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Lymphland International Lymphedema Online
Ann Dermatol Venereol. 2011 June - July;138(6-7):508-511. Epub 2011 Mar 27.
[Recurrent breast cellulitis associated with lymphangiectasia after tumorectomy for breast cancer.]
[Article in French]
Bibas N, Escande H, Ofaiche J, Le Moigne M, Viraben R, Nougué J.
Source
Service de dermatologie, CHG, 100, rue Léon-Cladel, 82013 Montauban cedex, France.
Abstract
BACKGROUND:
Recurrent breast cellulitis has been described as a complication following breast conservation therapy.
OBSERVATION:
A 50-year-old woman undergoing tumour excision, postoperative radiotherapy and chemotherapy
presented recurrent breast cellulitis in the same region. The presence of lymphangiectasia suggested a
complication subsequent to lymph stasis.
DISCUSSION:
Conservative therapy for breast cancer, allowing the development of subclinical or patent lymphœdema,
constitutes a prominent risk factor for recurrent cellulitis. This complication has also been considered in
patients with lower extremity cellulitis following saphenous venectomy for coronary bypass surgery. The
unusual presence of lymphangiectasia observed in our patient provides clear evidence that lymphœdema is
the most prominent risk factor for the development of cellulitis after breast conservation therapy.
Copyright © 2011. Published by Elsevier Masson SAS.
PMID: 21700073 [PubMed - as supplied by publisher]
July 8, 2011
J Oncol Pract. 2011 Mar;7(2):89-93.
Effects of early exercise on the development of lymphedema in patients with breast cancer treated with
axillary lymph node dissection.
Cavanaugh KM.
Source
University of Pennsylvania, Philadelphia, PA.
Abstract
PURPOSE:
Despite advances in the treatment of breast cancer, there is little research examining the prevention of
lymphedema after breast and/or axillary surgery. Currently, there are no national guidelines for activity
restrictions; however, many medical providers recommend restricting activity of the surgically affected arm,
which can create quality-of-life issues as well as future medical issues for patients with breast cancer.
METHODS:
A literature review of several current research articles was performed. This report reviews four studies
evaluating the effects of restricted activity versus progressive exercise and stretching activities on
development of lymphedema.
RESULTS:
The results show that there is no difference in the risk of developing lymphedema when following activity
guidelines. All four of the studies reviewed report results of either a decrease in the development of
lymphedema or no increased risk of development of lymphedema when early exercise regimens are
incorporated into postoperative care.
CONCLUSION:
The four research articles show promising results that support future change in practice guidelines. However,
none of the studies report follow-up results beyond 2 years. Additionl evaluation to monitor long-term
effects is warranted.
PMID: 21731515 [PubMed - in process] PMCID: PMC3051868
Clin Microbiol Infect. 2011 Jul;17(7):977-85. doi: 10.1111/j.1469-0691.2011.03586.x.
Filariasis in Africa-treatment challenges and prospects.
Hoerauf A, Pfarr K, Mand S, Debrah AY, Specht S.
Source
Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Sigmund Freud
Strasse, Bonn, Germany Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and
Technology Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.
Abstract
Clin Microbiol Infect 2011; 17: 977-985 ABSTRACT: Lymphatic filariasis (LF) and onchocerciasis are
parasitic nematode infections that are responsible for a major disease burden in the African continent.
Disease symptoms are induced by the immune reactions of the host, with lymphoedema and hydrocoele in
LF, and dermatitis and ocular inflammation in onchocerciasis. Wuchereria bancrofti and Onchocerca
volvulus, the species causing LF and onchocerciasis in Africa, live in mutual symbiosis with Wolbachia
endobacteria, which cause a major part of the inflammation leading to symptoms and are antibiotic targets
for treatment. The standard microfilaricidal drugs ivermectin and albendazole are used in mass drug
administration programmes, with the aim of interrupting transmission, with a consequent reduction in the
burden of infection and, in some situations, leading to regional elimination of LF and onchocerciasis. Co-
endemicity of Loa loa with W. bancrofti or O. volvulus is an impediment to mass drug administration with
ivermectin and albendazole, owing to the risk of encephalopathy being encountered upon administration of
ivermectin. Research into new treatment options is exploring several improved delivery strategies for the
classic drugs or new antibiotic treatment regimens for anti-wolbachial chemotherapy.
© 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical
Microbiology and Infectious Diseases.
PMID: 21722251 [PubMed - in process]
J Reconstr Microsurg. 2011 Jun 29. [Epub ahead of print]
Immediate Microsurgical Breast Reconstruction and Simultaneous Sentinel Lymph Node Dissection: Issues
with Node Positivity and Recipient Vessel Selection.
Curtis MS, Arslanian B, Colakoglu S, Tobias AM, Lee BT.
Source
Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York.
Abstract
Sentinel lymph node dissection (SLND) during mastectomy has been increasing given the decreased risk of
lymphedema. Simultaneous reconstruction with a microsurgical breast reconstruction is often performed, but
with node positivity a completion axillary lymph node dissection (ALND) must be performed subsequently.
This study examines the potential risks especially in relation to microsurgical reconstruction. All patients
undergoing microsurgical breast reconstruction at an academic institution from 2004 to 2010 were evaluated
in a prospective database. Patients with immediate reconstruction and SLND were identified. Management
of positive lymph node status was ascertained through extensive chart review. There were 610
reconstructions performed, 170 delayed and 440 immediate. From the immediate reconstructions, 110
patients (25%) had SLND and of these patients, 16 (14.55%) had a positive SLND. All 16 patients had
internal mammary recipient vessels for free tissue transfer. Seven patients had intraoperative completion
ALND, while nine patients had staged completion ALND at a later date. There were no adverse affects
from completion ALND. Simultaneous mastectomy, SLND, and microsurgical reconstruction can be
performed safely. The internal mammary vessels are preferred recipient vessels as node positive patients
may require subsequent completion ALND. If a thoracodorsal anastomosis is performed, a potential risk
exists for vessel injury and flap loss with completion ALND.
© Thieme Medical Publishers.
PMID: 21717397 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Jun 30. [Epub ahead of print]
Reduction/Prevention of Lower Extremity Lymphedema after Pelvic and Para-aortic Lymphadenectomy for
Patients with Gynecologic Malignancies.
Hareyama H, Ito K, Hada K, Uchida A, Hayakashi Y, Hirayama E, Oikawa M, Okuyama K.
Source
Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan, hitoshi.
hareyama@doc.city.sapporo.jp.
Abstract
BACKGROUND:
Lower extremity lymphedema (LEL) is a serious complication caused by lymphadenectomy in patients with
gynecologic malignancies. In this study, we evaluated the effect of preserving the circumflex iliac lymph
nodes (CILNs), i.e., the most caudal external iliac lymph nodes, for the prevention and reduction of LEL by
comparing two groups of patients, one in which CILN were removed and the other in which CILNs were
preserved.
METHODS:
We retrospectively reviewed 329 patients with gynecologic malignancies who had undergone abdominal
complete systematic pelvic and para-aortic lymphadenectomy. The patients were divided into nonpreserved
(n = 189) and preserved (n = 140) groups, depending on whether CILNs were removed. Primary outcome
measures included the incidence and severity of LEL.
RESULTS:
The incidence of LEL was significantly lower in the preserved group than in the nonpreserved group (P <
0.0001). The frequency of LEL was also significantly lower in the preserved group than in the nonpreserved
group regardless of the range of pelvic and para-aortic lymphadenectomy (P < 0.0001). LEL in the
overwhelming majority of cases in the preserved group was mild, and no patients experienced severe LEL.
Further, the incidence of cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved
group (P < 0.0001). Lymphoscintigraphy revealed collateral pathways from the preserved CILN along the
iliac and large abdominal vessels.
CONCLUSIONS:
This method of lymph node preservation is a simple and extremely effective approach for
preventing/reducing LEL after pelvic and para-aortic lymphadenectomy for patients with gynecologic
malignancies.
PMID: 21717243 [PubMed - as supplied by publisher]
July 12, 2011
Afr J Med Med Sci. 2010 Dec;39(4):329-32.
The learning curve of radical hysterectomy for early cervical carcinoma.
Oladokun A, Morhason-Bello IO, Bello FA, Adewole IF.
Source
Department of Obstetrics & Gynaecology, College of Medicine, University College Hospital, Ibadan,
Nigeria. sinaoladokun@yahoo.com
Abstract
Cervical cancer remains a public health concern in developing countries that lack the wherewithal to cope
with the associated challenges. Screening for premalignant cervical lesions and offering definitive care for
early disease is the key to preventing the scourge. We conducted an audit of the radical hysterectomies
performed on account of early cervical carcinoma at our centre between September 2006 and August
2008, following capacity-building by Operation Stop Cervical Cancer. Ten women aged 35 to 60 years
were managed. All had type III radical hysterectomy. Three patients had adjuvant teletherapy (one was
stage IIb, diagnosed intra-operatively). There was a linear reduction in the surgical blood loss and duration
of surgery. Average blood loss was 1500 mls; four had blood transfusions. One case was complicated with
rectovaginal fistula (the woman with stage IIb disease) and another had bilateral lymphoedema and left lower
limb sensory neuropathy. There was no tumour recurrence on follow-up. Definitive surgery for early cervical
cancer is feasible in developing countries despite limited resources. Audit of surgical care of cervical cancer
will assist in strengthening the scarce skill. Determination of suitable cases during preoperative evaluation is
crucial to the success of the surgery.
PMID: 21736000 [PubMed - in process]
ONS Connect. 2011 Jun;26(6):14-5.
Lymphedema in head and neck cancer.
Becze E.
PMID: 21735767 [PubMed - in process]
J Cancer Surviv. 2011 Jul 7. [Epub ahead of print]
Do breast cancer survivors' post-surgery difficulties with recreational activities persist over time?
Miedema B, Hamilton R, Tatemichi S, Thomas-Maclean R, Hack TF, Quinlan E, Towers A, Tilley A,
Kwan W.
Source
Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, 700
Priestman Street, Fredericton, NB, Canada, baukje.miedema@horizonNB.ca.
Abstract
INTRODUCTION:
Most longitudinal breast cancer studies have found that treatment-related sequelae such as arm morbidity
[lymphedema, pain, and range of motion (ROM) restrictions] can have a significant impact on quality of life.
In a previous study, we found that at 6-12 months after breast cancer surgery, 49% of participants had
difficulties engaging in recreational activities and that arm morbidity significantly predicted difficulties with
participation in recreation.
METHODS:
A longitudinal national study employing clinical assessments and survey methods followed 178 women over
43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical
multiple regression analyses were conducted to identify which variables were predictive of recreational
difficulties experienced by women 8 and 43 months post-surgery.
RESULTS:
Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight
increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM
restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women
continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be
statistically significant (p < 0.001) predictors of recreational difficulties at both 8 and 43 months post-surgery,
with pain accounting for the greatest proportion of variance.
DISCUSSION/CONCLUSION:
Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6
years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer
surgery report difficulties in their recreational pursuits. IMPLICATIONS FOR CANCER SURVIVORS:
Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should
be sought.
PMID: 21735276 [PubMed - as supplied by publisher
Breast Cancer Res Treat. 2011 Jul 7. [Epub ahead of print]
A SEER-Medicare population-based study of lymphedema-related claims incidence following breast cancer
in men.
Reiner AS, Jacks LM, Van Zee KJ, Panageas KS.
Source
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd
Street, New York, NY, 10065, USA, reinera@mskcc.org.
Abstract
Each year there are an estimated 200,000 new breast cancer cases diagnosed in the United States; of these,
1% of cases are in men. Lymphedema can be a devastating complication from breast cancer and its
treatment. Currently, almost all lymphedema-related research is based on women and extrapolated to men.
We conducted the first population-based study of men with incident breast cancer of any stage, diagnosed
from 1998 to 2005, who were 65 years and older in the Surveillance, Epidemiology, and End Results
(SEER)-Medicare linked database. We utilized claims related to lymphedema and lymphedema treatment in
our cohort. We defined 'lymphedema-specific' claims to contain the word 'lymphedema' in the Medicare
claim description; similarly, 'lymphedema-related' claims were defined as treatments reimbursed for
lymphedema but not necessarily containing the word 'lymphedema' in the Medicare claim description. We
identified 628 men with incident breast cancer from 1998 to 2005 who were 65 years and older. The
cumulative incidence, censored for deaths, of lymphedema-specific claims at 2, 3, 4, and 5 years was 8.0,
9.2, 10.5, and 10.5%, respectively. The median follow-up was 3.4 years and for those without any event
was 4.7 years. The cumulative incidence, censored for deaths, of lymphedema-related claims at 2, 3, 4, and
5 years was 26.9, 32.2, 35.4, and 39.8%. Rates for men were similar to analogous rates for women.
Lymphedema is a common complication affecting men with breast cancer as well as women and appropriate
treatment and rehabilitation strategies need to be implemented for both genders.
PMID: 21735047 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 Jul 5. [Epub ahead of print]
Upper Extremity Lymphedema Index: A Simple Method for Severity Evaluation of Upper Extremity
Lymphedema.
Yamamoto T, Yamamoto N, Hara H, Mihara M, Narushima M, Koshima I.
Source
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University
of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Measurement of the circumference is the most commonly employed method for evaluating extremity
lymphedema. However, comparison between different patients is difficult with this measurement. To resolve
this problem, we have formulated a new index, upper extremity lymphedema (UEL) index, which can be
easily obtained from measurements of the body. We evaluated correlation between UEL index and clinical
stage in patients with UEL. The UEL indices were significantly correlated with clinical stages and could be
used as a severity scale. The lower extremity lymphedema index makes objective assessment of the severity
of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the
index useful for evaluation of lymphedema severities between different cases.
PMID: 21734534 [PubMed - as supplied by publisher
Integr Cancer Ther. 2011 Jul 6. [Epub ahead of print]
Impact of Yoga on Functional Outcomes in Breast Cancer Survivors With Aromatase Inhibitor-Associated
Arthralgias.
Galantino ML, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ.
Source
The Richard Stockton College of New Jersey, Pomona, NJ, USA; University of Pennsylvania, Philadelphia,
PA, USA.
Abstract
Arthralgia affects postmenopausal breast cancer survivors (BCSs) receiving aromatase inhibitors (AIs). This
study aims to establish the feasibility of studying the impact of yoga on objective functional outcomes, pain,
and health-related quality of life (HR-QOL) for AI-associated arthralgia (AIAA). Postmenopausal women
with stage I to III breast cancer who reported AIAA were enrolled in a single-arm pilot trial. A yoga
program was provided twice a week for 8 weeks. The Functional Reach (FR) and Sit and Reach (SR) were
evaluated as primary outcomes. Pain, as measured by the Brief Pain Inventory (BPI), self-reported Patient
Specific Functional Scale (PSFS), and Functional Assessment of Cancer Therapy-Breast (FACT-B) were
secondary outcomes. Paired t tests were used for analysis, and 90% provided data for assessment at the
end of the intervention. Participants experienced significant improvement in balance, as measured by FR,
and flexibility, as measured by SR. The PSFS improved from 4.55 to 7.21, and HR-QOL measured by
FACT-B also improved; both P < .05. The score for the Pain Severity subscale of the BPI reduced. No
adverse events nor development or worsening of lymphedema was observed. In all, 80% of participants
adhered to the home program. Preliminary data suggest that yoga may reduce pain and improve balance and
flexibility in BCSs with AIAA. A randomized controlled trial is needed to establish the definitive efficacy of
yoga for objective functional improvement in BCSs related to AIAA.
PMID: 21733988 [PubMed - as supplied by publisher]
[Recurrent breast cellulitis associated with lymphangiectasia after tumorectomy for breast cancer.]
[Article in French]
Bibas N, Escande H, Ofaiche J, Le Moigne M, Viraben R, Nougué J.
Source
Service de dermatologie, CHG, 100, rue Léon-Cladel, 82013 Montauban cedex, France.
Abstract
BACKGROUND:
Recurrent breast cellulitis has been described as a complication following breast conservation therapy.
OBSERVATION:
A 50-year-old woman undergoing tumour excision, postoperative radiotherapy and chemotherapy
presented recurrent breast cellulitis in the same region. The presence of lymphangiectasia suggested a
complication subsequent to lymph stasis.
DISCUSSION:
Conservative therapy for breast cancer, allowing the development of subclinical or patent lymphœdema,
constitutes a prominent risk factor for recurrent cellulitis. This complication has also been considered in
patients with lower extremity cellulitis following saphenous venectomy for coronary bypass surgery. The
unusual presence of lymphangiectasia observed in our patient provides clear evidence that lymphœdema is
the most prominent risk factor for the development of cellulitis after breast conservation therapy.
Copyright © 2011. Published by Elsevier Masson SAS.
PMID: 21700073 [PubMed - as supplied by publisher]
July 8, 2011
J Oncol Pract. 2011 Mar;7(2):89-93.
Effects of early exercise on the development of lymphedema in patients with breast cancer treated with
axillary lymph node dissection.
Cavanaugh KM.
Source
University of Pennsylvania, Philadelphia, PA.
Abstract
PURPOSE:
Despite advances in the treatment of breast cancer, there is little research examining the prevention of
lymphedema after breast and/or axillary surgery. Currently, there are no national guidelines for activity
restrictions; however, many medical providers recommend restricting activity of the surgically affected arm,
which can create quality-of-life issues as well as future medical issues for patients with breast cancer.
METHODS:
A literature review of several current research articles was performed. This report reviews four studies
evaluating the effects of restricted activity versus progressive exercise and stretching activities on
development of lymphedema.
RESULTS:
The results show that there is no difference in the risk of developing lymphedema when following activity
guidelines. All four of the studies reviewed report results of either a decrease in the development of
lymphedema or no increased risk of development of lymphedema when early exercise regimens are
incorporated into postoperative care.
CONCLUSION:
The four research articles show promising results that support future change in practice guidelines. However,
none of the studies report follow-up results beyond 2 years. Additionl evaluation to monitor long-term
effects is warranted.
PMID: 21731515 [PubMed - in process] PMCID: PMC3051868
Clin Microbiol Infect. 2011 Jul;17(7):977-85. doi: 10.1111/j.1469-0691.2011.03586.x.
Filariasis in Africa-treatment challenges and prospects.
Hoerauf A, Pfarr K, Mand S, Debrah AY, Specht S.
Source
Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Sigmund Freud
Strasse, Bonn, Germany Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and
Technology Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana.
Abstract
Clin Microbiol Infect 2011; 17: 977-985 ABSTRACT: Lymphatic filariasis (LF) and onchocerciasis are
parasitic nematode infections that are responsible for a major disease burden in the African continent.
Disease symptoms are induced by the immune reactions of the host, with lymphoedema and hydrocoele in
LF, and dermatitis and ocular inflammation in onchocerciasis. Wuchereria bancrofti and Onchocerca
volvulus, the species causing LF and onchocerciasis in Africa, live in mutual symbiosis with Wolbachia
endobacteria, which cause a major part of the inflammation leading to symptoms and are antibiotic targets
for treatment. The standard microfilaricidal drugs ivermectin and albendazole are used in mass drug
administration programmes, with the aim of interrupting transmission, with a consequent reduction in the
burden of infection and, in some situations, leading to regional elimination of LF and onchocerciasis. Co-
endemicity of Loa loa with W. bancrofti or O. volvulus is an impediment to mass drug administration with
ivermectin and albendazole, owing to the risk of encephalopathy being encountered upon administration of
ivermectin. Research into new treatment options is exploring several improved delivery strategies for the
classic drugs or new antibiotic treatment regimens for anti-wolbachial chemotherapy.
© 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical
Microbiology and Infectious Diseases.
PMID: 21722251 [PubMed - in process]
J Reconstr Microsurg. 2011 Jun 29. [Epub ahead of print]
Immediate Microsurgical Breast Reconstruction and Simultaneous Sentinel Lymph Node Dissection: Issues
with Node Positivity and Recipient Vessel Selection.
Curtis MS, Arslanian B, Colakoglu S, Tobias AM, Lee BT.
Source
Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York.
Abstract
Sentinel lymph node dissection (SLND) during mastectomy has been increasing given the decreased risk of
lymphedema. Simultaneous reconstruction with a microsurgical breast reconstruction is often performed, but
with node positivity a completion axillary lymph node dissection (ALND) must be performed subsequently.
This study examines the potential risks especially in relation to microsurgical reconstruction. All patients
undergoing microsurgical breast reconstruction at an academic institution from 2004 to 2010 were evaluated
in a prospective database. Patients with immediate reconstruction and SLND were identified. Management
of positive lymph node status was ascertained through extensive chart review. There were 610
reconstructions performed, 170 delayed and 440 immediate. From the immediate reconstructions, 110
patients (25%) had SLND and of these patients, 16 (14.55%) had a positive SLND. All 16 patients had
internal mammary recipient vessels for free tissue transfer. Seven patients had intraoperative completion
ALND, while nine patients had staged completion ALND at a later date. There were no adverse affects
from completion ALND. Simultaneous mastectomy, SLND, and microsurgical reconstruction can be
performed safely. The internal mammary vessels are preferred recipient vessels as node positive patients
may require subsequent completion ALND. If a thoracodorsal anastomosis is performed, a potential risk
exists for vessel injury and flap loss with completion ALND.
© Thieme Medical Publishers.
PMID: 21717397 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Jun 30. [Epub ahead of print]
Reduction/Prevention of Lower Extremity Lymphedema after Pelvic and Para-aortic Lymphadenectomy for
Patients with Gynecologic Malignancies.
Hareyama H, Ito K, Hada K, Uchida A, Hayakashi Y, Hirayama E, Oikawa M, Okuyama K.
Source
Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan, hitoshi.
hareyama@doc.city.sapporo.jp.
Abstract
BACKGROUND:
Lower extremity lymphedema (LEL) is a serious complication caused by lymphadenectomy in patients with
gynecologic malignancies. In this study, we evaluated the effect of preserving the circumflex iliac lymph
nodes (CILNs), i.e., the most caudal external iliac lymph nodes, for the prevention and reduction of LEL by
comparing two groups of patients, one in which CILN were removed and the other in which CILNs were
preserved.
METHODS:
We retrospectively reviewed 329 patients with gynecologic malignancies who had undergone abdominal
complete systematic pelvic and para-aortic lymphadenectomy. The patients were divided into nonpreserved
(n = 189) and preserved (n = 140) groups, depending on whether CILNs were removed. Primary outcome
measures included the incidence and severity of LEL.
RESULTS:
The incidence of LEL was significantly lower in the preserved group than in the nonpreserved group (P <
0.0001). The frequency of LEL was also significantly lower in the preserved group than in the nonpreserved
group regardless of the range of pelvic and para-aortic lymphadenectomy (P < 0.0001). LEL in the
overwhelming majority of cases in the preserved group was mild, and no patients experienced severe LEL.
Further, the incidence of cellulitis was 0% in the preserved group, while it was 12.7% in the nonpreserved
group (P < 0.0001). Lymphoscintigraphy revealed collateral pathways from the preserved CILN along the
iliac and large abdominal vessels.
CONCLUSIONS:
This method of lymph node preservation is a simple and extremely effective approach for
preventing/reducing LEL after pelvic and para-aortic lymphadenectomy for patients with gynecologic
malignancies.
PMID: 21717243 [PubMed - as supplied by publisher]
July 12, 2011
Afr J Med Med Sci. 2010 Dec;39(4):329-32.
The learning curve of radical hysterectomy for early cervical carcinoma.
Oladokun A, Morhason-Bello IO, Bello FA, Adewole IF.
Source
Department of Obstetrics & Gynaecology, College of Medicine, University College Hospital, Ibadan,
Nigeria. sinaoladokun@yahoo.com
Abstract
Cervical cancer remains a public health concern in developing countries that lack the wherewithal to cope
with the associated challenges. Screening for premalignant cervical lesions and offering definitive care for
early disease is the key to preventing the scourge. We conducted an audit of the radical hysterectomies
performed on account of early cervical carcinoma at our centre between September 2006 and August
2008, following capacity-building by Operation Stop Cervical Cancer. Ten women aged 35 to 60 years
were managed. All had type III radical hysterectomy. Three patients had adjuvant teletherapy (one was
stage IIb, diagnosed intra-operatively). There was a linear reduction in the surgical blood loss and duration
of surgery. Average blood loss was 1500 mls; four had blood transfusions. One case was complicated with
rectovaginal fistula (the woman with stage IIb disease) and another had bilateral lymphoedema and left lower
limb sensory neuropathy. There was no tumour recurrence on follow-up. Definitive surgery for early cervical
cancer is feasible in developing countries despite limited resources. Audit of surgical care of cervical cancer
will assist in strengthening the scarce skill. Determination of suitable cases during preoperative evaluation is
crucial to the success of the surgery.
PMID: 21736000 [PubMed - in process]
ONS Connect. 2011 Jun;26(6):14-5.
Lymphedema in head and neck cancer.
Becze E.
PMID: 21735767 [PubMed - in process]
J Cancer Surviv. 2011 Jul 7. [Epub ahead of print]
Do breast cancer survivors' post-surgery difficulties with recreational activities persist over time?
Miedema B, Hamilton R, Tatemichi S, Thomas-Maclean R, Hack TF, Quinlan E, Towers A, Tilley A,
Kwan W.
Source
Dalhousie University Family Medicine Teaching Unit, Dr. Everett Chalmers Regional Hospital, 700
Priestman Street, Fredericton, NB, Canada, baukje.miedema@horizonNB.ca.
Abstract
INTRODUCTION:
Most longitudinal breast cancer studies have found that treatment-related sequelae such as arm morbidity
[lymphedema, pain, and range of motion (ROM) restrictions] can have a significant impact on quality of life.
In a previous study, we found that at 6-12 months after breast cancer surgery, 49% of participants had
difficulties engaging in recreational activities and that arm morbidity significantly predicted difficulties with
participation in recreation.
METHODS:
A longitudinal national study employing clinical assessments and survey methods followed 178 women over
43 months (3.6 years) to assess issues related to arm morbidity post-breast cancer surgery. Hierarchical
multiple regression analyses were conducted to identify which variables were predictive of recreational
difficulties experienced by women 8 and 43 months post-surgery.
RESULTS:
Between 8 months (T1) and 43 months (T2) post-breast cancer surgery, women demonstrated slight
increases in lymphedema. Conversely, a significant decrease was observed in the number of ROM
restrictions and pain when using the arm. Despite the overall improvements in arm morbidity, some women
continued to report moderate pain and ROM restrictions. The two arm morbidity factors were found to be
statistically significant (p < 0.001) predictors of recreational difficulties at both 8 and 43 months post-surgery,
with pain accounting for the greatest proportion of variance.
DISCUSSION/CONCLUSION:
Pain and ROM restrictions were the only significant predictors of recreational difficulties during the first 3.6
years after breast cancer surgery. Specifically, women who still experience pain years after breast cancer
surgery report difficulties in their recreational pursuits. IMPLICATIONS FOR CANCER SURVIVORS:
Pain and ROM restrictions may prohibit participation in recreational activity and targeted intervention should
be sought.
PMID: 21735276 [PubMed - as supplied by publisher
Breast Cancer Res Treat. 2011 Jul 7. [Epub ahead of print]
A SEER-Medicare population-based study of lymphedema-related claims incidence following breast cancer
in men.
Reiner AS, Jacks LM, Van Zee KJ, Panageas KS.
Source
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd
Street, New York, NY, 10065, USA, reinera@mskcc.org.
Abstract
Each year there are an estimated 200,000 new breast cancer cases diagnosed in the United States; of these,
1% of cases are in men. Lymphedema can be a devastating complication from breast cancer and its
treatment. Currently, almost all lymphedema-related research is based on women and extrapolated to men.
We conducted the first population-based study of men with incident breast cancer of any stage, diagnosed
from 1998 to 2005, who were 65 years and older in the Surveillance, Epidemiology, and End Results
(SEER)-Medicare linked database. We utilized claims related to lymphedema and lymphedema treatment in
our cohort. We defined 'lymphedema-specific' claims to contain the word 'lymphedema' in the Medicare
claim description; similarly, 'lymphedema-related' claims were defined as treatments reimbursed for
lymphedema but not necessarily containing the word 'lymphedema' in the Medicare claim description. We
identified 628 men with incident breast cancer from 1998 to 2005 who were 65 years and older. The
cumulative incidence, censored for deaths, of lymphedema-specific claims at 2, 3, 4, and 5 years was 8.0,
9.2, 10.5, and 10.5%, respectively. The median follow-up was 3.4 years and for those without any event
was 4.7 years. The cumulative incidence, censored for deaths, of lymphedema-related claims at 2, 3, 4, and
5 years was 26.9, 32.2, 35.4, and 39.8%. Rates for men were similar to analogous rates for women.
Lymphedema is a common complication affecting men with breast cancer as well as women and appropriate
treatment and rehabilitation strategies need to be implemented for both genders.
PMID: 21735047 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 Jul 5. [Epub ahead of print]
Upper Extremity Lymphedema Index: A Simple Method for Severity Evaluation of Upper Extremity
Lymphedema.
Yamamoto T, Yamamoto N, Hara H, Mihara M, Narushima M, Koshima I.
Source
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University
of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Measurement of the circumference is the most commonly employed method for evaluating extremity
lymphedema. However, comparison between different patients is difficult with this measurement. To resolve
this problem, we have formulated a new index, upper extremity lymphedema (UEL) index, which can be
easily obtained from measurements of the body. We evaluated correlation between UEL index and clinical
stage in patients with UEL. The UEL indices were significantly correlated with clinical stages and could be
used as a severity scale. The lower extremity lymphedema index makes objective assessment of the severity
of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the
index useful for evaluation of lymphedema severities between different cases.
PMID: 21734534 [PubMed - as supplied by publisher
Integr Cancer Ther. 2011 Jul 6. [Epub ahead of print]
Impact of Yoga on Functional Outcomes in Breast Cancer Survivors With Aromatase Inhibitor-Associated
Arthralgias.
Galantino ML, Desai K, Greene L, Demichele A, Stricker CT, Mao JJ.
Source
The Richard Stockton College of New Jersey, Pomona, NJ, USA; University of Pennsylvania, Philadelphia,
PA, USA.
Abstract
Arthralgia affects postmenopausal breast cancer survivors (BCSs) receiving aromatase inhibitors (AIs). This
study aims to establish the feasibility of studying the impact of yoga on objective functional outcomes, pain,
and health-related quality of life (HR-QOL) for AI-associated arthralgia (AIAA). Postmenopausal women
with stage I to III breast cancer who reported AIAA were enrolled in a single-arm pilot trial. A yoga
program was provided twice a week for 8 weeks. The Functional Reach (FR) and Sit and Reach (SR) were
evaluated as primary outcomes. Pain, as measured by the Brief Pain Inventory (BPI), self-reported Patient
Specific Functional Scale (PSFS), and Functional Assessment of Cancer Therapy-Breast (FACT-B) were
secondary outcomes. Paired t tests were used for analysis, and 90% provided data for assessment at the
end of the intervention. Participants experienced significant improvement in balance, as measured by FR,
and flexibility, as measured by SR. The PSFS improved from 4.55 to 7.21, and HR-QOL measured by
FACT-B also improved; both P < .05. The score for the Pain Severity subscale of the BPI reduced. No
adverse events nor development or worsening of lymphedema was observed. In all, 80% of participants
adhered to the home program. Preliminary data suggest that yoga may reduce pain and improve balance and
flexibility in BCSs with AIAA. A randomized controlled trial is needed to establish the definitive efficacy of
yoga for objective functional improvement in BCSs related to AIAA.
PMID: 21733988 [PubMed - as supplied by publisher]