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Lymphland International Lymphedema Online
June 1, 2011
Plast Reconstr Surg. 2011 Jun;127(6):2419-31.
Primary lymphedema: clinical features and management in 138 pediatric patients.
Schook CC, Mulliken JB, Fishman SJ, Grant FD, Zurakowski D, Greene AK.
Source
Boston, Mass. From the Departments of Plastic and Oral Surgery, Surgery, and Radiology, Vascular
Anomalies Center, Children's Hospital Boston, Harvard Medical School.
Abstract
BACKGROUND:
: Lymphedema results from maldevelopment of the lymphatic system (primary) or injury to lymphatic
vasculature (secondary). Primary lymphedema is far less common than the secondary condition. The
purpose of this study was to determine the clinical features of primary lymphedema in the pediatric age
group.
METHODS:
: The authors' Vascular Anomalies Center database was reviewed for patients evaluated between 1999
and 2010 with onset of lymphedema before 21 years of age. Cause, sex, age of onset, location, and
familial/syndromic association were determined. Morbidity, progression, and treatment were analyzed.
RESULTS:
: Lymphedema was confirmed in 142 children: 138 cases (97.2 percent) were primary and four (2.8
percent) were secondary. Analysis of the primary cohort showed that 58.7 percent of the patients were
female. Age of onset was infancy, 49.2 percent; childhood, 9.5 percent; or adolescence, 41.3 percent.
Boys most commonly presented in infancy (68.0 percent), whereas girls usually developed swelling in
adolescence (55.3 percent). Lymphedema involved an extremity (81.9 percent), genitalia (4.3 percent), or
both (13.8 percent). The lower limb was most commonly affected (91.7 percent), and 52.9 percent had
bilateral lower extremity disease. Eleven percent of patients had familial or syndromic lymphedema.
Cellulitis occurred in 18.8 percent of children; 13.0 percent required hospitalization. The majority of
patients (57.9 percent) had progression of their disease. Treatment was compression garments alone (75.4
percent) or in combination with pneumatic compression (19.6 percent); 13.0 percent had operative
intervention.
CONCLUSIONS:
: Pediatric primary lymphedema usually involves the lower extremities. Boys typically are affected at birth,
and girls most often present during adolescence. Most patients do not have major morbidity, are
successfully managed by compression, and do not require surgical treatment.
PMID: 21617474 [PubMed - in process]
Jpn J Nurs Sci. 2011 Jun;8(1):109. doi: 10.1111/j.1742-7924.2011.00181.x.
Response to: Assessment of lymphedema by bioelectrical impedance spectroscopy.
Sakuda H.
Source
Graduate School of Medicine and Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan.
PMID: 21615704 [PubMed - in process]
Jpn J Nurs Sci. 2011 Jun;8(1):108. doi: 10.1111/j.1742-7924.2010.00165.x.
Assessment of lymphedema by bioelectrical impedance spectroscopy.
Ward LC.
Source
School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland;
and Breast Cancer Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, New
South Wales, Australia.
PMID: 21615703 [PubMed - in process]
Histochem Cell Biol. 2011 Jun;135(6):603-13. Epub 2011 May 26.
Dysmorphogenesis of lymph nodes in Foxc2 haploinsufficient mice.
Shimoda H, Bernas MJ, Witte MH.
Source
Department of Surgery, The University of Arizona, Tucson, AZ, USA, shimoda@oita-nhs.ac.jp.
Abstract
Dysmorphogenesis of lymph nodes displayed in a fork head transcription factor Foxc2 haploinsufficient
mice-a model for lymphedema-distichiasis syndrome-was studied by immunohistochemistry and electron
microscopy. The Foxc2 heterozygous mice manifested lymph node hyperplasia composed of conspicuous
proliferation of endothelial cells forming the lymphatic sinus and α-smooth muscle actin (SMA)-
immunopositive fibroblast-like cells in the lymphatic pulp, particularly around the sinus. The hyperplastic
sinus endothelial cells and the SMA-positive cells demonstrated distinct immunolocalization of platelet-
derived growth factor (PDGF)-B, a crucial chemoattractant for vascular mural cell recruitment, and its
receptor, PDGFR-β, respectively. The observations suggest that the sinus endothelial cells elicit abnormal
recruitment of the fibroblast-like cells as a type of vascular mural cells via PDGF-B/PDGFR-β signaling in
lymph nodes of the Foxc2 heterozygotes. Furthermore, in Foxc2 heterozygous lymph nodes, recruited
SMA-positive cells displayed an intense immunoreaction for vascular endothelial growth factor (VEGF)-C,
a highly specific lymphangiogenic factor, and its receptor, VEGFR-3, was preferentially distributed in the
lymphatic sinus endothelial cells. These findings suggest that an interactive cycle between lymphatic sinus
endothelial cells and the fibroblast-like cells, which involves PDGF-B/PDGFR-β and VEGF-C/VEGFR-3
signaling, is essential for aberrant hyperplasia of the lymphatic sinus and the fibroblast-like cells in Foxc2
haploinsufficiency.
PMID: 21614587 [PubMed - in process]
Arch Esp Urol. 2011 May;64(4):351-362.
Penile cancer: are there currently indications for radiotherapy?.
[Article in English, Spanish]
González Domingo M, González San Segundo C.
Source
Department of Oncological Radiotherapy. Instituto Oncológico. Viña del Mar. Chile.
Abstract
Penile cancer is a radiocurable disease. The different types of radiotherapy (RT)-brachytherapy,
plesiotherapy, external beam radiation therapy-have proven valid in the treatment of the primary tumor
allowing preservation of the penis and sexual function. RT is even an option in candidates for surgery who
reject surgery for clinical or personal reasons. A high nodal recurrence rate has been observed after
inguinal lymphadenectomy, specially in patients at high risk of relapse. Technological advances in the field
of RT, new imaging techniques, and more modern equipment enable RT to enhance local control and
improve survival in patients with this condition. Palliative RT can exercise a decompressive effect that
makes possible tumor size reduction in cases of inguinal-pelvic recurrence in patients with lymphedema and
thus improve quality of life. In this article, we review the current role of RT in the treatment of penile
cancer. We also present two cases that illustrate the main indications.
PMID: 21610280 [PubMed - as supplied by publisher]
Aesthetic Plast Surg. 2011 May 24. [Epub ahead of print]
Large Necrosis: A Rare Complication of Medial Thighplasty.
Bertheuil N, Aillet S, Heusse JL, Flecher E, Watier E.
Source
Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, 16 Boulevard de Bulgarie,
35200, Rennes, France, nbertheuil@gmail.com.
Abstract
Obesity is a major public health problem in Western societies. After failure of diet and exercise, patients
can have bariatric surgery. Weight loss causes excess skin on the body, including the thighs. This leads to
difficulty walking and psychological disorders such as devalued self-image. Medial thighplasty is an
intervention to reduce excess skin and fat in the thighs. The main complications are scar migration, scar
infection, hematoma, lymphedema, gaping vulva, and, rarely, skin necrosis. We describe a case of flap
necrosis after a reoperation of medial thighplasty. Treatment included debridement of necrotic tissue and
healing of the wound by secondary intention (vacuum-assisted closure and dressings with calcium alginate).
Complete healing was achieved in 4 months. As the patient refused any new procedure, skin grafting was
not performed. The aesthetic results of plastic surgery procedures are often imperfect. Patients should be
clearly prepared and informed about the results expected from the operation. Surgeons should know
contraindications for reoperation.
PMID: 21607533 [PubMed - as supplied by publisher]
Khirurgiia (Mosk). 2011;(5):15-18.
[Prevention of complications after surgery in patients with upper limbs' lymphedema.]
[Article in Russian]
Liubarskiĭ MS, Nimaev VV, Shumkov OA, Konenkov VI.
Source
Nauchno-issledovatel'skiĭ institut klinicheskoĭ i éksperimental'noĭ limfologii Sibirskogo otdeleniia RAMN,
Novosibirsk.
Abstract
The results of surgical treatment of patients with the fourth stage of the upper limbs' lymphedema was
studied. Of all 170 patients with lymphedema, 16 (9.4%) had the fourth stage of the disease. The debulking
procedures were performed in 15 patients (8 had standart operations, 7 - simultaneous rwo-stage
operations). Beeing a preliminary stage of the radical surgical excision of lymphoedematously changed
tissues, the liposuction allows a more precisional hemostasis for the accurate vessel visualization. It led to
the 4,4 times decrease of the postoperative morbidity rate and shortened the time of the operation.
PMID: 21606915 [PubMed - as supplied by publisher]
Dermatology. 2011 May 24. [Epub ahead of print]
Safety of Tumescent Liposuction under Local Anesthesia in a Series of 4,380 Patients.
Boeni R.
Source
White House Center for Liposuction, Zurich, Switzerland.
Abstract
Background: Liposuction is increasingly performed under local anesthesia and in an outpatient setting. The
term 'tumescent liposuction' has been used in the literature in patients receiving other forms of anesthesia as
well, hence the confusion regarding the safety profile of liposuction performed under local anesthesia alone.
Objective: To analyze the safety of tumescent liposuction performed under local anesthesia in a larger
group of patients. Methods: Between 2003 and 2010, 4,380 consecutive patients underwent tumescent
liposuction by the same surgeon. The occurrence of complications was recorded in detail. Results: There
were no serious complications requiring hospitalization. There were no injuries, no nerve damage or
permanent lymphedema, no deep venous thrombosis or seroma. Seven patients needed closer follow-up
due to large hematoma (n = 3; no drainage needed), allergic drug reaction to doxycycline (n = 2),
erysipelas (n = 1) and generalized edema (n = 1). Conclusions: Tumescent liposuction under local
anesthesia is a safe method, providing it is performed by an experienced surgeon and the guidelines of care
for liposuction are strictly followed.
Copyright © 2011 S. Karger AG, Basel.
PMID: 21606638 [PubMed - as supplied by publisher]
Semin Oncol. 2011 Jun;38(3):386-93.
Cancer rehabilitation.
Stubblefield MD.
Source
Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan-Kettering Cancer Center,
New York, NY; Department of Physical Medicine and Rehabilitation, Weill Medical College of Cornell
University, New York, NY.
Abstract
Cancer rehabilitation is the subspecialty of rehabilitation medicine concerned with restoring and maintaining
the highest possible level of function, independence, and quality of life to patients at all stages of their
cancer diagnosis, including those undergoing potentially curative therapy and those receiving palliative care,
as well as cancer survivors. Cancer rehabilitation physicians specialize in the evaluation and treatment of
neuromuscular, musculoskeletal, and functional complications of cancer and cancer treatments such as
acute and chronic pain, weakness, muscle spasm, myelopathy, radiculopathy, plexopathy, neuropathy,
myopathy, deconditioning, contracture, spasticity, lymphedema, amputation, shoulder dysfunction, and gait
disorders, among others. Late effects of radiation represents a particular challenge for cancer rehabilitation
physicians as radiation fibrosis may affect multiple structures, including the spinal cord, nerve roots, plexus,
local nerves, and muscles, as well as their supporting structures. A comprehensive clinical evaluation
involving an in-depth working knowledge of neuromuscular and musculoskeletal anatomy and incorporating
specialized physical examination maneuvers allows the physiatrist to clarify the specific etiology of pain and
functional disorders. A safe and effective rehabilitation program will depend heavily on an accurate
diagnosis of the cause of pain or dysfunction.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21600368 [PubMed - in process]
June 7, 2011
J Egypt Soc Parasitol. 2011 Apr;41(1):179-97.
Clinical, parasitological and social studies on Wuchereria bancrofti in Egypt.
Tayel Sel S, Sharapy Ael D, El Shazly AM, Shahat SA, Zaalouk TKh, Al Sayed MY.
Source
Departments of Parasitology, Faculty of Medicine, Al-Azhar University, Nasr City, Egypt.
Abstract
This study was conducted on patients attending Al-Hussein University Hospital and Mansura University
Hospitals. Sheets were filled out on each patient (age, residence, occupation, family similar condition,
travelling, disease duration, symptoms suggesting acute dermatolymphangitis attacks, frequency and
duration. They were 25 lymphoedema patients and 8 controls (17 males & 16 females) and subjected to
clinical and parasitological examinations. According to residence, five patients were from Giza Govemorate
(18.18%), four from Dakahlia G. (12.12%), four from Gharbia G. (12.12%), five from Menoufia G.
(15.15%), four from Sharkia G. (12.12%), two cases from Kafr Elsheikh G. (6.06%) and one patient from
Assiut G. (3.03%). In controls, 6 were from Al-Hussein Cairo G. (15.15%), and two cases (6.06) from
Al-Abbassia. They were 48% farmers (10 male & 2 female); 4% grocers (1 male); 8% carpenters (2
male); and 40% house wife (10 female). According to lymphedema site: 3 cases (12%) were bilateral
lower limbs lymphedema (2 female & 1 male), 13 cases (52%) had right lower limb lymphedema (6 female
& 7 male), and 9 cases (36%) had left lower limb lymphedema (4 female & 5 male). They were 18 (72%)
with below knee extension of lymphedema (10 male & 8 female) and 7 (28%) above knee extension of
lymphedema (3 male & 4 female). Grade of lymphedema was one case (male) with grade II lymphedema
(4%), 13 cases (52%) with grade III (7 male & 6 female) and 11 cases (44%) with grade IV (5 male & 6
female). Duration of lymphedema was one case with grade II lymphedema in a period of 3 years, 13 cases
with grade III lymphedema and the durations of lymphedema for these cases were (one case with 5 years
duration, 3 cases were > 6-9 years,6 cases were > 9-12 years and 3 cases were > 12 years) and 11 cases
with grade IV lymphedema and duration of lymphedema for these cases were (one case with 6 years
duration, 2 cases were > 6-9 years,3 cases were > 9-12 years and 5 cases were > 12 years).
PMID: 21634252 [PubMed - in process]
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
Massive Localized Lymphedema: Review of an Emerging Problem and Report of a Complex Case in the
Mons Pubis.
Brewer MB, Singh DP.
Source
From the Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center,
Baltimore, MD.
Abstract
Massive localized lymphedema (MLL) is an emerging complication of the obesity epidemic. Caused by the
obstruction of lymphatics, MLL presents as a giant swelling, with characteristic skin changes, and often
lymphatic weeping. MLL has also been called "pseudosarcoma" because of its morphologic and pathologic
similarity to sarcoma. Left untreated, MLL can degenerate into angiosarcoma. We present a case of MLL
of the mons pubis in a 40-year-old man with a body mass index of 69. The literature is reviewed and an
additional 40 cases of MLL are described. We found a female predominance of 1.6 to 1, an average
weight of 421 lbs, and a 58% majority of cases in the thigh.
PMID: 21629105 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
Assessment of Figuration of Thoracic Duct Using Magnetic Resonance Thoracic Ductography in Idiopathic
Lymphedema.
Hara H, Koshima I, Okuda I, Narushima M, Mihara M, Todokoro T.
Source
From the *Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo,
Japan; and †Department of Radiology, International University of Health and Wefare, Mita Hospital,
Tokyo, Japan.
Abstract
The structure and the function of the peripheral lymph channels have been investigated, but the thoracic
duct has not been investigated. This study used magnetic resonance thoracic ductography for 2 patients
with idiopathic lymphedema to evaluate the configuration of the thoracic duct in these patients. Anomalies
of thoracic duct were detected in both cases. This result suggests that deformity of the thoracic duct is one
of the causes of idiopathic lymphedema. Characterization of the etiology could lead to a breakthrough in
resolving the occurrence of idiopathic lymphedema and developing a treatment procedure for it. In
addition, visualization of the thoracic duct may assist in selecting the optimal therapy for each idiopathic
lymphedema patient.
PMID: 21629101 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
Outcome Study of the Surgical Management of Panniculitis.
Zannis J, Wood BC, Griffin LP, Knipper E, Marks MW, David LR.
Source
From the *Department of Plastic and Reconstructive Surgery, Wake Forest University School of
Medicine, Winston-Salem, NC; and †Department of Biostatistical Sciences, Division of Public Health
Sciences, Wake Forest University Health Sciences, Winston-Salem, NC.
Abstract
Patients with panniculus morbidus have an abdominal panniculus that becomes a pathologic entity,
associated with the development of candidal intertrigo, dermatitis, lymphedema, and ischemic panniculitis.
Panniculectomy is a standard treatment for this problem. The objective of this study was to determine risk
factors for complications associated with panniculectomy surgery to lower the complication rate. We
performed a retrospective chart review of patients who underwent panniculectomy between 1999 and
2007 by looking at data related to surgical complications, comorbidities, age, and gender. In 563 patients,
we recorded the incidence of the following complications: wound-related (infection, dehiscence, and/or
necrosis), hematoma/seroma, respiratory distress, blood transfusions, deep venous thrombosis or
pulmonary embolism, and death. Overall, 34.3% of patients suffered at least 1 complication. In patients
with wound complications specifically, there was a significantly higher body mass index versus those with
no wound complications (43.7% vs. 30.7%, P < 0.0001). Smokers also had a higher rate of wound
complications (40.5% vs. 19.5%, P < 0.0001).
PMID: 21629099 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
A New Aspect of Metastasis in Cutaneous Cancer: Two Cases of Presacral Squamous Cell Carcinoma
With Metastases to Internal Iliac Nodes.
Oashi K, Hayashi T, Furukawa H, Tsutsumida A, Kimura C, Oyamatsu H, Oyama A, Funayama E, Saito
A, Yamamoto Y.
Source
From the *Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of
Hokkaido at Sapporo, Sapporo, Japan; †Department of Skin Oncology/Dermatology, Comprehensive
Cancer Center, Saitama Medical University International Medical Center, Hidaka, Japan; ‡Department of
Plastic and Reconstructive Surgery, Hakodate Central General Hospital, Hakodate, Japan; and §Division
of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medical and Dental
Sciences, Niigata, Japan.
Abstract
We report 2 cases of presacral squamous cell carcinoma. In these cases, it was suspicious that the tumor
disseminated to the internal iliac nodes through the direct pathway called neurovascular lymphatic space
(NVLS) around the superior/inferior gluteal vessels or sciatic nerve bypassing external iliac nodes. NVLS
was initially reported as accessory pathway which follows the major vessels forming a sheath like structure
with an actual or potential space between the vessel wall and the enveloping membrane. NVLS has been
reported to be observed as a tubular shadow within the neurovascular sheath by lymphangiographies of
lymphedema patients using oil-based contrast material. These cases provide insights into the potential
pathway through which a cutaneous tumor disseminates.
PMID: 21629061 [PubMed - as supplied by publisher
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
A New Model of Acquired Lymphedema in the Mouse Hind Limb: A Preliminary Report of a Half-Year
Course.
Oashi K, Furukawa H, Oyama A, Funayama E, Hayashi T, Saito A, Yamamoto Y.
Source
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of
Hokkaido at Sapporo, Sapporo, Japan.
Abstract
Lymphedema is known to be caused by many pathologic conditions; however, its correct diagnosis and
optimal therapeutic strategies remain to be established. In this report, we describe an experimental model
for acquired lymphedema in the lower extremity of the mouse that creates a lymphatic block in the groin
induced by both radiation treatment and surgical division of the superficial and deep lymphatics. To
evaluate the lymphatic system in this model, an indocyanine green fluorescence-sensitive camera system
was used. This model has the advantages of relative technical simplicity and cost-effective use of a rodent
animal model. Furthermore, a greater range of research tools such as antibodies and various databases are
available for mice. This mouse model may be useful to anyone modeling lymphedema mechanisms, by
providing a defined molecular context.
PMID: 21629054 [PubMed - as supplied by publisher]
World J Urol. 2011 May 31. [Epub ahead of print]
Tensor fascia lata flap reconstruction following groin dissection: is it worthwhile?
Nirmal TJ, Gupta AK, Kumar S, Devasia A, Chacko N, Kekre NS.
Source
Department of Urology, Christian Medical College, Vellore, Tamil Nadu, 632004, India, nirmaltj@gmail.
com.
Abstract
OBJECTIVE:
To compare the morbidity of primary skin closure with elective Tensor Fascia Lata (TFL) flap cover in
groin dissections.
MATERIALS AND METHODS:
This was a retrospective study between January 2007 and December 2009. All patients undergoing groin
dissections without skin involvement were included.
RESULTS:
Of the twenty-five patients, who underwent groin dissections, 14 had primary skin closure (28 groin
dissections)-group I. Eleven had TFL flap cover as a means of primary reconstruction (20 groin dissections)
-group II. In group I, there were 16 (57%) inguinal dissections and 12 (43%) ilioinguinal block dissections,
whereas 82% in group II underwent ilioinguinal dissections (p = 0.09). Wound infection requiring treatment
with a culture specific antibiotic was required in 4 (14%) in group I (n = 28) and only 1 (5%) in group II (n
= 20) (p = 0.38). In group I, 7 (25%) had major flap necrosis and minor necrosis was seen in another 7
(25%). Only three (15%) in group II developed minor flap necrosis (p = 0.01). Following an ilioinguinal
dissection, flap necrosis occurred in 75% of groins that underwent primary closure and in 17% of those
which were reconstructed with TFL (p = 0.001). Seroma formation was seen in 5 (18%) in group I and 3
(15%) in group II (p = 1.0). Lymphoedema occurred in equal numbers in both groups. The duration of
hospital stay was 20 ± 14 days in the primary closure group and 16 ± 3 days in the TFL group.
CONCLUSION:
The TFL flap can reduce postoperative morbidity and decrease hospital stay. Prophylactic TFL flap
reconstruction following ilioinguinal dissections is advisable.
PMID: 21626446 [PubMed - as supplied by publisher]
Int J Gen Med. 2011;4:373-6. Epub 2011 May 10.
Association of Godoy & Godoy contention with mechanism with apparatus-assisted exercises in patients
with arm lymphedema after breast cancer.
de Fátima Guerreiro Godoy M, Guimaraes TD, Oliani AH, de Godoy JM.
Source
CAPES (Coordination of Improvement of Higher Education Personal), São José do Rio Preto, Brazil;
Abstract
AIM:
The aim of the current study was to evaluate the reduction in the volume of the upper limbs with
lymphedema after exercises using the apparatus-assisted program associated with contention mechanism.
PATIENTS AND METHOD:
Twenty-eight female patients were selected and referred for evaluation and treatment of lymphedema after
breast cancer therapy. The ages of the women ranged from 42 to 72 years with a mean age of 57 years.
Inclusion criteria were treatment of cancer associated to a difference of at least 200 mL between the
edematous and the contralateral limbs. Patients with active infections, skin lesions, and active disease were
not included in the study. Four series of exercises using devices based on pedals, pulleys, a horizontal
reflexion bar, and an elevation bar were selected. The participants were advised about the form of exercise:
15 minutes for each device, low intensity (less than 10 movements per minute), in the seated position, and
the use of contention. Water displacement volumetry was performed before and after the 60-minute
exercise session. The paired t-test was utilized with an alpha error of 5% considered acceptable (P value <
0.05).
RESULTS:
The mean difference between the volumetric measures before and after exercise was significant, with all the
participants having reductions in the volume of the limbs using the four selected devices over time and at an
intensity determined by this study.
CONCLUSION:
Association of a Godoy and Godoy contention during apparatus-assisted exercise reduced the edema in
patients with lymphedema of the upper limbs.
PMID: 21625413 [PubMed - in process] PMCID: PMC3100219
Yonsei Med J. 2011 Jul 1;52(4):661-7. doi: 10.3349/ymj.2011.52.4.661.
Causes of shoulder pain in women with breast cancer-related lymphedema: a pilot study.
Jeong HJ, Sim YJ, Hwang KH, Kim GC.
Source
Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, 34 Amnam-
dong, Seo-gu, Busan 602-702, Korea. oggum@daum.net.
Abstract
Purpose: To inform on shoulder pathology and to identify the disabilities and level of quality of life (QOL)
associated with shoulder pain in patients with breast cancer- related lymphedema (BCRL). Materials and
Methods: Using patient history, physical examination, and ultrasound (US), we classified patients with
BCRL into the following three groups: no pain with normal ultrasound (US), pain with normal US, and pain
with abnormal US. We evaluated shoulder pathology using US, pain intensity using a visual analogue scale
(VAS), and functional disability using the Korean version of the Disabilities of Arm, Shoulder, and Hand
(DASH) questionnaire. For assessment of QOL, we used the Korean version of the brief form of the
World Health Organization Quality of Life Assessment Instrument (WHOQOL- BREF). Results: 28.9% of
patients had no pain and normal US, 31.6% had pain with normal US, and 39.5% had pain with abnormal
US. The US findings for those with pain and abnormal US revealed the following: 53.3% had a
supraspinatus tear, 13.3% had biceps tenosynovitis, 13.3% had acromioclavicular arthritis, 13.3% had
subdeltoid bursitis, and 53.3% had adhesive capsulitis. Patients with shoulder pain and abnormal US
findings had significantly higher mean DASH and pain scores. Pain scores were positively correlated with
DASH scores and negatively correlated with QOL. Conclusion: We found that BCRL with shoulder pain
and evidence of shoulder pathology on US was associated with reduced QOL and increased disability.
Proper diagnosis and treatment of shoulder pain are necessary to improve QOL and decrease disability in
patients with BCRL.
PMID: 21623610 [PubMed - in process] PMCID: PMC3104463 [Available on 2011/7/1]
Ann Thorac Surg. 2011 Jun;91(6):1702-8.
Forequarter amputation combined with chest wall resection: a single-center experience.
Nierlich P, Funovics P, Dominkus M, Aszmann O, Frey M, Klepetko W.
Source
Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna,
Austria.
Abstract
BACKGROUND:
Forequarter amputation combined with chest wall resection is a rarely performed procedure. Six patients
were treated for advanced malignancies with this operation in our institution since 1993. Uncontrollable
pain, lymphedema, loss of function of the affected limb and, in some patients, localized ulceration of the
tumor at the time of presentation, provided the indication for the operation. All patients underwent radical
amputation of the upper limb and the structures of the shoulder girdle, in combination with resection of the
thoracic chest wall in an extent of 2 to 7 ribs.
METHODS:
Chest wall reconstruction was achieved by implantation of a polytetrafluoroethylene patch (n = 5) or a
combination of a metal implant (Stratos System R, MedXpert GmbH, Heitersheim, Germany) and a
polytetrafluoroethylene patch (n = 1). Myocutaneous coverage of the defects was achieved by use of
pedicled flaps from adjacent tissue (n = 3) or by free myocutaneous flaps harvested from the amputated
forearm (n = 3).
RESULTS:
No perioperative mortality occurred; however, significant morbidity was seen after the use of the free
forearm flaps based on occurring vascular problems. All 3 patients had to undergo surgical revision of the
flap. Survival ranged from 5 to 50 months (median = 23.5 months) with 3 patients still alive at the time of
this investigation.
CONCLUSIONS:
Forequarter amputation in combination with chest wall resection is a feasible and potentially curative
treatment for malignant tumors of the shoulder girdle with invasion of the chest wall. The operation results in
immediate palliation and long-term survival can be obtained in selected cases.
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PMID: 21619966 [PubMed - in process]
June 10, 2011
Int J Palliat Nurs. 2011 May;17(5):231-8.
Collaborative lymphoedema management: developing a clinical protocol.
Thomson M, Walker J.
Abstract
Lymphoedema is a very distressing chronic condition prevalent in some metastatic cancers. Conservative
treatment of lymphoedema in palliative care involves complete/complex decongestive therapy (CDT) using
manual lymphatic drainage (MLD), compression therapy (bandaging and/or garments), skincare, and
remedial exercises, adapted to the needs of the patient. The aim of this service development project was to
identify current practice in a hospice palliative care service, develop new assessment tools, and implement a
collaborative clinical protocol to improve access to lymphoedema management for patients in the hospice.
Two audits provided new evidence about patient profiles, patient assessment, and treatment outcomes for
cancer- and non-cancer-related lymphoedema. This project had a quality-improvement effect on service
delivery and developed an effective partnership approach to lymphoedema management between local
district nursing services and the specialist lymphoedema physiotherapist.
PMID: 21647077 [PubMed - in process]
June 15, 2011
Can J Surg. 2011 Jun 1;54(3):7810. doi: 10.1503/cjs.007810. [Epub ahead of print]
Factors that determine whether a patient receives completion axillary lymph node dissection after apositive
sentinel lymph node biopsy for breast cancer in British Columbia.
Aslani N, Swanson T, Kennecke H, Woods R, Davis N.
Source
The General Surgery Residency Program, University of British Columbia, Vancouver, BC.
Abstract
Background: Completion axillary lymph node dissection (CALND) is recommended in the setting of
positive sentinel lymph node biopsy (SLNB) but is associated with a higher rate of postoperative
complications. In this study, the characteristics and outcomes of patients who did and did not have
CALND are compared. Methods: We identified all patients with breast cancer with positive sentinel
lymphnodes (SLNs) who did not have concurrent CALND from 2003 to 2006 using a prospectively
collected database (British Columbia Cancer Breast Outcomes database) and retrospective chart review.
Patient and tumour characteristics were compared between those who received CALND and those who
did not. Results: Among 185 patients with positive SLNs identified by SLNB, 90 had a CALND and 95
had no further surgical therapy. Patients who did not receive CALND had more sentinel nodes removed (p
< 0.001), a lower percentage of positiveSLNs (p < 0.001) and lower pathologic N stage (p = 0.044) than
those who did receive CALND. The size of the breast lesion, size of the largest SLN deposit, estrogen
receptor status, grade, lymphovascular invasion, histology and multifocality were not significantly different
between groups. Sixty-two percent of women who did not have CALND received radiation to the axilla.
Postoperative complication rates (including lymphedema) were higher in the CALND group (21%)
compared with the SLNB group (7%). The rates of locoregional recurrence (1% in both groups) and
systemic metastases (6% in the CALND group v. 8% in the SLNB group) were similar at 36months'
follow-up. Conclusion: Compared with women who had CALND, women who did not receive CALND
had on average a lower N stage with 3 or more SLNs removed and less than 50% node positivity. Most of
these women received radiation therapy to the axilla and had comparable recurrence rates to those who
had CALND.
PMID: 21651836 [PubMed - as supplied by publisher
June 20, 2011
J Plast Reconstr Aesthet Surg. 2011 Jun 11. [Epub ahead of print]
Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to
manual lymph drainage: A case report.
Mihara M, Hayashi Y, Hara H, Iida T.
Source
Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku,
Tokyo 113-8655, Japan.
Abstract
Conservative and surgical treatment for lymphedema are performed independently, and combined
treatment with lymphatico-venous anastomosis (LVA) followed by manual massage is increasingly
reported. However, a problem with this approach is that manual massage cannot be initiated immediately
after LVA because of concerns of injuring surgical wounds and anastomosed regions. To overcome this
problem, we developed a treatment method using a cosmetic roller instead of manual massage, which
allows lymph drainage to be initiated immediately after surgery. In this study, we treated a patient with
bilateral lower limb lymphedema using this method. Conventional manual massage starting 3 weeks after
surgery was used for the left lower limb, while early massage using a cosmetic roller was used for the right
lower limb from the day after surgery. A higher therapeutic effect was obtained in the right lower limb
compared to that in the left lower limb. The results in this case suggest that further studies should be
performed to examine the new method in various types of patients.
Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights
reserved.
PMID: 21669555 [PubMed - as supplied by publisher]
Breast Cancer. 2011 Jun 14. [Epub ahead of print]
Erratum to: Lymphedema and breast cancer: a review of the literature.
Stamatakos M, Stefanaki C, Kontzoglou K.
Source
4th Department of Surgery, Medical School, Attikon General Hospital, University of Athens, Athens,
Greece, mixalislak@gmail.com.
PMID: 21671036 [PubMed - as supplied by publisher]
J Plast Reconstr Aesthet Surg. 2011 Jun 11. [Epub ahead of print]
Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to
manual lymph drainage: A case report.
Mihara M, Hayashi Y, Hara H, Iida T.
Source
Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku,
Tokyo 113-8655, Japan.
Abstract
Conservative and surgical treatment for lymphedema are performed independently, and combined
treatment with lymphatico-venous anastomosis (LVA) followed by manual massage is increasingly
reported. However, a problem with this approach is that manual massage cannot be initiated immediately
after LVA because of concerns of injuring surgical wounds and anastomosed regions. To overcome this
problem, we developed a treatment method using a cosmetic roller instead of manual massage, which
allows lymph drainage to be initiated immediately after surgery. In this study, we treated a patient with
bilateral lower limb lymphedema using this method. Conventional manual massage starting 3 weeks after
surgery was used for the left lower limb, while early massage using a cosmetic roller was used for the right
lower limb from the day after surgery. A higher therapeutic effect was obtained in the right lower limb
compared to that in the left lower limb. The results in this case suggest that further studies should be
performed to examine the new method in various types of patients.
Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights
reserved.
PMID: 21669555 [PubMed - as supplied by publisher]
Lymphology. 2011 Mar;44(1):29-34.
B-type natriuretic peptide in lymphedema.
Todd J, Austwick T, Berridge D, Tan LB, Barth JH.
Source
Department of Lymphoedema, Leeds Teaching Hospitals NHS Trust, Leeds. Jacquelyne.Todd@leedsth.
nhs.uk
Abstract
Lymphedema often responds to compression therapy which can also cause undesirable cardiac overload if
heart failure coexists. We hypothesized that the biomarker B-type natriuretic peptide (BNP) can be used to
screen lymphedema patients for undetected cardiac dysfunction. We studied unselected consecutive
patients with lymphedema to determine their BNP status and compared these data with those obtained
from healthy subjects without known cardiovascular diseases. Out of a total of 305 subjects with
lymphedema screened, 102 (33%) consented to take part in this study. The majority (87%) were female
with a mean age of 60.5 +/- 13.2 (SD) years, and 47% had just lower limb swelling. The groups were
equally divided between cancer and non-cancer related causes. There were 45 females and 4 males under
60 years old, and 44 female and 9 male patients over 60 years old. Median (IQR) BNP (ng/L) were as
follows: <60 years females = 17.9 (15.2) (median [RR: 3 - 64] and males = 12.4 (14.7) [RR: 0.2 - 44],
>60 years females = 35.8 (57.9) [RR: 2 -247)] and males = 47.2 (44.1) [RR: 2 - 238]. For this
population, the BNP concentration 100 ng/L was adopted as the value to exclude heart failure. Using this
definition, 7 lymphedema subjects had BNP concentrations of 120 (19.8) ng/L, and all were found to have
cardiac abnormalities on echocardiography. This study demonstrated that 93% of unselected subjects with
lymphedema had BNP concentrations that exclude a diagnosis of heart failure. Those subjects with
elevated BNP were found on subsequent echocardiography to have cardiac abnormalities. The use of a
BNP assay is of potential value in screening patients who are more likely to have cardiac failure. Indicative
factors include bilateral leg swelling, over the age of 50 years, breathlessness, where there is no known
cause for the swelling. A BNP assay using a BNP concentration threshold of 100 ng/L (29 pmol/L) will
identify those patients who require more detailed investigations.
PMID: 21667820 [PubMed - indexed for MEDLINE]
Lymphology. 2011 Mar;44(1):13-20.
Impact of manual lymphatic drainage on hemodynamic parameters in patients with heart failure and lower
limb edema.
Leduc O, Crasset V, Leleu C, Baptiste N, Koziel A, Delahaie C, Pastouret F, Wilputte F, Leduc A.
Source
Haute Ecole P.H. Spaak, Lympho-Phlebology Unit, Brussels. oleduc@skynet.be
Abstract
Manual lymphatic drainage (MLD), intermittent sequential pneumatic therapy (ISPT), multilayered
bandages (MLB), and compression garments are main techniques in conservative treatment of peripheral
lymphedema. Since 1990, it has been thought that ISPT applied to both lower limbs simultaneously should
not be used for patients with heart failure because right atrial, pulmonary arterial, and pulmonary wedge
pressures may increase to a critical point. In 2005, these same results were observed in patients with heart
failure wearing MLB. For these reasons, MLB and ISPT have been contraindicated during lymphedema
treatment in cardiac patients. The aim of this study was to determine if we may continue the treatment of
lower limb lymphedema using MLD in patients with heart failure. We evaluated hemodynamic parameters
using echography during MLD in patients with cardiac disease and obtained circumferential measurements
of the edematous limb before and after treatment. MLD treatment significantly decreased the limbs as
expected. The heart rate also decreased following MLD in contrast with all other hemodynamic parameters
which were not affected by MLD. The findings suggest that there is no contraindication to use MLD in
patients with heart failure and lower limb edema.
PMID: 21667818 [PubMed - indexed for MEDLINE]
PLoS Negl Trop Dis. 2011 Jun;5(6):e1184. Epub 2011 Jun 7.
Burden of Podoconiosis in Poor Rural Communities in Gulliso woreda, West Ethiopia.
Alemu G, Tekola Ayele F, Daniel T, Ahrens C, Davey G.
Source
SOS Children's Villages International, Addis Ababa, Ethiopia.
Abstract
BACKGROUND:
Podoconiosis is an environmental lymphoedema affecting people living and working barefoot on irritant red
clay soil. Podoconiosis is relatively well described in southern Ethiopia, but remains neglected in other parts
of the Ethiopian highlands. This study aimed to assess the burden of podoconiosis in rural communities in
western Ethiopia.
METHODOLOGY/PRINCIPAL FINDINGS:
A cross-sectional study was conducted in Gulliso woreda (district), west Ethiopia. A household survey in
the 26 rural kebeles (villages) of this district was conducted to identify podoconiosis patients and to
measure disease prevalence. A more detailed study was done in six randomly selected kebeles to describe
clinical features of the disease, patients' experiences of foot hygiene, and shoe wearing practice. 1,935
cases of podoconiosis were registered, giving a prevalence of 2.8%. The prevalence was higher in those
aged 15-64 years (5.2%) and in females than males (prevalence ratio 2.6∶1). 90.3% of patients were in
the 15-64 year age group. In the detailed study, 335 cases were interviewed and their feet assessed. The
majority of patients were farmers, uneducated, and poor. Two-third of patients developed the disease
before the age of thirty. Almost all patients (97.0%) had experienced adenolymphangitis (ALA - red, hot
legs, swollen and painful groin) at least once during the previous year. Patients experienced an average of
5.5 ALA episodes annually, each of average 4.4 days, thus 24 working days were lost annually. The
incidence of ALA in podoconiosis patients was higher than that reported for filariasis in other countries.
Shoe wearing was limited mainly due to financial problems.
CONCLUSIONS:
We have documented high podoconiosis prevalence, frequent adenolymphangitis and high disease-related
morbidity in west Ethiopia. Interventions must be developed to prevent, treat and control podoconiosis,
one of the core neglected tropical diseases in Ethiopia.
PMID: 21666795 [PubMed - in process] PMCID: PMC3110157
Clin Breast Cancer. 2011 Jun;11(3):171-6. Epub 2011 Apr 20.
Reirradiation as a component of the multidisciplinary management of locally recurrent breast cancer.
Harkenrider MM, Wilson MR, Dragun AE.
Source
University of Louisville School of Medicine, James Graham Brown Cancer Center, Department of
Radiation Oncology, Louisville, KY.
Abstract
BACKGROUND AND PURPOSE:
Our intent was to review a modern multidisciplinary institutional experience involving reirradiation of the
breast, chest wall, and lymphatics for locoregional recurrences of breast cancer and report toxicity and
clinical outcomes.
MATERIALS AND METHODS:
Between 1995 and 2009, 12 locoregional recurrences were reirradiated in 8 patients. The mean dose of
initial radiotherapy was 57.1 Gy (range, 50.4-60.6 Gy), and the mean dose of reirradiation was 46.7 Gy
(range, 30-62.1 Gy). The second course of radiotherapy was delivered using daily radiotherapy to 5
recurrences, twice-daily radiotherapy to 5 recurrences (1 with mold brachytherapy boost), and a
combination of once- and twice-daily radiotherapy to 2 recurrences.
RESULTS:
The median follow-up from time of completion of reirradiation was 30 months (range, 1.5-67 months).
Local control was achieved in 7 of 8 patients and 11 of 12 recurrences. Regional control was achieved in 5
of 8 patients and 6 of 12 recurrences. Distant control was achieved in 5 of 8 patients. At time of analysis, 5
of 8 patients were alive. Median survival since reirradiation completion was 36 months (range, 4.5-47
months). Acute toxicity included grade 2 dermatitis in 4 patients, ipsilateral shoulder pain in 1 patient, and
ipsilateral pleurisy in 1 patient. Late skin and soft tissue toxicity manifested as fibrosis in 4 patients,
hyperpigmentation in 3 patients, and telangiectasia in 3 patients. Three patients reported lymphedema, 1
patient reporting chest wall pain and 1 patient with an ipsilateral rib fracture.
CONCLUSIONS:
Multidisciplinary management of locoregional recurrence of breast cancer using reirradiation is well
tolerated as salvage treatment and provides durable locoregional control.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21665137 [PubMed - in process]
Can Oncol Nurs J. 2011 Spring;21(2):129-31.
Better lymphedema management needed--the role of the specialized oncology nurse.
[Article in English, French]
Bowles S.
Source
Odette Cancer Centre, 2075 Bayview Ave., Toronto ON M4N 3M5. susan.bowles@sunnybrook.ca
PMID: 21661625 [PubMed - in process]
Nurs Stand. 2011 Apr 20-26;25(33):51-2, 54, 56 passim.
Psychosocial aspects of living with non-cancer-related lymphoedema.
Upton D, Solowiej K.
Source
Institute of Health and Society, University of Worcester. d.upton@worc.ac.uk
Abstract
Lymphoedema is a chronic condition that causes swelling, pain, altered appearance and reduced mobility.
Little is known about the psychosocial effects. This review aims to identify psychosocial aspects of living
with non-cancer-related lymphoedema, as such information is not readily available to healthcare
professionals or patients.
PMID: 21661532 [PubMed - indexed for MEDLINE]
Nurs Stand. 2011 Apr 20-26;25(33):20-1.
Treat with care.
Cooper C.
Abstract
Lymphoedema affects at least 100,000 people in the UK but health professionals do not always know how
to help prevent complications.
PMID: 21661527 [PubMed - indexed for MEDLINE]
June 22, 2011
Breast Cancer Res Treat. 2011 Jun 17. [Epub ahead of print]
Associations among baseline variables, treatment-related factors and health-related quality of life 2 years
after breast cancer surgery.
Taira N, Shimozuma K, Shiroiwa T, Ohsumi S, Kuroi K, Saji S, Saito M, Iha S, Watanabe T, Katsumata
N.
Source
Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-cho,
Okayama, 700-8558, Japan, ntaira@md.okayama-u.ac.jp.
Abstract
Provision of social support and rehabilitation for patients with physical, mental, and functional problems
after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of
human and financial healthcare resources requires identification of patients requiring rehabilitation. The
objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time,
to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months,
1, and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each
point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression,
and HRQOL at 1 month (baseline), 6 months, 1, and 2 years after surgery in 196 patients (mean age: 53.3
years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated
using a patient-reported symptom checklist. HRQOL was rated using the functional assessment of cancer
treatment scale-general (FACT-G) and the breast cancer subscale (FACT-B). Anxiety and depression
were rated using the hospital anxiety and depression scale (HADS). More than 50% of patients had local
problems of "tightness", "arm weakness." and "arm lymphedema", and systemic problems of "reduced
energy, fatigue, and general weakness" postoperatively. The HRQOL score significantly improved 1 year
after surgery, and scores for physical, emotional and functional well-being also increased with time,
whereas the score for social well-being was the highest at baseline and decreased with time. Depression
and anxiety significantly improved with time. Concomitant disease, marital status, and the presence of a
partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous
chemotherapy were significant factors predicting FACT-G scores at 6 months, 1, and 2 years after
surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These
results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term
postoperative physical function. A further study of psychosocial interventions is required to improve
depression and social well-being after breast cancer surgery.
PMID: 21681445 [PubMed - as supplied by publisher]
Plast Reconstr Surg. 2011 Jun 15. [Epub ahead of print]
Indocyanine Green (ICG)-enhanced Lymphography for Upper Extremity Lymphedema: A Novel Severity
Staging System Using Dermal Backflow (DB) Patterns.
Yamamoto T, Yamamoto N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M,
Narushima M, Iida T, Koshima I.
Source
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo,
Japan.
Abstract
BACKGROUND:
Management of arm lymphedema following breast cancer treatment is challenging, and emphasis should be
put on early diagnosis and prevention of secondary lymphedema. Indocyanine green (ICG) lymphography
is becoming a method of choice for evaluation of lymphedema.
METHODS:
Twenty patients with secondary arm lymphedema after breast cancer treatment underwent ICG
lymphography. Characteristic findings of ICG lymphography were analyzed according to corresponding
clinical stages and duration of edema. Based on changes in ICG lymphography findings with progression of
lymphedema, a new severity stage, arm dermal backflow (ADB) stage was developed and compared with
clinical stages.
RESULTS:
The ICG lymphography findings were classified into two large groups: linear pattern (LP) and dermal
backflow (DB) patterns. The DB patterns could be subdivided into splash, stardust, and diffuse patterns.
The DB patterns were found more frequently than the LP in the proximal upper extremity (P = 0.001). The
DB patterns also increased significantly in prevalence overall as the duration of lymphedema increased (P =
0.032). The ADB stage was linearly correlated with clinical stage as described by the line y = 1.092x +
0.083 (R = 0.997; ANOVA P < 0.001).
CONCLUSIONS:
ICG lymphography is a safe and convenient evaluation method for lymphedema, which allows qualitative
pathophysiological assessment of the lymphedema. The ADB stage, based on ICG lymphography findings,
is a simple severity staging system which demonstrates a significant correlation with clinical stage. ICG
lymphography may come to play an important role in early diagnosis of secondary arm lymphedema.
PMID: 21681123 [PubMed - as supplied by publisher]
Am Surg. 2011 Jun;77(6):799-801.
Appearance of Retroperitoneal Lymphedema on CT Scan after Penetrating Neck Injury.
Ferguson EJ, Stombaugh HA, Lowe S.
PMID: 21679658 [PubMed - in process]
June 25, 2011
Clin Cosmet Investig Dermatol. 2011;4:55-9. Epub 2011 May 26.
Treatment of cellulite based on the hypothesis of a novel physiopathology.
de Godoy JM, de Godoy Mde F.
Source
Department of Cardiology and Cardiovascular Surgery.
Abstract
BACKGROUND:
The aim of the current study is to report on a new form of treatment for cellulite based on a novel
physiological hypothesis.
METHODS:
A novel treatment for cellulite was evaluated in 14 patients aged 19-36 (mean 27.5) years. The only
inclusion criterion was clinically diagnosed cellulite, and the exclusion criteria were history of edema,
obesity, or any other disease diagnosed during the physical examination. Perimetry was performed at the
gluteal fold, at 5 cm and 10 cm below the gluteal fold for both legs, and 5 cm and 10 cm below the navel.
Additionally, standard photographs were taken and a questionnaire of satisfaction was applied. The
patients were submitted to a treatment regimen of 1.5 hours per day adapted for the treatment of cellulite,
consisting of manual and mechanical lymph drainage and cervical stimulation using the Godoy and Godoy
technique. After 10 sessions over two weeks, the patients were evaluated again.
RESULTS:
Reductions were identified at both points below the navel, the points on the thighs, and at the gluteal fold (P
< 0.0001).
CONCLUSION:
This technique of lymphatic system stimulation is efficacious in the treatment of cellulite.
PMID: 21691567 [PubMed - in process] PMCID: PMC3114606
Ann Surg Oncol. 2011 Jun 22. [Epub ahead of print]
Lymphoceles, Lymphorrhea, and Lymphedema after Laparoscopic and Open Endometrial Cancer Staging.
Ghezzi F, Uccella S, Cromi A, Bogani G, Robba C, Serati M, Bolis P.
Source
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy, Fabio.
ghezzi@uninsubria.it.
Abstract
PURPOSE:
To evaluate the incidence of lymphoceles, lymphorrhea, and lymphedema after systematic pelvic
lymphadenectomy in patients who underwent laparoscopic or open abdominal staging for endometrial
cancer.
METHODS:
A total of 138 consecutive women who underwent systematic laparoscopic pelvic lymphadenectomy for
endometrial cancer staging were compared to 123 historical control subjects staged via an open approach.
Postoperative screening for lymphadenectomy-related complications by ultrasound was consistently
performed.
RESULTS:
The incidence of perioperative complications was lower in cases than in control subjects. Overall,
lymphoceles were diagnosed in 19 (15.4%) and 2 (1.4%) patients who had open and laparoscopic staging,
respectively (odds ratio 12.42; 95% confidence interval 2.82-54.55; P < 0.0001). Symptomatic
lymphoceles were more frequent after open staging than after laparoscopy (P = 0.028). Lymphorrhea
occurred in 1 and 4 patients after laparoscopic and open surgery (P = 0.19). No difference in the incidence
of lymphedema was observed.
CONCLUSIONS:
Our findings suggest that laparoscopic endometrial cancer staging is associated with a lower occurrence of
both asymptomatic and symptomatic lymphoceles compared to open surgery.
PMID: 21695563 [PubMed - as supplied by publisher]
BMJ. 2011 Jun 21;342:d3442. doi: 10.1136/bmj.d3442.
Priorities for women with lymphoedema after treatment for breast cancer: population based cohort study.
Girgis A, Stacey F, Lee T, Black D, Kilbreath S.
Source
University of Newcastle, Callaghan, NSW 2308, Australia.
Abstract
OBJECTIVE:
To explore the perceived unmet needs among women treated for breast cancer and in whom symptoms
and signs indicate the presence of lymphoedema.
DESIGN:
Population based cross sectional survey with a purpose designed questionnaire (60 items).
SETTING:
Cancer registries of New South Wales, Victoria, and South Australia.
PARTICIPANTS:
237 women with symptoms and signs indicative of lymphoedema from an initial 1930 eligible women.
MAIN OUTCOME MEASURE:
Unmet needs in the previous month across psychological, health system and information, physical and daily
living, patient care and support, sexuality needs, body image, and financial domains.
RESULTS:
The 10 items most commonly identified as a "moderate to high current need" included having their doctor
and allied health workers being fully informed about lymphoedema, acknowledge the seriousness of the
condition, and be willing to treat it. Women also wanted access to up to date treatments, both mainstream
and alternative, and financial assistance for their garments. The three factors that explained most of the
variance were: information and support (11 items), which accounted for 49% of the variance; body image
and self esteem (seven items; 7% variance); and health system (seven items; 5% variance). Examination of
these three factors showed that while the levels of need were generally low, they were common.
CONCLUSION:
To address the needs of women with lymphoedema and perhaps to prevent progression of lymphoedema,
it is important that practitioners do not dismiss mild symptoms and that women are referred to an
appropriate specialist.
PMID: 21693532 [PubMed - in process]
Scand J Caring Sci. 2011 Jun 21. doi: 10.1111/j.1471-6712.2011.00903.x. [Epub ahead of print]
Information provision and problem-solving processes in Japanese breast cancer survivors with
lymphoedema symptoms.
Tsuchiya M, Horn S, Ingham R.
Source
School of Psychology, University of Southampton, Southampton, UK.
Abstract
Scand J Caring Sci; 2011 Information provision and problem-solving processes in Japanese breast cancer
survivors with lymphoedema symptoms Background: In Japan, a high proportion of breast cancer (BC)
survivors develop lymphoedema as a consequence of the treatment received. Japanese BC survivors are
generally not provided with standardised information about risks, early signs and symptom management.
The effects of (in)adequate information on the problem-solving processes among Japanese BC survivors
with lymphoedema symptoms have not been investigated. Purpose: The aim of this study was to explore
how the provision of medical information by doctors affected the problem-solving processes of Japanese
BC survivors with lymphoedema symptoms. Method: Ten Japanese BC survivors participated in audio-
taped focus group discussions. Transcripts were analysed using an inductive thematic analysis. Results:
Analysis identified two phases during which participants attempted to address problems with managing their
lymphoedema symptoms - a help-seeking phase and an evaluation phase. Perceptions of information
provision affected emotional responses to the onset and cognitive appraisals of lymphoedema symptoms
(seen as accepted or burden). However, perceptions of information provision did not affect help-seeking
behaviours from surgeons or adherence behaviours. Participants often perceived compression sleeves as
inefficient and not worth continuing. Conclusion: This study suggests that information provision is a key
process in helping BC patients to adjust to symptoms of lymphoedema. In order to promote effective
symptom management, doctors and nurses should provide support not only during the help-seeking phase
but also the evaluation phase. Further research on the most effective ways to change negative treatment
beliefs should be conducted.
© 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.
PMID: 21692823 [PubMed - as supplied by publisher
Lymphat Res Biol. 2011;9(2):101-7.
Inter-rater reliability of arm circumference measurement.
Foroughi N, Dylke ES, Paterson RD, Sparrow KA, Fan J, Warwick EB, Kilbreath SL.
Source
Clinical and Rehabilitation Sciences, Breast Cancer Research Group, Faculty of Health Sciences,
University of Sydney , Sydney, NSW, Australia .
Abstract
Abstract Background: Arm lymphedema is routinely assessed by clinicians and researchers, using arm
circumference measurements. A protocol was developed for measuring arm circumference independent of
medically trained professionals. The aim of this project was to assess the protocol's inter-rater reliability
and its coherence with perometry measures. Methods and Results: Community-dwelling adults (n = 57),
aged 60.2 ± 12.8 years, in good general health, were included in this study. Circumference of both arms
were measured at the ulnar styloid of the wrist and at four 10 cm intervals up the arm by a friend of the
participant, as well as the trained assessor using a tape measure. The same measures were also obtained
with a perometer. The assessment tools had moderate to high concordance (r(c) = 0.84-0.94 for assessor
vs. perometer and r(c) = 0.68-0.93 for assessor vs. participant). Limits of agreement analysis revealed that
the mean difference between methods varied based on the measurement location; the bias ranged from
-5.5% to 1.5% for assessor-measured vs. perometer methods and from -2.4% to 4.0% for assessor-
measured vs. participant-measured methods. Conclusions: The written instructions and cartoons are
reliable tools that could be used by women at risk of lymphedema as well as those with lymphedema
following treatment for breast cancer to measure their arm circumference reliably independent of medically
trained personnel.
PMID: 21688979 [PubMed - in process]
Lymphat Res Biol. 2011;9(2):93-9.
Bioimpedance in the assessment of unilateral lymphedema of a limb: the optimal frequency.
Gaw R, Box R, Cornish B.
Source
1 Faculty of Science and Technology, Queensland University of Technology , Brisbane, Australia .
Abstract
Abstract Background: Bioimpedance techniques provide a reliable method of assessing unilateral
lymphedema in a clinical setting. Bioimpedance devices are traditionally used to assess body composition at
a current frequency of 50 kHz. However, these devices are not transferable to the assessment of
lymphedema, as the sensitivity of measuring the impedance of extracellular fluid is frequency dependent. It
has previously been shown that the best frequency to detect extracellular fluid is 0 kHz (or DC). However,
measurement at this frequency is not possible in practice due to the high skin impedance at DC, and an
estimate is usually determined from low frequency measurements. This study investigated the efficacy of
various low frequency ranges for the detection of lymphedema. Methods and Results: Limb impedance was
measured at 256 frequencies between 3 kHz and 1000 kHz for a sample control population, arm
lymphedema population, and leg lymphedema population. Limb impedance was measured using the
ImpediMed SFB7 and ImpediMed L-Dex(®) U400 with equipotential electrode placement on the wrists
and ankles. The contralateral limb impedance ratio for arms and legs was used to calculate a lymphedema
index (L-Dex) at each measurement frequency. The standard deviation of the limb impedance ratio in a
healthy control population has been shown to increase with frequency for both the arm and leg. Box and
whisker plots of the spread of the control and lymphedema populations show that there exists good
differentiation between the arm and leg L-Dex measured for lymphedema subjects and the arm and leg L-
Dex measured for control subjects up to a frequency of about 30 kHz. Conclusions: It can be concluded
that impedance measurements above a frequency of 30 kHz decrease sensitivity to extracellular fluid and
are not reliable for early detection of lymphedema.
PMID: 21688978 [PubMed - in process]
Lymphat Res Biol. 2011;9(2):77-83.
Tissue Fluid Pressure and Flow during Pneumatic Compression in Lymphedema of Lower Limbs.
Olszewski WL, Jain P, Ambujam G, Zaleska M, Cakala M, Gradalski T.
Source
1 Department of Surgical Research and Transplantology, Medical Research Center , Polish Academy of
Sciences, Warsaw, Poland .
Abstract
Abstract Background: Physiotherapy of edema in cases with obstructed main lymphatics of lower limbs
requires knowledge of how high external pressures should be applied manually or set in compression
devices in order to generate tissue pressures high enough to move tissue fluid to nonswollen regions and to
measure its flow rate. Methods: We measured tissue fluid pressure and flow in subcutaneous tissue of
lymphedematous limbs stages II to IV at rest and during pneumatic compression under various pressures
and inflation timing. An 8-chamber sequential compression device inflated to pressures 50-120 mmHg, for
50 sec each chamber, with no distal deflation, was used. Pressures were measured using a wick-in-needle
and electronic manometer. Fluid flow was calculated from continuously recorded changes in limb
circumference using strain gauge plethysmography. Results: Before massage, in all stages of lymphedema,
stagnant tissue fluid pressures in subcutaneous tissue ranged between -1 and +10 mmHg and did not differ
from those measured in normal subjects. Pressures generated in tissue fluid by pneumatic compression
reached 40-100 mmHg and were lower than those in inflated chambers. High pressure gradient through the
skin was caused by its rigidity (fibrosis) and dissipation of applied compression force to proximal
noncompressed limb regions. The calculated volumes of displaced tissue fluid ranged from 10 to 30 ml per
compression cycle, to reach in some cases 100 ml in the groin region. Conclusions: Tissue fluid pressures
generated by a pneumatic device were found lower than in the compression chambers. The obtained results
point to the necessity of applying high pressures and longer compression times to generate effective tissue
fluid pressures and to provide enough time for moving the stagnant fluid.
PMID: 21688976 [PubMed - in process]
J Parasitol Res. 2011;2011:201617. Epub 2011 May 22.
Macrofilaricidal Activity in Wuchereria bancrofti after 2 Weeks Treatment with a Combination of
Rifampicin plus Doxycycline.
Debrah AY, Mand S, Marfo-Debrekyei Y, Batsa L, Albers A, Specht S, Klarmann U, Pfarr K, Adjei O,
Hoerauf A.
Source
Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, UPO, PMB,
Kumasi, Ghana.
Abstract
Infection with the filarial nematode Wuchereria bancrofti can lead to lymphedema, hydrocele, and
elephantiasis. Since adult worms cause pathology in lymphatic filariasis (LF), it is imperative to discover
macrofilaricidal drugs for the treatment of the infection. Endosymbiotic Wolbachia in filariae have emerged
as a new target for antibiotics which can lead to macrofilaricidal effects. In Ghana, a pilot study was carried
out with 39 LF-infected men; 12 were treated with 200 mg doxycycline/day for 4 weeks, 16 were treated
with a combination of 200 mg doxycycline/day + 10 mg/kg/day rifampicin for 2 weeks, and 11 patients
received placebo. Patients were monitored for Wolbachia and microfilaria loads, antigenaemia, and filarial
dance sign (FDS). Both 4-week doxycycline and the 2-week combination treatment reduced Wolbachia
load significantly. At 18 months posttreatment, four-week doxycycline resulted in 100% adult worm loss,
and the 2-week combination treatment resulted in a 50% adult worm loss. In conclusion, this pilot study
with a combination of 2-week doxycycline and rifampicin demonstrates moderate macrofilaricidal activity
against W. bancrofti.
PMID: 21687646 [PubMed - in process] PMCID: PMC3112504
Acupunct Med. 2011 Jun 18. [Epub ahead of print]
A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphoedema.
Cassileth BR, Van Zee KJ, Chan Y, Coleton MI, Hudis CA, Cohen S, Lozada J, Vickers AJ.
Source
1Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA.
Abstract
BACKGROUND:
Lymphoedema is a distressing problem affecting many women after breast cancer surgery. There is no cure
and existing treatments are marginally beneficial, rarely reducing arm swelling in any meaningful way.
Needling and even lifting of objects using the affected arm has been prohibited, but our clinical experience
and that of others suggested that acupuncture was safe and that it might be a useful treatment for
lymphoedema.
OBJECTIVE:
We sought to conduct a pilot study of the safety and effectiveness of acupuncture in women diagnosed with
chronic lymphoedema for at least 6 months and less than 5 years.
METHODS:
Women with chronic lymphoedema (affected arm with >2 cm circumference than unaffected arm) after
breast cancer surgery received acupuncture twice a week for 4 weeks. Response was defined as at least a
30% reduction in the difference in size between the affected and unaffected arms. Monthly follow-up calls
for 6 months following treatment were made to obtain information about side effects.
RESULTS:
Study goals were met after nine subjects were treated: four women showed at least a 30% reduction in the
extent of lymphoedema at 4 weeks when compared with their respective baseline values. No serious
adverse events occurred during or after 73 treatment sessions. Limitations This pilot study requires a larger,
randomised follow-up investigation plus enquiries into possible mechanisms. Both are in development by
our group.
CONCLUSION:
Acupuncture appears safe and may reduce lymphoedema associated with breast cancer surgery.
PMID: 21685498 [PubMed - as supplied by publisher]
Bull Cancer. 2011 Jun 17. [Epub ahead of print]
Return to work after treatment for breast cancer: single center experience in a cohort of 273 patients.
Peugniez C, Fantoni S, Leroyer A, Skrzypczak J, Duprey M, Bonneterre J.
Source
Centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille Cedex, FranceCentre Oscar-
Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille Cedex, France.
Abstract
<p>An increasing number of patients is treated for breast cancer during their professional life. The aim
of this study was to assess factors impacting return to work and time to return to work after treatment.
</p><p>One thousand and sixty-seven patients less than 60 years of age, and surgically treated
in our institution between January 1st, 2004 and December 31st, 2005 received a questionnaire with
medical, sociodemographic and professional items. An answer was obtained in 586 cases. Two hundred
and seventy-three patients were evaluable. All the clinical files of these patients were reviewed.<
/p><p>Overall, 79.8% of the patients returned to work after a median delay of 11.5 months. In the
multivariate analysis, the factors affecting the return to work were: age (P < 0.0001), educational level
(P < 0.001), colleagues' support (P < 0.001), chemotherapy (P < 0.05), lymphedema (P
< 0.01), and the physical (P = 0.01) and psychological (P < 0.01) constraints of the job. The
factors affecting the time until return to work were very quite similar. No significant difference was
observed according to the type of surgery, radiation therapy or not, hormonotherapy or not.<
/p><p>Eighty percent of the patients with a professional activity before treatment returned to work;
the factors affecting return to work were medical, demographic and socio-professional.</p>
PMID: 21684837 [PubMed - as supplied by publisher]
J Plast Reconstr Aesthet Surg. 2011 Jun 15. [Epub ahead of print]
Indocyanine green (ICG)-enhanced lymphography for evaluation of facial lymphoedema.
Yamamoto T, Iida T, Matsuda N, Kikuchi K, Yoshimatsu H, Mihara M, Narushima M, Koshima I.
Source
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-
3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
PMID: 21683666 [PubMed - as supplied by publisher
Plast Reconstr Surg. 2011 Jun;127(6):2419-31.
Primary lymphedema: clinical features and management in 138 pediatric patients.
Schook CC, Mulliken JB, Fishman SJ, Grant FD, Zurakowski D, Greene AK.
Source
Boston, Mass. From the Departments of Plastic and Oral Surgery, Surgery, and Radiology, Vascular
Anomalies Center, Children's Hospital Boston, Harvard Medical School.
Abstract
BACKGROUND:
: Lymphedema results from maldevelopment of the lymphatic system (primary) or injury to lymphatic
vasculature (secondary). Primary lymphedema is far less common than the secondary condition. The
purpose of this study was to determine the clinical features of primary lymphedema in the pediatric age
group.
METHODS:
: The authors' Vascular Anomalies Center database was reviewed for patients evaluated between 1999
and 2010 with onset of lymphedema before 21 years of age. Cause, sex, age of onset, location, and
familial/syndromic association were determined. Morbidity, progression, and treatment were analyzed.
RESULTS:
: Lymphedema was confirmed in 142 children: 138 cases (97.2 percent) were primary and four (2.8
percent) were secondary. Analysis of the primary cohort showed that 58.7 percent of the patients were
female. Age of onset was infancy, 49.2 percent; childhood, 9.5 percent; or adolescence, 41.3 percent.
Boys most commonly presented in infancy (68.0 percent), whereas girls usually developed swelling in
adolescence (55.3 percent). Lymphedema involved an extremity (81.9 percent), genitalia (4.3 percent), or
both (13.8 percent). The lower limb was most commonly affected (91.7 percent), and 52.9 percent had
bilateral lower extremity disease. Eleven percent of patients had familial or syndromic lymphedema.
Cellulitis occurred in 18.8 percent of children; 13.0 percent required hospitalization. The majority of
patients (57.9 percent) had progression of their disease. Treatment was compression garments alone (75.4
percent) or in combination with pneumatic compression (19.6 percent); 13.0 percent had operative
intervention.
CONCLUSIONS:
: Pediatric primary lymphedema usually involves the lower extremities. Boys typically are affected at birth,
and girls most often present during adolescence. Most patients do not have major morbidity, are
successfully managed by compression, and do not require surgical treatment.
PMID: 21617474 [PubMed - in process]
Jpn J Nurs Sci. 2011 Jun;8(1):109. doi: 10.1111/j.1742-7924.2011.00181.x.
Response to: Assessment of lymphedema by bioelectrical impedance spectroscopy.
Sakuda H.
Source
Graduate School of Medicine and Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan.
PMID: 21615704 [PubMed - in process]
Jpn J Nurs Sci. 2011 Jun;8(1):108. doi: 10.1111/j.1742-7924.2010.00165.x.
Assessment of lymphedema by bioelectrical impedance spectroscopy.
Ward LC.
Source
School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland;
and Breast Cancer Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, New
South Wales, Australia.
PMID: 21615703 [PubMed - in process]
Histochem Cell Biol. 2011 Jun;135(6):603-13. Epub 2011 May 26.
Dysmorphogenesis of lymph nodes in Foxc2 haploinsufficient mice.
Shimoda H, Bernas MJ, Witte MH.
Source
Department of Surgery, The University of Arizona, Tucson, AZ, USA, shimoda@oita-nhs.ac.jp.
Abstract
Dysmorphogenesis of lymph nodes displayed in a fork head transcription factor Foxc2 haploinsufficient
mice-a model for lymphedema-distichiasis syndrome-was studied by immunohistochemistry and electron
microscopy. The Foxc2 heterozygous mice manifested lymph node hyperplasia composed of conspicuous
proliferation of endothelial cells forming the lymphatic sinus and α-smooth muscle actin (SMA)-
immunopositive fibroblast-like cells in the lymphatic pulp, particularly around the sinus. The hyperplastic
sinus endothelial cells and the SMA-positive cells demonstrated distinct immunolocalization of platelet-
derived growth factor (PDGF)-B, a crucial chemoattractant for vascular mural cell recruitment, and its
receptor, PDGFR-β, respectively. The observations suggest that the sinus endothelial cells elicit abnormal
recruitment of the fibroblast-like cells as a type of vascular mural cells via PDGF-B/PDGFR-β signaling in
lymph nodes of the Foxc2 heterozygotes. Furthermore, in Foxc2 heterozygous lymph nodes, recruited
SMA-positive cells displayed an intense immunoreaction for vascular endothelial growth factor (VEGF)-C,
a highly specific lymphangiogenic factor, and its receptor, VEGFR-3, was preferentially distributed in the
lymphatic sinus endothelial cells. These findings suggest that an interactive cycle between lymphatic sinus
endothelial cells and the fibroblast-like cells, which involves PDGF-B/PDGFR-β and VEGF-C/VEGFR-3
signaling, is essential for aberrant hyperplasia of the lymphatic sinus and the fibroblast-like cells in Foxc2
haploinsufficiency.
PMID: 21614587 [PubMed - in process]
Arch Esp Urol. 2011 May;64(4):351-362.
Penile cancer: are there currently indications for radiotherapy?.
[Article in English, Spanish]
González Domingo M, González San Segundo C.
Source
Department of Oncological Radiotherapy. Instituto Oncológico. Viña del Mar. Chile.
Abstract
Penile cancer is a radiocurable disease. The different types of radiotherapy (RT)-brachytherapy,
plesiotherapy, external beam radiation therapy-have proven valid in the treatment of the primary tumor
allowing preservation of the penis and sexual function. RT is even an option in candidates for surgery who
reject surgery for clinical or personal reasons. A high nodal recurrence rate has been observed after
inguinal lymphadenectomy, specially in patients at high risk of relapse. Technological advances in the field
of RT, new imaging techniques, and more modern equipment enable RT to enhance local control and
improve survival in patients with this condition. Palliative RT can exercise a decompressive effect that
makes possible tumor size reduction in cases of inguinal-pelvic recurrence in patients with lymphedema and
thus improve quality of life. In this article, we review the current role of RT in the treatment of penile
cancer. We also present two cases that illustrate the main indications.
PMID: 21610280 [PubMed - as supplied by publisher]
Aesthetic Plast Surg. 2011 May 24. [Epub ahead of print]
Large Necrosis: A Rare Complication of Medial Thighplasty.
Bertheuil N, Aillet S, Heusse JL, Flecher E, Watier E.
Source
Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, 16 Boulevard de Bulgarie,
35200, Rennes, France, nbertheuil@gmail.com.
Abstract
Obesity is a major public health problem in Western societies. After failure of diet and exercise, patients
can have bariatric surgery. Weight loss causes excess skin on the body, including the thighs. This leads to
difficulty walking and psychological disorders such as devalued self-image. Medial thighplasty is an
intervention to reduce excess skin and fat in the thighs. The main complications are scar migration, scar
infection, hematoma, lymphedema, gaping vulva, and, rarely, skin necrosis. We describe a case of flap
necrosis after a reoperation of medial thighplasty. Treatment included debridement of necrotic tissue and
healing of the wound by secondary intention (vacuum-assisted closure and dressings with calcium alginate).
Complete healing was achieved in 4 months. As the patient refused any new procedure, skin grafting was
not performed. The aesthetic results of plastic surgery procedures are often imperfect. Patients should be
clearly prepared and informed about the results expected from the operation. Surgeons should know
contraindications for reoperation.
PMID: 21607533 [PubMed - as supplied by publisher]
Khirurgiia (Mosk). 2011;(5):15-18.
[Prevention of complications after surgery in patients with upper limbs' lymphedema.]
[Article in Russian]
Liubarskiĭ MS, Nimaev VV, Shumkov OA, Konenkov VI.
Source
Nauchno-issledovatel'skiĭ institut klinicheskoĭ i éksperimental'noĭ limfologii Sibirskogo otdeleniia RAMN,
Novosibirsk.
Abstract
The results of surgical treatment of patients with the fourth stage of the upper limbs' lymphedema was
studied. Of all 170 patients with lymphedema, 16 (9.4%) had the fourth stage of the disease. The debulking
procedures were performed in 15 patients (8 had standart operations, 7 - simultaneous rwo-stage
operations). Beeing a preliminary stage of the radical surgical excision of lymphoedematously changed
tissues, the liposuction allows a more precisional hemostasis for the accurate vessel visualization. It led to
the 4,4 times decrease of the postoperative morbidity rate and shortened the time of the operation.
PMID: 21606915 [PubMed - as supplied by publisher]
Dermatology. 2011 May 24. [Epub ahead of print]
Safety of Tumescent Liposuction under Local Anesthesia in a Series of 4,380 Patients.
Boeni R.
Source
White House Center for Liposuction, Zurich, Switzerland.
Abstract
Background: Liposuction is increasingly performed under local anesthesia and in an outpatient setting. The
term 'tumescent liposuction' has been used in the literature in patients receiving other forms of anesthesia as
well, hence the confusion regarding the safety profile of liposuction performed under local anesthesia alone.
Objective: To analyze the safety of tumescent liposuction performed under local anesthesia in a larger
group of patients. Methods: Between 2003 and 2010, 4,380 consecutive patients underwent tumescent
liposuction by the same surgeon. The occurrence of complications was recorded in detail. Results: There
were no serious complications requiring hospitalization. There were no injuries, no nerve damage or
permanent lymphedema, no deep venous thrombosis or seroma. Seven patients needed closer follow-up
due to large hematoma (n = 3; no drainage needed), allergic drug reaction to doxycycline (n = 2),
erysipelas (n = 1) and generalized edema (n = 1). Conclusions: Tumescent liposuction under local
anesthesia is a safe method, providing it is performed by an experienced surgeon and the guidelines of care
for liposuction are strictly followed.
Copyright © 2011 S. Karger AG, Basel.
PMID: 21606638 [PubMed - as supplied by publisher]
Semin Oncol. 2011 Jun;38(3):386-93.
Cancer rehabilitation.
Stubblefield MD.
Source
Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan-Kettering Cancer Center,
New York, NY; Department of Physical Medicine and Rehabilitation, Weill Medical College of Cornell
University, New York, NY.
Abstract
Cancer rehabilitation is the subspecialty of rehabilitation medicine concerned with restoring and maintaining
the highest possible level of function, independence, and quality of life to patients at all stages of their
cancer diagnosis, including those undergoing potentially curative therapy and those receiving palliative care,
as well as cancer survivors. Cancer rehabilitation physicians specialize in the evaluation and treatment of
neuromuscular, musculoskeletal, and functional complications of cancer and cancer treatments such as
acute and chronic pain, weakness, muscle spasm, myelopathy, radiculopathy, plexopathy, neuropathy,
myopathy, deconditioning, contracture, spasticity, lymphedema, amputation, shoulder dysfunction, and gait
disorders, among others. Late effects of radiation represents a particular challenge for cancer rehabilitation
physicians as radiation fibrosis may affect multiple structures, including the spinal cord, nerve roots, plexus,
local nerves, and muscles, as well as their supporting structures. A comprehensive clinical evaluation
involving an in-depth working knowledge of neuromuscular and musculoskeletal anatomy and incorporating
specialized physical examination maneuvers allows the physiatrist to clarify the specific etiology of pain and
functional disorders. A safe and effective rehabilitation program will depend heavily on an accurate
diagnosis of the cause of pain or dysfunction.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21600368 [PubMed - in process]
June 7, 2011
J Egypt Soc Parasitol. 2011 Apr;41(1):179-97.
Clinical, parasitological and social studies on Wuchereria bancrofti in Egypt.
Tayel Sel S, Sharapy Ael D, El Shazly AM, Shahat SA, Zaalouk TKh, Al Sayed MY.
Source
Departments of Parasitology, Faculty of Medicine, Al-Azhar University, Nasr City, Egypt.
Abstract
This study was conducted on patients attending Al-Hussein University Hospital and Mansura University
Hospitals. Sheets were filled out on each patient (age, residence, occupation, family similar condition,
travelling, disease duration, symptoms suggesting acute dermatolymphangitis attacks, frequency and
duration. They were 25 lymphoedema patients and 8 controls (17 males & 16 females) and subjected to
clinical and parasitological examinations. According to residence, five patients were from Giza Govemorate
(18.18%), four from Dakahlia G. (12.12%), four from Gharbia G. (12.12%), five from Menoufia G.
(15.15%), four from Sharkia G. (12.12%), two cases from Kafr Elsheikh G. (6.06%) and one patient from
Assiut G. (3.03%). In controls, 6 were from Al-Hussein Cairo G. (15.15%), and two cases (6.06) from
Al-Abbassia. They were 48% farmers (10 male & 2 female); 4% grocers (1 male); 8% carpenters (2
male); and 40% house wife (10 female). According to lymphedema site: 3 cases (12%) were bilateral
lower limbs lymphedema (2 female & 1 male), 13 cases (52%) had right lower limb lymphedema (6 female
& 7 male), and 9 cases (36%) had left lower limb lymphedema (4 female & 5 male). They were 18 (72%)
with below knee extension of lymphedema (10 male & 8 female) and 7 (28%) above knee extension of
lymphedema (3 male & 4 female). Grade of lymphedema was one case (male) with grade II lymphedema
(4%), 13 cases (52%) with grade III (7 male & 6 female) and 11 cases (44%) with grade IV (5 male & 6
female). Duration of lymphedema was one case with grade II lymphedema in a period of 3 years, 13 cases
with grade III lymphedema and the durations of lymphedema for these cases were (one case with 5 years
duration, 3 cases were > 6-9 years,6 cases were > 9-12 years and 3 cases were > 12 years) and 11 cases
with grade IV lymphedema and duration of lymphedema for these cases were (one case with 6 years
duration, 2 cases were > 6-9 years,3 cases were > 9-12 years and 5 cases were > 12 years).
PMID: 21634252 [PubMed - in process]
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
Massive Localized Lymphedema: Review of an Emerging Problem and Report of a Complex Case in the
Mons Pubis.
Brewer MB, Singh DP.
Source
From the Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center,
Baltimore, MD.
Abstract
Massive localized lymphedema (MLL) is an emerging complication of the obesity epidemic. Caused by the
obstruction of lymphatics, MLL presents as a giant swelling, with characteristic skin changes, and often
lymphatic weeping. MLL has also been called "pseudosarcoma" because of its morphologic and pathologic
similarity to sarcoma. Left untreated, MLL can degenerate into angiosarcoma. We present a case of MLL
of the mons pubis in a 40-year-old man with a body mass index of 69. The literature is reviewed and an
additional 40 cases of MLL are described. We found a female predominance of 1.6 to 1, an average
weight of 421 lbs, and a 58% majority of cases in the thigh.
PMID: 21629105 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
Assessment of Figuration of Thoracic Duct Using Magnetic Resonance Thoracic Ductography in Idiopathic
Lymphedema.
Hara H, Koshima I, Okuda I, Narushima M, Mihara M, Todokoro T.
Source
From the *Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo,
Japan; and †Department of Radiology, International University of Health and Wefare, Mita Hospital,
Tokyo, Japan.
Abstract
The structure and the function of the peripheral lymph channels have been investigated, but the thoracic
duct has not been investigated. This study used magnetic resonance thoracic ductography for 2 patients
with idiopathic lymphedema to evaluate the configuration of the thoracic duct in these patients. Anomalies
of thoracic duct were detected in both cases. This result suggests that deformity of the thoracic duct is one
of the causes of idiopathic lymphedema. Characterization of the etiology could lead to a breakthrough in
resolving the occurrence of idiopathic lymphedema and developing a treatment procedure for it. In
addition, visualization of the thoracic duct may assist in selecting the optimal therapy for each idiopathic
lymphedema patient.
PMID: 21629101 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
Outcome Study of the Surgical Management of Panniculitis.
Zannis J, Wood BC, Griffin LP, Knipper E, Marks MW, David LR.
Source
From the *Department of Plastic and Reconstructive Surgery, Wake Forest University School of
Medicine, Winston-Salem, NC; and †Department of Biostatistical Sciences, Division of Public Health
Sciences, Wake Forest University Health Sciences, Winston-Salem, NC.
Abstract
Patients with panniculus morbidus have an abdominal panniculus that becomes a pathologic entity,
associated with the development of candidal intertrigo, dermatitis, lymphedema, and ischemic panniculitis.
Panniculectomy is a standard treatment for this problem. The objective of this study was to determine risk
factors for complications associated with panniculectomy surgery to lower the complication rate. We
performed a retrospective chart review of patients who underwent panniculectomy between 1999 and
2007 by looking at data related to surgical complications, comorbidities, age, and gender. In 563 patients,
we recorded the incidence of the following complications: wound-related (infection, dehiscence, and/or
necrosis), hematoma/seroma, respiratory distress, blood transfusions, deep venous thrombosis or
pulmonary embolism, and death. Overall, 34.3% of patients suffered at least 1 complication. In patients
with wound complications specifically, there was a significantly higher body mass index versus those with
no wound complications (43.7% vs. 30.7%, P < 0.0001). Smokers also had a higher rate of wound
complications (40.5% vs. 19.5%, P < 0.0001).
PMID: 21629099 [PubMed - as supplied by publisher]
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
A New Aspect of Metastasis in Cutaneous Cancer: Two Cases of Presacral Squamous Cell Carcinoma
With Metastases to Internal Iliac Nodes.
Oashi K, Hayashi T, Furukawa H, Tsutsumida A, Kimura C, Oyamatsu H, Oyama A, Funayama E, Saito
A, Yamamoto Y.
Source
From the *Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of
Hokkaido at Sapporo, Sapporo, Japan; †Department of Skin Oncology/Dermatology, Comprehensive
Cancer Center, Saitama Medical University International Medical Center, Hidaka, Japan; ‡Department of
Plastic and Reconstructive Surgery, Hakodate Central General Hospital, Hakodate, Japan; and §Division
of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medical and Dental
Sciences, Niigata, Japan.
Abstract
We report 2 cases of presacral squamous cell carcinoma. In these cases, it was suspicious that the tumor
disseminated to the internal iliac nodes through the direct pathway called neurovascular lymphatic space
(NVLS) around the superior/inferior gluteal vessels or sciatic nerve bypassing external iliac nodes. NVLS
was initially reported as accessory pathway which follows the major vessels forming a sheath like structure
with an actual or potential space between the vessel wall and the enveloping membrane. NVLS has been
reported to be observed as a tubular shadow within the neurovascular sheath by lymphangiographies of
lymphedema patients using oil-based contrast material. These cases provide insights into the potential
pathway through which a cutaneous tumor disseminates.
PMID: 21629061 [PubMed - as supplied by publisher
Ann Plast Surg. 2011 May 27. [Epub ahead of print]
A New Model of Acquired Lymphedema in the Mouse Hind Limb: A Preliminary Report of a Half-Year
Course.
Oashi K, Furukawa H, Oyama A, Funayama E, Hayashi T, Saito A, Yamamoto Y.
Source
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of
Hokkaido at Sapporo, Sapporo, Japan.
Abstract
Lymphedema is known to be caused by many pathologic conditions; however, its correct diagnosis and
optimal therapeutic strategies remain to be established. In this report, we describe an experimental model
for acquired lymphedema in the lower extremity of the mouse that creates a lymphatic block in the groin
induced by both radiation treatment and surgical division of the superficial and deep lymphatics. To
evaluate the lymphatic system in this model, an indocyanine green fluorescence-sensitive camera system
was used. This model has the advantages of relative technical simplicity and cost-effective use of a rodent
animal model. Furthermore, a greater range of research tools such as antibodies and various databases are
available for mice. This mouse model may be useful to anyone modeling lymphedema mechanisms, by
providing a defined molecular context.
PMID: 21629054 [PubMed - as supplied by publisher]
World J Urol. 2011 May 31. [Epub ahead of print]
Tensor fascia lata flap reconstruction following groin dissection: is it worthwhile?
Nirmal TJ, Gupta AK, Kumar S, Devasia A, Chacko N, Kekre NS.
Source
Department of Urology, Christian Medical College, Vellore, Tamil Nadu, 632004, India, nirmaltj@gmail.
com.
Abstract
OBJECTIVE:
To compare the morbidity of primary skin closure with elective Tensor Fascia Lata (TFL) flap cover in
groin dissections.
MATERIALS AND METHODS:
This was a retrospective study between January 2007 and December 2009. All patients undergoing groin
dissections without skin involvement were included.
RESULTS:
Of the twenty-five patients, who underwent groin dissections, 14 had primary skin closure (28 groin
dissections)-group I. Eleven had TFL flap cover as a means of primary reconstruction (20 groin dissections)
-group II. In group I, there were 16 (57%) inguinal dissections and 12 (43%) ilioinguinal block dissections,
whereas 82% in group II underwent ilioinguinal dissections (p = 0.09). Wound infection requiring treatment
with a culture specific antibiotic was required in 4 (14%) in group I (n = 28) and only 1 (5%) in group II (n
= 20) (p = 0.38). In group I, 7 (25%) had major flap necrosis and minor necrosis was seen in another 7
(25%). Only three (15%) in group II developed minor flap necrosis (p = 0.01). Following an ilioinguinal
dissection, flap necrosis occurred in 75% of groins that underwent primary closure and in 17% of those
which were reconstructed with TFL (p = 0.001). Seroma formation was seen in 5 (18%) in group I and 3
(15%) in group II (p = 1.0). Lymphoedema occurred in equal numbers in both groups. The duration of
hospital stay was 20 ± 14 days in the primary closure group and 16 ± 3 days in the TFL group.
CONCLUSION:
The TFL flap can reduce postoperative morbidity and decrease hospital stay. Prophylactic TFL flap
reconstruction following ilioinguinal dissections is advisable.
PMID: 21626446 [PubMed - as supplied by publisher]
Int J Gen Med. 2011;4:373-6. Epub 2011 May 10.
Association of Godoy & Godoy contention with mechanism with apparatus-assisted exercises in patients
with arm lymphedema after breast cancer.
de Fátima Guerreiro Godoy M, Guimaraes TD, Oliani AH, de Godoy JM.
Source
CAPES (Coordination of Improvement of Higher Education Personal), São José do Rio Preto, Brazil;
Abstract
AIM:
The aim of the current study was to evaluate the reduction in the volume of the upper limbs with
lymphedema after exercises using the apparatus-assisted program associated with contention mechanism.
PATIENTS AND METHOD:
Twenty-eight female patients were selected and referred for evaluation and treatment of lymphedema after
breast cancer therapy. The ages of the women ranged from 42 to 72 years with a mean age of 57 years.
Inclusion criteria were treatment of cancer associated to a difference of at least 200 mL between the
edematous and the contralateral limbs. Patients with active infections, skin lesions, and active disease were
not included in the study. Four series of exercises using devices based on pedals, pulleys, a horizontal
reflexion bar, and an elevation bar were selected. The participants were advised about the form of exercise:
15 minutes for each device, low intensity (less than 10 movements per minute), in the seated position, and
the use of contention. Water displacement volumetry was performed before and after the 60-minute
exercise session. The paired t-test was utilized with an alpha error of 5% considered acceptable (P value <
0.05).
RESULTS:
The mean difference between the volumetric measures before and after exercise was significant, with all the
participants having reductions in the volume of the limbs using the four selected devices over time and at an
intensity determined by this study.
CONCLUSION:
Association of a Godoy and Godoy contention during apparatus-assisted exercise reduced the edema in
patients with lymphedema of the upper limbs.
PMID: 21625413 [PubMed - in process] PMCID: PMC3100219
Yonsei Med J. 2011 Jul 1;52(4):661-7. doi: 10.3349/ymj.2011.52.4.661.
Causes of shoulder pain in women with breast cancer-related lymphedema: a pilot study.
Jeong HJ, Sim YJ, Hwang KH, Kim GC.
Source
Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, 34 Amnam-
dong, Seo-gu, Busan 602-702, Korea. oggum@daum.net.
Abstract
Purpose: To inform on shoulder pathology and to identify the disabilities and level of quality of life (QOL)
associated with shoulder pain in patients with breast cancer- related lymphedema (BCRL). Materials and
Methods: Using patient history, physical examination, and ultrasound (US), we classified patients with
BCRL into the following three groups: no pain with normal ultrasound (US), pain with normal US, and pain
with abnormal US. We evaluated shoulder pathology using US, pain intensity using a visual analogue scale
(VAS), and functional disability using the Korean version of the Disabilities of Arm, Shoulder, and Hand
(DASH) questionnaire. For assessment of QOL, we used the Korean version of the brief form of the
World Health Organization Quality of Life Assessment Instrument (WHOQOL- BREF). Results: 28.9% of
patients had no pain and normal US, 31.6% had pain with normal US, and 39.5% had pain with abnormal
US. The US findings for those with pain and abnormal US revealed the following: 53.3% had a
supraspinatus tear, 13.3% had biceps tenosynovitis, 13.3% had acromioclavicular arthritis, 13.3% had
subdeltoid bursitis, and 53.3% had adhesive capsulitis. Patients with shoulder pain and abnormal US
findings had significantly higher mean DASH and pain scores. Pain scores were positively correlated with
DASH scores and negatively correlated with QOL. Conclusion: We found that BCRL with shoulder pain
and evidence of shoulder pathology on US was associated with reduced QOL and increased disability.
Proper diagnosis and treatment of shoulder pain are necessary to improve QOL and decrease disability in
patients with BCRL.
PMID: 21623610 [PubMed - in process] PMCID: PMC3104463 [Available on 2011/7/1]
Ann Thorac Surg. 2011 Jun;91(6):1702-8.
Forequarter amputation combined with chest wall resection: a single-center experience.
Nierlich P, Funovics P, Dominkus M, Aszmann O, Frey M, Klepetko W.
Source
Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna,
Austria.
Abstract
BACKGROUND:
Forequarter amputation combined with chest wall resection is a rarely performed procedure. Six patients
were treated for advanced malignancies with this operation in our institution since 1993. Uncontrollable
pain, lymphedema, loss of function of the affected limb and, in some patients, localized ulceration of the
tumor at the time of presentation, provided the indication for the operation. All patients underwent radical
amputation of the upper limb and the structures of the shoulder girdle, in combination with resection of the
thoracic chest wall in an extent of 2 to 7 ribs.
METHODS:
Chest wall reconstruction was achieved by implantation of a polytetrafluoroethylene patch (n = 5) or a
combination of a metal implant (Stratos System R, MedXpert GmbH, Heitersheim, Germany) and a
polytetrafluoroethylene patch (n = 1). Myocutaneous coverage of the defects was achieved by use of
pedicled flaps from adjacent tissue (n = 3) or by free myocutaneous flaps harvested from the amputated
forearm (n = 3).
RESULTS:
No perioperative mortality occurred; however, significant morbidity was seen after the use of the free
forearm flaps based on occurring vascular problems. All 3 patients had to undergo surgical revision of the
flap. Survival ranged from 5 to 50 months (median = 23.5 months) with 3 patients still alive at the time of
this investigation.
CONCLUSIONS:
Forequarter amputation in combination with chest wall resection is a feasible and potentially curative
treatment for malignant tumors of the shoulder girdle with invasion of the chest wall. The operation results in
immediate palliation and long-term survival can be obtained in selected cases.
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PMID: 21619966 [PubMed - in process]
June 10, 2011
Int J Palliat Nurs. 2011 May;17(5):231-8.
Collaborative lymphoedema management: developing a clinical protocol.
Thomson M, Walker J.
Abstract
Lymphoedema is a very distressing chronic condition prevalent in some metastatic cancers. Conservative
treatment of lymphoedema in palliative care involves complete/complex decongestive therapy (CDT) using
manual lymphatic drainage (MLD), compression therapy (bandaging and/or garments), skincare, and
remedial exercises, adapted to the needs of the patient. The aim of this service development project was to
identify current practice in a hospice palliative care service, develop new assessment tools, and implement a
collaborative clinical protocol to improve access to lymphoedema management for patients in the hospice.
Two audits provided new evidence about patient profiles, patient assessment, and treatment outcomes for
cancer- and non-cancer-related lymphoedema. This project had a quality-improvement effect on service
delivery and developed an effective partnership approach to lymphoedema management between local
district nursing services and the specialist lymphoedema physiotherapist.
PMID: 21647077 [PubMed - in process]
June 15, 2011
Can J Surg. 2011 Jun 1;54(3):7810. doi: 10.1503/cjs.007810. [Epub ahead of print]
Factors that determine whether a patient receives completion axillary lymph node dissection after apositive
sentinel lymph node biopsy for breast cancer in British Columbia.
Aslani N, Swanson T, Kennecke H, Woods R, Davis N.
Source
The General Surgery Residency Program, University of British Columbia, Vancouver, BC.
Abstract
Background: Completion axillary lymph node dissection (CALND) is recommended in the setting of
positive sentinel lymph node biopsy (SLNB) but is associated with a higher rate of postoperative
complications. In this study, the characteristics and outcomes of patients who did and did not have
CALND are compared. Methods: We identified all patients with breast cancer with positive sentinel
lymphnodes (SLNs) who did not have concurrent CALND from 2003 to 2006 using a prospectively
collected database (British Columbia Cancer Breast Outcomes database) and retrospective chart review.
Patient and tumour characteristics were compared between those who received CALND and those who
did not. Results: Among 185 patients with positive SLNs identified by SLNB, 90 had a CALND and 95
had no further surgical therapy. Patients who did not receive CALND had more sentinel nodes removed (p
< 0.001), a lower percentage of positiveSLNs (p < 0.001) and lower pathologic N stage (p = 0.044) than
those who did receive CALND. The size of the breast lesion, size of the largest SLN deposit, estrogen
receptor status, grade, lymphovascular invasion, histology and multifocality were not significantly different
between groups. Sixty-two percent of women who did not have CALND received radiation to the axilla.
Postoperative complication rates (including lymphedema) were higher in the CALND group (21%)
compared with the SLNB group (7%). The rates of locoregional recurrence (1% in both groups) and
systemic metastases (6% in the CALND group v. 8% in the SLNB group) were similar at 36months'
follow-up. Conclusion: Compared with women who had CALND, women who did not receive CALND
had on average a lower N stage with 3 or more SLNs removed and less than 50% node positivity. Most of
these women received radiation therapy to the axilla and had comparable recurrence rates to those who
had CALND.
PMID: 21651836 [PubMed - as supplied by publisher
June 20, 2011
J Plast Reconstr Aesthet Surg. 2011 Jun 11. [Epub ahead of print]
Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to
manual lymph drainage: A case report.
Mihara M, Hayashi Y, Hara H, Iida T.
Source
Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku,
Tokyo 113-8655, Japan.
Abstract
Conservative and surgical treatment for lymphedema are performed independently, and combined
treatment with lymphatico-venous anastomosis (LVA) followed by manual massage is increasingly
reported. However, a problem with this approach is that manual massage cannot be initiated immediately
after LVA because of concerns of injuring surgical wounds and anastomosed regions. To overcome this
problem, we developed a treatment method using a cosmetic roller instead of manual massage, which
allows lymph drainage to be initiated immediately after surgery. In this study, we treated a patient with
bilateral lower limb lymphedema using this method. Conventional manual massage starting 3 weeks after
surgery was used for the left lower limb, while early massage using a cosmetic roller was used for the right
lower limb from the day after surgery. A higher therapeutic effect was obtained in the right lower limb
compared to that in the left lower limb. The results in this case suggest that further studies should be
performed to examine the new method in various types of patients.
Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights
reserved.
PMID: 21669555 [PubMed - as supplied by publisher]
Breast Cancer. 2011 Jun 14. [Epub ahead of print]
Erratum to: Lymphedema and breast cancer: a review of the literature.
Stamatakos M, Stefanaki C, Kontzoglou K.
Source
4th Department of Surgery, Medical School, Attikon General Hospital, University of Athens, Athens,
Greece, mixalislak@gmail.com.
PMID: 21671036 [PubMed - as supplied by publisher]
J Plast Reconstr Aesthet Surg. 2011 Jun 11. [Epub ahead of print]
Early lymph-drainage massage using a cosmetic roller after lymphatico-venous anastomosis compared to
manual lymph drainage: A case report.
Mihara M, Hayashi Y, Hara H, Iida T.
Source
Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku,
Tokyo 113-8655, Japan.
Abstract
Conservative and surgical treatment for lymphedema are performed independently, and combined
treatment with lymphatico-venous anastomosis (LVA) followed by manual massage is increasingly
reported. However, a problem with this approach is that manual massage cannot be initiated immediately
after LVA because of concerns of injuring surgical wounds and anastomosed regions. To overcome this
problem, we developed a treatment method using a cosmetic roller instead of manual massage, which
allows lymph drainage to be initiated immediately after surgery. In this study, we treated a patient with
bilateral lower limb lymphedema using this method. Conventional manual massage starting 3 weeks after
surgery was used for the left lower limb, while early massage using a cosmetic roller was used for the right
lower limb from the day after surgery. A higher therapeutic effect was obtained in the right lower limb
compared to that in the left lower limb. The results in this case suggest that further studies should be
performed to examine the new method in various types of patients.
Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights
reserved.
PMID: 21669555 [PubMed - as supplied by publisher]
Lymphology. 2011 Mar;44(1):29-34.
B-type natriuretic peptide in lymphedema.
Todd J, Austwick T, Berridge D, Tan LB, Barth JH.
Source
Department of Lymphoedema, Leeds Teaching Hospitals NHS Trust, Leeds. Jacquelyne.Todd@leedsth.
nhs.uk
Abstract
Lymphedema often responds to compression therapy which can also cause undesirable cardiac overload if
heart failure coexists. We hypothesized that the biomarker B-type natriuretic peptide (BNP) can be used to
screen lymphedema patients for undetected cardiac dysfunction. We studied unselected consecutive
patients with lymphedema to determine their BNP status and compared these data with those obtained
from healthy subjects without known cardiovascular diseases. Out of a total of 305 subjects with
lymphedema screened, 102 (33%) consented to take part in this study. The majority (87%) were female
with a mean age of 60.5 +/- 13.2 (SD) years, and 47% had just lower limb swelling. The groups were
equally divided between cancer and non-cancer related causes. There were 45 females and 4 males under
60 years old, and 44 female and 9 male patients over 60 years old. Median (IQR) BNP (ng/L) were as
follows: <60 years females = 17.9 (15.2) (median [RR: 3 - 64] and males = 12.4 (14.7) [RR: 0.2 - 44],
>60 years females = 35.8 (57.9) [RR: 2 -247)] and males = 47.2 (44.1) [RR: 2 - 238]. For this
population, the BNP concentration 100 ng/L was adopted as the value to exclude heart failure. Using this
definition, 7 lymphedema subjects had BNP concentrations of 120 (19.8) ng/L, and all were found to have
cardiac abnormalities on echocardiography. This study demonstrated that 93% of unselected subjects with
lymphedema had BNP concentrations that exclude a diagnosis of heart failure. Those subjects with
elevated BNP were found on subsequent echocardiography to have cardiac abnormalities. The use of a
BNP assay is of potential value in screening patients who are more likely to have cardiac failure. Indicative
factors include bilateral leg swelling, over the age of 50 years, breathlessness, where there is no known
cause for the swelling. A BNP assay using a BNP concentration threshold of 100 ng/L (29 pmol/L) will
identify those patients who require more detailed investigations.
PMID: 21667820 [PubMed - indexed for MEDLINE]
Lymphology. 2011 Mar;44(1):13-20.
Impact of manual lymphatic drainage on hemodynamic parameters in patients with heart failure and lower
limb edema.
Leduc O, Crasset V, Leleu C, Baptiste N, Koziel A, Delahaie C, Pastouret F, Wilputte F, Leduc A.
Source
Haute Ecole P.H. Spaak, Lympho-Phlebology Unit, Brussels. oleduc@skynet.be
Abstract
Manual lymphatic drainage (MLD), intermittent sequential pneumatic therapy (ISPT), multilayered
bandages (MLB), and compression garments are main techniques in conservative treatment of peripheral
lymphedema. Since 1990, it has been thought that ISPT applied to both lower limbs simultaneously should
not be used for patients with heart failure because right atrial, pulmonary arterial, and pulmonary wedge
pressures may increase to a critical point. In 2005, these same results were observed in patients with heart
failure wearing MLB. For these reasons, MLB and ISPT have been contraindicated during lymphedema
treatment in cardiac patients. The aim of this study was to determine if we may continue the treatment of
lower limb lymphedema using MLD in patients with heart failure. We evaluated hemodynamic parameters
using echography during MLD in patients with cardiac disease and obtained circumferential measurements
of the edematous limb before and after treatment. MLD treatment significantly decreased the limbs as
expected. The heart rate also decreased following MLD in contrast with all other hemodynamic parameters
which were not affected by MLD. The findings suggest that there is no contraindication to use MLD in
patients with heart failure and lower limb edema.
PMID: 21667818 [PubMed - indexed for MEDLINE]
PLoS Negl Trop Dis. 2011 Jun;5(6):e1184. Epub 2011 Jun 7.
Burden of Podoconiosis in Poor Rural Communities in Gulliso woreda, West Ethiopia.
Alemu G, Tekola Ayele F, Daniel T, Ahrens C, Davey G.
Source
SOS Children's Villages International, Addis Ababa, Ethiopia.
Abstract
BACKGROUND:
Podoconiosis is an environmental lymphoedema affecting people living and working barefoot on irritant red
clay soil. Podoconiosis is relatively well described in southern Ethiopia, but remains neglected in other parts
of the Ethiopian highlands. This study aimed to assess the burden of podoconiosis in rural communities in
western Ethiopia.
METHODOLOGY/PRINCIPAL FINDINGS:
A cross-sectional study was conducted in Gulliso woreda (district), west Ethiopia. A household survey in
the 26 rural kebeles (villages) of this district was conducted to identify podoconiosis patients and to
measure disease prevalence. A more detailed study was done in six randomly selected kebeles to describe
clinical features of the disease, patients' experiences of foot hygiene, and shoe wearing practice. 1,935
cases of podoconiosis were registered, giving a prevalence of 2.8%. The prevalence was higher in those
aged 15-64 years (5.2%) and in females than males (prevalence ratio 2.6∶1). 90.3% of patients were in
the 15-64 year age group. In the detailed study, 335 cases were interviewed and their feet assessed. The
majority of patients were farmers, uneducated, and poor. Two-third of patients developed the disease
before the age of thirty. Almost all patients (97.0%) had experienced adenolymphangitis (ALA - red, hot
legs, swollen and painful groin) at least once during the previous year. Patients experienced an average of
5.5 ALA episodes annually, each of average 4.4 days, thus 24 working days were lost annually. The
incidence of ALA in podoconiosis patients was higher than that reported for filariasis in other countries.
Shoe wearing was limited mainly due to financial problems.
CONCLUSIONS:
We have documented high podoconiosis prevalence, frequent adenolymphangitis and high disease-related
morbidity in west Ethiopia. Interventions must be developed to prevent, treat and control podoconiosis,
one of the core neglected tropical diseases in Ethiopia.
PMID: 21666795 [PubMed - in process] PMCID: PMC3110157
Clin Breast Cancer. 2011 Jun;11(3):171-6. Epub 2011 Apr 20.
Reirradiation as a component of the multidisciplinary management of locally recurrent breast cancer.
Harkenrider MM, Wilson MR, Dragun AE.
Source
University of Louisville School of Medicine, James Graham Brown Cancer Center, Department of
Radiation Oncology, Louisville, KY.
Abstract
BACKGROUND AND PURPOSE:
Our intent was to review a modern multidisciplinary institutional experience involving reirradiation of the
breast, chest wall, and lymphatics for locoregional recurrences of breast cancer and report toxicity and
clinical outcomes.
MATERIALS AND METHODS:
Between 1995 and 2009, 12 locoregional recurrences were reirradiated in 8 patients. The mean dose of
initial radiotherapy was 57.1 Gy (range, 50.4-60.6 Gy), and the mean dose of reirradiation was 46.7 Gy
(range, 30-62.1 Gy). The second course of radiotherapy was delivered using daily radiotherapy to 5
recurrences, twice-daily radiotherapy to 5 recurrences (1 with mold brachytherapy boost), and a
combination of once- and twice-daily radiotherapy to 2 recurrences.
RESULTS:
The median follow-up from time of completion of reirradiation was 30 months (range, 1.5-67 months).
Local control was achieved in 7 of 8 patients and 11 of 12 recurrences. Regional control was achieved in 5
of 8 patients and 6 of 12 recurrences. Distant control was achieved in 5 of 8 patients. At time of analysis, 5
of 8 patients were alive. Median survival since reirradiation completion was 36 months (range, 4.5-47
months). Acute toxicity included grade 2 dermatitis in 4 patients, ipsilateral shoulder pain in 1 patient, and
ipsilateral pleurisy in 1 patient. Late skin and soft tissue toxicity manifested as fibrosis in 4 patients,
hyperpigmentation in 3 patients, and telangiectasia in 3 patients. Three patients reported lymphedema, 1
patient reporting chest wall pain and 1 patient with an ipsilateral rib fracture.
CONCLUSIONS:
Multidisciplinary management of locoregional recurrence of breast cancer using reirradiation is well
tolerated as salvage treatment and provides durable locoregional control.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21665137 [PubMed - in process]
Can Oncol Nurs J. 2011 Spring;21(2):129-31.
Better lymphedema management needed--the role of the specialized oncology nurse.
[Article in English, French]
Bowles S.
Source
Odette Cancer Centre, 2075 Bayview Ave., Toronto ON M4N 3M5. susan.bowles@sunnybrook.ca
PMID: 21661625 [PubMed - in process]
Nurs Stand. 2011 Apr 20-26;25(33):51-2, 54, 56 passim.
Psychosocial aspects of living with non-cancer-related lymphoedema.
Upton D, Solowiej K.
Source
Institute of Health and Society, University of Worcester. d.upton@worc.ac.uk
Abstract
Lymphoedema is a chronic condition that causes swelling, pain, altered appearance and reduced mobility.
Little is known about the psychosocial effects. This review aims to identify psychosocial aspects of living
with non-cancer-related lymphoedema, as such information is not readily available to healthcare
professionals or patients.
PMID: 21661532 [PubMed - indexed for MEDLINE]
Nurs Stand. 2011 Apr 20-26;25(33):20-1.
Treat with care.
Cooper C.
Abstract
Lymphoedema affects at least 100,000 people in the UK but health professionals do not always know how
to help prevent complications.
PMID: 21661527 [PubMed - indexed for MEDLINE]
June 22, 2011
Breast Cancer Res Treat. 2011 Jun 17. [Epub ahead of print]
Associations among baseline variables, treatment-related factors and health-related quality of life 2 years
after breast cancer surgery.
Taira N, Shimozuma K, Shiroiwa T, Ohsumi S, Kuroi K, Saji S, Saito M, Iha S, Watanabe T, Katsumata
N.
Source
Department of Breast and Endocrine Surgery, Okayama University Hospital, 2-5-1 Shikata-cho,
Okayama, 700-8558, Japan, ntaira@md.okayama-u.ac.jp.
Abstract
Provision of social support and rehabilitation for patients with physical, mental, and functional problems
after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of
human and financial healthcare resources requires identification of patients requiring rehabilitation. The
objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time,
to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months,
1, and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each
point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression,
and HRQOL at 1 month (baseline), 6 months, 1, and 2 years after surgery in 196 patients (mean age: 53.3
years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated
using a patient-reported symptom checklist. HRQOL was rated using the functional assessment of cancer
treatment scale-general (FACT-G) and the breast cancer subscale (FACT-B). Anxiety and depression
were rated using the hospital anxiety and depression scale (HADS). More than 50% of patients had local
problems of "tightness", "arm weakness." and "arm lymphedema", and systemic problems of "reduced
energy, fatigue, and general weakness" postoperatively. The HRQOL score significantly improved 1 year
after surgery, and scores for physical, emotional and functional well-being also increased with time,
whereas the score for social well-being was the highest at baseline and decreased with time. Depression
and anxiety significantly improved with time. Concomitant disease, marital status, and the presence of a
partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous
chemotherapy were significant factors predicting FACT-G scores at 6 months, 1, and 2 years after
surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These
results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term
postoperative physical function. A further study of psychosocial interventions is required to improve
depression and social well-being after breast cancer surgery.
PMID: 21681445 [PubMed - as supplied by publisher]
Plast Reconstr Surg. 2011 Jun 15. [Epub ahead of print]
Indocyanine Green (ICG)-enhanced Lymphography for Upper Extremity Lymphedema: A Novel Severity
Staging System Using Dermal Backflow (DB) Patterns.
Yamamoto T, Yamamoto N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M,
Narushima M, Iida T, Koshima I.
Source
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo,
Japan.
Abstract
BACKGROUND:
Management of arm lymphedema following breast cancer treatment is challenging, and emphasis should be
put on early diagnosis and prevention of secondary lymphedema. Indocyanine green (ICG) lymphography
is becoming a method of choice for evaluation of lymphedema.
METHODS:
Twenty patients with secondary arm lymphedema after breast cancer treatment underwent ICG
lymphography. Characteristic findings of ICG lymphography were analyzed according to corresponding
clinical stages and duration of edema. Based on changes in ICG lymphography findings with progression of
lymphedema, a new severity stage, arm dermal backflow (ADB) stage was developed and compared with
clinical stages.
RESULTS:
The ICG lymphography findings were classified into two large groups: linear pattern (LP) and dermal
backflow (DB) patterns. The DB patterns could be subdivided into splash, stardust, and diffuse patterns.
The DB patterns were found more frequently than the LP in the proximal upper extremity (P = 0.001). The
DB patterns also increased significantly in prevalence overall as the duration of lymphedema increased (P =
0.032). The ADB stage was linearly correlated with clinical stage as described by the line y = 1.092x +
0.083 (R = 0.997; ANOVA P < 0.001).
CONCLUSIONS:
ICG lymphography is a safe and convenient evaluation method for lymphedema, which allows qualitative
pathophysiological assessment of the lymphedema. The ADB stage, based on ICG lymphography findings,
is a simple severity staging system which demonstrates a significant correlation with clinical stage. ICG
lymphography may come to play an important role in early diagnosis of secondary arm lymphedema.
PMID: 21681123 [PubMed - as supplied by publisher]
Am Surg. 2011 Jun;77(6):799-801.
Appearance of Retroperitoneal Lymphedema on CT Scan after Penetrating Neck Injury.
Ferguson EJ, Stombaugh HA, Lowe S.
PMID: 21679658 [PubMed - in process]
June 25, 2011
Clin Cosmet Investig Dermatol. 2011;4:55-9. Epub 2011 May 26.
Treatment of cellulite based on the hypothesis of a novel physiopathology.
de Godoy JM, de Godoy Mde F.
Source
Department of Cardiology and Cardiovascular Surgery.
Abstract
BACKGROUND:
The aim of the current study is to report on a new form of treatment for cellulite based on a novel
physiological hypothesis.
METHODS:
A novel treatment for cellulite was evaluated in 14 patients aged 19-36 (mean 27.5) years. The only
inclusion criterion was clinically diagnosed cellulite, and the exclusion criteria were history of edema,
obesity, or any other disease diagnosed during the physical examination. Perimetry was performed at the
gluteal fold, at 5 cm and 10 cm below the gluteal fold for both legs, and 5 cm and 10 cm below the navel.
Additionally, standard photographs were taken and a questionnaire of satisfaction was applied. The
patients were submitted to a treatment regimen of 1.5 hours per day adapted for the treatment of cellulite,
consisting of manual and mechanical lymph drainage and cervical stimulation using the Godoy and Godoy
technique. After 10 sessions over two weeks, the patients were evaluated again.
RESULTS:
Reductions were identified at both points below the navel, the points on the thighs, and at the gluteal fold (P
< 0.0001).
CONCLUSION:
This technique of lymphatic system stimulation is efficacious in the treatment of cellulite.
PMID: 21691567 [PubMed - in process] PMCID: PMC3114606
Ann Surg Oncol. 2011 Jun 22. [Epub ahead of print]
Lymphoceles, Lymphorrhea, and Lymphedema after Laparoscopic and Open Endometrial Cancer Staging.
Ghezzi F, Uccella S, Cromi A, Bogani G, Robba C, Serati M, Bolis P.
Source
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy, Fabio.
ghezzi@uninsubria.it.
Abstract
PURPOSE:
To evaluate the incidence of lymphoceles, lymphorrhea, and lymphedema after systematic pelvic
lymphadenectomy in patients who underwent laparoscopic or open abdominal staging for endometrial
cancer.
METHODS:
A total of 138 consecutive women who underwent systematic laparoscopic pelvic lymphadenectomy for
endometrial cancer staging were compared to 123 historical control subjects staged via an open approach.
Postoperative screening for lymphadenectomy-related complications by ultrasound was consistently
performed.
RESULTS:
The incidence of perioperative complications was lower in cases than in control subjects. Overall,
lymphoceles were diagnosed in 19 (15.4%) and 2 (1.4%) patients who had open and laparoscopic staging,
respectively (odds ratio 12.42; 95% confidence interval 2.82-54.55; P < 0.0001). Symptomatic
lymphoceles were more frequent after open staging than after laparoscopy (P = 0.028). Lymphorrhea
occurred in 1 and 4 patients after laparoscopic and open surgery (P = 0.19). No difference in the incidence
of lymphedema was observed.
CONCLUSIONS:
Our findings suggest that laparoscopic endometrial cancer staging is associated with a lower occurrence of
both asymptomatic and symptomatic lymphoceles compared to open surgery.
PMID: 21695563 [PubMed - as supplied by publisher]
BMJ. 2011 Jun 21;342:d3442. doi: 10.1136/bmj.d3442.
Priorities for women with lymphoedema after treatment for breast cancer: population based cohort study.
Girgis A, Stacey F, Lee T, Black D, Kilbreath S.
Source
University of Newcastle, Callaghan, NSW 2308, Australia.
Abstract
OBJECTIVE:
To explore the perceived unmet needs among women treated for breast cancer and in whom symptoms
and signs indicate the presence of lymphoedema.
DESIGN:
Population based cross sectional survey with a purpose designed questionnaire (60 items).
SETTING:
Cancer registries of New South Wales, Victoria, and South Australia.
PARTICIPANTS:
237 women with symptoms and signs indicative of lymphoedema from an initial 1930 eligible women.
MAIN OUTCOME MEASURE:
Unmet needs in the previous month across psychological, health system and information, physical and daily
living, patient care and support, sexuality needs, body image, and financial domains.
RESULTS:
The 10 items most commonly identified as a "moderate to high current need" included having their doctor
and allied health workers being fully informed about lymphoedema, acknowledge the seriousness of the
condition, and be willing to treat it. Women also wanted access to up to date treatments, both mainstream
and alternative, and financial assistance for their garments. The three factors that explained most of the
variance were: information and support (11 items), which accounted for 49% of the variance; body image
and self esteem (seven items; 7% variance); and health system (seven items; 5% variance). Examination of
these three factors showed that while the levels of need were generally low, they were common.
CONCLUSION:
To address the needs of women with lymphoedema and perhaps to prevent progression of lymphoedema,
it is important that practitioners do not dismiss mild symptoms and that women are referred to an
appropriate specialist.
PMID: 21693532 [PubMed - in process]
Scand J Caring Sci. 2011 Jun 21. doi: 10.1111/j.1471-6712.2011.00903.x. [Epub ahead of print]
Information provision and problem-solving processes in Japanese breast cancer survivors with
lymphoedema symptoms.
Tsuchiya M, Horn S, Ingham R.
Source
School of Psychology, University of Southampton, Southampton, UK.
Abstract
Scand J Caring Sci; 2011 Information provision and problem-solving processes in Japanese breast cancer
survivors with lymphoedema symptoms Background: In Japan, a high proportion of breast cancer (BC)
survivors develop lymphoedema as a consequence of the treatment received. Japanese BC survivors are
generally not provided with standardised information about risks, early signs and symptom management.
The effects of (in)adequate information on the problem-solving processes among Japanese BC survivors
with lymphoedema symptoms have not been investigated. Purpose: The aim of this study was to explore
how the provision of medical information by doctors affected the problem-solving processes of Japanese
BC survivors with lymphoedema symptoms. Method: Ten Japanese BC survivors participated in audio-
taped focus group discussions. Transcripts were analysed using an inductive thematic analysis. Results:
Analysis identified two phases during which participants attempted to address problems with managing their
lymphoedema symptoms - a help-seeking phase and an evaluation phase. Perceptions of information
provision affected emotional responses to the onset and cognitive appraisals of lymphoedema symptoms
(seen as accepted or burden). However, perceptions of information provision did not affect help-seeking
behaviours from surgeons or adherence behaviours. Participants often perceived compression sleeves as
inefficient and not worth continuing. Conclusion: This study suggests that information provision is a key
process in helping BC patients to adjust to symptoms of lymphoedema. In order to promote effective
symptom management, doctors and nurses should provide support not only during the help-seeking phase
but also the evaluation phase. Further research on the most effective ways to change negative treatment
beliefs should be conducted.
© 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.
PMID: 21692823 [PubMed - as supplied by publisher
Lymphat Res Biol. 2011;9(2):101-7.
Inter-rater reliability of arm circumference measurement.
Foroughi N, Dylke ES, Paterson RD, Sparrow KA, Fan J, Warwick EB, Kilbreath SL.
Source
Clinical and Rehabilitation Sciences, Breast Cancer Research Group, Faculty of Health Sciences,
University of Sydney , Sydney, NSW, Australia .
Abstract
Abstract Background: Arm lymphedema is routinely assessed by clinicians and researchers, using arm
circumference measurements. A protocol was developed for measuring arm circumference independent of
medically trained professionals. The aim of this project was to assess the protocol's inter-rater reliability
and its coherence with perometry measures. Methods and Results: Community-dwelling adults (n = 57),
aged 60.2 ± 12.8 years, in good general health, were included in this study. Circumference of both arms
were measured at the ulnar styloid of the wrist and at four 10 cm intervals up the arm by a friend of the
participant, as well as the trained assessor using a tape measure. The same measures were also obtained
with a perometer. The assessment tools had moderate to high concordance (r(c) = 0.84-0.94 for assessor
vs. perometer and r(c) = 0.68-0.93 for assessor vs. participant). Limits of agreement analysis revealed that
the mean difference between methods varied based on the measurement location; the bias ranged from
-5.5% to 1.5% for assessor-measured vs. perometer methods and from -2.4% to 4.0% for assessor-
measured vs. participant-measured methods. Conclusions: The written instructions and cartoons are
reliable tools that could be used by women at risk of lymphedema as well as those with lymphedema
following treatment for breast cancer to measure their arm circumference reliably independent of medically
trained personnel.
PMID: 21688979 [PubMed - in process]
Lymphat Res Biol. 2011;9(2):93-9.
Bioimpedance in the assessment of unilateral lymphedema of a limb: the optimal frequency.
Gaw R, Box R, Cornish B.
Source
1 Faculty of Science and Technology, Queensland University of Technology , Brisbane, Australia .
Abstract
Abstract Background: Bioimpedance techniques provide a reliable method of assessing unilateral
lymphedema in a clinical setting. Bioimpedance devices are traditionally used to assess body composition at
a current frequency of 50 kHz. However, these devices are not transferable to the assessment of
lymphedema, as the sensitivity of measuring the impedance of extracellular fluid is frequency dependent. It
has previously been shown that the best frequency to detect extracellular fluid is 0 kHz (or DC). However,
measurement at this frequency is not possible in practice due to the high skin impedance at DC, and an
estimate is usually determined from low frequency measurements. This study investigated the efficacy of
various low frequency ranges for the detection of lymphedema. Methods and Results: Limb impedance was
measured at 256 frequencies between 3 kHz and 1000 kHz for a sample control population, arm
lymphedema population, and leg lymphedema population. Limb impedance was measured using the
ImpediMed SFB7 and ImpediMed L-Dex(®) U400 with equipotential electrode placement on the wrists
and ankles. The contralateral limb impedance ratio for arms and legs was used to calculate a lymphedema
index (L-Dex) at each measurement frequency. The standard deviation of the limb impedance ratio in a
healthy control population has been shown to increase with frequency for both the arm and leg. Box and
whisker plots of the spread of the control and lymphedema populations show that there exists good
differentiation between the arm and leg L-Dex measured for lymphedema subjects and the arm and leg L-
Dex measured for control subjects up to a frequency of about 30 kHz. Conclusions: It can be concluded
that impedance measurements above a frequency of 30 kHz decrease sensitivity to extracellular fluid and
are not reliable for early detection of lymphedema.
PMID: 21688978 [PubMed - in process]
Lymphat Res Biol. 2011;9(2):77-83.
Tissue Fluid Pressure and Flow during Pneumatic Compression in Lymphedema of Lower Limbs.
Olszewski WL, Jain P, Ambujam G, Zaleska M, Cakala M, Gradalski T.
Source
1 Department of Surgical Research and Transplantology, Medical Research Center , Polish Academy of
Sciences, Warsaw, Poland .
Abstract
Abstract Background: Physiotherapy of edema in cases with obstructed main lymphatics of lower limbs
requires knowledge of how high external pressures should be applied manually or set in compression
devices in order to generate tissue pressures high enough to move tissue fluid to nonswollen regions and to
measure its flow rate. Methods: We measured tissue fluid pressure and flow in subcutaneous tissue of
lymphedematous limbs stages II to IV at rest and during pneumatic compression under various pressures
and inflation timing. An 8-chamber sequential compression device inflated to pressures 50-120 mmHg, for
50 sec each chamber, with no distal deflation, was used. Pressures were measured using a wick-in-needle
and electronic manometer. Fluid flow was calculated from continuously recorded changes in limb
circumference using strain gauge plethysmography. Results: Before massage, in all stages of lymphedema,
stagnant tissue fluid pressures in subcutaneous tissue ranged between -1 and +10 mmHg and did not differ
from those measured in normal subjects. Pressures generated in tissue fluid by pneumatic compression
reached 40-100 mmHg and were lower than those in inflated chambers. High pressure gradient through the
skin was caused by its rigidity (fibrosis) and dissipation of applied compression force to proximal
noncompressed limb regions. The calculated volumes of displaced tissue fluid ranged from 10 to 30 ml per
compression cycle, to reach in some cases 100 ml in the groin region. Conclusions: Tissue fluid pressures
generated by a pneumatic device were found lower than in the compression chambers. The obtained results
point to the necessity of applying high pressures and longer compression times to generate effective tissue
fluid pressures and to provide enough time for moving the stagnant fluid.
PMID: 21688976 [PubMed - in process]
J Parasitol Res. 2011;2011:201617. Epub 2011 May 22.
Macrofilaricidal Activity in Wuchereria bancrofti after 2 Weeks Treatment with a Combination of
Rifampicin plus Doxycycline.
Debrah AY, Mand S, Marfo-Debrekyei Y, Batsa L, Albers A, Specht S, Klarmann U, Pfarr K, Adjei O,
Hoerauf A.
Source
Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, UPO, PMB,
Kumasi, Ghana.
Abstract
Infection with the filarial nematode Wuchereria bancrofti can lead to lymphedema, hydrocele, and
elephantiasis. Since adult worms cause pathology in lymphatic filariasis (LF), it is imperative to discover
macrofilaricidal drugs for the treatment of the infection. Endosymbiotic Wolbachia in filariae have emerged
as a new target for antibiotics which can lead to macrofilaricidal effects. In Ghana, a pilot study was carried
out with 39 LF-infected men; 12 were treated with 200 mg doxycycline/day for 4 weeks, 16 were treated
with a combination of 200 mg doxycycline/day + 10 mg/kg/day rifampicin for 2 weeks, and 11 patients
received placebo. Patients were monitored for Wolbachia and microfilaria loads, antigenaemia, and filarial
dance sign (FDS). Both 4-week doxycycline and the 2-week combination treatment reduced Wolbachia
load significantly. At 18 months posttreatment, four-week doxycycline resulted in 100% adult worm loss,
and the 2-week combination treatment resulted in a 50% adult worm loss. In conclusion, this pilot study
with a combination of 2-week doxycycline and rifampicin demonstrates moderate macrofilaricidal activity
against W. bancrofti.
PMID: 21687646 [PubMed - in process] PMCID: PMC3112504
Acupunct Med. 2011 Jun 18. [Epub ahead of print]
A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphoedema.
Cassileth BR, Van Zee KJ, Chan Y, Coleton MI, Hudis CA, Cohen S, Lozada J, Vickers AJ.
Source
1Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, USA.
Abstract
BACKGROUND:
Lymphoedema is a distressing problem affecting many women after breast cancer surgery. There is no cure
and existing treatments are marginally beneficial, rarely reducing arm swelling in any meaningful way.
Needling and even lifting of objects using the affected arm has been prohibited, but our clinical experience
and that of others suggested that acupuncture was safe and that it might be a useful treatment for
lymphoedema.
OBJECTIVE:
We sought to conduct a pilot study of the safety and effectiveness of acupuncture in women diagnosed with
chronic lymphoedema for at least 6 months and less than 5 years.
METHODS:
Women with chronic lymphoedema (affected arm with >2 cm circumference than unaffected arm) after
breast cancer surgery received acupuncture twice a week for 4 weeks. Response was defined as at least a
30% reduction in the difference in size between the affected and unaffected arms. Monthly follow-up calls
for 6 months following treatment were made to obtain information about side effects.
RESULTS:
Study goals were met after nine subjects were treated: four women showed at least a 30% reduction in the
extent of lymphoedema at 4 weeks when compared with their respective baseline values. No serious
adverse events occurred during or after 73 treatment sessions. Limitations This pilot study requires a larger,
randomised follow-up investigation plus enquiries into possible mechanisms. Both are in development by
our group.
CONCLUSION:
Acupuncture appears safe and may reduce lymphoedema associated with breast cancer surgery.
PMID: 21685498 [PubMed - as supplied by publisher]
Bull Cancer. 2011 Jun 17. [Epub ahead of print]
Return to work after treatment for breast cancer: single center experience in a cohort of 273 patients.
Peugniez C, Fantoni S, Leroyer A, Skrzypczak J, Duprey M, Bonneterre J.
Source
Centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille Cedex, FranceCentre Oscar-
Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille Cedex, France.
Abstract
<p>An increasing number of patients is treated for breast cancer during their professional life. The aim
of this study was to assess factors impacting return to work and time to return to work after treatment.
</p><p>One thousand and sixty-seven patients less than 60 years of age, and surgically treated
in our institution between January 1st, 2004 and December 31st, 2005 received a questionnaire with
medical, sociodemographic and professional items. An answer was obtained in 586 cases. Two hundred
and seventy-three patients were evaluable. All the clinical files of these patients were reviewed.<
/p><p>Overall, 79.8% of the patients returned to work after a median delay of 11.5 months. In the
multivariate analysis, the factors affecting the return to work were: age (P < 0.0001), educational level
(P < 0.001), colleagues' support (P < 0.001), chemotherapy (P < 0.05), lymphedema (P
< 0.01), and the physical (P = 0.01) and psychological (P < 0.01) constraints of the job. The
factors affecting the time until return to work were very quite similar. No significant difference was
observed according to the type of surgery, radiation therapy or not, hormonotherapy or not.<
/p><p>Eighty percent of the patients with a professional activity before treatment returned to work;
the factors affecting return to work were medical, demographic and socio-professional.</p>
PMID: 21684837 [PubMed - as supplied by publisher]
J Plast Reconstr Aesthet Surg. 2011 Jun 15. [Epub ahead of print]
Indocyanine green (ICG)-enhanced lymphography for evaluation of facial lymphoedema.
Yamamoto T, Iida T, Matsuda N, Kikuchi K, Yoshimatsu H, Mihara M, Narushima M, Koshima I.
Source
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-
3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
PMID: 21683666 [PubMed - as supplied by publisher