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Lymphland International Lymphedema Online
| 1. Br J Community Nurs. 2009 Oct;14(10):S9-12, 14. Tackling obesity as part of a lymphoedema management programme. Stigant A. NHS Cumbria. andrea.stigant@cumbriapct.nhs.uk PMID: 19966696 [PubMed - indexed for MEDLINE] ----------- 2. Br J Community Nurs. 2009 Oct;14(10):S28-30. Lymphoedema is part of who I am. Summerhill L. PMID: 19966693 [PubMed - indexed for MEDLINE] ---------------------- 3. Br J Community Nurs. 2009 Oct;14(10):S20, 22-3. Manual handling in lymphoedema: the importance of getting it right. Pike C. British Lymphology Society. Cheryl.Pike@abm-tr.wales.nhs.uk PMID: 19966691 [PubMed - indexed for MEDLINE] --------------------------- 4. Br J Community Nurs. 2009 Oct;14(10):S15-6, 18-9. Breast cancer-related lymphoedema: implications for primary care. Harmer V. St.Mary's Hospital, Imperial College Healthcare NHS Trust, London. victoria.harmer@imperial.nhs.uk ------------------ PMID: 19966690 [PubMed - indexed for MEDLINE] ----------------- 1. Am J Clin Oncol. 2010 Jan 15. [Epub ahead of print] The Role of Chemo-Radiotherapy in the Management of Locally Advanced Carcinoma of the Vulva: Single Institutional Experience and Review of Literature. Tans L, Ansink AC, van Rooij PH, Kleijnen C, Mens JW. From the *Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands; daggerDepartment of Gynecological Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands; and double daggerDepartment of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. OBJECTIVE:: To retrospectively investigate the outcome and toxicity of concurrent chemo-radiotherapy in the treatment of locally advanced vulvar cancer (LAVC). PATIENTS AND METHODS:: Between 1996 and 2007, 28 consecutive patients with LAVC were treated with chemoradiation (20 primary tumors and 8 loco-regional recurrences). Treatment consists of 2 separate courses of external-beam radiotherapy (40 Gy-2 weeks split-20 Gy). During each course of radiotherapy, 5-fluorouracil (1000 mg/m /d), was given as a continuous intravenous infusion over the first 4 days, and mitomycin-C (10 mg/m on day 1), as a bolus intravenous injection. Outcome measures were rates of complete and partial response, loco-regional control, progression-free survival, overall survival, and toxicity. RESULTS:: The median follow-up was 42 months and the median age of patients was 68 years. Twenty patients (72%) achieved complete remission, 4 patients (14%) partial remission, for an overall response rate of 86%. Four patients (14%) had progressive disease directly after chemo-radiotherapy. The actuarial rates of loco-regional control, progression-free survival and overall survival at 4 years were 75%, 71%, and 65%, respectively. There was no treatment break for acute toxicity. Vulvar desquamation was the main acute treatment-related side effect (93%). Three patients developed transient grade 2 neutropenia or thrombocytopenia. Mild skin fibrosis and atrophy (n = 6, 21%), radiation ulcer (n = 4, 14%, in one patient treatment was needed), telangectasia (n = 3, 11%), and lymphoedema (n = 2, 7%) were the most common late toxicity of chemoradiation. CONCLUSION:: These data support the use of concurrent chemoradiotherapy as an effective alternative to primary ultra-radical surgery to treat LAVC with an acceptable toxicity profile. PMID: 20087157 [PubMed - as supplied by publisher] ------------------------ 2. J Postgrad Med. 2009 Oct-Dec;55(4):270-1. Yellow nail syndrome following thoracic surgery: A new association? Banta DP, Dandamudi N, Parekh HJ, Anholm JD. Loma Linda University Medical Center, VA Loma Linda Healthcare System, Loma Linda, California, USA. An 80-year-old man presented with the characteristic triad of yellow nail syndrome (chronic respiratory disorders, primary lymphedema and yellow nails) in association with coronary artery bypass graft surgery. Treatment with mechanical pleurodesis and vitamin E resulted in near complete resolution of the yellow nails, pleural effusions, and lower extremity edema. The etiology of the yellow nail syndrome has been described as an anatomical or functional lymphatic abnormality. Several conditions have previously been described as associated with this disease. This is the first report of the association of this syndrome with thoracic surgery. PMID: 20083874 [PubMed - in process] ------------------------- 3. Int J Palliat Nurs. 2009 Oct;15(10):474, 476-80. Understanding lymphoedema in advanced disease in a palliative care setting. Todd M. Specialist Lymphoedema Clinic, Glasgow, UK. marie.todd@ggc.scot.nhs.uk Lymphoedema in the palliative patient can be very distressing and uncomfortable, and managing this symptom is often difficult and labour intensive. Using a humanistic approach, the practitioner can holistically and sensitively assess the patient's needs and problems and develop a management strategy that ensures these needs are addressed. This requires a high level of skill in assessment, communication, collaborative working, and symptom management. The four basic principles of lymphoedema management are compression, massage, skin care and exercise. These principles are modified and applied on an individual patient basis through the support and collaboration of the team involved in each patient's care. PMID: 20081719 [PubMed - in process] --------------- 4. J Wound Care. 2010 Jan;19(1):15-7. Using VAC to facilitate healing of traumatic wounds in patients with chronic lymphoedema. Wollina U, Hansel G, Krönert C, Heinig B. Healing of traumatic injuries in patients with chronic lymphoedema is often delayed. This article describes how topical negative pressure was used to promote healing in two such cases. It also eliminated pain and prevented re-infection. PMID: 20081569 [PubMed - in process] ---------------- Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007585. Lymphadenectomy for the management of endometrial cancer. May K, Bryant A, Dickinson HO, Kehoe S, Morrison J. Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK, OX3 9DU. BACKGROUND: Endometrial carcinoma is the most common gynaecological cancer in western Europe and North America. Lymph node metastases can be found in approximately 10% of women who clinically have cancer confined to the womb prior to surgery and removal of all pelvic and para-aortic lymph nodes (lymphadenectomy) is widely advocated. Pelvic and para-aortic lymphadenectomy is part of the FIGO staging system for endometrial cancer. This recommendation is based on non-randomised controlled trials (RCTs) data that suggested improvement in survival following pelvic and para-aortic lymphadenectomy. However, treatment of pelvic lymph nodes may not confer a direct therapeutic benefit, other than allocating women to poorer prognosis groups. Furthermore, a systematic review and meta-analysis of RCTs of routine adjuvant radiotherapy to treat possible lymph node metastases in women with early-stage endometrial cancer, did not find a survival advantage. Surgical removal of pelvic and para-aortic lymph nodes has serious potential short and long-term sequelae and most women will not have positive lymph nodes. It is therefore important to establish the clinical value of a treatment with known morbidity. OBJECTIVES: To evaluate the effectiveness and safety of lymphadenectomy for the management of endometrial cancer. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2009. Cochrane Gynaecological Cancer Review Group Trials Register, MEDLINE (1966 to June 2009), Embase (1966 to June 2009). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA: RCTs and quasi-RCTs that compared lymphadenectomy with no lymphadenectomy, in adult women diagnosed with endometrial cancer. DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted data and assessed risk of bias. Hazard ratios (HRs) for overall and progression-free survival and risk ratios (RRs) comparing adverse events in women who received lymphadenectomy or no lymphadenectomy were pooled in random effects meta-analyses. MAIN RESULTS: Two RCTs met the inclusion criteria; they randomised 1945 women, and reported HRs for survival, adjusted for prognostic factors, based on 1851 women.Meta-analysis indicated no significant difference in overall and recurrence-free survival between women who received lymphadenectomy and those who received no lymphadenectomy (pooled HR = 1.07, 95% CI: 0.81 to 1.43 and HR = 1.23, 95% CI: 0.96 to 1.58 for overall and recurrence-free survival respectively).We found no statistically significant difference in risk of direct surgical morbidity between women who received lymphadenectomy and those who received no lymphadenectomy. However, women who received lymphadenectomy had a significantly higher risk of surgically related systemic morbidity and lymphoedema/lymphocyst formation than those who had no lymphadenectomy (RR = 3.72, 95% CI: 1.04 to 13.27 and RR = 8.39, 95% CI: 4.06, 17.33 for risk of surgically related systemic morbidity and lymphoedema/lymphocyst formation respectively). AUTHORS' CONCLUSIONS: We found no evidence that lymphadenectomy decreases the risk of death or disease recurrence compared with no lymphadenectomy in women with presumed stage I disease. The evidence on serious adverse events suggests that women who receive lymphadenectomy are more likely to experience surgically related systemic morbidity or lymphoedema/lymphocyst formation. PMID: 20091639 [PubMed - in process] ---------------- 2. Ann Oncol. 2010 Jan 20. [Epub ahead of print] Eccrine porocarcinoma presenting with scrotal lymphedema: a case report and review of systemic treatment. Perez-Garcia J, Morales R, Valverde CM, Rodon J, Suarez C, Semidey ME, Garcia-Patos V, Bartralot R, Serra M, Carles J. Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain. PMID: 20089564 [PubMed - as supplied by publisher ----------------------- 3. Zhongguo Zhen Jiu. 2009 Dec;29(12):998-1000. [Observation on 27 elderly women in britain with lymphedema syndrome treated by acupuncture combined with medicine] [Article in Chinese] Yang XH, Liu H, Chai JH, Zhao XC. Department of Acupuncture and Moxibustion, Jingmen Hospital of TCM, Jingmen 448000, China. xianhaiyang659@hotmail.com OBJECTIVE: To observe clinical effect of acupuncture combined with medicine therapy for elderly women in Britain with lymphedema syndrome. METHODS: Twenty-seven cases were classified according to syndrome differentiation of TCM into cold congealing and dampness obstruction type (11 cases), qi-blood stagnation type (12 cases) and downward attack of damp-heat type (4 cases). They were treated with acupuncture at main points Zusanli (ST 36), Yanglingquan (GB 34), Yinglingquan (SP 9), Sanyinjiao (SP 6), Taichong (LR 3), Fenglong (ST 40), Xuehai (SP 10), Fengshi (GB 31), Futu (ST 32), Liangqiu (ST 34), Weizhong (BL 40), etc., twice each week and oral administration of modified Duhuojisheng Decoction, Huangqiwuwu Decoction and Simiao San Decoction, respectively, meanwhile washing the affected limb with again decoction of remaining gruffs one medicament each day. They were treated for 12 weeks. RESULTS: Twelve cases were clinically cured, accounting for 44.4%, 14 cases were effective, accounting for 51.9%; and 1 case was ineffective, accounting for 3.7%. CONCLUSION: Acupuncture combined with medicine has a good therapeutic effect on lymphedema syndrome. PMID: 20088421 [PubMed - in process] ------------------ 1. Mamm Genome. 2009 Dec 29. [Epub ahead of print] Whole-genome scan identifies quantitative trait loci for chronic pastern dermatitis in German draft horses. Mittmann EH, Mömke S, Distl O. Institute of Animal Breeding and Genetics, University of Veterinary Medicine Hannover, Bünteweg 17p, 30559, Hannover, Germany. Chronic pastern dermatitis (CPD), also known as chronic progressive lymphedema (CPL), is a skin disease that affects draft horses. This disease causes painful lower-leg swelling, nodule formation, and skin ulceration, interfering with movement. The aim of this whole-genome scan was to identify quantitative trait loci (QTL) for CPD in German draft horses. We recorded clinical data for CPD in 917 German draft horses and collected blood samples from these horses. Of these 917 horses, 31 paternal half-sib families comprising 378 horses from the breeds Rhenish German, Schleswig, Saxon-Thuringian, and South German were chosen for genotyping. Each half-sib family was constituted by only one draft horse breed. Genotyping was done for 318 polymorphic microsatellites evenly distributed on all equine autosomes and the X chromosome with a mean distance of 7.5 Mb. An across-breed multipoint linkage analysis revealed chromosome-wide significant QTL on horse chromosomes (ECA) 1, 9, 16, and 17. Analyses by breed confirmed the QTL on ECA1 in South German and the QTL on ECA9, 16, and 17 in Saxon-Thuringian draft horses. For the Rhenish German and Schleswig draft horses, additional QTL on ECA4 and 10 and for the South German draft horses an additional QTL on ECA7 were found. This is the first whole-genome scan for CPD in draft horses and it is an important step toward the identification of candidate genes. PMID: 20039044 [PubMed - as supplied by publisher] -------------------- 2. Work. 2009;34(3):285-96. The impact of breast cancer among Canadian women: disability and productivity. Quinlan E, Thomas-MacLean R, Hack T, Kwan W, Miedema B, Tatemichi S, Towers A, Tilley A. University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N5A5. quinlanl@sasktel.net Each year over 20,000 Canadian women are diagnosed with breast cancer. Many breast cancer survivors anticipate a considerable number of years of potential participation in the paid labour market, therefore, the link between breast cancer survivorship and productivity deserves serious consideration. The hypothesis guiding this study is that arm morbidities such as lymphedema, pain, and range of motion limitations are important explanatory variables in survivors' loss of productivity. The study draws from a larger longitudinal research project involving over 600 breast cancer survivors in four geographical locations across Canada. The study's regression results indicate that, after adjusting for fatigue, breast cancer stage, and geographical location, survivors with range of motion limitations and arm pain are more than two and half times as likely to lose some productivity capacity as compared to counterparts with no arm morbidity. The findings make a compelling argument for the necessity of adequate rehabilitation programs delivered at crucial times in breast cancer survivors' recovery. The study's unexpected finding that geographical location is a highly significant predictor of changes in productivity among breast cancer survivors is interpreted as a factor of the regulatory framework governing employment relationships in the four different jurisdictions. PMID: 20037243 [PubMed - in process ----------------- 1. Clin Exp Dermatol. 2009 Dec;34(8):e931-3. Localized bullous pemphigoid in a patient with primary lymphoedema tarda. Perez A, Clements SE, Benton E, Robson A, Bhogal B, Stefanato CM, McGibbon D. St John's Institute of Dermatology, St Thomas' Hospital, London, UK. alfonso.perez@gstt.nhs.uk We report a case of localized bullous pemphigoid (BP) in a woman patient with primary lymphoedema tarda. There is only one previous case reported of localized pemphigoid in an area of lymphoedema, this being of the cicatricial variant. Slow circulation in the lymphatic vessels, increased capillary permeability with preferential localization of antibodies in the area, and potential cleavage of the epidermal junction due to increased hydrostatic pressure leading to autoimmunity, have all been advocated as possible pathogenic mechanisms. Nevertheless, we consider that the mechanism by which localized pemphigoid arises on lymphoedema remains elusive, based on a previous case of generalized BP sparing an area of postsurgical lymphoedema. PMID: 20055870 [PubMed - in process ---------------------- 2. Clin Exp Dermatol. 2009 Dec;34(8):e696-8. Epub 2009 Jul 3. Elephantiasis nostras verrucosa in a patient with systemic sclerosis. Chatterjee S, Karai LJ. Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic, 9500 Euclid Avenue/Desk A50, Cleveland, OH 44195, USA. chattes@ccf.org Elephantiasis nostras verrucosa (ENV) is an unusual skin condition characterized by dermal fibrosis and hyperkeratotic verrucous lesions resulting from chronic nonfilarial lymphoedema. The condition is similar to 'elephantiasis tropica', in which elephantiasis develops secondary to filariasis. Lymphatic obstruction can be primary or due to various causes such as surgery, tumour, radiation, congestive heart failure or obesity. Recurrent attacks of cellulitis lead to further impairment of lymphatic drainage, causing permanent swelling, dermal fibrosis and epidermal thickening. We report a case of a 56-year-old man with systemic sclerosis (SS), who presented with painful lesions on both legs, consistent with ENV. He developed extensive, fungating, papillomatous lesions on the skin of the legs, toes and dorsa of the feet over a period of 3 years. Histology revealed dense dermal fibrosis, oedema of the papillary dermis and extensive pseudo-epitheliomatous changes. To our knowledge, this is the first report of ENV in which SS was considered to be the primary cause for the impairment of lymphatic flow. PMID: 20055839 [PubMed - in process ----------------------------- 3. Breast Cancer Res Treat. 2010 Jan 7. [Epub ahead of print] Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer. Springer BA, Levy E, McGarvey C, Pfalzer LA, Stout NL, Gerber LH, Soballe PW, Danoff J. Proponency Office for Rehabilitation and Reintegration, Office of the Surgeon General, 5109 Leesburg Pike, Suite 684, Falls Church, VA, 22041-3258, USA, barb.springer@us.army.mil. In order to determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer (BC), and followed prospectively, a novel physical therapy surveillance model post-treatment was used. Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC, and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre-surgery), and 1, 3-6, and 12 months post-surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises. All measures of function were significantly reduced 1 month post-surgery, but most recovered to baseline levels by 1-year post-surgery. Some subjects developed signs of lymphedema 3-12 months post-surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ. Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by 3 months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by 1-year post-surgery. Lymphedema develops independently of shoulder function 3-12 months post-surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients. PMID: 20054643 [PubMed - as supplied by publisher ------------------------- 4. Hernia. 2010 Jan 7. [Epub ahead of print] Abdominoscrotal hydrocele in a 9-month old infant. Blevrakis E, Anyfantakis DI, Sakellaris G. Department of Pediatric Surgery, University General Hospital of Heraklion, Crete, Greece. Abdominoscrotal hydrocele represents an uncommon condition, especially in childhood, resulting from the communication of a large scrotal hydrocele with the abdominal cavity through the inguinal canal. The disorder has been associated with a variety of pathological entities such as hydronephrosis, lymphedema, and malignancy of the tunica vaginalis. Diagnosis is made by physical examination and confirmed by abdominal ultrasound scan. Surgical correction, although complex, remains the optimal therapeutic option. The present article reports the case of a 9-month infant from Greece with abdominoscrotal hydrocele. Regardless of rarity, the disorder should be included in the differential diagnosis of scrotal and abdominal masses, as early diagnosis and surgical intervention may prevent the development of potential complications. The difficulty in establishing a preoperative diagnosis highlights the necessity for a physician to have a high level of familiarity with abdominoscrotal hydrocele and its possible complications. Awareness of this abnormality will ensure its prompt recognition and optimal management. PMID: 20054596 [PubMed - as supplied by publisher] ---------------------- 1. J Mal Vasc. 2009 Nov;34(5):314-22. [Limb lymphedema: Diagnosis, explorations, complications][Article in French] Vignes S, Coupé M, Baulieu F, Vaillant L; Groupe Recommandations de la Société Française de Lymphologie. Unité de lymphologie, hôpital Cognacq-Jay, Centre national de référence des maladies vasculaires rares, 15, rue Eugène-Millon,75015 Paris, France. Lymphedema results from impaired lymphatic transport with increased limb volume. Primary and secondary forms can be distinguished. Secondary lymphedema of the upper limb is the most frequent in France. A 2-cm difference on any segment of the limb confirms the diagnosis of lymphedema. Calculated lymphedema volume using the formula for a truncated cone is required to assess the efficacy of treatment and to monitor follow-up. Primary lymphedema is sporadic but rarely familial. Lymphoscintigraphy is useful in the primary form to evaluate precisely lymphatic function of the two limbs. Erysipelas is the main complication,but psychological or functional discomfort may occur throughout the course of lymphedema. Lipedema is the main differential diagnosis, defined as an abnormal accumulation of fat from hip to ankle and occurs almost exclusively in obese women. PMID: 20050179 [PubMed - in process ---------------------- 2. Plast Reconstr Surg. 2010 Jan;125(1):19-23. Breast reconstruction and lymphedema. Chang DW, Kim S. Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. dchang@mdanderson.org BACKGROUND: The authors conducted this study to determine the following: Does delayed breast reconstruction that requires surgical dissection in the previously operated on and/or irradiated axilla lead to a higher incidence of lymphedema? In patients who have developed lymphedema following mastectomy, does delayed breast reconstruction with autologous flap reduce the severity of the lymphedema? METHODS: Four hundred eighty-two consecutive delayed autologous breast reconstructions performed at the authors' institution were evaluated. The authors evaluated the effects of flap choice, recipient vessel choice, previous radiotherapy, and previous axillary node dissection on lymphedema development after breast reconstruction. The authors also evaluated the effect of autologous breast reconstruction on the status of the preexisting lymphedema. RESULTS: Four hundred forty-four delayed breast reconstructions were performed using 394 free flaps and 50 latissimus dorsi flaps in patients with no lymphedema. Lymphedema developed in 16 cases (3.6 percent). The type of flap, the site of recipient vessel, previous radiotherapy, and previous axillary node dissection did not have a significant effect on the incidence of lymphedema after breast reconstruction. Breast reconstructions were performed in 38 patients who already had lymphedema: nine (23.7 percent) demonstrated significant improvement, and none demonstrated worsening of lymphedema after breast reconstruction. CONCLUSIONS: The incidence of lymphedema following delayed autologous breast reconstruction is low, and the use of thoracodorsal vessels or a latissimus dorsi flap, even in patients with previous axillary node dissection or irradiation, was not associated with a significantly higher risk of developing lymphedema. In patients who developed lymphedema following mastectomy, delayed autologous breast reconstruction may help reduce the severity of lymphedema. PMID: 20048582 [PubMed - in process -------------------- 1. Oncol Nurs Forum. 2010 Jan;37(1):85-91. Patient perceptions of arm care and exercise advice after breast cancer surgery. Lee TS, Kilbreath SL, Sullivan G, Refshauge KM, Beith JM. Royal North Shore Hospital, Sydney, Australia. teresa_s_lee@optusnet.com.au PURPOSE/OBJECTIVES: To describe in greater detail women's experiences receiving advice about arm care and exercise after breast cancer treatment. DESIGN: Cross-sectional survey. SETTING: Three hospitals in Sydney, Australia. SAMPLE: 175 patients with breast cancer recruited 6-15 months after their surgery. METHODS: Patients completed a survey about their perceptions of arm activity after breast cancer and were asked to respond to an open-ended question about their experience receiving advice about arm care and exercise. Comments from 48 women (27%) who volunteered responses were collated and categorized. MAIN RESEARCH VARIABLES: Patients' experience with arm care and exercise advice after breast cancer surgery. FINDINGS: Topics raised by respondents included perceptions of inadequate and conflicting advice, lack of acknowledgment of women's concerns about upper limb impairments, an unsupported search for information about upper limb impairments, fear of lymphedema, women's demand for follow-up physiotherapy, and some positive experiences with supportive care. CONCLUSIONS: Upper limb impairments are problematic for some breast cancer survivors, and these concerns are not always taken seriously by health professionals. To date, standardized advice is provided that does not meet the needs and expectations of a cohort of women after breast cancer surgery. IMPLICATIONS FOR NURSING: Health professionals could better address patients' concerns about upper limb impairments by providing accurate advice relevant to the surgery. PMID: 20044343 [PubMed - in process ---------------------- 2. Oncol Nurs Forum. 2010 Jan;37(1):E28-33. Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Rosedale M, Fu MR. College of Nursing, New York University, New York City, USA. mtr3@nyu.edu PURPOSE/OBJECTIVES: To describe women's unexpected and distressing symptom experiences after breast cancer treatment. RESEARCH APPROACH: Qualitative and descriptive.Setting: Depending upon their preference, participants were interviewed in their homes or in a private office space in a nearby library. PARTICIPANTS: Purposive sample of 13 women 1-18 years after breast cancer treatment. METHODOLOGIC APPROACH: Secondary analysis of phenomenologic data (constant comparative method). MAIN RESEARCH VARIABLES: Breast cancer symptom distress, ongoing symptoms, and unexpected experiences. FINDINGS: Women described experiences of unexpected and distressing symptoms in the years following breast cancer treatment. Symptoms included pain, loss of energy, impaired limb movement, cognitive disturbance, changed sexual experience, and lymphedema. Four central themes were derived: living with lingering symptoms, confronting unexpected situations, losing precancer being, and feeling like a has-been. Distress intensified when women expected symptoms to disappear but symptoms persisted instead. Increased distress also was associated with sudden and unexpected situations or when symptoms elicited feelings of loss about precancer being and feelings of being a has been. Findings suggest that symptom distress has temporal, situational, and attributive dimensions. CONCLUSIONS: Breast cancer survivors' perceptions of ongoing and unexpected symptoms have important influences on quality of life. Understanding temporal, situational, and attributive dimensions of symptom distress empowers nurses and healthcare professionals to help breast cancer survivors prepare for subsequent ongoing or unexpected experiences in the years after breast cancer treatment. INTERPRETATION: Follow-up care for breast cancer survivors should foster dialogue about ways that symptoms might emerge and that unexpected situations might occur. Prospective studies are needed to examine symptom distress in terms of temporal, situational, and attributive dimensions and explore the relationship between symptom distress and psychological distress after breast cancer treatment. PMID: 20044329 [PubMed - in process ---------------- 1. J Man Manip Ther. 2009;17(3):e80-9. Systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation: an evidence-based practice approach. Vairo GL, Miller SJ, McBrier NM, Buckley WE. Manual therapists question integrating manual lymphatic drainage techniques (MLDTs) into conventional treatments for athletic injuries due to the scarcity of literature concerning musculoskeletal applications and established orthopaedic clinical practice guidelines. The purpose of this systematic review is to provide manual therapy clinicians with pertinent information regarding progression of MLDTs as well as to critique the evidence for efficacy of this method in sports medicine. We surveyed English-language publications from 1998 to 2008 by searching PubMed, PEDro, CINAHL, the Cochrane Library, and SPORTDiscus databases using the terms lymphatic system, lymph drainage, lymphatic therapy, manual lymph drainage, and lymphatic pump techniques. We selected articles investigating the effects of MLDTs on orthopaedic and athletic injury outcomes. Nine articles met inclusion criteria, of which 3 were randomized controlled trials (RCTs). We evaluated the 3 RCTs using a validity score (PEDro scale). Due to differences in experimental design, data could not be collapsed for meta-analysis. Animal model experiments reinforce theoretical principles for application of MLDTs. When combined with concomitant musculoskeletal therapy, pilot and case studies demonstrate MLDT effectiveness. The best evidence suggests that efficacy of MLDT in sports medicine and rehabilitation is specific to resolution of enzyme serum levels associated with acute skeletal muscle cell damage as well as reduction of edema following acute ankle joint sprain and radial wrist fracture. Currently, there is limited high-ranking evidence available. Well-designed RCTs assessing outcome variables following implementation of MLDTs in treating athletic injuries may provide conclusive evidence for establishing applicable clinical practice guidelines in sports medicine and rehabilitation. PMID: 20046617 [PubMed - in process ------------------ 1. Gynecol Obstet Invest. 2010 Jan 12;69(3):212-216. [Epub ahead of print] Vulvar Lymphoedematous Pseudotumours Mistaken for Aggressive Angiomyxoma: Report of Two Cases. D'Antonio A, Caleo A, Boscaino A, Mossetti G, Iannantuoni N. Unit of Pathologic Anatomy, A.U.O. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy. Background: We describe 2 cases of vulvar pseudotumour due to lymphatic obstruction with chronic lymphoedema of unknown cause that presented as a solitary mass that mimicked aggressive angiomyxoma. Material and Methods: Both patients presented with a vulvar mass without medical history of trauma, surgery in the anogenital region or skin diseases. One patient was overweight (BMI = 26). Both surgically resected vulvar specimens were represented by a polypoid mass with a soft and a gelatinous cut surface. Results: Histologically, the presence of an abundant oedematous stroma with spindle-shaped cells and numerous thin-walled small-to-medium vessels may be confused with an aggressive angiomyxoma. The diagnostic key was represented by the massive oedema, rather than myxoid stroma, with the presence of dilated, tortuous lymphatic channels (some surrounded by clusters of lymphocytes) in the dermis. Conclusion: The recognition of these lesions is important because they may be the cause of problems in differential diagnosis and therapeutic management. In fact, such lesions can be mistaken from both the clinical and histological perspective as a primitive tumour of the vulva-like aggressive angiomyxoma. However, these lesions are not true neoplasms and are likely due to lymphatic obstruction with lymphoedema. A simple surgical excision with vulvoplasty is curative. Copyright © 2010 S. Karger AG, Basel. PMID: 20068325 [PubMed - as supplied by publisher ----------------- 2. BMJ. 2010 Jan 12;340:b5396. doi: 10.1136/bmj.b5396. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, Prieto Merino D, Mayoral del Moral O, Cerezo Téllez E, Minayo Mogollón E. Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain. maria.torres@uah.es OBJECTIVE: To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer. DESIGN: Randomised, single blinded, clinical trial. SETTING: University hospital in Alcalá de Henares, Madrid, Spain. PARTICIPANTS: 120 women who had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007. INTERVENTION: The early physiotherapy group was treated by a physiotherapist with a physiotherapy programme including manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder exercises. This group also received an educational strategy. The control group received the educational strategy only. MAIN OUTCOME MEASURE: Incidence of clinically significant secondary lymphoedema (>2 cm increase in arm circumference measured at two adjacent points compared with the non-affected arm). RESULTS: 116 women completed the one year follow-up. Of these, 18 developed secondary lymphoedema (16%): 14 in the control group (25%) and four in the intervention group (7%). The difference was significant (P=0.01); risk ratio 0.28 (95% confidence interval 0.10 to 0.79). A survival analysis showed a significant difference, with secondary lymphoedema being diagnosed four times earlier in the control group than in the intervention group (intervention/control, hazard ratio 0.26, 95% confidence interval 0.09 to 0.79). CONCLUSION: Early physiotherapy could be an effective intervention in the prevention of secondary lymphoedema in women for at least one year after surgery for breast cancer involving dissection of axillary lymph nodes. TRIAL REGISTRATION: Current controlled trials ISRCTN95870846. PMID: 20068255 [PubMed - in process ---------------------- 3. BMJ. 2010 Jan 12;340:b5235. doi: 10.1136/bmj.b5235. Prevention of lymphoedema after axillary surgery for breast cancer. Cheville A. PMID: 20068254 [PubMed - in process] ------------------------- 4. Physiother Theory Pract. 2010 Jan;26(1):62-8. Physical therapy management of primary lymphedema in the lower extremities: A case report. Greene R, Fowler R. Howard University, Washington, DC, USA. ragreene@howard.edu Lymphedema is the tissue fluid accumulation that arises as a consequence of impaired lymphatic drainage. Lymphedema can result from either congenital (primary) or acquired (secondary) anomalies. Primary lymphedema affects 1-2 million people in the United States. Women are more affected by this disorder than men. The management of lymphedema by physical therapists usually includes a combination of skin care, external pressure, isotonic exercise, and massage. This case report describes the course of treatment for a 24-year-old female with stages 2 and 3 primary lymphedema. The goals of physical therapy intervention were as follows: 1) to reduce total limb girth circumference for both lower extremities; 2) to improve skin texture; 3) to promote independence with skin care to reduce the risk of infection; and 4) to facilitate independence with self-management. Following intervention, the patient met and exceeded all goals to decrease limb circumference. She had minimal fibrosis in the lower extremities, and she exhibited no signs and/or symptoms of infection. Decongestive lymphedema therapy was effective in treating this patient with primary lymphedema of the lower extremities. Continuous maintenance is required to ensure that the patient's limb size continues to reduce. PMID: 20067355 [PubMed - in process] ------------------------- 5. Support Care Cancer. 2010 Jan 12. [Epub ahead of print] Retrospective trial of complete decongestive physical therapy for lower extremity secondary lymphedema in melanoma patients. Carmeli E, Bartoletti R. Tel Aviv University, Tel Aviv, Israel, elie@post.tau.ac.il. BACKGROUND: Melanoma is a malignant tumour of melanocytes, which are found predominantly in skin, and at least 10-45% of patients develop secondary lymphedema (SL). PURPOSE: This study seeks to investigate if individual's lymphatic system can benefit from complete decongestive physical therapy (CDPT) 1 year after discharge from CDPT and consequently endorsing a better quality of life. METHODS: Male and female(n = 12) melanoma survivors 1-4 years post diagnosis with unilateral SL. Questionnaire and limb measurements were used to asses retrospective outcomes. RESULTS: A significant improvements (p < 0.05) has been in the categories of localisation, staging, disability and symptoms of SL. CONCLUSIONS: CDPT provides relief in signs and symptoms for patients with SL following groyne dissection. PMID: 20066550 [PubMed - as supplied by publisher] ---------------------- 6. J Surg Oncol. 2010 Jan 8. [Epub ahead of print] Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer. Noguchi M, Yokoi M, Nakano Y. Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku, Japan. BACKGROUND: The ARM technique was proposed to prevent arm lymphedema after ALND and/or SLN biopsy. However, several problems remain to be resolved in the practical application of this technique. METHODS: The fluorescent ARM nodes and/or lymphatics were identified using a fluorescence imaging system with subdermal injection of indocyanine green into the upper limb. ALND was performed in patients with clinically involved nodes, and the ARM nodes were separately removed during ALND. SLN biopsy was performed in patients with clinically uninvolved nodes. If SLN was positive, ALND was performed with removal of ARM nodes. Otherwise, identified ARM nodes were preserved unless they were the same as SLN. RESULTS: ARM nodes and/or lymphatics were identified in 7 (88%) of 8 patients who underwent ALND, whereas they were identified in 9 (75%) of 12 patients who underwent SLN biopsy alone. ARM nodes were involved with tumors in 3 (43%) of the former patients, and SLN was the same as the ARM node in 2 (14%) of 14 patients who underwent SLN biopsy. CONCLUSIONS: Fluorescence imaging was sensitive for identification of ARM nodes and/or lymphatics. However, further studies are needed before efforts to preserve these nodes can be safely implemented. PMID: 20063370 [PubMed - as supplied by publisher] ------------------- 7. Cases J. 2009 Dec 22;2:9377. Challenges of cellulitis in a lymphedematous extremity: a case report. Connor MP, Gamelli R. Loyola University of Chicago, Stritch School of Medicine, 2160 South First Ave, Maywood IL, 60153, USA. INTRODUCTION: Lymphedema is a relatively common phenomenon. It is important that clinicians appreciate the relative risks imposed by this condition. While for some it may only represent a flaw in appearance, this condition can potentially have fatal consequences. Our case reports on the challenges of cellulitis in a lymphedematous extremity that progressed to septic shock. CASE PRESENTATION: A 37-year-old Hispanic male was transferred to the Burn Unit from an outside hospital for wound care of an extremely severe case of cellulitis. He suffered massive lymphedema of his lower extremity, with innumerable nodules and chronic skin changes. After 3 days of cellulitis, he was in critical condition and required intubation and vasopressors. With intense wound care and systemic antibiotics, he gradually recovered and was discharged in 16 days with his cellulitis resolved and ambulating independently. CONCLUSION: Our case highlights the special care and attention that chronic lymphedema deserves. These patients can exhibit marked disfigurement and physical disability affecting them on both social and physical levels. They also are at great medical risk, as cellulitis almost cost our patient his life. Evidence indicates that lymphedema, no matter the etiology, is susceptible to cellulitis with both great propensity and virulence. Physicians should be aware of the great risk of lymphedema, strive to prevent deterioration and complications, and be prepared to educate and closely monitor these patients. PMID: 20062550 [PubMed - in process] ----------------- 1. BMJ. 2010 Jan 12;340:b5396. doi: 10.1136/bmj.b5396. Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. Torres Lacomba M, Yuste Sánchez MJ, Zapico Goñi A, Prieto Merino D, Mayoral del Moral O, Cerezo Téllez E, Minayo Mogollón E. Physiotherapy Department, School of Physiotherapy, Alcalá de Henares University, E-28871 Alcalá de Henares, Madrid, Spain. maria.torres@uah.es OBJECTIVE: To determine the effectiveness of early physiotherapy in reducing the risk of secondary lymphoedema after surgery for breast cancer. DESIGN: Randomised, single blinded, clinical trial. SETTING: University hospital in Alcalá de Henares, Madrid, Spain. PARTICIPANTS: 120 women who had breast surgery involving dissection of axillary lymph nodes between May 2005 and June 2007. INTERVENTION: The early physiotherapy group was treated by a physiotherapist with a physiotherapy programme including manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder exercises. This group also received an educational strategy. The control group received the educational strategy only. MAIN OUTCOME MEASURE: Incidence of clinically significant secondary lymphoedema (>2 cm increase in arm circumference measured at two adjacent points compared with the non-affected arm). RESULTS: 116 women completed the one year follow-up. Of these, 18 developed secondary lymphoedema (16%): 14 in the control group (25%) and four in the intervention group (7%). The difference was significant (P=0.01); risk ratio 0.28 (95% confidence interval 0.10 to 0.79). A survival analysis showed a significant difference, with secondary lymphoedema being diagnosed four times earlier in the control group than in the intervention group (intervention/control, hazard ratio 0.26, 95% confidence interval 0.09 to 0.79). CONCLUSION: Early physiotherapy could be an effective intervention in the prevention of secondary lymphoedema in women for at least one year after surgery for breast cancer involving dissection of axillary lymph nodes. TRIAL REGISTRATION: Current controlled trials ISRCTN95870846. PMID: 20068255 [PubMed - in process] ----- 1. Br J Surg. 2010 Jan 25. [Epub ahead of print] Comparison of radionuclide lymphoscintigraphy and dynamic magnetic resonance lymphangiography for investigating extremity lymphoedema. Liu NF, Lu Q, Liu PA, Wu XF, Wang BS. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, China. BACKGROUND:: Lymphoscintigraphy is widely used to image the lymphatic system. The aim of this study was to compare lymphoscintigraphy and dynamic magnetic resonance lymphangiography (MRL) in the investigation of extremity lymphoedema. METHODS:: Sixteen patients with primary extremity lymphoedema and two with Klippel-Trenaunay syndrome with lymphoedema were examined by lymphoscintigraphy using the tracer (99)Tc-labelled dextran, and by MRL using gadobenate dimeglumine as contrast agent. Morphological abnormalities and functional state of the lymphatic systems of affected limbs were compared between the two imaging methods. RESULTS:: Lymphatic vessels were imaged in 14 of 18 limbs with lymphoedema using MRL, compared with one of 18 using lymphoscintigraphy. MRL detected the inguinal nodes in 16 of 17 patients, whereas lymphoscintigraphy revealed inguinal nodes in only nine. MRL revealed more precise information about structural and functional abnormalities of lymph vessels and nodes than lymphoscintigraphy by real-time measurement of lymph flow in vessels and nodes. CONCLUSION:: Dynamic MRL was more sensitive and accurate than lymphoscintigraphy in the detection of anatomical and functional abnormalities in the lymphatic system in patients with extremity lymphoedema. Copyright (c) 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. PMID: 20101589 [PubMed - as supplied by publisher] 2. Acta Oncol. 2010;49(2):166-73. Arm lymphoedema in a cohort of breast cancer survivors 10 years after diagnosis. Johansson K, Branje E. Department of Health Science, Lund University, S-221 00 Lund, Sweden. INTRODUCTION: Arm lymphoedema is a frequent complication after breast cancer treatment. Early diagnosis and treatment is considered important for successful management of breast cancer related arm lymphoedema (BCRL). The purpose was to identify BCRL incidence, time of onset, progression/regression and associated factors 10 years after breast cancer diagnosis. MATERIAL AND METHODS: Two hundred and ninety two patients treated with axillary node dissection and radiotherapy were included in this retrospective study. A total of 111 diagnosed with BCRL (incidence 38.7%). Of these women 98 were followed for up to 10 years after BCRL diagnosis. Forty consecutive patients registered with no BCRL were included in the control group. BCRL was defined as an increase in arm volume difference >or=5% and an increased thickness of subcutis. Follow-up was performed twice a year, including assessment of lymphoedema relative volume (LRV) by water displacement method and compression treatment. Additional intensive treatment was given if LRV increased by more than 5% since the previous visit or exceeded 20% in total. RESULTS: Mean LRV was 8.1 +/-3.6% at diagnosis and 9.0+/-6.7% at last follow-up measurement (mean 48.9+/-39.2 months) with no significant difference. There was no difference in progression of LRV between groups with early versus late diagnosis (within or after 12 months postoperatively), small (5-<10%) versus large (>or=10%) LRV at time of diagnosis, or regular (at least twice a year) versus non-regular treatment. More BCRL patients with large LRV at diagnosis (15.8%), exceeded LRV >or=20% during follow-up time, than patients with small LRV at diagnosis (10.1%). CONCLUSION: BCRL can be identified at an early stage both in regard to time of diagnosis after operation and to edema volume, and that edema volume can be kept at a low level for at least 10 years. Small LRV at time of diagnosis appears to be more important for minimizing the progression of LRV than time of diagnosis after operation. PMID: 20100154 [PubMed - in process] 3. Psychooncology. 2010 Jan 22. [Epub ahead of print] Predictors of arm morbidity following breast cancer surgery. Hack TF, Kwan WB, Thomas-Maclean RL, Towers A, Miedema B, Tilley A, Chateau D. Faculty of Nursing, University of Manitoba, Winnipeg, MB, Canada. Objective: Arm morbidity post-breast cancer surgery is increasingly being recognized as a chronic problem for some women following breast cancer surgery. The purpose of this study was to examine demographic, disease, and treatment-related predictors of a comprehensive array of chronic arm morbidity (pain, lymphedema, functional disability, and range of motion) post-breast cancer surgery. Methods: Women (n=316) with a non-metastatic primary diagnosis of breast cancer were accrued from cancer centers in four Canadian cities. Patients completed a clinical assessment and measures of arm morbidity at 6-12 months post-breast cancer surgery. The independent variables in the MANOVA to predict arm morbidity included: Lymph node management type, number of axillary nodes dissected, type of surgery, disease stage, presence of post-operative infection, radiation to the axilla, body mass index (BMI), assessment time post-surgery, education, and partner status. Results: Pain was significantly predicted by axillary lymph node management, lack of a partner, and post-operative infection; lymphedema by axillary lymph node management, number of axillary nodes dissected, radiation to the axilla, and having a modified radical mastectomy; functional disability by post-operative infection and high BMI; and restricted external rotation by axillary lymph node management, low educational attainment, and advanced disease. Conclusion: Comprehensive behavioral management and rehabilitation programs are needed to treat arm morbidity following breast cancer surgery. These programs should address the full scope of symptoms and associated psychosocial and functional sequelae. Copyright (c) 2010 John Wiley & Sons, Ltd. PMID: 20099254 [PubMed - as supplied by publisher] 4. J Dtsch Dermatol Ges. 2010 Jan;8(1):7-14 Podoconiosis - non-filarial geochemical elephantiasis - a neglected tropical disease? [Article in English, German] Nenoff P, Simon JC, Muylowa GK, Davey G. Laboratorium für medizinische Mikrobiologie, Mölbis, Germany. pietro.nenoff@gmx.de Podoconiosis or mossy foot is a form of non-filarial lymphedema. This geochemical elephantiasis is a disabling condition caused by the passage of microparticles of silica and aluminum silicates through the skin of people walking barefoot in areas with a high content of soil of volcanic origin. Podoconiosis is widespread in tropical Africa, Central America and North India, yet it remains a neglected and under-researched condition. The disabling effects of podoconiosis cause great hardship to patients. It adversely affects the economic (reduced productivity and absenteeism), social (marriage, education, etc.) and psychological (social stigma) well-being of those affected. Podoconiosis can be prevented; the main primary preventive measure is protective footwear. Secondary measures include a strict hygiene regimen and compression therapy, which can reverse initial lesions. Tertiary approaches include surgical management, such as shaving operations to reduce hyperplastic and verrucous elephantiasis. PMID: 20096054 [PubMed - in process] ---- 07 January 2010 - Leukemia Vaccine Appears To Mop Up Cancer Cells Gleevec Leaves Behind Preliminary investigations by US researchers suggest that a vaccine made with leukemia cells appears able to reduce or wipe out the last few cancer cells that are left behind in some patients with chronic myeloid leukemia (CML) who are taking the drug Gleevec (Imatinib mesylate). However, the researchers said the results are tentative and there could be other reasons for this apparent success. The pilot study, which was funded by the National Institutes of Health, is the work of a team led by Dr Hyam Levitsky, professor of oncology, medicine and urology at the Johns Hopkins Kimmel Cancer Center in Baltimore, Maryland, and appears in the 1 January issue of the journal Clinical Cancer Research. Gleevec, marketed by Novartis as Gleevec in the US and Glivec in Europe and Australia, is one of the first targeted cancer drugs to succeed in patients with CML. It destroys most of the cancer cells, but for many patients a few cells remain that can be detected with sensitive molecular tests. These remaining cells can cause the cancer to return, said the researchers, and especially when they come off the Gleevec. The researchers explained that most patients with CML have to stay on Gleevec for most of their lives and 90 per cent of them achieve remisson, but about 10 to 15 per cent can't tolerate it in the long term. Lead author Dr B Douglas Smith, associate professor of oncology at the Johns Hopkins Kimmel Cancer Center, told the press that: "Often patients have low blood cell counts, fluid retention, significant nausea and other gastrointestinal problems." Secondary therapies, including the drugs dasatinib and nilotinib, also have many side effects, he said, adding that another common side effect with Gleevec is fatigue: "Patients often tell me that they feel about 80 to 90 percent of what they should, and over time, this may have a big impact on their quality of life," he added. Gleevec also can't be taken by pregnant women, and since one third of CML patients tend to be in their 20s and 30s, many patients on the drug would like to come off it because they want to have children. Levitsky said that the ability to get patients off Gleevec would be a great advance, and if this vaccine is successful, that goal would be reached. For the study, Levitsky and colleagues used a vaccine made from CML cells. The vaccine is made by first irradiating the CML cells to stop them being cancerous, then altering their genetic make up so they produce an immune system stimulator known as GM-CSF (granulocyte-macrophage colony-stimulating factor, a substance that helps make more white blood cells of particular types). The treated CML cells also carry antigens that are specific to CML and prime the immune system to target and destroy any circulating CML cells. The researchers treated 19 CML patients with the vaccine: all the patients had measurable levels of CML cells, even though they had taken Gleevec for more than 12 months. They administered the vaccine on four occasions, three weeks apart, with 10 skin injections each time. They then followed up the patients after a median (mid-range) period of 6 years, at which point they found that the remaining cancer cells had gone down in 13 patients, of whom 12 also reached their lowest measured level of residual cancer cells at this point and of these seven had CML levels that were completely undetectable. However, the researchers were cautious to point out the limitations of the study: there was a limited number of patients, and there were no comparisons with other therapies. They said they could not be sure that it was the vaccine that caused the CML levels to drop. Levitsky told the media that more research was needed to confirm these findings, and that: "We want to get rid of every last cancer cell in the body, and using cancer vaccines may be a good way to mop up residual disease." Levitsky and colleagues are now testing the patients' blood to identify exactly which antigens are stimulating the immune system so they can tailor the vaccine for further investigations that examine the immune response in more detail. They said during this pilot study the patients showed few side effects from the trial vaccine, these included pain at the injection site, swelling, occasional muscle ache and mild fever. "K562/GM-CSF Immunotherapy Reduces Tumor Burden in Chronic Myeloid Leukemia Patients with Residual Disease on Imatinib Mesylate." B. Douglas Smith, Yvette L. Kasamon, Jeanne Kowalski, Christopher Gocke, Kathleen Murphy, Carole B. Miller, Elizabeth Garrett-Mayer, Hua-Ling Tsai, Lu Qin, Christina Chia, Barbara Biedrzycki, Thomas C. Harding, Guang Haun Tu, Richard Jones, Kristen Hege, and Hyam I. Levitsky. Clin Cancer Res January 1, 2010 16:338-347. DOI:10.1158/1078-0432.CCR-09-2046 Source: Johns Hopkins Medical Institutions, NCI Dictionary of cancer terms. Written by: Catharine Paddock, PhD 2. 31 December 2009 - Morbidity Of Open Retroperitoneal Lymph Node Dissection For Testicular Cancer: Contemporary Perioperative Data UroToday.com - Ours is a retrospective review of patients who underwent open retroperitoneal lymph node dissection between 2001-2008. We identified perioperative data for patients who underwent primary (P-RPLND) versus post-chemotherapy RPLND (PC-RPLND) and found mean blood loss, operative duration and hospital stay to be significantly less for the former group (P<0.05). A majority of the patients had high risk features at orchiectomy consisting of 146 (76%) embryonal carcinoma and 83 (44%) having lymphovascular invasion. Not surprisingly, more clinical stage I (CS I) patients underwent primary versus PC-RPLND (55% vs. 38%) and the converse for clinical stage II (CSII) disease (45% vs. 62%). Overall, there were 18 (9%) complications with 7 (7%) and 11 (12%) in the primary and PC-RPLND groups, respectively. All of these complications consisted pain, ileus, and chylous ascites except one patient who had an intraoperative aortic injury. There were no peri-operative deaths. This contemporary data should be considered when comparing open versus laparoscopic RPLND (L-RPLND). Although L-RPLND has become an established alternative for management of CS I patients, more research is needed in patients with high-risk features and/or post-chemotherapy treated patients. The minimal morbidity of patients undergoing open RPLND by a dedicated tertiary center has been described in this contemporary group of patients and should be considered when comparing open to L-RPLND. Written by Stephen B. Williams, MD, et al. as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract. UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com ------------------ 1. Oper Orthop Traumatol. 2009 Dec;21(6):545-56. The surgical treatment of chronic extension deficits of the knee] [Article in German] Freiling D, Lobenhoffer P. Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Henriettenstiftung Hannover, Hannover, Germany. d.freiling@gmx.de OBJECTIVE : Restoration of full knee extension in patients with chronic extension deficits, especially in posttraumatic and postoperative cases. INDICATIONS : Chronic knee extension deficits of more than 10 degrees . CONTRAINDICATIONS : Local intraarticular problems caused by cyclops syndrome, graft hypertrophy or graft impingement after anterior cruciate ligament reconstruction (notch impingement). These patients should be treated with arthroscopic procedures. Spastic flexion contracture. Noncompliant patients. Acute or chronic infections. Poor soft-tissue conditions on site of surgery. SURGICAL TECHNIQUE : If necessary, arthroscopy before arthrolysis to assure that the extension deficit is not caused by a local problem (cyclops, osteophytes, graft hypertrophy or graft impingement after anterior cruciate ligament reconstruction). Anterior skin incision at the medial border of the patellar ligament. Resection of Hoffa's fat pad, which is extremely fibrotic in almost all cases. Second skin incision at the posteromedial side of the knee joint. Incision of the medial retinaculum between the posterior border of the medial collateral ligament and the posterior oblique ligament. Posteromedial arthrotomy between the distal part of the tendon of the adductor magnus muscle and the posterior horn of the medial meniscus. Release of all adhesions in the posterior recess of the knee joint. Complete release of the posterior joint capsule from the femoral shaft. POSTOPERATIVE MANAGEMENT : Immobilization for 48 h after surgery in full extension (no knee motion allowed in the first 48 h). For 48 h after surgery only short walks to the bathroom are allowed. Special dynamic extension brace (Dynasplint((R)), CDS((R)) Forte, Albrecht company, Stephanskirchen, Germany) for 4-6 weeks after surgery 6-8 h per day. Painkillers following WHO (World Health Organization) protocol. Manual lymph drainage and electric muscle stimulation help to decrease pain and swelling. Physiotherapy twice daily starting at the 2nd postoperative day. No flexion exercises for the first 7 days after surgery. 15 kg partial weight bearing for 4-6 weeks. Daily physiotherapy is recommended after discharge. RESULTS : 121 patients underwent anterior and posterior arthrolysis between 1990 and 2000. 86 of these patients could be included in this study. The average follow-up was 4.6 years (1-10 years). The extension deficit before surgery averaged 20 degrees compared with the opposite side. At follow-up, the average extension had increased by 17 degrees , no patient had more than 5 degrees of flexion contracture. The Lysholm Score was 84 postoperatively. The Tegner Activity Scale increased from 1.9 to 4.0 after arthrolysis. In the AOSSM Subjective Outcome Score, 35 patients showed excellent and 60 good results. 14 patients were satisfied after surgery and nine were not. Three patients required revision surgery (two synovial fistulas, one hematoma). PMID: 20087716 [PubMed - in process] |