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Lymphland International Lymphedema Online
July 5, 2010 (4 docs)
Ann R Coll Surg Engl. 2010 Jun 28. [Epub ahead of print]
Hand surgery after axillary lymph node clearance for breast cancer: contra-indication to surgery?
Fulford D, Dalal S, Winstanley J, Hayton MJ.
Abstract
INTRODUCTION Breast cancer patients who have had prior axillary lymph node clearance (ALNC)
can present with ipsilateral hand conditions that could easily be treated with surgical intervention. These
patients are often advised to avoid interventional procedures due to risks of complications such
lymphoedema, infection and cellulitis.
SUBJECTS AND METHODS Between April and June 2009, we conducted an online survey of hand
surgeons, breast surgeons and breast-care nurses to obtain their views on hand surgery after ipsilateral
axillary lymph node clearance.
RESULTS The majority of hand surgeons (58%) felt there was no contra-indication to surgery in a
breast cancer patient with prior ipsilateral ALNC compared to just 30% of breast surgeons and 10%
of breast-care nurses. The majority of breast surgeons and breast-care nurses (70% and 89%,
respectively) felt that hand surgery was a relative contra-indication compared to just 41% of hand
surgeons. Postoperative lymphoedema was the commonest cited reason for avoiding surgery. The
majority of hand surgeons (79%) and nearly two-thirds of breast surgeons (57%) would use a
tourniquet during surgery if it was normal practice.
CONCLUSIONS A review of the published literature does not support the notion that these patients
experience increased complications; therefore, we recommend the advice given to breast cancer
patients regarding ipsilateral surgery be re-evaluated.
PMID: 20587171 [PubMed - as supplied by publisher]
J Med Case Reports. 2010 Jun 29;4(1):196. [Epub ahead of print]
Recurrent furunculosis as a cause of isolated penile lymphedema: a case report.
Alshaham A, Sood S.
Abstract
ABSTRACT: INTRODUCTION: Isolated lymphedema of the penis is extremely rare: combined
involvement of the scrotum and penis is the norm. Furunculosis as a cause is not, to our knowledge,
previously reported. We present a case of isolated penile lymphedema that responded to excision of
lymphedematous tissue and reconstruction with flaps.
CASE PRESENTATION: A 32-year-old Arab man presented with a three-year history of a gradually
increasing, painless penile swelling. Our patient's main complaint was non-erectile sexual dysfunction.
The swelling was preceded by at least three prior episodes of severe furunculosis at the penile root. He
had no other contributory past medical or family history. On examination there was gross penile
enlargement, maximally at the mid shaft, associated with thickened skin at the sites of prior furunculosis.
The glans and scrotum were normal. Both testes were palpable. Serology for filariasis, and urinary tract
ultrasound and computed tomography scan were normal. The clinical diagnosis was lymphedema
following recurrent penile furunculosis. At operation the lymphedematous tissues were removed.
Closure of the penile shaft was accomplished by bilateral advancement of flaps from both ends of the
penis. He resumed normal sexual activity one month after surgery. At 12 months, he had a good
cosmetic result, with no signs of recurrence.
CONCLUSIONS: Furunculosis at the penile root may result in lymphedema confined to the penile
shaft, sparing the scrotum. Excision of abnormal tissue and cover with a skin flap gave excellent
cosmetic results, and allowed satisfactory sexual activity.
PMID: 20584337 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2010 Jun;8(2):111-9.
Assessment of volume measurement of breast cancer-related lymphedema by three methods:
circumference measurement, water displacement, and dual energy X-ray absorptiometry.
Gjorup C, Zerahn B, Hendel HW.
Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Herlev,
Denmark. caroline@gjorup.com
Abstract
BACKGROUND: Following treatment for breast cancer 12%-60% develop breast cancer-related
lymphedema (BCRL). There are several ways of assessing BCRL. Circumference measurement (CM)
and water displacement (WD) for volume measurements (VM) are frequently used methods in practice
and research, respectively. The aim of this study was to evaluate CM and WD for VM of the BCRL
arm and the contralateral arm, comparing the results with regional dual energy X-ray absorptiometry
(DXA).
METHODS AND RESULTS: Twenty-four women with unilateral BCRL were included in the study.
Blinded duplicate VM were obtained from both arms using the three methods mentioned above. CM
and DXA were performed by two observers. WD was performed by a group of observers. Mean
differences (d) in duplicated volumes, limits of agreement (LOA), and 95% confidence intervals (CI)
were calculated for each method. The repeatability expressed as d (95% CI) between the duplicated
VM of the BCRL arm and the contralateral arm was for DXA 3 ml (-6-11) and 3 ml (1-7),
respectively. For CM and WD, the d (95% CI) of the BCRL arm were 107 ml (86-127) and 26 ml
(-26-79), respectively and in the contralateral arm 100 ml (78-122) and -6 ml (-29-17), respectively.
CONCLUSIONS: DXA is superior in repeatability when compared to CM and WD for VM,
especially for the BCRL arm but also the contralateral arm.
PMID: 20583873 [PubMed - in process]
Am J Med Genet A. 2010 Jul;152A(7):1621-6.
Agenesis of the corpus callosum and congenital lymphedema: A novel recognizable syndrome?
O'Driscoll MC, Jenny K, Saitta S, Dobyns WB, Gripp KW.
Medical Genetics Research Group and Regional Genetics Service, St Mary's Hospital, Manchester,
UK.
Abstract
We present double first cousins, a girl and a boy, with the uncommon association of agenesis of the
corpus callosum and congenital lymphedema. Other features shared by both include oligohydramnios,
similar facial dysmorphism, sacral dimple, developmental delay, and sociable personality. While some
of these findings overlap with FG syndrome and Hennekam syndrome, the findings in our patients are
sufficiently different to exclude these diagnoses. We propose that this is a new syndrome with
presumed autosomal recessive inheritance. (c) 2010 Wiley-Liss, Inc.
PMID: 20583147 [PubMed - in process]
Indian J Dermatol. 2010 Apr;55(2):144-147.
INTENSIVE TREATMENT OF LEG LYMPHEDEMA.
Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro de Godoy M.
Department of Cardiology and Cardiovascular Surgery and professor of the post graduation course of
Medicine School of São Jose do Rio Preto-FAMERP-Brazil.
Abstract
BACKGROUND: Despite of all the problems caused by lymphedema, this disease continues to affect
millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is
necessary. AIM: The aim of this study was to evaluate a novel intensive outpatient treatment for leg
lymphedema.
METHODS: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The
inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by
volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg.
Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance
was utilized for statistical analysis with an alpha error of 5% (P-value <0.05) being considered
significant.
RESULTS: All limbs had significant reductions in size with the final mean loss being 81.1% of the
volume of edema. The greatest losses occurred in the first week (P-value <0.001). Losses of more
than 90% of the lymphedema occurred in 9 (39.13%) patients; losses of more than 80% in 13
(56.52%), losses of more than 70% in 17 (73.91%) and losses of more than 50% were recorded for
95.65% of the patients; only 1 patient lost less than 50% (37.9%) of the edema.
CONCLUSION: The intensive treatment of lymphedema in the outpatient clinic can produce significant
reductions in the volume of edema over a short period of time and can be recommended for any grade
of lymphedema, in particular the more advanced degrees.
PMID: 20606882 [PubMed - as supplied by publisher]
Radiother Oncol. 2010 May 31. [Epub ahead of print]
Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema
after radiotherapy for cancer.
Gothard L, Haviland J, Bryson P, Laden G, Glover M, Harrison S, Woods M, Cook G, Peckitt C,
Pearson A, Somaiah N, Stanton A, Mortimer P, Yarnold J.
Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK.
Abstract
BACKGROUND: A non-randomised phase II study suggested a therapeutic effect of hyperbaric
oxygen (HBO) therapy on arm lymphoedema following adjuvant radiotherapy for early breast cancer,
justifying further investigation in a randomised trial.
METHODS: Fifty-eight patients with 15% increase in arm volume after supraclavicular+/-axillary
radiotherapy (axillary surgery in 52/58 patients) were randomised in a 2:1 ratio to HBO (n=38) or to
best standard care (n=20). The HBO group breathed 100% oxygen at 2.4 atmospheres absolute for
100min on 30 occasions over 6weeks. Primary endpoint was ipsilateral limb volume expressed as a
percentage of contralateral limb volume. Secondary endpoints included fractional removal rate of
radioisotopic tracer from the arm, extracellular water content, patient self-assessments and UK SF-36
Health Survey Questionnaire.
FINDINGS: Of 53/58 (91.4%) patients with baseline assessments, 46 had 12-month assessments
(86.8%). Median volume of ipsilateral limb (relative to contralateral) at baseline was 133.5% (IQR
126.0-152.3%) in the control group, and 135.5% (IQR 126.5-146.0%) in the treatment group.
Twelve months after baseline the median (IQR) volume of the ipsilateral limb was 131.2% (IQR 122.7-
151.5%) in the control group and 133.5% (IQR 122.3-144.9%) in the treatment group. Results for the
secondary endpoints were similar between randomised groups.
INTERPRETATION: No evidence has been found of a beneficial effect of HBO in the treatment of
arm lymphoedema following primary surgery and adjuvant radiotherapy for early breast cancer.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 20605648 [PubMed - as supplied by publisher]
Int J Radiat Oncol Biol Phys. 2010 Jun 2. [Epub ahead of print]
Standardized Method for Quantification of Developing Lymphedema in Patients Treated for Breast
Cancer.
Ancukiewicz M, Russell TA, Otoole J, Specht M, Singer M, Kelada A, Murphy CD, Pogachar J,
Gioioso V, Patel M, Skolny M, Smith BL, Taghian AG.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Abstract
PURPOSE: To develop a simple and practical formula for quantifying breast cancer-related
lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal
changes,
METHODS AND MATERIALS: We analyzed bilateral perometer measurements of the upper
extremity in a series of 677 women who prospectively underwent lymphedema screening during
treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and
November 2008. Four sources of variation were analyzed: between repeated measurements on the
same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up
measurements; and between patients. Effects of hand dominance, time since diagnosis and surgery,
age, weight, and body mass index were also analyzed.
RESULTS: The statistical distribution of variation of measurements suggests that the ratio of volume
ratios is most appropriate for quantification of both asymmetry and temporal changes. Therefore, we
present the formula for relative volume change (RVC): RVC = (A(2)U(1))/(U(2)A(1)) - 1, where A
(1), A(2) are arm volumes on the side of the treated breast at two different time points, and U(1), U(2)
are volumes on the contralateral side. Relative volume change is not significantly associated with hand
dominance, age, or time since diagnosis. Baseline weight correlates (p = 0.0074) with higher RVC;
however, baseline body mass index or weight changes over time do not.
CONCLUSIONS: We propose the use of the RVC formula to assess the presence and course of
breast cancer-related lymphedema in clinical practice and research. Copyright © 2010 Elsevier Inc. All
rights reserved.
PMID: 20605339 [PubMed - as supplied by publisher]
J Obstet Gynaecol Res. 2010 Jun;36(3):555-9.
Analysis of the complications after radical hysterectomy for stage IB, IIA and IIB uterine cervical
cancer patients.
Kashima K, Yahata T, Fujita K, Tanaka K.
Departments of Obstetrics and Gynecology, Niigata University Graduate School of Medical and
Dental Sciences, Niigata, Japan. kashimak@med.niigata-u.ac.jp
Abstract
AIM: This study was undertaken to assess whether radical hysterectomy and pelvic lymphadenectomy
could be carried out within acceptable complications in uterine cervical cancer patients.
MATERIAL & METHODS: One hundred and forty-six patients of the International Federation of
Gynecology and Obstetrics stage IB, IIA and IIB cervical cancer treated by radical hysterectomy or
combined with postoperative radiation therapy were enrolled in this study. The study population was
41 women over the age of 60 and 105 women under the age of 59. Complications after the treatment
of all patients were examined.
RESULTS: The complications were significantly high with the patients over the age of 60 (53.7%) in
comparison with the patients under the age of 59 (24.8%). Especially, the cases combined with
radiation therapy had higher complication rate. The most commonly recorded complications were
lymphedema (13.7%) and small bowel obstruction (8.2%).
CONCLUSION: We conclude that the complications influenced on the quality of life were more
frequent in patients over the age of 60.
PMID: 20598037 [PubMed - in process]
July 10, 2010 (7 docs)
Indian J Dermatol. 2010 Apr;55(2):144-147.
INTENSIVE TREATMENT OF LEG LYMPHEDEMA.
Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro de Godoy M.
Department of Cardiology and Cardiovascular Surgery and professor of the post graduation course of
Medicine School of São Jose do Rio Preto-FAMERP-Brazil.
Abstract
BACKGROUND: Despite of all the problems caused by lymphedema, this disease continues to affect
millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is
necessary. AIM: The aim of this study was to evaluate a novel intensive outpatient treatment for leg
lymphedema.
METHODS: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The
inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by
volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg.
Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance
was utilized for statistical analysis with an alpha error of 5% (P-value <0.05) being considered
significant.
RESULTS: All limbs had significant reductions in size with the final mean loss being 81.1% of the
volume of edema. The greatest losses occurred in the first week (P-value <0.001). Losses of more
than 90% of the lymphedema occurred in 9 (39.13%) patients; losses of more than 80% in 13
(56.52%), losses of more than 70% in 17 (73.91%) and losses of more than 50% were recorded for
95.65% of the patients; only 1 patient lost less than 50% (37.9%) of the edema.
CONCLUSION: The intensive treatment of lymphedema in the outpatient clinic can produce significant
reductions in the volume of edema over a short period of time and can be recommended for any grade
of lymphedema, in particular the more advanced degrees.
PMID: 20606882 [PubMed - as supplied by publisher]
Br J Nurs. 2010 Jul 8-21;19(13):826-30.
Keeping breast cancer survivors lymphoedema-free.
Fleysher LA.
Abstract
With the increasing number of breast cancer survivors, post-treatment interventions to improve quality
of life are gaining priority. Current breast cancer treatment modalities put patients at risk of developing
upper-extremity lymphoedema. Upper-extremity lymphoedema is a common and overlooked
complication of breast cancer treatment. Health professionals play an important role in identifying
breast cancer and promptly referring these patients for further interventions. After successful
completion of breast cancer treatment, these patients continue to have regular evaluations by their
oncologists; and, provided there are no signs and symptoms of breast cancer, primary and community
care health professionals will continue to play an essential role in the management of this unique patient
group. As breast cancer treatment places these patients at a lifetime risk of developing upper-extremity
lymphoedema, radiation oncologists, surgical and medical oncologists, and primary care practitioners
must be knowledgeable and educate these patients about risk reduction behaviours. Prevention,
prompt identification, and treatment of lymphoedema are the goals for achieving positive and cost-
effective patient outcomes. This article aims to provide health professionals with specific educational
tools with regard to the prevention, recognition, and management of upper-extremity lymphoedema;
these tools should be used to change the ongoing trends in the management of breast cancer survivors'
follow-up care.
PMID: 20606611 [PubMed - in process]
Int J Gynecol Cancer. 2010 Jul;20(5):900-4.
A prospective study of postoperative lymphedema after surgery for cervical cancer.
Halaska MJ, Novackova M, Mala I, Pluta M, Chmel R, Stankusova H, Robova H, Rob L.
*Department of Obstetrics and Gynaecology, 2nd Medical Faculty of the Charles University in Prague
and Faculty Hospital Motol, Prague; daggerFaculty of Statistics, University of Economics in Prague;
and double daggerDepartment of Oncology and Radiotherapy, Faculty Hospital Motol, Prague, Czech
Republic.
Abstract
OBJECTIVE:: Lymphedema is a severe postoperative complication in oncological surgery.
Multifrequency bioelectrical impedance analysis (MFBIA) is a new method for early lymphedema
detection. The objective was to establish the methodology of MFBIA for lower-limb lymphedema and
to detect a lymphedema in patients undergoing cervical cancer surgery.
METHODS:: From a population of 60 patients undergoing cervical cancer surgery, 39 underwent
radical hysterectomy Wertheim III (RAD group), and 21 underwent conservative surgery
(laparoscopic lymphadenectomy plus simple trachelectomy/simple hysterectomy - CONS group). A
control group of 29 patients (CONTR group) was used to determine the SD of impedance at zero
frequency (R0). Patients were examined before surgery and at 3 and 6 months after surgery by
MFBIA and by measuring the circumference of the lower limbs.
RESULTS:: No differences were found between the CONS and RAD groups on age, height, weight,
and histopathologic type of tumor. However, the number of dissected lymph nodes differed significantly
between the groups (17.3 in the CONS group vs 25.8 in the RAD group, P = 0.0012). The SD of R0
in the CONTR group was 36.0 and 39.0 for the right and the left leg, respectively. No difference in
prevalence of lymphedema based on circumference method was found (35.9% in the RAD and 47.6%
in the CONS groups, not statistically significant).
CONCLUSIONS:: No difference in the prevalence of lymphedema was found between the CONS
and RAD groups. A methodology for MFBIA for the detection of lower-limb lymphedema was
described.
PMID: 20606541 [PubMed - in process]
Radiother Oncol. 2010 May 31. [Epub ahead of print]
Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema
after radiotherapy for cancer.
Gothard L, Haviland J, Bryson P, Laden G, Glover M, Harrison S, Woods M, Cook G, Peckitt C,
Pearson A, Somaiah N, Stanton A, Mortimer P, Yarnold J.
Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK.
Abstract
BACKGROUND: A non-randomised phase II study suggested a therapeutic effect of hyperbaric
oxygen (HBO) therapy on arm lymphoedema following adjuvant radiotherapy for early breast cancer,
justifying further investigation in a randomised trial.
METHODS: Fifty-eight patients with 15% increase in arm volume after supraclavicular+/-axillary
radiotherapy (axillary surgery in 52/58 patients) were randomised in a 2:1 ratio to HBO (n=38) or to
best standard care (n=20). The HBO group breathed 100% oxygen at 2.4 atmospheres absolute for
100min on 30 occasions over 6weeks. Primary endpoint was ipsilateral limb volume expressed as a
percentage of contralateral limb volume. Secondary endpoints included fractional removal rate of
radioisotopic tracer from the arm, extracellular water content, patient self-assessments and UK SF-36
Health Survey Questionnaire.
FINDINGS: Of 53/58 (91.4%) patients with baseline assessments, 46 had 12-month assessments
(86.8%). Median volume of ipsilateral limb (relative to contralateral) at baseline was 133.5% (IQR
126.0-152.3%) in the control group, and 135.5% (IQR 126.5-146.0%) in the treatment group.
Twelve months after baseline the median (IQR) volume of the ipsilateral limb was 131.2% (IQR 122.7-
151.5%) in the control group and 133.5% (IQR 122.3-144.9%) in the treatment group. Results for the
secondary endpoints were similar between randomised groups.
INTERPRETATION: No evidence has been found of a beneficial effect of HBO in the treatment of
arm lymphoedema following primary surgery and adjuvant radiotherapy for early breast cancer.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 20605648 [PubMed - as supplied by publisher]
Int J Radiat Oncol Biol Phys. 2010 Jun 2. [Epub ahead of print]
Standardized Method for Quantification of Developing Lymphedema in Patients Treated for Breast
Cancer.
Ancukiewicz M, Russell TA, Otoole J, Specht M, Singer M, Kelada A, Murphy CD, Pogachar J,
Gioioso V, Patel M, Skolny M, Smith BL, Taghian AG.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Abstract
PURPOSE: To develop a simple and practical formula for quantifying breast cancer-related
lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal
changes,
METHODS AND MATERIALS: We analyzed bilateral perometer measurements of the upper
extremity in a series of 677 women who prospectively underwent lymphedema screening during
treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and
November 2008. Four sources of variation were analyzed: between repeated measurements on the
same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up
measurements; and between patients. Effects of hand dominance, time since diagnosis and surgery,
age, weight, and body mass index were also analyzed.
RESULTS: The statistical distribution of variation of measurements suggests that the ratio of volume
ratios is most appropriate for quantification of both asymmetry and temporal changes. Therefore, we
present the formula for relative volume change (RVC): RVC = (A(2)U(1))/(U(2)A(1)) - 1, where A
(1), A(2) are arm volumes on the side of the treated breast at two different time points, and U(1), U(2)
are volumes on the contralateral side. Relative volume change is not significantly associated with hand
dominance, age, or time since diagnosis. Baseline weight correlates (p = 0.0074) with higher RVC;
however, baseline body mass index or weight changes over time do not.
CONCLUSIONS: We propose the use of the RVC formula to assess the presence and course of
breast cancer-related lymphedema in clinical practice and research. Copyright © 2010 Elsevier Inc. All
rights reserved.
PMID: 20605339 [PubMed - as supplied by publisher]
Arch Phys Med Rehabil. 2010 Jul;91(7):1070-6.
Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility
study.
Katz E, Dugan NL, Cohn JC, Chu C, Smith RG, Schmitz KH.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Abstract
OBJECTIVE: To assess the feasibility of recruiting and retaining cancer survivors with lower-limb
lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety
and efficacy of this intervention. We hypothesized that progressive weight training would not
exacerbate leg swelling and that the intervention would improve functional mobility and quality of life.
DESIGN: Before-after pilot study with a duration of 5 months.
SETTING: University of Pennsylvania.
PARTICIPANTS: Cancer survivors with a known diagnosis of lower-limb lymphedema (N=10) were
directly referred by University of Pennsylvania clinicians. All 10 participants completed the study.
INTERVENTION: Twice weekly slowly progressive weight lifting, supervised for 2 months,
unsupervised for 3 months.
MAIN OUTCOME MEASURES: The primary outcome was interlimb volume differences as
measured by optoelectronic perometry. Additional outcome measures included safety (adverse events),
muscle strength, objective physical function, and quality of life.
RESULTS: Interlimb volume differences were 44.4% and 45.3% at baseline and 5 months,
respectively (pre-post comparison, P=.70). There were 2 unexpected incident cases of cellulitis within
the first 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months.
Bench and leg press strength increased by 47% and 27% over 5 months (P=.001 and P=.07,
respectively). Distance walked in 6 minutes increased by 7% in 5 months (P=.01). No improvement
was noted in self-reported quality of life.
CONCLUSIONS: Recruitment of patients with lower-limb-lymphedema into an exercise program is
feasible. Despite some indications that the intervention may be safe (eg, a lack of clinically significant
interlimb volume increases over 5 mo), the unexpected finding of 2 cellulitic infections among the 10
participants suggests additional study is required before concluding that patients with lower-extremity
lymphedema can safely perform weight lifting. Copyright 2010 American Congress of Rehabilitation
Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 20599045 [PubMed - in process]PMCID: PMC2897812 [Available on 2011/7/1]
J Obstet Gynaecol Res. 2010 Jun;36(3):555-9.
Analysis of the complications after radical hysterectomy for stage IB, IIA and IIB uterine cervical
cancer patients.
Kashima K, Yahata T, Fujita K, Tanaka K.
Departments of Obstetrics and Gynecology, Niigata University Graduate School of Medical and
Dental Sciences, Niigata, Japan. kashimak@med.niigata-u.ac.jp
Abstract
AIM: This study was undertaken to assess whether radical hysterectomy and pelvic lymphadenectomy
could be carried out within acceptable complications in uterine cervical cancer patients.
MATERIAL & METHODS: One hundred and forty-six patients of the International Federation of
Gynecology and Obstetrics stage IB, IIA and IIB cervical cancer treated by radical hysterectomy or
combined with postoperative radiation therapy were enrolled in this study. The study population was
41 women over the age of 60 and 105 women under the age of 59. Complications after the treatment
of all patients were examined.
RESULTS: The complications were significantly high with the patients over the age of 60 (53.7%) in
comparison with the patients under the age of 59 (24.8%). Especially, the cases combined with
radiation therapy had higher complication rate. The most commonly recorded complications were
lymphedema (13.7%) and small bowel obstruction (8.2%).
CONCLUSION: We conclude that the complications influenced on the quality of life were more
frequent in patients over the age of 60.
PMID: 20598037 [PubMed - in process]
July 18, 2010 (8 docs)
Eur J Ophthalmol. 2010 Jul 6. pii: 15C85F11-38C9-45C7-A19F-2E3556D7D52F. [Epub ahead of
print]
Unusual presentation of giant cell angiofibroma of the eyelids.
Surace D, Blandamura S, Bernardini FP, Galan A, Lo Giudice G.
Department of Ophthalmology, Santa Maria del Carmine Hospital, Rovereto - Italy.
Abstract
Purpose. To describe a case of bilateral eyelid-confined giant cell angiofibroma (GCAF) in a patient
with a slowly progressive bilateral eyelid swelling. Methods. A 40-year-old man with a 5-year history
of slowly progressive bilateral eyelid swelling, severe functional impairment, and bilateral cosmetic
deformity was studied. An extensive ophthalmologic evaluation, laboratory examinations, and orbital
magnetic resonance imaging were carried out.
Results. Clinical examination showed nonpitting lymphedema affecting both upper and lower eyelids,
with orange peel skin. Orbital magnetic resonance imaging revealed diffuse thickening of the preseptal
structures in the eyelids without extension to the orbit. Histologic specimen revealed the presence of
spindle and multinucleated giant cells surrounding pseudovascular spaces strongly positive to CD34
and vimentin. A diagnosis of GCAF was made and radiation therapy was performed 3 weeks after
surgical debulking with partial recovery of visual and anatomic function.
Conclusions. Giant cell angiofibroma involving the eyelid is rare and can represent a diagnostic and
therapeutic challenge to the ophthalmologist.
PMID: 20623470 [PubMed - as supplied by publisher]
Ann Dermatol Venereol. 2010 Jun-Jul;137(6-7):477-9. Epub 2010 May 14.
[Lymphoedema and neutrophilic dermatosis] Article in French]
Guyot-Caquelin P, Cuny JF, Depardieu C, Barbaud A, Schmutz JL.
PMID: 20620580 [PubMed - in process]
J Urol. 2010 Aug;184(2):546-552. Epub 2010 Jun 17.
Modified Technique of Radical Inguinal Lymphadenectomy for Penile Carcinoma: Morbidity and
Outcome.
Yao K, Tu H, Li YH, Qin ZK, Liu ZW, Zhou FJ, Han H.
Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of
Oncology in Southern China, Guangzhou, P. R. China.
Abstract
PURPOSE: Classic radical inguinal lymphadenectomy is associated with significant morbidity. Modified
inguinal lymphadenectomy has been used to decrease the complication rate but it may compromise the
oncological effect and depends on the use of intraoperative frozen sections, which may be inaccurate.
We modified the technique of radical inguinal lymphadenectomy to decrease postoperative
complications without compromising oncological effectiveness.
MATERIALS AND METHODS: We performed 150 modified radical inguinal dissections in 75
patients with penile carcinoma from February 1999 to September 2008. Patients underwent modified
radical inguinal dissection characterized by an S-shaped incision, precisely separating layers using an
anatomical landmark and preserving the fascia lata. The boundaries of dissection are the same as those
of radical inguinal lymphadenectomy. Survival and morbidity data were retrospectively analyzed, and
survival probabilities were calculated. RESULTS: Followup ranged from 12 to 113 months. Overall 3-
year survival was 92%, and for N0, N1, N2 and N3 disease it was 100%, 100%, 85% and 57.1%,
respectively. A total of 37 complications occurred including wound infection (1.4%), skin necrosis
(4.7%), lymphedema (13.9%), seroma (2.0%), lymphocele (2.0%) and deep venous thrombosis
(0.7%).
CONCLUSIONS: Morbidity related to groin dissection in patients with penile carcinoma can be
decreased and oncological effectiveness can be preserved using this modified inguinal dissection
technique. Copyright © 2010 American Urological Association Education and Research, Inc.
Published by Elsevier Inc. All rights reserved.
PMID: 20620415 [PubMed - as supplied by publisher]
J Vasc Surg. 2010 Jul 7. [Epub ahead of print]
A novel method of measuring human lymphatic pumping using indocyanine green fluorescence
lymphography.
Unno N, Nishiyama M, Suzuki M, Tanaka H, Yamamoto N, Sagara D, Mano Y, Konno H.
Division of Vascular Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan; Second
Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Abstract
OBJECTIVES: Lymph transportation through the body is partly controlled by the intrinsic pumping of
lymphatic vessels. Although an understanding of this process is important for medical application, little
is currently known because it is difficult to measure. Here, we introduce an easy, safe, and cost-
effective technique for measuring lymphatic pumping in leg superficial lymphatic vessels. Readings
obtained with this technique were compared with values obtained with dynamic lymphoscintigraphy.
Differences in lymphatic pumping between healthy volunteers and patients with lymphedema were also
investigated.
METHODS: Indocyanine green (ICG) fluorescence lymphography was performed by subcutaneously
injecting 0.3 mL of ICG (0.5%) into the dorsum of the foot. Real-time fluorescence images of lymph
propulsion were obtained with an infrared-light camera system with the individual supine or sitting. A
custom-made transparent sphygmomanometer cuff was wrapped around the lower leg and connected
to a standard mercury sphygmomanometer. The cuff was inflated to 60 mm Hg and then gradually
deflated at 5-minute intervals to lower the pressure by 10-mm Hg steps until the fluorescence contrast
agent exceeded the upper border of the cuff, indicating that the lymphatic contraction had overcome
the cuff pressure. Lymph pumping pressure (P(pump)) was defined as the value of the cuff pressure
when the contrast agent exceeded the upper border of the cuff. We measured P(pump) among healthy
volunteers who maintained a supine position and compared these values with measurements obtained
from lymphoscintigraphy. P(pump) values while sitting were also compared between 30 legs from
healthy volunteers and 30 legs from lymphedematous patients.
RESULTS: Among healthy, supine participants, P(pump) was 25.2 +/- 16.7 mm Hg (mean +/-
standard deviation [SD]) when measured by ICG fluorescence lymphography. These values were
significantly correlated with values taken using dynamic lymphoscintigraphy (r(2) = 0.54, p < .01),
while 2 SDs of the mean were approximately 20 mm Hg, suggesting a substantial disagreement
between the two methods (Bland-Altman plots). In the comparison of seated meaurements, readings
for healthy participants (P(pump) = 29.3 +/- 16.0) were higher than those for lymphedematous
participants (13.2 +/- 14.9).
CONCLUSION: ICG fluorescence is an accurate-as well as a safe, easy, and economical-method of
measuring lymphatic pumping. Therefore, it may develop as a vital tool for diagnosing lymphatic
malfunctions even when they are only in their formative stages. Studies that use this technique may
increase our knowledge of the lymphatic system as a whole, allowing us to develop better treatments
for lymphatic disorders. Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc.
All rights reserved.
PMID: 20619581 [PubMed - as supplied by publisher]
J Pain Symptom Manage. 2010 Jul;40(1):e7-10.
A case of massive complicated lower limb lymphedema after pelvic nodal dissection and radiotherapy.
Jain S, Mahantshetty U, Engineer R, Shrivastava SK.
PMID: 20619201 [PubMed - in process]
Jpn J Nurs Sci. 2010 Jun;7(1):108-18.
Physiological characteristics of the body fluid in lymphedematous patients postbreast cancer surgery,
focusing on the intracellular/extracellular fluid ratio of the upper limb.
Sakuda H, Satoh M, Sakaguchi M, Miyakoshi Y, Kataoka T.
Department of Human Health Science, Graduate School of Medicine, Faculty of Medicine, Kyoto
University, 53 Syogoin Kawahara-cho,Kyoto, Japan. sakuda@hs.med.kyoto-u.ac.jp
Abstract
AIM: The aim of this research was to determine the physiological characteristics of patients with
lymphedema following breast cancer surgery, based on differences between the quantity of body water
in the right and left fingertips, with a view to establishing whether or not this simple measurement could
serve as a predictive index for the onset of lymphedema.
METHOD: The research was conducted at a hospital in Hiroshima, Japan (August 2004 to December
2004). Observations were made on 39 female breast cancer patients who had undergone surgery and
45 healthy female participants. Additional information was collected via interviews with the individual
participants. The quantity of body water in all the participants was measured by using a bioimpedance
spectrum analysis system. Comparisons of the intracellular/extracellular fluid ratios (I/Es) were made
between the edema patients and the non-edema patients, with further testing being done between the
affected and unaffected sides of the upper limb in the edema patients.
RESULTS: In the edema patients, significant differences were recognized between the affected side's
upper limb I/E and the unaffected side's upper limb I/E. In relation to the affected side's upper limb I/E
of the edema patients, even when the mean value and standard deviation were included, the value did
not exceed 1.0 and the mean - 3 SD value of the affected side's upper limb I/E in the non-edema
patients was 1.04.
CONCLUSIONS: The results suggest that measurements of the affected and unaffected sides' upper
limb I/E showed a potential for use as a reliable predictive index for lymphedema.
PMID: 20618682 [PubMed - in process]
Ann Surg Oncol. 2010 Jul 8. [Epub ahead of print]
The Impact on Morbidity and Length of Stay of Early Versus Delayed Complete Lymphadenectomy in
Melanoma: Results of the Multicenter Selective Lymphadenectomy Trial (I).
Faries MB, Thompson JF, Cochran A, Elashoff R, Glass EC, Mozzillo N, Nieweg OE, Roses DF,
Hoekstra HJ, Karakousis CP, Reintgen DS, Coventry BJ, Wang HJ, Morton DL; for the MSLT
Cooperative Group.
John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA, fariesm@jwci.
org.
Abstract
BACKGROUND: Complete lymph node dissection, the current standard treatment for nodal
metastasis in melanoma, carries the risk of significant morbidity. Clinically apparent nodal tumor is likely
to impact both preoperative lymphatic function and extent of soft tissue dissection required to clear the
basin. We hypothesized that early dissection would be associated with less morbidity than delayed
dissection at the time of clinical recurrence.
MATERIALS AND METHODS: The Multicenter Selective Lymphadenectomy Trial I randomized
patients to wide excision of a primary melanoma with or without sentinel lymph node biopsy.
Immediate completion lymph node dissection (early CLND) was performed when indicated in the SLN
arm, while therapeutic dissection (delayed CLND) was performed at the time of clinical recurrence in
the wide excision-alone arm. Acute and chronic morbidities were prospectively monitored.
RESULTS: Early CLND was performed in 225 patients, and in the wide excision-alone arm 132 have
undergone delayed CLND. The 2 groups were similar for primary tumor features, body mass index,
basin location, and demographics except age, which were higher for delayed CLND. The number of
nodes evaluated and the number of positive nodes was greater for delayed CLND. There was no
significant difference in acute morbidity, but lymphedema was significantly higher in the delayed CLND
group (20.4% vs. 12.4%, P = .04). Length of inpatient hospitalization was also longer for delayed
CLND.
CONCLUSION: Immediate nodal treatment provides critical prognostic information and a likely
therapeutic effect for those patients with nodal involvement. These data show that early CLND is also
less likely to result in lymphedema.
PMID: 20614193 [PubMed - as supplied by publisher]
Vet Dermatol. 2010 Jul 1. [Epub ahead of print]
Combined moxidectin and environmental therapy do not eliminate Chorioptes bovis infestation in
heavily feathered horses.
Rüfenacht S, Roosje PJ, Sager H, Doherr MG, Straub R, Goldinger-Müller P, Gerber V.
Dermatology Unit, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Berne,
Switzerland.
Abstract
Abstract Chorioptes bovis infestation is a common cause of pastern dermatitis in the horse, with a
predilection in draft horses and other horses with thick hair 'feathers' on the distal limbs. The treatment
of this superficial mite is challenging; treatment failure and relapse are common. Furthermore, C. bovis
infestation may affect the progression of chronic pastern dermatitis (also known as chronic proliferative
pastern dermatitis, chronic progressive lymphoedema and dermatitis verrucosa) in draft horses,
manifesting with oedema, lichenification and excessive skin folds that can progress to verruciform
lesions. An effective cure for C. bovis infestation would therefore be of great clinical value. In a
prospective, double-blind, placebo-controlled study, the efficacy of oral moxidectin (0.4 mg/kg body
weight) given twice with a 3 week interval in combination with environmental treatment with 4-chloro-3-
methylphenol and propoxur was tested in 19 heavily feathered horses with clinical pastern dermatitis
and C. bovis infestation. Follow-up examinations over a period of 180 days revealed significantly more
skin crusting in the placebo group than in the treatment group. However, no other differences in clinical
signs or the numbers of mites detected were found between the two groups. The results of this study
suggest that moxidectin in combination with environmental insecticide treatment as used in this study is
ineffective in the treatment of C. bovis in feathered horses.
PMID: 20609205 [PubMed - as supplied by publisher]
July 22, 2010 (4 docs)
Clin Nucl Med. 2010 Aug;35(8):579-82.
Lymphoscintigraphy in the diagnosis of lymphangiomatosis.
Beveridge N, Allen L, Rogers K.
Department of Nuclear Medicine/PET, Hunter New England Imaging, John Hunter Hospital,
Newcastle, NSW, Australia. nicole.beveridge@hnehealth.nsw.gov.au
Abstract
Lymphangiomatosis is a rare condition characterized by multiple abnormalities of the lymphatic system.
Diagnosis is often difficult, as chronic, intermittent, or acute pain; edema; and other symptoms may
affect the respiratory, gastrointestinal, renal, hepatic, skeletal, and other organ systems. We report the
case of a patient who first presented with lymphedema in childhood and was treated intermittently for
related symptoms before diagnosis was achieved 36 years later. Plain film radiography, bone scanning,
computed tomography, magnetic resonance imaging, and lymphoscintigraphy were used to arrive at a
diagnosis. Information derived from all scan types was combined to derive a diagnosis of
lymphangiomatosis. Lymphoscintigraphy provided direct evidence of the abnormal lymphatic flows
associated with lymphangiomatosis. Lymphangiomatosis presents a diagnostic challenge; information
from several scan types, including lymphoscintigraphy, is useful in deriving this diagnosis.
PMID: 20631503 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2010 Jul 12. [Epub ahead of print]
Objective improvement in upper limb lymphoedema following ipsilaterall latissimus dorsi pedicled flap
breast reconstruction - A case series and review of literature.
Abbas Khan MA, Mohan A, Hardwicke J, Srinivasan K, Billingham R, Taylor C, Prinsloo D.
Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust,
Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK.
Abstract
OBJECTIVE: We present a series of three patients whose upper limb lymphoedema (following total
oncologic mastectomy and level III axillary clearance) resolved significantly after ipsilateral pedicled
latissimus dorsi (LD) flap breast reconstruction.
METHODS: A retrospective review of the medical records of patients who had undergone oncologic
mastectomy and level III axillary clearance with subsequent LD pedicled flap reconstruction was
carried out. Individuals who had undergone review and treatment by the lymphoedema service were
identified and patients with incomplete pre- or post-operative records were excluded. A minimum
follow-up period of 2 years of conservative therapy, as well as 2 years post-operatively was
undertaken.
RESULTS: The rate of improvement of lymphoedema following conservative therapy was, on average,
0.095mL/week and reached a plateau at 2-year follow-up. Following latissimus dorsi flap breast
reconstruction, the rate of improvement in lymphoedema increased in all three cases, with an average
improvement of 2.55mL/week and remained sustained in the follow-up period.
CONCLUSION: Pedicled myocutaneous flap reconstruction of the ipsilateral breast proved to be a
useful treatment for upper limb lymphoedema in our series. This adds an important dimension to the
assessment and treatment of patients with upper limb oedema resulting from mastectomy and axillary
clearance. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.
PMID: 20630818 [PubMed - as supplied by publisher]
PLoS Negl Trop Dis. 2010 Jun 29;4(6):e728.
Increasing compliance with mass drug administration programs for lymphatic filariasis in India through
education and lymphedema management programs.
Cantey PT, Rout J, Rao G, Williamson J, Fox LM.
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease
Control and Prevention, Atlanta, Georgia, United States of America. pcantey@cdc.gov
Abstract
BACKGROUND: Nearly 45% of people living at risk for lymphatic filariasis (LF) worldwide live in
India. India has faced challenges obtaining the needed levels of compliance with its mass drug
administration (MDA) program to interrupt LF transmission, which utilizes diethylcarbamazine (DEC)
or DEC plus albendazole. Previously identified predictors of and barriers to compliance with the MDA
program were used to refine a pre-MDA educational campaign. The objectives of this study were to
assess the impact of these refinements and of a lymphedema morbidity management program on MDA
compliance.
METHODS/PRINCIPAL FINDINGS: A randomized, 30-cluster survey was performed in each of 3
areas: the community-based pre-MDA education plus community-based lymphedema management
education (Com-MDA+LM) area, the community-based pre-MDA education (Com-MDA) area, and
the Indian standard pre-MDA education (MDA-only) area. Compliance with the MDA program was
90.2% in Com-MDA+LM, 75.0% in Com-MDA, and 52.9% in the MDA-only areas (p<0.0001).
Identified barriers to adherence included: 1) fear of side effects and 2) lack of recognition of one's
personal benefit from adherence. Multivariable predictors of adherence amenable to educational
intervention were: 1) knowing about the MDA in advance of its occurrence, 2) knowing everyone is at
risk for LF, 3) knowing that the MDA was for LF, and 4) knowing at least one component of the
lymphedema management techniques taught in the lymphedema management program.
CONCLUSIONS/SIGNIFICANCE: This study confirmed previously identified predictors of and
barriers to compliance with India's MDA program for LF. More importantly, it showed that targeting
these predictors and barriers in a timely and clear pre-MDA educational campaign can increase
compliance with MDA programs, and it demonstrated, for the first time, that lymphedema management
programs may also increase compliance with MDA programs.
PMID: 20628595 [PubMed - in process]PMCID: PMC2900179
J Adv Nurs. 2010 Jul 2. [Epub ahead of print]
Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node
dissection for breast cancer: systematic review.
Chan DN, Lui LY, So WK.
Dorothy N.S. Chan BN MN RN Registered Nurse Department of Surgery, Ruttonjee and Tang Shiu
Kin Hospital, Hong Kong SAR, China.
Abstract
chan d.n.s., lui l.y.y. & so w.k.w. (2010) Effectiveness of exercise programmes on shoulder mobility
and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. Journal of
Advanced Nursing. Abstract Aim. This article is a report of a review of the effectiveness of exercise
programmes on shoulder mobility and lymphoedema in postoperative patients with breast cancer
having axillary lymph node dissection, as revealed by randomized controlled trials.
Background. Breast cancer is the most common malignancy in women. After surgery, the most
common postoperative complications are reduced range of motion in the shoulder, muscle weakness in
the upper extremities, lymphoedema, pain and numbness. To reduce these impairments, shoulder
exercises are usually prescribed. However, conflicting results regarding the effect and timing of such
exercises have been reported.
Data sources. Studies were retrieved from a systematic search of published works over the period
2000-2009 indexed in the Cumulative Index to Nursing and Allied Health Literature, Ovid Medline,
the British Nursing Index, Proquest, Science Direct, Pubmed, Scopus and the Cochrane Library, using
the combined search terms 'breast cancer', 'breast cancer surgery', 'exercise', 'lymphoedema', 'shoulder
mobility' and 'randomized controlled trials'.
Methods. A quantitative review of effectiveness was carried out. Studies were critically appraised by
three independent reviewers, and categorized according to levels of evidence defined by the Joanna
Briggs Institute.
Results. Six studies were included in the review. Early rather than delayed onset of training did not
affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in
avoiding deterioration in range of shoulder motion.
Conclusion. Further studies are required to investigate the optimal time for starting arm exercises after
this surgery. Nurses have an important role in educating and encouraging patients to practise these
exercises to speed up recovery.
PMID: 20626480 [PubMed - as supplied by publisher]
July 24, 2010 (1 doc)
Gynecol Oncol. 2010 Jul 15. [Epub ahead of print]
Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had
treatment including lymphadenectomy.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, Aoyagi Y, Ohba Y, Okamoto
K, Kato H.
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center,
Sapporo, Japan.
Abstract
OBJECTIVE: The aim of this study was to determine the incidence rate of lower-extremity
lymphedema after systematic lymphadenectomy in patients with uterine corpus malignancies and to
elucidate risk factors for this type of lymphedema.
METHODS: A retrospective chart review was carried out for all patients with uterine corpus malignant
tumor managed at Hokkaido Cancer Center between 1991 and 2007. Patients who did not undergo
lymphadenectomy as a treatment or died of cancer/intercurrent disease were excluded from this study.
All living patients included in this study had hysterectomy, bilateral salpingo-oophorectomy and
lymphadenectomy and their medical records were reviewed. We identified patients with postoperative
lower-extremity lymphedema (POLEL). Logistic regression analysis was used to select the risk factors
for POLEL.
RESULTS: Of 286 patients evaluated, 103 (37.8%) had POLEL. Multivariate analysis confirmed that
adjuvant radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more than 31 lymph nodes
(OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to the distal external iliac nodes
(CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were independent risk factors for POLEL.
CONCLUSION: Adjuvant radiation therapy should be avoided in patients who undergo systematic
lymphadenectomy if an alternative postoperative strategy is possible. Although reducing the number of
resected lymph nodes is not appropriate from a therapeutical point of view, elimination of CINDEIN
dissection may be helpful in reducing the incidence of POLEL. The clinical significance of CINDEIN
dissection needs to be investigated by a randomized controlled trial. Copyright © 2010 Elsevier Inc.
All rights reserved.
PMID: 20638109 [PubMed - as supplied by publisher]
Gynecol Oncol. 2010 Jul 15. [Epub ahead of print]
Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had
treatment including lymphadenectomy.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, Aoyagi Y, Ohba Y, Okamoto
K, Kato H.
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center,
Sapporo, Japan.
Abstract
OBJECTIVE: The aim of this study was to determine the incidence rate of lower-extremity
lymphedema after systematic lymphadenectomy in patients with uterine corpus malignancies and to
elucidate risk factors for this type of lymphedema.
METHODS: A retrospective chart review was carried out for all patients with uterine corpus malignant
tumor managed at Hokkaido Cancer Center between 1991 and 2007. Patients who did not undergo
lymphadenectomy as a treatment or died of cancer/intercurrent disease were excluded from this study.
All living patients included in this study had hysterectomy, bilateral salpingo-oophorectomy and
lymphadenectomy and their medical records were reviewed. We identified patients with postoperative
lower-extremity lymphedema (POLEL). Logistic regression analysis was used to select the risk factors
for POLEL.
RESULTS: Of 286 patients evaluated, 103 (37.8%) had POLEL. Multivariate analysis confirmed that
adjuvant radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more than 31 lymph nodes
(OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to the distal external iliac nodes
(CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were independent risk factors for POLEL.
CONCLUSION: Adjuvant radiation therapy should be avoided in patients who undergo systematic
lymphadenectomy if an alternative postoperative strategy is possible. Although reducing the number of
resected lymph nodes is not appropriate from a therapeutical point of view, elimination of CINDEIN
dissection may be helpful in reducing the incidence of POLEL. The clinical significance of CINDEIN
dissection needs to be investigated by a randomized controlled trial. Copyright © 2010 Elsevier Inc.
All rights reserved.
PMID: 20638109 [PubMed - as supplied by publisher]
Cancer. 2010 Jul 27. [Epub ahead of print]
Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related
secondary lymphedema.
Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM.
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston,
Texas.
Abstract
BACKGROUND:: Secondary lymphedema is a debilitating, chronic, progressive condition that
commonly occurs after the treatment of breast cancer. The purpose of the current study was to
perform a systematic review and meta-analysis of the oncology-related literature excluding breast
cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various
malignancies.
METHODS:: The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane
Library databases, and Scopus) to identify studies (1972-2008) that included a prospective
assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy,
and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence,
and follow-up interval. A quality assessment of individual studies was performed using established
criteria for systematic reviews. Bayesian meta-analytic techniques were applied to derive summary
estimates when sufficient data were available.
RESULTS:: A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n = 15),
gynecologic malignancies (n = 22), genitourinary cancers (n = 8), head/neck cancers (n = 1), and
sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .
001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary,
10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients
undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods
and longer follow-up were both associated with increased lymphedema incidence.
CONCLUSIONS:: Lymphedema is a common condition affecting cancer survivors with various
malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic
location, heterogeneity of assessment methods, and length of follow-up. Cancer 2010. (c) 2010
American Cancer Society.
PMID: 20665892 [PubMed - as supplied by publisher]
IEEE Eng Med Biol Mag. 2010 Mar-Apr;29(2):63-70.
Optical coherence tomography: the intraoperative assessment of lymph nodes in breast cancer.
Nguyen FT, Zysk AM, Chaney EJ, Adie SG, Kotynek JG, Oliphant UJ, Bellafiore FJ, Rowland KM,
Johnson PA, Boppart SA.
Abstract
During breast-conserving surgeries, axillary lymph nodes draining from the primary tumor site are
removed for disease staging. Although a high number of lymph nodes are often resected during sentinel
and lymph-node dissections, only a relatively small percentage of nodes are found to be metastatic, a
fact that must be weighed against potential complications such as lymphedema. Without a real-time in
vivo or in situ intraoperative imaging tool to provide a microscopic assessment of the nodes,
postoperative paraffin section histopathological analysis currently remains the gold standard in assessing
the status of lymph nodes. This paper investigates the use of optical coherence tomography (OCT), a
high-resolution real-time microscopic optical-imaging technique, for the intraoperative ex vivo imaging
and assessment of axillary lymph nodes. Normal (13), reactive (1), and metastatic (3) lymph nodes
from 17 human patients with breast cancer were imaged intraoperatively with OCT. These preliminary
clinical studies have identified scattering changes in the cortex, relative to the capsule, which can be
used to differentiate normal from reactive and metastatic nodes. These optical scattering changes are
correlated with inflammatory and immunological changes observed in the follicles and germinal centers.
These results suggest that intraoperative OCT has the potential to assess the real-time node status in
situ, without having to physically resect and histologically process specimens to visualize microscopic
features.
PMID: 20659842 [PubMed - in process]
August 7, 2010 (5 docs)
J Vasc Surg. 2010 Aug;52(2):429-34.
Extracorporeal shock wave therapy ameliorates secondary lymphedema by promoting
lymphangiogenesis.
Kubo M, Li TS, Kamota T, Ohshima M, Shirasawa B, Hamano K.
Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine,
Ube, Yamaguchi, Japan.
Abstract
OBJECTIVE: Although secondary lymphedema is a common complication after surgical and radiation
therapy for cancer, the treatment options for lymphedema remain limited and largely ineffective. We
thus studied the effect of extracorporeal shock wave therapy on promoting lymphangiogenesis and
improving secondary lymphedema.
METHODS: A rabbit ear model of lymphedema was created by disruption of lymphatic vessels. Two
weeks after surgery, the lymphedematous ear was treated with or without low-energy shock waves
(0.09 mJ/mm(2), 200 shots), three times per week for 4 weeks.
RESULTS: Western blot analysis showed that the expression of vascular endothelial growth factor
(VEGF)-C (1.23-fold, P < .05) and VEGF receptor 3 (VEGFR3; 1.53-fold, P < .05) was
significantly increased in the ears treated with shock wave than in the untreated lymphedematous ears.
Compared with the control group, shock wave treatment led to a significant decrease in the thickness
of lymphedematous ears (3.80 +/- 0.25 mm vs 4.54 +/- 0.18 mm, P < .05). Immunohistochemistry for
VEGFR3 showed the density of lymphatic vessels was significantly increased by shock wave treatment
(P < .05).
CONCLUSION: Extracorporeal shock wave therapy promotes lymphangiogenesis and ameliorates
secondary lymphedema, suggesting that extracorporeal shock wave therapy may be a novel, feasible,
effective, and noninvasive treatment for lymphedema. Copyright (c) 2010 Society for Vascular
Surgery. Published by Mosby, Inc. All rights reserved.
PMID: 20670777 [PubMed - in process]
Oper Orthop Traumatol. 2010 Jul;22(3):317-34.
[The medial closed-wedge osteotomy of the distal femur for the treatment of unicompartmental lateral
osteoarthritis of the knee.] [Article in German]
Freiling D, van Heerwaarden R, Staubli A, Lobenhoffer P.
Klinik für Unfall- und Wiederherstellungschirurgie, Diakonie- krankenhaus Henriettenstiftung,
Hannover, Germany, d.freiling@gmx.de.
Abstract
OBJECTIVE : Shifting of the mechanical axis from the lateral to the medial compartment in patients
with lateral osteoarthritis in combination with valgus deformity.
INDICATIONS : Osteoarthritis of the lateral compartment in combination with valgus deformity of the
(distal) femur. Posttraumatic and congenital valgus deformities of the (distal) femur.
CONTRAINDICATIONS : Osteoarthritis of the medial compartment (>/= grade 3 on Outerbridge
Scale). Total loss of the medial meniscus. Acute or chronic infections. Rheumatoid arthritis. Heavy
smoking. Extension or flexion deficit > 20 degrees . Poor soft-tissue conditions on site of surgery.
SURGICAL TECHNIQUE : Optional: arthroscopy before osteotomy. Anteromedial skin incision,
subvastus approach with blunt preparation around the vastus medialis muscle and separation of this
muscle from the intermuscular septum. The posterior osteotomy is marked with Kirschner wires (OGD
[osteotomy guiding device], Synthes, Switzerland, can be used optionally). The biplanar cut is marked
on the bone with an electrocautery device. The bone cuts start with the posterior incomplete
osteotomy, followed by the anterior biplanar cut. After finishing the osteotomy (three bone cuts!), the
bone wedge can be removed. Closing the osteotomy should start very gently as a plastic deformation
of the bone. A radiologic control of the leg alignment and the mechanical axis is achieved with an
alignment rod (Synthes, Switzerland). The plate should be inserted under the vastus medialis muscle. It
is very important, that the surgeon controls the correct anteromedial position of the plate at the distal
femur (right and left version of the implant). Fixation of the plate with locking screws distally.
Positioning of a lag screw in the dynamic hole directly above the osteotomy. Insertion of monocortical
screws in the three remaining holes proximal of the lag screw. Finally, the lag screw is changed to a self-
tapping bicortical locking head screw. X-ray control, wound closure.
POSTOPERATIVE MANAGEMENT : Elastic bandage of the leg up to the thigh in the operating
room. Change of the dressing on day 1 after surgery. Ice treatment. Walking on crutches starting day 1
after surgery. Physiotherapy and manual lymph drainage starting on day 1 after surgery. Partial weight
bearing for the first 4-6 weeks after surgery. Suture removal after 10-12 days. X-ray control on day 3
and 6 weeks after surgery. Discharge possible, if wounds are dry (day 4-7).
RESULTS : Between January 2005 and October 2008, 60 patients were treated with medial closed-
wedge osteotomy of the distal femur (since 11/2006 only with biplanar osteotomy technique) at the
Department of Trauma and Reconstructive Surgery, Diakoniekrankenhaus Henriettenstiftung
Hannover, Germany. The average wedge size was 7.6 mm (4-13 mm). The mean age was 39.7 years
(17-79 years). The patients had had 2.3 previous surgeries. The mean follow- up was 21 months (3-
45 months). Freiling D, et al. Biplanare Osteotomie bei unikompartimentaler lateraler
Kniegelenkarthrose Flexion was 126 degrees (95-140 degrees ) preoperatively, and 128 degrees
(105-140 degrees ) postoperatively. 25 patients had at least 5 degrees extension deficit (5-15 degrees
) before surgery, whereas ten patient did not reach the full extension at follow-up examination. The
Tegner Activity Score increased from 2.8 (1-4) preoperatively to 5.6 (2-9) postoperatively, in IKDC
(International Knee Documentation Committee) Score, 18 patients reached grade A, 27 grade B, nine
grade C, and six grade D. The visual analog scale (VAS) score decreased from 6.8 (8-2)
preoperatively to 3.1 (0-7) postoperatively. Seven patients had revision surgery (three times delayed
union/nonunion of the osteotomy, one superficial and one deep infection, one hematoma, one fracture
[proximal of the internal plate fixator] after a fall).
PMID: 20676825 [PubMed - in process]
Plast Reconstr Surg. 2010 Aug;126(2):55e-69e.
Vascular anomalies and lymphedema.
Chim H, Drolet B, Duffy K, Koshima I, Gosain AK.
Cleveland, Ohio; Milwaukee, Wis.; and Tokyo, Japan From the Department of Plastic Surgery, Case
Western Reserve University; the Department of Dermatology, Children's Hospital of Wisconsin; and
the Department of Plastic and Reconstructive Surgery, University of Tokyo.
Abstract
LEARNING OBJECTIVES:: After studying this article, the participant should be able to: 1. Define the
difference between vascular tumors and malformations. 2. Distinguish between the natural history of
hemangiomas and that of vascular malformations. 3. Identify the different types of hemangiomas and
vascular malformations and understand evaluation, treatment, and complications. 4. Understand the
role of lymphaticovenular anastomoses in the treatment of extremity lymphedema.
BACKGROUND:: The International Society for the Study of Vascular Anomalies classification, which
is the most widely accepted classification system in use, divides vascular anomalies into vascular tumors
(inclusive of hemangiomas) and malformations. This serves as a guideline for diagnosis, evaluation, and
treatment of these lesions.
METHODS:: Although hemangiomas tend to have a predictable clinical course over the first year of
life, going through proliferating, involuting, and involuted stages, vascular malformations demonstrate
growth commensurate with age, often becoming more prominent in puberty. In addition, they never
regress, and persist throughout life.
RESULTS:: Different modalities of treatment may be appropriate for vascular tumors and different
subsets of vascular malformations. Details are provided in this review. Lymphaticovenular anastomoses
provide an excellent addition to our methods of treatment of extremity lymphedema, and are made
possible through development of supermicrosurgical techniques.
CONCLUSIONS:: Vascular anomalies have a high prevalence in the general population. Thus, it is
vital that the plastic surgeon has a good understanding of classification, evaluation, and treatment
options. Lymphedema is another common condition that is encountered. Understanding of
lymphaticovenular anastomoses and their applications aids treatment planning for select patients.
PMID: 20679788 [PubMed - in process]
Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2010 Aug;27(4):371-5.
[Identification of VEGFR3 gene mutation in a Chinese family with autosomal dominant primary
congenital lymphoedema.] [Article in Chinese]
Sheng J, Zeng F, Li C, Liu J, Wang Q, Liu M.
Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and
Technology, Center for Human Genome Research, Huazhong University of Science and Technology,
Wuhan, Hubei, 430074 P. R. China. lium@mail.hust.edu.cn.
Abstract
OBJECTIVE: To identify the disease-causing gene in a four-generation Chinese family with 9 members
affected with primary congenital lymphoedema (PCL, also known as Milroy disease).
METHODS: Linkage analysis was performed with a few microsatellite markers flanking the candidate
genetic loci for PCL, including 3 known genes associated with autosomal dominant PCL. For mutation
analysis, VEGFR3 gene was sequenced with DNA from the proband. Direct DNA sequencing of exon
25 of the VEGFR3 gene was performed in all family members.
RESULTS: The disease gene in the family was mapped to chromosome 5q35.3 with a maximum Lod
score of 2.07. Direct DNA sequencing of VEGFR3 gene revealed a heterozygous C to T transition at
nucleotide 3341, resulting in p.Pro1114Leu mutation. The p.Pro1114Leu mutation co-segregated with
all affected individuals in the family.
CONCLUSION: This study identified a C3341T (p.Pro1114Leu) mutation in the VEGFR3 gene in a
Chinese family with PCL, provided evidence that VEGFR3 mutation can cause PCL in Chinese.
PMID: 20677139 [PubMed - in process]
Physiotherapy. 2010 Sep;96(3):264. Epub 2010 Jun 2.
Comments on book review of 'Lymphoedema: Advice on Self-management'.
Friett K.
Lymphoedema Support Network, St. Lukes Crypt, Sydney Street, London SW3 6NH, UK.
PMID: 20674660 [PubMed - in process]
August 14, 2010 (3 docs)
Coll Antropol. 2010 Jun;34(2):645-8.
A case report of breast angiosarcoma.
Kardum-Skelin I, Jelić-Puskarić B, Pazur M, Vidić-Paulisić I, Jakić-Razumović J, Separović V.
Laboratory for Cytology and Hematology, Department of Medicine, "Merkur" University Hospital,
Zagreb, Croatia. ikardum@hi.t-com.hr
Abstract
Angiosarcoma is a rare disease of the breast with the reported incidence of only 0.04% of all breast
malignancies. The etiology of angiosarcoma remains unknown. It occurs post-mastectomy, in
association with chronic lymphedema (Stewart-Treves syndrome), or after radiotherapy. We present a
patient with angiosarcoma which developed 12 years of the diagnosis of breast carcinoma and 8 years
of the operative procedure and radiotherapy for disease recurrence. A small angiomatous lesion of a
few mm in size, cytologically suspect of vascular tumor (hemangioma or hemangiopericytoma) and
histopathologically verified to be an atypical vascular lesion, was detected two years before breast
enlargement and cytologic and histologic diagnosis of angiosarcoma. The patient died 15 months of the
diagnosis of angiosarcoma, after two tumor recurrences and intrathoracic cavity invasion.
PMID: 20698145 [PubMed - in process]
Am J Surg Pathol. 2010 Aug 6. [Epub ahead of print]
Epithelioid Angiosarcoma of the Skin: A Study of 18 Cases With Emphasis on its Clinicopathologic
Spectrum and Unusual Morphologic Features.
Bacchi CE, Silva TR, Zambrano E, Plaza J, Suster S, Luzar B, Lamovec J, Pizzolitto S, Falconieri G.
*Consultoria em Patologia, Botucatu, SP, Brazil daggerDepartment of Pathology, Medical College of
Wisconsin, Milwaukee, WI double daggerInstitute of Pathology, Medical Faculty, University of
Ljubljana School of Medicine section signDepartment of Pathology, Institute of Oncology, Ljubljana,
Slovenia parallelDepartment of Pathology, General University Hospital S. Maria della Misericordia,
Udine, Italy.
Abstract
We report 18 cases of cutaneous angiosarcoma with predominant or exclusive epithelioid morphology.
Both sexes were similarly affected. Patients' ages ranged from 2 to 97 years, median 77.5 years; 2
were pediatric patients. In elderly patients scalp or facial lesions and cutaneous lesions arising within
irradiated breast skin predominated. Limb lesions were seen in younger patients. Microscopically, the
tumors were composed of packed polygonal cells with focal evidence of endothelial differentiation.
Diverging phenotypes included syncytial growth of large cells with clear nuclei and prominent nucleoli,
micronodules of tumor cells scattered in dermis, predominance of discohesive plasmacytoid polygonal
cells with abundant bright eosinophilic cytoplasm, sheets of clear cells with coarse granular cytoplasm,
trabecular and cord arrangement of tumor cells splaying the dermal collagen, or a pseudoglandular
appearance owing to clear cell tubular arrangement with open lumina. These cases posed further
diagnostic challenges simulating lymphoma, melanoma, lymphoepithelioma-like carcinoma, adnexal
carcinoma, and neuroendocrine carcinoma. Immunohistochemical studies showed positivity for CD31
and CD34; no immunoreactivity was documented for other tested antigens including cytokeratins,
S100 protein, melanocytic antigens, leukocyte common antigen, and desmin. Therapeutic modalities
included combined local excision, chemotherapy, and radiotherapy, depending on patient clinical status.
Of the 9 patients available for follow-up, 5 were alive and apparently well, 2 had recurrent disease, and
2 had died of tumor. Our data show that epithelioid cutaneous angiosarcoma may have a broad
morphological spectrum, raising interpretive challenges on microscopy. In addition, its clinical
presentation seems to differ in nonelderly patients, with lesions likely related to lymphedema or vascular
malformations.
PMID: 20697249 [PubMed - as supplied by publisher]
J Biotechnol. 2010 Aug 3. [Epub ahead of print]
Reconstruction of lymph vessel by lymphatic endothelial cells combined with polyglycolic acid
scaffolds: a pilot study.
Dai TT, Jiang ZH, Li SL, Zhou GD, Kretlow JD, Cao WG, Liu W, Cao YL.
Department of Plastic and Reconstructive Surgery, Shanghai ninth people's hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China.
Abstract
Restoration of lymphatic drainage using lymph vessels or tissue grafting is becoming an efficient method
for alleviating obstructive lymphedema. However, the lack of ideal lymphatic grafts is the key problem
that limits the application of lymphatic transplantation, but now that may be resolved with tissue-
engineered lymph vessels. In this study, the feasibility of reconstructing lymph vessels was explored
using lymphatic endothelial cells (LECs) combined with polyglycolic acid (PGA) scaffolds. The highly
purified human dermal LECs can be isolated from human dermis by immunomagnetic bead sorting and
multiplied in culture. The viability and growth potential of subcultured LECs make it possible to obtain
large amount of cells in vitro. Light and scanning electron microscopy (SEM) showed that the
prefabricated PGA scaffolds, with 3-dimensional structure, can support cell adhesion, growth and
spreading. The constructs formed with LECs combined with PGA scaffolds were cultured in vitro for
ten days and then implanted subcutaneously into nude mice. Six weeks after implantation, the portions
of implanted tubules were harvested. Gross and histological observation demonstrated that the tubular
structure still remained in the experimental groups but not in the control groups. Immunohistochemical
staining and RT-PCR assay of the implanted vessels revealed positive staining in experimental groups
for the lymphatic specific markers podoplanin, VEGFR-3 and LYVE-1. The results indicate that LECs
can serve as seed cells and be successfully combined with PGA scaffolds, and the tissue-engineered
tubular structure using implanted LECs-PGA compounds showed preliminary characteristics of lymph
vessels. A gap between the nearly normal or functional lymph vessel still exists as we have only the
endothelial cell lined duct, but this study demonstrates that it is feasible to construct tissue-engineered
lymph vessels using LECs combined with a biodegradable material. Copyright © 2010. Published by
Elsevier B.V.
PMID: 20691226 [PubMed - as supplied by publisher]
The next 5 documments are Medifocus.com but when I click on each individual link a Pub Med
document did come up and they may be duplicates because they are dated from May to July 2010:
Medfocus Document Alert – August 2010 issue (5 docs)
Each month hundreds of thousands of consumers and healthcare professionals search the National
Library of Medicine's Medline database seeking the latest information on their disease/condition.
Conducting a thorough and effective Medline search is both a time consuming and daunting task. At
Medifocus, we have developed an effective solution to this problem: each month our staff of expert
researchers searches Medline for the latest advances in research and clinical medicine for over 70
diseases / conditions. We do this with one goal in mind: to empower you to effectively take control
over your health.
Here is the result of our team's work in Lymphedema this month:
Arch Phys Med Rehabil. 2010 Jul;91(7):1070-6.
Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility
study.
Katz E, Dugan NL, Cohn JC, Chu C, Smith RG, Schmitz KH.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Abstract
OBJECTIVE: To assess the feasibility of recruiting and retaining cancer survivors with lower-limb
lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety
and efficacy of this intervention. We hypothesized that progressive weight training would not
exacerbate leg swelling and that the intervention would improve functional mobility and quality of life.
DESIGN: Before-after pilot study with a duration of 5 months.
SETTING: University of Pennsylvania.
PARTICIPANTS: Cancer survivors with a known diagnosis of lower-limb lymphedema (N=10) were
directly referred by University of Pennsylvania clinicians. All 10 participants completed the study.
INTERVENTION: Twice weekly slowly progressive weight lifting, supervised for 2 months,
unsupervised for 3 months.
MAIN OUTCOME MEASURES: The primary outcome was interlimb volume differences as
measured by optoelectronic perometry. Additional outcome measures included safety (adverse events),
muscle strength, objective physical function, and quality of life.
RESULTS: Interlimb volume differences were 44.4% and 45.3% at baseline and 5 months,
respectively (pre-post comparison, P=.70). There were 2 unexpected incident cases of cellulitis within
the first 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months.
Bench and leg press strength increased by 47% and 27% over 5 months (P=.001 and P=.07,
respectively). Distance walked in 6 minutes increased by 7% in 5 months (P=.01). No improvement
was noted in self-reported quality of life.
CONCLUSIONS: Recruitment of patients with lower-limb-lymphedema into an exercise program is
feasible. Despite some indications that the intervention may be safe (eg, a lack of clinically significant
interlimb volume increases over 5 mo), the unexpected finding of 2 cellulitic infections among the 10
participants suggests additional study is required before concluding that patients with lower-extremity
lymphedema can safely perform weight lifting.
PMID: 20599045 [PubMed - indexed for MEDLINE]
Am J Hum Genet. 2010 Jun 11;86(6):943-8. Epub 2010 May 27.
GJC2 missense mutations cause human lymphedema.
Ferrell RE, Baty CJ, Kimak MA, Karlsson JM, Lawrence EC, Franke-Snyder M, Meriney SD,
Feingold E, Finegold DN.
Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh,
Pittsburgh, PA 15261, USA.
Abstract
Lymphedema is the clinical manifestation of defects in lymphatic structure or function. Mutations
identified in genes regulating lymphatic development result in inherited lymphedema. No mutations have
yet been identified in genes mediating lymphatic function that result in inherited lymphedema. Survey
microarray studies comparing lymphatic and blood endothelial cells identified expression of several
connexins in lymphatic endothelial cells. Additionally, gap junctions are implicated in maintaining
lymphatic flow. By sequencing GJA1, GJA4, and GJC2 in a group of families with dominantly inherited
lymphedema, we identified six probands with unique missense mutations in GJC2 (encoding connexin
[Cx] 47). Two larger families cosegregate lymphedema and GJC2 mutation (LOD score = 6.5). We
hypothesize that missense mutations in GJC2 alter gap junction function and disrupt lymphatic flow.
Until now, GJC2 mutations were only thought to cause dysmyelination, with primary expression of
Cx47 limited to the central nervous system. The identification of GJC2 mutations as a cause of primary
lymphedema raises the possibility of novel gap-junction-modifying agents as potential therapy for some
forms of lymphedema.
PMID: 20537300 [PubMed - indexed for MEDLINE]
Womens Health (Lond Engl). 2010 May;6(3):399-406.
Breast cancer and lymphedema: a current overview for the healthcare provider.
Rourke LL, Hunt KK, Cormier JN.
University of Texas, MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX
77030, USA. lrourke@mdanderson.org
Abstract
Lymphedema is a troublesome condition faced by many breast cancer survivors today. Since
lymphedema represents a debilitating and progressive problem that is feared by most breast cancer
patients and their providers, an up-to-date understanding is necessary in order to better diagnose, treat
and manage these patients. The etiology of lymphedema is multifactorial and poorly understood.
Although lymphedema is not clearly defined within the medical community, there are several diagnostic
tools available to the clinician, of which the most widely accepted in the clinical setting are the arm
circumference measurements. Misinformation has recently been conveyed regarding activity
recommendations for those patients afflicted with lymphedema. These recent events highlight the critical
importance of education, heightened awareness and dedicated future cooperative research in order to
favorably impact on lymphedema care and the quality of life for those living with lymphedema.
PMID: 20426606 [PubMed - indexed for MEDLINE]
Nucl Med Commun. 2010 Jun;31(6):547-51.
Intradermal lymphoscintigraphy at rest and after exercise: a new technique for the functional assessment
of the lymphatic system in patients with lymphoedema.
Tartaglione G, Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C, Paone G, Bernabucci
V, Bartoletti R, Marchetti P, Marzola MC, Naji M, Rubello D.
Unit of Nuclear Medicine, Cristo Re Hospital, Istituto Dermopatico dell'Immacolata, IDI-IRCCS.
Abstract
AIM: The aim of this study was to evaluate the effect of implementing a new technique, intradermal
injection lymphoscintigraphy, at rest and after muscular exercise on the functional assessment of the
lymphatic system in a group of patients with delayed or absent lymph drainage.
METHODS: We selected 44 patients (32 women and 12 men; 15 of 44 with upper limb and 29 of 44
with lower limb lymphoedema). Thirty of 44 patients had bilateral limb lymphoedema and 14 of 44 had
unilateral disease; 14 contralateral normal limbs were used as controls. Twenty-three patients had
secondary lymphoedema after lymphadenectomy and the remaining 21 had idiopathic lymphoedema.
Each of the 44 patients was injected with 50 MBq (0.3-0.4 ml) of (99m)Tc-albumin-nanocolloid,
which was administered intradermally at the first interdigital space of the affected limb. Two planar
static scans were performed using a low-energy general-purpose collimator (acquisition matrix 128 x
128, anterior and posterior views for 5 min), and in which drainage was slow or absent, patients were
asked to walk or exercise for 2 min. A postexercise scan was then performed to monitor and record
the tracer pathway and the tracer appearance time (TAT) in the inguinal or axillary lymph nodes.
RESULTS: The postexercise scans showed that (i) 21 limbs (15 lower and six upper limbs) had
accelerated tracer drainage and tracer uptake in the inguinal and/or axillary lymph nodes. Two-thirds of
these showed lymph stagnation points; (ii) 27 limbs had collateral lymph drainage pathways; (iii) in 11
limbs, there was lymph drainage into the deeper lymphatic channels, with unusual uptake in the popliteal
or antecubital lymph nodes; (iv) six limbs had dermal backflow; (v) three limbs did not show lymph
drainage (TAT=not applicable). TAT=15 + or - 3 min, ranging from 12 to 32 min in limbs with
lymphoedema versus 5 + or - 2 min, ranging from 1 to 12 min in the contralateral normal limbs (P<0.
001).
CONCLUSION: Intradermal injection lymphoscintigraphy gives a better imaging of the lymph drainage
pathways in a shorter time, including cases with advanced lymphoedema. In some patients with
lymphoedema, a 2-min exercise can accelerate tracer drainage, showing several compensatory
mechanisms of lymph drainage. The effect of the exercise technique on TAT and lymphoscintigraphy
findings could result in a more accurate functional assessment of lymphoedema patients.
PMID: 20215978 [PubMed - indexed for MEDLINE]
Eur J Vasc Endovasc Surg. 2010 May;39(5):646-53. Epub 2010 Feb 21.
Primary lymphoedema and lymphatic malformation: are they the two sides of the same coin?
Lee BB, Villavicencio JL.
Division of Vascular Surgery, Georgetown University School of Medicine, Washington, DC 20007,
USA. bblee38@comcast.net
Abstract
OBJECTIVES: To clear the confusion regarding the relationship between the 'primary lymphoedema'
and (truncular) lymphatic malformation (LM); the latter is one of congenital vascular malformations.
MATERIALS & METHODS: A literature review was carried out on the primary lymphoedema either
existing as an independent LM lesion or as a component of the Klippel-Trenaunay syndrome.
RESULTS: The review was able to provide a contemporary guide/conclusion on the definition and
classification, clinical evaluation and clinical management regarding conservative (physical) therapy,
reconstructive surgical therapy and ablative/excisional surgical therapy, for the primary lymphoedema
as an LM.
CONCLUSIONS: Primary lymphoedema can be considered as 'congenital' since its majority
represents a clinical manifestation of the truncular type of LM arising during the later stages of
lymphangiogenesis. Such embryological staging information of the LM is critical for proper management
of the primary lymphoedema when it exists with other congenital vascular malformations (Klippel-
Trenaunay syndrome). 2. Basic non-invasive to minimally invasive tests will provide an adequate
diagnosis and lead to the correct multidisciplinary, specifically targeted and sequenced treatment
strategy. 3. The mainstay of current management of the primary lymphoedema/truncular LM is complex
decongestive therapy; and the reconstructive as well as ablative surgical therapy remain adjunctive
therapies at best.
PMID: 20176496 [PubMed - indexed for MEDLINE]
August 24, 2010 (2 docs)
Rev Med Chir Soc Med Nat Iasi. 2010 Apr-Jun;114(2):434-8.
[Advanced cervical cancer surgical treatment considerations][Article in Romanian]
Velenciuc N, Luncă S, Velenciuc I, Pantazescu A.
Universităţii de Medicină şi Farmacie Gr.T. Popa Iaşi, Spitalul Clinic de Urgenţe Sf. Ioan Iaşi.
Abstract
The aim of this study was to highlight the importance of surgical treatment in advanced cervical cancer
(IIB-IIIB). MATERIAL AND METHOD: Data from 179 patients with cervical cancer, admitted in
the Clinic of Emergency Surgery, "Sf. Ioan" Hospital, Iaşi, between January, 1st, 2003 and December,
31st, 2009, were collected. RESULTS: A number of 11 cases (6.1%) cases were without any clinical
response, so that they benefit by radical radiotherapy; a radical surgical intervention was performed in
the other 168 cases (93.7%), in 4-6 weeks after chemotherapy. No intraoperative complications were
evidenced, but after surgical intervention we recorded: urinary troubles--10 (6.5%); lymphedema--3
(1.9%); posttoperative intestinal occlusions--2 (1.3%); extended dynamic ileus--2 (1.3%); phlebitis--2
(1.3%).
PMID: 20700981 [PubMed - in process]
Urology. 2010 Aug;76(2 Suppl 1):S43-57.
Management of the lymph nodes in penile cancer.
Heyns CF, Fleshner N, Sangar V, Schlenker B, Yuvaraja TB, van Poppel H.
Department of Urology, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa.
cfh2@sun.ac.za
Abstract
A comprehensive literature study was conducted to evaluate the levels of evidence (LEs) in
publications on the diagnosis and staging of penile cancer. Recommendations from the available
evidence were formulated and discussed by the full panel of the International Consultation on Penile
Cancer in November 2008. The final grades of recommendation (GRs) were assigned according to the
LE of the relevant publications. The following consensus recommendations were accepted. Fine needle
aspiration cytology should be performed in all patients (with ultrasound guidance in those with
nonpalpable nodes). If the findings are positive, therapeutic, rather than diagnostic, inguinal lymph node
dissection (ILND) can be performed (GR B). Antibiotic treatment for 3-6 weeks before ILND in
patients with palpable inguinal nodes is not recommended (GR B). Abdominopelvic computed
tomography (CT) and magnetic resonance imaging (MRI) are not useful in patients with nonpalpable
nodes. However, they can be used in those with large, palpable inguinal nodes (GR B). The statistical
probability of inguinal micrometastases can be estimated using risk group stratification or a risk
calculation nomogram (GR B). Surveillance is recommended if the nomogram probability of positive
nodes is <0.1 (10%). Surveillance is also recommended if the primary lesion is grade 1, pTis, pTa
(verrucous carcinoma), or pT1, with no lymphovascular invasion, and clinically nonpalpable inguinal
nodes, but only provided the patient is willing to comply with regular follow-up (GR B). In the presence
of factors that impede reliable surveillance (obesity, previous inguinal surgery, or radiotherapy)
prophylactic ILND might be a preferable option (GR C). In the intermediate-risk group (nomogram
probability .1-.5 [10%-50%] or primary tumor grade 1-2, T1-T2, cN0, no lymphovascular invasion),
surveillance is acceptable, provided the patient is informed of the risks and is willing and able to
comply. If not, sentinel node biopsy (SNB) or limited (modified) ILND should be performed (GR B).
In the high-risk group (nomogram probability >.5 [50%] or primary tumor grade 2-3 or T2-T4 or cN1-
N2, or with lymphovascular invasion), bilateral ILND should be performed (GR B). ILND can be
performed at the same time as penectomy, instead of 2-6 weeks later (GR C). SNB based on the
anatomic position can be performed, provided the patient is willing to accept the potential false-
negative rate of </=25% (GR C). Dynamic SNB with lymphoscintigraphic and blue dye localization
can be performed if the technology and expertise are available (GR C). Limited ILND can be
performed instead of complete ILND to reduce the complication rate, although the false-negative rate
might be similar to that of anatomic SNB (GR C). Frozen section histologic examination can be used
during SNB or limited ILND. If the results are positive, complete ILND can be performed immediately
(GR C). In patients with cytologically or histologically proven inguinal metastases, complete ILND
should be performed ipsilaterally (GR B). In patients with histologically confirmed inguinal metastases
involving >/=2 nodes on one side, contralateral limited ILND with frozen section analysis can be
performed, with complete ILND if the frozen section analysis findings are positive (GR B). If clinically
suspicious inguinal metastases develop during surveillance, complete ILND should be performed on
that side only (GR B), and SNB or limited ILND with frozen section analysis on the contralateral side
can be considered (GR C). Endoscopic ILND requires additional study to determine the complication
and long-term survival rates (GR C). Pelvic lymph node dissection is recommended if >/=2 proven
inguinal metastases, grade 3 tumor in the lymph nodes, extranodal extension (ENE), or large (2-4 cm)
inguinal nodes are present, or if the femoral (Cloquet's) node is involved (GR C). Performing ILND
before pelvic lymph node dissection is preferable, because pelvic lymph node dissection can be
avoided in patients with minimal inguinal metastases, thus avoiding the greater risk of chronic
lymphedema (GR B). In patients with numerous or large inguinal metastases, CT or MRI should be
performed. If grossly enlarged iliac nodes are present, neoadjuvant chemotherapy should be given and
the response assessed before proceeding with pelvic lymph node dissection (GR C). Antibiotic
treatment should be started before surgery to minimize the risk of wound infection (GR C).
Perioperative low-dose heparin to prevent thromboembolic complications can be used, although it
might increase lymph leakage (GR C). The skin incision for ILND should be parallel to the inguinal
ligament, and sufficient subcutaneous tissue should be preserved to minimize the risk of skin flap
necrosis (GR B). Sartorius muscle transposition to cover the femoral vessels can be used in radical
ILND (GR C). Closed suction drainage can be used after ILND to prevent fluid accumulation and
wound breakdown (GR B). Early mobilization after ILND is recommended, unless a myocutaneous
flap has been used (GR B). Elastic stockings or sequential compression devices are advisable to
minimize the risk of lymphedema and thromboembolism (GR C). Radiotherapy to the inguinal areas is
not recommended in patients without cytologically or histologically proven metastases nor in those with
micrometastases, but it can be considered for bulky metastases as neoadjuvant therapy to surgery (GR
B). Adjuvant radiotherapy after complete ILND can be considered in patients with multiple or large
inguinal metastases or ENE (GR C). Adjuvant chemotherapy after complete ILND can be used instead
of radiotherapy in patients with >/=2 inguinal metastases, large nodes, ENE, or pelvic metastases (GR
C). Follow-up should be individualized according to the histopathologic features and the management
chosen for the primary tumor and inguinal nodes (GR B).
PMID: 20691885 [PubMed - in process]
August 27, 2010 (2 docs)
Am J Ther. 2010 Aug 19. [Epub ahead of print]
Recurrent Lower Extremity Pseudocellulitis.
Korniyenko A, Lozada J, Ranade A, Sandhu G.
1Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College
of Physicians and Surgeons, New York, NY; and 2Department of Pathology, St. Luke's-Roosevelt
Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.
Abstract
The term "Pseudocellulitis" can be used to describe an uncomplicated nonnecrotizing inflammation of
the dermis and hypodermis from a noninfectious etiology. Chemotherapeutic agents have been
associated with a variety of cutaneous reactions, including radiation recall dermatitis, hypersensitivity
reactions, and erysipeloid reactions. Gemcitabine (2,2-difluorodeoxycytidine) is currently being used
for treatment of a variety of solid malignancies, including carcinoma of the lung. The dermatitis involved
with gemcitabine is typically a radiation recall reaction whereby an inflammatory reaction occurs in the
area previously treated with radiotherapy. We describe here a case of Gemcitabine-induced
pseudocellulitis that was unrelated to radiation exposure and manifested in an area of lymphedema. The
pseudocellulitis in such cases could be related to the drug's pharmacokinetics and may last until the
drug is displaced from the subcutaneous tissue of the affected area. Antibiotics have no role in the
treatment, and diphenhydramine with nonsteroidal anti-inflammatories may be used for symptomatic
management.
PMID: 20724909 [PubMed - as supplied by publisher]
Clin Physiol Funct Imaging. 2010 Aug 16. [Epub ahead of print]
Lymphoedema of the lower extremities - background, pathophysiology and diagnostic considerations.
Jensen MR, Simonsen L, Karlsmark T, Bülow J.
Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of
Copenhagen, Copenhagen NV, Denmark.
Abstract
Summary Lymphoedema of the lower extremities is a chronic debilitating disease that is often
underdiagnosed. Early diagnosis and treatment is paramount in reducing the risk of progression and
complications. Lymphoedema has traditionally been defined as interstitial oedema and protein
accumulation because of a defect in the lymphatic drainage; however, some findings suggest that the
interstitial protein concentration may be low in some types of lymphoedema. Primary lymphoedema is
caused by an inherent defect in the lymphatic vessels or lymph nodes. Secondary lymphoedema is
caused by damages to the lymphatic system most often caused by cancer or its treatment. Many of the
underlying pathophysiological mechanisms have yet to be elucidated. Many methods have been
developed for examination of the lymphatic system. Lymphoscintigraphy is presently the preferred
diagnostic modality. Lack of consensus regarding protocol and qualitative interpretation criteria results
in a too observer dependent outcome. Methods for objectifying the scintigraphy through quantification
have been criticized. Depot clearance rates are an alternative method of quantification of lymphatic
drainage capacity. This method however has mostly been applied on upper extremity lymphoedema.
The aim of this review is to provide a literature-based overview of the aetiology and pathophysiology of
lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and
depot clearance techniques. The abundance of factors influencing the outcome of the examination
stresses the need for consensus regarding examination protocols and interpretation. Further studies are
needed to improve diagnostic performance and understanding of pathophysiological mechanisms.
PMID: 20718809 [PubMed - as supplied by publisher]
September 1, 2010
Eur J Cancer. 2010 Aug 24. [Epub ahead of print]
Psychological consequences of lymphoedema associated with breast cancer: A prospective cohort
study.
Vassard D, Olsen MH, Zinckernagel L, Vibe-Petersen J, Dalton SO, Johansen C.
Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer
Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
Abstract
BACKGROUND: The aim of this prospective cohort study of women attending a rehabilitation course
at the Dallund Rehabilitation Centre was to explore the emotional and psychological aspects of living
with lymphoedema, expressed as psychological distress, poorer quality of life and poorer self-reported
health.
METHODS: Between November 2002 and January 2007 within the FOCARE study, self-completed
questionnaires were collected 3weeks before and 6 and 12months after the rehabilitation course to
elicit sociodemographic, physical and lifestyle information and responses to three psychometric tests.
The population consisted of 633 women, 125 with and 508 without verified lymphoedema (time since
surgery, 1month-5years). The population was reduced to 553 women at the first follow-up and 494 at
the second.
RESULTS: Multivariate analysis showed that, in comparison with women without lymphoedema, those
with lymphoedema had a 14% higher risk for scoring one level higher on the POMS-SF test, a 9%
higher probability of scoring one point lower on the quality of life scale and a 29% higher likelihood of
reporting poorer or bad health than women without lymphoedema. These findings were seen at all three
measurement times.
CONCLUSIONS: In this cohort of women with breast cancer, women with lymphoedema after
surgery for breast cancer had significantly worse overall emotional well-being and adjustment to life
compared to women without lymphoedema.
PMID: 20797846 [PubMed - as supplied by publisher]
Case Rep Oncol. 2010 Apr 30;3(2):148-153.
Epithelioid Angiosarcoma in a Patient with Klippel-Trénaunay-Weber Syndrome: An Unexpected
Response to Therapy.
Simas A, Matos C, Lopes da Silva R, Brotas V, Teófilo E, Albino JP.
Serviço de Medicina Interna 3, Hospital Santo António dos Capuchos.
Abstract
We present a rare case of Stewart-Treves syndrome characterized by a diffuse angiosarcoma of the
leg in a 22-year-old man with a history of chronic lymphedema due to Klippel-Trénaunay-Weber
syndrome. He underwent limb disarticulation and medical treatment with cycles of doxorubicin, oral
thalidomide and sunitinib with a very good response after 12 months of follow-up.
PMID: 20740188 [PubMed]PMCID: PMC2919991
Lancet. 2010 Aug 23. [Epub ahead of print]
Lymphatic filariasis and onchocerciasis.
Taylor MJ, Hoerauf A, Bockarie M.
Liverpool School of Tropical Medicine, Liverpool, UK.
Abstract
Lymphatic filariasis and onchocerciasis are parasitic helminth diseases that constitute a serious public
health issue in tropical regions. The filarial nematodes that cause these diseases are transmitted by
blood-feeding insects and produce chronic and long-term infection through suppression of host
immunity. Disease pathogenesis is linked to host inflammation invoked by the death of the parasite,
causing hydrocoele, lymphoedema, and elephantiasis in lymphatic filariasis, and skin disease and
blindness in onchocerciasis. Most filarial species that infect people co-exist in mutualistic symbiosis with
Wolbachia bacteria, which are essential for growth, development, and survival of their nematode hosts.
These endosymbionts contribute to inflammatory disease pathogenesis and are a target for doxycycline
therapy, which delivers macrofilaricidal activity, improves pathological outcomes, and is effective as
monotherapy. Drugs to treat filariasis include diethylcarbamazine, ivermectin, and albendazole, which
are used mostly in combination to reduce microfilariae in blood (lymphatic filariasis) and skin
(onchocerciasis). Global programmes for control and elimination have been developed to provide
sustained delivery of drugs to affected communities to interrupt transmission of disease and ultimately
eliminate this burden on public health.
PMID: 20739055 [PubMed - as supplied by publisher]
Pediatr Dermatol. 2010 Aug 4. [Epub ahead of print]
Congenital Lymphedema with Tuberous Sclerosis and Clinical Hirschsprung Disease.
Lucas M, Andrade Y.
St. Peter's University Hospital, New Brunswick, New Jersey, USA.
Abstract
Case of an 18-month-old child with congenital lymphedema subsequently diagnosed with tuberous
sclerosis and Hirschsprung disease.
PMID: 20738790 [PubMed - as supplied by publisher]
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 May;26(3):190-4.
[Diagnosis of peripheral lymph circulation disorders with contrast MR lymphangiography]
[Article in Chinese]
Liu NF, Lu Q, Jiang ZH, Wang CG, Zhou JG.
Department of Plastic Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200011, China. liuningfei@126.com
Abstract
OBJECTIVE: To evaluate anatomical and functional images of contrast MR lymphangiography in the
diagnosis of limb lymphatic circulation disorders.
METHODS: 30 patients with limb lymphedema were enrolled in the study. There were 27 patients of
primary lymphedema and 3 of secondary lymphedema. Contrast enhanced lymphangiography was
performed with 3.0 T MR Unit after intracutaneous injection of gadobenate dimelumine into the
interdigital webs of the dorsal foot and hand. The kinetics of enhanced lymph flow within the lymphatics
were calculated using the formula: Speed (cm) = total length of visualized lymph vessel (cm)/ inspection
time (minutes) and by comparing dynamic nodal enhancement and time-signal intensity curves between
edematous and contralateral limbs. Morphological abnormalities of the lymphatic system were also
evaluated.
RESULTS: Following injection of the contrast agent enhanced lymphatic channels were consistently
visualized in all clinical lymphedematous limbs and five contralateral limbs of unilateral lymphedema
cases. The speed of enhanced flow within the lymphatics of lymphedematous limbs ranged from 0.30
to 1.48 cm/min. The contrast enhancement in inguinal nodes of edematous limbs was significantly lower
than that of contralateral limbs (P < 0.01). Dynamic measurement of contrast enhancement showed a
remarkable lowering of peak time (P < 0.01) and peak enhancement (P < 0.01) and a delay in outflow
in inguinal nodes of affected limbs compared with that of control limbs. Post-contrast MR imaging also
depicted varied distribution patterns of lymphatics and abnormal lymph flow pathways within lymph
nodes in the limbs with lymphatic circulation disorders.
CONCLUSIONS: Contrast MR lymphangiography with gadobenate dimelumine was able to visualize
the precise anatomy of lymphatic vessels and lymph nodes in lymphedematous limbs. It also provided
comprehensive information about the functional status of lymph flow transportation in lymphatics and
lymph nodes.
PMID: 20737947 [PubMed - in process]
September 5, 2010
Dermatol Online J. 2010 Aug 15;16(8):14.
Elephantiasis nostras verrucosa on the abdomen of a Turkish female patient caused by morbid obesity.
Buyuktas D, Arslan E, Celik O, Tasan E, Demirkesen C, Gundogdu S.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical
School, University of Istanbul, Istanbul, Turkey. sadigundogdu@gmail.com.
Abstract
Elephantiasis Nostras Verrucosa is a rare disorder of an extremity or a body region, which is
associated with chronic lymphedema. There are 7 reported cases of abdominal elephantiasis in the
medical literature. Here we report a morbidly obese female patient with elephantiasis nostras verrucosa
on the abdominal wall.
PMID: 20804691 [PubMed - in process]
Health Qual Life Outcomes. 2010 Aug 31;8(1):92. [Epub ahead of print]
Upper-body morbidity following breast cancer treatment is common, may persist longer-term and
adversely influences quality of life.
Hayes SC, Rye S, Battistutta D, Disipio T, Newman B.
ABSTRACT:
BACKGROUND: Impairments in upper-body function (UBF) are common following breast cancer.
However, the relationship between arm morbidity and quality of life (QoL) remains unclear. This
investigation uses longitudinal data to describe UBF in a population-based sample of women with
breast cancer and examines its relationship with QoL.
METHODS: Australian women (n=287) with unilateral breast cancer were assessed at three-monthly
intervals, from six- to 18-months post-surgery (PS). Strength, endurance and flexibility were used to
assess objective UBF, while the Disability of the Arm, Shoulder and Hand questionnaire and the
Functional Assessment of Cancer Therapy-Breast questionnaire were used to assess self-reported
UBF and QoL, respectively.
RESULTS: Although mean UBF improved over time, up to 41% of women revealed declines in UBF
between six- and 18-months PS. Older age, lower socioeconomic position, treatment on the dominant
side, mastectomy, more extensive lymph node removal and having lymphoedema each increased odds
of declines in UBF by at least two-fold (p<0.05). Lower baseline and declines in perceived UBF
between six- and 18-months PS were each associated with poorer QoL at 18-months PS (p<0.05).
CONCLUSIONS: Significant upper-body morbidity is experienced by many following breast cancer
treatment, persisting longer term, and adversely influencing the QoL of breast cancer survivors.
PMID: 20804558 [PubMed - as supplied by publisher]
Br J Dermatol. 2010 Aug 28. [Epub ahead of print]
Severe Congenital Lymphedema Not Caused by Mutations in Known Lymphedema Genes.
Greenberger S, Reznik-Wolf H, Ghalamkarpour A, Marek-Yagel D, Vikkula M, Pras E.
Sheba Medical Center, The Department of Dermatology, Ramat-Gan, Israel.
PMID: 20804492 [PubMed - as supplied by publisher]
Am J Med Genet A. 2010 Sep;152A(9):2287-96.
Emberger syndrome-primary lymphedema with myelodysplasia: report of seven new cases.
Mansour S, Connell F, Steward C, Ostergaard P, Brice G, Smithson S, Lunt P, Jeffery S, Dokal I,
Vulliamy T, Gibson B, Hodgson S, Cottrell S, Kiely L, Tinworth L, Kalidas K, Mufti G, Cornish J,
Keenan R, Mortimer P, Murday V; Lymphoedema Research Consortium.
SW Thames Regional Genetics Service, St. George's, University of London, London, UK.
smansour@sgul.ac.uk
Abstract
Four reports have been published on an association between acute myeloid leukaemia (AML) and
primary lymphedema, with or without congenital deafness. We report seven new cases, including one
extended family, confirming this entity as a genetic syndrome. The lymphedema typically presents in one
or both lower limbs, before the hematological abnormalities, with onset between infancy and puberty
and frequently affecting the genitalia. The AML is often preceded by pancytopenia or myelodysplasia
with a high incidence of monosomy 7 in the bone marrow (five propositi and two relatives). Associated
anomalies included hypotelorism, epicanthic folds, long tapering fingers and/or neck webbing (four
patients), recurrent cellulitis in the affected limb (four patients), generalized warts (two patients), and
congenital, high frequency sensorineural deafness (one patient). Children with lower limb and genital
lymphedema should be screened for hematological abnormalities and immunodeficiency.
PMID: 20803646 [PubMed - in process]
Med Sci Monit. 2010 Aug 7;16(9):BR313-319.
Evaluation of lymphatic function by means of dynamic Gd-BOPTA-enhanced MRL in experimental
rabbit limb lymphedema.
Jiang Z, Lu Q, Kretlow JD, Hu X, Zhou G, Liu N.
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China.
Abstract
Background: The aim of this study was to investigate the value and technical methods of 3D dynamic
contrast-enhanced magnetic resonance lymphangiography (MRL) in the assessment of lymphatic
anatomy and function in the presence of extremity lymphedema.
Material/Methods: An improved experimental model of obstructive lymphedema was established in 1
hind limb of 6 New Zealand White rabbits. 3D contrast-enhanced MRL was performed with a 3.0-T
MR unit after the intracutaneous injection of Gd-BOPTA into the interdigital webs of the dorsal paws.
Maximum-intensity projection (MIP) was used to reconstruct the images of the lymphatic system. The
dynamic nodal enhancement in the popliteal fossa and time-signal intensity curves between
lymphedematous and contralateral limbs were compared. Morphologic abnormalities of the lymphatic
system were also evaluated and compared with lymphoscintigraphy (LSG).
Results: 3D dynamic contrast-enhanced MRL images were obtained after the administration of Gd-
BOPTA. In the normal limb, the popliteal fossa lymph nodes and their afferent and efferent lymph-
collecting vessels were clearly visualized as the Gd tracer was rapidly cleared from the interstitial
compartment. In contrast, the Gd tracer accumulated slowly at the prior surgical site in the
lymphedematous limb. The nodal enhancement of lymphedematous limbs was significantly less than that
of the contralateral limbs (P<0.01). Types of time-signal intensity curves were also significantly different
between the 2 groups (P<0.001).
Conclusions: 3D dynamic contrast-enhanced MRL can visualize the precise anatomy of lymphatic
vessels and lymph nodes in extremity lymphedema, as well as objectively evaluate the functional status
of lymph flow transport.
PMID: 20802408 [PubMed - in process]
J Vasc Surg. 2010 Aug 25. [Epub ahead of print]
Lymphatic malformation is a common component of Klippel-Trenaunay syndrome.
Liu NF, Lu Q, Yan ZX.
Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China.
Abstract
OBJECTIVES: Few previous studies have focused on the involvement of the lymphatic system in
Klippel-Trenaunay syndrome (KTS), although some evidence suggests that lymphatic abnormalities are
associated with the disease. The aim of the present study was to investigate the involvement of the
lymphatic system in KTS.
METHODS: Magnetic resonance lymphangiography (MRL) with the use of gadobenate dimeglumine
as the contrast was performed on 32 patients with KTS involving the extremities to evaluate lymphatic
vessels, lymph nodes, and veins.
RESULTS: Thirty-one of 32 patients exhibited lymphatic vessel and/or lymph node anomalies,
including hyperplasia (11/31), hypoplasia or aplasia (20/31) of lymphatic vessels, and lymphedema
(31/31) of the affected limbs. Twenty-two patients showed asymmetry of the inguinal nodes exhibiting
either the absence, or an increase or a decrease in number and size of the inguinal nodes. Venous
dysplasia was found in 31 patients in superficial and/or deep veins. The results showed a high
concomitance of malformations of the lymphatic system and veins in the affected limbs of patients with
KTS.
CONCLUSIONS: Lymphatic system abnormalities as examined with MRL are commonly associated
with KTS and are likely to play a significant role in the disorder.
PMID: 20800418 [PubMed - as supplied by publisher]
September 8, 2010
Orbit. 2010 Aug;29(4):222-6.
Chronic lymphedema of the eyelid: case series.
Chalasani R, McNab A.
Ophthalmology Registrar, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
Abstract
Purpose: To evaluate the clinical features, management and outcomes of treatment of chronic
lymphedema of the eyelid in a tertiary referral setting.
Design: Retrospective case series. Participants: 15 patients referred to the authors with unilateral or
bilateral eyelid swelling of greater than 3 months duration.
Main Outcome Measures: Clinical features, patient management, response to treatment.
Results: Chronic eyelid lymphedema was associated with acne rosacea in 9 patients, radiotherapy in 1
patient, trauma in 1 patient and post-vitrectomy silicone oil leak in 1 patient. In the remaining 4 patients
no associated condition or factor was identified. Surgical debulking was performed in 9 cases with
improvement in all cases and no complications.
Conclusion: Chronic eyelid lymphedema is a rare condition most commonly associated with rosacea. In
our experience, surgical resection of involved subcutaneous tissue was helpful.
PMID: 20812843 [PubMed - in process]
Plast Reconstr Surg. 2010 Sep;126(3):1118-9.
Breast reconstruction and lymphedema.
Khan MA, Srinivasan K, Mohan A, Hardwicke J, Rayatt S.
University Hospital of North Staffordshire NHS Trust; Stoke-on-Trent, Staffordshire, United Kingdom.
PMID: 20811251 [PubMed - in process]
Plast Reconstr Surg. 2010 Sep;126(3):759-61.
Discussion: lymphaticovenular bypass for lymphedema management in breast cancer patients: a
prospective study.
Cheng J.
Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical
Center.
PMID: 20811211 [PubMed - in process]
Plast Reconstr Surg. 2010 Sep;126(3):752-8.
Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study.
Chang DW.
Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer
Center.
Abstract
BACKGROUND: Lymphedema is a common and debilitating condition. Management options for
lymphedema are limited and controversial. The purpose of this prospective study was to provide a
preliminary analysis of lymphaticovenular bypass for the treatment of upper limb lymphedema in breast
cancer patients.
METHODS: Twenty patients with upper extremity lymphedema secondary to treatment of breast
cancer underwent lymphaticovenular bypass using a "supermicrosurgical" approach. The mean age of
the patients was 54 years, 16 patients had received preoperative radiation therapy, and all patients had
received axillary lymph node dissection. The mean duration of lymphedema was 4.8 years, and the
mean volume differential of the lymphedematous arm compared with the unaffected arm was 34
percent. Evaluation included qualitative assessment and quantitative volumetric analysis before surgery
and at 1 month, 3 months, 6 months, and 1 year after the procedure.
RESULTS: The mean number of bypasses performed per patient was 3.5 (range, two to five), and the
size of bypasses ranged from 0.3 to 0.8 mm. The mean operative time was 3.3 hours (range, 2 to 5
hours). Hospital stay was less than 24 hours for all patients. The mean follow-up time was 18 months.
Nineteen patients (95 percent) reported symptom improvement following surgery, and 13 patients had
quantitative improvement. The mean volume differential reduction was 29 percent at 1 month, 36
percent at 3 months, 39 percent at 6 months, and 35 percent at 1 year. No patients experienced
postoperative complications or lymphedema exacerbation.
CONCLUSIONS: Lymphaticovenular bypass may effectively reduce the severity of lymphedema in
breast cancer patients. Long-term analysis is needed.
PMID: 20811210 [PubMed - in process]
Biol Trace Elem Res. 2010 Sep 1. [Epub ahead of print]
Titanium, Sinusitis, and the Yellow Nail Syndrome.
Berglund F, Carlmark B.
, Solvägen 8 A, SE 192 66, Sollentuna, Sweden, fred.berglund@swipnet.se.
Abstract
Yellow nail syndrome is characterized by nail changes, respiratory disorders, and lymphedema. In a
yellow nail patient with a skeletal titanium implant and with gold in her teeth, we found high levels of
titanium in nail clippings. This study aims to examine the possible role of titanium in the genesis of the
yellow nail syndrome. Nail clippings from patients with one or more features of the yellow nail
syndrome were analyzed by energy dispersive X-ray fluorescence. Titanium was regularly found in
finger nails in patients but not in control subjects. Visible nail changes were present in only half of the
patients. Sinusitis with postnasal drip and cough was the most common complaint. The dominant
source of titanium ions was titanium implants in the teeth or elsewhere. The titanium ions were released
through the galvanic action of dental gold or amalgam or through the oxidative action of fluorides. In
other patients the titanium was derived from titanium dioxide in drugs and confectionary. Stopping
galvanic release of titanium ions or canceling exposure to titanium dioxide led to recovery. In one
patient with a titanium implant, the symptoms recurred after renewed exposure to titanium. Yellow nail
syndrome is caused by titanium.
PMID: 20809268 [PubMed - as supplied by publisher]
Physiother Can. 2009 Fall;61(4):244-51. Epub 2009 Nov 12.
Effect of acute exercise on upper-limb volume in breast cancer survivors: a pilot study.
McNeely ML, Campbell KL, Courneya KS, Mackey JR.
Margaret L. McNeely, PhD: Physical Therapy Department, University of Alberta, and Cross Cancer
Institute, Edmonton, Alberta.
Abstract
Purpose: Strenuous upper-extremity activity and/or exercise have traditionally been prescribed for
breast cancer survivors with or at risk of developing lymphedema. The purpose of this study was to
assess the effect of an acute bout of exercise on upper-limb volume and symptoms in breast cancer
survivors, with the intent to provide pilot data to guide a subsequent larger study.
Methods: Twenty-three women who regularly participated in dragon-boat racing took part in the study.
A single exercise bout was performed at a moderate intensity (rating of perceived exertion: 13-14) for
20 continuous minutes on an arm ergometer. The difference between affected and unaffected limb
volume was assessed pre- and post-exercise via measurements of limb circumference at five time
points.
Results: Although limb volume increased following exercise in both limbs, the difference between the
limbs remained stable at each measurement point. Only one participant was found to have an increase
in arm-volume difference of >100 ml post intervention, and only four participants reported symptoms
of tension and/or heaviness in the affected limb.
Conclusion: The results suggest that limb volume in breast cancer survivors increases after an acute
bout of upper-limb exercise but that, for the majority of women, the response is not different between
affected and unaffected limbs. Future research using a larger sample and more sensitive measurement
methods are recommended.
PMID: 20808486 [PubMed - in process]
Pediatr Dermatol. 2010 Aug 26. [Epub ahead of print]
Congenital Yellow Nail Syndrome: A Case Report and Its Relationship to Nonimmune Fetal Hydrops.
Nanda A, Al-Essa FH, El-Shafei WM, Alsaleh QA.
As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait.
Abstract
Yellow nail syndrome (YNS) is an uncommon disorder characterized by a triad of nail dystrophy,
lymphedema, and pleural effusion. It is rare in children and congenital occurrence of YNS has been
very rarely described. We report a 2-year-old Arab boy having congenital yellow nail syndrome with
mild facial dysmorphism and bilateral conjunctival pigmentation born to consanguineous parents. One
of his older siblings had died of nonimmune fetal hydrops (NIFH). The case supports the genetic basis
of yellow nail syndrome with a possible relationship to nonimmune fetal hydrops.
PMID: 20807364 [PubMed - as supplied by publisher]
These are the current Pub Med list you sent me, not a backlogged one Tina, so I used today’s date for
it per my note above:
September 17, 2010
Breast Cancer Res. 2010 Sep 8;12(5):R70. [Epub ahead of print]
Experimental assessment of pro-lymphangiogenic growth factors in the treatment of post-surgical
lymphedema following lymphadenectomy.
Baker A, Kim H, Semple JL, Dumont D, Shoichet M, Tobbia D, Johnston M.
ABSTRACT:
INTRODUCTION: Lymphedema is a frequent consequence of lymph node excision during breast
cancer surgery. Current treatment options are limited mainly to external compression therapies to limit
edema development. We investigated previously, post-surgical lymphedema in a sheep model following
the removal of a single lymph node and determined that autologous lymph node transplantation has the
potential to reduce or prevent edema development. In this report, we examine the potential of
lymphangiogenic therapy to restore lymphatic function and reduce post-surgical lymphedema.
METHODS: Lymphangiogenic growth factors (vascular endothelial growth factor-C (VEGF-C) and
angiopoitein-2 (ANG-2)) were loaded into a gel-based drug delivery system (HAMC; a blend of
hyaluronan and methylcellulose). Drug release rates and lymphangiogenic signaling in target endothelial
cells were assessed in vitro and vascular permeability biocompatibility tests were examined in vivo.
Following, the removal of a single popliteal lymph node, HAMC with the growth factors was injected
into the excision site. Six weeks later, lymphatic functionality was assessed by injecting 125Iodoine
radiolabelled bovine serum albumin (125I-BSA) into prenodal vessels and measuring its recovery in
plasma. Circumferential leg measurements were plotted over time and areas under the curves used to
quantify edema formation.
RESULTS: The growth factors were released over a two-week period in vitro by diffusion from
HAMC, with 50% being released in the first 24 hours. The system induced lymphangiogenic signaling
in target endothelial cells, while inducing only a minimal inflammatory response in sheep. Removal of the
node significantly reduced lymphatic functionality (Nodectomy 1.9 +/- 0.9, HAMC alone 1.7 +/- 0.8)
compared with intact groups (3.2 +/- 0.7). There was no significant difference between the growth
factor treatment group (2.3 +/- 0.73) and the intact group. An increase in the number of regenerated
lymphatic vessels at treatment sites was observed with fluoroscopy. Groups receiving HAMC plus
growth factors displayed significantly reduced edema (107.4 +/- 51.3) compared with non-treated
groups (nodectomy 219.8 +/- 118.7, and HAMC alone 162.6 +/- 141).
CONCLUSIONS: Growth factor therapy has the potential to increase lymphatic function and reduce
edema magnitude in an animal model of lymphedema. The application of this concept to lymphedema
patients warrants further examination.
PMID: 20825671 [PubMed - as supplied by publisher]
Med Oncol. 2010 Sep 9. [Epub ahead of print]
Whether drainage should be used after surgery for breast cancer? A systematic review of randomized
controlled trials.
He XD, Guo ZH, Tian JH, Yang KH, Xie XD.
Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199
Donggang West Road, Lanzhou, Gansu, 730000, China, hxdls58@163.com.
Abstract
A systematic review of randomized controlled trials (RCTs) was conducted to evaluate whether
patients benefit from the suction drainage after axillary lymph node dissection (ALND) in breast cancer
surgery. RCTs of drainage versus no drainage after ALND in women with breast cancer were
retrieved from PubMed, EMBASE, Cochrane Library and Chinese Biomedical database. Two authors
independently assessed the quality of included trials and extracted data. Odds ratio (OR) for
dichotomous outcomes and mean difference (MD) for continuous outcomes were presented with 95%
confidence intervals (CI). A total of 1115 titles were indentified from the databases; 1109 obvious
irrelevant studies were excluded by examining the titles, abstracts, full texts because of duplicates, no
RCT, different modality of drainage, drain for lymphedema, application of fibrin sealant and so on. And
then, only 6 RCTs to compare drainage with no drainage after ALND in breast cancer surgery were
included in the systematic review and a total of 585 patients were included in the pathological diagnosis
of breast cancer in women before surgery, management by ALND with or without addition surgical
procedures. The study demonstrated that insertion of a drain in the axilla after breast cancer surgery
resulted in a statistically significant reduction in the rate of seroma (OR = 0.36, 95% CI, 0.16 to 0.81,
P = 0.01), the volume of aspiration (MD = -100.10, 95% CI, -174.36 to -25.85, P = 0.008), or the
frequency of seroma aspiration (MD = -1.03, 95% CI, -1.35 to -0.71, P < 0.00001), but prolonged
the length of hospital stay (MD = 1.52, 95% CI, 0.36 to 2.68, P = 0.01). There was no statistically
significant difference in the incidence of wound infection (OR = 0.67, 95% CI, 0.34 to 1.32, P = 0.25)
between drainage group and no drainage group. Based on the current evidence, insertion of a drain in
the axilla following ALND in breast cancer surgery effectively decreased seroma formation, volume of
aspiration as well as the frequency of seroma aspiration without increasing the incidence of wound
infection, but extending their stay in hospital.
PMID: 20827578 [PubMed - as supplied by publisher]
Am J Hum Genet. 2010 Sep 10;87(3):436-44.
Protein tyrosine phosphatase PTPN14 is a regulator of lymphatic function and choanal development in
humans.
Au AC, Hernandez PA, Lieber E, Nadroo AM, Shen YM, Kelley KA, Gelb BD, Diaz GA.
Department of Genetics & Genomic Sciences, Mount Sinai School of Medicine, New York, NY
10029, USA.
Abstract
The lymphatic vasculature is essential for the recirculation of extracellular fluid, fat absorption, and
immune function and as a route of tumor metastasis. The dissection of molecular mechanisms underlying
lymphangiogenesis has been accelerated by the identification of tissue-specific lymphatic endothelial
markers and the study of congenital lymphedema syndromes. We report the results of genetic analyses
of a kindred inheriting a unique autosomal-recessive lymphedema-choanal atresia syndrome. These
studies establish linkage of the trait to chromosome 1q32-q41 and identify a loss-of-function mutation
in PTPN14, which encodes a nonreceptor tyrosine phosphatase. The causal role of PTPN14
deficiency was confirmed by the generation of a murine Ptpn14 gene trap model that manifested
lymphatic hyperplasia with lymphedema. Biochemical studies revealed a potential interaction between
PTPN14 and the vascular endothelial growth factor receptor 3 (VEGFR3), a receptor tyrosine kinase
essential for lymphangiogenesis. These results suggest a unique and conserved role for PTPN14 in the
regulation of lymphatic development in mammals and a nonconserved role in choanal development in
humans.
PMID: 20826270 [PubMed - in process]
Duodecim. 2010;126(15):1827-30.
[Mystery of the swollen leg]
[Article in Finnish]
Sundell J.
TYKS, Raision sairaala, sisätautien klinikka PL 43, 21201 Raisio.
Abstract
This case report demonstrates a 90-year-old female patient who had an amelanotic subungual
melanoma of the right hallux. As usual non healing ulcer of the nail bed was initially misdiagnosed.
Finally melanoma spread to the groin lymph nodes and induced lymphedema of the leg leading to the
right diagnosis. Acral lesion requires early biopsy if any clinical uncertainty exists.
PMID: 20824972 [PubMed - in process]
September 17, 2010 - this will be the date of the email to me FYI
June 2010 - Clinics (Sao Paulo). 2010 Jun;65(8):781-7.
Comparison of quality of life, satisfaction with surgery and shoulder-arm morbidity in breast cancer
survivors submitted to breast-conserving therapy or mastectomy followed by immediate breast
reconstruction.
Freitas-Silva R, Conde DM, Freitas-Júnior R, Martinez EZ.
Department of Gynecology and Obstetrics, Universidade Federal de Goiás, Goiânia, GO, Brasil.
Abstract
OBJECTIVES: This study was designed to compare the prevalence of shoulder-arm morbidity, patient
satisfaction with surgery and the quality of life of women submitted to breast-conserving therapy or
modified radical mastectomy and immediate breast reconstruction .
METHODS: This study was a cross-sectional study of women who underwent breast-conserving
therapy (n=44) or modified radical mastectomy and immediate breast reconstruction (n=26). Quality of
life was evaluated with the SF-36 Health Survey Questionnaire.
RESULTS: No differences were found in the prevalence of lymphedema. The movements that were
most commonly affected by these procedures were abduction, flexion and external rotation. When the
two groups were compared, however, we only found a statistically significant difference for the
prevalence of restricted internal rotation, which occurred in 32% of women in the breast-conserving
therapy group and 12% of those in the modified radical mastectomy and immediate breast
reconstruction group (OR: 7.23; p=0.03 following adjustment for potential confounding factors). No
difference in quality of life or satisfaction with surgery was found between the two groups.
CONCLUSIONS: These data suggest that the type of surgery did not affect the occurrence of
lymphedema. Breast-conserving therapy, however, increased the risk of shoulder movement limitation.
No differences were found between the two surgical techniques with respect to quality of life or
satisfaction with surgery.
PMID: 20835555 [PubMed - in process]
September 7, 2010 - Orthopedics. 2010 Sep 7;33(9). doi: 10.3928/01477447-20100722-35.
Wound healing in total joint arthroplasty.
Jones RE.
Abstract
Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing
problems can occur and the consequences can be devastating. Determination of the host healing
capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no
healing compromises; and type B, systemic or local healing compromising factors present. Local
factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor
vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver
disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon
should encourage positive choices such as smoking cessation and nutritional supplementation to elevate
the total lymphocyte count and total albumin.Careful planning of incisions, particularly in patients with
scarring or multiple previous operations, is productive. Around the knee the vascular viability is better
in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle
tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet
to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound
problems.If wound drainage or healing problems occur, immediate action is required. Deep sepsis can
be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative
culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be
managed by debridement to obtain a live wound.
PMID: 20839686 [PubMed - in process]
September 13, 2010 - Stem Cells Dev. 2010 Sep 13. [Epub ahead of print]
Cellular trans/-differentiation and morphogenesis towards the lymphatic lineage in regenerative medicine.
Laco F, Grant MH, Flint D, Black RA.
Universtity of Strathclyde, Bioengineering, Glasgow, United Kingdom; filiplaco@googlemail.com.
Abstract
Lymphoedema is a medically irresolvable condition. The lack of therapies addressing lymphatic vessel
dysfunction suggests that improved understanding of lymphatic cell differentiation and vessel maturation
processes is key to the development of novel, regenerative medicine and tissue engineering
approaches. In this review we provide an overview of lymphatic characterisation markers and
morphology in development. Furthermore, we describe multiple differentiation processes of the
lymphatic system during embryonic, post-natal and pathogenic development. Using the example of
pathogenic Kaposi Sarcoma-associated Herpes infection we illustrate the involvement of the Notch
and PI3K pathways for lymphatic trans-differentiation. We also discuss the plasticity of certain cell
types and bio-factors which enable trans-differentiation towards the lymphatic lineage. Here we argue
the importance of pathway-associated induction factors for lymphatic trans-differentiation including
growth factors such as VEGF-C and interleukins, and the involvement of extracellular matrix
characteristics and dynamics for morphological functionality.
PMID: 20836656 [PubMed - as supplied by publisher]
September 28, 2010
Presse Med. 2010 Sep 20. [Epub ahead of print]
[Lymphoscintigraphic exploration in the limbs lymphatic disease.]
[Article in French]
Baulieu F, Lorette G, Baulieu JL, Vaillant L.
CHRU de Tours, université François-Rabelais de Tours, médecine nucléaire, 37044 Tours cedex,
France.
Abstract
Lymphoscintigraphy is based upon the physiological transport of small radioactive particles injected
into interstitium toward lymphatic vessels and nodes. Lymphoscintigraphy directly investigates
lymphatic system while other methods (ultrasounds, CT, MRI) investigate tissular consequences of
lymphatic disease. The scintigraphic procedure has to be standardized in order to be reproducible.
Lymphatic vessels, lymphatic nodes and interstitium are systematically analysed. Interpretation is visual
and qualitative. Multiple abnormalities can be observed. However, none of them can consistently
differentiate between primary and secondary lymphedema. Differential diagnosis is usually obtained by
taking together clinical and lymphoscintigraphic data. By providing informations about lymphatic
component and physiopathology of edema, lymphoscintigraphy contributes to the management of
lymphedema. Hybrid imaging is a new imaging modality of edema. Recently used, it combines
functional (scintigraphy) and anatomical (CT) data and seems to be able to provide further informations.
PMID: 20863652 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2010 Sep;8(3):175-9.
Lymphangiosarcoma complicating extensive congenital mixed vascular malformations.
Al Dhaybi R, Agoumi M, Powell J, Dubois J, Kokta V.
Division of Dermatology, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.
roladhaybi@yahoo.com
Abstract
Pediatric hepatic angiosarcoma is a very rare malignant vascular tumor. A few cases have shown
pediatric hepatic angiosarcoma occurring on a background of preexisting vascular lesions. We report
the case of a newborn girl who presented extensive limbs and upper trunk cutaneous mixed vascular
malformations at birth. These malformations were associated with thrombocytopenia. Cutaneous
biopsies revealed complex vascular malformations with a significant lymphatic component.
Compressive body suit therapy led to regression of the limbs' cutaneous vascular malformations. At the
age of 9 months, the patient presented multiple heterogeneous hepatosplenic nodules. Aggressive
treatment with prednisone, vincristine, and hepatosplenic embolizations resulted in initial improvement
of the hepatosplenic lesions for few months, followed by an increase of the lesions with failure of
response to treatment despite adding alpha-interferon-2b to treatment. The patient died at the age of
19 months. The autopsy's pathological examination revealed a hepatic-based angiosarcoma with
plurimetastatic dissemination to the spleen, lungs, peritoneum, pleura, mesenteric linings as well as the
serosa of the stomach and small intestine. Multiple cutaneous and visceral complex capillaro-
lymphatico-venous malformations were also identified. We hypothesize that these multiple extensive
mixed vascular malformations were associated with chronic lymphedema which probably predisposed
to the development of the angiosarcoma in our patient.
PMID: 20863270 [PubMed - in process]
Hu Li Za Zhi. 2010 Apr;57(2 Suppl):S99-103.
[Providing care to an elephant leg patient: a nurse's experience]
[Article in Chinese]
Chen TH, Wang CY, Chang ML.
General Surgery, Department of Nursing, Taipei Medical University-Wan Fang Hospital, Taipei
Medical University.
Abstract
This article reports on the experience of nurses who provided nursing care to a woman who had
recently immigrated to Taiwan from Mainland China. The woman suffered from chronic lymphedema,
and had previously received surgical treatment for the condition. The period of nursing care ran from
June 10th through September 9th, 2008. Nursing care experience focused on the two care issues of
anxiety and health seeking behavior. During the nursing process, we expressed empathy, encouraged
the patient to express her feelings, and provided disease-related information. We successfully resolved
the patient's anxiety problem. The patient learned to use distraction to help relieve pain. The patient
also participated in a rehabilitation program to improve her blood circulation. We tracked the patient's
rehabilitation progress through e-mail correspondence. We hope that this complete nursing experience
can serve as reference in caring for patients facing similar problems in the future.
PMID: 20405406 [PubMed - in process]
October 2, 2010
Microsurgery. 2010 Sep;30(6):437-42.
Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis.
Maegawa J, Mikami T, Yamamoto Y, Satake T, Kobayashi S.
Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama
City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Abstract
Several authors have reported the usefulness and benefits of lymphoscintigraphy. However, it is
insufficient to indicate microvascular treatment based on lymphedema. Here, we present the
relationships between lymphoscintigraphic types and indications for lymphatic microsurgery.
Preoperative lymphoscintigraphy was performed in 142 limbs with secondary lymphedema of the lower
extremity. The images obtained were classified into five types. Type I: Visible inguinal lymph nodes,
lymphatics along the saphenous vein and/or collateral lymphatics. Type II: Dermal backflow in the thigh
and stasis of an isotopic material in the lymphatics. Type III: Dermal backflow in the thigh and leg.
Type IV: Dermal backflow in the leg. Type V: Radiolabeled colloid remaining in the foot.
Lymphaticovenous anastomosis was performed in 35 limbs. The average number of anastomoses per
limb was 3.3 in type II, 4.4 in type III, 3.6 in type IV, and 3 in type V. The highest number of
anastomosis was performed in type III. In conclusion, type III is suggested to be the best indication for
anastomosis compared with types IV and V. © 2010 Wiley-Liss, Inc. Microsurgery 30:437-442,
2010.
PMID: 20878726 [PubMed - in process]
Med Klin (Munich). 2010 Sep;105(9):619-26. Epub 2010 Sep 28.
[Alternative sonographic diagnoses in patients with clinical suspicion of deep vein thrombosis.]
[Article in German]
Taute BM, Melnyk H, Podhaisky H.
Universitätsklinik und Poliklinik für Innere Medizin III, Schwerpunkt Angiologie, Universitätsklinikum
der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Germany, bettina.taute@medizin.
uni-halle.de.
Abstract
BACKGROUND AND PURPOSE: : Unclear extremity complaints are common symptoms of
inpatients. In a subset of these patients, a clinical suspicion of deep vein thrombosis (DVT) results; this
needs to be quickly and definitively clarified by a vascular physician. The question arose of how often a
clinical suspicion of DVT was confirmed in an inpatient population and which alternative diagnoses
were able to be made by angiologists.
PATIENTS AND METHODS: : In a retrospective analysis, all inpatients in the Angiologic Vascular
Diagnostics Center of the University Hospital Halle, Germany, examined in 2007 for a suspicion of
DVT were evaluated with respect to the definitively made diagnosis.
RESULTS: : In 213 (28.6%) of 745 suspected cases of DVT, a DVT was confirmed. In 532 patients
(71.4%), DVT was excluded. In 314 of these patients, 436 alternative diagnoses were recorded in the
diagnostic reports of angiologic examinations. In 38.6% (n = 168), other venous causes could be
confirmed as the most common alternative diagnosis. There were chronic venous diseases in 28% (n =
122), superficial thrombophlebitis (n = 27), and tumor-related pelvic vein compression (n = 19).
17.4% (n = 76) exhibited lymphedema. In 13.3% (n = 58), a generalized edema was diagnosed.
Arthrogenic causes followed with 12.8% (n = 56). Lipedema (5.3%) and hematoma (5%) could be
verified as other important differential diagnoses. Rare causes were symptomatic or ruptured Baker's
cysts (2.5%), erysipelas (2.5%), abscess, aneurysm, muscle tears, and tumors.
CONCLUSION: : The variety of alternative diagnoses in patients with clinical suspicion of DVT is
high. The knowledge and systematic examination of potential, even rare differential diagnoses after
exclusion of DVT are part of the repertoire of the vascular physician. Unnecessary and expensive, as
well as onerous, diagnostic procedures on the patient can be avoided. Anticoagulation that was begun
as a result of the suspicion of DVT can quickly be stopped.
PMID: 20878299 [PubMed - in process]
An Pediatr (Barc). 2010 Sep 24. [Epub ahead of print]
[Early primary lymphoedema. A condition to remember.]
[Article in Spanish]
Carreira Sande N, Rodríguez Blanco MA, Martín Morales JM, González Alonso N, Dosil Gallardo S,
Cea Pereiro C.
Servicio de Pediatría, Hospital da Barbanza, Ribeira, A Coruña, España.
PMID: 20870471 [PubMed - as supplied by publisher]
Tina, the next two look duplicates to me, though the first came in a doc with 3 others and the second in
a doc all by itself. But I put them both here just in case I missed something that wasn’t duplicate
Hautarzt. 2010 Sep 26. [Epub ahead of print]
[Fatter through lipids or water : Lipohyperplasia dolorosa versus lymphedema.]
[Article in German]
Cornely ME.
Praxis Prof. Hon. (Univ. Puebla) Dr. med. Manuel E. Cornely, Kaiserswerther Str. 296, 40474,
Düsseldorf, Deutschland, post@hautarzt-duesseldorf.de.
Abstract
Lipohyperplasia dolorosa and lymphedema are completely different disease entities, which are both,
however, classified under lymphology. While in lipohyperplasia dolorosa a congenital lipid distribution
disorder leads to a high volume insufficiency and the corresponding clinical symptoms, lymphedema is
characterized by a congenital transport incompetence of the vessels or acquired disorders of transport
capacity. Both lymphedemas of different genesis are familial volume alterations of the affected regions
and the increase in volume is irreversible if not exclusively still in stage I or II. According to current
knowledge the solid increase in volume by lymphedema is due to a malfunctioning biomechanism by
which the release of additional proteoglycans in the homeostasis system of the fluid in the interstital
space plays an important role. Removal of this tissue and the sponge-like substance of proteoglycans is
the aim of therapeutic approaches. Manual lymph drainage and compression can evacuate the sponge
but not remove it. Lymphological liposculpture is a successful dermatosurgical measure even for
secondary lymphedema. Reduction of the necessity of complex hemostasis therapy to 20% of the initial
value and an adjustment of the affected extremity on the healthy side, represent a clear improvement in
quality of life of patients. The same dermatosurgical method, lymphological liposculpture, has been
known for many years to fulfil the successfully proven purpose for the treatment of lipohyperplasia
dolorosa by the removal of subcutaneous fatty tissue, present as hyperplasia and not hypertrophy.
Tenderness and the necessity for complex hemostasis therapy are no longer present or no longer
necessary after lymphological liposculpture for lipohyperplasia dolorosa. This condition is permanent
because the congenital fatty masses do not reoccur following surgical removal. Lipohyperplasia
dolorosa is therefore curable by lymphological liposculpture. For secondary lymphedema a drastic
improvement in quality of life of the patient can be achieved by this method which is demonstrated by
the adjustment of symmetry of the extremities and reduction or even avoidance of complex hemostasis
therapy.
PMID: 20871969 [PubMed - as supplied by publisher]
Hautarzt. 2010 Sep 26. [Epub ahead of print]
[Fatter through lipids or water : Lipohyperplasia dolorosa versus lymphedema.]
[Article in German]
Cornely ME.
Praxis Prof. Hon. (Univ. Puebla) Dr. med. Manuel E. Cornely, Kaiserswerther Str. 296, 40474,
Düsseldorf, Deutschland, post@hautarzt-duesseldorf.de.
Abstract
Lipohyperplasia dolorosa and lymphedema are completely different disease entities, which are both,
however, classified under lymphology. While in lipohyperplasia dolorosa a congenital lipid distribution
disorder leads to a high volume insufficiency and the corresponding clinical symptoms, lymphedema is
characterized by a congenital transport incompetence of the vessels or acquired disorders of transport
capacity. Both lymphedemas of different genesis are familial volume alterations of the affected regions
and the increase in volume is irreversible if not exclusively still in stage I or II. According to current
knowledge the solid increase in volume by lymphedema is due to a malfunctioning biomechanism by
which the release of additional proteoglycans in the homeostasis system of the fluid in the interstital
space plays an important role. Removal of this tissue and the sponge-like substance of proteoglycans is
the aim of therapeutic approaches. Manual lymph drainage and compression can evacuate the sponge
but not remove it. Lymphological liposculpture is a successful dermatosurgical measure even for
secondary lymphedema. Reduction of the necessity of complex hemostasis therapy to 20% of the initial
value and an adjustment of the affected extremity on the healthy side, represent a clear improvement in
quality of life of patients. The same dermatosurgical method, lymphological liposculpture, has been
known for many years to fulfil the successfully proven purpose for the treatment of lipohyperplasia
dolorosa by the removal of subcutaneous fatty tissue, present as hyperplasia and not hypertrophy.
Tenderness and the necessity for complex hemostasis therapy are no longer present or no longer
necessary after lymphological liposculpture for lipohyperplasia dolorosa. This condition is permanent
because the congenital fatty masses do not reoccur following surgical removal. Lipohyperplasia
dolorosa is therefore curable by lymphological liposculpture. For secondary lymphedema a drastic
improvement in quality of life of the patient can be achieved by this method which is demonstrated by
the adjustment of symmetry of the extremities and reduction or even avoidance of complex hemostasis
therapy.
----------------------------
October 5, 2010
Indian J Pediatr. 2010 Sep 30. [Epub ahead of print]
Home-made Compression Stockings and Shoes of a Cotton-Polyester Material in the Treatment of
Primary Congenital Lymphedema.
de Godoy JM, Azoubel LM, de Godoy MD.
Department of Cardiology and Cardiovascular Surgery, Medical School of São Jose do Rio Preto-
FAMERP-Brazil and CNPq (National Council for Research and Development), São José do Rio
Preto, Brazil, godoyjmp@riopreto.com.br.
PMID: 20882431 [PubMed - as supplied by publisher]
Phlebology. 2010 Sep 29. [Epub ahead of print]
Unilateral leg swelling: deep vein thrombosis?
Bekou V, Galis D, Traber J.
Venenklinik Bellevue, Kreuzlingen, Switzerland.
Abstract
OBJECTIVE: We present two cases of a unilateral leg swelling of unusual aetiology as a reminder to
the physician to consider causes of unilateral leg swelling other than deep vein thrombosis,
lymphoedema and infectious diseases. Case reports Both of our patients developed progressive leg
swelling. Subsequent investigation revealed a lesion compressing the femoral vein. At exploration this
was found to be a ganglion cyst. In one patient surgical removal of the cyst and in the other puncture of
the cyst and instillation of steroid resulted in prompt resolution of the swelling.
CONCLUSION: Venous compression due to external cystic lesions, although rare, is recognized. In
strange cases this differential diagnosis should also be taken into account. Therapeutic options are the
surgical removal or puncture of the cyst.
PMID: 20881310 [PubMed - as supplied by publisher]
Clin J Oncol Nurs. 2010 Oct 1;14(5):585-93.
NO SToPS: Reducing treatment breaks during chemoradiation for head and neck cancer.
Lambertz CK, Gruell J, Robenstein V, Mueller-Funaiole V, Cummings K, Knapp V.
St. Luke's Mountain States Tumor Institute, Boise, ID, USA. lambertc@slhs.org
Abstract
The addition of chemotherapy to radiation aids in the survival of patients with head and neck cancer but
also increases acute toxicity, primarily painful oral mucositis and dermatitis exacerbated by xerostomia.
The consequences of these side effects often result in hospitalization and breaks in treatment, which
lead to lower locoregional control and survival rates. No strategies reliably prevent radiation-induced
mucositis; therefore, emphasis is placed on management to prevent treatment breaks. The NO SToPS
approach describes specific multidisciplinary strategies for management of nutrition; oral care; skin
care; therapy for swallowing, range of motion, and lymphedema; pain; and social support to assist
patients through this difficult therapy.
PMID: 20880816 [PubMed - in process]
Ann Surg Oncol. 2010 Oct;17(Suppl 3):352-8. Epub 2010 Sep 19.
Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving
surgery using low-kilovoltage x-rays.
Blank E, Kraus-Tiefenbacher U, Welzel G, Keller A, Bohrer M, Sütterlin M, Wenz F.
Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg,
Mannheim, Germany.
elena.blank@umm.de
Abstract
BACKGROUND: Intraoperative radiotherapy (IORT) during breast-conserving surgery as a boost
followed by whole-breast radiotherapy is increasingly used.
METHODS: Between February 2002 and December 2008, a total of 197 patients were treated with
IORT as a boost (20 Gy, 50 kV x-rays; Intrabeam System, Carl Zeiss Surgical, Oberkochen,
Germany) during breast-conserving surgery, followed by whole-breast radiotherapy (46-50 Gy).
Systemic therapy was provided according to the St. Gallen consensus. Patients were recalled every 6-
12 months for follow-up. Findings were scored according to the LENT-SOMA scale.
RESULTS: Median age was 61.8 (range 30-84) years, and median follow-up was 37 (range 5-91)
months. There were T1, T2, and Tx tumors in 129, 67, and 1 patients, respectively, and N0, N1, N2,
and N3 disease in 144, 36, 15, and 2 patients, respectively. Until December 2009, 5 local invasive
relapses, 1 local ductal carcinoma-in-situ, 1 axillary relapse, 6 secondary cancers, and 11 distant
metastases were seen, resulting in a 5-year disease-free survival of 81.0% and an overall survival of
91.3%. Local relapse-free survival (invasive cancers) at 3 and 5 years was 97.0%. After a follow-up
of 5 years (n =58), only 8 patients (13.8%) had chronic skin toxicities, and 2 patients (3.4%) had a
marked increase in density (fibrosis III), while 62.0% had no/barely palpable fibrosis 0-I. Other
toxicities observed included severe pain (n = 4, 6.9%), retraction (n =17, 29.3%), edema of the breast
(n =1, 1.7%), and lymphedema in general (n =2, 3.4%).
CONCLUSIONS: After IORT as a tumor bed boost with low-kilovoltage x-rays followed by whole-
breast radiotherapy, low local recurrence and chronic toxicity rates were seen after 5-year follow-up.
PMID: 20853058 [PubMed - in process]
October 8, 2010
Int Angiol. 2010 Oct;29(5):454-70.
Diagnosis and treatment of primary lymphedema. Consensus Document of the International Union of
Phlebology (IUP)-2009.
Lee B, Andrade M, Bergan J, Boccardo F, Campisi C, Damstra R, Flour M, Gloviczki P, Laredo J,
Piller N, Michelini S, Mortimer P, Villavicencio JL.
Center for Vein, Lymphatics, and Vascular Malformation, Division of Vascular Surgery, Department of
Surgery, Georgetown University School of Medicine, Washington DC, USA - bblee38@comcast.net.
Abstract
Primary lymphedema can be managed safely as one of the chronic lymphedemas by a proper
combination of DLT with compression therapy. Treatment in the maintenance phase should include
compression garments, self management including the compression therapy, self massage and
meticulous personal hygiene and skin care in addition to lymph-transport promoting excercises. The
management of primary lymphedema can be further improved with proper addition of surgical therapy
either reconstructive or ablative. These two surgical therapies can be effective only when fully
integrated with MLD-based DLT postoperatively. Compliance with a long-term commitment of DLT
postoperatively is the most critical factor determining the success of any new treatment strategy with
either reconstructive or palliative surgery. The future of management of primary lymphedema caused by
truncular lymphatic malformation has never been brighter with the new prospect of gene-oriented
management.
PMID: 20924350 [PubMed - in process]
Int Angiol. 2010 Oct;29(5):442-453.
Clinical trials needed to evaluate compression therapy in breast cancer related lymphedema (BCRL).
Proposals from an expert group.
Partsch H, Stout N, Forner-Cordero I, Flour M, Moffatt C, Szuba A, Milic D, Szolnoky G, Brorson
H, Abel M, Schuren J, Schingale F, Vignes S, Piller N, Döller W.
Dermatology, Medical University of Vienna, Vienna, Austria2 Breast Care Department, National
Naval Medical Center, Bethesda, MD, USA3 Specialist in Physical Medicine and Rehabilitation,
Valencia, Spain4 Dermatology, University Hospital KU Leuven, Belgium5 Glasgow Medical School,
Glasgow, UK6 Department of Internal Medicine, Wroclaw Medical University, Wroclaw, Poland7
Department of Physiotherapy, Wroclaw School of Physical Education, Wroclaw, Poland8 Clinic for
Vascular Surgery, University Clinical Centre Nis, Nis, Serbia9 Department of Dermatology and
Allergology, University of Szeged, Szeged, Hungary10Department of Clinical Sciences Malmö, Lund
University, Plastic and Reconstructive Surgery, Malmö University Hospital, Malmö,
Sweden11Lohmann & Rauscher, Rengsdorf, Germany12Medical Markets Laboratory, Neuss,
Germany13Lympho-Opt Clinic, Pommelsbrunn, Germany14Department of Lymphology, Hôpital
Cognacq-Jay, Paris, France15Department of Surgery, School of Medicine, Flinders Medical Centre,
Bedford Park South, Australia16Center of Lymphology, General Hospital Wolfsberg, Austria - nicole.
stout@med.navy.mil.
Abstract
AIM: A mainstay of lymphedema management involves the use of compression therapy. Compression
therapy application is variable at different levels of disease severity. Evidence is scant to direct clinicians
in best practice regarding compression therapy use. Further, compression clinical trials are fragmented
and poorly extrapolable to the greater population. An ideal construct for conducting clinical trials in
regards to compression therapy will promote parallel global initiatives based on a standard research
agenda. The purpose of this article is to review current evidence in practice regarding compression
therapy for BCRL management and based on this evidence, offer an expert consensus
recommendation for a research agenda and prescriptive trials. Recommendations herein focus solely on
compression interventions.
METHODS: This document represents the proceedings of a session organized by the International
Compression Club (ICC) in June 2009 in Ponzano (Veneto, Italy). The purpose of the meeting was to
enable a group of experts to discuss the existing evidence for compression treatment in breast cancer
related lymphedema (BCRL) concentrating on areas where randomized controlled trials (RCTs) are
lacking.
RESULTS: The current body of research suggests efficacy of compression interventions in the
treatment and management of lymphedema. However, studies to date have failed to adequately
address various forms of compression therapy and their optimal application in BCRL. We offer
recommendations for standardized compression research trials for prophylaxis of arm lymphedema and
for the management of chronic BCRL. Suggestions are also made regarding; inclusion and exclusion
criteria, measurement methodology and additional variables of interest for researchers to capture.
CONCLUSION: This document should inform future research trials in compression therapy and serve
as a guide to clinical researchers, industry researchers and lymphologists regarding the strengths,
weaknesses and shortcomings of the current literature. By providing this construct for research trials,
the authors aim to support evidence-based therapy interventions, promote a cohesive, standardized
and informative body of literature to enhance clinical outcomes, improve the quality of future research
trials, inform industry innovation and guide policy related to BCRL.
PMID: 20924349 [PubMed - as supplied by publisher]
Int Angiol. 2010 Oct;29(5):436-41.
Medical compression: effects on pulsatile leg blood flow.
Mayrovitz HN, Macdonald JM.
Nova Southeastern University, College of Medical Sciences, Ft Lauderdale, FL, USA2 Miller School
of Medicine, University of Miami, Miami, FL, USA - mayrovit@nova.edu.
Abstract
AIM: Leg compression bandaging is the mainstay of venous ulcer treatment, yet little is known about
the impact of therapeutic compression levels on arterial haemodynamics. In this study, the effect of foot-
to-knee, four-layer compression bandaging on below-knee arterial pulsatile blood flow was assessed
by nuclear magnetic resonance flowmetry.
METHODS: In 14 healthy supine subjects, bilateral pulsatile blood flow measured at five below-knee
sites without compression; and during compression of one leg to an average malleolar sub-bandage
pressure of 40.7±4.0 mmHg.
RESULTS: The forefoot-to-knee compression bandaging caused a highly significant (P<0.001)
increase in the bandaged leg pulsatile blood flow due to increases in both peak flow and pulse width.
CONCLUSION: It is hypothesized that arteriolar vasodilatation, induced either myogenically by
reduced transmural pressure or by vasodilatory substance release triggered by increased venous shear
stress and veno-arterial interactions, possibly combined with altered vascular compliance, produce the
observed compression-related phenomenon. Whatever the mechanism(s), the finding of a compression-
associated pulsatile flow increase suggests an arterial linkage, which may play a role in the well-
documented beneficial effects of compression bandaging in venous ulcer and lymphedema treatment.
Possible beneficial effects of the arterial flow-pulse increase on venous ulcer outcome may be related to
a decrease in leukocyte effects in the distal microvasculature.
PMID: 20924348 [PubMed - in process]
Int Angiol. 2010 Oct;29(5):392-4.
Limb volume measurement: from the past methods to optoelectronic technologies, bioimpedance
analysis and laser based devices.
Cavezzi A, Schingale F, Elio C.
Vascular Unit, Stella Maris Clinic and Hippocrates Poliambulatory, S. Benedetto del Tronto, Ascoli
Piceno, Italy - info@cavezzi.it.
Abstract
Accurate measurement of limb volume is considered crucial to lymphedema management. Various non-
invasive methods may be used and have been validated in recent years, though suboptimal
standardisation has been highlighted in different publications.
PMID: 20924339 [PubMed - in process]
Skin Res Technol. 2010 Jul 6. doi: 10.1111/j.1600-0846.2010.00456.x. [Epub ahead of print]
Spatial variations in forearm skin tissue dielectric constant.
Mayrovitz HN, Luis M.
College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA.
Abstract
Background: Tissue dielectric constant (TDC) values measured at 300 MHz via the open-ended
coaxial line reflection method depend on the effective measurement depth and the anatomical site being
evaluated. Measurements on the forearm have shown that the TDC values decrease with increasing
measurement depth but the spatial variability of the TDC values among forearm anatomical positions is
unknown. Our goal was to characterize the extent of such spatial variations.
Methods: In 30 healthy seated women (27.4±6.5 years), TDC was measured on the forearm midline
and 1.2 cm medial and lateral to the midline at sites 4, 8 and 12 cm distal to the antecubital crease.
Results: The midline and medial TDC values increased progressively from 4 to 8 to 12 cm sites (P<0.
001), with the largest spatial gradient along the midline. At a depth of 2.5 mm, the TDC values
increased from 26.3±2.8 to 27.4±3.4 to 28.4±3.7, with a maximum difference of 8.2±10.6%. For all
sites, the TDC values were significantly (P<0.001) less for increasing depths.
Conclusion: The findings reveal increased TDC values along the forearm from proximal to distal, most
prominent at the midline and medial positions. Because many skin-related dermatological and
biophysical studies utilize the forearm as a test target, such differences may be important to consider
because TDC values in part are reflective of local tissue water (LTW). Although the variation in the
TDC values among sites was less than 10%, such differences are of importance when evaluating LTW
changes using the TDC method in patients with arm lymphedema that is present in variable arm
anatomical locations.
PMID: 20923455 [PubMed - as supplied by publisher]
Acta Med Croatica. 2010 Jul;64(3):167-73.
[Compression therapy for lymphedema: our experience]
[Article in Croatian]
Planinsek Rucigaj T, Tlaker Zunter V, Miljković J.
University Department of Dermatovenereology, Ljubljana University Hospital Center, Ljubljana,
Slovenia. t.rucigaj@gmail.com
Abstract
The term lymphedema refers to a chronic, progressive edema, usually of a limb, due to insufficient
lymphatic flow. It may appear as a primary disturbance or secondary to other causes, e.g., after
infections or surgery. The most common cause of lymphedema in the Western world is cancer surgery
and/or radiotherapy. The authors summarize the etiology, pathophysiology and clinical staging of
lymphedema. The diagnosis of lymphedema is usually based on history and clinical appearance.
However, lymphoscintigraphy is the gold standard of imaging in doubtful cases. Adequate and early
compression therapy and good patient compliance are the cornerstones of management of
lymphedema. The authors present their experience with compression therapy for lymphedema. While
no differences were found in the efficiency of compression therapy between oncologic and non-
oncologic patients, compression stockings of class III seemed to be efficient in the majority of
secondary lower limb lymphedemas but not as maintenance therapy for primary lower limb
lymphedema.
PMID: 20922859 [PubMed - in process]
Clin Dysmorphol. 2010 Sep 30. [Epub ahead of print]
Cantu syndrome and lymphoedema.
García-Cruz D, Mampel A, Echeverria MI, Vargas AL, Castañeda-Cisneros G, Davalos-Rodriguez
N, Patiño-Garcia B, Garcia-Cruz MO, Castañeda V, Cardona EG, Marin-Solis B, Cantu JM, Nuñez-
Reveles N, Moran-Moguel C, Thavanati PK, Ramirez-Garcia S, Sanchez-Corona J.
aInstituto de Genetica Humana 'Dr Enrique Corona Rivera' bInstituto de Enfermedades Cronico-
Degenerativas, Departamento de Biologia Molecular y Genomica, Centro Universitario de Ciencias de
la Salud, Universidad de Guadalajara cHospital de Especialidades, CMNO dDivision de Medicina
Molecular, CIBO, CMNO, IMSS eHospital General Regional 46 fHospital General Regional 45,
IMSS, Guadalajara, Jalisco, Mexico gInstituto de Genetica de la Facultad de Ciencias Medicas de la
Universidad Nacional de Cuyo, Mendoza, Argentina.
Abstract
Three female patients with Cantu syndrome were studied, two of whom were adults presenting with the
complication of lymphoedema, as described earlier in a male patient with this syndrome. The aim of this
study is to report the clinical characteristics of these three new cases and to emphasize that
lymphoedema, as observed in two of the patients described here, has been observed in 11.5% of
patients with Cantu syndrome and that heterochromia iridis, observed in one patient, is probably a new
feature of this condition.
PMID: 20890180 [PubMed - as supplied by publisher]
Am J Trop Med Hyg. 2010 Oct;83(4):884-90.
Elevated levels of plasma angiogenic factors are associated with human lymphatic filarial infections.
Bennuru S, Maldarelli G, Kumaraswami V, Klion AD, Nutman TB.
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Bethesda, Maryland 20892, USA. bennurus@niaid.nih.gov
Abstract
Lymphatic dilatation, dysfunction, and lymphangiogenesis are hallmarks of patent lymphatic filariasis,
observed even in those with subclinical microfilaremia, through processes associated, in part, by
vascular endothelial growth factors (VEGFs). A panel of pro-angiogenic factors was measured in the
plasma of subjects from filaria-endemic regions using multiplexed immunological assays. Compared
with endemic normal control subjects, those with both subclinical microfilaremia, and those with
longstanding lymphedema had significantly elevated levels of VEGF-A, VEGF-C, VEGF-D, and
angiopoietins (Ang-1/Ang-2), with only levels of basic fibroblast growth factor (bFGF) and placental
growth factor (PlGF) being elevated only if lymphedema was evident. Furthermore, levels of these
factors 1-year post-treatment with doxycycline were similar to pretreatment levels suggesting a minimal
role, if any, for Wolbachia. Our data support the concept that filarial infection per se is associated with
elevated levels of most of the known pro-angiogenic factors, with only a few being associated with the
serious pathologic consequences associated with Wuchereria bancrofti infection.
PMID: 20889885 [PubMed - in process]PMCID: PMC2946762 [Available on 2011/10/5]
Genes Dev. 2010 Oct 1;24(19):2115-26.
Current views on the function of the lymphatic vasculature in health and disease.
Wang Y, Oliver G.
Department of Genetics and Tumor Cell Biology, St. Jude Children's Research Hospital, Memphis,
Tennessee 38105, USA.
Abstract
The lymphatic vascular system is essential for lipid absorption, fluid homeostasis, and immune
surveillance. Until recently, lymphatic vessel dysfunction had been associated with symptomatic
pathologic conditions such as lymphedema. Work in the last few years had led to a better
understanding of the functional roles of this vascular system in health and disease. Furthermore, recent
work has also unraveled additional functional roles of the lymphatic vasculature in fat metabolism,
obesity, inflammation, and the regulation of salt storage in hypertension. In this review, we summarize
the functional roles of the lymphatic vasculature in health and disease.
PMID: 20889712 [PubMed - indexed for MEDLINE]
Ann Vasc Surg. 2010 Oct 2. [Epub ahead of print]
Vena Cava Thrombectomy and Primary Repair after Radical Nephrectomy for Renal Cell Carcinoma:
Single-Center Experience.
Helfand BT, Smith ND, Kozlowski JM, Eskandari MK.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND: Inferior vena cava (IVC) reconstruction for locally advanced renal cell carcinoma
(RCC) includes resection with and without interposition grafting, patch graft, or primary repair. The
proposed benefits of lateral venorrhaphy and primary repair are avoidance of foreign material, a more
expeditious repair, and preservation of lower extremity venous outflow.
METHODS: A single-center retrospective review of 22 patients with RCC and IVC tumor thrombus
treated with radical nephrectomy, lateral venorrhaphy, thrombectomy, and primary vena cava repair
between July 2002 and June 2009 was carried out. Demographic data, diagnostic information,
radiographic cross-sectional imaging, and procedural outcomes were examined.
RESULTS: Among the 13 men and nine women, the mean age was 62.1 years (42-83); mean tumor
size was 9.8 cm (3-17 cm), and 90% (n = 18) of the cases with RCC were identified pathologically as
clear cell adenocarcinoma; on the basis of the classification system adopted by Neves, level I was for
50% (n = 11), level II for 32% (n = 7), level III for 9% (n = 2), and level IV for 9% (n = 2) of the
patients. All patients underwent en bloc radical nephrectomy with tumor thrombus removal and primary
IVC repair. Mean total operative time was 547.9 ± 138.5 minutes, whereas mean IVC cross-clamp
time was 10.8 minutes (6-29 minutes). There were no intraoperative deaths or pulmonary embolism
and all IVC margins were found to be pathologically negative. Postoperative complications included
one pulmonary embolism, one exacerbation of chronic lymphedema, and two cases of new onset
erectile dysfunction. Mean follow-up was 36.4 ± 23.2 months (6-92 months). There were no
radiographic or clinically significant changes in mean IVC diameter during follow-up. Five late deaths
(23%) occurred as a result of metastatic RCC over a mean period of 24 months (range, 12-48), but
without any local recurrences.
CONCLUSION: For advanced RCC with tumor thrombus extension into the IVC, lateral
venorrhaphy and primary IVC repair avoids complicated caval reconstructions and results in high
patency rates with a low local tumor recurrence rate.
PMID: 20889305 [PubMed - as supplied by publisher]
Phlebology. 2010 Oct;25 Suppl 1:52-63.
From lymph to fat: complete reduction of lymphoedema.
Brorson H.
Department of Plastic and Reconstructive Surgery, Lund University, Skåne University Hospital, SE-
205 02 Malmö, Sweden.
Abstract
Liposuction for late-stage lymphoedema remains a controversial technique. While it is clear that
conservative therapies such as combined decongestive therapy (CDT) and controlled compression
therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphoedema
that is not responding to treatment is not so clear. Liposuction has been used for many years to treat
lipodystrophy. Some results have been far from optimal; however, improvements in technique, patient
preparation and patient follow-up have led to a greater and a wider acceptance of liposuction as a
treatment for lymphoedema. This paper outlines the benefits of using liposuction and presents the
evidence to support its use.
PMID: 20870820 [PubMed - in process]
October 15, 2010
Ginecol Obstet Mex. 2010 Jul;78(7):345-51.
[Laparoscopic radical hysterectomy with lymphatic mapping and sentinel lymph node biopsy in early
cervical cancer][Article in Spanish]
Maffuz A, Quijano F, López D, Hernández-Ramírez D.
División de Cirurgía, Departamento de Ginecología Oncológica, Hospital de Oncología, Centro
Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, DF México. tonomaffuz@yahoo.
com
Abstract
BACKGROUND: in patients with early-stage cervical cancer (FIGO IA, IB2 and IIA), the incidence
of lymph node metastases is up to 15%; the majority of early cervical cancer patients with pelvic and
para-aortic lymphadenectomy does not benefit with the procedure and are at risk of associated
morbidity (linfocyst, lymphedema, vascular or nerve damage).
OBJECTIVE: To describe the experience and usefulness of lymphatic mapping and sentinel lymph
node with total laparoscopic radical hysterectomy in early stage cervical cancer. Patients and method:
Retrospective study in patients with diagnosis of cervical cancer in early stage, submitted to
laparoscopic radical hysterectomy with lymphatic mapping and sentinel lymph node biopsy. We
analyzed sentinel lymph node identification, false negative rate and surgical variables.
RESULTS: in 36 months 15 patients were included, two in IA2 FIGO stage, twelve IB1 and one IIA;
thirteen patients were mapping with combined technique and two only with dye. The sentinel lymph
node identification rate was 87% (two failures in the patients using only blue dye); the false negative
rate was 0%.
CONCLUSION: Laparoscopic radical hysterectomy with lymphatic mapping is a secure technique for
patients with early stage cervical cancer; it allows the correct identification of lymph node status as the
principal prognostic factor. We recommend the use of combined technique (radiocolloid tracer and
blue dye) for best rate sentinel lymph node identification.
PMID: 20931810 [PubMed - in process]
Cancer. 2010 Oct 13. [Epub ahead of print]
The effects of body mass index on complications and survival outcomes in patients with cervical
carcinoma undergoing curative chemoradiation therapy.
Kizer NT, Thaker PH, Gao F, Zighelboim I, Powell MA, Rader JS, Mutch DG, Grigsby PW.
Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri.
Abstract
BACKGROUND: The effect of body mass index (BMI) on treatment outcomes for patients with
locally advanced cervical carcinoma who receive definitive chemoradiation is unclear.
METHODS: The cohort in this study included all patients with cervical carcinoma (n = 404) who had
stage IB(1) disease and positive lymph nodes or stage ≥IB(2) disease and received treatment at the
authors' facility between January 1998 and January 2008. The mean follow-up was 47.2 months. BMI
was calculated using the National Institute of Health online calculator. BMI categories were created
according to the World Health Organization classification system. Primary outcomes were overall
survival, disease-free survival, and complication rate. Univariate and multivariate analyses were
performed. Kaplan-Meier survival curves were generated and compared using Cox proportional
hazard models.
RESULTS: On multivariate analysis, compared with normal weight (BMI 18.5-24.9 kg/m(2)), a BMI
<18.5 kg/m(2) was associated with decreased overall survival (hazard ratio, 2.37; 95% confidence
interval, 1.28-4.38; P < .01). The 5-year overall survival rate was 33%, 60%, and 68% for a of BMI
<18.5 kg/m(2), a BMI from 18.5 kg/m(2) to 24.9 kg/m(2), and a BMI >24.9 kg/m(2), respectively. A
BMI <18.5 kg/m(2) was associated with increased risk of grade 3 or 4 complications compared with a
BMI >24.9 kg/m(2) (radiation enteritis: 16.7% vs 13.6%, respectively; P = .03; fistula: 11.1% vs
8.8%, respectively; P = .05; bowel obstruction: 33.3% vs 4.4%, respectively; P < .001; lymphedema:
5.6% vs 1.2%, respectively; P = .02).
CONCLUSIONS: Underweight patients (BMI <18.5 kg/m(2)) with locally advanced cervical cancer
had diminished overall survival and more complications than normal weight and obese patients. Cancer
2010. © 2010 American Cancer Society.
PMID: 20945318 [PubMed - as supplied by publisher]
October 26, 2010
Br J Community Nurs. 2010 Oct;15(10):26-30.
Microfine glove and toe caps and their use in lymphoedema management.
Close G.
Abstract
Lymphoedema garments have progressed in the last 10 years, so gone are the days when only one
colour is available (that lovely beige!). How many patients would have to be persuaded to wear their
compression hosiery in that desirable colour? Not just have the colours become more acceptable, so
have the fabrics. There are a wide range of compression gloves available to the lymphoedema specialist
to fit on the patient but that cannot be said of toe caps. The Microfine toe cap is the only one available
as an off-the-shelf garment, and when the lymphoedema is deemed to be manageable in these
garments, it offers an alternative to flat knit. The Microfine glove and Microfine toe cap are adaptable
and can offer colour options and a fabric that is less bulky and fine. It also allows therapists to trim the
length of each digit for a better fit without reducing compression. The author will present three case
studies of patients that are using.
PMID: 20966839 [PubMed - in process]
Br J Community Nurs. 2010 Oct;15(10):17-21.
Key-worker clinics: the maintenance phase of lymphoedema therapy.
Green T.
Abstract
This article describes the development of services for patients with mild and uncomplicated
lymphoedema through a network of community-based staff nurses specially trained in the management
of mild and uncomplicated lymphoedema in order to deliver an integrated service across the acute
foundation and primary care trusts . Government policies, increasing referral rates and patients with
complex co-morbidity requiring intensive treatments had prompted a review of the service provision to
examine ways to deliver an efficient and cost-effective service across the local health economy. Patients
with mild and uncomplicated lymphoedema do not necessarily require specialist care but can be
managed effectively by key workers with appropriate training and skills (British Lymphology Society,
2001a; b; Lymphoedema Framework, 2006). This development demonstrates the benefit of training
existing community staff, using their existing skills. Providing access to clinics within the primary care
setting helps to provide a cost-effective, structured and co-ordinated care pathway at all levels of
intervention, ultimately improving treatment outcomes and patient satisfaction. A cohort of community
staff nurses were identified and trained in the provision of lymphoedema management to key worker
level, providing the opportunity to develop a lymphoedema service based upon health-care need and
not disease site as has occurred with other national developments. These clinics offer the same advice,
support and monitoring of the patients condition alongside education and information in a more locally
accessible setting, avoiding the need for hospital visits.
PMID: 20966836 [PubMed - in process]
Br J Community Nurs. 2010 Oct;15(10):14-6.
Management of the bariatric patient with lymphoedema: South West Wales.
Coveney E.
Abstract
Twenty-four percent of adults (age 16 and over) in England are classified as obese. This represents an
increase from 15% in 1993. (NHS Information Centre, 2008). As obesity rates increase across the
UK lymphoedema services face increasing numbers of obese patients in their clinics. This short article
will explore some ideas of how we manage this patient group at present in our lymphoedema service.
Management of lymphoedema involves what are considered the four cornerstones of care: daily skin
care, movement and exercise, maintaining weight in the healthy range and wearing compression
garments daily. While it is considered helpful for overweight/obese patients to lose weight to improve
the management of lymphoedema, it is not always easy for patients to make the necessary lifestyle
changes, particularly for those patients with a body mass index (BMI) over 35 (bariatric).
PMID: 20966835 [PubMed - in process]
Br J Community Nurs. 2010 Oct;15(10):4-12.
Chronic oedema and lymphoedema of the lower limb.
Hampton S.
Abstract
There is a very fine line between oedema, chronic oedema, lymph venous oedema and lymphoedema
with the names 'chronic oedema'and 'lymphoedema' often used interchangeably. Therefore, there can
be difficulty with diagnosis of which condition is present in the individual patient, particularly when
another unrelated condition (lipoedema) can also be mistakenly diagnosed as lymphoedema. The most
important thing to remember is that, although there is this fine line between the conditions, each part of
the disease development cannot be entirely separated or treated completely in isolation. The key to
good outcomes in lymphovenous oedema is to treat it at the earliest stage possible to prevent
deterioration, venous ulceration and the almost inevitable cellulitis that is associated with lymphoedema
skin changes. This article will aim to promote an understanding of the different conditions and stages,
will provide a simple identification of the condition and will discuss how lymphovenous oedema can
lead eventually to the very difficult-to-treat chronic lymphoedema with ideas of how to prevent this
deterioration.
PMID: 20966834 [PubMed - in process]
Br J Community Nurs. 2010 Oct;15(10):3-Unknown.
Change is afoot, are you ready?
Pike C.
Abstract
Treatment starts with a patient's willingness to take on board the basics of lymphoedema management,
without this, their commitment to further treatment would be in question. However, most services are
now over-prescribed and many are looking into referral criteria, but to deny a person treatment based
on their BMI is not sound practice; to exclude anyone on the grounds of their size or weight would be
unethical and may result in legal repercussions. To avoid such situations, community nurses can
encourage GPs to teach their patients the importance of skin care and exercise. If a patient does not
take this advice on board, you can explain to the GP that you can only commence treatment once the
patient has complied with the advice given. The latest government initiatives to save costs and reduce
overheads mean that services are being scrutinized for cost-saving potentials. A simple means of
proving your service's viability is by keeping statistical records of all staff daily activities and treatments.
A database can be drawn up to compare, for example, cancer and non-cancer lymphoedema, by
looking at the number of patient contacts for first assessments, follow ups, intensive treatments and
record of time in units. The database I created at Singleton Hospital's Lymphoedema Service enables
us to prove each staff member's activity and value for money (if you would like a copy, email me:
cheryl.pike@wales.nhs.uk). Approaching various companies for discount incentives will show a
willingness to work with manufacturers in further reducing costs on your service.
PMID: 20966833 [PubMed - in process]
--------------------
November 5, 2010:
Ann Plast Surg. 2010 Oct 29. [Epub ahead of print]
Optimizing Outcome of Charles Procedure for Chronic Lower Extremity Lymphoedema.
Karri V, Yang MC, Lee IJ, Chen SH, Hong JP, Xu ES, Cruz-Vargas J, Chen HC.
From the *Department of Plastic and Reconstructive Surgery, E-Da Hospital/I-Shou University,
Kaohsiung County; †Department of Public Health, Institute of Health Organization Administration,
College of Public Health, National Taiwan University, Taiwan, Republic of China; ‡Department of
Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon City; §Department of Plastic and
Reconstructive Surgery, Asan Medical Center, Seoul, South Korea; and ¶China Medical University
Hospital, Taichung, Taiwan, Republic of China.
Abstract
BACKGROUND: Charles procedure for late-stage lower limb lymphoedema (LLL) is often criticized
for its unpredictable and poor result. We have adopted a systematic approach to optimize outcome of
patients treated with this excisional surgery.
METHODS: From June 2004 to March 2009 we performed Charles procedure on 1 lower limb of 19
women and 8 men with late-stage LLL. Mean age and follow-up was 48 (range, 16.5-77.8) years and
21.6 (range, 1.5-48) months, respectively.
RESULTS: Average inpatient stay was 27 (range, 11-54) days. After discharge, 16 (59.3%) patients
underwent further minor surgery. The most frequent complication was a single, short episode of
cellulitis, affecting 5 (18.5%) patients. Self-reported mobility was either the same or improved at 6
months, and appearance of their limbs satisfactory.
CONCLUSIONS: Charles procedure is an effective treatment for selected patients and by applying
our systematic approach, a positive outcome can be achieved.
PMID: 21042186 [PubMed - as supplied by publisher]
World J Surg Oncol. 2010 Nov 1;8(1):94. [Epub ahead of print]
Management options for vulvar carcinoma in a low resource setting.
Eke AC, Alabi-Isama LI, Akabuike JC.
ABSTRACT:
BACKGROUND: Vulvar carcinoma is a rare tumor of the female genital tract. In Nigeria, very few
studies have looked at the management options for vulvar carcinoma. The objective of this study was
therefore, to describe the management options available and the challenges in treating this malignancy in
Nigeria.
METHODS: A descriptive study of all vulvar cancer cases managed at the Nnamdi Azikiwe University
Teaching Hospital, Nnewi over a 12 year period (1998-2009). The theatre, ward register, histo-
pathologic records and case notes of all women who had surgery for vulvar carcinomas were retrieved
and socio-demographic characteristics, clinical presentation, type of surgery, histologic type and
complications of treatment were retrieved and analyzed.
RESULTS: There were 867 gynecological malignancies and vulval carcinoma accounted for 11 cases,
giving a prevalence of 1.27%. The ages ranged from 54 to 79 years with a mean of 61.2 years. The
parities of the women ranged from 2-14. Most of the patients were of low socio-economic class. All
the 11 patients had surgery as 1st line treatment.
Radical vulvectomy was done for 6 cases since they presented in the advanced stage. The
complications of surgery included hemorrhage (18.2%), chronic lymphedema, wound infection and
anesthetic complications. There were no hospital mortalities. Late presentation, with stage III (45.4%)
was the commonest stage at presentation while the majority of the vulvar carcinomas (72.7%) were of
epithelial origin. Squamous cell carcinoma predominated (63.6%).
CONCLUSION: Carcinoma of the vulva is a rare gynecological malignancy in Nigeria. Surgery and
radiotherapy remain the mainstay of this disease in Nigeria. Treatment can be highly successful if
patients present early.
PMID: 21040577 [PubMed - as supplied by publisher]
Diabetes Res Clin Pract. 2010 Oct 28. [Epub ahead of print]
Chronic interdigital dermatophytic infection: A common lesion associated with potentially severe
consequences.
Vanhooteghem O, Szepetiuk G, Paurobally D, Heureux F.
Department of Dermatology, Sainte Elisabeth Hospital, B-5000 Namur, Belgium; Department of
Dermatology, University Hospital Sart Tilman, B-4000 Liège, Belgium.
Abstract
Interdigital intertrigo and onychomycosis has the potential cause of severe bacterial infectious
complications with pain, mobility problems, abscess, erysipelas, cellulitis, fasciitis and osteomyelitis. In
another hand, diabetic neuropathy, which affects 60-70% of those with diabetes mellitus, is one of the
most troubling complications for persons with diabetes. These people are high suspecting to be infected
by dermatophytic infections in interdigital spaces or onychomycosis witch are frequently induce damage
to the stratum corneum, leading to bacterial proliferation and secondary infection. A patient presented
with an asymptomatic warm, painless, erythematous swelling of the second left toe, which had been
present for a few weeks. Clinically, the lesion was categorized as erysipelas upon an insidious abscess
formation. Further investigation was undertaken to confirm the presence of diabetes. Leg erysipelas is a
common affection which, according to various studies, has both local concomitants (interdigital
intertrigo, lymphoedema, surgical antecedents) and/or general causes (immune suppression, diabetes,
alcoholism, etc). Interdigital intertrigo, tinea pedis, and onychomycosis present as public health
problems that could trigger serious deterioration in patient quality of life, due to complications induced
by secondary bacterial infections.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 21035887 [PubMed - as supplied by publisher]
Presse Med. 2010 Oct 27. [Epub ahead of print] [Primary lymphedema of limbs.][Article in French]
Vaillant L, Tauveron V.
Université François-Rabelais de Tours, CHRU de Tours, 37044 Tours cedex 01, France; CNRS FRE
2448, unité Inserm U930, 37044 Tours cedex, France.
Abstract
Limb lymphedema is frequent and not well-known. Clinical classification distinguishes primary
lymphedemas due to developmental disorders of the lymphatic system (hereditary or not, sometimes
associated with other malformations) and secondary lymphedemas. Primary lymphedema is a
lymphedema without a cause to explain lymphatic impairment. It is due to an abnormal
lymphangiogenesis in utero. It is often associated with mutation in a gene involved in lymphangiogenesis
(FOX C2, VEGFR 3, SOX18, PROX 1…). To assess clinical diagnosis, non-invasive techniques are
able to study structure and function of the lymphatic system (mainly isotopic lymphography). Treatment
is the complex decongestive therapy which associates manual lymphatic drainage and bandage.
Predisposing or precipitating factors have to be treated (particularly streptococcal infections). Surgical
treatment has precise and rare indication.
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21035299 [PubMed - as supplied by publisher]
November 9, 2010:
J Vis Exp. 2010 Oct 20;(44). pii: 2225. doi: 10.3791/2225.
Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph
Node in Gynecologic Oncology.
Crane LM, Themelis G, Buddingh T, Harlaar NJ, Pleijhuis RG, Sarantopoulos A, van der Zee AG,
Ntziachristos V, van Dam GM.
Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen.
Abstract
The prognosis in virtually all solid tumors depends on the presence or absence of lymph node
metastases.(1-3) Surgical treatment most often combines radical excision of the tumor with a full
lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated
with increased morbidity due to infection, wound breakdown and lymphedema.(4,5) As an alternative,
the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first
draining lymph node from the tumor.(6) In case of lymphogenic dissemination, the SLN is the first
lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream
lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure
is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of
the vulva and cervix.(7) The current standard methodology for SLN-detection is by peritumoral
injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of
the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to
increased psychological distress for the patient, and the use of radioactive colloid. Multispectral
fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the
need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are
needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a
fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess
cardiac function, cerebral perfusion and liver perfusion.(8) It is an inert drug with a safe pharmaco-
biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around
800 nm. A custom-made multispectral fluorescence imaging camera system was used.(9). The aim of
this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in
patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard
procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging
might replace the current method and is also easily transferable to other indications like breast cancer
and melanoma.
PMID: 21048667 [PubMed - in process]
MED NEWS DOCS FORMATTED:
November 3, 2010 - Fox Chase Researchers Identify Risk Factors For The Spread Of Breast Cancer
To Lymph Nodes –
Breast cancer, one of the most prevalent cancers in women, afflicts an additional 200,000 women each
year and causes about 40,000 deaths annually. The disease often extends to neighboring lymph nodes,
in part, through lymphovascular invasion (LVI) - a process in which cancer cells invade blood vessels
or the lymphatic system - and can often translate into a poor prognosis for patients. Some scientists
argue that evidence of LVI does not necessarily mean that the disease will recur in the lymph nodes
after radiation to the breast alone, but research from Fox Chase Cancer Center now shows that the
appearance of LVI in the breast tissue does in fact predict recurrence of breast in the regional lymph
nodes.
By carefully examining recurrence patterns of thousands of women with breast cancer from records
spanning more than 30 years, Wilhelm Lubbe, M.D.,Ph.D., chief resident in Fox Chase's Radiation
Oncology Department, and his colleagues have now shown that the appearance of LVI in breast tissue
predicts the future recurrence of cancer to nearby lymph nodes. "The microscopic diagnosis of LVI is
challenging which highlights the importance of excellent pathologists," says Lubbe, who will present the
results this week at the Annual Meeting of the American Society for Radiation Oncology.
Knowing that the disease is going to extend to neighboring lymph nodes, such as those in the armpit, is
important prognostically. But it has still been unclear whether supplementary radiation therapy targeting
these areas improves outcomes.
"There still is a lot of debate as to whether additional radiation to the regional lymph nodes is needed in
a woman with LVI," Lubbe says.
In the study, Lubbe's team analyzed an extensive database of 3,082 breast cancer patients who
underwent whole-breast radiation or minimal surgical resection of breast tissue between 1970 and
2009. This dataset, at least twice as large as many others of its kind, provided enough statistical power
for the investigators to detect a subtle, yet significant trend.
"Luckily, at Fox Chase, we had the resources to maintain this huge database by meticulously following
a large number of patients over the course of decades," Lubbe says.
The team searched for factors aside from LVI that determine outcomes. The disease was more likely
to invade lymph nodes in women younger than 35. Also, additional radiation therapy under the armpit
via a technique called a posterior axillary boost (PAB) lead to fewer breast cancer recurrences in these
women's regional lymph nodes. Ironically, this extra procedure led to less regional recurrence even
though the women were of higher risk than other treatment groups. Overall, the 10-year recurrence
rate was only 1.4%. But it was 4% for women treated with radiation above the collar bone alone,
compared to 0.5% for those who also received a PAB - the posterior boost of radiation under the
armpits.
"Our data suggest that patients who are at higher risk of their cancer spreading can potentially benefit
from additional radiation by a technique called a posterior axillary boost," Lubbe says. "But the
recommendation to add radiation, and what technique is used, is very patient-specific, because with
any intervention there's additional risk."
In the future, Lubbe would like to identify other objective biological markers, such as proteins or genes,
which predict recurrence rates and patient outcomes. "Ultimately, we'd like to find a faster and more
accurate process for assessing the risk of cancer spread to regional lymph nodes and the rest of the
body," Lubbe says.
Co-investigators include Tianyu Li, Penny Anderson, Lori Goldstein, Crystal Denlinger, Holly Dushkin,
Ramona Swaby, Richard Bleicher, Elin Sigurdson and Gary Freedman.
November 5, 2010 - Shire Presents Positive New Data At The 60th Annual American Society Of
Human Genetics (ASHG) For Patients With Type 1 Gaucher Disease –
Shire plc (LSE: SHP, Nasdaq: SHPGY), the global specialty biopharmaceutical company, presented
positive new data from a Phase III clinical trial (study 039) designed to evaluate the efficacy of
VPRIV® (velaglucerase alfa for injection) compared with imiglucerase in patients with type 1 Gaucher
disease at the 2010 Annual American Society of Human Genetics (ASHG) in Washington, D.C. The
study met its primary endpoint and adds to the growing body of clinical evidence which supports the
use of VPRIV in patients who have transitioned from imiglucerase or who are treatment-naive.
In the 039 (head-to-head) study, adult and pediatric patients with type 1 Gaucher disease were
included in a 9-month, global, randomized, double-blind, non-inferiority study comparing VPRIV with
imiglucerase in treatment-naive patients aged >/= 2 years, with anemia and either thrombocytopenia or
organomegaly. Patients were randomized in a 1:1 ratio to receive either VPRIV or imiglucerase at a
dose of 60U/kg via continuous infusion over one hour every other week for 39 weeks (total of 20
infusions per patient). 35 patients in 9 countries were randomized and 34 received the study drug
(intent-to-treat [ITT] population was 17 in both the VPRIV and imiglucerase groups). The per-
protocol (PP) analysis included 15 patients in each group. Baseline clinical characteristics were
generally similar between the 2 groups, although hemoglobin concentrations appeared slightly higher in
the VPRIV group.
After 9 months of treatment, hemoglobin concentration improved in both groups. The estimated mean
treatment difference for hemoglobin concentration from baseline between patients treated with VPRIV
and imiglucerase was 0.14 and 0.16 g/dL in the ITT and PP populations, respectively, with a lower
bound of the 97.5% one-sided confidence interval of 0.60 g/dL in both populations, greater than the
pre-defined non-inferiority margin of 1.0 g/dL. These results indicate that the primary endpoint was
met. Both the VPRIV and imiglucerase groups showed substantial improvements in the secondary
endpoints, including platelet counts, spleen volume, liver volume, and plasma biomarkers with no
statistically significant difference demonstrated between the treatment groups. The majority of adverse
events were mild or moderate in severity, including one serious adverse event (SAE) seen with VPRIV
which was an allergic skin reaction that resolved without sequalae.
Shire also reported important findings that suggested substantial antigenic differences when antibody
response to treatment with VPRIV and imiglucerase were compared. No patient treated with VPRIV
developed anti-drug antibodies while 4 patients in the imiglucerase group developed antibodies to
imiglucerase. Of these four imiglucerase treated patients, 1 patient had antibodies that inhibited enzyme
activity in vitro and enzyme uptake in a cell-based assay. 3 patients had antibodies that did not inhibit
enzyme activity or uptake.
November 11, 2010 - Post-Treatment Condition Often Overlooked In Breast Cancer Patients –
As many as 70% of women with breast cancer develop painful swelling of the lymph nodes after
treatment, but the condition is frequently ignored, misdiagnosed or otherwise left untreated, the
Washington Post reports. The condition, known as lymphedema, affects three million to five million
people in the U.S., including those who have undergone treatment for breast, prostate, ovarian and
other cancers. Most research on lymphedema has focused on its connection with breast cancer surgery
and radiation.
Lymphedema develops when fluid accumulates at or near the surgery site -- typically building up in the
groin, the hands, the arms, the legs or the chest -- because of a blockage in the lymphatic system. Over
time, this causes swelling, which "can get worse, becoming painful, chronic and debilitating: restricting
movement, impeding daily activities and requiring constant care," the Post reports. One patient profiled
in the story uses massage and "wears special garments 24 hours a day to deal with her condition,"
according to the Post. Although cancer surgery is not the sole cause of lymphedema, "there is strong
evidence of cause and effect" when patients undergo cancer surgeries involving examination of the
lymph nodes to determine whether the cancer has spread, the Post reports.
Few doctors and hospitals acknowledge the risk for lymphedema when discussing surgery or cancer
treatment, and patient advocates note that it is not mentioned in consent forms signed prior to surgery
or treatment. The criteria for diagnosing the condition are inconsistent; thus, various estimates about
lymphedema rates in women treated for breast cancer range from 6% to 70%, depending on which
criteria are used, how long after surgery the studies are conducted and which body parts were
examined.
Judy Nudelman, a family physician at Brown University who has lymphoma and also treats patients
with the condition, said many patients become frustrated because doctors and hospitals tell them "we
have zero incidence of lymphedema cases in our institution." According to the Post, some surgeons or
hospitals view lymphedema as a complication and avoid mentioning it for fear of developing a negative
reputation (Mishori, Washington Post, 11/9).
Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily
Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily
Women's Health Policy Report is a free service of the National Partnership for Women & Families.
November 12, 2010
Cancer. 2010 Nov 8. [Epub ahead of print]
Conservative and dietary interventions for cancer-related lymphedema: a Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
Abstract
The findings support the use of compression garments and compression bandaging for reducing
lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast
cancer, a statistically significant, clinically small beneficial effect was found from the addition of manual
lymph drainage massage to compression therapy for upper extremity lymphedema volume. Cancer
2010. © 2010 American Cancer Society.
PMID: 21061344 [PubMed - as supplied by publisher]
Am J Pathol. 2010 Nov 5. [Epub ahead of print]
Blockade of Transforming Growth Factor-{beta}1 Accelerates Lymphatic Regeneration during
Wound Repair.
Avraham T, Daluvoy S, Zampell J, Yan A, Haviv YS, Rockson SG, Mehrara BJ.
From the Division of Plastic and Reconstructive Surgery,* Department of Surgery, Memorial Sloan-
Kettering Cancer Center, New York, New York; the Department of Medicine, Hadassah-Hebrew
University Medical Center, Jerusalem, Israel; and the Division of Cardiology, Department of Medicine,
Stanford University Medical Center, Stanford, California.
Abstract
Lymphedema is a complication of cancer treatment occurring in approximately 50% of patients who
undergo lymph node resection. Despite its prevalence, the etiology of this disorder remains unknown.
In this study, we determined the effect of soft tissue fibrosis on lymphatic function and the role of
transforming growth factor (TGF)-ß1 in the regulation of this response. We determined TGF-ß
expression patterns in matched biopsy specimens collected from lymphedematous and normal limbs of
patients with secondary lymphedema. To determine the role of TGF-ß in regulating tissue fibrosis, we
used a mouse model of lymphedema and inhibited TGF-ß function either systemically with a
monoclonal antibody or locally by using a soluble, defective TGF-ß receptor. Lymphedematous tissue
demonstrated a nearly threefold increase in the number of cells that stained for TGF-ß1. TGF-ß
inhibition markedly decreased tissue fibrosis, increased lymphangiogenesis, and improved lymphatic
function compared with controls. In addition, inhibition of TGF-ß not only decreased TGF-ß
expression in lymphedematous tissues, but also diminished inflammation, migration of T-helper type 2
(Th2) cells, and expression of profibrotic Th2 cytokines. Similarly, systemic depletion of T-cells
markedly decreased TGF-ß expression in tail tissues. Inhibition of TGF-ß function promoted lymphatic
regeneration, decreased tissue fibrosis, decreased chronic inflammation and Th2 cell migration, and
improved lymphatic function. The use of these strategies may represent a novel means of preventing
lymphedema after lymph node resection.
PMID: 21056998 [PubMed - as supplied by publisher]
November 13, 2010
Cancer. 2010 Nov 8. [Epub ahead of print]
Conservative and dietary interventions for cancer-related lymphedema: a Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
Abstract
The findings support the use of compression garments and compression bandaging for reducing
lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast
cancer, a statistically significant, clinically small beneficial effect was found from the addition of manual
lymph drainage massage to compression therapy for upper extremity lymphedema volume. Cancer
2010. © 2010 American Cancer Society.
PMID: 21061344 [PubMed - as supplied by publisher]
November 19, 2010
Arch Surg. 2010 Nov;145(11):1055-63.
Risk factors for lymphedema in a prospective breast cancer survivorship study: the pathways study.
Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner SE, Kushi LH.
Kaiser Permanente Northern California, Oakland, 94612, USA. Marilyn.L.Kwan@kp.org
Comment in:
Arch Surg. 2010 Nov;145(11):1063-4.
Abstract
OBJECTIVE: To determine the incidence of breast cancer-related lymphedema (BCRL) during the
early survivorship period as well as demographic, lifestyle, and clinical factors associated with BCRL
development.
DESIGN: The Pathways Study, a prospective cohort study of breast cancer survivors with a mean
follow-up time of 20.9 months.
SETTING: Kaiser Permanente Northern California medical care program.
PARTICIPANTS: We studied 997 women diagnosed from January 9, 2006, through October 15,
2007, with primary invasive breast cancer and who were at least 21 years of age at diagnosis, had no
history of any cancer, and spoke English, Spanish, Cantonese, or Mandarin.
MAIN OUTCOME MEASURE: Clinical indication for BCRL as determined from outpatient or
hospitalization diagnostic codes, outpatient procedural codes, and durable medical equipment orders.
RESULTS: A clinical indication for BCRL was found in 133 women (13.3%), with a mean time to
diagnosis of 8.3 months (range, 0.7-27.3 months). Being African American (hazard ratio, 1.93; 95%
confidence interval, 1.00-3.72) or more educated (P for trend = .03) was associated with an increased
risk of BCRL. Removal of at least 1 lymph node (hazard ratio, 1.04; 95% confidence interval, 1.02-
1.07) was associated with an increased risk, yet no significant association was observed for type of
lymph node surgery. Being obese at breast cancer diagnosis was suggestive of an elevated risk (hazard
ratio, 1.43; 95% confidence interval, 0.88-2.31).
CONCLUSIONS: In a large cohort study, BCRL occurs among a substantial proportion of early
breast cancer survivors. Our findings agree with those of previous studies on the increased risk of
BCRL with removal of lymph nodes and being obese, but they point to a differential risk according to
race or ethnicity.
PMID: 21079093 [PubMed - in process]
Head Neck. 2010 Nov 12. [Epub ahead of print]
Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Division of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The University of
Texas Health Science Center, Houston, Texas.
Abstract
BACKGROUND: Lymphedema is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions where treatment options
are limited. Although upper and lower extremity lymphedema may be effectively treated with manual
lymphatic drainage (MLD) therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS AND RESULTS: Herein, we describe the compassionate use of an investigatory
technique of near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy and
function, help direct MLD, and use 3-dimensional (3D) surface profilometry to monitor response to
therapy in a patient with head and neck lymphedema after surgery and radiation treatment.
CONCLUSION: NIR fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are needed to assess the
efficacy of MLD therapy when directed by NIR fluorescence imaging. © 2010 Wiley Periodicals, Inc.
Head Neck, 2010.
PMID: 21077150 [PubMed - as supplied by publisher]
Ann Dermatol Venereol. 2010 Nov;137(11):727-9. Epub 2010 Sep 6.
[Unilateral acneiform rash in facial palsy].
[Article in French]
Kerob D, Hennequin V, Bousquet G, Behm E, Lebbe C.
Hôpital Saint-Louis, AP-HP, Paris, France. delphine.kerob@sls.aphp.fr
Abstract
BACKGROUND: Cetuximab is a chimeric monoclonal antibody selective for epidermal growth factor
receptor (EGFR). It is increasingly used in epithelial cancer, often in combination with radiotherapy or
chemotherapeutic agents, since it induces a broad range of cellular responses that enhance tumour
sensitivity to these therapies. However, it can cause numerous adverse effects, the most common being
acneiform eruption on the face and trunk, which is generally bilateral and symmetric.
PATIENTS AND METHODS: Herein we present the first case of unilateral cetuximab-induced
acneiform eruption in facial palsy.
DISCUSSION: To our knowledge the medical literature contains no other such cases. Our hypothesis
is that lymphoedema associated with facial palsy reduces lymphatic drainage, promoting the deposition
of cetuximab on EGFR and persistence of local signs.
Elsevier Masson SAS. All rights reserved.
PMID: 21074658 [PubMed - in process]
November 20, 2010
Head Neck. 2010 Nov 12. [Epub ahead of print]
Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Division of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The University of
Texas Health Science Center, Houston, Texas.
Abstract
BACKGROUND: Lymphedema is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions where treatment options
are limited. Although upper and lower extremity lymphedema may be effectively treated with manual
lymphatic drainage (MLD) therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS AND RESULTS: Herein, we describe the compassionate use of an investigatory
technique of near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy and
function, help direct MLD, and use 3-dimensional (3D) surface profilometry to monitor response to
therapy in a patient with head and neck lymphedema after surgery and radiation treatment.
CONCLUSION: NIR fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are needed to assess the
efficacy of MLD therapy when directed by NIR fluorescence imaging. © 2010 Wiley Periodicals, Inc.
Head Neck, 2010.
PMID: 21077150 [PubMed - as supplied by publisher]
November 27, 2010
Vopr Kurortol Fizioter Lech Fiz Kult. 2010 Jul-Aug;(4):42-8.
[Topical problems of the diagnosis and rehabilitative treatment of lymphedema of the lower extremities].
[Article in Russian]
[No authors listed]
Abstract
The present review of the literature data highlights modern approaches to and major trends in
diagnostics and conservative treatment of lymphedema of the lower extremities based on the
generalized world experience. Patients with lymphedema of the lower extremities comprise a "difficult
to manage" group because the disease is characterized by steady progression and marked
refractoriness to various conservative therapeutic modalities creating problems for both the patient and
the attending physician. Modern methods for the diagnosis of lymphedema are discussed with special
reference to noninvasive and minimally invasive techniques (such as lymphoscintiography, computed
tomography, MRT, laser Doppler flowmetry, etc.). During the last 20 years, combined conservative
therapy has been considered as the method of choice for the management of different stages and forms
of lymphedema of the lower extremities in foreign clinics. The basis of conservative therapy is
constituted by manual lymph drainage (MLD), compression bandages using short-stretch materials,
physical exercises, and skin care (using the method of M. Foldi). Also reviewed are the main
physiobalneotherapeutic methods traditionally widely applied for the treatment of lymphedema of the
lower extremities in this country. Original methods for the same purpose developed by the authors are
described including modifications of cryotherapy, pulsed matrix laserotherapy, hydro- and
balneotherapy. Mechanisms of their therapeutic action on the main pathogenetic factors responsible for
the development of lymphedema (with special reference to lymph transport and formation) are
discussed. The principles of combined application of physiotherapeutic methods for the rehabilitative
treatment of patients presenting with lymphedema of the lower extremities are briefly substantiated.
Special emphasis is laid on their influence on major components of the pathological process.
PMID: 21089207 [PubMed - in process]
November 30, 2010
J Plast Reconstr Aesthet Surg. 2010 Nov 17. [Epub ahead of print]
Simultaneous multi-site lymphaticovenular anastomoses for primary lower extremity and genital
lymphoedema complicated with severe lymphorrhea.
Yamamoto T, Koshima I, Yoshimatsu H, Narushima M, Miahara M, Iida T.
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan.
Abstract
Primary lower extremity and genital lymphoedema (GL) is difficult to manage, especially when
complicated with severe lymphorrhea. With abundant experience of treatment for lower-extremity
lymphoedema (LEL), we performed simultaneous multi-site lymphaticovenular anastomoses (LVAs)
for GL with severe lymphorrhea. In two cases of primary LEL and GL, LVAs were performed via 2-
cm-long skin incisions using two to three operating microscopes under local anaesthesia. Symptoms of
oedema and lymphorrhea improved clinically. LVA is a minimally invasive surgery, which is effective
for the treatment of LEL and GL even in primary cases with severe lymphorrhea. Simultaneous multi-
site LVAs can serve as the most effective therapy for lymphoedema.
2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd.
All rights reserved.
PMID: 21093398 [PubMed - as supplied by publisher]
Rev Med Interne. 2010 Nov 17. [Epub ahead of print]
[Inflammatory bowel disease and lower limb lymphedema: A fortuitous association?][Article in French]
Arrault M, Blanchard M, Vignes S.
Unité de lymphologie, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
INTRODUCTION: Extra-intestinal manifestations of chronic inflammatory bowel disease (CIBD) are
various. Cases of genital lymphedema has previously been reported in Crohn's disease.
CASE REPORTS: We report two women aged 57 and 68 years who presented with a lower limb
lymphedema 8 and 20 years after a diagnosis of CIBD (Crohn's disease and ulcerative colitis),
respectively. At the time of diagnosis of lymphedema, CIBD was asymptomatic.
CONCLUSION: Pathophysiological mechanisms of this rare manifestation are unclear and
lymphedema outcome is unrelated to CIBD activity.
Copyright © 2010. Published by Elsevier SAS.
PMID: 21093120 [PubMed - as supplied by publisher]
J Med Case Reports. 2010 Nov 18;4(1):369. [Epub ahead of print]
Vulval elephantiasis as a result of tubercular lymphadenitis: two case reports and a review of the
literature.
Chintamani, Singh J, Tandon M, Khandelwal R, Aeron T, Jain S, Narayan N, Bamal R, Kumar Y,
Srinivas S, Saxena S.
ABSTRACT:
INTRODUCTION: Elephantiasis as a result of chronic lymphedema is characterized by gross
enlargement of the arms, legs or genitalia, and occurs due to a variety of obstructive diseases of the
lymphatic system. Genital elephantiasis usually follows common filariasis and lymphogranuloma
venereum. It may follow granuloma inguinale, carcinomas, lymph node dissection or irradiation and
tuberculosis but this happens rarely. Vulval elephantiasis as a consequence of extensive lymph node
destruction by tuberculosis is very rare. We present two very unusual cases of vulval elephantiasis due
to tuberculous destruction of the inguinal lymph nodes.
CASE PRESENTATION: Two Indian women - one aged 40 years and the other aged 27 years, with
progressively increasing vulval swellings over a period of five and four years respectively - presented to
our hospital. In both cases, there was a significant history on presentation. Both women had previously
taken a complete course of anti-tubercular treatment for generalized lymphadenopathy. The vulval
swellings were extremely large: in the first case report, measuring 35x25cm on the right side and
45x30cm on the left side, weighing 20lb and 16lb respectively. Both cases were managed by surgical
excision with reconstruction and the outcome was positive. Satisfactory results have been maintained
during a follow-up period of six years in both cases.
CONCLUSIONS: Elephantiasis of the female genitalia is unusual and it has rarely been reported
following tuberculosis. We report two cases of vulval elephantiasis as a consequence of extensive
lymph node destruction by tuberculosis, in order to highlight this very rare clinical scenario.
PMID: 21092075 [PubMed - as supplied by publisher]
-------------------
December 3, 2010
Arch Surg. 2010 Nov;145(11):1063-4.
Risky business: Identifying risk factors associated with lymphedema after breast cancer: Comment on
"Risk factors for lymphedema in a prospective breast cancer survivorship study".
Hunt KK, Cormier JN.
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston,
77030, USA.
Comment on:
Arch Surg. 2010 Nov;145(11):1055-63.
PMID: 21121095 [PubMed - in process]
December 21, 2010
Am J Surg Pathol. 2011 Jan;35(1):70-5.
Pediatric cutaneous angiosarcomas: a clinicopathologic study of 10 cases.
Deyrup AT, Miettinen M, North PE, Khoury JD, Tighiouart M, Spunt SL, Parham DM, Shehata BM,
Weiss SW.
Pathology Consultants, Greenville, SC 29605, USA. adeyrup@ghs.org
Abstract
Cutaneous angiosarcomas are rare tumors, which predominantly arise in the sun-exposed skin of the
head and neck of adult and elderly patients. Rarely, these tumors can be seen in children. We identified
cutaneous angiosarcomas in 10 children and assessed clinical (patient age, tumor site, tumor size, and
tumor focality) and histologic features including growth pattern (vasoformative vs. solid), mitotic rate
(mitotic figures per 10 high power field), necrosis (present vs. absent), and cell shape (epithelioid vs.
nonepithelioid). Tumors predominated in the lower extremities (6 of 10) of female patients (2 male and
8 female); age at diagnosis ranged from 1.5 months to 15 years. Four patients had preexisting
conditions: congenital hemihypertrophy of the contralateral limb, the Aicardi syndrome, congenital
lymphedema, and congenital hemangioma treated with radiation therapy. Tumors were located in the
lower extremity (6), flank (1), elbow (1), and buccal mucosa (1), and ranged in size from 0.6 to 6.5
cm. Eight cases showed predominantly epithelioid morphology, 1 case showed mixed epithelioid and
spindled morphology and 1 case was entirely spindled. Mitotic activity ranged from 1 to 55 mitotic
figures per 10 high power field. Necrosis was seen in 5 cases. Clinical follow-up was obtained for 9
patients: 4 died of disease (range, 12 to 49 mo; mean, 25 mo) and 5 patients were alive without
disease (18 mo to 28 y). Five patients had metastatic disease; sites of involvement included the lung,
soft tissue, lymph node, pleura, liver, and bone. Cutaneous angiosarcomas in children are rare tumors,
which are commonly associated with a preexisting condition, suggesting a greater role for genetics as
opposed to environmental factors in the pathogenesis of these tumors.
PMID: 21164289 [PubMed - indexed for MEDLINE]
Am J Surg Pathol. 2011 Jan;35(1):60-9.
Primary cutaneous epithelioid angiosarcoma: a clinicopathologic study of 13 cases of a rare neoplasm
occurring outside the setting of conventional angiosarcomas and with predilection for the limbs.
Suchak R, Thway K, Zelger B, Fisher C, Calonje E.
Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London,
UK.
Abstract
Epithelioid angiosarcomas are rare aggressive neoplasms that occur most frequently in deep soft
tissues. Primary cutaneous lesions are rare, and there are discrepant findings in the literature regarding
their behavior. In this study, we report a series of 13 cases of primary cutaneous epithelioid
angiosarcoma and analyze their clinicopathologic features. The tumors arising in the conventional
settings for cutaneous angiosarcoma (ie, in the head and neck region of elderly patients, and those
occurring postradiation or associated with lymphedema) were excluded. Primary cutaneous epithelioid
angiosarcoma occurred in adults (mean age, 66 y) with an equal sex distribution, and presented as
solitary (n=10) or multiple (n=3) nodules ranging in size from 8 to 80 mm, with a predilection for the
limbs (n=10). Histopathologically, the tumors comprised infiltrative sheets of atypical epithelioid cells
within the dermis with or without the involvement of the subcutis. Vascular channel formation and
intracytoplasmic lumina were seen, at least focally, in most cases. Mitoses were readily identified and
necrosis was seen in 40% of the cases. The tumors were immunoreactive for vascular markers, with
CD31 and FLI-1 offering the highest sensitivity. Pancytokeratin was positive in two thirds of the cases,
and epithelial membrane antigen was positive in one-quarter of the cases. There was rare focal
expression of Melan-A (n=2) and smooth muscle actin (n=3). Follow-up information was available for
11 patients. Six patients died of metastatic disease after a median follow-up of 12 months (range, 3 to
36 mo), and 1 patient died of unrelated causes. These findings suggest that primary cutaneous
epithelioid angiosarcoma occurring outside the conventional settings of angiosarcoma is a highly
aggressive malignant tumor with mortality rates in excess of 55% after 3 years.
PMID: 21164288 [PubMed - indexed for MEDLINE]
Br J Radiol. 2010 Dec 15. [Epub ahead of print]
Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography.
Lohrmann C, Foeldi E, Langer M.
Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg,
Germany.
Abstract
Objective: Lymphocutaneous fistulas with intractable lymphatic leakage represent a serious clinical
condition leading to a severe impairment of quality of life for the affected patients. To date, no adequate
diagnostic imaging modality is in existence, to allow selection of the correct treatment option. The aim
of this study was to perform a pre-therapeutic evaluation of the lymphatic system in patients with
lymphocutaneous fistulas by magnetic resonance lymphangiography (MRL).
Methods: Eight lower extremities in four patients with lymphocutaneous fistulas were examined by
MRL. Three locations were examined: first, the lower leg and foot regions; second, the upper leg and
the knee region; and third, the pelvic and retroperitoneal regions. A T(1) weighted three-dimensional
(3D) spoiled gradient echo and a T(2) weighted 3D turbo spin echo sequence were utilised to
undertake MRL.
Results: In all four patients (100%), the clinically suspected lymphocutaneous fistulas (groin and
forefoot) were exactly delineated by MRL. In two patients (50%) adjacent diffuse lymphangiomatous
changes were detected, extending into the upper leg, pelvis, retroperitoneum, abdomen and abdominal
walls. In one patient (25%) with primary lymphoedema of the right lower extremity, MRL revealed an
aplasia of the lymphatic collectors at the levels of the lower and upper leg. All patients (100%) suffered
from an ipsilateral lymphoedema of the lower extremity, whereby in two patients with diffuse
lymphangiomatosis, the lymphatic vessels were consecutively enlarged up to a diameter of 6 
mm.
Conclusion: MRL is a safe and accurate imaging modality for a comprehensive evaluation of the
lymphatic system in patients suffering from lymphocutaneous fistulas.
PMID: 21159808 [PubMed - as supplied by publisher]
December 24, 2010
Am J Phys Med Rehabil. 2011 Feb;90(2):89-96.
The frequency of lymphedema in an adult spina bifida population.
Garcia AM, Dicianno BE.
From the Dept. of Physical Medicine and Rehabilitation (AMG, BED); Adult Outpatient Spina Bifida
Clinic University of Pittsburgh Medical Center (UPMC) (BED); Human Engineering Research
Laboratories, VA Pittsburgh Healthcare System (BED); and Dept. of Rehabilitation Science and
Technology, University of Pittsburgh (BED), Pennsylvania.
Abstract
OBJECTIVE: : In the United States, there are more than 100,000 people with spina bifida. There have
been very few studies to date documenting the occurrence of lymphedema in the spina bifida
population, despite a case series in 2001 that suggested that the occurrence may be higher than in the
general population. Currently, approximately 1 million people have lymphedema in the United States.
The purpose of this study was to document the occurrence of lymphedema and associated medical
factors in a regional adult spina bifida population.
DESIGN: : A total of 240 electronic medical records from the Adult Spina Bifida Clinic from January
2005 to August 2008 were retrospectively reviewed. Subjects were divided into two groups based on
the presence or absence of lymphedema. ? analyses were used to compare lymphedema groups with
respect to history of medical comorbidities and ethnicity. Fisher exact tests were used to compare
groups with respect to mobility status and the presence of power wheelchair seat functions. Mann-
Whitney U tests were used to compare groups with respect to age, anatomic lesion level, employment
level, and income.
RESULTS: : Twenty-two (9.2%) patients had lymphedema. Mean ± SD population age was 35.1 ±
11.1 yrs. Lymphedema was associated with a history of trauma (P = 0.044), cellulitis (P < 0.001),
cancer (P = 0.038), obesity (P < 0.001), wounds (P < 0.001), hypertension (P = 0.036), higher lesion
level spina bifida (P = 0.049), and mobility status (P = 0.007). Hypertension and obesity were present
in 38.3% and 37.5% of the total study population, respectively.
CONCLUSIONS: : This is the first study to document the occurrence of lymphedema in a spina bifida
patient population, which was almost 100 times higher than that in the general patient population. We
also documented a high occurrence of hypertension and obesity in the total study population. These
findings may help guide further prospective studies to more clearly delineate the risk factors for the
development of lymphedema and to determine the appropriate therapies. Better screening, prevention
and treatment algorithms are needed for hypertension and obesity in the spina bifida population.
PMID: 21173682 [PubMed - in process]
Cir Cir. 2010 Jul-Aug;78(4):310-4.
[Collagen-polyvinylpyrrolidone: a new therapeutic option for treatment of sequelae after radical
mastectomy in women with breast cancer. Preliminary study].
[Article in Spanish]
Ruiz-Eng R, Montiel-Jarquín A, de la Rosa-Pérez R, López-Colombo A, Gómez-Conde E, Zamudio-
Huerta L.
Departamento de Cirugía Plástica, Hospital General Regional 36, Instituto Mexicano del Seguro
Social, Puebla, México. alvaro.montielj@imss.gob.mx
Abstract
BACKGROUND: Approximately 30% of women who undergo mastectomy without reconstructive
treatment due to breast cancer present sequelae. These include paresthesias, keloid healing,
hypoesthesia, lymphedema and limitation of the function of the ipsilateral upper extremity. We
undertook this study to present the results using collagen-polyvinylpyrrolidone (Clg- Pvp) as treatment
for posmastectomy sequelae in women with breast cancer.
METHODS: We conducted a unicentric, longitudinal and prospective clinical trial between August 1,
2007 and July 31, 2008. Included variables were age, lymphedema, limitation of the function of the
ipsilateral upper extremity, collapse of the wound, keloid healing, paresthesias, and appearance of the
surgical area. The appearance of the surgical area (aesthetic aspect) was evaluated before and 6
months after treatment was initiated. Clg-Pvp was administered weekly for a 6-month period.
RESULTS: Seven women were included with a median age of 49 years (range: 40-72 years). One
patient (14.28%) presented lymphedema, two patients (28.57%) presented collapse of the wound,
two patients (28.57%) had keloid healing, three patients (42.85%) experienced paresthesias, five
patients (71.4%) reported pain, and five patients (71.4%) reported limitation of the function of the
ipsilateral upper extremity. At the completion of the treatment, aesthetic improvement was statistically
significant (p = 0.0020, Mann-Whitney U test).
CONCLUSIONS: Clinical and aesthetic results are good after application of Clg-Pvp for treating
sequelae in women with breast cancer who underwent mastectomy without reconstructive surgery.
PMID: 21167096 [PubMed - in process]
December 25, 2010
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Sep;26(5):337-9.
[Treatment of chronic extremity lymphedema with manual lymph drainage].
[Article in Chinese]
Liu NF, Wang L, Chen JL, Zhou JG, Wu XF, Yan ZX, Jiang ZH.
Department of Plastic & Reconstructive Surgery, Lymphology Center, Shanghai 9th People's Hospital,
Shanghai Jiao Tong University, Shanghai 200011, China.
Abstract
OBJECTIVE: To evaluate the effect of manual lymph drainage on chronic extremity lymphedema.
METHODS: Fifty patients with chronic lymphedema of extremity were treated with manual lymph
drainage (MLD) complex decongestion therapy. Among them, 29 had primary lymphedema, 21 had
secondary lymphedema. 42 had lymphedema of lower extremity and 8 had lymphedema of upper limb.
The result of treatment was evaluated with measurement of circumference of extremities and edema
fluid in tissue with Multiple-frequency bioelectrical impedance analysis.
RESULTS: After 1-2 treatment courses, all 50 patients showed significant decrease of circumference
of lymphedmatous limbs (P < 0.05) and remarkable reduction of accumulated edema fluid in tissue (P
< 0. 05). There was highly correlation between the decrease of limb circumference and edema fluid in
tissue (r(s) = 0.774, P < 0.01).
CONCLUSIONS: MLD complex decongestion therapy is effective for the treatment of chronic
lymphedema of extremity.
PMID: 21174786 [PubMed - in process]
December 28, 2010
Nephrology (Carlton). 2010 Dec;15(8):779-80. doi: 10.1111/j.1440-1797.2010.01323.x.
Unilateral upper limb lympatic obstruction and severe lymphoedema in a patient on long-term sirolimus.
Damasiewicz MJ, Ierino FL.
PMID: 21175966 [PubMed - in process]
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Sep;26(5):337-9.
[Treatment of chronic extremity lymphedema with manual lymph drainage].
[Article in Chinese]
Liu NF, Wang L, Chen JL, Zhou JG, Wu XF, Yan ZX, Jiang ZH.
Department of Plastic & Reconstructive Surgery, Lymphology Center, Shanghai 9th People's Hospital,
Shanghai Jiao Tong University, Shanghai 200011, China.
Abstract
OBJECTIVE: To evaluate the effect of manual lymph drainage on chronic extremity lymphedema.
METHODS: Fifty patients with chronic lymphedema of extremity were treated with manual lymph
drainage (MLD) complex decongestion therapy. Among them, 29 had primary lymphedema, 21 had
secondary lymphedema. 42 had lymphedema of lower extremity and 8 had lymphedema of upper limb.
The result of treatment was evaluated with measurement of circumference of extremities and edema
fluid in tissue with Multiple-frequency bioelectrical impedance analysis.
RESULTS: After 1-2 treatment courses, all 50 patients showed significant decrease of circumference
of lymphedmatous limbs (P < 0.05) and remarkable reduction of accumulated edema fluid in tissue (P
< 0. 05). There was highly correlation between the decrease of limb circumference and edema fluid in
tissue (r(s) = 0.774, P < 0.01).
CONCLUSIONS: MLD complex decongestion therapy is effective for the treatment of chronic
lymphedema of extremity.
PMID: 21174786 [PubMed - in process]
December 31, 2010
Plast Reconstr Surg. 2010 Dec 23. [Epub ahead of print]
Differential Diagnosis of Lower Extremity Enlargement in Pediatric Patients Referred with a Diagnosis
of "Lymphedema"
Schook CC, Mulliken JB, Fishman SJ, Alomari AI, Grant FD, Greene AK.
1Departments of Plastic and Oral Surgery, 2Surgery, 3Radiology, Vascular Anomalies Center,
Children's Hospital Boston, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: There are many causes for a large lower limb in the pediatric age group. These
children are often mislabeled as having "lymphedema", and incorrect diagnosis can lead to improper
treatment. The purpose of this study was to determine the differential diagnosis in pediatric patients
referred for lower extremity "lymphedema" and to clarify management.
METHODS: Our Vascular Anomalies Center database was reviewed between 1999 - 2010 for
patients referred with a diagnosis of "lymphedema" of the lower extremity. Records were studied to
determine the correct etiology for the enlarged extremity. Alternative diagnoses, gender, age-of-onset,
and imaging studies also were analyzed.
RESULTS: A referral diagnosis of lower extremity "lymphedema" was given to 170 children; however,
the condition was confirmed in only 72.9% of patients. Forty-six children (27.1%) had another
disorder: micro/macrocystic lymphatic malformation (19.6%), non-eponymous combined vascular
malformation (13.0%), capillary malformation (10.9%), Klippel-Trenaunay syndrome (10.9%), hemi-
hypertrophy (8.7%), post-traumatic swelling (8.7%), Parkes Weber syndrome (6.5%), lipedema
(6.5%), venous malformation (4.3%), rheumatologic disorder (4.3%), infantile hemangioma (2.2%),
kaposiform hemangioendothelioma (2.2%), or lipofibromatosis (2.2%). Age-of-onset in children with
lymphedema was older than patients with another diagnosis (p = 0.027).
CONCLUSION: "Lymphedema" is not a generic term. Approximately one-fourth of pediatric patients
with a large lower extremity are misdiagnosed as having "lymphedema"; the most commonly confused
etiologies are other types of vascular anomalies. History, physical examination, and often radiological
studies are required to differentiate lymphedema from other conditions to ensure the child is managed
appropriately.
PMID: 21187804 [PubMed - as supplied by publisher]
Oncol Nurs Forum. 2011 Jan 1;38(1):E27-36.
The role of information sources and objective risk status on lymphedema risk-minimization behaviors in
women recently diagnosed with breast cancer.
Sherman KA, Koelmeyer L.
Department of Psychology, Macquarie University, Sydney, Australia. kerry.sherman@mq.edu.au
Abstract
PURPOSE/OBJECTIVES: to assess the role of education sources and objective risk status on
knowledge and practice of lymphedema risk-minimization behaviors among women recently diagnosed
with breast cancer.
RESEARCH APPROACH: prospective survey.
SETTING: a hospital in Sydney, Australia.
PARTICIPANTS: 106 women recently diagnosed with breast cancer at increased risk for developing
lymphedema following lymph node dissection.
METHODOLOGIC APPROACH: a questionnaire administered at the time of surgery and three
months after surgery measured demographics, lymphedema knowledge, lymphedema information
sources used, and adherence to risk-minimization recommendations.
MAIN RESEARCH VARIABLES: lymphedema knowledge, source of information used, objective
lymphedema risk, and adherence to risk-minimization behaviors.
FINDINGS: knowledge was high and increased over time. Lymphedema information from the clinic (e.
g., brochures, nursing staff) was the most cited source. Adherence to recommendations was moderate;
nonadherence was mostly for behaviors requiring regular enactment. Regression analysis revealed that
only receipt of information from nursing staff and lymphedema knowledge three months after surgery
were significant predictors of risk-minimization behaviors.
CONCLUSIONS: exposing women to lymphedema risk information at the time of breast cancer
diagnosis facilitates
increased awareness and enactment of risk-minimization behaviors. Nursing staff play a key role in
disseminating this information and in convincing women to perform the recommendations.
INTERPRETATION: provision of lymphedema education by breast clinic staff is critical to ensure that
women realize the importance of early detection and treatment. Reminder booster sessions by nursing
staff may be beneficial particularly for longer-term knowledge retention and adherence to
recommended behaviors.
PMID: 21186149 [PubMed - in process]
Oncol Nurs Forum. 2011 Jan 1;38(1):E1-E10.
Lymphedema in patients with head and neck cancer.
Deng J, Ridner SH, Murphy BA.
School of Nursing, Vanderbilt University, Nashville, TN, USA. jie.deng@vanderbilt.edu
Abstract
PURPOSE/OBJECTIVES: to describe the current state of the science on secondary lymphedema in
patients with head and neck cancer.
DATA SOURCES: published journal articles and books and data from the National Cancer Institute,
the American Cancer Society, and other healthcare-related professional association Web sites.
DATA SYNTHESIS: survivors of head and neck cancer may develop secondary lymphedema as a
result of the cancer or its treatment. Secondary lymphedema may involve external (e.g., submental
area) and internal (e.g., laryngeal, pharyngeal, oral cavity) structures. Although lymphedema affects
highly visible anatomic sites (e.g., face, neck), and profoundly influences critical physical functions (e.g.,
speech, breathing, swallowing, cervical range of motion), research regarding this issue is lacking.
Studies are needed to address a variety of vital questions, including incidence and prevalence, optimal
measurement techniques, associated symptom burden, functional loss, and psychosocial impact.
CONCLUSIONS: secondary lymphedema in patients with head and neck cancer is a significant but
understudied issue.
IMPLICATIONS FOR NURSING: a need exists to systematically examine secondary lymphedema
related to treatment for head and neck cancer and address gaps in the current literature, such as
symptom burden, effects on body functions, and influences on quality of life. Oncology nurses and
other healthcare professionals should have empirical evidence to help them manage lymphedema after
head and neck cancer treatment.
PMID: 21186146 [PubMed - in process]
Breast J. 2010 Nov-Dec;16(6):639-43.
Anatomical and Surgical Concepts in Lymphatic Regeneration.
Avraham T, Daluvoy SV, Kueberuwa E, Kasten JL, Mehrara BJ.
The Division of Plastic and Reconstructive Surgery, The Department of Surgery, Memorial Sloan-
Kettering Cancer Center, New York City, New York 10065, USA. mehrarab@mskcc.org
Abstract
Chronic post-surgical lymphedema is common condition that afflicts nearly 2 million Americans. In the
USA, it is most commonly encountered in the upper extremities of patients who have undergone
axillary lymph node dissection for breast cancer. Lymphedema has a significant negative effect on
cosmesis, limb function, and overall quality of life. Despite the impact of this condition, very little is
known about how to effectively prevent or treat lymphedema. While therapeutic options for chronic
extremity lymphedema remain limited, several surgical approaches have been suggested. These include
techniques aimed at reducing limb volume, as well as techniques that aim to reconstitute disrupted
lymphatic channels. Operations proposed to re-establish lymphatic continuity include lymphatico-
venous anastomoses, lymphatico-lymphatico anastomoses, and tissue transfer.
PMID: 21121083 [PubMed - in process]
Eur J Surg Oncol. 2010 Nov 27. [Epub ahead of print]
Cost-effectiveness of MRI and PET imaging for the evaluation of axillary lymph node metastases in
early stage breast cancer.
Meng Y, Ward S, Cooper K, Harnan S, Wyld L.
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street,
Sheffield S1 4DA, UK.
Abstract
BACKGROUND: UK guidelines for breast cancer recommend axillary nodal assessment via surgical
methods such as sentinel lymph node biopsy (SLNB). However, these procedures are associated with
adverse effects such as lymphoedema. Magnetic resonance imaging (MRI) and positron emission
tomography (PET) are non-invasive imaging techniques. The aim of this study is to evaluate the cost-
effectiveness of MRI and PET compared with SLNB for assessment of axillary lymph node metastases
in newly-diagnosed early stage breast cancer patients in the UK.
METHODS: An individual patient discrete-event simulation model was developed in SIMUL8(®) to
estimate the lifetime costs and benefits of replacing SLNB with MRI or PET, or adding MRI or PET
before SLNB. Effectiveness outcomes were derived from a recent systematic review; patient utilities
and resource use data were sourced from the literature.
RESULTS: Based on our analysis the baseline SLNB strategy is dominated by the strategies of
replacing SLNB with either MRI or PET. The strategy of replacing SLNB with MRI has the highest
total quality-adjusted life years (QALYs) and lowest total costs. However, clinical evidence for MRI is
based on a limited number of small studies and replacing SLNB with MRI or PET leads to more false-
positive and false-negative cases. The strategy of adding MRI before SLNB is cost-effective, but
subject to greater uncertainty.
CONCLUSIONS: Based on this analysis the most cost-effective strategy is to replace SLNB with
MRI. However, further large studies using up-to-date techniques are required to obtain more accurate
data on the sensitivity and specificity of MRI.
Elsevier Ltd. All rights reserved.
PMID: 21115232 [PubMed - as supplied by publisher]
Recent Results Cancer Res. 2011;186:189-215.
Physical activity and breast cancer survivorship.
Schmitz K.
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 903
Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA, Schmitz@mail.med.upenn.
edu.
Abstract
A diagnosis of breast cancer is associated with treatments that have physiologic effects beyond the
intended curative therapy. The first section of this chapter provides and integrative physiology review of
the effects of breast cancer treatment on the body systems used by and affected by physical activity,
including effects of chemotherapy, radiation, and surgery. In later sections, we review the literature on
physical activity and breast cancer from the point of diagnosis and for the balance of life. The efficacy
of physical activity for supportive cancer care outcomes is reviewed separately from the purported
usefulness of physical activity for disease-free and overall survival from breast cancer. The current
evidence supports the safety of physical activity during and after breast cancer therapy. The supportive
cancer care outcomes for which there is sufficient evidence of efficacy during and after breast cancer
treatment include fitness, fatigue, body size, and quality of life. Further, there is growing evidence that
upper body exercise does not pose additional risk for negative lymphedema outcomes among survivors
with and at risk for lymphedema. For overall survival, the evidence is largely observational, with
sufficient evidence that physical activity does confer benefit. Finally, we outline future directions for
research on physical activity among breast cancer survivors, including expanding to focus on subsets of
the population not included in most prior studies (minority women and older women), tailoring of
interventions to stages of cancer most likely to benefit, expanding to study women with metastatic
cancer, and new modes of exercise, such as team sports, martial arts, and Pilates.
PMID: 21113765 [PubMed - in process]
Arch Phys Med Rehabil. 2010 Dec;91(12):1844-8.
Effect of active resistive exercise on breast cancer-related lymphedema: a randomized controlled trial.
Kim do S, Sim YJ, Jeong HJ, Kim GC.
Abstract
Kim DS, Sim Y-J, Jeong HJ, Kim GC. Effect of active resistive exercise on breast cancer-related
lymphedema: a randomized controlled trial.
OBJECTIVE: To investigate the differences between the effects of complex decongestive
physiotherapy with and without active resistive exercise for the treatment of patients with breast cancer-
related lymphedema (BCRL).
DESIGN: Randomized control-group study.
SETTING: An outpatient rehabilitation clinic.
PARTICIPANTS: Patients (N=40) with diagnosed BCRL.
INTERVENTIONS: Patients were randomly assigned to either the active resistive exercise group or
the nonactive resistive exercise group. In the active resistive exercise group, after complex
decongestive physiotherapy, active resistive exercise was performed for 15min/d, 5 days a week for 8
weeks. The nonactive resistive exercise group performed only complex decongestive physiotherapy.
MAIN OUTCOME MEASURES: The circumferences of the upper limbs (proximal, distal, and total)
for the volume changes, and the Short Form-36 version 2 questionnaire for the quality of life (QOL) at
pretreatment and 8 weeks posttreatment for each patient.
RESULTS: The volume of the proximal part of the arm was significantly more reduced in the active
resistive exercise group than that of the nonactive resistive exercise group (P<.05). In the active
resistive exercise group, there was significantly more improvement in physical health and general health,
as compared with that of the nonactive resistive exercise group (P<.05).
CONCLUSIONS: For the treatment of patients with BCRL, active resistive exercise with complex
decongestive physiotherapy did not cause additional swelling, and it significantly reduced proximal arm
volume and helped improve QOL.
American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21112424 [PubMed - in process]
Gynecol Obstet Fertil. 2010 Nov 24. [Epub ahead of print]
[Sentinel lymph node procedure and uterine cancers.][Article in French]
Huchon C, Bats AS, Achouri A, Lefrère-Belda MA, Buénerd A, Bensaid C, Farragi M, Mathevet P,
Lécuru F.
Service de chirurgie gynécologique et cancérologique, hôpital européen Georges-Pompidou, AP-HP,
20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes,
75006 Paris, France.
Abstract
Lymph node metastases in cervical and endometrial cancer are major prognostic factors. Lymph-nodal
involvement determines adjuvant therapy. As imagery is not reliable to diagnose lymph node status,
pelvic +/- para-aortic lymphadenectomy remains the gold standard. These surgical procedures are,
however, responsible for specific morbidity: lymphocele and lymphedema. Sentinel lymph node
procedure could avoid lymphadenectomy and their complications in cervical and endometrial cancer
with good negative predictive values. We present actual indications, procedure and results of sentinel
lymph node procedures in cervical and endometrial cancer.
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21111648 [PubMed - as supplied by publisher]
December 7, 2010
Am J Clin Oncol. 2010 Nov 30. [Epub ahead of print]
Estimating the Probability of Lymphedema After Breast Cancer Surgery.
Soran A, Wu WC, Dirican A, Johnson R, Andacoglu O, Wilson J.
*Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of
Pittsburgh Medical Center †Department of Biostatistics, Graduate School of Public Health, University
of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVES: Lymphedema is a common complication of breast cancer surgery, leading to a
decreased quality of life. The risk and severity of lymphedema were associated with surgery side upper
extremity infection, =25 kg/m body mass index (BMI), and the level of hand use (LHU). Our aim was
to estimate the probability of lymphedema after breast cancer surgery by using previously published
incidence rates and these 3 risk factors.
METHODS: The design was a n:m matched case control study; data were analyzed on 51 patients
with lymphedema and 126 available controls matched on age, radiation therapy, and operation type. In
conjunction with published estimates of lymphedema, incidence rates, and estimates of the proportions
of risk factor combinations in cases and controls, the Bayes' theorem was used to estimate the
probability of developing lymphedema.
RESULTS: Lymphedema probabilities of 7 combinations for 6 different published calculations were
used. With the assumption of 16% LE incidence rate of lymphedema, a BMI<25, no infection, and a
low LHU, the estimated probability of lymphedema was 6.8%. With the assumption of 46.3% LE
incidence a BMI =25, infection, and a high LHU led to an estimated lymphedema probability of 93.7%.
CONCLUSIONS: This study shows that control of predisposing factors in both high and low
incidence rates has a marked effect on the probability of LE development. In other words, patients with
low incidence for LE are more prone to develop LE if the predisposing factors are controlled poorly
compared to the high incidence patients whom the predisposing factors are avoided.
PMID: 21127413 [PubMed - as supplied by publisher]
Plast Reconstr Surg. 2010 Dec;126(6):1853-63.
Overview of surgical treatments for breast cancer-related lymphedema.
Suami H, Chang DW.
Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer
Center.
Abstract
SUMMARY:: Breast cancer-related upper extremity lymphedema is an unsolved iatrogenic
complication with a reported incidence ranging from 9 to 41 percent. The increase in volume and
recurrent cellulitis of the affected limb cause both physical and mental distress to many breast cancer
survivors. However, postmastectomy lymphedema has received little attention, and no curative
treatment is available. Conservative treatment with decongestive therapy has been the primary choice
for lymphedema treatment, but it is cumbersome and has limited benefits. To date, there is no
consensus on surgical procedure and protocol. However, refinements in microsurgical techniques and
improved examination devices may lead to the establishment of a standard surgical treatment for
lymphedema. This review of surgical procedures for the treatment of postmastectomy lymphedema
focuses on microsurgical lymphovenous shunt operations and discusses current issues in surgical
treatment and the need for uniform treatment standards.
PMID: 21124127 [PubMed - in process]
December 17, 2010
Indian J Ophthalmol. 2011 Jan-Feb;59(1):71-2.
Distichiasis-lymphedema syndrome with optic disc pit.
Kaarthigeyan K, Ramprakash M, Kalpana G.
PMID: 21157084 [PubMed - in process
Br J Dermatol. 2010 Dec 14. doi: 10.1111/j.1365-2133.2010.10179.x. [Epub ahead of print]
Changes in the nail unit in patients with secondary lymphoedema identified using clinical, dermoscopic
and ultrasound examination.
Le Fourn E, Duhard E, Tauveron V, Maruani A, Samimi M, Lorette G, Vaillant L, Machet L.
Department of Dermatology, CHRU Tours, Tours, France Lymphology unit, CHRU de Tours, Tours,
France University François Rabelais de Tours; Tours, France UMR INSERM U930, ERL 3106,
Tours, France.
Abstract
Background Secondary lymphoedema is characterized by lymphatic stasis that is often the result of a
lymph node lesion. At advanced stages it may cause trophic changes in the skin. However, the
presence of changes in the nail unit has not been reported to date.
Objectives The aim of this study was to determine the presence of nail abnormalities in cases of
secondary lymphoedema.
Methods This was a prospective study, conducted on patients with unilateral secondary lymphoedema.
A comparative clinical and dermoscopic examination and 20 MHz high resolution ultrasound imaging of
the affected limb and the contralateral limb were performed Results Thirty-three patients were
included. On physical examination, hyperkeratosis of the lateral nail folds, friability of the nail surface,
"ragged" proximal nail folds and cuticle and apparent leuconychia were observed more frequently on
the lymphoedematous limb. The ultrasound study of the nails of the thumb and the big toe did not reveal
any differences in thickness of the different structures of the nail between the lymphoedema side and the
opposite side. The nail matrix was longer on the lymphoedema side.
Conclusions Our study showed mild changes in the nail unit compatible with the xerosis often
associated with severe lymphoedema. However, the study also showed frequent evidence of "ragged"
cuticles which in these patients at high risk of erysipelas are entry points for bacteria. This should be
taken into account when counselling patients with limb lymphoedema in order to prevent erysipelas.
2010 British Association of Dermatologists.
PMID: 21155752 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2010 Dec 14. [Epub ahead of print]
A Pilot Study Reporting Outcomes for Melanoma Patients of a Minimal Access Ilio-inguinal Dissection
Technique Based on Two Incisions.
Spillane AJ, Tucker M, Pasquali S.
Sydney Medical School, The University of Sydney, Sydney, Australia, andrew.spillane@melanoma.org.
au.
Abstract
BACKGROUND: A modified procedure for ilio-inguinal regional lymph node dissection (I-I RLND)
involving 2 small skin incisions was evaluated with the aim of assessing surgical and oncological
noninferiority compared with the traditional single, longitudinal incision I-I RLND.
MATERIALS AND METHODS: A total of 20 melanoma patients with positive groin lymph nodes
who had traditional I-I RLND were compared with 20 patients who had a minimal access I-I RLND
using 2 small surgical access incisions of 3-6 cm in length-one sited below and one above the inguinal
ligament. Clinical, staging features, number of lymph nodes retrieved, length of hospital stay, time drains
remained in situ, morbidity (wound infections, dehiscence, hematoma, seroma, and lymphedema), and
disease free survival were compared.
RESULTS: Patients in the groups were comparable with the exception that the minimal access I-I
RLND group had a higher rate of AJCC stage N3 disease (60% vs 20%; P = .03) and more cases
with extranodal spread (45% vs 15%; P = .041). After a median follow-up of 5 months (range 1-8)
for the minimal access group and median 13 months (range 1-30) for the standard group there were no
differences in disease-free survival (P = .13). Retrieved lymph node counts were similar (P = .34)
including for the inguinal and pelvic components of the operations separately. No significant differences
in wound complications or rates of early lymphedema were observed.
CONCLUSIONS: At early follow-up, minimal access I-I RLND is feasible and noninferior to single
longitudinal incision I-I RLND in regard to surgical morbidity and oncological outcome. Further
evaluation is progressing.
PMID: 21153883 [PubMed - as supplied by publisher]
PLoS Negl Trop Dis. 2010 Nov 30;4(11):e902.
Effectiveness of a simple lymphoedema treatment regimen in podoconiosis management in southern
ethiopia: one year follow-up.
Sikorski C, Ashine M, Zeleke Z, Davey G.
University College London Medical School, London, United Kingdom.
Abstract
BACKGROUND: Podoconiosis is a non-filarial elephantiasis caused by long-term barefoot exposure
to volcanic soils in endemic areas. Irritant silicate particles penetrate the skin, causing a progressive,
debilitating lymphoedema of the lower leg, often starting in the second decade of life. A simple patient-
led treatment approach appropriate for resource poor settings has been developed, comprising (1)
education on aetiology and prevention of podoconiosis, (2) foot hygiene (daily washing with soap,
water and an antiseptic), (3) the regular use of emollient, (4) elevation of the limb at night, and (5)
emphasis on the consistent use of shoes and socks.
METHODOLOGY/PRINCIPAL FINDINGS: We did a 12-month, non-comparative, longitudinal
evaluation of 33 patients newly presenting to one clinic site of a non-government organization (the
Mossy Foot Treatment & Prevention Association, MFTPA) in southern Ethiopia. Outcome measures
used for the monitoring of disease progress were (1) the clinical staging system for podoconiosis, and
(2) the Amharic Dermatology Life Quality Index (DLQI), both of which have been recently validated
for use in this setting. Digital photographs were also taken at each visit. Twenty-seven patients
completed follow up. Characteristics of patients completing follow-up were not significantly different to
those not. Mean clinical stage and lower leg circumference decreased significantly (mean difference
-0.67 (95% CI -0.38 to -0.96) and -2.00 (95% CI -1.26 to -2.74), respectively, p<0.001 for both
changes). Mean DLQI diminished from 21 (out of a maximum of 30) to 6 (p<0.001). There was a non-
significant change in proportion of patients with mossy lesions (p?=?0.375).
CONCLUSIONS/SIGNIFICANCE: This simple, resource-appropriate regimen has a considerable
impact both on clinical progression and self-reported quality of life of affected individuals. The regimen
appears ideal for scaling up to other endemic regions in Ethiopia and internationally. We recommend
that further research in the area include analysis of cost-effectiveness of the regimen.
PMID: 21152059 [PubMed - in process]
Transl Oncol. 2010 Dec 1;3(6):362-72.
Human Lymphatic Architecture and Dynamic Transport Imaged Using Near-infrared Fluorescence.
Rasmussen JC, Tan IC, Marshall MV, Adams KE, Kwon S, Fife CE, Maus EA, Smith LA,
Covington KR, Sevick-Muraca EM.
Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine at the University
of Texas Health Science Center at Houston, Houston, TX, USA.
Abstract
BACKGROUND: Although the importance of lymphatic function is well recognized, the lack of real-
time imaging modalities limits our understanding of its role in many diseases. In a phase 0 exploratory
study, we used dynamic, near-infrared (NIR) fluorescence imaging to assess the extremes of lymphatic
architecture and transport in healthy human subjects and in subjects clinically diagnosed with unilateral
lymphedema (LE), a disease that can be prevalent in cancer survivors.
METHODS AND RESULTS: Active lymphatic propulsion was imaged after intradermal injections of
25 µg of indocyanine green (total maximum dose =400 µg) bilaterally in the arms or legs of control and
subjects. Images show well-defined lymphatic structures with propulsive dye transport in limbs of
healthy subjects. In LE subjects, we observed extravascular dye accumulation, networks of fluorescent
lymphatic capillaries, and/or tortuous lymphatic vessels in all symptomatic and some asymptomatic
limbs. Statistical models indicate that disease status and/or limb significantly affect parameters of
apparent lymph propagation velocity and contractile frequency.
CONCLUSIONS: These clinical research studies demonstrate the potential of NIR fluorescence
imaging as a diagnostic measure of functional lymphatics and as a new tool in translational research
studies to decipher the role of the lymphatic system in cancer and other diseases.
PMID: 21151475 [PubMed - in process]
JAMA. 2010 Dec 22;304(24):2699-705. Epub 2010 Dec 8.
Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial.
Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith R, Bryan CJ, Williams-Smith
CT, Chittams J.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine and
Abramson Cancer Center, Philadelphia, PA 19104-6021, USA. schmitz@mail.med.upenn.edu
Abstract
CONTEXT: Clinical guidelines for breast cancer survivors without lymphedema advise against upper
body exercise, preventing them from obtaining established health benefits of weight lifting.
OBJECTIVE: To evaluate lymphedema onset after a 1-year weight lifting intervention vs no exercise
(control) among survivors at risk for breast cancer-related lymphedema (BCRL).
DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled equivalence trial (Physical
Activity and Lymphedema trial) in the Philadelphia metropolitan area of 154 breast cancer survivors 1
to 5 years postunilateral breast cancer, with at least 2 lymph nodes removed and without clinical signs
of BCRL at study entry. Participants were recruited between October 1, 2005, and February 2007,
with data collection ending in August 2008.
INTERVENTION: Weight lifting intervention included a gym membership and 13 weeks of supervised
instruction, with the remaining 9 months unsupervised, vs no exercise.
MAIN OUTCOME MEASURES: Incident BCRL determined by increased arm swelling during 12
months (=5% increase in interlimb difference). Clinician-defined BCRL onset was also evaluated.
Equivalence margin was defined as doubling of lymphedema incidence.
RESULTS: A total of 134 participants completed follow-up measures at 1 year. The proportion of
women who experienced incident BCRL onset was 11% (8 of 72) in the weight lifting intervention
group and 17% (13 of 75) in the control group (cumulative incidence difference [CID], -6.0%; 95%
confidence interval [CI], -17.2% to 5.2%; P for equivalence = .04). Among women with 5 or more
lymph nodes removed, the proportion who experienced incident BCRL onset was 7% (3 of 45) in the
weight lifting intervention group and 22% (11 of 49) in the control group (CID, -15.0%; 95% CI,
-18.6% to -11.4%; P for equivalence = .003). Clinician-defined BCRL onset occurred in 1 woman in
the weight lifting intervention group and 3 women in the control group (1.5% vs 4.4%, P for
equivalence = .12).
CONCLUSION: In breast cancer survivors at risk for lymphedema, a program of slowly progressive
weight lifting compared with no exercise did not result in increased incidence of lymphedema.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00194363.
PMID: 21148134 [PubMed - indexed for MEDLINE]
Med Clin (Barc). 2010 Dec 7. [Epub ahead of print]
[Preventing lymphoedema after breast cancer surgery by elastic restraint orthotic and manual lymphatic
drainage: A randomized clinical trial.]
[Article in Spanish]
Castro-Sánchez AM, Moreno-Lorenzo C, Matarán-Peñarrocha GA, Aguilar-Ferrándiz ME, Almagro-
Céspedes I, Anaya-Ojeda J.
Departamento de Enfermería y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Almería,
Almería, España.
Abstract
BACKGROUND AND OBJECTIVE: Secondary lymphoedema is considered one of the most
common complications after breast cancer surgery. The aim of the present study was to analyze the
effectiveness of containment elastic orthosis and manual lymphatic drainage in the prevention of
lymphoedema secondary to mastectomy.
PATIENTS AND METHOD: An experimental study was performed with a control group. Forty-eight
patients were randomly assigned to experimental (containment elastic orthosis and manual lymphatic
drainage) and control (postural measures) groups. Outcomes measures were quality of life, body
composition, temperature, functional assessment of the shoulder, pain and limb volume. Measures were
performed at baseline and after 8-months intervention.
RESULTS: After the intervention period, the experimental group showed significant differences (P<.
05) in the quality of life, extracellular water, and functional assessment of the volume of the limb of the
mastectomized side.
CONCLUSIONS: The application of containment elastic orthosis and manual lymphatic drainage
contribute to prevent secondary lymphoedema after breast cancer surgery, improving the quality of life
in these patients.
Copyright © 2010 Elsevier España, S.L. All rights reserved.
PMID: 21145085 [PubMed - as supplied by publisher]
J Sex Med. 2010 Dec 8. doi: 10.1111/j.1743-6109.2010.02133.x. [Epub ahead of print]
Quality of Life and Sexual Function after Type c2/Type III Radical Hysterectomy for Locally
Advanced Cervical Cancer: A Prospective Study.
Plotti F, Sansone M, Di Donato V, Antonelli E, Altavilla T, Angioli R, Panici PB.
Sapienza University, Department of Obstetrics and Gynecology, Rome, Italy Campus Biomedico
University, Department of Obstetrics and Gynecology, Rome, Italy.
Abstract
Introduction. The introduction of screening programs have made cervical cancer detectable at earlier
stages and in younger patients. Nevertheless, only a few studies have examined the QoL and sexual
function in disease-free cervical cancer survivors. Aim. The objective of this study is to evaluate the
sexual function in a cervical cancer patient's group treated with neoadjuvant chemotherapy (NACT)
plus type C2/type III radical hysterectomy (RH).
Methods. We have enrolled in the oncologic group (OG) sexually active patients affected by cervical
cancer (stage IB2 to IIIB) treated with NACT followed by RH. Main Outcome Measures. Included
subjects were interviewed with the European Organization for Research and Treatment of Cancer
(EORTC) QLQ-CX24 Questionnaire. Two consecutive assessments were recorded: at the first
evaluation postoperatively (T1) and at the 12-month follow-up visit (T2). Results were compared with
a benign gynecological disease group (BG) and with a healthy control group (HG). Results. A total of
33 patients for OG, 37 for BG, and 35 women for HG were recruited. After surgery, sexual activity
has been resumed by 76% of the OG patients and 83.7% of the BG patients (P = not significant).
Cancer survivors had clinically worse problems with symptom experience, body image, and
sexual/vaginal functioning than controls (P < 0.05). OG patients also reported more severe
lymphedema, peripheral neuropathy, menopausal symptoms, and sexual worry. For sexual activity, the
score difference between cancer survivors and women with benign gynecological disease is not
statically significant. Concerning sexual enjoyment assessment, our study shows comparable results for
OG and BG.
Conclusion. Nevertheless, the worsening of symptom experience, body image, and sexual/vaginal
functioning, OG patients have same sexual activity and sexual enjoyment data compared with those of
BG patients. Thus, NACT followed by RH could be a valid therapeutic strategy to treat and improve
well-being especially in young cervical cancer patients. Plotti F, Sansone M, Di Donato V, Antonelli E,
Altavilla T, Angioli R, and Panici PB. Quality of life and sexual function after type c2/type III radical
hysterectomy for locally advanced cervical cancer: A prospective study. J Sex Med **;**:**-**.
International Society for Sexual Medicine.
PMID: 21143414 [PubMed - as supplied by publisher]
PMID: 20871969 [PubMed - as supplied by publisher]
Ann R Coll Surg Engl. 2010 Jun 28. [Epub ahead of print]
Hand surgery after axillary lymph node clearance for breast cancer: contra-indication to surgery?
Fulford D, Dalal S, Winstanley J, Hayton MJ.
Abstract
INTRODUCTION Breast cancer patients who have had prior axillary lymph node clearance (ALNC)
can present with ipsilateral hand conditions that could easily be treated with surgical intervention. These
patients are often advised to avoid interventional procedures due to risks of complications such
lymphoedema, infection and cellulitis.
SUBJECTS AND METHODS Between April and June 2009, we conducted an online survey of hand
surgeons, breast surgeons and breast-care nurses to obtain their views on hand surgery after ipsilateral
axillary lymph node clearance.
RESULTS The majority of hand surgeons (58%) felt there was no contra-indication to surgery in a
breast cancer patient with prior ipsilateral ALNC compared to just 30% of breast surgeons and 10%
of breast-care nurses. The majority of breast surgeons and breast-care nurses (70% and 89%,
respectively) felt that hand surgery was a relative contra-indication compared to just 41% of hand
surgeons. Postoperative lymphoedema was the commonest cited reason for avoiding surgery. The
majority of hand surgeons (79%) and nearly two-thirds of breast surgeons (57%) would use a
tourniquet during surgery if it was normal practice.
CONCLUSIONS A review of the published literature does not support the notion that these patients
experience increased complications; therefore, we recommend the advice given to breast cancer
patients regarding ipsilateral surgery be re-evaluated.
PMID: 20587171 [PubMed - as supplied by publisher]
J Med Case Reports. 2010 Jun 29;4(1):196. [Epub ahead of print]
Recurrent furunculosis as a cause of isolated penile lymphedema: a case report.
Alshaham A, Sood S.
Abstract
ABSTRACT: INTRODUCTION: Isolated lymphedema of the penis is extremely rare: combined
involvement of the scrotum and penis is the norm. Furunculosis as a cause is not, to our knowledge,
previously reported. We present a case of isolated penile lymphedema that responded to excision of
lymphedematous tissue and reconstruction with flaps.
CASE PRESENTATION: A 32-year-old Arab man presented with a three-year history of a gradually
increasing, painless penile swelling. Our patient's main complaint was non-erectile sexual dysfunction.
The swelling was preceded by at least three prior episodes of severe furunculosis at the penile root. He
had no other contributory past medical or family history. On examination there was gross penile
enlargement, maximally at the mid shaft, associated with thickened skin at the sites of prior furunculosis.
The glans and scrotum were normal. Both testes were palpable. Serology for filariasis, and urinary tract
ultrasound and computed tomography scan were normal. The clinical diagnosis was lymphedema
following recurrent penile furunculosis. At operation the lymphedematous tissues were removed.
Closure of the penile shaft was accomplished by bilateral advancement of flaps from both ends of the
penis. He resumed normal sexual activity one month after surgery. At 12 months, he had a good
cosmetic result, with no signs of recurrence.
CONCLUSIONS: Furunculosis at the penile root may result in lymphedema confined to the penile
shaft, sparing the scrotum. Excision of abnormal tissue and cover with a skin flap gave excellent
cosmetic results, and allowed satisfactory sexual activity.
PMID: 20584337 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2010 Jun;8(2):111-9.
Assessment of volume measurement of breast cancer-related lymphedema by three methods:
circumference measurement, water displacement, and dual energy X-ray absorptiometry.
Gjorup C, Zerahn B, Hendel HW.
Department of Clinical Physiology and Nuclear Medicine, Herlev University Hospital, Herlev,
Denmark. caroline@gjorup.com
Abstract
BACKGROUND: Following treatment for breast cancer 12%-60% develop breast cancer-related
lymphedema (BCRL). There are several ways of assessing BCRL. Circumference measurement (CM)
and water displacement (WD) for volume measurements (VM) are frequently used methods in practice
and research, respectively. The aim of this study was to evaluate CM and WD for VM of the BCRL
arm and the contralateral arm, comparing the results with regional dual energy X-ray absorptiometry
(DXA).
METHODS AND RESULTS: Twenty-four women with unilateral BCRL were included in the study.
Blinded duplicate VM were obtained from both arms using the three methods mentioned above. CM
and DXA were performed by two observers. WD was performed by a group of observers. Mean
differences (d) in duplicated volumes, limits of agreement (LOA), and 95% confidence intervals (CI)
were calculated for each method. The repeatability expressed as d (95% CI) between the duplicated
VM of the BCRL arm and the contralateral arm was for DXA 3 ml (-6-11) and 3 ml (1-7),
respectively. For CM and WD, the d (95% CI) of the BCRL arm were 107 ml (86-127) and 26 ml
(-26-79), respectively and in the contralateral arm 100 ml (78-122) and -6 ml (-29-17), respectively.
CONCLUSIONS: DXA is superior in repeatability when compared to CM and WD for VM,
especially for the BCRL arm but also the contralateral arm.
PMID: 20583873 [PubMed - in process]
Am J Med Genet A. 2010 Jul;152A(7):1621-6.
Agenesis of the corpus callosum and congenital lymphedema: A novel recognizable syndrome?
O'Driscoll MC, Jenny K, Saitta S, Dobyns WB, Gripp KW.
Medical Genetics Research Group and Regional Genetics Service, St Mary's Hospital, Manchester,
UK.
Abstract
We present double first cousins, a girl and a boy, with the uncommon association of agenesis of the
corpus callosum and congenital lymphedema. Other features shared by both include oligohydramnios,
similar facial dysmorphism, sacral dimple, developmental delay, and sociable personality. While some
of these findings overlap with FG syndrome and Hennekam syndrome, the findings in our patients are
sufficiently different to exclude these diagnoses. We propose that this is a new syndrome with
presumed autosomal recessive inheritance. (c) 2010 Wiley-Liss, Inc.
PMID: 20583147 [PubMed - in process]
Indian J Dermatol. 2010 Apr;55(2):144-147.
INTENSIVE TREATMENT OF LEG LYMPHEDEMA.
Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro de Godoy M.
Department of Cardiology and Cardiovascular Surgery and professor of the post graduation course of
Medicine School of São Jose do Rio Preto-FAMERP-Brazil.
Abstract
BACKGROUND: Despite of all the problems caused by lymphedema, this disease continues to affect
millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is
necessary. AIM: The aim of this study was to evaluate a novel intensive outpatient treatment for leg
lymphedema.
METHODS: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The
inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by
volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg.
Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance
was utilized for statistical analysis with an alpha error of 5% (P-value <0.05) being considered
significant.
RESULTS: All limbs had significant reductions in size with the final mean loss being 81.1% of the
volume of edema. The greatest losses occurred in the first week (P-value <0.001). Losses of more
than 90% of the lymphedema occurred in 9 (39.13%) patients; losses of more than 80% in 13
(56.52%), losses of more than 70% in 17 (73.91%) and losses of more than 50% were recorded for
95.65% of the patients; only 1 patient lost less than 50% (37.9%) of the edema.
CONCLUSION: The intensive treatment of lymphedema in the outpatient clinic can produce significant
reductions in the volume of edema over a short period of time and can be recommended for any grade
of lymphedema, in particular the more advanced degrees.
PMID: 20606882 [PubMed - as supplied by publisher]
Radiother Oncol. 2010 May 31. [Epub ahead of print]
Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema
after radiotherapy for cancer.
Gothard L, Haviland J, Bryson P, Laden G, Glover M, Harrison S, Woods M, Cook G, Peckitt C,
Pearson A, Somaiah N, Stanton A, Mortimer P, Yarnold J.
Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK.
Abstract
BACKGROUND: A non-randomised phase II study suggested a therapeutic effect of hyperbaric
oxygen (HBO) therapy on arm lymphoedema following adjuvant radiotherapy for early breast cancer,
justifying further investigation in a randomised trial.
METHODS: Fifty-eight patients with 15% increase in arm volume after supraclavicular+/-axillary
radiotherapy (axillary surgery in 52/58 patients) were randomised in a 2:1 ratio to HBO (n=38) or to
best standard care (n=20). The HBO group breathed 100% oxygen at 2.4 atmospheres absolute for
100min on 30 occasions over 6weeks. Primary endpoint was ipsilateral limb volume expressed as a
percentage of contralateral limb volume. Secondary endpoints included fractional removal rate of
radioisotopic tracer from the arm, extracellular water content, patient self-assessments and UK SF-36
Health Survey Questionnaire.
FINDINGS: Of 53/58 (91.4%) patients with baseline assessments, 46 had 12-month assessments
(86.8%). Median volume of ipsilateral limb (relative to contralateral) at baseline was 133.5% (IQR
126.0-152.3%) in the control group, and 135.5% (IQR 126.5-146.0%) in the treatment group.
Twelve months after baseline the median (IQR) volume of the ipsilateral limb was 131.2% (IQR 122.7-
151.5%) in the control group and 133.5% (IQR 122.3-144.9%) in the treatment group. Results for the
secondary endpoints were similar between randomised groups.
INTERPRETATION: No evidence has been found of a beneficial effect of HBO in the treatment of
arm lymphoedema following primary surgery and adjuvant radiotherapy for early breast cancer.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 20605648 [PubMed - as supplied by publisher]
Int J Radiat Oncol Biol Phys. 2010 Jun 2. [Epub ahead of print]
Standardized Method for Quantification of Developing Lymphedema in Patients Treated for Breast
Cancer.
Ancukiewicz M, Russell TA, Otoole J, Specht M, Singer M, Kelada A, Murphy CD, Pogachar J,
Gioioso V, Patel M, Skolny M, Smith BL, Taghian AG.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Abstract
PURPOSE: To develop a simple and practical formula for quantifying breast cancer-related
lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal
changes,
METHODS AND MATERIALS: We analyzed bilateral perometer measurements of the upper
extremity in a series of 677 women who prospectively underwent lymphedema screening during
treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and
November 2008. Four sources of variation were analyzed: between repeated measurements on the
same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up
measurements; and between patients. Effects of hand dominance, time since diagnosis and surgery,
age, weight, and body mass index were also analyzed.
RESULTS: The statistical distribution of variation of measurements suggests that the ratio of volume
ratios is most appropriate for quantification of both asymmetry and temporal changes. Therefore, we
present the formula for relative volume change (RVC): RVC = (A(2)U(1))/(U(2)A(1)) - 1, where A
(1), A(2) are arm volumes on the side of the treated breast at two different time points, and U(1), U(2)
are volumes on the contralateral side. Relative volume change is not significantly associated with hand
dominance, age, or time since diagnosis. Baseline weight correlates (p = 0.0074) with higher RVC;
however, baseline body mass index or weight changes over time do not.
CONCLUSIONS: We propose the use of the RVC formula to assess the presence and course of
breast cancer-related lymphedema in clinical practice and research. Copyright © 2010 Elsevier Inc. All
rights reserved.
PMID: 20605339 [PubMed - as supplied by publisher]
J Obstet Gynaecol Res. 2010 Jun;36(3):555-9.
Analysis of the complications after radical hysterectomy for stage IB, IIA and IIB uterine cervical
cancer patients.
Kashima K, Yahata T, Fujita K, Tanaka K.
Departments of Obstetrics and Gynecology, Niigata University Graduate School of Medical and
Dental Sciences, Niigata, Japan. kashimak@med.niigata-u.ac.jp
Abstract
AIM: This study was undertaken to assess whether radical hysterectomy and pelvic lymphadenectomy
could be carried out within acceptable complications in uterine cervical cancer patients.
MATERIAL & METHODS: One hundred and forty-six patients of the International Federation of
Gynecology and Obstetrics stage IB, IIA and IIB cervical cancer treated by radical hysterectomy or
combined with postoperative radiation therapy were enrolled in this study. The study population was
41 women over the age of 60 and 105 women under the age of 59. Complications after the treatment
of all patients were examined.
RESULTS: The complications were significantly high with the patients over the age of 60 (53.7%) in
comparison with the patients under the age of 59 (24.8%). Especially, the cases combined with
radiation therapy had higher complication rate. The most commonly recorded complications were
lymphedema (13.7%) and small bowel obstruction (8.2%).
CONCLUSION: We conclude that the complications influenced on the quality of life were more
frequent in patients over the age of 60.
PMID: 20598037 [PubMed - in process]
July 10, 2010 (7 docs)
Indian J Dermatol. 2010 Apr;55(2):144-147.
INTENSIVE TREATMENT OF LEG LYMPHEDEMA.
Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro de Godoy M.
Department of Cardiology and Cardiovascular Surgery and professor of the post graduation course of
Medicine School of São Jose do Rio Preto-FAMERP-Brazil.
Abstract
BACKGROUND: Despite of all the problems caused by lymphedema, this disease continues to affect
millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is
necessary. AIM: The aim of this study was to evaluate a novel intensive outpatient treatment for leg
lymphedema.
METHODS: Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The
inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by
volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg.
Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance
was utilized for statistical analysis with an alpha error of 5% (P-value <0.05) being considered
significant.
RESULTS: All limbs had significant reductions in size with the final mean loss being 81.1% of the
volume of edema. The greatest losses occurred in the first week (P-value <0.001). Losses of more
than 90% of the lymphedema occurred in 9 (39.13%) patients; losses of more than 80% in 13
(56.52%), losses of more than 70% in 17 (73.91%) and losses of more than 50% were recorded for
95.65% of the patients; only 1 patient lost less than 50% (37.9%) of the edema.
CONCLUSION: The intensive treatment of lymphedema in the outpatient clinic can produce significant
reductions in the volume of edema over a short period of time and can be recommended for any grade
of lymphedema, in particular the more advanced degrees.
PMID: 20606882 [PubMed - as supplied by publisher]
Br J Nurs. 2010 Jul 8-21;19(13):826-30.
Keeping breast cancer survivors lymphoedema-free.
Fleysher LA.
Abstract
With the increasing number of breast cancer survivors, post-treatment interventions to improve quality
of life are gaining priority. Current breast cancer treatment modalities put patients at risk of developing
upper-extremity lymphoedema. Upper-extremity lymphoedema is a common and overlooked
complication of breast cancer treatment. Health professionals play an important role in identifying
breast cancer and promptly referring these patients for further interventions. After successful
completion of breast cancer treatment, these patients continue to have regular evaluations by their
oncologists; and, provided there are no signs and symptoms of breast cancer, primary and community
care health professionals will continue to play an essential role in the management of this unique patient
group. As breast cancer treatment places these patients at a lifetime risk of developing upper-extremity
lymphoedema, radiation oncologists, surgical and medical oncologists, and primary care practitioners
must be knowledgeable and educate these patients about risk reduction behaviours. Prevention,
prompt identification, and treatment of lymphoedema are the goals for achieving positive and cost-
effective patient outcomes. This article aims to provide health professionals with specific educational
tools with regard to the prevention, recognition, and management of upper-extremity lymphoedema;
these tools should be used to change the ongoing trends in the management of breast cancer survivors'
follow-up care.
PMID: 20606611 [PubMed - in process]
Int J Gynecol Cancer. 2010 Jul;20(5):900-4.
A prospective study of postoperative lymphedema after surgery for cervical cancer.
Halaska MJ, Novackova M, Mala I, Pluta M, Chmel R, Stankusova H, Robova H, Rob L.
*Department of Obstetrics and Gynaecology, 2nd Medical Faculty of the Charles University in Prague
and Faculty Hospital Motol, Prague; daggerFaculty of Statistics, University of Economics in Prague;
and double daggerDepartment of Oncology and Radiotherapy, Faculty Hospital Motol, Prague, Czech
Republic.
Abstract
OBJECTIVE:: Lymphedema is a severe postoperative complication in oncological surgery.
Multifrequency bioelectrical impedance analysis (MFBIA) is a new method for early lymphedema
detection. The objective was to establish the methodology of MFBIA for lower-limb lymphedema and
to detect a lymphedema in patients undergoing cervical cancer surgery.
METHODS:: From a population of 60 patients undergoing cervical cancer surgery, 39 underwent
radical hysterectomy Wertheim III (RAD group), and 21 underwent conservative surgery
(laparoscopic lymphadenectomy plus simple trachelectomy/simple hysterectomy - CONS group). A
control group of 29 patients (CONTR group) was used to determine the SD of impedance at zero
frequency (R0). Patients were examined before surgery and at 3 and 6 months after surgery by
MFBIA and by measuring the circumference of the lower limbs.
RESULTS:: No differences were found between the CONS and RAD groups on age, height, weight,
and histopathologic type of tumor. However, the number of dissected lymph nodes differed significantly
between the groups (17.3 in the CONS group vs 25.8 in the RAD group, P = 0.0012). The SD of R0
in the CONTR group was 36.0 and 39.0 for the right and the left leg, respectively. No difference in
prevalence of lymphedema based on circumference method was found (35.9% in the RAD and 47.6%
in the CONS groups, not statistically significant).
CONCLUSIONS:: No difference in the prevalence of lymphedema was found between the CONS
and RAD groups. A methodology for MFBIA for the detection of lower-limb lymphedema was
described.
PMID: 20606541 [PubMed - in process]
Radiother Oncol. 2010 May 31. [Epub ahead of print]
Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema
after radiotherapy for cancer.
Gothard L, Haviland J, Bryson P, Laden G, Glover M, Harrison S, Woods M, Cook G, Peckitt C,
Pearson A, Somaiah N, Stanton A, Mortimer P, Yarnold J.
Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK.
Abstract
BACKGROUND: A non-randomised phase II study suggested a therapeutic effect of hyperbaric
oxygen (HBO) therapy on arm lymphoedema following adjuvant radiotherapy for early breast cancer,
justifying further investigation in a randomised trial.
METHODS: Fifty-eight patients with 15% increase in arm volume after supraclavicular+/-axillary
radiotherapy (axillary surgery in 52/58 patients) were randomised in a 2:1 ratio to HBO (n=38) or to
best standard care (n=20). The HBO group breathed 100% oxygen at 2.4 atmospheres absolute for
100min on 30 occasions over 6weeks. Primary endpoint was ipsilateral limb volume expressed as a
percentage of contralateral limb volume. Secondary endpoints included fractional removal rate of
radioisotopic tracer from the arm, extracellular water content, patient self-assessments and UK SF-36
Health Survey Questionnaire.
FINDINGS: Of 53/58 (91.4%) patients with baseline assessments, 46 had 12-month assessments
(86.8%). Median volume of ipsilateral limb (relative to contralateral) at baseline was 133.5% (IQR
126.0-152.3%) in the control group, and 135.5% (IQR 126.5-146.0%) in the treatment group.
Twelve months after baseline the median (IQR) volume of the ipsilateral limb was 131.2% (IQR 122.7-
151.5%) in the control group and 133.5% (IQR 122.3-144.9%) in the treatment group. Results for the
secondary endpoints were similar between randomised groups.
INTERPRETATION: No evidence has been found of a beneficial effect of HBO in the treatment of
arm lymphoedema following primary surgery and adjuvant radiotherapy for early breast cancer.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 20605648 [PubMed - as supplied by publisher]
Int J Radiat Oncol Biol Phys. 2010 Jun 2. [Epub ahead of print]
Standardized Method for Quantification of Developing Lymphedema in Patients Treated for Breast
Cancer.
Ancukiewicz M, Russell TA, Otoole J, Specht M, Singer M, Kelada A, Murphy CD, Pogachar J,
Gioioso V, Patel M, Skolny M, Smith BL, Taghian AG.
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Abstract
PURPOSE: To develop a simple and practical formula for quantifying breast cancer-related
lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal
changes,
METHODS AND MATERIALS: We analyzed bilateral perometer measurements of the upper
extremity in a series of 677 women who prospectively underwent lymphedema screening during
treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and
November 2008. Four sources of variation were analyzed: between repeated measurements on the
same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up
measurements; and between patients. Effects of hand dominance, time since diagnosis and surgery,
age, weight, and body mass index were also analyzed.
RESULTS: The statistical distribution of variation of measurements suggests that the ratio of volume
ratios is most appropriate for quantification of both asymmetry and temporal changes. Therefore, we
present the formula for relative volume change (RVC): RVC = (A(2)U(1))/(U(2)A(1)) - 1, where A
(1), A(2) are arm volumes on the side of the treated breast at two different time points, and U(1), U(2)
are volumes on the contralateral side. Relative volume change is not significantly associated with hand
dominance, age, or time since diagnosis. Baseline weight correlates (p = 0.0074) with higher RVC;
however, baseline body mass index or weight changes over time do not.
CONCLUSIONS: We propose the use of the RVC formula to assess the presence and course of
breast cancer-related lymphedema in clinical practice and research. Copyright © 2010 Elsevier Inc. All
rights reserved.
PMID: 20605339 [PubMed - as supplied by publisher]
Arch Phys Med Rehabil. 2010 Jul;91(7):1070-6.
Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility
study.
Katz E, Dugan NL, Cohn JC, Chu C, Smith RG, Schmitz KH.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Abstract
OBJECTIVE: To assess the feasibility of recruiting and retaining cancer survivors with lower-limb
lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety
and efficacy of this intervention. We hypothesized that progressive weight training would not
exacerbate leg swelling and that the intervention would improve functional mobility and quality of life.
DESIGN: Before-after pilot study with a duration of 5 months.
SETTING: University of Pennsylvania.
PARTICIPANTS: Cancer survivors with a known diagnosis of lower-limb lymphedema (N=10) were
directly referred by University of Pennsylvania clinicians. All 10 participants completed the study.
INTERVENTION: Twice weekly slowly progressive weight lifting, supervised for 2 months,
unsupervised for 3 months.
MAIN OUTCOME MEASURES: The primary outcome was interlimb volume differences as
measured by optoelectronic perometry. Additional outcome measures included safety (adverse events),
muscle strength, objective physical function, and quality of life.
RESULTS: Interlimb volume differences were 44.4% and 45.3% at baseline and 5 months,
respectively (pre-post comparison, P=.70). There were 2 unexpected incident cases of cellulitis within
the first 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months.
Bench and leg press strength increased by 47% and 27% over 5 months (P=.001 and P=.07,
respectively). Distance walked in 6 minutes increased by 7% in 5 months (P=.01). No improvement
was noted in self-reported quality of life.
CONCLUSIONS: Recruitment of patients with lower-limb-lymphedema into an exercise program is
feasible. Despite some indications that the intervention may be safe (eg, a lack of clinically significant
interlimb volume increases over 5 mo), the unexpected finding of 2 cellulitic infections among the 10
participants suggests additional study is required before concluding that patients with lower-extremity
lymphedema can safely perform weight lifting. Copyright 2010 American Congress of Rehabilitation
Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 20599045 [PubMed - in process]PMCID: PMC2897812 [Available on 2011/7/1]
J Obstet Gynaecol Res. 2010 Jun;36(3):555-9.
Analysis of the complications after radical hysterectomy for stage IB, IIA and IIB uterine cervical
cancer patients.
Kashima K, Yahata T, Fujita K, Tanaka K.
Departments of Obstetrics and Gynecology, Niigata University Graduate School of Medical and
Dental Sciences, Niigata, Japan. kashimak@med.niigata-u.ac.jp
Abstract
AIM: This study was undertaken to assess whether radical hysterectomy and pelvic lymphadenectomy
could be carried out within acceptable complications in uterine cervical cancer patients.
MATERIAL & METHODS: One hundred and forty-six patients of the International Federation of
Gynecology and Obstetrics stage IB, IIA and IIB cervical cancer treated by radical hysterectomy or
combined with postoperative radiation therapy were enrolled in this study. The study population was
41 women over the age of 60 and 105 women under the age of 59. Complications after the treatment
of all patients were examined.
RESULTS: The complications were significantly high with the patients over the age of 60 (53.7%) in
comparison with the patients under the age of 59 (24.8%). Especially, the cases combined with
radiation therapy had higher complication rate. The most commonly recorded complications were
lymphedema (13.7%) and small bowel obstruction (8.2%).
CONCLUSION: We conclude that the complications influenced on the quality of life were more
frequent in patients over the age of 60.
PMID: 20598037 [PubMed - in process]
July 18, 2010 (8 docs)
Eur J Ophthalmol. 2010 Jul 6. pii: 15C85F11-38C9-45C7-A19F-2E3556D7D52F. [Epub ahead of
print]
Unusual presentation of giant cell angiofibroma of the eyelids.
Surace D, Blandamura S, Bernardini FP, Galan A, Lo Giudice G.
Department of Ophthalmology, Santa Maria del Carmine Hospital, Rovereto - Italy.
Abstract
Purpose. To describe a case of bilateral eyelid-confined giant cell angiofibroma (GCAF) in a patient
with a slowly progressive bilateral eyelid swelling. Methods. A 40-year-old man with a 5-year history
of slowly progressive bilateral eyelid swelling, severe functional impairment, and bilateral cosmetic
deformity was studied. An extensive ophthalmologic evaluation, laboratory examinations, and orbital
magnetic resonance imaging were carried out.
Results. Clinical examination showed nonpitting lymphedema affecting both upper and lower eyelids,
with orange peel skin. Orbital magnetic resonance imaging revealed diffuse thickening of the preseptal
structures in the eyelids without extension to the orbit. Histologic specimen revealed the presence of
spindle and multinucleated giant cells surrounding pseudovascular spaces strongly positive to CD34
and vimentin. A diagnosis of GCAF was made and radiation therapy was performed 3 weeks after
surgical debulking with partial recovery of visual and anatomic function.
Conclusions. Giant cell angiofibroma involving the eyelid is rare and can represent a diagnostic and
therapeutic challenge to the ophthalmologist.
PMID: 20623470 [PubMed - as supplied by publisher]
Ann Dermatol Venereol. 2010 Jun-Jul;137(6-7):477-9. Epub 2010 May 14.
[Lymphoedema and neutrophilic dermatosis] Article in French]
Guyot-Caquelin P, Cuny JF, Depardieu C, Barbaud A, Schmutz JL.
PMID: 20620580 [PubMed - in process]
J Urol. 2010 Aug;184(2):546-552. Epub 2010 Jun 17.
Modified Technique of Radical Inguinal Lymphadenectomy for Penile Carcinoma: Morbidity and
Outcome.
Yao K, Tu H, Li YH, Qin ZK, Liu ZW, Zhou FJ, Han H.
Department of Urology, Cancer Center, Sun Yat-Sen University and State Key Laboratory of
Oncology in Southern China, Guangzhou, P. R. China.
Abstract
PURPOSE: Classic radical inguinal lymphadenectomy is associated with significant morbidity. Modified
inguinal lymphadenectomy has been used to decrease the complication rate but it may compromise the
oncological effect and depends on the use of intraoperative frozen sections, which may be inaccurate.
We modified the technique of radical inguinal lymphadenectomy to decrease postoperative
complications without compromising oncological effectiveness.
MATERIALS AND METHODS: We performed 150 modified radical inguinal dissections in 75
patients with penile carcinoma from February 1999 to September 2008. Patients underwent modified
radical inguinal dissection characterized by an S-shaped incision, precisely separating layers using an
anatomical landmark and preserving the fascia lata. The boundaries of dissection are the same as those
of radical inguinal lymphadenectomy. Survival and morbidity data were retrospectively analyzed, and
survival probabilities were calculated. RESULTS: Followup ranged from 12 to 113 months. Overall 3-
year survival was 92%, and for N0, N1, N2 and N3 disease it was 100%, 100%, 85% and 57.1%,
respectively. A total of 37 complications occurred including wound infection (1.4%), skin necrosis
(4.7%), lymphedema (13.9%), seroma (2.0%), lymphocele (2.0%) and deep venous thrombosis
(0.7%).
CONCLUSIONS: Morbidity related to groin dissection in patients with penile carcinoma can be
decreased and oncological effectiveness can be preserved using this modified inguinal dissection
technique. Copyright © 2010 American Urological Association Education and Research, Inc.
Published by Elsevier Inc. All rights reserved.
PMID: 20620415 [PubMed - as supplied by publisher]
J Vasc Surg. 2010 Jul 7. [Epub ahead of print]
A novel method of measuring human lymphatic pumping using indocyanine green fluorescence
lymphography.
Unno N, Nishiyama M, Suzuki M, Tanaka H, Yamamoto N, Sagara D, Mano Y, Konno H.
Division of Vascular Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan; Second
Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
Abstract
OBJECTIVES: Lymph transportation through the body is partly controlled by the intrinsic pumping of
lymphatic vessels. Although an understanding of this process is important for medical application, little
is currently known because it is difficult to measure. Here, we introduce an easy, safe, and cost-
effective technique for measuring lymphatic pumping in leg superficial lymphatic vessels. Readings
obtained with this technique were compared with values obtained with dynamic lymphoscintigraphy.
Differences in lymphatic pumping between healthy volunteers and patients with lymphedema were also
investigated.
METHODS: Indocyanine green (ICG) fluorescence lymphography was performed by subcutaneously
injecting 0.3 mL of ICG (0.5%) into the dorsum of the foot. Real-time fluorescence images of lymph
propulsion were obtained with an infrared-light camera system with the individual supine or sitting. A
custom-made transparent sphygmomanometer cuff was wrapped around the lower leg and connected
to a standard mercury sphygmomanometer. The cuff was inflated to 60 mm Hg and then gradually
deflated at 5-minute intervals to lower the pressure by 10-mm Hg steps until the fluorescence contrast
agent exceeded the upper border of the cuff, indicating that the lymphatic contraction had overcome
the cuff pressure. Lymph pumping pressure (P(pump)) was defined as the value of the cuff pressure
when the contrast agent exceeded the upper border of the cuff. We measured P(pump) among healthy
volunteers who maintained a supine position and compared these values with measurements obtained
from lymphoscintigraphy. P(pump) values while sitting were also compared between 30 legs from
healthy volunteers and 30 legs from lymphedematous patients.
RESULTS: Among healthy, supine participants, P(pump) was 25.2 +/- 16.7 mm Hg (mean +/-
standard deviation [SD]) when measured by ICG fluorescence lymphography. These values were
significantly correlated with values taken using dynamic lymphoscintigraphy (r(2) = 0.54, p < .01),
while 2 SDs of the mean were approximately 20 mm Hg, suggesting a substantial disagreement
between the two methods (Bland-Altman plots). In the comparison of seated meaurements, readings
for healthy participants (P(pump) = 29.3 +/- 16.0) were higher than those for lymphedematous
participants (13.2 +/- 14.9).
CONCLUSION: ICG fluorescence is an accurate-as well as a safe, easy, and economical-method of
measuring lymphatic pumping. Therefore, it may develop as a vital tool for diagnosing lymphatic
malfunctions even when they are only in their formative stages. Studies that use this technique may
increase our knowledge of the lymphatic system as a whole, allowing us to develop better treatments
for lymphatic disorders. Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc.
All rights reserved.
PMID: 20619581 [PubMed - as supplied by publisher]
J Pain Symptom Manage. 2010 Jul;40(1):e7-10.
A case of massive complicated lower limb lymphedema after pelvic nodal dissection and radiotherapy.
Jain S, Mahantshetty U, Engineer R, Shrivastava SK.
PMID: 20619201 [PubMed - in process]
Jpn J Nurs Sci. 2010 Jun;7(1):108-18.
Physiological characteristics of the body fluid in lymphedematous patients postbreast cancer surgery,
focusing on the intracellular/extracellular fluid ratio of the upper limb.
Sakuda H, Satoh M, Sakaguchi M, Miyakoshi Y, Kataoka T.
Department of Human Health Science, Graduate School of Medicine, Faculty of Medicine, Kyoto
University, 53 Syogoin Kawahara-cho,Kyoto, Japan. sakuda@hs.med.kyoto-u.ac.jp
Abstract
AIM: The aim of this research was to determine the physiological characteristics of patients with
lymphedema following breast cancer surgery, based on differences between the quantity of body water
in the right and left fingertips, with a view to establishing whether or not this simple measurement could
serve as a predictive index for the onset of lymphedema.
METHOD: The research was conducted at a hospital in Hiroshima, Japan (August 2004 to December
2004). Observations were made on 39 female breast cancer patients who had undergone surgery and
45 healthy female participants. Additional information was collected via interviews with the individual
participants. The quantity of body water in all the participants was measured by using a bioimpedance
spectrum analysis system. Comparisons of the intracellular/extracellular fluid ratios (I/Es) were made
between the edema patients and the non-edema patients, with further testing being done between the
affected and unaffected sides of the upper limb in the edema patients.
RESULTS: In the edema patients, significant differences were recognized between the affected side's
upper limb I/E and the unaffected side's upper limb I/E. In relation to the affected side's upper limb I/E
of the edema patients, even when the mean value and standard deviation were included, the value did
not exceed 1.0 and the mean - 3 SD value of the affected side's upper limb I/E in the non-edema
patients was 1.04.
CONCLUSIONS: The results suggest that measurements of the affected and unaffected sides' upper
limb I/E showed a potential for use as a reliable predictive index for lymphedema.
PMID: 20618682 [PubMed - in process]
Ann Surg Oncol. 2010 Jul 8. [Epub ahead of print]
The Impact on Morbidity and Length of Stay of Early Versus Delayed Complete Lymphadenectomy in
Melanoma: Results of the Multicenter Selective Lymphadenectomy Trial (I).
Faries MB, Thompson JF, Cochran A, Elashoff R, Glass EC, Mozzillo N, Nieweg OE, Roses DF,
Hoekstra HJ, Karakousis CP, Reintgen DS, Coventry BJ, Wang HJ, Morton DL; for the MSLT
Cooperative Group.
John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA, fariesm@jwci.
org.
Abstract
BACKGROUND: Complete lymph node dissection, the current standard treatment for nodal
metastasis in melanoma, carries the risk of significant morbidity. Clinically apparent nodal tumor is likely
to impact both preoperative lymphatic function and extent of soft tissue dissection required to clear the
basin. We hypothesized that early dissection would be associated with less morbidity than delayed
dissection at the time of clinical recurrence.
MATERIALS AND METHODS: The Multicenter Selective Lymphadenectomy Trial I randomized
patients to wide excision of a primary melanoma with or without sentinel lymph node biopsy.
Immediate completion lymph node dissection (early CLND) was performed when indicated in the SLN
arm, while therapeutic dissection (delayed CLND) was performed at the time of clinical recurrence in
the wide excision-alone arm. Acute and chronic morbidities were prospectively monitored.
RESULTS: Early CLND was performed in 225 patients, and in the wide excision-alone arm 132 have
undergone delayed CLND. The 2 groups were similar for primary tumor features, body mass index,
basin location, and demographics except age, which were higher for delayed CLND. The number of
nodes evaluated and the number of positive nodes was greater for delayed CLND. There was no
significant difference in acute morbidity, but lymphedema was significantly higher in the delayed CLND
group (20.4% vs. 12.4%, P = .04). Length of inpatient hospitalization was also longer for delayed
CLND.
CONCLUSION: Immediate nodal treatment provides critical prognostic information and a likely
therapeutic effect for those patients with nodal involvement. These data show that early CLND is also
less likely to result in lymphedema.
PMID: 20614193 [PubMed - as supplied by publisher]
Vet Dermatol. 2010 Jul 1. [Epub ahead of print]
Combined moxidectin and environmental therapy do not eliminate Chorioptes bovis infestation in
heavily feathered horses.
Rüfenacht S, Roosje PJ, Sager H, Doherr MG, Straub R, Goldinger-Müller P, Gerber V.
Dermatology Unit, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Berne,
Switzerland.
Abstract
Abstract Chorioptes bovis infestation is a common cause of pastern dermatitis in the horse, with a
predilection in draft horses and other horses with thick hair 'feathers' on the distal limbs. The treatment
of this superficial mite is challenging; treatment failure and relapse are common. Furthermore, C. bovis
infestation may affect the progression of chronic pastern dermatitis (also known as chronic proliferative
pastern dermatitis, chronic progressive lymphoedema and dermatitis verrucosa) in draft horses,
manifesting with oedema, lichenification and excessive skin folds that can progress to verruciform
lesions. An effective cure for C. bovis infestation would therefore be of great clinical value. In a
prospective, double-blind, placebo-controlled study, the efficacy of oral moxidectin (0.4 mg/kg body
weight) given twice with a 3 week interval in combination with environmental treatment with 4-chloro-3-
methylphenol and propoxur was tested in 19 heavily feathered horses with clinical pastern dermatitis
and C. bovis infestation. Follow-up examinations over a period of 180 days revealed significantly more
skin crusting in the placebo group than in the treatment group. However, no other differences in clinical
signs or the numbers of mites detected were found between the two groups. The results of this study
suggest that moxidectin in combination with environmental insecticide treatment as used in this study is
ineffective in the treatment of C. bovis in feathered horses.
PMID: 20609205 [PubMed - as supplied by publisher]
July 22, 2010 (4 docs)
Clin Nucl Med. 2010 Aug;35(8):579-82.
Lymphoscintigraphy in the diagnosis of lymphangiomatosis.
Beveridge N, Allen L, Rogers K.
Department of Nuclear Medicine/PET, Hunter New England Imaging, John Hunter Hospital,
Newcastle, NSW, Australia. nicole.beveridge@hnehealth.nsw.gov.au
Abstract
Lymphangiomatosis is a rare condition characterized by multiple abnormalities of the lymphatic system.
Diagnosis is often difficult, as chronic, intermittent, or acute pain; edema; and other symptoms may
affect the respiratory, gastrointestinal, renal, hepatic, skeletal, and other organ systems. We report the
case of a patient who first presented with lymphedema in childhood and was treated intermittently for
related symptoms before diagnosis was achieved 36 years later. Plain film radiography, bone scanning,
computed tomography, magnetic resonance imaging, and lymphoscintigraphy were used to arrive at a
diagnosis. Information derived from all scan types was combined to derive a diagnosis of
lymphangiomatosis. Lymphoscintigraphy provided direct evidence of the abnormal lymphatic flows
associated with lymphangiomatosis. Lymphangiomatosis presents a diagnostic challenge; information
from several scan types, including lymphoscintigraphy, is useful in deriving this diagnosis.
PMID: 20631503 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2010 Jul 12. [Epub ahead of print]
Objective improvement in upper limb lymphoedema following ipsilaterall latissimus dorsi pedicled flap
breast reconstruction - A case series and review of literature.
Abbas Khan MA, Mohan A, Hardwicke J, Srinivasan K, Billingham R, Taylor C, Prinsloo D.
Department of Plastic and Reconstructive Surgery, University Hospital North Staffordshire NHS Trust,
Newcastle Rd, Stoke on Trent, Staffordshire ST4 6QG, UK.
Abstract
OBJECTIVE: We present a series of three patients whose upper limb lymphoedema (following total
oncologic mastectomy and level III axillary clearance) resolved significantly after ipsilateral pedicled
latissimus dorsi (LD) flap breast reconstruction.
METHODS: A retrospective review of the medical records of patients who had undergone oncologic
mastectomy and level III axillary clearance with subsequent LD pedicled flap reconstruction was
carried out. Individuals who had undergone review and treatment by the lymphoedema service were
identified and patients with incomplete pre- or post-operative records were excluded. A minimum
follow-up period of 2 years of conservative therapy, as well as 2 years post-operatively was
undertaken.
RESULTS: The rate of improvement of lymphoedema following conservative therapy was, on average,
0.095mL/week and reached a plateau at 2-year follow-up. Following latissimus dorsi flap breast
reconstruction, the rate of improvement in lymphoedema increased in all three cases, with an average
improvement of 2.55mL/week and remained sustained in the follow-up period.
CONCLUSION: Pedicled myocutaneous flap reconstruction of the ipsilateral breast proved to be a
useful treatment for upper limb lymphoedema in our series. This adds an important dimension to the
assessment and treatment of patients with upper limb oedema resulting from mastectomy and axillary
clearance. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.
PMID: 20630818 [PubMed - as supplied by publisher]
PLoS Negl Trop Dis. 2010 Jun 29;4(6):e728.
Increasing compliance with mass drug administration programs for lymphatic filariasis in India through
education and lymphedema management programs.
Cantey PT, Rout J, Rao G, Williamson J, Fox LM.
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease
Control and Prevention, Atlanta, Georgia, United States of America. pcantey@cdc.gov
Abstract
BACKGROUND: Nearly 45% of people living at risk for lymphatic filariasis (LF) worldwide live in
India. India has faced challenges obtaining the needed levels of compliance with its mass drug
administration (MDA) program to interrupt LF transmission, which utilizes diethylcarbamazine (DEC)
or DEC plus albendazole. Previously identified predictors of and barriers to compliance with the MDA
program were used to refine a pre-MDA educational campaign. The objectives of this study were to
assess the impact of these refinements and of a lymphedema morbidity management program on MDA
compliance.
METHODS/PRINCIPAL FINDINGS: A randomized, 30-cluster survey was performed in each of 3
areas: the community-based pre-MDA education plus community-based lymphedema management
education (Com-MDA+LM) area, the community-based pre-MDA education (Com-MDA) area, and
the Indian standard pre-MDA education (MDA-only) area. Compliance with the MDA program was
90.2% in Com-MDA+LM, 75.0% in Com-MDA, and 52.9% in the MDA-only areas (p<0.0001).
Identified barriers to adherence included: 1) fear of side effects and 2) lack of recognition of one's
personal benefit from adherence. Multivariable predictors of adherence amenable to educational
intervention were: 1) knowing about the MDA in advance of its occurrence, 2) knowing everyone is at
risk for LF, 3) knowing that the MDA was for LF, and 4) knowing at least one component of the
lymphedema management techniques taught in the lymphedema management program.
CONCLUSIONS/SIGNIFICANCE: This study confirmed previously identified predictors of and
barriers to compliance with India's MDA program for LF. More importantly, it showed that targeting
these predictors and barriers in a timely and clear pre-MDA educational campaign can increase
compliance with MDA programs, and it demonstrated, for the first time, that lymphedema management
programs may also increase compliance with MDA programs.
PMID: 20628595 [PubMed - in process]PMCID: PMC2900179
J Adv Nurs. 2010 Jul 2. [Epub ahead of print]
Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node
dissection for breast cancer: systematic review.
Chan DN, Lui LY, So WK.
Dorothy N.S. Chan BN MN RN Registered Nurse Department of Surgery, Ruttonjee and Tang Shiu
Kin Hospital, Hong Kong SAR, China.
Abstract
chan d.n.s., lui l.y.y. & so w.k.w. (2010) Effectiveness of exercise programmes on shoulder mobility
and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. Journal of
Advanced Nursing. Abstract Aim. This article is a report of a review of the effectiveness of exercise
programmes on shoulder mobility and lymphoedema in postoperative patients with breast cancer
having axillary lymph node dissection, as revealed by randomized controlled trials.
Background. Breast cancer is the most common malignancy in women. After surgery, the most
common postoperative complications are reduced range of motion in the shoulder, muscle weakness in
the upper extremities, lymphoedema, pain and numbness. To reduce these impairments, shoulder
exercises are usually prescribed. However, conflicting results regarding the effect and timing of such
exercises have been reported.
Data sources. Studies were retrieved from a systematic search of published works over the period
2000-2009 indexed in the Cumulative Index to Nursing and Allied Health Literature, Ovid Medline,
the British Nursing Index, Proquest, Science Direct, Pubmed, Scopus and the Cochrane Library, using
the combined search terms 'breast cancer', 'breast cancer surgery', 'exercise', 'lymphoedema', 'shoulder
mobility' and 'randomized controlled trials'.
Methods. A quantitative review of effectiveness was carried out. Studies were critically appraised by
three independent reviewers, and categorized according to levels of evidence defined by the Joanna
Briggs Institute.
Results. Six studies were included in the review. Early rather than delayed onset of training did not
affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in
avoiding deterioration in range of shoulder motion.
Conclusion. Further studies are required to investigate the optimal time for starting arm exercises after
this surgery. Nurses have an important role in educating and encouraging patients to practise these
exercises to speed up recovery.
PMID: 20626480 [PubMed - as supplied by publisher]
July 24, 2010 (1 doc)
Gynecol Oncol. 2010 Jul 15. [Epub ahead of print]
Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had
treatment including lymphadenectomy.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, Aoyagi Y, Ohba Y, Okamoto
K, Kato H.
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center,
Sapporo, Japan.
Abstract
OBJECTIVE: The aim of this study was to determine the incidence rate of lower-extremity
lymphedema after systematic lymphadenectomy in patients with uterine corpus malignancies and to
elucidate risk factors for this type of lymphedema.
METHODS: A retrospective chart review was carried out for all patients with uterine corpus malignant
tumor managed at Hokkaido Cancer Center between 1991 and 2007. Patients who did not undergo
lymphadenectomy as a treatment or died of cancer/intercurrent disease were excluded from this study.
All living patients included in this study had hysterectomy, bilateral salpingo-oophorectomy and
lymphadenectomy and their medical records were reviewed. We identified patients with postoperative
lower-extremity lymphedema (POLEL). Logistic regression analysis was used to select the risk factors
for POLEL.
RESULTS: Of 286 patients evaluated, 103 (37.8%) had POLEL. Multivariate analysis confirmed that
adjuvant radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more than 31 lymph nodes
(OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to the distal external iliac nodes
(CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were independent risk factors for POLEL.
CONCLUSION: Adjuvant radiation therapy should be avoided in patients who undergo systematic
lymphadenectomy if an alternative postoperative strategy is possible. Although reducing the number of
resected lymph nodes is not appropriate from a therapeutical point of view, elimination of CINDEIN
dissection may be helpful in reducing the incidence of POLEL. The clinical significance of CINDEIN
dissection needs to be investigated by a randomized controlled trial. Copyright © 2010 Elsevier Inc.
All rights reserved.
PMID: 20638109 [PubMed - as supplied by publisher]
Gynecol Oncol. 2010 Jul 15. [Epub ahead of print]
Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had
treatment including lymphadenectomy.
Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M, Aoyagi Y, Ohba Y, Okamoto
K, Kato H.
Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center,
Sapporo, Japan.
Abstract
OBJECTIVE: The aim of this study was to determine the incidence rate of lower-extremity
lymphedema after systematic lymphadenectomy in patients with uterine corpus malignancies and to
elucidate risk factors for this type of lymphedema.
METHODS: A retrospective chart review was carried out for all patients with uterine corpus malignant
tumor managed at Hokkaido Cancer Center between 1991 and 2007. Patients who did not undergo
lymphadenectomy as a treatment or died of cancer/intercurrent disease were excluded from this study.
All living patients included in this study had hysterectomy, bilateral salpingo-oophorectomy and
lymphadenectomy and their medical records were reviewed. We identified patients with postoperative
lower-extremity lymphedema (POLEL). Logistic regression analysis was used to select the risk factors
for POLEL.
RESULTS: Of 286 patients evaluated, 103 (37.8%) had POLEL. Multivariate analysis confirmed that
adjuvant radiation therapy (OR=5.2, 95% CI=2.1-12.7), resection of more than 31 lymph nodes
(OR=2.6, 95% CI=1.4-4.9), and removal of circumflex iliac nodes to the distal external iliac nodes
(CINDEIN) (OR=6.1, 95% CI=1.3-28.2) were independent risk factors for POLEL.
CONCLUSION: Adjuvant radiation therapy should be avoided in patients who undergo systematic
lymphadenectomy if an alternative postoperative strategy is possible. Although reducing the number of
resected lymph nodes is not appropriate from a therapeutical point of view, elimination of CINDEIN
dissection may be helpful in reducing the incidence of POLEL. The clinical significance of CINDEIN
dissection needs to be investigated by a randomized controlled trial. Copyright © 2010 Elsevier Inc.
All rights reserved.
PMID: 20638109 [PubMed - as supplied by publisher]
Cancer. 2010 Jul 27. [Epub ahead of print]
Lymphedema beyond breast cancer: a systematic review and meta-analysis of cancer-related
secondary lymphedema.
Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM.
Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston,
Texas.
Abstract
BACKGROUND:: Secondary lymphedema is a debilitating, chronic, progressive condition that
commonly occurs after the treatment of breast cancer. The purpose of the current study was to
perform a systematic review and meta-analysis of the oncology-related literature excluding breast
cancer to derive estimates of lymphedema incidence and to identify potential risk factors among various
malignancies.
METHODS:: The authors systematically reviewed 3 major medical indices (MEDLINE, Cochrane
Library databases, and Scopus) to identify studies (1972-2008) that included a prospective
assessment of lymphedema after cancer treatment. Studies were categorized according to malignancy,
and data included treatment, complications, lymphedema measurement criteria, lymphedema incidence,
and follow-up interval. A quality assessment of individual studies was performed using established
criteria for systematic reviews. Bayesian meta-analytic techniques were applied to derive summary
estimates when sufficient data were available.
RESULTS:: A total of 47 studies (7779 cancer survivors) met inclusion criteria: melanoma (n = 15),
gynecologic malignancies (n = 22), genitourinary cancers (n = 8), head/neck cancers (n = 1), and
sarcomas (n = 1). The overall incidence of lymphedema was 15.5% and varied by malignancy (P < .
001): melanoma, 16% (upper extremity, 5%; lower extremity, 28%); gynecologic, 20%; genitourinary,
10%; head/neck, 4%; and sarcoma, 30%. Increased lymphedema risk was also noted for patients
undergoing pelvic dissections (22%) and radiation therapy (31%). Objective measurement methods
and longer follow-up were both associated with increased lymphedema incidence.
CONCLUSIONS:: Lymphedema is a common condition affecting cancer survivors with various
malignancies. The incidence of lymphedema is related to the type and extent of treatment, anatomic
location, heterogeneity of assessment methods, and length of follow-up. Cancer 2010. (c) 2010
American Cancer Society.
PMID: 20665892 [PubMed - as supplied by publisher]
IEEE Eng Med Biol Mag. 2010 Mar-Apr;29(2):63-70.
Optical coherence tomography: the intraoperative assessment of lymph nodes in breast cancer.
Nguyen FT, Zysk AM, Chaney EJ, Adie SG, Kotynek JG, Oliphant UJ, Bellafiore FJ, Rowland KM,
Johnson PA, Boppart SA.
Abstract
During breast-conserving surgeries, axillary lymph nodes draining from the primary tumor site are
removed for disease staging. Although a high number of lymph nodes are often resected during sentinel
and lymph-node dissections, only a relatively small percentage of nodes are found to be metastatic, a
fact that must be weighed against potential complications such as lymphedema. Without a real-time in
vivo or in situ intraoperative imaging tool to provide a microscopic assessment of the nodes,
postoperative paraffin section histopathological analysis currently remains the gold standard in assessing
the status of lymph nodes. This paper investigates the use of optical coherence tomography (OCT), a
high-resolution real-time microscopic optical-imaging technique, for the intraoperative ex vivo imaging
and assessment of axillary lymph nodes. Normal (13), reactive (1), and metastatic (3) lymph nodes
from 17 human patients with breast cancer were imaged intraoperatively with OCT. These preliminary
clinical studies have identified scattering changes in the cortex, relative to the capsule, which can be
used to differentiate normal from reactive and metastatic nodes. These optical scattering changes are
correlated with inflammatory and immunological changes observed in the follicles and germinal centers.
These results suggest that intraoperative OCT has the potential to assess the real-time node status in
situ, without having to physically resect and histologically process specimens to visualize microscopic
features.
PMID: 20659842 [PubMed - in process]
August 7, 2010 (5 docs)
J Vasc Surg. 2010 Aug;52(2):429-34.
Extracorporeal shock wave therapy ameliorates secondary lymphedema by promoting
lymphangiogenesis.
Kubo M, Li TS, Kamota T, Ohshima M, Shirasawa B, Hamano K.
Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine,
Ube, Yamaguchi, Japan.
Abstract
OBJECTIVE: Although secondary lymphedema is a common complication after surgical and radiation
therapy for cancer, the treatment options for lymphedema remain limited and largely ineffective. We
thus studied the effect of extracorporeal shock wave therapy on promoting lymphangiogenesis and
improving secondary lymphedema.
METHODS: A rabbit ear model of lymphedema was created by disruption of lymphatic vessels. Two
weeks after surgery, the lymphedematous ear was treated with or without low-energy shock waves
(0.09 mJ/mm(2), 200 shots), three times per week for 4 weeks.
RESULTS: Western blot analysis showed that the expression of vascular endothelial growth factor
(VEGF)-C (1.23-fold, P < .05) and VEGF receptor 3 (VEGFR3; 1.53-fold, P < .05) was
significantly increased in the ears treated with shock wave than in the untreated lymphedematous ears.
Compared with the control group, shock wave treatment led to a significant decrease in the thickness
of lymphedematous ears (3.80 +/- 0.25 mm vs 4.54 +/- 0.18 mm, P < .05). Immunohistochemistry for
VEGFR3 showed the density of lymphatic vessels was significantly increased by shock wave treatment
(P < .05).
CONCLUSION: Extracorporeal shock wave therapy promotes lymphangiogenesis and ameliorates
secondary lymphedema, suggesting that extracorporeal shock wave therapy may be a novel, feasible,
effective, and noninvasive treatment for lymphedema. Copyright (c) 2010 Society for Vascular
Surgery. Published by Mosby, Inc. All rights reserved.
PMID: 20670777 [PubMed - in process]
Oper Orthop Traumatol. 2010 Jul;22(3):317-34.
[The medial closed-wedge osteotomy of the distal femur for the treatment of unicompartmental lateral
osteoarthritis of the knee.] [Article in German]
Freiling D, van Heerwaarden R, Staubli A, Lobenhoffer P.
Klinik für Unfall- und Wiederherstellungschirurgie, Diakonie- krankenhaus Henriettenstiftung,
Hannover, Germany, d.freiling@gmx.de.
Abstract
OBJECTIVE : Shifting of the mechanical axis from the lateral to the medial compartment in patients
with lateral osteoarthritis in combination with valgus deformity.
INDICATIONS : Osteoarthritis of the lateral compartment in combination with valgus deformity of the
(distal) femur. Posttraumatic and congenital valgus deformities of the (distal) femur.
CONTRAINDICATIONS : Osteoarthritis of the medial compartment (>/= grade 3 on Outerbridge
Scale). Total loss of the medial meniscus. Acute or chronic infections. Rheumatoid arthritis. Heavy
smoking. Extension or flexion deficit > 20 degrees . Poor soft-tissue conditions on site of surgery.
SURGICAL TECHNIQUE : Optional: arthroscopy before osteotomy. Anteromedial skin incision,
subvastus approach with blunt preparation around the vastus medialis muscle and separation of this
muscle from the intermuscular septum. The posterior osteotomy is marked with Kirschner wires (OGD
[osteotomy guiding device], Synthes, Switzerland, can be used optionally). The biplanar cut is marked
on the bone with an electrocautery device. The bone cuts start with the posterior incomplete
osteotomy, followed by the anterior biplanar cut. After finishing the osteotomy (three bone cuts!), the
bone wedge can be removed. Closing the osteotomy should start very gently as a plastic deformation
of the bone. A radiologic control of the leg alignment and the mechanical axis is achieved with an
alignment rod (Synthes, Switzerland). The plate should be inserted under the vastus medialis muscle. It
is very important, that the surgeon controls the correct anteromedial position of the plate at the distal
femur (right and left version of the implant). Fixation of the plate with locking screws distally.
Positioning of a lag screw in the dynamic hole directly above the osteotomy. Insertion of monocortical
screws in the three remaining holes proximal of the lag screw. Finally, the lag screw is changed to a self-
tapping bicortical locking head screw. X-ray control, wound closure.
POSTOPERATIVE MANAGEMENT : Elastic bandage of the leg up to the thigh in the operating
room. Change of the dressing on day 1 after surgery. Ice treatment. Walking on crutches starting day 1
after surgery. Physiotherapy and manual lymph drainage starting on day 1 after surgery. Partial weight
bearing for the first 4-6 weeks after surgery. Suture removal after 10-12 days. X-ray control on day 3
and 6 weeks after surgery. Discharge possible, if wounds are dry (day 4-7).
RESULTS : Between January 2005 and October 2008, 60 patients were treated with medial closed-
wedge osteotomy of the distal femur (since 11/2006 only with biplanar osteotomy technique) at the
Department of Trauma and Reconstructive Surgery, Diakoniekrankenhaus Henriettenstiftung
Hannover, Germany. The average wedge size was 7.6 mm (4-13 mm). The mean age was 39.7 years
(17-79 years). The patients had had 2.3 previous surgeries. The mean follow- up was 21 months (3-
45 months). Freiling D, et al. Biplanare Osteotomie bei unikompartimentaler lateraler
Kniegelenkarthrose Flexion was 126 degrees (95-140 degrees ) preoperatively, and 128 degrees
(105-140 degrees ) postoperatively. 25 patients had at least 5 degrees extension deficit (5-15 degrees
) before surgery, whereas ten patient did not reach the full extension at follow-up examination. The
Tegner Activity Score increased from 2.8 (1-4) preoperatively to 5.6 (2-9) postoperatively, in IKDC
(International Knee Documentation Committee) Score, 18 patients reached grade A, 27 grade B, nine
grade C, and six grade D. The visual analog scale (VAS) score decreased from 6.8 (8-2)
preoperatively to 3.1 (0-7) postoperatively. Seven patients had revision surgery (three times delayed
union/nonunion of the osteotomy, one superficial and one deep infection, one hematoma, one fracture
[proximal of the internal plate fixator] after a fall).
PMID: 20676825 [PubMed - in process]
Plast Reconstr Surg. 2010 Aug;126(2):55e-69e.
Vascular anomalies and lymphedema.
Chim H, Drolet B, Duffy K, Koshima I, Gosain AK.
Cleveland, Ohio; Milwaukee, Wis.; and Tokyo, Japan From the Department of Plastic Surgery, Case
Western Reserve University; the Department of Dermatology, Children's Hospital of Wisconsin; and
the Department of Plastic and Reconstructive Surgery, University of Tokyo.
Abstract
LEARNING OBJECTIVES:: After studying this article, the participant should be able to: 1. Define the
difference between vascular tumors and malformations. 2. Distinguish between the natural history of
hemangiomas and that of vascular malformations. 3. Identify the different types of hemangiomas and
vascular malformations and understand evaluation, treatment, and complications. 4. Understand the
role of lymphaticovenular anastomoses in the treatment of extremity lymphedema.
BACKGROUND:: The International Society for the Study of Vascular Anomalies classification, which
is the most widely accepted classification system in use, divides vascular anomalies into vascular tumors
(inclusive of hemangiomas) and malformations. This serves as a guideline for diagnosis, evaluation, and
treatment of these lesions.
METHODS:: Although hemangiomas tend to have a predictable clinical course over the first year of
life, going through proliferating, involuting, and involuted stages, vascular malformations demonstrate
growth commensurate with age, often becoming more prominent in puberty. In addition, they never
regress, and persist throughout life.
RESULTS:: Different modalities of treatment may be appropriate for vascular tumors and different
subsets of vascular malformations. Details are provided in this review. Lymphaticovenular anastomoses
provide an excellent addition to our methods of treatment of extremity lymphedema, and are made
possible through development of supermicrosurgical techniques.
CONCLUSIONS:: Vascular anomalies have a high prevalence in the general population. Thus, it is
vital that the plastic surgeon has a good understanding of classification, evaluation, and treatment
options. Lymphedema is another common condition that is encountered. Understanding of
lymphaticovenular anastomoses and their applications aids treatment planning for select patients.
PMID: 20679788 [PubMed - in process]
Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2010 Aug;27(4):371-5.
[Identification of VEGFR3 gene mutation in a Chinese family with autosomal dominant primary
congenital lymphoedema.] [Article in Chinese]
Sheng J, Zeng F, Li C, Liu J, Wang Q, Liu M.
Key Laboratory of Molecular Biophysics of Ministry of Education, College of Life Science and
Technology, Center for Human Genome Research, Huazhong University of Science and Technology,
Wuhan, Hubei, 430074 P. R. China. lium@mail.hust.edu.cn.
Abstract
OBJECTIVE: To identify the disease-causing gene in a four-generation Chinese family with 9 members
affected with primary congenital lymphoedema (PCL, also known as Milroy disease).
METHODS: Linkage analysis was performed with a few microsatellite markers flanking the candidate
genetic loci for PCL, including 3 known genes associated with autosomal dominant PCL. For mutation
analysis, VEGFR3 gene was sequenced with DNA from the proband. Direct DNA sequencing of exon
25 of the VEGFR3 gene was performed in all family members.
RESULTS: The disease gene in the family was mapped to chromosome 5q35.3 with a maximum Lod
score of 2.07. Direct DNA sequencing of VEGFR3 gene revealed a heterozygous C to T transition at
nucleotide 3341, resulting in p.Pro1114Leu mutation. The p.Pro1114Leu mutation co-segregated with
all affected individuals in the family.
CONCLUSION: This study identified a C3341T (p.Pro1114Leu) mutation in the VEGFR3 gene in a
Chinese family with PCL, provided evidence that VEGFR3 mutation can cause PCL in Chinese.
PMID: 20677139 [PubMed - in process]
Physiotherapy. 2010 Sep;96(3):264. Epub 2010 Jun 2.
Comments on book review of 'Lymphoedema: Advice on Self-management'.
Friett K.
Lymphoedema Support Network, St. Lukes Crypt, Sydney Street, London SW3 6NH, UK.
PMID: 20674660 [PubMed - in process]
August 14, 2010 (3 docs)
Coll Antropol. 2010 Jun;34(2):645-8.
A case report of breast angiosarcoma.
Kardum-Skelin I, Jelić-Puskarić B, Pazur M, Vidić-Paulisić I, Jakić-Razumović J, Separović V.
Laboratory for Cytology and Hematology, Department of Medicine, "Merkur" University Hospital,
Zagreb, Croatia. ikardum@hi.t-com.hr
Abstract
Angiosarcoma is a rare disease of the breast with the reported incidence of only 0.04% of all breast
malignancies. The etiology of angiosarcoma remains unknown. It occurs post-mastectomy, in
association with chronic lymphedema (Stewart-Treves syndrome), or after radiotherapy. We present a
patient with angiosarcoma which developed 12 years of the diagnosis of breast carcinoma and 8 years
of the operative procedure and radiotherapy for disease recurrence. A small angiomatous lesion of a
few mm in size, cytologically suspect of vascular tumor (hemangioma or hemangiopericytoma) and
histopathologically verified to be an atypical vascular lesion, was detected two years before breast
enlargement and cytologic and histologic diagnosis of angiosarcoma. The patient died 15 months of the
diagnosis of angiosarcoma, after two tumor recurrences and intrathoracic cavity invasion.
PMID: 20698145 [PubMed - in process]
Am J Surg Pathol. 2010 Aug 6. [Epub ahead of print]
Epithelioid Angiosarcoma of the Skin: A Study of 18 Cases With Emphasis on its Clinicopathologic
Spectrum and Unusual Morphologic Features.
Bacchi CE, Silva TR, Zambrano E, Plaza J, Suster S, Luzar B, Lamovec J, Pizzolitto S, Falconieri G.
*Consultoria em Patologia, Botucatu, SP, Brazil daggerDepartment of Pathology, Medical College of
Wisconsin, Milwaukee, WI double daggerInstitute of Pathology, Medical Faculty, University of
Ljubljana School of Medicine section signDepartment of Pathology, Institute of Oncology, Ljubljana,
Slovenia parallelDepartment of Pathology, General University Hospital S. Maria della Misericordia,
Udine, Italy.
Abstract
We report 18 cases of cutaneous angiosarcoma with predominant or exclusive epithelioid morphology.
Both sexes were similarly affected. Patients' ages ranged from 2 to 97 years, median 77.5 years; 2
were pediatric patients. In elderly patients scalp or facial lesions and cutaneous lesions arising within
irradiated breast skin predominated. Limb lesions were seen in younger patients. Microscopically, the
tumors were composed of packed polygonal cells with focal evidence of endothelial differentiation.
Diverging phenotypes included syncytial growth of large cells with clear nuclei and prominent nucleoli,
micronodules of tumor cells scattered in dermis, predominance of discohesive plasmacytoid polygonal
cells with abundant bright eosinophilic cytoplasm, sheets of clear cells with coarse granular cytoplasm,
trabecular and cord arrangement of tumor cells splaying the dermal collagen, or a pseudoglandular
appearance owing to clear cell tubular arrangement with open lumina. These cases posed further
diagnostic challenges simulating lymphoma, melanoma, lymphoepithelioma-like carcinoma, adnexal
carcinoma, and neuroendocrine carcinoma. Immunohistochemical studies showed positivity for CD31
and CD34; no immunoreactivity was documented for other tested antigens including cytokeratins,
S100 protein, melanocytic antigens, leukocyte common antigen, and desmin. Therapeutic modalities
included combined local excision, chemotherapy, and radiotherapy, depending on patient clinical status.
Of the 9 patients available for follow-up, 5 were alive and apparently well, 2 had recurrent disease, and
2 had died of tumor. Our data show that epithelioid cutaneous angiosarcoma may have a broad
morphological spectrum, raising interpretive challenges on microscopy. In addition, its clinical
presentation seems to differ in nonelderly patients, with lesions likely related to lymphedema or vascular
malformations.
PMID: 20697249 [PubMed - as supplied by publisher]
J Biotechnol. 2010 Aug 3. [Epub ahead of print]
Reconstruction of lymph vessel by lymphatic endothelial cells combined with polyglycolic acid
scaffolds: a pilot study.
Dai TT, Jiang ZH, Li SL, Zhou GD, Kretlow JD, Cao WG, Liu W, Cao YL.
Department of Plastic and Reconstructive Surgery, Shanghai ninth people's hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China.
Abstract
Restoration of lymphatic drainage using lymph vessels or tissue grafting is becoming an efficient method
for alleviating obstructive lymphedema. However, the lack of ideal lymphatic grafts is the key problem
that limits the application of lymphatic transplantation, but now that may be resolved with tissue-
engineered lymph vessels. In this study, the feasibility of reconstructing lymph vessels was explored
using lymphatic endothelial cells (LECs) combined with polyglycolic acid (PGA) scaffolds. The highly
purified human dermal LECs can be isolated from human dermis by immunomagnetic bead sorting and
multiplied in culture. The viability and growth potential of subcultured LECs make it possible to obtain
large amount of cells in vitro. Light and scanning electron microscopy (SEM) showed that the
prefabricated PGA scaffolds, with 3-dimensional structure, can support cell adhesion, growth and
spreading. The constructs formed with LECs combined with PGA scaffolds were cultured in vitro for
ten days and then implanted subcutaneously into nude mice. Six weeks after implantation, the portions
of implanted tubules were harvested. Gross and histological observation demonstrated that the tubular
structure still remained in the experimental groups but not in the control groups. Immunohistochemical
staining and RT-PCR assay of the implanted vessels revealed positive staining in experimental groups
for the lymphatic specific markers podoplanin, VEGFR-3 and LYVE-1. The results indicate that LECs
can serve as seed cells and be successfully combined with PGA scaffolds, and the tissue-engineered
tubular structure using implanted LECs-PGA compounds showed preliminary characteristics of lymph
vessels. A gap between the nearly normal or functional lymph vessel still exists as we have only the
endothelial cell lined duct, but this study demonstrates that it is feasible to construct tissue-engineered
lymph vessels using LECs combined with a biodegradable material. Copyright © 2010. Published by
Elsevier B.V.
PMID: 20691226 [PubMed - as supplied by publisher]
The next 5 documments are Medifocus.com but when I click on each individual link a Pub Med
document did come up and they may be duplicates because they are dated from May to July 2010:
Medfocus Document Alert – August 2010 issue (5 docs)
Each month hundreds of thousands of consumers and healthcare professionals search the National
Library of Medicine's Medline database seeking the latest information on their disease/condition.
Conducting a thorough and effective Medline search is both a time consuming and daunting task. At
Medifocus, we have developed an effective solution to this problem: each month our staff of expert
researchers searches Medline for the latest advances in research and clinical medicine for over 70
diseases / conditions. We do this with one goal in mind: to empower you to effectively take control
over your health.
Here is the result of our team's work in Lymphedema this month:
Arch Phys Med Rehabil. 2010 Jul;91(7):1070-6.
Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility
study.
Katz E, Dugan NL, Cohn JC, Chu C, Smith RG, Schmitz KH.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Abstract
OBJECTIVE: To assess the feasibility of recruiting and retaining cancer survivors with lower-limb
lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety
and efficacy of this intervention. We hypothesized that progressive weight training would not
exacerbate leg swelling and that the intervention would improve functional mobility and quality of life.
DESIGN: Before-after pilot study with a duration of 5 months.
SETTING: University of Pennsylvania.
PARTICIPANTS: Cancer survivors with a known diagnosis of lower-limb lymphedema (N=10) were
directly referred by University of Pennsylvania clinicians. All 10 participants completed the study.
INTERVENTION: Twice weekly slowly progressive weight lifting, supervised for 2 months,
unsupervised for 3 months.
MAIN OUTCOME MEASURES: The primary outcome was interlimb volume differences as
measured by optoelectronic perometry. Additional outcome measures included safety (adverse events),
muscle strength, objective physical function, and quality of life.
RESULTS: Interlimb volume differences were 44.4% and 45.3% at baseline and 5 months,
respectively (pre-post comparison, P=.70). There were 2 unexpected incident cases of cellulitis within
the first 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months.
Bench and leg press strength increased by 47% and 27% over 5 months (P=.001 and P=.07,
respectively). Distance walked in 6 minutes increased by 7% in 5 months (P=.01). No improvement
was noted in self-reported quality of life.
CONCLUSIONS: Recruitment of patients with lower-limb-lymphedema into an exercise program is
feasible. Despite some indications that the intervention may be safe (eg, a lack of clinically significant
interlimb volume increases over 5 mo), the unexpected finding of 2 cellulitic infections among the 10
participants suggests additional study is required before concluding that patients with lower-extremity
lymphedema can safely perform weight lifting.
PMID: 20599045 [PubMed - indexed for MEDLINE]
Am J Hum Genet. 2010 Jun 11;86(6):943-8. Epub 2010 May 27.
GJC2 missense mutations cause human lymphedema.
Ferrell RE, Baty CJ, Kimak MA, Karlsson JM, Lawrence EC, Franke-Snyder M, Meriney SD,
Feingold E, Finegold DN.
Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh,
Pittsburgh, PA 15261, USA.
Abstract
Lymphedema is the clinical manifestation of defects in lymphatic structure or function. Mutations
identified in genes regulating lymphatic development result in inherited lymphedema. No mutations have
yet been identified in genes mediating lymphatic function that result in inherited lymphedema. Survey
microarray studies comparing lymphatic and blood endothelial cells identified expression of several
connexins in lymphatic endothelial cells. Additionally, gap junctions are implicated in maintaining
lymphatic flow. By sequencing GJA1, GJA4, and GJC2 in a group of families with dominantly inherited
lymphedema, we identified six probands with unique missense mutations in GJC2 (encoding connexin
[Cx] 47). Two larger families cosegregate lymphedema and GJC2 mutation (LOD score = 6.5). We
hypothesize that missense mutations in GJC2 alter gap junction function and disrupt lymphatic flow.
Until now, GJC2 mutations were only thought to cause dysmyelination, with primary expression of
Cx47 limited to the central nervous system. The identification of GJC2 mutations as a cause of primary
lymphedema raises the possibility of novel gap-junction-modifying agents as potential therapy for some
forms of lymphedema.
PMID: 20537300 [PubMed - indexed for MEDLINE]
Womens Health (Lond Engl). 2010 May;6(3):399-406.
Breast cancer and lymphedema: a current overview for the healthcare provider.
Rourke LL, Hunt KK, Cormier JN.
University of Texas, MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX
77030, USA. lrourke@mdanderson.org
Abstract
Lymphedema is a troublesome condition faced by many breast cancer survivors today. Since
lymphedema represents a debilitating and progressive problem that is feared by most breast cancer
patients and their providers, an up-to-date understanding is necessary in order to better diagnose, treat
and manage these patients. The etiology of lymphedema is multifactorial and poorly understood.
Although lymphedema is not clearly defined within the medical community, there are several diagnostic
tools available to the clinician, of which the most widely accepted in the clinical setting are the arm
circumference measurements. Misinformation has recently been conveyed regarding activity
recommendations for those patients afflicted with lymphedema. These recent events highlight the critical
importance of education, heightened awareness and dedicated future cooperative research in order to
favorably impact on lymphedema care and the quality of life for those living with lymphedema.
PMID: 20426606 [PubMed - indexed for MEDLINE]
Nucl Med Commun. 2010 Jun;31(6):547-51.
Intradermal lymphoscintigraphy at rest and after exercise: a new technique for the functional assessment
of the lymphatic system in patients with lymphoedema.
Tartaglione G, Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C, Paone G, Bernabucci
V, Bartoletti R, Marchetti P, Marzola MC, Naji M, Rubello D.
Unit of Nuclear Medicine, Cristo Re Hospital, Istituto Dermopatico dell'Immacolata, IDI-IRCCS.
Abstract
AIM: The aim of this study was to evaluate the effect of implementing a new technique, intradermal
injection lymphoscintigraphy, at rest and after muscular exercise on the functional assessment of the
lymphatic system in a group of patients with delayed or absent lymph drainage.
METHODS: We selected 44 patients (32 women and 12 men; 15 of 44 with upper limb and 29 of 44
with lower limb lymphoedema). Thirty of 44 patients had bilateral limb lymphoedema and 14 of 44 had
unilateral disease; 14 contralateral normal limbs were used as controls. Twenty-three patients had
secondary lymphoedema after lymphadenectomy and the remaining 21 had idiopathic lymphoedema.
Each of the 44 patients was injected with 50 MBq (0.3-0.4 ml) of (99m)Tc-albumin-nanocolloid,
which was administered intradermally at the first interdigital space of the affected limb. Two planar
static scans were performed using a low-energy general-purpose collimator (acquisition matrix 128 x
128, anterior and posterior views for 5 min), and in which drainage was slow or absent, patients were
asked to walk or exercise for 2 min. A postexercise scan was then performed to monitor and record
the tracer pathway and the tracer appearance time (TAT) in the inguinal or axillary lymph nodes.
RESULTS: The postexercise scans showed that (i) 21 limbs (15 lower and six upper limbs) had
accelerated tracer drainage and tracer uptake in the inguinal and/or axillary lymph nodes. Two-thirds of
these showed lymph stagnation points; (ii) 27 limbs had collateral lymph drainage pathways; (iii) in 11
limbs, there was lymph drainage into the deeper lymphatic channels, with unusual uptake in the popliteal
or antecubital lymph nodes; (iv) six limbs had dermal backflow; (v) three limbs did not show lymph
drainage (TAT=not applicable). TAT=15 + or - 3 min, ranging from 12 to 32 min in limbs with
lymphoedema versus 5 + or - 2 min, ranging from 1 to 12 min in the contralateral normal limbs (P<0.
001).
CONCLUSION: Intradermal injection lymphoscintigraphy gives a better imaging of the lymph drainage
pathways in a shorter time, including cases with advanced lymphoedema. In some patients with
lymphoedema, a 2-min exercise can accelerate tracer drainage, showing several compensatory
mechanisms of lymph drainage. The effect of the exercise technique on TAT and lymphoscintigraphy
findings could result in a more accurate functional assessment of lymphoedema patients.
PMID: 20215978 [PubMed - indexed for MEDLINE]
Eur J Vasc Endovasc Surg. 2010 May;39(5):646-53. Epub 2010 Feb 21.
Primary lymphoedema and lymphatic malformation: are they the two sides of the same coin?
Lee BB, Villavicencio JL.
Division of Vascular Surgery, Georgetown University School of Medicine, Washington, DC 20007,
USA. bblee38@comcast.net
Abstract
OBJECTIVES: To clear the confusion regarding the relationship between the 'primary lymphoedema'
and (truncular) lymphatic malformation (LM); the latter is one of congenital vascular malformations.
MATERIALS & METHODS: A literature review was carried out on the primary lymphoedema either
existing as an independent LM lesion or as a component of the Klippel-Trenaunay syndrome.
RESULTS: The review was able to provide a contemporary guide/conclusion on the definition and
classification, clinical evaluation and clinical management regarding conservative (physical) therapy,
reconstructive surgical therapy and ablative/excisional surgical therapy, for the primary lymphoedema
as an LM.
CONCLUSIONS: Primary lymphoedema can be considered as 'congenital' since its majority
represents a clinical manifestation of the truncular type of LM arising during the later stages of
lymphangiogenesis. Such embryological staging information of the LM is critical for proper management
of the primary lymphoedema when it exists with other congenital vascular malformations (Klippel-
Trenaunay syndrome). 2. Basic non-invasive to minimally invasive tests will provide an adequate
diagnosis and lead to the correct multidisciplinary, specifically targeted and sequenced treatment
strategy. 3. The mainstay of current management of the primary lymphoedema/truncular LM is complex
decongestive therapy; and the reconstructive as well as ablative surgical therapy remain adjunctive
therapies at best.
PMID: 20176496 [PubMed - indexed for MEDLINE]
August 24, 2010 (2 docs)
Rev Med Chir Soc Med Nat Iasi. 2010 Apr-Jun;114(2):434-8.
[Advanced cervical cancer surgical treatment considerations][Article in Romanian]
Velenciuc N, Luncă S, Velenciuc I, Pantazescu A.
Universităţii de Medicină şi Farmacie Gr.T. Popa Iaşi, Spitalul Clinic de Urgenţe Sf. Ioan Iaşi.
Abstract
The aim of this study was to highlight the importance of surgical treatment in advanced cervical cancer
(IIB-IIIB). MATERIAL AND METHOD: Data from 179 patients with cervical cancer, admitted in
the Clinic of Emergency Surgery, "Sf. Ioan" Hospital, Iaşi, between January, 1st, 2003 and December,
31st, 2009, were collected. RESULTS: A number of 11 cases (6.1%) cases were without any clinical
response, so that they benefit by radical radiotherapy; a radical surgical intervention was performed in
the other 168 cases (93.7%), in 4-6 weeks after chemotherapy. No intraoperative complications were
evidenced, but after surgical intervention we recorded: urinary troubles--10 (6.5%); lymphedema--3
(1.9%); posttoperative intestinal occlusions--2 (1.3%); extended dynamic ileus--2 (1.3%); phlebitis--2
(1.3%).
PMID: 20700981 [PubMed - in process]
Urology. 2010 Aug;76(2 Suppl 1):S43-57.
Management of the lymph nodes in penile cancer.
Heyns CF, Fleshner N, Sangar V, Schlenker B, Yuvaraja TB, van Poppel H.
Department of Urology, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa.
cfh2@sun.ac.za
Abstract
A comprehensive literature study was conducted to evaluate the levels of evidence (LEs) in
publications on the diagnosis and staging of penile cancer. Recommendations from the available
evidence were formulated and discussed by the full panel of the International Consultation on Penile
Cancer in November 2008. The final grades of recommendation (GRs) were assigned according to the
LE of the relevant publications. The following consensus recommendations were accepted. Fine needle
aspiration cytology should be performed in all patients (with ultrasound guidance in those with
nonpalpable nodes). If the findings are positive, therapeutic, rather than diagnostic, inguinal lymph node
dissection (ILND) can be performed (GR B). Antibiotic treatment for 3-6 weeks before ILND in
patients with palpable inguinal nodes is not recommended (GR B). Abdominopelvic computed
tomography (CT) and magnetic resonance imaging (MRI) are not useful in patients with nonpalpable
nodes. However, they can be used in those with large, palpable inguinal nodes (GR B). The statistical
probability of inguinal micrometastases can be estimated using risk group stratification or a risk
calculation nomogram (GR B). Surveillance is recommended if the nomogram probability of positive
nodes is <0.1 (10%). Surveillance is also recommended if the primary lesion is grade 1, pTis, pTa
(verrucous carcinoma), or pT1, with no lymphovascular invasion, and clinically nonpalpable inguinal
nodes, but only provided the patient is willing to comply with regular follow-up (GR B). In the presence
of factors that impede reliable surveillance (obesity, previous inguinal surgery, or radiotherapy)
prophylactic ILND might be a preferable option (GR C). In the intermediate-risk group (nomogram
probability .1-.5 [10%-50%] or primary tumor grade 1-2, T1-T2, cN0, no lymphovascular invasion),
surveillance is acceptable, provided the patient is informed of the risks and is willing and able to
comply. If not, sentinel node biopsy (SNB) or limited (modified) ILND should be performed (GR B).
In the high-risk group (nomogram probability >.5 [50%] or primary tumor grade 2-3 or T2-T4 or cN1-
N2, or with lymphovascular invasion), bilateral ILND should be performed (GR B). ILND can be
performed at the same time as penectomy, instead of 2-6 weeks later (GR C). SNB based on the
anatomic position can be performed, provided the patient is willing to accept the potential false-
negative rate of </=25% (GR C). Dynamic SNB with lymphoscintigraphic and blue dye localization
can be performed if the technology and expertise are available (GR C). Limited ILND can be
performed instead of complete ILND to reduce the complication rate, although the false-negative rate
might be similar to that of anatomic SNB (GR C). Frozen section histologic examination can be used
during SNB or limited ILND. If the results are positive, complete ILND can be performed immediately
(GR C). In patients with cytologically or histologically proven inguinal metastases, complete ILND
should be performed ipsilaterally (GR B). In patients with histologically confirmed inguinal metastases
involving >/=2 nodes on one side, contralateral limited ILND with frozen section analysis can be
performed, with complete ILND if the frozen section analysis findings are positive (GR B). If clinically
suspicious inguinal metastases develop during surveillance, complete ILND should be performed on
that side only (GR B), and SNB or limited ILND with frozen section analysis on the contralateral side
can be considered (GR C). Endoscopic ILND requires additional study to determine the complication
and long-term survival rates (GR C). Pelvic lymph node dissection is recommended if >/=2 proven
inguinal metastases, grade 3 tumor in the lymph nodes, extranodal extension (ENE), or large (2-4 cm)
inguinal nodes are present, or if the femoral (Cloquet's) node is involved (GR C). Performing ILND
before pelvic lymph node dissection is preferable, because pelvic lymph node dissection can be
avoided in patients with minimal inguinal metastases, thus avoiding the greater risk of chronic
lymphedema (GR B). In patients with numerous or large inguinal metastases, CT or MRI should be
performed. If grossly enlarged iliac nodes are present, neoadjuvant chemotherapy should be given and
the response assessed before proceeding with pelvic lymph node dissection (GR C). Antibiotic
treatment should be started before surgery to minimize the risk of wound infection (GR C).
Perioperative low-dose heparin to prevent thromboembolic complications can be used, although it
might increase lymph leakage (GR C). The skin incision for ILND should be parallel to the inguinal
ligament, and sufficient subcutaneous tissue should be preserved to minimize the risk of skin flap
necrosis (GR B). Sartorius muscle transposition to cover the femoral vessels can be used in radical
ILND (GR C). Closed suction drainage can be used after ILND to prevent fluid accumulation and
wound breakdown (GR B). Early mobilization after ILND is recommended, unless a myocutaneous
flap has been used (GR B). Elastic stockings or sequential compression devices are advisable to
minimize the risk of lymphedema and thromboembolism (GR C). Radiotherapy to the inguinal areas is
not recommended in patients without cytologically or histologically proven metastases nor in those with
micrometastases, but it can be considered for bulky metastases as neoadjuvant therapy to surgery (GR
B). Adjuvant radiotherapy after complete ILND can be considered in patients with multiple or large
inguinal metastases or ENE (GR C). Adjuvant chemotherapy after complete ILND can be used instead
of radiotherapy in patients with >/=2 inguinal metastases, large nodes, ENE, or pelvic metastases (GR
C). Follow-up should be individualized according to the histopathologic features and the management
chosen for the primary tumor and inguinal nodes (GR B).
PMID: 20691885 [PubMed - in process]
August 27, 2010 (2 docs)
Am J Ther. 2010 Aug 19. [Epub ahead of print]
Recurrent Lower Extremity Pseudocellulitis.
Korniyenko A, Lozada J, Ranade A, Sandhu G.
1Department of Internal Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College
of Physicians and Surgeons, New York, NY; and 2Department of Pathology, St. Luke's-Roosevelt
Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY.
Abstract
The term "Pseudocellulitis" can be used to describe an uncomplicated nonnecrotizing inflammation of
the dermis and hypodermis from a noninfectious etiology. Chemotherapeutic agents have been
associated with a variety of cutaneous reactions, including radiation recall dermatitis, hypersensitivity
reactions, and erysipeloid reactions. Gemcitabine (2,2-difluorodeoxycytidine) is currently being used
for treatment of a variety of solid malignancies, including carcinoma of the lung. The dermatitis involved
with gemcitabine is typically a radiation recall reaction whereby an inflammatory reaction occurs in the
area previously treated with radiotherapy. We describe here a case of Gemcitabine-induced
pseudocellulitis that was unrelated to radiation exposure and manifested in an area of lymphedema. The
pseudocellulitis in such cases could be related to the drug's pharmacokinetics and may last until the
drug is displaced from the subcutaneous tissue of the affected area. Antibiotics have no role in the
treatment, and diphenhydramine with nonsteroidal anti-inflammatories may be used for symptomatic
management.
PMID: 20724909 [PubMed - as supplied by publisher]
Clin Physiol Funct Imaging. 2010 Aug 16. [Epub ahead of print]
Lymphoedema of the lower extremities - background, pathophysiology and diagnostic considerations.
Jensen MR, Simonsen L, Karlsmark T, Bülow J.
Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of
Copenhagen, Copenhagen NV, Denmark.
Abstract
Summary Lymphoedema of the lower extremities is a chronic debilitating disease that is often
underdiagnosed. Early diagnosis and treatment is paramount in reducing the risk of progression and
complications. Lymphoedema has traditionally been defined as interstitial oedema and protein
accumulation because of a defect in the lymphatic drainage; however, some findings suggest that the
interstitial protein concentration may be low in some types of lymphoedema. Primary lymphoedema is
caused by an inherent defect in the lymphatic vessels or lymph nodes. Secondary lymphoedema is
caused by damages to the lymphatic system most often caused by cancer or its treatment. Many of the
underlying pathophysiological mechanisms have yet to be elucidated. Many methods have been
developed for examination of the lymphatic system. Lymphoscintigraphy is presently the preferred
diagnostic modality. Lack of consensus regarding protocol and qualitative interpretation criteria results
in a too observer dependent outcome. Methods for objectifying the scintigraphy through quantification
have been criticized. Depot clearance rates are an alternative method of quantification of lymphatic
drainage capacity. This method however has mostly been applied on upper extremity lymphoedema.
The aim of this review is to provide a literature-based overview of the aetiology and pathophysiology of
lower extremity lymphoedema and to summarize the current knowledge about lymphoscintigraphy and
depot clearance techniques. The abundance of factors influencing the outcome of the examination
stresses the need for consensus regarding examination protocols and interpretation. Further studies are
needed to improve diagnostic performance and understanding of pathophysiological mechanisms.
PMID: 20718809 [PubMed - as supplied by publisher]
September 1, 2010
Eur J Cancer. 2010 Aug 24. [Epub ahead of print]
Psychological consequences of lymphoedema associated with breast cancer: A prospective cohort
study.
Vassard D, Olsen MH, Zinckernagel L, Vibe-Petersen J, Dalton SO, Johansen C.
Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer
Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
Abstract
BACKGROUND: The aim of this prospective cohort study of women attending a rehabilitation course
at the Dallund Rehabilitation Centre was to explore the emotional and psychological aspects of living
with lymphoedema, expressed as psychological distress, poorer quality of life and poorer self-reported
health.
METHODS: Between November 2002 and January 2007 within the FOCARE study, self-completed
questionnaires were collected 3weeks before and 6 and 12months after the rehabilitation course to
elicit sociodemographic, physical and lifestyle information and responses to three psychometric tests.
The population consisted of 633 women, 125 with and 508 without verified lymphoedema (time since
surgery, 1month-5years). The population was reduced to 553 women at the first follow-up and 494 at
the second.
RESULTS: Multivariate analysis showed that, in comparison with women without lymphoedema, those
with lymphoedema had a 14% higher risk for scoring one level higher on the POMS-SF test, a 9%
higher probability of scoring one point lower on the quality of life scale and a 29% higher likelihood of
reporting poorer or bad health than women without lymphoedema. These findings were seen at all three
measurement times.
CONCLUSIONS: In this cohort of women with breast cancer, women with lymphoedema after
surgery for breast cancer had significantly worse overall emotional well-being and adjustment to life
compared to women without lymphoedema.
PMID: 20797846 [PubMed - as supplied by publisher]
Case Rep Oncol. 2010 Apr 30;3(2):148-153.
Epithelioid Angiosarcoma in a Patient with Klippel-Trénaunay-Weber Syndrome: An Unexpected
Response to Therapy.
Simas A, Matos C, Lopes da Silva R, Brotas V, Teófilo E, Albino JP.
Serviço de Medicina Interna 3, Hospital Santo António dos Capuchos.
Abstract
We present a rare case of Stewart-Treves syndrome characterized by a diffuse angiosarcoma of the
leg in a 22-year-old man with a history of chronic lymphedema due to Klippel-Trénaunay-Weber
syndrome. He underwent limb disarticulation and medical treatment with cycles of doxorubicin, oral
thalidomide and sunitinib with a very good response after 12 months of follow-up.
PMID: 20740188 [PubMed]PMCID: PMC2919991
Lancet. 2010 Aug 23. [Epub ahead of print]
Lymphatic filariasis and onchocerciasis.
Taylor MJ, Hoerauf A, Bockarie M.
Liverpool School of Tropical Medicine, Liverpool, UK.
Abstract
Lymphatic filariasis and onchocerciasis are parasitic helminth diseases that constitute a serious public
health issue in tropical regions. The filarial nematodes that cause these diseases are transmitted by
blood-feeding insects and produce chronic and long-term infection through suppression of host
immunity. Disease pathogenesis is linked to host inflammation invoked by the death of the parasite,
causing hydrocoele, lymphoedema, and elephantiasis in lymphatic filariasis, and skin disease and
blindness in onchocerciasis. Most filarial species that infect people co-exist in mutualistic symbiosis with
Wolbachia bacteria, which are essential for growth, development, and survival of their nematode hosts.
These endosymbionts contribute to inflammatory disease pathogenesis and are a target for doxycycline
therapy, which delivers macrofilaricidal activity, improves pathological outcomes, and is effective as
monotherapy. Drugs to treat filariasis include diethylcarbamazine, ivermectin, and albendazole, which
are used mostly in combination to reduce microfilariae in blood (lymphatic filariasis) and skin
(onchocerciasis). Global programmes for control and elimination have been developed to provide
sustained delivery of drugs to affected communities to interrupt transmission of disease and ultimately
eliminate this burden on public health.
PMID: 20739055 [PubMed - as supplied by publisher]
Pediatr Dermatol. 2010 Aug 4. [Epub ahead of print]
Congenital Lymphedema with Tuberous Sclerosis and Clinical Hirschsprung Disease.
Lucas M, Andrade Y.
St. Peter's University Hospital, New Brunswick, New Jersey, USA.
Abstract
Case of an 18-month-old child with congenital lymphedema subsequently diagnosed with tuberous
sclerosis and Hirschsprung disease.
PMID: 20738790 [PubMed - as supplied by publisher]
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 May;26(3):190-4.
[Diagnosis of peripheral lymph circulation disorders with contrast MR lymphangiography]
[Article in Chinese]
Liu NF, Lu Q, Jiang ZH, Wang CG, Zhou JG.
Department of Plastic Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200011, China. liuningfei@126.com
Abstract
OBJECTIVE: To evaluate anatomical and functional images of contrast MR lymphangiography in the
diagnosis of limb lymphatic circulation disorders.
METHODS: 30 patients with limb lymphedema were enrolled in the study. There were 27 patients of
primary lymphedema and 3 of secondary lymphedema. Contrast enhanced lymphangiography was
performed with 3.0 T MR Unit after intracutaneous injection of gadobenate dimelumine into the
interdigital webs of the dorsal foot and hand. The kinetics of enhanced lymph flow within the lymphatics
were calculated using the formula: Speed (cm) = total length of visualized lymph vessel (cm)/ inspection
time (minutes) and by comparing dynamic nodal enhancement and time-signal intensity curves between
edematous and contralateral limbs. Morphological abnormalities of the lymphatic system were also
evaluated.
RESULTS: Following injection of the contrast agent enhanced lymphatic channels were consistently
visualized in all clinical lymphedematous limbs and five contralateral limbs of unilateral lymphedema
cases. The speed of enhanced flow within the lymphatics of lymphedematous limbs ranged from 0.30
to 1.48 cm/min. The contrast enhancement in inguinal nodes of edematous limbs was significantly lower
than that of contralateral limbs (P < 0.01). Dynamic measurement of contrast enhancement showed a
remarkable lowering of peak time (P < 0.01) and peak enhancement (P < 0.01) and a delay in outflow
in inguinal nodes of affected limbs compared with that of control limbs. Post-contrast MR imaging also
depicted varied distribution patterns of lymphatics and abnormal lymph flow pathways within lymph
nodes in the limbs with lymphatic circulation disorders.
CONCLUSIONS: Contrast MR lymphangiography with gadobenate dimelumine was able to visualize
the precise anatomy of lymphatic vessels and lymph nodes in lymphedematous limbs. It also provided
comprehensive information about the functional status of lymph flow transportation in lymphatics and
lymph nodes.
PMID: 20737947 [PubMed - in process]
September 5, 2010
Dermatol Online J. 2010 Aug 15;16(8):14.
Elephantiasis nostras verrucosa on the abdomen of a Turkish female patient caused by morbid obesity.
Buyuktas D, Arslan E, Celik O, Tasan E, Demirkesen C, Gundogdu S.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical
School, University of Istanbul, Istanbul, Turkey. sadigundogdu@gmail.com.
Abstract
Elephantiasis Nostras Verrucosa is a rare disorder of an extremity or a body region, which is
associated with chronic lymphedema. There are 7 reported cases of abdominal elephantiasis in the
medical literature. Here we report a morbidly obese female patient with elephantiasis nostras verrucosa
on the abdominal wall.
PMID: 20804691 [PubMed - in process]
Health Qual Life Outcomes. 2010 Aug 31;8(1):92. [Epub ahead of print]
Upper-body morbidity following breast cancer treatment is common, may persist longer-term and
adversely influences quality of life.
Hayes SC, Rye S, Battistutta D, Disipio T, Newman B.
ABSTRACT:
BACKGROUND: Impairments in upper-body function (UBF) are common following breast cancer.
However, the relationship between arm morbidity and quality of life (QoL) remains unclear. This
investigation uses longitudinal data to describe UBF in a population-based sample of women with
breast cancer and examines its relationship with QoL.
METHODS: Australian women (n=287) with unilateral breast cancer were assessed at three-monthly
intervals, from six- to 18-months post-surgery (PS). Strength, endurance and flexibility were used to
assess objective UBF, while the Disability of the Arm, Shoulder and Hand questionnaire and the
Functional Assessment of Cancer Therapy-Breast questionnaire were used to assess self-reported
UBF and QoL, respectively.
RESULTS: Although mean UBF improved over time, up to 41% of women revealed declines in UBF
between six- and 18-months PS. Older age, lower socioeconomic position, treatment on the dominant
side, mastectomy, more extensive lymph node removal and having lymphoedema each increased odds
of declines in UBF by at least two-fold (p<0.05). Lower baseline and declines in perceived UBF
between six- and 18-months PS were each associated with poorer QoL at 18-months PS (p<0.05).
CONCLUSIONS: Significant upper-body morbidity is experienced by many following breast cancer
treatment, persisting longer term, and adversely influencing the QoL of breast cancer survivors.
PMID: 20804558 [PubMed - as supplied by publisher]
Br J Dermatol. 2010 Aug 28. [Epub ahead of print]
Severe Congenital Lymphedema Not Caused by Mutations in Known Lymphedema Genes.
Greenberger S, Reznik-Wolf H, Ghalamkarpour A, Marek-Yagel D, Vikkula M, Pras E.
Sheba Medical Center, The Department of Dermatology, Ramat-Gan, Israel.
PMID: 20804492 [PubMed - as supplied by publisher]
Am J Med Genet A. 2010 Sep;152A(9):2287-96.
Emberger syndrome-primary lymphedema with myelodysplasia: report of seven new cases.
Mansour S, Connell F, Steward C, Ostergaard P, Brice G, Smithson S, Lunt P, Jeffery S, Dokal I,
Vulliamy T, Gibson B, Hodgson S, Cottrell S, Kiely L, Tinworth L, Kalidas K, Mufti G, Cornish J,
Keenan R, Mortimer P, Murday V; Lymphoedema Research Consortium.
SW Thames Regional Genetics Service, St. George's, University of London, London, UK.
smansour@sgul.ac.uk
Abstract
Four reports have been published on an association between acute myeloid leukaemia (AML) and
primary lymphedema, with or without congenital deafness. We report seven new cases, including one
extended family, confirming this entity as a genetic syndrome. The lymphedema typically presents in one
or both lower limbs, before the hematological abnormalities, with onset between infancy and puberty
and frequently affecting the genitalia. The AML is often preceded by pancytopenia or myelodysplasia
with a high incidence of monosomy 7 in the bone marrow (five propositi and two relatives). Associated
anomalies included hypotelorism, epicanthic folds, long tapering fingers and/or neck webbing (four
patients), recurrent cellulitis in the affected limb (four patients), generalized warts (two patients), and
congenital, high frequency sensorineural deafness (one patient). Children with lower limb and genital
lymphedema should be screened for hematological abnormalities and immunodeficiency.
PMID: 20803646 [PubMed - in process]
Med Sci Monit. 2010 Aug 7;16(9):BR313-319.
Evaluation of lymphatic function by means of dynamic Gd-BOPTA-enhanced MRL in experimental
rabbit limb lymphedema.
Jiang Z, Lu Q, Kretlow JD, Hu X, Zhou G, Liu N.
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao
Tong University School of Medicine, Shanghai, China.
Abstract
Background: The aim of this study was to investigate the value and technical methods of 3D dynamic
contrast-enhanced magnetic resonance lymphangiography (MRL) in the assessment of lymphatic
anatomy and function in the presence of extremity lymphedema.
Material/Methods: An improved experimental model of obstructive lymphedema was established in 1
hind limb of 6 New Zealand White rabbits. 3D contrast-enhanced MRL was performed with a 3.0-T
MR unit after the intracutaneous injection of Gd-BOPTA into the interdigital webs of the dorsal paws.
Maximum-intensity projection (MIP) was used to reconstruct the images of the lymphatic system. The
dynamic nodal enhancement in the popliteal fossa and time-signal intensity curves between
lymphedematous and contralateral limbs were compared. Morphologic abnormalities of the lymphatic
system were also evaluated and compared with lymphoscintigraphy (LSG).
Results: 3D dynamic contrast-enhanced MRL images were obtained after the administration of Gd-
BOPTA. In the normal limb, the popliteal fossa lymph nodes and their afferent and efferent lymph-
collecting vessels were clearly visualized as the Gd tracer was rapidly cleared from the interstitial
compartment. In contrast, the Gd tracer accumulated slowly at the prior surgical site in the
lymphedematous limb. The nodal enhancement of lymphedematous limbs was significantly less than that
of the contralateral limbs (P<0.01). Types of time-signal intensity curves were also significantly different
between the 2 groups (P<0.001).
Conclusions: 3D dynamic contrast-enhanced MRL can visualize the precise anatomy of lymphatic
vessels and lymph nodes in extremity lymphedema, as well as objectively evaluate the functional status
of lymph flow transport.
PMID: 20802408 [PubMed - in process]
J Vasc Surg. 2010 Aug 25. [Epub ahead of print]
Lymphatic malformation is a common component of Klippel-Trenaunay syndrome.
Liu NF, Lu Q, Yan ZX.
Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong
University School of Medicine, Shanghai, China.
Abstract
OBJECTIVES: Few previous studies have focused on the involvement of the lymphatic system in
Klippel-Trenaunay syndrome (KTS), although some evidence suggests that lymphatic abnormalities are
associated with the disease. The aim of the present study was to investigate the involvement of the
lymphatic system in KTS.
METHODS: Magnetic resonance lymphangiography (MRL) with the use of gadobenate dimeglumine
as the contrast was performed on 32 patients with KTS involving the extremities to evaluate lymphatic
vessels, lymph nodes, and veins.
RESULTS: Thirty-one of 32 patients exhibited lymphatic vessel and/or lymph node anomalies,
including hyperplasia (11/31), hypoplasia or aplasia (20/31) of lymphatic vessels, and lymphedema
(31/31) of the affected limbs. Twenty-two patients showed asymmetry of the inguinal nodes exhibiting
either the absence, or an increase or a decrease in number and size of the inguinal nodes. Venous
dysplasia was found in 31 patients in superficial and/or deep veins. The results showed a high
concomitance of malformations of the lymphatic system and veins in the affected limbs of patients with
KTS.
CONCLUSIONS: Lymphatic system abnormalities as examined with MRL are commonly associated
with KTS and are likely to play a significant role in the disorder.
PMID: 20800418 [PubMed - as supplied by publisher]
September 8, 2010
Orbit. 2010 Aug;29(4):222-6.
Chronic lymphedema of the eyelid: case series.
Chalasani R, McNab A.
Ophthalmology Registrar, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
Abstract
Purpose: To evaluate the clinical features, management and outcomes of treatment of chronic
lymphedema of the eyelid in a tertiary referral setting.
Design: Retrospective case series. Participants: 15 patients referred to the authors with unilateral or
bilateral eyelid swelling of greater than 3 months duration.
Main Outcome Measures: Clinical features, patient management, response to treatment.
Results: Chronic eyelid lymphedema was associated with acne rosacea in 9 patients, radiotherapy in 1
patient, trauma in 1 patient and post-vitrectomy silicone oil leak in 1 patient. In the remaining 4 patients
no associated condition or factor was identified. Surgical debulking was performed in 9 cases with
improvement in all cases and no complications.
Conclusion: Chronic eyelid lymphedema is a rare condition most commonly associated with rosacea. In
our experience, surgical resection of involved subcutaneous tissue was helpful.
PMID: 20812843 [PubMed - in process]
Plast Reconstr Surg. 2010 Sep;126(3):1118-9.
Breast reconstruction and lymphedema.
Khan MA, Srinivasan K, Mohan A, Hardwicke J, Rayatt S.
University Hospital of North Staffordshire NHS Trust; Stoke-on-Trent, Staffordshire, United Kingdom.
PMID: 20811251 [PubMed - in process]
Plast Reconstr Surg. 2010 Sep;126(3):759-61.
Discussion: lymphaticovenular bypass for lymphedema management in breast cancer patients: a
prospective study.
Cheng J.
Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical
Center.
PMID: 20811211 [PubMed - in process]
Plast Reconstr Surg. 2010 Sep;126(3):752-8.
Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study.
Chang DW.
Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer
Center.
Abstract
BACKGROUND: Lymphedema is a common and debilitating condition. Management options for
lymphedema are limited and controversial. The purpose of this prospective study was to provide a
preliminary analysis of lymphaticovenular bypass for the treatment of upper limb lymphedema in breast
cancer patients.
METHODS: Twenty patients with upper extremity lymphedema secondary to treatment of breast
cancer underwent lymphaticovenular bypass using a "supermicrosurgical" approach. The mean age of
the patients was 54 years, 16 patients had received preoperative radiation therapy, and all patients had
received axillary lymph node dissection. The mean duration of lymphedema was 4.8 years, and the
mean volume differential of the lymphedematous arm compared with the unaffected arm was 34
percent. Evaluation included qualitative assessment and quantitative volumetric analysis before surgery
and at 1 month, 3 months, 6 months, and 1 year after the procedure.
RESULTS: The mean number of bypasses performed per patient was 3.5 (range, two to five), and the
size of bypasses ranged from 0.3 to 0.8 mm. The mean operative time was 3.3 hours (range, 2 to 5
hours). Hospital stay was less than 24 hours for all patients. The mean follow-up time was 18 months.
Nineteen patients (95 percent) reported symptom improvement following surgery, and 13 patients had
quantitative improvement. The mean volume differential reduction was 29 percent at 1 month, 36
percent at 3 months, 39 percent at 6 months, and 35 percent at 1 year. No patients experienced
postoperative complications or lymphedema exacerbation.
CONCLUSIONS: Lymphaticovenular bypass may effectively reduce the severity of lymphedema in
breast cancer patients. Long-term analysis is needed.
PMID: 20811210 [PubMed - in process]
Biol Trace Elem Res. 2010 Sep 1. [Epub ahead of print]
Titanium, Sinusitis, and the Yellow Nail Syndrome.
Berglund F, Carlmark B.
, Solvägen 8 A, SE 192 66, Sollentuna, Sweden, fred.berglund@swipnet.se.
Abstract
Yellow nail syndrome is characterized by nail changes, respiratory disorders, and lymphedema. In a
yellow nail patient with a skeletal titanium implant and with gold in her teeth, we found high levels of
titanium in nail clippings. This study aims to examine the possible role of titanium in the genesis of the
yellow nail syndrome. Nail clippings from patients with one or more features of the yellow nail
syndrome were analyzed by energy dispersive X-ray fluorescence. Titanium was regularly found in
finger nails in patients but not in control subjects. Visible nail changes were present in only half of the
patients. Sinusitis with postnasal drip and cough was the most common complaint. The dominant
source of titanium ions was titanium implants in the teeth or elsewhere. The titanium ions were released
through the galvanic action of dental gold or amalgam or through the oxidative action of fluorides. In
other patients the titanium was derived from titanium dioxide in drugs and confectionary. Stopping
galvanic release of titanium ions or canceling exposure to titanium dioxide led to recovery. In one
patient with a titanium implant, the symptoms recurred after renewed exposure to titanium. Yellow nail
syndrome is caused by titanium.
PMID: 20809268 [PubMed - as supplied by publisher]
Physiother Can. 2009 Fall;61(4):244-51. Epub 2009 Nov 12.
Effect of acute exercise on upper-limb volume in breast cancer survivors: a pilot study.
McNeely ML, Campbell KL, Courneya KS, Mackey JR.
Margaret L. McNeely, PhD: Physical Therapy Department, University of Alberta, and Cross Cancer
Institute, Edmonton, Alberta.
Abstract
Purpose: Strenuous upper-extremity activity and/or exercise have traditionally been prescribed for
breast cancer survivors with or at risk of developing lymphedema. The purpose of this study was to
assess the effect of an acute bout of exercise on upper-limb volume and symptoms in breast cancer
survivors, with the intent to provide pilot data to guide a subsequent larger study.
Methods: Twenty-three women who regularly participated in dragon-boat racing took part in the study.
A single exercise bout was performed at a moderate intensity (rating of perceived exertion: 13-14) for
20 continuous minutes on an arm ergometer. The difference between affected and unaffected limb
volume was assessed pre- and post-exercise via measurements of limb circumference at five time
points.
Results: Although limb volume increased following exercise in both limbs, the difference between the
limbs remained stable at each measurement point. Only one participant was found to have an increase
in arm-volume difference of >100 ml post intervention, and only four participants reported symptoms
of tension and/or heaviness in the affected limb.
Conclusion: The results suggest that limb volume in breast cancer survivors increases after an acute
bout of upper-limb exercise but that, for the majority of women, the response is not different between
affected and unaffected limbs. Future research using a larger sample and more sensitive measurement
methods are recommended.
PMID: 20808486 [PubMed - in process]
Pediatr Dermatol. 2010 Aug 26. [Epub ahead of print]
Congenital Yellow Nail Syndrome: A Case Report and Its Relationship to Nonimmune Fetal Hydrops.
Nanda A, Al-Essa FH, El-Shafei WM, Alsaleh QA.
As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait.
Abstract
Yellow nail syndrome (YNS) is an uncommon disorder characterized by a triad of nail dystrophy,
lymphedema, and pleural effusion. It is rare in children and congenital occurrence of YNS has been
very rarely described. We report a 2-year-old Arab boy having congenital yellow nail syndrome with
mild facial dysmorphism and bilateral conjunctival pigmentation born to consanguineous parents. One
of his older siblings had died of nonimmune fetal hydrops (NIFH). The case supports the genetic basis
of yellow nail syndrome with a possible relationship to nonimmune fetal hydrops.
PMID: 20807364 [PubMed - as supplied by publisher]
These are the current Pub Med list you sent me, not a backlogged one Tina, so I used today’s date for
it per my note above:
September 17, 2010
Breast Cancer Res. 2010 Sep 8;12(5):R70. [Epub ahead of print]
Experimental assessment of pro-lymphangiogenic growth factors in the treatment of post-surgical
lymphedema following lymphadenectomy.
Baker A, Kim H, Semple JL, Dumont D, Shoichet M, Tobbia D, Johnston M.
ABSTRACT:
INTRODUCTION: Lymphedema is a frequent consequence of lymph node excision during breast
cancer surgery. Current treatment options are limited mainly to external compression therapies to limit
edema development. We investigated previously, post-surgical lymphedema in a sheep model following
the removal of a single lymph node and determined that autologous lymph node transplantation has the
potential to reduce or prevent edema development. In this report, we examine the potential of
lymphangiogenic therapy to restore lymphatic function and reduce post-surgical lymphedema.
METHODS: Lymphangiogenic growth factors (vascular endothelial growth factor-C (VEGF-C) and
angiopoitein-2 (ANG-2)) were loaded into a gel-based drug delivery system (HAMC; a blend of
hyaluronan and methylcellulose). Drug release rates and lymphangiogenic signaling in target endothelial
cells were assessed in vitro and vascular permeability biocompatibility tests were examined in vivo.
Following, the removal of a single popliteal lymph node, HAMC with the growth factors was injected
into the excision site. Six weeks later, lymphatic functionality was assessed by injecting 125Iodoine
radiolabelled bovine serum albumin (125I-BSA) into prenodal vessels and measuring its recovery in
plasma. Circumferential leg measurements were plotted over time and areas under the curves used to
quantify edema formation.
RESULTS: The growth factors were released over a two-week period in vitro by diffusion from
HAMC, with 50% being released in the first 24 hours. The system induced lymphangiogenic signaling
in target endothelial cells, while inducing only a minimal inflammatory response in sheep. Removal of the
node significantly reduced lymphatic functionality (Nodectomy 1.9 +/- 0.9, HAMC alone 1.7 +/- 0.8)
compared with intact groups (3.2 +/- 0.7). There was no significant difference between the growth
factor treatment group (2.3 +/- 0.73) and the intact group. An increase in the number of regenerated
lymphatic vessels at treatment sites was observed with fluoroscopy. Groups receiving HAMC plus
growth factors displayed significantly reduced edema (107.4 +/- 51.3) compared with non-treated
groups (nodectomy 219.8 +/- 118.7, and HAMC alone 162.6 +/- 141).
CONCLUSIONS: Growth factor therapy has the potential to increase lymphatic function and reduce
edema magnitude in an animal model of lymphedema. The application of this concept to lymphedema
patients warrants further examination.
PMID: 20825671 [PubMed - as supplied by publisher]
Med Oncol. 2010 Sep 9. [Epub ahead of print]
Whether drainage should be used after surgery for breast cancer? A systematic review of randomized
controlled trials.
He XD, Guo ZH, Tian JH, Yang KH, Xie XD.
Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199
Donggang West Road, Lanzhou, Gansu, 730000, China, hxdls58@163.com.
Abstract
A systematic review of randomized controlled trials (RCTs) was conducted to evaluate whether
patients benefit from the suction drainage after axillary lymph node dissection (ALND) in breast cancer
surgery. RCTs of drainage versus no drainage after ALND in women with breast cancer were
retrieved from PubMed, EMBASE, Cochrane Library and Chinese Biomedical database. Two authors
independently assessed the quality of included trials and extracted data. Odds ratio (OR) for
dichotomous outcomes and mean difference (MD) for continuous outcomes were presented with 95%
confidence intervals (CI). A total of 1115 titles were indentified from the databases; 1109 obvious
irrelevant studies were excluded by examining the titles, abstracts, full texts because of duplicates, no
RCT, different modality of drainage, drain for lymphedema, application of fibrin sealant and so on. And
then, only 6 RCTs to compare drainage with no drainage after ALND in breast cancer surgery were
included in the systematic review and a total of 585 patients were included in the pathological diagnosis
of breast cancer in women before surgery, management by ALND with or without addition surgical
procedures. The study demonstrated that insertion of a drain in the axilla after breast cancer surgery
resulted in a statistically significant reduction in the rate of seroma (OR = 0.36, 95% CI, 0.16 to 0.81,
P = 0.01), the volume of aspiration (MD = -100.10, 95% CI, -174.36 to -25.85, P = 0.008), or the
frequency of seroma aspiration (MD = -1.03, 95% CI, -1.35 to -0.71, P < 0.00001), but prolonged
the length of hospital stay (MD = 1.52, 95% CI, 0.36 to 2.68, P = 0.01). There was no statistically
significant difference in the incidence of wound infection (OR = 0.67, 95% CI, 0.34 to 1.32, P = 0.25)
between drainage group and no drainage group. Based on the current evidence, insertion of a drain in
the axilla following ALND in breast cancer surgery effectively decreased seroma formation, volume of
aspiration as well as the frequency of seroma aspiration without increasing the incidence of wound
infection, but extending their stay in hospital.
PMID: 20827578 [PubMed - as supplied by publisher]
Am J Hum Genet. 2010 Sep 10;87(3):436-44.
Protein tyrosine phosphatase PTPN14 is a regulator of lymphatic function and choanal development in
humans.
Au AC, Hernandez PA, Lieber E, Nadroo AM, Shen YM, Kelley KA, Gelb BD, Diaz GA.
Department of Genetics & Genomic Sciences, Mount Sinai School of Medicine, New York, NY
10029, USA.
Abstract
The lymphatic vasculature is essential for the recirculation of extracellular fluid, fat absorption, and
immune function and as a route of tumor metastasis. The dissection of molecular mechanisms underlying
lymphangiogenesis has been accelerated by the identification of tissue-specific lymphatic endothelial
markers and the study of congenital lymphedema syndromes. We report the results of genetic analyses
of a kindred inheriting a unique autosomal-recessive lymphedema-choanal atresia syndrome. These
studies establish linkage of the trait to chromosome 1q32-q41 and identify a loss-of-function mutation
in PTPN14, which encodes a nonreceptor tyrosine phosphatase. The causal role of PTPN14
deficiency was confirmed by the generation of a murine Ptpn14 gene trap model that manifested
lymphatic hyperplasia with lymphedema. Biochemical studies revealed a potential interaction between
PTPN14 and the vascular endothelial growth factor receptor 3 (VEGFR3), a receptor tyrosine kinase
essential for lymphangiogenesis. These results suggest a unique and conserved role for PTPN14 in the
regulation of lymphatic development in mammals and a nonconserved role in choanal development in
humans.
PMID: 20826270 [PubMed - in process]
Duodecim. 2010;126(15):1827-30.
[Mystery of the swollen leg]
[Article in Finnish]
Sundell J.
TYKS, Raision sairaala, sisätautien klinikka PL 43, 21201 Raisio.
Abstract
This case report demonstrates a 90-year-old female patient who had an amelanotic subungual
melanoma of the right hallux. As usual non healing ulcer of the nail bed was initially misdiagnosed.
Finally melanoma spread to the groin lymph nodes and induced lymphedema of the leg leading to the
right diagnosis. Acral lesion requires early biopsy if any clinical uncertainty exists.
PMID: 20824972 [PubMed - in process]
September 17, 2010 - this will be the date of the email to me FYI
June 2010 - Clinics (Sao Paulo). 2010 Jun;65(8):781-7.
Comparison of quality of life, satisfaction with surgery and shoulder-arm morbidity in breast cancer
survivors submitted to breast-conserving therapy or mastectomy followed by immediate breast
reconstruction.
Freitas-Silva R, Conde DM, Freitas-Júnior R, Martinez EZ.
Department of Gynecology and Obstetrics, Universidade Federal de Goiás, Goiânia, GO, Brasil.
Abstract
OBJECTIVES: This study was designed to compare the prevalence of shoulder-arm morbidity, patient
satisfaction with surgery and the quality of life of women submitted to breast-conserving therapy or
modified radical mastectomy and immediate breast reconstruction .
METHODS: This study was a cross-sectional study of women who underwent breast-conserving
therapy (n=44) or modified radical mastectomy and immediate breast reconstruction (n=26). Quality of
life was evaluated with the SF-36 Health Survey Questionnaire.
RESULTS: No differences were found in the prevalence of lymphedema. The movements that were
most commonly affected by these procedures were abduction, flexion and external rotation. When the
two groups were compared, however, we only found a statistically significant difference for the
prevalence of restricted internal rotation, which occurred in 32% of women in the breast-conserving
therapy group and 12% of those in the modified radical mastectomy and immediate breast
reconstruction group (OR: 7.23; p=0.03 following adjustment for potential confounding factors). No
difference in quality of life or satisfaction with surgery was found between the two groups.
CONCLUSIONS: These data suggest that the type of surgery did not affect the occurrence of
lymphedema. Breast-conserving therapy, however, increased the risk of shoulder movement limitation.
No differences were found between the two surgical techniques with respect to quality of life or
satisfaction with surgery.
PMID: 20835555 [PubMed - in process]
September 7, 2010 - Orthopedics. 2010 Sep 7;33(9). doi: 10.3928/01477447-20100722-35.
Wound healing in total joint arthroplasty.
Jones RE.
Abstract
Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing
problems can occur and the consequences can be devastating. Determination of the host healing
capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no
healing compromises; and type B, systemic or local healing compromising factors present. Local
factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor
vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver
disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon
should encourage positive choices such as smoking cessation and nutritional supplementation to elevate
the total lymphocyte count and total albumin.Careful planning of incisions, particularly in patients with
scarring or multiple previous operations, is productive. Around the knee the vascular viability is better
in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle
tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet
to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound
problems.If wound drainage or healing problems occur, immediate action is required. Deep sepsis can
be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative
culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be
managed by debridement to obtain a live wound.
PMID: 20839686 [PubMed - in process]
September 13, 2010 - Stem Cells Dev. 2010 Sep 13. [Epub ahead of print]
Cellular trans/-differentiation and morphogenesis towards the lymphatic lineage in regenerative medicine.
Laco F, Grant MH, Flint D, Black RA.
Universtity of Strathclyde, Bioengineering, Glasgow, United Kingdom; filiplaco@googlemail.com.
Abstract
Lymphoedema is a medically irresolvable condition. The lack of therapies addressing lymphatic vessel
dysfunction suggests that improved understanding of lymphatic cell differentiation and vessel maturation
processes is key to the development of novel, regenerative medicine and tissue engineering
approaches. In this review we provide an overview of lymphatic characterisation markers and
morphology in development. Furthermore, we describe multiple differentiation processes of the
lymphatic system during embryonic, post-natal and pathogenic development. Using the example of
pathogenic Kaposi Sarcoma-associated Herpes infection we illustrate the involvement of the Notch
and PI3K pathways for lymphatic trans-differentiation. We also discuss the plasticity of certain cell
types and bio-factors which enable trans-differentiation towards the lymphatic lineage. Here we argue
the importance of pathway-associated induction factors for lymphatic trans-differentiation including
growth factors such as VEGF-C and interleukins, and the involvement of extracellular matrix
characteristics and dynamics for morphological functionality.
PMID: 20836656 [PubMed - as supplied by publisher]
September 28, 2010
Presse Med. 2010 Sep 20. [Epub ahead of print]
[Lymphoscintigraphic exploration in the limbs lymphatic disease.]
[Article in French]
Baulieu F, Lorette G, Baulieu JL, Vaillant L.
CHRU de Tours, université François-Rabelais de Tours, médecine nucléaire, 37044 Tours cedex,
France.
Abstract
Lymphoscintigraphy is based upon the physiological transport of small radioactive particles injected
into interstitium toward lymphatic vessels and nodes. Lymphoscintigraphy directly investigates
lymphatic system while other methods (ultrasounds, CT, MRI) investigate tissular consequences of
lymphatic disease. The scintigraphic procedure has to be standardized in order to be reproducible.
Lymphatic vessels, lymphatic nodes and interstitium are systematically analysed. Interpretation is visual
and qualitative. Multiple abnormalities can be observed. However, none of them can consistently
differentiate between primary and secondary lymphedema. Differential diagnosis is usually obtained by
taking together clinical and lymphoscintigraphic data. By providing informations about lymphatic
component and physiopathology of edema, lymphoscintigraphy contributes to the management of
lymphedema. Hybrid imaging is a new imaging modality of edema. Recently used, it combines
functional (scintigraphy) and anatomical (CT) data and seems to be able to provide further informations.
PMID: 20863652 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2010 Sep;8(3):175-9.
Lymphangiosarcoma complicating extensive congenital mixed vascular malformations.
Al Dhaybi R, Agoumi M, Powell J, Dubois J, Kokta V.
Division of Dermatology, CHU Sainte Justine, University of Montreal, Montreal, Quebec, Canada.
roladhaybi@yahoo.com
Abstract
Pediatric hepatic angiosarcoma is a very rare malignant vascular tumor. A few cases have shown
pediatric hepatic angiosarcoma occurring on a background of preexisting vascular lesions. We report
the case of a newborn girl who presented extensive limbs and upper trunk cutaneous mixed vascular
malformations at birth. These malformations were associated with thrombocytopenia. Cutaneous
biopsies revealed complex vascular malformations with a significant lymphatic component.
Compressive body suit therapy led to regression of the limbs' cutaneous vascular malformations. At the
age of 9 months, the patient presented multiple heterogeneous hepatosplenic nodules. Aggressive
treatment with prednisone, vincristine, and hepatosplenic embolizations resulted in initial improvement
of the hepatosplenic lesions for few months, followed by an increase of the lesions with failure of
response to treatment despite adding alpha-interferon-2b to treatment. The patient died at the age of
19 months. The autopsy's pathological examination revealed a hepatic-based angiosarcoma with
plurimetastatic dissemination to the spleen, lungs, peritoneum, pleura, mesenteric linings as well as the
serosa of the stomach and small intestine. Multiple cutaneous and visceral complex capillaro-
lymphatico-venous malformations were also identified. We hypothesize that these multiple extensive
mixed vascular malformations were associated with chronic lymphedema which probably predisposed
to the development of the angiosarcoma in our patient.
PMID: 20863270 [PubMed - in process]
Hu Li Za Zhi. 2010 Apr;57(2 Suppl):S99-103.
[Providing care to an elephant leg patient: a nurse's experience]
[Article in Chinese]
Chen TH, Wang CY, Chang ML.
General Surgery, Department of Nursing, Taipei Medical University-Wan Fang Hospital, Taipei
Medical University.
Abstract
This article reports on the experience of nurses who provided nursing care to a woman who had
recently immigrated to Taiwan from Mainland China. The woman suffered from chronic lymphedema,
and had previously received surgical treatment for the condition. The period of nursing care ran from
June 10th through September 9th, 2008. Nursing care experience focused on the two care issues of
anxiety and health seeking behavior. During the nursing process, we expressed empathy, encouraged
the patient to express her feelings, and provided disease-related information. We successfully resolved
the patient's anxiety problem. The patient learned to use distraction to help relieve pain. The patient
also participated in a rehabilitation program to improve her blood circulation. We tracked the patient's
rehabilitation progress through e-mail correspondence. We hope that this complete nursing experience
can serve as reference in caring for patients facing similar problems in the future.
PMID: 20405406 [PubMed - in process]
October 2, 2010
Microsurgery. 2010 Sep;30(6):437-42.
Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis.
Maegawa J, Mikami T, Yamamoto Y, Satake T, Kobayashi S.
Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama
City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Abstract
Several authors have reported the usefulness and benefits of lymphoscintigraphy. However, it is
insufficient to indicate microvascular treatment based on lymphedema. Here, we present the
relationships between lymphoscintigraphic types and indications for lymphatic microsurgery.
Preoperative lymphoscintigraphy was performed in 142 limbs with secondary lymphedema of the lower
extremity. The images obtained were classified into five types. Type I: Visible inguinal lymph nodes,
lymphatics along the saphenous vein and/or collateral lymphatics. Type II: Dermal backflow in the thigh
and stasis of an isotopic material in the lymphatics. Type III: Dermal backflow in the thigh and leg.
Type IV: Dermal backflow in the leg. Type V: Radiolabeled colloid remaining in the foot.
Lymphaticovenous anastomosis was performed in 35 limbs. The average number of anastomoses per
limb was 3.3 in type II, 4.4 in type III, 3.6 in type IV, and 3 in type V. The highest number of
anastomosis was performed in type III. In conclusion, type III is suggested to be the best indication for
anastomosis compared with types IV and V. © 2010 Wiley-Liss, Inc. Microsurgery 30:437-442,
2010.
PMID: 20878726 [PubMed - in process]
Med Klin (Munich). 2010 Sep;105(9):619-26. Epub 2010 Sep 28.
[Alternative sonographic diagnoses in patients with clinical suspicion of deep vein thrombosis.]
[Article in German]
Taute BM, Melnyk H, Podhaisky H.
Universitätsklinik und Poliklinik für Innere Medizin III, Schwerpunkt Angiologie, Universitätsklinikum
der Martin-Luther-Universität Halle-Wittenberg, Halle-Wittenberg, Germany, bettina.taute@medizin.
uni-halle.de.
Abstract
BACKGROUND AND PURPOSE: : Unclear extremity complaints are common symptoms of
inpatients. In a subset of these patients, a clinical suspicion of deep vein thrombosis (DVT) results; this
needs to be quickly and definitively clarified by a vascular physician. The question arose of how often a
clinical suspicion of DVT was confirmed in an inpatient population and which alternative diagnoses
were able to be made by angiologists.
PATIENTS AND METHODS: : In a retrospective analysis, all inpatients in the Angiologic Vascular
Diagnostics Center of the University Hospital Halle, Germany, examined in 2007 for a suspicion of
DVT were evaluated with respect to the definitively made diagnosis.
RESULTS: : In 213 (28.6%) of 745 suspected cases of DVT, a DVT was confirmed. In 532 patients
(71.4%), DVT was excluded. In 314 of these patients, 436 alternative diagnoses were recorded in the
diagnostic reports of angiologic examinations. In 38.6% (n = 168), other venous causes could be
confirmed as the most common alternative diagnosis. There were chronic venous diseases in 28% (n =
122), superficial thrombophlebitis (n = 27), and tumor-related pelvic vein compression (n = 19).
17.4% (n = 76) exhibited lymphedema. In 13.3% (n = 58), a generalized edema was diagnosed.
Arthrogenic causes followed with 12.8% (n = 56). Lipedema (5.3%) and hematoma (5%) could be
verified as other important differential diagnoses. Rare causes were symptomatic or ruptured Baker's
cysts (2.5%), erysipelas (2.5%), abscess, aneurysm, muscle tears, and tumors.
CONCLUSION: : The variety of alternative diagnoses in patients with clinical suspicion of DVT is
high. The knowledge and systematic examination of potential, even rare differential diagnoses after
exclusion of DVT are part of the repertoire of the vascular physician. Unnecessary and expensive, as
well as onerous, diagnostic procedures on the patient can be avoided. Anticoagulation that was begun
as a result of the suspicion of DVT can quickly be stopped.
PMID: 20878299 [PubMed - in process]
An Pediatr (Barc). 2010 Sep 24. [Epub ahead of print]
[Early primary lymphoedema. A condition to remember.]
[Article in Spanish]
Carreira Sande N, Rodríguez Blanco MA, Martín Morales JM, González Alonso N, Dosil Gallardo S,
Cea Pereiro C.
Servicio de Pediatría, Hospital da Barbanza, Ribeira, A Coruña, España.
PMID: 20870471 [PubMed - as supplied by publisher]
Tina, the next two look duplicates to me, though the first came in a doc with 3 others and the second in
a doc all by itself. But I put them both here just in case I missed something that wasn’t duplicate
Hautarzt. 2010 Sep 26. [Epub ahead of print]
[Fatter through lipids or water : Lipohyperplasia dolorosa versus lymphedema.]
[Article in German]
Cornely ME.
Praxis Prof. Hon. (Univ. Puebla) Dr. med. Manuel E. Cornely, Kaiserswerther Str. 296, 40474,
Düsseldorf, Deutschland, post@hautarzt-duesseldorf.de.
Abstract
Lipohyperplasia dolorosa and lymphedema are completely different disease entities, which are both,
however, classified under lymphology. While in lipohyperplasia dolorosa a congenital lipid distribution
disorder leads to a high volume insufficiency and the corresponding clinical symptoms, lymphedema is
characterized by a congenital transport incompetence of the vessels or acquired disorders of transport
capacity. Both lymphedemas of different genesis are familial volume alterations of the affected regions
and the increase in volume is irreversible if not exclusively still in stage I or II. According to current
knowledge the solid increase in volume by lymphedema is due to a malfunctioning biomechanism by
which the release of additional proteoglycans in the homeostasis system of the fluid in the interstital
space plays an important role. Removal of this tissue and the sponge-like substance of proteoglycans is
the aim of therapeutic approaches. Manual lymph drainage and compression can evacuate the sponge
but not remove it. Lymphological liposculpture is a successful dermatosurgical measure even for
secondary lymphedema. Reduction of the necessity of complex hemostasis therapy to 20% of the initial
value and an adjustment of the affected extremity on the healthy side, represent a clear improvement in
quality of life of patients. The same dermatosurgical method, lymphological liposculpture, has been
known for many years to fulfil the successfully proven purpose for the treatment of lipohyperplasia
dolorosa by the removal of subcutaneous fatty tissue, present as hyperplasia and not hypertrophy.
Tenderness and the necessity for complex hemostasis therapy are no longer present or no longer
necessary after lymphological liposculpture for lipohyperplasia dolorosa. This condition is permanent
because the congenital fatty masses do not reoccur following surgical removal. Lipohyperplasia
dolorosa is therefore curable by lymphological liposculpture. For secondary lymphedema a drastic
improvement in quality of life of the patient can be achieved by this method which is demonstrated by
the adjustment of symmetry of the extremities and reduction or even avoidance of complex hemostasis
therapy.
PMID: 20871969 [PubMed - as supplied by publisher]
Hautarzt. 2010 Sep 26. [Epub ahead of print]
[Fatter through lipids or water : Lipohyperplasia dolorosa versus lymphedema.]
[Article in German]
Cornely ME.
Praxis Prof. Hon. (Univ. Puebla) Dr. med. Manuel E. Cornely, Kaiserswerther Str. 296, 40474,
Düsseldorf, Deutschland, post@hautarzt-duesseldorf.de.
Abstract
Lipohyperplasia dolorosa and lymphedema are completely different disease entities, which are both,
however, classified under lymphology. While in lipohyperplasia dolorosa a congenital lipid distribution
disorder leads to a high volume insufficiency and the corresponding clinical symptoms, lymphedema is
characterized by a congenital transport incompetence of the vessels or acquired disorders of transport
capacity. Both lymphedemas of different genesis are familial volume alterations of the affected regions
and the increase in volume is irreversible if not exclusively still in stage I or II. According to current
knowledge the solid increase in volume by lymphedema is due to a malfunctioning biomechanism by
which the release of additional proteoglycans in the homeostasis system of the fluid in the interstital
space plays an important role. Removal of this tissue and the sponge-like substance of proteoglycans is
the aim of therapeutic approaches. Manual lymph drainage and compression can evacuate the sponge
but not remove it. Lymphological liposculpture is a successful dermatosurgical measure even for
secondary lymphedema. Reduction of the necessity of complex hemostasis therapy to 20% of the initial
value and an adjustment of the affected extremity on the healthy side, represent a clear improvement in
quality of life of patients. The same dermatosurgical method, lymphological liposculpture, has been
known for many years to fulfil the successfully proven purpose for the treatment of lipohyperplasia
dolorosa by the removal of subcutaneous fatty tissue, present as hyperplasia and not hypertrophy.
Tenderness and the necessity for complex hemostasis therapy are no longer present or no longer
necessary after lymphological liposculpture for lipohyperplasia dolorosa. This condition is permanent
because the congenital fatty masses do not reoccur following surgical removal. Lipohyperplasia
dolorosa is therefore curable by lymphological liposculpture. For secondary lymphedema a drastic
improvement in quality of life of the patient can be achieved by this method which is demonstrated by
the adjustment of symmetry of the extremities and reduction or even avoidance of complex hemostasis
therapy.
----------------------------
October 5, 2010
Indian J Pediatr. 2010 Sep 30. [Epub ahead of print]
Home-made Compression Stockings and Shoes of a Cotton-Polyester Material in the Treatment of
Primary Congenital Lymphedema.
de Godoy JM, Azoubel LM, de Godoy MD.
Department of Cardiology and Cardiovascular Surgery, Medical School of São Jose do Rio Preto-
FAMERP-Brazil and CNPq (National Council for Research and Development), São José do Rio
Preto, Brazil, godoyjmp@riopreto.com.br.
PMID: 20882431 [PubMed - as supplied by publisher]
Phlebology. 2010 Sep 29. [Epub ahead of print]
Unilateral leg swelling: deep vein thrombosis?
Bekou V, Galis D, Traber J.
Venenklinik Bellevue, Kreuzlingen, Switzerland.
Abstract
OBJECTIVE: We present two cases of a unilateral leg swelling of unusual aetiology as a reminder to
the physician to consider causes of unilateral leg swelling other than deep vein thrombosis,
lymphoedema and infectious diseases. Case reports Both of our patients developed progressive leg
swelling. Subsequent investigation revealed a lesion compressing the femoral vein. At exploration this
was found to be a ganglion cyst. In one patient surgical removal of the cyst and in the other puncture of
the cyst and instillation of steroid resulted in prompt resolution of the swelling.
CONCLUSION: Venous compression due to external cystic lesions, although rare, is recognized. In
strange cases this differential diagnosis should also be taken into account. Therapeutic options are the
surgical removal or puncture of the cyst.
PMID: 20881310 [PubMed - as supplied by publisher]
Clin J Oncol Nurs. 2010 Oct 1;14(5):585-93.
NO SToPS: Reducing treatment breaks during chemoradiation for head and neck cancer.
Lambertz CK, Gruell J, Robenstein V, Mueller-Funaiole V, Cummings K, Knapp V.
St. Luke's Mountain States Tumor Institute, Boise, ID, USA. lambertc@slhs.org
Abstract
The addition of chemotherapy to radiation aids in the survival of patients with head and neck cancer but
also increases acute toxicity, primarily painful oral mucositis and dermatitis exacerbated by xerostomia.
The consequences of these side effects often result in hospitalization and breaks in treatment, which
lead to lower locoregional control and survival rates. No strategies reliably prevent radiation-induced
mucositis; therefore, emphasis is placed on management to prevent treatment breaks. The NO SToPS
approach describes specific multidisciplinary strategies for management of nutrition; oral care; skin
care; therapy for swallowing, range of motion, and lymphedema; pain; and social support to assist
patients through this difficult therapy.
PMID: 20880816 [PubMed - in process]
Ann Surg Oncol. 2010 Oct;17(Suppl 3):352-8. Epub 2010 Sep 19.
Single-center long-term follow-up after intraoperative radiotherapy as a boost during breast-conserving
surgery using low-kilovoltage x-rays.
Blank E, Kraus-Tiefenbacher U, Welzel G, Keller A, Bohrer M, Sütterlin M, Wenz F.
Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg,
Mannheim, Germany.
elena.blank@umm.de
Abstract
BACKGROUND: Intraoperative radiotherapy (IORT) during breast-conserving surgery as a boost
followed by whole-breast radiotherapy is increasingly used.
METHODS: Between February 2002 and December 2008, a total of 197 patients were treated with
IORT as a boost (20 Gy, 50 kV x-rays; Intrabeam System, Carl Zeiss Surgical, Oberkochen,
Germany) during breast-conserving surgery, followed by whole-breast radiotherapy (46-50 Gy).
Systemic therapy was provided according to the St. Gallen consensus. Patients were recalled every 6-
12 months for follow-up. Findings were scored according to the LENT-SOMA scale.
RESULTS: Median age was 61.8 (range 30-84) years, and median follow-up was 37 (range 5-91)
months. There were T1, T2, and Tx tumors in 129, 67, and 1 patients, respectively, and N0, N1, N2,
and N3 disease in 144, 36, 15, and 2 patients, respectively. Until December 2009, 5 local invasive
relapses, 1 local ductal carcinoma-in-situ, 1 axillary relapse, 6 secondary cancers, and 11 distant
metastases were seen, resulting in a 5-year disease-free survival of 81.0% and an overall survival of
91.3%. Local relapse-free survival (invasive cancers) at 3 and 5 years was 97.0%. After a follow-up
of 5 years (n =58), only 8 patients (13.8%) had chronic skin toxicities, and 2 patients (3.4%) had a
marked increase in density (fibrosis III), while 62.0% had no/barely palpable fibrosis 0-I. Other
toxicities observed included severe pain (n = 4, 6.9%), retraction (n =17, 29.3%), edema of the breast
(n =1, 1.7%), and lymphedema in general (n =2, 3.4%).
CONCLUSIONS: After IORT as a tumor bed boost with low-kilovoltage x-rays followed by whole-
breast radiotherapy, low local recurrence and chronic toxicity rates were seen after 5-year follow-up.
PMID: 20853058 [PubMed - in process]
October 8, 2010
Int Angiol. 2010 Oct;29(5):454-70.
Diagnosis and treatment of primary lymphedema. Consensus Document of the International Union of
Phlebology (IUP)-2009.
Lee B, Andrade M, Bergan J, Boccardo F, Campisi C, Damstra R, Flour M, Gloviczki P, Laredo J,
Piller N, Michelini S, Mortimer P, Villavicencio JL.
Center for Vein, Lymphatics, and Vascular Malformation, Division of Vascular Surgery, Department of
Surgery, Georgetown University School of Medicine, Washington DC, USA - bblee38@comcast.net.
Abstract
Primary lymphedema can be managed safely as one of the chronic lymphedemas by a proper
combination of DLT with compression therapy. Treatment in the maintenance phase should include
compression garments, self management including the compression therapy, self massage and
meticulous personal hygiene and skin care in addition to lymph-transport promoting excercises. The
management of primary lymphedema can be further improved with proper addition of surgical therapy
either reconstructive or ablative. These two surgical therapies can be effective only when fully
integrated with MLD-based DLT postoperatively. Compliance with a long-term commitment of DLT
postoperatively is the most critical factor determining the success of any new treatment strategy with
either reconstructive or palliative surgery. The future of management of primary lymphedema caused by
truncular lymphatic malformation has never been brighter with the new prospect of gene-oriented
management.
PMID: 20924350 [PubMed - in process]
Int Angiol. 2010 Oct;29(5):442-453.
Clinical trials needed to evaluate compression therapy in breast cancer related lymphedema (BCRL).
Proposals from an expert group.
Partsch H, Stout N, Forner-Cordero I, Flour M, Moffatt C, Szuba A, Milic D, Szolnoky G, Brorson
H, Abel M, Schuren J, Schingale F, Vignes S, Piller N, Döller W.
Dermatology, Medical University of Vienna, Vienna, Austria2 Breast Care Department, National
Naval Medical Center, Bethesda, MD, USA3 Specialist in Physical Medicine and Rehabilitation,
Valencia, Spain4 Dermatology, University Hospital KU Leuven, Belgium5 Glasgow Medical School,
Glasgow, UK6 Department of Internal Medicine, Wroclaw Medical University, Wroclaw, Poland7
Department of Physiotherapy, Wroclaw School of Physical Education, Wroclaw, Poland8 Clinic for
Vascular Surgery, University Clinical Centre Nis, Nis, Serbia9 Department of Dermatology and
Allergology, University of Szeged, Szeged, Hungary10Department of Clinical Sciences Malmö, Lund
University, Plastic and Reconstructive Surgery, Malmö University Hospital, Malmö,
Sweden11Lohmann & Rauscher, Rengsdorf, Germany12Medical Markets Laboratory, Neuss,
Germany13Lympho-Opt Clinic, Pommelsbrunn, Germany14Department of Lymphology, Hôpital
Cognacq-Jay, Paris, France15Department of Surgery, School of Medicine, Flinders Medical Centre,
Bedford Park South, Australia16Center of Lymphology, General Hospital Wolfsberg, Austria - nicole.
stout@med.navy.mil.
Abstract
AIM: A mainstay of lymphedema management involves the use of compression therapy. Compression
therapy application is variable at different levels of disease severity. Evidence is scant to direct clinicians
in best practice regarding compression therapy use. Further, compression clinical trials are fragmented
and poorly extrapolable to the greater population. An ideal construct for conducting clinical trials in
regards to compression therapy will promote parallel global initiatives based on a standard research
agenda. The purpose of this article is to review current evidence in practice regarding compression
therapy for BCRL management and based on this evidence, offer an expert consensus
recommendation for a research agenda and prescriptive trials. Recommendations herein focus solely on
compression interventions.
METHODS: This document represents the proceedings of a session organized by the International
Compression Club (ICC) in June 2009 in Ponzano (Veneto, Italy). The purpose of the meeting was to
enable a group of experts to discuss the existing evidence for compression treatment in breast cancer
related lymphedema (BCRL) concentrating on areas where randomized controlled trials (RCTs) are
lacking.
RESULTS: The current body of research suggests efficacy of compression interventions in the
treatment and management of lymphedema. However, studies to date have failed to adequately
address various forms of compression therapy and their optimal application in BCRL. We offer
recommendations for standardized compression research trials for prophylaxis of arm lymphedema and
for the management of chronic BCRL. Suggestions are also made regarding; inclusion and exclusion
criteria, measurement methodology and additional variables of interest for researchers to capture.
CONCLUSION: This document should inform future research trials in compression therapy and serve
as a guide to clinical researchers, industry researchers and lymphologists regarding the strengths,
weaknesses and shortcomings of the current literature. By providing this construct for research trials,
the authors aim to support evidence-based therapy interventions, promote a cohesive, standardized
and informative body of literature to enhance clinical outcomes, improve the quality of future research
trials, inform industry innovation and guide policy related to BCRL.
PMID: 20924349 [PubMed - as supplied by publisher]
Int Angiol. 2010 Oct;29(5):436-41.
Medical compression: effects on pulsatile leg blood flow.
Mayrovitz HN, Macdonald JM.
Nova Southeastern University, College of Medical Sciences, Ft Lauderdale, FL, USA2 Miller School
of Medicine, University of Miami, Miami, FL, USA - mayrovit@nova.edu.
Abstract
AIM: Leg compression bandaging is the mainstay of venous ulcer treatment, yet little is known about
the impact of therapeutic compression levels on arterial haemodynamics. In this study, the effect of foot-
to-knee, four-layer compression bandaging on below-knee arterial pulsatile blood flow was assessed
by nuclear magnetic resonance flowmetry.
METHODS: In 14 healthy supine subjects, bilateral pulsatile blood flow measured at five below-knee
sites without compression; and during compression of one leg to an average malleolar sub-bandage
pressure of 40.7±4.0 mmHg.
RESULTS: The forefoot-to-knee compression bandaging caused a highly significant (P<0.001)
increase in the bandaged leg pulsatile blood flow due to increases in both peak flow and pulse width.
CONCLUSION: It is hypothesized that arteriolar vasodilatation, induced either myogenically by
reduced transmural pressure or by vasodilatory substance release triggered by increased venous shear
stress and veno-arterial interactions, possibly combined with altered vascular compliance, produce the
observed compression-related phenomenon. Whatever the mechanism(s), the finding of a compression-
associated pulsatile flow increase suggests an arterial linkage, which may play a role in the well-
documented beneficial effects of compression bandaging in venous ulcer and lymphedema treatment.
Possible beneficial effects of the arterial flow-pulse increase on venous ulcer outcome may be related to
a decrease in leukocyte effects in the distal microvasculature.
PMID: 20924348 [PubMed - in process]
Int Angiol. 2010 Oct;29(5):392-4.
Limb volume measurement: from the past methods to optoelectronic technologies, bioimpedance
analysis and laser based devices.
Cavezzi A, Schingale F, Elio C.
Vascular Unit, Stella Maris Clinic and Hippocrates Poliambulatory, S. Benedetto del Tronto, Ascoli
Piceno, Italy - info@cavezzi.it.
Abstract
Accurate measurement of limb volume is considered crucial to lymphedema management. Various non-
invasive methods may be used and have been validated in recent years, though suboptimal
standardisation has been highlighted in different publications.
PMID: 20924339 [PubMed - in process]
Skin Res Technol. 2010 Jul 6. doi: 10.1111/j.1600-0846.2010.00456.x. [Epub ahead of print]
Spatial variations in forearm skin tissue dielectric constant.
Mayrovitz HN, Luis M.
College of Medical Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA.
Abstract
Background: Tissue dielectric constant (TDC) values measured at 300 MHz via the open-ended
coaxial line reflection method depend on the effective measurement depth and the anatomical site being
evaluated. Measurements on the forearm have shown that the TDC values decrease with increasing
measurement depth but the spatial variability of the TDC values among forearm anatomical positions is
unknown. Our goal was to characterize the extent of such spatial variations.
Methods: In 30 healthy seated women (27.4±6.5 years), TDC was measured on the forearm midline
and 1.2 cm medial and lateral to the midline at sites 4, 8 and 12 cm distal to the antecubital crease.
Results: The midline and medial TDC values increased progressively from 4 to 8 to 12 cm sites (P<0.
001), with the largest spatial gradient along the midline. At a depth of 2.5 mm, the TDC values
increased from 26.3±2.8 to 27.4±3.4 to 28.4±3.7, with a maximum difference of 8.2±10.6%. For all
sites, the TDC values were significantly (P<0.001) less for increasing depths.
Conclusion: The findings reveal increased TDC values along the forearm from proximal to distal, most
prominent at the midline and medial positions. Because many skin-related dermatological and
biophysical studies utilize the forearm as a test target, such differences may be important to consider
because TDC values in part are reflective of local tissue water (LTW). Although the variation in the
TDC values among sites was less than 10%, such differences are of importance when evaluating LTW
changes using the TDC method in patients with arm lymphedema that is present in variable arm
anatomical locations.
PMID: 20923455 [PubMed - as supplied by publisher]
Acta Med Croatica. 2010 Jul;64(3):167-73.
[Compression therapy for lymphedema: our experience]
[Article in Croatian]
Planinsek Rucigaj T, Tlaker Zunter V, Miljković J.
University Department of Dermatovenereology, Ljubljana University Hospital Center, Ljubljana,
Slovenia. t.rucigaj@gmail.com
Abstract
The term lymphedema refers to a chronic, progressive edema, usually of a limb, due to insufficient
lymphatic flow. It may appear as a primary disturbance or secondary to other causes, e.g., after
infections or surgery. The most common cause of lymphedema in the Western world is cancer surgery
and/or radiotherapy. The authors summarize the etiology, pathophysiology and clinical staging of
lymphedema. The diagnosis of lymphedema is usually based on history and clinical appearance.
However, lymphoscintigraphy is the gold standard of imaging in doubtful cases. Adequate and early
compression therapy and good patient compliance are the cornerstones of management of
lymphedema. The authors present their experience with compression therapy for lymphedema. While
no differences were found in the efficiency of compression therapy between oncologic and non-
oncologic patients, compression stockings of class III seemed to be efficient in the majority of
secondary lower limb lymphedemas but not as maintenance therapy for primary lower limb
lymphedema.
PMID: 20922859 [PubMed - in process]
Clin Dysmorphol. 2010 Sep 30. [Epub ahead of print]
Cantu syndrome and lymphoedema.
García-Cruz D, Mampel A, Echeverria MI, Vargas AL, Castañeda-Cisneros G, Davalos-Rodriguez
N, Patiño-Garcia B, Garcia-Cruz MO, Castañeda V, Cardona EG, Marin-Solis B, Cantu JM, Nuñez-
Reveles N, Moran-Moguel C, Thavanati PK, Ramirez-Garcia S, Sanchez-Corona J.
aInstituto de Genetica Humana 'Dr Enrique Corona Rivera' bInstituto de Enfermedades Cronico-
Degenerativas, Departamento de Biologia Molecular y Genomica, Centro Universitario de Ciencias de
la Salud, Universidad de Guadalajara cHospital de Especialidades, CMNO dDivision de Medicina
Molecular, CIBO, CMNO, IMSS eHospital General Regional 46 fHospital General Regional 45,
IMSS, Guadalajara, Jalisco, Mexico gInstituto de Genetica de la Facultad de Ciencias Medicas de la
Universidad Nacional de Cuyo, Mendoza, Argentina.
Abstract
Three female patients with Cantu syndrome were studied, two of whom were adults presenting with the
complication of lymphoedema, as described earlier in a male patient with this syndrome. The aim of this
study is to report the clinical characteristics of these three new cases and to emphasize that
lymphoedema, as observed in two of the patients described here, has been observed in 11.5% of
patients with Cantu syndrome and that heterochromia iridis, observed in one patient, is probably a new
feature of this condition.
PMID: 20890180 [PubMed - as supplied by publisher]
Am J Trop Med Hyg. 2010 Oct;83(4):884-90.
Elevated levels of plasma angiogenic factors are associated with human lymphatic filarial infections.
Bennuru S, Maldarelli G, Kumaraswami V, Klion AD, Nutman TB.
Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Bethesda, Maryland 20892, USA. bennurus@niaid.nih.gov
Abstract
Lymphatic dilatation, dysfunction, and lymphangiogenesis are hallmarks of patent lymphatic filariasis,
observed even in those with subclinical microfilaremia, through processes associated, in part, by
vascular endothelial growth factors (VEGFs). A panel of pro-angiogenic factors was measured in the
plasma of subjects from filaria-endemic regions using multiplexed immunological assays. Compared
with endemic normal control subjects, those with both subclinical microfilaremia, and those with
longstanding lymphedema had significantly elevated levels of VEGF-A, VEGF-C, VEGF-D, and
angiopoietins (Ang-1/Ang-2), with only levels of basic fibroblast growth factor (bFGF) and placental
growth factor (PlGF) being elevated only if lymphedema was evident. Furthermore, levels of these
factors 1-year post-treatment with doxycycline were similar to pretreatment levels suggesting a minimal
role, if any, for Wolbachia. Our data support the concept that filarial infection per se is associated with
elevated levels of most of the known pro-angiogenic factors, with only a few being associated with the
serious pathologic consequences associated with Wuchereria bancrofti infection.
PMID: 20889885 [PubMed - in process]PMCID: PMC2946762 [Available on 2011/10/5]
Genes Dev. 2010 Oct 1;24(19):2115-26.
Current views on the function of the lymphatic vasculature in health and disease.
Wang Y, Oliver G.
Department of Genetics and Tumor Cell Biology, St. Jude Children's Research Hospital, Memphis,
Tennessee 38105, USA.
Abstract
The lymphatic vascular system is essential for lipid absorption, fluid homeostasis, and immune
surveillance. Until recently, lymphatic vessel dysfunction had been associated with symptomatic
pathologic conditions such as lymphedema. Work in the last few years had led to a better
understanding of the functional roles of this vascular system in health and disease. Furthermore, recent
work has also unraveled additional functional roles of the lymphatic vasculature in fat metabolism,
obesity, inflammation, and the regulation of salt storage in hypertension. In this review, we summarize
the functional roles of the lymphatic vasculature in health and disease.
PMID: 20889712 [PubMed - indexed for MEDLINE]
Ann Vasc Surg. 2010 Oct 2. [Epub ahead of print]
Vena Cava Thrombectomy and Primary Repair after Radical Nephrectomy for Renal Cell Carcinoma:
Single-Center Experience.
Helfand BT, Smith ND, Kozlowski JM, Eskandari MK.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND: Inferior vena cava (IVC) reconstruction for locally advanced renal cell carcinoma
(RCC) includes resection with and without interposition grafting, patch graft, or primary repair. The
proposed benefits of lateral venorrhaphy and primary repair are avoidance of foreign material, a more
expeditious repair, and preservation of lower extremity venous outflow.
METHODS: A single-center retrospective review of 22 patients with RCC and IVC tumor thrombus
treated with radical nephrectomy, lateral venorrhaphy, thrombectomy, and primary vena cava repair
between July 2002 and June 2009 was carried out. Demographic data, diagnostic information,
radiographic cross-sectional imaging, and procedural outcomes were examined.
RESULTS: Among the 13 men and nine women, the mean age was 62.1 years (42-83); mean tumor
size was 9.8 cm (3-17 cm), and 90% (n = 18) of the cases with RCC were identified pathologically as
clear cell adenocarcinoma; on the basis of the classification system adopted by Neves, level I was for
50% (n = 11), level II for 32% (n = 7), level III for 9% (n = 2), and level IV for 9% (n = 2) of the
patients. All patients underwent en bloc radical nephrectomy with tumor thrombus removal and primary
IVC repair. Mean total operative time was 547.9 ± 138.5 minutes, whereas mean IVC cross-clamp
time was 10.8 minutes (6-29 minutes). There were no intraoperative deaths or pulmonary embolism
and all IVC margins were found to be pathologically negative. Postoperative complications included
one pulmonary embolism, one exacerbation of chronic lymphedema, and two cases of new onset
erectile dysfunction. Mean follow-up was 36.4 ± 23.2 months (6-92 months). There were no
radiographic or clinically significant changes in mean IVC diameter during follow-up. Five late deaths
(23%) occurred as a result of metastatic RCC over a mean period of 24 months (range, 12-48), but
without any local recurrences.
CONCLUSION: For advanced RCC with tumor thrombus extension into the IVC, lateral
venorrhaphy and primary IVC repair avoids complicated caval reconstructions and results in high
patency rates with a low local tumor recurrence rate.
PMID: 20889305 [PubMed - as supplied by publisher]
Phlebology. 2010 Oct;25 Suppl 1:52-63.
From lymph to fat: complete reduction of lymphoedema.
Brorson H.
Department of Plastic and Reconstructive Surgery, Lund University, Skåne University Hospital, SE-
205 02 Malmö, Sweden.
Abstract
Liposuction for late-stage lymphoedema remains a controversial technique. While it is clear that
conservative therapies such as combined decongestive therapy (CDT) and controlled compression
therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphoedema
that is not responding to treatment is not so clear. Liposuction has been used for many years to treat
lipodystrophy. Some results have been far from optimal; however, improvements in technique, patient
preparation and patient follow-up have led to a greater and a wider acceptance of liposuction as a
treatment for lymphoedema. This paper outlines the benefits of using liposuction and presents the
evidence to support its use.
PMID: 20870820 [PubMed - in process]
October 15, 2010
Ginecol Obstet Mex. 2010 Jul;78(7):345-51.
[Laparoscopic radical hysterectomy with lymphatic mapping and sentinel lymph node biopsy in early
cervical cancer][Article in Spanish]
Maffuz A, Quijano F, López D, Hernández-Ramírez D.
División de Cirurgía, Departamento de Ginecología Oncológica, Hospital de Oncología, Centro
Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, DF México. tonomaffuz@yahoo.
com
Abstract
BACKGROUND: in patients with early-stage cervical cancer (FIGO IA, IB2 and IIA), the incidence
of lymph node metastases is up to 15%; the majority of early cervical cancer patients with pelvic and
para-aortic lymphadenectomy does not benefit with the procedure and are at risk of associated
morbidity (linfocyst, lymphedema, vascular or nerve damage).
OBJECTIVE: To describe the experience and usefulness of lymphatic mapping and sentinel lymph
node with total laparoscopic radical hysterectomy in early stage cervical cancer. Patients and method:
Retrospective study in patients with diagnosis of cervical cancer in early stage, submitted to
laparoscopic radical hysterectomy with lymphatic mapping and sentinel lymph node biopsy. We
analyzed sentinel lymph node identification, false negative rate and surgical variables.
RESULTS: in 36 months 15 patients were included, two in IA2 FIGO stage, twelve IB1 and one IIA;
thirteen patients were mapping with combined technique and two only with dye. The sentinel lymph
node identification rate was 87% (two failures in the patients using only blue dye); the false negative
rate was 0%.
CONCLUSION: Laparoscopic radical hysterectomy with lymphatic mapping is a secure technique for
patients with early stage cervical cancer; it allows the correct identification of lymph node status as the
principal prognostic factor. We recommend the use of combined technique (radiocolloid tracer and
blue dye) for best rate sentinel lymph node identification.
PMID: 20931810 [PubMed - in process]
Cancer. 2010 Oct 13. [Epub ahead of print]
The effects of body mass index on complications and survival outcomes in patients with cervical
carcinoma undergoing curative chemoradiation therapy.
Kizer NT, Thaker PH, Gao F, Zighelboim I, Powell MA, Rader JS, Mutch DG, Grigsby PW.
Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, Missouri.
Abstract
BACKGROUND: The effect of body mass index (BMI) on treatment outcomes for patients with
locally advanced cervical carcinoma who receive definitive chemoradiation is unclear.
METHODS: The cohort in this study included all patients with cervical carcinoma (n = 404) who had
stage IB(1) disease and positive lymph nodes or stage ≥IB(2) disease and received treatment at the
authors' facility between January 1998 and January 2008. The mean follow-up was 47.2 months. BMI
was calculated using the National Institute of Health online calculator. BMI categories were created
according to the World Health Organization classification system. Primary outcomes were overall
survival, disease-free survival, and complication rate. Univariate and multivariate analyses were
performed. Kaplan-Meier survival curves were generated and compared using Cox proportional
hazard models.
RESULTS: On multivariate analysis, compared with normal weight (BMI 18.5-24.9 kg/m(2)), a BMI
<18.5 kg/m(2) was associated with decreased overall survival (hazard ratio, 2.37; 95% confidence
interval, 1.28-4.38; P < .01). The 5-year overall survival rate was 33%, 60%, and 68% for a of BMI
<18.5 kg/m(2), a BMI from 18.5 kg/m(2) to 24.9 kg/m(2), and a BMI >24.9 kg/m(2), respectively. A
BMI <18.5 kg/m(2) was associated with increased risk of grade 3 or 4 complications compared with a
BMI >24.9 kg/m(2) (radiation enteritis: 16.7% vs 13.6%, respectively; P = .03; fistula: 11.1% vs
8.8%, respectively; P = .05; bowel obstruction: 33.3% vs 4.4%, respectively; P < .001; lymphedema:
5.6% vs 1.2%, respectively; P = .02).
CONCLUSIONS: Underweight patients (BMI <18.5 kg/m(2)) with locally advanced cervical cancer
had diminished overall survival and more complications than normal weight and obese patients. Cancer
2010. © 2010 American Cancer Society.
PMID: 20945318 [PubMed - as supplied by publisher]
October 26, 2010
Br J Community Nurs. 2010 Oct;15(10):26-30.
Microfine glove and toe caps and their use in lymphoedema management.
Close G.
Abstract
Lymphoedema garments have progressed in the last 10 years, so gone are the days when only one
colour is available (that lovely beige!). How many patients would have to be persuaded to wear their
compression hosiery in that desirable colour? Not just have the colours become more acceptable, so
have the fabrics. There are a wide range of compression gloves available to the lymphoedema specialist
to fit on the patient but that cannot be said of toe caps. The Microfine toe cap is the only one available
as an off-the-shelf garment, and when the lymphoedema is deemed to be manageable in these
garments, it offers an alternative to flat knit. The Microfine glove and Microfine toe cap are adaptable
and can offer colour options and a fabric that is less bulky and fine. It also allows therapists to trim the
length of each digit for a better fit without reducing compression. The author will present three case
studies of patients that are using.
PMID: 20966839 [PubMed - in process]
Br J Community Nurs. 2010 Oct;15(10):17-21.
Key-worker clinics: the maintenance phase of lymphoedema therapy.
Green T.
Abstract
This article describes the development of services for patients with mild and uncomplicated
lymphoedema through a network of community-based staff nurses specially trained in the management
of mild and uncomplicated lymphoedema in order to deliver an integrated service across the acute
foundation and primary care trusts . Government policies, increasing referral rates and patients with
complex co-morbidity requiring intensive treatments had prompted a review of the service provision to
examine ways to deliver an efficient and cost-effective service across the local health economy. Patients
with mild and uncomplicated lymphoedema do not necessarily require specialist care but can be
managed effectively by key workers with appropriate training and skills (British Lymphology Society,
2001a; b; Lymphoedema Framework, 2006). This development demonstrates the benefit of training
existing community staff, using their existing skills. Providing access to clinics within the primary care
setting helps to provide a cost-effective, structured and co-ordinated care pathway at all levels of
intervention, ultimately improving treatment outcomes and patient satisfaction. A cohort of community
staff nurses were identified and trained in the provision of lymphoedema management to key worker
level, providing the opportunity to develop a lymphoedema service based upon health-care need and
not disease site as has occurred with other national developments. These clinics offer the same advice,
support and monitoring of the patients condition alongside education and information in a more locally
accessible setting, avoiding the need for hospital visits.
PMID: 20966836 [PubMed - in process]
Br J Community Nurs. 2010 Oct;15(10):14-6.
Management of the bariatric patient with lymphoedema: South West Wales.
Coveney E.
Abstract
Twenty-four percent of adults (age 16 and over) in England are classified as obese. This represents an
increase from 15% in 1993. (NHS Information Centre, 2008). As obesity rates increase across the
UK lymphoedema services face increasing numbers of obese patients in their clinics. This short article
will explore some ideas of how we manage this patient group at present in our lymphoedema service.
Management of lymphoedema involves what are considered the four cornerstones of care: daily skin
care, movement and exercise, maintaining weight in the healthy range and wearing compression
garments daily. While it is considered helpful for overweight/obese patients to lose weight to improve
the management of lymphoedema, it is not always easy for patients to make the necessary lifestyle
changes, particularly for those patients with a body mass index (BMI) over 35 (bariatric).
PMID: 20966835 [PubMed - in process]
Br J Community Nurs. 2010 Oct;15(10):4-12.
Chronic oedema and lymphoedema of the lower limb.
Hampton S.
Abstract
There is a very fine line between oedema, chronic oedema, lymph venous oedema and lymphoedema
with the names 'chronic oedema'and 'lymphoedema' often used interchangeably. Therefore, there can
be difficulty with diagnosis of which condition is present in the individual patient, particularly when
another unrelated condition (lipoedema) can also be mistakenly diagnosed as lymphoedema. The most
important thing to remember is that, although there is this fine line between the conditions, each part of
the disease development cannot be entirely separated or treated completely in isolation. The key to
good outcomes in lymphovenous oedema is to treat it at the earliest stage possible to prevent
deterioration, venous ulceration and the almost inevitable cellulitis that is associated with lymphoedema
skin changes. This article will aim to promote an understanding of the different conditions and stages,
will provide a simple identification of the condition and will discuss how lymphovenous oedema can
lead eventually to the very difficult-to-treat chronic lymphoedema with ideas of how to prevent this
deterioration.
PMID: 20966834 [PubMed - in process]
Br J Community Nurs. 2010 Oct;15(10):3-Unknown.
Change is afoot, are you ready?
Pike C.
Abstract
Treatment starts with a patient's willingness to take on board the basics of lymphoedema management,
without this, their commitment to further treatment would be in question. However, most services are
now over-prescribed and many are looking into referral criteria, but to deny a person treatment based
on their BMI is not sound practice; to exclude anyone on the grounds of their size or weight would be
unethical and may result in legal repercussions. To avoid such situations, community nurses can
encourage GPs to teach their patients the importance of skin care and exercise. If a patient does not
take this advice on board, you can explain to the GP that you can only commence treatment once the
patient has complied with the advice given. The latest government initiatives to save costs and reduce
overheads mean that services are being scrutinized for cost-saving potentials. A simple means of
proving your service's viability is by keeping statistical records of all staff daily activities and treatments.
A database can be drawn up to compare, for example, cancer and non-cancer lymphoedema, by
looking at the number of patient contacts for first assessments, follow ups, intensive treatments and
record of time in units. The database I created at Singleton Hospital's Lymphoedema Service enables
us to prove each staff member's activity and value for money (if you would like a copy, email me:
cheryl.pike@wales.nhs.uk). Approaching various companies for discount incentives will show a
willingness to work with manufacturers in further reducing costs on your service.
PMID: 20966833 [PubMed - in process]
--------------------
November 5, 2010:
Ann Plast Surg. 2010 Oct 29. [Epub ahead of print]
Optimizing Outcome of Charles Procedure for Chronic Lower Extremity Lymphoedema.
Karri V, Yang MC, Lee IJ, Chen SH, Hong JP, Xu ES, Cruz-Vargas J, Chen HC.
From the *Department of Plastic and Reconstructive Surgery, E-Da Hospital/I-Shou University,
Kaohsiung County; †Department of Public Health, Institute of Health Organization Administration,
College of Public Health, National Taiwan University, Taiwan, Republic of China; ‡Department of
Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon City; §Department of Plastic and
Reconstructive Surgery, Asan Medical Center, Seoul, South Korea; and ¶China Medical University
Hospital, Taichung, Taiwan, Republic of China.
Abstract
BACKGROUND: Charles procedure for late-stage lower limb lymphoedema (LLL) is often criticized
for its unpredictable and poor result. We have adopted a systematic approach to optimize outcome of
patients treated with this excisional surgery.
METHODS: From June 2004 to March 2009 we performed Charles procedure on 1 lower limb of 19
women and 8 men with late-stage LLL. Mean age and follow-up was 48 (range, 16.5-77.8) years and
21.6 (range, 1.5-48) months, respectively.
RESULTS: Average inpatient stay was 27 (range, 11-54) days. After discharge, 16 (59.3%) patients
underwent further minor surgery. The most frequent complication was a single, short episode of
cellulitis, affecting 5 (18.5%) patients. Self-reported mobility was either the same or improved at 6
months, and appearance of their limbs satisfactory.
CONCLUSIONS: Charles procedure is an effective treatment for selected patients and by applying
our systematic approach, a positive outcome can be achieved.
PMID: 21042186 [PubMed - as supplied by publisher]
World J Surg Oncol. 2010 Nov 1;8(1):94. [Epub ahead of print]
Management options for vulvar carcinoma in a low resource setting.
Eke AC, Alabi-Isama LI, Akabuike JC.
ABSTRACT:
BACKGROUND: Vulvar carcinoma is a rare tumor of the female genital tract. In Nigeria, very few
studies have looked at the management options for vulvar carcinoma. The objective of this study was
therefore, to describe the management options available and the challenges in treating this malignancy in
Nigeria.
METHODS: A descriptive study of all vulvar cancer cases managed at the Nnamdi Azikiwe University
Teaching Hospital, Nnewi over a 12 year period (1998-2009). The theatre, ward register, histo-
pathologic records and case notes of all women who had surgery for vulvar carcinomas were retrieved
and socio-demographic characteristics, clinical presentation, type of surgery, histologic type and
complications of treatment were retrieved and analyzed.
RESULTS: There were 867 gynecological malignancies and vulval carcinoma accounted for 11 cases,
giving a prevalence of 1.27%. The ages ranged from 54 to 79 years with a mean of 61.2 years. The
parities of the women ranged from 2-14. Most of the patients were of low socio-economic class. All
the 11 patients had surgery as 1st line treatment.
Radical vulvectomy was done for 6 cases since they presented in the advanced stage. The
complications of surgery included hemorrhage (18.2%), chronic lymphedema, wound infection and
anesthetic complications. There were no hospital mortalities. Late presentation, with stage III (45.4%)
was the commonest stage at presentation while the majority of the vulvar carcinomas (72.7%) were of
epithelial origin. Squamous cell carcinoma predominated (63.6%).
CONCLUSION: Carcinoma of the vulva is a rare gynecological malignancy in Nigeria. Surgery and
radiotherapy remain the mainstay of this disease in Nigeria. Treatment can be highly successful if
patients present early.
PMID: 21040577 [PubMed - as supplied by publisher]
Diabetes Res Clin Pract. 2010 Oct 28. [Epub ahead of print]
Chronic interdigital dermatophytic infection: A common lesion associated with potentially severe
consequences.
Vanhooteghem O, Szepetiuk G, Paurobally D, Heureux F.
Department of Dermatology, Sainte Elisabeth Hospital, B-5000 Namur, Belgium; Department of
Dermatology, University Hospital Sart Tilman, B-4000 Liège, Belgium.
Abstract
Interdigital intertrigo and onychomycosis has the potential cause of severe bacterial infectious
complications with pain, mobility problems, abscess, erysipelas, cellulitis, fasciitis and osteomyelitis. In
another hand, diabetic neuropathy, which affects 60-70% of those with diabetes mellitus, is one of the
most troubling complications for persons with diabetes. These people are high suspecting to be infected
by dermatophytic infections in interdigital spaces or onychomycosis witch are frequently induce damage
to the stratum corneum, leading to bacterial proliferation and secondary infection. A patient presented
with an asymptomatic warm, painless, erythematous swelling of the second left toe, which had been
present for a few weeks. Clinically, the lesion was categorized as erysipelas upon an insidious abscess
formation. Further investigation was undertaken to confirm the presence of diabetes. Leg erysipelas is a
common affection which, according to various studies, has both local concomitants (interdigital
intertrigo, lymphoedema, surgical antecedents) and/or general causes (immune suppression, diabetes,
alcoholism, etc). Interdigital intertrigo, tinea pedis, and onychomycosis present as public health
problems that could trigger serious deterioration in patient quality of life, due to complications induced
by secondary bacterial infections.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 21035887 [PubMed - as supplied by publisher]
Presse Med. 2010 Oct 27. [Epub ahead of print] [Primary lymphedema of limbs.][Article in French]
Vaillant L, Tauveron V.
Université François-Rabelais de Tours, CHRU de Tours, 37044 Tours cedex 01, France; CNRS FRE
2448, unité Inserm U930, 37044 Tours cedex, France.
Abstract
Limb lymphedema is frequent and not well-known. Clinical classification distinguishes primary
lymphedemas due to developmental disorders of the lymphatic system (hereditary or not, sometimes
associated with other malformations) and secondary lymphedemas. Primary lymphedema is a
lymphedema without a cause to explain lymphatic impairment. It is due to an abnormal
lymphangiogenesis in utero. It is often associated with mutation in a gene involved in lymphangiogenesis
(FOX C2, VEGFR 3, SOX18, PROX 1…). To assess clinical diagnosis, non-invasive techniques are
able to study structure and function of the lymphatic system (mainly isotopic lymphography). Treatment
is the complex decongestive therapy which associates manual lymphatic drainage and bandage.
Predisposing or precipitating factors have to be treated (particularly streptococcal infections). Surgical
treatment has precise and rare indication.
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21035299 [PubMed - as supplied by publisher]
November 9, 2010:
J Vis Exp. 2010 Oct 20;(44). pii: 2225. doi: 10.3791/2225.
Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph
Node in Gynecologic Oncology.
Crane LM, Themelis G, Buddingh T, Harlaar NJ, Pleijhuis RG, Sarantopoulos A, van der Zee AG,
Ntziachristos V, van Dam GM.
Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen.
Abstract
The prognosis in virtually all solid tumors depends on the presence or absence of lymph node
metastases.(1-3) Surgical treatment most often combines radical excision of the tumor with a full
lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated
with increased morbidity due to infection, wound breakdown and lymphedema.(4,5) As an alternative,
the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first
draining lymph node from the tumor.(6) In case of lymphogenic dissemination, the SLN is the first
lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream
lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure
is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of
the vulva and cervix.(7) The current standard methodology for SLN-detection is by peritumoral
injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of
the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to
increased psychological distress for the patient, and the use of radioactive colloid. Multispectral
fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the
need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are
needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a
fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess
cardiac function, cerebral perfusion and liver perfusion.(8) It is an inert drug with a safe pharmaco-
biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around
800 nm. A custom-made multispectral fluorescence imaging camera system was used.(9). The aim of
this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in
patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard
procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging
might replace the current method and is also easily transferable to other indications like breast cancer
and melanoma.
PMID: 21048667 [PubMed - in process]
MED NEWS DOCS FORMATTED:
November 3, 2010 - Fox Chase Researchers Identify Risk Factors For The Spread Of Breast Cancer
To Lymph Nodes –
Breast cancer, one of the most prevalent cancers in women, afflicts an additional 200,000 women each
year and causes about 40,000 deaths annually. The disease often extends to neighboring lymph nodes,
in part, through lymphovascular invasion (LVI) - a process in which cancer cells invade blood vessels
or the lymphatic system - and can often translate into a poor prognosis for patients. Some scientists
argue that evidence of LVI does not necessarily mean that the disease will recur in the lymph nodes
after radiation to the breast alone, but research from Fox Chase Cancer Center now shows that the
appearance of LVI in the breast tissue does in fact predict recurrence of breast in the regional lymph
nodes.
By carefully examining recurrence patterns of thousands of women with breast cancer from records
spanning more than 30 years, Wilhelm Lubbe, M.D.,Ph.D., chief resident in Fox Chase's Radiation
Oncology Department, and his colleagues have now shown that the appearance of LVI in breast tissue
predicts the future recurrence of cancer to nearby lymph nodes. "The microscopic diagnosis of LVI is
challenging which highlights the importance of excellent pathologists," says Lubbe, who will present the
results this week at the Annual Meeting of the American Society for Radiation Oncology.
Knowing that the disease is going to extend to neighboring lymph nodes, such as those in the armpit, is
important prognostically. But it has still been unclear whether supplementary radiation therapy targeting
these areas improves outcomes.
"There still is a lot of debate as to whether additional radiation to the regional lymph nodes is needed in
a woman with LVI," Lubbe says.
In the study, Lubbe's team analyzed an extensive database of 3,082 breast cancer patients who
underwent whole-breast radiation or minimal surgical resection of breast tissue between 1970 and
2009. This dataset, at least twice as large as many others of its kind, provided enough statistical power
for the investigators to detect a subtle, yet significant trend.
"Luckily, at Fox Chase, we had the resources to maintain this huge database by meticulously following
a large number of patients over the course of decades," Lubbe says.
The team searched for factors aside from LVI that determine outcomes. The disease was more likely
to invade lymph nodes in women younger than 35. Also, additional radiation therapy under the armpit
via a technique called a posterior axillary boost (PAB) lead to fewer breast cancer recurrences in these
women's regional lymph nodes. Ironically, this extra procedure led to less regional recurrence even
though the women were of higher risk than other treatment groups. Overall, the 10-year recurrence
rate was only 1.4%. But it was 4% for women treated with radiation above the collar bone alone,
compared to 0.5% for those who also received a PAB - the posterior boost of radiation under the
armpits.
"Our data suggest that patients who are at higher risk of their cancer spreading can potentially benefit
from additional radiation by a technique called a posterior axillary boost," Lubbe says. "But the
recommendation to add radiation, and what technique is used, is very patient-specific, because with
any intervention there's additional risk."
In the future, Lubbe would like to identify other objective biological markers, such as proteins or genes,
which predict recurrence rates and patient outcomes. "Ultimately, we'd like to find a faster and more
accurate process for assessing the risk of cancer spread to regional lymph nodes and the rest of the
body," Lubbe says.
Co-investigators include Tianyu Li, Penny Anderson, Lori Goldstein, Crystal Denlinger, Holly Dushkin,
Ramona Swaby, Richard Bleicher, Elin Sigurdson and Gary Freedman.
November 5, 2010 - Shire Presents Positive New Data At The 60th Annual American Society Of
Human Genetics (ASHG) For Patients With Type 1 Gaucher Disease –
Shire plc (LSE: SHP, Nasdaq: SHPGY), the global specialty biopharmaceutical company, presented
positive new data from a Phase III clinical trial (study 039) designed to evaluate the efficacy of
VPRIV® (velaglucerase alfa for injection) compared with imiglucerase in patients with type 1 Gaucher
disease at the 2010 Annual American Society of Human Genetics (ASHG) in Washington, D.C. The
study met its primary endpoint and adds to the growing body of clinical evidence which supports the
use of VPRIV in patients who have transitioned from imiglucerase or who are treatment-naive.
In the 039 (head-to-head) study, adult and pediatric patients with type 1 Gaucher disease were
included in a 9-month, global, randomized, double-blind, non-inferiority study comparing VPRIV with
imiglucerase in treatment-naive patients aged >/= 2 years, with anemia and either thrombocytopenia or
organomegaly. Patients were randomized in a 1:1 ratio to receive either VPRIV or imiglucerase at a
dose of 60U/kg via continuous infusion over one hour every other week for 39 weeks (total of 20
infusions per patient). 35 patients in 9 countries were randomized and 34 received the study drug
(intent-to-treat [ITT] population was 17 in both the VPRIV and imiglucerase groups). The per-
protocol (PP) analysis included 15 patients in each group. Baseline clinical characteristics were
generally similar between the 2 groups, although hemoglobin concentrations appeared slightly higher in
the VPRIV group.
After 9 months of treatment, hemoglobin concentration improved in both groups. The estimated mean
treatment difference for hemoglobin concentration from baseline between patients treated with VPRIV
and imiglucerase was 0.14 and 0.16 g/dL in the ITT and PP populations, respectively, with a lower
bound of the 97.5% one-sided confidence interval of 0.60 g/dL in both populations, greater than the
pre-defined non-inferiority margin of 1.0 g/dL. These results indicate that the primary endpoint was
met. Both the VPRIV and imiglucerase groups showed substantial improvements in the secondary
endpoints, including platelet counts, spleen volume, liver volume, and plasma biomarkers with no
statistically significant difference demonstrated between the treatment groups. The majority of adverse
events were mild or moderate in severity, including one serious adverse event (SAE) seen with VPRIV
which was an allergic skin reaction that resolved without sequalae.
Shire also reported important findings that suggested substantial antigenic differences when antibody
response to treatment with VPRIV and imiglucerase were compared. No patient treated with VPRIV
developed anti-drug antibodies while 4 patients in the imiglucerase group developed antibodies to
imiglucerase. Of these four imiglucerase treated patients, 1 patient had antibodies that inhibited enzyme
activity in vitro and enzyme uptake in a cell-based assay. 3 patients had antibodies that did not inhibit
enzyme activity or uptake.
November 11, 2010 - Post-Treatment Condition Often Overlooked In Breast Cancer Patients –
As many as 70% of women with breast cancer develop painful swelling of the lymph nodes after
treatment, but the condition is frequently ignored, misdiagnosed or otherwise left untreated, the
Washington Post reports. The condition, known as lymphedema, affects three million to five million
people in the U.S., including those who have undergone treatment for breast, prostate, ovarian and
other cancers. Most research on lymphedema has focused on its connection with breast cancer surgery
and radiation.
Lymphedema develops when fluid accumulates at or near the surgery site -- typically building up in the
groin, the hands, the arms, the legs or the chest -- because of a blockage in the lymphatic system. Over
time, this causes swelling, which "can get worse, becoming painful, chronic and debilitating: restricting
movement, impeding daily activities and requiring constant care," the Post reports. One patient profiled
in the story uses massage and "wears special garments 24 hours a day to deal with her condition,"
according to the Post. Although cancer surgery is not the sole cause of lymphedema, "there is strong
evidence of cause and effect" when patients undergo cancer surgeries involving examination of the
lymph nodes to determine whether the cancer has spread, the Post reports.
Few doctors and hospitals acknowledge the risk for lymphedema when discussing surgery or cancer
treatment, and patient advocates note that it is not mentioned in consent forms signed prior to surgery
or treatment. The criteria for diagnosing the condition are inconsistent; thus, various estimates about
lymphedema rates in women treated for breast cancer range from 6% to 70%, depending on which
criteria are used, how long after surgery the studies are conducted and which body parts were
examined.
Judy Nudelman, a family physician at Brown University who has lymphoma and also treats patients
with the condition, said many patients become frustrated because doctors and hospitals tell them "we
have zero incidence of lymphedema cases in our institution." According to the Post, some surgeons or
hospitals view lymphedema as a complication and avoid mentioning it for fear of developing a negative
reputation (Mishori, Washington Post, 11/9).
Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily
Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily
Women's Health Policy Report is a free service of the National Partnership for Women & Families.
November 12, 2010
Cancer. 2010 Nov 8. [Epub ahead of print]
Conservative and dietary interventions for cancer-related lymphedema: a Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
Abstract
The findings support the use of compression garments and compression bandaging for reducing
lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast
cancer, a statistically significant, clinically small beneficial effect was found from the addition of manual
lymph drainage massage to compression therapy for upper extremity lymphedema volume. Cancer
2010. © 2010 American Cancer Society.
PMID: 21061344 [PubMed - as supplied by publisher]
Am J Pathol. 2010 Nov 5. [Epub ahead of print]
Blockade of Transforming Growth Factor-{beta}1 Accelerates Lymphatic Regeneration during
Wound Repair.
Avraham T, Daluvoy S, Zampell J, Yan A, Haviv YS, Rockson SG, Mehrara BJ.
From the Division of Plastic and Reconstructive Surgery,* Department of Surgery, Memorial Sloan-
Kettering Cancer Center, New York, New York; the Department of Medicine, Hadassah-Hebrew
University Medical Center, Jerusalem, Israel; and the Division of Cardiology, Department of Medicine,
Stanford University Medical Center, Stanford, California.
Abstract
Lymphedema is a complication of cancer treatment occurring in approximately 50% of patients who
undergo lymph node resection. Despite its prevalence, the etiology of this disorder remains unknown.
In this study, we determined the effect of soft tissue fibrosis on lymphatic function and the role of
transforming growth factor (TGF)-ß1 in the regulation of this response. We determined TGF-ß
expression patterns in matched biopsy specimens collected from lymphedematous and normal limbs of
patients with secondary lymphedema. To determine the role of TGF-ß in regulating tissue fibrosis, we
used a mouse model of lymphedema and inhibited TGF-ß function either systemically with a
monoclonal antibody or locally by using a soluble, defective TGF-ß receptor. Lymphedematous tissue
demonstrated a nearly threefold increase in the number of cells that stained for TGF-ß1. TGF-ß
inhibition markedly decreased tissue fibrosis, increased lymphangiogenesis, and improved lymphatic
function compared with controls. In addition, inhibition of TGF-ß not only decreased TGF-ß
expression in lymphedematous tissues, but also diminished inflammation, migration of T-helper type 2
(Th2) cells, and expression of profibrotic Th2 cytokines. Similarly, systemic depletion of T-cells
markedly decreased TGF-ß expression in tail tissues. Inhibition of TGF-ß function promoted lymphatic
regeneration, decreased tissue fibrosis, decreased chronic inflammation and Th2 cell migration, and
improved lymphatic function. The use of these strategies may represent a novel means of preventing
lymphedema after lymph node resection.
PMID: 21056998 [PubMed - as supplied by publisher]
November 13, 2010
Cancer. 2010 Nov 8. [Epub ahead of print]
Conservative and dietary interventions for cancer-related lymphedema: a Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
Abstract
The findings support the use of compression garments and compression bandaging for reducing
lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast
cancer, a statistically significant, clinically small beneficial effect was found from the addition of manual
lymph drainage massage to compression therapy for upper extremity lymphedema volume. Cancer
2010. © 2010 American Cancer Society.
PMID: 21061344 [PubMed - as supplied by publisher]
November 19, 2010
Arch Surg. 2010 Nov;145(11):1055-63.
Risk factors for lymphedema in a prospective breast cancer survivorship study: the pathways study.
Kwan ML, Darbinian J, Schmitz KH, Citron R, Partee P, Kutner SE, Kushi LH.
Kaiser Permanente Northern California, Oakland, 94612, USA. Marilyn.L.Kwan@kp.org
Comment in:
Arch Surg. 2010 Nov;145(11):1063-4.
Abstract
OBJECTIVE: To determine the incidence of breast cancer-related lymphedema (BCRL) during the
early survivorship period as well as demographic, lifestyle, and clinical factors associated with BCRL
development.
DESIGN: The Pathways Study, a prospective cohort study of breast cancer survivors with a mean
follow-up time of 20.9 months.
SETTING: Kaiser Permanente Northern California medical care program.
PARTICIPANTS: We studied 997 women diagnosed from January 9, 2006, through October 15,
2007, with primary invasive breast cancer and who were at least 21 years of age at diagnosis, had no
history of any cancer, and spoke English, Spanish, Cantonese, or Mandarin.
MAIN OUTCOME MEASURE: Clinical indication for BCRL as determined from outpatient or
hospitalization diagnostic codes, outpatient procedural codes, and durable medical equipment orders.
RESULTS: A clinical indication for BCRL was found in 133 women (13.3%), with a mean time to
diagnosis of 8.3 months (range, 0.7-27.3 months). Being African American (hazard ratio, 1.93; 95%
confidence interval, 1.00-3.72) or more educated (P for trend = .03) was associated with an increased
risk of BCRL. Removal of at least 1 lymph node (hazard ratio, 1.04; 95% confidence interval, 1.02-
1.07) was associated with an increased risk, yet no significant association was observed for type of
lymph node surgery. Being obese at breast cancer diagnosis was suggestive of an elevated risk (hazard
ratio, 1.43; 95% confidence interval, 0.88-2.31).
CONCLUSIONS: In a large cohort study, BCRL occurs among a substantial proportion of early
breast cancer survivors. Our findings agree with those of previous studies on the increased risk of
BCRL with removal of lymph nodes and being obese, but they point to a differential risk according to
race or ethnicity.
PMID: 21079093 [PubMed - in process]
Head Neck. 2010 Nov 12. [Epub ahead of print]
Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Division of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The University of
Texas Health Science Center, Houston, Texas.
Abstract
BACKGROUND: Lymphedema is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions where treatment options
are limited. Although upper and lower extremity lymphedema may be effectively treated with manual
lymphatic drainage (MLD) therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS AND RESULTS: Herein, we describe the compassionate use of an investigatory
technique of near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy and
function, help direct MLD, and use 3-dimensional (3D) surface profilometry to monitor response to
therapy in a patient with head and neck lymphedema after surgery and radiation treatment.
CONCLUSION: NIR fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are needed to assess the
efficacy of MLD therapy when directed by NIR fluorescence imaging. © 2010 Wiley Periodicals, Inc.
Head Neck, 2010.
PMID: 21077150 [PubMed - as supplied by publisher]
Ann Dermatol Venereol. 2010 Nov;137(11):727-9. Epub 2010 Sep 6.
[Unilateral acneiform rash in facial palsy].
[Article in French]
Kerob D, Hennequin V, Bousquet G, Behm E, Lebbe C.
Hôpital Saint-Louis, AP-HP, Paris, France. delphine.kerob@sls.aphp.fr
Abstract
BACKGROUND: Cetuximab is a chimeric monoclonal antibody selective for epidermal growth factor
receptor (EGFR). It is increasingly used in epithelial cancer, often in combination with radiotherapy or
chemotherapeutic agents, since it induces a broad range of cellular responses that enhance tumour
sensitivity to these therapies. However, it can cause numerous adverse effects, the most common being
acneiform eruption on the face and trunk, which is generally bilateral and symmetric.
PATIENTS AND METHODS: Herein we present the first case of unilateral cetuximab-induced
acneiform eruption in facial palsy.
DISCUSSION: To our knowledge the medical literature contains no other such cases. Our hypothesis
is that lymphoedema associated with facial palsy reduces lymphatic drainage, promoting the deposition
of cetuximab on EGFR and persistence of local signs.
Elsevier Masson SAS. All rights reserved.
PMID: 21074658 [PubMed - in process]
November 20, 2010
Head Neck. 2010 Nov 12. [Epub ahead of print]
Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Division of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The University of
Texas Health Science Center, Houston, Texas.
Abstract
BACKGROUND: Lymphedema is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions where treatment options
are limited. Although upper and lower extremity lymphedema may be effectively treated with manual
lymphatic drainage (MLD) therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS AND RESULTS: Herein, we describe the compassionate use of an investigatory
technique of near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy and
function, help direct MLD, and use 3-dimensional (3D) surface profilometry to monitor response to
therapy in a patient with head and neck lymphedema after surgery and radiation treatment.
CONCLUSION: NIR fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are needed to assess the
efficacy of MLD therapy when directed by NIR fluorescence imaging. © 2010 Wiley Periodicals, Inc.
Head Neck, 2010.
PMID: 21077150 [PubMed - as supplied by publisher]
November 27, 2010
Vopr Kurortol Fizioter Lech Fiz Kult. 2010 Jul-Aug;(4):42-8.
[Topical problems of the diagnosis and rehabilitative treatment of lymphedema of the lower extremities].
[Article in Russian]
[No authors listed]
Abstract
The present review of the literature data highlights modern approaches to and major trends in
diagnostics and conservative treatment of lymphedema of the lower extremities based on the
generalized world experience. Patients with lymphedema of the lower extremities comprise a "difficult
to manage" group because the disease is characterized by steady progression and marked
refractoriness to various conservative therapeutic modalities creating problems for both the patient and
the attending physician. Modern methods for the diagnosis of lymphedema are discussed with special
reference to noninvasive and minimally invasive techniques (such as lymphoscintiography, computed
tomography, MRT, laser Doppler flowmetry, etc.). During the last 20 years, combined conservative
therapy has been considered as the method of choice for the management of different stages and forms
of lymphedema of the lower extremities in foreign clinics. The basis of conservative therapy is
constituted by manual lymph drainage (MLD), compression bandages using short-stretch materials,
physical exercises, and skin care (using the method of M. Foldi). Also reviewed are the main
physiobalneotherapeutic methods traditionally widely applied for the treatment of lymphedema of the
lower extremities in this country. Original methods for the same purpose developed by the authors are
described including modifications of cryotherapy, pulsed matrix laserotherapy, hydro- and
balneotherapy. Mechanisms of their therapeutic action on the main pathogenetic factors responsible for
the development of lymphedema (with special reference to lymph transport and formation) are
discussed. The principles of combined application of physiotherapeutic methods for the rehabilitative
treatment of patients presenting with lymphedema of the lower extremities are briefly substantiated.
Special emphasis is laid on their influence on major components of the pathological process.
PMID: 21089207 [PubMed - in process]
November 30, 2010
J Plast Reconstr Aesthet Surg. 2010 Nov 17. [Epub ahead of print]
Simultaneous multi-site lymphaticovenular anastomoses for primary lower extremity and genital
lymphoedema complicated with severe lymphorrhea.
Yamamoto T, Koshima I, Yoshimatsu H, Narushima M, Miahara M, Iida T.
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo,
7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan.
Abstract
Primary lower extremity and genital lymphoedema (GL) is difficult to manage, especially when
complicated with severe lymphorrhea. With abundant experience of treatment for lower-extremity
lymphoedema (LEL), we performed simultaneous multi-site lymphaticovenular anastomoses (LVAs)
for GL with severe lymphorrhea. In two cases of primary LEL and GL, LVAs were performed via 2-
cm-long skin incisions using two to three operating microscopes under local anaesthesia. Symptoms of
oedema and lymphorrhea improved clinically. LVA is a minimally invasive surgery, which is effective
for the treatment of LEL and GL even in primary cases with severe lymphorrhea. Simultaneous multi-
site LVAs can serve as the most effective therapy for lymphoedema.
2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd.
All rights reserved.
PMID: 21093398 [PubMed - as supplied by publisher]
Rev Med Interne. 2010 Nov 17. [Epub ahead of print]
[Inflammatory bowel disease and lower limb lymphedema: A fortuitous association?][Article in French]
Arrault M, Blanchard M, Vignes S.
Unité de lymphologie, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
INTRODUCTION: Extra-intestinal manifestations of chronic inflammatory bowel disease (CIBD) are
various. Cases of genital lymphedema has previously been reported in Crohn's disease.
CASE REPORTS: We report two women aged 57 and 68 years who presented with a lower limb
lymphedema 8 and 20 years after a diagnosis of CIBD (Crohn's disease and ulcerative colitis),
respectively. At the time of diagnosis of lymphedema, CIBD was asymptomatic.
CONCLUSION: Pathophysiological mechanisms of this rare manifestation are unclear and
lymphedema outcome is unrelated to CIBD activity.
Copyright © 2010. Published by Elsevier SAS.
PMID: 21093120 [PubMed - as supplied by publisher]
J Med Case Reports. 2010 Nov 18;4(1):369. [Epub ahead of print]
Vulval elephantiasis as a result of tubercular lymphadenitis: two case reports and a review of the
literature.
Chintamani, Singh J, Tandon M, Khandelwal R, Aeron T, Jain S, Narayan N, Bamal R, Kumar Y,
Srinivas S, Saxena S.
ABSTRACT:
INTRODUCTION: Elephantiasis as a result of chronic lymphedema is characterized by gross
enlargement of the arms, legs or genitalia, and occurs due to a variety of obstructive diseases of the
lymphatic system. Genital elephantiasis usually follows common filariasis and lymphogranuloma
venereum. It may follow granuloma inguinale, carcinomas, lymph node dissection or irradiation and
tuberculosis but this happens rarely. Vulval elephantiasis as a consequence of extensive lymph node
destruction by tuberculosis is very rare. We present two very unusual cases of vulval elephantiasis due
to tuberculous destruction of the inguinal lymph nodes.
CASE PRESENTATION: Two Indian women - one aged 40 years and the other aged 27 years, with
progressively increasing vulval swellings over a period of five and four years respectively - presented to
our hospital. In both cases, there was a significant history on presentation. Both women had previously
taken a complete course of anti-tubercular treatment for generalized lymphadenopathy. The vulval
swellings were extremely large: in the first case report, measuring 35x25cm on the right side and
45x30cm on the left side, weighing 20lb and 16lb respectively. Both cases were managed by surgical
excision with reconstruction and the outcome was positive. Satisfactory results have been maintained
during a follow-up period of six years in both cases.
CONCLUSIONS: Elephantiasis of the female genitalia is unusual and it has rarely been reported
following tuberculosis. We report two cases of vulval elephantiasis as a consequence of extensive
lymph node destruction by tuberculosis, in order to highlight this very rare clinical scenario.
PMID: 21092075 [PubMed - as supplied by publisher]
-------------------
December 3, 2010
Arch Surg. 2010 Nov;145(11):1063-4.
Risky business: Identifying risk factors associated with lymphedema after breast cancer: Comment on
"Risk factors for lymphedema in a prospective breast cancer survivorship study".
Hunt KK, Cormier JN.
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston,
77030, USA.
Comment on:
Arch Surg. 2010 Nov;145(11):1055-63.
PMID: 21121095 [PubMed - in process]
December 21, 2010
Am J Surg Pathol. 2011 Jan;35(1):70-5.
Pediatric cutaneous angiosarcomas: a clinicopathologic study of 10 cases.
Deyrup AT, Miettinen M, North PE, Khoury JD, Tighiouart M, Spunt SL, Parham DM, Shehata BM,
Weiss SW.
Pathology Consultants, Greenville, SC 29605, USA. adeyrup@ghs.org
Abstract
Cutaneous angiosarcomas are rare tumors, which predominantly arise in the sun-exposed skin of the
head and neck of adult and elderly patients. Rarely, these tumors can be seen in children. We identified
cutaneous angiosarcomas in 10 children and assessed clinical (patient age, tumor site, tumor size, and
tumor focality) and histologic features including growth pattern (vasoformative vs. solid), mitotic rate
(mitotic figures per 10 high power field), necrosis (present vs. absent), and cell shape (epithelioid vs.
nonepithelioid). Tumors predominated in the lower extremities (6 of 10) of female patients (2 male and
8 female); age at diagnosis ranged from 1.5 months to 15 years. Four patients had preexisting
conditions: congenital hemihypertrophy of the contralateral limb, the Aicardi syndrome, congenital
lymphedema, and congenital hemangioma treated with radiation therapy. Tumors were located in the
lower extremity (6), flank (1), elbow (1), and buccal mucosa (1), and ranged in size from 0.6 to 6.5
cm. Eight cases showed predominantly epithelioid morphology, 1 case showed mixed epithelioid and
spindled morphology and 1 case was entirely spindled. Mitotic activity ranged from 1 to 55 mitotic
figures per 10 high power field. Necrosis was seen in 5 cases. Clinical follow-up was obtained for 9
patients: 4 died of disease (range, 12 to 49 mo; mean, 25 mo) and 5 patients were alive without
disease (18 mo to 28 y). Five patients had metastatic disease; sites of involvement included the lung,
soft tissue, lymph node, pleura, liver, and bone. Cutaneous angiosarcomas in children are rare tumors,
which are commonly associated with a preexisting condition, suggesting a greater role for genetics as
opposed to environmental factors in the pathogenesis of these tumors.
PMID: 21164289 [PubMed - indexed for MEDLINE]
Am J Surg Pathol. 2011 Jan;35(1):60-9.
Primary cutaneous epithelioid angiosarcoma: a clinicopathologic study of 13 cases of a rare neoplasm
occurring outside the setting of conventional angiosarcomas and with predilection for the limbs.
Suchak R, Thway K, Zelger B, Fisher C, Calonje E.
Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London,
UK.
Abstract
Epithelioid angiosarcomas are rare aggressive neoplasms that occur most frequently in deep soft
tissues. Primary cutaneous lesions are rare, and there are discrepant findings in the literature regarding
their behavior. In this study, we report a series of 13 cases of primary cutaneous epithelioid
angiosarcoma and analyze their clinicopathologic features. The tumors arising in the conventional
settings for cutaneous angiosarcoma (ie, in the head and neck region of elderly patients, and those
occurring postradiation or associated with lymphedema) were excluded. Primary cutaneous epithelioid
angiosarcoma occurred in adults (mean age, 66 y) with an equal sex distribution, and presented as
solitary (n=10) or multiple (n=3) nodules ranging in size from 8 to 80 mm, with a predilection for the
limbs (n=10). Histopathologically, the tumors comprised infiltrative sheets of atypical epithelioid cells
within the dermis with or without the involvement of the subcutis. Vascular channel formation and
intracytoplasmic lumina were seen, at least focally, in most cases. Mitoses were readily identified and
necrosis was seen in 40% of the cases. The tumors were immunoreactive for vascular markers, with
CD31 and FLI-1 offering the highest sensitivity. Pancytokeratin was positive in two thirds of the cases,
and epithelial membrane antigen was positive in one-quarter of the cases. There was rare focal
expression of Melan-A (n=2) and smooth muscle actin (n=3). Follow-up information was available for
11 patients. Six patients died of metastatic disease after a median follow-up of 12 months (range, 3 to
36 mo), and 1 patient died of unrelated causes. These findings suggest that primary cutaneous
epithelioid angiosarcoma occurring outside the conventional settings of angiosarcoma is a highly
aggressive malignant tumor with mortality rates in excess of 55% after 3 years.
PMID: 21164288 [PubMed - indexed for MEDLINE]
Br J Radiol. 2010 Dec 15. [Epub ahead of print]
Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography.
Lohrmann C, Foeldi E, Langer M.
Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg,
Germany.
Abstract
Objective: Lymphocutaneous fistulas with intractable lymphatic leakage represent a serious clinical
condition leading to a severe impairment of quality of life for the affected patients. To date, no adequate
diagnostic imaging modality is in existence, to allow selection of the correct treatment option. The aim
of this study was to perform a pre-therapeutic evaluation of the lymphatic system in patients with
lymphocutaneous fistulas by magnetic resonance lymphangiography (MRL).
Methods: Eight lower extremities in four patients with lymphocutaneous fistulas were examined by
MRL. Three locations were examined: first, the lower leg and foot regions; second, the upper leg and
the knee region; and third, the pelvic and retroperitoneal regions. A T(1) weighted three-dimensional
(3D) spoiled gradient echo and a T(2) weighted 3D turbo spin echo sequence were utilised to
undertake MRL.
Results: In all four patients (100%), the clinically suspected lymphocutaneous fistulas (groin and
forefoot) were exactly delineated by MRL. In two patients (50%) adjacent diffuse lymphangiomatous
changes were detected, extending into the upper leg, pelvis, retroperitoneum, abdomen and abdominal
walls. In one patient (25%) with primary lymphoedema of the right lower extremity, MRL revealed an
aplasia of the lymphatic collectors at the levels of the lower and upper leg. All patients (100%) suffered
from an ipsilateral lymphoedema of the lower extremity, whereby in two patients with diffuse
lymphangiomatosis, the lymphatic vessels were consecutively enlarged up to a diameter of 6 
mm.
Conclusion: MRL is a safe and accurate imaging modality for a comprehensive evaluation of the
lymphatic system in patients suffering from lymphocutaneous fistulas.
PMID: 21159808 [PubMed - as supplied by publisher]
December 24, 2010
Am J Phys Med Rehabil. 2011 Feb;90(2):89-96.
The frequency of lymphedema in an adult spina bifida population.
Garcia AM, Dicianno BE.
From the Dept. of Physical Medicine and Rehabilitation (AMG, BED); Adult Outpatient Spina Bifida
Clinic University of Pittsburgh Medical Center (UPMC) (BED); Human Engineering Research
Laboratories, VA Pittsburgh Healthcare System (BED); and Dept. of Rehabilitation Science and
Technology, University of Pittsburgh (BED), Pennsylvania.
Abstract
OBJECTIVE: : In the United States, there are more than 100,000 people with spina bifida. There have
been very few studies to date documenting the occurrence of lymphedema in the spina bifida
population, despite a case series in 2001 that suggested that the occurrence may be higher than in the
general population. Currently, approximately 1 million people have lymphedema in the United States.
The purpose of this study was to document the occurrence of lymphedema and associated medical
factors in a regional adult spina bifida population.
DESIGN: : A total of 240 electronic medical records from the Adult Spina Bifida Clinic from January
2005 to August 2008 were retrospectively reviewed. Subjects were divided into two groups based on
the presence or absence of lymphedema. ? analyses were used to compare lymphedema groups with
respect to history of medical comorbidities and ethnicity. Fisher exact tests were used to compare
groups with respect to mobility status and the presence of power wheelchair seat functions. Mann-
Whitney U tests were used to compare groups with respect to age, anatomic lesion level, employment
level, and income.
RESULTS: : Twenty-two (9.2%) patients had lymphedema. Mean ± SD population age was 35.1 ±
11.1 yrs. Lymphedema was associated with a history of trauma (P = 0.044), cellulitis (P < 0.001),
cancer (P = 0.038), obesity (P < 0.001), wounds (P < 0.001), hypertension (P = 0.036), higher lesion
level spina bifida (P = 0.049), and mobility status (P = 0.007). Hypertension and obesity were present
in 38.3% and 37.5% of the total study population, respectively.
CONCLUSIONS: : This is the first study to document the occurrence of lymphedema in a spina bifida
patient population, which was almost 100 times higher than that in the general patient population. We
also documented a high occurrence of hypertension and obesity in the total study population. These
findings may help guide further prospective studies to more clearly delineate the risk factors for the
development of lymphedema and to determine the appropriate therapies. Better screening, prevention
and treatment algorithms are needed for hypertension and obesity in the spina bifida population.
PMID: 21173682 [PubMed - in process]
Cir Cir. 2010 Jul-Aug;78(4):310-4.
[Collagen-polyvinylpyrrolidone: a new therapeutic option for treatment of sequelae after radical
mastectomy in women with breast cancer. Preliminary study].
[Article in Spanish]
Ruiz-Eng R, Montiel-Jarquín A, de la Rosa-Pérez R, López-Colombo A, Gómez-Conde E, Zamudio-
Huerta L.
Departamento de Cirugía Plástica, Hospital General Regional 36, Instituto Mexicano del Seguro
Social, Puebla, México. alvaro.montielj@imss.gob.mx
Abstract
BACKGROUND: Approximately 30% of women who undergo mastectomy without reconstructive
treatment due to breast cancer present sequelae. These include paresthesias, keloid healing,
hypoesthesia, lymphedema and limitation of the function of the ipsilateral upper extremity. We
undertook this study to present the results using collagen-polyvinylpyrrolidone (Clg- Pvp) as treatment
for posmastectomy sequelae in women with breast cancer.
METHODS: We conducted a unicentric, longitudinal and prospective clinical trial between August 1,
2007 and July 31, 2008. Included variables were age, lymphedema, limitation of the function of the
ipsilateral upper extremity, collapse of the wound, keloid healing, paresthesias, and appearance of the
surgical area. The appearance of the surgical area (aesthetic aspect) was evaluated before and 6
months after treatment was initiated. Clg-Pvp was administered weekly for a 6-month period.
RESULTS: Seven women were included with a median age of 49 years (range: 40-72 years). One
patient (14.28%) presented lymphedema, two patients (28.57%) presented collapse of the wound,
two patients (28.57%) had keloid healing, three patients (42.85%) experienced paresthesias, five
patients (71.4%) reported pain, and five patients (71.4%) reported limitation of the function of the
ipsilateral upper extremity. At the completion of the treatment, aesthetic improvement was statistically
significant (p = 0.0020, Mann-Whitney U test).
CONCLUSIONS: Clinical and aesthetic results are good after application of Clg-Pvp for treating
sequelae in women with breast cancer who underwent mastectomy without reconstructive surgery.
PMID: 21167096 [PubMed - in process]
December 25, 2010
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Sep;26(5):337-9.
[Treatment of chronic extremity lymphedema with manual lymph drainage].
[Article in Chinese]
Liu NF, Wang L, Chen JL, Zhou JG, Wu XF, Yan ZX, Jiang ZH.
Department of Plastic & Reconstructive Surgery, Lymphology Center, Shanghai 9th People's Hospital,
Shanghai Jiao Tong University, Shanghai 200011, China.
Abstract
OBJECTIVE: To evaluate the effect of manual lymph drainage on chronic extremity lymphedema.
METHODS: Fifty patients with chronic lymphedema of extremity were treated with manual lymph
drainage (MLD) complex decongestion therapy. Among them, 29 had primary lymphedema, 21 had
secondary lymphedema. 42 had lymphedema of lower extremity and 8 had lymphedema of upper limb.
The result of treatment was evaluated with measurement of circumference of extremities and edema
fluid in tissue with Multiple-frequency bioelectrical impedance analysis.
RESULTS: After 1-2 treatment courses, all 50 patients showed significant decrease of circumference
of lymphedmatous limbs (P < 0.05) and remarkable reduction of accumulated edema fluid in tissue (P
< 0. 05). There was highly correlation between the decrease of limb circumference and edema fluid in
tissue (r(s) = 0.774, P < 0.01).
CONCLUSIONS: MLD complex decongestion therapy is effective for the treatment of chronic
lymphedema of extremity.
PMID: 21174786 [PubMed - in process]
December 28, 2010
Nephrology (Carlton). 2010 Dec;15(8):779-80. doi: 10.1111/j.1440-1797.2010.01323.x.
Unilateral upper limb lympatic obstruction and severe lymphoedema in a patient on long-term sirolimus.
Damasiewicz MJ, Ierino FL.
PMID: 21175966 [PubMed - in process]
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Sep;26(5):337-9.
[Treatment of chronic extremity lymphedema with manual lymph drainage].
[Article in Chinese]
Liu NF, Wang L, Chen JL, Zhou JG, Wu XF, Yan ZX, Jiang ZH.
Department of Plastic & Reconstructive Surgery, Lymphology Center, Shanghai 9th People's Hospital,
Shanghai Jiao Tong University, Shanghai 200011, China.
Abstract
OBJECTIVE: To evaluate the effect of manual lymph drainage on chronic extremity lymphedema.
METHODS: Fifty patients with chronic lymphedema of extremity were treated with manual lymph
drainage (MLD) complex decongestion therapy. Among them, 29 had primary lymphedema, 21 had
secondary lymphedema. 42 had lymphedema of lower extremity and 8 had lymphedema of upper limb.
The result of treatment was evaluated with measurement of circumference of extremities and edema
fluid in tissue with Multiple-frequency bioelectrical impedance analysis.
RESULTS: After 1-2 treatment courses, all 50 patients showed significant decrease of circumference
of lymphedmatous limbs (P < 0.05) and remarkable reduction of accumulated edema fluid in tissue (P
< 0. 05). There was highly correlation between the decrease of limb circumference and edema fluid in
tissue (r(s) = 0.774, P < 0.01).
CONCLUSIONS: MLD complex decongestion therapy is effective for the treatment of chronic
lymphedema of extremity.
PMID: 21174786 [PubMed - in process]
December 31, 2010
Plast Reconstr Surg. 2010 Dec 23. [Epub ahead of print]
Differential Diagnosis of Lower Extremity Enlargement in Pediatric Patients Referred with a Diagnosis
of "Lymphedema"
Schook CC, Mulliken JB, Fishman SJ, Alomari AI, Grant FD, Greene AK.
1Departments of Plastic and Oral Surgery, 2Surgery, 3Radiology, Vascular Anomalies Center,
Children's Hospital Boston, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: There are many causes for a large lower limb in the pediatric age group. These
children are often mislabeled as having "lymphedema", and incorrect diagnosis can lead to improper
treatment. The purpose of this study was to determine the differential diagnosis in pediatric patients
referred for lower extremity "lymphedema" and to clarify management.
METHODS: Our Vascular Anomalies Center database was reviewed between 1999 - 2010 for
patients referred with a diagnosis of "lymphedema" of the lower extremity. Records were studied to
determine the correct etiology for the enlarged extremity. Alternative diagnoses, gender, age-of-onset,
and imaging studies also were analyzed.
RESULTS: A referral diagnosis of lower extremity "lymphedema" was given to 170 children; however,
the condition was confirmed in only 72.9% of patients. Forty-six children (27.1%) had another
disorder: micro/macrocystic lymphatic malformation (19.6%), non-eponymous combined vascular
malformation (13.0%), capillary malformation (10.9%), Klippel-Trenaunay syndrome (10.9%), hemi-
hypertrophy (8.7%), post-traumatic swelling (8.7%), Parkes Weber syndrome (6.5%), lipedema
(6.5%), venous malformation (4.3%), rheumatologic disorder (4.3%), infantile hemangioma (2.2%),
kaposiform hemangioendothelioma (2.2%), or lipofibromatosis (2.2%). Age-of-onset in children with
lymphedema was older than patients with another diagnosis (p = 0.027).
CONCLUSION: "Lymphedema" is not a generic term. Approximately one-fourth of pediatric patients
with a large lower extremity are misdiagnosed as having "lymphedema"; the most commonly confused
etiologies are other types of vascular anomalies. History, physical examination, and often radiological
studies are required to differentiate lymphedema from other conditions to ensure the child is managed
appropriately.
PMID: 21187804 [PubMed - as supplied by publisher]
Oncol Nurs Forum. 2011 Jan 1;38(1):E27-36.
The role of information sources and objective risk status on lymphedema risk-minimization behaviors in
women recently diagnosed with breast cancer.
Sherman KA, Koelmeyer L.
Department of Psychology, Macquarie University, Sydney, Australia. kerry.sherman@mq.edu.au
Abstract
PURPOSE/OBJECTIVES: to assess the role of education sources and objective risk status on
knowledge and practice of lymphedema risk-minimization behaviors among women recently diagnosed
with breast cancer.
RESEARCH APPROACH: prospective survey.
SETTING: a hospital in Sydney, Australia.
PARTICIPANTS: 106 women recently diagnosed with breast cancer at increased risk for developing
lymphedema following lymph node dissection.
METHODOLOGIC APPROACH: a questionnaire administered at the time of surgery and three
months after surgery measured demographics, lymphedema knowledge, lymphedema information
sources used, and adherence to risk-minimization recommendations.
MAIN RESEARCH VARIABLES: lymphedema knowledge, source of information used, objective
lymphedema risk, and adherence to risk-minimization behaviors.
FINDINGS: knowledge was high and increased over time. Lymphedema information from the clinic (e.
g., brochures, nursing staff) was the most cited source. Adherence to recommendations was moderate;
nonadherence was mostly for behaviors requiring regular enactment. Regression analysis revealed that
only receipt of information from nursing staff and lymphedema knowledge three months after surgery
were significant predictors of risk-minimization behaviors.
CONCLUSIONS: exposing women to lymphedema risk information at the time of breast cancer
diagnosis facilitates
increased awareness and enactment of risk-minimization behaviors. Nursing staff play a key role in
disseminating this information and in convincing women to perform the recommendations.
INTERPRETATION: provision of lymphedema education by breast clinic staff is critical to ensure that
women realize the importance of early detection and treatment. Reminder booster sessions by nursing
staff may be beneficial particularly for longer-term knowledge retention and adherence to
recommended behaviors.
PMID: 21186149 [PubMed - in process]
Oncol Nurs Forum. 2011 Jan 1;38(1):E1-E10.
Lymphedema in patients with head and neck cancer.
Deng J, Ridner SH, Murphy BA.
School of Nursing, Vanderbilt University, Nashville, TN, USA. jie.deng@vanderbilt.edu
Abstract
PURPOSE/OBJECTIVES: to describe the current state of the science on secondary lymphedema in
patients with head and neck cancer.
DATA SOURCES: published journal articles and books and data from the National Cancer Institute,
the American Cancer Society, and other healthcare-related professional association Web sites.
DATA SYNTHESIS: survivors of head and neck cancer may develop secondary lymphedema as a
result of the cancer or its treatment. Secondary lymphedema may involve external (e.g., submental
area) and internal (e.g., laryngeal, pharyngeal, oral cavity) structures. Although lymphedema affects
highly visible anatomic sites (e.g., face, neck), and profoundly influences critical physical functions (e.g.,
speech, breathing, swallowing, cervical range of motion), research regarding this issue is lacking.
Studies are needed to address a variety of vital questions, including incidence and prevalence, optimal
measurement techniques, associated symptom burden, functional loss, and psychosocial impact.
CONCLUSIONS: secondary lymphedema in patients with head and neck cancer is a significant but
understudied issue.
IMPLICATIONS FOR NURSING: a need exists to systematically examine secondary lymphedema
related to treatment for head and neck cancer and address gaps in the current literature, such as
symptom burden, effects on body functions, and influences on quality of life. Oncology nurses and
other healthcare professionals should have empirical evidence to help them manage lymphedema after
head and neck cancer treatment.
PMID: 21186146 [PubMed - in process]
Breast J. 2010 Nov-Dec;16(6):639-43.
Anatomical and Surgical Concepts in Lymphatic Regeneration.
Avraham T, Daluvoy SV, Kueberuwa E, Kasten JL, Mehrara BJ.
The Division of Plastic and Reconstructive Surgery, The Department of Surgery, Memorial Sloan-
Kettering Cancer Center, New York City, New York 10065, USA. mehrarab@mskcc.org
Abstract
Chronic post-surgical lymphedema is common condition that afflicts nearly 2 million Americans. In the
USA, it is most commonly encountered in the upper extremities of patients who have undergone
axillary lymph node dissection for breast cancer. Lymphedema has a significant negative effect on
cosmesis, limb function, and overall quality of life. Despite the impact of this condition, very little is
known about how to effectively prevent or treat lymphedema. While therapeutic options for chronic
extremity lymphedema remain limited, several surgical approaches have been suggested. These include
techniques aimed at reducing limb volume, as well as techniques that aim to reconstitute disrupted
lymphatic channels. Operations proposed to re-establish lymphatic continuity include lymphatico-
venous anastomoses, lymphatico-lymphatico anastomoses, and tissue transfer.
PMID: 21121083 [PubMed - in process]
Eur J Surg Oncol. 2010 Nov 27. [Epub ahead of print]
Cost-effectiveness of MRI and PET imaging for the evaluation of axillary lymph node metastases in
early stage breast cancer.
Meng Y, Ward S, Cooper K, Harnan S, Wyld L.
School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street,
Sheffield S1 4DA, UK.
Abstract
BACKGROUND: UK guidelines for breast cancer recommend axillary nodal assessment via surgical
methods such as sentinel lymph node biopsy (SLNB). However, these procedures are associated with
adverse effects such as lymphoedema. Magnetic resonance imaging (MRI) and positron emission
tomography (PET) are non-invasive imaging techniques. The aim of this study is to evaluate the cost-
effectiveness of MRI and PET compared with SLNB for assessment of axillary lymph node metastases
in newly-diagnosed early stage breast cancer patients in the UK.
METHODS: An individual patient discrete-event simulation model was developed in SIMUL8(®) to
estimate the lifetime costs and benefits of replacing SLNB with MRI or PET, or adding MRI or PET
before SLNB. Effectiveness outcomes were derived from a recent systematic review; patient utilities
and resource use data were sourced from the literature.
RESULTS: Based on our analysis the baseline SLNB strategy is dominated by the strategies of
replacing SLNB with either MRI or PET. The strategy of replacing SLNB with MRI has the highest
total quality-adjusted life years (QALYs) and lowest total costs. However, clinical evidence for MRI is
based on a limited number of small studies and replacing SLNB with MRI or PET leads to more false-
positive and false-negative cases. The strategy of adding MRI before SLNB is cost-effective, but
subject to greater uncertainty.
CONCLUSIONS: Based on this analysis the most cost-effective strategy is to replace SLNB with
MRI. However, further large studies using up-to-date techniques are required to obtain more accurate
data on the sensitivity and specificity of MRI.
Elsevier Ltd. All rights reserved.
PMID: 21115232 [PubMed - as supplied by publisher]
Recent Results Cancer Res. 2011;186:189-215.
Physical activity and breast cancer survivorship.
Schmitz K.
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 903
Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA, Schmitz@mail.med.upenn.
edu.
Abstract
A diagnosis of breast cancer is associated with treatments that have physiologic effects beyond the
intended curative therapy. The first section of this chapter provides and integrative physiology review of
the effects of breast cancer treatment on the body systems used by and affected by physical activity,
including effects of chemotherapy, radiation, and surgery. In later sections, we review the literature on
physical activity and breast cancer from the point of diagnosis and for the balance of life. The efficacy
of physical activity for supportive cancer care outcomes is reviewed separately from the purported
usefulness of physical activity for disease-free and overall survival from breast cancer. The current
evidence supports the safety of physical activity during and after breast cancer therapy. The supportive
cancer care outcomes for which there is sufficient evidence of efficacy during and after breast cancer
treatment include fitness, fatigue, body size, and quality of life. Further, there is growing evidence that
upper body exercise does not pose additional risk for negative lymphedema outcomes among survivors
with and at risk for lymphedema. For overall survival, the evidence is largely observational, with
sufficient evidence that physical activity does confer benefit. Finally, we outline future directions for
research on physical activity among breast cancer survivors, including expanding to focus on subsets of
the population not included in most prior studies (minority women and older women), tailoring of
interventions to stages of cancer most likely to benefit, expanding to study women with metastatic
cancer, and new modes of exercise, such as team sports, martial arts, and Pilates.
PMID: 21113765 [PubMed - in process]
Arch Phys Med Rehabil. 2010 Dec;91(12):1844-8.
Effect of active resistive exercise on breast cancer-related lymphedema: a randomized controlled trial.
Kim do S, Sim YJ, Jeong HJ, Kim GC.
Abstract
Kim DS, Sim Y-J, Jeong HJ, Kim GC. Effect of active resistive exercise on breast cancer-related
lymphedema: a randomized controlled trial.
OBJECTIVE: To investigate the differences between the effects of complex decongestive
physiotherapy with and without active resistive exercise for the treatment of patients with breast cancer-
related lymphedema (BCRL).
DESIGN: Randomized control-group study.
SETTING: An outpatient rehabilitation clinic.
PARTICIPANTS: Patients (N=40) with diagnosed BCRL.
INTERVENTIONS: Patients were randomly assigned to either the active resistive exercise group or
the nonactive resistive exercise group. In the active resistive exercise group, after complex
decongestive physiotherapy, active resistive exercise was performed for 15min/d, 5 days a week for 8
weeks. The nonactive resistive exercise group performed only complex decongestive physiotherapy.
MAIN OUTCOME MEASURES: The circumferences of the upper limbs (proximal, distal, and total)
for the volume changes, and the Short Form-36 version 2 questionnaire for the quality of life (QOL) at
pretreatment and 8 weeks posttreatment for each patient.
RESULTS: The volume of the proximal part of the arm was significantly more reduced in the active
resistive exercise group than that of the nonactive resistive exercise group (P<.05). In the active
resistive exercise group, there was significantly more improvement in physical health and general health,
as compared with that of the nonactive resistive exercise group (P<.05).
CONCLUSIONS: For the treatment of patients with BCRL, active resistive exercise with complex
decongestive physiotherapy did not cause additional swelling, and it significantly reduced proximal arm
volume and helped improve QOL.
American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 21112424 [PubMed - in process]
Gynecol Obstet Fertil. 2010 Nov 24. [Epub ahead of print]
[Sentinel lymph node procedure and uterine cancers.][Article in French]
Huchon C, Bats AS, Achouri A, Lefrère-Belda MA, Buénerd A, Bensaid C, Farragi M, Mathevet P,
Lécuru F.
Service de chirurgie gynécologique et cancérologique, hôpital européen Georges-Pompidou, AP-HP,
20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes,
75006 Paris, France.
Abstract
Lymph node metastases in cervical and endometrial cancer are major prognostic factors. Lymph-nodal
involvement determines adjuvant therapy. As imagery is not reliable to diagnose lymph node status,
pelvic +/- para-aortic lymphadenectomy remains the gold standard. These surgical procedures are,
however, responsible for specific morbidity: lymphocele and lymphedema. Sentinel lymph node
procedure could avoid lymphadenectomy and their complications in cervical and endometrial cancer
with good negative predictive values. We present actual indications, procedure and results of sentinel
lymph node procedures in cervical and endometrial cancer.
Copyright © 2010 Elsevier Masson SAS. All rights reserved.
PMID: 21111648 [PubMed - as supplied by publisher]
December 7, 2010
Am J Clin Oncol. 2010 Nov 30. [Epub ahead of print]
Estimating the Probability of Lymphedema After Breast Cancer Surgery.
Soran A, Wu WC, Dirican A, Johnson R, Andacoglu O, Wilson J.
*Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of
Pittsburgh Medical Center †Department of Biostatistics, Graduate School of Public Health, University
of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVES: Lymphedema is a common complication of breast cancer surgery, leading to a
decreased quality of life. The risk and severity of lymphedema were associated with surgery side upper
extremity infection, =25 kg/m body mass index (BMI), and the level of hand use (LHU). Our aim was
to estimate the probability of lymphedema after breast cancer surgery by using previously published
incidence rates and these 3 risk factors.
METHODS: The design was a n:m matched case control study; data were analyzed on 51 patients
with lymphedema and 126 available controls matched on age, radiation therapy, and operation type. In
conjunction with published estimates of lymphedema, incidence rates, and estimates of the proportions
of risk factor combinations in cases and controls, the Bayes' theorem was used to estimate the
probability of developing lymphedema.
RESULTS: Lymphedema probabilities of 7 combinations for 6 different published calculations were
used. With the assumption of 16% LE incidence rate of lymphedema, a BMI<25, no infection, and a
low LHU, the estimated probability of lymphedema was 6.8%. With the assumption of 46.3% LE
incidence a BMI =25, infection, and a high LHU led to an estimated lymphedema probability of 93.7%.
CONCLUSIONS: This study shows that control of predisposing factors in both high and low
incidence rates has a marked effect on the probability of LE development. In other words, patients with
low incidence for LE are more prone to develop LE if the predisposing factors are controlled poorly
compared to the high incidence patients whom the predisposing factors are avoided.
PMID: 21127413 [PubMed - as supplied by publisher]
Plast Reconstr Surg. 2010 Dec;126(6):1853-63.
Overview of surgical treatments for breast cancer-related lymphedema.
Suami H, Chang DW.
Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer
Center.
Abstract
SUMMARY:: Breast cancer-related upper extremity lymphedema is an unsolved iatrogenic
complication with a reported incidence ranging from 9 to 41 percent. The increase in volume and
recurrent cellulitis of the affected limb cause both physical and mental distress to many breast cancer
survivors. However, postmastectomy lymphedema has received little attention, and no curative
treatment is available. Conservative treatment with decongestive therapy has been the primary choice
for lymphedema treatment, but it is cumbersome and has limited benefits. To date, there is no
consensus on surgical procedure and protocol. However, refinements in microsurgical techniques and
improved examination devices may lead to the establishment of a standard surgical treatment for
lymphedema. This review of surgical procedures for the treatment of postmastectomy lymphedema
focuses on microsurgical lymphovenous shunt operations and discusses current issues in surgical
treatment and the need for uniform treatment standards.
PMID: 21124127 [PubMed - in process]
December 17, 2010
Indian J Ophthalmol. 2011 Jan-Feb;59(1):71-2.
Distichiasis-lymphedema syndrome with optic disc pit.
Kaarthigeyan K, Ramprakash M, Kalpana G.
PMID: 21157084 [PubMed - in process
Br J Dermatol. 2010 Dec 14. doi: 10.1111/j.1365-2133.2010.10179.x. [Epub ahead of print]
Changes in the nail unit in patients with secondary lymphoedema identified using clinical, dermoscopic
and ultrasound examination.
Le Fourn E, Duhard E, Tauveron V, Maruani A, Samimi M, Lorette G, Vaillant L, Machet L.
Department of Dermatology, CHRU Tours, Tours, France Lymphology unit, CHRU de Tours, Tours,
France University François Rabelais de Tours; Tours, France UMR INSERM U930, ERL 3106,
Tours, France.
Abstract
Background Secondary lymphoedema is characterized by lymphatic stasis that is often the result of a
lymph node lesion. At advanced stages it may cause trophic changes in the skin. However, the
presence of changes in the nail unit has not been reported to date.
Objectives The aim of this study was to determine the presence of nail abnormalities in cases of
secondary lymphoedema.
Methods This was a prospective study, conducted on patients with unilateral secondary lymphoedema.
A comparative clinical and dermoscopic examination and 20 MHz high resolution ultrasound imaging of
the affected limb and the contralateral limb were performed Results Thirty-three patients were
included. On physical examination, hyperkeratosis of the lateral nail folds, friability of the nail surface,
"ragged" proximal nail folds and cuticle and apparent leuconychia were observed more frequently on
the lymphoedematous limb. The ultrasound study of the nails of the thumb and the big toe did not reveal
any differences in thickness of the different structures of the nail between the lymphoedema side and the
opposite side. The nail matrix was longer on the lymphoedema side.
Conclusions Our study showed mild changes in the nail unit compatible with the xerosis often
associated with severe lymphoedema. However, the study also showed frequent evidence of "ragged"
cuticles which in these patients at high risk of erysipelas are entry points for bacteria. This should be
taken into account when counselling patients with limb lymphoedema in order to prevent erysipelas.
2010 British Association of Dermatologists.
PMID: 21155752 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2010 Dec 14. [Epub ahead of print]
A Pilot Study Reporting Outcomes for Melanoma Patients of a Minimal Access Ilio-inguinal Dissection
Technique Based on Two Incisions.
Spillane AJ, Tucker M, Pasquali S.
Sydney Medical School, The University of Sydney, Sydney, Australia, andrew.spillane@melanoma.org.
au.
Abstract
BACKGROUND: A modified procedure for ilio-inguinal regional lymph node dissection (I-I RLND)
involving 2 small skin incisions was evaluated with the aim of assessing surgical and oncological
noninferiority compared with the traditional single, longitudinal incision I-I RLND.
MATERIALS AND METHODS: A total of 20 melanoma patients with positive groin lymph nodes
who had traditional I-I RLND were compared with 20 patients who had a minimal access I-I RLND
using 2 small surgical access incisions of 3-6 cm in length-one sited below and one above the inguinal
ligament. Clinical, staging features, number of lymph nodes retrieved, length of hospital stay, time drains
remained in situ, morbidity (wound infections, dehiscence, hematoma, seroma, and lymphedema), and
disease free survival were compared.
RESULTS: Patients in the groups were comparable with the exception that the minimal access I-I
RLND group had a higher rate of AJCC stage N3 disease (60% vs 20%; P = .03) and more cases
with extranodal spread (45% vs 15%; P = .041). After a median follow-up of 5 months (range 1-8)
for the minimal access group and median 13 months (range 1-30) for the standard group there were no
differences in disease-free survival (P = .13). Retrieved lymph node counts were similar (P = .34)
including for the inguinal and pelvic components of the operations separately. No significant differences
in wound complications or rates of early lymphedema were observed.
CONCLUSIONS: At early follow-up, minimal access I-I RLND is feasible and noninferior to single
longitudinal incision I-I RLND in regard to surgical morbidity and oncological outcome. Further
evaluation is progressing.
PMID: 21153883 [PubMed - as supplied by publisher]
PLoS Negl Trop Dis. 2010 Nov 30;4(11):e902.
Effectiveness of a simple lymphoedema treatment regimen in podoconiosis management in southern
ethiopia: one year follow-up.
Sikorski C, Ashine M, Zeleke Z, Davey G.
University College London Medical School, London, United Kingdom.
Abstract
BACKGROUND: Podoconiosis is a non-filarial elephantiasis caused by long-term barefoot exposure
to volcanic soils in endemic areas. Irritant silicate particles penetrate the skin, causing a progressive,
debilitating lymphoedema of the lower leg, often starting in the second decade of life. A simple patient-
led treatment approach appropriate for resource poor settings has been developed, comprising (1)
education on aetiology and prevention of podoconiosis, (2) foot hygiene (daily washing with soap,
water and an antiseptic), (3) the regular use of emollient, (4) elevation of the limb at night, and (5)
emphasis on the consistent use of shoes and socks.
METHODOLOGY/PRINCIPAL FINDINGS: We did a 12-month, non-comparative, longitudinal
evaluation of 33 patients newly presenting to one clinic site of a non-government organization (the
Mossy Foot Treatment & Prevention Association, MFTPA) in southern Ethiopia. Outcome measures
used for the monitoring of disease progress were (1) the clinical staging system for podoconiosis, and
(2) the Amharic Dermatology Life Quality Index (DLQI), both of which have been recently validated
for use in this setting. Digital photographs were also taken at each visit. Twenty-seven patients
completed follow up. Characteristics of patients completing follow-up were not significantly different to
those not. Mean clinical stage and lower leg circumference decreased significantly (mean difference
-0.67 (95% CI -0.38 to -0.96) and -2.00 (95% CI -1.26 to -2.74), respectively, p<0.001 for both
changes). Mean DLQI diminished from 21 (out of a maximum of 30) to 6 (p<0.001). There was a non-
significant change in proportion of patients with mossy lesions (p?=?0.375).
CONCLUSIONS/SIGNIFICANCE: This simple, resource-appropriate regimen has a considerable
impact both on clinical progression and self-reported quality of life of affected individuals. The regimen
appears ideal for scaling up to other endemic regions in Ethiopia and internationally. We recommend
that further research in the area include analysis of cost-effectiveness of the regimen.
PMID: 21152059 [PubMed - in process]
Transl Oncol. 2010 Dec 1;3(6):362-72.
Human Lymphatic Architecture and Dynamic Transport Imaged Using Near-infrared Fluorescence.
Rasmussen JC, Tan IC, Marshall MV, Adams KE, Kwon S, Fife CE, Maus EA, Smith LA,
Covington KR, Sevick-Muraca EM.
Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine at the University
of Texas Health Science Center at Houston, Houston, TX, USA.
Abstract
BACKGROUND: Although the importance of lymphatic function is well recognized, the lack of real-
time imaging modalities limits our understanding of its role in many diseases. In a phase 0 exploratory
study, we used dynamic, near-infrared (NIR) fluorescence imaging to assess the extremes of lymphatic
architecture and transport in healthy human subjects and in subjects clinically diagnosed with unilateral
lymphedema (LE), a disease that can be prevalent in cancer survivors.
METHODS AND RESULTS: Active lymphatic propulsion was imaged after intradermal injections of
25 µg of indocyanine green (total maximum dose =400 µg) bilaterally in the arms or legs of control and
subjects. Images show well-defined lymphatic structures with propulsive dye transport in limbs of
healthy subjects. In LE subjects, we observed extravascular dye accumulation, networks of fluorescent
lymphatic capillaries, and/or tortuous lymphatic vessels in all symptomatic and some asymptomatic
limbs. Statistical models indicate that disease status and/or limb significantly affect parameters of
apparent lymph propagation velocity and contractile frequency.
CONCLUSIONS: These clinical research studies demonstrate the potential of NIR fluorescence
imaging as a diagnostic measure of functional lymphatics and as a new tool in translational research
studies to decipher the role of the lymphatic system in cancer and other diseases.
PMID: 21151475 [PubMed - in process]
JAMA. 2010 Dec 22;304(24):2699-705. Epub 2010 Dec 8.
Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial.
Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith R, Bryan CJ, Williams-Smith
CT, Chittams J.
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine and
Abramson Cancer Center, Philadelphia, PA 19104-6021, USA. schmitz@mail.med.upenn.edu
Abstract
CONTEXT: Clinical guidelines for breast cancer survivors without lymphedema advise against upper
body exercise, preventing them from obtaining established health benefits of weight lifting.
OBJECTIVE: To evaluate lymphedema onset after a 1-year weight lifting intervention vs no exercise
(control) among survivors at risk for breast cancer-related lymphedema (BCRL).
DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled equivalence trial (Physical
Activity and Lymphedema trial) in the Philadelphia metropolitan area of 154 breast cancer survivors 1
to 5 years postunilateral breast cancer, with at least 2 lymph nodes removed and without clinical signs
of BCRL at study entry. Participants were recruited between October 1, 2005, and February 2007,
with data collection ending in August 2008.
INTERVENTION: Weight lifting intervention included a gym membership and 13 weeks of supervised
instruction, with the remaining 9 months unsupervised, vs no exercise.
MAIN OUTCOME MEASURES: Incident BCRL determined by increased arm swelling during 12
months (=5% increase in interlimb difference). Clinician-defined BCRL onset was also evaluated.
Equivalence margin was defined as doubling of lymphedema incidence.
RESULTS: A total of 134 participants completed follow-up measures at 1 year. The proportion of
women who experienced incident BCRL onset was 11% (8 of 72) in the weight lifting intervention
group and 17% (13 of 75) in the control group (cumulative incidence difference [CID], -6.0%; 95%
confidence interval [CI], -17.2% to 5.2%; P for equivalence = .04). Among women with 5 or more
lymph nodes removed, the proportion who experienced incident BCRL onset was 7% (3 of 45) in the
weight lifting intervention group and 22% (11 of 49) in the control group (CID, -15.0%; 95% CI,
-18.6% to -11.4%; P for equivalence = .003). Clinician-defined BCRL onset occurred in 1 woman in
the weight lifting intervention group and 3 women in the control group (1.5% vs 4.4%, P for
equivalence = .12).
CONCLUSION: In breast cancer survivors at risk for lymphedema, a program of slowly progressive
weight lifting compared with no exercise did not result in increased incidence of lymphedema.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00194363.
PMID: 21148134 [PubMed - indexed for MEDLINE]
Med Clin (Barc). 2010 Dec 7. [Epub ahead of print]
[Preventing lymphoedema after breast cancer surgery by elastic restraint orthotic and manual lymphatic
drainage: A randomized clinical trial.]
[Article in Spanish]
Castro-Sánchez AM, Moreno-Lorenzo C, Matarán-Peñarrocha GA, Aguilar-Ferrándiz ME, Almagro-
Céspedes I, Anaya-Ojeda J.
Departamento de Enfermería y Fisioterapia, Facultad de Ciencias de la Salud, Universidad de Almería,
Almería, España.
Abstract
BACKGROUND AND OBJECTIVE: Secondary lymphoedema is considered one of the most
common complications after breast cancer surgery. The aim of the present study was to analyze the
effectiveness of containment elastic orthosis and manual lymphatic drainage in the prevention of
lymphoedema secondary to mastectomy.
PATIENTS AND METHOD: An experimental study was performed with a control group. Forty-eight
patients were randomly assigned to experimental (containment elastic orthosis and manual lymphatic
drainage) and control (postural measures) groups. Outcomes measures were quality of life, body
composition, temperature, functional assessment of the shoulder, pain and limb volume. Measures were
performed at baseline and after 8-months intervention.
RESULTS: After the intervention period, the experimental group showed significant differences (P<.
05) in the quality of life, extracellular water, and functional assessment of the volume of the limb of the
mastectomized side.
CONCLUSIONS: The application of containment elastic orthosis and manual lymphatic drainage
contribute to prevent secondary lymphoedema after breast cancer surgery, improving the quality of life
in these patients.
Copyright © 2010 Elsevier España, S.L. All rights reserved.
PMID: 21145085 [PubMed - as supplied by publisher]
J Sex Med. 2010 Dec 8. doi: 10.1111/j.1743-6109.2010.02133.x. [Epub ahead of print]
Quality of Life and Sexual Function after Type c2/Type III Radical Hysterectomy for Locally
Advanced Cervical Cancer: A Prospective Study.
Plotti F, Sansone M, Di Donato V, Antonelli E, Altavilla T, Angioli R, Panici PB.
Sapienza University, Department of Obstetrics and Gynecology, Rome, Italy Campus Biomedico
University, Department of Obstetrics and Gynecology, Rome, Italy.
Abstract
Introduction. The introduction of screening programs have made cervical cancer detectable at earlier
stages and in younger patients. Nevertheless, only a few studies have examined the QoL and sexual
function in disease-free cervical cancer survivors. Aim. The objective of this study is to evaluate the
sexual function in a cervical cancer patient's group treated with neoadjuvant chemotherapy (NACT)
plus type C2/type III radical hysterectomy (RH).
Methods. We have enrolled in the oncologic group (OG) sexually active patients affected by cervical
cancer (stage IB2 to IIIB) treated with NACT followed by RH. Main Outcome Measures. Included
subjects were interviewed with the European Organization for Research and Treatment of Cancer
(EORTC) QLQ-CX24 Questionnaire. Two consecutive assessments were recorded: at the first
evaluation postoperatively (T1) and at the 12-month follow-up visit (T2). Results were compared with
a benign gynecological disease group (BG) and with a healthy control group (HG). Results. A total of
33 patients for OG, 37 for BG, and 35 women for HG were recruited. After surgery, sexual activity
has been resumed by 76% of the OG patients and 83.7% of the BG patients (P = not significant).
Cancer survivors had clinically worse problems with symptom experience, body image, and
sexual/vaginal functioning than controls (P < 0.05). OG patients also reported more severe
lymphedema, peripheral neuropathy, menopausal symptoms, and sexual worry. For sexual activity, the
score difference between cancer survivors and women with benign gynecological disease is not
statically significant. Concerning sexual enjoyment assessment, our study shows comparable results for
OG and BG.
Conclusion. Nevertheless, the worsening of symptom experience, body image, and sexual/vaginal
functioning, OG patients have same sexual activity and sexual enjoyment data compared with those of
BG patients. Thus, NACT followed by RH could be a valid therapeutic strategy to treat and improve
well-being especially in young cervical cancer patients. Plotti F, Sansone M, Di Donato V, Antonelli E,
Altavilla T, Angioli R, and Panici PB. Quality of life and sexual function after type c2/type III radical
hysterectomy for locally advanced cervical cancer: A prospective study. J Sex Med **;**:**-**.
International Society for Sexual Medicine.
PMID: 21143414 [PubMed - as supplied by publisher]
PMID: 20871969 [PubMed - as supplied by publisher]