July 5, 2010 (4
docs)
Ann R Coll Surg Engl. 2010 Jun 28. [Epub ahead of
print]
Hand surgery after axillary lymph node clearance for
breast cancer:
contra-indication to surgery?
Fulford D, Dalal
S, Winstanley J, Hayton MJ.
Abstract
INTRODUCTION
Breast cancer patients who have had prior axillary lymph node
clearance
(ALNC)
can present with ipsilateral hand conditions that could easily be
treated
with surgical intervention. These
patients are often advised to
avoid interventional procedures due to risks
of complications
such
lymphoedema, infection and cellulitis.
SUBJECTS AND
METHODS Between April and June 2009, we conducted an online
survey of
hand
surgeons, breast surgeons and breast-care nurses to obtain their views
on
hand surgery after ipsilateral
axillary lymph node
clearance.
RESULTS The majority of hand surgeons (58%) felt
there was no
contra-indication to surgery in a
breast cancer patient with
prior ipsilateral ALNC compared to just 30% of
breast surgeons and 10%
of
breast-care nurses. The majority of breast surgeons and breast-care
nurses
(70% and 89%,
respectively) felt that hand surgery was a relative
contra-indication
compared to just 41% of hand
surgeons. Postoperative
lymphoedema was the commonest cited reason for
avoiding surgery.
The
majority of hand surgeons (79%) and nearly two-thirds of breast
surgeons
(57%) would use a
tourniquet during surgery if it was normal
practice.
CONCLUSIONS A review of the published literature does
not support the
notion that these patients
experience increased
complications; therefore, we recommend the advice
given to breast
cancer
patients regarding ipsilateral surgery be
re-evaluated.
PMID: 20587171 [PubMed - as supplied by
publisher]
J Med Case Reports. 2010 Jun 29;4(1):196. [Epub ahead
of print]
Recurrent furunculosis as a cause of isolated penile
lymphedema: a case
report.
Alshaham A, Sood
S.
Abstract
ABSTRACT: INTRODUCTION: Isolated
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 PRESENTATION: A 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.
PMID: 20584337 [PubMed - as supplied by
publisher]
Lymphat Res Biol. 2010
Jun;8(2):111-9.
Assessment of volume measurement of breast
cancer-related lymphedema by
three methods:
circumference measurement,
water displacement, and dual energy
X-ray
absorptiometry.
Gjorup C, Zerahn B, Hendel
HW.
Department of Clinical Physiology and Nuclear Medicine,
Herlev University
Hospital, Herlev,
Denmark. [email protected]
Abstract
BACKGROUND: Following treatment for breast cancer 12%-60% develop breast
cancer-related
lymphedema (BCRL). There are several ways of
assessing BCRL. Circumference
measurement (CM)
and water displacement
(WD) for volume measurements (VM) are frequently
used methods in
practice
and research, respectively. The aim of this study was to evaluate
CM and
WD for VM of the BCRL
arm and the contralateral arm, comparing the
results with regional dual
energy X-ray
absorptiometry
(DXA).
METHODS AND RESULTS: Twenty-four women
with unilateral BCRL were included
in the study.
Blinded duplicate VM
were obtained from both arms using the three methods
mentioned above.
CM
and DXA were performed by two observers. WD was performed by a group
of
observers. Mean
differences (d) in duplicated volumes, limits of
agreement (LOA), and 95%
confidence intervals (CI)
were calculated for
each method. The repeatability expressed as d (95% CI)
between the
duplicated
VM of the BCRL arm and the contralateral arm was for DXA 3 ml
(-6-11) and
3 ml (1-7),
respectively. For CM and WD, the d (95% CI) of
the BCRL arm were 107 ml
(86-127) and 26 ml
(-26-79), respectively and in
the contralateral arm 100 ml (78-122) and -6
ml (-29-17),
respectively.
CONCLUSIONS: DXA is superior in repeatability when
compared to CM and WD
for VM,
especially for the BCRL arm but also the
contralateral arm.
PMID: 20583873 [PubMed - in
process]
Am J Med Genet A. 2010
Jul;152A(7):1621-6.
Agenesis of the corpus callosum and
congenital lymphedema: A novel
recognizable
syndrome?
O'Driscoll MC, Jenny K, Saitta S, Dobyns WB, Gripp
KW.
Medical Genetics Research Group and Regional Genetics
Service, St Mary's
Hospital,
Manchester,
UK.
Abstract
We present double first
cousins, a girl and a boy, with the uncommon
association of agenesis of
the
corpus callosum and congenital lymphedema. Other features shared by
both
include oligohydramnios,
similar facial dysmorphism, sacral dimple,
developmental delay, and
sociable personality. While some
of these
findings overlap with FG syndrome and Hennekam syndrome, the
findings in our
patients are
sufficiently different to exclude these diagnoses. We propose
that this is
a new syndrome with
presumed autosomal recessive
inheritance. (c) 2010 Wiley-Liss, Inc.
PMID: 20583147 [PubMed -
in process]
Indian J Dermatol. 2010
Apr;55(2):144-147.
INTENSIVE TREATMENT OF LEG
LYMPHEDEMA.
Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro
de Godoy M.
Department of Cardiology and Cardiovascular Surgery
and professor of the
post graduation course of
Medicine School of São
Jose do Rio Preto-FAMERP-Brazil.
Abstract
BACKGROUND:
Despite of all the problems caused by lymphedema, this disease
continues to
affect
millions of people worldwide. Thus, the identification of the
most
efficacious forms of treatment is
necessary. AIM: The aim of this
study was to evaluate a novel intensive
outpatient treatment for
leg
lymphedema.
METHODS: Twenty-three legs of 19 patients
were evaluated in a prospective
randomized study. The
inclusion criteria
were patients with Grade II and III lymphedema, where
the difference,
measured by
volumetry, between the affected limb below the knee and the
healthy limb
was greater than 1.5 kg.
Intensive treatment was carried out
for 6- to 8-h sessions in the
outpatient clinic. Analysis of variance
was
utilized for statistical analysis with an alpha error of 5%
(P-value
<0.05) being considered
significant.
RESULTS:
All limbs had significant reductions in size with the final mean
loss being
81.1% of the
volume of edema. The greatest losses occurred in the first week
(P-value
<0.001). Losses of more
than 90% of the lymphedema occurred
in 9 (39.13%) patients; losses of more
than 80% in 13
(56.52%), losses of
more than 70% in 17 (73.91%) and losses of more than
50% were recorded
for
95.65% of the patients; only 1 patient lost less than 50% (37.9%) of
the
edema.
CONCLUSION: The intensive treatment of lymphedema
in the outpatient clinic
can produce significant
reductions in the volume
of edema over a short period of time and can be
recommended for any
grade
of lymphedema, in particular the more advanced
degrees.
PMID: 20606882 [PubMed - as supplied by
publisher]
Radiother Oncol. 2010 May 31. [Epub ahead of
print]
Randomised phase II trial of hyperbaric oxygen therapy in
patients with
chronic arm lymphoedema
after radiotherapy for
cancer.
Gothard L, Haviland J, Bryson P, Laden G, Glover M,
Harrison S, Woods M,
Cook G, Peckitt C,
Pearson A, Somaiah N, Stanton A,
Mortimer P, Yarnold J.
Department of Radiotherapy, The Royal
Marsden NHS Foundation Trust,
Sutton,
UK.
Abstract
BACKGROUND: A non-randomised phase II
study suggested a therapeutic effect
of hyperbaric
oxygen (HBO) therapy
on arm lymphoedema following adjuvant radiotherapy
for early breast
cancer,
justifying further investigation in a randomised
trial.
METHODS: Fifty-eight patients with 15% increase in arm
volume after
supraclavicular+/-axillary
radiotherapy (axillary surgery in
52/58 patients) were randomised in a 2:1
ratio to HBO (n=38) or to
best
standard care (n=20). The HBO group breathed 100% oxygen at 2.4
atmospheres
absolute for
100min on 30 occasions over 6weeks. Primary endpoint was
ipsilateral limb
volume expressed as a
percentage of contralateral limb
volume. Secondary endpoints included
fractional removal rate
of
radioisotopic tracer from the arm, extracellular water content,
patient
self-assessments and UK SF-36
Health Survey
Questionnaire.
FINDINGS: Of 53/58 (91.4%) patients with baseline
assessments, 46 had
12-month assessments
(86.8%). Median volume of
ipsilateral limb (relative to contralateral) at
baseline was 133.5%
(IQR
126.0-152.3%) in the control group, and 135.5% (IQR 126.5-146.0%) in
the
treatment group.
Twelve months after baseline the median (IQR) volume
of the ipsilateral
limb was 131.2% (IQR 122.7-
151.5%) in the control
group and 133.5% (IQR 122.3-144.9%) in the
treatment group. Results for
the
secondary endpoints were similar between randomised
groups.
INTERPRETATION: No evidence has been found of a
beneficial effect of HBO
in the treatment of
arm lymphoedema following
primary surgery and adjuvant radiotherapy for
early breast
cancer.
Copyright © 2010 Elsevier Ireland Ltd. All rights
reserved.
PMID: 20605648 [PubMed - as supplied by
publisher]
Int J Radiat Oncol Biol Phys. 2010 Jun 2. [Epub ahead
of print]
Standardized Method for Quantification of Developing
Lymphedema in
Patients Treated for
Breast
Cancer.
Ancukiewicz M, Russell TA, Otoole J, Specht M,
Singer M, Kelada A, Murphy
CD, Pogachar J,
Gioioso V, Patel M, Skolny M,
Smith BL, Taghian AG.
Department of Radiation Oncology,
Massachusetts General Hospital, Boston,
MA.
Abstract
PURPOSE: To develop a simple and
practical formula for quantifying breast
cancer-related
lymphedema,
accounting for both the asymmetry of upper extremities'
volumes and their
temporal
changes,
METHODS AND MATERIALS: We analyzed
bilateral perometer measurements of the
upper
extremity in a series of
677 women who prospectively underwent lymphedema
screening
during
treatment for unilateral breast cancer at Massachusetts General
Hospital
between August 2005 and
November 2008. Four sources of variation
were analyzed: between repeated
measurements on the
same arm at the same
session; between both arms at baseline (preoperative)
visit; in
follow-up
measurements; and between patients. Effects of hand dominance,
time since
diagnosis and surgery,
age, weight, and body mass index were
also analyzed.
RESULTS: The statistical distribution of
variation of measurements
suggests that the ratio of volume
ratios is
most appropriate for quantification of both asymmetry and
temporal changes.
Therefore, we
present the formula for relative volume change (RVC): RVC
=
(A(2)U(1))/(U(2)A(1)) - 1, where A
(1), A(2) are arm volumes on the
side of the treated breast at two
different time points, and U(1),
U(2)
are volumes on the contralateral side. Relative volume change is
not
significantly associated with hand
dominance, age, or time since
diagnosis. Baseline weight correlates (p =
0.0074) with higher
RVC;
however, baseline body mass index or weight changes over time do
not.
CONCLUSIONS: We propose the use of the RVC formula to
assess the presence
and course of
breast cancer-related lymphedema in
clinical practice and research.
Copyright © 2010 Elsevier Inc. All
rights
reserved.
PMID: 20605339 [PubMed - as supplied by
publisher]
J Obstet Gynaecol Res. 2010
Jun;36(3):555-9.
Analysis of the complications after radical
hysterectomy for stage IB, IIA
and IIB uterine cervical
cancer
patients.
Kashima K, Yahata T, Fujita K, Tanaka
K.
Departments of Obstetrics and Gynecology, Niigata University
Graduate
School of Medical and
Dental Sciences, Niigata, Japan. [email protected]
Abstract
AIM:
This study was undertaken to assess whether radical hysterectomy and
pelvic
lymphadenectomy
could be carried out within acceptable complications in
uterine cervical
cancer patients.
MATERIAL & METHODS: One
hundred and forty-six patients of the
International Federation
of
Gynecology and Obstetrics stage IB, IIA and IIB cervical cancer treated
by
radical hysterectomy or
combined with postoperative radiation therapy
were enrolled in this study.
The study population was
41 women over the
age of 60 and 105 women under the age of 59.
Complications after the
treatment
of all patients were examined.
RESULTS: The
complications were significantly high with the patients over
the age of 60
(53.7%) in
comparison with the patients under the age of 59 (24.8%).
Especially, the
cases combined with
radiation therapy had higher
complication rate. The most commonly recorded
complications
were
lymphedema (13.7%) and small bowel obstruction
(8.2%).
CONCLUSION: We conclude that the complications
influenced on the quality
of life were more
frequent in patients over the
age of 60.
PMID: 20598037 [PubMed - in
process]
July 10, 2010 (7 docs)
Indian J
Dermatol. 2010 Apr;55(2):144-147.
INTENSIVE TREATMENT OF LEG
LYMPHEDEMA.
Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro
de Godoy M.
Department of Cardiology and Cardiovascular Surgery
and professor of the
post graduation course of
Medicine School of São
Jose do Rio Preto-FAMERP-Brazil.
Abstract
BACKGROUND:
Despite of all the problems caused by lymphedema, this disease
continues to
affect
millions of people worldwide. Thus, the identification of the
most
efficacious forms of treatment is
necessary. AIM: The aim of this
study was to evaluate a novel intensive
outpatient treatment for
leg
lymphedema.
METHODS: Twenty-three legs of 19 patients
were evaluated in a prospective
randomized study. The
inclusion criteria
were patients with Grade II and III lymphedema, where
the difference,
measured by
volumetry, between the affected limb below the knee and the
healthy limb
was greater than 1.5 kg.
Intensive treatment was carried out
for 6- to 8-h sessions in the
outpatient clinic. Analysis of variance
was
utilized for statistical analysis with an alpha error of 5%
(P-value
<0.05) being considered
significant.
RESULTS:
All limbs had significant reductions in size with the final mean
loss being
81.1% of the
volume of edema. The greatest losses occurred in the first week
(P-value
<0.001). Losses of more
than 90% of the lymphedema occurred
in 9 (39.13%) patients; losses of more
than 80% in 13
(56.52%), losses of
more than 70% in 17 (73.91%) and losses of more than
50% were recorded
for
95.65% of the patients; only 1 patient lost less than 50% (37.9%) of
the
edema.
CONCLUSION: The intensive treatment of lymphedema
in the outpatient clinic
can produce significant
reductions in the volume
of edema over a short period of time and can be
recommended for any
grade
of lymphedema, in particular the more advanced
degrees.
PMID: 20606882 [PubMed - as supplied by
publisher]
Br J Nurs. 2010 Jul
8-21;19(13):826-30.
Keeping breast cancer survivors
lymphoedema-free.
Fleysher
LA.
Abstract
With the increasing number of breast
cancer survivors, post-treatment
interventions to improve quality
of life
are gaining priority. Current breast cancer treatment modalities
put
patients at risk of developing
upper-extremity lymphoedema. Upper-extremity
lymphoedema is a common and
overlooked
complication of breast cancer
treatment. Health professionals play an
important role in
identifying
breast cancer and promptly referring these patients for
further
interventions. After successful
completion of breast cancer
treatment, these patients continue to have
regular evaluations by
their
oncologists; and, provided there are no signs and symptoms of
breast
cancer, primary and community
care health professionals will
continue to play an essential role in the
management of this unique
patient
group. As breast cancer treatment places these patients at a
lifetime risk
of developing upper-extremity
lymphoedema, radiation
oncologists, surgical and medical oncologists, and
primary care
practitioners
must be knowledgeable and educate these patients about risk
reduction
behaviours. Prevention,
prompt identification, and treatment of
lymphoedema are the goals for
achieving positive and cost-
effective
patient outcomes. This article aims to provide health
professionals with
specific educational
tools with regard to the prevention, recognition, and
management of
upper-extremity lymphoedema;
these tools should be used to
change the ongoing trends in the management
of breast cancer
survivors'
follow-up care.
PMID: 20606611 [PubMed - in
process]
Int J Gynecol Cancer. 2010
Jul;20(5):900-4.
A prospective study of postoperative lymphedema
after surgery for cervical
cancer.
Halaska MJ, Novackova M,
Mala I, Pluta M, Chmel R, Stankusova H, Robova H,
Rob
L.
*Department of Obstetrics and Gynaecology, 2nd Medical
Faculty of the
Charles University in Prague
and Faculty Hospital Motol,
Prague; daggerFaculty of Statistics,
University of Economics in
Prague;
and double daggerDepartment of Oncology and Radiotherapy, Faculty
Hospital
Motol, Prague,
Czech
Republic.
Abstract
OBJECTIVE:: Lymphedema is
a severe postoperative complication in
oncological
surgery.
Multifrequency bioelectrical impedance analysis (MFBIA) is a new
method
for early lymphedema
detection. The objective was to establish the
methodology of MFBIA for
lower-limb lymphedema and
to detect a lymphedema
in patients undergoing cervical cancer surgery.
METHODS:: From a
population of 60 patients undergoing cervical cancer
surgery, 39
underwent
radical hysterectomy Wertheim III (RAD group), and 21
underwent
conservative surgery
(laparoscopic lymphadenectomy plus simple
trachelectomy/simple
hysterectomy - CONS group). A
control group of 29
patients (CONTR group) was used to determine the SD of
impedance at
zero
frequency (R0). Patients were examined before surgery and at 3 and
6
months after surgery by
MFBIA and by measuring the circumference of the
lower limbs.
RESULTS:: No differences were found between the
CONS and RAD groups on
age, height, weight,
and histopathologic type of
tumor. However, the number of dissected lymph
nodes differed
significantly
between the groups (17.3 in the CONS group vs 25.8 in the RAD
group, P =
0.0012). The SD of R0
in the CONTR group was 36.0 and 39.0 for
the right and the left leg,
respectively. No difference in
prevalence of
lymphedema based on circumference method was found (35.9% in
the RAD and
47.6%
in the CONS groups, not statistically
significant).
CONCLUSIONS:: No difference in the prevalence of
lymphedema was found
between the CONS
and RAD groups. A methodology for
MFBIA for the detection of lower-limb
lymphedema
was
described.
PMID: 20606541 [PubMed - in
process]
Radiother Oncol. 2010 May 31. [Epub ahead of
print]
Randomised phase II trial of hyperbaric oxygen therapy in
patients with
chronic arm lymphoedema
after radiotherapy for
cancer.
Gothard L, Haviland J, Bryson P, Laden G, Glover M,
Harrison S, Woods M,
Cook G, Peckitt C,
Pearson A, Somaiah N, Stanton A,
Mortimer P, Yarnold J.
Department of Radiotherapy, The Royal
Marsden NHS Foundation Trust,
Sutton,
UK.
Abstract
BACKGROUND: A non-randomised phase II
study suggested a therapeutic effect
of hyperbaric
oxygen (HBO) therapy
on arm lymphoedema following adjuvant radiotherapy
for early breast
cancer,
justifying further investigation in a randomised
trial.
METHODS: Fifty-eight patients with 15% increase in arm
volume after
supraclavicular+/-axillary
radiotherapy (axillary surgery in
52/58 patients) were randomised in a 2:1
ratio to HBO (n=38) or to
best
standard care (n=20). The HBO group breathed 100% oxygen at 2.4
atmospheres
absolute for
100min on 30 occasions over 6weeks. Primary endpoint was
ipsilateral limb
volume expressed as a
percentage of contralateral limb
volume. Secondary endpoints included
fractional removal rate
of
radioisotopic tracer from the arm, extracellular water content,
patient
self-assessments and UK SF-36
Health Survey
Questionnaire.
FINDINGS: Of 53/58 (91.4%) patients with baseline
assessments, 46 had
12-month assessments
(86.8%). Median volume of
ipsilateral limb (relative to contralateral) at
baseline was 133.5%
(IQR
126.0-152.3%) in the control group, and 135.5% (IQR 126.5-146.0%) in
the
treatment group.
Twelve months after baseline the median (IQR) volume
of the ipsilateral
limb was 131.2% (IQR 122.7-
151.5%) in the control
group and 133.5% (IQR 122.3-144.9%) in the
treatment group. Results for
the
secondary endpoints were similar between randomised
groups.
INTERPRETATION: No evidence has been found of a
beneficial effect of HBO
in the treatment of
arm lymphoedema following
primary surgery and adjuvant radiotherapy for
early breast
cancer.
Copyright © 2010 Elsevier Ireland Ltd. All rights
reserved.
PMID: 20605648 [PubMed - as supplied by
publisher]
Int J Radiat Oncol Biol Phys. 2010 Jun 2. [Epub ahead
of print]
Standardized Method for Quantification of Developing
Lymphedema in
Patients Treated for
Breast
Cancer.
Ancukiewicz M, Russell TA, Otoole J, Specht M,
Singer M, Kelada A, Murphy
CD, Pogachar J,
Gioioso V, Patel M, Skolny M,
Smith BL, Taghian AG.
Department of Radiation Oncology,
Massachusetts General Hospital, Boston,
MA.
Abstract
PURPOSE: To develop a simple and
practical formula for quantifying breast
cancer-related
lymphedema,
accounting for both the asymmetry of upper extremities'
volumes and their
temporal
changes,
METHODS AND MATERIALS: We analyzed
bilateral perometer measurements of the
upper
extremity in a series of
677 women who prospectively underwent lymphedema
screening
during
treatment for unilateral breast cancer at Massachusetts General
Hospital
between August 2005 and
November 2008. Four sources of variation
were analyzed: between repeated
measurements on the
same arm at the same
session; between both arms at baseline (preoperative)
visit; in
follow-up
measurements; and between patients. Effects of hand dominance,
time since
diagnosis and surgery,
age, weight, and body mass index were
also analyzed.
RESULTS: The statistical distribution of
variation of measurements
suggests that the ratio of volume
ratios is
most appropriate for quantification of both asymmetry and
temporal changes.
Therefore, we
present the formula for relative volume change (RVC): RVC
=
(A(2)U(1))/(U(2)A(1)) - 1, where A
(1), A(2) are arm volumes on the
side of the treated breast at two
different time points, and U(1),
U(2)
are volumes on the contralateral side. Relative volume change is
not
significantly associated with hand
dominance, age, or time since
diagnosis. Baseline weight correlates (p =
0.0074) with higher
RVC;
however, baseline body mass index or weight changes over time do
not.
CONCLUSIONS: We propose the use of the RVC formula to
assess the presence
and course of
breast cancer-related lymphedema in
clinical practice and research.
Copyright © 2010 Elsevier Inc. All
rights
reserved.
PMID: 20605339 [PubMed - as supplied by
publisher]
Arch Phys Med Rehabil. 2010
Jul;91(7):1070-6.
Weight lifting in patients with
lower-extremity lymphedema secondary to
cancer: a pilot and
feasibility
study.
Katz E, Dugan NL, Cohn JC, Chu C, Smith
RG, Schmitz KH.
Department of Rehabilitation Medicine,
University of Washington, Seattle,
WA,
USA.
Abstract
OBJECTIVE: To assess the feasibility of
recruiting and retaining cancer
survivors with lower-limb
lymphedema into
an exercise intervention study. To develop preliminary
estimates regarding
the safety
and efficacy of this intervention. We hypothesized that
progressive weight
training would not
exacerbate leg swelling and that
the intervention would improve functional
mobility and quality of
life.
DESIGN: Before-after pilot study with a duration of 5
months.
SETTING: University of
Pennsylvania.
PARTICIPANTS: Cancer survivors with a known
diagnosis of lower-limb
lymphedema (N=10) were
directly referred by
University of Pennsylvania clinicians. All 10
participants completed the
study.
INTERVENTION: Twice weekly slowly progressive weight
lifting, supervised
for 2 months,
unsupervised for 3
months.
MAIN OUTCOME MEASURES: The primary outcome was interlimb
volume
differences as
measured by optoelectronic perometry. Additional
outcome measures included
safety (adverse events),
muscle strength,
objective physical function, and quality of life.
RESULTS:
Interlimb volume differences were 44.4% and 45.3% at baseline and
5
months,
respectively (pre-post comparison, P=.70). There were 2
unexpected
incident cases of cellulitis within
the first 2 months. Both
resolved with oral antibiotics and complete
decongestive therapy by 5
months.
Bench and leg press strength increased by 47% and 27% over 5
months
(P=.001 and P=.07,
respectively). Distance walked in 6 minutes
increased by 7% in 5 months
(P=.01). No improvement
was noted in
self-reported quality of life.
CONCLUSIONS: Recruitment of
patients with lower-limb-lymphedema into an
exercise program is
feasible.
Despite some indications that the intervention may be safe (eg,
a lack of
clinically significant
interlimb volume increases over 5 mo), the unexpected
finding of 2
cellulitic infections among the 10
participants suggests
additional study is required before concluding that
patients with
lower-extremity
lymphedema can safely perform weight lifting. Copyright 2010
American
Congress of Rehabilitation
Medicine. Published by Elsevier Inc.
All rights reserved.
PMID: 20599045 [PubMed - in process]PMCID:
PMC2897812 [Available on 2011/7/1]
J Obstet Gynaecol Res. 2010
Jun;36(3):555-9.
Analysis of the complications after radical
hysterectomy for stage IB, IIA
and IIB uterine cervical
cancer
patients.
Kashima K, Yahata T, Fujita K, Tanaka
K.
Departments of Obstetrics and Gynecology, Niigata University
Graduate
School of Medical and
Dental Sciences, Niigata, Japan. [email protected]
Abstract
AIM:
This study was undertaken to assess whether radical hysterectomy and
pelvic
lymphadenectomy
could be carried out within acceptable complications in
uterine cervical
cancer patients.
MATERIAL & METHODS: One
hundred and forty-six patients of the
International Federation
of
Gynecology and Obstetrics stage IB, IIA and IIB cervical cancer treated
by
radical hysterectomy or
combined with postoperative radiation therapy
were enrolled in this study.
The study population was
41 women over the
age of 60 and 105 women under the age of 59.
Complications after the
treatment
of all patients were examined.
RESULTS: The
complications were significantly high with the patients over
the age of 60
(53.7%) in
comparison with the patients under the age of 59 (24.8%).
Especially, the
cases combined with
radiation therapy had higher
complication rate. The most commonly recorded
complications
were
lymphedema (13.7%) and small bowel obstruction
(8.2%).
CONCLUSION: We conclude that the complications
influenced on the quality
of life were more
frequent in patients over the
age of 60.
PMID: 20598037 [PubMed - in
process]
July 18, 2010 (8 docs)
Eur J Ophthalmol.
2010 Jul 6. pii: 15C85F11-38C9-45C7-A19F-2E3556D7D52F.
[Epub ahead
of
print]
Unusual presentation of giant cell angiofibroma of
the eyelids.
Surace D, Blandamura S, Bernardini FP, Galan A, Lo
Giudice G.
Department of Ophthalmology, Santa Maria del Carmine
Hospital, Rovereto -
Italy.
Abstract
Purpose. To
describe a case of bilateral eyelid-confined giant cell
angiofibroma (GCAF)
in a patient
with a slowly progressive bilateral eyelid swelling. Methods.
A
40-year-old man with a 5-year history
of slowly progressive bilateral
eyelid swelling, severe functional
impairment, and bilateral
cosmetic
deformity was studied. An extensive ophthalmologic evaluation,
laboratory
examinations, and orbital
magnetic resonance imaging were
carried out.
Results. Clinical examination showed nonpitting
lymphedema affecting both
upper and lower eyelids,
with orange peel skin.
Orbital magnetic resonance imaging revealed diffuse
thickening of the
preseptal
structures in the eyelids without extension to the orbit.
Histologic
specimen revealed the presence of
spindle and multinucleated
giant cells surrounding pseudovascular spaces
strongly positive to
CD34
and vimentin. A diagnosis of GCAF was made and radiation therapy
was
performed 3 weeks after
surgical debulking with partial recovery of
visual and anatomic function.
Conclusions. Giant cell
angiofibroma involving the eyelid is rare and can
represent a diagnostic
and
therapeutic challenge to the ophthalmologist.
PMID:
20623470 [PubMed - as supplied by publisher]
Ann Dermatol
Venereol. 2010 Jun-Jul;137(6-7):477-9. Epub 2010 May
14.
[Lymphoedema and neutrophilic dermatosis] Article in
French]
Guyot-Caquelin P, Cuny JF, Depardieu C, Barbaud A,
Schmutz JL.
PMID: 20620580 [PubMed - in
process]
J Urol. 2010 Aug;184(2):546-552. Epub 2010 Jun
17.
Modified Technique of Radical Inguinal Lymphadenectomy for
Penile
Carcinoma: Morbidity and
Outcome.
Yao K, Tu H, Li
YH, Qin ZK, Liu ZW, Zhou FJ, Han H.
Department of Urology,
Cancer Center, Sun Yat-Sen University and State Key
Laboratory
of
Oncology in Southern China, Guangzhou, P. R.
China.
Abstract
PURPOSE: Classic radical inguinal
lymphadenectomy is associated with
significant morbidity.
Modified
inguinal lymphadenectomy has been used to decrease the complication
rate
but it may compromise the
oncological effect and depends on the use
of intraoperative frozen
sections, which may be inaccurate.
We modified
the technique of radical inguinal lymphadenectomy to
decrease
postoperative
complications without compromising oncological
effectiveness.
MATERIALS AND METHODS: We performed 150 modified
radical inguinal
dissections in 75
patients with penile carcinoma from
February 1999 to September 2008.
Patients underwent modified
radical
inguinal dissection characterized by an S-shaped incision,
precisely
separating layers using an
anatomical landmark and preserving the fascia
lata. The boundaries of
dissection are the same as those
of radical
inguinal lymphadenectomy. Survival and morbidity data were
retrospectively
analyzed, and
survival probabilities were calculated. RESULTS: Followup
ranged from 12
to 113 months. Overall 3-
year survival was 92%, and for
N0, N1, N2 and N3 disease it was 100%,
100%, 85% and 57.1%,
respectively.
A total of 37 complications occurred including wound
infection (1.4%), skin
necrosis
(4.7%), lymphedema (13.9%), seroma (2.0%), lymphocele (2.0%) and
deep
venous thrombosis
(0.7%).
CONCLUSIONS: Morbidity
related to groin dissection in patients with penile
carcinoma can
be
decreased and oncological effectiveness can be preserved using
this
modified inguinal dissection
technique. Copyright © 2010 American
Urological Association Education and
Research, Inc.
Published by Elsevier
Inc. All rights reserved.
PMID: 20620415 [PubMed - as supplied
by publisher]
J Vasc Surg. 2010 Jul 7. [Epub ahead of
print]
A novel method of measuring human lymphatic pumping using
indocyanine
green fluorescence
lymphography.
Unno N,
Nishiyama M, Suzuki M, Tanaka H, Yamamoto N, Sagara D, Mano Y,
Konno
H.
Division of Vascular Surgery, Hamamatsu University School of
Medicine,
Shizuoka, Japan; Second
Department of Surgery, Hamamatsu
University School of Medicine,
Shizuoka,
Japan.
Abstract
OBJECTIVES: Lymph
transportation through the body is partly controlled by
the intrinsic
pumping of
lymphatic vessels. Although an understanding of this process is
important
for medical application, little
is currently known because it
is difficult to measure. Here, we introduce
an easy, safe, and
cost-
effective technique for measuring lymphatic pumping in leg
superficial
lymphatic vessels. Readings
obtained with this technique were
compared with values obtained with
dynamic
lymphoscintigraphy.
Differences in lymphatic pumping between healthy
volunteers and patients
with lymphedema were
also
investigated.
METHODS: Indocyanine green (ICG)
fluorescence lymphography was performed
by subcutaneously
injecting 0.3
mL of ICG (0.5%) into the dorsum of the foot. Real-time
fluorescence images
of lymph
propulsion were obtained with an infrared-light camera system with
the
individual supine or sitting. A
custom-made transparent
sphygmomanometer cuff was wrapped around the lower
leg and connected
to a
standard mercury sphygmomanometer. The cuff was inflated to 60 mm Hg
and
then gradually
deflated at 5-minute intervals to lower the pressure by 10-mm
Hg steps
until the fluorescence contrast
agent exceeded the upper border
of the cuff, indicating that the lymphatic
contraction had overcome
the
cuff pressure. Lymph pumping pressure (P(pump)) was defined as the
value of
the cuff pressure
when the contrast agent exceeded the upper border of the
cuff. We measured
P(pump) among healthy
volunteers who maintained a
supine position and compared these values with
measurements obtained
from
lymphoscintigraphy. P(pump) values while sitting were also compared
between
30 legs from
healthy volunteers and 30 legs from lymphedematous
patients.
RESULTS: Among healthy, supine participants, P(pump)
was 25.2 +/- 16.7 mm
Hg (mean +/-
standard deviation [SD]) when measured
by ICG fluorescence lymphography.
These values were
significantly
correlated with values taken using dynamic
lymphoscintigraphy (r(2) = 0.54,
p < .01),
while 2 SDs of the mean were approximately 20 mm Hg, suggesting
a
substantial disagreement
between the two methods (Bland-Altman plots).
In the comparison of seated
meaurements, readings
for healthy
participants (P(pump) = 29.3 +/- 16.0) were higher than those
for
lymphedematous
participants (13.2 +/- 14.9).
CONCLUSION: ICG
fluorescence is an accurate-as well as a safe, easy, and
economical-method
of
measuring lymphatic pumping. Therefore, it may develop as a vital tool
for
diagnosing lymphatic
malfunctions even when they are only in their
formative stages. Studies
that use this technique may
increase our
knowledge of the lymphatic system as a whole, allowing us to
develop better
treatments
for lymphatic disorders. Copyright © 2010 Society for Vascular
Surgery.
Published by Mosby, Inc.
All rights
reserved.
PMID: 20619581 [PubMed - as supplied by
publisher]
J Pain Symptom Manage. 2010
Jul;40(1):e7-10.
A case of massive complicated lower limb
lymphedema after pelvic nodal
dissection and
radiotherapy.
Jain S, Mahantshetty U, Engineer R, Shrivastava
SK.
PMID: 20619201 [PubMed - in process]
Jpn J
Nurs Sci. 2010 Jun;7(1):108-18.
Physiological characteristics of
the body fluid in lymphedematous patients
postbreast cancer
surgery,
focusing on the intracellular/extracellular fluid ratio of the
upper limb.
Sakuda H, Satoh M, Sakaguchi M, Miyakoshi Y, Kataoka
T.
Department of Human Health Science, Graduate School of
Medicine, Faculty
of Medicine, Kyoto
University, 53 Syogoin
Kawahara-cho,Kyoto, Japan. [email protected]
Abstract
AIM:
The aim of this research was to determine the physiological
characteristics
of patients with
lymphedema following breast cancer surgery, based on
differences between
the quantity of body water
in the right and left
fingertips, with a view to establishing whether or
not this simple
measurement could
serve as a predictive index for the onset of
lymphedema.
METHOD: The research was conducted at a hospital in
Hiroshima, Japan
(August 2004 to December
2004). Observations were made
on 39 female breast cancer patients who had
undergone surgery and
45
healthy female participants. Additional information was collected
via
interviews with the individual
participants. The quantity of body
water in all the participants was
measured by using a
bioimpedance
spectrum analysis system. Comparisons of the
intracellular/extracellular
fluid ratios (I/Es) were made
between the
edema patients and the non-edema patients, with further
testing being done
between the
affected and unaffected sides of the upper limb in the edema
patients.
RESULTS: In the edema patients, significant
differences were recognized
between the affected side's
upper limb I/E
and the unaffected side's upper limb I/E. In relation to
the affected side's
upper limb I/E
of the edema patients, even when the mean value and standard
deviation
were included, the value did
not exceed 1.0 and the mean - 3 SD
value of the affected side's upper limb
I/E in the non-edema
patients was
1.04.
CONCLUSIONS: The results suggest that measurements of the
affected and
unaffected sides' upper
limb I/E showed a potential for use
as a reliable predictive index for
lymphedema.
PMID: 20618682
[PubMed - in process]
Ann Surg Oncol. 2010 Jul 8. [Epub ahead of
print]
The Impact on Morbidity and Length of Stay of Early
Versus Delayed
Complete Lymphadenectomy in
Melanoma: Results of the
Multicenter Selective Lymphadenectomy Trial (I).
Faries MB,
Thompson JF, Cochran A, Elashoff R, Glass EC, Mozzillo N,
Nieweg OE, Roses
DF,
Hoekstra HJ, Karakousis CP, Reintgen DS, Coventry BJ, Wang HJ, Morton
DL;
for the MSLT
Cooperative Group.
John Wayne Cancer
Institute at Saint John's Health Center, Santa Monica,
CA, USA,
fariesm@jwci.
org.
Abstract
BACKGROUND: Complete
lymph node dissection, the current standard treatment
for
nodal
metastasis in melanoma, carries the risk of significant
morbidity.
Clinically apparent nodal tumor is likely
to impact both
preoperative lymphatic function and extent of soft tissue
dissection
required to clear the
basin. We hypothesized that early dissection would be
associated with less
morbidity than delayed
dissection at the time of
clinical recurrence.
MATERIALS AND METHODS: The Multicenter
Selective Lymphadenectomy Trial I
randomized
patients to wide excision of
a primary melanoma with or without sentinel
lymph node biopsy.
Immediate
completion lymph node dissection (early CLND) was performed when
indicated
in the SLN
arm, while therapeutic dissection (delayed CLND) was performed at
the time
of clinical recurrence in
the wide excision-alone arm. Acute and
chronic morbidities were
prospectively monitored.
RESULTS:
Early CLND was performed in 225 patients, and in the wide
excision-alone arm
132 have
undergone delayed CLND. The 2 groups were similar for primary
tumor
features, body mass index,
basin location, and demographics except
age, which were higher for delayed
CLND. The number of
nodes evaluated
and the number of positive nodes was greater for delayed
CLND. There was
no
significant difference in acute morbidity, but lymphedema
was
significantly higher in the delayed CLND
group (20.4% vs. 12.4%, P =
.04). Length of inpatient hospitalization was
also longer for
delayed
CLND.
CONCLUSION: Immediate nodal treatment provides
critical prognostic
information and a likely
therapeutic effect for those
patients with nodal involvement. These data
show that early CLND is
also
less likely to result in lymphedema.
PMID: 20614193
[PubMed - as supplied by publisher]
Vet Dermatol. 2010 Jul 1.
[Epub ahead of print]
Combined moxidectin and environmental
therapy do not eliminate Chorioptes
bovis infestation in
heavily
feathered horses.
Rüfenacht S, Roosje PJ, Sager H, Doherr MG,
Straub R, Goldinger-Müller P,
Gerber V.
Dermatology Unit,
Department of Clinical Veterinary Medicine, Vetsuisse
Faculty, University of
Berne,
Switzerland.
Abstract
Abstract Chorioptes
bovis infestation is a common cause of pastern
dermatitis in the horse, with
a
predilection in draft horses and other horses with thick hair
'feathers'
on the distal limbs. The treatment
of this superficial mite is
challenging; treatment failure and relapse are
common. Furthermore, C.
bovis
infestation may affect the progression of chronic pastern dermatitis
(also
known as chronic proliferative
pastern dermatitis, chronic
progressive lymphoedema and dermatitis
verrucosa) in draft
horses,
manifesting with oedema, lichenification and excessive skin folds
that can
progress to verruciform
lesions. An effective cure for C. bovis
infestation would therefore be of
great clinical value. In a
prospective,
double-blind, placebo-controlled study, the efficacy of oral
moxidectin (0.4
mg/kg body
weight) given twice with a 3 week interval in combination
with
environmental treatment with 4-chloro-3-
methylphenol and propoxur
was tested in 19 heavily feathered horses with
clinical pastern
dermatitis
and C. bovis infestation. Follow-up examinations over a period of
180 days
revealed significantly more
skin crusting in the placebo group
than in the treatment group. However,
no other differences in
clinical
signs or the numbers of mites detected were found between the two
groups.
The results of this study
suggest that moxidectin in combination
with environmental insecticide
treatment as used in this study
is
ineffective in the treatment of C. bovis in feathered
horses.
PMID: 20609205 [PubMed - as supplied by
publisher]
July 22, 2010 (4 docs)
Clin Nucl Med.
2010 Aug;35(8):579-82.
Lymphoscintigraphy in the diagnosis of
lymphangiomatosis.
Beveridge N, Allen L, Rogers
K.
Department of Nuclear Medicine/PET, Hunter New England
Imaging, John
Hunter Hospital,
Newcastle, NSW, Australia. [email protected]
Abstract
Lymphangiomatosis
is a rare condition characterized by multiple
abnormalities of the lymphatic
system.
Diagnosis is often difficult, as chronic, intermittent, or acute
pain;
edema; and other symptoms may
affect the respiratory,
gastrointestinal, renal, hepatic, skeletal, and
other organ systems. We
report the
case of a patient who first presented with lymphedema in
childhood and was
treated intermittently for
related symptoms before
diagnosis was achieved 36 years later. Plain film
radiography, bone
scanning,
computed tomography, magnetic resonance imaging, and
lymphoscintigraphy
were used to arrive at a
diagnosis. Information
derived from all scan types was combined to derive
a diagnosis
of
lymphangiomatosis. Lymphoscintigraphy provided direct evidence of
the
abnormal lymphatic flows
associated with lymphangiomatosis.
Lymphangiomatosis presents a diagnostic
challenge; information
from
several scan types, including lymphoscintigraphy, is useful in
deriving this
diagnosis.
PMID: 20631503 [PubMed - in process]
J
Plast Reconstr Aesthet Surg. 2010 Jul 12. [Epub ahead of
print]
Objective improvement in upper limb lymphoedema following
ipsilaterall
latissimus dorsi pedicled flap
breast reconstruction - A
case series and review of literature.
Abbas Khan MA, Mohan A,
Hardwicke J, Srinivasan K, Billingham R, Taylor C,
Prinsloo
D.
Department of Plastic and Reconstructive Surgery, University
Hospital
North Staffordshire NHS Trust,
Newcastle Rd, Stoke on Trent,
Staffordshire ST4 6QG, UK.
Abstract
OBJECTIVE: We
present a series of three patients whose upper limb
lymphoedema (following
total
oncologic mastectomy and level III axillary clearance)
resolved
significantly after ipsilateral pedicled
latissimus dorsi (LD)
flap breast reconstruction.
METHODS: A retrospective review of
the medical records of patients who had
undergone oncologic
mastectomy
and level III axillary clearance with subsequent LD pedicled
flap
reconstruction was
carried out. Individuals who had undergone review and
treatment by the
lymphoedema service were
identified and patients with
incomplete pre- or post-operative records
were excluded. A
minimum
follow-up period of 2 years of conservative therapy, as well as 2
years
post-operatively was
undertaken.
RESULTS: The rate
of improvement of lymphoedema following conservative
therapy was, on
average,
0.095mL/week and reached a plateau at 2-year follow-up.
Following
latissimus dorsi flap breast
reconstruction, the rate of
improvement in lymphoedema increased in all
three cases, with an
average
improvement of 2.55mL/week and remained sustained in the follow-up
period.
CONCLUSION: Pedicled myocutaneous flap reconstruction of
the ipsilateral
breast proved to be a
useful treatment for upper limb
lymphoedema in our series. This adds an
important dimension to
the
assessment and treatment of patients with upper limb oedema resulting
from
mastectomy and axillary
clearance. Copyright © 2010 British
Association of Plastic, Reconstructive
and Aesthetic Surgeons.
Published
by Elsevier Ltd. All rights reserved.
PMID: 20630818 [PubMed -
as supplied by publisher]
PLoS Negl Trop Dis. 2010 Jun
29;4(6):e728.
Increasing compliance with mass drug
administration programs for lymphatic
filariasis in India
through
education and lymphedema management programs.
Cantey
PT, Rout J, Rao G, Williamson J, Fox LM.
Epidemic Intelligence
Service, Office of Workforce and Career Development,
Centers for
Disease
Control and Prevention, Atlanta, Georgia, United States of
America.
[email protected]
Abstract
BACKGROUND:
Nearly 45% of people living at risk for lymphatic filariasis
(LF) worldwide
live in
India. India has faced challenges obtaining the needed levels
of
compliance with its mass drug
administration (MDA) program to
interrupt LF transmission, which utilizes
diethylcarbamazine (DEC)
or DEC
plus albendazole. Previously identified predictors of and barriers
to
compliance with the MDA
program were used to refine a pre-MDA educational
campaign. The objectives
of this study were to
assess the impact of these
refinements and of a lymphedema morbidity
management program on
MDA
compliance.
METHODS/PRINCIPAL FINDINGS: A randomized,
30-cluster survey was performed
in each of 3
areas: the community-based
pre-MDA education plus community-based
lymphedema management
education
(Com-MDA+LM) area, the community-based pre-MDA education
(Com-MDA) area,
and
the Indian standard pre-MDA education (MDA-only) area. Compliance with
the
MDA program was
90.2% in Com-MDA+LM, 75.0% in Com-MDA, and 52.9% in
the MDA-only areas
(p<0.0001).
Identified barriers to adherence
included: 1) fear of side effects and 2)
lack of recognition of
one's
personal benefit from adherence. Multivariable predictors of
adherence
amenable to educational
intervention were: 1) knowing about the
MDA in advance of its occurrence,
2) knowing everyone is at
risk for LF,
3) knowing that the MDA was for LF, and 4) knowing at least
one component of
the
lymphedema management techniques taught in the lymphedema management
program.
CONCLUSIONS/SIGNIFICANCE: This study confirmed
previously identified
predictors of and
barriers to compliance with
India's MDA program for LF. More importantly,
it showed that
targeting
these predictors and barriers in a timely and clear pre-MDA
educational
campaign can increase
compliance with MDA programs, and it
demonstrated, for the first time,
that lymphedema management
programs may
also increase compliance with MDA programs.
PMID: 20628595
[PubMed - in process]PMCID: PMC2900179
J Adv Nurs. 2010 Jul 2.
[Epub ahead of print]
Effectiveness of exercise programmes on
shoulder mobility and lymphoedema
after axillary lymph node
dissection
for breast cancer: systematic review.
Chan DN, Lui LY, So
WK.
Dorothy N.S. Chan BN MN RN Registered Nurse Department of
Surgery,
Ruttonjee and Tang Shiu
Kin Hospital, Hong Kong SAR,
China.
Abstract
chan d.n.s., lui l.y.y. & so
w.k.w. (2010) Effectiveness of exercise
programmes on shoulder
mobility
and lymphoedema after axillary lymph node dissection for breast
cancer:
systematic review. Journal of
Advanced Nursing. Abstract Aim.
This article is a report of a review of
the effectiveness of
exercise
programmes on shoulder mobility and lymphoedema in postoperative
patients
with breast cancer
having axillary lymph node dissection, as
revealed by randomized
controlled trials.
Background. Breast
cancer is the most common malignancy in women. After
surgery, the
most
common postoperative complications are reduced range of motion in
the
shoulder, muscle weakness in
the upper extremities, lymphoedema, pain
and numbness. To reduce these
impairments, shoulder
exercises are usually
prescribed. However, conflicting results regarding
the effect and timing of
such
exercises have been reported.
Data sources. Studies were
retrieved from a systematic search of published
works over the
period
2000-2009 indexed in the Cumulative Index to Nursing and Allied
Health
Literature, Ovid Medline,
the British Nursing Index, Proquest,
Science Direct, Pubmed, Scopus and
the Cochrane Library, using
the
combined search terms 'breast cancer', 'breast cancer surgery',
'exercise',
'lymphoedema', 'shoulder
mobility' and 'randomized controlled
trials'.
Methods. A quantitative review of effectiveness was
carried out. Studies
were critically appraised by
three independent
reviewers, and categorized according to levels of
evidence defined by the
Joanna
Briggs Institute.
Results. Six studies were included
in the review. Early rather than
delayed onset of training did not
affect
the incidence of postoperative lymphoedema, but early introduction
of
exercises was valuable in
avoiding deterioration in range of shoulder
motion.
Conclusion. Further studies are required to investigate
the optimal time
for starting arm exercises after
this surgery. Nurses
have an important role in educating and encouraging
patients to practise
these
exercises to speed up recovery.
PMID: 20626480 [PubMed
- as supplied by publisher]
July 24, 2010 (1
doc)
Gynecol Oncol. 2010 Jul 15. [Epub ahead of
print]
Risk factors for postoperative lower-extremity lymphedema
in endometrial
cancer survivors who had
treatment including
lymphadenectomy.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi
U, Nakatani M, Aoyagi Y,
Ohba Y, Okamoto
K, Kato
H.
Division of Gynecologic Oncology, National Hospital
Organization, Hokkaido
Cancer Center,
Sapporo,
Japan.
Abstract
OBJECTIVE: The aim of this study was
to determine the incidence rate of
lower-extremity
lymphedema after
systematic lymphadenectomy in patients with uterine
corpus malignancies and
to
elucidate risk factors for this type of
lymphedema.
METHODS: A retrospective chart review was carried
out for all patients
with uterine corpus malignant
tumor managed at
Hokkaido Cancer Center between 1991 and 2007. Patients
who did not
undergo
lymphadenectomy as a treatment or died of cancer/intercurrent
disease were
excluded from this study.
All living patients included in
this study had hysterectomy, bilateral
salpingo-oophorectomy
and
lymphadenectomy and their medical records were reviewed. We
identified
patients with postoperative
lower-extremity lymphedema
(POLEL). Logistic regression analysis was used
to select the risk
factors
for POLEL.
RESULTS: Of 286 patients evaluated, 103
(37.8%) had POLEL. Multivariate
analysis confirmed that
adjuvant
radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more
than 31 lymph
nodes
(OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to
the
distal external iliac nodes
(CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were
independent risk factors for POLEL.
CONCLUSION: Adjuvant
radiation therapy should be avoided in patients who
undergo
systematic
lymphadenectomy if an alternative postoperative strategy is
possible.
Although reducing the number of
resected lymph nodes is not
appropriate from a therapeutical point of
view, elimination of
CINDEIN
dissection may be helpful in reducing the incidence of POLEL. The
clinical
significance of CINDEIN
dissection needs to be investigated by a
randomized controlled trial.
Copyright © 2010 Elsevier Inc.
All rights
reserved.
PMID: 20638109 [PubMed - as supplied by
publisher]
Gynecol Oncol. 2010 Jul 15. [Epub ahead of
print]
Risk factors for postoperative lower-extremity lymphedema
in endometrial
cancer survivors who had
treatment including
lymphadenectomy.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi
U, Nakatani M, Aoyagi Y,
Ohba Y, Okamoto
K, Kato
H.
Division of Gynecologic Oncology, National Hospital
Organization, Hokkaido
Cancer Center,
Sapporo,
Japan.
Abstract
OBJECTIVE: The aim of this study
was to determine the incidence rate of
lower-extremity
lymphedema after
systematic lymphadenectomy in patients with uterine
corpus malignancies and
to
elucidate risk factors for this type of
lymphedema.
METHODS: A retrospective chart review was carried
out for all patients
with uterine corpus malignant
tumor managed at
Hokkaido Cancer Center between 1991 and 2007. Patients
who did not
undergo
lymphadenectomy as a treatment or died of cancer/intercurrent
disease were
excluded from this study.
All living patients included in
this study had hysterectomy, bilateral
salpingo-oophorectomy
and
lymphadenectomy and their medical records were reviewed. We
identified
patients with postoperative
lower-extremity lymphedema
(POLEL). Logistic regression analysis was used
to select the risk
factors
for POLEL.
RESULTS: Of 286 patients evaluated, 103
(37.8%) had POLEL. Multivariate
analysis confirmed that
adjuvant
radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more
than 31 lymph
nodes
(OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to
the
distal external iliac nodes
(CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were
independent risk factors for POLEL.
CONCLUSION: Adjuvant
radiation therapy should be avoided in patients who
undergo
systematic
lymphadenectomy if an alternative postoperative strategy is
possible.
Although reducing the number of
resected lymph nodes is not
appropriate from a therapeutical point of
view, elimination of
CINDEIN
dissection may be helpful in reducing the incidence of POLEL. The
clinical
significance of CINDEIN
dissection needs to be investigated by a
randomized controlled trial.
Copyright © 2010 Elsevier Inc.
All rights
reserved.
PMID: 20638109 [PubMed - as supplied by
publisher]
Cancer. 2010 Jul 27. [Epub ahead of
print]
Lymphedema beyond breast cancer: a systematic review and
meta-analysis of
cancer-related
secondary
lymphedema.
Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI,
Armer JM.
Department of Surgical Oncology, The University of
Texas M. D. Anderson
Cancer Center,
Houston,
Texas.
Abstract
BACKGROUND::
Secondary lymphedema is a debilitating, chronic, progressive
condition
that
commonly occurs after the treatment of breast cancer. The purpose of
the
current study was to
perform a systematic review and meta-analysis of
the oncology-related
literature excluding breast
cancer to derive
estimates of lymphedema incidence and to identify
potential risk factors
among various
malignancies.
METHODS:: The authors
systematically reviewed 3 major medical indices
(MEDLINE,
Cochrane
Library databases, and Scopus) to identify studies (1972-2008)
that
included a prospective
assessment of lymphedema after cancer
treatment. Studies were categorized
according to malignancy,
and data
included treatment, complications, lymphedema measurement
criteria,
lymphedema incidence,
and follow-up interval. A quality assessment of
individual studies was
performed using established
criteria for
systematic reviews. Bayesian meta-analytic techniques were
applied to derive
summary
estimates when sufficient data were
available.
RESULTS:: A total of 47 studies (7779 cancer
survivors) met inclusion
criteria: melanoma (n = 15),
gynecologic
malignancies (n = 22), genitourinary cancers (n = 8),
head/neck cancers (n =
1), and
sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and
varied
by malignancy (P < .
001): melanoma, 16% (upper extremity, 5%;
lower extremity, 28%);
gynecologic, 20%; genitourinary,
10%; head/neck,
4%; and sarcoma, 30%. Increased lymphedema risk was also
noted for
patients
undergoing pelvic dissections (22%) and radiation therapy (31%).
Objective
measurement methods
and longer follow-up were both associated
with increased lymphedema
incidence.
CONCLUSIONS:: Lymphedema
is a common condition affecting cancer survivors
with
various
malignancies. The incidence of lymphedema is related to the type
and
extent of treatment, anatomic
location, heterogeneity of assessment
methods, and length of follow-up.
Cancer 2010. (c) 2010
American Cancer
Society.
PMID: 20665892 [PubMed - as supplied by
publisher]
IEEE Eng Med Biol Mag. 2010
Mar-Apr;29(2):63-70.
Optical coherence tomography: the
intraoperative assessment of lymph nodes
in breast
cancer.
Nguyen FT, Zysk AM, Chaney EJ, Adie SG, Kotynek JG,
Oliphant UJ,
Bellafiore FJ, Rowland KM,
Johnson PA, Boppart
SA.
Abstract
During breast-conserving surgeries,
axillary lymph nodes draining from the
primary tumor site are
removed for
disease staging. Although a high number of lymph nodes are
often resected
during sentinel
and lymph-node dissections, only a relatively small
percentage of nodes
are found to be metastatic, a
fact that must be
weighed against potential complications such as
lymphedema. Without a
real-time in
vivo or in situ intraoperative imaging tool to provide a
microscopic
assessment of the nodes,
postoperative paraffin section
histopathological analysis currently
remains the gold standard in
assessing
the status of lymph nodes. This paper investigates the use of
optical
coherence tomography (OCT), a
high-resolution real-time
microscopic optical-imaging technique, for the
intraoperative ex vivo
imaging
and assessment of axillary lymph nodes. Normal (13), reactive (1),
and
metastatic (3) lymph nodes
from 17 human patients with breast cancer
were imaged intraoperatively
with OCT. These preliminary
clinical studies
have identified scattering changes in the cortex,
relative to the capsule,
which can be
used to differentiate normal from reactive and metastatic
nodes. These
optical scattering changes are
correlated with inflammatory
and immunological changes observed in the
follicles and germinal
centers.
These results suggest that intraoperative OCT has the potential to
assess
the real-time node status in
situ, without having to physically
resect and histologically process
specimens to visualize
microscopic
features.
PMID: 20659842 [PubMed - in
process]
August 7, 2010 (5 docs)
J Vasc Surg.
2010 Aug;52(2):429-34.
Extracorporeal shock wave therapy
ameliorates secondary lymphedema
by
promoting
lymphangiogenesis.
Kubo M, Li TS, Kamota T,
Ohshima M, Shirasawa B, Hamano K.
Department of Surgery and
Clinical Science, Yamaguchi University Graduate
School of Medicine,
Ube,
Yamaguchi, Japan.
Abstract
OBJECTIVE: Although
secondary lymphedema is a common complication after
surgical and
radiation
therapy for cancer, the treatment options for lymphedema remain
limited
and largely ineffective. We
thus studied the effect of
extracorporeal shock wave therapy on promoting
lymphangiogenesis
and
improving secondary lymphedema.
METHODS: A rabbit ear
model of lymphedema was created by disruption of
lymphatic vessels.
Two
weeks after surgery, the lymphedematous ear was treated with or
without
low-energy shock waves
(0.09 mJ/mm(2), 200 shots), three times
per week for 4 weeks.
RESULTS: Western blot analysis showed that
the expression of vascular
endothelial growth factor
(VEGF)-C (1.23-fold,
P < .05) and VEGF receptor 3 (VEGFR3; 1.53-fold, P <
.05)
was
significantly increased in the ears treated with shock wave than in
the
untreated lymphedematous ears.
Compared with the control group, shock
wave treatment led to a significant
decrease in the thickness
of
lymphedematous ears (3.80 +/- 0.25 mm vs 4.54 +/- 0.18 mm, P <
.05).
Immunohistochemistry for
VEGFR3 showed the density of lymphatic
vessels was significantly increased
by shock wave treatment
(P <
.05).
CONCLUSION: Extracorporeal shock wave therapy promotes
lymphangiogenesis
and ameliorates
secondary lymphedema, suggesting that
extracorporeal shock wave therapy
may be a novel, feasible,
effective,
and noninvasive treatment for lymphedema. Copyright (c) 2010
Society for
Vascular
Surgery. Published by Mosby, Inc. All rights
reserved.
PMID: 20670777 [PubMed - in
process]
Oper Orthop Traumatol. 2010
Jul;22(3):317-34.
[The medial closed-wedge osteotomy of the
distal femur for the treatment
of unicompartmental lateral
osteoarthritis
of the knee.] [Article in German]
Freiling D, van Heerwaarden R,
Staubli A, Lobenhoffer P.
Klinik für Unfall- und
Wiederherstellungschirurgie, Diakonie-
krankenhaus
Henriettenstiftung,
Hannover, Germany, [email protected].
Abstract
OBJECTIVE
: Shifting of the mechanical axis from the lateral to the medial
compartment
in patients
with lateral osteoarthritis in combination with valgus
deformity.
INDICATIONS : Osteoarthritis of the lateral
compartment in combination
with valgus deformity of the
(distal) femur.
Posttraumatic and congenital valgus deformities of the
(distal)
femur.
CONTRAINDICATIONS : Osteoarthritis of the medial
compartment (>/= grade 3
on Outerbridge
Scale). Total loss of the
medial meniscus. Acute or chronic infections.
Rheumatoid arthritis.
Heavy
smoking. Extension or flexion deficit > 20 degrees . Poor
soft-tissue
conditions on site of surgery.
SURGICAL TECHNIQUE
: Optional: arthroscopy before osteotomy. Anteromedial
skin
incision,
subvastus approach with blunt preparation around the vastus
medialis
muscle and separation of this
muscle from the intermuscular
septum. The posterior osteotomy is marked
with Kirschner wires
(OGD
[osteotomy guiding device], Synthes, Switzerland, can be used
optionally).
The biplanar cut is marked
on the bone with an
electrocautery device. The bone cuts start with the
posterior
incomplete
osteotomy, followed by the anterior biplanar cut. After finishing
the
osteotomy (three bone cuts!), the
bone wedge can be removed. Closing
the osteotomy should start very gently
as a plastic deformation
of the
bone. A radiologic control of the leg alignment and the mechanical
axis is
achieved with an
alignment rod (Synthes, Switzerland). The plate should be
inserted under
the vastus medialis muscle. It
is very important, that the
surgeon controls the correct anteromedial
position of the plate at the
distal
femur (right and left version of the implant). Fixation of the plate
with
locking screws distally.
Positioning of a lag screw in the dynamic
hole directly above the
osteotomy. Insertion of monocortical
screws in
the three remaining holes proximal of the lag screw. Finally,
the lag screw
is changed to a self-
tapping bicortical locking head screw. X-ray control,
wound closure.
POSTOPERATIVE MANAGEMENT : Elastic bandage of the
leg up to the thigh in
the operating
room. Change of the dressing on day
1 after surgery. Ice treatment.
Walking on crutches starting day 1
after
surgery. Physiotherapy and manual lymph drainage starting on day 1
after
surgery. Partial weight
bearing for the first 4-6 weeks after surgery.
Suture removal after 10-12
days. X-ray control on day 3
and 6 weeks after
surgery. Discharge possible, if wounds are dry (day
4-7).
RESULTS : Between January 2005 and October 2008, 60
patients were treated
with medial closed-
wedge osteotomy of the distal
femur (since 11/2006 only with biplanar
osteotomy technique) at
the
Department of Trauma and Reconstructive Surgery,
Diakoniekrankenhaus
Henriettenstiftung
Hannover, Germany. The average
wedge size was 7.6 mm (4-13 mm). The mean
age was 39.7 years
(17-79
years). The patients had had 2.3 previous surgeries. The mean
follow- up was
21 months (3-
45 months). Freiling D, et al. Biplanare Osteotomie
bei
unikompartimentaler lateraler
Kniegelenkarthrose Flexion was 126
degrees (95-140 degrees )
preoperatively, and 128 degrees
(105-140
degrees ) postoperatively. 25 patients had at least 5 degrees
extension
deficit (5-15 degrees
) before surgery, whereas ten patient did not reach
the full extension at
follow-up examination. The
Tegner Activity Score
increased from 2.8 (1-4) preoperatively to 5.6 (2-9)
postoperatively, in
IKDC
(International Knee Documentation Committee) Score, 18 patients
reached
grade A, 27 grade B, nine
grade C, and six grade D. The visual
analog scale (VAS) score decreased
from 6.8 (8-2)
preoperatively to 3.1
(0-7) postoperatively. Seven patients had revision
surgery (three times
delayed
union/nonunion of the osteotomy, one superficial and one deep
infection,
one hematoma, one fracture
[proximal of the internal plate
fixator] after a fall).
PMID: 20676825 [PubMed - in
process]
Plast Reconstr Surg. 2010
Aug;126(2):55e-69e.
Vascular anomalies and
lymphedema.
Chim H, Drolet B, Duffy K, Koshima I, Gosain
AK.
Cleveland, Ohio; Milwaukee, Wis.; and Tokyo, Japan From the
Department of
Plastic Surgery, Case
Western Reserve University; the
Department of Dermatology, Children's
Hospital of Wisconsin; and
the
Department of Plastic and Reconstructive Surgery, University of
Tokyo.
Abstract
LEARNING OBJECTIVES:: After
studying this article, the participant should
be able to: 1. Define
the
difference between vascular tumors and malformations. 2.
Distinguish
between the natural history of
hemangiomas and that of
vascular malformations. 3. Identify the different
types of hemangiomas
and
vascular malformations and understand evaluation, treatment,
and
complications. 4. Understand the
role of lymphaticovenular
anastomoses in the treatment of
extremity
lymphedema.
BACKGROUND:: The International Society
for the Study of Vascular Anomalies
classification, which
is the most
widely accepted classification system in use, divides vascular
anomalies
into vascular tumors
(inclusive of hemangiomas) and malformations. This
serves as a guideline
for diagnosis, evaluation, and
treatment of these
lesions.
METHODS:: Although hemangiomas tend to have a
predictable clinical course
over the first year of
life, going through
proliferating, involuting, and involuted stages,
vascular malformations
demonstrate
growth commensurate with age, often becoming more prominent in
puberty. In
addition, they never
regress, and persist throughout
life.
RESULTS:: Different modalities of treatment may be
appropriate for
vascular tumors and different
subsets of vascular
malformations. Details are provided in this review.
Lymphaticovenular
anastomoses
provide an excellent addition to our methods of treatment of
extremity
lymphedema, and are made
possible through development of
supermicrosurgical techniques.
CONCLUSIONS:: Vascular anomalies
have a high prevalence in the general
population. Thus, it is
vital that
the plastic surgeon has a good understanding of classification,
evaluation,
and treatment
options. Lymphedema is another common condition that is
encountered.
Understanding of
lymphaticovenular anastomoses and their
applications aids treatment
planning for select
patients.
PMID: 20679788 [PubMed - in
process]
Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2010
Aug;27(4):371-5.
[Identification of VEGFR3 gene mutation in a
Chinese family with autosomal
dominant primary
congenital lymphoedema.]
[Article in Chinese]
Sheng J, Zeng F, Li C, Liu J, Wang Q, Liu
M.
Key Laboratory of Molecular Biophysics of Ministry of
Education, College
of Life Science and
Technology, Center for Human
Genome Research, Huazhong University of
Science and Technology,
Wuhan,
Hubei, 430074 P. R. China. [email protected].
Abstract
OBJECTIVE:
To identify the disease-causing gene in a four-generation
Chinese family
with 9 members
affected with primary congenital lymphoedema (PCL, also known
as Milroy
disease).
METHODS: Linkage analysis was performed
with a few microsatellite markers
flanking the candidate
genetic loci for
PCL, including 3 known genes associated with autosomal
dominant PCL. For
mutation
analysis, VEGFR3 gene was sequenced with DNA from the proband.
Direct DNA
sequencing of exon
25 of the VEGFR3 gene was performed in all
family members.
RESULTS: The disease gene in the family was
mapped to chromosome 5q35.3
with a maximum Lod
score of 2.07. Direct DNA
sequencing of VEGFR3 gene revealed a
heterozygous C to T transition
at
nucleotide 3341, resulting in p.Pro1114Leu mutation. The
p.Pro1114Leu
mutation co-segregated with
all affected individuals in the
family.
CONCLUSION: This study identified a C3341T
(p.Pro1114Leu) mutation in the
VEGFR3 gene in a
Chinese family with PCL,
provided evidence that VEGFR3 mutation can cause
PCL in
Chinese.
PMID: 20677139 [PubMed - in
process]
Physiotherapy. 2010 Sep;96(3):264. Epub 2010 Jun
2.
Comments on book review of 'Lymphoedema: Advice on
Self-management'.
Friett K.
Lymphoedema Support
Network, St. Lukes Crypt, Sydney Street, London SW3
6NH,
UK.
PMID: 20674660 [PubMed - in process]
August
14, 2010 (3 docs)
Coll Antropol. 2010
Jun;34(2):645-8.
A case report of breast
angiosarcoma.
Kardum-Skelin I, Jelić-Puskarić B, Pazur
M,
Vidić-Paulisić I, Jakić-Razumović J, Separović
V.
Laboratory for Cytology and Hematology, Department of
Medicine, "Merkur"
University Hospital,
Zagreb, Croatia. [email protected]
Abstract
Angiosarcoma
is a rare disease of the breast with the reported incidence
of only 0.04% of
all breast
malignancies. The etiology of angiosarcoma remains unknown. It
occurs
post-mastectomy, in
association with chronic lymphedema
(Stewart-Treves syndrome), or after
radiotherapy. We present a
patient
with angiosarcoma which developed 12 years of the diagnosis of
breast
carcinoma and 8 years
of the operative procedure and radiotherapy for
disease recurrence. A
small angiomatous lesion of a
few mm in size,
cytologically suspect of vascular tumor (hemangioma or
hemangiopericytoma)
and
histopathologically verified to be an atypical vascular lesion,
was
detected two years before breast
enlargement and cytologic and
histologic diagnosis of angiosarcoma. The
patient died 15 months of
the
diagnosis of angiosarcoma, after two tumor recurrences and
intrathoracic
cavity invasion.
PMID: 20698145 [PubMed - in
process]
Am J Surg Pathol. 2010 Aug 6. [Epub ahead of
print]
Epithelioid Angiosarcoma of the Skin: A Study of 18 Cases
With Emphasis on
its Clinicopathologic
Spectrum and Unusual Morphologic
Features.
Bacchi CE, Silva TR, Zambrano E, Plaza J, Suster S,
Luzar B, Lamovec J,
Pizzolitto S, Falconieri G.
*Consultoria
em Patologia, Botucatu, SP, Brazil daggerDepartment of
Pathology, Medical
College of
Wisconsin, Milwaukee, WI double daggerInstitute of Pathology,
Medical
Faculty, University of
Ljubljana School of Medicine section
signDepartment of Pathology,
Institute of Oncology, Ljubljana,
Slovenia
parallelDepartment of Pathology, General University Hospital S.
Maria della
Misericordia,
Udine, Italy.
Abstract
We report
18 cases of cutaneous angiosarcoma with predominant or exclusive
epithelioid
morphology.
Both sexes were similarly affected. Patients' ages ranged from 2
to 97
years, median 77.5 years; 2
were pediatric patients. In elderly
patients scalp or facial lesions and
cutaneous lesions arising
within
irradiated breast skin predominated. Limb lesions were seen in
younger
patients. Microscopically, the
tumors were composed of packed
polygonal cells with focal evidence of
endothelial
differentiation.
Diverging phenotypes included syncytial growth of large
cells with clear
nuclei and prominent nucleoli,
micronodules of tumor
cells scattered in dermis, predominance of
discohesive plasmacytoid
polygonal
cells with abundant bright eosinophilic cytoplasm, sheets of clear
cells
with coarse granular cytoplasm,
trabecular and cord arrangement of
tumor cells splaying the dermal
collagen, or a pseudoglandular
appearance
owing to clear cell tubular arrangement with open lumina. These
cases posed
further
diagnostic challenges simulating lymphoma,
melanoma,
lymphoepithelioma-like carcinoma, adnexal
carcinoma, and
neuroendocrine carcinoma. Immunohistochemical studies
showed positivity for
CD31
and CD34; no immunoreactivity was documented for other tested
antigens
including cytokeratins,
S100 protein, melanocytic antigens,
leukocyte common antigen, and desmin.
Therapeutic modalities
included
combined local excision, chemotherapy, and radiotherapy,
depending on
patient clinical status.
Of the 9 patients available for follow-up, 5 were
alive and apparently
well, 2 had recurrent disease, and
2 had died of
tumor. Our data show that epithelioid cutaneous angiosarcoma
may have a
broad
morphological spectrum, raising interpretive challenges on microscopy.
In
addition, its clinical
presentation seems to differ in nonelderly
patients, with lesions likely
related to lymphedema or
vascular
malformations.
PMID: 20697249 [PubMed - as supplied
by publisher]
J Biotechnol. 2010 Aug 3. [Epub ahead of
print]
Reconstruction of lymph vessel by lymphatic endothelial
cells combined
with polyglycolic acid
scaffolds: a pilot
study.
Dai TT, Jiang ZH, Li SL, Zhou GD, Kretlow JD, Cao WG, Liu
W, Cao YL.
Department of Plastic and Reconstructive Surgery,
Shanghai ninth people's
hospital, Shanghai Jiao
Tong University School of
Medicine, Shanghai, China.
Abstract
Restoration
of lymphatic drainage using lymph vessels or tissue grafting
is becoming an
efficient method
for alleviating obstructive lymphedema. However, the lack
of ideal
lymphatic grafts is the key problem
that limits the application
of lymphatic transplantation, but now that may
be resolved with
tissue-
engineered lymph vessels. In this study, the feasibility of
reconstructing
lymph vessels was explored
using lymphatic endothelial
cells (LECs) combined with polyglycolic acid
(PGA) scaffolds. The
highly
purified human dermal LECs can be isolated from human dermis
by
immunomagnetic bead sorting and
multiplied in culture. The viability
and growth potential of subcultured
LECs make it possible to obtain
large
amount of cells in vitro. Light and scanning electron microscopy
(SEM)
showed that the
prefabricated PGA scaffolds, with 3-dimensional structure,
can support
cell adhesion, growth and
spreading. The constructs formed
with LECs combined with PGA scaffolds
were cultured in vitro for
ten days
and then implanted subcutaneously into nude mice. Six weeks
after
implantation, the portions
of implanted tubules were harvested.
Gross and histological observation
demonstrated that the
tubular
structure still remained in the experimental groups but not in the
control
groups. Immunohistochemical
staining and RT-PCR assay of the
implanted vessels revealed positive
staining in experimental groups
for
the lymphatic specific markers podoplanin, VEGFR-3 and LYVE-1. The
results
indicate that LECs
can serve as seed cells and be successfully combined with
PGA scaffolds,
and the tissue-engineered
tubular structure using
implanted LECs-PGA compounds showed preliminary
characteristics of
lymph
vessels. A gap between the nearly normal or functional lymph vessel
still
exists as we have only the
endothelial cell lined duct, but this
study demonstrates that it is
feasible to construct
tissue-engineered
lymph vessels using LECs combined with a biodegradable
material. Copyright
© 2010. Published by
Elsevier
B.V.
PMID: 20691226 [PubMed - as supplied by
publisher]
The next 5 documments are Medifocus.com but when I
click on each
individual link a Pub Med
document did come up and they may
be duplicates because they are dated
from May to July
2010:
Medfocus Document Alert – August 2010 issue (5
docs)
Each month hundreds of thousands of consumers and
healthcare professionals
search the National
Library of Medicine's
Medline database seeking the latest information on
their
disease/condition.
Conducting a thorough and effective Medline search is
both a time
consuming and daunting task. At
Medifocus, we have developed
an effective solution to this problem: each
month our staff of
expert
researchers searches Medline for the latest advances in research
and
clinical medicine for over 70
diseases / conditions. We do this with
one goal in mind: to empower you to
effectively take control
over your
health.
Here is the result of our team's work in Lymphedema this
month:
Arch Phys Med Rehabil. 2010
Jul;91(7):1070-6.
Weight lifting in patients with
lower-extremity lymphedema secondary to
cancer: a pilot and
feasibility
study.
Katz E, Dugan NL, Cohn JC, Chu C, Smith
RG, Schmitz KH.
Department of Rehabilitation Medicine,
University of Washington, Seattle,
WA,
USA.
Abstract
OBJECTIVE: To assess the
feasibility of recruiting and retaining cancer
survivors with
lower-limb
lymphedema into an exercise intervention study. To develop
preliminary
estimates regarding the safety
and efficacy of this
intervention. We hypothesized that progressive weight
training would
not
exacerbate leg swelling and that the intervention would improve
functional
mobility and quality of life.
DESIGN: Before-after
pilot study with a duration of 5 months.
SETTING: University of
Pennsylvania.
PARTICIPANTS: Cancer survivors with a known
diagnosis of lower-limb
lymphedema (N=10) were
directly referred by
University of Pennsylvania clinicians. All 10
participants completed the
study.
INTERVENTION: Twice weekly slowly progressive weight
lifting, supervised
for 2 months,
unsupervised for 3
months.
MAIN OUTCOME MEASURES: The primary outcome was interlimb
volume
differences as
measured by optoelectronic perometry. Additional
outcome measures included
safety (adverse events),
muscle strength,
objective physical function, and quality of life.
RESULTS:
Interlimb volume differences were 44.4% and 45.3% at baseline and
5
months,
respectively (pre-post comparison, P=.70). There were 2
unexpected
incident cases of cellulitis within
the first 2 months. Both
resolved with oral antibiotics and complete
decongestive therapy by 5
months.
Bench and leg press strength increased by 47% and 27% over 5
months
(P=.001 and P=.07,
respectively). Distance walked in 6 minutes
increased by 7% in 5 months
(P=.01). No improvement
was noted in
self-reported quality of life.
CONCLUSIONS: Recruitment of
patients with lower-limb-lymphedema into an
exercise program is
feasible.
Despite some indications that the intervention may be safe (eg,
a lack of
clinically significant
interlimb volume increases over 5 mo), the unexpected
finding of 2
cellulitic infections among the 10
participants suggests
additional study is required before concluding that
patients with
lower-extremity
lymphedema can safely perform weight
lifting.
PMID: 20599045 [PubMed - indexed for
MEDLINE]
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.
PMID: 20537300 [PubMed - indexed for
MEDLINE]
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 - indexed for
MEDLINE]
Nucl Med Commun. 2010
Jun;31(6):547-51.
Intradermal lymphoscintigraphy at rest and
after exercise: a new technique
for the functional assessment
of the
lymphatic system in patients with lymphoedema.
Tartaglione G,
Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C,
Paone G,
Bernabucci
V, Bartoletti R, Marchetti P, Marzola MC, Naji M, Rubello
D.
Unit of Nuclear Medicine, Cristo Re Hospital, Istituto
Dermopatico
dell'Immacolata,
IDI-IRCCS.
Abstract
AIM: The aim of this study
was to evaluate the effect of implementing a
new technique,
intradermal
injection lymphoscintigraphy, at rest and after muscular
exercise on the
functional assessment of the
lymphatic system in a group
of patients with delayed or absent lymph
drainage.
METHODS:
We selected 44 patients (32 women and 12 men; 15 of 44 with upper
limb and
29 of 44
with lower limb lymphoedema). Thirty of 44 patients had bilateral
limb
lymphoedema and 14 of 44 had
unilateral disease; 14 contralateral
normal limbs were used as controls.
Twenty-three patients had
secondary
lymphoedema after lymphadenectomy and the remaining 21 had
idiopathic
lymphoedema.
Each of the 44 patients was injected with 50 MBq (0.3-0.4 ml)
of
(99m)Tc-albumin-nanocolloid,
which was administered intradermally at
the first interdigital space of
the affected limb. Two planar
static
scans were performed using a low-energy general-purpose
collimator
(acquisition matrix 128 x
128, anterior and posterior views
for 5 min), and in which drainage was
slow or absent, patients were
asked
to walk or exercise for 2 min. A postexercise scan was then
performed to
monitor and record
the tracer pathway and the tracer appearance time (TAT)
in the inguinal or
axillary lymph nodes.
RESULTS: The
postexercise scans showed that (i) 21 limbs (15 lower and six
upper limbs)
had
accelerated tracer drainage and tracer uptake in the inguinal
and/or
axillary lymph nodes. Two-thirds of
these showed lymph stagnation
points; (ii) 27 limbs had collateral lymph
drainage pathways; (iii) in
11
limbs, there was lymph drainage into the deeper lymphatic channels,
with
unusual uptake in the popliteal
or antecubital lymph nodes; (iv) six
limbs had dermal backflow; (v) three
limbs did not show lymph
drainage
(TAT=not applicable). TAT=15 + or - 3 min, ranging from 12 to 32
min in limbs
with
lymphoedema versus 5 + or - 2 min, ranging from 1 to 12 min in
the
contralateral normal limbs (P<0.
001).
CONCLUSION:
Intradermal injection lymphoscintigraphy gives a better
imaging of the lymph
drainage
pathways in a shorter time, including cases with advanced
lymphoedema. In
some patients with
lymphoedema, a 2-min exercise can
accelerate tracer drainage, showing
several compensatory
mechanisms of
lymph drainage. The effect of the exercise technique on TAT
and
lymphoscintigraphy
findings could result in a more accurate functional
assessment of
lymphoedema patients.
PMID: 20215978 [PubMed -
indexed for MEDLINE]
Eur J Vasc Endovasc Surg. 2010
May;39(5):646-53. Epub 2010 Feb 21.
Primary lymphoedema and
lymphatic malformation: are they the two sides of
the same
coin?
Lee BB, Villavicencio JL.
Division of
Vascular Surgery, Georgetown University School of Medicine,
Washington, DC
20007,
USA. [email protected]
Abstract
OBJECTIVES:
To clear the confusion regarding the relationship between the
'primary
lymphoedema'
and (truncular) lymphatic malformation (LM); the latter is one
of
congenital vascular malformations.
MATERIALS &
METHODS: A literature review was carried out on the primary
lymphoedema
either
existing as an independent LM lesion or as a component of
the
Klippel-Trenaunay syndrome.
RESULTS: The review was able
to provide a contemporary guide/conclusion on
the definition
and
classification, clinical evaluation and clinical management
regarding
conservative (physical) therapy,
reconstructive surgical
therapy and ablative/excisional surgical therapy,
for the primary
lymphoedema
as an LM.
CONCLUSIONS: Primary lymphoedema can be
considered as 'congenital' since
its majority
represents a clinical
manifestation of the truncular type of LM arising
during the later stages
of
lymphangiogenesis. Such embryological staging information of the LM
is
critical for proper management
of the primary lymphoedema when it
exists with other congenital vascular
malformations (Klippel-
Trenaunay
syndrome). 2. Basic non-invasive to minimally invasive tests
will provide an
adequate
diagnosis and lead to the correct multidisciplinary, specifically
targeted
and sequenced treatment
strategy. 3. The mainstay of current
management of the primary
lymphoedema/truncular LM is
complex
decongestive therapy; and the reconstructive as well as ablative
surgical
therapy remain adjunctive
therapies at
best.
PMID: 20176496 [PubMed - indexed for
MEDLINE]
August 24, 2010 (2 docs)
Rev Med Chir
Soc Med Nat Iasi. 2010 Apr-Jun;114(2):434-8.
[Advanced cervical
cancer surgical treatment considerations][Article
in
Romanian]
Velenciuc N, Luncă S, Velenciuc I, Pantazescu
A.
Universităţii de Medicină şi Farmacie Gr.T. Popa
Iaşi,
Spitalul Clinic de Urgenţe Sf. Ioan
Iaşi.
Abstract
The aim of this study was to
highlight the importance of surgical
treatment in advanced cervical
cancer
(IIB-IIIB). MATERIAL AND METHOD: Data from 179 patients with
cervical
cancer, admitted in
the Clinic of Emergency Surgery, "Sf. Ioan"
Hospital, Iaşi, between
January, 1st, 2003 and December,
31st, 2009, were
collected. RESULTS: A number of 11 cases (6.1%) cases
were without any
clinical
response, so that they benefit by radical radiotherapy; a radical
surgical
intervention was performed in
the other 168 cases (93.7%), in
4-6 weeks after chemotherapy. No
intraoperative complications
were
evidenced, but after surgical intervention we recorded:
urinary
troubles--10 (6.5%); lymphedema--3
(1.9%); posttoperative
intestinal occlusions--2 (1.3%); extended dynamic
ileus--2 (1.3%);
phlebitis--2
(1.3%).
PMID: 20700981 [PubMed - in
process]
Urology. 2010 Aug;76(2 Suppl
1):S43-57.
Management of the lymph nodes in penile
cancer.
Heyns CF, Fleshner N, Sangar V, Schlenker B, Yuvaraja
TB, van Poppel H.
Department of Urology, Stellenbosch University
and Tygerberg Hospital,
Tygerberg, South Africa.
[email protected]
Abstract
A
comprehensive literature study was conducted to evaluate the levels
of
evidence (LEs) in
publications on the diagnosis and staging of penile
cancer.
Recommendations from the available
evidence were formulated and
discussed by the full panel of the
International Consultation on
Penile
Cancer in November 2008. The final grades of recommendation (GRs)
were
assigned according to the
LE of the relevant publications. The
following consensus recommendations
were accepted. Fine needle
aspiration
cytology should be performed in all patients (with ultrasound
guidance in
those with
nonpalpable nodes). If the findings are positive, therapeutic,
rather than
diagnostic, inguinal lymph node
dissection (ILND) can be
performed (GR B). Antibiotic treatment for 3-6
weeks before ILND
in
patients with palpable inguinal nodes is not recommended (GR
B).
Abdominopelvic computed
tomography (CT) and magnetic resonance
imaging (MRI) are not useful in
patients with nonpalpable
nodes. However,
they can be used in those with large, palpable inguinal
nodes (GR B). The
statistical
probability of inguinal micrometastases can be estimated using
risk group
stratification or a risk
calculation nomogram (GR B).
Surveillance is recommended if the nomogram
probability of positive
nodes
is <0.1 (10%). Surveillance is also recommended if the primary
lesion is
grade 1, pTis, pTa
(verrucous carcinoma), or pT1, with no lymphovascular
invasion, and
clinically nonpalpable inguinal
nodes, but only provided
the patient is willing to comply with regular
follow-up (GR B). In the
presence
of factors that impede reliable surveillance (obesity, previous
inguinal
surgery, or radiotherapy)
prophylactic ILND might be a
preferable option (GR C). In the
intermediate-risk group
(nomogram
probability .1-.5 [10%-50%] or primary tumor grade 1-2, T1-T2,
cN0, no
lymphovascular invasion),
surveillance is acceptable, provided
the patient is informed of the risks
and is willing and able to
comply.
If not, sentinel node biopsy (SNB) or limited (modified) ILND
should be
performed (GR B).
In the high-risk group (nomogram probability >.5 [50%]
or primary tumor
grade 2-3 or T2-T4 or cN1-
N2, or with lymphovascular
invasion), bilateral ILND should be performed
(GR B). ILND can
be
performed at the same time as penectomy, instead of 2-6 weeks later
(GR
C). SNB based on the
anatomic position can be performed, provided the
patient is willing to
accept the potential false-
negative rate of
</=25% (GR C). Dynamic SNB with lymphoscintigraphic and
blue dye
localization
can be performed if the technology and expertise are available
(GR C).
Limited ILND can be
performed instead of complete ILND to reduce
the complication rate,
although the false-negative rate
might be similar
to that of anatomic SNB (GR C). Frozen section histologic
examination can be
used
during SNB or limited ILND. If the results are positive, complete ILND
can
be performed immediately
(GR C). In patients with cytologically or
histologically proven inguinal
metastases, complete ILND
should be
performed ipsilaterally (GR B). In patients with histologically
confirmed
inguinal metastases
involving >/=2 nodes on one side, contralateral
limited ILND with frozen
section analysis can be
performed, with complete
ILND if the frozen section analysis findings are
positive (GR B). If
clinically
suspicious inguinal metastases develop during surveillance,
complete ILND
should be performed on
that side only (GR B), and SNB or
limited ILND with frozen section
analysis on the contralateral side
can
be considered (GR C). Endoscopic ILND requires additional study to
determine
the complication
and long-term survival rates (GR C). Pelvic lymph node
dissection is
recommended if >/=2 proven
inguinal metastases, grade 3
tumor in the lymph nodes, extranodal
extension (ENE), or large (2-4
cm)
inguinal nodes are present, or if the femoral (Cloquet's) node is
involved
(GR C). Performing ILND
before pelvic lymph node dissection is
preferable, because pelvic lymph
node dissection can be
avoided in
patients with minimal inguinal metastases, thus avoiding the
greater risk of
chronic
lymphedema (GR B). In patients with numerous or large inguinal
metastases,
CT or MRI should be
performed. If grossly enlarged iliac
nodes are present, neoadjuvant
chemotherapy should be given and
the
response assessed before proceeding with pelvic lymph node dissection
(GR
C). Antibiotic
treatment should be started before surgery to minimize the
risk of wound
infection (GR C).
Perioperative low-dose heparin to prevent
thromboembolic complications can
be used, although it
might increase
lymph leakage (GR C). The skin incision for ILND should be
parallel to the
inguinal
ligament, and sufficient subcutaneous tissue should be preserved
to
minimize the risk of skin flap
necrosis (GR B). Sartorius muscle
transposition to cover the femoral
vessels can be used in radical
ILND
(GR C). Closed suction drainage can be used after ILND to prevent
fluid
accumulation and
wound breakdown (GR B). Early mobilization after ILND is
recommended,
unless a myocutaneous
flap has been used (GR B). Elastic
stockings or sequential compression
devices are advisable to
minimize the
risk of lymphedema and thromboembolism (GR C). Radiotherapy
to the inguinal
areas is
not recommended in patients without cytologically or histologically
proven
metastases nor in those with
micrometastases, but it can be
considered for bulky metastases as
neoadjuvant therapy to surgery (GR
B).
Adjuvant radiotherapy after complete ILND can be considered in
patients with
multiple or large
inguinal metastases or ENE (GR C). Adjuvant chemotherapy
after complete
ILND can be used instead
of radiotherapy in patients with
> /=2 inguinal metastases, large nodes,
ENE, or pelvic metastases
(GR
C). Follow-up should be individualized according to the
histopathologic
features and the management
chosen for the primary tumor
and inguinal nodes (GR B).
PMID: 20691885 [PubMed - in
process]
August 27, 2010 (2 docs)
Am J Ther. 2010 Aug 19.
[Epub ahead of print]
Recurrent Lower Extremity
Pseudocellulitis.
Korniyenko A, Lozada J, Ranade A, Sandhu
G.
1Department of Internal Medicine, St. Luke's-Roosevelt
Hospital Center,
Columbia University College
of Physicians and Surgeons,
New York, NY; and 2Department of Pathology,
St. Luke's-Roosevelt
Hospital
Center, Columbia University College of Physicians and Surgeons,
New York,
NY.
Abstract
The term "Pseudocellulitis" can be
used to describe an uncomplicated
nonnecrotizing inflammation of
the
dermis and hypodermis from a noninfectious etiology. Chemotherapeutic
agents
have been
associated with a variety of cutaneous reactions, including
radiation
recall dermatitis, hypersensitivity
reactions, and erysipeloid
reactions. Gemcitabine
(2,2-difluorodeoxycytidine) is currently being
used
for treatment of a variety of solid malignancies, including carcinoma
of
the lung. The dermatitis involved
with gemcitabine is typically a
radiation recall reaction whereby an
inflammatory reaction occurs in
the
area previously treated with radiotherapy. We describe here a case
of
Gemcitabine-induced
pseudocellulitis that was unrelated to radiation
exposure and manifested
in an area of lymphedema. The
pseudocellulitis in
such cases could be related to the drug's
pharmacokinetics and may last
until the
drug is displaced from the subcutaneous tissue of the affected
area.
Antibiotics have no role in the
treatment, and diphenhydramine with
nonsteroidal anti-inflammatories may
be used for
symptomatic
management.
PMID: 20724909 [PubMed - as supplied
by publisher]
Clin Physiol Funct Imaging. 2010 Aug 16. [Epub
ahead of print]
Lymphoedema of the lower extremities -
background, pathophysiology and
diagnostic
considerations.
Jensen MR, Simonsen L, Karlsmark T, Bülow
J.
Department of Clinical Physiology and Nuclear Medicine,
Bispebjerg
Hospital, University Hospital of
Copenhagen, Copenhagen NV,
Denmark.
Abstract
Summary Lymphoedema of the
lower extremities is a chronic debilitating
disease that is
often
underdiagnosed. Early diagnosis and treatment is paramount in reducing
the
risk of progression and
complications. Lymphoedema has traditionally
been defined as interstitial
oedema and protein
accumulation because of a
defect in the lymphatic drainage; however, some
findings suggest that
the
interstitial protein concentration may be low in some types
of
lymphoedema. Primary lymphoedema is
caused by an inherent defect in
the lymphatic vessels or lymph nodes.
Secondary lymphoedema is
caused by
damages to the lymphatic system most often caused by cancer or
its
treatment. Many of the
underlying pathophysiological mechanisms have yet to
be elucidated. Many
methods have been
developed for examination of the
lymphatic system. Lymphoscintigraphy is
presently the
preferred
diagnostic modality. Lack of consensus regarding protocol and
qualitative
interpretation criteria results
in a too observer dependent
outcome. Methods for objectifying the
scintigraphy through
quantification
have been criticized. Depot clearance rates are an
alternative method of
quantification of lymphatic
drainage capacity. This
method however has mostly been applied on upper
extremity
lymphoedema.
The aim of this review is to provide a literature-based
overview of the
aetiology and pathophysiology of
lower extremity
lymphoedema and to summarize the current knowledge about
lymphoscintigraphy
and
depot clearance techniques. The abundance of factors influencing
the
outcome of the examination
stresses the need for consensus regarding
examination protocols and
interpretation. Further studies are
needed to
improve diagnostic performance and understanding of
pathophysiological
mechanisms.
PMID: 20718809 [PubMed - as supplied by
publisher]
September 1, 2010
Eur J Cancer. 2010 Aug
24. [Epub ahead of print]
Psychological consequences of
lymphoedema associated with breast cancer: A
prospective
cohort
study.
Vassard D, Olsen MH, Zinckernagel L,
Vibe-Petersen J, Dalton SO, Johansen C.
Department of
Psychosocial Cancer Research, Institute of Cancer
Epidemiology, Danish
Cancer
Society, Strandboulevarden 49, DK-2100 Copenhagen,
Denmark.
Abstract
BACKGROUND: The aim of this
prospective cohort study of women attending a
rehabilitation course
at
the Dallund Rehabilitation Centre was to explore the emotional
and
psychological aspects of living
with lymphoedema, expressed as
psychological distress, poorer quality of
life and poorer
self-reported
health.
METHODS: Between November 2002 and
January 2007 within the FOCARE study,
self-completed
questionnaires were
collected 3weeks before and 6 and 12months after the
rehabilitation course
to
elicit sociodemographic, physical and lifestyle information and
responses
to three psychometric tests.
The population consisted of 633
women, 125 with and 508 without verified
lymphoedema (time since
surgery,
1month-5years). The population was reduced to 553 women at the
first
follow-up and 494 at
the second.
RESULTS: Multivariate
analysis showed that, in comparison with women
without lymphoedema,
those
with lymphoedema had a 14% higher risk for scoring one level higher on
the
POMS-SF test, a 9%
higher probability of scoring one point lower on
the quality of life scale
and a 29% higher likelihood of
reporting poorer
or bad health than women without lymphoedema. These
findings were seen at
all three
measurement times.
CONCLUSIONS: In this cohort of
women with breast cancer, women with
lymphoedema after
surgery for breast
cancer had significantly worse overall emotional
well-being and adjustment
to life
compared to women without lymphoedema.
PMID: 20797846
[PubMed - as supplied by publisher]
Case Rep Oncol. 2010 Apr
30;3(2):148-153.
Epithelioid Angiosarcoma in a Patient with
Klippel-Trénaunay-Weber
Syndrome: An Unexpected
Response to
Therapy.
Simas A, Matos C, Lopes da Silva R, Brotas V, Teófilo
E, Albino JP.
Serviço de Medicina Interna 3, Hospital Santo
António dos Capuchos.
Abstract
We present a rare
case of Stewart-Treves syndrome characterized by a
diffuse angiosarcoma of
the
leg in a 22-year-old man with a history of chronic lymphedema due
to
Klippel-Trénaunay-Weber
syndrome. He underwent limb disarticulation
and medical treatment with
cycles of doxorubicin, oral
thalidomide and
sunitinib with a very good response after 12 months
of
follow-up.
PMID: 20740188 [PubMed]PMCID:
PMC2919991
Lancet. 2010 Aug 23. [Epub ahead of
print]
Lymphatic filariasis and
onchocerciasis.
Taylor MJ, Hoerauf A, Bockarie
M.
Liverpool School of Tropical Medicine, Liverpool,
UK.
Abstract
Lymphatic filariasis and
onchocerciasis are parasitic helminth diseases
that constitute a serious
public
health issue in tropical regions. The filarial nematodes that cause
these
diseases are transmitted by
blood-feeding insects and produce
chronic and long-term infection through
suppression of host
immunity.
Disease pathogenesis is linked to host inflammation invoked by
the death of
the parasite,
causing hydrocoele, lymphoedema, and elephantiasis in
lymphatic
filariasis, and skin disease and
blindness in onchocerciasis.
Most filarial species that infect people
co-exist in mutualistic symbiosis
with
Wolbachia bacteria, which are essential for growth, development,
and
survival of their nematode hosts.
These endosymbionts contribute to
inflammatory disease pathogenesis and
are a target for
doxycycline
therapy, which delivers macrofilaricidal activity, improves
pathological
outcomes, and is effective as
monotherapy. Drugs to treat
filariasis include diethylcarbamazine,
ivermectin, and albendazole,
which
are used mostly in combination to reduce microfilariae in blood
(lymphatic
filariasis) and skin
(onchocerciasis). Global programmes for
control and elimination have been
developed to provide
sustained delivery
of drugs to affected communities to interrupt
transmission of disease and
ultimately
eliminate this burden on public health.
PMID:
20739055 [PubMed - as supplied by publisher]
Pediatr Dermatol.
2010 Aug 4. [Epub ahead of print]
Congenital Lymphedema with
Tuberous Sclerosis and Clinical Hirschsprung
Disease.
Lucas
M, Andrade Y.
St. Peter's University Hospital, New Brunswick,
New Jersey, USA.
Abstract
Case of an 18-month-old
child with congenital lymphedema subsequently
diagnosed with
tuberous
sclerosis and Hirschsprung disease.
PMID: 20738790
[PubMed - as supplied by publisher]
Zhonghua Zheng Xing Wai Ke
Za Zhi. 2010 May;26(3):190-4.
[Diagnosis of peripheral lymph
circulation disorders with contrast MR
lymphangiography]
[Article in
Chinese]
Liu NF, Lu Q, Jiang ZH, Wang CG, Zhou
JG.
Department of Plastic Reconstructive Surgery, Shanghai Ninth
People's
Hospital, Shanghai Jiaotong
University School of Medicine,
Shanghai 200011, China. [email protected]
Abstract
OBJECTIVE:
To evaluate anatomical and functional images of contrast MR
lymphangiography
in the
diagnosis of limb lymphatic circulation
disorders.
METHODS: 30 patients with limb lymphedema were
enrolled in the study.
There were 27 patients of
primary lymphedema and 3
of secondary lymphedema. Contrast enhanced
lymphangiography was
performed
with 3.0 T MR Unit after intracutaneous injection of gadobenate
dimelumine
into the
interdigital webs of the dorsal foot and hand. The kinetics of
enhanced
lymph flow within the lymphatics
were calculated using the
formula: Speed (cm) = total length of visualized
lymph vessel (cm)/
inspection
time (minutes) and by comparing dynamic nodal enhancement and
time-signal
intensity curves between
edematous and contralateral limbs.
Morphological abnormalities of the
lymphatic system were
also
evaluated.
RESULTS: Following injection of the contrast
agent enhanced lymphatic
channels were consistently
visualized in all
clinical lymphedematous limbs and five contralateral
limbs of unilateral
lymphedema
cases. The speed of enhanced flow within the lymphatics of
lymphedematous
limbs ranged from 0.30
to 1.48 cm/min. The contrast
enhancement in inguinal nodes of edematous
limbs was significantly
lower
than that of contralateral limbs (P < 0.01). Dynamic measurement
of
contrast enhancement showed a
remarkable lowering of peak time (P <
0.01) and peak enhancement (P <
0.01) and a delay in outflow
in
inguinal nodes of affected limbs compared with that of control
limbs.
Post-contrast MR imaging also
depicted varied distribution
patterns of lymphatics and abnormal lymph
flow pathways within
lymph
nodes in the limbs with lymphatic circulation
disorders.
CONCLUSIONS: Contrast MR lymphangiography with
gadobenate dimelumine was
able to visualize
the precise anatomy of
lymphatic vessels and lymph nodes in lymphedematous
limbs. It also
provided
comprehensive information about the functional status of lymph
flow
transportation in lymphatics and
lymph nodes.
PMID:
20737947 [PubMed - in process]
September 5,
2010
Dermatol Online J. 2010 Aug
15;16(8):14.
Elephantiasis nostras verrucosa on the abdomen of a
Turkish female patient
caused by morbid obesity.
Buyuktas D,
Arslan E, Celik O, Tasan E, Demirkesen C, Gundogdu S.
Division
of Endocrinology and Metabolism, Department of Internal Medicine,
Cerrahpasa
Medical
School, University of Istanbul, Istanbul, Turkey. [email protected].
Abstract
Elephantiasis
Nostras Verrucosa is a rare disorder of an extremity or a
body region, which
is
associated with chronic lymphedema. There are 7 reported cases
of
abdominal elephantiasis in the
medical literature. Here we report a
morbidly obese female patient with
elephantiasis nostras verrucosa
on the
abdominal wall.
PMID: 20804691 [PubMed - in
process]
Health Qual Life Outcomes. 2010 Aug 31;8(1):92. [Epub
ahead of print]
Upper-body morbidity following breast cancer
treatment is common, may
persist longer-term and
adversely influences
quality of life.
Hayes SC, Rye S, Battistutta D, Disipio T,
Newman B.
ABSTRACT:
BACKGROUND: Impairments in
upper-body function (UBF) are common following
breast cancer.
However,
the relationship between arm morbidity and quality of life (QoL)
remains
unclear. This
investigation uses longitudinal data to describe UBF in a
population-based
sample of women with
breast cancer and examines its
relationship with QoL.
METHODS: Australian women (n=287) with
unilateral breast cancer were
assessed at three-monthly
intervals, from
six- to 18-months post-surgery (PS). Strength, endurance
and flexibility
were used to
assess objective UBF, while the Disability of the Arm, Shoulder
and Hand
questionnaire and the
Functional Assessment of Cancer
Therapy-Breast questionnaire were used to
assess self-reported
UBF and
QoL, respectively.
RESULTS: Although mean UBF improved over
time, up to 41% of women revealed
declines in UBF
between six- and
18-months PS. Older age, lower socioeconomic position,
treatment on the
dominant
side, mastectomy, more extensive lymph node removal and having
lymphoedema
each increased odds
of declines in UBF by at least two-fold
(p<0.05). Lower baseline and
declines in perceived UBF
between six-
and 18-months PS were each associated with poorer QoL at
18-months PS
(p<0.05).
CONCLUSIONS: Significant upper-body morbidity is
experienced by many
following breast cancer
treatment, persisting longer
term, and adversely influencing the QoL of
breast cancer
survivors.
PMID: 20804558 [PubMed - as supplied by
publisher]
Br J Dermatol. 2010 Aug 28. [Epub ahead of
print]
Severe Congenital Lymphedema Not Caused by Mutations in
Known Lymphedema
Genes.
Greenberger S, Reznik-Wolf H,
Ghalamkarpour A, Marek-Yagel D, Vikkula M,
Pras E.
Sheba
Medical Center, The Department of Dermatology, Ramat-Gan,
Israel.
PMID: 20804492 [PubMed - as supplied by
publisher]
Am J Med Genet A. 2010
Sep;152A(9):2287-96.
Emberger syndrome-primary lymphedema with
myelodysplasia: report of seven
new cases.
Mansour S, Connell
F, Steward C, Ostergaard P, Brice G, Smithson S, Lunt
P, Jeffery S, Dokal
I,
Vulliamy T, Gibson B, Hodgson S, Cottrell S, Kiely L, Tinworth L,
Kalidas
K, Mufti G, Cornish J,
Keenan R, Mortimer P, Murday V;
Lymphoedema Research Consortium.
SW Thames Regional Genetics
Service, St. George's, University of London,
London, UK.
[email protected]
Abstract
Four
reports have been published on an association between acute
myeloid
leukaemia (AML) and
primary lymphedema, with or without
congenital deafness. We report seven
new cases, including one
extended
family, confirming this entity as a genetic syndrome. The
lymphedema
typically presents in one
or both lower limbs, before the hematological
abnormalities, with onset
between infancy and puberty
and frequently
affecting the genitalia. The AML is often preceded by
pancytopenia or
myelodysplasia
with a high incidence of monosomy 7 in the bone marrow (five
propositi and
two relatives). Associated
anomalies included hypotelorism,
epicanthic folds, long tapering fingers
and/or neck webbing
(four
patients), recurrent cellulitis in the affected limb (four
patients),
generalized warts (two patients), and
congenital, high
frequency sensorineural deafness (one patient). Children
with lower limb and
genital
lymphedema should be screened for hematological abnormalities
and
immunodeficiency.
PMID: 20803646 [PubMed - in
process]
Med Sci Monit. 2010 Aug
7;16(9):BR313-319.
Evaluation of lymphatic function by means of
dynamic Gd-BOPTA-enhanced MRL
in experimental
rabbit limb
lymphedema.
Jiang Z, Lu Q, Kretlow JD, Hu X, Zhou G, Liu
N.
Department of Plastic and Reconstructive Surgery, Shanghai
Ninth People's
Hospital, Shanghai Jiao
Tong University School of
Medicine, Shanghai, China.
Abstract
Background:
The aim of this study was to investigate the value and
technical methods of
3D dynamic
contrast-enhanced magnetic resonance lymphangiography (MRL) in
the
assessment of lymphatic
anatomy and function in the presence of
extremity lymphedema.
Material/Methods: An improved experimental
model of obstructive lymphedema
was established in 1
hind limb of 6 New
Zealand White rabbits. 3D contrast-enhanced MRL was
performed with a
3.0-T
MR unit after the intracutaneous injection of Gd-BOPTA into
the
interdigital webs of the dorsal paws.
Maximum-intensity projection
(MIP) was used to reconstruct the images of
the lymphatic system.
The
dynamic nodal enhancement in the popliteal fossa and time-signal
intensity
curves between
lymphedematous and contralateral limbs were
compared. Morphologic
abnormalities of the lymphatic
system were also
evaluated and compared with lymphoscintigraphy (LSG).
Results:
3D dynamic contrast-enhanced MRL images were obtained after
the
administration of Gd-
BOPTA. In the normal limb, the popliteal fossa
lymph nodes and their
afferent and efferent lymph-
collecting vessels
were clearly visualized as the Gd tracer was rapidly
cleared from the
interstitial
compartment. In contrast, the Gd tracer accumulated slowly at
the prior
surgical site in the
lymphedematous limb. The nodal enhancement
of lymphedematous limbs was
significantly less than that
of the
contralateral limbs (P<0.01). Types of time-signal intensity curves
were
also significantly different
between the 2 groups
(P<0.001).
Conclusions: 3D dynamic contrast-enhanced MRL can
visualize the precise
anatomy of lymphatic
vessels and lymph nodes in
extremity lymphedema, as well as objectively
evaluate the functional
status
of lymph flow transport.
PMID: 20802408 [PubMed - in
process]
J Vasc Surg. 2010 Aug 25. [Epub ahead of
print]
Lymphatic malformation is a common component of
Klippel-Trenaunay syndrome.
Liu NF, Lu Q, Yan
ZX.
Department of Plastic and Reconstructive Surgery, Shanghai
9th People's
Hospital, Shanghai Jiao Tong
University School of Medicine,
Shanghai, China.
Abstract
OBJECTIVES: Few
previous studies have focused on the involvement of the
lymphatic system
in
Klippel-Trenaunay syndrome (KTS), although some evidence suggests
that
lymphatic abnormalities are
associated with the disease. The aim of
the present study was to
investigate the involvement of the
lymphatic
system in KTS.
METHODS: Magnetic resonance lymphangiography
(MRL) with the use of
gadobenate dimeglumine
as the contrast was
performed on 32 patients with KTS involving the
extremities to evaluate
lymphatic
vessels, lymph nodes, and veins.
RESULTS:
Thirty-one of 32 patients exhibited lymphatic vessel and/or lymph
node
anomalies,
including hyperplasia (11/31), hypoplasia or aplasia (20/31) of
lymphatic
vessels, and lymphedema
(31/31) of the affected limbs.
Twenty-two patients showed asymmetry of the
inguinal nodes
exhibiting
either the absence, or an increase or a decrease in number and
size of the
inguinal nodes. Venous
dysplasia was found in 31 patients in
superficial and/or deep veins. The
results showed a high
concomitance of
malformations of the lymphatic system and veins in the
affected limbs of
patients with
KTS.
CONCLUSIONS: Lymphatic system
abnormalities as examined with MRL are
commonly associated
with KTS and
are likely to play a significant role in the disorder.
PMID:
20800418 [PubMed - as supplied by publisher]
September 8,
2010
Orbit. 2010 Aug;29(4):222-6.
Chronic
lymphedema of the eyelid: case series.
Chalasani R, McNab
A.
Ophthalmology Registrar, Royal Victorian Eye and Ear
Hospital,
Melbourne,
Australia.
Abstract
Purpose: To
evaluate the clinical features, management and outcomes of
treatment of
chronic
lymphedema of the eyelid in a tertiary referral
setting.
Design: Retrospective case series. Participants: 15
patients referred to
the authors with unilateral or
bilateral eyelid
swelling of greater than 3 months duration.
Main Outcome
Measures: Clinical features, patient management, response
to
treatment.
Results: Chronic eyelid lymphedema was
associated with acne rosacea in 9
patients, radiotherapy in 1
patient,
trauma in 1 patient and post-vitrectomy silicone oil leak in 1
patient. In
the remaining 4 patients
no associated condition or factor was identified.
Surgical debulking was
performed in 9 cases with
improvement in all cases
and no complications.
Conclusion: Chronic eyelid lymphedema is a
rare condition most commonly
associated with rosacea. In
our experience,
surgical resection of involved subcutaneous tissue
was
helpful.
PMID: 20812843 [PubMed - in
process]
Plast Reconstr Surg. 2010
Sep;126(3):1118-9.
Breast reconstruction and
lymphedema.
Khan MA, Srinivasan K, Mohan A, Hardwicke J, Rayatt
S.
University Hospital of North Staffordshire NHS Trust;
Stoke-on-Trent,
Staffordshire, United Kingdom.
PMID: 20811251
[PubMed - in process]
Plast Reconstr Surg. 2010
Sep;126(3):759-61.
Discussion: lymphaticovenular bypass for
lymphedema management in breast
cancer patients: a
prospective
study.
Cheng J.
Dallas, Texas From the Department
of Plastic Surgery, University of Texas
Southwestern
Medical
Center.
PMID: 20811211 [PubMed - in
process]
Plast Reconstr Surg. 2010
Sep;126(3):752-8.
Lymphaticovenular bypass for lymphedema
management in breast cancer
patients: a prospective
study.
Chang DW.
Houston, Texas From the
Department of Plastic Surgery, University of Texas
M. D. Anderson
Cancer
Center.
Abstract
BACKGROUND: Lymphedema
is a common and debilitating condition. Management
options for
lymphedema
are limited and controversial. The purpose of this prospective
study was to
provide a
preliminary analysis of lymphaticovenular bypass for the treatment
of
upper limb lymphedema in breast
cancer
patients.
METHODS: Twenty patients with upper extremity
lymphedema secondary to
treatment of breast
cancer underwent
lymphaticovenular bypass using a "supermicrosurgical"
approach. The mean age
of
the patients was 54 years, 16 patients had received preoperative
radiation
therapy, and all patients had
received axillary lymph node
dissection. The mean duration of lymphedema
was 4.8 years, and the
mean
volume differential of the lymphedematous arm compared with the
unaffected
arm was 34
percent. Evaluation included qualitative assessment and
quantitative
volumetric analysis before surgery
and at 1 month, 3 months,
6 months, and 1 year after the procedure.
RESULTS: The mean
number of bypasses performed per patient was 3.5 (range,
two to five), and
the
size of bypasses ranged from 0.3 to 0.8 mm. The mean operative time
was
3.3 hours (range, 2 to 5
hours). Hospital stay was less than 24 hours
for all patients. The mean
follow-up time was 18 months.
Nineteen
patients (95 percent) reported symptom improvement following
surgery, and 13
patients had
quantitative improvement. The mean volume differential
reduction was 29
percent at 1 month, 36
percent at 3 months, 39 percent
at 6 months, and 35 percent at 1 year. No
patients
experienced
postoperative complications or lymphedema
exacerbation.
CONCLUSIONS: Lymphaticovenular bypass may
effectively reduce the severity
of lymphedema in
breast cancer patients.
Long-term analysis is needed.
PMID: 20811210 [PubMed - in
process]
Biol Trace Elem Res. 2010 Sep 1. [Epub ahead of
print]
Titanium, Sinusitis, and the Yellow Nail
Syndrome.
Berglund F, Carlmark B.
, Solvägen 8 A,
SE 192 66, Sollentuna, Sweden, [email protected].
Abstract
Yellow
nail syndrome is characterized by nail changes, respiratory
disorders, and
lymphedema. In a
yellow nail patient with a skeletal titanium implant and
with gold in her
teeth, we found high levels of
titanium in nail
clippings. This study aims to examine the possible role
of titanium in the
genesis of the
yellow nail syndrome. Nail clippings from patients with one
or more
features of the yellow nail
syndrome were analyzed by energy
dispersive X-ray fluorescence. Titanium
was regularly found in
finger
nails in patients but not in control subjects. Visible nail changes
were
present in only half of the
patients. Sinusitis with postnasal drip and
cough was the most common
complaint. The dominant
source of titanium ions
was titanium implants in the teeth or elsewhere.
The titanium ions were
released
through the galvanic action of dental gold or amalgam or through
the
oxidative action of fluorides. In
other patients the titanium was
derived from titanium dioxide in drugs and
confectionary.
Stopping
galvanic release of titanium ions or canceling exposure to
titanium
dioxide led to recovery. In one
patient with a titanium implant,
the symptoms recurred after renewed
exposure to titanium. Yellow
nail
syndrome is caused by titanium.
PMID: 20809268 [PubMed -
as supplied by publisher]
Physiother Can. 2009 Fall;61(4):244-51.
Epub 2009 Nov 12.
Effect of acute exercise on upper-limb volume
in breast cancer survivors:
a pilot study.
McNeely ML,
Campbell KL, Courneya KS, Mackey JR.
Margaret L. McNeely, PhD:
Physical Therapy Department, University of
Alberta, and Cross
Cancer
Institute, Edmonton,
Alberta.
Abstract
Purpose: Strenuous
upper-extremity activity and/or exercise have
traditionally been prescribed
for
breast cancer survivors with or at risk of developing lymphedema.
The
purpose of this study was to
assess the effect of an acute bout of
exercise on upper-limb volume and
symptoms in breast cancer
survivors,
with the intent to provide pilot data to guide a subsequent
larger
study.
Methods: Twenty-three women who regularly participated in
dragon-boat
racing took part in the study.
A single exercise bout was
performed at a moderate intensity (rating of
perceived exertion: 13-14)
for
20 continuous minutes on an arm ergometer. The difference between
affected
and unaffected limb
volume was assessed pre- and post-exercise
via measurements of limb
circumference at five
time
points.
Results: Although limb volume increased
following exercise in both limbs,
the difference between the
limbs
remained stable at each measurement point. Only one participant was
found to
have an increase
in arm-volume difference of >100 ml post intervention,
and only four
participants reported symptoms
of tension and/or heaviness
in the affected limb.
Conclusion: The results suggest that limb
volume in breast cancer
survivors increases after an acute
bout of
upper-limb exercise but that, for the majority of women, the
response is not
different between
affected and unaffected limbs. Future research using a
larger sample and
more sensitive measurement
methods are
recommended.
PMID: 20808486 [PubMed - in
process]
Pediatr Dermatol. 2010 Aug 26. [Epub ahead of
print]
Congenital Yellow Nail Syndrome: A Case Report and Its
Relationship to
Nonimmune Fetal Hydrops.
Nanda A, Al-Essa FH,
El-Shafei WM, Alsaleh QA.
As'ad Al-Hamad Dermatology Center,
Al-Sabah Hospital, Kuwait.
Abstract
Yellow nail
syndrome (YNS) is an uncommon disorder characterized by a
triad of nail
dystrophy,
lymphedema, and pleural effusion. It is rare in children and
congenital
occurrence of YNS has been
very rarely described. We report a
2-year-old Arab boy having congenital
yellow nail syndrome with
mild
facial dysmorphism and bilateral conjunctival pigmentation born
to
consanguineous parents. One
of his older siblings had died of
nonimmune fetal hydrops (NIFH). The case
supports the genetic basis
of
yellow nail syndrome with a possible relationship to nonimmune
fetal
hydrops.
PMID: 20807364 [PubMed - as supplied by
publisher]
These are the current Pub Med list you sent me, not a
backlogged one Tina,
so I used today’s date for
it per my note
above:
September 17, 2010
Breast Cancer Res. 2010
Sep 8;12(5):R70. [Epub ahead of print]
Experimental assessment
of pro-lymphangiogenic growth factors in the
treatment of
post-surgical
lymphedema following lymphadenectomy.
Baker A,
Kim H, Semple JL, Dumont D, Shoichet M, Tobbia D, Johnston
M.
ABSTRACT:
INTRODUCTION: Lymphedema is a
frequent consequence of lymph node excision
during breast
cancer surgery.
Current treatment options are limited mainly to external
compression
therapies to limit
edema development. We investigated previously,
post-surgical lymphedema in
a sheep model following
the removal of a
single lymph node and determined that autologous lymph
node transplantation
has the
potential to reduce or prevent edema development. In this report,
we
examine the potential of
lymphangiogenic therapy to restore lymphatic
function and reduce
post-surgical lymphedema.
METHODS:
Lymphangiogenic growth factors (vascular endothelial growth
factor-C
(VEGF-C) and
angiopoitein-2 (ANG-2)) were loaded into a gel-based drug
delivery system
(HAMC; a blend of
hyaluronan and methylcellulose). Drug
release rates and lymphangiogenic
signaling in target endothelial
cells
were assessed in vitro and vascular permeability biocompatibility
tests were
examined in vivo.
Following, the removal of a single popliteal lymph node,
HAMC with the
growth factors was injected
into the excision site. Six
weeks later, lymphatic functionality was
assessed by injecting
125Iodoine
radiolabelled bovine serum albumin (125I-BSA) into prenodal
vessels and
measuring its recovery in
plasma. Circumferential leg
measurements were plotted over time and areas
under the curves used
to
quantify edema formation.
RESULTS: The growth factors were
released over a two-week period in vitro
by diffusion from
HAMC, with 50%
being released in the first 24 hours. The system induced
lymphangiogenic
signaling
in target endothelial cells, while inducing only a minimal
inflammatory
response in sheep. Removal of the
node significantly reduced
lymphatic functionality (Nodectomy 1.9 +/- 0.9,
HAMC alone 1.7 +/-
0.8)
compared with intact groups (3.2 +/- 0.7). There was no
significant
difference between the growth
factor treatment group (2.3 +/-
0.73) and the intact group. An increase in
the number of
regenerated
lymphatic vessels at treatment sites was observed with
fluoroscopy. Groups
receiving HAMC plus
growth factors displayed
significantly reduced edema (107.4 +/- 51.3)
compared with
non-treated
groups (nodectomy 219.8 +/- 118.7, and HAMC alone 162.6 +/-
141).
CONCLUSIONS: Growth factor therapy has the potential to
increase lymphatic
function and reduce
edema magnitude in an animal model
of lymphedema. The application of this
concept to lymphedema
patients
warrants further examination.
PMID: 20825671 [PubMed - as supplied by
publisher]
Med Oncol. 2010 Sep 9. [Epub ahead of
print]
Whether drainage should be used after surgery for breast
cancer? A
systematic review of randomized
controlled
trials.
He XD, Guo ZH, Tian JH, Yang KH, Xie
XD.
Evidence Based Medicine Center, School of Basic Medical
Sciences, Lanzhou
University, No. 199
Donggang West Road, Lanzhou, Gansu,
730000, China, [email protected].
Abstract
A
systematic review of randomized controlled trials (RCTs) was conducted
to
evaluate whether
patients benefit from the suction drainage after axillary
lymph node
dissection (ALND) in breast cancer
surgery. RCTs of drainage
versus no drainage after ALND in women with
breast cancer were
retrieved
from PubMed, EMBASE, Cochrane Library and Chinese Biomedical
database. Two
authors
independently assessed the quality of included trials and extracted
data.
Odds ratio (OR) for
dichotomous outcomes and mean difference (MD)
for continuous outcomes were
presented with 95%
confidence intervals
(CI). A total of 1115 titles were indentified from
the databases; 1109
obvious
irrelevant studies were excluded by examining the titles, abstracts,
full
texts because of duplicates, no
RCT, different modality of drainage,
drain for lymphedema, application of
fibrin sealant and so on. And
then,
only 6 RCTs to compare drainage with no drainage after ALND in
breast cancer
surgery were
included in the systematic review and a total of 585 patients
were
included in the pathological diagnosis
of breast cancer in women
before surgery, management by ALND with or
without addition
surgical
procedures. The study demonstrated that insertion of a drain in the
axilla
after breast cancer surgery
resulted in a statistically
significant reduction in the rate of seroma
(OR = 0.36, 95% CI, 0.16 to
0.81,
P = 0.01), the volume of aspiration (MD = -100.10, 95% CI, -174.36
to
-25.85, P = 0.008), or the
frequency of seroma aspiration (MD = -1.03,
95% CI, -1.35 to -0.71, P <
0.00001), but prolonged
the length of
hospital stay (MD = 1.52, 95% CI, 0.36 to 2.68, P = 0.01).
There was no
statistically
significant difference in the incidence of wound infection (OR
= 0.67, 95%
CI, 0.34 to 1.32, P = 0.25)
between drainage group and no
drainage group. Based on the current
evidence, insertion of a drain
in
the axilla following ALND in breast cancer surgery effectively
decreased
seroma formation, volume of
aspiration as well as the frequency
of seroma aspiration without
increasing the incidence of wound
infection,
but extending their stay in hospital.
PMID: 20827578 [PubMed -
as supplied by publisher]
Am J Hum Genet. 2010 Sep
10;87(3):436-44.
Protein tyrosine phosphatase PTPN14 is a
regulator of lymphatic function
and choanal development
in
humans.
Au AC, Hernandez PA, Lieber E, Nadroo AM, Shen YM,
Kelley KA, Gelb BD,
Diaz GA.
Department of Genetics &
Genomic Sciences, Mount Sinai School of Medicine,
New York, NY
10029,
USA.
Abstract
The lymphatic vasculature is
essential for the recirculation of
extracellular fluid, fat absorption,
and
immune function and as a route of tumor metastasis. The dissection
of
molecular mechanisms underlying
lymphangiogenesis has been accelerated
by the identification of
tissue-specific lymphatic endothelial
markers
and the study of congenital lymphedema syndromes. We report the
results of
genetic analyses
of a kindred inheriting a unique autosomal-recessive
lymphedema-choanal
atresia syndrome. These
studies establish linkage of
the trait to chromosome 1q32-q41 and identify
a loss-of-function
mutation
in PTPN14, which encodes a nonreceptor tyrosine phosphatase. The
causal
role of PTPN14
deficiency was confirmed by the generation of a
murine Ptpn14 gene trap
model that manifested
lymphatic hyperplasia with
lymphedema. Biochemical studies revealed a
potential interaction
between
PTPN14 and the vascular endothelial growth factor receptor 3
(VEGFR3), a
receptor tyrosine kinase
essential for lymphangiogenesis.
These results suggest a unique and
conserved role for PTPN14 in
the
regulation of lymphatic development in mammals and a nonconserved role
in
choanal development in
humans.
PMID: 20826270 [PubMed -
in process]
Duodecim.
2010;126(15):1827-30.
[Mystery of the swollen
leg]
[Article in Finnish]
Sundell
J.
TYKS, Raision sairaala, sisätautien klinikka PL 43, 21201
Raisio.
Abstract
This case report demonstrates a
90-year-old female patient who had an
amelanotic subungual
melanoma of
the right hallux. As usual non healing ulcer of the nail bed
was initially
misdiagnosed.
Finally melanoma spread to the groin lymph nodes and induced
lymphedema of
the leg leading to the
right diagnosis. Acral lesion
requires early biopsy if any clinical
uncertainty
exists.
PMID: 20824972 [PubMed - in process]
September
17, 2010 - this will be the date of the email to me FYI
June
2010 - Clinics (Sao Paulo). 2010 Jun;65(8):781-7.
Comparison of
quality of life, satisfaction with surgery and shoulder-arm
morbidity in
breast cancer
survivors submitted to breast-conserving therapy or mastectomy
followed by
immediate breast
reconstruction.
Freitas-Silva
R, Conde DM, Freitas-Júnior R, Martinez EZ.
Department of
Gynecology and Obstetrics, Universidade Federal de Goiás,
Goiânia, GO,
Brasil.
Abstract
OBJECTIVES: This study was
designed to compare the prevalence of
shoulder-arm morbidity,
patient
satisfaction with surgery and the quality of life of women submitted
to
breast-conserving therapy or
modified radical mastectomy and immediate
breast reconstruction .
METHODS: This study was a
cross-sectional study of women who underwent
breast-conserving
therapy
(n=44) or modified radical mastectomy and immediate breast
reconstruction
(n=26). Quality of
life was evaluated with the SF-36 Health Survey
Questionnaire.
RESULTS: No differences were found in the
prevalence of lymphedema. The
movements that were
most commonly affected
by these procedures were abduction, flexion and
external rotation. When
the
two groups were compared, however, we only found a
statistically
significant difference for the
prevalence of restricted
internal rotation, which occurred in 32% of women
in the
breast-conserving
therapy group and 12% of those in the modified radical
mastectomy and
immediate breast
reconstruction group (OR: 7.23; p=0.03
following adjustment for potential
confounding factors). No
difference in
quality of life or satisfaction with surgery was found
between the two
groups.
CONCLUSIONS: These data suggest that the type of surgery
did not affect
the occurrence of
lymphedema. Breast-conserving therapy,
however, increased the risk of
shoulder movement limitation.
No
differences were found between the two surgical techniques with respect
to
quality of life or
satisfaction with surgery.
PMID: 20835555
[PubMed - in process]
September 7, 2010 - Orthopedics. 2010 Sep
7;33(9). doi:
10.3928/01477447-20100722-35.
Wound healing in
total joint arthroplasty.
Jones
RE.
Abstract
Obtaining primary wound healing in
total joint arthroplasty is essential
to a good result. Wound
healing
problems can occur and the consequences can be devastating.
Determination
of the host healing
capacity can be useful in predicting
complications. Cierney and Mader
classified patients as type A,
no
healing compromises; and type B, systemic or local healing
compromising
factors present. Local
factors include traumatic arthritis,
multiple previous incisions,
extensive scarring, lymphedema,
poor
vascular perfusion. Systemic compromising factors include
diabetes,
rheumatic diseases, renal or liver
disease, immunocompromise,
steroids, smoking, and poor nutrition. In
high-risk patients, the
surgeon
should encourage positive choices such as smoking cessation
and
nutritional supplementation to elevate
the total lymphocyte count and
total albumin.Careful planning of
incisions, particularly in patients
with
scarring or multiple previous operations, is productive. Around the
knee
the vascular viability is better
in the medial flap. Thus, use the
most lateral previous incision, do
minimal undermining, and handle
tissue
meticulously. We perform all potentially complicated total
knee
arthroplasties without tourniquet
to enhance blood flow and tissue
viability. The use of perioperative
anticoagulation will increase
wound
problems.If wound drainage or healing problems occur, immediate action
is
required. Deep sepsis can
be ruled out with a joint aspiration and
cell count (>2000), differential
(>50% polys), and negative
culture
and sensitivity. All hematomas should be evacuated and necrosis
or
dehiscence should be
managed by debridement to obtain a live
wound.
PMID: 20839686 [PubMed - in
process]
September 13, 2010 - Stem Cells Dev. 2010 Sep 13. [Epub
ahead of print]
Cellular trans/-differentiation and
morphogenesis towards the lymphatic
lineage in regenerative
medicine.
Laco F, Grant MH, Flint D, Black
RA.
Universtity of Strathclyde, Bioengineering, Glasgow, United
Kingdom;
[email protected].
Abstract
Lymphoedema
is a medically irresolvable condition. The lack of therapies
addressing
lymphatic vessel
dysfunction suggests that improved understanding of
lymphatic cell
differentiation and vessel maturation
processes is key to
the development of novel, regenerative medicine and
tissue
engineering
approaches. In this review we provide an overview of
lymphatic
characterisation markers and
morphology in development.
Furthermore, we describe multiple
differentiation processes of
the
lymphatic system during embryonic, post-natal and pathogenic
development.
Using the example of
pathogenic Kaposi Sarcoma-associated
Herpes infection we illustrate the
involvement of the Notch
and PI3K
pathways for lymphatic trans-differentiation. We also discuss the
plasticity
of certain cell
types and bio-factors which enable trans-differentiation
towards the
lymphatic lineage. Here we argue
the importance of
pathway-associated induction factors for lymphatic
trans-differentiation
including
growth factors such as VEGF-C and interleukins, and the
involvement of
extracellular matrix
characteristics and dynamics for
morphological functionality.
PMID: 20836656 [PubMed - as
supplied by publisher]
September 28, 2010
Presse Med.
2010 Sep 20. [Epub ahead of print]
[Lymphoscintigraphic
exploration in the limbs lymphatic disease.]
[Article in
French]
Baulieu F, Lorette G, Baulieu JL, Vaillant
L.
CHRU de Tours, université François-Rabelais de Tours,
médecine nucléaire,
37044 Tours
cedex,
France.
Abstract
Lymphoscintigraphy is
based upon the physiological transport of small
radioactive particles
injected
into interstitium toward lymphatic vessels and nodes.
Lymphoscintigraphy
directly investigates
lymphatic system while other
methods (ultrasounds, CT, MRI) investigate
tissular consequences
of
lymphatic disease. The scintigraphic procedure has to be standardized
in
order to be reproducible.
Lymphatic vessels, lymphatic nodes and
interstitium are systematically
analysed. Interpretation is visual
and
qualitative. Multiple abnormalities can be observed. However, none of
them
can consistently
differentiate between primary and secondary lymphedema.
Differential
diagnosis is usually obtained by
taking together clinical
and lymphoscintigraphic data. By providing
informations about
lymphatic
component and physiopathology of edema, lymphoscintigraphy
contributes to
the management of
lymphedema. Hybrid imaging is a new
imaging modality of edema. Recently
used, it combines
functional
(scintigraphy) and anatomical (CT) data and seems to be able to
provide
further informations.
PMID: 20863652 [PubMed - as supplied by
publisher]
Lymphat Res Biol. 2010
Sep;8(3):175-9.
Lymphangiosarcoma complicating extensive
congenital mixed vascular
malformations.
Al Dhaybi R, Agoumi
M, Powell J, Dubois J, Kokta V.
Division of Dermatology, CHU
Sainte Justine, University of Montreal,
Montreal, Quebec, Canada.
[email protected]
Abstract
Pediatric
hepatic angiosarcoma is a very rare malignant vascular tumor. A
few cases
have shown
pediatric hepatic angiosarcoma occurring on a background of
preexisting
vascular lesions. We report
the case of a newborn girl who
presented extensive limbs and upper trunk
cutaneous mixed
vascular
malformations at birth. These malformations were associated
with
thrombocytopenia. Cutaneous
biopsies revealed complex vascular
malformations with a significant
lymphatic component.
Compressive body
suit therapy led to regression of the limbs' cutaneous
vascular
malformations. At the
age of 9 months, the patient presented multiple
heterogeneous
hepatosplenic nodules. Aggressive
treatment with
prednisone, vincristine, and hepatosplenic embolizations
resulted in initial
improvement
of the hepatosplenic lesions for few months, followed by an
increase of
the lesions with failure of
response to treatment despite
adding alpha-interferon-2b to treatment. The
patient died at the age
of
19 months. The autopsy's pathological examination revealed a
hepatic-based
angiosarcoma with
plurimetastatic dissemination to the
spleen, lungs, peritoneum, pleura,
mesenteric linings as well as
the
serosa of the stomach and small intestine. Multiple cutaneous and
visceral
complex capillaro-
lymphatico-venous malformations were also
identified. We hypothesize that
these multiple extensive
mixed vascular
malformations were associated with chronic lymphedema which
probably
predisposed
to the development of the angiosarcoma in our
patient.
PMID: 20863270 [PubMed - in process]
Hu
Li Za Zhi. 2010 Apr;57(2 Suppl):S99-103.
[Providing care
to an elephant leg patient: a nurse's experience]
[Article in
Chinese]
Chen TH, Wang CY, Chang ML.
General
Surgery, Department of Nursing, Taipei Medical University-Wan Fang
Hospital,
Taipei
Medical University.
Abstract
This
article reports on the experience of nurses who provided nursing care
to a
woman who had
recently immigrated to Taiwan from Mainland China. The woman
suffered from
chronic lymphedema,
and had previously received surgical
treatment for the condition. The
period of nursing care ran from
June
10th through September 9th, 2008. Nursing care experience focused on
the two
care issues of
anxiety and health seeking behavior. During the nursing
process, we
expressed empathy, encouraged
the patient to express her
feelings, and provided disease-related
information. We successfully
resolved
the patient's anxiety problem. The patient learned to use
distraction to
help relieve pain. The patient
also participated in a
rehabilitation program to improve her blood
circulation. We tracked the
patient's
rehabilitation progress through e-mail correspondence. We hope
that this
complete nursing experience
can serve as reference in caring
for patients facing similar problems in
the future.
PMID:
20405406 [PubMed - in process]
October 2,
2010
Microsurgery. 2010 Sep;30(6):437-42.
Types
of lymphoscintigraphy and indications for lymphaticovenous
anastomosis.
Maegawa J, Mikami T, Yamamoto Y, Satake T,
Kobayashi S.
Department of Plastic and Reconstructive Surgery,
Yokohama City University
Hospital, Yokohama
City University, 3-9 Fukuura,
Kanazawa-ku, Yokohama 236-0004,
Japan.
Abstract
Several authors have reported the
usefulness and benefits of
lymphoscintigraphy. However, it
is
insufficient to indicate microvascular treatment based on
lymphedema.
Here, we present the
relationships between
lymphoscintigraphic types and indications for
lymphatic
microsurgery.
Preoperative lymphoscintigraphy was performed in 142 limbs
with secondary
lymphedema of the lower
extremity. The images obtained
were classified into five types. Type I:
Visible inguinal lymph
nodes,
lymphatics along the saphenous vein and/or collateral lymphatics.
Type II:
Dermal backflow in the thigh
and stasis of an isotopic material
in the lymphatics. Type III: Dermal
backflow in the thigh and leg.
Type
IV: Dermal backflow in the leg. Type V: Radiolabeled colloid
remaining in
the foot.
Lymphaticovenous anastomosis was performed in 35 limbs. The
average number
of anastomoses per
limb was 3.3 in type II, 4.4 in type
III, 3.6 in type IV, and 3 in type V.
The highest number of
anastomosis
was performed in type III. In conclusion, type III is
suggested to be the
best indication for
anastomosis compared with types IV and V. © 2010
Wiley-Liss, Inc.
Microsurgery 30:437-442,
2010.
PMID:
20878726 [PubMed - in process]
Med Klin (Munich). 2010
Sep;105(9):619-26. Epub 2010 Sep 28.
[Alternative sonographic
diagnoses in patients with clinical suspicion of
deep vein
thrombosis.]
[Article in German]
Taute BM, Melnyk
H, Podhaisky H.
Universitätsklinik und Poliklinik für Innere
Medizin III, Schwerpunkt
Angiologie, Universitätsklinikum
der
Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg,
Germany,
bettina.taute@medizin.
uni-halle.de.
Abstract
BACKGROUND
AND PURPOSE: : Unclear extremity complaints are common symptoms
of
inpatients. In a subset of these patients, a clinical suspicion of
deep
vein thrombosis (DVT) results; this
needs to be quickly and
definitively clarified by a vascular physician.
The question arose of how
often a
clinical suspicion of DVT was confirmed in an inpatient population
and
which alternative diagnoses
were able to be made by
angiologists.
PATIENTS AND METHODS: : In a retrospective
analysis, all inpatients in the
Angiologic Vascular
Diagnostics Center of
the University Hospital Halle, Germany, examined in
2007 for a suspicion
of
DVT were evaluated with respect to the definitively made
diagnosis.
RESULTS: : In 213 (28.6%) of 745 suspected cases of
DVT, a DVT was
confirmed. In 532 patients
(71.4%), DVT was excluded. In
314 of these patients, 436 alternative
diagnoses were recorded in
the
diagnostic reports of angiologic examinations. In 38.6% (n = 168),
other
venous causes could be
confirmed as the most common alternative
diagnosis. There were chronic
venous diseases in 28% (n =
122),
superficial thrombophlebitis (n = 27), and tumor-related pelvic
vein
compression (n = 19).
17.4% (n = 76) exhibited lymphedema. In 13.3%
(n = 58), a generalized
edema was diagnosed.
Arthrogenic causes followed
with 12.8% (n = 56). Lipedema (5.3%) and
hematoma (5%) could be
verified
as other important differential diagnoses. Rare causes were
symptomatic or
ruptured Baker's
cysts (2.5%), erysipelas (2.5%), abscess, aneurysm, muscle
tears, and tumors.
CONCLUSION: : The variety of alternative
diagnoses in patients with
clinical suspicion of DVT is
high. The
knowledge and systematic examination of potential, even rare
differential
diagnoses after
exclusion of DVT are part of the repertoire of the vascular
physician.
Unnecessary and expensive, as
well as onerous, diagnostic
procedures on the patient can be avoided.
Anticoagulation that was
begun
as a result of the suspicion of DVT can quickly be
stopped.
PMID: 20878299 [PubMed - in process]
An
Pediatr (Barc). 2010 Sep 24. [Epub ahead of print]
[Early
primary lymphoedema. A condition to remember.]
[Article in
Spanish]
Carreira Sande N, Rodríguez Blanco MA, Martín Morales
JM, González Alonso
N, Dosil Gallardo S,
Cea Pereiro C.
Servicio
de Pediatría, Hospital da Barbanza, Ribeira, A Coruña,
España.
PMID: 20870471 [PubMed - as supplied by
publisher]
Tina, the next two look duplicates to me, though the
first came in a doc
with 3 others and the second in
a doc all by itself.
But I put them both here just in case I missed
something that wasn’t
duplicate
Hautarzt. 2010 Sep 26. [Epub ahead of
print]
[Fatter through lipids or water : Lipohyperplasia
dolorosa versus
lymphedema.]
[Article in
German]
Cornely ME.
Praxis Prof. Hon. (Univ.
Puebla) Dr. med. Manuel E. Cornely,
Kaiserswerther Str. 296,
40474,
Düsseldorf, Deutschland, [email protected].
Abstract
Lipohyperplasia
dolorosa and lymphedema are completely different disease
entities, which are
both,
however, classified under lymphology. While in lipohyperplasia
dolorosa a
congenital lipid distribution
disorder leads to a high volume
insufficiency and the corresponding
clinical symptoms, lymphedema
is
characterized by a congenital transport incompetence of the vessels
or
acquired disorders of transport
capacity. Both lymphedemas of
different genesis are familial volume
alterations of the affected
regions
and the increase in volume is irreversible if not exclusively still
in
stage I or II. According to current
knowledge the solid increase in
volume by lymphedema is due to a
malfunctioning biomechanism by
which the
release of additional proteoglycans in the homeostasis system of
the fluid
in the interstital
space plays an important role. Removal of this tissue and
the sponge-like
substance of proteoglycans is
the aim of therapeutic
approaches. Manual lymph drainage and compression
can evacuate the
sponge
but not remove it. Lymphological liposculpture is a
successful
dermatosurgical measure even for
secondary lymphedema.
Reduction of the necessity of complex hemostasis
therapy to 20% of the
initial
value and an adjustment of the affected extremity on the healthy
side,
represent a clear improvement in
quality of life of patients. The
same dermatosurgical method,
lymphological liposculpture, has been
known
for many years to fulfil the successfully proven purpose for the
treatment
of lipohyperplasia
dolorosa by the removal of subcutaneous fatty tissue,
present as
hyperplasia and not hypertrophy.
Tenderness and the necessity
for complex hemostasis therapy are no longer
present or no
longer
necessary after lymphological liposculpture for lipohyperplasia
dolorosa.
This condition is permanent
because the congenital fatty masses
do not reoccur following surgical
removal. Lipohyperplasia
dolorosa is
therefore curable by lymphological liposculpture. For
secondary lymphedema a
drastic
improvement in quality of life of the patient can be achieved by
this
method which is demonstrated by
the adjustment of symmetry of the
extremities and reduction or even
avoidance of complex
hemostasis
therapy.
PMID: 20871969 [PubMed - as supplied by
publisher]
Hautarzt. 2010 Sep 26. [Epub ahead of
print]
[Fatter through lipids or water : Lipohyperplasia
dolorosa versus
lymphedema.]
[Article in
German]
Cornely ME.
Praxis Prof. Hon. (Univ.
Puebla) Dr. med. Manuel E. Cornely,
Kaiserswerther Str. 296,
40474,
Düsseldorf, Deutschland, [email protected].
Abstract
Lipohyperplasia
dolorosa and lymphedema are completely different disease
entities, which are
both,
however, classified under lymphology. While in lipohyperplasia
dolorosa a
congenital lipid distribution
disorder leads to a high volume
insufficiency and the corresponding
clinical symptoms, lymphedema
is
characterized by a congenital transport incompetence of the vessels
or
acquired disorders of transport
capacity. Both lymphedemas of
different genesis are familial volume
alterations of the affected
regions
and the increase in volume is irreversible if not exclusively still
in
stage I or II. According to current
knowledge the solid increase in
volume by lymphedema is due to a
malfunctioning biomechanism by
which the
release of additional proteoglycans in the homeostasis system of
the fluid
in the interstital
space plays an important role. Removal of this tissue and
the sponge-like
substance of proteoglycans is
the aim of therapeutic
approaches. Manual lymph drainage and compression
can evacuate the
sponge
but not remove it. Lymphological liposculpture is a
successful
dermatosurgical measure even for
secondary lymphedema.
Reduction of the necessity of complex hemostasis
therapy to 20% of the
initial
value and an adjustment of the affected extremity on the healthy
side,
represent a clear improvement in
quality of life of patients. The
same dermatosurgical method,
lymphological liposculpture, has been
known
for many years to fulfil the successfully proven purpose for the
treatment
of lipohyperplasia
dolorosa by the removal of subcutaneous fatty tissue,
present as
hyperplasia and not hypertrophy.
Tenderness and the necessity
for complex hemostasis therapy are no longer
present or no
longer
necessary after lymphological liposculpture for lipohyperplasia
dolorosa.
This condition is permanent
because the congenital fatty masses
do not reoccur following surgical
removal. Lipohyperplasia
dolorosa is
therefore curable by lymphological liposculpture. For
secondary lymphedema a
drastic
improvement in quality of life of the patient can be achieved by
this
method which is demonstrated by
the adjustment of symmetry of the
extremities and reduction or even
avoidance of complex
hemostasis
therapy.
----------------------------
October
5, 2010
Indian J Pediatr. 2010 Sep 30. [Epub ahead of
print]
Home-made Compression Stockings and Shoes of a
Cotton-Polyester Material
in the Treatment of
Primary Congenital
Lymphedema.
de Godoy JM, Azoubel LM, de Godoy
MD.
Department of Cardiology and Cardiovascular Surgery, Medical
School of São
Jose do Rio Preto-
FAMERP-Brazil and CNPq (National Council
for Research and Development),
São José do Rio
Preto, Brazil, [email protected].
PMID:
20882431 [PubMed - as supplied by publisher]
Phlebology. 2010
Sep 29. [Epub ahead of print]
Unilateral leg swelling: deep vein
thrombosis?
Bekou V, Galis D, Traber
J.
Venenklinik Bellevue, Kreuzlingen,
Switzerland.
Abstract
OBJECTIVE: We present two
cases of a unilateral leg swelling of unusual
aetiology as a reminder
to
the physician to consider causes of unilateral leg swelling other
than
deep vein thrombosis,
lymphoedema and infectious diseases. Case
reports Both of our patients
developed progressive leg
swelling.
Subsequent investigation revealed a lesion compressing the
femoral vein. At
exploration this
was found to be a ganglion cyst. In one patient surgical
removal of the
cyst and in the other puncture of
the cyst and
instillation of steroid resulted in prompt resolution of
the
swelling.
CONCLUSION: Venous compression due to external
cystic lesions, although
rare, is recognized. In
strange cases this
differential diagnosis should also be taken into
account. Therapeutic
options are the
surgical removal or puncture of the
cyst.
PMID: 20881310 [PubMed - as supplied by
publisher]
Clin J Oncol Nurs. 2010 Oct
1;14(5):585-93.
NO SToPS: Reducing treatment breaks during
chemoradiation for head and
neck cancer.
Lambertz CK, Gruell
J, Robenstein V, Mueller-Funaiole V, Cummings K, Knapp V.
St.
Luke's Mountain States Tumor Institute, Boise, ID, USA. [email protected]
Abstract
The
addition of chemotherapy to radiation aids in the survival of patients
with
head and neck cancer but
also increases acute toxicity, primarily painful
oral mucositis and
dermatitis exacerbated by xerostomia.
The consequences
of these side effects often result in hospitalization and
breaks in
treatment, which
lead to lower locoregional control and survival rates. No
strategies
reliably prevent radiation-induced
mucositis; therefore,
emphasis is placed on management to prevent
treatment breaks. The NO
SToPS
approach describes specific multidisciplinary strategies for
management of
nutrition; oral care; skin
care; therapy for swallowing,
range of motion, and lymphedema; pain; and
social support to
assist
patients through this difficult therapy.
PMID:
20880816 [PubMed - in process]
Ann Surg Oncol. 2010 Oct;17(Suppl
3):352-8. Epub 2010 Sep 19.
Single-center long-term follow-up
after intraoperative radiotherapy as a
boost during
breast-conserving
surgery using low-kilovoltage x-rays.
Blank
E, Kraus-Tiefenbacher U, Welzel G, Keller A, Bohrer M, Sütterlin M,
Wenz
F.
Department of Radiation Oncology, University Medical Centre
Mannheim,
University of Heidelberg,
Mannheim, Germany.
[email protected]
Abstract
BACKGROUND:
Intraoperative radiotherapy (IORT) during breast-conserving
surgery as a
boost
followed by whole-breast radiotherapy is increasingly
used.
METHODS: Between February 2002 and December 2008, a total
of 197 patients
were treated with
IORT as a boost (20 Gy, 50 kV x-rays;
Intrabeam System, Carl Zeiss
Surgical, Oberkochen,
Germany) during
breast-conserving surgery, followed by whole-breast
radiotherapy (46-50
Gy).
Systemic therapy was provided according to the St. Gallen
consensus.
Patients were recalled every 6-
12 months for follow-up.
Findings were scored according to the
LENT-SOMA
scale.
RESULTS: Median age was 61.8 (range 30-84)
years, and median follow-up was
37 (range 5-91)
months. There were T1,
T2, and Tx tumors in 129, 67, and 1 patients,
respectively, and N0, N1,
N2,
and N3 disease in 144, 36, 15, and 2 patients, respectively.
Until
December 2009, 5 local invasive
relapses, 1 local ductal
carcinoma-in-situ, 1 axillary relapse, 6
secondary cancers, and 11
distant
metastases were seen, resulting in a 5-year disease-free survival of
81.0%
and an overall survival of
91.3%. Local relapse-free survival
(invasive cancers) at 3 and 5 years was
97.0%. After a follow-up
of 5
years (n =58), only 8 patients (13.8%) had chronic skin toxicities,
and 2
patients (3.4%) had a
marked increase in density (fibrosis III), while 62.0%
had no/barely
palpable fibrosis 0-I. Other
toxicities observed included
severe pain (n = 4, 6.9%), retraction (n =17,
29.3%), edema of the
breast
(n =1, 1.7%), and lymphedema in general (n =2,
3.4%).
CONCLUSIONS: After IORT as a tumor bed boost with
low-kilovoltage x-rays
followed by whole-
breast radiotherapy, low local
recurrence and chronic toxicity rates were
seen after 5-year
follow-up.
PMID: 20853058 [PubMed - in
process]
October 8, 2010
Int Angiol.
2010 Oct;29(5):454-70.
Diagnosis and treatment of primary
lymphedema. Consensus Document of the
International Union of
Phlebology
(IUP)-2009.
Lee B, Andrade M, Bergan J, Boccardo F, Campisi C,
Damstra R, Flour M,
Gloviczki P, Laredo J,
Piller N, Michelini S,
Mortimer P, Villavicencio JL.
Center for Vein, Lymphatics, and
Vascular Malformation, Division of
Vascular Surgery, Department
of
Surgery, Georgetown University School of Medicine, Washington DC, USA
-
[email protected].
Abstract
Primary
lymphedema can be managed safely as one of the chronic lymphedemas
by a
proper
combination of DLT with compression therapy. Treatment in the
maintenance
phase should include
compression garments, self management
including the compression therapy,
self massage and
meticulous personal
hygiene and skin care in addition to lymph-transport
promoting excercises.
The
management of primary lymphedema can be further improved with
proper
addition of surgical therapy
either reconstructive or ablative.
These two surgical therapies can be
effective only when fully
integrated
with MLD-based DLT postoperatively. Compliance with a long-term
commitment
of DLT
postoperatively is the most critical factor determining the success
of any
new treatment strategy with
either reconstructive or palliative
surgery. The future of management of
primary lymphedema caused
by
truncular lymphatic malformation has never been brighter with the
new
prospect of gene-oriented
management.
PMID: 20924350
[PubMed - in process]
Int Angiol. 2010
Oct;29(5):442-453.
Clinical trials needed to evaluate
compression therapy in breast cancer
related lymphedema (BCRL).
Proposals
from an expert group.
Partsch H, Stout N, Forner-Cordero I,
Flour M, Moffatt C, Szuba A, Milic
D, Szolnoky G, Brorson
H, Abel M,
Schuren J, Schingale F, Vignes S, Piller N, Döller
W.
Dermatology, Medical University of Vienna, Vienna, Austria2
Breast Care
Department, National
Naval Medical Center, Bethesda, MD, USA3
Specialist in Physical Medicine
and Rehabilitation,
Valencia, Spain4
Dermatology, University Hospital KU Leuven, Belgium5
Glasgow Medical
School,
Glasgow, UK6 Department of Internal Medicine, Wroclaw Medical
University,
Wroclaw, Poland7
Department of Physiotherapy, Wroclaw School
of Physical Education,
Wroclaw, Poland8 Clinic for
Vascular Surgery,
University Clinical Centre Nis, Nis, Serbia9 Department
of Dermatology
and
Allergology, University of Szeged, Szeged, Hungary10Department of
Clinical
Sciences Malmö, Lund
University, Plastic and Reconstructive
Surgery, Malmö University Hospital,
Malmö,
Sweden11Lohmann &
Rauscher, Rengsdorf, Germany12Medical Markets
Laboratory,
Neuss,
Germany13Lympho-Opt Clinic, Pommelsbrunn, Germany14Department
of
Lymphology, Hôpital
Cognacq-Jay, Paris, France15Department of Surgery,
School of Medicine,
Flinders Medical Centre,
Bedford Park South,
Australia16Center of Lymphology, General Hospital
Wolfsberg, Austria -
nicole.
[email protected].
Abstract
AIM:
A mainstay of lymphedema management involves the use of compression
therapy.
Compression
therapy application is variable at different levels of disease
severity.
Evidence is scant to direct clinicians
in best practice
regarding compression therapy use. Further, compression
clinical trials are
fragmented
and poorly extrapolable to the greater population. An ideal
construct for
conducting clinical trials in
regards to compression
therapy will promote parallel global initiatives
based on a standard
research
agenda. The purpose of this article is to review current evidence
in
practice regarding compression
therapy for BCRL management and based
on this evidence, offer an expert
consensus
recommendation for a research
agenda and prescriptive trials.
Recommendations herein focus solely
on
compression interventions.
METHODS: This document
represents the proceedings of a session organized
by the
International
Compression Club (ICC) in June 2009 in Ponzano (Veneto,
Italy). The
purpose of the meeting was to
enable a group of experts to
discuss the existing evidence for compression
treatment in breast
cancer
related lymphedema (BCRL) concentrating on areas where
randomized
controlled trials (RCTs) are
lacking.
RESULTS:
The current body of research suggests efficacy of compression
interventions
in the
treatment and management of lymphedema. However, studies to date
have
failed to adequately
address various forms of compression therapy
and their optimal application
in BCRL. We offer
recommendations for
standardized compression research trials for
prophylaxis of arm lymphedema
and
for the management of chronic BCRL. Suggestions are also made
regarding;
inclusion and exclusion
criteria, measurement methodology and
additional variables of interest for
researchers to
capture.
CONCLUSION: This document should inform future research
trials in
compression therapy and serve
as a guide to clinical
researchers, industry researchers and lymphologists
regarding the
strengths,
weaknesses and shortcomings of the current literature. By
providing this
construct for research trials,
the authors aim to support
evidence-based therapy interventions, promote a
cohesive,
standardized
and informative body of literature to enhance clinical
outcomes, improve
the quality of future research
trials, inform industry
innovation and guide policy related to BCRL.
PMID: 20924349
[PubMed - as supplied by publisher]
Int Angiol. 2010
Oct;29(5):436-41.
Medical compression: effects on pulsatile leg
blood flow.
Mayrovitz HN, Macdonald JM.
Nova
Southeastern University, College of Medical Sciences, Ft Lauderdale,
FL,
USA2 Miller School
of Medicine, University of Miami, Miami, FL, USA - [email protected].
Abstract
AIM:
Leg compression bandaging is the mainstay of venous ulcer treatment,
yet
little is known about
the impact of therapeutic compression levels on
arterial haemodynamics. In
this study, the effect of foot-
to-knee,
four-layer compression bandaging on below-knee arterial pulsatile
blood flow
was assessed
by nuclear magnetic resonance
flowmetry.
METHODS: In 14 healthy supine subjects, bilateral
pulsatile blood flow
measured at five below-knee
sites without
compression; and during compression of one leg to an average
malleolar
sub-bandage
pressure of 40.7±4.0 mmHg.
RESULTS: The
forefoot-to-knee compression bandaging caused a highly
significant
(P<0.001)
increase in the bandaged leg pulsatile blood flow due to
increases in both
peak flow and pulse width.
CONCLUSION: It
is hypothesized that arteriolar vasodilatation, induced
either myogenically
by
reduced transmural pressure or by vasodilatory substance release
triggered
by increased venous shear
stress and veno-arterial
interactions, possibly combined with altered
vascular compliance, produce
the
observed compression-related phenomenon. Whatever the mechanism(s),
the
finding of a compression-
associated pulsatile flow increase suggests
an arterial linkage, which may
play a role in the well-
documented
beneficial effects of compression bandaging in venous ulcer and
lymphedema
treatment.
Possible beneficial effects of the arterial flow-pulse increase
on venous
ulcer outcome may be related to
a decrease in leukocyte effects
in the distal microvasculature.
PMID: 20924348 [PubMed - in
process]
Int Angiol. 2010 Oct;29(5):392-4.
Limb
volume measurement: from the past methods to optoelectronic
technologies,
bioimpedance
analysis and laser based devices.
Cavezzi A,
Schingale F, Elio C.
Vascular Unit, Stella Maris Clinic and
Hippocrates Poliambulatory, S.
Benedetto del Tronto, Ascoli
Piceno, Italy
- [email protected].
Abstract
Accurate
measurement of limb volume is considered crucial to lymphedema
management.
Various non-
invasive methods may be used and have been validated in recent
years,
though suboptimal
standardisation has been highlighted in
different publications.
PMID: 20924339 [PubMed - in
process]
Skin Res Technol. 2010 Jul 6. doi:
10.1111/j.1600-0846.2010.00456.x. [Epub
ahead of
print]
Spatial variations in forearm skin tissue dielectric
constant.
Mayrovitz HN, Luis M.
College of
Medical Sciences, Nova Southeastern University, Ft. Lauderdale,
FL,
USA.
Abstract
Background: Tissue dielectric
constant (TDC) values measured at
300 MHz via the open-ended
coaxial line
reflection method depend on the effective measurement depth
and the
anatomical site being
evaluated. Measurements on the forearm have shown that
the TDC values
decrease with increasing
measurement depth but the spatial
variability of the TDC values among
forearm anatomical positions
is
unknown. Our goal was to characterize the extent of such spatial
variations.
Methods: In 30 healthy seated women (27.4±6.5
years), TDC was measured on
the forearm midline
and 1.2 cm medial and
lateral to the midline at sites 4, 8 and
12 cm distal to the antecubital
crease.
Results: The midline and medial TDC values increased
progressively from 4
to 8 to 12 cm sites (P<0.
001), with the largest
spatial gradient along the midline. At a depth of
2.5 mm, the TDC
values
increased from 26.3±2.8 to 27.4±3.4 to 28.4±3.7, with a maximum
difference
of 8.2±10.6%. For all
sites, the TDC values were significantly
(P<0.001) less for increasing
depths.
Conclusion: The
findings reveal increased TDC values along the forearm
from proximal to
distal, most
prominent at the midline and medial positions. Because many
skin-related
dermatological and
biophysical studies utilize the forearm
as a test target, such differences
may be important to consider
because
TDC values in part are reflective of local tissue water (LTW).
Although the
variation in the
TDC values among sites was less than 10%, such differences
are of
importance when evaluating LTW
changes using the TDC method in
patients with arm lymphedema that is
present in variable arm
anatomical
locations.
PMID: 20923455 [PubMed - as supplied by
publisher]
Acta Med Croatica. 2010
Jul;64(3):167-73.
[Compression therapy for lymphedema: our
experience]
[Article in Croatian]
Planinsek
Rucigaj T, Tlaker Zunter V, Miljković J.
University Department
of Dermatovenereology, Ljubljana University Hospital
Center,
Ljubljana,
Slovenia. [email protected]
Abstract
The
term lymphedema refers to a chronic, progressive edema, usually of a
limb,
due to insufficient
lymphatic flow. It may appear as a primary disturbance
or secondary to
other causes, e.g., after
infections or surgery. The most
common cause of lymphedema in the Western
world is cancer surgery
and/or
radiotherapy. The authors summarize the etiology, pathophysiology
and
clinical staging of
lymphedema. The diagnosis of lymphedema is usually based
on history and
clinical appearance.
However, lymphoscintigraphy is the
gold standard of imaging in doubtful
cases. Adequate and
early
compression therapy and good patient compliance are the cornerstones
of
management of
lymphedema. The authors present their experience with
compression therapy
for lymphedema. While
no differences were found in
the efficiency of compression therapy between
oncologic and
non-
oncologic patients, compression stockings of class III seemed to
be
efficient in the majority of
secondary lower limb lymphedemas but not
as maintenance therapy for
primary lower
limb
lymphedema.
PMID: 20922859 [PubMed - in
process]
Clin Dysmorphol. 2010 Sep 30. [Epub ahead of
print]
Cantu syndrome and
lymphoedema.
García-Cruz D, Mampel A, Echeverria MI, Vargas AL,
Castañeda-Cisneros G,
Davalos-Rodriguez
N, Patiño-Garcia B, Garcia-Cruz
MO, Castañeda V, Cardona EG, Marin-Solis
B, Cantu JM, Nuñez-
Reveles N,
Moran-Moguel C, Thavanati PK, Ramirez-Garcia S, Sanchez-Corona
J.
aInstituto de Genetica Humana 'Dr Enrique Corona Rivera'
bInstituto de
Enfermedades Cronico-
Degenerativas, Departamento de
Biologia Molecular y Genomica, Centro
Universitario de Ciencias de
la
Salud, Universidad de Guadalajara cHospital de Especialidades,
CMNO
dDivision de Medicina
Molecular, CIBO, CMNO, IMSS eHospital General
Regional 46 fHospital
General Regional 45,
IMSS, Guadalajara, Jalisco,
Mexico gInstituto de Genetica de la Facultad
de Ciencias Medicas de
la
Universidad Nacional de Cuyo, Mendoza,
Argentina.
Abstract
Three female patients with
Cantu syndrome were studied, two of whom were
adults presenting with
the
complication of lymphoedema, as described earlier in a male patient
with
this syndrome. The aim of this
study is to report the clinical
characteristics of these three new cases
and to emphasize
that
lymphoedema, as observed in two of the patients described here, has
been
observed in 11.5% of
patients with Cantu syndrome and that
heterochromia iridis, observed in
one patient, is probably a new
feature
of this condition.
PMID: 20890180 [PubMed - as supplied by
publisher]
Am J Trop Med Hyg. 2010
Oct;83(4):884-90.
Elevated levels of plasma angiogenic factors
are associated with human
lymphatic filarial
infections.
Bennuru S, Maldarelli G, Kumaraswami V, Klion AD,
Nutman TB.
Laboratory of Parasitic Diseases, National Institute
of Allergy and
Infectious Diseases, National
Institutes of Health,
Bethesda, Maryland 20892, USA. [email protected]
Abstract
Lymphatic
dilatation, dysfunction, and lymphangiogenesis are hallmarks of
patent
lymphatic filariasis,
observed even in those with subclinical
microfilaremia, through processes
associated, in part, by
vascular
endothelial growth factors (VEGFs). A panel of pro-angiogenic
factors was
measured in the
plasma of subjects from filaria-endemic regions using
multiplexed
immunological assays. Compared
with endemic normal control
subjects, those with both subclinical
microfilaremia, and those
with
longstanding lymphedema had significantly elevated levels of
VEGF-A,
VEGF-C, VEGF-D, and
angiopoietins (Ang-1/Ang-2), with only levels
of basic fibroblast growth
factor (bFGF) and placental
growth factor
(PlGF) being elevated only if lymphedema was evident.
Furthermore, levels of
these
factors 1-year post-treatment with doxycycline were similar
to
pretreatment levels suggesting a minimal
role, if any, for Wolbachia.
Our data support the concept that filarial
infection per se is associated
with
elevated levels of most of the known pro-angiogenic factors, with only
a
few being associated with the
serious pathologic consequences
associated with Wuchereria bancrofti
infection.
PMID:
20889885 [PubMed - in process]PMCID: PMC2946762 [Available
on
2011/10/5]
Genes Dev. 2010 Oct
1;24(19):2115-26.
Current views on the function of the lymphatic
vasculature in health and
disease.
Wang Y, Oliver
G.
Department of Genetics and Tumor Cell Biology, St. Jude
Children's
Research Hospital, Memphis,
Tennessee 38105,
USA.
Abstract
The lymphatic vascular system is
essential for lipid absorption, fluid
homeostasis, and
immune
surveillance. Until recently, lymphatic vessel dysfunction had
been
associated with symptomatic
pathologic conditions such as
lymphedema. Work in the last few years had
led to a better
understanding
of the functional roles of this vascular system in health
and disease.
Furthermore, recent
work has also unraveled additional functional roles of
the lymphatic
vasculature in fat metabolism,
obesity, inflammation, and
the regulation of salt storage in hypertension.
In this review, we
summarize
the functional roles of the lymphatic vasculature in health and
disease.
PMID: 20889712 [PubMed - indexed for
MEDLINE]
Ann Vasc Surg. 2010 Oct 2. [Epub ahead of
print]
Vena Cava Thrombectomy and Primary Repair after Radical
Nephrectomy for
Renal Cell Carcinoma:
Single-Center
Experience.
Helfand BT, Smith ND, Kozlowski JM, Eskandari
MK.
Department of Urology, Northwestern University Feinberg
School of
Medicine, Chicago,
IL.
Abstract
BACKGROUND: Inferior vena cava (IVC)
reconstruction for locally advanced
renal cell carcinoma
(RCC) includes
resection with and without interposition grafting, patch
graft, or primary
repair. The
proposed benefits of lateral venorrhaphy and primary repair are
avoidance
of foreign material, a more
expeditious repair, and
preservation of lower extremity venous outflow.
METHODS: A
single-center retrospective review of 22 patients with RCC and
IVC tumor
thrombus
treated with radical nephrectomy, lateral venorrhaphy,
thrombectomy, and
primary vena cava repair
between July 2002 and June
2009 was carried out. Demographic data,
diagnostic
information,
radiographic cross-sectional imaging, and procedural outcomes
were examined.
RESULTS: Among the 13 men and nine women, the
mean age was 62.1 years
(42-83); mean tumor
size was 9.8 cm (3-17 cm),
and 90% (n = 18) of the cases with RCC were
identified pathologically
as
clear cell adenocarcinoma; on the basis of the classification
system
adopted by Neves, level I was for
50% (n = 11), level II for 32%
(n = 7), level III for 9% (n = 2), and
level IV for 9% (n = 2) of
the
patients. All patients underwent en bloc radical nephrectomy with
tumor
thrombus removal and primary
IVC repair. Mean total operative time
was 547.9 ± 138.5 minutes, whereas
mean IVC cross-clamp
time was 10.8
minutes (6-29 minutes). There were no intraoperative deaths
or pulmonary
embolism
and all IVC margins were found to be pathologically
negative.
Postoperative complications included
one pulmonary embolism,
one exacerbation of chronic lymphedema, and two
cases of new
onset
erectile dysfunction. Mean follow-up was 36.4 ± 23.2 months (6-92
months).
There were no
radiographic or clinically significant changes in
mean IVC diameter during
follow-up. Five late deaths
(23%) occurred as a
result of metastatic RCC over a mean period of 24
months (range, 12-48),
but
without any local recurrences.
CONCLUSION: For advanced
RCC with tumor thrombus extension into the IVC,
lateral
venorrhaphy and
primary IVC repair avoids complicated caval
reconstructions and results in
high
patency rates with a low local tumor recurrence
rate.
PMID: 20889305 [PubMed - as supplied by
publisher]
Phlebology. 2010 Oct;25 Suppl
1:52-63.
From lymph to fat: complete reduction of
lymphoedema.
Brorson H.
Department of Plastic and
Reconstructive Surgery, Lund University, Skåne
University Hospital,
SE-
205 02 Malmö, Sweden.
Abstract
Liposuction
for late-stage lymphoedema remains a controversial technique.
While it is
clear that
conservative therapies such as combined decongestive therapy
(CDT) and
controlled compression
therapy (CCT) should be tried in the
first instance, options for the
treatment of late-stage lymphoedema
that
is not responding to treatment is not so clear. Liposuction has been
used
for many years to treat
lipodystrophy. Some results have been far from
optimal; however,
improvements in technique, patient
preparation and
patient follow-up have led to a greater and a wider
acceptance of
liposuction as a
treatment for lymphoedema. This paper outlines the benefits
of using
liposuction and presents the
evidence to support its
use.
PMID: 20870820 [PubMed - in
process]
October 15, 2010
Ginecol
Obstet Mex. 2010 Jul;78(7):345-51.
[Laparoscopic radical
hysterectomy with lymphatic mapping and sentinel
lymph node biopsy in
early
cervical cancer][Article in Spanish]
Maffuz A, Quijano
F, López D, Hernández-Ramírez D.
División de Cirurgía, Departamento de
Ginecología Oncológica, Hospital de
Oncología, Centro
Médico Nacional
Siglo XXI, Instituto Mexicano del Seguro Social, DF
México.
tonomaffuz@yahoo.
com
Abstract
BACKGROUND: in
patients with early-stage cervical cancer (FIGO IA, IB2 and
IIA), the
incidence
of lymph node metastases is up to 15%; the majority of early
cervical
cancer patients with pelvic and
para-aortic lymphadenectomy does
not benefit with the procedure and are at
risk of associated
morbidity
(linfocyst, lymphedema, vascular or nerve damage).
OBJECTIVE: To
describe the experience and usefulness of lymphatic mapping
and sentinel
lymph
node with total laparoscopic radical hysterectomy in early stage
cervical
cancer. Patients and method:
Retrospective study in patients
with diagnosis of cervical cancer in early
stage, submitted
to
laparoscopic radical hysterectomy with lymphatic mapping and
sentinel
lymph node biopsy. We
analyzed sentinel lymph node
identification, false negative rate and
surgical
variables.
RESULTS: in 36 months 15 patients were included, two
in IA2 FIGO stage,
twelve IB1 and one IIA;
thirteen patients were mapping
with combined technique and two only with
dye. The sentinel lymph
node
identification rate was 87% (two failures in the patients using only
blue
dye); the false negative
rate was 0%.
CONCLUSION:
Laparoscopic radical hysterectomy with lymphatic mapping is a
secure
technique for
patients with early stage cervical cancer; it allows the
correct
identification of lymph node status as the
principal prognostic
factor. We recommend the use of combined technique
(radiocolloid tracer
and
blue dye) for best rate sentinel lymph node
identification.
PMID: 20931810 [PubMed - in
process]
Cancer. 2010 Oct 13. [Epub ahead of
print]
The effects of body mass index on complications and
survival outcomes in
patients with cervical
carcinoma undergoing curative
chemoradiation therapy.
Kizer NT, Thaker PH, Gao F, Zighelboim
I, Powell MA, Rader JS, Mutch DG,
Grigsby PW.
Division of
Gynecologic Oncology, Washington University School of
Medicine, St. Louis,
Missouri.
Abstract
BACKGROUND: The effect of body
mass index (BMI) on treatment outcomes for
patients with
locally advanced
cervical carcinoma who receive definitive chemoradiation
is
unclear.
METHODS: The cohort in this study included all patients
with cervical
carcinoma (n = 404) who had
stage IB(1) disease and
positive lymph nodes or stage ≥IB(2) disease
and received treatment at
the
authors' facility between January 1998 and January 2008. The
mean
follow-up was 47.2 months. BMI
was calculated using the National
Institute of Health online calculator.
BMI categories were
created
according to the World Health Organization classification system.
Primary
outcomes were overall
survival, disease-free survival, and
complication rate. Univariate and
multivariate analyses were
performed.
Kaplan-Meier survival curves were generated and compared using
Cox
proportional
hazard models.
RESULTS: On multivariate
analysis, compared with normal weight (BMI
18.5-24.9 kg/m(2)), a
BMI
<18.5 kg/m(2) was associated with decreased overall survival
(hazard
ratio, 2.37; 95% confidence
interval, 1.28-4.38; P < .01). The
5-year overall survival rate was 33%,
60%, and 68% for a of BMI
<18.5
kg/m(2), a BMI from 18.5 kg/m(2) to 24.9 kg/m(2), and a BMI
>24.9
kg/m(2), respectively. A
BMI <18.5 kg/m(2) was associated
with increased risk of grade 3 or 4
complications compared with a
BMI
>24.9 kg/m(2) (radiation enteritis: 16.7% vs 13.6%, respectively; P
=
.03; fistula: 11.1% vs
8.8%, respectively; P = .05; bowel obstruction:
33.3% vs 4.4%,
respectively; P < .001; lymphedema:
5.6% vs 1.2%,
respectively; P = .02).
CONCLUSIONS: Underweight patients (BMI
< 18.5 kg/m(2)) with locally
advanced cervical cancer
had diminished
overall survival and more complications than normal weight
and obese
patients. Cancer
2010. © 2010 American Cancer Society.
PMID: 20945318
[PubMed - as supplied by publisher]
October 26,
2010
Br J Community Nurs. 2010
Oct;15(10):26-30.
Microfine glove and toe caps and their use in
lymphoedema management.
Close
G.
Abstract
Lymphoedema garments have progressed
in the last 10 years, so gone are the
days when only one
colour is
available (that lovely beige!). How many patients would have to
be persuaded
to wear their
compression hosiery in that desirable colour? Not just have
the colours
become more acceptable, so
have the fabrics. There are a wide
range of compression gloves available
to the lymphoedema specialist
to
fit on the patient but that cannot be said of toe caps. The Microfine
toe
cap is the only one available
as an off-the-shelf garment, and when the
lymphoedema is deemed to be
manageable in these
garments, it offers an
alternative to flat knit. The Microfine glove and
Microfine toe cap are
adaptable
and can offer colour options and a fabric that is less bulky and
fine. It
also allows therapists to trim the
length of each digit for a
better fit without reducing compression. The
author will present three
case
studies of patients that are using.
PMID: 20966839
[PubMed - in process]
Br J Community Nurs. 2010
Oct;15(10):17-21.
Key-worker clinics: the maintenance phase of
lymphoedema therapy.
Green
T.
Abstract
This article describes the
development of services for patients with mild
and
uncomplicated
lymphoedema through a network of community-based staff nurses
specially
trained in the management
of mild and uncomplicated lymphoedema
in order to deliver an integrated
service across the acute
foundation and
primary care trusts . Government policies, increasing
referral rates and
patients with
complex co-morbidity requiring intensive treatments had
prompted a review
of the service provision to
examine ways to deliver an
efficient and cost-effective service across the
local health economy.
Patients
with mild and uncomplicated lymphoedema do not necessarily
require
specialist care but can be
managed effectively by key workers
with appropriate training and skills
(British Lymphology Society,
2001a;
b; Lymphoedema Framework, 2006). This development demonstrates the
benefit
of training
existing community staff, using their existing skills. Providing
access to
clinics within the primary care
setting helps to provide a
cost-effective, structured and co-ordinated
care pathway at all levels
of
intervention, ultimately improving treatment outcomes and
patient
satisfaction. A cohort of community
staff nurses were identified
and trained in the provision of lymphoedema
management to key
worker
level, providing the opportunity to develop a lymphoedema service
based
upon health-care need and
not disease site as has occurred with
other national developments. These
clinics offer the same advice,
support
and monitoring of the patients condition alongside education and
information
in a more locally
accessible setting, avoiding the need for hospital
visits.
PMID: 20966836 [PubMed - in process]
Br J
Community Nurs. 2010 Oct;15(10):14-6.
Management of the
bariatric patient with lymphoedema: South West Wales.
Coveney
E.
Abstract
Twenty-four percent of adults (age 16
and over) in England are classified
as obese. This represents an
increase
from 15% in 1993. (NHS Information Centre, 2008). As obesity
rates increase
across the
UK lymphoedema services face increasing numbers of obese patients
in their
clinics. This short article
will explore some ideas of how we
manage this patient group at present in
our lymphoedema
service.
Management of lymphoedema involves what are considered the
four
cornerstones of care: daily skin
care, movement and exercise,
maintaining weight in the healthy range and
wearing compression
garments
daily. While it is considered helpful for overweight/obese
patients to lose
weight to improve
the management of lymphoedema, it is not always easy for
patients to make
the necessary lifestyle
changes, particularly for those
patients with a body mass index (BMI) over
35
(bariatric).
PMID: 20966835 [PubMed - in
process]
Br J Community Nurs. 2010
Oct;15(10):4-12.
Chronic oedema and lymphoedema of the lower
limb.
Hampton S.
Abstract
There is
a very fine line between oedema, chronic oedema, lymph venous
oedema and
lymphoedema
with the names 'chronic oedema'and 'lymphoedema' often
used
interchangeably. Therefore, there can
be difficulty with diagnosis
of which condition is present in the
individual patient, particularly
when
another unrelated condition (lipoedema) can also be mistakenly
diagnosed
as lymphoedema. The most
important thing to remember is that,
although there is this fine line
between the conditions, each part of
the
disease development cannot be entirely separated or treated completely
in
isolation. The key to
good outcomes in lymphovenous oedema is to treat it at
the earliest stage
possible to prevent
deterioration, venous ulceration
and the almost inevitable cellulitis that
is associated with
lymphoedema
skin changes. This article will aim to promote an understanding
of the
different conditions and stages,
will provide a simple
identification of the condition and will discuss how
lymphovenous oedema
can
lead eventually to the very difficult-to-treat chronic lymphoedema
with
ideas of how to prevent this
deterioration.
PMID:
20966834 [PubMed - in process]
Br J Community Nurs. 2010
Oct;15(10):3-Unknown.
Change is afoot, are you
ready?
Pike C.
Abstract
Treatment
starts with a patient's willingness to take on board the basics
of
lymphoedema management,
without this, their commitment to further treatment
would be in question.
However, most services are
now over-prescribed and
many are looking into referral criteria, but to
deny a person treatment
based
on their BMI is not sound practice; to exclude anyone on the grounds
of
their size or weight would be
unethical and may result in legal
repercussions. To avoid such situations,
community nurses can
encourage
GPs to teach their patients the importance of skin care and
exercise. If a
patient does not
take this advice on board, you can explain to the GP that
you can only
commence treatment once the
patient has complied with the
advice given. The latest government
initiatives to save costs and
reduce
overheads mean that services are being scrutinized for
cost-saving
potentials. A simple means of
proving your service's
viability is by keeping statistical records of all
staff daily activities
and treatments.
A database can be drawn up to compare, for example, cancer
and non-cancer
lymphoedema, by
looking at the number of patient contacts
for first assessments, follow
ups, intensive treatments and
record of
time in units. The database I created at Singleton Hospital's
Lymphoedema
Service enables
us to prove each staff member's activity and value for money
(if you would
like a copy, email me:
[email protected]). Approaching various
companies for discount
incentives will show a
willingness to work with
manufacturers in further reducing costs on
your
service.
PMID: 20966833 [PubMed - in
process]
--------------------
November 5,
2010:
Ann Plast Surg. 2010 Oct 29. [Epub ahead of
print]
Optimizing Outcome of Charles Procedure for Chronic Lower
Extremity
Lymphoedema.
Karri V, Yang MC, Lee IJ, Chen SH, Hong JP, Xu
ES, Cruz-Vargas J, Chen HC.
From the *Department of Plastic and
Reconstructive Surgery, E-Da
Hospital/I-Shou University,
Kaohsiung
County; †Department of Public Health, Institute of Health
Organization
Administration,
College of Public Health, National Taiwan University,
Taiwan, Republic of
China; ‡Department of
Plastic and Reconstructive
Surgery, Ajou University Hospital, Suwon City;
§Department of Plastic
and
Reconstructive Surgery, Asan Medical Center, Seoul, South Korea;
and
¶China Medical University
Hospital, Taichung, Taiwan, Republic of
China.
Abstract
BACKGROUND: Charles procedure for
late-stage lower limb lymphoedema (LLL)
is often criticized
for its
unpredictable and poor result. We have adopted a systematic
approach to
optimize outcome of
patients treated with this excisional
surgery.
METHODS: From June 2004 to March 2009 we performed
Charles procedure on 1
lower limb of 19
women and 8 men with late-stage
LLL. Mean age and follow-up was 48 (range,
16.5-77.8) years and
21.6
(range, 1.5-48) months, respectively.
RESULTS: Average inpatient
stay was 27 (range, 11-54) days. After
discharge, 16 (59.3%)
patients
underwent further minor surgery. The most frequent complication was
a
single, short episode of
cellulitis, affecting 5 (18.5%) patients.
Self-reported mobility was
either the same or improved at 6
months, and
appearance of their limbs satisfactory.
CONCLUSIONS: Charles
procedure is an effective treatment for selected
patients and by
applying
our systematic approach, a positive outcome can be
achieved.
PMID: 21042186 [PubMed - as supplied by
publisher]
World J Surg Oncol. 2010 Nov 1;8(1):94. [Epub ahead
of print]
Management options for vulvar carcinoma in a low
resource setting.
Eke AC, Alabi-Isama LI, Akabuike
JC.
ABSTRACT:
BACKGROUND: Vulvar carcinoma is a
rare tumor of the female genital tract.
In Nigeria, very few
studies have
looked at the management options for vulvar carcinoma. The
objective of this
study was
therefore, to describe the management options available and the
challenges
in treating this malignancy
in
Nigeria.
METHODS: A descriptive study of all vulvar cancer
cases managed at the
Nnamdi Azikiwe University
Teaching Hospital, Nnewi
over a 12 year period (1998-2009). The theatre,
ward register,
histo-
pathologic records and case notes of all women who had surgery for
vulvar
carcinomas were retrieved
and socio-demographic characteristics,
clinical presentation, type of
surgery, histologic type and
complications
of treatment were retrieved and analyzed.
RESULTS: There were
867 gynecological malignancies and vulval carcinoma
accounted for 11
cases,
giving a prevalence of 1.27%. The ages ranged from 54 to 79 years
with a
mean of 61.2 years. The
parities of the women ranged from 2-14.
Most of the patients were of low
socio-economic class. All
the 11
patients had surgery as 1st line treatment.
Radical vulvectomy was done
for 6 cases since they presented in the
advanced stage. The
complications
of surgery included hemorrhage (18.2%), chronic lymphedema,
wound infection
and
anesthetic complications. There were no hospital mortalities.
Late
presentation, with stage III (45.4%)
was the commonest stage at
presentation while the majority of the vulvar
carcinomas (72.7%) were
of
epithelial origin. Squamous cell carcinoma predominated
(63.6%).
CONCLUSION: Carcinoma of the vulva is a rare
gynecological malignancy in
Nigeria. Surgery and
radiotherapy remain the
mainstay of this disease in Nigeria. Treatment can
be highly successful
if
patients present early.
PMID: 21040577 [PubMed - as
supplied by publisher]
Diabetes Res Clin Pract. 2010 Oct 28.
[Epub ahead of print]
Chronic interdigital dermatophytic
infection: A common lesion associated
with potentially
severe
consequences.
Vanhooteghem O, Szepetiuk G, Paurobally
D, Heureux F.
Department of Dermatology, Sainte Elisabeth
Hospital, B-5000 Namur,
Belgium; Department of
Dermatology, University
Hospital Sart Tilman, B-4000 Liège,
Belgium.
Abstract
Interdigital intertrigo and
onychomycosis has the potential cause of
severe bacterial
infectious
complications with pain, mobility problems, abscess,
erysipelas,
cellulitis, fasciitis and osteomyelitis. In
another hand,
diabetic neuropathy, which affects 60-70% of those with
diabetes mellitus,
is one of the
most troubling complications for persons with diabetes. These
people are
high suspecting to be infected
by dermatophytic infections in
interdigital spaces or onychomycosis witch
are frequently induce
damage
to the stratum corneum, leading to bacterial proliferation and
secondary
infection. A patient presented
with an asymptomatic warm,
painless, erythematous swelling of the second
left toe, which had
been
present for a few weeks. Clinically, the lesion was categorized
as
erysipelas upon an insidious abscess
formation. Further investigation
was undertaken to confirm the presence of
diabetes. Leg erysipelas is
a
common affection which, according to various studies, has both
local
concomitants (interdigital
intertrigo, lymphoedema, surgical
antecedents) and/or general causes
(immune suppression,
diabetes,
alcoholism, etc). Interdigital intertrigo, tinea pedis, and
onychomycosis
present as public health
problems that could trigger
serious deterioration in patient quality of
life, due to complications
induced
by secondary bacterial infections.
Copyright © 2010
Elsevier Ireland Ltd. All rights reserved.
PMID: 21035887
[PubMed - as supplied by publisher]
Presse Med. 2010 Oct 27.
[Epub ahead of print] [Primary lymphedema of
limbs.][Article in
French]
Vaillant L, Tauveron V.
Université
François-Rabelais de Tours, CHRU de Tours, 37044 Tours cedex
01, France;
CNRS FRE
2448, unité Inserm U930, 37044 Tours cedex,
France.
Abstract
Limb lymphedema is frequent and
not well-known. Clinical classification
distinguishes primary
lymphedemas
due to developmental disorders of the lymphatic system
(hereditary or not,
sometimes
associated with other malformations) and secondary lymphedemas.
Primary
lymphedema is a
lymphedema without a cause to explain lymphatic
impairment. It is due to
an abnormal
lymphangiogenesis in utero. It is
often associated with mutation in a gene
involved in
lymphangiogenesis
(FOX C2, VEGFR 3, SOX18, PROX 1…). To assess clinical
diagnosis,
non-invasive techniques are
able to study structure and
function of the lymphatic system (mainly
isotopic lymphography).
Treatment
is the complex decongestive therapy which associates manual
lymphatic
drainage and bandage.
Predisposing or precipitating factors
have to be treated (particularly
streptococcal infections).
Surgical
treatment has precise and rare indication.
Copyright © 2010
Elsevier Masson SAS. All rights reserved.
PMID: 21035299 [PubMed
- as supplied by publisher]
November 9, 2010:
J
Vis Exp. 2010 Oct 20;(44). pii: 2225. doi:
10.3791/2225.
Multispectral Real-time Fluorescence Imaging for
Intraoperative Detection
of the Sentinel Lymph
Node in Gynecologic
Oncology.
Crane LM, Themelis G, Buddingh T, Harlaar NJ,
Pleijhuis RG, Sarantopoulos
A, van der Zee AG,
Ntziachristos V, van Dam
GM.
Department of Surgery, Division of Surgical Oncology,
University Medical
Center
Groningen.
Abstract
The prognosis in virtually
all solid tumors depends on the presence or
absence of lymph
node
metastases.(1-3) Surgical treatment most often combines radical
excision
of the tumor with a full
lymphadenectomy in the drainage area of
the tumor. However, removal of
lymph nodes is associated
with increased
morbidity due to infection, wound breakdown and
lymphedema.(4,5) As an
alternative,
the sentinel lymph node procedure (SLN) was developed several
decades ago
to detect the first
draining lymph node from the tumor.(6) In
case of lymphogenic
dissemination, the SLN is the first
lymph node that
is affected (Figure 1). Hence, if the SLN does not contain
metastases,
downstream
lymph nodes will also be free from tumor metastases and need not
to be
removed. The SLN procedure
is part of the treatment for many tumor
types, like breast cancer and
melanoma, but also for cancer of
the vulva
and cervix.(7) The current standard methodology for
SLN-detection is by
peritumoral
injection of radiocolloid one day prior to surgery, and a
colored dye
intraoperatively. Disadvantages of
the procedure in cervical
and vulvar cancer are multiple injections in the
genital area, leading
to
increased psychological distress for the patient, and the use
of
radioactive colloid. Multispectral
fluorescence imaging is an emerging
imaging modality that can be applied
intraoperatively without the
need
for injection of radiocolloid. For intraoperative fluorescence
imaging, two
components are
needed: a fluorescent agent and a quantitative optical system
for
intraoperative imaging. As a
fluorophore we have used indocyanine
green (ICG). ICG has been used for
many decades to assess
cardiac
function, cerebral perfusion and liver perfusion.(8) It is an
inert drug
with a safe pharmaco-
biological profile. When excited at around 750 nm, it
emits light in the
near-infrared spectrum around
800 nm. A custom-made
multispectral fluorescence imaging camera system was
used.(9). The aim
of
this video article is to demonstrate the detection of the SLN
using
intraoperative fluorescence imaging in
patients with cervical and
vulvar cancer. Fluorescence imaging is used in
conjunction with the
standard
procedure, consisting of radiocolloid and a blue dye. In the
future,
intraoperative fluorescence imaging
might replace the current
method and is also easily transferable to other
indications like breast
cancer
and melanoma.
PMID: 21048667 [PubMed - in
process]
MED NEWS DOCS FORMATTED:
November 3,
2010 - Fox Chase Researchers Identify Risk Factors For The
Spread Of Breast
Cancer
To Lymph Nodes –
Breast cancer, one of the most
prevalent cancers in women, afflicts an
additional 200,000 women
each
year and causes about 40,000 deaths annually. The disease often extends
to
neighboring lymph nodes,
in part, through lymphovascular invasion
(LVI) - a process in which cancer
cells invade blood vessels
or the
lymphatic system - and can often translate into a poor prognosis
for
patients. Some scientists
argue that evidence of LVI does not necessarily
mean that the disease will
recur in the lymph nodes
after radiation to
the breast alone, but research from Fox Chase Cancer
Center now shows that
the
appearance of LVI in the breast tissue does in fact predict recurrence
of
breast in the regional lymph
nodes.
By carefully examining
recurrence patterns of thousands of women with
breast cancer from
records
spanning more than 30 years, Wilhelm Lubbe, M.D.,Ph.D., chief
resident in
Fox Chase's Radiation
Oncology Department, and his colleagues
have now shown that the appearance
of LVI in breast tissue
predicts the
future recurrence of cancer to nearby lymph nodes. "The
microscopic
diagnosis of LVI is
challenging which highlights the importance of excellent
pathologists,"
says Lubbe, who will present the
results this week at the
Annual Meeting of the American Society for
Radiation
Oncology.
Knowing that the disease is going to extend to neighboring
lymph nodes,
such as those in the armpit, is
important prognostically.
But it has still been unclear whether
supplementary radiation therapy
targeting
these areas improves outcomes.
"There still is a lot of
debate as to whether additional radiation to the
regional lymph nodes is
needed in
a woman with LVI," Lubbe says.
In the study, Lubbe's team
analyzed an extensive database of 3,082 breast
cancer patients
who
underwent whole-breast radiation or minimal surgical resection of
breast
tissue between 1970 and
2009. This dataset, at least twice as
large as many others of its kind,
provided enough statistical power
for
the investigators to detect a subtle, yet significant trend.
"Luckily,
at Fox Chase, we had the resources to maintain this huge
database by
meticulously following
a large number of patients over the course of
decades," Lubbe says.
The team searched for factors aside from LVI that
determine outcomes. The
disease was more likely
to invade lymph nodes in
women younger than 35. Also, additional radiation
therapy under the
armpit
via a technique called a posterior axillary boost (PAB) lead to
fewer
breast cancer recurrences in these
women's regional lymph nodes.
Ironically, this extra procedure led to less
regional recurrence
even
though the women were of higher risk than other treatment groups.
Overall,
the 10-year recurrence
rate was only 1.4%. But it was 4% for
women treated with radiation above
the collar bone alone,
compared to
0.5% for those who also received a PAB - the posterior boost
of radiation
under the
armpits.
"Our data suggest that patients who are at higher
risk of their cancer
spreading can potentially benefit
from additional
radiation by a technique called a posterior axillary
boost," Lubbe says.
"But the
recommendation to add radiation, and what technique is used, is
very
patient-specific, because with
any intervention there's additional
risk."
In the future, Lubbe would like to identify other objective
biological
markers, such as proteins or genes,
which predict recurrence
rates and patient outcomes. "Ultimately, we'd
like to find a faster and
more
accurate process for assessing the risk of cancer spread to regional
lymph
nodes and the rest of the
body," Lubbe
says.
Co-investigators include Tianyu Li, Penny Anderson, Lori
Goldstein,
Crystal Denlinger, Holly Dushkin,
Ramona Swaby, Richard
Bleicher, Elin Sigurdson and Gary Freedman.
November 5, 2010 -
Shire Presents Positive New Data At The 60th Annual
American Society
Of
Human Genetics (ASHG) For Patients With Type 1 Gaucher Disease
–
Shire plc (LSE: SHP, Nasdaq: SHPGY), the global
specialty
biopharmaceutical company, presented
positive new data from a
Phase III clinical trial (study 039) designed to
evaluate the efficacy
of
VPRIV® (velaglucerase alfa for injection) compared with imiglucerase
in
patients with type 1 Gaucher
disease at the 2010 Annual American
Society of Human Genetics (ASHG) in
Washington, D.C. The
study met its
primary endpoint and adds to the growing body of clinical
evidence which
supports the
use of VPRIV in patients who have transitioned from
imiglucerase or who
are treatment-naive.
In the 039
(head-to-head) study, adult and pediatric patients with type 1
Gaucher
disease were
included in a 9-month, global, randomized, double-blind,
non-inferiority
study comparing VPRIV with
imiglucerase in
treatment-naive patients aged >/= 2 years, with anemia and
either
thrombocytopenia or
organomegaly. Patients were randomized in a 1:1 ratio to
receive either
VPRIV or imiglucerase at a
dose of 60U/kg via continuous
infusion over one hour every other week for
39 weeks (total of
20
infusions per patient). 35 patients in 9 countries were randomized and
34
received the study drug
(intent-to-treat [ITT] population was 17 in
both the VPRIV and
imiglucerase groups). The per-
protocol (PP) analysis
included 15 patients in each group. Baseline
clinical characteristics
were
generally similar between the 2 groups, although hemoglobin
concentrations
appeared slightly higher in
the VPRIV group.
After
9 months of treatment, hemoglobin concentration improved in both
groups. The
estimated mean
treatment difference for hemoglobin concentration from
baseline between
patients treated with VPRIV
and imiglucerase was 0.14
and 0.16 g/dL in the ITT and PP populations,
respectively, with a
lower
bound of the 97.5% one-sided confidence interval of 0.60 g/dL in
both
populations, greater than the
pre-defined non-inferiority margin of
1.0 g/dL. These results indicate
that the primary endpoint was
met. Both
the VPRIV and imiglucerase groups showed substantial
improvements in the
secondary
endpoints, including platelet counts, spleen volume, liver volume,
and
plasma biomarkers with no
statistically significant difference
demonstrated between the treatment
groups. The majority of adverse
events
were mild or moderate in severity, including one serious adverse
event (SAE)
seen with VPRIV
which was an allergic skin reaction that resolved without
sequalae.
Shire also reported important findings that suggested
substantial
antigenic differences when antibody
response to treatment
with VPRIV and imiglucerase were compared. No
patient treated with
VPRIV
developed anti-drug antibodies while 4 patients in the imiglucerase
group
developed antibodies to
imiglucerase. Of these four imiglucerase
treated patients, 1 patient had
antibodies that inhibited enzyme
activity
in vitro and enzyme uptake in a cell-based assay. 3 patients had
antibodies
that did not inhibit
enzyme activity or uptake.
November 11,
2010 - Post-Treatment Condition Often Overlooked In Breast
Cancer Patients
–
As many as 70% of women with breast cancer develop painful
swelling of the
lymph nodes after
treatment, but the condition is
frequently ignored, misdiagnosed or
otherwise left untreated,
the
Washington Post reports. The condition, known as lymphedema, affects
three
million to five million
people in the U.S., including those who
have undergone treatment for
breast, prostate, ovarian and
other cancers.
Most research on lymphedema has focused on its connection
with breast cancer
surgery
and radiation.
Lymphedema develops when fluid
accumulates at or near the surgery site --
typically building up in
the
groin, the hands, the arms, the legs or the chest -- because of a
blockage
in the lymphatic system. Over
time, this causes swelling, which
"can get worse, becoming painful,
chronic and debilitating:
restricting
movement, impeding daily activities and requiring constant
care," the Post
reports. One patient profiled
in the story uses massage
and "wears special garments 24 hours a day to
deal with her
condition,"
according to the Post. Although cancer surgery is not the sole
cause of
lymphedema, "there is strong
evidence of cause and effect" when
patients undergo cancer surgeries
involving examination of the
lymph
nodes to determine whether the cancer has spread, the Post reports.
Few
doctors and hospitals acknowledge the risk for lymphedema when
discussing
surgery or cancer
treatment, and patient advocates note that it is not
mentioned in consent
forms signed prior to surgery
or treatment. The
criteria for diagnosing the condition are inconsistent;
thus, various
estimates about
lymphedema rates in women treated for breast cancer range
from 6% to 70%,
depending on which
criteria are used, how long after
surgery the studies are conducted and
which body parts
were
examined.
Judy Nudelman, a family physician at Brown University
who has lymphoma and
also treats patients
with the condition, said many
patients become frustrated because doctors
and hospitals tell them
"we
have zero incidence of lymphedema cases in our institution." According
to
the Post, some surgeons or
hospitals view lymphedema as a complication
and avoid mentioning it for
fear of developing a negative
reputation
(Mishori, Washington Post, 11/9).
Reprinted with kind permission from http://www.nationalpartnership.org.
You
can view the entire Daily
Women's Health Policy Report, search the archives,
or sign up for email
delivery here. The Daily
Women's Health Policy
Report is a free service of the National Partnership
for Women &
Families.
November 12, 2010
Cancer. 2010 Nov 8. [Epub
ahead of print]
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.
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
2010. © 2010 American Cancer
Society.
PMID: 21061344 [PubMed - as supplied by
publisher]
Am J Pathol. 2010 Nov 5. [Epub ahead of
print]
Blockade of Transforming Growth Factor-{beta}1
Accelerates Lymphatic
Regeneration during
Wound
Repair.
Avraham T, Daluvoy S, Zampell J, Yan A, Haviv YS,
Rockson SG, Mehrara BJ.
From the Division of Plastic and
Reconstructive Surgery,* Department of
Surgery, Memorial Sloan-
Kettering
Cancer Center, New York, New York; the Department of
Medicine,
Hadassah-Hebrew
University Medical Center, Jerusalem, Israel;
and the Division of
Cardiology, Department of Medicine,
Stanford
University Medical Center, Stanford,
California.
Abstract
Lymphedema is a complication
of cancer treatment occurring in
approximately 50% of patients
who
undergo lymph node resection. Despite its prevalence, the etiology of
this
disorder remains unknown.
In this study, we determined the effect of
soft tissue fibrosis on
lymphatic function and the role of
transforming
growth factor (TGF)-ß1 in the regulation of this response. We
determined
TGF-ß
expression patterns in matched biopsy specimens collected
from
lymphedematous and normal limbs of
patients with secondary
lymphedema. To determine the role of TGF-ß in
regulating tissue fibrosis,
we
used a mouse model of lymphedema and inhibited TGF-ß function
either
systemically with a
monoclonal antibody or locally by using a
soluble, defective TGF-ß
receptor. Lymphedematous tissue
demonstrated a
nearly threefold increase in the number of cells that
stained for TGF-ß1.
TGF-ß
inhibition markedly decreased tissue fibrosis,
increased
lymphangiogenesis, and improved lymphatic
function compared
with controls. In addition, inhibition of TGF-ß not only
decreased
TGF-ß
expression in lymphedematous tissues, but also diminished
inflammation,
migration of T-helper type 2
(Th2) cells, and expression of
profibrotic Th2 cytokines. Similarly,
systemic depletion of
T-cells
markedly decreased TGF-ß expression in tail tissues. Inhibition of
TGF-ß
function promoted lymphatic
regeneration, decreased tissue
fibrosis, decreased chronic inflammation
and Th2 cell migration,
and
improved lymphatic function. The use of these strategies may represent
a
novel means of preventing
lymphedema after lymph node
resection.
PMID: 21056998 [PubMed - as supplied by
publisher]
November 13, 2010
Cancer. 2010 Nov 8.
[Epub ahead of print]
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.
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
2010. © 2010 American Cancer
Society.
PMID: 21061344 [PubMed - as supplied by
publisher]
November 19, 2010
Arch Surg. 2010
Nov;145(11):1055-63.
Risk factors for lymphedema in a
prospective breast cancer survivorship
study: the pathways
study.
Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P,
Kutner SE, Kushi LH.
Kaiser Permanente Northern California,
Oakland, 94612, USA.
[email protected]
Comment
in:
Arch Surg. 2010
Nov;145(11):1063-4.
Abstract
OBJECTIVE: To
determine the incidence of breast cancer-related lymphedema
(BCRL) during
the
early survivorship period as well as demographic, lifestyle, and
clinical
factors associated with BCRL
development.
DESIGN:
The Pathways Study, a prospective cohort study of breast cancer
survivors
with a mean
follow-up time of 20.9 months.
SETTING: Kaiser
Permanente Northern California medical care
program.
PARTICIPANTS: We studied 997 women diagnosed from
January 9, 2006, through
October 15,
2007, with primary invasive breast
cancer and who were at least 21 years
of age at diagnosis, had no
history
of any cancer, and spoke English, Spanish, Cantonese, or
Mandarin.
MAIN OUTCOME MEASURE: Clinical indication for BCRL as
determined from
outpatient or
hospitalization diagnostic codes,
outpatient procedural codes, and durable
medical equipment
orders.
RESULTS: A clinical indication for BCRL was found in 133
women (13.3%),
with a mean time to
diagnosis of 8.3 months (range,
0.7-27.3 months). Being African American
(hazard ratio, 1.93;
95%
confidence interval, 1.00-3.72) or more educated (P for trend = .03)
was
associated with an increased
risk of BCRL. Removal of at least 1
lymph node (hazard ratio, 1.04; 95%
confidence interval, 1.02-
1.07) was
associated with an increased risk, yet no significant
association was
observed for type of
lymph node surgery. Being obese at breast cancer
diagnosis was suggestive
of an elevated risk (hazard
ratio, 1.43; 95%
confidence interval, 0.88-2.31).
CONCLUSIONS: In a large cohort
study, BCRL occurs among a substantial
proportion of early
breast cancer
survivors. Our findings agree with those of previous studies
on the
increased risk of
BCRL with removal of lymph nodes and being obese, but they
point to a
differential risk according to
race or
ethnicity.
PMID: 21079093 [PubMed - in
process]
Head Neck. 2010 Nov 12. [Epub ahead of
print]
Near-infrared fluorescence imaging of lymphatics in head
and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV,
Fife CE, Smith LA, Guilliod R,
Sevick-Muraca EM.
Division of
Cardiology and Hyperbaric Medicine, Department of Internal
Medicine at The
University of
Texas Health Science Center, Houston,
Texas.
Abstract
BACKGROUND: Lymphedema is a
complication that may occur after surgical
resection and
radiation
treatment in a number of cancer types and is especially
debilitating in
regions where treatment options
are limited. Although
upper and lower extremity lymphedema may be
effectively treated with
manual
lymphatic drainage (MLD) therapies and devices that use compression
to
direct proximal flow of lymph
fluids, head and neck lymphedema is more
challenging.
METHODS AND RESULTS: Herein, we describe the
compassionate use of an
investigatory
technique of near-infrared (NIR)
fluorescence imaging to understand the
lymphatic anatomy and
function,
help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor
response to
therapy in a patient with head and neck lymphedema after surgery
and
radiation treatment.
CONCLUSION: NIR fluorescence imaging
provides a mapping of functional
lymph vessels for
direction of efficient
MLD therapy in the head and neck. Additional
studies are needed to assess
the
efficacy of MLD therapy when directed by NIR fluorescence imaging. ©
2010
Wiley Periodicals, Inc.
Head Neck, 2010.
PMID:
21077150 [PubMed - as supplied by publisher]
Ann Dermatol
Venereol. 2010 Nov;137(11):727-9. Epub 2010 Sep 6.
[Unilateral
acneiform rash in facial palsy].
[Article in
French]
Kerob D, Hennequin V, Bousquet G, Behm E, Lebbe
C.
Hôpital Saint-Louis, AP-HP, Paris, France. [email protected]
Abstract
BACKGROUND:
Cetuximab is a chimeric monoclonal antibody selective for
epidermal growth
factor
receptor (EGFR). It is increasingly used in epithelial cancer, often
in
combination with radiotherapy or
chemotherapeutic agents, since it
induces a broad range of cellular
responses that enhance
tumour
sensitivity to these therapies. However, it can cause numerous
adverse
effects, the most common being
acneiform eruption on the face and
trunk, which is generally bilateral and
symmetric.
PATIENTS
AND METHODS: Herein we present the first case of
unilateral
cetuximab-induced
acneiform eruption in facial
palsy.
DISCUSSION: To our knowledge the medical literature
contains no other such
cases. Our hypothesis
is that lymphoedema
associated with facial palsy reduces lymphatic
drainage, promoting the
deposition
of cetuximab on EGFR and persistence of local
signs.
Elsevier Masson SAS. All rights
reserved.
PMID: 21074658 [PubMed - in
process]
November 20, 2010
Head Neck. 2010 Nov
12. [Epub ahead of print]
Near-infrared fluorescence imaging of
lymphatics in head and neck lymphedema.
Maus EA, Tan IC,
Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R,
Sevick-Muraca
EM.
Division of Cardiology and Hyperbaric Medicine, Department
of Internal
Medicine at The University of
Texas Health Science Center,
Houston, Texas.
Abstract
BACKGROUND: Lymphedema
is a complication that may occur after surgical
resection and
radiation
treatment in a number of cancer types and is especially
debilitating in
regions where treatment options
are limited. Although
upper and lower extremity lymphedema may be
effectively treated with
manual
lymphatic drainage (MLD) therapies and devices that use compression
to
direct proximal flow of lymph
fluids, head and neck lymphedema is more
challenging.
METHODS AND RESULTS: Herein, we describe the
compassionate use of an
investigatory
technique of near-infrared (NIR)
fluorescence imaging to understand the
lymphatic anatomy and
function,
help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor
response to
therapy in a patient with head and neck lymphedema after surgery
and
radiation treatment.
CONCLUSION: NIR fluorescence imaging
provides a mapping of functional
lymph vessels for
direction of efficient
MLD therapy in the head and neck. Additional
studies are needed to assess
the
efficacy of MLD therapy when directed by NIR fluorescence imaging. ©
2010
Wiley Periodicals, Inc.
Head Neck, 2010.
PMID:
21077150 [PubMed - as supplied by publisher]
November 27,
2010
Vopr Kurortol Fizioter Lech Fiz Kult. 2010
Jul-Aug;(4):42-8.
[Topical problems of the diagnosis and
rehabilitative treatment of
lymphedema of the lower
extremities].
[Article in Russian]
[No authors
listed]
Abstract
The present review of the
literature data highlights modern approaches to
and major trends
in
diagnostics and conservative treatment of lymphedema of the
lower
extremities based on the
generalized world experience. Patients
with lymphedema of the lower
extremities comprise a "difficult
to manage"
group because the disease is characterized by steady
progression and
marked
refractoriness to various conservative therapeutic modalities
creating
problems for both the patient and
the attending physician.
Modern methods for the diagnosis of lymphedema
are discussed with
special
reference to noninvasive and minimally invasive techniques (such
as
lymphoscintiography, computed
tomography, MRT, laser Doppler
flowmetry, etc.). During the last 20 years,
combined conservative
therapy
has been considered as the method of choice for the management of
different
stages and forms
of lymphedema of the lower extremities in foreign clinics.
The basis of
conservative therapy is
constituted by manual lymph drainage
(MLD), compression bandages using
short-stretch materials,
physical
exercises, and skin care (using the method of M. Foldi). Also
reviewed are
the main
physiobalneotherapeutic methods traditionally widely applied for
the
treatment of lymphedema of the
lower extremities in this country.
Original methods for the same purpose
developed by the authors
are
described including modifications of cryotherapy, pulsed
matrix
laserotherapy, hydro- and
balneotherapy. Mechanisms of their
therapeutic action on the main
pathogenetic factors responsible for
the
development of lymphedema (with special reference to lymph transport
and
formation) are
discussed. The principles of combined application of
physiotherapeutic
methods for the rehabilitative
treatment of patients
presenting with lymphedema of the lower extremities
are briefly
substantiated.
Special emphasis is laid on their influence on major
components of the
pathological process.
PMID: 21089207
[PubMed - in process]
November 30, 2010
J Plast Reconstr
Aesthet Surg. 2010 Nov 17. [Epub ahead of print]
Simultaneous
multi-site lymphaticovenular anastomoses for primary lower
extremity and
genital
lymphoedema complicated with severe
lymphorrhea.
Yamamoto T, Koshima I, Yoshimatsu H, Narushima M,
Miahara M, Iida T.
Department of Plastic and Reconstructive
Surgery, Graduate School of
Medicine, University of Tokyo,
7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655 Japan.
Abstract
Primary
lower extremity and genital lymphoedema (GL) is difficult to
manage,
especially when
complicated with severe lymphorrhea. With abundant
experience of treatment
for lower-extremity
lymphoedema (LEL), we
performed simultaneous multi-site lymphaticovenular
anastomoses
(LVAs)
for GL with severe lymphorrhea. In two cases of primary LEL and GL,
LVAs
were performed via 2-
cm-long skin incisions using two to three
operating microscopes under
local anaesthesia. Symptoms of
oedema and
lymphorrhea improved clinically. LVA is a minimally invasive
surgery, which
is effective
for the treatment of LEL and GL even in primary cases with
severe
lymphorrhea. Simultaneous multi-
site LVAs can serve as the most
effective therapy for lymphoedema.
2010 British Association of
Plastic, Reconstructive and Aesthetic
Surgeons. Published by Elsevier
Ltd.
All rights reserved.
PMID: 21093398 [PubMed - as
supplied by publisher]
Rev Med Interne. 2010 Nov 17. [Epub ahead
of print]
[Inflammatory bowel disease and lower limb lymphedema:
A fortuitous
association?][Article in French]
Arrault M,
Blanchard M, Vignes S.
Unité de lymphologie, hôpital Cognacq-Jay, 15,
rue Eugène-Millon, 75015
Paris,
France.
Abstract
INTRODUCTION: Extra-intestinal
manifestations of chronic inflammatory
bowel disease (CIBD) are
various.
Cases of genital lymphedema has previously been reported in
Crohn's
disease.
CASE REPORTS: We report two women aged 57 and 68 years
who presented with
a lower limb
lymphedema 8 and 20 years after a
diagnosis of CIBD (Crohn's disease and
ulcerative colitis),
respectively.
At the time of diagnosis of lymphedema, CIBD was
asymptomatic.
CONCLUSION: Pathophysiological mechanisms of this
rare manifestation are
unclear and
lymphedema outcome is unrelated to
CIBD activity.
Copyright © 2010. Published by Elsevier
SAS.
PMID: 21093120 [PubMed - as supplied by
publisher]
J Med Case Reports. 2010 Nov 18;4(1):369. [Epub ahead
of print]
Vulval elephantiasis as a result of tubercular
lymphadenitis: two case
reports and a review of
the
literature.
Chintamani, Singh J, Tandon M, Khandelwal R,
Aeron T, Jain S, Narayan N,
Bamal R, Kumar Y,
Srinivas S, Saxena
S.
ABSTRACT:
INTRODUCTION: Elephantiasis as a
result of chronic lymphedema is
characterized by gross
enlargement of the
arms, legs or genitalia, and occurs due to a variety of
obstructive diseases
of the
lymphatic system. Genital elephantiasis usually follows common
filariasis
and lymphogranuloma
venereum. It may follow granuloma
inguinale, carcinomas, lymph node
dissection or irradiation
and
tuberculosis but this happens rarely. Vulval elephantiasis as
a
consequence of extensive lymph node
destruction by tuberculosis is very
rare. We present two very unusual
cases of vulval elephantiasis due
to
tuberculous destruction of the inguinal lymph nodes.
CASE
PRESENTATION: Two Indian women - one aged 40 years and the other aged
27
years, with
progressively increasing vulval swellings over a period of five
and four
years respectively - presented to
our hospital. In both cases,
there was a significant history on
presentation. Both women had
previously
taken a complete course of anti-tubercular treatment for
generalized
lymphadenopathy. The vulval
swellings were extremely large:
in the first case report, measuring
35x25cm on the right side and
45x30cm
on the left side, weighing 20lb and 16lb respectively. Both cases
were
managed by surgical
excision with reconstruction and the outcome was
positive. Satisfactory
results have been maintained
during a follow-up
period of six years in both cases.
CONCLUSIONS: Elephantiasis of
the female genitalia is unusual and it has
rarely been reported
following
tuberculosis. We report two cases of vulval elephantiasis as a
consequence
of extensive
lymph node destruction by tuberculosis, in order to highlight
this very
rare clinical scenario.
PMID: 21092075 [PubMed - as
supplied by publisher]
-------------------
December 3,
2010
Arch Surg. 2010 Nov;145(11):1063-4.
Risky
business: Identifying risk factors associated with lymphedema after
breast
cancer: Comment on
"Risk factors for lymphedema in a prospective breast
cancer survivorship
study".
Hunt KK, Cormier
JN.
Department of Surgical Oncology, University of Texas MD
Anderson Cancer
Center, Houston,
77030, USA.
Comment
on:
Arch Surg. 2010 Nov;145(11):1055-63.
PMID:
21121095 [PubMed - in process]
December 21, 2010
Am J
Surg Pathol. 2011 Jan;35(1):70-5.
Pediatric cutaneous
angiosarcomas: a clinicopathologic study of 10 cases.
Deyrup AT,
Miettinen M, North PE, Khoury JD, Tighiouart M, Spunt SL,
Parham DM, Shehata
BM,
Weiss SW.
Pathology Consultants, Greenville, SC 29605,
USA. [email protected]
Abstract
Cutaneous
angiosarcomas are rare tumors, which predominantly arise in the
sun-exposed
skin of the
head and neck of adult and elderly patients. Rarely, these
tumors can be
seen in children. We identified
cutaneous angiosarcomas in
10 children and assessed clinical (patient age,
tumor site, tumor size,
and
tumor focality) and histologic features including growth
pattern
(vasoformative vs. solid), mitotic rate
(mitotic figures per 10
high power field), necrosis (present vs. absent),
and cell shape
(epithelioid vs.
nonepithelioid). Tumors predominated in the lower
extremities (6 of 10) of
female patients (2 male and
8 female); age at
diagnosis ranged from 1.5 months to 15 years. Four
patients had
preexisting
conditions: congenital hemihypertrophy of the contralateral
limb, the
Aicardi syndrome, congenital
lymphedema, and congenital
hemangioma treated with radiation therapy.
Tumors were located in
the
lower extremity (6), flank (1), elbow (1), and buccal mucosa (1),
and
ranged in size from 0.6 to 6.5
cm. Eight cases showed predominantly
epithelioid morphology, 1 case showed
mixed epithelioid and
spindled
morphology and 1 case was entirely spindled. Mitotic activity
ranged from 1
to 55 mitotic
figures per 10 high power field. Necrosis was seen in 5 cases.
Clinical
follow-up was obtained for 9
patients: 4 died of disease (range,
12 to 49 mo; mean, 25 mo) and 5
patients were alive without
disease (18
mo to 28 y). Five patients had metastatic disease; sites of
involvement
included the lung,
soft tissue, lymph node, pleura, liver, and bone.
Cutaneous angiosarcomas
in children are rare tumors,
which are commonly
associated with a preexisting condition, suggesting a
greater role for
genetics as
opposed to environmental factors in the pathogenesis of these
tumors.
PMID: 21164289 [PubMed - indexed for
MEDLINE]
Am J Surg Pathol. 2011
Jan;35(1):60-9.
Primary cutaneous epithelioid angiosarcoma: a
clinicopathologic study of
13 cases of a rare neoplasm
occurring outside
the setting of conventional angiosarcomas and with
predilection for the
limbs.
Suchak R, Thway K, Zelger B, Fisher C, Calonje
E.
Department of Dermatopathology, St John's Institute of Dermatology,
St
Thomas' Hospital,
London,
UK.
Abstract
Epithelioid angiosarcomas
are rare aggressive neoplasms that occur most
frequently in deep
soft
tissues. Primary cutaneous lesions are rare, and there are
discrepant
findings in the literature regarding
their behavior. In this
study, we report a series of 13 cases of primary
cutaneous
epithelioid
angiosarcoma and analyze their clinicopathologic features. The
tumors
arising in the conventional
settings for cutaneous angiosarcoma
(ie, in the head and neck region of
elderly patients, and those
occurring
postradiation or associated with lymphedema) were excluded.
Primary
cutaneous epithelioid
angiosarcoma occurred in adults (mean age, 66 y) with
an equal sex
distribution, and presented as
solitary (n=10) or multiple
(n=3) nodules ranging in size from 8 to 80 mm,
with a predilection for
the
limbs (n=10). Histopathologically, the tumors comprised
infiltrative
sheets of atypical epithelioid cells
within the dermis with
or without the involvement of the subcutis.
Vascular channel formation
and
intracytoplasmic lumina were seen, at least focally, in most
cases.
Mitoses were readily identified and
necrosis was seen in 40% of
the cases. The tumors were immunoreactive for
vascular markers, with
CD31
and FLI-1 offering the highest sensitivity. Pancytokeratin was
positive in
two thirds of the cases,
and epithelial membrane antigen was positive in
one-quarter of the cases.
There was rare focal
expression of Melan-A
(n=2) and smooth muscle actin (n=3). Follow-up
information was available
for
11 patients. Six patients died of metastatic disease after a
median
follow-up of 12 months (range, 3 to
36 mo), and 1 patient died of
unrelated causes. These findings suggest
that primary
cutaneous
epithelioid angiosarcoma occurring outside the conventional
settings of
angiosarcoma is a highly
aggressive malignant tumor with
mortality rates in excess of 55% after 3
years.
PMID:
21164288 [PubMed - indexed for MEDLINE]
Br J Radiol. 2010 Dec
15. [Epub ahead of print]
Lymphocutaneous fistulas:
pre-therapeutic evaluation by magnetic
resonance
lymphangiography.
Lohrmann C, Foeldi E, Langer
M.
Department of Radiology, University Hospital of Freiburg,
Hugstetter
Strasse 55, D-79106,
Freiburg,
Germany.
Abstract
Objective:
Lymphocutaneous fistulas with intractable lymphatic leakage
represent a
serious clinical
condition leading to a severe impairment of quality of life
for the
affected patients. To date, no adequate
diagnostic imaging
modality is in existence, to allow selection of the
correct treatment
option. The aim
of this study was to perform a pre-therapeutic evaluation of
the lymphatic
system in patients with
lymphocutaneous fistulas by
magnetic resonance lymphangiography (MRL).
Methods: Eight lower
extremities in four patients with lymphocutaneous
fistulas were examined
by
MRL. Three locations were examined: first, the lower leg and foot
regions;
second, the upper leg and
the knee region; and third, the pelvic
and retroperitoneal regions. A T(1)
weighted three-dimensional
(3D)
spoiled gradient echo and a T(2) weighted 3D turbo spin echo sequence
were
utilised to
undertake MRL.
Results: In all four patients
(100%), the clinically suspected
lymphocutaneous fistulas (groin
and
forefoot) were exactly delineated by MRL. In two patients (50%)
adjacent
diffuse lymphangiomatous
changes were detected, extending into
the upper leg, pelvis,
retroperitoneum, abdomen and abdominal
walls. In
one patient (25%) with primary lymphoedema of the right lower
extremity, MRL
revealed an
aplasia of the lymphatic collectors at the levels of the lower
and upper
leg. All patients (100%) suffered
from an ipsilateral
lymphoedema of the lower extremity, whereby in two
patients with
diffuse
lymphangiomatosis, the lymphatic vessels were consecutively enlarged
up to
a diameter of 6 
mm.
Conclusion: MRL is a
safe and accurate imaging modality for a
comprehensive evaluation of
the
lymphatic system in patients suffering from lymphocutaneous
fistulas.
PMID: 21159808 [PubMed - as supplied by
publisher]
December 24, 2010
Am J Phys Med
Rehabil. 2011 Feb;90(2):89-96.
The frequency of lymphedema in an
adult spina bifida population.
Garcia AM, Dicianno
BE.
From the Dept. of Physical Medicine and Rehabilitation (AMG,
BED); Adult
Outpatient Spina Bifida
Clinic University of Pittsburgh
Medical Center (UPMC) (BED); Human
Engineering Research
Laboratories, VA
Pittsburgh Healthcare System (BED); and Dept. of
Rehabilitation Science
and
Technology, University of Pittsburgh (BED),
Pennsylvania.
Abstract
OBJECTIVE: : In the United
States, there are more than 100,000 people with
spina bifida. There
have
been very few studies to date documenting the occurrence of lymphedema
in
the spina bifida
population, despite a case series in 2001 that
suggested that the
occurrence may be higher than in the
general
population. Currently, approximately 1 million people have
lymphedema in the
United States.
The purpose of this study was to document the occurrence of
lymphedema and
associated medical
factors in a regional adult spina
bifida population.
DESIGN: : A total of 240 electronic medical
records from the Adult Spina
Bifida Clinic from January
2005 to August
2008 were retrospectively reviewed. Subjects were divided
into two groups
based on
the presence or absence of lymphedema. ? analyses were used to
compare
lymphedema groups with
respect to history of medical
comorbidities and ethnicity. Fisher exact
tests were used to
compare
groups with respect to mobility status and the presence of
power
wheelchair seat functions. Mann-
Whitney U tests were used to
compare groups with respect to age, anatomic
lesion level,
employment
level, and income.
RESULTS: : Twenty-two (9.2%)
patients had lymphedema. Mean ± SD population
age was 35.1 ±
11.1 yrs.
Lymphedema was associated with a history of trauma (P = 0.044),
cellulitis
(P < 0.001),
cancer (P = 0.038), obesity (P < 0.001), wounds (P <
0.001), hypertension
(P = 0.036), higher lesion
level spina bifida (P =
0.049), and mobility status (P = 0.007).
Hypertension and obesity were
present
in 38.3% and 37.5% of the total study population,
respectively.
CONCLUSIONS: : This is the first study to document
the occurrence of
lymphedema in a spina bifida
patient population, which
was almost 100 times higher than that in the
general patient population.
We
also documented a high occurrence of hypertension and obesity in the
total
study population. These
findings may help guide further prospective
studies to more clearly
delineate the risk factors for the
development of
lymphedema and to determine the appropriate therapies.
Better screening,
prevention
and treatment algorithms are needed for hypertension and obesity
in the
spina bifida population.
PMID: 21173682 [PubMed - in
process]
Cir Cir. 2010
Jul-Aug;78(4):310-4.
[Collagen-polyvinylpyrrolidone: a new
therapeutic option for treatment of
sequelae after radical
mastectomy in
women with breast cancer. Preliminary study].
[Article in
Spanish]
Ruiz-Eng R, Montiel-Jarquín A, de la Rosa-Pérez R,
López-Colombo A,
Gómez-Conde E, Zamudio-
Huerta
L.
Departamento de Cirugía Plástica, Hospital General Regional
36, Instituto
Mexicano del Seguro
Social, Puebla, México. [email protected]
Abstract
BACKGROUND:
Approximately 30% of women who undergo mastectomy
without
reconstructive
treatment due to breast cancer present sequelae.
These include
paresthesias, keloid healing,
hypoesthesia, lymphedema and
limitation of the function of the ipsilateral
upper extremity.
We
undertook this study to present the results
using
collagen-polyvinylpyrrolidone (Clg- Pvp) as treatment
for
posmastectomy sequelae in women with breast cancer.
METHODS: We
conducted a unicentric, longitudinal and prospective clinical
trial between
August 1,
2007 and July 31, 2008. Included variables were age,
lymphedema,
limitation of the function of the
ipsilateral upper
extremity, collapse of the wound, keloid healing,
paresthesias, and
appearance of the
surgical area. The appearance of the surgical area
(aesthetic aspect) was
evaluated before and 6
months after treatment was
initiated. Clg-Pvp was administered weekly for
a 6-month
period.
RESULTS: Seven women were included with a median age of
49 years (range:
40-72 years). One
patient (14.28%) presented lymphedema,
two patients (28.57%) presented
collapse of the wound,
two patients
(28.57%) had keloid healing, three patients (42.85%)
experienced
paresthesias, five
patients (71.4%) reported pain, and five patients (71.4%)
reported
limitation of the function of the
ipsilateral upper extremity.
At the completion of the treatment, aesthetic
improvement was
statistically
significant (p = 0.0020, Mann-Whitney U
test).
CONCLUSIONS: Clinical and aesthetic results are good
after application of
Clg-Pvp for treating
sequelae in women with breast
cancer who underwent mastectomy without
reconstructive
surgery.
PMID: 21167096 [PubMed - in
process]
December 25, 2010
Zhonghua Zheng Xing
Wai Ke Za Zhi. 2010 Sep;26(5):337-9.
[Treatment of chronic
extremity lymphedema with manual lymph drainage].
[Article in
Chinese]
Liu NF, Wang L, Chen JL, Zhou JG, Wu XF, Yan ZX, Jiang
ZH.
Department of Plastic & Reconstructive Surgery,
Lymphology Center,
Shanghai 9th People's Hospital,
Shanghai Jiao Tong
University, Shanghai 200011,
China.
Abstract
OBJECTIVE: To evaluate the effect
of manual lymph drainage on chronic
extremity
lymphedema.
METHODS: Fifty patients with chronic lymphedema of
extremity were treated
with manual lymph
drainage (MLD) complex
decongestion therapy. Among them, 29 had primary
lymphedema, 21
had
secondary lymphedema. 42 had lymphedema of lower extremity and 8
had
lymphedema of upper limb.
The result of treatment was evaluated with
measurement of circumference of
extremities and edema
fluid in tissue
with Multiple-frequency bioelectrical impedance
analysis.
RESULTS: After 1-2 treatment courses, all 50 patients
showed significant
decrease of circumference
of lymphedmatous limbs (P
< 0.05) and remarkable reduction of accumulated
edema fluid in tissue
(P
< 0. 05). There was highly correlation between the decrease of
limb
circumference and edema fluid in
tissue (r(s) = 0.774, P <
0.01).
CONCLUSIONS: MLD complex decongestion therapy is
effective for the
treatment of chronic
lymphedema of
extremity.
PMID: 21174786 [PubMed - in
process]
December 28, 2010
Nephrology (Carlton).
2010 Dec;15(8):779-80.
doi:
10.1111/j.1440-1797.2010.01323.x.
Unilateral upper limb
lympatic obstruction and severe lymphoedema in a
patient on long-term
sirolimus.
Damasiewicz MJ, Ierino FL.
PMID:
21175966 [PubMed - in process]
Zhonghua Zheng Xing Wai Ke Za
Zhi. 2010 Sep;26(5):337-9.
[Treatment of chronic extremity
lymphedema with manual lymph drainage].
[Article in
Chinese]
Liu NF, Wang L, Chen JL, Zhou JG, Wu XF, Yan ZX, Jiang
ZH.
Department of Plastic & Reconstructive Surgery,
Lymphology Center,
Shanghai 9th People's Hospital,
Shanghai Jiao Tong
University, Shanghai 200011,
China.
Abstract
OBJECTIVE: To evaluate the effect
of manual lymph drainage on chronic
extremity
lymphedema.
METHODS: Fifty patients with chronic lymphedema of
extremity were treated
with manual lymph
drainage (MLD) complex
decongestion therapy. Among them, 29 had primary
lymphedema, 21
had
secondary lymphedema. 42 had lymphedema of lower extremity and 8
had
lymphedema of upper limb.
The result of treatment was evaluated with
measurement of circumference of
extremities and edema
fluid in tissue
with Multiple-frequency bioelectrical impedance
analysis.
RESULTS: After 1-2 treatment courses, all 50 patients
showed significant
decrease of circumference
of lymphedmatous limbs (P
< 0.05) and remarkable reduction of accumulated
edema fluid in tissue
(P
< 0. 05). There was highly correlation between the decrease of
limb
circumference and edema fluid in
tissue (r(s) = 0.774, P <
0.01).
CONCLUSIONS: MLD complex decongestion therapy is
effective for the
treatment of chronic
lymphedema of
extremity.
PMID: 21174786 [PubMed - in
process]
December 31, 2010
Plast Reconstr Surg.
2010 Dec 23. [Epub ahead of print]
Differential Diagnosis of
Lower Extremity Enlargement in Pediatric
Patients Referred with a
Diagnosis
of "Lymphedema"
Schook CC, Mulliken JB, Fishman SJ,
Alomari AI, Grant FD, Greene AK.
1Departments of Plastic and
Oral Surgery, 2Surgery, 3Radiology, Vascular
Anomalies Center,
Children's
Hospital Boston, Harvard Medical School, Boston,
MA.
Abstract
BACKGROUND: There are many causes
for a large lower limb in the pediatric
age group. These
children are
often mislabeled as having "lymphedema", and incorrect
diagnosis can lead to
improper
treatment. The purpose of this study was to determine the
differential
diagnosis in pediatric patients
referred for lower extremity
"lymphedema" and to clarify management.
METHODS: Our Vascular
Anomalies Center database was reviewed between 1999
- 2010 for
patients
referred with a diagnosis of "lymphedema" of the lower extremity.
Records
were studied to
determine the correct etiology for the enlarged extremity.
Alternative
diagnoses, gender, age-of-onset,
and imaging studies also
were analyzed.
RESULTS: A referral diagnosis of lower extremity
"lymphedema" was given to
170 children; however,
the condition was
confirmed in only 72.9% of patients. Forty-six children
(27.1%) had
another
disorder: micro/macrocystic lymphatic malformation (19.6%),
non-eponymous
combined vascular
malformation (13.0%), capillary
malformation (10.9%), Klippel-Trenaunay
syndrome (10.9%),
hemi-
hypertrophy (8.7%), post-traumatic swelling (8.7%), Parkes Weber
syndrome
(6.5%), lipedema
(6.5%), venous malformation (4.3%),
rheumatologic disorder (4.3%),
infantile hemangioma (2.2%),
kaposiform
hemangioendothelioma (2.2%), or lipofibromatosis (2.2%).
Age-of-onset in
children with
lymphedema was older than patients with another diagnosis (p =
0.027).
CONCLUSION: "Lymphedema" is not a generic term.
Approximately one-fourth
of pediatric patients
with a large lower
extremity are misdiagnosed as having "lymphedema"; the
most commonly
confused
etiologies are other types of vascular anomalies. History,
physical
examination, and often radiological
studies are required to
differentiate lymphedema from other conditions to
ensure the child is
managed
appropriately.
PMID: 21187804 [PubMed - as supplied
by publisher]
Oncol Nurs Forum. 2011 Jan
1;38(1):E27-36.
The role of information sources and objective
risk status on lymphedema
risk-minimization behaviors in
women recently
diagnosed with breast cancer.
Sherman KA, Koelmeyer
L.
Department of Psychology, Macquarie University, Sydney,
Australia.
[email protected]
Abstract
PURPOSE/OBJECTIVES:
to assess the role of education sources and objective
risk status
on
knowledge and practice of lymphedema risk-minimization behaviors
among
women recently diagnosed
with breast
cancer.
RESEARCH APPROACH: prospective
survey.
SETTING: a hospital in Sydney,
Australia.
PARTICIPANTS: 106 women recently diagnosed with
breast cancer at increased
risk for developing
lymphedema following lymph
node dissection.
METHODOLOGIC APPROACH: a questionnaire
administered at the time of surgery
and three
months after surgery
measured demographics, lymphedema knowledge,
lymphedema
information
sources used, and adherence to risk-minimization
recommendations.
MAIN RESEARCH VARIABLES: lymphedema knowledge,
source of information used,
objective
lymphedema risk, and adherence to
risk-minimization behaviors.
FINDINGS: knowledge was high and
increased over time. Lymphedema
information from the clinic (e.
g.,
brochures, nursing staff) was the most cited source. Adherence
to
recommendations was moderate;
nonadherence was mostly for behaviors
requiring regular enactment.
Regression analysis revealed that
only
receipt of information from nursing staff and lymphedema knowledge
three
months after surgery
were significant predictors of risk-minimization
behaviors.
CONCLUSIONS: exposing women to lymphedema risk information at
the time of
breast cancer
diagnosis facilitates
increased
awareness and enactment of risk-minimization behaviors. Nursing
staff play a
key role in
disseminating this information and in convincing women to
perform the
recommendations.
INTERPRETATION: provision of
lymphedema education by breast clinic staff
is critical to ensure
that
women realize the importance of early detection and treatment.
Reminder
booster sessions by nursing
staff may be beneficial particularly
for longer-term knowledge retention
and adherence to
recommended
behaviors.
PMID: 21186149 [PubMed - in
process]
Oncol Nurs Forum. 2011 Jan
1;38(1):E1-E10.
Lymphedema in patients with head and neck
cancer.
Deng J, Ridner SH, Murphy BA.
School of
Nursing, Vanderbilt University, Nashville, TN, USA.
[email protected]
Abstract
PURPOSE/OBJECTIVES:
to describe the current state of the science on
secondary lymphedema
in
patients with head and neck cancer.
DATA SOURCES:
published journal articles and books and data from the
National Cancer
Institute,
the American Cancer Society, and other healthcare-related
professional
association Web sites.
DATA SYNTHESIS: survivors
of head and neck cancer may develop secondary
lymphedema as a
result of
the cancer or its treatment. Secondary lymphedema may involve
external
(e.g., submental
area) and internal (e.g., laryngeal, pharyngeal, oral
cavity) structures.
Although lymphedema affects
highly visible anatomic
sites (e.g., face, neck), and profoundly
influences critical physical
functions (e.g.,
speech, breathing, swallowing, cervical range of motion),
research
regarding this issue is lacking.
Studies are needed to address a
variety of vital questions, including
incidence and prevalence,
optimal
measurement techniques, associated symptom burden, functional loss,
and
psychosocial impact.
CONCLUSIONS: secondary lymphedema in
patients with head and neck cancer is
a significant but
understudied
issue.
IMPLICATIONS FOR NURSING: a need exists to systematically
examine
secondary lymphedema
related to treatment for head and neck
cancer and address gaps in the
current literature, such as
symptom
burden, effects on body functions, and influences on quality of
life.
Oncology nurses and
other healthcare professionals should have empirical
evidence to help them
manage lymphedema after
head and neck cancer
treatment.
PMID: 21186146 [PubMed - in
process]
Breast J. 2010
Nov-Dec;16(6):639-43.
Anatomical and Surgical Concepts in
Lymphatic Regeneration.
Avraham T, Daluvoy SV, Kueberuwa E,
Kasten JL, Mehrara BJ.
The Division of Plastic and
Reconstructive Surgery, The Department of
Surgery, Memorial
Sloan-
Kettering Cancer Center, New York City, New York 10065, USA.
[email protected]
Abstract
Chronic
post-surgical lymphedema is common condition that afflicts nearly
2 million
Americans. In the
USA, it is most commonly encountered in the upper
extremities of patients
who have undergone
axillary lymph node dissection
for breast cancer. Lymphedema has a
significant negative effect
on
cosmesis, limb function, and overall quality of life. Despite the
impact
of this condition, very little is
known about how to effectively
prevent or treat lymphedema. While
therapeutic options for
chronic
extremity lymphedema remain limited, several surgical approaches
have been
suggested. These include
techniques aimed at reducing limb
volume, as well as techniques that aim
to reconstitute
disrupted
lymphatic channels. Operations proposed to re-establish
lymphatic
continuity include lymphatico-
venous anastomoses,
lymphatico-lymphatico anastomoses, and tissue transfer.
PMID:
21121083 [PubMed - in process]
Eur J Surg Oncol. 2010 Nov 27.
[Epub ahead of print]
Cost-effectiveness of MRI and PET imaging
for the evaluation of axillary
lymph node metastases in
early stage
breast cancer.
Meng Y, Ward S, Cooper K, Harnan S, Wyld
L.
School of Health and Related Research, University of
Sheffield, Regent
Court, 30 Regent Street,
Sheffield S1 4DA,
UK.
Abstract
BACKGROUND: UK guidelines for breast
cancer recommend axillary nodal
assessment via surgical
methods such as
sentinel lymph node biopsy (SLNB). However, these
procedures are associated
with
adverse effects such as lymphoedema. Magnetic resonance imaging (MRI)
and
positron emission
tomography (PET) are non-invasive imaging
techniques. The aim of this
study is to evaluate the cost-
effectiveness
of MRI and PET compared with SLNB for assessment of axillary
lymph node
metastases
in newly-diagnosed early stage breast cancer patients in the
UK.
METHODS: An individual patient discrete-event simulation
model was
developed in SIMUL8(®) to
estimate the lifetime costs and
benefits of replacing SLNB with MRI or
PET, or adding MRI or PET
before
SLNB. Effectiveness outcomes were derived from a recent systematic
review;
patient utilities
and resource use data were sourced from the
literature.
RESULTS: Based on our analysis the baseline SLNB
strategy is dominated by
the strategies of
replacing SLNB with either MRI
or PET. The strategy of replacing SLNB with
MRI has the highest
total
quality-adjusted life years (QALYs) and lowest total costs.
However,
clinical evidence for MRI is
based on a limited number of small
studies and replacing SLNB with MRI or
PET leads to more false-
positive
and false-negative cases. The strategy of adding MRI before SLNB
is
cost-effective, but
subject to greater
uncertainty.
CONCLUSIONS: Based on this analysis the most
cost-effective strategy is to
replace SLNB with
MRI. However, further
large studies using up-to-date techniques are
required to obtain more
accurate
data on the sensitivity and specificity of MRI.
Elsevier
Ltd. All rights reserved.
PMID: 21115232 [PubMed - as supplied
by publisher]
Recent Results Cancer Res.
2011;186:189-215.
Physical activity and breast cancer
survivorship.
Schmitz K.
Department of
Biostatistics and Epidemiology, University of Pennsylvania
School of
Medicine, 903
Blockley Hall, 423 Guardian Drive, Philadelphia, PA,
19104-6021, USA,
[email protected].
edu.
Abstract
A
diagnosis of breast cancer is associated with treatments that
have
physiologic effects beyond the
intended curative therapy. The first
section of this chapter provides and
integrative physiology review of
the
effects of breast cancer treatment on the body systems used by and
affected
by physical activity,
including effects of chemotherapy, radiation, and
surgery. In later
sections, we review the literature on
physical activity
and breast cancer from the point of diagnosis and for
the balance of life.
The efficacy
of physical activity for supportive cancer care outcomes is
reviewed
separately from the purported
usefulness of physical activity
for disease-free and overall survival from
breast cancer. The
current
evidence supports the safety of physical activity during and after
breast
cancer therapy. The supportive
cancer care outcomes for which
there is sufficient evidence of efficacy
during and after breast
cancer
treatment include fitness, fatigue, body size, and quality of
life.
Further, there is growing evidence that
upper body exercise does
not pose additional risk for negative lymphedema
outcomes among
survivors
with and at risk for lymphedema. For overall survival, the
evidence is
largely observational, with
sufficient evidence that physical
activity does confer benefit. Finally,
we outline future directions
for
research on physical activity among breast cancer survivors,
including
expanding to focus on subsets of
the population not included in
most prior studies (minority women and
older women), tailoring
of
interventions to stages of cancer most likely to benefit, expanding
to
study women with metastatic
cancer, and new modes of exercise, such as
team sports, martial arts, and
Pilates.
PMID: 21113765
[PubMed - in process]
Arch Phys Med Rehabil. 2010
Dec;91(12):1844-8.
Effect of active resistive exercise on breast
cancer-related lymphedema: a
randomized controlled trial.
Kim
do S, Sim YJ, Jeong HJ, Kim GC.
Abstract
Kim DS,
Sim Y-J, Jeong HJ, Kim GC. Effect of active resistive exercise on
breast
cancer-related
lymphedema: a randomized controlled
trial.
OBJECTIVE: To investigate the differences between the
effects of complex
decongestive
physiotherapy with and without active
resistive exercise for the treatment
of patients with breast
cancer-
related lymphedema (BCRL).
DESIGN: Randomized
control-group study.
SETTING: An outpatient rehabilitation
clinic.
PARTICIPANTS: Patients (N=40) with diagnosed
BCRL.
INTERVENTIONS: Patients were randomly assigned to either
the active
resistive exercise group or
the nonactive resistive exercise
group. In the active resistive exercise
group, after complex
decongestive
physiotherapy, active resistive exercise was performed for
15min/d, 5 days a
week for 8
weeks. The nonactive resistive exercise group performed only
complex
decongestive physiotherapy.
MAIN OUTCOME MEASURES:
The circumferences of the upper limbs (proximal,
distal, and total)
for
the volume changes, and the Short Form-36 version 2 questionnaire for
the
quality of life (QOL) at
pretreatment and 8 weeks posttreatment for each
patient.
RESULTS: The volume of the proximal part of the arm was
significantly more
reduced in the active
resistive exercise group than
that of the nonactive resistive exercise
group (P<.05). In the
active
resistive exercise group, there was significantly more improvement
in
physical health and general health,
as compared with that of the
nonactive resistive exercise group (P<.05).
CONCLUSIONS: For
the treatment of patients with BCRL, active resistive
exercise with
complex
decongestive physiotherapy did not cause additional swelling, and
it
significantly reduced proximal arm
volume and helped improve
QOL.
American Congress of Rehabilitation Medicine. Published by
Elsevier Inc.
All rights reserved.
PMID: 21112424 [PubMed -
in process]
Gynecol Obstet Fertil. 2010 Nov 24. [Epub ahead of
print]
[Sentinel lymph node procedure and uterine
cancers.][Article in French]
Huchon C, Bats AS, Achouri A,
Lefrère-Belda MA, Buénerd A, Bensaid C,
Farragi M, Mathevet P,
Lécuru
F.
Service de chirurgie gynécologique et cancérologique, hôpital
européen
Georges-Pompidou, AP-HP,
20, rue Leblanc, 75908 Paris cedex 15,
France; Faculté de médecine,
université Paris-Descartes,
75006 Paris,
France.
Abstract
Lymph node metastases in
cervical and endometrial cancer are major
prognostic factors.
Lymph-nodal
involvement determines adjuvant therapy. As imagery is not
reliable to
diagnose lymph node status,
pelvic +/- para-aortic
lymphadenectomy remains the gold standard. These
surgical procedures
are,
however, responsible for specific morbidity: lymphocele and
lymphedema.
Sentinel lymph node
procedure could avoid lymphadenectomy and
their complications in cervical
and endometrial cancer
with good negative
predictive values. We present actual indications,
procedure and results of
sentinel
lymph node procedures in cervical and endometrial
cancer.
Copyright © 2010 Elsevier Masson SAS. All rights
reserved.
PMID: 21111648 [PubMed - as supplied by
publisher]
December 7, 2010
Am J Clin Oncol. 2010
Nov 30. [Epub ahead of print]
Estimating the Probability of
Lymphedema After Breast Cancer Surgery.
Soran A, Wu WC, Dirican
A, Johnson R, Andacoglu O, Wilson J.
*Division of Surgical
Oncology, Department of Surgery, Magee-Womens
Hospital of University
of
Pittsburgh Medical Center †Department of Biostatistics, Graduate School
of
Public Health, University
of Pittsburgh, Pittsburgh,
PA.
Abstract
OBJECTIVES: Lymphedema is a common
complication of breast cancer surgery,
leading to a
decreased quality of
life. The risk and severity of lymphedema were
associated with surgery side
upper
extremity infection, =25 kg/m body mass index (BMI), and the level of
hand
use (LHU). Our aim was
to estimate the probability of lymphedema
after breast cancer surgery by
using previously published
incidence rates
and these 3 risk factors.
METHODS: The design was a n:m matched
case control study; data were
analyzed on 51 patients
with lymphedema and
126 available controls matched on age, radiation
therapy, and operation
type. In
conjunction with published estimates of lymphedema, incidence
rates, and
estimates of the proportions
of risk factor combinations in
cases and controls, the Bayes' theorem was
used to estimate
the
probability of developing lymphedema.
RESULTS: Lymphedema
probabilities of 7 combinations for 6 different
published calculations
were
used. With the assumption of 16% LE incidence rate of lymphedema,
a
BMI<25, no infection, and a
low LHU, the estimated probability of
lymphedema was 6.8%. With the
assumption of 46.3% LE
incidence a BMI =25,
infection, and a high LHU led to an estimated
lymphedema probability of
93.7%.
CONCLUSIONS: This study shows that control of
predisposing factors in both
high and low
incidence rates has a marked
effect on the probability of LE development.
In other words, patients
with
low incidence for LE are more prone to develop LE if the
predisposing
factors are controlled poorly
compared to the high incidence
patients whom the predisposing factors are
avoided.
PMID:
21127413 [PubMed - as supplied by publisher]
Plast Reconstr
Surg. 2010 Dec;126(6):1853-63.
Overview of surgical treatments
for breast cancer-related lymphedema.
Suami H, Chang
DW.
Houston, Texas From the Department of Plastic Surgery,
University of Texas
M. D. Anderson
Cancer
Center.
Abstract
SUMMARY:: Breast
cancer-related upper extremity lymphedema is an
unsolved
iatrogenic
complication with a reported incidence ranging from 9
to 41 percent. The
increase in volume and
recurrent cellulitis of the
affected limb cause both physical and mental
distress to many breast
cancer
survivors. However, postmastectomy lymphedema has received
little
attention, and no curative
treatment is available. Conservative
treatment with decongestive therapy
has been the primary choice
for
lymphedema treatment, but it is cumbersome and has limited benefits.
To
date, there is no
consensus on surgical procedure and protocol. However,
refinements in
microsurgical techniques and
improved examination devices
may lead to the establishment of a standard
surgical treatment
for
lymphedema. This review of surgical procedures for the treatment
of
postmastectomy lymphedema
focuses on microsurgical lymphovenous shunt
operations and discusses
current issues in surgical
treatment and the
need for uniform treatment standards.
PMID: 21124127 [PubMed -
in process]
December 17, 2010
Indian J Ophthalmol. 2011
Jan-Feb;59(1):71-2.
Distichiasis-lymphedema syndrome with optic
disc pit.
Kaarthigeyan K, Ramprakash M, Kalpana
G.
PMID: 21157084 [PubMed - in process
Br J
Dermatol. 2010 Dec 14. doi: 10.1111/j.1365-2133.2010.10179.x. [Epub
ahead of
print]
Changes in the nail unit in patients with secondary
lymphoedema identified
using clinical, dermoscopic
and ultrasound
examination.
Le Fourn E, Duhard E, Tauveron V, Maruani A, Samimi
M, Lorette G, Vaillant
L, Machet L.
Department of
Dermatology, CHRU Tours, Tours, France Lymphology unit, CHRU
de Tours,
Tours,
France University François Rabelais de Tours; Tours, France UMR
INSERM
U930, ERL 3106,
Tours,
France.
Abstract
Background Secondary lymphoedema
is characterized by lymphatic stasis that
is often the result of a
lymph
node lesion. At advanced stages it may cause trophic changes in the
skin.
However, the
presence of changes in the nail unit has not been reported to
date.
Objectives The aim of this study was to determine the
presence of nail
abnormalities in cases of
secondary
lymphoedema.
Methods This was a prospective study, conducted on
patients with
unilateral secondary lymphoedema.
A comparative clinical
and dermoscopic examination and 20 MHz high
resolution ultrasound imaging
of
the affected limb and the contralateral limb were performed Results
Thirty-three patients were
included. On physical examination,
hyperkeratosis of the lateral nail
folds, friability of the nail
surface,
"ragged" proximal nail folds and cuticle and apparent leuconychia
were
observed more frequently on
the lymphoedematous limb. The ultrasound
study of the nails of the thumb
and the big toe did not reveal
any
differences in thickness of the different structures of the nail
between the
lymphoedema side and the
opposite side. The nail matrix was longer on the
lymphoedema side.
Conclusions Our study showed mild changes in
the nail unit compatible with
the xerosis often
associated with severe
lymphoedema. However, the study also showed
frequent evidence of
"ragged"
cuticles which in these patients at high risk of erysipelas are
entry
points for bacteria. This should be
taken into account when
counselling patients with limb lymphoedema in
order to prevent
erysipelas.
2010 British Association of
Dermatologists.
PMID: 21155752 [PubMed - as supplied by
publisher]
Ann Surg Oncol. 2010 Dec 14. [Epub ahead of
print]
A Pilot Study Reporting Outcomes for Melanoma Patients of
a Minimal Access
Ilio-inguinal Dissection
Technique Based on Two
Incisions.
Spillane AJ, Tucker M, Pasquali
S.
Sydney Medical School, The University of Sydney, Sydney,
Australia,
[email protected].
au.
Abstract
BACKGROUND:
A modified procedure for ilio-inguinal regional lymph node
dissection (I-I
RLND)
involving 2 small skin incisions was evaluated with the aim of
assessing
surgical and oncological
noninferiority compared with the
traditional single, longitudinal incision
I-I RLND.
MATERIALS
AND METHODS: A total of 20 melanoma patients with positive groin
lymph
nodes
who had traditional I-I RLND were compared with 20 patients who had
a
minimal access I-I RLND
using 2 small surgical access incisions of 3-6
cm in length-one sited
below and one above the inguinal
ligament.
Clinical, staging features, number of lymph nodes retrieved,
length of
hospital stay, time drains
remained in situ, morbidity (wound infections,
dehiscence, hematoma,
seroma, and lymphedema), and
disease free survival
were compared.
RESULTS: Patients in the groups were comparable
with the exception that
the minimal access I-I
RLND group had a higher
rate of AJCC stage N3 disease (60% vs 20%; P =
.03) and more cases
with
extranodal spread (45% vs 15%; P = .041). After a median follow-up of
5
months (range 1-8)
for the minimal access group and median 13 months (range
1-30) for the
standard group there were no
differences in disease-free
survival (P = .13). Retrieved lymph node
counts were similar (P =
.34)
including for the inguinal and pelvic components of the
operations
separately. No significant differences
in wound complications
or rates of early lymphedema were observed.
CONCLUSIONS: At
early follow-up, minimal access I-I RLND is feasible and
noninferior to
single
longitudinal incision I-I RLND in regard to surgical morbidity
and
oncological outcome. Further
evaluation is progressing.
PMID:
21153883 [PubMed - as supplied by publisher]
PLoS Negl Trop Dis.
2010 Nov 30;4(11):e902.
Effectiveness of a simple lymphoedema
treatment regimen in podoconiosis
management in southern
ethiopia: one
year follow-up.
Sikorski C, Ashine M, Zeleke Z, Davey
G.
University College London Medical School, London, United
Kingdom.
Abstract
BACKGROUND: Podoconiosis is a
non-filarial elephantiasis caused by
long-term barefoot exposure
to
volcanic soils in endemic areas. Irritant silicate particles penetrate
the
skin, causing a progressive,
debilitating lymphoedema of the lower leg,
often starting in the second
decade of life. A simple patient-
led
treatment approach appropriate for resource poor settings has
been
developed, comprising (1)
education on aetiology and prevention of
podoconiosis, (2) foot hygiene
(daily washing with soap,
water and an
antiseptic), (3) the regular use of emollient, (4) elevation
of the limb at
night, and (5)
emphasis on the consistent use of shoes and
socks.
METHODOLOGY/PRINCIPAL FINDINGS: We did a 12-month,
non-comparative,
longitudinal
evaluation of 33 patients newly presenting
to one clinic site of a
non-government organization (the
Mossy Foot
Treatment & Prevention Association, MFTPA) in southern
Ethiopia. Outcome
measures
used for the monitoring of disease progress were (1) the clinical
staging
system for podoconiosis, and
(2) the Amharic Dermatology Life
Quality Index (DLQI), both of which have
been recently validated
for use
in this setting. Digital photographs were also taken at each
visit.
Twenty-seven patients
completed follow up. Characteristics of patients
completing follow-up were
not significantly different to
those not. Mean
clinical stage and lower leg circumference decreased
significantly (mean
difference
-0.67 (95% CI -0.38 to -0.96) and -2.00 (95% CI -1.26 to
-2.74),
respectively, p<0.001 for both
changes). Mean DLQI diminished
from 21 (out of a maximum of 30) to 6
(p<0.001). There was a
non-
significant change in proportion of patients with mossy lesions
(p?=?0.375).
CONCLUSIONS/SIGNIFICANCE: This simple,
resource-appropriate regimen has a
considerable
impact both on clinical
progression and self-reported quality of life of
affected individuals. The
regimen
appears ideal for scaling up to other endemic regions in Ethiopia
and
internationally. We recommend
that further research in the area
include analysis of cost-effectiveness
of the regimen.
PMID:
21152059 [PubMed - in process]
Transl Oncol. 2010 Dec
1;3(6):362-72.
Human Lymphatic Architecture and Dynamic
Transport Imaged Using
Near-infrared Fluorescence.
Rasmussen
JC, Tan IC, Marshall MV, Adams KE, Kwon S, Fife CE, Maus EA,
Smith
LA,
Covington KR, Sevick-Muraca EM.
Center for Molecular
Imaging, The Brown Foundation Institute of Molecular
Medicine at the
University
of Texas Health Science Center at Houston, Houston, TX,
USA.
Abstract
BACKGROUND: Although the importance
of lymphatic function is well
recognized, the lack of real-
time imaging
modalities limits our understanding of its role in many
diseases. In a phase
0 exploratory
study, we used dynamic, near-infrared (NIR) fluorescence
imaging to assess
the extremes of lymphatic
architecture and transport in
healthy human subjects and in subjects
clinically diagnosed with
unilateral
lymphedema (LE), a disease that can be prevalent in cancer
survivors.
METHODS AND RESULTS: Active lymphatic propulsion was
imaged after
intradermal injections of
25 µg of indocyanine green (total
maximum dose =400 µg) bilaterally in the
arms or legs of control
and
subjects. Images show well-defined lymphatic structures with
propulsive
dye transport in limbs of
healthy subjects. In LE subjects, we
observed extravascular dye
accumulation, networks of
fluorescent
lymphatic capillaries, and/or tortuous lymphatic vessels in
all
symptomatic and some asymptomatic
limbs. Statistical models indicate
that disease status and/or limb
significantly affect parameters
of
apparent lymph propagation velocity and contractile
frequency.
CONCLUSIONS: These clinical research studies
demonstrate the potential of
NIR fluorescence
imaging as a diagnostic
measure of functional lymphatics and as a new tool
in translational
research
studies to decipher the role of the lymphatic system in cancer and
other
diseases.
PMID: 21151475 [PubMed - in
process]
JAMA. 2010 Dec 22;304(24):2699-705. Epub 2010 Dec
8.
Weight lifting for women at risk for breast cancer-related
lymphedema: a
randomized trial.
Schmitz KH, Ahmed RL, Troxel
AB, Cheville A, Lewis-Grant L, Smith R, Bryan
CJ, Williams-Smith
CT,
Chittams J.
Center for Clinical Epidemiology and Biostatistics,
University of
Pennsylvania School of Medicine and
Abramson Cancer Center,
Philadelphia, PA 19104-6021, USA.
[email protected]
Abstract
CONTEXT:
Clinical guidelines for breast cancer survivors without
lymphedema advise
against upper
body exercise, preventing them from obtaining established
health benefits
of weight lifting.
OBJECTIVE: To evaluate
lymphedema onset after a 1-year weight lifting
intervention vs no
exercise
(control) among survivors at risk for breast cancer-related
lymphedema
(BCRL).
DESIGN, SETTING, AND PARTICIPANTS: A
randomized controlled equivalence
trial (Physical
Activity and Lymphedema
trial) in the Philadelphia metropolitan area of
154 breast cancer survivors
1
to 5 years postunilateral breast cancer, with at least 2 lymph
nodes
removed and without clinical signs
of BCRL at study entry.
Participants were recruited between October 1,
2005, and February
2007,
with data collection ending in August
2008.
INTERVENTION: Weight lifting intervention included a gym
membership and 13
weeks of supervised
instruction, with the remaining 9
months unsupervised, vs no exercise.
MAIN OUTCOME MEASURES:
Incident BCRL determined by increased arm swelling
during 12
months (=5%
increase in interlimb difference). Clinician-defined BCRL
onset was also
evaluated.
Equivalence margin was defined as doubling of lymphedema
incidence.
RESULTS: A total of 134 participants completed
follow-up measures at 1
year. The proportion of
women who experienced
incident BCRL onset was 11% (8 of 72) in the weight
lifting
intervention
group and 17% (13 of 75) in the control group (cumulative
incidence
difference [CID], -6.0%; 95%
confidence interval [CI], -17.2%
to 5.2%; P for equivalence = .04). Among
women with 5 or more
lymph nodes
removed, the proportion who experienced incident BCRL onset
was 7% (3 of 45)
in the
weight lifting intervention group and 22% (11 of 49) in the control
group
(CID, -15.0%; 95% CI,
-18.6% to -11.4%; P for equivalence = .003).
Clinician-defined BCRL onset
occurred in 1 woman in
the weight lifting
intervention group and 3 women in the control group
(1.5% vs 4.4%, P
for
equivalence = .12).
CONCLUSION: In breast cancer
survivors at risk for lymphedema, a program
of slowly progressive
weight
lifting compared with no exercise did not result in increased
incidence of
lymphedema.
TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00194363.
PMID: 21148134 [PubMed - indexed for
MEDLINE]
Med Clin (Barc). 2010 Dec 7. [Epub ahead of
print]
[Preventing lymphoedema after breast cancer surgery by
elastic restraint
orthotic and manual lymphatic
drainage: A randomized
clinical trial.]
[Article in
Spanish]
Castro-Sánchez AM, Moreno-Lorenzo C, Matarán-Peñarrocha
GA,
Aguilar-Ferrándiz ME, Almagro-
Céspedes I, Anaya-Ojeda
J.
Departamento de Enfermería y Fisioterapia, Facultad de
Ciencias de la
Salud, Universidad de Almería,
Almería,
España.
Abstract
BACKGROUND AND OBJECTIVE:
Secondary lymphoedema is considered one of the most
common complications
after breast cancer surgery. The aim of the present
study was to analyze
the
effectiveness of containment elastic orthosis and manual
lymphatic
drainage in the prevention of
lymphoedema secondary to
mastectomy.
PATIENTS AND METHOD: An experimental study was
performed with a control
group. Forty-eight
patients were randomly
assigned to experimental (containment elastic
orthosis and manual
lymphatic
drainage) and control (postural measures) groups. Outcomes
measures were
quality of life, body
composition, temperature, functional
assessment of the shoulder, pain and
limb volume. Measures were
performed
at baseline and after 8-months intervention.
RESULTS: After the
intervention period, the experimental group showed
significant differences
(P<.
05) in the quality of life, extracellular water, and functional
assessment
of the volume of the limb of the
mastectomized
side.
CONCLUSIONS: The application of containment elastic
orthosis and manual
lymphatic drainage
contribute to prevent secondary
lymphoedema after breast cancer surgery,
improving the quality of life
in
these patients.
Copyright © 2010 Elsevier España, S.L. All
rights reserved.
PMID: 21145085 [PubMed - as supplied by
publisher]
J Sex Med. 2010 Dec 8. doi:
10.1111/j.1743-6109.2010.02133.x. [Epub ahead
of
print]
Quality of Life and Sexual Function after Type c2/Type
III Radical
Hysterectomy for Locally
Advanced Cervical Cancer: A
Prospective Study.
Plotti F, Sansone M, Di Donato V, Antonelli
E, Altavilla T, Angioli R,
Panici PB.
Sapienza University,
Department of Obstetrics and Gynecology, Rome, Italy
Campus
Biomedico
University, Department of Obstetrics and Gynecology, Rome,
Italy.
Abstract
Introduction. The introduction
of screening programs have made cervical
cancer detectable at
earlier
stages and in younger patients. Nevertheless, only a few studies
have
examined the QoL and sexual
function in disease-free cervical cancer
survivors. Aim. The objective of
this study is to evaluate the
sexual
function in a cervical cancer patient's group treated with
neoadjuvant
chemotherapy (NACT)
plus type C2/type III radical hysterectomy
(RH).
Methods. We have enrolled in the oncologic group (OG)
sexually active
patients affected by cervical
cancer (stage IB2 to IIIB)
treated with NACT followed by RH. Main Outcome
Measures.
Included
subjects were interviewed with the European Organization for
Research and
Treatment of Cancer
(EORTC) QLQ-CX24 Questionnaire. Two
consecutive assessments were recorded:
at the first
evaluation
postoperatively (T1) and at the 12-month follow-up visit (T2).
Results were
compared with
a benign gynecological disease group (BG) and with a healthy
control group
(HG). Results. A total of
33 patients for OG, 37 for BG,
and 35 women for HG were recruited. After
surgery, sexual activity
has
been resumed by 76% of the OG patients and 83.7% of the BG patients (P
= not
significant).
Cancer survivors had clinically worse problems with symptom
experience,
body image, and
sexual/vaginal functioning than controls (P
< 0.05). OG patients also
reported more severe
lymphedema, peripheral
neuropathy, menopausal symptoms, and sexual worry.
For sexual activity,
the
score difference between cancer survivors and women with
benign
gynecological disease is not
statically significant. Concerning
sexual enjoyment assessment, our study
shows comparable results for
OG
and BG.
Conclusion. Nevertheless, the worsening of symptom
experience, body
image, and sexual/vaginal
functioning, OG patients have
same sexual activity and sexual enjoyment
data compared with those of
BG
patients. Thus, NACT followed by RH could be a valid therapeutic
strategy to
treat and improve
well-being especially in young cervical cancer patients.
Plotti F, Sansone
M, Di Donato V, Antonelli E,
Altavilla T, Angioli R,
and Panici PB. Quality of life and sexual function
after type c2/type III
radical
hysterectomy for locally advanced cervical cancer: A prospective
study. J
Sex Med **;**:**-**.
International Society for
Sexual Medicine.
PMID: 21143414 [PubMed - as supplied by
publisher]
PMID: 20871969 [PubMed - as supplied by
publisher]
docs)
Ann R Coll Surg Engl. 2010 Jun 28. [Epub ahead of
print]
Hand surgery after axillary lymph node clearance for
breast cancer:
contra-indication to surgery?
Fulford D, Dalal
S, Winstanley J, Hayton MJ.
Abstract
INTRODUCTION
Breast cancer patients who have had prior axillary lymph node
clearance
(ALNC)
can present with ipsilateral hand conditions that could easily be
treated
with surgical intervention. These
patients are often advised to
avoid interventional procedures due to risks
of complications
such
lymphoedema, infection and cellulitis.
SUBJECTS AND
METHODS Between April and June 2009, we conducted an online
survey of
hand
surgeons, breast surgeons and breast-care nurses to obtain their views
on
hand surgery after ipsilateral
axillary lymph node
clearance.
RESULTS The majority of hand surgeons (58%) felt
there was no
contra-indication to surgery in a
breast cancer patient with
prior ipsilateral ALNC compared to just 30% of
breast surgeons and 10%
of
breast-care nurses. The majority of breast surgeons and breast-care
nurses
(70% and 89%,
respectively) felt that hand surgery was a relative
contra-indication
compared to just 41% of hand
surgeons. Postoperative
lymphoedema was the commonest cited reason for
avoiding surgery.
The
majority of hand surgeons (79%) and nearly two-thirds of breast
surgeons
(57%) would use a
tourniquet during surgery if it was normal
practice.
CONCLUSIONS A review of the published literature does
not support the
notion that these patients
experience increased
complications; therefore, we recommend the advice
given to breast
cancer
patients regarding ipsilateral surgery be
re-evaluated.
PMID: 20587171 [PubMed - as supplied by
publisher]
J Med Case Reports. 2010 Jun 29;4(1):196. [Epub ahead
of print]
Recurrent furunculosis as a cause of isolated penile
lymphedema: a case
report.
Alshaham A, Sood
S.
Abstract
ABSTRACT: INTRODUCTION: Isolated
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 PRESENTATION: A 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.
PMID: 20584337 [PubMed - as supplied by
publisher]
Lymphat Res Biol. 2010
Jun;8(2):111-9.
Assessment of volume measurement of breast
cancer-related lymphedema by
three methods:
circumference measurement,
water displacement, and dual energy
X-ray
absorptiometry.
Gjorup C, Zerahn B, Hendel
HW.
Department of Clinical Physiology and Nuclear Medicine,
Herlev University
Hospital, Herlev,
Denmark. [email protected]
Abstract
BACKGROUND: Following treatment for breast cancer 12%-60% develop breast
cancer-related
lymphedema (BCRL). There are several ways of
assessing BCRL. Circumference
measurement (CM)
and water displacement
(WD) for volume measurements (VM) are frequently
used methods in
practice
and research, respectively. The aim of this study was to evaluate
CM and
WD for VM of the BCRL
arm and the contralateral arm, comparing the
results with regional dual
energy X-ray
absorptiometry
(DXA).
METHODS AND RESULTS: Twenty-four women
with unilateral BCRL were included
in the study.
Blinded duplicate VM
were obtained from both arms using the three methods
mentioned above.
CM
and DXA were performed by two observers. WD was performed by a group
of
observers. Mean
differences (d) in duplicated volumes, limits of
agreement (LOA), and 95%
confidence intervals (CI)
were calculated for
each method. The repeatability expressed as d (95% CI)
between the
duplicated
VM of the BCRL arm and the contralateral arm was for DXA 3 ml
(-6-11) and
3 ml (1-7),
respectively. For CM and WD, the d (95% CI) of
the BCRL arm were 107 ml
(86-127) and 26 ml
(-26-79), respectively and in
the contralateral arm 100 ml (78-122) and -6
ml (-29-17),
respectively.
CONCLUSIONS: DXA is superior in repeatability when
compared to CM and WD
for VM,
especially for the BCRL arm but also the
contralateral arm.
PMID: 20583873 [PubMed - in
process]
Am J Med Genet A. 2010
Jul;152A(7):1621-6.
Agenesis of the corpus callosum and
congenital lymphedema: A novel
recognizable
syndrome?
O'Driscoll MC, Jenny K, Saitta S, Dobyns WB, Gripp
KW.
Medical Genetics Research Group and Regional Genetics
Service, St Mary's
Hospital,
Manchester,
UK.
Abstract
We present double first
cousins, a girl and a boy, with the uncommon
association of agenesis of
the
corpus callosum and congenital lymphedema. Other features shared by
both
include oligohydramnios,
similar facial dysmorphism, sacral dimple,
developmental delay, and
sociable personality. While some
of these
findings overlap with FG syndrome and Hennekam syndrome, the
findings in our
patients are
sufficiently different to exclude these diagnoses. We propose
that this is
a new syndrome with
presumed autosomal recessive
inheritance. (c) 2010 Wiley-Liss, Inc.
PMID: 20583147 [PubMed -
in process]
Indian J Dermatol. 2010
Apr;55(2):144-147.
INTENSIVE TREATMENT OF LEG
LYMPHEDEMA.
Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro
de Godoy M.
Department of Cardiology and Cardiovascular Surgery
and professor of the
post graduation course of
Medicine School of São
Jose do Rio Preto-FAMERP-Brazil.
Abstract
BACKGROUND:
Despite of all the problems caused by lymphedema, this disease
continues to
affect
millions of people worldwide. Thus, the identification of the
most
efficacious forms of treatment is
necessary. AIM: The aim of this
study was to evaluate a novel intensive
outpatient treatment for
leg
lymphedema.
METHODS: Twenty-three legs of 19 patients
were evaluated in a prospective
randomized study. The
inclusion criteria
were patients with Grade II and III lymphedema, where
the difference,
measured by
volumetry, between the affected limb below the knee and the
healthy limb
was greater than 1.5 kg.
Intensive treatment was carried out
for 6- to 8-h sessions in the
outpatient clinic. Analysis of variance
was
utilized for statistical analysis with an alpha error of 5%
(P-value
<0.05) being considered
significant.
RESULTS:
All limbs had significant reductions in size with the final mean
loss being
81.1% of the
volume of edema. The greatest losses occurred in the first week
(P-value
<0.001). Losses of more
than 90% of the lymphedema occurred
in 9 (39.13%) patients; losses of more
than 80% in 13
(56.52%), losses of
more than 70% in 17 (73.91%) and losses of more than
50% were recorded
for
95.65% of the patients; only 1 patient lost less than 50% (37.9%) of
the
edema.
CONCLUSION: The intensive treatment of lymphedema
in the outpatient clinic
can produce significant
reductions in the volume
of edema over a short period of time and can be
recommended for any
grade
of lymphedema, in particular the more advanced
degrees.
PMID: 20606882 [PubMed - as supplied by
publisher]
Radiother Oncol. 2010 May 31. [Epub ahead of
print]
Randomised phase II trial of hyperbaric oxygen therapy in
patients with
chronic arm lymphoedema
after radiotherapy for
cancer.
Gothard L, Haviland J, Bryson P, Laden G, Glover M,
Harrison S, Woods M,
Cook G, Peckitt C,
Pearson A, Somaiah N, Stanton A,
Mortimer P, Yarnold J.
Department of Radiotherapy, The Royal
Marsden NHS Foundation Trust,
Sutton,
UK.
Abstract
BACKGROUND: A non-randomised phase II
study suggested a therapeutic effect
of hyperbaric
oxygen (HBO) therapy
on arm lymphoedema following adjuvant radiotherapy
for early breast
cancer,
justifying further investigation in a randomised
trial.
METHODS: Fifty-eight patients with 15% increase in arm
volume after
supraclavicular+/-axillary
radiotherapy (axillary surgery in
52/58 patients) were randomised in a 2:1
ratio to HBO (n=38) or to
best
standard care (n=20). The HBO group breathed 100% oxygen at 2.4
atmospheres
absolute for
100min on 30 occasions over 6weeks. Primary endpoint was
ipsilateral limb
volume expressed as a
percentage of contralateral limb
volume. Secondary endpoints included
fractional removal rate
of
radioisotopic tracer from the arm, extracellular water content,
patient
self-assessments and UK SF-36
Health Survey
Questionnaire.
FINDINGS: Of 53/58 (91.4%) patients with baseline
assessments, 46 had
12-month assessments
(86.8%). Median volume of
ipsilateral limb (relative to contralateral) at
baseline was 133.5%
(IQR
126.0-152.3%) in the control group, and 135.5% (IQR 126.5-146.0%) in
the
treatment group.
Twelve months after baseline the median (IQR) volume
of the ipsilateral
limb was 131.2% (IQR 122.7-
151.5%) in the control
group and 133.5% (IQR 122.3-144.9%) in the
treatment group. Results for
the
secondary endpoints were similar between randomised
groups.
INTERPRETATION: No evidence has been found of a
beneficial effect of HBO
in the treatment of
arm lymphoedema following
primary surgery and adjuvant radiotherapy for
early breast
cancer.
Copyright © 2010 Elsevier Ireland Ltd. All rights
reserved.
PMID: 20605648 [PubMed - as supplied by
publisher]
Int J Radiat Oncol Biol Phys. 2010 Jun 2. [Epub ahead
of print]
Standardized Method for Quantification of Developing
Lymphedema in
Patients Treated for
Breast
Cancer.
Ancukiewicz M, Russell TA, Otoole J, Specht M,
Singer M, Kelada A, Murphy
CD, Pogachar J,
Gioioso V, Patel M, Skolny M,
Smith BL, Taghian AG.
Department of Radiation Oncology,
Massachusetts General Hospital, Boston,
MA.
Abstract
PURPOSE: To develop a simple and
practical formula for quantifying breast
cancer-related
lymphedema,
accounting for both the asymmetry of upper extremities'
volumes and their
temporal
changes,
METHODS AND MATERIALS: We analyzed
bilateral perometer measurements of the
upper
extremity in a series of
677 women who prospectively underwent lymphedema
screening
during
treatment for unilateral breast cancer at Massachusetts General
Hospital
between August 2005 and
November 2008. Four sources of variation
were analyzed: between repeated
measurements on the
same arm at the same
session; between both arms at baseline (preoperative)
visit; in
follow-up
measurements; and between patients. Effects of hand dominance,
time since
diagnosis and surgery,
age, weight, and body mass index were
also analyzed.
RESULTS: The statistical distribution of
variation of measurements
suggests that the ratio of volume
ratios is
most appropriate for quantification of both asymmetry and
temporal changes.
Therefore, we
present the formula for relative volume change (RVC): RVC
=
(A(2)U(1))/(U(2)A(1)) - 1, where A
(1), A(2) are arm volumes on the
side of the treated breast at two
different time points, and U(1),
U(2)
are volumes on the contralateral side. Relative volume change is
not
significantly associated with hand
dominance, age, or time since
diagnosis. Baseline weight correlates (p =
0.0074) with higher
RVC;
however, baseline body mass index or weight changes over time do
not.
CONCLUSIONS: We propose the use of the RVC formula to
assess the presence
and course of
breast cancer-related lymphedema in
clinical practice and research.
Copyright © 2010 Elsevier Inc. All
rights
reserved.
PMID: 20605339 [PubMed - as supplied by
publisher]
J Obstet Gynaecol Res. 2010
Jun;36(3):555-9.
Analysis of the complications after radical
hysterectomy for stage IB, IIA
and IIB uterine cervical
cancer
patients.
Kashima K, Yahata T, Fujita K, Tanaka
K.
Departments of Obstetrics and Gynecology, Niigata University
Graduate
School of Medical and
Dental Sciences, Niigata, Japan. [email protected]
Abstract
AIM:
This study was undertaken to assess whether radical hysterectomy and
pelvic
lymphadenectomy
could be carried out within acceptable complications in
uterine cervical
cancer patients.
MATERIAL & METHODS: One
hundred and forty-six patients of the
International Federation
of
Gynecology and Obstetrics stage IB, IIA and IIB cervical cancer treated
by
radical hysterectomy or
combined with postoperative radiation therapy
were enrolled in this study.
The study population was
41 women over the
age of 60 and 105 women under the age of 59.
Complications after the
treatment
of all patients were examined.
RESULTS: The
complications were significantly high with the patients over
the age of 60
(53.7%) in
comparison with the patients under the age of 59 (24.8%).
Especially, the
cases combined with
radiation therapy had higher
complication rate. The most commonly recorded
complications
were
lymphedema (13.7%) and small bowel obstruction
(8.2%).
CONCLUSION: We conclude that the complications
influenced on the quality
of life were more
frequent in patients over the
age of 60.
PMID: 20598037 [PubMed - in
process]
July 10, 2010 (7 docs)
Indian J
Dermatol. 2010 Apr;55(2):144-147.
INTENSIVE TREATMENT OF LEG
LYMPHEDEMA.
Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro
de Godoy M.
Department of Cardiology and Cardiovascular Surgery
and professor of the
post graduation course of
Medicine School of São
Jose do Rio Preto-FAMERP-Brazil.
Abstract
BACKGROUND:
Despite of all the problems caused by lymphedema, this disease
continues to
affect
millions of people worldwide. Thus, the identification of the
most
efficacious forms of treatment is
necessary. AIM: The aim of this
study was to evaluate a novel intensive
outpatient treatment for
leg
lymphedema.
METHODS: Twenty-three legs of 19 patients
were evaluated in a prospective
randomized study. The
inclusion criteria
were patients with Grade II and III lymphedema, where
the difference,
measured by
volumetry, between the affected limb below the knee and the
healthy limb
was greater than 1.5 kg.
Intensive treatment was carried out
for 6- to 8-h sessions in the
outpatient clinic. Analysis of variance
was
utilized for statistical analysis with an alpha error of 5%
(P-value
<0.05) being considered
significant.
RESULTS:
All limbs had significant reductions in size with the final mean
loss being
81.1% of the
volume of edema. The greatest losses occurred in the first week
(P-value
<0.001). Losses of more
than 90% of the lymphedema occurred
in 9 (39.13%) patients; losses of more
than 80% in 13
(56.52%), losses of
more than 70% in 17 (73.91%) and losses of more than
50% were recorded
for
95.65% of the patients; only 1 patient lost less than 50% (37.9%) of
the
edema.
CONCLUSION: The intensive treatment of lymphedema
in the outpatient clinic
can produce significant
reductions in the volume
of edema over a short period of time and can be
recommended for any
grade
of lymphedema, in particular the more advanced
degrees.
PMID: 20606882 [PubMed - as supplied by
publisher]
Br J Nurs. 2010 Jul
8-21;19(13):826-30.
Keeping breast cancer survivors
lymphoedema-free.
Fleysher
LA.
Abstract
With the increasing number of breast
cancer survivors, post-treatment
interventions to improve quality
of life
are gaining priority. Current breast cancer treatment modalities
put
patients at risk of developing
upper-extremity lymphoedema. Upper-extremity
lymphoedema is a common and
overlooked
complication of breast cancer
treatment. Health professionals play an
important role in
identifying
breast cancer and promptly referring these patients for
further
interventions. After successful
completion of breast cancer
treatment, these patients continue to have
regular evaluations by
their
oncologists; and, provided there are no signs and symptoms of
breast
cancer, primary and community
care health professionals will
continue to play an essential role in the
management of this unique
patient
group. As breast cancer treatment places these patients at a
lifetime risk
of developing upper-extremity
lymphoedema, radiation
oncologists, surgical and medical oncologists, and
primary care
practitioners
must be knowledgeable and educate these patients about risk
reduction
behaviours. Prevention,
prompt identification, and treatment of
lymphoedema are the goals for
achieving positive and cost-
effective
patient outcomes. This article aims to provide health
professionals with
specific educational
tools with regard to the prevention, recognition, and
management of
upper-extremity lymphoedema;
these tools should be used to
change the ongoing trends in the management
of breast cancer
survivors'
follow-up care.
PMID: 20606611 [PubMed - in
process]
Int J Gynecol Cancer. 2010
Jul;20(5):900-4.
A prospective study of postoperative lymphedema
after surgery for cervical
cancer.
Halaska MJ, Novackova M,
Mala I, Pluta M, Chmel R, Stankusova H, Robova H,
Rob
L.
*Department of Obstetrics and Gynaecology, 2nd Medical
Faculty of the
Charles University in Prague
and Faculty Hospital Motol,
Prague; daggerFaculty of Statistics,
University of Economics in
Prague;
and double daggerDepartment of Oncology and Radiotherapy, Faculty
Hospital
Motol, Prague,
Czech
Republic.
Abstract
OBJECTIVE:: Lymphedema is
a severe postoperative complication in
oncological
surgery.
Multifrequency bioelectrical impedance analysis (MFBIA) is a new
method
for early lymphedema
detection. The objective was to establish the
methodology of MFBIA for
lower-limb lymphedema and
to detect a lymphedema
in patients undergoing cervical cancer surgery.
METHODS:: From a
population of 60 patients undergoing cervical cancer
surgery, 39
underwent
radical hysterectomy Wertheim III (RAD group), and 21
underwent
conservative surgery
(laparoscopic lymphadenectomy plus simple
trachelectomy/simple
hysterectomy - CONS group). A
control group of 29
patients (CONTR group) was used to determine the SD of
impedance at
zero
frequency (R0). Patients were examined before surgery and at 3 and
6
months after surgery by
MFBIA and by measuring the circumference of the
lower limbs.
RESULTS:: No differences were found between the
CONS and RAD groups on
age, height, weight,
and histopathologic type of
tumor. However, the number of dissected lymph
nodes differed
significantly
between the groups (17.3 in the CONS group vs 25.8 in the RAD
group, P =
0.0012). The SD of R0
in the CONTR group was 36.0 and 39.0 for
the right and the left leg,
respectively. No difference in
prevalence of
lymphedema based on circumference method was found (35.9% in
the RAD and
47.6%
in the CONS groups, not statistically
significant).
CONCLUSIONS:: No difference in the prevalence of
lymphedema was found
between the CONS
and RAD groups. A methodology for
MFBIA for the detection of lower-limb
lymphedema
was
described.
PMID: 20606541 [PubMed - in
process]
Radiother Oncol. 2010 May 31. [Epub ahead of
print]
Randomised phase II trial of hyperbaric oxygen therapy in
patients with
chronic arm lymphoedema
after radiotherapy for
cancer.
Gothard L, Haviland J, Bryson P, Laden G, Glover M,
Harrison S, Woods M,
Cook G, Peckitt C,
Pearson A, Somaiah N, Stanton A,
Mortimer P, Yarnold J.
Department of Radiotherapy, The Royal
Marsden NHS Foundation Trust,
Sutton,
UK.
Abstract
BACKGROUND: A non-randomised phase II
study suggested a therapeutic effect
of hyperbaric
oxygen (HBO) therapy
on arm lymphoedema following adjuvant radiotherapy
for early breast
cancer,
justifying further investigation in a randomised
trial.
METHODS: Fifty-eight patients with 15% increase in arm
volume after
supraclavicular+/-axillary
radiotherapy (axillary surgery in
52/58 patients) were randomised in a 2:1
ratio to HBO (n=38) or to
best
standard care (n=20). The HBO group breathed 100% oxygen at 2.4
atmospheres
absolute for
100min on 30 occasions over 6weeks. Primary endpoint was
ipsilateral limb
volume expressed as a
percentage of contralateral limb
volume. Secondary endpoints included
fractional removal rate
of
radioisotopic tracer from the arm, extracellular water content,
patient
self-assessments and UK SF-36
Health Survey
Questionnaire.
FINDINGS: Of 53/58 (91.4%) patients with baseline
assessments, 46 had
12-month assessments
(86.8%). Median volume of
ipsilateral limb (relative to contralateral) at
baseline was 133.5%
(IQR
126.0-152.3%) in the control group, and 135.5% (IQR 126.5-146.0%) in
the
treatment group.
Twelve months after baseline the median (IQR) volume
of the ipsilateral
limb was 131.2% (IQR 122.7-
151.5%) in the control
group and 133.5% (IQR 122.3-144.9%) in the
treatment group. Results for
the
secondary endpoints were similar between randomised
groups.
INTERPRETATION: No evidence has been found of a
beneficial effect of HBO
in the treatment of
arm lymphoedema following
primary surgery and adjuvant radiotherapy for
early breast
cancer.
Copyright © 2010 Elsevier Ireland Ltd. All rights
reserved.
PMID: 20605648 [PubMed - as supplied by
publisher]
Int J Radiat Oncol Biol Phys. 2010 Jun 2. [Epub ahead
of print]
Standardized Method for Quantification of Developing
Lymphedema in
Patients Treated for
Breast
Cancer.
Ancukiewicz M, Russell TA, Otoole J, Specht M,
Singer M, Kelada A, Murphy
CD, Pogachar J,
Gioioso V, Patel M, Skolny M,
Smith BL, Taghian AG.
Department of Radiation Oncology,
Massachusetts General Hospital, Boston,
MA.
Abstract
PURPOSE: To develop a simple and
practical formula for quantifying breast
cancer-related
lymphedema,
accounting for both the asymmetry of upper extremities'
volumes and their
temporal
changes,
METHODS AND MATERIALS: We analyzed
bilateral perometer measurements of the
upper
extremity in a series of
677 women who prospectively underwent lymphedema
screening
during
treatment for unilateral breast cancer at Massachusetts General
Hospital
between August 2005 and
November 2008. Four sources of variation
were analyzed: between repeated
measurements on the
same arm at the same
session; between both arms at baseline (preoperative)
visit; in
follow-up
measurements; and between patients. Effects of hand dominance,
time since
diagnosis and surgery,
age, weight, and body mass index were
also analyzed.
RESULTS: The statistical distribution of
variation of measurements
suggests that the ratio of volume
ratios is
most appropriate for quantification of both asymmetry and
temporal changes.
Therefore, we
present the formula for relative volume change (RVC): RVC
=
(A(2)U(1))/(U(2)A(1)) - 1, where A
(1), A(2) are arm volumes on the
side of the treated breast at two
different time points, and U(1),
U(2)
are volumes on the contralateral side. Relative volume change is
not
significantly associated with hand
dominance, age, or time since
diagnosis. Baseline weight correlates (p =
0.0074) with higher
RVC;
however, baseline body mass index or weight changes over time do
not.
CONCLUSIONS: We propose the use of the RVC formula to
assess the presence
and course of
breast cancer-related lymphedema in
clinical practice and research.
Copyright © 2010 Elsevier Inc. All
rights
reserved.
PMID: 20605339 [PubMed - as supplied by
publisher]
Arch Phys Med Rehabil. 2010
Jul;91(7):1070-6.
Weight lifting in patients with
lower-extremity lymphedema secondary to
cancer: a pilot and
feasibility
study.
Katz E, Dugan NL, Cohn JC, Chu C, Smith
RG, Schmitz KH.
Department of Rehabilitation Medicine,
University of Washington, Seattle,
WA,
USA.
Abstract
OBJECTIVE: To assess the feasibility of
recruiting and retaining cancer
survivors with lower-limb
lymphedema into
an exercise intervention study. To develop preliminary
estimates regarding
the safety
and efficacy of this intervention. We hypothesized that
progressive weight
training would not
exacerbate leg swelling and that
the intervention would improve functional
mobility and quality of
life.
DESIGN: Before-after pilot study with a duration of 5
months.
SETTING: University of
Pennsylvania.
PARTICIPANTS: Cancer survivors with a known
diagnosis of lower-limb
lymphedema (N=10) were
directly referred by
University of Pennsylvania clinicians. All 10
participants completed the
study.
INTERVENTION: Twice weekly slowly progressive weight
lifting, supervised
for 2 months,
unsupervised for 3
months.
MAIN OUTCOME MEASURES: The primary outcome was interlimb
volume
differences as
measured by optoelectronic perometry. Additional
outcome measures included
safety (adverse events),
muscle strength,
objective physical function, and quality of life.
RESULTS:
Interlimb volume differences were 44.4% and 45.3% at baseline and
5
months,
respectively (pre-post comparison, P=.70). There were 2
unexpected
incident cases of cellulitis within
the first 2 months. Both
resolved with oral antibiotics and complete
decongestive therapy by 5
months.
Bench and leg press strength increased by 47% and 27% over 5
months
(P=.001 and P=.07,
respectively). Distance walked in 6 minutes
increased by 7% in 5 months
(P=.01). No improvement
was noted in
self-reported quality of life.
CONCLUSIONS: Recruitment of
patients with lower-limb-lymphedema into an
exercise program is
feasible.
Despite some indications that the intervention may be safe (eg,
a lack of
clinically significant
interlimb volume increases over 5 mo), the unexpected
finding of 2
cellulitic infections among the 10
participants suggests
additional study is required before concluding that
patients with
lower-extremity
lymphedema can safely perform weight lifting. Copyright 2010
American
Congress of Rehabilitation
Medicine. Published by Elsevier Inc.
All rights reserved.
PMID: 20599045 [PubMed - in process]PMCID:
PMC2897812 [Available on 2011/7/1]
J Obstet Gynaecol Res. 2010
Jun;36(3):555-9.
Analysis of the complications after radical
hysterectomy for stage IB, IIA
and IIB uterine cervical
cancer
patients.
Kashima K, Yahata T, Fujita K, Tanaka
K.
Departments of Obstetrics and Gynecology, Niigata University
Graduate
School of Medical and
Dental Sciences, Niigata, Japan. [email protected]
Abstract
AIM:
This study was undertaken to assess whether radical hysterectomy and
pelvic
lymphadenectomy
could be carried out within acceptable complications in
uterine cervical
cancer patients.
MATERIAL & METHODS: One
hundred and forty-six patients of the
International Federation
of
Gynecology and Obstetrics stage IB, IIA and IIB cervical cancer treated
by
radical hysterectomy or
combined with postoperative radiation therapy
were enrolled in this study.
The study population was
41 women over the
age of 60 and 105 women under the age of 59.
Complications after the
treatment
of all patients were examined.
RESULTS: The
complications were significantly high with the patients over
the age of 60
(53.7%) in
comparison with the patients under the age of 59 (24.8%).
Especially, the
cases combined with
radiation therapy had higher
complication rate. The most commonly recorded
complications
were
lymphedema (13.7%) and small bowel obstruction
(8.2%).
CONCLUSION: We conclude that the complications
influenced on the quality
of life were more
frequent in patients over the
age of 60.
PMID: 20598037 [PubMed - in
process]
July 18, 2010 (8 docs)
Eur J Ophthalmol.
2010 Jul 6. pii: 15C85F11-38C9-45C7-A19F-2E3556D7D52F.
[Epub ahead
of
print]
Unusual presentation of giant cell angiofibroma of
the eyelids.
Surace D, Blandamura S, Bernardini FP, Galan A, Lo
Giudice G.
Department of Ophthalmology, Santa Maria del Carmine
Hospital, Rovereto -
Italy.
Abstract
Purpose. To
describe a case of bilateral eyelid-confined giant cell
angiofibroma (GCAF)
in a patient
with a slowly progressive bilateral eyelid swelling. Methods.
A
40-year-old man with a 5-year history
of slowly progressive bilateral
eyelid swelling, severe functional
impairment, and bilateral
cosmetic
deformity was studied. An extensive ophthalmologic evaluation,
laboratory
examinations, and orbital
magnetic resonance imaging were
carried out.
Results. Clinical examination showed nonpitting
lymphedema affecting both
upper and lower eyelids,
with orange peel skin.
Orbital magnetic resonance imaging revealed diffuse
thickening of the
preseptal
structures in the eyelids without extension to the orbit.
Histologic
specimen revealed the presence of
spindle and multinucleated
giant cells surrounding pseudovascular spaces
strongly positive to
CD34
and vimentin. A diagnosis of GCAF was made and radiation therapy
was
performed 3 weeks after
surgical debulking with partial recovery of
visual and anatomic function.
Conclusions. Giant cell
angiofibroma involving the eyelid is rare and can
represent a diagnostic
and
therapeutic challenge to the ophthalmologist.
PMID:
20623470 [PubMed - as supplied by publisher]
Ann Dermatol
Venereol. 2010 Jun-Jul;137(6-7):477-9. Epub 2010 May
14.
[Lymphoedema and neutrophilic dermatosis] Article in
French]
Guyot-Caquelin P, Cuny JF, Depardieu C, Barbaud A,
Schmutz JL.
PMID: 20620580 [PubMed - in
process]
J Urol. 2010 Aug;184(2):546-552. Epub 2010 Jun
17.
Modified Technique of Radical Inguinal Lymphadenectomy for
Penile
Carcinoma: Morbidity and
Outcome.
Yao K, Tu H, Li
YH, Qin ZK, Liu ZW, Zhou FJ, Han H.
Department of Urology,
Cancer Center, Sun Yat-Sen University and State Key
Laboratory
of
Oncology in Southern China, Guangzhou, P. R.
China.
Abstract
PURPOSE: Classic radical inguinal
lymphadenectomy is associated with
significant morbidity.
Modified
inguinal lymphadenectomy has been used to decrease the complication
rate
but it may compromise the
oncological effect and depends on the use
of intraoperative frozen
sections, which may be inaccurate.
We modified
the technique of radical inguinal lymphadenectomy to
decrease
postoperative
complications without compromising oncological
effectiveness.
MATERIALS AND METHODS: We performed 150 modified
radical inguinal
dissections in 75
patients with penile carcinoma from
February 1999 to September 2008.
Patients underwent modified
radical
inguinal dissection characterized by an S-shaped incision,
precisely
separating layers using an
anatomical landmark and preserving the fascia
lata. The boundaries of
dissection are the same as those
of radical
inguinal lymphadenectomy. Survival and morbidity data were
retrospectively
analyzed, and
survival probabilities were calculated. RESULTS: Followup
ranged from 12
to 113 months. Overall 3-
year survival was 92%, and for
N0, N1, N2 and N3 disease it was 100%,
100%, 85% and 57.1%,
respectively.
A total of 37 complications occurred including wound
infection (1.4%), skin
necrosis
(4.7%), lymphedema (13.9%), seroma (2.0%), lymphocele (2.0%) and
deep
venous thrombosis
(0.7%).
CONCLUSIONS: Morbidity
related to groin dissection in patients with penile
carcinoma can
be
decreased and oncological effectiveness can be preserved using
this
modified inguinal dissection
technique. Copyright © 2010 American
Urological Association Education and
Research, Inc.
Published by Elsevier
Inc. All rights reserved.
PMID: 20620415 [PubMed - as supplied
by publisher]
J Vasc Surg. 2010 Jul 7. [Epub ahead of
print]
A novel method of measuring human lymphatic pumping using
indocyanine
green fluorescence
lymphography.
Unno N,
Nishiyama M, Suzuki M, Tanaka H, Yamamoto N, Sagara D, Mano Y,
Konno
H.
Division of Vascular Surgery, Hamamatsu University School of
Medicine,
Shizuoka, Japan; Second
Department of Surgery, Hamamatsu
University School of Medicine,
Shizuoka,
Japan.
Abstract
OBJECTIVES: Lymph
transportation through the body is partly controlled by
the intrinsic
pumping of
lymphatic vessels. Although an understanding of this process is
important
for medical application, little
is currently known because it
is difficult to measure. Here, we introduce
an easy, safe, and
cost-
effective technique for measuring lymphatic pumping in leg
superficial
lymphatic vessels. Readings
obtained with this technique were
compared with values obtained with
dynamic
lymphoscintigraphy.
Differences in lymphatic pumping between healthy
volunteers and patients
with lymphedema were
also
investigated.
METHODS: Indocyanine green (ICG)
fluorescence lymphography was performed
by subcutaneously
injecting 0.3
mL of ICG (0.5%) into the dorsum of the foot. Real-time
fluorescence images
of lymph
propulsion were obtained with an infrared-light camera system with
the
individual supine or sitting. A
custom-made transparent
sphygmomanometer cuff was wrapped around the lower
leg and connected
to a
standard mercury sphygmomanometer. The cuff was inflated to 60 mm Hg
and
then gradually
deflated at 5-minute intervals to lower the pressure by 10-mm
Hg steps
until the fluorescence contrast
agent exceeded the upper border
of the cuff, indicating that the lymphatic
contraction had overcome
the
cuff pressure. Lymph pumping pressure (P(pump)) was defined as the
value of
the cuff pressure
when the contrast agent exceeded the upper border of the
cuff. We measured
P(pump) among healthy
volunteers who maintained a
supine position and compared these values with
measurements obtained
from
lymphoscintigraphy. P(pump) values while sitting were also compared
between
30 legs from
healthy volunteers and 30 legs from lymphedematous
patients.
RESULTS: Among healthy, supine participants, P(pump)
was 25.2 +/- 16.7 mm
Hg (mean +/-
standard deviation [SD]) when measured
by ICG fluorescence lymphography.
These values were
significantly
correlated with values taken using dynamic
lymphoscintigraphy (r(2) = 0.54,
p < .01),
while 2 SDs of the mean were approximately 20 mm Hg, suggesting
a
substantial disagreement
between the two methods (Bland-Altman plots).
In the comparison of seated
meaurements, readings
for healthy
participants (P(pump) = 29.3 +/- 16.0) were higher than those
for
lymphedematous
participants (13.2 +/- 14.9).
CONCLUSION: ICG
fluorescence is an accurate-as well as a safe, easy, and
economical-method
of
measuring lymphatic pumping. Therefore, it may develop as a vital tool
for
diagnosing lymphatic
malfunctions even when they are only in their
formative stages. Studies
that use this technique may
increase our
knowledge of the lymphatic system as a whole, allowing us to
develop better
treatments
for lymphatic disorders. Copyright © 2010 Society for Vascular
Surgery.
Published by Mosby, Inc.
All rights
reserved.
PMID: 20619581 [PubMed - as supplied by
publisher]
J Pain Symptom Manage. 2010
Jul;40(1):e7-10.
A case of massive complicated lower limb
lymphedema after pelvic nodal
dissection and
radiotherapy.
Jain S, Mahantshetty U, Engineer R, Shrivastava
SK.
PMID: 20619201 [PubMed - in process]
Jpn J
Nurs Sci. 2010 Jun;7(1):108-18.
Physiological characteristics of
the body fluid in lymphedematous patients
postbreast cancer
surgery,
focusing on the intracellular/extracellular fluid ratio of the
upper limb.
Sakuda H, Satoh M, Sakaguchi M, Miyakoshi Y, Kataoka
T.
Department of Human Health Science, Graduate School of
Medicine, Faculty
of Medicine, Kyoto
University, 53 Syogoin
Kawahara-cho,Kyoto, Japan. [email protected]
Abstract
AIM:
The aim of this research was to determine the physiological
characteristics
of patients with
lymphedema following breast cancer surgery, based on
differences between
the quantity of body water
in the right and left
fingertips, with a view to establishing whether or
not this simple
measurement could
serve as a predictive index for the onset of
lymphedema.
METHOD: The research was conducted at a hospital in
Hiroshima, Japan
(August 2004 to December
2004). Observations were made
on 39 female breast cancer patients who had
undergone surgery and
45
healthy female participants. Additional information was collected
via
interviews with the individual
participants. The quantity of body
water in all the participants was
measured by using a
bioimpedance
spectrum analysis system. Comparisons of the
intracellular/extracellular
fluid ratios (I/Es) were made
between the
edema patients and the non-edema patients, with further
testing being done
between the
affected and unaffected sides of the upper limb in the edema
patients.
RESULTS: In the edema patients, significant
differences were recognized
between the affected side's
upper limb I/E
and the unaffected side's upper limb I/E. In relation to
the affected side's
upper limb I/E
of the edema patients, even when the mean value and standard
deviation
were included, the value did
not exceed 1.0 and the mean - 3 SD
value of the affected side's upper limb
I/E in the non-edema
patients was
1.04.
CONCLUSIONS: The results suggest that measurements of the
affected and
unaffected sides' upper
limb I/E showed a potential for use
as a reliable predictive index for
lymphedema.
PMID: 20618682
[PubMed - in process]
Ann Surg Oncol. 2010 Jul 8. [Epub ahead of
print]
The Impact on Morbidity and Length of Stay of Early
Versus Delayed
Complete Lymphadenectomy in
Melanoma: Results of the
Multicenter Selective Lymphadenectomy Trial (I).
Faries MB,
Thompson JF, Cochran A, Elashoff R, Glass EC, Mozzillo N,
Nieweg OE, Roses
DF,
Hoekstra HJ, Karakousis CP, Reintgen DS, Coventry BJ, Wang HJ, Morton
DL;
for the MSLT
Cooperative Group.
John Wayne Cancer
Institute at Saint John's Health Center, Santa Monica,
CA, USA,
fariesm@jwci.
org.
Abstract
BACKGROUND: Complete
lymph node dissection, the current standard treatment
for
nodal
metastasis in melanoma, carries the risk of significant
morbidity.
Clinically apparent nodal tumor is likely
to impact both
preoperative lymphatic function and extent of soft tissue
dissection
required to clear the
basin. We hypothesized that early dissection would be
associated with less
morbidity than delayed
dissection at the time of
clinical recurrence.
MATERIALS AND METHODS: The Multicenter
Selective Lymphadenectomy Trial I
randomized
patients to wide excision of
a primary melanoma with or without sentinel
lymph node biopsy.
Immediate
completion lymph node dissection (early CLND) was performed when
indicated
in the SLN
arm, while therapeutic dissection (delayed CLND) was performed at
the time
of clinical recurrence in
the wide excision-alone arm. Acute and
chronic morbidities were
prospectively monitored.
RESULTS:
Early CLND was performed in 225 patients, and in the wide
excision-alone arm
132 have
undergone delayed CLND. The 2 groups were similar for primary
tumor
features, body mass index,
basin location, and demographics except
age, which were higher for delayed
CLND. The number of
nodes evaluated
and the number of positive nodes was greater for delayed
CLND. There was
no
significant difference in acute morbidity, but lymphedema
was
significantly higher in the delayed CLND
group (20.4% vs. 12.4%, P =
.04). Length of inpatient hospitalization was
also longer for
delayed
CLND.
CONCLUSION: Immediate nodal treatment provides
critical prognostic
information and a likely
therapeutic effect for those
patients with nodal involvement. These data
show that early CLND is
also
less likely to result in lymphedema.
PMID: 20614193
[PubMed - as supplied by publisher]
Vet Dermatol. 2010 Jul 1.
[Epub ahead of print]
Combined moxidectin and environmental
therapy do not eliminate Chorioptes
bovis infestation in
heavily
feathered horses.
Rüfenacht S, Roosje PJ, Sager H, Doherr MG,
Straub R, Goldinger-Müller P,
Gerber V.
Dermatology Unit,
Department of Clinical Veterinary Medicine, Vetsuisse
Faculty, University of
Berne,
Switzerland.
Abstract
Abstract Chorioptes
bovis infestation is a common cause of pastern
dermatitis in the horse, with
a
predilection in draft horses and other horses with thick hair
'feathers'
on the distal limbs. The treatment
of this superficial mite is
challenging; treatment failure and relapse are
common. Furthermore, C.
bovis
infestation may affect the progression of chronic pastern dermatitis
(also
known as chronic proliferative
pastern dermatitis, chronic
progressive lymphoedema and dermatitis
verrucosa) in draft
horses,
manifesting with oedema, lichenification and excessive skin folds
that can
progress to verruciform
lesions. An effective cure for C. bovis
infestation would therefore be of
great clinical value. In a
prospective,
double-blind, placebo-controlled study, the efficacy of oral
moxidectin (0.4
mg/kg body
weight) given twice with a 3 week interval in combination
with
environmental treatment with 4-chloro-3-
methylphenol and propoxur
was tested in 19 heavily feathered horses with
clinical pastern
dermatitis
and C. bovis infestation. Follow-up examinations over a period of
180 days
revealed significantly more
skin crusting in the placebo group
than in the treatment group. However,
no other differences in
clinical
signs or the numbers of mites detected were found between the two
groups.
The results of this study
suggest that moxidectin in combination
with environmental insecticide
treatment as used in this study
is
ineffective in the treatment of C. bovis in feathered
horses.
PMID: 20609205 [PubMed - as supplied by
publisher]
July 22, 2010 (4 docs)
Clin Nucl Med.
2010 Aug;35(8):579-82.
Lymphoscintigraphy in the diagnosis of
lymphangiomatosis.
Beveridge N, Allen L, Rogers
K.
Department of Nuclear Medicine/PET, Hunter New England
Imaging, John
Hunter Hospital,
Newcastle, NSW, Australia. [email protected]
Abstract
Lymphangiomatosis
is a rare condition characterized by multiple
abnormalities of the lymphatic
system.
Diagnosis is often difficult, as chronic, intermittent, or acute
pain;
edema; and other symptoms may
affect the respiratory,
gastrointestinal, renal, hepatic, skeletal, and
other organ systems. We
report the
case of a patient who first presented with lymphedema in
childhood and was
treated intermittently for
related symptoms before
diagnosis was achieved 36 years later. Plain film
radiography, bone
scanning,
computed tomography, magnetic resonance imaging, and
lymphoscintigraphy
were used to arrive at a
diagnosis. Information
derived from all scan types was combined to derive
a diagnosis
of
lymphangiomatosis. Lymphoscintigraphy provided direct evidence of
the
abnormal lymphatic flows
associated with lymphangiomatosis.
Lymphangiomatosis presents a diagnostic
challenge; information
from
several scan types, including lymphoscintigraphy, is useful in
deriving this
diagnosis.
PMID: 20631503 [PubMed - in process]
J
Plast Reconstr Aesthet Surg. 2010 Jul 12. [Epub ahead of
print]
Objective improvement in upper limb lymphoedema following
ipsilaterall
latissimus dorsi pedicled flap
breast reconstruction - A
case series and review of literature.
Abbas Khan MA, Mohan A,
Hardwicke J, Srinivasan K, Billingham R, Taylor C,
Prinsloo
D.
Department of Plastic and Reconstructive Surgery, University
Hospital
North Staffordshire NHS Trust,
Newcastle Rd, Stoke on Trent,
Staffordshire ST4 6QG, UK.
Abstract
OBJECTIVE: We
present a series of three patients whose upper limb
lymphoedema (following
total
oncologic mastectomy and level III axillary clearance)
resolved
significantly after ipsilateral pedicled
latissimus dorsi (LD)
flap breast reconstruction.
METHODS: A retrospective review of
the medical records of patients who had
undergone oncologic
mastectomy
and level III axillary clearance with subsequent LD pedicled
flap
reconstruction was
carried out. Individuals who had undergone review and
treatment by the
lymphoedema service were
identified and patients with
incomplete pre- or post-operative records
were excluded. A
minimum
follow-up period of 2 years of conservative therapy, as well as 2
years
post-operatively was
undertaken.
RESULTS: The rate
of improvement of lymphoedema following conservative
therapy was, on
average,
0.095mL/week and reached a plateau at 2-year follow-up.
Following
latissimus dorsi flap breast
reconstruction, the rate of
improvement in lymphoedema increased in all
three cases, with an
average
improvement of 2.55mL/week and remained sustained in the follow-up
period.
CONCLUSION: Pedicled myocutaneous flap reconstruction of
the ipsilateral
breast proved to be a
useful treatment for upper limb
lymphoedema in our series. This adds an
important dimension to
the
assessment and treatment of patients with upper limb oedema resulting
from
mastectomy and axillary
clearance. Copyright © 2010 British
Association of Plastic, Reconstructive
and Aesthetic Surgeons.
Published
by Elsevier Ltd. All rights reserved.
PMID: 20630818 [PubMed -
as supplied by publisher]
PLoS Negl Trop Dis. 2010 Jun
29;4(6):e728.
Increasing compliance with mass drug
administration programs for lymphatic
filariasis in India
through
education and lymphedema management programs.
Cantey
PT, Rout J, Rao G, Williamson J, Fox LM.
Epidemic Intelligence
Service, Office of Workforce and Career Development,
Centers for
Disease
Control and Prevention, Atlanta, Georgia, United States of
America.
[email protected]
Abstract
BACKGROUND:
Nearly 45% of people living at risk for lymphatic filariasis
(LF) worldwide
live in
India. India has faced challenges obtaining the needed levels
of
compliance with its mass drug
administration (MDA) program to
interrupt LF transmission, which utilizes
diethylcarbamazine (DEC)
or DEC
plus albendazole. Previously identified predictors of and barriers
to
compliance with the MDA
program were used to refine a pre-MDA educational
campaign. The objectives
of this study were to
assess the impact of these
refinements and of a lymphedema morbidity
management program on
MDA
compliance.
METHODS/PRINCIPAL FINDINGS: A randomized,
30-cluster survey was performed
in each of 3
areas: the community-based
pre-MDA education plus community-based
lymphedema management
education
(Com-MDA+LM) area, the community-based pre-MDA education
(Com-MDA) area,
and
the Indian standard pre-MDA education (MDA-only) area. Compliance with
the
MDA program was
90.2% in Com-MDA+LM, 75.0% in Com-MDA, and 52.9% in
the MDA-only areas
(p<0.0001).
Identified barriers to adherence
included: 1) fear of side effects and 2)
lack of recognition of
one's
personal benefit from adherence. Multivariable predictors of
adherence
amenable to educational
intervention were: 1) knowing about the
MDA in advance of its occurrence,
2) knowing everyone is at
risk for LF,
3) knowing that the MDA was for LF, and 4) knowing at least
one component of
the
lymphedema management techniques taught in the lymphedema management
program.
CONCLUSIONS/SIGNIFICANCE: This study confirmed
previously identified
predictors of and
barriers to compliance with
India's MDA program for LF. More importantly,
it showed that
targeting
these predictors and barriers in a timely and clear pre-MDA
educational
campaign can increase
compliance with MDA programs, and it
demonstrated, for the first time,
that lymphedema management
programs may
also increase compliance with MDA programs.
PMID: 20628595
[PubMed - in process]PMCID: PMC2900179
J Adv Nurs. 2010 Jul 2.
[Epub ahead of print]
Effectiveness of exercise programmes on
shoulder mobility and lymphoedema
after axillary lymph node
dissection
for breast cancer: systematic review.
Chan DN, Lui LY, So
WK.
Dorothy N.S. Chan BN MN RN Registered Nurse Department of
Surgery,
Ruttonjee and Tang Shiu
Kin Hospital, Hong Kong SAR,
China.
Abstract
chan d.n.s., lui l.y.y. & so
w.k.w. (2010) Effectiveness of exercise
programmes on shoulder
mobility
and lymphoedema after axillary lymph node dissection for breast
cancer:
systematic review. Journal of
Advanced Nursing. Abstract Aim.
This article is a report of a review of
the effectiveness of
exercise
programmes on shoulder mobility and lymphoedema in postoperative
patients
with breast cancer
having axillary lymph node dissection, as
revealed by randomized
controlled trials.
Background. Breast
cancer is the most common malignancy in women. After
surgery, the
most
common postoperative complications are reduced range of motion in
the
shoulder, muscle weakness in
the upper extremities, lymphoedema, pain
and numbness. To reduce these
impairments, shoulder
exercises are usually
prescribed. However, conflicting results regarding
the effect and timing of
such
exercises have been reported.
Data sources. Studies were
retrieved from a systematic search of published
works over the
period
2000-2009 indexed in the Cumulative Index to Nursing and Allied
Health
Literature, Ovid Medline,
the British Nursing Index, Proquest,
Science Direct, Pubmed, Scopus and
the Cochrane Library, using
the
combined search terms 'breast cancer', 'breast cancer surgery',
'exercise',
'lymphoedema', 'shoulder
mobility' and 'randomized controlled
trials'.
Methods. A quantitative review of effectiveness was
carried out. Studies
were critically appraised by
three independent
reviewers, and categorized according to levels of
evidence defined by the
Joanna
Briggs Institute.
Results. Six studies were included
in the review. Early rather than
delayed onset of training did not
affect
the incidence of postoperative lymphoedema, but early introduction
of
exercises was valuable in
avoiding deterioration in range of shoulder
motion.
Conclusion. Further studies are required to investigate
the optimal time
for starting arm exercises after
this surgery. Nurses
have an important role in educating and encouraging
patients to practise
these
exercises to speed up recovery.
PMID: 20626480 [PubMed
- as supplied by publisher]
July 24, 2010 (1
doc)
Gynecol Oncol. 2010 Jul 15. [Epub ahead of
print]
Risk factors for postoperative lower-extremity lymphedema
in endometrial
cancer survivors who had
treatment including
lymphadenectomy.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi
U, Nakatani M, Aoyagi Y,
Ohba Y, Okamoto
K, Kato
H.
Division of Gynecologic Oncology, National Hospital
Organization, Hokkaido
Cancer Center,
Sapporo,
Japan.
Abstract
OBJECTIVE: The aim of this study was
to determine the incidence rate of
lower-extremity
lymphedema after
systematic lymphadenectomy in patients with uterine
corpus malignancies and
to
elucidate risk factors for this type of
lymphedema.
METHODS: A retrospective chart review was carried
out for all patients
with uterine corpus malignant
tumor managed at
Hokkaido Cancer Center between 1991 and 2007. Patients
who did not
undergo
lymphadenectomy as a treatment or died of cancer/intercurrent
disease were
excluded from this study.
All living patients included in
this study had hysterectomy, bilateral
salpingo-oophorectomy
and
lymphadenectomy and their medical records were reviewed. We
identified
patients with postoperative
lower-extremity lymphedema
(POLEL). Logistic regression analysis was used
to select the risk
factors
for POLEL.
RESULTS: Of 286 patients evaluated, 103
(37.8%) had POLEL. Multivariate
analysis confirmed that
adjuvant
radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more
than 31 lymph
nodes
(OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to
the
distal external iliac nodes
(CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were
independent risk factors for POLEL.
CONCLUSION: Adjuvant
radiation therapy should be avoided in patients who
undergo
systematic
lymphadenectomy if an alternative postoperative strategy is
possible.
Although reducing the number of
resected lymph nodes is not
appropriate from a therapeutical point of
view, elimination of
CINDEIN
dissection may be helpful in reducing the incidence of POLEL. The
clinical
significance of CINDEIN
dissection needs to be investigated by a
randomized controlled trial.
Copyright © 2010 Elsevier Inc.
All rights
reserved.
PMID: 20638109 [PubMed - as supplied by
publisher]
Gynecol Oncol. 2010 Jul 15. [Epub ahead of
print]
Risk factors for postoperative lower-extremity lymphedema
in endometrial
cancer survivors who had
treatment including
lymphadenectomy.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi
U, Nakatani M, Aoyagi Y,
Ohba Y, Okamoto
K, Kato
H.
Division of Gynecologic Oncology, National Hospital
Organization, Hokkaido
Cancer Center,
Sapporo,
Japan.
Abstract
OBJECTIVE: The aim of this study
was to determine the incidence rate of
lower-extremity
lymphedema after
systematic lymphadenectomy in patients with uterine
corpus malignancies and
to
elucidate risk factors for this type of
lymphedema.
METHODS: A retrospective chart review was carried
out for all patients
with uterine corpus malignant
tumor managed at
Hokkaido Cancer Center between 1991 and 2007. Patients
who did not
undergo
lymphadenectomy as a treatment or died of cancer/intercurrent
disease were
excluded from this study.
All living patients included in
this study had hysterectomy, bilateral
salpingo-oophorectomy
and
lymphadenectomy and their medical records were reviewed. We
identified
patients with postoperative
lower-extremity lymphedema
(POLEL). Logistic regression analysis was used
to select the risk
factors
for POLEL.
RESULTS: Of 286 patients evaluated, 103
(37.8%) had POLEL. Multivariate
analysis confirmed that
adjuvant
radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more
than 31 lymph
nodes
(OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to
the
distal external iliac nodes
(CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were
independent risk factors for POLEL.
CONCLUSION: Adjuvant
radiation therapy should be avoided in patients who
undergo
systematic
lymphadenectomy if an alternative postoperative strategy is
possible.
Although reducing the number of
resected lymph nodes is not
appropriate from a therapeutical point of
view, elimination of
CINDEIN
dissection may be helpful in reducing the incidence of POLEL. The
clinical
significance of CINDEIN
dissection needs to be investigated by a
randomized controlled trial.
Copyright © 2010 Elsevier Inc.
All rights
reserved.
PMID: 20638109 [PubMed - as supplied by
publisher]
Cancer. 2010 Jul 27. [Epub ahead of
print]
Lymphedema beyond breast cancer: a systematic review and
meta-analysis of
cancer-related
secondary
lymphedema.
Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI,
Armer JM.
Department of Surgical Oncology, The University of
Texas M. D. Anderson
Cancer Center,
Houston,
Texas.
Abstract
BACKGROUND::
Secondary lymphedema is a debilitating, chronic, progressive
condition
that
commonly occurs after the treatment of breast cancer. The purpose of
the
current study was to
perform a systematic review and meta-analysis of
the oncology-related
literature excluding breast
cancer to derive
estimates of lymphedema incidence and to identify
potential risk factors
among various
malignancies.
METHODS:: The authors
systematically reviewed 3 major medical indices
(MEDLINE,
Cochrane
Library databases, and Scopus) to identify studies (1972-2008)
that
included a prospective
assessment of lymphedema after cancer
treatment. Studies were categorized
according to malignancy,
and data
included treatment, complications, lymphedema measurement
criteria,
lymphedema incidence,
and follow-up interval. A quality assessment of
individual studies was
performed using established
criteria for
systematic reviews. Bayesian meta-analytic techniques were
applied to derive
summary
estimates when sufficient data were
available.
RESULTS:: A total of 47 studies (7779 cancer
survivors) met inclusion
criteria: melanoma (n = 15),
gynecologic
malignancies (n = 22), genitourinary cancers (n = 8),
head/neck cancers (n =
1), and
sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and
varied
by malignancy (P < .
001): melanoma, 16% (upper extremity, 5%;
lower extremity, 28%);
gynecologic, 20%; genitourinary,
10%; head/neck,
4%; and sarcoma, 30%. Increased lymphedema risk was also
noted for
patients
undergoing pelvic dissections (22%) and radiation therapy (31%).
Objective
measurement methods
and longer follow-up were both associated
with increased lymphedema
incidence.
CONCLUSIONS:: Lymphedema
is a common condition affecting cancer survivors
with
various
malignancies. The incidence of lymphedema is related to the type
and
extent of treatment, anatomic
location, heterogeneity of assessment
methods, and length of follow-up.
Cancer 2010. (c) 2010
American Cancer
Society.
PMID: 20665892 [PubMed - as supplied by
publisher]
IEEE Eng Med Biol Mag. 2010
Mar-Apr;29(2):63-70.
Optical coherence tomography: the
intraoperative assessment of lymph nodes
in breast
cancer.
Nguyen FT, Zysk AM, Chaney EJ, Adie SG, Kotynek JG,
Oliphant UJ,
Bellafiore FJ, Rowland KM,
Johnson PA, Boppart
SA.
Abstract
During breast-conserving surgeries,
axillary lymph nodes draining from the
primary tumor site are
removed for
disease staging. Although a high number of lymph nodes are
often resected
during sentinel
and lymph-node dissections, only a relatively small
percentage of nodes
are found to be metastatic, a
fact that must be
weighed against potential complications such as
lymphedema. Without a
real-time in
vivo or in situ intraoperative imaging tool to provide a
microscopic
assessment of the nodes,
postoperative paraffin section
histopathological analysis currently
remains the gold standard in
assessing
the status of lymph nodes. This paper investigates the use of
optical
coherence tomography (OCT), a
high-resolution real-time
microscopic optical-imaging technique, for the
intraoperative ex vivo
imaging
and assessment of axillary lymph nodes. Normal (13), reactive (1),
and
metastatic (3) lymph nodes
from 17 human patients with breast cancer
were imaged intraoperatively
with OCT. These preliminary
clinical studies
have identified scattering changes in the cortex,
relative to the capsule,
which can be
used to differentiate normal from reactive and metastatic
nodes. These
optical scattering changes are
correlated with inflammatory
and immunological changes observed in the
follicles and germinal
centers.
These results suggest that intraoperative OCT has the potential to
assess
the real-time node status in
situ, without having to physically
resect and histologically process
specimens to visualize
microscopic
features.
PMID: 20659842 [PubMed - in
process]
August 7, 2010 (5 docs)
J Vasc Surg.
2010 Aug;52(2):429-34.
Extracorporeal shock wave therapy
ameliorates secondary lymphedema
by
promoting
lymphangiogenesis.
Kubo M, Li TS, Kamota T,
Ohshima M, Shirasawa B, Hamano K.
Department of Surgery and
Clinical Science, Yamaguchi University Graduate
School of Medicine,
Ube,
Yamaguchi, Japan.
Abstract
OBJECTIVE: Although
secondary lymphedema is a common complication after
surgical and
radiation
therapy for cancer, the treatment options for lymphedema remain
limited
and largely ineffective. We
thus studied the effect of
extracorporeal shock wave therapy on promoting
lymphangiogenesis
and
improving secondary lymphedema.
METHODS: A rabbit ear
model of lymphedema was created by disruption of
lymphatic vessels.
Two
weeks after surgery, the lymphedematous ear was treated with or
without
low-energy shock waves
(0.09 mJ/mm(2), 200 shots), three times
per week for 4 weeks.
RESULTS: Western blot analysis showed that
the expression of vascular
endothelial growth factor
(VEGF)-C (1.23-fold,
P < .05) and VEGF receptor 3 (VEGFR3; 1.53-fold, P <
.05)
was
significantly increased in the ears treated with shock wave than in
the
untreated lymphedematous ears.
Compared with the control group, shock
wave treatment led to a significant
decrease in the thickness
of
lymphedematous ears (3.80 +/- 0.25 mm vs 4.54 +/- 0.18 mm, P <
.05).
Immunohistochemistry for
VEGFR3 showed the density of lymphatic
vessels was significantly increased
by shock wave treatment
(P <
.05).
CONCLUSION: Extracorporeal shock wave therapy promotes
lymphangiogenesis
and ameliorates
secondary lymphedema, suggesting that
extracorporeal shock wave therapy
may be a novel, feasible,
effective,
and noninvasive treatment for lymphedema. Copyright (c) 2010
Society for
Vascular
Surgery. Published by Mosby, Inc. All rights
reserved.
PMID: 20670777 [PubMed - in
process]
Oper Orthop Traumatol. 2010
Jul;22(3):317-34.
[The medial closed-wedge osteotomy of the
distal femur for the treatment
of unicompartmental lateral
osteoarthritis
of the knee.] [Article in German]
Freiling D, van Heerwaarden R,
Staubli A, Lobenhoffer P.
Klinik für Unfall- und
Wiederherstellungschirurgie, Diakonie-
krankenhaus
Henriettenstiftung,
Hannover, Germany, [email protected].
Abstract
OBJECTIVE
: Shifting of the mechanical axis from the lateral to the medial
compartment
in patients
with lateral osteoarthritis in combination with valgus
deformity.
INDICATIONS : Osteoarthritis of the lateral
compartment in combination
with valgus deformity of the
(distal) femur.
Posttraumatic and congenital valgus deformities of the
(distal)
femur.
CONTRAINDICATIONS : Osteoarthritis of the medial
compartment (>/= grade 3
on Outerbridge
Scale). Total loss of the
medial meniscus. Acute or chronic infections.
Rheumatoid arthritis.
Heavy
smoking. Extension or flexion deficit > 20 degrees . Poor
soft-tissue
conditions on site of surgery.
SURGICAL TECHNIQUE
: Optional: arthroscopy before osteotomy. Anteromedial
skin
incision,
subvastus approach with blunt preparation around the vastus
medialis
muscle and separation of this
muscle from the intermuscular
septum. The posterior osteotomy is marked
with Kirschner wires
(OGD
[osteotomy guiding device], Synthes, Switzerland, can be used
optionally).
The biplanar cut is marked
on the bone with an
electrocautery device. The bone cuts start with the
posterior
incomplete
osteotomy, followed by the anterior biplanar cut. After finishing
the
osteotomy (three bone cuts!), the
bone wedge can be removed. Closing
the osteotomy should start very gently
as a plastic deformation
of the
bone. A radiologic control of the leg alignment and the mechanical
axis is
achieved with an
alignment rod (Synthes, Switzerland). The plate should be
inserted under
the vastus medialis muscle. It
is very important, that the
surgeon controls the correct anteromedial
position of the plate at the
distal
femur (right and left version of the implant). Fixation of the plate
with
locking screws distally.
Positioning of a lag screw in the dynamic
hole directly above the
osteotomy. Insertion of monocortical
screws in
the three remaining holes proximal of the lag screw. Finally,
the lag screw
is changed to a self-
tapping bicortical locking head screw. X-ray control,
wound closure.
POSTOPERATIVE MANAGEMENT : Elastic bandage of the
leg up to the thigh in
the operating
room. Change of the dressing on day
1 after surgery. Ice treatment.
Walking on crutches starting day 1
after
surgery. Physiotherapy and manual lymph drainage starting on day 1
after
surgery. Partial weight
bearing for the first 4-6 weeks after surgery.
Suture removal after 10-12
days. X-ray control on day 3
and 6 weeks after
surgery. Discharge possible, if wounds are dry (day
4-7).
RESULTS : Between January 2005 and October 2008, 60
patients were treated
with medial closed-
wedge osteotomy of the distal
femur (since 11/2006 only with biplanar
osteotomy technique) at
the
Department of Trauma and Reconstructive Surgery,
Diakoniekrankenhaus
Henriettenstiftung
Hannover, Germany. The average
wedge size was 7.6 mm (4-13 mm). The mean
age was 39.7 years
(17-79
years). The patients had had 2.3 previous surgeries. The mean
follow- up was
21 months (3-
45 months). Freiling D, et al. Biplanare Osteotomie
bei
unikompartimentaler lateraler
Kniegelenkarthrose Flexion was 126
degrees (95-140 degrees )
preoperatively, and 128 degrees
(105-140
degrees ) postoperatively. 25 patients had at least 5 degrees
extension
deficit (5-15 degrees
) before surgery, whereas ten patient did not reach
the full extension at
follow-up examination. The
Tegner Activity Score
increased from 2.8 (1-4) preoperatively to 5.6 (2-9)
postoperatively, in
IKDC
(International Knee Documentation Committee) Score, 18 patients
reached
grade A, 27 grade B, nine
grade C, and six grade D. The visual
analog scale (VAS) score decreased
from 6.8 (8-2)
preoperatively to 3.1
(0-7) postoperatively. Seven patients had revision
surgery (three times
delayed
union/nonunion of the osteotomy, one superficial and one deep
infection,
one hematoma, one fracture
[proximal of the internal plate
fixator] after a fall).
PMID: 20676825 [PubMed - in
process]
Plast Reconstr Surg. 2010
Aug;126(2):55e-69e.
Vascular anomalies and
lymphedema.
Chim H, Drolet B, Duffy K, Koshima I, Gosain
AK.
Cleveland, Ohio; Milwaukee, Wis.; and Tokyo, Japan From the
Department of
Plastic Surgery, Case
Western Reserve University; the
Department of Dermatology, Children's
Hospital of Wisconsin; and
the
Department of Plastic and Reconstructive Surgery, University of
Tokyo.
Abstract
LEARNING OBJECTIVES:: After
studying this article, the participant should
be able to: 1. Define
the
difference between vascular tumors and malformations. 2.
Distinguish
between the natural history of
hemangiomas and that of
vascular malformations. 3. Identify the different
types of hemangiomas
and
vascular malformations and understand evaluation, treatment,
and
complications. 4. Understand the
role of lymphaticovenular
anastomoses in the treatment of
extremity
lymphedema.
BACKGROUND:: The International Society
for the Study of Vascular Anomalies
classification, which
is the most
widely accepted classification system in use, divides vascular
anomalies
into vascular tumors
(inclusive of hemangiomas) and malformations. This
serves as a guideline
for diagnosis, evaluation, and
treatment of these
lesions.
METHODS:: Although hemangiomas tend to have a
predictable clinical course
over the first year of
life, going through
proliferating, involuting, and involuted stages,
vascular malformations
demonstrate
growth commensurate with age, often becoming more prominent in
puberty. In
addition, they never
regress, and persist throughout
life.
RESULTS:: Different modalities of treatment may be
appropriate for
vascular tumors and different
subsets of vascular
malformations. Details are provided in this review.
Lymphaticovenular
anastomoses
provide an excellent addition to our methods of treatment of
extremity
lymphedema, and are made
possible through development of
supermicrosurgical techniques.
CONCLUSIONS:: Vascular anomalies
have a high prevalence in the general
population. Thus, it is
vital that
the plastic surgeon has a good understanding of classification,
evaluation,
and treatment
options. Lymphedema is another common condition that is
encountered.
Understanding of
lymphaticovenular anastomoses and their
applications aids treatment
planning for select
patients.
PMID: 20679788 [PubMed - in
process]
Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2010
Aug;27(4):371-5.
[Identification of VEGFR3 gene mutation in a
Chinese family with autosomal
dominant primary
congenital lymphoedema.]
[Article in Chinese]
Sheng J, Zeng F, Li C, Liu J, Wang Q, Liu
M.
Key Laboratory of Molecular Biophysics of Ministry of
Education, College
of Life Science and
Technology, Center for Human
Genome Research, Huazhong University of
Science and Technology,
Wuhan,
Hubei, 430074 P. R. China. [email protected].
Abstract
OBJECTIVE:
To identify the disease-causing gene in a four-generation
Chinese family
with 9 members
affected with primary congenital lymphoedema (PCL, also known
as Milroy
disease).
METHODS: Linkage analysis was performed
with a few microsatellite markers
flanking the candidate
genetic loci for
PCL, including 3 known genes associated with autosomal
dominant PCL. For
mutation
analysis, VEGFR3 gene was sequenced with DNA from the proband.
Direct DNA
sequencing of exon
25 of the VEGFR3 gene was performed in all
family members.
RESULTS: The disease gene in the family was
mapped to chromosome 5q35.3
with a maximum Lod
score of 2.07. Direct DNA
sequencing of VEGFR3 gene revealed a
heterozygous C to T transition
at
nucleotide 3341, resulting in p.Pro1114Leu mutation. The
p.Pro1114Leu
mutation co-segregated with
all affected individuals in the
family.
CONCLUSION: This study identified a C3341T
(p.Pro1114Leu) mutation in the
VEGFR3 gene in a
Chinese family with PCL,
provided evidence that VEGFR3 mutation can cause
PCL in
Chinese.
PMID: 20677139 [PubMed - in
process]
Physiotherapy. 2010 Sep;96(3):264. Epub 2010 Jun
2.
Comments on book review of 'Lymphoedema: Advice on
Self-management'.
Friett K.
Lymphoedema Support
Network, St. Lukes Crypt, Sydney Street, London SW3
6NH,
UK.
PMID: 20674660 [PubMed - in process]
August
14, 2010 (3 docs)
Coll Antropol. 2010
Jun;34(2):645-8.
A case report of breast
angiosarcoma.
Kardum-Skelin I, Jelić-Puskarić B, Pazur
M,
Vidić-Paulisić I, Jakić-Razumović J, Separović
V.
Laboratory for Cytology and Hematology, Department of
Medicine, "Merkur"
University Hospital,
Zagreb, Croatia. [email protected]
Abstract
Angiosarcoma
is a rare disease of the breast with the reported incidence
of only 0.04% of
all breast
malignancies. The etiology of angiosarcoma remains unknown. It
occurs
post-mastectomy, in
association with chronic lymphedema
(Stewart-Treves syndrome), or after
radiotherapy. We present a
patient
with angiosarcoma which developed 12 years of the diagnosis of
breast
carcinoma and 8 years
of the operative procedure and radiotherapy for
disease recurrence. A
small angiomatous lesion of a
few mm in size,
cytologically suspect of vascular tumor (hemangioma or
hemangiopericytoma)
and
histopathologically verified to be an atypical vascular lesion,
was
detected two years before breast
enlargement and cytologic and
histologic diagnosis of angiosarcoma. The
patient died 15 months of
the
diagnosis of angiosarcoma, after two tumor recurrences and
intrathoracic
cavity invasion.
PMID: 20698145 [PubMed - in
process]
Am J Surg Pathol. 2010 Aug 6. [Epub ahead of
print]
Epithelioid Angiosarcoma of the Skin: A Study of 18 Cases
With Emphasis on
its Clinicopathologic
Spectrum and Unusual Morphologic
Features.
Bacchi CE, Silva TR, Zambrano E, Plaza J, Suster S,
Luzar B, Lamovec J,
Pizzolitto S, Falconieri G.
*Consultoria
em Patologia, Botucatu, SP, Brazil daggerDepartment of
Pathology, Medical
College of
Wisconsin, Milwaukee, WI double daggerInstitute of Pathology,
Medical
Faculty, University of
Ljubljana School of Medicine section
signDepartment of Pathology,
Institute of Oncology, Ljubljana,
Slovenia
parallelDepartment of Pathology, General University Hospital S.
Maria della
Misericordia,
Udine, Italy.
Abstract
We report
18 cases of cutaneous angiosarcoma with predominant or exclusive
epithelioid
morphology.
Both sexes were similarly affected. Patients' ages ranged from 2
to 97
years, median 77.5 years; 2
were pediatric patients. In elderly
patients scalp or facial lesions and
cutaneous lesions arising
within
irradiated breast skin predominated. Limb lesions were seen in
younger
patients. Microscopically, the
tumors were composed of packed
polygonal cells with focal evidence of
endothelial
differentiation.
Diverging phenotypes included syncytial growth of large
cells with clear
nuclei and prominent nucleoli,
micronodules of tumor
cells scattered in dermis, predominance of
discohesive plasmacytoid
polygonal
cells with abundant bright eosinophilic cytoplasm, sheets of clear
cells
with coarse granular cytoplasm,
trabecular and cord arrangement of
tumor cells splaying the dermal
collagen, or a pseudoglandular
appearance
owing to clear cell tubular arrangement with open lumina. These
cases posed
further
diagnostic challenges simulating lymphoma,
melanoma,
lymphoepithelioma-like carcinoma, adnexal
carcinoma, and
neuroendocrine carcinoma. Immunohistochemical studies
showed positivity for
CD31
and CD34; no immunoreactivity was documented for other tested
antigens
including cytokeratins,
S100 protein, melanocytic antigens,
leukocyte common antigen, and desmin.
Therapeutic modalities
included
combined local excision, chemotherapy, and radiotherapy,
depending on
patient clinical status.
Of the 9 patients available for follow-up, 5 were
alive and apparently
well, 2 had recurrent disease, and
2 had died of
tumor. Our data show that epithelioid cutaneous angiosarcoma
may have a
broad
morphological spectrum, raising interpretive challenges on microscopy.
In
addition, its clinical
presentation seems to differ in nonelderly
patients, with lesions likely
related to lymphedema or
vascular
malformations.
PMID: 20697249 [PubMed - as supplied
by publisher]
J Biotechnol. 2010 Aug 3. [Epub ahead of
print]
Reconstruction of lymph vessel by lymphatic endothelial
cells combined
with polyglycolic acid
scaffolds: a pilot
study.
Dai TT, Jiang ZH, Li SL, Zhou GD, Kretlow JD, Cao WG, Liu
W, Cao YL.
Department of Plastic and Reconstructive Surgery,
Shanghai ninth people's
hospital, Shanghai Jiao
Tong University School of
Medicine, Shanghai, China.
Abstract
Restoration
of lymphatic drainage using lymph vessels or tissue grafting
is becoming an
efficient method
for alleviating obstructive lymphedema. However, the lack
of ideal
lymphatic grafts is the key problem
that limits the application
of lymphatic transplantation, but now that may
be resolved with
tissue-
engineered lymph vessels. In this study, the feasibility of
reconstructing
lymph vessels was explored
using lymphatic endothelial
cells (LECs) combined with polyglycolic acid
(PGA) scaffolds. The
highly
purified human dermal LECs can be isolated from human dermis
by
immunomagnetic bead sorting and
multiplied in culture. The viability
and growth potential of subcultured
LECs make it possible to obtain
large
amount of cells in vitro. Light and scanning electron microscopy
(SEM)
showed that the
prefabricated PGA scaffolds, with 3-dimensional structure,
can support
cell adhesion, growth and
spreading. The constructs formed
with LECs combined with PGA scaffolds
were cultured in vitro for
ten days
and then implanted subcutaneously into nude mice. Six weeks
after
implantation, the portions
of implanted tubules were harvested.
Gross and histological observation
demonstrated that the
tubular
structure still remained in the experimental groups but not in the
control
groups. Immunohistochemical
staining and RT-PCR assay of the
implanted vessels revealed positive
staining in experimental groups
for
the lymphatic specific markers podoplanin, VEGFR-3 and LYVE-1. The
results
indicate that LECs
can serve as seed cells and be successfully combined with
PGA scaffolds,
and the tissue-engineered
tubular structure using
implanted LECs-PGA compounds showed preliminary
characteristics of
lymph
vessels. A gap between the nearly normal or functional lymph vessel
still
exists as we have only the
endothelial cell lined duct, but this
study demonstrates that it is
feasible to construct
tissue-engineered
lymph vessels using LECs combined with a biodegradable
material. Copyright
© 2010. Published by
Elsevier
B.V.
PMID: 20691226 [PubMed - as supplied by
publisher]
The next 5 documments are Medifocus.com but when I
click on each
individual link a Pub Med
document did come up and they may
be duplicates because they are dated
from May to July
2010:
Medfocus Document Alert – August 2010 issue (5
docs)
Each month hundreds of thousands of consumers and
healthcare professionals
search the National
Library of Medicine's
Medline database seeking the latest information on
their
disease/condition.
Conducting a thorough and effective Medline search is
both a time
consuming and daunting task. At
Medifocus, we have developed
an effective solution to this problem: each
month our staff of
expert
researchers searches Medline for the latest advances in research
and
clinical medicine for over 70
diseases / conditions. We do this with
one goal in mind: to empower you to
effectively take control
over your
health.
Here is the result of our team's work in Lymphedema this
month:
Arch Phys Med Rehabil. 2010
Jul;91(7):1070-6.
Weight lifting in patients with
lower-extremity lymphedema secondary to
cancer: a pilot and
feasibility
study.
Katz E, Dugan NL, Cohn JC, Chu C, Smith
RG, Schmitz KH.
Department of Rehabilitation Medicine,
University of Washington, Seattle,
WA,
USA.
Abstract
OBJECTIVE: To assess the
feasibility of recruiting and retaining cancer
survivors with
lower-limb
lymphedema into an exercise intervention study. To develop
preliminary
estimates regarding the safety
and efficacy of this
intervention. We hypothesized that progressive weight
training would
not
exacerbate leg swelling and that the intervention would improve
functional
mobility and quality of life.
DESIGN: Before-after
pilot study with a duration of 5 months.
SETTING: University of
Pennsylvania.
PARTICIPANTS: Cancer survivors with a known
diagnosis of lower-limb
lymphedema (N=10) were
directly referred by
University of Pennsylvania clinicians. All 10
participants completed the
study.
INTERVENTION: Twice weekly slowly progressive weight
lifting, supervised
for 2 months,
unsupervised for 3
months.
MAIN OUTCOME MEASURES: The primary outcome was interlimb
volume
differences as
measured by optoelectronic perometry. Additional
outcome measures included
safety (adverse events),
muscle strength,
objective physical function, and quality of life.
RESULTS:
Interlimb volume differences were 44.4% and 45.3% at baseline and
5
months,
respectively (pre-post comparison, P=.70). There were 2
unexpected
incident cases of cellulitis within
the first 2 months. Both
resolved with oral antibiotics and complete
decongestive therapy by 5
months.
Bench and leg press strength increased by 47% and 27% over 5
months
(P=.001 and P=.07,
respectively). Distance walked in 6 minutes
increased by 7% in 5 months
(P=.01). No improvement
was noted in
self-reported quality of life.
CONCLUSIONS: Recruitment of
patients with lower-limb-lymphedema into an
exercise program is
feasible.
Despite some indications that the intervention may be safe (eg,
a lack of
clinically significant
interlimb volume increases over 5 mo), the unexpected
finding of 2
cellulitic infections among the 10
participants suggests
additional study is required before concluding that
patients with
lower-extremity
lymphedema can safely perform weight
lifting.
PMID: 20599045 [PubMed - indexed for
MEDLINE]
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.
PMID: 20537300 [PubMed - indexed for
MEDLINE]
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 - indexed for
MEDLINE]
Nucl Med Commun. 2010
Jun;31(6):547-51.
Intradermal lymphoscintigraphy at rest and
after exercise: a new technique
for the functional assessment
of the
lymphatic system in patients with lymphoedema.
Tartaglione G,
Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C,
Paone G,
Bernabucci
V, Bartoletti R, Marchetti P, Marzola MC, Naji M, Rubello
D.
Unit of Nuclear Medicine, Cristo Re Hospital, Istituto
Dermopatico
dell'Immacolata,
IDI-IRCCS.
Abstract
AIM: The aim of this study
was to evaluate the effect of implementing a
new technique,
intradermal
injection lymphoscintigraphy, at rest and after muscular
exercise on the
functional assessment of the
lymphatic system in a group
of patients with delayed or absent lymph
drainage.
METHODS:
We selected 44 patients (32 women and 12 men; 15 of 44 with upper
limb and
29 of 44
with lower limb lymphoedema). Thirty of 44 patients had bilateral
limb
lymphoedema and 14 of 44 had
unilateral disease; 14 contralateral
normal limbs were used as controls.
Twenty-three patients had
secondary
lymphoedema after lymphadenectomy and the remaining 21 had
idiopathic
lymphoedema.
Each of the 44 patients was injected with 50 MBq (0.3-0.4 ml)
of
(99m)Tc-albumin-nanocolloid,
which was administered intradermally at
the first interdigital space of
the affected limb. Two planar
static
scans were performed using a low-energy general-purpose
collimator
(acquisition matrix 128 x
128, anterior and posterior views
for 5 min), and in which drainage was
slow or absent, patients were
asked
to walk or exercise for 2 min. A postexercise scan was then
performed to
monitor and record
the tracer pathway and the tracer appearance time (TAT)
in the inguinal or
axillary lymph nodes.
RESULTS: The
postexercise scans showed that (i) 21 limbs (15 lower and six
upper limbs)
had
accelerated tracer drainage and tracer uptake in the inguinal
and/or
axillary lymph nodes. Two-thirds of
these showed lymph stagnation
points; (ii) 27 limbs had collateral lymph
drainage pathways; (iii) in
11
limbs, there was lymph drainage into the deeper lymphatic channels,
with
unusual uptake in the popliteal
or antecubital lymph nodes; (iv) six
limbs had dermal backflow; (v) three
limbs did not show lymph
drainage
(TAT=not applicable). TAT=15 + or - 3 min, ranging from 12 to 32
min in limbs
with
lymphoedema versus 5 + or - 2 min, ranging from 1 to 12 min in
the
contralateral normal limbs (P<0.
001).
CONCLUSION:
Intradermal injection lymphoscintigraphy gives a better
imaging of the lymph
drainage
pathways in a shorter time, including cases with advanced
lymphoedema. In
some patients with
lymphoedema, a 2-min exercise can
accelerate tracer drainage, showing
several compensatory
mechanisms of
lymph drainage. The effect of the exercise technique on TAT
and
lymphoscintigraphy
findings could result in a more accurate functional
assessment of
lymphoedema patients.
PMID: 20215978 [PubMed -
indexed for MEDLINE]
Eur J Vasc Endovasc Surg. 2010
May;39(5):646-53. Epub 2010 Feb 21.
Primary lymphoedema and
lymphatic malformation: are they the two sides of
the same
coin?
Lee BB, Villavicencio JL.
Division of
Vascular Surgery, Georgetown University School of Medicine,
Washington, DC
20007,
USA. [email protected]
Abstract
OBJECTIVES:
To clear the confusion regarding the relationship between the
'primary
lymphoedema'
and (truncular) lymphatic malformation (LM); the latter is one
of
congenital vascular malformations.
MATERIALS &
METHODS: A literature review was carried out on the primary
lymphoedema
either
existing as an independent LM lesion or as a component of
the
Klippel-Trenaunay syndrome.
RESULTS: The review was able
to provide a contemporary guide/conclusion on
the definition
and
classification, clinical evaluation and clinical management
regarding
conservative (physical) therapy,
reconstructive surgical
therapy and ablative/excisional surgical therapy,
for the primary
lymphoedema
as an LM.
CONCLUSIONS: Primary lymphoedema can be
considered as 'congenital' since
its majority
represents a clinical
manifestation of the truncular type of LM arising
during the later stages
of
lymphangiogenesis. Such embryological staging information of the LM
is
critical for proper management
of the primary lymphoedema when it
exists with other congenital vascular
malformations (Klippel-
Trenaunay
syndrome). 2. Basic non-invasive to minimally invasive tests
will provide an
adequate
diagnosis and lead to the correct multidisciplinary, specifically
targeted
and sequenced treatment
strategy. 3. The mainstay of current
management of the primary
lymphoedema/truncular LM is
complex
decongestive therapy; and the reconstructive as well as ablative
surgical
therapy remain adjunctive
therapies at
best.
PMID: 20176496 [PubMed - indexed for
MEDLINE]
August 24, 2010 (2 docs)
Rev Med Chir
Soc Med Nat Iasi. 2010 Apr-Jun;114(2):434-8.
[Advanced cervical
cancer surgical treatment considerations][Article
in
Romanian]
Velenciuc N, Luncă S, Velenciuc I, Pantazescu
A.
Universităţii de Medicină şi Farmacie Gr.T. Popa
Iaşi,
Spitalul Clinic de Urgenţe Sf. Ioan
Iaşi.
Abstract
The aim of this study was to
highlight the importance of surgical
treatment in advanced cervical
cancer
(IIB-IIIB). MATERIAL AND METHOD: Data from 179 patients with
cervical
cancer, admitted in
the Clinic of Emergency Surgery, "Sf. Ioan"
Hospital, Iaşi, between
January, 1st, 2003 and December,
31st, 2009, were
collected. RESULTS: A number of 11 cases (6.1%) cases
were without any
clinical
response, so that they benefit by radical radiotherapy; a radical
surgical
intervention was performed in
the other 168 cases (93.7%), in
4-6 weeks after chemotherapy. No
intraoperative complications
were
evidenced, but after surgical intervention we recorded:
urinary
troubles--10 (6.5%); lymphedema--3
(1.9%); posttoperative
intestinal occlusions--2 (1.3%); extended dynamic
ileus--2 (1.3%);
phlebitis--2
(1.3%).
PMID: 20700981 [PubMed - in
process]
Urology. 2010 Aug;76(2 Suppl
1):S43-57.
Management of the lymph nodes in penile
cancer.
Heyns CF, Fleshner N, Sangar V, Schlenker B, Yuvaraja
TB, van Poppel H.
Department of Urology, Stellenbosch University
and Tygerberg Hospital,
Tygerberg, South Africa.
[email protected]
Abstract
A
comprehensive literature study was conducted to evaluate the levels
of
evidence (LEs) in
publications on the diagnosis and staging of penile
cancer.
Recommendations from the available
evidence were formulated and
discussed by the full panel of the
International Consultation on
Penile
Cancer in November 2008. The final grades of recommendation (GRs)
were
assigned according to the
LE of the relevant publications. The
following consensus recommendations
were accepted. Fine needle
aspiration
cytology should be performed in all patients (with ultrasound
guidance in
those with
nonpalpable nodes). If the findings are positive, therapeutic,
rather than
diagnostic, inguinal lymph node
dissection (ILND) can be
performed (GR B). Antibiotic treatment for 3-6
weeks before ILND
in
patients with palpable inguinal nodes is not recommended (GR
B).
Abdominopelvic computed
tomography (CT) and magnetic resonance
imaging (MRI) are not useful in
patients with nonpalpable
nodes. However,
they can be used in those with large, palpable inguinal
nodes (GR B). The
statistical
probability of inguinal micrometastases can be estimated using
risk group
stratification or a risk
calculation nomogram (GR B).
Surveillance is recommended if the nomogram
probability of positive
nodes
is <0.1 (10%). Surveillance is also recommended if the primary
lesion is
grade 1, pTis, pTa
(verrucous carcinoma), or pT1, with no lymphovascular
invasion, and
clinically nonpalpable inguinal
nodes, but only provided
the patient is willing to comply with regular
follow-up (GR B). In the
presence
of factors that impede reliable surveillance (obesity, previous
inguinal
surgery, or radiotherapy)
prophylactic ILND might be a
preferable option (GR C). In the
intermediate-risk group
(nomogram
probability .1-.5 [10%-50%] or primary tumor grade 1-2, T1-T2,
cN0, no
lymphovascular invasion),
surveillance is acceptable, provided
the patient is informed of the risks
and is willing and able to
comply.
If not, sentinel node biopsy (SNB) or limited (modified) ILND
should be
performed (GR B).
In the high-risk group (nomogram probability >.5 [50%]
or primary tumor
grade 2-3 or T2-T4 or cN1-
N2, or with lymphovascular
invasion), bilateral ILND should be performed
(GR B). ILND can
be
performed at the same time as penectomy, instead of 2-6 weeks later
(GR
C). SNB based on the
anatomic position can be performed, provided the
patient is willing to
accept the potential false-
negative rate of
</=25% (GR C). Dynamic SNB with lymphoscintigraphic and
blue dye
localization
can be performed if the technology and expertise are available
(GR C).
Limited ILND can be
performed instead of complete ILND to reduce
the complication rate,
although the false-negative rate
might be similar
to that of anatomic SNB (GR C). Frozen section histologic
examination can be
used
during SNB or limited ILND. If the results are positive, complete ILND
can
be performed immediately
(GR C). In patients with cytologically or
histologically proven inguinal
metastases, complete ILND
should be
performed ipsilaterally (GR B). In patients with histologically
confirmed
inguinal metastases
involving >/=2 nodes on one side, contralateral
limited ILND with frozen
section analysis can be
performed, with complete
ILND if the frozen section analysis findings are
positive (GR B). If
clinically
suspicious inguinal metastases develop during surveillance,
complete ILND
should be performed on
that side only (GR B), and SNB or
limited ILND with frozen section
analysis on the contralateral side
can
be considered (GR C). Endoscopic ILND requires additional study to
determine
the complication
and long-term survival rates (GR C). Pelvic lymph node
dissection is
recommended if >/=2 proven
inguinal metastases, grade 3
tumor in the lymph nodes, extranodal
extension (ENE), or large (2-4
cm)
inguinal nodes are present, or if the femoral (Cloquet's) node is
involved
(GR C). Performing ILND
before pelvic lymph node dissection is
preferable, because pelvic lymph
node dissection can be
avoided in
patients with minimal inguinal metastases, thus avoiding the
greater risk of
chronic
lymphedema (GR B). In patients with numerous or large inguinal
metastases,
CT or MRI should be
performed. If grossly enlarged iliac
nodes are present, neoadjuvant
chemotherapy should be given and
the
response assessed before proceeding with pelvic lymph node dissection
(GR
C). Antibiotic
treatment should be started before surgery to minimize the
risk of wound
infection (GR C).
Perioperative low-dose heparin to prevent
thromboembolic complications can
be used, although it
might increase
lymph leakage (GR C). The skin incision for ILND should be
parallel to the
inguinal
ligament, and sufficient subcutaneous tissue should be preserved
to
minimize the risk of skin flap
necrosis (GR B). Sartorius muscle
transposition to cover the femoral
vessels can be used in radical
ILND
(GR C). Closed suction drainage can be used after ILND to prevent
fluid
accumulation and
wound breakdown (GR B). Early mobilization after ILND is
recommended,
unless a myocutaneous
flap has been used (GR B). Elastic
stockings or sequential compression
devices are advisable to
minimize the
risk of lymphedema and thromboembolism (GR C). Radiotherapy
to the inguinal
areas is
not recommended in patients without cytologically or histologically
proven
metastases nor in those with
micrometastases, but it can be
considered for bulky metastases as
neoadjuvant therapy to surgery (GR
B).
Adjuvant radiotherapy after complete ILND can be considered in
patients with
multiple or large
inguinal metastases or ENE (GR C). Adjuvant chemotherapy
after complete
ILND can be used instead
of radiotherapy in patients with
> /=2 inguinal metastases, large nodes,
ENE, or pelvic metastases
(GR
C). Follow-up should be individualized according to the
histopathologic
features and the management
chosen for the primary tumor
and inguinal nodes (GR B).
PMID: 20691885 [PubMed - in
process]
August 27, 2010 (2 docs)
Am J Ther. 2010 Aug 19.
[Epub ahead of print]
Recurrent Lower Extremity
Pseudocellulitis.
Korniyenko A, Lozada J, Ranade A, Sandhu
G.
1Department of Internal Medicine, St. Luke's-Roosevelt
Hospital Center,
Columbia University College
of Physicians and Surgeons,
New York, NY; and 2Department of Pathology,
St. Luke's-Roosevelt
Hospital
Center, Columbia University College of Physicians and Surgeons,
New York,
NY.
Abstract
The term "Pseudocellulitis" can be
used to describe an uncomplicated
nonnecrotizing inflammation of
the
dermis and hypodermis from a noninfectious etiology. Chemotherapeutic
agents
have been
associated with a variety of cutaneous reactions, including
radiation
recall dermatitis, hypersensitivity
reactions, and erysipeloid
reactions. Gemcitabine
(2,2-difluorodeoxycytidine) is currently being
used
for treatment of a variety of solid malignancies, including carcinoma
of
the lung. The dermatitis involved
with gemcitabine is typically a
radiation recall reaction whereby an
inflammatory reaction occurs in
the
area previously treated with radiotherapy. We describe here a case
of
Gemcitabine-induced
pseudocellulitis that was unrelated to radiation
exposure and manifested
in an area of lymphedema. The
pseudocellulitis in
such cases could be related to the drug's
pharmacokinetics and may last
until the
drug is displaced from the subcutaneous tissue of the affected
area.
Antibiotics have no role in the
treatment, and diphenhydramine with
nonsteroidal anti-inflammatories may
be used for
symptomatic
management.
PMID: 20724909 [PubMed - as supplied
by publisher]
Clin Physiol Funct Imaging. 2010 Aug 16. [Epub
ahead of print]
Lymphoedema of the lower extremities -
background, pathophysiology and
diagnostic
considerations.
Jensen MR, Simonsen L, Karlsmark T, Bülow
J.
Department of Clinical Physiology and Nuclear Medicine,
Bispebjerg
Hospital, University Hospital of
Copenhagen, Copenhagen NV,
Denmark.
Abstract
Summary Lymphoedema of the
lower extremities is a chronic debilitating
disease that is
often
underdiagnosed. Early diagnosis and treatment is paramount in reducing
the
risk of progression and
complications. Lymphoedema has traditionally
been defined as interstitial
oedema and protein
accumulation because of a
defect in the lymphatic drainage; however, some
findings suggest that
the
interstitial protein concentration may be low in some types
of
lymphoedema. Primary lymphoedema is
caused by an inherent defect in
the lymphatic vessels or lymph nodes.
Secondary lymphoedema is
caused by
damages to the lymphatic system most often caused by cancer or
its
treatment. Many of the
underlying pathophysiological mechanisms have yet to
be elucidated. Many
methods have been
developed for examination of the
lymphatic system. Lymphoscintigraphy is
presently the
preferred
diagnostic modality. Lack of consensus regarding protocol and
qualitative
interpretation criteria results
in a too observer dependent
outcome. Methods for objectifying the
scintigraphy through
quantification
have been criticized. Depot clearance rates are an
alternative method of
quantification of lymphatic
drainage capacity. This
method however has mostly been applied on upper
extremity
lymphoedema.
The aim of this review is to provide a literature-based
overview of the
aetiology and pathophysiology of
lower extremity
lymphoedema and to summarize the current knowledge about
lymphoscintigraphy
and
depot clearance techniques. The abundance of factors influencing
the
outcome of the examination
stresses the need for consensus regarding
examination protocols and
interpretation. Further studies are
needed to
improve diagnostic performance and understanding of
pathophysiological
mechanisms.
PMID: 20718809 [PubMed - as supplied by
publisher]
September 1, 2010
Eur J Cancer. 2010 Aug
24. [Epub ahead of print]
Psychological consequences of
lymphoedema associated with breast cancer: A
prospective
cohort
study.
Vassard D, Olsen MH, Zinckernagel L,
Vibe-Petersen J, Dalton SO, Johansen C.
Department of
Psychosocial Cancer Research, Institute of Cancer
Epidemiology, Danish
Cancer
Society, Strandboulevarden 49, DK-2100 Copenhagen,
Denmark.
Abstract
BACKGROUND: The aim of this
prospective cohort study of women attending a
rehabilitation course
at
the Dallund Rehabilitation Centre was to explore the emotional
and
psychological aspects of living
with lymphoedema, expressed as
psychological distress, poorer quality of
life and poorer
self-reported
health.
METHODS: Between November 2002 and
January 2007 within the FOCARE study,
self-completed
questionnaires were
collected 3weeks before and 6 and 12months after the
rehabilitation course
to
elicit sociodemographic, physical and lifestyle information and
responses
to three psychometric tests.
The population consisted of 633
women, 125 with and 508 without verified
lymphoedema (time since
surgery,
1month-5years). The population was reduced to 553 women at the
first
follow-up and 494 at
the second.
RESULTS: Multivariate
analysis showed that, in comparison with women
without lymphoedema,
those
with lymphoedema had a 14% higher risk for scoring one level higher on
the
POMS-SF test, a 9%
higher probability of scoring one point lower on
the quality of life scale
and a 29% higher likelihood of
reporting poorer
or bad health than women without lymphoedema. These
findings were seen at
all three
measurement times.
CONCLUSIONS: In this cohort of
women with breast cancer, women with
lymphoedema after
surgery for breast
cancer had significantly worse overall emotional
well-being and adjustment
to life
compared to women without lymphoedema.
PMID: 20797846
[PubMed - as supplied by publisher]
Case Rep Oncol. 2010 Apr
30;3(2):148-153.
Epithelioid Angiosarcoma in a Patient with
Klippel-Trénaunay-Weber
Syndrome: An Unexpected
Response to
Therapy.
Simas A, Matos C, Lopes da Silva R, Brotas V, Teófilo
E, Albino JP.
Serviço de Medicina Interna 3, Hospital Santo
António dos Capuchos.
Abstract
We present a rare
case of Stewart-Treves syndrome characterized by a
diffuse angiosarcoma of
the
leg in a 22-year-old man with a history of chronic lymphedema due
to
Klippel-Trénaunay-Weber
syndrome. He underwent limb disarticulation
and medical treatment with
cycles of doxorubicin, oral
thalidomide and
sunitinib with a very good response after 12 months
of
follow-up.
PMID: 20740188 [PubMed]PMCID:
PMC2919991
Lancet. 2010 Aug 23. [Epub ahead of
print]
Lymphatic filariasis and
onchocerciasis.
Taylor MJ, Hoerauf A, Bockarie
M.
Liverpool School of Tropical Medicine, Liverpool,
UK.
Abstract
Lymphatic filariasis and
onchocerciasis are parasitic helminth diseases
that constitute a serious
public
health issue in tropical regions. The filarial nematodes that cause
these
diseases are transmitted by
blood-feeding insects and produce
chronic and long-term infection through
suppression of host
immunity.
Disease pathogenesis is linked to host inflammation invoked by
the death of
the parasite,
causing hydrocoele, lymphoedema, and elephantiasis in
lymphatic
filariasis, and skin disease and
blindness in onchocerciasis.
Most filarial species that infect people
co-exist in mutualistic symbiosis
with
Wolbachia bacteria, which are essential for growth, development,
and
survival of their nematode hosts.
These endosymbionts contribute to
inflammatory disease pathogenesis and
are a target for
doxycycline
therapy, which delivers macrofilaricidal activity, improves
pathological
outcomes, and is effective as
monotherapy. Drugs to treat
filariasis include diethylcarbamazine,
ivermectin, and albendazole,
which
are used mostly in combination to reduce microfilariae in blood
(lymphatic
filariasis) and skin
(onchocerciasis). Global programmes for
control and elimination have been
developed to provide
sustained delivery
of drugs to affected communities to interrupt
transmission of disease and
ultimately
eliminate this burden on public health.
PMID:
20739055 [PubMed - as supplied by publisher]
Pediatr Dermatol.
2010 Aug 4. [Epub ahead of print]
Congenital Lymphedema with
Tuberous Sclerosis and Clinical Hirschsprung
Disease.
Lucas
M, Andrade Y.
St. Peter's University Hospital, New Brunswick,
New Jersey, USA.
Abstract
Case of an 18-month-old
child with congenital lymphedema subsequently
diagnosed with
tuberous
sclerosis and Hirschsprung disease.
PMID: 20738790
[PubMed - as supplied by publisher]
Zhonghua Zheng Xing Wai Ke
Za Zhi. 2010 May;26(3):190-4.
[Diagnosis of peripheral lymph
circulation disorders with contrast MR
lymphangiography]
[Article in
Chinese]
Liu NF, Lu Q, Jiang ZH, Wang CG, Zhou
JG.
Department of Plastic Reconstructive Surgery, Shanghai Ninth
People's
Hospital, Shanghai Jiaotong
University School of Medicine,
Shanghai 200011, China. [email protected]
Abstract
OBJECTIVE:
To evaluate anatomical and functional images of contrast MR
lymphangiography
in the
diagnosis of limb lymphatic circulation
disorders.
METHODS: 30 patients with limb lymphedema were
enrolled in the study.
There were 27 patients of
primary lymphedema and 3
of secondary lymphedema. Contrast enhanced
lymphangiography was
performed
with 3.0 T MR Unit after intracutaneous injection of gadobenate
dimelumine
into the
interdigital webs of the dorsal foot and hand. The kinetics of
enhanced
lymph flow within the lymphatics
were calculated using the
formula: Speed (cm) = total length of visualized
lymph vessel (cm)/
inspection
time (minutes) and by comparing dynamic nodal enhancement and
time-signal
intensity curves between
edematous and contralateral limbs.
Morphological abnormalities of the
lymphatic system were
also
evaluated.
RESULTS: Following injection of the contrast
agent enhanced lymphatic
channels were consistently
visualized in all
clinical lymphedematous limbs and five contralateral
limbs of unilateral
lymphedema
cases. The speed of enhanced flow within the lymphatics of
lymphedematous
limbs ranged from 0.30
to 1.48 cm/min. The contrast
enhancement in inguinal nodes of edematous
limbs was significantly
lower
than that of contralateral limbs (P < 0.01). Dynamic measurement
of
contrast enhancement showed a
remarkable lowering of peak time (P <
0.01) and peak enhancement (P <
0.01) and a delay in outflow
in
inguinal nodes of affected limbs compared with that of control
limbs.
Post-contrast MR imaging also
depicted varied distribution
patterns of lymphatics and abnormal lymph
flow pathways within
lymph
nodes in the limbs with lymphatic circulation
disorders.
CONCLUSIONS: Contrast MR lymphangiography with
gadobenate dimelumine was
able to visualize
the precise anatomy of
lymphatic vessels and lymph nodes in lymphedematous
limbs. It also
provided
comprehensive information about the functional status of lymph
flow
transportation in lymphatics and
lymph nodes.
PMID:
20737947 [PubMed - in process]
September 5,
2010
Dermatol Online J. 2010 Aug
15;16(8):14.
Elephantiasis nostras verrucosa on the abdomen of a
Turkish female patient
caused by morbid obesity.
Buyuktas D,
Arslan E, Celik O, Tasan E, Demirkesen C, Gundogdu S.
Division
of Endocrinology and Metabolism, Department of Internal Medicine,
Cerrahpasa
Medical
School, University of Istanbul, Istanbul, Turkey. [email protected].
Abstract
Elephantiasis
Nostras Verrucosa is a rare disorder of an extremity or a
body region, which
is
associated with chronic lymphedema. There are 7 reported cases
of
abdominal elephantiasis in the
medical literature. Here we report a
morbidly obese female patient with
elephantiasis nostras verrucosa
on the
abdominal wall.
PMID: 20804691 [PubMed - in
process]
Health Qual Life Outcomes. 2010 Aug 31;8(1):92. [Epub
ahead of print]
Upper-body morbidity following breast cancer
treatment is common, may
persist longer-term and
adversely influences
quality of life.
Hayes SC, Rye S, Battistutta D, Disipio T,
Newman B.
ABSTRACT:
BACKGROUND: Impairments in
upper-body function (UBF) are common following
breast cancer.
However,
the relationship between arm morbidity and quality of life (QoL)
remains
unclear. This
investigation uses longitudinal data to describe UBF in a
population-based
sample of women with
breast cancer and examines its
relationship with QoL.
METHODS: Australian women (n=287) with
unilateral breast cancer were
assessed at three-monthly
intervals, from
six- to 18-months post-surgery (PS). Strength, endurance
and flexibility
were used to
assess objective UBF, while the Disability of the Arm, Shoulder
and Hand
questionnaire and the
Functional Assessment of Cancer
Therapy-Breast questionnaire were used to
assess self-reported
UBF and
QoL, respectively.
RESULTS: Although mean UBF improved over
time, up to 41% of women revealed
declines in UBF
between six- and
18-months PS. Older age, lower socioeconomic position,
treatment on the
dominant
side, mastectomy, more extensive lymph node removal and having
lymphoedema
each increased odds
of declines in UBF by at least two-fold
(p<0.05). Lower baseline and
declines in perceived UBF
between six-
and 18-months PS were each associated with poorer QoL at
18-months PS
(p<0.05).
CONCLUSIONS: Significant upper-body morbidity is
experienced by many
following breast cancer
treatment, persisting longer
term, and adversely influencing the QoL of
breast cancer
survivors.
PMID: 20804558 [PubMed - as supplied by
publisher]
Br J Dermatol. 2010 Aug 28. [Epub ahead of
print]
Severe Congenital Lymphedema Not Caused by Mutations in
Known Lymphedema
Genes.
Greenberger S, Reznik-Wolf H,
Ghalamkarpour A, Marek-Yagel D, Vikkula M,
Pras E.
Sheba
Medical Center, The Department of Dermatology, Ramat-Gan,
Israel.
PMID: 20804492 [PubMed - as supplied by
publisher]
Am J Med Genet A. 2010
Sep;152A(9):2287-96.
Emberger syndrome-primary lymphedema with
myelodysplasia: report of seven
new cases.
Mansour S, Connell
F, Steward C, Ostergaard P, Brice G, Smithson S, Lunt
P, Jeffery S, Dokal
I,
Vulliamy T, Gibson B, Hodgson S, Cottrell S, Kiely L, Tinworth L,
Kalidas
K, Mufti G, Cornish J,
Keenan R, Mortimer P, Murday V;
Lymphoedema Research Consortium.
SW Thames Regional Genetics
Service, St. George's, University of London,
London, UK.
[email protected]
Abstract
Four
reports have been published on an association between acute
myeloid
leukaemia (AML) and
primary lymphedema, with or without
congenital deafness. We report seven
new cases, including one
extended
family, confirming this entity as a genetic syndrome. The
lymphedema
typically presents in one
or both lower limbs, before the hematological
abnormalities, with onset
between infancy and puberty
and frequently
affecting the genitalia. The AML is often preceded by
pancytopenia or
myelodysplasia
with a high incidence of monosomy 7 in the bone marrow (five
propositi and
two relatives). Associated
anomalies included hypotelorism,
epicanthic folds, long tapering fingers
and/or neck webbing
(four
patients), recurrent cellulitis in the affected limb (four
patients),
generalized warts (two patients), and
congenital, high
frequency sensorineural deafness (one patient). Children
with lower limb and
genital
lymphedema should be screened for hematological abnormalities
and
immunodeficiency.
PMID: 20803646 [PubMed - in
process]
Med Sci Monit. 2010 Aug
7;16(9):BR313-319.
Evaluation of lymphatic function by means of
dynamic Gd-BOPTA-enhanced MRL
in experimental
rabbit limb
lymphedema.
Jiang Z, Lu Q, Kretlow JD, Hu X, Zhou G, Liu
N.
Department of Plastic and Reconstructive Surgery, Shanghai
Ninth People's
Hospital, Shanghai Jiao
Tong University School of
Medicine, Shanghai, China.
Abstract
Background:
The aim of this study was to investigate the value and
technical methods of
3D dynamic
contrast-enhanced magnetic resonance lymphangiography (MRL) in
the
assessment of lymphatic
anatomy and function in the presence of
extremity lymphedema.
Material/Methods: An improved experimental
model of obstructive lymphedema
was established in 1
hind limb of 6 New
Zealand White rabbits. 3D contrast-enhanced MRL was
performed with a
3.0-T
MR unit after the intracutaneous injection of Gd-BOPTA into
the
interdigital webs of the dorsal paws.
Maximum-intensity projection
(MIP) was used to reconstruct the images of
the lymphatic system.
The
dynamic nodal enhancement in the popliteal fossa and time-signal
intensity
curves between
lymphedematous and contralateral limbs were
compared. Morphologic
abnormalities of the lymphatic
system were also
evaluated and compared with lymphoscintigraphy (LSG).
Results:
3D dynamic contrast-enhanced MRL images were obtained after
the
administration of Gd-
BOPTA. In the normal limb, the popliteal fossa
lymph nodes and their
afferent and efferent lymph-
collecting vessels
were clearly visualized as the Gd tracer was rapidly
cleared from the
interstitial
compartment. In contrast, the Gd tracer accumulated slowly at
the prior
surgical site in the
lymphedematous limb. The nodal enhancement
of lymphedematous limbs was
significantly less than that
of the
contralateral limbs (P<0.01). Types of time-signal intensity curves
were
also significantly different
between the 2 groups
(P<0.001).
Conclusions: 3D dynamic contrast-enhanced MRL can
visualize the precise
anatomy of lymphatic
vessels and lymph nodes in
extremity lymphedema, as well as objectively
evaluate the functional
status
of lymph flow transport.
PMID: 20802408 [PubMed - in
process]
J Vasc Surg. 2010 Aug 25. [Epub ahead of
print]
Lymphatic malformation is a common component of
Klippel-Trenaunay syndrome.
Liu NF, Lu Q, Yan
ZX.
Department of Plastic and Reconstructive Surgery, Shanghai
9th People's
Hospital, Shanghai Jiao Tong
University School of Medicine,
Shanghai, China.
Abstract
OBJECTIVES: Few
previous studies have focused on the involvement of the
lymphatic system
in
Klippel-Trenaunay syndrome (KTS), although some evidence suggests
that
lymphatic abnormalities are
associated with the disease. The aim of
the present study was to
investigate the involvement of the
lymphatic
system in KTS.
METHODS: Magnetic resonance lymphangiography
(MRL) with the use of
gadobenate dimeglumine
as the contrast was
performed on 32 patients with KTS involving the
extremities to evaluate
lymphatic
vessels, lymph nodes, and veins.
RESULTS:
Thirty-one of 32 patients exhibited lymphatic vessel and/or lymph
node
anomalies,
including hyperplasia (11/31), hypoplasia or aplasia (20/31) of
lymphatic
vessels, and lymphedema
(31/31) of the affected limbs.
Twenty-two patients showed asymmetry of the
inguinal nodes
exhibiting
either the absence, or an increase or a decrease in number and
size of the
inguinal nodes. Venous
dysplasia was found in 31 patients in
superficial and/or deep veins. The
results showed a high
concomitance of
malformations of the lymphatic system and veins in the
affected limbs of
patients with
KTS.
CONCLUSIONS: Lymphatic system
abnormalities as examined with MRL are
commonly associated
with KTS and
are likely to play a significant role in the disorder.
PMID:
20800418 [PubMed - as supplied by publisher]
September 8,
2010
Orbit. 2010 Aug;29(4):222-6.
Chronic
lymphedema of the eyelid: case series.
Chalasani R, McNab
A.
Ophthalmology Registrar, Royal Victorian Eye and Ear
Hospital,
Melbourne,
Australia.
Abstract
Purpose: To
evaluate the clinical features, management and outcomes of
treatment of
chronic
lymphedema of the eyelid in a tertiary referral
setting.
Design: Retrospective case series. Participants: 15
patients referred to
the authors with unilateral or
bilateral eyelid
swelling of greater than 3 months duration.
Main Outcome
Measures: Clinical features, patient management, response
to
treatment.
Results: Chronic eyelid lymphedema was
associated with acne rosacea in 9
patients, radiotherapy in 1
patient,
trauma in 1 patient and post-vitrectomy silicone oil leak in 1
patient. In
the remaining 4 patients
no associated condition or factor was identified.
Surgical debulking was
performed in 9 cases with
improvement in all cases
and no complications.
Conclusion: Chronic eyelid lymphedema is a
rare condition most commonly
associated with rosacea. In
our experience,
surgical resection of involved subcutaneous tissue
was
helpful.
PMID: 20812843 [PubMed - in
process]
Plast Reconstr Surg. 2010
Sep;126(3):1118-9.
Breast reconstruction and
lymphedema.
Khan MA, Srinivasan K, Mohan A, Hardwicke J, Rayatt
S.
University Hospital of North Staffordshire NHS Trust;
Stoke-on-Trent,
Staffordshire, United Kingdom.
PMID: 20811251
[PubMed - in process]
Plast Reconstr Surg. 2010
Sep;126(3):759-61.
Discussion: lymphaticovenular bypass for
lymphedema management in breast
cancer patients: a
prospective
study.
Cheng J.
Dallas, Texas From the Department
of Plastic Surgery, University of Texas
Southwestern
Medical
Center.
PMID: 20811211 [PubMed - in
process]
Plast Reconstr Surg. 2010
Sep;126(3):752-8.
Lymphaticovenular bypass for lymphedema
management in breast cancer
patients: a prospective
study.
Chang DW.
Houston, Texas From the
Department of Plastic Surgery, University of Texas
M. D. Anderson
Cancer
Center.
Abstract
BACKGROUND: Lymphedema
is a common and debilitating condition. Management
options for
lymphedema
are limited and controversial. The purpose of this prospective
study was to
provide a
preliminary analysis of lymphaticovenular bypass for the treatment
of
upper limb lymphedema in breast
cancer
patients.
METHODS: Twenty patients with upper extremity
lymphedema secondary to
treatment of breast
cancer underwent
lymphaticovenular bypass using a "supermicrosurgical"
approach. The mean age
of
the patients was 54 years, 16 patients had received preoperative
radiation
therapy, and all patients had
received axillary lymph node
dissection. The mean duration of lymphedema
was 4.8 years, and the
mean
volume differential of the lymphedematous arm compared with the
unaffected
arm was 34
percent. Evaluation included qualitative assessment and
quantitative
volumetric analysis before surgery
and at 1 month, 3 months,
6 months, and 1 year after the procedure.
RESULTS: The mean
number of bypasses performed per patient was 3.5 (range,
two to five), and
the
size of bypasses ranged from 0.3 to 0.8 mm. The mean operative time
was
3.3 hours (range, 2 to 5
hours). Hospital stay was less than 24 hours
for all patients. The mean
follow-up time was 18 months.
Nineteen
patients (95 percent) reported symptom improvement following
surgery, and 13
patients had
quantitative improvement. The mean volume differential
reduction was 29
percent at 1 month, 36
percent at 3 months, 39 percent
at 6 months, and 35 percent at 1 year. No
patients
experienced
postoperative complications or lymphedema
exacerbation.
CONCLUSIONS: Lymphaticovenular bypass may
effectively reduce the severity
of lymphedema in
breast cancer patients.
Long-term analysis is needed.
PMID: 20811210 [PubMed - in
process]
Biol Trace Elem Res. 2010 Sep 1. [Epub ahead of
print]
Titanium, Sinusitis, and the Yellow Nail
Syndrome.
Berglund F, Carlmark B.
, Solvägen 8 A,
SE 192 66, Sollentuna, Sweden, [email protected].
Abstract
Yellow
nail syndrome is characterized by nail changes, respiratory
disorders, and
lymphedema. In a
yellow nail patient with a skeletal titanium implant and
with gold in her
teeth, we found high levels of
titanium in nail
clippings. This study aims to examine the possible role
of titanium in the
genesis of the
yellow nail syndrome. Nail clippings from patients with one
or more
features of the yellow nail
syndrome were analyzed by energy
dispersive X-ray fluorescence. Titanium
was regularly found in
finger
nails in patients but not in control subjects. Visible nail changes
were
present in only half of the
patients. Sinusitis with postnasal drip and
cough was the most common
complaint. The dominant
source of titanium ions
was titanium implants in the teeth or elsewhere.
The titanium ions were
released
through the galvanic action of dental gold or amalgam or through
the
oxidative action of fluorides. In
other patients the titanium was
derived from titanium dioxide in drugs and
confectionary.
Stopping
galvanic release of titanium ions or canceling exposure to
titanium
dioxide led to recovery. In one
patient with a titanium implant,
the symptoms recurred after renewed
exposure to titanium. Yellow
nail
syndrome is caused by titanium.
PMID: 20809268 [PubMed -
as supplied by publisher]
Physiother Can. 2009 Fall;61(4):244-51.
Epub 2009 Nov 12.
Effect of acute exercise on upper-limb volume
in breast cancer survivors:
a pilot study.
McNeely ML,
Campbell KL, Courneya KS, Mackey JR.
Margaret L. McNeely, PhD:
Physical Therapy Department, University of
Alberta, and Cross
Cancer
Institute, Edmonton,
Alberta.
Abstract
Purpose: Strenuous
upper-extremity activity and/or exercise have
traditionally been prescribed
for
breast cancer survivors with or at risk of developing lymphedema.
The
purpose of this study was to
assess the effect of an acute bout of
exercise on upper-limb volume and
symptoms in breast cancer
survivors,
with the intent to provide pilot data to guide a subsequent
larger
study.
Methods: Twenty-three women who regularly participated in
dragon-boat
racing took part in the study.
A single exercise bout was
performed at a moderate intensity (rating of
perceived exertion: 13-14)
for
20 continuous minutes on an arm ergometer. The difference between
affected
and unaffected limb
volume was assessed pre- and post-exercise
via measurements of limb
circumference at five
time
points.
Results: Although limb volume increased
following exercise in both limbs,
the difference between the
limbs
remained stable at each measurement point. Only one participant was
found to
have an increase
in arm-volume difference of >100 ml post intervention,
and only four
participants reported symptoms
of tension and/or heaviness
in the affected limb.
Conclusion: The results suggest that limb
volume in breast cancer
survivors increases after an acute
bout of
upper-limb exercise but that, for the majority of women, the
response is not
different between
affected and unaffected limbs. Future research using a
larger sample and
more sensitive measurement
methods are
recommended.
PMID: 20808486 [PubMed - in
process]
Pediatr Dermatol. 2010 Aug 26. [Epub ahead of
print]
Congenital Yellow Nail Syndrome: A Case Report and Its
Relationship to
Nonimmune Fetal Hydrops.
Nanda A, Al-Essa FH,
El-Shafei WM, Alsaleh QA.
As'ad Al-Hamad Dermatology Center,
Al-Sabah Hospital, Kuwait.
Abstract
Yellow nail
syndrome (YNS) is an uncommon disorder characterized by a
triad of nail
dystrophy,
lymphedema, and pleural effusion. It is rare in children and
congenital
occurrence of YNS has been
very rarely described. We report a
2-year-old Arab boy having congenital
yellow nail syndrome with
mild
facial dysmorphism and bilateral conjunctival pigmentation born
to
consanguineous parents. One
of his older siblings had died of
nonimmune fetal hydrops (NIFH). The case
supports the genetic basis
of
yellow nail syndrome with a possible relationship to nonimmune
fetal
hydrops.
PMID: 20807364 [PubMed - as supplied by
publisher]
These are the current Pub Med list you sent me, not a
backlogged one Tina,
so I used today’s date for
it per my note
above:
September 17, 2010
Breast Cancer Res. 2010
Sep 8;12(5):R70. [Epub ahead of print]
Experimental assessment
of pro-lymphangiogenic growth factors in the
treatment of
post-surgical
lymphedema following lymphadenectomy.
Baker A,
Kim H, Semple JL, Dumont D, Shoichet M, Tobbia D, Johnston
M.
ABSTRACT:
INTRODUCTION: Lymphedema is a
frequent consequence of lymph node excision
during breast
cancer surgery.
Current treatment options are limited mainly to external
compression
therapies to limit
edema development. We investigated previously,
post-surgical lymphedema in
a sheep model following
the removal of a
single lymph node and determined that autologous lymph
node transplantation
has the
potential to reduce or prevent edema development. In this report,
we
examine the potential of
lymphangiogenic therapy to restore lymphatic
function and reduce
post-surgical lymphedema.
METHODS:
Lymphangiogenic growth factors (vascular endothelial growth
factor-C
(VEGF-C) and
angiopoitein-2 (ANG-2)) were loaded into a gel-based drug
delivery system
(HAMC; a blend of
hyaluronan and methylcellulose). Drug
release rates and lymphangiogenic
signaling in target endothelial
cells
were assessed in vitro and vascular permeability biocompatibility
tests were
examined in vivo.
Following, the removal of a single popliteal lymph node,
HAMC with the
growth factors was injected
into the excision site. Six
weeks later, lymphatic functionality was
assessed by injecting
125Iodoine
radiolabelled bovine serum albumin (125I-BSA) into prenodal
vessels and
measuring its recovery in
plasma. Circumferential leg
measurements were plotted over time and areas
under the curves used
to
quantify edema formation.
RESULTS: The growth factors were
released over a two-week period in vitro
by diffusion from
HAMC, with 50%
being released in the first 24 hours. The system induced
lymphangiogenic
signaling
in target endothelial cells, while inducing only a minimal
inflammatory
response in sheep. Removal of the
node significantly reduced
lymphatic functionality (Nodectomy 1.9 +/- 0.9,
HAMC alone 1.7 +/-
0.8)
compared with intact groups (3.2 +/- 0.7). There was no
significant
difference between the growth
factor treatment group (2.3 +/-
0.73) and the intact group. An increase in
the number of
regenerated
lymphatic vessels at treatment sites was observed with
fluoroscopy. Groups
receiving HAMC plus
growth factors displayed
significantly reduced edema (107.4 +/- 51.3)
compared with
non-treated
groups (nodectomy 219.8 +/- 118.7, and HAMC alone 162.6 +/-
141).
CONCLUSIONS: Growth factor therapy has the potential to
increase lymphatic
function and reduce
edema magnitude in an animal model
of lymphedema. The application of this
concept to lymphedema
patients
warrants further examination.
PMID: 20825671 [PubMed - as supplied by
publisher]
Med Oncol. 2010 Sep 9. [Epub ahead of
print]
Whether drainage should be used after surgery for breast
cancer? A
systematic review of randomized
controlled
trials.
He XD, Guo ZH, Tian JH, Yang KH, Xie
XD.
Evidence Based Medicine Center, School of Basic Medical
Sciences, Lanzhou
University, No. 199
Donggang West Road, Lanzhou, Gansu,
730000, China, [email protected].
Abstract
A
systematic review of randomized controlled trials (RCTs) was conducted
to
evaluate whether
patients benefit from the suction drainage after axillary
lymph node
dissection (ALND) in breast cancer
surgery. RCTs of drainage
versus no drainage after ALND in women with
breast cancer were
retrieved
from PubMed, EMBASE, Cochrane Library and Chinese Biomedical
database. Two
authors
independently assessed the quality of included trials and extracted
data.
Odds ratio (OR) for
dichotomous outcomes and mean difference (MD)
for continuous outcomes were
presented with 95%
confidence intervals
(CI). A total of 1115 titles were indentified from
the databases; 1109
obvious
irrelevant studies were excluded by examining the titles, abstracts,
full
texts because of duplicates, no
RCT, different modality of drainage,
drain for lymphedema, application of
fibrin sealant and so on. And
then,
only 6 RCTs to compare drainage with no drainage after ALND in
breast cancer
surgery were
included in the systematic review and a total of 585 patients
were
included in the pathological diagnosis
of breast cancer in women
before surgery, management by ALND with or
without addition
surgical
procedures. The study demonstrated that insertion of a drain in the
axilla
after breast cancer surgery
resulted in a statistically
significant reduction in the rate of seroma
(OR = 0.36, 95% CI, 0.16 to
0.81,
P = 0.01), the volume of aspiration (MD = -100.10, 95% CI, -174.36
to
-25.85, P = 0.008), or the
frequency of seroma aspiration (MD = -1.03,
95% CI, -1.35 to -0.71, P <
0.00001), but prolonged
the length of
hospital stay (MD = 1.52, 95% CI, 0.36 to 2.68, P = 0.01).
There was no
statistically
significant difference in the incidence of wound infection (OR
= 0.67, 95%
CI, 0.34 to 1.32, P = 0.25)
between drainage group and no
drainage group. Based on the current
evidence, insertion of a drain
in
the axilla following ALND in breast cancer surgery effectively
decreased
seroma formation, volume of
aspiration as well as the frequency
of seroma aspiration without
increasing the incidence of wound
infection,
but extending their stay in hospital.
PMID: 20827578 [PubMed -
as supplied by publisher]
Am J Hum Genet. 2010 Sep
10;87(3):436-44.
Protein tyrosine phosphatase PTPN14 is a
regulator of lymphatic function
and choanal development
in
humans.
Au AC, Hernandez PA, Lieber E, Nadroo AM, Shen YM,
Kelley KA, Gelb BD,
Diaz GA.
Department of Genetics &
Genomic Sciences, Mount Sinai School of Medicine,
New York, NY
10029,
USA.
Abstract
The lymphatic vasculature is
essential for the recirculation of
extracellular fluid, fat absorption,
and
immune function and as a route of tumor metastasis. The dissection
of
molecular mechanisms underlying
lymphangiogenesis has been accelerated
by the identification of
tissue-specific lymphatic endothelial
markers
and the study of congenital lymphedema syndromes. We report the
results of
genetic analyses
of a kindred inheriting a unique autosomal-recessive
lymphedema-choanal
atresia syndrome. These
studies establish linkage of
the trait to chromosome 1q32-q41 and identify
a loss-of-function
mutation
in PTPN14, which encodes a nonreceptor tyrosine phosphatase. The
causal
role of PTPN14
deficiency was confirmed by the generation of a
murine Ptpn14 gene trap
model that manifested
lymphatic hyperplasia with
lymphedema. Biochemical studies revealed a
potential interaction
between
PTPN14 and the vascular endothelial growth factor receptor 3
(VEGFR3), a
receptor tyrosine kinase
essential for lymphangiogenesis.
These results suggest a unique and
conserved role for PTPN14 in
the
regulation of lymphatic development in mammals and a nonconserved role
in
choanal development in
humans.
PMID: 20826270 [PubMed -
in process]
Duodecim.
2010;126(15):1827-30.
[Mystery of the swollen
leg]
[Article in Finnish]
Sundell
J.
TYKS, Raision sairaala, sisätautien klinikka PL 43, 21201
Raisio.
Abstract
This case report demonstrates a
90-year-old female patient who had an
amelanotic subungual
melanoma of
the right hallux. As usual non healing ulcer of the nail bed
was initially
misdiagnosed.
Finally melanoma spread to the groin lymph nodes and induced
lymphedema of
the leg leading to the
right diagnosis. Acral lesion
requires early biopsy if any clinical
uncertainty
exists.
PMID: 20824972 [PubMed - in process]
September
17, 2010 - this will be the date of the email to me FYI
June
2010 - Clinics (Sao Paulo). 2010 Jun;65(8):781-7.
Comparison of
quality of life, satisfaction with surgery and shoulder-arm
morbidity in
breast cancer
survivors submitted to breast-conserving therapy or mastectomy
followed by
immediate breast
reconstruction.
Freitas-Silva
R, Conde DM, Freitas-Júnior R, Martinez EZ.
Department of
Gynecology and Obstetrics, Universidade Federal de Goiás,
Goiânia, GO,
Brasil.
Abstract
OBJECTIVES: This study was
designed to compare the prevalence of
shoulder-arm morbidity,
patient
satisfaction with surgery and the quality of life of women submitted
to
breast-conserving therapy or
modified radical mastectomy and immediate
breast reconstruction .
METHODS: This study was a
cross-sectional study of women who underwent
breast-conserving
therapy
(n=44) or modified radical mastectomy and immediate breast
reconstruction
(n=26). Quality of
life was evaluated with the SF-36 Health Survey
Questionnaire.
RESULTS: No differences were found in the
prevalence of lymphedema. The
movements that were
most commonly affected
by these procedures were abduction, flexion and
external rotation. When
the
two groups were compared, however, we only found a
statistically
significant difference for the
prevalence of restricted
internal rotation, which occurred in 32% of women
in the
breast-conserving
therapy group and 12% of those in the modified radical
mastectomy and
immediate breast
reconstruction group (OR: 7.23; p=0.03
following adjustment for potential
confounding factors). No
difference in
quality of life or satisfaction with surgery was found
between the two
groups.
CONCLUSIONS: These data suggest that the type of surgery
did not affect
the occurrence of
lymphedema. Breast-conserving therapy,
however, increased the risk of
shoulder movement limitation.
No
differences were found between the two surgical techniques with respect
to
quality of life or
satisfaction with surgery.
PMID: 20835555
[PubMed - in process]
September 7, 2010 - Orthopedics. 2010 Sep
7;33(9). doi:
10.3928/01477447-20100722-35.
Wound healing in
total joint arthroplasty.
Jones
RE.
Abstract
Obtaining primary wound healing in
total joint arthroplasty is essential
to a good result. Wound
healing
problems can occur and the consequences can be devastating.
Determination
of the host healing
capacity can be useful in predicting
complications. Cierney and Mader
classified patients as type A,
no
healing compromises; and type B, systemic or local healing
compromising
factors present. Local
factors include traumatic arthritis,
multiple previous incisions,
extensive scarring, lymphedema,
poor
vascular perfusion. Systemic compromising factors include
diabetes,
rheumatic diseases, renal or liver
disease, immunocompromise,
steroids, smoking, and poor nutrition. In
high-risk patients, the
surgeon
should encourage positive choices such as smoking cessation
and
nutritional supplementation to elevate
the total lymphocyte count and
total albumin.Careful planning of
incisions, particularly in patients
with
scarring or multiple previous operations, is productive. Around the
knee
the vascular viability is better
in the medial flap. Thus, use the
most lateral previous incision, do
minimal undermining, and handle
tissue
meticulously. We perform all potentially complicated total
knee
arthroplasties without tourniquet
to enhance blood flow and tissue
viability. The use of perioperative
anticoagulation will increase
wound
problems.If wound drainage or healing problems occur, immediate action
is
required. Deep sepsis can
be ruled out with a joint aspiration and
cell count (>2000), differential
(>50% polys), and negative
culture
and sensitivity. All hematomas should be evacuated and necrosis
or
dehiscence should be
managed by debridement to obtain a live
wound.
PMID: 20839686 [PubMed - in
process]
September 13, 2010 - Stem Cells Dev. 2010 Sep 13. [Epub
ahead of print]
Cellular trans/-differentiation and
morphogenesis towards the lymphatic
lineage in regenerative
medicine.
Laco F, Grant MH, Flint D, Black
RA.
Universtity of Strathclyde, Bioengineering, Glasgow, United
Kingdom;
[email protected].
Abstract
Lymphoedema
is a medically irresolvable condition. The lack of therapies
addressing
lymphatic vessel
dysfunction suggests that improved understanding of
lymphatic cell
differentiation and vessel maturation
processes is key to
the development of novel, regenerative medicine and
tissue
engineering
approaches. In this review we provide an overview of
lymphatic
characterisation markers and
morphology in development.
Furthermore, we describe multiple
differentiation processes of
the
lymphatic system during embryonic, post-natal and pathogenic
development.
Using the example of
pathogenic Kaposi Sarcoma-associated
Herpes infection we illustrate the
involvement of the Notch
and PI3K
pathways for lymphatic trans-differentiation. We also discuss the
plasticity
of certain cell
types and bio-factors which enable trans-differentiation
towards the
lymphatic lineage. Here we argue
the importance of
pathway-associated induction factors for lymphatic
trans-differentiation
including
growth factors such as VEGF-C and interleukins, and the
involvement of
extracellular matrix
characteristics and dynamics for
morphological functionality.
PMID: 20836656 [PubMed - as
supplied by publisher]
September 28, 2010
Presse Med.
2010 Sep 20. [Epub ahead of print]
[Lymphoscintigraphic
exploration in the limbs lymphatic disease.]
[Article in
French]
Baulieu F, Lorette G, Baulieu JL, Vaillant
L.
CHRU de Tours, université François-Rabelais de Tours,
médecine nucléaire,
37044 Tours
cedex,
France.
Abstract
Lymphoscintigraphy is
based upon the physiological transport of small
radioactive particles
injected
into interstitium toward lymphatic vessels and nodes.
Lymphoscintigraphy
directly investigates
lymphatic system while other
methods (ultrasounds, CT, MRI) investigate
tissular consequences
of
lymphatic disease. The scintigraphic procedure has to be standardized
in
order to be reproducible.
Lymphatic vessels, lymphatic nodes and
interstitium are systematically
analysed. Interpretation is visual
and
qualitative. Multiple abnormalities can be observed. However, none of
them
can consistently
differentiate between primary and secondary lymphedema.
Differential
diagnosis is usually obtained by
taking together clinical
and lymphoscintigraphic data. By providing
informations about
lymphatic
component and physiopathology of edema, lymphoscintigraphy
contributes to
the management of
lymphedema. Hybrid imaging is a new
imaging modality of edema. Recently
used, it combines
functional
(scintigraphy) and anatomical (CT) data and seems to be able to
provide
further informations.
PMID: 20863652 [PubMed - as supplied by
publisher]
Lymphat Res Biol. 2010
Sep;8(3):175-9.
Lymphangiosarcoma complicating extensive
congenital mixed vascular
malformations.
Al Dhaybi R, Agoumi
M, Powell J, Dubois J, Kokta V.
Division of Dermatology, CHU
Sainte Justine, University of Montreal,
Montreal, Quebec, Canada.
[email protected]
Abstract
Pediatric
hepatic angiosarcoma is a very rare malignant vascular tumor. A
few cases
have shown
pediatric hepatic angiosarcoma occurring on a background of
preexisting
vascular lesions. We report
the case of a newborn girl who
presented extensive limbs and upper trunk
cutaneous mixed
vascular
malformations at birth. These malformations were associated
with
thrombocytopenia. Cutaneous
biopsies revealed complex vascular
malformations with a significant
lymphatic component.
Compressive body
suit therapy led to regression of the limbs' cutaneous
vascular
malformations. At the
age of 9 months, the patient presented multiple
heterogeneous
hepatosplenic nodules. Aggressive
treatment with
prednisone, vincristine, and hepatosplenic embolizations
resulted in initial
improvement
of the hepatosplenic lesions for few months, followed by an
increase of
the lesions with failure of
response to treatment despite
adding alpha-interferon-2b to treatment. The
patient died at the age
of
19 months. The autopsy's pathological examination revealed a
hepatic-based
angiosarcoma with
plurimetastatic dissemination to the
spleen, lungs, peritoneum, pleura,
mesenteric linings as well as
the
serosa of the stomach and small intestine. Multiple cutaneous and
visceral
complex capillaro-
lymphatico-venous malformations were also
identified. We hypothesize that
these multiple extensive
mixed vascular
malformations were associated with chronic lymphedema which
probably
predisposed
to the development of the angiosarcoma in our
patient.
PMID: 20863270 [PubMed - in process]
Hu
Li Za Zhi. 2010 Apr;57(2 Suppl):S99-103.
[Providing care
to an elephant leg patient: a nurse's experience]
[Article in
Chinese]
Chen TH, Wang CY, Chang ML.
General
Surgery, Department of Nursing, Taipei Medical University-Wan Fang
Hospital,
Taipei
Medical University.
Abstract
This
article reports on the experience of nurses who provided nursing care
to a
woman who had
recently immigrated to Taiwan from Mainland China. The woman
suffered from
chronic lymphedema,
and had previously received surgical
treatment for the condition. The
period of nursing care ran from
June
10th through September 9th, 2008. Nursing care experience focused on
the two
care issues of
anxiety and health seeking behavior. During the nursing
process, we
expressed empathy, encouraged
the patient to express her
feelings, and provided disease-related
information. We successfully
resolved
the patient's anxiety problem. The patient learned to use
distraction to
help relieve pain. The patient
also participated in a
rehabilitation program to improve her blood
circulation. We tracked the
patient's
rehabilitation progress through e-mail correspondence. We hope
that this
complete nursing experience
can serve as reference in caring
for patients facing similar problems in
the future.
PMID:
20405406 [PubMed - in process]
October 2,
2010
Microsurgery. 2010 Sep;30(6):437-42.
Types
of lymphoscintigraphy and indications for lymphaticovenous
anastomosis.
Maegawa J, Mikami T, Yamamoto Y, Satake T,
Kobayashi S.
Department of Plastic and Reconstructive Surgery,
Yokohama City University
Hospital, Yokohama
City University, 3-9 Fukuura,
Kanazawa-ku, Yokohama 236-0004,
Japan.
Abstract
Several authors have reported the
usefulness and benefits of
lymphoscintigraphy. However, it
is
insufficient to indicate microvascular treatment based on
lymphedema.
Here, we present the
relationships between
lymphoscintigraphic types and indications for
lymphatic
microsurgery.
Preoperative lymphoscintigraphy was performed in 142 limbs
with secondary
lymphedema of the lower
extremity. The images obtained
were classified into five types. Type I:
Visible inguinal lymph
nodes,
lymphatics along the saphenous vein and/or collateral lymphatics.
Type II:
Dermal backflow in the thigh
and stasis of an isotopic material
in the lymphatics. Type III: Dermal
backflow in the thigh and leg.
Type
IV: Dermal backflow in the leg. Type V: Radiolabeled colloid
remaining in
the foot.
Lymphaticovenous anastomosis was performed in 35 limbs. The
average number
of anastomoses per
limb was 3.3 in type II, 4.4 in type
III, 3.6 in type IV, and 3 in type V.
The highest number of
anastomosis
was performed in type III. In conclusion, type III is
suggested to be the
best indication for
anastomosis compared with types IV and V. © 2010
Wiley-Liss, Inc.
Microsurgery 30:437-442,
2010.
PMID:
20878726 [PubMed - in process]
Med Klin (Munich). 2010
Sep;105(9):619-26. Epub 2010 Sep 28.
[Alternative sonographic
diagnoses in patients with clinical suspicion of
deep vein
thrombosis.]
[Article in German]
Taute BM, Melnyk
H, Podhaisky H.
Universitätsklinik und Poliklinik für Innere
Medizin III, Schwerpunkt
Angiologie, Universitätsklinikum
der
Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg,
Germany,
bettina.taute@medizin.
uni-halle.de.
Abstract
BACKGROUND
AND PURPOSE: : Unclear extremity complaints are common symptoms
of
inpatients. In a subset of these patients, a clinical suspicion of
deep
vein thrombosis (DVT) results; this
needs to be quickly and
definitively clarified by a vascular physician.
The question arose of how
often a
clinical suspicion of DVT was confirmed in an inpatient population
and
which alternative diagnoses
were able to be made by
angiologists.
PATIENTS AND METHODS: : In a retrospective
analysis, all inpatients in the
Angiologic Vascular
Diagnostics Center of
the University Hospital Halle, Germany, examined in
2007 for a suspicion
of
DVT were evaluated with respect to the definitively made
diagnosis.
RESULTS: : In 213 (28.6%) of 745 suspected cases of
DVT, a DVT was
confirmed. In 532 patients
(71.4%), DVT was excluded. In
314 of these patients, 436 alternative
diagnoses were recorded in
the
diagnostic reports of angiologic examinations. In 38.6% (n = 168),
other
venous causes could be
confirmed as the most common alternative
diagnosis. There were chronic
venous diseases in 28% (n =
122),
superficial thrombophlebitis (n = 27), and tumor-related pelvic
vein
compression (n = 19).
17.4% (n = 76) exhibited lymphedema. In 13.3%
(n = 58), a generalized
edema was diagnosed.
Arthrogenic causes followed
with 12.8% (n = 56). Lipedema (5.3%) and
hematoma (5%) could be
verified
as other important differential diagnoses. Rare causes were
symptomatic or
ruptured Baker's
cysts (2.5%), erysipelas (2.5%), abscess, aneurysm, muscle
tears, and tumors.
CONCLUSION: : The variety of alternative
diagnoses in patients with
clinical suspicion of DVT is
high. The
knowledge and systematic examination of potential, even rare
differential
diagnoses after
exclusion of DVT are part of the repertoire of the vascular
physician.
Unnecessary and expensive, as
well as onerous, diagnostic
procedures on the patient can be avoided.
Anticoagulation that was
begun
as a result of the suspicion of DVT can quickly be
stopped.
PMID: 20878299 [PubMed - in process]
An
Pediatr (Barc). 2010 Sep 24. [Epub ahead of print]
[Early
primary lymphoedema. A condition to remember.]
[Article in
Spanish]
Carreira Sande N, Rodríguez Blanco MA, Martín Morales
JM, González Alonso
N, Dosil Gallardo S,
Cea Pereiro C.
Servicio
de Pediatría, Hospital da Barbanza, Ribeira, A Coruña,
España.
PMID: 20870471 [PubMed - as supplied by
publisher]
Tina, the next two look duplicates to me, though the
first came in a doc
with 3 others and the second in
a doc all by itself.
But I put them both here just in case I missed
something that wasn’t
duplicate
Hautarzt. 2010 Sep 26. [Epub ahead of
print]
[Fatter through lipids or water : Lipohyperplasia
dolorosa versus
lymphedema.]
[Article in
German]
Cornely ME.
Praxis Prof. Hon. (Univ.
Puebla) Dr. med. Manuel E. Cornely,
Kaiserswerther Str. 296,
40474,
Düsseldorf, Deutschland, [email protected].
Abstract
Lipohyperplasia
dolorosa and lymphedema are completely different disease
entities, which are
both,
however, classified under lymphology. While in lipohyperplasia
dolorosa a
congenital lipid distribution
disorder leads to a high volume
insufficiency and the corresponding
clinical symptoms, lymphedema
is
characterized by a congenital transport incompetence of the vessels
or
acquired disorders of transport
capacity. Both lymphedemas of
different genesis are familial volume
alterations of the affected
regions
and the increase in volume is irreversible if not exclusively still
in
stage I or II. According to current
knowledge the solid increase in
volume by lymphedema is due to a
malfunctioning biomechanism by
which the
release of additional proteoglycans in the homeostasis system of
the fluid
in the interstital
space plays an important role. Removal of this tissue and
the sponge-like
substance of proteoglycans is
the aim of therapeutic
approaches. Manual lymph drainage and compression
can evacuate the
sponge
but not remove it. Lymphological liposculpture is a
successful
dermatosurgical measure even for
secondary lymphedema.
Reduction of the necessity of complex hemostasis
therapy to 20% of the
initial
value and an adjustment of the affected extremity on the healthy
side,
represent a clear improvement in
quality of life of patients. The
same dermatosurgical method,
lymphological liposculpture, has been
known
for many years to fulfil the successfully proven purpose for the
treatment
of lipohyperplasia
dolorosa by the removal of subcutaneous fatty tissue,
present as
hyperplasia and not hypertrophy.
Tenderness and the necessity
for complex hemostasis therapy are no longer
present or no
longer
necessary after lymphological liposculpture for lipohyperplasia
dolorosa.
This condition is permanent
because the congenital fatty masses
do not reoccur following surgical
removal. Lipohyperplasia
dolorosa is
therefore curable by lymphological liposculpture. For
secondary lymphedema a
drastic
improvement in quality of life of the patient can be achieved by
this
method which is demonstrated by
the adjustment of symmetry of the
extremities and reduction or even
avoidance of complex
hemostasis
therapy.
PMID: 20871969 [PubMed - as supplied by
publisher]
Hautarzt. 2010 Sep 26. [Epub ahead of
print]
[Fatter through lipids or water : Lipohyperplasia
dolorosa versus
lymphedema.]
[Article in
German]
Cornely ME.
Praxis Prof. Hon. (Univ.
Puebla) Dr. med. Manuel E. Cornely,
Kaiserswerther Str. 296,
40474,
Düsseldorf, Deutschland, [email protected].
Abstract
Lipohyperplasia
dolorosa and lymphedema are completely different disease
entities, which are
both,
however, classified under lymphology. While in lipohyperplasia
dolorosa a
congenital lipid distribution
disorder leads to a high volume
insufficiency and the corresponding
clinical symptoms, lymphedema
is
characterized by a congenital transport incompetence of the vessels
or
acquired disorders of transport
capacity. Both lymphedemas of
different genesis are familial volume
alterations of the affected
regions
and the increase in volume is irreversible if not exclusively still
in
stage I or II. According to current
knowledge the solid increase in
volume by lymphedema is due to a
malfunctioning biomechanism by
which the
release of additional proteoglycans in the homeostasis system of
the fluid
in the interstital
space plays an important role. Removal of this tissue and
the sponge-like
substance of proteoglycans is
the aim of therapeutic
approaches. Manual lymph drainage and compression
can evacuate the
sponge
but not remove it. Lymphological liposculpture is a
successful
dermatosurgical measure even for
secondary lymphedema.
Reduction of the necessity of complex hemostasis
therapy to 20% of the
initial
value and an adjustment of the affected extremity on the healthy
side,
represent a clear improvement in
quality of life of patients. The
same dermatosurgical method,
lymphological liposculpture, has been
known
for many years to fulfil the successfully proven purpose for the
treatment
of lipohyperplasia
dolorosa by the removal of subcutaneous fatty tissue,
present as
hyperplasia and not hypertrophy.
Tenderness and the necessity
for complex hemostasis therapy are no longer
present or no
longer
necessary after lymphological liposculpture for lipohyperplasia
dolorosa.
This condition is permanent
because the congenital fatty masses
do not reoccur following surgical
removal. Lipohyperplasia
dolorosa is
therefore curable by lymphological liposculpture. For
secondary lymphedema a
drastic
improvement in quality of life of the patient can be achieved by
this
method which is demonstrated by
the adjustment of symmetry of the
extremities and reduction or even
avoidance of complex
hemostasis
therapy.
----------------------------
October
5, 2010
Indian J Pediatr. 2010 Sep 30. [Epub ahead of
print]
Home-made Compression Stockings and Shoes of a
Cotton-Polyester Material
in the Treatment of
Primary Congenital
Lymphedema.
de Godoy JM, Azoubel LM, de Godoy
MD.
Department of Cardiology and Cardiovascular Surgery, Medical
School of São
Jose do Rio Preto-
FAMERP-Brazil and CNPq (National Council
for Research and Development),
São José do Rio
Preto, Brazil, [email protected].
PMID:
20882431 [PubMed - as supplied by publisher]
Phlebology. 2010
Sep 29. [Epub ahead of print]
Unilateral leg swelling: deep vein
thrombosis?
Bekou V, Galis D, Traber
J.
Venenklinik Bellevue, Kreuzlingen,
Switzerland.
Abstract
OBJECTIVE: We present two
cases of a unilateral leg swelling of unusual
aetiology as a reminder
to
the physician to consider causes of unilateral leg swelling other
than
deep vein thrombosis,
lymphoedema and infectious diseases. Case
reports Both of our patients
developed progressive leg
swelling.
Subsequent investigation revealed a lesion compressing the
femoral vein. At
exploration this
was found to be a ganglion cyst. In one patient surgical
removal of the
cyst and in the other puncture of
the cyst and
instillation of steroid resulted in prompt resolution of
the
swelling.
CONCLUSION: Venous compression due to external
cystic lesions, although
rare, is recognized. In
strange cases this
differential diagnosis should also be taken into
account. Therapeutic
options are the
surgical removal or puncture of the
cyst.
PMID: 20881310 [PubMed - as supplied by
publisher]
Clin J Oncol Nurs. 2010 Oct
1;14(5):585-93.
NO SToPS: Reducing treatment breaks during
chemoradiation for head and
neck cancer.
Lambertz CK, Gruell
J, Robenstein V, Mueller-Funaiole V, Cummings K, Knapp V.
St.
Luke's Mountain States Tumor Institute, Boise, ID, USA. [email protected]
Abstract
The
addition of chemotherapy to radiation aids in the survival of patients
with
head and neck cancer but
also increases acute toxicity, primarily painful
oral mucositis and
dermatitis exacerbated by xerostomia.
The consequences
of these side effects often result in hospitalization and
breaks in
treatment, which
lead to lower locoregional control and survival rates. No
strategies
reliably prevent radiation-induced
mucositis; therefore,
emphasis is placed on management to prevent
treatment breaks. The NO
SToPS
approach describes specific multidisciplinary strategies for
management of
nutrition; oral care; skin
care; therapy for swallowing,
range of motion, and lymphedema; pain; and
social support to
assist
patients through this difficult therapy.
PMID:
20880816 [PubMed - in process]
Ann Surg Oncol. 2010 Oct;17(Suppl
3):352-8. Epub 2010 Sep 19.
Single-center long-term follow-up
after intraoperative radiotherapy as a
boost during
breast-conserving
surgery using low-kilovoltage x-rays.
Blank
E, Kraus-Tiefenbacher U, Welzel G, Keller A, Bohrer M, Sütterlin M,
Wenz
F.
Department of Radiation Oncology, University Medical Centre
Mannheim,
University of Heidelberg,
Mannheim, Germany.
[email protected]
Abstract
BACKGROUND:
Intraoperative radiotherapy (IORT) during breast-conserving
surgery as a
boost
followed by whole-breast radiotherapy is increasingly
used.
METHODS: Between February 2002 and December 2008, a total
of 197 patients
were treated with
IORT as a boost (20 Gy, 50 kV x-rays;
Intrabeam System, Carl Zeiss
Surgical, Oberkochen,
Germany) during
breast-conserving surgery, followed by whole-breast
radiotherapy (46-50
Gy).
Systemic therapy was provided according to the St. Gallen
consensus.
Patients were recalled every 6-
12 months for follow-up.
Findings were scored according to the
LENT-SOMA
scale.
RESULTS: Median age was 61.8 (range 30-84)
years, and median follow-up was
37 (range 5-91)
months. There were T1,
T2, and Tx tumors in 129, 67, and 1 patients,
respectively, and N0, N1,
N2,
and N3 disease in 144, 36, 15, and 2 patients, respectively.
Until
December 2009, 5 local invasive
relapses, 1 local ductal
carcinoma-in-situ, 1 axillary relapse, 6
secondary cancers, and 11
distant
metastases were seen, resulting in a 5-year disease-free survival of
81.0%
and an overall survival of
91.3%. Local relapse-free survival
(invasive cancers) at 3 and 5 years was
97.0%. After a follow-up
of 5
years (n =58), only 8 patients (13.8%) had chronic skin toxicities,
and 2
patients (3.4%) had a
marked increase in density (fibrosis III), while 62.0%
had no/barely
palpable fibrosis 0-I. Other
toxicities observed included
severe pain (n = 4, 6.9%), retraction (n =17,
29.3%), edema of the
breast
(n =1, 1.7%), and lymphedema in general (n =2,
3.4%).
CONCLUSIONS: After IORT as a tumor bed boost with
low-kilovoltage x-rays
followed by whole-
breast radiotherapy, low local
recurrence and chronic toxicity rates were
seen after 5-year
follow-up.
PMID: 20853058 [PubMed - in
process]
October 8, 2010
Int Angiol.
2010 Oct;29(5):454-70.
Diagnosis and treatment of primary
lymphedema. Consensus Document of the
International Union of
Phlebology
(IUP)-2009.
Lee B, Andrade M, Bergan J, Boccardo F, Campisi C,
Damstra R, Flour M,
Gloviczki P, Laredo J,
Piller N, Michelini S,
Mortimer P, Villavicencio JL.
Center for Vein, Lymphatics, and
Vascular Malformation, Division of
Vascular Surgery, Department
of
Surgery, Georgetown University School of Medicine, Washington DC, USA
-
[email protected].
Abstract
Primary
lymphedema can be managed safely as one of the chronic lymphedemas
by a
proper
combination of DLT with compression therapy. Treatment in the
maintenance
phase should include
compression garments, self management
including the compression therapy,
self massage and
meticulous personal
hygiene and skin care in addition to lymph-transport
promoting excercises.
The
management of primary lymphedema can be further improved with
proper
addition of surgical therapy
either reconstructive or ablative.
These two surgical therapies can be
effective only when fully
integrated
with MLD-based DLT postoperatively. Compliance with a long-term
commitment
of DLT
postoperatively is the most critical factor determining the success
of any
new treatment strategy with
either reconstructive or palliative
surgery. The future of management of
primary lymphedema caused
by
truncular lymphatic malformation has never been brighter with the
new
prospect of gene-oriented
management.
PMID: 20924350
[PubMed - in process]
Int Angiol. 2010
Oct;29(5):442-453.
Clinical trials needed to evaluate
compression therapy in breast cancer
related lymphedema (BCRL).
Proposals
from an expert group.
Partsch H, Stout N, Forner-Cordero I,
Flour M, Moffatt C, Szuba A, Milic
D, Szolnoky G, Brorson
H, Abel M,
Schuren J, Schingale F, Vignes S, Piller N, Döller
W.
Dermatology, Medical University of Vienna, Vienna, Austria2
Breast Care
Department, National
Naval Medical Center, Bethesda, MD, USA3
Specialist in Physical Medicine
and Rehabilitation,
Valencia, Spain4
Dermatology, University Hospital KU Leuven, Belgium5
Glasgow Medical
School,
Glasgow, UK6 Department of Internal Medicine, Wroclaw Medical
University,
Wroclaw, Poland7
Department of Physiotherapy, Wroclaw School
of Physical Education,
Wroclaw, Poland8 Clinic for
Vascular Surgery,
University Clinical Centre Nis, Nis, Serbia9 Department
of Dermatology
and
Allergology, University of Szeged, Szeged, Hungary10Department of
Clinical
Sciences Malmö, Lund
University, Plastic and Reconstructive
Surgery, Malmö University Hospital,
Malmö,
Sweden11Lohmann &
Rauscher, Rengsdorf, Germany12Medical Markets
Laboratory,
Neuss,
Germany13Lympho-Opt Clinic, Pommelsbrunn, Germany14Department
of
Lymphology, Hôpital
Cognacq-Jay, Paris, France15Department of Surgery,
School of Medicine,
Flinders Medical Centre,
Bedford Park South,
Australia16Center of Lymphology, General Hospital
Wolfsberg, Austria -
nicole.
[email protected].
Abstract
AIM:
A mainstay of lymphedema management involves the use of compression
therapy.
Compression
therapy application is variable at different levels of disease
severity.
Evidence is scant to direct clinicians
in best practice
regarding compression therapy use. Further, compression
clinical trials are
fragmented
and poorly extrapolable to the greater population. An ideal
construct for
conducting clinical trials in
regards to compression
therapy will promote parallel global initiatives
based on a standard
research
agenda. The purpose of this article is to review current evidence
in
practice regarding compression
therapy for BCRL management and based
on this evidence, offer an expert
consensus
recommendation for a research
agenda and prescriptive trials.
Recommendations herein focus solely
on
compression interventions.
METHODS: This document
represents the proceedings of a session organized
by the
International
Compression Club (ICC) in June 2009 in Ponzano (Veneto,
Italy). The
purpose of the meeting was to
enable a group of experts to
discuss the existing evidence for compression
treatment in breast
cancer
related lymphedema (BCRL) concentrating on areas where
randomized
controlled trials (RCTs) are
lacking.
RESULTS:
The current body of research suggests efficacy of compression
interventions
in the
treatment and management of lymphedema. However, studies to date
have
failed to adequately
address various forms of compression therapy
and their optimal application
in BCRL. We offer
recommendations for
standardized compression research trials for
prophylaxis of arm lymphedema
and
for the management of chronic BCRL. Suggestions are also made
regarding;
inclusion and exclusion
criteria, measurement methodology and
additional variables of interest for
researchers to
capture.
CONCLUSION: This document should inform future research
trials in
compression therapy and serve
as a guide to clinical
researchers, industry researchers and lymphologists
regarding the
strengths,
weaknesses and shortcomings of the current literature. By
providing this
construct for research trials,
the authors aim to support
evidence-based therapy interventions, promote a
cohesive,
standardized
and informative body of literature to enhance clinical
outcomes, improve
the quality of future research
trials, inform industry
innovation and guide policy related to BCRL.
PMID: 20924349
[PubMed - as supplied by publisher]
Int Angiol. 2010
Oct;29(5):436-41.
Medical compression: effects on pulsatile leg
blood flow.
Mayrovitz HN, Macdonald JM.
Nova
Southeastern University, College of Medical Sciences, Ft Lauderdale,
FL,
USA2 Miller School
of Medicine, University of Miami, Miami, FL, USA - [email protected].
Abstract
AIM:
Leg compression bandaging is the mainstay of venous ulcer treatment,
yet
little is known about
the impact of therapeutic compression levels on
arterial haemodynamics. In
this study, the effect of foot-
to-knee,
four-layer compression bandaging on below-knee arterial pulsatile
blood flow
was assessed
by nuclear magnetic resonance
flowmetry.
METHODS: In 14 healthy supine subjects, bilateral
pulsatile blood flow
measured at five below-knee
sites without
compression; and during compression of one leg to an average
malleolar
sub-bandage
pressure of 40.7±4.0 mmHg.
RESULTS: The
forefoot-to-knee compression bandaging caused a highly
significant
(P<0.001)
increase in the bandaged leg pulsatile blood flow due to
increases in both
peak flow and pulse width.
CONCLUSION: It
is hypothesized that arteriolar vasodilatation, induced
either myogenically
by
reduced transmural pressure or by vasodilatory substance release
triggered
by increased venous shear
stress and veno-arterial
interactions, possibly combined with altered
vascular compliance, produce
the
observed compression-related phenomenon. Whatever the mechanism(s),
the
finding of a compression-
associated pulsatile flow increase suggests
an arterial linkage, which may
play a role in the well-
documented
beneficial effects of compression bandaging in venous ulcer and
lymphedema
treatment.
Possible beneficial effects of the arterial flow-pulse increase
on venous
ulcer outcome may be related to
a decrease in leukocyte effects
in the distal microvasculature.
PMID: 20924348 [PubMed - in
process]
Int Angiol. 2010 Oct;29(5):392-4.
Limb
volume measurement: from the past methods to optoelectronic
technologies,
bioimpedance
analysis and laser based devices.
Cavezzi A,
Schingale F, Elio C.
Vascular Unit, Stella Maris Clinic and
Hippocrates Poliambulatory, S.
Benedetto del Tronto, Ascoli
Piceno, Italy
- [email protected].
Abstract
Accurate
measurement of limb volume is considered crucial to lymphedema
management.
Various non-
invasive methods may be used and have been validated in recent
years,
though suboptimal
standardisation has been highlighted in
different publications.
PMID: 20924339 [PubMed - in
process]
Skin Res Technol. 2010 Jul 6. doi:
10.1111/j.1600-0846.2010.00456.x. [Epub
ahead of
print]
Spatial variations in forearm skin tissue dielectric
constant.
Mayrovitz HN, Luis M.
College of
Medical Sciences, Nova Southeastern University, Ft. Lauderdale,
FL,
USA.
Abstract
Background: Tissue dielectric
constant (TDC) values measured at
300 MHz via the open-ended
coaxial line
reflection method depend on the effective measurement depth
and the
anatomical site being
evaluated. Measurements on the forearm have shown that
the TDC values
decrease with increasing
measurement depth but the spatial
variability of the TDC values among
forearm anatomical positions
is
unknown. Our goal was to characterize the extent of such spatial
variations.
Methods: In 30 healthy seated women (27.4±6.5
years), TDC was measured on
the forearm midline
and 1.2 cm medial and
lateral to the midline at sites 4, 8 and
12 cm distal to the antecubital
crease.
Results: The midline and medial TDC values increased
progressively from 4
to 8 to 12 cm sites (P<0.
001), with the largest
spatial gradient along the midline. At a depth of
2.5 mm, the TDC
values
increased from 26.3±2.8 to 27.4±3.4 to 28.4±3.7, with a maximum
difference
of 8.2±10.6%. For all
sites, the TDC values were significantly
(P<0.001) less for increasing
depths.
Conclusion: The
findings reveal increased TDC values along the forearm
from proximal to
distal, most
prominent at the midline and medial positions. Because many
skin-related
dermatological and
biophysical studies utilize the forearm
as a test target, such differences
may be important to consider
because
TDC values in part are reflective of local tissue water (LTW).
Although the
variation in the
TDC values among sites was less than 10%, such differences
are of
importance when evaluating LTW
changes using the TDC method in
patients with arm lymphedema that is
present in variable arm
anatomical
locations.
PMID: 20923455 [PubMed - as supplied by
publisher]
Acta Med Croatica. 2010
Jul;64(3):167-73.
[Compression therapy for lymphedema: our
experience]
[Article in Croatian]
Planinsek
Rucigaj T, Tlaker Zunter V, Miljković J.
University Department
of Dermatovenereology, Ljubljana University Hospital
Center,
Ljubljana,
Slovenia. [email protected]
Abstract
The
term lymphedema refers to a chronic, progressive edema, usually of a
limb,
due to insufficient
lymphatic flow. It may appear as a primary disturbance
or secondary to
other causes, e.g., after
infections or surgery. The most
common cause of lymphedema in the Western
world is cancer surgery
and/or
radiotherapy. The authors summarize the etiology, pathophysiology
and
clinical staging of
lymphedema. The diagnosis of lymphedema is usually based
on history and
clinical appearance.
However, lymphoscintigraphy is the
gold standard of imaging in doubtful
cases. Adequate and
early
compression therapy and good patient compliance are the cornerstones
of
management of
lymphedema. The authors present their experience with
compression therapy
for lymphedema. While
no differences were found in
the efficiency of compression therapy between
oncologic and
non-
oncologic patients, compression stockings of class III seemed to
be
efficient in the majority of
secondary lower limb lymphedemas but not
as maintenance therapy for
primary lower
limb
lymphedema.
PMID: 20922859 [PubMed - in
process]
Clin Dysmorphol. 2010 Sep 30. [Epub ahead of
print]
Cantu syndrome and
lymphoedema.
García-Cruz D, Mampel A, Echeverria MI, Vargas AL,
Castañeda-Cisneros G,
Davalos-Rodriguez
N, Patiño-Garcia B, Garcia-Cruz
MO, Castañeda V, Cardona EG, Marin-Solis
B, Cantu JM, Nuñez-
Reveles N,
Moran-Moguel C, Thavanati PK, Ramirez-Garcia S, Sanchez-Corona
J.
aInstituto de Genetica Humana 'Dr Enrique Corona Rivera'
bInstituto de
Enfermedades Cronico-
Degenerativas, Departamento de
Biologia Molecular y Genomica, Centro
Universitario de Ciencias de
la
Salud, Universidad de Guadalajara cHospital de Especialidades,
CMNO
dDivision de Medicina
Molecular, CIBO, CMNO, IMSS eHospital General
Regional 46 fHospital
General Regional 45,
IMSS, Guadalajara, Jalisco,
Mexico gInstituto de Genetica de la Facultad
de Ciencias Medicas de
la
Universidad Nacional de Cuyo, Mendoza,
Argentina.
Abstract
Three female patients with
Cantu syndrome were studied, two of whom were
adults presenting with
the
complication of lymphoedema, as described earlier in a male patient
with
this syndrome. The aim of this
study is to report the clinical
characteristics of these three new cases
and to emphasize
that
lymphoedema, as observed in two of the patients described here, has
been
observed in 11.5% of
patients with Cantu syndrome and that
heterochromia iridis, observed in
one patient, is probably a new
feature
of this condition.
PMID: 20890180 [PubMed - as supplied by
publisher]
Am J Trop Med Hyg. 2010
Oct;83(4):884-90.
Elevated levels of plasma angiogenic factors
are associated with human
lymphatic filarial
infections.
Bennuru S, Maldarelli G, Kumaraswami V, Klion AD,
Nutman TB.
Laboratory of Parasitic Diseases, National Institute
of Allergy and
Infectious Diseases, National
Institutes of Health,
Bethesda, Maryland 20892, USA. [email protected]
Abstract
Lymphatic
dilatation, dysfunction, and lymphangiogenesis are hallmarks of
patent
lymphatic filariasis,
observed even in those with subclinical
microfilaremia, through processes
associated, in part, by
vascular
endothelial growth factors (VEGFs). A panel of pro-angiogenic
factors was
measured in the
plasma of subjects from filaria-endemic regions using
multiplexed
immunological assays. Compared
with endemic normal control
subjects, those with both subclinical
microfilaremia, and those
with
longstanding lymphedema had significantly elevated levels of
VEGF-A,
VEGF-C, VEGF-D, and
angiopoietins (Ang-1/Ang-2), with only levels
of basic fibroblast growth
factor (bFGF) and placental
growth factor
(PlGF) being elevated only if lymphedema was evident.
Furthermore, levels of
these
factors 1-year post-treatment with doxycycline were similar
to
pretreatment levels suggesting a minimal
role, if any, for Wolbachia.
Our data support the concept that filarial
infection per se is associated
with
elevated levels of most of the known pro-angiogenic factors, with only
a
few being associated with the
serious pathologic consequences
associated with Wuchereria bancrofti
infection.
PMID:
20889885 [PubMed - in process]PMCID: PMC2946762 [Available
on
2011/10/5]
Genes Dev. 2010 Oct
1;24(19):2115-26.
Current views on the function of the lymphatic
vasculature in health and
disease.
Wang Y, Oliver
G.
Department of Genetics and Tumor Cell Biology, St. Jude
Children's
Research Hospital, Memphis,
Tennessee 38105,
USA.
Abstract
The lymphatic vascular system is
essential for lipid absorption, fluid
homeostasis, and
immune
surveillance. Until recently, lymphatic vessel dysfunction had
been
associated with symptomatic
pathologic conditions such as
lymphedema. Work in the last few years had
led to a better
understanding
of the functional roles of this vascular system in health
and disease.
Furthermore, recent
work has also unraveled additional functional roles of
the lymphatic
vasculature in fat metabolism,
obesity, inflammation, and
the regulation of salt storage in hypertension.
In this review, we
summarize
the functional roles of the lymphatic vasculature in health and
disease.
PMID: 20889712 [PubMed - indexed for
MEDLINE]
Ann Vasc Surg. 2010 Oct 2. [Epub ahead of
print]
Vena Cava Thrombectomy and Primary Repair after Radical
Nephrectomy for
Renal Cell Carcinoma:
Single-Center
Experience.
Helfand BT, Smith ND, Kozlowski JM, Eskandari
MK.
Department of Urology, Northwestern University Feinberg
School of
Medicine, Chicago,
IL.
Abstract
BACKGROUND: Inferior vena cava (IVC)
reconstruction for locally advanced
renal cell carcinoma
(RCC) includes
resection with and without interposition grafting, patch
graft, or primary
repair. The
proposed benefits of lateral venorrhaphy and primary repair are
avoidance
of foreign material, a more
expeditious repair, and
preservation of lower extremity venous outflow.
METHODS: A
single-center retrospective review of 22 patients with RCC and
IVC tumor
thrombus
treated with radical nephrectomy, lateral venorrhaphy,
thrombectomy, and
primary vena cava repair
between July 2002 and June
2009 was carried out. Demographic data,
diagnostic
information,
radiographic cross-sectional imaging, and procedural outcomes
were examined.
RESULTS: Among the 13 men and nine women, the
mean age was 62.1 years
(42-83); mean tumor
size was 9.8 cm (3-17 cm),
and 90% (n = 18) of the cases with RCC were
identified pathologically
as
clear cell adenocarcinoma; on the basis of the classification
system
adopted by Neves, level I was for
50% (n = 11), level II for 32%
(n = 7), level III for 9% (n = 2), and
level IV for 9% (n = 2) of
the
patients. All patients underwent en bloc radical nephrectomy with
tumor
thrombus removal and primary
IVC repair. Mean total operative time
was 547.9 ± 138.5 minutes, whereas
mean IVC cross-clamp
time was 10.8
minutes (6-29 minutes). There were no intraoperative deaths
or pulmonary
embolism
and all IVC margins were found to be pathologically
negative.
Postoperative complications included
one pulmonary embolism,
one exacerbation of chronic lymphedema, and two
cases of new
onset
erectile dysfunction. Mean follow-up was 36.4 ± 23.2 months (6-92
months).
There were no
radiographic or clinically significant changes in
mean IVC diameter during
follow-up. Five late deaths
(23%) occurred as a
result of metastatic RCC over a mean period of 24
months (range, 12-48),
but
without any local recurrences.
CONCLUSION: For advanced
RCC with tumor thrombus extension into the IVC,
lateral
venorrhaphy and
primary IVC repair avoids complicated caval
reconstructions and results in
high
patency rates with a low local tumor recurrence
rate.
PMID: 20889305 [PubMed - as supplied by
publisher]
Phlebology. 2010 Oct;25 Suppl
1:52-63.
From lymph to fat: complete reduction of
lymphoedema.
Brorson H.
Department of Plastic and
Reconstructive Surgery, Lund University, Skåne
University Hospital,
SE-
205 02 Malmö, Sweden.
Abstract
Liposuction
for late-stage lymphoedema remains a controversial technique.
While it is
clear that
conservative therapies such as combined decongestive therapy
(CDT) and
controlled compression
therapy (CCT) should be tried in the
first instance, options for the
treatment of late-stage lymphoedema
that
is not responding to treatment is not so clear. Liposuction has been
used
for many years to treat
lipodystrophy. Some results have been far from
optimal; however,
improvements in technique, patient
preparation and
patient follow-up have led to a greater and a wider
acceptance of
liposuction as a
treatment for lymphoedema. This paper outlines the benefits
of using
liposuction and presents the
evidence to support its
use.
PMID: 20870820 [PubMed - in
process]
October 15, 2010
Ginecol
Obstet Mex. 2010 Jul;78(7):345-51.
[Laparoscopic radical
hysterectomy with lymphatic mapping and sentinel
lymph node biopsy in
early
cervical cancer][Article in Spanish]
Maffuz A, Quijano
F, López D, Hernández-Ramírez D.
División de Cirurgía, Departamento de
Ginecología Oncológica, Hospital de
Oncología, Centro
Médico Nacional
Siglo XXI, Instituto Mexicano del Seguro Social, DF
México.
tonomaffuz@yahoo.
com
Abstract
BACKGROUND: in
patients with early-stage cervical cancer (FIGO IA, IB2 and
IIA), the
incidence
of lymph node metastases is up to 15%; the majority of early
cervical
cancer patients with pelvic and
para-aortic lymphadenectomy does
not benefit with the procedure and are at
risk of associated
morbidity
(linfocyst, lymphedema, vascular or nerve damage).
OBJECTIVE: To
describe the experience and usefulness of lymphatic mapping
and sentinel
lymph
node with total laparoscopic radical hysterectomy in early stage
cervical
cancer. Patients and method:
Retrospective study in patients
with diagnosis of cervical cancer in early
stage, submitted
to
laparoscopic radical hysterectomy with lymphatic mapping and
sentinel
lymph node biopsy. We
analyzed sentinel lymph node
identification, false negative rate and
surgical
variables.
RESULTS: in 36 months 15 patients were included, two
in IA2 FIGO stage,
twelve IB1 and one IIA;
thirteen patients were mapping
with combined technique and two only with
dye. The sentinel lymph
node
identification rate was 87% (two failures in the patients using only
blue
dye); the false negative
rate was 0%.
CONCLUSION:
Laparoscopic radical hysterectomy with lymphatic mapping is a
secure
technique for
patients with early stage cervical cancer; it allows the
correct
identification of lymph node status as the
principal prognostic
factor. We recommend the use of combined technique
(radiocolloid tracer
and
blue dye) for best rate sentinel lymph node
identification.
PMID: 20931810 [PubMed - in
process]
Cancer. 2010 Oct 13. [Epub ahead of
print]
The effects of body mass index on complications and
survival outcomes in
patients with cervical
carcinoma undergoing curative
chemoradiation therapy.
Kizer NT, Thaker PH, Gao F, Zighelboim
I, Powell MA, Rader JS, Mutch DG,
Grigsby PW.
Division of
Gynecologic Oncology, Washington University School of
Medicine, St. Louis,
Missouri.
Abstract
BACKGROUND: The effect of body
mass index (BMI) on treatment outcomes for
patients with
locally advanced
cervical carcinoma who receive definitive chemoradiation
is
unclear.
METHODS: The cohort in this study included all patients
with cervical
carcinoma (n = 404) who had
stage IB(1) disease and
positive lymph nodes or stage ≥IB(2) disease
and received treatment at
the
authors' facility between January 1998 and January 2008. The
mean
follow-up was 47.2 months. BMI
was calculated using the National
Institute of Health online calculator.
BMI categories were
created
according to the World Health Organization classification system.
Primary
outcomes were overall
survival, disease-free survival, and
complication rate. Univariate and
multivariate analyses were
performed.
Kaplan-Meier survival curves were generated and compared using
Cox
proportional
hazard models.
RESULTS: On multivariate
analysis, compared with normal weight (BMI
18.5-24.9 kg/m(2)), a
BMI
<18.5 kg/m(2) was associated with decreased overall survival
(hazard
ratio, 2.37; 95% confidence
interval, 1.28-4.38; P < .01). The
5-year overall survival rate was 33%,
60%, and 68% for a of BMI
<18.5
kg/m(2), a BMI from 18.5 kg/m(2) to 24.9 kg/m(2), and a BMI
>24.9
kg/m(2), respectively. A
BMI <18.5 kg/m(2) was associated
with increased risk of grade 3 or 4
complications compared with a
BMI
>24.9 kg/m(2) (radiation enteritis: 16.7% vs 13.6%, respectively; P
=
.03; fistula: 11.1% vs
8.8%, respectively; P = .05; bowel obstruction:
33.3% vs 4.4%,
respectively; P < .001; lymphedema:
5.6% vs 1.2%,
respectively; P = .02).
CONCLUSIONS: Underweight patients (BMI
< 18.5 kg/m(2)) with locally
advanced cervical cancer
had diminished
overall survival and more complications than normal weight
and obese
patients. Cancer
2010. © 2010 American Cancer Society.
PMID: 20945318
[PubMed - as supplied by publisher]
October 26,
2010
Br J Community Nurs. 2010
Oct;15(10):26-30.
Microfine glove and toe caps and their use in
lymphoedema management.
Close
G.
Abstract
Lymphoedema garments have progressed
in the last 10 years, so gone are the
days when only one
colour is
available (that lovely beige!). How many patients would have to
be persuaded
to wear their
compression hosiery in that desirable colour? Not just have
the colours
become more acceptable, so
have the fabrics. There are a wide
range of compression gloves available
to the lymphoedema specialist
to
fit on the patient but that cannot be said of toe caps. The Microfine
toe
cap is the only one available
as an off-the-shelf garment, and when the
lymphoedema is deemed to be
manageable in these
garments, it offers an
alternative to flat knit. The Microfine glove and
Microfine toe cap are
adaptable
and can offer colour options and a fabric that is less bulky and
fine. It
also allows therapists to trim the
length of each digit for a
better fit without reducing compression. The
author will present three
case
studies of patients that are using.
PMID: 20966839
[PubMed - in process]
Br J Community Nurs. 2010
Oct;15(10):17-21.
Key-worker clinics: the maintenance phase of
lymphoedema therapy.
Green
T.
Abstract
This article describes the
development of services for patients with mild
and
uncomplicated
lymphoedema through a network of community-based staff nurses
specially
trained in the management
of mild and uncomplicated lymphoedema
in order to deliver an integrated
service across the acute
foundation and
primary care trusts . Government policies, increasing
referral rates and
patients with
complex co-morbidity requiring intensive treatments had
prompted a review
of the service provision to
examine ways to deliver an
efficient and cost-effective service across the
local health economy.
Patients
with mild and uncomplicated lymphoedema do not necessarily
require
specialist care but can be
managed effectively by key workers
with appropriate training and skills
(British Lymphology Society,
2001a;
b; Lymphoedema Framework, 2006). This development demonstrates the
benefit
of training
existing community staff, using their existing skills. Providing
access to
clinics within the primary care
setting helps to provide a
cost-effective, structured and co-ordinated
care pathway at all levels
of
intervention, ultimately improving treatment outcomes and
patient
satisfaction. A cohort of community
staff nurses were identified
and trained in the provision of lymphoedema
management to key
worker
level, providing the opportunity to develop a lymphoedema service
based
upon health-care need and
not disease site as has occurred with
other national developments. These
clinics offer the same advice,
support
and monitoring of the patients condition alongside education and
information
in a more locally
accessible setting, avoiding the need for hospital
visits.
PMID: 20966836 [PubMed - in process]
Br J
Community Nurs. 2010 Oct;15(10):14-6.
Management of the
bariatric patient with lymphoedema: South West Wales.
Coveney
E.
Abstract
Twenty-four percent of adults (age 16
and over) in England are classified
as obese. This represents an
increase
from 15% in 1993. (NHS Information Centre, 2008). As obesity
rates increase
across the
UK lymphoedema services face increasing numbers of obese patients
in their
clinics. This short article
will explore some ideas of how we
manage this patient group at present in
our lymphoedema
service.
Management of lymphoedema involves what are considered the
four
cornerstones of care: daily skin
care, movement and exercise,
maintaining weight in the healthy range and
wearing compression
garments
daily. While it is considered helpful for overweight/obese
patients to lose
weight to improve
the management of lymphoedema, it is not always easy for
patients to make
the necessary lifestyle
changes, particularly for those
patients with a body mass index (BMI) over
35
(bariatric).
PMID: 20966835 [PubMed - in
process]
Br J Community Nurs. 2010
Oct;15(10):4-12.
Chronic oedema and lymphoedema of the lower
limb.
Hampton S.
Abstract
There is
a very fine line between oedema, chronic oedema, lymph venous
oedema and
lymphoedema
with the names 'chronic oedema'and 'lymphoedema' often
used
interchangeably. Therefore, there can
be difficulty with diagnosis
of which condition is present in the
individual patient, particularly
when
another unrelated condition (lipoedema) can also be mistakenly
diagnosed
as lymphoedema. The most
important thing to remember is that,
although there is this fine line
between the conditions, each part of
the
disease development cannot be entirely separated or treated completely
in
isolation. The key to
good outcomes in lymphovenous oedema is to treat it at
the earliest stage
possible to prevent
deterioration, venous ulceration
and the almost inevitable cellulitis that
is associated with
lymphoedema
skin changes. This article will aim to promote an understanding
of the
different conditions and stages,
will provide a simple
identification of the condition and will discuss how
lymphovenous oedema
can
lead eventually to the very difficult-to-treat chronic lymphoedema
with
ideas of how to prevent this
deterioration.
PMID:
20966834 [PubMed - in process]
Br J Community Nurs. 2010
Oct;15(10):3-Unknown.
Change is afoot, are you
ready?
Pike C.
Abstract
Treatment
starts with a patient's willingness to take on board the basics
of
lymphoedema management,
without this, their commitment to further treatment
would be in question.
However, most services are
now over-prescribed and
many are looking into referral criteria, but to
deny a person treatment
based
on their BMI is not sound practice; to exclude anyone on the grounds
of
their size or weight would be
unethical and may result in legal
repercussions. To avoid such situations,
community nurses can
encourage
GPs to teach their patients the importance of skin care and
exercise. If a
patient does not
take this advice on board, you can explain to the GP that
you can only
commence treatment once the
patient has complied with the
advice given. The latest government
initiatives to save costs and
reduce
overheads mean that services are being scrutinized for
cost-saving
potentials. A simple means of
proving your service's
viability is by keeping statistical records of all
staff daily activities
and treatments.
A database can be drawn up to compare, for example, cancer
and non-cancer
lymphoedema, by
looking at the number of patient contacts
for first assessments, follow
ups, intensive treatments and
record of
time in units. The database I created at Singleton Hospital's
Lymphoedema
Service enables
us to prove each staff member's activity and value for money
(if you would
like a copy, email me:
[email protected]). Approaching various
companies for discount
incentives will show a
willingness to work with
manufacturers in further reducing costs on
your
service.
PMID: 20966833 [PubMed - in
process]
--------------------
November 5,
2010:
Ann Plast Surg. 2010 Oct 29. [Epub ahead of
print]
Optimizing Outcome of Charles Procedure for Chronic Lower
Extremity
Lymphoedema.
Karri V, Yang MC, Lee IJ, Chen SH, Hong JP, Xu
ES, Cruz-Vargas J, Chen HC.
From the *Department of Plastic and
Reconstructive Surgery, E-Da
Hospital/I-Shou University,
Kaohsiung
County; †Department of Public Health, Institute of Health
Organization
Administration,
College of Public Health, National Taiwan University,
Taiwan, Republic of
China; ‡Department of
Plastic and Reconstructive
Surgery, Ajou University Hospital, Suwon City;
§Department of Plastic
and
Reconstructive Surgery, Asan Medical Center, Seoul, South Korea;
and
¶China Medical University
Hospital, Taichung, Taiwan, Republic of
China.
Abstract
BACKGROUND: Charles procedure for
late-stage lower limb lymphoedema (LLL)
is often criticized
for its
unpredictable and poor result. We have adopted a systematic
approach to
optimize outcome of
patients treated with this excisional
surgery.
METHODS: From June 2004 to March 2009 we performed
Charles procedure on 1
lower limb of 19
women and 8 men with late-stage
LLL. Mean age and follow-up was 48 (range,
16.5-77.8) years and
21.6
(range, 1.5-48) months, respectively.
RESULTS: Average inpatient
stay was 27 (range, 11-54) days. After
discharge, 16 (59.3%)
patients
underwent further minor surgery. The most frequent complication was
a
single, short episode of
cellulitis, affecting 5 (18.5%) patients.
Self-reported mobility was
either the same or improved at 6
months, and
appearance of their limbs satisfactory.
CONCLUSIONS: Charles
procedure is an effective treatment for selected
patients and by
applying
our systematic approach, a positive outcome can be
achieved.
PMID: 21042186 [PubMed - as supplied by
publisher]
World J Surg Oncol. 2010 Nov 1;8(1):94. [Epub ahead
of print]
Management options for vulvar carcinoma in a low
resource setting.
Eke AC, Alabi-Isama LI, Akabuike
JC.
ABSTRACT:
BACKGROUND: Vulvar carcinoma is a
rare tumor of the female genital tract.
In Nigeria, very few
studies have
looked at the management options for vulvar carcinoma. The
objective of this
study was
therefore, to describe the management options available and the
challenges
in treating this malignancy
in
Nigeria.
METHODS: A descriptive study of all vulvar cancer
cases managed at the
Nnamdi Azikiwe University
Teaching Hospital, Nnewi
over a 12 year period (1998-2009). The theatre,
ward register,
histo-
pathologic records and case notes of all women who had surgery for
vulvar
carcinomas were retrieved
and socio-demographic characteristics,
clinical presentation, type of
surgery, histologic type and
complications
of treatment were retrieved and analyzed.
RESULTS: There were
867 gynecological malignancies and vulval carcinoma
accounted for 11
cases,
giving a prevalence of 1.27%. The ages ranged from 54 to 79 years
with a
mean of 61.2 years. The
parities of the women ranged from 2-14.
Most of the patients were of low
socio-economic class. All
the 11
patients had surgery as 1st line treatment.
Radical vulvectomy was done
for 6 cases since they presented in the
advanced stage. The
complications
of surgery included hemorrhage (18.2%), chronic lymphedema,
wound infection
and
anesthetic complications. There were no hospital mortalities.
Late
presentation, with stage III (45.4%)
was the commonest stage at
presentation while the majority of the vulvar
carcinomas (72.7%) were
of
epithelial origin. Squamous cell carcinoma predominated
(63.6%).
CONCLUSION: Carcinoma of the vulva is a rare
gynecological malignancy in
Nigeria. Surgery and
radiotherapy remain the
mainstay of this disease in Nigeria. Treatment can
be highly successful
if
patients present early.
PMID: 21040577 [PubMed - as
supplied by publisher]
Diabetes Res Clin Pract. 2010 Oct 28.
[Epub ahead of print]
Chronic interdigital dermatophytic
infection: A common lesion associated
with potentially
severe
consequences.
Vanhooteghem O, Szepetiuk G, Paurobally
D, Heureux F.
Department of Dermatology, Sainte Elisabeth
Hospital, B-5000 Namur,
Belgium; Department of
Dermatology, University
Hospital Sart Tilman, B-4000 Liège,
Belgium.
Abstract
Interdigital intertrigo and
onychomycosis has the potential cause of
severe bacterial
infectious
complications with pain, mobility problems, abscess,
erysipelas,
cellulitis, fasciitis and osteomyelitis. In
another hand,
diabetic neuropathy, which affects 60-70% of those with
diabetes mellitus,
is one of the
most troubling complications for persons with diabetes. These
people are
high suspecting to be infected
by dermatophytic infections in
interdigital spaces or onychomycosis witch
are frequently induce
damage
to the stratum corneum, leading to bacterial proliferation and
secondary
infection. A patient presented
with an asymptomatic warm,
painless, erythematous swelling of the second
left toe, which had
been
present for a few weeks. Clinically, the lesion was categorized
as
erysipelas upon an insidious abscess
formation. Further investigation
was undertaken to confirm the presence of
diabetes. Leg erysipelas is
a
common affection which, according to various studies, has both
local
concomitants (interdigital
intertrigo, lymphoedema, surgical
antecedents) and/or general causes
(immune suppression,
diabetes,
alcoholism, etc). Interdigital intertrigo, tinea pedis, and
onychomycosis
present as public health
problems that could trigger
serious deterioration in patient quality of
life, due to complications
induced
by secondary bacterial infections.
Copyright © 2010
Elsevier Ireland Ltd. All rights reserved.
PMID: 21035887
[PubMed - as supplied by publisher]
Presse Med. 2010 Oct 27.
[Epub ahead of print] [Primary lymphedema of
limbs.][Article in
French]
Vaillant L, Tauveron V.
Université
François-Rabelais de Tours, CHRU de Tours, 37044 Tours cedex
01, France;
CNRS FRE
2448, unité Inserm U930, 37044 Tours cedex,
France.
Abstract
Limb lymphedema is frequent and
not well-known. Clinical classification
distinguishes primary
lymphedemas
due to developmental disorders of the lymphatic system
(hereditary or not,
sometimes
associated with other malformations) and secondary lymphedemas.
Primary
lymphedema is a
lymphedema without a cause to explain lymphatic
impairment. It is due to
an abnormal
lymphangiogenesis in utero. It is
often associated with mutation in a gene
involved in
lymphangiogenesis
(FOX C2, VEGFR 3, SOX18, PROX 1…). To assess clinical
diagnosis,
non-invasive techniques are
able to study structure and
function of the lymphatic system (mainly
isotopic lymphography).
Treatment
is the complex decongestive therapy which associates manual
lymphatic
drainage and bandage.
Predisposing or precipitating factors
have to be treated (particularly
streptococcal infections).
Surgical
treatment has precise and rare indication.
Copyright © 2010
Elsevier Masson SAS. All rights reserved.
PMID: 21035299 [PubMed
- as supplied by publisher]
November 9, 2010:
J
Vis Exp. 2010 Oct 20;(44). pii: 2225. doi:
10.3791/2225.
Multispectral Real-time Fluorescence Imaging for
Intraoperative Detection
of the Sentinel Lymph
Node in Gynecologic
Oncology.
Crane LM, Themelis G, Buddingh T, Harlaar NJ,
Pleijhuis RG, Sarantopoulos
A, van der Zee AG,
Ntziachristos V, van Dam
GM.
Department of Surgery, Division of Surgical Oncology,
University Medical
Center
Groningen.
Abstract
The prognosis in virtually
all solid tumors depends on the presence or
absence of lymph
node
metastases.(1-3) Surgical treatment most often combines radical
excision
of the tumor with a full
lymphadenectomy in the drainage area of
the tumor. However, removal of
lymph nodes is associated
with increased
morbidity due to infection, wound breakdown and
lymphedema.(4,5) As an
alternative,
the sentinel lymph node procedure (SLN) was developed several
decades ago
to detect the first
draining lymph node from the tumor.(6) In
case of lymphogenic
dissemination, the SLN is the first
lymph node that
is affected (Figure 1). Hence, if the SLN does not contain
metastases,
downstream
lymph nodes will also be free from tumor metastases and need not
to be
removed. The SLN procedure
is part of the treatment for many tumor
types, like breast cancer and
melanoma, but also for cancer of
the vulva
and cervix.(7) The current standard methodology for
SLN-detection is by
peritumoral
injection of radiocolloid one day prior to surgery, and a
colored dye
intraoperatively. Disadvantages of
the procedure in cervical
and vulvar cancer are multiple injections in the
genital area, leading
to
increased psychological distress for the patient, and the use
of
radioactive colloid. Multispectral
fluorescence imaging is an emerging
imaging modality that can be applied
intraoperatively without the
need
for injection of radiocolloid. For intraoperative fluorescence
imaging, two
components are
needed: a fluorescent agent and a quantitative optical system
for
intraoperative imaging. As a
fluorophore we have used indocyanine
green (ICG). ICG has been used for
many decades to assess
cardiac
function, cerebral perfusion and liver perfusion.(8) It is an
inert drug
with a safe pharmaco-
biological profile. When excited at around 750 nm, it
emits light in the
near-infrared spectrum around
800 nm. A custom-made
multispectral fluorescence imaging camera system was
used.(9). The aim
of
this video article is to demonstrate the detection of the SLN
using
intraoperative fluorescence imaging in
patients with cervical and
vulvar cancer. Fluorescence imaging is used in
conjunction with the
standard
procedure, consisting of radiocolloid and a blue dye. In the
future,
intraoperative fluorescence imaging
might replace the current
method and is also easily transferable to other
indications like breast
cancer
and melanoma.
PMID: 21048667 [PubMed - in
process]
MED NEWS DOCS FORMATTED:
November 3,
2010 - Fox Chase Researchers Identify Risk Factors For The
Spread Of Breast
Cancer
To Lymph Nodes –
Breast cancer, one of the most
prevalent cancers in women, afflicts an
additional 200,000 women
each
year and causes about 40,000 deaths annually. The disease often extends
to
neighboring lymph nodes,
in part, through lymphovascular invasion
(LVI) - a process in which cancer
cells invade blood vessels
or the
lymphatic system - and can often translate into a poor prognosis
for
patients. Some scientists
argue that evidence of LVI does not necessarily
mean that the disease will
recur in the lymph nodes
after radiation to
the breast alone, but research from Fox Chase Cancer
Center now shows that
the
appearance of LVI in the breast tissue does in fact predict recurrence
of
breast in the regional lymph
nodes.
By carefully examining
recurrence patterns of thousands of women with
breast cancer from
records
spanning more than 30 years, Wilhelm Lubbe, M.D.,Ph.D., chief
resident in
Fox Chase's Radiation
Oncology Department, and his colleagues
have now shown that the appearance
of LVI in breast tissue
predicts the
future recurrence of cancer to nearby lymph nodes. "The
microscopic
diagnosis of LVI is
challenging which highlights the importance of excellent
pathologists,"
says Lubbe, who will present the
results this week at the
Annual Meeting of the American Society for
Radiation
Oncology.
Knowing that the disease is going to extend to neighboring
lymph nodes,
such as those in the armpit, is
important prognostically.
But it has still been unclear whether
supplementary radiation therapy
targeting
these areas improves outcomes.
"There still is a lot of
debate as to whether additional radiation to the
regional lymph nodes is
needed in
a woman with LVI," Lubbe says.
In the study, Lubbe's team
analyzed an extensive database of 3,082 breast
cancer patients
who
underwent whole-breast radiation or minimal surgical resection of
breast
tissue between 1970 and
2009. This dataset, at least twice as
large as many others of its kind,
provided enough statistical power
for
the investigators to detect a subtle, yet significant trend.
"Luckily,
at Fox Chase, we had the resources to maintain this huge
database by
meticulously following
a large number of patients over the course of
decades," Lubbe says.
The team searched for factors aside from LVI that
determine outcomes. The
disease was more likely
to invade lymph nodes in
women younger than 35. Also, additional radiation
therapy under the
armpit
via a technique called a posterior axillary boost (PAB) lead to
fewer
breast cancer recurrences in these
women's regional lymph nodes.
Ironically, this extra procedure led to less
regional recurrence
even
though the women were of higher risk than other treatment groups.
Overall,
the 10-year recurrence
rate was only 1.4%. But it was 4% for
women treated with radiation above
the collar bone alone,
compared to
0.5% for those who also received a PAB - the posterior boost
of radiation
under the
armpits.
"Our data suggest that patients who are at higher
risk of their cancer
spreading can potentially benefit
from additional
radiation by a technique called a posterior axillary
boost," Lubbe says.
"But the
recommendation to add radiation, and what technique is used, is
very
patient-specific, because with
any intervention there's additional
risk."
In the future, Lubbe would like to identify other objective
biological
markers, such as proteins or genes,
which predict recurrence
rates and patient outcomes. "Ultimately, we'd
like to find a faster and
more
accurate process for assessing the risk of cancer spread to regional
lymph
nodes and the rest of the
body," Lubbe
says.
Co-investigators include Tianyu Li, Penny Anderson, Lori
Goldstein,
Crystal Denlinger, Holly Dushkin,
Ramona Swaby, Richard
Bleicher, Elin Sigurdson and Gary Freedman.
November 5, 2010 -
Shire Presents Positive New Data At The 60th Annual
American Society
Of
Human Genetics (ASHG) For Patients With Type 1 Gaucher Disease
–
Shire plc (LSE: SHP, Nasdaq: SHPGY), the global
specialty
biopharmaceutical company, presented
positive new data from a
Phase III clinical trial (study 039) designed to
evaluate the efficacy
of
VPRIV® (velaglucerase alfa for injection) compared with imiglucerase
in
patients with type 1 Gaucher
disease at the 2010 Annual American
Society of Human Genetics (ASHG) in
Washington, D.C. The
study met its
primary endpoint and adds to the growing body of clinical
evidence which
supports the
use of VPRIV in patients who have transitioned from
imiglucerase or who
are treatment-naive.
In the 039
(head-to-head) study, adult and pediatric patients with type 1
Gaucher
disease were
included in a 9-month, global, randomized, double-blind,
non-inferiority
study comparing VPRIV with
imiglucerase in
treatment-naive patients aged >/= 2 years, with anemia and
either
thrombocytopenia or
organomegaly. Patients were randomized in a 1:1 ratio to
receive either
VPRIV or imiglucerase at a
dose of 60U/kg via continuous
infusion over one hour every other week for
39 weeks (total of
20
infusions per patient). 35 patients in 9 countries were randomized and
34
received the study drug
(intent-to-treat [ITT] population was 17 in
both the VPRIV and
imiglucerase groups). The per-
protocol (PP) analysis
included 15 patients in each group. Baseline
clinical characteristics
were
generally similar between the 2 groups, although hemoglobin
concentrations
appeared slightly higher in
the VPRIV group.
After
9 months of treatment, hemoglobin concentration improved in both
groups. The
estimated mean
treatment difference for hemoglobin concentration from
baseline between
patients treated with VPRIV
and imiglucerase was 0.14
and 0.16 g/dL in the ITT and PP populations,
respectively, with a
lower
bound of the 97.5% one-sided confidence interval of 0.60 g/dL in
both
populations, greater than the
pre-defined non-inferiority margin of
1.0 g/dL. These results indicate
that the primary endpoint was
met. Both
the VPRIV and imiglucerase groups showed substantial
improvements in the
secondary
endpoints, including platelet counts, spleen volume, liver volume,
and
plasma biomarkers with no
statistically significant difference
demonstrated between the treatment
groups. The majority of adverse
events
were mild or moderate in severity, including one serious adverse
event (SAE)
seen with VPRIV
which was an allergic skin reaction that resolved without
sequalae.
Shire also reported important findings that suggested
substantial
antigenic differences when antibody
response to treatment
with VPRIV and imiglucerase were compared. No
patient treated with
VPRIV
developed anti-drug antibodies while 4 patients in the imiglucerase
group
developed antibodies to
imiglucerase. Of these four imiglucerase
treated patients, 1 patient had
antibodies that inhibited enzyme
activity
in vitro and enzyme uptake in a cell-based assay. 3 patients had
antibodies
that did not inhibit
enzyme activity or uptake.
November 11,
2010 - Post-Treatment Condition Often Overlooked In Breast
Cancer Patients
–
As many as 70% of women with breast cancer develop painful
swelling of the
lymph nodes after
treatment, but the condition is
frequently ignored, misdiagnosed or
otherwise left untreated,
the
Washington Post reports. The condition, known as lymphedema, affects
three
million to five million
people in the U.S., including those who
have undergone treatment for
breast, prostate, ovarian and
other cancers.
Most research on lymphedema has focused on its connection
with breast cancer
surgery
and radiation.
Lymphedema develops when fluid
accumulates at or near the surgery site --
typically building up in
the
groin, the hands, the arms, the legs or the chest -- because of a
blockage
in the lymphatic system. Over
time, this causes swelling, which
"can get worse, becoming painful,
chronic and debilitating:
restricting
movement, impeding daily activities and requiring constant
care," the Post
reports. One patient profiled
in the story uses massage
and "wears special garments 24 hours a day to
deal with her
condition,"
according to the Post. Although cancer surgery is not the sole
cause of
lymphedema, "there is strong
evidence of cause and effect" when
patients undergo cancer surgeries
involving examination of the
lymph
nodes to determine whether the cancer has spread, the Post reports.
Few
doctors and hospitals acknowledge the risk for lymphedema when
discussing
surgery or cancer
treatment, and patient advocates note that it is not
mentioned in consent
forms signed prior to surgery
or treatment. The
criteria for diagnosing the condition are inconsistent;
thus, various
estimates about
lymphedema rates in women treated for breast cancer range
from 6% to 70%,
depending on which
criteria are used, how long after
surgery the studies are conducted and
which body parts
were
examined.
Judy Nudelman, a family physician at Brown University
who has lymphoma and
also treats patients
with the condition, said many
patients become frustrated because doctors
and hospitals tell them
"we
have zero incidence of lymphedema cases in our institution." According
to
the Post, some surgeons or
hospitals view lymphedema as a complication
and avoid mentioning it for
fear of developing a negative
reputation
(Mishori, Washington Post, 11/9).
Reprinted with kind permission from http://www.nationalpartnership.org.
You
can view the entire Daily
Women's Health Policy Report, search the archives,
or sign up for email
delivery here. The Daily
Women's Health Policy
Report is a free service of the National Partnership
for Women &
Families.
November 12, 2010
Cancer. 2010 Nov 8. [Epub
ahead of print]
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.
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
2010. © 2010 American Cancer
Society.
PMID: 21061344 [PubMed - as supplied by
publisher]
Am J Pathol. 2010 Nov 5. [Epub ahead of
print]
Blockade of Transforming Growth Factor-{beta}1
Accelerates Lymphatic
Regeneration during
Wound
Repair.
Avraham T, Daluvoy S, Zampell J, Yan A, Haviv YS,
Rockson SG, Mehrara BJ.
From the Division of Plastic and
Reconstructive Surgery,* Department of
Surgery, Memorial Sloan-
Kettering
Cancer Center, New York, New York; the Department of
Medicine,
Hadassah-Hebrew
University Medical Center, Jerusalem, Israel;
and the Division of
Cardiology, Department of Medicine,
Stanford
University Medical Center, Stanford,
California.
Abstract
Lymphedema is a complication
of cancer treatment occurring in
approximately 50% of patients
who
undergo lymph node resection. Despite its prevalence, the etiology of
this
disorder remains unknown.
In this study, we determined the effect of
soft tissue fibrosis on
lymphatic function and the role of
transforming
growth factor (TGF)-ß1 in the regulation of this response. We
determined
TGF-ß
expression patterns in matched biopsy specimens collected
from
lymphedematous and normal limbs of
patients with secondary
lymphedema. To determine the role of TGF-ß in
regulating tissue fibrosis,
we
used a mouse model of lymphedema and inhibited TGF-ß function
either
systemically with a
monoclonal antibody or locally by using a
soluble, defective TGF-ß
receptor. Lymphedematous tissue
demonstrated a
nearly threefold increase in the number of cells that
stained for TGF-ß1.
TGF-ß
inhibition markedly decreased tissue fibrosis,
increased
lymphangiogenesis, and improved lymphatic
function compared
with controls. In addition, inhibition of TGF-ß not only
decreased
TGF-ß
expression in lymphedematous tissues, but also diminished
inflammation,
migration of T-helper type 2
(Th2) cells, and expression of
profibrotic Th2 cytokines. Similarly,
systemic depletion of
T-cells
markedly decreased TGF-ß expression in tail tissues. Inhibition of
TGF-ß
function promoted lymphatic
regeneration, decreased tissue
fibrosis, decreased chronic inflammation
and Th2 cell migration,
and
improved lymphatic function. The use of these strategies may represent
a
novel means of preventing
lymphedema after lymph node
resection.
PMID: 21056998 [PubMed - as supplied by
publisher]
November 13, 2010
Cancer. 2010 Nov 8.
[Epub ahead of print]
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.
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
2010. © 2010 American Cancer
Society.
PMID: 21061344 [PubMed - as supplied by
publisher]
November 19, 2010
Arch Surg. 2010
Nov;145(11):1055-63.
Risk factors for lymphedema in a
prospective breast cancer survivorship
study: the pathways
study.
Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P,
Kutner SE, Kushi LH.
Kaiser Permanente Northern California,
Oakland, 94612, USA.
[email protected]
Comment
in:
Arch Surg. 2010
Nov;145(11):1063-4.
Abstract
OBJECTIVE: To
determine the incidence of breast cancer-related lymphedema
(BCRL) during
the
early survivorship period as well as demographic, lifestyle, and
clinical
factors associated with BCRL
development.
DESIGN:
The Pathways Study, a prospective cohort study of breast cancer
survivors
with a mean
follow-up time of 20.9 months.
SETTING: Kaiser
Permanente Northern California medical care
program.
PARTICIPANTS: We studied 997 women diagnosed from
January 9, 2006, through
October 15,
2007, with primary invasive breast
cancer and who were at least 21 years
of age at diagnosis, had no
history
of any cancer, and spoke English, Spanish, Cantonese, or
Mandarin.
MAIN OUTCOME MEASURE: Clinical indication for BCRL as
determined from
outpatient or
hospitalization diagnostic codes,
outpatient procedural codes, and durable
medical equipment
orders.
RESULTS: A clinical indication for BCRL was found in 133
women (13.3%),
with a mean time to
diagnosis of 8.3 months (range,
0.7-27.3 months). Being African American
(hazard ratio, 1.93;
95%
confidence interval, 1.00-3.72) or more educated (P for trend = .03)
was
associated with an increased
risk of BCRL. Removal of at least 1
lymph node (hazard ratio, 1.04; 95%
confidence interval, 1.02-
1.07) was
associated with an increased risk, yet no significant
association was
observed for type of
lymph node surgery. Being obese at breast cancer
diagnosis was suggestive
of an elevated risk (hazard
ratio, 1.43; 95%
confidence interval, 0.88-2.31).
CONCLUSIONS: In a large cohort
study, BCRL occurs among a substantial
proportion of early
breast cancer
survivors. Our findings agree with those of previous studies
on the
increased risk of
BCRL with removal of lymph nodes and being obese, but they
point to a
differential risk according to
race or
ethnicity.
PMID: 21079093 [PubMed - in
process]
Head Neck. 2010 Nov 12. [Epub ahead of
print]
Near-infrared fluorescence imaging of lymphatics in head
and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV,
Fife CE, Smith LA, Guilliod R,
Sevick-Muraca EM.
Division of
Cardiology and Hyperbaric Medicine, Department of Internal
Medicine at The
University of
Texas Health Science Center, Houston,
Texas.
Abstract
BACKGROUND: Lymphedema is a
complication that may occur after surgical
resection and
radiation
treatment in a number of cancer types and is especially
debilitating in
regions where treatment options
are limited. Although
upper and lower extremity lymphedema may be
effectively treated with
manual
lymphatic drainage (MLD) therapies and devices that use compression
to
direct proximal flow of lymph
fluids, head and neck lymphedema is more
challenging.
METHODS AND RESULTS: Herein, we describe the
compassionate use of an
investigatory
technique of near-infrared (NIR)
fluorescence imaging to understand the
lymphatic anatomy and
function,
help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor
response to
therapy in a patient with head and neck lymphedema after surgery
and
radiation treatment.
CONCLUSION: NIR fluorescence imaging
provides a mapping of functional
lymph vessels for
direction of efficient
MLD therapy in the head and neck. Additional
studies are needed to assess
the
efficacy of MLD therapy when directed by NIR fluorescence imaging. ©
2010
Wiley Periodicals, Inc.
Head Neck, 2010.
PMID:
21077150 [PubMed - as supplied by publisher]
Ann Dermatol
Venereol. 2010 Nov;137(11):727-9. Epub 2010 Sep 6.
[Unilateral
acneiform rash in facial palsy].
[Article in
French]
Kerob D, Hennequin V, Bousquet G, Behm E, Lebbe
C.
Hôpital Saint-Louis, AP-HP, Paris, France. [email protected]
Abstract
BACKGROUND:
Cetuximab is a chimeric monoclonal antibody selective for
epidermal growth
factor
receptor (EGFR). It is increasingly used in epithelial cancer, often
in
combination with radiotherapy or
chemotherapeutic agents, since it
induces a broad range of cellular
responses that enhance
tumour
sensitivity to these therapies. However, it can cause numerous
adverse
effects, the most common being
acneiform eruption on the face and
trunk, which is generally bilateral and
symmetric.
PATIENTS
AND METHODS: Herein we present the first case of
unilateral
cetuximab-induced
acneiform eruption in facial
palsy.
DISCUSSION: To our knowledge the medical literature
contains no other such
cases. Our hypothesis
is that lymphoedema
associated with facial palsy reduces lymphatic
drainage, promoting the
deposition
of cetuximab on EGFR and persistence of local
signs.
Elsevier Masson SAS. All rights
reserved.
PMID: 21074658 [PubMed - in
process]
November 20, 2010
Head Neck. 2010 Nov
12. [Epub ahead of print]
Near-infrared fluorescence imaging of
lymphatics in head and neck lymphedema.
Maus EA, Tan IC,
Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R,
Sevick-Muraca
EM.
Division of Cardiology and Hyperbaric Medicine, Department
of Internal
Medicine at The University of
Texas Health Science Center,
Houston, Texas.
Abstract
BACKGROUND: Lymphedema
is a complication that may occur after surgical
resection and
radiation
treatment in a number of cancer types and is especially
debilitating in
regions where treatment options
are limited. Although
upper and lower extremity lymphedema may be
effectively treated with
manual
lymphatic drainage (MLD) therapies and devices that use compression
to
direct proximal flow of lymph
fluids, head and neck lymphedema is more
challenging.
METHODS AND RESULTS: Herein, we describe the
compassionate use of an
investigatory
technique of near-infrared (NIR)
fluorescence imaging to understand the
lymphatic anatomy and
function,
help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor
response to
therapy in a patient with head and neck lymphedema after surgery
and
radiation treatment.
CONCLUSION: NIR fluorescence imaging
provides a mapping of functional
lymph vessels for
direction of efficient
MLD therapy in the head and neck. Additional
studies are needed to assess
the
efficacy of MLD therapy when directed by NIR fluorescence imaging. ©
2010
Wiley Periodicals, Inc.
Head Neck, 2010.
PMID:
21077150 [PubMed - as supplied by publisher]
November 27,
2010
Vopr Kurortol Fizioter Lech Fiz Kult. 2010
Jul-Aug;(4):42-8.
[Topical problems of the diagnosis and
rehabilitative treatment of
lymphedema of the lower
extremities].
[Article in Russian]
[No authors
listed]
Abstract
The present review of the
literature data highlights modern approaches to
and major trends
in
diagnostics and conservative treatment of lymphedema of the
lower
extremities based on the
generalized world experience. Patients
with lymphedema of the lower
extremities comprise a "difficult
to manage"
group because the disease is characterized by steady
progression and
marked
refractoriness to various conservative therapeutic modalities
creating
problems for both the patient and
the attending physician.
Modern methods for the diagnosis of lymphedema
are discussed with
special
reference to noninvasive and minimally invasive techniques (such
as
lymphoscintiography, computed
tomography, MRT, laser Doppler
flowmetry, etc.). During the last 20 years,
combined conservative
therapy
has been considered as the method of choice for the management of
different
stages and forms
of lymphedema of the lower extremities in foreign clinics.
The basis of
conservative therapy is
constituted by manual lymph drainage
(MLD), compression bandages using
short-stretch materials,
physical
exercises, and skin care (using the method of M. Foldi). Also
reviewed are
the main
physiobalneotherapeutic methods traditionally widely applied for
the
treatment of lymphedema of the
lower extremities in this country.
Original methods for the same purpose
developed by the authors
are
described including modifications of cryotherapy, pulsed
matrix
laserotherapy, hydro- and
balneotherapy. Mechanisms of their
therapeutic action on the main
pathogenetic factors responsible for
the
development of lymphedema (with special reference to lymph transport
and
formation) are
discussed. The principles of combined application of
physiotherapeutic
methods for the rehabilitative
treatment of patients
presenting with lymphedema of the lower extremities
are briefly
substantiated.
Special emphasis is laid on their influence on major
components of the
pathological process.
PMID: 21089207
[PubMed - in process]
November 30, 2010
J Plast Reconstr
Aesthet Surg. 2010 Nov 17. [Epub ahead of print]
Simultaneous
multi-site lymphaticovenular anastomoses for primary lower
extremity and
genital
lymphoedema complicated with severe
lymphorrhea.
Yamamoto T, Koshima I, Yoshimatsu H, Narushima M,
Miahara M, Iida T.
Department of Plastic and Reconstructive
Surgery, Graduate School of
Medicine, University of Tokyo,
7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655 Japan.
Abstract
Primary
lower extremity and genital lymphoedema (GL) is difficult to
manage,
especially when
complicated with severe lymphorrhea. With abundant
experience of treatment
for lower-extremity
lymphoedema (LEL), we
performed simultaneous multi-site lymphaticovenular
anastomoses
(LVAs)
for GL with severe lymphorrhea. In two cases of primary LEL and GL,
LVAs
were performed via 2-
cm-long skin incisions using two to three
operating microscopes under
local anaesthesia. Symptoms of
oedema and
lymphorrhea improved clinically. LVA is a minimally invasive
surgery, which
is effective
for the treatment of LEL and GL even in primary cases with
severe
lymphorrhea. Simultaneous multi-
site LVAs can serve as the most
effective therapy for lymphoedema.
2010 British Association of
Plastic, Reconstructive and Aesthetic
Surgeons. Published by Elsevier
Ltd.
All rights reserved.
PMID: 21093398 [PubMed - as
supplied by publisher]
Rev Med Interne. 2010 Nov 17. [Epub ahead
of print]
[Inflammatory bowel disease and lower limb lymphedema:
A fortuitous
association?][Article in French]
Arrault M,
Blanchard M, Vignes S.
Unité de lymphologie, hôpital Cognacq-Jay, 15,
rue Eugène-Millon, 75015
Paris,
France.
Abstract
INTRODUCTION: Extra-intestinal
manifestations of chronic inflammatory
bowel disease (CIBD) are
various.
Cases of genital lymphedema has previously been reported in
Crohn's
disease.
CASE REPORTS: We report two women aged 57 and 68 years
who presented with
a lower limb
lymphedema 8 and 20 years after a
diagnosis of CIBD (Crohn's disease and
ulcerative colitis),
respectively.
At the time of diagnosis of lymphedema, CIBD was
asymptomatic.
CONCLUSION: Pathophysiological mechanisms of this
rare manifestation are
unclear and
lymphedema outcome is unrelated to
CIBD activity.
Copyright © 2010. Published by Elsevier
SAS.
PMID: 21093120 [PubMed - as supplied by
publisher]
J Med Case Reports. 2010 Nov 18;4(1):369. [Epub ahead
of print]
Vulval elephantiasis as a result of tubercular
lymphadenitis: two case
reports and a review of
the
literature.
Chintamani, Singh J, Tandon M, Khandelwal R,
Aeron T, Jain S, Narayan N,
Bamal R, Kumar Y,
Srinivas S, Saxena
S.
ABSTRACT:
INTRODUCTION: Elephantiasis as a
result of chronic lymphedema is
characterized by gross
enlargement of the
arms, legs or genitalia, and occurs due to a variety of
obstructive diseases
of the
lymphatic system. Genital elephantiasis usually follows common
filariasis
and lymphogranuloma
venereum. It may follow granuloma
inguinale, carcinomas, lymph node
dissection or irradiation
and
tuberculosis but this happens rarely. Vulval elephantiasis as
a
consequence of extensive lymph node
destruction by tuberculosis is very
rare. We present two very unusual
cases of vulval elephantiasis due
to
tuberculous destruction of the inguinal lymph nodes.
CASE
PRESENTATION: Two Indian women - one aged 40 years and the other aged
27
years, with
progressively increasing vulval swellings over a period of five
and four
years respectively - presented to
our hospital. In both cases,
there was a significant history on
presentation. Both women had
previously
taken a complete course of anti-tubercular treatment for
generalized
lymphadenopathy. The vulval
swellings were extremely large:
in the first case report, measuring
35x25cm on the right side and
45x30cm
on the left side, weighing 20lb and 16lb respectively. Both cases
were
managed by surgical
excision with reconstruction and the outcome was
positive. Satisfactory
results have been maintained
during a follow-up
period of six years in both cases.
CONCLUSIONS: Elephantiasis of
the female genitalia is unusual and it has
rarely been reported
following
tuberculosis. We report two cases of vulval elephantiasis as a
consequence
of extensive
lymph node destruction by tuberculosis, in order to highlight
this very
rare clinical scenario.
PMID: 21092075 [PubMed - as
supplied by publisher]
-------------------
December 3,
2010
Arch Surg. 2010 Nov;145(11):1063-4.
Risky
business: Identifying risk factors associated with lymphedema after
breast
cancer: Comment on
"Risk factors for lymphedema in a prospective breast
cancer survivorship
study".
Hunt KK, Cormier
JN.
Department of Surgical Oncology, University of Texas MD
Anderson Cancer
Center, Houston,
77030, USA.
Comment
on:
Arch Surg. 2010 Nov;145(11):1055-63.
PMID:
21121095 [PubMed - in process]
December 21, 2010
Am J
Surg Pathol. 2011 Jan;35(1):70-5.
Pediatric cutaneous
angiosarcomas: a clinicopathologic study of 10 cases.
Deyrup AT,
Miettinen M, North PE, Khoury JD, Tighiouart M, Spunt SL,
Parham DM, Shehata
BM,
Weiss SW.
Pathology Consultants, Greenville, SC 29605,
USA. [email protected]
Abstract
Cutaneous
angiosarcomas are rare tumors, which predominantly arise in the
sun-exposed
skin of the
head and neck of adult and elderly patients. Rarely, these
tumors can be
seen in children. We identified
cutaneous angiosarcomas in
10 children and assessed clinical (patient age,
tumor site, tumor size,
and
tumor focality) and histologic features including growth
pattern
(vasoformative vs. solid), mitotic rate
(mitotic figures per 10
high power field), necrosis (present vs. absent),
and cell shape
(epithelioid vs.
nonepithelioid). Tumors predominated in the lower
extremities (6 of 10) of
female patients (2 male and
8 female); age at
diagnosis ranged from 1.5 months to 15 years. Four
patients had
preexisting
conditions: congenital hemihypertrophy of the contralateral
limb, the
Aicardi syndrome, congenital
lymphedema, and congenital
hemangioma treated with radiation therapy.
Tumors were located in
the
lower extremity (6), flank (1), elbow (1), and buccal mucosa (1),
and
ranged in size from 0.6 to 6.5
cm. Eight cases showed predominantly
epithelioid morphology, 1 case showed
mixed epithelioid and
spindled
morphology and 1 case was entirely spindled. Mitotic activity
ranged from 1
to 55 mitotic
figures per 10 high power field. Necrosis was seen in 5 cases.
Clinical
follow-up was obtained for 9
patients: 4 died of disease (range,
12 to 49 mo; mean, 25 mo) and 5
patients were alive without
disease (18
mo to 28 y). Five patients had metastatic disease; sites of
involvement
included the lung,
soft tissue, lymph node, pleura, liver, and bone.
Cutaneous angiosarcomas
in children are rare tumors,
which are commonly
associated with a preexisting condition, suggesting a
greater role for
genetics as
opposed to environmental factors in the pathogenesis of these
tumors.
PMID: 21164289 [PubMed - indexed for
MEDLINE]
Am J Surg Pathol. 2011
Jan;35(1):60-9.
Primary cutaneous epithelioid angiosarcoma: a
clinicopathologic study of
13 cases of a rare neoplasm
occurring outside
the setting of conventional angiosarcomas and with
predilection for the
limbs.
Suchak R, Thway K, Zelger B, Fisher C, Calonje
E.
Department of Dermatopathology, St John's Institute of Dermatology,
St
Thomas' Hospital,
London,
UK.
Abstract
Epithelioid angiosarcomas
are rare aggressive neoplasms that occur most
frequently in deep
soft
tissues. Primary cutaneous lesions are rare, and there are
discrepant
findings in the literature regarding
their behavior. In this
study, we report a series of 13 cases of primary
cutaneous
epithelioid
angiosarcoma and analyze their clinicopathologic features. The
tumors
arising in the conventional
settings for cutaneous angiosarcoma
(ie, in the head and neck region of
elderly patients, and those
occurring
postradiation or associated with lymphedema) were excluded.
Primary
cutaneous epithelioid
angiosarcoma occurred in adults (mean age, 66 y) with
an equal sex
distribution, and presented as
solitary (n=10) or multiple
(n=3) nodules ranging in size from 8 to 80 mm,
with a predilection for
the
limbs (n=10). Histopathologically, the tumors comprised
infiltrative
sheets of atypical epithelioid cells
within the dermis with
or without the involvement of the subcutis.
Vascular channel formation
and
intracytoplasmic lumina were seen, at least focally, in most
cases.
Mitoses were readily identified and
necrosis was seen in 40% of
the cases. The tumors were immunoreactive for
vascular markers, with
CD31
and FLI-1 offering the highest sensitivity. Pancytokeratin was
positive in
two thirds of the cases,
and epithelial membrane antigen was positive in
one-quarter of the cases.
There was rare focal
expression of Melan-A
(n=2) and smooth muscle actin (n=3). Follow-up
information was available
for
11 patients. Six patients died of metastatic disease after a
median
follow-up of 12 months (range, 3 to
36 mo), and 1 patient died of
unrelated causes. These findings suggest
that primary
cutaneous
epithelioid angiosarcoma occurring outside the conventional
settings of
angiosarcoma is a highly
aggressive malignant tumor with
mortality rates in excess of 55% after 3
years.
PMID:
21164288 [PubMed - indexed for MEDLINE]
Br J Radiol. 2010 Dec
15. [Epub ahead of print]
Lymphocutaneous fistulas:
pre-therapeutic evaluation by magnetic
resonance
lymphangiography.
Lohrmann C, Foeldi E, Langer
M.
Department of Radiology, University Hospital of Freiburg,
Hugstetter
Strasse 55, D-79106,
Freiburg,
Germany.
Abstract
Objective:
Lymphocutaneous fistulas with intractable lymphatic leakage
represent a
serious clinical
condition leading to a severe impairment of quality of life
for the
affected patients. To date, no adequate
diagnostic imaging
modality is in existence, to allow selection of the
correct treatment
option. The aim
of this study was to perform a pre-therapeutic evaluation of
the lymphatic
system in patients with
lymphocutaneous fistulas by
magnetic resonance lymphangiography (MRL).
Methods: Eight lower
extremities in four patients with lymphocutaneous
fistulas were examined
by
MRL. Three locations were examined: first, the lower leg and foot
regions;
second, the upper leg and
the knee region; and third, the pelvic
and retroperitoneal regions. A T(1)
weighted three-dimensional
(3D)
spoiled gradient echo and a T(2) weighted 3D turbo spin echo sequence
were
utilised to
undertake MRL.
Results: In all four patients
(100%), the clinically suspected
lymphocutaneous fistulas (groin
and
forefoot) were exactly delineated by MRL. In two patients (50%)
adjacent
diffuse lymphangiomatous
changes were detected, extending into
the upper leg, pelvis,
retroperitoneum, abdomen and abdominal
walls. In
one patient (25%) with primary lymphoedema of the right lower
extremity, MRL
revealed an
aplasia of the lymphatic collectors at the levels of the lower
and upper
leg. All patients (100%) suffered
from an ipsilateral
lymphoedema of the lower extremity, whereby in two
patients with
diffuse
lymphangiomatosis, the lymphatic vessels were consecutively enlarged
up to
a diameter of 6 
mm.
Conclusion: MRL is a
safe and accurate imaging modality for a
comprehensive evaluation of
the
lymphatic system in patients suffering from lymphocutaneous
fistulas.
PMID: 21159808 [PubMed - as supplied by
publisher]
December 24, 2010
Am J Phys Med
Rehabil. 2011 Feb;90(2):89-96.
The frequency of lymphedema in an
adult spina bifida population.
Garcia AM, Dicianno
BE.
From the Dept. of Physical Medicine and Rehabilitation (AMG,
BED); Adult
Outpatient Spina Bifida
Clinic University of Pittsburgh
Medical Center (UPMC) (BED); Human
Engineering Research
Laboratories, VA
Pittsburgh Healthcare System (BED); and Dept. of
Rehabilitation Science
and
Technology, University of Pittsburgh (BED),
Pennsylvania.
Abstract
OBJECTIVE: : In the United
States, there are more than 100,000 people with
spina bifida. There
have
been very few studies to date documenting the occurrence of lymphedema
in
the spina bifida
population, despite a case series in 2001 that
suggested that the
occurrence may be higher than in the
general
population. Currently, approximately 1 million people have
lymphedema in the
United States.
The purpose of this study was to document the occurrence of
lymphedema and
associated medical
factors in a regional adult spina
bifida population.
DESIGN: : A total of 240 electronic medical
records from the Adult Spina
Bifida Clinic from January
2005 to August
2008 were retrospectively reviewed. Subjects were divided
into two groups
based on
the presence or absence of lymphedema. ? analyses were used to
compare
lymphedema groups with
respect to history of medical
comorbidities and ethnicity. Fisher exact
tests were used to
compare
groups with respect to mobility status and the presence of
power
wheelchair seat functions. Mann-
Whitney U tests were used to
compare groups with respect to age, anatomic
lesion level,
employment
level, and income.
RESULTS: : Twenty-two (9.2%)
patients had lymphedema. Mean ± SD population
age was 35.1 ±
11.1 yrs.
Lymphedema was associated with a history of trauma (P = 0.044),
cellulitis
(P < 0.001),
cancer (P = 0.038), obesity (P < 0.001), wounds (P <
0.001), hypertension
(P = 0.036), higher lesion
level spina bifida (P =
0.049), and mobility status (P = 0.007).
Hypertension and obesity were
present
in 38.3% and 37.5% of the total study population,
respectively.
CONCLUSIONS: : This is the first study to document
the occurrence of
lymphedema in a spina bifida
patient population, which
was almost 100 times higher than that in the
general patient population.
We
also documented a high occurrence of hypertension and obesity in the
total
study population. These
findings may help guide further prospective
studies to more clearly
delineate the risk factors for the
development of
lymphedema and to determine the appropriate therapies.
Better screening,
prevention
and treatment algorithms are needed for hypertension and obesity
in the
spina bifida population.
PMID: 21173682 [PubMed - in
process]
Cir Cir. 2010
Jul-Aug;78(4):310-4.
[Collagen-polyvinylpyrrolidone: a new
therapeutic option for treatment of
sequelae after radical
mastectomy in
women with breast cancer. Preliminary study].
[Article in
Spanish]
Ruiz-Eng R, Montiel-Jarquín A, de la Rosa-Pérez R,
López-Colombo A,
Gómez-Conde E, Zamudio-
Huerta
L.
Departamento de Cirugía Plástica, Hospital General Regional
36, Instituto
Mexicano del Seguro
Social, Puebla, México. [email protected]
Abstract
BACKGROUND:
Approximately 30% of women who undergo mastectomy
without
reconstructive
treatment due to breast cancer present sequelae.
These include
paresthesias, keloid healing,
hypoesthesia, lymphedema and
limitation of the function of the ipsilateral
upper extremity.
We
undertook this study to present the results
using
collagen-polyvinylpyrrolidone (Clg- Pvp) as treatment
for
posmastectomy sequelae in women with breast cancer.
METHODS: We
conducted a unicentric, longitudinal and prospective clinical
trial between
August 1,
2007 and July 31, 2008. Included variables were age,
lymphedema,
limitation of the function of the
ipsilateral upper
extremity, collapse of the wound, keloid healing,
paresthesias, and
appearance of the
surgical area. The appearance of the surgical area
(aesthetic aspect) was
evaluated before and 6
months after treatment was
initiated. Clg-Pvp was administered weekly for
a 6-month
period.
RESULTS: Seven women were included with a median age of
49 years (range:
40-72 years). One
patient (14.28%) presented lymphedema,
two patients (28.57%) presented
collapse of the wound,
two patients
(28.57%) had keloid healing, three patients (42.85%)
experienced
paresthesias, five
patients (71.4%) reported pain, and five patients (71.4%)
reported
limitation of the function of the
ipsilateral upper extremity.
At the completion of the treatment, aesthetic
improvement was
statistically
significant (p = 0.0020, Mann-Whitney U
test).
CONCLUSIONS: Clinical and aesthetic results are good
after application of
Clg-Pvp for treating
sequelae in women with breast
cancer who underwent mastectomy without
reconstructive
surgery.
PMID: 21167096 [PubMed - in
process]
December 25, 2010
Zhonghua Zheng Xing
Wai Ke Za Zhi. 2010 Sep;26(5):337-9.
[Treatment of chronic
extremity lymphedema with manual lymph drainage].
[Article in
Chinese]
Liu NF, Wang L, Chen JL, Zhou JG, Wu XF, Yan ZX, Jiang
ZH.
Department of Plastic & Reconstructive Surgery,
Lymphology Center,
Shanghai 9th People's Hospital,
Shanghai Jiao Tong
University, Shanghai 200011,
China.
Abstract
OBJECTIVE: To evaluate the effect
of manual lymph drainage on chronic
extremity
lymphedema.
METHODS: Fifty patients with chronic lymphedema of
extremity were treated
with manual lymph
drainage (MLD) complex
decongestion therapy. Among them, 29 had primary
lymphedema, 21
had
secondary lymphedema. 42 had lymphedema of lower extremity and 8
had
lymphedema of upper limb.
The result of treatment was evaluated with
measurement of circumference of
extremities and edema
fluid in tissue
with Multiple-frequency bioelectrical impedance
analysis.
RESULTS: After 1-2 treatment courses, all 50 patients
showed significant
decrease of circumference
of lymphedmatous limbs (P
< 0.05) and remarkable reduction of accumulated
edema fluid in tissue
(P
< 0. 05). There was highly correlation between the decrease of
limb
circumference and edema fluid in
tissue (r(s) = 0.774, P <
0.01).
CONCLUSIONS: MLD complex decongestion therapy is
effective for the
treatment of chronic
lymphedema of
extremity.
PMID: 21174786 [PubMed - in
process]
December 28, 2010
Nephrology (Carlton).
2010 Dec;15(8):779-80.
doi:
10.1111/j.1440-1797.2010.01323.x.
Unilateral upper limb
lympatic obstruction and severe lymphoedema in a
patient on long-term
sirolimus.
Damasiewicz MJ, Ierino FL.
PMID:
21175966 [PubMed - in process]
Zhonghua Zheng Xing Wai Ke Za
Zhi. 2010 Sep;26(5):337-9.
[Treatment of chronic extremity
lymphedema with manual lymph drainage].
[Article in
Chinese]
Liu NF, Wang L, Chen JL, Zhou JG, Wu XF, Yan ZX, Jiang
ZH.
Department of Plastic & Reconstructive Surgery,
Lymphology Center,
Shanghai 9th People's Hospital,
Shanghai Jiao Tong
University, Shanghai 200011,
China.
Abstract
OBJECTIVE: To evaluate the effect
of manual lymph drainage on chronic
extremity
lymphedema.
METHODS: Fifty patients with chronic lymphedema of
extremity were treated
with manual lymph
drainage (MLD) complex
decongestion therapy. Among them, 29 had primary
lymphedema, 21
had
secondary lymphedema. 42 had lymphedema of lower extremity and 8
had
lymphedema of upper limb.
The result of treatment was evaluated with
measurement of circumference of
extremities and edema
fluid in tissue
with Multiple-frequency bioelectrical impedance
analysis.
RESULTS: After 1-2 treatment courses, all 50 patients
showed significant
decrease of circumference
of lymphedmatous limbs (P
< 0.05) and remarkable reduction of accumulated
edema fluid in tissue
(P
< 0. 05). There was highly correlation between the decrease of
limb
circumference and edema fluid in
tissue (r(s) = 0.774, P <
0.01).
CONCLUSIONS: MLD complex decongestion therapy is
effective for the
treatment of chronic
lymphedema of
extremity.
PMID: 21174786 [PubMed - in
process]
December 31, 2010
Plast Reconstr Surg.
2010 Dec 23. [Epub ahead of print]
Differential Diagnosis of
Lower Extremity Enlargement in Pediatric
Patients Referred with a
Diagnosis
of "Lymphedema"
Schook CC, Mulliken JB, Fishman SJ,
Alomari AI, Grant FD, Greene AK.
1Departments of Plastic and
Oral Surgery, 2Surgery, 3Radiology, Vascular
Anomalies Center,
Children's
Hospital Boston, Harvard Medical School, Boston,
MA.
Abstract
BACKGROUND: There are many causes
for a large lower limb in the pediatric
age group. These
children are
often mislabeled as having "lymphedema", and incorrect
diagnosis can lead to
improper
treatment. The purpose of this study was to determine the
differential
diagnosis in pediatric patients
referred for lower extremity
"lymphedema" and to clarify management.
METHODS: Our Vascular
Anomalies Center database was reviewed between 1999
- 2010 for
patients
referred with a diagnosis of "lymphedema" of the lower extremity.
Records
were studied to
determine the correct etiology for the enlarged extremity.
Alternative
diagnoses, gender, age-of-onset,
and imaging studies also
were analyzed.
RESULTS: A referral diagnosis of lower extremity
"lymphedema" was given to
170 children; however,
the condition was
confirmed in only 72.9% of patients. Forty-six children
(27.1%) had
another
disorder: micro/macrocystic lymphatic malformation (19.6%),
non-eponymous
combined vascular
malformation (13.0%), capillary
malformation (10.9%), Klippel-Trenaunay
syndrome (10.9%),
hemi-
hypertrophy (8.7%), post-traumatic swelling (8.7%), Parkes Weber
syndrome
(6.5%), lipedema
(6.5%), venous malformation (4.3%),
rheumatologic disorder (4.3%),
infantile hemangioma (2.2%),
kaposiform
hemangioendothelioma (2.2%), or lipofibromatosis (2.2%).
Age-of-onset in
children with
lymphedema was older than patients with another diagnosis (p =
0.027).
CONCLUSION: "Lymphedema" is not a generic term.
Approximately one-fourth
of pediatric patients
with a large lower
extremity are misdiagnosed as having "lymphedema"; the
most commonly
confused
etiologies are other types of vascular anomalies. History,
physical
examination, and often radiological
studies are required to
differentiate lymphedema from other conditions to
ensure the child is
managed
appropriately.
PMID: 21187804 [PubMed - as supplied
by publisher]
Oncol Nurs Forum. 2011 Jan
1;38(1):E27-36.
The role of information sources and objective
risk status on lymphedema
risk-minimization behaviors in
women recently
diagnosed with breast cancer.
Sherman KA, Koelmeyer
L.
Department of Psychology, Macquarie University, Sydney,
Australia.
[email protected]
Abstract
PURPOSE/OBJECTIVES:
to assess the role of education sources and objective
risk status
on
knowledge and practice of lymphedema risk-minimization behaviors
among
women recently diagnosed
with breast
cancer.
RESEARCH APPROACH: prospective
survey.
SETTING: a hospital in Sydney,
Australia.
PARTICIPANTS: 106 women recently diagnosed with
breast cancer at increased
risk for developing
lymphedema following lymph
node dissection.
METHODOLOGIC APPROACH: a questionnaire
administered at the time of surgery
and three
months after surgery
measured demographics, lymphedema knowledge,
lymphedema
information
sources used, and adherence to risk-minimization
recommendations.
MAIN RESEARCH VARIABLES: lymphedema knowledge,
source of information used,
objective
lymphedema risk, and adherence to
risk-minimization behaviors.
FINDINGS: knowledge was high and
increased over time. Lymphedema
information from the clinic (e.
g.,
brochures, nursing staff) was the most cited source. Adherence
to
recommendations was moderate;
nonadherence was mostly for behaviors
requiring regular enactment.
Regression analysis revealed that
only
receipt of information from nursing staff and lymphedema knowledge
three
months after surgery
were significant predictors of risk-minimization
behaviors.
CONCLUSIONS: exposing women to lymphedema risk information at
the time of
breast cancer
diagnosis facilitates
increased
awareness and enactment of risk-minimization behaviors. Nursing
staff play a
key role in
disseminating this information and in convincing women to
perform the
recommendations.
INTERPRETATION: provision of
lymphedema education by breast clinic staff
is critical to ensure
that
women realize the importance of early detection and treatment.
Reminder
booster sessions by nursing
staff may be beneficial particularly
for longer-term knowledge retention
and adherence to
recommended
behaviors.
PMID: 21186149 [PubMed - in
process]
Oncol Nurs Forum. 2011 Jan
1;38(1):E1-E10.
Lymphedema in patients with head and neck
cancer.
Deng J, Ridner SH, Murphy BA.
School of
Nursing, Vanderbilt University, Nashville, TN, USA.
[email protected]
Abstract
PURPOSE/OBJECTIVES:
to describe the current state of the science on
secondary lymphedema
in
patients with head and neck cancer.
DATA SOURCES:
published journal articles and books and data from the
National Cancer
Institute,
the American Cancer Society, and other healthcare-related
professional
association Web sites.
DATA SYNTHESIS: survivors
of head and neck cancer may develop secondary
lymphedema as a
result of
the cancer or its treatment. Secondary lymphedema may involve
external
(e.g., submental
area) and internal (e.g., laryngeal, pharyngeal, oral
cavity) structures.
Although lymphedema affects
highly visible anatomic
sites (e.g., face, neck), and profoundly
influences critical physical
functions (e.g.,
speech, breathing, swallowing, cervical range of motion),
research
regarding this issue is lacking.
Studies are needed to address a
variety of vital questions, including
incidence and prevalence,
optimal
measurement techniques, associated symptom burden, functional loss,
and
psychosocial impact.
CONCLUSIONS: secondary lymphedema in
patients with head and neck cancer is
a significant but
understudied
issue.
IMPLICATIONS FOR NURSING: a need exists to systematically
examine
secondary lymphedema
related to treatment for head and neck
cancer and address gaps in the
current literature, such as
symptom
burden, effects on body functions, and influences on quality of
life.
Oncology nurses and
other healthcare professionals should have empirical
evidence to help them
manage lymphedema after
head and neck cancer
treatment.
PMID: 21186146 [PubMed - in
process]
Breast J. 2010
Nov-Dec;16(6):639-43.
Anatomical and Surgical Concepts in
Lymphatic Regeneration.
Avraham T, Daluvoy SV, Kueberuwa E,
Kasten JL, Mehrara BJ.
The Division of Plastic and
Reconstructive Surgery, The Department of
Surgery, Memorial
Sloan-
Kettering Cancer Center, New York City, New York 10065, USA.
[email protected]
Abstract
Chronic
post-surgical lymphedema is common condition that afflicts nearly
2 million
Americans. In the
USA, it is most commonly encountered in the upper
extremities of patients
who have undergone
axillary lymph node dissection
for breast cancer. Lymphedema has a
significant negative effect
on
cosmesis, limb function, and overall quality of life. Despite the
impact
of this condition, very little is
known about how to effectively
prevent or treat lymphedema. While
therapeutic options for
chronic
extremity lymphedema remain limited, several surgical approaches
have been
suggested. These include
techniques aimed at reducing limb
volume, as well as techniques that aim
to reconstitute
disrupted
lymphatic channels. Operations proposed to re-establish
lymphatic
continuity include lymphatico-
venous anastomoses,
lymphatico-lymphatico anastomoses, and tissue transfer.
PMID:
21121083 [PubMed - in process]
Eur J Surg Oncol. 2010 Nov 27.
[Epub ahead of print]
Cost-effectiveness of MRI and PET imaging
for the evaluation of axillary
lymph node metastases in
early stage
breast cancer.
Meng Y, Ward S, Cooper K, Harnan S, Wyld
L.
School of Health and Related Research, University of
Sheffield, Regent
Court, 30 Regent Street,
Sheffield S1 4DA,
UK.
Abstract
BACKGROUND: UK guidelines for breast
cancer recommend axillary nodal
assessment via surgical
methods such as
sentinel lymph node biopsy (SLNB). However, these
procedures are associated
with
adverse effects such as lymphoedema. Magnetic resonance imaging (MRI)
and
positron emission
tomography (PET) are non-invasive imaging
techniques. The aim of this
study is to evaluate the cost-
effectiveness
of MRI and PET compared with SLNB for assessment of axillary
lymph node
metastases
in newly-diagnosed early stage breast cancer patients in the
UK.
METHODS: An individual patient discrete-event simulation
model was
developed in SIMUL8(®) to
estimate the lifetime costs and
benefits of replacing SLNB with MRI or
PET, or adding MRI or PET
before
SLNB. Effectiveness outcomes were derived from a recent systematic
review;
patient utilities
and resource use data were sourced from the
literature.
RESULTS: Based on our analysis the baseline SLNB
strategy is dominated by
the strategies of
replacing SLNB with either MRI
or PET. The strategy of replacing SLNB with
MRI has the highest
total
quality-adjusted life years (QALYs) and lowest total costs.
However,
clinical evidence for MRI is
based on a limited number of small
studies and replacing SLNB with MRI or
PET leads to more false-
positive
and false-negative cases. The strategy of adding MRI before SLNB
is
cost-effective, but
subject to greater
uncertainty.
CONCLUSIONS: Based on this analysis the most
cost-effective strategy is to
replace SLNB with
MRI. However, further
large studies using up-to-date techniques are
required to obtain more
accurate
data on the sensitivity and specificity of MRI.
Elsevier
Ltd. All rights reserved.
PMID: 21115232 [PubMed - as supplied
by publisher]
Recent Results Cancer Res.
2011;186:189-215.
Physical activity and breast cancer
survivorship.
Schmitz K.
Department of
Biostatistics and Epidemiology, University of Pennsylvania
School of
Medicine, 903
Blockley Hall, 423 Guardian Drive, Philadelphia, PA,
19104-6021, USA,
[email protected].
edu.
Abstract
A
diagnosis of breast cancer is associated with treatments that
have
physiologic effects beyond the
intended curative therapy. The first
section of this chapter provides and
integrative physiology review of
the
effects of breast cancer treatment on the body systems used by and
affected
by physical activity,
including effects of chemotherapy, radiation, and
surgery. In later
sections, we review the literature on
physical activity
and breast cancer from the point of diagnosis and for
the balance of life.
The efficacy
of physical activity for supportive cancer care outcomes is
reviewed
separately from the purported
usefulness of physical activity
for disease-free and overall survival from
breast cancer. The
current
evidence supports the safety of physical activity during and after
breast
cancer therapy. The supportive
cancer care outcomes for which
there is sufficient evidence of efficacy
during and after breast
cancer
treatment include fitness, fatigue, body size, and quality of
life.
Further, there is growing evidence that
upper body exercise does
not pose additional risk for negative lymphedema
outcomes among
survivors
with and at risk for lymphedema. For overall survival, the
evidence is
largely observational, with
sufficient evidence that physical
activity does confer benefit. Finally,
we outline future directions
for
research on physical activity among breast cancer survivors,
including
expanding to focus on subsets of
the population not included in
most prior studies (minority women and
older women), tailoring
of
interventions to stages of cancer most likely to benefit, expanding
to
study women with metastatic
cancer, and new modes of exercise, such as
team sports, martial arts, and
Pilates.
PMID: 21113765
[PubMed - in process]
Arch Phys Med Rehabil. 2010
Dec;91(12):1844-8.
Effect of active resistive exercise on breast
cancer-related lymphedema: a
randomized controlled trial.
Kim
do S, Sim YJ, Jeong HJ, Kim GC.
Abstract
Kim DS,
Sim Y-J, Jeong HJ, Kim GC. Effect of active resistive exercise on
breast
cancer-related
lymphedema: a randomized controlled
trial.
OBJECTIVE: To investigate the differences between the
effects of complex
decongestive
physiotherapy with and without active
resistive exercise for the treatment
of patients with breast
cancer-
related lymphedema (BCRL).
DESIGN: Randomized
control-group study.
SETTING: An outpatient rehabilitation
clinic.
PARTICIPANTS: Patients (N=40) with diagnosed
BCRL.
INTERVENTIONS: Patients were randomly assigned to either
the active
resistive exercise group or
the nonactive resistive exercise
group. In the active resistive exercise
group, after complex
decongestive
physiotherapy, active resistive exercise was performed for
15min/d, 5 days a
week for 8
weeks. The nonactive resistive exercise group performed only
complex
decongestive physiotherapy.
MAIN OUTCOME MEASURES:
The circumferences of the upper limbs (proximal,
distal, and total)
for
the volume changes, and the Short Form-36 version 2 questionnaire for
the
quality of life (QOL) at
pretreatment and 8 weeks posttreatment for each
patient.
RESULTS: The volume of the proximal part of the arm was
significantly more
reduced in the active
resistive exercise group than
that of the nonactive resistive exercise
group (P<.05). In the
active
resistive exercise group, there was significantly more improvement
in
physical health and general health,
as compared with that of the
nonactive resistive exercise group (P<.05).
CONCLUSIONS: For
the treatment of patients with BCRL, active resistive
exercise with
complex
decongestive physiotherapy did not cause additional swelling, and
it
significantly reduced proximal arm
volume and helped improve
QOL.
American Congress of Rehabilitation Medicine. Published by
Elsevier Inc.
All rights reserved.
PMID: 21112424 [PubMed -
in process]
Gynecol Obstet Fertil. 2010 Nov 24. [Epub ahead of
print]
[Sentinel lymph node procedure and uterine
cancers.][Article in French]
Huchon C, Bats AS, Achouri A,
Lefrère-Belda MA, Buénerd A, Bensaid C,
Farragi M, Mathevet P,
Lécuru
F.
Service de chirurgie gynécologique et cancérologique, hôpital
européen
Georges-Pompidou, AP-HP,
20, rue Leblanc, 75908 Paris cedex 15,
France; Faculté de médecine,
université Paris-Descartes,
75006 Paris,
France.
Abstract
Lymph node metastases in
cervical and endometrial cancer are major
prognostic factors.
Lymph-nodal
involvement determines adjuvant therapy. As imagery is not
reliable to
diagnose lymph node status,
pelvic +/- para-aortic
lymphadenectomy remains the gold standard. These
surgical procedures
are,
however, responsible for specific morbidity: lymphocele and
lymphedema.
Sentinel lymph node
procedure could avoid lymphadenectomy and
their complications in cervical
and endometrial cancer
with good negative
predictive values. We present actual indications,
procedure and results of
sentinel
lymph node procedures in cervical and endometrial
cancer.
Copyright © 2010 Elsevier Masson SAS. All rights
reserved.
PMID: 21111648 [PubMed - as supplied by
publisher]
December 7, 2010
Am J Clin Oncol. 2010
Nov 30. [Epub ahead of print]
Estimating the Probability of
Lymphedema After Breast Cancer Surgery.
Soran A, Wu WC, Dirican
A, Johnson R, Andacoglu O, Wilson J.
*Division of Surgical
Oncology, Department of Surgery, Magee-Womens
Hospital of University
of
Pittsburgh Medical Center †Department of Biostatistics, Graduate School
of
Public Health, University
of Pittsburgh, Pittsburgh,
PA.
Abstract
OBJECTIVES: Lymphedema is a common
complication of breast cancer surgery,
leading to a
decreased quality of
life. The risk and severity of lymphedema were
associated with surgery side
upper
extremity infection, =25 kg/m body mass index (BMI), and the level of
hand
use (LHU). Our aim was
to estimate the probability of lymphedema
after breast cancer surgery by
using previously published
incidence rates
and these 3 risk factors.
METHODS: The design was a n:m matched
case control study; data were
analyzed on 51 patients
with lymphedema and
126 available controls matched on age, radiation
therapy, and operation
type. In
conjunction with published estimates of lymphedema, incidence
rates, and
estimates of the proportions
of risk factor combinations in
cases and controls, the Bayes' theorem was
used to estimate
the
probability of developing lymphedema.
RESULTS: Lymphedema
probabilities of 7 combinations for 6 different
published calculations
were
used. With the assumption of 16% LE incidence rate of lymphedema,
a
BMI<25, no infection, and a
low LHU, the estimated probability of
lymphedema was 6.8%. With the
assumption of 46.3% LE
incidence a BMI =25,
infection, and a high LHU led to an estimated
lymphedema probability of
93.7%.
CONCLUSIONS: This study shows that control of
predisposing factors in both
high and low
incidence rates has a marked
effect on the probability of LE development.
In other words, patients
with
low incidence for LE are more prone to develop LE if the
predisposing
factors are controlled poorly
compared to the high incidence
patients whom the predisposing factors are
avoided.
PMID:
21127413 [PubMed - as supplied by publisher]
Plast Reconstr
Surg. 2010 Dec;126(6):1853-63.
Overview of surgical treatments
for breast cancer-related lymphedema.
Suami H, Chang
DW.
Houston, Texas From the Department of Plastic Surgery,
University of Texas
M. D. Anderson
Cancer
Center.
Abstract
SUMMARY:: Breast
cancer-related upper extremity lymphedema is an
unsolved
iatrogenic
complication with a reported incidence ranging from 9
to 41 percent. The
increase in volume and
recurrent cellulitis of the
affected limb cause both physical and mental
distress to many breast
cancer
survivors. However, postmastectomy lymphedema has received
little
attention, and no curative
treatment is available. Conservative
treatment with decongestive therapy
has been the primary choice
for
lymphedema treatment, but it is cumbersome and has limited benefits.
To
date, there is no
consensus on surgical procedure and protocol. However,
refinements in
microsurgical techniques and
improved examination devices
may lead to the establishment of a standard
surgical treatment
for
lymphedema. This review of surgical procedures for the treatment
of
postmastectomy lymphedema
focuses on microsurgical lymphovenous shunt
operations and discusses
current issues in surgical
treatment and the
need for uniform treatment standards.
PMID: 21124127 [PubMed -
in process]
December 17, 2010
Indian J Ophthalmol. 2011
Jan-Feb;59(1):71-2.
Distichiasis-lymphedema syndrome with optic
disc pit.
Kaarthigeyan K, Ramprakash M, Kalpana
G.
PMID: 21157084 [PubMed - in process
Br J
Dermatol. 2010 Dec 14. doi: 10.1111/j.1365-2133.2010.10179.x. [Epub
ahead of
print]
Changes in the nail unit in patients with secondary
lymphoedema identified
using clinical, dermoscopic
and ultrasound
examination.
Le Fourn E, Duhard E, Tauveron V, Maruani A, Samimi
M, Lorette G, Vaillant
L, Machet L.
Department of
Dermatology, CHRU Tours, Tours, France Lymphology unit, CHRU
de Tours,
Tours,
France University François Rabelais de Tours; Tours, France UMR
INSERM
U930, ERL 3106,
Tours,
France.
Abstract
Background Secondary lymphoedema
is characterized by lymphatic stasis that
is often the result of a
lymph
node lesion. At advanced stages it may cause trophic changes in the
skin.
However, the
presence of changes in the nail unit has not been reported to
date.
Objectives The aim of this study was to determine the
presence of nail
abnormalities in cases of
secondary
lymphoedema.
Methods This was a prospective study, conducted on
patients with
unilateral secondary lymphoedema.
A comparative clinical
and dermoscopic examination and 20 MHz high
resolution ultrasound imaging
of
the affected limb and the contralateral limb were performed Results
Thirty-three patients were
included. On physical examination,
hyperkeratosis of the lateral nail
folds, friability of the nail
surface,
"ragged" proximal nail folds and cuticle and apparent leuconychia
were
observed more frequently on
the lymphoedematous limb. The ultrasound
study of the nails of the thumb
and the big toe did not reveal
any
differences in thickness of the different structures of the nail
between the
lymphoedema side and the
opposite side. The nail matrix was longer on the
lymphoedema side.
Conclusions Our study showed mild changes in
the nail unit compatible with
the xerosis often
associated with severe
lymphoedema. However, the study also showed
frequent evidence of
"ragged"
cuticles which in these patients at high risk of erysipelas are
entry
points for bacteria. This should be
taken into account when
counselling patients with limb lymphoedema in
order to prevent
erysipelas.
2010 British Association of
Dermatologists.
PMID: 21155752 [PubMed - as supplied by
publisher]
Ann Surg Oncol. 2010 Dec 14. [Epub ahead of
print]
A Pilot Study Reporting Outcomes for Melanoma Patients of
a Minimal Access
Ilio-inguinal Dissection
Technique Based on Two
Incisions.
Spillane AJ, Tucker M, Pasquali
S.
Sydney Medical School, The University of Sydney, Sydney,
Australia,
[email protected].
au.
Abstract
BACKGROUND:
A modified procedure for ilio-inguinal regional lymph node
dissection (I-I
RLND)
involving 2 small skin incisions was evaluated with the aim of
assessing
surgical and oncological
noninferiority compared with the
traditional single, longitudinal incision
I-I RLND.
MATERIALS
AND METHODS: A total of 20 melanoma patients with positive groin
lymph
nodes
who had traditional I-I RLND were compared with 20 patients who had
a
minimal access I-I RLND
using 2 small surgical access incisions of 3-6
cm in length-one sited
below and one above the inguinal
ligament.
Clinical, staging features, number of lymph nodes retrieved,
length of
hospital stay, time drains
remained in situ, morbidity (wound infections,
dehiscence, hematoma,
seroma, and lymphedema), and
disease free survival
were compared.
RESULTS: Patients in the groups were comparable
with the exception that
the minimal access I-I
RLND group had a higher
rate of AJCC stage N3 disease (60% vs 20%; P =
.03) and more cases
with
extranodal spread (45% vs 15%; P = .041). After a median follow-up of
5
months (range 1-8)
for the minimal access group and median 13 months (range
1-30) for the
standard group there were no
differences in disease-free
survival (P = .13). Retrieved lymph node
counts were similar (P =
.34)
including for the inguinal and pelvic components of the
operations
separately. No significant differences
in wound complications
or rates of early lymphedema were observed.
CONCLUSIONS: At
early follow-up, minimal access I-I RLND is feasible and
noninferior to
single
longitudinal incision I-I RLND in regard to surgical morbidity
and
oncological outcome. Further
evaluation is progressing.
PMID:
21153883 [PubMed - as supplied by publisher]
PLoS Negl Trop Dis.
2010 Nov 30;4(11):e902.
Effectiveness of a simple lymphoedema
treatment regimen in podoconiosis
management in southern
ethiopia: one
year follow-up.
Sikorski C, Ashine M, Zeleke Z, Davey
G.
University College London Medical School, London, United
Kingdom.
Abstract
BACKGROUND: Podoconiosis is a
non-filarial elephantiasis caused by
long-term barefoot exposure
to
volcanic soils in endemic areas. Irritant silicate particles penetrate
the
skin, causing a progressive,
debilitating lymphoedema of the lower leg,
often starting in the second
decade of life. A simple patient-
led
treatment approach appropriate for resource poor settings has
been
developed, comprising (1)
education on aetiology and prevention of
podoconiosis, (2) foot hygiene
(daily washing with soap,
water and an
antiseptic), (3) the regular use of emollient, (4) elevation
of the limb at
night, and (5)
emphasis on the consistent use of shoes and
socks.
METHODOLOGY/PRINCIPAL FINDINGS: We did a 12-month,
non-comparative,
longitudinal
evaluation of 33 patients newly presenting
to one clinic site of a
non-government organization (the
Mossy Foot
Treatment & Prevention Association, MFTPA) in southern
Ethiopia. Outcome
measures
used for the monitoring of disease progress were (1) the clinical
staging
system for podoconiosis, and
(2) the Amharic Dermatology Life
Quality Index (DLQI), both of which have
been recently validated
for use
in this setting. Digital photographs were also taken at each
visit.
Twenty-seven patients
completed follow up. Characteristics of patients
completing follow-up were
not significantly different to
those not. Mean
clinical stage and lower leg circumference decreased
significantly (mean
difference
-0.67 (95% CI -0.38 to -0.96) and -2.00 (95% CI -1.26 to
-2.74),
respectively, p<0.001 for both
changes). Mean DLQI diminished
from 21 (out of a maximum of 30) to 6
(p<0.001). There was a
non-
significant change in proportion of patients with mossy lesions
(p?=?0.375).
CONCLUSIONS/SIGNIFICANCE: This simple,
resource-appropriate regimen has a
considerable
impact both on clinical
progression and self-reported quality of life of
affected individuals. The
regimen
appears ideal for scaling up to other endemic regions in Ethiopia
and
internationally. We recommend
that further research in the area
include analysis of cost-effectiveness
of the regimen.
PMID:
21152059 [PubMed - in process]
Transl Oncol. 2010 Dec
1;3(6):362-72.
Human Lymphatic Architecture and Dynamic
Transport Imaged Using
Near-infrared Fluorescence.
Rasmussen
JC, Tan IC, Marshall MV, Adams KE, Kwon S, Fife CE, Maus EA,
Smith
LA,
Covington KR, Sevick-Muraca EM.
Center for Molecular
Imaging, The Brown Foundation Institute of Molecular
Medicine at the
University
of Texas Health Science Center at Houston, Houston, TX,
USA.
Abstract
BACKGROUND: Although the importance
of lymphatic function is well
recognized, the lack of real-
time imaging
modalities limits our understanding of its role in many
diseases. In a phase
0 exploratory
study, we used dynamic, near-infrared (NIR) fluorescence
imaging to assess
the extremes of lymphatic
architecture and transport in
healthy human subjects and in subjects
clinically diagnosed with
unilateral
lymphedema (LE), a disease that can be prevalent in cancer
survivors.
METHODS AND RESULTS: Active lymphatic propulsion was
imaged after
intradermal injections of
25 µg of indocyanine green (total
maximum dose =400 µg) bilaterally in the
arms or legs of control
and
subjects. Images show well-defined lymphatic structures with
propulsive
dye transport in limbs of
healthy subjects. In LE subjects, we
observed extravascular dye
accumulation, networks of
fluorescent
lymphatic capillaries, and/or tortuous lymphatic vessels in
all
symptomatic and some asymptomatic
limbs. Statistical models indicate
that disease status and/or limb
significantly affect parameters
of
apparent lymph propagation velocity and contractile
frequency.
CONCLUSIONS: These clinical research studies
demonstrate the potential of
NIR fluorescence
imaging as a diagnostic
measure of functional lymphatics and as a new tool
in translational
research
studies to decipher the role of the lymphatic system in cancer and
other
diseases.
PMID: 21151475 [PubMed - in
process]
JAMA. 2010 Dec 22;304(24):2699-705. Epub 2010 Dec
8.
Weight lifting for women at risk for breast cancer-related
lymphedema: a
randomized trial.
Schmitz KH, Ahmed RL, Troxel
AB, Cheville A, Lewis-Grant L, Smith R, Bryan
CJ, Williams-Smith
CT,
Chittams J.
Center for Clinical Epidemiology and Biostatistics,
University of
Pennsylvania School of Medicine and
Abramson Cancer Center,
Philadelphia, PA 19104-6021, USA.
[email protected]
Abstract
CONTEXT:
Clinical guidelines for breast cancer survivors without
lymphedema advise
against upper
body exercise, preventing them from obtaining established
health benefits
of weight lifting.
OBJECTIVE: To evaluate
lymphedema onset after a 1-year weight lifting
intervention vs no
exercise
(control) among survivors at risk for breast cancer-related
lymphedema
(BCRL).
DESIGN, SETTING, AND PARTICIPANTS: A
randomized controlled equivalence
trial (Physical
Activity and Lymphedema
trial) in the Philadelphia metropolitan area of
154 breast cancer survivors
1
to 5 years postunilateral breast cancer, with at least 2 lymph
nodes
removed and without clinical signs
of BCRL at study entry.
Participants were recruited between October 1,
2005, and February
2007,
with data collection ending in August
2008.
INTERVENTION: Weight lifting intervention included a gym
membership and 13
weeks of supervised
instruction, with the remaining 9
months unsupervised, vs no exercise.
MAIN OUTCOME MEASURES:
Incident BCRL determined by increased arm swelling
during 12
months (=5%
increase in interlimb difference). Clinician-defined BCRL
onset was also
evaluated.
Equivalence margin was defined as doubling of lymphedema
incidence.
RESULTS: A total of 134 participants completed
follow-up measures at 1
year. The proportion of
women who experienced
incident BCRL onset was 11% (8 of 72) in the weight
lifting
intervention
group and 17% (13 of 75) in the control group (cumulative
incidence
difference [CID], -6.0%; 95%
confidence interval [CI], -17.2%
to 5.2%; P for equivalence = .04). Among
women with 5 or more
lymph nodes
removed, the proportion who experienced incident BCRL onset
was 7% (3 of 45)
in the
weight lifting intervention group and 22% (11 of 49) in the control
group
(CID, -15.0%; 95% CI,
-18.6% to -11.4%; P for equivalence = .003).
Clinician-defined BCRL onset
occurred in 1 woman in
the weight lifting
intervention group and 3 women in the control group
(1.5% vs 4.4%, P
for
equivalence = .12).
CONCLUSION: In breast cancer
survivors at risk for lymphedema, a program
of slowly progressive
weight
lifting compared with no exercise did not result in increased
incidence of
lymphedema.
TRIAL REGISTRATION: clinicaltrials.gov Identifier:
NCT00194363.
PMID: 21148134 [PubMed - indexed for
MEDLINE]
Med Clin (Barc). 2010 Dec 7. [Epub ahead of
print]
[Preventing lymphoedema after breast cancer surgery by
elastic restraint
orthotic and manual lymphatic
drainage: A randomized
clinical trial.]
[Article in
Spanish]
Castro-Sánchez AM, Moreno-Lorenzo C, Matarán-Peñarrocha
GA,
Aguilar-Ferrándiz ME, Almagro-
Céspedes I, Anaya-Ojeda
J.
Departamento de Enfermería y Fisioterapia, Facultad de
Ciencias de la
Salud, Universidad de Almería,
Almería,
España.
Abstract
BACKGROUND AND OBJECTIVE:
Secondary lymphoedema is considered one of the most
common complications
after breast cancer surgery. The aim of the present
study was to analyze
the
effectiveness of containment elastic orthosis and manual
lymphatic
drainage in the prevention of
lymphoedema secondary to
mastectomy.
PATIENTS AND METHOD: An experimental study was
performed with a control
group. Forty-eight
patients were randomly
assigned to experimental (containment elastic
orthosis and manual
lymphatic
drainage) and control (postural measures) groups. Outcomes
measures were
quality of life, body
composition, temperature, functional
assessment of the shoulder, pain and
limb volume. Measures were
performed
at baseline and after 8-months intervention.
RESULTS: After the
intervention period, the experimental group showed
significant differences
(P<.
05) in the quality of life, extracellular water, and functional
assessment
of the volume of the limb of the
mastectomized
side.
CONCLUSIONS: The application of containment elastic
orthosis and manual
lymphatic drainage
contribute to prevent secondary
lymphoedema after breast cancer surgery,
improving the quality of life
in
these patients.
Copyright © 2010 Elsevier España, S.L. All
rights reserved.
PMID: 21145085 [PubMed - as supplied by
publisher]
J Sex Med. 2010 Dec 8. doi:
10.1111/j.1743-6109.2010.02133.x. [Epub ahead
of
print]
Quality of Life and Sexual Function after Type c2/Type
III Radical
Hysterectomy for Locally
Advanced Cervical Cancer: A
Prospective Study.
Plotti F, Sansone M, Di Donato V, Antonelli
E, Altavilla T, Angioli R,
Panici PB.
Sapienza University,
Department of Obstetrics and Gynecology, Rome, Italy
Campus
Biomedico
University, Department of Obstetrics and Gynecology, Rome,
Italy.
Abstract
Introduction. The introduction
of screening programs have made cervical
cancer detectable at
earlier
stages and in younger patients. Nevertheless, only a few studies
have
examined the QoL and sexual
function in disease-free cervical cancer
survivors. Aim. The objective of
this study is to evaluate the
sexual
function in a cervical cancer patient's group treated with
neoadjuvant
chemotherapy (NACT)
plus type C2/type III radical hysterectomy
(RH).
Methods. We have enrolled in the oncologic group (OG)
sexually active
patients affected by cervical
cancer (stage IB2 to IIIB)
treated with NACT followed by RH. Main Outcome
Measures.
Included
subjects were interviewed with the European Organization for
Research and
Treatment of Cancer
(EORTC) QLQ-CX24 Questionnaire. Two
consecutive assessments were recorded:
at the first
evaluation
postoperatively (T1) and at the 12-month follow-up visit (T2).
Results were
compared with
a benign gynecological disease group (BG) and with a healthy
control group
(HG). Results. A total of
33 patients for OG, 37 for BG,
and 35 women for HG were recruited. After
surgery, sexual activity
has
been resumed by 76% of the OG patients and 83.7% of the BG patients (P
= not
significant).
Cancer survivors had clinically worse problems with symptom
experience,
body image, and
sexual/vaginal functioning than controls (P
< 0.05). OG patients also
reported more severe
lymphedema, peripheral
neuropathy, menopausal symptoms, and sexual worry.
For sexual activity,
the
score difference between cancer survivors and women with
benign
gynecological disease is not
statically significant. Concerning
sexual enjoyment assessment, our study
shows comparable results for
OG
and BG.
Conclusion. Nevertheless, the worsening of symptom
experience, body
image, and sexual/vaginal
functioning, OG patients have
same sexual activity and sexual enjoyment
data compared with those of
BG
patients. Thus, NACT followed by RH could be a valid therapeutic
strategy to
treat and improve
well-being especially in young cervical cancer patients.
Plotti F, Sansone
M, Di Donato V, Antonelli E,
Altavilla T, Angioli R,
and Panici PB. Quality of life and sexual function
after type c2/type III
radical
hysterectomy for locally advanced cervical cancer: A prospective
study. J
Sex Med **;**:**-**.
International Society for
Sexual Medicine.
PMID: 21143414 [PubMed - as supplied by
publisher]
PMID: 20871969 [PubMed - as supplied by
publisher]