership with the Church's Auxiliary for Social
Action, an
India-based non-governmental organization, and IMA World Health,
a US-based non-governmental
organization, identified barriers to compliance
with India's MDA program for LF, and suggest that
timely educational and
lymphedema management programs can reverse this trend.
Nearly 1.3 billion people worldwide live at risk of infection with the
parasite that causes lymphatic
filariasis. Infected individuals may develop
long-term complications, such as grossly swollen limbs
from lymphedema.
Elimination of this disease of poverty requires giving drugs at least once per
year
to people who are at risk; of that population, 80% or more need to
continue receiving medication on
an annual basis for 5 or more years to stop
transmission.
The authors evaluated a community-based education campaign, noted
deficiencies, and designed
interventions to correct them. An evaluation of
the revised education program, covering over 8,000
people in ninety
villages, showed markedly improved drug compliance and, for the first time,
showed
that lymphedema management programs, which teach leg care to patients
with swollen legs, may also
increase compliance with lymphatic filariasis
mass drug administration programs. The increase was
greatest in areas that
had implemented U.S. Agency for International Development-supported
programs
to teach people how to care for legs swollen from infection.
This evaluation was confined to rural areas in Orissa State, so the findings
do not necessarily apply to
urban areas or areas outside the state.
Nonetheless, lymphatic filariasis elimination programs facing
difficulties
in achieving the necessary level of drug compliance should consider evaluating
their
education campaigns using similar methods and integrating lymphedema
management with lymphatic
filariasis elimination efforts, the authors
say.
FINANCIAL DISCLOSURE: Funding for this work was provided by USAID
(GHA-G-00-03-
0005-00) to IMA World Health and by CDC (IAA GHH99-006). The
funders had no role in study
design, data collection and analysis, decision
to publish, or preparation of the manucript.
COMPETING INTERESTS: The authors have declared that no competing interests
exist
PLEASE ADD THIS LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF
YOUR
REPORT: http://dx.plos.org/10.1371/journal.pntd.0000728
CITATION: Cantey PT, Rout J, Rao G, Williamson J, Fox LM (2010) Increasing
Compliance with
Mass Drug Administration Programs for Lymphatic Filariasis
in India through Education and
Lymphedema Management Programs. PLoS Negl
Trop Dis 4(6): e728. doi:10.1371/journal.pntd.
0000728
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June 29, 2010 - Lymphedema treatment options -
Chronic lymphedema often turns into cellulitis in patients with diabetes.
What is the preferred
treatment?—PAULA JAUERING, ARNP, Leavenworth, Kan.
The diagnosis of lymphedema is usually made based on clinical presentation
and history. Imaging
studies may also be used for diagnosis and evaluation
of treatment; lymphoscintigraphy is considered
the gold standard. Duplex
ultrasound, CT, and MRI may also be used. Conservative physiotherapy
treatments include complex or complete decongestive therapy (which
incorporates manual lymphatic
drainage, compression bandages,
myolymphokinetic exercises, skin care, and precautions during
daily
activities) and pneumatic compression, also referred to as pressure therapy.
Pneumatic
compression utilizes a segmental air pump to fill air chambers
(gloves or boots) that provide pressure
to the edematous limb. Newer
techniques include high-voltage electrical stimulation (which reduces
lymphedema by producing muscle contractions and relaxation that increase
venous and lymphatic
flow) and laser therapy (which reduces fibosis and
stimulates lymphangiogenesis, lymph activity,
lymphatic movement,
macrophages, and the immune system). Surgical therapies for patients in whom
conservative therapy was not effective may include resection procedures,
microsurgical interventions,
and liposuction.
For more information, see Rev Lat Am Enfermagem. 2009;17:730-736 and Ann
Plast Surg. 2007;
59:464-472.—Philip R. Cohen, MD
June 30, 2010 - People and Places: Carroll Hospital foundation
disperses funds to nonprofits -
The Carroll Hospital Center Foundation released more than $2.5 million to
support programs and
services at Carroll Hospital Center and Carroll
Hospice.
Jack Tevis, chairman of the Foundation’s Board of Trustees, presented checks
to Mark Blacksten,
chairman of Carroll Hospice’s Board of Directors, and
John Sernulka, FACHE, president and CEO
of Carroll Hospital Center.
The donation represents proceeds accumulated from the foundation’s various
fundraising efforts for
the hospital and Carroll Hospice throughout the
year. The funds will be used to support a variety of
capital programs
including adding a new cardiovascular lab, renovating the emergency department’s
triage area as well as the waiting room in The Family Birthplace and
creating a dedicated orthopaedic
unit on the third floor of the
hospital.
In addition, the gifts will enhance many programs provided by the hospital
including the navigation
and lymphedema services at The Women’s Place and
Breast Center. It also will provide educational
support to staff such as
those offered through the Libman Nursing Scholarship and the College
Scholarship for Dependants of Associates.
People and Places and New Business briefs offer information about Carroll
County-based
companies, employees and their operations, and news of awards,
promotions, new business
openings, new hires, etc. To have your information
included, send your typed, double-spaced press
release to Business Briefs,
Carroll County Times, P.O. Box 346, Westminster, MD 21158..
Information must
reach this office within four weeks after an event.
Pub Med doc 1 (3):
Am J Med. 2010 Jun;123(6):489-95.
Caring for the breast cancer survivor: a guide for primary care
physicians.
Chalasani P, Downey L, Stopeck AT.
Arizona Cancer Center, University of Arizona, Tucson, AZ 85724-5024, USA. pchalasani@azcc.
arizona.edu
Abstract
Breast cancer accounts for more than 25% of cancers in women. Because of
improved screening
and treatment modalities, mortality has decreased
significantly. Currently, over 2.5 million breast
cancer survivors live in
the US and receive care from a primary care provider. Providers need to be
aware of common and serious complications of breast cancer treatment. In
this review we discuss
complications of local and systemic treatment for
breast cancer, including lymphedema, osteoporosis,
cardiovascular disease,
and vasomotor symptoms. Current strategies for screening, monitoring, and
treating these complications also are outlined. Copyright 2010. Published by
Elsevier Inc.
PMID: 20569749 [PubMed - in process]
Cancer. 2010 Apr 29. [Epub ahead of print]
A prospective cohort study defining utilities using time trade-offs and the
Euroqol-5D to assess the
impact of cancer-related lymphedema.
Cheville AL, Almoza M, Courmier JN, Basford JR.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester,
Minnesota.
Abstract
BACKGROUND:: The devastating impact of lymphedema on cancer survivors'
quality of life has
prompted consideration of several changes in medical and
surgical care. Unfortunately, our
understanding of the benefits gained from
these approaches relative to their cost remains limited. This
study was
designed to estimate utilities for lymphedema and characterize how utilities
differ between
subgroups defined by lymphedema etiology and
distribution.
METHODS:: A consecutive sample of 236 subjects with lymphedema seen at a
lymphedema clinic
completed both a time trade-off (TTO) exercise and the
Euroqol 5D. Responses were adjusted in
multivariate regression models for
demographic factors, comorbidities, and lymphedema
severity/location.
RESULTS:: Most participants (167 of 236, 71%) had lymphedema as a consequence
of cancer
treatment; 123 with breast cancer and upper extremity involvement.
Mean TTO utility estimates were
consistently higher than Euroqol 5D
estimates. Unadjusted TTO (0.85; standard deviation [SD],
0.21) and Euroqol
5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and
patient body mass index (BMI). Adjusted utility scores were lowest in
patients with cancer-related
lower extremity lymphedema (TTO = 0.82; SD,
0.04 and Euroqol 5D = 0.80; SD, 0.03). Breast
cancer patients also had lower
adjusted Euroqol 5D scores (0.80; SD, 0.02).
CONCLUSIONS:: Lymphedema-associated utilities are in the range of 0.80. Lower
utilities are
observed for patients with higher lymphedema stages, elevated
BMI, and cancer-related
lymphedema. Greater expenditures for the prevention
and treatment of cancer-related lymphedema
are warranted. Cancer, 2010. (c)
2010 American Cancer Society.
PMID: 20564063 [PubMed - as supplied by publisher]
Breast. 2010 Jun 17. [Epub ahead of print]
Self-reported arm-lymphedema and functional impairment after breast cancer
treatment - A
nationwide study of prevalence and associated factors.
Gärtner R, Jensen MB, Kronborg L, Ewertz M, Kehlet H, Kroman N.
Department of Breast Surgery, Rigshospitalet 3103, Copenhagen University,
2100 Copenhagen,
Denmark.
Abstract
Lymphedema and impairment of function are well-established sequelae to breast
cancer treatment
and affect an increasing number of women due to continually
improved survival. The aim of the
present nationwide questionnaire study was
to examine the impact of breast cancer treatment on
perceived
swelling/sensation of heaviness (lymphedema) and on function, reporting
prevalence in 12
subgroups of modern treatment and offering estimates for
treatment-related associated factors. 3253
Women (87%) returned the study
questionnaire. Depending on treatment group prevalence of
perceived
swelling/heaviness varied from 13 to 65%. Associated factors were young age,
axillary
lymph node dissection (ALND) and radiotherapy but not type of
breast surgery or use of
chemotherapy. Depending on treatment group 11-44%
had to give up activities. Giving up activities
was associated with pain and
swelling/heaviness, younger age, ALND, chemotherapy, time elapsed
since
surgery, and surgery on the dominant side. Radiotherapy and type of breast
surgery were of no
importance. Copyright © 2010 Elsevier Ltd. All rights
reserved.
PMID: 20561790 [PubMed - as supplied by publisher]
PUB MED DOC 2 (2)
Br J Community Nurs. 2010 Apr;15(4):S18-24.
Manual lymphatic drainage: exploring the history and evidence base.
Williams A.
Edinburgh Napier University. [email protected]
Abstract
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but
there is limited
evidence to guide clinical practice. This paper outlines
the historical background to MLD and
provides insights into the evidence
relating to the effect and efficacy of manual lymph drainage,
highlighting
considerations for lymphoedema practitioners.
PMID: 20559172 [PubMed - in process]
Jpn J Clin Oncol. 2010 Jun 17. [Epub ahead of print]
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of
Lymphoedema in
Palliative Care Patients.
Clemens KE, Jaspers B, Klaschik E, Nieland P.
1Department of Science and Research, Centre for Palliative Medicine,
University of Bonn.
Abstract
OBJECTIVE: Lymphoedema is a common sequela of cancer or its treatment that
affects lymph node
drainage. The physiotherapist, as member of the
multiprofessional team in palliative care, is one of the
keys to successful
rehabilitation and management of patients with cancer and non-malignant
motoneuron disease such as amyotrophic lateral sclerosis and palliative care
needs. The aim of the
study was to evaluate the frequency and effect of
manual lymphatic drainage in palliative care patients
with lymphoedema in a
far advanced stage of their disease.
METHODS: Retrospective study (reflexive control design) of data of the 208
patients admitted to
our palliative care unit from January 2007 to December
2007. Demographic and disease-related
data (diagnosis, symptoms, Karnofsky
performance status and effect of manual lymphatic drainage
interventions)
were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's
test.
RESULTS: Of the 208 patients, 90 who reported symptom load due to lymphoedema
were
included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient
trunk oedema. Mean age
65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index
50% (30-80%), mean length of stay 15.6
+/- 8.0 days. The mean number of
physiotherapeutic treatment interventions was 7.0 +/- 5.8.
Manual lymphatic
drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients
showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in
dyspnoea.
CONCLUSIONS: The majority of the patients showed a clinical improvement in
the intensity of
symptoms after manual lymphatic drainage.
PMID: 20558463 [PubMed - as supplied by publisher]
Pub med doc 3 (1)
Ann Surg Oncol. 2010 Jun 24. [Epub ahead of print]
Morbidity of Sentinel Node Biopsy in Breast Cancer: The Relationship Between
the Number of
Excised Lymph Nodes and Lymphedema.
Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ.
Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer
Center, New York, NY,
USA.
Abstract
BACKGROUND: Despite the reduced morbidity associated with sentinel lymph node
biopsy
(SLNB), lymphedema remains a clinically relevant complication. We
hypothesized that a higher
number of lymph nodes (LNs) removed during SLNB
is associated with a higher risk of lymphedema.
METHODS: Six hundred patients with clinically node-negative breast cancer who
underwent SLNB
were prospectively studied. Circumferential bilateral upper
extremity measurements were performed
preoperatively and at 3-8 years after
surgery. Association of lymphedema with total number of LNs
excised and
other clinicopathologic variables was analyzed by the Spearman rank correlation
coefficient, Fisher's exact test, Wilcoxon rank sum test, and logistic
regression.
RESULTS: At a median follow-up of 5 years, 5% of patients had developed
lymphedema. Factors
associated with lymphedema included weight and body mass
index. There was no association
between the number of LNs removed and the
change in upper extremity measurements or in the
incidence of lymphedema.
Among patients with lymphedema (n = 31) compared to those without,
the mean
(3.9 vs. 4.2), median (4 vs. 3), and range (1-9 vs. 1-17) of number of LNs
removed were
similar (P = 0.93). Among the 33 women with >/=10 LNs
removed, none developed lymphedema.
CONCLUSIONS: In this population of 600 women who underwent SLNB, there is no
correlation
between number of LNs removed and change in upper extremity
circumference or incidence of
lymphedema. These data suggest that other
factors, such as the global disruption of the lymphatic
channels during
axillary lymph node dissection, play a larger role in development of lymphedema
than
does the number of LNs removed.
PMID: 20574774 [PubMed - as supplied by publisher]
PUB MED DOC 4 (11)
Br J Community Nurs. 2010 Apr;15(4):S28-30.
Massage: a helping hand for people with chronic oedema and lymphoedema.
Pyke C.
British Lymphology Society. [email protected]
Abstract
Skin care is fundamental in maintaining the integrity of one's skin and it
has become modern practice
to wash and dry ourselves on a daily basis to
eliminate odour and rejuvenate the skin. What is
becoming more apparent is
that as health professionals we are not transferring this basic act to our
patient's care and this simple form of neglect can be detrimental to your
patient's recovery.
Moreover, when washing with the soapy products that are
available to us, and then drying ourselves
rigorously, we remove our skin's
natural oils thus the skin appears drier and is more susceptible to
damage.
This is where the simple application of a moisturising agent will not only
replace the lost oils,
but it will in fact stimulate the initial lymphatics
lying under your skin. The action of rubbing a cream or
emollient into the
skin is a form of massage, and this simple action will go a very long way
towards
the recovery of skin integrity and in the prevention of harm and
infection. Make this part of your
practice when looking after your patient's
wounds and swollen limbs.
PMID: 20559174 [PubMed - in process]
Br J Community Nurs. 2010 Apr;15(4):S18-24.
Manual lymphatic drainage: exploring the history and evidence base.
Williams A.
Edinburgh Napier University. [email protected]
Abstract
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but
there is limited
evidence to guide clinical practice. This paper outlines
the historical background to MLD and
provides insights into the evidence
relating to the effect and efficacy of manual lymph drainage,
highlighting
considerations for lymphoedema practitioners.
PMID: 20559172 [PubMed - in process]
Br J Community Nurs. 2010 Apr;15(4):S10-6.
Lipoedema: presentation and management.
Todd M.
Specialist Lymphoedema Service, Greater Glasgow & Clyde NHS Trust. [email protected].
uk
Abstract
Lipoedema is a distinct clinical condition characterized by bilateral,
symmetrical enlargement of the
buttocks and lower limbs owing to excess
deposition of subcutaneous fat. It is found almost
exclusively in women. The
common features associated with this condition are 'column- shaped' legs
with sparing of the feet, bruising, sensitivity to pressure, and orthostatic
oedema. The progression to
lipo-lymphoedema or morbid obesity is possible.
Conservative measures used in the management of
lymphoedema can prevent
progression/limit the orthostatic oedema. Surgical procedures may also
play
a part in the management of lipoedema.
PMID: 20559170 [PubMed - in process]
Jpn J Clin Oncol. 2010 Jun 17. [Epub ahead of print]
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of
Lymphoedema in
Palliative Care Patients.
Clemens KE, Jaspers B, Klaschik E, Nieland P.
1Department of Science and Research, Centre for Palliative Medicine,
University of Bonn.
Abstract
OBJECTIVE: Lymphoedema is a common sequela of cancer or its treatment that
affects lymph node
drainage. The physiotherapist, as member of the
multiprofessional team in palliative care, is one of the
keys to successful
rehabilitation and management of patients with cancer and non-malignant
motoneuron disease such as amyotrophic lateral sclerosis and palliative care
needs. The aim of the
study was to evaluate the frequency and effect of
manual lymphatic drainage in palliative care patients
with lymphoedema in a
far advanced stage of their disease.
METHODS: Retrospective study (reflexive control design) of data of the 208
patients admitted to
our palliative care unit from January 2007 to December
2007. Demographic and disease-related
data (diagnosis, symptoms, Karnofsky
performance status and effect of manual lymphatic drainage
interventions)
were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's
test.
RESULTS: Of the 208 patients, 90 who reported symptom load due to lymphoedema
were
included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient
trunk oedema. Mean age
65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index
50% (30-80%), mean length of stay 15.6
+/- 8.0 days. The mean number of
physiotherapeutic treatment interventions was 7.0 +/- 5.8.
Manual lymphatic
drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients
showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in
dyspnoea.
CONCLUSIONS: The majority of the patients showed a clinical improvement in
the intensity of
symptoms after manual lymphatic drainage.
PMID: 20558463 [PubMed - as supplied by publisher]
Cochrane Database Syst Rev. 2010 Jun 16;6:CD005211.
Exercise interventions for upper-limb dysfunction due to breast cancer
treatment.
McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, Mackey J,
Courneya K.
Department of Physical Therapy, University of Alberta, 2-50, Corbett Hall,
Edmonton, Alberta,
Canada, T6G 2G4.
Abstract
BACKGROUND: Upper-limb dysfunction is a commonly reported side effect of
treatment for
breast cancer and may include decreased shoulder range of
motion (the range through which a joint
can be moved) (ROM) and strength,
pain and lymphedema.
OBJECTIVES: To review randomized controlled trials (RCTs) evaluating the
effectiveness of
exercise interventions in preventing, minimi sing, or
improving upper-limb dysfunction due to breast
cancer treatment.
SEARCH STRATEGY: We searched the Specialised Register of the Cochrane Breast
Cancer
Group, MEDLINE, EMBASE, CINAHL, and LILACS (to August 2008);
contacted experts,
handsearched reference lists, conference proceedings,
clinical practice guidelines and other
unpublished literature sources.
SELECTION CRITERIA: RCTs evaluating the effectiveness and safety of exercise
for upper-limb
dysfunction.
DATA COLLECTION AND ANALYSIS: Two authors independently performed the data
abstraction. Investigators were contacted for missing data.
MAIN RESULTS: We included 24 studies involving 2132 participants. Ten of the
24 were
considered of adequate methodological quality.Ten studies examined
the effect of early versus
delayed implementation of post-operative
exercise. Implementing early exercise was more effective
than delayed
exercise in the short term recovery of shoulder flexion ROM (Weighted Mean
Difference (WMD): 10.6 degrees; 95% Confidence Interval (CI): 4.51 to 16.6);
however, early
exercise also resulted in a statistically significant
increase in wound drainage volume (Standardized
Mean Difference (SMD) 0.31;
95% CI: 0.13 to 0.49) and duration (WMD: 1.15 days; 95% CI:
0.65 to
1.65).Fourteen studies examined the effect of structured exercise compared to
usual
care/comparison. Of these, six were post-operative, three during
adjuvant treatment and five
following cancer treatment. Structured exercise
programs in the post-operative period significantly
improved shoulder
flexion ROM in the short-term (WMD: 12.92 degrees; 95% CI: 0.69 to 25.16).
Physical therapy treatment yielded additional benefit for shoulder function
post-intervention (SMD:
0.77; 95% CI: 0.33 to 1.21) and at six-month
follow-up (SMD: 0.75; 95% CI: 0.32 to 1.19). There
was no evidence of
increased risk of lymphedema from exercise at any time point.
AUTHORS' CONCLUSIONS: Exercise can result in a significant and clinically
meaningful
improvement in shoulder ROM in women with breast cancer. In the
post-operative period,
consideration should be given to early implementation
of exercises, although this approach may need
to be carefully weighed
against the potential for increases in wound drainage volume and duration.
High quality research studies that closely monitor exercise prescription
factors (e.g. intensity), and
address persistent upper-limb dysfunction are
needed.
PMID: 20556760 [PubMed - in process]
In Vivo. 2010 May-Jun;24(3):309-14.
Milroy's Primary Congenital Lymphedema in a Male Infant and Review of the
Literature.
Kitsiou-Tzeli S, Vrettou C, Leze E, Makrythanasis P, Kanavakis E, Willems
P.
"Choremeio" Research Laboratory of Medical Genetics, Children's Hospital
"Aghia Sophia", Thivon
and Levadeias, 11527, Greece. [email protected].
Abstract
BACKGROUND: Milroy's primary congenital lymphedema is a non-syndromic primary
lymphedema caused mainly by autosomal dominant mutations in the FLT4
(VEGFR3) gene. Here,
we report on a 6-month-old boy with congenital
non-syndromic bilateral lymphedema at both feet
and tibias, who underwent
molecular investigation, consisted of PCR amplification and DHPLC
analysis
of exons 17-26 of the FLT4 gene. The clinical diagnosis of Milroy disease was
confirmed by
molecular analysis showing the c.3109G>C mutation in the
FLT4 gene, inherited from the
asymptomatic father. This is a known missense
mutation, which substitutes an aspartic acid into a
histidine on amino acid
position 1037 of the resulting protein (p.D1037H), described in two other
families with Milroy disease. A thorough genetic molecular investigation and
clinical evaluation
contributes to the provision of proper genetic
counseling for parents of an affected child with Milroy
disease. The herein
described case, which is the third reported so far with c.3109G>C mutation,
adds data on genotypic-phenotypic correlation of Milroy disease. The
relative literature regarding the
pathophysiology, molecular basis, clinical
spectrum and treatment of Milroy disease is reviewed.
PMID: 20555004 [PubMed - in process]
Lymphology. 2010 Mar;43(1):42-4.
Primary lymphedema and acute leukemia--is there a link?
Todd M, Welsh J, Drummond MW.
Specialist Lymphoedema Clinic, NHS Greater Glasgow and Clyde, Scotland, UK.
Marie.todd@ggc.
scot.nhs.uk
Abstract
The lymphedema service in Glasgow has been treating patients with lymphedema
of all causes since
1991. In the past five years 3 patients with primary
lymphedema have been diagnosed with
myelodysplasia (leading to acute
leukemia) or acute leukemia. These are relatively unusual
malignancies given
the ages of the patients and all three of these patients died within an average
of 12
months of diagnosis. A connection between the presence of primary
lymphedema and the subsequent
development of the hematological disorder is
postulated. Standard marrow cytogenetics failed to
identify a common
abnormality but the authors feel that further study is warranted.
PMID: 20552819 [PubMed - in process]
Lymphology. 2010 Mar;43(1):25-33.
Comparing two treatment methods for post mastectomy lymphedema: complex
decongestive therapy
alone and in combination with intermittent pneumatic
compression.
Haghighat S, Lotfi-Tokaldany M, Yunesian M, Akbari ME, Nazemi F, Weiss J.
Breast Research Department, Iranian Center for Breast Cancer, Tehran, Iran.
Sh_haghighat@yahoo.
com
Abstract
There is no cure for breast cancer related lymphedema. This study was
conducted to compare two
treatment methods for postmastectomy lymphedema:
Complex Decongestive Therapy (CDT) and
Modified CDT (MCDT) combined with
Intermittent Pneumatic Compression (IPC). One hundred
and twelve patients
referred to the Lymphedema Clinic of the Iranian Center for Breast Cancer in
2008, were included in a randomized clinical trial. They were randomly
allocated into two equal
groups receiving daily CDT alone or in combination
with IPC. The volume reduction of the upper
limb was measured by water
displacement volumetry. No statistically significant differences in
demographic and clinical variables between the two groups were observed.
During the intensive
phase (phase I) of treatment, CDT alone yielded a
significantly higher mean volume reduction than
the combination modality
(43.1% vs. 37.5%; p = 0.036). Limb volume measured three months
following
treatment, showed 16.9% volume reduction by CDT alone, and 7.5% reduction by
MCDT
plus IPC. This study demonstrated that the use of CDT alone, or in
combination with IPC
significantly reduced limb volume in patients with post
mastectomy lymphedema. CDT alone
provided better results in both treatment
phases. Further studies will help to define the role of
multidisciplinary
approaches in the management of postmastectomy lymphedema.
PMID: 20552817 [PubMed - in process]
Lymphology. 2010 Mar;43(1):19-24.
Cutaneous metastasis of pancreatic carcinoma as an initial symptom in the
lower extremity with
obstructive lymphedema treated by physiotherapy and
lymphaticovenous shunt: a case report,
review, and pathophysiological
implications.
Shimizu H, Maegawa J, Ho T, Yamamoto Y, Mikami T, Nagahama K.
Department of Plastic and Reconstructive Surgery, Yokohama City University
Hospital, Yokohama,
Japan. [email protected]
Abstract
Cutaneous metastasis from pancreatic cancer is relatively rare as an initial
symptom, and it is
generally localized on the periumbilical area that is
known as Sister Mary Joseph's nodule. We report
a rare case of a 49-year-old
female who developed cutaneous metastasis of pancreatic cancer as an
initial
symptom. The patient was referred to our department for treatment of lymphedema
due to
surgical treatment of cervical cancer and underwent combined
physiotherapy and, 2 months later, a
lymph venous anastomosis (LVA) for
treatment of the lymphedema. Two months after the operation,
she developed
erythema on her right leg which spread from the leg to the groin in series. This
pattern
corresponded to the direction of lymph drainage, which may have been
enhanced by the
conservative physiotherapy and LVA treatments. These facts
suggest a possible relationship between
cutaneous metastasis of carcinoma
and treatment for lymphedema. Alternatively, the
lymphedematous limb may be
a privileged site for cancer growth, and metastatic seeding could have
taken
place from pre-existing hematogenous spread at the time of operation.
PMID: 20552816 [PubMed - in process]
Lymphology. 2010 Mar;43(1):14-8.
A novel missense mutation and two microrearrangements in the FOXC2 gene of
three families with
lymphedema-distichiasis syndrome.
Fauret AL, Tuleja E, Jeunemaitre X, Vignes S.
Département de Génétique et Centre de Référence des Maladies Vasculaires
Rares, AP-HP,
Hôpital Européen Georges Pompidou Paris, France.
Abstract
Lymphedema-distichiasis (LD) syndrome is a rare autosomal dominant disorder
of the FOXC2
gene, which codes for a forkhead transcription factor. Most of
the mutations described in this gene to
date are deletions or insertions,
suggesting a mechanism of haploinsufficiency. We studied three
independent
families with LD presenting with both lymphedema and distichiasis. Two
microrearrangements (one 8-bp deletion and one 7-bp duplication) occurring
in a GC-rich genomic
region (c.893-930) known to be prone to mutations were
identified. A new missense mutation (p.
Lys132Glu) located in a highly
conserved sequence, the forkhead domain, was also identified.
Mutations in
this domain have been previously shown to impair FOXC2 transactivation ability.
At a
genetic level, this study confirms the heterogeneity of mutations
responsible for LD and is consistent
with a mechanism of haploinsufficiency.
At a clinical level, it reinforces the importance of genetic
testing in
subjects with familial lymphedema or distichiasis, since measures can be taken
at an early
stage to prevent complications and to reduce the progression of
lymphedema or delay its occurrence.
PMID: 20552815 [PubMed - in process]
Lymphology. 2010 Mar;43(1):1-13.
Impact of lymphedema and arm symptoms on quality of life in breast cancer
survivors.
Hormes JM, Bryan C, Lytle LA, Gross CR, Ahmed RL, Troxel AB, Schmitz KH.
Department of Psychology, University of Pennsylvania , Philadelphia,
Pennsylvania 19104-6021,
USA.
Abstract
Lymphedema is one of many arm problems reported by breast cancer survivors.
Understanding the
impact of lymphedema on quality of life requires
consideration that arm symptoms may occur with or
without lymphedema. It was
hypothesized that specific arm symptoms and pain, related or unrelated
to
lymphedema, would be more associated with quality of life outcomes than arm
swelling. The
relation of arm swelling and of arm symptoms and associated
severity with a range of quality of life
outcomes following breast cancer
treatment was assessed in a diverse sample of 295 women, 141 of
whom had a
clinical diagnosis of lymphedema. Arm swelling (as defined by interlimb volume
or
circumference differences) and lymphedema severity (defined by Common
Toxicity Criteria) were
less correlated with quality of life than total
number of arm symptoms and specific individual
symptoms. Pain in the
affected arm correlated with poor quality of life outcomes, regardless of arm
swelling. When evaluating the impact of lymphedema on quality of life, arm
swelling may not be as
important as the total number and specific types of
arm symptoms present, as these may be more
informative about quality of life
outcomes in survivors of breast cancer with and without lymphedema.
PMID: 20552814 [PubMed - in process]
This one I don’t know where it goes, but you said “goes in news for July O/T
and you never
answered me when I question it, so Im putting it here though
it was sent to the group by Robert
Weiss but it isn’t about Medicare:
July 10, 2010 (1 doc)
FDA Warns of Risks With Unapproved Use of Quinine Sulfate
ROCKVILLE, Md -- July 8, 2010 -- The US Food and Drug Administration (FDA)
today warned
that the unapproved use of the malaria drug quinine sulfate
(Qualaquin) to treat night time leg cramps
has resulted in serious side
effects and prompted the manufacturer to develop a risk management
plan
aimed at educating healthcare professionals and patients about the potential
risks.
Quinine is not FDA-approved to treat or prevent night time leg cramps.
A review of reports submitted to the FDA's Adverse Event Reporting System
(AERS) between
April 2005 and October 1, 2008, found 38 US cases of serious
side effects associated with the use
of quinine.
Quinine use resulted in serious and life-threatening reactions in 24 cases,
including thrombocytopenia
and hemolytic uremic syndrome/thrombotic
thrombocytopenic purpura.
In some patients, these side effects resulted in permanent kidney impairment
and hospitalisation. Two
patients died. Most of those reporting serious side
effects took the drug to prevent or treat leg
cramps or restless leg
syndrome.
The risk management plan, called a Risk Evaluation and Mitigation Strategy
(REMS), requires that
patients be given a Medication Guide explaining what
quinine is and is not approved for, as well as
the potential side effects of
the drug. The company is also required to issue a Dear Health Care
Provider
Letter warning of the potential risk of serious and life-threatening
haematologic reactions.
SOURCE: US Food and Drug Administration
Tackling obesity as part of a lymphoedema management programme.
Stigant A.
NHS Cumbria. [email protected]
PMID: 19966696 [PubMed - indexed for MEDLINE]
-----------
2. Br J Community Nurs. 2009 Oct;14(10):S28-30.
Lymphoedema is part of who I am.
Summerhill L.
PMID: 19966693 [PubMed - indexed for MEDLINE]
----------------------
3. Br J Community Nurs. 2009 Oct;14(10):S20, 22-3.
Manual handling in lymphoedema: the importance of getting it right.
Pike C.
British Lymphology Society. [email protected]
PMID: 19966691 [PubMed - indexed for MEDLINE]
---------------------------
4. Br J Community Nurs. 2009 Oct;14(10):S15-6, 18-9.
Breast cancer-related lymphoedema: implications for primary care.
Harmer V.
St.Mary's Hospital, Imperial College Healthcare NHS Trust, London. [email protected]
------------------
PMID: 19966690 [PubMed - indexed for MEDLINE]
-----------------
1. Am J Clin Oncol. 2010 Jan 15. [Epub ahead of print]
The Role of Chemo-Radiotherapy in the Management of Locally Advanced
Carcinoma of the Vulva: Single
Institutional Experience and Review of
Literature.
Tans L, Ansink AC, van Rooij PH, Kleijnen C, Mens JW.
From the *Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer
Center, Rotterdam,
The Netherlands; daggerDepartment of Gynecological
Oncology, Erasmus MC-Daniel den Hoed Cancer
Center, Rotterdam, The
Netherlands; and double daggerDepartment of Radiation Oncology, University
Medical Center Utrecht, Utrecht, The Netherlands.
OBJECTIVE:: To retrospectively investigate the outcome and toxicity of
concurrent chemo-radiotherapy in
the treatment of locally advanced vulvar
cancer (LAVC).
PATIENTS AND METHODS:: Between 1996 and 2007, 28 consecutive patients with
LAVC were
treated with chemoradiation (20 primary tumors and 8 loco-regional
recurrences). Treatment consists of 2
separate courses of external-beam
radiotherapy (40 Gy-2 weeks split-20 Gy). During each course of
radiotherapy, 5-fluorouracil (1000 mg/m /d), was given as a continuous intravenous infusion over the first 4
days, and mitomycin-C (10 mg/m on day
1), as a bolus intravenous injection. Outcome measures were
rates of complete and partial response, loco-regional control, progression-free survival, overall survival,
and toxicity.
RESULTS:: The median follow-up was 42 months and the median age of patients
was 68 years. Twenty
patients (72%) achieved complete remission, 4 patients
(14%) partial remission, for an overall response
rate of 86%. Four patients
(14%) had progressive disease directly after chemo-radiotherapy. The actuarial
rates of loco-regional control, progression-free survival and overall
survival at 4 years were 75%, 71%,
and 65%, respectively. There was no
treatment break for acute toxicity. Vulvar desquamation was the main
acute
treatment-related side effect (93%). Three patients developed transient grade 2
neutropenia or
thrombocytopenia. Mild skin fibrosis and atrophy (n = 6,
21%), radiation ulcer (n = 4, 14%, in one patient
treatment was needed),
telangectasia (n = 3, 11%), and lymphoedema (n = 2, 7%) were the most common
late toxicity of chemoradiation.
CONCLUSION:: These data support the use of concurrent chemoradiotherapy as an
effective alternative
to primary ultra-radical surgery to treat LAVC with an
acceptable toxicity profile.
PMID: 20087157 [PubMed - as supplied by publisher]
------------------------
2.
J Postgrad Med. 2009 Oct-Dec;55(4):270-1.
Yellow nail syndrome following thoracic surgery: A new association?
Banta DP, Dandamudi N, Parekh HJ, Anholm JD.
Loma Linda University Medical Center, VA Loma Linda Healthcare System, Loma
Linda, California,
USA.
An 80-year-old man presented with the characteristic triad of yellow nail
syndrome (chronic respiratory
disorders, primary lymphedema and yellow
nails) in association with coronary artery bypass graft surgery.
Treatment
with mechanical pleurodesis and vitamin E resulted in near complete resolution
of the yellow
nails, pleural effusions, and lower extremity edema. The
etiology of the yellow nail syndrome has been
described as an anatomical or
functional lymphatic abnormality. Several conditions have previously been
described as associated with this disease. This is the first report of the
association of this syndrome with
thoracic surgery.
PMID: 20083874 [PubMed - in process]
-------------------------
3. Int J Palliat Nurs. 2009 Oct;15(10):474, 476-80.
Understanding lymphoedema in advanced disease in a palliative care
setting.
Todd M.
Specialist Lymphoedema Clinic, Glasgow, UK. [email protected]
Lymphoedema in the palliative patient can be very distressing and
uncomfortable, and managing this
symptom is often difficult and labour
intensive. Using a humanistic approach, the practitioner can holistically
and sensitively assess the patient's needs and problems and develop a
management strategy that ensures
these needs are addressed. This requires a
high level of skill in assessment, communication, collaborative
working, and
symptom management. The four basic principles of lymphoedema management are
compression, massage, skin care and exercise. These principles are modified
and applied on an individual
patient basis through the support and
collaboration of the team involved in each patient's care.
PMID: 20081719 [PubMed - in process]
---------------
4. J Wound Care. 2010 Jan;19(1):15-7.
Using VAC to facilitate healing of traumatic wounds in patients with chronic
lymphoedema.
Wollina U, Hansel G, Krönert C, Heinig B.
Healing of traumatic injuries in patients with chronic lymphoedema is often
delayed. This article describes
how topical negative pressure was used to
promote healing in two such cases. It also eliminated pain and
prevented
re-infection.
PMID: 20081569 [PubMed - in process]
----------------
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007585.
Lymphadenectomy for the management of endometrial cancer.
May K, Bryant A, Dickinson HO, Kehoe S, Morrison J.
Nuffield Department of Obstetrics and Gynaecology, University of Oxford,
Women's Centre, John
Radcliffe Hospital, Oxford, UK, OX3 9DU.
BACKGROUND: Endometrial carcinoma is the most common gynaecological cancer in
western Europe
and North America. Lymph node metastases can be found in
approximately 10% of women who clinically
have cancer confined to the womb
prior to surgery and removal of all pelvic and para-aortic lymph nodes
(lymphadenectomy) is widely advocated. Pelvic and para-aortic
lymphadenectomy is part of the FIGO
staging system for endometrial cancer.
This recommendation is based on non-randomised controlled trials
(RCTs) data
that suggested improvement in survival following pelvic and para-aortic
lymphadenectomy.
However, treatment of pelvic lymph nodes may not confer a
direct therapeutic benefit, other than allocating
women to poorer prognosis
groups. Furthermore, a systematic review and meta-analysis of RCTs of
routine adjuvant radiotherapy to treat possible lymph node metastases in
women with early-stage
endometrial cancer, did not find a survival
advantage. Surgical removal of pelvic and para-aortic lymph
nodes has
serious potential short and long-term sequelae and most women will not have
positive lymph
nodes. It is therefore important to establish the clinical
value of a treatment with known morbidity.
OBJECTIVES: To evaluate the effectiveness and safety of lymphadenectomy for
the management of
endometrial cancer.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL)
Issue 2, 2009. Cochrane Gynaecological Cancer Review Group
Trials Register, MEDLINE (1966 to June
2009), Embase (1966 to June 2009). We
also searched registers of clinical trials, abstracts of scientific
meetings, reference lists of included studies and contacted experts in the
field.
SELECTION CRITERIA: RCTs and quasi-RCTs that compared lymphadenectomy with no
lymphadenectomy, in adult women diagnosed with endometrial cancer.
DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted
data and
assessed risk of bias. Hazard ratios (HRs) for overall and
progression-free survival and risk ratios (RRs)
comparing adverse events in
women who received lymphadenectomy or no lymphadenectomy were
pooled in
random effects meta-analyses.
MAIN RESULTS: Two RCTs met the inclusion criteria; they randomised 1945
women, and reported HRs
for survival, adjusted for prognostic factors, based
on 1851 women.Meta-analysis indicated no significant
difference in overall
and recurrence-free survival between women who received lymphadenectomy and
those who received no lymphadenectomy (pooled HR = 1.07, 95% CI: 0.81 to
1.43 and HR = 1.23, 95%
CI: 0.96 to 1.58 for overall and recurrence-free
survival respectively).We found no statistically significant
difference in
risk of direct surgical morbidity between women who received lymphadenectomy and
those
who received no lymphadenectomy. However, women who received
lymphadenectomy had a significantly
higher risk of surgically related
systemic morbidity and lymphoedema/lymphocyst formation than those who
had
no lymphadenectomy (RR = 3.72, 95% CI: 1.04 to 13.27 and RR = 8.39, 95% CI:
4.06, 17.33 for
risk of surgically related systemic morbidity and
lymphoedema/lymphocyst formation respectively).
AUTHORS' CONCLUSIONS: We found no evidence that lymphadenectomy decreases the
risk of death
or disease recurrence compared with no lymphadenectomy in
women with presumed stage I disease. The
evidence on serious adverse events
suggests that women who receive lymphadenectomy are more likely to
experience surgically related systemic morbidity or lymphoedema/lymphocyst
formation.
PMID: 20091639 [PubMed - in process]
----------------
2. Ann Oncol. 2010 Jan 20. [Epub ahead of print]
Eccrine porocarcinoma presenting with scrotal lymphedema: a case report and
review of systemic
treatment.
Perez-Garcia J, Morales R, Valverde CM, Rodon J, Suarez C, Semidey ME,
Garcia-Patos V, Bartralot
R, Serra M, Carles J.
Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona,
Spain.
PMID: 20089564 [PubMed - as supplied by publisher
-----------------------
3. Zhongguo Zhen Jiu. 2009 Dec;29(12):998-1000.
[Observation on 27 elderly women in britain with lymphedema syndrome treated
by acupuncture combined
with medicine] [Article in Chinese]
Yang XH, Liu H, Chai JH, Zhao XC.
Department of Acupuncture and Moxibustion, Jingmen Hospital of TCM, Jingmen
448000, China.
[email protected]
OBJECTIVE: To observe clinical effect of acupuncture combined with medicine
therapy for elderly women
in Britain with lymphedema syndrome.
METHODS: Twenty-seven cases were classified according to syndrome
differentiation of TCM into cold
congealing and dampness obstruction type
(11 cases), qi-blood stagnation type (12 cases) and downward
attack of
damp-heat type (4 cases). They were treated with acupuncture at main points
Zusanli (ST 36),
Yanglingquan (GB 34), Yinglingquan (SP 9), Sanyinjiao (SP
6), Taichong (LR 3), Fenglong (ST 40),
Xuehai (SP 10), Fengshi (GB 31), Futu
(ST 32), Liangqiu (ST 34), Weizhong (BL 40), etc., twice each
week and oral
administration of modified Duhuojisheng Decoction, Huangqiwuwu Decoction and
Simiao
San Decoction, respectively, meanwhile washing the affected limb with
again decoction of remaining gruffs
one medicament each day. They were
treated for 12 weeks.
RESULTS: Twelve cases were clinically cured, accounting for 44.4%, 14 cases
were effective, accounting
for 51.9%; and 1 case was ineffective, accounting
for 3.7%.
CONCLUSION: Acupuncture combined with medicine has a good therapeutic effect
on lymphedema
syndrome.
PMID: 20088421 [PubMed - in process]
------------------
1. Mamm Genome. 2009 Dec 29. [Epub ahead of print]
Whole-genome scan identifies quantitative trait loci for chronic pastern
dermatitis in German draft horses.
Mittmann EH, Mömke S, Distl O.
Institute of Animal Breeding and Genetics, University of Veterinary Medicine
Hannover, Bünteweg 17p,
30559, Hannover, Germany.
Chronic pastern dermatitis (CPD), also known as chronic progressive
lymphedema (CPL), is a skin
disease that affects draft horses. This disease
causes painful lower-leg swelling, nodule formation, and skin
ulceration,
interfering with movement. The aim of this whole-genome scan was to identify
quantitative trait
loci (QTL) for CPD in German draft horses. We recorded
clinical data for CPD in 917 German draft
horses and collected blood samples
from these horses. Of these 917 horses, 31 paternal half-sib families
comprising 378 horses from the breeds Rhenish German, Schleswig,
Saxon-Thuringian, and South German
were chosen for genotyping. Each half-sib
family was constituted by only one draft horse breed.
Genotyping was done
for 318 polymorphic microsatellites evenly distributed on all equine autosomes
and
the X chromosome with a mean distance of 7.5 Mb. An across-breed
multipoint linkage analysis revealed
chromosome-wide significant QTL on
horse chromosomes (ECA) 1, 9, 16, and 17. Analyses by breed
confirmed the
QTL on ECA1 in South German and the QTL on ECA9, 16, and 17 in Saxon-Thuringian
draft horses. For the Rhenish German and Schleswig draft horses, additional
QTL on ECA4 and 10 and
for the South German draft horses an additional QTL
on ECA7 were found. This is the first whole-genome
scan for CPD in draft
horses and it is an important step toward the identification of candidate
genes.
PMID: 20039044 [PubMed - as supplied by publisher]
--------------------
2. Work. 2009;34(3):285-96.
The impact of breast cancer among Canadian women: disability and
productivity.
Quinlan E, Thomas-MacLean R, Hack T, Kwan W, Miedema B, Tatemichi S, Towers
A, Tilley A.
University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N5A5. [email protected]
Each year over 20,000 Canadian women are diagnosed with breast cancer. Many
breast cancer survivors
anticipate a considerable number of years of
potential participation in the paid labour market, therefore, the
link
between breast cancer survivorship and productivity deserves serious
consideration. The hypothesis
guiding this study is that arm morbidities
such as lymphedema, pain, and range of motion limitations are
important
explanatory variables in survivors' loss of productivity. The study draws from a
larger longitudinal
research project involving over 600 breast cancer
survivors in four geographical locations across Canada.
The study's regression results indicate that, after adjusting for fatigue, breast cancer stage, and geographical
location, survivors with range of motion limitations
and arm pain are more than two and half times as likely
to lose some
productivity capacity as compared to counterparts with no arm morbidity. The
findings make
a compelling argument for the necessity of adequate
rehabilitation programs delivered at crucial times in
breast cancer
survivors' recovery. The study's unexpected finding that geographical location
is a highly
significant predictor of changes in productivity among breast
cancer survivors is interpreted as a factor of
the regulatory framework
governing employment relationships in the four different jurisdictions.
PMID: 20037243 [PubMed - in process
-----------------
1. Clin Exp Dermatol. 2009 Dec;34(8):e931-3.
Localized bullous pemphigoid in a patient with primary lymphoedema tarda.
Perez A, Clements SE, Benton E, Robson A, Bhogal B, Stefanato CM, McGibbon
D.
St John's Institute of Dermatology, St Thomas' Hospital, London, UK. [email protected]
We report a case of localized bullous pemphigoid (BP) in a woman patient with
primary lymphoedema
tarda. There is only one previous case reported of
localized pemphigoid in an area of lymphoedema, this
being of the
cicatricial variant. Slow circulation in the lymphatic vessels, increased
capillary permeability
with preferential localization of antibodies in the
area, and potential cleavage of the epidermal junction due
to increased
hydrostatic pressure leading to autoimmunity, have all been advocated as
possible pathogenic
mechanisms. Nevertheless, we consider that the mechanism
by which localized pemphigoid arises on
lymphoedema remains elusive, based
on a previous case of generalized BP sparing an area of postsurgical
lymphoedema.
PMID: 20055870 [PubMed - in process
----------------------
2. Clin Exp Dermatol. 2009 Dec;34(8):e696-8. Epub 2009 Jul 3.
Elephantiasis nostras verrucosa in a patient with systemic sclerosis.
Chatterjee S, Karai LJ.
Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic, 9500
Euclid Avenue/Desk
A50, Cleveland, OH 44195, USA. [email protected]
Elephantiasis nostras verrucosa (ENV) is an unusual skin condition
characterized by dermal fibrosis and
hyperkeratotic verrucous lesions
resulting from chronic nonfilarial lymphoedema. The condition is similar to
'elephantiasis tropica', in which elephantiasis develops secondary to
filariasis. Lymphatic obstruction can be
primary or due to various causes
such as surgery, tumour, radiation, congestive heart failure or obesity.
Recurrent attacks of cellulitis lead to further impairment of lymphatic
drainage, causing permanent swelling,
dermal fibrosis and epidermal
thickening. We report a case of a 56-year-old man with systemic sclerosis
(SS), who presented with painful lesions on both legs, consistent with ENV.
He developed extensive,
fungating, papillomatous lesions on the skin of the
legs, toes and dorsa of the feet over a period of 3 years.
Histology
revealed dense dermal fibrosis, oedema of the papillary dermis and extensive
pseudo-epitheliomatous changes. To our knowledge, this is the first report
of ENV in which SS was
considered to be the primary cause for the impairment
of lymphatic flow.
PMID: 20055839 [PubMed - in process
-----------------------------
3. Breast Cancer Res Treat. 2010 Jan 7. [Epub ahead of print]
Pre-operative assessment enables early diagnosis and recovery of shoulder
function in patients with breast
cancer.
Springer BA, Levy E, McGarvey C, Pfalzer LA, Stout NL, Gerber LH, Soballe PW,
Danoff J.
Proponency Office for Rehabilitation and Reintegration, Office of the Surgeon
General, 5109 Leesburg
Pike, Suite 684, Falls Church, VA, 22041-3258, USA,
[email protected].
In order to determine the extent and time course of upper limb impairment and
dysfunction in women being
treated for breast cancer (BC), and followed
prospectively, a novel physical therapy surveillance model
post-treatment
was used. Subjects included adult women with newly diagnosed, untreated,
unilateral, Stage
I to III BC, and normal physiological and biomechanical
shoulder function. Subjects were excluded if they
had a previous history of
BC, or prior injury or surgery of the affected upper limb. Measurements included
body weight, shoulder ranges of motion (ROM), manual muscle tests, pain
levels, upper limb volume, and
an upper limb disability questionnaire
(ULDQ). Measurements were taken at baseline (pre-surgery), and 1,
3-6, and
12 months post-surgery. All subjects received pre-operative education and
exercise instruction
and specific physical therapy (PT) protocol after
surgery including ROM and strengthening exercises. All
measures of function
were significantly reduced 1 month post-surgery, but most recovered to baseline
levels by 1-year post-surgery. Some subjects developed signs of lymphedema
3-12 months post-surgery,
but this did not compromise function. Shoulder
abduction, flexion, and external rotation, but not internal
rotation ROM,
were associated with the ULDQ. Most women in this cohort undergoing surgery for
BC
who receive PT intervention may expect a return to baseline ROM and
strength by 3 months. Those who
do not reach baseline, often continue to
improve and reach their pre-operative levels by 1-year
post-surgery.
Lymphedema develops independently of shoulder function 3-12 months post-surgery,
necessitating continued monitoring. A prospective physical therapy model of
surveillance allows for
detection of early and later onset of impairment
following surgery for BC in this specific cohort of patients.
PMID: 20054643 [PubMed - as supplied by publisher
-------------------------
4. Hernia. 2010 Jan 7. [Epub ahead of print]
Abdominoscrotal hydrocele in a 9-month old infant.
Blevrakis E, Anyfantakis DI, Sakellaris G.
Department of Pediatric Surgery, University General Hospital of Heraklion,
Crete, Greece.
Abdominoscrotal hydrocele represents an uncommon condition, especially in
childhood, resulting from the
communication of a large scrotal hydrocele
with the abdominal cavity through the inguinal canal. The
disorder has been
associated with a variety of pathological entities such as hydronephrosis,
lymphedema,
and malignancy of the tunica vaginalis. Diagnosis is made by
physical examination and confirmed by
abdominal ultrasound scan. Surgical
correction, although complex, remains the optimal therapeutic option.
The
present article reports the case of a 9-month infant from Greece with
abdominoscrotal hydrocele.
Regardless of rarity, the disorder should be
included in the differential diagnosis of scrotal and abdominal
masses, as
early diagnosis and surgical intervention may prevent the development of
potential
complications. The difficulty in establishing a preoperative
diagnosis highlights the necessity for a physician
to have a high level of
familiarity with abdominoscrotal hydrocele and its possible complications.
Awareness
of this abnormality will ensure its prompt recognition and optimal
management.
PMID: 20054596 [PubMed - as supplied by publisher]
----------------------
1. J Mal Vasc. 2009 Nov;34(5):314-22.
[Limb lymphedema: Diagnosis, explorations, complications][Article in
French]
Vignes S, Coupé M, Baulieu F, Vaillant L; Groupe Recommandations de la
Société Française de
Lymphologie.
Unité de lymphologie, hôpital Cognacq-Jay, Centre national de référence des
maladies vasculaires rares,
15, rue Eugène-Millon,75015 Paris, France.
Lymphedema results from impaired lymphatic transport with increased limb
volume. Primary and secondary
forms can be distinguished. Secondary
lymphedema of the upper limb is the most frequent in France. A
2-cm
difference on any segment of the limb confirms the diagnosis of lymphedema.
Calculated lymphedema
volume using the formula for a truncated cone is
required to assess the efficacy of treatment and to monitor
follow-up.
Primary lymphedema is sporadic but rarely familial. Lymphoscintigraphy is useful
in the primary
form to evaluate precisely lymphatic function of the two
limbs. Erysipelas is the main complication,but
psychological or functional
discomfort may occur throughout the course of lymphedema. Lipedema is the
main differential diagnosis, defined as an abnormal accumulation of fat from
hip to ankle and occurs almost
exclusively in obese women.
PMID: 20050179 [PubMed - in process
----------------------
2. Plast Reconstr Surg. 2010 Jan;125(1):19-23.
Breast reconstruction and lymphedema.
Chang DW, Kim S.
Department of Plastic Surgery, University of Texas M. D. Anderson Cancer
Center, Houston, Texas
77030-4009, USA. [email protected]
BACKGROUND: The authors conducted this study to determine the following: Does
delayed breast
reconstruction that requires surgical dissection in the
previously operated on and/or irradiated axilla lead to
a higher incidence
of lymphedema? In patients who have developed lymphedema following mastectomy,
does delayed breast reconstruction with autologous flap reduce the severity
of the lymphedema?
METHODS: Four hundred eighty-two consecutive delayed autologous breast
reconstructions performed at
the authors' institution were evaluated. The
authors evaluated the effects of flap choice, recipient vessel
choice,
previous radiotherapy, and previous axillary node dissection on lymphedema
development after
breast reconstruction. The authors also evaluated the
effect of autologous breast reconstruction on the
status of the preexisting
lymphedema.
RESULTS: Four hundred forty-four delayed breast reconstructions were
performed using 394 free flaps
and 50 latissimus dorsi flaps in patients
with no lymphedema. Lymphedema developed in 16 cases (3.6
percent). The type
of flap, the site of recipient vessel, previous radiotherapy, and previous
axillary node
dissection did not have a significant effect on the incidence
of lymphedema after breast reconstruction.
Breast reconstructions were
performed in 38 patients who already had lymphedema: nine (23.7 percent)
demonstrated significant improvement, and none demonstrated worsening of
lymphedema after breast
reconstruction.
CONCLUSIONS: The incidence of lymphedema following delayed autologous breast
reconstruction is
low, and the use of thoracodorsal vessels or a latissimus
dorsi flap, even in patients with previous axillary
node dissection or
irradiation, was not associated with a significantly higher risk of developing
lymphedema.
In patients who developed lymphedema following mastectomy,
delayed autologous breast reconstruction
may help reduce the severity of
lymphedema.
PMID: 20048582 [PubMed - in process
--------------------
1. Oncol Nurs Forum. 2010 Jan;37(1):85-91.
Patient perceptions of arm care and exercise advice after breast cancer
surgery.
Lee TS, Kilbreath SL, Sullivan G, Refshauge KM, Beith JM.
Royal North Shore Hospital, Sydney, Australia. [email protected]
PURPOSE/OBJECTIVES: To describe in greater detail women's experiences
receiving advice about arm
care and exercise after breast cancer treatment.
DESIGN: Cross-sectional survey.
SETTING: Three hospitals in Sydney, Australia.
SAMPLE: 175 patients with breast cancer recruited 6-15 months after their
surgery.
METHODS: Patients completed a survey about their perceptions of arm activity
after breast cancer and
were asked to respond to an open-ended question
about their experience receiving advice about arm care
and exercise.
Comments from 48 women (27%) who volunteered responses were collated and
categorized.
MAIN RESEARCH VARIABLES: Patients' experience with arm care and exercise
advice after breast
cancer surgery.
FINDINGS: Topics raised by respondents included perceptions of inadequate and
conflicting advice, lack
of acknowledgment of women's concerns about upper
limb impairments, an unsupported search for
information about upper limb
impairments, fear of lymphedema, women's demand for follow-up
physiotherapy,
and some positive experiences with supportive care.
CONCLUSIONS: Upper limb impairments are problematic for some breast cancer
survivors, and these
concerns are not always taken seriously by health
professionals. To date, standardized advice is provided
that does not meet
the needs and expectations of a cohort of women after breast cancer surgery.
IMPLICATIONS FOR NURSING: Health professionals could better address patients'
concerns about
upper limb impairments by providing accurate advice relevant
to the surgery.
PMID: 20044343 [PubMed - in process
----------------------
2. Oncol Nurs Forum. 2010 Jan;37(1):E28-33.
Confronting the unexpected: temporal, situational, and attributive dimensions
of distressing symptom
experience for breast cancer survivors.
Rosedale M, Fu MR.
College of Nursing, New York University, New York City, USA. [email protected]
PURPOSE/OBJECTIVES: To describe women's unexpected and distressing symptom
experiences after
breast cancer treatment.
RESEARCH APPROACH: Qualitative and descriptive.Setting: Depending upon their
preference,
participants were interviewed in their homes or in a private
office space in a nearby library.
PARTICIPANTS: Purposive sample of 13 women 1-18 years after breast cancer
treatment.
METHODOLOGIC APPROACH: Secondary analysis of phenomenologic data (constant
comparative
method).
MAIN RESEARCH VARIABLES: Breast cancer symptom distress, ongoing symptoms,
and unexpected
experiences.
FINDINGS: Women described experiences of unexpected and distressing symptoms
in the years following
breast cancer treatment. Symptoms included pain, loss
of energy, impaired limb movement, cognitive
disturbance, changed sexual
experience, and lymphedema. Four central themes were derived: living with
lingering symptoms, confronting unexpected situations, losing precancer
being, and feeling like a has-been.
Distress intensified when women expected
symptoms to disappear but symptoms persisted instead.
Increased distress
also was associated with sudden and unexpected situations or when symptoms
elicited
feelings of loss about precancer being and feelings of being a has
been. Findings suggest that symptom
distress has temporal, situational, and
attributive dimensions.
CONCLUSIONS: Breast cancer survivors' perceptions of ongoing and unexpected
symptoms have
important influences on quality of life. Understanding
temporal, situational, and attributive dimensions of
symptom distress
empowers nurses and healthcare professionals to help breast cancer survivors
prepare
for subsequent ongoing or unexpected experiences in the years after
breast cancer treatment.
INTERPRETATION: Follow-up care for breast cancer survivors should foster
dialogue about ways that
symptoms might emerge and that unexpected
situations might occur. Prospective studies are needed to
examine symptom
distress in terms of temporal, situational, and attributive dimensions and
explore the
relationship between symptom distress and psychological distress
after breast cancer treatment.
PMID: 20044329 [PubMed - in process
----------------
1. J Man Manip Ther. 2009;17(3):e80-9.
Systematic review of efficacy for manual lymphatic drainage techniques in
sports medicine and
rehabilitation: an evidence-based practice approach.
Vairo GL, Miller SJ, McBrier NM, Buckley WE.
Manual therapists question integrating manual lymphatic drainage techniques
(MLDTs) into conventional
treatments for athletic injuries due to the
scarcity of literature concerning musculoskeletal applications and
established orthopaedic clinical practice guidelines. The purpose of this
systematic review is to provide
manual therapy clinicians with pertinent
information regarding progression of MLDTs as well as to critique
the
evidence for efficacy of this method in sports medicine. We surveyed
English-language publications
from 1998 to 2008 by searching PubMed, PEDro,
CINAHL, the Cochrane Library, and SPORTDiscus
databases using the terms
lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage,
and lymphatic pump techniques. We selected articles investigating the
effects of MLDTs on orthopaedic
and athletic injury outcomes. Nine articles
met inclusion criteria, of which 3 were randomized controlled
trials (RCTs).
We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences
in
experimental design, data could not be collapsed for meta-analysis.
Animal model experiments reinforce
theoretical principles for application of
MLDTs. When combined with concomitant musculoskeletal
therapy, pilot and
case studies demonstrate MLDT effectiveness. The best evidence suggests that
efficacy
of MLDT in sports medicine and rehabilitation is specific to
resolution of enzyme serum levels associated
with acute skeletal muscle cell
damage as well as reduction of edema following acute ankle joint sprain and
radial wrist fracture. Currently, there is limited high-ranking evidence
available. Well-designed RCTs
assessing outcome variables following
implementation of MLDTs in treating athletic injuries may provide
conclusive
evidence for establishing applicable clinical practice guidelines in sports
medicine and
rehabilitation.
PMID: 20046617 [PubMed - in process
------------------
1. Gynecol Obstet Invest. 2010 Jan 12;69(3):212-216. [Epub ahead of
print]
Vulvar Lymphoedematous Pseudotumours Mistaken for Aggressive Angiomyxoma:
Report of Two Cases.
D'Antonio A, Caleo A, Boscaino A, Mossetti G, Iannantuoni N.
Unit of Pathologic Anatomy, A.U.O. San Giovanni di Dio e Ruggi d'Aragona,
Salerno, Italy.
Background: We describe 2 cases of vulvar pseudotumour due to lymphatic
obstruction with chronic
lymphoedema of unknown cause that presented as a
solitary mass that mimicked aggressive angiomyxoma.
Material and Methods:
Both patients presented with a vulvar mass without medical history of trauma,
surgery in the anogenital region or skin diseases. One patient was
overweight (BMI = 26). Both surgically
resected vulvar specimens were
represented by a polypoid mass with a soft and a gelatinous cut surface.
Results: Histologically, the presence of an abundant oedematous stroma with
spindle-shaped cells and
numerous thin-walled small-to-medium vessels may be
confused with an aggressive angiomyxoma. The
diagnostic key was represented
by the massive oedema, rather than myxoid stroma, with the presence of
dilated, tortuous lymphatic channels (some surrounded by clusters of
lymphocytes) in the dermis.
Conclusion: The recognition of these lesions is
important because they may be the cause of problems in
differential
diagnosis and therapeutic management. In fact, such lesions can be mistaken from
both the
clinical and histological perspective as a primitive tumour of the
vulva-like aggressive angiomyxoma.
However, these lesions are not true
neoplasms and are likely due to lymphatic obstruction with
lymphoedema. A
simple surgical excision with vulvoplasty is curative. Copyright © 2010 S.
Karger AG,
Basel.
PMID: 20068325 [PubMed - as supplied by publisher
-----------------
2. BMJ. 2010 Jan 12;340:b5396. doi: 10.1136/bmj.b5396.
Effectiveness of early physiotherapy to prevent lymphoedema after surgery for
breast cancer: randomised,
single blinded, clinical trial.
Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, Prieto Merino D, Mayoral
del Moral O, Cerezo
Téllez E, Minayo Mogollón E.
Physiotherapy Department, School of Physiotherapy, Alcalá de Henares
University, E-28871 Alcalá de
Henares, Madrid, Spain. [email protected]
OBJECTIVE: To determine the effectiveness of early physiotherapy in reducing
the risk of secondary
lymphoedema after surgery for breast cancer.
DESIGN: Randomised, single blinded, clinical trial.
SETTING: University hospital in Alcalá de Henares, Madrid, Spain.
PARTICIPANTS: 120 women who had breast surgery involving dissection of
axillary lymph nodes
between May 2005 and June 2007.
INTERVENTION: The early physiotherapy group was treated by a physiotherapist
with a physiotherapy
programme including manual lymph drainage, massage of
scar tissue, and progressive active and action
assisted shoulder exercises.
This group also received an educational strategy. The control group received
the educational strategy only.
MAIN OUTCOME MEASURE: Incidence of clinically significant secondary
lymphoedema (>2 cm
increase in arm circumference measured at two adjacent
points compared with the non-affected arm).
RESULTS: 116 women completed the
one year follow-up. Of these, 18 developed secondary
lymphoedema (16%): 14
in the control group (25%) and four in the intervention group (7%). The
difference was significant (P=0.01); risk ratio 0.28 (95% confidence
interval 0.10 to 0.79). A survival
analysis showed a significant difference,
with secondary lymphoedema being diagnosed four times earlier in
the control
group than in the intervention group (intervention/control, hazard ratio 0.26,
95% confidence
interval 0.09 to 0.79).
CONCLUSION: Early physiotherapy could be an effective intervention in the
prevention of secondary
lymphoedema in women for at least one year after
surgery for breast cancer involving dissection of axillary
lymph nodes.
TRIAL REGISTRATION: Current controlled trials ISRCTN95870846.
PMID: 20068255 [PubMed - in process
----------------------
3. BMJ. 2010 Jan 12;340:b5235. doi: 10.1136/bmj.b5235.
Prevention of lymphoedema after axillary surgery for breast cancer.
Cheville A.
PMID: 20068254 [PubMed - in process]
-------------------------
4. Physiother Theory Pract. 2010 Jan;26(1):62-8.
Physical therapy management of primary lymphedema in the lower extremities: A
case report.
Greene R, Fowler R.
Howard University, Washington, DC, USA. [email protected]
Lymphedema is the tissue fluid accumulation that arises as a consequence of
impaired lymphatic drainage.
Lymphedema can result from either congenital
(primary) or acquired (secondary) anomalies. Primary
lymphedema affects 1-2
million people in the United States. Women are more affected by this disorder
than men. The management of lymphedema by physical therapists usually
includes a combination of skin
care, external pressure, isotonic exercise,
and massage. This case report describes the course of treatment
for a
24-year-old female with stages 2 and 3 primary lymphedema. The goals of physical
therapy
intervention were as follows: 1) to reduce total limb girth
circumference for both lower extremities; 2) to
improve skin texture; 3) to
promote independence with skin care to reduce the risk of infection; and 4) to
facilitate independence with self-management. Following intervention, the
patient met and exceeded all
goals to decrease limb circumference. She had
minimal fibrosis in the lower extremities, and she exhibited
no signs and/or
symptoms of infection. Decongestive lymphedema therapy was effective in treating
this
patient with primary lymphedema of the lower extremities. Continuous
maintenance is required to ensure
that the patient's limb size continues to
reduce.
PMID: 20067355 [PubMed - in process]
-------------------------
5. Support Care Cancer. 2010 Jan 12. [Epub ahead of print]
Retrospective trial of complete decongestive physical therapy for lower
extremity secondary lymphedema
in melanoma patients.
Carmeli E, Bartoletti R.
Tel Aviv University, Tel Aviv, Israel, [email protected].
BACKGROUND: Melanoma is a malignant tumour of melanocytes, which are found
predominantly in
skin, and at least 10-45% of patients develop secondary
lymphedema (SL).
PURPOSE: This study seeks to investigate if individual's lymphatic system can
benefit from complete
decongestive physical therapy (CDPT) 1 year after
discharge from CDPT and consequently endorsing a
better quality of life.
METHODS: Male and female(n = 12) melanoma survivors 1-4 years post diagnosis
with unilateral SL.
Questionnaire and limb measurements were used to asses
retrospective outcomes. RESULTS: A significant
improvements (p < 0.05)
has been in the categories of localisation, staging, disability and symptoms of
SL.
CONCLUSIONS: CDPT provides relief in signs and symptoms for patients with SL
following groyne
dissection.
PMID: 20066550 [PubMed - as supplied by publisher]
----------------------
6. J Surg Oncol. 2010 Jan 8. [Epub ahead of print]
Axillary reverse mapping with indocyanine fluorescence imaging in patients
with breast cancer.
Noguchi M, Yokoi M, Nakano Y.
Department of Breast and Endocrine Surgery, Kanazawa Medical University
Hospital, Uchinada-daigaku,
Japan.
BACKGROUND: The ARM technique was proposed to prevent arm lymphedema after
ALND and/or
SLN biopsy. However, several problems remain to be resolved in
the practical application of this technique.
METHODS: The fluorescent ARM nodes and/or lymphatics were identified using a
fluorescence imaging
system with subdermal injection of indocyanine green
into the upper limb. ALND was performed in patients
with clinically involved
nodes, and the ARM nodes were separately removed during ALND. SLN biopsy
was
performed in patients with clinically uninvolved nodes. If SLN was positive,
ALND was performed
with removal of ARM nodes. Otherwise, identified ARM
nodes were preserved unless they were the same
as SLN.
RESULTS: ARM nodes and/or lymphatics were identified in 7 (88%) of 8 patients
who underwent
ALND, whereas they were identified in 9 (75%) of 12 patients
who underwent SLN biopsy alone. ARM
nodes were involved with tumors in 3
(43%) of the former patients, and SLN was the same as the ARM
node in 2
(14%) of 14 patients who underwent SLN biopsy.
CONCLUSIONS: Fluorescence imaging was sensitive for identification of ARM
nodes and/or lymphatics.
However, further studies are needed before efforts
to preserve these nodes can be safely implemented.
PMID: 20063370 [PubMed - as supplied by publisher]
-------------------
7. Cases J. 2009 Dec 22;2:9377.
Challenges of cellulitis in a lymphedematous extremity: a case report.
Connor MP, Gamelli R.
Loyola University of Chicago, Stritch School of Medicine, 2160 South First
Ave, Maywood IL, 60153,
USA.
INTRODUCTION: Lymphedema is a relatively common phenomenon. It is important
that clinicians
appreciate the relative risks imposed by this condition.
While for some it may only represent a flaw in
appearance, this condition
can potentially have fatal consequences. Our case reports on the challenges of
cellulitis in a lymphedematous extremity that progressed to septic
shock.
CASE PRESENTATION: A 37-year-old Hispanic male was transferred to the Burn
Unit from an outside
hospital for wound care of an extremely severe case of
cellulitis. He suffered massive lymphedema of his
lower extremity, with
innumerable nodules and chronic skin changes. After 3 days of cellulitis, he was
in
critical condition and required intubation and vasopressors. With intense
wound care and systemic
antibiotics, he gradually recovered and was
discharged in 16 days with his cellulitis resolved and ambulating
independently.
CONCLUSION: Our case highlights the special care and attention that chronic
lymphedema deserves.
These patients can exhibit marked disfigurement and
physical disability affecting them on both social and
physical levels. They
also are at great medical risk, as cellulitis almost cost our patient his life.
Evidence
indicates that lymphedema, no matter the etiology, is susceptible
to cellulitis with both great propensity and
virulence. Physicians should be
aware of the great risk of lymphedema, strive to prevent deterioration and
complications, and be prepared to educate and closely monitor these
patients.
PMID: 20062550 [PubMed - in process]
-----------------
1. BMJ. 2010 Jan 12;340:b5396. doi: 10.1136/bmj.b5396.
Effectiveness of early physiotherapy to prevent lymphoedema after surgery for
breast cancer: randomised,
single blinded, clinical trial.
Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, Prieto Merino D, Mayoral
del Moral O, Cerezo
Téllez E, Minayo Mogollón E.
Physiotherapy Department, School of Physiotherapy, Alcalá de Henares
University, E-28871 Alcalá de
Henares, Madrid, Spain. [email protected]
OBJECTIVE: To determine the effectiveness of early physiotherapy in reducing
the risk of secondary
lymphoedema after surgery for breast cancer. DESIGN:
Randomised, single blinded, clinical trial.
SETTING: University hospital in Alcalá de Henares, Madrid, Spain.
PARTICIPANTS: 120 women who had breast surgery involving dissection of
axillary lymph nodes
between May 2005 and June 2007.
INTERVENTION: The early physiotherapy group was treated by a physiotherapist
with a physiotherapy
programme including manual lymph drainage, massage of
scar tissue, and progressive active and action
assisted shoulder exercises.
This group also received an educational strategy. The control group received
the educational strategy only.
MAIN OUTCOME MEASURE: Incidence of clinically significant secondary
lymphoedema (>2 cm
increase in arm circumference measured at two adjacent
points compared with the non-affected arm).
RESULTS: 116 women completed the one year follow-up. Of these, 18 developed
secondary
lymphoedema (16%): 14 in the control group (25%) and four in the
intervention group (7%). The
difference was significant (P=0.01); risk ratio
0.28 (95% confidence interval 0.10 to 0.79). A survival
analysis showed a
significant difference, with secondary lymphoedema being diagnosed four times
earlier in
the control group than in the intervention group
(intervention/control, hazard ratio 0.26, 95% confidence
interval 0.09 to
0.79).
CONCLUSION: Early physiotherapy could be an effective intervention in the
prevention of secondary
lymphoedema in women for at least one year after
surgery for breast cancer involving dissection of axillary
lymph nodes.
TRIAL REGISTRATION: Current controlled trials ISRCTN95870846.
PMID: 20068255 [PubMed - in process]
-----
1. Br J Surg. 2010 Jan 25. [Epub ahead of print]
Comparison of radionuclide lymphoscintigraphy and dynamic magnetic resonance
lymphangiography for
investigating extremity lymphoedema.
Liu NF, Lu Q, Liu PA, Wu XF, Wang BS.
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's
Hospital, China.
BACKGROUND:: Lymphoscintigraphy is widely used to image the lymphatic system.
The aim of this
study was to compare lymphoscintigraphy and dynamic magnetic
resonance lymphangiography (MRL) in
the investigation of extremity
lymphoedema.
METHODS:: Sixteen patients with primary extremity lymphoedema and two with
Klippel-Trenaunay
syndrome with lymphoedema were examined by
lymphoscintigraphy using the tracer (99)Tc-labelled
dextran, and by MRL
using gadobenate dimeglumine as contrast agent. Morphological abnormalities and
functional state of the lymphatic systems of affected limbs were compared
between the two imaging
methods.
RESULTS:: Lymphatic vessels were imaged in 14 of 18 limbs with lymphoedema
using MRL, compared
with one of 18 using lymphoscintigraphy. MRL detected
the inguinal nodes in 16 of 17 patients, whereas
lymphoscintigraphy revealed
inguinal nodes in only nine. MRL revealed more precise information about
structural and functional abnormalities of lymph vessels and nodes than
lymphoscintigraphy by real-time
measurement of lymph flow in vessels and
nodes.
CONCLUSION:: Dynamic MRL was more sensitive and accurate than
lymphoscintigraphy in the
detection of anatomical and functional
abnormalities in the lymphatic system in patients with extremity
lymphoedema. Copyright (c) 2010 British Journal of Surgery Society Ltd.
Published by John Wiley &
Sons, Ltd.
PMID: 20101589 [PubMed - as supplied by publisher]
2. Acta Oncol. 2010;49(2):166-73.
Arm lymphoedema in a cohort of breast cancer survivors 10 years after
diagnosis.
Johansson K, Branje E.
Department of Health Science, Lund University, S-221 00 Lund, Sweden.
INTRODUCTION: Arm lymphoedema is a frequent complication after breast cancer
treatment. Early
diagnosis and treatment is considered important for
successful management of breast cancer related arm
lymphoedema (BCRL). The
purpose was to identify BCRL incidence, time of onset,
progression/regression and associated factors 10 years after breast cancer
diagnosis.
MATERIAL AND METHODS: Two hundred and ninety two patients treated with
axillary node dissection
and radiotherapy were included in this
retrospective study. A total of 111 diagnosed with BCRL (incidence
38.7%).
Of these women 98 were followed for up to 10 years after BCRL diagnosis. Forty
consecutive
patients registered with no BCRL were included in the control
group. BCRL was defined as an increase in
arm volume difference >or=5%
and an increased thickness of subcutis. Follow-up was performed twice a
year, including assessment of lymphoedema relative volume (LRV) by water
displacement method and
compression treatment. Additional intensive
treatment was given if LRV increased by more than 5% since
the previous
visit or exceeded 20% in total.
RESULTS: Mean LRV was 8.1 +/-3.6% at diagnosis and 9.0+/-6.7% at last
follow-up measurement
(mean 48.9+/-39.2 months) with no significant
difference. There was no difference in progression of LRV
between groups
with early versus late diagnosis (within or after 12 months postoperatively),
small
(5-<10%) versus large (>or=10%) LRV at time of diagnosis, or
regular (at least twice a year) versus
non-regular treatment. More BCRL
patients with large LRV at diagnosis (15.8%), exceeded LRV
>or=20% during
follow-up time, than patients with small LRV at diagnosis (10.1%).
CONCLUSION: BCRL can be identified at an early stage both in regard to time
of diagnosis after
operation and to edema volume, and that edema volume can
be kept at a low level for at least 10 years.
Small LRV at time of diagnosis
appears to be more important for minimizing the progression of LRV than
time
of diagnosis after operation.
PMID: 20100154 [PubMed - in process]
3. Psychooncology. 2010 Jan 22. [Epub ahead of print]
Predictors of arm morbidity following breast cancer surgery.
Hack TF, Kwan WB, Thomas-Maclean RL, Towers A, Miedema B, Tilley A, Chateau
D.
Faculty of Nursing, University of Manitoba, Winnipeg, MB, Canada.
Objective: Arm morbidity post-breast cancer surgery is increasingly being
recognized as a chronic problem
for some women following breast cancer
surgery. The purpose of this study was to examine demographic,
disease, and
treatment-related predictors of a comprehensive array of chronic arm morbidity
(pain,
lymphedema, functional disability, and range of motion) post-breast
cancer surgery.
Methods: Women (n=316) with a non-metastatic primary diagnosis of breast
cancer were accrued from
cancer centers in four Canadian cities. Patients
completed a clinical assessment and measures of arm
morbidity at 6-12 months
post-breast cancer surgery. The independent variables in the MANOVA to
predict arm morbidity included: Lymph node management type, number of
axillary nodes dissected, type of
surgery, disease stage, presence of
post-operative infection, radiation to the axilla, body mass index (BMI),
assessment time post-surgery, education, and partner status.
Results: Pain was significantly predicted by axillary lymph node management,
lack of a partner, and
post-operative infection; lymphedema by axillary
lymph node management, number of axillary nodes
dissected, radiation to the
axilla, and having a modified radical mastectomy; functional disability by
post-operative infection and high BMI; and restricted external rotation by
axillary lymph node management,
low educational attainment, and advanced
disease.
Conclusion: Comprehensive behavioral management and rehabilitation programs
are needed to treat arm
morbidity following breast cancer surgery. These
programs should address the full scope of symptoms and
associated
psychosocial and functional sequelae. Copyright (c) 2010 John Wiley & Sons,
Ltd.
PMID: 20099254 [PubMed - as supplied by publisher]
4. J Dtsch Dermatol Ges. 2010 Jan;8(1):7-14
Podoconiosis - non-filarial geochemical elephantiasis - a neglected tropical
disease?
[Article in English, German]
Nenoff P, Simon JC, Muylowa GK, Davey G.
Laboratorium für medizinische Mikrobiologie, Mölbis, Germany. [email protected]
Podoconiosis or mossy foot is a form of non-filarial lymphedema. This
geochemical elephantiasis is a
disabling condition caused by the passage of
microparticles of silica and aluminum silicates through the skin
of people
walking barefoot in areas with a high content of soil of volcanic origin.
Podoconiosis is
widespread in tropical Africa, Central America and North
India, yet it remains a neglected and
under-researched condition. The
disabling effects of podoconiosis cause great hardship to patients. It
adversely affects the economic (reduced productivity and absenteeism),
social (marriage, education, etc.)
and psychological (social stigma)
well-being of those affected. Podoconiosis can be prevented; the main
primary preventive measure is protective footwear. Secondary measures
include a strict hygiene regimen
and compression therapy, which can reverse
initial lesions. Tertiary approaches include surgical
management, such as
shaving operations to reduce hyperplastic and verrucous elephantiasis.
PMID: 20096054 [PubMed - in process]
----
07 January 2010 - Leukemia Vaccine Appears To Mop Up Cancer Cells Gleevec
Leaves Behind
Preliminary investigations by US researchers suggest that a vaccine made with
leukemia cells appears able
to reduce or wipe out the last few cancer cells
that are left behind in some patients with chronic myeloid
leukemia (CML)
who are taking the drug Gleevec (Imatinib mesylate). However, the researchers
said the
results are tentative and there could be other reasons for this
apparent success.
The pilot study, which was funded by the National Institutes of Health, is
the work of a team led by Dr
Hyam Levitsky, professor of oncology, medicine
and urology at the Johns Hopkins Kimmel Cancer Center
in Baltimore,
Maryland, and appears in the 1 January issue of the journal Clinical Cancer
Research.
Gleevec, marketed by Novartis as Gleevec in the US and Glivec in Europe and
Australia, is one of the first
targeted cancer drugs to succeed in patients
with CML. It destroys most of the cancer cells, but for many
patients a few
cells remain that can be detected with sensitive molecular tests.
These remaining cells can cause the cancer to return, said the researchers,
and especially when they come
off the Gleevec.
The researchers explained that most patients with CML have to stay on Gleevec
for most of their lives and
90 per cent of them achieve remisson, but about
10 to 15 per cent can't tolerate it in the long term.
Lead author Dr B Douglas Smith, associate professor of oncology at the Johns
Hopkins Kimmel Cancer
Center, told the press that:
"Often patients have low blood cell counts, fluid retention, significant
nausea and other gastrointestinal
problems."
Secondary therapies, including the drugs dasatinib and nilotinib, also have
many side effects, he said, adding
that another common side effect with
Gleevec is fatigue:
"Patients often tell me that they feel about 80 to 90 percent of what they
should, and over time, this may
have a big impact on their quality of life,"
he added.
Gleevec also can't be taken by pregnant women, and since one third of CML
patients tend to be in their
20s and 30s, many patients on the drug would
like to come off it because they want to have children.
Levitsky said that the ability to get patients off Gleevec would be a great
advance, and if this vaccine is
successful, that goal would be reached.
For the study, Levitsky and colleagues used a vaccine made from CML
cells.
The vaccine is made by first irradiating the CML cells to stop them being
cancerous, then altering their
genetic make up so they produce an immune
system stimulator known as GM-CSF
(granulocyte-macrophage colony-stimulating
factor, a substance that helps make more white blood cells of
particular
types).
The treated CML cells also carry antigens that are specific to CML and prime
the immune system to target
and destroy any circulating CML cells.
The researchers treated 19 CML patients with the vaccine: all the patients
had measurable levels of CML
cells, even though they had taken Gleevec for
more than 12 months. They administered the vaccine on four
occasions, three
weeks apart, with 10 skin injections each time.
They then followed up the patients after a median (mid-range) period of 6
years, at which point they found
that the remaining cancer cells had gone
down in 13 patients, of whom 12 also reached their lowest
measured level of
residual cancer cells at this point and of these seven had CML levels that were
completely undetectable.
However, the researchers were cautious to point out the limitations of the
study: there was a limited number
of patients, and there were no comparisons
with other therapies. They said they could not be sure that it
was the
vaccine that caused the CML levels to drop.
Levitsky told the media that more research was needed to confirm these
findings, and that:
"We want to get rid of every last cancer cell in the body, and using cancer
vaccines may be a good way to
mop up residual disease."
Levitsky and colleagues are now testing the patients' blood to identify
exactly which antigens are stimulating
the immune system so they can tailor
the vaccine for further investigations that examine the immune
response in
more detail.
They said during this pilot study the patients showed few side effects from
the trial vaccine, these included
pain at the injection site, swelling,
occasional muscle ache and mild fever.
"K562/GM-CSF Immunotherapy Reduces Tumor Burden in Chronic Myeloid Leukemia
Patients with
Residual Disease on Imatinib Mesylate."
B. Douglas Smith,
Yvette L. Kasamon, Jeanne Kowalski, Christopher Gocke, Kathleen Murphy, Carole
B. Miller, Elizabeth Garrett-Mayer, Hua-Ling Tsai, Lu Qin, Christina Chia,
Barbara Biedrzycki, Thomas
C. Harding, Guang Haun Tu, Richard Jones, Kristen
Hege, and Hyam I. Levitsky.
Clin Cancer Res January 1, 2010
16:338-347.
DOI:10.1158/1078-0432.CCR-09-2046
Source: Johns Hopkins Medical Institutions, NCI Dictionary of cancer
terms.
Written by: Catharine Paddock, PhD
2.
31 December 2009 - Morbidity Of Open Retroperitoneal Lymph Node Dissection
For Testicular Cancer:
Contemporary Perioperative Data
UroToday.com - Ours is a retrospective review of patients who underwent open
retroperitoneal lymph
node dissection between 2001-2008.
We identified perioperative data for patients who underwent primary (P-RPLND)
versus
post-chemotherapy RPLND (PC-RPLND) and found mean blood loss,
operative duration and hospital
stay to be significantly less for the former
group (P<0.05). A majority of the patients had high risk features
at
orchiectomy consisting of 146 (76%) embryonal carcinoma and 83 (44%) having
lymphovascular
invasion. Not surprisingly, more clinical stage I (CS I)
patients underwent primary versus PC-RPLND
(55% vs. 38%) and the converse
for clinical stage II (CSII) disease (45% vs. 62%). Overall, there were
18
(9%) complications with 7 (7%) and 11 (12%) in the primary and PC-RPLND groups,
respectively. All
of these complications consisted pain, ileus, and chylous
ascites except one patient who had an
intraoperative aortic injury. There
were no peri-operative deaths.
This contemporary data should be considered when comparing open versus
laparoscopic RPLND
(L-RPLND). Although L-RPLND has become an established
alternative for management of CS I patients,
more research is needed in
patients with high-risk features and/or post-chemotherapy treated patients. The
minimal morbidity of patients undergoing open RPLND by a dedicated tertiary
center has been described
in this contemporary group of patients and should
be considered when comparing open to L-RPLND.
Written by Stephen B. Williams, MD, et al. as part of Beyond the Abstract on
UroToday.com. This
initiative offers a method of publishing for the
professional urology community. Authors are given an
opportunity to expand
on the circumstances, limitations, etc., of their research by referencing the
published
abstract.
UroToday - the only urology website with original content written by global
urology key opinion leaders
actively engaged in clinical practice. To access
the latest urology news releases from UroToday, go to:
www.urotoday.com
------------------
1. Oper Orthop Traumatol. 2009 Dec;21(6):545-56.
The surgical treatment of chronic extension deficits of the knee] [Article in
German]
Freiling D, Lobenhoffer P.
Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus
Henriettenstiftung Hannover,
Hannover, Germany. [email protected]
OBJECTIVE : Restoration of full knee extension in patients with chronic
extension deficits, especially in
posttraumatic and postoperative cases.
INDICATIONS : Chronic knee extension deficits of more than 10 degrees .
CONTRAINDICATIONS : Local intraarticular problems caused by cyclops syndrome,
graft hypertrophy
or graft impingement after anterior cruciate ligament
reconstruction (notch impingement). These patients
should be treated with
arthroscopic procedures. Spastic flexion contracture. Noncompliant patients.
Acute
or chronic infections. Poor soft-tissue conditions on site of
surgery.
SURGICAL TECHNIQUE : If necessary, arthroscopy before arthrolysis to assure
that the extension
deficit is not caused by a local problem (cyclops,
osteophytes, graft hypertrophy or graft impingement after
anterior cruciate
ligament reconstruction). Anterior skin incision at the medial border of the
patellar
ligament. Resection of Hoffa's fat pad, which is extremely fibrotic
in almost all cases. Second skin incision
at the posteromedial side of the
knee joint. Incision of the medial retinaculum between the posterior border
of the medial collateral ligament and the posterior oblique ligament.
Posteromedial arthrotomy between the
distal part of the tendon of the
adductor magnus muscle and the posterior horn of the medial meniscus.
Release of all adhesions in the posterior recess of the knee joint. Complete
release of the posterior joint
capsule from the femoral shaft.
POSTOPERATIVE MANAGEMENT : Immobilization for 48 h after surgery in full
extension (no knee
motion allowed in the first 48 h). For 48 h after surgery
only short walks to the bathroom are allowed.
Special dynamic extension
brace (Dynasplint((R)), CDS((R)) Forte, Albrecht company, Stephanskirchen,
Germany) for 4-6 weeks after surgery 6-8 h per day. Painkillers following
WHO (World Health
Organization) protocol. Manual lymph drainage and electric
muscle stimulation help to decrease pain and
swelling. Physiotherapy twice
daily starting at the 2nd postoperative day. No flexion exercises for the first
7
days after surgery. 15 kg partial weight bearing for 4-6 weeks. Daily
physiotherapy is recommended after
discharge. RESULTS : 121 patients
underwent anterior and posterior arthrolysis between 1990 and 2000.
86 of
these patients could be included in this study. The average follow-up was 4.6
years (1-10 years). The
extension deficit before surgery averaged 20 degrees
compared with the opposite side. At follow-up, the
average extension had
increased by 17 degrees , no patient had more than 5 degrees of flexion
contracture.
The Lysholm Score was 84 postoperatively. The Tegner Activity
Scale increased from 1.9 to 4.0 after
arthrolysis. In the AOSSM Subjective
Outcome Score, 35 patients showed excellent and 60 good results.
14 patients
were satisfied after surgery and nine were not. Three patients required revision
surgery (two
synovial fistulas, one hematoma).
PMID: 20087716 [PubMed - in process]
. Breast Cancer Res
Treat. 2010 Feb 24. [Epub ahead of print]
Effect of air travel on lymphedema risk in women with history of breast
cancer.
Kilbreath SL, Ward LC, Lane K, McNeely M, Dylke ES, Refshauge KM, McKenzie D,
Lee MJ,
Peddle C, Battersby KJ.
Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW,
1825, Australia,
[email protected].
To assess the impact of air travel on swelling of the 'at risk' arm of women
treated for breast cancer.
Women treated for breast cancer from Canada (n =
60) and from within Australia (n = 12) attending a
dragon boat regatta in
Queensland, Australia participated. Women were measured within 2 weeks prior
to their flight, on arrival in Queensland and, for 40 women travelling from
Canada, measured again 6
weeks following return to Canada. Changes to
extracellular fluid were measured using a single-frequency
bioimpedance
device (BIA). Each arm was measured separately using a standardized protocol to
obtain
the inter-limb impedance ratio. An increase in the ratio indicates
accumulated fluid. Information regarding
medical management of participants'
breast cancer, use of compression garment and history of exercise
were also
obtained. For most women (95%), air travel did not adversely affect the
impedance ratio. The
BIA ratio of long-haul travellers was 1.007 +/- 0.065
prior to the flight and 1.006 +/- 0.087 following the
flight. The ratio of
short-haul travellers was 0.994 +/- 0.033 and following the flight was 1.001 +/-
0.038.
Air travel did not cause significant change in BIA ratio in the
'at-risk' arm for the majority of breast cancer
survivors who participated
in dragon boat racing. Further research is required to determine whether these
findings are generalizable to the population of women who have been treated
for breast cancer.
PMID: 20180016 [PubMed - as supplied by publisher]
2. Cell. 2010 Feb 19;140(4):460-76.
Lymphangiogenesis: Molecular mechanisms and future promise.
Tammela T, Alitalo K.
Molecular/Cancer Biology Laboratory and Haartman Institute, University of
Helsinki, Finland.
The growth of lymphatic vessels (lymphangiogenesis) is actively involved in a
number of pathological
processes including tissue inflammation and tumor
dissemination but is insufficient in patients suffering from
lymphedema, a
debilitating condition characterized by chronic tissue edema and impaired
immunity. The
recent explosion of knowledge on the molecular mechanisms
governing lymphangiogenesis provides new
possibilities to treat these
diseases. 2010 Elsevier Inc. All rights reserved.
PMID: 20178740 [PubMed - in process]
3. Eur J Vasc Endovasc Surg. 2010 Feb 20. [Epub ahead of print]
Primary Lymphoedema and Lymphatic Malformation: Are they the Two Sides of the
Same Coin?
Lee BB, Villavicencio JL.
Division of Vascular Surgery, Georgetown University School of Medicine,
Washington, DC 20007,
USA; Georgetown University Hospital, 4th floor PHC,
3800 Reservoir Road NW, Washington, DC
20007, USA.
OBJECTIVES: To clear the confusion regarding the relationship between the
'primary lymphoedema' and
(truncular) lymphatic malformation (LM); the
latter is one of congenital vascular malformations.
MATERIALS & METHODS: A literature review was carried out on the primary
lymphoedema either
existing as an independent LM lesion or as a component of
the Klippel-Trenaunay syndrome.
RESULTS: The review was able to provide a contemporary guide/conclusion on
the definition and
classification, clinical evaluation and clinical
management regarding conservative (physical) therapy,
reconstructive
surgical therapy and ablative/excisional surgical therapy, for the primary
lymphoedema as
an LM.
CONCLUSIONS: Primary lymphoedema can be considered as 'congenital' since its
majority represents
a clinical manifestation of the truncular type of LM
arising during the later stages of lymphangiogenesis.
Such embryological
staging information of the LM is critical for proper management of the primary
lymphoedema when it exists with other congenital vascular malformations
(Klippel-Trenaunay syndrome).
2. Basic non-invasive to minimally invasive
tests will provide an adequate diagnosis and lead to the
correct
multidisciplinary, specifically targeted and sequenced treatment strategy. 3.
The mainstay of
current management of the primary lymphoedema/truncular LM
is complex decongestive therapy; and the
reconstructive as well as ablative
surgical therapy remain adjunctive therapies at best. Copyright © 2010
European Society for Vascular Surgery. Published by Elsevier Ltd. All rights
reserved.
PMID: 20176496 [PubMed - as supplied by publisher]
4. Clin Nutr. 2010 Feb 17. [Epub ahead of print]
Do patients with lymphoedema cholestasis syndrome 1/Aagenaes syndrome need
dietary counselling
outside cholestatic episodes?
Drivdal M, Løken EB, Hagve TA, Bergstad I, Aagenæs O.
Regional Department of Eating Disorders, Division of Psychiatry, Building
37A, Oslo University Hospital,
Ullevaal, N-0407 Oslo, Norway.
BACKGROUND&AIMS: Patients with lymphoedema cholestasis syndrome
1/Aagenaes Syndrome
need a fat reduced diet when cholestatic. We wanted to
assess the need for dietary counselling outside
cholestatic episodes, and
hypothetized that no counselling was needed.
METHODS: Fifteen patients above 10 years of age without symptoms of
cholestasis were compared
with a sex and age matched control group. Diet
from a four-day weighed record and blood samples were
compared between the
two groups and with general Norwegian recommendations.
RESULTS: The patients had a similar diet to the healthy controls, except for
statistically significant lower
intake of energy from total fat (p=0.04) and
saturated fat (0.02), and fish (0.05). The patients met the
dietary
recommendations for macronutrients, except for saturated fat, monounsaturated
fat, refined sugar
and fibre. Supplements were needed to meet the
micronutrient recommendations. Patients had a
significantly lower serum
level of alpha-tocopherol (0.01) compared with the control group, and the
serum 25-OH D level was below reference ranges.
CONCLUSIONS: The patients would benefit from counselling on fat quality,
carbohydrates including
fibre intake, and individual needs for vitamins D
and E. To secure serum 25-OH D and alpha-tocopherol
levels within reference
ranges, regular examinations to determine the need for supplementary vitamins D
and E are recommended.
Copyright © 2009 Elsevier Ltd and European Society for Clinical Nutrition and
Metabolism. All rights
reserved.
PMID: 20170991 [PubMed - as supplied by publisher]
----------------------
1. Microsurgery. 2010 Mar 2. [Epub ahead of print]
Prevention of lymphatic injuries in surgery.
Francesco B, Corrado C, Giuseppe M, Emanuela B, Chiara B, Francesco P,
Corradino C.
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San
Martino Hospital, University
of Genoa, Italy.
BACKGROUND:: The problem of prevention of lymphatic injuries in surgery is
extremely important if
we think about the frequency of both early
complications such as lymphorrhea, lymphocele, wound
dehiscence, and
infections and late complications such as lymphangites and lymphedema. Nowadays,
it is
possible to identify risk patients and prevent these lesions or treat
them at an early stage. This article helps
to demonstrate how it is
important to integrate diagnostic and clinical findings to better understand how
to
properly identify risk patients for lymphatic injuries and, therefore,
when it is useful and proper to do
prevention.
METHODS:: Authors report their experiences in the prevention and treatment of
lymphatic injuries after
surgical operations and trauma. After an accurate
diagnostic approach, prevention is based on different
technical procedures
among which microsurgical procedures. It is very important to follow-up the
patient
not only clinically but also by lymphoscintigraphy.
RESULTS AND CONCLUSIONS:: It was identified a protocol of prevention of
secondary limb
lymphedema that included, from the diagnostic point of view,
lymphoscintigraphy and, as concerns
therapy, it also recognized a role to
early microsurgery. It is necessary to accurately follow-up the patient
who
has undergone an operation at risk for the appearance of lymphatic complications
and, even better,
to assess clinically and by lymphoscintigraphy the patient
before surgical operation. (c) 2010 Wiley-Liss,
Inc. Microsurgery, 2010.
PMID: 20198663 [PubMed - as supplied by publisher]
2. Horm Res Paediatr. 2010;73(3):210-214. Epub 2010 Mar 3.
Tall Stature and Gonadal Dysgenesis in a Non-Mosaic Girl 45,X.
Fernandez R, Pasaro E.
Department of Psychobiology, University of A Coruña, Campus Elviña, A Coruña,
Spain.
Turner's syndrome, also known as 'monosomy X', is a genetic disorder that
occurs in 1/2,500 female
births and is hypothesized to result from
haploinsufficiency of certain genes expressed from both sex
chromosomes that
escape X inactivation. While the classic karyotype related to Turner's syndrome
is 45,
X, the majority of those affected actually have a mosaic chromosomal
complement, most often with a
second normal cell line (46,XX). The resulting
phenotype is variable and related to the underlying
chromosomal pattern, but
it is characterized by three cardinal features: short stature (around 100%),
ovarian failure (>90%) and congenital lymphedema (>80%). In this paper
we report a molecular and
cytogenetic investigation of a 26-year-old female
with non-mosaic 45,X karyotype, who has a stature of
170 cm without GH
treatment, and whose only apparent Turner feature is gonadal dysgenesis. The
only
possible explanation for the absence of Turner phenotype is the hidden
mosaicism combined with an
untreated gonadal dysgenesis. Our results support
the theory that significant ascertainment bias exists in
our understanding
of Turner's syndrome. Copyright © 2010 S. Karger AG, Basel.
PMID: 20197675 [PubMed - as supplied by publisher]
3. Plast Reconstr Surg. 2010 Mar;125(3):935-43.
The intravascular stenting method for treatment of extremity lymphedema with
multiconfiguration
lymphaticovenous anastomoses.
Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS.
Tokyo, Japan; and Baltimore, Md. From the Department of Plastic and
Reconstructive Surgery, Tokyo
University School of Medicine, and the
Division of Plastic, Reconstructive, and Maxillofacial Surgery,
Johns
Hopkins Hospital.
BACKGROUND:: In secondary extremity lymphedema, normal antegrade lymphatic
flow is disrupted by
the disease state. Attempts to capture aberrant
retrograde lymphatic flow by means of microsurgical
lymphaticovenous
anastomoses have been hindered because of technical limitations. The authors
applied
the intravascular stenting method to the surgical correction of
extremity lymphedema to generate
multiconfiguration lymphaticovenous
anastomoses capable of decompressing both proximal and distal
lymphatic
flow.
METHODS:: Lymphatic channels were detected using indocyanine green injection
and infrared scope
imaging. Sites felt to be adequate for lymphaticovenous
anastomosis were accessed through 2-cm skin
incisions under local
anesthesia. Using the intravascular stenting method, the authors performed a
total of
39 lymphaticovenous anastomoses (15 flow-through, 11 end-to-end,
eight end-to-side, two double end-
to-end, two end-to-end/end-to-side, and
one pi-type) on both the proximal and distal ends of lymphatic
channels in
14 female patients with upper (n = 2) and lower (n = 12) extremity
lymphedema.
RESULTS:: At an average follow-up of 8.9 months, average limb girth decreased
3.6 cm (range, 1.5 to 7
cm) or 11.3 percent (range, 4 to 33 percent). There
was a greater reduction in cross-sectional area with
increasing number of
lymphaticovenous anastomoses per limb.
CONCLUSIONS:: The intravascular stenting method facilitated
multiconfiguration lymphaticovenous
anastomoses capable of decompressing
both antegrade and retrograde lymphatic flow. This approach
resulted in
durable reduction of both upper and lower extremity lymphedema. As
multiconfiguration
lymphaticovenous anastomoses are now technically
feasible, the influence of the number of
lymphaticovenous anastomoses and
the effectiveness of specific lymphaticovenous anastomosis
configurations
for the treatment of lymphedema deserves further study.
PMID: 20195120 [PubMed - in process]
4. Am J Med. 2010 Mar;123(3):e3-4.
Nocturia: an uncommon presentation of lower-limb lymphedema.
Cagnati P, Colombo BM, Gulli R, Russo R, Puppo F, Boccardo F,
Campisi C, Murdaca G.
PMID: 20193816 [PubMed - in process]
5. An Bras Dermatol. 2009 Dec;84(6):659-62. published Feb 2010.
[Yellow nail syndrome: case report]
[Article in Portuguese]
Machado RF, Rosa DJ, Leite CC, Martins Neto MP, Gamonai A.
Universidade Federal de Juiz de Fora, MG, Brasil. [email protected]
The yellow nail syndrome is a rare disease, in which there is a triad of
lymphedema, pleural effusion and
slow-growing dystrophic yellow nails. Many
associations have already been described; among them,
chronic respiratory
tract diseases, autoimmune disorders, malignancies and immunodeficiency
conditions.
Only one third of cases in the literature show all findings. The
case reported next is an example of the
classical triad.
PMID: 20191179 [PubMed - in process]
----------------------
1. Ann Plast Surg. 2010 Mar 11. [Epub ahead of print]
Preservation of Toes in Advanced Lymphedema: An Important Step in the Control
of Infection.
Karonidis A, Chen HC.
From the Department of Plastic Surgery, E-Da Hospital/I-Shou University,
Yan-Chau Shiang, Kaohsiung
County, Taiwan, Republic of China.
ABSTRACT:: In advanced lymphedema, the most important goal of treatment is
the control or
eradication of infection. Toes are the major cause of
infection mainly due to lack of space at the webs.
The fibrosis of the soft
tissue with impaired circulation of the toes certainly contribute to infection
of the
toes, foot, and even proximal to the leg.Between 2004 and 2008, 20
patients with severe lymphedema
and fibrosis of lower limbs were treated
with Charles' procedure and included in this study. The toes were
preserved.
Excisional therapy is the only choice to decrease the lymphatic load and control
the infection.
The toes can be preserved if there is only swelling without
previous cellulites or verrucous hyperkeratosis
and neither deformity nor
osteomyelitis of the toes. The surgical technique to treat the toes includes (1)
excision of the soft tissue at the dorsum of the toes with preservation of
the extensor tendon and its
paratenon, to facilitate the take of skin graft,
and (2) preservation of skin flaps at the web spaces. This
avoids
contracture at the web spaces and crowding of the toes, improves foot hygiene,
and hence
prevents infection.Proper aesthetic and functional results were
obtained in all patients and 18 of 20
patients have been free of recurrent
infection at 3-years follow-up.In the treatment of advanced
lymphedema of
the lower extremity, the toes are the major determinant of future infection
after surgery.
For preservation of toes, careful selection of patients and
correct surgical procedure are essential for
success.
PMID: 20224333 [PubMed - as supplied by publisher]
2. Lymphology. 2009 Dec;42(4):188-94.
Intermittent pneumatic compression acts synergistically with manual lymphatic
drainage in complex
decongestive physiotherapy for breast cancer
treatment-related lymphedema.
Szolnoky G, Lakatos B, Keskeny T, Varga E, Varga M, Dobozy A, Kemény L.
Department of Dermatology and Allergology, University of Szeged, Szeged,
Hungary. szolnoky@dermall.
hu
The application of intermittent pneumatic compression (IPC) as a part of
complex decongestive
physiotherapy (CDP) remains controversial. The aim of
this study was to investigate whether the
combination of IPC with manual
lymph drainage (MLD) could improve CDP treatment outcomes in
women with
secondary lymphedema after breast cancer treatment. A randomized study was
undertaken
with 13 subjects receiving MLD (60 min) and 14 receiving MLD (30
min) plus IPC (30 min) followed by
standardized components of CDP including
multilayered compression bandaging, physical exercise, and
skin care 10
times in a 2-week-period. Efficacy of treatment was evaluated by limb volume
reduction and
a subjective symptom questionnaire at end of the treatment,
and one and two months after beginning
treatment. The two groups had similar
demographic and clinical characteristics. Mean reductions in limb
volumes
for each group at the end of therapy, and at one and two months were 7.93% and
3.06%,
9.02% and 2.9%, and 9.62% and 3.6%, respectively (p < 0.05 from
baseline for each group and also
between groups at each measurement).
Although a significant decrease in the subjective symptom survey
was found
for both groups compared to baseline, no significant difference between the
groups was found
at any time point. The application of IPC with MLD provides
a synergistic enhancement of the effect of
CDP in arm volume reduction.
PMID: 20218087 [PubMed - in process]
3. Lymphology. 2009 Dec;42(4):176-81.
Axillary web syndrome: nature and localization.
Leduc O, Sichere M, Moreau A, Rigolet J, Tinlot A, Darc S, Wilputte F,
Strapart J, Parijs T, Clément
A, Snoeck T, Pastouret F, Leduc A.
Haute Ecole P.H. Spaak, Département de Kinésithérapie, Unité de
Lympho-Phlébologie, Bruxelles,
Belgique. [email protected]
Axillary Web Syndrome (AWS) is a complication that can arise in patients
following treatment for breast
cancer. It is also known variously as
syndrome of the axillary cords, syndrome of the axillary adhesion,
and
cording lymphedema. The exact origin, presentation, course, and treatment of AWS
is still largely
undefined. Because so little is known about AWS, we
undertook a case series study consisting of 15
women who had undergone
breast cancer surgery and presented with AWS. All subjects received a
clinical examination which included body size determination and detailed
measurements of the size and
location of the cords. The cords were found to
originate from the axilla, continue on the medial aspect of
the arm up to
the epitrochlea region, then to the anteromedian aspect of the forearm, and
finally reaching
the base of the thumb. The cords averaged approximately 44%
of the limb length. Correlation of the cord
location with anatomical studies
shows that in fact this path follows the specific course taken by the
antero-radial pedicle which arises at the anterior aspect of the elbow from
the brachial medial pedicule to
anastomose in the axilla at the level of the
lateral thoracic chain nodes. Although our series is small, the
correspondence between the physical findings and the anatomical studies
strongly supports the notion that
the cords are lymphatic in origin.
PMID: 20218085 [PubMed - in process]
4. Lymphology. 2009 Dec;42(4):152-60.
Lymphedema-distichiasis syndrome without FOXC2 mutation: evidence for
chromosome 16 duplication
upstream of FOXC2.
Witte MH, Erickson RP, Khalil M, Dellinger M, Bernas M, Grogan T, Nitta H,
Feng J, Duggan D, Witte
CL.
Department of Surgery, University of Arizona College of Medicine, Tucson, AZ
85724-5200, USA.
[email protected]
A patient with the classical phenotype of Lymphedema-Distichiasis syndrome
(OMIM 153400) is
described who showed no mutations in the sequence of FOXC2.
Accordingly, a Gene Chip 250k array
analysis was undertaken with dense SNP
genotyping of the genomic region surrounding the FOXC2
locus on Chromosome
16 followed by copy number evaluation by real time PCR. The latter assay
showed evidence of a duplicated region 5' of FOXC2 that could be causative
for the patient's striking
phenotype, which included both distichiasis and a
hyperplastic refluxing lymphatic vascular and lymph
node phenotype
associated with pubertal onset lymphedema, scoliosis and strabismus.
PMID: 20218083 [PubMed - in process]
1. Dermatology. 2010 Mar 20. [Epub ahead of print]
Leg Ulceration in Rheumatoid Arthritis - An Underreported Multicausal
Complication with Considerable
Morbidity: Analysis of Thirty-Six Patients
and Review of the Literature.
Seitz CS, Berens N, Bröcker EB, Trautmann A.
Departments of Dermatology, Venereology and Allergology, University of
Würzburg, Würzburg,
Germany.
Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease
which may present with extra-
articular symptoms, including cutaneous
manifestations. Ulcerated rheumatoid nodules, necrotic vasculitic
lesions
and pyoderma gangrenosum are fairly characteristic and well-recognized causes of
skin ulcers in
RA. However, most RA patients develop leg ulcers due to other
pathophysiological factors posing a
diagnostic and therapeutic challenge and
leading to considerable morbidity.
Methods: A retrospective chart analysis of all patients with RA and leg
ulcers hospitalized at our
Dermatology Department between January 1998 and
March 2008 was performed to evaluate risk
factors and identify underlying
conditions that predispose RA patients to the development of leg ulcers.
Results: A total of 36 patients with RA and leg ulcers were identified. Three
patients presented with
necrotizing vasculitis and 2 with pyoderma
gangrenosum. Chronic venous insufficiency was diagnosed as
the underlying
cause of leg ulcers in 8 patients, peripheral arterial disease in 4 patients,
and combined
arterial and venous malfunction in 3 patients. Five patients
suffered from pressure ulcers. Interestingly, in
11 patients (31%) other
underlying causes besides constricted mobility followed by secondary
lymphedema could not be identified, and these ulcers were classified as
'inactivity leg ulcers'.
Conclusions: The majority of leg ulcers in patients with RA are due to
underlying venous/arterial
malfunction while vasculitic or traumatic ulcers
are less common. Additionally, we identified a relevant
subgroup of patients
with 'inactivity ulcers' due to impaired mobility and consecutive lymphedema.
Morphology and localization of ulcerations as well as duplex sonography
provide the most important
clues for accurate diagnosis, ensuring adequate
treatment. Copyright © 2010 S. Karger AG, Basel.
PMID: 20332595 [PubMed - as supplied by publisher]
1. Microsurgery. 2010 Mar 16. [Epub ahead of print]
Microsurgery for lymphedema: Clinical research and long-term results.
Campisi C, Bellini C, Campisi C, Accogli S, Bonioli E, Boccardo F.
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San
Martino Hospital, University
of Genoa, Italy.
Objectives: To report the wide clinical experience and the research studies
in the microsurgical treatment
of peripheral lymphedema.
Methods: More than 1800 patients with peripheral lymphedema have been treated
with microsurgical
techniques. Derivative lymphatic microvascular procedures
recognize today its most exemplary
application in multiple lymphatic-venous
anastomoses (LVA). In case of associated venous disease
reconstructive
lymphatic microsurgery techniques have been developed. Objective assessment was
undertaken by water volumetry and lymphoscintigraphy.
Results: Subjective improvement was noted in 87% of patients. Objectively,
volume changes showed a
significant improvement in 83%, with an average
reduction of 67% of the excess volume. Of those
patients followed-up, 85%
have been able to discontinue the use of conservative measures, with an
average follow-up of more than 10 years and average reduction in excess
volume of 69%. There was a
87% reduction in the incidence of cellulitis
after microsurgery.
Conclusions: Microsurgical LVA have a place in the treatment of peripheral
lymphedema, and should be
the therapy of choice in patients who are not
sufficiently responsive to nonsurgical treatment. (c) 2010
Wiley-Liss, Inc.
Microsurgery, 2010.
PMID: 20235160 [PubMed - as supplied by publisher]
2. Cancer Res. 2010 Mar 16. [Epub ahead of print]
Imaging of Human Lymph Nodes Using Optical Coherence Tomography: Potential
for Staging Cancer.
McLaughlin RA, Scolaro L, Robbins P, Hamza S, Saunders C, Sampson DD.
Authors' Affiliations: Optical + Biomedical Engineering Laboratory, School of
Electrical, Electronic, and
Computer Engineering and School of Surgery,
University of Western Australia, Crawley, Western
Australia, Australia; and
PathWest, QEII Medical Centre and Sir Charles Gairdner Hospital, Nedlands,
Western Australia, Australia.
Histologic assessment is the gold standard technique for the identification
of metastatic involvement of
lymph nodes in malignant disease, but can only
be performed ex vivo and often results in the unnecessary
excision of
healthy lymph nodes, leading to complications such as lymphedema. Optical
coherence
tomography (OCT) is a high-resolution, near-IR imaging modality
capable of visualizing microscopic
features within tissue. OCT has the
potential to provide in vivo assessment of tissue involvement by
cancer. In
this morphologic study, we show the capability of OCT to image nodal
microarchitecture
through an assessment of fresh, unstained ex vivo lymph
node samples. Examples include both benign
human axillary lymph nodes and
nodes containing metastatic breast carcinoma. Through accurate
correlation
with the histologic gold standard, OCT is shown to enable differentiation of
lymph node tissue
from surrounding adipose tissue, reveal nodal structures
such as germinal centers and intranodal vessels,
and show both diffuse and
well circumscribed patterns of metastatic node involvement. Cancer Res;
70
(7); 2579-84.
PMID: 20233873 [PubMed - as supplied by publisher]
3. Arch Dermatol. 2010 Mar;146(3):337-42.
Large nodular plaque on leg in the setting of chronic lymphedema--quiz case.
Angiosarcoma in the setting
of familial lymphedema.
Cronin H, Mowad C, Ferringer T.
Geisinger Medical Center, Danville, Pennsylvania, USA.
PMID: 20231513 [PubMed - in process]
1. Lymphology. 2009 Dec;42(4):188-94.Published March 2010
Intermittent pneumatic compression acts synergistically with manual lymphatic
drainage in complex
decongestive physiotherapy for breast cancer
treatment-related lymphedema.
Szolnoky G, Lakatos B, Keskeny T, Varga E, Varga M, Dobozy A, Kemény L.
Department of Dermatology and Allergology, University of Szeged, Szeged,
Hungary. szolnoky@dermall.
hu
The application of intermittent pneumatic compression (IPC) as a part of
complex decongestive
physiotherapy (CDP) remains controversial. The aim of
this study was to investigate whether the
combination of IPC with manual
lymph drainage (MLD) could improve CDP treatment outcomes in
women with
secondary lymphedema after breast cancer treatment. A randomized study was
undertaken
with 13 subjects receiving MLD (60 min) and 14 receiving MLD (30
min) plus IPC (30 min) followed by
standardized components of CDP including
multilayered compression bandaging, physical exercise, and
skin care 10
times in a 2-week-period. Efficacy of treatment was evaluated by limb volume
reduction and
a subjective symptom questionnaire at end of the treatment,
and one and two months after beginning
treatment. The two groups had similar
demographic and clinical characteristics. Mean reductions in limb
volumes
for each group at the end of therapy, and at one and two months were 7.93% and
3.06%,
9.02% and 2.9%, and 9.62% and 3.6%, respectively (p < 0.05 from
baseline for each group and also
between groups at each measurement).
Although a significant decrease in the subjective symptom survey
was found
for both groups compared to baseline, no significant difference between the
groups was found
at any time point. The application of IPC with MLD provides
a synergistic enhancement of the effect of
CDP in arm volume reduction.
PMID: 20218087 [PubMed - in process]
1. Nucl Med Commun. 2010 Mar 2. [Epub ahead of print]
Intradermal lymphoscintigraphy at rest and after exercise: a new technique
for the functional assessment of
the lymphatic system in patients with
lymphoedema.
Tartaglione G, Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C,
Paone G, Bernabucci V,
Bartoletti R, Marchetti P, Marzola MC, Naji M,
Rubello D.
aUnit of Nuclear Medicine, Cristo Re Hospital bUnit of Medical and
Dermatologic Oncology cUnit of
Oncological Rehabilitation, Istituto
Dermopatico dell'Immacolata, IDI-IRCCS dUnit of Medical
Oncology,
Sant'Andrea Hospital, Rome eDepartment of Nuclear Medicine, PET Centre,
Radiology,
Medical Physics, Santa Maria della Misericordia Hospital, Rovigo,
Italy fDepartment of Nuclear
Medicine, Hammersmith Hospital, London, UK.
AIM: The aim of this study was to evaluate the effect of implementing a new
technique, intradermal
injection lymphoscintigraphy, at rest and after
muscular exercise on the functional assessment of the
lymphatic system in a
group of patients with delayed or absent lymph drainage.
METHODS: We selected 44 patients (32 women and 12 men; 15 of 44 with upper
limb and 29 of 44
with lower limb lymphoedema). Thirty of 44 patients had
bilateral limb lymphoedema and 14 of 44 had
unilateral disease; 14
contralateral normal limbs were used as controls. Twenty-three patients had
secondary lymphoedema after lymphadenectomy and the remaining 21 had
idiopathic lymphoedema.
Each of the 44 patients was injected with 50 MBq
(0.3-0.4 ml) of Tc-albumin-nanocolloid, which was
administered intradermally
at the first interdigital space of the affected limb. Two planar static scans
were
performed using a low-energy general-purpose collimator (acquisition
matrix 128x128, anterior and
posterior views for 5 min), and in which
drainage was slow or absent, patients were asked to walk or
exercise for 2
min. A postexercise scan was then performed to monitor and record the tracer
pathway
and the tracer appearance time (TAT) in the inguinal or axillary
lymph nodes.
RESULTS: The postexercise scans showed that (i) 21 limbs (15 lower and six
upper limbs) had
accelerated tracer drainage and tracer uptake in the
inguinal and/or axillary lymph nodes. Two-thirds of
these showed lymph
stagnation points; (ii) 27 limbs had collateral lymph drainage pathways; (iii)
in 11
limbs, there was lymph drainage into the deeper lymphatic channels,
with unusual uptake in the popliteal
or antecubital lymph nodes; (iv) six
limbs had dermal backflow; (v) three limbs did not show lymph
drainage
(TAT=not applicable). TAT=15+/-3 min, ranging from 12 to 32 min in limbs with
lymphoedema
versus 5+/-2 min, ranging from 1 to 12 min in the contralateral
normal limbs (P<0.001).
CONCLUSION: Intradermal injection lymphoscintigraphy gives a better imaging
of the lymph drainage
pathways in a shorter time, including cases with
advanced lymphoedema. In some patients with
lymphoedema, a 2-min exercise
can accelerate tracer drainage, showing several compensatory
mechanisms of
lymph drainage. The effect of the exercise technique on TAT and
lymphoscintigraphy
findings could result in a more accurate functional
assessment of lymphoedema patients.
PMID: 20215978 [PubMed - as supplied by publisher]
2. J Neurol Phys Ther. 2010 Mar;34(1):41-9.
Rehabilitation postfacial reanimation surgery after removal of acoustic
neuroma: a case study.
Wilson CM, Ronan SL.
Department of Physical and Occupational Therapy (C.M.W.), William Beaumont
Hospital, Troy,
Michigan; Department of Physical Therapy (C.M.W.), School of
Health Sciences, Oakland University in
Rochester, Michigan; and Department
of Physical Therapy (S.R.), New York Medical College, School
of Public
Health, Valhalla, New York.
BACKGROUND AND PURPOSE:: Facial paralysis can have a significant negative
impact on an
individual's social, physical, and emotional well-being;
however, little information has been reported on the
efficacy of physical
therapy interventions for this condition. The purpose of this case study was to
describe the details of a physical therapy evaluation and intervention for a
patient who underwent facial
muscle transfer after resection of acoustic
neuroma.
CASE DESCRIPTION:: A 29-year-old woman underwent left-sided facial
reanimation surgery, which
included transplantation of the temporalis muscle
and platysma muscle to the corner of the mouth.
INTERVENTION:: The patient received 30 sessions of physical therapy that
included electrical
stimulation, biofeedback, lymphatic drainage, home
exercises and facial stretching, and scar management.
OUTCOMES:: The patient exhibited an improvement in the Composite score of the
Sunnybrook Facial
Grading System from 17 to 41. She was able to regain
function of the left side of her face with gains in
expressions of smiling,
frowning, and puckering, but symmetry was not completely restored. The patient
had chronic difficulty with left-sided lymphedema, requiring frequent manual
lymphatic drainage.
DISCUSSION:: Data from this case study suggest that physical therapy
management improves functional
outcomes for individuals with postoperative
changes in facial motor function from facial reanimation
surgery. Further
research is required to explore factors that influence the rate and extent of
recovery
derived from physical therapy interventions.
PMID: 20212367 [PubMed - in process]
3. Zhonghua Zheng Xing Wai Ke Za Zhi. 2009 Nov;25(6):433-6.
[Interstitial high-resolution MR lymphangiography in patients with lower
extremity lymphedema][Article in
Chinese]
Ren YQ, Lu Q, Cao WG.
Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of
Medicine, Shanghai 200011,
China.
OBJECTIVE: To assess the feasibility of interstitial magnetic resonance
lymphangiography (IMRL) with
intracutaneous injection of gadobenate
dimeglumine--a commercially available, non-ionic, extracellular
paramagnetic
contrast agent.
METHODS: We studied 10 patients with lower extremity lymphedema. A mixture of
7.5 ml gadobenate
dimeglumine and 0.5 ml 2% lidocaine were evenly subdivided
into 8 portions and injected
intracutaneously into each web space of both
feet. For IMRL, a 3D fast spoiled gradient-recalled echo
T1-weighted images
with a fat saturation technique (T1 high resolution isotropic volume excitation,
THRIVE) was performed.
RESULTS: The beaded appearance of lymphatic vessels extending from the
injection site were detected
in 11 of 12 lower legs and the best delineation
of lymphatic vessels was present at 15-30 minutes after
injection. In 6 of
12 affected thighs, lymphatic vessels could be also visualized with the
strongest
enhancement at 45 minutes.
CONCLUSION: IMRL is a safe and technically feasible new method which can
effectively visualize the
pathological lymphatic vessels in lower extremity
lymphedema.
PMID: 20209934 [PubMed - in process]
Large Nodular Plaque on Leg in the Setting of Chronic
Lymphedema—Diagnosis
Arch Dermatol.2010; 146: 337-342.
1. Pediatr Dermatol. 2010 Jan 1;27(1):58-61.
Lymphatic compression by sclerotic patches of morphea: an original mechanism
of lymphedema in a child.
Samimi M, Maruani A, Machet MC, Baulieu F, Machet L, Lorette G.
University François Rabelais, Tours, France.
Lymphedema in children is mostly primary, due to lymphatic hypoplasia.
Secondary lymphedema is
caused by lymphatic injury or obstruction. We report
the case of a child that developed a lymphedema of
the left upper and lower
extremities, with a simultaneous onset of ipsilateral hemicorporal morphea. We
concluded that lymphatic obstruction was due to sclerosis from morphea. This
is a unique, rarely reported
mechanism of lymphedema. Lymphoscintigraphy
revealed attenuated lymphatic flow in the left upper and
lower limbs.
Systemic corticosteroids were associated with slow improvement in the sclerotic
patches.
We simultaneously noticed an improvement in the lymphedema of
limbs. Repeat lymphoscintigraphy
revealed dramatically improved lymphatic
function. This case suggests that at least in some cases
lymphedema may be
caused by morphea.
PMID: 20199412 [PubMed - in process]
1. Am J Med Genet A. 2010 Mar;152A(3):737-40.
c. 595-596 insC of FOXC2 underlies lymphedema, distichiasis, ptosis,
ankyloglossia, and Robin
sequence in a Thai patient.
Tanpaiboon P, Kantaputra P, Wejathikul K, Piyamongkol W.
Faculty of Medicine, Department of Pediatrics, Chiang Mai University, Chiang
Mai, Thailand.
[email protected]
Lymphedema-distichiasis syndrome is a rare primary lymphedema inherited as an
autosomal dominant
disorder. The characteristic features consist of late
onset-lymphedema and distichiasis together with other
occasionally seen
features including varicose vein, cleft palate, ptosis, and congenital heart
diseases.
FOXC2 is the gene found to be associated with this syndrome. We
report here the first Thai patient who
has characteristic features of this
syndrome and the infrequently described features including
ankyloglossia,
and Robin sequence which consists of glossoptosis, cleft palate, and
micrognathia.
Mutation analysis of FOXC2 revealed c. 595-596 insC. (c) 2010
Wiley-Liss, Inc.
PMID: 20186799 [PubMed - in process]
2. Cases J. 2009 Mar 23;2:6625.
Pneumatic compression devices for in-home management of lymphedema: two case
reports.
[No authors listed]
ABSTRACT : The two patients in this case series had experienced long-term
difficulty controlling
lymphedema at home. Both patients had used numerous
home therapies, including older-generation
intermittent pneumatic
compression devices, without success. The Flexitouch(R) system, an advanced
pneumatic device, was prescribed to assist them with in-home efforts by
providing therapy to their
affected limbs in addition to the lower trunk
area for the patient with lymphedema of the lower extremity;
and the trunk,
chest wall, and shoulder areas for the patient with lymphedema of the upper
extremity.
Both patients achieved successful home maintenance of lymphedema,
as judged by limb volume, clinical
observations, and subjective patient
impressions, after incorporating the Flexitouch(R) system. Neither
patient
experienced the deleterious effects (worsening genital edema; fibrotic cuff
development) that they
had experienced with the older-generation
intermittent pneumatic compression devices they had
previously used.
Incorporating the Flexitouch(R) system as part of maintenance may improve
success for
lymphedema patients who have previously struggled with in-home
management.
PMID: 20184680 [PubMed - in process]
3. J Lymphoedema. 2009 Apr 1;4(1):14-18.
30-MONTH POST-BREAST CANCER TREATMENT LYMPHOEDEMA.
Armer JM, Stewart BR, Shook RP.
Jane M Armer, Professor, Sinclair School of Nursing (SSON), Director, Nursing
Research, Ellis Fischel
Cancer Center; Bob R Stewart, Professor Emeritus,
College of Education, Adjunct Clinical Professor,
SSON; Robin P Shook,
Project Development Specialist, Lymphedema Research Project, SSON,
University of Missouri, Columbia, USA.
BACKGROUND: Quantification of lymphoedema (LE) has been problematic, and the
reported
incidence of LE varies greatly among women treated with surgery and
radiation for breast cancer. AIMS:
This study aims to describe LE occurrence
over time among breast cancer survivors using four diagnostic
criteria based
on three measurement techniques.
METHODS: Limb volume and symptom assessment data were followed after surgery
every three months
for 12 months, then every six months for 30 months. Limb
volume changes (LVC) were measured by
circumferences and by perometry, and
by symptom experience via interview. Standard survival analysis
methods
identified when the criteria indicating LE were met.
RESULTS: Trends in LE occurrence are reported for data from 211 participants.
At 30 months post-
treatment, LE incidence ranged from 41-91%, with 2cm being
the highest estimation method and self-
reported signs and symtoms (SS) the
lowest.
CONCLUSIONS: This 30-month analysis supports the previous 12-month analysis
in finding the 2cm
criteria as the most liberal definition of LE.
Self-reporting of heaviness and swelling, along with 10%
LVC, represented
the most conservative definitions (41% and 45%, respectively).
PMID: 20182653 [PubMed]
4. J Altern Complement Med. 2010 Feb;16(2):145-9.
An integrative treatment for lower limb lymphedema (elephantiasis).
Narahari SR, Aggithaya MG, Prasanna KS, Bose KS.
Department of Ayurveda, Kasaragod, Kerala, India.
PMID: 20180687 [PubMed - in process]
1. Circ Res. 2010 Feb 4. [Epub ahead of print]
Transmural Flow Modulates Cell and Fluid Transport Functions of Lymphatic
Endothelium.
Miteva DO, Rutkowski JM, Dixon JB, Kilarski W, Shields JD, Swartz MA.
Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne,
Switzerland.
Rationale: Lymphatic transport of peripheral interstitial fluid and dendritic cells (DCs) is important for both
adaptive immunity and maintenance of
tolerance to self-antigens. Lymphatic drainage can change rapidly
and
dramatically on tissue injury or inflammation, and therefore increased fluid
flow may serve as an
important early cue for inflammation; however, the
effects of transmural flow on lymphatic function are
unknown.
Objective: Here we tested the hypothesis that lymph drainage regulates the
fluid and cell transport
functions of lymphatic endothelium.
Methods and Results: Using in vitro and in vivo models, we demonstrated that
lymphatic endothelium is
sensitive to low levels of transmural flow.
Basal-to-luminal flow (0.1 and 1 mum/sec) increased lymphatic
permeability,
dextran transport, and aquaporin-2 expression, as well as DC transmigration into
lymphatics. The latter was associated with increased lymphatic expression of
the DC homing chemokine
CCL21 and the adhesion molecules intercellular
adhesion molecule-1 and endothelial selectin. In addition,
transmural flow
induced delocalization and downregulation of vascular endothelial cadherin and
PECAM-
1 (platelet/endothelial cell adhesion molecule-1). Flow-enhanced DC
transmigration could be reversed by
blocking CCR7, intercellular adhesion
molecule-1, or endothelial selectin. In an experimental model of
lymphedema,
where lymphatic drainage is greatly reduced or absent, lymphatic endothelial
expression of
CCL21 was nearly absent.
Conclusions: These findings introduce transmural flow as an important
regulator of lymphatic endothelial
function and suggest that flow might
serve as an early inflammatory signal for lymphatics, causing them to
regulate transport functions to facilitate the delivery of soluble antigens
and DCs to lymph nodes.
PMID: 20133901 [PubMed - as supplied by publisher]
2. Am J Occup Ther. 2010 Jan-Feb;64(1):59-72.
Randomized controlled trial of the Breast Cancer Recovery Program for women
with breast cancer-
related lymphedema.
McClure MK, McClure RJ, Day R, Brufsky AM.
Magee-Women's Research Institute, Pittsburgh, PA, USA.
Evidence-based exercise and relaxation recommendations for people with breast
cancer-related
lymphedema (BCRL) are needed. We report a randomized
controlled study of one program, designed to
achieve synergistic
improvements in physical and emotional BCRL symptoms. People in the treatment
group received an exercise and relaxation program, The Breast Cancer
Recovery Program (N=16). The
control participants (N=16) continued with
health professionals' recommendations. Participants were
tested at entry,
2.5 weeks, 5 weeks, and 3 months. Treatment group participants, compared with
control
participants, demonstrated significant treatment effects for
improved bioimpedance z, arm flexibility,
quality of life, mood at 3 months,
and weight loss. Adherence was high for this safe and effective
program,
which improved lymphedema physical and emotional symptoms.
PMID: 20131565 [PubMed - in process]
------------------------------
1. Angiology. 2010 Feb 10. [Epub ahead of print]
Epidemiological Data and Comorbidities of 428 Patients Hospitalized With
Erysipelas.
Pereira de Godoy JM, Massari PG, Rosinha MY, Brandão RM, Foroni Casas AL.
The aim of this study was to evaluate the epidemiological data and the main
comorbidities of patients with
erysipelas admitted to a tertiary hospital.
All patients admitted due to erysipelas during the period from
1999 to 2008
were included in a prospective and cross-sectional study. The Fisher exact test
and logistic
regression were used for statistical analysis. A total of 428
individuals were hospitalized with 41
rehospitalizations; 51.17% of the
patients were women, the mean age was 58.6 years. The main
comorbidities
were hypertension (51.6%), diabetes mellitus (41.6%), chronic venous
insufficiency
(36.2%), other cardiovascular diseases (33.2%) including
angina, peripheral arterial insufficiency, acute
myocardial infarction, and
strokes, obesity (12.1%), chronic renal failure (6.8%), neoplasms (4.9%),
cirrhosis (4.9%), chronic lymphedema (4.2%), and leg ulcers (2.6%).
Erysipelas is a seasonal disease
that affects adults and the elderly people,
has a repetitive nature, and is associated with comorbidities.
PMID: 20147345 [PubMed - as supplied by publisher]
------------------------------
1. Lymphat Res Biol. 2009 Dec;7(4):239-45.
Topography of
accumulation of stagnant lymph and tissue fluid in soft tissues of human
lymphedematous
lower limbs.
Olszewski WL, Jain P, Ambujam G, Zaleska M, Cakala M.
1 Department of Surgical Research and Transplantology, Medical Research
Center , Polish Academy of
Sciences, Warsaw, Poland .
Abstract Background: The knowledge of where does excess tissue fluid
accumulate in obstructive
lymphedema is indispensable for rational physical
therapy. However, it has so far been limited to that
obtained from
lymphoscintigraphic, ultrasonographic, and MR images. None of these modalities
provide
composite pictures of dilated lymphatics and expanded tissue space
in dermis, subcutis, and muscles. So
far, only anatomical dissection and
histological processing of biopsy material can visualize the tissue
lymphatic network and the sites of accumulation of the excess of mobile
tissue fluid.
Methods and Results: We visualized the "tissue fluid and lymph" space in skin
and subcutaneous tissue of
foot, calf, and thigh in various stages of
lymphedema in specimens obtained during lymphatic microsurgical
procedures
or tissue debulking, using special staining techniques. The volume of
accumulated fluid was
calculated from the densitometric data of stained
tissue sections. We found that lymph was present only in
the subepidermal
lymphatics, whereas the collecting trunks were obliterated in most cases. Mobile
tissue
fluid accumulated in the spontaneously formed spaces in the
subcutaneous tissue, around small veins and
above and underneath muscular
fascia. Deformation of subcutaneous tissue by free fluid led to formation
of
interconnecting channels. The volume of subcutaneous free fluid ranged around
50% of total tissue
volume and there were no significant differences in
various stages of lymphedema. This could be
explained by the presence of
thick layers of subcutaneous fat tissue even in the most advanced stage of
lymphedema.
Conclusions: In lymphedema caused by obliteration of collecting trunks, lymph
is present only in the
subepidermal lymphatics, whereas the bulk of stagnant
tissue fluid accumulates in the subcutaneous tissue
and above and beneath
muscular fascia. These findings should be useful for designing pneumatic devices
for limb massage as well as for rational manual lymphatic drainage in terms
of sites of massage and level
of applied external pressures.
PMID: 20143923 [PubMed - in process]
---------------------------
1. Lymphat Res Biol. 2009 Dec;7(4):239-45.
Topography of accumulation of stagnant lymph and tissue fluid in soft tissues
of human lymphedematous
lower limbs.
Olszewski WL, Jain P, Ambujam G, Zaleska M, Cakala M.
1 Department of Surgical Research and Transplantology, Medical Research
Center , Polish Academy of
Sciences, Warsaw, Poland .
Abstract Background: The knowledge of where does excess tissue fluid
accumulate in obstructive
lymphedema is indispensable for rational physical
therapy. However, it has so far been limited to that
obtained from
lymphoscintigraphic, ultrasonographic, and MR images. None of these modalities
provide
composite pictures of dilated lymphatics and expanded tissue space
in dermis, subcutis, and muscles. So
far, only anatomical dissection and
histological processing of biopsy material can visualize the tissue
lymphatic network and the sites of accumulation of the excess of mobile
tissue fluid.
Methods and Results: We visualized the "tissue fluid and lymph" space in skin
and subcutaneous tissue of
foot, calf, and thigh in various stages of
lymphedema in specimens obtained during lymphatic microsurgical
procedures
or tissue debulking, using special staining techniques. The volume of
accumulated fluid was
calculated from the densitometric data of stained
tissue sections. We found that lymph was present only in
the subepidermal
lymphatics, whereas the collecting trunks were obliterated in most cases. Mobile
tissue
fluid accumulated in the spontaneously formed spaces in the
subcutaneous tissue, around small veins and
above and underneath muscular
fascia. Deformation of subcutaneous tissue by free fluid led to formation
of
interconnecting channels. The volume of subcutaneous free fluid ranged around
50% of total tissue
volume and there were no significant differences in
various stages of lymphedema. This could be
explained by the presence of
thick layers of subcutaneous fat tissue even in the most advanced stage of
lymphedema.
Conclusions: In lymphedema caused by obliteration of collecting trunks, lymph
is present only in the
subepidermal lymphatics, whereas the bulk of stagnant
tissue fluid accumulates in the subcutaneous tissue
and above and beneath
muscular fascia. These findings should be useful for designing pneumatic devices
for limb massage as well as for rational manual lymphatic drainage in terms
of sites of massage and level
of applied external pressures.
PMID: 20143923 [PubMed - in process]
2. Lymphat Res Biol. 2009 Dec;7(4):215-9.
Lymphatics in human lymphatic filariasis: in vitro models of parasite-induced
lymphatic remodeling.
Bennuru S, Nutman TB.
Laboratory of Parasitic Diseases, National Institute of Allergy and
Infectious Diseases , Bethesda,
Maryland.
Abstract Lymphatic filariasis characterized by the dysfunction of the
lymphatics can lead to severe (and
often) irreversible lymphedema and
elephantiasis. Decades of research in the field shows that the
establishment
of the adult parasites in the lymphatics triggers a cascade of events that
ultimately results in
tissue scarring and fibrosis. In this minireview, we
focus on the studies addressing the mechanisms
underlying the
parasite-induced lymphatic dilatation that suggests parasite-induced lymphatic
remodeling
and lymphangiogenesis may be the prelude towards developing
chronic and irreversible filarial pathology.
PMID: 20143920 [PubMed - in process
3. Lymphat Res Biol. 2009 Dec;7(4):205-14.
New approaches to lymphatic imaging.
Lucarelli RT, Ogawa M, Kosaka N, Turkbey B, Kobayashi H, Choyke PL.
Molecular Imaging Program, National Cancer Institute , Bethesda,
Maryland.
Abstract Accurate imaging of the lymphatic system can aid in cancer staging,
optimize surgical procedures
to reduce lymphedema, and may one day be a
means of delivering intralymphatic therapy. The Sentinel
Lymph Node (SLN)
concept has been pivotal in driving new imaging techniques. Metastasis to a SLN
is
a critical indicator of advanced disease. However, presently, few tools
are available for imaging the
lymphatics, and even fewer are available for
locating the SLN for biopsy. Recently, new macromolecular
agents, including
gadolinium-labeled dendrimers, fluorescent quantum dots, and
fluorescently-labeled
immunoglobins, have been used to image the lymphatics
and SLN with MRI and optical techniques, and
new fluorescent nanoparticles
such as upconverting nanocrystals are potential future agents. Additionally,
multi-modality probes combining two modalities such as optical/MR dendrimers
have been designed to
provide both preoperative imaging, and intraoperative
guidance during lymph node resections. These
probes can map the lymphatic
system for maximal therapeutic benefit while minimizing complications such
as lymphedema. Advances in the understanding of the molecular mechanisms of
lymphangiogenesis and
lymphatic spread of tumors offer the opportunity for
more targeted imaging of the lymphatic system.
Additionally, these imaging
agents could be used as powerful research tools for tracking immunological
cells and monitoring the immune response as well as providing the means to
deliver lymphatic-targeted
therapies. The future holds great promise for the
translation of these methods to the clinic.
PMID: 20143919 [PubMed - in process]
4. Ann Surg Oncol. 2010 Feb 6. [Epub ahead of print]
The Effect of Providing Information about Lymphedema on the Cognitive and
Symptom Outcomes of
Breast Cancer Survivors.
Fu MR, Chen CM, Haber J, Guth AA, Axelrod D.
College of Nursing, New York University, New York, NY, USA, [email protected].
BACKGROUND: Despite recent advances in breast cancer treatment, breast cancer
related
lymphedema (BCRL) continues to be a significant problem for many
survivors. Some BCRL risk factors
may be largely unavoidable, such as
mastectomy, axillary lymph node dissection (ALND), or radiation
therapy.
Potentially avoidable risk factors unrelated to breast cancer treatment include
minor upper
extremity infections, injury or trauma to the arm, overuse of
the limb, and air travel. This study investigates
how providing information
about BCRL affects the cognitive and symptomatic outcome of breast cancer
survivors.
METHODS: Data were collected from 136 breast cancer survivors using a
Demographic and Medical
Information interview instrument, a Lymphedema
Education Status interview instrument, a Knowledge
Test for cognitive
outcome, and the Lymphedema and Breast Cancer Questionnaire for symptom
outcome. Data analysis included descriptive statistics, t tests, chi-square
(chi(2)) tests, and regression.
RESULTS: BCRL information was given to 57% of subjects during treatment. The
mean number of
lymphedema-related symptoms was 3 symptoms. Patients who
received information reported significantly
fewer symptoms and scored
significantly higher in the knowledge test. After controlling for confounding
factors, patient education remains an additional predictor of BCRL outcome.
Significantly fewer women
who received information about BCRL reported
swelling, heaviness, impaired shoulder mobility, seroma
formation, and
breast swelling.
CONCLUSIONS: Breast cancer survivors who received information about BCRL had
significantly
reduced symptoms and increased knowledge about BCRL. In
clinical practice, breast cancer survivors
should be engaged in supportive
dialogues so they can be educated about ways to reduce their risk of
developing BCRL.
PMID: 20140528 [PubMed - as supplied by publisher]
1. Cancer. 2010 Mar 24. [Epub ahead of print]
A phase I study to assess the feasibility and oncologic safety of axillary
reverse mapping in breast cancer
patients.
Bedrosian I, Babiera GV, Mittendorf EA, Kuerer HM, Pantoja L, Hunt KK,
Krishnamurthy S, Meric-
Bernstam F.
Department of Surgical Oncology, The University of Texas M. D. Anderson
Cancer Center, Houston
Texas.
BACKGROUND:: Axillary reverse mapping (ARM) is a novel technique to preserve
upper extremity
lymphatics that may reduce the incidence of lymphedema after
axillary lymph node dissection. Early
reports have suggested that ARM lymph
nodes do not contain metastatic disease from breast cancer;
however, these
studies were conducted in early stage patients with low likelihood of lymph node
metastasis. This study reported a phase 1 trial conducted in patients with
cytologically documented
axillary metastasis undergoing axillary lymph node
dissection to determine the feasibility and oncologic
safety of ARM.
METHODS:: Thirty patients, 23 (77%) of whom received preoperative therapy
(chemotherapy in 22
patients and hormonal therapy in 1 patient), were
enrolled. Blue dye was injected in the upper inner
ipsilateral arm. The
presence of blue lymphatics was noted, and blue lymph nodes were sent separately
for pathologic evaluation.
RESULTS:: The average time between blue dye injection and axillary exposure
was 35 minutes (range,
15-60 minutes). Blue lymphatics were identified in 21
patients (70%) and blue lymph nodes in 15 patients
(50%). The median number
of ARM lymph nodes was 1 (range, 0-3 lymph nodes) and the median
number of
axillary lymph nodes was 26 (range, 6-47 lymph nodes). Axillary metastases were
noted in
60% (18 of 30) of patients. Of 11 patients who had axillary
metastasis and at least 1 ARM lymph node
identified, 2 (18%) had metastasis
to the ARM lymph node.
CONCLUSIONS:: ARM appears to be a feasible technique with which to identify
upper arm lymphatics
during axillary surgery. However, the high prevalence
of disease involving ARM lymph nodes in this small
cohort suggested that
preservation of these lymphatics is not oncologically safe in women with
documented axillary lymph node metastasis from breast cancer. Cancer 2010.
(c) 2010 American
Cancer Society.
PMID: 20336790 [PubMed - as supplied by publisher]
2. Ann Surg Oncol. 2010 Mar 25. [Epub ahead of print]
Prospective Assessment of Postoperative Complications and Associated Costs
Following Inguinal Lymph
Node Dissection (ILND) in Melanoma Patients.
Chang SB, Askew RL, Xing Y, Weaver S, Gershenwald JE, Lee JE, Royal R, Lucci
A, Ross MI,
Cormier JN.
Department of Surgical Oncology, University of Texas M. D. Anderson Cancer
Center, Houston, TX,
USA.
BACKGROUND: We prospectively assessed the incidence, risk factors, and costs
associated with
wound complications and lymphedema in melanoma patients
undergoing inguinal lymph node dissection
(ILND).
MATERIALS AND METHODS: A total of 53 melanoma patients were accrued to 2
trials (June 2005
to July 2008) that included prospective evaluations of
postoperative complications; 30-day wound
complications included infection,
seroma, and/or dehiscence. There were 20 patients who underwent limb
volume
measurement and completed a 19-item lymphedema symptom assessment questionnaire
preoperatively and 3 months postoperatively. A multivariate analysis was
performed to evaluate potential
risk factors for complications. A
microcosting analysis was also performed to evaluate the direct costs
associated with wound complications.
RESULTS: The 30-day wound complications were noted in 77.4% of patients. A
BMI >/= 30 (n = 28)
increased the risk for wound complications (odds
ratio [OR] = 11.4, 95% confidence interval [95%CI]
1.6-78.5, P = .01), while
advanced nodal disease approached significance (OR = 9.0, 95%CI: 0.79-
103.1,
P = .08). Other risk factors, including diabetes, smoking, and the addition of a
deep pelvic
(iliac/obturator) dissection to ILND, were not significant. Of
20 patients, 9 (45%) developed limb volume
change (LVC) >/=5% at 3
months, with associated mean symptom scores of 6.1 versus 4.6 for those
without LVC. Costs for patients with wound complications were significantly
higher than for those without
wound complications.
CONCLUSIONS: Postoperative wound complications and early onset lymphedema
occur frequently
following ILND for melanoma. Obesity is an adverse risk
factor for 30-day wound complications that can
significantly increase
postoperative costs, as is likely the case for advanced disease. Risk reduction
practices and novel treatment approaches are needed to reduce postoperative
morbidity.
PMID: 20336388 [PubMed - as supplied by publisher]
1. J Clin Nurs. 2010 Mar 16. [Epub ahead of print]
After axillary surgery for breast cancer - is it safe to take blood samples
or give intravenous infusions?
Winge C, Mattiasson AC, Schultz I.
Authors:Charlotte Winge, RN, Division of Surgery, Department of Clinical
Sciences, Karolinska Institute
at Danderyd Hospital; Anne-Cathrine
Mattiasson, RNT, Professor, Division of Surgery, Department of
Clinical
Sciences, Karolinska Institute at Danderyd Hospital and Sophiahemmet University
College;
Inkeri Schultz, MD, PhD, Department of Clinical Sciences,
Karolinska Institute at Danderyd Hospital and
Department of Plastic and
Reconstructive Surgery, Karolinska University Hospital, Stockholm, Sweden.
Aim. To investigate the occurrence of complications after a needle puncture
or intravenous injection in the
ipsilateral arm of women who have undergone
axillary lymph node clearance for breast cancer.
Background. After axillary lymph node clearance in patients with breast
cancer, some women experience
lymphoedema and recurrent infections. To
reduce the risk of these postoperative complications, most
women are advised
to not have intravenous infusions in, or blood samples taken from, the arm in
the
operated side. Very little published data are available regarding the
incidence of lymphoedema after
intravenous procedures under clean conditions
in the hospital setting. This study set out to investigate the
occurrence of
complications after a needle puncture or intravenous injection in the
ipsilateral arm of
women who have undergone axillary lymph node clearance
for breast cancer is therefore important.
Design. Descriptive. Methods. Self-reported questionnaire. Results. Most of
the reported complications
were minor, including itching, bruises and
vomiting at the time of the intravenous procedure. The most
serious
complication was infection in one patient needing antibiotic treatment and
subsequent arm swelling.
Conclusions. This study indicates that if a blood sample is taken or
intravenous injection is given
according to the current Swedish guidelines
for health care professionals, there should be a very low risk
of
complications. Relevance to clinical practice. If intravenous procedures are
performed without any
disadvantage in the arm of the operated side in women
who have undergone axillary surgery, the clinical
problem of finding a
proper vein and the psychological concern of the women can be reduced.
PMID: 20345831 [PubMed - as supplied by publisher]
1. Am J Med Genet A. 2010 Apr;152A(4):970-6.
Lipedema: an inherited condition.
Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S, Mortimer
PS.
Department of Cardiac and Vascular Sciences, St. George's, University of
London, London, UK.
[email protected]
Abstract
Lipedema is a condition characterized by swelling and enlargement of the
lower limbs due to abnormal
deposition of subcutaneous fat. Lipedema is an
under-recognized condition, often misdiagnosed as
lymphedema or dismissed as
simple obesity. We present a series of pedigrees and propose that
lipedema
is a genetic condition with either X-linked dominant inheritance or more likely,
autosomal
dominant inheritance with sex limitation. Lipedema appears to be a
condition almost exclusively affecting
females, presumably
estrogen-requiring as it usually manifests at puberty. Lipedema is an entity
distinct
from obesity, but may be wrongly diagnosed as primary obesity, due
to clinical overlap. The phenotype
suggests a condition distinct from
obesity and associated with pain, tenderness, and easy bruising in
affected
areas. (c) 2010 Wiley-Liss, Inc.
PMID: 20358611 [PubMed - in process]
---
1. J Cancer Surviv. 2010 Apr 7. [Epub ahead of print]
Upper extremity impairments in women with or without lymphedema following
breast cancer treatment.
Smoot B, Wong J, Cooper B, Wanek L, Topp K, Byl N, Dodd M.
Department of Physical Therapy and Rehabilitation Science, University of
California San Francisco, San
Francisco, CA, USA, [email protected].
Abstract
INTRODUCTION: Breast-cancer-related lymphedema affects
approximately 25% of breast cancer
(BC) survivors and may impact use of the
upper limb during activity. The purpose of this study is to
compare upper
extremity (UE) impairment and activity between women with and without lymphedema
after BC treatment.
METHODS: 144 women post BC treatment completed demographic, symptom, and
Disability of
Arm-Shoulder-Hand (DASH) questionnaires. Objective measures
included Purdue pegboard,
finger-tapper, Semmes-Weinstein monofilaments,
vibration perception threshold, strength, range of
motion (ROM), and
volume.
RESULTS: Women with lymphedema had more lymph nodes removed (p < .001),
more UE symptoms
(p < .001), higher BMI (p = .041), and higher DASH
scores (greater limitation) (p < .001). For all
participants there was
less strength (elbow flexion, wrist flexion, grip), less shoulder ROM, and
decreased sensation at the medial upper arm (p < .05) in the affected UE.
These differences were
greater in women with lymphedema, particularly in
shoulder abduction ROM (p < .05). Women with
lymphedema had bilaterally
less elbow flexion strength and shoulder ROM (p < .05). Past diagnosis of
lymphedema, grip strength, shoulder abduction ROM, and number of
comorbidities contributed to the
variance in DASH scores (R (2) of 0.463, p
< .001).
IMPLICATIONS FOR CANCER SURVIVORS: UE impairments are found in women
following
treatment for BC. Women with lymphedema have greater UE impairment
and limitation in activities than
women without. Many of these impairments
are amenable to prevention measures or treatment, so early
detection by
health care providers is essential.
PMID: 20373044 [PubMed - as supplied by
publisher]
2. Support Care Cancer. 2010 Apr 6. [Epub ahead of print]
Can ICF model for patients with breast-cancer-related lymphedema predict
quality of life?
Tsauo JY, Hung HC, Tsai HJ, Huang CS.
--------------------
1: Ridner SH, Dietrich MS, Kidd N RelatedArticles
Breast cancer
treatment-related lymphedema self-care: Education, practices, symptoms, and
quality of
life.
Support Care Cancer. 2010 Apr 15.
PMID: 20393753
[PubMed - Publisher]
School and Graduate Institute of Physical Therapy, College of Medicine,
National Taiwan University,
Taipei, Taiwan.
Abstract
GOAL OF WORK: The aim of the study was to investigate if the
International Classification of
Functioning, Disability and Health (ICF)
model with clinical data from patients with
breast-cancer-related lymphedema
can predict their health-related quality of life (HRQL).
MATERIALS AND METHODS: Sixty-one patients with breast-cancer-related
lymphedema were
recruited. Data were collected from records, including age,
type(s) of surgery, number of dissected
lymph nodes and history of
radiotherapy and/or chemotherapy, duration of lymphedema, and duration
between surgery and enrollment. Excessive arm volume, average arm symptom,
function of upper
extremity (U/E), and HRQL were assessed four times during
and after patients' treatment of
lymphedema.
RESULTS: The ICF model accounted for 20.5% to 55.6% variance in each domain
of HRQL. Activity
and participation reflected by U/E function were the most
important factor, significantly predicting every
domain of HRQL. Among
measured impairments, average arm symptom was found to be most
correlated
with U/E function (r = 0.590, P < 0.05).
CONCLUSION: The ICF model consisting of clinical measures for patients with
breast-cancer-related
lymphedema can predict their HRQL. Activity and
participation were the most important component.
Arm symptoms rather than
arm volume significantly correlated with U/E function. This might suggest that
reducing arm symptoms is relatively more important while treating patients
with breast-cancer-related
lymphedema.
PMID: 20372972 [PubMed - as supplied by publisher]
3. Indian J Plast Surg. 2009 Jul;42(2):248-50.
Lymphangiectasis of lower limb: A rare challenging case.
Bhattacharya V, Mishra B, Barooah PS, Chaudhuri GR, Bhattacharya S.
Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu
University, Varanasi - 221
005, U.P, India.
Abstract
Lymphangiectasis usually occurs in the viscera. Involvement of
the lower limb is very rare. It is difficult to
establish the diagnosis
without detailed investigations. Clinical features are peculiar and may mimic
lymphoedema of different origins which needs to be ruled out. Contrary to
the expectation, the
post-operative result is excellent in the long-term
follow-up.
PMID: 20368868 [PubMed - in process]
4. J Clin Invest. 2010 Apr 1. pii: 40101. doi: 10.1172/JCI40101. [Epub
ahead of print]
Direct transcriptional regulation of neuropilin-2 by COUP-TFII modulates
multiple steps in murine
lymphatic vessel development.
Lin FJ, Chen X, Qin J, Hong YK, Tsai MJ, Tsai SY.
Abstract
The lymphatic system plays a key role in tissue fluid
homeostasis. Lymphatic dysfunction contributes to
the pathogenesis of many
human diseases, including lymphedema and tumor metastasis. However, the
mechanisms regulating lymphangiogenesis remain largely unknown. Here, we
show that COUP-TFII
(also known as Nr2f2), an orphan member of the nuclear
receptor superfamily, mediates both
developmental and pathological
lymphangiogenesis in mice. Conditional ablation of COUP-TFII at an
early
embryonic stage resulted in failed formation of pre-lymphatic ECs (pre-LECs) and
lymphatic
vessels. COUP-TFII deficiency at a late developmental stage
resulted in loss of LEC identity, gain of
blood EC fate, and impaired
lymphatic vessel sprouting. siRNA-mediated downregulation of
COUP-TFII in
cultured primary human LECs demonstrated that the maintenance of lymphatic
identity
and VEGF-C-induced lymphangiogenic activity, including cell
proliferation and migration, are
COUP-TFII-dependent and cell-autonomous
processes. COUP-TFII enhanced the
pro-lymphangiogenic actions of VEGF-C, at
least in part by directly stimulating expression of
neuropilin-2, a
coreceptor for VEGF-C. In addition, COUP-TFII inactivation in a mammary gland
mouse tumor model resulted in inhibition of tumor lymphangiogenesis,
suggesting that COUP-TFII also
regulates neo-lymphangiogenesis in the adult.
Thus, COUP-TFII is a critical factor that controls
lymphangiogenesis in
embryonic development and tumorigenesis in adults.
PMID: 20364082 [PubMed - as supplied by publisher
----
1. PLoS Negl Trop Dis. 2010 Apr 20;4(4):e668.
Feasibility and effectiveness of basic lymphedema management in Leogane,
Haiti, an area endemic for
bancroftian filariasis.
Addiss DG, Louis-Charles J, Roberts J, Leconte F, Wendt JM, Milord MD, Lammie
PJ, Dreyer G.
Division of Parasitic Diseases, National Center for Infectious Diseases, U.S.
Centers for Disease
Control and Prevention, Atlanta, Georgia, United States
of America. [email protected]
Abstract
BACKGROUND: Approximately 14 million persons living in areas
endemic for lymphatic filariasis have
lymphedema of the leg. Clinical
studies indicate that repeated episodes of bacterial acute
dermatolymphangioadenitis (ADLA) lead to progression of lymphedema and that
basic lymphedema
management, which emphasizes hygiene, skin care, exercise,
and leg elevation, can reduce ADLA
frequency. However, few studies have
prospectively evaluated the effectiveness of basic lymphedema
management or
assessed the role of compressive bandaging for lymphedema in resource-poor
settings.
METHODOLOGY/PRINCIPAL FINDINGS: Between 1995 and 1998, we prospectively
monitored
ADLA incidence and leg volume in 175 persons with lymphedema of
the leg who enrolled in a
lymphedema clinic in Leogane, Haiti, an area
endemic for Wuchereria bancrofti. During the first phase of
the study, when
a major focus of the program was to reduce leg volume using compression
bandages,
ADLA incidence was 1.56 episodes per person-year. After March
1997, when hygiene and skin care
were systematically emphasized and
bandaging discouraged, ADLA incidence decreased to 0.48
episodes per
person-year (P<0.0001). ADLA incidence was significantly associated with leg
volume,
stage of lymphedema, illiteracy, and use of compression bandages.
Leg volume decreased in 78% of
patients; over the entire study period, this
reduction was statistically significant only for legs with stage 2
lymphedema (P = 0.01).
CONCLUSIONS/SIGNIFICANCE: Basic lymphedema management, which emphasized
hygiene and
self-care, was associated with a 69% reduction in ADLA
incidence. Use of compression bandages in
this setting was associated with
an increased risk of ADLA. Basic lymphedema management is feasible
and
effective in resource-limited areas that are endemic for lymphatic
filariasis.
PMID: 20422031 [PubMed - in process]PMCID: PMC2857874
2. Support Care Cancer. 2010 Apr 25. [Epub ahead of print]
Longitudinal changes in sexual problems related to cancer treatment in Korean
breast cancer survivors: a
prospective cohort study.
Yang EJ, Kim SW, Heo CY, Lim JY.
Int J Med Sci. 2010 Apr 15;7(2):68-71.
Godoy & Godoy technique in the treatment of lymphedema for
under-privileged populations.
de Godoy JM, de Godoy Mde F.
Stricto-Sensu and Lato-Sensu of Course in Medicine of Medical School in São
José do Rio Preto- SP
(FAMERP), Brazil. [email protected]
Abstract
The aim of this paper is to report new options in the treatment
of lymphedema for under-privileged
populations. Several articles and books
have been published reporting recent advances and
contributions. A new
technique of manual lymph drainage, mechanisms of compression, development of
active and passive exercising apparatuses and the adaptation of
myolymphokinetic activities have been
developed for the treatment of
lymphedema. This novel approach can be adapted for the treatment of
lymphedema in mass.
PMID: 20428336 [PubMed - in process]
Department of Rehabilitation Medicine, Seoul National University College of
Medicine, Seoul National
University Bundang Hospital, 300 Gumi-dong
Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707,
Republic of Korea.
Abstract
PURPOSE: The aims of the study were to investigate longitudinal
changes in multiple domains of
problems with sexual functioning in Korean
breast cancer survivors in the first year after surgery for
breast cancer
and to determine which factor(s), including upper limb dysfunction, may
influence sexual
problems.
METHODS: Women diagnosed with breast cancer (n = 191) were initially assessed
at baseline before
surgery and completed follow-ups at 3, 6, and 12 months
after surgery. Survey items included sexual
interest, sexual activity,
satisfaction with sex life, feeling sexually attractive, body image, medical
history,
symptoms, upper limb dysfunction, and sociodemographics.
RESULTS: The prevalence of sexually active women was 39.2% at 3 months, which
increased to
48.2% at 6 months, and 50% at 12 months after surgery. Compared
with pretreatment levels,
considerably more women reported moderate or
severe problems with sexual interest and sexual activity
at 3, 6, and 12
months after surgery. Chemotherapy was related to sexual problems only early
after
treatment, and surgical procedure (extensive vs. conservative) had no
significant effect on sexual
problems. Low perceived sexual attractiveness
in 3 months after surgery was related to greater overall
sexual problems.
Lymphedema was significantly related to sexual disinterest at all stages of
follow-up
and to sexual satisfaction at the 6 month follow-up after
adjusting for other predicting factors.
CONCLUSIONS: Although sexual activity gradually improved during the first
year, more women
reported moderate or severe problems with sexual interest
and activity over time. Upper limb
dysfunction, such as that caused by
lymphedema, is a significant factor that may interfere with sexual
functioning in breast cancer survivors.
PMID: 20419495 [PubMed - as supplied by publisher]
3. J Indian Assoc Pediatr Surg. 2009 Oct;14(4):230-1.
Saxophone penis due to primary lymphoedema.
Jain VK, Singh S, Garge S, Negi A.
Department of Surgery, SAIMS, Indore, India.
Abstract
Congenital lymphoedema is a rare disorder that may result in
disfiguring edema of the male genitalia. The
treatment of persistent
lymphoedema is surgical and consists of meticulous excision of all subcutaneous
layers of the affected skin, combined with reconstruction of the penis and
or scrotum.
PMID: 20419030 [PubMed - in process]PMCID: PMC2858891
4. Indian J Orthop. 2010 Apr;44(2):198-201.
One-stage release of congenital constriction band in lower limb from new born
to 3 years.
Das SP, Sahoo P, Mohanty R, Das S.
Swami Vivekananda National Institute of Rehabilitation Training and Research,
Olatpur, Bairoi, Cuttack,
Orissa-754 010, India.
Abstract
BACKGROUND: Congenital constriction band is the most common cause
of terminal congenital
malformation of a limb and lymphoedema. Superficial
bands do not need any treatment, but deeper
bands are managed with excision
and Z-plasty. The circumferential bands are released in two to three
stages
to prevent vascular compromise. The purpose of this study was to present the
outcome of
one-stage release.
MATERIALS AND METHODS: Nineteen children, 12 boys and 7 girls, with 24
congenital
constriction bands constituted the clinical material. The mean
age at presentation was 57 days (range 12
hours to 3 years) Band was
unilateral in 14 and bilateral in five limbs. In unilateral cases, right side
was
involved in nine cases and left side in five. The constriction band is
seen at the junction of middle and
distal third. The patients having
constriction bands in lower limbs and age less than 3 years were included
in
the study. One stage circumferential release of congenital constriction band was
performed. Our
youngest patient was operated at the age of six months. Club
feet, (n=8) and lymphedema (n=7) were
associated anomalies. Club feet and
band were released in one stage in three limbs. The results were
evaluated
by criteria described by Joseph Upton and Cissy Tan.
RESULTS: There were 18
excellent, six satisfactory results. No wound problem occurred. No vascular
compromise was noted during or after the procedure. On follow-up, distal
swelling reduced.
CONCLUSIONS: One-stage circumferential release of
congenital constriction band in lower limbs with
or without lymphodema is a
safe and easy procedure.
PMID: 20419008 [PubMed - in process]PMCID: PMC2856396
1. SADJ. 2010 Feb;65(1):14, 16-8.
Facial lymphoedema as an indicator of terminal disease in oral HIV-associated
Kaposi sarcoma.
Feller L, Khammissa RA, Wood NH, Jose RJ, Lemmer J.
Department of Periodontology and Oral Medicine, School of Oral Health
Sciences, University of
Limpopo, Medunsa Campus, South Africa. [email protected]
Abstract
Rapidly progressive facial lymphoedema developing concurrently
with, or immediately after rapid
enlargment of oral Kaposi sarcoma (KS) in
HIV-seropositive highly active antiretroviral treatment
(HAART)-naïve
subjects, foretokens death. We present here an unusual case of HIV-KS in an
11-year-old HIV-seropositive HAART-naïve boy. Our patient's KS disease had
had a fulminant course
characterised by rapidly progressing oral HIV-KS,
resorption of the mandibular alveolar bone process
beneath some of the
HIV-KS lesions, and rapidly progressive facial lymphoedema. He died 3 weeks
after the onset of facial lymphoedema.
PMID: 20411797 [PubMed - in process]
2. Hell J Nucl Med. 2010 Jan-Apr;13(1):6-10.
Diagnostic application of lymphoscintigraphy in the management of
lymphoedema.
Sadeghi R, Kazemzadeh G, Keshtgar M.
Nuclear Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract
Lymphoedema (LOE) is an under-diagnosed condition which can cause
severe incapacitating swelling of
the extremities. Misdiagno sis and/or
delayed diagnosis are common and the goal of further evaluation is
to
confirm the cause and determine the type and site of lymphatic obstruction.
Lymphoscintigraphy
(LSG) is a minimally invasive way of evaluation of the
lymphatic system and can be used in the
management of the LOE patients.
However, many aspects of this useful diagnostic procedure are not
fully
explained in the med ical literature. In this article we briefly explain the
etiology and pathophysiology
of LOE. Methodology and applications of LSG for
the evaluation of this disease are extensively
reviewed.
PMID: 20411162 [PubMed - in process
3. Dermatol Online J. 2010 Apr 15;16(4):4.
Papillary intralymphatic angioendothelioma of the thigh: A case report and
review of the literature.
Ward KA, Ecker PM, White RR, Melnik TE, Gulbahce EH, Wilke MS, Sangueza
OP.
University of Minnesota, USA.
Abstract
The term angiosarcoma, encompasses several neoplasms, all of
which exhibit a malignant process
derived from endothelial cells of the
vessels. The most common form of angiosarcoma is highly
aggressive, often
fatal, and usually affects the head and neck region of elderly white men. Other
low-grade forms of angiosarcoma, including papillary intralymphatic
angioendothelioma, also known as
Dabska tumor, are less invasive, affect a
wider age range, and offer a better prognosis. There are several
predisposing factors that increase the risk of angiosarcoma and include
chronic lymphedema of the
extremities, preexisting vascular lesions, and
prior radiation, often as therapy for other malignancies. We
report an
unusual case of a very small, low-grade angiosarcoma on the thigh of an adult
female with no
known predisposing risk factors.
PMID: 20409411 [PubMed - in process]
4. Int Wound J. 2010 Feb;7(1):14-26.
The experience of children and families with lymphoedema--a journey within a
journey.
Moffatt CJ, Murray SG.
University of Glasgow, Glasgow, UK. [email protected]
Abstract
This paper reports on a study in the UK that explored the
experience of children suffering with
Lymphoedema and that of their
families. Qualitative data was collected from 20 children between the
ages
of 6 and 18 and their respective parents. Single, semi-structured interviews
were used in which
children and their parents were asked to share how
lymphoedema impacted on their family life. Children
were asked about their
school experience, their dreams and their aspirations. Three categories emerged.
Firstly, the negotiation of the health care system. Themes included correct
diagnosis, finding robust
information and reaching a knowledgeable expert.
The second category explored the complex role of the
parents as advocates.
Themes within this category included the dilemmas of parenting and the
increasing
challenges as children reached adolescence. The final category
involved the impact on the family unit.
The first theme concerned the
integration of lymphoedema into daily activities and the intrusion on family
time. The second explored the impact on siblings and the final theme the
changing dilemmas as children
moved through the stages of childhood and
faced adulthood.
PMID: 20409247 [PubMed - in process]
5. Br J Dermatol. 2010 Apr 16. [Epub ahead of print]
High resolution cutaneous ultrasonography to differentiate lipoedema from
lymphoedema.
Naouri M, Samimi M, Atlan M, Perrodeau E, Vallin C, Zakine G, Vaillant L,
Machet L.
Université François Rabelais de Tours; UMR, Inserm U930, CNRS ERL 3106;
Inserm CIC 202,
Department of Dermatology, Department of Plastic Surgery,
Department of Radiology, CHRU de
Tours; France.
Abstract
Summary Introduction. Lipoedema is an accumulation of fat
abnormally distributed in the lower limbs,
and lymphoedema is edema caused
by a deficiency of the lymphatic system. High-resolution ultrasound
operating at 20 MHz makes it possible to characterise dermal oedema. The
purpose of our study was to
demonstrate that high-resolution ultrasound
imaging of the skin was able to differentiate lipoedema from
lymphoedema.
Patients and method. Sixteen patients with lymphoedema (22 legs), 8 patients
with
lipoedema (16 legs) and 8 controls (16 legs) were included. Patients
with lipolymphoedema were
excluded. Ultrasound examinations were carried out
with a real time high resolution ultrasound device on
3 different sites for
each lower limb. The images were then anonymized and examined by an independent
dermatologist who was blind to the clinical diagnosis. A new series of
images was examined by 3
dermatologists to check inter-observer agreement.
Results. A significant difference in dermal thickness
was observed between
lymphoedema and lipoedema patients and lymphoedema patients and controls.
No
significant difference in dermal thickness was shown between lipoedema and
controls at the thigh or
ankle. Dermal hypoechogenicity was evidenced on at
least one of the three sites in 100% of
lymphoedema patients, 12.5% of
lipoedema patients and 6.25% of controls. Hypoechogenicity affected
the
entire dermis in all cases of lymphoedema except one. In cases of lipoedema and
controls,
hypoechogenicity was only localized at the ankle and prevailed in
the upper dermis. The expert
diagnosed all lower limbs with lymphoedema. No
cases of lipoedema were diagnosed as lymphoedema.
Exact inter-observer
agreement was excellent (0.98). Conclusions. High-resolution cutaneous
ultrasonography makes it possible to differentiate lymphoedema from
lipoedema. Obtaining a reliable
diagnosis through high resolution cutaneous
ultrasonography might be valuable to improve the treatment
of lipoedema and
lymphoedema.
PMID: 20408836 [PubMed - as supplied by publisher]
. Int J Med Sci. 2010 Apr 15;7(2):68-71.
Godoy & Godoy technique in the treatment of lymphedema for
under-privileged populations.
de Godoy JM, de Godoy Mde F.
Stricto-Sensu and Lato-Sensu of Course in Medicine of Medical School in São
José do Rio Preto-
SP (FAMERP), Brazil. [email protected]
Abstract
The aim of this paper is to report new options in the treatment
of lymphedema for under-privileged
populations. Several articles and books
have been published reporting recent advances and
contributions. A new
technique of manual lymph drainage, mechanisms of compression, development
of active and passive exercising apparatuses and the adaptation of
myolymphokinetic activities have
been developed for the treatment of
lymphedema. This novel approach can be adapted for the
treatment of
lymphedema in mass.
PMID: 20428336 [PubMed - in process]PMCID: PMC2860639
2. Contrib Nephrol. 2010;164:227-36. Epub 2010 Apr 20.
Fluid assessment and management in the emergency department.
Di Somma S, Gori CS, Grandi T, Risicato MG, Salvatori E.
Sant'Andrea Hospital, Second Faculty Medical School, "La Sapienza" University
of Rome, Rome,
Italy.
Abstract
Evaluation of hydration state or water homeostasis is an
important component in the assessment and
treatment of critically ill
patients in the emergency department (ED). The main purpose of ED
physicians
is to immediately distinguish between normal hydrated, dehydrated and
hyperhydrated
states. Fluid depletion may result from renal losses and
extrarenal losses (from the GI tract,
respiratory system, skin, fever,
sepsis, third space accumulations). Total body fluid increase can
result
from heart failure, kidney disease, liver disease, malignant lymphoedema or
thyroid disease. In
patients with fluid overload due to acute heart failure,
diuretics should be given when there is
evidence of systemic volume
overload, in a dose up-titrated according to renal function, systolic
blood
pressure, and history of chronic diuretic use. The bioelectrical impedance
vector analysis
(BIVA) is a noninvasive technique to estimate body mass and
water composition by bioelectrical
impedance measurements, resistance and
reactance. In patients with hyperhydration state due to
heart failure, some
authors showed that reactance is strongly related to BNP values and the NYHA
functional classes. Other authors found a correlation between impedance and
central venous pressure
in critically ill patients. We have been analyzing
the hydration state at admission to the ED, 24, 72 h
after admission and at
discharge, and found a significant and indirectly proportional correlation
between BIVA hydration and the Caval index at the time of presentation to
the ED and 24 and 72 h
after hospital admission. Moreover, at admission we
found an inverse relationship between BIVA
hydration and reduced urine
output that became directly proportional at 72 h. This confirms the good
response to diuretic therapy with the shift of fluids from interstitial
spaces.
Copyright (c) 64\C S. Karger AG, Basel.
PMID: 20428007 [PubMed - in process]
3. Womens Health (Lond Engl). 2010 May;6(3):399-406.
Breast cancer and lymphedema: a current overview for the healthcare
provider.
Rourke LL, Hunt KK, Cormier JN.
University of Texas, MD Anderson Cancer Center, Department of Surgical
Oncology, Houston, TX
77030, USA. [email protected]
Abstract
Lymphedema is a troublesome condition faced by many breast cancer
survivors today. Since
lymphedema represents a debilitating and progressive
problem that is feared by most breast cancer
patients and their providers,
an up-to-date understanding is necessary in order to better diagnose,
treat
and manage these patients. The etiology of lymphedema is multifactorial and
poorly understood.
Although lymphedema is not clearly defined within the
medical community, there are several
diagnostic tools available to the
clinician, of which the most widely accepted in the clinical setting are
the
arm circumference measurements. Misinformation has recently been conveyed
regarding activity
recommendations for those patients afflicted with
lymphedema. These recent events highlight the
critical importance of
education, heightened awareness and dedicated future cooperative research in
order to favorably impact on lymphedema care and the quality of life for
those living with
lymphedema.
PMID: 20426606 [PubMed - in process]
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Mar;26(2):103-6.
[The pathological characteristics and clinical significances of maturational
change of port-wine stain]
[Article in Chinese]
Wang W, Lin XX, Ma G, Li W, Hu XJ, Jin YB, Chen H, Yang C, Wang W.
Department of Plastic and Reconstructive Surgery, Ninth People's Hospital,
Shanghai Jiaotong
University, Shanghai 200011, China. [email protected]
Abstract
OBJECTIVE: In this study histologic observations were presented
to elucidate the possible
mechanism of maturational change of port-wine
stain(PWS).
METHODS: Normal PWS(3 cases) , thicken PWS (11 cases) and nodular PWS (9
cases) were
included to present histologic observations.
RESULTS: Normal PWS, only shows mild dilated, thin-walled vessels within
superficial dermis.
Thicken PWS, shows further dilated vessels and sebaceous
gland throughout dermis and superficial
subcutaneous fat. Nodular PWS can be
divided into three groups. I Similar to thicken PWS, shows
further dilated
vessels and sebaceous gland throughout dermis and superficial subcutaneous fat.
II
Shows Large number of dilated vessels, honeycombin and less vascular
mesenchymall. III Tenacious
texture shows mild dilated vessels, diffused
collagen, mesenchymal rarefactin, lymphocyte infiltration
and lymphedema
change.
CONCLUSIONS: Histologic examination revealed not only the expected vascular
abnormalities, but
also a number of widely distributed hamartomatous changes
in thicken and nodular PWS. The
complex hamartomatous changes suggest a
genetically determined, multilineage developmental field
defect in the
pathogenesis of PWS.
PMID: 20540312 [PubMed - in process]
1. J Vector Borne Dis. 2010 Jun;47(2):91-6.
Bancroftian filariasis among the Mbembe people of Cross River state,
Nigeria.
Okon OE, Iboh CI, Opara KN.
Department of Zoology & Environmental Biology, University of Calabar,
Calabar, Nigeria.
Abstract
BACKGROUND & OBJECTIVE: Bancroftian filariasis is a major
public health and socioeconomic
problems in the humid tropical and
subtropical regions of the world. A study was undertaken to
investigate the
status of the disease in some rural communities of Cross River State, Nigeria,
with a
view to enriching the epidemiological baseline data of the disease in
Nigeria.
METHODS: A total of 897 Mbembe people living in six major villages of Obubra
Local
Government Area of Cross River State, Nigeria were examined between
December 2008 and June
2009 for lymphatic filariasis due to Wuchereria
bancrofti.
RESULTS: Out of the 897 persons examined, 139 (15.5%) were positive for
microfilariae in their
blood smear. Infection varied significantly among
villages (p <0.05) but was not sex-specific (p >0.
05). The overall
mean microfilarial density among the total population was 9.9 mf/50 microl. The
occurrence of microfilaria in the peripheral blood of the infected persons
was neither age nor sex
specific (p >0.05). The most important clinical
manifestations were hydrocele (9.7%) and
lymphoedema (2.3%). Overall disease
prevalence was (6.8%).
CONCLUSION: Government effort on the Community Directed Treatment with
Ivermectin (CDTI)
project should be complimented with albendazole
distribution to the endemic communities.
Environmental sanitation should
also be intensified to eliminate the breeding sites of the mosquito
vectors.
PMID: 20539046 [PubMed - in process]
2. J Surg Res. 2010 Apr 18. [Epub ahead of print]
Treatment of Post-Mastectomy Lymphedema with Laser Therapy: Double Blind
Placebo Control
Randomized Study.
Ahmed Omar MT, El Morsy AM, Abd-El-Gayed Ebid A.
Faculty of Physical Therapy, Cairo, Egypt. Member of International Panel of
Advisory Board for
Indian Journal of Physiotherapy and Occupational
Therapy.
Abstract
BACKGROUND: In post-mastectomy patients, lymphedema has the
potential to become a
permanent progressive condition and become extremely
resistant to treatment. Thus, it can results in
function impairment and
decrease quality of life. The aim of this study was to evaluate the effect of
low level laser therapy (LLLT) on limb volume, shoulder mobility, and hand
grip strength.
MATERIAL AND METHODS: Fifty women with breast cancer-related lymphedema were
enrolled
in a double-blind, placebo controlled trial. Patients were randomly
assigned to active laser (n = 25)
and placebo (n = 25) groups and received
irradiation with Ga-As laser device that had wavelength of
904 nm, power of
5 mW, and spot size of 0.2 cm(2) over the axillary and arm areas, three times a
week for 12 wk. The total energy applied at each point was 300 mjoules over
seven points, giving a
dosage of 1.5 joules/cm(2) in the active group. The
placebo group received placebo therapy in
which the laser had been disabled
without affecting its apparent function. Limb circumference,
shoulder
mobility, and grip strength were measured before treatment and at 4, 8, and 12
wk.
RESULTS: The two groups had similar parameters at baseline. The reduction of
limb volume tended
to decline in both groups. The trend being more
significantly pronounced in active LLLT group than
placebo at 8 and 12 wk,
respectively (P < 0.05). Goniometric data for shoulder mobility and hand
grip strength were statistically significance for LLLT group than for
placebo.
CONCLUSION: Laser treatment was found to be effective in reducing the limb
volume, increase
shoulder mobility, and hand grip strength in approximately
93% of patients with postmastectomy
lymphedema. Copyright © 2010 Elsevier
Inc. All rights reserved.
PMID: 20538293 [PubMed - as supplied by publisher]
3. Lancet Oncol. 2010 May 25. [Epub ahead of print]
Angiosarcoma.
Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ.
Academic Unit of Surgical Oncology, School of Medicine and Biomedical
Sciences, University of
Sheffield, Sheffield, UK.
Abstract
Angiosarcomas are rare soft-tissue sarcomas of endothelial cell
origin that have a poor prognosis.
They can arise anywhere in the body, most
commonly presenting as cutaneous disease in elderly
white men, involving the
head and neck and particularly the scalp. They can be caused by therapeutic
radiation or chronic lymphoedema and hence secondary breast angiosarcomas
are an important
subgroup. Recent work has sought to establish the molecular
biology of angiosarcomas and identify
specific targets for treatment.
Interest is now focused on trials of vascular-targeted drugs, which are
showing promise in the control of angiosarcomas. In this review we discuss
angiosarcoma and its
current management, with a focus on clinical trials
investigating the treatment of advanced disease.
Copyright © 2010 Elsevier
Ltd. All rights reserved.
PMID: 20537949 [PubMed - as supplied by publisher]
4. Am J Hum Genet. 2010 Jun 11;86(6):943-8. Epub 2010 May 27.
GJC2 missense mutations cause human lymphedema.
Ferrell RE, Baty CJ, Kimak MA, Karlsson JM, Lawrence EC, Franke-Snyder M,
Meriney SD,
Feingold E, Finegold DN.
Department of Human Genetics, Graduate School of Public Health, University of
Pittsburgh,
Pittsburgh, PA 15261, USA.
Abstract
Lymphedema is the clinical manifestation of defects in lymphatic
structure or function. Mutations
identified in genes regulating lymphatic
development result in inherited lymphedema. No mutations
have yet been
identified in genes mediating lymphatic function that result in inherited
lymphedema.
Survey microarray studies comparing lymphatic and blood
endothelial cells identified expression of
several connexins in lymphatic
endothelial cells. Additionally, gap junctions are implicated in
maintaining
lymphatic flow. By sequencing GJA1, GJA4, and GJC2 in a group of families with
dominantly inherited lymphedema, we identified six probands with unique
missense mutations in
GJC2 (encoding connexin [Cx] 47). Two larger families
cosegregate lymphedema and GJC2
mutation (LOD score = 6.5). We hypothesize
that missense mutations in GJC2 alter gap junction
function and disrupt
lymphatic flow. Until now, GJC2 mutations were only thought to cause
dysmyelination, with primary expression of Cx47 limited to the central
nervous system. The
identification of GJC2 mutations as a cause of primary
lymphedema raises the possibility of novel
gap-junction-modifying agents as
potential therapy for some forms of lymphedema. Copyright 2010
The American
Society of Human Genetics. Published by Elsevier Inc. All rights reserved.
PMID: 20537300 [PubMed - in process]
5. Microcirculation. 2010 May;17(4):281-96.
Lymphatic dysfunction, not aplasia, underlies milroy disease.
Mellor RH, Hubert CE, Stanton AW, Tate N, Akhras V, Smith A, Burnand KG,
Jeffery S, Mäkinen
T, Levick JR, Mortimer PS.
Cardiac & Vascular Sciences (Dermatology), St George's Hospital Medical
School, University of
London, London, UK.
Abstract
OBJECTIVE: Milroy disease is an inherited autosomal dominant
lymphoedema caused by mutations
in the gene for vascular endothelial growth
factor receptor-3 (VEGFR-3, also known as FLT4). The
phenotype has to date
been ascribed to lymphatic aplasia. We further investigated the structural and
functional defects underlying the phenotype in humans.
METHODS: The skin of the swollen foot and the non-swollen forearm was
examined by (i)
fluorescence microlymphangiography, to quantify functional
initial lymphatic density in vivo; and (ii)
podoplanin and LYVE-1
immunohistochemistry of biopsies, to quantify structural lymphatic density.
Leg vein function was assessed by colour Doppler duplex ultrasound.
RESULTS: Milroy patients exhibited profound (86-91%) functional failure of
the initial lymphatics in
the foot; the forearm was unimpaired. Dermal
lymphatics were present in biopsies but density was
reduced by 51-61% (foot)
and 26-33% (forearm). Saphenous venous reflux was present in 9/10
individuals with VEGFR3 mutations, including two carriers.
CONCLUSION: We propose that VEGFR3 mutations in humans cause lymphoedema
through a
failure of tissue protein and fluid absorption. This is due to a
profound functional failure of initial
lymphatics and is not explained by
microlymphatic hypoplasia alone. The superficial venous valve
reflux
indicates the dual role of VEGFR-3 in lymphatic and venous development.
PMID: 20536741 [PubMed - in process]
6. Genet Med. 2010 Jun 8. [Epub ahead of print]
Spinal extradural arachnoid cysts in lymphedema-distichiasis syndrome.
Sánchez-Carpintero R, Dominguez P, Núñez MT, Patiño-García A.
From the 1Department of Pediatrics, Pediatric Neurology Unit; 2Department of
Radiology,
Neuroradiology Unit; and 3Department of Pediatrics, Laboratory of
Pediatrics, University Clinic of
Navarra, Pamplona, Spain.
Abstract
PURPOSE:: Lymphedema-distichiasis syndrome is characterized by
the presence of lower limb
lymphedema and supernumerary eyelashes arising
from the Meibomian glands. Spinal extradural
arachnoid cysts have been
observed in some families but their true frequency is unknown. The aim of
this study is to determine the frequency of spinal extradural arachnoid
cysts in lymphedema
distichiasis syndrome.
METHODS:: We collected clinical information from all 45 living members of a
complete family of 48
members and performed molecular analysis of the FOXC2
gene in 30 individuals. We obtained
spinal magnetic resonance imaging from
all family members with a FOXC2 gene mutation.
RESULTS:: Twelve family
members carried a mutation in the FOXC2 gene and had clinical features
of
lymphedema-distichiasis syndrome. Of these, 58% (seven individuals) had
extradural arachnoid
cysts.
DISCUSSION:: We suggest that a follow-up protocol for lymphedema-distichiasis
syndrome
families should include spinal magnetic resonance imaging for all
affected members so that the timing
of surgery for removal of these cysts
can be optimized.
PMID: 20535019 [PubMed - as supplied by publisher]
7. Ugeskr Laeger. 2010 Jun 7;172(23):1765-6.
[Recurrent post surgical cellulitis of the breast][Article in Danish]
Thoning JM, Thormann H.
Svendborg Sygehus, Medicinsk Afdeling, Odense Universitetshospital, 5230
Odense, Denmark.
[email protected]
Abstract
Differentiation between infectious and non-infectious cellulitis
is a frequent clinical issue. Often, there
is no proven portal of entry for
infection and it is difficult to obtain a positive culture. Two case
stories
with recurrence of postoperative cellulitis are presented. Lymphoedema, often
seen post
surgery, is itself inflammatory and may cause inflammatory
cellulitis. In recurrent cases of cellulitis
without any effect of
antibiotic treatment, inflammatory cellulitis should be considered.
PMID: 20534207 [PubMed - in process]
June 6, 1010 - This is Now Considered a Critical Piece of Cancer
Treatment -
The research of Dr. Kathryn Schmitz, which had already research reversed
decades of cautionary
exercise advice given to breast cancer patients with
lymphedema, led an expert panel to developed
the new recommendations.
According to Eurekalert:
"Cancer patients and survivors should strive to get the same 150 minutes per
week of moderate-
intensity aerobic exercise that is recommended for the
general public ... Though the evidence
indicates that most types of physical
activity -- from swimming to yoga to strength training -- are
beneficial for
cancer patients, clinicians should tailor exercise recommendations to individual
patients".
Sources: Science Daily June 1, 2010
Dr. Mercola's Comments:
As little as a decade ago, it was common for physicians to advise their heart
attack patients to avoid
exercise for fear that they could stress out their
heart and trigger a second attack.
Now, it's common knowledge that exercise is a phenomenal way to strengthen
your heart after a
heart attack as well as lessen your risk of further
problems, and regular exercise is routinely
recommended to heart
patients.
For cancer patients, this trend is still in the beginning stages, with many
practitioners advising their
patients to avoid exercise during and after
cancer treatment. But increasing evidence is showing that
this outdated
advice is actually causing cancer patients harm, as regular exercise can lead to
a
number of health improvements for cancer patients, including:
· Better aerobic fitness
· Increased muscular
strength
· Improved quality of
life
· Less fatigue
Exercise Improves Cancer Survival
I've written a lot about how exercise can help to reduce your risk of cancer
in the first place, but
does it do any good if you're already fighting
cancer? Yes … a lot.
Harvard Medical School researchers found patients who exercise moderately --
3-5 hours a week
-- reduce their odds of dying from breast cancer by about
half as compared to sedentary women. In
fact, any amount of weekly exercise
increased a patient's odds of surviving breast cancer. This
benefit also
remained constant regardless of whether women were diagnosed early on or after
their
cancer had spread.
Patients receiving the biggest boost from exercise were those most sensitive
to estrogen, the most
common form of breast cancer. (Previous research has
shown exercise lowers estrogen levels, which
can fuel the growth of breast
cancer cells.)
Think about it. If just three to five hours of walking per week can so
drastically improve your
chances of surviving a hormone-responsive breast
cancer tumor, imagine what a few more hours a
week of exercise could do for
you.
If you're male, be aware that athletes have lower levels of circulating
testosterone than non-athletes,
and similar to the association between
estrogen levels and breast cancer in women, testosterone is
known to
influence the development of prostate cancer in men.
Physical activity can reduce your risk and boost your chances of recovery if
you have cancer.
Exercise is a Potent Cancer Fighter
Cancer thrives on sugar, but regular exercise reduces your insulin levels,
which creates a low sugar
environment that discourages the growth and spread
of cancer cells. Controlling your insulin levels is
one of the most powerful
steps you can take to reduce your cancer risk and help keep it from
returning.
Physically active adults experience about half the incidence of colon cancer
as their sedentary
counterparts. Exercise has a beneficial influence on
insulin, prostaglandins and bile acids, all of which
are thought to
encourage the growth and spread of cancer cells in your colon. Exercise also
improves
bowel transit time, which means your body's waste is spending less
time in contact with the mucosal
lining of your colon.
Exercise also improves the circulation of immune cells in your blood. The job
of these cells is to
neutralize pathogens throughout your body.
The better these cells circulate, the more efficient your immune system is at
locating and defending
against viruses and diseases, including cancer,
trying to attack your body.
It's also been suggested that apoptosis (programmed cell death) is triggered
by exercise, causing
cancer cells to die. So you can see why a regular
exercise program is important not only during any
treatment you're receiving
but also afterward as well.
Exercise Tips for Cancer Patients
I would also strongly recommend that you read the lead article in today's
newsletter that reviews
some of the newest insights on how to optimize your
exercise program and actually reduce your
exercise time and improve your
benefits.
You will need to tailor your exercise routine to your individual scenario,
taking into account your
stamina and current health. Often, you will be able
to take part in a regular exercise program -- one
that involves a variety of
exercises like strength training, core-building, stretching, aerobic and
anaerobic -- with very little changes necessary.
However, you may find that you need to exercise at a lower intensity or for
shorter durations at
times. Always listen to your body and if you feel you
need a break, take time to rest. Even exercising
for a few minutes a day is
better than not exercising at all, and you'll likely find that your stamina
increases and you're able to complete more challenging workouts with each
passing day.
In the event you are suffering from a very weakened immune system, you may
want to exercise in
your home instead of visiting a public gym. But remember
that exercise will ultimately help to boost
your immune system, so it's very
important to continue with your program.
June 21, 2010 - Indian River County health notes for June 22 -
VNA screenings
The Visiting Nurse Association of the Treasure Coast is offering the
following no-cost blood
pressure and blood glucose screenings in June
June 22, (BP/BS) 9-11 a.m. Staples, 1191 U.S. 1, Vero Beach.
June 28, (BP/BS) 8:30-10 a.m. Sebastian Gym & Fitness, 345 Sebastian
Blvd., Sebastian.
For morning blood sugar tests, you should fast after midnight on the evening
before the screening.
For more information about health screenings or other
VNA services, call (772) 567-5551 or visit
www.vnatc.com.
Balancing hormones
A free workshop, “Balancing Hormones Safely and Naturally,” will be presented
6 p.m. Tuesday,
June 22, at Alternative Medicine Family Care Center, 3408
Aviation Blvd., Vero Beach.
The workshop addresses non-drug solutions to the hormone-related concerns of
women 0f all ages
including thyroid problems, hot flashes, fatigue, night
sweats, irregular cycle, headaches, trouble
sleeping, abnormal cramping,
depression and anxiety.
To R.S.V.P., call (772) 778-8877. Visit www.amfcc.info for more information on
alternative
medicine.
Digestive disorders
A free workshop on digestive disorders will be presented 6-7 p.m. Thursday,
June 24, at Alternative
Medicine Family Care Center, 3408 Aviation Blvd.,
Vero Beach.
This workshop will teach alternative approaches to preventing and relieving
common digestive
disorders including acid reflux, hiatal hernia, gas,
bloating, irritable bowel, diarrhea, stomach cramps,
Crohn’s Disease and
constipation.
Call (772) 778-8877 to R.S.V.P. For more info, visit www.amfcc.info.
Balance screenings
Sunshine Physical Therapy Clinic will be at the Walgreens on 17th Avenue and
U.S. 1 in Vero
Beach 10 a.m.-noon Wednesday, June 30, to do balance
screenings. For more information, call the
clinic at (772) 562-6877.
Blood pressure screenings
Blood pressure screenings are offered 10-11:30 a.m. the third Tuesday of
every month as Oxygen
Plus, 2360 U.S. 1, Vero Beach. For more information,
call (772) 569-0232 or write oxygen-
[email protected].
Wellness program
A free wellness presentation to raise antioxidant levels, improve immune
system functions and reduce
DNA damage will be offered at the Institute of
Colorectal Health & Wellness, 1255 37th St., Suite
B, Vero Beach, 7 p.m.
Thursdays.
R.S.V.P. at (772) 778-4773 or [email protected].
Walkers, wheelchairs
Veterans of Foreign Wars Post 3918, Vero Beach, has walkers, wheelchairs,
crutches, portable
commodes and motor scooters, available free for anybody
who needs them. For information, call the
Post 3918 office at (772) 567-8487
and leave your name and number.
Quit smoking
Free quit smoking now classes (all forms of tobacco) are offered to all
county residents 18 and older
at the Indian River County Health Department,
1900 27th St., Vero Beach.
Call (561) 640-3620 for dates and times. This is a community health promotion
program offered by
Everglades Area Health Education Center.
Mental health
The Mental Health Association has opened a walk-in center to provide people
in crisis immediate
access to help. Death in the family, domestic abuse,
depression, anxiety, parenting issues —
whatever the difficulty, MHA’s
therapists stand ready to assist. If you are interested in donating to
the
MHA or if you need help for yourself or your loved ones, call (772)
569-9788.
Health talk show
If you have missed any of Indian River Medical Center’s Health Talk TV
segments that air on
WWCI-TV Channel 10, you can now go to the hospital’s
Web site, www.irmc.cc. Under “Health
Resources” at the top of the home page, choose to watch any or all segments
from the first four
shows.
To view on YouTube, go to www.youtube.com and type “Indian River Medical
Center” in the
search box.
The show, hosted by Kim Beckett, wife of Dr. Clark W. Beckett, IRMC vascular
surgeon, features
the latest in health news and medical advances. The series
airs on Channel 10 on alternate Mondays
and Wednesdays at 4, 7 and 11
p.m.
E-mail questions, comments and suggested topics to [email protected].
Fitness camp
In partnership with the Club at Spine & Sport Institute, CityFit Outdoor
Fitness Camp is hosting
Brown Bag boot camps from noon to 12:50 p.m.
Tuesdays and Thursdays on 36th Street in Vero
Beach.
The camps are designed with a holistic approach to health and include
workouts, workshops and
field trips focused on smarter shopping and menu
planning..
The cost is $250 for six weeks. Call Jill at (772) 713-7938 or e-mail [email protected] to
reserve a spot.
Macular Degeneration
Free initial eye screenings are available at Diabetes Eye and Macular
Degeneration Institute for
patients who are diabetic or age 50 and older.
Call (772) 770-1577 to schedule an appointment at
93 Royal Palm Pointe, Vero
Beach.
Florida Eye Institute
Florida Eye Institute will begin free initial vision and glaucoma screenings
from 9 to 11 a.m. Fridays
at 2750 Indian River Blvd. in Vero Beach. Call
(772) 569-9500 or visit www.fleye.com for
more
information.
Monnett Eye Center
Monnett Eye Center provides free vision, glaucoma and hearing screenings from
9 a.m. to 2 p.m.
Tuesdays at the clinic, 14410 U.S. 1 in Sebastian. Monnett
Eye Center also provides local
businesses with free vision, glaucoma and
hearing screenings for their employees. For more
information and
appointments, call (772) 589-8111.
Aesthetic medicine
Find out what’s new in aesthetic medicine at a free informational seminar
presented by Ferdinand
Becker M.D., F.A.C.S. and Barry Boyd, M.D. 10-11 a.m.
Friday, June 25, at Advanced Facial
Cosmetic and Laser Surgery Center, 5070
N. State Road A1A, Vero Beach. Topics include
surgical and nonsurgical
cosmetic procedures such as dermal fillers, Zerona, fractional laser
resurfacing and photorejuvenation, as well as aesthetic surgery for the face
and body, including
facelifts and eyelid surgery, breast surgery, tummy
tucks and liposuction. The seminar is free, but
reservations are required.
Call (772) 234-3700.
Lymphedema therapy
Sunshine Physical Therapy Clinic, 1705 17th Ave., Vero Beach, now offers
lymphedema therapy
among its regular services. Michelle Dorfman is certified
in treating anyone with lymphedema of the
upper extremity. If you have had a
mastectomy, lumpectomy radiation treatment, lymph node
removal, other
surgeries or infections to the limbs, you may be at risk for developing
lymphedema.
For information, call (772) 562-6877.
June 22, 2010 - Dragonboat gets grant –
Prince George Northbreast Passage Dragon Boat team has received a grant for
$2,000 for the
upcoming season. The grant was part of a $50,000 Canadian
Breast Cancer Foundation grant
allotted to 22 B.C. Dragon Boat breast cancer
survivor teams for 2010.
The grant was created to celebrate the fact women can lead healthy and active
lives after breast
cancer. This region has supported the teams since 1997.
The Dragon Boat movement for breast
cancer survivors began in 1996 as the
result of a ground breaking study led by Dr. Don McKenzie ,
professor of
sports medicine at the University of British Columbia. He set out to investigate
the link
between upper body exercise and the development of lymphedema in
women with breast cancer.
Lymphedema is the swelling some women experience due to accumulation of fluid
in the arm and
chest after removal of lymph nodes for the treatment of
breast cancer.
In his study, 24 women, all with a history of breast cancer, volunteered for
the research project and
began training as dragon boaters. McKenzie found
that despite rigorous repetitive upper-body
exercises – which dragon boating
requires – no new cases of lymphemdema occurred and none of
the existing
cases progressed.
Women who participated showed a marked improvement in both physical and
mental health. From
this initial project in Vancouver, an international
movement of breast cancer survivor Dragon boat
teams has evolved.
Balance a touch away - Jerrilyn Zavada - 06/24/2010
An oasis of peace sits relatively untapped in downtown Streator.
Body/Mind/Spirit, owned by Amy Ryan of Streator, offers massage and
lymphedema therapy and
Reiki, among other services to provide a balance
between body and spirit.
Ryan is a graduate of the Illinois Valley Community College massage therapy
program. She practiced
locally for seven years, before going into private
practice.
"I love what I do and I love helping people," Ryan said. "I believe I have a
gift and I want to share it."
Ryan's philosophy in providing the services is simple. She provides massage
techniques tailored to
individual needs.
"A few simple changes can bring more balance into a busy lifestyle and you
can enjoy a higher, more
vibrant state of health," she said. "Blending the
wise ways of the East with dynamic ways of the West
is the necessary step
that would bring us closer to manifesting health and inner peace."
Ryan offers competitive prices for 30-minute, one-hour and 90-minute massage
sessions. She offers
discounts to senior citizens.
"A lot of them are on fixed incomes and it's so wonderful for them," she
said.
June 25, 2010 - Pulling together - Joey Coleman -
They paddle the west harbour every Saturday morning. Forty women in two
boats, determined to
paddle the fastest dragon boat in the world. Like all
athletes, they're focused on the next race -- the
next big challenge.
What makes these athletes different is their biggest challenge is behind
them. They're breast cancer
survivors.
The team formed 13 years ago after an article in Chatelaine about the debate
over upper body
exercise for women with breast cancer. Two decades ago, it
was believed this activity increased the
risk of lymphedema.
But a study by Dr. Don McKenzie of the University of British Columbia proved
conventional
wisdom was wrong.
Dragon boating is physically demanding and a challenge for even the most
healthy person.
"A lot of people believe it's canoeing and canoeing is a nice easy stroke,"
said Kathy Levy, a
founding member and now a coach with the team.
"A lot of our ladies, including me, did not do a lot of physical activity.
Now, all of the sudden, we
have triceps, biceps and calf muscles," said
coach Ann Fowbes Arndt.
They practise at Macassa Bay Yacht Club two days a week and on other days do
water aerobics,
marathon training, spinning, cross-training and even
boxing.
Two weekends ago, they won an international breast cancer survivors dragon
boat festival, beating
72 other international teams.
Husbands get involved, too, sometimes treating team members to breakfast when
they come off the
water.
"A couple years back, they had a race and they had to pull off a good time,"
said Jim Martin, whose
wife, Loraine, is on the team.
"I said if you can do this, I'll cook breakfast ... waffles and ice cream
with shaved chocolate,
strawberries cut into hearts."
Since then, he has been part of the shore team preparing breakfast following
each victory.
Racing, and the mental preparation involved, helps the paddlers think about
something other than
cancer, but it's never far from their thoughts.
"It's always in the back of your head that one day it may come back to bite
you," said Levy. "We
have lost three members already this year. It's
hard."
Team member Rae Puttock listened by cellphone from her bed as the team won in
Peterborough.
She died the next day.
"She was always a part of everything we were doing right up to the day before
she died," said Levy.
"You don't leave the team because you've retired or
you've been traded."
Levy and Fowbes Arndt say the losses increase their determination.
"We gather strength from the girls we've lost. It makes us paddle harder for
each of them. They're
with us on the boat."
June 24, 2010 - Decongestive Physiotherapy Helps Patients with Painful Leg
Swelling -
Source: Wolters Kluwer Health: Lippincott Williams &
Wilkins
Combination Approach Benefits Patients with Chronic Venous Insufficiency or
Lymphedema,
Reports Topics in Geriatric Rehabilitation
Newswise — For patients with painful swelling of the legs caused by chronic
venous insufficiency
(CVI), a combination treatment approach called
"complete decongestive physiotherapy" improves
symptoms, walking ability,
and quality of life, reports a study in Topics in Geriatric Rehabilitation.
The journal is published by Lippincott Williams & Wilkins, a part of
Wolters Kluwer Health, a
leading provider of information and business
intelligence for students, professionals, and institutions in
medicine,
nursing, allied health, and pharmacy.
Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce
leg swelling and
pain in patients with CVI, according to the new study, led
by Yesim Bakar, Ph.D., P.T., of Abant
Izzet Baysal University in Bolu,
Turkey. Another paper in the same issue of TGR shows similar
benefits of CDP
in a patient with lymphatic obstruction (lymphedema) related to the skin
condition
psoriasis.
Complete Decongestive Physiotherapy Brings Good Results
Dr Bakar and coauthors evaluated the effects of CDP in 62 older adults
(average age 65 years) with
CVI. Patients with CVI have poor blood flow in
the veins of the leg, leading to fluid buildup. This
results in painful
swelling, making it difficult for patients to walk and perform other activities.
Usually
only one leg is affected.
All patients were treated using the CDP approach, which combines four types
of physical therapy
treatments:
• Manual lymph drainage—massage to promote drainage of the lymph
nodes.
• Skin care—moisturizers and other treatments for skin changes caused
by poor circulation.
• Compression—bandages are applied to prevent fluid from
reaccumulating.
• Exercise—simple leg exercises to improve blood flow and leg
motion.
For the first month, patients met with a physical therapist five days a week
for treatment. They also
received education in performing each of the four
types of therapy for themselves. The goal was to
keep fluid buildup under
control through lifelong, daily self-care.
The CDP treatment program dramatically reduced leg swelling—on average, fluid
buildup in the
affected leg decreased by the equivalent of nearly half a
liter. Pain was also decreased, from an
average score of 67 to 18 on a
100-point scale. Patients had improved walking ability, less pain
when
walking, and improved ability to perform daily activities. The authors believe
that including
exercise in the treatment program was a key factor in
improving walking ability.
Dr. Bakar is also a co-author of the other paper, which reports on the use of
CDP in a woman with
lymphedema related to the chronic skin condition
psoriasis. In patients with lymphedema, obstruction
of the lymph nodes
causes similar symptoms of leg pain and swelling. In both the short and long
term,
CDP brought significant improvement in pain, swelling, and
activity.
In recent years, CDP has become an accepted approach to treatment for
lymphedema. Although not
a cure, CDP incorporates several physical therapy
techniques that can help keep fluid buildup, leg
swelling, and pain under
control.
The new studies are the first to evaluate the fully integrated CDP
approach—including daily home
maintenance therapy—in patients with CVI and
psoriasis-related lymphedema. "CDP is a time-
consuming process for patients
and physiotherapists," Dr. Bakar and colleagues write. "However, it
is
widely used and an effective treatment for patients with lymphedema." The new
results suggest that
this combination physical therapy approach could also
be very helpful for patients with leg pain and
swelling caused by CVI.
About Topics in Geriatric Rehabilitation
Topics in Geriatric Rehabilitation is a peer-reviewed quarterly
publication that presents clinical, basic,
and applied research, as well as
theoretic information, consolidated into a clinically relevant form.
TGR is
a leading resource for the healthcare professional practicing in the area of
geriatric
rehabilitation. TGR provides useful treatment information written
by and for specialists in all aspects
of geriatric care. Each issue focuses
on a specific topic, providing best practices and dependable
hands-on tips
and techniques.
Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international
publisher for healthcare professionals
and students with nearly 300
periodicals and 1,500 books in more than 100 disciplines publishing
under
the LWW brand, as well as content-based sites and online corporate and customer
services.
LWW is part of Wolters Kluwer Health, a leading provider of information and
business intelligence
for students, professionals and institutions in
medicine, nursing, allied health and pharmacy. Major
brands include
traditional publishers of medical and drug reference tools and textbooks, such
as
Lippincott Williams & Wilkins and Facts & Comparisons®; and
electronic information providers,
such as Ovid®, UpToDate®, Medi-Span® and
ProVation® Medical.
Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global
information services
company. Professionals in the areas of legal, business,
tax, accounting, finance, audit, risk,
compliance, and healthcare rely on
Wolters Kluwer’s leading, information-enabled tools and
solutions to manage
their business efficiently, deliver results to their clients, and succeed in an
ever
more dynamic world.
Wolters Kluwer has 2009 annual revenues of €3.4 billion ($4.8 billion),
employs approximately
19,300 people worldwide, and maintains operations in
over 40 countries across Europe, North
America, Asia Pacific, and Latin
America. Wolters Kluwer is headquartered in Alphen aan den Rijn,
the
Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included
in the AEX
and Euronext 100 indices.
June 19, 2010 - Post-surgery lymphedema often goes untreated -
Massage technique can help reduce hand swelling
Lymphedema is a physical and emotional problem for many post-surgery cancer
patients, "and all
too often not diagnosed," says Canadian lymphedema expert
Dr. Anna Towers.
"People go to emergency with a skin infection or ulcer and they are treated
for that, but not for the
underlying cause, which is severe swelling
lymphedema," says the McGill University professor.
She visited Victoria recently to talk about lymphedema, a fluid-retention
condition that can affect
anyone who has had radiation or surgery involving
lymph nodes.
Towers is founding chairwoman of the newly formed Canadian Lymphedema
Framework, which
seeks to raise the profile and treatment of this
condition.
Lymph is a fluid, found between the body's cells, that is carried by the
lymphatic system through
nodes. Unlike blood, it has no central pump, but
moves due to muscle action. Under ideal conditions,
the fluid feeds cells
and carries away excess waste and cancer cells, says the palliative care
physician.
But when damaged, the system doesn't drain well and any inflammation causes
even more to build
up. "We're doing a large Canadian study now
following women who've had breast cancer. We're
only halfway through; the
study goes from 2005 to 2015, and already we're showing 17 per cent
have
lymphedema. "It can appear immediately after treatment or years later,
after an injury - a
suntan, an infection from an insect sting, even air
travel," Towers says. "Inflammation exacerbates the
problem."
Untreated, lymphedema can lead to disability, loss of function, job loss and
early death.
Forty per cent of patients with the condition develop complications ranging
from infection to blood
clots, says Towers, associate professor in McGill's
oncology department and former director of its
palliative care division. She
is advocating across the country for better research, care and medical
coverage.
About 25,000 new cases occur in B.C. every year, mostly following surgeries
for breast, prostate,
colorectal, gynecological or melanoma cancers. (The
condition can also be genetic.)
Once lymphedema develops, the preferred treatment is hands-on, decongestive
massage to softly
guide lymph in the right direction, to reduce swelling and
improve function. A compression garment
or bandage is worn for
maintenance.
Robert Harris operates the Dr. Vodder clinic here, which trains therapists in
the massage. "It's very
light, gentle, rhythmic, and stimulates the lymph
vessels to pump," he says. "Patients love it," and
frequent massage can
bring a limb down 40 to 50 per cent in a month, which also lowers infection
risk.
"The therapy is life-changing but its success depends on how soon it
happens." One hour costs about
$85. The medical services plan picks up $23,
while some extended-health plans pay more.
A 60-year-old woman, who asked not to be identified, had a recent lumpectomy
and developed
swelling in her hand, arm and breast. "It was like an
overfilled balloon. I couldn't close my fist, get
my rings off. But after
about six treatments the therapist got my breast draining and my hand
working.
"I tried to get physio at the cancer clinic, but was told it would be up to
six week. I didn't want to
wait because it was getting bigger and bigger.
This therapy is wonderful."
Combined decongestive therapist Beth Atkinson took the Dr. Vodder lymph
drainage course and
works at Vitality Treatment Centre in Oak Bay, with
others trained in the specialty. There are eight in
the city. "We
cover seven days a week, because when a person comes in with a severe problem,
there's an intense phase before maintenance can begin. We might see them
three, four times a week,
for three weeks. "A patient might have a leg
that weighs twice what's normal. Even after massage,
there's tremendous
difference. People get off the table and say: Wow, I can bend my knee.' (Excess
water is eliminated through waste.)" She adds lymph drainage is useful
for other inflammatory
conditions, too, and patients can learn to do it
themselves.
Towers says the therapy should be covered by provincial medical plans, but
blamed lack of
leadership. Health policy favours prevention and treatment -
"as it should" - but that leaves less for
followup care, she says.
Because the treatment is not pharmacological, "we don't have the benefit of
pharmaceutical firms' resources to help advocate." In addition, many
problems appear years after the
cancer management ends.
The B.C. Cancer Agency recommends patients contact the Dr. Vodder school - www.vodderschool.
com or at 250-598-9862
for combined decongestive therapy. It's not available in hospitals, which
use compression pumps instead.
June 25, 2010 - Cancer centers revitalize survivors - By Helena Oliviero
-
For almost five months, Priscilla Tomlinson’s life revolved around regular
trips to the basement of
Piedmont Hospital. There, on every third Tuesday,
she underwent chemotherapy sessions lasting
almost eight hours to battle
ovarian cancer.
After each session, she went into her backyard and lit a bouquet of dried
sage, letting it waft over her
like incense. Two days later, a flu-like wave
would smash her to her core. Slowly, she would begin
to feel better. And
then it was time for the next Tuesday chemo date at Piedmont.
Then suddenly, in January 2007, her cancer treatments were done. She would
require checkups and
medication, but she was no longer a cancer patient.
Yet, moving forward was difficult, and she found herself returning to
Piedmont, again and again. But
no longer to the basement. Now she takes the
elevator to the 7th floor, to Piedmont’s Cancer
Wellness Center.
There, Tomlinson takes African drumming classes. She molds clay into pinch
pots. She jots down
her thoughts in an “expressive arts room.” She
participates in food demonstrations. She meditates
and meets with
therapists.
Tomlinson is among a growing number of cancer patients who are looking to
cancer centers for help
in making the transition to life as a survivor. And
more cancer centers are offering post-treatment
options.
Yoga, massage therapy and mind-body studios are becoming mainstream as
medical facilities extend
the traditional boundaries of health care. It
allows them to maintain relationships with the patients, as
well as meet
patient demands for more complementary and alternative approaches to
wellness.
“It helps me deal with the anxiety of scans and helps me stay in the
present,” said Tomlinson, 70,
who lives in Decatur. “It helps me from not
running stories in my mind thinking of all of the bad things
that can
happen. This helps me live my life.”
Seeking help
Cancer survivors are living longer and healthier lives. The chance of
surviving most cancer has been
steadily rising. For example, the 5-year
survival rate for breast cancer is now 90 percent, up from 75
percent in the
mid-to-late 1970s, according to the National Cancer Institute.
Still, fighting a deadly disease can leave survivors feeling battered and
confused, and struggling to find
their way. From soreness and scars to being
emotionally shaken, survivors often need help grappling
with everything from
depression and fatigue to body image concerns and relationship woes.
At the same time, Americans overall are increasingly looking outside
traditional medicine for their
health care needs.
About a third of Americans are using at least one form of what’s referred to
as “complementary or
alternative medicine.”
When megavitamins and prayer are included in this definition, the percentage
rises to 62 percent,
according to the National Institutes of Health.
Americans spend $34 billion annually in out-of-pocket
expenses on
complementary and alternative approaches, according to a 2009 analysis by the
Centers for Disease Control and Prevention.
Several smaller studies of cancer patients suggest many of them are seeking
alternative care. A study
published in the 2000 issue of the Journal of
Oncology found 69 percent of 453 cancer patients
turned to some aspect of
alternative care as part of their cancer treatment. A more recent study
published in a December 2004 issue of the Journal found 88 percent of 102
cancer patients enrolled
in a research study turned to CAM therapy, which
can include vitamins or minerals and acupuncture.
Filling a void
Dr. Perry Ballard, an oncologist at Piedmont since 1987, said he used to be
skeptical of
nontraditional care but now embraces its role in helping a
person get better.
“Life is never the same after you have cancer, and it goes beyond having the
most cutting-edge
therapies,” said Ballard. “You have to heal yourself
psychologically and spiritually. We are learning
more and more about the
mind-body connection.”
As a doctor seeing as many as 25 patients a day, Ballard said he hears a wide
range of emotional
aches and pains: a young woman who’s been prematurely
thrust into menopause because of a
mastectomy; a man losing sexual function;
young singles wondering if they will ever get married.
Complementary care, he said, helps fill the void of what traditional medicine
can do. And patients
addressing emotional and physical needs are better
patients — they are more likely to keep
appointments and stay on top of
their treatments.
Erika Baube, a licensed social worker at Georgia Cancer Specialists, said the
majority of her clients
seek counseling after they complete treatment.
During the treatment stage, patients are intently focused on doctors’
appointments, chemotherapy
and other all-consuming medical needs. Once that
intense routine ends, many emotions bubble up.
“There’s this emotional letdown at the end of treatment,” said Baube. “They
have been so focused
on getting through the treatment, and then it’s, ‘Now
what?’ They are finally allowing themselves to
feel the fear.”
Feeling up to par
After surgery and undergoing several rounds of radiation in 2007, Alice
Stubblefield turned to
Turning Point in Alpharetta, a nonprofit resource for
women with breast cancer offering physical
therapy, massage, counseling and
other services.
Stubblefield couldn’t shake lingering soreness and lymphedema, an
accumulation of fluid that
sometimes builds up and causes swelling after
cancer treatment. She also worried about her body
image, concerned about her
husband’s reaction to the mastectomy.
“I know my husband is here for me and still loves me, but the women there
helped me work through
the process and really accept myself,” said
Stubblefield.
Going to Turning Point also encouraged her to set goals. Among them: To play
golf with her husband
again.
For the longest time after her cancer, she had no interest in picking up a
set of clubs. Over time, her
outlook on life brightened. She and her husband
are golfing together again.
“Not only do you want to do more things, but it’s not the end of the world,”
she said. ‘What do I do
now?’
For Ned Crystal, who is 36, launching a new support group helped re-energize
him after his cancer
treatments. “We have been going through this
ritual of doctors and restrictive diet and you have this
moment of clarity
that gets clouded again.
What is a normal life and what do I do now? How do I go through a transition
of getting back to the
grindstone of work?” said Crystal, who was diagnosed
with sarcoma, a rare form of cancer
developing in the soft tissues of the
body, after suffering a knee injury three years ago. “They are
calling me a survivor and saying I am in the clear now. ... It’s frightening
and it’s unnerving” said
Crystal, who lives in Smyrna with his wife.
Crystal, who underwent treatment at Emory University’s Winship Cancer Center,
joined a steering
committee to help design a new program for cancer
survivors, including a peer-to-peer program
matching newly diagnosed cancer
patients with survivors. He’s also founded a new sarcoma support
group,
believed to be the first in Atlanta.
“According to the statistics, there is a 95 percent chance I’m not going to
make it five years. You can
fold up the tent and go home or make a
difference. ... For me, getting involved has renewed my
passion.” ‘I really needed this’
On a recent afternoon, Priscilla Tomlinson closes her eyes and taps on an
African drum. Then her
eyes spring open and she begins pounding
the instrument — boom, boom, boom! She releases
nervous energy. She releases
anxiety.
All of the participants in this class are cancer survivors. The chemotherapy,
the radiation, the surgery
is behind them. Yet, they all wrestle with the
fear it may one day return.
Harriet Sims, 40, is among those in this class. Dripping in sweat and
tearful, she smiles. Sims was
diagnosed two years ago with multiple myeloma,
a blood cancer. She underwent a stem-cell
treatment a year and a half ago.
She will get a follow-up biopsy during the coming days to see if the
cancer
has been kept at bay, “I can’t tell you how much I needed this,”
said Sims. “I come here
and it makes me feel good.”
Tomlinson gives her a hug.
As the class comes to a close, they sing together: “I’m a tower of strength
within and without, I am a
tower of strength within. All my fears slip away,
slip away, all my fears slip away.”
June 25, 2010 - CDP treatment can reduce pain and swelling in CVI patients
-
For patients with painful swelling of the legs caused by chronic venous
insufficiency (CVI), a
combination treatment approach called "complete
decongestive physiotherapy" improves symptoms,
walking ability, and quality
of life, reports a study in Topics in Geriatric Rehabilitation. The journal is
published by Lippincott Williams & Wilkins, a part of Wolters Kluwer
Health, a leading provider of
information and business intelligence for
students, professionals, and institutions in medicine, nursing,
allied
health, and pharmacy.
Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce
leg swelling and
pain in patients with CVI, according to the new study, led
by Yesim Bakar, Ph.D., P.T., of Abant
Izzet Baysal University in Bolu,
Turkey. Another paper in the same issue of TGR shows similar
benefits of CDP
in a patient with lymphatic obstruction (lymphedema) related to the skin
condition
psoriasis.
Complete Decongestive Physiotherapy Brings Good Results
Dr Bakar and coauthors evaluated the effects of CDP in 62 older adults
(average age 65 years) with
CVI. Patients with CVI have poor blood flow in
the veins of the leg, leading to fluid buildup. This
results in painful
swelling, making it difficult for patients to walk and perform other activities.
Usually
only one leg is affected.
All patients were treated using the CDP approach, which combines four types
of physical therapy
treatments:
•Manual lymph drainage—massage to promote drainage of the lymph
nodes.
•Skin care—moisturizers and other treatments for skin changes caused
by poor circulation.
•Compression—bandages are applied to prevent fluid from
reaccumulating.
•Exercise—simple leg exercises to improve blood flow and leg
motion.
For the first month, patients met with a physical therapist five days a week
for treatment. They also
received education in performing each of the four
types of therapy for themselves. The goal was to
keep fluid buildup under
control through lifelong, daily self-care.
The CDP treatment program dramatically reduced leg swelling—on average, fluid
buildup in the
affected leg decreased by the equivalent of nearly half a
liter. Pain was also decreased, from an
average score of 67 to 18 on a
100-point scale. Patients had improved walking ability, less pain
when
walking, and improved ability to perform daily activities. The authors believe
that including
exercise in the treatment program was a key factor in
improving walking ability.
Dr. Bakar is also a co-author of the other paper, which reports on the use of
CDP in a woman with
lymphedema related to the chronic skin condition
psoriasis. In patients with lymphedema, obstruction
of the lymph nodes
causes similar symptoms of leg pain and swelling. In both the short and long
term,
CDP brought significant improvement in pain, swelling, and
activity.
In recent years, CDP has become an accepted approach to treatment for
lymphedema. Although not
a cure, CDP incorporates several physical therapy
techniques that can help keep fluid buildup, leg
swelling, and pain under
control.
The new studies are the first to evaluate the fully integrated CDP
approach—including daily home
maintenance therapy—in patients with CVI and
psoriasis-related lymphedema. "CDP is a time-
consuming process for patients
and physiotherapists," Dr. Bakar and colleagues write. "However, it
is
widely used and an effective treatment for patients with lymphedema." The new
results suggest that
this combination physical therapy approach could also
be very helpful for patients with leg pain and
swelling caused by CVI.
June 26, 2010 - This is Now Considered a Critical Piece of Cancer
Treatment…-
The research of Dr. Kathryn Schmitz, which had already research reversed
decades of cautionary
exercise advice given to breast cancer patients with
lymphedema, led an expert panel to developed
the new recommendations.
According to Eurekalert:
"Cancer patients and survivors should strive to get the same 150 minutes per
week of moderate-
intensity aerobic exercise that is recommended for the
general public ... Though the evidence
indicates that most types of physical
activity -- from swimming to yoga to strength training -- are
beneficial for
cancer patients, clinicians should tailor exercise recommendations to individual
patients".
Sources: Science Daily June 1, 2010
Dr. Mercola's Comments:
As little as a decade ago, it was common for physicians to advise their heart
attack patients to avoid
exercise for fear that they could stress out their
heart and trigger a second attack.
Now, it's common knowledge that exercise is a phenomenal way to strengthen
your heart after a
heart attack as well as lessen your risk of further
problems, and regular exercise is routinely
recommended to heart
patients.
For cancer patients, this trend is still in the beginning stages, with many
practitioners advising their
patients to avoid exercise during and after
cancer treatment. But increasing evidence is showing that
this outdated
advice is actually causing cancer patients harm, as regular exercise can lead to
a
number of health improvements for cancer patients, including:
· Better aerobic fitness
· Increased muscular
strength
· Improved quality of
life
· Less fatigue
Exercise Improves Cancer Survival
I've written a lot about how exercise can help to reduce your risk of cancer
in the first place, but
does it do any good if you're already fighting
cancer? Yes … a lot.
Harvard Medical School researchers found patients who exercise moderately --
3-5 hours a week
-- reduce their odds of dying from breast cancer by about
half as compared to sedentary women. In
fact, any amount of weekly exercise
increased a patient's odds of surviving breast cancer. This
benefit also
remained constant regardless of whether women were diagnosed early on or after
their
cancer had spread.
Patients receiving the biggest boost from exercise were those most sensitive
to estrogen, the most
common form of breast cancer. (Previous research has
shown exercise lowers estrogen levels, which
can fuel the growth of breast
cancer cells.)
Think about it. If just three to five hours of walking per week can so
drastically improve your
chances of surviving a hormone-responsive breast
cancer tumor, imagine what a few more hours a
week of exercise could do for
you.
If you're male, be aware that athletes have lower levels of circulating
testosterone than non-athletes,
and similar to the association between
estrogen levels and breast cancer in women, testosterone is
known to
influence the development of prostate cancer in men.
Physical activity can reduce your risk and boost your chances of recovery if
you have cancer.
Exercise is a Potent Cancer Fighter
Cancer thrives on sugar, but regular exercise reduces your insulin levels,
which creates a low sugar
environment that discourages the growth and spread
of cancer cells. Controlling your insulin levels is
one of the most powerful
steps you can take to reduce your cancer risk and help keep it from
returning.
Physically active adults experience about half the incidence of colon cancer
as their sedentary
counterparts. Exercise has a beneficial influence on
insulin, prostaglandins and bile acids, all of which
are thought to
encourage the growth and spread of cancer cells in your colon. Exercise also
improves
bowel transit time, which means your body's waste is spending less
time in contact with the mucosal
lining of your colon.
Exercise also improves the circulation of immune cells in your blood. The job
of these cells is to
neutralize pathogens throughout your body.
The better these cells circulate, the more efficient your immune system is at
locating and defending
against viruses and diseases, including cancer,
trying to attack your body.
It's also been suggested that apoptosis (programmed cell death) is triggered
by exercise, causing
cancer cells to die. So you can see why a regular
exercise program is important not only during any
treatment you're receiving
but also afterward as well.
Exercise Tips for Cancer Patients
I would also strongly recommend that you read the lead article in today's
newsletter that reviews
some of the newest insights on how to optimize your
exercise program and actually reduce your
exercise time and improve your
benefits.
You will need to tailor your exercise routine to your individual scenario,
taking into account your
stamina and current health. Often, you will be able
to take part in a regular exercise program -- one
that involves a variety of
exercises like strength training, core-building, stretching, aerobic and
anaerobic -- with very little changes necessary.
However, you may find that you need to exercise at a lower intensity or for
shorter durations at
times. Always listen to your body and if you feel you
need a break, take time to rest. Even exercising
for a few minutes a day is
better than not exercising at all, and you'll likely find that your stamina
increases and you're able to complete more challenging workouts with each
passing day.
In the event you are suffering from a very weakened immune system, you may
want to exercise in
your home instead of visiting a public gym. But remember
that exercise will ultimately help to boost
your immune system, so it's very
important to continue with your program.
June 28, 2010 - HFM offers programming for cancer patients - Lakeshore health
briefs -
MANITOWOC — The Holy Family Memorial Wellness Center is offering individual
programming
for cancer patients.
Among the benefits: reduced pain and fatigue associated with cancer and
treatments; prevention,
identification and management of lymphedema;
increased treatment tolerance; and return to pre-
treatment levels of
strength and fitness.
Wellness Center coordinator Melissa Sperbeck, recently certified as a cancer
exercise specialist, will
meet with patients for a free consultation and
discuss individual programming unique to each client
and illness. Funding
for program participation is available through the Carol Rose Wester Fund.
For information, or to schedule a free consultation, call Sperbeck at (920)
320-4620.
Personal yoga instruction offered
MANITOWOC — The Holy Family Memorial Wellness Center is offering personal
yoga instruction.
Wellness Center yoga instructor Corinne Knab has more than 30 years of yoga
experience, and will
be studying this summer to earn certification as a yoga
therapist.
Each session will begin with an assessment of how the individual is feeling,
both physically and
emotionally. Based on the assessment, Knab will
determine which breathing practices, poses and
meditation techniques to lead
the participant through.
For information, call (920) 320-4600.
HFM Laboratory receives reaccreditation
MANITOWOC — Holy Family Memorial Laboratory has been awarded
reaccreditation by the
Accreditation Committee of the College of American
Pathologists (CAP), based on the results of a
recent onsite inspection. The
reaccreditation includes the laboratories at Holy Family Memorial
Medical
Center, Woodland Clinic and Harbor Town Campus.
The CAP Laboratory Accreditation Program, started in the early 1960s, is
recognized by the federal
government as being equal to, or more strict than
the government's own inspection program, an
HFM news release said.
During the CAP accreditation process, inspectors examine the laboratory's
records and quality of
procedures for the previous two years. Inspectors
also examine laboratory staff qualifications, as well
as the laboratory's
equipment, facilities, safety program and record, in addition to the overall
management of the lab.
HFM offers free classes, screenings
MANITOWOC — Holy Family Memorial's Health Resource Center, 2300 Western
Ave., offers
the following:
A free, one-hour class on the basics of how to search the Internet for health
information is open to
the public on a one-on-one basis by appointment
between 8 a.m. to 4 p.m. Monday through Friday.
To make an appointment, call
(920) 320-2519.
A variety of health related books, videos and DVDs , a computer with Internet
access,
knowledgeable staff and information on HFM physicians, programs and
services is available to the
public during the above hours.
Free blood pressure screenings will be offered from 1 to 3 p.m. July 6 and 20
and from 9 to 11 a.m.
July 8 and 22. Walk-ins are welcome.
A cholesterol and blood sugar screening will be offered from 6:30 to 10 a.m.
July 15. To schedule an
appointment, call (920) 320-6777.
June 28th, 2010 - More exercise prescribed for cancer survivors, even
before they finish therapy –
WASHINGTON - New guidelines urge cancer survivors to exercise more, even,
difficult as it may
sound, those who have not yet finished their
treatment.
There Is growing evidence that physical activity improves quality of life and
eases some cancer-
related fatigue. More, it can help fend off a serious
decline in physical function that can last long after
therapy is
finished.
Consider: In one year, women who needed chemotherapy for their breast cancer
can see a swapping
of muscle for fat that is equivalent to 10 years of
normal aging, says Dr. Wendy Demark-Wahnefried
of the University of Alabama
at Birmingham.
In other words, a 45-year-old may find herself with the fatter, weaker body
type of a 55-year-old.
Scientists have long advised that being overweight and sedentary increases
the risk for various
cancers. Among the nearly 12 million U.S. cancer
survivors, there are hints — although not yet proof
— that people who are
more active may lower risk of a recurrence. Like everyone who ages, the
longer cancer survivors live, the higher their risk for heart disease that
exercise definitely fights.
The American College of Sports Medicine convened a panel of cancer and
exercise specialists to
evaluate the evidence. Guidelines issued this month
advise cancer survivors to aim for the same
amount of exercise as
recommended for the average person: about 2½ hours a week.
Patients still in treatment may not feel up to that much, the guidelines
acknowledge, but should avoid
inactivity on their good days.
"You don't have to be Lance Armstrong," stresses Dr. Julia Rowland of the
National Cancer
Institute, speaking from a survivorship meeting this month
that highlighted exercise research. "Walk
the dog, play a little golf."
But how much exercise is needed? And what kind? Innovative new studies are
under way to start
answering those questions, including:
—Oregon Health and Science University is training prostate cancer survivors
to exercise with their
wives. The study will enrol 66 couples, comparing
those given twice-a-week muscle-strengthening
exercises with pairs who do
not get active.
Researchers think exercising together may help both partners stick with it.
They also are testing
whether the shared activity improves both physical
functioning and eases the strain that cancer puts
on the caregiver and the
marriage.
"It has the potential to have not just physical benefits but emotional
benefits, too," says lead
researcher Dr. Kerri Winters-Stone.
—Demark-Wahnefried led a recent study of 641 overweight breast cancer
survivors that found at-
home exercises with some muscle-strengthening, plus
a better diet, could slow physical decline.
—Duke University is recruiting 160 lung cancer patients to test whether
three-times-a-week aerobic
exercise, strength training or both could improve
their fitness after surgery. Lung cancer has long
been thought beyond the
reach of exercise benefits because it so often is diagnosed at late stages.
Duke's Dr. Lee Jones notes that thousands who are caught in time to remove
the lung tumour do
survive about five years, and he suspects that fitness,
measured by how well their bodies use oxygen,
plays a role.
People with cancer usually get less active as symptoms or treatments make
them feel lousy. Plus,
certain therapies can weaken muscles, bones, even the
heart. Not that long ago, doctors advised
taking it easy.
Not anymore: Be as active as you are able, says Dr. Kathryn Schmitz of the
University of
Pennsylvania, lead author of the new guidelines.
"Absolutely it's as simple as getting up off the couch
and walking," she
says.
Exercise programs are beginning to target cancer survivors, like Livestrong
at the YMCA, a
partnership with cycling great and cancer survivor
Armstrong's foundation. The American College of
Sports Medicine now
certifies fitness trainers who specialize in cancer survivors.
Still, anyone starting more vigorous activity for the first time or who has
particular risks, like the
painful arm swelling called lymphedema that some
breast cancer survivors experience, may need
more specialized exercise
advice, Schmitz says. They should discuss physical therapy with their
oncologist, she advises. For example, Schmitz led a major study that
found careful weight training
can protect against lymphedema, reversing
years of advice to coddle the at-risk arm. But the
average
fitness trainer does not know how to offer that special training safely, she
cautions.
Mary Lou Galantino of Wilmington, Delaware, is a physical therapist who
specializes in cancer care
and kept exercising when her own breast cancer
was diagnosed at the University of Pennsylvania in
2003. Then 42, she says
she was on the treadmill within 24 hours of each chemo session, to stay fit
enough to care for her two preschoolers. "You can feel more energy"
with the right exercise, says
Galantino, a physical therapy professor at the
Richard Stockton College of New Jersey. "I was
giving my body up to the
surgeons and chemo, but I could take my body back through yoga and
aerobic
exercise."
June 29, 2010 - Recurrent furunculosis as a cause of isolated penile
lymphedema: a case report - Ali
AlshahamSuneet Sood -
IntroductionIsolated lymphedema of the penis is extremely rare: combined
involvement of the
scrotum and penis is the norm. Furunculosis as a cause is
not, to our knowledge, previously reported.
We present a case of isolated penile lymphedema that responded to excision of
lymphedematous
tissue and reconstruction with flaps.Case presentationA
32-year-old Arab man presented with a
three-year history of a gradually
increasing, painless penile swelling. Our patient's main complaint was
non-erectile sexual dysfunction.
The swelling was preceded by at least three prior episodes of severe
furunculosis at the penile root.
He had no other contributory past medical
or family history.
On examination there was gross penile enlargement, maximally at the mid
shaft, associated with
thickened skin at the sites of prior furunculosis.
The glans and scrotum were normal.
Both testes were palpable. Serology for filariasis, and urinary tract
ultrasound and computed
tomography scan were normal.
The clinical diagnosis was lymphedema following recurrent penile
furunculosis. At operation the
lymphedematous tissues were removed.
Closure of the penile shaft was accomplished by bilateral advancement of
flaps from both ends of the
penis. He resumed normal sexual activity one
month after surgery.
At 12 months, he had a good cosmetic result, with no signs of recurrence.
Conclusions: Furunculosis at the penile root may result in lymphedema
confined to the penile shaft,
sparing the scrotum. Excision of abnormal
tissue and cover with a skin flap gave excellent cosmetic
results, and
allowed satisfactory sexual activity.
June 29, 2010 - What's the Big Idea? Inaugural Conference Aims to Find out -
By Joan Delaney -
Just as the G8 and G20 summits have wound up in Ontario, a conference of a
very different kind is
being planned on the other side of the country in
Victoria.
Called IdeaWave, the aim of conference is to bring innovative thinkers
together to brainstorm a wide
range of issues, from sewage treatment and
drug prohibition to health and public transit.
The two-day conference will feature 50 short talks on any topic the speaker
desires, giving critical
thinkers from the Pacific Northwest a forum to
explore issues that affect both their immediate region
and further
afield.
“There’s a lot of critical thinkers out there who are meeting regularly,
talking about ideas informally,
and so I just thought, ‘What would it take
to get all of those people together in a room?’ To me,
having 200 critical
thinkers in a room is quite exciting,” says event organizer Kris Constable.
Constable believes his conference is the first ever to keep the talks to 10
minutes with no limit on the
subject matter. Established ideas conferences
that take place annually in Vancouver and California
cost between $3,000 and
$7,000 to participate, he adds.
“I, like most North Americans, can’t afford to attend such a thing. So this
is kind of my answer to
that. I'm going to make this the first approachable
ideas conference ever. We've got both speakers
and attendees coming from
Washington State and all over B.C.”
Limiting the talks to 10 minutes keeps them from becoming boring and “cuts
right to the meat” of the
topic, he says.
“It separates the wheat from the chaff essentially. You've got 10 minutes to
make sure that you’ve
clearly articulated your idea in the best way that you
can. With 10 minutes you're concentrating your
talk to be as effective as
possible.”
Frank Heidt, a chief executive officer with a company in Seattle, will talk
about expanding on the
idea of transforming abandoned shipping containers
into housing. There are about three million
unused shipping containers in
the Pacific Rim because it’s cheaper for companies to leave them there
than
return them to their country of origin empty or partially filled, according to
Heidt.
His talk will be about using these shipping containers as lending libraries
of hand tools, enabling
people in developing countries to “build their own
future.”
Margaret Pulton, a nurse from B.C., will explore using technology to create
clothing as a treatment
for Lymphedema, while Clem Persaud, a professor of
biotechnology, will devote his 10 minutes to
how we can positively impact
our lives by influencing the expression of our genes.
As well as airing their ideas, there will also be a chance for both speakers
and attendees to mingle
and network.
“If your idea’s good enough that other people are excited, they're going to
go ahead and talk to you
and hopefully get a few people helping you make
your idea happen,” says Constable.
“These are the people who are kind of the thinkers and the doers in one.”
Being still a few shy of the required 50 speakers, Constable is looking for
more people to submit
their proposals. The conference will take place July
10 and 11 at the Ambrosia Centre in downtown
Victoria.
June 29, 2010 - Community-based education strengthens campaign for
elimination of lymphatic
filariasis - Joseph Quimby
Community-based lymphatic filariasis education in Orissa State, India,
increased treatment
compliance from around 50% to up to 90%, according to a
study published June 29 in the open-
access journal PLoS Neglected Tropical
Diseases. In their study, researchers from the U.S. Centers
for Disease
Control and Prevention, in partnership with the Church's Auxiliary for Social
Action, an
India-based non-governmental organization, and IMA World Health,
a US-based non-governmental
organization, identified barriers to compliance
with India's MDA program for LF, and suggest that
timely educational and
lymphedema management programs can reverse this trend.
Nearly 1.3 billion people worldwide live at risk of infection with the
parasite that causes lymphatic
filariasis. Infected individuals may develop
long-term complications, such as grossly swollen limbs
from lymphedema.
Elimination of this disease of poverty requires giving drugs at least once per
year
to people who are at risk; of that population, 80% or more need to
continue receiving medication on
an annual basis for 5 or more years to stop
transmission.
The authors evaluated a community-based education campaign, noted
deficiencies, and designed
interventions to correct them. An evaluation of
the revised education program, covering over 8,000
people in ninety
villages, showed markedly improved drug compliance and, for the first time,
showed
that lymphedema management programs, which teach leg care to patients
with swollen legs, may also
increase compliance with lymphatic filariasis
mass drug administration programs. The increase was
greatest in areas that
had implemented U.S. Agency for International Development-supported
programs
to teach people how to care for legs swollen from infection.
This evaluation was confined to rural areas in Orissa State, so the findings
do not necessarily apply to
urban areas or areas outside the state.
Nonetheless, lymphatic filariasis elimination programs facing
difficulties
in achieving the necessary level of drug compliance should consider evaluating
their
education campaigns using similar methods and integrating lymphedema
management with lymphatic
filariasis elimination efforts, the authors
say.
FINANCIAL DISCLOSURE: Funding for this work was provided by USAID
(GHA-G-00-03-
0005-00) to IMA World Health and by CDC (IAA GHH99-006). The
funders had no role in study
design, data collection and analysis, decision
to publish, or preparation of the manucript.
COMPETING INTERESTS: The authors have declared that no competing interests
exist
PLEASE ADD THIS LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF
YOUR
REPORT: http://dx.plos.org/10.1371/journal.pntd.0000728
CITATION: Cantey PT, Rout J, Rao G, Williamson J, Fox LM (2010) Increasing
Compliance with
Mass Drug Administration Programs for Lymphatic Filariasis
in India through Education and
Lymphedema Management Programs. PLoS Negl
Trop Dis 4(6): e728. doi:10.1371/journal.pntd.
0000728
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June 29, 2010 - Lymphedema treatment options -
Chronic lymphedema often turns into cellulitis in patients with diabetes.
What is the preferred
treatment?—PAULA JAUERING, ARNP, Leavenworth, Kan.
The diagnosis of lymphedema is usually made based on clinical presentation
and history. Imaging
studies may also be used for diagnosis and evaluation
of treatment; lymphoscintigraphy is considered
the gold standard. Duplex
ultrasound, CT, and MRI may also be used. Conservative physiotherapy
treatments include complex or complete decongestive therapy (which
incorporates manual lymphatic
drainage, compression bandages,
myolymphokinetic exercises, skin care, and precautions during
daily
activities) and pneumatic compression, also referred to as pressure therapy.
Pneumatic
compression utilizes a segmental air pump to fill air chambers
(gloves or boots) that provide pressure
to the edematous limb. Newer
techniques include high-voltage electrical stimulation (which reduces
lymphedema by producing muscle contractions and relaxation that increase
venous and lymphatic
flow) and laser therapy (which reduces fibosis and
stimulates lymphangiogenesis, lymph activity,
lymphatic movement,
macrophages, and the immune system). Surgical therapies for patients in whom
conservative therapy was not effective may include resection procedures,
microsurgical interventions,
and liposuction.
For more information, see Rev Lat Am Enfermagem. 2009;17:730-736 and Ann
Plast Surg. 2007;
59:464-472.—Philip R. Cohen, MD
June 30, 2010 - People and Places: Carroll Hospital foundation
disperses funds to nonprofits -
The Carroll Hospital Center Foundation released more than $2.5 million to
support programs and
services at Carroll Hospital Center and Carroll
Hospice.
Jack Tevis, chairman of the Foundation’s Board of Trustees, presented checks
to Mark Blacksten,
chairman of Carroll Hospice’s Board of Directors, and
John Sernulka, FACHE, president and CEO
of Carroll Hospital Center.
The donation represents proceeds accumulated from the foundation’s various
fundraising efforts for
the hospital and Carroll Hospice throughout the
year. The funds will be used to support a variety of
capital programs
including adding a new cardiovascular lab, renovating the emergency department’s
triage area as well as the waiting room in The Family Birthplace and
creating a dedicated orthopaedic
unit on the third floor of the
hospital.
In addition, the gifts will enhance many programs provided by the hospital
including the navigation
and lymphedema services at The Women’s Place and
Breast Center. It also will provide educational
support to staff such as
those offered through the Libman Nursing Scholarship and the College
Scholarship for Dependants of Associates.
People and Places and New Business briefs offer information about Carroll
County-based
companies, employees and their operations, and news of awards,
promotions, new business
openings, new hires, etc. To have your information
included, send your typed, double-spaced press
release to Business Briefs,
Carroll County Times, P.O. Box 346, Westminster, MD 21158..
Information must
reach this office within four weeks after an event.
Pub Med doc 1 (3):
Am J Med. 2010 Jun;123(6):489-95.
Caring for the breast cancer survivor: a guide for primary care
physicians.
Chalasani P, Downey L, Stopeck AT.
Arizona Cancer Center, University of Arizona, Tucson, AZ 85724-5024, USA. pchalasani@azcc.
arizona.edu
Abstract
Breast cancer accounts for more than 25% of cancers in women. Because of
improved screening
and treatment modalities, mortality has decreased
significantly. Currently, over 2.5 million breast
cancer survivors live in
the US and receive care from a primary care provider. Providers need to be
aware of common and serious complications of breast cancer treatment. In
this review we discuss
complications of local and systemic treatment for
breast cancer, including lymphedema, osteoporosis,
cardiovascular disease,
and vasomotor symptoms. Current strategies for screening, monitoring, and
treating these complications also are outlined. Copyright 2010. Published by
Elsevier Inc.
PMID: 20569749 [PubMed - in process]
Cancer. 2010 Apr 29. [Epub ahead of print]
A prospective cohort study defining utilities using time trade-offs and the
Euroqol-5D to assess the
impact of cancer-related lymphedema.
Cheville AL, Almoza M, Courmier JN, Basford JR.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester,
Minnesota.
Abstract
BACKGROUND:: The devastating impact of lymphedema on cancer survivors'
quality of life has
prompted consideration of several changes in medical and
surgical care. Unfortunately, our
understanding of the benefits gained from
these approaches relative to their cost remains limited. This
study was
designed to estimate utilities for lymphedema and characterize how utilities
differ between
subgroups defined by lymphedema etiology and
distribution.
METHODS:: A consecutive sample of 236 subjects with lymphedema seen at a
lymphedema clinic
completed both a time trade-off (TTO) exercise and the
Euroqol 5D. Responses were adjusted in
multivariate regression models for
demographic factors, comorbidities, and lymphedema
severity/location.
RESULTS:: Most participants (167 of 236, 71%) had lymphedema as a consequence
of cancer
treatment; 123 with breast cancer and upper extremity involvement.
Mean TTO utility estimates were
consistently higher than Euroqol 5D
estimates. Unadjusted TTO (0.85; standard deviation [SD],
0.21) and Euroqol
5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and
patient body mass index (BMI). Adjusted utility scores were lowest in
patients with cancer-related
lower extremity lymphedema (TTO = 0.82; SD,
0.04 and Euroqol 5D = 0.80; SD, 0.03). Breast
cancer patients also had lower
adjusted Euroqol 5D scores (0.80; SD, 0.02).
CONCLUSIONS:: Lymphedema-associated utilities are in the range of 0.80. Lower
utilities are
observed for patients with higher lymphedema stages, elevated
BMI, and cancer-related
lymphedema. Greater expenditures for the prevention
and treatment of cancer-related lymphedema
are warranted. Cancer, 2010. (c)
2010 American Cancer Society.
PMID: 20564063 [PubMed - as supplied by publisher]
Breast. 2010 Jun 17. [Epub ahead of print]
Self-reported arm-lymphedema and functional impairment after breast cancer
treatment - A
nationwide study of prevalence and associated factors.
Gärtner R, Jensen MB, Kronborg L, Ewertz M, Kehlet H, Kroman N.
Department of Breast Surgery, Rigshospitalet 3103, Copenhagen University,
2100 Copenhagen,
Denmark.
Abstract
Lymphedema and impairment of function are well-established sequelae to breast
cancer treatment
and affect an increasing number of women due to continually
improved survival. The aim of the
present nationwide questionnaire study was
to examine the impact of breast cancer treatment on
perceived
swelling/sensation of heaviness (lymphedema) and on function, reporting
prevalence in 12
subgroups of modern treatment and offering estimates for
treatment-related associated factors. 3253
Women (87%) returned the study
questionnaire. Depending on treatment group prevalence of
perceived
swelling/heaviness varied from 13 to 65%. Associated factors were young age,
axillary
lymph node dissection (ALND) and radiotherapy but not type of
breast surgery or use of
chemotherapy. Depending on treatment group 11-44%
had to give up activities. Giving up activities
was associated with pain and
swelling/heaviness, younger age, ALND, chemotherapy, time elapsed
since
surgery, and surgery on the dominant side. Radiotherapy and type of breast
surgery were of no
importance. Copyright © 2010 Elsevier Ltd. All rights
reserved.
PMID: 20561790 [PubMed - as supplied by publisher]
PUB MED DOC 2 (2)
Br J Community Nurs. 2010 Apr;15(4):S18-24.
Manual lymphatic drainage: exploring the history and evidence base.
Williams A.
Edinburgh Napier University. [email protected]
Abstract
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but
there is limited
evidence to guide clinical practice. This paper outlines
the historical background to MLD and
provides insights into the evidence
relating to the effect and efficacy of manual lymph drainage,
highlighting
considerations for lymphoedema practitioners.
PMID: 20559172 [PubMed - in process]
Jpn J Clin Oncol. 2010 Jun 17. [Epub ahead of print]
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of
Lymphoedema in
Palliative Care Patients.
Clemens KE, Jaspers B, Klaschik E, Nieland P.
1Department of Science and Research, Centre for Palliative Medicine,
University of Bonn.
Abstract
OBJECTIVE: Lymphoedema is a common sequela of cancer or its treatment that
affects lymph node
drainage. The physiotherapist, as member of the
multiprofessional team in palliative care, is one of the
keys to successful
rehabilitation and management of patients with cancer and non-malignant
motoneuron disease such as amyotrophic lateral sclerosis and palliative care
needs. The aim of the
study was to evaluate the frequency and effect of
manual lymphatic drainage in palliative care patients
with lymphoedema in a
far advanced stage of their disease.
METHODS: Retrospective study (reflexive control design) of data of the 208
patients admitted to
our palliative care unit from January 2007 to December
2007. Demographic and disease-related
data (diagnosis, symptoms, Karnofsky
performance status and effect of manual lymphatic drainage
interventions)
were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's
test.
RESULTS: Of the 208 patients, 90 who reported symptom load due to lymphoedema
were
included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient
trunk oedema. Mean age
65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index
50% (30-80%), mean length of stay 15.6
+/- 8.0 days. The mean number of
physiotherapeutic treatment interventions was 7.0 +/- 5.8.
Manual lymphatic
drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients
showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in
dyspnoea.
CONCLUSIONS: The majority of the patients showed a clinical improvement in
the intensity of
symptoms after manual lymphatic drainage.
PMID: 20558463 [PubMed - as supplied by publisher]
Pub med doc 3 (1)
Ann Surg Oncol. 2010 Jun 24. [Epub ahead of print]
Morbidity of Sentinel Node Biopsy in Breast Cancer: The Relationship Between
the Number of
Excised Lymph Nodes and Lymphedema.
Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ.
Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer
Center, New York, NY,
USA.
Abstract
BACKGROUND: Despite the reduced morbidity associated with sentinel lymph node
biopsy
(SLNB), lymphedema remains a clinically relevant complication. We
hypothesized that a higher
number of lymph nodes (LNs) removed during SLNB
is associated with a higher risk of lymphedema.
METHODS: Six hundred patients with clinically node-negative breast cancer who
underwent SLNB
were prospectively studied. Circumferential bilateral upper
extremity measurements were performed
preoperatively and at 3-8 years after
surgery. Association of lymphedema with total number of LNs
excised and
other clinicopathologic variables was analyzed by the Spearman rank correlation
coefficient, Fisher's exact test, Wilcoxon rank sum test, and logistic
regression.
RESULTS: At a median follow-up of 5 years, 5% of patients had developed
lymphedema. Factors
associated with lymphedema included weight and body mass
index. There was no association
between the number of LNs removed and the
change in upper extremity measurements or in the
incidence of lymphedema.
Among patients with lymphedema (n = 31) compared to those without,
the mean
(3.9 vs. 4.2), median (4 vs. 3), and range (1-9 vs. 1-17) of number of LNs
removed were
similar (P = 0.93). Among the 33 women with >/=10 LNs
removed, none developed lymphedema.
CONCLUSIONS: In this population of 600 women who underwent SLNB, there is no
correlation
between number of LNs removed and change in upper extremity
circumference or incidence of
lymphedema. These data suggest that other
factors, such as the global disruption of the lymphatic
channels during
axillary lymph node dissection, play a larger role in development of lymphedema
than
does the number of LNs removed.
PMID: 20574774 [PubMed - as supplied by publisher]
PUB MED DOC 4 (11)
Br J Community Nurs. 2010 Apr;15(4):S28-30.
Massage: a helping hand for people with chronic oedema and lymphoedema.
Pyke C.
British Lymphology Society. [email protected]
Abstract
Skin care is fundamental in maintaining the integrity of one's skin and it
has become modern practice
to wash and dry ourselves on a daily basis to
eliminate odour and rejuvenate the skin. What is
becoming more apparent is
that as health professionals we are not transferring this basic act to our
patient's care and this simple form of neglect can be detrimental to your
patient's recovery.
Moreover, when washing with the soapy products that are
available to us, and then drying ourselves
rigorously, we remove our skin's
natural oils thus the skin appears drier and is more susceptible to
damage.
This is where the simple application of a moisturising agent will not only
replace the lost oils,
but it will in fact stimulate the initial lymphatics
lying under your skin. The action of rubbing a cream or
emollient into the
skin is a form of massage, and this simple action will go a very long way
towards
the recovery of skin integrity and in the prevention of harm and
infection. Make this part of your
practice when looking after your patient's
wounds and swollen limbs.
PMID: 20559174 [PubMed - in process]
Br J Community Nurs. 2010 Apr;15(4):S18-24.
Manual lymphatic drainage: exploring the history and evidence base.
Williams A.
Edinburgh Napier University. [email protected]
Abstract
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but
there is limited
evidence to guide clinical practice. This paper outlines
the historical background to MLD and
provides insights into the evidence
relating to the effect and efficacy of manual lymph drainage,
highlighting
considerations for lymphoedema practitioners.
PMID: 20559172 [PubMed - in process]
Br J Community Nurs. 2010 Apr;15(4):S10-6.
Lipoedema: presentation and management.
Todd M.
Specialist Lymphoedema Service, Greater Glasgow & Clyde NHS Trust. [email protected].
uk
Abstract
Lipoedema is a distinct clinical condition characterized by bilateral,
symmetrical enlargement of the
buttocks and lower limbs owing to excess
deposition of subcutaneous fat. It is found almost
exclusively in women. The
common features associated with this condition are 'column- shaped' legs
with sparing of the feet, bruising, sensitivity to pressure, and orthostatic
oedema. The progression to
lipo-lymphoedema or morbid obesity is possible.
Conservative measures used in the management of
lymphoedema can prevent
progression/limit the orthostatic oedema. Surgical procedures may also
play
a part in the management of lipoedema.
PMID: 20559170 [PubMed - in process]
Jpn J Clin Oncol. 2010 Jun 17. [Epub ahead of print]
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of
Lymphoedema in
Palliative Care Patients.
Clemens KE, Jaspers B, Klaschik E, Nieland P.
1Department of Science and Research, Centre for Palliative Medicine,
University of Bonn.
Abstract
OBJECTIVE: Lymphoedema is a common sequela of cancer or its treatment that
affects lymph node
drainage. The physiotherapist, as member of the
multiprofessional team in palliative care, is one of the
keys to successful
rehabilitation and management of patients with cancer and non-malignant
motoneuron disease such as amyotrophic lateral sclerosis and palliative care
needs. The aim of the
study was to evaluate the frequency and effect of
manual lymphatic drainage in palliative care patients
with lymphoedema in a
far advanced stage of their disease.
METHODS: Retrospective study (reflexive control design) of data of the 208
patients admitted to
our palliative care unit from January 2007 to December
2007. Demographic and disease-related
data (diagnosis, symptoms, Karnofsky
performance status and effect of manual lymphatic drainage
interventions)
were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's
test.
RESULTS: Of the 208 patients, 90 who reported symptom load due to lymphoedema
were
included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient
trunk oedema. Mean age
65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index
50% (30-80%), mean length of stay 15.6
+/- 8.0 days. The mean number of
physiotherapeutic treatment interventions was 7.0 +/- 5.8.
Manual lymphatic
drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients
showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in
dyspnoea.
CONCLUSIONS: The majority of the patients showed a clinical improvement in
the intensity of
symptoms after manual lymphatic drainage.
PMID: 20558463 [PubMed - as supplied by publisher]
Cochrane Database Syst Rev. 2010 Jun 16;6:CD005211.
Exercise interventions for upper-limb dysfunction due to breast cancer
treatment.
McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, Mackey J,
Courneya K.
Department of Physical Therapy, University of Alberta, 2-50, Corbett Hall,
Edmonton, Alberta,
Canada, T6G 2G4.
Abstract
BACKGROUND: Upper-limb dysfunction is a commonly reported side effect of
treatment for
breast cancer and may include decreased shoulder range of
motion (the range through which a joint
can be moved) (ROM) and strength,
pain and lymphedema.
OBJECTIVES: To review randomized controlled trials (RCTs) evaluating the
effectiveness of
exercise interventions in preventing, minimi sing, or
improving upper-limb dysfunction due to breast
cancer treatment.
SEARCH STRATEGY: We searched the Specialised Register of the Cochrane Breast
Cancer
Group, MEDLINE, EMBASE, CINAHL, and LILACS (to August 2008);
contacted experts,
handsearched reference lists, conference proceedings,
clinical practice guidelines and other
unpublished literature sources.
SELECTION CRITERIA: RCTs evaluating the effectiveness and safety of exercise
for upper-limb
dysfunction.
DATA COLLECTION AND ANALYSIS: Two authors independently performed the data
abstraction. Investigators were contacted for missing data.
MAIN RESULTS: We included 24 studies involving 2132 participants. Ten of the
24 were
considered of adequate methodological quality.Ten studies examined
the effect of early versus
delayed implementation of post-operative
exercise. Implementing early exercise was more effective
than delayed
exercise in the short term recovery of shoulder flexion ROM (Weighted Mean
Difference (WMD): 10.6 degrees; 95% Confidence Interval (CI): 4.51 to 16.6);
however, early
exercise also resulted in a statistically significant
increase in wound drainage volume (Standardized
Mean Difference (SMD) 0.31;
95% CI: 0.13 to 0.49) and duration (WMD: 1.15 days; 95% CI:
0.65 to
1.65).Fourteen studies examined the effect of structured exercise compared to
usual
care/comparison. Of these, six were post-operative, three during
adjuvant treatment and five
following cancer treatment. Structured exercise
programs in the post-operative period significantly
improved shoulder
flexion ROM in the short-term (WMD: 12.92 degrees; 95% CI: 0.69 to 25.16).
Physical therapy treatment yielded additional benefit for shoulder function
post-intervention (SMD:
0.77; 95% CI: 0.33 to 1.21) and at six-month
follow-up (SMD: 0.75; 95% CI: 0.32 to 1.19). There
was no evidence of
increased risk of lymphedema from exercise at any time point.
AUTHORS' CONCLUSIONS: Exercise can result in a significant and clinically
meaningful
improvement in shoulder ROM in women with breast cancer. In the
post-operative period,
consideration should be given to early implementation
of exercises, although this approach may need
to be carefully weighed
against the potential for increases in wound drainage volume and duration.
High quality research studies that closely monitor exercise prescription
factors (e.g. intensity), and
address persistent upper-limb dysfunction are
needed.
PMID: 20556760 [PubMed - in process]
In Vivo. 2010 May-Jun;24(3):309-14.
Milroy's Primary Congenital Lymphedema in a Male Infant and Review of the
Literature.
Kitsiou-Tzeli S, Vrettou C, Leze E, Makrythanasis P, Kanavakis E, Willems
P.
"Choremeio" Research Laboratory of Medical Genetics, Children's Hospital
"Aghia Sophia", Thivon
and Levadeias, 11527, Greece. [email protected].
Abstract
BACKGROUND: Milroy's primary congenital lymphedema is a non-syndromic primary
lymphedema caused mainly by autosomal dominant mutations in the FLT4
(VEGFR3) gene. Here,
we report on a 6-month-old boy with congenital
non-syndromic bilateral lymphedema at both feet
and tibias, who underwent
molecular investigation, consisted of PCR amplification and DHPLC
analysis
of exons 17-26 of the FLT4 gene. The clinical diagnosis of Milroy disease was
confirmed by
molecular analysis showing the c.3109G>C mutation in the
FLT4 gene, inherited from the
asymptomatic father. This is a known missense
mutation, which substitutes an aspartic acid into a
histidine on amino acid
position 1037 of the resulting protein (p.D1037H), described in two other
families with Milroy disease. A thorough genetic molecular investigation and
clinical evaluation
contributes to the provision of proper genetic
counseling for parents of an affected child with Milroy
disease. The herein
described case, which is the third reported so far with c.3109G>C mutation,
adds data on genotypic-phenotypic correlation of Milroy disease. The
relative literature regarding the
pathophysiology, molecular basis, clinical
spectrum and treatment of Milroy disease is reviewed.
PMID: 20555004 [PubMed - in process]
Lymphology. 2010 Mar;43(1):42-4.
Primary lymphedema and acute leukemia--is there a link?
Todd M, Welsh J, Drummond MW.
Specialist Lymphoedema Clinic, NHS Greater Glasgow and Clyde, Scotland, UK.
Marie.todd@ggc.
scot.nhs.uk
Abstract
The lymphedema service in Glasgow has been treating patients with lymphedema
of all causes since
1991. In the past five years 3 patients with primary
lymphedema have been diagnosed with
myelodysplasia (leading to acute
leukemia) or acute leukemia. These are relatively unusual
malignancies given
the ages of the patients and all three of these patients died within an average
of 12
months of diagnosis. A connection between the presence of primary
lymphedema and the subsequent
development of the hematological disorder is
postulated. Standard marrow cytogenetics failed to
identify a common
abnormality but the authors feel that further study is warranted.
PMID: 20552819 [PubMed - in process]
Lymphology. 2010 Mar;43(1):25-33.
Comparing two treatment methods for post mastectomy lymphedema: complex
decongestive therapy
alone and in combination with intermittent pneumatic
compression.
Haghighat S, Lotfi-Tokaldany M, Yunesian M, Akbari ME, Nazemi F, Weiss J.
Breast Research Department, Iranian Center for Breast Cancer, Tehran, Iran.
Sh_haghighat@yahoo.
com
Abstract
There is no cure for breast cancer related lymphedema. This study was
conducted to compare two
treatment methods for postmastectomy lymphedema:
Complex Decongestive Therapy (CDT) and
Modified CDT (MCDT) combined with
Intermittent Pneumatic Compression (IPC). One hundred
and twelve patients
referred to the Lymphedema Clinic of the Iranian Center for Breast Cancer in
2008, were included in a randomized clinical trial. They were randomly
allocated into two equal
groups receiving daily CDT alone or in combination
with IPC. The volume reduction of the upper
limb was measured by water
displacement volumetry. No statistically significant differences in
demographic and clinical variables between the two groups were observed.
During the intensive
phase (phase I) of treatment, CDT alone yielded a
significantly higher mean volume reduction than
the combination modality
(43.1% vs. 37.5%; p = 0.036). Limb volume measured three months
following
treatment, showed 16.9% volume reduction by CDT alone, and 7.5% reduction by
MCDT
plus IPC. This study demonstrated that the use of CDT alone, or in
combination with IPC
significantly reduced limb volume in patients with post
mastectomy lymphedema. CDT alone
provided better results in both treatment
phases. Further studies will help to define the role of
multidisciplinary
approaches in the management of postmastectomy lymphedema.
PMID: 20552817 [PubMed - in process]
Lymphology. 2010 Mar;43(1):19-24.
Cutaneous metastasis of pancreatic carcinoma as an initial symptom in the
lower extremity with
obstructive lymphedema treated by physiotherapy and
lymphaticovenous shunt: a case report,
review, and pathophysiological
implications.
Shimizu H, Maegawa J, Ho T, Yamamoto Y, Mikami T, Nagahama K.
Department of Plastic and Reconstructive Surgery, Yokohama City University
Hospital, Yokohama,
Japan. [email protected]
Abstract
Cutaneous metastasis from pancreatic cancer is relatively rare as an initial
symptom, and it is
generally localized on the periumbilical area that is
known as Sister Mary Joseph's nodule. We report
a rare case of a 49-year-old
female who developed cutaneous metastasis of pancreatic cancer as an
initial
symptom. The patient was referred to our department for treatment of lymphedema
due to
surgical treatment of cervical cancer and underwent combined
physiotherapy and, 2 months later, a
lymph venous anastomosis (LVA) for
treatment of the lymphedema. Two months after the operation,
she developed
erythema on her right leg which spread from the leg to the groin in series. This
pattern
corresponded to the direction of lymph drainage, which may have been
enhanced by the
conservative physiotherapy and LVA treatments. These facts
suggest a possible relationship between
cutaneous metastasis of carcinoma
and treatment for lymphedema. Alternatively, the
lymphedematous limb may be
a privileged site for cancer growth, and metastatic seeding could have
taken
place from pre-existing hematogenous spread at the time of operation.
PMID: 20552816 [PubMed - in process]
Lymphology. 2010 Mar;43(1):14-8.
A novel missense mutation and two microrearrangements in the FOXC2 gene of
three families with
lymphedema-distichiasis syndrome.
Fauret AL, Tuleja E, Jeunemaitre X, Vignes S.
Département de Génétique et Centre de Référence des Maladies Vasculaires
Rares, AP-HP,
Hôpital Européen Georges Pompidou Paris, France.
Abstract
Lymphedema-distichiasis (LD) syndrome is a rare autosomal dominant disorder
of the FOXC2
gene, which codes for a forkhead transcription factor. Most of
the mutations described in this gene to
date are deletions or insertions,
suggesting a mechanism of haploinsufficiency. We studied three
independent
families with LD presenting with both lymphedema and distichiasis. Two
microrearrangements (one 8-bp deletion and one 7-bp duplication) occurring
in a GC-rich genomic
region (c.893-930) known to be prone to mutations were
identified. A new missense mutation (p.
Lys132Glu) located in a highly
conserved sequence, the forkhead domain, was also identified.
Mutations in
this domain have been previously shown to impair FOXC2 transactivation ability.
At a
genetic level, this study confirms the heterogeneity of mutations
responsible for LD and is consistent
with a mechanism of haploinsufficiency.
At a clinical level, it reinforces the importance of genetic
testing in
subjects with familial lymphedema or distichiasis, since measures can be taken
at an early
stage to prevent complications and to reduce the progression of
lymphedema or delay its occurrence.
PMID: 20552815 [PubMed - in process]
Lymphology. 2010 Mar;43(1):1-13.
Impact of lymphedema and arm symptoms on quality of life in breast cancer
survivors.
Hormes JM, Bryan C, Lytle LA, Gross CR, Ahmed RL, Troxel AB, Schmitz KH.
Department of Psychology, University of Pennsylvania , Philadelphia,
Pennsylvania 19104-6021,
USA.
Abstract
Lymphedema is one of many arm problems reported by breast cancer survivors.
Understanding the
impact of lymphedema on quality of life requires
consideration that arm symptoms may occur with or
without lymphedema. It was
hypothesized that specific arm symptoms and pain, related or unrelated
to
lymphedema, would be more associated with quality of life outcomes than arm
swelling. The
relation of arm swelling and of arm symptoms and associated
severity with a range of quality of life
outcomes following breast cancer
treatment was assessed in a diverse sample of 295 women, 141 of
whom had a
clinical diagnosis of lymphedema. Arm swelling (as defined by interlimb volume
or
circumference differences) and lymphedema severity (defined by Common
Toxicity Criteria) were
less correlated with quality of life than total
number of arm symptoms and specific individual
symptoms. Pain in the
affected arm correlated with poor quality of life outcomes, regardless of arm
swelling. When evaluating the impact of lymphedema on quality of life, arm
swelling may not be as
important as the total number and specific types of
arm symptoms present, as these may be more
informative about quality of life
outcomes in survivors of breast cancer with and without lymphedema.
PMID: 20552814 [PubMed - in process]
This one I don’t know where it goes, but you said “goes in news for July O/T
and you never
answered me when I question it, so Im putting it here though
it was sent to the group by Robert
Weiss but it isn’t about Medicare:
July 10, 2010 (1 doc)
FDA Warns of Risks With Unapproved Use of Quinine Sulfate
ROCKVILLE, Md -- July 8, 2010 -- The US Food and Drug Administration (FDA)
today warned
that the unapproved use of the malaria drug quinine sulfate
(Qualaquin) to treat night time leg cramps
has resulted in serious side
effects and prompted the manufacturer to develop a risk management
plan
aimed at educating healthcare professionals and patients about the potential
risks.
Quinine is not FDA-approved to treat or prevent night time leg cramps.
A review of reports submitted to the FDA's Adverse Event Reporting System
(AERS) between
April 2005 and October 1, 2008, found 38 US cases of serious
side effects associated with the use
of quinine.
Quinine use resulted in serious and life-threatening reactions in 24 cases,
including thrombocytopenia
and hemolytic uremic syndrome/thrombotic
thrombocytopenic purpura.
In some patients, these side effects resulted in permanent kidney impairment
and hospitalisation. Two
patients died. Most of those reporting serious side
effects took the drug to prevent or treat leg
cramps or restless leg
syndrome.
The risk management plan, called a Risk Evaluation and Mitigation Strategy
(REMS), requires that
patients be given a Medication Guide explaining what
quinine is and is not approved for, as well as
the potential side effects of
the drug. The company is also required to issue a Dear Health Care
Provider
Letter warning of the potential risk of serious and life-threatening
haematologic reactions.
SOURCE: US Food and Drug Administration