Counter
Page updated
11/30/11
Lymphland International Lymphedema Online
October 28, 2011 –
J Indian Soc Periodontol. 2011 Jul;15(3):280-3.
A rare case of unusual gingival enlargement post radiotherapy.
Singh V, Bhat GS, Bhat KM.
Source
Department of Periodontics, Manipal College of Dental Sciences, Manipal, Karnataka, India.
Abstract
Oral changes following radiotherapy are not uncommon. Oral mucositis, alteration in salivary gland function,
radiation caries, and gingival changes have all been reported following radiotherapy and chemotherapy. The
gingival changes seen after radiotherapy may be unusual and often cause diagnostic dilemma. Metastasis to
the gingiva has also to be ruled out in these cases. A 30-year-old female patient presented with enlargement
of the gingiva of 6 months' duration and lower lip swelling of 7 months' duration. She was a known case of
carcinoma of nasopharynx and had received radiotherapy and chemotherapy. Based on the history, the
clinical appearance of the gingiva, and the other oral changes we considered both post-radiotherapy gingival
enlargement and secondary metastasis to gingiva as possibilities. An incisional biopsy was performed
(internal bevel gingivectomy). The histopathological report did not reveal any metastatic changes. Thus, we
diagnosed post-radiotherapy gingival enlargement. For the multiple carious teeth, extraction and root canal
treatment was carried out as necessary. The patient was referred to the department of Oral and
Maxillofacial Surgery for management of swelling of the lips, which was diagnosed as lymphedema of the lip.
Gingival enlargement is rare post radiotherapy. Such nonplaque-associated gingival enlargement in a patient
who has undergone radiotherapy should be subjected to biopsy and histopathological examination to
distinguish between secondary metastasis and post-radiation changes.
PMID: 22028519 [PubMed - in process]
Rozhl Chir. 2011 Jun;90(6):343-7.
[Benefits of sentinel lymph node examination in early breast carcinoma].
[Article in Slovak]
Mytnik M, Petrík J, Hanudel' J, Wereb M, Klc J, Straka L.
Source
Chirurgická klinika FNsP PreSov, Slovenská republika. mytnik@fnsppresov.sk
Abstract
INTRODUCTION:
Sentinel lymph node biopsy improves staging of disease, saves the axilla, and significantly reduces the risk of
complications.
MATERIAL AND METHODS:
The authors compare the two groups of surgical treatment of breast cancer patients--after conventional
surgery with axillary exenteration with a group of patients with sentinel node biopsy using gamma probe with
limited power.
RESULTS:
In group of 42 patients after axillary exenteration authors observed: hematoma in 2 patients, 1 postoperative
bleeding that need for surgical revision, 2 patients had paresthesia and 1 patient had lymphedema, which
represents 11.5% of complications. In the group of 54 patients after limited exercise with the use of sentinel
biopsy and gamma probe authors reported only one complication--an infected surgical wound seroma in the
axilla (1.8% complications).
CONCLUSION:
Examination of sentinel node biopsy in combination with exact measurement of gamma probe allows friendly
operating performance in the axilla and significantly reduces the incidence of postoperative complications.
PMID: 22026101 [PubMed - in process]   ahead of print]
[Psychosocial impact of breast cancer in long-term survival: proposal of an integral follow-up care for
survivors.]
[Article in Spanish]
Vivar CG.
Source
Departamento de Enfermería Comunitaria y Materno Infantil, Facultad de Enfermería, Universidad de
Navarra, España.
Abstract
The aim of the article is to show the psychosocial impact of breast cancer in the long-term survival and to
promote the idea of implementing a follow-up plan for survivors. A narrative review of published articles on
the experience of survival in breast cancer survivors was conducted. Data were organised according to the
domains of measurement (physical, psychological and social) of the Quality of Life of Long-term Breast
Cancer Survivors Scale (LTQOL-BC). Breast cancer survivors may feel emotionally affected by the
physical sequels (mastectomy, lymphedema, early menopause, and infertility), psychological (fear of
recurrence and emotional stress) and/or social (family relationships and employment changes). The data are
the foundation of a proposal of specific follow-up care for breast cancer survivors.
Copyright © 2010 Elsevier España, S.L. All rights reserved.
PMID: 22019066 [PubMed - as supplied by publisher]
October 25, 2011
Maturitas. 2011 Oct 18. [Epub ahead of print]
Improving quality of life after breast cancer: Dealing with symptoms.
Pinto AC, de Azambuja E.
Source
Department of Medical Oncology, Portuguese Institute of Oncology Francisco Gentil, EPE - Coimbra, Av.
Bissaya Barreto, n° 98, Apartado 2005, 3001-651 Coimbra, Portugal.
Abstract
BACKGROUND:
Advances in breast cancer therapies have given rise to a growing number of patient survivors. Nevertheless,
these women deal with long-term sequelae that impair their quality of life and that are lacking satisfactory
assessment and expeditious management. Importantly, a new era is raising in the oncology field, namely,
survivorship.
METHODS:
A search for English-language articles on Medline was undertaken covering the last 15 years, using the terms
"cancer survivorship", "quality of life", "fatigue", "insomnia", "sleep disturbances", "depression", "cognitive
dysfunction", "chemofog", "peripheral neuropathy", "fertility", "sexual behaviour", "menopause",
"lymphedema", "physical activity" and "breast neoplasms". Selection was limited to systematic reviews and
meta-analysis, but their reference list was examined to include papers of potential interest.
RESULTS:
We found the most common symptoms affecting breast cancer survivors were fatigue, insomnia, depression,
cognitive dysfunction, reproductive and menopausal symptoms and lymphoedema.
CONCLUSION:
Some of these symptoms have even been the objective of randomised controlled trials, but consistent data
are missing. The available interventions include pharmacological, behavioural therapies and complementary
and alternative medicine approaches and will mostly depend on the type of symptom.
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
PMID: 22014722 [PubMed - as supplied by publisher
October 16, 2011
Am J Med Genet A. 2011 Nov;155(11):2762-5. doi: 10.1002/ajmg.a.34188. Epub 2011 Sep 22.
Primary lymphedema with coarctation of the aorta: Possible new syndrome or variant of Irons-Bianchi
syndrome?
Ferguson JS, Gunatheesan S, Brice G, Hastings R, Newbury-Ecob R, Mortimer PS, Mansour S.
Source
Department of Dermatology, St George's Healthcare NHS Trust, London, UK. John.Ferguson@gmail.com.
Abstract
We present a boy with congenital lymphedema, a congenital heart defect (coarctation of the aorta), and mild
dysmorphic features. Clinical impression and targeted investigations ruled out Noonan syndrome and Milroy
syndrome, but it was not clear whether or not he had Irons-Bianchi syndrome. We discuss the genomic and
lymphoscintigraphy evaluation of this case, and review whether the small number of current case reports
represent the original Irons-Bianchi syndrome or variants. We anticipate that ongoing molecular
investigations such as Next Generation Sequencing will delineate a currently clinically defined phenotypic
spectrum. © 2011 Wiley Periodicals, Inc.
Copyright © 2011 Wiley Periodicals, Inc.
PMID: 21954173 [PubMed - in process]
Methods Cell Biol. 2011;105:223-38.
Zebrafish provides a novel model for lymphatic vascular research.
Karpanen T, Schulte-Merker S.
Abstract
The mammalian lymphatic vasculature has an important function in the maintenance of tissue fluid
homeostasis, absorption of dietary lipids, and immune surveillance. The lymphatic vessels are also recruited
by many tumors as primary routes for metastasis and mediate immune responses in inflammatory diseases,
whereas dysfunction of the lymphatic drainage leads to lymphedema. The characterization of a lymphatic
vasculature in zebrafish has made the advantages of this small model organism, the suitability for intravital
time-lapse imaging of developmental processes and the amenability for chemical and forward genetic
screens, available to lymphatic vascular research. Here we review our current understanding of embryonic
lymphangiogenesis in zebrafish, its molecular and anatomical similarities to mammalian lymphatic vascular
development, and the possibilities zebrafish offers to complement mouse models and cell culture assays in
the lymphangiogenesis field.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21951532 [PubMed - in process]
Lymphology. 2011 Jun;44(2):72-81.
Measurement of lymphedema using ultrasonography with the compression method.
Lim CY, Seo HG, Kim K, Chung SG, Seo KS.
Source
Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Korea.
Abstract
Lymphedema is swelling of soft tissues by accumulation of lymphatic fluid due to failure of the lymphatic
drainage system. Although most measures for lymphedema focus on change of volume or size of the
extremity, the physical properties of the tissue such as resistance to compression are also of clinical
importance because they affect the quality of life of lymphedema patients. In this study, we aimed to
compare the thickness and resistance to compression of the skin and subcutis between the affected and
unaffected arms of patients with lymphedema by using ultrasonography together with the compression
technique, and we also investigated the factors that have an influence on the results. Thirty-nine patients with
post-mastectomy lymphedema participated in this study. All ultrasonographically-assessed thicknesses of
skin and subcutaneous tissue in affected upper arms and forearms were significantly larger than the
contralateral (p < 0.05) while all resistances to compression values were significantly lower (p < 0.05).
These results suggest that measuring the resistance to compression and thickness using the compression
method with ultrasonography may be a valuable tool for evaluating lymphedema after breast cancer surgery.
PMID: 21949976 [PubMed - indexed for MEDLINE]
Lymphology. 2011 Jun;44(2):65-71.
Changes in quality of life of patients with lymphedema after lymphatic vessel transplantation.
Springer S, Koller M, Baumeister RG, Frick A.
Source
Division of Plastic-, Hand- and Microsurgery, Department of Surgery, Ludwig-Maximilians-University of
Munich, Campus Grosshadern, Germany.
Abstract
There are multiple treatment options for patients with chronic lymphedema, and one successful approach is
lymph vessel transplantation. As quality of life assessments are frequently not utilized in standard treatment
regimes, we investigated the change in quality of life for patients with chronic lymphedema (total = 212) who
had undergone lymphatic vessel transplantation and conservative therapy for at least 6 months prior to
operation. Quality of life was assessed by a modified standard questionnaire examining the physiological and
psychological status of the patients. Results document a significant improvement in quality of life and
underscore success of autologous lymphatic vessel transplantation as a therapy for lymphedema.
PMID: 21949975 [PubMed - indexed for MEDLINE]
Lymphology. 2011 Jun;44(2):54-64.
Pathways of lymph and tissue fluid flow during intermittent pneumatic massage of lower limbs with
obstructive lymphedema.
Olszewski WL, Cwikla J, Zaleska M, Domaszewska-Szostek A, Gradalski T, Szopinska S.
Source
Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of
Sciences, Warsaw, Poland. wlo@cmdik.pan.pl
Abstract
Questions remain on the use of sequential pneumatic compression including where does the fluid flow to and
whether fluid can be moved to the non-swollen tissues of the hypogastrium and gluteal region? During
pneumatic massage of the limb, we studied pathways of lymph and mobile tissue fluid flow using
lymphoscintigraphy: a) from the calf and thigh across the inguinal region to the healthy non-swollen tissues of
the hypogastrium and b) in the hypogastrium to the lateral and upper abdominal quadrants. To examine if
there was effective fluid flow during pneumatic massage, plethysmographic flow measurements were also
carried out. We demonstrated that: (i) pneumatic compression moved isotope in lymph remaining in
functioning lymphatics and in tissue fluid in the interstitial space toward the inguinal region and femoral
channel, (ii) there was no isotope crossing the inguinal crease or moving to the gluteal area, and (iii) isotope
injected intradermally in the hypogastrium did not spread during manual massage to the upper and
contralateral abdominal quadrants. In conclusion, intermittent pneumatic compression is effective in pushing
mobile tissue fluid and relocating large fluid volumes toward the groin. However, the question that still
remains is how to facilitate further flow toward the non-swollen tissues and thereby increase local absorption
of fluid.
PMID: 21949974 [PubMed - indexed for MEDLINE]
Int J Radiat Oncol Biol Phys. 2011 Sep 22. [Epub ahead of print]
Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management
and Risk Reduction Strategies.
Shah C, Vicini FA.
Source
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI.
Abstract
As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema
(LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates,
identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction
guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of
these issues. As a result, standardized recommendations are still lacking. This review will summarize the
latest data addressing all of these concerns in order to provide patients and health care providers with
optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a
range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields, and the use
of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical
disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can
lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL
present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive
physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management
of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical,
radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments
before and after treatment should be employed to diagnose subclinical disease. In those patients who require
aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-
term sequelae of BCRL.
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21945108 [PubMed - as supplied by publisher]
J Am Coll Surg. 2011 Oct;213(4):543-51. Epub 2011 Jul 28.
Preventative measures for lymphedema: separating fact from fiction.
Cemal Y, Pusic A, Mehrara BJ.
Source
Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer
Center, New York, NY.
PMID: 21802319 [PubMed - in process]
Am J Clin Oncol. 2011 Oct;34(5):506-10.
Estimating the probability of lymphedema after breast cancer surgery.
Soran A, Wu WC, Dirican A, Johnson R, Andacoglu O, Wilson J.
Source
Division of Surgical Oncology, Department of Surgery, Magee-Womens Hospital of University of Pittsburgh
Medical Center, PA, USA. asoran@upmc.edu
Abstract
OBJECTIVES:
Lymphedema is a common complication of breast cancer surgery, leading to a decreased quality of life. The
risk and severity of lymphedema were associated with surgery side upper extremity infection, ≥25 kg/m(2)
body mass index (BMI), and the level of hand use (LHU). Our aim was to estimate the probability of
lymphedema after breast cancer surgery by using previously published incidence rates and these 3 risk
factors.
METHODS:
The design was a n:m matched case control study; data were analyzed on 51 patients with lymphedema and
126 available controls matched on age, radiation therapy, and operation type. In conjunction with published
estimates of lymphedema, incidence rates, and estimates of the proportions of risk factor combinations in
cases and controls, the Bayes' theorem was used to estimate the probability of developing lymphedema.
RESULTS:
Lymphedema probabilities of 7 combinations for 6 different published calculations were used. With the
assumption of 16% LE incidence rate of lymphedema, a BMI<25, no infection, and a low LHU, the
estimated probability of lymphedema was 6.8%. With the assumption of 46.3% LE incidence a BMI ≥25,
infection, and a high LHU led to an estimated lymphedema probability of 93.7%.
CONCLUSIONS:
This study shows that control of predisposing factors in both high and low incidence rates has a marked
effect on the probability of LE development. In other words, patients with low incidence for LE are more
prone to develop LE if the predisposing factors are controlled poorly compared to the high incidence
patients whom the predisposing factors are avoided.
PMID: 21127413 [PubMed - in process]
October 16, 2011
Breast Cancer Res Treat. 2011 Sep 30. [Epub ahead of print]
A randomized clinical trial comparing advanced pneumatic truncal, chest, and arm treatment to arm
treatment only in self-care of arm lymphedema.
Ridner SH, Murphy B, Deng J, Kidd N, Galford E, Bonner C, Bond SM, Dietrich MS.
Source
Vanderbilt University School of Nursing, 461 21st Avenue South, Godchaux Hall, Nashville, TN, 37240,
USA, sheila.ridner@vanderbilt.edu.
Abstract
Treatment of the truncal lymphatics prior to treatment of the lymphedematous arm is an accepted, although
not empirically tested, therapeutic intervention delivered during decongestive lymphatic therapy (DLT).
Breast cancer survivors with arm lymphedema are encouraged to use these techniques when performing
simple lymphatic drainage as part of their life-long lymphedema self-care. Self-massage is at times difficult
and pneumatic compression devices are used by many patients to assist with self-care. One such device, the
Flexitouch(®) System, replicates the techniques used during DLT; however, the need for application of
pneumatic compression in unaffected truncal areas to improve self-care outcomes in arm only lymphedema
is not established. The objective of this study was to compare the therapeutic benefit of truncal/chest/arm
advanced pneumatic compression therapy (experimental group) verses arm only pneumatic compression
(control group) in self-care for arm lymphedema without truncal involvement using the Flexitouch(®)
System. Outcomes of interest were self-reported symptoms, function, arm impedance ratios, circumference,
volume, and trunk circumference. Forty-two breast cancer survivors, (21 per group), with Stage II
lymphedema completed 30 days of home self-care using the Flexitouch(®) System. Findings revealed a
statistically significant reduction in both the number of symptoms and overall symptom burden within each
group; however, there were no statistically significant differences in these outcomes between the groups.
There was no statistically significant overall change or differential pattern of change between the groups in
function. A statistically significant reduction in bioelectrical impedance and arm circumference within both of
the groups was achieved; however, there was no statistically significant difference in reduction between
groups. These findings indicate that both configurations are effective, but that there may be no added benefit
to advanced pneumatic treatment of the truncal lymphatics prior to arm massage when the trunk is not also
affected. Further research is indicated in a larger sample.
PMID: 21960113 [PubMed - as supplied by publisher]
J Vasc Surg. 2011 Sep 27. [Epub ahead of print]
Diagnosis and treatment of venous lymphedema.
Raju S, Furrh JB 4th, Neglén P.
Source
The Rane Center, Flowood, Miss.
Abstract
BACKGROUND:
Chronic venous disease (CVD) is a common cause of secondary lymphedema. Venous lymphedema is
sometimes misdiagnosed as primary lymphedema and does not receive optimal treatment. We have routinely
used intravascular ultrasound (IVUS) imaging in all cases of limb swelling. The aim of this study is to show
that (1) routine use of IVUS can detect venous obstruction missed by traditional venous testing, and (2) iliac-
caval venous stenting can yield satisfactory clinical relief and can sometimes reverse abnormal
lymphangiographic findings.
METHODS:
The study comprised CVD patients who underwent iliac vein stenting. Lymphangiography was abnormal in
72 of 443 CEAP C(3) limbs, with leg swelling as the primary complaint (abnormal lymphangiography
group). Clinical features and stent outcome were compared with a control group of 205 of 443 with normal
lymphangiography (normal lymphangiographic group).
RESULTS:
Clinical features were a poor guide to the diagnosis of lymphedema. Isotope lymphangiography was not
helpful in differentiating primary from secondary lymphedema. Venography had 61% sensitivity to the
diagnosis of venous obstruction. IVUS had a sensitivity of 88% for significant (≥50% area stenosis) venous
obstruction. At 40 months, cumulative secondary stent patency was similar for the abnormal (100%) and
normal lymphangiographic (95%) groups. Swelling improved significantly after stent placement in the
abnormal lymphangiographic group (mean [standard deviation] swelling grade improvement 0.8 ± 1.1) but
was less (P < .004) than in the control group (1.4 ± 1.3). Complete swelling relief was 16% and 44% (P < .
001) and partial improvement (≥1 grade of swelling) was 45% and 66% (P < .01) in the abnormal and
normal lymphangiographic groups, respectively. Associated pain was present in 50% and 36% of the
swollen limbs in the abnormal and normal lymphangiographic groups. Pain relief (≥3 visual analog scale) at
40 months was 87% and 83%, respectively (P = .3), with 65% and 71%, experiencing complete pain relief.
Quality of life criteria improved after stent placement in both groups but to a better extent in the normal
lymphangiographic group. Abnormal lymphangiography improved or normalized in 9 of 36 (25%) of those
tested after stent correction.
CONCLUSIONS:
Prevailing practice patterns and diagnostic deficiencies probably result in the misdiagnosis of many cases of
venous lymphedema as "primary" lymphedema. IVUS is recommended to rule out venous obstruction as the
associated or initiating cause of lymphedema. Iliac venous stenting to correct the obstruction has excellent
long-term patency and good clinical outcome, although results are not as good as in those with normal
lymphatic function.
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
PMID: 21958566 [PubMed - as supplied by publisher]
Jpn J Clin Oncol. 2011 Oct;41(10):1162-7. Epub 2011 Sep 8.
The incidence and predictor of lymph node metastasis for patients with t1mi breast cancer who underwent
axillary dissection and breast irradiation: an institutional analysis.
Lee JH, Suh YJ, Shim BY, Kim SH.
Source
*St. Vincent's hospital, 442-723, 93-6, Ji-dong, Paldal-gu, Suwon, Kyeonggi-do, Republic of Korea.
kimandre@catholic.ac.kr.
Abstract
OBJECTIVE:
This study was designed to evaluate the rate and the predictors of axillary lymph node metastasis in patients
with T1mi breast cancer.
METHODS:
We analyzed 62 cases of ductal carcinoma in situ with microinvasion, and the pathology records and
treatment charts were retrospectively reviewed for information on the patient and tumor characteristics. All
the included patients underwent breast conserving surgery and 48 patients underwent axillary lymph node
dissection.
RESULTS:
The incidence of axillary involvement was 8.3%. Comedo ductal carcinoma in situ (P = 0.031), histologic
grade 3 (P = 0.025), the presence of necrosis (P = 0.007) and Van Nuys group 3 (P = 0.025) were
significant predictors of axillary involvement on the statistical analysis. Axillary dissection was significantly
associated with the occurrence of arm lymphedema (P = 0.030).
CONCLUSIONS:
A significant rate of axillary metastases occurred in the patients with T1mi breast carcinoma in this study.
The comedo subtype of ductal carcinoma in situ, a high histologic grade, the presence of necrosis and the
Van Nuys group 3 were significant predictors of axillary lymph node metastasis in patients with T1mi breast
cancer. Thus, the patients with T1mi breast disease are indicated to a careful evaluation of axillary lymph
node metastasis, if they have the earlier-mentioned unfavorable factors.
PMID: 21903706 [PubMed - in process]
Nat Genet. 2011 Sep 4;43(10):929-31. doi: 10.1038/ng.923.
Mutations in GATA2 cause primary lymphedema associated with a predisposition to acute myeloid
leukemia (Emberger syndrome).
Ostergaard P, Simpson MA, Connell FC, Steward CG, Brice G, Woollard WJ, Dafou D, Kilo T, Smithson
S, Lunt P, Murday VA, Hodgson S, Keenan R, Pilz DT, Martinez-Corral I, Makinen T, Mortimer PS,
Jeffery S, Trembath RC, Mansour S.
Source
1] Medical Genetics Unit, Biomedical Sciences, St. George's University of London, London, UK. [2].
Abstract
We report an allelic series of eight mutations in GATA2 underlying Emberger syndrome, an autosomal
dominant primary lymphedema associated with a predisposition to acute myeloid leukemia. GATA2 is a
transcription factor that plays an essential role in gene regulation during vascular development and
hematopoietic differentiation. Our findings indicate that haploinsufficiency of GATA2 underlies primary
lymphedema and predisposes to acute myeloid leukemia in this syndrome.
PMID: 21892158 [PubMed - in process]
Breast Cancer Res Treat. 2011 Nov;130(1):301-6. Epub 2011 Jul 7.
A SEER-Medicare population-based study of lymphedema-related claims incidence following breast cancer
in men.
Reiner AS, Jacks LM, Van Zee KJ, Panageas KS.
Source
Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 307 East 63rd
Street, New York, NY, 10065, USA, reinera@mskcc.org.
Abstract
Each year there are an estimated 200,000 new breast cancer cases diagnosed in the United States; of these,
1% of cases are in men. Lymphedema can be a devastating complication from breast cancer and its
treatment. Currently, almost all lymphedema-related research is based on women and extrapolated to men.
We conducted the first population-based study of men with incident breast cancer of any stage, diagnosed
from 1998 to 2005, who were 65 years and older in the Surveillance, Epidemiology, and End Results
(SEER)-Medicare linked database. We utilized claims related to lymphedema and lymphedema treatment in
our cohort. We defined 'lymphedema-specific' claims to contain the word 'lymphedema' in the Medicare
claim description; similarly, 'lymphedema-related' claims were defined as treatments reimbursed for
lymphedema but not necessarily containing the word 'lymphedema' in the Medicare claim description. We
identified 628 men with incident breast cancer from 1998 to 2005 who were 65 years and older. The
cumulative incidence, censored for deaths, of lymphedema-specific claims at 2, 3, 4, and 5 years was 8.0,
9.2, 10.5, and 10.5%, respectively. The median follow-up was 3.4 years and for those without any event
was 4.7 years. The cumulative incidence, censored for deaths, of lymphedema-related claims at 2, 3, 4, and
5 years was 26.9, 32.2, 35.4, and 39.8%. Rates for men were similar to analogous rates for women.
Lymphedema is a common complication affecting men with breast cancer as well as women and appropriate
treatment and rehabilitation strategies need to be implemented for both genders.
PMID: 21735047 [PubMed - in process]
Breast Cancer Res Treat. 2011 Nov;130(1):227-34. Epub 2011 May 12.
Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results
from a randomized controlled trial.
Hayes SC, Speck RM, Reimet E, Stark A, Schmitz KH.
Source
Queensland University of Technology, School of Public Health, Institute of Biomedical Innovation, Brisbane,
Australia.
Abstract
The lymphedema diagnostic method used in descriptive or intervention studies may influence results found.
The purposes of this work were to compare baseline lymphedema prevalence in the physical activity and
lymphedema (PAL) trial cohort and to subsequently compare the effect of the weight-lifting intervention on
lymphedema, according to four standard diagnostic methods. The PAL trial was a randomized controlled
intervention study, involving 295 women who had previously been treated for breast cancer, and evaluated
the effect of 12 months of weight lifting on lymphedema status. Four diagnostic methods were used to
evaluate lymphedema outcomes: (i) interlimb volume difference through water displacement, (ii) interlimb size
difference through sum of arm circumferences, (iii) interlimb impedance ratio using bioimpedance
spectroscopy, and (iv) a validated self-report survey. Of the 295 women who participated in the PAL trial,
between 22 and 52% were considered to have lymphedema at baseline according to the four diagnostic
criteria used. No between-group differences were noted in the proportion of women who had a change in
interlimb volume, interlimb size, interlimb ratio, or survey score of ≥5, ≥5, ≥10%, and 1 unit, respectively
(cumulative incidence ratio at study end for each measure ranged between 0.6 and 0.8, with confidence
intervals spanning 1.0). The variation in proportions of women within the PAL trial considered to have
lymphoedema at baseline highlights the potential impact of the diagnostic criteria on population surveillance
regarding prevalence of this common morbidity of treatment. Importantly though, progressive weight lifting
was shown to be safe for women following breast cancer, even for those at risk or with lymphedema,
irrespective of the diagnostic criteria used.
PMID: 21562712 [PubMed - in process]
October 16, 2011
Br J Cancer. 2011 Oct 25;105(9):1279-87. doi: 10.1038/bjc.2011.407. Epub 2011 Oct 4.
Risk factors for short- and long-term complications after groin surgery in vulvar cancer.
Hinten F, van den Einden LC, Hendriks JC, van der Zee AG, Bulten J, Massuger LF, van de Nieuwenhof
HP, de Hullu JA.
Source
Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101,
6500 HB Nijmegen, The Netherlands.
Abstract
Background:The cornerstone of treatment in early-stage squamous cell carcinoma (SCC) of the vulva is
surgery, predominantly consisting of wide local excision with elective uni- or bi-lateral inguinofemoral
lymphadenectomy. This strategy is associated with a good prognosis, but also with impressive treatment-
related morbidity. The aim of this study was to determine risk factors for the short-term (wound breakdown,
infection and lymphocele) and long-term (lymphoedema and cellulitis/erysipelas) complications after groin
surgery as part of the treatment of vulvar SCC.Methods:Between January 1988 and June 2009, 164
consecutive patients underwent an inguinofemoral lymphadenectomy as part of their surgical treatment for
vulvar SCC at the Department of Gynaecologic Oncology at the Radboud University Nijmegen Medical
Centre. The clinical and histopathological data were retrospectively analysed.Results:Multivariate analysis
showed that older age, diabetes, 'en bloc' surgery and higher drain production on the last day of drain in situ
gave a higher risk of developing short-term complications. Younger age and lymphocele gave higher risk of
developing long-term complications. Higher number of lymph nodes dissected seems to protect against
developing any long-term complications.Conclusion:Our analysis shows that patient characteristics,
extension of surgery and postoperative management influence short- and/or long-term complications after
inguinofemoral lymphadenectomy in vulvar SCC patients. Further research of postoperative management is
necessary to analyse possibilities to decrease the complication rate of inguinofemoral lymphadenectomy;
although the sentinel lymph node procedure appears to be a promising technique, in ∼50% of the patients an
inguinofemoral lymphadenectomy is still indicated.
PMID: 21970884 [PubMed - in process]
Eur Urol. 2011 Nov;60(5):1114-9. Epub 2010 Nov 24.
Assessment and follow-up of patency after lymphovenous microsurgery for treatment of secondary
lymphedema in external male genital organs.
Mukenge SM, Catena M, Negrini D, Ratti F, Moriondo A, Briganti A, Rigatti P, Cipriani F, Ferla G.
Source
Department of Surgical Sciences, Università Vita e Salute, San Raffaele, Milano, Italy.
Abstract
Secondary lymphedema of external male genital organs is a frequent complication of pelvic radical surgery
following pelvic lymphadenectomy. Microsurgical lymphovenous anastomoses are usually performed using
only the superficial scrotal lymphatics, excluding testicular lymphatic drainage. We have experimented using
a new microsurgical technique based on lymphovenous anastomosis between the collectors of the spermatic
funiculus and the veins of the pampiniform plexus, allowing testicular lymphatic drainage. The study included
11 patients with external genital organ lymphedema, five of whom were subjected to microsurgical
lymphovenous derivation. At 3, 6, and 12 mo after surgery, the patency of lymphovenous anastomoses was
assessed by noninvasive lymphography using indocyanine green fluorescence images obtained with the
Photodynamic Eye (PDE) infrared camera system (Hamamatsu Photonics K.K., Hamamatsu, Japan).
Progressive improvement of clinical conditions was assessed both by patients' self evaluation and by
objective clinical follow-up based on: (1) PDE lymphography, (2) tomography of the pubic area, (3)
recovery of the soft consistency of the scrotal tissue, (4) recovery of the scrotal skin normochromic aspect,
(5) absence of pain, and (6) disappearance of edema with evident reduction of the scrotal and penile
dimensions and normal palpability of the testis. The present study shows that lymphovenous anastomosis is a
valuable method of resolving the edematous condition. The indocyanine green approach for
lymphangiography is a very supportive method during follow-up because, with the least invasive approach, it
is possible to ascertain the complete patency of the anastomosis, to confirm its localization, and to assess its
lymphatic drainage.
Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PMID: 21129845 [PubMed - in process]
October 16, 2011
Curr Oncol. 2011 Oct;18(5):e218-26.
Caring for survivors of breast cancer: perspective of the primary care physician.
Smith SL, Wai ES, Alexander C, Singh-Carlson S.
Source
Division of Radiation Oncology, Department of Surgery, Faculty of Medicine, University of British
Columbia, Vancouver, and BC Cancer Agency-Vancouver Island Centre, Victoria, BC.
Abstract
BACKGROUND AND OBJECTIVES:
Increasing numbers of women are surviving breast cancer, and survivorship care is becoming more complex.
Primary care physicians provide care for most survivors of breast cancer in the Canadian province of British
Columbia. The present study offers insight into the confidence of primary care physicians in their abilities to
provide such care. It also explores potential ways to assist those providers in enhancing this aspect of their
practice.
METHODS:
A questionnaire was mailed to 1000 primary care physicians caring for survivors of breast cancer. The
questionnaire explored the perspectives of the responding physicians on their ability to manage various
aspects of survivorship care for breast cancer patients, identified preferences for the content and format of
communication from oncologists at the time of transition from active oncology treatment to survivorship, and
determined the means most commonly used to obtain knowledge about breast cancer. This 1-page, 31-item
checkbox and open-answer questionnaire assessed the perceptions of primary care physicians about the
care of breast cancer survivors after completion of active treatment and their personal preferences for
resources providing information about breast cancer.
RESULTS:
The questionnaire response rate was 59%. Primary care physicians reported being most confident in
screening for recurrence and managing patient anxiety; they were least confident in managing lymphedema
and providing psychosocial counselling. Compared with physicians following fewer survivors of breast
cancer, those who followed more breast cancer survivors had higher confidence in managing the biomedical
aspects of follow-up and in providing counselling about nutrition and exercise. Most physicians found
discharge letters from oncologists to be useful. Point-form discharge information was preferred by 43%;
detailed description, by 19%; and both formats, by 38%. The most useful information items identified for
inclusion in a discharge letter were a diagnosis and treatment summary and the recommended surveillance
and endocrine therapy. Continuing medical education events and online resources were the means most
commonly used to obtain knowledge about breast cancer.
CONCLUSIONS:
Primary care physicians who provide follow-up for survivors of breast cancer report that they are confident
in managing care and satisfied with discharge letters containing a diagnosis and treatment summary, and
recommendations for surveillance and endocrine treatment. At the time of patient discharge, additional
information about common medical and psychosocial issues in this patient population would be useful to
primary care physicians. Preferred means to access current breast cancer information include continuing
medical education events and online resources.
PMID: 21980253 [PubMed - in process]  PMCID: PMC3185903
Support Care Cancer. 2011 Oct 7. [Epub ahead of print]
Racial disparities in physical and functional domains in women with breast cancer.
Morehead-Gee AJ, Pfalzer L, Levy E, McGarvey C, Springer B, Soballe P, Gerber L, Stout NL.
Source
Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Abstract
INTRODUCTION:
African-American women are more likely than white women to have functional impairments after breast
cancer (BC) surgery; however, no differences were found in self-reported health status surveys at 12+
months postsurgery.
PURPOSE:
This analysis compared white and African-American BC survivors' (BCS) health status, health-related
quality of life, and the occurrence of physical impairments after BC treatment.
METHODS:
One hundred sixty-six women (130 white, 28 African-American, 8 other) were assessed for impairments
preoperatively and at 1, 3, 6, 9, and 12+ months postsurgery. Health status was assessed at 12+ months
using the Short Form Health Survey (SF36v2™). Analysis of variance estimated differences between
groups for health status and impairment occurrence.
RESULTS:
No differences were found between groups for BC type, stage, grade, or tumor size; surgery type; or
number of lymph nodes sampled. African-American BCS had more estrogen/progesterone receptor-
negative tumors (p < 0.001; p = 0.036) and received radiation more frequently (p = 0.03). More
African-American BCS were employed (p = 0.022) and reported higher rates of social activities (p = 
0.011) but less recreational activities (p = 0.020) than white BCS. African-American BCS had higher
rates of cording (p = 0.013) and lymphedema (p = 0.011) postoperatively. No differences were found
in self-reported health status.
CONCLUSION:
In a military healthcare system, where access to care is ubiquitous, there were no significant differences in
many BC characteristics commonly attributed to race. African-American women had more ER/PR-negative
tumors; however, no other BC characteristics differed between racial groups. African-American women
exhibited more physical impairments, although their BC treatment only differed regarding radiation therapy.
This suggests that African-American BCS may be at higher risk for physical impairments and should be
monitored prospectively for early identification and treatment.
PMID: 21979903 [PubMed - as supplied by publisher]
Cochrane Database Syst Rev. 2011 Oct 5;(10):CD007103.
Dance/movement therapy for improving psychological and physical outcomes in cancer patients.
Bradt J, Goodill SW, Dileo C.
Source
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, 1505
Race Street, rm 1041, Philadelphia, PA, USA, 19102.
Abstract
BACKGROUND:
Current cancer care increasingly incorporates psychosocial interventions. Cancer patients use
dance/movement therapy to learn to accept and reconnect with their bodies, build new self-confidence,
enhance self-expression, address feelings of isolation, depression, anger and fear and to strengthen personal
resources.
OBJECTIVES:
To compare the effects of dance/movement therapy and standard care with standard care alone or standard
care and other interventions in patients with cancer.
SEARCH STRATEGY:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library
2011, Issue 2), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index,
CancerLit, International Bibliography of Theatre and Dance, Proquest Digital Dissertations, ClinicalTrials.
gov, Current Controlled Trials and the National Research Register (all to March 2011). We handsearched
dance/movement therapy and related topics journals, reviewed reference lists and contacted experts. There
was no language restriction.
SELECTION CRITERIA:
We included all randomized and quasi-randomized controlled trials of dance/movement therapy interventions
for improving psychological and physical outcomes in patients with cancer.
DATA COLLECTION AND ANALYSIS:
Two review authors independently extracted the data and assessed the methodological quality. Results were
presented using standardized mean differences.
MAIN RESULTS:
We included two studies with a total of 68 participants. No evidence was found for an effect of
dance/movement therapy on body image in women with breast cancer. The data of one study with moderate
risk of bias suggested that dance/movement therapy had a large beneficial effect on participants' quality of
life (QoL). The second trial reported a large beneficial effect on fatigue. However, this trial was at high risk
of bias. The individual studies did not find support for an effect of dance/movement therapy on mood,
distress,and mental health. It is unclear whether this was due to ineffectiveness of the treatment or limited
power of the trials. Finally, the results of one study did not find evidence for an effect of dance/movement
therapy on shoulder range of motion (ROM) or arm circumference in women who underwent a lumpectomy
or breast surgery. However, this was likely due to large within-group variability for shoulder ROM and a
limited number of participants with lymphedema.
AUTHORS' CONCLUSIONS:
We did not find support for an effect of dance/movement therapy on body image. The findings of one study
suggest that dance/movement therapy may have a beneficial effect on QoL. However, the limited number of
studies prevents us from drawing conclusions concerning the effects of dance/movement therapy on
psychological and physical outcomes in cancer patients.
PMID: 21975762 [PubMed - in process]
Clin Nucl Med. 2011 Nov;36(11):1031-2.
Scrotal lymphedema mimicking urine leakage.
Bozkurt H, Sürücü E, Bekiş R.
Source
From the Department of Nuclear Medicine, School of Medicine, Dokuz Eylül University, Izmir, Turkey.
Abstract
Tc-99m diethylene triamine pentaacetic acid (DTPA) dynamic renal scan is widely used to evaluate
urological complications after renal transplantation, especially for urine leakage. Although the most common
site of urine leakage is based on urethrovesical anastomoses, it can also be seen anywhere in the abdomen,
even in the scrotum. In our case, we showed scrotal lymphedema caused false-positive result for scrotal
urine leakage detected by Tc-99m DTPA dynamic renal scan.
PMID: 21975396 [PubMed - in process
J Tissue Viability. 2011 Nov;20(4):107. Epub 2011 Oct 5.
Tissue viability society update.
Hopkins A.
Source
Wound Care and Lymphoedema Service, Mile End Hospital, Bancroft Road, London E14DG, United
Kingdom.
PMID: 21975010 [PubMed - in process]
PM R. 2011 Oct 4. [Epub ahead of print]
Segmental Limb Volume Change as a Predictor of the Onset of Lymphedema in Women With Early Breast
Cancer.
Stout NL, Pfalzer LA, Levy E, McGarvey C, Springer B, Gerber LH, Soballe P.
Source
National Naval Medical Center, 8901 Wisconsin Avenue, Breast Care Center Bldg. 19, 3rd floor,
Bethesda, MD 20889-5600.
Abstract
OBJECTIVE:
To demonstrate that segmental changes along the upper extremity occur before the onset of breast cancer-
related lymphedema (BCRL). These changes may be subclinical in nature and may be predictive of the onset
of chronic lymphedema.
DESIGN:
A retrospective subset analysis of a larger prospective cohort trial. PATIENT COHORT: A total of 196
patients provided consent and were enrolled in the prospective study. Subclinical lymphedema developed in
46 of these patients. Limb volume data were available for 45 of these 46 patients from visits before the
onset of lymphedema and were used in this analysis. We compared this group with an age-matched control
group without BCRL from the same cohort (n = 45).
SETTING:
Military hospital outpatient breast care center.
METHODS:
Women were enrolled and assessed preoperatively. Baseline measures of limb volume were obtained with
the use of optoelectronic perometry, and reassessment was conducted at 1, 3, 6, 9, and 12 months
postoperatively. BCRL was identified in 46 of 196 women at an average of 6.9 months postoperatively. A
retrospective analysis was conducted in which we examined volume changes over four 10-cm segments of
the limb at the visits before the onset of BCRL. By using repeated-measures multivariate analysis of
variance, we compared segmental volumes between groups at preoperative baseline, time of diagnosis of
BCRL, and time of follow-up after early intervention. Linear regression analysis was performed to determine
the strength of the relationship between total limb volume change with segmental volumes at the time of
diagnosis of BCRL.
MAIN OUTCOME MEASUREMENTS:
We hypothesized that segmental volume changes occur and can be measured in the limb before the onset of
lymphedema.
RESULTS:
At arm segments 10-20 cm (P = .044) and 20-30 cm (P <.001), a significant volume increase was noted
before the diagnosis of subclinical BCRL. Segmental volume changes correlated to the total limb volume
(TLV) change. At segments 20-30 cm, the coefficient of determination was r(2) = 0.952, and at 10-20 cm
it was r(2) = 0.845, suggesting that these segments predicted TLV changes. Serial interval assessment of
limb volume segments may be an important clinical tool to detect early-onset lymphedema before TLV
changes.
Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc.
All rights reserved.
PMID: 21974905 [PubMed - as supplied by publisher]
Am J Physiol Cell Physiol. 2011 Sep 21. [Epub ahead of print]
Lymphatic function is regulated by a coordinated expression of lymphangiogenic and anti-lymphangiogenic
cytokines.
Zampell J, Avraham T, Yoder N, Fort N, Yan A, Weitman ES, Mehrara BJ.
Source
Memorial Sloan-Kettering Cancer Center.
Abstract
Lymphangiogenic cytokines such as vascular endothelial growth factor-C (VEGF-C) are critically required
for lymphatic regeneration; however, in some circumstances, lymphatic function is impaired despite normal
or elevated levels of these cytokines. The recent identification of anti-lymphangiogenic molecules such as
interferon-gamma (IFN-γ), transforming growth factor-beta 1, and endostatin has led us to hypothesize that
impaired lymphatic function may represent a dysregulated balance in the expression of pro/anti-
lymphangiogenic stimuli. We observed that nude mice have significantly improved lymphatic function as
compared with wild-type mice in a tail model of lymphedema. We show that gradients of lymphatic fluid
stasis regulate the expression of lymphangiogenic cytokines (VEGF-A, VEGF-C, and hepatocyte growth
factor) and that paradoxically, the expression of these molecules is increased in wild-type mice. More
importantly, we show that as a consequence of T-cell mediated inflammation, these same gradients also
regulate expression patterns of anti-lymphangiogenic molecules corresponding temporally and spatially with
impaired lymphatic function in wild-type mice. We show that neutralization of IFN-γ significantly increases
inflammatory lymph node lymphangiogenesis independently of changes in VEGF-A or VEGF-C expression,
suggesting that alterations in the balance of pro- and anti-lymphangiogenic cytokine expression can regulate
lymphatic vessel formation. In conclusion, we show that gradients of lymphatic fluid stasis regulate not only
the expression of pro-lymphangiogenic cytokines but also potent suppressors of lymphangiogenesis as a
consequence of T-cell inflammation and that modulation of the balance between these stimuli can regulate
lymphatic function.
PMID: 21940662 [PubMed - as supplied by publisher]
Eur J Surg Oncol. 2011 Sep 19. [Epub ahead of print]
Prevalence of lymphoedema more than five years after breast cancer treatment.
Lopez Penha TR, Slangen JJ, Heuts EM, Voogd AC, Von Meyenfeldt MF.
Source
Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht,
Netherlands.
Abstract
AIM:
A lack of consistency in the definition of breast cancer related lymphoedema (BCRL) and of uniform
measurement criteria contribute to the wide prevalence range found in current literature. This report aims to
describe the long-term prevalence of BCRL and secondly, to compare the long-term prevalence of BCRL
when assessed by two objective measures and one subjective measure.
METHODS:
The upper-limbs of 145 post-surgical breast cancer patients were evaluated for the presence of
lymphoedema using the water displacement method. Two circumference methods and patient perceived
swelling were applied secondarily for comparison. Limb measurements were performed once, more than
five years after surgery.
RESULTS:
The long-term prevalence of BCRL using water displacement was 8%. Prevalence varied when the sum of
arm circumference (SOAC), the arm circumference and the self-report methods were used: 16, 31 and
17% [P < 0.001], respectively. Of the women identified with BCRL using the water displacement technique,
82% were detected with the SOAC method, 82% with the arm circumference method and 91% by self-
report. Using water displacement as the gold standard the methods with the highest specificities were the
SOAC (90%) and self-report method (89%), arm circumference resulted in a low specificity of 73%.
CONCLUSION:
The prevalence of BCRL more than five years after surgical treatment differs depending on the measuring
method used. Our data underlines the necessity for consensus on the diagnostic criteria for BCRL.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21937192 [PubMed - as supplied by publisher]
October 24, 2011
Acta Trop. 2011 Sep;120 Suppl 1:S55-61. Epub 2011 Apr 4.
Efficacy of home-based lymphoedema management in reducing acute attacks in subjects with lymphatic
filariasis in Burkina Faso.
Jullien P, Somé J, Brantus P, Bougma RW, Bamba I, Kyelem D.
Source
Handicap International, 14 Avenue Berthelot, 69007 Lyon, France.
Abstract
One of the two main goals of the Global Programme to Eliminate Lymphatic Filariasis (LF) is to provide
care for those suffering from the devastating clinical manifestations of this filarial infection. Among the 120
million infected people worldwide, up to 16 million have lymphoedema. The WHO strategy for managing
lymphoedema is based on rigorous skin hygiene, exercise, antibiotics and antifungals when indicated. The
aim is to reduce acute attacks of adenolymphangitis and cellulitis responsible for lymphoedema progression
and disability. The objective of our study was to assess the effectiveness of home-based lymphoedema
management implemented by the national health system of Burkina Faso. Any patient was eligible to
participate in the study if suffering from LF-related lymphoedema of a lower limb at any stage, and receiving
care as part of the health education and washing project between April 2005 and December 2007. The
primary readout was the occurrence of an acute attack in the month preceding the consultation reported by
the patient or observed by the care-giver. In all, 1089 patients were enrolled in the study. Before
lymphoedema management intervention, 78.1% (95%CI: 75.5-80.5) of the patients had an acute attack in
the month preceding the consultation; after four and half months of lymphoedema management, this was
reduced to 39.1% (95%CI: 36.2-42.1). A reduction of acute attacks related to the number of consultations
or related to the patients' age and gender was not observed. Our results suggest that the home-based
lymphoedema management programme in the primary health care system of Burkina Faso is effective in
reducing morbidity due to LF in the short-term (4.5 months). The lymphoedema management requires no
additional human resources, but whether its effect can be sustained remains to be seen.
Copyright © 2011. Published by Elsevier B.V.
PMID: 21470557 [PubMed - in process]
Acta Trop. 2011 Sep;120 Suppl 1:S62-8. Epub 2011 Apr 4.
Rapid community identification, pain and distress associated with lymphoedema and adenolymphangitis due
to lymphatic filariasis in resource-limited communities of North-eastern Nigeria.
Akogun OB, Akogun MK, Apake E, Kale OO.
Source
The Elephantiasis Project, Common Heritage Foundation, No. 27 Shelter Road, Federal Housing Estate
Phase 2, Bajabure, Box 5124, Yola, Nigeria.
Abstract
Identification of communities with people that could benefit from adenolymphangitis (ADL) and
lymphoedema morbidity management within Lymphatic Filariasis Elimination Programmes (NLFEP) in many
African countries is a major challenge to programme managers. Another challenge is advocating for
proportionate allocation of funds to alleviating the suffering that afflicted people bear. In this study we
developed a rapid qualitative technique of identifying communities where morbidity management programme
could be situated and documenting the pain and distress that afflicted persons endure. Estimates given by
health personnel and by community resource persons were compared with systematic household surveys for
the number of persons with lymphoedema of the lower limb. Communities in Northeastern Nigeria, with the
largest number of lymphoedema cases were selected and a study of local knowledge, physical, psychosocial
burden and intervention-seeking activities associated with the disease documented using an array of
techniques (including household surveys, key informant interviews, group discussions and informal
conversations). Health personnel gave a more accurate estimate of the number of lymphoedema patients in
their communities than either the community leader or the community directed ivermectin distributor (CDD).
Community members with lymphoedema preferred to confide in health personnel from other communities.
The people had a well developed local vocabulary for lymphoedema and are well aware of the indigenous
transmission theories. Although the people associated the episodic ADL attacks with the rains which were
more frequent at that period they did not associate the episodes with gross lymphoedema. There were
diverse theories about lymphoedema causation with heredity, accidental stepping on charmed objects and
organisms, breaking taboos. The most popular belief about causation, however, is witchcraft (60.9%). The
episodic attacks are dreaded by the afflicted, since they are accompanied by severe pain (18%). The
emotional trauma included rejection (27.5%) by family, friends and other community members to the extent
that divorce and isolation are common. Holistic approach to lymphoedema morbidity management should
necessarily be an integral component of the ongoing transmission elimination programme. Any transmission
prevention effort that ignores the physical and psychological pain and distress that those already afflicted
suffer is unethical and should not be promoted.
Copyright © 2011 Elsevier B.V. All rights reserved.
PMID: 21470556 [PubMed - in process]
Acta Trop. 2011 Sep;120 Suppl 1:S69-75. Epub 2010 Oct 23.
Management of adenolymphangitis and lymphoedema due to lymphatic filariasis in resource-limited North-
eastern Nigeria.
Akogun OB, Badaki JA.
Source
The Elephantiasis Project, Common Heritage Foundation, No. 27 Shelter Road, Federal Housing Estate
Phase 2, Bajabure, Box 5124, Yola, Nigeria.
Abstract
Procedures for health facility-based management of lymphoedema and adenolymphangitis (ADL) have
proved very effective in some countries. Unfortunately, in resource-poor communities of Africa where health
facilities are few, overburdened and inaccessible, an alternative approach is required. Community-based
care (CC), patient care (PC) and health facility care (HC) approaches were compared. In the CC arm,
communities were required to select one of their members for care-giving to its affected members, while in
the PC, participants were allocated to groups under a leader with responsibility for care giving to group
members. In HC, care was given by the nearest health facility. Caregivers from the three arms were trained
and supplies were kept at the local government health office. At the sixth month of intervention, 325
lymphoedema and adenolymphangitis patients had been recruited into the study as participants. Within 12
months, compliance with hygiene practices increased from 29.4% to 62.6% and ADL episodes declined
from 43.1% to 4.4% in the community designs arm and the cost on the health system was minimal.
However, in the patient and health care arms, compliance and accessibility to supplies was severely affected
by poor coordination, delay in resource collection leading to very minimal effect on lesions, odour, ADL
frequency and duration. Participants abandoned the health facilities after the second visit. Community care
approach was more culturally acceptable and effective for the management lymphoedema and ADL than
other approaches.
Copyright © 2010 Elsevier B.V. All rights reserved.
PMID: 20974106 [PubMed - in process
J Cancer Surviv. 2011 Oct 16. [Epub ahead of print]
Exercise in patients with lymphedema: a systematic review of the contemporary literature.
Kwan ML, Cohn JC, Armer JM, Stewart BR, Cormier JN.
Source
Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA, 94612, USA, Marilyn.L.
Kwan@kp.org.
Abstract
BACKGROUND:
Controversy exists regarding the role of exercise in cancer patients with or at risk for lymphedema,
particularly breast. We conducted a systematic review of the contemporary literature to distill the weight of
the evidence and provide recommendations for exercise and lymphedema care in breast cancer survivors.
METHODS:
Publications were retrieved from 11 major medical indices for articles published from 2004 to 2010 using
search terms for exercise and lymphedema; 1,303 potential articles were selected, of which 659 articles
were reviewed by clinical lymphedema experts for inclusion, yielding 35 articles. After applying exclusion
criteria, 19 articles were selected for final review. Information on study design/objectives, participants,
outcomes, intervention, results, and study strengths and weaknesses was extracted. Study evidence was also
rated according to the Oncology Nursing Society Putting Evidence Into Practice® Weight-of-Evidence
Classification.
RESULTS:
Seven studies were identified addressing resistance exercise, seven studies on aerobic and resistance
exercise, and five studies on other exercise modalities. Studies concluded that slowly progressive exercise of
varying modalities is not associated with the development or exacerbation of breast cancer-related
lymphedema and can be safely pursued with proper supervision. Combined aerobic and resistance exercise
appear safe, but confirmation requires larger and more rigorous studies.
CONCLUSIONS:
Strong evidence is now available on the safety of resistance exercise without an increase in risk of
lymphedema for breast cancer patients. Comparable studies are needed for other cancer patients at risk for
lymphedema. IMPLICATIONS FOR CANCER SURVIVORS: With reasonable precautions, it is safe for
breast cancer survivors to exercise throughout the trajectory of their cancer experience, including during
treatment.
PMID: 22002586 [PubMed - as supplied by publisher]
Cytotherapy. 2011 Nov;13(10):1249-55.
Autologous stem cells for the treatment of post-mastectomy lymphedema: a pilot study.
Maldonado GE, Pérez CA, Covarrubias EE, Cabriales SA, Leyva LA, Pérez JC, Almaguer DG.
Source
Hospital Universitario 'Dr José Eleuterio González', Universidad Autónoma de Nuevo León , México.
Abstract
Abstract Background aims. Lymphedema is a common complication with breast cancer treatment that does
not have a definite cure. Our objective was to determine the efficacy of autologous stem cells (ASC) in the
treatment of lymphedema secondary to mastectomy and axillary lymphadenectomy in comparison with
traditional decongestive treatment with compression sleeves. Methods. A prospective study including 20
women with lymphedema secondary to breast cancer surgery with axillary lymphadenectomy was
conducted. Women were assigned at random to one of two groups. One group of 10 women was injected
with ASC in the affected arm, whereas the other 10 women comprised the control group and received
traditional compression sleeve therapy (CST). The follow-up for both groups was 12 weeks. Pain,
sensitivity and mobility were assessed before and after therapy. Results. There was improvement in the
volume of lymphedema in both groups, with no significant difference. In the ASC group there was an overall
volume reduction during the follow-up, whereas in the CST group lymphedema recurred after the
compression sleeve was removed. Conclusions. Our findings suggest that ASC injection for patients with
lymphedema can be an effective treatment. It reduces arm volume and associated co-morbidities of pain and
decreased sensitivity. Traditional CST was also effective for lymphedema reduction, but it was dependent
on continuous use of the treatment.
PMID: 21999374 [PubMed - in process]
Int J Gynecol Cancer. 2011 Nov;21(8):1495-9.
Do surgical techniques used in groin lymphadenectomy for vulval cancer affect morbidity rates?
Walker KF, Day H, Abu J, Nunns D, Williamson K, Duncan T.
Source
*Derby Royal Hospital, Derby; †Royal Albert Edward Infirmary, Lancashire; ‡Nottingham University
Hospitals, Nottingham; and §Norfolk and Norwich University Hospital, Norwich, UK.
Abstract
OBJECTIVE:
: To determine the complication rates associated with differing surgical techniques for groin node dissection
for vulval cancer.
MATERIALS AND METHODS:
: We performed a retrospective case note review of patients undergoing groin node dissection for vulval
cancer between 2001 and 2009 at Nottingham University Hospitals NHS Trust.
RESULTS:
: Notes for 56 patients undergoing a total of 98 groin node dissections were examined. Sixty-four percent of
the patients had at least one complication from surgery. The use of suction drains was not associated with an
increase in complications. However, when drains were used, a short duration of use was associated with
high rates of wound breakdown and a long duration of use was associated with higher rates of lymphedema.
The use of staples for skin closure was associated with an increased risk of lymphocysts and chronic
lymphedema. The greater the number of nodes collected at lymphadenectomy, the higher the risk of
lymphocysts and lymphedema.
CONCLUSIONS:
: We recommend the use of subcuticular suture for wound closure. Patients who undergo lymphadenectomy
with a node count per groin of more than 7 should be closely monitored for lymphedema and referred
promptly to specialist services. The prolonged use of suction drainage may increase the risk of lymphedema.
PMID: 21997167 [PubMed - in process]
Scand J Immunol. 2011 Oct 13. doi: 10.1111/j.1365-3083.2011.02653.x. [Epub ahead of print]
T- and B-cell Deficiency Associated with Yellow Nail Syndrome.
Gupta S, Samra D, Yel L, Agrawal S.
Source
Division of Basic and Clinical Immunology, University of California, Irvine, California.
Abstract
Yellow nail syndrome (YNS) is a rare disorder of unknown etiology that is characterized by yellow nails
associated with lymphedema, and chronic respiratory manifestations. There are no detailed immunological
studies in YNS. In this study we present first extensive immunological analysis of both adaptive and innate
immunity in two patients with YNS. One patient has common variable immunodeficiency, whereas, second
patient has specific antibody deficiency syndrome. Severe lymphopenia, and a striking deficiency of naïve
CD4+ and CD8+ T cells and total B cells, and increased transitional B cells were observed. T cell
proliferative response to mitogens and antigens were significantly reduced in both patients. Both patients
failed to make specific antibody response to pneumococci. Complement, NK cell activity, and neutrophil
oxidative burst were normal. Immunoglobulin administration resulted in decreased frequency and severity of
infections, and an impressive effect was observed on lymphedema and on the recurrence of pleural effusion.
Our data show that YNS is associated with both T and B cell defects. Furthermore, Immunoglobulin may be
beneficial in clinical manifestations of lymphedema.
Copyright © 2011 Blackwell Publishing Ltd.
PMID: 21995335 [PubMed - as supplied by publisher]