Ann Dermatol Venereol. 2011 June - July;138(6-7):508-511. Epub 2011 Mar
27.
[Recurrent breast cellulitis associated with lymphangiectasia after
tumorectomy for breast cancer.]
[Article in French]
Bibas N, Escande H, Ofaiche J, Le Moigne M, Viraben R, Nougué J.
Source
Service de dermatologie, CHG, 100, rue Léon-Cladel, 82013 Montauban cedex,
France.
Abstract
BACKGROUND:
Recurrent breast cellulitis has been described as a complication following
breast conservation therapy.
OBSERVATION:
A 50-year-old woman undergoing tumour excision, postoperative radiotherapy
and chemotherapy
presented recurrent breast cellulitis in the same region.
The presence of lymphangiectasia suggested a
complication subsequent to
lymph stasis.
DISCUSSION:
Conservative therapy for breast cancer, allowing the development of
subclinical or patent lymphœdema,
constitutes a prominent risk factor for
recurrent cellulitis. This complication has also been considered in
patients
with lower extremity cellulitis following saphenous venectomy for coronary
bypass surgery. The
unusual presence of lymphangiectasia observed in our
patient provides clear evidence that lymphœdema is
the most prominent risk
factor for the development of cellulitis after breast conservation therapy.
Copyright © 2011. Published by Elsevier Masson SAS.
PMID: 21700073 [PubMed - as supplied by publisher]
July 8, 2011
J Oncol Pract. 2011 Mar;7(2):89-93.
Effects of early exercise on the development of lymphedema in patients with
breast cancer treated with
axillary lymph node dissection.
Cavanaugh KM.
Source
University of Pennsylvania, Philadelphia, PA.
Abstract
PURPOSE:
Despite advances in the treatment of breast cancer, there is little research
examining the prevention of
lymphedema after breast and/or axillary surgery.
Currently, there are no national guidelines for activity
restrictions;
however, many medical providers recommend restricting activity of the surgically
affected arm,
which can create quality-of-life issues as well as future
medical issues for patients with breast cancer.
METHODS:
A literature review of several current research articles was performed. This
report reviews four studies
evaluating the effects of restricted activity
versus progressive exercise and stretching activities on
development of
lymphedema.
RESULTS:
The results show that there is no difference in the risk of developing
lymphedema when following activity
guidelines. All four of the studies
reviewed report results of either a decrease in the development of
lymphedema or no increased risk of development of lymphedema when early
exercise regimens are
incorporated into postoperative care.
CONCLUSION:
The four research articles show promising results that support future change in practice guidelines. However,
none of the studies report follow-up
results beyond 2 years. Additionl evaluation to monitor long-term
effects is
warranted.
PMID: 21731515 [PubMed - in process] PMCID: PMC3051868
Clin Microbiol Infect. 2011 Jul;17(7):977-85. doi:
10.1111/j.1469-0691.2011.03586.x.
Filariasis in Africa-treatment challenges and prospects.
Hoerauf A, Pfarr K, Mand S, Debrah AY, Specht S.
Source
Institute for Medical Microbiology, Immunology and Parasitology, University
Hospital Bonn, Sigmund Freud
Strasse, Bonn, Germany Faculty of Allied
Health Sciences, Kwame Nkrumah University of Science and
Technology Kumasi
Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi,
Ghana.
Abstract
Clin Microbiol Infect 2011; 17: 977-985 ABSTRACT: Lymphatic filariasis (LF)
and onchocerciasis are
parasitic nematode infections that are responsible
for a major disease burden in the African continent.
Disease symptoms are
induced by the immune reactions of the host, with lymphoedema and hydrocoele in
LF, and dermatitis and ocular inflammation in onchocerciasis. Wuchereria
bancrofti and Onchocerca
volvulus, the species causing LF and onchocerciasis
in Africa, live in mutual symbiosis with Wolbachia
endobacteria, which cause
a major part of the inflammation leading to symptoms and are antibiotic targets
for treatment. The standard microfilaricidal drugs ivermectin and
albendazole are used in mass drug
administration programmes, with the aim of
interrupting transmission, with a consequent reduction in the
burden of
infection and, in some situations, leading to regional elimination of LF and
onchocerciasis. Co-
endemicity of Loa loa with W. bancrofti or O. volvulus is
an impediment to mass drug administration with
ivermectin and albendazole,
owing to the risk of encephalopathy being encountered upon administration of
ivermectin. Research into new treatment options is exploring several
improved delivery strategies for the
classic drugs or new antibiotic
treatment regimens for anti-wolbachial chemotherapy.
© 2011 The Authors. Clinical Microbiology and Infection © 2011 European
Society of Clinical
Microbiology and Infectious Diseases.
PMID: 21722251 [PubMed - in process]
J Reconstr Microsurg. 2011 Jun 29. [Epub ahead of print]
Immediate Microsurgical Breast Reconstruction and Simultaneous Sentinel Lymph
Node Dissection: Issues
with Node Positivity and Recipient Vessel
Selection.
Curtis MS, Arslanian B, Colakoglu S, Tobias AM, Lee BT.
Source
Department of Surgery, State University of New York, Upstate Medical
University, Syracuse, New York.
Abstract
Sentinel lymph node dissection (SLND) during mastectomy has been increasing
given the decreased risk of
lymphedema. Simultaneous reconstruction with a
microsurgical breast reconstruction is often performed, but
with node
positivity a completion axillary lymph node dissection (ALND) must be performed
subsequently.
This study examines the potential risks especially in relation
to microsurgical reconstruction. All patients
undergoing microsurgical
breast reconstruction at an academic institution from 2004 to 2010 were
evaluated
in a prospective database. Patients with immediate reconstruction
and SLND were identified. Management
of positive lymph node status was
ascertained through extensive chart review. There were 610
reconstructions
performed, 170 delayed and 440 immediate. From the immediate reconstructions,
110
patients (25%) had SLND and of these patients, 16 (14.55%) had a
positive SLND. All 16 patients had
internal mammary recipient vessels for
free tissue transfer. Seven patients had intraoperative completion
ALND,
while nine patients had staged completion ALND at a later date. There were no
adverse affects
from completion ALND. Simultaneous mastectomy, SLND, and
microsurgical reconstruction can be
performed safely. The internal mammary
vessels are preferred recipient vessels as node positive patients
may
require subsequent completion ALND. If a thoracodorsal anastomosis is performed,
a potential risk
exists for vessel injury and flap loss with completion
ALND.
© Thieme Medical Publishers.
PMID: 21717397 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Jun 30. [Epub ahead of print]
Reduction/Prevention of Lower Extremity Lymphedema after Pelvic and
Para-aortic Lymphadenectomy for
Patients with Gynecologic Malignancies.
Hareyama H, Ito K, Hada K, Uchida A, Hayakashi Y, Hirayama E, Oikawa M,
Okuyama K.
Source
Department of Obstetrics and Gynecology, Sapporo City General Hospital,
Sapporo, Japan, hitoshi.
[email protected].
Abstract
BACKGROUND:
Lower extremity lymphedema (LEL) is a serious complication caused by
lymphadenectomy in patients with
gynecologic malignancies. In this study, we
evaluated the effect of preserving the circumflex iliac lymph
nodes (CILNs),
i.e., the most caudal external iliac lymph nodes, for the prevention and
reduction of LEL by
comparing two groups of patients, one in which CILN were
removed and the other in which CILNs were
preserved.
METHODS:
We retrospectively reviewed 329 patients with gynecologic malignancies who
had undergone abdominal
complete systematic pelvic and para-aortic
lymphadenectomy. The patients were divided into nonpreserved
(n = 189) and
preserved (n = 140) groups, depending on whether CILNs were removed. Primary
outcome
measures included the incidence and severity of LEL.
RESULTS:
The incidence of LEL was significantly lower in the preserved group than in
the nonpreserved group (P <
0.0001). The frequency of LEL was also
significantly lower in the preserved group than in the nonpreserved
group
regardless of the range of pelvic and para-aortic lymphadenectomy (P <
0.0001). LEL in the
overwhelming majority of cases in the preserved group
was mild, and no patients experienced severe LEL.
Further, the incidence of
cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved
group (P < 0.0001). Lymphoscintigraphy revealed collateral pathways from
the preserved CILN along the
iliac and large abdominal vessels.
CONCLUSIONS:
This method of lymph node preservation is a simple and extremely effective
approach for
preventing/reducing LEL after pelvic and para-aortic
lymphadenectomy for patients with gynecologic
malignancies.
PMID: 21717243 [PubMed - as supplied by publisher]
July 12, 2011
Afr J Med Med Sci. 2010 Dec;39(4):329-32.
The learning curve of radical hysterectomy for early cervical carcinoma.
Oladokun A, Morhason-Bello IO, Bello FA, Adewole IF.
Source
Department of Obstetrics & Gynaecology, College of Medicine, University
College Hospital, Ibadan,
Nigeria. [email protected]
Abstract
Cervical cancer remains a public health concern in developing countries that
lack the wherewithal to cope
with the associated challenges. Screening for
premalignant cervical lesions and offering definitive care for
early disease
is the key to preventing the scourge. We conducted an audit of the radical
hysterectomies
performed on account of early cervical carcinoma at our
centre between September 2006 and August
2008, following capacity-building
by Operation Stop Cervical Cancer. Ten women aged 35 to 60 years
were
managed. All had type III radical hysterectomy. Three patients had adjuvant
teletherapy (one was
stage IIb, diagnosed intra-operatively). There was a
linear reduction in the surgical blood loss and duration
of surgery. Average
blood loss was 1500 mls; four had blood transfusions. One case was complicated
with
rectovaginal fistula (the woman with stage IIb disease) and another had
bilateral lymphoedema and left lower
limb sensory neuropathy. There was no
tumour recurrence on follow-up. Definitive surgery for early cervical
cancer
is feasible in developing countries despite limited resources. Audit of surgical
care of cervical cancer
will assist in strengthening the scarce skill.
Determination of suitable cases during preoperative evaluation is
crucial to
the success of the surgery.
PMID: 21736000 [PubMed - in process]
ONS Connect. 2011 Jun;26(6):14-5.
Lymphedema in head and neck cancer.
Becze E.
PMID: 21735767 [PubMed - in process]
J Cancer Surviv. 2011 Jul 7. [Epub ahead of print]
Do breast cancer survivors' post-surgery difficulties with recreational
activities persist over time?
Miedema B, Hamilton R, Tatemichi S, Thomas-Maclean R, Hack TF, Quinlan E,
Towers A, Tilley A,
Kwan W.
Source
Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers
Regional Hospital, 700
Priestman Street, Fredericton, NB, Canada, [email protected].
Abstract
INTRODUCTION:
Most longitudinal breast cancer studies have found that treatment-related
sequelae such as arm morbidity
[lymphedema, pain, and range of motion (ROM)
restrictions] can have a significant impact on quality of life.
In a
previous study, we found that at 6-12 months after breast cancer surgery, 49% of
participants had
difficulties engaging in recreational activities and that
arm morbidity significantly predicted difficulties with
participation in
recreation.
METHODS:
A longitudinal national study employing clinical assessments and survey
methods followed 178 women over
43 months (3.6 years) to assess issues
related to arm morbidity post-breast cancer surgery. Hierarchical
multiple
regression analyses were conducted to identify which variables were predictive
of recreational
difficulties experienced by women 8 and 43 months
post-surgery.
RESULTS:
Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women
demonstrated slight
increases in lymphedema. Conversely, a significant
decrease was observed in the number of ROM
restrictions and pain when using
the arm. Despite the overall improvements in arm morbidity, some women
continued to report moderate pain and ROM restrictions. The two arm
morbidity factors were found to be
statistically significant (p < 0.001)
predictors of recreational difficulties at both 8 and 43 months post-surgery,
with pain accounting for the greatest proportion of variance.
DISCUSSION/CONCLUSION:
Pain and ROM restrictions were the only significant predictors of
recreational difficulties during the first 3.6
years after breast cancer
surgery. Specifically, women who still experience pain years after breast cancer
surgery report difficulties in their recreational pursuits. IMPLICATIONS FOR
CANCER SURVIVORS:
Pain and ROM restrictions may prohibit participation in
recreational activity and targeted intervention should
be sought.
PMID: 21735276 [PubMed - as supplied by publisher
Breast Cancer Res Treat. 2011 Jul 7. [Epub ahead of print]
A SEER-Medicare population-based study of lymphedema-related claims incidence
following breast cancer
in men.
Reiner AS, Jacks LM, Van Zee KJ, Panageas KS.
Source
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer
Center, 307 East 63rd
Street, New York, NY, 10065, USA, [email protected].
Abstract
Each year there are an estimated 200,000 new breast cancer cases diagnosed in
the United States; of these,
1% of cases are in men. Lymphedema can be a
devastating complication from breast cancer and its
treatment. Currently,
almost all lymphedema-related research is based on women and extrapolated to
men.
We conducted the first population-based study of men with incident
breast cancer of any stage, diagnosed
from 1998 to 2005, who were 65 years
and older in the Surveillance, Epidemiology, and End Results
(SEER)-Medicare
linked database. We utilized claims related to lymphedema and lymphedema
treatment in
our cohort. We defined 'lymphedema-specific' claims to contain
the word 'lymphedema' in the Medicare
claim description; similarly,
'lymphedema-related' claims were defined as treatments reimbursed for
lymphedema but not necessarily containing the word 'lymphedema' in the
Medicare claim description. We
identified 628 men with incident breast
cancer from 1998 to 2005 who were 65 years and older. The
cumulative
incidence, censored for deaths, of lymphedema-specific claims at 2, 3, 4, and 5
years was 8.0,
9.2, 10.5, and 10.5%, respectively. The median follow-up was
3.4 years and for those without any event
was 4.7 years. The cumulative
incidence, censored for deaths, of lymphedema-related claims at 2, 3, 4, and
5 years was 26.9, 32.2, 35.4, and 39.8%. Rates for men were similar to
analogous rates for women.
Lymphedema is a common complication affecting men
with breast cancer as well as women and appropriate
treatment and
rehabilitation strategies need to be implemented for both genders.
PMID: 21735047 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 Jul 5. [Epub ahead of print]
Upper Extremity Lymphedema Index: A Simple Method for Severity Evaluation of
Upper Extremity
Lymphedema.
Yamamoto T, Yamamoto N, Hara H, Mihara M, Narushima M, Koshima I.
Source
From the Department of Plastic and Reconstructive Surgery, Graduate School of
Medicine, the University
of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655,
Japan.
Abstract
Measurement of the circumference is the most commonly employed method for
evaluating extremity
lymphedema. However, comparison between different
patients is difficult with this measurement. To resolve
this problem, we
have formulated a new index, upper extremity lymphedema (UEL) index, which can
be
easily obtained from measurements of the body. We evaluated correlation
between UEL index and clinical
stage in patients with UEL. The UEL indices
were significantly correlated with clinical stages and could be
used as a
severity scale. The lower extremity lymphedema index makes objective assessment
of the severity
of lymphedema through a numerical rating, regardless of the
body type. This numerical rating makes the
index useful for evaluation of
lymphedema severities between different cases.
PMID: 21734534 [PubMed - as supplied by publisher
Integr Cancer Ther. 2011 Jul 6. [Epub ahead of print]
Impact of Yoga on Functional Outcomes in Breast Cancer Survivors With
Aromatase Inhibitor-Associated
Arthralgias.
Galantino ML, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ.
Source
The Richard Stockton College of New Jersey, Pomona, NJ, USA; University of
Pennsylvania, Philadelphia,
PA, USA.
Abstract
Arthralgia affects postmenopausal breast cancer survivors (BCSs) receiving
aromatase inhibitors (AIs). This
study aims to establish the feasibility of
studying the impact of yoga on objective functional outcomes, pain,
and
health-related quality of life (HR-QOL) for AI-associated arthralgia (AIAA).
Postmenopausal women
with stage I to III breast cancer who reported AIAA
were enrolled in a single-arm pilot trial. A yoga
program was provided twice
a week for 8 weeks. The Functional Reach (FR) and Sit and Reach (SR) were
evaluated as primary outcomes. Pain, as measured by the Brief Pain Inventory
(BPI), self-reported Patient
Specific Functional Scale (PSFS), and
Functional Assessment of Cancer Therapy-Breast (FACT-B) were
secondary
outcomes. Paired t tests were used for analysis, and 90% provided data for
assessment at the
end of the intervention. Participants experienced
significant improvement in balance, as measured by FR,
and flexibility, as
measured by SR. The PSFS improved from 4.55 to 7.21, and HR-QOL measured by
FACT-B also improved; both P < .05. The score for the Pain Severity
subscale of the BPI reduced. No
adverse events nor development or worsening
of lymphedema was observed. In all, 80% of participants
adhered to the home
program. Preliminary data suggest that yoga may reduce pain and improve balance
and
flexibility in BCSs with AIAA. A randomized controlled trial is needed
to establish the definitive efficacy of
yoga for objective functional
improvement in BCSs related to AIAA.
PMID: 21733988 [PubMed - as supplied by publisher]
Page updated
11/30/11
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Lymphland
International Lymphedema Online
Email Tina
September 5, 2011
Wkly Epidemiol Rec. 2011 Aug 5;86(32):341-51.
Meeting of the International Task Force for Disease Eradication, April
2011.
[Article in English, French]
[No authors listed]
PMID: 21837843 [PubMed - indexed for MEDLINE]
Int Wound J. 2011 Aug 17. doi: 10.1111/j.1742-481X.2011.00832.x. [Epub ahead
of print]
The experience of patients with lymphoedema undergoing a period of
compression bandaging in the UK and
Canada using the 3M™ Coban™ 2
compression system.
Morgan PA, Murray S, Moffatt CJ, Young H.
Source
PA Morgan, RN, EdD, Centre for Research and Implementation of
Clinical Practice, London, UK S
Murray, RN, MA, Department of Lymphoedema,
Royal Derby Hospital, Derby Hospitals NHS Foundation
Trust, Uttoxeter Road,
Derby DE22 3NE, UK CJ Moffatt, RN, PhD, Department of Lymphoedema, Royal
Derby Hospital, Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby
DE22 3NE, UK and
Division of Nursing and Healthcare, University of Glasgow,
Glasgow G12 8LW, UK H Young, RN, MSc,
St Giles Hospice, Fisherwick Road,
Whittington, Staffordshire WS14 9YT, UK.
Abstract
This article reports on a qualitative study that explored the
experience of patients who have undergone a
period of complete decongestive
therapy using the 3M™ Coban™ 2 compression system (Coban 2
system).
Qualitative data were collected from 12 patients from the UK and 8 from Canada
with a range of
presentations of lymphoedema. Single semi-structured
interviews were used and participants were asked
questions relating to their
experience of diagnosis, the impact of lymphoedema on their lives, previous
treatment using multilayer lymphoedema bandaging and their experiences of
the 3M™ Coban™ 2 system.
Treatment with multilayer lymphoedema bandaging was
seen as constraining in that it was tiring, time
consuming, heavy, bulky and
led to feelings of clumsiness and a restricted life. Treatment with the 3M™
Coban™ 2 system was reported as enabling in that it was quicker and easier
to apply, increased mobility,
enhanced patient confidence and provided a
sense of control and well-being. The article also explores how
aspects of
the 3M™ Coban™ 2 system might be improved from the patient's point of view.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com
Inc.
PMID: 21848728 [PubMed - as supplied by publisher]
Int Wound J. 2011 Aug 17. doi: 10.1111/j.1742-481X.2011.00845.x. [Epub ahead
of print]
The challenges of managing complex lymphoedema/chronic oedema in the UK and
Canada.
Morgan PA, Murray S, Moffatt CJ, Honnor A.
Source
PA Morgan, RN, EdD, Centre for Research and Implementation of
Clinical Practice, St Luke's Crypt,
Sydney Street, London SW3 6NH, UK S
Murray, RN, MA, Royal Derby Hospital, Derby Hospitals NHS
Foundation Trust,
Uttoxeter Road, Derby DE22 3NE, UK CJ Moffatt, RN, PhD, Royal Derby Hospital,
Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK.
Faculty of Medicine,
Division of Nursing and Healthcare, University of
Glasgow, Glasgow G12 8LW, UK A Honnor, RN, BSc,
MSc, LOROS Hospice, Groby
Road, Leicester LE3 9QE, UK.
Abstract
This article explores the professional challenges of treating
patients with complex/severe forms of chronic
oedema/lymphoedema with
compression therapy. Four focus groups were held, two in the UK and two in
Canada, to examine the challenges faced by practitioners in their everyday
practice. A number of challenges
were identified by participants in both
countries and include the changing profile of lymphoedema/chronic
oedema and
how increasing complexity is outpacing the development of services and
research-based
guidelines. Focus groups also highlighted a lack of public
awareness, poor professional knowledge, delayed
diagnosis and inappropriate
treatment as having a significant impact on practice. Other practice-related
issues include a poor understanding of treatment options among
practitioners, a lack of evidence-based
practice as well as difficulties
associated with managing psychosocial problems and of ensuring concordance
with treatment. In Canada, services tend to be more rural and remote than in
the UK, autonomous specialist
practice is less developed and practitioners
were generally less confident and felt more vulnerable than their
UK
colleagues. There is a need for integrated, multi-disciplinary services in both
countries, with improved
education and training, as well as the development
of cost-effective compression bandaging systems that can
make a major
contribution to meeting the challenges of contemporary lymphoedema practice.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com
Inc.
PMID: 21848727 [PubMed - as supplied by publisher]
Infect Immun. 2011 Aug 29. [Epub ahead of print]
Filarial Lymphatic Pathology Reflects Augmented TLR-mediated, MAPK-mediated
Pro-inflammatory
Cytokine Production.
Babu S, Anuradha R, Pavan Kumar N,
George PJ, Kumaraswami V, Nutman TB.
Source
National Institutes of Health-International Center for Excellence
in Research, Chennai, India.
Abstract
Lymphatic filariasis can be associated with the development of
serious pathology in the form of lymphedema,
hydrocele, and elephantiasis in
a subset of infected patients. Toll-like receptors (TLRs) are thought to play a
major role in the development of filarial pathology. To elucidate the role
of TLRs in the development of
lymphatic pathology, we examined cytokine
responses to different Toll ligands in patients with lymphatic
pathology
(CP), infected patients with subclinical pathology (INF), and uninfected,
endemic normal (EN)
individuals. TLR 2, 7 and 9 ligands induced
significantly elevated production of Th1 and other pro-
inflammatory
cytokines in CP patients in comparison to both INF and EN. TLR adaptor
expression was not
significantly different among the groups; however, both
TLR2 and TLR9 ligands induced significantly higher
levels of phosphorylation
of ERK1/2 and p38 MAP kinases as well as increased activation of NF-κB in CP
individuals. Pharmacologic inhibition of both ERK1/2 and p38 MAP kinase
pathways resulted in significantly
diminished production of pro-inflammatory
cytokines in CP individuals. Our data, therefore, strongly suggest
an
important role for TLR2- and TLR9-mediated pro-inflammatory cytokine induction
and activation of
both the MAPK and NF-κB pathways in the development of
pathology in human lymphatic filariasis.
PMID: 21875961 [PubMed - as supplied by publisher]
J Altern Complement Med. 2011 Sep;17(9):867-9.
Lymphedema after breast or gynecological cancer: use and effectiveness of
mainstream and complementary
therapies.
Finnane A, Liu Y, Battistutta D,
Janda M, Hayes SC.
Source
1 School of Public Health, Queensland University of Technology ,
Brisbane, Queensland, Australia .
Abstract
Abstract Objectives: The purpose of this study was to describe
the use, as well as perceived effectiveness,
of mainstream and complementary
and alternative medicine (CAM) therapies in the treatment of
lymphedema
following breast or gynecological cancer. Further, the study assessed the
relationship between
the characteristics of lymphedema (including type,
severity, stability, and duration), and the use of CAM
and/or mainstream
treatment. Methods: This was a cross-sectional study using a convenience sample
of
women with lymphedema following breast and gynecological cancers. A
self-administered questionnaire was
sent to 247 potentially eligible women.
Of those returned (50%), 23 were ineligible and 6 were excluded
due to level
of missing data. Results: In the previous 12 months, the majority of women (90%)
had used
mainstream treatments to treat their lymphedema, with massage being
the most commonly used (86%). One
(1) in 2 women had used CAM to treat their
lymphedema, and 98% of those using CAM were also using
mainstream
treatments. Over 27 types of CAM were reported, with use of a chi machine,
vitamin E
supplements, yoga, and meditation being the most commonly reported
forms. The perceived effectiveness
ratings (1-7 with 7=completely effective)
of mainstream (mean±standard deviation (SD): 5.3±1.5) and
CAM therapies
(mean±SD: 5.2+1.6) were considered high. Conclusions: These results demonstrate
that
mainstream and CAM treatment use is common, varied, and considered to
be effective among women with
lymphedema following breast or gynecological
cancer. Furthermore, it highlights the immediate need for
larger prospective
studies assessing the inter-relationship between the use of mainstream and CAM
therapies for treatment success.
PMID: 21875352 [PubMed - in process]
Phys Ther. 2011 Aug 25. [Epub ahead of print]
Complete Decongestive Physical Therapy in a Patient With Secondary Lymphedema
Due to Orthopedic
Trauma and Surgery of the Lower Extremity.
Cohen
MD.
Source
a home-based and outpatient therapy practice focusing on lymphedema
management in Nassau County,
New York. Dr Cohen was a clinical specialist at
New York Presbyterian Hospital-Weill Cornell Medical
Center, New York, New
York, at the time of the case report.
Abstract
BACKGROUND AND PURPOSE:
/b>This case report describes a
patient who developed lower-extremity lymphedema secondary to
orthopedic
trauma and surgery and reports the response to complete decongestive physical
therapy (CDP),
with 8 treatment sessions over 3 months.
CASE DESCRIPTION:
/b>The patient was a 56-year-old man who sustained a
right ankle displaced fibular fracture, underwent
open reduction internal
fixation surgery 12 days later, and developed lymphedema 4 months postinjury.
The
patient's impairments of the right lower extremity included increased
girth, decreased ankle range of motion,
and increased pain. Due to these
impairments and the inability to fit into normal footwear, the patient limited
activities such as ambulating long distances and climbing stairs. This
limited activity restricted him from
participating in his normal lifestyle
activities such as walking his dog in the community and performing all
necessary work duties.
OUTCOMES:
/b>Using the truncated cone formula to measure limb volume,
the limb volume of the right (involved) lower
extremity decreased 368 mL as
a result of CDP. The percentage of difference in limb volume between the
right and left lower extremities at the initial examination was 9%, and it
was reduced to less than 1% at
discharge. He was independent with his home
program in order to maintain the results of therapy.
CONCLUSION:
/b>Physical therapy management of secondary lymphedema due
to orthopedic trauma and surgery of the
lower extremity resulted in
decreased circumferential girth measurements and decreased limb volume,
thereby improving gait and allowing the patient to fit into his work and
leisure shoes. The patient reported
improvement in his ability to perform
all work activities, and he returned to his prior level of participation in
the community.
PMID: 21868611 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Aug 24. [Epub ahead of print]
The Surgical Treatment of Lymphedema: A Systematic Review of the Contemporary
Literature (2004-
2010).
Cormier JN, Rourke L, Crosby M, Chang D, Armer
J.
Source
Department of Surgical Oncology, University of Texas MD Anderson
Cancer Center, Houston, TX, USA,
[email protected].
Abstract
PURPOSE:
A systematic review of the literature was performed
to examine contemporary peer-reviewed literature
(2004-2010) evaluating the
surgical treatment of lymphedema.
METHODS:
A comprehensive search of 11 major medical indices was performed.
Selected articles were sorted to
identify those related to the surgical
treatment of lymphedema. Extracted data included the number of
patients,
specific surgical procedure performed, length of follow-up, criteria for
defining lymphedema,
measurement methods, volume or circumference reduction,
and reported complications.
RESULTS:
A total of 20 studies met inclusion criteria; procedures were
categorized as excisional procedures (n = 8),
lymphatic reconstruction (n =
8), and tissue transfer (n = 4). The reported incidence of volume reduction of
lymphedema in these studies varied from 118% reduction to a 13% increase
over the follow-up intervals
ranging from 6 months to 15 years. The largest
reported reductions were noted after excisional procedures
(91.1%),
lymphatic reconstruction (54.9%), and tissue transfer procedures (47.6%).
Procedure
complications were rarely reported.
CONCLUSIONS:
A number of surgical approaches have demonstrated beneficial
effects for select patients with lymphedema.
Most of these reports, however,
are based on small numbers of patients, use nonstandardized or
inconsistent
measurement techniques, and lack long-term follow-up. The proposed benefits of
any surgical
approach should be evaluated in the context of the potential
morbidity to the individual patient and the
availability of surgical
expertise. In addition, although these surgical techniques have shown promising
results,
nearly all note that the procedures do not obviate the need for
continued use of conventional therapies,
including compression, for
long-term maintenance.
PMID: 21863361 [PubMed - as supplied by publisher]
Cancer Treat Rev. 2011 Aug 17. [Epub ahead of print]
Electrochemotherapy of chest wall breast cancer recurrence.
Sersa G, Cufer
T, Paulin SM, Cemazar M, Snoj M.
Source
Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana,
Slovenia.
Abstract
Chest wall breast cancer recurrence after mastectomy is a disease
difficult to treat. Its incidence varies
between 5% and 30% in different
subset of patients. When possible, radical surgical therapy represents the
main treatment approach, however when the disease progresses and/or
treatments are not successful,
ulceration, bleeding, lymphedema and
psychological distress of progressive disease significantly decrease the
quality of the remaining life of a patient. When surgical excision of chest
wall recurrence is not possible, other
local treatments such as
radiotherapy, radiotherapy with hyperthermia, topical chemotherapy and
electrochemotherapy might be taken into account. Electrochemotherapy
provides safe, efficient and non-
invasive locoregional treatment approach
for chest wall breast cancer recurrence. Several clinical studies
have
demonstrated high efficacy and a good safety profile of electrochemotherapy
applied in single or
multiple consecutive sessions, till clinical response
was reached. Electrochemotherapy can be performed
either with cisplatin
injected intratumorally or with bleomycin given intratumorally or intravenously.
Furthermore, it can be effectively used in heavily pre-treated areas, after
surgery, radiotherapy or systemic
chemotherapy. These are the advantages
that might demand its use especially in patients with pre-treated
extensive
disease and in frail elderly patients. With development of the technology
electrochemotherapy
could even be suggested as a primary local therapy in
patients not suitable for surgical removal of the
primary tumor.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21856080 [PubMed - as supplied by publisher
Clin Dermatol. 2011 Sep-Oct;29(5):483-8.
Opportunistic localization of skin lesions on vulnerable areas.
Ruocco V,
Ruocco E, Brunetti G, Sangiuliano S, Wolf R.
Source
Department of Dermatology, Second University of Naples, via Sergio
Pansini, 5, 80131 Napoli, Italy.
Abstract
Genetic, developmental, and immune defects can make certain
anatomic areas of the body more prone than
others to harbor skin lesions.
Cutaneous areas with skin barrier dysfunction (eg, atopic dermatitis) are the
clearest example of vulnerable sites where opportunistic diseases, mainly
infections (eg, herpes simplex), can
easily occur. Somatic mosaicism, by
giving rise to mutated cell clones with a bandlike arrangement, may
form
tissue segments prone to developing congenital or acquired skin disorders.
Cutaneous districts that
have been infected by herpes viruses become sites
permissive for a subsequent onset of heterogeneous skin
disorders, mainly
tumors, further infections, and disimmune reactions (Wolf isotopic response).
Regional
lymphedema, by impairing lymph circulation and consequently the
local immune control, favors the location
of immunity-related lesions in the
involved district. A vast series of skin injuries, such as ionizing or
ultraviolet
radiation, burns, traumas, and even vaccinations, can render the
affected areas vulnerable to subsequent
cutaneous disorders. Lack of immune
control, ensuing from locally altered neuroimmune interaction, may be
the
basic defect responsible for the opportunistic location of skin lesions in
herpes-infected,
lymphedematous, or otherwise damaged areas, together
featuring the novel concept of
"immunocompromised district."
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21855722 [PubMed - in process]
September 8, 2011
J Glob Infect Dis. 2011 Jul;3(3):227-32.
Impact of basic lymphedema management and antifilarial treatment on acute
dermatolymphangioadenitis
episodes and filarial antigenaemia.
El-Nahas H,
El-Shazly A, Abulhassan M, Nabih N, Mousa N.
Source
Department of Parasitology, Faculty of Medicine, Mansoura
University, Mansoura, Egypt.
Abstract
BACKGROUND:
A major factor in the progression of lymphedema is
acute dermatolymphangioadenitis (ADLA).
AIMS:
To study ADLA episodes and antigenaemia in patients with different
grades of filarial lymphedema at pre-
and two years post-treatment.
SETTING AND DESIGN:
A prospectively conducted study from May 2008 through
May 2010.
PATIENTS AND METHODS:
Forty five patients complaining of limb swelling
with present or past history of limb redness suggestive of
ADLA attacks were
included. Patients were clinically examined for lymphedema grading, detection of
potential entry points and diagnosis of microfilaraemia. Wuchereria
bancrofti antigen titer was estimated by
"Trop-Ag W. Bancrofti" ELISA kit.
Basic lymphedema management and treatment with antifilarial drugs
were
applied.
STATISTICAL ANALYSIS:
Mann-Whitney test and Chi-square test were used.
RESULTS:
The number of ADLA attacks in the pretreatment period, ranged
from one to three per year. Mean duration
of the attacks was 3.87±0.79 days.
Entry points were detected in 82% of cases. The study revealed
statistical
significance between extension and grade of lymphedema and number of ADLA
attacks per year
(P=0.018 and 0.022, respectively). Microfilaraemia was
detected in four cases and positive filarial
antigenaemia were detected in
29 patients (64.4). The number of ADLA attacks per year significantly
decreased from the pre-treatment period (mean: 2.05±0.560) to be 1.23±0.706
after one year and 0.89±0.
575 after two years post treatment. There was a
significant decrease in the mean antigen titer one year and
two years after
treatment.
CONCLUSION:
Basic lymphedema management is effective for controlling ADLA
attacks in areas where lymphatic filariasis
is endemic.
PMID: 21887053 [PubMed - in process] PMCID: PMC3162808
BMJ. 2011 Sep 1;343:d5326. doi: 10.1136/bmj.d5326.
Effect of manual lymph drainage in addition to guidelines and exercise
therapy on arm lymphoedema related
to breast cancer: randomised controlled
trial.
Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets A, Leunen K,
Neven P, Van Kampen M.
Source
Department of Rehabilitation Sciences, Katholieke Universiteit
Leuven and Department of Physiotherapy,
University Hospitals Leuven, Leuven,
Belgium.
Abstract
OBJECTIVE:
To determine the preventive effect of manual lymph
drainage on the development of lymphoedema related to
breast cancer.
DESIGN:
Randomised single blinded controlled trial.
SETTING:
University Hospitals Leuven, Leuven, Belgium.
PARTICIPANTS:
160 consecutive patients with breast cancer and unilateral
axillary lymph node dissection. The randomisation
was stratified for body
mass index (BMI) and axillary irradiation and treatment allocation was
concealed.
Randomisation was done independently from recruitment and
treatment. Baseline characteristics were
comparable between the groups.
INTERVENTION:
For six months the intervention group (n=79) performed a
treatment programme consisting of guidelines
about the prevention of
lymphoedema, exercise therapy, and manual lymph drainage. The control group
(n=81) performed the same programme without manual lymph drainage.
MAIN OUTCOME MEASURES:
Cumulative incidence of arm lymphoedema and time to
develop arm lymphoedema, defined as an increase in
arm volume of 200 mL or
more in the value before surgery.
RESULTS:
Four patients in the intervention group and two in the control
group were lost to follow-up. At 12 months
after surgery, the cumulative
incidence rate for arm lymphoedema was comparable between the intervention
group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval
0.6 to 2.9; P=0.45). The
time to develop arm lymphoedema was comparable
between the two group during the first year after
surgery (hazard ratio 1.3,
0.6 to 2.5; P=0.49). The sample size calculation was based on a presumed odds
ratio of 0.3, which is not included in the 95% confidence interval. This
odds ratio was calculated as
(presumed cumulative incidence of lymphoedema
in intervention group/presumed cumulative incidence of no
lymphoedema in
intervention group)×(presumed cumulative incidence of no lymphoedema in control
group/presumed cumulative incidence of lymphoedema in control group) or
(10/90)×(70/30).
CONCLUSION:
Manual lymph drainage in addition to guidelines and exercise
therapy after axillary lymph node dissection for
breast cancer is unlikely
to have a medium to large effect in reducing the incidence of arm lymphoedema in
the short term. Trial registration Netherlands Trial Register No NTR
1055.
PMID: 21885537 [PubMed - in process]
September 24, 2011
Plast Reconstr Surg. 2011 Oct;128(4):372e.
Reply:
acute lymphedema of the eyelid after major reconstruction of the medial canthus:
the role of the
lymphatic drainage pattern.
Pan WR, Le Roux CM, Briggs
CA.
Source
Jack Brockhoff Reconstructive Plastic Surgery Research Unit,
Department of Anatomy and Cell Biology,
University of Melbourne, Melbourne,
Victoria, Australia.
PMID: 21921753 [PubMed - in process]
Plast Reconstr
Surg. 2011 Oct;128(4):370e-2e.
Acute lymphedema of the eyelid after major
reconstruction of the medial canthus: the role of the lymphatic
drainage
pattern.
Aveta A, Tenna S, Segreto F, Cagli B, Brunetti B, Marangi GF,
Persichetti P.
Source
Plastic and Reconstructive Surgery Unit, Campus
Bio-Medico University of Rome, Rome, Italy.
PMID: 21921751 [PubMed - in
process]
Plast Reconstr Surg. 2011 Oct;128(4):314e-21e.
The earliest
finding of indocyanine green lymphography in asymptomatic limbs of lower
extremity
lymphedema patients secondary to cancer treatment: the modified
dermal backflow stage and concept of
subclinical lymphedema.
Yamamoto T,
Matsuda N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M,
Narushima
M, Iida T, Koshima I.
Source
Tokyo, Japan From the
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine,
University of Tokyo.
Abstract
BACKGROUND:
: Early diagnosis and
treatment are as important for management of secondary lymphedema following
cancer
treatment as in primary cancer treatment. Indocyanine green
lymphography is the modality of choice for
routine follow-up evaluation of
patients at high risk of developing lymphedema after cancer
therapy.
METHODS:
: Fifty-six limbs of 28 so-called unilateral secondary
lower extremity lymphedema patients who underwent
indocyanine green
lymphography were compared with dermal backflow patterns of indocyanine green
lymphography on 28 asymptomatic limbs and assessed using leg dermal backflow
stage.
RESULTS:
: Of 28 asymptomatic limbs of secondary lower extremity
lymphedema patients, the dermal backflow
patterns were detected in 19 limbs
but were absent in nine limbs. Significant differences were seen between
asymptomatic limbs with dermal backflow patterns (n = 19) and limbs without
them (n = 9): age, 51.4 ±
15.3 years versus 34.8 ± 12.7 years (p = 0.007);
body weight, 75.1 ± 7.9 kg versus 50.1 ± 5.3 kg (p =
0.012); body mass
index, 23.1 ± 4.2 versus 19.7 ± 1.8 (p = 0.005); leg dermal backflow stage of
asymptomatic limb, 1.2 ± 0.4 versus 0.0 ± 0.0 (p < 0.001); and leg dermal
backflow stage of symptomatic
limb, 3.5 ± 0.6 versus 2.8 ± 0.8 (p =
0.033).
CONCLUSIONS:
: The splash pattern is the earliest finding on
indocyanine green lymphography of asymptomatic limbs of
secondary lower
extremity lymphedema patients. The leg dermal backflow stage allows early
diagnosis of
secondary lower extremity lymphedema even in a subclinical
stage. The concept of subclinical lymphedema
could play an important role in
early diagnosis and prevention of lymphedema after cancer treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE:: Diagnostic, V.
PMID: 21921744
[PubMed - in process]
Phys Ther. 2011 Sep 15. [Epub ahead of print]
Breast
Cancer-Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance
Model and a
Traditional Model of Care.
Stout NL, Pfalzer LA, Springer B,
Levy E, McGarvey CL, Danoff JV, Gerber LH, Soballe PW.
Source
N.L. Stout,
MPT, CLT-LANA, National Naval Medical Center, Breast Care Center, 8901 Wisconsin
Ave, Bldg 10, 4 West, Bethesda, MD 20814 (USA).
Abstract
Secondary
prevention involves monitoring and screening to prevent negative sequelae from
chronic diseases
such as cancer. Breast cancer treatment sequelae, such as
lymphedema, may occur early or late and often
negatively affect function.
Secondary prevention through prospective physical therapy surveillance aids in
early identification and treatment of breast cancer-related lymphedema
(BCRL). Early intervention may
reduce the need for intensive rehabilitation
and be cost saving. This perspective article compares a
prospective
surveillance model with a traditional model of impairment-based care and
examines direct
treatment costs associated with each program. Intervention
and supply costs were estimated based on the
Medicare 2009 physician fee
schedule for 2 groups: (1) a prospective surveillance model group (PSM
group) and (2) a traditional model group (TM group). The PSM group comprised
all women with breast
cancer who were receiving interval prospective
surveillance, assuming that one third would develop early-
stage BCRL. The
prospective surveillance model includes the cost of screening all women plus the
cost of
intervention for early-stage BCRL. The TM group comprised women
referred for BCRL treatment using a
traditional model of referral based on
late-stage lymphedema. The traditional model cost includes the direct
cost
of treating patients with advanced-stage lymphedema. The cost to manage
early-stage BCRL per
patient per year using a prospective surveillance model
is $636.19. The cost to manage late-stage BCRL
per patient per year using a
traditional model is $3,124.92. The prospective surveillance model is emerging
as the standard of care in breast cancer treatment and is a potential
cost-saving mechanism for BCRL
treatment. Further analysis of indirect costs
and utility is necessary to assess cost-effectiveness. A shift in the
paradigm of physical therapy toward a prospective surveillance model is
warranted.
PMID: 21921254 [PubMed - as supplied by publisher]
Eur J
Pediatr. 2011 Sep 15. [Epub ahead of print]
Hydrops fetalis and pulmonary
lymphangiectasia due to FOXC2 mutation: an autosomal dominant hereditary
lymphedema syndrome with variable expression.
de Bruyn G, Casaer A,
Devolder K, Van Acker G, Logghe H, Devriendt K, Cornette
L.
Source
University Hospital of Leuven, Herestraat 49, 3000, Leuven,
Belgium, [email protected].
Abstract
Non-immune
hydrops fetalis may find its origin within genetically determined lymphedema
syndromes,
caused by mutations in FOXC2 and SOX-18. We describe a newborn
girl, diagnosed with non-immune
hydrops fetalis at a gestational age of 30
weeks. Family history revealed the presence of an autosomal
dominant
late-onset form of lymphedema of the lower limbs in her father, associated with
an aberrant
implantation of the eyelashes in some individuals. The newborn,
hydropic girl suffered from severe
pulmonary lymphangiectasia, resulting in
terminal respiratory failure at the age of 3 months. Genetic analysis
in
both the father and the newborn girl demonstrated a heterozygous FOXC2 mutation,
i.e., c.939C>A, p.
Tyr313X. Her two older sisters are currently
asymptomatic and the parents decided not to test them for the
FOXC2
mutation. Conclusion: Patients with a mutation in the FOXC2 transcription factor
usually show
lower limb lymphedema with onset at or after puberty, together
with distichiasis. However, the eye
manifestations can be very mild and
easily overlooked. The association between FOXC2 mutation and
neonatal
hydrops resulting in terminal respiratory failure is not reported so far.
Therefore, in sporadic
patients diagnosed with non-immune hydrops fetalis,
lymphangiogenic genes should be systematically
screened for mutations. In
addition, all cases of fetal edema must prompt a thorough analysis of the
familial
pedigree, in order to detect familial patterns and to facilitate
adequate antenatal counseling.
PMID: 21918810 [PubMed - as supplied by
publisher]
September 24, 2011
J Cancer Res Clin Oncol. 2011 Sep 21. [Epub ahead of
print]
Safety study of axillary reverse mapping in the surgical treatment for
breast cancer patients.
Deng H, Chen L, Jia W, Chen K, Zeng Y, Rao N, Li S,
Jin L, Su F.
Source
Department of Breast Surgery, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, 107 Yanjiangxi
Road, Guangzhou, 510120,
People's Republic of China.
Abstract
PURPOSE:
With the purpose of
minimizing arm lymphedema after axillary staging surgeries in breast cancer
patients, the
axillary reverse mapping (ARM) technique has been developed to
identify and preserve arm drainage
system during axillary surgery. This
study aimed to clarify risk factors for metastasis in arm lymphatic
drainage
system in breast cancer patients with clinically negative axillary
nodes.
METHODS:
Sixty-nine patients who underwent successful both sentinel
lymph node (SLN) biopsy (SLNB) and ARM
from October 2009 to August 2010 were
enrolled in this study. Radioactive tracer was used for SLN
localization and
blue dye was used for ARM. All of the identified SLNs and ARM nodes were sent
for
pathological assessment.
RESULTS:
ARM nodes metastasis occured in
6 of 69 patients. Age, pathological tumor size (pT) and pathological
lymph
node status (pN) were not associated with ARM nodes metastasis (P > 0.01).
Interestingly, in these
6 patients, all metastatic ARM nodes coincided with
SLN-ARM nodes (hot SLN and blue ARM node
were the same lymph node). In 50 of
69 patients whose ARM nodes did not coincided with SLNs, all
ARM nodes were
negative, even in 12 patients with metastatic SLNs.
CONCLUSION:
Crossover
between breast and ipsilateral arm lymphatic drainage system contributes for
ipsilateral arm
lymph node metastasis. When ARM and SLNB are simultaneously
performed in a patient, selectively
preservation of the ARM nodes that do
not coincided with SLNs would be safe, even if the SLNs are
positive.
Pathological lymph node status does not account for the occurrence of metastasis
in ARM nodes.
ARM nodes could be preserved safely, independent of the
pathological lymph node status.
PMID: 21935615 [PubMed - as supplied by
publisher]
J Eur Acad Dermatol Venereol. 2011 Sep 20. doi:
10.1111/j.1468-3083.2011.04265.x. [Epub ahead of
print]
Skin
manifestations of obesity: a comparative study.
Boza JC, Trindade EN, Peruzzo
J, Sachett L, Rech L, Cestari TF.
Source
Department of Dermatology,
Federal University of Rio Grande do Sul (UFRGS), Hospital de Clínicas de
Porto Alegre (HCPA), Porto Alegre, Brazil.
Abstract
Background
Obesity is one of the world's biggest health problems nowadays. Little research
has been
done on the skin diseases that affect obese patients. Objective To
study the prevalence of skin
manifestations in obese patients compared with
a control group of normal-weight patients. Methods A
total of 76 obese
patients [body mass index (BMI) ≥30 kg/m(2) ] and 73 with normal-weight
volunteers
(BMI 18.5-24.9 kg/m(2) ) were included in the study and had their
complete medical history and skin
examination evaluated by the same
examiner. All patients were investigated for the presence of metabolic
syndrome. Results The dermatoses that showed a statistically significant
relationship with obesity,
compared with the control group were: striae
(P < 0.001), plantar hyperkeratosis (P < 0.001),
acrochordons
(P = 0.007), intertrigo (P < 0.001), pseudoacanthosis nigricans
(P < 0.001),
keratosis pilaris (P = 0.006), lymphedema (P = 0.002) and
bacterial infections (P = 0.05). The
presence of striae, pseudoacanthosis
nigricans and bacterial infections were also found to be correlated with
the
degree of obesity. Conclusions Obesity is strongly related to several skin
alterations that could be
considered as markers of excessive weight. Skin
care of obese patients deserves particular attention, not
only because of
the high prevalence of cutaneous alteration but mainly because many of these
disorders are
preventable and could be treated, improving patient's quality
of life.
© 2011 The Authors. Journal of the European Academy of Dermatology
and Venereology © 2011
European Academy of Dermatology and
Venereology.
PMID: 21929550 [PubMed - as supplied by publisher
September 19, 2011
Nat Genet. 2011 Sep 4. doi: 10.1038/ng.923. [Epub ahead
of print]
Mutations in GATA2 cause primary lymphedema associated with a
predisposition to acute myeloid
leukemia (Emberger syndrome).
Ostergaard
P, Simpson MA, Connell FC, Steward CG, Brice G, Woollard WJ, Dafou D, Kilo T,
Smithson
S, Lunt P, Murday VA, Hodgson S, Keenan R, Pilz DT, Martinez-Corral
I, Makinen T, Mortimer PS,
Jeffery S, Trembath RC, Mansour
S.
Source
1] Medical Genetics Unit, Biomedical Sciences, St. George's
University of London, London, UK. [2].
Abstract
We report an allelic
series of eight mutations in GATA2 underlying Emberger syndrome, an autosomal
dominant primary lymphedema associated with a predisposition to acute
myeloid leukemia. GATA2 is a
transcription factor that plays an essential
role in gene regulation during vascular development and
hematopoietic
differentiation. Our findings indicate that haploinsufficiency of GATA2
underlies primary
lymphedema and predisposes to acute myeloid leukemia in
this syndrome.
PMID: 21892158 [PubMed - as supplied by publisher]
Wkly
Epidemiol Rec. 2011 Aug 26;86(35):377-88.
Global Programme to eliminate
lymphatic filariasis: progress report on mass drug administration,
2010.
[Article in English, French]
[No authors listed]
September 19,
2011
Jpn J Clin Oncol. 2011 Sep 8. [Epub ahead of print]
The Incidence and
Predictor of Lymph Node Metastasis for Patients with T1mi Breast Cancer Who
Underwent Axillary Dissection and Breast Irradiation: An Institutional
Analysis.
Lee JH, Suh YJ, Shim BY, Kim SH.
Source
1Department of
Radiation Oncology, Seoul St. Mary' s Hospital, College of Medicine, The
Catholic
University of Korea, Suwon.
Abstract
OBJECTIVE:
This study
was designed to evaluate the rate and the predictors of axillary lymph node
metastasis in patients
with T1mi breast cancer.
METHODS:
We analyzed
62 cases of ductal carcinoma in situ with microinvasion, and the pathology
records and
treatment charts were retrospectively reviewed for information
on the patient and tumor characteristics. All
the included patients
underwent breast conserving surgery and 48 patients underwent axillary lymph
node
dissection.
RESULTS:
The incidence of axillary involvement was
8.3%. Comedo ductal carcinoma in situ (P = 0.031), histologic
grade 3 (P =
0.025), the presence of necrosis (P = 0.007) and Van Nuys group 3 (P = 0.025)
were
significant predictors of axillary involvement on the statistical
analysis. Axillary dissection was significantly
associated with the
occurrence of arm lymphedema (P = 0.030).
CONCLUSIONS:
A significant rate
of axillary metastases occurred in the patients with T1mi breast carcinoma in
this study.
The comedo subtype of ductal carcinoma in situ, a high
histologic grade, the presence of necrosis and the
Van Nuys group 3 were
significant predictors of axillary lymph node metastasis in patients with T1mi
breast
cancer. Thus, the patients with T1mi breast disease are indicated to
a careful evaluation of axillary lymph
node metastasis, if they have the
earlier-mentioned unfavorable factors.
PMID: 21903706 [PubMed - as supplied
by publisher]
September 19, 2011
Int Wound J. 2011 Sep 13. doi:
10.1111/j.1742-481X.2011.00851.x. [Epub ahead of print]
Prevalence of
lymphoedema and quality of life among patients attending a hospital-based wound
management and vascular clinic.
Gethin G, Byrne D, Tierney S, Strapp H,
Cowman S.
Source
G Gethin, PhD, HE Dip. Wound Care, RGN, Dip. Anatomy,
Dip. Applied Physiology, FFNMRCSI,
Centre for Nursing and Midwifery
Research, Royal College of Surgeons in Ireland, Dublin, Ireland D Byrne,
4th
year medical student, Trinity College Dublin, Dublin, Ireland S Tierney, BSc,
MCh, FRCSI, Royal
College of Surgeons in Ireland, Dublin, Ireland; Vascular
Surgery Unit, Adelaide & Meath Hospital, Dublin,
Ireland H Strapp, RGN,
RSCN, PG Dip., MSc Nursing, Vascular Surgery Unit, Adelaide & Meath
Hospital, Dublin, Ireland S Cowman, MSc, PhD, FFNMRCSI, PGCEA, RNT, DipN
(London), RGN,
Head of Department, Faculty of Nursing & Midwifery, Royal
College of Surgeons in Ireland, Dublin,
Ireland.
Abstract
Lymphoedema
is a chronic, incurable, debilitating condition, usually affecting a limb and
causes discomfort,
pain, heaviness, limited motion, unsatisfactory
appearance and impacts on quality of life. However, there is a
paucity of
prevalence data on this condition. This study aimed to determine the prevalence
of lymphoedema
among persons attending wound management and vascular clinics
in an acute tertiary referral hospital. Four
hundred and eighteen patients
meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n =
11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and
broken skin, 64% (n = 7) had
history of broken skin and 36% (n = 4) had
undergone treatment for venous leg ulcers. The most common
co-morbidities
were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3),
hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of
life scores identified that
physical functioning was the domain most
affected among this group. This study has identified the need to
raise
awareness of this condition among clinicians working in the area of wound
management.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and
Medicalhelplines.com Inc.
PMID: 21910829 [PubMed - as supplied by
publisher]
September 19, 2011
BMJ. 2011 Sep 1;343:d5326. doi:
10.1136/bmj.d5326.
Effect of manual lymph drainage in addition to guidelines
and exercise therapy on arm lymphoedema related
to breast cancer: randomised
controlled trial.
Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets
A, Leunen K, Neven P, Van Kampen M.
Source
Department of Rehabilitation
Sciences, Katholieke Universiteit Leuven and Department of Physiotherapy,
University Hospitals Leuven, Leuven,
Belgium.
Abstract
OBJECTIVE:
To determine the preventive effect of
manual lymph drainage on the development of lymphoedema related to
breast
cancer.
DESIGN:
Randomised single blinded controlled
trial.
SETTING:
University Hospitals Leuven, Leuven,
Belgium.
PARTICIPANTS:
160 consecutive patients with breast cancer and
unilateral axillary lymph node dissection. The randomisation
was stratified
for body mass index (BMI) and axillary irradiation and treatment allocation was
concealed.
Randomisation was done independently from recruitment and
treatment. Baseline characteristics were
comparable between the
groups.
INTERVENTION:
For six months the intervention group (n=79)
performed a treatment programme consisting of guidelines
about the
prevention of lymphoedema, exercise therapy, and manual lymph drainage. The
control group
(n=81) performed the same programme without manual lymph
drainage.
MAIN OUTCOME MEASURES:
Cumulative incidence of arm lymphoedema
and time to develop arm lymphoedema, defined as an increase in
arm volume of
200 mL or more in the value before surgery.
RESULTS:
Four patients in the
intervention group and two in the control group were lost to follow-up. At 12
months
after surgery, the cumulative incidence rate for arm lymphoedema was
comparable between the intervention
group (24%) and control group (19%)
(odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P=0.45). The
time to
develop arm lymphoedema was comparable between the two group during the first
year after
surgery (hazard ratio 1.3, 0.6 to 2.5; P=0.49). The sample size
calculation was based on a presumed odds
ratio of 0.3, which is not included
in the 95% confidence interval. This odds ratio was calculated as
(presumed
cumulative incidence of lymphoedema in intervention group/presumed cumulative
incidence of no
lymphoedema in intervention group)×(presumed cumulative
incidence of no lymphoedema in control
group/presumed cumulative incidence
of lymphoedema in control group) or (10/90)×(70/30).
CONCLUSION:
Manual
lymph drainage in addition to guidelines and exercise therapy after axillary
lymph node dissection for
breast cancer is unlikely to have a medium to
large effect in reducing the incidence of arm lymphoedema in
the short term.
Trial registration Netherlands Trial Register No NTR 1055.
PMID: 21885537
[PubMed - in process] PMCID: PMC3164214
October 28, 2011
–
J Indian Soc Periodontol. 2011 Jul;15(3):280-3.
A rare case of unusual
gingival enlargement post radiotherapy.
Singh V, Bhat GS, Bhat
KM.
Source
Department of Periodontics, Manipal College of Dental Sciences,
Manipal, Karnataka, India.
Abstract
Oral changes following radiotherapy
are not uncommon. Oral mucositis, alteration in salivary gland function,
radiation caries, and gingival changes have all been reported following
radiotherapy and chemotherapy. The
gingival changes seen after radiotherapy
may be unusual and often cause diagnostic dilemma. Metastasis to
the gingiva
has also to be ruled out in these cases. A 30-year-old female patient presented
with enlargement
of the gingiva of 6 months' duration and lower lip swelling
of 7 months' duration. She was a known case of
carcinoma of nasopharynx and
had received radiotherapy and chemotherapy. Based on the history, the
clinical appearance of the gingiva, and the other oral changes we considered
both post-radiotherapy gingival
enlargement and secondary metastasis to
gingiva as possibilities. An incisional biopsy was performed
(internal bevel
gingivectomy). The histopathological report did not reveal any metastatic
changes. Thus, we
diagnosed post-radiotherapy gingival enlargement. For the
multiple carious teeth, extraction and root canal
treatment was carried out
as necessary. The patient was referred to the department of Oral and
Maxillofacial Surgery for management of swelling of the lips, which was
diagnosed as lymphedema of the lip.
Gingival enlargement is rare post
radiotherapy. Such nonplaque-associated gingival enlargement in a patient
who has undergone radiotherapy should be subjected to biopsy and
histopathological examination to
distinguish between secondary metastasis
and post-radiation changes.
PMID: 22028519 [PubMed - in process]
Rozhl
Chir. 2011 Jun;90(6):343-7.
[Benefits of sentinel lymph node examination in
early breast carcinoma].
[Article in Slovak]
Mytnik M, Petrík J, Hanudel'
J, Wereb M, Klc J, Straka L.
Source
Chirurgická klinika FNsP PreSov,
Slovenská republika. [email protected]
Abstract
INTRODUCTION:
Sentinel
lymph node biopsy improves staging of disease, saves the axilla, and
significantly reduces the risk of
complications.
MATERIAL AND
METHODS:
The authors compare the two groups of surgical treatment of breast
cancer patients--after conventional
surgery with axillary exenteration with
a group of patients with sentinel node biopsy using gamma probe with
limited
power.
RESULTS:
In group of 42 patients after axillary exenteration
authors observed: hematoma in 2 patients, 1 postoperative
bleeding that need
for surgical revision, 2 patients had paresthesia and 1 patient had lymphedema,
which
represents 11.5% of complications. In the group of 54 patients after
limited exercise with the use of sentinel
biopsy and gamma probe authors
reported only one complication--an infected surgical wound seroma in the
axilla (1.8% complications).
CONCLUSION:
Examination of sentinel node
biopsy in combination with exact measurement of gamma probe allows friendly
operating performance in the axilla and significantly reduces the incidence
of postoperative complications.
PMID: 22026101 [PubMed - in
process] ahead of print]
[Psychosocial impact of breast cancer in
long-term survival: proposal of an integral follow-up care for
survivors.]
[Article in Spanish]
Vivar CG.
Source
Departamento
de Enfermería Comunitaria y Materno Infantil, Facultad de Enfermería,
Universidad de
Navarra, España.
Abstract
The aim of the article is to
show the psychosocial impact of breast cancer in the long-term survival and to
promote the idea of implementing a follow-up plan for survivors. A narrative
review of published articles on
the experience of survival in breast cancer
survivors was conducted. Data were organised according to the
domains of
measurement (physical, psychological and social) of the Quality of Life of
Long-term Breast
Cancer Survivors Scale (LTQOL-BC). Breast cancer survivors
may feel emotionally affected by the
physical sequels (mastectomy,
lymphedema, early menopause, and infertility), psychological (fear of
recurrence and emotional stress) and/or social (family relationships and
employment changes). The data are
the foundation of a proposal of specific
follow-up care for breast cancer survivors.
Copyright © 2010 Elsevier España,
S.L. All rights reserved.
PMID: 22019066 [PubMed - as supplied by
publisher]
October 25, 2011
Maturitas. 2011 Oct 18. [Epub ahead of
print]
Improving quality of life after breast cancer: Dealing with
symptoms.
Pinto AC, de Azambuja E.
Source
Department of Medical
Oncology, Portuguese Institute of Oncology Francisco Gentil, EPE - Coimbra, Av.
Bissaya Barreto, n° 98, Apartado 2005, 3001-651 Coimbra,
Portugal.
Abstract
BACKGROUND:
Advances in breast cancer therapies have
given rise to a growing number of patient survivors. Nevertheless,
these
women deal with long-term sequelae that impair their quality of life and that
are lacking satisfactory
assessment and expeditious management. Importantly,
a new era is raising in the oncology field, namely,
survivorship.
METHODS:
A search for English-language articles on
Medline was undertaken covering the last 15 years, using the terms
"cancer
survivorship", "quality of life", "fatigue", "insomnia", "sleep disturbances",
"depression", "cognitive
dysfunction", "chemofog", "peripheral neuropathy",
"fertility", "sexual behaviour", "menopause",
"lymphedema", "physical
activity" and "breast neoplasms". Selection was limited to systematic reviews
and
meta-analysis, but their reference list was examined to include papers
of potential interest.
RESULTS:
We found the most common symptoms
affecting breast cancer survivors were fatigue, insomnia, depression,
cognitive dysfunction, reproductive and menopausal symptoms and
lymphoedema.
CONCLUSION:
Some of these symptoms have even been the
objective of randomised controlled trials, but consistent data
are missing.
The available interventions include pharmacological, behavioural therapies and
complementary
and alternative medicine approaches and will mostly depend on
the type of symptom.
Copyright © 2011 Elsevier Ireland Ltd. All rights
reserved.
PMID: 22014722 [PubMed - as supplied by publisher
October 16,
2011
Am J Med Genet A. 2011 Nov;155(11):2762-5. doi: 10.1002/ajmg.a.34188.
Epub 2011 Sep 22.
Primary lymphedema with coarctation of the aorta: Possible
new syndrome or variant of Irons-Bianchi
syndrome?
Ferguson JS,
Gunatheesan S, Brice G, Hastings R, Newbury-Ecob R, Mortimer PS, Mansour
S.
Source
Department of Dermatology, St George's Healthcare NHS Trust,
London, UK. [email protected].
Abstract
We
present a boy with congenital lymphedema, a congenital heart defect (coarctation
of the aorta), and mild
dysmorphic features. Clinical impression and
targeted investigations ruled out Noonan syndrome and Milroy
syndrome, but
it was not clear whether or not he had Irons-Bianchi syndrome. We discuss the
genomic and
lymphoscintigraphy evaluation of this case, and review whether
the small number of current case reports
represent the original
Irons-Bianchi syndrome or variants. We anticipate that ongoing molecular
investigations such as Next Generation Sequencing will delineate a currently
clinically defined phenotypic
spectrum. © 2011 Wiley Periodicals,
Inc.
Copyright © 2011 Wiley Periodicals, Inc.
PMID: 21954173 [PubMed - in
process]
Methods Cell Biol. 2011;105:223-38.
Zebrafish provides a novel
model for lymphatic vascular research.
Karpanen T, Schulte-Merker
S.
Abstract
The mammalian lymphatic vasculature has an important function
in the maintenance of tissue fluid
homeostasis, absorption of dietary
lipids, and immune surveillance. The lymphatic vessels are also recruited
by
many tumors as primary routes for metastasis and mediate immune responses in
inflammatory diseases,
whereas dysfunction of the lymphatic drainage leads
to lymphedema. The characterization of a lymphatic
vasculature in zebrafish
has made the advantages of this small model organism, the suitability for
intravital
time-lapse imaging of developmental processes and the amenability
for chemical and forward genetic
screens, available to lymphatic vascular
research. Here we review our current understanding of embryonic
lymphangiogenesis in zebrafish, its molecular and anatomical similarities to
mammalian lymphatic vascular
development, and the possibilities zebrafish
offers to complement mouse models and cell culture assays in
the
lymphangiogenesis field.
Copyright © 2011 Elsevier Inc. All rights
reserved.
PMID: 21951532 [PubMed - in process]
Lymphology. 2011
Jun;44(2):72-81.
Measurement of lymphedema using ultrasonography with the
compression method.
Lim CY, Seo HG, Kim K, Chung SG, Seo
KS.
Source
Department of Rehabilitation Medicine, Seoul National
University Hospital, Seoul, Korea.
Abstract
Lymphedema is swelling of soft
tissues by accumulation of lymphatic fluid due to failure of the lymphatic
drainage system. Although most measures for lymphedema focus on change of
volume or size of the
extremity, the physical properties of the tissue such
as resistance to compression are also of clinical
importance because they
affect the quality of life of lymphedema patients. In this study, we aimed to
compare the thickness and resistance to compression of the skin and subcutis
between the affected and
unaffected arms of patients with lymphedema by
using ultrasonography together with the compression
technique, and we also
investigated the factors that have an influence on the results. Thirty-nine
patients with
post-mastectomy lymphedema participated in this study. All
ultrasonographically-assessed thicknesses of
skin and subcutaneous tissue in
affected upper arms and forearms were significantly larger than the
contralateral (p < 0.05) while all resistances to compression values were
significantly lower (p < 0.05).
These results suggest that measuring the
resistance to compression and thickness using the compression
method with
ultrasonography may be a valuable tool for evaluating lymphedema after breast
cancer surgery.
PMID: 21949976 [PubMed - indexed for MEDLINE]
Lymphology.
2011 Jun;44(2):65-71.
Changes in quality of life of patients with lymphedema
after lymphatic vessel transplantation.
Springer S, Koller M, Baumeister RG,
Frick A.
Source
Division of Plastic-, Hand- and Microsurgery, Department
of Surgery, Ludwig-Maximilians-University of
Munich, Campus Grosshadern,
Germany.
Abstract
There are multiple treatment options for patients with
chronic lymphedema, and one successful approach is
lymph vessel
transplantation. As quality of life assessments are frequently not utilized in
standard treatment
regimes, we investigated the change in quality of life
for patients with chronic lymphedema (total = 212) who
had undergone
lymphatic vessel transplantation and conservative therapy for at least 6 months
prior to
operation. Quality of life was assessed by a modified standard
questionnaire examining the physiological and
psychological status of the
patients. Results document a significant improvement in quality of life and
underscore success of autologous lymphatic vessel transplantation as a
therapy for lymphedema.
PMID: 21949975 [PubMed - indexed for
MEDLINE]
Lymphology. 2011 Jun;44(2):54-64.
Pathways of lymph and tissue
fluid flow during intermittent pneumatic massage of lower limbs with
obstructive lymphedema.
Olszewski WL, Cwikla J, Zaleska M,
Domaszewska-Szostek A, Gradalski T, Szopinska S.
Source
Department of
Surgical Research and Transplantology, Medical Research Center, Polish Academy
of
Sciences, Warsaw, Poland. [email protected]
Abstract
Questions
remain on the use of sequential pneumatic compression including where does the
fluid flow to and
whether fluid can be moved to the non-swollen tissues of
the hypogastrium and gluteal region? During
pneumatic massage of the limb,
we studied pathways of lymph and mobile tissue fluid flow using
lymphoscintigraphy: a) from the calf and thigh across the inguinal region to
the healthy non-swollen tissues of
the hypogastrium and b) in the
hypogastrium to the lateral and upper abdominal quadrants. To examine if
there was effective fluid flow during pneumatic massage, plethysmographic
flow measurements were also
carried out. We demonstrated that: (i) pneumatic
compression moved isotope in lymph remaining in
functioning lymphatics and
in tissue fluid in the interstitial space toward the inguinal region and femoral
channel, (ii) there was no isotope crossing the inguinal crease or moving to
the gluteal area, and (iii) isotope
injected intradermally in the
hypogastrium did not spread during manual massage to the upper and
contralateral abdominal quadrants. In conclusion, intermittent pneumatic
compression is effective in pushing
mobile tissue fluid and relocating large
fluid volumes toward the groin. However, the question that still
remains is
how to facilitate further flow toward the non-swollen tissues and thereby
increase local absorption
of fluid.
PMID: 21949974 [PubMed - indexed for
MEDLINE]
Int J Radiat Oncol Biol Phys. 2011 Sep 22. [Epub ahead of
print]
Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic
Techniques, Optimal Management
and Risk Reduction Strategies.
Shah C,
Vicini FA.
Source
Department of Radiation Oncology, William Beaumont
Hospital, Royal Oak, MI.
Abstract
As more women survive breast cancer,
long-term toxicities affecting their quality of life, such as lymphedema
(LE) of the arm, gain importance. Although numerous studies have attempted
to determine incidence rates,
identify optimal diagnostic tests, enumerate
efficacious treatment strategies and outline risk reduction
guidelines for
breast cancer-related lymphedema (BCRL), few groups have consistently agreed on
any of
these issues. As a result, standardized recommendations are still
lacking. This review will summarize the
latest data addressing all of these
concerns in order to provide patients and health care providers with
optimal, contemporary recommendations. Published incidence rates for BCRL
vary substantially with a
range of 2-65% based on surgical technique,
axillary sampling method, radiation therapy fields, and the use
of
chemotherapy. Newer clinical assessment tools can potentially identify BCRL in
patients with subclinical
disease with prospective data suggesting that
early diagnosis and management with noninvasive therapy can
lead to
excellent outcomes. Multiple therapies exist with treatments defined by the
severity of BCRL
present. Currently, the standard of care for BCRL in
patients with significant LE is complex decongestive
physiotherapy (CDP).
Contemporary data also suggest that a multidisciplinary approach to the
management
of BCRL should begin prior to definitive treatment for breast
cancer employing patient-specific surgical,
radiation therapy, and
chemotherapy paradigms that limit risks. Further, prospective clinical
assessments
before and after treatment should be employed to diagnose
subclinical disease. In those patients who require
aggressive locoregional
management, prophylactic therapies and the use of CDP can help reduce the
long-
term sequelae of BCRL.
Copyright © 2011 Elsevier Inc. All rights
reserved.
PMID: 21945108 [PubMed - as supplied by publisher]
J Am Coll
Surg. 2011 Oct;213(4):543-51. Epub 2011 Jul 28.
Preventative measures for
lymphedema: separating fact from fiction.
Cemal Y, Pusic A, Mehrara
BJ.
Source
Division of Plastic and Reconstructive Surgery, Department of
Surgery, Memorial Sloan-Kettering Cancer
Center, New York, NY.
PMID:
21802319 [PubMed - in process]
Am J Clin Oncol. 2011
Oct;34(5):506-10.
Estimating the probability of lymphedema after breast
cancer surgery.
Soran A, Wu WC, Dirican A, Johnson R, Andacoglu O, Wilson
J.
Source
Division of Surgical Oncology, Department of Surgery,
Magee-Womens Hospital of University of Pittsburgh
Medical Center, PA, USA.
[email protected]
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(2)
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 - in process]
October 16, 2011
Breast Cancer Res Treat. 2011 Sep
30. [Epub ahead of print]
A randomized clinical trial comparing advanced
pneumatic truncal, chest, and arm treatment to arm
treatment only in
self-care of arm lymphedema.
Ridner SH, Murphy B, Deng J, Kidd N, Galford E,
Bonner C, Bond SM, Dietrich MS.
Source
Vanderbilt University School of
Nursing, 461 21st Avenue South, Godchaux Hall, Nashville, TN, 37240,
USA, [email protected].
Abstract
Treatment
of the truncal lymphatics prior to treatment of the lymphedematous arm is an
accepted, although
not empirically tested, therapeutic intervention
delivered during decongestive lymphatic therapy (DLT).
Breast cancer
survivors with arm lymphedema are encouraged to use these techniques when
performing
simple lymphatic drainage as part of their life-long lymphedema
self-care. Self-massage is at times difficult
and pneumatic compression
devices are used by many patients to assist with self-care. One such device, the
Flexitouch(®) System, replicates the techniques used during DLT; however,
the need for application of
pneumatic compression in unaffected truncal
areas to improve self-care outcomes in arm only lymphedema
is not
established. The objective of this study was to compare the therapeutic benefit
of truncal/chest/arm
advanced pneumatic compression therapy (experimental
group) verses arm only pneumatic compression
(control group) in self-care
for arm lymphedema without truncal involvement using the Flexitouch(®)
System. Outcomes of interest were self-reported symptoms, function, arm
impedance ratios, circumference,
volume, and trunk circumference. Forty-two
breast cancer survivors, (21 per group), with Stage II
lymphedema completed
30 days of home self-care using the Flexitouch(®) System. Findings revealed a
statistically significant reduction in both the number of symptoms and
overall symptom burden within each
group; however, there were no
statistically significant differences in these outcomes between the groups.
There was no statistically significant overall change or differential
pattern of change between the groups in
function. A statistically
significant reduction in bioelectrical impedance and arm circumference within
both of
the groups was achieved; however, there was no statistically
significant difference in reduction between
groups. These findings indicate
that both configurations are effective, but that there may be no added benefit
to advanced pneumatic treatment of the truncal lymphatics prior to arm
massage when the trunk is not also
affected. Further research is indicated
in a larger sample.
PMID: 21960113 [PubMed - as supplied by publisher]
J
Vasc Surg. 2011 Sep 27. [Epub ahead of print]
Diagnosis and treatment of
venous lymphedema.
Raju S, Furrh JB 4th, Neglén P.
Source
The Rane
Center, Flowood, Miss.
Abstract
BACKGROUND:
Chronic venous disease
(CVD) is a common cause of secondary lymphedema. Venous lymphedema is
sometimes misdiagnosed as primary lymphedema and does not receive optimal
treatment. We have routinely
used intravascular ultrasound (IVUS) imaging in
all cases of limb swelling. The aim of this study is to show
that (1)
routine use of IVUS can detect venous obstruction missed by traditional venous
testing, and (2) iliac-
caval venous stenting can yield satisfactory clinical
relief and can sometimes reverse abnormal
lymphangiographic
findings.
METHODS:
The study comprised CVD patients who underwent iliac
vein stenting. Lymphangiography was abnormal in
72 of 443 CEAP C(3) limbs,
with leg swelling as the primary complaint (abnormal lymphangiography
group). Clinical features and stent outcome were compared with a control
group of 205 of 443 with normal
lymphangiography (normal lymphangiographic
group).
RESULTS:
Clinical features were a poor guide to the diagnosis of
lymphedema. Isotope lymphangiography was not
helpful in differentiating
primary from secondary lymphedema. Venography had 61% sensitivity to the
diagnosis of venous obstruction. IVUS had a sensitivity of 88% for
significant (≥50% area stenosis) venous
obstruction. At 40 months,
cumulative secondary stent patency was similar for the abnormal (100%) and
normal lymphangiographic (95%) groups. Swelling improved significantly after
stent placement in the
abnormal lymphangiographic group (mean [standard
deviation] swelling grade improvement 0.8 ± 1.1) but
was less (P < .004)
than in the control group (1.4 ± 1.3). Complete swelling relief was 16% and 44%
(P < .
001) and partial improvement (≥1 grade of swelling) was 45% and 66%
(P < .01) in the abnormal and
normal lymphangiographic groups,
respectively. Associated pain was present in 50% and 36% of the
swollen
limbs in the abnormal and normal lymphangiographic groups. Pain relief (≥3
visual analog scale) at
40 months was 87% and 83%, respectively (P = .3),
with 65% and 71%, experiencing complete pain relief.
Quality of life
criteria improved after stent placement in both groups but to a better extent in
the normal
lymphangiographic group. Abnormal lymphangiography improved or
normalized in 9 of 36 (25%) of those
tested after stent
correction.
CONCLUSIONS:
Prevailing practice patterns and diagnostic
deficiencies probably result in the misdiagnosis of many cases of
venous
lymphedema as "primary" lymphedema. IVUS is recommended to rule out venous
obstruction as the
associated or initiating cause of lymphedema. Iliac
venous stenting to correct the obstruction has excellent
long-term patency
and good clinical outcome, although results are not as good as in those with
normal
lymphatic function.
Copyright © 2011 Society for Vascular Surgery.
Published by Mosby, Inc. All rights reserved.
PMID: 21958566 [PubMed - as
supplied by publisher]
Jpn J Clin Oncol. 2011 Oct;41(10):1162-7. Epub 2011
Sep 8.
The incidence and predictor of lymph node metastasis for patients with
t1mi breast cancer who underwent
axillary dissection and breast irradiation:
an institutional analysis.
Lee JH, Suh YJ, Shim BY, Kim SH.
Source
*St.
Vincent's hospital, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do,
Republic of Korea.
[email protected].
Abstract
OBJECTIVE:
This
study was designed to evaluate the rate and the predictors of axillary lymph
node metastasis in patients
with T1mi breast cancer.
METHODS:
We
analyzed 62 cases of ductal carcinoma in situ with microinvasion, and the
pathology records and
treatment charts were retrospectively reviewed for
information on the patient and tumor characteristics. All
the included
patients underwent breast conserving surgery and 48 patients underwent axillary
lymph node
dissection.
RESULTS:
The incidence of axillary involvement
was 8.3%. Comedo ductal carcinoma in situ (P = 0.031), histologic
grade 3 (P
= 0.025), the presence of necrosis (P = 0.007) and Van Nuys group 3 (P = 0.025)
were
significant predictors of axillary involvement on the statistical
analysis. Axillary dissection was significantly
associated with the
occurrence of arm lymphedema (P = 0.030).
CONCLUSIONS:
A significant rate
of axillary metastases occurred in the patients with T1mi breast carcinoma in
this study.
The comedo subtype of ductal carcinoma in situ, a high
histologic grade, the presence of necrosis and the
Van Nuys group 3 were
significant predictors of axillary lymph node metastasis in patients with T1mi
breast
cancer. Thus, the patients with T1mi breast disease are indicated to
a careful evaluation of axillary lymph
node metastasis, if they have the
earlier-mentioned unfavorable factors.
PMID: 21903706 [PubMed - in
process]
Nat Genet. 2011 Sep 4;43(10):929-31. doi:
10.1038/ng.923.
Mutations in GATA2 cause primary lymphedema associated with a
predisposition to acute myeloid
leukemia (Emberger syndrome).
Ostergaard
P, Simpson MA, Connell FC, Steward CG, Brice G, Woollard WJ, Dafou D, Kilo T,
Smithson
S, Lunt P, Murday VA, Hodgson S, Keenan R, Pilz DT, Martinez-Corral
I, Makinen T, Mortimer PS,
Jeffery S, Trembath RC, Mansour
S.
Source
1] Medical Genetics Unit, Biomedical Sciences, St. George's
University of London, London, UK. [2].
Abstract
We report an allelic
series of eight mutations in GATA2 underlying Emberger syndrome, an autosomal
dominant primary lymphedema associated with a predisposition to acute
myeloid leukemia. GATA2 is a
transcription factor that plays an essential
role in gene regulation during vascular development and
hematopoietic
differentiation. Our findings indicate that haploinsufficiency of GATA2
underlies primary
lymphedema and predisposes to acute myeloid leukemia in
this syndrome.
PMID: 21892158 [PubMed - in process]
Breast Cancer Res
Treat. 2011 Nov;130(1):301-6. Epub 2011 Jul 7.
A SEER-Medicare
population-based study of lymphedema-related claims incidence following breast
cancer
in men.
Reiner AS, Jacks LM, Van Zee KJ, Panageas
KS.
Source
Department of Epidemiology and Biostatistics, Memorial
Sloan-Kettering Cancer Center, 307 East 63rd
Street, New York, NY, 10065,
USA, [email protected].
Abstract
Each year
there are an estimated 200,000 new breast cancer cases diagnosed in the United
States; of these,
1% of cases are in men. Lymphedema can be a devastating
complication from breast cancer and its
treatment. Currently, almost all
lymphedema-related research is based on women and extrapolated to men.
We
conducted the first population-based study of men with incident breast cancer of
any stage, diagnosed
from 1998 to 2005, who were 65 years and older in the
Surveillance, Epidemiology, and End Results
(SEER)-Medicare linked database.
We utilized claims related to lymphedema and lymphedema treatment in
our
cohort. We defined 'lymphedema-specific' claims to contain the word 'lymphedema'
in the Medicare
claim description; similarly, 'lymphedema-related' claims
were defined as treatments reimbursed for
lymphedema but not necessarily
containing the word 'lymphedema' in the Medicare claim description. We
identified 628 men with incident breast cancer from 1998 to 2005 who were 65
years and older. The
cumulative incidence, censored for deaths, of
lymphedema-specific claims at 2, 3, 4, and 5 years was 8.0,
9.2, 10.5, and
10.5%, respectively. The median follow-up was 3.4 years and for those without
any event
was 4.7 years. The cumulative incidence, censored for deaths, of
lymphedema-related claims at 2, 3, 4, and
5 years was 26.9, 32.2, 35.4, and
39.8%. Rates for men were similar to analogous rates for women.
Lymphedema
is a common complication affecting men with breast cancer as well as women and
appropriate
treatment and rehabilitation strategies need to be implemented
for both genders.
PMID: 21735047 [PubMed - in process]
Breast Cancer Res
Treat. 2011 Nov;130(1):227-34. Epub 2011 May 12.
Does the effect of weight
lifting on lymphedema following breast cancer differ by diagnostic method:
results
from a randomized controlled trial.
Hayes SC, Speck RM, Reimet E,
Stark A, Schmitz KH.
Source
Queensland University of Technology, School of
Public Health, Institute of Biomedical Innovation, Brisbane,
Australia.
Abstract
The lymphedema diagnostic method used in
descriptive or intervention studies may influence results found.
The
purposes of this work were to compare baseline lymphedema prevalence in the
physical activity and
lymphedema (PAL) trial cohort and to subsequently
compare the effect of the weight-lifting intervention on
lymphedema,
according to four standard diagnostic methods. The PAL trial was a randomized
controlled
intervention study, involving 295 women who had previously been
treated for breast cancer, and evaluated
the effect of 12 months of weight
lifting on lymphedema status. Four diagnostic methods were used to
evaluate
lymphedema outcomes: (i) interlimb volume difference through water displacement,
(ii) interlimb size
difference through sum of arm circumferences, (iii)
interlimb impedance ratio using bioimpedance
spectroscopy, and (iv) a
validated self-report survey. Of the 295 women who participated in the PAL
trial,
between 22 and 52% were considered to have lymphedema at baseline
according to the four diagnostic
criteria used. No between-group differences
were noted in the proportion of women who had a change in
interlimb volume,
interlimb size, interlimb ratio, or survey score of ≥5, ≥5, ≥10%, and 1 unit,
respectively
(cumulative incidence ratio at study end for each measure
ranged between 0.6 and 0.8, with confidence
intervals spanning 1.0). The
variation in proportions of women within the PAL trial considered to have
lymphoedema at baseline highlights the potential impact of the diagnostic
criteria on population surveillance
regarding prevalence of this common
morbidity of treatment. Importantly though, progressive weight lifting
was
shown to be safe for women following breast cancer, even for those at risk or
with lymphedema,
irrespective of the diagnostic criteria used.
PMID:
21562712 [PubMed - in process]
October 16, 2011
Br J Cancer. 2011 Oct
25;105(9):1279-87. doi: 10.1038/bjc.2011.407. Epub 2011 Oct 4.
Risk factors
for short- and long-term complications after groin surgery in vulvar
cancer.
Hinten F, van den Einden LC, Hendriks JC, van der Zee AG, Bulten J,
Massuger LF, van de Nieuwenhof
HP, de Hullu JA.
Source
Department of
Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box
9101,
6500 HB Nijmegen, The Netherlands.
Abstract
Background:The
cornerstone of treatment in early-stage squamous cell carcinoma (SCC) of the
vulva is
surgery, predominantly consisting of wide local excision with
elective uni- or bi-lateral inguinofemoral
lymphadenectomy. This strategy is
associated with a good prognosis, but also with impressive treatment-
related
morbidity. The aim of this study was to determine risk factors for the
short-term (wound breakdown,
infection and lymphocele) and long-term
(lymphoedema and cellulitis/erysipelas) complications after groin
surgery as
part of the treatment of vulvar SCC.Methods:Between January 1988 and June 2009,
164
consecutive patients underwent an inguinofemoral lymphadenectomy as part
of their surgical treatment for
vulvar SCC at the Department of Gynaecologic
Oncology at the Radboud University Nijmegen Medical
Centre. The clinical and
histopathological data were retrospectively analysed.Results:Multivariate
analysis
showed that older age, diabetes, 'en bloc' surgery and higher drain
production on the last day of drain in situ
gave a higher risk of developing
short-term complications. Younger age and lymphocele gave higher risk of
developing long-term complications. Higher number of lymph nodes dissected
seems to protect against
developing any long-term
complications.Conclusion:Our analysis shows that patient characteristics,
extension of surgery and postoperative management influence short- and/or
long-term complications after
inguinofemoral lymphadenectomy in vulvar SCC
patients. Further research of postoperative management is
necessary to
analyse possibilities to decrease the complication rate of inguinofemoral
lymphadenectomy;
although the sentinel lymph node procedure appears to be a
promising technique, in ∼50% of the patients an
inguinofemoral
lymphadenectomy is still indicated.
PMID: 21970884 [PubMed - in
process]
Eur Urol. 2011 Nov;60(5):1114-9. Epub 2010 Nov 24.
Assessment and
follow-up of patency after lymphovenous microsurgery for treatment of secondary
lymphedema in external male genital organs.
Mukenge SM, Catena M, Negrini
D, Ratti F, Moriondo A, Briganti A, Rigatti P, Cipriani F, Ferla
G.
Source
Department of Surgical Sciences, Università Vita e Salute, San
Raffaele, Milano, Italy.
Abstract
Secondary lymphedema of external male
genital organs is a frequent complication of pelvic radical surgery
following pelvic lymphadenectomy. Microsurgical lymphovenous anastomoses are
usually performed using
only the superficial scrotal lymphatics, excluding
testicular lymphatic drainage. We have experimented using
a new
microsurgical technique based on lymphovenous anastomosis between the collectors
of the spermatic
funiculus and the veins of the pampiniform plexus, allowing
testicular lymphatic drainage. The study included
11 patients with external
genital organ lymphedema, five of whom were subjected to microsurgical
lymphovenous derivation. At 3, 6, and 12 mo after surgery, the patency of
lymphovenous anastomoses was
assessed by noninvasive lymphography using
indocyanine green fluorescence images obtained with the
Photodynamic Eye
(PDE) infrared camera system (Hamamatsu Photonics K.K., Hamamatsu, Japan).
Progressive improvement of clinical conditions was assessed both by
patients' self evaluation and by
objective clinical follow-up based on: (1)
PDE lymphography, (2) tomography of the pubic area, (3)
recovery of the soft
consistency of the scrotal tissue, (4) recovery of the scrotal skin normochromic
aspect,
(5) absence of pain, and (6) disappearance of edema with evident
reduction of the scrotal and penile
dimensions and normal palpability of the
testis. The present study shows that lymphovenous anastomosis is a
valuable
method of resolving the edematous condition. The indocyanine green approach for
lymphangiography is a very supportive method during follow-up because, with
the least invasive approach, it
is possible to ascertain the complete
patency of the anastomosis, to confirm its localization, and to assess its
lymphatic drainage.
Copyright © 2010 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
PMID: 21129845 [PubMed - in
process]
October 16, 2011
Curr Oncol. 2011 Oct;18(5):e218-26.
Caring
for survivors of breast cancer: perspective of the primary care
physician.
Smith SL, Wai ES, Alexander C, Singh-Carlson
S.
Source
Division of Radiation Oncology, Department of Surgery, Faculty
of Medicine, University of British
Columbia, Vancouver, and BC Cancer
Agency-Vancouver Island Centre, Victoria, BC.
Abstract
BACKGROUND AND
OBJECTIVES:
Increasing numbers of women are surviving breast cancer, and
survivorship care is becoming more complex.
Primary care physicians provide
care for most survivors of breast cancer in the Canadian province of British
Columbia. The present study offers insight into the confidence of primary
care physicians in their abilities to
provide such care. It also explores
potential ways to assist those providers in enhancing this aspect of their
practice.
METHODS:
A questionnaire was mailed to 1000 primary care
physicians caring for survivors of breast cancer. The
questionnaire explored
the perspectives of the responding physicians on their ability to manage various
aspects of survivorship care for breast cancer patients, identified
preferences for the content and format of
communication from oncologists at
the time of transition from active oncology treatment to survivorship, and
determined the means most commonly used to obtain knowledge about breast
cancer. This 1-page, 31-item
checkbox and open-answer questionnaire assessed
the perceptions of primary care physicians about the
care of breast cancer
survivors after completion of active treatment and their personal preferences
for
resources providing information about breast cancer.
RESULTS:
The
questionnaire response rate was 59%. Primary care physicians reported being most
confident in
screening for recurrence and managing patient anxiety; they
were least confident in managing lymphedema
and providing psychosocial
counselling. Compared with physicians following fewer survivors of breast
cancer, those who followed more breast cancer survivors had higher
confidence in managing the biomedical
aspects of follow-up and in providing
counselling about nutrition and exercise. Most physicians found
discharge
letters from oncologists to be useful. Point-form discharge information was
preferred by 43%;
detailed description, by 19%; and both formats, by 38%.
The most useful information items identified for
inclusion in a discharge
letter were a diagnosis and treatment summary and the recommended surveillance
and endocrine therapy. Continuing medical education events and online
resources were the means most
commonly used to obtain knowledge about breast
cancer.
CONCLUSIONS:
Primary care physicians who provide follow-up for
survivors of breast cancer report that they are confident
in managing care
and satisfied with discharge letters containing a diagnosis and treatment
summary, and
recommendations for surveillance and endocrine treatment. At
the time of patient discharge, additional
information about common medical
and psychosocial issues in this patient population would be useful to
primary care physicians. Preferred means to access current breast cancer
information include continuing
medical education events and online
resources.
PMID: 21980253 [PubMed - in process] PMCID:
PMC3185903
Support Care Cancer. 2011 Oct 7. [Epub ahead of print]
Racial
disparities in physical and functional domains in women with breast
cancer.
Morehead-Gee AJ, Pfalzer L, Levy E, McGarvey C, Springer B, Soballe
P, Gerber L, Stout NL.
Source
Rehabilitation Medicine Department, Clinical
Center, National Institutes of Health, Bethesda, MD,
USA.
Abstract
INTRODUCTION:
African-American women are more likely than
white women to have functional impairments after breast
cancer (BC) surgery;
however, no differences were found in self-reported health status surveys at 12+
months postsurgery.
PURPOSE:
This analysis compared white and
African-American BC survivors' (BCS) health status, health-related
quality
of life, and the occurrence of physical impairments after BC
treatment.
METHODS:
One hundred sixty-six women (130 white, 28
African-American, 8 other) were assessed for impairments
preoperatively and
at 1, 3, 6, 9, and 12+ months postsurgery. Health status was assessed at 12+
months
using the Short Form Health Survey (SF36v2™). Analysis of variance
estimated differences between
groups for health status and impairment
occurrence.
RESULTS:
No differences were found between groups for BC type,
stage, grade, or tumor size; surgery type; or
number of lymph nodes sampled.
African-American BCS had more estrogen/progesterone receptor-
negative tumors
(p < 0.001; p = 0.036) and received radiation more frequently (p = 0.03).
More
African-American BCS were employed (p = 0.022) and reported higher
rates of social activities (p =
0.011) but less recreational activities
(p = 0.020) than white BCS. African-American BCS had higher
rates of cording
(p = 0.013) and lymphedema (p = 0.011) postoperatively. No differences were
found
in self-reported health status.
CONCLUSION:
In a military
healthcare system, where access to care is ubiquitous, there were no significant
differences in
many BC characteristics commonly attributed to race.
African-American women had more ER/PR-negative
tumors; however, no other BC
characteristics differed between racial groups. African-American women
exhibited more physical impairments, although their BC treatment only
differed regarding radiation therapy.
This suggests that African-American
BCS may be at higher risk for physical impairments and should be
monitored
prospectively for early identification and treatment.
PMID: 21979903 [PubMed
- as supplied by publisher]
Cochrane Database Syst Rev. 2011 Oct
5;(10):CD007103.
Dance/movement therapy for improving psychological and
physical outcomes in cancer patients.
Bradt J, Goodill SW, Dileo
C.
Source
Department of Creative Arts Therapies, College of Nursing and
Health Professions, Drexel University, 1505
Race Street, rm 1041,
Philadelphia, PA, USA, 19102.
Abstract
BACKGROUND:
Current cancer care
increasingly incorporates psychosocial interventions. Cancer patients use
dance/movement therapy to learn to accept and reconnect with their bodies,
build new self-confidence,
enhance self-expression, address feelings of
isolation, depression, anger and fear and to strengthen personal
resources.
OBJECTIVES:
To compare the effects of dance/movement
therapy and standard care with standard care alone or standard
care and
other interventions in patients with cancer.
SEARCH STRATEGY:
We searched
the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane
Library
2011, Issue 2), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science
Citation Index,
CancerLit, International Bibliography of Theatre and Dance,
Proquest Digital Dissertations, ClinicalTrials.
gov, Current Controlled
Trials and the National Research Register (all to March 2011). We handsearched
dance/movement therapy and related topics journals, reviewed reference lists
and contacted experts. There
was no language restriction.
SELECTION
CRITERIA:
We included all randomized and quasi-randomized controlled trials
of dance/movement therapy interventions
for improving psychological and
physical outcomes in patients with cancer.
DATA COLLECTION AND
ANALYSIS:
Two review authors independently extracted the data and assessed
the methodological quality. Results were
presented using standardized mean
differences.
MAIN RESULTS:
We included two studies with a total of 68
participants. No evidence was found for an effect of
dance/movement therapy
on body image in women with breast cancer. The data of one study with moderate
risk of bias suggested that dance/movement therapy had a large beneficial
effect on participants' quality of
life (QoL). The second trial reported a
large beneficial effect on fatigue. However, this trial was at high risk
of
bias. The individual studies did not find support for an effect of
dance/movement therapy on mood,
distress,and mental health. It is unclear
whether this was due to ineffectiveness of the treatment or limited
power of
the trials. Finally, the results of one study did not find evidence for an
effect of dance/movement
therapy on shoulder range of motion (ROM) or arm
circumference in women who underwent a lumpectomy
or breast surgery.
However, this was likely due to large within-group variability for shoulder ROM
and a
limited number of participants with lymphedema.
AUTHORS'
CONCLUSIONS:
We did not find support for an effect of dance/movement therapy
on body image. The findings of one study
suggest that dance/movement therapy
may have a beneficial effect on QoL. However, the limited number of
studies
prevents us from drawing conclusions concerning the effects of dance/movement
therapy on
psychological and physical outcomes in cancer patients.
PMID:
21975762 [PubMed - in process]
Clin Nucl Med. 2011
Nov;36(11):1031-2.
Scrotal lymphedema mimicking urine leakage.
Bozkurt H,
Sürücü E, Bekiş R.
Source
From the Department of Nuclear Medicine, School
of Medicine, Dokuz Eylül University, Izmir, Turkey.
Abstract
Tc-99m
diethylene triamine pentaacetic acid (DTPA) dynamic renal scan is widely used to
evaluate
urological complications after renal transplantation, especially
for urine leakage. Although the most common
site of urine leakage is based
on urethrovesical anastomoses, it can also be seen anywhere in the abdomen,
even in the scrotum. In our case, we showed scrotal lymphedema caused
false-positive result for scrotal
urine leakage detected by Tc-99m DTPA
dynamic renal scan.
PMID: 21975396 [PubMed - in process
J Tissue
Viability. 2011 Nov;20(4):107. Epub 2011 Oct 5.
Tissue viability society
update.
Hopkins A.
Source
Wound Care and Lymphoedema Service, Mile End
Hospital, Bancroft Road, London E14DG, United
Kingdom.
PMID: 21975010
[PubMed - in process]
PM R. 2011 Oct 4. [Epub ahead of print]
Segmental
Limb Volume Change as a Predictor of the Onset of Lymphedema in Women With Early
Breast
Cancer.
Stout NL, Pfalzer LA, Levy E, McGarvey C, Springer B,
Gerber LH, Soballe P.
Source
National Naval Medical Center, 8901 Wisconsin
Avenue, Breast Care Center Bldg. 19, 3rd floor,
Bethesda, MD
20889-5600.
Abstract
OBJECTIVE:
To demonstrate that segmental changes
along the upper extremity occur before the onset of breast cancer-
related
lymphedema (BCRL). These changes may be subclinical in nature and may be
predictive of the onset
of chronic lymphedema.
DESIGN:
A retrospective
subset analysis of a larger prospective cohort trial. PATIENT COHORT: A total of
196
patients provided consent and were enrolled in the prospective study.
Subclinical lymphedema developed in
46 of these patients. Limb volume data
were available for 45 of these 46 patients from visits before the
onset of
lymphedema and were used in this analysis. We compared this group with an
age-matched control
group without BCRL from the same cohort (n =
45).
SETTING:
Military hospital outpatient breast care
center.
METHODS:
Women were enrolled and assessed preoperatively. Baseline
measures of limb volume were obtained with
the use of optoelectronic
perometry, and reassessment was conducted at 1, 3, 6, 9, and 12 months
postoperatively. BCRL was identified in 46 of 196 women at an average of 6.9
months postoperatively. A
retrospective analysis was conducted in which we
examined volume changes over four 10-cm segments of
the limb at the visits
before the onset of BCRL. By using repeated-measures multivariate analysis of
variance, we compared segmental volumes between groups at preoperative
baseline, time of diagnosis of
BCRL, and time of follow-up after early
intervention. Linear regression analysis was performed to determine
the
strength of the relationship between total limb volume change with segmental
volumes at the time of
diagnosis of BCRL.
MAIN OUTCOME
MEASUREMENTS:
We hypothesized that segmental volume changes occur and can be
measured in the limb before the onset of
lymphedema.
RESULTS:
At arm
segments 10-20 cm (P = .044) and 20-30 cm (P <.001), a significant volume
increase was noted
before the diagnosis of subclinical BCRL. Segmental
volume changes correlated to the total limb volume
(TLV) change. At segments
20-30 cm, the coefficient of determination was r(2) = 0.952, and at 10-20 cm
it was r(2) = 0.845, suggesting that these segments predicted TLV changes.
Serial interval assessment of
limb volume segments may be an important
clinical tool to detect early-onset lymphedema before TLV
changes.
Copyright © 2011 American Academy of Physical Medicine and
Rehabilitation. Published by Elsevier Inc.
All rights reserved.
PMID:
21974905 [PubMed - as supplied by publisher]
Am J Physiol Cell Physiol. 2011
Sep 21. [Epub ahead of print]
Lymphatic function is regulated by a
coordinated expression of lymphangiogenic and anti-lymphangiogenic
cytokines.
Zampell J, Avraham T, Yoder N, Fort N, Yan A, Weitman ES,
Mehrara BJ.
Source
Memorial Sloan-Kettering Cancer
Center.
Abstract
Lymphangiogenic cytokines such as vascular endothelial
growth factor-C (VEGF-C) are critically required
for lymphatic regeneration;
however, in some circumstances, lymphatic function is impaired despite normal
or elevated levels of these cytokines. The recent identification of
anti-lymphangiogenic molecules such as
interferon-gamma (IFN-γ),
transforming growth factor-beta 1, and endostatin has led us to hypothesize that
impaired lymphatic function may represent a dysregulated balance in the
expression of pro/anti-
lymphangiogenic stimuli. We observed that nude mice
have significantly improved lymphatic function as
compared with wild-type
mice in a tail model of lymphedema. We show that gradients of lymphatic fluid
stasis regulate the expression of lymphangiogenic cytokines (VEGF-A, VEGF-C,
and hepatocyte growth
factor) and that paradoxically, the expression of
these molecules is increased in wild-type mice. More
importantly, we show
that as a consequence of T-cell mediated inflammation, these same gradients also
regulate expression patterns of anti-lymphangiogenic molecules corresponding
temporally and spatially with
impaired lymphatic function in wild-type mice.
We show that neutralization of IFN-γ significantly increases
inflammatory
lymph node lymphangiogenesis independently of changes in VEGF-A or VEGF-C
expression,
suggesting that alterations in the balance of pro- and
anti-lymphangiogenic cytokine expression can regulate
lymphatic vessel
formation. In conclusion, we show that gradients of lymphatic fluid stasis
regulate not only
the expression of pro-lymphangiogenic cytokines but also
potent suppressors of lymphangiogenesis as a
consequence of T-cell
inflammation and that modulation of the balance between these stimuli can
regulate
lymphatic function.
PMID: 21940662 [PubMed - as supplied by
publisher]
Eur J Surg Oncol. 2011 Sep 19. [Epub ahead of print]
Prevalence
of lymphoedema more than five years after breast cancer treatment.
Lopez
Penha TR, Slangen JJ, Heuts EM, Voogd AC, Von Meyenfeldt
MF.
Source
Department of Surgery, Maastricht University Medical Centre,
P.O. Box 5800, 6202 AZ Maastricht,
Netherlands.
Abstract
AIM:
A
lack of consistency in the definition of breast cancer related lymphoedema
(BCRL) and of uniform
measurement criteria contribute to the wide prevalence
range found in current literature. This report aims to
describe the
long-term prevalence of BCRL and secondly, to compare the long-term prevalence
of BCRL
when assessed by two objective measures and one subjective
measure.
METHODS:
The upper-limbs of 145 post-surgical breast cancer
patients were evaluated for the presence of
lymphoedema using the water
displacement method. Two circumference methods and patient perceived
swelling were applied secondarily for comparison. Limb measurements were
performed once, more than
five years after surgery.
RESULTS:
The
long-term prevalence of BCRL using water displacement was 8%. Prevalence varied
when the sum of
arm circumference (SOAC), the arm circumference and the
self-report methods were used: 16, 31 and
17% [P < 0.001], respectively.
Of the women identified with BCRL using the water displacement technique,
82% were detected with the SOAC method, 82% with the arm circumference
method and 91% by self-
report. Using water displacement as the gold standard
the methods with the highest specificities were the
SOAC (90%) and
self-report method (89%), arm circumference resulted in a low specificity of
73%.
CONCLUSION:
The prevalence of BCRL more than five years after
surgical treatment differs depending on the measuring
method used. Our data
underlines the necessity for consensus on the diagnostic criteria for
BCRL.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21937192
[PubMed - as supplied by publisher]
October 24, 2011
Acta Trop. 2011
Sep;120 Suppl 1:S55-61. Epub 2011 Apr 4.
Efficacy of home-based lymphoedema
management in reducing acute attacks in subjects with lymphatic
filariasis
in Burkina Faso.
Jullien P, Somé J, Brantus P, Bougma RW, Bamba I, Kyelem
D.
Source
Handicap International, 14 Avenue Berthelot, 69007 Lyon,
France.
Abstract
One of the two main goals of the Global Programme to
Eliminate Lymphatic Filariasis (LF) is to provide
care for those suffering
from the devastating clinical manifestations of this filarial infection. Among
the 120
million infected people worldwide, up to 16 million have
lymphoedema. The WHO strategy for managing
lymphoedema is based on rigorous
skin hygiene, exercise, antibiotics and antifungals when indicated. The
aim
is to reduce acute attacks of adenolymphangitis and cellulitis responsible for
lymphoedema progression
and disability. The objective of our study was to
assess the effectiveness of home-based lymphoedema
management implemented by
the national health system of Burkina Faso. Any patient was eligible to
participate in the study if suffering from LF-related lymphoedema of a lower
limb at any stage, and receiving
care as part of the health education and
washing project between April 2005 and December 2007. The
primary readout
was the occurrence of an acute attack in the month preceding the consultation
reported by
the patient or observed by the care-giver. In all, 1089 patients
were enrolled in the study. Before
lymphoedema management intervention,
78.1% (95%CI: 75.5-80.5) of the patients had an acute attack in
the month
preceding the consultation; after four and half months of lymphoedema
management, this was
reduced to 39.1% (95%CI: 36.2-42.1). A reduction of
acute attacks related to the number of consultations
or related to the
patients' age and gender was not observed. Our results suggest that the
home-based
lymphoedema management programme in the primary health care
system of Burkina Faso is effective in
reducing morbidity due to LF in the
short-term (4.5 months). The lymphoedema management requires no
additional
human resources, but whether its effect can be sustained remains to be
seen.
Copyright © 2011. Published by Elsevier B.V.
PMID: 21470557 [PubMed
- in process]
Acta Trop. 2011 Sep;120 Suppl 1:S62-8. Epub 2011 Apr
4.
Rapid community identification, pain and distress associated with
lymphoedema and adenolymphangitis due
to lymphatic filariasis in
resource-limited communities of North-eastern Nigeria.
Akogun OB, Akogun MK,
Apake E, Kale OO.
Source
The Elephantiasis Project, Common Heritage
Foundation, No. 27 Shelter Road, Federal Housing Estate
Phase 2, Bajabure,
Box 5124, Yola, Nigeria.
Abstract
Identification of communities with
people that could benefit from adenolymphangitis (ADL) and
lymphoedema
morbidity management within Lymphatic Filariasis Elimination Programmes (NLFEP)
in many
African countries is a major challenge to programme managers.
Another challenge is advocating for
proportionate allocation of funds to
alleviating the suffering that afflicted people bear. In this study we
developed a rapid qualitative technique of identifying communities where
morbidity management programme
could be situated and documenting the pain
and distress that afflicted persons endure. Estimates given by
health
personnel and by community resource persons were compared with systematic
household surveys for
the number of persons with lymphoedema of the lower
limb. Communities in Northeastern Nigeria, with the
largest number of
lymphoedema cases were selected and a study of local knowledge, physical,
psychosocial
burden and intervention-seeking activities associated with the
disease documented using an array of
techniques (including household
surveys, key informant interviews, group discussions and informal
conversations). Health personnel gave a more accurate estimate of the number
of lymphoedema patients in
their communities than either the community
leader or the community directed ivermectin distributor (CDD).
Community
members with lymphoedema preferred to confide in health personnel from other
communities.
The people had a well developed local vocabulary for
lymphoedema and are well aware of the indigenous
transmission theories.
Although the people associated the episodic ADL attacks with the rains which
were
more frequent at that period they did not associate the episodes with
gross lymphoedema. There were
diverse theories about lymphoedema causation
with heredity, accidental stepping on charmed objects and
organisms,
breaking taboos. The most popular belief about causation, however, is witchcraft
(60.9%). The
episodic attacks are dreaded by the afflicted, since they are
accompanied by severe pain (18%). The
emotional trauma included rejection
(27.5%) by family, friends and other community members to the extent
that
divorce and isolation are common. Holistic approach to lymphoedema morbidity
management should
necessarily be an integral component of the ongoing
transmission elimination programme. Any transmission
prevention effort that
ignores the physical and psychological pain and distress that those already
afflicted
suffer is unethical and should not be promoted.
Copyright ©
2011 Elsevier B.V. All rights reserved.
PMID: 21470556 [PubMed - in
process]
Acta Trop. 2011 Sep;120 Suppl 1:S69-75. Epub 2010 Oct
23.
Management of adenolymphangitis and lymphoedema due to lymphatic
filariasis in resource-limited North-
eastern Nigeria.
Akogun OB, Badaki
JA.
Source
The Elephantiasis Project, Common Heritage Foundation, No. 27
Shelter Road, Federal Housing Estate
Phase 2, Bajabure, Box 5124, Yola,
Nigeria.
Abstract
Procedures for health facility-based management of
lymphoedema and adenolymphangitis (ADL) have
proved very effective in some
countries. Unfortunately, in resource-poor communities of Africa where health
facilities are few, overburdened and inaccessible, an alternative approach
is required. Community-based
care (CC), patient care (PC) and health
facility care (HC) approaches were compared. In the CC arm,
communities were
required to select one of their members for care-giving to its affected members,
while in
the PC, participants were allocated to groups under a leader with
responsibility for care giving to group
members. In HC, care was given by
the nearest health facility. Caregivers from the three arms were trained
and
supplies were kept at the local government health office. At the sixth month of
intervention, 325
lymphoedema and adenolymphangitis patients had been
recruited into the study as participants. Within 12
months, compliance with
hygiene practices increased from 29.4% to 62.6% and ADL episodes declined
from 43.1% to 4.4% in the community designs arm and the cost on the health
system was minimal.
However, in the patient and health care arms, compliance
and accessibility to supplies was severely affected
by poor coordination,
delay in resource collection leading to very minimal effect on lesions, odour,
ADL
frequency and duration. Participants abandoned the health facilities
after the second visit. Community care
approach was more culturally
acceptable and effective for the management lymphoedema and ADL than
other
approaches.
Copyright © 2010 Elsevier B.V. All rights reserved.
PMID:
20974106 [PubMed - in process
J Cancer Surviv. 2011 Oct 16. [Epub ahead of
print]
Exercise in patients with lymphedema: a systematic review of the
contemporary literature.
Kwan ML, Cohn JC, Armer JM, Stewart BR, Cormier
JN.
Source
Division of Research, Kaiser Permanente, 2000 Broadway,
Oakland, CA, 94612, USA, Marilyn.L.
[email protected].
Abstract
BACKGROUND:
Controversy
exists regarding the role of exercise in cancer patients with or at risk for
lymphedema,
particularly breast. We conducted a systematic review of the
contemporary literature to distill the weight of
the evidence and provide
recommendations for exercise and lymphedema care in breast cancer
survivors.
METHODS:
Publications were retrieved from 11 major medical
indices for articles published from 2004 to 2010 using
search terms for
exercise and lymphedema; 1,303 potential articles were selected, of which 659
articles
were reviewed by clinical lymphedema experts for inclusion,
yielding 35 articles. After applying exclusion
criteria, 19 articles were
selected for final review. Information on study design/objectives, participants,
outcomes, intervention, results, and study strengths and weaknesses was
extracted. Study evidence was also
rated according to the Oncology Nursing
Society Putting Evidence Into Practice® Weight-of-Evidence
Classification.
RESULTS:
Seven studies were identified addressing
resistance exercise, seven studies on aerobic and resistance
exercise, and
five studies on other exercise modalities. Studies concluded that slowly
progressive exercise of
varying modalities is not associated with the
development or exacerbation of breast cancer-related
lymphedema and can be
safely pursued with proper supervision. Combined aerobic and resistance exercise
appear safe, but confirmation requires larger and more rigorous
studies.
CONCLUSIONS:
Strong evidence is now available on the safety of
resistance exercise without an increase in risk of
lymphedema for breast
cancer patients. Comparable studies are needed for other cancer patients at risk
for
lymphedema. IMPLICATIONS FOR CANCER SURVIVORS: With reasonable
precautions, it is safe for
breast cancer survivors to exercise throughout
the trajectory of their cancer experience, including during
treatment.
PMID: 22002586 [PubMed - as supplied by
publisher]
Cytotherapy. 2011 Nov;13(10):1249-55.
Autologous stem cells for
the treatment of post-mastectomy lymphedema: a pilot study.
Maldonado GE,
Pérez CA, Covarrubias EE, Cabriales SA, Leyva LA, Pérez JC, Almaguer
DG.
Source
Hospital Universitario 'Dr José Eleuterio González',
Universidad Autónoma de Nuevo León , México.
Abstract
Abstract Background
aims. Lymphedema is a common complication with breast cancer treatment that does
not have a definite cure. Our objective was to determine the efficacy of
autologous stem cells (ASC) in the
treatment of lymphedema secondary to
mastectomy and axillary lymphadenectomy in comparison with
traditional
decongestive treatment with compression sleeves. Methods. A prospective study
including 20
women with lymphedema secondary to breast cancer surgery with
axillary lymphadenectomy was
conducted. Women were assigned at random to one
of two groups. One group of 10 women was injected
with ASC in the affected
arm, whereas the other 10 women comprised the control group and received
traditional compression sleeve therapy (CST). The follow-up for both groups
was 12 weeks. Pain,
sensitivity and mobility were assessed before and after
therapy. Results. There was improvement in the
volume of lymphedema in both
groups, with no significant difference. In the ASC group there was an overall
volume reduction during the follow-up, whereas in the CST group lymphedema
recurred after the
compression sleeve was removed. Conclusions. Our findings
suggest that ASC injection for patients with
lymphedema can be an effective
treatment. It reduces arm volume and associated co-morbidities of pain and
decreased sensitivity. Traditional CST was also effective for lymphedema
reduction, but it was dependent
on continuous use of the treatment.
PMID:
21999374 [PubMed - in process]
Int J Gynecol Cancer. 2011
Nov;21(8):1495-9.
Do surgical techniques used in groin lymphadenectomy for
vulval cancer affect morbidity rates?
Walker KF, Day H, Abu J, Nunns D,
Williamson K, Duncan T.
Source
*Derby Royal Hospital, Derby; †Royal Albert
Edward Infirmary, Lancashire; ‡Nottingham University
Hospitals, Nottingham;
and §Norfolk and Norwich University Hospital, Norwich,
UK.
Abstract
OBJECTIVE:
: To determine the complication rates
associated with differing surgical techniques for groin node dissection
for
vulval cancer.
MATERIALS AND METHODS:
: We performed a retrospective case
note review of patients undergoing groin node dissection for vulval
cancer
between 2001 and 2009 at Nottingham University Hospitals NHS
Trust.
RESULTS:
: Notes for 56 patients undergoing a total of 98 groin
node dissections were examined. Sixty-four percent of
the patients had at
least one complication from surgery. The use of suction drains was not
associated with an
increase in complications. However, when drains were
used, a short duration of use was associated with
high rates of wound
breakdown and a long duration of use was associated with higher rates of
lymphedema.
The use of staples for skin closure was associated with an
increased risk of lymphocysts and chronic
lymphedema. The greater the number
of nodes collected at lymphadenectomy, the higher the risk of
lymphocysts
and lymphedema.
CONCLUSIONS:
: We recommend the use of subcuticular suture
for wound closure. Patients who undergo lymphadenectomy
with a node count
per groin of more than 7 should be closely monitored for lymphedema and referred
promptly to specialist services. The prolonged use of suction drainage may
increase the risk of lymphedema.
PMID: 21997167 [PubMed - in
process]
Scand J Immunol. 2011 Oct 13. doi: 10.1111/j.1365-3083.2011.02653.x.
[Epub ahead of print]
T- and B-cell Deficiency Associated with Yellow Nail
Syndrome.
Gupta S, Samra D, Yel L, Agrawal S.
Source
Division of Basic
and Clinical Immunology, University of California, Irvine,
California.
Abstract
Yellow nail syndrome (YNS) is a rare disorder of
unknown etiology that is characterized by yellow nails
associated with
lymphedema, and chronic respiratory manifestations. There are no detailed
immunological
studies in YNS. In this study we present first extensive
immunological analysis of both adaptive and innate
immunity in two patients
with YNS. One patient has common variable immunodeficiency, whereas, second
patient has specific antibody deficiency syndrome. Severe lymphopenia, and a
striking deficiency of naïve
CD4+ and CD8+ T cells and total B cells, and
increased transitional B cells were observed. T cell
proliferative response
to mitogens and antigens were significantly reduced in both patients. Both
patients
failed to make specific antibody response to pneumococci.
Complement, NK cell activity, and neutrophil
oxidative burst were normal.
Immunoglobulin administration resulted in decreased frequency and severity of
infections, and an impressive effect was observed on lymphedema and on the
recurrence of pleural effusion.
Our data show that YNS is associated with
both T and B cell defects. Furthermore, Immunoglobulin may be
beneficial in
clinical manifestations of lymphedema.
Copyright © 2011 Blackwell Publishing
Ltd.
PMID: 21995335 [PubMed - as supplied by publisher]
November 1,
2011
J Pharm Sci. 2011 Oct 26. doi: 10.1002/jps.22795. [Epub ahead of
print]
Influence of route of administration and liposomal encapsulation on
blood and lymph node exposure to the
protein VEGF-C156S.
Bhansali SG,
Balu-Iyer SV, Morris ME.
Source
Department of Pharmaceutical Sciences,
School of Pharmacy and Pharmaceutical Sciences, University at
Buffalo,
Amherst, New York 14260-1200.
Abstract
VEGF-C156S is a recombinant form of
human vascular endothelial growth factor C (VEGF-C), which
targets the
receptor VEGFR-3 present in the lymphatics. VEGF-C156S has lymphangiogenic
properties
and may represent a potential therapeutic approach in treating
the lymphatic disease lymphedema. In the
present study, we tested the
hypotheses that (1) subcutaneous (s.c.) injection will provide higher lymphatic
exposure than intravenous (i.v.) administration of VEGF-C156S and (2) s.c.
injection of liposomal (s.c.
Lipo) VEGF-C156S will provide greater lymphatic
exposure than nonliposomal proteins. The protein
VEGF-C156S was radiolabeled
with Iodine-125 by a modified chloramine-T method and encapsulated into
liposomes. The protein was injected at a dose of 125 μg/kg to mice i.v. or
s.c.; the liposomal preparation
was administered s.c. (s.c. Lipo). Blood and
lymph nodes were collected over 24 h. The mean residence
time in lymph nodes
after s.c. or s.c. (Lipo) administration was approximately double that following
i.v.
administration. The area under the concentration-time curve (AUC) ratio
of lymph node-blood after s.c.
administration of VEGF-C156S was more than
double of the AUC ratio after i.v. administration. The results
suggest that
lymph node exposure of VEGF-C156S was significantly higher after s.c.
administration of
liposomal or nonliposomal protein as compared with i.v.
administration. © 2011 Wiley-Liss, Inc. and the
American Pharmacists
Association J Pharm Sci.
Copyright © 2011 Wiley-Liss, Inc.
PMID: 22030745
[PubMed - as supplied by publisher
November 15, 2011
Br J Nurs. 2011 Oct 28-Nov 10;20(19):1246-51.
Using
Actico bandaging for chronic oedema/lymphoedema management.
Pike
C.
Abstract
Actico has been used successfully within clinical and
community settings and is best used as part of a multi-
layered lymphoedema
bandaging (MLLB) system. This system is designed to produce a semi-rigid casing
that is comfortable enough to allow patients to continue with their
activities and exercises so as to generate
an optimal resisted muscle pump
action within. Correct application is key to using this cohesive short-stretch
bandage, and collaborative working between clinics and community nurses is
made easier through using
Actico as part of oedema management. The case
studies enclosed aim to illustrate the use of Actico MLLB
for both patients
and clinicians.
PMID: 22067837 [PubMed - in process]
Lymphat Res Biol.
2011;9(3):159-67.
Surgical management of lymphedema: past, present, and
future.
Mehrara BJ, Zampell JC, Suami H, Chang DW.
Source
1 The
Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial
Sloan-Kettering
Cancer Center , New York, New York.
Abstract
Abstract
Recent advances in surgical management of lymphedema have provided options for
patients who
have failed conservative management with manual lymphatic
massage and/or compression garments. The
purpose of this review is to
provide a historical background to the surgical treatment of lymphedema and
how these options have evolved over time. In addition, we aim to delineate
the various types of surgical
approaches available, indications for surgery,
and reported out comes. Our goal is to increase awareness of
these options
and foster research to improve their outcomes.
PMID: 22066746 [PubMed - in
process]
Lymphat Res Biol. 2011;9(3):151-8.
Normal Interstitial Flow is
Critical for Developmental Lymphangiogenesis in the
Zebrafish.
Coffindaffer-Wilson M, Craig MP, Hove JR.
Source
1
Department of Molecular and Cellular Physiology, University of Cincinnati
College of Medicine ,
Cincinnati, Ohio.
Abstract
Abstract Background:
The lymphatic system plays a critical role in the body's fluid and protein
homeostasis,
immune regulation, and dietary fat absorption. One of the major
pathologies of the lymphatic system is
primary lymphedema, which occurs in
approximately 0.6% of live births and is caused by missing or
impaired
lymphatic vessels. Although there is a great need for medical intervention into
diseases of the
lymphatic system, very little is known about its development
or how it maintains integrity over time. Recent
studies have suggested that
biophysical components, such as local extracellular fluid flow, may be important
factors during initiation of lymphangiogenesis. We hypothesize that
interstitial fluid flow functions as an
important morphoregulator during
developmental lymphangiogenesis. Methods and Results: In the present
study
we use pharmacological agents and a mutant fish line to modulate interstitial
flow. Our data confirm
that a sufficient increase or decrease in
interstitial flow can profoundly affect lymphatic patterning and may
result
in a lymphedema-like phenotype. Proper interstitial flow appears to be necessary
during LEC
migration for proper lymphatic development. Conclusions: These
results support the contention that
interstitial flow is an important
morphoregulator of developmental lymphangiogenesis.
PMID: 22066745 [PubMed -
in process]
Lymphat Res Biol. 2011;9(3):143-9.
Expression of angiogenic
and vasculogenic factors in human lymphedematous tissue.
Couto RA,
Kulungowski AM, Chawla AS, Fishman SJ, Greene AK.
Source
1 Department of
Plastic and Oral Surgery, Harvard Medical School , Boston,
Massachusetts.
Abstract
Abstract Background: Lymphedema is the progressive
distention of tissue due to lymphatic dysfunction. The
affected area
enlarges over time because of fibroadipose deposition, causing morbidity.
Because increasing
tissue mass requires neovascularization, we hypothesized
that angiogenesis or vasculogenesis might be
upregulated in lymphedema.
Methods and Results: Lymphedematous tissue was collected prospectively
from
nine patients after resection: upper extremity (n=1), lower extremity (n=3),
penis/scrotum (n=5).
Neovascularization was compared to normal tissue.
Specimens were analyzed using immunohistochemistry
for ?-smooth muscle actin
(pericyte marker), CD31 (microvascular density), CD31/Ki67 (proliferating
endothelial cells), and CD34/CD133 (endothelial progenitor cells).
Quantitative real-time PCR (qRT-PCR)
was used to determine mRNA expression
of progenitor cells (CD133) and factors that recruit them:
vascular
endothelial growth factor-A (VEGF-A), hypoxia-inducible factor 1? (HIF-1?),
matrix
metalloproteinase-9 (MMP-9), and stromal-cell derived factor 1?
(SDF-1?). Angiopoetin-1,-2 (ANG-1,
-2), matrix metalloproteinase-2 (MMP-2),
and VEGF receptors (VEGFR1,2) were quantified using qRT-
PCR. There was no
difference in microvascular density, pericytic density, or endothelial
proliferation
between lymphedematous and normal tissue (p=0.1). Endothelial
progenitor cells were not present in
lymphedema or normal specimens
(p<0.01). VEGF-A (1.3-fold), HIF-1? (0.8-fold), SDF-1? (2.1-fold),
VEGFR2
(0.09-fold), and CD133 (0.02-fold) expression were not elevated compared to
normal tissue
(p=0.1). ANG-1 (5.6-fold), ANG-2 (2.5-fold), MMP-2 (3.9-fold),
MMP-9 (33.4-fold), and VEGFR1
(12.8-fold) mRNA was increased in
lymphedematous specimens compared to control (p<0.05).
Conclusions:
Lymphedematous tissue does not exhibit upregulation of angiogenesis or
vasculogenesis.
Neovascularization is unlikely to be involved in the
pathogenesis of this disease.
PMID: 22066744 [PubMed - in process]
Lymphat
Res Biol. 2011;9(3):135-41.
Prevalence and prognostic significance of
secondary lymphedema following breast cancer.
Hayes S, Sipio TD, Rye S, L Pez
JA, Saunders C, Pyke C, Bashford J, Battistutta D, Newman B.
Source
1
Institute of Health and Biomedical Innovation, Queensland University of
Technology , Brisbane,
Queensland, Australia .
Abstract
Abstract
Background: The adverse consequences of lymphedema following breast cancer in
relation to
physical function and quality of life are clear; however, its
potential relationship with survival has not been
investigated. Our purpose
was to determine the prevalence of lymphedema and associated upper-body
symptoms at 6 years following breast cancer and to examine the prognostic
significance of lymphedema with
respect to overall 6-year survival (OS).
Methods and Results: A population-based sample of Australian
women (n=287)
diagnosed with invasive, unilateral breast cancer was followed for a median of
6.6 years
and prospectively assessed for lymphedema (using bioimpedance
spectroscopy [BIS], sum of arm
circumferences [SOAC], and self-reported arm
swelling), a range of upper-body symptoms, and vital
status. OS was measured
from date of diagnosis to date of death or last follow-up. Kaplan-Meier methods
were used to calculate OS and Cox proportional hazards models quantified the
risk associated with
lymphedema. Approximately 45% of women had reported at
least one moderate to extreme symptom at
6.6 years postdiagnosis, while 34%
had shown clinical evidence of lymphedema, and 48% reported arm
swelling at
least once since baseline assessment. A total of 27 (9.4%) women died during the
follow-up
period, and lymphedema, diagnosed by BIS or SOAC between 6?18
months postdiagnosis, predicted
mortality (BIS: HR=2.5; 95% CI: 0.9, 6.8,
p=0.08; SOAC: 3.0; 95% CI: 1.1, 8.7, p=0.04). There was no
association
(HR=1.2; 95% CI: 0.5, 2.6, p=0.68) between self-reported arm swelling and OS.
Conclusions:
These findings suggest that lymphedema may influence survival
following breast cancer treatment and
warrant further investigation in other
cancer cohorts and explication of a potential underlying biology.
PMID:
22066743 [PubMed - in process]
Proc Natl Acad Sci U S A. 2011 Nov
15;108(46):18784-9. Epub 2011 Nov 7.
Impaired lymphatic contraction
associated with immunosuppression.
Liao S, Cheng G, Conner DA, Huang Y,
Kucherlapati RS, Munn LL, Ruddle NH, Jain RK, Fukumura D,
Padera
TP.
Source
E. L. Steele Laboratory, Department of Radiation Oncology,
Harvard Medical School and Massachusetts
General Hospital, Boston, MA
02114.
Abstract
To trigger an effective immune response, antigen and
antigen-presenting cells travel to the lymph nodes via
collecting lymphatic
vessels. However, our understanding of the regulation of collecting lymphatic
vessel
function and lymph transport is limited. To dissect the molecular
control of lymphatic function, we developed
a unique mouse model that allows
intravital imaging of autonomous lymphatic vessel contraction. Using this
method, we demonstrated that endothelial nitric oxide synthase (eNOS) in
lymphatic endothelial cells is
required for robust lymphatic contractions
under physiological conditions. By contrast, under inflammatory
conditions,
inducible NOS (iNOS)-expressing CD11b(+)Gr-1(+) cells attenuate lymphatic
contraction. This
inhibition of lymphatic contraction was associated with a
reduction in the response to antigen in a model of
immune-induced multiple
sclerosis. These results suggest the suppression of lymphatic function by the
CD11b
(+)Gr-1(+) cells as a potential mechanism of self-protection from
autoreactive responses during on-going
inflammation. The central role for
nitric oxide also suggests that other diseases such as cancer and infection
may also mediate lymphatic contraction and thus immune response. Our unique
method allows the study of
lymphatic function and its molecular regulation
during inflammation, lymphedema, and lymphatic metastasis.
PMID: 22065738
[PubMed - in process] PMCID: PMC3219138 [Available on 2012/5/15]
Nat
Med. 2011 Nov 7;17(11):1371-80. doi: 10.1038/nm.2545.
The lymphatic
vasculature in disease.
Alitalo K.
Source
Molecular/Cancer Biology
Program, Faculty of Medicine, Institute for Molecular Medicine Finland and
Helsinki University Central Hospital, Biomedicum Helsinki, University of
Helsinki, Helsinki, Finland.
Abstract
Blood vessels form a closed
circulatory system, whereas lymphatic vessels form a one-way conduit for
tissue fluid and leukocytes. In most vertebrates, the main function of
lymphatic vessels is to collect excess
protein-rich fluid that has
extravasated from blood vessels and transport it back into the blood
circulation.
Lymphatic vessels have an important immune surveillance
function, as they import various antigens and
activated antigen-presenting
cells into the lymph nodes and export immune effector cells and humoral
response factors into the blood circulation. Defects in lymphatic function
can lead to lymph accumulation in
tissues, dampened immune responses,
connective tissue and fat accumulation, and tissue swelling known as
lymphedema. This review highlights the most recent developments in lymphatic
biology and how the
lymphatic system contributes to the pathogenesis of
various diseases involving immune and inflammatory
responses and its role in
disseminating tumor cells.
PMID: 22064427 [PubMed - in process]
Br J
Dermatol. 2011 Nov 7. doi: 10.1111/j.1365-2133.2011.10731.x. [Epub ahead of
print]
A preliminary randomised controlled study to determine the application
frequency of a new lymphoedema
bandaging system.
Moffatt CJ, Franks PJ, Hardy D, Lewis M, Parker V, Feldman
JL.
Source
Royal Derby Hospital Lymphoedema Service, Derby, UK Faculty of
Medicine, Division of Nursing and
Healthcare, University of Glasgow, UK
Centre for Research & Implementation of Clinical Practice,
London, UK
London South Bank University, Faculty of Health & Social Care, London, UK
Kendal
Lymphology Centre, Kendal, UK Swansea Lymphoedema Service Singleton
Hospital, Swansea, UK
University of Missouri, Columbia, Missouri, USA
NorthShore University HealthSystem Research Institute,
Evanston, Illinois,
USA.
Abstract
Objective: To investigate efficacy and safety of the
3M™Coban™ 2 compression system (Coban 2
system) with different application
frequencies in comparison to short-stretch bandaging Methods: A
multi-
centre, randomised, prospective study was performed with 82 patients
suffering from arm or leg
lymphoedema stage II or late stage II. Patients
were allocated to traditional short-stretch 5 times/week or to
the Coban 2
system applied two, three or five times/week for 19 days. Limb volume and
adverse events
were recorded at each study visit. The primary endpoint was
percent volume reduction. Results: The
highest lymphoedema volume reduction
was achieved with the Coban 2 system applied 2 times/week. A
mean (SD)
reduction of 18.7 (14.5)% in legs and 10.5 (8.3)% in arms was achieved. More
frequent
bandage changes of 3 and 5 times/week could not demonstrate
additional benefits. Short-stretch 5
times/week showed a mean (SD) volume
reduction of 10.9 (5.2)% and 8.2 (3.1)% for legs and arms.
Bandage slippage
was low for all treatment groups. A relevant change in overall mobility was
achieved
during the use of the Coban 2 system. The adverse reactions were in
agreement with already known side
effects and did not differ remarkably
between the treatment groups. Conclusion: The 3M(TM) Coban™ 2
compression
system applied twice weekly demonstrated a high rate of volume reduction and a
good safety
profile. Oedema reduction was still effective with four days
between bandage change, which allows a
constant therapeutic effect in
routine practice. This should give the patient a high degree of independence
and mobility.
Copyright © 2011 British Association of
Dermatologists.
PMID: 22059933 [PubMed - as supplied by publisher]
Can
Respir J. 2011 Jul;18(4):e68-9.
Yellow nail syndrome: Dystrophic nails,
peripheral lymphedema and chronic cough.
Dornia C, Johst U, Lange T, Kab S,
Hamer OW.
Abstract
A case involving a 41-year-old man with yellow nail
syndrome (YNS) is reported. YNS is a rare disorder
characterized by yellow,
dystrophic nails, peripheral lymphedema and bronchiectasis with recurrent lower
respiratory tract infections. YNS is often misdiagnosed because the syndrome
is not well known. An
interdisciplinary approach is required to recognize
and collate the components of the syndrome accurately.
Correct diagnosis is
of utmost clinical importance because YNS can occur secondary to malignancies
and
autoimmune disorders. Hence, the diagnosis of YNS must prompt further
investigation.
PMID: 22059188 [PubMed - in process] PMCID: PMC3205111
[Available on 2012/7/1]
November 15, 2011
Berl Munch Tierarztl Wochenschr.
2011 May-Jun;124(5-6):257-64.
[Influence of exercise on horses' limb volume,
measured by an optoelectronic device].
[Article in German]
Siewert C,
Böttcher A, Hellige M, Beyerbach M, von Rautenfeld DB, Seifert
H.
Source
Fachgebiet Allgemeine Radiologie und Medizinische Physik,
Stiftung Tierärztliche Hochschule Hannover.
[email protected]
Abstract
This
study tested for the first time an optoelectronic device (Perometer*) measuring
limb volume of horses.
An analysis of its application was performed
regarding the influence of different types of physical exercise on
the
volume of the extremities. 40 horses were divided into four groups often horses,
each group being
exposed to exercise, differing in kind and duration of
lunging, horse-ridden and riderless. The volume
measurement was performed by
determining the inactive value (I) after a twelfe-hour standing period, the
load value (II) immediately after exercise and recovery value (III) one hour
after exercise. The results
showed a highly significant decrease in limb
volume of 5.7% between values (I) and (II), as well as a highly
significant
increase of 68% between (II) and (III). The volume changes observed in male
horses were
significantly higher than in female horses. Volume changes in
horse-ridden groups were higher than riderless
ones, but not significant.
There were fewer leg volume changes at low ambient temperatures (1-12 degrees
C) compared to high temperatures (23-31 degrees C), but these were not
statistically significant. Well-
trained horses showed lower volume changes
than less trained horses (not statistically significant). The
Perometer is a
fast and reliable tool for measuring limb volume of horses. The ICC (Interclass
Correlation
Coefficient) calculated a high measurement reproducibility of
0.996. A variance analysis showed no
significant differences between the
three repeated leg measurements. Thus, the Perometer can be used for
monitoring and quantifying edema and documenting limb volume changes
resulting from training, wearing
compression stockings or bandages, manual
lymph drainage.
PMID: 22059298 [PubMed - in process]
November 15, 2011
Support Care Cancer. 2011 Nov 10. [Epub ahead of print]
Preliminary
development of a lymphedema symptom assessment scale for patients with head and
neck
cancer.
Deng J, Ridner SH, Murphy BA, Dietrich
MS.
Source
School of Nursing, Vanderbilt University, 461 21st Ave. South,
600B Godchaux Hall, Nashville, TN,
37240, USA, [email protected].
Abstract
PURPOSE:
Currently,
no instruments are available to assess symptoms secondary to lymphedema in
patients with head
and neck cancer (HNC). The study aim was to develop and
conduct preliminary tests of such an instrument.
METHODS:
A preliminary
item pool was generated from a literature review, previous work in breast
cancer-related
lymphedema, and an observational study. The item pool was
revised based on an expert panel's suggestions
and feedback from 18 patients
with HNC. The current questionnaire, the Lymphedema Symptom Intensity
and
Distress Survey-Head and Neck (LSIDS-H&N), was then pilot tested in 30
patients with HNC.
RESULTS:
Preliminary testing (1) demonstrated
feasibility, readability, and ease of use of the LSIDS-H&N and (2)
identified that there was a considerable level of symptom burden in the
cohort of patients in the piloting
sample.
CONCLUSION:
Content
validity of the LSIDS-H&N was supported by the expert panel during
development of the LSIDS-
H&N. Further testing is ongoing.
PMID:
22072048 [PubMed - as supplied by publisher]
Cell Biol Int. 2011 Dec
1;35(12):1177-87.
Gene expression profile of lymphatic endothelial
cells.
Wang P, Cheng Y.
Source
*Center of Oncology, The Fifth
Affiliated Hospital of Xinjiang Medical University, 118 Henan Road, Xinshi
District, Urumqi 830011, Peoples Republic of China.
Abstract
The
lymphatic system was first described at around the same time as the blood
circulation centuries ago, but
the biological function elucidation of LECs
(lymphatic endothelial cells) is far less than that of BVECs (blood
vascular
endothelial cells). Since the discovery of molecular markers for LECs and
exploration of lymphatic
role in tumour metastasis, more attention has been
given to basic lymphatic research. Approx. 150 known
genes were found to be
expressed at the mRNA and protein levels by LECs. These molecules play an
important role in lymphangiogenesis, signalling, tumour metastasis, immune
function and fluid transport. This
review provides a brief outline of gene
expression profile of LECs and the molecular biological function,
which will
give the reader a better understanding about the mechanics of lymphatic function
and some
pathologies related to the lymphatic system such as lymphoedema,
and facilitate advanced scientific research
into lymphatic biology.
PMID:
22070412 [PubMed - in process]
Klin Onkol. 2011;24(5):382-8.
[Secondary
angiosarcomas after conservation treatment for breast cancers].
[Article in
Czech]
Vojtísek R, Kinkor Z, Fínek J.
Source
Radioterapeutické a
onkologické oddelení, FN Plzen. [email protected]
Abstract
BACKGROUNDS:
The
cancerogenic effect of ionizing radiation was documented just several years
after it started to be used as
a treatment option. Ionizing radiation
produces a small but detectable risk of carcinoma as well as bone and
soft
tissue sarcomas. Over the past 20 years angiosarcomas arising from the area of
the irradiated breast
have been reported with increasing frequency as the
number of women undergoing the breast conserving
surgery with consecutive
radiotherapy has increased also. Angiosarcomas can originate from either
lymphatic or capillary endothelium, namely lymphangiosarcomas and
haemangiosarcomas. The most of
haemangiosarcomas arising from the breast
skin developed in the irradiated area after breast conserving
procedure--secondary angiosarcomas. Lymphangiosarcoma is typically
associated with longstanding
extremity lymphedema--Stewart-Treves
syndrome.
CASES:
We report three cases of angiosarcomas which occured in
this region after breast conserving treatment and
we also review the
literature.
CONCLUSION:
Paradoxically, the decrease in the use of
radiotherapy to the post-mastectomy chest wall and the axillary
area is
expected to reduce the incidence of angiosarcomas, while the increase in the use
of breast conserving
procedure plus radiotherapy could lead to increased
incidence of angiosarcomas in the residual breast tissue.
Special attention
should be paid to skin leasions and changes occuring after breast conserving
treatment and
especially to the ones with the skinthickening. The early
detection and diagnosis has the crucial prognostic
value.
PMID:
[PubMed - in process] 22070020
November 21, 2011
Hell J Nucl Med. 2011 Sep;14(3):313-5.
Comparison between one day and two
days protocols for sentinel node mapping of breast cancer patients.
Ali J,
Alireza R, Mostafa M, Naser FM, Bahram M, Ramin S.
Source
Surgical
Oncology Research Center, Faculty of Medicine, Imam Reza Hospital, Mashhad
University of
Medical Sciences, Ebn Sina Street Mashhad, Iran. [email protected].
Abstract
Sentinel
node biopsy can decrease the morbidity of breast cancer treatment significantly
by sparing many
patients of axillary lymph node dissection and resulting arm
lymphedema. Despite widespread use of sentinel
node mapping for breast
cancer patients almost all aspects of this procedure are controversial; such as:
type
of the radiotracer, eligibility, time of injection, etc. One of these
controversial issues is the efficacy of 2 days
protocol (injection of the
tracer on one day and sentinel node mapping and surgery on the following day).
The main reason to perform 2 days protocol is the ease of operation room
scheduling the patient does not
need to complete injection and imaging in
the nuclear medicine department. Despite widespread use of 2
days protocol
for sentinel node mapping, very few studies have specifically evaluated this
protocol in
comparison to 1 day protocol and also the false negative rate
which is the better index of sentinel node
mapping success. Most of the
above studies used tracers with large particle size such as (99m)Tc-sulfur
colloid. Tracers with small particle size can theoretically be washed out
from the real sentinel nodes and
move to the second echelon nodes, so some
recommended using large particle size radiotracers for the 2
days protocol.
In this study, we compared the false negative rate of sentinel node mapping
between 1 and 2
days protocols using intradermal injection of
(99m)Tc-antimony sulfide colloid ((99m)Tc-SbSC) which has
very small
particle size. Eighty patients with early stage breast cancer (clinical stages
of I and II) were
evaluated. The diagnosis of the breast cancer was
established by either excisional or core needle biopsy.
The patients didn't
take any chemotherapeutic drug before surgery and were divided into two groups:
1 day
(Group I) and 2 days (Group II) protocols (45 in Group I and 35 in
Group II). For Group I, periareolar
intradermal injections of 0.5Bq/0.2mL
(99m)Tc-SbSC were applied for patients without previous excisional
biopsy.
For patients with excisional biopsy two intradermal injections of 0.5Bq/0.2mL
(99m)Tc-SbSC were
used on both sides of the incision line. All injections
were followed by gentle massage for 1min. For Group
II, the same injection
techniques were used but the dose of the tracer was doubled. Anterior, and
lateral
spot views were acquired 30min after the injection (5min/image,
128Χ128 matrix) using a dual head gamma
camera (E.CAM Siemens) and parallel
hole low energy high resolution collimator. The operation was
performed 4h
(for Group I) or 20h (for Group II) post radiotracer injection. All patients
received 2mL
patent blue V dye in a subdermal and periareolar fashion, 2min
after general anesthesia. A surgical gamma
probe (EUROPROBE, France) was
used for harvesting the sentinel lymph nodes during surgery. As sentinel
node was defined any blue node or any node with an ex vivo radioisotope
count of twofold or greater than
the axillary background. After completion
of sentinel node biopsy, all patients underwent standard axillary
lymph node
dissection. The study was approved by our local ethical committee and all
patients gave their
informed consent before inclusion into the study.
Quantitative data were expressed as mean±SD. For
comparison between groups,
independent sample student's t-test for quantitative variables, and chi-square
or Fisher's exact tests for categorical variables were used. P-values less
than 0.05 were considered
statistically significant. SPSS version 11.5 was
used for statistical analyses. The patients characteristics are
shown in
Table I. These general characteristics were not significantly different between
the study groups
(P>0.05). Detection rate was 100% for both Groups. The
median number of sentinel nodes in both Groups
was one sentinel node. The
mean number of detected sentinel nodes during surgery was not statistically
different between groups (1.28±0.7 and 1.32±0.6 for Group I and II
respectively). One false negative
sentinel node case with positive axillary
nodes after dissection was found in both groups. This amounts to
6.25% and
6.66% false negative rate for Group I and II patients respectively. During
surgery mean count
rate at the injection site was 243123±22134 and
29430±2125 for Groups I and II, respectively. Mean
count rate at the
sentinel nodes was 4345±457 and 2375±356 for Groups I and II, respectively.
Although
the mean count rate at the injection site and the sentinel nodes
were both higher in Group I of the study
compared to Group II (P<0.0001
for both), the mean ratio of sentinel to injection site was statistically higher
in Group II (P<0.0001). The 2 days protocol allows that the required
lymphoscintigraphy imaging (including
delayed views) can be performed before
and during operation without any time limits. Most studies have
reported
similar to ours detection or false negative rates for both protocols. Our study
showed comparable
mean number of harvested sentinel nodes by the two
protocols which is against the hypothesis of moving the
tracer to other
sentinel nodes by time. Others had similar results. The count rate of the
sentinel nodes during
surgery was statistically acceptable. Similar results
have been reported by others too. Although we didn't
evaluate radiation
exposure in our study, this was acceptable in other studies and Buscombe et al
showed a
maximum effective dose of 2.6μSv/MBq for these patients and even
assuming this highest value the patient
exposure was very low compared to
many other procedures. In conclusion, two days protocol gives the
sentinel
node biopsy team considerable flexibility and lymphoscintigrpahy imaging can be
completed before
surgery. Finding of the axillary sentinel node during
surgery is also being easier. False negative rates as well
as the detection
rate for one day and two days protocols are comparable.
PMID: 22087458
[PubMed - in process]
ISRN Urol. 2011;2011:431536. Epub 2011 Mar
30.
Penile reconstruction for a case of genital lymphoedema secondary to
proteus syndrome.
Ashouri F, Manners J, Rees R.
Source
Department of
Urology, RHCH, SO22 5DE Winchester, UK.
Abstract
To our knowledge penile
lymphoedema secondary to Proteus syndrome has not previously been reported.
Hence we report a case of a 16-year-old male who was referred with features
of right hemi-hypertrophy
and severe lymphoedema affecting his scrotum and
penis. He had previously undergone scrotal reduction
surgery at the age of
13, but had since developed worsening penile oedema. His main concern was that
of
cosmetic appearance prior to sexual debut, and he also complained of
erectile dysfunction. An MRI
confirmed gross oedema of the penile skin, but
normal underlying cavernosal structure, and no other
anatomical abnormality.
Under general anaesthesia, the entire diseased penile skin was excised. Two full
thickness skin grafts were harvested from the axillae, and grafted onto the
dorsal and ventral penile shaft
respectively. A compressive dressing and
urinary catheter was applied for 7 days. Follow-up at 4 months
confirmed
complete graft take with minimal scarring, and the patient was very satisfied
with the cosmetic
outcome. He had also noticed a recovery in erectile
activity, and feels psychologically and physically more
prepared for sexual
relations.
PMID: 22084799 [PubMed - in process] PMCID: PMC3197011
J
Am Acad Dermatol. 2011 Dec;65(6):e163.
Lymphedema, yellow nails, and a
persistent cough.
Wenk KS, Ehrlich A.
Source
Department of Dermatology,
The George Washington University Medical Center, Washington, DC.
PMID:
22082852 [PubMed - in process]
Ann Vasc Surg. 2011 Nov 11. [Epub ahead of
print]
Using Indocyanine Green Fluorescent Lymphography and Lymphatic-Venous
Anastomosis for Cancer-
Related Lymphedema.
Mihara M, Murai N, Hayashi Y,
Hara H, Iida T, Narushima M, Todokoro T, Uchida G, Yamamoto T,
Koshima
I.
Source
Department of Plastic Surgery and Reconstructive Surgery, The
University of Tokyo, Tokyo, Japan.
Abstract
Advances in cancer therapy
have increased the importance of improvement of quality of life after cancer
survival. Cancer-related lymphedema or secondary lymphedema that occurs
after lymph node dissection in
resection of tumors of abdominal visceral
organs can impair quality of life. However, standard curative
treatment for
secondary lymphedema has not been established. This may be due to the lack of a
method for
early diagnosis of lymphedema, and because of selection of
conservative treatment such as compression
therapy to delay edema
progression in many cases. To develop a curative approach, we have performed
definite diagnosis of early-stage lymphedema using magnetic resonance
imaging and an indocyanine green
fluorescent lymphography, followed by
surgical treatment with lymphatic-venous anastomosis using
supermicrosurgery. Herein, we report the first case of secondary lymphedema
in which we performed early
diagnosis and surgery using these techniques and
achieved an almost complete cure of lymphedema. We
suggest that early
diagnostic imaging and early microsurgery is the key of lymphedema
treatment.
Copyright © 2011 Annals of Vascular Surgery Inc. Published by
Elsevier Inc. All rights reserved.
PMID: 22079465 [PubMed - as supplied by
publisher]
BMC Dermatol. 2011 Nov 11;11(1):15. [Epub ahead of
print]
Classic Kaposi's Sarcoma In Morocco: Clinico -epidemiological study at
the National Institute Of Oncology.
Errihani H, Berrada N, Raissouni S, Rais
F, Mrabti H, Rais G.
Abstract
ABSTRACT:
BACKGROUND:
Classic Kaposi's
sarcoma (CKS) is a rare disease likely associated with human herpesvirus 8
(HHV-8)
infection, and occurs predominantly in Jewish, Mediterranean and
middle eastern men .There is a dearth of
data in Moroccan patients with CKS
regarding epidemiology, clinical characteristics and outcomes. This
report
examines a cohort of patients with CKS evaluated at the national institute of
oncology over 11-year
period.
METHODS:
A retrospective analysis of
patients referred to the national institute of oncology with classical Kaposi
sarcoma, between January 1998 and February 2008, was performed. Reviewed
information included
demographics, clinical and pathological staging, death
or last follow-up.
RESULTS:
During the study period, 56 patients with a
diagnosis of CKS have been referred to our hospital. There were
11(19,7%)
females and 45 (80,3 %) males (male-to-female ratio: 4:1). Mean age at diagnosis
was 61,7 +/-
15 (range: 15- 86 years). Nodules and/or plaques were the most
frequent type of lesion. The most common
location was the lower limbs,
particularly the distal lower extremity ( 90%). In addition to skin involvement,
visceral spread was evident in 9 cases. The most common visceral involvement
sites were lymph nodes (44
%), lung (22%), and gastrointestinal tract (22%).
Associated lymphoedema was seen in 24 (42%) of the
patients. There were 18
stage I patients (32,14 %), 8: stage II (14,28%), 21 stage III(37,5%) and 9
stage
IV (16,07%). A second primary malignancy was diagnosed in 6 cases
(10,7%), none of the
reticuloendothelial system. With a median follow-up of
45 months, 38 (67,8) patients are alive ,of whom 25
(65,78%) patients with
stable disease, five with progressive disease currently under systemic
chemotherapy
and 8(21,05%) are alive and free of disease, over a mean
interval of 5 years.
CONCLUSION:
This is the largest reported series in
our context. In Morocco, CKS exhibits some special characteristics
including
a disseminated skin disease at diagnosis especially in men, a more common
visceral or lymph node
involvement and a less frequent association with
second malignancies.
PMID: 22078023 [PubMed - as supplied by
publisher]
MED NEWS:
November 15, 2011
Story Of Lymphatic System Expands To Include Chapter On Valve Formation
A century after the valves that link the lymphatic and blood systems were
first described, St. Jude Children's
Research Hospital scientists have
detailed how those valves form and identified a gene that is critical to the
process.
The gene is Prox1. Earlier work led by Guillermo Oliver, Ph.D., a member of
the St. Jude Department of
Genetics, showed Prox1 was essential for
formation and maintenance of the entire lymphatic vasculature.
The lymphatic
vasculature is the network of vessels and ducts that help maintain the body's
fluid balance and
serves as a highway along which everything from cancer
cells to disease-fighting immune components
moves. Oliver is senior author
of the new study, which appeared in the October 15 edition of the scientific
journal Genes & Development.
The new research suggests that Prox1 is also essential for proper formation
of the one-way valves that
control movement of fluid and nutrients from the
lymphatic system into the blood stream. Researchers found
evidence that the
Prox1 protein also has a role in formation of the venous valves.
"Understanding how valves form is crucial to efforts to develop treatments
for valve defects that affect both
children and adults," said the paper's
first author, R. Sathish Srinivasan, Ph.D., a research associate in the St.
Jude Department of Genetics. Those defects are linked to a variety of
problems including lymphedema and
deep vein thrombosis, which are blood
clots that form deep in veins and have the potential for causing
life-
threatening complications. Lymphedema is the painful and sometimes
disfiguring swelling that can occur
when lymph flow is disrupted.
For more than a decade, the lymphatic system has been a focus of Oliver's
laboratory. The laboratory's
contributions through the years include
evidence that leaky lymphatic vessels might contribute to obesity.
Oliver
and his colleagues also demonstrated how the lymphatic system forms from
Prox1-producing cells
destined to become lymphatic endothelial cells (LECs)
when they leave the developing veins and migrate
throughout the body.
The investigators also showed the Coup-TFII gene is essential to the process.
The Coup-TFII protein binds
to the promoter region of the Prox1 gene. The
binding switches on production of the Prox1 protein that is
required to
create and maintain the lymphatic system.
The newer research builds on that earlier work from Oliver's laboratory. The
latest study focused on the
lymphovenous valves. These valves are found at
just two locations in the body, on either side of the chest
just under the
clavicle bone where the lymphatic vessels intersect with the subclavian and
internal jugular
veins.
Working in mice, investigators discovered that these lymphovenous valves form
from a newly identified
subtype of endothelial cell found in developing
veins. Like the LECs that form the lymphatic system, the
newly identified
endothelial cells make Prox1. But while the LECs leave the veins and migrate
throughout the
body, these endothelial cells stay put to form the
lymphovenous valves.
Researchers demonstrated the process requires two copies of the Prox1 gene.
That ensures adequate levels
of the Coup-TFII-Prox1 complex and with it
enough Prox1 to build and maintain the lymphatic system.
Mice engineered to
carry a single copy of Prox1 either did not survive or were born without
lymphovenous
and venous valves.
"If you have only one copy of Prox1 you are going to have a reduction in the
Coup-TFII Prox1 complex
and so a dramatic reduction in the number of cells
available to build the lymphatic system. That explains the
defects we see,"
Srinivasan said.
December 6, 2011Am J Clin Oncol. 2011 Nov 29. [Epub ahead of
print]
Complication Rates in Patients With Negative Axillary Nodes 10 Years
After Local Breast Radiotherapy
After Either Sentinel Lymph Node Dissection
or Axillary Clearance.
Wernicke AG, Shamis M, Sidhu KK, Turner BC, Goltser Y,
Khan I, Christos PJ, Komarnicky-Kocher LT.
Source
*Department of Radiation
Oncology ¶Department of Public Health, Division of Biostatistics and
Epidemiology, Weill Cornell Medical College of Cornell University, New York
∥Department of Biological
Sciences, State University of New York, Stony
Brook, NY †Department of Medical Sciences, Saint
George University, Grenada,
WI ‡Department of Radiation Oncology, Thomas Jefferson University
Hospital
#Department of Radiation Oncology, Drexel University Hospital, Philadelphia, PA
§Department of
Biological Sciences, Brandeis University, Waltham,
MA.
Abstract
BACKGROUND:
We assess complication rates in node negative
breast cancer patients treated with breast radiotherapy (RT)
only after
sentinel lymph node dissection (SLND) or axillary lymph node dissection
(ALND).
MATERIALS AND METHODS:
Between 1995 and 2001, 226 women with AJCC
stage I-II breast cancer were treated with lumpectomy,
either SLND or
SLND+ALND, and had available toxicities in follow-up: 111/136 (82%) and 115/129
(89%) in SLND and ALND groups, respectively. RT targeted the breast to
median dose of 48.2 Gy (range,
46.0 to 50.4 Gy) without axillary RT.
Chi-square tests compared complication rates of 2 groups for axillary
web
syndrome (AWS), seroma, wound infection, decreased range of motion of the
ipsilateral shoulder,
paresthesia, and lymphedema.
RESULTS:
Median
follow-up was 9.9 years (range, 8.3-15.3 y). Median number of nodes assessed was
2 (range, 1-5)
in SLND and 18 (range, 7-36) in ALND (P < 0.0001). Acute
complications occurred during the first 2
years and were AWS, seroma, and
wound infection. Incidences of seroma 5/111 (4.5%) in SLND and
16/115
(13.9%) in ALND (P < 0.02, respectively) and wound infection 3/111 (2.7%) in
SLND and
10/115 (8.7%) in ALND (P < 0.05, respectively) differed
significantly. AWS was not statistically
different between the groups. At 10
years, the only chronic complications decreased were range of motion
of the
shoulder 46/111 (41.4%) in SLND and 92/115 (80.0%) in ALND (P < 0.0001),
paresthesia
12/111 (10.8%) in SLND and 39/115 (33.9%) in ALND
(P < 0.0001), and lymphedema assessed by
patients 10/111 (10.0%) in SLND
and 39/115 (33.9%) in ALND (P < 0.0001). Chronic lymphedema,
assessed by
clinicians, occurred in 6/111 (5.4%) in SLND and 21/115 (18.3%) in ALND cohorts,
respectively (P < 0.0001).
CONCLUSIONS:
Our mature findings support
that in patients with negative axillary nodal status SLND and breast RT provide
excellent long-term cure rates while avoiding morbidities associated with
ALND or addition of axillary RT
field.
PMID: 22134519 [PubMed - as
supplied by publisher]
Orphanet J Rare Dis. 2011 Dec 1;6(1):80. [Epub ahead
of print]
Fibrodysplasia Ossificans Progressiva: Clinical and Genetic
Aspects.
Pignolo RJ, Shore EM, Kaplan FS.
Abstract
ABSTRACT:
Fibrodysplasia ossificans progressiva (FOP) is a severely disabling heritable
disorder of
connective tissue characterized by congenital malformations of
the great toes and progressive heterotopic
ossification that forms
qualitatively normal bone in characteristic extraskeletal sites. The worldwide
prevalence is approximately 1/2,000,000. There is no ethnic, racial, gender,
or geographic predilection to
FOP. Children who have FOP appear normal at
birth except for congenital malformations of the great toes.
During the
first decade of life, sporadic episodes of painful soft tissue swellings
(flare-ups) occur which are
often precipitated by soft tissue injury,
intramuscular injections, viral infection, muscular stretching, falls or
fatigue. These flare-ups transform skeletal muscles, tendons, ligaments,
fascia, and aponeuroses into
heterotopic bone, rendering movement
impossible. Patients with atypical forms of FOP have been
described. They
either present with the classic features of FOP plus one or more atypical
features [FOP
plus], or present with major variations in one or both of the
two classic defining features of FOP [FOP
variants]. Classic FOP is caused
by a recurrent activating mutation (617G>A; R206H) in the gene
ACVR1/ALK2
encoding Activin A receptor type I/Activin-like kinase2, a bone morphogenetic
protein
(BMP) type I receptor. Atypical FOP patients also have heterozygous
ACVR1 missense mutations in
conserved amino acids. The diagnosis of FOP is
made by clinical evaluation. Confirmatory genetic testing is
available.
Differential diagnosis includes progressive osseous heteroplasia, osteosarcoma,
lymphedema, soft
tissue sarcoma, desmoids tumors, aggressive juvenile
fibromatosis, and non-hereditary (acquired)
heterotopic ossification.
Although most cases of FOP are sporadic (non-inherited mutations), a small
number of inherited FOP cases show germline transmission in an autosomal
dominant pattern. At present,
there is no definitive treatment, but a brief
4-day course of high-dose corticosteroids, started within the first
24 hours
of a flare-up, may help reduce the intense inflammation and tissue edema seen in
the early stages of
the disease. Preventative management is based on
prophylactic measures against falls, respiratory decline,
and viral
infections. The median lifespan is approximately 40 years of age. Most patients
are wheelchair-
bound by the end of the second decade of life and commonly
die of complications of thoracic insufficiency
syndrome.
PMID: 22133093
[PubMed - as supplied by publisher]
Ceska Gynekol. 2011
Oct;76(5):355-9.
[Axillary reverse mapping--chance to prevent lymphedema in
breast cancer patients].
[Article in Czech]
Pavlista D, Koliba P, Eliska
O.
Source
Gynekologicko-porodnická klinika 1. LF UK a VFN,
Onkogynekologické centrum, Praha.
Abstract
OBJECTIVE:
The axillary
reverse mapping (ARM) technique has been developed to map and preserve arm
lymphatic
drainage during axillary lymph node dissection (ALND) and/or
sentinel lymph node (SLN) biopsy, thereby
minimizing arm lymphedema.
However, several problems remain to be resolved in the practical application
of this technique. This article presents a review of current knowledge
regarding ARM and discusses the
practical applicability and relevance of
this technique.
TYPE OF STUDY:
Review.
SETTING:
Oncogynecologic
center, Gynecology-Obstetrics Clinic, 1st Medical Faculty and General Teaching
Hospital, Prague.
CONCLUSIONS:
The axillary reverse mapping (ARM)
procedure is based on the hypothesis that the lymphatic drainage from
the
upper arm is different from that of the breast and offers the opportunity to
prevent lymphedema in breast
cancer patients. However, the oncologic safety
of the procedure has not yet been determined.
PMID: 22132635 [PubMed - in
process]
December 9, 2011
Blood. 2011 Dec 6. [Epub ahead of
print]
Loss-of-function germline GATA2 mutations in patients with MDS/AML or
MonoMAC syndrome and
primary lymphedema reveal a key role for GATA2 in the
lymphatic vasculature.
Kazenwadel J, Secker GA, Liu YJ, Rosenfeld JA, Wildin
RS, Cuellar-Rodriguez J, Hsu AP, Dyack S,
Fernandez CV, Chong CE, Babic M,
Bardy PG, Shimamura A, Zhang M, Walsh T, Holland SM, Hickstein
DD, Horwitz
MS, Hahn CN, Scott HS, Harvey NL.
Source
Division of Haematology, Centre
for Cancer Biology, SA Pathology, Adelaide, SA, Australia;
Abstract
Recent
work has established that heterozygous germline GATA2 mutations predispose
carriers to familial
myelodysplastic syndrome (MDS)/acute myeloid leukaemia
(AML), "MonoMAC" syndrome and DCML
deficiency. Here, we describe a
previously unreported MDS family carrying a missense mutation in GATA2
(p.Thr354Met), one patient with MDS/AML carrying a frameshift mutation in
GATA2 (p.
Leu332Thrfs*53), another individual with MDS harboring a GATA2
splice site mutation, and three patients
exhibiting MDS or MDS/AML who have
large deletions encompassing the GATA2 locus. Intriguingly, two
patients
with GATA2 deletions and one with a frameshift mutation who have MDS/AML or
"MonoMAC"
syndrome also have primary lymphedema. Primary lymphedema occurs
as a result of aberrations in the
development and/or function of lymphatic
vessels, spurring us to investigate whether GATA2 plays a role in
the
lymphatic vasculature. We demonstrate here that GATA2 protein is present at high
levels in the leaflets
of lymphatic vessel valves, and that GATA2 controls
the expression of genes that play key roles in
programming lymphatic valve
development. Our data expand the phenotypes associated with germline
GATA2
mutations to include predisposition to primary lymphedema and suggest that
complete
haploinsufficiency or loss-of-function (LOF) of GATA2, rather than
missense mutations, is the key
predisposing factor for lymphedema onset.
Moreover, we reveal a crucial role for GATA2 in lymphatic
vascular
development, particularly in controlling valve development and/or
function.
PMID: 22147895 [PubMed - as supplied by publisher]
Ann Biomed
Eng. 2011 Dec 3. [Epub ahead of print]
The Role of Lymphatics in Cancer as
Assessed by Near-Infrared Fluorescence Imaging.
Rasmussen JC, Kwon S,
Sevick-Muraca EM, Cormier JN.
Source
Center for Molecular Imaging, The
Brown Foundation Institute of Molecular Medicine, The University of
Texas
Health Science Center, Houston, 1825 Pressler St, SRB 330F, Houston, TX, 77030,
USA, john.
[email protected].
Abstract
The
lymphatic system is the secondary circulatory system responsible for fluid
homeostasis and protein
transport in the body. In addition, because the
lymphatic system provides a primary pathway for cancer
metastasis, lymph
node involvement is routinely used as a determinant in cancer staging. Despite
their
importance, the lymphatics remain poorly understood, in part because
of the historic lack of imaging
modalities with sufficient spatial and/or
temporal resolution to visualize the fine lymphatic structure and subtle
contractile function. In recent years, near-infrared fluorescence (NIRF)
imaging has emerged as a new
imaging modality to non-invasively visualize
the lymphatics and assess contractile lymphatic function in
humans following
administration of microdose amounts of a NIRF contrast agent. In this
contribution, we
first review NIRF imaging and its clinical application in
sentinel lymph node mapping, intraoperative
guidance, and assessing the
architecture and contractile function of the lymphatics in health and in
cancer-
related lymphedema. We then present recent NIRF lymphatic imaging for
non-invasive assessment of
lymphatics both in preclinical melanoma models
and in human subjects with melanoma.
PMID: 22139396 [PubMed - as supplied by
publisher]
Int J Radiat Oncol Biol Phys. 2011 Dec 2. [Epub ahead of
print]
Cosmetic Outcomes and Complications Reported by Patients Having
Undergone Breast-Conserving
Treatment.
Hill-Kayser CE, Vachani C,
Hampshire MK, Di Lullo GA, Metz JM.
Source
Department of Radiation
Oncology, University of Pennsylvania, Philadelphia,
Pennsylvania.
Abstract
PURPOSE:
Over the past 30 years, much work in
treatment of breast cancer has contributed to improvement of
cosmetic and
functional outcomes. The goal of breast-conservation treatment (BCT) is
avoidance of
mastectomy through use of lumpectomy and adjuvant radiation.
Modern data demonstrate "excellent" or
"good" cosmesis in >90% of
patients treated with BCT.
METHODS AND MATERIALS:
Patient-reported data
were gathered via a convenience sample frame from breast cancer survivors using
a
publically available, free, Internet-based tool for creation of
survivorship care plans. During use of the tool,
breast cancer survivors are
queried as to the cosmetic appearance of the treated breast, as well as
perceived late effects. All data have been maintained anonymously with
internal review board approval.
RESULTS:
Three hundred fifty-four breast
cancer survivors having undergone BCT and voluntarily using this tool were
queried with regard to breast cosmesis and perceived late effects. Median
diagnosis age was 48 years, and
median current age 52 years. "Excellent"
cosmesis was reported by 27% (n = 88), "Good" by 44% (n =
144), "Fair" by
24% (n = 81), and "Poor" by 5% (n = 18). Of the queries posted to survivors
after BCT,
late effects most commonly reported were cognitive changes (62%);
sexual concerns (52%); changes in
texture and color of irradiated skin
(48%); chronic pain, numbness, or tingling (35%); and loss of flexibility in
the irradiated area (30%). Survivors also described osteopenia/osteoporosis
(35%), cardiopulmonary
problems (12%), and lymphedema
(19%).
CONCLUSIONS:
This anonymous tool uses a convenience sample frame to
gather patient reported assessments of cosmesis
and complications after
breast cancer. Among the BCT population, cosmetic assessment by survivors
appears less likely to be "excellent" or "good" than would be expected, with
30% of BCT survivors
reporting "fair" or "poor" cosmesis. Patient reported
incidence of chronic pain, as well as cognitive and
sexual changes, also
appears higher than expected.
Copyright © 2011 Elsevier Inc. All rights
reserved.
PMID: 22137022 [PubMed - as supplied by publisher]
MED
NEWS:
December 4, 2011
MU Researchers Recommend Exercise For Breast Cancer
Survivors, Lymphedema Patients –
Lymphedema a chronic swelling condition
common in breast cancer survivors, affects three million people in
the U.S.
In the past, most people believed that exercise might induce or worsen
lymphedema. After
reviewing the literature, University of Missouri
researchers say the benefits of exercise outweigh the risks for
breast
cancer survivors and patients with lymphedema.
Jane Armer, professor in the Sinclair School of Nursing, says patients at
risk for lymphedema can exercise if
they closely monitor their
activities.
"Exercise can be beneficial and not harmful for breast cancer survivors,"
Armer said. "Each individual should
balance the pros and cons of the
activity she chooses, but keep in mind that being sedentary has risks and
being active is beneficial in many ways, including possibly reducing the
risk of cancer recurrence."
Lymphedema can occur any time after cancer treatment and is usually caused by
the removal or radiation of
lymph nodes as part of the treatment process.
Armer found that patients who exercise had no greater risk
for developing
lymphedema than those who do not exercise. In addition, patients with lymphedema
did not
worsen their condition by exercising. She says future research is
needed to determine whether exercise
prevents the condition.
"Breast cancer survivors do not need to restrict their activity as we once
thought," Armer said. "If patients
want to be active, they should carefully
condition their bodies by increasing repetitions of resistance
exercises
under proper supervision."
In another new literature review, Armer and her colleagues examined published
literature pertaining to the
surgical treatment of lymphedema. They found
that in most studies surgery did not eliminate the need for
traditional
compression garments in patients with lymphedema.
"Many people think surgery will correct the underlying lymphatic problem, but
that is not correct," Armer
said. "There are several surgical techniques
that may reduce the swelling associated with lymphedema. In
most cases, it
is recommended that patients undergo traditional therapy using specialized
massage and
compression garments and bandages to reduce fluid and swelling
before considering surgery."
December 12, 2011
New Research Finding
Presented At American Society Of Hematology Annual Meeting –
Researchers from
Seidman Cancer Center at University Hospitals (UH) Case Medical Center and Case
Western Reserve University School of Medicine presented new research
findings in 25 presentations at the
53rd Annual Meeting of the American
Society of Hematology (ASH) at the San Diego Convention Center.
"The breadth and depth of this innovative cancer research presented at ASH is
truly outstanding," says Stan
Gerson, MD, Director of the Seidman Cancer
Center at UH Case Medical Center and the Case
Comprehensive Cancer Center at
Case Western Reserve University. "Our faculty members are making
tremendous
advances in hematology and oncology which is reflected in their being chosen for
oral and
poster presentations."
Speaking at the ASH "Scientific Symposium on Lymphoid Neoplasia" in a session
titled "Autophagy and
Metabolism in Lymphoid Malignancies," Clark
Distelhorst, MD, provided a synthesis of the latest research
indicating that
autophagy occurs in lymphoid malignancies and may be a novel therapeutic target
for
lymphoma and other lymphoid neoplasia. His research suggests that
targeting autophagy (a process through
which cells eat parts of themselves
to generate sufficient energy to stay alive) may be a useful adjunct to the
longstanding use of glucocorticoids, such as prednisone, to kill cancer
cells.
His session outlined the growing body of evidence that treatments aimed at
inducing autophagy have great
promise in treating lymphoid malignancies. In
his session, Dr. Distelhorst presented important data explaining
how
glucocorticoids starve tumor cells of glucose and thus induce autophagy.
Researchers at UH Case
Medical Center and Case Western Reserve University
identified the Dexamethasone-induced Gene 2 (dig2)
that encodes a protein
mediator of autophagy.
"This new cancer-fighting strategy lays the groundwork for further
development of autophagy inhibitors to
enhance the glucocorticoids
properties," says Dr. Distelhorst, who is vice-chair of the ASH subcommittee
on Lymphoid Neoplasia. "This is a major step forward in our research efforts
to develop new therapies for
lymphoid malignancies."
Dr. Distelhorst's session was Saturday, December 10, 4 p.m. - 5:30 p.m. in
Room 6A. (San Diego
Convention Center). http://ash.confex.com/ash/2011/webprogram/Paper35836.html
In a poster presentation (Abstract# 1907), Jeffery Auletta, MD, Kenneth
Cooke, MD, and colleagues
presented significant findings that mesenchymal
stem cells (MSCs) effectively treat graft-versus-host disease
(GvHD) while
not interfering with bone marrow transplant's efficacy in treating leukemia.
MSCs are non-hematopoietic (not blood-forming cells) adult stem cells found
in the bone marrow and were
discovered at UH Seidman Cancer Center and Case
Western Reserve University. They maintain
hematopoietic stem cell
(blood-forming cells) development and also differentiate into fat cells, bone
cells and
cartilage cells. MSCs have been shown to suppress immune responses
ex vivo (outside the body in cell
culture conditions).
Due to these properties, MSCs have been used to treat GvHD in bone marrow
transplant (BMT) patients.
However, how MSC immunomodulation works in vivo
(inside the body) has not been well studied, and, in
fact, could potentially
promote leukemia/lymphoma recurrence in transplant patients. That is, the
benefit of
BMT is that the donor graft kills residual leukemia in the
transplant recipient (host), a process called graft-
versus-leukemia
(GvL).
"We used a pre-clinical mouse model of BMT to study how human MSCs mediate in
vivo immune effects,"
says Dr. Auletta. "Our results show for the first time
using an animal model that human MSCs simultaneously
attenuate GvHD, but
spare GvL activity."
December 17, 2011
Lymphology. 2011 Sep;44(3):134-43.
The effects of symptomatic seroma on
lymphedema symptoms following breast cancer treatment.
Fu MR, Guth AA,
Cleland CM, Lima ED, Kayal M, Haber J, Gallup L, Axelrod D.
Source
College
of Nursing, New York University, NYU Clinical Cancer Center, New York University
School of
Medicine, New York, NY 10003, USA. [email protected]
Abstract
It has been
speculated that symptomatic seroma, or seroma requiring needle aspiration, is
one of the risk
factors for lymphedema symptoms following breast cancer
treatment. These symptoms exert tremendous
impact on patients' quality of
life and include arm swelling, chest/breast swelling, heaviness, tightness,
firmness, pain, numbness, stiffness, or impaired limb mobility. Our aim was
to explore if symptomatic seroma
affects lymphedema symptoms following
breast cancer treatment. Data were collected from 130 patients
using a
Demographic and Medical Information interview tool, Lymphedema and Breast Cancer
Questionnaire, and review of medical record. Arm swelling was verified by
Sequential Circumferential Arm
Measurements and Bioelectrical Impedance
Spectroscopy. Data analysis included descriptive statistics, Chi-
squared
tests, regression, exploratory factor analysis and exploratory structural
equation modeling. Thirty-
five patients (27%) developed symptomatic seroma.
Locations of seroma included axilla, breast, and upper
chest. Significantly,
more women with seroma experienced more lymphedema symptoms. A well-fit
exploratory structural equation model [X2(79) = 92.15, p = 0.148; CFI =
0.97; TLI = 0.96] revealed a
significant unique effect of seroma on
lymphedema symptoms of arm swelling, chest/breast swelling,
tenderness, and
blistering (beta = 0.48, p < 0.01). Patients who developed symptomatic seroma
had 7.78
and 10.64 times the odds of developing arm swelling and
chest/breast swelling versus those who did not,
respectively (p < 0.001).
Symptomatic seroma is associated with increased risk of developing lymphedema
symptoms following breast cancer treatment. Patients who develop symptomatic
seroma should be
considered at higher risk for lymphedema symptoms and
receive lymphedema risk reduction interventions.
PMID: 22165584 [PubMed - in
process]
Lymphology. 2011 Sep;44(3):121-30.
The effects of reduction
operation with genital lymphedema on the frequency of erysipelas and the quality
of
life.
Zvonik M, Földi E, Felmerer G.
Source
Division of Plastic
Surgery, Department of Trauma Surgery, Plastic and Reconstruction Surgery,
University
Hospital Goettingen, Germany. [email protected]
Abstract
Genital
lymphedema represents a severe disability for patients particularly when
complicated by erysipelas,
the most frequent complication. The objectives of
this study were: to investigate the frequency of erysipelas
in patients with
genital lymphedema and genital lymphatic cysts who underwent evaluation for
surgical
treatment, to observe the influence of resection operations on the
frequency of erysipelas, and to measure
changes in the quality of life due
to the resection. A total of 93 patients with genital lymphedema were
studied. All patients underwent integrated care treatment in the Földi
Clinic, Hinterzarten and the
Department of Plastic and Hand Surgery of the
University Hospital Freiburg during the period between
1997 and 2007. 44 of
these patients underwent surgical treatment of genital lymphedema. The results
indicate that lymphatic cysts were the most important risk-aggravating
factor for recurrent erysipelas with
lymphorrhea in the genital region (p
< 0.001). Following the resection operation, however, the number of
erysipelas incidents significantly decreased (p < 0.001). In addition,
the antibiotic dose could be reduced
after surgery (p = 0.039) and an
improved quality of life was achieved (p < 0.001).
PMID: 22165582 [PubMed
- in process]
Lymphology. 2011 Sep;44(3):103-12.
Axillary lymph nodes and
arm lymphatic drainage pathways are spared during routine complete axillary
clearance in majority of women undergoing breast cancer surgery.
Szuba A,
Chachaj Z, Koba-Wszedybylb M, Hawro R, Jasinski R, Tarkowski R, Szewczyk K,
Bebenek
M, Forgacz J, Jodkowska A, Jedrzejuk D, Janczak D, Mrozinska M,
Pilch U, Wozniewski M.
Source
Department of Internal Medicine, Wroclaw
Medical University, Wroclaw, Poland. [email protected]
Abstract
Alterations
in axillary lymph nodes (ALNs) after complete axillary lymph node dissection
(ALND) in
comparison to the preoperative status were evaluated using
lymphoscintigraphy performed preoperatively
and 1-6 weeks after surgery in
30 women with a new diagnosis of unilateral, invasive breast carcinoma.
Analysis of lymphoscintigrams revealed that ALNs after surgery were present
in 26 of 30 examined women.
In comparison to preoperative status, they were
visualized in the same location (12 women), in the same and
additionally in
different locations (9 women), or only in different locations (4 women). No
lymph nodes were
visualized in one woman and lymphocoele were in 4 women.
Thus, after ALND, a variable number of
axillary lymph nodes remain and were
visualized on lymphoscintigraphy in the majority of women. The
classical
ALND, therefore, does not allow complete dissection and removal of axillary
nodes with total
disruption of axillary lymphatic pathways, accounting in
part for the variable incidence and severity of
lymphedema after the
procedure.
PMID: 22165580 [PubMed - in process]
J Cancer Surviv. 2011 Dec
10. [Epub ahead of print]
A randomized trial of exercise on well-being and
function following breast cancer surgery: the RESTORE
trial.
Anderson RT,
Kimmick GG, McCoy TP, Hopkins J, Levine E, Miller G, Ribisl P, Mihalko
SL.
Source
Department of Public Health Sciences, College of Medicine, Penn
State Milton S. Hershey Medical Center,
600 Centerview Drive, Suite 2200,
P.O. Box 855, Hershey, PA, 17033-0855, USA, [email protected].
Abstract
OBJECTIVES:
This
study aimed to determine the effect of a moderate, tailored exercise program on
health-related quality
of life, physical function, and arm volume in women
receiving treatment for nonmetastatic breast cancer.
METHODS:
Women who
were within 4-12 weeks of surgery for stage I-III breast cancer were randomized
to center-
based exercise and lymphedema education intervention or patient
education. Functional Assessment of
Cancer Therapy-Breast Cancer (FACT-B),
6-min walk, and arm volume were performed at 3-month
intervals through 18
months. Repeated measures analysis of covariance was used to model the total
meters
walked over time, FACT-B scores, and arm volume. Models were adjusted
for baseline measurement,
baseline affected arm volume, number of nodes
removed, age, self-reported symptoms, baseline SF-12
mental and physical
component scores, visit, and treatment group.
RESULTS:
Of the recruited
104 women, 82 completed all 18 months. Mean age (range) was 53.6 (32-82) years;
88%
were Caucasian; 45% were employed full time; 44% were overweight; and
28% obese. Approximately,
46% had breast-conserving surgery; 79% had
axillary node dissection; 59% received chemotherapy; and
64% received
radiation. The intervention resulted in an average increase of 34.3 ml
(SD = 12.8) versus
patient education (p = 0.01). Changes in FACT-B scores
and arm volumes were not significantly different.
CONCLUSIONS:
With this
early exercise intervention after breast cancer diagnosis, a significant
improvement was achieved in
physical function, with no decline in
health-related quality of life or detrimental effect on arm volume.
IMPLICATIONS FOR CANCER SURVIVORS: Starting a supervised exercise regimen
that is tailored to
an individual's strength and stamina within 3 months
following breast cancer surgery appears safe and may
hasten improvements in
physical functioning.
PMID: 22160629 [PubMed - as supplied by
publisher]
Am J Clin Oncol. 2011 Dec 12. [Epub ahead of print]
Comparison
of Lymphedema in Patients With Axillary Lymph Node Dissections to Those With
Sentinel
Lymph Node Biopsy Followed by Immediate and Delayed
ALND.
Kuwajerwala NK, Feczko C, Dekhne N, Pettinga J, Lucia VC, Riutta J,
Vicini F.
Source
*Departments of Surgery, William Beaumont Hospital, Troy
and Royal Oak †Cancer Clinical Trials
§Physical Medicine and Rehabilitation
‡Research Institute, William Beaumont Hospital ∥Department of
Radiation
Oncology, Royal Oak, MI.
Abstract
PURPOSE:
The purpose of the study was
to show that delayed axillary lymph node dissection (ALND) has higher rates
of lymphedema compared with immediate ALND, using data from NSABP-B32 at
Beaumont Hospital.
METHOD:
NSABP B-32 at Beaumont had 207 patients with
follow-up data on 199 patients, randomizing clinically
negative axilla to
sentinel lymph node biopsy (SLNB)+ALND (GrA N=98), and SLNB+cytology±ALND
(GrB N=101). All patients had preoperative volumetric arm measurements and
only node negatives had
routine postoperative measurements assessing
lymphedema for 36 months. We contacted node-positive
patients for
postoperative measurements for this study. Twenty-four and 15 cytology-positive
patients had
SLNB+ALND in GrA and GrB, respectively (SubGrA1 N=24; SubGrB1
N=15). Fourteen hematoxylin
and eosin-positive patients had delayed ALND
(SubGrB2a N=14).
RESULTS:
Lymphedema rate for node-positive SLNB+ALND was
10.3% [SubGrA1 (3/24)+SubGrB1 (1/15)=4/39]
and node-negative SLNB+ALND was
6.8% (SubGrA2=5/74). Lymphedema was 14.3% for delayed
ALND in SubGrB2a (2 of
14) and 0% for 72 SLNBs in SubGrB2b. Our study comparing immediate and
delayed ALND lymphedema was not statistically significant (10.3% vs. 14.3%,
P=0.65). Comparing node-
negative ALND (SubGrA2= 5/74=6.8%) to node-positive
ALND (A1+B1+B2a=6/53=11.3%) was not
statistically significant (P=0.52).
Comparing lymphedema for node-negative ALND (SubGrA2) to SLNB
(SubGrB2b)
only approached significance (6.8% vs. 0%, P=0.058).
CONCLUSIONS:
The rate
of lymphedema was higher in delayed ALND but not statistically significant.
Comparison, however,
is difficult, given the limited sample size. We urge
the other centers of NSABP-B32 to validate this, by
contacting the
node-positive patients for measurements. The lymphedema rate for SLNB alone was
0% and
approached statistical significance when compared with node-negative
ALND.
PMID: 22157215 [PubMed - as supplied by publisher]
Clin Nucl Med.
2012 Jan;37(1):9-13.
Lymphatic dysfunction in the apparently clinically
normal contralateral limbs of patients with unilateral lower
limb
swelling.
Burnand KM, Glass DM, Mortimer PS, Peters AM.
Source
From the
*Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, United
Kingdom;
†Department of Nuclear Medicine, Harley St Clinic, London, United
Kingdom; and ‡Department of
Medicine, St George's Hospital, London, United
Kingdom.
Abstract
PURPOSE:
: To determine how often lymphatic
dysfunction is bilateral when, clinically, lymphedema appears
unilateral.
METHODS:
: Lymphoscintigraphy was performed after subcutaneous
Tc-99m-nanocolloid injection in the first
webspaces of both feet. The
percentage of injected radioactivity accumulating in the ilioinguinal regions
was
recorded in dedicated images separately acquired at 60 and 180 minutes
after injection.
RESULTS:
: Within a consecutive series of 204 patients,
74 had unilateral clinical lymphedema of whom 68 had
abnormal scintigraphy.
Of these 68 patients, 46 had unilateral abnormal scintigraphy affecting the
clinically
abnormal limb, but 20 patients had bilateral abnormal
scintigraphy and 2 had unilateral abnormal scintigraphy
in the clinically
unaffected limb. Thus, 32% (22/68) of patients in whom clinical lymphedema
appeared to be
unilateral, nevertheless, had abnormal scintigraphy in the
clinically normal limb. Twenty-nine patients had no
clinical evidence of
lymphedema in either limb and were scintigraphically normal bilaterally. Mean
ilioinguinal
nodal accumulation at 180 minutes in the 44 limbs of 22 of
these clinically and scintigraphically normal
patients (dedicated
ilioinguinal imaging was not performed in all patients) was 13.1% (standard
deviation,
8.8%), higher (P = 0.02) than the mean value of 9.3% (standard
deviation, 5.0%) in the clinically and
scintigraphically normal
contralateral limbs of 39 patients with unilateral clinical
lymphedema.
CONCLUSIONS:
: In the presence of unilateral lymphedema, the
contralateral limb is often also abnormal. On
lymphoscintigraphy, therefore,
care should be taken before diagnosing unilateral lymphatic dysfunction.
Quantification should be included in routine lymphoscintigraphy, as reduced
ilioinguinal nodal accumulation
may be the only apparent
abnormality.
PMID: 22157021 [PubMed - in process]
Phlebology. 2011 Dec 12.
[Epub ahead of print]
Intensive decongestive treatment restores ability to
work in patients with advanced forms of primary and
secondary lower
extremity lymphoedema.
Stanisic MG, Gabriel M, Pawlaczyk
K.
Source
Department of General and Vascular Surgery, Poznan University of
Medical Sciences, ul Długa 1/2, 61-848
Poznań,
Poland.
Abstract
OBJECTIVE:
To show that adequate therapy for
lymphoedema is able to restore ability to work.
MATERIALS AND METHODS:
The
population of patients with primary lymphoedema registered in the university
clinical centre diagnosed
with primary or secondary lymphoedema and presumed
by the national social institution as completely
unable to work was selected
for the retrospective analysis and divided into two groups. Group 1 consisted
of 25 patients treated with a complex decongestive therapy programme daily
for 3-6 weeks. The study
population comprised 19 women and six men from 14
to 61 years of age (mean 31.5). In all 25 patients,
complete inability to
work was certified by the social institution before the treatment started. Group
2
consisted of 47 patients, 14 men and 33 women, aged from 26 to 71 years
(mean 39 years) treated by so-
called standard methods, who resigned from the
proposed intensive treatment. In all 47 patients, complete
inability to work
was declared by the social institution before the treatment. Ability to work and
oedema
reduction were assessed by the treating physician.
RESULTS:
The
intensive phase of treatment succeeded in 3870-15,330 mL oedema reduction in
Group 1. After the
end of therapy, 21 patients were able to work or study
without any limitation and patients returned to their
regular professional
activity. Among four others, two were on welfare for at least 10 years, for
another one
welfare was their only income and one person was receiving a
social pension. In none of the patients from
group 2 was any significant
oedema reduction observed. Every patient from group 2 maintained the social
pension due to ineffective treatment.
CONCLUSIONS:
Complex
decongestive therapy is a very efficient form of treatment in advanced primary
and secondary
lymphoedema. It allows returning to work after a short period
of temporary disability without the necessity
of a social pension.
PMID:
22156385 [PubMed - as supplied by publisher]
Phys Ther. 2011 Dec 9. [Epub ahead of print]
Factors That Affect Physical
Activity and Exercise Decisions of Survivors of Breast Cancer: Qualitative
Study.
Sander AP, Wilson J, Izzo N, Mountford SA, Hayes
KW.
Source
A.P. Sander, PT, DPT, MS, CLT-LANA, Department of Physical
Therapy and Human Movement
Sciences, Northwestern University Feinberg School
of Medicine, 645 N Michigan Ave, Suite 1100,
Chicago, IL 60611
(USA).
Abstract
BackgroundExercise has many benefits for breast cancer
survivors, yet only half of survivors regularly
exercise. Fear has been
identified as a barrier to exercise for people with neuromusculoskeletal
conditions,
but has been minimally explored among women with breast
cancer.ObjectivesThe purpose of this study was
to investigate factors that
impact the physical activity and exercise decisions of breast cancer survivors
and
to determine whether fear was among those factors.DesignThis was a
grounded theory qualitative study. The
qualitative data were triangulated
with two quantitative scales that measured participants' beliefs about
exercise and their activity level.
METHODS:
/b>Thirty-four breast
cancer survivors participated in 8 focus groups using semi-structured interviews
that
were recorded, transcribed and coded. Concept maps created for each
group were merged to develop
themes. Physical activity/exercise beliefs were
assessed using the Decisional Balance Scale. The Rapid
Assessment of
Physical Activity Scale assessed physical activity/exercise behaviors pre and
post breast
cancer diagnosis.
RESULTS:
/b>Participants generally
believed that exercise was beneficial (Decisional Balance score mean; SD; range
=
28.1/44; 7.6; 10-43). Participants decreased the amount of physical
activity/exercise during treatment, but
increased the amount of exercise
beyond pre-diagnosis levels following treatment (Rapid Assessment of
Physical Activity median; range = 6; 2-7). Three prominent themes described
the physical activity/exercise
behaviors of participants: values and beliefs
about exercise; facilitators and barriers that were both similar to
the
general population and cancer specific; and lack of or inaccurate information
about safe exercise.
CONCLUSION:
/b>The active survivors in this study
were not afraid to exercise. However, concerns about lymphedema and
knowledge of safe and effective exercise programs influenced physical
activity and exercise choices.
PMID: 22156026 [PubMed - as supplied by
publisher]
Trans R Soc Trop Med Hyg. 2011 Dec 9. [Epub ahead of
print]
Lymphatic filariasis in western Ethiopia with special emphasis on
prevalence of Wuchereria bancrofti
antigenaemia in and around onchocerciasis
endemic areas.
Shiferaw W, Kebede T, Graves PM, Golasa L, Gebre T, Mosher AW,
Tadesse A, Sime H, Lambiyo T,
Panicker KN, Richards FO, Hailu
A.
Source
Department of Microbiology, Immunology and Parasitology (DMIP);
Faculty of Medicine, Addis Ababa
University, PO Box 9086, Addis Ababa,
Ethiopia.
Abstract
Lymphatic filariasis is known to be endemic in Gambella
Region, western Ethiopia, but the full extent of its
endemicity in other
regions is unknown. A national mapping program for Ethiopia was initiated in
2008. This
report summarizes initial data on the prevalence of Wuchereria
bancrofti antigenaemia based on surveys
carried out in a sampled population
of 11685 individuals living in 125 villages (112 districts) of western
Ethiopia. The overall prevalence rate was 3.7%, but high geographical
clustering and variation in prevalence
(ranging from 0% to more than 50%)
was found. The prevalence of hydrocele (in males) and lymphoedema
of limbs
was 0.8% and 3.6% respectively. Significantly higher (χ(2)=49.6; P<0.01)
prevalence of
antigenaemia was noted in known onchocerciasis endemic
districts (4.7%) compared to non-onchocerciasis
endemic districts (2.3%).
Thirty-four of the 112 districts, with a population of 1547685 in 2007, were
found
to be endemic. Of these, the numbers of districts with prevalence
rates of >20%, 10-20% and 5-9% were
nine, 14 and 20 respectively.
Twenty-nine of these 34 endemic districts were found in three regions:
Gambella Region (seven districts), Beneshangul-Gumuz Region (13 districts),
and Southern Nations,
Nationalities and Peoples' Region (SNNPR) (nine
districts). The other five were from Amhara (two
districts) and Oromia
(three districts) regions. A tentative distribution map has been drawn to
facilitate the
launching of the Ethiopia LF elimination
program.
Copyright © 2011 Royal Society of Tropical Medicine and Hygiene. All
rights reserved.
PMID: 22154976 [PubMed - as supplied by publisher]
Ann
Surg Oncol. 2011 Dec;18 Suppl 3:312-4. Epub 2011 Aug 12.
Reply to Letter to
the Editor "Lymphoedema in the Observation and Biopsy Arms of MSLT-1" by Thomas,
J Meirion (ASO-2011-04-0666).
Faries MB, Morton DL, Cochran AJ, Thompson
JF.
Source
Department of Surgery, Yale School of Medicine, New Haven, CT,
USA, [email protected].
PMID:
21837533 [PubMed - in process]
Ann Surg Oncol. 2011 Dec;18 Suppl 3:311. Epub 2011 Jul 20.
Lymphoedema in
the Observation and Biopsy Arms of MSLT-1.
Thomas JM.
Source
Surgical
Oncology, Royal Marsden Hospital, London, UK, [email protected].
PMID:
21773841 [PubMed - in process]
December 20, 2011
Clin Rehabil. 2011 Dec 21. [Epub ahead of print]
Efficacy of low-frequency
low-intensity electrotherapy in the treatment of breast cancer-related
lymphoedema: a cross-over randomized trial.
Belmonte R, Tejero M, Ferrer
M, Muniesa JM, Duarte E, Cunillera O, Escalada F.
Source
Medicina Física i
Rehabilitació, Hospital Mar-Esperança, Barcelona,
Spain.
Abstract
Objective: To compare the efficacy of low-frequency
low-intensity electrotherapy and manual lymphatic
drainage in the treatment
of chronic upper limb breast cancer-related lymphoedema.Design: Cross-over
single-blind random clinical trial.Setting: Rehabilitation
service.Participants: Thirty-six women with chronic
upper limb breast
cancer-related lymphoedema.Methods: Patients were randomized to undergo 10
sessions
of manual lymphatic drainage followed by 10 sessions of
low-frequency low-intensity electrotherapy or to
undergo first low-frequency
low-intensity electrotherapy followed by manual lymphatic drainage. There was
a month of washout time between treatments. Each patient was examined just
before and after each
treatment. Researchers and outcome assessors were
blinded for assigned treatment.Measures: Outcomes
were lymphoedema volume,
pain, heaviness and tightness, and health-related quality of life measured with
the Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer
version 4 (FACT-B+4).
Carry-over, period and treatment effects were
analysed. Treatment effect was assessed using paired t-test.
Results: Thirty
patients finalized treatment. Comparing the changes in low-frequency
low-intensity
electrotherapy with manual lymphatic drainage changes, there
were no significant differences.Low-frequency
low-intensity electrotherapy
did not reduce lymphoedema volume (mean of change = 19.77 mL, P = 0.36),
but
significant reductions were observed in pain, heaviness and tightness (mean of
change = 13.1, 16.2 and
6.4 mm, respectively), and FACT-B+4 summaries
improved significantly (Trial Outcome Index mean of
change = 5.4, P =
0.015). Manual lymphatic drainage showed no significant changes in any of the
outcomesConclusion: Although there are no significant differences between
treatment changes, the observed
trend towards a better health-related
quality of life is remarkable in low-frequency low-intensity
electrotherapy.
PMID: 22172923 [PubMed - as supplied by
publisher]
December 24, 2011
Plast Reconstr Surg. 2012
Jan;129(1):221e-2e.
Primary lymphedema: definition of onset based on
developmental age.
Greene AK, Schook CC.
Source
Department of Plastic
and Oral Surgery, Vascular Anomalies Center and Lymphedema Program, Children's
Hospital Boston, Harvard Medical School, Boston, Mass.
PMID: 22186578
[PubMed - in process]
Eplasty. 2011;11:ic15. Epub 2011 Nov 4.
Scrotal
lymphedema.
Pastor C, Granick MS.
Source
Division of Plastic Surgery,
University of Medicine and Dentistry of New Jersey, Newark, NJ.
PMID:
22184510 [PubMed - in process] PMCID: PMC3236059
Curr Oncol. 2011
Dec;18(6):e260-4.
Lymphedema in Canada: a qualitative study to help develop a
clinical, research, and education strategy.
Hodgson P, Towers A, Keast DH,
Kennedy A, Pritzker R, Allen J.
Source
Lymphedema Program, McGill
University Health Centre, Montreal, QC.
Abstract
OBJECTIVE:
The aim of
this study was to gather data from Canadian stakeholders to help construct a
national strategy
and agenda for lymphedema management.
METHODS:
The
Canadian Lymphedema Framework, a collaboration of medical academics, lymphedema
therapists,
patient advocates, and others, used participatory action
research and Open Space Technology to identify
issues and build consensus at
a national meeting of lymphedema stakeholders. Proceedings were videotaped
and underwent content analysis. Existing Canadian documentation on
lymphedema services was analyzed.
Using those data sources, the Canadian
Lymphedema Framework drafted a development strategy.
RESULTS:
Of 320
invited stakeholders (patients, therapists, physicians, industry
representatives, and health
policymakers), 108 participated in a day-long
videotaped meeting discussing strategies to improve the
management of
lymphedema and related disorders in Canada. Participants identified barriers,
challenges,
and issues related to the need to raise awareness about
lymphedema with patients, physicians, and the
public. Five priority areas
for development were articulated: education, standards, research, reimbursement
and access to treatment, and advocacy. The main barrier to development was
identified as the lack of clear
responsibility within the health care system
for lymphedema care.
CONCLUSIONS:
Data from stakeholders was obtained to
solidly define priority areas for lymphedema development at a
national
level. The Canadian Lymphedema Framework has created a working plan, an advisory
board, and
working groups to implement the strategy.
PMID: 22184493
[PubMed - in process] PMCID: PMC3224034
Clin Anat. 2012
Jan;25(1):72-85. doi: 10.1002/ca.22009.
Cutaneous lymphatics and chronic
lymphedema of the head and neck.
Feely MA, Olsen KD, Gamble GL, Davis MD,
Pittelkow MR.
Source
Mayo Clinic College of Medicine, Mayo Clinic,
Rochester, Minnesota.
Abstract
Extensive attention has been directed to
lymphedema involving the extremities. However, there has been
relatively
limited study of the cutaneous lymphatics of the head and neck. In this review
of head and neck
lymphatics, we capsulize the history of the lymphatics, the
anatomy of the cutaneous lymphatics, lymphatic
function and physiology, and
imaging modalities used to define this intricate vascular system. To appreciate
the clinical challenges associated with head and neck lymphatic dysfunction,
we also provide an overview of
disease processes of the cutaneous lymphatics
and their treatment, theories on the etiology of lymphedema,
and future
directions to better understand lymphatic function and disease. Knowledge of the
cutaneous
lymphatics of the head and neck are critical to the clinical
evaluation of patients, who present with this
debilitating condition and to
our understanding of its pathogenesis and appropriate management. Clin. Anat.
25:72-85, 2012. © 2011 Wiley Periodicals, Inc.
Copyright © 2011
Wiley-Liss, Inc.
PMID: 22180138 [PubMed - in process]
J Minim Invasive
Gynecol. 2011 Dec 14. [Epub ahead of print]
Laparoscopic Lymphadenectomy for
Isolated Lymph Node Recurrence in Gynecologic Malignancies.
Hong JH, Choi JS,
Lee JH, Bae JW, Eom JM, Kim JT, Oh S.
Source
Division of Gynecologic
Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics
and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of
Medicine, Seoul, Korea.
Abstract
STUDY OBJECTIVE:
To assess the
feasibility and efficacy of laparoscopic lymphadenectomy in patients with
isolated lymph node
recurrences (ILNR) who underwent initial surgery because
of gynecologic malignancy.
DESIGN:
Retrospective study (Canadian Task
Force classification II-3).
SETTING:
University teaching
hospital.
PATIENTS:
Six patients with ILNR (1 cervical, 4 ovarian, and 1
peritoneal) diagnosed between March 2003 and July
2010.
INTERVENTION:
Laparoscopic lymphadenectomy.
MEASUREMENTS AND
MAIN RESULTS:
Median (range) patient age was 59.5 (24-70) years, and body
mass index was 21.7 (21.0-24.6). There
was no unplanned conversion to
laparotomy. Operating time was 337.5 (200-400) minutes, hemoglobin
change
was 0.9 (0.4-2.6) g/dL, and hospital stay was 8.5 (5-19) days. The number of
harvested lymph
nodes was 20 (5-27), and of positive lymph nodes was 4
(1-24). One patient had common iliac vein
laceration, with complete
hemostasis achieved using intracorporeal suture. Postoperative lymphedema
occurred in 1 patient, and was managed conservatively. All patients received
adjuvant chemotherapy after
laparoscopic
lymphadenectomy.
CONCLUSION:
Laparoscopic lymphadenectomy in patients with
ILNR is feasible and might be an alternative therapeutic
strategy.
Copyright © 2011 AAGL. Published by Elsevier Inc. All rights
reserved.
PMID: 22176995 [PubMed - as supplied by publisher]
December 27, 2011
Ann Plast Surg. 2012 Jan;68(1):94-6.
Treating chronic
lower limb lymphedema with the charles procedure in a renal allograft
recipient.
Wu HS, Cheng HT, Chen HC.
Source
From the Department of
Surgery, Subdivision of Plastic and Reconstructive Surgery, China Medical
University Hospital, China Medical University, Taichung City,
Taiwan.
Abstract
We report our experience in applying the Charles
procedure to a female renal allograft recipient for her left
lower leg
lymphedema. This is a rare comorbidity in limb lymphedema victims, and the use
of the Charles
procedure has not been reported in such an immunocompromised
patient. After surgery, infection was well
controlled, and there was minimal
scar in the affected limb.
PMID: 22193429 [PubMed - in process]
Sarcoma.
2011;2011:289673. Epub 2011 Nov 20.
Incidence and Severity of Lymphoedema
following Limb Salvage of Extremity Soft Tissue Sarcoma.
Friedmann D, Wunder
JS, Ferguson P, O'Sullivan B, Roberge D, Catton C, Freeman C, Saran N, Turcotte
RE.
Source
Division of Orthopedic Surgery, McGill University Health
Centre, Montreal, QC, Canada H3G 1A4.
Abstract
Background and Purpose.
Lymphoedema is a serious complication following limb salvage for extremity soft
tissue sarcomas (STSs) for which little is known. We aimed to evaluate its
incidence, its, severity and its
associated risk factors. Material and
Method. Patient and tumor characteristics, treatment modalities and
complications and functional outcomes (MSTS 1987, TESS), and lymphoedema
severity (Stern) were all
collected from prospective databases. Charts were
retrospectively abstracted for BMI and comorbidities.
Results. There were
289 patients (158 males). Mean age was 53 (16-88). Followup ranged between 12
and 60 months with an average of 35 and a median of 36 months. Mean BMI was
27.4 (15.8-52.1). 72%
had lower extremity tumors and 38% upper extremity.
Mean tumor size was 8.1 cm (1.0-35.6 cm). 27%
had no adjuvant radiation, 62%
had 50 Gy, and 11% received 66 Gy. The incidence of lymphoedema
was 28.8%
(206 none, 58 mild, 22 moderate, 3 severe, and 0 very severe). Mean MSTS score
was 32
(11-35) and TESS was 89.4 (32.4-100). Radiation dose was
significantly correlated with tumor size > 5
cm (P = 0.0001) and TESS
score (P = 0.001), but not MSTS score (P = 0.090). Only tumor size > 5 cm
and depth were found to be independent predictors of significant
lymphoedema. Conclusion. Nine percent
of STS patients in our cohort
developed significant (grade ≥ 2) lymphoedema. Tumor size > 5 cm and
deep
tumors were associated with an increased occurrence of lymphoedema but not
radiation dosage.
PMID: 22190861 [PubMed - in process] PMCID:
PMC3236348
Oper Orthop Traumatol. 2011 Dec 23. [Epub ahead of print]
[Soft
tissue reconstruction of the distal lower extremity using the 180-degree
perforator-based propeller
flap.]
[Article in German]
Jakubietz RG,
Schmidt K, Holzapfel BM, Meffert RH, Rudert M, Jakubietz MG.
Source
Klinik
und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie,
Uniklinikum Würzburg,
Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland, [email protected].
Abstract
OBJECTIVE:
Operative technique of propeller flap reconstruction of soft tissue defects
in the distal lower extremity. Soft
tissue reconstruction of the distal
third of the lower extremity with local, reliable perforator flaps avoiding
free tissue transfer.
INDICATIONS:
Complex wounds (maximum width of 6
cm) of the distal lower extremity with exposed bones, joints,
tendons, and
neurovascular structures.
CONTRAINDICATIONS:
Arterial vascular disease
(stage III or IV), diabetes mellitus, postthrombotic syndrome, venous ulcers,
chronic lymphedema, contusion of adjacent soft tissue, previous radiation,
and lack of perforators
SURGICAL TECHNIQUE:
The perforator represents the
pivot point around which rotation of up to 180º of the subfascially harvested
flap allows closure of the defect. The proximal donor site can be closed
primarily up to a width of 6 cm.
POSTOPERATIVE MANAGEMENT:
Strict
elevation of the extremity for 5 days, then flap conditioning.
RESULTS:
This technique was used for soft tissue reconstruction in 17 patients. In
one patient with diabetes, complete
flap necrosis occurred, requiring
amputation of the extremity. One case of epidermolysis healed without
further surgery.
PMID: 22190271 [PubMed - as supplied by publisher]
Wkly Epidemiol Rec. 2011 Dec 16;86(51-52):581-5.
Managing morbidity and
preventing disability in the Global Programme to Eliminate Lymphatic Filariasis:
WHO position statement.
[Article in English, French]
[No authors
listed]
PMID: 22191103 [PubMed - indexed for MEDLINE
27.
[Recurrent breast cellulitis associated with lymphangiectasia after
tumorectomy for breast cancer.]
[Article in French]
Bibas N, Escande H, Ofaiche J, Le Moigne M, Viraben R, Nougué J.
Source
Service de dermatologie, CHG, 100, rue Léon-Cladel, 82013 Montauban cedex,
France.
Abstract
BACKGROUND:
Recurrent breast cellulitis has been described as a complication following
breast conservation therapy.
OBSERVATION:
A 50-year-old woman undergoing tumour excision, postoperative radiotherapy
and chemotherapy
presented recurrent breast cellulitis in the same region.
The presence of lymphangiectasia suggested a
complication subsequent to
lymph stasis.
DISCUSSION:
Conservative therapy for breast cancer, allowing the development of
subclinical or patent lymphœdema,
constitutes a prominent risk factor for
recurrent cellulitis. This complication has also been considered in
patients
with lower extremity cellulitis following saphenous venectomy for coronary
bypass surgery. The
unusual presence of lymphangiectasia observed in our
patient provides clear evidence that lymphœdema is
the most prominent risk
factor for the development of cellulitis after breast conservation therapy.
Copyright © 2011. Published by Elsevier Masson SAS.
PMID: 21700073 [PubMed - as supplied by publisher]
July 8, 2011
J Oncol Pract. 2011 Mar;7(2):89-93.
Effects of early exercise on the development of lymphedema in patients with
breast cancer treated with
axillary lymph node dissection.
Cavanaugh KM.
Source
University of Pennsylvania, Philadelphia, PA.
Abstract
PURPOSE:
Despite advances in the treatment of breast cancer, there is little research
examining the prevention of
lymphedema after breast and/or axillary surgery.
Currently, there are no national guidelines for activity
restrictions;
however, many medical providers recommend restricting activity of the surgically
affected arm,
which can create quality-of-life issues as well as future
medical issues for patients with breast cancer.
METHODS:
A literature review of several current research articles was performed. This
report reviews four studies
evaluating the effects of restricted activity
versus progressive exercise and stretching activities on
development of
lymphedema.
RESULTS:
The results show that there is no difference in the risk of developing
lymphedema when following activity
guidelines. All four of the studies
reviewed report results of either a decrease in the development of
lymphedema or no increased risk of development of lymphedema when early
exercise regimens are
incorporated into postoperative care.
CONCLUSION:
The four research articles show promising results that support future change in practice guidelines. However,
none of the studies report follow-up
results beyond 2 years. Additionl evaluation to monitor long-term
effects is
warranted.
PMID: 21731515 [PubMed - in process] PMCID: PMC3051868
Clin Microbiol Infect. 2011 Jul;17(7):977-85. doi:
10.1111/j.1469-0691.2011.03586.x.
Filariasis in Africa-treatment challenges and prospects.
Hoerauf A, Pfarr K, Mand S, Debrah AY, Specht S.
Source
Institute for Medical Microbiology, Immunology and Parasitology, University
Hospital Bonn, Sigmund Freud
Strasse, Bonn, Germany Faculty of Allied
Health Sciences, Kwame Nkrumah University of Science and
Technology Kumasi
Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi,
Ghana.
Abstract
Clin Microbiol Infect 2011; 17: 977-985 ABSTRACT: Lymphatic filariasis (LF)
and onchocerciasis are
parasitic nematode infections that are responsible
for a major disease burden in the African continent.
Disease symptoms are
induced by the immune reactions of the host, with lymphoedema and hydrocoele in
LF, and dermatitis and ocular inflammation in onchocerciasis. Wuchereria
bancrofti and Onchocerca
volvulus, the species causing LF and onchocerciasis
in Africa, live in mutual symbiosis with Wolbachia
endobacteria, which cause
a major part of the inflammation leading to symptoms and are antibiotic targets
for treatment. The standard microfilaricidal drugs ivermectin and
albendazole are used in mass drug
administration programmes, with the aim of
interrupting transmission, with a consequent reduction in the
burden of
infection and, in some situations, leading to regional elimination of LF and
onchocerciasis. Co-
endemicity of Loa loa with W. bancrofti or O. volvulus is
an impediment to mass drug administration with
ivermectin and albendazole,
owing to the risk of encephalopathy being encountered upon administration of
ivermectin. Research into new treatment options is exploring several
improved delivery strategies for the
classic drugs or new antibiotic
treatment regimens for anti-wolbachial chemotherapy.
© 2011 The Authors. Clinical Microbiology and Infection © 2011 European
Society of Clinical
Microbiology and Infectious Diseases.
PMID: 21722251 [PubMed - in process]
J Reconstr Microsurg. 2011 Jun 29. [Epub ahead of print]
Immediate Microsurgical Breast Reconstruction and Simultaneous Sentinel Lymph
Node Dissection: Issues
with Node Positivity and Recipient Vessel
Selection.
Curtis MS, Arslanian B, Colakoglu S, Tobias AM, Lee BT.
Source
Department of Surgery, State University of New York, Upstate Medical
University, Syracuse, New York.
Abstract
Sentinel lymph node dissection (SLND) during mastectomy has been increasing
given the decreased risk of
lymphedema. Simultaneous reconstruction with a
microsurgical breast reconstruction is often performed, but
with node
positivity a completion axillary lymph node dissection (ALND) must be performed
subsequently.
This study examines the potential risks especially in relation
to microsurgical reconstruction. All patients
undergoing microsurgical
breast reconstruction at an academic institution from 2004 to 2010 were
evaluated
in a prospective database. Patients with immediate reconstruction
and SLND were identified. Management
of positive lymph node status was
ascertained through extensive chart review. There were 610
reconstructions
performed, 170 delayed and 440 immediate. From the immediate reconstructions,
110
patients (25%) had SLND and of these patients, 16 (14.55%) had a
positive SLND. All 16 patients had
internal mammary recipient vessels for
free tissue transfer. Seven patients had intraoperative completion
ALND,
while nine patients had staged completion ALND at a later date. There were no
adverse affects
from completion ALND. Simultaneous mastectomy, SLND, and
microsurgical reconstruction can be
performed safely. The internal mammary
vessels are preferred recipient vessels as node positive patients
may
require subsequent completion ALND. If a thoracodorsal anastomosis is performed,
a potential risk
exists for vessel injury and flap loss with completion
ALND.
© Thieme Medical Publishers.
PMID: 21717397 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Jun 30. [Epub ahead of print]
Reduction/Prevention of Lower Extremity Lymphedema after Pelvic and
Para-aortic Lymphadenectomy for
Patients with Gynecologic Malignancies.
Hareyama H, Ito K, Hada K, Uchida A, Hayakashi Y, Hirayama E, Oikawa M,
Okuyama K.
Source
Department of Obstetrics and Gynecology, Sapporo City General Hospital,
Sapporo, Japan, hitoshi.
[email protected].
Abstract
BACKGROUND:
Lower extremity lymphedema (LEL) is a serious complication caused by
lymphadenectomy in patients with
gynecologic malignancies. In this study, we
evaluated the effect of preserving the circumflex iliac lymph
nodes (CILNs),
i.e., the most caudal external iliac lymph nodes, for the prevention and
reduction of LEL by
comparing two groups of patients, one in which CILN were
removed and the other in which CILNs were
preserved.
METHODS:
We retrospectively reviewed 329 patients with gynecologic malignancies who
had undergone abdominal
complete systematic pelvic and para-aortic
lymphadenectomy. The patients were divided into nonpreserved
(n = 189) and
preserved (n = 140) groups, depending on whether CILNs were removed. Primary
outcome
measures included the incidence and severity of LEL.
RESULTS:
The incidence of LEL was significantly lower in the preserved group than in
the nonpreserved group (P <
0.0001). The frequency of LEL was also
significantly lower in the preserved group than in the nonpreserved
group
regardless of the range of pelvic and para-aortic lymphadenectomy (P <
0.0001). LEL in the
overwhelming majority of cases in the preserved group
was mild, and no patients experienced severe LEL.
Further, the incidence of
cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved
group (P < 0.0001). Lymphoscintigraphy revealed collateral pathways from
the preserved CILN along the
iliac and large abdominal vessels.
CONCLUSIONS:
This method of lymph node preservation is a simple and extremely effective
approach for
preventing/reducing LEL after pelvic and para-aortic
lymphadenectomy for patients with gynecologic
malignancies.
PMID: 21717243 [PubMed - as supplied by publisher]
July 12, 2011
Afr J Med Med Sci. 2010 Dec;39(4):329-32.
The learning curve of radical hysterectomy for early cervical carcinoma.
Oladokun A, Morhason-Bello IO, Bello FA, Adewole IF.
Source
Department of Obstetrics & Gynaecology, College of Medicine, University
College Hospital, Ibadan,
Nigeria. [email protected]
Abstract
Cervical cancer remains a public health concern in developing countries that
lack the wherewithal to cope
with the associated challenges. Screening for
premalignant cervical lesions and offering definitive care for
early disease
is the key to preventing the scourge. We conducted an audit of the radical
hysterectomies
performed on account of early cervical carcinoma at our
centre between September 2006 and August
2008, following capacity-building
by Operation Stop Cervical Cancer. Ten women aged 35 to 60 years
were
managed. All had type III radical hysterectomy. Three patients had adjuvant
teletherapy (one was
stage IIb, diagnosed intra-operatively). There was a
linear reduction in the surgical blood loss and duration
of surgery. Average
blood loss was 1500 mls; four had blood transfusions. One case was complicated
with
rectovaginal fistula (the woman with stage IIb disease) and another had
bilateral lymphoedema and left lower
limb sensory neuropathy. There was no
tumour recurrence on follow-up. Definitive surgery for early cervical
cancer
is feasible in developing countries despite limited resources. Audit of surgical
care of cervical cancer
will assist in strengthening the scarce skill.
Determination of suitable cases during preoperative evaluation is
crucial to
the success of the surgery.
PMID: 21736000 [PubMed - in process]
ONS Connect. 2011 Jun;26(6):14-5.
Lymphedema in head and neck cancer.
Becze E.
PMID: 21735767 [PubMed - in process]
J Cancer Surviv. 2011 Jul 7. [Epub ahead of print]
Do breast cancer survivors' post-surgery difficulties with recreational
activities persist over time?
Miedema B, Hamilton R, Tatemichi S, Thomas-Maclean R, Hack TF, Quinlan E,
Towers A, Tilley A,
Kwan W.
Source
Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers
Regional Hospital, 700
Priestman Street, Fredericton, NB, Canada, [email protected].
Abstract
INTRODUCTION:
Most longitudinal breast cancer studies have found that treatment-related
sequelae such as arm morbidity
[lymphedema, pain, and range of motion (ROM)
restrictions] can have a significant impact on quality of life.
In a
previous study, we found that at 6-12 months after breast cancer surgery, 49% of
participants had
difficulties engaging in recreational activities and that
arm morbidity significantly predicted difficulties with
participation in
recreation.
METHODS:
A longitudinal national study employing clinical assessments and survey
methods followed 178 women over
43 months (3.6 years) to assess issues
related to arm morbidity post-breast cancer surgery. Hierarchical
multiple
regression analyses were conducted to identify which variables were predictive
of recreational
difficulties experienced by women 8 and 43 months
post-surgery.
RESULTS:
Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women
demonstrated slight
increases in lymphedema. Conversely, a significant
decrease was observed in the number of ROM
restrictions and pain when using
the arm. Despite the overall improvements in arm morbidity, some women
continued to report moderate pain and ROM restrictions. The two arm
morbidity factors were found to be
statistically significant (p < 0.001)
predictors of recreational difficulties at both 8 and 43 months post-surgery,
with pain accounting for the greatest proportion of variance.
DISCUSSION/CONCLUSION:
Pain and ROM restrictions were the only significant predictors of
recreational difficulties during the first 3.6
years after breast cancer
surgery. Specifically, women who still experience pain years after breast cancer
surgery report difficulties in their recreational pursuits. IMPLICATIONS FOR
CANCER SURVIVORS:
Pain and ROM restrictions may prohibit participation in
recreational activity and targeted intervention should
be sought.
PMID: 21735276 [PubMed - as supplied by publisher
Breast Cancer Res Treat. 2011 Jul 7. [Epub ahead of print]
A SEER-Medicare population-based study of lymphedema-related claims incidence
following breast cancer
in men.
Reiner AS, Jacks LM, Van Zee KJ, Panageas KS.
Source
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer
Center, 307 East 63rd
Street, New York, NY, 10065, USA, [email protected].
Abstract
Each year there are an estimated 200,000 new breast cancer cases diagnosed in
the United States; of these,
1% of cases are in men. Lymphedema can be a
devastating complication from breast cancer and its
treatment. Currently,
almost all lymphedema-related research is based on women and extrapolated to
men.
We conducted the first population-based study of men with incident
breast cancer of any stage, diagnosed
from 1998 to 2005, who were 65 years
and older in the Surveillance, Epidemiology, and End Results
(SEER)-Medicare
linked database. We utilized claims related to lymphedema and lymphedema
treatment in
our cohort. We defined 'lymphedema-specific' claims to contain
the word 'lymphedema' in the Medicare
claim description; similarly,
'lymphedema-related' claims were defined as treatments reimbursed for
lymphedema but not necessarily containing the word 'lymphedema' in the
Medicare claim description. We
identified 628 men with incident breast
cancer from 1998 to 2005 who were 65 years and older. The
cumulative
incidence, censored for deaths, of lymphedema-specific claims at 2, 3, 4, and 5
years was 8.0,
9.2, 10.5, and 10.5%, respectively. The median follow-up was
3.4 years and for those without any event
was 4.7 years. The cumulative
incidence, censored for deaths, of lymphedema-related claims at 2, 3, 4, and
5 years was 26.9, 32.2, 35.4, and 39.8%. Rates for men were similar to
analogous rates for women.
Lymphedema is a common complication affecting men
with breast cancer as well as women and appropriate
treatment and
rehabilitation strategies need to be implemented for both genders.
PMID: 21735047 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 Jul 5. [Epub ahead of print]
Upper Extremity Lymphedema Index: A Simple Method for Severity Evaluation of
Upper Extremity
Lymphedema.
Yamamoto T, Yamamoto N, Hara H, Mihara M, Narushima M, Koshima I.
Source
From the Department of Plastic and Reconstructive Surgery, Graduate School of
Medicine, the University
of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655,
Japan.
Abstract
Measurement of the circumference is the most commonly employed method for
evaluating extremity
lymphedema. However, comparison between different
patients is difficult with this measurement. To resolve
this problem, we
have formulated a new index, upper extremity lymphedema (UEL) index, which can
be
easily obtained from measurements of the body. We evaluated correlation
between UEL index and clinical
stage in patients with UEL. The UEL indices
were significantly correlated with clinical stages and could be
used as a
severity scale. The lower extremity lymphedema index makes objective assessment
of the severity
of lymphedema through a numerical rating, regardless of the
body type. This numerical rating makes the
index useful for evaluation of
lymphedema severities between different cases.
PMID: 21734534 [PubMed - as supplied by publisher
Integr Cancer Ther. 2011 Jul 6. [Epub ahead of print]
Impact of Yoga on Functional Outcomes in Breast Cancer Survivors With
Aromatase Inhibitor-Associated
Arthralgias.
Galantino ML, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ.
Source
The Richard Stockton College of New Jersey, Pomona, NJ, USA; University of
Pennsylvania, Philadelphia,
PA, USA.
Abstract
Arthralgia affects postmenopausal breast cancer survivors (BCSs) receiving
aromatase inhibitors (AIs). This
study aims to establish the feasibility of
studying the impact of yoga on objective functional outcomes, pain,
and
health-related quality of life (HR-QOL) for AI-associated arthralgia (AIAA).
Postmenopausal women
with stage I to III breast cancer who reported AIAA
were enrolled in a single-arm pilot trial. A yoga
program was provided twice
a week for 8 weeks. The Functional Reach (FR) and Sit and Reach (SR) were
evaluated as primary outcomes. Pain, as measured by the Brief Pain Inventory
(BPI), self-reported Patient
Specific Functional Scale (PSFS), and
Functional Assessment of Cancer Therapy-Breast (FACT-B) were
secondary
outcomes. Paired t tests were used for analysis, and 90% provided data for
assessment at the
end of the intervention. Participants experienced
significant improvement in balance, as measured by FR,
and flexibility, as
measured by SR. The PSFS improved from 4.55 to 7.21, and HR-QOL measured by
FACT-B also improved; both P < .05. The score for the Pain Severity
subscale of the BPI reduced. No
adverse events nor development or worsening
of lymphedema was observed. In all, 80% of participants
adhered to the home
program. Preliminary data suggest that yoga may reduce pain and improve balance
and
flexibility in BCSs with AIAA. A randomized controlled trial is needed
to establish the definitive efficacy of
yoga for objective functional
improvement in BCSs related to AIAA.
PMID: 21733988 [PubMed - as supplied by publisher]
Page updated
11/30/11
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Lymphland
International Lymphedema Online
Email Tina
September 5, 2011
Wkly Epidemiol Rec. 2011 Aug 5;86(32):341-51.
Meeting of the International Task Force for Disease Eradication, April
2011.
[Article in English, French]
[No authors listed]
PMID: 21837843 [PubMed - indexed for MEDLINE]
Int Wound J. 2011 Aug 17. doi: 10.1111/j.1742-481X.2011.00832.x. [Epub ahead
of print]
The experience of patients with lymphoedema undergoing a period of
compression bandaging in the UK and
Canada using the 3M™ Coban™ 2
compression system.
Morgan PA, Murray S, Moffatt CJ, Young H.
Source
PA Morgan, RN, EdD, Centre for Research and Implementation of
Clinical Practice, London, UK S
Murray, RN, MA, Department of Lymphoedema,
Royal Derby Hospital, Derby Hospitals NHS Foundation
Trust, Uttoxeter Road,
Derby DE22 3NE, UK CJ Moffatt, RN, PhD, Department of Lymphoedema, Royal
Derby Hospital, Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby
DE22 3NE, UK and
Division of Nursing and Healthcare, University of Glasgow,
Glasgow G12 8LW, UK H Young, RN, MSc,
St Giles Hospice, Fisherwick Road,
Whittington, Staffordshire WS14 9YT, UK.
Abstract
This article reports on a qualitative study that explored the
experience of patients who have undergone a
period of complete decongestive
therapy using the 3M™ Coban™ 2 compression system (Coban 2
system).
Qualitative data were collected from 12 patients from the UK and 8 from Canada
with a range of
presentations of lymphoedema. Single semi-structured
interviews were used and participants were asked
questions relating to their
experience of diagnosis, the impact of lymphoedema on their lives, previous
treatment using multilayer lymphoedema bandaging and their experiences of
the 3M™ Coban™ 2 system.
Treatment with multilayer lymphoedema bandaging was
seen as constraining in that it was tiring, time
consuming, heavy, bulky and
led to feelings of clumsiness and a restricted life. Treatment with the 3M™
Coban™ 2 system was reported as enabling in that it was quicker and easier
to apply, increased mobility,
enhanced patient confidence and provided a
sense of control and well-being. The article also explores how
aspects of
the 3M™ Coban™ 2 system might be improved from the patient's point of view.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com
Inc.
PMID: 21848728 [PubMed - as supplied by publisher]
Int Wound J. 2011 Aug 17. doi: 10.1111/j.1742-481X.2011.00845.x. [Epub ahead
of print]
The challenges of managing complex lymphoedema/chronic oedema in the UK and
Canada.
Morgan PA, Murray S, Moffatt CJ, Honnor A.
Source
PA Morgan, RN, EdD, Centre for Research and Implementation of
Clinical Practice, St Luke's Crypt,
Sydney Street, London SW3 6NH, UK S
Murray, RN, MA, Royal Derby Hospital, Derby Hospitals NHS
Foundation Trust,
Uttoxeter Road, Derby DE22 3NE, UK CJ Moffatt, RN, PhD, Royal Derby Hospital,
Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK.
Faculty of Medicine,
Division of Nursing and Healthcare, University of
Glasgow, Glasgow G12 8LW, UK A Honnor, RN, BSc,
MSc, LOROS Hospice, Groby
Road, Leicester LE3 9QE, UK.
Abstract
This article explores the professional challenges of treating
patients with complex/severe forms of chronic
oedema/lymphoedema with
compression therapy. Four focus groups were held, two in the UK and two in
Canada, to examine the challenges faced by practitioners in their everyday
practice. A number of challenges
were identified by participants in both
countries and include the changing profile of lymphoedema/chronic
oedema and
how increasing complexity is outpacing the development of services and
research-based
guidelines. Focus groups also highlighted a lack of public
awareness, poor professional knowledge, delayed
diagnosis and inappropriate
treatment as having a significant impact on practice. Other practice-related
issues include a poor understanding of treatment options among
practitioners, a lack of evidence-based
practice as well as difficulties
associated with managing psychosocial problems and of ensuring concordance
with treatment. In Canada, services tend to be more rural and remote than in
the UK, autonomous specialist
practice is less developed and practitioners
were generally less confident and felt more vulnerable than their
UK
colleagues. There is a need for integrated, multi-disciplinary services in both
countries, with improved
education and training, as well as the development
of cost-effective compression bandaging systems that can
make a major
contribution to meeting the challenges of contemporary lymphoedema practice.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com
Inc.
PMID: 21848727 [PubMed - as supplied by publisher]
Infect Immun. 2011 Aug 29. [Epub ahead of print]
Filarial Lymphatic Pathology Reflects Augmented TLR-mediated, MAPK-mediated
Pro-inflammatory
Cytokine Production.
Babu S, Anuradha R, Pavan Kumar N,
George PJ, Kumaraswami V, Nutman TB.
Source
National Institutes of Health-International Center for Excellence
in Research, Chennai, India.
Abstract
Lymphatic filariasis can be associated with the development of
serious pathology in the form of lymphedema,
hydrocele, and elephantiasis in
a subset of infected patients. Toll-like receptors (TLRs) are thought to play a
major role in the development of filarial pathology. To elucidate the role
of TLRs in the development of
lymphatic pathology, we examined cytokine
responses to different Toll ligands in patients with lymphatic
pathology
(CP), infected patients with subclinical pathology (INF), and uninfected,
endemic normal (EN)
individuals. TLR 2, 7 and 9 ligands induced
significantly elevated production of Th1 and other pro-
inflammatory
cytokines in CP patients in comparison to both INF and EN. TLR adaptor
expression was not
significantly different among the groups; however, both
TLR2 and TLR9 ligands induced significantly higher
levels of phosphorylation
of ERK1/2 and p38 MAP kinases as well as increased activation of NF-κB in CP
individuals. Pharmacologic inhibition of both ERK1/2 and p38 MAP kinase
pathways resulted in significantly
diminished production of pro-inflammatory
cytokines in CP individuals. Our data, therefore, strongly suggest
an
important role for TLR2- and TLR9-mediated pro-inflammatory cytokine induction
and activation of
both the MAPK and NF-κB pathways in the development of
pathology in human lymphatic filariasis.
PMID: 21875961 [PubMed - as supplied by publisher]
J Altern Complement Med. 2011 Sep;17(9):867-9.
Lymphedema after breast or gynecological cancer: use and effectiveness of
mainstream and complementary
therapies.
Finnane A, Liu Y, Battistutta D,
Janda M, Hayes SC.
Source
1 School of Public Health, Queensland University of Technology ,
Brisbane, Queensland, Australia .
Abstract
Abstract Objectives: The purpose of this study was to describe
the use, as well as perceived effectiveness,
of mainstream and complementary
and alternative medicine (CAM) therapies in the treatment of
lymphedema
following breast or gynecological cancer. Further, the study assessed the
relationship between
the characteristics of lymphedema (including type,
severity, stability, and duration), and the use of CAM
and/or mainstream
treatment. Methods: This was a cross-sectional study using a convenience sample
of
women with lymphedema following breast and gynecological cancers. A
self-administered questionnaire was
sent to 247 potentially eligible women.
Of those returned (50%), 23 were ineligible and 6 were excluded
due to level
of missing data. Results: In the previous 12 months, the majority of women (90%)
had used
mainstream treatments to treat their lymphedema, with massage being
the most commonly used (86%). One
(1) in 2 women had used CAM to treat their
lymphedema, and 98% of those using CAM were also using
mainstream
treatments. Over 27 types of CAM were reported, with use of a chi machine,
vitamin E
supplements, yoga, and meditation being the most commonly reported
forms. The perceived effectiveness
ratings (1-7 with 7=completely effective)
of mainstream (mean±standard deviation (SD): 5.3±1.5) and
CAM therapies
(mean±SD: 5.2+1.6) were considered high. Conclusions: These results demonstrate
that
mainstream and CAM treatment use is common, varied, and considered to
be effective among women with
lymphedema following breast or gynecological
cancer. Furthermore, it highlights the immediate need for
larger prospective
studies assessing the inter-relationship between the use of mainstream and CAM
therapies for treatment success.
PMID: 21875352 [PubMed - in process]
Phys Ther. 2011 Aug 25. [Epub ahead of print]
Complete Decongestive Physical Therapy in a Patient With Secondary Lymphedema
Due to Orthopedic
Trauma and Surgery of the Lower Extremity.
Cohen
MD.
Source
a home-based and outpatient therapy practice focusing on lymphedema
management in Nassau County,
New York. Dr Cohen was a clinical specialist at
New York Presbyterian Hospital-Weill Cornell Medical
Center, New York, New
York, at the time of the case report.
Abstract
BACKGROUND AND PURPOSE:
/b>This case report describes a
patient who developed lower-extremity lymphedema secondary to
orthopedic
trauma and surgery and reports the response to complete decongestive physical
therapy (CDP),
with 8 treatment sessions over 3 months.
CASE DESCRIPTION:
/b>The patient was a 56-year-old man who sustained a
right ankle displaced fibular fracture, underwent
open reduction internal
fixation surgery 12 days later, and developed lymphedema 4 months postinjury.
The
patient's impairments of the right lower extremity included increased
girth, decreased ankle range of motion,
and increased pain. Due to these
impairments and the inability to fit into normal footwear, the patient limited
activities such as ambulating long distances and climbing stairs. This
limited activity restricted him from
participating in his normal lifestyle
activities such as walking his dog in the community and performing all
necessary work duties.
OUTCOMES:
/b>Using the truncated cone formula to measure limb volume,
the limb volume of the right (involved) lower
extremity decreased 368 mL as
a result of CDP. The percentage of difference in limb volume between the
right and left lower extremities at the initial examination was 9%, and it
was reduced to less than 1% at
discharge. He was independent with his home
program in order to maintain the results of therapy.
CONCLUSION:
/b>Physical therapy management of secondary lymphedema due
to orthopedic trauma and surgery of the
lower extremity resulted in
decreased circumferential girth measurements and decreased limb volume,
thereby improving gait and allowing the patient to fit into his work and
leisure shoes. The patient reported
improvement in his ability to perform
all work activities, and he returned to his prior level of participation in
the community.
PMID: 21868611 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Aug 24. [Epub ahead of print]
The Surgical Treatment of Lymphedema: A Systematic Review of the Contemporary
Literature (2004-
2010).
Cormier JN, Rourke L, Crosby M, Chang D, Armer
J.
Source
Department of Surgical Oncology, University of Texas MD Anderson
Cancer Center, Houston, TX, USA,
[email protected].
Abstract
PURPOSE:
A systematic review of the literature was performed
to examine contemporary peer-reviewed literature
(2004-2010) evaluating the
surgical treatment of lymphedema.
METHODS:
A comprehensive search of 11 major medical indices was performed.
Selected articles were sorted to
identify those related to the surgical
treatment of lymphedema. Extracted data included the number of
patients,
specific surgical procedure performed, length of follow-up, criteria for
defining lymphedema,
measurement methods, volume or circumference reduction,
and reported complications.
RESULTS:
A total of 20 studies met inclusion criteria; procedures were
categorized as excisional procedures (n = 8),
lymphatic reconstruction (n =
8), and tissue transfer (n = 4). The reported incidence of volume reduction of
lymphedema in these studies varied from 118% reduction to a 13% increase
over the follow-up intervals
ranging from 6 months to 15 years. The largest
reported reductions were noted after excisional procedures
(91.1%),
lymphatic reconstruction (54.9%), and tissue transfer procedures (47.6%).
Procedure
complications were rarely reported.
CONCLUSIONS:
A number of surgical approaches have demonstrated beneficial
effects for select patients with lymphedema.
Most of these reports, however,
are based on small numbers of patients, use nonstandardized or
inconsistent
measurement techniques, and lack long-term follow-up. The proposed benefits of
any surgical
approach should be evaluated in the context of the potential
morbidity to the individual patient and the
availability of surgical
expertise. In addition, although these surgical techniques have shown promising
results,
nearly all note that the procedures do not obviate the need for
continued use of conventional therapies,
including compression, for
long-term maintenance.
PMID: 21863361 [PubMed - as supplied by publisher]
Cancer Treat Rev. 2011 Aug 17. [Epub ahead of print]
Electrochemotherapy of chest wall breast cancer recurrence.
Sersa G, Cufer
T, Paulin SM, Cemazar M, Snoj M.
Source
Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana,
Slovenia.
Abstract
Chest wall breast cancer recurrence after mastectomy is a disease
difficult to treat. Its incidence varies
between 5% and 30% in different
subset of patients. When possible, radical surgical therapy represents the
main treatment approach, however when the disease progresses and/or
treatments are not successful,
ulceration, bleeding, lymphedema and
psychological distress of progressive disease significantly decrease the
quality of the remaining life of a patient. When surgical excision of chest
wall recurrence is not possible, other
local treatments such as
radiotherapy, radiotherapy with hyperthermia, topical chemotherapy and
electrochemotherapy might be taken into account. Electrochemotherapy
provides safe, efficient and non-
invasive locoregional treatment approach
for chest wall breast cancer recurrence. Several clinical studies
have
demonstrated high efficacy and a good safety profile of electrochemotherapy
applied in single or
multiple consecutive sessions, till clinical response
was reached. Electrochemotherapy can be performed
either with cisplatin
injected intratumorally or with bleomycin given intratumorally or intravenously.
Furthermore, it can be effectively used in heavily pre-treated areas, after
surgery, radiotherapy or systemic
chemotherapy. These are the advantages
that might demand its use especially in patients with pre-treated
extensive
disease and in frail elderly patients. With development of the technology
electrochemotherapy
could even be suggested as a primary local therapy in
patients not suitable for surgical removal of the
primary tumor.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21856080 [PubMed - as supplied by publisher
Clin Dermatol. 2011 Sep-Oct;29(5):483-8.
Opportunistic localization of skin lesions on vulnerable areas.
Ruocco V,
Ruocco E, Brunetti G, Sangiuliano S, Wolf R.
Source
Department of Dermatology, Second University of Naples, via Sergio
Pansini, 5, 80131 Napoli, Italy.
Abstract
Genetic, developmental, and immune defects can make certain
anatomic areas of the body more prone than
others to harbor skin lesions.
Cutaneous areas with skin barrier dysfunction (eg, atopic dermatitis) are the
clearest example of vulnerable sites where opportunistic diseases, mainly
infections (eg, herpes simplex), can
easily occur. Somatic mosaicism, by
giving rise to mutated cell clones with a bandlike arrangement, may
form
tissue segments prone to developing congenital or acquired skin disorders.
Cutaneous districts that
have been infected by herpes viruses become sites
permissive for a subsequent onset of heterogeneous skin
disorders, mainly
tumors, further infections, and disimmune reactions (Wolf isotopic response).
Regional
lymphedema, by impairing lymph circulation and consequently the
local immune control, favors the location
of immunity-related lesions in the
involved district. A vast series of skin injuries, such as ionizing or
ultraviolet
radiation, burns, traumas, and even vaccinations, can render the
affected areas vulnerable to subsequent
cutaneous disorders. Lack of immune
control, ensuing from locally altered neuroimmune interaction, may be
the
basic defect responsible for the opportunistic location of skin lesions in
herpes-infected,
lymphedematous, or otherwise damaged areas, together
featuring the novel concept of
"immunocompromised district."
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21855722 [PubMed - in process]
September 8, 2011
J Glob Infect Dis. 2011 Jul;3(3):227-32.
Impact of basic lymphedema management and antifilarial treatment on acute
dermatolymphangioadenitis
episodes and filarial antigenaemia.
El-Nahas H,
El-Shazly A, Abulhassan M, Nabih N, Mousa N.
Source
Department of Parasitology, Faculty of Medicine, Mansoura
University, Mansoura, Egypt.
Abstract
BACKGROUND:
A major factor in the progression of lymphedema is
acute dermatolymphangioadenitis (ADLA).
AIMS:
To study ADLA episodes and antigenaemia in patients with different
grades of filarial lymphedema at pre-
and two years post-treatment.
SETTING AND DESIGN:
A prospectively conducted study from May 2008 through
May 2010.
PATIENTS AND METHODS:
Forty five patients complaining of limb swelling
with present or past history of limb redness suggestive of
ADLA attacks were
included. Patients were clinically examined for lymphedema grading, detection of
potential entry points and diagnosis of microfilaraemia. Wuchereria
bancrofti antigen titer was estimated by
"Trop-Ag W. Bancrofti" ELISA kit.
Basic lymphedema management and treatment with antifilarial drugs
were
applied.
STATISTICAL ANALYSIS:
Mann-Whitney test and Chi-square test were used.
RESULTS:
The number of ADLA attacks in the pretreatment period, ranged
from one to three per year. Mean duration
of the attacks was 3.87±0.79 days.
Entry points were detected in 82% of cases. The study revealed
statistical
significance between extension and grade of lymphedema and number of ADLA
attacks per year
(P=0.018 and 0.022, respectively). Microfilaraemia was
detected in four cases and positive filarial
antigenaemia were detected in
29 patients (64.4). The number of ADLA attacks per year significantly
decreased from the pre-treatment period (mean: 2.05±0.560) to be 1.23±0.706
after one year and 0.89±0.
575 after two years post treatment. There was a
significant decrease in the mean antigen titer one year and
two years after
treatment.
CONCLUSION:
Basic lymphedema management is effective for controlling ADLA
attacks in areas where lymphatic filariasis
is endemic.
PMID: 21887053 [PubMed - in process] PMCID: PMC3162808
BMJ. 2011 Sep 1;343:d5326. doi: 10.1136/bmj.d5326.
Effect of manual lymph drainage in addition to guidelines and exercise
therapy on arm lymphoedema related
to breast cancer: randomised controlled
trial.
Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets A, Leunen K,
Neven P, Van Kampen M.
Source
Department of Rehabilitation Sciences, Katholieke Universiteit
Leuven and Department of Physiotherapy,
University Hospitals Leuven, Leuven,
Belgium.
Abstract
OBJECTIVE:
To determine the preventive effect of manual lymph
drainage on the development of lymphoedema related to
breast cancer.
DESIGN:
Randomised single blinded controlled trial.
SETTING:
University Hospitals Leuven, Leuven, Belgium.
PARTICIPANTS:
160 consecutive patients with breast cancer and unilateral
axillary lymph node dissection. The randomisation
was stratified for body
mass index (BMI) and axillary irradiation and treatment allocation was
concealed.
Randomisation was done independently from recruitment and
treatment. Baseline characteristics were
comparable between the groups.
INTERVENTION:
For six months the intervention group (n=79) performed a
treatment programme consisting of guidelines
about the prevention of
lymphoedema, exercise therapy, and manual lymph drainage. The control group
(n=81) performed the same programme without manual lymph drainage.
MAIN OUTCOME MEASURES:
Cumulative incidence of arm lymphoedema and time to
develop arm lymphoedema, defined as an increase in
arm volume of 200 mL or
more in the value before surgery.
RESULTS:
Four patients in the intervention group and two in the control
group were lost to follow-up. At 12 months
after surgery, the cumulative
incidence rate for arm lymphoedema was comparable between the intervention
group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval
0.6 to 2.9; P=0.45). The
time to develop arm lymphoedema was comparable
between the two group during the first year after
surgery (hazard ratio 1.3,
0.6 to 2.5; P=0.49). The sample size calculation was based on a presumed odds
ratio of 0.3, which is not included in the 95% confidence interval. This
odds ratio was calculated as
(presumed cumulative incidence of lymphoedema
in intervention group/presumed cumulative incidence of no
lymphoedema in
intervention group)×(presumed cumulative incidence of no lymphoedema in control
group/presumed cumulative incidence of lymphoedema in control group) or
(10/90)×(70/30).
CONCLUSION:
Manual lymph drainage in addition to guidelines and exercise
therapy after axillary lymph node dissection for
breast cancer is unlikely
to have a medium to large effect in reducing the incidence of arm lymphoedema in
the short term. Trial registration Netherlands Trial Register No NTR
1055.
PMID: 21885537 [PubMed - in process]
September 24, 2011
Plast Reconstr Surg. 2011 Oct;128(4):372e.
Reply:
acute lymphedema of the eyelid after major reconstruction of the medial canthus:
the role of the
lymphatic drainage pattern.
Pan WR, Le Roux CM, Briggs
CA.
Source
Jack Brockhoff Reconstructive Plastic Surgery Research Unit,
Department of Anatomy and Cell Biology,
University of Melbourne, Melbourne,
Victoria, Australia.
PMID: 21921753 [PubMed - in process]
Plast Reconstr
Surg. 2011 Oct;128(4):370e-2e.
Acute lymphedema of the eyelid after major
reconstruction of the medial canthus: the role of the lymphatic
drainage
pattern.
Aveta A, Tenna S, Segreto F, Cagli B, Brunetti B, Marangi GF,
Persichetti P.
Source
Plastic and Reconstructive Surgery Unit, Campus
Bio-Medico University of Rome, Rome, Italy.
PMID: 21921751 [PubMed - in
process]
Plast Reconstr Surg. 2011 Oct;128(4):314e-21e.
The earliest
finding of indocyanine green lymphography in asymptomatic limbs of lower
extremity
lymphedema patients secondary to cancer treatment: the modified
dermal backflow stage and concept of
subclinical lymphedema.
Yamamoto T,
Matsuda N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M,
Narushima
M, Iida T, Koshima I.
Source
Tokyo, Japan From the
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine,
University of Tokyo.
Abstract
BACKGROUND:
: Early diagnosis and
treatment are as important for management of secondary lymphedema following
cancer
treatment as in primary cancer treatment. Indocyanine green
lymphography is the modality of choice for
routine follow-up evaluation of
patients at high risk of developing lymphedema after cancer
therapy.
METHODS:
: Fifty-six limbs of 28 so-called unilateral secondary
lower extremity lymphedema patients who underwent
indocyanine green
lymphography were compared with dermal backflow patterns of indocyanine green
lymphography on 28 asymptomatic limbs and assessed using leg dermal backflow
stage.
RESULTS:
: Of 28 asymptomatic limbs of secondary lower extremity
lymphedema patients, the dermal backflow
patterns were detected in 19 limbs
but were absent in nine limbs. Significant differences were seen between
asymptomatic limbs with dermal backflow patterns (n = 19) and limbs without
them (n = 9): age, 51.4 ±
15.3 years versus 34.8 ± 12.7 years (p = 0.007);
body weight, 75.1 ± 7.9 kg versus 50.1 ± 5.3 kg (p =
0.012); body mass
index, 23.1 ± 4.2 versus 19.7 ± 1.8 (p = 0.005); leg dermal backflow stage of
asymptomatic limb, 1.2 ± 0.4 versus 0.0 ± 0.0 (p < 0.001); and leg dermal
backflow stage of symptomatic
limb, 3.5 ± 0.6 versus 2.8 ± 0.8 (p =
0.033).
CONCLUSIONS:
: The splash pattern is the earliest finding on
indocyanine green lymphography of asymptomatic limbs of
secondary lower
extremity lymphedema patients. The leg dermal backflow stage allows early
diagnosis of
secondary lower extremity lymphedema even in a subclinical
stage. The concept of subclinical lymphedema
could play an important role in
early diagnosis and prevention of lymphedema after cancer treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE:: Diagnostic, V.
PMID: 21921744
[PubMed - in process]
Phys Ther. 2011 Sep 15. [Epub ahead of print]
Breast
Cancer-Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance
Model and a
Traditional Model of Care.
Stout NL, Pfalzer LA, Springer B,
Levy E, McGarvey CL, Danoff JV, Gerber LH, Soballe PW.
Source
N.L. Stout,
MPT, CLT-LANA, National Naval Medical Center, Breast Care Center, 8901 Wisconsin
Ave, Bldg 10, 4 West, Bethesda, MD 20814 (USA).
Abstract
Secondary
prevention involves monitoring and screening to prevent negative sequelae from
chronic diseases
such as cancer. Breast cancer treatment sequelae, such as
lymphedema, may occur early or late and often
negatively affect function.
Secondary prevention through prospective physical therapy surveillance aids in
early identification and treatment of breast cancer-related lymphedema
(BCRL). Early intervention may
reduce the need for intensive rehabilitation
and be cost saving. This perspective article compares a
prospective
surveillance model with a traditional model of impairment-based care and
examines direct
treatment costs associated with each program. Intervention
and supply costs were estimated based on the
Medicare 2009 physician fee
schedule for 2 groups: (1) a prospective surveillance model group (PSM
group) and (2) a traditional model group (TM group). The PSM group comprised
all women with breast
cancer who were receiving interval prospective
surveillance, assuming that one third would develop early-
stage BCRL. The
prospective surveillance model includes the cost of screening all women plus the
cost of
intervention for early-stage BCRL. The TM group comprised women
referred for BCRL treatment using a
traditional model of referral based on
late-stage lymphedema. The traditional model cost includes the direct
cost
of treating patients with advanced-stage lymphedema. The cost to manage
early-stage BCRL per
patient per year using a prospective surveillance model
is $636.19. The cost to manage late-stage BCRL
per patient per year using a
traditional model is $3,124.92. The prospective surveillance model is emerging
as the standard of care in breast cancer treatment and is a potential
cost-saving mechanism for BCRL
treatment. Further analysis of indirect costs
and utility is necessary to assess cost-effectiveness. A shift in the
paradigm of physical therapy toward a prospective surveillance model is
warranted.
PMID: 21921254 [PubMed - as supplied by publisher]
Eur J
Pediatr. 2011 Sep 15. [Epub ahead of print]
Hydrops fetalis and pulmonary
lymphangiectasia due to FOXC2 mutation: an autosomal dominant hereditary
lymphedema syndrome with variable expression.
de Bruyn G, Casaer A,
Devolder K, Van Acker G, Logghe H, Devriendt K, Cornette
L.
Source
University Hospital of Leuven, Herestraat 49, 3000, Leuven,
Belgium, [email protected].
Abstract
Non-immune
hydrops fetalis may find its origin within genetically determined lymphedema
syndromes,
caused by mutations in FOXC2 and SOX-18. We describe a newborn
girl, diagnosed with non-immune
hydrops fetalis at a gestational age of 30
weeks. Family history revealed the presence of an autosomal
dominant
late-onset form of lymphedema of the lower limbs in her father, associated with
an aberrant
implantation of the eyelashes in some individuals. The newborn,
hydropic girl suffered from severe
pulmonary lymphangiectasia, resulting in
terminal respiratory failure at the age of 3 months. Genetic analysis
in
both the father and the newborn girl demonstrated a heterozygous FOXC2 mutation,
i.e., c.939C>A, p.
Tyr313X. Her two older sisters are currently
asymptomatic and the parents decided not to test them for the
FOXC2
mutation. Conclusion: Patients with a mutation in the FOXC2 transcription factor
usually show
lower limb lymphedema with onset at or after puberty, together
with distichiasis. However, the eye
manifestations can be very mild and
easily overlooked. The association between FOXC2 mutation and
neonatal
hydrops resulting in terminal respiratory failure is not reported so far.
Therefore, in sporadic
patients diagnosed with non-immune hydrops fetalis,
lymphangiogenic genes should be systematically
screened for mutations. In
addition, all cases of fetal edema must prompt a thorough analysis of the
familial
pedigree, in order to detect familial patterns and to facilitate
adequate antenatal counseling.
PMID: 21918810 [PubMed - as supplied by
publisher]
September 24, 2011
J Cancer Res Clin Oncol. 2011 Sep 21. [Epub ahead of
print]
Safety study of axillary reverse mapping in the surgical treatment for
breast cancer patients.
Deng H, Chen L, Jia W, Chen K, Zeng Y, Rao N, Li S,
Jin L, Su F.
Source
Department of Breast Surgery, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, 107 Yanjiangxi
Road, Guangzhou, 510120,
People's Republic of China.
Abstract
PURPOSE:
With the purpose of
minimizing arm lymphedema after axillary staging surgeries in breast cancer
patients, the
axillary reverse mapping (ARM) technique has been developed to
identify and preserve arm drainage
system during axillary surgery. This
study aimed to clarify risk factors for metastasis in arm lymphatic
drainage
system in breast cancer patients with clinically negative axillary
nodes.
METHODS:
Sixty-nine patients who underwent successful both sentinel
lymph node (SLN) biopsy (SLNB) and ARM
from October 2009 to August 2010 were
enrolled in this study. Radioactive tracer was used for SLN
localization and
blue dye was used for ARM. All of the identified SLNs and ARM nodes were sent
for
pathological assessment.
RESULTS:
ARM nodes metastasis occured in
6 of 69 patients. Age, pathological tumor size (pT) and pathological
lymph
node status (pN) were not associated with ARM nodes metastasis (P > 0.01).
Interestingly, in these
6 patients, all metastatic ARM nodes coincided with
SLN-ARM nodes (hot SLN and blue ARM node
were the same lymph node). In 50 of
69 patients whose ARM nodes did not coincided with SLNs, all
ARM nodes were
negative, even in 12 patients with metastatic SLNs.
CONCLUSION:
Crossover
between breast and ipsilateral arm lymphatic drainage system contributes for
ipsilateral arm
lymph node metastasis. When ARM and SLNB are simultaneously
performed in a patient, selectively
preservation of the ARM nodes that do
not coincided with SLNs would be safe, even if the SLNs are
positive.
Pathological lymph node status does not account for the occurrence of metastasis
in ARM nodes.
ARM nodes could be preserved safely, independent of the
pathological lymph node status.
PMID: 21935615 [PubMed - as supplied by
publisher]
J Eur Acad Dermatol Venereol. 2011 Sep 20. doi:
10.1111/j.1468-3083.2011.04265.x. [Epub ahead of
print]
Skin
manifestations of obesity: a comparative study.
Boza JC, Trindade EN, Peruzzo
J, Sachett L, Rech L, Cestari TF.
Source
Department of Dermatology,
Federal University of Rio Grande do Sul (UFRGS), Hospital de Clínicas de
Porto Alegre (HCPA), Porto Alegre, Brazil.
Abstract
Background
Obesity is one of the world's biggest health problems nowadays. Little research
has been
done on the skin diseases that affect obese patients. Objective To
study the prevalence of skin
manifestations in obese patients compared with
a control group of normal-weight patients. Methods A
total of 76 obese
patients [body mass index (BMI) ≥30 kg/m(2) ] and 73 with normal-weight
volunteers
(BMI 18.5-24.9 kg/m(2) ) were included in the study and had their
complete medical history and skin
examination evaluated by the same
examiner. All patients were investigated for the presence of metabolic
syndrome. Results The dermatoses that showed a statistically significant
relationship with obesity,
compared with the control group were: striae
(P < 0.001), plantar hyperkeratosis (P < 0.001),
acrochordons
(P = 0.007), intertrigo (P < 0.001), pseudoacanthosis nigricans
(P < 0.001),
keratosis pilaris (P = 0.006), lymphedema (P = 0.002) and
bacterial infections (P = 0.05). The
presence of striae, pseudoacanthosis
nigricans and bacterial infections were also found to be correlated with
the
degree of obesity. Conclusions Obesity is strongly related to several skin
alterations that could be
considered as markers of excessive weight. Skin
care of obese patients deserves particular attention, not
only because of
the high prevalence of cutaneous alteration but mainly because many of these
disorders are
preventable and could be treated, improving patient's quality
of life.
© 2011 The Authors. Journal of the European Academy of Dermatology
and Venereology © 2011
European Academy of Dermatology and
Venereology.
PMID: 21929550 [PubMed - as supplied by publisher
September 19, 2011
Nat Genet. 2011 Sep 4. doi: 10.1038/ng.923. [Epub ahead
of print]
Mutations in GATA2 cause primary lymphedema associated with a
predisposition to acute myeloid
leukemia (Emberger syndrome).
Ostergaard
P, Simpson MA, Connell FC, Steward CG, Brice G, Woollard WJ, Dafou D, Kilo T,
Smithson
S, Lunt P, Murday VA, Hodgson S, Keenan R, Pilz DT, Martinez-Corral
I, Makinen T, Mortimer PS,
Jeffery S, Trembath RC, Mansour
S.
Source
1] Medical Genetics Unit, Biomedical Sciences, St. George's
University of London, London, UK. [2].
Abstract
We report an allelic
series of eight mutations in GATA2 underlying Emberger syndrome, an autosomal
dominant primary lymphedema associated with a predisposition to acute
myeloid leukemia. GATA2 is a
transcription factor that plays an essential
role in gene regulation during vascular development and
hematopoietic
differentiation. Our findings indicate that haploinsufficiency of GATA2
underlies primary
lymphedema and predisposes to acute myeloid leukemia in
this syndrome.
PMID: 21892158 [PubMed - as supplied by publisher]
Wkly
Epidemiol Rec. 2011 Aug 26;86(35):377-88.
Global Programme to eliminate
lymphatic filariasis: progress report on mass drug administration,
2010.
[Article in English, French]
[No authors listed]
September 19,
2011
Jpn J Clin Oncol. 2011 Sep 8. [Epub ahead of print]
The Incidence and
Predictor of Lymph Node Metastasis for Patients with T1mi Breast Cancer Who
Underwent Axillary Dissection and Breast Irradiation: An Institutional
Analysis.
Lee JH, Suh YJ, Shim BY, Kim SH.
Source
1Department of
Radiation Oncology, Seoul St. Mary' s Hospital, College of Medicine, The
Catholic
University of Korea, Suwon.
Abstract
OBJECTIVE:
This study
was designed to evaluate the rate and the predictors of axillary lymph node
metastasis in patients
with T1mi breast cancer.
METHODS:
We analyzed
62 cases of ductal carcinoma in situ with microinvasion, and the pathology
records and
treatment charts were retrospectively reviewed for information
on the patient and tumor characteristics. All
the included patients
underwent breast conserving surgery and 48 patients underwent axillary lymph
node
dissection.
RESULTS:
The incidence of axillary involvement was
8.3%. Comedo ductal carcinoma in situ (P = 0.031), histologic
grade 3 (P =
0.025), the presence of necrosis (P = 0.007) and Van Nuys group 3 (P = 0.025)
were
significant predictors of axillary involvement on the statistical
analysis. Axillary dissection was significantly
associated with the
occurrence of arm lymphedema (P = 0.030).
CONCLUSIONS:
A significant rate
of axillary metastases occurred in the patients with T1mi breast carcinoma in
this study.
The comedo subtype of ductal carcinoma in situ, a high
histologic grade, the presence of necrosis and the
Van Nuys group 3 were
significant predictors of axillary lymph node metastasis in patients with T1mi
breast
cancer. Thus, the patients with T1mi breast disease are indicated to
a careful evaluation of axillary lymph
node metastasis, if they have the
earlier-mentioned unfavorable factors.
PMID: 21903706 [PubMed - as supplied
by publisher]
September 19, 2011
Int Wound J. 2011 Sep 13. doi:
10.1111/j.1742-481X.2011.00851.x. [Epub ahead of print]
Prevalence of
lymphoedema and quality of life among patients attending a hospital-based wound
management and vascular clinic.
Gethin G, Byrne D, Tierney S, Strapp H,
Cowman S.
Source
G Gethin, PhD, HE Dip. Wound Care, RGN, Dip. Anatomy,
Dip. Applied Physiology, FFNMRCSI,
Centre for Nursing and Midwifery
Research, Royal College of Surgeons in Ireland, Dublin, Ireland D Byrne,
4th
year medical student, Trinity College Dublin, Dublin, Ireland S Tierney, BSc,
MCh, FRCSI, Royal
College of Surgeons in Ireland, Dublin, Ireland; Vascular
Surgery Unit, Adelaide & Meath Hospital, Dublin,
Ireland H Strapp, RGN,
RSCN, PG Dip., MSc Nursing, Vascular Surgery Unit, Adelaide & Meath
Hospital, Dublin, Ireland S Cowman, MSc, PhD, FFNMRCSI, PGCEA, RNT, DipN
(London), RGN,
Head of Department, Faculty of Nursing & Midwifery, Royal
College of Surgeons in Ireland, Dublin,
Ireland.
Abstract
Lymphoedema
is a chronic, incurable, debilitating condition, usually affecting a limb and
causes discomfort,
pain, heaviness, limited motion, unsatisfactory
appearance and impacts on quality of life. However, there is a
paucity of
prevalence data on this condition. This study aimed to determine the prevalence
of lymphoedema
among persons attending wound management and vascular clinics
in an acute tertiary referral hospital. Four
hundred and eighteen patients
meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n =
11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and
broken skin, 64% (n = 7) had
history of broken skin and 36% (n = 4) had
undergone treatment for venous leg ulcers. The most common
co-morbidities
were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3),
hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of
life scores identified that
physical functioning was the domain most
affected among this group. This study has identified the need to
raise
awareness of this condition among clinicians working in the area of wound
management.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and
Medicalhelplines.com Inc.
PMID: 21910829 [PubMed - as supplied by
publisher]
September 19, 2011
BMJ. 2011 Sep 1;343:d5326. doi:
10.1136/bmj.d5326.
Effect of manual lymph drainage in addition to guidelines
and exercise therapy on arm lymphoedema related
to breast cancer: randomised
controlled trial.
Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets
A, Leunen K, Neven P, Van Kampen M.
Source
Department of Rehabilitation
Sciences, Katholieke Universiteit Leuven and Department of Physiotherapy,
University Hospitals Leuven, Leuven,
Belgium.
Abstract
OBJECTIVE:
To determine the preventive effect of
manual lymph drainage on the development of lymphoedema related to
breast
cancer.
DESIGN:
Randomised single blinded controlled
trial.
SETTING:
University Hospitals Leuven, Leuven,
Belgium.
PARTICIPANTS:
160 consecutive patients with breast cancer and
unilateral axillary lymph node dissection. The randomisation
was stratified
for body mass index (BMI) and axillary irradiation and treatment allocation was
concealed.
Randomisation was done independently from recruitment and
treatment. Baseline characteristics were
comparable between the
groups.
INTERVENTION:
For six months the intervention group (n=79)
performed a treatment programme consisting of guidelines
about the
prevention of lymphoedema, exercise therapy, and manual lymph drainage. The
control group
(n=81) performed the same programme without manual lymph
drainage.
MAIN OUTCOME MEASURES:
Cumulative incidence of arm lymphoedema
and time to develop arm lymphoedema, defined as an increase in
arm volume of
200 mL or more in the value before surgery.
RESULTS:
Four patients in the
intervention group and two in the control group were lost to follow-up. At 12
months
after surgery, the cumulative incidence rate for arm lymphoedema was
comparable between the intervention
group (24%) and control group (19%)
(odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P=0.45). The
time to
develop arm lymphoedema was comparable between the two group during the first
year after
surgery (hazard ratio 1.3, 0.6 to 2.5; P=0.49). The sample size
calculation was based on a presumed odds
ratio of 0.3, which is not included
in the 95% confidence interval. This odds ratio was calculated as
(presumed
cumulative incidence of lymphoedema in intervention group/presumed cumulative
incidence of no
lymphoedema in intervention group)×(presumed cumulative
incidence of no lymphoedema in control
group/presumed cumulative incidence
of lymphoedema in control group) or (10/90)×(70/30).
CONCLUSION:
Manual
lymph drainage in addition to guidelines and exercise therapy after axillary
lymph node dissection for
breast cancer is unlikely to have a medium to
large effect in reducing the incidence of arm lymphoedema in
the short term.
Trial registration Netherlands Trial Register No NTR 1055.
PMID: 21885537
[PubMed - in process] PMCID: PMC3164214
October 28, 2011
–
J Indian Soc Periodontol. 2011 Jul;15(3):280-3.
A rare case of unusual
gingival enlargement post radiotherapy.
Singh V, Bhat GS, Bhat
KM.
Source
Department of Periodontics, Manipal College of Dental Sciences,
Manipal, Karnataka, India.
Abstract
Oral changes following radiotherapy
are not uncommon. Oral mucositis, alteration in salivary gland function,
radiation caries, and gingival changes have all been reported following
radiotherapy and chemotherapy. The
gingival changes seen after radiotherapy
may be unusual and often cause diagnostic dilemma. Metastasis to
the gingiva
has also to be ruled out in these cases. A 30-year-old female patient presented
with enlargement
of the gingiva of 6 months' duration and lower lip swelling
of 7 months' duration. She was a known case of
carcinoma of nasopharynx and
had received radiotherapy and chemotherapy. Based on the history, the
clinical appearance of the gingiva, and the other oral changes we considered
both post-radiotherapy gingival
enlargement and secondary metastasis to
gingiva as possibilities. An incisional biopsy was performed
(internal bevel
gingivectomy). The histopathological report did not reveal any metastatic
changes. Thus, we
diagnosed post-radiotherapy gingival enlargement. For the
multiple carious teeth, extraction and root canal
treatment was carried out
as necessary. The patient was referred to the department of Oral and
Maxillofacial Surgery for management of swelling of the lips, which was
diagnosed as lymphedema of the lip.
Gingival enlargement is rare post
radiotherapy. Such nonplaque-associated gingival enlargement in a patient
who has undergone radiotherapy should be subjected to biopsy and
histopathological examination to
distinguish between secondary metastasis
and post-radiation changes.
PMID: 22028519 [PubMed - in process]
Rozhl
Chir. 2011 Jun;90(6):343-7.
[Benefits of sentinel lymph node examination in
early breast carcinoma].
[Article in Slovak]
Mytnik M, Petrík J, Hanudel'
J, Wereb M, Klc J, Straka L.
Source
Chirurgická klinika FNsP PreSov,
Slovenská republika. [email protected]
Abstract
INTRODUCTION:
Sentinel
lymph node biopsy improves staging of disease, saves the axilla, and
significantly reduces the risk of
complications.
MATERIAL AND
METHODS:
The authors compare the two groups of surgical treatment of breast
cancer patients--after conventional
surgery with axillary exenteration with
a group of patients with sentinel node biopsy using gamma probe with
limited
power.
RESULTS:
In group of 42 patients after axillary exenteration
authors observed: hematoma in 2 patients, 1 postoperative
bleeding that need
for surgical revision, 2 patients had paresthesia and 1 patient had lymphedema,
which
represents 11.5% of complications. In the group of 54 patients after
limited exercise with the use of sentinel
biopsy and gamma probe authors
reported only one complication--an infected surgical wound seroma in the
axilla (1.8% complications).
CONCLUSION:
Examination of sentinel node
biopsy in combination with exact measurement of gamma probe allows friendly
operating performance in the axilla and significantly reduces the incidence
of postoperative complications.
PMID: 22026101 [PubMed - in
process] ahead of print]
[Psychosocial impact of breast cancer in
long-term survival: proposal of an integral follow-up care for
survivors.]
[Article in Spanish]
Vivar CG.
Source
Departamento
de Enfermería Comunitaria y Materno Infantil, Facultad de Enfermería,
Universidad de
Navarra, España.
Abstract
The aim of the article is to
show the psychosocial impact of breast cancer in the long-term survival and to
promote the idea of implementing a follow-up plan for survivors. A narrative
review of published articles on
the experience of survival in breast cancer
survivors was conducted. Data were organised according to the
domains of
measurement (physical, psychological and social) of the Quality of Life of
Long-term Breast
Cancer Survivors Scale (LTQOL-BC). Breast cancer survivors
may feel emotionally affected by the
physical sequels (mastectomy,
lymphedema, early menopause, and infertility), psychological (fear of
recurrence and emotional stress) and/or social (family relationships and
employment changes). The data are
the foundation of a proposal of specific
follow-up care for breast cancer survivors.
Copyright © 2010 Elsevier España,
S.L. All rights reserved.
PMID: 22019066 [PubMed - as supplied by
publisher]
October 25, 2011
Maturitas. 2011 Oct 18. [Epub ahead of
print]
Improving quality of life after breast cancer: Dealing with
symptoms.
Pinto AC, de Azambuja E.
Source
Department of Medical
Oncology, Portuguese Institute of Oncology Francisco Gentil, EPE - Coimbra, Av.
Bissaya Barreto, n° 98, Apartado 2005, 3001-651 Coimbra,
Portugal.
Abstract
BACKGROUND:
Advances in breast cancer therapies have
given rise to a growing number of patient survivors. Nevertheless,
these
women deal with long-term sequelae that impair their quality of life and that
are lacking satisfactory
assessment and expeditious management. Importantly,
a new era is raising in the oncology field, namely,
survivorship.
METHODS:
A search for English-language articles on
Medline was undertaken covering the last 15 years, using the terms
"cancer
survivorship", "quality of life", "fatigue", "insomnia", "sleep disturbances",
"depression", "cognitive
dysfunction", "chemofog", "peripheral neuropathy",
"fertility", "sexual behaviour", "menopause",
"lymphedema", "physical
activity" and "breast neoplasms". Selection was limited to systematic reviews
and
meta-analysis, but their reference list was examined to include papers
of potential interest.
RESULTS:
We found the most common symptoms
affecting breast cancer survivors were fatigue, insomnia, depression,
cognitive dysfunction, reproductive and menopausal symptoms and
lymphoedema.
CONCLUSION:
Some of these symptoms have even been the
objective of randomised controlled trials, but consistent data
are missing.
The available interventions include pharmacological, behavioural therapies and
complementary
and alternative medicine approaches and will mostly depend on
the type of symptom.
Copyright © 2011 Elsevier Ireland Ltd. All rights
reserved.
PMID: 22014722 [PubMed - as supplied by publisher
October 16,
2011
Am J Med Genet A. 2011 Nov;155(11):2762-5. doi: 10.1002/ajmg.a.34188.
Epub 2011 Sep 22.
Primary lymphedema with coarctation of the aorta: Possible
new syndrome or variant of Irons-Bianchi
syndrome?
Ferguson JS,
Gunatheesan S, Brice G, Hastings R, Newbury-Ecob R, Mortimer PS, Mansour
S.
Source
Department of Dermatology, St George's Healthcare NHS Trust,
London, UK. [email protected].
Abstract
We
present a boy with congenital lymphedema, a congenital heart defect (coarctation
of the aorta), and mild
dysmorphic features. Clinical impression and
targeted investigations ruled out Noonan syndrome and Milroy
syndrome, but
it was not clear whether or not he had Irons-Bianchi syndrome. We discuss the
genomic and
lymphoscintigraphy evaluation of this case, and review whether
the small number of current case reports
represent the original
Irons-Bianchi syndrome or variants. We anticipate that ongoing molecular
investigations such as Next Generation Sequencing will delineate a currently
clinically defined phenotypic
spectrum. © 2011 Wiley Periodicals,
Inc.
Copyright © 2011 Wiley Periodicals, Inc.
PMID: 21954173 [PubMed - in
process]
Methods Cell Biol. 2011;105:223-38.
Zebrafish provides a novel
model for lymphatic vascular research.
Karpanen T, Schulte-Merker
S.
Abstract
The mammalian lymphatic vasculature has an important function
in the maintenance of tissue fluid
homeostasis, absorption of dietary
lipids, and immune surveillance. The lymphatic vessels are also recruited
by
many tumors as primary routes for metastasis and mediate immune responses in
inflammatory diseases,
whereas dysfunction of the lymphatic drainage leads
to lymphedema. The characterization of a lymphatic
vasculature in zebrafish
has made the advantages of this small model organism, the suitability for
intravital
time-lapse imaging of developmental processes and the amenability
for chemical and forward genetic
screens, available to lymphatic vascular
research. Here we review our current understanding of embryonic
lymphangiogenesis in zebrafish, its molecular and anatomical similarities to
mammalian lymphatic vascular
development, and the possibilities zebrafish
offers to complement mouse models and cell culture assays in
the
lymphangiogenesis field.
Copyright © 2011 Elsevier Inc. All rights
reserved.
PMID: 21951532 [PubMed - in process]
Lymphology. 2011
Jun;44(2):72-81.
Measurement of lymphedema using ultrasonography with the
compression method.
Lim CY, Seo HG, Kim K, Chung SG, Seo
KS.
Source
Department of Rehabilitation Medicine, Seoul National
University Hospital, Seoul, Korea.
Abstract
Lymphedema is swelling of soft
tissues by accumulation of lymphatic fluid due to failure of the lymphatic
drainage system. Although most measures for lymphedema focus on change of
volume or size of the
extremity, the physical properties of the tissue such
as resistance to compression are also of clinical
importance because they
affect the quality of life of lymphedema patients. In this study, we aimed to
compare the thickness and resistance to compression of the skin and subcutis
between the affected and
unaffected arms of patients with lymphedema by
using ultrasonography together with the compression
technique, and we also
investigated the factors that have an influence on the results. Thirty-nine
patients with
post-mastectomy lymphedema participated in this study. All
ultrasonographically-assessed thicknesses of
skin and subcutaneous tissue in
affected upper arms and forearms were significantly larger than the
contralateral (p < 0.05) while all resistances to compression values were
significantly lower (p < 0.05).
These results suggest that measuring the
resistance to compression and thickness using the compression
method with
ultrasonography may be a valuable tool for evaluating lymphedema after breast
cancer surgery.
PMID: 21949976 [PubMed - indexed for MEDLINE]
Lymphology.
2011 Jun;44(2):65-71.
Changes in quality of life of patients with lymphedema
after lymphatic vessel transplantation.
Springer S, Koller M, Baumeister RG,
Frick A.
Source
Division of Plastic-, Hand- and Microsurgery, Department
of Surgery, Ludwig-Maximilians-University of
Munich, Campus Grosshadern,
Germany.
Abstract
There are multiple treatment options for patients with
chronic lymphedema, and one successful approach is
lymph vessel
transplantation. As quality of life assessments are frequently not utilized in
standard treatment
regimes, we investigated the change in quality of life
for patients with chronic lymphedema (total = 212) who
had undergone
lymphatic vessel transplantation and conservative therapy for at least 6 months
prior to
operation. Quality of life was assessed by a modified standard
questionnaire examining the physiological and
psychological status of the
patients. Results document a significant improvement in quality of life and
underscore success of autologous lymphatic vessel transplantation as a
therapy for lymphedema.
PMID: 21949975 [PubMed - indexed for
MEDLINE]
Lymphology. 2011 Jun;44(2):54-64.
Pathways of lymph and tissue
fluid flow during intermittent pneumatic massage of lower limbs with
obstructive lymphedema.
Olszewski WL, Cwikla J, Zaleska M,
Domaszewska-Szostek A, Gradalski T, Szopinska S.
Source
Department of
Surgical Research and Transplantology, Medical Research Center, Polish Academy
of
Sciences, Warsaw, Poland. [email protected]
Abstract
Questions
remain on the use of sequential pneumatic compression including where does the
fluid flow to and
whether fluid can be moved to the non-swollen tissues of
the hypogastrium and gluteal region? During
pneumatic massage of the limb,
we studied pathways of lymph and mobile tissue fluid flow using
lymphoscintigraphy: a) from the calf and thigh across the inguinal region to
the healthy non-swollen tissues of
the hypogastrium and b) in the
hypogastrium to the lateral and upper abdominal quadrants. To examine if
there was effective fluid flow during pneumatic massage, plethysmographic
flow measurements were also
carried out. We demonstrated that: (i) pneumatic
compression moved isotope in lymph remaining in
functioning lymphatics and
in tissue fluid in the interstitial space toward the inguinal region and femoral
channel, (ii) there was no isotope crossing the inguinal crease or moving to
the gluteal area, and (iii) isotope
injected intradermally in the
hypogastrium did not spread during manual massage to the upper and
contralateral abdominal quadrants. In conclusion, intermittent pneumatic
compression is effective in pushing
mobile tissue fluid and relocating large
fluid volumes toward the groin. However, the question that still
remains is
how to facilitate further flow toward the non-swollen tissues and thereby
increase local absorption
of fluid.
PMID: 21949974 [PubMed - indexed for
MEDLINE]
Int J Radiat Oncol Biol Phys. 2011 Sep 22. [Epub ahead of
print]
Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic
Techniques, Optimal Management
and Risk Reduction Strategies.
Shah C,
Vicini FA.
Source
Department of Radiation Oncology, William Beaumont
Hospital, Royal Oak, MI.
Abstract
As more women survive breast cancer,
long-term toxicities affecting their quality of life, such as lymphedema
(LE) of the arm, gain importance. Although numerous studies have attempted
to determine incidence rates,
identify optimal diagnostic tests, enumerate
efficacious treatment strategies and outline risk reduction
guidelines for
breast cancer-related lymphedema (BCRL), few groups have consistently agreed on
any of
these issues. As a result, standardized recommendations are still
lacking. This review will summarize the
latest data addressing all of these
concerns in order to provide patients and health care providers with
optimal, contemporary recommendations. Published incidence rates for BCRL
vary substantially with a
range of 2-65% based on surgical technique,
axillary sampling method, radiation therapy fields, and the use
of
chemotherapy. Newer clinical assessment tools can potentially identify BCRL in
patients with subclinical
disease with prospective data suggesting that
early diagnosis and management with noninvasive therapy can
lead to
excellent outcomes. Multiple therapies exist with treatments defined by the
severity of BCRL
present. Currently, the standard of care for BCRL in
patients with significant LE is complex decongestive
physiotherapy (CDP).
Contemporary data also suggest that a multidisciplinary approach to the
management
of BCRL should begin prior to definitive treatment for breast
cancer employing patient-specific surgical,
radiation therapy, and
chemotherapy paradigms that limit risks. Further, prospective clinical
assessments
before and after treatment should be employed to diagnose
subclinical disease. In those patients who require
aggressive locoregional
management, prophylactic therapies and the use of CDP can help reduce the
long-
term sequelae of BCRL.
Copyright © 2011 Elsevier Inc. All rights
reserved.
PMID: 21945108 [PubMed - as supplied by publisher]
J Am Coll
Surg. 2011 Oct;213(4):543-51. Epub 2011 Jul 28.
Preventative measures for
lymphedema: separating fact from fiction.
Cemal Y, Pusic A, Mehrara
BJ.
Source
Division of Plastic and Reconstructive Surgery, Department of
Surgery, Memorial Sloan-Kettering Cancer
Center, New York, NY.
PMID:
21802319 [PubMed - in process]
Am J Clin Oncol. 2011
Oct;34(5):506-10.
Estimating the probability of lymphedema after breast
cancer surgery.
Soran A, Wu WC, Dirican A, Johnson R, Andacoglu O, Wilson
J.
Source
Division of Surgical Oncology, Department of Surgery,
Magee-Womens Hospital of University of Pittsburgh
Medical Center, PA, USA.
[email protected]
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(2)
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 - in process]
October 16, 2011
Breast Cancer Res Treat. 2011 Sep
30. [Epub ahead of print]
A randomized clinical trial comparing advanced
pneumatic truncal, chest, and arm treatment to arm
treatment only in
self-care of arm lymphedema.
Ridner SH, Murphy B, Deng J, Kidd N, Galford E,
Bonner C, Bond SM, Dietrich MS.
Source
Vanderbilt University School of
Nursing, 461 21st Avenue South, Godchaux Hall, Nashville, TN, 37240,
USA, [email protected].
Abstract
Treatment
of the truncal lymphatics prior to treatment of the lymphedematous arm is an
accepted, although
not empirically tested, therapeutic intervention
delivered during decongestive lymphatic therapy (DLT).
Breast cancer
survivors with arm lymphedema are encouraged to use these techniques when
performing
simple lymphatic drainage as part of their life-long lymphedema
self-care. Self-massage is at times difficult
and pneumatic compression
devices are used by many patients to assist with self-care. One such device, the
Flexitouch(®) System, replicates the techniques used during DLT; however,
the need for application of
pneumatic compression in unaffected truncal
areas to improve self-care outcomes in arm only lymphedema
is not
established. The objective of this study was to compare the therapeutic benefit
of truncal/chest/arm
advanced pneumatic compression therapy (experimental
group) verses arm only pneumatic compression
(control group) in self-care
for arm lymphedema without truncal involvement using the Flexitouch(®)
System. Outcomes of interest were self-reported symptoms, function, arm
impedance ratios, circumference,
volume, and trunk circumference. Forty-two
breast cancer survivors, (21 per group), with Stage II
lymphedema completed
30 days of home self-care using the Flexitouch(®) System. Findings revealed a
statistically significant reduction in both the number of symptoms and
overall symptom burden within each
group; however, there were no
statistically significant differences in these outcomes between the groups.
There was no statistically significant overall change or differential
pattern of change between the groups in
function. A statistically
significant reduction in bioelectrical impedance and arm circumference within
both of
the groups was achieved; however, there was no statistically
significant difference in reduction between
groups. These findings indicate
that both configurations are effective, but that there may be no added benefit
to advanced pneumatic treatment of the truncal lymphatics prior to arm
massage when the trunk is not also
affected. Further research is indicated
in a larger sample.
PMID: 21960113 [PubMed - as supplied by publisher]
J
Vasc Surg. 2011 Sep 27. [Epub ahead of print]
Diagnosis and treatment of
venous lymphedema.
Raju S, Furrh JB 4th, Neglén P.
Source
The Rane
Center, Flowood, Miss.
Abstract
BACKGROUND:
Chronic venous disease
(CVD) is a common cause of secondary lymphedema. Venous lymphedema is
sometimes misdiagnosed as primary lymphedema and does not receive optimal
treatment. We have routinely
used intravascular ultrasound (IVUS) imaging in
all cases of limb swelling. The aim of this study is to show
that (1)
routine use of IVUS can detect venous obstruction missed by traditional venous
testing, and (2) iliac-
caval venous stenting can yield satisfactory clinical
relief and can sometimes reverse abnormal
lymphangiographic
findings.
METHODS:
The study comprised CVD patients who underwent iliac
vein stenting. Lymphangiography was abnormal in
72 of 443 CEAP C(3) limbs,
with leg swelling as the primary complaint (abnormal lymphangiography
group). Clinical features and stent outcome were compared with a control
group of 205 of 443 with normal
lymphangiography (normal lymphangiographic
group).
RESULTS:
Clinical features were a poor guide to the diagnosis of
lymphedema. Isotope lymphangiography was not
helpful in differentiating
primary from secondary lymphedema. Venography had 61% sensitivity to the
diagnosis of venous obstruction. IVUS had a sensitivity of 88% for
significant (≥50% area stenosis) venous
obstruction. At 40 months,
cumulative secondary stent patency was similar for the abnormal (100%) and
normal lymphangiographic (95%) groups. Swelling improved significantly after
stent placement in the
abnormal lymphangiographic group (mean [standard
deviation] swelling grade improvement 0.8 ± 1.1) but
was less (P < .004)
than in the control group (1.4 ± 1.3). Complete swelling relief was 16% and 44%
(P < .
001) and partial improvement (≥1 grade of swelling) was 45% and 66%
(P < .01) in the abnormal and
normal lymphangiographic groups,
respectively. Associated pain was present in 50% and 36% of the
swollen
limbs in the abnormal and normal lymphangiographic groups. Pain relief (≥3
visual analog scale) at
40 months was 87% and 83%, respectively (P = .3),
with 65% and 71%, experiencing complete pain relief.
Quality of life
criteria improved after stent placement in both groups but to a better extent in
the normal
lymphangiographic group. Abnormal lymphangiography improved or
normalized in 9 of 36 (25%) of those
tested after stent
correction.
CONCLUSIONS:
Prevailing practice patterns and diagnostic
deficiencies probably result in the misdiagnosis of many cases of
venous
lymphedema as "primary" lymphedema. IVUS is recommended to rule out venous
obstruction as the
associated or initiating cause of lymphedema. Iliac
venous stenting to correct the obstruction has excellent
long-term patency
and good clinical outcome, although results are not as good as in those with
normal
lymphatic function.
Copyright © 2011 Society for Vascular Surgery.
Published by Mosby, Inc. All rights reserved.
PMID: 21958566 [PubMed - as
supplied by publisher]
Jpn J Clin Oncol. 2011 Oct;41(10):1162-7. Epub 2011
Sep 8.
The incidence and predictor of lymph node metastasis for patients with
t1mi breast cancer who underwent
axillary dissection and breast irradiation:
an institutional analysis.
Lee JH, Suh YJ, Shim BY, Kim SH.
Source
*St.
Vincent's hospital, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do,
Republic of Korea.
[email protected].
Abstract
OBJECTIVE:
This
study was designed to evaluate the rate and the predictors of axillary lymph
node metastasis in patients
with T1mi breast cancer.
METHODS:
We
analyzed 62 cases of ductal carcinoma in situ with microinvasion, and the
pathology records and
treatment charts were retrospectively reviewed for
information on the patient and tumor characteristics. All
the included
patients underwent breast conserving surgery and 48 patients underwent axillary
lymph node
dissection.
RESULTS:
The incidence of axillary involvement
was 8.3%. Comedo ductal carcinoma in situ (P = 0.031), histologic
grade 3 (P
= 0.025), the presence of necrosis (P = 0.007) and Van Nuys group 3 (P = 0.025)
were
significant predictors of axillary involvement on the statistical
analysis. Axillary dissection was significantly
associated with the
occurrence of arm lymphedema (P = 0.030).
CONCLUSIONS:
A significant rate
of axillary metastases occurred in the patients with T1mi breast carcinoma in
this study.
The comedo subtype of ductal carcinoma in situ, a high
histologic grade, the presence of necrosis and the
Van Nuys group 3 were
significant predictors of axillary lymph node metastasis in patients with T1mi
breast
cancer. Thus, the patients with T1mi breast disease are indicated to
a careful evaluation of axillary lymph
node metastasis, if they have the
earlier-mentioned unfavorable factors.
PMID: 21903706 [PubMed - in
process]
Nat Genet. 2011 Sep 4;43(10):929-31. doi:
10.1038/ng.923.
Mutations in GATA2 cause primary lymphedema associated with a
predisposition to acute myeloid
leukemia (Emberger syndrome).
Ostergaard
P, Simpson MA, Connell FC, Steward CG, Brice G, Woollard WJ, Dafou D, Kilo T,
Smithson
S, Lunt P, Murday VA, Hodgson S, Keenan R, Pilz DT, Martinez-Corral
I, Makinen T, Mortimer PS,
Jeffery S, Trembath RC, Mansour
S.
Source
1] Medical Genetics Unit, Biomedical Sciences, St. George's
University of London, London, UK. [2].
Abstract
We report an allelic
series of eight mutations in GATA2 underlying Emberger syndrome, an autosomal
dominant primary lymphedema associated with a predisposition to acute
myeloid leukemia. GATA2 is a
transcription factor that plays an essential
role in gene regulation during vascular development and
hematopoietic
differentiation. Our findings indicate that haploinsufficiency of GATA2
underlies primary
lymphedema and predisposes to acute myeloid leukemia in
this syndrome.
PMID: 21892158 [PubMed - in process]
Breast Cancer Res
Treat. 2011 Nov;130(1):301-6. Epub 2011 Jul 7.
A SEER-Medicare
population-based study of lymphedema-related claims incidence following breast
cancer
in men.
Reiner AS, Jacks LM, Van Zee KJ, Panageas
KS.
Source
Department of Epidemiology and Biostatistics, Memorial
Sloan-Kettering Cancer Center, 307 East 63rd
Street, New York, NY, 10065,
USA, [email protected].
Abstract
Each year
there are an estimated 200,000 new breast cancer cases diagnosed in the United
States; of these,
1% of cases are in men. Lymphedema can be a devastating
complication from breast cancer and its
treatment. Currently, almost all
lymphedema-related research is based on women and extrapolated to men.
We
conducted the first population-based study of men with incident breast cancer of
any stage, diagnosed
from 1998 to 2005, who were 65 years and older in the
Surveillance, Epidemiology, and End Results
(SEER)-Medicare linked database.
We utilized claims related to lymphedema and lymphedema treatment in
our
cohort. We defined 'lymphedema-specific' claims to contain the word 'lymphedema'
in the Medicare
claim description; similarly, 'lymphedema-related' claims
were defined as treatments reimbursed for
lymphedema but not necessarily
containing the word 'lymphedema' in the Medicare claim description. We
identified 628 men with incident breast cancer from 1998 to 2005 who were 65
years and older. The
cumulative incidence, censored for deaths, of
lymphedema-specific claims at 2, 3, 4, and 5 years was 8.0,
9.2, 10.5, and
10.5%, respectively. The median follow-up was 3.4 years and for those without
any event
was 4.7 years. The cumulative incidence, censored for deaths, of
lymphedema-related claims at 2, 3, 4, and
5 years was 26.9, 32.2, 35.4, and
39.8%. Rates for men were similar to analogous rates for women.
Lymphedema
is a common complication affecting men with breast cancer as well as women and
appropriate
treatment and rehabilitation strategies need to be implemented
for both genders.
PMID: 21735047 [PubMed - in process]
Breast Cancer Res
Treat. 2011 Nov;130(1):227-34. Epub 2011 May 12.
Does the effect of weight
lifting on lymphedema following breast cancer differ by diagnostic method:
results
from a randomized controlled trial.
Hayes SC, Speck RM, Reimet E,
Stark A, Schmitz KH.
Source
Queensland University of Technology, School of
Public Health, Institute of Biomedical Innovation, Brisbane,
Australia.
Abstract
The lymphedema diagnostic method used in
descriptive or intervention studies may influence results found.
The
purposes of this work were to compare baseline lymphedema prevalence in the
physical activity and
lymphedema (PAL) trial cohort and to subsequently
compare the effect of the weight-lifting intervention on
lymphedema,
according to four standard diagnostic methods. The PAL trial was a randomized
controlled
intervention study, involving 295 women who had previously been
treated for breast cancer, and evaluated
the effect of 12 months of weight
lifting on lymphedema status. Four diagnostic methods were used to
evaluate
lymphedema outcomes: (i) interlimb volume difference through water displacement,
(ii) interlimb size
difference through sum of arm circumferences, (iii)
interlimb impedance ratio using bioimpedance
spectroscopy, and (iv) a
validated self-report survey. Of the 295 women who participated in the PAL
trial,
between 22 and 52% were considered to have lymphedema at baseline
according to the four diagnostic
criteria used. No between-group differences
were noted in the proportion of women who had a change in
interlimb volume,
interlimb size, interlimb ratio, or survey score of ≥5, ≥5, ≥10%, and 1 unit,
respectively
(cumulative incidence ratio at study end for each measure
ranged between 0.6 and 0.8, with confidence
intervals spanning 1.0). The
variation in proportions of women within the PAL trial considered to have
lymphoedema at baseline highlights the potential impact of the diagnostic
criteria on population surveillance
regarding prevalence of this common
morbidity of treatment. Importantly though, progressive weight lifting
was
shown to be safe for women following breast cancer, even for those at risk or
with lymphedema,
irrespective of the diagnostic criteria used.
PMID:
21562712 [PubMed - in process]
October 16, 2011
Br J Cancer. 2011 Oct
25;105(9):1279-87. doi: 10.1038/bjc.2011.407. Epub 2011 Oct 4.
Risk factors
for short- and long-term complications after groin surgery in vulvar
cancer.
Hinten F, van den Einden LC, Hendriks JC, van der Zee AG, Bulten J,
Massuger LF, van de Nieuwenhof
HP, de Hullu JA.
Source
Department of
Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box
9101,
6500 HB Nijmegen, The Netherlands.
Abstract
Background:The
cornerstone of treatment in early-stage squamous cell carcinoma (SCC) of the
vulva is
surgery, predominantly consisting of wide local excision with
elective uni- or bi-lateral inguinofemoral
lymphadenectomy. This strategy is
associated with a good prognosis, but also with impressive treatment-
related
morbidity. The aim of this study was to determine risk factors for the
short-term (wound breakdown,
infection and lymphocele) and long-term
(lymphoedema and cellulitis/erysipelas) complications after groin
surgery as
part of the treatment of vulvar SCC.Methods:Between January 1988 and June 2009,
164
consecutive patients underwent an inguinofemoral lymphadenectomy as part
of their surgical treatment for
vulvar SCC at the Department of Gynaecologic
Oncology at the Radboud University Nijmegen Medical
Centre. The clinical and
histopathological data were retrospectively analysed.Results:Multivariate
analysis
showed that older age, diabetes, 'en bloc' surgery and higher drain
production on the last day of drain in situ
gave a higher risk of developing
short-term complications. Younger age and lymphocele gave higher risk of
developing long-term complications. Higher number of lymph nodes dissected
seems to protect against
developing any long-term
complications.Conclusion:Our analysis shows that patient characteristics,
extension of surgery and postoperative management influence short- and/or
long-term complications after
inguinofemoral lymphadenectomy in vulvar SCC
patients. Further research of postoperative management is
necessary to
analyse possibilities to decrease the complication rate of inguinofemoral
lymphadenectomy;
although the sentinel lymph node procedure appears to be a
promising technique, in ∼50% of the patients an
inguinofemoral
lymphadenectomy is still indicated.
PMID: 21970884 [PubMed - in
process]
Eur Urol. 2011 Nov;60(5):1114-9. Epub 2010 Nov 24.
Assessment and
follow-up of patency after lymphovenous microsurgery for treatment of secondary
lymphedema in external male genital organs.
Mukenge SM, Catena M, Negrini
D, Ratti F, Moriondo A, Briganti A, Rigatti P, Cipriani F, Ferla
G.
Source
Department of Surgical Sciences, Università Vita e Salute, San
Raffaele, Milano, Italy.
Abstract
Secondary lymphedema of external male
genital organs is a frequent complication of pelvic radical surgery
following pelvic lymphadenectomy. Microsurgical lymphovenous anastomoses are
usually performed using
only the superficial scrotal lymphatics, excluding
testicular lymphatic drainage. We have experimented using
a new
microsurgical technique based on lymphovenous anastomosis between the collectors
of the spermatic
funiculus and the veins of the pampiniform plexus, allowing
testicular lymphatic drainage. The study included
11 patients with external
genital organ lymphedema, five of whom were subjected to microsurgical
lymphovenous derivation. At 3, 6, and 12 mo after surgery, the patency of
lymphovenous anastomoses was
assessed by noninvasive lymphography using
indocyanine green fluorescence images obtained with the
Photodynamic Eye
(PDE) infrared camera system (Hamamatsu Photonics K.K., Hamamatsu, Japan).
Progressive improvement of clinical conditions was assessed both by
patients' self evaluation and by
objective clinical follow-up based on: (1)
PDE lymphography, (2) tomography of the pubic area, (3)
recovery of the soft
consistency of the scrotal tissue, (4) recovery of the scrotal skin normochromic
aspect,
(5) absence of pain, and (6) disappearance of edema with evident
reduction of the scrotal and penile
dimensions and normal palpability of the
testis. The present study shows that lymphovenous anastomosis is a
valuable
method of resolving the edematous condition. The indocyanine green approach for
lymphangiography is a very supportive method during follow-up because, with
the least invasive approach, it
is possible to ascertain the complete
patency of the anastomosis, to confirm its localization, and to assess its
lymphatic drainage.
Copyright © 2010 European Association of Urology.
Published by Elsevier B.V. All rights reserved.
PMID: 21129845 [PubMed - in
process]
October 16, 2011
Curr Oncol. 2011 Oct;18(5):e218-26.
Caring
for survivors of breast cancer: perspective of the primary care
physician.
Smith SL, Wai ES, Alexander C, Singh-Carlson
S.
Source
Division of Radiation Oncology, Department of Surgery, Faculty
of Medicine, University of British
Columbia, Vancouver, and BC Cancer
Agency-Vancouver Island Centre, Victoria, BC.
Abstract
BACKGROUND AND
OBJECTIVES:
Increasing numbers of women are surviving breast cancer, and
survivorship care is becoming more complex.
Primary care physicians provide
care for most survivors of breast cancer in the Canadian province of British
Columbia. The present study offers insight into the confidence of primary
care physicians in their abilities to
provide such care. It also explores
potential ways to assist those providers in enhancing this aspect of their
practice.
METHODS:
A questionnaire was mailed to 1000 primary care
physicians caring for survivors of breast cancer. The
questionnaire explored
the perspectives of the responding physicians on their ability to manage various
aspects of survivorship care for breast cancer patients, identified
preferences for the content and format of
communication from oncologists at
the time of transition from active oncology treatment to survivorship, and
determined the means most commonly used to obtain knowledge about breast
cancer. This 1-page, 31-item
checkbox and open-answer questionnaire assessed
the perceptions of primary care physicians about the
care of breast cancer
survivors after completion of active treatment and their personal preferences
for
resources providing information about breast cancer.
RESULTS:
The
questionnaire response rate was 59%. Primary care physicians reported being most
confident in
screening for recurrence and managing patient anxiety; they
were least confident in managing lymphedema
and providing psychosocial
counselling. Compared with physicians following fewer survivors of breast
cancer, those who followed more breast cancer survivors had higher
confidence in managing the biomedical
aspects of follow-up and in providing
counselling about nutrition and exercise. Most physicians found
discharge
letters from oncologists to be useful. Point-form discharge information was
preferred by 43%;
detailed description, by 19%; and both formats, by 38%.
The most useful information items identified for
inclusion in a discharge
letter were a diagnosis and treatment summary and the recommended surveillance
and endocrine therapy. Continuing medical education events and online
resources were the means most
commonly used to obtain knowledge about breast
cancer.
CONCLUSIONS:
Primary care physicians who provide follow-up for
survivors of breast cancer report that they are confident
in managing care
and satisfied with discharge letters containing a diagnosis and treatment
summary, and
recommendations for surveillance and endocrine treatment. At
the time of patient discharge, additional
information about common medical
and psychosocial issues in this patient population would be useful to
primary care physicians. Preferred means to access current breast cancer
information include continuing
medical education events and online
resources.
PMID: 21980253 [PubMed - in process] PMCID:
PMC3185903
Support Care Cancer. 2011 Oct 7. [Epub ahead of print]
Racial
disparities in physical and functional domains in women with breast
cancer.
Morehead-Gee AJ, Pfalzer L, Levy E, McGarvey C, Springer B, Soballe
P, Gerber L, Stout NL.
Source
Rehabilitation Medicine Department, Clinical
Center, National Institutes of Health, Bethesda, MD,
USA.
Abstract
INTRODUCTION:
African-American women are more likely than
white women to have functional impairments after breast
cancer (BC) surgery;
however, no differences were found in self-reported health status surveys at 12+
months postsurgery.
PURPOSE:
This analysis compared white and
African-American BC survivors' (BCS) health status, health-related
quality
of life, and the occurrence of physical impairments after BC
treatment.
METHODS:
One hundred sixty-six women (130 white, 28
African-American, 8 other) were assessed for impairments
preoperatively and
at 1, 3, 6, 9, and 12+ months postsurgery. Health status was assessed at 12+
months
using the Short Form Health Survey (SF36v2™). Analysis of variance
estimated differences between
groups for health status and impairment
occurrence.
RESULTS:
No differences were found between groups for BC type,
stage, grade, or tumor size; surgery type; or
number of lymph nodes sampled.
African-American BCS had more estrogen/progesterone receptor-
negative tumors
(p < 0.001; p = 0.036) and received radiation more frequently (p = 0.03).
More
African-American BCS were employed (p = 0.022) and reported higher
rates of social activities (p =
0.011) but less recreational activities
(p = 0.020) than white BCS. African-American BCS had higher
rates of cording
(p = 0.013) and lymphedema (p = 0.011) postoperatively. No differences were
found
in self-reported health status.
CONCLUSION:
In a military
healthcare system, where access to care is ubiquitous, there were no significant
differences in
many BC characteristics commonly attributed to race.
African-American women had more ER/PR-negative
tumors; however, no other BC
characteristics differed between racial groups. African-American women
exhibited more physical impairments, although their BC treatment only
differed regarding radiation therapy.
This suggests that African-American
BCS may be at higher risk for physical impairments and should be
monitored
prospectively for early identification and treatment.
PMID: 21979903 [PubMed
- as supplied by publisher]
Cochrane Database Syst Rev. 2011 Oct
5;(10):CD007103.
Dance/movement therapy for improving psychological and
physical outcomes in cancer patients.
Bradt J, Goodill SW, Dileo
C.
Source
Department of Creative Arts Therapies, College of Nursing and
Health Professions, Drexel University, 1505
Race Street, rm 1041,
Philadelphia, PA, USA, 19102.
Abstract
BACKGROUND:
Current cancer care
increasingly incorporates psychosocial interventions. Cancer patients use
dance/movement therapy to learn to accept and reconnect with their bodies,
build new self-confidence,
enhance self-expression, address feelings of
isolation, depression, anger and fear and to strengthen personal
resources.
OBJECTIVES:
To compare the effects of dance/movement
therapy and standard care with standard care alone or standard
care and
other interventions in patients with cancer.
SEARCH STRATEGY:
We searched
the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane
Library
2011, Issue 2), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science
Citation Index,
CancerLit, International Bibliography of Theatre and Dance,
Proquest Digital Dissertations, ClinicalTrials.
gov, Current Controlled
Trials and the National Research Register (all to March 2011). We handsearched
dance/movement therapy and related topics journals, reviewed reference lists
and contacted experts. There
was no language restriction.
SELECTION
CRITERIA:
We included all randomized and quasi-randomized controlled trials
of dance/movement therapy interventions
for improving psychological and
physical outcomes in patients with cancer.
DATA COLLECTION AND
ANALYSIS:
Two review authors independently extracted the data and assessed
the methodological quality. Results were
presented using standardized mean
differences.
MAIN RESULTS:
We included two studies with a total of 68
participants. No evidence was found for an effect of
dance/movement therapy
on body image in women with breast cancer. The data of one study with moderate
risk of bias suggested that dance/movement therapy had a large beneficial
effect on participants' quality of
life (QoL). The second trial reported a
large beneficial effect on fatigue. However, this trial was at high risk
of
bias. The individual studies did not find support for an effect of
dance/movement therapy on mood,
distress,and mental health. It is unclear
whether this was due to ineffectiveness of the treatment or limited
power of
the trials. Finally, the results of one study did not find evidence for an
effect of dance/movement
therapy on shoulder range of motion (ROM) or arm
circumference in women who underwent a lumpectomy
or breast surgery.
However, this was likely due to large within-group variability for shoulder ROM
and a
limited number of participants with lymphedema.
AUTHORS'
CONCLUSIONS:
We did not find support for an effect of dance/movement therapy
on body image. The findings of one study
suggest that dance/movement therapy
may have a beneficial effect on QoL. However, the limited number of
studies
prevents us from drawing conclusions concerning the effects of dance/movement
therapy on
psychological and physical outcomes in cancer patients.
PMID:
21975762 [PubMed - in process]
Clin Nucl Med. 2011
Nov;36(11):1031-2.
Scrotal lymphedema mimicking urine leakage.
Bozkurt H,
Sürücü E, Bekiş R.
Source
From the Department of Nuclear Medicine, School
of Medicine, Dokuz Eylül University, Izmir, Turkey.
Abstract
Tc-99m
diethylene triamine pentaacetic acid (DTPA) dynamic renal scan is widely used to
evaluate
urological complications after renal transplantation, especially
for urine leakage. Although the most common
site of urine leakage is based
on urethrovesical anastomoses, it can also be seen anywhere in the abdomen,
even in the scrotum. In our case, we showed scrotal lymphedema caused
false-positive result for scrotal
urine leakage detected by Tc-99m DTPA
dynamic renal scan.
PMID: 21975396 [PubMed - in process
J Tissue
Viability. 2011 Nov;20(4):107. Epub 2011 Oct 5.
Tissue viability society
update.
Hopkins A.
Source
Wound Care and Lymphoedema Service, Mile End
Hospital, Bancroft Road, London E14DG, United
Kingdom.
PMID: 21975010
[PubMed - in process]
PM R. 2011 Oct 4. [Epub ahead of print]
Segmental
Limb Volume Change as a Predictor of the Onset of Lymphedema in Women With Early
Breast
Cancer.
Stout NL, Pfalzer LA, Levy E, McGarvey C, Springer B,
Gerber LH, Soballe P.
Source
National Naval Medical Center, 8901 Wisconsin
Avenue, Breast Care Center Bldg. 19, 3rd floor,
Bethesda, MD
20889-5600.
Abstract
OBJECTIVE:
To demonstrate that segmental changes
along the upper extremity occur before the onset of breast cancer-
related
lymphedema (BCRL). These changes may be subclinical in nature and may be
predictive of the onset
of chronic lymphedema.
DESIGN:
A retrospective
subset analysis of a larger prospective cohort trial. PATIENT COHORT: A total of
196
patients provided consent and were enrolled in the prospective study.
Subclinical lymphedema developed in
46 of these patients. Limb volume data
were available for 45 of these 46 patients from visits before the
onset of
lymphedema and were used in this analysis. We compared this group with an
age-matched control
group without BCRL from the same cohort (n =
45).
SETTING:
Military hospital outpatient breast care
center.
METHODS:
Women were enrolled and assessed preoperatively. Baseline
measures of limb volume were obtained with
the use of optoelectronic
perometry, and reassessment was conducted at 1, 3, 6, 9, and 12 months
postoperatively. BCRL was identified in 46 of 196 women at an average of 6.9
months postoperatively. A
retrospective analysis was conducted in which we
examined volume changes over four 10-cm segments of
the limb at the visits
before the onset of BCRL. By using repeated-measures multivariate analysis of
variance, we compared segmental volumes between groups at preoperative
baseline, time of diagnosis of
BCRL, and time of follow-up after early
intervention. Linear regression analysis was performed to determine
the
strength of the relationship between total limb volume change with segmental
volumes at the time of
diagnosis of BCRL.
MAIN OUTCOME
MEASUREMENTS:
We hypothesized that segmental volume changes occur and can be
measured in the limb before the onset of
lymphedema.
RESULTS:
At arm
segments 10-20 cm (P = .044) and 20-30 cm (P <.001), a significant volume
increase was noted
before the diagnosis of subclinical BCRL. Segmental
volume changes correlated to the total limb volume
(TLV) change. At segments
20-30 cm, the coefficient of determination was r(2) = 0.952, and at 10-20 cm
it was r(2) = 0.845, suggesting that these segments predicted TLV changes.
Serial interval assessment of
limb volume segments may be an important
clinical tool to detect early-onset lymphedema before TLV
changes.
Copyright © 2011 American Academy of Physical Medicine and
Rehabilitation. Published by Elsevier Inc.
All rights reserved.
PMID:
21974905 [PubMed - as supplied by publisher]
Am J Physiol Cell Physiol. 2011
Sep 21. [Epub ahead of print]
Lymphatic function is regulated by a
coordinated expression of lymphangiogenic and anti-lymphangiogenic
cytokines.
Zampell J, Avraham T, Yoder N, Fort N, Yan A, Weitman ES,
Mehrara BJ.
Source
Memorial Sloan-Kettering Cancer
Center.
Abstract
Lymphangiogenic cytokines such as vascular endothelial
growth factor-C (VEGF-C) are critically required
for lymphatic regeneration;
however, in some circumstances, lymphatic function is impaired despite normal
or elevated levels of these cytokines. The recent identification of
anti-lymphangiogenic molecules such as
interferon-gamma (IFN-γ),
transforming growth factor-beta 1, and endostatin has led us to hypothesize that
impaired lymphatic function may represent a dysregulated balance in the
expression of pro/anti-
lymphangiogenic stimuli. We observed that nude mice
have significantly improved lymphatic function as
compared with wild-type
mice in a tail model of lymphedema. We show that gradients of lymphatic fluid
stasis regulate the expression of lymphangiogenic cytokines (VEGF-A, VEGF-C,
and hepatocyte growth
factor) and that paradoxically, the expression of
these molecules is increased in wild-type mice. More
importantly, we show
that as a consequence of T-cell mediated inflammation, these same gradients also
regulate expression patterns of anti-lymphangiogenic molecules corresponding
temporally and spatially with
impaired lymphatic function in wild-type mice.
We show that neutralization of IFN-γ significantly increases
inflammatory
lymph node lymphangiogenesis independently of changes in VEGF-A or VEGF-C
expression,
suggesting that alterations in the balance of pro- and
anti-lymphangiogenic cytokine expression can regulate
lymphatic vessel
formation. In conclusion, we show that gradients of lymphatic fluid stasis
regulate not only
the expression of pro-lymphangiogenic cytokines but also
potent suppressors of lymphangiogenesis as a
consequence of T-cell
inflammation and that modulation of the balance between these stimuli can
regulate
lymphatic function.
PMID: 21940662 [PubMed - as supplied by
publisher]
Eur J Surg Oncol. 2011 Sep 19. [Epub ahead of print]
Prevalence
of lymphoedema more than five years after breast cancer treatment.
Lopez
Penha TR, Slangen JJ, Heuts EM, Voogd AC, Von Meyenfeldt
MF.
Source
Department of Surgery, Maastricht University Medical Centre,
P.O. Box 5800, 6202 AZ Maastricht,
Netherlands.
Abstract
AIM:
A
lack of consistency in the definition of breast cancer related lymphoedema
(BCRL) and of uniform
measurement criteria contribute to the wide prevalence
range found in current literature. This report aims to
describe the
long-term prevalence of BCRL and secondly, to compare the long-term prevalence
of BCRL
when assessed by two objective measures and one subjective
measure.
METHODS:
The upper-limbs of 145 post-surgical breast cancer
patients were evaluated for the presence of
lymphoedema using the water
displacement method. Two circumference methods and patient perceived
swelling were applied secondarily for comparison. Limb measurements were
performed once, more than
five years after surgery.
RESULTS:
The
long-term prevalence of BCRL using water displacement was 8%. Prevalence varied
when the sum of
arm circumference (SOAC), the arm circumference and the
self-report methods were used: 16, 31 and
17% [P < 0.001], respectively.
Of the women identified with BCRL using the water displacement technique,
82% were detected with the SOAC method, 82% with the arm circumference
method and 91% by self-
report. Using water displacement as the gold standard
the methods with the highest specificities were the
SOAC (90%) and
self-report method (89%), arm circumference resulted in a low specificity of
73%.
CONCLUSION:
The prevalence of BCRL more than five years after
surgical treatment differs depending on the measuring
method used. Our data
underlines the necessity for consensus on the diagnostic criteria for
BCRL.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21937192
[PubMed - as supplied by publisher]
October 24, 2011
Acta Trop. 2011
Sep;120 Suppl 1:S55-61. Epub 2011 Apr 4.
Efficacy of home-based lymphoedema
management in reducing acute attacks in subjects with lymphatic
filariasis
in Burkina Faso.
Jullien P, Somé J, Brantus P, Bougma RW, Bamba I, Kyelem
D.
Source
Handicap International, 14 Avenue Berthelot, 69007 Lyon,
France.
Abstract
One of the two main goals of the Global Programme to
Eliminate Lymphatic Filariasis (LF) is to provide
care for those suffering
from the devastating clinical manifestations of this filarial infection. Among
the 120
million infected people worldwide, up to 16 million have
lymphoedema. The WHO strategy for managing
lymphoedema is based on rigorous
skin hygiene, exercise, antibiotics and antifungals when indicated. The
aim
is to reduce acute attacks of adenolymphangitis and cellulitis responsible for
lymphoedema progression
and disability. The objective of our study was to
assess the effectiveness of home-based lymphoedema
management implemented by
the national health system of Burkina Faso. Any patient was eligible to
participate in the study if suffering from LF-related lymphoedema of a lower
limb at any stage, and receiving
care as part of the health education and
washing project between April 2005 and December 2007. The
primary readout
was the occurrence of an acute attack in the month preceding the consultation
reported by
the patient or observed by the care-giver. In all, 1089 patients
were enrolled in the study. Before
lymphoedema management intervention,
78.1% (95%CI: 75.5-80.5) of the patients had an acute attack in
the month
preceding the consultation; after four and half months of lymphoedema
management, this was
reduced to 39.1% (95%CI: 36.2-42.1). A reduction of
acute attacks related to the number of consultations
or related to the
patients' age and gender was not observed. Our results suggest that the
home-based
lymphoedema management programme in the primary health care
system of Burkina Faso is effective in
reducing morbidity due to LF in the
short-term (4.5 months). The lymphoedema management requires no
additional
human resources, but whether its effect can be sustained remains to be
seen.
Copyright © 2011. Published by Elsevier B.V.
PMID: 21470557 [PubMed
- in process]
Acta Trop. 2011 Sep;120 Suppl 1:S62-8. Epub 2011 Apr
4.
Rapid community identification, pain and distress associated with
lymphoedema and adenolymphangitis due
to lymphatic filariasis in
resource-limited communities of North-eastern Nigeria.
Akogun OB, Akogun MK,
Apake E, Kale OO.
Source
The Elephantiasis Project, Common Heritage
Foundation, No. 27 Shelter Road, Federal Housing Estate
Phase 2, Bajabure,
Box 5124, Yola, Nigeria.
Abstract
Identification of communities with
people that could benefit from adenolymphangitis (ADL) and
lymphoedema
morbidity management within Lymphatic Filariasis Elimination Programmes (NLFEP)
in many
African countries is a major challenge to programme managers.
Another challenge is advocating for
proportionate allocation of funds to
alleviating the suffering that afflicted people bear. In this study we
developed a rapid qualitative technique of identifying communities where
morbidity management programme
could be situated and documenting the pain
and distress that afflicted persons endure. Estimates given by
health
personnel and by community resource persons were compared with systematic
household surveys for
the number of persons with lymphoedema of the lower
limb. Communities in Northeastern Nigeria, with the
largest number of
lymphoedema cases were selected and a study of local knowledge, physical,
psychosocial
burden and intervention-seeking activities associated with the
disease documented using an array of
techniques (including household
surveys, key informant interviews, group discussions and informal
conversations). Health personnel gave a more accurate estimate of the number
of lymphoedema patients in
their communities than either the community
leader or the community directed ivermectin distributor (CDD).
Community
members with lymphoedema preferred to confide in health personnel from other
communities.
The people had a well developed local vocabulary for
lymphoedema and are well aware of the indigenous
transmission theories.
Although the people associated the episodic ADL attacks with the rains which
were
more frequent at that period they did not associate the episodes with
gross lymphoedema. There were
diverse theories about lymphoedema causation
with heredity, accidental stepping on charmed objects and
organisms,
breaking taboos. The most popular belief about causation, however, is witchcraft
(60.9%). The
episodic attacks are dreaded by the afflicted, since they are
accompanied by severe pain (18%). The
emotional trauma included rejection
(27.5%) by family, friends and other community members to the extent
that
divorce and isolation are common. Holistic approach to lymphoedema morbidity
management should
necessarily be an integral component of the ongoing
transmission elimination programme. Any transmission
prevention effort that
ignores the physical and psychological pain and distress that those already
afflicted
suffer is unethical and should not be promoted.
Copyright ©
2011 Elsevier B.V. All rights reserved.
PMID: 21470556 [PubMed - in
process]
Acta Trop. 2011 Sep;120 Suppl 1:S69-75. Epub 2010 Oct
23.
Management of adenolymphangitis and lymphoedema due to lymphatic
filariasis in resource-limited North-
eastern Nigeria.
Akogun OB, Badaki
JA.
Source
The Elephantiasis Project, Common Heritage Foundation, No. 27
Shelter Road, Federal Housing Estate
Phase 2, Bajabure, Box 5124, Yola,
Nigeria.
Abstract
Procedures for health facility-based management of
lymphoedema and adenolymphangitis (ADL) have
proved very effective in some
countries. Unfortunately, in resource-poor communities of Africa where health
facilities are few, overburdened and inaccessible, an alternative approach
is required. Community-based
care (CC), patient care (PC) and health
facility care (HC) approaches were compared. In the CC arm,
communities were
required to select one of their members for care-giving to its affected members,
while in
the PC, participants were allocated to groups under a leader with
responsibility for care giving to group
members. In HC, care was given by
the nearest health facility. Caregivers from the three arms were trained
and
supplies were kept at the local government health office. At the sixth month of
intervention, 325
lymphoedema and adenolymphangitis patients had been
recruited into the study as participants. Within 12
months, compliance with
hygiene practices increased from 29.4% to 62.6% and ADL episodes declined
from 43.1% to 4.4% in the community designs arm and the cost on the health
system was minimal.
However, in the patient and health care arms, compliance
and accessibility to supplies was severely affected
by poor coordination,
delay in resource collection leading to very minimal effect on lesions, odour,
ADL
frequency and duration. Participants abandoned the health facilities
after the second visit. Community care
approach was more culturally
acceptable and effective for the management lymphoedema and ADL than
other
approaches.
Copyright © 2010 Elsevier B.V. All rights reserved.
PMID:
20974106 [PubMed - in process
J Cancer Surviv. 2011 Oct 16. [Epub ahead of
print]
Exercise in patients with lymphedema: a systematic review of the
contemporary literature.
Kwan ML, Cohn JC, Armer JM, Stewart BR, Cormier
JN.
Source
Division of Research, Kaiser Permanente, 2000 Broadway,
Oakland, CA, 94612, USA, Marilyn.L.
[email protected].
Abstract
BACKGROUND:
Controversy
exists regarding the role of exercise in cancer patients with or at risk for
lymphedema,
particularly breast. We conducted a systematic review of the
contemporary literature to distill the weight of
the evidence and provide
recommendations for exercise and lymphedema care in breast cancer
survivors.
METHODS:
Publications were retrieved from 11 major medical
indices for articles published from 2004 to 2010 using
search terms for
exercise and lymphedema; 1,303 potential articles were selected, of which 659
articles
were reviewed by clinical lymphedema experts for inclusion,
yielding 35 articles. After applying exclusion
criteria, 19 articles were
selected for final review. Information on study design/objectives, participants,
outcomes, intervention, results, and study strengths and weaknesses was
extracted. Study evidence was also
rated according to the Oncology Nursing
Society Putting Evidence Into Practice® Weight-of-Evidence
Classification.
RESULTS:
Seven studies were identified addressing
resistance exercise, seven studies on aerobic and resistance
exercise, and
five studies on other exercise modalities. Studies concluded that slowly
progressive exercise of
varying modalities is not associated with the
development or exacerbation of breast cancer-related
lymphedema and can be
safely pursued with proper supervision. Combined aerobic and resistance exercise
appear safe, but confirmation requires larger and more rigorous
studies.
CONCLUSIONS:
Strong evidence is now available on the safety of
resistance exercise without an increase in risk of
lymphedema for breast
cancer patients. Comparable studies are needed for other cancer patients at risk
for
lymphedema. IMPLICATIONS FOR CANCER SURVIVORS: With reasonable
precautions, it is safe for
breast cancer survivors to exercise throughout
the trajectory of their cancer experience, including during
treatment.
PMID: 22002586 [PubMed - as supplied by
publisher]
Cytotherapy. 2011 Nov;13(10):1249-55.
Autologous stem cells for
the treatment of post-mastectomy lymphedema: a pilot study.
Maldonado GE,
Pérez CA, Covarrubias EE, Cabriales SA, Leyva LA, Pérez JC, Almaguer
DG.
Source
Hospital Universitario 'Dr José Eleuterio González',
Universidad Autónoma de Nuevo León , México.
Abstract
Abstract Background
aims. Lymphedema is a common complication with breast cancer treatment that does
not have a definite cure. Our objective was to determine the efficacy of
autologous stem cells (ASC) in the
treatment of lymphedema secondary to
mastectomy and axillary lymphadenectomy in comparison with
traditional
decongestive treatment with compression sleeves. Methods. A prospective study
including 20
women with lymphedema secondary to breast cancer surgery with
axillary lymphadenectomy was
conducted. Women were assigned at random to one
of two groups. One group of 10 women was injected
with ASC in the affected
arm, whereas the other 10 women comprised the control group and received
traditional compression sleeve therapy (CST). The follow-up for both groups
was 12 weeks. Pain,
sensitivity and mobility were assessed before and after
therapy. Results. There was improvement in the
volume of lymphedema in both
groups, with no significant difference. In the ASC group there was an overall
volume reduction during the follow-up, whereas in the CST group lymphedema
recurred after the
compression sleeve was removed. Conclusions. Our findings
suggest that ASC injection for patients with
lymphedema can be an effective
treatment. It reduces arm volume and associated co-morbidities of pain and
decreased sensitivity. Traditional CST was also effective for lymphedema
reduction, but it was dependent
on continuous use of the treatment.
PMID:
21999374 [PubMed - in process]
Int J Gynecol Cancer. 2011
Nov;21(8):1495-9.
Do surgical techniques used in groin lymphadenectomy for
vulval cancer affect morbidity rates?
Walker KF, Day H, Abu J, Nunns D,
Williamson K, Duncan T.
Source
*Derby Royal Hospital, Derby; †Royal Albert
Edward Infirmary, Lancashire; ‡Nottingham University
Hospitals, Nottingham;
and §Norfolk and Norwich University Hospital, Norwich,
UK.
Abstract
OBJECTIVE:
: To determine the complication rates
associated with differing surgical techniques for groin node dissection
for
vulval cancer.
MATERIALS AND METHODS:
: We performed a retrospective case
note review of patients undergoing groin node dissection for vulval
cancer
between 2001 and 2009 at Nottingham University Hospitals NHS
Trust.
RESULTS:
: Notes for 56 patients undergoing a total of 98 groin
node dissections were examined. Sixty-four percent of
the patients had at
least one complication from surgery. The use of suction drains was not
associated with an
increase in complications. However, when drains were
used, a short duration of use was associated with
high rates of wound
breakdown and a long duration of use was associated with higher rates of
lymphedema.
The use of staples for skin closure was associated with an
increased risk of lymphocysts and chronic
lymphedema. The greater the number
of nodes collected at lymphadenectomy, the higher the risk of
lymphocysts
and lymphedema.
CONCLUSIONS:
: We recommend the use of subcuticular suture
for wound closure. Patients who undergo lymphadenectomy
with a node count
per groin of more than 7 should be closely monitored for lymphedema and referred
promptly to specialist services. The prolonged use of suction drainage may
increase the risk of lymphedema.
PMID: 21997167 [PubMed - in
process]
Scand J Immunol. 2011 Oct 13. doi: 10.1111/j.1365-3083.2011.02653.x.
[Epub ahead of print]
T- and B-cell Deficiency Associated with Yellow Nail
Syndrome.
Gupta S, Samra D, Yel L, Agrawal S.
Source
Division of Basic
and Clinical Immunology, University of California, Irvine,
California.
Abstract
Yellow nail syndrome (YNS) is a rare disorder of
unknown etiology that is characterized by yellow nails
associated with
lymphedema, and chronic respiratory manifestations. There are no detailed
immunological
studies in YNS. In this study we present first extensive
immunological analysis of both adaptive and innate
immunity in two patients
with YNS. One patient has common variable immunodeficiency, whereas, second
patient has specific antibody deficiency syndrome. Severe lymphopenia, and a
striking deficiency of naïve
CD4+ and CD8+ T cells and total B cells, and
increased transitional B cells were observed. T cell
proliferative response
to mitogens and antigens were significantly reduced in both patients. Both
patients
failed to make specific antibody response to pneumococci.
Complement, NK cell activity, and neutrophil
oxidative burst were normal.
Immunoglobulin administration resulted in decreased frequency and severity of
infections, and an impressive effect was observed on lymphedema and on the
recurrence of pleural effusion.
Our data show that YNS is associated with
both T and B cell defects. Furthermore, Immunoglobulin may be
beneficial in
clinical manifestations of lymphedema.
Copyright © 2011 Blackwell Publishing
Ltd.
PMID: 21995335 [PubMed - as supplied by publisher]
November 1,
2011
J Pharm Sci. 2011 Oct 26. doi: 10.1002/jps.22795. [Epub ahead of
print]
Influence of route of administration and liposomal encapsulation on
blood and lymph node exposure to the
protein VEGF-C156S.
Bhansali SG,
Balu-Iyer SV, Morris ME.
Source
Department of Pharmaceutical Sciences,
School of Pharmacy and Pharmaceutical Sciences, University at
Buffalo,
Amherst, New York 14260-1200.
Abstract
VEGF-C156S is a recombinant form of
human vascular endothelial growth factor C (VEGF-C), which
targets the
receptor VEGFR-3 present in the lymphatics. VEGF-C156S has lymphangiogenic
properties
and may represent a potential therapeutic approach in treating
the lymphatic disease lymphedema. In the
present study, we tested the
hypotheses that (1) subcutaneous (s.c.) injection will provide higher lymphatic
exposure than intravenous (i.v.) administration of VEGF-C156S and (2) s.c.
injection of liposomal (s.c.
Lipo) VEGF-C156S will provide greater lymphatic
exposure than nonliposomal proteins. The protein
VEGF-C156S was radiolabeled
with Iodine-125 by a modified chloramine-T method and encapsulated into
liposomes. The protein was injected at a dose of 125 μg/kg to mice i.v. or
s.c.; the liposomal preparation
was administered s.c. (s.c. Lipo). Blood and
lymph nodes were collected over 24 h. The mean residence
time in lymph nodes
after s.c. or s.c. (Lipo) administration was approximately double that following
i.v.
administration. The area under the concentration-time curve (AUC) ratio
of lymph node-blood after s.c.
administration of VEGF-C156S was more than
double of the AUC ratio after i.v. administration. The results
suggest that
lymph node exposure of VEGF-C156S was significantly higher after s.c.
administration of
liposomal or nonliposomal protein as compared with i.v.
administration. © 2011 Wiley-Liss, Inc. and the
American Pharmacists
Association J Pharm Sci.
Copyright © 2011 Wiley-Liss, Inc.
PMID: 22030745
[PubMed - as supplied by publisher
November 15, 2011
Br J Nurs. 2011 Oct 28-Nov 10;20(19):1246-51.
Using
Actico bandaging for chronic oedema/lymphoedema management.
Pike
C.
Abstract
Actico has been used successfully within clinical and
community settings and is best used as part of a multi-
layered lymphoedema
bandaging (MLLB) system. This system is designed to produce a semi-rigid casing
that is comfortable enough to allow patients to continue with their
activities and exercises so as to generate
an optimal resisted muscle pump
action within. Correct application is key to using this cohesive short-stretch
bandage, and collaborative working between clinics and community nurses is
made easier through using
Actico as part of oedema management. The case
studies enclosed aim to illustrate the use of Actico MLLB
for both patients
and clinicians.
PMID: 22067837 [PubMed - in process]
Lymphat Res Biol.
2011;9(3):159-67.
Surgical management of lymphedema: past, present, and
future.
Mehrara BJ, Zampell JC, Suami H, Chang DW.
Source
1 The
Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial
Sloan-Kettering
Cancer Center , New York, New York.
Abstract
Abstract
Recent advances in surgical management of lymphedema have provided options for
patients who
have failed conservative management with manual lymphatic
massage and/or compression garments. The
purpose of this review is to
provide a historical background to the surgical treatment of lymphedema and
how these options have evolved over time. In addition, we aim to delineate
the various types of surgical
approaches available, indications for surgery,
and reported out comes. Our goal is to increase awareness of
these options
and foster research to improve their outcomes.
PMID: 22066746 [PubMed - in
process]
Lymphat Res Biol. 2011;9(3):151-8.
Normal Interstitial Flow is
Critical for Developmental Lymphangiogenesis in the
Zebrafish.
Coffindaffer-Wilson M, Craig MP, Hove JR.
Source
1
Department of Molecular and Cellular Physiology, University of Cincinnati
College of Medicine ,
Cincinnati, Ohio.
Abstract
Abstract Background:
The lymphatic system plays a critical role in the body's fluid and protein
homeostasis,
immune regulation, and dietary fat absorption. One of the major
pathologies of the lymphatic system is
primary lymphedema, which occurs in
approximately 0.6% of live births and is caused by missing or
impaired
lymphatic vessels. Although there is a great need for medical intervention into
diseases of the
lymphatic system, very little is known about its development
or how it maintains integrity over time. Recent
studies have suggested that
biophysical components, such as local extracellular fluid flow, may be important
factors during initiation of lymphangiogenesis. We hypothesize that
interstitial fluid flow functions as an
important morphoregulator during
developmental lymphangiogenesis. Methods and Results: In the present
study
we use pharmacological agents and a mutant fish line to modulate interstitial
flow. Our data confirm
that a sufficient increase or decrease in
interstitial flow can profoundly affect lymphatic patterning and may
result
in a lymphedema-like phenotype. Proper interstitial flow appears to be necessary
during LEC
migration for proper lymphatic development. Conclusions: These
results support the contention that
interstitial flow is an important
morphoregulator of developmental lymphangiogenesis.
PMID: 22066745 [PubMed -
in process]
Lymphat Res Biol. 2011;9(3):143-9.
Expression of angiogenic
and vasculogenic factors in human lymphedematous tissue.
Couto RA,
Kulungowski AM, Chawla AS, Fishman SJ, Greene AK.
Source
1 Department of
Plastic and Oral Surgery, Harvard Medical School , Boston,
Massachusetts.
Abstract
Abstract Background: Lymphedema is the progressive
distention of tissue due to lymphatic dysfunction. The
affected area
enlarges over time because of fibroadipose deposition, causing morbidity.
Because increasing
tissue mass requires neovascularization, we hypothesized
that angiogenesis or vasculogenesis might be
upregulated in lymphedema.
Methods and Results: Lymphedematous tissue was collected prospectively
from
nine patients after resection: upper extremity (n=1), lower extremity (n=3),
penis/scrotum (n=5).
Neovascularization was compared to normal tissue.
Specimens were analyzed using immunohistochemistry
for ?-smooth muscle actin
(pericyte marker), CD31 (microvascular density), CD31/Ki67 (proliferating
endothelial cells), and CD34/CD133 (endothelial progenitor cells).
Quantitative real-time PCR (qRT-PCR)
was used to determine mRNA expression
of progenitor cells (CD133) and factors that recruit them:
vascular
endothelial growth factor-A (VEGF-A), hypoxia-inducible factor 1? (HIF-1?),
matrix
metalloproteinase-9 (MMP-9), and stromal-cell derived factor 1?
(SDF-1?). Angiopoetin-1,-2 (ANG-1,
-2), matrix metalloproteinase-2 (MMP-2),
and VEGF receptors (VEGFR1,2) were quantified using qRT-
PCR. There was no
difference in microvascular density, pericytic density, or endothelial
proliferation
between lymphedematous and normal tissue (p=0.1). Endothelial
progenitor cells were not present in
lymphedema or normal specimens
(p<0.01). VEGF-A (1.3-fold), HIF-1? (0.8-fold), SDF-1? (2.1-fold),
VEGFR2
(0.09-fold), and CD133 (0.02-fold) expression were not elevated compared to
normal tissue
(p=0.1). ANG-1 (5.6-fold), ANG-2 (2.5-fold), MMP-2 (3.9-fold),
MMP-9 (33.4-fold), and VEGFR1
(12.8-fold) mRNA was increased in
lymphedematous specimens compared to control (p<0.05).
Conclusions:
Lymphedematous tissue does not exhibit upregulation of angiogenesis or
vasculogenesis.
Neovascularization is unlikely to be involved in the
pathogenesis of this disease.
PMID: 22066744 [PubMed - in process]
Lymphat
Res Biol. 2011;9(3):135-41.
Prevalence and prognostic significance of
secondary lymphedema following breast cancer.
Hayes S, Sipio TD, Rye S, L Pez
JA, Saunders C, Pyke C, Bashford J, Battistutta D, Newman B.
Source
1
Institute of Health and Biomedical Innovation, Queensland University of
Technology , Brisbane,
Queensland, Australia .
Abstract
Abstract
Background: The adverse consequences of lymphedema following breast cancer in
relation to
physical function and quality of life are clear; however, its
potential relationship with survival has not been
investigated. Our purpose
was to determine the prevalence of lymphedema and associated upper-body
symptoms at 6 years following breast cancer and to examine the prognostic
significance of lymphedema with
respect to overall 6-year survival (OS).
Methods and Results: A population-based sample of Australian
women (n=287)
diagnosed with invasive, unilateral breast cancer was followed for a median of
6.6 years
and prospectively assessed for lymphedema (using bioimpedance
spectroscopy [BIS], sum of arm
circumferences [SOAC], and self-reported arm
swelling), a range of upper-body symptoms, and vital
status. OS was measured
from date of diagnosis to date of death or last follow-up. Kaplan-Meier methods
were used to calculate OS and Cox proportional hazards models quantified the
risk associated with
lymphedema. Approximately 45% of women had reported at
least one moderate to extreme symptom at
6.6 years postdiagnosis, while 34%
had shown clinical evidence of lymphedema, and 48% reported arm
swelling at
least once since baseline assessment. A total of 27 (9.4%) women died during the
follow-up
period, and lymphedema, diagnosed by BIS or SOAC between 6?18
months postdiagnosis, predicted
mortality (BIS: HR=2.5; 95% CI: 0.9, 6.8,
p=0.08; SOAC: 3.0; 95% CI: 1.1, 8.7, p=0.04). There was no
association
(HR=1.2; 95% CI: 0.5, 2.6, p=0.68) between self-reported arm swelling and OS.
Conclusions:
These findings suggest that lymphedema may influence survival
following breast cancer treatment and
warrant further investigation in other
cancer cohorts and explication of a potential underlying biology.
PMID:
22066743 [PubMed - in process]
Proc Natl Acad Sci U S A. 2011 Nov
15;108(46):18784-9. Epub 2011 Nov 7.
Impaired lymphatic contraction
associated with immunosuppression.
Liao S, Cheng G, Conner DA, Huang Y,
Kucherlapati RS, Munn LL, Ruddle NH, Jain RK, Fukumura D,
Padera
TP.
Source
E. L. Steele Laboratory, Department of Radiation Oncology,
Harvard Medical School and Massachusetts
General Hospital, Boston, MA
02114.
Abstract
To trigger an effective immune response, antigen and
antigen-presenting cells travel to the lymph nodes via
collecting lymphatic
vessels. However, our understanding of the regulation of collecting lymphatic
vessel
function and lymph transport is limited. To dissect the molecular
control of lymphatic function, we developed
a unique mouse model that allows
intravital imaging of autonomous lymphatic vessel contraction. Using this
method, we demonstrated that endothelial nitric oxide synthase (eNOS) in
lymphatic endothelial cells is
required for robust lymphatic contractions
under physiological conditions. By contrast, under inflammatory
conditions,
inducible NOS (iNOS)-expressing CD11b(+)Gr-1(+) cells attenuate lymphatic
contraction. This
inhibition of lymphatic contraction was associated with a
reduction in the response to antigen in a model of
immune-induced multiple
sclerosis. These results suggest the suppression of lymphatic function by the
CD11b
(+)Gr-1(+) cells as a potential mechanism of self-protection from
autoreactive responses during on-going
inflammation. The central role for
nitric oxide also suggests that other diseases such as cancer and infection
may also mediate lymphatic contraction and thus immune response. Our unique
method allows the study of
lymphatic function and its molecular regulation
during inflammation, lymphedema, and lymphatic metastasis.
PMID: 22065738
[PubMed - in process] PMCID: PMC3219138 [Available on 2012/5/15]
Nat
Med. 2011 Nov 7;17(11):1371-80. doi: 10.1038/nm.2545.
The lymphatic
vasculature in disease.
Alitalo K.
Source
Molecular/Cancer Biology
Program, Faculty of Medicine, Institute for Molecular Medicine Finland and
Helsinki University Central Hospital, Biomedicum Helsinki, University of
Helsinki, Helsinki, Finland.
Abstract
Blood vessels form a closed
circulatory system, whereas lymphatic vessels form a one-way conduit for
tissue fluid and leukocytes. In most vertebrates, the main function of
lymphatic vessels is to collect excess
protein-rich fluid that has
extravasated from blood vessels and transport it back into the blood
circulation.
Lymphatic vessels have an important immune surveillance
function, as they import various antigens and
activated antigen-presenting
cells into the lymph nodes and export immune effector cells and humoral
response factors into the blood circulation. Defects in lymphatic function
can lead to lymph accumulation in
tissues, dampened immune responses,
connective tissue and fat accumulation, and tissue swelling known as
lymphedema. This review highlights the most recent developments in lymphatic
biology and how the
lymphatic system contributes to the pathogenesis of
various diseases involving immune and inflammatory
responses and its role in
disseminating tumor cells.
PMID: 22064427 [PubMed - in process]
Br J
Dermatol. 2011 Nov 7. doi: 10.1111/j.1365-2133.2011.10731.x. [Epub ahead of
print]
A preliminary randomised controlled study to determine the application
frequency of a new lymphoedema
bandaging system.
Moffatt CJ, Franks PJ, Hardy D, Lewis M, Parker V, Feldman
JL.
Source
Royal Derby Hospital Lymphoedema Service, Derby, UK Faculty of
Medicine, Division of Nursing and
Healthcare, University of Glasgow, UK
Centre for Research & Implementation of Clinical Practice,
London, UK
London South Bank University, Faculty of Health & Social Care, London, UK
Kendal
Lymphology Centre, Kendal, UK Swansea Lymphoedema Service Singleton
Hospital, Swansea, UK
University of Missouri, Columbia, Missouri, USA
NorthShore University HealthSystem Research Institute,
Evanston, Illinois,
USA.
Abstract
Objective: To investigate efficacy and safety of the
3M™Coban™ 2 compression system (Coban 2
system) with different application
frequencies in comparison to short-stretch bandaging Methods: A
multi-
centre, randomised, prospective study was performed with 82 patients
suffering from arm or leg
lymphoedema stage II or late stage II. Patients
were allocated to traditional short-stretch 5 times/week or to
the Coban 2
system applied two, three or five times/week for 19 days. Limb volume and
adverse events
were recorded at each study visit. The primary endpoint was
percent volume reduction. Results: The
highest lymphoedema volume reduction
was achieved with the Coban 2 system applied 2 times/week. A
mean (SD)
reduction of 18.7 (14.5)% in legs and 10.5 (8.3)% in arms was achieved. More
frequent
bandage changes of 3 and 5 times/week could not demonstrate
additional benefits. Short-stretch 5
times/week showed a mean (SD) volume
reduction of 10.9 (5.2)% and 8.2 (3.1)% for legs and arms.
Bandage slippage
was low for all treatment groups. A relevant change in overall mobility was
achieved
during the use of the Coban 2 system. The adverse reactions were in
agreement with already known side
effects and did not differ remarkably
between the treatment groups. Conclusion: The 3M(TM) Coban™ 2
compression
system applied twice weekly demonstrated a high rate of volume reduction and a
good safety
profile. Oedema reduction was still effective with four days
between bandage change, which allows a
constant therapeutic effect in
routine practice. This should give the patient a high degree of independence
and mobility.
Copyright © 2011 British Association of
Dermatologists.
PMID: 22059933 [PubMed - as supplied by publisher]
Can
Respir J. 2011 Jul;18(4):e68-9.
Yellow nail syndrome: Dystrophic nails,
peripheral lymphedema and chronic cough.
Dornia C, Johst U, Lange T, Kab S,
Hamer OW.
Abstract
A case involving a 41-year-old man with yellow nail
syndrome (YNS) is reported. YNS is a rare disorder
characterized by yellow,
dystrophic nails, peripheral lymphedema and bronchiectasis with recurrent lower
respiratory tract infections. YNS is often misdiagnosed because the syndrome
is not well known. An
interdisciplinary approach is required to recognize
and collate the components of the syndrome accurately.
Correct diagnosis is
of utmost clinical importance because YNS can occur secondary to malignancies
and
autoimmune disorders. Hence, the diagnosis of YNS must prompt further
investigation.
PMID: 22059188 [PubMed - in process] PMCID: PMC3205111
[Available on 2012/7/1]
November 15, 2011
Berl Munch Tierarztl Wochenschr.
2011 May-Jun;124(5-6):257-64.
[Influence of exercise on horses' limb volume,
measured by an optoelectronic device].
[Article in German]
Siewert C,
Böttcher A, Hellige M, Beyerbach M, von Rautenfeld DB, Seifert
H.
Source
Fachgebiet Allgemeine Radiologie und Medizinische Physik,
Stiftung Tierärztliche Hochschule Hannover.
[email protected]
Abstract
This
study tested for the first time an optoelectronic device (Perometer*) measuring
limb volume of horses.
An analysis of its application was performed
regarding the influence of different types of physical exercise on
the
volume of the extremities. 40 horses were divided into four groups often horses,
each group being
exposed to exercise, differing in kind and duration of
lunging, horse-ridden and riderless. The volume
measurement was performed by
determining the inactive value (I) after a twelfe-hour standing period, the
load value (II) immediately after exercise and recovery value (III) one hour
after exercise. The results
showed a highly significant decrease in limb
volume of 5.7% between values (I) and (II), as well as a highly
significant
increase of 68% between (II) and (III). The volume changes observed in male
horses were
significantly higher than in female horses. Volume changes in
horse-ridden groups were higher than riderless
ones, but not significant.
There were fewer leg volume changes at low ambient temperatures (1-12 degrees
C) compared to high temperatures (23-31 degrees C), but these were not
statistically significant. Well-
trained horses showed lower volume changes
than less trained horses (not statistically significant). The
Perometer is a
fast and reliable tool for measuring limb volume of horses. The ICC (Interclass
Correlation
Coefficient) calculated a high measurement reproducibility of
0.996. A variance analysis showed no
significant differences between the
three repeated leg measurements. Thus, the Perometer can be used for
monitoring and quantifying edema and documenting limb volume changes
resulting from training, wearing
compression stockings or bandages, manual
lymph drainage.
PMID: 22059298 [PubMed - in process]
November 15, 2011
Support Care Cancer. 2011 Nov 10. [Epub ahead of print]
Preliminary
development of a lymphedema symptom assessment scale for patients with head and
neck
cancer.
Deng J, Ridner SH, Murphy BA, Dietrich
MS.
Source
School of Nursing, Vanderbilt University, 461 21st Ave. South,
600B Godchaux Hall, Nashville, TN,
37240, USA, [email protected].
Abstract
PURPOSE:
Currently,
no instruments are available to assess symptoms secondary to lymphedema in
patients with head
and neck cancer (HNC). The study aim was to develop and
conduct preliminary tests of such an instrument.
METHODS:
A preliminary
item pool was generated from a literature review, previous work in breast
cancer-related
lymphedema, and an observational study. The item pool was
revised based on an expert panel's suggestions
and feedback from 18 patients
with HNC. The current questionnaire, the Lymphedema Symptom Intensity
and
Distress Survey-Head and Neck (LSIDS-H&N), was then pilot tested in 30
patients with HNC.
RESULTS:
Preliminary testing (1) demonstrated
feasibility, readability, and ease of use of the LSIDS-H&N and (2)
identified that there was a considerable level of symptom burden in the
cohort of patients in the piloting
sample.
CONCLUSION:
Content
validity of the LSIDS-H&N was supported by the expert panel during
development of the LSIDS-
H&N. Further testing is ongoing.
PMID:
22072048 [PubMed - as supplied by publisher]
Cell Biol Int. 2011 Dec
1;35(12):1177-87.
Gene expression profile of lymphatic endothelial
cells.
Wang P, Cheng Y.
Source
*Center of Oncology, The Fifth
Affiliated Hospital of Xinjiang Medical University, 118 Henan Road, Xinshi
District, Urumqi 830011, Peoples Republic of China.
Abstract
The
lymphatic system was first described at around the same time as the blood
circulation centuries ago, but
the biological function elucidation of LECs
(lymphatic endothelial cells) is far less than that of BVECs (blood
vascular
endothelial cells). Since the discovery of molecular markers for LECs and
exploration of lymphatic
role in tumour metastasis, more attention has been
given to basic lymphatic research. Approx. 150 known
genes were found to be
expressed at the mRNA and protein levels by LECs. These molecules play an
important role in lymphangiogenesis, signalling, tumour metastasis, immune
function and fluid transport. This
review provides a brief outline of gene
expression profile of LECs and the molecular biological function,
which will
give the reader a better understanding about the mechanics of lymphatic function
and some
pathologies related to the lymphatic system such as lymphoedema,
and facilitate advanced scientific research
into lymphatic biology.
PMID:
22070412 [PubMed - in process]
Klin Onkol. 2011;24(5):382-8.
[Secondary
angiosarcomas after conservation treatment for breast cancers].
[Article in
Czech]
Vojtísek R, Kinkor Z, Fínek J.
Source
Radioterapeutické a
onkologické oddelení, FN Plzen. [email protected]
Abstract
BACKGROUNDS:
The
cancerogenic effect of ionizing radiation was documented just several years
after it started to be used as
a treatment option. Ionizing radiation
produces a small but detectable risk of carcinoma as well as bone and
soft
tissue sarcomas. Over the past 20 years angiosarcomas arising from the area of
the irradiated breast
have been reported with increasing frequency as the
number of women undergoing the breast conserving
surgery with consecutive
radiotherapy has increased also. Angiosarcomas can originate from either
lymphatic or capillary endothelium, namely lymphangiosarcomas and
haemangiosarcomas. The most of
haemangiosarcomas arising from the breast
skin developed in the irradiated area after breast conserving
procedure--secondary angiosarcomas. Lymphangiosarcoma is typically
associated with longstanding
extremity lymphedema--Stewart-Treves
syndrome.
CASES:
We report three cases of angiosarcomas which occured in
this region after breast conserving treatment and
we also review the
literature.
CONCLUSION:
Paradoxically, the decrease in the use of
radiotherapy to the post-mastectomy chest wall and the axillary
area is
expected to reduce the incidence of angiosarcomas, while the increase in the use
of breast conserving
procedure plus radiotherapy could lead to increased
incidence of angiosarcomas in the residual breast tissue.
Special attention
should be paid to skin leasions and changes occuring after breast conserving
treatment and
especially to the ones with the skinthickening. The early
detection and diagnosis has the crucial prognostic
value.
PMID:
[PubMed - in process] 22070020
November 21, 2011
Hell J Nucl Med. 2011 Sep;14(3):313-5.
Comparison between one day and two
days protocols for sentinel node mapping of breast cancer patients.
Ali J,
Alireza R, Mostafa M, Naser FM, Bahram M, Ramin S.
Source
Surgical
Oncology Research Center, Faculty of Medicine, Imam Reza Hospital, Mashhad
University of
Medical Sciences, Ebn Sina Street Mashhad, Iran. [email protected].
Abstract
Sentinel
node biopsy can decrease the morbidity of breast cancer treatment significantly
by sparing many
patients of axillary lymph node dissection and resulting arm
lymphedema. Despite widespread use of sentinel
node mapping for breast
cancer patients almost all aspects of this procedure are controversial; such as:
type
of the radiotracer, eligibility, time of injection, etc. One of these
controversial issues is the efficacy of 2 days
protocol (injection of the
tracer on one day and sentinel node mapping and surgery on the following day).
The main reason to perform 2 days protocol is the ease of operation room
scheduling the patient does not
need to complete injection and imaging in
the nuclear medicine department. Despite widespread use of 2
days protocol
for sentinel node mapping, very few studies have specifically evaluated this
protocol in
comparison to 1 day protocol and also the false negative rate
which is the better index of sentinel node
mapping success. Most of the
above studies used tracers with large particle size such as (99m)Tc-sulfur
colloid. Tracers with small particle size can theoretically be washed out
from the real sentinel nodes and
move to the second echelon nodes, so some
recommended using large particle size radiotracers for the 2
days protocol.
In this study, we compared the false negative rate of sentinel node mapping
between 1 and 2
days protocols using intradermal injection of
(99m)Tc-antimony sulfide colloid ((99m)Tc-SbSC) which has
very small
particle size. Eighty patients with early stage breast cancer (clinical stages
of I and II) were
evaluated. The diagnosis of the breast cancer was
established by either excisional or core needle biopsy.
The patients didn't
take any chemotherapeutic drug before surgery and were divided into two groups:
1 day
(Group I) and 2 days (Group II) protocols (45 in Group I and 35 in
Group II). For Group I, periareolar
intradermal injections of 0.5Bq/0.2mL
(99m)Tc-SbSC were applied for patients without previous excisional
biopsy.
For patients with excisional biopsy two intradermal injections of 0.5Bq/0.2mL
(99m)Tc-SbSC were
used on both sides of the incision line. All injections
were followed by gentle massage for 1min. For Group
II, the same injection
techniques were used but the dose of the tracer was doubled. Anterior, and
lateral
spot views were acquired 30min after the injection (5min/image,
128Χ128 matrix) using a dual head gamma
camera (E.CAM Siemens) and parallel
hole low energy high resolution collimator. The operation was
performed 4h
(for Group I) or 20h (for Group II) post radiotracer injection. All patients
received 2mL
patent blue V dye in a subdermal and periareolar fashion, 2min
after general anesthesia. A surgical gamma
probe (EUROPROBE, France) was
used for harvesting the sentinel lymph nodes during surgery. As sentinel
node was defined any blue node or any node with an ex vivo radioisotope
count of twofold or greater than
the axillary background. After completion
of sentinel node biopsy, all patients underwent standard axillary
lymph node
dissection. The study was approved by our local ethical committee and all
patients gave their
informed consent before inclusion into the study.
Quantitative data were expressed as mean±SD. For
comparison between groups,
independent sample student's t-test for quantitative variables, and chi-square
or Fisher's exact tests for categorical variables were used. P-values less
than 0.05 were considered
statistically significant. SPSS version 11.5 was
used for statistical analyses. The patients characteristics are
shown in
Table I. These general characteristics were not significantly different between
the study groups
(P>0.05). Detection rate was 100% for both Groups. The
median number of sentinel nodes in both Groups
was one sentinel node. The
mean number of detected sentinel nodes during surgery was not statistically
different between groups (1.28±0.7 and 1.32±0.6 for Group I and II
respectively). One false negative
sentinel node case with positive axillary
nodes after dissection was found in both groups. This amounts to
6.25% and
6.66% false negative rate for Group I and II patients respectively. During
surgery mean count
rate at the injection site was 243123±22134 and
29430±2125 for Groups I and II, respectively. Mean
count rate at the
sentinel nodes was 4345±457 and 2375±356 for Groups I and II, respectively.
Although
the mean count rate at the injection site and the sentinel nodes
were both higher in Group I of the study
compared to Group II (P<0.0001
for both), the mean ratio of sentinel to injection site was statistically higher
in Group II (P<0.0001). The 2 days protocol allows that the required
lymphoscintigraphy imaging (including
delayed views) can be performed before
and during operation without any time limits. Most studies have
reported
similar to ours detection or false negative rates for both protocols. Our study
showed comparable
mean number of harvested sentinel nodes by the two
protocols which is against the hypothesis of moving the
tracer to other
sentinel nodes by time. Others had similar results. The count rate of the
sentinel nodes during
surgery was statistically acceptable. Similar results
have been reported by others too. Although we didn't
evaluate radiation
exposure in our study, this was acceptable in other studies and Buscombe et al
showed a
maximum effective dose of 2.6μSv/MBq for these patients and even
assuming this highest value the patient
exposure was very low compared to
many other procedures. In conclusion, two days protocol gives the
sentinel
node biopsy team considerable flexibility and lymphoscintigrpahy imaging can be
completed before
surgery. Finding of the axillary sentinel node during
surgery is also being easier. False negative rates as well
as the detection
rate for one day and two days protocols are comparable.
PMID: 22087458
[PubMed - in process]
ISRN Urol. 2011;2011:431536. Epub 2011 Mar
30.
Penile reconstruction for a case of genital lymphoedema secondary to
proteus syndrome.
Ashouri F, Manners J, Rees R.
Source
Department of
Urology, RHCH, SO22 5DE Winchester, UK.
Abstract
To our knowledge penile
lymphoedema secondary to Proteus syndrome has not previously been reported.
Hence we report a case of a 16-year-old male who was referred with features
of right hemi-hypertrophy
and severe lymphoedema affecting his scrotum and
penis. He had previously undergone scrotal reduction
surgery at the age of
13, but had since developed worsening penile oedema. His main concern was that
of
cosmetic appearance prior to sexual debut, and he also complained of
erectile dysfunction. An MRI
confirmed gross oedema of the penile skin, but
normal underlying cavernosal structure, and no other
anatomical abnormality.
Under general anaesthesia, the entire diseased penile skin was excised. Two full
thickness skin grafts were harvested from the axillae, and grafted onto the
dorsal and ventral penile shaft
respectively. A compressive dressing and
urinary catheter was applied for 7 days. Follow-up at 4 months
confirmed
complete graft take with minimal scarring, and the patient was very satisfied
with the cosmetic
outcome. He had also noticed a recovery in erectile
activity, and feels psychologically and physically more
prepared for sexual
relations.
PMID: 22084799 [PubMed - in process] PMCID: PMC3197011
J
Am Acad Dermatol. 2011 Dec;65(6):e163.
Lymphedema, yellow nails, and a
persistent cough.
Wenk KS, Ehrlich A.
Source
Department of Dermatology,
The George Washington University Medical Center, Washington, DC.
PMID:
22082852 [PubMed - in process]
Ann Vasc Surg. 2011 Nov 11. [Epub ahead of
print]
Using Indocyanine Green Fluorescent Lymphography and Lymphatic-Venous
Anastomosis for Cancer-
Related Lymphedema.
Mihara M, Murai N, Hayashi Y,
Hara H, Iida T, Narushima M, Todokoro T, Uchida G, Yamamoto T,
Koshima
I.
Source
Department of Plastic Surgery and Reconstructive Surgery, The
University of Tokyo, Tokyo, Japan.
Abstract
Advances in cancer therapy
have increased the importance of improvement of quality of life after cancer
survival. Cancer-related lymphedema or secondary lymphedema that occurs
after lymph node dissection in
resection of tumors of abdominal visceral
organs can impair quality of life. However, standard curative
treatment for
secondary lymphedema has not been established. This may be due to the lack of a
method for
early diagnosis of lymphedema, and because of selection of
conservative treatment such as compression
therapy to delay edema
progression in many cases. To develop a curative approach, we have performed
definite diagnosis of early-stage lymphedema using magnetic resonance
imaging and an indocyanine green
fluorescent lymphography, followed by
surgical treatment with lymphatic-venous anastomosis using
supermicrosurgery. Herein, we report the first case of secondary lymphedema
in which we performed early
diagnosis and surgery using these techniques and
achieved an almost complete cure of lymphedema. We
suggest that early
diagnostic imaging and early microsurgery is the key of lymphedema
treatment.
Copyright © 2011 Annals of Vascular Surgery Inc. Published by
Elsevier Inc. All rights reserved.
PMID: 22079465 [PubMed - as supplied by
publisher]
BMC Dermatol. 2011 Nov 11;11(1):15. [Epub ahead of
print]
Classic Kaposi's Sarcoma In Morocco: Clinico -epidemiological study at
the National Institute Of Oncology.
Errihani H, Berrada N, Raissouni S, Rais
F, Mrabti H, Rais G.
Abstract
ABSTRACT:
BACKGROUND:
Classic Kaposi's
sarcoma (CKS) is a rare disease likely associated with human herpesvirus 8
(HHV-8)
infection, and occurs predominantly in Jewish, Mediterranean and
middle eastern men .There is a dearth of
data in Moroccan patients with CKS
regarding epidemiology, clinical characteristics and outcomes. This
report
examines a cohort of patients with CKS evaluated at the national institute of
oncology over 11-year
period.
METHODS:
A retrospective analysis of
patients referred to the national institute of oncology with classical Kaposi
sarcoma, between January 1998 and February 2008, was performed. Reviewed
information included
demographics, clinical and pathological staging, death
or last follow-up.
RESULTS:
During the study period, 56 patients with a
diagnosis of CKS have been referred to our hospital. There were
11(19,7%)
females and 45 (80,3 %) males (male-to-female ratio: 4:1). Mean age at diagnosis
was 61,7 +/-
15 (range: 15- 86 years). Nodules and/or plaques were the most
frequent type of lesion. The most common
location was the lower limbs,
particularly the distal lower extremity ( 90%). In addition to skin involvement,
visceral spread was evident in 9 cases. The most common visceral involvement
sites were lymph nodes (44
%), lung (22%), and gastrointestinal tract (22%).
Associated lymphoedema was seen in 24 (42%) of the
patients. There were 18
stage I patients (32,14 %), 8: stage II (14,28%), 21 stage III(37,5%) and 9
stage
IV (16,07%). A second primary malignancy was diagnosed in 6 cases
(10,7%), none of the
reticuloendothelial system. With a median follow-up of
45 months, 38 (67,8) patients are alive ,of whom 25
(65,78%) patients with
stable disease, five with progressive disease currently under systemic
chemotherapy
and 8(21,05%) are alive and free of disease, over a mean
interval of 5 years.
CONCLUSION:
This is the largest reported series in
our context. In Morocco, CKS exhibits some special characteristics
including
a disseminated skin disease at diagnosis especially in men, a more common
visceral or lymph node
involvement and a less frequent association with
second malignancies.
PMID: 22078023 [PubMed - as supplied by
publisher]
MED NEWS:
November 15, 2011
Story Of Lymphatic System Expands To Include Chapter On Valve Formation
A century after the valves that link the lymphatic and blood systems were
first described, St. Jude Children's
Research Hospital scientists have
detailed how those valves form and identified a gene that is critical to the
process.
The gene is Prox1. Earlier work led by Guillermo Oliver, Ph.D., a member of
the St. Jude Department of
Genetics, showed Prox1 was essential for
formation and maintenance of the entire lymphatic vasculature.
The lymphatic
vasculature is the network of vessels and ducts that help maintain the body's
fluid balance and
serves as a highway along which everything from cancer
cells to disease-fighting immune components
moves. Oliver is senior author
of the new study, which appeared in the October 15 edition of the scientific
journal Genes & Development.
The new research suggests that Prox1 is also essential for proper formation
of the one-way valves that
control movement of fluid and nutrients from the
lymphatic system into the blood stream. Researchers found
evidence that the
Prox1 protein also has a role in formation of the venous valves.
"Understanding how valves form is crucial to efforts to develop treatments
for valve defects that affect both
children and adults," said the paper's
first author, R. Sathish Srinivasan, Ph.D., a research associate in the St.
Jude Department of Genetics. Those defects are linked to a variety of
problems including lymphedema and
deep vein thrombosis, which are blood
clots that form deep in veins and have the potential for causing
life-
threatening complications. Lymphedema is the painful and sometimes
disfiguring swelling that can occur
when lymph flow is disrupted.
For more than a decade, the lymphatic system has been a focus of Oliver's
laboratory. The laboratory's
contributions through the years include
evidence that leaky lymphatic vessels might contribute to obesity.
Oliver
and his colleagues also demonstrated how the lymphatic system forms from
Prox1-producing cells
destined to become lymphatic endothelial cells (LECs)
when they leave the developing veins and migrate
throughout the body.
The investigators also showed the Coup-TFII gene is essential to the process.
The Coup-TFII protein binds
to the promoter region of the Prox1 gene. The
binding switches on production of the Prox1 protein that is
required to
create and maintain the lymphatic system.
The newer research builds on that earlier work from Oliver's laboratory. The
latest study focused on the
lymphovenous valves. These valves are found at
just two locations in the body, on either side of the chest
just under the
clavicle bone where the lymphatic vessels intersect with the subclavian and
internal jugular
veins.
Working in mice, investigators discovered that these lymphovenous valves form
from a newly identified
subtype of endothelial cell found in developing
veins. Like the LECs that form the lymphatic system, the
newly identified
endothelial cells make Prox1. But while the LECs leave the veins and migrate
throughout the
body, these endothelial cells stay put to form the
lymphovenous valves.
Researchers demonstrated the process requires two copies of the Prox1 gene.
That ensures adequate levels
of the Coup-TFII-Prox1 complex and with it
enough Prox1 to build and maintain the lymphatic system.
Mice engineered to
carry a single copy of Prox1 either did not survive or were born without
lymphovenous
and venous valves.
"If you have only one copy of Prox1 you are going to have a reduction in the
Coup-TFII Prox1 complex
and so a dramatic reduction in the number of cells
available to build the lymphatic system. That explains the
defects we see,"
Srinivasan said.
December 6, 2011Am J Clin Oncol. 2011 Nov 29. [Epub ahead of
print]
Complication Rates in Patients With Negative Axillary Nodes 10 Years
After Local Breast Radiotherapy
After Either Sentinel Lymph Node Dissection
or Axillary Clearance.
Wernicke AG, Shamis M, Sidhu KK, Turner BC, Goltser Y,
Khan I, Christos PJ, Komarnicky-Kocher LT.
Source
*Department of Radiation
Oncology ¶Department of Public Health, Division of Biostatistics and
Epidemiology, Weill Cornell Medical College of Cornell University, New York
∥Department of Biological
Sciences, State University of New York, Stony
Brook, NY †Department of Medical Sciences, Saint
George University, Grenada,
WI ‡Department of Radiation Oncology, Thomas Jefferson University
Hospital
#Department of Radiation Oncology, Drexel University Hospital, Philadelphia, PA
§Department of
Biological Sciences, Brandeis University, Waltham,
MA.
Abstract
BACKGROUND:
We assess complication rates in node negative
breast cancer patients treated with breast radiotherapy (RT)
only after
sentinel lymph node dissection (SLND) or axillary lymph node dissection
(ALND).
MATERIALS AND METHODS:
Between 1995 and 2001, 226 women with AJCC
stage I-II breast cancer were treated with lumpectomy,
either SLND or
SLND+ALND, and had available toxicities in follow-up: 111/136 (82%) and 115/129
(89%) in SLND and ALND groups, respectively. RT targeted the breast to
median dose of 48.2 Gy (range,
46.0 to 50.4 Gy) without axillary RT.
Chi-square tests compared complication rates of 2 groups for axillary
web
syndrome (AWS), seroma, wound infection, decreased range of motion of the
ipsilateral shoulder,
paresthesia, and lymphedema.
RESULTS:
Median
follow-up was 9.9 years (range, 8.3-15.3 y). Median number of nodes assessed was
2 (range, 1-5)
in SLND and 18 (range, 7-36) in ALND (P < 0.0001). Acute
complications occurred during the first 2
years and were AWS, seroma, and
wound infection. Incidences of seroma 5/111 (4.5%) in SLND and
16/115
(13.9%) in ALND (P < 0.02, respectively) and wound infection 3/111 (2.7%) in
SLND and
10/115 (8.7%) in ALND (P < 0.05, respectively) differed
significantly. AWS was not statistically
different between the groups. At 10
years, the only chronic complications decreased were range of motion
of the
shoulder 46/111 (41.4%) in SLND and 92/115 (80.0%) in ALND (P < 0.0001),
paresthesia
12/111 (10.8%) in SLND and 39/115 (33.9%) in ALND
(P < 0.0001), and lymphedema assessed by
patients 10/111 (10.0%) in SLND
and 39/115 (33.9%) in ALND (P < 0.0001). Chronic lymphedema,
assessed by
clinicians, occurred in 6/111 (5.4%) in SLND and 21/115 (18.3%) in ALND cohorts,
respectively (P < 0.0001).
CONCLUSIONS:
Our mature findings support
that in patients with negative axillary nodal status SLND and breast RT provide
excellent long-term cure rates while avoiding morbidities associated with
ALND or addition of axillary RT
field.
PMID: 22134519 [PubMed - as
supplied by publisher]
Orphanet J Rare Dis. 2011 Dec 1;6(1):80. [Epub ahead
of print]
Fibrodysplasia Ossificans Progressiva: Clinical and Genetic
Aspects.
Pignolo RJ, Shore EM, Kaplan FS.
Abstract
ABSTRACT:
Fibrodysplasia ossificans progressiva (FOP) is a severely disabling heritable
disorder of
connective tissue characterized by congenital malformations of
the great toes and progressive heterotopic
ossification that forms
qualitatively normal bone in characteristic extraskeletal sites. The worldwide
prevalence is approximately 1/2,000,000. There is no ethnic, racial, gender,
or geographic predilection to
FOP. Children who have FOP appear normal at
birth except for congenital malformations of the great toes.
During the
first decade of life, sporadic episodes of painful soft tissue swellings
(flare-ups) occur which are
often precipitated by soft tissue injury,
intramuscular injections, viral infection, muscular stretching, falls or
fatigue. These flare-ups transform skeletal muscles, tendons, ligaments,
fascia, and aponeuroses into
heterotopic bone, rendering movement
impossible. Patients with atypical forms of FOP have been
described. They
either present with the classic features of FOP plus one or more atypical
features [FOP
plus], or present with major variations in one or both of the
two classic defining features of FOP [FOP
variants]. Classic FOP is caused
by a recurrent activating mutation (617G>A; R206H) in the gene
ACVR1/ALK2
encoding Activin A receptor type I/Activin-like kinase2, a bone morphogenetic
protein
(BMP) type I receptor. Atypical FOP patients also have heterozygous
ACVR1 missense mutations in
conserved amino acids. The diagnosis of FOP is
made by clinical evaluation. Confirmatory genetic testing is
available.
Differential diagnosis includes progressive osseous heteroplasia, osteosarcoma,
lymphedema, soft
tissue sarcoma, desmoids tumors, aggressive juvenile
fibromatosis, and non-hereditary (acquired)
heterotopic ossification.
Although most cases of FOP are sporadic (non-inherited mutations), a small
number of inherited FOP cases show germline transmission in an autosomal
dominant pattern. At present,
there is no definitive treatment, but a brief
4-day course of high-dose corticosteroids, started within the first
24 hours
of a flare-up, may help reduce the intense inflammation and tissue edema seen in
the early stages of
the disease. Preventative management is based on
prophylactic measures against falls, respiratory decline,
and viral
infections. The median lifespan is approximately 40 years of age. Most patients
are wheelchair-
bound by the end of the second decade of life and commonly
die of complications of thoracic insufficiency
syndrome.
PMID: 22133093
[PubMed - as supplied by publisher]
Ceska Gynekol. 2011
Oct;76(5):355-9.
[Axillary reverse mapping--chance to prevent lymphedema in
breast cancer patients].
[Article in Czech]
Pavlista D, Koliba P, Eliska
O.
Source
Gynekologicko-porodnická klinika 1. LF UK a VFN,
Onkogynekologické centrum, Praha.
Abstract
OBJECTIVE:
The axillary
reverse mapping (ARM) technique has been developed to map and preserve arm
lymphatic
drainage during axillary lymph node dissection (ALND) and/or
sentinel lymph node (SLN) biopsy, thereby
minimizing arm lymphedema.
However, several problems remain to be resolved in the practical application
of this technique. This article presents a review of current knowledge
regarding ARM and discusses the
practical applicability and relevance of
this technique.
TYPE OF STUDY:
Review.
SETTING:
Oncogynecologic
center, Gynecology-Obstetrics Clinic, 1st Medical Faculty and General Teaching
Hospital, Prague.
CONCLUSIONS:
The axillary reverse mapping (ARM)
procedure is based on the hypothesis that the lymphatic drainage from
the
upper arm is different from that of the breast and offers the opportunity to
prevent lymphedema in breast
cancer patients. However, the oncologic safety
of the procedure has not yet been determined.
PMID: 22132635 [PubMed - in
process]
December 9, 2011
Blood. 2011 Dec 6. [Epub ahead of
print]
Loss-of-function germline GATA2 mutations in patients with MDS/AML or
MonoMAC syndrome and
primary lymphedema reveal a key role for GATA2 in the
lymphatic vasculature.
Kazenwadel J, Secker GA, Liu YJ, Rosenfeld JA, Wildin
RS, Cuellar-Rodriguez J, Hsu AP, Dyack S,
Fernandez CV, Chong CE, Babic M,
Bardy PG, Shimamura A, Zhang M, Walsh T, Holland SM, Hickstein
DD, Horwitz
MS, Hahn CN, Scott HS, Harvey NL.
Source
Division of Haematology, Centre
for Cancer Biology, SA Pathology, Adelaide, SA, Australia;
Abstract
Recent
work has established that heterozygous germline GATA2 mutations predispose
carriers to familial
myelodysplastic syndrome (MDS)/acute myeloid leukaemia
(AML), "MonoMAC" syndrome and DCML
deficiency. Here, we describe a
previously unreported MDS family carrying a missense mutation in GATA2
(p.Thr354Met), one patient with MDS/AML carrying a frameshift mutation in
GATA2 (p.
Leu332Thrfs*53), another individual with MDS harboring a GATA2
splice site mutation, and three patients
exhibiting MDS or MDS/AML who have
large deletions encompassing the GATA2 locus. Intriguingly, two
patients
with GATA2 deletions and one with a frameshift mutation who have MDS/AML or
"MonoMAC"
syndrome also have primary lymphedema. Primary lymphedema occurs
as a result of aberrations in the
development and/or function of lymphatic
vessels, spurring us to investigate whether GATA2 plays a role in
the
lymphatic vasculature. We demonstrate here that GATA2 protein is present at high
levels in the leaflets
of lymphatic vessel valves, and that GATA2 controls
the expression of genes that play key roles in
programming lymphatic valve
development. Our data expand the phenotypes associated with germline
GATA2
mutations to include predisposition to primary lymphedema and suggest that
complete
haploinsufficiency or loss-of-function (LOF) of GATA2, rather than
missense mutations, is the key
predisposing factor for lymphedema onset.
Moreover, we reveal a crucial role for GATA2 in lymphatic
vascular
development, particularly in controlling valve development and/or
function.
PMID: 22147895 [PubMed - as supplied by publisher]
Ann Biomed
Eng. 2011 Dec 3. [Epub ahead of print]
The Role of Lymphatics in Cancer as
Assessed by Near-Infrared Fluorescence Imaging.
Rasmussen JC, Kwon S,
Sevick-Muraca EM, Cormier JN.
Source
Center for Molecular Imaging, The
Brown Foundation Institute of Molecular Medicine, The University of
Texas
Health Science Center, Houston, 1825 Pressler St, SRB 330F, Houston, TX, 77030,
USA, john.
[email protected].
Abstract
The
lymphatic system is the secondary circulatory system responsible for fluid
homeostasis and protein
transport in the body. In addition, because the
lymphatic system provides a primary pathway for cancer
metastasis, lymph
node involvement is routinely used as a determinant in cancer staging. Despite
their
importance, the lymphatics remain poorly understood, in part because
of the historic lack of imaging
modalities with sufficient spatial and/or
temporal resolution to visualize the fine lymphatic structure and subtle
contractile function. In recent years, near-infrared fluorescence (NIRF)
imaging has emerged as a new
imaging modality to non-invasively visualize
the lymphatics and assess contractile lymphatic function in
humans following
administration of microdose amounts of a NIRF contrast agent. In this
contribution, we
first review NIRF imaging and its clinical application in
sentinel lymph node mapping, intraoperative
guidance, and assessing the
architecture and contractile function of the lymphatics in health and in
cancer-
related lymphedema. We then present recent NIRF lymphatic imaging for
non-invasive assessment of
lymphatics both in preclinical melanoma models
and in human subjects with melanoma.
PMID: 22139396 [PubMed - as supplied by
publisher]
Int J Radiat Oncol Biol Phys. 2011 Dec 2. [Epub ahead of
print]
Cosmetic Outcomes and Complications Reported by Patients Having
Undergone Breast-Conserving
Treatment.
Hill-Kayser CE, Vachani C,
Hampshire MK, Di Lullo GA, Metz JM.
Source
Department of Radiation
Oncology, University of Pennsylvania, Philadelphia,
Pennsylvania.
Abstract
PURPOSE:
Over the past 30 years, much work in
treatment of breast cancer has contributed to improvement of
cosmetic and
functional outcomes. The goal of breast-conservation treatment (BCT) is
avoidance of
mastectomy through use of lumpectomy and adjuvant radiation.
Modern data demonstrate "excellent" or
"good" cosmesis in >90% of
patients treated with BCT.
METHODS AND MATERIALS:
Patient-reported data
were gathered via a convenience sample frame from breast cancer survivors using
a
publically available, free, Internet-based tool for creation of
survivorship care plans. During use of the tool,
breast cancer survivors are
queried as to the cosmetic appearance of the treated breast, as well as
perceived late effects. All data have been maintained anonymously with
internal review board approval.
RESULTS:
Three hundred fifty-four breast
cancer survivors having undergone BCT and voluntarily using this tool were
queried with regard to breast cosmesis and perceived late effects. Median
diagnosis age was 48 years, and
median current age 52 years. "Excellent"
cosmesis was reported by 27% (n = 88), "Good" by 44% (n =
144), "Fair" by
24% (n = 81), and "Poor" by 5% (n = 18). Of the queries posted to survivors
after BCT,
late effects most commonly reported were cognitive changes (62%);
sexual concerns (52%); changes in
texture and color of irradiated skin
(48%); chronic pain, numbness, or tingling (35%); and loss of flexibility in
the irradiated area (30%). Survivors also described osteopenia/osteoporosis
(35%), cardiopulmonary
problems (12%), and lymphedema
(19%).
CONCLUSIONS:
This anonymous tool uses a convenience sample frame to
gather patient reported assessments of cosmesis
and complications after
breast cancer. Among the BCT population, cosmetic assessment by survivors
appears less likely to be "excellent" or "good" than would be expected, with
30% of BCT survivors
reporting "fair" or "poor" cosmesis. Patient reported
incidence of chronic pain, as well as cognitive and
sexual changes, also
appears higher than expected.
Copyright © 2011 Elsevier Inc. All rights
reserved.
PMID: 22137022 [PubMed - as supplied by publisher]
MED
NEWS:
December 4, 2011
MU Researchers Recommend Exercise For Breast Cancer
Survivors, Lymphedema Patients –
Lymphedema a chronic swelling condition
common in breast cancer survivors, affects three million people in
the U.S.
In the past, most people believed that exercise might induce or worsen
lymphedema. After
reviewing the literature, University of Missouri
researchers say the benefits of exercise outweigh the risks for
breast
cancer survivors and patients with lymphedema.
Jane Armer, professor in the Sinclair School of Nursing, says patients at
risk for lymphedema can exercise if
they closely monitor their
activities.
"Exercise can be beneficial and not harmful for breast cancer survivors,"
Armer said. "Each individual should
balance the pros and cons of the
activity she chooses, but keep in mind that being sedentary has risks and
being active is beneficial in many ways, including possibly reducing the
risk of cancer recurrence."
Lymphedema can occur any time after cancer treatment and is usually caused by
the removal or radiation of
lymph nodes as part of the treatment process.
Armer found that patients who exercise had no greater risk
for developing
lymphedema than those who do not exercise. In addition, patients with lymphedema
did not
worsen their condition by exercising. She says future research is
needed to determine whether exercise
prevents the condition.
"Breast cancer survivors do not need to restrict their activity as we once
thought," Armer said. "If patients
want to be active, they should carefully
condition their bodies by increasing repetitions of resistance
exercises
under proper supervision."
In another new literature review, Armer and her colleagues examined published
literature pertaining to the
surgical treatment of lymphedema. They found
that in most studies surgery did not eliminate the need for
traditional
compression garments in patients with lymphedema.
"Many people think surgery will correct the underlying lymphatic problem, but
that is not correct," Armer
said. "There are several surgical techniques
that may reduce the swelling associated with lymphedema. In
most cases, it
is recommended that patients undergo traditional therapy using specialized
massage and
compression garments and bandages to reduce fluid and swelling
before considering surgery."
December 12, 2011
New Research Finding
Presented At American Society Of Hematology Annual Meeting –
Researchers from
Seidman Cancer Center at University Hospitals (UH) Case Medical Center and Case
Western Reserve University School of Medicine presented new research
findings in 25 presentations at the
53rd Annual Meeting of the American
Society of Hematology (ASH) at the San Diego Convention Center.
"The breadth and depth of this innovative cancer research presented at ASH is
truly outstanding," says Stan
Gerson, MD, Director of the Seidman Cancer
Center at UH Case Medical Center and the Case
Comprehensive Cancer Center at
Case Western Reserve University. "Our faculty members are making
tremendous
advances in hematology and oncology which is reflected in their being chosen for
oral and
poster presentations."
Speaking at the ASH "Scientific Symposium on Lymphoid Neoplasia" in a session
titled "Autophagy and
Metabolism in Lymphoid Malignancies," Clark
Distelhorst, MD, provided a synthesis of the latest research
indicating that
autophagy occurs in lymphoid malignancies and may be a novel therapeutic target
for
lymphoma and other lymphoid neoplasia. His research suggests that
targeting autophagy (a process through
which cells eat parts of themselves
to generate sufficient energy to stay alive) may be a useful adjunct to the
longstanding use of glucocorticoids, such as prednisone, to kill cancer
cells.
His session outlined the growing body of evidence that treatments aimed at
inducing autophagy have great
promise in treating lymphoid malignancies. In
his session, Dr. Distelhorst presented important data explaining
how
glucocorticoids starve tumor cells of glucose and thus induce autophagy.
Researchers at UH Case
Medical Center and Case Western Reserve University
identified the Dexamethasone-induced Gene 2 (dig2)
that encodes a protein
mediator of autophagy.
"This new cancer-fighting strategy lays the groundwork for further
development of autophagy inhibitors to
enhance the glucocorticoids
properties," says Dr. Distelhorst, who is vice-chair of the ASH subcommittee
on Lymphoid Neoplasia. "This is a major step forward in our research efforts
to develop new therapies for
lymphoid malignancies."
Dr. Distelhorst's session was Saturday, December 10, 4 p.m. - 5:30 p.m. in
Room 6A. (San Diego
Convention Center). http://ash.confex.com/ash/2011/webprogram/Paper35836.html
In a poster presentation (Abstract# 1907), Jeffery Auletta, MD, Kenneth
Cooke, MD, and colleagues
presented significant findings that mesenchymal
stem cells (MSCs) effectively treat graft-versus-host disease
(GvHD) while
not interfering with bone marrow transplant's efficacy in treating leukemia.
MSCs are non-hematopoietic (not blood-forming cells) adult stem cells found
in the bone marrow and were
discovered at UH Seidman Cancer Center and Case
Western Reserve University. They maintain
hematopoietic stem cell
(blood-forming cells) development and also differentiate into fat cells, bone
cells and
cartilage cells. MSCs have been shown to suppress immune responses
ex vivo (outside the body in cell
culture conditions).
Due to these properties, MSCs have been used to treat GvHD in bone marrow
transplant (BMT) patients.
However, how MSC immunomodulation works in vivo
(inside the body) has not been well studied, and, in
fact, could potentially
promote leukemia/lymphoma recurrence in transplant patients. That is, the
benefit of
BMT is that the donor graft kills residual leukemia in the
transplant recipient (host), a process called graft-
versus-leukemia
(GvL).
"We used a pre-clinical mouse model of BMT to study how human MSCs mediate in
vivo immune effects,"
says Dr. Auletta. "Our results show for the first time
using an animal model that human MSCs simultaneously
attenuate GvHD, but
spare GvL activity."
December 17, 2011
Lymphology. 2011 Sep;44(3):134-43.
The effects of symptomatic seroma on
lymphedema symptoms following breast cancer treatment.
Fu MR, Guth AA,
Cleland CM, Lima ED, Kayal M, Haber J, Gallup L, Axelrod D.
Source
College
of Nursing, New York University, NYU Clinical Cancer Center, New York University
School of
Medicine, New York, NY 10003, USA. [email protected]
Abstract
It has been
speculated that symptomatic seroma, or seroma requiring needle aspiration, is
one of the risk
factors for lymphedema symptoms following breast cancer
treatment. These symptoms exert tremendous
impact on patients' quality of
life and include arm swelling, chest/breast swelling, heaviness, tightness,
firmness, pain, numbness, stiffness, or impaired limb mobility. Our aim was
to explore if symptomatic seroma
affects lymphedema symptoms following
breast cancer treatment. Data were collected from 130 patients
using a
Demographic and Medical Information interview tool, Lymphedema and Breast Cancer
Questionnaire, and review of medical record. Arm swelling was verified by
Sequential Circumferential Arm
Measurements and Bioelectrical Impedance
Spectroscopy. Data analysis included descriptive statistics, Chi-
squared
tests, regression, exploratory factor analysis and exploratory structural
equation modeling. Thirty-
five patients (27%) developed symptomatic seroma.
Locations of seroma included axilla, breast, and upper
chest. Significantly,
more women with seroma experienced more lymphedema symptoms. A well-fit
exploratory structural equation model [X2(79) = 92.15, p = 0.148; CFI =
0.97; TLI = 0.96] revealed a
significant unique effect of seroma on
lymphedema symptoms of arm swelling, chest/breast swelling,
tenderness, and
blistering (beta = 0.48, p < 0.01). Patients who developed symptomatic seroma
had 7.78
and 10.64 times the odds of developing arm swelling and
chest/breast swelling versus those who did not,
respectively (p < 0.001).
Symptomatic seroma is associated with increased risk of developing lymphedema
symptoms following breast cancer treatment. Patients who develop symptomatic
seroma should be
considered at higher risk for lymphedema symptoms and
receive lymphedema risk reduction interventions.
PMID: 22165584 [PubMed - in
process]
Lymphology. 2011 Sep;44(3):121-30.
The effects of reduction
operation with genital lymphedema on the frequency of erysipelas and the quality
of
life.
Zvonik M, Földi E, Felmerer G.
Source
Division of Plastic
Surgery, Department of Trauma Surgery, Plastic and Reconstruction Surgery,
University
Hospital Goettingen, Germany. [email protected]
Abstract
Genital
lymphedema represents a severe disability for patients particularly when
complicated by erysipelas,
the most frequent complication. The objectives of
this study were: to investigate the frequency of erysipelas
in patients with
genital lymphedema and genital lymphatic cysts who underwent evaluation for
surgical
treatment, to observe the influence of resection operations on the
frequency of erysipelas, and to measure
changes in the quality of life due
to the resection. A total of 93 patients with genital lymphedema were
studied. All patients underwent integrated care treatment in the Földi
Clinic, Hinterzarten and the
Department of Plastic and Hand Surgery of the
University Hospital Freiburg during the period between
1997 and 2007. 44 of
these patients underwent surgical treatment of genital lymphedema. The results
indicate that lymphatic cysts were the most important risk-aggravating
factor for recurrent erysipelas with
lymphorrhea in the genital region (p
< 0.001). Following the resection operation, however, the number of
erysipelas incidents significantly decreased (p < 0.001). In addition,
the antibiotic dose could be reduced
after surgery (p = 0.039) and an
improved quality of life was achieved (p < 0.001).
PMID: 22165582 [PubMed
- in process]
Lymphology. 2011 Sep;44(3):103-12.
Axillary lymph nodes and
arm lymphatic drainage pathways are spared during routine complete axillary
clearance in majority of women undergoing breast cancer surgery.
Szuba A,
Chachaj Z, Koba-Wszedybylb M, Hawro R, Jasinski R, Tarkowski R, Szewczyk K,
Bebenek
M, Forgacz J, Jodkowska A, Jedrzejuk D, Janczak D, Mrozinska M,
Pilch U, Wozniewski M.
Source
Department of Internal Medicine, Wroclaw
Medical University, Wroclaw, Poland. [email protected]
Abstract
Alterations
in axillary lymph nodes (ALNs) after complete axillary lymph node dissection
(ALND) in
comparison to the preoperative status were evaluated using
lymphoscintigraphy performed preoperatively
and 1-6 weeks after surgery in
30 women with a new diagnosis of unilateral, invasive breast carcinoma.
Analysis of lymphoscintigrams revealed that ALNs after surgery were present
in 26 of 30 examined women.
In comparison to preoperative status, they were
visualized in the same location (12 women), in the same and
additionally in
different locations (9 women), or only in different locations (4 women). No
lymph nodes were
visualized in one woman and lymphocoele were in 4 women.
Thus, after ALND, a variable number of
axillary lymph nodes remain and were
visualized on lymphoscintigraphy in the majority of women. The
classical
ALND, therefore, does not allow complete dissection and removal of axillary
nodes with total
disruption of axillary lymphatic pathways, accounting in
part for the variable incidence and severity of
lymphedema after the
procedure.
PMID: 22165580 [PubMed - in process]
J Cancer Surviv. 2011 Dec
10. [Epub ahead of print]
A randomized trial of exercise on well-being and
function following breast cancer surgery: the RESTORE
trial.
Anderson RT,
Kimmick GG, McCoy TP, Hopkins J, Levine E, Miller G, Ribisl P, Mihalko
SL.
Source
Department of Public Health Sciences, College of Medicine, Penn
State Milton S. Hershey Medical Center,
600 Centerview Drive, Suite 2200,
P.O. Box 855, Hershey, PA, 17033-0855, USA, [email protected].
Abstract
OBJECTIVES:
This
study aimed to determine the effect of a moderate, tailored exercise program on
health-related quality
of life, physical function, and arm volume in women
receiving treatment for nonmetastatic breast cancer.
METHODS:
Women who
were within 4-12 weeks of surgery for stage I-III breast cancer were randomized
to center-
based exercise and lymphedema education intervention or patient
education. Functional Assessment of
Cancer Therapy-Breast Cancer (FACT-B),
6-min walk, and arm volume were performed at 3-month
intervals through 18
months. Repeated measures analysis of covariance was used to model the total
meters
walked over time, FACT-B scores, and arm volume. Models were adjusted
for baseline measurement,
baseline affected arm volume, number of nodes
removed, age, self-reported symptoms, baseline SF-12
mental and physical
component scores, visit, and treatment group.
RESULTS:
Of the recruited
104 women, 82 completed all 18 months. Mean age (range) was 53.6 (32-82) years;
88%
were Caucasian; 45% were employed full time; 44% were overweight; and
28% obese. Approximately,
46% had breast-conserving surgery; 79% had
axillary node dissection; 59% received chemotherapy; and
64% received
radiation. The intervention resulted in an average increase of 34.3 ml
(SD = 12.8) versus
patient education (p = 0.01). Changes in FACT-B scores
and arm volumes were not significantly different.
CONCLUSIONS:
With this
early exercise intervention after breast cancer diagnosis, a significant
improvement was achieved in
physical function, with no decline in
health-related quality of life or detrimental effect on arm volume.
IMPLICATIONS FOR CANCER SURVIVORS: Starting a supervised exercise regimen
that is tailored to
an individual's strength and stamina within 3 months
following breast cancer surgery appears safe and may
hasten improvements in
physical functioning.
PMID: 22160629 [PubMed - as supplied by
publisher]
Am J Clin Oncol. 2011 Dec 12. [Epub ahead of print]
Comparison
of Lymphedema in Patients With Axillary Lymph Node Dissections to Those With
Sentinel
Lymph Node Biopsy Followed by Immediate and Delayed
ALND.
Kuwajerwala NK, Feczko C, Dekhne N, Pettinga J, Lucia VC, Riutta J,
Vicini F.
Source
*Departments of Surgery, William Beaumont Hospital, Troy
and Royal Oak †Cancer Clinical Trials
§Physical Medicine and Rehabilitation
‡Research Institute, William Beaumont Hospital ∥Department of
Radiation
Oncology, Royal Oak, MI.
Abstract
PURPOSE:
The purpose of the study was
to show that delayed axillary lymph node dissection (ALND) has higher rates
of lymphedema compared with immediate ALND, using data from NSABP-B32 at
Beaumont Hospital.
METHOD:
NSABP B-32 at Beaumont had 207 patients with
follow-up data on 199 patients, randomizing clinically
negative axilla to
sentinel lymph node biopsy (SLNB)+ALND (GrA N=98), and SLNB+cytology±ALND
(GrB N=101). All patients had preoperative volumetric arm measurements and
only node negatives had
routine postoperative measurements assessing
lymphedema for 36 months. We contacted node-positive
patients for
postoperative measurements for this study. Twenty-four and 15 cytology-positive
patients had
SLNB+ALND in GrA and GrB, respectively (SubGrA1 N=24; SubGrB1
N=15). Fourteen hematoxylin
and eosin-positive patients had delayed ALND
(SubGrB2a N=14).
RESULTS:
Lymphedema rate for node-positive SLNB+ALND was
10.3% [SubGrA1 (3/24)+SubGrB1 (1/15)=4/39]
and node-negative SLNB+ALND was
6.8% (SubGrA2=5/74). Lymphedema was 14.3% for delayed
ALND in SubGrB2a (2 of
14) and 0% for 72 SLNBs in SubGrB2b. Our study comparing immediate and
delayed ALND lymphedema was not statistically significant (10.3% vs. 14.3%,
P=0.65). Comparing node-
negative ALND (SubGrA2= 5/74=6.8%) to node-positive
ALND (A1+B1+B2a=6/53=11.3%) was not
statistically significant (P=0.52).
Comparing lymphedema for node-negative ALND (SubGrA2) to SLNB
(SubGrB2b)
only approached significance (6.8% vs. 0%, P=0.058).
CONCLUSIONS:
The rate
of lymphedema was higher in delayed ALND but not statistically significant.
Comparison, however,
is difficult, given the limited sample size. We urge
the other centers of NSABP-B32 to validate this, by
contacting the
node-positive patients for measurements. The lymphedema rate for SLNB alone was
0% and
approached statistical significance when compared with node-negative
ALND.
PMID: 22157215 [PubMed - as supplied by publisher]
Clin Nucl Med.
2012 Jan;37(1):9-13.
Lymphatic dysfunction in the apparently clinically
normal contralateral limbs of patients with unilateral lower
limb
swelling.
Burnand KM, Glass DM, Mortimer PS, Peters AM.
Source
From the
*Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, United
Kingdom;
†Department of Nuclear Medicine, Harley St Clinic, London, United
Kingdom; and ‡Department of
Medicine, St George's Hospital, London, United
Kingdom.
Abstract
PURPOSE:
: To determine how often lymphatic
dysfunction is bilateral when, clinically, lymphedema appears
unilateral.
METHODS:
: Lymphoscintigraphy was performed after subcutaneous
Tc-99m-nanocolloid injection in the first
webspaces of both feet. The
percentage of injected radioactivity accumulating in the ilioinguinal regions
was
recorded in dedicated images separately acquired at 60 and 180 minutes
after injection.
RESULTS:
: Within a consecutive series of 204 patients,
74 had unilateral clinical lymphedema of whom 68 had
abnormal scintigraphy.
Of these 68 patients, 46 had unilateral abnormal scintigraphy affecting the
clinically
abnormal limb, but 20 patients had bilateral abnormal
scintigraphy and 2 had unilateral abnormal scintigraphy
in the clinically
unaffected limb. Thus, 32% (22/68) of patients in whom clinical lymphedema
appeared to be
unilateral, nevertheless, had abnormal scintigraphy in the
clinically normal limb. Twenty-nine patients had no
clinical evidence of
lymphedema in either limb and were scintigraphically normal bilaterally. Mean
ilioinguinal
nodal accumulation at 180 minutes in the 44 limbs of 22 of
these clinically and scintigraphically normal
patients (dedicated
ilioinguinal imaging was not performed in all patients) was 13.1% (standard
deviation,
8.8%), higher (P = 0.02) than the mean value of 9.3% (standard
deviation, 5.0%) in the clinically and
scintigraphically normal
contralateral limbs of 39 patients with unilateral clinical
lymphedema.
CONCLUSIONS:
: In the presence of unilateral lymphedema, the
contralateral limb is often also abnormal. On
lymphoscintigraphy, therefore,
care should be taken before diagnosing unilateral lymphatic dysfunction.
Quantification should be included in routine lymphoscintigraphy, as reduced
ilioinguinal nodal accumulation
may be the only apparent
abnormality.
PMID: 22157021 [PubMed - in process]
Phlebology. 2011 Dec 12.
[Epub ahead of print]
Intensive decongestive treatment restores ability to
work in patients with advanced forms of primary and
secondary lower
extremity lymphoedema.
Stanisic MG, Gabriel M, Pawlaczyk
K.
Source
Department of General and Vascular Surgery, Poznan University of
Medical Sciences, ul Długa 1/2, 61-848
Poznań,
Poland.
Abstract
OBJECTIVE:
To show that adequate therapy for
lymphoedema is able to restore ability to work.
MATERIALS AND METHODS:
The
population of patients with primary lymphoedema registered in the university
clinical centre diagnosed
with primary or secondary lymphoedema and presumed
by the national social institution as completely
unable to work was selected
for the retrospective analysis and divided into two groups. Group 1 consisted
of 25 patients treated with a complex decongestive therapy programme daily
for 3-6 weeks. The study
population comprised 19 women and six men from 14
to 61 years of age (mean 31.5). In all 25 patients,
complete inability to
work was certified by the social institution before the treatment started. Group
2
consisted of 47 patients, 14 men and 33 women, aged from 26 to 71 years
(mean 39 years) treated by so-
called standard methods, who resigned from the
proposed intensive treatment. In all 47 patients, complete
inability to work
was declared by the social institution before the treatment. Ability to work and
oedema
reduction were assessed by the treating physician.
RESULTS:
The
intensive phase of treatment succeeded in 3870-15,330 mL oedema reduction in
Group 1. After the
end of therapy, 21 patients were able to work or study
without any limitation and patients returned to their
regular professional
activity. Among four others, two were on welfare for at least 10 years, for
another one
welfare was their only income and one person was receiving a
social pension. In none of the patients from
group 2 was any significant
oedema reduction observed. Every patient from group 2 maintained the social
pension due to ineffective treatment.
CONCLUSIONS:
Complex
decongestive therapy is a very efficient form of treatment in advanced primary
and secondary
lymphoedema. It allows returning to work after a short period
of temporary disability without the necessity
of a social pension.
PMID:
22156385 [PubMed - as supplied by publisher]
Phys Ther. 2011 Dec 9. [Epub ahead of print]
Factors That Affect Physical
Activity and Exercise Decisions of Survivors of Breast Cancer: Qualitative
Study.
Sander AP, Wilson J, Izzo N, Mountford SA, Hayes
KW.
Source
A.P. Sander, PT, DPT, MS, CLT-LANA, Department of Physical
Therapy and Human Movement
Sciences, Northwestern University Feinberg School
of Medicine, 645 N Michigan Ave, Suite 1100,
Chicago, IL 60611
(USA).
Abstract
BackgroundExercise has many benefits for breast cancer
survivors, yet only half of survivors regularly
exercise. Fear has been
identified as a barrier to exercise for people with neuromusculoskeletal
conditions,
but has been minimally explored among women with breast
cancer.ObjectivesThe purpose of this study was
to investigate factors that
impact the physical activity and exercise decisions of breast cancer survivors
and
to determine whether fear was among those factors.DesignThis was a
grounded theory qualitative study. The
qualitative data were triangulated
with two quantitative scales that measured participants' beliefs about
exercise and their activity level.
METHODS:
/b>Thirty-four breast
cancer survivors participated in 8 focus groups using semi-structured interviews
that
were recorded, transcribed and coded. Concept maps created for each
group were merged to develop
themes. Physical activity/exercise beliefs were
assessed using the Decisional Balance Scale. The Rapid
Assessment of
Physical Activity Scale assessed physical activity/exercise behaviors pre and
post breast
cancer diagnosis.
RESULTS:
/b>Participants generally
believed that exercise was beneficial (Decisional Balance score mean; SD; range
=
28.1/44; 7.6; 10-43). Participants decreased the amount of physical
activity/exercise during treatment, but
increased the amount of exercise
beyond pre-diagnosis levels following treatment (Rapid Assessment of
Physical Activity median; range = 6; 2-7). Three prominent themes described
the physical activity/exercise
behaviors of participants: values and beliefs
about exercise; facilitators and barriers that were both similar to
the
general population and cancer specific; and lack of or inaccurate information
about safe exercise.
CONCLUSION:
/b>The active survivors in this study
were not afraid to exercise. However, concerns about lymphedema and
knowledge of safe and effective exercise programs influenced physical
activity and exercise choices.
PMID: 22156026 [PubMed - as supplied by
publisher]
Trans R Soc Trop Med Hyg. 2011 Dec 9. [Epub ahead of
print]
Lymphatic filariasis in western Ethiopia with special emphasis on
prevalence of Wuchereria bancrofti
antigenaemia in and around onchocerciasis
endemic areas.
Shiferaw W, Kebede T, Graves PM, Golasa L, Gebre T, Mosher AW,
Tadesse A, Sime H, Lambiyo T,
Panicker KN, Richards FO, Hailu
A.
Source
Department of Microbiology, Immunology and Parasitology (DMIP);
Faculty of Medicine, Addis Ababa
University, PO Box 9086, Addis Ababa,
Ethiopia.
Abstract
Lymphatic filariasis is known to be endemic in Gambella
Region, western Ethiopia, but the full extent of its
endemicity in other
regions is unknown. A national mapping program for Ethiopia was initiated in
2008. This
report summarizes initial data on the prevalence of Wuchereria
bancrofti antigenaemia based on surveys
carried out in a sampled population
of 11685 individuals living in 125 villages (112 districts) of western
Ethiopia. The overall prevalence rate was 3.7%, but high geographical
clustering and variation in prevalence
(ranging from 0% to more than 50%)
was found. The prevalence of hydrocele (in males) and lymphoedema
of limbs
was 0.8% and 3.6% respectively. Significantly higher (χ(2)=49.6; P<0.01)
prevalence of
antigenaemia was noted in known onchocerciasis endemic
districts (4.7%) compared to non-onchocerciasis
endemic districts (2.3%).
Thirty-four of the 112 districts, with a population of 1547685 in 2007, were
found
to be endemic. Of these, the numbers of districts with prevalence
rates of >20%, 10-20% and 5-9% were
nine, 14 and 20 respectively.
Twenty-nine of these 34 endemic districts were found in three regions:
Gambella Region (seven districts), Beneshangul-Gumuz Region (13 districts),
and Southern Nations,
Nationalities and Peoples' Region (SNNPR) (nine
districts). The other five were from Amhara (two
districts) and Oromia
(three districts) regions. A tentative distribution map has been drawn to
facilitate the
launching of the Ethiopia LF elimination
program.
Copyright © 2011 Royal Society of Tropical Medicine and Hygiene. All
rights reserved.
PMID: 22154976 [PubMed - as supplied by publisher]
Ann
Surg Oncol. 2011 Dec;18 Suppl 3:312-4. Epub 2011 Aug 12.
Reply to Letter to
the Editor "Lymphoedema in the Observation and Biopsy Arms of MSLT-1" by Thomas,
J Meirion (ASO-2011-04-0666).
Faries MB, Morton DL, Cochran AJ, Thompson
JF.
Source
Department of Surgery, Yale School of Medicine, New Haven, CT,
USA, [email protected].
PMID:
21837533 [PubMed - in process]
Ann Surg Oncol. 2011 Dec;18 Suppl 3:311. Epub 2011 Jul 20.
Lymphoedema in
the Observation and Biopsy Arms of MSLT-1.
Thomas JM.
Source
Surgical
Oncology, Royal Marsden Hospital, London, UK, [email protected].
PMID:
21773841 [PubMed - in process]
December 20, 2011
Clin Rehabil. 2011 Dec 21. [Epub ahead of print]
Efficacy of low-frequency
low-intensity electrotherapy in the treatment of breast cancer-related
lymphoedema: a cross-over randomized trial.
Belmonte R, Tejero M, Ferrer
M, Muniesa JM, Duarte E, Cunillera O, Escalada F.
Source
Medicina Física i
Rehabilitació, Hospital Mar-Esperança, Barcelona,
Spain.
Abstract
Objective: To compare the efficacy of low-frequency
low-intensity electrotherapy and manual lymphatic
drainage in the treatment
of chronic upper limb breast cancer-related lymphoedema.Design: Cross-over
single-blind random clinical trial.Setting: Rehabilitation
service.Participants: Thirty-six women with chronic
upper limb breast
cancer-related lymphoedema.Methods: Patients were randomized to undergo 10
sessions
of manual lymphatic drainage followed by 10 sessions of
low-frequency low-intensity electrotherapy or to
undergo first low-frequency
low-intensity electrotherapy followed by manual lymphatic drainage. There was
a month of washout time between treatments. Each patient was examined just
before and after each
treatment. Researchers and outcome assessors were
blinded for assigned treatment.Measures: Outcomes
were lymphoedema volume,
pain, heaviness and tightness, and health-related quality of life measured with
the Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer
version 4 (FACT-B+4).
Carry-over, period and treatment effects were
analysed. Treatment effect was assessed using paired t-test.
Results: Thirty
patients finalized treatment. Comparing the changes in low-frequency
low-intensity
electrotherapy with manual lymphatic drainage changes, there
were no significant differences.Low-frequency
low-intensity electrotherapy
did not reduce lymphoedema volume (mean of change = 19.77 mL, P = 0.36),
but
significant reductions were observed in pain, heaviness and tightness (mean of
change = 13.1, 16.2 and
6.4 mm, respectively), and FACT-B+4 summaries
improved significantly (Trial Outcome Index mean of
change = 5.4, P =
0.015). Manual lymphatic drainage showed no significant changes in any of the
outcomesConclusion: Although there are no significant differences between
treatment changes, the observed
trend towards a better health-related
quality of life is remarkable in low-frequency low-intensity
electrotherapy.
PMID: 22172923 [PubMed - as supplied by
publisher]
December 24, 2011
Plast Reconstr Surg. 2012
Jan;129(1):221e-2e.
Primary lymphedema: definition of onset based on
developmental age.
Greene AK, Schook CC.
Source
Department of Plastic
and Oral Surgery, Vascular Anomalies Center and Lymphedema Program, Children's
Hospital Boston, Harvard Medical School, Boston, Mass.
PMID: 22186578
[PubMed - in process]
Eplasty. 2011;11:ic15. Epub 2011 Nov 4.
Scrotal
lymphedema.
Pastor C, Granick MS.
Source
Division of Plastic Surgery,
University of Medicine and Dentistry of New Jersey, Newark, NJ.
PMID:
22184510 [PubMed - in process] PMCID: PMC3236059
Curr Oncol. 2011
Dec;18(6):e260-4.
Lymphedema in Canada: a qualitative study to help develop a
clinical, research, and education strategy.
Hodgson P, Towers A, Keast DH,
Kennedy A, Pritzker R, Allen J.
Source
Lymphedema Program, McGill
University Health Centre, Montreal, QC.
Abstract
OBJECTIVE:
The aim of
this study was to gather data from Canadian stakeholders to help construct a
national strategy
and agenda for lymphedema management.
METHODS:
The
Canadian Lymphedema Framework, a collaboration of medical academics, lymphedema
therapists,
patient advocates, and others, used participatory action
research and Open Space Technology to identify
issues and build consensus at
a national meeting of lymphedema stakeholders. Proceedings were videotaped
and underwent content analysis. Existing Canadian documentation on
lymphedema services was analyzed.
Using those data sources, the Canadian
Lymphedema Framework drafted a development strategy.
RESULTS:
Of 320
invited stakeholders (patients, therapists, physicians, industry
representatives, and health
policymakers), 108 participated in a day-long
videotaped meeting discussing strategies to improve the
management of
lymphedema and related disorders in Canada. Participants identified barriers,
challenges,
and issues related to the need to raise awareness about
lymphedema with patients, physicians, and the
public. Five priority areas
for development were articulated: education, standards, research, reimbursement
and access to treatment, and advocacy. The main barrier to development was
identified as the lack of clear
responsibility within the health care system
for lymphedema care.
CONCLUSIONS:
Data from stakeholders was obtained to
solidly define priority areas for lymphedema development at a
national
level. The Canadian Lymphedema Framework has created a working plan, an advisory
board, and
working groups to implement the strategy.
PMID: 22184493
[PubMed - in process] PMCID: PMC3224034
Clin Anat. 2012
Jan;25(1):72-85. doi: 10.1002/ca.22009.
Cutaneous lymphatics and chronic
lymphedema of the head and neck.
Feely MA, Olsen KD, Gamble GL, Davis MD,
Pittelkow MR.
Source
Mayo Clinic College of Medicine, Mayo Clinic,
Rochester, Minnesota.
Abstract
Extensive attention has been directed to
lymphedema involving the extremities. However, there has been
relatively
limited study of the cutaneous lymphatics of the head and neck. In this review
of head and neck
lymphatics, we capsulize the history of the lymphatics, the
anatomy of the cutaneous lymphatics, lymphatic
function and physiology, and
imaging modalities used to define this intricate vascular system. To appreciate
the clinical challenges associated with head and neck lymphatic dysfunction,
we also provide an overview of
disease processes of the cutaneous lymphatics
and their treatment, theories on the etiology of lymphedema,
and future
directions to better understand lymphatic function and disease. Knowledge of the
cutaneous
lymphatics of the head and neck are critical to the clinical
evaluation of patients, who present with this
debilitating condition and to
our understanding of its pathogenesis and appropriate management. Clin. Anat.
25:72-85, 2012. © 2011 Wiley Periodicals, Inc.
Copyright © 2011
Wiley-Liss, Inc.
PMID: 22180138 [PubMed - in process]
J Minim Invasive
Gynecol. 2011 Dec 14. [Epub ahead of print]
Laparoscopic Lymphadenectomy for
Isolated Lymph Node Recurrence in Gynecologic Malignancies.
Hong JH, Choi JS,
Lee JH, Bae JW, Eom JM, Kim JT, Oh S.
Source
Division of Gynecologic
Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics
and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of
Medicine, Seoul, Korea.
Abstract
STUDY OBJECTIVE:
To assess the
feasibility and efficacy of laparoscopic lymphadenectomy in patients with
isolated lymph node
recurrences (ILNR) who underwent initial surgery because
of gynecologic malignancy.
DESIGN:
Retrospective study (Canadian Task
Force classification II-3).
SETTING:
University teaching
hospital.
PATIENTS:
Six patients with ILNR (1 cervical, 4 ovarian, and 1
peritoneal) diagnosed between March 2003 and July
2010.
INTERVENTION:
Laparoscopic lymphadenectomy.
MEASUREMENTS AND
MAIN RESULTS:
Median (range) patient age was 59.5 (24-70) years, and body
mass index was 21.7 (21.0-24.6). There
was no unplanned conversion to
laparotomy. Operating time was 337.5 (200-400) minutes, hemoglobin
change
was 0.9 (0.4-2.6) g/dL, and hospital stay was 8.5 (5-19) days. The number of
harvested lymph
nodes was 20 (5-27), and of positive lymph nodes was 4
(1-24). One patient had common iliac vein
laceration, with complete
hemostasis achieved using intracorporeal suture. Postoperative lymphedema
occurred in 1 patient, and was managed conservatively. All patients received
adjuvant chemotherapy after
laparoscopic
lymphadenectomy.
CONCLUSION:
Laparoscopic lymphadenectomy in patients with
ILNR is feasible and might be an alternative therapeutic
strategy.
Copyright © 2011 AAGL. Published by Elsevier Inc. All rights
reserved.
PMID: 22176995 [PubMed - as supplied by publisher]
December 27, 2011
Ann Plast Surg. 2012 Jan;68(1):94-6.
Treating chronic
lower limb lymphedema with the charles procedure in a renal allograft
recipient.
Wu HS, Cheng HT, Chen HC.
Source
From the Department of
Surgery, Subdivision of Plastic and Reconstructive Surgery, China Medical
University Hospital, China Medical University, Taichung City,
Taiwan.
Abstract
We report our experience in applying the Charles
procedure to a female renal allograft recipient for her left
lower leg
lymphedema. This is a rare comorbidity in limb lymphedema victims, and the use
of the Charles
procedure has not been reported in such an immunocompromised
patient. After surgery, infection was well
controlled, and there was minimal
scar in the affected limb.
PMID: 22193429 [PubMed - in process]
Sarcoma.
2011;2011:289673. Epub 2011 Nov 20.
Incidence and Severity of Lymphoedema
following Limb Salvage of Extremity Soft Tissue Sarcoma.
Friedmann D, Wunder
JS, Ferguson P, O'Sullivan B, Roberge D, Catton C, Freeman C, Saran N, Turcotte
RE.
Source
Division of Orthopedic Surgery, McGill University Health
Centre, Montreal, QC, Canada H3G 1A4.
Abstract
Background and Purpose.
Lymphoedema is a serious complication following limb salvage for extremity soft
tissue sarcomas (STSs) for which little is known. We aimed to evaluate its
incidence, its, severity and its
associated risk factors. Material and
Method. Patient and tumor characteristics, treatment modalities and
complications and functional outcomes (MSTS 1987, TESS), and lymphoedema
severity (Stern) were all
collected from prospective databases. Charts were
retrospectively abstracted for BMI and comorbidities.
Results. There were
289 patients (158 males). Mean age was 53 (16-88). Followup ranged between 12
and 60 months with an average of 35 and a median of 36 months. Mean BMI was
27.4 (15.8-52.1). 72%
had lower extremity tumors and 38% upper extremity.
Mean tumor size was 8.1 cm (1.0-35.6 cm). 27%
had no adjuvant radiation, 62%
had 50 Gy, and 11% received 66 Gy. The incidence of lymphoedema
was 28.8%
(206 none, 58 mild, 22 moderate, 3 severe, and 0 very severe). Mean MSTS score
was 32
(11-35) and TESS was 89.4 (32.4-100). Radiation dose was
significantly correlated with tumor size > 5
cm (P = 0.0001) and TESS
score (P = 0.001), but not MSTS score (P = 0.090). Only tumor size > 5 cm
and depth were found to be independent predictors of significant
lymphoedema. Conclusion. Nine percent
of STS patients in our cohort
developed significant (grade ≥ 2) lymphoedema. Tumor size > 5 cm and
deep
tumors were associated with an increased occurrence of lymphoedema but not
radiation dosage.
PMID: 22190861 [PubMed - in process] PMCID:
PMC3236348
Oper Orthop Traumatol. 2011 Dec 23. [Epub ahead of print]
[Soft
tissue reconstruction of the distal lower extremity using the 180-degree
perforator-based propeller
flap.]
[Article in German]
Jakubietz RG,
Schmidt K, Holzapfel BM, Meffert RH, Rudert M, Jakubietz MG.
Source
Klinik
und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie,
Uniklinikum Würzburg,
Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland, [email protected].
Abstract
OBJECTIVE:
Operative technique of propeller flap reconstruction of soft tissue defects
in the distal lower extremity. Soft
tissue reconstruction of the distal
third of the lower extremity with local, reliable perforator flaps avoiding
free tissue transfer.
INDICATIONS:
Complex wounds (maximum width of 6
cm) of the distal lower extremity with exposed bones, joints,
tendons, and
neurovascular structures.
CONTRAINDICATIONS:
Arterial vascular disease
(stage III or IV), diabetes mellitus, postthrombotic syndrome, venous ulcers,
chronic lymphedema, contusion of adjacent soft tissue, previous radiation,
and lack of perforators
SURGICAL TECHNIQUE:
The perforator represents the
pivot point around which rotation of up to 180º of the subfascially harvested
flap allows closure of the defect. The proximal donor site can be closed
primarily up to a width of 6 cm.
POSTOPERATIVE MANAGEMENT:
Strict
elevation of the extremity for 5 days, then flap conditioning.
RESULTS:
This technique was used for soft tissue reconstruction in 17 patients. In
one patient with diabetes, complete
flap necrosis occurred, requiring
amputation of the extremity. One case of epidermolysis healed without
further surgery.
PMID: 22190271 [PubMed - as supplied by publisher]
Wkly Epidemiol Rec. 2011 Dec 16;86(51-52):581-5.
Managing morbidity and
preventing disability in the Global Programme to Eliminate Lymphatic Filariasis:
WHO position statement.
[Article in English, French]
[No authors
listed]
PMID: 22191103 [PubMed - indexed for MEDLINE