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Lymphland International Lymphedema Online
February 26, 2011 published March 1
Rev Esc Enferm USP. 2010 Dec;44(4):1085-92.
[Effects of the decongestive physiotherapy in the healing of venous ulcers].
[Article in Portuguese]
Azoubel R, Torres Gde V, da Silva LW, Gomes FV, dos Reis LA.
Departamento de Saúde da Universidade Estadual do Sudeste da Bahia, Jequié, BA, Brasil.
robertaazoubel@hotmail.com
Abstract
The objective of this study was to verify the effects of the decongestive physiotherapy (DP) in the healing
of venous ulcers. It is an interventionist, and almost experimental, study with the participation of 20 clients
who were divided into 2 groups: the control group (n = 10) and the intervention group (n = 10). Clients
from the first group were only treated with conventional dressing and those in the second group were
treated with conventional dressing and decongestive physiotherapy (association of techniques: manual
lymph drainage, compressive bandaging, elevation of the lower limbs, myolymphokinetic exercises and
skin care). Both groups were treated during six months. The clients submitted to DP presented significant
reduction of the edema and the pain, besides an improvement in the healing process. Results allowed to
verify that the decongestive therapy stimulated the healing process of venous ulcers, improving the quality
of life of the subjects.
PMID: 21337794 [PubMed - in process]
March 1, 2011
AMIA Annu Symp Proc. 2010 Nov 13;2010:912-6.
Efficient selection of association rules from lymphedema symptoms data using a graph structure.
Xu S, Shyu CR.
Informatics Institute.
Abstract
Secondary lymphedema (LE) is a chronic progressive disease often caused by cancer treatment,
especially in patients who require surgical removal of or radiation to lymph nodes. While LE is incurable,
it can be managed successfully with early detection and appropriate treatment. Detection and prediction
of LE is difficult due to the absence of a "gold standard" for diagnosis. Despite this, management of the
disease is accomplished through adherence to a set of guidelines developed by experts in the field.
Unfortunately, not all the recommendations in such a document are supported by clear research evidence,
and most of them are only based on expert judgment with limited evidence. This paper focuses on
developing a new algorithm to extract specific association rules from LE survey data and efficiently index
the rules for easy knowledge retrieval, with the ultimate goal discovering evidence-based and relevant
knowledge for inclusion into the best practice document (BP) for the LE community.
PMID: 21347111 [PubMed - in process]
Cutan Ocul Toxicol. 2011 Feb 24. [Epub ahead of print]
Evaluation of microbiological spectrum and risk factors of cellulitis in hospitalized patients.
Serdar ZA, Akçay SS, Inan A, Dagli O.
Haydarpasa Numune Training and Research Hospital, Dermatology, Istanbul, Turkey.
Abstract
Background and design: Cellulitis is a common soft tissue infection and the severity of disease vary from
mild to life threatening. The aim of the present retrospective study was to evaluate age, sex, site of
infection, microbiological spectrum and the risk factors of cellulitis in hospitalized patients. Materials and
methods: The data were retrospectively obtained by the review of 185 hospitalized patients who were
diagnosed as cellulitis between 2003 and 2009 in the departments of dermatology, infectious diseases,
internal medicine and surgery clinics of Haydarpasa Numune Training and Research Hospital (Istanbul,
Turkey). The diagnosis was done by infectious diseases and dermatology specialists in all patients who
were included to this study. Demographic findings, wound-blood cultures and risk factors of the patients
with cellulitis were evaluated. Results: Eighty-six were female, 99 were male of total 185 patients, and the
mean age of them was 48?±?27 (14-85). The leg was the involved site in 69% of the patients. The most
frequent isolated bacteria from wound cultures were methicillin-sensitive Staphylococcus aureus 31.5%,
Pseudomonas aeruginosa 12.6%, and Escherichia coli 12.3%. However, methicillin-sensitive S. aureus
32.5%, methicillin-resistant S. aureus 22.5%, coagulase-negative staphylococci 17.5% were detected
from blood cultures. There was not any underlying risk factor in 104 (55.3%) patients. The risk factors
observed in the other 81 patients were previous surgery or open wound 29 (35.8%), diabetes mellitus 19
(26.6%), cardiovascular diseases 16 (19.7%), immunosuppression 11 (13.5%), lymphoedema 6 (7.4%).
Conclusion: In the patients hospitalized for cellulitis, the most frequently isolated microorganism from the
wound and blood cultures was S. aureus and the most frequently detected risk factors were to have an
open wound and previous surgery. Especially when the patients had risk factors, it was observed that the
bacterial spectrum was broader and the clinical presentation was severe. The wound and blood cultures
should be performed simultaneously for the microbiological diagnosis and the appropriate management of
cellulitis.
PMID: 21345156 [PubMed - as supplied by publisher]
March 5, 2011
World J Gastrointest Oncol. 2011 Feb 15;3(2):19-23.
Intestinal lymphangiectasia in adults.
Freeman HJ, Nimmo M.
Hugh James Freeman, Department of Medicine (Gastroenterology), University of British Columbia,
Vancouver, BC, V6T 1W5, Canada.
Abstract
Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals
causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia,
hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or
lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates,
usually with other congenital abnormalities but initial definition in adults including the elderly has become
increasingly more common. Shared clinical features with the pediatric population such as bilateral lower
limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect
the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased
fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin levels, while others may present with
iron deficiency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia
in adults detected in recent years, however, appears to have few or no clinical features of malabsorption.
Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing
histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy
have revealed more extensive changes along the length of the small intestine. A critical diagnostic element
in adults with lymphangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that
might lead to obstruction of the lymphatic system and "secondary" changes in the small bowel biopsy. In
addition, occult infectious (e.g. Whipple's disease from Tropheryma whipplei) or inflammatory disorders
(e.g. Crohn's disease) may also present with profound changes in intestinal permeability and protein-
losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been
described even decades following initial diagnosis of intestinal lymphangiectasia. Treatment has been
historically defined to include a low fat diet with medium-chain triglyceride supplementation that leads to
portal venous rather than lacteal uptake. A number of other pharmacological measures have been
reported or proposed but these are largely anecdotal. Finally, rare reports of localized surgical resection
of involved areas of small intestine have been described but follow-up in these cases is often limited.
PMID: 21364842 [PubMed - in process]
J Cutan Pathol. 2011 Mar 1. doi: 10.1111/j.1600-0560.2011.01691.x. [Epub ahead of print]
Verruciform xanthoma: localized lymphedema (elephantiasis) is an essential pathogenic factor.
Lu S, Rohwedder A, Murphy M, Andrew Carlson J.
Department of Pathology, University of Maryland, Baltimore, MD, USA Am Weiher 14, Kalkar,
Germany Department of Dermatology, University of Connecticut Medical Center, Framington, CT, USA
Divisions of Dermatopathology and Dermatology, Albany Medical College MC-81, Albany, NY, USA.
PMID: 21362016 [PubMed - as supplied by publisher]
Glob Public Health. 2011 Feb 24:1-17. [Epub ahead of print]
Lymphoedema management: An international intersect between developed and developing countries.
Similarities, differences and challenges.
Stout NL, Brantus P, Moffatt C.
Breast Care Department, National Naval Medical Center, Bethesda, MD, USA.
Abstract
Lymphoedema is a chronic swelling condition that contributes to disability, dysfunction and lost quality of
life. Significant disparities exist worldwide regarding the availability of resources necessary to identify,
treat and manage lymphoedema. This disparity transcends socio-economic status and is a common
problem in both developed and developing countries. The overall impact of lymphoedema as a public
health problem, however, is underestimated, principally due to the lack of epidemiologic data. These
problems pose barriers to optimal identification and management of this disabling, lifelong condition. In
1997, the World Health Organization (50.29) resolved that lymphatic filariasis should be eliminated as a
public health problem. A component of this strategy focuses on disability management for those suffering
from lymphatic filariasis-related morbidity. This initiative has enhanced lymphoedema awareness in
developing countries. However, significant deficits persist in health care providers' knowledge,
educational initiatives and basic disease identification and treatment. In developed countries,
lymphoedema continues to be an underrecognised condition and assumed to be only cancer-related.
Health care resources allocated to treat and manage the disease are insufficient for basic and ongoing
care, resulting in disease progression and disability. The International Lymphoedema Framework project,
established in 2002, seeks to establish a consensus for best practices in the management of lymphoedema
worldwide to reduce this disability burden. A basic global construct for lymphoedema management is
needed to decrease morbidity and promote optimal disease management across all cultural and socio-
economic boundaries. Many countries are unaware of the importance of lymphoedema management and
have not defined a national strategy with respect to this problem. The objective of this article is to define
similarities and differences in strategies for lymphoedema management between developed and
developing countries and advocate for a cohesive and concerted approach to disease management.
PMID: 21360379 [PubMed - as supplied by publisher
PLoS One. 2011 Feb 17;6(2):e17201.
Mechanisms of lymphatic regeneration after tissue transfer.
Yan A, Avraham T, Zampell JC, Aschen SZ, Mehrara BJ.
The Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering
Cancer Center, New York, New York, United States of America.
Abstract
INTRODUCTION: Lymphedema is the chronic swelling of an extremity that occurs commonly after
lymph node resection for cancer treatment. Recent studies have demonstrated that transfer of healthy
tissues can be used as a means of bypassing damaged lymphatics and ameliorating lymphedema. The
purpose of these studies was to investigate the mechanisms that regulate lymphatic regeneration after
tissue transfer.
METHODS: Nude mice (recipients) underwent 2-mm tail skin excisions that were either left open or
repaired with full-thickness skin grafts harvested from donor transgenic mice that expressed green
fluorescent protein in all tissues or from LYVE-1 knockout mice. Lymphatic regeneration, expression of
VEGF-C, macrophage infiltration, and potential for skin grafting to bypass damaged lymphatics were
assessed.
RESULTS: Skin grafts healed rapidly and restored lymphatic flow. Lymphatic regeneration occurred
beginning at the peripheral edges of the graft, primarily from ingrowth of new lymphatic vessels originating
from the recipient mouse. In addition, donor lymphatic vessels appeared to spontaneously re-anastomose
with recipient vessels. Patterns of VEGF-C expression and macrophage infiltration were temporally and
spatially associated with lymphatic regeneration. When compared to mice treated with excision only,
there was a 4-fold decrease in tail volumes, 2.5-fold increase in lymphatic transport by
lymphoscintigraphy, 40% decrease in dermal thickness, and 54% decrease in scar index in skin-grafted
animals, indicating that tissue transfer could bypass damaged lymphatics and promote rapid lymphatic
regeneration.
CONCLUSIONS: Our studies suggest that lymphatic regeneration after tissue transfer occurs by
ingrowth of lymphatic vessels and spontaneous re-connection of existing lymphatics. This process is
temporally and spatially associated with VEGF-C expression and macrophage infiltration. Finally, tissue
transfer can be used to bypass damaged lymphatics and promote rapid lymphatic regeneration.
PMID: 21359148 [PubMed - in process]
March 10, 2011
Head Neck. 2011 Mar 3. doi: 10.1002/hed.21689. [Epub ahead of print]
Morbidity of supraomohyoidal and modified radical neck dissection combined with radiotherapy for head
and neck cancer. A prospective longitudinal study.
Ahlberg A, Nikolaidis P, Engström T, Gunnarsson K, Johansson H, Sharp L, Laurell G.
Department of Otolaryngology and Head and Neck Surgery, Karolinska University Hospital, Stockholm,
Sweden; Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska
Institutet, Stockholm, Sweden. Alexander.ahlberg@karolinska.se.
Abstract
BACKGROUND: The purpose of this study was to show the investigated impact of supraomohyoidal
neck dissection and modified radical neck dissection, both combined with radiotherapy, on cervical range
of motion (CROM), mouth opening, swallowing, lymphedema, and shoulder function.
METHODS: One hundred eight patients who had neck dissections and 98 patients who had non-neck
dissections were evaluated in a prospective, nonselective, longitudinal cohort study by a physiotherapist
and a speech-language pathologist (SLP) before the start of radiotherapy and up to 12 months after
treatment.
RESULTS: The incidence of shoulder disability after neck dissection was 18%. Supraomohyoidal neck
dissection had no significant effect on the evaluated parameters at any time point. Modified radical neck
dissection significantly reduced CROM and mouth opening 2 months after treatment, but after 12 months
only cervical rotation was still significantly reduced.
CONCLUSION: In patients treated with external beam radiation (EBRT), modified radical neck
dissection induced additional morbidity regarding CROM but not regarding mouth opening, swallowing,
and lymphedema 1 year after treatment. Both modified radical neck dissection and supraomohyoidal
neck dissection induced shoulder disability. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.
Copyright © 2010 Wiley Periodicals, Inc.
PMID: 21374755 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Mar 3. [Epub ahead of print]
Surgical Prevention of Arm Lymphedema After Breast Cancer Treatment.
Boccardo FM, Casabona F, Friedman D, Puglisi M, De Cian F, Ansaldi F, Campisi C.
Department of Surgery, Unit of Lymphatic Surgery, S. Martino Hospital, University of Genoa, Genoa,
Italy, francesco.boccardo@unige.it.
Abstract
PURPOSE: To prospectively assess the efficacy of the lymphatic microsurgical preventive healing
approach (LYMPHA) to prevent lymphedema after axillary dissection (AD) for breast cancer treatment.
METHODS: Among 49 consecutive women referred from March 2008 to September 2009 to undergo
complete AD, 46 were randomly divided in 2 groups. Twenty-three underwent the LYMPHA technique
for the prevention of arm lymphedema. The other 23 patients had no preventive surgical approach
(control group). The LYMPHA procedure consisted of performing lymphatic-venous anastomoses
(LVA) at the time of AD. All patients underwent preoperative lymphoscintigraphy (LS). Patients were
followed up clinically at 1, 3, 6, 12, and 18 months by volumetry. Postoperatively, LS was performed
after 18 months in 41 patients (21 treatment group and 20 control group). Arm volume and LS alterations
were assessed.
RESULTS: Lymphedema appeared in 1 patient in the treatment group 6 months after surgery (4.34%).
In the control group, lymphedema occurred in 7 patients (30.43%). No statistically significant differences
in the arm volume were observed in the treatment group during follow-up, while the arm volume in the
control group showed a significant increase after 1, 3, and 6 months from operation. There was significant
difference between the 2 groups in the volume changes with respect to baseline after 1, 3, 6, 12, and 18
months after surgery (every timing P value < 0.01).
CONCLUSIONS: LYMPHA represents a valid technique for primary prevention of secondary arm
lymphedema with no risk of leaving undetected malignant disease in the axilla.
PMID: 21369739 [PubMed - as supplied by publisher]
Clin Nucl Med. 2011 Apr;36(4):e11-2.
The role of lymphoscintigraphy in diagnosis and monitor the response of physiotherapeutic technique in
congenital lymphedema.
Chang L, Cheng MF, Chang HH, Kao YH, Wu YW.
From the *Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Departments of
†Nuclear Medicine and ‡Pediatrics, National Taiwan University Hospital and National Taiwan University
College of Medicine, Taipei, Taiwan; and §Division of Nuclear Medicine, Department of Radiology,
Hsin-Chu General Hospital, Hsin-Chu County, Taiwan.
Abstract
We describe the case of a 4-month-old girl who was admitted for bilateral legs swelling for several
weeks. Lymphoscintigraphy revealed the absence of the radiotracer proximal to the ilioinguinal nodes up
to 6 hours postinjection. In light of the clinical and image findings, a diagnosis of congenital lymphedema
was compatible. Systemic corticosteroid was given, and physical massage was applied at the lower
extremities for 3 weeks. Repeat lymphoscintigraphy revealed faster lymphatic flow and liver visualization,
demonstrating improvement in lymphatic function. This case illustrates the usefulness of
lymphoscintigraphy in diagnosis and evaluating therapy response of lymphedema in children.
PMID: 21368595 [PubMed - in process]
March 14, 2011
Dermatol Online J. 2011 Feb 15;17(2):9.
Granulomatous rosacea: Unusual presentation as solitary plaque.
Batra M, Bansal C, Tulsyan S.
Abstract
A 45-year-old male presented with a 6 month history of an enlarging smooth, erythematous plaque over
the central part of his face. Mild erythema of both eyes was present. Sarcoidosis, Hansen disease, lupus
vulgaris, cutaneous leishmaniasis, pseudolymphoma, foreign body granuloma, granuloma faciale, discoid
lupus erythematosus, and granulomatous rosacea were considered in the differential diagnosis. CBC,
urinalysis, renal function tests, liver function tests, serum electrolytes, and blood sugar were all normal.
Chest X-ray and ECG revealed no abnormality. Serology for syphilis and HIV, and mantoux test were
negative. Slit-skin smear, tissue smear and culture for AFB and fungi were negative. Skin biopsy revealed
multiple non-caseating epitheloid granulomas around the pilosebaceous unit suggestive of granulomatous
rosacea. Granulomatous rosacea, a rare entity comprising only about 10 percent of cases of rosacea can
mimic many granulomatous conditions both clinically and histologically making the diagnosis an enigma. It
usually presents as yellowish brown-red discrete papules on the face; non-caseating epithelioid
granulomas are seen on histology examination. We herein report the case because it presented in atypical
fashion, as a solitary indurated plaque on the nose, likely representing Morbihan's disease or solid
persistent facial edema of rosacea (rosacea lymphedema).
PMID: 21382292 [PubMed - in process]
Elephantiasis Nostras Verrucosa on the buttocks and sacrum of two immobile men.
Setyadi HG, Iacco MR, Shwayder TA, Ormsby A.
Department of Dermatology, Henry Ford Health System, Detroit, Michigan.
Abstract
Though typically involving the lower extremities, elephantiasis nostras verrucosa (ENV) can occur in any
area affected by lymphedema. Here we report two cases of ENV: one is a biopsy-proven case and the
other is a clinically diagnosed case. Both occurred on the buttocks and sacrum of immobile, morbidly
obese men who were persistently in the supine or seated position. Whereas classic ENV is not
uncommon, this striking presentation on these unusual areas is quite rare.
PMID: 21382291 [PubMed - in process]
Cancer. 2011 Mar 15;117(6):1136-48. doi: 10.1002/cncr.25513. Epub 2010 Nov 8.
Conservative and dietary interventions for cancer-related lymphedema: A Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada; Department of
Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada. mmcneely@ualberta.ca.
Abstract
The findings support the use of compression garments and compression bandaging for reducing
lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast cancer,
a statistically significant, clinically small beneficial effect was found from the addition of manual lymph
drainage massage to compression therapy for upper extremity lymphedema volume. Cancer 2011. ©
2010 American Cancer Society.
PMID: 21381006 [PubMed - in process
Int J Palliat Nurs. 2011 Feb;17(2):60-6.
Reflections on lymphoedema, fungating wounds and the power of touch in the last weeks of life.
Fenton S.
Abstract
Terminal care is a significant chapter of life in which each individual has the right to expect dignity,
compassion, holistic care, and quality of life. The case of 'Sally', a 57-year-old woman with a diagnosis of
inflammatory breast cancer, left arm lymphoedema, and a fungating chest wound, gave palliative care
nurses a multitude of distressing and complex challenges to manage. Management of lymphoedema is
often put into the 'too hard basket', especially in the palliative care setting. Similarly, fungating wounds are
hard to confront, and the power of touch is often underestimated. The aim of this case study is to explore
and reflect on how these issues entwine, and how vital it is for nurses to feel comfortable in providing the
most appropriate care. As a result of reflection on Sally's care management many issues were highlighted,
including the crucial need to relieve her symptoms with timely, appropriate, dignified, and respectful care,
optimizing her sense of worth and quality of life.
PMID: 21378689 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]
Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-
neck cancer.
Mihara M, Uchida G, Hara H, Hayashi Y, Moriguchi H, Narushima M, Iida T, Yamamoto T, Koshima I.
Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can improve lymph
circulation by the anastomosis of lymph vessels and veins. A therapeutic effect of LVA for lymphoedema
has been shown in limbs, but efficacy for other regions has not been shown. Lymphoedema in the head-
and-neck region following cancer resection and radiotherapy is mainly treated with manual lymphatic
drainage. However, there is no alternative when this treatment is ineffective because application of
compression treatment using a bandage is difficult in this region. We used LVA for lymphoedema in the
head-and-neck region and achieved a good outcome. Functional and dilating lymph vessels were
identified using pre- and intra-operative fluorescent lymphography, and a lymph vessel with a diameter of
about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The outcome of this case
suggests that LVA is applicable for treatment of lymphoedema in the head-and-neck region.
Copyright © 2011. Published by Elsevier Ltd.
PMID: 21377943 [PubMed - as supplied by publisher]
Can Fam Physician. 2010 Dec;56(12):1277-84.
Management of secondary lymphedema related to breast cancer.
Cheifetz O, Haley L; Breast Cancer Action.
Hamilton Health Sciences, 711 Concession St, Hamilton, ON L8V 1C3. cheifetz@hhsc.ca
PMID: 21375063 [PubMed - in process]
March 14, 2011
Cancer. 2011 Mar 15;117(6):1136-48. doi: 10.1002/cncr.25513. Epub 2010 Nov 8.
Conservative and dietary interventions for cancer-related lymphedema: A Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada; Department of
Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada. mmcneely@ualberta.ca.
Abstract
The findings support the use of compression garments and compression bandaging for reducing
lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast cancer,
a statistically significant, clinically small beneficial effect was found from the addition of manual lymph
drainage massage to compression therapy for upper extremity lymphedema volume. Cancer 2011. ©
2010 American Cancer Society.
PMID: 21381006 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]
Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-
neck cancer.
Mihara M, Uchida G, Hara H, Hayashi Y, Moriguchi H, Narushima M, Iida T, Yamamoto T, Koshima I.
Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can improve lymph
circulation by the anastomosis of lymph vessels and veins. A therapeutic effect of LVA for lymphoedema
has been shown in limbs, but efficacy for other regions has not been shown. Lymphoedema in the head-
and-neck region following cancer resection and radiotherapy is mainly treated with manual lymphatic
drainage. However, there is no alternative when this treatment is ineffective because application of
compression treatment using a bandage is difficult in this region. We used LVA for lymphoedema in the
head-and-neck region and achieved a good outcome. Functional and dilating lymph vessels were
identified using pre- and intra-operative fluorescent lymphography, and a lymph vessel with a diameter of
about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The outcome of this case
suggests that LVA is applicable for treatment of lymphoedema in the head-and-neck region.
Copyright © 2011. Published by Elsevier Ltd.
PMID: 21377943 [PubMed - as supplied by publisher]
March 15, 2011
Curr Urol Rep. 2011 Mar 11. [Epub ahead of print]
Complications of Pelvic Lymph Node Dissection for Prostate Cancer.
Keegan KA, Cookson MS.
Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North,
Nashville, TN, 37232, USA.
Abstract
Pelvic lymph node dissection (PLND) represents the standard for detection of occult pelvic nodal
metastases from prostate cancer, and may be performed separately from or at the time of radical
prostatectomy. In addition to its potential for diagnostic staging, a PLND may be therapeutic in some
patients. However, considerable debate centers on the appropriate candidates for the procedure, the
extent and proper boundaries of dissection, optimal surgical approach, and absolute oncologic benefit.
Several series suggest that there likely is limited benefit of PLND in low-risk patients and that PLND can
be safely omitted in a high percentage of men undergoing contemporary radical prostatectomy.
Furthermore, the value of PLND in patients with intermediate- and high-risk disease must be balanced
against the potential morbidity of the procedure. In the setting of this debate, concern over morbidity
directly attributable to this procedure is of paramount importance. This review focuses on the
complications associated with PLND, including lymphocele, thromboembolic events, ureteral injury,
nerve injury, vascular injury, and lymphedema.
PMID: 21394597 [PubMed - as supplied by publisher]
BMC Cancer. 2011 Mar 9;11(1):94. [Epub ahead of print]
Manual lymphatic drainage therapy in patients with breast cancer related lymphoedema.
Lopez Martin M, Hernandez MA, Avendano C, Rodriguez F, Martinez H.
ABSTRACT:
BACKGROUND: Lymphoedema is a common and troublesome problem that develops following breast
cancer treatment. The aim of this study is to analyze the effectiveness of Manual Lymphatic Drainage
(MLD) in the treatment of postmastectomy lymphoedema in order to reduce the volume of lymphoedema
and evaluate the improvement of the concomitant symptomatology.
METHODS: Randomized controlled clinical trial of 58 women suffering postmastectomy lymphoedema.
Control group includes 29 patients with standard treatment (care of the skin, exercise and measures of
compression, bandage for one month and later garment of compression). Experimental group includes
patients with stardard treatment and, in addition they received Manual Lymphatic Drainage. The therapy
will be administered daily during four weeks and the patients will be reviewed after one, three and six
months of the treatment. The main outcome is volume reduction of the affected arm after the treatment
expressed in percentage. Secondary outcome parameters include duration of lymphoedema reduction
and improvement of the concominant symtomatology (degree of pain, sensation of swelling and functional
limitation in the affected extremity, subjective sensation of physical attraction and feminity, dificulty to look
at oneself nude and desilution grade about the corporal image).
DISCUSSION: The results of this study will provide information on the effectiveness of manual lymph
drainage and its impact on the quality of life and physical limitations of these patients. Trial registration:
NCT01152099.
PMID: 21392372 [PubMed - as supplied by publisher]
March 25, 2011 - New Technology at NewYork-Presbyterian/Columbia Aids Surgeons With Early
Detection of Lymphedemain Breast Cancer Patients - Newswise –
Early Detection and Intervention May Prevent Disabling Complication of Breast Cancer Surgery
Newswise — NEW YORK (March 24, 2011) -- Breast cancer specialists at NewYork-Presbyterian
Hospital/Columbia University Medical Center are offering patients new ways to detect early signs of
lymphedema, a common side effect of breast cancer surgery that causes painful, debilitating and
disfiguring swelling in the arms following removal of lymph nodes.
As many as 30 percent of women who have breast cancer surgery with lymph node removal will develop
lymphedema. Radiation treatment increases this risk to as high as 50 percent. While it is possible to arrest
the condition through physical therapy and bandaging, there is no cure.
"Just as we've used early detection to improve breast cancer survival, we are using early detection to
reduce women's risk for developing lymphedema,"says Dr. Sheldon Feldman, the Vivian L. Milstein
Associate Professor of Clinical Surgery at Columbia University College of Physicians and Surgeons and
chief of breast surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center.
Dr. Feldman and his colleagues at NewYork-Presbyterian/Columbia are employing a technique called
bioimpedence spectroscopy to help them identify the earliest onset of lymphedema. An FDA-approved
device called L-DEX (ImpediMed Inc.) uses a mild electrical current to measure minute changes in
extracellular fluid, allowing for a diagnosis of lymphedema by the physician well before any swelling is
noticeable. "By catching it early, we can reverse the process and prevent unnecessary pain,
embarrassment, debilitation and risk of infection,"says Dr. Feldman.
Alongside its clinical use, the bioimpedence technique is also being used in research to better understand
which patients are most at risk for lymphedema and whether the condition always progressively worsens,
or if it can naturally correct itself over time. Other studies will investigate the common belief that
lymphedema is negatively affected by air travel and weight training.
Another method of reducing risk for lymphedema is a technique called "reverse arm mapping.""The lymph
nodes that drain the arm are sometimes removed during breast cancer surgery because they're situated
within the armpit (axilla) in the same area as the lymph nodes that relate to the breast. With reverse arm
mapping, we inject dye into the patient's arm to differentiate the two kinds of lymph nodes. This allows
the surgeon to avoid removing any nodes related to arm drainage while still accurately identifying the
sentinel nodes, which are important for breast cancer evaluation and treatment,"says Dr. Feldman. "This
should reduce the risk of developing lymphedema.”
Arm mapping is part of a larger trend toward reducing or eliminating the need to remove a woman's
lymph nodes -- thereby reducing the incidence of lymphedema. Beginning in the 1990s, sentinel node
biopsy used dye injected into the breast to target the sentinel lymph node, the gatekeeper to the axilla and
the one most at risk for cancer spread. Today, the latest research indicates that fewer patients need any
lymph nodes removed than previously thought. Even if the sentinel node is shown to be positive, patients
with early-stage breast cancer who are treated with lumpectomy, chemotherapy and radiation may not
need to have any further lymph nodes removed.
For more information, patients may call (866) NYP-NEWS.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical
research, in medical and health sciences education, and in patient care. The Medical Center trains future
leaders and includes the dedicated work of many physicians, scientists, public health professionals,
dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the
College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School
of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's
College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is
now among the most selective medical schools in the country. Columbia University Medical Center is
home to the largest medical research enterprise in New York City and state and one of the largest in the
United States. For more information, please visit www.cumc.columbia.edu.
NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-
sectarian hospital, with 2,353 beds. The Hospital has more than 2 million inpatient and outpatient visits in
a year, including more than 220,000 visits to its emergency departments -- more than any other area
hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all
areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center,
NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan
Stanley Children's Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian
Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the
Hospital is committed to excellence in patient care, research, education and community service.
NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked
among the best academic medical institutions in the nation, according to U.S.News & World Report. The
Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical
College and Columbia University College of Physicians and Surgeons. For more information, visit www.
nyp.org.
PUB MED DOCS TO BE FORMATTED:
March 25, 2011
Ann Plast Surg. 2011 Mar 14. [Epub ahead of print]
Lower Extremity Lymphedema Index: A Simple Method for Severity Evaluation of Lower Extremity
Lymphedema.
Yamamoto T, Matsuda N, Todokoro T, Yoshimatsu H, Narushima M, Mihara M, Uchida G, Koshima I.
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of
Tokyo, Bunkyo-ku, Tokyo, Japan.
Abstract
Measurement of the circumference is the most commonly used method for evaluating extremity
lymphedema. However, comparison between different patients is difficult with this measurement. To
resolve this problem, we have formulated a new index, lower extremity lymphedema (LEL) index, which
can be easily obtained from measurements of the body. We evaluated correlation between lower LEL
index and clinical stage in patients with LEL. The LEL indices were significantly correlated with clinical
stages and could be used as a severity scale. The LEL index makes objective assessment of the severity
of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the
index useful for evaluation of lymphedema severities between different cases.
PMID: 21407058 [PubMed - as supplied by publisher]
J Pain Symptom Manage. 2011 Mar 12. [Epub ahead of print]
Subcutaneous Lymphatic Drainage (Lymphcentesis) for Palliation of Severe Refractory Lymphedema in
Cancer Patients.
Jacobsen J, Blinderman CD.
Palliative Care Service (J.J.), Massachusetts General Hospital, and Harvard Medical School (J.J.),
Boston, Massachusetts; and Palliative Medicine Service (C.D.B.), Departments of Anesthesiology and
Medicine, Columbia University Medical Center, New York, New York, USA.
Abstract
Subcutaneous lymphatic drainage has been reported to be an effective treatment for severe refractory
lymphedema in patients with lymphatic accumulation because of obstructive cancer. We review published
techniques for lymphatic drainage and describe two cases where these techniques were modified with
good results.
Copyright © 2011. Published by Elsevier Inc.
PMID: 21402464 [PubMed - as supplied by publisher]
Gan To Kagaku Ryoho. 2010 Dec;37 Suppl 2:229-31.
[Two cases of stewart-treves syndrome observed at sanshu hospital].
[Article in Japanese]
Yokoyama A, Yokoyama K, Matsumoto K.
The Palliative Care Units, Sanshu Hospital.
Abstract
Stewart-Treves syndrome is angiosarcoma, which occurs in the chronic lymphedema of the upper or
lower limbs. Presently, an effective therapy is not established. The survival period is only several months
to one year. There are some reports that angiosarcoma will occur in the period of 5~15 years after a
continuation of lymphedema of the extremities. Therefore, it is important to prevent lymphedema after
surgical operations of primary disease and the lymphedema.
PMID: 21368533 [PubMed - in process]
ScientificWorldJournal. 2011 Mar 7;11:614-23.
Penile anomalies in adolescence.
Wood D, Woodhouse C.
Abstract
This article considers the impact and outcomes of both treatment and underlying condition of penile
anomalies in adolescent males. Major congenital anomalies (such as exstrophy/epispadias) are discussed,
including the psychological outcomes, common problems (such as corporal asymmetry, chordee, and
scarring) in this group, and surgical assessment for potential surgical candidates. The emergence of new
surgical techniques continues to improve outcomes and potentially raises patient expectations. The
importance of balanced discussion in conditions such as micropenis, including multidisciplinary support for
patients, is important in order to achieve appropriate treatment decisions. Topical treatments may be of
value, but in extreme cases, phalloplasty is a valuable option for patients to consider. In buried penis, the
importance of careful assessment and, for the majority, a delay in surgery until puberty has completed is
emphasised. In hypospadias patients, the variety of surgical procedures has complicated assessment of
outcomes. It appears that true surgical success may be difficult to measure as many men who have had
earlier operations are not reassessed in either puberty or adult life. There is also a brief discussion of
acquired penile anomalies, including causation and treatment of lymphoedema, penile fracture/trauma, and
priapism.
PMID: 21399858 [PubMed - in process]
Arch Esp Urol. 2011 Mar;64(2):121-124.
Surgical treatment in a case of giant scrotal lymphedema.
[Article in English, Spanish]
Rubio Hidalgo E, López García-Moreno A, Buendía González E, Sampietro Crespo A, Arce Casado B,
De La Fuente Núñez J.
Urology Department.Hospital Virgen de la Salud. Complejo Hospitalario de Toledo. Toledo. Spain.
Abstract
OBJECTIVE: Scrotal lymphedema (SL) is a rare clinical pathology with multiple etiologies. We report a
case of idiopathic giant scrotal lymphedema and review the existing medical literature in Medline from the
last ten years.
METHODS: We report the case of a male patient with a giant scrotal lymphedema (43×40 cm) of
unknown etiology developed over four years.
RESULTS: The patient was treated by scrotal excision and reconstruction with skin graft plasty, with a
successful result.
CONCLUSIONS: Scrotal Lymphedema is a rare entity, especially in industrialized countries. If the
lymphedema is severe, surgery is the most appropriate therapeutic option, whatever the cause is.
Complete resection up to healthy tissue and surgical reconstruction is the choice. Thin skin grafts are
necessary for reconstruction when it affects the entire scrotum.
PMID: 21399245 [PubMed - as supplied by publisher]
BMC Cancer. 2011 Mar 9;11:94.
Manual lymphatic drainage therapy in patients with breast cancer related lymphoedema.
Martín ML, Hernández MA, Avendaño C, Rodríguez F, Martínez H.
Unidad de Investigación, Hospital Universitario de La Princesa, Diego de León 36, 28046 Madrid,
Spain. martaloma@yahoo.es.
Abstract
ABSTRACT:
BACKGROUND: Lymphoedema is a common and troublesome condition that develops following
breast cancer treatment. The aim of this study is to analyze the effectiveness of Manual Lymphatic
Drainage in the treatment of postmastectomy lymphoedema in order to reduce the volume of
lymphoedema and evaluate the improvement of the concomitant symptomatology.
METHODS: A randomized, controlled clinical trial in 58 women with post-mastectomy lymphoedema.
The control group includes 29 patients with standard treatment (skin care, exercise and compression
measures, bandages for one month and, subsequently, compression garnments). The experimental group
includes 29 patients with standard treatment plus Manual Lymphatic Drainage. The therapy will be
administered daily for four weeks and the patient's condition will be assessed one, three and six months
after treatment.The primary outcome parameter is volume reduction of the affected arm after treatment,
expressed as a percentage. Secondary outcome parameters include: duration of lymphoedema reduction
and improvement of the concomitant symptomatology (degree of pain, sensation of swelling and
functional limitation in the affected extremity, subjective feeling of being physically less atractive and less
feminine, difficulty looking at oneself naked and dissatisfaction with the corporal image).
DISCUSSION: The results of this study will provide information on the effectiveness of Manual
Lymphatic Drainage and its impact on the quality of life and physical limitations of these patients.
TRIAL REGISTRATION: ClinicalTrials (NCT): NCT01152099.
PMID: 21392372 [PubMed - in process]
Biomaterials. 2011 Mar 19. [Epub ahead of print]
Therapeutic lymphangiogenesis using stem cell and VEGF-C hydrogel.
Hwang JH, Kim IG, Lee JY, Piao S, Lee DS, Lee TS, Ra JC, Lee JY.
Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine,
Samsung Medical Center, Seoul, Republic of Korea.
Abstract
Lymphedema is a manifestation of lymphatic system insufficiency. It arises from primary lymphatic
dysplasia or secondary obliteration after lymph node dissection or irradiation. Although improvement of
swelling can be achieved by comprehensive non-operative therapy, treatment of this condition requires
lifelong care and good compliance. Recently molecular-based treatments using VEGF-C have been
investigated by several researchers. We designed the present study to determine whether the therapeutic
efficacy of implanted human adipose-derived stem cells (hADSCs) could be improved by applying a
gelatin hydrogel containing VEGF-C (VEGF-C hydrogel) to the site of tissue injury in a lymphedema
mouse model. Four weeks after the operation, we evaluated edema and determined lymphatic vessel
density at various post-operative time points. Mice treated with hADSCs and VEGF-C hydrogel showed
a significantly decreased dermal edema depth compared to the groups of mice that received hADSCs
only or VEGF-C hydrogel only. Immunohistochemical analysis also revealed that the hADSC/VEGF-C
hydrogel group showed significantly greater lymphatic vessel regeneration than all the other groups.
hADSCs were detected in the implantation sites of all mice in the hADSC/VEGF-C group, and exhibited
a lymphatic endothelial differentiation phenotype as determined by co-staining PKH-labeled hADSCs for
the lymphatic marker LYVE-1. Our results suggest that co-administration of hADSCs and VEGF-C
hydrogel has a substantial positive effect on lymphangiogenesis.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21421266 [PubMed - as supplied by publisher]
Med Clin (Barc). 2011 Mar 17. [Epub ahead of print]
[Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4). Spanish
version validation.]
[Article in Spanish]
Belmonte Martínez R, Garin Boronat O, Segura Badía M, Sanz Latiesas J, Navarro EM, Fores MF.
Servei de Medicina Física i Rehabilitació, Hospital Mar-Esperança, Parc de Salut Mar, Barcelona,
España; Departament de Medicina de la Universitat Autònoma de Barcelona. Bellaterra, Barcelona,
España.
Abstract
BACKGROUND AND OBJECTIVES: To evaluate the acceptability, reliability, validity, and sensitivity
to change of the Spanish version of the FACT-B+4 questionnaire, designed to assess the health related
quality of life (HRQL) in breast cancer.
PATIENTS AND METHODS: Prospective study with 2 samples: patients with incident breast cancer
(n=104) evaluated before and after surgery; and patients with chronic lymphedema of the upper extremity
(n=30), evaluated twice in 7days. HRQL was assessed using the generic instrument SF-36 and the
specific one FACT-B+4.
RESULTS: Reliability coefficients were = 0.7 for most scores. The Physical wellbeing, Breast Cancer,
Arm and TOI scores discriminated between patients with and without chemotherapy (p<0.05), while the
Arm scale discriminated between patients with and without axillary surgery (p<0.001). In the worsening
sub-sample, the FACT-B+4 detected changes in Physical, Emotional and Functional Wellbeing, and TOI
scores.
CONCLUSIONS: The metric characteristics of the Spanish version of the FACT-B+4 are similar to the
original questionnaire and support its equivalence, documenting its suitability for use in our country or in
international studies.
Copyright © 2010 Elsevier España, S.L. All rights reserved.
PMID: 21420133 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2011 Mar;9(1):61-4.
(18)F-FDG PET/CT in a Rare Case of Stewart-Treves Syndrome: Future Implications and Diagnostic
Considerations.
Jensen MR, Friberg L, Karlsmark T, Bülow J.
1 Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of
Copenhagen , Denmark .
Abstract
Abstract Background: The aim of this article is to illustrate the possible applications of (18)F-
fluorodeoxyglucose positron emission tomography/computer tomography ((18)F-FDG PET/CT) in
chronic extremity lymphedema and its complications. Methods and Results: (18)F-FDG PET/CT findings
in a rare case of Stewart-Treves Syndrome (STS), angiosarcoma secondary to chronic extremity
lymphedema, are presented. Lymphedema of the extremities is a debilitating disease characterized by
chronic swelling due to interstitial edema caused by insufficient lymphatic drainage capacity. Progression
with skin thickening, subcutaneous fibrosis, and increased adipose tissue volume is common. Chronic
inflammation has been suggested as a key pathophysiologic component. STS is a rare complication with a
very poor prognosis; however, early diagnosis and radical treatment is associated with increased survival.
Thus, accurate pretreatment staging is paramount. (18)F-FDG PET/CT is highly sensitive in detecting
increased glucose metabolism as seen in many types of cancer and inflammation. The role of (18)F-FDG
PET/CT in the management of lymphedema and its complications has to our knowledge yet to be
described. This case documents high (18)F-FDG uptake in STS, but is at the same time an example of
the low specificity of this imaging modality. Conclusions: We suggest that (18)F-FDG PET/CT has the
potential to become an important tool in the staging and treatment planning of Stewart-Treves syndrome.
Furthermore, (18)F-FDG-accumulation may be a sensitive tool in detecting low grade inflammation in the
skin and subcutis, which has been suggested to cause tissue remodeling in lymphedema progression.
However, further studies are needed to elucidate this theory.
PMID: 21417769 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):47-51.
Confirmation of the reference impedance ratios used for assessment of breast cancer-related
lymphedema by bioelectrical impedance spectroscopy.
Ward LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL.
1 School of Chemistry and Molecular Biosciences, University of Queensland , St. Lucia, Brisbane,
Australia .
Abstract
Abstract Background: Breast cancer-related lymphedema in the arm is commonly detected by
bioelectrical impedance spectroscopy as an increased inter-arm impedance ratio due to the presence of
excess lymph in the at-risk arm relative to that of the unaffected arm. The presence of lymphedema is
determined by a value of this ratio greater than the mean ratio, plus three standard deviations observed in
a comparable healthy population. This threshold value has not been established using the measurement
protocols in current practice. The aim of the present study was to determine the reference range of the
inter-arm impedance ratio to allow a cut-off value to be established as a criterion for the detection of
breast cancer-related lymphedema. Methods: The mean and variation (3 SD) of the inter-arm impedance
ratio for the arms of 172 healthy female control participants were determined from an accumulated
database of impedance data obtained using present generation impedance instrumentation and
methodology. This reference range and threshold value was compared to the original threshold ratio
determined a decade ago but still in current use. Results: The presence of lymphedema is indicated when
the impedance ratio exceeded 1.106 when the nondominant limb is at risk, and 1.134 when the dominant
limb is at risk compared with the currently used values of 1.066 and 1.139, respectively. Although the
difference in these values was statistically significant, this difference was determined to be of minor
importance to clinical practice. Conclusions: The impedance ratio thresholds for early detection of
lymphedema remain suitable for clinical use with present day bioimpedance spectroscopy analyzers and
measurement protocols.
PMID: 21417767 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):43-6.
Reference ranges for assessment of unilateral lymphedema in legs by bioelectrical impedance
spectroscopy.
Ward LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL.
1 School of Chemistry and Molecular Biosciences, The University of Queensland , St. Lucia, Brisbane,
Australia .
Abstract
Abstract Background: Secondary unilateral lymphedema in the leg may occur as a consequence of pelvic
surgery and/or radiation therapy, which causes damage to the pelvic lymphatic system. To date,
assessment has been typically by manual measurement of the volume excess of the affected leg compared
to the contralateral leg. In contrast, the assessment of unilateral arm lymphedema is readily accomplished
by the use of bioelectrical impedance spectroscopy (BIS) as an increased inter-arm impedance ratio due
to the presence of excess lymph in the affected arm relative to that of the unaffected arm. The presence of
lymphedema is defined by a value of this ratio greater than the mean ratio plus three standard deviations
(SD) observed in a comparable healthy population. The aim of the present study was to determine the
equivalent reference range of the impedance ratio for the legs. This would allow a cut-off value to be
established as a criterion for the detection and assessment of lower limb lymphedema. Methods: The
impedances of the legs of 172 healthy females and 150 healthy males, measured by BIS, were extracted
from an accumulated database of impedance data. These data were used to determine the normal
distribution of inter-leg impedance ratios and the reference range and threshold value (mean?+?3 SD).
Results: The presence of lymphedema is indicated when the impedance ratio exceeds 1.167 in males and
1.136 in females. Unlike in the arms, the effect of limb dominance in the legs is minimal and it is suggested
that no correction for limb dominance is warranted. Conclusions: The impedance ratio thresholds for
lymphedema of the legs have been established, opening the way for BIS to become established clinically
for the early detection and assessment of lower limb lymphedema.
PMID: 21417766 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):31-42.
Segmental blood flow and hemodynamic state of lymphedematous and nonlymphedematous arms.
Montgomery LD, Dietrich MS, Armer JM, Stewart BR, Ridner SH.
1 LDM Associates , San Jose, California.
Abstract
Abstract Background: Findings regarding the influence hemodynamic factors, such as increased arterial
blood flow or venous abnormalities, on breast cancer treatment-related lymphedema are mixed. The
purpose of this study was to compare segmental arterial blood flow, venous blood return, and blood
volumes between breast cancer survivors with treatment-related lymphedema and healthy normal
individuals without lymphedema. Methods and Results: A Tetrapolar High Resolution Impedance Monitor
and Cardiotachometer were used to compare segmental arterial blood flow, venous blood return, and
blood volumes between breast cancer survivors with treatment-related lymphedema and healthy normal
volunteers. Average arterial blood flow in lymphedema-affected arms was higher than that in arms of
healthy normal volunteers or in contralateral nonlymphedema affected arms. Time of venous outflow
period of blood flow pulse was lower in lymphedema-affected arms than in healthy normal or
lymphedema nonaffected arms. Amplitude of the venous component of blood flow pulse signal was lower
in lymphedema-affected arms than in healthy or lymphedema nonaffected arms. Index of venular tone was
also lower in lymphedema-affected arms than healthy or lymphedema nonaffected arms. Conclusions:
Both arterial and venous components may be altered in the lymphedema-affected arms when compared
to healthy normal arms and contralateral arms in the breast cancer survivors.
PMID: 21417765 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):19-30.
Molecular characterization of dermal lymphatic endothelial cells from primary lymphedema skin.
Ogunbiyi S, Chinien G, Field D, Humphries J, Burand K, Sawyer B, Jeffrey S, Mortimer P, Clasper S,
Jackson D, Smith For The London Lymphedema Consortium A.
1 Academic Department of Surgery, BHF Centre of Research Excellence and NIMR Biomedical
Research Centre at Kings Health Partners , St. Thomas Hospital, London, United Kingdom .
Abstract
Abstract Background: Lymphatic endothelial cells from primary lymphedema skin have never been
cultured nor characterized. A subgroup of patients with primary lymphedema undergo surgery to bring
about an improvement in their quality of life. The aim of this study was to culture and characterize LECs
from the skin of these patients. Methods and Results: Lymphatic endothelial cells were isolated and
cultured from the skin of patients with primary lymphedema and from normal skin. The isolated cells were
compared in their ability to form microvascular networks in a three-dimensional culture medium, and in
their response to treatment with vascular endothelial growth factors A, C, and D. Whole tissue
transcriptional profiling was carried out on two pools of isolated lymphatic endothelial cells-one from
primary lymphedema skin and the other from normal skin. Lymphatic endothelial cells from primary
lymphedema skin form tubule-like structures when cultured in three-dimensional media. They respond in a
similar fashion to stimulation with the vascular endothelial growth factors A, C, and D. Comparative
analysis between lymphedema tissue and normal tissue (fold change >2) showed differential expression of
2793 genes (5% of all transcripts), 2184 upregulated, and 609 downregulated. Genes involved in cellular
apoptosis (vascular endothelial growth inhibitor, zinc finger protein), extracellular matrix turnover (matrix
metalloproteinase inhibitor-16), and type IV collagen deposition were upregulated. Various pro-
inflammatory genes (interleukin-6, interleukin-8, interleukin-32, E-selectin) were downregulated.
Conclusion: Cellular adhesion, apoptosis, and increased extracellular matrix turnover play a more
prominent role in primary lymphedema than previously thought. In addition, the acute inflammatory
response is attenuated as evidenced by the downregulation of various pro-inflammatory genes.This sheds
further light on the interplay of the various pathological processes taking place in primary lymphedema.
PMID: 21417764 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):13-8.
Reliability and concurrent validity of the perometer for measuring hand volume in women with and without
lymphedema.
Lee MJ, Boland RA, Czerniec S, Kilbreath SL.
Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney , Sydney, Australia .
Abstract
Abstract Background: Lymphedema of hand after breast cancer treatment causes significant loss of hand
function. Although there are several ways of assessing limb volume, measuring hand volume has been
problematic due to technical difficulties associated with assessment of finger volumes. The aim of this
study was to investigate the criterion validity and reliability of Perometer™ for measuring hand volume in
woman with and without lymphedema. Methods and Results: Hand volume of forty women with (n?=?
20) and without lymphedema (n?=?20) was assessed twice by one rater and once by another rater using
the Perometer, and once by one rater using the water volumetry method. Intra- and inter-rater reliability
was determined from the intraclass correlation coefficients and Percent Close Agreement. Agreement
between the Perometer and water volumetry was determined using a limit of agreement and Lin's
concordance correlation. The Perometer had high intra [ICC(2,1)?=?0.989 (95% CI: 0.98-0.99)] and
inter-rater reliability [ICC(2,1)?=?0.993 (95% CI: 0.99-1.0)]. Percent close agreement revealed that
80% of the measures were within 9?ml for inter-rater reliability and within 15?ml for intra-rater reliability.
In addition, there was high concordance between hand volumes obtained with the Perometer and water
volumetry method (R(c)?=?0.88). However, the Perometer overestimated the volume of hand compared
to water volumetry method (bias: 7.5%). Conclusions: The Perometer can be used with high reliability to
measure hand volume but caution should be exercised when data are compared with measures derived
from the water volumetry method.
PMID: 21417763 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):1.
Non-invasive assessment of human clinical lymphedema: the progress continues.
Rockson SG.
PMID: 21417761 [PubMed - in process]
Filarial Nematodes.
Cross JH.
In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical
Branch at Galveston; 1996. Chapter 92.
Excerpt
The filariae are thread-like parasitic nematodes (roundworms) that are transmitted by arthropod vectors.
The adult worms inhabit specific tissues where they mate and produce microfilariae, the characteristic
tiny, thread-like larvae. The microfilariae infect vector arthropods, in which they mature to infective
larvae. Filarial diseases are a major health problem in many tropical and subtropical areas. The disease
produced by a filarial worm depends on the tissue locations preferred by adults and microfilariae. The
adults of the lymphatic filariae inhabit lymph vessels, where blockage and host reaction can result in
lymphatic inflammation and dysfunction, and eventually in lymphedema and fibrosis. Repeated, prolonged
infection with these worms can lead to elephantiasis, a buildup of excess tissue in the affected area. Other
filariae mature in the skin and subcutaneous tissues, where they induce nodule formation and dermatitis;
migrating filariae of these species can cause ocular damage. Table 92-1 summarizes the filarial infections
of humans.
Copyright © 1996, The University of Texas Medical Branch at Galveston
Sections
•General Concepts•Introduction•Lymphatic Filariae Wuchereria Bancrofti and Brugia
Malayi•Onchocerca Volvulus•Minor Filarial Infections•Dirofilaria Species•Dracunculus
Medinensis•ReferencesPMID: 21413271 [PubMed]
April 3, 2011
Lymphology. 2010 Dec;43(4):188-91.
Congenital lymphatic dysplasia in Kabuki syndrome: first report of an unusual association.
Morcaldi G, Boccardo F, Campisi C, Bellini T, Massocco D, Bonioli E.
Department of Pediatrics, University of Genoa, Gaslini Children's Hospital, Italy. gmorcaldi@fastwebnet.it
Abstract
Kabuki syndrome was first described in Japan in 1981 as a rare disorder of unknown cause. Its main
features include characteristic facies, postnatal growth retardation, and mental delay. To date, there is no
molecular marker for Kabuki syndrome, which is considered genetically heterogeneous and still is a
clinically-based diagnosis. Here we describe the first case of a patient affected by Kabuki syndrome
associated with lymphatic dysplasia. We suggest accurate evaluation of all Kabuki patients as early as
possible in order to diagnose lymphedema or other clinical manifestations of lymphatic system
involvement. Early identification of lymphatic system maldevelopment provides the best chance for
reducing the risk of developing progressive lymphedema with associated tissue changes (fibrosis,
sclerosis, and fat deposition).
PMID: 21446574 [PubMed - indexed for MEDLINE]
Lymphology. 2010 Dec;43(4):178-87.
Prevalence of upper-body symptoms following breast cancer and its relationship with upper-body
function and lymphedema.
Hayes SC, Rye S, Battistutta D, Newman B.
School of Public Health, Faculty of Health, Queensland University of Technology, Queensland, Australia.
sc.hayes@qut.edu.au
Abstract
This investigation describes the prevalence of upper-body symptoms in a population-based sample of
women with breast cancer (BC) and examines their relationships with upper-body function (UBF) and
lymphedema, as two clinically important sequelae. Australian women (n=287) with unilateral BC were
assessed at three-monthly intervals, from six to 18 months post-surgery (PS). Participants reported the
presence and intensity of upper-body symptoms on the treated side. Objective and self-reported UBF
and lymphedema (bioimpedance spectroscopy) were also assessed. Approximately 50% of women
reported at least one moderate-to-extreme symptom at 6- and at 18-months PS. There was a significant
relationship between symptoms and function (p < 0.01), whereby perceived and objective function
declined with increasing number of symptoms present. Those with lymphedema were more likely to
report multiple symptoms, and presence of symptoms at baseline was associated with an increased risk of
lymphedema (ORs > 1.3, p = 0.02), although presence of symptoms explained only 5.5% of the variation
in the odds for lymphedema. Upper-body symptoms are common and persistent following breast cancer
and are associated with clinical ramifications, including reduced UBF and increased risk of developing
lymphedema. However, using the presence of symptoms as a diagnostic indicator or prognosticator of
lymphedema has its limitations.
PMID: 21446573 [PubMed - indexed for MEDLINE]
Cancer. 2011 Mar 28. doi: 10.1002/cncr.26088. [Epub ahead of print]
Sphincter-sparing local excision and hypofractionated radiation therapy for anorectal melanoma: A 20-
Year Experience.
Kelly P, Zagars GK, Cormier JN, Ross MI, Guadagnolo BA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston,
Texas.
Abstract
BACKGROUND: Anorectal melanoma is a rare disease with a poor prognosis. Because survival is
determined by distant failure, many centers have adopted sphincter-sparing excision for primary tumor
control. However, this approach is associated with high rates of local failure (~50%). In this study, the
authors report their 20-year experience with sphincter-sparing excision combined with radiation therapy
(RT) for the treatment of localized anorectal melanoma.
METHODS: The authors reviewed the records of 54 patients with localized anorectal melanoma who
were treated at the University of Texas MD Anderson Cancer Center from 1989 to 2008. All patients
underwent definitive local excision with or without sentinel lymph node biopsy or lymph node dissection.
RT (25-36 grays in 5-6 fractions) was delivered to extended fields that targeted the primary site and
draining pelvic/inguinal lymphatics in 39 patients and to limited fields that targeted only the primary site in
15 patients.
RESULTS: The 5-year rates of local control (LC), lymph node control (NC), and sphincter preservation
were 82%, 88%, and 96%, respectively. However, because of the high rate of distant metastasis, the
overall survival (OS) rate at 5 years was only 30%. Although there were no significant differences in LC,
NC, or OS based on RT field extent, patients who received extended-field RT had higher rates of
lymphedema than patients who received limited-field RT.
CONCLUSIONS: The current results indicated that combined sphincter-sparing local excision and RT is
a well tolerated approach that provides effective LC for patients with anorectal melanoma. Inclusion of
the inguinal lymph node basins in the RT fields did not improve outcomes and was associated with an
increased risk of lymphedema. Cancer 2011;. © 2011 American Cancer Society.
Copyright © 2011 American Cancer Society.
PMID: 21446049 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2011 Mar 29. [Epub ahead of print]
Change in blood flow velocity demonstrated by Doppler ultrasound in upper limb after axillary dissection
surgery for the treatment of breast cancer.
Nascimben Matheus C, Caldeira de Oliveira Guirro E.
Physical Therapy Program, Faculty of Health Sciences, Methodist University of Piracicaba, Piracicaba,
Brazil.
Abstract
The aim of this study was to evaluate the arterial and venous blood flow in women who underwent upper
limb axillary dissection surgery for the treatment of breast cancer. Sixty women were divided into two
groups: group 1 (G1)-30 women who underwent breast surgery with axillary dissection level II or III
(55.6 ± 8.6 years); group 2 (G2)-control, 30 women with no breast cancer (57.4 ± 7.0 years). Blood
flow profile was evaluated by a continuous wave ultrasound Doppler device (Nicolet Vascular Versalab
SE(®)) with an 8 MHz probe. Axillary, brachial arteries and veins, arm circumference, volumes, and the
ankle-brachial index (ABI) were examined. Wilcoxon test and Mann-Whitney tests were applied to
analyze blood flow velocity intra-group and between G1 and G2, respectively. The G1 results showed no
lymphedema and no peripheral arterial disease (ABI > 0.9). Moreover, the mean blood flow velocity of
the vessels ipsilateral to the surgery was significantly higher than the contralateral ones for all vessels
examined (P < 0.05). The mean velocity of blood flow of the vessels contralateral to surgery was
significantly higher than the axillary artery in G2 (P < 0.05). It can be concluded that women who
underwent axillary dissection due to breast cancer showed probable stenosis in the arterial and venous
axillary and brachial vessels of the upper limb ipsilateral to the surgery, confirmed by the increase of
blood flow velocity, and such obstruction might affect the limb contralateral to the operation site.
PMID: 21445573 [PubMed - as supplied by publisher]
Arch Phys Med Rehabil. 2011 Apr;92(4):603-10.
Comparison of diagnostic accuracy of clinical measures of breast cancer-related lymphedema: area under
the curve.
Smoot BJ, Wong JF, Dodd MJ.
Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San
Francisco, CA.
Abstract
Smoot BJ, Wong JF, Dodd MJ. Comparison of diagnostic accuracy of clinical measures of breast
cancer-related lymphedema: area under the curve.
OBJECTIVE: To compare diagnostic accuracy of measures of breast cancer-related lymphedema
(BCRL).
DESIGN: Cross-sectional design comparing clinical measures with the criterion standard of previous
diagnosis of BCRL.
SETTING: University of California San Francisco Translational Science Clinical Research Center.
PARTICIPANTS: Women older than 18 years and more than 6 months posttreatment for breast cancer
(n=141; 70 with BCRL, 71 without BCRL).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Sensitivity, specificity, receiver operator characteristic curve, and
area under the curve (AUC) were used to evaluate accuracy.
RESULTS: A total of 141 women were categorized as having (n=70) or not having (n=71) BCRL based
on past diagnosis by a health care provider, which was used as the reference standard. Analyses of ROC
curves for the continuous outcomes yielded AUC of .68 to .88 (P<.001); of the physical measures
bioimpedance spectroscopy yielded the highest accuracy with an AUC of .88 (95% confidence interval, .
80-.96) for women whose dominant arm was the affected arm. The lowest accuracy was found using the
2-cm diagnostic cutoff score to identify previously diagnosed BCRL (AUC, .54-.65).
CONCLUSIONS: Our findings support the use of bioimpedance spectroscopy in the assessment of
existing BCRL. Refining diagnostic cutoff values may improve accuracy of diagnosis and warrant further
investigation.
Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights
reserved.
PMID: 21440706 [PubMed - in process]
J Am Acad Dermatol. 2011 Mar 24. [Epub ahead of print]
Elephantiasis nostras verrucosa: An institutional analysis of 21 cases.
Dean SM, Zirwas MJ, Horst AV.
Department of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus, Ohio.
Abstract
BACKGROUND: Previous reports regarding elephantiasis nostras verrucosa (ENV) have been typically
limited to 3 or fewer patients.
OBJECTIVES: We sought to statistically ascertain what demographic features and clinical variables are
associated with ENV.
METHODS: A retrospective chart review of 21 patients with ENV from 2006 to 2008 was performed
and statistically analyzed.
RESULTS: All 21 patients were obese (morbid obesity in 91%) with a mean body mass index of 55.8.
The average maximal calf circumference was 63.7 cm. Concurrent chronic venous insufficiency was
identified in 15 patients (71%). ENV was predominantly bilateral (86%) and typically involved the calves
(81%). Proximal cutaneous involvement (thighs 19%/abdomen 9.5%) was less common. Eighteen (86%)
related a history of lower extremity cellulitis/lymphangitis and/or manifested soft-tissue infection upon
presentation. Multisegmental ENV was statistically more likely in setting of a higher body mass index (P =
.02), larger calf circumference (P = .01), multiple lymphedema risk factors (P = .05), ulcerations (P < .
001), and nodules (P < .001). Calf circumference was significantly and proportionally linked to
developing lower extremity ulcerations (P = .02). Ulcerations and nodules were significantly prone to
occur concomitantly (P = .05). Nodules appeared more likely to exist in the presence of a higher body
mass index (P = .06) and multiple lymphedema risk factors (P = .06).
LIMITATIONS: The statistical conclusions were potentially inhibited by the relatively small cohort. The
study was retrospective.
CONCLUSIONS: Our data confirm the association among obesity, soft-tissue infection, and ENV.
Chronic venous insufficiency may be an underappreciated risk factor in the genesis of ENV.
Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights
reserved.
PMID: 21440328 [PubMed - as supplied by publisher]
Wkly Epidemiol Rec. 2011 Mar 25;86(13):121-7.
WHO position statement on integrated vector management to control malaria and lymphatic filariasis.
[Article in English, French]
[No authors listed]
PMID: 21438441 [PubMed - indexed for MEDLINE
Rev Esc Enferm USP. 2010 Dec;44(4):1085-92.
[Effects of the decongestive physiotherapy in the healing of venous ulcers].
[Article in Portuguese]
Azoubel R, Torres Gde V, da Silva LW, Gomes FV, dos Reis LA.
Departamento de Saúde da Universidade Estadual do Sudeste da Bahia, Jequié, BA, Brasil.
robertaazoubel@hotmail.com
Abstract
The objective of this study was to verify the effects of the decongestive physiotherapy (DP) in the healing
of venous ulcers. It is an interventionist, and almost experimental, study with the participation of 20 clients
who were divided into 2 groups: the control group (n = 10) and the intervention group (n = 10). Clients
from the first group were only treated with conventional dressing and those in the second group were
treated with conventional dressing and decongestive physiotherapy (association of techniques: manual
lymph drainage, compressive bandaging, elevation of the lower limbs, myolymphokinetic exercises and
skin care). Both groups were treated during six months. The clients submitted to DP presented significant
reduction of the edema and the pain, besides an improvement in the healing process. Results allowed to
verify that the decongestive therapy stimulated the healing process of venous ulcers, improving the quality
of life of the subjects.
PMID: 21337794 [PubMed - in process]
March 1, 2011
AMIA Annu Symp Proc. 2010 Nov 13;2010:912-6.
Efficient selection of association rules from lymphedema symptoms data using a graph structure.
Xu S, Shyu CR.
Informatics Institute.
Abstract
Secondary lymphedema (LE) is a chronic progressive disease often caused by cancer treatment,
especially in patients who require surgical removal of or radiation to lymph nodes. While LE is incurable,
it can be managed successfully with early detection and appropriate treatment. Detection and prediction
of LE is difficult due to the absence of a "gold standard" for diagnosis. Despite this, management of the
disease is accomplished through adherence to a set of guidelines developed by experts in the field.
Unfortunately, not all the recommendations in such a document are supported by clear research evidence,
and most of them are only based on expert judgment with limited evidence. This paper focuses on
developing a new algorithm to extract specific association rules from LE survey data and efficiently index
the rules for easy knowledge retrieval, with the ultimate goal discovering evidence-based and relevant
knowledge for inclusion into the best practice document (BP) for the LE community.
PMID: 21347111 [PubMed - in process]
Cutan Ocul Toxicol. 2011 Feb 24. [Epub ahead of print]
Evaluation of microbiological spectrum and risk factors of cellulitis in hospitalized patients.
Serdar ZA, Akçay SS, Inan A, Dagli O.
Haydarpasa Numune Training and Research Hospital, Dermatology, Istanbul, Turkey.
Abstract
Background and design: Cellulitis is a common soft tissue infection and the severity of disease vary from
mild to life threatening. The aim of the present retrospective study was to evaluate age, sex, site of
infection, microbiological spectrum and the risk factors of cellulitis in hospitalized patients. Materials and
methods: The data were retrospectively obtained by the review of 185 hospitalized patients who were
diagnosed as cellulitis between 2003 and 2009 in the departments of dermatology, infectious diseases,
internal medicine and surgery clinics of Haydarpasa Numune Training and Research Hospital (Istanbul,
Turkey). The diagnosis was done by infectious diseases and dermatology specialists in all patients who
were included to this study. Demographic findings, wound-blood cultures and risk factors of the patients
with cellulitis were evaluated. Results: Eighty-six were female, 99 were male of total 185 patients, and the
mean age of them was 48?±?27 (14-85). The leg was the involved site in 69% of the patients. The most
frequent isolated bacteria from wound cultures were methicillin-sensitive Staphylococcus aureus 31.5%,
Pseudomonas aeruginosa 12.6%, and Escherichia coli 12.3%. However, methicillin-sensitive S. aureus
32.5%, methicillin-resistant S. aureus 22.5%, coagulase-negative staphylococci 17.5% were detected
from blood cultures. There was not any underlying risk factor in 104 (55.3%) patients. The risk factors
observed in the other 81 patients were previous surgery or open wound 29 (35.8%), diabetes mellitus 19
(26.6%), cardiovascular diseases 16 (19.7%), immunosuppression 11 (13.5%), lymphoedema 6 (7.4%).
Conclusion: In the patients hospitalized for cellulitis, the most frequently isolated microorganism from the
wound and blood cultures was S. aureus and the most frequently detected risk factors were to have an
open wound and previous surgery. Especially when the patients had risk factors, it was observed that the
bacterial spectrum was broader and the clinical presentation was severe. The wound and blood cultures
should be performed simultaneously for the microbiological diagnosis and the appropriate management of
cellulitis.
PMID: 21345156 [PubMed - as supplied by publisher]
March 5, 2011
World J Gastrointest Oncol. 2011 Feb 15;3(2):19-23.
Intestinal lymphangiectasia in adults.
Freeman HJ, Nimmo M.
Hugh James Freeman, Department of Medicine (Gastroenterology), University of British Columbia,
Vancouver, BC, V6T 1W5, Canada.
Abstract
Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals
causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia,
hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or
lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates,
usually with other congenital abnormalities but initial definition in adults including the elderly has become
increasingly more common. Shared clinical features with the pediatric population such as bilateral lower
limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect
the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased
fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin levels, while others may present with
iron deficiency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia
in adults detected in recent years, however, appears to have few or no clinical features of malabsorption.
Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing
histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy
have revealed more extensive changes along the length of the small intestine. A critical diagnostic element
in adults with lymphangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that
might lead to obstruction of the lymphatic system and "secondary" changes in the small bowel biopsy. In
addition, occult infectious (e.g. Whipple's disease from Tropheryma whipplei) or inflammatory disorders
(e.g. Crohn's disease) may also present with profound changes in intestinal permeability and protein-
losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been
described even decades following initial diagnosis of intestinal lymphangiectasia. Treatment has been
historically defined to include a low fat diet with medium-chain triglyceride supplementation that leads to
portal venous rather than lacteal uptake. A number of other pharmacological measures have been
reported or proposed but these are largely anecdotal. Finally, rare reports of localized surgical resection
of involved areas of small intestine have been described but follow-up in these cases is often limited.
PMID: 21364842 [PubMed - in process]
J Cutan Pathol. 2011 Mar 1. doi: 10.1111/j.1600-0560.2011.01691.x. [Epub ahead of print]
Verruciform xanthoma: localized lymphedema (elephantiasis) is an essential pathogenic factor.
Lu S, Rohwedder A, Murphy M, Andrew Carlson J.
Department of Pathology, University of Maryland, Baltimore, MD, USA Am Weiher 14, Kalkar,
Germany Department of Dermatology, University of Connecticut Medical Center, Framington, CT, USA
Divisions of Dermatopathology and Dermatology, Albany Medical College MC-81, Albany, NY, USA.
PMID: 21362016 [PubMed - as supplied by publisher]
Glob Public Health. 2011 Feb 24:1-17. [Epub ahead of print]
Lymphoedema management: An international intersect between developed and developing countries.
Similarities, differences and challenges.
Stout NL, Brantus P, Moffatt C.
Breast Care Department, National Naval Medical Center, Bethesda, MD, USA.
Abstract
Lymphoedema is a chronic swelling condition that contributes to disability, dysfunction and lost quality of
life. Significant disparities exist worldwide regarding the availability of resources necessary to identify,
treat and manage lymphoedema. This disparity transcends socio-economic status and is a common
problem in both developed and developing countries. The overall impact of lymphoedema as a public
health problem, however, is underestimated, principally due to the lack of epidemiologic data. These
problems pose barriers to optimal identification and management of this disabling, lifelong condition. In
1997, the World Health Organization (50.29) resolved that lymphatic filariasis should be eliminated as a
public health problem. A component of this strategy focuses on disability management for those suffering
from lymphatic filariasis-related morbidity. This initiative has enhanced lymphoedema awareness in
developing countries. However, significant deficits persist in health care providers' knowledge,
educational initiatives and basic disease identification and treatment. In developed countries,
lymphoedema continues to be an underrecognised condition and assumed to be only cancer-related.
Health care resources allocated to treat and manage the disease are insufficient for basic and ongoing
care, resulting in disease progression and disability. The International Lymphoedema Framework project,
established in 2002, seeks to establish a consensus for best practices in the management of lymphoedema
worldwide to reduce this disability burden. A basic global construct for lymphoedema management is
needed to decrease morbidity and promote optimal disease management across all cultural and socio-
economic boundaries. Many countries are unaware of the importance of lymphoedema management and
have not defined a national strategy with respect to this problem. The objective of this article is to define
similarities and differences in strategies for lymphoedema management between developed and
developing countries and advocate for a cohesive and concerted approach to disease management.
PMID: 21360379 [PubMed - as supplied by publisher
PLoS One. 2011 Feb 17;6(2):e17201.
Mechanisms of lymphatic regeneration after tissue transfer.
Yan A, Avraham T, Zampell JC, Aschen SZ, Mehrara BJ.
The Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering
Cancer Center, New York, New York, United States of America.
Abstract
INTRODUCTION: Lymphedema is the chronic swelling of an extremity that occurs commonly after
lymph node resection for cancer treatment. Recent studies have demonstrated that transfer of healthy
tissues can be used as a means of bypassing damaged lymphatics and ameliorating lymphedema. The
purpose of these studies was to investigate the mechanisms that regulate lymphatic regeneration after
tissue transfer.
METHODS: Nude mice (recipients) underwent 2-mm tail skin excisions that were either left open or
repaired with full-thickness skin grafts harvested from donor transgenic mice that expressed green
fluorescent protein in all tissues or from LYVE-1 knockout mice. Lymphatic regeneration, expression of
VEGF-C, macrophage infiltration, and potential for skin grafting to bypass damaged lymphatics were
assessed.
RESULTS: Skin grafts healed rapidly and restored lymphatic flow. Lymphatic regeneration occurred
beginning at the peripheral edges of the graft, primarily from ingrowth of new lymphatic vessels originating
from the recipient mouse. In addition, donor lymphatic vessels appeared to spontaneously re-anastomose
with recipient vessels. Patterns of VEGF-C expression and macrophage infiltration were temporally and
spatially associated with lymphatic regeneration. When compared to mice treated with excision only,
there was a 4-fold decrease in tail volumes, 2.5-fold increase in lymphatic transport by
lymphoscintigraphy, 40% decrease in dermal thickness, and 54% decrease in scar index in skin-grafted
animals, indicating that tissue transfer could bypass damaged lymphatics and promote rapid lymphatic
regeneration.
CONCLUSIONS: Our studies suggest that lymphatic regeneration after tissue transfer occurs by
ingrowth of lymphatic vessels and spontaneous re-connection of existing lymphatics. This process is
temporally and spatially associated with VEGF-C expression and macrophage infiltration. Finally, tissue
transfer can be used to bypass damaged lymphatics and promote rapid lymphatic regeneration.
PMID: 21359148 [PubMed - in process]
March 10, 2011
Head Neck. 2011 Mar 3. doi: 10.1002/hed.21689. [Epub ahead of print]
Morbidity of supraomohyoidal and modified radical neck dissection combined with radiotherapy for head
and neck cancer. A prospective longitudinal study.
Ahlberg A, Nikolaidis P, Engström T, Gunnarsson K, Johansson H, Sharp L, Laurell G.
Department of Otolaryngology and Head and Neck Surgery, Karolinska University Hospital, Stockholm,
Sweden; Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska
Institutet, Stockholm, Sweden. Alexander.ahlberg@karolinska.se.
Abstract
BACKGROUND: The purpose of this study was to show the investigated impact of supraomohyoidal
neck dissection and modified radical neck dissection, both combined with radiotherapy, on cervical range
of motion (CROM), mouth opening, swallowing, lymphedema, and shoulder function.
METHODS: One hundred eight patients who had neck dissections and 98 patients who had non-neck
dissections were evaluated in a prospective, nonselective, longitudinal cohort study by a physiotherapist
and a speech-language pathologist (SLP) before the start of radiotherapy and up to 12 months after
treatment.
RESULTS: The incidence of shoulder disability after neck dissection was 18%. Supraomohyoidal neck
dissection had no significant effect on the evaluated parameters at any time point. Modified radical neck
dissection significantly reduced CROM and mouth opening 2 months after treatment, but after 12 months
only cervical rotation was still significantly reduced.
CONCLUSION: In patients treated with external beam radiation (EBRT), modified radical neck
dissection induced additional morbidity regarding CROM but not regarding mouth opening, swallowing,
and lymphedema 1 year after treatment. Both modified radical neck dissection and supraomohyoidal
neck dissection induced shoulder disability. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.
Copyright © 2010 Wiley Periodicals, Inc.
PMID: 21374755 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Mar 3. [Epub ahead of print]
Surgical Prevention of Arm Lymphedema After Breast Cancer Treatment.
Boccardo FM, Casabona F, Friedman D, Puglisi M, De Cian F, Ansaldi F, Campisi C.
Department of Surgery, Unit of Lymphatic Surgery, S. Martino Hospital, University of Genoa, Genoa,
Italy, francesco.boccardo@unige.it.
Abstract
PURPOSE: To prospectively assess the efficacy of the lymphatic microsurgical preventive healing
approach (LYMPHA) to prevent lymphedema after axillary dissection (AD) for breast cancer treatment.
METHODS: Among 49 consecutive women referred from March 2008 to September 2009 to undergo
complete AD, 46 were randomly divided in 2 groups. Twenty-three underwent the LYMPHA technique
for the prevention of arm lymphedema. The other 23 patients had no preventive surgical approach
(control group). The LYMPHA procedure consisted of performing lymphatic-venous anastomoses
(LVA) at the time of AD. All patients underwent preoperative lymphoscintigraphy (LS). Patients were
followed up clinically at 1, 3, 6, 12, and 18 months by volumetry. Postoperatively, LS was performed
after 18 months in 41 patients (21 treatment group and 20 control group). Arm volume and LS alterations
were assessed.
RESULTS: Lymphedema appeared in 1 patient in the treatment group 6 months after surgery (4.34%).
In the control group, lymphedema occurred in 7 patients (30.43%). No statistically significant differences
in the arm volume were observed in the treatment group during follow-up, while the arm volume in the
control group showed a significant increase after 1, 3, and 6 months from operation. There was significant
difference between the 2 groups in the volume changes with respect to baseline after 1, 3, 6, 12, and 18
months after surgery (every timing P value < 0.01).
CONCLUSIONS: LYMPHA represents a valid technique for primary prevention of secondary arm
lymphedema with no risk of leaving undetected malignant disease in the axilla.
PMID: 21369739 [PubMed - as supplied by publisher]
Clin Nucl Med. 2011 Apr;36(4):e11-2.
The role of lymphoscintigraphy in diagnosis and monitor the response of physiotherapeutic technique in
congenital lymphedema.
Chang L, Cheng MF, Chang HH, Kao YH, Wu YW.
From the *Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Departments of
†Nuclear Medicine and ‡Pediatrics, National Taiwan University Hospital and National Taiwan University
College of Medicine, Taipei, Taiwan; and §Division of Nuclear Medicine, Department of Radiology,
Hsin-Chu General Hospital, Hsin-Chu County, Taiwan.
Abstract
We describe the case of a 4-month-old girl who was admitted for bilateral legs swelling for several
weeks. Lymphoscintigraphy revealed the absence of the radiotracer proximal to the ilioinguinal nodes up
to 6 hours postinjection. In light of the clinical and image findings, a diagnosis of congenital lymphedema
was compatible. Systemic corticosteroid was given, and physical massage was applied at the lower
extremities for 3 weeks. Repeat lymphoscintigraphy revealed faster lymphatic flow and liver visualization,
demonstrating improvement in lymphatic function. This case illustrates the usefulness of
lymphoscintigraphy in diagnosis and evaluating therapy response of lymphedema in children.
PMID: 21368595 [PubMed - in process]
March 14, 2011
Dermatol Online J. 2011 Feb 15;17(2):9.
Granulomatous rosacea: Unusual presentation as solitary plaque.
Batra M, Bansal C, Tulsyan S.
Abstract
A 45-year-old male presented with a 6 month history of an enlarging smooth, erythematous plaque over
the central part of his face. Mild erythema of both eyes was present. Sarcoidosis, Hansen disease, lupus
vulgaris, cutaneous leishmaniasis, pseudolymphoma, foreign body granuloma, granuloma faciale, discoid
lupus erythematosus, and granulomatous rosacea were considered in the differential diagnosis. CBC,
urinalysis, renal function tests, liver function tests, serum electrolytes, and blood sugar were all normal.
Chest X-ray and ECG revealed no abnormality. Serology for syphilis and HIV, and mantoux test were
negative. Slit-skin smear, tissue smear and culture for AFB and fungi were negative. Skin biopsy revealed
multiple non-caseating epitheloid granulomas around the pilosebaceous unit suggestive of granulomatous
rosacea. Granulomatous rosacea, a rare entity comprising only about 10 percent of cases of rosacea can
mimic many granulomatous conditions both clinically and histologically making the diagnosis an enigma. It
usually presents as yellowish brown-red discrete papules on the face; non-caseating epithelioid
granulomas are seen on histology examination. We herein report the case because it presented in atypical
fashion, as a solitary indurated plaque on the nose, likely representing Morbihan's disease or solid
persistent facial edema of rosacea (rosacea lymphedema).
PMID: 21382292 [PubMed - in process]
Elephantiasis Nostras Verrucosa on the buttocks and sacrum of two immobile men.
Setyadi HG, Iacco MR, Shwayder TA, Ormsby A.
Department of Dermatology, Henry Ford Health System, Detroit, Michigan.
Abstract
Though typically involving the lower extremities, elephantiasis nostras verrucosa (ENV) can occur in any
area affected by lymphedema. Here we report two cases of ENV: one is a biopsy-proven case and the
other is a clinically diagnosed case. Both occurred on the buttocks and sacrum of immobile, morbidly
obese men who were persistently in the supine or seated position. Whereas classic ENV is not
uncommon, this striking presentation on these unusual areas is quite rare.
PMID: 21382291 [PubMed - in process]
Cancer. 2011 Mar 15;117(6):1136-48. doi: 10.1002/cncr.25513. Epub 2010 Nov 8.
Conservative and dietary interventions for cancer-related lymphedema: A Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada; Department of
Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada. mmcneely@ualberta.ca.
Abstract
The findings support the use of compression garments and compression bandaging for reducing
lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast cancer,
a statistically significant, clinically small beneficial effect was found from the addition of manual lymph
drainage massage to compression therapy for upper extremity lymphedema volume. Cancer 2011. ©
2010 American Cancer Society.
PMID: 21381006 [PubMed - in process
Int J Palliat Nurs. 2011 Feb;17(2):60-6.
Reflections on lymphoedema, fungating wounds and the power of touch in the last weeks of life.
Fenton S.
Abstract
Terminal care is a significant chapter of life in which each individual has the right to expect dignity,
compassion, holistic care, and quality of life. The case of 'Sally', a 57-year-old woman with a diagnosis of
inflammatory breast cancer, left arm lymphoedema, and a fungating chest wound, gave palliative care
nurses a multitude of distressing and complex challenges to manage. Management of lymphoedema is
often put into the 'too hard basket', especially in the palliative care setting. Similarly, fungating wounds are
hard to confront, and the power of touch is often underestimated. The aim of this case study is to explore
and reflect on how these issues entwine, and how vital it is for nurses to feel comfortable in providing the
most appropriate care. As a result of reflection on Sally's care management many issues were highlighted,
including the crucial need to relieve her symptoms with timely, appropriate, dignified, and respectful care,
optimizing her sense of worth and quality of life.
PMID: 21378689 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]
Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-
neck cancer.
Mihara M, Uchida G, Hara H, Hayashi Y, Moriguchi H, Narushima M, Iida T, Yamamoto T, Koshima I.
Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can improve lymph
circulation by the anastomosis of lymph vessels and veins. A therapeutic effect of LVA for lymphoedema
has been shown in limbs, but efficacy for other regions has not been shown. Lymphoedema in the head-
and-neck region following cancer resection and radiotherapy is mainly treated with manual lymphatic
drainage. However, there is no alternative when this treatment is ineffective because application of
compression treatment using a bandage is difficult in this region. We used LVA for lymphoedema in the
head-and-neck region and achieved a good outcome. Functional and dilating lymph vessels were
identified using pre- and intra-operative fluorescent lymphography, and a lymph vessel with a diameter of
about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The outcome of this case
suggests that LVA is applicable for treatment of lymphoedema in the head-and-neck region.
Copyright © 2011. Published by Elsevier Ltd.
PMID: 21377943 [PubMed - as supplied by publisher]
Can Fam Physician. 2010 Dec;56(12):1277-84.
Management of secondary lymphedema related to breast cancer.
Cheifetz O, Haley L; Breast Cancer Action.
Hamilton Health Sciences, 711 Concession St, Hamilton, ON L8V 1C3. cheifetz@hhsc.ca
PMID: 21375063 [PubMed - in process]
March 14, 2011
Cancer. 2011 Mar 15;117(6):1136-48. doi: 10.1002/cncr.25513. Epub 2010 Nov 8.
Conservative and dietary interventions for cancer-related lymphedema: A Systematic review and meta-
analysis.
McNeely ML, Peddle CJ, Yurick JL, Dayes IS, Mackey JR.
Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada; Department of
Rehabilitation Medicine, Cross Cancer Institute, Edmonton, Alberta, Canada. mmcneely@ualberta.ca.
Abstract
The findings support the use of compression garments and compression bandaging for reducing
lymphedema volume in upper and lower extremity cancer-related lymphedema. Specific to breast cancer,
a statistically significant, clinically small beneficial effect was found from the addition of manual lymph
drainage massage to compression therapy for upper extremity lymphedema volume. Cancer 2011. ©
2010 American Cancer Society.
PMID: 21381006 [PubMed - in process]
J Plast Reconstr Aesthet Surg. 2011 Mar 4. [Epub ahead of print]
Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-
neck cancer.
Mihara M, Uchida G, Hara H, Hayashi Y, Moriguchi H, Narushima M, Iida T, Yamamoto T, Koshima I.
Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo,
Bunkyo-ku, Tokyo 113-8655, Japan.
Abstract
Lymphaticovenous anastomosis (LVA) is a treatment for lymphoedema that can improve lymph
circulation by the anastomosis of lymph vessels and veins. A therapeutic effect of LVA for lymphoedema
has been shown in limbs, but efficacy for other regions has not been shown. Lymphoedema in the head-
and-neck region following cancer resection and radiotherapy is mainly treated with manual lymphatic
drainage. However, there is no alternative when this treatment is ineffective because application of
compression treatment using a bandage is difficult in this region. We used LVA for lymphoedema in the
head-and-neck region and achieved a good outcome. Functional and dilating lymph vessels were
identified using pre- and intra-operative fluorescent lymphography, and a lymph vessel with a diameter of
about 0.2-1.0 mm was anastomosed with a vein using supermicrosurgery. The outcome of this case
suggests that LVA is applicable for treatment of lymphoedema in the head-and-neck region.
Copyright © 2011. Published by Elsevier Ltd.
PMID: 21377943 [PubMed - as supplied by publisher]
March 15, 2011
Curr Urol Rep. 2011 Mar 11. [Epub ahead of print]
Complications of Pelvic Lymph Node Dissection for Prostate Cancer.
Keegan KA, Cookson MS.
Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North,
Nashville, TN, 37232, USA.
Abstract
Pelvic lymph node dissection (PLND) represents the standard for detection of occult pelvic nodal
metastases from prostate cancer, and may be performed separately from or at the time of radical
prostatectomy. In addition to its potential for diagnostic staging, a PLND may be therapeutic in some
patients. However, considerable debate centers on the appropriate candidates for the procedure, the
extent and proper boundaries of dissection, optimal surgical approach, and absolute oncologic benefit.
Several series suggest that there likely is limited benefit of PLND in low-risk patients and that PLND can
be safely omitted in a high percentage of men undergoing contemporary radical prostatectomy.
Furthermore, the value of PLND in patients with intermediate- and high-risk disease must be balanced
against the potential morbidity of the procedure. In the setting of this debate, concern over morbidity
directly attributable to this procedure is of paramount importance. This review focuses on the
complications associated with PLND, including lymphocele, thromboembolic events, ureteral injury,
nerve injury, vascular injury, and lymphedema.
PMID: 21394597 [PubMed - as supplied by publisher]
BMC Cancer. 2011 Mar 9;11(1):94. [Epub ahead of print]
Manual lymphatic drainage therapy in patients with breast cancer related lymphoedema.
Lopez Martin M, Hernandez MA, Avendano C, Rodriguez F, Martinez H.
ABSTRACT:
BACKGROUND: Lymphoedema is a common and troublesome problem that develops following breast
cancer treatment. The aim of this study is to analyze the effectiveness of Manual Lymphatic Drainage
(MLD) in the treatment of postmastectomy lymphoedema in order to reduce the volume of lymphoedema
and evaluate the improvement of the concomitant symptomatology.
METHODS: Randomized controlled clinical trial of 58 women suffering postmastectomy lymphoedema.
Control group includes 29 patients with standard treatment (care of the skin, exercise and measures of
compression, bandage for one month and later garment of compression). Experimental group includes
patients with stardard treatment and, in addition they received Manual Lymphatic Drainage. The therapy
will be administered daily during four weeks and the patients will be reviewed after one, three and six
months of the treatment. The main outcome is volume reduction of the affected arm after the treatment
expressed in percentage. Secondary outcome parameters include duration of lymphoedema reduction
and improvement of the concominant symtomatology (degree of pain, sensation of swelling and functional
limitation in the affected extremity, subjective sensation of physical attraction and feminity, dificulty to look
at oneself nude and desilution grade about the corporal image).
DISCUSSION: The results of this study will provide information on the effectiveness of manual lymph
drainage and its impact on the quality of life and physical limitations of these patients. Trial registration:
NCT01152099.
PMID: 21392372 [PubMed - as supplied by publisher]
March 25, 2011 - New Technology at NewYork-Presbyterian/Columbia Aids Surgeons With Early
Detection of Lymphedemain Breast Cancer Patients - Newswise –
Early Detection and Intervention May Prevent Disabling Complication of Breast Cancer Surgery
Newswise — NEW YORK (March 24, 2011) -- Breast cancer specialists at NewYork-Presbyterian
Hospital/Columbia University Medical Center are offering patients new ways to detect early signs of
lymphedema, a common side effect of breast cancer surgery that causes painful, debilitating and
disfiguring swelling in the arms following removal of lymph nodes.
As many as 30 percent of women who have breast cancer surgery with lymph node removal will develop
lymphedema. Radiation treatment increases this risk to as high as 50 percent. While it is possible to arrest
the condition through physical therapy and bandaging, there is no cure.
"Just as we've used early detection to improve breast cancer survival, we are using early detection to
reduce women's risk for developing lymphedema,"says Dr. Sheldon Feldman, the Vivian L. Milstein
Associate Professor of Clinical Surgery at Columbia University College of Physicians and Surgeons and
chief of breast surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center.
Dr. Feldman and his colleagues at NewYork-Presbyterian/Columbia are employing a technique called
bioimpedence spectroscopy to help them identify the earliest onset of lymphedema. An FDA-approved
device called L-DEX (ImpediMed Inc.) uses a mild electrical current to measure minute changes in
extracellular fluid, allowing for a diagnosis of lymphedema by the physician well before any swelling is
noticeable. "By catching it early, we can reverse the process and prevent unnecessary pain,
embarrassment, debilitation and risk of infection,"says Dr. Feldman.
Alongside its clinical use, the bioimpedence technique is also being used in research to better understand
which patients are most at risk for lymphedema and whether the condition always progressively worsens,
or if it can naturally correct itself over time. Other studies will investigate the common belief that
lymphedema is negatively affected by air travel and weight training.
Another method of reducing risk for lymphedema is a technique called "reverse arm mapping.""The lymph
nodes that drain the arm are sometimes removed during breast cancer surgery because they're situated
within the armpit (axilla) in the same area as the lymph nodes that relate to the breast. With reverse arm
mapping, we inject dye into the patient's arm to differentiate the two kinds of lymph nodes. This allows
the surgeon to avoid removing any nodes related to arm drainage while still accurately identifying the
sentinel nodes, which are important for breast cancer evaluation and treatment,"says Dr. Feldman. "This
should reduce the risk of developing lymphedema.”
Arm mapping is part of a larger trend toward reducing or eliminating the need to remove a woman's
lymph nodes -- thereby reducing the incidence of lymphedema. Beginning in the 1990s, sentinel node
biopsy used dye injected into the breast to target the sentinel lymph node, the gatekeeper to the axilla and
the one most at risk for cancer spread. Today, the latest research indicates that fewer patients need any
lymph nodes removed than previously thought. Even if the sentinel node is shown to be positive, patients
with early-stage breast cancer who are treated with lumpectomy, chemotherapy and radiation may not
need to have any further lymph nodes removed.
For more information, patients may call (866) NYP-NEWS.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical
research, in medical and health sciences education, and in patient care. The Medical Center trains future
leaders and includes the dedicated work of many physicians, scientists, public health professionals,
dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the
College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School
of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's
College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is
now among the most selective medical schools in the country. Columbia University Medical Center is
home to the largest medical research enterprise in New York City and state and one of the largest in the
United States. For more information, please visit www.cumc.columbia.edu.
NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-
sectarian hospital, with 2,353 beds. The Hospital has more than 2 million inpatient and outpatient visits in
a year, including more than 220,000 visits to its emergency departments -- more than any other area
hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all
areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center,
NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan
Stanley Children's Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian
Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the
Hospital is committed to excellence in patient care, research, education and community service.
NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked
among the best academic medical institutions in the nation, according to U.S.News & World Report. The
Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical
College and Columbia University College of Physicians and Surgeons. For more information, visit www.
nyp.org.
PUB MED DOCS TO BE FORMATTED:
March 25, 2011
Ann Plast Surg. 2011 Mar 14. [Epub ahead of print]
Lower Extremity Lymphedema Index: A Simple Method for Severity Evaluation of Lower Extremity
Lymphedema.
Yamamoto T, Matsuda N, Todokoro T, Yoshimatsu H, Narushima M, Mihara M, Uchida G, Koshima I.
From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of
Tokyo, Bunkyo-ku, Tokyo, Japan.
Abstract
Measurement of the circumference is the most commonly used method for evaluating extremity
lymphedema. However, comparison between different patients is difficult with this measurement. To
resolve this problem, we have formulated a new index, lower extremity lymphedema (LEL) index, which
can be easily obtained from measurements of the body. We evaluated correlation between lower LEL
index and clinical stage in patients with LEL. The LEL indices were significantly correlated with clinical
stages and could be used as a severity scale. The LEL index makes objective assessment of the severity
of lymphedema through a numerical rating, regardless of the body type. This numerical rating makes the
index useful for evaluation of lymphedema severities between different cases.
PMID: 21407058 [PubMed - as supplied by publisher]
J Pain Symptom Manage. 2011 Mar 12. [Epub ahead of print]
Subcutaneous Lymphatic Drainage (Lymphcentesis) for Palliation of Severe Refractory Lymphedema in
Cancer Patients.
Jacobsen J, Blinderman CD.
Palliative Care Service (J.J.), Massachusetts General Hospital, and Harvard Medical School (J.J.),
Boston, Massachusetts; and Palliative Medicine Service (C.D.B.), Departments of Anesthesiology and
Medicine, Columbia University Medical Center, New York, New York, USA.
Abstract
Subcutaneous lymphatic drainage has been reported to be an effective treatment for severe refractory
lymphedema in patients with lymphatic accumulation because of obstructive cancer. We review published
techniques for lymphatic drainage and describe two cases where these techniques were modified with
good results.
Copyright © 2011. Published by Elsevier Inc.
PMID: 21402464 [PubMed - as supplied by publisher]
Gan To Kagaku Ryoho. 2010 Dec;37 Suppl 2:229-31.
[Two cases of stewart-treves syndrome observed at sanshu hospital].
[Article in Japanese]
Yokoyama A, Yokoyama K, Matsumoto K.
The Palliative Care Units, Sanshu Hospital.
Abstract
Stewart-Treves syndrome is angiosarcoma, which occurs in the chronic lymphedema of the upper or
lower limbs. Presently, an effective therapy is not established. The survival period is only several months
to one year. There are some reports that angiosarcoma will occur in the period of 5~15 years after a
continuation of lymphedema of the extremities. Therefore, it is important to prevent lymphedema after
surgical operations of primary disease and the lymphedema.
PMID: 21368533 [PubMed - in process]
ScientificWorldJournal. 2011 Mar 7;11:614-23.
Penile anomalies in adolescence.
Wood D, Woodhouse C.
Abstract
This article considers the impact and outcomes of both treatment and underlying condition of penile
anomalies in adolescent males. Major congenital anomalies (such as exstrophy/epispadias) are discussed,
including the psychological outcomes, common problems (such as corporal asymmetry, chordee, and
scarring) in this group, and surgical assessment for potential surgical candidates. The emergence of new
surgical techniques continues to improve outcomes and potentially raises patient expectations. The
importance of balanced discussion in conditions such as micropenis, including multidisciplinary support for
patients, is important in order to achieve appropriate treatment decisions. Topical treatments may be of
value, but in extreme cases, phalloplasty is a valuable option for patients to consider. In buried penis, the
importance of careful assessment and, for the majority, a delay in surgery until puberty has completed is
emphasised. In hypospadias patients, the variety of surgical procedures has complicated assessment of
outcomes. It appears that true surgical success may be difficult to measure as many men who have had
earlier operations are not reassessed in either puberty or adult life. There is also a brief discussion of
acquired penile anomalies, including causation and treatment of lymphoedema, penile fracture/trauma, and
priapism.
PMID: 21399858 [PubMed - in process]
Arch Esp Urol. 2011 Mar;64(2):121-124.
Surgical treatment in a case of giant scrotal lymphedema.
[Article in English, Spanish]
Rubio Hidalgo E, López García-Moreno A, Buendía González E, Sampietro Crespo A, Arce Casado B,
De La Fuente Núñez J.
Urology Department.Hospital Virgen de la Salud. Complejo Hospitalario de Toledo. Toledo. Spain.
Abstract
OBJECTIVE: Scrotal lymphedema (SL) is a rare clinical pathology with multiple etiologies. We report a
case of idiopathic giant scrotal lymphedema and review the existing medical literature in Medline from the
last ten years.
METHODS: We report the case of a male patient with a giant scrotal lymphedema (43×40 cm) of
unknown etiology developed over four years.
RESULTS: The patient was treated by scrotal excision and reconstruction with skin graft plasty, with a
successful result.
CONCLUSIONS: Scrotal Lymphedema is a rare entity, especially in industrialized countries. If the
lymphedema is severe, surgery is the most appropriate therapeutic option, whatever the cause is.
Complete resection up to healthy tissue and surgical reconstruction is the choice. Thin skin grafts are
necessary for reconstruction when it affects the entire scrotum.
PMID: 21399245 [PubMed - as supplied by publisher]
BMC Cancer. 2011 Mar 9;11:94.
Manual lymphatic drainage therapy in patients with breast cancer related lymphoedema.
Martín ML, Hernández MA, Avendaño C, Rodríguez F, Martínez H.
Unidad de Investigación, Hospital Universitario de La Princesa, Diego de León 36, 28046 Madrid,
Spain. martaloma@yahoo.es.
Abstract
ABSTRACT:
BACKGROUND: Lymphoedema is a common and troublesome condition that develops following
breast cancer treatment. The aim of this study is to analyze the effectiveness of Manual Lymphatic
Drainage in the treatment of postmastectomy lymphoedema in order to reduce the volume of
lymphoedema and evaluate the improvement of the concomitant symptomatology.
METHODS: A randomized, controlled clinical trial in 58 women with post-mastectomy lymphoedema.
The control group includes 29 patients with standard treatment (skin care, exercise and compression
measures, bandages for one month and, subsequently, compression garnments). The experimental group
includes 29 patients with standard treatment plus Manual Lymphatic Drainage. The therapy will be
administered daily for four weeks and the patient's condition will be assessed one, three and six months
after treatment.The primary outcome parameter is volume reduction of the affected arm after treatment,
expressed as a percentage. Secondary outcome parameters include: duration of lymphoedema reduction
and improvement of the concomitant symptomatology (degree of pain, sensation of swelling and
functional limitation in the affected extremity, subjective feeling of being physically less atractive and less
feminine, difficulty looking at oneself naked and dissatisfaction with the corporal image).
DISCUSSION: The results of this study will provide information on the effectiveness of Manual
Lymphatic Drainage and its impact on the quality of life and physical limitations of these patients.
TRIAL REGISTRATION: ClinicalTrials (NCT): NCT01152099.
PMID: 21392372 [PubMed - in process]
Biomaterials. 2011 Mar 19. [Epub ahead of print]
Therapeutic lymphangiogenesis using stem cell and VEGF-C hydrogel.
Hwang JH, Kim IG, Lee JY, Piao S, Lee DS, Lee TS, Ra JC, Lee JY.
Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine,
Samsung Medical Center, Seoul, Republic of Korea.
Abstract
Lymphedema is a manifestation of lymphatic system insufficiency. It arises from primary lymphatic
dysplasia or secondary obliteration after lymph node dissection or irradiation. Although improvement of
swelling can be achieved by comprehensive non-operative therapy, treatment of this condition requires
lifelong care and good compliance. Recently molecular-based treatments using VEGF-C have been
investigated by several researchers. We designed the present study to determine whether the therapeutic
efficacy of implanted human adipose-derived stem cells (hADSCs) could be improved by applying a
gelatin hydrogel containing VEGF-C (VEGF-C hydrogel) to the site of tissue injury in a lymphedema
mouse model. Four weeks after the operation, we evaluated edema and determined lymphatic vessel
density at various post-operative time points. Mice treated with hADSCs and VEGF-C hydrogel showed
a significantly decreased dermal edema depth compared to the groups of mice that received hADSCs
only or VEGF-C hydrogel only. Immunohistochemical analysis also revealed that the hADSC/VEGF-C
hydrogel group showed significantly greater lymphatic vessel regeneration than all the other groups.
hADSCs were detected in the implantation sites of all mice in the hADSC/VEGF-C group, and exhibited
a lymphatic endothelial differentiation phenotype as determined by co-staining PKH-labeled hADSCs for
the lymphatic marker LYVE-1. Our results suggest that co-administration of hADSCs and VEGF-C
hydrogel has a substantial positive effect on lymphangiogenesis.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21421266 [PubMed - as supplied by publisher]
Med Clin (Barc). 2011 Mar 17. [Epub ahead of print]
[Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4). Spanish
version validation.]
[Article in Spanish]
Belmonte Martínez R, Garin Boronat O, Segura Badía M, Sanz Latiesas J, Navarro EM, Fores MF.
Servei de Medicina Física i Rehabilitació, Hospital Mar-Esperança, Parc de Salut Mar, Barcelona,
España; Departament de Medicina de la Universitat Autònoma de Barcelona. Bellaterra, Barcelona,
España.
Abstract
BACKGROUND AND OBJECTIVES: To evaluate the acceptability, reliability, validity, and sensitivity
to change of the Spanish version of the FACT-B+4 questionnaire, designed to assess the health related
quality of life (HRQL) in breast cancer.
PATIENTS AND METHODS: Prospective study with 2 samples: patients with incident breast cancer
(n=104) evaluated before and after surgery; and patients with chronic lymphedema of the upper extremity
(n=30), evaluated twice in 7days. HRQL was assessed using the generic instrument SF-36 and the
specific one FACT-B+4.
RESULTS: Reliability coefficients were = 0.7 for most scores. The Physical wellbeing, Breast Cancer,
Arm and TOI scores discriminated between patients with and without chemotherapy (p<0.05), while the
Arm scale discriminated between patients with and without axillary surgery (p<0.001). In the worsening
sub-sample, the FACT-B+4 detected changes in Physical, Emotional and Functional Wellbeing, and TOI
scores.
CONCLUSIONS: The metric characteristics of the Spanish version of the FACT-B+4 are similar to the
original questionnaire and support its equivalence, documenting its suitability for use in our country or in
international studies.
Copyright © 2010 Elsevier España, S.L. All rights reserved.
PMID: 21420133 [PubMed - as supplied by publisher]
Lymphat Res Biol. 2011 Mar;9(1):61-4.
(18)F-FDG PET/CT in a Rare Case of Stewart-Treves Syndrome: Future Implications and Diagnostic
Considerations.
Jensen MR, Friberg L, Karlsmark T, Bülow J.
1 Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, University Hospital of
Copenhagen , Denmark .
Abstract
Abstract Background: The aim of this article is to illustrate the possible applications of (18)F-
fluorodeoxyglucose positron emission tomography/computer tomography ((18)F-FDG PET/CT) in
chronic extremity lymphedema and its complications. Methods and Results: (18)F-FDG PET/CT findings
in a rare case of Stewart-Treves Syndrome (STS), angiosarcoma secondary to chronic extremity
lymphedema, are presented. Lymphedema of the extremities is a debilitating disease characterized by
chronic swelling due to interstitial edema caused by insufficient lymphatic drainage capacity. Progression
with skin thickening, subcutaneous fibrosis, and increased adipose tissue volume is common. Chronic
inflammation has been suggested as a key pathophysiologic component. STS is a rare complication with a
very poor prognosis; however, early diagnosis and radical treatment is associated with increased survival.
Thus, accurate pretreatment staging is paramount. (18)F-FDG PET/CT is highly sensitive in detecting
increased glucose metabolism as seen in many types of cancer and inflammation. The role of (18)F-FDG
PET/CT in the management of lymphedema and its complications has to our knowledge yet to be
described. This case documents high (18)F-FDG uptake in STS, but is at the same time an example of
the low specificity of this imaging modality. Conclusions: We suggest that (18)F-FDG PET/CT has the
potential to become an important tool in the staging and treatment planning of Stewart-Treves syndrome.
Furthermore, (18)F-FDG-accumulation may be a sensitive tool in detecting low grade inflammation in the
skin and subcutis, which has been suggested to cause tissue remodeling in lymphedema progression.
However, further studies are needed to elucidate this theory.
PMID: 21417769 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):47-51.
Confirmation of the reference impedance ratios used for assessment of breast cancer-related
lymphedema by bioelectrical impedance spectroscopy.
Ward LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL.
1 School of Chemistry and Molecular Biosciences, University of Queensland , St. Lucia, Brisbane,
Australia .
Abstract
Abstract Background: Breast cancer-related lymphedema in the arm is commonly detected by
bioelectrical impedance spectroscopy as an increased inter-arm impedance ratio due to the presence of
excess lymph in the at-risk arm relative to that of the unaffected arm. The presence of lymphedema is
determined by a value of this ratio greater than the mean ratio, plus three standard deviations observed in
a comparable healthy population. This threshold value has not been established using the measurement
protocols in current practice. The aim of the present study was to determine the reference range of the
inter-arm impedance ratio to allow a cut-off value to be established as a criterion for the detection of
breast cancer-related lymphedema. Methods: The mean and variation (3 SD) of the inter-arm impedance
ratio for the arms of 172 healthy female control participants were determined from an accumulated
database of impedance data obtained using present generation impedance instrumentation and
methodology. This reference range and threshold value was compared to the original threshold ratio
determined a decade ago but still in current use. Results: The presence of lymphedema is indicated when
the impedance ratio exceeded 1.106 when the nondominant limb is at risk, and 1.134 when the dominant
limb is at risk compared with the currently used values of 1.066 and 1.139, respectively. Although the
difference in these values was statistically significant, this difference was determined to be of minor
importance to clinical practice. Conclusions: The impedance ratio thresholds for early detection of
lymphedema remain suitable for clinical use with present day bioimpedance spectroscopy analyzers and
measurement protocols.
PMID: 21417767 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):43-6.
Reference ranges for assessment of unilateral lymphedema in legs by bioelectrical impedance
spectroscopy.
Ward LC, Dylke E, Czerniec S, Isenring E, Kilbreath SL.
1 School of Chemistry and Molecular Biosciences, The University of Queensland , St. Lucia, Brisbane,
Australia .
Abstract
Abstract Background: Secondary unilateral lymphedema in the leg may occur as a consequence of pelvic
surgery and/or radiation therapy, which causes damage to the pelvic lymphatic system. To date,
assessment has been typically by manual measurement of the volume excess of the affected leg compared
to the contralateral leg. In contrast, the assessment of unilateral arm lymphedema is readily accomplished
by the use of bioelectrical impedance spectroscopy (BIS) as an increased inter-arm impedance ratio due
to the presence of excess lymph in the affected arm relative to that of the unaffected arm. The presence of
lymphedema is defined by a value of this ratio greater than the mean ratio plus three standard deviations
(SD) observed in a comparable healthy population. The aim of the present study was to determine the
equivalent reference range of the impedance ratio for the legs. This would allow a cut-off value to be
established as a criterion for the detection and assessment of lower limb lymphedema. Methods: The
impedances of the legs of 172 healthy females and 150 healthy males, measured by BIS, were extracted
from an accumulated database of impedance data. These data were used to determine the normal
distribution of inter-leg impedance ratios and the reference range and threshold value (mean?+?3 SD).
Results: The presence of lymphedema is indicated when the impedance ratio exceeds 1.167 in males and
1.136 in females. Unlike in the arms, the effect of limb dominance in the legs is minimal and it is suggested
that no correction for limb dominance is warranted. Conclusions: The impedance ratio thresholds for
lymphedema of the legs have been established, opening the way for BIS to become established clinically
for the early detection and assessment of lower limb lymphedema.
PMID: 21417766 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):31-42.
Segmental blood flow and hemodynamic state of lymphedematous and nonlymphedematous arms.
Montgomery LD, Dietrich MS, Armer JM, Stewart BR, Ridner SH.
1 LDM Associates , San Jose, California.
Abstract
Abstract Background: Findings regarding the influence hemodynamic factors, such as increased arterial
blood flow or venous abnormalities, on breast cancer treatment-related lymphedema are mixed. The
purpose of this study was to compare segmental arterial blood flow, venous blood return, and blood
volumes between breast cancer survivors with treatment-related lymphedema and healthy normal
individuals without lymphedema. Methods and Results: A Tetrapolar High Resolution Impedance Monitor
and Cardiotachometer were used to compare segmental arterial blood flow, venous blood return, and
blood volumes between breast cancer survivors with treatment-related lymphedema and healthy normal
volunteers. Average arterial blood flow in lymphedema-affected arms was higher than that in arms of
healthy normal volunteers or in contralateral nonlymphedema affected arms. Time of venous outflow
period of blood flow pulse was lower in lymphedema-affected arms than in healthy normal or
lymphedema nonaffected arms. Amplitude of the venous component of blood flow pulse signal was lower
in lymphedema-affected arms than in healthy or lymphedema nonaffected arms. Index of venular tone was
also lower in lymphedema-affected arms than healthy or lymphedema nonaffected arms. Conclusions:
Both arterial and venous components may be altered in the lymphedema-affected arms when compared
to healthy normal arms and contralateral arms in the breast cancer survivors.
PMID: 21417765 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):19-30.
Molecular characterization of dermal lymphatic endothelial cells from primary lymphedema skin.
Ogunbiyi S, Chinien G, Field D, Humphries J, Burand K, Sawyer B, Jeffrey S, Mortimer P, Clasper S,
Jackson D, Smith For The London Lymphedema Consortium A.
1 Academic Department of Surgery, BHF Centre of Research Excellence and NIMR Biomedical
Research Centre at Kings Health Partners , St. Thomas Hospital, London, United Kingdom .
Abstract
Abstract Background: Lymphatic endothelial cells from primary lymphedema skin have never been
cultured nor characterized. A subgroup of patients with primary lymphedema undergo surgery to bring
about an improvement in their quality of life. The aim of this study was to culture and characterize LECs
from the skin of these patients. Methods and Results: Lymphatic endothelial cells were isolated and
cultured from the skin of patients with primary lymphedema and from normal skin. The isolated cells were
compared in their ability to form microvascular networks in a three-dimensional culture medium, and in
their response to treatment with vascular endothelial growth factors A, C, and D. Whole tissue
transcriptional profiling was carried out on two pools of isolated lymphatic endothelial cells-one from
primary lymphedema skin and the other from normal skin. Lymphatic endothelial cells from primary
lymphedema skin form tubule-like structures when cultured in three-dimensional media. They respond in a
similar fashion to stimulation with the vascular endothelial growth factors A, C, and D. Comparative
analysis between lymphedema tissue and normal tissue (fold change >2) showed differential expression of
2793 genes (5% of all transcripts), 2184 upregulated, and 609 downregulated. Genes involved in cellular
apoptosis (vascular endothelial growth inhibitor, zinc finger protein), extracellular matrix turnover (matrix
metalloproteinase inhibitor-16), and type IV collagen deposition were upregulated. Various pro-
inflammatory genes (interleukin-6, interleukin-8, interleukin-32, E-selectin) were downregulated.
Conclusion: Cellular adhesion, apoptosis, and increased extracellular matrix turnover play a more
prominent role in primary lymphedema than previously thought. In addition, the acute inflammatory
response is attenuated as evidenced by the downregulation of various pro-inflammatory genes.This sheds
further light on the interplay of the various pathological processes taking place in primary lymphedema.
PMID: 21417764 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):13-8.
Reliability and concurrent validity of the perometer for measuring hand volume in women with and without
lymphedema.
Lee MJ, Boland RA, Czerniec S, Kilbreath SL.
Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney , Sydney, Australia .
Abstract
Abstract Background: Lymphedema of hand after breast cancer treatment causes significant loss of hand
function. Although there are several ways of assessing limb volume, measuring hand volume has been
problematic due to technical difficulties associated with assessment of finger volumes. The aim of this
study was to investigate the criterion validity and reliability of Perometer™ for measuring hand volume in
woman with and without lymphedema. Methods and Results: Hand volume of forty women with (n?=?
20) and without lymphedema (n?=?20) was assessed twice by one rater and once by another rater using
the Perometer, and once by one rater using the water volumetry method. Intra- and inter-rater reliability
was determined from the intraclass correlation coefficients and Percent Close Agreement. Agreement
between the Perometer and water volumetry was determined using a limit of agreement and Lin's
concordance correlation. The Perometer had high intra [ICC(2,1)?=?0.989 (95% CI: 0.98-0.99)] and
inter-rater reliability [ICC(2,1)?=?0.993 (95% CI: 0.99-1.0)]. Percent close agreement revealed that
80% of the measures were within 9?ml for inter-rater reliability and within 15?ml for intra-rater reliability.
In addition, there was high concordance between hand volumes obtained with the Perometer and water
volumetry method (R(c)?=?0.88). However, the Perometer overestimated the volume of hand compared
to water volumetry method (bias: 7.5%). Conclusions: The Perometer can be used with high reliability to
measure hand volume but caution should be exercised when data are compared with measures derived
from the water volumetry method.
PMID: 21417763 [PubMed - in process]
Lymphat Res Biol. 2011 Mar;9(1):1.
Non-invasive assessment of human clinical lymphedema: the progress continues.
Rockson SG.
PMID: 21417761 [PubMed - in process]
Filarial Nematodes.
Cross JH.
In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical
Branch at Galveston; 1996. Chapter 92.
Excerpt
The filariae are thread-like parasitic nematodes (roundworms) that are transmitted by arthropod vectors.
The adult worms inhabit specific tissues where they mate and produce microfilariae, the characteristic
tiny, thread-like larvae. The microfilariae infect vector arthropods, in which they mature to infective
larvae. Filarial diseases are a major health problem in many tropical and subtropical areas. The disease
produced by a filarial worm depends on the tissue locations preferred by adults and microfilariae. The
adults of the lymphatic filariae inhabit lymph vessels, where blockage and host reaction can result in
lymphatic inflammation and dysfunction, and eventually in lymphedema and fibrosis. Repeated, prolonged
infection with these worms can lead to elephantiasis, a buildup of excess tissue in the affected area. Other
filariae mature in the skin and subcutaneous tissues, where they induce nodule formation and dermatitis;
migrating filariae of these species can cause ocular damage. Table 92-1 summarizes the filarial infections
of humans.
Copyright © 1996, The University of Texas Medical Branch at Galveston
Sections
•General Concepts•Introduction•Lymphatic Filariae Wuchereria Bancrofti and Brugia
Malayi•Onchocerca Volvulus•Minor Filarial Infections•Dirofilaria Species•Dracunculus
Medinensis•ReferencesPMID: 21413271 [PubMed]
April 3, 2011
Lymphology. 2010 Dec;43(4):188-91.
Congenital lymphatic dysplasia in Kabuki syndrome: first report of an unusual association.
Morcaldi G, Boccardo F, Campisi C, Bellini T, Massocco D, Bonioli E.
Department of Pediatrics, University of Genoa, Gaslini Children's Hospital, Italy. gmorcaldi@fastwebnet.it
Abstract
Kabuki syndrome was first described in Japan in 1981 as a rare disorder of unknown cause. Its main
features include characteristic facies, postnatal growth retardation, and mental delay. To date, there is no
molecular marker for Kabuki syndrome, which is considered genetically heterogeneous and still is a
clinically-based diagnosis. Here we describe the first case of a patient affected by Kabuki syndrome
associated with lymphatic dysplasia. We suggest accurate evaluation of all Kabuki patients as early as
possible in order to diagnose lymphedema or other clinical manifestations of lymphatic system
involvement. Early identification of lymphatic system maldevelopment provides the best chance for
reducing the risk of developing progressive lymphedema with associated tissue changes (fibrosis,
sclerosis, and fat deposition).
PMID: 21446574 [PubMed - indexed for MEDLINE]
Lymphology. 2010 Dec;43(4):178-87.
Prevalence of upper-body symptoms following breast cancer and its relationship with upper-body
function and lymphedema.
Hayes SC, Rye S, Battistutta D, Newman B.
School of Public Health, Faculty of Health, Queensland University of Technology, Queensland, Australia.
sc.hayes@qut.edu.au
Abstract
This investigation describes the prevalence of upper-body symptoms in a population-based sample of
women with breast cancer (BC) and examines their relationships with upper-body function (UBF) and
lymphedema, as two clinically important sequelae. Australian women (n=287) with unilateral BC were
assessed at three-monthly intervals, from six to 18 months post-surgery (PS). Participants reported the
presence and intensity of upper-body symptoms on the treated side. Objective and self-reported UBF
and lymphedema (bioimpedance spectroscopy) were also assessed. Approximately 50% of women
reported at least one moderate-to-extreme symptom at 6- and at 18-months PS. There was a significant
relationship between symptoms and function (p < 0.01), whereby perceived and objective function
declined with increasing number of symptoms present. Those with lymphedema were more likely to
report multiple symptoms, and presence of symptoms at baseline was associated with an increased risk of
lymphedema (ORs > 1.3, p = 0.02), although presence of symptoms explained only 5.5% of the variation
in the odds for lymphedema. Upper-body symptoms are common and persistent following breast cancer
and are associated with clinical ramifications, including reduced UBF and increased risk of developing
lymphedema. However, using the presence of symptoms as a diagnostic indicator or prognosticator of
lymphedema has its limitations.
PMID: 21446573 [PubMed - indexed for MEDLINE]
Cancer. 2011 Mar 28. doi: 10.1002/cncr.26088. [Epub ahead of print]
Sphincter-sparing local excision and hypofractionated radiation therapy for anorectal melanoma: A 20-
Year Experience.
Kelly P, Zagars GK, Cormier JN, Ross MI, Guadagnolo BA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston,
Texas.
Abstract
BACKGROUND: Anorectal melanoma is a rare disease with a poor prognosis. Because survival is
determined by distant failure, many centers have adopted sphincter-sparing excision for primary tumor
control. However, this approach is associated with high rates of local failure (~50%). In this study, the
authors report their 20-year experience with sphincter-sparing excision combined with radiation therapy
(RT) for the treatment of localized anorectal melanoma.
METHODS: The authors reviewed the records of 54 patients with localized anorectal melanoma who
were treated at the University of Texas MD Anderson Cancer Center from 1989 to 2008. All patients
underwent definitive local excision with or without sentinel lymph node biopsy or lymph node dissection.
RT (25-36 grays in 5-6 fractions) was delivered to extended fields that targeted the primary site and
draining pelvic/inguinal lymphatics in 39 patients and to limited fields that targeted only the primary site in
15 patients.
RESULTS: The 5-year rates of local control (LC), lymph node control (NC), and sphincter preservation
were 82%, 88%, and 96%, respectively. However, because of the high rate of distant metastasis, the
overall survival (OS) rate at 5 years was only 30%. Although there were no significant differences in LC,
NC, or OS based on RT field extent, patients who received extended-field RT had higher rates of
lymphedema than patients who received limited-field RT.
CONCLUSIONS: The current results indicated that combined sphincter-sparing local excision and RT is
a well tolerated approach that provides effective LC for patients with anorectal melanoma. Inclusion of
the inguinal lymph node basins in the RT fields did not improve outcomes and was associated with an
increased risk of lymphedema. Cancer 2011;. © 2011 American Cancer Society.
Copyright © 2011 American Cancer Society.
PMID: 21446049 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2011 Mar 29. [Epub ahead of print]
Change in blood flow velocity demonstrated by Doppler ultrasound in upper limb after axillary dissection
surgery for the treatment of breast cancer.
Nascimben Matheus C, Caldeira de Oliveira Guirro E.
Physical Therapy Program, Faculty of Health Sciences, Methodist University of Piracicaba, Piracicaba,
Brazil.
Abstract
The aim of this study was to evaluate the arterial and venous blood flow in women who underwent upper
limb axillary dissection surgery for the treatment of breast cancer. Sixty women were divided into two
groups: group 1 (G1)-30 women who underwent breast surgery with axillary dissection level II or III
(55.6 ± 8.6 years); group 2 (G2)-control, 30 women with no breast cancer (57.4 ± 7.0 years). Blood
flow profile was evaluated by a continuous wave ultrasound Doppler device (Nicolet Vascular Versalab
SE(®)) with an 8 MHz probe. Axillary, brachial arteries and veins, arm circumference, volumes, and the
ankle-brachial index (ABI) were examined. Wilcoxon test and Mann-Whitney tests were applied to
analyze blood flow velocity intra-group and between G1 and G2, respectively. The G1 results showed no
lymphedema and no peripheral arterial disease (ABI > 0.9). Moreover, the mean blood flow velocity of
the vessels ipsilateral to the surgery was significantly higher than the contralateral ones for all vessels
examined (P < 0.05). The mean velocity of blood flow of the vessels contralateral to surgery was
significantly higher than the axillary artery in G2 (P < 0.05). It can be concluded that women who
underwent axillary dissection due to breast cancer showed probable stenosis in the arterial and venous
axillary and brachial vessels of the upper limb ipsilateral to the surgery, confirmed by the increase of
blood flow velocity, and such obstruction might affect the limb contralateral to the operation site.
PMID: 21445573 [PubMed - as supplied by publisher]
Arch Phys Med Rehabil. 2011 Apr;92(4):603-10.
Comparison of diagnostic accuracy of clinical measures of breast cancer-related lymphedema: area under
the curve.
Smoot BJ, Wong JF, Dodd MJ.
Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San
Francisco, CA.
Abstract
Smoot BJ, Wong JF, Dodd MJ. Comparison of diagnostic accuracy of clinical measures of breast
cancer-related lymphedema: area under the curve.
OBJECTIVE: To compare diagnostic accuracy of measures of breast cancer-related lymphedema
(BCRL).
DESIGN: Cross-sectional design comparing clinical measures with the criterion standard of previous
diagnosis of BCRL.
SETTING: University of California San Francisco Translational Science Clinical Research Center.
PARTICIPANTS: Women older than 18 years and more than 6 months posttreatment for breast cancer
(n=141; 70 with BCRL, 71 without BCRL).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Sensitivity, specificity, receiver operator characteristic curve, and
area under the curve (AUC) were used to evaluate accuracy.
RESULTS: A total of 141 women were categorized as having (n=70) or not having (n=71) BCRL based
on past diagnosis by a health care provider, which was used as the reference standard. Analyses of ROC
curves for the continuous outcomes yielded AUC of .68 to .88 (P<.001); of the physical measures
bioimpedance spectroscopy yielded the highest accuracy with an AUC of .88 (95% confidence interval, .
80-.96) for women whose dominant arm was the affected arm. The lowest accuracy was found using the
2-cm diagnostic cutoff score to identify previously diagnosed BCRL (AUC, .54-.65).
CONCLUSIONS: Our findings support the use of bioimpedance spectroscopy in the assessment of
existing BCRL. Refining diagnostic cutoff values may improve accuracy of diagnosis and warrant further
investigation.
Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights
reserved.
PMID: 21440706 [PubMed - in process]
J Am Acad Dermatol. 2011 Mar 24. [Epub ahead of print]
Elephantiasis nostras verrucosa: An institutional analysis of 21 cases.
Dean SM, Zirwas MJ, Horst AV.
Department of Cardiovascular Medicine, Ohio State University College of Medicine, Columbus, Ohio.
Abstract
BACKGROUND: Previous reports regarding elephantiasis nostras verrucosa (ENV) have been typically
limited to 3 or fewer patients.
OBJECTIVES: We sought to statistically ascertain what demographic features and clinical variables are
associated with ENV.
METHODS: A retrospective chart review of 21 patients with ENV from 2006 to 2008 was performed
and statistically analyzed.
RESULTS: All 21 patients were obese (morbid obesity in 91%) with a mean body mass index of 55.8.
The average maximal calf circumference was 63.7 cm. Concurrent chronic venous insufficiency was
identified in 15 patients (71%). ENV was predominantly bilateral (86%) and typically involved the calves
(81%). Proximal cutaneous involvement (thighs 19%/abdomen 9.5%) was less common. Eighteen (86%)
related a history of lower extremity cellulitis/lymphangitis and/or manifested soft-tissue infection upon
presentation. Multisegmental ENV was statistically more likely in setting of a higher body mass index (P =
.02), larger calf circumference (P = .01), multiple lymphedema risk factors (P = .05), ulcerations (P < .
001), and nodules (P < .001). Calf circumference was significantly and proportionally linked to
developing lower extremity ulcerations (P = .02). Ulcerations and nodules were significantly prone to
occur concomitantly (P = .05). Nodules appeared more likely to exist in the presence of a higher body
mass index (P = .06) and multiple lymphedema risk factors (P = .06).
LIMITATIONS: The statistical conclusions were potentially inhibited by the relatively small cohort. The
study was retrospective.
CONCLUSIONS: Our data confirm the association among obesity, soft-tissue infection, and ENV.
Chronic venous insufficiency may be an underappreciated risk factor in the genesis of ENV.
Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights
reserved.
PMID: 21440328 [PubMed - as supplied by publisher]
Wkly Epidemiol Rec. 2011 Mar 25;86(13):121-7.
WHO position statement on integrated vector management to control malaria and lymphatic filariasis.
[Article in English, French]
[No authors listed]
PMID: 21438441 [PubMed - indexed for MEDLINE