January 3, 2011
Jpn J Ophthalmol. 2010 Nov;54(6):626-8. Epub 2010 Dec 30.
Congenital toxoplasmosis mimicking microcephaly-lymphedema-chorioretinal
dysplasia.
Ozeki Y, Shimada Y, Tanikawa A, Horiguchi M, Takeuchi M, Yamazaki T.
PMID: 21191727 [PubMed - in process]
Lymphat Res Biol. 2010 Dec;8(4):209-15.
Advanced pneumatic therapy in self-care of chronic lymphedema of the
trunk.
Ridner SH, Murphy B, Deng J, Kidd N, Galford E, Dietrich MS.
Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA.
sheila.
[email protected]
Comment in:
Lymphat Res Biol. 2010 Dec;8(4):v.
Abstract
BACKGROUND: The purpose of this study was to conduct a preliminary,
post-market, home
study of the Flexitouch(®) system to examine the potential
efficacy of the device as a component of
self-care in breast cancer
survivors with truncal lymphedema.
METHODS AND RESULTS: A quasi-experimental, pre-treatment, post-treatment
design was
used. Twelve participants received a total of ten
self-administered, consecutive, one hour per day
treatments. Treatments one
and two were observed by study staff and the remaining eight were
unobserved. Assessments were conducted at baseline, after the first two
treatments, mid-way
through therapy, and at the end-of-study. Logs revealed
100% compliance with the eight prescribed
unobserved home treatments.
Symptoms were assessed by self-report symptom surveys. Signs,
objectively
observed physical phenomenon, were assessed by staff-initiated skin examination
and
circumferential truncal measurements. Statistically significant
improvement in truncal symptoms and
sleep were found. Changes in function
and girth were not statistically significant in this initial study.
CONCLUSIONS: Breast cancer survivors with truncal lymphedema may benefit from
using an
advanced pneumatic compression devices with truncal treatment as
part of their self-care program.
Participants were highly compliant in
device use. Further research of this intervention is warranted.
To
facilitate future research, clinically meaningful reductions in truncal girth
should be defined.
PMID: 21190493 [PubMed - in process]PMCID: PMC3008167 [Available on
2011/12/1]
Lymphat Res Biol. 2010 Dec;8(4):v.
Accruing evidence for a beneficial role of pneumatic biocompression in
lymphedema.
Rockson SG.
Comment on:
Lymphat Res Biol. 2010 Dec;8(4):183-7.
Lymphat Res Biol. 2010 Dec;8(4):209-15.
PMID: 21190488 [PubMed - in process]
Rev Med Liege. 2010 Nov;65(11):655-61.
[How to diagnose the cause of oedema, a clinical approach].
[Article in French]
Krzesinski JM.
Universite de Liège, Service de Néphrologie-Dialyse-Hypertension, CHU de
Liège, Belgique. jm.
[email protected]
Abstract
Oedema is a frequent disorder and the easily detectable consequence of an
increase of fluid located
in the interstitial tissue. It could be localized
or generalized and related either to a primary
disturbance of hemodynamics
at the capillary level, due to a modification of the Starling's law
components with secondary water and saline retention, or to a primary
retention of salt and water
linked to a kidney abnormality. Generalized
forms are pitting oedema, most often painless, white,
bilateral and
symmetric, distributed at the lower part of the body (localisation according to
the
gravitation law). They are different in their characteristics from
localized oedema or lymphoedema
which are tough. We propose a diagnostic
approach based on medical history, clinical examination
which allows a
confident medical diagnosis and so an adapted therapy.
PMID: 21189533 [PubMed - in process]
January 7, 2011
J Travel Med. 2011 Jan;18(1):68-9. doi: 10.1111/j.1708-8305.2010.00472.x.
Epub 2010 Nov 25.
Lymphedema in a guyanan migrant.
Depetrillo JC, Singer C.
Division of Infectious Diseases, Department of Medicine, Long Island Jewish
Medical Center, New
Hyde Park, NY, USA.
PMID: 21199149 [PubMed - in process]
J Pain Res. 2010 Aug 20;3:147-53.
Pilot study: rapidly cycling hypobaric pressure improves pain after 5 days in
adiposis dolorosa.
Herbst KL, Rutledge T.
Department of Medicine, University of California, San Diego, California,
USA;
Abstract
Adiposis dolorosa (AD) is a rare disorder of painful nodular subcutaneous fat
accompanied by
fatigue, difficulty with weight loss, inflammation, increased
fluid in adipose tissue (lipedema and
lymphedema), and hyperalgesia.
Sequential compression relieves lymphedema pain; we therefore
hypothesized
that whole body cyclic pneumatic hypobaric compression may relieve pain in AD.
To
avoid exacerbating hyperalgesia, we utilized a touch-free method, which
is delivered via a high-
performance altitude simulator, the Cyclic
Variations in Altitude Conditioning™ (CVAC™)
process. As a pilot study, 10
participants with AD completed pain and quality of life questionnaires
before and after 20-40 minutes of CVAC process daily for 5 days.
Participants lost weight (195.5
± 17.6-193.8 ± 17.3 lb; P = 0.03), and
bioimpedance significantly decreased (510 ± 36-490 ± 38
ohm; P = 0.01).
There was a significant decrease in scores on the Pain Catastrophizing Scale (P
=
0.039), in average (P = 0.002), highest (P = 0.029), lowest (P = 0.04),
and current pain severity (P
= 0.02) on the Visual Analogue Scale, but there
was no change in pain quality by the McGill Pain
Questionnaire. There were
no significant changes in total and physical SF-36 scores, but the mental
score improved significantly (P = 0.049). There were no changes in the Pain
Disability Index or
Pittsburgh Sleep Quality Index. These data present a
potential, new, noninvasive means of treating
pain in AD by whole body
pneumatic compression as part of the CVAC process. Although
randomized,
controlled trials are needed to confirm these data, the CVAC process could
potentially
help in treating AD pain and other chronic pain disorders.
PMID: 21197318 [PubMed - in process]PMCID: PMC3004643
January 11, 2011
Int J Clin Oncol. 2011 Jan 7. [Epub ahead of print]
Risk factors for lower-limb lymphedema after surgery for cervical cancer.
Ohba Y, Todo Y, Kobayashi N, Kaneuchi M, Watari H, Takeda M, Sudo S, Kudo M,
Kato H,
Sakuragi N.
Department of Gynecology, Hokkaido University Graduate School of Medicine,
N15W7 Kita-ku,
Sapporo, 060-8638, Japan.
Abstract
BACKGROUND: Lower-limb lymphedema (LLL) is a prevalent complication that is
encountered
after treatment for gynecological malignancies. The aim of this
study was to evaluate the risk factors
for postoperative LLL in patients
with cervical cancer.
METHODS: We conducted a retrospective chart review for patients who had
undergone surgery,
including systematic lymphadenectomy, for cervical
cancer. Patients who died of cancer, were
evaluated for short periods of
time (<2 years), had missing medical records, or were suffering from
deep
venous thrombosis were excluded. We utilized the International Society of
Lymphology staging
of lymphedema severity as the diagnostic criteria for
LLL, and patients with stage II or III
lymphedema, as objectively determined
by physicians, were included in the group of patients with
LLL. Multivariate
analysis was performed to confirm independent risk factors.
RESULTS: A total of 155 patients with cervical cancer were evaluated.
Thirty-one patients (20.0%)
contracted LLL with a median follow-up of 6.1
years. Suprafemoral node dissection (odds ratio,
9.5; 95% confidence
interval, 1.2-73.3; P = 0.031) and adjuvant radiotherapy (3.7; 1.2-10.9; P =
0.019) were identified as independent risk factors.
CONCLUSION: Given that the effectiveness of the above two therapeutic options
for cervical
cancer is currently controversial, the clinical benefits of
these therapies should be reevaluated
specifically to conserve the quality
of life for patients with this disease.
PMID: 21213009 [PubMed - as supplied by publisher]
Eur J Med Genet. 2011 Jan 3. [Epub ahead of print]
3.7 Mb tandem microduplication in chromosome 5p13.1-p13.2 associated with
developmental
delay, macrocephaly, obesity, and lymphedema. Further
characterization of the dup(5p13)
syndrome.
Oexle K, Hempel M, Jauch A, Meitinger T, Rivera-Brugués N, Stengel-Rutkowski
S, Strom T.
Institute of Human Genetics, Technische Universität München, Munich,
Germany.
Abstract
In a male patient with developmental delay, autistic behaviour, obesity,
lymphedema, hypertension,
macrocephaly, and facial features of chromosome 5p
duplication (trisomy 5p) a 3.7 Mb de novo
tandem microduplication of
5p13.1-13.2 (rs4703415-rs261752, i.e., chr5:35.62-39.36Mb) was
identified. This observation contributes to the characterization and dissection of the 5p13 duplication
syndrome. The possible role of increased NIPBL gene dosage is
discussed.
Copyright © 2010. Published by Elsevier Masson SAS.
PMID: 21211577 [PubMed - as supplied by publisher]
January 14, 2011
Nurs Sci Q. 2011 Jan;24(1):57-63.
Limitations of self-care in reducing the risk of lymphedema:
supportive-educative systems.
Armer JM, Brooks CW, Stewart BR.
University of Missouri, USA.
Abstract
The purpose of this study was to examine patient perceptions of
limitations related to self-care
measures to reduce lymphedema risk
following breast cancer surgery. Secondary analysis of survey
data from a
companion study to a study piloting a behavioral-educational intervention was
conducted to examine the specific limitations in performing lymphedema
risk-reduction self-care
measures. Findings suggest a more comprehensive
approach is needed if patients are to engage in
self-care actions to reduce
lymphedema risk. Understanding the concepts of self-care and personal
support interventions that include motivational interviewing can help nurses
design supportive-
educative care systems that assist patients in overcoming limitations in the estimative, transitional, and
productive phases of
self-care necessary to reduce lymphedema risk.
PMID: 21220577 [PubMed - in process]
January 18, 2011
Eur J Dermatol. 2011 Jan 14. [Epub ahead of print]
Intra-arterial mitoxantrone/paclitaxel in angiosarcoma of the lower limb
associated with chronic
lymphedema (Stewart-Treves syndrome) in a patient
with cervical cancer.
Fujisawa Y, Ito M, Mori K, Okada S, Nakamura Y, Kawachi Y, Otsuka F.
Department of Dermatology, University of Tsukuba, 1-1-1 Tennodai, 305-8575
Tsukuba, Japan.
PMID: 21233070 [PubMed - as supplied by publisher]
Acta Oncol. 2011 Feb;50(2):187-93.
Late effects of breast cancer treatment and potentials for
rehabilitation.
Ewertz M, Jensen AB.
Department of Oncology, Odense University Hospital, Institute of Clinical
Research, University of
Southern Denmark, Denmark.
Abstract
Abstract Background. Breast cancer is the most frequent malignant disease
among women world
wide. Survival has been improving leading to an increasing
number of breast cancer survivors, in the
US estimated to about 2.6 million.
Material and methods. The literature was reviewed with focus on
data from
the Nordic countries. Results. Local therapies such as breast cancer surgery and
radiotherapy may cause persistent pain in the breast area, arm, and shoulder
reported by 30-50% of
patients after three to five years, lymphedema in
15-25% of patients, and restrictions of arm and
shoulder movement in 35%.
Physiotherapy is the standard treatment for the latter while no pain
intervention trials have been published. Chemotherapy may cause infertility
and premature
menopause, resulting in vasomotor symptoms, sexual
dysfunction, and osteoporosis, which are
similar to the side effects of
endocrine treatment in postmenopausal women. Awareness of
cardiotoxicity is
needed since anthracyclines, trastuzumab, and radiotherapy can damage the heart.
Breast cancer survivors have an increased risk of a major depression and far
from all receive
adequate anti-depressive treatment. Other psychological
symptoms include fear of recurrence, sleep
disturbances, cognitive problems,
fatigue, and sexual problems. Discussion. To improve
rehabilitation,
specific goals have to be formulated into national guidelines and high priority
directed
towards research into developing and testing new interventions for
alleviating symptoms and side
effects experienced by breast cancer
survivors.
PMID: 21231780 [PubMed - in process]
Lymphology. 2010 Sep;43(3):135-45.
Assessment of quality of life in lymphedema patients: validity and
reliability of the Swedish version of
the Lymphedema Quality of Life
Inventory (LQOLI).
Klernäs P, Kristjanson LJ, Johansson K.
Department of Physiotherapy, Institution of Neurobiology, Care Sciences and
Society, Karolinska
Institute, Stockholm, Sweden. [email protected]
Abstract
The Lymphedema Quality of Life Inventory (LQOLI) is an instrument
developed for patients with
different types of lymphedema. It contains
physical, emotional, social, and practical dimensions and
consists of 58
items, each with three sub items concerning life quality, daily life changes,
and
difficulties of changing and two items concerning life quality in
general and in relation to lymphedema.
The purpose of this study was to
adapt the Australian LQOLI to Swedish conditions and to test it
for clarity,
face validity, content validity, construct validity, and reliability. Content
and face validity
was completed by experts (n=11) and patients with
different types of lymphedema (n=16). For
construct validation the SF-36
(n=63) was used. Test-retest reliability was evaluated with
lymphedema
patients (n=58) answering the questionnaire twice, within median 3 weeks. Three
items
were added in the Swedish version of LQOLI (SLQOLI). The kappa
coefficients in test-retest for
all items and sub items varied (range =
0.25-0.83). Construct validity showed moderate correlation
with SF-36. The
SLQOLI is adapted and valid, with moderate reliability, and it can be used in
clinic
to describe life quality for patients with lymphedema. In this study,
67% of the patients experienced
an effect on life quality within the
physical dimension and 54-58% within the emotional, social, and
practical
dimensions.
PMID: 21226416 [PubMed - indexed for MEDLINE]
Lymphology. 2010 Sep;43(3):118-27.
Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60
months.
Armer JM, Stewart BR.
Sinclair School of Nursing, University of Missouri, Columbia, Missouri 65211,
USA.
[email protected]
Abstract
Breast cancer survivors are at life-time risk of developing lymphedema
(LE). Quantification of LE
has been problematic as the criteria used to
identify lymphedema use various methods to assess
changes in the volume of
the affected limb. In part because of difficulties and variability in
measurement and diagnosis, the reported incidence of LE varies greatly among
women treated with
surgery and radiation for breast cancer. The goal of this
research was to describe the trends for LE
occurrence over three points in
time (12, 30, and 60 months) among breast cancer survivors using
four
diagnostic criteria based on three measurement techniques. Participants were
enrolled following
diagnosis of breast cancer but before surgery. Baseline
limb volume and symptom assessment data
were obtained. Participants were
followed every 3 months for 12 months, then every 6 months
thereafter for a
total of 60 months. Limb volume changes (LVC) in both limbs were measured using
three techniques: objectively by (a) circumferences at 4 cm intervals and
(b) perometry and
subjectively by (c) symptom experience via interview. Four
diagnostic criteria for LE most often
reported in the literature were used:
(i) 2 cm circumferential change; (ii) 200 mL perometry LVC;
(iii) 10%
perometry LVC; and (iv) signs and symptoms (SS) report of limb heaviness and
swelling,
either 'now' or 'in the past year' (diagnostic criteria i-iii
define increases/differences in limb volume
from baseline and/or between the
affected and non-affected limb). Standard survival analysis
methods were
applied to identify when the criteria corresponding to LE were met. Trends in LE
occurrence are reported for preliminary analysis of data from 236
participants collected at 6-, 12-,
18-, 24-, 30-, and 60-months post-op. At
60 months post-treatment, LE incidence using the four
criteria ranged from
43% to 94%, with 2 cm associated with the highest frequency for lymphedema
occurrence and SS the lowest. Sixty-month trends are compared to earlier
trends at 12- and 30-
months, per criterion. These preliminary findings
provide additional evidence that breast cancer
survivors are at risk for
developing LE beyond the first year following treatment. Cases of
lymphedema
continue to emerge through 60-months post-breast cancer surgery. This 60-month
analysis supports the previous 12- and 30-month analyses in finding the 2 cm
criteria to be the most
liberal definition of LE. The self-report of
heaviness and swelling, along with 10% LVC, represent
the most conservative
definitions (41% and 45%, respectively). Furthermore, the variety of criteria
used to identify LE, along with the absence of baseline (pre-treatment)
measurements, likely
contribute to the wide range of LE incidence rates
reported in the literature.
PMID: 21226414 [PubMed - indexed for MEDLINE]
Mayo Clin Health Lett. 2010 Dec;28(12):6.
Lymphedema. Swelling not to be ignored.
[No authors listed]
PMID: 21226243 [PubMed - indexed for MEDLINE]
January 21, 2011
Support Care Cancer. 2011 Jan 16. [Epub ahead of print]
Body mass index and breast cancer treatment-related lymphedema.
Ridner SH, Dietrich MS, Stewart BR, Armer JM.
School of Nursing, Vanderbilt University, 460 21st Avenue South, 525 Godchaux
Hall, Nashville,
TN, 37240, USA, [email protected].
Abstract
PURPOSE: The main purpose was to examine longitudinally the influence of
body mass index
(BMI) and obesity on the development of breast cancer
treatment-related lymphedema. We asked,
does elevated BMI increase
lymphedema risk?
METHODS: A secondary analysis was conducted on de-identified data collected
from 138 newly
diagnosed breast cancer survivors who had arm-volume
measurements and symptom assessment at
pre-treatment baseline and
measurements up to 30 months post-surgery in a prospective longitudinal
parent study. Arm volume and weight data, part of the information collected
during each participant
visit, were examined.
RESULTS: Breast cancer survivors whose BMI was =30 at the time of breast
cancer treatment
were approximately 3.6 times more likely to develop
lymphedema at 6 months or greater after
diagnosis than those with a
BMI?<?30 at the time of cancer treatment (95% confidence interval, C.
I.,
for odds ratio, O.R., 1.42-9.04; p?=?0.007). Those with a general BMI increase
or a BMI rise
to 30 or greater during their first 30 months of survivorship
were not more likely to develop late-
onset lymphedema than those who did not
have similar changes in BMI.
CONCLUSIONS: Pre-treatment BMI may be a risk factor for lymphedema. Weight
gain post-
treatment may not be.
Further research is warranted.
PMID: 21240649 [PubMed - as supplied by publisher]
Ann Chir Plast Esthet. 2011 Jan 13. [Epub ahead of print]
[About an extreme case of giant lymphoedema of the upper limb: Ligasure
may be useful and a
multidisciplinary approach is mandatory.]
[Article in French]
Lafosse A, Vandeputte C, Sabor I, Mahaudens P, Denoel C.
Service de chirurgie plastique, cliniques universitaires Saint-Luc, avenue
Hippocrate 10, 1200
Bruxelles, Belgique.
Abstract
Treatment of giant lymphoedema remains very difficult. The main problem
is not only the obtention
of early postoperative favorable results but to
keep them long-lasting. The available treatment
options are numerous and
often combined. The indications have to be adapted to the clinical stage
of
the lesion. Ligasure(®) give us many advantages in the achievement of the
surgical resection due
to the quality of the lymphostasis that can be
obtained and to the very limited thermic lesions caused
to tissues. Long
lasting postoperative physiotherapy is of first importance. We here describe a
case
of a giant lymphoedema of the upper limb after axillary lymph node
dissection for breast cancer. The
first physiotherapy failed, causing a
lymphatic decompensation resulting in a lymphoedematous mass
of nearly 7kg.
The surgical resection with Ligasure(®) associated to drainage and compressive
physiotherapy in the long run allows to obtain good results. The late
follow-up after 4 years still
shows stable results.
Published by Elsevier SAS.
PMID: 21237550 [PubMed - as supplied by publisher]
Ann Chir Plast Esthet. 2011 Jan 13. [Epub ahead of print]
[From microsurgery to supermicrosurgery: Experimental feasibility study
and perspectives.]
[Article in French]
Qassemyar Q, Sinna R.
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord,
CHU d'Amiens, place
Victor-Pauchet, 80054 Amiens cedex 1, France.
Abstract
INTRODUCTION: Supermicrosurgical techniques developed for the anastomoses
less or equal to
0.5mm show convincing results in specialized centers and
with an advanced instrumentation. Can we
integrate supermicrosurgical
training animal models in the current teaching program of microsurgery?.
MATERIALS AND METHODS: Ten arterial anastomoses of the inferior epigastric
artery
(diameter less than or equal to 0.5mm) were performed consecutively
in five rats by the same
beginner operator in microsurgery, with standard
microsurgical set of instruments. The intravascular
stenting anastomosis
method was used with 11-0 nylon sutures. The immediate patency and flap
survival on postoperative day three was assessed. The duration of each
anastomosis was measured.
RESULTS: The mean diameter of the arteries was 0.4mm. The average time for
each anastomosis
was 30 minutes with a maximum of 55 minutes and a minimum
of 18 minutes. The average number
of stitches was 5.5. The immediate patency
was 100 % with a 70 % success rate at the third day.
CONCLUSIONS: There are several applications of supermicrosurgical techniques,
especially in
hand surgery, lymphoedema surgical treatment and for
perforator-to-perforator flaps. The
intravascular stenting method allows
fast learning of the technique with a satisfactory success rate
despite
non-specific instrumentation. Furthermore, this method could easily be
integrated among the
microsurgical courses of many universities.
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21237545 [PubMed - as supplied by publisher]
Health Qual Life Outcomes. 2011 Jan 14;9(1):3. [Epub ahead of print]
Health-related quality of life in Spanish breast cancer patients: a
systematic review.
Delgado-Sanz MC, Garcia-Mendizabal MJ, Pollan M, Forjaz MJ, Lopez-Abente
G, Aragones N,
Perez-Gomez B.
Abstract
BACKGROUND: Breast cancer is one of the oncological diseases in which
health-related quality of
life (HRQL) has been most studied. This is mainly
due to its high incidence and survival. This paper
seeks to: review
published research into HRQL among women with breast cancer in Spain; analyse
the characteristics of these studies; and describe the instruments used and
main results reported.
METHODS: The databases consulted were MEDLINE, EMBASE, PsycINFO, Dialnet,
IBECS,
CUIDEN, ISOC and LILACS. The inclusion criteria required studies to:
1) include Spanish
patients, and a breakdown of results where other types of
tumours and/or women from other
countries were also included; and, 2)
furnish original data and measure HRQL using a purpose-
designed
questionnaire. The methodological quality of the studies was assessed.
RESULTS: Spain ranked midway in the European Union in terms of the number of
studies
conducted on the HRQL of breast cancer patients. Of the total of 133
papers published from 1993
to 2009, 25 met the inclusion criteria. Among
them, only 12 were considered as having good or
excellent quality. A total
of 2236 women participated in the studies analysed. In descending order of
frequency, the questionnaires used were the EORTC, FACT-B, QL-CA-Afex,
SF-12, FLIC,
RSCL and CCV. Five papers focused on validation or adaptation
of questionnaires. Most papers
examined HRQL in terms of type of treatment.
Few differences were detected by type of
chemotherapy, with the single
exception of worse results among younger women treated with
radiotherapy. In
the short term, better results were reported for all HRQL components by women
undergoing conservative rather than radical surgery. Presence of lymphedema
was associated with
worse HRQL. Three studies assessed differences in HRQL
by patients' psychological traits.
Psychosocial disorder and level of
depression and anxiety, regardless of treatment or disease stage,
worsened
HRQL. In addition, there was a positive effect among patients who reported
having a
"fighting spirit" and using "denial" as a defence mechanism. One
study found that breast cancer
patients scored worse than did healthy women
on almost all SF-12 scales.
CONCLUSION: Research into health-related quality of life of breast-cancer
patients is a little
developed field in Spain.
PMID: 21235770 [PubMed - as supplied by publisher]
January 22, 2011
Klin Monbl Augenheilkd. 2011 Jan;228(1):19-24. Epub 2011 Jan 19.
[Chronic Eyelid Oedema and Rosacea (Morbus Morbihan): Diagnostic and
Therapeutic Challenges.]
[Article in German]
Renieri G, Brochhausen C, Pfeiffer N, Pitz S.
Augenklinik und Poliklinik, Universitätsmedizin der
Johannes-Gutenberg-Universität, Mainz.
Abstract
BACKGROUND: Morbus Morbihan is a rare complication of rosacea, consisting
of a persistent
lymphoedema of the upper part of the face. It has typically
a chronic course, unspecific
histopathological findings and an extreme
refractoriness to therapy.
PATIENTS AND METHODS: Between February 2008 and January 2010, 5 patients with
Morbus Morbihan were observed at the Department of Ophthalmology of the
University Medical
Centre Mainz. In the present cohort study, we describe
the clinical, laboratory and histological
findings that led to the
diagnosis. The course of the affection and the results of different therapeutic
options are also reported.
RESULTS: Each patient underwent a complete ophthalmological examination, as
well as general
and dermatological consultations. All patients showed facial
skin alterations typical for rosacea. 4
out of 5 subjects underwent a lid
biopsy to confirm the diagnosis of Morbus Morbihan, one patient
refused it.
Initial treatment consisted of various systemic and local medical therapies,
however, with
poor success. One patient had intravenous therapy with
corticosteroids elsewhere with no effect.
We treated 3 cases with
intralesional triamcinolone injections with good results. 2 patients
underwent upper lid blepharoplasty. Results of surgery remained stable also
due to manual lymph
drainage and intralesional injections of triamcinolon.
No complications or side effects were seen in
patients treated with
triamcinolone.
CONCLUSIONS: Morbus Morbihan can be diagnosed only after excluding other
conditions
leading to chronic lid swelling. In our series, good results were
achieved with intralesional injection of
triamcinolone. Surgery also led to
relevant improvements for a long period (13 months), with some
adjuvant
therapy. The treatment of chronic eyelid oedema associated with rosacea remains
a
challenge for the ophthalmologist and the oculoplastic surgeon.
Georg Thieme Verlag KG Stuttgart · New York.
PMID: 21249610 [PubMed - as supplied by publisher]
January 25, 2011
Klin Monbl Augenheilkd. 2011 Jan;228(1):19-24. Epub 2011 Jan 19.
[
Chronic Eyelid Oedema and Rosacea (Morbus Morbihan): Diagnostic and
Therapeutic Challenges.]
[Article in German]
Renieri G, Brochhausen C, Pfeiffer N, Pitz S.
Augenklinik und Poliklinik, Universitätsmedizin der
Johannes-Gutenberg-Universität, Mainz.
Abstract
BACKGROUND: Morbus Morbihan is a rare complication of rosacea, consisting
of a persistent
lymphoedema of the upper part of the face. It has typically
a chronic course, unspecific
histopathological findings and an extreme
refractoriness to therapy.
PATIENTS AND METHODS: Between February 2008 and January 2010, 5 patients with
Morbus Morbihan were observed at the Department of Ophthalmology of the
University Medical
Centre Mainz. In the present cohort study, we describe
the clinical, laboratory and histological
findings that led to the
diagnosis. The course of the affection and the results of different therapeutic
options are also reported.
RESULTS: Each patient underwent a complete ophthalmological examination, as
well as general
and dermatological consultations. All patients showed facial
skin alterations typical for rosacea. 4
out of 5 subjects underwent a lid
biopsy to confirm the diagnosis of Morbus Morbihan, one patient
refused it.
Initial treatment consisted of various systemic and local medical therapies,
however, with
poor success. One patient had intravenous therapy with
corticosteroids elsewhere with no effect.
We treated 3 cases with
intralesional triamcinolone injections with good results. 2 patients
underwent upper lid blepharoplasty. Results of surgery remained stable also
due to manual lymph
drainage and intralesional injections of triamcinolon.
No complications or side effects were seen in
patients treated with
triamcinolone.
CONCLUSIONS: Morbus Morbihan can be diagnosed only after excluding other
conditions
leading to chronic lid swelling. In our series, good results were
achieved with intralesional injection of
triamcinolone. Surgery also led to
relevant improvements for a long period (13 months), with some
adjuvant
therapy. The treatment of chronic eyelid oedema associated with rosacea remains
a
challenge for the ophthalmologist and the oculoplastic surgeon.
© Georg Thieme Verlag KG Stuttgart · New York.
PMID: 21249610 [PubMed - as supplied by publisher]
Skeletal Radiol. 2011 Jan 20. [Epub ahead of print]
Massive localised lymphoedema: clinical presentation and MR imaging
characteristics.
Khanna M, Naraghi AM, Salonen D, Bhumbra R, Dickson BC, Kransdorf MJ,
White LM.
Department of Clinical Imaging, Imperial College Healthcare NHS Trust,
London, UK, monica.
[email protected].
Abstract
Three morbidly obese women were referred to us with suspected soft-tissue
sarcomas. All lesions
arose from the medial subcutaneous tissues of the
thigh, and were shown to represent massive
localised lymphoedema (MLL), a
rare condition occurring in morbidly obese adults. MR imaging
typically
demonstrates a sharply demarcated, pedunculated mass consisting of fat
partitioned by
fibrous septae surrounded by a thickened dermis. There is
oedema both within the mass and
tracking along the subcutaneous septae in a
"lace-like" fashion outwards from the pedicle, outlining
large lobules of
fat. Minimal enhancement is observed within the dermis of the lesion following
intravenous gadolinium administration. Obesity is a growing problem that is
likely to result in an
increase in the prevalence of this condition;
therefore, familiarity with the radiological appearance is
important in
establishing a correct diagnosis in this condition that may mimic a soft-tissue
sarcoma.
PMID: 21249496 [PubMed - as supplied by publisher]
Am J Physiol Cell Physiol. 2011 Jan 19. [Epub ahead of print]
Temporal and spatial patterns of endogenous danger signal expression
after wound healing and in
response to lymphedema.
Zampell JC, Yan A, Avraham T, Andrade V, Malliaris S, Aschen SZ, Rockson
SG, Mehrara BJ.
1Memorial Sloan-Kettering Cancer Center.
Abstract
While acute tissue injury potently induces endogenous danger signal
expression, the role of these
molecules in chronic wound healing and
lymphedema is undefined. The purpose of this study was to
determine the
spatial and temporal expression patterns of the endogenous danger signals HMGB1
and HSP70 during wound healing and chronic lymphatic fluid stasis. In a
surgical mouse tail model
of tissue injury and lymphedema, HMGB1 and HSP70
expression occurred along a spatial gradient
relative to the site of injury,
with peak expression at the wound and >2-fold reduced expression
within 5
mm (P<0.05). Expression primarily occurred in cells native to injured tissue.
In particular,
HMGB1 was highly expressed by lymphatic endothelial cells
(LECs, >40% positivity; 2-fold
increase in chronic inflammation,
P<0.001). We found similar findings using a peritoneal
inflammation
model. Interestingly, upregulation of HMGB1 (2.2-fold), HSP70 (1.4-fold), and
NF-
kß activation persisted at least 6 weeks post-operatively only in
lymphedematous tissues. Similarly,
we found upregulation of endogenous
danger signals in soft tissue of the arm after axillary
lymphadenectomy in a
mouse model and in matched biopsy samples obtained from patients with
secondary lymphedema comparing normal to lymphedematous arms (2.4-fold
increased HMGB1,
1.9-fold increased HSP70; P<0.01). Finally, HMGB1
blockade significantly reduced inflammatory
lymphangiogenesis within
inflamed draining lymph nodes (35% reduction, P<0.01). In conclusion,
HMGB1 and HSP70 are expressed along spatial gradients and upregulated in
chronic lymphatic
fluid stasis; furthermore, acute expression of endogenous
danger signals may play a role in
inflammatory lymphangiogenesis.
PMID: 21248077 [PubMed - as supplied by publisher]
January 28, 2011
Int J Obes (Lond). 2011 Jan 25. [Epub ahead of print]
Oedema in obesity; role of structural lymphatic abnormalities.
Vasileiou AM, Bull R, Kitou D, Alexiadou K, Garvie NJ, Coppack SW.
East London Obesity Service, Barts and The London Medical School, Homerton
University
Hospital and Nuclear Medicine, The Royal London Hospital, London,
UK.
Abstract
Oedema is a common finding in obesity and its cause is not always clear.
Possible causes include
impairment of cardiac, respiratory and/or renal
function, chronic venous insufficiency and lymphatic
problems.
Lymphoscintigraphy is the best method to detect structural lymphatic
abnormalities that
can cause lymphoedema. We reviewed 49 female subjects
with pitting oedema who had undergone
lymphoscintigraphy, divided in three
groups. The first group was comprised of severely obese
patients in whom
cardiorespiratory causes for oedema had been excluded. The second group
consisted of non-obese patients with recognized causes for oedema and the
third group was non-
obese patients with 'idiopathic' oedema. A standard
classification was used to interpret
lymphoscintigraphy results. The
frequency and severity of lymphoscintigraphic abnormalities was
greatest in
patients with clinical diagnoses of oedema related to 'recognized causes' (any
abnormality
in 50% of legs with obstruction in 22%). Obese patients and
those with 'idiopathic'oedema had
fewer (P=0.02 for both) and milder
lymphoscintographic abnormalities (any abnormality 32 and
25%, respectively,
obstruction 5 and 3%, respectively), and although the clinical oedema was
invariably bilateral, the lymphoscintigraphy abnormalities were usually
unilateral. In conclusion,
structural lymphoscintigraphic abnormalities are
uncommon in obesity and do not closely correlate
with the clinical pattern
of oedema.International Journal of Obesity advance online publication, 25
January 2011; doi:10.1038/ijo.2010.273.
PMID: 21266949 [PubMed - as supplied by publisher]
J Med Genet. 2011 Jan 25. [Epub ahead of print]
Rapid identification of mutations in GJC2 in primary lymphoedema using
whole exome sequencing
combined with linkage analysis with delineation of
the phenotype.
Ostergaard P, Simpson MA, Brice G, Mansour S, Connell FC, Onoufriadis A,
Child AH, Hwang J,
Kalidas K, Mortimer PS, Trembath R, Jeffery S.
1Medical Genetics, St George's, University of London, London, UK.
Abstract
Background Primary lymphoedema describes a chronic, frequently
progressive, failure of lymphatic
drainage. This disorder is frequently
genetic in origin, and a multigenerational family in which eight
individuals
developed postnatal lymphoedema of all four limbs was ascertained from the joint
Lymphoedema/Genetic clinic at St George's Hospital. Methods Linkage analysis
was used to
determine a locus, and exome sequencing was employed to look for
causative variants. Results
Linkage analysis revealed cosegregation of a
16.1 Mb haplotype on chromosome 1q42 that
contained 173 known or predicted
genes. Whole exome sequencing in a single affected individual
was
undertaken, and the search for the causative variant was focused to within the
linkage interval.
This approach revealed two novel non-synonymous single
nucleotide substitutions within the
chromosome 1 locus, in NVL and GJC2. NVL
and GJC2 were sequenced in an additional cohort
of individuals with a
similar phenotype and non-synonymous variants were found in GJC2 in four
additional families. Conclusion This report demonstrates the power of exome
sequencing efficiently
applied to a traditional positional cloning pipeline
in disease gene discovery, and suggests that the
phenotype produced by GJC2
mutations is predominantly one of 4 limb lymphoedema.
PMID: 21266381 [PubMed - as supplied by publisher]
Lik Sprava. 2010 Apr-Jun;(3-4):11-20.
[Lymphedema: clinic-therapeutic aspect].
[Article in Ukrainian]
[No authors listed]
Abstract
Lymphedema may be presented in mild or less severe form. Nowadays,
accurate diagnosis and
effective therapy are available. Wearing surgical
bandage, massage, exercise, and pumps form the
core program for most
patients with lymphedema. The application of pharmacological therapies has
been notably absent from the management strategies for lymphatic vascular
insufficiency states but
lately some progress has been made by applying
wobenzym in the treatment. Surgical approaches to
improve lymphatic flow
through vascular anastamosis have been, in large part, unsuccessful, but
controlled liposuction affords lasting benefit in selected patients.
PMID: 21265117 [PubMed - in process]
Nurs Times. 2010 Dec 14-2011 Jan 10;106(49-50):15-7.
Early diagnosis of lymphoedema helps to reduce its psychological and
social impact.
Cooper G.
Walsall Lymphoedema Service, Walsall Community Health.
Abstract
Lymphoedema is often unrecognised by both health professionals and
patients. In addition, its
impact is often underestimated. This article
discusses how to recognise the condition, the
consequences of misdiagnosis,
reducing or preventing complications and various treatment options.
PMID: 21261161 [PubMed - in process]
Biomed Opt Express. 2010 Jul 15;1(1):114-125.
Direct evidence of lymphatic function improvement after advanced
pneumatic compression device
treatment of lymphedema.
Adams KE, Rasmussen JC, Darne C, Tan IC, Aldrich MB, Marshall MV, Fife
CE, Maus EA,
Smith LA, Guilloid R, Hoy S, Sevick-Muraca EM.
Abstract
Lymphedema affects up to 50% of all breast cancer survivors. Management
with pneumatic
compression devices (PCDs) is controversial, owing to the
lack of methods to directly assess
benefit. This pilot study employed an
investigational, near-infrared (NIR) fluorescence imaging
technique to
evaluate lymphatic response to PCD therapy in normal control and breast
cancer-
related lymphedema (BCRL) subjects. Lymphatic propulsion rate,
apparent lymph velocity, and
lymphatic vessel recruitment were measured
before, during, and after advanced PCD therapy.
Lymphatic function improved
in all control subjects and all asymptomatic arms of BCRL subjects.
Lymphatic function improved in 4 of 6 BCRL affected arms, improvement
defined as proximal
movement of dye after therapy. NIR fluorescence
lymphatic imaging may be useful to directly
evaluate lymphatic response to
therapy. These results suggest that PCDs can stimulate lymphatic
function
and may be an effective method to manage BCRL, warranting future clinical
trials.
PMID: 21258451 [PubMed - as supplied by publisher]PMCID: PMC3005162
Urology. 2011 Jan 20. [Epub ahead of print]
Reconstructive Surgery for Penoscrotal Filarial Lymphedema: A Decade of
Experience and Follow-
up.
Singh V, Sinha RJ, Sankhwar SN, Kumar V.
Department of Urology, Chhatrapati Shahuji Maharaj Medical University
(formerly King George's
Medical University),
Lucknow, India.
Abstract
OBJECTIVES: To present our experience of reconstructive surgery in
patients with penoscrotal
filarial lymphedema.
METHODS: From January 2000 to December 2009, we treated 48 patients with
penile and
penoscrotal filarial lymphedema using reconstructive surgery.
Isolated penile involvement was seen in
14 patients, and 34 patients had
penoscrotal involvement. All the patients had taken multiple courses
of
antifilarial drug before surgery. For isolated penile involvement, the diseased
penile skin was
excised and covered with a split-thickness skin graft. In
some patients, the inner prepucial skin was
preserved and used to cover the
penile shaft. For those with penoscrotal involvement, scrotoplasty
was
performed, after excising the diseased scrotal skin and underlying soft tissue,
while sparing the
testes and spermatic cords.
RESULTS: The mean patient age was 38 years (range 25-52), and the median
follow-up time was
48 months (range 10-120). All 48 patients reported a
satisfactory cosmetic appearance after the
procedure and noted improvement
in their ability to void while standing. Also, all of them could
ambulate
better and resumed sexual activity. Local groin infection was present in 12
patients; all
were cured after proper management.
CONCLUSIONS: In filarial lymphedema of penis and/or scrotum, excision of the
diseased tissue
and covering with a split-thickness skin graft provided good
results. If the inner prepucial skin is
healthy, it should be used to cover
the distal penile shaft. If the scrotum is involved, scrotoplasty with
lateral and posterior mobilized flaps provides satisfactory results.
2011 Elsevier Inc. All rights reserved.
PMID: 21256561 [PubMed - as supplied by publisher]
January 3, 2011
Jpn J Ophthalmol. 2010 Nov;54(6):626-8. Epub 2010 Dec 30.
Congenital toxoplasmosis mimicking microcephaly-lymphedema-chorioretinal
dysplasia.
Ozeki Y, Shimada Y, Tanikawa A, Horiguchi M, Takeuchi M, Yamazaki T.
PMID: 21191727 [PubMed - in process]
Lymphat Res Biol. 2010 Dec;8(4):209-15.
Advanced pneumatic therapy in self-care of chronic lymphedema of the
trunk.
Ridner SH, Murphy B, Deng J, Kidd N, Galford E, Dietrich MS.
Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA.
sheila.
[email protected]
Comment in:
Lymphat Res Biol. 2010 Dec;8(4):v.
Abstract
BACKGROUND: The purpose of this study was to conduct a preliminary,
post-market, home
study of the Flexitouch(®) system to examine the potential
efficacy of the device as a component of
self-care in breast cancer
survivors with truncal lymphedema.
METHODS AND RESULTS: A quasi-experimental, pre-treatment, post-treatment
design was
used. Twelve participants received a total of ten
self-administered, consecutive, one hour per day
treatments. Treatments one
and two were observed by study staff and the remaining eight were
unobserved. Assessments were conducted at baseline, after the first two
treatments, mid-way
through therapy, and at the end-of-study. Logs revealed
100% compliance with the eight prescribed
unobserved home treatments.
Symptoms were assessed by self-report symptom surveys. Signs,
objectively
observed physical phenomenon, were assessed by staff-initiated skin examination
and
circumferential truncal measurements. Statistically significant
improvement in truncal symptoms and
sleep were found. Changes in function
and girth were not statistically significant in this initial study.
CONCLUSIONS: Breast cancer survivors with truncal lymphedema may benefit from
using an
advanced pneumatic compression devices with truncal treatment as
part of their self-care program.
Participants were highly compliant in
device use. Further research of this intervention is warranted.
To
facilitate future research, clinically meaningful reductions in truncal girth
should be defined.
PMID: 21190493 [PubMed - in process]PMCID: PMC3008167 [Available on
2011/12/1]
Lymphat Res Biol. 2010 Dec;8(4):v.
Accruing evidence for a beneficial role of pneumatic biocompression in
lymphedema.
Rockson SG.
Comment on:
Lymphat Res Biol. 2010 Dec;8(4):183-7.
Lymphat Res Biol. 2010 Dec;8(4):209-15.
PMID: 21190488 [PubMed - in process]
Rev Med Liege. 2010 Nov;65(11):655-61.
[How to diagnose the cause of oedema, a clinical approach].
[Article in French]
Krzesinski JM.
Universite de Liège, Service de Néphrologie-Dialyse-Hypertension, CHU de
Liège, Belgique. jm.
[email protected]
Abstract
Oedema is a frequent disorder and the easily detectable consequence of an
increase of fluid located
in the interstitial tissue. It could be localized
or generalized and related either to a primary
disturbance of hemodynamics
at the capillary level, due to a modification of the Starling's law
components with secondary water and saline retention, or to a primary
retention of salt and water
linked to a kidney abnormality. Generalized
forms are pitting oedema, most often painless, white,
bilateral and
symmetric, distributed at the lower part of the body (localisation according to
the
gravitation law). They are different in their characteristics from
localized oedema or lymphoedema
which are tough. We propose a diagnostic
approach based on medical history, clinical examination
which allows a
confident medical diagnosis and so an adapted therapy.
PMID: 21189533 [PubMed - in process]
January 7, 2011
J Travel Med. 2011 Jan;18(1):68-9. doi: 10.1111/j.1708-8305.2010.00472.x.
Epub 2010 Nov 25.
Lymphedema in a guyanan migrant.
Depetrillo JC, Singer C.
Division of Infectious Diseases, Department of Medicine, Long Island Jewish
Medical Center, New
Hyde Park, NY, USA.
PMID: 21199149 [PubMed - in process]
J Pain Res. 2010 Aug 20;3:147-53.
Pilot study: rapidly cycling hypobaric pressure improves pain after 5 days in
adiposis dolorosa.
Herbst KL, Rutledge T.
Department of Medicine, University of California, San Diego, California,
USA;
Abstract
Adiposis dolorosa (AD) is a rare disorder of painful nodular subcutaneous fat
accompanied by
fatigue, difficulty with weight loss, inflammation, increased
fluid in adipose tissue (lipedema and
lymphedema), and hyperalgesia.
Sequential compression relieves lymphedema pain; we therefore
hypothesized
that whole body cyclic pneumatic hypobaric compression may relieve pain in AD.
To
avoid exacerbating hyperalgesia, we utilized a touch-free method, which
is delivered via a high-
performance altitude simulator, the Cyclic
Variations in Altitude Conditioning™ (CVAC™)
process. As a pilot study, 10
participants with AD completed pain and quality of life questionnaires
before and after 20-40 minutes of CVAC process daily for 5 days.
Participants lost weight (195.5
± 17.6-193.8 ± 17.3 lb; P = 0.03), and
bioimpedance significantly decreased (510 ± 36-490 ± 38
ohm; P = 0.01).
There was a significant decrease in scores on the Pain Catastrophizing Scale (P
=
0.039), in average (P = 0.002), highest (P = 0.029), lowest (P = 0.04),
and current pain severity (P
= 0.02) on the Visual Analogue Scale, but there
was no change in pain quality by the McGill Pain
Questionnaire. There were
no significant changes in total and physical SF-36 scores, but the mental
score improved significantly (P = 0.049). There were no changes in the Pain
Disability Index or
Pittsburgh Sleep Quality Index. These data present a
potential, new, noninvasive means of treating
pain in AD by whole body
pneumatic compression as part of the CVAC process. Although
randomized,
controlled trials are needed to confirm these data, the CVAC process could
potentially
help in treating AD pain and other chronic pain disorders.
PMID: 21197318 [PubMed - in process]PMCID: PMC3004643
January 11, 2011
Int J Clin Oncol. 2011 Jan 7. [Epub ahead of print]
Risk factors for lower-limb lymphedema after surgery for cervical cancer.
Ohba Y, Todo Y, Kobayashi N, Kaneuchi M, Watari H, Takeda M, Sudo S, Kudo M,
Kato H,
Sakuragi N.
Department of Gynecology, Hokkaido University Graduate School of Medicine,
N15W7 Kita-ku,
Sapporo, 060-8638, Japan.
Abstract
BACKGROUND: Lower-limb lymphedema (LLL) is a prevalent complication that is
encountered
after treatment for gynecological malignancies. The aim of this
study was to evaluate the risk factors
for postoperative LLL in patients
with cervical cancer.
METHODS: We conducted a retrospective chart review for patients who had
undergone surgery,
including systematic lymphadenectomy, for cervical
cancer. Patients who died of cancer, were
evaluated for short periods of
time (<2 years), had missing medical records, or were suffering from
deep
venous thrombosis were excluded. We utilized the International Society of
Lymphology staging
of lymphedema severity as the diagnostic criteria for
LLL, and patients with stage II or III
lymphedema, as objectively determined
by physicians, were included in the group of patients with
LLL. Multivariate
analysis was performed to confirm independent risk factors.
RESULTS: A total of 155 patients with cervical cancer were evaluated.
Thirty-one patients (20.0%)
contracted LLL with a median follow-up of 6.1
years. Suprafemoral node dissection (odds ratio,
9.5; 95% confidence
interval, 1.2-73.3; P = 0.031) and adjuvant radiotherapy (3.7; 1.2-10.9; P =
0.019) were identified as independent risk factors.
CONCLUSION: Given that the effectiveness of the above two therapeutic options
for cervical
cancer is currently controversial, the clinical benefits of
these therapies should be reevaluated
specifically to conserve the quality
of life for patients with this disease.
PMID: 21213009 [PubMed - as supplied by publisher]
Eur J Med Genet. 2011 Jan 3. [Epub ahead of print]
3.7 Mb tandem microduplication in chromosome 5p13.1-p13.2 associated with
developmental
delay, macrocephaly, obesity, and lymphedema. Further
characterization of the dup(5p13)
syndrome.
Oexle K, Hempel M, Jauch A, Meitinger T, Rivera-Brugués N, Stengel-Rutkowski
S, Strom T.
Institute of Human Genetics, Technische Universität München, Munich,
Germany.
Abstract
In a male patient with developmental delay, autistic behaviour, obesity,
lymphedema, hypertension,
macrocephaly, and facial features of chromosome 5p
duplication (trisomy 5p) a 3.7 Mb de novo
tandem microduplication of
5p13.1-13.2 (rs4703415-rs261752, i.e., chr5:35.62-39.36Mb) was
identified.
This observation contributes to the characterization and dissection of the 5p13
duplication
syndrome. The possible role of increased NIPBL gene dosage is
discussed.
Copyright © 2010. Published by Elsevier Masson SAS.
PMID: 21211577 [PubMed - as supplied by publisher]
January 14, 2011
Nurs Sci Q. 2011 Jan;24(1):57-63.
Limitations of self-care in reducing the risk of lymphedema:
supportive-educative systems.
Armer JM, Brooks CW, Stewart BR.
University of Missouri, USA.
Abstract
The purpose of this study was to examine patient perceptions of
limitations related to self-care
measures to reduce lymphedema risk
following breast cancer surgery. Secondary analysis of survey
data from a
companion study to a study piloting a behavioral-educational intervention was
conducted to examine the specific limitations in performing lymphedema
risk-reduction self-care
measures. Findings suggest a more comprehensive
approach is needed if patients are to engage in
self-care actions to reduce
lymphedema risk. Understanding the concepts of self-care and personal
support interventions that include motivational interviewing can help nurses
design supportive-
educative care systems that assist patients in overcoming
limitations in the estimative, transitional, and
productive phases of
self-care necessary to reduce lymphedema risk.
PMID: 21220577 [PubMed - in process]
January 18, 2011
Eur J Dermatol. 2011 Jan 14. [Epub ahead of print]
Intra-arterial mitoxantrone/paclitaxel in angiosarcoma of the lower limb
associated with chronic
lymphedema (Stewart-Treves syndrome) in a patient
with cervical cancer.
Fujisawa Y, Ito M, Mori K, Okada S, Nakamura Y, Kawachi Y, Otsuka F.
Department of Dermatology, University of Tsukuba, 1-1-1 Tennodai, 305-8575
Tsukuba, Japan.
PMID: 21233070 [PubMed - as supplied by publisher]
Acta Oncol. 2011 Feb;50(2):187-93.
Late effects of breast cancer treatment and potentials for
rehabilitation.
Ewertz M, Jensen AB.
Department of Oncology, Odense University Hospital, Institute of Clinical
Research, University of
Southern Denmark, Denmark.
Abstract
Abstract Background. Breast cancer is the most frequent malignant disease
among women world
wide. Survival has been improving leading to an increasing
number of breast cancer survivors, in the
US estimated to about 2.6 million.
Material and methods. The literature was reviewed with focus on
data from
the Nordic countries. Results. Local therapies such as breast cancer surgery and
radiotherapy may cause persistent pain in the breast area, arm, and shoulder
reported by 30-50% of
patients after three to five years, lymphedema in
15-25% of patients, and restrictions of arm and
shoulder movement in 35%.
Physiotherapy is the standard treatment for the latter while no pain
intervention trials have been published. Chemotherapy may cause infertility
and premature
menopause, resulting in vasomotor symptoms, sexual
dysfunction, and osteoporosis, which are
similar to the side effects of
endocrine treatment in postmenopausal women. Awareness of
cardiotoxicity is
needed since anthracyclines, trastuzumab, and radiotherapy can damage the heart.
Breast cancer survivors have an increased risk of a major depression and far
from all receive
adequate anti-depressive treatment. Other psychological
symptoms include fear of recurrence, sleep
disturbances, cognitive problems,
fatigue, and sexual problems. Discussion. To improve
rehabilitation,
specific goals have to be formulated into national guidelines and high priority
directed
towards research into developing and testing new interventions for
alleviating symptoms and side
effects experienced by breast cancer
survivors.
PMID: 21231780 [PubMed - in process]
Lymphology. 2010 Sep;43(3):135-45.
Assessment of quality of life in lymphedema patients: validity and
reliability of the Swedish version of
the Lymphedema Quality of Life
Inventory (LQOLI).
Klernäs P, Kristjanson LJ, Johansson K.
Department of Physiotherapy, Institution of Neurobiology, Care Sciences and
Society, Karolinska
Institute, Stockholm, Sweden. [email protected]
Abstract
The Lymphedema Quality of Life Inventory (LQOLI) is an instrument
developed for patients with
different types of lymphedema. It contains
physical, emotional, social, and practical dimensions and
consists of 58
items, each with three sub items concerning life quality, daily life changes,
and
difficulties of changing and two items concerning life quality in
general and in relation to lymphedema.
The purpose of this study was to
adapt the Australian LQOLI to Swedish conditions and to test it
for clarity,
face validity, content validity, construct validity, and reliability. Content
and face validity
was completed by experts (n=11) and patients with
different types of lymphedema (n=16). For
construct validation the SF-36
(n=63) was used. Test-retest reliability was evaluated with
lymphedema
patients (n=58) answering the questionnaire twice, within median 3 weeks. Three
items
were added in the Swedish version of LQOLI (SLQOLI). The kappa
coefficients in test-retest for
all items and sub items varied (range =
0.25-0.83). Construct validity showed moderate correlation
with SF-36. The
SLQOLI is adapted and valid, with moderate reliability, and it can be used in
clinic
to describe life quality for patients with lymphedema. In this study,
67% of the patients experienced
an effect on life quality within the
physical dimension and 54-58% within the emotional, social, and
practical
dimensions.
PMID: 21226416 [PubMed - indexed for MEDLINE]
Lymphology. 2010 Sep;43(3):118-27.
Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60
months.
Armer JM, Stewart BR.
Sinclair School of Nursing, University of Missouri, Columbia, Missouri 65211,
USA.
[email protected]
Abstract
Breast cancer survivors are at life-time risk of developing lymphedema
(LE). Quantification of LE
has been problematic as the criteria used to
identify lymphedema use various methods to assess
changes in the volume of
the affected limb. In part because of difficulties and variability in
measurement and diagnosis, the reported incidence of LE varies greatly among
women treated with
surgery and radiation for breast cancer. The goal of this
research was to describe the trends for LE
occurrence over three points in
time (12, 30, and 60 months) among breast cancer survivors using
four
diagnostic criteria based on three measurement techniques. Participants were
enrolled following
diagnosis of breast cancer but before surgery. Baseline
limb volume and symptom assessment data
were obtained. Participants were
followed every 3 months for 12 months, then every 6 months
thereafter for a
total of 60 months. Limb volume changes (LVC) in both limbs were measured using
three techniques: objectively by (a) circumferences at 4 cm intervals and
(b) perometry and
subjectively by (c) symptom experience via interview. Four
diagnostic criteria for LE most often
reported in the literature were used:
(i) 2 cm circumferential change; (ii) 200 mL perometry LVC;
(iii) 10%
perometry LVC; and (iv) signs and symptoms (SS) report of limb heaviness and
swelling,
either 'now' or 'in the past year' (diagnostic criteria i-iii
define increases/differences in limb volume
from baseline and/or between the
affected and non-affected limb). Standard survival analysis
methods were
applied to identify when the criteria corresponding to LE were met. Trends in LE
occurrence are reported for preliminary analysis of data from 236
participants collected at 6-, 12-,
18-, 24-, 30-, and 60-months post-op. At
60 months post-treatment, LE incidence using the four
criteria ranged from
43% to 94%, with 2 cm associated with the highest frequency for lymphedema
occurrence and SS the lowest. Sixty-month trends are compared to earlier
trends at 12- and 30-
months, per criterion. These preliminary findings
provide additional evidence that breast cancer
survivors are at risk for
developing LE beyond the first year following treatment. Cases of
lymphedema
continue to emerge through 60-months post-breast cancer surgery. This 60-month
analysis supports the previous 12- and 30-month analyses in finding the 2 cm
criteria to be the most
liberal definition of LE. The self-report of
heaviness and swelling, along with 10% LVC, represent
the most conservative
definitions (41% and 45%, respectively). Furthermore, the variety of criteria
used to identify LE, along with the absence of baseline (pre-treatment)
measurements, likely
contribute to the wide range of LE incidence rates
reported in the literature.
PMID: 21226414 [PubMed - indexed for MEDLINE]
Mayo Clin Health Lett. 2010 Dec;28(12):6.
Lymphedema. Swelling not to be ignored.
[No authors listed]
PMID: 21226243 [PubMed - indexed for MEDLINE]
January 21, 2011
Support Care Cancer. 2011 Jan 16. [Epub ahead of print]
Body mass index and breast cancer treatment-related lymphedema.
Ridner SH, Dietrich MS, Stewart BR, Armer JM.
School of Nursing, Vanderbilt University, 460 21st Avenue South, 525 Godchaux
Hall, Nashville,
TN, 37240, USA, [email protected].
Abstract
PURPOSE: The main purpose was to examine longitudinally the influence of
body mass index
(BMI) and obesity on the development of breast cancer
treatment-related lymphedema. We asked,
does elevated BMI increase
lymphedema risk?
METHODS: A secondary analysis was conducted on de-identified data collected
from 138 newly
diagnosed breast cancer survivors who had arm-volume
measurements and symptom assessment at
pre-treatment baseline and
measurements up to 30 months post-surgery in a prospective longitudinal
parent study. Arm volume and weight data, part of the information collected
during each participant
visit, were examined.
RESULTS: Breast cancer survivors whose BMI was =30 at the time of breast
cancer treatment
were approximately 3.6 times more likely to develop
lymphedema at 6 months or greater after
diagnosis than those with a
BMI?<?30 at the time of cancer treatment (95% confidence interval, C.
I.,
for odds ratio, O.R., 1.42-9.04; p?=?0.007). Those with a general BMI increase
or a BMI rise
to 30 or greater during their first 30 months of survivorship
were not more likely to develop late-
onset lymphedema than those who did not
have similar changes in BMI.
CONCLUSIONS: Pre-treatment BMI may be a risk factor for lymphedema. Weight
gain post-
treatment may not be.
Further research is warranted.
PMID: 21240649 [PubMed - as supplied by publisher]
Ann Chir Plast Esthet. 2011 Jan 13. [Epub ahead of print]
[About an extreme case of giant lymphoedema of the upper limb: Ligasure
may be useful and a
multidisciplinary approach is mandatory.]
[Article in French]
Lafosse A, Vandeputte C, Sabor I, Mahaudens P, Denoel C.
Service de chirurgie plastique, cliniques universitaires Saint-Luc, avenue
Hippocrate 10, 1200
Bruxelles, Belgique.
Abstract
Treatment of giant lymphoedema remains very difficult. The main problem
is not only the obtention
of early postoperative favorable results but to
keep them long-lasting. The available treatment
options are numerous and
often combined. The indications have to be adapted to the clinical stage
of
the lesion. Ligasure(®) give us many advantages in the achievement of the
surgical resection due
to the quality of the lymphostasis that can be
obtained and to the very limited thermic lesions caused
to tissues. Long
lasting postoperative physiotherapy is of first importance. We here describe a
case
of a giant lymphoedema of the upper limb after axillary lymph node
dissection for breast cancer. The
first physiotherapy failed, causing a
lymphatic decompensation resulting in a lymphoedematous mass
of nearly 7kg.
The surgical resection with Ligasure(®) associated to drainage and compressive
physiotherapy in the long run allows to obtain good results. The late
follow-up after 4 years still
shows stable results.
Published by Elsevier SAS.
PMID: 21237550 [PubMed - as supplied by publisher]
Ann Chir Plast Esthet. 2011 Jan 13. [Epub ahead of print]
[From microsurgery to supermicrosurgery: Experimental feasibility study
and perspectives.]
[Article in French]
Qassemyar Q, Sinna R.
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord,
CHU d'Amiens, place
Victor-Pauchet, 80054 Amiens cedex 1, France.
Abstract
INTRODUCTION: Supermicrosurgical techniques developed for the anastomoses
less or equal to
0.5mm show convincing results in specialized centers and
with an advanced instrumentation. Can we
integrate supermicrosurgical
training animal models in the current teaching program of microsurgery?.
MATERIALS AND METHODS: Ten arterial anastomoses of the inferior epigastric
artery
(diameter less than or equal to 0.5mm) were performed consecutively
in five rats by the same
beginner operator in microsurgery, with standard
microsurgical set of instruments. The intravascular
stenting anastomosis
method was used with 11-0 nylon sutures. The immediate patency and flap
survival on postoperative day three was assessed. The duration of each
anastomosis was measured.
RESULTS: The mean diameter of the arteries was 0.4mm. The average time for
each anastomosis
was 30 minutes with a maximum of 55 minutes and a minimum
of 18 minutes. The average number
of stitches was 5.5. The immediate patency
was 100 % with a 70 % success rate at the third day.
CONCLUSIONS: There are several applications of supermicrosurgical techniques,
especially in
hand surgery, lymphoedema surgical treatment and for
perforator-to-perforator flaps. The
intravascular stenting method allows
fast learning of the technique with a satisfactory success rate
despite
non-specific instrumentation. Furthermore, this method could easily be
integrated among the
microsurgical courses of many universities.
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21237545 [PubMed - as supplied by publisher]
Health Qual Life Outcomes. 2011 Jan 14;9(1):3. [Epub ahead of print]
Health-related quality of life in Spanish breast cancer patients: a
systematic review.
Delgado-Sanz MC, Garcia-Mendizabal MJ, Pollan M, Forjaz MJ, Lopez-Abente
G, Aragones N,
Perez-Gomez B.
Abstract
BACKGROUND: Breast cancer is one of the oncological diseases in which
health-related quality of
life (HRQL) has been most studied. This is mainly
due to its high incidence and survival. This paper
seeks to: review
published research into HRQL among women with breast cancer in Spain; analyse
the characteristics of these studies; and describe the instruments used and
main results reported.
METHODS: The databases consulted were MEDLINE, EMBASE, PsycINFO, Dialnet,
IBECS,
CUIDEN, ISOC and LILACS. The inclusion criteria required studies to:
1) include Spanish
patients, and a breakdown of results where other types of
tumours and/or women from other
countries were also included; and, 2)
furnish original data and measure HRQL using a purpose-
designed
questionnaire. The methodological quality of the studies was assessed.
RESULTS: Spain ranked midway in the European Union in terms of the number of
studies
conducted on the HRQL of breast cancer patients. Of the total of 133
papers published from 1993
to 2009, 25 met the inclusion criteria. Among
them, only 12 were considered as having good or
excellent quality. A total
of 2236 women participated in the studies analysed. In descending order of
frequency, the questionnaires used were the EORTC, FACT-B, QL-CA-Afex,
SF-12, FLIC,
RSCL and CCV. Five papers focused on validation or adaptation
of questionnaires. Most papers
examined HRQL in terms of type of treatment.
Few differences were detected by type of
chemotherapy, with the single
exception of worse results among younger women treated with
radiotherapy. In
the short term, better results were reported for all HRQL components by women
undergoing conservative rather than radical surgery. Presence of lymphedema
was associated with
worse HRQL. Three studies assessed differences in HRQL
by patients' psychological traits.
Psychosocial disorder and level of
depression and anxiety, regardless of treatment or disease stage,
worsened
HRQL. In addition, there was a positive effect among patients who reported
having a
"fighting spirit" and using "denial" as a defence mechanism. One
study found that breast cancer
patients scored worse than did healthy women
on almost all SF-12 scales.
CONCLUSION: Research into health-related quality of life of breast-cancer
patients is a little
developed field in Spain.
PMID: 21235770 [PubMed - as supplied by publisher]
January 22, 2011
Klin Monbl Augenheilkd. 2011 Jan;228(1):19-24. Epub 2011 Jan 19.
[Chronic Eyelid Oedema and Rosacea (Morbus Morbihan): Diagnostic and
Therapeutic Challenges.]
[Article in German]
Renieri G, Brochhausen C, Pfeiffer N, Pitz S.
Augenklinik und Poliklinik, Universitätsmedizin der
Johannes-Gutenberg-Universität, Mainz.
Abstract
BACKGROUND: Morbus Morbihan is a rare complication of rosacea, consisting
of a persistent
lymphoedema of the upper part of the face. It has typically
a chronic course, unspecific
histopathological findings and an extreme
refractoriness to therapy.
PATIENTS AND METHODS: Between February 2008 and January 2010, 5 patients with
Morbus Morbihan were observed at the Department of Ophthalmology of the
University Medical
Centre Mainz. In the present cohort study, we describe
the clinical, laboratory and histological
findings that led to the
diagnosis. The course of the affection and the results of different therapeutic
options are also reported.
RESULTS: Each patient underwent a complete ophthalmological examination, as
well as general
and dermatological consultations. All patients showed facial
skin alterations typical for rosacea. 4
out of 5 subjects underwent a lid
biopsy to confirm the diagnosis of Morbus Morbihan, one patient
refused it.
Initial treatment consisted of various systemic and local medical therapies,
however, with
poor success. One patient had intravenous therapy with
corticosteroids elsewhere with no effect.
We treated 3 cases with
intralesional triamcinolone injections with good results. 2 patients
underwent upper lid blepharoplasty. Results of surgery remained stable also
due to manual lymph
drainage and intralesional injections of triamcinolon.
No complications or side effects were seen in
patients treated with
triamcinolone.
CONCLUSIONS: Morbus Morbihan can be diagnosed only after excluding other
conditions
leading to chronic lid swelling. In our series, good results were
achieved with intralesional injection of
triamcinolone. Surgery also led to
relevant improvements for a long period (13 months), with some
adjuvant
therapy. The treatment of chronic eyelid oedema associated with rosacea remains
a
challenge for the ophthalmologist and the oculoplastic surgeon.
Georg Thieme Verlag KG Stuttgart · New York.
PMID: 21249610 [PubMed - as supplied by publisher]
January 25, 2011
Klin Monbl Augenheilkd. 2011 Jan;228(1):19-24. Epub 2011 Jan 19.
[
Chronic Eyelid Oedema and Rosacea (Morbus Morbihan): Diagnostic and
Therapeutic Challenges.]
[Article in German]
Renieri G, Brochhausen C, Pfeiffer N, Pitz S.
Augenklinik und Poliklinik, Universitätsmedizin der
Johannes-Gutenberg-Universität, Mainz.
Abstract
BACKGROUND: Morbus Morbihan is a rare complication of rosacea, consisting
of a persistent
lymphoedema of the upper part of the face. It has typically
a chronic course, unspecific
histopathological findings and an extreme
refractoriness to therapy.
PATIENTS AND METHODS: Between February 2008 and January 2010, 5 patients with
Morbus Morbihan were observed at the Department of Ophthalmology of the
University Medical
Centre Mainz. In the present cohort study, we describe
the clinical, laboratory and histological
findings that led to the
diagnosis. The course of the affection and the results of different therapeutic
options are also reported.
RESULTS: Each patient underwent a complete ophthalmological examination, as
well as general
and dermatological consultations. All patients showed facial
skin alterations typical for rosacea. 4
out of 5 subjects underwent a lid
biopsy to confirm the diagnosis of Morbus Morbihan, one patient
refused it.
Initial treatment consisted of various systemic and local medical therapies,
however, with
poor success. One patient had intravenous therapy with
corticosteroids elsewhere with no effect.
We treated 3 cases with
intralesional triamcinolone injections with good results. 2 patients
underwent upper lid blepharoplasty. Results of surgery remained stable also
due to manual lymph
drainage and intralesional injections of triamcinolon.
No complications or side effects were seen in
patients treated with
triamcinolone.
CONCLUSIONS: Morbus Morbihan can be diagnosed only after excluding other
conditions
leading to chronic lid swelling. In our series, good results were
achieved with intralesional injection of
triamcinolone. Surgery also led to
relevant improvements for a long period (13 months), with some
adjuvant
therapy. The treatment of chronic eyelid oedema associated with rosacea remains
a
challenge for the ophthalmologist and the oculoplastic surgeon.
© Georg Thieme Verlag KG Stuttgart · New York.
PMID: 21249610 [PubMed - as supplied by publisher]
Skeletal Radiol. 2011 Jan 20. [Epub ahead of print]
Massive localised lymphoedema: clinical presentation and MR imaging
characteristics.
Khanna M, Naraghi AM, Salonen D, Bhumbra R, Dickson BC, Kransdorf MJ,
White LM.
Department of Clinical Imaging, Imperial College Healthcare NHS Trust,
London, UK, monica.
[email protected].
Abstract
Three morbidly obese women were referred to us with suspected soft-tissue
sarcomas. All lesions
arose from the medial subcutaneous tissues of the
thigh, and were shown to represent massive
localised lymphoedema (MLL), a
rare condition occurring in morbidly obese adults. MR imaging
typically
demonstrates a sharply demarcated, pedunculated mass consisting of fat
partitioned by
fibrous septae surrounded by a thickened dermis. There is
oedema both within the mass and
tracking along the subcutaneous septae in a
"lace-like" fashion outwards from the pedicle, outlining
large lobules of
fat. Minimal enhancement is observed within the dermis of the lesion following
intravenous gadolinium administration. Obesity is a growing problem that is
likely to result in an
increase in the prevalence of this condition;
therefore, familiarity with the radiological appearance is
important in
establishing a correct diagnosis in this condition that may mimic a soft-tissue
sarcoma.
PMID: 21249496 [PubMed - as supplied by publisher]
Am J Physiol Cell Physiol. 2011 Jan 19. [Epub ahead of print]
Temporal and spatial patterns of endogenous danger signal expression
after wound healing and in
response to lymphedema.
Zampell JC, Yan A, Avraham T, Andrade V, Malliaris S, Aschen SZ, Rockson
SG, Mehrara BJ.
1Memorial Sloan-Kettering Cancer Center.
Abstract
While acute tissue injury potently induces endogenous danger signal
expression, the role of these
molecules in chronic wound healing and
lymphedema is undefined. The purpose of this study was to
determine the
spatial and temporal expression patterns of the endogenous danger signals HMGB1
and HSP70 during wound healing and chronic lymphatic fluid stasis. In a
surgical mouse tail model
of tissue injury and lymphedema, HMGB1 and HSP70
expression occurred along a spatial gradient
relative to the site of injury,
with peak expression at the wound and >2-fold reduced expression
within 5
mm (P<0.05). Expression primarily occurred in cells native to injured tissue.
In particular,
HMGB1 was highly expressed by lymphatic endothelial cells
(LECs, >40% positivity; 2-fold
increase in chronic inflammation,
P<0.001). We found similar findings using a peritoneal
inflammation
model. Interestingly, upregulation of HMGB1 (2.2-fold), HSP70 (1.4-fold), and
NF-
kß activation persisted at least 6 weeks post-operatively only in
lymphedematous tissues. Similarly,
we found upregulation of endogenous
danger signals in soft tissue of the arm after axillary
lymphadenectomy in a
mouse model and in matched biopsy samples obtained from patients with
secondary lymphedema comparing normal to lymphedematous arms (2.4-fold
increased HMGB1,
1.9-fold increased HSP70; P<0.01). Finally, HMGB1
blockade significantly reduced inflammatory
lymphangiogenesis within
inflamed draining lymph nodes (35% reduction, P<0.01). In conclusion,
HMGB1 and HSP70 are expressed along spatial gradients and upregulated in
chronic lymphatic
fluid stasis; furthermore, acute expression of endogenous
danger signals may play a role in
inflammatory lymphangiogenesis.
PMID: 21248077 [PubMed - as supplied by publisher]
January 28, 2011
Int J Obes (Lond). 2011 Jan 25. [Epub ahead of print]
Oedema in obesity; role of structural lymphatic abnormalities.
Vasileiou AM, Bull R, Kitou D, Alexiadou K, Garvie NJ, Coppack SW.
East London Obesity Service, Barts and The London Medical School, Homerton
University
Hospital and Nuclear Medicine, The Royal London Hospital, London,
UK.
Abstract
Oedema is a common finding in obesity and its cause is not always clear.
Possible causes include
impairment of cardiac, respiratory and/or renal
function, chronic venous insufficiency and lymphatic
problems.
Lymphoscintigraphy is the best method to detect structural lymphatic
abnormalities that
can cause lymphoedema. We reviewed 49 female subjects
with pitting oedema who had undergone
lymphoscintigraphy, divided in three
groups. The first group was comprised of severely obese
patients in whom
cardiorespiratory causes for oedema had been excluded. The second group
consisted of non-obese patients with recognized causes for oedema and the
third group was non-
obese patients with 'idiopathic' oedema. A standard
classification was used to interpret
lymphoscintigraphy results. The
frequency and severity of lymphoscintigraphic abnormalities was
greatest in
patients with clinical diagnoses of oedema related to 'recognized causes' (any
abnormality
in 50% of legs with obstruction in 22%). Obese patients and
those with 'idiopathic'oedema had
fewer (P=0.02 for both) and milder
lymphoscintographic abnormalities (any abnormality 32 and
25%, respectively,
obstruction 5 and 3%, respectively), and although the clinical oedema was
invariably bilateral, the lymphoscintigraphy abnormalities were usually
unilateral. In conclusion,
structural lymphoscintigraphic abnormalities are
uncommon in obesity and do not closely correlate
with the clinical pattern
of oedema.International Journal of Obesity advance online publication, 25
January 2011; doi:10.1038/ijo.2010.273.
PMID: 21266949 [PubMed - as supplied by publisher]
J Med Genet. 2011 Jan 25. [Epub ahead of print]
Rapid identification of mutations in GJC2 in primary lymphoedema using
whole exome sequencing
combined with linkage analysis with delineation of
the phenotype.
Ostergaard P, Simpson MA, Brice G, Mansour S, Connell FC, Onoufriadis A,
Child AH, Hwang J,
Kalidas K, Mortimer PS, Trembath R, Jeffery S.
1Medical Genetics, St George's, University of London, London, UK.
Abstract
Background Primary lymphoedema describes a chronic, frequently
progressive, failure of lymphatic
drainage. This disorder is frequently
genetic in origin, and a multigenerational family in which eight
individuals
developed postnatal lymphoedema of all four limbs was ascertained from the joint
Lymphoedema/Genetic clinic at St George's Hospital. Methods Linkage analysis
was used to
determine a locus, and exome sequencing was employed to look for
causative variants. Results
Linkage analysis revealed cosegregation of a
16.1 Mb haplotype on chromosome 1q42 that
contained 173 known or predicted
genes. Whole exome sequencing in a single affected individual
was
undertaken, and the search for the causative variant was focused to within the
linkage interval.
This approach revealed two novel non-synonymous single
nucleotide substitutions within the
chromosome 1 locus, in NVL and GJC2. NVL
and GJC2 were sequenced in an additional cohort
of individuals with a
similar phenotype and non-synonymous variants were found in GJC2 in four
additional families. Conclusion This report demonstrates the power of exome
sequencing efficiently
applied to a traditional positional cloning pipeline
in disease gene discovery, and suggests that the
phenotype produced by GJC2
mutations is predominantly one of 4 limb lymphoedema.
PMID: 21266381 [PubMed - as supplied by publisher]
Lik Sprava. 2010 Apr-Jun;(3-4):11-20.
[Lymphedema: clinic-therapeutic aspect].
[Article in Ukrainian]
[No authors listed]
Abstract
Lymphedema may be presented in mild or less severe form. Nowadays,
accurate diagnosis and
effective therapy are available. Wearing surgical
bandage, massage, exercise, and pumps form the
core program for most
patients with lymphedema. The application of pharmacological therapies has
been notably absent from the management strategies for lymphatic vascular
insufficiency states but
lately some progress has been made by applying
wobenzym in the treatment. Surgical approaches to
improve lymphatic flow
through vascular anastamosis have been, in large part, unsuccessful, but
controlled liposuction affords lasting benefit in selected patients.
PMID: 21265117 [PubMed - in process]
Nurs Times. 2010 Dec 14-2011 Jan 10;106(49-50):15-7.
Early diagnosis of lymphoedema helps to reduce its psychological and
social impact.
Cooper G.
Walsall Lymphoedema Service, Walsall Community Health.
Abstract
Lymphoedema is often unrecognised by both health professionals and
patients. In addition, its
impact is often underestimated. This article
discusses how to recognise the condition, the
consequences of misdiagnosis,
reducing or preventing complications and various treatment options.
PMID: 21261161 [PubMed - in process]
Biomed Opt Express. 2010 Jul 15;1(1):114-125.
Direct evidence of lymphatic function improvement after advanced
pneumatic compression device
treatment of lymphedema.
Adams KE, Rasmussen JC, Darne C, Tan IC, Aldrich MB, Marshall MV, Fife
CE, Maus EA,
Smith LA, Guilloid R, Hoy S, Sevick-Muraca EM.
Abstract
Lymphedema affects up to 50% of all breast cancer survivors. Management
with pneumatic
compression devices (PCDs) is controversial, owing to the
lack of methods to directly assess
benefit. This pilot study employed an
investigational, near-infrared (NIR) fluorescence imaging
technique to
evaluate lymphatic response to PCD therapy in normal control and breast
cancer-
related lymphedema (BCRL) subjects. Lymphatic propulsion rate,
apparent lymph velocity, and
lymphatic vessel recruitment were measured
before, during, and after advanced PCD therapy.
Lymphatic function improved
in all control subjects and all asymptomatic arms of BCRL subjects.
Lymphatic function improved in 4 of 6 BCRL affected arms, improvement
defined as proximal
movement of dye after therapy. NIR fluorescence
lymphatic imaging may be useful to directly
evaluate lymphatic response to
therapy. These results suggest that PCDs can stimulate lymphatic
function
and may be an effective method to manage BCRL, warranting future clinical
trials.
PMID: 21258451 [PubMed - as supplied by publisher]PMCID: PMC3005162
Urology. 2011 Jan 20. [Epub ahead of print]
Reconstructive Surgery for Penoscrotal Filarial Lymphedema: A Decade of
Experience and Follow-
up.
Singh V, Sinha RJ, Sankhwar SN, Kumar V.
Department of Urology, Chhatrapati Shahuji Maharaj Medical University
(formerly King George's
Medical University),
Lucknow, India.
Abstract
OBJECTIVES: To present our experience of reconstructive surgery in
patients with penoscrotal
filarial lymphedema.
METHODS: From January 2000 to December 2009, we treated 48 patients with
penile and
penoscrotal filarial lymphedema using reconstructive surgery.
Isolated penile involvement was seen in
14 patients, and 34 patients had
penoscrotal involvement. All the patients had taken multiple courses
of
antifilarial drug before surgery. For isolated penile involvement, the diseased
penile skin was
excised and covered with a split-thickness skin graft. In
some patients, the inner prepucial skin was
preserved and used to cover the
penile shaft. For those with penoscrotal involvement, scrotoplasty
was
performed, after excising the diseased scrotal skin and underlying soft tissue,
while sparing the
testes and spermatic cords.
RESULTS: The mean patient age was 38 years (range 25-52), and the median
follow-up time was
48 months (range 10-120). All 48 patients reported a
satisfactory cosmetic appearance after the
procedure and noted improvement
in their ability to void while standing. Also, all of them could
ambulate
better and resumed sexual activity. Local groin infection was present in 12
patients; all
were cured after proper management.
CONCLUSIONS: In filarial lymphedema of penis and/or scrotum, excision of the
diseased tissue
and covering with a split-thickness skin graft provided good
results. If the inner prepucial skin is
healthy, it should be used to cover
the distal penile shaft. If the scrotum is involved, scrotoplasty with
lateral and posterior mobilized flaps provides satisfactory results.
2011 Elsevier Inc. All rights reserved.
PMID: 21256561 [PubMed - as supplied by publisher]
February 26, 2011 published March 1
Rev Esc Enferm USP. 2010 Dec;44(4):1085-92.
[Effects of the decongestive physiotherapy in the healing of venous
ulcers].
[Article in Portuguese]
Azoubel R, Torres Gde V, da Silva LW, Gomes FV, dos Reis LA.
Departamento de Saúde da Universidade Estadual do Sudeste da Bahia, Jequié,
BA, Brasil.
[email protected]
Abstract
The objective of this study was to verify the effects of the decongestive physiotherapy (DP) in the healing
of venous ulcers. It is an
interventionist, and almost experimental, study with the participation of 20
clients
who were divided into 2 groups: the control group (n = 10) and the
intervention group (n = 10). Clients
from the first group were only treated
with conventional dressing and those in the second group were
treated with
conventional dressing and decongestive physiotherapy (association of techniques:
manual
lymph drainage, compressive bandaging, elevation of the lower limbs,
myolymphokinetic exercises and
skin care). Both groups were treated during
six months. The clients submitted to DP presented significant
reduction of
the edema and the pain, besides an improvement in the healing process. Results
allowed to
verify that the decongestive therapy stimulated the healing
process of venous ulcers, improving the quality
of life of the subjects.
PMID: 21337794 [PubMed - in process]
March 1, 2011
AMIA Annu Symp Proc. 2010 Nov 13;2010:912-6.
Efficient selection of association rules from lymphedema symptoms data using
a graph structure.
Xu S, Shyu CR.
Informatics Institute.
Abstract
Secondary lymphedema (LE) is a chronic progressive disease often caused by
cancer treatment,
especially in patients who require surgical removal of or
radiation to lymph nodes. While LE is incurable,
it can be managed
successfully with early detection and appropriate treatment. Detection and
prediction
of LE is difficult due to the absence of a "gold standard" for
diagnosis. Despite this, management of the
disease is accomplished through
adherence to a set of guidelines developed by experts in the field.
Unfortunately, not all the recommendations in such a document are supported
by clear research evidence,
and most of them are only based on expert
judgment with limited evidence. This paper focuses on
developing a new
algorithm to extract specific association rules from LE survey data and
efficiently index
the rules for easy knowledge retrieval, with the ultimate
goal discovering evidence-based and relevant
knowledge for inclusion into
the best practice document (BP) for the LE community.
PMID: 21347111 [PubMed - in process]
Cutan Ocul Toxicol. 2011 Feb 24. [Epub ahead of print]
Evaluation of microbiological spectrum and risk factors of cellulitis in
hospitalized patients.
Serdar ZA, Akçay SS, Inan A, Dagli O.
Haydarpasa Numune Training and Research Hospital, Dermatology, Istanbul,
Turkey.
Abstract
Background and design: Cellulitis is a common soft tissue infection and the
severity of disease vary from
mild to life threatening. The aim of the
present retrospective study was to evaluate age, sex, site of
infection,
microbiological spectrum and the risk factors of cellulitis in hospitalized
patients. Materials and
methods: The data were retrospectively obtained by
the review of 185 hospitalized patients who were
diagnosed as cellulitis
between 2003 and 2009 in the departments of dermatology, infectious diseases,
internal medicine and surgery clinics of Haydarpasa Numune Training and
Research Hospital (Istanbul,
Turkey). The diagnosis was done by infectious
diseases and dermatology specialists in all patients who
were included to
this study. Demographic findings, wound-blood cultures and risk factors of the
patients
with cellulitis were evaluated. Results: Eighty-six were female, 99
were male of total 185 patients, and the
mean age of them was 48?±?27
(14-85). The leg was the involved site in 69% of the patients. The most
frequent isolated bacteria from wound cultures were methicillin-sensitive
Staphylococcus aureus 31.5%,
Pseudomonas aeruginosa 12.6%, and Escherichia
coli 12.3%. However, methicillin-sensitive S. aureus
32.5%,
methicillin-resistant S. aureus 22.5%, coagulase-negative staphylococci 17.5%
were detected
from blood cultures. There was not any underlying risk factor
in 104 (55.3%) patients. The risk factors
observed in the other 81 patients
were previous surgery or open wound 29 (35.8%), diabetes mellitus 19
(26.6%), cardiovascular diseases 16 (19.7%), immunosuppression 11 (13.5%),
lymphoedema 6 (7.4%).
Conclusion: In the patients hospitalized for
cellulitis, the most frequently isolated microorganism from the
wound and
blood cultures was S. aureus and the most frequently detected risk factors were
to have an
open wound and previous surgery. Especially when the patients had
risk factors, it was observed that the
bacterial spectrum was broader and
the clinical presentation was severe. The wound and blood cultures
should be
performed simultaneously for the microbiological diagnosis and the appropriate
management of
cellulitis.
PMID: 21345156 [PubMed - as supplied by publisher]
March 5, 2011
World J Gastrointest Oncol. 2011 Feb 15;3(2):19-23.
Intestinal lymphangiectasia in adults.
Freeman HJ, Nimmo M.
Hugh James Freeman, Department of Medicine (Gastroenterology), University of
British Columbia,
Vancouver, BC, V6T 1W5, Canada.
Abstract
Intestinal lymphangiectasia in the adult may be characterized as a disorder
with dilated intestinal lacteals
causing loss of lymph into the lumen of the
small intestine and resultant hypoproteinemia,
hypogammaglobulinemia,
hypoalbuminemia and reduced number of circulating lymphocytes or
lymphopenia. Most often, intestinal lymphangiectasia has been recorded in
children, often in neonates,
usually with other congenital abnormalities but
initial definition in adults including the elderly has become
increasingly
more common. Shared clinical features with the pediatric population such as
bilateral lower
limb edema, sometimes with lymphedema, pleural effusion and
chylous ascites may occur but these reflect
the severe end of the clinical
spectrum. In some, diarrhea occurs with steatorrhea along with increased
fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin
levels, while others may present with
iron deficiency anemia, sometimes
associated with occult small intestinal bleeding. Most lymphangiectasia
in
adults detected in recent years, however, appears to have few or no clinical
features of malabsorption.
Diagnosis remains dependent on endoscopic changes
confirmed by small bowel biopsy showing
histological evidence of intestinal
lymphangiectasia. In some, video capsule endoscopy and enteroscopy
have
revealed more extensive changes along the length of the small intestine. A
critical diagnostic element
in adults with lymphangiectasia is the exclusion
of entities (e.g. malignancies including lymphoma) that
might lead to
obstruction of the lymphatic system and "secondary" changes in the small bowel
biopsy. In
addition, occult infectious (e.g. Whipple's disease from
Tropheryma whipplei) or inflammatory disorders
(e.g. Crohn's disease) may
also present with profound changes in intestinal permeability and
protein-
losing enteropathy that also require exclusion. Conversely, rare
B-cell type lymphomas have also been
described even decades following
initial diagnosis of intestinal lymphangiectasia. Treatment has been
historically defined to include a low fat diet with medium-chain
triglyceride supplementation that leads to
portal venous rather than lacteal
uptake. A number of other pharmacological measures have been
reported or
proposed but these are largely anecdotal. Finally, rare reports of localized
surgical resection
of involved areas of small intestine have been described
but follow-up in these cases is often limited.
PMID: 21364842 [PubMed - in process]
J Cutan Pathol. 2011 Mar 1. doi: 10.1111/j.1600-0560.2011.01691.x. [Epub
ahead of print]
Verruciform xanthoma: localized lymphedema (elephantiasis) is an essential
pathogenic factor.
Lu S, Rohwedder A, Murphy M, Andrew Carlson J.
Department of Pathology, University of Maryland, Baltimore, MD, USA Am Weiher
14, Kalkar,
Germany Department of Dermatology, University of Connecticut
Medical Center, Framington, CT, USA
Divisions of Dermatopathology and
Dermatology, Albany Medical College MC-81, Albany, NY, USA.
PMID: 21362016 [PubMed - as supplied by publisher]
Glob Public Health. 2011 Feb 24:1-17. [Epub ahead of print]
Lymphoedema management: An international intersect between developed and
developing countries.
Similarities, differences and challenges.
Stout NL, Brantus P, Moffatt C.
Breast Care Department, National Naval Medical Center, Bethesda, MD, USA.
Abstract
Lymphoedema is a chronic swelling condition that contributes to disability,
dysfunction and lost quality of
life. Significant disparities exist
worldwide regarding the availability of resources necessary to identify,
treat and manage lymphoedema. This disparity transcends socio-economic
status and is a common
problem in both developed and developing countries.
The overall impact of lymphoedema as a public
health problem, however, is
underestimated, principally due to the lack of epidemiologic data. These
problems pose barriers to optimal identification and management of this
disabling, lifelong condition. In
1997, the World Health Organization
(50.29) resolved that lymphatic filariasis should be eliminated as a
public
health problem. A component of this strategy focuses on disability management
for those suffering
from lymphatic filariasis-related morbidity. This
initiative has enhanced lymphoedema awareness in
developing countries.
However, significant deficits persist in health care providers' knowledge,
educational initiatives and basic disease identification and treatment. In
developed countries,
lymphoedema continues to be an underrecognised
condition and assumed to be only cancer-related.
Health care resources
allocated to treat and manage the disease are insufficient for basic and ongoing
care, resulting in disease progression and disability. The International
Lymphoedema Framework project,
established in 2002, seeks to establish a
consensus for best practices in the management of lymphoedema
worldwide to
reduce this disability burden. A basic global construct for lymphoedema
management is
needed to decrease morbidity and promote optimal disease
management across all cultural and socio-
economic boundaries. Many countries
are unaware of the importance of lymphoedema management and
have not defined
a national strategy with respect to this problem. The objective of this article
is to define
similarities and differences in strategies for lymphoedema
management between developed and
developing countries and advocate for a
cohesive and concerted approach to disease management.
PMID: 21360379 [PubMed - as supplied by publisher
PLoS One. 2011 Feb 17;6(2):e17201.
Mechanisms of lymphatic regeneration after tissue transfer.
Yan A, Avraham T, Zampell JC, Aschen SZ, Mehrara BJ.
The Division of Plastic and Reconstructive Surgery, Department of Surgery,
Memorial Sloan-Kettering
Cancer Center, New York, New York, United States of
America.
Abstract
INTRODUCTION: Lymphedema is the chronic swelling of an extremity that occurs
commonly after
lymph node resection for cancer treatment. Recent studies
have demonstrated that transfer of healthy
tissues can be used as a means of
bypassing damaged lymphatics and ameliorating lymphedema. The
purpose of
these studies was to investigate the mechanisms that regulate lymphatic
regeneration after
tissue transfer.
METHODS: Nude mice (recipients) underwent 2-mm tail skin excisions that were
either left open or
repaired with full-thickness skin grafts harvested from
donor transgenic mice that expressed green
fluorescent protein in all
tissues or from LYVE-1 knockout mice. Lymphatic regeneration, expression of
VEGF-C, macrophage infiltration, and potential for skin grafting to bypass
damaged lymphatics were
assessed.
RESULTS: Skin grafts healed rapidly and restored lymphatic flow. Lymphatic
regeneration occurred
beginning at the peripheral edges of the graft,
primarily from ingrowth of new lymphatic vessels originating
from the
recipient mouse. In addition, donor lymphatic vessels appeared to spontaneously
re-anastomose
with recipient vessels. Patterns of VEGF-C expression and
macrophage infiltration were temporally and
spatially associated with
lymphatic regeneration. When compared to mice treated with excision only,
there was a 4-fold decrease in tail volumes, 2.5-fold increase in lymphatic
transport by
lymphoscintigraphy, 40% decrease in dermal thickness, and 54%
decrease in scar index in skin-grafted
animals, indicating that tissue
transfer could bypass damaged lymphatics and promote rapid lymphatic
regeneration.
CONCLUSIONS: Our studies suggest that lymphatic regeneration after tissue
transfer occurs by
ingrowth of lymphatic vessels and spontaneous
re-connection of existing lymphatics. This process is
temporally and
spatially associated with VEGF-C expression and macrophage infiltration.
Finally, tissue
transfer can be used to bypass damaged lymphatics and
promote rapid lymphatic regeneration.
PMID: 21359148 [PubMed - in process]
March 10, 2011
Head Neck. 2011 Mar 3. doi: 10.1002/hed.21689. [Epub ahead of print]
Morbidity of supraomohyoidal and modified radical neck dissection combined
with radiotherapy for head
and neck cancer. A prospective longitudinal
study.
Ahlberg A, Nikolaidis P, Engström T, Gunnarsson K, Johansson H, Sharp L,
Laurell G.
Department of Otolaryngology and Head and Neck Surgery, Karolinska University
Hospital, Stockholm,
Sweden; Department of Clinical Sciences, Intervention
and Technology (CLINTEC), Karolinska
Institutet, Stockholm, Sweden. [email protected].
Abstract
BACKGROUND: The purpose of this study was to show the investigated impact of
supraomohyoidal
neck dissection and modified radical neck dissection, both
combined with radiotherapy, on cervical range
of motion (CROM), mouth
opening, swallowing, lymphedema, and shoulder function.
METHODS: One hundred eight patients who had neck dissections and 98 patients
who had non-neck
dissections were evaluated in a prospective, nonselective,
longitudinal cohort study by a physiotherapist
and a speech-language
pathologist (SLP) before the start of radiotherapy and up to 12 months after
treatment.
RESULTS: The incidence of shoulder disability after neck dissection was 18%.
Supraomohyoidal neck
dissection had no significant effect on the evaluated
parameters at any time point. Modified radical neck
dissection significantly
reduced CROM and mouth opening 2 months after treatment, but after 12 months
only cervical rotation was still significantly reduced.
CONCLUSION: In patients treated with external beam radiation (EBRT), modified
radical neck
dissection induced additional morbidity regarding CROM but not
regarding mouth opening, swallowing,
and lymphedema 1 year after treatment.
Both modified radical neck dissection and supraomohyoidal
neck dissection
induced shoulder disability. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.
Copyright © 2010 Wiley Periodicals, Inc.
PMID: 21374755 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Mar 3. [Epub ahead of print]
Surgical Prevention of Arm Lymphedema After Breast Cancer Treatment.
Boccardo FM, Casabona F, Friedman D, Puglisi M, De Cian F, Ansaldi F, Campisi
C.
Department of Surgery, Unit of Lymphatic Surgery, S. Martino Hospital,
University of Genoa, Genoa,
Italy, [email protected].
Abstract
PURPOSE: To prospectively assess the efficacy of the lymphatic microsurgical
preventive healing
approach (LYMPHA) to prevent lymphedema after axillary
dissection (AD) for breast cancer treatment.
METHODS: Among 49 consecutive women referred from March 2008 to September
2009 to undergo
complete AD, 46 were randomly divided in 2 groups.
Twenty-three underwent the LYMPHA technique
for the prevention of arm
lymphedema. The other 23 patients had no preventive surgical approach
(control group). The LYMPHA procedure consisted of performing
lymphatic-venous anastomoses
(LVA) at the time of AD. All patients underwent
preoperative lymphoscintigraphy (LS). Patients were
followed up clinically
at 1, 3, 6, 12, and 18 months by volumetry. Postoperatively, LS was performed
after 18 months in 41 patients (21 treatment group and 20 control group).
Arm volume and LS alterations
were assessed.
RESULTS: Lymphedema appeared in 1 patient in the treatment group 6 months
after surgery (4.34%).
In the control group, lymphedema occurred in 7
patients (30.43%). No statistically significant differences
in the arm
volume were observed in the treatment group during follow-up, while the arm
volume in the
control group showed a significant increase after 1, 3, and 6
months from operation. There was significant
difference between the 2 groups
in the volume changes with respect to baseline after 1, 3, 6, 12, and 18
months after surgery (every timing P value < 0.01).
CONCLUSIONS: LYMPHA represents a valid technique for primary prevention of
secondary arm
lymphedema with no risk of leaving undetected malignant
disease in the axilla.
PMID: 21369739 [PubMed - as supplied by publisher]
Clin Nucl Med. 2011 Apr;36(4):e11-2.
The role of lymphoscintigraphy in diagnosis and monitor the response of
physiotherapeutic technique in
congenital lymphedema.
Chang L, Cheng MF, Chang HH, Kao YH, Wu YW.
From the *Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan;
Departments of
†Nuclear Medicine and ‡Pediatrics, National Taiwan University
Hospital and National Taiwan University
College of Medicine, Taipei, Taiwan;
and §Division of Nuclear Medicine, Department of Radiology,
Hsin-Chu General
Hospital, Hsin-Chu County, Taiwan.
Abstract
We describe the case of a 4-month-old girl who was admitted for bilateral
legs swelling for several
weeks. Lymphoscintigraphy revealed the absence of
the radiotracer proximal to the ilioinguinal nodes up
to 6 hours
postinjection. In light of the clinical and image findings, a diagnosis of
congenital lymphedema
was compatible. Systemic corticosteroid was given, and
physical massage was applied at the lower
extremities for 3 weeks. Repeat
lymphoscintigraphy revealed faster lymphatic flow and liver visualization,
demonstrating improvement in lymphatic function. This case illustrates the
usefulness of
lymphoscintigraphy in diagnosis and evaluating therapy
response of lymphedema in children.
PMID: 21368595 [PubMed - in process]
March 14, 2011
Dermatol Online J. 2011 Feb 15;17(2):9.
Granulomatous rosacea: Unusual presentation as solitary plaque.
Batra M, Bansal C, Tulsyan S.
Abstract
A 45-year-old male presented with a 6 month history of an enlarging smooth,
erythematous plaque over
the central part of his face. Mild erythema of both
eyes was present. Sarcoidosis, Hansen disease, lupus
vulgaris, cutaneous
leishmaniasis, pseudolymphoma, foreign body granuloma, granuloma faciale,
discoid
lupus erythematosus, and granulomatous rosacea were considered in
the differential diagnosis. CBC,
urinalysis, renal function tests, liver
function tests, serum electrolytes, and blood sugar were all normal.
Chest
X-ray and ECG revealed no abnormality. Serology for syphilis and HIV, and
mantoux test were
negative. Slit-skin smear, tissue smear and culture for
AFB and fungi were negative. Skin biopsy revealed
multiple non-caseating
epitheloid granulomas around the pilosebaceous unit suggestive of granulomatous
rosacea. Granulomatous rosacea, a rare entity comprising only about 10
percent of cases of rosacea can
mimic many granulomatous conditions both
clinically and histologically making the diagnosis an enigma. It
usually
presents as yellowish brown-red discrete papules on the face; non-caseating
epithelioid
granulomas are seen on histology examination. We herein report
the case because it presented in atypical
fashion, as a solitary indurated
plaque on the nose, likely representing Morbihan's disease or solid
persistent facial edema of rosacea (rosacea lymphedema).
PMID: 21382292 [PubMed - in process]
Elephantiasis Nostras Verrucosa on the buttocks and sacrum of two immobile
men.
Setyadi HG, Iacco MR, Shwayder TA, Ormsby A.
Department of Dermatology, Henry Ford Health System, Detroit, Michigan.
Abstract
Though typically involving the lower extremities, elephantiasis nostras
verrucosa (ENV) can occur in any
area affected by lymphedema. Here we report
two cases of ENV: one is a biopsy-proven case and the
other is a clinically
diagnosed case. Both occurred on the buttocks and sacrum of immobile, morbidly
obese men who were persistently in the supine or seated position. Whereas
classic ENV is not
uncommon, this striking presentation on these unusual
areas is quite rare.
PMID: 21382291 [PubMed - in process]
Cancer. 2011 Mar 15;117(6):1136-48. doi: 10.1002/cncr.25513. Epub 2010 Nov
8.
Conservative and dietary interventions for cancer-related lymphedema: A
Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta,
Canada; Department of
Rehabilitation Medicine, Cross Cancer Institute,
Edmonton, Alberta, Canada. [email protected].
Abstract
The findings support the use of compression garments and compression
bandaging for reducing
lymphedema volume in upper and lower extremity
cancer-related lymphedema. Specific to breast cancer,
a statistically
significant, clinically small beneficial effect was found from the addition of
manual lymph
drainage massage to compression therapy for upper extremity
lymphedema volume. Cancer 2011. ©
2010 American Cancer Society.
PMID: 21381006 [PubMed - in process
Int J Palliat Nurs. 2011 Feb;17(2):60-6.
Reflections on lymphoedema, fungating wounds and the power of touch in the
last weeks of life.
Fenton S.
Abstract
Terminal care is a significant chapter of life in which each individual has
the right to expect dignity,
compassion, holistic care, and quality of life.
The case of 'Sally', a 57-year-old woman with a diagnosis of
inflammatory
breast cancer, left arm lymphoedema, and a fungating chest wound, gave
palliative care
nurses a multitude of distressing and complex challenges to
manage. Management of lymphoedema is
often put into the 'too hard basket', especially in the palliative care setting. Similarly, fungating wounds are
hard to confront, and the power of touch is often underestimated. The aim of
this case study is to explore
and reflect on how these issues entwine, and
how vital it is for nurses to feel comfortable in providing the
most
appropriate care. As a result of reflection on Sally's care management many
issues were highlighted,
including the crucial need to relieve her symptoms
with timely, appropriate, dignified, and respectful care,
optimizing her
sense of worth and quality of life.
PMID: 21378689 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]
Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of
therapy for head-and-
neck cancer.
Mihara M, Uchida G, Hara H, Hayashi Y, Moriguchi H, Narushima M, Iida T,
Yamamoto T, Koshima I.
Department of Plastic Surgery and Reconstructive Surgery, The University of
Tokyo, 7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can
improve lymph
circulation by the anastomosis of lymph vessels and veins. A
therapeutic effect of LVA for lymphoedema
has been shown in limbs, but
efficacy for other regions has not been shown. Lymphoedema in the
head-
and-neck region following cancer resection and radiotherapy is mainly
treated with manual lymphatic
drainage. However, there is no alternative
when this treatment is ineffective because application of
compression
treatment using a bandage is difficult in this region. We used LVA for
lymphoedema in the
head-and-neck region and achieved a good outcome.
Functional and dilating lymph vessels were
identified using pre- and
intra-operative fluorescent lymphography, and a lymph vessel with a diameter of
about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The
outcome of this case
suggests that LVA is applicable for treatment of
lymphoedema in the head-and-neck region.
Copyright © 2011. Published by Elsevier Ltd.
PMID: 21377943 [PubMed - as supplied by publisher]
Can Fam Physician. 2010 Dec;56(12):1277-84.
Management of secondary lymphedema related to breast cancer.
Cheifetz O, Haley L; Breast Cancer Action.
Hamilton Health Sciences, 711 Concession St, Hamilton, ON L8V 1C3. [email protected]
PMID: 21375063 [PubMed - in process]
March 14, 2011
Cancer. 2011 Mar 15;117(6):1136-48. doi: 10.1002/cncr.25513. Epub 2010 Nov
8.
Conservative and dietary interventions for cancer-related lymphedema: A
Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta,
Canada; Department of
Rehabilitation Medicine, Cross Cancer Institute,
Edmonton, Alberta, Canada. [email protected].
Abstract
The findings support the use of compression garments and compression
bandaging for reducing
lymphedema volume in upper and lower extremity
cancer-related lymphedema. Specific to breast cancer,
a statistically
significant, clinically small beneficial effect was found from the addition of
manual lymph
drainage massage to compression therapy for upper extremity
lymphedema volume. Cancer 2011. ©
2010 American Cancer Society.
PMID: 21381006 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]
Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of
therapy for head-and-
neck cancer.
Mihara M, Uchida G, Hara H, Hayashi Y, Moriguchi H, Narushima M, Iida T,
Yamamoto T, Koshima I.
Department of Plastic Surgery and Reconstructive Surgery, The University of
Tokyo, 7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can
improve lymph
circulation by the anastomosis of lymph vessels and veins. A
therapeutic effect of LVA for lymphoedema
has been shown in limbs, but
efficacy for other regions has not been shown. Lymphoedema in the
head-
and-neck region following cancer resection and radiotherapy is mainly
treated with manual lymphatic
drainage. However, there is no alternative
when this treatment is ineffective because application of
compression
treatment using a bandage is difficult in this region. We used LVA for
lymphoedema in the
head-and-neck region and achieved a good outcome.
Functional and dilating lymph vessels were
identified using pre- and
intra-operative fluorescent lymphography, and a lymph vessel with a diameter of
about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The
outcome of this case
suggests that LVA is applicable for treatment of
lymphoedema in the head-and-neck region.
Copyright © 2011. Published by Elsevier Ltd.
PMID: 21377943 [PubMed - as supplied by publisher]
March 15, 2011
Curr Urol Rep. 2011 Mar 11. [Epub ahead of print]
Complications of Pelvic Lymph Node Dissection for Prostate Cancer.
Keegan KA, Cookson MS.
Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302
Medical Center North,
Nashville, TN, 37232, USA.
Abstract
Pelvic lymph node dissection (PLND) represents the standard for detection of
occult pelvic nodal
metastases from prostate cancer, and may be performed
separately from or at the time of radical
prostatectomy. In addition to its
potential for diagnostic staging, a PLND may be therapeutic in some
patients. However, considerable debate centers on the appropriate candidates
for the procedure, the
extent and proper boundaries of dissection, optimal
surgical approach, and absolute oncologic benefit.
Several series suggest
that there likely is limited benefit of PLND in low-risk patients and that PLND
can
be safely omitted in a high percentage of men undergoing contemporary
radical prostatectomy.
Furthermore, the value of PLND in patients with
intermediate- and high-risk disease must be balanced
against the potential
morbidity of the procedure. In the setting of this debate, concern over
morbidity
directly attributable to this procedure is of paramount
importance. This review focuses on the
complications associated with PLND,
including lymphocele, thromboembolic events, ureteral injury,
nerve injury,
vascular injury, and lymphedema.
PMID: 21394597 [PubMed - as supplied by publisher]
BMC Cancer. 2011 Mar 9;11(1):94. [Epub ahead of print]
Manual lymphatic drainage therapy in patients with breast cancer related
lymphoedema.
Lopez Martin M, Hernandez MA, Avendano C, Rodriguez F, Martinez H.
ABSTRACT:
BACKGROUND: Lymphoedema is a common and troublesome problem that develops
following breast
cancer treatment. The aim of this study is to analyze the
effectiveness of Manual Lymphatic Drainage
(MLD) in the treatment of
postmastectomy lymphoedema in order to reduce the volume of lymphoedema
and
evaluate the improvement of the concomitant symptomatology.
METHODS: Randomized controlled clinical trial of 58 women suffering
postmastectomy lymphoedema.
Control group includes 29 patients with standard
treatment (care of the skin, exercise and measures of
compression, bandage
for one month and later garment of compression). Experimental group includes
patients with stardard treatment and, in addition they received Manual
Lymphatic Drainage. The therapy
will be administered daily during four weeks
and the patients will be reviewed after one, three and six
months of the
treatment. The main outcome is volume reduction of the affected arm after the
treatment
expressed in percentage. Secondary outcome parameters include
duration of lymphoedema reduction
and improvement of the concominant
symtomatology (degree of pain, sensation of swelling and functional
limitation in the affected extremity, subjective sensation of physical
attraction and feminity, dificulty to look
at oneself nude and desilution
grade about the corporal image).
DISCUSSION: The results of this study will provide information on the
effectiveness of manual lymph
drainage and its impact on the quality of life
and physical limitations of these patients. Trial registration:
NCT01152099.
PMID: 21392372 [PubMed - as supplied by publisher]
March 25, 2011 - New Technology at NewYork-Presbyterian/Columbia Aids
Surgeons With Early
Detection of Lymphedemain Breast Cancer Patients -
Newswise –
Early Detection and Intervention May Prevent Disabling Complication of Breast
Cancer Surgery
Newswise — NEW YORK (March 24, 2011) -- Breast cancer
specialists at NewYork-Presbyterian
Hospital/Columbia University Medical
Center are offering patients new ways to detect early signs of
lymphedema, a
common side effect of breast cancer surgery that causes painful, debilitating
and
disfiguring swelling in the arms following removal of lymph nodes.
As many as 30 percent of women who have breast cancer surgery with lymph node
removal will develop
lymphedema. Radiation treatment increases this risk to
as high as 50 percent. While it is possible to arrest
the condition through
physical therapy and bandaging, there is no cure.
"Just as we've used early detection to improve breast cancer survival, we are
using early detection to
reduce women's risk for developing lymphedema,"says
Dr. Sheldon Feldman, the Vivian L. Milstein
Associate Professor of Clinical
Surgery at Columbia University College of Physicians and Surgeons and
chief
of breast surgery at NewYork-Presbyterian Hospital/Columbia University Medical
Center.
Dr. Feldman and his colleagues at NewYork-Presbyterian/Columbia are employing
a technique called
bioimpedence spectroscopy to help them identify the
earliest onset of lymphedema. An FDA-approved
device called L-DEX (ImpediMed
Inc.) uses a mild electrical current to measure minute changes in
extracellular fluid, allowing for a diagnosis of lymphedema by the physician
well before any swelling is
noticeable. "By catching it early, we can
reverse the process and prevent unnecessary pain,
embarrassment,
debilitation and risk of infection,"says Dr. Feldman.
Alongside its clinical use, the bioimpedence technique is also being used in
research to better understand
which patients are most at risk for lymphedema
and whether the condition always progressively worsens,
or if it can
naturally correct itself over time. Other studies will investigate the common
belief that
lymphedema is negatively affected by air travel and weight
training.
Another method of reducing risk for lymphedema is a technique called "reverse
arm mapping.""The lymph
nodes that drain the arm are sometimes removed
during breast cancer surgery because they're situated
within the armpit
(axilla) in the same area as the lymph nodes that relate to the breast. With
reverse arm
mapping, we inject dye into the patient's arm to differentiate
the two kinds of lymph nodes. This allows
the surgeon to avoid removing any
nodes related to arm drainage while still accurately identifying the
sentinel nodes, which are important for breast cancer evaluation and
treatment,"says Dr. Feldman. "This
should reduce the risk of developing
lymphedema.”
Arm mapping is part of a larger trend toward reducing or eliminating the need
to remove a woman's
lymph nodes -- thereby reducing the incidence of
lymphedema. Beginning in the 1990s, sentinel node
biopsy used dye injected
into the breast to target the sentinel lymph node, the gatekeeper to the axilla
and
the one most at risk for cancer spread. Today, the latest research
indicates that fewer patients need any
lymph nodes removed than previously
thought. Even if the sentinel node is shown to be positive, patients
with
early-stage breast cancer who are treated with lumpectomy, chemotherapy and
radiation may not
need to have any further lymph nodes removed.
For more information, patients may call (866) NYP-NEWS.
Columbia University Medical Center
Columbia University Medical Center
provides international leadership in basic, pre-clinical and clinical
research, in medical and health sciences education, and in patient care. The
Medical Center trains future
leaders and includes the dedicated work of many
physicians, scientists, public health professionals,
dentists, and nurses at
the College of Physicians & Surgeons, the Mailman School of Public Health,
the
College of Dental Medicine, the School of Nursing, the biomedical
departments of the Graduate School
of Arts and Sciences, and allied research
centers and institutions. Established in 1767, Columbia's
College of
Physicians and Surgeons was the first institution in the country to grant the
M.D. degree and is
now among the most selective medical schools in the
country. Columbia University Medical Center is
home to the largest medical
research enterprise in New York City and state and one of the largest in the
United States. For more information, please visit www.cumc.columbia.edu.
NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital, based in New
York City, is the nation's largest not-for-profit, non-
sectarian hospital,
with 2,353 beds. The Hospital has more than 2 million inpatient and outpatient
visits in
a year, including more than 220,000 visits to its emergency
departments -- more than any other area
hospital. NewYork-Presbyterian
provides state-of-the-art inpatient, ambulatory and preventive care in all
areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill
Cornell Medical Center,
NewYork-Presbyterian Hospital/Columbia University
Medical Center, NewYork-Presbyterian/Morgan
Stanley Children's Hospital,
NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian
Hospital/Westchester Division. One of the most comprehensive health care
institutions in the world, the
Hospital is committed to excellence in
patient care, research, education and community service.
NewYork-Presbyterian is the #1 hospital in the New York metropolitan area
and is consistently ranked
among the best academic medical institutions in
the nation, according to U.S.News & World Report. The
Hospital has
academic affiliations with two of the nation's leading medical colleges: Weill
Cornell Medical
College and Columbia University College of Physicians and
Surgeons. For more information, visit www.
nyp.org.
PUB MED DOCS TO BE FORMATTED:
March 25, 2011
Ann Plast Surg. 2011 Mar 14. [Epub ahead of print]
Lower Extremity Lymphedema Index: A Simple Method for Severity Evaluation of
Lower Extremity
Lymphedema.
Yamamoto T, Matsuda N, Todokoro T, Yoshimatsu
H, Narushima M, Mihara M, Uchida G, Koshima I.
From the Department of Plastic and Reconstructive Surgery, Graduate School of
Medicine, University of
Tokyo, Bunkyo-ku, Tokyo, Japan.
Abstract
Measurement of the circumference is the most commonly used method
for evaluating extremity
lymphedema. However, comparison between different
patients is difficult with this measurement. To
resolve this problem, we
have formulated a new index, lower extremity lymphedema (LEL) index, which
can be easily obtained from measurements of the body. We evaluated
correlation between lower LEL
index and clinical stage in patients with LEL.
The LEL indices were significantly correlated with clinical
stages and could
be used as a severity scale. The LEL index makes objective assessment of the
severity
of lymphedema through a numerical rating, regardless of the body
type. This numerical rating makes the
index useful for evaluation of
lymphedema severities between different cases.
PMID: 21407058 [PubMed - as
supplied by publisher]
J Pain Symptom Manage. 2011 Mar 12. [Epub ahead of print]
Subcutaneous Lymphatic Drainage (Lymphcentesis) for Palliation of Severe
Refractory Lymphedema in
Cancer Patients.
Jacobsen J, Blinderman CD.
Palliative Care Service (J.J.), Massachusetts General Hospital, and Harvard
Medical School (J.J.),
Boston, Massachusetts; and Palliative Medicine
Service (C.D.B.), Departments of Anesthesiology and
Medicine, Columbia
University Medical Center, New York, New York, USA.
Abstract
Subcutaneous lymphatic drainage has been reported to be an
effective treatment for severe refractory
lymphedema in patients with
lymphatic accumulation because of obstructive cancer. We review published
techniques for lymphatic drainage and describe two cases where these
techniques were modified with
good results.
Copyright © 2011. Published
by Elsevier Inc.
PMID: 21402464 [PubMed - as supplied by publisher]
Gan To Kagaku Ryoho. 2010 Dec;37 Suppl 2:229-31.
[Two cases of stewart-treves syndrome observed at sanshu
hospital].
[Article in Japanese]
Yokoyama A, Yokoyama K, Matsumoto K.
The Palliative Care Units, Sanshu Hospital.
Abstract
Stewart-Treves syndrome is angiosarcoma, which occurs in the
chronic lymphedema of the upper or
lower limbs. Presently, an effective
therapy is not established. The survival period is only several months
to
one year. There are some reports that angiosarcoma will occur in the period of
5~15 years after a
continuation of lymphedema of the extremities. Therefore,
it is important to prevent lymphedema after
surgical operations of primary
disease and the lymphedema.
PMID: 21368533 [PubMed - in process]
ScientificWorldJournal. 2011 Mar 7;11:614-23.
Penile anomalies in adolescence.
Wood D, Woodhouse C.
Abstract
This article considers the impact and outcomes of both treatment
and underlying condition of penile
anomalies in adolescent males. Major
congenital anomalies (such as exstrophy/epispadias) are discussed,
including
the psychological outcomes, common problems (such as corporal asymmetry,
chordee, and
scarring) in this group, and surgical assessment for potential
surgical candidates. The emergence of new
surgical techniques continues to
improve outcomes and potentially raises patient expectations. The
importance
of balanced discussion in conditions such as micropenis, including
multidisciplinary support for
patients, is important in order to achieve
appropriate treatment decisions. Topical treatments may be of
value, but in
extreme cases, phalloplasty is a valuable option for patients to consider. In
buried penis, the
importance of careful assessment and, for the majority, a
delay in surgery until puberty has completed is
emphasised. In hypospadias
patients, the variety of surgical procedures has complicated assessment of
outcomes. It appears that true surgical success may be difficult to measure
as many men who have had
earlier operations are not reassessed in either
puberty or adult life. There is also a brief discussion of
acquired penile
anomalies, including causation and treatment of lymphoedema, penile
fracture/trauma, and
priapism.
PMID: 21399858 [PubMed - in process]
Arch Esp Urol. 2011 Mar;64(2):121-124.
Surgical treatment in a case of giant scrotal lymphedema.
[Article in
English, Spanish]
Rubio Hidalgo E, López García-Moreno A, Buendía González E, Sampietro Crespo
A, Arce Casado B,
De La Fuente Núñez J.
Urology Department.Hospital Virgen de la Salud. Complejo Hospitalario de
Toledo. Toledo. Spain.
Abstract
OBJECTIVE: Scrotal lymphedema (SL) is a rare clinical pathology
with multiple etiologies. We report a
case of idiopathic giant scrotal
lymphedema and review the existing medical literature in Medline from the
last ten years.
METHODS: We report the case of a male patient with a
giant scrotal lymphedema (43×40 cm) of
unknown etiology developed over four
years.
RESULTS: The patient was treated by scrotal excision and
reconstruction with skin graft plasty, with a
successful
result.
CONCLUSIONS: Scrotal Lymphedema is a rare entity, especially in
industrialized countries. If the
lymphedema is severe, surgery is the most
appropriate therapeutic option, whatever the cause is.
Complete resection up
to healthy tissue and surgical reconstruction is the choice. Thin skin grafts
are
necessary for reconstruction when it affects the entire
scrotum.
PMID: 21399245 [PubMed - as supplied by publisher]
BMC Cancer. 2011 Mar 9;11:94.
Manual lymphatic drainage therapy in patients with breast cancer related
lymphoedema.
Martín ML, Hernández MA, Avendaño C, Rodríguez F, Martínez
H.
Unidad de Investigación, Hospital Universitario de La Princesa, Diego de León
36, 28046 Madrid,
Spain. [email protected].
Abstract
ABSTRACT:
BACKGROUND: Lymphoedema is a common and troublesome
condition that develops following
breast cancer treatment. The aim of this
study is to analyze the effectiveness of Manual Lymphatic
Drainage in the
treatment of postmastectomy lymphoedema in order to reduce the volume of
lymphoedema and evaluate the improvement of the concomitant
symptomatology.
METHODS: A randomized, controlled clinical trial in 58 women
with post-mastectomy lymphoedema.
The control group includes 29 patients
with standard treatment (skin care, exercise and compression
measures,
bandages for one month and, subsequently, compression garnments). The
experimental group
includes 29 patients with standard treatment plus Manual
Lymphatic Drainage. The therapy will be
administered daily for four weeks
and the patient's condition will be assessed one, three and six months
after
treatment.The primary outcome parameter is volume reduction of the affected arm
after treatment,
expressed as a percentage. Secondary outcome parameters
include: duration of lymphoedema reduction
and improvement of the
concomitant symptomatology (degree of pain, sensation of swelling and
functional limitation in the affected extremity, subjective feeling of being
physically less atractive and less
feminine, difficulty looking at oneself
naked and dissatisfaction with the corporal image).
DISCUSSION: The results
of this study will provide information on the effectiveness of Manual
Lymphatic Drainage and its impact on the quality of life and physical
limitations of these patients.
TRIAL REGISTRATION: ClinicalTrials (NCT):
NCT01152099.
PMID: 21392372 [PubMed - in process]
Biomaterials. 2011 Mar 19. [Epub ahead of print]
Therapeutic lymphangiogenesis using stem cell and VEGF-C hydrogel.
Hwang
JH, Kim IG, Lee JY, Piao S, Lee DS, Lee TS, Ra JC, Lee JY.
Department of Physical and Rehabilitation Medicine, Sungkyunkwan University
School of Medicine,
Samsung Medical Center, Seoul, Republic of Korea.
Abstract
Lymphedema is a manifestation of lymphatic system insufficiency.
It arises from primary lymphatic
dysplasia or secondary obliteration after
lymph node dissection or irradiation. Although improvement of
swelling can
be achieved by comprehensive non-operative therapy, treatment of this condition
requires
lifelong care and good compliance. Recently molecular-based
treatments using VEGF-C have been
investigated by several researchers. We
designed the present study to determine whether the therapeutic
efficacy of
implanted human adipose-derived stem cells (hADSCs) could be improved by
applying a
gelatin hydrogel containing VEGF-C (VEGF-C hydrogel) to the site
of tissue injury in a lymphedema
mouse model. Four weeks after the
operation, we evaluated edema and determined lymphatic vessel
density at
various post-operative time points. Mice treated with hADSCs and VEGF-C hydrogel
showed
a significantly decreased dermal edema depth compared to the groups
of mice that received hADSCs
only or VEGF-C hydrogel only.
Immunohistochemical analysis also revealed that the hADSC/VEGF-C
hydrogel
group showed significantly greater lymphatic vessel regeneration than all the
other groups.
hADSCs were detected in the implantation sites of all mice in
the hADSC/VEGF-C group, and exhibited
a lymphatic endothelial
differentiation phenotype as determined by co-staining PKH-labeled hADSCs for
the lymphatic marker LYVE-1. Our results suggest that co-administration of
hADSCs and VEGF-C
hydrogel has a substantial positive effect on
lymphangiogenesis.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21421266 [PubMed - as supplied by publisher]
Med Clin (Barc). 2011 Mar 17. [Epub ahead of print]
[Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer
(FACT-B+4). Spanish
version validation.]
[Article in Spanish]
Belmonte Martínez R, Garin Boronat O, Segura Badía M, Sanz Latiesas J,
Navarro EM, Fores MF.
Servei de Medicina Física i Rehabilitació, Hospital Mar-Esperança, Parc de
Salut Mar, Barcelona,
España; Departament de Medicina de la Universitat
Autònoma de Barcelona. Bellaterra, Barcelona,
España.
Abstract
BACKGROUND AND OBJECTIVES: To evaluate the acceptability,
reliability, validity, and sensitivity
to change of the Spanish version of
the FACT-B+4 questionnaire, designed to assess the health related
quality of
life (HRQL) in breast cancer.
PATIENTS AND METHODS: Prospective study with 2
samples: patients with incident breast cancer
(n=104) evaluated before and
after surgery; and patients with chronic lymphedema of the upper extremity
(n=30), evaluated twice in 7days. HRQL was assessed using the generic
instrument SF-36 and the
specific one FACT-B+4.
RESULTS: Reliability
coefficients were = 0.7 for most scores. The Physical wellbeing, Breast Cancer,
Arm and TOI scores discriminated between patients with and without
chemotherapy (p<0.05), while the
Arm scale discriminated between patients
with and without axillary surgery (p<0.001). In the worsening
sub-sample,
the FACT-B+4 detected changes in Physical, Emotional and Functional Wellbeing,
and TOI
scores.
CONCLUSIONS: The metric characteristics of the Spanish
version of the FACT-B+4 are similar to the
original questionnaire and
support its equivalence, documenting its suitability for use in our country or
in
international studies.
Copyright © 2010 Elsevier España, S.L. All
rights reserved.
PMID: 21420133 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2011 Mar;9(1):61-4.
(18)F-FDG PET/CT in a Rare Case of Stewart-Treves Syndrome: Future
Implications and Diagnostic
Considerations.
Jensen MR, Friberg L,
Karlsmark T, Bülow J.
1 Department of Clinical Physiology and Nuclear Medicine, Bispebjerg
Hospital, University Hospital of
Copenhagen , Denmark .
Abstract
Abstract Background: The aim of this article is to illustrate the
possible applications of (18)F-
fluorodeoxyglucose positron emission
tomography/computer tomography ((18)F-FDG PET/CT) in
chronic extremity
lymphedema and its complications. Methods and Results: (18)F-FDG PET/CT findings
in a rare case of Stewart-Treves Syndrome (STS), angiosarcoma secondary to
chronic extremity
lymphedema, are presented. Lymphedema of the extremities
is a debilitating disease characterized by
chronic swelling due to
interstitial edema caused by insufficient lymphatic drainage capacity.
Progression
with skin thickening, subcutaneous fibrosis, and increased
adipose tissue volume is common. Chronic
inflammation has been suggested as
a key pathophysiologic component. STS is a rare complication with a
very
poor prognosis; however, early diagnosis and radical treatment is associated
with increased survival.
Thus, accurate pretreatment staging is paramount.
(18)F-FDG PET/CT is highly sensitive in detecting
increased glucose
metabolism as seen in many types of cancer and inflammation. The role of
(18)F-FDG
PET/CT in the management of lymphedema and its complications has
to our knowledge yet to be
described. This case documents high (18)F-FDG
uptake in STS, but is at the same time an example of
the low specificity of
this imaging modality. Conclusions: We suggest that (18)F-FDG PET/CT has the
potential to become an important tool in the staging and treatment planning
of Stewart-Treves syndrome.
Furthermore, (18)F-FDG-accumulation may be a
sensitive tool in detecting low grade inflammation in the
skin and subcutis,
which has been suggested to cause tissue remodeling in lymphedema progression.
However, further studies are needed to elucidate this theory.
PMID:
21417769 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):47-51.
Confirmation of the reference impedance ratios used for assessment of breast
cancer-related
lymphedema by bioelectrical impedance spectroscopy.
Ward
LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL.
1 School of Chemistry and Molecular Biosciences, University of Queensland ,
St. Lucia, Brisbane,
Australia .
Abstract
Abstract Background: Breast cancer-related lymphedema in the arm
is commonly detected by
bioelectrical impedance spectroscopy as an increased
inter-arm impedance ratio due to the presence of
excess lymph in the at-risk
arm relative to that of the unaffected arm. The presence of lymphedema is
determined by a value of this ratio greater than the mean ratio, plus three
standard deviations observed in
a comparable healthy population. This
threshold value has not been established using the measurement
protocols in
current practice. The aim of the present study was to determine the reference
range of the
inter-arm impedance ratio to allow a cut-off value to be
established as a criterion for the detection of
breast cancer-related
lymphedema. Methods: The mean and variation (3 SD) of the inter-arm impedance
ratio for the arms of 172 healthy female control participants were
determined from an accumulated
database of impedance data obtained using
present generation impedance instrumentation and
methodology. This reference
range and threshold value was compared to the original threshold ratio
determined a decade ago but still in current use. Results: The presence of
lymphedema is indicated when
the impedance ratio exceeded 1.106 when the
nondominant limb is at risk, and 1.134 when the dominant
limb is at risk
compared with the currently used values of 1.066 and 1.139, respectively.
Although the
difference in these values was statistically significant, this
difference was determined to be of minor
importance to clinical practice.
Conclusions: The impedance ratio thresholds for early detection of
lymphedema remain suitable for clinical use with present day bioimpedance
spectroscopy analyzers and
measurement protocols.
PMID: 21417767 [PubMed
- in process]
Lymphat Res Biol. 2011 Mar;9(1):43-6.
Reference ranges for assessment of unilateral lymphedema in legs by
bioelectrical impedance
spectroscopy.
Ward LC, Dylke E, Czerniec S,
Isenring E, Kilbreath SL.
1 School of Chemistry and Molecular Biosciences, The University of Queensland
, St. Lucia, Brisbane,
Australia .
Abstract
Abstract Background: Secondary unilateral lymphedema in the leg
may occur as a consequence of pelvic
surgery and/or radiation therapy, which
causes damage to the pelvic lymphatic system. To date,
assessment has been
typically by manual measurement of the volume excess of the affected leg
compared
to the contralateral leg. In contrast, the assessment of unilateral
arm lymphedema is readily accomplished
by the use of bioelectrical impedance
spectroscopy (BIS) as an increased inter-arm impedance ratio due
to the
presence of excess lymph in the affected arm relative to that of the unaffected
arm. The presence of
lymphedema is defined by a value of this ratio greater
than the mean ratio plus three standard deviations
(SD) observed in a
comparable healthy population. The aim of the present study was to determine the
equivalent reference range of the impedance ratio for the legs. This would
allow a cut-off value to be
established as a criterion for the detection and
assessment of lower limb lymphedema. Methods: The
impedances of the legs of
172 healthy females and 150 healthy males, measured by BIS, were extracted
from an accumulated database of impedance data. These data were used to
determine the normal
distribution of inter-leg impedance ratios and the
reference range and threshold value (mean?+?3 SD).
Results: The presence of
lymphedema is indicated when the impedance ratio exceeds 1.167 in males and
1.136 in females. Unlike in the arms, the effect of limb dominance in the
legs is minimal and it is suggested
that no correction for limb dominance is
warranted. Conclusions: The impedance ratio thresholds for
lymphedema of the
legs have been established, opening the way for BIS to become established
clinically
for the early detection and assessment of lower limb
lymphedema.
PMID: 21417766 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):31-42.
Segmental blood flow and hemodynamic state of lymphedematous and
nonlymphedematous arms.
Montgomery LD, Dietrich MS, Armer JM, Stewart BR,
Ridner SH.
1 LDM Associates , San Jose, California.
Abstract
Abstract Background: Findings regarding the influence hemodynamic
factors, such as increased arterial
blood flow or venous abnormalities, on
breast cancer treatment-related lymphedema are mixed. The
purpose of this
study was to compare segmental arterial blood flow, venous blood return, and
blood
volumes between breast cancer survivors with treatment-related
lymphedema and healthy normal
individuals without lymphedema. Methods and
Results: A Tetrapolar High Resolution Impedance Monitor
and Cardiotachometer
were used to compare segmental arterial blood flow, venous blood return, and
blood volumes between breast cancer survivors with treatment-related
lymphedema and healthy normal
volunteers. Average arterial blood flow in
lymphedema-affected arms was higher than that in arms of
healthy normal
volunteers or in contralateral nonlymphedema affected arms. Time of venous
outflow
period of blood flow pulse was lower in lymphedema-affected arms
than in healthy normal or
lymphedema nonaffected arms. Amplitude of the
venous component of blood flow pulse signal was lower
in lymphedema-affected
arms than in healthy or lymphedema nonaffected arms. Index of venular tone was
also lower in lymphedema-affected arms than healthy or lymphedema
nonaffected arms. Conclusions:
Both arterial and venous components may be
altered in the lymphedema-affected arms when compared
to healthy normal arms
and contralateral arms in the breast cancer survivors.
PMID: 21417765 [PubMed
- in process]
Lymphat Res Biol. 2011 Mar;9(1):19-30.
Molecular characterization of dermal lymphatic endothelial cells from primary
lymphedema skin.
Ogunbiyi S, Chinien G, Field D, Humphries J, Burand K,
Sawyer B, Jeffrey S, Mortimer P, Clasper S,
Jackson D, Smith For The London
Lymphedema Consortium A.
1 Academic Department of Surgery, BHF Centre of Research Excellence and NIMR
Biomedical
Research Centre at Kings Health Partners , St. Thomas Hospital,
London, United Kingdom .
Abstract
Abstract Background: Lymphatic endothelial cells from primary
lymphedema skin have never been
cultured nor characterized. A subgroup of
patients with primary lymphedema undergo surgery to bring
about an
improvement in their quality of life. The aim of this study was to culture and
characterize LECs
from the skin of these patients. Methods and Results:
Lymphatic endothelial cells were isolated and
cultured from the skin of
patients with primary lymphedema and from normal skin. The isolated cells were
compared in their ability to form microvascular networks in a
three-dimensional culture medium, and in
their response to treatment with
vascular endothelial growth factors A, C, and D. Whole tissue
transcriptional profiling was carried out on two pools of isolated lymphatic
endothelial cells-one from
primary lymphedema skin and the other from normal
skin. Lymphatic endothelial cells from primary
lymphedema skin form
tubule-like structures when cultured in three-dimensional media. They respond in
a
similar fashion to stimulation with the vascular endothelial growth
factors A, C, and D. Comparative
analysis between lymphedema tissue and
normal tissue (fold change >2) showed differential expression of
2793
genes (5% of all transcripts), 2184 upregulated, and 609 downregulated. Genes
involved in cellular
apoptosis (vascular endothelial growth inhibitor, zinc
finger protein), extracellular matrix turnover (matrix
metalloproteinase
inhibitor-16), and type IV collagen deposition were upregulated. Various
pro-
inflammatory genes (interleukin-6, interleukin-8, interleukin-32,
E-selectin) were downregulated.
Conclusion: Cellular adhesion, apoptosis,
and increased extracellular matrix turnover play a more
prominent role in
primary lymphedema than previously thought. In addition, the acute inflammatory
response is attenuated as evidenced by the downregulation of various
pro-inflammatory genes.This sheds
further light on the interplay of the
various pathological processes taking place in primary lymphedema.
PMID:
21417764 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):13-8.
Reliability and concurrent validity of the perometer for measuring hand
volume in women with and without
lymphedema.
Lee MJ, Boland RA, Czerniec
S, Kilbreath SL.
Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney
, Sydney, Australia .
Abstract
Abstract Background: Lymphedema of hand after breast cancer
treatment causes significant loss of hand
function. Although there are
several ways of assessing limb volume, measuring hand volume has been
problematic due to technical difficulties associated with assessment of
finger volumes. The aim of this
study was to investigate the criterion
validity and reliability of Perometer™ for measuring hand volume in
woman
with and without lymphedema. Methods and Results: Hand volume of forty women
with (n?=?
20) and without lymphedema (n?=?20) was assessed twice by one
rater and once by another rater using
the Perometer, and once by one rater
using the water volumetry method. Intra- and inter-rater reliability
was
determined from the intraclass correlation coefficients and Percent Close
Agreement. Agreement
between the Perometer and water volumetry was
determined using a limit of agreement and Lin's
concordance correlation. The
Perometer had high intra [ICC(2,1)?=?0.989 (95% CI: 0.98-0.99)] and
inter-rater reliability [ICC(2,1)?=?0.993 (95% CI: 0.99-1.0)]. Percent close
agreement revealed that
80% of the measures were within 9?ml for inter-rater
reliability and within 15?ml for intra-rater reliability.
In addition, there
was high concordance between hand volumes obtained with the Perometer and water
volumetry method (R(c)?=?0.88). However, the Perometer overestimated the
volume of hand compared
to water volumetry method (bias: 7.5%). Conclusions:
The Perometer can be used with high reliability to
measure hand volume but
caution should be exercised when data are compared with measures derived
from the water volumetry method.
PMID: 21417763 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):1.
Non-invasive assessment of human clinical lymphedema: the progress
continues.
Rockson SG.
PMID: 21417761 [PubMed - in process]
Filarial Nematodes.
Cross JH.
In: Baron S, editor. Medical
Microbiology. 4th edition. Galveston (TX): University of Texas Medical
Branch at Galveston; 1996. Chapter 92.
Excerpt
The filariae are
thread-like parasitic nematodes (roundworms) that are transmitted by arthropod
vectors.
The adult worms inhabit specific tissues where they mate and
produce microfilariae, the characteristic
tiny, thread-like larvae. The
microfilariae infect vector arthropods, in which they mature to infective
larvae. Filarial diseases are a major health problem in many tropical and
subtropical areas. The disease
produced by a filarial worm depends on the
tissue locations preferred by adults and microfilariae. The
adults of the
lymphatic filariae inhabit lymph vessels, where blockage and host reaction can
result in
lymphatic inflammation and dysfunction, and eventually in
lymphedema and fibrosis. Repeated, prolonged
infection with these worms can
lead to elephantiasis, a buildup of excess tissue in the affected area. Other
filariae mature in the skin and subcutaneous tissues, where they induce
nodule formation and dermatitis;
migrating filariae of these species can
cause ocular damage. Table 92-1 summarizes the filarial infections
of
humans.
Copyright © 1996, The University of Texas Medical Branch at
Galveston
Sections
•General Concepts•Introduction•Lymphatic Filariae Wuchereria
Bancrofti and Brugia
Malayi•Onchocerca Volvulus•Minor Filarial
Infections•Dirofilaria Species•Dracunculus
Medinensis•ReferencesPMID:
21413271 [PubMed]
April 3, 2011
Lymphology. 2010 Dec;43(4):188-91.
Congenital lymphatic dysplasia in Kabuki syndrome: first report of an unusual
association.
Morcaldi G, Boccardo F, Campisi C, Bellini T, Massocco D,
Bonioli E.
Department of Pediatrics, University of Genoa, Gaslini Children's Hospital,
Italy. [email protected]
Abstract
Kabuki syndrome was first described in Japan in 1981 as a rare
disorder of unknown cause. Its main
features include characteristic facies,
postnatal growth retardation, and mental delay. To date, there is no
molecular marker for Kabuki syndrome, which is considered genetically
heterogeneous and still is a
clinically-based diagnosis. Here we describe
the first case of a patient affected by Kabuki syndrome
associated with
lymphatic dysplasia. We suggest accurate evaluation of all Kabuki patients as
early as
possible in order to diagnose lymphedema or other clinical
manifestations of lymphatic system
involvement. Early identification of
lymphatic system maldevelopment provides the best chance for
reducing the
risk of developing progressive lymphedema with associated tissue changes
(fibrosis,
sclerosis, and fat deposition).
PMID: 21446574 [PubMed -
indexed for MEDLINE]
Lymphology. 2010 Dec;43(4):178-87.
Prevalence of upper-body symptoms following breast cancer and its
relationship with upper-body
function and lymphedema.
Hayes SC, Rye S,
Battistutta D, Newman B.
School of Public Health, Faculty of Health, Queensland University of
Technology, Queensland, Australia.
[email protected]
Abstract
This investigation describes the prevalence of upper-body
symptoms in a population-based sample of
women with breast cancer (BC) and
examines their relationships with upper-body function (UBF) and
lymphedema,
as two clinically important sequelae. Australian women (n=287) with unilateral
BC were
assessed at three-monthly intervals, from six to 18 months
post-surgery (PS). Participants reported the
presence and intensity of
upper-body symptoms on the treated side. Objective and self-reported UBF
and
lymphedema (bioimpedance spectroscopy) were also assessed. Approximately 50% of
women
reported at least one moderate-to-extreme symptom at 6- and at
18-months PS. There was a significant
relationship between symptoms and
function (p < 0.01), whereby perceived and objective function
declined
with increasing number of symptoms present. Those with lymphedema were more
likely to
report multiple symptoms, and presence of symptoms at baseline was
associated with an increased risk of
lymphedema (ORs > 1.3, p = 0.02),
although presence of symptoms explained only 5.5% of the variation
in the
odds for lymphedema. Upper-body symptoms are common and persistent following
breast cancer
and are associated with clinical ramifications, including
reduced UBF and increased risk of developing
lymphedema. However, using the
presence of symptoms as a diagnostic indicator or prognosticator of
lymphedema has its limitations.
PMID: 21446573 [PubMed - indexed for
MEDLINE]
Cancer. 2011 Mar 28. doi: 10.1002/cncr.26088. [Epub ahead of print]
Sphincter-sparing local excision and hypofractionated radiation therapy for
anorectal melanoma: A 20-
Year Experience.
Kelly P, Zagars GK, Cormier JN,
Ross MI, Guadagnolo BA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer
Center, Houston,
Texas.
Abstract
BACKGROUND: Anorectal melanoma is a rare disease with a poor
prognosis. Because survival is
determined by distant failure, many centers
have adopted sphincter-sparing excision for primary tumor
control. However,
this approach is associated with high rates of local failure (~50%). In this
study, the
authors report their 20-year experience with sphincter-sparing
excision combined with radiation therapy
(RT) for the treatment of localized
anorectal melanoma.
METHODS: The authors reviewed the records of 54 patients
with localized anorectal melanoma who
were treated at the University of
Texas MD Anderson Cancer Center from 1989 to 2008. All patients
underwent
definitive local excision with or without sentinel lymph node biopsy or lymph
node dissection.
RT (25-36 grays in 5-6 fractions) was delivered to extended
fields that targeted the primary site and
draining pelvic/inguinal
lymphatics in 39 patients and to limited fields that targeted only the primary
site in
15 patients.
RESULTS: The 5-year rates of local control (LC),
lymph node control (NC), and sphincter preservation
were 82%, 88%, and 96%,
respectively. However, because of the high rate of distant metastasis, the
overall survival (OS) rate at 5 years was only 30%. Although there were no
significant differences in LC,
NC, or OS based on RT field extent, patients
who received extended-field RT had higher rates of
lymphedema than patients
who received limited-field RT.
CONCLUSIONS: The current results indicated
that combined sphincter-sparing local excision and RT is
a well tolerated
approach that provides effective LC for patients with anorectal melanoma.
Inclusion of
the inguinal lymph node basins in the RT fields did not improve
outcomes and was associated with an
increased risk of lymphedema. Cancer
2011;. © 2011 American Cancer Society.
Copyright © 2011 American Cancer
Society.
PMID: 21446049 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2011 Mar 29. [Epub ahead of print]
Change in blood flow velocity demonstrated by Doppler ultrasound in upper
limb after axillary dissection
surgery for the treatment of breast
cancer.
Nascimben Matheus C, Caldeira de Oliveira Guirro E.
Physical Therapy Program, Faculty of Health Sciences, Methodist University of
Piracicaba, Piracicaba,
Brazil.
Abstract
The aim of this study was to evaluate the arterial and venous
blood flow in women who underwent upper
limb axillary dissection surgery for
the treatment of breast cancer. Sixty women were divided into two
groups:
group 1 (G1)-30 women who underwent breast surgery with axillary dissection
level II or III
(55.6 ± 8.6 years); group 2 (G2)-control, 30 women with no
breast cancer (57.4 ± 7.0 years). Blood
flow profile was evaluated by a
continuous wave ultrasound Doppler device (Nicolet Vascular Versalab
SE(®))
with an 8 MHz probe. Axillary, brachial arteries and veins, arm circumference,
volumes, and the
ankle-brachial index (ABI) were examined. Wilcoxon test and
Mann-Whitney tests were applied to
analyze blood flow velocity intra-group
and between G1 and G2, respectively. The G1 results showed no
lymphedema and
no peripheral arterial disease (ABI > 0.9). Moreover, the mean blood flow
velocity of
the vessels ipsilateral to the surgery was significantly higher
than the contralateral ones for all vessels
examined (P < 0.05). The mean
velocity of blood flow of the vessels contralateral to surgery was
significantly higher than the axillary artery in G2 (P < 0.05). It can be
concluded that women who
underwent axillary dissection due to breast cancer
showed probable stenosis in the arterial and venous
axillary and brachial
vessels of the upper limb ipsilateral to the surgery, confirmed by the increase
of
blood flow velocity, and such obstruction might affect the limb
contralateral to the operation site.
PMID: 21445573 [PubMed - as supplied by
publisher]
Arch Phys Med Rehabil. 2011 Apr;92(4):603-10.
Comparison of diagnostic accuracy of clinical measures of breast
cancer-related lymphedema: area under
the curve.
Smoot BJ, Wong JF, Dodd
MJ.
Department of Physical Therapy and Rehabilitation Science, University of
California San Francisco, San
Francisco, CA.
Abstract
Smoot BJ, Wong JF, Dodd MJ. Comparison of diagnostic accuracy of
clinical measures of breast
cancer-related lymphedema: area under the
curve.
OBJECTIVE: To compare diagnostic accuracy of measures of breast
cancer-related lymphedema
(BCRL).
DESIGN: Cross-sectional design
comparing clinical measures with the criterion standard of previous
diagnosis of BCRL.
SETTING: University of California San Francisco
Translational Science Clinical Research Center.
PARTICIPANTS: Women older
than 18 years and more than 6 months posttreatment for breast cancer
(n=141;
70 with BCRL, 71 without BCRL).
INTERVENTIONS: Not applicable.
MAIN
OUTCOME MEASURES: Sensitivity, specificity, receiver operator characteristic
curve, and
area under the curve (AUC) were used to evaluate
accuracy.
RESULTS: A total of 141 women were categorized as having (n=70) or
not having (n=71) BCRL based
on past diagnosis by a health care provider,
which was used as the reference standard. Analyses of ROC
curves for the
continuous outcomes yielded AUC of .68 to .88 (P<.001); of the physical
measures
bioimpedance spectroscopy yielded the highest accuracy with an AUC
of .88 (95% confidence interval, .
80-.96) for women whose dominant arm was
the affected arm. The lowest accuracy was found using the
2-cm diagnostic
cutoff score to identify previously diagnosed BCRL (AUC,
.54-.65).
CONCLUSIONS: Our findings support the use of bioimpedance
spectroscopy in the assessment of
existing BCRL. Refining diagnostic cutoff
values may improve accuracy of diagnosis and warrant further
investigation.
Copyright © 2011 American Congress of Rehabilitation
Medicine. Published by Elsevier Inc. All rights
reserved.
PMID: 21440706 [PubMed - in process]
J Am Acad Dermatol. 2011 Mar 24. [Epub ahead of print]
Elephantiasis nostras verrucosa: An institutional analysis of 21
cases.
Dean SM, Zirwas MJ, Horst AV.
Department of Cardiovascular Medicine, Ohio State University College of
Medicine, Columbus, Ohio.
Abstract
BACKGROUND: Previous reports regarding elephantiasis nostras
verrucosa (ENV) have been typically
limited to 3 or fewer
patients.
OBJECTIVES: We sought to statistically ascertain what demographic
features and clinical variables are
associated with ENV.
METHODS: A
retrospective chart review of 21 patients with ENV from 2006 to 2008 was
performed
and statistically analyzed.
RESULTS: All 21 patients were obese
(morbid obesity in 91%) with a mean body mass index of 55.8.
The average
maximal calf circumference was 63.7 cm. Concurrent chronic venous insufficiency
was
identified in 15 patients (71%). ENV was predominantly bilateral (86%)
and typically involved the calves
(81%). Proximal cutaneous involvement
(thighs 19%/abdomen 9.5%) was less common. Eighteen (86%)
related a history
of lower extremity cellulitis/lymphangitis and/or manifested soft-tissue
infection upon
presentation. Multisegmental ENV was statistically more
likely in setting of a higher body mass index (P =
.02), larger calf
circumference (P = .01), multiple lymphedema risk factors (P = .05), ulcerations
(P < .
001), and nodules (P < .001). Calf circumference was
significantly and proportionally linked to
developing lower extremity
ulcerations (P = .02). Ulcerations and nodules were significantly prone to
occur concomitantly (P = .05). Nodules appeared more likely to exist in the
presence of a higher body
mass index (P = .06) and multiple lymphedema risk
factors (P = .06).
LIMITATIONS: The statistical conclusions were potentially
inhibited by the relatively small cohort. The
study was
retrospective.
CONCLUSIONS: Our data confirm the association among obesity,
soft-tissue infection, and ENV.
Chronic venous insufficiency may be an
underappreciated risk factor in the genesis of ENV.
Copyright © 2010 American
Academy of Dermatology, Inc. Published by Mosby, Inc. All rights
reserved.
PMID: 21440328 [PubMed - as supplied by publisher]
Wkly Epidemiol Rec. 2011 Mar 25;86(13):121-7.
WHO position statement on integrated vector management to control malaria and
lymphatic filariasis.
[Article in English, French]
[No authors listed]
PMID: 21438441 [PubMed - indexed for MEDLINE
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]
1. 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
Disclaimer
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and articles and your
use of such information.
About PLoS Neglected Tropical Diseases
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journal devoted to the pathology, epidemiology,
prevention, treatment, and control of the neglected
tropical diseases, as
well as public policy relevant to this group of diseases. All works published in
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For more information,
visit http://www.plos.org.
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
Jpn J Ophthalmol. 2010 Nov;54(6):626-8. Epub 2010 Dec 30.
Congenital toxoplasmosis mimicking microcephaly-lymphedema-chorioretinal
dysplasia.
Ozeki Y, Shimada Y, Tanikawa A, Horiguchi M, Takeuchi M, Yamazaki T.
PMID: 21191727 [PubMed - in process]
Lymphat Res Biol. 2010 Dec;8(4):209-15.
Advanced pneumatic therapy in self-care of chronic lymphedema of the
trunk.
Ridner SH, Murphy B, Deng J, Kidd N, Galford E, Dietrich MS.
Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA.
sheila.
[email protected]
Comment in:
Lymphat Res Biol. 2010 Dec;8(4):v.
Abstract
BACKGROUND: The purpose of this study was to conduct a preliminary,
post-market, home
study of the Flexitouch(®) system to examine the potential
efficacy of the device as a component of
self-care in breast cancer
survivors with truncal lymphedema.
METHODS AND RESULTS: A quasi-experimental, pre-treatment, post-treatment
design was
used. Twelve participants received a total of ten
self-administered, consecutive, one hour per day
treatments. Treatments one
and two were observed by study staff and the remaining eight were
unobserved. Assessments were conducted at baseline, after the first two
treatments, mid-way
through therapy, and at the end-of-study. Logs revealed
100% compliance with the eight prescribed
unobserved home treatments.
Symptoms were assessed by self-report symptom surveys. Signs,
objectively
observed physical phenomenon, were assessed by staff-initiated skin examination
and
circumferential truncal measurements. Statistically significant
improvement in truncal symptoms and
sleep were found. Changes in function
and girth were not statistically significant in this initial study.
CONCLUSIONS: Breast cancer survivors with truncal lymphedema may benefit from
using an
advanced pneumatic compression devices with truncal treatment as
part of their self-care program.
Participants were highly compliant in
device use. Further research of this intervention is warranted.
To
facilitate future research, clinically meaningful reductions in truncal girth
should be defined.
PMID: 21190493 [PubMed - in process]PMCID: PMC3008167 [Available on
2011/12/1]
Lymphat Res Biol. 2010 Dec;8(4):v.
Accruing evidence for a beneficial role of pneumatic biocompression in
lymphedema.
Rockson SG.
Comment on:
Lymphat Res Biol. 2010 Dec;8(4):183-7.
Lymphat Res Biol. 2010 Dec;8(4):209-15.
PMID: 21190488 [PubMed - in process]
Rev Med Liege. 2010 Nov;65(11):655-61.
[How to diagnose the cause of oedema, a clinical approach].
[Article in French]
Krzesinski JM.
Universite de Liège, Service de Néphrologie-Dialyse-Hypertension, CHU de
Liège, Belgique. jm.
[email protected]
Abstract
Oedema is a frequent disorder and the easily detectable consequence of an
increase of fluid located
in the interstitial tissue. It could be localized
or generalized and related either to a primary
disturbance of hemodynamics
at the capillary level, due to a modification of the Starling's law
components with secondary water and saline retention, or to a primary
retention of salt and water
linked to a kidney abnormality. Generalized
forms are pitting oedema, most often painless, white,
bilateral and
symmetric, distributed at the lower part of the body (localisation according to
the
gravitation law). They are different in their characteristics from
localized oedema or lymphoedema
which are tough. We propose a diagnostic
approach based on medical history, clinical examination
which allows a
confident medical diagnosis and so an adapted therapy.
PMID: 21189533 [PubMed - in process]
January 7, 2011
J Travel Med. 2011 Jan;18(1):68-9. doi: 10.1111/j.1708-8305.2010.00472.x.
Epub 2010 Nov 25.
Lymphedema in a guyanan migrant.
Depetrillo JC, Singer C.
Division of Infectious Diseases, Department of Medicine, Long Island Jewish
Medical Center, New
Hyde Park, NY, USA.
PMID: 21199149 [PubMed - in process]
J Pain Res. 2010 Aug 20;3:147-53.
Pilot study: rapidly cycling hypobaric pressure improves pain after 5 days in
adiposis dolorosa.
Herbst KL, Rutledge T.
Department of Medicine, University of California, San Diego, California,
USA;
Abstract
Adiposis dolorosa (AD) is a rare disorder of painful nodular subcutaneous fat
accompanied by
fatigue, difficulty with weight loss, inflammation, increased
fluid in adipose tissue (lipedema and
lymphedema), and hyperalgesia.
Sequential compression relieves lymphedema pain; we therefore
hypothesized
that whole body cyclic pneumatic hypobaric compression may relieve pain in AD.
To
avoid exacerbating hyperalgesia, we utilized a touch-free method, which
is delivered via a high-
performance altitude simulator, the Cyclic
Variations in Altitude Conditioning™ (CVAC™)
process. As a pilot study, 10
participants with AD completed pain and quality of life questionnaires
before and after 20-40 minutes of CVAC process daily for 5 days.
Participants lost weight (195.5
± 17.6-193.8 ± 17.3 lb; P = 0.03), and
bioimpedance significantly decreased (510 ± 36-490 ± 38
ohm; P = 0.01).
There was a significant decrease in scores on the Pain Catastrophizing Scale (P
=
0.039), in average (P = 0.002), highest (P = 0.029), lowest (P = 0.04),
and current pain severity (P
= 0.02) on the Visual Analogue Scale, but there
was no change in pain quality by the McGill Pain
Questionnaire. There were
no significant changes in total and physical SF-36 scores, but the mental
score improved significantly (P = 0.049). There were no changes in the Pain
Disability Index or
Pittsburgh Sleep Quality Index. These data present a
potential, new, noninvasive means of treating
pain in AD by whole body
pneumatic compression as part of the CVAC process. Although
randomized,
controlled trials are needed to confirm these data, the CVAC process could
potentially
help in treating AD pain and other chronic pain disorders.
PMID: 21197318 [PubMed - in process]PMCID: PMC3004643
January 11, 2011
Int J Clin Oncol. 2011 Jan 7. [Epub ahead of print]
Risk factors for lower-limb lymphedema after surgery for cervical cancer.
Ohba Y, Todo Y, Kobayashi N, Kaneuchi M, Watari H, Takeda M, Sudo S, Kudo M,
Kato H,
Sakuragi N.
Department of Gynecology, Hokkaido University Graduate School of Medicine,
N15W7 Kita-ku,
Sapporo, 060-8638, Japan.
Abstract
BACKGROUND: Lower-limb lymphedema (LLL) is a prevalent complication that is
encountered
after treatment for gynecological malignancies. The aim of this
study was to evaluate the risk factors
for postoperative LLL in patients
with cervical cancer.
METHODS: We conducted a retrospective chart review for patients who had
undergone surgery,
including systematic lymphadenectomy, for cervical
cancer. Patients who died of cancer, were
evaluated for short periods of
time (<2 years), had missing medical records, or were suffering from
deep
venous thrombosis were excluded. We utilized the International Society of
Lymphology staging
of lymphedema severity as the diagnostic criteria for
LLL, and patients with stage II or III
lymphedema, as objectively determined
by physicians, were included in the group of patients with
LLL. Multivariate
analysis was performed to confirm independent risk factors.
RESULTS: A total of 155 patients with cervical cancer were evaluated.
Thirty-one patients (20.0%)
contracted LLL with a median follow-up of 6.1
years. Suprafemoral node dissection (odds ratio,
9.5; 95% confidence
interval, 1.2-73.3; P = 0.031) and adjuvant radiotherapy (3.7; 1.2-10.9; P =
0.019) were identified as independent risk factors.
CONCLUSION: Given that the effectiveness of the above two therapeutic options
for cervical
cancer is currently controversial, the clinical benefits of
these therapies should be reevaluated
specifically to conserve the quality
of life for patients with this disease.
PMID: 21213009 [PubMed - as supplied by publisher]
Eur J Med Genet. 2011 Jan 3. [Epub ahead of print]
3.7 Mb tandem microduplication in chromosome 5p13.1-p13.2 associated with
developmental
delay, macrocephaly, obesity, and lymphedema. Further
characterization of the dup(5p13)
syndrome.
Oexle K, Hempel M, Jauch A, Meitinger T, Rivera-Brugués N, Stengel-Rutkowski
S, Strom T.
Institute of Human Genetics, Technische Universität München, Munich,
Germany.
Abstract
In a male patient with developmental delay, autistic behaviour, obesity,
lymphedema, hypertension,
macrocephaly, and facial features of chromosome 5p
duplication (trisomy 5p) a 3.7 Mb de novo
tandem microduplication of
5p13.1-13.2 (rs4703415-rs261752, i.e., chr5:35.62-39.36Mb) was
identified. This observation contributes to the characterization and dissection of the 5p13 duplication
syndrome. The possible role of increased NIPBL gene dosage is
discussed.
Copyright © 2010. Published by Elsevier Masson SAS.
PMID: 21211577 [PubMed - as supplied by publisher]
January 14, 2011
Nurs Sci Q. 2011 Jan;24(1):57-63.
Limitations of self-care in reducing the risk of lymphedema:
supportive-educative systems.
Armer JM, Brooks CW, Stewart BR.
University of Missouri, USA.
Abstract
The purpose of this study was to examine patient perceptions of
limitations related to self-care
measures to reduce lymphedema risk
following breast cancer surgery. Secondary analysis of survey
data from a
companion study to a study piloting a behavioral-educational intervention was
conducted to examine the specific limitations in performing lymphedema
risk-reduction self-care
measures. Findings suggest a more comprehensive
approach is needed if patients are to engage in
self-care actions to reduce
lymphedema risk. Understanding the concepts of self-care and personal
support interventions that include motivational interviewing can help nurses
design supportive-
educative care systems that assist patients in overcoming limitations in the estimative, transitional, and
productive phases of
self-care necessary to reduce lymphedema risk.
PMID: 21220577 [PubMed - in process]
January 18, 2011
Eur J Dermatol. 2011 Jan 14. [Epub ahead of print]
Intra-arterial mitoxantrone/paclitaxel in angiosarcoma of the lower limb
associated with chronic
lymphedema (Stewart-Treves syndrome) in a patient
with cervical cancer.
Fujisawa Y, Ito M, Mori K, Okada S, Nakamura Y, Kawachi Y, Otsuka F.
Department of Dermatology, University of Tsukuba, 1-1-1 Tennodai, 305-8575
Tsukuba, Japan.
PMID: 21233070 [PubMed - as supplied by publisher]
Acta Oncol. 2011 Feb;50(2):187-93.
Late effects of breast cancer treatment and potentials for
rehabilitation.
Ewertz M, Jensen AB.
Department of Oncology, Odense University Hospital, Institute of Clinical
Research, University of
Southern Denmark, Denmark.
Abstract
Abstract Background. Breast cancer is the most frequent malignant disease
among women world
wide. Survival has been improving leading to an increasing
number of breast cancer survivors, in the
US estimated to about 2.6 million.
Material and methods. The literature was reviewed with focus on
data from
the Nordic countries. Results. Local therapies such as breast cancer surgery and
radiotherapy may cause persistent pain in the breast area, arm, and shoulder
reported by 30-50% of
patients after three to five years, lymphedema in
15-25% of patients, and restrictions of arm and
shoulder movement in 35%.
Physiotherapy is the standard treatment for the latter while no pain
intervention trials have been published. Chemotherapy may cause infertility
and premature
menopause, resulting in vasomotor symptoms, sexual
dysfunction, and osteoporosis, which are
similar to the side effects of
endocrine treatment in postmenopausal women. Awareness of
cardiotoxicity is
needed since anthracyclines, trastuzumab, and radiotherapy can damage the heart.
Breast cancer survivors have an increased risk of a major depression and far
from all receive
adequate anti-depressive treatment. Other psychological
symptoms include fear of recurrence, sleep
disturbances, cognitive problems,
fatigue, and sexual problems. Discussion. To improve
rehabilitation,
specific goals have to be formulated into national guidelines and high priority
directed
towards research into developing and testing new interventions for
alleviating symptoms and side
effects experienced by breast cancer
survivors.
PMID: 21231780 [PubMed - in process]
Lymphology. 2010 Sep;43(3):135-45.
Assessment of quality of life in lymphedema patients: validity and
reliability of the Swedish version of
the Lymphedema Quality of Life
Inventory (LQOLI).
Klernäs P, Kristjanson LJ, Johansson K.
Department of Physiotherapy, Institution of Neurobiology, Care Sciences and
Society, Karolinska
Institute, Stockholm, Sweden. [email protected]
Abstract
The Lymphedema Quality of Life Inventory (LQOLI) is an instrument
developed for patients with
different types of lymphedema. It contains
physical, emotional, social, and practical dimensions and
consists of 58
items, each with three sub items concerning life quality, daily life changes,
and
difficulties of changing and two items concerning life quality in
general and in relation to lymphedema.
The purpose of this study was to
adapt the Australian LQOLI to Swedish conditions and to test it
for clarity,
face validity, content validity, construct validity, and reliability. Content
and face validity
was completed by experts (n=11) and patients with
different types of lymphedema (n=16). For
construct validation the SF-36
(n=63) was used. Test-retest reliability was evaluated with
lymphedema
patients (n=58) answering the questionnaire twice, within median 3 weeks. Three
items
were added in the Swedish version of LQOLI (SLQOLI). The kappa
coefficients in test-retest for
all items and sub items varied (range =
0.25-0.83). Construct validity showed moderate correlation
with SF-36. The
SLQOLI is adapted and valid, with moderate reliability, and it can be used in
clinic
to describe life quality for patients with lymphedema. In this study,
67% of the patients experienced
an effect on life quality within the
physical dimension and 54-58% within the emotional, social, and
practical
dimensions.
PMID: 21226416 [PubMed - indexed for MEDLINE]
Lymphology. 2010 Sep;43(3):118-27.
Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60
months.
Armer JM, Stewart BR.
Sinclair School of Nursing, University of Missouri, Columbia, Missouri 65211,
USA.
[email protected]
Abstract
Breast cancer survivors are at life-time risk of developing lymphedema
(LE). Quantification of LE
has been problematic as the criteria used to
identify lymphedema use various methods to assess
changes in the volume of
the affected limb. In part because of difficulties and variability in
measurement and diagnosis, the reported incidence of LE varies greatly among
women treated with
surgery and radiation for breast cancer. The goal of this
research was to describe the trends for LE
occurrence over three points in
time (12, 30, and 60 months) among breast cancer survivors using
four
diagnostic criteria based on three measurement techniques. Participants were
enrolled following
diagnosis of breast cancer but before surgery. Baseline
limb volume and symptom assessment data
were obtained. Participants were
followed every 3 months for 12 months, then every 6 months
thereafter for a
total of 60 months. Limb volume changes (LVC) in both limbs were measured using
three techniques: objectively by (a) circumferences at 4 cm intervals and
(b) perometry and
subjectively by (c) symptom experience via interview. Four
diagnostic criteria for LE most often
reported in the literature were used:
(i) 2 cm circumferential change; (ii) 200 mL perometry LVC;
(iii) 10%
perometry LVC; and (iv) signs and symptoms (SS) report of limb heaviness and
swelling,
either 'now' or 'in the past year' (diagnostic criteria i-iii
define increases/differences in limb volume
from baseline and/or between the
affected and non-affected limb). Standard survival analysis
methods were
applied to identify when the criteria corresponding to LE were met. Trends in LE
occurrence are reported for preliminary analysis of data from 236
participants collected at 6-, 12-,
18-, 24-, 30-, and 60-months post-op. At
60 months post-treatment, LE incidence using the four
criteria ranged from
43% to 94%, with 2 cm associated with the highest frequency for lymphedema
occurrence and SS the lowest. Sixty-month trends are compared to earlier
trends at 12- and 30-
months, per criterion. These preliminary findings
provide additional evidence that breast cancer
survivors are at risk for
developing LE beyond the first year following treatment. Cases of
lymphedema
continue to emerge through 60-months post-breast cancer surgery. This 60-month
analysis supports the previous 12- and 30-month analyses in finding the 2 cm
criteria to be the most
liberal definition of LE. The self-report of
heaviness and swelling, along with 10% LVC, represent
the most conservative
definitions (41% and 45%, respectively). Furthermore, the variety of criteria
used to identify LE, along with the absence of baseline (pre-treatment)
measurements, likely
contribute to the wide range of LE incidence rates
reported in the literature.
PMID: 21226414 [PubMed - indexed for MEDLINE]
Mayo Clin Health Lett. 2010 Dec;28(12):6.
Lymphedema. Swelling not to be ignored.
[No authors listed]
PMID: 21226243 [PubMed - indexed for MEDLINE]
January 21, 2011
Support Care Cancer. 2011 Jan 16. [Epub ahead of print]
Body mass index and breast cancer treatment-related lymphedema.
Ridner SH, Dietrich MS, Stewart BR, Armer JM.
School of Nursing, Vanderbilt University, 460 21st Avenue South, 525 Godchaux
Hall, Nashville,
TN, 37240, USA, [email protected].
Abstract
PURPOSE: The main purpose was to examine longitudinally the influence of
body mass index
(BMI) and obesity on the development of breast cancer
treatment-related lymphedema. We asked,
does elevated BMI increase
lymphedema risk?
METHODS: A secondary analysis was conducted on de-identified data collected
from 138 newly
diagnosed breast cancer survivors who had arm-volume
measurements and symptom assessment at
pre-treatment baseline and
measurements up to 30 months post-surgery in a prospective longitudinal
parent study. Arm volume and weight data, part of the information collected
during each participant
visit, were examined.
RESULTS: Breast cancer survivors whose BMI was =30 at the time of breast
cancer treatment
were approximately 3.6 times more likely to develop
lymphedema at 6 months or greater after
diagnosis than those with a
BMI?<?30 at the time of cancer treatment (95% confidence interval, C.
I.,
for odds ratio, O.R., 1.42-9.04; p?=?0.007). Those with a general BMI increase
or a BMI rise
to 30 or greater during their first 30 months of survivorship
were not more likely to develop late-
onset lymphedema than those who did not
have similar changes in BMI.
CONCLUSIONS: Pre-treatment BMI may be a risk factor for lymphedema. Weight
gain post-
treatment may not be.
Further research is warranted.
PMID: 21240649 [PubMed - as supplied by publisher]
Ann Chir Plast Esthet. 2011 Jan 13. [Epub ahead of print]
[About an extreme case of giant lymphoedema of the upper limb: Ligasure
may be useful and a
multidisciplinary approach is mandatory.]
[Article in French]
Lafosse A, Vandeputte C, Sabor I, Mahaudens P, Denoel C.
Service de chirurgie plastique, cliniques universitaires Saint-Luc, avenue
Hippocrate 10, 1200
Bruxelles, Belgique.
Abstract
Treatment of giant lymphoedema remains very difficult. The main problem
is not only the obtention
of early postoperative favorable results but to
keep them long-lasting. The available treatment
options are numerous and
often combined. The indications have to be adapted to the clinical stage
of
the lesion. Ligasure(®) give us many advantages in the achievement of the
surgical resection due
to the quality of the lymphostasis that can be
obtained and to the very limited thermic lesions caused
to tissues. Long
lasting postoperative physiotherapy is of first importance. We here describe a
case
of a giant lymphoedema of the upper limb after axillary lymph node
dissection for breast cancer. The
first physiotherapy failed, causing a
lymphatic decompensation resulting in a lymphoedematous mass
of nearly 7kg.
The surgical resection with Ligasure(®) associated to drainage and compressive
physiotherapy in the long run allows to obtain good results. The late
follow-up after 4 years still
shows stable results.
Published by Elsevier SAS.
PMID: 21237550 [PubMed - as supplied by publisher]
Ann Chir Plast Esthet. 2011 Jan 13. [Epub ahead of print]
[From microsurgery to supermicrosurgery: Experimental feasibility study
and perspectives.]
[Article in French]
Qassemyar Q, Sinna R.
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord,
CHU d'Amiens, place
Victor-Pauchet, 80054 Amiens cedex 1, France.
Abstract
INTRODUCTION: Supermicrosurgical techniques developed for the anastomoses
less or equal to
0.5mm show convincing results in specialized centers and
with an advanced instrumentation. Can we
integrate supermicrosurgical
training animal models in the current teaching program of microsurgery?.
MATERIALS AND METHODS: Ten arterial anastomoses of the inferior epigastric
artery
(diameter less than or equal to 0.5mm) were performed consecutively
in five rats by the same
beginner operator in microsurgery, with standard
microsurgical set of instruments. The intravascular
stenting anastomosis
method was used with 11-0 nylon sutures. The immediate patency and flap
survival on postoperative day three was assessed. The duration of each
anastomosis was measured.
RESULTS: The mean diameter of the arteries was 0.4mm. The average time for
each anastomosis
was 30 minutes with a maximum of 55 minutes and a minimum
of 18 minutes. The average number
of stitches was 5.5. The immediate patency
was 100 % with a 70 % success rate at the third day.
CONCLUSIONS: There are several applications of supermicrosurgical techniques,
especially in
hand surgery, lymphoedema surgical treatment and for
perforator-to-perforator flaps. The
intravascular stenting method allows
fast learning of the technique with a satisfactory success rate
despite
non-specific instrumentation. Furthermore, this method could easily be
integrated among the
microsurgical courses of many universities.
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21237545 [PubMed - as supplied by publisher]
Health Qual Life Outcomes. 2011 Jan 14;9(1):3. [Epub ahead of print]
Health-related quality of life in Spanish breast cancer patients: a
systematic review.
Delgado-Sanz MC, Garcia-Mendizabal MJ, Pollan M, Forjaz MJ, Lopez-Abente
G, Aragones N,
Perez-Gomez B.
Abstract
BACKGROUND: Breast cancer is one of the oncological diseases in which
health-related quality of
life (HRQL) has been most studied. This is mainly
due to its high incidence and survival. This paper
seeks to: review
published research into HRQL among women with breast cancer in Spain; analyse
the characteristics of these studies; and describe the instruments used and
main results reported.
METHODS: The databases consulted were MEDLINE, EMBASE, PsycINFO, Dialnet,
IBECS,
CUIDEN, ISOC and LILACS. The inclusion criteria required studies to:
1) include Spanish
patients, and a breakdown of results where other types of
tumours and/or women from other
countries were also included; and, 2)
furnish original data and measure HRQL using a purpose-
designed
questionnaire. The methodological quality of the studies was assessed.
RESULTS: Spain ranked midway in the European Union in terms of the number of
studies
conducted on the HRQL of breast cancer patients. Of the total of 133
papers published from 1993
to 2009, 25 met the inclusion criteria. Among
them, only 12 were considered as having good or
excellent quality. A total
of 2236 women participated in the studies analysed. In descending order of
frequency, the questionnaires used were the EORTC, FACT-B, QL-CA-Afex,
SF-12, FLIC,
RSCL and CCV. Five papers focused on validation or adaptation
of questionnaires. Most papers
examined HRQL in terms of type of treatment.
Few differences were detected by type of
chemotherapy, with the single
exception of worse results among younger women treated with
radiotherapy. In
the short term, better results were reported for all HRQL components by women
undergoing conservative rather than radical surgery. Presence of lymphedema
was associated with
worse HRQL. Three studies assessed differences in HRQL
by patients' psychological traits.
Psychosocial disorder and level of
depression and anxiety, regardless of treatment or disease stage,
worsened
HRQL. In addition, there was a positive effect among patients who reported
having a
"fighting spirit" and using "denial" as a defence mechanism. One
study found that breast cancer
patients scored worse than did healthy women
on almost all SF-12 scales.
CONCLUSION: Research into health-related quality of life of breast-cancer
patients is a little
developed field in Spain.
PMID: 21235770 [PubMed - as supplied by publisher]
January 22, 2011
Klin Monbl Augenheilkd. 2011 Jan;228(1):19-24. Epub 2011 Jan 19.
[Chronic Eyelid Oedema and Rosacea (Morbus Morbihan): Diagnostic and
Therapeutic Challenges.]
[Article in German]
Renieri G, Brochhausen C, Pfeiffer N, Pitz S.
Augenklinik und Poliklinik, Universitätsmedizin der
Johannes-Gutenberg-Universität, Mainz.
Abstract
BACKGROUND: Morbus Morbihan is a rare complication of rosacea, consisting
of a persistent
lymphoedema of the upper part of the face. It has typically
a chronic course, unspecific
histopathological findings and an extreme
refractoriness to therapy.
PATIENTS AND METHODS: Between February 2008 and January 2010, 5 patients with
Morbus Morbihan were observed at the Department of Ophthalmology of the
University Medical
Centre Mainz. In the present cohort study, we describe
the clinical, laboratory and histological
findings that led to the
diagnosis. The course of the affection and the results of different therapeutic
options are also reported.
RESULTS: Each patient underwent a complete ophthalmological examination, as
well as general
and dermatological consultations. All patients showed facial
skin alterations typical for rosacea. 4
out of 5 subjects underwent a lid
biopsy to confirm the diagnosis of Morbus Morbihan, one patient
refused it.
Initial treatment consisted of various systemic and local medical therapies,
however, with
poor success. One patient had intravenous therapy with
corticosteroids elsewhere with no effect.
We treated 3 cases with
intralesional triamcinolone injections with good results. 2 patients
underwent upper lid blepharoplasty. Results of surgery remained stable also
due to manual lymph
drainage and intralesional injections of triamcinolon.
No complications or side effects were seen in
patients treated with
triamcinolone.
CONCLUSIONS: Morbus Morbihan can be diagnosed only after excluding other
conditions
leading to chronic lid swelling. In our series, good results were
achieved with intralesional injection of
triamcinolone. Surgery also led to
relevant improvements for a long period (13 months), with some
adjuvant
therapy. The treatment of chronic eyelid oedema associated with rosacea remains
a
challenge for the ophthalmologist and the oculoplastic surgeon.
Georg Thieme Verlag KG Stuttgart · New York.
PMID: 21249610 [PubMed - as supplied by publisher]
January 25, 2011
Klin Monbl Augenheilkd. 2011 Jan;228(1):19-24. Epub 2011 Jan 19.
[
Chronic Eyelid Oedema and Rosacea (Morbus Morbihan): Diagnostic and
Therapeutic Challenges.]
[Article in German]
Renieri G, Brochhausen C, Pfeiffer N, Pitz S.
Augenklinik und Poliklinik, Universitätsmedizin der
Johannes-Gutenberg-Universität, Mainz.
Abstract
BACKGROUND: Morbus Morbihan is a rare complication of rosacea, consisting
of a persistent
lymphoedema of the upper part of the face. It has typically
a chronic course, unspecific
histopathological findings and an extreme
refractoriness to therapy.
PATIENTS AND METHODS: Between February 2008 and January 2010, 5 patients with
Morbus Morbihan were observed at the Department of Ophthalmology of the
University Medical
Centre Mainz. In the present cohort study, we describe
the clinical, laboratory and histological
findings that led to the
diagnosis. The course of the affection and the results of different therapeutic
options are also reported.
RESULTS: Each patient underwent a complete ophthalmological examination, as
well as general
and dermatological consultations. All patients showed facial
skin alterations typical for rosacea. 4
out of 5 subjects underwent a lid
biopsy to confirm the diagnosis of Morbus Morbihan, one patient
refused it.
Initial treatment consisted of various systemic and local medical therapies,
however, with
poor success. One patient had intravenous therapy with
corticosteroids elsewhere with no effect.
We treated 3 cases with
intralesional triamcinolone injections with good results. 2 patients
underwent upper lid blepharoplasty. Results of surgery remained stable also
due to manual lymph
drainage and intralesional injections of triamcinolon.
No complications or side effects were seen in
patients treated with
triamcinolone.
CONCLUSIONS: Morbus Morbihan can be diagnosed only after excluding other
conditions
leading to chronic lid swelling. In our series, good results were
achieved with intralesional injection of
triamcinolone. Surgery also led to
relevant improvements for a long period (13 months), with some
adjuvant
therapy. The treatment of chronic eyelid oedema associated with rosacea remains
a
challenge for the ophthalmologist and the oculoplastic surgeon.
© Georg Thieme Verlag KG Stuttgart · New York.
PMID: 21249610 [PubMed - as supplied by publisher]
Skeletal Radiol. 2011 Jan 20. [Epub ahead of print]
Massive localised lymphoedema: clinical presentation and MR imaging
characteristics.
Khanna M, Naraghi AM, Salonen D, Bhumbra R, Dickson BC, Kransdorf MJ,
White LM.
Department of Clinical Imaging, Imperial College Healthcare NHS Trust,
London, UK, monica.
[email protected].
Abstract
Three morbidly obese women were referred to us with suspected soft-tissue
sarcomas. All lesions
arose from the medial subcutaneous tissues of the
thigh, and were shown to represent massive
localised lymphoedema (MLL), a
rare condition occurring in morbidly obese adults. MR imaging
typically
demonstrates a sharply demarcated, pedunculated mass consisting of fat
partitioned by
fibrous septae surrounded by a thickened dermis. There is
oedema both within the mass and
tracking along the subcutaneous septae in a
"lace-like" fashion outwards from the pedicle, outlining
large lobules of
fat. Minimal enhancement is observed within the dermis of the lesion following
intravenous gadolinium administration. Obesity is a growing problem that is
likely to result in an
increase in the prevalence of this condition;
therefore, familiarity with the radiological appearance is
important in
establishing a correct diagnosis in this condition that may mimic a soft-tissue
sarcoma.
PMID: 21249496 [PubMed - as supplied by publisher]
Am J Physiol Cell Physiol. 2011 Jan 19. [Epub ahead of print]
Temporal and spatial patterns of endogenous danger signal expression
after wound healing and in
response to lymphedema.
Zampell JC, Yan A, Avraham T, Andrade V, Malliaris S, Aschen SZ, Rockson
SG, Mehrara BJ.
1Memorial Sloan-Kettering Cancer Center.
Abstract
While acute tissue injury potently induces endogenous danger signal
expression, the role of these
molecules in chronic wound healing and
lymphedema is undefined. The purpose of this study was to
determine the
spatial and temporal expression patterns of the endogenous danger signals HMGB1
and HSP70 during wound healing and chronic lymphatic fluid stasis. In a
surgical mouse tail model
of tissue injury and lymphedema, HMGB1 and HSP70
expression occurred along a spatial gradient
relative to the site of injury,
with peak expression at the wound and >2-fold reduced expression
within 5
mm (P<0.05). Expression primarily occurred in cells native to injured tissue.
In particular,
HMGB1 was highly expressed by lymphatic endothelial cells
(LECs, >40% positivity; 2-fold
increase in chronic inflammation,
P<0.001). We found similar findings using a peritoneal
inflammation
model. Interestingly, upregulation of HMGB1 (2.2-fold), HSP70 (1.4-fold), and
NF-
kß activation persisted at least 6 weeks post-operatively only in
lymphedematous tissues. Similarly,
we found upregulation of endogenous
danger signals in soft tissue of the arm after axillary
lymphadenectomy in a
mouse model and in matched biopsy samples obtained from patients with
secondary lymphedema comparing normal to lymphedematous arms (2.4-fold
increased HMGB1,
1.9-fold increased HSP70; P<0.01). Finally, HMGB1
blockade significantly reduced inflammatory
lymphangiogenesis within
inflamed draining lymph nodes (35% reduction, P<0.01). In conclusion,
HMGB1 and HSP70 are expressed along spatial gradients and upregulated in
chronic lymphatic
fluid stasis; furthermore, acute expression of endogenous
danger signals may play a role in
inflammatory lymphangiogenesis.
PMID: 21248077 [PubMed - as supplied by publisher]
January 28, 2011
Int J Obes (Lond). 2011 Jan 25. [Epub ahead of print]
Oedema in obesity; role of structural lymphatic abnormalities.
Vasileiou AM, Bull R, Kitou D, Alexiadou K, Garvie NJ, Coppack SW.
East London Obesity Service, Barts and The London Medical School, Homerton
University
Hospital and Nuclear Medicine, The Royal London Hospital, London,
UK.
Abstract
Oedema is a common finding in obesity and its cause is not always clear.
Possible causes include
impairment of cardiac, respiratory and/or renal
function, chronic venous insufficiency and lymphatic
problems.
Lymphoscintigraphy is the best method to detect structural lymphatic
abnormalities that
can cause lymphoedema. We reviewed 49 female subjects
with pitting oedema who had undergone
lymphoscintigraphy, divided in three
groups. The first group was comprised of severely obese
patients in whom
cardiorespiratory causes for oedema had been excluded. The second group
consisted of non-obese patients with recognized causes for oedema and the
third group was non-
obese patients with 'idiopathic' oedema. A standard
classification was used to interpret
lymphoscintigraphy results. The
frequency and severity of lymphoscintigraphic abnormalities was
greatest in
patients with clinical diagnoses of oedema related to 'recognized causes' (any
abnormality
in 50% of legs with obstruction in 22%). Obese patients and
those with 'idiopathic'oedema had
fewer (P=0.02 for both) and milder
lymphoscintographic abnormalities (any abnormality 32 and
25%, respectively,
obstruction 5 and 3%, respectively), and although the clinical oedema was
invariably bilateral, the lymphoscintigraphy abnormalities were usually
unilateral. In conclusion,
structural lymphoscintigraphic abnormalities are
uncommon in obesity and do not closely correlate
with the clinical pattern
of oedema.International Journal of Obesity advance online publication, 25
January 2011; doi:10.1038/ijo.2010.273.
PMID: 21266949 [PubMed - as supplied by publisher]
J Med Genet. 2011 Jan 25. [Epub ahead of print]
Rapid identification of mutations in GJC2 in primary lymphoedema using
whole exome sequencing
combined with linkage analysis with delineation of
the phenotype.
Ostergaard P, Simpson MA, Brice G, Mansour S, Connell FC, Onoufriadis A,
Child AH, Hwang J,
Kalidas K, Mortimer PS, Trembath R, Jeffery S.
1Medical Genetics, St George's, University of London, London, UK.
Abstract
Background Primary lymphoedema describes a chronic, frequently
progressive, failure of lymphatic
drainage. This disorder is frequently
genetic in origin, and a multigenerational family in which eight
individuals
developed postnatal lymphoedema of all four limbs was ascertained from the joint
Lymphoedema/Genetic clinic at St George's Hospital. Methods Linkage analysis
was used to
determine a locus, and exome sequencing was employed to look for
causative variants. Results
Linkage analysis revealed cosegregation of a
16.1 Mb haplotype on chromosome 1q42 that
contained 173 known or predicted
genes. Whole exome sequencing in a single affected individual
was
undertaken, and the search for the causative variant was focused to within the
linkage interval.
This approach revealed two novel non-synonymous single
nucleotide substitutions within the
chromosome 1 locus, in NVL and GJC2. NVL
and GJC2 were sequenced in an additional cohort
of individuals with a
similar phenotype and non-synonymous variants were found in GJC2 in four
additional families. Conclusion This report demonstrates the power of exome
sequencing efficiently
applied to a traditional positional cloning pipeline
in disease gene discovery, and suggests that the
phenotype produced by GJC2
mutations is predominantly one of 4 limb lymphoedema.
PMID: 21266381 [PubMed - as supplied by publisher]
Lik Sprava. 2010 Apr-Jun;(3-4):11-20.
[Lymphedema: clinic-therapeutic aspect].
[Article in Ukrainian]
[No authors listed]
Abstract
Lymphedema may be presented in mild or less severe form. Nowadays,
accurate diagnosis and
effective therapy are available. Wearing surgical
bandage, massage, exercise, and pumps form the
core program for most
patients with lymphedema. The application of pharmacological therapies has
been notably absent from the management strategies for lymphatic vascular
insufficiency states but
lately some progress has been made by applying
wobenzym in the treatment. Surgical approaches to
improve lymphatic flow
through vascular anastamosis have been, in large part, unsuccessful, but
controlled liposuction affords lasting benefit in selected patients.
PMID: 21265117 [PubMed - in process]
Nurs Times. 2010 Dec 14-2011 Jan 10;106(49-50):15-7.
Early diagnosis of lymphoedema helps to reduce its psychological and
social impact.
Cooper G.
Walsall Lymphoedema Service, Walsall Community Health.
Abstract
Lymphoedema is often unrecognised by both health professionals and
patients. In addition, its
impact is often underestimated. This article
discusses how to recognise the condition, the
consequences of misdiagnosis,
reducing or preventing complications and various treatment options.
PMID: 21261161 [PubMed - in process]
Biomed Opt Express. 2010 Jul 15;1(1):114-125.
Direct evidence of lymphatic function improvement after advanced
pneumatic compression device
treatment of lymphedema.
Adams KE, Rasmussen JC, Darne C, Tan IC, Aldrich MB, Marshall MV, Fife
CE, Maus EA,
Smith LA, Guilloid R, Hoy S, Sevick-Muraca EM.
Abstract
Lymphedema affects up to 50% of all breast cancer survivors. Management
with pneumatic
compression devices (PCDs) is controversial, owing to the
lack of methods to directly assess
benefit. This pilot study employed an
investigational, near-infrared (NIR) fluorescence imaging
technique to
evaluate lymphatic response to PCD therapy in normal control and breast
cancer-
related lymphedema (BCRL) subjects. Lymphatic propulsion rate,
apparent lymph velocity, and
lymphatic vessel recruitment were measured
before, during, and after advanced PCD therapy.
Lymphatic function improved
in all control subjects and all asymptomatic arms of BCRL subjects.
Lymphatic function improved in 4 of 6 BCRL affected arms, improvement
defined as proximal
movement of dye after therapy. NIR fluorescence
lymphatic imaging may be useful to directly
evaluate lymphatic response to
therapy. These results suggest that PCDs can stimulate lymphatic
function
and may be an effective method to manage BCRL, warranting future clinical
trials.
PMID: 21258451 [PubMed - as supplied by publisher]PMCID: PMC3005162
Urology. 2011 Jan 20. [Epub ahead of print]
Reconstructive Surgery for Penoscrotal Filarial Lymphedema: A Decade of
Experience and Follow-
up.
Singh V, Sinha RJ, Sankhwar SN, Kumar V.
Department of Urology, Chhatrapati Shahuji Maharaj Medical University
(formerly King George's
Medical University),
Lucknow, India.
Abstract
OBJECTIVES: To present our experience of reconstructive surgery in
patients with penoscrotal
filarial lymphedema.
METHODS: From January 2000 to December 2009, we treated 48 patients with
penile and
penoscrotal filarial lymphedema using reconstructive surgery.
Isolated penile involvement was seen in
14 patients, and 34 patients had
penoscrotal involvement. All the patients had taken multiple courses
of
antifilarial drug before surgery. For isolated penile involvement, the diseased
penile skin was
excised and covered with a split-thickness skin graft. In
some patients, the inner prepucial skin was
preserved and used to cover the
penile shaft. For those with penoscrotal involvement, scrotoplasty
was
performed, after excising the diseased scrotal skin and underlying soft tissue,
while sparing the
testes and spermatic cords.
RESULTS: The mean patient age was 38 years (range 25-52), and the median
follow-up time was
48 months (range 10-120). All 48 patients reported a
satisfactory cosmetic appearance after the
procedure and noted improvement
in their ability to void while standing. Also, all of them could
ambulate
better and resumed sexual activity. Local groin infection was present in 12
patients; all
were cured after proper management.
CONCLUSIONS: In filarial lymphedema of penis and/or scrotum, excision of the
diseased tissue
and covering with a split-thickness skin graft provided good
results. If the inner prepucial skin is
healthy, it should be used to cover
the distal penile shaft. If the scrotum is involved, scrotoplasty with
lateral and posterior mobilized flaps provides satisfactory results.
2011 Elsevier Inc. All rights reserved.
PMID: 21256561 [PubMed - as supplied by publisher]
January 3, 2011
Jpn J Ophthalmol. 2010 Nov;54(6):626-8. Epub 2010 Dec 30.
Congenital toxoplasmosis mimicking microcephaly-lymphedema-chorioretinal
dysplasia.
Ozeki Y, Shimada Y, Tanikawa A, Horiguchi M, Takeuchi M, Yamazaki T.
PMID: 21191727 [PubMed - in process]
Lymphat Res Biol. 2010 Dec;8(4):209-15.
Advanced pneumatic therapy in self-care of chronic lymphedema of the
trunk.
Ridner SH, Murphy B, Deng J, Kidd N, Galford E, Dietrich MS.
Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA.
sheila.
[email protected]
Comment in:
Lymphat Res Biol. 2010 Dec;8(4):v.
Abstract
BACKGROUND: The purpose of this study was to conduct a preliminary,
post-market, home
study of the Flexitouch(®) system to examine the potential
efficacy of the device as a component of
self-care in breast cancer
survivors with truncal lymphedema.
METHODS AND RESULTS: A quasi-experimental, pre-treatment, post-treatment
design was
used. Twelve participants received a total of ten
self-administered, consecutive, one hour per day
treatments. Treatments one
and two were observed by study staff and the remaining eight were
unobserved. Assessments were conducted at baseline, after the first two
treatments, mid-way
through therapy, and at the end-of-study. Logs revealed
100% compliance with the eight prescribed
unobserved home treatments.
Symptoms were assessed by self-report symptom surveys. Signs,
objectively
observed physical phenomenon, were assessed by staff-initiated skin examination
and
circumferential truncal measurements. Statistically significant
improvement in truncal symptoms and
sleep were found. Changes in function
and girth were not statistically significant in this initial study.
CONCLUSIONS: Breast cancer survivors with truncal lymphedema may benefit from
using an
advanced pneumatic compression devices with truncal treatment as
part of their self-care program.
Participants were highly compliant in
device use. Further research of this intervention is warranted.
To
facilitate future research, clinically meaningful reductions in truncal girth
should be defined.
PMID: 21190493 [PubMed - in process]PMCID: PMC3008167 [Available on
2011/12/1]
Lymphat Res Biol. 2010 Dec;8(4):v.
Accruing evidence for a beneficial role of pneumatic biocompression in
lymphedema.
Rockson SG.
Comment on:
Lymphat Res Biol. 2010 Dec;8(4):183-7.
Lymphat Res Biol. 2010 Dec;8(4):209-15.
PMID: 21190488 [PubMed - in process]
Rev Med Liege. 2010 Nov;65(11):655-61.
[How to diagnose the cause of oedema, a clinical approach].
[Article in French]
Krzesinski JM.
Universite de Liège, Service de Néphrologie-Dialyse-Hypertension, CHU de
Liège, Belgique. jm.
[email protected]
Abstract
Oedema is a frequent disorder and the easily detectable consequence of an
increase of fluid located
in the interstitial tissue. It could be localized
or generalized and related either to a primary
disturbance of hemodynamics
at the capillary level, due to a modification of the Starling's law
components with secondary water and saline retention, or to a primary
retention of salt and water
linked to a kidney abnormality. Generalized
forms are pitting oedema, most often painless, white,
bilateral and
symmetric, distributed at the lower part of the body (localisation according to
the
gravitation law). They are different in their characteristics from
localized oedema or lymphoedema
which are tough. We propose a diagnostic
approach based on medical history, clinical examination
which allows a
confident medical diagnosis and so an adapted therapy.
PMID: 21189533 [PubMed - in process]
January 7, 2011
J Travel Med. 2011 Jan;18(1):68-9. doi: 10.1111/j.1708-8305.2010.00472.x.
Epub 2010 Nov 25.
Lymphedema in a guyanan migrant.
Depetrillo JC, Singer C.
Division of Infectious Diseases, Department of Medicine, Long Island Jewish
Medical Center, New
Hyde Park, NY, USA.
PMID: 21199149 [PubMed - in process]
J Pain Res. 2010 Aug 20;3:147-53.
Pilot study: rapidly cycling hypobaric pressure improves pain after 5 days in
adiposis dolorosa.
Herbst KL, Rutledge T.
Department of Medicine, University of California, San Diego, California,
USA;
Abstract
Adiposis dolorosa (AD) is a rare disorder of painful nodular subcutaneous fat
accompanied by
fatigue, difficulty with weight loss, inflammation, increased
fluid in adipose tissue (lipedema and
lymphedema), and hyperalgesia.
Sequential compression relieves lymphedema pain; we therefore
hypothesized
that whole body cyclic pneumatic hypobaric compression may relieve pain in AD.
To
avoid exacerbating hyperalgesia, we utilized a touch-free method, which
is delivered via a high-
performance altitude simulator, the Cyclic
Variations in Altitude Conditioning™ (CVAC™)
process. As a pilot study, 10
participants with AD completed pain and quality of life questionnaires
before and after 20-40 minutes of CVAC process daily for 5 days.
Participants lost weight (195.5
± 17.6-193.8 ± 17.3 lb; P = 0.03), and
bioimpedance significantly decreased (510 ± 36-490 ± 38
ohm; P = 0.01).
There was a significant decrease in scores on the Pain Catastrophizing Scale (P
=
0.039), in average (P = 0.002), highest (P = 0.029), lowest (P = 0.04),
and current pain severity (P
= 0.02) on the Visual Analogue Scale, but there
was no change in pain quality by the McGill Pain
Questionnaire. There were
no significant changes in total and physical SF-36 scores, but the mental
score improved significantly (P = 0.049). There were no changes in the Pain
Disability Index or
Pittsburgh Sleep Quality Index. These data present a
potential, new, noninvasive means of treating
pain in AD by whole body
pneumatic compression as part of the CVAC process. Although
randomized,
controlled trials are needed to confirm these data, the CVAC process could
potentially
help in treating AD pain and other chronic pain disorders.
PMID: 21197318 [PubMed - in process]PMCID: PMC3004643
January 11, 2011
Int J Clin Oncol. 2011 Jan 7. [Epub ahead of print]
Risk factors for lower-limb lymphedema after surgery for cervical cancer.
Ohba Y, Todo Y, Kobayashi N, Kaneuchi M, Watari H, Takeda M, Sudo S, Kudo M,
Kato H,
Sakuragi N.
Department of Gynecology, Hokkaido University Graduate School of Medicine,
N15W7 Kita-ku,
Sapporo, 060-8638, Japan.
Abstract
BACKGROUND: Lower-limb lymphedema (LLL) is a prevalent complication that is
encountered
after treatment for gynecological malignancies. The aim of this
study was to evaluate the risk factors
for postoperative LLL in patients
with cervical cancer.
METHODS: We conducted a retrospective chart review for patients who had
undergone surgery,
including systematic lymphadenectomy, for cervical
cancer. Patients who died of cancer, were
evaluated for short periods of
time (<2 years), had missing medical records, or were suffering from
deep
venous thrombosis were excluded. We utilized the International Society of
Lymphology staging
of lymphedema severity as the diagnostic criteria for
LLL, and patients with stage II or III
lymphedema, as objectively determined
by physicians, were included in the group of patients with
LLL. Multivariate
analysis was performed to confirm independent risk factors.
RESULTS: A total of 155 patients with cervical cancer were evaluated.
Thirty-one patients (20.0%)
contracted LLL with a median follow-up of 6.1
years. Suprafemoral node dissection (odds ratio,
9.5; 95% confidence
interval, 1.2-73.3; P = 0.031) and adjuvant radiotherapy (3.7; 1.2-10.9; P =
0.019) were identified as independent risk factors.
CONCLUSION: Given that the effectiveness of the above two therapeutic options
for cervical
cancer is currently controversial, the clinical benefits of
these therapies should be reevaluated
specifically to conserve the quality
of life for patients with this disease.
PMID: 21213009 [PubMed - as supplied by publisher]
Eur J Med Genet. 2011 Jan 3. [Epub ahead of print]
3.7 Mb tandem microduplication in chromosome 5p13.1-p13.2 associated with
developmental
delay, macrocephaly, obesity, and lymphedema. Further
characterization of the dup(5p13)
syndrome.
Oexle K, Hempel M, Jauch A, Meitinger T, Rivera-Brugués N, Stengel-Rutkowski
S, Strom T.
Institute of Human Genetics, Technische Universität München, Munich,
Germany.
Abstract
In a male patient with developmental delay, autistic behaviour, obesity,
lymphedema, hypertension,
macrocephaly, and facial features of chromosome 5p
duplication (trisomy 5p) a 3.7 Mb de novo
tandem microduplication of
5p13.1-13.2 (rs4703415-rs261752, i.e., chr5:35.62-39.36Mb) was
identified.
This observation contributes to the characterization and dissection of the 5p13
duplication
syndrome. The possible role of increased NIPBL gene dosage is
discussed.
Copyright © 2010. Published by Elsevier Masson SAS.
PMID: 21211577 [PubMed - as supplied by publisher]
January 14, 2011
Nurs Sci Q. 2011 Jan;24(1):57-63.
Limitations of self-care in reducing the risk of lymphedema:
supportive-educative systems.
Armer JM, Brooks CW, Stewart BR.
University of Missouri, USA.
Abstract
The purpose of this study was to examine patient perceptions of
limitations related to self-care
measures to reduce lymphedema risk
following breast cancer surgery. Secondary analysis of survey
data from a
companion study to a study piloting a behavioral-educational intervention was
conducted to examine the specific limitations in performing lymphedema
risk-reduction self-care
measures. Findings suggest a more comprehensive
approach is needed if patients are to engage in
self-care actions to reduce
lymphedema risk. Understanding the concepts of self-care and personal
support interventions that include motivational interviewing can help nurses
design supportive-
educative care systems that assist patients in overcoming
limitations in the estimative, transitional, and
productive phases of
self-care necessary to reduce lymphedema risk.
PMID: 21220577 [PubMed - in process]
January 18, 2011
Eur J Dermatol. 2011 Jan 14. [Epub ahead of print]
Intra-arterial mitoxantrone/paclitaxel in angiosarcoma of the lower limb
associated with chronic
lymphedema (Stewart-Treves syndrome) in a patient
with cervical cancer.
Fujisawa Y, Ito M, Mori K, Okada S, Nakamura Y, Kawachi Y, Otsuka F.
Department of Dermatology, University of Tsukuba, 1-1-1 Tennodai, 305-8575
Tsukuba, Japan.
PMID: 21233070 [PubMed - as supplied by publisher]
Acta Oncol. 2011 Feb;50(2):187-93.
Late effects of breast cancer treatment and potentials for
rehabilitation.
Ewertz M, Jensen AB.
Department of Oncology, Odense University Hospital, Institute of Clinical
Research, University of
Southern Denmark, Denmark.
Abstract
Abstract Background. Breast cancer is the most frequent malignant disease
among women world
wide. Survival has been improving leading to an increasing
number of breast cancer survivors, in the
US estimated to about 2.6 million.
Material and methods. The literature was reviewed with focus on
data from
the Nordic countries. Results. Local therapies such as breast cancer surgery and
radiotherapy may cause persistent pain in the breast area, arm, and shoulder
reported by 30-50% of
patients after three to five years, lymphedema in
15-25% of patients, and restrictions of arm and
shoulder movement in 35%.
Physiotherapy is the standard treatment for the latter while no pain
intervention trials have been published. Chemotherapy may cause infertility
and premature
menopause, resulting in vasomotor symptoms, sexual
dysfunction, and osteoporosis, which are
similar to the side effects of
endocrine treatment in postmenopausal women. Awareness of
cardiotoxicity is
needed since anthracyclines, trastuzumab, and radiotherapy can damage the heart.
Breast cancer survivors have an increased risk of a major depression and far
from all receive
adequate anti-depressive treatment. Other psychological
symptoms include fear of recurrence, sleep
disturbances, cognitive problems,
fatigue, and sexual problems. Discussion. To improve
rehabilitation,
specific goals have to be formulated into national guidelines and high priority
directed
towards research into developing and testing new interventions for
alleviating symptoms and side
effects experienced by breast cancer
survivors.
PMID: 21231780 [PubMed - in process]
Lymphology. 2010 Sep;43(3):135-45.
Assessment of quality of life in lymphedema patients: validity and
reliability of the Swedish version of
the Lymphedema Quality of Life
Inventory (LQOLI).
Klernäs P, Kristjanson LJ, Johansson K.
Department of Physiotherapy, Institution of Neurobiology, Care Sciences and
Society, Karolinska
Institute, Stockholm, Sweden. [email protected]
Abstract
The Lymphedema Quality of Life Inventory (LQOLI) is an instrument
developed for patients with
different types of lymphedema. It contains
physical, emotional, social, and practical dimensions and
consists of 58
items, each with three sub items concerning life quality, daily life changes,
and
difficulties of changing and two items concerning life quality in
general and in relation to lymphedema.
The purpose of this study was to
adapt the Australian LQOLI to Swedish conditions and to test it
for clarity,
face validity, content validity, construct validity, and reliability. Content
and face validity
was completed by experts (n=11) and patients with
different types of lymphedema (n=16). For
construct validation the SF-36
(n=63) was used. Test-retest reliability was evaluated with
lymphedema
patients (n=58) answering the questionnaire twice, within median 3 weeks. Three
items
were added in the Swedish version of LQOLI (SLQOLI). The kappa
coefficients in test-retest for
all items and sub items varied (range =
0.25-0.83). Construct validity showed moderate correlation
with SF-36. The
SLQOLI is adapted and valid, with moderate reliability, and it can be used in
clinic
to describe life quality for patients with lymphedema. In this study,
67% of the patients experienced
an effect on life quality within the
physical dimension and 54-58% within the emotional, social, and
practical
dimensions.
PMID: 21226416 [PubMed - indexed for MEDLINE]
Lymphology. 2010 Sep;43(3):118-27.
Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60
months.
Armer JM, Stewart BR.
Sinclair School of Nursing, University of Missouri, Columbia, Missouri 65211,
USA.
[email protected]
Abstract
Breast cancer survivors are at life-time risk of developing lymphedema
(LE). Quantification of LE
has been problematic as the criteria used to
identify lymphedema use various methods to assess
changes in the volume of
the affected limb. In part because of difficulties and variability in
measurement and diagnosis, the reported incidence of LE varies greatly among
women treated with
surgery and radiation for breast cancer. The goal of this
research was to describe the trends for LE
occurrence over three points in
time (12, 30, and 60 months) among breast cancer survivors using
four
diagnostic criteria based on three measurement techniques. Participants were
enrolled following
diagnosis of breast cancer but before surgery. Baseline
limb volume and symptom assessment data
were obtained. Participants were
followed every 3 months for 12 months, then every 6 months
thereafter for a
total of 60 months. Limb volume changes (LVC) in both limbs were measured using
three techniques: objectively by (a) circumferences at 4 cm intervals and
(b) perometry and
subjectively by (c) symptom experience via interview. Four
diagnostic criteria for LE most often
reported in the literature were used:
(i) 2 cm circumferential change; (ii) 200 mL perometry LVC;
(iii) 10%
perometry LVC; and (iv) signs and symptoms (SS) report of limb heaviness and
swelling,
either 'now' or 'in the past year' (diagnostic criteria i-iii
define increases/differences in limb volume
from baseline and/or between the
affected and non-affected limb). Standard survival analysis
methods were
applied to identify when the criteria corresponding to LE were met. Trends in LE
occurrence are reported for preliminary analysis of data from 236
participants collected at 6-, 12-,
18-, 24-, 30-, and 60-months post-op. At
60 months post-treatment, LE incidence using the four
criteria ranged from
43% to 94%, with 2 cm associated with the highest frequency for lymphedema
occurrence and SS the lowest. Sixty-month trends are compared to earlier
trends at 12- and 30-
months, per criterion. These preliminary findings
provide additional evidence that breast cancer
survivors are at risk for
developing LE beyond the first year following treatment. Cases of
lymphedema
continue to emerge through 60-months post-breast cancer surgery. This 60-month
analysis supports the previous 12- and 30-month analyses in finding the 2 cm
criteria to be the most
liberal definition of LE. The self-report of
heaviness and swelling, along with 10% LVC, represent
the most conservative
definitions (41% and 45%, respectively). Furthermore, the variety of criteria
used to identify LE, along with the absence of baseline (pre-treatment)
measurements, likely
contribute to the wide range of LE incidence rates
reported in the literature.
PMID: 21226414 [PubMed - indexed for MEDLINE]
Mayo Clin Health Lett. 2010 Dec;28(12):6.
Lymphedema. Swelling not to be ignored.
[No authors listed]
PMID: 21226243 [PubMed - indexed for MEDLINE]
January 21, 2011
Support Care Cancer. 2011 Jan 16. [Epub ahead of print]
Body mass index and breast cancer treatment-related lymphedema.
Ridner SH, Dietrich MS, Stewart BR, Armer JM.
School of Nursing, Vanderbilt University, 460 21st Avenue South, 525 Godchaux
Hall, Nashville,
TN, 37240, USA, [email protected].
Abstract
PURPOSE: The main purpose was to examine longitudinally the influence of
body mass index
(BMI) and obesity on the development of breast cancer
treatment-related lymphedema. We asked,
does elevated BMI increase
lymphedema risk?
METHODS: A secondary analysis was conducted on de-identified data collected
from 138 newly
diagnosed breast cancer survivors who had arm-volume
measurements and symptom assessment at
pre-treatment baseline and
measurements up to 30 months post-surgery in a prospective longitudinal
parent study. Arm volume and weight data, part of the information collected
during each participant
visit, were examined.
RESULTS: Breast cancer survivors whose BMI was =30 at the time of breast
cancer treatment
were approximately 3.6 times more likely to develop
lymphedema at 6 months or greater after
diagnosis than those with a
BMI?<?30 at the time of cancer treatment (95% confidence interval, C.
I.,
for odds ratio, O.R., 1.42-9.04; p?=?0.007). Those with a general BMI increase
or a BMI rise
to 30 or greater during their first 30 months of survivorship
were not more likely to develop late-
onset lymphedema than those who did not
have similar changes in BMI.
CONCLUSIONS: Pre-treatment BMI may be a risk factor for lymphedema. Weight
gain post-
treatment may not be.
Further research is warranted.
PMID: 21240649 [PubMed - as supplied by publisher]
Ann Chir Plast Esthet. 2011 Jan 13. [Epub ahead of print]
[About an extreme case of giant lymphoedema of the upper limb: Ligasure
may be useful and a
multidisciplinary approach is mandatory.]
[Article in French]
Lafosse A, Vandeputte C, Sabor I, Mahaudens P, Denoel C.
Service de chirurgie plastique, cliniques universitaires Saint-Luc, avenue
Hippocrate 10, 1200
Bruxelles, Belgique.
Abstract
Treatment of giant lymphoedema remains very difficult. The main problem
is not only the obtention
of early postoperative favorable results but to
keep them long-lasting. The available treatment
options are numerous and
often combined. The indications have to be adapted to the clinical stage
of
the lesion. Ligasure(®) give us many advantages in the achievement of the
surgical resection due
to the quality of the lymphostasis that can be
obtained and to the very limited thermic lesions caused
to tissues. Long
lasting postoperative physiotherapy is of first importance. We here describe a
case
of a giant lymphoedema of the upper limb after axillary lymph node
dissection for breast cancer. The
first physiotherapy failed, causing a
lymphatic decompensation resulting in a lymphoedematous mass
of nearly 7kg.
The surgical resection with Ligasure(®) associated to drainage and compressive
physiotherapy in the long run allows to obtain good results. The late
follow-up after 4 years still
shows stable results.
Published by Elsevier SAS.
PMID: 21237550 [PubMed - as supplied by publisher]
Ann Chir Plast Esthet. 2011 Jan 13. [Epub ahead of print]
[From microsurgery to supermicrosurgery: Experimental feasibility study
and perspectives.]
[Article in French]
Qassemyar Q, Sinna R.
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord,
CHU d'Amiens, place
Victor-Pauchet, 80054 Amiens cedex 1, France.
Abstract
INTRODUCTION: Supermicrosurgical techniques developed for the anastomoses
less or equal to
0.5mm show convincing results in specialized centers and
with an advanced instrumentation. Can we
integrate supermicrosurgical
training animal models in the current teaching program of microsurgery?.
MATERIALS AND METHODS: Ten arterial anastomoses of the inferior epigastric
artery
(diameter less than or equal to 0.5mm) were performed consecutively
in five rats by the same
beginner operator in microsurgery, with standard
microsurgical set of instruments. The intravascular
stenting anastomosis
method was used with 11-0 nylon sutures. The immediate patency and flap
survival on postoperative day three was assessed. The duration of each
anastomosis was measured.
RESULTS: The mean diameter of the arteries was 0.4mm. The average time for
each anastomosis
was 30 minutes with a maximum of 55 minutes and a minimum
of 18 minutes. The average number
of stitches was 5.5. The immediate patency
was 100 % with a 70 % success rate at the third day.
CONCLUSIONS: There are several applications of supermicrosurgical techniques,
especially in
hand surgery, lymphoedema surgical treatment and for
perforator-to-perforator flaps. The
intravascular stenting method allows
fast learning of the technique with a satisfactory success rate
despite
non-specific instrumentation. Furthermore, this method could easily be
integrated among the
microsurgical courses of many universities.
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21237545 [PubMed - as supplied by publisher]
Health Qual Life Outcomes. 2011 Jan 14;9(1):3. [Epub ahead of print]
Health-related quality of life in Spanish breast cancer patients: a
systematic review.
Delgado-Sanz MC, Garcia-Mendizabal MJ, Pollan M, Forjaz MJ, Lopez-Abente
G, Aragones N,
Perez-Gomez B.
Abstract
BACKGROUND: Breast cancer is one of the oncological diseases in which
health-related quality of
life (HRQL) has been most studied. This is mainly
due to its high incidence and survival. This paper
seeks to: review
published research into HRQL among women with breast cancer in Spain; analyse
the characteristics of these studies; and describe the instruments used and
main results reported.
METHODS: The databases consulted were MEDLINE, EMBASE, PsycINFO, Dialnet,
IBECS,
CUIDEN, ISOC and LILACS. The inclusion criteria required studies to:
1) include Spanish
patients, and a breakdown of results where other types of
tumours and/or women from other
countries were also included; and, 2)
furnish original data and measure HRQL using a purpose-
designed
questionnaire. The methodological quality of the studies was assessed.
RESULTS: Spain ranked midway in the European Union in terms of the number of
studies
conducted on the HRQL of breast cancer patients. Of the total of 133
papers published from 1993
to 2009, 25 met the inclusion criteria. Among
them, only 12 were considered as having good or
excellent quality. A total
of 2236 women participated in the studies analysed. In descending order of
frequency, the questionnaires used were the EORTC, FACT-B, QL-CA-Afex,
SF-12, FLIC,
RSCL and CCV. Five papers focused on validation or adaptation
of questionnaires. Most papers
examined HRQL in terms of type of treatment.
Few differences were detected by type of
chemotherapy, with the single
exception of worse results among younger women treated with
radiotherapy. In
the short term, better results were reported for all HRQL components by women
undergoing conservative rather than radical surgery. Presence of lymphedema
was associated with
worse HRQL. Three studies assessed differences in HRQL
by patients' psychological traits.
Psychosocial disorder and level of
depression and anxiety, regardless of treatment or disease stage,
worsened
HRQL. In addition, there was a positive effect among patients who reported
having a
"fighting spirit" and using "denial" as a defence mechanism. One
study found that breast cancer
patients scored worse than did healthy women
on almost all SF-12 scales.
CONCLUSION: Research into health-related quality of life of breast-cancer
patients is a little
developed field in Spain.
PMID: 21235770 [PubMed - as supplied by publisher]
January 22, 2011
Klin Monbl Augenheilkd. 2011 Jan;228(1):19-24. Epub 2011 Jan 19.
[Chronic Eyelid Oedema and Rosacea (Morbus Morbihan): Diagnostic and
Therapeutic Challenges.]
[Article in German]
Renieri G, Brochhausen C, Pfeiffer N, Pitz S.
Augenklinik und Poliklinik, Universitätsmedizin der
Johannes-Gutenberg-Universität, Mainz.
Abstract
BACKGROUND: Morbus Morbihan is a rare complication of rosacea, consisting
of a persistent
lymphoedema of the upper part of the face. It has typically
a chronic course, unspecific
histopathological findings and an extreme
refractoriness to therapy.
PATIENTS AND METHODS: Between February 2008 and January 2010, 5 patients with
Morbus Morbihan were observed at the Department of Ophthalmology of the
University Medical
Centre Mainz. In the present cohort study, we describe
the clinical, laboratory and histological
findings that led to the
diagnosis. The course of the affection and the results of different therapeutic
options are also reported.
RESULTS: Each patient underwent a complete ophthalmological examination, as
well as general
and dermatological consultations. All patients showed facial
skin alterations typical for rosacea. 4
out of 5 subjects underwent a lid
biopsy to confirm the diagnosis of Morbus Morbihan, one patient
refused it.
Initial treatment consisted of various systemic and local medical therapies,
however, with
poor success. One patient had intravenous therapy with
corticosteroids elsewhere with no effect.
We treated 3 cases with
intralesional triamcinolone injections with good results. 2 patients
underwent upper lid blepharoplasty. Results of surgery remained stable also
due to manual lymph
drainage and intralesional injections of triamcinolon.
No complications or side effects were seen in
patients treated with
triamcinolone.
CONCLUSIONS: Morbus Morbihan can be diagnosed only after excluding other
conditions
leading to chronic lid swelling. In our series, good results were
achieved with intralesional injection of
triamcinolone. Surgery also led to
relevant improvements for a long period (13 months), with some
adjuvant
therapy. The treatment of chronic eyelid oedema associated with rosacea remains
a
challenge for the ophthalmologist and the oculoplastic surgeon.
Georg Thieme Verlag KG Stuttgart · New York.
PMID: 21249610 [PubMed - as supplied by publisher]
January 25, 2011
Klin Monbl Augenheilkd. 2011 Jan;228(1):19-24. Epub 2011 Jan 19.
[
Chronic Eyelid Oedema and Rosacea (Morbus Morbihan): Diagnostic and
Therapeutic Challenges.]
[Article in German]
Renieri G, Brochhausen C, Pfeiffer N, Pitz S.
Augenklinik und Poliklinik, Universitätsmedizin der
Johannes-Gutenberg-Universität, Mainz.
Abstract
BACKGROUND: Morbus Morbihan is a rare complication of rosacea, consisting
of a persistent
lymphoedema of the upper part of the face. It has typically
a chronic course, unspecific
histopathological findings and an extreme
refractoriness to therapy.
PATIENTS AND METHODS: Between February 2008 and January 2010, 5 patients with
Morbus Morbihan were observed at the Department of Ophthalmology of the
University Medical
Centre Mainz. In the present cohort study, we describe
the clinical, laboratory and histological
findings that led to the
diagnosis. The course of the affection and the results of different therapeutic
options are also reported.
RESULTS: Each patient underwent a complete ophthalmological examination, as
well as general
and dermatological consultations. All patients showed facial
skin alterations typical for rosacea. 4
out of 5 subjects underwent a lid
biopsy to confirm the diagnosis of Morbus Morbihan, one patient
refused it.
Initial treatment consisted of various systemic and local medical therapies,
however, with
poor success. One patient had intravenous therapy with
corticosteroids elsewhere with no effect.
We treated 3 cases with
intralesional triamcinolone injections with good results. 2 patients
underwent upper lid blepharoplasty. Results of surgery remained stable also
due to manual lymph
drainage and intralesional injections of triamcinolon.
No complications or side effects were seen in
patients treated with
triamcinolone.
CONCLUSIONS: Morbus Morbihan can be diagnosed only after excluding other
conditions
leading to chronic lid swelling. In our series, good results were
achieved with intralesional injection of
triamcinolone. Surgery also led to
relevant improvements for a long period (13 months), with some
adjuvant
therapy. The treatment of chronic eyelid oedema associated with rosacea remains
a
challenge for the ophthalmologist and the oculoplastic surgeon.
© Georg Thieme Verlag KG Stuttgart · New York.
PMID: 21249610 [PubMed - as supplied by publisher]
Skeletal Radiol. 2011 Jan 20. [Epub ahead of print]
Massive localised lymphoedema: clinical presentation and MR imaging
characteristics.
Khanna M, Naraghi AM, Salonen D, Bhumbra R, Dickson BC, Kransdorf MJ,
White LM.
Department of Clinical Imaging, Imperial College Healthcare NHS Trust,
London, UK, monica.
[email protected].
Abstract
Three morbidly obese women were referred to us with suspected soft-tissue
sarcomas. All lesions
arose from the medial subcutaneous tissues of the
thigh, and were shown to represent massive
localised lymphoedema (MLL), a
rare condition occurring in morbidly obese adults. MR imaging
typically
demonstrates a sharply demarcated, pedunculated mass consisting of fat
partitioned by
fibrous septae surrounded by a thickened dermis. There is
oedema both within the mass and
tracking along the subcutaneous septae in a
"lace-like" fashion outwards from the pedicle, outlining
large lobules of
fat. Minimal enhancement is observed within the dermis of the lesion following
intravenous gadolinium administration. Obesity is a growing problem that is
likely to result in an
increase in the prevalence of this condition;
therefore, familiarity with the radiological appearance is
important in
establishing a correct diagnosis in this condition that may mimic a soft-tissue
sarcoma.
PMID: 21249496 [PubMed - as supplied by publisher]
Am J Physiol Cell Physiol. 2011 Jan 19. [Epub ahead of print]
Temporal and spatial patterns of endogenous danger signal expression
after wound healing and in
response to lymphedema.
Zampell JC, Yan A, Avraham T, Andrade V, Malliaris S, Aschen SZ, Rockson
SG, Mehrara BJ.
1Memorial Sloan-Kettering Cancer Center.
Abstract
While acute tissue injury potently induces endogenous danger signal
expression, the role of these
molecules in chronic wound healing and
lymphedema is undefined. The purpose of this study was to
determine the
spatial and temporal expression patterns of the endogenous danger signals HMGB1
and HSP70 during wound healing and chronic lymphatic fluid stasis. In a
surgical mouse tail model
of tissue injury and lymphedema, HMGB1 and HSP70
expression occurred along a spatial gradient
relative to the site of injury,
with peak expression at the wound and >2-fold reduced expression
within 5
mm (P<0.05). Expression primarily occurred in cells native to injured tissue.
In particular,
HMGB1 was highly expressed by lymphatic endothelial cells
(LECs, >40% positivity; 2-fold
increase in chronic inflammation,
P<0.001). We found similar findings using a peritoneal
inflammation
model. Interestingly, upregulation of HMGB1 (2.2-fold), HSP70 (1.4-fold), and
NF-
kß activation persisted at least 6 weeks post-operatively only in
lymphedematous tissues. Similarly,
we found upregulation of endogenous
danger signals in soft tissue of the arm after axillary
lymphadenectomy in a
mouse model and in matched biopsy samples obtained from patients with
secondary lymphedema comparing normal to lymphedematous arms (2.4-fold
increased HMGB1,
1.9-fold increased HSP70; P<0.01). Finally, HMGB1
blockade significantly reduced inflammatory
lymphangiogenesis within
inflamed draining lymph nodes (35% reduction, P<0.01). In conclusion,
HMGB1 and HSP70 are expressed along spatial gradients and upregulated in
chronic lymphatic
fluid stasis; furthermore, acute expression of endogenous
danger signals may play a role in
inflammatory lymphangiogenesis.
PMID: 21248077 [PubMed - as supplied by publisher]
January 28, 2011
Int J Obes (Lond). 2011 Jan 25. [Epub ahead of print]
Oedema in obesity; role of structural lymphatic abnormalities.
Vasileiou AM, Bull R, Kitou D, Alexiadou K, Garvie NJ, Coppack SW.
East London Obesity Service, Barts and The London Medical School, Homerton
University
Hospital and Nuclear Medicine, The Royal London Hospital, London,
UK.
Abstract
Oedema is a common finding in obesity and its cause is not always clear.
Possible causes include
impairment of cardiac, respiratory and/or renal
function, chronic venous insufficiency and lymphatic
problems.
Lymphoscintigraphy is the best method to detect structural lymphatic
abnormalities that
can cause lymphoedema. We reviewed 49 female subjects
with pitting oedema who had undergone
lymphoscintigraphy, divided in three
groups. The first group was comprised of severely obese
patients in whom
cardiorespiratory causes for oedema had been excluded. The second group
consisted of non-obese patients with recognized causes for oedema and the
third group was non-
obese patients with 'idiopathic' oedema. A standard
classification was used to interpret
lymphoscintigraphy results. The
frequency and severity of lymphoscintigraphic abnormalities was
greatest in
patients with clinical diagnoses of oedema related to 'recognized causes' (any
abnormality
in 50% of legs with obstruction in 22%). Obese patients and
those with 'idiopathic'oedema had
fewer (P=0.02 for both) and milder
lymphoscintographic abnormalities (any abnormality 32 and
25%, respectively,
obstruction 5 and 3%, respectively), and although the clinical oedema was
invariably bilateral, the lymphoscintigraphy abnormalities were usually
unilateral. In conclusion,
structural lymphoscintigraphic abnormalities are
uncommon in obesity and do not closely correlate
with the clinical pattern
of oedema.International Journal of Obesity advance online publication, 25
January 2011; doi:10.1038/ijo.2010.273.
PMID: 21266949 [PubMed - as supplied by publisher]
J Med Genet. 2011 Jan 25. [Epub ahead of print]
Rapid identification of mutations in GJC2 in primary lymphoedema using
whole exome sequencing
combined with linkage analysis with delineation of
the phenotype.
Ostergaard P, Simpson MA, Brice G, Mansour S, Connell FC, Onoufriadis A,
Child AH, Hwang J,
Kalidas K, Mortimer PS, Trembath R, Jeffery S.
1Medical Genetics, St George's, University of London, London, UK.
Abstract
Background Primary lymphoedema describes a chronic, frequently
progressive, failure of lymphatic
drainage. This disorder is frequently
genetic in origin, and a multigenerational family in which eight
individuals
developed postnatal lymphoedema of all four limbs was ascertained from the joint
Lymphoedema/Genetic clinic at St George's Hospital. Methods Linkage analysis
was used to
determine a locus, and exome sequencing was employed to look for
causative variants. Results
Linkage analysis revealed cosegregation of a
16.1 Mb haplotype on chromosome 1q42 that
contained 173 known or predicted
genes. Whole exome sequencing in a single affected individual
was
undertaken, and the search for the causative variant was focused to within the
linkage interval.
This approach revealed two novel non-synonymous single
nucleotide substitutions within the
chromosome 1 locus, in NVL and GJC2. NVL
and GJC2 were sequenced in an additional cohort
of individuals with a
similar phenotype and non-synonymous variants were found in GJC2 in four
additional families. Conclusion This report demonstrates the power of exome
sequencing efficiently
applied to a traditional positional cloning pipeline
in disease gene discovery, and suggests that the
phenotype produced by GJC2
mutations is predominantly one of 4 limb lymphoedema.
PMID: 21266381 [PubMed - as supplied by publisher]
Lik Sprava. 2010 Apr-Jun;(3-4):11-20.
[Lymphedema: clinic-therapeutic aspect].
[Article in Ukrainian]
[No authors listed]
Abstract
Lymphedema may be presented in mild or less severe form. Nowadays,
accurate diagnosis and
effective therapy are available. Wearing surgical
bandage, massage, exercise, and pumps form the
core program for most
patients with lymphedema. The application of pharmacological therapies has
been notably absent from the management strategies for lymphatic vascular
insufficiency states but
lately some progress has been made by applying
wobenzym in the treatment. Surgical approaches to
improve lymphatic flow
through vascular anastamosis have been, in large part, unsuccessful, but
controlled liposuction affords lasting benefit in selected patients.
PMID: 21265117 [PubMed - in process]
Nurs Times. 2010 Dec 14-2011 Jan 10;106(49-50):15-7.
Early diagnosis of lymphoedema helps to reduce its psychological and
social impact.
Cooper G.
Walsall Lymphoedema Service, Walsall Community Health.
Abstract
Lymphoedema is often unrecognised by both health professionals and
patients. In addition, its
impact is often underestimated. This article
discusses how to recognise the condition, the
consequences of misdiagnosis,
reducing or preventing complications and various treatment options.
PMID: 21261161 [PubMed - in process]
Biomed Opt Express. 2010 Jul 15;1(1):114-125.
Direct evidence of lymphatic function improvement after advanced
pneumatic compression device
treatment of lymphedema.
Adams KE, Rasmussen JC, Darne C, Tan IC, Aldrich MB, Marshall MV, Fife
CE, Maus EA,
Smith LA, Guilloid R, Hoy S, Sevick-Muraca EM.
Abstract
Lymphedema affects up to 50% of all breast cancer survivors. Management
with pneumatic
compression devices (PCDs) is controversial, owing to the
lack of methods to directly assess
benefit. This pilot study employed an
investigational, near-infrared (NIR) fluorescence imaging
technique to
evaluate lymphatic response to PCD therapy in normal control and breast
cancer-
related lymphedema (BCRL) subjects. Lymphatic propulsion rate,
apparent lymph velocity, and
lymphatic vessel recruitment were measured
before, during, and after advanced PCD therapy.
Lymphatic function improved
in all control subjects and all asymptomatic arms of BCRL subjects.
Lymphatic function improved in 4 of 6 BCRL affected arms, improvement
defined as proximal
movement of dye after therapy. NIR fluorescence
lymphatic imaging may be useful to directly
evaluate lymphatic response to
therapy. These results suggest that PCDs can stimulate lymphatic
function
and may be an effective method to manage BCRL, warranting future clinical
trials.
PMID: 21258451 [PubMed - as supplied by publisher]PMCID: PMC3005162
Urology. 2011 Jan 20. [Epub ahead of print]
Reconstructive Surgery for Penoscrotal Filarial Lymphedema: A Decade of
Experience and Follow-
up.
Singh V, Sinha RJ, Sankhwar SN, Kumar V.
Department of Urology, Chhatrapati Shahuji Maharaj Medical University
(formerly King George's
Medical University),
Lucknow, India.
Abstract
OBJECTIVES: To present our experience of reconstructive surgery in
patients with penoscrotal
filarial lymphedema.
METHODS: From January 2000 to December 2009, we treated 48 patients with
penile and
penoscrotal filarial lymphedema using reconstructive surgery.
Isolated penile involvement was seen in
14 patients, and 34 patients had
penoscrotal involvement. All the patients had taken multiple courses
of
antifilarial drug before surgery. For isolated penile involvement, the diseased
penile skin was
excised and covered with a split-thickness skin graft. In
some patients, the inner prepucial skin was
preserved and used to cover the
penile shaft. For those with penoscrotal involvement, scrotoplasty
was
performed, after excising the diseased scrotal skin and underlying soft tissue,
while sparing the
testes and spermatic cords.
RESULTS: The mean patient age was 38 years (range 25-52), and the median
follow-up time was
48 months (range 10-120). All 48 patients reported a
satisfactory cosmetic appearance after the
procedure and noted improvement
in their ability to void while standing. Also, all of them could
ambulate
better and resumed sexual activity. Local groin infection was present in 12
patients; all
were cured after proper management.
CONCLUSIONS: In filarial lymphedema of penis and/or scrotum, excision of the
diseased tissue
and covering with a split-thickness skin graft provided good
results. If the inner prepucial skin is
healthy, it should be used to cover
the distal penile shaft. If the scrotum is involved, scrotoplasty with
lateral and posterior mobilized flaps provides satisfactory results.
2011 Elsevier Inc. All rights reserved.
PMID: 21256561 [PubMed - as supplied by publisher]
February 26, 2011 published March 1
Rev Esc Enferm USP. 2010 Dec;44(4):1085-92.
[Effects of the decongestive physiotherapy in the healing of venous
ulcers].
[Article in Portuguese]
Azoubel R, Torres Gde V, da Silva LW, Gomes FV, dos Reis LA.
Departamento de Saúde da Universidade Estadual do Sudeste da Bahia, Jequié,
BA, Brasil.
[email protected]
Abstract
The objective of this study was to verify the effects of the decongestive physiotherapy (DP) in the healing
of venous ulcers. It is an
interventionist, and almost experimental, study with the participation of 20
clients
who were divided into 2 groups: the control group (n = 10) and the
intervention group (n = 10). Clients
from the first group were only treated
with conventional dressing and those in the second group were
treated with
conventional dressing and decongestive physiotherapy (association of techniques:
manual
lymph drainage, compressive bandaging, elevation of the lower limbs,
myolymphokinetic exercises and
skin care). Both groups were treated during
six months. The clients submitted to DP presented significant
reduction of
the edema and the pain, besides an improvement in the healing process. Results
allowed to
verify that the decongestive therapy stimulated the healing
process of venous ulcers, improving the quality
of life of the subjects.
PMID: 21337794 [PubMed - in process]
March 1, 2011
AMIA Annu Symp Proc. 2010 Nov 13;2010:912-6.
Efficient selection of association rules from lymphedema symptoms data using
a graph structure.
Xu S, Shyu CR.
Informatics Institute.
Abstract
Secondary lymphedema (LE) is a chronic progressive disease often caused by
cancer treatment,
especially in patients who require surgical removal of or
radiation to lymph nodes. While LE is incurable,
it can be managed
successfully with early detection and appropriate treatment. Detection and
prediction
of LE is difficult due to the absence of a "gold standard" for
diagnosis. Despite this, management of the
disease is accomplished through
adherence to a set of guidelines developed by experts in the field.
Unfortunately, not all the recommendations in such a document are supported
by clear research evidence,
and most of them are only based on expert
judgment with limited evidence. This paper focuses on
developing a new
algorithm to extract specific association rules from LE survey data and
efficiently index
the rules for easy knowledge retrieval, with the ultimate
goal discovering evidence-based and relevant
knowledge for inclusion into
the best practice document (BP) for the LE community.
PMID: 21347111 [PubMed - in process]
Cutan Ocul Toxicol. 2011 Feb 24. [Epub ahead of print]
Evaluation of microbiological spectrum and risk factors of cellulitis in
hospitalized patients.
Serdar ZA, Akçay SS, Inan A, Dagli O.
Haydarpasa Numune Training and Research Hospital, Dermatology, Istanbul,
Turkey.
Abstract
Background and design: Cellulitis is a common soft tissue infection and the
severity of disease vary from
mild to life threatening. The aim of the
present retrospective study was to evaluate age, sex, site of
infection,
microbiological spectrum and the risk factors of cellulitis in hospitalized
patients. Materials and
methods: The data were retrospectively obtained by
the review of 185 hospitalized patients who were
diagnosed as cellulitis
between 2003 and 2009 in the departments of dermatology, infectious diseases,
internal medicine and surgery clinics of Haydarpasa Numune Training and
Research Hospital (Istanbul,
Turkey). The diagnosis was done by infectious
diseases and dermatology specialists in all patients who
were included to
this study. Demographic findings, wound-blood cultures and risk factors of the
patients
with cellulitis were evaluated. Results: Eighty-six were female, 99
were male of total 185 patients, and the
mean age of them was 48?±?27
(14-85). The leg was the involved site in 69% of the patients. The most
frequent isolated bacteria from wound cultures were methicillin-sensitive
Staphylococcus aureus 31.5%,
Pseudomonas aeruginosa 12.6%, and Escherichia
coli 12.3%. However, methicillin-sensitive S. aureus
32.5%,
methicillin-resistant S. aureus 22.5%, coagulase-negative staphylococci 17.5%
were detected
from blood cultures. There was not any underlying risk factor
in 104 (55.3%) patients. The risk factors
observed in the other 81 patients
were previous surgery or open wound 29 (35.8%), diabetes mellitus 19
(26.6%), cardiovascular diseases 16 (19.7%), immunosuppression 11 (13.5%),
lymphoedema 6 (7.4%).
Conclusion: In the patients hospitalized for
cellulitis, the most frequently isolated microorganism from the
wound and
blood cultures was S. aureus and the most frequently detected risk factors were
to have an
open wound and previous surgery. Especially when the patients had
risk factors, it was observed that the
bacterial spectrum was broader and
the clinical presentation was severe. The wound and blood cultures
should be
performed simultaneously for the microbiological diagnosis and the appropriate
management of
cellulitis.
PMID: 21345156 [PubMed - as supplied by publisher]
March 5, 2011
World J Gastrointest Oncol. 2011 Feb 15;3(2):19-23.
Intestinal lymphangiectasia in adults.
Freeman HJ, Nimmo M.
Hugh James Freeman, Department of Medicine (Gastroenterology), University of
British Columbia,
Vancouver, BC, V6T 1W5, Canada.
Abstract
Intestinal lymphangiectasia in the adult may be characterized as a disorder
with dilated intestinal lacteals
causing loss of lymph into the lumen of the
small intestine and resultant hypoproteinemia,
hypogammaglobulinemia,
hypoalbuminemia and reduced number of circulating lymphocytes or
lymphopenia. Most often, intestinal lymphangiectasia has been recorded in
children, often in neonates,
usually with other congenital abnormalities but
initial definition in adults including the elderly has become
increasingly
more common. Shared clinical features with the pediatric population such as
bilateral lower
limb edema, sometimes with lymphedema, pleural effusion and
chylous ascites may occur but these reflect
the severe end of the clinical
spectrum. In some, diarrhea occurs with steatorrhea along with increased
fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin
levels, while others may present with
iron deficiency anemia, sometimes
associated with occult small intestinal bleeding. Most lymphangiectasia
in
adults detected in recent years, however, appears to have few or no clinical
features of malabsorption.
Diagnosis remains dependent on endoscopic changes
confirmed by small bowel biopsy showing
histological evidence of intestinal
lymphangiectasia. In some, video capsule endoscopy and enteroscopy
have
revealed more extensive changes along the length of the small intestine. A
critical diagnostic element
in adults with lymphangiectasia is the exclusion
of entities (e.g. malignancies including lymphoma) that
might lead to
obstruction of the lymphatic system and "secondary" changes in the small bowel
biopsy. In
addition, occult infectious (e.g. Whipple's disease from
Tropheryma whipplei) or inflammatory disorders
(e.g. Crohn's disease) may
also present with profound changes in intestinal permeability and
protein-
losing enteropathy that also require exclusion. Conversely, rare
B-cell type lymphomas have also been
described even decades following
initial diagnosis of intestinal lymphangiectasia. Treatment has been
historically defined to include a low fat diet with medium-chain
triglyceride supplementation that leads to
portal venous rather than lacteal
uptake. A number of other pharmacological measures have been
reported or
proposed but these are largely anecdotal. Finally, rare reports of localized
surgical resection
of involved areas of small intestine have been described
but follow-up in these cases is often limited.
PMID: 21364842 [PubMed - in process]
J Cutan Pathol. 2011 Mar 1. doi: 10.1111/j.1600-0560.2011.01691.x. [Epub
ahead of print]
Verruciform xanthoma: localized lymphedema (elephantiasis) is an essential
pathogenic factor.
Lu S, Rohwedder A, Murphy M, Andrew Carlson J.
Department of Pathology, University of Maryland, Baltimore, MD, USA Am Weiher
14, Kalkar,
Germany Department of Dermatology, University of Connecticut
Medical Center, Framington, CT, USA
Divisions of Dermatopathology and
Dermatology, Albany Medical College MC-81, Albany, NY, USA.
PMID: 21362016 [PubMed - as supplied by publisher]
Glob Public Health. 2011 Feb 24:1-17. [Epub ahead of print]
Lymphoedema management: An international intersect between developed and
developing countries.
Similarities, differences and challenges.
Stout NL, Brantus P, Moffatt C.
Breast Care Department, National Naval Medical Center, Bethesda, MD, USA.
Abstract
Lymphoedema is a chronic swelling condition that contributes to disability,
dysfunction and lost quality of
life. Significant disparities exist
worldwide regarding the availability of resources necessary to identify,
treat and manage lymphoedema. This disparity transcends socio-economic
status and is a common
problem in both developed and developing countries.
The overall impact of lymphoedema as a public
health problem, however, is
underestimated, principally due to the lack of epidemiologic data. These
problems pose barriers to optimal identification and management of this
disabling, lifelong condition. In
1997, the World Health Organization
(50.29) resolved that lymphatic filariasis should be eliminated as a
public
health problem. A component of this strategy focuses on disability management
for those suffering
from lymphatic filariasis-related morbidity. This
initiative has enhanced lymphoedema awareness in
developing countries.
However, significant deficits persist in health care providers' knowledge,
educational initiatives and basic disease identification and treatment. In
developed countries,
lymphoedema continues to be an underrecognised
condition and assumed to be only cancer-related.
Health care resources
allocated to treat and manage the disease are insufficient for basic and ongoing
care, resulting in disease progression and disability. The International
Lymphoedema Framework project,
established in 2002, seeks to establish a
consensus for best practices in the management of lymphoedema
worldwide to
reduce this disability burden. A basic global construct for lymphoedema
management is
needed to decrease morbidity and promote optimal disease
management across all cultural and socio-
economic boundaries. Many countries
are unaware of the importance of lymphoedema management and
have not defined
a national strategy with respect to this problem. The objective of this article
is to define
similarities and differences in strategies for lymphoedema
management between developed and
developing countries and advocate for a
cohesive and concerted approach to disease management.
PMID: 21360379 [PubMed - as supplied by publisher
PLoS One. 2011 Feb 17;6(2):e17201.
Mechanisms of lymphatic regeneration after tissue transfer.
Yan A, Avraham T, Zampell JC, Aschen SZ, Mehrara BJ.
The Division of Plastic and Reconstructive Surgery, Department of Surgery,
Memorial Sloan-Kettering
Cancer Center, New York, New York, United States of
America.
Abstract
INTRODUCTION: Lymphedema is the chronic swelling of an extremity that occurs
commonly after
lymph node resection for cancer treatment. Recent studies
have demonstrated that transfer of healthy
tissues can be used as a means of
bypassing damaged lymphatics and ameliorating lymphedema. The
purpose of
these studies was to investigate the mechanisms that regulate lymphatic
regeneration after
tissue transfer.
METHODS: Nude mice (recipients) underwent 2-mm tail skin excisions that were
either left open or
repaired with full-thickness skin grafts harvested from
donor transgenic mice that expressed green
fluorescent protein in all
tissues or from LYVE-1 knockout mice. Lymphatic regeneration, expression of
VEGF-C, macrophage infiltration, and potential for skin grafting to bypass
damaged lymphatics were
assessed.
RESULTS: Skin grafts healed rapidly and restored lymphatic flow. Lymphatic
regeneration occurred
beginning at the peripheral edges of the graft,
primarily from ingrowth of new lymphatic vessels originating
from the
recipient mouse. In addition, donor lymphatic vessels appeared to spontaneously
re-anastomose
with recipient vessels. Patterns of VEGF-C expression and
macrophage infiltration were temporally and
spatially associated with
lymphatic regeneration. When compared to mice treated with excision only,
there was a 4-fold decrease in tail volumes, 2.5-fold increase in lymphatic
transport by
lymphoscintigraphy, 40% decrease in dermal thickness, and 54%
decrease in scar index in skin-grafted
animals, indicating that tissue
transfer could bypass damaged lymphatics and promote rapid lymphatic
regeneration.
CONCLUSIONS: Our studies suggest that lymphatic regeneration after tissue
transfer occurs by
ingrowth of lymphatic vessels and spontaneous
re-connection of existing lymphatics. This process is
temporally and
spatially associated with VEGF-C expression and macrophage infiltration.
Finally, tissue
transfer can be used to bypass damaged lymphatics and
promote rapid lymphatic regeneration.
PMID: 21359148 [PubMed - in process]
March 10, 2011
Head Neck. 2011 Mar 3. doi: 10.1002/hed.21689. [Epub ahead of print]
Morbidity of supraomohyoidal and modified radical neck dissection combined
with radiotherapy for head
and neck cancer. A prospective longitudinal
study.
Ahlberg A, Nikolaidis P, Engström T, Gunnarsson K, Johansson H, Sharp L,
Laurell G.
Department of Otolaryngology and Head and Neck Surgery, Karolinska University
Hospital, Stockholm,
Sweden; Department of Clinical Sciences, Intervention
and Technology (CLINTEC), Karolinska
Institutet, Stockholm, Sweden. [email protected].
Abstract
BACKGROUND: The purpose of this study was to show the investigated impact of
supraomohyoidal
neck dissection and modified radical neck dissection, both
combined with radiotherapy, on cervical range
of motion (CROM), mouth
opening, swallowing, lymphedema, and shoulder function.
METHODS: One hundred eight patients who had neck dissections and 98 patients
who had non-neck
dissections were evaluated in a prospective, nonselective,
longitudinal cohort study by a physiotherapist
and a speech-language
pathologist (SLP) before the start of radiotherapy and up to 12 months after
treatment.
RESULTS: The incidence of shoulder disability after neck dissection was 18%.
Supraomohyoidal neck
dissection had no significant effect on the evaluated
parameters at any time point. Modified radical neck
dissection significantly
reduced CROM and mouth opening 2 months after treatment, but after 12 months
only cervical rotation was still significantly reduced.
CONCLUSION: In patients treated with external beam radiation (EBRT), modified
radical neck
dissection induced additional morbidity regarding CROM but not
regarding mouth opening, swallowing,
and lymphedema 1 year after treatment.
Both modified radical neck dissection and supraomohyoidal
neck dissection
induced shoulder disability. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.
Copyright © 2010 Wiley Periodicals, Inc.
PMID: 21374755 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Mar 3. [Epub ahead of print]
Surgical Prevention of Arm Lymphedema After Breast Cancer Treatment.
Boccardo FM, Casabona F, Friedman D, Puglisi M, De Cian F, Ansaldi F, Campisi
C.
Department of Surgery, Unit of Lymphatic Surgery, S. Martino Hospital,
University of Genoa, Genoa,
Italy, [email protected].
Abstract
PURPOSE: To prospectively assess the efficacy of the lymphatic microsurgical
preventive healing
approach (LYMPHA) to prevent lymphedema after axillary
dissection (AD) for breast cancer treatment.
METHODS: Among 49 consecutive women referred from March 2008 to September
2009 to undergo
complete AD, 46 were randomly divided in 2 groups.
Twenty-three underwent the LYMPHA technique
for the prevention of arm
lymphedema. The other 23 patients had no preventive surgical approach
(control group). The LYMPHA procedure consisted of performing
lymphatic-venous anastomoses
(LVA) at the time of AD. All patients underwent
preoperative lymphoscintigraphy (LS). Patients were
followed up clinically
at 1, 3, 6, 12, and 18 months by volumetry. Postoperatively, LS was performed
after 18 months in 41 patients (21 treatment group and 20 control group).
Arm volume and LS alterations
were assessed.
RESULTS: Lymphedema appeared in 1 patient in the treatment group 6 months
after surgery (4.34%).
In the control group, lymphedema occurred in 7
patients (30.43%). No statistically significant differences
in the arm
volume were observed in the treatment group during follow-up, while the arm
volume in the
control group showed a significant increase after 1, 3, and 6
months from operation. There was significant
difference between the 2 groups
in the volume changes with respect to baseline after 1, 3, 6, 12, and 18
months after surgery (every timing P value < 0.01).
CONCLUSIONS: LYMPHA represents a valid technique for primary prevention of
secondary arm
lymphedema with no risk of leaving undetected malignant
disease in the axilla.
PMID: 21369739 [PubMed - as supplied by publisher]
Clin Nucl Med. 2011 Apr;36(4):e11-2.
The role of lymphoscintigraphy in diagnosis and monitor the response of
physiotherapeutic technique in
congenital lymphedema.
Chang L, Cheng MF, Chang HH, Kao YH, Wu YW.
From the *Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan;
Departments of
†Nuclear Medicine and ‡Pediatrics, National Taiwan University
Hospital and National Taiwan University
College of Medicine, Taipei, Taiwan;
and §Division of Nuclear Medicine, Department of Radiology,
Hsin-Chu General
Hospital, Hsin-Chu County, Taiwan.
Abstract
We describe the case of a 4-month-old girl who was admitted for bilateral
legs swelling for several
weeks. Lymphoscintigraphy revealed the absence of
the radiotracer proximal to the ilioinguinal nodes up
to 6 hours
postinjection. In light of the clinical and image findings, a diagnosis of
congenital lymphedema
was compatible. Systemic corticosteroid was given, and
physical massage was applied at the lower
extremities for 3 weeks. Repeat
lymphoscintigraphy revealed faster lymphatic flow and liver visualization,
demonstrating improvement in lymphatic function. This case illustrates the
usefulness of
lymphoscintigraphy in diagnosis and evaluating therapy
response of lymphedema in children.
PMID: 21368595 [PubMed - in process]
March 14, 2011
Dermatol Online J. 2011 Feb 15;17(2):9.
Granulomatous rosacea: Unusual presentation as solitary plaque.
Batra M, Bansal C, Tulsyan S.
Abstract
A 45-year-old male presented with a 6 month history of an enlarging smooth,
erythematous plaque over
the central part of his face. Mild erythema of both
eyes was present. Sarcoidosis, Hansen disease, lupus
vulgaris, cutaneous
leishmaniasis, pseudolymphoma, foreign body granuloma, granuloma faciale,
discoid
lupus erythematosus, and granulomatous rosacea were considered in
the differential diagnosis. CBC,
urinalysis, renal function tests, liver
function tests, serum electrolytes, and blood sugar were all normal.
Chest
X-ray and ECG revealed no abnormality. Serology for syphilis and HIV, and
mantoux test were
negative. Slit-skin smear, tissue smear and culture for
AFB and fungi were negative. Skin biopsy revealed
multiple non-caseating
epitheloid granulomas around the pilosebaceous unit suggestive of granulomatous
rosacea. Granulomatous rosacea, a rare entity comprising only about 10
percent of cases of rosacea can
mimic many granulomatous conditions both
clinically and histologically making the diagnosis an enigma. It
usually
presents as yellowish brown-red discrete papules on the face; non-caseating
epithelioid
granulomas are seen on histology examination. We herein report
the case because it presented in atypical
fashion, as a solitary indurated
plaque on the nose, likely representing Morbihan's disease or solid
persistent facial edema of rosacea (rosacea lymphedema).
PMID: 21382292 [PubMed - in process]
Elephantiasis Nostras Verrucosa on the buttocks and sacrum of two immobile
men.
Setyadi HG, Iacco MR, Shwayder TA, Ormsby A.
Department of Dermatology, Henry Ford Health System, Detroit, Michigan.
Abstract
Though typically involving the lower extremities, elephantiasis nostras
verrucosa (ENV) can occur in any
area affected by lymphedema. Here we report
two cases of ENV: one is a biopsy-proven case and the
other is a clinically
diagnosed case. Both occurred on the buttocks and sacrum of immobile, morbidly
obese men who were persistently in the supine or seated position. Whereas
classic ENV is not
uncommon, this striking presentation on these unusual
areas is quite rare.
PMID: 21382291 [PubMed - in process]
Cancer. 2011 Mar 15;117(6):1136-48. doi: 10.1002/cncr.25513. Epub 2010 Nov
8.
Conservative and dietary interventions for cancer-related lymphedema: A
Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta,
Canada; Department of
Rehabilitation Medicine, Cross Cancer Institute,
Edmonton, Alberta, Canada. [email protected].
Abstract
The findings support the use of compression garments and compression
bandaging for reducing
lymphedema volume in upper and lower extremity
cancer-related lymphedema. Specific to breast cancer,
a statistically
significant, clinically small beneficial effect was found from the addition of
manual lymph
drainage massage to compression therapy for upper extremity
lymphedema volume. Cancer 2011. ©
2010 American Cancer Society.
PMID: 21381006 [PubMed - in process
Int J Palliat Nurs. 2011 Feb;17(2):60-6.
Reflections on lymphoedema, fungating wounds and the power of touch in the
last weeks of life.
Fenton S.
Abstract
Terminal care is a significant chapter of life in which each individual has
the right to expect dignity,
compassion, holistic care, and quality of life.
The case of 'Sally', a 57-year-old woman with a diagnosis of
inflammatory
breast cancer, left arm lymphoedema, and a fungating chest wound, gave
palliative care
nurses a multitude of distressing and complex challenges to
manage. Management of lymphoedema is
often put into the 'too hard basket', especially in the palliative care setting. Similarly, fungating wounds are
hard to confront, and the power of touch is often underestimated. The aim of
this case study is to explore
and reflect on how these issues entwine, and
how vital it is for nurses to feel comfortable in providing the
most
appropriate care. As a result of reflection on Sally's care management many
issues were highlighted,
including the crucial need to relieve her symptoms
with timely, appropriate, dignified, and respectful care,
optimizing her
sense of worth and quality of life.
PMID: 21378689 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]
Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of
therapy for head-and-
neck cancer.
Mihara M, Uchida G, Hara H, Hayashi Y, Moriguchi H, Narushima M, Iida T,
Yamamoto T, Koshima I.
Department of Plastic Surgery and Reconstructive Surgery, The University of
Tokyo, 7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can
improve lymph
circulation by the anastomosis of lymph vessels and veins. A
therapeutic effect of LVA for lymphoedema
has been shown in limbs, but
efficacy for other regions has not been shown. Lymphoedema in the
head-
and-neck region following cancer resection and radiotherapy is mainly
treated with manual lymphatic
drainage. However, there is no alternative
when this treatment is ineffective because application of
compression
treatment using a bandage is difficult in this region. We used LVA for
lymphoedema in the
head-and-neck region and achieved a good outcome.
Functional and dilating lymph vessels were
identified using pre- and
intra-operative fluorescent lymphography, and a lymph vessel with a diameter of
about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The
outcome of this case
suggests that LVA is applicable for treatment of
lymphoedema in the head-and-neck region.
Copyright © 2011. Published by Elsevier Ltd.
PMID: 21377943 [PubMed - as supplied by publisher]
Can Fam Physician. 2010 Dec;56(12):1277-84.
Management of secondary lymphedema related to breast cancer.
Cheifetz O, Haley L; Breast Cancer Action.
Hamilton Health Sciences, 711 Concession St, Hamilton, ON L8V 1C3. [email protected]
PMID: 21375063 [PubMed - in process]
March 14, 2011
Cancer. 2011 Mar 15;117(6):1136-48. doi: 10.1002/cncr.25513. Epub 2010 Nov
8.
Conservative and dietary interventions for cancer-related lymphedema: A
Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta,
Canada; Department of
Rehabilitation Medicine, Cross Cancer Institute,
Edmonton, Alberta, Canada. [email protected].
Abstract
The findings support the use of compression garments and compression
bandaging for reducing
lymphedema volume in upper and lower extremity
cancer-related lymphedema. Specific to breast cancer,
a statistically
significant, clinically small beneficial effect was found from the addition of
manual lymph
drainage massage to compression therapy for upper extremity
lymphedema volume. Cancer 2011. ©
2010 American Cancer Society.
PMID: 21381006 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]
Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of
therapy for head-and-
neck cancer.
Mihara M, Uchida G, Hara H, Hayashi Y, Moriguchi H, Narushima M, Iida T,
Yamamoto T, Koshima I.
Department of Plastic Surgery and Reconstructive Surgery, The University of
Tokyo, 7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can
improve lymph
circulation by the anastomosis of lymph vessels and veins. A
therapeutic effect of LVA for lymphoedema
has been shown in limbs, but
efficacy for other regions has not been shown. Lymphoedema in the
head-
and-neck region following cancer resection and radiotherapy is mainly
treated with manual lymphatic
drainage. However, there is no alternative
when this treatment is ineffective because application of
compression
treatment using a bandage is difficult in this region. We used LVA for
lymphoedema in the
head-and-neck region and achieved a good outcome.
Functional and dilating lymph vessels were
identified using pre- and
intra-operative fluorescent lymphography, and a lymph vessel with a diameter of
about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The
outcome of this case
suggests that LVA is applicable for treatment of
lymphoedema in the head-and-neck region.
Copyright © 2011. Published by Elsevier Ltd.
PMID: 21377943 [PubMed - as supplied by publisher]
March 15, 2011
Curr Urol Rep. 2011 Mar 11. [Epub ahead of print]
Complications of Pelvic Lymph Node Dissection for Prostate Cancer.
Keegan KA, Cookson MS.
Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302
Medical Center North,
Nashville, TN, 37232, USA.
Abstract
Pelvic lymph node dissection (PLND) represents the standard for detection of
occult pelvic nodal
metastases from prostate cancer, and may be performed
separately from or at the time of radical
prostatectomy. In addition to its
potential for diagnostic staging, a PLND may be therapeutic in some
patients. However, considerable debate centers on the appropriate candidates
for the procedure, the
extent and proper boundaries of dissection, optimal
surgical approach, and absolute oncologic benefit.
Several series suggest
that there likely is limited benefit of PLND in low-risk patients and that PLND
can
be safely omitted in a high percentage of men undergoing contemporary
radical prostatectomy.
Furthermore, the value of PLND in patients with
intermediate- and high-risk disease must be balanced
against the potential
morbidity of the procedure. In the setting of this debate, concern over
morbidity
directly attributable to this procedure is of paramount
importance. This review focuses on the
complications associated with PLND,
including lymphocele, thromboembolic events, ureteral injury,
nerve injury,
vascular injury, and lymphedema.
PMID: 21394597 [PubMed - as supplied by publisher]
BMC Cancer. 2011 Mar 9;11(1):94. [Epub ahead of print]
Manual lymphatic drainage therapy in patients with breast cancer related
lymphoedema.
Lopez Martin M, Hernandez MA, Avendano C, Rodriguez F, Martinez H.
ABSTRACT:
BACKGROUND: Lymphoedema is a common and troublesome problem that develops
following breast
cancer treatment. The aim of this study is to analyze the
effectiveness of Manual Lymphatic Drainage
(MLD) in the treatment of
postmastectomy lymphoedema in order to reduce the volume of lymphoedema
and
evaluate the improvement of the concomitant symptomatology.
METHODS: Randomized controlled clinical trial of 58 women suffering
postmastectomy lymphoedema.
Control group includes 29 patients with standard
treatment (care of the skin, exercise and measures of
compression, bandage
for one month and later garment of compression). Experimental group includes
patients with stardard treatment and, in addition they received Manual
Lymphatic Drainage. The therapy
will be administered daily during four weeks
and the patients will be reviewed after one, three and six
months of the
treatment. The main outcome is volume reduction of the affected arm after the
treatment
expressed in percentage. Secondary outcome parameters include
duration of lymphoedema reduction
and improvement of the concominant
symtomatology (degree of pain, sensation of swelling and functional
limitation in the affected extremity, subjective sensation of physical
attraction and feminity, dificulty to look
at oneself nude and desilution
grade about the corporal image).
DISCUSSION: The results of this study will provide information on the
effectiveness of manual lymph
drainage and its impact on the quality of life
and physical limitations of these patients. Trial registration:
NCT01152099.
PMID: 21392372 [PubMed - as supplied by publisher]
March 25, 2011 - New Technology at NewYork-Presbyterian/Columbia Aids
Surgeons With Early
Detection of Lymphedemain Breast Cancer Patients -
Newswise –
Early Detection and Intervention May Prevent Disabling Complication of Breast
Cancer Surgery
Newswise — NEW YORK (March 24, 2011) -- Breast cancer
specialists at NewYork-Presbyterian
Hospital/Columbia University Medical
Center are offering patients new ways to detect early signs of
lymphedema, a
common side effect of breast cancer surgery that causes painful, debilitating
and
disfiguring swelling in the arms following removal of lymph nodes.
As many as 30 percent of women who have breast cancer surgery with lymph node
removal will develop
lymphedema. Radiation treatment increases this risk to
as high as 50 percent. While it is possible to arrest
the condition through
physical therapy and bandaging, there is no cure.
"Just as we've used early detection to improve breast cancer survival, we are
using early detection to
reduce women's risk for developing lymphedema,"says
Dr. Sheldon Feldman, the Vivian L. Milstein
Associate Professor of Clinical
Surgery at Columbia University College of Physicians and Surgeons and
chief
of breast surgery at NewYork-Presbyterian Hospital/Columbia University Medical
Center.
Dr. Feldman and his colleagues at NewYork-Presbyterian/Columbia are employing
a technique called
bioimpedence spectroscopy to help them identify the
earliest onset of lymphedema. An FDA-approved
device called L-DEX (ImpediMed
Inc.) uses a mild electrical current to measure minute changes in
extracellular fluid, allowing for a diagnosis of lymphedema by the physician
well before any swelling is
noticeable. "By catching it early, we can
reverse the process and prevent unnecessary pain,
embarrassment,
debilitation and risk of infection,"says Dr. Feldman.
Alongside its clinical use, the bioimpedence technique is also being used in
research to better understand
which patients are most at risk for lymphedema
and whether the condition always progressively worsens,
or if it can
naturally correct itself over time. Other studies will investigate the common
belief that
lymphedema is negatively affected by air travel and weight
training.
Another method of reducing risk for lymphedema is a technique called "reverse
arm mapping.""The lymph
nodes that drain the arm are sometimes removed
during breast cancer surgery because they're situated
within the armpit
(axilla) in the same area as the lymph nodes that relate to the breast. With
reverse arm
mapping, we inject dye into the patient's arm to differentiate
the two kinds of lymph nodes. This allows
the surgeon to avoid removing any
nodes related to arm drainage while still accurately identifying the
sentinel nodes, which are important for breast cancer evaluation and
treatment,"says Dr. Feldman. "This
should reduce the risk of developing
lymphedema.”
Arm mapping is part of a larger trend toward reducing or eliminating the need
to remove a woman's
lymph nodes -- thereby reducing the incidence of
lymphedema. Beginning in the 1990s, sentinel node
biopsy used dye injected
into the breast to target the sentinel lymph node, the gatekeeper to the axilla
and
the one most at risk for cancer spread. Today, the latest research
indicates that fewer patients need any
lymph nodes removed than previously
thought. Even if the sentinel node is shown to be positive, patients
with
early-stage breast cancer who are treated with lumpectomy, chemotherapy and
radiation may not
need to have any further lymph nodes removed.
For more information, patients may call (866) NYP-NEWS.
Columbia University Medical Center
Columbia University Medical Center
provides international leadership in basic, pre-clinical and clinical
research, in medical and health sciences education, and in patient care. The
Medical Center trains future
leaders and includes the dedicated work of many
physicians, scientists, public health professionals,
dentists, and nurses at
the College of Physicians & Surgeons, the Mailman School of Public Health,
the
College of Dental Medicine, the School of Nursing, the biomedical
departments of the Graduate School
of Arts and Sciences, and allied research
centers and institutions. Established in 1767, Columbia's
College of
Physicians and Surgeons was the first institution in the country to grant the
M.D. degree and is
now among the most selective medical schools in the
country. Columbia University Medical Center is
home to the largest medical
research enterprise in New York City and state and one of the largest in the
United States. For more information, please visit www.cumc.columbia.edu.
NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital, based in New
York City, is the nation's largest not-for-profit, non-
sectarian hospital,
with 2,353 beds. The Hospital has more than 2 million inpatient and outpatient
visits in
a year, including more than 220,000 visits to its emergency
departments -- more than any other area
hospital. NewYork-Presbyterian
provides state-of-the-art inpatient, ambulatory and preventive care in all
areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill
Cornell Medical Center,
NewYork-Presbyterian Hospital/Columbia University
Medical Center, NewYork-Presbyterian/Morgan
Stanley Children's Hospital,
NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian
Hospital/Westchester Division. One of the most comprehensive health care
institutions in the world, the
Hospital is committed to excellence in
patient care, research, education and community service.
NewYork-Presbyterian is the #1 hospital in the New York metropolitan area
and is consistently ranked
among the best academic medical institutions in
the nation, according to U.S.News & World Report. The
Hospital has
academic affiliations with two of the nation's leading medical colleges: Weill
Cornell Medical
College and Columbia University College of Physicians and
Surgeons. For more information, visit www.
nyp.org.
PUB MED DOCS TO BE FORMATTED:
March 25, 2011
Ann Plast Surg. 2011 Mar 14. [Epub ahead of print]
Lower Extremity Lymphedema Index: A Simple Method for Severity Evaluation of
Lower Extremity
Lymphedema.
Yamamoto T, Matsuda N, Todokoro T, Yoshimatsu
H, Narushima M, Mihara M, Uchida G, Koshima I.
From the Department of Plastic and Reconstructive Surgery, Graduate School of
Medicine, University of
Tokyo, Bunkyo-ku, Tokyo, Japan.
Abstract
Measurement of the circumference is the most commonly used method
for evaluating extremity
lymphedema. However, comparison between different
patients is difficult with this measurement. To
resolve this problem, we
have formulated a new index, lower extremity lymphedema (LEL) index, which
can be easily obtained from measurements of the body. We evaluated
correlation between lower LEL
index and clinical stage in patients with LEL.
The LEL indices were significantly correlated with clinical
stages and could
be used as a severity scale. The LEL index makes objective assessment of the
severity
of lymphedema through a numerical rating, regardless of the body
type. This numerical rating makes the
index useful for evaluation of
lymphedema severities between different cases.
PMID: 21407058 [PubMed - as
supplied by publisher]
J Pain Symptom Manage. 2011 Mar 12. [Epub ahead of print]
Subcutaneous Lymphatic Drainage (Lymphcentesis) for Palliation of Severe
Refractory Lymphedema in
Cancer Patients.
Jacobsen J, Blinderman CD.
Palliative Care Service (J.J.), Massachusetts General Hospital, and Harvard
Medical School (J.J.),
Boston, Massachusetts; and Palliative Medicine
Service (C.D.B.), Departments of Anesthesiology and
Medicine, Columbia
University Medical Center, New York, New York, USA.
Abstract
Subcutaneous lymphatic drainage has been reported to be an
effective treatment for severe refractory
lymphedema in patients with
lymphatic accumulation because of obstructive cancer. We review published
techniques for lymphatic drainage and describe two cases where these
techniques were modified with
good results.
Copyright © 2011. Published
by Elsevier Inc.
PMID: 21402464 [PubMed - as supplied by publisher]
Gan To Kagaku Ryoho. 2010 Dec;37 Suppl 2:229-31.
[Two cases of stewart-treves syndrome observed at sanshu
hospital].
[Article in Japanese]
Yokoyama A, Yokoyama K, Matsumoto K.
The Palliative Care Units, Sanshu Hospital.
Abstract
Stewart-Treves syndrome is angiosarcoma, which occurs in the
chronic lymphedema of the upper or
lower limbs. Presently, an effective
therapy is not established. The survival period is only several months
to
one year. There are some reports that angiosarcoma will occur in the period of
5~15 years after a
continuation of lymphedema of the extremities. Therefore,
it is important to prevent lymphedema after
surgical operations of primary
disease and the lymphedema.
PMID: 21368533 [PubMed - in process]
ScientificWorldJournal. 2011 Mar 7;11:614-23.
Penile anomalies in adolescence.
Wood D, Woodhouse C.
Abstract
This article considers the impact and outcomes of both treatment
and underlying condition of penile
anomalies in adolescent males. Major
congenital anomalies (such as exstrophy/epispadias) are discussed,
including
the psychological outcomes, common problems (such as corporal asymmetry,
chordee, and
scarring) in this group, and surgical assessment for potential
surgical candidates. The emergence of new
surgical techniques continues to
improve outcomes and potentially raises patient expectations. The
importance
of balanced discussion in conditions such as micropenis, including
multidisciplinary support for
patients, is important in order to achieve
appropriate treatment decisions. Topical treatments may be of
value, but in
extreme cases, phalloplasty is a valuable option for patients to consider. In
buried penis, the
importance of careful assessment and, for the majority, a
delay in surgery until puberty has completed is
emphasised. In hypospadias
patients, the variety of surgical procedures has complicated assessment of
outcomes. It appears that true surgical success may be difficult to measure
as many men who have had
earlier operations are not reassessed in either
puberty or adult life. There is also a brief discussion of
acquired penile
anomalies, including causation and treatment of lymphoedema, penile
fracture/trauma, and
priapism.
PMID: 21399858 [PubMed - in process]
Arch Esp Urol. 2011 Mar;64(2):121-124.
Surgical treatment in a case of giant scrotal lymphedema.
[Article in
English, Spanish]
Rubio Hidalgo E, López García-Moreno A, Buendía González E, Sampietro Crespo
A, Arce Casado B,
De La Fuente Núñez J.
Urology Department.Hospital Virgen de la Salud. Complejo Hospitalario de
Toledo. Toledo. Spain.
Abstract
OBJECTIVE: Scrotal lymphedema (SL) is a rare clinical pathology
with multiple etiologies. We report a
case of idiopathic giant scrotal
lymphedema and review the existing medical literature in Medline from the
last ten years.
METHODS: We report the case of a male patient with a
giant scrotal lymphedema (43×40 cm) of
unknown etiology developed over four
years.
RESULTS: The patient was treated by scrotal excision and
reconstruction with skin graft plasty, with a
successful
result.
CONCLUSIONS: Scrotal Lymphedema is a rare entity, especially in
industrialized countries. If the
lymphedema is severe, surgery is the most
appropriate therapeutic option, whatever the cause is.
Complete resection up
to healthy tissue and surgical reconstruction is the choice. Thin skin grafts
are
necessary for reconstruction when it affects the entire
scrotum.
PMID: 21399245 [PubMed - as supplied by publisher]
BMC Cancer. 2011 Mar 9;11:94.
Manual lymphatic drainage therapy in patients with breast cancer related
lymphoedema.
Martín ML, Hernández MA, Avendaño C, Rodríguez F, Martínez
H.
Unidad de Investigación, Hospital Universitario de La Princesa, Diego de León
36, 28046 Madrid,
Spain. [email protected].
Abstract
ABSTRACT:
BACKGROUND: Lymphoedema is a common and troublesome
condition that develops following
breast cancer treatment. The aim of this
study is to analyze the effectiveness of Manual Lymphatic
Drainage in the
treatment of postmastectomy lymphoedema in order to reduce the volume of
lymphoedema and evaluate the improvement of the concomitant
symptomatology.
METHODS: A randomized, controlled clinical trial in 58 women
with post-mastectomy lymphoedema.
The control group includes 29 patients
with standard treatment (skin care, exercise and compression
measures,
bandages for one month and, subsequently, compression garnments). The
experimental group
includes 29 patients with standard treatment plus Manual
Lymphatic Drainage. The therapy will be
administered daily for four weeks
and the patient's condition will be assessed one, three and six months
after
treatment.The primary outcome parameter is volume reduction of the affected arm
after treatment,
expressed as a percentage. Secondary outcome parameters
include: duration of lymphoedema reduction
and improvement of the
concomitant symptomatology (degree of pain, sensation of swelling and
functional limitation in the affected extremity, subjective feeling of being
physically less atractive and less
feminine, difficulty looking at oneself
naked and dissatisfaction with the corporal image).
DISCUSSION: The results
of this study will provide information on the effectiveness of Manual
Lymphatic Drainage and its impact on the quality of life and physical
limitations of these patients.
TRIAL REGISTRATION: ClinicalTrials (NCT):
NCT01152099.
PMID: 21392372 [PubMed - in process]
Biomaterials. 2011 Mar 19. [Epub ahead of print]
Therapeutic lymphangiogenesis using stem cell and VEGF-C hydrogel.
Hwang
JH, Kim IG, Lee JY, Piao S, Lee DS, Lee TS, Ra JC, Lee JY.
Department of Physical and Rehabilitation Medicine, Sungkyunkwan University
School of Medicine,
Samsung Medical Center, Seoul, Republic of Korea.
Abstract
Lymphedema is a manifestation of lymphatic system insufficiency.
It arises from primary lymphatic
dysplasia or secondary obliteration after
lymph node dissection or irradiation. Although improvement of
swelling can
be achieved by comprehensive non-operative therapy, treatment of this condition
requires
lifelong care and good compliance. Recently molecular-based
treatments using VEGF-C have been
investigated by several researchers. We
designed the present study to determine whether the therapeutic
efficacy of
implanted human adipose-derived stem cells (hADSCs) could be improved by
applying a
gelatin hydrogel containing VEGF-C (VEGF-C hydrogel) to the site
of tissue injury in a lymphedema
mouse model. Four weeks after the
operation, we evaluated edema and determined lymphatic vessel
density at
various post-operative time points. Mice treated with hADSCs and VEGF-C hydrogel
showed
a significantly decreased dermal edema depth compared to the groups
of mice that received hADSCs
only or VEGF-C hydrogel only.
Immunohistochemical analysis also revealed that the hADSC/VEGF-C
hydrogel
group showed significantly greater lymphatic vessel regeneration than all the
other groups.
hADSCs were detected in the implantation sites of all mice in
the hADSC/VEGF-C group, and exhibited
a lymphatic endothelial
differentiation phenotype as determined by co-staining PKH-labeled hADSCs for
the lymphatic marker LYVE-1. Our results suggest that co-administration of
hADSCs and VEGF-C
hydrogel has a substantial positive effect on
lymphangiogenesis.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21421266 [PubMed - as supplied by publisher]
Med Clin (Barc). 2011 Mar 17. [Epub ahead of print]
[Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer
(FACT-B+4). Spanish
version validation.]
[Article in Spanish]
Belmonte Martínez R, Garin Boronat O, Segura Badía M, Sanz Latiesas J,
Navarro EM, Fores MF.
Servei de Medicina Física i Rehabilitació, Hospital Mar-Esperança, Parc de
Salut Mar, Barcelona,
España; Departament de Medicina de la Universitat
Autònoma de Barcelona. Bellaterra, Barcelona,
España.
Abstract
BACKGROUND AND OBJECTIVES: To evaluate the acceptability,
reliability, validity, and sensitivity
to change of the Spanish version of
the FACT-B+4 questionnaire, designed to assess the health related
quality of
life (HRQL) in breast cancer.
PATIENTS AND METHODS: Prospective study with 2
samples: patients with incident breast cancer
(n=104) evaluated before and
after surgery; and patients with chronic lymphedema of the upper extremity
(n=30), evaluated twice in 7days. HRQL was assessed using the generic
instrument SF-36 and the
specific one FACT-B+4.
RESULTS: Reliability
coefficients were = 0.7 for most scores. The Physical wellbeing, Breast Cancer,
Arm and TOI scores discriminated between patients with and without
chemotherapy (p<0.05), while the
Arm scale discriminated between patients
with and without axillary surgery (p<0.001). In the worsening
sub-sample,
the FACT-B+4 detected changes in Physical, Emotional and Functional Wellbeing,
and TOI
scores.
CONCLUSIONS: The metric characteristics of the Spanish
version of the FACT-B+4 are similar to the
original questionnaire and
support its equivalence, documenting its suitability for use in our country or
in
international studies.
Copyright © 2010 Elsevier España, S.L. All
rights reserved.
PMID: 21420133 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2011 Mar;9(1):61-4.
(18)F-FDG PET/CT in a Rare Case of Stewart-Treves Syndrome: Future
Implications and Diagnostic
Considerations.
Jensen MR, Friberg L,
Karlsmark T, Bülow J.
1 Department of Clinical Physiology and Nuclear Medicine, Bispebjerg
Hospital, University Hospital of
Copenhagen , Denmark .
Abstract
Abstract Background: The aim of this article is to illustrate the
possible applications of (18)F-
fluorodeoxyglucose positron emission
tomography/computer tomography ((18)F-FDG PET/CT) in
chronic extremity
lymphedema and its complications. Methods and Results: (18)F-FDG PET/CT findings
in a rare case of Stewart-Treves Syndrome (STS), angiosarcoma secondary to
chronic extremity
lymphedema, are presented. Lymphedema of the extremities
is a debilitating disease characterized by
chronic swelling due to
interstitial edema caused by insufficient lymphatic drainage capacity.
Progression
with skin thickening, subcutaneous fibrosis, and increased
adipose tissue volume is common. Chronic
inflammation has been suggested as
a key pathophysiologic component. STS is a rare complication with a
very
poor prognosis; however, early diagnosis and radical treatment is associated
with increased survival.
Thus, accurate pretreatment staging is paramount.
(18)F-FDG PET/CT is highly sensitive in detecting
increased glucose
metabolism as seen in many types of cancer and inflammation. The role of
(18)F-FDG
PET/CT in the management of lymphedema and its complications has
to our knowledge yet to be
described. This case documents high (18)F-FDG
uptake in STS, but is at the same time an example of
the low specificity of
this imaging modality. Conclusions: We suggest that (18)F-FDG PET/CT has the
potential to become an important tool in the staging and treatment planning
of Stewart-Treves syndrome.
Furthermore, (18)F-FDG-accumulation may be a
sensitive tool in detecting low grade inflammation in the
skin and subcutis,
which has been suggested to cause tissue remodeling in lymphedema progression.
However, further studies are needed to elucidate this theory.
PMID:
21417769 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):47-51.
Confirmation of the reference impedance ratios used for assessment of breast
cancer-related
lymphedema by bioelectrical impedance spectroscopy.
Ward
LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL.
1 School of Chemistry and Molecular Biosciences, University of Queensland ,
St. Lucia, Brisbane,
Australia .
Abstract
Abstract Background: Breast cancer-related lymphedema in the arm
is commonly detected by
bioelectrical impedance spectroscopy as an increased
inter-arm impedance ratio due to the presence of
excess lymph in the at-risk
arm relative to that of the unaffected arm. The presence of lymphedema is
determined by a value of this ratio greater than the mean ratio, plus three
standard deviations observed in
a comparable healthy population. This
threshold value has not been established using the measurement
protocols in
current practice. The aim of the present study was to determine the reference
range of the
inter-arm impedance ratio to allow a cut-off value to be
established as a criterion for the detection of
breast cancer-related
lymphedema. Methods: The mean and variation (3 SD) of the inter-arm impedance
ratio for the arms of 172 healthy female control participants were
determined from an accumulated
database of impedance data obtained using
present generation impedance instrumentation and
methodology. This reference
range and threshold value was compared to the original threshold ratio
determined a decade ago but still in current use. Results: The presence of
lymphedema is indicated when
the impedance ratio exceeded 1.106 when the
nondominant limb is at risk, and 1.134 when the dominant
limb is at risk
compared with the currently used values of 1.066 and 1.139, respectively.
Although the
difference in these values was statistically significant, this
difference was determined to be of minor
importance to clinical practice.
Conclusions: The impedance ratio thresholds for early detection of
lymphedema remain suitable for clinical use with present day bioimpedance
spectroscopy analyzers and
measurement protocols.
PMID: 21417767 [PubMed
- in process]
Lymphat Res Biol. 2011 Mar;9(1):43-6.
Reference ranges for assessment of unilateral lymphedema in legs by
bioelectrical impedance
spectroscopy.
Ward LC, Dylke E, Czerniec S,
Isenring E, Kilbreath SL.
1 School of Chemistry and Molecular Biosciences, The University of Queensland
, St. Lucia, Brisbane,
Australia .
Abstract
Abstract Background: Secondary unilateral lymphedema in the leg
may occur as a consequence of pelvic
surgery and/or radiation therapy, which
causes damage to the pelvic lymphatic system. To date,
assessment has been
typically by manual measurement of the volume excess of the affected leg
compared
to the contralateral leg. In contrast, the assessment of unilateral
arm lymphedema is readily accomplished
by the use of bioelectrical impedance
spectroscopy (BIS) as an increased inter-arm impedance ratio due
to the
presence of excess lymph in the affected arm relative to that of the unaffected
arm. The presence of
lymphedema is defined by a value of this ratio greater
than the mean ratio plus three standard deviations
(SD) observed in a
comparable healthy population. The aim of the present study was to determine the
equivalent reference range of the impedance ratio for the legs. This would
allow a cut-off value to be
established as a criterion for the detection and
assessment of lower limb lymphedema. Methods: The
impedances of the legs of
172 healthy females and 150 healthy males, measured by BIS, were extracted
from an accumulated database of impedance data. These data were used to
determine the normal
distribution of inter-leg impedance ratios and the
reference range and threshold value (mean?+?3 SD).
Results: The presence of
lymphedema is indicated when the impedance ratio exceeds 1.167 in males and
1.136 in females. Unlike in the arms, the effect of limb dominance in the
legs is minimal and it is suggested
that no correction for limb dominance is
warranted. Conclusions: The impedance ratio thresholds for
lymphedema of the
legs have been established, opening the way for BIS to become established
clinically
for the early detection and assessment of lower limb
lymphedema.
PMID: 21417766 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):31-42.
Segmental blood flow and hemodynamic state of lymphedematous and
nonlymphedematous arms.
Montgomery LD, Dietrich MS, Armer JM, Stewart BR,
Ridner SH.
1 LDM Associates , San Jose, California.
Abstract
Abstract Background: Findings regarding the influence hemodynamic
factors, such as increased arterial
blood flow or venous abnormalities, on
breast cancer treatment-related lymphedema are mixed. The
purpose of this
study was to compare segmental arterial blood flow, venous blood return, and
blood
volumes between breast cancer survivors with treatment-related
lymphedema and healthy normal
individuals without lymphedema. Methods and
Results: A Tetrapolar High Resolution Impedance Monitor
and Cardiotachometer
were used to compare segmental arterial blood flow, venous blood return, and
blood volumes between breast cancer survivors with treatment-related
lymphedema and healthy normal
volunteers. Average arterial blood flow in
lymphedema-affected arms was higher than that in arms of
healthy normal
volunteers or in contralateral nonlymphedema affected arms. Time of venous
outflow
period of blood flow pulse was lower in lymphedema-affected arms
than in healthy normal or
lymphedema nonaffected arms. Amplitude of the
venous component of blood flow pulse signal was lower
in lymphedema-affected
arms than in healthy or lymphedema nonaffected arms. Index of venular tone was
also lower in lymphedema-affected arms than healthy or lymphedema
nonaffected arms. Conclusions:
Both arterial and venous components may be
altered in the lymphedema-affected arms when compared
to healthy normal arms
and contralateral arms in the breast cancer survivors.
PMID: 21417765 [PubMed
- in process]
Lymphat Res Biol. 2011 Mar;9(1):19-30.
Molecular characterization of dermal lymphatic endothelial cells from primary
lymphedema skin.
Ogunbiyi S, Chinien G, Field D, Humphries J, Burand K,
Sawyer B, Jeffrey S, Mortimer P, Clasper S,
Jackson D, Smith For The London
Lymphedema Consortium A.
1 Academic Department of Surgery, BHF Centre of Research Excellence and NIMR
Biomedical
Research Centre at Kings Health Partners , St. Thomas Hospital,
London, United Kingdom .
Abstract
Abstract Background: Lymphatic endothelial cells from primary
lymphedema skin have never been
cultured nor characterized. A subgroup of
patients with primary lymphedema undergo surgery to bring
about an
improvement in their quality of life. The aim of this study was to culture and
characterize LECs
from the skin of these patients. Methods and Results:
Lymphatic endothelial cells were isolated and
cultured from the skin of
patients with primary lymphedema and from normal skin. The isolated cells were
compared in their ability to form microvascular networks in a
three-dimensional culture medium, and in
their response to treatment with
vascular endothelial growth factors A, C, and D. Whole tissue
transcriptional profiling was carried out on two pools of isolated lymphatic
endothelial cells-one from
primary lymphedema skin and the other from normal
skin. Lymphatic endothelial cells from primary
lymphedema skin form
tubule-like structures when cultured in three-dimensional media. They respond in
a
similar fashion to stimulation with the vascular endothelial growth
factors A, C, and D. Comparative
analysis between lymphedema tissue and
normal tissue (fold change >2) showed differential expression of
2793
genes (5% of all transcripts), 2184 upregulated, and 609 downregulated. Genes
involved in cellular
apoptosis (vascular endothelial growth inhibitor, zinc
finger protein), extracellular matrix turnover (matrix
metalloproteinase
inhibitor-16), and type IV collagen deposition were upregulated. Various
pro-
inflammatory genes (interleukin-6, interleukin-8, interleukin-32,
E-selectin) were downregulated.
Conclusion: Cellular adhesion, apoptosis,
and increased extracellular matrix turnover play a more
prominent role in
primary lymphedema than previously thought. In addition, the acute inflammatory
response is attenuated as evidenced by the downregulation of various
pro-inflammatory genes.This sheds
further light on the interplay of the
various pathological processes taking place in primary lymphedema.
PMID:
21417764 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):13-8.
Reliability and concurrent validity of the perometer for measuring hand
volume in women with and without
lymphedema.
Lee MJ, Boland RA, Czerniec
S, Kilbreath SL.
Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney
, Sydney, Australia .
Abstract
Abstract Background: Lymphedema of hand after breast cancer
treatment causes significant loss of hand
function. Although there are
several ways of assessing limb volume, measuring hand volume has been
problematic due to technical difficulties associated with assessment of
finger volumes. The aim of this
study was to investigate the criterion
validity and reliability of Perometer™ for measuring hand volume in
woman
with and without lymphedema. Methods and Results: Hand volume of forty women
with (n?=?
20) and without lymphedema (n?=?20) was assessed twice by one
rater and once by another rater using
the Perometer, and once by one rater
using the water volumetry method. Intra- and inter-rater reliability
was
determined from the intraclass correlation coefficients and Percent Close
Agreement. Agreement
between the Perometer and water volumetry was
determined using a limit of agreement and Lin's
concordance correlation. The
Perometer had high intra [ICC(2,1)?=?0.989 (95% CI: 0.98-0.99)] and
inter-rater reliability [ICC(2,1)?=?0.993 (95% CI: 0.99-1.0)]. Percent close
agreement revealed that
80% of the measures were within 9?ml for inter-rater
reliability and within 15?ml for intra-rater reliability.
In addition, there
was high concordance between hand volumes obtained with the Perometer and water
volumetry method (R(c)?=?0.88). However, the Perometer overestimated the
volume of hand compared
to water volumetry method (bias: 7.5%). Conclusions:
The Perometer can be used with high reliability to
measure hand volume but
caution should be exercised when data are compared with measures derived
from the water volumetry method.
PMID: 21417763 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):1.
Non-invasive assessment of human clinical lymphedema: the progress
continues.
Rockson SG.
PMID: 21417761 [PubMed - in process]
Filarial Nematodes.
Cross JH.
In: Baron S, editor. Medical
Microbiology. 4th edition. Galveston (TX): University of Texas Medical
Branch at Galveston; 1996. Chapter 92.
Excerpt
The filariae are
thread-like parasitic nematodes (roundworms) that are transmitted by arthropod
vectors.
The adult worms inhabit specific tissues where they mate and
produce microfilariae, the characteristic
tiny, thread-like larvae. The
microfilariae infect vector arthropods, in which they mature to infective
larvae. Filarial diseases are a major health problem in many tropical and
subtropical areas. The disease
produced by a filarial worm depends on the
tissue locations preferred by adults and microfilariae. The
adults of the
lymphatic filariae inhabit lymph vessels, where blockage and host reaction can
result in
lymphatic inflammation and dysfunction, and eventually in
lymphedema and fibrosis. Repeated, prolonged
infection with these worms can
lead to elephantiasis, a buildup of excess tissue in the affected area. Other
filariae mature in the skin and subcutaneous tissues, where they induce
nodule formation and dermatitis;
migrating filariae of these species can
cause ocular damage. Table 92-1 summarizes the filarial infections
of
humans.
Copyright © 1996, The University of Texas Medical Branch at
Galveston
Sections
•General Concepts•Introduction•Lymphatic Filariae Wuchereria
Bancrofti and Brugia
Malayi•Onchocerca Volvulus•Minor Filarial
Infections•Dirofilaria Species•Dracunculus
Medinensis•ReferencesPMID:
21413271 [PubMed]
April 3, 2011
Lymphology. 2010 Dec;43(4):188-91.
Congenital lymphatic dysplasia in Kabuki syndrome: first report of an unusual
association.
Morcaldi G, Boccardo F, Campisi C, Bellini T, Massocco D,
Bonioli E.
Department of Pediatrics, University of Genoa, Gaslini Children's Hospital,
Italy. [email protected]
Abstract
Kabuki syndrome was first described in Japan in 1981 as a rare
disorder of unknown cause. Its main
features include characteristic facies,
postnatal growth retardation, and mental delay. To date, there is no
molecular marker for Kabuki syndrome, which is considered genetically
heterogeneous and still is a
clinically-based diagnosis. Here we describe
the first case of a patient affected by Kabuki syndrome
associated with
lymphatic dysplasia. We suggest accurate evaluation of all Kabuki patients as
early as
possible in order to diagnose lymphedema or other clinical
manifestations of lymphatic system
involvement. Early identification of
lymphatic system maldevelopment provides the best chance for
reducing the
risk of developing progressive lymphedema with associated tissue changes
(fibrosis,
sclerosis, and fat deposition).
PMID: 21446574 [PubMed -
indexed for MEDLINE]
Lymphology. 2010 Dec;43(4):178-87.
Prevalence of upper-body symptoms following breast cancer and its
relationship with upper-body
function and lymphedema.
Hayes SC, Rye S,
Battistutta D, Newman B.
School of Public Health, Faculty of Health, Queensland University of
Technology, Queensland, Australia.
[email protected]
Abstract
This investigation describes the prevalence of upper-body
symptoms in a population-based sample of
women with breast cancer (BC) and
examines their relationships with upper-body function (UBF) and
lymphedema,
as two clinically important sequelae. Australian women (n=287) with unilateral
BC were
assessed at three-monthly intervals, from six to 18 months
post-surgery (PS). Participants reported the
presence and intensity of
upper-body symptoms on the treated side. Objective and self-reported UBF
and
lymphedema (bioimpedance spectroscopy) were also assessed. Approximately 50% of
women
reported at least one moderate-to-extreme symptom at 6- and at
18-months PS. There was a significant
relationship between symptoms and
function (p < 0.01), whereby perceived and objective function
declined
with increasing number of symptoms present. Those with lymphedema were more
likely to
report multiple symptoms, and presence of symptoms at baseline was
associated with an increased risk of
lymphedema (ORs > 1.3, p = 0.02),
although presence of symptoms explained only 5.5% of the variation
in the
odds for lymphedema. Upper-body symptoms are common and persistent following
breast cancer
and are associated with clinical ramifications, including
reduced UBF and increased risk of developing
lymphedema. However, using the
presence of symptoms as a diagnostic indicator or prognosticator of
lymphedema has its limitations.
PMID: 21446573 [PubMed - indexed for
MEDLINE]
Cancer. 2011 Mar 28. doi: 10.1002/cncr.26088. [Epub ahead of print]
Sphincter-sparing local excision and hypofractionated radiation therapy for
anorectal melanoma: A 20-
Year Experience.
Kelly P, Zagars GK, Cormier JN,
Ross MI, Guadagnolo BA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer
Center, Houston,
Texas.
Abstract
BACKGROUND: Anorectal melanoma is a rare disease with a poor
prognosis. Because survival is
determined by distant failure, many centers
have adopted sphincter-sparing excision for primary tumor
control. However,
this approach is associated with high rates of local failure (~50%). In this
study, the
authors report their 20-year experience with sphincter-sparing
excision combined with radiation therapy
(RT) for the treatment of localized
anorectal melanoma.
METHODS: The authors reviewed the records of 54 patients
with localized anorectal melanoma who
were treated at the University of
Texas MD Anderson Cancer Center from 1989 to 2008. All patients
underwent
definitive local excision with or without sentinel lymph node biopsy or lymph
node dissection.
RT (25-36 grays in 5-6 fractions) was delivered to extended
fields that targeted the primary site and
draining pelvic/inguinal
lymphatics in 39 patients and to limited fields that targeted only the primary
site in
15 patients.
RESULTS: The 5-year rates of local control (LC),
lymph node control (NC), and sphincter preservation
were 82%, 88%, and 96%,
respectively. However, because of the high rate of distant metastasis, the
overall survival (OS) rate at 5 years was only 30%. Although there were no
significant differences in LC,
NC, or OS based on RT field extent, patients
who received extended-field RT had higher rates of
lymphedema than patients
who received limited-field RT.
CONCLUSIONS: The current results indicated
that combined sphincter-sparing local excision and RT is
a well tolerated
approach that provides effective LC for patients with anorectal melanoma.
Inclusion of
the inguinal lymph node basins in the RT fields did not improve
outcomes and was associated with an
increased risk of lymphedema. Cancer
2011;. © 2011 American Cancer Society.
Copyright © 2011 American Cancer
Society.
PMID: 21446049 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2011 Mar 29. [Epub ahead of print]
Change in blood flow velocity demonstrated by Doppler ultrasound in upper
limb after axillary dissection
surgery for the treatment of breast
cancer.
Nascimben Matheus C, Caldeira de Oliveira Guirro E.
Physical Therapy Program, Faculty of Health Sciences, Methodist University of
Piracicaba, Piracicaba,
Brazil.
Abstract
The aim of this study was to evaluate the arterial and venous
blood flow in women who underwent upper
limb axillary dissection surgery for
the treatment of breast cancer. Sixty women were divided into two
groups:
group 1 (G1)-30 women who underwent breast surgery with axillary dissection
level II or III
(55.6 ± 8.6 years); group 2 (G2)-control, 30 women with no
breast cancer (57.4 ± 7.0 years). Blood
flow profile was evaluated by a
continuous wave ultrasound Doppler device (Nicolet Vascular Versalab
SE(®))
with an 8 MHz probe. Axillary, brachial arteries and veins, arm circumference,
volumes, and the
ankle-brachial index (ABI) were examined. Wilcoxon test and
Mann-Whitney tests were applied to
analyze blood flow velocity intra-group
and between G1 and G2, respectively. The G1 results showed no
lymphedema and
no peripheral arterial disease (ABI > 0.9). Moreover, the mean blood flow
velocity of
the vessels ipsilateral to the surgery was significantly higher
than the contralateral ones for all vessels
examined (P < 0.05). The mean
velocity of blood flow of the vessels contralateral to surgery was
significantly higher than the axillary artery in G2 (P < 0.05). It can be
concluded that women who
underwent axillary dissection due to breast cancer
showed probable stenosis in the arterial and venous
axillary and brachial
vessels of the upper limb ipsilateral to the surgery, confirmed by the increase
of
blood flow velocity, and such obstruction might affect the limb
contralateral to the operation site.
PMID: 21445573 [PubMed - as supplied by
publisher]
Arch Phys Med Rehabil. 2011 Apr;92(4):603-10.
Comparison of diagnostic accuracy of clinical measures of breast
cancer-related lymphedema: area under
the curve.
Smoot BJ, Wong JF, Dodd
MJ.
Department of Physical Therapy and Rehabilitation Science, University of
California San Francisco, San
Francisco, CA.
Abstract
Smoot BJ, Wong JF, Dodd MJ. Comparison of diagnostic accuracy of
clinical measures of breast
cancer-related lymphedema: area under the
curve.
OBJECTIVE: To compare diagnostic accuracy of measures of breast
cancer-related lymphedema
(BCRL).
DESIGN: Cross-sectional design
comparing clinical measures with the criterion standard of previous
diagnosis of BCRL.
SETTING: University of California San Francisco
Translational Science Clinical Research Center.
PARTICIPANTS: Women older
than 18 years and more than 6 months posttreatment for breast cancer
(n=141;
70 with BCRL, 71 without BCRL).
INTERVENTIONS: Not applicable.
MAIN
OUTCOME MEASURES: Sensitivity, specificity, receiver operator characteristic
curve, and
area under the curve (AUC) were used to evaluate
accuracy.
RESULTS: A total of 141 women were categorized as having (n=70) or
not having (n=71) BCRL based
on past diagnosis by a health care provider,
which was used as the reference standard. Analyses of ROC
curves for the
continuous outcomes yielded AUC of .68 to .88 (P<.001); of the physical
measures
bioimpedance spectroscopy yielded the highest accuracy with an AUC
of .88 (95% confidence interval, .
80-.96) for women whose dominant arm was
the affected arm. The lowest accuracy was found using the
2-cm diagnostic
cutoff score to identify previously diagnosed BCRL (AUC,
.54-.65).
CONCLUSIONS: Our findings support the use of bioimpedance
spectroscopy in the assessment of
existing BCRL. Refining diagnostic cutoff
values may improve accuracy of diagnosis and warrant further
investigation.
Copyright © 2011 American Congress of Rehabilitation
Medicine. Published by Elsevier Inc. All rights
reserved.
PMID: 21440706 [PubMed - in process]
J Am Acad Dermatol. 2011 Mar 24. [Epub ahead of print]
Elephantiasis nostras verrucosa: An institutional analysis of 21
cases.
Dean SM, Zirwas MJ, Horst AV.
Department of Cardiovascular Medicine, Ohio State University College of
Medicine, Columbus, Ohio.
Abstract
BACKGROUND: Previous reports regarding elephantiasis nostras
verrucosa (ENV) have been typically
limited to 3 or fewer
patients.
OBJECTIVES: We sought to statistically ascertain what demographic
features and clinical variables are
associated with ENV.
METHODS: A
retrospective chart review of 21 patients with ENV from 2006 to 2008 was
performed
and statistically analyzed.
RESULTS: All 21 patients were obese
(morbid obesity in 91%) with a mean body mass index of 55.8.
The average
maximal calf circumference was 63.7 cm. Concurrent chronic venous insufficiency
was
identified in 15 patients (71%). ENV was predominantly bilateral (86%)
and typically involved the calves
(81%). Proximal cutaneous involvement
(thighs 19%/abdomen 9.5%) was less common. Eighteen (86%)
related a history
of lower extremity cellulitis/lymphangitis and/or manifested soft-tissue
infection upon
presentation. Multisegmental ENV was statistically more
likely in setting of a higher body mass index (P =
.02), larger calf
circumference (P = .01), multiple lymphedema risk factors (P = .05), ulcerations
(P < .
001), and nodules (P < .001). Calf circumference was
significantly and proportionally linked to
developing lower extremity
ulcerations (P = .02). Ulcerations and nodules were significantly prone to
occur concomitantly (P = .05). Nodules appeared more likely to exist in the
presence of a higher body
mass index (P = .06) and multiple lymphedema risk
factors (P = .06).
LIMITATIONS: The statistical conclusions were potentially
inhibited by the relatively small cohort. The
study was
retrospective.
CONCLUSIONS: Our data confirm the association among obesity,
soft-tissue infection, and ENV.
Chronic venous insufficiency may be an
underappreciated risk factor in the genesis of ENV.
Copyright © 2010 American
Academy of Dermatology, Inc. Published by Mosby, Inc. All rights
reserved.
PMID: 21440328 [PubMed - as supplied by publisher]
Wkly Epidemiol Rec. 2011 Mar 25;86(13):121-7.
WHO position statement on integrated vector management to control malaria and
lymphatic filariasis.
[Article in English, French]
[No authors listed]
PMID: 21438441 [PubMed - indexed for MEDLINE
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]
1. 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