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Lymphland International Lymphedema Online
J Assoc Physicians India. 2011 Apr;59:258-60.
Yellow nail syndrome: missed diagnosis of a rare syndrome.
Chavda LK, Vaidya RA, Vaidya AD.
Source
Panchanath Medical Trust, Rajkot, Gujarat.
Abstract
A 61 year old male, with a bilateral persistent and recurrent pleural effusion, had undergone frequent tapping
over a period of eight months, prior to the referral. The patient was treated earlier to the referral empirically
for pulmonary tuberculosis with no response to the treatment. Malignancy was suspected and ruled out. A
detailed examination showed that he also had atrophic nails with yellow discoloration and lymphedema of
feet. Yellow nail syndrome was diagnosed on the basis of the clinical findings of the triad viz. yellow atrophic
nails, lymphedema and bilateral pleural effusions. Pathogenesis still remains elusive for the syndrome.
Pleurodesis provided both symptomatic relief and a respite from repeated tapping. The case is presented as
a rare condition, which was missed for diagnosis, for quite some time by several specialists.
PMID:
21755767
[PubMed - in process]
April 8, 2011
Eur J Vasc Endovasc Surg. 2011 Mar 30. [Epub ahead of print]
Extracorporeal Shock Wave Therapy Induces Therapeutic Lymphangiogenesis in a Rat Model of
Secondary Lymphoedema.
Serizawa F, Ito K, Matsubara M, Sato A, Shimokawa H, Satomi S.
Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine,
1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan.
Abstract
OBJECTIVE: Lymphoedema is a common complication after cancer treatment. We have reported that low-
energy extracorporeal shock wave (SW) therapy up-regulates vascular endothelial growth factor (VEGF) in
ischaemic myocardium. As VEGF plays an important role in lymphangiogenesis, we investigated whether
our low-energy SW therapy enhances lymphangiogenesis in rats.
METHODS: We created a tail model of lymphoedema in rats. The tail was treated with or without low-
energy SW therapy (0.25 mJ mm(-2), 500 impulses) four times (days 3, 5, 7, and 9). The tail volume and
the fluorescence intensity of indocyanine green (ICG) were measured. The expression of VEGF-C and
basic fibroblast growth factor (bFGF) were evaluated by RT-PCR, and the lymphatic vessel density was
assessed histochemically.
RESULTS: The tail volume increased significantly in the control group and was significantly improved in the
SW group. The lymphatic system function (evaluated with fluorescence intensity of ICG), the lymphatic
vessel density, and the expression of VEGF-C and bFGF were all enhanced by the SW therapy (all P <
0.05).
CONCLUSIONS: The low-energy SW therapy induces therapeutic lymphangiogenesis by up-regulating
VEGF-C and bFGF, and improves lymphoedema in a rat-tail model, suggesting that low-energy SW
therapy could be a non-invasive and effective strategy for lymphoedema in humans.
Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
PMID: 21454105 [PubMed - as supplied by publisher]
Actas Urol Esp. 2011 Mar 29. [Epub ahead of print]
Simplification of the surgical treatment of a hidden penis.
[Article in English, Spanish]
Rivas S, Romero R, Parente A, Fanjul M, Angulo JM.
Sección de Urología Infantil, Servicio de Cirugía Pediátrica, Hospital General Universitario Gregorio
Marañón, Madrid, España.
Abstract
INTRODUCTION: The treatment of a hidden penis consists of completely and effectively exteriorizing the
penile shaft from a functional and aesthetic point of view.
PATIENTS AND METHODS: Over a period of 15 months (02/2008-05/2009), we treated 7 children
(mean age 4.6years) with hidden penis (five had a buried penis, one had a webbed penis and another a
trapped penis) using the Borsellino reconstruction technique modified with an "S" dorsal incision. We
performed a pubic lipectomy in one patient through the same incision. Surgical indication was for aesthetic
reasons in all the cases, secondary phimosis in four, repeated balanitis in one and pain in another.
RESULTS: Hospital stay was 24hours. With a short-term follow-up (1-12 months), we detected the
following complications: partial recurrence, post-surgical lymphedema and hypertrophic scarring, each of
them in one case. Patients and parents were satisfied with the result.
CONCLUSIONS: The technique that we present achieves good cosmetic results and has few immediate
complications. The substitution of the two dorsal incisions with one "S" incision allows simultaneous
lipectomy without the need for another incision.
Copyright © 2010 AEU. Published by Elsevier Espana. All rights reserved.
PMID: 21453989 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 Mar 29. [Epub ahead of print]
The Circumferential Thigh Lift and Vertical Extension Circumferential Thigh Lift: Maximizing Aesthetics and
Safety in Lower Extremity Contouring.
Kolker AR, Xipoleas GD.
From the Department of Surgery, Division of Plastic Surgery, Mount Sinai School of Medicine, New York,
NY.
Abstract
Excess skin and soft tissue of the thighs after massive weight loss (MWL) can present with varying degrees
of severity. The classic medial thigh lift has considerable limitations in the postbariatric population, inspiring
the quest for safer and more effective technical solutions. In this study, the circumferential thigh lift (CTL),
and CTL with vertical extension, predicated on a theoretical and technical approach that improves safety
and aesthetics in thighplasty after MWL, is described and evaluated. Nine patients were treated; all patients
experienced MWL and all had previously undergone first-stage contouring with circumferential abdominal
dermolipectomy. Patients were treated with a prone-to-supine approach with concomitant suction-assisted
lipectomy (SAL). Lumbar and lateral thigh and infragluteal skin and fat were excised to the midaxillary lines
and medial thigh meridians. Direct excision of anterolateral thigh skin was carried in a superficial plane into
the medial thigh to confluence with the posterior excision. No direct undermining of any skin margin was
performed. When soft-tissue excess is limited to the proximal third of the thigh, a horizontal excision pattern
is used; with middle and lower one-third thigh excess, a vertical extension is employed. The medial
superficial fascial system is anchored to the superficial perineal fascia. Data were reviewed retrospectively.
In the 9 procedures performed, 3 achieved MWL by nonsurgical means, and 6 underwent bariatric surgery
(bypass or band). Three patients were treated with CTL, and 6 with CTL with vertical extension. There
were 3 seromas (33%) treated with percutaneous aspiration. There was 1 case of cellulitis (11%) treated
successfully with in-office incision and drainage, and oral antibiotics. There were no hematomas, skin loss,
wound dehiscences, lymphedema, or vulvar distortions. The circumferential excision of thigh excess without
direct undermining allows for the maintenance of a rich blood supply to skin margins, and concomitant SAL
improves thigh contour while providing discontinuous thigh undermining. Anchoring of the superficial fascial
system to superficial perineal fascia reinforces the medial lift and prevents scar migration. CTL with or
without vertical extension can be combined with SAL to maximize safety and aesthetic results after MWL.
PMID: 21451373 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Apr 5. [Epub ahead of print]
Morbidity of Sentinel Node Biopsy: Relationship Between Number of Excised Lymph Nodes and Patient
Perceptions of Lymphedema.
Goldberg JI, Riedel ER, Morrow M, Van Zee KJ.
Breast Service, Department of Surgery, Evelyn H. Lauder Breast Center, Memorial Sloan-Kettering Cancer
Center, New York, NY, USA.
Abstract
BACKGROUND: Sentinel lymph node biopsy (SLNB) is associated with reduced morbidity, although
lymphedema remains a significant complication. Previously, we found no association between number of
excised lymph nodes (LNs) and measured lymphedema in SLNB patients. In this analysis, we examined the
relationship between number of LNs excised during SLNB and patient-perceived lymphedema.
METHODS: A total of 600 women who underwent SLNB for breast cancer were prospectively studied.
Measured lymphedema was evaluated by circumferential bilateral upper-extremity measurements taken
preoperatively and 3-8 years postoperatively. Patient-perceived lymphedema was evaluated by interview at
follow-up. The relationship between lymphedema, total LNs excised, and clinicopathologic variables was
assessed with Fisher's exact test, Wilcoxon rank-sum test, kappa statistic, and McNemar's test.
RESULTS: At a median of 5 years, 18 (3%) patients reported perceived lymphedema. More LNs were
excised in patients with perceived lymphedema compared with those without (median, 5.5 vs. 3; p = 0.01).
Only 6 of 18 women with perceived lymphedema had objectively measured lymphedema (kappa = 0.22).
Patients with numbness more likely reported perceived lymphedema (p = 0.03) and had more LNs excised
(p = 0.02). Women with surgery on the nondominant axilla were less likely to perceive arm swelling,
regardless of the presence of measured lymphedema.
CONCLUSIONS: After SLNB alone, patient-perceived lymphedema is uncommon, but its prevalence
increases with more LNs excised. There is poor agreement between patient perceptions and objective
measures. Our data suggest that factors other than limb enlargement, such as sensory nerve injury resulting
from retrieval of more LNs and laterality of surgery, may play a significant role in patient perception of
lymphedema after SLNB.
PMID: 21465310 [PubMed - as supplied by publisher]
Int J Gynecol Pathol. 2011 Apr 1. [Epub ahead of print]
Localized Lymphedema of the Vulva: A Clinicopathologic Study of 2 Cases and a Review of the Literature.
Fadare O, Brannan SM, Arin-Silasi D, Parkash V.
Department of Pathology (O.F.), Vanderbilt University School of Medicine, Nashville, TN Department of
Radiology (S.M.B.) Department of Pathology (D.A.-S., V.P.), Bridgeport Hospital, Bridgeport Yale
University School of Medicine (V.P.), New Haven, CT.
Abstract
This report describes 2 cases of localized vulvar lymphedema that were diagnosed in 2 morbidly obese
women, including a unique case of a massive localized vulvar lymphedema associated with lymphangioma
circumscriptum of the vulva. Herein, we also review previously reported cases of vulvar lymphedema and
discuss differential diagnostic considerations. Our review of the recent literature showed 17 cases that we
considered approximately similar, reported under the appellations "vulvar lymphoedematous pseudotumor,"
"massive vulval edema," "vulvar hypertrophy with lymphedema," and "localized lymphedema (elephantiasis)."
The patients ranged in age from 19 to 59 years (average 38.5 yrs), and typically presented with
papillomatous plaques, skin polyps, generalized vulvar enlargement, or massive pedunculated masses that
had been present for durations that ranged from 3 months to 36 years. The average lesional size was 6.1 cm
(range: 0.6 - 45 cm), and 10 (59%) of the 17 cases were 3 cm or less. Excisions were generally curative,
although persistent or recurrent disease was reported in 3 cases. The patients were overweight in 9 (75%)
of the 12 cases in which the patient weight was noted, and 2 others had chronic immobilization. Stromal
edema was the only morphologic finding that was uniformly seen in all 17 cases. However, the following
morphologic features were identified in significant subsets: multinucleated giant cells, dermal fibrosis, dermal
lymphangiectasia, dermal chronic inflammation, perivascular chronic inflammation (superficial and/or deep),
hyperkeratosis, acanthosis, and blood vessels of varying calibers. Several attributes of localized vulvar
lymphedema may cause them to closely mimic aggressive angiomyxoma, a differential diagnosis that is herein
discussed in detail. Localized vulvar lymphedema may also be a small lesion, and can potentially mimic other
myxedematous tumors of the vulvovaginal region. The strongest clinical association is with obesity. The term
"localized vulvar lymphedema" is an appropriate generic descriptor for the spectrum of lesions whose
fundamental and underlying etiology is thought to be chronic lymphedema.
PMID: 21464721 [PubMed - as supplied by publisher]
J Vasc Res. 2011 Apr 4;48(5):397-407. [Epub ahead of print]
Mutations in FOXC2 in Humans (Lymphoedema Distichiasis Syndrome) Cause Lymphatic Dysfunction on
Dependency.
Mellor RH, Tate N, Stanton AW, Hubert C, Mäkinen T, Smith A, Burnand KG, Jeffery S, Levick JR,
Mortimer PS.
Cardiac and Vascular Sciences (Dermatology), St. George's, University of London, London, UK.
Abstract
Background: Human lymphoedema distichiasis syndrome (LDS) results from germline mutations in
transcription factor FOXC2. In a mouse model, lack of lymphatic and venous valves is observed plus
abnormal smooth muscle cell recruitment to initial lymphatics. We investigated the mechanism of
lymphoedema in humans with FOXC2 mutations, specifically the effect of gravitational forces on dermal
lymphatic function. Methods: We performed (1) quantitative fluorescence microlymphangiography (FML)
on the skin of the forearm (non-swollen region) at heart level, and the foot (swollen region) below heart level
(dependent) and then at heart level, and (2) immunohistochemical staining of microlymphatics in forearm and
foot skin biopsies, using antibodies to podoplanin, LYVE-1 and smooth muscle actin. Results: FML
revealed a marked reduction in fluid uptake by initial lymphatics in the LDS foot during dependency, yet
normal uptake (similar to controls) in the same foot at heart level and in LDS forearms. In control subjects,
dependency did not impair initial lymphatic filling. Immunohistochemical microlymphatic density in forearm
and foot did not differ between LDS and controls. Conclusions:FOXC2 mutations cause a functional failure
of dermal initial lymphatics during gravitational stress (dependency), but not hypoplasia. The results reveal a
pathophysiological mechanism contributing to swelling in LDS.
Copyright © 2011 S. Karger AG, Basel.
PMID: 21464574 [PubMed - as supplied by publisher]
Cancer Prev Res (Phila). 2011 Apr;4(4):476-80.
Exercise for secondary prevention of breast cancer: moving from evidence to changing clinical practice.
Schmitz KH.
University of Pennsylvania School of Medicine, 423 Guardian Drive, 8th floor Blockley, Philadelphia, PA
19104. schmitz@mail.med.upenn.edu.
Abstract
Relating to the report of Irwin and colleagues in this issue of the journal (beginning on page 522), this
perspective discusses exercise training interventions as secondary prevention in breast cancer survivors.
Burgeoning observational evidence indicates that prescribing aerobic exercise of 3 hours or more per week
could have meaningful mortality and morbidity benefits for breast cancer survivors. Adherence to this
exercise prescription, however, will require an infrastructure to guide survivors and to address the common
clinical treatment sequelae that might interfere with survivors' ability to regularly perform this level of activity
(e.g., symptoms related to estrogen deprivation, arthralgias due to aromatase inhibitors, fatigue,
lymphedema, chemotherapy-induced peripheral neuropathy, osteoporosis, upper-extremity functional
impairments, and overall functional decline). On the basis of cardiac rehabilitation, a model is proposed to
integrate exercise prescription into breast cancer survivor clinical care, with referral to community-based
programs for most women. Cancer Prev Res; 4(4); 476-80. ©2011 AACR.
PMID: 21464028 [PubMed - in process]
April 17, 2011
Pediatr Neurol. 2011 May;44(5):381-4.
Ectodermal, skeletal, and genitourinary abnormalities with neonatal hyperekplexia.
McAbee GN, Santilli AM, Stone J, Schnur RE.
Source
Division of Neurology, Department of Pediatrics, Robert Wood Johnson School of Medicine, and
Children's Regional Hospital and Cooper University Hospital, Camden, New Jersey.
Abstract
A new syndrome of the major form of hyperekplexia with neonatal onset is described. An infant manifested
multisystem involvement with ectodermal anomalies, including lymphedema and double eyelashes
(lymphedema-distichiasis syndrome), genitourinary anomalies, and skeletal dysplasia. Despite extensive
genetic evaluation, no cytogenetic or molecular etiologies were identified. The literature was reviewed to
assess other unusual neurologic and nonneurologic features that have been reported in association with
neonatal-onset hyperekplexia-that is, hyperekplexia-plus syndromes.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21481749 [PubMed - in process]
J Surg Oncol. 2011 May 1;103(6):484-8. doi: 10.1002/jso.21808.
Perspectives on lymphangiogenesis and angiogenesis in cancer.
Holopainen T, Bry M, Alitalo K, Saaristo A.
Source
Molecular/Cancer Biology Laboratory, Research Program Unit, Department of Pathology, Haartman
Institute, Institute for Molecular Medicine Finland, Helsinki University Central Hospital, Biomedicum
Helsinki, University of Helsinki, Helsinki, Finland.
Abstract
Tumor-associated neovascularization allows tumor cells to express their critical growth advantage, whereas
lymphatic invasion is crucial for the metastatic process. Various growth factors stimulate blood and
lymphatic neovascularization and modulate vessel permeability in tumors. The first anti-angiogenic drugs are
already in routine use, and new anti-vascular therapeutics are evaluated in clinical trials. Conversely, pro-
lymphangiogenic therapy could be implemented to treat cancer survivors suffering from secondary
lymphedema. J. Surg. Oncol. 2011;103:484-488. © 2011 Wiley-Liss, Inc.
Copyright © 2011 Wiley-Liss, Inc.
PMID: 21480240 [PubMed - in process]
April 17, 2011
Acta Trop. 2011 Apr 3. [Epub ahead of print]
Efficacy of home-based lymphoedema management in reducing acute attacks in subjects with lymphatic
filariasis in Burkina Faso.
Jullien P, Somé JD, 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 studu 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 - as supplied by publisher]
Acta Trop. 2011 Apr 3. [Epub ahead of print]
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 th at 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. Published by Elsevier B.V.
PMID: 21470556 [PubMed - as supplied by publisher]
April 19, 2011
Phys Ther. 2011 Apr 14. [Epub ahead of print]
Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF): Reliability and Validity.
Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR.
Source
Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium, and
Department of Health Care Sciences, University College of Antwerp, Antwerp, Belgium.
Abstract
Background Lymphedema occurs frequently after axillary dissection for breast cancer and causes significant
physical and psychosocial problems. To plan the treatment for lymphedema and monitor the patient's
progress, arm swelling and arm function need to be assessed. Objective The purpose of this study was to
investigate the reliability (test-retest, internal consistency, measurement variability) and validity (content and
construct) of data obtained with the Lymphoedema Functioning, Disability and Health questionnaire (Lymph-
ICF).
METHODS:
The Lymph-ICF is a descriptive and evaluative tool and consists of 29 questions about impairments in
function, activity limitations, and participation restrictions of patients with breast cancer and arm
lymphedema. The questionnaire is divided into 5 domains: physical function, mental function, household
activities, mobility activities, and life and social activities. Reliability and validity were examined on 60
patients with lymphedema and 30 patients without lymphedema.
RESULTS:
Intraclass correlation coefficients for test-retest reliability ranged from .65 to .93. Cronbach alpha
coefficients for internal consistency were higher than .70. There were no systematic changes from the first
test to the second test, and measurement variability was acceptable (standard errors of measurement=4.8-
12.5). Content validity was good because all questions were understandable for all participants, the scoring
system (visual analog scale) was clear for 88% of the participants, and all complaints due to arm
lymphedema were mentioned by 85% of the participants. Construct validity was good. There was good
convergent validity because 5 expected domains of the Lymph-ICF had the strongest correlation with 5
expected domains of the 36-Item Short-Form Health Survey questionnaire (SF-36). Thus, the 5 hypotheses
assessing convergent validity were accepted. There was acceptable divergent validity because 3 of 5
hypotheses assessing divergent validity were accepted. There was good known-groups validity because
patients with lymphedema had a higher total score on the Lymph-ICF and had a higher score on each
domain and on each question (except one) compared with patients without lymphedema.
CONCLUSION:
The Lymph-ICF is a reliable and valid questionnaire to assess impairments in function, activity limitations,
and participation restrictions of patients with arm lymphedema after axillary dissection for breast cancer.
PMID: 21493748 [PubMed - as supplied by publisher]
Eur J Oncol Nurs. 2011 Apr 11. [Epub ahead of print]
The physical and practical problems experienced by cancer survivors: A rapid review and synthesis of the
literature.
Brearley SG, Stamataki Z, Addington-Hall J, Foster C, Hodges L, Jarrett N, Richardson A, Scott I, Sharpe
M, Stark D, Siller C, Ziegler L, Amir Z.
Source
International Observatory on End of Life Care, School of Health and Medicine, Lancaster University,
Lancaster LA1 4YT, UK.
Abstract
PURPOSE:
A rapid and comprehensive review to identify what is known and not known about the physical and
practical problems faced by adult cancer survivors.
METHODS:
A systematic literature review process was used. This focused on published reviews to enable a fast but
rigorous identification of both the gaps and well-researched areas within survivorship.
RESULTS:
The search identified 5121 reviews, of which 42 were screened and 9 met the quality and inclusion criteria.
The majority of papers focused on physical well being (n = 6) with the remaining papers focusing on
practical well being (employment and finance). The quality of the reviews varied (ranging from weak to
good). Gaps identified include sexual function, lower-limb lymphoedema, peripheral neuropathy, bladder
and GI problems, hormonal sequelae, older cancer survivors, work impact of cancer and context-specific
unmet supportive care needs. The review found a lack of standardised nomenclature for survivorship and
methodological limitations.
CONCLUSIONS:
Four main gaps in knowledge relating to the practical and physical problems associated with cancer
survivorship have been identified. These are key symptoms, unmet supportive care needs, employment and
older cancer survivors, and should be addressed by future research and systematic literature reviews. Work
is also needed to address the nomenclature of survivorship and to improve the methodology of research into
cancer survivors (including standardised measures, theoretical frameworks, longitudinal design, inclusion of
older survivors and age-matched controls for comparison). The review highlighted the need for better
research within the identified areas in order to improve the experiences of cancer survivors.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21489873 [PubMed - as supplied by publisher]
Maturitas. 2011 Apr 11. [Epub ahead of print]
Overview of long term care of breast cancer survivors.
Brennan ME, Houssami N.
Source
Screening and Test Evaluation Program (STEP), School of Public Health, SydneyMedicalSchool, University
of Sydney, Camperdown, Sydney, NSW, Australia.
Abstract
Breast cancer, the most common cancer in women in developed countries, has a generally excellent
prognosis, therefore long-term survivors living with the consequences of breast cancer ('survivors') and its
treatment are an increasing group in clinical practice. This review discusses the complex issues relevant to
survivorship care, including current recommendations for ongoing adjuvant hormonal therapy (tamoxifen and
aromatase inhibitors), and the management of side effects of cancer treatment (such as menopause,
arthralgia, and lymphoedema). Annual mammography screening is advised for detection of second breast
cancers, and symptom-directed assessment is warranted where there is suspicion of distant recurrence or (in
women using tamoxifen) of endometrial cancer. Management of menopausal symptoms, including treatment-
induced premature menopause, is a key issue for many survivors, and can be challenging to manage as
conventional hormone replacement therapy is contraindicated in most of these women. Specific therapeutic
options for hot flushes and vaginal symptoms are discussed. The review also emphasises the need for
survivorship care to include optimisation of general health, including psychosocial and sexual health, bone
health and the evaluation of lifestyle-related risk factors and genetic factors. The review provides guidance
on the management of many of these issues, and highlights areas requiring further evidence and research.
Copyright © 2011. Published by Elsevier Ireland Ltd.
PMID: 21489727 [PubMed - as supplied by publisher]
Ostomy Wound Manage. 2010 May;56(5):6.
Global efforts address wounds and lymphedema.
Bolton LL, Macdonald J, Geyer MJ.
PMID: 21488417 [PubMed - in process]
April 23, 2011
Circulation. 2011 Apr 19;123(15):e408-9.
Massive Buffalo Hump: A Case of Stage III Lymphedema.
Kolluri R, Belangee Webb KN.
Source
401 E Carpenter St, Springfield, IL 62702. rkolluri@prairieheart.com.
PMID: 21502579 [PubMed - in process]
Gan To Kagaku Ryoho. 2011 Apr;38(4):528-533.
[Lymphedema.]
[Article in Japanese]
Takakura S, Yoshizawa I, Abo M, Ochiai K.
Source
Dept. of Obstetrics and Gynecology, The Jikei University School of Medicine.
Abstract
Prognostic benefits of lymph node dissection have been proven for patients with breast cancer or
gynecological malignancies; however, one ofthe complications associated with this procedure is
lymphedema. We reviewed therapies for secondary lymphedema, including complex decongestive
physiotherapy, skin care, manual lymphatic drainage, compression bandaging and garments, and limb
exercises. The challenge to secondary lymphedema in Jikei University Hospital, consisting ofAggressive
Protocol for Patients with LymphedemA Using SophisticatEd methods(APPLAUSE)has been implemented.
Jikei Lymphedema Assessment Scale(JLA-Se)and the LPG technic®, have also been introduced.
PMID: 21498979 [PubMed - as supplied by publisher]
Gynecol Endocrinol. 2011 Apr 15. [Epub ahead of print]
Bone quantitative ultrasound at hand phalanges of women following breast cancer surgery.
Bolanowski M, Chwalczynska A, Pluskiewicz W.
Source
Department of Endocrinology, Diabetology and Isotope Therapy, Medical University, Wroclaw, Poland.
Abstract
Breast cancer surgery and its adjunctive therapy follow in lymphedema, decreased limb mobility and bone
deterioration. The aim was to establish relation of postsurgical limb lymphedema with bone properties
assessed by quantitative ultrasound (QUS) measurement of hand phalanges in postmenopausal women after
breast cancer surgery. In all, 63 women aged 62.81?±?8.83 years, after breast cancer surgery were
compared with control group of 418 age-matched women. Their skeletal status was assessed by QUS
measurements at proximal phalanges using DBM Sonic 1200. There were no statistically significant
differences in QUS measurements (Ad-SoS) between groups of operated subjects and the controls,
between limbs (operated vs. nonoperated side, with and without lymphedema), and regarding method of
surgery. Ad-SoS was greater in estrogen-treated patients than in nontreated ones at the side with no breast
surgery (1994.11?±?67.83 vs. 1943.27?±?58.34; P?=?0.046). Ad-SoS was lower in patients with
adjunctive antiestrogen therapy than without this therapy at the side of surgery (1937.35?±?54.71 vs.
1966.78?±?59.18; P?=?0.0449), and nonbreast surgery side (1934.55?±?52.06 vs. 1973.31?±?57.17; P?
=?0.0066). Breast cancer surgery followed by concomitant therapies does not influence significantly QUS at
hand phalanges. This was proven regarding method of surgery, side of surgery, and lymphedema. Additional
hormonal treatment can influence phalangeal QUS in breast cancer survivors.
PMID: 21495803 [PubMed - as supplied by publisher]
April 24, 2011
Gan To Kagaku Ryoho. 2011 Apr;38(4):528-33.
[Lymphedema].
[Article in Japanese]
Takakura S, Yoshizawa I, Abo M, Ochiai K.
Source
Dept. of Obstetrics and Gynecology, The Jikei University School of Medicine, Japan.
Abstract
Prognostic benefits of lymph node dissection have been proven for patients with breast cancer or
gynecological malignancies; however, one of the complications associated with this procedure is
lymphedema. We reviewed therapies for secondary lymphedema, including complex decongestive
physiotherapy, skin care, manual lymphatic drainage, compression bandaging and garments, and limb
exercises. The challenge to secondary lymphedema in Jikei University Hospital, consisting of Aggressive
Protocol for Patients with LymphedemA Using SophisticatEd methods(APPLAUSE)has been implemented.
Jikei Lymphedema Assessment Scale(JLA-Se)and the LPG technic®, have also been introduced.
PMID:21498979 [PubMed - indexed for MEDLINE]
April 30, 2011
Hell J Nucl Med. 2011 Jan-Apr;14(1):74-5.
Two cases of (18)F- FDG PET/CT indings in HIV-negative Kaposi's sarcoma. Original presentation of one
case favorably treated with interferon.
Canbaz F, Ersoy D, Basoglu T.
Source
Departments of Nuclear Medicine, Ondokuz Mayύs University Hospital, Kurupelύt 55139 Samsun,
Turkey. fcanbaz@omu.edu.tr, fcanbazt@gmail.com.
Abstract
To the Editor: Kaposi's sarcoma (KS) is a rarely seen angioproliferative tumor associated with human
herpes virus 8 (HHV-8) infection, also known as Kaposi sarcoma herpes virus (KSHV). Four
epidemiological types of KS have been described: a) The classic type originally described by Kaposi, which
is typically found in midaged or in the elderly, b) The endemic type, several subtypes of which have been
described in sub-Saharan indigenous Africans prior to the acquired immune deficiency syndrome (AIDS)
epidemic after 2000s, c) The iatrogenic type associated with immunosuppressive drug treatment, typically
seen in organ transplant recipients, and d) AIDS-associated, epidemic KS, which is usually aggressive in
HIV-related or in post transplant patients, but may be more indolent. Clinically, in KS we find dark blue or
purplish macular or spindleshaped nodular skin lesions. The same lesions are found in pathology in the
lymphoid, respiratory, and/or in the gastrointestinal tissues. The disease carries a variable clinical course
ranging from minimal mucocutaneous disease to extensive organ involvement. Treatment for localized
pathology is surgery or radiation treatment, while widespread disease may be treated by systemic
chemotherapy or immunomodulators. Currently, fluorine-18-fluorodesoxyglucose positron emission
tomography/computed tomography ((18)F-FDG-PET/CT) is used as a very effective tool in monitoring
treatment response for many (18)F-FDG avid tumors. To our knowledge, the role of (18)F-FDG-PET/CT,
in HIV-negative KS of the skin and soft tissues was documented in only one case report. In that report, the
authors documented a case of human immunodeficiency virus (HIV)-negative classic KS, which responded
to target of rapamycin (mTOR), a kinase delivering phosphate groups to amino acid residues of downstream
proteins. The treatment response to rapamycin was well demonstrated by PET-CT. No published report
refering to the interferon (INF) response in a HIV-negative KS using (18)F-FDG-PET/CT could be found
in current literature till January 2010. In case 1, a 76 years old man with violaceous plaques and nodular skin
lesions diffusely involving the lower thigh, legs and upper extremities was admitted. He had no significant
medical history except for asthma. His blood tests were normal. The histopathological diagnosis obtained
from skin lesions of the thigh revealed low grade KS. Before starting INF treatment, he was referred to us
for a (18)F-FDG-PET/CT test for staging and treatment response. Fluorine-18-FDG-PET scan using
444MBq activity showed multifocal increased dermal and subdermal (18)F-FDG uptake in the distal parts
of the lower extremities more intense on the dorsal surface of the left foot. The lesions on the scan were
fewer than lesions seen on physical examination. Upper extremities' lesions showed no (18)F-FDG avidity.
Bilateral (18)F-FDG positive axillary lympadenopathy was an unexpected finding which may be due to
benign or malignant lymphoprolipherative disease related or unrelated with KS. No change in axillary lymph
nodes sizes as compared to previous thorax CT indings was found indicating a benign course. A control
PET/CT scan after 6 months revealed dimished metabolic activity in both axillas and in the lower extremities.
New lesions on the upper extremities were (18)F-FDG negative. The second case was a 77 years old
woman with ulcerated plaques disseminated on the distal portion of both legs, since years. She had no
significant medical history and blood tests were normal. Excisional biopsy from a dermal lesion of the right
dorsal foot showed KS. One year later, similar lesions occured around the excised area suggesting
recurrence and the patient had paliative radiotherapy. On follow up, the patient had more dermal lesions and
was admitted for restaging. A PET/CT study using 400MBq of (18)F-FDG showed multifocal dermal and
subdermal (18)F-FDG accumulation, mainly on the right distal lower extremity. In addition, bilateral diffuse
(18)F-FDG uptake was seen in the distal portions of the legs suggesting lymphedema and venous stasis.In
conclusion, these two cases accentuated that HIV negative cutaneous KS can present with heterogenous
(18)F-FDG avidity. The (18)F-FDG study may be useful in initial staging and in treatment monitoring.
PMID:21512674 [PubMed - in process]
Thyroid. 2011 Apr 21. [Epub ahead of print]
Gene Expression in Graves' Ophthalmopathy and Arm Lymphedema: Similarities and Differences.
Planck T, Parikh H, Brorson H, Mårtensson T, Asman P, Groop L, Hallengren B, Lantz M.
Source
1 Department of Endocrinology, Skåne University Hospital , Malmö, Sweden .
Abstract
Background: Graves' ophthalmopathy (GO) and lymphedema share some pathogenetic mechanisms, such as
edema, inflammation, and adipogenesis. The aim of this study was to examine similarities and differences
between chronic GO and chronic lymphedema. Methods: Intraorbital adipose tissue was collected from
patients with active (n = 10) or chronic GO (n = 10) and thyroid-healthy controls (n = 10). Arm
subcutaneous adipose tissue was obtained from patients with chronic arm lymphedema (n = 10), where
the unaffected arm served as a control. Gene expression was studied using microarray and real-time
polymerase chain reaction. Results: The following genes were significantly upregulated (p < 0.05) in
lymphedema but not in GO and have functions in wound healing, fibrosis, fat metabolism, inflammation,
differentiation, development, adhesion, and the cytoskeleton: ATP-binding cassette, sub-family G (WHITE),
member 1 (ABCG1), actin, alpha 2, smooth muscle, aorta (ACTA2), secreted frizzled-related protein 2
(SFRP2), tenascin C (TNC), pentraxin-related gene, rapidly induced by IL-1 beta (PTX3), and
carboxypeptidase X (M14 family), member 1 (CPMX1). In chronic GO, but not in lymphedema, adipocyte-
related immediate early genes known to be overexpressed in patients with active GO were upregulated but
at a lower level than previously shown for the active phase. Genes of the Wnt pathway, such as secreted
frizzled-related protein 1, 2, and 3, were up- and downregulated in both chronic GO and lymphedema.
Parathyroid hormone-like hormone (PTHLH) was downregulated (p = 0.01) and apolipoprotein L
domain containing 1 (APOLD1) was upregulated (p = 0.05) in both active and chronic GO. Conclusions:
There are more differences than similarities between chronic ophthalmopathy and chronic lymphedema, but
both conditions exhibit less inflammation and adipogenesis compared to the active phases. In lymphedema,
fibrosis dominates. PTHLH, which can inhibit adipogenesis, is downregulated both in active and chronic
ophthalmopathy, indicating the possibility of an increased risk of adipogenesis.
PMID: 21510802 [PubMed - as supplied by publisher
Pediatr Dermatol. 2010 Nov-Dec;27(6):675-6.
Yellow nail syndrome.
Al Hawsawi K, Pope E.
Source
Section of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
Yellow nail syndrome is an acquired condition of unknown etiology, rarely seen in children, characterized by
a triad of thickened yellow nails, primary lymphedema, and respiratory manifestations. We report an 8-year-
old girl with this syndrome who showed improvement with Fluconazole, 200 mg once weekly and vitamin E,
1000 IU once daily.
© 2010 Wiley Periodicals, Inc.
PMID: 21510012 [PubMed - in process
Gynecol Oncol. 2011 Apr 18. [Epub ahead of print]
Incidence of metastasis in circumflex iliac nodes distal to the external iliac nodes in intermediate- and high-
risk endometrial cancer.
Todo Y, Kato H, Okamoto K, Minobe S, Suzuki Y, Ohba Y, Takeda M, Watari H, Kaneuchi M,
Sakuragi N.
Source
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo,
Japan.
Abstract
OBJECTIVE:
The aim of this study was to elucidate the incidence of metastasis in circumflex iliac nodes distal to the
external iliac nodes (CINDEIN), which are also called suprainguinal nodes, in intermediate- and high-risk
endometrial cancer. Removal of these nodes needs to be discussed from the viewpoint of patient's quality of
life because removal of CINDEIN is strongly related to lower extremity lymphedema.
METHODS:
A retrospective chart review was carried out for 508 patients with intermediate- and high-risk endometrial
cancer who were included in this study. We identified patients with lymph node metastasis. Lymph node
sites were classified into four groups: (1) CINDEIN, (2) external iliac nodes, (3) Group A consisting of
circumflex iliac nodes to the distal obturator nodes, internal iliac nodes, obturator nodes, cardinal ligament
nodes (including deep obturator nodes), and sacral nodes, and (4) Group B consisting of common iliac
nodes and para-aortic nodes. Logistic regression analysis was used to select risk factors for CINDEIN
metastasis.
RESULTS:
In an analysis of 508 patients with intermediate- and high-risk disease, CINDEIN metastasis was found in
fourteen (2.8%) of the patients. Multivariate analysis confirmed that high-risk histology (OR=5.7, 95% CI=1.
2-16.1) and Group A node metastasis (OR=9.7, 95% CI=2.9-31.4) were independent risk factors for
CINDEIN metastasis. None of the patients with G1 endometrioid adenocarcinoma had CINDEIN
metastasis. Three (2.5%) of the patients with G2 endometrioid adenocarcinoma had CINDEIN metastasis
and all of these three patients had other pelvic node metastasis.
CONCLUSION:
Removal of CINDEIN can be eliminated in patients with G1 endometrial cancer and patients with G2
endometrial cancer who have no pelvic node metastasis.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21507473 [PubMed - as supplied by publisher]
Arthritis Care Res (Hoboken). 2011 Apr 26. doi: 10.1002/acr.20487. [Epub ahead of print]
Manual lymph drainage improves upper limb oedema and hand function in patients with systemic sclerosis
(SSC) in oedematous phase.
Bongi SM, Del Rosso A, Passalacqua M, Miccio S, Cerinic MM.
Source
Department of BioMedicine, Division of Rheumatology, Denothe Centre, Careggi Hospital (AOUC),
University of Florence, Italy.
Abstract
OBJECTIVE:
In Systemic Sclerosis (SSc) patients in oedematous phase, hand oedema is often present. Manual lymph
drainage (MLD) stimulates lymphatic system and reduces oedema. Our aim was to evaluate the efficacy of
MLD in reducing oedema and in improving functionality of the hands and perceived quality of life (QoL) in
SSc patients in oedematous phase.
METHODS:
Out of 35 SSc patients with oedematous hands, 20 were treated with MLD according to Vodder technique
once a week for 5 weeks [Interventional group (IG)] and 15 served as Observational Group (OG). Patients
were evaluated at enrolment (T0), at the end of treatment (T1), and after 9 weeks of follow-up (T2), by
volumetric test, assessing hands volume, Hand Mobility in Scleroderma (HAMIS) test and by 4 VAS (0-
10) evaluating perception of hand oedema and pain and their interference on the daily activities. QoL and
disability were assessed by Physical (PSI) and Mental Synthetic Index (MSI) of Short Form 36 (SF-36)
and Health Assessment Questionnaire (HAQ).
RESULTS:
In the IG, hand volume, HAMIS, and the 4 VAS were improved significantly at the end of treatment (p<0.
001). The results were maintained at T2 (p<0.001). Also HAQ, PSI and MSI of SF-36 improved
significantly at T1 (p<0.001), but only PSI improvement was maintained at T2 (p<0.001). In the OG, no
improvement at T1 and at T2 was observed.
CONCLUSIONS:
In SSc, MLD reduces significantly hand oedema and improves hand function and perceived QoL. © 2011
American College of Rheumatology.
Copyright © 2011 by the American College of Rheumatology.
PMID: 21523925 [PubMed - as supplied by publisher]
Clin Exp Nephrol. 2011 Apr 26. [Epub ahead of print]
A rare case of reversible acquired AA-type renal amyloidosis in a chronic filariasis patient receiving
antifilarial therapy.
Nayak HK, Daga MK, Garg SK, Sinha NK, Kumar R, Mohanty PK, Pandey BK.
Source
Lok Nayak Hospital, Maulana Azad Medical College, P.G Men's Hostel, Room no-96, Bahadurshah Zafar
Marg, New Delhi, 110002, India, drhemantnayak@gmail.com.
Abstract
Lymphatic filariasis is a major health problem in India with a large number of patients tending to be
asymptomatic. In the Southeast and South Asian regions, Wuchereria bancrofti is the most prevalent
parasite, causing filariasis in 99.4% of cases. While kidney involvement is a rare event in chronic filariasis,
this case is unique because AA-type renal amyloidosis occurs in chronic W. bancrofti infection. We present
here a unique case of lymphatic filariasis. The patient, a 25-year-old male who was previously diagnosed
with right lower limb filarial lymphedema and had undergone lymphovenous anastomosis, was admitted for
evaluation of persistent nephrotic-range proteinuria. Autoimmune markers in the form of anti-nuclear
antibodies, anti-double-stranded DNA and anti-neutrophil cytoplasmic antibody were negative; C3 was
normal. Urine analysis revealed inactive sediment with moderate proteinuria. Both serum and urine
electrophoresis were negative for paraproteins and bone marrow aspirate and biopsy were normal.
Evidence of active filarial infection was established on the basis of microfilariae in the peripheral smear and a
positive W. bancrofti antigen test. Kidney biopsy revealed renal amyloidosis when stained with Congo red
and anti-AA immunostain. The patient's proteinuria improved on conservative management with angiotensin-
converting enzyme inhibitors and a course of antifilarial drugs. His proteinuria returned to <1 g/24 h with
normalization of renal function and no significant proteinuria on periodic follow-up at 6-month and 1-year
intervals. Repeat kidney biopsy after 1.5 years showed regression of amyloidosis. Repeat demonstration of
filarial antigen and microfilariae in the peripheral smear were negative on multiple occasions during the follow-
up period. Although various chronic infections can lead to secondary renal amyloidosis, this is the first case
reported in world literature where secondary amyloidosis developed as a complication of chronic filarial
infection due to W. bancrofti. This is probably also the first case reported in world literature where renal
amyloidosis has an etiological association with W. bancrofti infection and where patient symptoms improved
with antifilarial and antiproteinuric management.
PMID: 21519822 [PubMed - as supplied by publisher]
J Cutan Pathol. 2011 Apr 26. doi: 10.1111/j.1600-0560.2011.01703.x. [Epub ahead of print]
Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five
cases and review of the literature.
Shon W, Ida CM, Boland-Froemming JM, Rose PS, Folpe A.
Source
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Abstract
A significant proportion of angiosarcoma arises in the setting of chronic lymphedema, often following surgery
for breast carcinoma (Stewart-Treves syndrome). Massive localized lymphedema (MLL), a relatively
recently described and rare pseudotumor most often occurring in morbidly obese patients, is thought to be
the result of derangements in lymphatic drainage secondary to excessive adipose tissue. Only a very small
number of cases of angiosarcoma have been reported in patients with MLL. We reviewed the clinical and
pathological features of five patients with angiosarcoma arising in this unusual clinical setting. The tumors
arose in three women and two men, who were in the age range from 36 to 81 years (median: 52 years). All
patients were or had recently been morbidly obese (mean body mass index = 47.2 kg/cm(2) ; range:37.6-
68.5 kg/cm(2) ) and had long-standing soft tissue changes of MLL. The tumors arose in the thigh (two
cases), lower leg (two cases) and abdomen/proximal thigh (one case) and ranged from 6 to 28.5 cm in size
(mean: 15.9 cm). All tumors were conventional high-grade angiosarcomas and microscopically exhibited an
admixture of vasoformative, spindled and epithelioid features. Microscopic changes of MLL, including
dermal fibrosis, expansion of interlobular fibrous septa and lymphangiectasia, were identified in all cases.
Clinical follow-up (four cases; mean: 13.8 months; range: 2-32 months) showed one patient to be dead of
disease, one patient to be dead from therapy-related complications and two patients to be alive without
disease. One case was too recent for meaningful clinical follow-up. We conclude that lymphedema
secondary to obesity should be recognized as a significant risk factor for the development of angiosarcoma.
The clinical and pathological features of angiosarcoma arising in this distinctive clinical setting appear to be
identical to those of other lymphedema-associated angiosarcomas. With the continuing epidemic of obesity
in Western societies, the incidence of obesity-related angiosarcoma is probably to increase. Consequently, it
is critical that lymphedematous areas in obese patients be carefully examined for clinical evidence of early
angiosarcoma, with the hope that timely diagnosis may lead to improved patient outcome. Shon W, Ida CM,
Boland-Froemming JM, Rose PS, Folpe A. Cutaneous angiosarcoma arising in massive localized
lymphedema of the morbidly obese: a report of five cases and review of the literature.
Copyright © 2011 John Wiley & Sons A/S.
PMID: 21518378 [PubMed - as supplied by publisher]
Dev Biol. 2011 Apr 16. [Epub ahead of print]
Connexin37 and Connexin43 deficiencies in mice disrupt lymphatic valve development and result in
lymphatic disorders including lymphedema and chylothorax.
Kanady JD, Dellinger MT, Munger SJ, Witte MH, Simon AM.
Source
Department of Physiology, University of Arizona, Tucson, AZ 85724, USA.
Abstract
Intraluminal valves are required for the proper function of lymphatic collecting vessels and large lymphatic
trunks like the thoracic duct. Despite recent progress in the study of lymphvasculogenesis and
lymphangiogenesis, the molecular mechanisms controlling the morphogenesis of lymphatic valves remain
poorly understood. Here, we report that gap junction proteins, or connexins (Cxs), are required for
lymphatic valvulogenesis. Cx37 and Cx43 are expressed early in mouse lymphatic development in the
jugular lymph sacs, and later in development these Cxs become enriched and differentially expressed by
lymphatic endothelial cells on the upstream and downstream sides of the valves. Specific deficiencies of
Cx37 and Cx43 alone or in combination result in defective valve formation in lymphatic collecting vessels,
lymphedema, and chylothorax. We also show that Cx37 regulates jugular lymph sac size and that both Cx37
and Cx43 are required for normal thoracic duct development, including valve formation. Another Cx family
member, Cx47, whose human analog is mutated in some families with lymphedema, is also highly enriched in
a subset of endothelial cells in lymphatic valves. Mechanistically, we present data from Foxc2-/- embryos
suggesting that Cx37 may be a target of regulation by Foxc2, a transcription factor that is mutated in human
lymphedema-distichiasis syndrome. These results show that at least three Cxs are expressed in the
developing lymphatic vasculature and, when defective, are associated with clinically manifest lymphatic
disorders in mice and man.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21515254 [PubMed - as supplied by publisher]
Am J Obstet Gynecol. 2011 Mar 16. [Epub ahead of print]
Adverse events associated with laparoscopy vs laparotomy in the treatment of endometrial cancer.
Barnett JC, Havrilesky LJ, Bondurant AE, Fleming ND, Lee PS, Secord AA, Berchuck A, A Valea F.
Source
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University School of
Medicine, Durham, NC.
Abstract
OBJECTIVE:
The objective of the study was to compare adverse event rates between laparoscopic vs open surgery for
endometrial cancer.
STUDY DESIGN:
This was a retrospective cohort study comparing 107 women who underwent laparoscopy with 269 age-
and body mass index-matched women who underwent laparotomy for treatment of endometrial cancer.
RESULTS:
Adverse event rates were similar between cohorts (37% laparoscopy vs 43% laparotomy, P = .248).
Laparotomies had higher rates of cellulitis (16% vs 7%, P = .018) and open wound infection (9% vs 2%, P
= .02), whereas laparoscopy had higher rates of sensory peripheral nerve deficit (5% vs 0%, P = .008) and
lymphedema (7% vs. 1%, P = .003). Laparoscopy was associated with longer mean operating room times
but with shorter hospital stays and lower mean blood loss.
CONCLUSION:
Laparoscopy was associated with decreased rates of surgical site infections but had an increased risk of
peripheral sensory nerve deficits and lymphedema when compared with laparotomy.
Published by Mosby, Inc.
PMID: 21514921 [PubMed - as supplied by publisher]
Ann Vasc Surg. 2011 Apr 20. [Epub ahead of print]
Stewart-Treves Syndrome and the Use of Positron Emission Tomographic Scanning.
Dawlatly SL, Dramis A, Sumathi VP, Grimer RJ.
Source
Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, West Midlands, UK.
Abstract
In this article, we provide an account of two rare cases of Stewart-Treves syndrome, that is, cutaneous
angiosarcoma secondary to lymphedema, treated at our center. Unusually, both occurred in the lower
extremity. The first case was treated initially with a wide local excision, followed by a further re-excision,
and eventually an above-the-knee amputation because of recurrence. In the second case, a hindquarter
amputation was undertaken after a positron emission tomographic scan, which revealed the extent and
spread of the lesions. In cases of cutaneous angiosarcoma, a positron emission tomographic scan can be
extremely helpful in demonstrating the extent of subcutaneous spread and planning surgical management.
Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
PMID: 21514109 [PubMed - as supplied by publisher]
Yellow nail syndrome: missed diagnosis of a rare syndrome.
Chavda LK, Vaidya RA, Vaidya AD.
Source
Panchanath Medical Trust, Rajkot, Gujarat.
Abstract
A 61 year old male, with a bilateral persistent and recurrent pleural effusion, had undergone frequent tapping
over a period of eight months, prior to the referral. The patient was treated earlier to the referral empirically
for pulmonary tuberculosis with no response to the treatment. Malignancy was suspected and ruled out. A
detailed examination showed that he also had atrophic nails with yellow discoloration and lymphedema of
feet. Yellow nail syndrome was diagnosed on the basis of the clinical findings of the triad viz. yellow atrophic
nails, lymphedema and bilateral pleural effusions. Pathogenesis still remains elusive for the syndrome.
Pleurodesis provided both symptomatic relief and a respite from repeated tapping. The case is presented as
a rare condition, which was missed for diagnosis, for quite some time by several specialists.
PMID:
21755767
[PubMed - in process]
April 8, 2011
Eur J Vasc Endovasc Surg. 2011 Mar 30. [Epub ahead of print]
Extracorporeal Shock Wave Therapy Induces Therapeutic Lymphangiogenesis in a Rat Model of
Secondary Lymphoedema.
Serizawa F, Ito K, Matsubara M, Sato A, Shimokawa H, Satomi S.
Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine,
1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan.
Abstract
OBJECTIVE: Lymphoedema is a common complication after cancer treatment. We have reported that low-
energy extracorporeal shock wave (SW) therapy up-regulates vascular endothelial growth factor (VEGF) in
ischaemic myocardium. As VEGF plays an important role in lymphangiogenesis, we investigated whether
our low-energy SW therapy enhances lymphangiogenesis in rats.
METHODS: We created a tail model of lymphoedema in rats. The tail was treated with or without low-
energy SW therapy (0.25 mJ mm(-2), 500 impulses) four times (days 3, 5, 7, and 9). The tail volume and
the fluorescence intensity of indocyanine green (ICG) were measured. The expression of VEGF-C and
basic fibroblast growth factor (bFGF) were evaluated by RT-PCR, and the lymphatic vessel density was
assessed histochemically.
RESULTS: The tail volume increased significantly in the control group and was significantly improved in the
SW group. The lymphatic system function (evaluated with fluorescence intensity of ICG), the lymphatic
vessel density, and the expression of VEGF-C and bFGF were all enhanced by the SW therapy (all P <
0.05).
CONCLUSIONS: The low-energy SW therapy induces therapeutic lymphangiogenesis by up-regulating
VEGF-C and bFGF, and improves lymphoedema in a rat-tail model, suggesting that low-energy SW
therapy could be a non-invasive and effective strategy for lymphoedema in humans.
Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
PMID: 21454105 [PubMed - as supplied by publisher]
Actas Urol Esp. 2011 Mar 29. [Epub ahead of print]
Simplification of the surgical treatment of a hidden penis.
[Article in English, Spanish]
Rivas S, Romero R, Parente A, Fanjul M, Angulo JM.
Sección de Urología Infantil, Servicio de Cirugía Pediátrica, Hospital General Universitario Gregorio
Marañón, Madrid, España.
Abstract
INTRODUCTION: The treatment of a hidden penis consists of completely and effectively exteriorizing the
penile shaft from a functional and aesthetic point of view.
PATIENTS AND METHODS: Over a period of 15 months (02/2008-05/2009), we treated 7 children
(mean age 4.6years) with hidden penis (five had a buried penis, one had a webbed penis and another a
trapped penis) using the Borsellino reconstruction technique modified with an "S" dorsal incision. We
performed a pubic lipectomy in one patient through the same incision. Surgical indication was for aesthetic
reasons in all the cases, secondary phimosis in four, repeated balanitis in one and pain in another.
RESULTS: Hospital stay was 24hours. With a short-term follow-up (1-12 months), we detected the
following complications: partial recurrence, post-surgical lymphedema and hypertrophic scarring, each of
them in one case. Patients and parents were satisfied with the result.
CONCLUSIONS: The technique that we present achieves good cosmetic results and has few immediate
complications. The substitution of the two dorsal incisions with one "S" incision allows simultaneous
lipectomy without the need for another incision.
Copyright © 2010 AEU. Published by Elsevier Espana. All rights reserved.
PMID: 21453989 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 Mar 29. [Epub ahead of print]
The Circumferential Thigh Lift and Vertical Extension Circumferential Thigh Lift: Maximizing Aesthetics and
Safety in Lower Extremity Contouring.
Kolker AR, Xipoleas GD.
From the Department of Surgery, Division of Plastic Surgery, Mount Sinai School of Medicine, New York,
NY.
Abstract
Excess skin and soft tissue of the thighs after massive weight loss (MWL) can present with varying degrees
of severity. The classic medial thigh lift has considerable limitations in the postbariatric population, inspiring
the quest for safer and more effective technical solutions. In this study, the circumferential thigh lift (CTL),
and CTL with vertical extension, predicated on a theoretical and technical approach that improves safety
and aesthetics in thighplasty after MWL, is described and evaluated. Nine patients were treated; all patients
experienced MWL and all had previously undergone first-stage contouring with circumferential abdominal
dermolipectomy. Patients were treated with a prone-to-supine approach with concomitant suction-assisted
lipectomy (SAL). Lumbar and lateral thigh and infragluteal skin and fat were excised to the midaxillary lines
and medial thigh meridians. Direct excision of anterolateral thigh skin was carried in a superficial plane into
the medial thigh to confluence with the posterior excision. No direct undermining of any skin margin was
performed. When soft-tissue excess is limited to the proximal third of the thigh, a horizontal excision pattern
is used; with middle and lower one-third thigh excess, a vertical extension is employed. The medial
superficial fascial system is anchored to the superficial perineal fascia. Data were reviewed retrospectively.
In the 9 procedures performed, 3 achieved MWL by nonsurgical means, and 6 underwent bariatric surgery
(bypass or band). Three patients were treated with CTL, and 6 with CTL with vertical extension. There
were 3 seromas (33%) treated with percutaneous aspiration. There was 1 case of cellulitis (11%) treated
successfully with in-office incision and drainage, and oral antibiotics. There were no hematomas, skin loss,
wound dehiscences, lymphedema, or vulvar distortions. The circumferential excision of thigh excess without
direct undermining allows for the maintenance of a rich blood supply to skin margins, and concomitant SAL
improves thigh contour while providing discontinuous thigh undermining. Anchoring of the superficial fascial
system to superficial perineal fascia reinforces the medial lift and prevents scar migration. CTL with or
without vertical extension can be combined with SAL to maximize safety and aesthetic results after MWL.
PMID: 21451373 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Apr 5. [Epub ahead of print]
Morbidity of Sentinel Node Biopsy: Relationship Between Number of Excised Lymph Nodes and Patient
Perceptions of Lymphedema.
Goldberg JI, Riedel ER, Morrow M, Van Zee KJ.
Breast Service, Department of Surgery, Evelyn H. Lauder Breast Center, Memorial Sloan-Kettering Cancer
Center, New York, NY, USA.
Abstract
BACKGROUND: Sentinel lymph node biopsy (SLNB) is associated with reduced morbidity, although
lymphedema remains a significant complication. Previously, we found no association between number of
excised lymph nodes (LNs) and measured lymphedema in SLNB patients. In this analysis, we examined the
relationship between number of LNs excised during SLNB and patient-perceived lymphedema.
METHODS: A total of 600 women who underwent SLNB for breast cancer were prospectively studied.
Measured lymphedema was evaluated by circumferential bilateral upper-extremity measurements taken
preoperatively and 3-8 years postoperatively. Patient-perceived lymphedema was evaluated by interview at
follow-up. The relationship between lymphedema, total LNs excised, and clinicopathologic variables was
assessed with Fisher's exact test, Wilcoxon rank-sum test, kappa statistic, and McNemar's test.
RESULTS: At a median of 5 years, 18 (3%) patients reported perceived lymphedema. More LNs were
excised in patients with perceived lymphedema compared with those without (median, 5.5 vs. 3; p = 0.01).
Only 6 of 18 women with perceived lymphedema had objectively measured lymphedema (kappa = 0.22).
Patients with numbness more likely reported perceived lymphedema (p = 0.03) and had more LNs excised
(p = 0.02). Women with surgery on the nondominant axilla were less likely to perceive arm swelling,
regardless of the presence of measured lymphedema.
CONCLUSIONS: After SLNB alone, patient-perceived lymphedema is uncommon, but its prevalence
increases with more LNs excised. There is poor agreement between patient perceptions and objective
measures. Our data suggest that factors other than limb enlargement, such as sensory nerve injury resulting
from retrieval of more LNs and laterality of surgery, may play a significant role in patient perception of
lymphedema after SLNB.
PMID: 21465310 [PubMed - as supplied by publisher]
Int J Gynecol Pathol. 2011 Apr 1. [Epub ahead of print]
Localized Lymphedema of the Vulva: A Clinicopathologic Study of 2 Cases and a Review of the Literature.
Fadare O, Brannan SM, Arin-Silasi D, Parkash V.
Department of Pathology (O.F.), Vanderbilt University School of Medicine, Nashville, TN Department of
Radiology (S.M.B.) Department of Pathology (D.A.-S., V.P.), Bridgeport Hospital, Bridgeport Yale
University School of Medicine (V.P.), New Haven, CT.
Abstract
This report describes 2 cases of localized vulvar lymphedema that were diagnosed in 2 morbidly obese
women, including a unique case of a massive localized vulvar lymphedema associated with lymphangioma
circumscriptum of the vulva. Herein, we also review previously reported cases of vulvar lymphedema and
discuss differential diagnostic considerations. Our review of the recent literature showed 17 cases that we
considered approximately similar, reported under the appellations "vulvar lymphoedematous pseudotumor,"
"massive vulval edema," "vulvar hypertrophy with lymphedema," and "localized lymphedema (elephantiasis)."
The patients ranged in age from 19 to 59 years (average 38.5 yrs), and typically presented with
papillomatous plaques, skin polyps, generalized vulvar enlargement, or massive pedunculated masses that
had been present for durations that ranged from 3 months to 36 years. The average lesional size was 6.1 cm
(range: 0.6 - 45 cm), and 10 (59%) of the 17 cases were 3 cm or less. Excisions were generally curative,
although persistent or recurrent disease was reported in 3 cases. The patients were overweight in 9 (75%)
of the 12 cases in which the patient weight was noted, and 2 others had chronic immobilization. Stromal
edema was the only morphologic finding that was uniformly seen in all 17 cases. However, the following
morphologic features were identified in significant subsets: multinucleated giant cells, dermal fibrosis, dermal
lymphangiectasia, dermal chronic inflammation, perivascular chronic inflammation (superficial and/or deep),
hyperkeratosis, acanthosis, and blood vessels of varying calibers. Several attributes of localized vulvar
lymphedema may cause them to closely mimic aggressive angiomyxoma, a differential diagnosis that is herein
discussed in detail. Localized vulvar lymphedema may also be a small lesion, and can potentially mimic other
myxedematous tumors of the vulvovaginal region. The strongest clinical association is with obesity. The term
"localized vulvar lymphedema" is an appropriate generic descriptor for the spectrum of lesions whose
fundamental and underlying etiology is thought to be chronic lymphedema.
PMID: 21464721 [PubMed - as supplied by publisher]
J Vasc Res. 2011 Apr 4;48(5):397-407. [Epub ahead of print]
Mutations in FOXC2 in Humans (Lymphoedema Distichiasis Syndrome) Cause Lymphatic Dysfunction on
Dependency.
Mellor RH, Tate N, Stanton AW, Hubert C, Mäkinen T, Smith A, Burnand KG, Jeffery S, Levick JR,
Mortimer PS.
Cardiac and Vascular Sciences (Dermatology), St. George's, University of London, London, UK.
Abstract
Background: Human lymphoedema distichiasis syndrome (LDS) results from germline mutations in
transcription factor FOXC2. In a mouse model, lack of lymphatic and venous valves is observed plus
abnormal smooth muscle cell recruitment to initial lymphatics. We investigated the mechanism of
lymphoedema in humans with FOXC2 mutations, specifically the effect of gravitational forces on dermal
lymphatic function. Methods: We performed (1) quantitative fluorescence microlymphangiography (FML)
on the skin of the forearm (non-swollen region) at heart level, and the foot (swollen region) below heart level
(dependent) and then at heart level, and (2) immunohistochemical staining of microlymphatics in forearm and
foot skin biopsies, using antibodies to podoplanin, LYVE-1 and smooth muscle actin. Results: FML
revealed a marked reduction in fluid uptake by initial lymphatics in the LDS foot during dependency, yet
normal uptake (similar to controls) in the same foot at heart level and in LDS forearms. In control subjects,
dependency did not impair initial lymphatic filling. Immunohistochemical microlymphatic density in forearm
and foot did not differ between LDS and controls. Conclusions:FOXC2 mutations cause a functional failure
of dermal initial lymphatics during gravitational stress (dependency), but not hypoplasia. The results reveal a
pathophysiological mechanism contributing to swelling in LDS.
Copyright © 2011 S. Karger AG, Basel.
PMID: 21464574 [PubMed - as supplied by publisher]
Cancer Prev Res (Phila). 2011 Apr;4(4):476-80.
Exercise for secondary prevention of breast cancer: moving from evidence to changing clinical practice.
Schmitz KH.
University of Pennsylvania School of Medicine, 423 Guardian Drive, 8th floor Blockley, Philadelphia, PA
19104. schmitz@mail.med.upenn.edu.
Abstract
Relating to the report of Irwin and colleagues in this issue of the journal (beginning on page 522), this
perspective discusses exercise training interventions as secondary prevention in breast cancer survivors.
Burgeoning observational evidence indicates that prescribing aerobic exercise of 3 hours or more per week
could have meaningful mortality and morbidity benefits for breast cancer survivors. Adherence to this
exercise prescription, however, will require an infrastructure to guide survivors and to address the common
clinical treatment sequelae that might interfere with survivors' ability to regularly perform this level of activity
(e.g., symptoms related to estrogen deprivation, arthralgias due to aromatase inhibitors, fatigue,
lymphedema, chemotherapy-induced peripheral neuropathy, osteoporosis, upper-extremity functional
impairments, and overall functional decline). On the basis of cardiac rehabilitation, a model is proposed to
integrate exercise prescription into breast cancer survivor clinical care, with referral to community-based
programs for most women. Cancer Prev Res; 4(4); 476-80. ©2011 AACR.
PMID: 21464028 [PubMed - in process]
April 17, 2011
Pediatr Neurol. 2011 May;44(5):381-4.
Ectodermal, skeletal, and genitourinary abnormalities with neonatal hyperekplexia.
McAbee GN, Santilli AM, Stone J, Schnur RE.
Source
Division of Neurology, Department of Pediatrics, Robert Wood Johnson School of Medicine, and
Children's Regional Hospital and Cooper University Hospital, Camden, New Jersey.
Abstract
A new syndrome of the major form of hyperekplexia with neonatal onset is described. An infant manifested
multisystem involvement with ectodermal anomalies, including lymphedema and double eyelashes
(lymphedema-distichiasis syndrome), genitourinary anomalies, and skeletal dysplasia. Despite extensive
genetic evaluation, no cytogenetic or molecular etiologies were identified. The literature was reviewed to
assess other unusual neurologic and nonneurologic features that have been reported in association with
neonatal-onset hyperekplexia-that is, hyperekplexia-plus syndromes.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21481749 [PubMed - in process]
J Surg Oncol. 2011 May 1;103(6):484-8. doi: 10.1002/jso.21808.
Perspectives on lymphangiogenesis and angiogenesis in cancer.
Holopainen T, Bry M, Alitalo K, Saaristo A.
Source
Molecular/Cancer Biology Laboratory, Research Program Unit, Department of Pathology, Haartman
Institute, Institute for Molecular Medicine Finland, Helsinki University Central Hospital, Biomedicum
Helsinki, University of Helsinki, Helsinki, Finland.
Abstract
Tumor-associated neovascularization allows tumor cells to express their critical growth advantage, whereas
lymphatic invasion is crucial for the metastatic process. Various growth factors stimulate blood and
lymphatic neovascularization and modulate vessel permeability in tumors. The first anti-angiogenic drugs are
already in routine use, and new anti-vascular therapeutics are evaluated in clinical trials. Conversely, pro-
lymphangiogenic therapy could be implemented to treat cancer survivors suffering from secondary
lymphedema. J. Surg. Oncol. 2011;103:484-488. © 2011 Wiley-Liss, Inc.
Copyright © 2011 Wiley-Liss, Inc.
PMID: 21480240 [PubMed - in process]
April 17, 2011
Acta Trop. 2011 Apr 3. [Epub ahead of print]
Efficacy of home-based lymphoedema management in reducing acute attacks in subjects with lymphatic
filariasis in Burkina Faso.
Jullien P, Somé JD, 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 studu 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 - as supplied by publisher]
Acta Trop. 2011 Apr 3. [Epub ahead of print]
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 th at 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. Published by Elsevier B.V.
PMID: 21470556 [PubMed - as supplied by publisher]
April 19, 2011
Phys Ther. 2011 Apr 14. [Epub ahead of print]
Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF): Reliability and Validity.
Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR.
Source
Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium, and
Department of Health Care Sciences, University College of Antwerp, Antwerp, Belgium.
Abstract
Background Lymphedema occurs frequently after axillary dissection for breast cancer and causes significant
physical and psychosocial problems. To plan the treatment for lymphedema and monitor the patient's
progress, arm swelling and arm function need to be assessed. Objective The purpose of this study was to
investigate the reliability (test-retest, internal consistency, measurement variability) and validity (content and
construct) of data obtained with the Lymphoedema Functioning, Disability and Health questionnaire (Lymph-
ICF).
METHODS:
The Lymph-ICF is a descriptive and evaluative tool and consists of 29 questions about impairments in
function, activity limitations, and participation restrictions of patients with breast cancer and arm
lymphedema. The questionnaire is divided into 5 domains: physical function, mental function, household
activities, mobility activities, and life and social activities. Reliability and validity were examined on 60
patients with lymphedema and 30 patients without lymphedema.
RESULTS:
Intraclass correlation coefficients for test-retest reliability ranged from .65 to .93. Cronbach alpha
coefficients for internal consistency were higher than .70. There were no systematic changes from the first
test to the second test, and measurement variability was acceptable (standard errors of measurement=4.8-
12.5). Content validity was good because all questions were understandable for all participants, the scoring
system (visual analog scale) was clear for 88% of the participants, and all complaints due to arm
lymphedema were mentioned by 85% of the participants. Construct validity was good. There was good
convergent validity because 5 expected domains of the Lymph-ICF had the strongest correlation with 5
expected domains of the 36-Item Short-Form Health Survey questionnaire (SF-36). Thus, the 5 hypotheses
assessing convergent validity were accepted. There was acceptable divergent validity because 3 of 5
hypotheses assessing divergent validity were accepted. There was good known-groups validity because
patients with lymphedema had a higher total score on the Lymph-ICF and had a higher score on each
domain and on each question (except one) compared with patients without lymphedema.
CONCLUSION:
The Lymph-ICF is a reliable and valid questionnaire to assess impairments in function, activity limitations,
and participation restrictions of patients with arm lymphedema after axillary dissection for breast cancer.
PMID: 21493748 [PubMed - as supplied by publisher]
Eur J Oncol Nurs. 2011 Apr 11. [Epub ahead of print]
The physical and practical problems experienced by cancer survivors: A rapid review and synthesis of the
literature.
Brearley SG, Stamataki Z, Addington-Hall J, Foster C, Hodges L, Jarrett N, Richardson A, Scott I, Sharpe
M, Stark D, Siller C, Ziegler L, Amir Z.
Source
International Observatory on End of Life Care, School of Health and Medicine, Lancaster University,
Lancaster LA1 4YT, UK.
Abstract
PURPOSE:
A rapid and comprehensive review to identify what is known and not known about the physical and
practical problems faced by adult cancer survivors.
METHODS:
A systematic literature review process was used. This focused on published reviews to enable a fast but
rigorous identification of both the gaps and well-researched areas within survivorship.
RESULTS:
The search identified 5121 reviews, of which 42 were screened and 9 met the quality and inclusion criteria.
The majority of papers focused on physical well being (n = 6) with the remaining papers focusing on
practical well being (employment and finance). The quality of the reviews varied (ranging from weak to
good). Gaps identified include sexual function, lower-limb lymphoedema, peripheral neuropathy, bladder
and GI problems, hormonal sequelae, older cancer survivors, work impact of cancer and context-specific
unmet supportive care needs. The review found a lack of standardised nomenclature for survivorship and
methodological limitations.
CONCLUSIONS:
Four main gaps in knowledge relating to the practical and physical problems associated with cancer
survivorship have been identified. These are key symptoms, unmet supportive care needs, employment and
older cancer survivors, and should be addressed by future research and systematic literature reviews. Work
is also needed to address the nomenclature of survivorship and to improve the methodology of research into
cancer survivors (including standardised measures, theoretical frameworks, longitudinal design, inclusion of
older survivors and age-matched controls for comparison). The review highlighted the need for better
research within the identified areas in order to improve the experiences of cancer survivors.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21489873 [PubMed - as supplied by publisher]
Maturitas. 2011 Apr 11. [Epub ahead of print]
Overview of long term care of breast cancer survivors.
Brennan ME, Houssami N.
Source
Screening and Test Evaluation Program (STEP), School of Public Health, SydneyMedicalSchool, University
of Sydney, Camperdown, Sydney, NSW, Australia.
Abstract
Breast cancer, the most common cancer in women in developed countries, has a generally excellent
prognosis, therefore long-term survivors living with the consequences of breast cancer ('survivors') and its
treatment are an increasing group in clinical practice. This review discusses the complex issues relevant to
survivorship care, including current recommendations for ongoing adjuvant hormonal therapy (tamoxifen and
aromatase inhibitors), and the management of side effects of cancer treatment (such as menopause,
arthralgia, and lymphoedema). Annual mammography screening is advised for detection of second breast
cancers, and symptom-directed assessment is warranted where there is suspicion of distant recurrence or (in
women using tamoxifen) of endometrial cancer. Management of menopausal symptoms, including treatment-
induced premature menopause, is a key issue for many survivors, and can be challenging to manage as
conventional hormone replacement therapy is contraindicated in most of these women. Specific therapeutic
options for hot flushes and vaginal symptoms are discussed. The review also emphasises the need for
survivorship care to include optimisation of general health, including psychosocial and sexual health, bone
health and the evaluation of lifestyle-related risk factors and genetic factors. The review provides guidance
on the management of many of these issues, and highlights areas requiring further evidence and research.
Copyright © 2011. Published by Elsevier Ireland Ltd.
PMID: 21489727 [PubMed - as supplied by publisher]
Ostomy Wound Manage. 2010 May;56(5):6.
Global efforts address wounds and lymphedema.
Bolton LL, Macdonald J, Geyer MJ.
PMID: 21488417 [PubMed - in process]
April 23, 2011
Circulation. 2011 Apr 19;123(15):e408-9.
Massive Buffalo Hump: A Case of Stage III Lymphedema.
Kolluri R, Belangee Webb KN.
Source
401 E Carpenter St, Springfield, IL 62702. rkolluri@prairieheart.com.
PMID: 21502579 [PubMed - in process]
Gan To Kagaku Ryoho. 2011 Apr;38(4):528-533.
[Lymphedema.]
[Article in Japanese]
Takakura S, Yoshizawa I, Abo M, Ochiai K.
Source
Dept. of Obstetrics and Gynecology, The Jikei University School of Medicine.
Abstract
Prognostic benefits of lymph node dissection have been proven for patients with breast cancer or
gynecological malignancies; however, one ofthe complications associated with this procedure is
lymphedema. We reviewed therapies for secondary lymphedema, including complex decongestive
physiotherapy, skin care, manual lymphatic drainage, compression bandaging and garments, and limb
exercises. The challenge to secondary lymphedema in Jikei University Hospital, consisting ofAggressive
Protocol for Patients with LymphedemA Using SophisticatEd methods(APPLAUSE)has been implemented.
Jikei Lymphedema Assessment Scale(JLA-Se)and the LPG technic®, have also been introduced.
PMID: 21498979 [PubMed - as supplied by publisher]
Gynecol Endocrinol. 2011 Apr 15. [Epub ahead of print]
Bone quantitative ultrasound at hand phalanges of women following breast cancer surgery.
Bolanowski M, Chwalczynska A, Pluskiewicz W.
Source
Department of Endocrinology, Diabetology and Isotope Therapy, Medical University, Wroclaw, Poland.
Abstract
Breast cancer surgery and its adjunctive therapy follow in lymphedema, decreased limb mobility and bone
deterioration. The aim was to establish relation of postsurgical limb lymphedema with bone properties
assessed by quantitative ultrasound (QUS) measurement of hand phalanges in postmenopausal women after
breast cancer surgery. In all, 63 women aged 62.81?±?8.83 years, after breast cancer surgery were
compared with control group of 418 age-matched women. Their skeletal status was assessed by QUS
measurements at proximal phalanges using DBM Sonic 1200. There were no statistically significant
differences in QUS measurements (Ad-SoS) between groups of operated subjects and the controls,
between limbs (operated vs. nonoperated side, with and without lymphedema), and regarding method of
surgery. Ad-SoS was greater in estrogen-treated patients than in nontreated ones at the side with no breast
surgery (1994.11?±?67.83 vs. 1943.27?±?58.34; P?=?0.046). Ad-SoS was lower in patients with
adjunctive antiestrogen therapy than without this therapy at the side of surgery (1937.35?±?54.71 vs.
1966.78?±?59.18; P?=?0.0449), and nonbreast surgery side (1934.55?±?52.06 vs. 1973.31?±?57.17; P?
=?0.0066). Breast cancer surgery followed by concomitant therapies does not influence significantly QUS at
hand phalanges. This was proven regarding method of surgery, side of surgery, and lymphedema. Additional
hormonal treatment can influence phalangeal QUS in breast cancer survivors.
PMID: 21495803 [PubMed - as supplied by publisher]
April 24, 2011
Gan To Kagaku Ryoho. 2011 Apr;38(4):528-33.
[Lymphedema].
[Article in Japanese]
Takakura S, Yoshizawa I, Abo M, Ochiai K.
Source
Dept. of Obstetrics and Gynecology, The Jikei University School of Medicine, Japan.
Abstract
Prognostic benefits of lymph node dissection have been proven for patients with breast cancer or
gynecological malignancies; however, one of the complications associated with this procedure is
lymphedema. We reviewed therapies for secondary lymphedema, including complex decongestive
physiotherapy, skin care, manual lymphatic drainage, compression bandaging and garments, and limb
exercises. The challenge to secondary lymphedema in Jikei University Hospital, consisting of Aggressive
Protocol for Patients with LymphedemA Using SophisticatEd methods(APPLAUSE)has been implemented.
Jikei Lymphedema Assessment Scale(JLA-Se)and the LPG technic®, have also been introduced.
PMID:21498979 [PubMed - indexed for MEDLINE]
April 30, 2011
Hell J Nucl Med. 2011 Jan-Apr;14(1):74-5.
Two cases of (18)F- FDG PET/CT indings in HIV-negative Kaposi's sarcoma. Original presentation of one
case favorably treated with interferon.
Canbaz F, Ersoy D, Basoglu T.
Source
Departments of Nuclear Medicine, Ondokuz Mayύs University Hospital, Kurupelύt 55139 Samsun,
Turkey. fcanbaz@omu.edu.tr, fcanbazt@gmail.com.
Abstract
To the Editor: Kaposi's sarcoma (KS) is a rarely seen angioproliferative tumor associated with human
herpes virus 8 (HHV-8) infection, also known as Kaposi sarcoma herpes virus (KSHV). Four
epidemiological types of KS have been described: a) The classic type originally described by Kaposi, which
is typically found in midaged or in the elderly, b) The endemic type, several subtypes of which have been
described in sub-Saharan indigenous Africans prior to the acquired immune deficiency syndrome (AIDS)
epidemic after 2000s, c) The iatrogenic type associated with immunosuppressive drug treatment, typically
seen in organ transplant recipients, and d) AIDS-associated, epidemic KS, which is usually aggressive in
HIV-related or in post transplant patients, but may be more indolent. Clinically, in KS we find dark blue or
purplish macular or spindleshaped nodular skin lesions. The same lesions are found in pathology in the
lymphoid, respiratory, and/or in the gastrointestinal tissues. The disease carries a variable clinical course
ranging from minimal mucocutaneous disease to extensive organ involvement. Treatment for localized
pathology is surgery or radiation treatment, while widespread disease may be treated by systemic
chemotherapy or immunomodulators. Currently, fluorine-18-fluorodesoxyglucose positron emission
tomography/computed tomography ((18)F-FDG-PET/CT) is used as a very effective tool in monitoring
treatment response for many (18)F-FDG avid tumors. To our knowledge, the role of (18)F-FDG-PET/CT,
in HIV-negative KS of the skin and soft tissues was documented in only one case report. In that report, the
authors documented a case of human immunodeficiency virus (HIV)-negative classic KS, which responded
to target of rapamycin (mTOR), a kinase delivering phosphate groups to amino acid residues of downstream
proteins. The treatment response to rapamycin was well demonstrated by PET-CT. No published report
refering to the interferon (INF) response in a HIV-negative KS using (18)F-FDG-PET/CT could be found
in current literature till January 2010. In case 1, a 76 years old man with violaceous plaques and nodular skin
lesions diffusely involving the lower thigh, legs and upper extremities was admitted. He had no significant
medical history except for asthma. His blood tests were normal. The histopathological diagnosis obtained
from skin lesions of the thigh revealed low grade KS. Before starting INF treatment, he was referred to us
for a (18)F-FDG-PET/CT test for staging and treatment response. Fluorine-18-FDG-PET scan using
444MBq activity showed multifocal increased dermal and subdermal (18)F-FDG uptake in the distal parts
of the lower extremities more intense on the dorsal surface of the left foot. The lesions on the scan were
fewer than lesions seen on physical examination. Upper extremities' lesions showed no (18)F-FDG avidity.
Bilateral (18)F-FDG positive axillary lympadenopathy was an unexpected finding which may be due to
benign or malignant lymphoprolipherative disease related or unrelated with KS. No change in axillary lymph
nodes sizes as compared to previous thorax CT indings was found indicating a benign course. A control
PET/CT scan after 6 months revealed dimished metabolic activity in both axillas and in the lower extremities.
New lesions on the upper extremities were (18)F-FDG negative. The second case was a 77 years old
woman with ulcerated plaques disseminated on the distal portion of both legs, since years. She had no
significant medical history and blood tests were normal. Excisional biopsy from a dermal lesion of the right
dorsal foot showed KS. One year later, similar lesions occured around the excised area suggesting
recurrence and the patient had paliative radiotherapy. On follow up, the patient had more dermal lesions and
was admitted for restaging. A PET/CT study using 400MBq of (18)F-FDG showed multifocal dermal and
subdermal (18)F-FDG accumulation, mainly on the right distal lower extremity. In addition, bilateral diffuse
(18)F-FDG uptake was seen in the distal portions of the legs suggesting lymphedema and venous stasis.In
conclusion, these two cases accentuated that HIV negative cutaneous KS can present with heterogenous
(18)F-FDG avidity. The (18)F-FDG study may be useful in initial staging and in treatment monitoring.
PMID:21512674 [PubMed - in process]
Thyroid. 2011 Apr 21. [Epub ahead of print]
Gene Expression in Graves' Ophthalmopathy and Arm Lymphedema: Similarities and Differences.
Planck T, Parikh H, Brorson H, Mårtensson T, Asman P, Groop L, Hallengren B, Lantz M.
Source
1 Department of Endocrinology, Skåne University Hospital , Malmö, Sweden .
Abstract
Background: Graves' ophthalmopathy (GO) and lymphedema share some pathogenetic mechanisms, such as
edema, inflammation, and adipogenesis. The aim of this study was to examine similarities and differences
between chronic GO and chronic lymphedema. Methods: Intraorbital adipose tissue was collected from
patients with active (n = 10) or chronic GO (n = 10) and thyroid-healthy controls (n = 10). Arm
subcutaneous adipose tissue was obtained from patients with chronic arm lymphedema (n = 10), where
the unaffected arm served as a control. Gene expression was studied using microarray and real-time
polymerase chain reaction. Results: The following genes were significantly upregulated (p < 0.05) in
lymphedema but not in GO and have functions in wound healing, fibrosis, fat metabolism, inflammation,
differentiation, development, adhesion, and the cytoskeleton: ATP-binding cassette, sub-family G (WHITE),
member 1 (ABCG1), actin, alpha 2, smooth muscle, aorta (ACTA2), secreted frizzled-related protein 2
(SFRP2), tenascin C (TNC), pentraxin-related gene, rapidly induced by IL-1 beta (PTX3), and
carboxypeptidase X (M14 family), member 1 (CPMX1). In chronic GO, but not in lymphedema, adipocyte-
related immediate early genes known to be overexpressed in patients with active GO were upregulated but
at a lower level than previously shown for the active phase. Genes of the Wnt pathway, such as secreted
frizzled-related protein 1, 2, and 3, were up- and downregulated in both chronic GO and lymphedema.
Parathyroid hormone-like hormone (PTHLH) was downregulated (p = 0.01) and apolipoprotein L
domain containing 1 (APOLD1) was upregulated (p = 0.05) in both active and chronic GO. Conclusions:
There are more differences than similarities between chronic ophthalmopathy and chronic lymphedema, but
both conditions exhibit less inflammation and adipogenesis compared to the active phases. In lymphedema,
fibrosis dominates. PTHLH, which can inhibit adipogenesis, is downregulated both in active and chronic
ophthalmopathy, indicating the possibility of an increased risk of adipogenesis.
PMID: 21510802 [PubMed - as supplied by publisher
Pediatr Dermatol. 2010 Nov-Dec;27(6):675-6.
Yellow nail syndrome.
Al Hawsawi K, Pope E.
Source
Section of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
Yellow nail syndrome is an acquired condition of unknown etiology, rarely seen in children, characterized by
a triad of thickened yellow nails, primary lymphedema, and respiratory manifestations. We report an 8-year-
old girl with this syndrome who showed improvement with Fluconazole, 200 mg once weekly and vitamin E,
1000 IU once daily.
© 2010 Wiley Periodicals, Inc.
PMID: 21510012 [PubMed - in process
Gynecol Oncol. 2011 Apr 18. [Epub ahead of print]
Incidence of metastasis in circumflex iliac nodes distal to the external iliac nodes in intermediate- and high-
risk endometrial cancer.
Todo Y, Kato H, Okamoto K, Minobe S, Suzuki Y, Ohba Y, Takeda M, Watari H, Kaneuchi M,
Sakuragi N.
Source
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo,
Japan.
Abstract
OBJECTIVE:
The aim of this study was to elucidate the incidence of metastasis in circumflex iliac nodes distal to the
external iliac nodes (CINDEIN), which are also called suprainguinal nodes, in intermediate- and high-risk
endometrial cancer. Removal of these nodes needs to be discussed from the viewpoint of patient's quality of
life because removal of CINDEIN is strongly related to lower extremity lymphedema.
METHODS:
A retrospective chart review was carried out for 508 patients with intermediate- and high-risk endometrial
cancer who were included in this study. We identified patients with lymph node metastasis. Lymph node
sites were classified into four groups: (1) CINDEIN, (2) external iliac nodes, (3) Group A consisting of
circumflex iliac nodes to the distal obturator nodes, internal iliac nodes, obturator nodes, cardinal ligament
nodes (including deep obturator nodes), and sacral nodes, and (4) Group B consisting of common iliac
nodes and para-aortic nodes. Logistic regression analysis was used to select risk factors for CINDEIN
metastasis.
RESULTS:
In an analysis of 508 patients with intermediate- and high-risk disease, CINDEIN metastasis was found in
fourteen (2.8%) of the patients. Multivariate analysis confirmed that high-risk histology (OR=5.7, 95% CI=1.
2-16.1) and Group A node metastasis (OR=9.7, 95% CI=2.9-31.4) were independent risk factors for
CINDEIN metastasis. None of the patients with G1 endometrioid adenocarcinoma had CINDEIN
metastasis. Three (2.5%) of the patients with G2 endometrioid adenocarcinoma had CINDEIN metastasis
and all of these three patients had other pelvic node metastasis.
CONCLUSION:
Removal of CINDEIN can be eliminated in patients with G1 endometrial cancer and patients with G2
endometrial cancer who have no pelvic node metastasis.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21507473 [PubMed - as supplied by publisher]
Arthritis Care Res (Hoboken). 2011 Apr 26. doi: 10.1002/acr.20487. [Epub ahead of print]
Manual lymph drainage improves upper limb oedema and hand function in patients with systemic sclerosis
(SSC) in oedematous phase.
Bongi SM, Del Rosso A, Passalacqua M, Miccio S, Cerinic MM.
Source
Department of BioMedicine, Division of Rheumatology, Denothe Centre, Careggi Hospital (AOUC),
University of Florence, Italy.
Abstract
OBJECTIVE:
In Systemic Sclerosis (SSc) patients in oedematous phase, hand oedema is often present. Manual lymph
drainage (MLD) stimulates lymphatic system and reduces oedema. Our aim was to evaluate the efficacy of
MLD in reducing oedema and in improving functionality of the hands and perceived quality of life (QoL) in
SSc patients in oedematous phase.
METHODS:
Out of 35 SSc patients with oedematous hands, 20 were treated with MLD according to Vodder technique
once a week for 5 weeks [Interventional group (IG)] and 15 served as Observational Group (OG). Patients
were evaluated at enrolment (T0), at the end of treatment (T1), and after 9 weeks of follow-up (T2), by
volumetric test, assessing hands volume, Hand Mobility in Scleroderma (HAMIS) test and by 4 VAS (0-
10) evaluating perception of hand oedema and pain and their interference on the daily activities. QoL and
disability were assessed by Physical (PSI) and Mental Synthetic Index (MSI) of Short Form 36 (SF-36)
and Health Assessment Questionnaire (HAQ).
RESULTS:
In the IG, hand volume, HAMIS, and the 4 VAS were improved significantly at the end of treatment (p<0.
001). The results were maintained at T2 (p<0.001). Also HAQ, PSI and MSI of SF-36 improved
significantly at T1 (p<0.001), but only PSI improvement was maintained at T2 (p<0.001). In the OG, no
improvement at T1 and at T2 was observed.
CONCLUSIONS:
In SSc, MLD reduces significantly hand oedema and improves hand function and perceived QoL. © 2011
American College of Rheumatology.
Copyright © 2011 by the American College of Rheumatology.
PMID: 21523925 [PubMed - as supplied by publisher]
Clin Exp Nephrol. 2011 Apr 26. [Epub ahead of print]
A rare case of reversible acquired AA-type renal amyloidosis in a chronic filariasis patient receiving
antifilarial therapy.
Nayak HK, Daga MK, Garg SK, Sinha NK, Kumar R, Mohanty PK, Pandey BK.
Source
Lok Nayak Hospital, Maulana Azad Medical College, P.G Men's Hostel, Room no-96, Bahadurshah Zafar
Marg, New Delhi, 110002, India, drhemantnayak@gmail.com.
Abstract
Lymphatic filariasis is a major health problem in India with a large number of patients tending to be
asymptomatic. In the Southeast and South Asian regions, Wuchereria bancrofti is the most prevalent
parasite, causing filariasis in 99.4% of cases. While kidney involvement is a rare event in chronic filariasis,
this case is unique because AA-type renal amyloidosis occurs in chronic W. bancrofti infection. We present
here a unique case of lymphatic filariasis. The patient, a 25-year-old male who was previously diagnosed
with right lower limb filarial lymphedema and had undergone lymphovenous anastomosis, was admitted for
evaluation of persistent nephrotic-range proteinuria. Autoimmune markers in the form of anti-nuclear
antibodies, anti-double-stranded DNA and anti-neutrophil cytoplasmic antibody were negative; C3 was
normal. Urine analysis revealed inactive sediment with moderate proteinuria. Both serum and urine
electrophoresis were negative for paraproteins and bone marrow aspirate and biopsy were normal.
Evidence of active filarial infection was established on the basis of microfilariae in the peripheral smear and a
positive W. bancrofti antigen test. Kidney biopsy revealed renal amyloidosis when stained with Congo red
and anti-AA immunostain. The patient's proteinuria improved on conservative management with angiotensin-
converting enzyme inhibitors and a course of antifilarial drugs. His proteinuria returned to <1 g/24 h with
normalization of renal function and no significant proteinuria on periodic follow-up at 6-month and 1-year
intervals. Repeat kidney biopsy after 1.5 years showed regression of amyloidosis. Repeat demonstration of
filarial antigen and microfilariae in the peripheral smear were negative on multiple occasions during the follow-
up period. Although various chronic infections can lead to secondary renal amyloidosis, this is the first case
reported in world literature where secondary amyloidosis developed as a complication of chronic filarial
infection due to W. bancrofti. This is probably also the first case reported in world literature where renal
amyloidosis has an etiological association with W. bancrofti infection and where patient symptoms improved
with antifilarial and antiproteinuric management.
PMID: 21519822 [PubMed - as supplied by publisher]
J Cutan Pathol. 2011 Apr 26. doi: 10.1111/j.1600-0560.2011.01703.x. [Epub ahead of print]
Cutaneous angiosarcoma arising in massive localized lymphedema of the morbidly obese: a report of five
cases and review of the literature.
Shon W, Ida CM, Boland-Froemming JM, Rose PS, Folpe A.
Source
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Abstract
A significant proportion of angiosarcoma arises in the setting of chronic lymphedema, often following surgery
for breast carcinoma (Stewart-Treves syndrome). Massive localized lymphedema (MLL), a relatively
recently described and rare pseudotumor most often occurring in morbidly obese patients, is thought to be
the result of derangements in lymphatic drainage secondary to excessive adipose tissue. Only a very small
number of cases of angiosarcoma have been reported in patients with MLL. We reviewed the clinical and
pathological features of five patients with angiosarcoma arising in this unusual clinical setting. The tumors
arose in three women and two men, who were in the age range from 36 to 81 years (median: 52 years). All
patients were or had recently been morbidly obese (mean body mass index = 47.2 kg/cm(2) ; range:37.6-
68.5 kg/cm(2) ) and had long-standing soft tissue changes of MLL. The tumors arose in the thigh (two
cases), lower leg (two cases) and abdomen/proximal thigh (one case) and ranged from 6 to 28.5 cm in size
(mean: 15.9 cm). All tumors were conventional high-grade angiosarcomas and microscopically exhibited an
admixture of vasoformative, spindled and epithelioid features. Microscopic changes of MLL, including
dermal fibrosis, expansion of interlobular fibrous septa and lymphangiectasia, were identified in all cases.
Clinical follow-up (four cases; mean: 13.8 months; range: 2-32 months) showed one patient to be dead of
disease, one patient to be dead from therapy-related complications and two patients to be alive without
disease. One case was too recent for meaningful clinical follow-up. We conclude that lymphedema
secondary to obesity should be recognized as a significant risk factor for the development of angiosarcoma.
The clinical and pathological features of angiosarcoma arising in this distinctive clinical setting appear to be
identical to those of other lymphedema-associated angiosarcomas. With the continuing epidemic of obesity
in Western societies, the incidence of obesity-related angiosarcoma is probably to increase. Consequently, it
is critical that lymphedematous areas in obese patients be carefully examined for clinical evidence of early
angiosarcoma, with the hope that timely diagnosis may lead to improved patient outcome. Shon W, Ida CM,
Boland-Froemming JM, Rose PS, Folpe A. Cutaneous angiosarcoma arising in massive localized
lymphedema of the morbidly obese: a report of five cases and review of the literature.
Copyright © 2011 John Wiley & Sons A/S.
PMID: 21518378 [PubMed - as supplied by publisher]
Dev Biol. 2011 Apr 16. [Epub ahead of print]
Connexin37 and Connexin43 deficiencies in mice disrupt lymphatic valve development and result in
lymphatic disorders including lymphedema and chylothorax.
Kanady JD, Dellinger MT, Munger SJ, Witte MH, Simon AM.
Source
Department of Physiology, University of Arizona, Tucson, AZ 85724, USA.
Abstract
Intraluminal valves are required for the proper function of lymphatic collecting vessels and large lymphatic
trunks like the thoracic duct. Despite recent progress in the study of lymphvasculogenesis and
lymphangiogenesis, the molecular mechanisms controlling the morphogenesis of lymphatic valves remain
poorly understood. Here, we report that gap junction proteins, or connexins (Cxs), are required for
lymphatic valvulogenesis. Cx37 and Cx43 are expressed early in mouse lymphatic development in the
jugular lymph sacs, and later in development these Cxs become enriched and differentially expressed by
lymphatic endothelial cells on the upstream and downstream sides of the valves. Specific deficiencies of
Cx37 and Cx43 alone or in combination result in defective valve formation in lymphatic collecting vessels,
lymphedema, and chylothorax. We also show that Cx37 regulates jugular lymph sac size and that both Cx37
and Cx43 are required for normal thoracic duct development, including valve formation. Another Cx family
member, Cx47, whose human analog is mutated in some families with lymphedema, is also highly enriched in
a subset of endothelial cells in lymphatic valves. Mechanistically, we present data from Foxc2-/- embryos
suggesting that Cx37 may be a target of regulation by Foxc2, a transcription factor that is mutated in human
lymphedema-distichiasis syndrome. These results show that at least three Cxs are expressed in the
developing lymphatic vasculature and, when defective, are associated with clinically manifest lymphatic
disorders in mice and man.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21515254 [PubMed - as supplied by publisher]
Am J Obstet Gynecol. 2011 Mar 16. [Epub ahead of print]
Adverse events associated with laparoscopy vs laparotomy in the treatment of endometrial cancer.
Barnett JC, Havrilesky LJ, Bondurant AE, Fleming ND, Lee PS, Secord AA, Berchuck A, A Valea F.
Source
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University School of
Medicine, Durham, NC.
Abstract
OBJECTIVE:
The objective of the study was to compare adverse event rates between laparoscopic vs open surgery for
endometrial cancer.
STUDY DESIGN:
This was a retrospective cohort study comparing 107 women who underwent laparoscopy with 269 age-
and body mass index-matched women who underwent laparotomy for treatment of endometrial cancer.
RESULTS:
Adverse event rates were similar between cohorts (37% laparoscopy vs 43% laparotomy, P = .248).
Laparotomies had higher rates of cellulitis (16% vs 7%, P = .018) and open wound infection (9% vs 2%, P
= .02), whereas laparoscopy had higher rates of sensory peripheral nerve deficit (5% vs 0%, P = .008) and
lymphedema (7% vs. 1%, P = .003). Laparoscopy was associated with longer mean operating room times
but with shorter hospital stays and lower mean blood loss.
CONCLUSION:
Laparoscopy was associated with decreased rates of surgical site infections but had an increased risk of
peripheral sensory nerve deficits and lymphedema when compared with laparotomy.
Published by Mosby, Inc.
PMID: 21514921 [PubMed - as supplied by publisher]
Ann Vasc Surg. 2011 Apr 20. [Epub ahead of print]
Stewart-Treves Syndrome and the Use of Positron Emission Tomographic Scanning.
Dawlatly SL, Dramis A, Sumathi VP, Grimer RJ.
Source
Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, West Midlands, UK.
Abstract
In this article, we provide an account of two rare cases of Stewart-Treves syndrome, that is, cutaneous
angiosarcoma secondary to lymphedema, treated at our center. Unusually, both occurred in the lower
extremity. The first case was treated initially with a wide local excision, followed by a further re-excision,
and eventually an above-the-knee amputation because of recurrence. In the second case, a hindquarter
amputation was undertaken after a positron emission tomographic scan, which revealed the extent and
spread of the lesions. In cases of cutaneous angiosarcoma, a positron emission tomographic scan can be
extremely helpful in demonstrating the extent of subcutaneous spread and planning surgical management.
Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.
PMID: 21514109 [PubMed - as supplied by publisher]