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Lymphland International Lymphedema Online
| Please note abstracts before August 2009 are in with the older news/abstracts pages, and some of the abstracts that are located here come to us in August but have prior dates. |
| 1. Plast Reconstr Surg. 2009 Aug;124(2):438-50. Fibrosis is a key inhibitor of lymphatic regeneration. Avraham T, Clavin NW, Daluvoy SV, Fernandez J, Soares MA, Cordeiro AP, Mehrara BJ. Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. BACKGROUND: Lymphedema is a common debilitating sequela of lymph node dissection. Although numerous clinical studies suggest that factors that lead to fibrosis are associated with the development of lymphedema, this relationship has not been proven. The purpose of these experiments was therefore to evaluate lymphatic regeneration in the setting of variable soft-tissue fibrosis. METHODS: A section of mouse tail skin including the capillary and collecting lymphatics was excised. Experimental animals (n = 20) were treated with topical collagen type I gel and a moist dressing, whereas control animals (n = 20) underwent excision followed by moist dressing alone. Fibrosis, acute lymphedema, lymphatic function, gene expression, lymphatic endothelial cell proliferation, and lymphatic fibrosis were evaluated at various time points. RESULTS: Collagen gel treatment significantly decreased fibrosis, with an attendant decrease in acute lymphedema and improved lymphatic function. Tails treated with collagen gel demonstrated greater numbers of lymphatic vessels, more normal lymphatic architecture, and more proliferating lymphatic endothelial cells. These findings appeared to be independent of vascular endothelial growth factor C expression. Decreased fibrosis was associated with a significant decrease in the expression of extracellular matrix components. Finally, decreased soft-tissue fibrosis was associated with a significant decrease in lymphatic fibrosis as evidenced by the number of lymphatic endothelial cells that coexpressed lymphatic and fibroblast markers. CONCLUSIONS: Soft-tissue fibrosis is associated with impairment in lymphatic regeneration and lymphatic function. These defects occur as a consequence of impaired lymphatic endothelial cell proliferation, abnormal lymphatic microarchitecture, and lymphatic fibrosis. Inhibition of fibrosis using a simple topical dressing can markedly accelerate lymphatic repair and promote regeneration of normal capillary lymphatics. PMID: 19644258 [PubMed - in process --- 2. Breast Cancer Res Treat. 2009 Jul 30. [Epub ahead of print] Pain perception and detailed visual pain mapping in breast cancer survivors. Jud SM, Fasching PA, Maihöfner C, Heusinger K, Loehberg CR, Hatko R, Rauh C, Bani H, Lux MP, Beckmann MW, Bani MR. Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Universitaetsstrasse 21-23, 91054, Erlangen, Germany. Chronic pain and neural irritation after breast surgery and radiation are still relevant sequelae of the treatment. Pain quantification and localization in patient groups are difficult to standardize. In order to quantify and localize pain in a group of breast cancer patients, a Java-based program was developed to visualize the frequency of pain in "pain maps." A questionnaire with structured questions on the perception of pain included pictograms of a body to mark possible pain areas. A group of 343 breast cancer survivors completed the questionnaires. The image information was digitalized and processed using a Java applet. Gray-scale summation pictures with numbers from "0," indicating black (100% pain), to "255," indicating white (0% pain), were generated. The visualization of pain by creating pain maps revealed the location of pain in breast cancer survivors on pictograms of the body. Analyzing the total number of pixels, in which pain was stated, made it possible to compare pain areas in several subgroups, showing that patients after mastectomy versus breast-conserving therapy (3,011 vs. 2,224 pixels), and patients with lymphedema versus patients without lymphedema (3,010 vs. 2,239 pixels), have larger pain areas. This study presents a method of visualizing pain areas and assigning them to a pictogram of the body in a sample of breast cancer patients. The method is easy to use and could help generate pain maps in several types of disease. PMID: 19641989 [PubMed - as supplied by publisher --- 3. Am J Nurs. 2009 Aug;109(8):34-41; quiz 42. Post-breast cancer lymphedema: part 2. Fu MR, Ridner SH, Armer J. New York University College of Nursing, New York City, USA. mf67@nyu.edu As breast cancer survivors often say, lymphedema is more than just a swollen arm. A result of surgical or radiologic breast cancer treatment, it's an abnormal accumulation of lymph in the arm, shoulder, breast, or thoracic area that usually develops within three years of a breast cancer diagnosis but can occur much later. In Part 1 (July) the authors described the pathophysiology and diagnosis of lymphedema. In Part 2 they discuss current approaches to risk reduction, treatment and management of the condition, and implications for nurses. PMID: 19641404 [PubMed - in process --- 4. Ann Acad Med Singapore. 2009 Jul;38(7):636-3. Primary lymphoedema at an unusual location triggered by nephrotic syndrome. Tabel Y, Mungan I, Sigirci A, Gungor S. Department of Paediatrics, Faculty of Medicine, Inonu University, Malatya, Turkey. yilmaztabel@yahoo. com INTRODUCTION: Lymphoedema results from impaired lymphatic transport leading to the pathologic accumulation of protein-rich lymphatic fluid in the interstitial space, most commonly in the extremities. Primary lymphoedema, a developmental abnormality of the lymphatic system, may become evident later in life when a triggering event exceeds the capacity of normal lymphatic flow. CLINICAL PICTURE: We present a 3-year-old nephrotic syndrome patient with an unusual localisation for primary lymphoedema. TREATMENT AND OUTCOME: The patient was treated with conservative approach and she was cured. CONCLUSION: In this particular case, lymphoedema developed at an unusual localisation, which has not been recorded before. PMID: 19652856 [PubMed - in process ---- 5. Int Angiol. 2009 Aug;28(4):315-24. The CEAP-L classification for lymphedemas of the limbs: the Italian experience. Gasbarro V, Michelini S, Antignani PL, Tsolaki E, Ricci M, Allegra C. Unit of Vascular and Endovascular Surgery, Department of Surgical, Anesthesiological and Radiological Sciences, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy allegra@mclink.it. AIM: A method to classificate lymphedema has been needed to gather all the important information on the clinical evolution of the disease using a common language and an easy clinical applicability. METHODS: The proposal for a new classification of the limb lymphedema was inspired by the C.E.A.P. classification for chronic venous insufficiency of the lower limb. The classification adopts the acronym C.E.A. P. by adding the letter L to underline the aspect ''lymphedema'' and is based on clinical data such as extension of lymphedema, presence of lymphangitis, leg ulcers and loss of functionality of the limb and instrumental criteria that permit to confirm and precise diagnosis. The Clinical classification is based on the most objective sign in these patients, the edema which is subdivided into 5 classes depending on the clinical manifestations. The etiological aspect considers 2 types of alterations of the lymphatic system: congenital and acquired. The anatomic is aimed to locate the anatomical structures involved. Pathophysiological conditions are gathered into 5 groups: agenesia or hypoplasia, hyperplasia, reflux, overload, obstruction. RESULTS: The classification has already been appraised after 4 years of activity at the unit of Vascular and Endovascular Surgery of Ferrara, at the S. Giovanni Battista Hospital in Rome, at the Umberto I Ancona Hospital and at the S. Giovanni- Addolorata Hospital in Rome. CONCLUSIONS: The proposal for a new classification of lymphedema C.E.A.P. L was developed in order to categorize patients with definite and objective marks, creating clinical reports with a common vocabulary, clear to all clinicians, permitting to stage the disease, evaluate treatment and finally obtain epidemiological and statistical data. PMID: 19648876 [PubMed - in process ----- Breast. 2009 Aug 3. [Epub ahead of print] Axillary metastatic disease as presentation of occult or contralateral breast cancer. Lanitis S, Behranwala KA, Al-Mufti R, Hadjiminas D. St Mary's hospital, Praed street, Paddington, London W2 1NY, UK. INTRODUCTION: Atypical axillary metastasis may arise from an occult ipsilateral or contralateral breast cancer or from primary non-breast tumour. The treatment of this entity is challenging and presents various options. We present our experience with a brief review of the literature. RESULTS: A study of atypical axillary metastasis done at St Mary's hospital, from 1998 to 2008, identified six cases. Radiological investigations and immunohistochemistry excluded non-breast primary tumour. Three patients had occult breast cancer on presentation, two patients had previously treated contralateral breast cancer and one patient developed a primary metachronous contralateral breast cancer, which had a completely different histological profile from the involved lymph nodes on the same side. Axillary nodal clearance was done for all patients except for the patient with lymphoedema. Four patients were alive with no evidence of disease and two patients died of the disease at a median follow-up of 23 months. CONCLUSION: Atypical axillary metastasis from ipsilateral occult or contralateral breast cancer should be treated with axillary node clearance and further endocrine or chemotherapy. Radiation treatment or a watchful policy to the ipsilateral breast should be validated by further studies. PMID: 19656680 [PubMed - as supplied by publisher ------------------------- Fukuoka Igaku Zasshi. 2009 Jun;100(6):235-41. [The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg][Article in Japanese] Nakao F, Furutani A, Yoshimura K, Hamano K, Kinoshita Y, Kawamoto R, Nakao H, Suzuki S. Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi- ku, Fukuoka 812-8582, Japan. Lymphedema is a chronic problem causing distress and loss of functions throughout the lifespan. Complex decongestive physiotherapy (CDP) is in common use in developed countries but has only recently been used in Japan for people in outpatient settings. CDP is a representative conservative treatment for lymphedema, conducted by combining four kinds of physical therapies: skin care, manual lymph drainage (MLD), bandage and exercise. This research project lead by a nurse is underway using CDP in an outpatient department. We report a case of secondary lymphedema caused by infection successfully treated by CDP. A 22-year-old man suffered from cellulitis of unknown origin when he was a high school student. After this event, he had been repeatedly admitted to hospital with infections as a result of the lymphedema. He underwent MLD once or twice monthly and received health education for skin care, self-massage and exercise, and was advised to wear compression stockings. Within 7 months the leg swelling had significantly reduced and his feelings of malaise and pain disappeared. Fourteen months later the circumferences of his knee and ankle had kept the sizes, and he has not re-entered hospital for infections. For this man, CDP had a positive outcome, as it has for many others around the world. Our experience has found it very important to establish adequate support systems for such people in outpatient and community settings. However, more research and knowledge sharing are required to understand the usefulness and effectiveness about this program as a primary treatment combined with health education in community settings in Japan. PMID: 19670806 [PubMed - in process ----------------------------------- Nat Med. 2009 Aug 9. [Epub ahead of print] Alternatively spliced vascular endothelial growth factor receptor-2 is an essential endogenous inhibitor of lymphatic vessel growth. Albuquerque RJ, Hayashi T, Cho WG, Kleinman ME, Dridi S, Takeda A, Baffi JZ, Yamada K, Kaneko H, Green MG, Chappell J, Wilting J, Weich HA, Yamagami S, Amano S, Mizuki N, Alexander JS, Peterson ML, Brekken RA, Hirashima M, Capoor S, Usui T, Ambati BK, Ambati J. [1] Departments of Ophthalmology & Visual Sciences, Lexington, Kentucky, USA. [2] Department of Physiology, University of Kentucky, Lexington, Kentucky, USA. Disruption of the precise balance of positive and negative molecular regulators of blood and lymphatic vessel growth can lead to myriad diseases. Although dozens of natural inhibitors of hemangiogenesis have been identified, an endogenous selective inhibitor of lymphatic vessel growth has not to our knowledge been previously described. We report the existence of a splice variant of the gene encoding vascular endothelial growth factor receptor-2 (Vegfr-2) that encodes a secreted form of the protein, designated soluble Vegfr-2 (sVegfr-2), that inhibits developmental and reparative lymphangiogenesis by blocking Vegf-c function. Tissue-specific loss of sVegfr-2 in mice induced, at birth, spontaneous lymphatic invasion of the normally alymphatic cornea and hyperplasia of skin lymphatics without affecting blood vasculature. Administration of sVegfr-2 inhibited lymphangiogenesis but not hemangiogenesis induced by corneal suture injury or transplantation, enhanced corneal allograft survival and suppressed lymphangioma cellular proliferation. Naturally occurring sVegfr-2 thus acts as a molecular uncoupler of blood and lymphatic vessels; modulation of sVegfr-2 might have therapeutic effects in treating lymphatic vascular malformations, transplantation rejection and, potentially, tumor lymphangiogenesis and lymphedema. PMID: 19668192 [PubMed - as supplied by publisher ------------------------------------- 1. 1: Integr Cancer Ther. 2009 Jun;8(2):123-9. Feasibility trial of electroacupuncture for aromatase inhibitor--related arthralgia in breast cancer survivors. Mao JJ, Bruner DW, Stricker C, Farrar JT, Xie SX, Bowman MA, Pucci D, Han X, DeMichele A. Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA BACKGROUND: Arthralgia affects postmenopausal women receiving aromatase inhibitors (AIs) for breast cancer. Given the existing evidence for electroacupuncture (EA) for treatment of osteoarthritis in the general population, this study aims to establish the feasibility of studying EA for treating AI-related arthralgia. PATIENTS AND METHODS: Postmenopausal women with stage I-III breast cancer who reported AI- related arthralgia were enrolled in a single-arm feasibility trial. EA was provided twice a week for 2 weeks followed by 6 weekly treatments. The protocol was based on Chinese medicine diagnosis of "Bi" syndrome with electrostimulation of needles around the painful joint(s). Pain severity of the modified Brief Pain Inventory was used as the primary outcome. Joint stiffness, joint interference, and Patient Global Impression of Change (PGIC) were secondary outcomes. Paired t tests were used for analysis. RESULTS: Twelve women were enrolled and all provided data for analysis. From baseline to the end of intervention, patients reported reduction in pain severity (from 5.3 to 1.9), stiffness (from 6.9 to 2.4), and joint symptom interference (from 4.7 to 0.8), all P < .001; 11/12 considered joint symptoms "very much better" based on the PGIC. Subjects also reported significant decrease in fatigue (from 4.4 to 1.9, P = .005) and anxiety (from 7.1 to 4.8, P = .01). No infection or development or worsening of lymphedema was observed. CONCLUSION: Preliminary data establish the feasibility of recruitment and acceptance as well as promising preliminary safety and effectiveness. A randomized controlled trial is warranted to establish the efficacy of EA for AI-related arthralgia in breast cancer survivors. PMID: 19679620 [PubMed - in process --------------------------------- 2. N Engl J Med. 2009 Aug 13;361(7):664-73. Comment in: N Engl J Med. 2009 Aug 13;361(7):710-1. Weight lifting in women with breast-cancer-related lymphedema. Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams-Smith CT, Greene QP. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. schmitz@mail.med.upenn.edu BACKGROUND: Weight lifting has generally been proscribed for women with breast-cancer-related lymphedema, preventing them from obtaining the well-established health benefits of weight lifting, including increases in bone density. METHODS: We performed a randomized, controlled trial of twice-weekly progressive weight lifting involving 141 breast-cancer survivors with stable lymphedema of the arm. The primary outcome was the change in arm and hand swelling at 1 year, as measured through displaced water volume of the affected and unaffected limbs. Secondary outcomes included the incidence of exacerbations of lymphedema, number and severity of lymphedema symptoms, and muscle strength. Participants were required to wear a well-fitted compression garment while weight lifting. RESULTS: The proportion of women who had an increase of 5% or more in limb swelling was similar in the weight-lifting group (11%) and the control group (12%) (cumulative incidence ratio, 1.00; 95% confidence interval, 0.88 to 1.13). As compared with the control group, the weight-lifting group had greater improvements in self-reported severity of lymphedema symptoms (P=0.03) and upper- and lower-body strength (P<0.001 for both comparisons) and a lower incidence of lymphedema exacerbations as assessed by a certified lymphedema specialist (14% vs. 29%, P=0.04). There were no serious adverse events related to the intervention. CONCLUSIONS: In breast-cancer survivors with lymphedema, slowly progressive weight lifting had no significant effect on limb swelling and resulted in a decreased incidence of exacerbations of lymphedema, reduced symptoms, and increased strength. (ClinicalTrials.gov number, NCT00194363.) 2009 Massachusetts Medical Society PMID: 19675330 [PubMed - indexed for MEDLINE ---------------------- 1. Dev Cell. 2009 Aug;17(2):175-86. Integrin-alpha9 is required for fibronectin matrix assembly during lymphatic valve morphogenesis. Bazigou E, Xie S, Chen C, Weston A, Miura N, Sorokin L, Adams R, Muro AF, Sheppard D, Makinen T. Lymphatic Development Laboratory, Cancer Research UK London Research Institute, 44 Lincoln's Inn Fields, London WC2A 3PX, UK. Dysfunction of lymphatic valves underlies human lymphedema, yet the process of valve morphogenesis is poorly understood. Here, we show that during embryogenesis, lymphatic valve leaflet formation is initiated by upregulation of integrin-alpha9 expression and deposition of its ligand fibronectin-EIIIA (FN-EIIIA) in the extracellular matrix. Endothelial cell-specific deletion of Itga9 (encoding integrin-alpha9) in mouse embryos results in the development of rudimentary valve leaflets characterized by disorganized FN matrix, short cusps, and retrograde lymphatic flow. Similar morphological and functional defects are observed in mice lacking the EIIIA domain of FN. Mechanistically, we demonstrate that in primary human lymphatic endothelial cells, the integrin-alpha9-EIIIA interaction directly regulates FN fibril assembly, which is essential for the formation of the extracellular matrix core of valve leaflets. Our findings reveal an important role for integrin-alpha9 signaling during lymphatic valve morphogenesis and implicate it as a candidate gene for primary lymphedema caused by valve defects. PMID: 19686679 [PubMed - in process ------------------ 2. Nurs Stand. 2009 Jul 8-14;23(44):25. A suitable case for treatment. Mason MC. Chronic lymphoedema is a common condition but its treatment is often overlooked. PMID: 19685788 [PubMed - in process ------- . Ann Plast Surg. 2009 Sep;63(2):300-1. Massive localized lymphoedema. Hutt J, Sturley W, Jemec B. Department of Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, United Kingdom. A case report of massive localized lymphoedema in a morbidly obese 50-year-old woman and review of the literature. PMID: 19700959 [PubMed - in process ----- 2. J Mal Vasc. 2009 Aug 18. [Epub ahead of print] [Adverse effects of compression in treatment of limb lymphedema.][Article in French] Vignes S, Arrault M. Unité de lymphologie, centre national de référence des maladies vasculaires rares, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France. INTRODUCTION: Limb lymphedema, whether primary or secondary, is a chronic disease. Compression is the cornerstone of therapy and includes multilayer low-stretch bandages and elastic garments. Compression is usually well-tolerated. The aim of our study was to identify all the different types of adverse effects of compression. MATERIALS AND METHODS: Since January 2005, we have recorded all adverse events occurring in outpatients and inpatients consulting in a single lymphology department, spontaneously reported by patient during consultations or physical examinations, and noted the type of compression material used. RESULTS: Adverse effects were secondary to poor choice of therapeutic material, excessive pressure or contact dermatitis. For the arms, an elastic garment stopping at the wrist can be responsible for lymphedema of the hand and fingers. Rubbing of sleeve seams may cause pain and even ulcers between the thumb and forefinger. Open-toed elastic stockings may exacerbate digital lymphedema, leading to the formation of oozing lymph vesicles. Hyperpressure may cause severe pain localized to the first and fifth toes, overlapping toes, interdigital corns and/or ingrown toenails. Silicone-banded soft-fit elastic garments may cause painful phlyctena, urticaria or eczematiform lesions. Elastic bandages may induce pain or purpuric lesions. CONCLUSION: Compression can be responsible for adverse effects, sometimes severe, requiring treatment change or withdrawal. Further studies are needed to precisely determine their frequency to improve prescriptions and currently available products. PMID: 19695803 [PubMed - as supplied by publisher ----- 3. Clin Rheumatol. 2009 Aug 20. [Epub ahead of print] Psoriatic arthritis and chronic lymphoedema: treatment efficacy by adalimumab. Tong D, Eather S, Manolios N. Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia, 2145, Lymphoedema is a rare complication of psoriatic arthritis (PsA) and inflammatory joint disease, with no response noted to disease-modifying drugs. However, reports are emerging of a beneficial effect on lymphoedema in patients treated with tumor necrosis factor-alpha antagonists for PsA (Etanercept), rheumatoid arthritis (Etanercept) and ankylosing spondylitis (Infliximab). We describe a psoriatic arthritis patient whose lymphoedema greatly improved following commencement of adalimumab. PMID: 19693641 [PubMed - as supplied by publisher ------- 4. Ann Plast Surg. 2009 Sep;63(2):302-6. Radical reduction of upper extremity lymphedema with preservation of perforators. Salgado CJ, Sassu P, Gharb BB, di Spilimbergo SS, Mardini S, Chen HC. Department of Plastic Surgery, University Hospitals Cleveland/Case Western Reserve University, Cleveland, Ohio, USA. Excisional procedures have been successfully utilized by different authors in multistage treatment of upper extremity lymphedema. We have used microsurgical principles of perforator flap surgery in order to develop a one-stage procedure that enables a radical reduction of the lymphedematous tissue with preservation of the vascular supply to the overlying skin.Between March 2000 and February 2007, 11 patients affected by late stage II lymphedema underwent radical reduction of the affected tissues with preservation of perforators. Perforator vessels from the radial and posterior interosseous arteries were identified and through medial and lateral forearm incisions, skin flaps were raised off the underlying lymphedematous tissue and the affected tissue was removed off the deep fascia. At a mean follow-up of 17.8 months the average percentage reductions above and below the elbow, at the wrist, and the hand were 15.1%, 20.7%, 0.5%, and 3.6%, respectively. Statistical analysis showed significant circumference reduction above and below the elbow (P = 0.048 and 0.022, respectively) but not at the wrist and hand. There were no cases of wound breakdown, skin necrosis, or cellulitis in the postoperative period. Four patients complained of mild numbness confined to the vicinity of the surgical incisions.Microvascular principles applied to the radical excision of the subcutaneous tissue seems to offer a new promising one-stage surgical procedure in patients affected by upper extremity lymphedema that has failed conservative therapy. PMID: 19692901 [PubMed - in process ------ 5. Clin Nucl Med. 2009 Sep;34(9):585-8. Progression of clinically stable lymphedema on lymphoscintigraphy. Luongo JA, Scalcione LR, Katz DS, Yung EY. Department of Radiology, Winthrop-University Hospital, Mineola, NY 11501, USA. Lymphedema is due to dysfunction in lymphatic transport, and is divided into primary and secondary subtypes. Primary lymphedema is a congenital lymphatic abnormality or dysfunction whereas secondary lymphedema is characterized by pathologic disruption or obstruction of a previously-normal lymphatic system. The stage of lymphedema is determined clinically. Lymphoscintigraphy, however, may be used to assess disease extent, for early detection of disease progression, and can be used to direct therapy. We report a case of a 56-year-old woman with clinically stable lymphedema of 5 years, yet with lymphoscintigraphy findings compatible with disease progression. PMID: 19692818 [PubMed - in process 6. J Urol. 2009 Aug 17. [Epub ahead of print] A New Technique of Concealed Penis Repair. Sugita Y, Ueoka K, Tagkagi S, Hisamatsu E, Yoshino K, Tanikaze S. Urology, Kobe Children's Hospital (YS, ST, EH), Kobe, Japan. PURPOSE: Phimosis associated with concealed penis is not amenable to ordinary circumcision. To our knowledge we describe a new technique to repair concealed penis. MATERIALS AND METHODS: From September 2003 to January 2008, 57 consecutive patients with concealed penis were treated using our technique. Median age at surgery was 33 months (range 7 months to 34 years). The technique consists of 3 steps. Step 1 is a ventral incision to slit the narrow ring of the prepuce and expose the glans. Step 2 is a circumferential skin incision made between 2 edges of the ventral diamond- shaped skin defect, followed by midline incision of the dorsal inner prepuce to make 2 skin flaps connected to the glans. Step 3 is skin coverage. Two skin flaps are brought down and sutured together on the ventral side of the penis. The suture line between the penile shaft skin and the flap eventually becomes elliptical. Medical records were reviewed for voiding function, scar formation, and replies from older patients and the parents of younger children about impressions of the surgical results. RESULTS: Median followup was 26 months. No patient had voiding problems. Lymphedema persisted due to suture line constriction in 2 patients who underwent incision of the constriction. All older patients and the parents of younger children were satisfied with the surgical results. CONCLUSIONS: Our new method is easy to design and perform to correct concealed penis. It provides a good cosmetic appearance and seems to be applicable in all cases with deficient penile shaft skin. PMID: 19692094 [PubMed - as supplied by publisher ---- 1. Acta Oncol. 2009 Aug 27:1-8.\ Changes in arm morbidities and health-related quality of life after breast cancer surgery - a five-year follow- up study. Sagen A, Kåresen R, Sandvik L, Risberg MA. Department of Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway. Background and purpose. Many breast cancer survivors (BCS) suffer from long-term upper limb morbidities after axillary node dissection. The purpose of this five-year follow-up study was to describe changes in long-term upper limb morbidities, physical activity level, and Health-Related Quality of Life (HRQoL) and to find factors that predict HRQoL five years after surgery. Patients and methods. This study included 204 women aged 55+/-10 years who had primary breast cancer surgery with axillary node dissection. The subjects were examined for arm volumes and arm lymphedema, arm pain, sensation of heaviness, shoulder function, physical activity level, and HRQoL, prior to surgery, and six months and five years after surgery. The statistical analyses used included ANOVA for repeated measures and multivariate linear regression. Results. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper limbs were present five years after surgery. ALE was the only morbidity that continued to increase over time. Several dimensions of HRQoL temporarily declined after surgery, but significantly improved in the period from six months to five years after surgery. The significant predictive factors of HRQoL five years after surgery included HRQoL prior to surgery, physical activity level at leisure time (both prior to and at six months after surgery), and duration of sick leave after surgery (in weeks). Conclusions. The overall HRQoL improved significantly from baseline to five years, despite the chronic arm pain and increase in ALE. Three independent predictive factors of HRQoL were identified. PMID: 19714526 [PubMed - as supplied by publisher ------ 2. Singapore Med J. 2009 Aug;50(8):781-4. Tensor fascia lata flap reconstruction in groin malignancy. Agarwal AK, Gupta S, Bhattacharya N, Guha G, Agarwal A. Department of General Surgery, Medical College Kolkata, 73 West Bengal, Kolkata 700072, India. \ INTRODUCTION: Block dissection of inguinal lymph nodes is done in cases of malignant inguinal lymphadenopathy, which requires the removal of skin where it is involved, or elevation of the flaps which have precarious blood supply leading to necrosis. Thus, wound closure presents a big challenge. It can be done either by primary closure which is frequently complicated by necrosis, or by split thickness skin graft which is complicated by rejection on radiotherapy. Another option is to cover the wound by a vascularised pedicled graft. This prospective study was conducted after obtaining clearance from the ethical committee. The results were compared with the accepted complication rates of the operation. METHODS: We presented our experience of coverage of wounds after block dissection of inguinal lymph nodes for malignant deposits in 15 patients (with median age of 46 years) by pedicled tensor fascia lata thigh flap. RESULTS: The results following the surgery were good. Healing was satisfactory in all 15 cases. There were two cases of marginal flap necrosis, and three cases developed lymphoedema which was managed by stockings. There were two cases of infection which were settled by antibiotics. There were three cases of loss of a small area of skin graft at the donor site. There was no reported case of recurrence in the inguinal region. CONCLUSION: This technique of coverage of the defect after inguinal block dissection is easy with predictable good results. ----- PMID: 19710976 [PubMed - in process 3. Eur J Cancer Care (Engl). 2009 Aug 25. [Epub ahead of print] Short- and long-term recovery of upper limb function after axillary lymph node dissection. Devoogdt N, VAN Kampen M, Christiaens MR, Troosters T, Piot W, Beets N, Nys S, Gosselink R. Department of Physiotherapy - University Hospitals Leuven, Leuven, Faculty of Kinesiology and Rehabilitation Sciences - Katholieke Universiteit Leuven, Leuven, and Department of Health Care Sciences - University College of Antwerp, Antwerp. All breast cancer patients, suspected with lymph node invasion, need an axillary lymph node dissection. This study investigated the short- and long-term effects of the treatment for breast cancer on shoulder mobility, development of lymphoedema, pain and activities of daily living. Patients who had a modified radical mastectomy (33%) or a breast-conserving procedure (67%) in combination with axillary lymph node dissection were included. Shoulder mobility, lymphoedema, pain and activities of daily living were evaluated at 3 months and at 3.4 years after surgery. At long term, 31% of the patients experienced impaired shoulder mobility, 18% developed lymphoedema, 79% had pain and 51% mentioned impaired daily activities. Between 3 months and 3.4 years after surgery, impaired shoulder mobility decreased from 57% to 31%. The incidence of lymphoedema increased from 4% to 18%. Patients experienced an equal amount of pain but fewer problems with daily activities. At 3.4 years, no significant differences between mastectomy and breast-conserving procedure were found. In conclusion, at long term, significant number of breast cancer survivors still had impaired shoulder mobility, developed lymphoedema, had pain and experienced difficulties during daily activities. Shoulder mobility, pain and daily activities evolved positively, while the incidence of lymphoedema increased. PMID: 19708945 [PubMed - as supplied by publisher ------ 29 August 2009 - Predicting Cancer Prognosis Researchers led by Dr. Soheil Dadras at the Stanford University Medical Center have developed a novel methodology to extract microRNAs from cancer tissues. The related report by Ma et al, "Profiling and discovery of novel miRNAs from formalin-fixed paraffin-embedded melanoma and nodal specimens," appears in the September 2009 issue of the Journal of Molecular Diagnostics. Cancer tissues from patients are often stored by a method that involves formalin fixation and paraffin embedding to retain morphological definition for identification; however, this method frequently prevents further molecular analysis of the tissue because of mRNA degradation. Even so, these tissues contain high numbers of microRNAs (miRNAs), which are short enough (~22 nucleotides) to not be broken down during the fixation process. In this study, Dr. Dadras and colleagues optimized a new protocol for extracting miRNAs from formalin- fixed paraffin-embedded tissues. Using their new procedure, they identified 17 new and 53 known miRNAs from normal skin, melanoma, and sentinel lymph nodes. These miRNAs were well-preserved in a 10-year- old specimen. This new protocol, therefore, will allow for the identification of novel miRNAs that may differ in cancerous and healthy tissue, even from long-preserved tissue, leading to better predictions of disease prognosis and treatment response. Ma et al suggest that their "cloning strategy has the advantage of not only discovering novel and known miRNA sequence identity but also providing an estimate of relative expression level. … [This methodology may provide] a more robust strategy to obtain an accurate expression profile for novel and/or previously characterized small RNAs from clinically defined [formalin-fixed paraffin-embedded] tumor specimens, thereby facilitating the discovery of 'oncomirs' as biomarkers." Ma Z, Lui W-O, Fire A, Dadras SS: Profiling and discovery of novel miRNAs from formalin-fixed paraffin- embedded melanoma and nodal specimens. J Mol Diagn 2009, 420-429 This work was supported in part by 2007 Dermatology Foundation Dermatopathology Research Grant and the department of Pathology research funds at Stanford University Medical Center. Source: Angela Colmone American Journal of Pathology ----- 1. Ann Acad Med Singapore. 2009 Aug;38(8):704-6.(pdf) Patent blue dye in lymphaticovenular anastomosis. Yap YL, Lim J, Shim TW, Naidu S, Ong WC, Lim TC. Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital, Singapore. INTRODUCTION: Lymphaticovenular anastomosis (LVA) has been described as a treatment of chronic lymphoedema. This microsurgical technique is new and technically difficult. The small caliber and thin wall lymphatic vessels are difficult to identify and easily destroyed during the dissection. MATERIALS AND METHODS: We describe a technique of performing lymphaticovenular anastomosis with patent blue dye enhancement. Our patient is a 50-year-old lady who suffers from chronic lymphoedema of the upper limb after mastectomy and axillary clearance for breast cancer 8 years ago. RESULTS: Patent blue dye is injected subdermally and is taken up readily by the draining lymphatic channels. This allows for easy identification of their course. The visualisation of the lumen of the lymphatic vessel facilitates microsurgical anastomosis. The patency of the anastomosis is also demonstrated by the dynamic pumping action of the lymphatic within the vessels. CONCLUSION: Patent blue dye staining during lymphaticovenular anastomosis is a simple, effective and safe method for mapping suitable subdermal lymphatics, allowing for speedier dissection of the lymphatic vessels intraoperatively. This technique also helps in the confirmation of the success of the lymphaticovenular anastomosis. PMID: 19736575 [PubMed - in process ---- 2. J Clin Pathol. 2009 Sep;62(9):808-11. Massive localised lymphoedema: a clinicopathological study of 22 cases and review of the literature. Manduch M, Oliveira AM, Nascimento AG, Folpe AL. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA. BACKGROUND: Massive localised lymphoedema (MLL) is a rare, relatively recently described pseudosarcoma most often occurring in morbidly obese patients. AIM: To perform a retrospective review of all cases diagnosed as MLL. METHODS AND RESULTS: Clinical information was obtained. 22 morbidly obese adults (mean patient weight 186 kg) presented with unilateral, large soft tissue lesions of longstanding duration. Most lesions involved the thigh, but also occurred in the posterior calf and lower leg. Clinically, most lesions were regarded as representing benign processes, including pedunculated lipoma, lymphocoele or recurrent cellulites, although soft tissue sarcoma was also suspected in two cases. Grossly, all masses showed markedly thickened skin with a "cobblestone" appearance, and were ill-defined, unencapsulated, lobulate, and very large (mean size 31 cm, range 15-61.5 cm, mean weight 3386 g, range 1133-10,800 g). Histologically, all 22 cases showed striking dermal fibrosis, expansion of the fibrous septa between fat lobules with increased numbers of stromal fibroblasts, lymphatic proliferation and lymphangiectasia. Multinucleated fibroblastic cells, marked vascular proliferation, moderate stromal cellularity and fascicular growth raised concern among referring pathologists for atypical lipomatous tumour/well differentiated liposarcoma, angiosarcoma, and a fibroblastic neoplasm such as fibromatosis in 10, 2 and 1 case, respectively. CONCLUSION: The diagnosis of MLL continues to be challenging, in particular for pathologists. Awareness of this entity, clinical correlation and gross pathological correlation are essential in the separation of this distinctive pseudosarcoma from its various morphological mimics. PMID: 19734477 [PubMed - in process -------------------------- 1. Plast Reconstr Surg. 2009 Sep;124(3):777-86. Experimental assessment of autologous lymph node transplantation as treatment of postsurgical lymphedema. Tobbia D, Semple J, Baker A, Dumont D, Johnston M. Brain Sciences Program, Department of Laboratory Medicine and Pathobiology, and Molecular and Cell Biology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. BACKGROUND: The authors' objective was to test whether the transplantation of an autologous lymph node into a nodal excision site in sheep would restore lymphatic transport function and reduce the magnitude of postsurgical lymphedema. METHODS: As a measure of lymph transport, iodine-125 human serum albumin was injected into prenodal vessels at 8 and 12 weeks after surgery, and plasma levels of the protein were used to calculate the transport rate of the tracer to blood (percent injected per hour). Edema was quantified from the circumferential measurement of the hind limbs. RESULTS: The transplantation of avascular lymph nodes at 8 (n = 6) and 12 weeks (n = 6) produced lymphatic function levels of 12.3 +/- 0.5 and 12.6 +/- 0.8, respectively. These values were significantly less (p < 0.001) than those measured at similar times in the animals receiving sham surgical procedures (16.6 +/- 0.7, n = 6; and 16.1 +/- 0.7, n = 6, respectively). When vascularized transplants were performed, lymphatic function was similar to the sham controls and significantly greater (p < 0.001) than that of the avascular group (8 weeks, 15.8 +/- 0.9, n = 8; 12 weeks, 15.7 +/- 1.0, n = 10). Lymph transport correlated significantly with the health of the transplanted nodes (scaled with histologic analysis) (p < 0.0001). The vascularized node transplants (n = 18) were associated with the greatest clinical improvement, with the magnitude of edema in these limbs exhibiting significantly lower levels of edema (p = 0.039) than nontreated limbs (n = 18). CONCLUSIONS: The successful reimplantation of a lymph node into a nodal excision site has the potential to restore lymphatic function and facilitate edema resolution. This result has important conceptual implications in the treatment of postsurgical lymphedema. PMID: 19730296 [PubMed - in process ------ 2. Plast Reconstr Surg. 2009 Sep;124(3):737-51. Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions. Massey MF, Spiegel AJ, Levine JL, Craigie JE, Kline RM, Khoobehi K, Erhard H, Greenspun DT, Allen RJ Jr, Allen RJ Sr; Group for the Advancement of Breast Reconstruction. The Dr. Marga Practice Group, 505 North Lake Shore Drive, Lake Point Tower Suite 214, Chicago, IL 60611, USA. me@drmarga.com Perforator flap breast reconstruction is an accepted surgical option for breast cancer patients electing to restore their body image after mastectomy. Since the introduction of the deep inferior epigastric perforator flap, microsurgical techniques have evolved to support a 99 percent success rate for a variety of flaps with donor sites that include the abdomen, buttock, thigh, and trunk. Recent experience highlights the perforator flap as a proven solution for patients who have experienced failed breast implant-based reconstructions or those requiring irradiation. Current trends suggest an application of these techniques in patients previously felt to be unacceptable surgical candidates with a focus on safety, aesthetics, and increased sensitization. Future challenges include the propagation of these reconstructive techniques into the hands of future plastic surgeons with a focus on the development of septocutaneous flaps and vascularized lymph node transfers for the treatment of lymphedema. PMID: 19730293 [PubMed - in process ----- 3. Clin Rheumatol. 2009 Sep 1. [Epub ahead of print] Lymphatic obstruction as a cause of extremity edema in systemic lupus erythematosus. Rajasekhar L, Habibi S, Sudhakar P, Gumdal N. Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India, 500082 Systemic lupus erythematosus (SLE) is a multisystem disease of autoimmune origin. Lymphedema is a very uncommon entity and has not been previously documented in SLE. We report lymphatic obstruction involving all four limbs as a cause of extremity edema in a patient with SLE. PMID: 19727913 [PubMed - as supplied by publisher 4. FASEB J. 2009 Sep 2. [Epub ahead of print] Links Lymphangiogenesis: in vitro and in vivo models. Bruyère F, Noë A. Laboratory of Tumor and Development Biology, Groupe Interdisciplinaire de Génoprotéomique Appliqué- Cancer (GIGA-Cancer), University of Liège, Liège, Belgium. Lymphangiogenesis, the formation of new lymphatic vessels from preexisting ones, is an important biological process associated with diverse pathologies, such as metastatic dissemination and graft rejection. In addition, lymphatic hypoplasia characterizes lymphedema, usually a progressive and lifelong condition for which no curative treatment exists. Much progress has been made in recent years in identifying molecules specifically expressed on lymphatic vessels and in the setting up of in vitro and in vivo models of lymphangiogenesis. These new tools rapidly provided an abundance of information on the mechanisms underlying lymphatic development and the progression of diseases associated with lymphatic dysfunction. In this review, we describe the common in vitro and in vivo models of lymphangiogenesis that have proven suitable for investigating lymphatic biology and the interactions occurring between lymphatic vessels and other cells, such as immune cells and cancer cells. Their rationales and limitations are discussed and illustrated by the most informative findings obtained with them.-Bruyère, F., Noël, A. Lymphangiogenesis: in vitro and in vivo models. PMID: 19726757 [PubMed - as supplied by publisher] ---- 5. Lymphology. 2009 Jun;42(2):88-98. Assessing lymphedema by tissue indentation force and local tissue water. Mayrovitz HN. Department of Physiology, College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, Florida 33328, USA. Tissue water and mechanical property changes accompany lymphedema, however the relationship between these changes, if any, is unclear. Local tissue water is quantifiable using the tissue's dielectric constant (TDC), but a non-gravity dependent handheld clinical assessment tool to easily quantify corresponding local tissue properties is not widely available. Herein such a tool is described along with results obtained with it and with TDC measurements made in healthy legs and in lymphedematous legs before and after one manual lymphatic drainage (MLD) treatment. Using the handheld device, tissue indentations to various depths could be completed and corresponding indentation forces (IF) recorded. Following tests in gels, foams, and 24 healthy human legs to confirm linearity and repeatability, IF and TDC were measured in 22 legs of 18 lymphedema patients prior to and after one MLD treatment. Results showed that pre-MLD both IF and TDC were significantly (p < 0.001) greater in lymphedematous legs compared to healthy legs and that both IF and TDC significantly (p < 0.001) decreased after MLD. However, no correlation was found between pretreatment IF and TDC nor between post-MLD changes. Thus, measurements of local IF and tissue water provide useful but apparently independent information as to lymphedematous status and its potential change with therapy. PMID: 19725274 [PubMed - in process] ----- 6. Lymphology. 2009 Jun;42(2):85-7. Hereditary palmoplantar keratoderma associated with primary (congenital) lymphedema. Ogunbiyi SO, Deguara J, Moss C, Burnand KG. Department of Academic Surgery, St Thomas' Hospital, London, UK. The palmoplantar keratodermas are a heterogenous group of hereditary disorders of keratinization. They are characterized by epidermal thickening and a yellow waxy appearance of the palms and soles. Genetic studies have linked various forms of palmoplantar keratoderma to markers on chromosomes one, twelve, and seventeen, and several genes have been identified. Primary lymphedema is occasionally present at birth (congenital lymphedema or Milroy's disease), but more commonly develops at puberty (lymphedema praecox). Genetic studies have linked various autosomal dominant forms of primary lymphedema (Milroy's disease and lymphedema distichiasis), to genes on chromosomes five and sixteen respectively. We report a case of palmoplantar keratoderma in a child with congenital lymphedema. To our knowledge, this has not been previously described and may represent a new phenotype for future genetic study. PMID: 19725273 [PubMed - in process] ----- 7. Lymphology. 2009 Jun;42(2):51-60. The diagnosis and treatment of peripheral lymphedema. 2009 Concensus Document of the International Society of Lymphology. International Society of Lymphology. PMID: 19725269 [PubMed - in process ------ Lymphology. 2003 Jun;36(2):84-91. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. International Society of Lymphology. This International Society of Lymphology (ISL) Consensus Document is the current revision of the 1995 Document for the evaluation and management of peripheral lymphedema. It is based upon modifications suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain, discussed at the 1999 XVII ICL in Chennai, India, considered at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany, and derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina. The document attempts to amalgamate the broad spectrum of protocols advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a "Consensus" of the international community. The document is not meant to override individual clinical considerations for problematic patients nor to stifle progress. It is also not meant to be a legal formulation from which variations define medical malpractice. The Society understands that in some clinics the method of treatment derives from national standards while in others access to medical equipment and supplies is limited and therefore the suggested treatments are impractical. We continue to struggle to keep the document concise while balancing the need for depth and details. With these considerations in mind, we believe that this version of the Consensus represents the best judgment of the ISL membership on how to approach patients with peripheral lymphedema as of 2003. We anticipate that the document will and should be challenged, debated in the pages of Lymphology (e.g., as Letters to the Editor), and ideally become a continued focal point for robust discussion at local, national and international conferences in lymphology and related disciplines. We further anticipate as experience evolves and new ideas and technologies emerge that this "living document" will undergo periodic revision and refinement. PMID: 12926833 [PubMed - indexed for MEDLINE ================================ 1. Cancer Res. 2009 Sep 1. [Epub ahead of print] KDR Activating Mutations in Human Angiosarcomas Are Sensitive to Specific Kinase Inhibitors. Antonescu CR, Yoshida A, Guo T, Chang NE, Zhang L, Agaram NP, Qin LX, Brennan MF, Singer S, Maki RG. Departments of Pathology, Epidemiology and Biostatistics, Surgery, and Medicine, Memorial Sloan- Kettering Cancer, New York, New York. Angiosarcomas (AS) represent a heterogeneous group of malignant vascular tumors occurring not only in different anatomic locations but also in distinct clinical settings, such as radiation or associated chronic lymphedema. Although representing only 1% to 2% of soft tissue sarcomas, vascular sarcomas provide unique insight into the general process of tumor angiogenesis. However, no molecular candidates have been identified to guide a specific therapeutic intervention. By expression profiling, AS show distinct up-regulation of vascular-specific receptor tyrosine kinases, including TIE1, KDR, SNRK, TEK, and FLT1. Full sequencing of these five candidate genes identified 10% of patients harboring KDR mutations. A KDR- positive genotype was associated with strong KDR protein expression and was restricted to the breast anatomic site with or without prior exposure to radiation. Transient transfection of KDR mutants into COS- 7 cells showed ligand-independent activation of the kinase, which was inhibited by specific KDR inhibitors. These data provide a basis for the activity of vascular endothelial growth factor receptor-directed therapy in the treatment of primary and radiation-induced AS. [Cancer Res 2009;69(18):7175-9]. PMID: 19723655 [PubMed - as supplied by publisher] ----- 2. Orv Hetil. 2009 Sep 12;150(37):1731-8. [Skin manifestations, treatment and rehabilitation in overweight and obesity.][Article in Hungarian] Wenczl E. Fovárosi Onkormányzat Egyesített Szent István és Szent László Kórház és Rendelointézet Borgyógyászati és Lymphológiai Rehabilitációs Osztály Budapest Nagyvárad tér 1. 1095. Overweight and obesity is a public health problem in Hungary and in the Western world. It is important to underline that obesity is an illness and an important risk factor for several skin and other diseases. An overview of skin diseases caused or aggravated by obesity (acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism, stria, adiposis dolorosa, lymphoedema, chronic venous insufficiency, plantar hyperkeratosis, lipoedema, skin infections, acne inversa, psoriasis, tophi) helps us to look and see as well. Look for the possibility of skin infections as it helps the early diagnosis and to avoid complications. Draw patients' attention to the preventive importance of skin care. In case of an obese patient the usual dosage of most local and systemic drugs should be modified. It must be kept in mind that obesity directly or indirectly starts unfavorable processes in almost all organ systems. Therefore, only a multidisciplinary care may secure treatment and rehabilitation of obese patients. Dermatological and lymphological care is often part of the rehabilitation. PMID: 19723602 [PubMed - in process ----- 1. Hum Mutat. 2009 Sep 16. [Epub ahead of print] Novel missense mutations in the FOXC2 gene alter transcriptional activity. van Steensel MA, Damstra RJ, Heitink M, Bladergroen RS, Veraart J, Steijlen PM, van Geel M. Departments of dermatology, Maastricht University Medical Center, Maastricht, the Netherlands. Mutations in the FOXC2 gene that codes for a forkhead transcription factor are associated with primary lymphedema that usually develops around puberty. Associated abnormalities include distichiasis and, very frequently, superficial and deep venous insufficiency. Most mutations reported so far either truncate the protein or are missense mutations in the forkhead domain causing a loss of function. The haplo-insufficient state is associated with lymphatic hyperplasia in mice as well as in humans. We analyzed the FOXC2 gene in 288 patients with primary lymphedema and found 11 pathogenic mutations, of which 9 are novel. Of those, 5 were novel missense mutations of which 4 were located outside of the forkhead domain. To examine their pathogenic potential we performed a transactivation assay using a luciferase reporter construct driven by FOXC1 response elements. We found that the mutations outside the forkhead domain cause a gain of function as measured by luciferase activity. Patient characteristics conform to previous reports with the exception of distichiasis, which was found in only 2 patients out of 11. FOXC2 mutations causing lymphedema-distichiasis syndrome reported thus far result in haplo-insufficiency and lead to lymphatic hyperplasia. Our results suggest that gain-of-function mutations may also cause lymphedema. One would expect that in this case, lymphatic hypoplasia would be the underlying abnormality. Patients with activating mutations might present with Meige disease. (c) 2009 Wiley-Liss, Inc. PMID: 19760751 [PubMed - as supplied by publisher] ===== 2. Breast Cancer Res Treat. 2009 Sep 17. [Epub ahead of print] The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review. Chao LF, Zhang AL, Liu HE, Cheng MH, Lam HB, Lo SK. School of Nursing, Chang Gung University, Gueishan, Taoyuan, Taiwan, ROC. The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale. Using pre- determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008. They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points. Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made. Very few minor adverse events were observed, and only in five trials. APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms. PMID: 19760035 [PubMed - as supplied by publisher] ---------------------- 1: Breast Cancer Res Treat. 2009 Sep 22. [Epub ahead of print] Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. Speck RM, Gross CR, Hormes JM, Ahmed RL, Lytle LA, Hwang WT, Schmitz KH. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, Blockley Hall, Philadelphia, PA, 19104-6021, USA. The aim of this study was to evaluate the impact of a twice-weekly strength training intervention on perceptions of body image in 234 breast cancer survivors (112 with lymphedema) who participated in the Physical Activity and Lymphedema (PAL) trial. The study population included two hundred and thirty-four women randomly assigned to twice-weekly strength training or control group that completed the 32-item Body Image and Relationships Scale (BIRS) at baseline and 12 months. Percent change in baseline to 12- month BIRS total and subscale scores, upper and lower body strength, and general quality of life (QOL) were compared by intervention status. A series of multiple linear regression models including indicator variables for subgroups based on age, marital status, race, education, BMI, and strength change were used to examine differential intervention impact by subgroup. Strength and QOL variables were assessed as mediators of the intervention effect on BIRS. Results: Baseline BIRS scores were similar across intervention and lymphedema status. Significantly greater improvement in BIRS total score was observed from baseline to 12 months in treatment vs.. control participants (12.0 vs. 2.0%; P < 0.0001). A differential impact of the intervention on the Strength and Health subscale was observed for older women (>50 years old) in the treatment group (P = 0.03). Significantly greater improvement was observed in bench and leg press among treatment group when compared to control group participants, regardless of lymphedema. Observed intervention effects were independent of observed strength and QOL changes. Twice-weekly strength training positively impacted self-perceptions of appearance, health, physical strength, sexuality, relationships, and social functioning. Evidence suggests the intervention was beneficial regardless of prior diagnosis of lymphedema. Strength and QOL improvements did not mediate the observed intervention effects. PMID: 19771507 [PubMed - as supplied by publisher ----- 1. Birth Defects Res C Embryo Today. 2009 Sep 11;87(3):222-231. [Epub ahead of print] Lymphatic development. Butler MG, Isogai S, Weinstein BM. Laboratory of Molecular Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892. The lymphatic system is essential for fluid homeostasis, immune responses, and fat absorption, and is involved in many pathological processes, including tumor metastasis and lymphedema. Despite its importance, progress in understanding the origins and early development of this system has been hampered by lack of defining molecular markers and difficulties in observing lymphatic cells in vivo and performing genetic and experimental manipulation of the lymphatic system. Recent identification of new molecular markers, new genes with important functional roles in lymphatic development, and new experimental models for studying lymphangiogenesis has begun to yield important insights into the emergence and assembly of this important tissue. This review focuses on the mechanisms regulating development of the lymphatic vasculature during embryogenesis. Birth Defects Research (Part C) 87:222-231, 2009. (c) 2009 Wiley-Liss, Inc. PMID: 19750516 [PubMed - as supplied by publisher] ======= 2. Indian J Cancer. 2009 Oct-Dec;46(4):337-9. Links Mechanical lymphatic drainage in the treatment of arm lymphedema. Bordin NA, Guerreiro Godoy Mde F, Pereira de Godoy JM. Department of the Medicine School in Sao Jose do Rio Preto-FAMERP, Brazil. Exercising is one of the three cornerstones in the treatment of lymphedema together with contention mechanisms and lymphatic drainage. The aim of the current study was to evaluate a new method of mechanic lymphatic drainage. Volumetric reductions were evaluated after passive exercises in 25 patients with arm lymphedema resulting from breast cancer treatment. Their ages ranged between 42 and 86 years old. All patients were submitted to one-hour sessions using the RAGodoy(R) electromechanical apparatus which performs from 15 to 25 elbow bending and stretching exercises per minute. Volumetry, using the water displacement technique, was performed before and after the sessions. The paired t-test was employed for statistical analysis with an alpha error of less than 5% being considered acceptable. The reduction in volume was significant (P-value < 0.001) with a mean initial volume of 2026.4 and final volume of 1967.2 giving a mean loss of 59.2 mL. The RAGodoy(R) apparatus was efficient to reduce the volume of lymphedematous arms and is an option for the treatment of lymphedema. PMID: 19749466 [PubMed - in process] ------ 1. Strahlenther Onkol. 2009 Oct;185(10):675-81. Epub 2009 Oct 6. Radiochemotherapy including cisplatin alone versus cisplatin + 5-fluorouracil for locally advanced unresectable stage IV squamous cell carcinoma of the head and neck. Tribius S, Kronemann S, Kilic Y, Schroeder U, Hakim S, Schild SE, Rades D. Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. BACKGROUND AND PURPOSE: The optimal radiochemotherapy regimen for advanced head-and-neck cancer is still debated. This nonrandomized study compares two cisplatin-based radiochemotherapy regimens in 128 patients with locally advanced unresectable stage IV squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Concurrent chemotherapy consisted of either two courses cisplatin (20 mg/m(2)/d1-5 + 29-33; n = 54) or two courses cisplatin (20 mg/m(2)/d1-5 + 29-33) + 5-fluorouracil (5- FU; 600 mg/m(2)/d1-5 + 29-33; n = 74). RESULTS: At least one grade 3 toxicity occurred in 25 of 54 patients (46%) receiving cisplatin alone and in 52 of 74 patients (70%) receiving cisplatin + 5-FU. The latter regimen was particularly associated with increased rates of mucositis (p = 0.027) and acute skin toxicity (p = 0.001). Seven of 54 (13%) and 20 of 74 patients (27%) received only one chemotherapy course due to treatment-related acute toxicity. Late toxicity in terms of xerostomia, neck fibrosis, skin toxicity, and lymphedema was not significantly different. The 2-year locoregional control rates were 67% after cisplatin alone and 52% after cisplatin + 5-FU (p = 0.35). The metastases-free survival rates were 79% and 69%, respectively (p = 0.65), and the overall survival rates 70% and 51%, respectively (p = 0.10). On multivariate analysis, outcome was significantly associated with performance status, T-category, N-category, hemoglobin level prior to radiotherapy, and radiotherapy break > 1 week. CONCLUSION: Two courses of fractionated cisplatin (20 mg/m(2)/day) alone appear preferable, as this regimen resulted in similar outcome and late toxicity as two courses of cisplatin + 5-FU, but in significantly less acute toxicity. PMID: 19806333 [PubMed - in process ----------------------- 2. Ann Dermatol Venereol. 2009 Oct;136(10):756-8. Epub 2009 Jun 4. [Puffy hand syndrome due to drug addiction. Chronic Lymphoedema and long-term intravenous drug addiction.][Article in French] Messikh R, Pelletier F, Bizouard N, Aubin F, Humbert P. Service de dermatologie, CHU Saint-Jacques, 2, place Saint-Jacques, 25030 Besançon cedex, France; Inserm U645, université de Franche-Comté, France. PMID: 19801268 [PubMed - in process ------------------------------- 3. Am J Surg. 2009 Oct;198(4):482-7. Scientific Impact Award: Axillary reverse mapping (ARM) to identify and protect lymphatics draining the arm during axillary lymphadenectomy. Boneti C, Korourian S, Diaz Z, Santiago C, Mumford S, Adkins L, Klimberg VS.. Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA. INTRODUCTION: The axillary reverse mapping (ARM) procedure distinguishes lymphatics draining the arm from those draining the breast. The aim of this study was to assess the ability of ARM to identify and preserve lymphatics draining the arm and the impact on lymphedema. METHODS: This study included 220 patients undergoing sentinel lymph node (SLN) biopsy (SLNB) with or without axillary lymph node dissection (ALND) from May 2006 to September 2008. After SLN localization with a radioactive tracer, blue dye was used to map ARM lymphatics. Data were collected on identification and variations in lymphatic drainage, crossover rate, the incidence of metastases, and nodal status. RESULTS: Crossover (ARM = SLN) occurred in 6 patients (2.8%). ARM lymphatics were near or in the SLN field in 40.6% of patients, placing it at risk for disruption during lymphadenectomy. ARM lymphatics juxtaposed to the hot SLNB (n = 12 [5.6%]) were preserved. Fifteen ARM nodes were excised and were negative even in positive axillae. There were no cases of lymphedema at 6-month follow-up where ARM nodes were preserved. CONCLUSION: Confluence of the arm and breast drainage is rarely the SLN, and none of these nodes contained metastases. Preserving the ARM nodes may translate into a lower incidence of postoperative lymphedema. PMID: 19800452 [PubMed - in process ------------------------ 4. Eur J Surg Oncol. 2009 Oct 1. [Epub ahead of print] Laparoscopic assisted radical vaginal hysterectomy for cervical carcinoma: Morbidity and long-term follow- up. Mehra G, Weekes A, Vantrappen P, Visvanathan D, Jeyarajah A. Gynaecological Oncology Cancer Centre, St. Bartholomew's Hospital, London, UK. OBJECTIVES: To study the feasibility, morbidity and outcome of cervical cancer patients treated with laparoscopic assisted radical vaginal hysterectomy (LARVH). METHODS: The study group included 53 women with cervical cancer (stage-Ib). They included women undergoing LARVH at the joint cancer-centres between 1994 and 2002. Data was collected on operating- time, nodal-yield, hospital-stay, complications recurrence rate and survival rate. The group was followed up until 2006. RESULTS: Of 53 women who were selected for LARVH, in 2 women LARVH was abandoned when nodes were positive at frozen section. The median age was 42 years while the operating-time was 210min with a nodal-yield of 23 and a hospital-stay of 5 days. Final histology revealed 10 women with lympho- vascular invasion, 1 nodal metastases and invasion of parametrium/vagina in 2 women. 7 received adjuvant radiotherapy. 3 had chemo-radiation. Complications included voiding difficulty (6), urinary tract infection (5), pyrexia (4), haemorrhage (2), pain (1), port-site haematoma (1) and nerve injury (1). Late complications included lymphoedema (4), urinary incontinence (4), voiding-problems (2), lymphocyst (1), venous-thrombosis (1) and rectocele (1). The median follow-up was 41 months. 4 women had recurrence, of which 3 women died. The five-year survival was 89%. CONCLUSIONS: Vaginal radical hysterectomy with laparoscopic pelvic lymphadenectomy is feasible and safe with regards to mortality and has low morbidity. PMID: 19800194 [PubMed - as supplied by publisher ------ 1: Trans R Soc Trop Med Hyg. 2009 Sep 29. [Epub ahead of print] Quality of life in filarial lymphoedema patients in Colombo, Sri Lanka. Wijesinghe RS, Wickremasinghe AR. Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayawardenepura, Nugegoda, Sri Lanka. The quality of life (QOL) was assessed in 141 filarial lymphoedema patients and 128 healthy people in the Colombo district of Sri Lanka. Information was gathered by administering the validated translated version of the WHO 100-item QOL questionnaire (WHOQOL-100), which ascertains an individual's perception of QOL in the physical, psychological, level of independence, environmental and spiritual domains, as well as the general QOL. Healthy controls had a better QOL in all domains as well as in the overall general QOL, when compared to patients with lymphoedema. Several facets such as pain and discomfort, sleep and rest, activities of daily living, dependence on medication and treatment, working capacity and social support were significantly affected by the acute adenolymphangitis attack/s patients had suffered. The environmental and spiritual domains were significantly affected by the maximum grade of lymphoedema. The significant difference in the QOL as perceived by patients suffering from filarial lymphoedema and apparently healthy individuals reiterates the importance of morbidity control in patients already affected by filarial lymphoedema. PMID: 19796782 [PubMed - as supplied by publisher ------ 1. Photomed Laser Surg. 2009 Oct 7. [Epub ahead of print] The Effect of Laser Irradiation on Proliferation of Human Breast Carcinoma, Melanoma, and Immortalized Mammary Epithelial Cells. Powell K, Low P, McDonnell PA, Laakso EL, Ralph SJ. 1 School of Medical Science, Griffith University , Gold Coast, Queensland, Australia . Abstract Objective: This study compared the effects of different doses (J/cm(2)) of laser phototherapy at wavelengths of either 780, 830, or 904 nm on human breast carcinoma, melanoma, and immortalized human mammary epithelial cell lines in vitro. In addition, we examined whether laser irradiation would malignantly transform the murine fibroblast NIH3T3 cell line. Background: Laser phototherapy is used in the clinical treatment of breast cancer-related lymphoedema, despite limited safety information. This study contributes to systematically developing guidelines for the safe use of laser in breast cancer-related lymphoedema. Methods: Human breast adenocarcinoma (MCF-7), human breast ductal carcinoma with melanomic genotypic traits (MDA-MB-435S), and immortalized human mammary epithelial (SVCT and Bre80hTERT) cell lines were irradiated with a single exposure of laser. MCF-7 cells were further irradiated with two and three exposures of each laser wavelength. Cell proliferation was assessed 24 h after irradiation. Results: Although certain doses of laser increased MCF-7 cell proliferation, multiple exposures had either no effect or showed negative dose response relationships. No sign of malignant transformation of cells by laser phototherapy was detected under the conditions applied here. Conclusion: Before a definitive conclusion can be made regarding the safety of laser for breast cancer-related lymphoedema, further in vivo research is required. PMID: 19811082 [PubMed - as supplied by publisher] ------------ Breast Cancer. 2009 Sep 30. [Epub ahead of print] A multicentre cross-sectional study of arm lymphedema four or more years after breast cancer treatment in Iranian patients. Haddad P, Farzin M, Amouzegar-Hashemi F, Kalaghchi B, Babazadeh S, Mirzaei HR, Mousavizadeh A, Harirchi I, Rafat J. Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, P.O. Box 13145-158, Tehran, Iran, haddad@sina.tums.ac.ir. BACKGROUND: We performed a cross-sectional multicentre study to assess the prevalence of lymphedema after breast cancer treatment in Iran. PATIENTS AND METHODS: All female breast cancer patients who attended our follow-up clinics four or more years after their surgery with no sign of disease were asked to participate in this study. Lymphedema was defined as an increase of 10% in the circumference of the arm on the involved side compared to the opposite arm. RESULTS: The total number of patients participating in this study was 355. The prevalence of lymphedema in the study patients was 17.5%, with the rate varying significantly (between 4 and 21%) among the three study centres (p = 0.007). The mean number of months post surgery was larger for patients with lymphedema (84 months) than for those without (79 months), though this was not statistically significant (p > 0.1). The relationships of various treatment factors and the education levels of the patients to the presence of lymphedema were also evaluated. None of the observed differences were statistically significant aside from those for the type of surgery (mastectomy vs. conservative surgery, p = 0.055), treatment with radiotherapy (p = 0.099), and prescription of a supraclavicular radiation field (p = 0.057), which were only just significant. CONCLUSION: The rate of lymphedema in our patients was 17.5%, ranging from 4 to 21% in different study centres. Time post surgery, treatment with radiotherapy and the technique used, and nodal radiation seem to be factors that are related to this large variation. PMID: 19789952 [PubMed - as supplied by publisher] ------------------------ 2. Breast Cancer. 2009 Sep 30. [Epub ahead of print] Axillary reverse mapping for preventing lymphedema in axillary lymph node dissection and/or sentinel lymph node biopsy. Noguchi M. Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada, Ishikawa, 920-0293, Japan, nogumasa@kanazawa-med.ac.jp. PMID: 19789947 [PubMed - as supplied by publisher] -------------------------- 3. Lymphat Res Biol. 2009;7(3):153-8. Local Tissue Water in At-Risk and Contralateral Forearms of Women with and without Breast Cancer Treatment-Related Lymphedema. Mayrovitz HN, Weingrad DN, Davey S. 1 College of Medical Sciences, Health Professions Division, Nova Southeastern University , Davie, Florida . Abstract Background: Quantitative measurements to help detect incipient or latent lymphedema in patients at risk for breast cancer treatment-related lymphedema (BCRL) are potentially useful supplements to clinical assessments. Suitable measurements for routine use include arm volumes, arm bioimpedance, and local tissue water (LTW) determined from the tissue dielectric constant (TDC). Because BCRL initially develops in skin and subcutis, measures that include whole arms may not be optimally sensitive for detecting the earliest changes. Thus, there is also a need for a local measurement in which tissues most likely to demonstrate early lymphedematous changes can be more selectively assessed. The TDC method satisfies this criterion. Our goal was to use this method to compare arm-to-arm differences in LTW within and among women grouped as healthy normal (HN), diagnosed with breast cancer (BC), but prior to surgery and established unilateral lymphedema (LE). Methods and Results: LTW was determined on both anterior forearms to a measurement depth of 2.5 mm in 30 women of each group. TDC arm ratios were determined as dominant/nondominant for HN and BC, at-risk/contralateral for BC, and lymphedematous/contralateral for LE. Results showed that TDC values for all arms except lymphedematous arms were very similar and insignificantly different with values among arms (mean +/- SD) ranging from 24.9 +/- 3.8 to 25.7 +/- 3.8. Arm ratios did not differ between HC and BC whereas dominant/non-dominant arm ratios for HN and BC separately and combined (1.006 +/- 0.085) were significantly less than the lymphedematous/contralateral ratio of the LE group (1.583 +/- 0.292). Conclusions: The findings indicate that LTW of at-risk arms is not affected by breast cancer and that lymphedema does not significantly affect LTW of contralateral arms as measured with the TDC method. Further, based on the standard deviation of measured arm ratios, an at- risk/contralateral TDC ratio of 1.26 is suggested as a possible threshold for detecting preclinical or latent lymphedema. PMID: 19778203 [PubMed - in process --------------------- 4. Lymphat Res Biol. 2009;7(3):145-51. Histological findings compared with magnetic resonance and ultrasonographic imaging in irreversible postmastectomy lymphedema: a case study. Tassenoy A, De Mey J, Stadnik T, De Ridder F, Peeters E, Van Schuerbeek P, Wylock P, Van Eeckhout GP, Verdonck K, Lamote J, Baeyens L, Lievens P. 1 Department of Rehabilitation Research, Free University Brussels , Brussels, Belgium . Abstract Postmastectomy edema is a current complication after axillary lymph node dissection in cases of breast cancer treatment. Staging is important in order to select those patients who can benefit from complex physical therapy (CPT). Different imaging techniques can be used to evaluate the edema. Ultrasonography (US) is a harmless, cheap, and easily applicable technique to visualize the dermal and subcutaneous tissue, but interpretation of the obtained images is not always evident. The aim of this study was to compare ultrasound images of irreversible edema with tissue histology, magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Ultrasonographic images of the edematous dermis show an homogeneous hypoechogenic dermal layer that appears on tissue histology to be less compact, due to the excess of fluid in the interstitium separating the collagen fibres and making it more transparent on light microscopy. MRI of the dermis gives a hyperintense signal, indicating the presence of fluid. In the subcutis, increase of the adipose tissue could be observed on US, MRI, and tissue histology. In the case of lymphedema, the area and perimeter of fat cells is significantly (p < 0.05) increased. Hypoechogenic areas near the muscle fascia are registrated on US corresponding with epifascial fluid on MRI, and hyperechogenic branches are embedded within the adipose tissue, on tissue histology seen as large fibrotic septa enclosing adipose cells. MRI has a honeycomb picture corresponding with fluid bound to fibrosis. PMID: 19778202 [PubMed - in process --------------------- 5. Rev Med Liege. 2009 Jul-Aug;64(7-8):409-13. [Angiosarcoma consecutive to chronic lymphoedema: a Stewart-Treves syndrome] [Article in French] Gonne E, Collignon J, Kurth W, Thiry A, Henry F, Jerusalem G, Gennigens C. Université de Liège, Belgique. The Stewart-Treves Syndrome is defined as an angiosarcoma (very aggressive malignant tumor originating from endothelial cells) appearing in a specific clinical setting. This tumor develops in patients suffering from chronic lymphedema of the upper limb following mastectomy and axillary lymph node dissection for breast cancer. The diagnosis relies on medical history, clinical examination and a histological assesment (biopsy or resection). This syndrome represents a rare clinical entity. Unfortunately, the prognosis is poor. A large surgical resection is the treatment of choice if the patient is a candidate for a surgical resection with a curative intent Radiotherapy is sometimes used as a palliative local treatment. Chemotherapy is only used in more advanced cases, not curable by surgery alone. PMID: 19777923 [PubMed - in process ---- 1. Acta Oncol. 2009 Oct 20. [Epub ahead of print] Arm/shoulder problems in breast cancer survivors are associated with reduced health and poorer physical quality of life. Nesvold IL, Fosså SD, Holm I, Naume B, Dahl AA. Department of Clinical Cancer Research, Oslo University Hospital, Rikshospitalet, 0310 Oslo, Norway. Abstract Background. Except for lymphedema, the consequences of arm/shoulder problems (ASPs), at long-term in breast cancer survivors (BCSs) have hardly been studied. We examined demography, lifestyle, quality of life (QoL) and somatic morbidity in BCSs with and without ASPs. We also compared the associations of restricted shoulder abduction and lymphedema with QoL. Methods. We used a cross-sectional case-control design. A sample of 256 BCSs all with lymph node metastases were examined at a mean of 4.1 (SD 0.9) years post-surgery. Based on objective examinations and self-rating the sample were separated into 81 BCSs (32%) with definite ASP (ASP+ group) and 175 (68%) with minimal or no ASP (ASP- group). The self-rating contained among other schedules the Short Form-36 (SF-36) and the Kwan's arm/shoulder problem scale (KAPS). Results. In univariate analysis ASP+ was associated with not being employed, having had mastectomy, longer follow-up time, radiotherapy to axilla, poorer self-rated health and physical condition, minimal physical activity, increased body mass index, regularly intake of analgesics, and poorer physical QoL. Multivariate analysis showed that mastectomy, longer follow-up time, minimal physical activity and poorer physical QoL were associated with belonging to ASP- group. All domains of the SF-36 were significantly associated with having impaired shoulder abduction (>/=25 degrees difference) while none of the associations with lymphedema were significant. Discussion. In BCSs, at four years after treatment, having ASP was associated with mastectomy, minimal physical activity and poorer physical QoL. Poor physical QoL is strongly associated with reduced shoulder abduction rather than with lymphedema. PMID: 19842790 [PubMed - as supplied by publisher] ----------------------- 2. Breast Cancer Res Treat. 2009 Oct 20. [Epub ahead of print] Axillary reverse mapping for breast cancer. Noguchi M. Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku 1- 1, Ishikawa, 920-0293, Japan, nogumasa@kanazawa-med.ac.jp. The axillary reverse mapping (ARM) technique has been developed to map and preserve arm lymphatic drainage during axillary lymph node dissection (ALND) and/or sentinel lymph node (SLN) biopsy, thereby minimizing arm lymphedema. However, several problems remain to be resolved in the practical application of this technique. This article presents a review of current knowledge regarding ARM and discusses the practical applicability and relevance of this technique. Identification rates of ARM nodes were insufficient using blue dye. Although this was improved using radioisotopes, radioisotopes alone do not permit visual mapping of ARM lymphatics. Fluorescence imaging may be useful to improve the identification rate of ARM nodes and lymphatics. On the other hand, the ARM nodes may be involved with metastatic foci in patients with extensive axillary lymph node metastases. Moreover, the SLN draining the breast may be the same as the ARM node draining the upper extremity in a minority of patients. These issues represent important drawbacks of the ARM procedure. The success of ARM in reducing lymphedema has not yet been determined. Further studies are needed before this can be accepted as a standard procedure in surgical management of breast cancer. PMID: 19842033 [PubMed - as supplied by publisher --------- 1. Int J Neurosci. 2009;119(8):1105-1117. Effects of Manual Lymph Drainage on Cardiac Autonomic Tone in Healthy Subjects. Kim SJ, Kwon OY, Yi CH. Department of Physical Therapy, Kangwon National University, Kangwon-do, 245-711, Republic of Korea. This study was designed to investigate the effects of manual lymph drainage on the cardiac autonomic tone. Thirty-two healthy male subjects were randomly assigned to manual lymph drainage (MLD) (experimental) and rest (control) groups. Electrocardiogram (ECG) parameters were recorded with bipolar electrocardiography using standard limb lead positions. The pressure-pain threshold (PPT) was quantitatively measured using an algometer. Heart rate variability differed significantly between the experimental and control groups (p < 0.05), but the PPT in the upper trapezius muscle did not (p > 0.05). These findings indicate that the application of MLD was effective in reducing the activity of the sympathetic nervous system. PMID: 19922342 [PubMed - as supplied by publisher ------ 1. 2009 Nov 18 - Subjective Assessment of Pregnancy Impact on Primary Lower Limb Lymphedema. Vignes S, Arrault M, Porcher R. Objective: To analyze subjective influence of pregnancy on lower limb lymphedema. Method: Cross-sectional study on 49 affected women was conducted in a single lymphology department between January 2002 and December 2006. All women were asked whether their lymphedema had worsened during pregnancy.Results: Mean age at lymphedema onset was 17 years, with no familial history of lymphedema. Lymphedema was unilateral for 30 women and bilateral for 19. Median age at the first delivery was 28 years. Eighteen women had only 1 pregnancy, 23 women had only 2, and 8 women had 3. For the first pregnancy, birth weight was 3.4 kg. Subjective lymphedema worsening was reported by 5 women after the first pregnancy compared to 44 women without worsening (P = ..006) and after 10 (11%) of the 88 pregnancies (1 twin birth) involving 9 women. During the median 18 years since the first pregnancy, only a 14-year-old boy has developed bilateral lymphedema. Conclusion: Pregnancy did not significantly exacerbate primary lower limb lymphedema. PMID: 19926624 [PubMed - as supplied by publisher ----- 2. 2009 Nov;9 - Topics of physiological and pathophysiological functions of lymphatics. Kawai Y, Ohhashi T. Department of Physiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. We have reviewed physiological significance of rhythmical spontaneous contractions of collecting lymphatics, which play an important role in lymph transport and seem to regulate lymph formation through changing the pacemaker sites of the rhythmic contractions and conractile patterns of lymphangions. Next, we reported experimental findings that the wall effective permeability of hydrophilic substances labelled with fluorescent dyes was evaluated in an isolated cannulated rat single lymphatic using a microscope system. With the experimental evidence, we have discussed physiological significance and crucial roles of the enrichment of albumin in lymph through the wall of small lymphatics in regulation of innate immunity. In addition, we have described the mode of action of recanalization of collecting lymphatics after excision of lymph node with special reference to clinical treatment for surgical removal of lymph nodes-mediated secondary lymphedema. Finally, we have addressed the possibility that primary tumor cells and/or metastatic carcinoma cells themselves release key chemical substances to develop environment suitable for micro-metastasis in sentinel lymph node. PMID: 19925407 [PubMed - in process ----- 3. 2009 Nov 18 - Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: A prospective cohort study. Yang EJ, Park WB, Seo KS, Kim SW, Heo CY, Lim JY. Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea. BACKGROUND AND OBJECTIVES: To investigate the prevalence of upper limb dysfunction (ULD) and subtypes after breast cancer surgery and to identify factors associated with late ULD. METHODS: Among 191 enrolled patients, 191 were evaluated at 3 months, 187 at 6 months, and 183 at 12 months after surgery. Pain, shoulder range of motion, muscle strength, and arm circumference were assessed. Based on symptoms and physical examinations, the types of ULD common after breast cancer treatment were diagnosed and categorized. RESULTS: The prevalence of ULD after surgery were 24.6%, 20.9%, and 26..8% at 3, 6, and 12 months, respectively. The most common types of ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Patients with pectoralis tightness or lymphedema at 3 or 6 months showed a higher prevalence of rotator cuff disease at 12 months compared with those without early pectoralis tightness or lymphedema. CONCLUSIONS: The major post-operative ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Late ULD such as rotator cuff disease were associated with pectoral tightness or lymphedema at earlier stages. Diagnosis and treatment of ULD should take place as soon as possible after surgery. J. Surg. Oncol. (c) 2009 Wiley-Liss, Inc. PMID: 19924721 [PubMed - as supplied by publisher ----- 4. 2009 Oct 12 - Selenium in oncology: from chemistry to clinics. Micke O, Schomburg L, Buentzel J, Kisters K, Muecke R. Department of Radiotherapy and Radiation Oncology, Franziskus Hospital, Kiskerstrasse 26, D- 33615 Bielefeld, Germany. The essential trace element selenium, which is a crucial cofactor in the most important endogenous antioxidative systems of the human body, is attracting more and more the attention of both laypersons and expert groups. The interest of oncologists mainly focuses in the following clinical aspects: radioprotection of normal tissues, radiosensitizing in malignant tumors, antiedematous effect, prognostic impact of selenium, and effects in primary and secondary cancer prevention. Selenium is a constituent of the small group of selenocysteine-containing selenoproteins and elicits important structural and enzymatic functions. Selenium deficiency has been linked to increased infection risk and adverse mood states. It has been shown to possess cancer-preventive and cytoprotective activities in both animal models and humans. It is well established that Se has a key role in redox regulation and antioxidant function, and hence in membrane integrity, energy metabolism and protection against DNA damage. Recent clinical trials have shown the importance of selenium in clinical oncology. Our own clinical study involving 48 patients suggest that selenium has a positive effect on radiation-associated secondary lymphedema in patients with limb edemas, as well as in the head and neck region, including endolaryngeal edema. Another randomized phase III study of our group was performed to examine the cytoprotective properties of selenium in radiation oncology. The aim was to evaluate whether sodium selenite is able to compensate a preexisting selenium deficiency and to prevent radiation induced diarrhea in adjuvant radiotherapy for pelvic gynecologic malignancies. Through this study, the significant benefits of sodium selenite supplementation with regards to selenium deficiency and radiotherapy induced diarrhea in patients with cervical and uterine cancer has been shown for the first time in a prospective randomized trial. Survival data imply that supplementation with selenium does not interfere with the positive biological effects of radiation treatment and might constitute a valuable adjuvant therapy option especially in marginally supplied individuals. More recently there were emerging concerns coming up from two large clinical prevention trials (NPC, SELECT), that selenium increases the possible risk of developing diabetes type II. Despite obvious flaws of both studies and good counterarguments, a controversial debate remains on the possible advantage and risks of selenium in cancer prevention. However, in the light of the recent clinical trials the potential benefits of selenium supplementation in tumor patients are undeniable, even if further research is needed. PMID: 19924043 [PubMed - in process] ----- 1. Eur J Dermatol. 2009 Nov 17. [Epub ahead of print] Mushroom-like soft fibromas on chronic leg lymphedema. Nakamura S, Hashimoto Y, Nishi K, Takeda K, Takahashi H, Mizumoto T, Iizuka H. PMID: 19919910 [PubMed - as supplied by publisher ------ 2. Cases J. 2009 Sep 1;2:6887. Lymphangiosarcoma of the arm presenting with lymphedema in a woman 16 years after mastectomy: a case report. Sepah YJ, Umer M, Qureshi A, Khan S. Department of Surgery (Orthopedics), Aga Khan University Medical College P.O. Box 3500, Karachi- 74800 Pakistan. Lymphangiosarcoma following breast cancer is a relatively rare entity, with around 300 cases so far reported worldwide. Affecting the long term survivors of breast cancer, lymphangiosarcoma (Stewart- Traves Syndrome) has a high mortality rate. Since lympedema following radical mastectomy or axillary clearance and radiotherapy seems to be the main predisposing factor, further research regarding modifications in the surgical technique of axillary nodes dissection as well as the development of new chemotherapeutic agents effective in lymphangiosarcoma are required. PMID: 19918554 [PubMed - in process ----- 3. Cancer Invest. 2009 Nov 16. [Epub ahead of print] Assessment of Breast Cancer-Related Arm Lymphedema-Comparison of Physical Measurement Methods and Self-Report. Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, Kilbreath SL. Faculty of Health Sciences, University of Sydney, Sydney, Australia1. ABSTRACT Purpose: To determine the relationship between physical methods of measuring lymphedema and self- reported swelling, their reliability, and standard error of measurement. Method: Lymphedema in each arm of women with (n = 33) and without (n = 18) unilateral arm lymphedema, secondary to breast cancer was measured by self-report, bioimpedance spectroscopy (BIS), perometer, and the truncated cone method. Results: The physical measurement tools were highly reliable (ICC((2,1)): 0.94 to 1.00) with high concordance (r(c): 0.89 to 0.99). Selfreport correlatedmoderately with physical measurements (r = 0.65 to 0.71) and was moderately reliable (ICC((2,1)): 0.70). Conclusions: Lymphedema assessment methods are concordant and reliable but not interchangeable. PMID: 19916749 [PubMed - as supplied by publisher ----- 4. Urol Oncol. 2009 Nov 12. [Epub ahead of print] Diffuse lymphangiomatosis with genital involvement-evaluation with magnetic resonance lymphangiography. Lohrmann C, Foeldi E, Langer M. Department of Radiology, University Hospital of Freiburg, Freiburg, Germany. OBJECTIVE: To assess, for the first time, the morphology of the lymphatic system in patients with diffuse lymphangiomatosis and genital involvement by magnetic resonance lymphangiography (MRL). MATERIALS AND METHODS: Ten patients with diffuse lymphangiomatosis and genital involvement were examined by MRL. Three locations were examined: first, the lower leg and foot region; second, the upper leg and the knee region; and third, the pelvic with retroperitoneal region. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For MRL, a T1-weighted 3D-spoiled gradient- echo and a T2-weighted 3D-TSE sequence were used. RESULTS: The size of the genital lymphangiomas, which were revealed in all patients, varied between 6 and 85 mm. In 60% of the patients, lymphangiomas were additionally detected at the level of the lower legs, and in 70% patients at the level of the upper leg. Furthermore, lymphangiomas were seen in the inguinal and retroperitoneal regions in 80%, and in the pelvic region and anterior abdominal wall in 90% of the patients examined. The genital lymphangiomas feeding lymphatic vessels were detected in 80% of the patients in the anterior abdominal wall and in 90% of the patients in the inguinal and pelvic regions; 90% of the patients suffered consecutively from a lymphedema of the lower extremities. All patients suffered from recurrent infections in the genital region; 80% of the patients repeatedly experienced genital lymphorrhea due to lympho-cutaneous fistulas and lymphcysts. CONCLUSION: MRL is a safe and accurate minimal-invasive imaging modality for the evaluation of the lymphatic circulation in patients with diffuse lymphangiomatosis and genital involvement. Because the site and extent of the lymphangiomas with their feeding lymphatic vessels are important prognostic factors, performing radiologic evaluation with a high resolution is crucial for the therapeutic planning of patients. PMID: 19914101 [PubMed - as supplied by publisher ----- 5. Eur J Radiol. 2009 Nov 11. [Epub ahead of print] Assessment of the lymphatic system in patients with diffuse lymphangiomatosis by magnetic resonance imaging. Lohrmann C, Foeldi E, Langer M. Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg i. Br., Germany. OBJECTIVE: To assess the lymphatic system in patients with diffuse lymphangiomatosis by magnetic resonance imaging. MATERIALS AND METHODS: 15 patients with diffuse lymphangiomatosis were examined by magnetic resonance imaging. Three locations were examined: first, the lower leg and foot region; second, the upper leg and the knee region; and third, the pelvic with retroperitoneal and abdominal region. For magnetic resonance lymphangiography a T1-weighted 3D spoiled gradient-echo and a T2-weighted 3D-TSE sequence was used. RESULTS: The size of the genital lymphangiomas, which were revealed in all patients, varied between 5 and 83mm. In 47% of the patients lymphangiomas were detected at the level of the lower legs, and in 87% of the patients at the level of the upper leg and retroperitoneum. Furthermore, lymphangiomas were seen in the inguinal and pelvic region in 100% and intraabdominally in 40% of the patients. The lymphangiomas extended into the abdominal wall in 93% of the examined patients. A chylous pleural effusion was revealed in 20% and a chylous ascites in 13% of patients. 93% of patients suffered due to the diffuse lymphangiomatous pathologies from a lymphedema of the lower extremities, while a generalized lymphedema of the trunk was found in 87% of the patients. CONCLUSION: Magnetic resonance imaging is a safe and accurate minimal-invasive imaging modality for the evaluation of the lymphatic system in patients with diffuse lymphangiomatosis. Since the localization and extension of the lymphangiomas are important prognostic factors, it is crucial to perform a safe radiologic evaluation with a high resolution for the patient's therapeutic planning. PMID: 19913379 [PubMed - as supplied by publisher ----- 6. Hum Genet. 2009 Nov 13. [Epub ahead of print] Linkage and sequence analysis indicate that CCBE1 is mutated in recessively inherited generalised lymphatic dysplasia. Connell F, Kalidas K, Ostergaard P, Brice G, Homfray T, Roberts L, Bunyan DJ, Mitton S, Mansour S, Mortimer P, Jeffery S; Lymphoedema Consortium. Medical Genetics Unit, Clinical Developmental Sciences, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK. Generalised lymphatic dysplasia (GLD) is characterised by extensive peripheral lymphoedema with visceral involvement. In some cases, it presents in utero with hydrops fetalis. Autosomal dominant and recessive inheritance has been reported. A large, non-consanguineous family with three affected siblings with generalised lymphatic dysplasia is presented. One child died aged 5 months, one spontaneously miscarried at 17 weeks gestation, and the third has survived with extensive lymphoedema. All three presented with hydrops fetalis. There are seven other siblings who are clinically unaffected. Linkage analysis produced two loci on chromosome 18, covering 22 Mb and containing 150 genes, one of which is CCBE1. A homozygous cysteine to serine change in CCBE1 has been identified in the proband, in a residue that is conserved across species. High density SNP analysis revealed homozygosity (a region of 900 kb) around the locus for CCBE1 in all three affected cases. This indicates a likely ancestral mutation that is common to both parents; an example of a homozygous mutation representing Identity by Descent (IBD) in this pedigree. Recent studies in zebrafish have shown this gene to be required for lymphangiogenesis and venous sprouting and are therefore supportive of our findings. In view of the conserved nature of the cysteine, the nature of the amino acid change, the occurrence of a homozygous region around the locus, the segregation within the family, and the evidence from zebrafish, we propose that this mutation is causative for the generalised lymphatic dysplasia in this family, and may be of relevance in cases of non-immune hydrops fetalis. PMID: 19911200 [PubMed - as supplied by publisher ------ 1. Cases J. 2009 Oct 24;2:165. Nonclassical yellow nail syndrome in six-year-old girl: a case report. Cebeci F, Celebi M, Onsun N. Department of Dermatology, Vakif Gureba Training and Research Hospital, Istanbul, Turkey. INTRODUCTION: The yellow nail syndrome is usually described as the combination of yellow nails with lymphoedema and often with respiratory manifestations such as pleural effusions, chronic sinusitis and bronchiectasis. The syndrome is most often seen in the middle-aged individuals. CASE PRESENTATION: We present a 6-year-old girl with yellow nail syndrome having pansinusitis and bronchiectasis. CONCLUSION: The components comprising the classical triad of yellow nail syndrome in children may not necessarily be present altogether. Therefore, yellow nail syndrome should be suspected in children having only typical nail changes. PMID: 19946476 [PubMed - in process ---- 2. Aesthet Surg J. 2009 Nov-Dec;29(6):513-22. Does thighplasty for upper thigh laxity after massive weight loss require a vertical incision? Shermak MA, Mallalieu J, Chang D. Division of Plastic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA. masherma@jhmi.edu Comment in: •Aesthet Surg J. 2009 Nov-Dec;29(6):522-3. BACKGROUND: After massive weight loss (MWL), many patients present with concerns about skin excess and laxity. The thigh is one of the more complex regions to address in MWL patients because of the differing degree, location, and quality of skin excess and fatty tissue, as well as surgical risk factors. OBJECTIVE: The authors describe a technique called the anterior proximal extended (APEX) thighlift to effectively treat upper thigh skin excess with a hidden scar while also enhancing adjacent body regions. METHODS: A review was performed of 97 MWL patients who underwent thighlift surgery between March 1998 and October 2007. Eighty-six women and 11 men, with average weight loss of 146 lb and average body mass index (BMI) at contouring of 29.8, were included in the study. The risk factors that were assessed included age, gender, medical conditions, tobacco use, BMI, weight of skin excised, and surgery performed. The outcomes that were assessed included wound healing and lymphedema. Extended vertical thighlift was performed in 11 patients and anterior superior thighlift in 86 patients. RESULTS: Complications of thighlift included wound healing problems (n = 18; 18.6%); lymphedema (n = 8; 8.3%); cellulitis (n = 7; 7.2%); seroma (n = 3; 3.1%); and bleeding (n = 1; 1%). On multivariate statistical analysis, age and BMI were found to impair healing in the entire thighlift group. For patients with a BMI greater than or equal to 35, the odds ratio (OR) for a wound healing complication was 13.7 (P = .03). Hypothyroidism was strongly associated with lymphedema, with an OR of 23 (P = .06). Extended thighlift trended toward lymphedema (OR = 16.7; P = .08). CONCLUSIONS: Thighlift can be a satisfying procedure for both the patient and surgeon because it provides aesthetic improvement in terms of skin excess and laxity. The APEX thighlift is a new technique that expands upon those previously described in the literature to effectively treat upper thigh laxity with a hidden scar after MWL. PMID: 19944997 [PubMed - in process ---- 1. Lymphology. 2009 Sep;42(3):146-7. The diagnosis and treatment of peripheral lymphedema. Piller N, Carati C. Comment on: •Lymphology. 2009 Jun;42(2):51-60. PMID: 19938271 [PubMed - in process] ----- 2. Nat Genet. 2009 Dec;41(12):1272-4. Mutations in CCBE1 cause generalized lymph vessel dysplasia in humans. Alders M, Hogan BM, Gjini E, Salehi F, Al-Gazali L, Hennekam EA, Holmberg EE, Mannens MM, Mulder MF, Offerhaus GJ, Prescott TE, Schroor EJ, Verheij JB, Witte M, Zwijnenburg PJ, Vikkula M, Schulte-Merker S, Hennekam RC. Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands. Lymphedema, lymphangiectasias, mental retardation and unusual facial characteristics define the autosomal recessive Hennekam syndrome. Homozygosity mapping identified a critical chromosomal region containing CCBE1, the human ortholog of a gene essential for lymphangiogenesis in zebrafish. Homozygous and compound heterozygous mutations in seven subjects paired with functional analysis in a zebrafish model identify CCBE1 as one of few genes causing primary generalized lymph-vessel dysplasia in humans. PMID: 19935664 [PubMed - in process ----- 3. Plast Reconstr Surg. 2009 Oct;124(4):1186-95. Management of "buried" penis in adulthood: an overview. Pestana IA, Greenfield JM, Walsh M, Donatucci CF, Erdmann D. Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. BACKGROUND: The condition of "buried" penis may arise from several factors. Although the pediatric form is a rare congenital disorder, it may become an acquired condition in adulthood, most commonly from obesity, radical circumcision, or penoscrotal lymphedema. As obesity has become a national epidemic, the incidence of this phenomenon will inevitably increase. The purpose of this article is to present current strategies in the management of this physically and psychologically debilitating condition. METHODS: A literature review of the surgical management of buried penis was obtained mainly in the plastic surgery and urology literature (PubMed), from 1977 to 2007. RESULTS: Several risk factors were identified in adult patients with buried penis, including morbid obesity and diabetes mellitus. Multiple techniques for release and reconstruction are described, including primary closure, Z-plasty, and skin resurfacing, all of which may or may not include a lipectomy. Recent publications focus on resurfacing with split-thickness skin grafts and negative-pressure dressings. These techniques have been successful in terms of graft survival and long-term cosmetic result. CONCLUSIONS: Buried penis is an unusual, difficult-to-treat condition that presents a unique challenge to the plastic surgeon and the urologist. Predisposing factors such as morbid obesity and diabetes mellitus are becoming increasingly prevalent, which suggests a potential increase in the incidence of this condition. Although no specific approach may be applicable to all patients, a combination of various techniques may be applied. In complicated and severe cases, a split-thickness skin graft to the penile shaft, reduction scrotoplasty, suction-assisted lipectomy, and/or surgical lipectomy, such as panniculectomy, may be indicated. Therapy adapted to the individual patient can result in high rates of successful reconstruction with acceptable cosmetic results. PMID: 19935302 [PubMed - in process ----- 4. Lymphology. 2009 Sep;42(3):139-45. Airplane travel and lymphedema: a case study. Ward LC, Battersby KJ, Kilbreath SL. School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia. l.ward@uq. edu.au A single subject prospective study of the relationship between air travel and lymphedema is reported. This proof of concept study was aimed at assessing the feasibility of using self-measured, inter-limb impedance ratios as a quantitative measure of lymphedema immediately prior to and following flying. The participant, a breast cancer survivor with lymphedema, measured whole arm impedance prior to and following air travel on 20 occasions, varying in duration of between 1 and 9 h, over a 12-month period. Although the inter-arm impedance ratio fluctuated over this time, it generally increased and worsened following flying. Impedance measurements were easily performed by the participant and could be obtained as close to the start and cessation of flying as is practicably possible. These data, when associated with self-assessment of lymphedema-related symptoms, could provide a comprehensive evidence base for an assessment of the risks associated with air travel and the provision of appropriate advice to prospective travelers. Further large-scale studies are recommended. PMID: 19927904 [PubMed - in process ---- 5. Lymphology. 2009 Sep;42(3):123-9. The role of lymphoscintigraphy in the diagnosis of lymphedema in Turner syndrome. Bellini C, Di Battista E, Boccardo F, Campisi C, Villa G, Taddei G, Traggiai C, Amisamo A, Perucchin PP, Benfenati CS, Bonioli E, Lorini R. Neuromuscular Diseases Unit, Department of Pediatrics, University of Genoa, Genoa, Italy. carlobellini@ospedale-gaslini.ge.it Lymphedema can be present in patients affected by Turner syndrome (TS) with the dorsum of the hands and feet most commonly affected. This lymphedema results from underdevelopment of the lymphatic system before birth, and it usually decreases during childhood. The aim of our study was to evaluate the role of lymphoscintigraphy as a diagnostic tool in patients with TS to assess possible impairments in the lymphatic system. Eighteen patients with TS were karyotyped to confirm diagnosis and were evaluated by lymphoscintigraphy. Lymphatic dysfunction was demonstrated in 15/18 patients. Lymphoscintigraphic studies showed: 1) lymphatic channels, 2) collateral lymphatic channels, 3) interrupted lymphatic structures, and 4) lymph nodes of the deep lymphatic system. Our data demonstrate that lymphoscintigraphy should be mandatory not only in patients affected by Turner syndrome with signs of lymphatic dysplasia but also in those with minimal or absent signs of lymphatic impairment in order to obtain a very early diagnosis and to provide substantial information for possible medical or surgical treatment. PMID: 19927901 [PubMed - in process ----- 6. Lymphology. 2009 Sep;42(3):105-11. Where do lymph and tissue fluid accumulate in lymphedema of the lower limbs caused by obliteration of lymphatic collectors? Olszewski WL, Ambujam PJ, Zaleska M, Cakala M. Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland. wlo@cmdik.pan.pl Obliteration of lymphatic collecting trunks of limbs by infective processes, trauma, oncologic surgery and irradiation bring about retention of lymph and tissue fluid in tissues. Knowledge as to where excess lymph is produced and accumulates as tissue fluid is indispensable for rational physical therapy. So far, this knowledge has been based on lymphoscintigraphic, ultrasonographic and MR images. None of these modalities provides distinct images of dilated lymphatics and fluid expanded tissue spaces in dermis, subcutis and muscles. Only anatomical dissection and histological processing of biopsy material can demonstrate the remnants of the lymphatic network and the sites of accumulation of mobile tissue fluid. We visualized and calculated the volume of the "tissue fluid and lymph" space in skin and subcutaneous tissue of foot, calf, and thigh in various stages of lymphedema, using special coloring techniques in specimens obtained during lymphatic microsurgical procedures or tissue debulking. When the collecting trunks were obliterated, lymph was present only in the subepidermal lymphatics, while mobile tissue fluid accumulated in the spontaneously formed spaces in the subcutaneous tissue, around small veins, and in the muscular fascia. Deformation of subcutaneous tissue by free fluid led to formation of interconnecting channels. In obstructive lymphedema caused by obliteration of collectors, lymph is present mainly in subepidermal lymphatics, and the bulk of stagnant tissue fluid accumulates in subcutis between fibrous septa and fat globules as well as above and underneath muscular fascia. These observations provide useful clues for designing pneumatic devices and rational manual lymphatic massage to move stagnant tissue fluid toward the non-swollen regions. PMID: 19927899 [PubMed - in process ----- 1. Pathophysiology. 2009 Nov 24. [Epub ahead of print] The role of lymphatic vessels in the heart. Cui Y. Case Cardiovascular Research Institute, Department of Medicine, Case Western Reserve University, Cleveland, OH 44106-7290, United States; University Hospitals Harrington-McLaughlin Heart & Vascular Institute, University Hospitals Case Medical Center, WRB 4-537, 2103 Cornell Road, Cleveland, OH 44106-7290, United States. Although cardiac lymphatic vessels have been described for over three centuries, research progress on the role of cardiac lymphatic vessels in regulating cardiac physiology and their disturbances in the pathogenesis of cardiac disease has progressed very slowly, largely due to technical challenges in developing both animal models and cardiac lymphatic vascular imaging technologies. This review summarizes evidence showing that blocking cardiac lymph flow may contribute to several forms of cardiac injury including cardiac lymphedema, cardiac valvular deformation, coronary arterial injury, conduction disturbances, myocardial injury, and poor heart performance in animal and human heart studies. Conversely, improving cardiac lymph flow may have beneficial effects on heart function after heart attack (myocardial infarction). In addition, this review summarizes recent hypotheses about the forces generating cardiac lymph flow, in which the role of both the subepicardial and mid-myocardial myocytes synchronized contractions causing lymph flow is discussed. Lastly, possible mechanisms of blood vessel injury caused by the failure of perivascular lymphatic remodeling are discussed. PMID: 19942415 [PubMed - as supplied by publisher -------- 1. J Clin Oncol. 2009 Oct 13. [Epub ahead of print] Axillary Reverse Mapping to Prevent Lymphedema After Breast Cancer Surgery: Defining the Limits of the Concept. Khan SA. Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine of Northwestern University, Chicago, IL. PMID: 19826108 [PubMed - as supplied by publisher -------- 2. Parasite Immunol. 2009 Nov;31(11):664-72. Filariasis and lymphoedema. Pfarr KM, Debrah AY, Specht S, Hoerauf A. Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany. Among the causes of lymphoedema (LE), secondary LE due to filariasis is the most prevalent. It affects only a minority of the 120 million people infected with the causative organisms of lymphatic filariasis (LF), Wuchereria bancrofti and Brugia malayi/timori, but is clustered in families, indicating a genetic basis for development of this pathology. The majority of infected individuals develop filarial-specific immunosuppression that starts even before birth in cases where mothers are infected and is characterized by regulatory T-cell responses and high levels of IgG4, thus tolerating high parasite loads and microfilaraemia. In contrast, individuals with this pathology show stronger immune reactions biased towards Th1, Th2 and probably also Th17. Importantly, as for the aberrant lymph vessel development, innate immune responses that are triggered by the filarial antigen ultimately result in the activation of vascular endothelial growth factors (VEGF), thus promoting lymph vessel hyperplasia as a first step to lymphoedema development. Wolbachia endosymbionts are major inducers of these responses in vitro, and their depletion by doxycycline in LF patients reduces plasma VEGF and soluble VEGF-receptor-3 levels to those seen in endemic normals preceding pathology improvement. The search for the immunogenetic basis for LE could lead to the identification of risk factors and thus, to prevention; and has so far led to the identification of single- nucleotide polymorphisms (SNP) with potential functional relevance to VEGF, cytokine and toll-like receptor (TLR) genes. Hydrocele, a pathology with some similarity to LE in which both lymph vessel dilation and lymph extravasation are shared sequelae, has been found to be strongly associated with a VEGF-A SNP known for upregulation of this (lymph-)angiogenesis factor. PMID: 19825106 [PubMed - in process --------------------------- 3. Rev Port Cir Cardiotorac Vasc. 2009 April- June;16(2):107-114. [Lymphedema of the extremities: A missed vascular pathology?] [Article in Portuguese] Pereira Albino J. Serviço de Cirurgia Vascular II do Centro Hospitalar Lisboa Norte,H. Pulido Valente, Lisboa. The diagnosis and treatment of lymphedemas of the extremities, although relatively common in the western countries, mainly in the area of oncology, are scarcely mentioned in the international literature and in Portugal very little work has been devoted to this area. Nevertheless, they may cause severe functional and aesthetic disability, the main reason why decided to reassess its pathology, with an emphasis on the clinical diagnosis and medical therapy. We stress the importance of oedema of the instep the value of the Stemmer's sign in the diagnosis, and the complete decongestive physiotherapy in the management. When associated to the pharmacological therapy and the correct use of elastic stockings, the control of most of the cases can be achieved. Surgical therapy is reserved for rare cases and should be regarded as an adjuvant to intensive medical therapy, which should accompany the patient throughout life time. PMID: 19823709 [PubMed - as supplied by publisher ------- 4. J Pain Symptom Manage. 2009 Oct 9. [Epub ahead of print] Breast Cancer Survivors' Experiences of Lymphedema-Related Symptoms. Fu MR, Rosedale M. New York University College of Nursing, New York, NY, USA. BACKGROUND: The purpose of this study was to explore and describe breast cancer survivors' lymphedema-related symptom experiences. As a serious chronic condition from breast cancer treatment, lymphedema or a syndrome of persistent swelling and symptoms is caused by chronic accumulation of lymph fluid in the interstitial spaces of the affected limb or surrounding areas. Although significant prevalence of ongoing multiple symptoms have been reported, little is known about how survivors with lymphedema perceive and respond to lymphedema-related symptoms in their daily lives. METHODS: This study used a descriptive phenomenological method. Thirty-four participants were recruited in the United States. Three in-depth interviews were conducted with each participant; a total of 102 interviews were completed, audio taped, and transcribed. Interview transcripts and field notes were the data sources for this analysis, which was part of three larger studies. DATA ANALYSIS: Data were analyzed to identify the essential themes within and across cases. Four essential themes were revealed: living with perpetual discomfort, confronting the unexpected, losing pre- lymphedema being, and feeling handicapped. FINDINGS: Participants experienced multiple symptoms on a daily basis. Distress was heightened when women expected symptoms to disappear, but instead, they remained as a "perpetual discomfort." Moreover, distress was intensified when symptoms evoked unexpected situations or when symptoms elicited emotional responses powerful enough to change perceived personal identity. CONCLUSIONS: Findings suggest that symptom distress may encompass temporal, situational, and attributive dimensions. Prospective studies are needed to examine lymphedema-related symptom distress in terms of these dimensions so that more specific interventions can be developed to target distress occurring in each dimension. PMID: 19819668 [PubMed - as supplied by publisher] ---- 1. Br J Surg. 2009 Nov;96(11):1274-9. Quality of life after surgical reduction for severe primary lymphoedema of the limbs and genitalia. Ogunbiyi SO, Modarai B, Smith A, Burnand KG; London Lymphoedema Consortium. Academic Department of Surgery, St Thomas' Hospital, Westminster Bridge Road, London, UK. BACKGROUND: The aim was to assess the quality of life (QoL) of patients who had surgery for primary lymphoedema. METHODS: A QoL questionnaire was administered to patients who had surgery between 1981 and 2003 (retrospective group) and between 2003 and 2006 (prospective group). RESULTS: The response rate was 70.3 per cent (109 of 155 patients): 88 patients had limb reduction (78, retrospective; ten, prospective) and 21 had genital reduction (13, retrospective; eight, prospective). Forty- nine patients (63 per cent) who had limb reduction studied retrospectively reported satisfaction with the procedure and most of these would opt for surgery again. In the prospectively studied group, nine of ten patients reported improved limbs, and seven would opt for surgery again. Nineteen of 21 patients who had genital reduction would choose to have surgery again if needed (11 of the retrospectively assessed group and all of the prospective group). Patients' perception that surgery was worthwhile was greater in both of the prospectively assessed groups (P = 0.013). CONCLUSION: Surgery for severe lymphoedema improved QoL at early assessment. This, however, may not be sustained. Genital reduction appeared to provide greater benefit than limb reduction. PMID: 19847880 [PubMed - in process ----------------------- 2. Afr J Paediatr Surg. 2008 Jul-Dec;5(2):79-83. Congenital constriction ring syndrome of the limbs: A prospective study of 16 cases. Adu EJ, Annan C. Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Background: The congenital constriction ring syndrome is characterised by fibrous bands that encircle, strangle and even amputate parts of the foetus. It is a common condition amongst Ghanaian patients, but data on it is quite scanty. Materials and Methods: A prospective study of patients presenting at a plastic surgical clinic in Ghana with the characteristics of the congenital constriction ring syndrome was undertaken. The patients were examined clinically and the findings recorded. An x-ray and clinical photograph of the affected limbs was taken. Treatment required several staged operations. Surgical correction of the constriction ring was done by excision and Z-plasty to prevent or alleviate lymphoedema, separation of distally fused digits and skin grafting of defect. Results: Sixteen patients made up of 10 males and six females were seen. The age at presentation ranged from nine days to 12 years with a mean age of 14.6 months. Twenty-two limbs were affected, made up of four right upper limbs, six left upper limbs, seven right lower limbs and five left lower limbs. In the upper limb malformations involved 42 digits; in the lower limb malformations involved 33 toes, one foot and five legs. Four main types of lesions were found: constriction rings, intrauterine amputations, acrosyndactyly, and simple syndactyly. Conclusion: Congenital constriction ring syndrome is of uncertain aetiology and could cause morbidity in the newborn. The syndrome and its complications are amenable to corrective surgery with good results. Early intervention is desirable for a successful outcome. PMID: 19858673 [PubMed - in process ---------------------------------- 3. Ann Surg Oncol. 2009 Oct 27. [Epub ahead of print] Predictive Factors of Response to Decongestive Therapy in Patients with Breast-Cancer-Related Lymphedema. Forner-Cordero I, Muñoz-Langa J, Forner-Cordero A, Demiguel-Jimeno JM. Physical Medicine and Rehabilitation Specialist, Hospital La Fe, Valencia, Spain, iforner@saludalia.com. BACKGROUND: Many studies have reported the benefits of Decongestive treatment in patients with breast-cancer-related lymphedema (BCRL) but few have study what are the predictive factors of response. METHODS: We performed a prospective, multicenter controlled cohort study of 171 patients with BCRL to identify independent predictive factors of response to decongestive treatment (CDT). Demographic data and clinical and lymphedema characteristics were collected prospectively. The end point was the "percentage reduction in excess volume (PREV)." Volumes were measured prior and at the end of CDT. Factors associated with response (PREV) were tested in univariate and multivariate analyses using linear regression techniques. RESULTS: Median age was 60.4 years (range 32-84); mean lymphedema chronicity 4 years [95% confidence interval (95% CI): 3.1-5.0]; mean baseline excess volume (EV) was 936 mL (95% CI: 846- 1026), and mean percentage EV was 35.3% (95% CI: 32.0-38.7); compliance to bandages was good in 81.3% of patients. PREV was 71.7% (95% CI: 65.2-78.2). After univariate screening, 11 variables were found to be associated with PREV but only 4 variables were independent predictive factors of response to CDT in the multivariate analysis: Venous insufficiency, percentage of EV (the higher the EV, the lower the reduction with CDT); compliance to bandages (a good compliance improved PREV in 25%), and treatment in autumn (better results than during the rest of the year). CONCLUSIONS: This study shows that compliance to bandages during CDT is one of the most important predictors of response. Moreover, data support the idea that more severe lymphedemas have a worse response to treatment, and it should be recommended in early stages. The association between the season of treatment and response was also very strong, so weather conditions are an additional factor that must be taken into account in further studies.. PMID: 19859769 [PubMed - as supplied by publisher ------------------------------------------ 4. Oncology (Williston Park). 2009 Feb;23(2 Suppl):34-8. Lower extremity lymphedema in a patient with melanoma. Rubin KM, Kuhlman C. Melanoma Program, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA. PMID: 19856587 [PubMed - in process --- 1. Cancer. 2009 Oct 28. [Epub ahead of print] Preoperative assessment enables the early detection and successful treatment of lymphedema. Hayes S, Cornish B, Newman B.. Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia. PMID: 19877116 [PubMed - as supplied by publisher --- 2(a). Acta Oncol. 2009;48(8):1111-8. Changes in arm morbidities and health-related quality of life after breast cancer surgery - a five-year follow- up study. Sagen A, Kåresen R, Sandvik L, Risberg MA. Department of Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway. aase.sagen@uus. no BACKGROUND AND PURPOSE. Many breast cancer survivors (BCS) suffer from long-term upper limb morbidities after axillary node dissection. The purpose of this five-year follow-up study was to describe changes in long-term upper limb morbidities, physical activity level, and Health-Related Quality of Life (HRQoL) and to find factors that predict HRQoL five years after surgery. PATIENTS AND METHODS. This study included 204 women aged 55+/-10 years who had primary breast cancer surgery with axillary node dissection. The subjects were examined for arm volumes and arm lymphedema, arm pain, sensation of heaviness, shoulder function, physical activity level, and HRQoL, prior to surgery, and six months and five years after surgery. The statistical analyses used included ANOVA for repeated measures and multivariate linear regression. RESULTS. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper limbs were present five years after surgery. ALE was the only morbidity that continued to increase over time. Several dimensions of HRQoL temporarily declined after surgery, but significantly improved in the period from six months to five years after surgery. The significant predictive factors of HRQoL five years after surgery included HRQoL prior to surgery, physical activity level at leisure time (both prior to and at six months after surgery), and duration of sick leave after surgery (in weeks). CONCLUSIONS. The overall HRQoL improved significantly from baseline to five years, despite the chronic arm pain and increase in ALE. Three independent predictive factors of HRQoL were identified. PMID: 19863218 [PubMed - in process --- 2(b) Acta Oncol. 2009 Aug 27:1-8. [Epub ahead of print] Changes in arm morbidities and health-related quality of life after breast cancer surgery - a five-year follow- up study. Sagen A, Kåresen R, Sandvik L, Risberg MA. Department of Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway. Background and purpose. Many breast cancer survivors (BCS) suffer from long-term upper limb morbidities after axillary node dissection. The purpose of this five-year follow-up study was to describe changes in long-term upper limb morbidities, physical activity level, and Health-Related Quality of Life (HRQoL) and to find factors that predict HRQoL five years after surgery. Patients and methods. This study included 204 women aged 55+/-10 years who had primary breast cancer surgery with axillary node dissection. The subjects were examined for arm volumes and arm lymphedema, arm pain, sensation of heaviness, shoulder function, physical activity level, and HRQoL, prior to surgery, and six months and five years after surgery. The statistical analyses used included ANOVA for repeated measures and multivariate linear regression. Results. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper limbs were present five years after surgery. ALE was the only morbidity that continued to increase over time. Several dimensions of HRQoL temporarily declined after surgery, but significantly improved in the period from six months to five years after surgery. The significant predictive factors of HRQoL five years after surgery included HRQoL prior to surgery, physical activity level at leisure time (both prior to and at six months after surgery), and duration of sick leave after surgery (in weeks). Conclusions. The overall HRQoL improved significantly from baseline to five years, despite the chronic arm pain and increase in ALE. Three independent predictive factors of HRQoL were identified. PMID: 19714526 [PubMed - as supplied by publisher --- 3(a). Acta Oncol. 2009;48(8):1102-10. Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Sagen A, Kåresen R, Risberg MA. Department of Breast and Endocrine Surgery, Oslo University Hospital, Ullevaal, Norway. aase.sagen@uus. no BACKGROUND. The influence of physical activity on the development of arm lymphedema (ALE) after breast cancer surgery with axillary node dissection has been debated. We evaluated the development of ALE in two different rehabilitation programs: a no activity restrictions (NAR) in daily living combined with a moderate resistance exercise program and an activity restrictions (AR) program combined with a usual care program. The risk factors associated with the development of ALE 2 years after surgery were also evaluated. MATERIAL AND METHODS. Women (n = 204) with a mean age of 55+/-10 years who had axillary node dissection were randomized into two different rehabilitation programs that lasted for 6 months: NAR (n = 104) or AR (n = 100). The primary outcomes were the difference in arm volume between the affected and control arms (Voldiff, in ml) and the development of ALE. Baseline (before surgery) and follow-up tests were performed 3 months, 6 months, and 2 years after surgery. Data were analyzed using ANCOVA and regression analysis. RESULTS. Voldiff did not differ significantly between the two treatment groups. Arm volume increased significantly over time in both the affected and the control arms. The development of ALE from baseline to 2 years increased significantly in both groups (p < 0.001). The only risk factor for ALE was BMI > 25 kg/m (2). CONCLUSION. Patients that undergo breast cancer surgery with axillary lymph node dissection should be encouraged to maintain physical activity in their daily lives without restrictions and without fear of developing ALE. PMID: 19863217 [PubMed - in process --- 3(b) Acta Oncol. 2009 Jun 23:1-9. [Epub ahead of print] Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Sagen A, Kåresen R, Risberg MA. Department of Breast and Endocrine Surgery, Oslo University Hospital, Ullevaal, Norway. Background. The influence of physical activity on the development of arm lymphedema (ALE) after breast cancer surgery with axillary node dissection has been debated. We evaluated the development of ALE in two different rehabilitation programs: a no activity restrictions (NAR) in daily living combined with a moderate resistance exercise program and an activity restrictions (AR) program combined with a usual care program. The risk factors associated with the development of ALE 2 years after surgery were also evaluated. Material and methods. Women (n=204) with a mean age of 55+/-10 years who had axillary node dissection were randomized into two different rehabilitation programs that lasted for 6 months: NAR (n=104) or AR (n=100). The primary outcomes were the difference in arm volume between the affected and control arms (Voldiff, in ml) and the development of ALE. Baseline (before surgery) and follow-up tests were performed 3 months, 6 months, and 2 years after surgery. Data were analyzed using ANCOVA and regression analysis. Results. Voldiff did not differ significantly between the two treatment groups. Arm volume increased significantly over time in both the affected and the control arms. The development of ALE from baseline to 2 years increased significantly in both groups (p<0.001). The only risk factor for ALE was BMI > 25 kg/m(2). Conclusion. Patients that undergo breast cancer surgery with axillary lymph node dissection should be encouraged to maintain physical activity in their daily lives without restrictions and without fear of developing ALE. PMID: 19551531 [PubMed - as supplied by publisher ----- 2(a). Acta Oncol. 2009;48(8):1111-8. Changes in arm morbidities and health-related quality of life after breast cancer surgery - a five-year follow- up study. Sagen A, Kåresen R, Sandvik L, Risberg MA. Department of Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway. aase.sagen@uus. no BACKGROUND AND PURPOSE. Many breast cancer survivors (BCS) suffer from long-term upper limb morbidities after axillary node dissection. The purpose of this five-year follow-up study was to describe changes in long-term upper limb morbidities, physical activity level, and Health-Related Quality of Life (HRQoL) and to find factors that predict HRQoL five years after surgery. PATIENTS AND METHODS. This study included 204 women aged 55+/-10 years who had primary breast cancer surgery with axillary node dissection. The subjects were examined for arm volumes and arm lymphedema, arm pain, sensation of heaviness, shoulder function, physical activity level, and HRQoL, prior to surgery, and six months and five years after surgery. The statistical analyses used included ANOVA for repeated measures and multivariate linear regression. RESULTS. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper limbs were present five years after surgery. ALE was the only morbidity that continued to increase over time. Several dimensions of HRQoL temporarily declined after surgery, but significantly improved in the period from six months to five years after surgery. The significant predictive factors of HRQoL five years after surgery included HRQoL prior to surgery, physical activity level at leisure time (both prior to and at six months after surgery), and duration of sick leave after surgery (in weeks). CONCLUSIONS. The overall HRQoL improved significantly from baseline to five years, despite the chronic arm pain and increase in ALE. Three independent predictive factors of HRQoL were identified. PMID: 19863218 [PubMed - in process 2(b) Acta Oncol. 2009 Aug 27:1-8. [Epub ahead of print] Changes in arm morbidities and health-related quality of life after breast cancer surgery - a five-year follow- up study. Sagen A, Kåresen R, Sandvik L, Risberg MA. Department of Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway. Background and purpose. Many breast cancer survivors (BCS) suffer from long-term upper limb morbidities after axillary node dissection. The purpose of this five-year follow-up study was to describe changes in long-term upper limb morbidities, physical activity level, and Health-Related Quality of Life (HRQoL) and to find factors that predict HRQoL five years after surgery. Patients and methods. This study included 204 women aged 55+/-10 years who had primary breast cancer surgery with axillary node dissection. The subjects were examined for arm volumes and arm lymphedema, arm pain, sensation of heaviness, shoulder function, physical activity level, and HRQoL, prior to surgery, and six months and five years after surgery. The statistical analyses used included ANOVA for repeated measures and multivariate linear regression. Results. ALE (13%), pain (36%), and sensation of heaviness (21%) in the upper limbs were present five years after surgery. ALE was the only morbidity that continued to increase over time. Several dimensions of HRQoL temporarily declined after surgery, but significantly improved in the period from six months to five years after surgery. The significant predictive factors of HRQoL five years after surgery included HRQoL prior to surgery, physical activity level at leisure time (both prior to and at six months after surgery), and duration of sick leave after surgery (in weeks). Conclusions. The overall HRQoL improved significantly from baseline to five years, despite the chronic arm pain and increase in ALE. Three independent predictive factors of HRQoL were identified. PMID: 19714526 [PubMed - as supplied by publisher 3(a). Acta Oncol. 2009;48(8):1102-10. Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Sagen A, Kåresen R, Risberg MA. Department of Breast and Endocrine Surgery, Oslo University Hospital, Ullevaal, Norway. aase.sagen@uus. no BACKGROUND. The influence of physical activity on the development of arm lymphedema (ALE) after breast cancer surgery with axillary node dissection has been debated. We evaluated the development of ALE in two different rehabilitation programs: a no activity restrictions (NAR) in daily living combined with a moderate resistance exercise program and an activity restrictions (AR) program combined with a usual care program. The risk factors associated with the development of ALE 2 years after surgery were also evaluated. MATERIAL AND METHODS. Women (n = 204) with a mean age of 55+/-10 years who had axillary node dissection were randomized into two different rehabilitation programs that lasted for 6 months: NAR (n = 104) or AR (n = 100). The primary outcomes were the difference in arm volume between the affected and control arms (Voldiff, in ml) and the development of ALE. Baseline (before surgery) and follow-up tests were performed 3 months, 6 months, and 2 years after surgery. Data were analyzed using ANCOVA and regression analysis. RESULTS. Voldiff did not differ significantly between the two treatment groups. Arm volume increased significantly over time in both the affected and the control arms. The development of ALE from baseline to 2 years increased significantly in both groups (p < 0.001). The only risk factor for ALE was BMI > 25 kg/m (2). CONCLUSION. Patients that undergo breast cancer surgery with axillary lymph node dissection should be encouraged to maintain physical activity in their daily lives without restrictions and without fear of developing ALE. PMID: 19863217 [PubMed - in process 3(b) Acta Oncol. 2009 Jun 23:1-9. [Epub ahead of print] Physical activity for the affected limb and arm lymphedema after breast cancer surgery. A prospective, randomized controlled trial with two years follow-up. Sagen A, Kåresen R, Risberg MA. Department of Breast and Endocrine Surgery, Oslo University Hospital, Ullevaal, Norway. Background. The influence of physical activity on the development of arm lymphedema (ALE) after breast cancer surgery with axillary node dissection has been debated. We evaluated the development of ALE in two different rehabilitation programs: a no activity restrictions (NAR) in daily living combined with a moderate resistance exercise program and an activity restrictions (AR) program combined with a usual care program. The risk factors associated with the development of ALE 2 years after surgery were also evaluated. Material and methods. Women (n=204) with a mean age of 55+/-10 years who had axillary node dissection were randomized into two different rehabilitation programs that lasted for 6 months: NAR (n=104) or AR (n=100). The primary outcomes were the difference in arm volume between the affected and control arms (Voldiff, in ml) and the development of ALE. Baseline (before surgery) and follow-up tests were performed 3 months, 6 months, and 2 years after surgery. Data were analyzed using ANCOVA and regression analysis. Results. Voldiff did not differ significantly between the two treatment groups. Arm volume increased significantly over time in both the affected and the control arms. The development of ALE from baseline to 2 years increased significantly in both groups (p<0.001). The only risk factor for ALE was BMI > 25 kg/m(2). Conclusion. Patients that undergo breast cancer surgery with axillary lymph node dissection should be encouraged to maintain physical activity in their daily lives without restrictions and without fear of developing ALE. PMID: 19551531 [PubMed - as supplied by publisher ---- 1. Dermatol Online J. 2009 Aug 15;15(8):7. Lymphedema praecox. Rizzo C, Gruson LM, Wainwright BD. Department of Dermatology, New York University, USA. A 57-year-old man presented with the post-pubertal onset of asymptomatic swelling of the left arm and legs that had been complicated by recurrent bouts of cellulitis. The presentation and disease course are consistent with lymphedema praecox, which is a subtype of primary lymphedema with onset at puberty and a slowly progressive course. The subtypes of lymphedema, pathogenesis, and treatment are reviewed. PMID: 19891915 [PubMed - in process 2. Breast J. 2009 Nov 2. [Epub ahead of print] Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer Patients. Helyer LK, Varnic M, Le LW, Leong W, McCready D. Department of Surgical Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. Lymphedema (LE) is a well-known postoperative complication after axillary node dissection (ALND). Although, sentinel lymph node dissection (SLND) involves more focused surgery and less disruption of the axilla, early reports show up to 13% of patients experience some symptoms of LE. The purpose of this study was to determine predictors of arm LE in our patients under going SLND with or without an ALND. One hundred and thirty-seven breast cancer patients were treated at a comprehensive cancer center. Prospective measurement of arm volume was carried every 6 months from date of diagnosis. This data base was retrospectively reviewed for tumor stage, treatment, and subjective complaints of LE. Objective LE was defined as a change greater than 200 mL compared with the control arm. Univariate and multivariate analyses were performed. Arm volume changes were measured over 24 months (median follow-up 20 months) in 137 women: 82 stage I, 48 stage II, and 5 stage III; median age 56 years. Breast-conserving surgery was performed in 133 patients. All patients underwent SLND for axillary staging and for 52 patients this was the only axillary staging procedure. All node-positive patients (31) and 54 node-negative patients under went an immediate completion ALND, the latter as part of a study protocol. At 24 months, 16 (11.6%) patients were found to have objective LE (>200 mL increase). Patient age, tumor size, number of nodes harvested, or adjuvant chemotherapy was not found to be predictive of LE by univariate analysis. The risk of developing postoperative LE was primarily and significantly related to the patients' BMI (p = 0.003). Multivariate analysis revealed patients with a BMI >30 (obese) had an odds ratio of 2.93 (95% CI 1.03- 8.31) compared with those with a BMI of <25 of having LE. Symptomatic LE (SLE), as defined by patient complaints was recorded in six of the above 16 patients, no SLE was recorded in patients without objective signs of edema. Univariate subgroup analysis compared the symptomatic to the nonsymptomatic patients and revealed the median number of nodes removed was higher in the symptomatic patients (17 verses 9, p = 0.045); however, these patients had a lower BMI (p = 0.0012). The mean change in arm volume was not significantly different between the groups. SLE occurs in one third of patients with objective arm swelling and most likely is multi-factorial in etiology. Although patients undergoing SLN were recorded as having objective LE, none reported SLE. The development of LE within 2 years of surgery is associated with the patient's BMI and this should be considered in preoperative counseling. PMID: 19889169 [PubMed - as supplied by publisher 3. Dermatol Ther. 2009 Nov-Dec;22(6):475-90. Filariasis: diagnosis and treatment. Mendoza N, Li A, Gill A, Tyring S.. Universidad El Bosque, Bogotá, Colombia. nmendoza@ccstexas.com Filariasis is an infectious disease of the lymphatics and subcutaneous tissues caused by nematodes or filariae. Carried by mosquito vectors, this disease causes millions of people to suffer from lymphedema and elephantiasis, characteristics of filariasis infection. This disease can be diagnosed through the identification of microfilariae in blood or skin samples, antigen detection, radiographic imaging, or polymerase chain reaction. Mass drug administration by the World Health Organization has helped to diminish the incidence of filariasis. However, continued research on new drugs and vaccinations will be needed to control and reduce the microfilarial levels in the human population. PMID: 19889133 [PubMed - in process ---- 1. J Occup Rehabil. 2009 Nov 10. [Epub ahead of print] Factors Related to Return to Work by Women with Breast Cancer in Northern France. Fantoni SQ, Peugniez C, Duhamel A, Skrzypczak J, Frimat P, Leroyer A. Department of Occupational Medicine, CHRU Lille, Université Lille 2, 1 Avenue Oscar Lambret, 59037, Lille Cedex, France, fanquin@wanadoo.fr. Introduction Earlier diagnosis and better treatment have increased the survival rates of breast cancer patients. This warrants research on return to work of cancer survivors, especially about subjective factors because they affect the mental desire to return to work. Moreover, knowledge in this issue is very limited in France. Objectives This study aims to explore the objective and subjective factors that affect whether and when women with breast cancer return to work. Methods 379 women with breast cancer aged 18-60 years who were working at the time of diagnosis responded to a 45 item questionnaire. The questionnaire had personal characteristics, disease-related characteristics and work-related ones. Multivariate logistic regressions were run to determine the association of these factors and return to work and time until return to work. Results During a median follow-up of 36 months, 82.1% of the 379 women who had worked before their diagnosis returned to work after a median sick leave of 10.8 months. Older age, lower educational level, chemotherapy, radiotherapy, lymphoedema, psychological or organizational self-perceived constraints related to their former job, and the lack of moral support from work colleagues both limited and delayed return to work. Conclusion The resumption of work by women with breast cancer depends on many factors, not all of them medical. The self-perceived factors must be considered: first to help support these women during their sick leave, while taking into account elements that may hinder early return to work; second to initiate a work resumption support process which takes into account both the person and her environment. PMID: 19902340 [PubMed - as supplied by publisher 2. Ann Trop Med Parasitol. 2009 Oct;103 Suppl 1:S41-51. Lymphatic filariasis: patients and the global elimination programme. Mackenzie CD, Lazarus WM, Mwakitalu ME, Mwingira U, Malecela MN. Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI 48824, USA. mackenz8@msu.edu The defining images of lymphatic filariasis are the horrendous disfigurements of lymphoedema, elephantiasis and hydrocele. These clinical presentations, although obviously important and life changing, are not, however, the only outcomes of this wide-spread filarial infection. The other effects of the disease range from severe, acute but short-term bouts of sickness to psychological impairment, poverty and family hardship. It is important to support cases of the disease through all means available, such as reparative hydrocelectomy, hygiene training and facilitation, and the provision of adequate chemotherapy. Although only a minority of the residents in any endemic community is affected with the severe clinical manifestations of this parasitic infection, these cases are central to, and important advocates for, the current global effort to eliminate the infection through mass drug administrations (MDA). Their clinical improvement acts as an important catalyst for the general population and encourages high compliance in the MDA. This communication discusses the central role that filariasis patients have played in the Tanzania Lymphatic Filariasis Elimination Programme to date, and covers some of the clinical successes achieved in the past 10 years. The abolition of the clinical manifestations of filarial infection remains the ultimate goal of the Global Programme to Eliminate Lymphatic Filariasis, and maintaining a focus on the affected individuals and their clinical condition is vital to that programme's overall success. PMID: 19843397 [PubMed - in process 3. Ann Trop Med Parasitol. 2009 Oct;103 Suppl 1:S5-10. Ten years of managing the clinical manifestations and disabilities of lymphatic filariasis. Brantus P. Neglected Tropical Diseases, Health and Rehabilitation Unit, Handicap International France, 14 Avenue Berthelot, 69361 Lyon Cedex 07, France. brantus.pierre@orange.fr The aim of the Global Programme to Eliminate Lymphatic Filariasis is to eradicate one of the world's leading causes of permanent and long-term disability, at least as a public-health problem. The achievement of this goal is based on the interruption of the transmission of the causative parasites (so preventing new cases) and, as a 'second pillar', the prevention of disability in those who are infected. The disability is associated with the main clinical manifestations of human infection with Wuchereria or Brugia spp. (i.e. hydrocele, lymphoedema and/or 'acute attacks'). The World Health Organization and its partners have established strategies and activities both for managing lymphoedema, through community home-based care, and for increasing access to surgery for hydrocele. Over the last decade, there has been progress made in preventing the disability of lymphatic filariasis, the monitoring and evaluation of such disability and its control, and the integration of disability prevention with mass drug administrations and efforts to control other disabling diseases. That progress and the challenges that remain in the prevention of the morbidity and disability attributable to lymphatic filariasis are here reviewed. PMID: 19843392 [PubMed - in process 4. J Minim Invasive Gynecol. 2009 Nov-Dec;16(6):669-81. Robotics and gynecologic oncology: review of the literature. Cho JE, Nezhat FR. Gynecologic Oncology Division, St. Luke's-Roosevelt Hospital Center, New York, New York. The objectives of this article were to review the published scientific literature about robotics and its application to gynecologic oncology to date and to summarize findings of this advanced computerenhanced laparoscopic technique. Relevant sources were identified by a search of PUBMED from January 1950 to January 2009 using the key words Robot or Robotics and Cervical cancer, Endometrial cancer, Gynecologic oncology, and Ovarian cancer. Appropriate case reports, case series, retrospective studies, prospective trials, and review articles were selected. A total of 38 articles were identified on the subject, and 27 were included in the study. The data for gynecologic cancer show comparable results between robotic and laparoscopic surgery for estimated blood loss, operative time, length of hospital stay, and complications. Overall, there were more wound complications with the laparotomy approach compared with laparoscopy and robotic-assisted laparoscopy. There were more lymphocysts, lymphoceles, and lymphedema in the robotic-assisted laparoscopic group compared with the laparoscopy and laparotomy groups in patients with cervical cancer. Infectious and lung-related morbidity, postoperative ileus, and bleeding or clot formation were more commonly reported in the laparotomy group compared with the other 2 cohorts in patients with endometrial cancer. Computer-enhanced technology may enable more surgeons to convert laparotomies to laparoscopic surgery with its associated benefits. It seems that in the hands of experienced laparoscopic surgeons, final outcomes are the same with or without use of the robot. There is good evidence that robotic surgery facilitates laparoscopic surgery, with equivalent if not better operative time and comparable surgical outcomes, shorter hospital stay, and fewer major complications than with surgeries using the laparotomy approach. PMID: 19896593 [PubMed - in process ---- 1. Indian J Plast Surg. 2009 Jan-Jun;42(1):22-30. Comparative results of non-operative multi-modal therapy for filarial lymphoedema. Gogia SB, Appavoo NC, Mohan A, Kumar MB. Sanwari Bai Surgical Centre, 28/31 Old Rajinder Nagar, New Delhi - 110 060, India. A comparative analysis of different conservative modes of therapy for lymphoedema, largely of Filarial origin, was conducted in a trial therapy unit in Chengalpattu, a Filarial endemic district in Tamil Nadu. Results were compared using a single chambered intermittent pneumatic compression pump, heat therapy, and interferential therapy machines. The results showed improvement of limb size between 20% and 60% of possible reduction (where 100% would mean return of limb circumference to the same as that of the normal side). Pneumatic compression therapy, when used alone, showed the best results, which were significantly better than all others whether alone or in combination. PMID: 19881016 [PubMed - in process 2. Photomed Laser Surg. 2009 Oct;27(5):763-9. Managing postmastectomy lymphedema with low-level laser therapy. Lau RW, Cheing GL. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China. OBJECTIVE: We aimed to investigate the effects of low-level laser therapy (LLLT) in managing postmastectomy lymphedema. BACKGROUND DATA: Postmastectomy lymphedema (PML) is a common complication of breast cancer treatment that causes various symptoms, functional impairment, or even psychosocial morbidity. A prospective, single-blinded, controlled clinical trial was conducted to examine the effectiveness of LLLT on managing PML. METHODS: Twenty-one women suffering from unilateral PML were randomly allocated to receive either 12 sessions of LLLT in 4 wk (the laser group) or no laser irradiation (the control group). Volumetry and tonometry were used to monitor arm volume and tissue resistance; the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire was used for measuring subjective symptoms. Outcome measures were assessed before and after the treatment period and at the 4 wk follow-up. RESULTS: Reduction in arm volume and increase in tissue softening was found in the laser group only. At the follow-up session, significant between-group differences (all p < 0.05) were found in arm volume and tissue resistance at the anterior torso and forearm region. The laser group had a 16% reduction in the arm volume at the end of the treatment period, that dropped to 28% in the follow-up. Moreover, the laser group demonstrated a cumulative increase from 15% to 33% in the tonometry readings over the forearm and anterior torso. The DASH score of the laser group showed progressive improvement over time. CONCLUSION: LLLT was effective in the management of PML, and the effects were maintained to the 4 wk follow-up. PMID: 19878027 [PubMed - in process ----------------------------- 1. Breast J. 2009 Nov 24. [Epub ahead of print] Older Breast Cancer Survivors: Factors Associated with Self-reported Symptoms of Persistent Lymphedema Over 7 years of Follow-up. Clough-Gorr KM, Ganz PA, Silliman RA. Geriatrics Section, Boston University Schools of Medicine and Public Health, Boston, Massachusetts. Lymphedema of the arm is a common complication of breast cancer with symptoms that can persist over long periods of time. For older women (over 50% of breast cancer cases) it means living with the potential for long-term complications of persistent lymphedema in conjunction with the common diseases and disabilities of aging over survivorship. We identified women >/=65 years diagnosed with primary stage I- IIIA breast cancer. Data were collected over 7 years of follow-up from consenting patients' medical records and telephone interviews. Data collected included self-reported symptoms of persistent lymphedema, breast cancer characteristics, and selected sociodemographic and health-related characteristics. The overall prevalence of symptoms of persistent lymphedema was 36% over 7 years of follow-up. Having stage II or III (OR = 1.77, 95% CI: 1.07-2.93) breast cancer and having a BMI >30 (OR = 3.04, 95% CI: 1.69- 5.45) were statistically significantly predictive of symptoms of persistent lymphedema. Women >/=80 years were less likely to report symptoms of persistent lymphedema when compared to younger women (OR = 0.44, 95% CI: 0.18-0.95). Women with symptoms of persistent lymphedema consistently reported worse general mental health and physical function. Symptoms of persistent lymphedema were common in this population of older breast cancer survivors and had a noticeable effect on both physical function and general mental health. Our findings provide evidence of the impact of symptoms of persistent lymphedema on the quality of survivorship of older women. Clinical and research efforts focused on risk factors for symptoms of persistent lymphedema in older breast cancer survivors may lead to preventative and therapeutic measures that help maintain their health and well-being over increasing periods of survivorship. PMID: 19968661 [PubMed - as supplied by publisher ------ 2. Hum Genet. 2009 Dec 5. [Epub ahead of print] Erratum to: Linkage and sequence analysis indicate that CCBE1 is mutated in recessively inherited generalised lymphatic dysplasia. Connell F, Kalidas K, Ostergaard P, Brice G, Homfray T, Roberts L, Bunyan DJ, Mitton S, Mansour S, Mortimer P, Jeffery S; Lymphoedema Consortium. Medical Genetics Unit, Clinical Developmental Sciences, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK. PMID: 19967415 [PubMed - as supplied by publisher ----- 3. J Cancer Surviv. 2009 Dec 6. [Epub ahead of print] The role of occupational upper extremity use in breast cancer related upper extremity lymphedema. Tahan G, Johnson R, Mager L, Soran A. Department of Surgery, Surgical Oncology, Magee-Womens Hospital of University of Pittsburgh, Pittsburgh, PA, 15213, USA. BACKGROUND: Upper extremity (UE) use has been related to breast cancer-related lymph edema (BCRL). Our aim was to evaluate severity of BCRL in different occupation groups, according to upper extremity use. METHODS: Fifty-five women with BCRL were recruited. Group-1 (n = 21), with a mean age of 59, included patients who worked continuously <30 min at a time and </=8 h per day. Group-2 (n = 15), with a mean age of 54, were patients who worked continuously between 30 to 60 min at a time, and </=8 h per day. Group-3 (n = 19), who had a mean age of 51, included patients who were working continuously for >1 h and >8 h per day. RESULTS: The age, operation type, infection occurrence, radiotherapy status, and the operation on the side of the dominant hand were not statistically different between the groups. The stage and grade of the BCRL in group-3 were higher than the other groups (both p < 0.001). The restriction of shoulder movements on the operation side (p = 0.04) and shoulder physiotherapy need (p < 0.001) were the highest in group-3. Arm pain (p = 0.004) and pain medicine needs (p = 0.028) in group-1 were lower than the other groups. CONCLUSION: Group-3 had the worst BCRL clinical stage and grade status and other breast cancer treatment related morbities. Occupations that require greater use of the upper extremities. At present there is a need for closer monitoring of patients with more severe BCRL. Potential exacerbating and maintaining factors of functional limitations and pain need to considered so that clinical management addresses these in relation to daily use of the affected UE PMID: 19967411 [PubMed - as supplied by publisher ------ 3. Rev Lat Am Enfermagem. 2009 Sep-Oct;17(5):730-6. Physiotherapy treatments for breast cancer-related lymphedema: a literature review. Leal NF, Carrara HH, Vieira KF, Ferreira CH. Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil. Breast cancer is the second most frequent cancer among women. Surgery is part of the therapeutic process to prevent metastases, but it can also cause some complications, including lymphedema. Physiotherapy contributes to its treatment, using different techniques that have been developed over the years. This systematic literature review aims to present physiotherapy modalities applied for lymphedema therapy. The literature review was conducted using textbooks and Lilacs, Pubmed and Scielo databases, from 1951 to 2009. Physiotherapy resources used for lymphedema treatment include complex decongestive therapy (CDT), pneumatic compression (PC), high voltage electrical stimulation (HVES) and laser therapy. The analyzed literature shows that better results are obtained with combined techniques. CDT is the most used protocol, and its association with PC has demonstrated efficacy. The new techniques HVES and laser present satisfactory results. PMID: 19967225 [PubMed - in process ----- 5. Br J Nurs. 2009 Oct 8-21;18(18):1120-4. Managing chronic oedema in the morbidly obese patient. Todd M. Lymphoedema Clinic, Greater Glasgow & Clyde NHS Trust, Glasgow. The obesity epidemic has become one of the major challenges for health and social policy makers around the world. The increase in obesity is commensurate with the rise in associated complications, including type 2 diabetes, cardiovascular disease and some types of cancer (breast, colon, endometrium, prostrate, kidney and gallbladder). There are also increased cost implications for health services, welfare services and employers. A crude estimate of approximately 15000 patients attending a US clinic showed almost 75% of morbidly obese patients have chronic oedema of the legs. An audit of body mass index of patients attending a specialist lymphoedema clinic showed 36% were clinically obese and 23% were morbidly obese. This has major implications for lymphoedema practitioners in terms of allocating time and resources, and health and safety issues relating to providing a safe environment for both patients and practitioners. This article investigates the financial and health consequences of the rising obesity problem and outlines some of the strategies implemented to halt this trend. The effects and management of chronic oedema in the morbidly obese patient are also presented. PMID: 19966731 [PubMed - in process] ---- 6. Pathophysiology. 2009 Dec 4. [Epub ahead of print] An interstitial hypothesis for breast cancer related lymphoedema. Bates DO. Microvascular Research Laboratories, Bristol Heart Institute, Department of Physiology and Pharmacology, School of Veterinary Sciences, University of Bristol, Southwell Street, Bristol BS2 8EJ, United Kingdom. Breast cancer related lymphoedema (BCRL), the chronically swollen arm of patients that have been treated for breast cancer, is no longer considered to be a result of lymphatic obstruction as recent studies have identified failing peripheral lymphatic function as a principal contributing factor. The aetiology and pathophysiology that results in this lymphatic failure is not clearly understood, but it can occur with minimal or even in some cases no damage to the axillary lymph nodes, and evidence suggests that some patients are pre-disposed to develop the disease, and have poor lymphatic function in their non-affected arms. It has been shown that interstitial forces such as hydrostatic pressure, and interstitial fluid velocity, can regulate both lymph flow, and lymph formation, and there is good evidence that interstitial forces are dysregulated in lymphoedema patients. Here I outline a hypothesis for how dysregulation of interstitial parameters could contribute to the generation of breast cancer related lymphoedema, by combining disparate strands of current evidence on the molecular and physiological control of interstitial and lymph flows. One mechanism by which lymphoedema could be generated is that a reduction in interstitial velocity results in increased VEGF-C production, which in low flow conditions, instead of acting on the lymphatics to increase pumping and lymphangiogenesis, acts on vasculature to increase fluid filtration. The resulting increase in interstitial pressure restores flow, but at the expense of increased volume and hence oedema. The evidence supporting the hypothesis and possible tests of it are presented and discussed. PMID: 19963358 [PubMed - as supplied by publisher --------------------- 1. J Reconstr Microsurg.. [Epub ahead of print] Comparison of Primary and Secondary Lower-Extremity Lymphedema Treated with Supermicrosurgical Lymphaticovenous Anastomosis and Lymphaticovenous Implantation. Demirtas Y, Ozturk N, Yapici O, Topalan M. Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey. Although some authors previously stated that microlymphatic surgery does not have application to primary lymphedema, opposite views are reported based on the observations that the lymphatics were not hypoplastic in majority of these patients and microlymphatic surgery yielded significant improvement. The aim of this study was to compare the intraoperative findings and outcomes of primary and secondary lower- extremity lymphedema cases treated with lymphaticovenous shunts. Between December 2006 and April 2009, microlymphatic surgery was performed in 80 lower extremities with primary and 21 with secondary lymphedema. These two groups of extremities are compared according to the morphology of the lymphatic vessels and possibility of precise anastomoses, their response to the treatment, and final outcomes based on volumetric measurements during the follow-up period. The morphology of the lymphatics in secondary lymphedema was more consistent, and at least one collector larger than 0.3 mm was available for anastomosis in 20 of 21 extremities. In the primary lymphedema group, the lymphatics were smaller than 0.3 mm in 13 of 80 extremities. It was, therefore, possible to perform supermicrosurgical lymphaticovenous anastomosis in 84% of extremities with primary lymphedema and 95% of extremities with secondary lymphedema. Reduction of the edema occurred earlier in the secondary lymphedema group, but the mean reduction in the edema volume was comparable between the two groups. Microlymphatic surgery, although more effective and offered as the treatment of choice for secondary lymphedema, would also be a valuable and relevant treatment of primary lymphedema. © Thieme Medical Publishers. PMID: 20013596 [PubMed - as supplied by publisher ---- 2. PLoS Pathog. 2009 Dec;5(12):e1000688. Lymphangiogenesis and lymphatic remodeling induced by filarial parasites: implications for pathogenesis. Bennuru S, Nutman TB. Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America. Even in the absence of an adaptive immune system in murine models, lymphatic dilatation and dysfunction occur in filarial infections, although severe irreversible lymphedema and elephantiasis appears to require an intact adaptive immune response in human infections. To address how filarial parasites and their antigens influence the lymphatics directly, human lymphatic endothelial cells were exposed to filarial antigens, live parasites, or infected patient serum. Live filarial parasites or filarial antigens induced both significant LEC proliferation and differentiation into tube-like structures in vitro. Moreover, serum from patently infected (microfilaria positive) patients and those with longstanding chronic lymphatic obstruction induced significantly increased LEC proliferation compared to sera from uninfected individuals. Differentiation of LEC into tube- like networks was found to be associated with significantly increased levels of matrix metalloproteases and inhibition of their TIMP inhibitors (Tissue inhibitors of matrix metalloproteases). Comparison of global gene expression induced by live parasites in LEC to parasite-unexposed LEC demonstrated that filarial parasites altered the expression of those genes involved in cellular organization and development as well as those associated with junction adherence pathways that in turn decreased trans-endothelial transport as assessed by FITC-Dextran. The data suggest that filarial parasites directly induce lymphangiogenesis and lymphatic differentiation and provide insight into the mechanisms underlying the pathology seen in lymphatic filariasis. PMID: 20011114 [PubMed - in process ---- 3. Am J Pathol.. [Epub ahead of print] MYC High Level Gene Amplification Is a Distinctive Feature of Angiosarcomas after Irradiation or Chronic Lymphedema. Manner J, Radlwimmer B, Hohenberger P, Mössinger K, Küffer S, Sauer C, Belharazem D, Zettl A, Coindre JM, Hallermann C, Hartmann JT, Katenkamp D, Katenkamp K, Schöffski P, Sciot R, Wozniak A, Lichter P, Marx A, Ströbel P. From the Institute of Pathology,* University Medical Centre Mannheim, University of Heidelberg, Germany; the German Cancer Research Center (DKFZ), Division of Molecular Genetics, Heidelberg, Germany; the Department of Surgery, Division of Surgical Oncology and Thoracic Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany; Pathology Viollier, Basle, Switzerland; the Department of Pathology and INSERM U916, Institut Bergonié and Laboratory of Pathology, University Victor Ségalen, Bordeaux, France; the Department of Dermatology, Fachklinik Hornheide, Münster; the Department of Medical Oncology,** Medical Center II, Eberhard-Karls-University, Tuebingen, Germany; the Institute of Pathology, University of Jena, Germany; the Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium; and the Laboratory of Morphology and Molecular Pathology, Department of Pathology, University Hospital, Catholic University of Leuven, Belgium. Angiosarcomas (AS) are rare vascular malignancies that arise either de novo as primary tumors or secondary to irradiation or chronic lymphedema. The cytogenetics of angiosarcomas are poorly characterized. We applied array-comparative genomic hybridization as a screening method to identify recurrent alterations in 22 cases. Recurrent genetic alterations were identified only in secondary but not in primary AS. The most frequent recurrent alterations were high level amplifications on chromosome 8q24.21 (50%), followed by 10p12.33 (33%) and 5q35.3 (11%). Fluorescence in situ hybridization analysis in 28 primary and 33 secondary angiosarcomas (31 tumors secondary to irradiation, 2 tumors secondary to chronic lymphedema) confirmed high level amplification of MYC on chromosome 8q24.21 as a recurrent genetic alteration found exclusively in 55% of AS secondary to irradiation or chronic lymphedema, but not in primary AS. Amplification of MYC did not predispose to high grade morphology or increased cell turnover. In conclusion, despite their identical morphology, secondary AS are genetically different from primary AS and are characterized by a high frequency of high level amplifications of MYC. This finding may have implications both for the diagnosis and treatment of these tumors. PMID: 20008140 [PubMed - as supplied by publisher --- 4. Surg Oncol.. [Epub ahead of print] Systematic review and meta-analysis of the used surgical techniques to reduce leg lymphedema following radical inguinal nodes dissection. Abbas S, Seitz M. Hunter and New England Health Area, Manning Hospital, 26 YORK Street, Taree, NSW 2430, Australia. BACKGROUND: Inguinal nodes dissection is associated with high rates of morbidity, lymphedema in particular is a chronic disabling condition which is a common complication following this operation. Prevention or minimization of this condition is an important aim when considering this procedure. Many technical modifications are suggested for this purpose. This systematic review aims at assessing the efficacy of the available strategies to reduce the risk and severity of leg lymphedema. METHODS: For this review, MEDLINE and EMBASE were searched to identify studies that reported surgical strategies designed to reduce complications of groin dissection and in particular leg lymphedema. Studies that reported outcome of long saphenous vein sparing, fascia preserving dissection, microvascular surgery, sartorius transposition and omental pedicle flap were located. Data were collected using predefined inclusion and exclusion criteria. A combined odds ratio was calculated combining studies suitable for meta- analysis using the random effect model. RESULTS: The search result defined few studies that reported results of saphenous vein sparing technique; some of those studies were found suitable for meta-analysis based on the Newcastle-Ottawa scale for non- randomized studies. The meta-analysis showed significant reduction of lymphedema (odds ratio 0.24, 95% CI 0.11-0.53) and other complications of inguinal node dissection. There were no randomized studies to address this problem; there are also isolated studies that reported benefits of other techniques but none of them was suitable for meta-analysis. CONCLUSION: Meta-analysis of the reported studies on sparing the long saphenous vein in inguinal nodes dissection suggests a reduced rate of lymphedema and other postoperative complications. Other methods that may be beneficial are fascia preserving dissection, pedicled omental flap and microsurgery; however sartorius transposition has not been shown to reduce the rate of complications. Randomized controlled trials are needed to prove the benefits of various technical modifications. PMID: 20005090 [PubMed - as supplied by publisher ---- 5. J Plast Reconstr Aesthet Surg.. [Epub ahead of print] Surgical resection of vulva lymphoedema circumscriptum. Vignes S, Arrault M, Trévidic P. Department of Lymphology, Hôpital Cognacq-Jay, 15, rue Eugène Millon, 75015 Paris, France. BACKGROUND: Lymphangioma circumscriptum, a rare, benign disease that can be either congenital or acquired, involves the deep dermis and subcutaneous lymphatics. OBJECTIVE: This study aims to analyse the efficacy of surgical resection of vulva lymphangioma circumscriptum (VLC). MATERIALS AND METHODS: Between January 2000 and December 2008, eight consecutive women referred to our centre and treated surgically for VLC were included in the study. VLC was responsible for recurrent lymph oozing in seven cases. All women were treated by the same plastic surgeon specialising in lymphatic diseases. RESULTS: The first surgery was performed after a median interval of 5.4 years since VLC onset. The first cutaneous resection included the labia majora of all women and labia minora of five and clitoral hood of four. Five women experienced rapidly recurrent vesicles associated with lymph oozing and underwent resection again (once: two women, twice: three women). The second resection was performed 4-6 months after the first, whereas the third took place 1-6 years after the second. Five women had moderate and transitory post- surgical lymph oozing. After a median follow-up of 53 months after the last surgery, seven of the eight women were free from symptom. CONCLUSION: Surgical resection is an effective and well-tolerated therapy for VLC in most women. Lesion recurrence is frequent but resection can be repeated several times with no adverse effects. PMID: 20004630 [PubMed - as supplied by publisher ---- 6. Adv Nurse Pract. 2009 Jun;17(6):29-30, 32. Fluid transport gone wrong. An introduction to lymphedema. Ridner SH. Vanderbilt University School of Nursing, Nashville, USA. PMID: 20000181 [PubMed - in process ----------------- 1. Eur J Obstet Gynecol Reprod Biol. 2009 Dec 15. [Epub ahead of print] Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: A review. Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR. Department Physiotherapy, University Hospitals Leuven, Belgium; Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium; Department of Health Care Sciences, University College of Antwerp, Belgium. The purpose of this article is to provide a systematic review of Combined Physical Therapy, Intermittent Pneumatic Compression and arm elevation for the treatment of lymphoedema secondary to an axillary dissection for breast cancer. Combined Physical Therapy starts with an intensive phase consisting of skin care, Manual Lymphatic Drainage, exercises and bandaging and continues with a maintenance phase consisting of skin care, exercises, wearing a compression sleeve and Manual Lymphatic Drainage if needed. We have searched the following databases: PubMed/MEDLINE, CINAHL, EMBASE, PEDro and Cochrane. Only (pseudo-) randomised controlled trials and non-randomised experimental trials investigating the effectiveness of Combined Physical Therapy and its different parts, of Intermittent Pneumatic Compression and of arm elevation were included. These physical treatments had to be applied to patients with arm lymphoedema which developed after axillary dissection for breast cancer. Ten randomised controlled trials, one pseudo-randomised controlled trial and four non-randomised experimental trials were found and analysed. Combined Physical Therapy can be considered as an effective treatment modality for lymphoedema. Bandaging the arm is effective, whether its effectiveness is investigated on a heterogeneous group consisting of patients with upper and lower limb lymphoedema from different causes. There is no consensus on the effectiveness of Manual Lymphatic Drainage. The effectiveness of skin care, exercises, wearing a compression sleeve and arm elevation is not investigated by a controlled trial. Intermittent Pneumatic Compression is effective, but once the treatment is interrupted, the lymphoedema volume increases. In conclusion, Combined Physical Therapy is an effective therapy for lymphoedema. However, the effectiveness of its different components remains uncertain. Furthermore, high-quality studies are warranted. The long-term effect of Intermittent Pneumatic Compression and the effect of elevation on lymphoedema are not yet proven. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved. PMID: 20018422 [PubMed - as supplied by publisher ---- 2. South Med J. 2009 Dec;102(12):1257-9. Palliation of malignant rectal obstruction from invasive prostate cancer with multiple overlapping self- expanding metal stents. Smith AS, Cole M, Vega KJ, Munoz JC. Division of Gastroenterology, University of Florida College of Medicine/Jacksonville, Jacksonville, FL 32207, USA. Self-expandable metal stents (SEMS) are used for colonic neoplastic and extracolonic metastatic obstruction relief. Limited data exists on their use for locally invasive prostate cancer. We describe a unique approach using overlapping SEMS to alleviate a rectosigmoid obstruction from locally invasive prostate cancer. A patient with locally advanced prostate cancer presented with obstipation and lymphedema. Placement of overlapping rectosigmoid SEMS was performed, relieving the visualized rectosigmoid obstruction. PMID: 20016435 [PubMed - in process ---- 3. Exerc Sport Sci Rev. 2010 Jan;38(1):17-24. Balancing lymphedema risk: exercise versus deconditioning for breast cancer survivors. Schmitz KH. University of Pennsylvania School of Medicine, Abramson Cancer Center, Philadelphia, 19104-6021, United States. Schmitz@mail.med.upenn.edu Lymphedema, a common and feared negative effect of breast cancer treatment, is generally described by arm swelling and dysfunction. Risk averse clinical recommendations guided survivors to avoid the use of the affected arm. This may lead to deconditioning and, ironically, the very outcome women seek to avoid. Recently published studies run counter to these guidelines. PMID: 20016295 [PubMed - in process ---- 4. Exerc Sport Sci Rev. 2010 Jan;38(1):2. Role of exercise in the prevention and management of lymphedema after breast cancer. Hayes SC. Queensland University of Technology, Australia. PMID: 20016292 [PubMed - in process 1. Eur J Obstet Gynecol Reprod Biol. 2009 Dec 15. [Epub ahead of print] Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: A review. Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR. Department Physiotherapy, University Hospitals Leuven, Belgium; Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium; Department of Health Care Sciences, University College of Antwerp, Belgium. The purpose of this article is to provide a systematic review of Combined Physical Therapy, Intermittent Pneumatic Compression and arm elevation for the treatment of lymphoedema secondary to an axillary dissection for breast cancer. Combined Physical Therapy starts with an intensive phase consisting of skin care, Manual Lymphatic Drainage, exercises and bandaging and continues with a maintenance phase consisting of skin care, exercises, wearing a compression sleeve and Manual Lymphatic Drainage if needed. We have searched the following databases: PubMed/MEDLINE, CINAHL, EMBASE, PEDro and Cochrane. Only (pseudo-) randomised controlled trials and non-randomised experimental trials investigating the effectiveness of Combined Physical Therapy and its different parts, of Intermittent Pneumatic Compression and of arm elevation were included. These physical treatments had to be applied to patients with arm lymphoedema which developed after axillary dissection for breast cancer. Ten randomised controlled trials, one pseudo-randomised controlled trial and four non-randomised experimental trials were found and analysed. Combined Physical Therapy can be considered as an effective treatment modality for lymphoedema. Bandaging the arm is effective, whether its effectiveness is investigated on a heterogeneous group consisting of patients with upper and lower limb lymphoedema from different causes. There is no consensus on the effectiveness of Manual Lymphatic Drainage. The effectiveness of skin care, exercises, wearing a compression sleeve and arm elevation is not investigated by a controlled trial. Intermittent Pneumatic Compression is effective, but once the treatment is interrupted, the lymphoedema volume increases. In conclusion, Combined Physical Therapy is an effective therapy for lymphoedema. However, the effectiveness of its different components remains uncertain. Furthermore, high-quality studies are warranted. The long-term effect of Intermittent Pneumatic Compression and the effect of elevation on lymphoedema are not yet proven. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved. PMID: 20018422 [PubMed - as supplied by publisher ---- 1. PLoS One. 2009 Dec 21;4(12):e8380. Anti-inflammatory pharmacotherapy with ketoprofen ameliorates experimental lymphatic vascular insufficiency in mice. Nakamura K, Radhakrishnan K, Wong YM, Rockson SG. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA. BACKGROUND: Disruption of the lymphatic vasculature causes edema, inflammation, and end-tissue destruction. To assess the therapeutic efficacy of systemic anti-inflammatory therapy in this disease, we examined the impact of a nonsteroidal anti-inflammatory drug (NSAID), ketoprofen, and of a soluble TNF- alpha receptor (sTNF-R1) upon tumor necrosis factor (TNF)-alpha activity in a mouse model of acquired lymphedema. METHODS AND FINDINGS: Lymphedema was induced by microsurgical ablation of major lymphatic conduits in the murine tail. Untreated control mice with lymphedema developed significant edema and extensive histopathological inflammation compared to sham surgical controls. Short-term ketoprofen treatment reduced tail edema and normalized the histopathology while paradoxically increasing TNF-alpha gene expression and cytokine levels. Conversely, sTNF-R1 treatment increased tail volume, exacerbated the histopathology, and decreased TNF-alpha gene expression. Expression of vascular endothelial growth factor-C (VEGF-C), which stimulates lymphangiogenesis, closely correlated with TNF-alpha expression. CONCLUSIONS: Ketoprofen therapy reduces experimental post-surgical lymphedema, yet direct TNF- alpha inhibition does not. Reducing inflammation while preserving TNF-alpha activity appears to optimize the repair response. It is possible that the observed favorable responses, at least in part, are mediated through enhanced VEGF-C signaling. PMID: 20027220 [PubMed - in process ---- 2. Vet Rec. 2009 Dec 26;165(25):758. Therapy for horses with chronic progressive lymphoedema. Powell H. 25A The Square, Alvechurch, Worcestershire B48 7LA. PMID: 20023285 [PubMed - in process ---- 3. In Vivo. 2009 Nov-Dec;23(6):1017-20. Incidence of arm lymphoedema following sentinel node biopsy, axillary sampling and axillary dissection in patients with breast cancer. Lumachi F, Basso SM, Bonamini M, Marino F, Marzano B, Milan E, Waclaw BU, Chiara GB. University of Padua, School of Medicine, Department of Surgical and Gastroenterological Sciences, Via Giustiniani 2, 35128 Padova, Italy. flumachi@unipd.it. The aim of this study was to compare the incidence of lymphoedema after different treatments of the axilla in patients with breast cancer (BC). Medical records of 205 women (median age 61 years, range 26-72 years) who underwent curative surgery for primary BC were reviewed. According to the treatment of the axilla, the study population was divided into four age- and stage-matched groups of patients: Group A (N=54 patients), sentinel node biopsy (SLNB) alone; Group B (N=48 patients), SLNB followed by axillary node (AN) sampling using ultrasound scissors (harmonic scalpel); Group C (N=53 patients), AN dissection using ultrasound scissors; Group D (N=50 patients), traditional AN dissection. The median follow-up was 22 months (range 18-28 months). The intraoperative frozen section of SLNB (Groups A and B) showed 32 out of 102 (31.4%) patients with metastasis to AN, while final pathology showed AN metastases in 20, 17, 16 and 17 patients of groups A, B, C and D, respectively (p=NS). The sensitivity of SLNB alone was 80% and that of SLNB followed by AN sampling was 95% (p=NS). At follow-up patients with lymphoedema were 2 (3.7%), 2 (4.2%), 3 (5.6%) and 8 (16%) in groups A, B, C and D, respectively (p=NS). In conclusion, AN sampling is a sensitive and low-morbidity procedure which, in conjunction with the use of harmonic scalpel, may reduce the onset of arm lymphoedema. PMID: 20023249 [PubMed - in process ----------------------- Eur J Cancer Care (Engl). 2009 Dec 17. [Epub ahead of print] Cancer-related secondary lymphoedema due to cutaneous lymphangitis carcinomatosa: clinical presentations and review of literature. Damstra RJ, Jagtman EA, Steijlen PM. Nij Smellinghe Hospital, Department of Dermatology and Phlebology and Lymphology, Compagnonsplein, Drachten, the Netherlands. DAMSTRA R.J., JAGTMAN E.A. & STEIJLEN P.M. (2009) European Journal of Cancer Care Cancer- related secondary lymphoedema due to cutaneous lymphangitis carcinomatosa: clinical presentations and review of literature Lymphoedema is a clinical condition caused by impairment of the lymphatic system, leading to swelling of subcutaneous soft tissues. As a result, accumulation of protein-rich interstitial fluid and lymphstasis often causes additional swelling, fibrosis and adipose tissue hypertrophy leading to progressive morbidity and loss of quality of life for the patient. Lymphoedema can be distinguished as primary or secondary. Lymphoedema is a complication frequently encountered in patients treated for cancer, especially after lymphadenoectomy and/or radiotherapy based on destruction of lymphatics. However, although lymphatic impairment is sometimes caused by obstructive solid metastasis, we present three cases of secondary lymphoedema with minor dermatological features without detectable solid metastasis. Sometimes this type of lymphoedema is mistakenly called malignant lymphoedema. All patients were previously treated for cancer without clinical signs of recurrence, presented with progressive lymphoedema and minor dermatological features of unknown origin. Clinical and histopathological examination of the skin revealed diffuse lymphangitis carcinomatosa, leading to secondary lymphoedema and adjustment of the therapeutic approach and prognosis. We reviewed literature on these rare presentations of cancer recurrence and recommend, where appropriate, consulting a dermatologist when discrete skin abnormalities are seen in patients with a history of cancer and developing lymphoedema. PMID: 20030691 [PubMed - as supplied by publisher ---- 1: Weight lifting in women with breast-cancer-related lymphedema. Authors: Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, Bryan CJ, Williams- Smith CT, Greene QP Institution: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. schmitz@mail.med.upenn.edu Journal: N Engl J Med. 2009 Aug 13;361(7):664-73. 2: Post-breast cancer lymphedema: part 2. Authors: Fu MR, Ridner SH, Armer J Institution: New York University College of Nursing, New York City, USA. mf67@nyu.edu Journal: Am J Nurs. 2009 Aug;109(8):34-41; quiz 42. 3: Post-breast cancer. Lymphedema: part 1. Authors: Fu MR, Ridner SH, Armer J Institution: New York University College of Nursing, New York City, USA. mf67@nyu.edu Journal: Am J Nurs. 2009 Jul;109(7):48-54; quiz 55. 4: The psycho-social impact of lymphedema. Authors: Ridner SH Institution: Vanderbilt University School of Nursing, Nashville, Tennessee 37240, USA. Sheila. Ridner@Vanderbilt.edu Journal: Lymphat Res Biol. 2009;7(2):109-12. 5: The standard of care for lymphedema: current concepts and physiological considerations. Authors: Mayrovitz HN Institution: College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL 33328, USA. mayrovit@nova.edu Journal: Lymphat Res Biol. 2009;7(2):101-8. 6: Prospective evaluation of a prevention protocol for lymphedema following surgery for breast cancer. Authors: Boccardo FM, Ansaldi F, Bellini C, Accogli S, Taddei G, Murdaca G, Campisi CC, Villa G, Icardi G, Durando P, Puppo F, Campisi C Institution: Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, S. Martino Hospital, University of Genoa, Italy. francesco.boccardo@unige.it Journal: Lymphology. 2009 Mar;42(1):1-9. 7: Suction-assisted lipectomy for treatment of lower-extremity lymphedema. Authors: Eryilmaz T, Kaya B, Ozmen S, Kandal S Institution: Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University School of Medicine, Ankara, Turkey. mdtolgaer@yahoo.com Journal: Aesthetic Plast Surg. 2009 Jul;33(4):671-3. Epub 2009 May 12. 8: Understanding the management of lymphoedema for patients with advanced disease. Authors: Honnor A Institution: Loros Hospice, Leicester, England. AmandaHonnor@loros.co.uk Journal: Int J Palliat Nurs. 2009 Apr;15(4):162, 164, 166-9. 9: Understanding breast cancer-related lymphoedema. Authors: Bennett Britton TM, Purushotham AD Institution: Department of Research Oncology, King's College London, Guy's & St. Thomas' NHS Foundation Trust, London, UK. Journal: Surgeon. 2009 Apr;7(2):120-4. 10: Compression therapy in breast cancer-related lymphedema: A randomized, controlled comparative study of relation between volume and interface pressure changes. Authors: Damstra RJ, Partsch H Institution: Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten, The Netherlands. r.damstra@nijsmellinghe.nl Journal: J Vasc Surg. 2009 May;49(5):1256-63. 11: Pole walking for patients with breast cancer-related arm lymphedema. Authors: Jonsson C, Johansson K Institution: Lymphedema Unit, Lund University Hospital, Lund, Sweden. charlotta.jonsson@skane.se Journal: Physiother Theory Pract. 2009 Apr;25(3):165-73. 12: Recent advances in breast cancer-related lymphedema of the arm: lymphatic pump failure and predisposing factors. Authors: Stanton AW, Modi S, Mellor RH, Levick JR, Mortimer PS Institution: Division of Cardiac & Vascular Sciences, Dermatology, St George's Hospital Medical School, University of London, London, United Kingdom. Journal: Lymphat Res Biol. 2009;7(1):29-45. 13: Breast cancer-related lymphoedema: risk factors and treatment. Authors: Harmer V Institution: Breast Care Unit, St Mary's Hospital Campus, Imperial College Healthcare, NHS Trust, London, UK. Journal: Br J Nurs. 2009 Feb 12-25;18(3):166-72. 14: Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: a randomized controlled trial. Authors: Kozanoglu E, Basaran S, Paydas S, Sarpel T Institution: Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey. Journal: Clin Rehabil. 2009 Feb;23(2):117-24. 15: Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Authors: Damstra RJ, Voesten HG, van Schelven WD, van der Lei B Institution: Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN, Drachten, The Netherlands. r.damstra@nijsmellinghe.nl Journal: Breast Cancer Res Treat. 2009 Jan;113(2):199-206. Epub 2008 Feb 13. 1. J Dermatol. 2009 Dec;36(12):646-8. Basal cell carcinoma arising on a chronic lymphedematous leg. Ueno T, Futagami A, Mitsuishi T, Niimi Y, Shimoda T, Kawana S. Department of Cutaneous and Mucosal Pathophysiology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. takashi-ueno@nms.ac.jp We describe a case of an 82-year-old Japanese woman with basal cell carcinoma (BCC) on the leg with secondary chronic lymphedema due to treatment for uterine cancer. Sparse tumor nests with remarkable edema of the dermis in the nodule appeared to be influenced by the chronic lymphedema. However, it remains inconclusive whether or not the tumorigenesis of the BCC was associated with chronic lymphedema in this case. PMID: 19958449 [PubMed - in process 2. Int J Gynecol Cancer. 2009 Dec;19(9):1649-54. Lower-limb lymphedema and vulval cancer: feasibility of prophylactic compression garments and validation of leg volume measurement. Sawan S, Mugnai R, Lopes Ade B, Hughes A, Edmondson RJ. Academic Unit of Obstetrics and Gynaecology, St Mary's Hospital, The University of Manchester, Manchester, United Kingdom. OBJECTIVES: Leg lymphedema remains a significant health problem after treatment of vulval cancer. This pilot study explored the feasibility of conducting a larger trial to investigate whether the early use of compression stockings is effective in preventing leg lymphedema. METHODS: Fourteen patients undergoing inguinofemoral lymphadenectomy for vulval cancer were randomized to either best supportive care or best supportive care plus the use of graduated compression stockings for 6 months. RESULTS: Six of 7 patients in the treatment group complied with the study protocol. The incidence of clinically significant lymphedema was not different between both groups; however, there was a greater increase in mean leg volume in the control group (953 vs 607 mL, P = 0.010). Furthermore, patients in the treatment group showed better performance as judged by leg symptoms (P = 0.031, at 3 months) and clinical examination (P = 0.039 at 4 weeks and P = 0.004 at 6 months). There was no difference in the incidence of groin wound dehiscence, infection, or lymphocyst formation. We detected no difference between both groups' scores when using a validated quality-of-life questionnaire. Intraobserver and interobserver variabilities of leg-volume measurement technique were investigated using the principles of repeatability and reproducibility statistics. Intraobserver variability was estimated at 270 mL, whereas interobserver variability was 1000 mL. CONCLUSIONS: The prophylactic use of stockings in this population is feasible, and further larger studies are justified to investigate its role in reducing the incidence of leg lymphedema. The design of these studies should take into account the observer-related variability in measuring leg volume or consider alternative methods. PMID: 19955953 [PubMed - in process |