Page updated
11/30/11
11/30/11
 |
| |
 |
| |
 |
Lymphland International Lymphedema Online
September 5, 2011
Wkly Epidemiol Rec. 2011 Aug 5;86(32):341-51.
Meeting of the International Task Force for Disease Eradication, April 2011.
[Article in English, French]
[No authors listed]
PMID: 21837843 [PubMed - indexed for MEDLINE]
Int Wound J. 2011 Aug 17. doi: 10.1111/j.1742-481X.2011.00832.x. [Epub ahead of print]
The experience of patients with lymphoedema undergoing a period of compression bandaging in the UK and
Canada using the 3M™ Coban™ 2 compression system.
Morgan PA, Murray S, Moffatt CJ, Young H.
Source
PA Morgan, RN, EdD, Centre for Research and Implementation of Clinical Practice, London, UK S
Murray, RN, MA, Department of Lymphoedema, Royal Derby Hospital, Derby Hospitals NHS Foundation
Trust, Uttoxeter Road, Derby DE22 3NE, UK CJ Moffatt, RN, PhD, Department of Lymphoedema, Royal
Derby Hospital, Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK and
Division of Nursing and Healthcare, University of Glasgow, Glasgow G12 8LW, UK H Young, RN, MSc,
St Giles Hospice, Fisherwick Road, Whittington, Staffordshire WS14 9YT, UK.
Abstract
This article reports on a qualitative study that explored the experience of patients who have undergone a
period of complete decongestive therapy using the 3M™ Coban™ 2 compression system (Coban 2
system). Qualitative data were collected from 12 patients from the UK and 8 from Canada with a range of
presentations of lymphoedema. Single semi-structured interviews were used and participants were asked
questions relating to their experience of diagnosis, the impact of lymphoedema on their lives, previous
treatment using multilayer lymphoedema bandaging and their experiences of the 3M™ Coban™ 2 system.
Treatment with multilayer lymphoedema bandaging was seen as constraining in that it was tiring, time
consuming, heavy, bulky and led to feelings of clumsiness and a restricted life. Treatment with the 3M™
Coban™ 2 system was reported as enabling in that it was quicker and easier to apply, increased mobility,
enhanced patient confidence and provided a sense of control and well-being. The article also explores how
aspects of the 3M™ Coban™ 2 system might be improved from the patient's point of view.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
PMID: 21848728 [PubMed - as supplied by publisher]
Int Wound J. 2011 Aug 17. doi: 10.1111/j.1742-481X.2011.00845.x. [Epub ahead of print]
The challenges of managing complex lymphoedema/chronic oedema in the UK and Canada.
Morgan PA, Murray S, Moffatt CJ, Honnor A.
Source
PA Morgan, RN, EdD, Centre for Research and Implementation of Clinical Practice, St Luke's Crypt,
Sydney Street, London SW3 6NH, UK S Murray, RN, MA, Royal Derby Hospital, Derby Hospitals NHS
Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK CJ Moffatt, RN, PhD, Royal Derby Hospital,
Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK. Faculty of Medicine,
Division of Nursing and Healthcare, University of Glasgow, Glasgow G12 8LW, UK A Honnor, RN, BSc,
MSc, LOROS Hospice, Groby Road, Leicester LE3 9QE, UK.
Abstract
This article explores the professional challenges of treating patients with complex/severe forms of chronic
oedema/lymphoedema with compression therapy. Four focus groups were held, two in the UK and two in
Canada, to examine the challenges faced by practitioners in their everyday practice. A number of challenges
were identified by participants in both countries and include the changing profile of lymphoedema/chronic
oedema and how increasing complexity is outpacing the development of services and research-based
guidelines. Focus groups also highlighted a lack of public awareness, poor professional knowledge, delayed
diagnosis and inappropriate treatment as having a significant impact on practice. Other practice-related
issues include a poor understanding of treatment options among practitioners, a lack of evidence-based
practice as well as difficulties associated with managing psychosocial problems and of ensuring concordance
with treatment. In Canada, services tend to be more rural and remote than in the UK, autonomous specialist
practice is less developed and practitioners were generally less confident and felt more vulnerable than their
UK colleagues. There is a need for integrated, multi-disciplinary services in both countries, with improved
education and training, as well as the development of cost-effective compression bandaging systems that can
make a major contribution to meeting the challenges of contemporary lymphoedema practice.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
PMID: 21848727 [PubMed - as supplied by publisher]
Infect Immun. 2011 Aug 29. [Epub ahead of print]
Filarial Lymphatic Pathology Reflects Augmented TLR-mediated, MAPK-mediated Pro-inflammatory
Cytokine Production.
Babu S, Anuradha R, Pavan Kumar N, George PJ, Kumaraswami V, Nutman TB.
Source
National Institutes of Health-International Center for Excellence in Research, Chennai, India.
Abstract
Lymphatic filariasis can be associated with the development of serious pathology in the form of lymphedema,
hydrocele, and elephantiasis in a subset of infected patients. Toll-like receptors (TLRs) are thought to play a
major role in the development of filarial pathology. To elucidate the role of TLRs in the development of
lymphatic pathology, we examined cytokine responses to different Toll ligands in patients with lymphatic
pathology (CP), infected patients with subclinical pathology (INF), and uninfected, endemic normal (EN)
individuals. TLR 2, 7 and 9 ligands induced significantly elevated production of Th1 and other pro-
inflammatory cytokines in CP patients in comparison to both INF and EN. TLR adaptor expression was not
significantly different among the groups; however, both TLR2 and TLR9 ligands induced significantly higher
levels of phosphorylation of ERK1/2 and p38 MAP kinases as well as increased activation of NF-κB in CP
individuals. Pharmacologic inhibition of both ERK1/2 and p38 MAP kinase pathways resulted in significantly
diminished production of pro-inflammatory cytokines in CP individuals. Our data, therefore, strongly suggest
an important role for TLR2- and TLR9-mediated pro-inflammatory cytokine induction and activation of
both the MAPK and NF-κB pathways in the development of pathology in human lymphatic filariasis.
PMID: 21875961 [PubMed - as supplied by publisher]
J Altern Complement Med. 2011 Sep;17(9):867-9.
Lymphedema after breast or gynecological cancer: use and effectiveness of mainstream and complementary
therapies.
Finnane A, Liu Y, Battistutta D, Janda M, Hayes SC.
Source
1 School of Public Health, Queensland University of Technology , Brisbane, Queensland, Australia .
Abstract
Abstract Objectives: The purpose of this study was to describe the use, as well as perceived effectiveness,
of mainstream and complementary and alternative medicine (CAM) therapies in the treatment of
lymphedema following breast or gynecological cancer. Further, the study assessed the relationship between
the characteristics of lymphedema (including type, severity, stability, and duration), and the use of CAM
and/or mainstream treatment. Methods: This was a cross-sectional study using a convenience sample of
women with lymphedema following breast and gynecological cancers. A self-administered questionnaire was
sent to 247 potentially eligible women. Of those returned (50%), 23 were ineligible and 6 were excluded
due to level of missing data. Results: In the previous 12 months, the majority of women (90%) had used
mainstream treatments to treat their lymphedema, with massage being the most commonly used (86%). One
(1) in 2 women had used CAM to treat their lymphedema, and 98% of those using CAM were also using
mainstream treatments. Over 27 types of CAM were reported, with use of a chi machine, vitamin E
supplements, yoga, and meditation being the most commonly reported forms. The perceived effectiveness
ratings (1-7 with 7=completely effective) of mainstream (mean±standard deviation (SD): 5.3±1.5) and
CAM therapies (mean±SD: 5.2+1.6) were considered high. Conclusions: These results demonstrate that
mainstream and CAM treatment use is common, varied, and considered to be effective among women with
lymphedema following breast or gynecological cancer. Furthermore, it highlights the immediate need for
larger prospective studies assessing the inter-relationship between the use of mainstream and CAM
therapies for treatment success.
PMID: 21875352 [PubMed - in process]
Phys Ther. 2011 Aug 25. [Epub ahead of print]
Complete Decongestive Physical Therapy in a Patient With Secondary Lymphedema Due to Orthopedic
Trauma and Surgery of the Lower Extremity.
Cohen MD.
Source
a home-based and outpatient therapy practice focusing on lymphedema management in Nassau County,
New York. Dr Cohen was a clinical specialist at New York Presbyterian Hospital-Weill Cornell Medical
Center, New York, New York, at the time of the case report.
Abstract
BACKGROUND AND PURPOSE:
/b>This case report describes a patient who developed lower-extremity lymphedema secondary to
orthopedic trauma and surgery and reports the response to complete decongestive physical therapy (CDP),
with 8 treatment sessions over 3 months.
CASE DESCRIPTION:
/b>The patient was a 56-year-old man who sustained a right ankle displaced fibular fracture, underwent
open reduction internal fixation surgery 12 days later, and developed lymphedema 4 months postinjury. The
patient's impairments of the right lower extremity included increased girth, decreased ankle range of motion,
and increased pain. Due to these impairments and the inability to fit into normal footwear, the patient limited
activities such as ambulating long distances and climbing stairs. This limited activity restricted him from
participating in his normal lifestyle activities such as walking his dog in the community and performing all
necessary work duties.
OUTCOMES:
/b>Using the truncated cone formula to measure limb volume, the limb volume of the right (involved) lower
extremity decreased 368 mL as a result of CDP. The percentage of difference in limb volume between the
right and left lower extremities at the initial examination was 9%, and it was reduced to less than 1% at
discharge. He was independent with his home program in order to maintain the results of therapy.
CONCLUSION:
/b>Physical therapy management of secondary lymphedema due to orthopedic trauma and surgery of the
lower extremity resulted in decreased circumferential girth measurements and decreased limb volume,
thereby improving gait and allowing the patient to fit into his work and leisure shoes. The patient reported
improvement in his ability to perform all work activities, and he returned to his prior level of participation in
the community.
PMID: 21868611 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Aug 24. [Epub ahead of print]
The Surgical Treatment of Lymphedema: A Systematic Review of the Contemporary Literature (2004-
2010).
Cormier JN, Rourke L, Crosby M, Chang D, Armer J.
Source
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA,
jcormier@mdanderson.org.
Abstract
PURPOSE:
A systematic review of the literature was performed to examine contemporary peer-reviewed literature
(2004-2010) evaluating the surgical treatment of lymphedema.
METHODS:
A comprehensive search of 11 major medical indices was performed. Selected articles were sorted to
identify those related to the surgical treatment of lymphedema. Extracted data included the number of
patients, specific surgical procedure performed, length of follow-up, criteria for defining lymphedema,
measurement methods, volume or circumference reduction, and reported complications.
RESULTS:
A total of 20 studies met inclusion criteria; procedures were categorized as excisional procedures (n = 8),
lymphatic reconstruction (n = 8), and tissue transfer (n = 4). The reported incidence of volume reduction of
lymphedema in these studies varied from 118% reduction to a 13% increase over the follow-up intervals
ranging from 6 months to 15 years. The largest reported reductions were noted after excisional procedures
(91.1%), lymphatic reconstruction (54.9%), and tissue transfer procedures (47.6%). Procedure
complications were rarely reported.
CONCLUSIONS:
A number of surgical approaches have demonstrated beneficial effects for select patients with lymphedema.
Most of these reports, however, are based on small numbers of patients, use nonstandardized or
inconsistent measurement techniques, and lack long-term follow-up. The proposed benefits of any surgical
approach should be evaluated in the context of the potential morbidity to the individual patient and the
availability of surgical expertise. In addition, although these surgical techniques have shown promising results,
nearly all note that the procedures do not obviate the need for continued use of conventional therapies,
including compression, for long-term maintenance.
PMID: 21863361 [PubMed - as supplied by publisher]
Cancer Treat Rev. 2011 Aug 17. [Epub ahead of print]
Electrochemotherapy of chest wall breast cancer recurrence.
Sersa G, Cufer T, Paulin SM, Cemazar M, Snoj M.
Source
Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia.
Abstract
Chest wall breast cancer recurrence after mastectomy is a disease difficult to treat. Its incidence varies
between 5% and 30% in different subset of patients. When possible, radical surgical therapy represents the
main treatment approach, however when the disease progresses and/or treatments are not successful,
ulceration, bleeding, lymphedema and psychological distress of progressive disease significantly decrease the
quality of the remaining life of a patient. When surgical excision of chest wall recurrence is not possible, other
local treatments such as radiotherapy, radiotherapy with hyperthermia, topical chemotherapy and
electrochemotherapy might be taken into account. Electrochemotherapy provides safe, efficient and non-
invasive locoregional treatment approach for chest wall breast cancer recurrence. Several clinical studies
have demonstrated high efficacy and a good safety profile of electrochemotherapy applied in single or
multiple consecutive sessions, till clinical response was reached. Electrochemotherapy can be performed
either with cisplatin injected intratumorally or with bleomycin given intratumorally or intravenously.
Furthermore, it can be effectively used in heavily pre-treated areas, after surgery, radiotherapy or systemic
chemotherapy. These are the advantages that might demand its use especially in patients with pre-treated
extensive disease and in frail elderly patients. With development of the technology electrochemotherapy
could even be suggested as a primary local therapy in patients not suitable for surgical removal of the
primary tumor.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21856080 [PubMed - as supplied by publisher
Clin Dermatol. 2011 Sep-Oct;29(5):483-8.
Opportunistic localization of skin lesions on vulnerable areas.
Ruocco V, Ruocco E, Brunetti G, Sangiuliano S, Wolf R.
Source
Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Napoli, Italy.
Abstract
Genetic, developmental, and immune defects can make certain anatomic areas of the body more prone than
others to harbor skin lesions. Cutaneous areas with skin barrier dysfunction (eg, atopic dermatitis) are the
clearest example of vulnerable sites where opportunistic diseases, mainly infections (eg, herpes simplex), can
easily occur. Somatic mosaicism, by giving rise to mutated cell clones with a bandlike arrangement, may
form tissue segments prone to developing congenital or acquired skin disorders. Cutaneous districts that
have been infected by herpes viruses become sites permissive for a subsequent onset of heterogeneous skin
disorders, mainly tumors, further infections, and disimmune reactions (Wolf isotopic response). Regional
lymphedema, by impairing lymph circulation and consequently the local immune control, favors the location
of immunity-related lesions in the involved district. A vast series of skin injuries, such as ionizing or ultraviolet
radiation, burns, traumas, and even vaccinations, can render the affected areas vulnerable to subsequent
cutaneous disorders. Lack of immune control, ensuing from locally altered neuroimmune interaction, may be
the basic defect responsible for the opportunistic location of skin lesions in herpes-infected,
lymphedematous, or otherwise damaged areas, together featuring the novel concept of
"immunocompromised district."
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21855722 [PubMed - in process]
September 8, 2011
J Glob Infect Dis. 2011 Jul;3(3):227-32.
Impact of basic lymphedema management and antifilarial treatment on acute dermatolymphangioadenitis
episodes and filarial antigenaemia.
El-Nahas H, El-Shazly A, Abulhassan M, Nabih N, Mousa N.
Source
Department of Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Abstract
BACKGROUND:
A major factor in the progression of lymphedema is acute dermatolymphangioadenitis (ADLA).
AIMS:
To study ADLA episodes and antigenaemia in patients with different grades of filarial lymphedema at pre-
and two years post-treatment.
SETTING AND DESIGN:
A prospectively conducted study from May 2008 through May 2010.
PATIENTS AND METHODS:
Forty five patients complaining of limb swelling with present or past history of limb redness suggestive of
ADLA attacks were included. Patients were clinically examined for lymphedema grading, detection of
potential entry points and diagnosis of microfilaraemia. Wuchereria bancrofti antigen titer was estimated by
"Trop-Ag W. Bancrofti" ELISA kit. Basic lymphedema management and treatment with antifilarial drugs
were applied.
STATISTICAL ANALYSIS:
Mann-Whitney test and Chi-square test were used.
RESULTS:
The number of ADLA attacks in the pretreatment period, ranged from one to three per year. Mean duration
of the attacks was 3.87±0.79 days. Entry points were detected in 82% of cases. The study revealed
statistical significance between extension and grade of lymphedema and number of ADLA attacks per year
(P=0.018 and 0.022, respectively). Microfilaraemia was detected in four cases and positive filarial
antigenaemia were detected in 29 patients (64.4). The number of ADLA attacks per year significantly
decreased from the pre-treatment period (mean: 2.05±0.560) to be 1.23±0.706 after one year and 0.89±0.
575 after two years post treatment. There was a significant decrease in the mean antigen titer one year and
two years after treatment.
CONCLUSION:
Basic lymphedema management is effective for controlling ADLA attacks in areas where lymphatic filariasis
is endemic.
PMID: 21887053 [PubMed - in process] PMCID: PMC3162808
BMJ. 2011 Sep 1;343:d5326. doi: 10.1136/bmj.d5326.
Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related
to breast cancer: randomised controlled trial.
Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets A, Leunen K, Neven P, Van Kampen M.
Source
Department of Rehabilitation Sciences, Katholieke Universiteit Leuven and Department of Physiotherapy,
University Hospitals Leuven, Leuven, Belgium.
Abstract
OBJECTIVE:
To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to
breast cancer.
DESIGN:
Randomised single blinded controlled trial.
SETTING:
University Hospitals Leuven, Leuven, Belgium.
PARTICIPANTS:
160 consecutive patients with breast cancer and unilateral axillary lymph node dissection. The randomisation
was stratified for body mass index (BMI) and axillary irradiation and treatment allocation was concealed.
Randomisation was done independently from recruitment and treatment. Baseline characteristics were
comparable between the groups.
INTERVENTION:
For six months the intervention group (n=79) performed a treatment programme consisting of guidelines
about the prevention of lymphoedema, exercise therapy, and manual lymph drainage. The control group
(n=81) performed the same programme without manual lymph drainage.
MAIN OUTCOME MEASURES:
Cumulative incidence of arm lymphoedema and time to develop arm lymphoedema, defined as an increase in
arm volume of 200 mL or more in the value before surgery.
RESULTS:
Four patients in the intervention group and two in the control group were lost to follow-up. At 12 months
after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention
group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P=0.45). The
time to develop arm lymphoedema was comparable between the two group during the first year after
surgery (hazard ratio 1.3, 0.6 to 2.5; P=0.49). The sample size calculation was based on a presumed odds
ratio of 0.3, which is not included in the 95% confidence interval. This odds ratio was calculated as
(presumed cumulative incidence of lymphoedema in intervention group/presumed cumulative incidence of no
lymphoedema in intervention group)×(presumed cumulative incidence of no lymphoedema in control
group/presumed cumulative incidence of lymphoedema in control group) or (10/90)×(70/30).
CONCLUSION:
Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for
breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphoedema in
the short term. Trial registration Netherlands Trial Register No NTR 1055.
PMID: 21885537 [PubMed - in process]
September 24, 2011
Plast Reconstr Surg. 2011 Oct;128(4):372e.
Reply: acute lymphedema of the eyelid after major reconstruction of the medial canthus: the role of the
lymphatic drainage pattern.
Pan WR, Le Roux CM, Briggs CA.
Source
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology,
University of Melbourne, Melbourne, Victoria, Australia.
PMID: 21921753 [PubMed - in process]
Plast Reconstr Surg. 2011 Oct;128(4):370e-2e.
Acute lymphedema of the eyelid after major reconstruction of the medial canthus: the role of the lymphatic
drainage pattern.
Aveta A, Tenna S, Segreto F, Cagli B, Brunetti B, Marangi GF, Persichetti P.
Source
Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy.
PMID: 21921751 [PubMed - in process]
Plast Reconstr Surg. 2011 Oct;128(4):314e-21e.
The earliest finding of indocyanine green lymphography in asymptomatic limbs of lower extremity
lymphedema patients secondary to cancer treatment: the modified dermal backflow stage and concept of
subclinical lymphedema.
Yamamoto T, Matsuda N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M, Narushima
M, Iida T, Koshima I.
Source
Tokyo, Japan From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine,
University of Tokyo.
Abstract
BACKGROUND:
: Early diagnosis and treatment are as important for management of secondary lymphedema following cancer
treatment as in primary cancer treatment. Indocyanine green lymphography is the modality of choice for
routine follow-up evaluation of patients at high risk of developing lymphedema after cancer therapy.
METHODS:
: Fifty-six limbs of 28 so-called unilateral secondary lower extremity lymphedema patients who underwent
indocyanine green lymphography were compared with dermal backflow patterns of indocyanine green
lymphography on 28 asymptomatic limbs and assessed using leg dermal backflow stage.
RESULTS:
: Of 28 asymptomatic limbs of secondary lower extremity lymphedema patients, the dermal backflow
patterns were detected in 19 limbs but were absent in nine limbs. Significant differences were seen between
asymptomatic limbs with dermal backflow patterns (n = 19) and limbs without them (n = 9): age, 51.4 ±
15.3 years versus 34.8 ± 12.7 years (p = 0.007); body weight, 75.1 ± 7.9 kg versus 50.1 ± 5.3 kg (p =
0.012); body mass index, 23.1 ± 4.2 versus 19.7 ± 1.8 (p = 0.005); leg dermal backflow stage of
asymptomatic limb, 1.2 ± 0.4 versus 0.0 ± 0.0 (p < 0.001); and leg dermal backflow stage of symptomatic
limb, 3.5 ± 0.6 versus 2.8 ± 0.8 (p = 0.033).
CONCLUSIONS:
: The splash pattern is the earliest finding on indocyanine green lymphography of asymptomatic limbs of
secondary lower extremity lymphedema patients. The leg dermal backflow stage allows early diagnosis of
secondary lower extremity lymphedema even in a subclinical stage. The concept of subclinical lymphedema
could play an important role in early diagnosis and prevention of lymphedema after cancer treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE:: Diagnostic, V.
PMID: 21921744 [PubMed - in process]
Phys Ther. 2011 Sep 15. [Epub ahead of print]
Breast Cancer-Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a
Traditional Model of Care.
Stout NL, Pfalzer LA, Springer B, Levy E, McGarvey CL, Danoff JV, Gerber LH, Soballe PW.
Source
N.L. Stout, MPT, CLT-LANA, National Naval Medical Center, Breast Care Center, 8901 Wisconsin
Ave, Bldg 10, 4 West, Bethesda, MD 20814 (USA).
Abstract
Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases
such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often
negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in
early identification and treatment of breast cancer-related lymphedema (BCRL). Early intervention may
reduce the need for intensive rehabilitation and be cost saving. This perspective article compares a
prospective surveillance model with a traditional model of impairment-based care and examines direct
treatment costs associated with each program. Intervention and supply costs were estimated based on the
Medicare 2009 physician fee schedule for 2 groups: (1) a prospective surveillance model group (PSM
group) and (2) a traditional model group (TM group). The PSM group comprised all women with breast
cancer who were receiving interval prospective surveillance, assuming that one third would develop early-
stage BCRL. The prospective surveillance model includes the cost of screening all women plus the cost of
intervention for early-stage BCRL. The TM group comprised women referred for BCRL treatment using a
traditional model of referral based on late-stage lymphedema. The traditional model cost includes the direct
cost of treating patients with advanced-stage lymphedema. The cost to manage early-stage BCRL per
patient per year using a prospective surveillance model is $636.19. The cost to manage late-stage BCRL
per patient per year using a traditional model is $3,124.92. The prospective surveillance model is emerging
as the standard of care in breast cancer treatment and is a potential cost-saving mechanism for BCRL
treatment. Further analysis of indirect costs and utility is necessary to assess cost-effectiveness. A shift in the
paradigm of physical therapy toward a prospective surveillance model is warranted.
PMID: 21921254 [PubMed - as supplied by publisher]
Eur J Pediatr. 2011 Sep 15. [Epub ahead of print]
Hydrops fetalis and pulmonary lymphangiectasia due to FOXC2 mutation: an autosomal dominant hereditary
lymphedema syndrome with variable expression.
de Bruyn G, Casaer A, Devolder K, Van Acker G, Logghe H, Devriendt K, Cornette L.
Source
University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium, gwendolyn.debruyn@uzleuven.be.
Abstract
Non-immune hydrops fetalis may find its origin within genetically determined lymphedema syndromes,
caused by mutations in FOXC2 and SOX-18. We describe a newborn girl, diagnosed with non-immune
hydrops fetalis at a gestational age of 30 weeks. Family history revealed the presence of an autosomal
dominant late-onset form of lymphedema of the lower limbs in her father, associated with an aberrant
implantation of the eyelashes in some individuals. The newborn, hydropic girl suffered from severe
pulmonary lymphangiectasia, resulting in terminal respiratory failure at the age of 3 months. Genetic analysis
in both the father and the newborn girl demonstrated a heterozygous FOXC2 mutation, i.e., c.939C>A, p.
Tyr313X. Her two older sisters are currently asymptomatic and the parents decided not to test them for the
FOXC2 mutation. Conclusion: Patients with a mutation in the FOXC2 transcription factor usually show
lower limb lymphedema with onset at or after puberty, together with distichiasis. However, the eye
manifestations can be very mild and easily overlooked. The association between FOXC2 mutation and
neonatal hydrops resulting in terminal respiratory failure is not reported so far. Therefore, in sporadic
patients diagnosed with non-immune hydrops fetalis, lymphangiogenic genes should be systematically
screened for mutations. In addition, all cases of fetal edema must prompt a thorough analysis of the familial
pedigree, in order to detect familial patterns and to facilitate adequate antenatal counseling.
PMID: 21918810 [PubMed - as supplied by publisher]
September 24, 2011
J Cancer Res Clin Oncol. 2011 Sep 21. [Epub ahead of print]
Safety study of axillary reverse mapping in the surgical treatment for breast cancer patients.
Deng H, Chen L, Jia W, Chen K, Zeng Y, Rao N, Li S, Jin L, Su F.
Source
Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiangxi
Road, Guangzhou, 510120, People's Republic of China.
Abstract
PURPOSE:
With the purpose of minimizing arm lymphedema after axillary staging surgeries in breast cancer patients, the
axillary reverse mapping (ARM) technique has been developed to identify and preserve arm drainage
system during axillary surgery. This study aimed to clarify risk factors for metastasis in arm lymphatic
drainage system in breast cancer patients with clinically negative axillary nodes.
METHODS:
Sixty-nine patients who underwent successful both sentinel lymph node (SLN) biopsy (SLNB) and ARM
from October 2009 to August 2010 were enrolled in this study. Radioactive tracer was used for SLN
localization and blue dye was used for ARM. All of the identified SLNs and ARM nodes were sent for
pathological assessment.
RESULTS:
ARM nodes metastasis occured in 6 of 69 patients. Age, pathological tumor size (pT) and pathological
lymph node status (pN) were not associated with ARM nodes metastasis (P > 0.01). Interestingly, in these
6 patients, all metastatic ARM nodes coincided with SLN-ARM nodes (hot SLN and blue ARM node
were the same lymph node). In 50 of 69 patients whose ARM nodes did not coincided with SLNs, all
ARM nodes were negative, even in 12 patients with metastatic SLNs.
CONCLUSION:
Crossover between breast and ipsilateral arm lymphatic drainage system contributes for ipsilateral arm
lymph node metastasis. When ARM and SLNB are simultaneously performed in a patient, selectively
preservation of the ARM nodes that do not coincided with SLNs would be safe, even if the SLNs are
positive. Pathological lymph node status does not account for the occurrence of metastasis in ARM nodes.
ARM nodes could be preserved safely, independent of the pathological lymph node status.
PMID: 21935615 [PubMed - as supplied by publisher]
J Eur Acad Dermatol Venereol. 2011 Sep 20. doi: 10.1111/j.1468-3083.2011.04265.x. [Epub ahead of
print]
Skin manifestations of obesity: a comparative study.
Boza JC, Trindade EN, Peruzzo J, Sachett L, Rech L, Cestari TF.
Source
Department of Dermatology, Federal University of Rio Grande do Sul (UFRGS), Hospital de Clínicas de
Porto Alegre (HCPA), Porto Alegre, Brazil.
Abstract
Background Obesity is one of the world's biggest health problems nowadays. Little research has been
done on the skin diseases that affect obese patients. Objective To study the prevalence of skin
manifestations in obese patients compared with a control group of normal-weight patients. Methods A
total of 76 obese patients [body mass index (BMI) ≥30 kg/m(2) ] and 73 with normal-weight volunteers
(BMI 18.5-24.9 kg/m(2) ) were included in the study and had their complete medical history and skin
examination evaluated by the same examiner. All patients were investigated for the presence of metabolic
syndrome. Results The dermatoses that showed a statistically significant relationship with obesity,
compared with the control group were: striae (P < 0.001), plantar hyperkeratosis (P < 0.001),
acrochordons (P = 0.007), intertrigo (P < 0.001), pseudoacanthosis nigricans (P < 0.001),
keratosis pilaris (P = 0.006), lymphedema (P = 0.002) and bacterial infections (P = 0.05). The
presence of striae, pseudoacanthosis nigricans and bacterial infections were also found to be correlated with
the degree of obesity. Conclusions Obesity is strongly related to several skin alterations that could be
considered as markers of excessive weight. Skin care of obese patients deserves particular attention, not
only because of the high prevalence of cutaneous alteration but mainly because many of these disorders are
preventable and could be treated, improving patient's quality of life.
© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011
European Academy of Dermatology and Venereology.
PMID: 21929550 [PubMed - as supplied by publisher
September 19, 2011
Nat Genet. 2011 Sep 4. doi: 10.1038/ng.923. [Epub ahead of print]
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 - as supplied by publisher]
Wkly Epidemiol Rec. 2011 Aug 26;86(35):377-88.
Global Programme to eliminate lymphatic filariasis: progress report on mass drug administration, 2010.
[Article in English, French]
[No authors listed]
September 19, 2011
Jpn J Clin Oncol. 2011 Sep 8. [Epub ahead of print]
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
1Department of Radiation Oncology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic
University of Korea, Suwon.
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 - as supplied by publisher]
September 19, 2011
Int Wound J. 2011 Sep 13. doi: 10.1111/j.1742-481X.2011.00851.x. [Epub ahead of print]
Prevalence of lymphoedema and quality of life among patients attending a hospital-based wound
management and vascular clinic.
Gethin G, Byrne D, Tierney S, Strapp H, Cowman S.
Source
G Gethin, PhD, HE Dip. Wound Care, RGN, Dip. Anatomy, Dip. Applied Physiology, FFNMRCSI,
Centre for Nursing and Midwifery Research, Royal College of Surgeons in Ireland, Dublin, Ireland D Byrne,
4th year medical student, Trinity College Dublin, Dublin, Ireland S Tierney, BSc, MCh, FRCSI, Royal
College of Surgeons in Ireland, Dublin, Ireland; Vascular Surgery Unit, Adelaide & Meath Hospital, Dublin,
Ireland H Strapp, RGN, RSCN, PG Dip., MSc Nursing, Vascular Surgery Unit, Adelaide & Meath
Hospital, Dublin, Ireland S Cowman, MSc, PhD, FFNMRCSI, PGCEA, RNT, DipN (London), RGN,
Head of Department, Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin,
Ireland.
Abstract
Lymphoedema is a chronic, incurable, debilitating condition, usually affecting a limb and causes discomfort,
pain, heaviness, limited motion, unsatisfactory appearance and impacts on quality of life. However, there is a
paucity of prevalence data on this condition. This study aimed to determine the prevalence of lymphoedema
among persons attending wound management and vascular clinics in an acute tertiary referral hospital. Four
hundred and eighteen patients meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n =
11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and broken skin, 64% (n = 7) had
history of broken skin and 36% (n = 4) had undergone treatment for venous leg ulcers. The most common
co-morbidities were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3),
hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of life scores identified that
physical functioning was the domain most affected among this group. This study has identified the need to
raise awareness of this condition among clinicians working in the area of wound management.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
PMID: 21910829 [PubMed - as supplied by publisher]
September 19, 2011
BMJ. 2011 Sep 1;343:d5326. doi: 10.1136/bmj.d5326.
Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related
to breast cancer: randomised controlled trial.
Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets A, Leunen K, Neven P, Van Kampen M.
Source
Department of Rehabilitation Sciences, Katholieke Universiteit Leuven and Department of Physiotherapy,
University Hospitals Leuven, Leuven, Belgium.
Abstract
OBJECTIVE:
To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to
breast cancer.
DESIGN:
Randomised single blinded controlled trial.
SETTING:
University Hospitals Leuven, Leuven, Belgium.
PARTICIPANTS:
160 consecutive patients with breast cancer and unilateral axillary lymph node dissection. The randomisation
was stratified for body mass index (BMI) and axillary irradiation and treatment allocation was concealed.
Randomisation was done independently from recruitment and treatment. Baseline characteristics were
comparable between the groups.
INTERVENTION:
For six months the intervention group (n=79) performed a treatment programme consisting of guidelines
about the prevention of lymphoedema, exercise therapy, and manual lymph drainage. The control group
(n=81) performed the same programme without manual lymph drainage.
MAIN OUTCOME MEASURES:
Cumulative incidence of arm lymphoedema and time to develop arm lymphoedema, defined as an increase in
arm volume of 200 mL or more in the value before surgery.
RESULTS:
Four patients in the intervention group and two in the control group were lost to follow-up. At 12 months
after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention
group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P=0.45). The
time to develop arm lymphoedema was comparable between the two group during the first year after
surgery (hazard ratio 1.3, 0.6 to 2.5; P=0.49). The sample size calculation was based on a presumed odds
ratio of 0.3, which is not included in the 95% confidence interval. This odds ratio was calculated as
(presumed cumulative incidence of lymphoedema in intervention group/presumed cumulative incidence of no
lymphoedema in intervention group)×(presumed cumulative incidence of no lymphoedema in control
group/presumed cumulative incidence of lymphoedema in control group) or (10/90)×(70/30).
CONCLUSION:
Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for
breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphoedema in
the short term. Trial registration Netherlands Trial Register No NTR 1055.
PMID: 21885537 [PubMed - in process] PMCID: PMC3164214
Wkly Epidemiol Rec. 2011 Aug 5;86(32):341-51.
Meeting of the International Task Force for Disease Eradication, April 2011.
[Article in English, French]
[No authors listed]
PMID: 21837843 [PubMed - indexed for MEDLINE]
Int Wound J. 2011 Aug 17. doi: 10.1111/j.1742-481X.2011.00832.x. [Epub ahead of print]
The experience of patients with lymphoedema undergoing a period of compression bandaging in the UK and
Canada using the 3M™ Coban™ 2 compression system.
Morgan PA, Murray S, Moffatt CJ, Young H.
Source
PA Morgan, RN, EdD, Centre for Research and Implementation of Clinical Practice, London, UK S
Murray, RN, MA, Department of Lymphoedema, Royal Derby Hospital, Derby Hospitals NHS Foundation
Trust, Uttoxeter Road, Derby DE22 3NE, UK CJ Moffatt, RN, PhD, Department of Lymphoedema, Royal
Derby Hospital, Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK and
Division of Nursing and Healthcare, University of Glasgow, Glasgow G12 8LW, UK H Young, RN, MSc,
St Giles Hospice, Fisherwick Road, Whittington, Staffordshire WS14 9YT, UK.
Abstract
This article reports on a qualitative study that explored the experience of patients who have undergone a
period of complete decongestive therapy using the 3M™ Coban™ 2 compression system (Coban 2
system). Qualitative data were collected from 12 patients from the UK and 8 from Canada with a range of
presentations of lymphoedema. Single semi-structured interviews were used and participants were asked
questions relating to their experience of diagnosis, the impact of lymphoedema on their lives, previous
treatment using multilayer lymphoedema bandaging and their experiences of the 3M™ Coban™ 2 system.
Treatment with multilayer lymphoedema bandaging was seen as constraining in that it was tiring, time
consuming, heavy, bulky and led to feelings of clumsiness and a restricted life. Treatment with the 3M™
Coban™ 2 system was reported as enabling in that it was quicker and easier to apply, increased mobility,
enhanced patient confidence and provided a sense of control and well-being. The article also explores how
aspects of the 3M™ Coban™ 2 system might be improved from the patient's point of view.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
PMID: 21848728 [PubMed - as supplied by publisher]
Int Wound J. 2011 Aug 17. doi: 10.1111/j.1742-481X.2011.00845.x. [Epub ahead of print]
The challenges of managing complex lymphoedema/chronic oedema in the UK and Canada.
Morgan PA, Murray S, Moffatt CJ, Honnor A.
Source
PA Morgan, RN, EdD, Centre for Research and Implementation of Clinical Practice, St Luke's Crypt,
Sydney Street, London SW3 6NH, UK S Murray, RN, MA, Royal Derby Hospital, Derby Hospitals NHS
Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK CJ Moffatt, RN, PhD, Royal Derby Hospital,
Derby Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK. Faculty of Medicine,
Division of Nursing and Healthcare, University of Glasgow, Glasgow G12 8LW, UK A Honnor, RN, BSc,
MSc, LOROS Hospice, Groby Road, Leicester LE3 9QE, UK.
Abstract
This article explores the professional challenges of treating patients with complex/severe forms of chronic
oedema/lymphoedema with compression therapy. Four focus groups were held, two in the UK and two in
Canada, to examine the challenges faced by practitioners in their everyday practice. A number of challenges
were identified by participants in both countries and include the changing profile of lymphoedema/chronic
oedema and how increasing complexity is outpacing the development of services and research-based
guidelines. Focus groups also highlighted a lack of public awareness, poor professional knowledge, delayed
diagnosis and inappropriate treatment as having a significant impact on practice. Other practice-related
issues include a poor understanding of treatment options among practitioners, a lack of evidence-based
practice as well as difficulties associated with managing psychosocial problems and of ensuring concordance
with treatment. In Canada, services tend to be more rural and remote than in the UK, autonomous specialist
practice is less developed and practitioners were generally less confident and felt more vulnerable than their
UK colleagues. There is a need for integrated, multi-disciplinary services in both countries, with improved
education and training, as well as the development of cost-effective compression bandaging systems that can
make a major contribution to meeting the challenges of contemporary lymphoedema practice.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
PMID: 21848727 [PubMed - as supplied by publisher]
Infect Immun. 2011 Aug 29. [Epub ahead of print]
Filarial Lymphatic Pathology Reflects Augmented TLR-mediated, MAPK-mediated Pro-inflammatory
Cytokine Production.
Babu S, Anuradha R, Pavan Kumar N, George PJ, Kumaraswami V, Nutman TB.
Source
National Institutes of Health-International Center for Excellence in Research, Chennai, India.
Abstract
Lymphatic filariasis can be associated with the development of serious pathology in the form of lymphedema,
hydrocele, and elephantiasis in a subset of infected patients. Toll-like receptors (TLRs) are thought to play a
major role in the development of filarial pathology. To elucidate the role of TLRs in the development of
lymphatic pathology, we examined cytokine responses to different Toll ligands in patients with lymphatic
pathology (CP), infected patients with subclinical pathology (INF), and uninfected, endemic normal (EN)
individuals. TLR 2, 7 and 9 ligands induced significantly elevated production of Th1 and other pro-
inflammatory cytokines in CP patients in comparison to both INF and EN. TLR adaptor expression was not
significantly different among the groups; however, both TLR2 and TLR9 ligands induced significantly higher
levels of phosphorylation of ERK1/2 and p38 MAP kinases as well as increased activation of NF-κB in CP
individuals. Pharmacologic inhibition of both ERK1/2 and p38 MAP kinase pathways resulted in significantly
diminished production of pro-inflammatory cytokines in CP individuals. Our data, therefore, strongly suggest
an important role for TLR2- and TLR9-mediated pro-inflammatory cytokine induction and activation of
both the MAPK and NF-κB pathways in the development of pathology in human lymphatic filariasis.
PMID: 21875961 [PubMed - as supplied by publisher]
J Altern Complement Med. 2011 Sep;17(9):867-9.
Lymphedema after breast or gynecological cancer: use and effectiveness of mainstream and complementary
therapies.
Finnane A, Liu Y, Battistutta D, Janda M, Hayes SC.
Source
1 School of Public Health, Queensland University of Technology , Brisbane, Queensland, Australia .
Abstract
Abstract Objectives: The purpose of this study was to describe the use, as well as perceived effectiveness,
of mainstream and complementary and alternative medicine (CAM) therapies in the treatment of
lymphedema following breast or gynecological cancer. Further, the study assessed the relationship between
the characteristics of lymphedema (including type, severity, stability, and duration), and the use of CAM
and/or mainstream treatment. Methods: This was a cross-sectional study using a convenience sample of
women with lymphedema following breast and gynecological cancers. A self-administered questionnaire was
sent to 247 potentially eligible women. Of those returned (50%), 23 were ineligible and 6 were excluded
due to level of missing data. Results: In the previous 12 months, the majority of women (90%) had used
mainstream treatments to treat their lymphedema, with massage being the most commonly used (86%). One
(1) in 2 women had used CAM to treat their lymphedema, and 98% of those using CAM were also using
mainstream treatments. Over 27 types of CAM were reported, with use of a chi machine, vitamin E
supplements, yoga, and meditation being the most commonly reported forms. The perceived effectiveness
ratings (1-7 with 7=completely effective) of mainstream (mean±standard deviation (SD): 5.3±1.5) and
CAM therapies (mean±SD: 5.2+1.6) were considered high. Conclusions: These results demonstrate that
mainstream and CAM treatment use is common, varied, and considered to be effective among women with
lymphedema following breast or gynecological cancer. Furthermore, it highlights the immediate need for
larger prospective studies assessing the inter-relationship between the use of mainstream and CAM
therapies for treatment success.
PMID: 21875352 [PubMed - in process]
Phys Ther. 2011 Aug 25. [Epub ahead of print]
Complete Decongestive Physical Therapy in a Patient With Secondary Lymphedema Due to Orthopedic
Trauma and Surgery of the Lower Extremity.
Cohen MD.
Source
a home-based and outpatient therapy practice focusing on lymphedema management in Nassau County,
New York. Dr Cohen was a clinical specialist at New York Presbyterian Hospital-Weill Cornell Medical
Center, New York, New York, at the time of the case report.
Abstract
BACKGROUND AND PURPOSE:
/b>This case report describes a patient who developed lower-extremity lymphedema secondary to
orthopedic trauma and surgery and reports the response to complete decongestive physical therapy (CDP),
with 8 treatment sessions over 3 months.
CASE DESCRIPTION:
/b>The patient was a 56-year-old man who sustained a right ankle displaced fibular fracture, underwent
open reduction internal fixation surgery 12 days later, and developed lymphedema 4 months postinjury. The
patient's impairments of the right lower extremity included increased girth, decreased ankle range of motion,
and increased pain. Due to these impairments and the inability to fit into normal footwear, the patient limited
activities such as ambulating long distances and climbing stairs. This limited activity restricted him from
participating in his normal lifestyle activities such as walking his dog in the community and performing all
necessary work duties.
OUTCOMES:
/b>Using the truncated cone formula to measure limb volume, the limb volume of the right (involved) lower
extremity decreased 368 mL as a result of CDP. The percentage of difference in limb volume between the
right and left lower extremities at the initial examination was 9%, and it was reduced to less than 1% at
discharge. He was independent with his home program in order to maintain the results of therapy.
CONCLUSION:
/b>Physical therapy management of secondary lymphedema due to orthopedic trauma and surgery of the
lower extremity resulted in decreased circumferential girth measurements and decreased limb volume,
thereby improving gait and allowing the patient to fit into his work and leisure shoes. The patient reported
improvement in his ability to perform all work activities, and he returned to his prior level of participation in
the community.
PMID: 21868611 [PubMed - as supplied by publisher]
Ann Surg Oncol. 2011 Aug 24. [Epub ahead of print]
The Surgical Treatment of Lymphedema: A Systematic Review of the Contemporary Literature (2004-
2010).
Cormier JN, Rourke L, Crosby M, Chang D, Armer J.
Source
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA,
jcormier@mdanderson.org.
Abstract
PURPOSE:
A systematic review of the literature was performed to examine contemporary peer-reviewed literature
(2004-2010) evaluating the surgical treatment of lymphedema.
METHODS:
A comprehensive search of 11 major medical indices was performed. Selected articles were sorted to
identify those related to the surgical treatment of lymphedema. Extracted data included the number of
patients, specific surgical procedure performed, length of follow-up, criteria for defining lymphedema,
measurement methods, volume or circumference reduction, and reported complications.
RESULTS:
A total of 20 studies met inclusion criteria; procedures were categorized as excisional procedures (n = 8),
lymphatic reconstruction (n = 8), and tissue transfer (n = 4). The reported incidence of volume reduction of
lymphedema in these studies varied from 118% reduction to a 13% increase over the follow-up intervals
ranging from 6 months to 15 years. The largest reported reductions were noted after excisional procedures
(91.1%), lymphatic reconstruction (54.9%), and tissue transfer procedures (47.6%). Procedure
complications were rarely reported.
CONCLUSIONS:
A number of surgical approaches have demonstrated beneficial effects for select patients with lymphedema.
Most of these reports, however, are based on small numbers of patients, use nonstandardized or
inconsistent measurement techniques, and lack long-term follow-up. The proposed benefits of any surgical
approach should be evaluated in the context of the potential morbidity to the individual patient and the
availability of surgical expertise. In addition, although these surgical techniques have shown promising results,
nearly all note that the procedures do not obviate the need for continued use of conventional therapies,
including compression, for long-term maintenance.
PMID: 21863361 [PubMed - as supplied by publisher]
Cancer Treat Rev. 2011 Aug 17. [Epub ahead of print]
Electrochemotherapy of chest wall breast cancer recurrence.
Sersa G, Cufer T, Paulin SM, Cemazar M, Snoj M.
Source
Institute of Oncology Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia.
Abstract
Chest wall breast cancer recurrence after mastectomy is a disease difficult to treat. Its incidence varies
between 5% and 30% in different subset of patients. When possible, radical surgical therapy represents the
main treatment approach, however when the disease progresses and/or treatments are not successful,
ulceration, bleeding, lymphedema and psychological distress of progressive disease significantly decrease the
quality of the remaining life of a patient. When surgical excision of chest wall recurrence is not possible, other
local treatments such as radiotherapy, radiotherapy with hyperthermia, topical chemotherapy and
electrochemotherapy might be taken into account. Electrochemotherapy provides safe, efficient and non-
invasive locoregional treatment approach for chest wall breast cancer recurrence. Several clinical studies
have demonstrated high efficacy and a good safety profile of electrochemotherapy applied in single or
multiple consecutive sessions, till clinical response was reached. Electrochemotherapy can be performed
either with cisplatin injected intratumorally or with bleomycin given intratumorally or intravenously.
Furthermore, it can be effectively used in heavily pre-treated areas, after surgery, radiotherapy or systemic
chemotherapy. These are the advantages that might demand its use especially in patients with pre-treated
extensive disease and in frail elderly patients. With development of the technology electrochemotherapy
could even be suggested as a primary local therapy in patients not suitable for surgical removal of the
primary tumor.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21856080 [PubMed - as supplied by publisher
Clin Dermatol. 2011 Sep-Oct;29(5):483-8.
Opportunistic localization of skin lesions on vulnerable areas.
Ruocco V, Ruocco E, Brunetti G, Sangiuliano S, Wolf R.
Source
Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Napoli, Italy.
Abstract
Genetic, developmental, and immune defects can make certain anatomic areas of the body more prone than
others to harbor skin lesions. Cutaneous areas with skin barrier dysfunction (eg, atopic dermatitis) are the
clearest example of vulnerable sites where opportunistic diseases, mainly infections (eg, herpes simplex), can
easily occur. Somatic mosaicism, by giving rise to mutated cell clones with a bandlike arrangement, may
form tissue segments prone to developing congenital or acquired skin disorders. Cutaneous districts that
have been infected by herpes viruses become sites permissive for a subsequent onset of heterogeneous skin
disorders, mainly tumors, further infections, and disimmune reactions (Wolf isotopic response). Regional
lymphedema, by impairing lymph circulation and consequently the local immune control, favors the location
of immunity-related lesions in the involved district. A vast series of skin injuries, such as ionizing or ultraviolet
radiation, burns, traumas, and even vaccinations, can render the affected areas vulnerable to subsequent
cutaneous disorders. Lack of immune control, ensuing from locally altered neuroimmune interaction, may be
the basic defect responsible for the opportunistic location of skin lesions in herpes-infected,
lymphedematous, or otherwise damaged areas, together featuring the novel concept of
"immunocompromised district."
Copyright © 2011 Elsevier Inc. All rights reserved.
PMID: 21855722 [PubMed - in process]
September 8, 2011
J Glob Infect Dis. 2011 Jul;3(3):227-32.
Impact of basic lymphedema management and antifilarial treatment on acute dermatolymphangioadenitis
episodes and filarial antigenaemia.
El-Nahas H, El-Shazly A, Abulhassan M, Nabih N, Mousa N.
Source
Department of Parasitology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Abstract
BACKGROUND:
A major factor in the progression of lymphedema is acute dermatolymphangioadenitis (ADLA).
AIMS:
To study ADLA episodes and antigenaemia in patients with different grades of filarial lymphedema at pre-
and two years post-treatment.
SETTING AND DESIGN:
A prospectively conducted study from May 2008 through May 2010.
PATIENTS AND METHODS:
Forty five patients complaining of limb swelling with present or past history of limb redness suggestive of
ADLA attacks were included. Patients were clinically examined for lymphedema grading, detection of
potential entry points and diagnosis of microfilaraemia. Wuchereria bancrofti antigen titer was estimated by
"Trop-Ag W. Bancrofti" ELISA kit. Basic lymphedema management and treatment with antifilarial drugs
were applied.
STATISTICAL ANALYSIS:
Mann-Whitney test and Chi-square test were used.
RESULTS:
The number of ADLA attacks in the pretreatment period, ranged from one to three per year. Mean duration
of the attacks was 3.87±0.79 days. Entry points were detected in 82% of cases. The study revealed
statistical significance between extension and grade of lymphedema and number of ADLA attacks per year
(P=0.018 and 0.022, respectively). Microfilaraemia was detected in four cases and positive filarial
antigenaemia were detected in 29 patients (64.4). The number of ADLA attacks per year significantly
decreased from the pre-treatment period (mean: 2.05±0.560) to be 1.23±0.706 after one year and 0.89±0.
575 after two years post treatment. There was a significant decrease in the mean antigen titer one year and
two years after treatment.
CONCLUSION:
Basic lymphedema management is effective for controlling ADLA attacks in areas where lymphatic filariasis
is endemic.
PMID: 21887053 [PubMed - in process] PMCID: PMC3162808
BMJ. 2011 Sep 1;343:d5326. doi: 10.1136/bmj.d5326.
Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related
to breast cancer: randomised controlled trial.
Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets A, Leunen K, Neven P, Van Kampen M.
Source
Department of Rehabilitation Sciences, Katholieke Universiteit Leuven and Department of Physiotherapy,
University Hospitals Leuven, Leuven, Belgium.
Abstract
OBJECTIVE:
To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to
breast cancer.
DESIGN:
Randomised single blinded controlled trial.
SETTING:
University Hospitals Leuven, Leuven, Belgium.
PARTICIPANTS:
160 consecutive patients with breast cancer and unilateral axillary lymph node dissection. The randomisation
was stratified for body mass index (BMI) and axillary irradiation and treatment allocation was concealed.
Randomisation was done independently from recruitment and treatment. Baseline characteristics were
comparable between the groups.
INTERVENTION:
For six months the intervention group (n=79) performed a treatment programme consisting of guidelines
about the prevention of lymphoedema, exercise therapy, and manual lymph drainage. The control group
(n=81) performed the same programme without manual lymph drainage.
MAIN OUTCOME MEASURES:
Cumulative incidence of arm lymphoedema and time to develop arm lymphoedema, defined as an increase in
arm volume of 200 mL or more in the value before surgery.
RESULTS:
Four patients in the intervention group and two in the control group were lost to follow-up. At 12 months
after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention
group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P=0.45). The
time to develop arm lymphoedema was comparable between the two group during the first year after
surgery (hazard ratio 1.3, 0.6 to 2.5; P=0.49). The sample size calculation was based on a presumed odds
ratio of 0.3, which is not included in the 95% confidence interval. This odds ratio was calculated as
(presumed cumulative incidence of lymphoedema in intervention group/presumed cumulative incidence of no
lymphoedema in intervention group)×(presumed cumulative incidence of no lymphoedema in control
group/presumed cumulative incidence of lymphoedema in control group) or (10/90)×(70/30).
CONCLUSION:
Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for
breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphoedema in
the short term. Trial registration Netherlands Trial Register No NTR 1055.
PMID: 21885537 [PubMed - in process]
September 24, 2011
Plast Reconstr Surg. 2011 Oct;128(4):372e.
Reply: acute lymphedema of the eyelid after major reconstruction of the medial canthus: the role of the
lymphatic drainage pattern.
Pan WR, Le Roux CM, Briggs CA.
Source
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology,
University of Melbourne, Melbourne, Victoria, Australia.
PMID: 21921753 [PubMed - in process]
Plast Reconstr Surg. 2011 Oct;128(4):370e-2e.
Acute lymphedema of the eyelid after major reconstruction of the medial canthus: the role of the lymphatic
drainage pattern.
Aveta A, Tenna S, Segreto F, Cagli B, Brunetti B, Marangi GF, Persichetti P.
Source
Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy.
PMID: 21921751 [PubMed - in process]
Plast Reconstr Surg. 2011 Oct;128(4):314e-21e.
The earliest finding of indocyanine green lymphography in asymptomatic limbs of lower extremity
lymphedema patients secondary to cancer treatment: the modified dermal backflow stage and concept of
subclinical lymphedema.
Yamamoto T, Matsuda N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M, Narushima
M, Iida T, Koshima I.
Source
Tokyo, Japan From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine,
University of Tokyo.
Abstract
BACKGROUND:
: Early diagnosis and treatment are as important for management of secondary lymphedema following cancer
treatment as in primary cancer treatment. Indocyanine green lymphography is the modality of choice for
routine follow-up evaluation of patients at high risk of developing lymphedema after cancer therapy.
METHODS:
: Fifty-six limbs of 28 so-called unilateral secondary lower extremity lymphedema patients who underwent
indocyanine green lymphography were compared with dermal backflow patterns of indocyanine green
lymphography on 28 asymptomatic limbs and assessed using leg dermal backflow stage.
RESULTS:
: Of 28 asymptomatic limbs of secondary lower extremity lymphedema patients, the dermal backflow
patterns were detected in 19 limbs but were absent in nine limbs. Significant differences were seen between
asymptomatic limbs with dermal backflow patterns (n = 19) and limbs without them (n = 9): age, 51.4 ±
15.3 years versus 34.8 ± 12.7 years (p = 0.007); body weight, 75.1 ± 7.9 kg versus 50.1 ± 5.3 kg (p =
0.012); body mass index, 23.1 ± 4.2 versus 19.7 ± 1.8 (p = 0.005); leg dermal backflow stage of
asymptomatic limb, 1.2 ± 0.4 versus 0.0 ± 0.0 (p < 0.001); and leg dermal backflow stage of symptomatic
limb, 3.5 ± 0.6 versus 2.8 ± 0.8 (p = 0.033).
CONCLUSIONS:
: The splash pattern is the earliest finding on indocyanine green lymphography of asymptomatic limbs of
secondary lower extremity lymphedema patients. The leg dermal backflow stage allows early diagnosis of
secondary lower extremity lymphedema even in a subclinical stage. The concept of subclinical lymphedema
could play an important role in early diagnosis and prevention of lymphedema after cancer treatment.
CLINICAL QUESTION/LEVEL OF EVIDENCE:: Diagnostic, V.
PMID: 21921744 [PubMed - in process]
Phys Ther. 2011 Sep 15. [Epub ahead of print]
Breast Cancer-Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a
Traditional Model of Care.
Stout NL, Pfalzer LA, Springer B, Levy E, McGarvey CL, Danoff JV, Gerber LH, Soballe PW.
Source
N.L. Stout, MPT, CLT-LANA, National Naval Medical Center, Breast Care Center, 8901 Wisconsin
Ave, Bldg 10, 4 West, Bethesda, MD 20814 (USA).
Abstract
Secondary prevention involves monitoring and screening to prevent negative sequelae from chronic diseases
such as cancer. Breast cancer treatment sequelae, such as lymphedema, may occur early or late and often
negatively affect function. Secondary prevention through prospective physical therapy surveillance aids in
early identification and treatment of breast cancer-related lymphedema (BCRL). Early intervention may
reduce the need for intensive rehabilitation and be cost saving. This perspective article compares a
prospective surveillance model with a traditional model of impairment-based care and examines direct
treatment costs associated with each program. Intervention and supply costs were estimated based on the
Medicare 2009 physician fee schedule for 2 groups: (1) a prospective surveillance model group (PSM
group) and (2) a traditional model group (TM group). The PSM group comprised all women with breast
cancer who were receiving interval prospective surveillance, assuming that one third would develop early-
stage BCRL. The prospective surveillance model includes the cost of screening all women plus the cost of
intervention for early-stage BCRL. The TM group comprised women referred for BCRL treatment using a
traditional model of referral based on late-stage lymphedema. The traditional model cost includes the direct
cost of treating patients with advanced-stage lymphedema. The cost to manage early-stage BCRL per
patient per year using a prospective surveillance model is $636.19. The cost to manage late-stage BCRL
per patient per year using a traditional model is $3,124.92. The prospective surveillance model is emerging
as the standard of care in breast cancer treatment and is a potential cost-saving mechanism for BCRL
treatment. Further analysis of indirect costs and utility is necessary to assess cost-effectiveness. A shift in the
paradigm of physical therapy toward a prospective surveillance model is warranted.
PMID: 21921254 [PubMed - as supplied by publisher]
Eur J Pediatr. 2011 Sep 15. [Epub ahead of print]
Hydrops fetalis and pulmonary lymphangiectasia due to FOXC2 mutation: an autosomal dominant hereditary
lymphedema syndrome with variable expression.
de Bruyn G, Casaer A, Devolder K, Van Acker G, Logghe H, Devriendt K, Cornette L.
Source
University Hospital of Leuven, Herestraat 49, 3000, Leuven, Belgium, gwendolyn.debruyn@uzleuven.be.
Abstract
Non-immune hydrops fetalis may find its origin within genetically determined lymphedema syndromes,
caused by mutations in FOXC2 and SOX-18. We describe a newborn girl, diagnosed with non-immune
hydrops fetalis at a gestational age of 30 weeks. Family history revealed the presence of an autosomal
dominant late-onset form of lymphedema of the lower limbs in her father, associated with an aberrant
implantation of the eyelashes in some individuals. The newborn, hydropic girl suffered from severe
pulmonary lymphangiectasia, resulting in terminal respiratory failure at the age of 3 months. Genetic analysis
in both the father and the newborn girl demonstrated a heterozygous FOXC2 mutation, i.e., c.939C>A, p.
Tyr313X. Her two older sisters are currently asymptomatic and the parents decided not to test them for the
FOXC2 mutation. Conclusion: Patients with a mutation in the FOXC2 transcription factor usually show
lower limb lymphedema with onset at or after puberty, together with distichiasis. However, the eye
manifestations can be very mild and easily overlooked. The association between FOXC2 mutation and
neonatal hydrops resulting in terminal respiratory failure is not reported so far. Therefore, in sporadic
patients diagnosed with non-immune hydrops fetalis, lymphangiogenic genes should be systematically
screened for mutations. In addition, all cases of fetal edema must prompt a thorough analysis of the familial
pedigree, in order to detect familial patterns and to facilitate adequate antenatal counseling.
PMID: 21918810 [PubMed - as supplied by publisher]
September 24, 2011
J Cancer Res Clin Oncol. 2011 Sep 21. [Epub ahead of print]
Safety study of axillary reverse mapping in the surgical treatment for breast cancer patients.
Deng H, Chen L, Jia W, Chen K, Zeng Y, Rao N, Li S, Jin L, Su F.
Source
Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiangxi
Road, Guangzhou, 510120, People's Republic of China.
Abstract
PURPOSE:
With the purpose of minimizing arm lymphedema after axillary staging surgeries in breast cancer patients, the
axillary reverse mapping (ARM) technique has been developed to identify and preserve arm drainage
system during axillary surgery. This study aimed to clarify risk factors for metastasis in arm lymphatic
drainage system in breast cancer patients with clinically negative axillary nodes.
METHODS:
Sixty-nine patients who underwent successful both sentinel lymph node (SLN) biopsy (SLNB) and ARM
from October 2009 to August 2010 were enrolled in this study. Radioactive tracer was used for SLN
localization and blue dye was used for ARM. All of the identified SLNs and ARM nodes were sent for
pathological assessment.
RESULTS:
ARM nodes metastasis occured in 6 of 69 patients. Age, pathological tumor size (pT) and pathological
lymph node status (pN) were not associated with ARM nodes metastasis (P > 0.01). Interestingly, in these
6 patients, all metastatic ARM nodes coincided with SLN-ARM nodes (hot SLN and blue ARM node
were the same lymph node). In 50 of 69 patients whose ARM nodes did not coincided with SLNs, all
ARM nodes were negative, even in 12 patients with metastatic SLNs.
CONCLUSION:
Crossover between breast and ipsilateral arm lymphatic drainage system contributes for ipsilateral arm
lymph node metastasis. When ARM and SLNB are simultaneously performed in a patient, selectively
preservation of the ARM nodes that do not coincided with SLNs would be safe, even if the SLNs are
positive. Pathological lymph node status does not account for the occurrence of metastasis in ARM nodes.
ARM nodes could be preserved safely, independent of the pathological lymph node status.
PMID: 21935615 [PubMed - as supplied by publisher]
J Eur Acad Dermatol Venereol. 2011 Sep 20. doi: 10.1111/j.1468-3083.2011.04265.x. [Epub ahead of
print]
Skin manifestations of obesity: a comparative study.
Boza JC, Trindade EN, Peruzzo J, Sachett L, Rech L, Cestari TF.
Source
Department of Dermatology, Federal University of Rio Grande do Sul (UFRGS), Hospital de Clínicas de
Porto Alegre (HCPA), Porto Alegre, Brazil.
Abstract
Background Obesity is one of the world's biggest health problems nowadays. Little research has been
done on the skin diseases that affect obese patients. Objective To study the prevalence of skin
manifestations in obese patients compared with a control group of normal-weight patients. Methods A
total of 76 obese patients [body mass index (BMI) ≥30 kg/m(2) ] and 73 with normal-weight volunteers
(BMI 18.5-24.9 kg/m(2) ) were included in the study and had their complete medical history and skin
examination evaluated by the same examiner. All patients were investigated for the presence of metabolic
syndrome. Results The dermatoses that showed a statistically significant relationship with obesity,
compared with the control group were: striae (P < 0.001), plantar hyperkeratosis (P < 0.001),
acrochordons (P = 0.007), intertrigo (P < 0.001), pseudoacanthosis nigricans (P < 0.001),
keratosis pilaris (P = 0.006), lymphedema (P = 0.002) and bacterial infections (P = 0.05). The
presence of striae, pseudoacanthosis nigricans and bacterial infections were also found to be correlated with
the degree of obesity. Conclusions Obesity is strongly related to several skin alterations that could be
considered as markers of excessive weight. Skin care of obese patients deserves particular attention, not
only because of the high prevalence of cutaneous alteration but mainly because many of these disorders are
preventable and could be treated, improving patient's quality of life.
© 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011
European Academy of Dermatology and Venereology.
PMID: 21929550 [PubMed - as supplied by publisher
September 19, 2011
Nat Genet. 2011 Sep 4. doi: 10.1038/ng.923. [Epub ahead of print]
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 - as supplied by publisher]
Wkly Epidemiol Rec. 2011 Aug 26;86(35):377-88.
Global Programme to eliminate lymphatic filariasis: progress report on mass drug administration, 2010.
[Article in English, French]
[No authors listed]
September 19, 2011
Jpn J Clin Oncol. 2011 Sep 8. [Epub ahead of print]
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
1Department of Radiation Oncology, Seoul St. Mary' s Hospital, College of Medicine, The Catholic
University of Korea, Suwon.
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 - as supplied by publisher]
September 19, 2011
Int Wound J. 2011 Sep 13. doi: 10.1111/j.1742-481X.2011.00851.x. [Epub ahead of print]
Prevalence of lymphoedema and quality of life among patients attending a hospital-based wound
management and vascular clinic.
Gethin G, Byrne D, Tierney S, Strapp H, Cowman S.
Source
G Gethin, PhD, HE Dip. Wound Care, RGN, Dip. Anatomy, Dip. Applied Physiology, FFNMRCSI,
Centre for Nursing and Midwifery Research, Royal College of Surgeons in Ireland, Dublin, Ireland D Byrne,
4th year medical student, Trinity College Dublin, Dublin, Ireland S Tierney, BSc, MCh, FRCSI, Royal
College of Surgeons in Ireland, Dublin, Ireland; Vascular Surgery Unit, Adelaide & Meath Hospital, Dublin,
Ireland H Strapp, RGN, RSCN, PG Dip., MSc Nursing, Vascular Surgery Unit, Adelaide & Meath
Hospital, Dublin, Ireland S Cowman, MSc, PhD, FFNMRCSI, PGCEA, RNT, DipN (London), RGN,
Head of Department, Faculty of Nursing & Midwifery, Royal College of Surgeons in Ireland, Dublin,
Ireland.
Abstract
Lymphoedema is a chronic, incurable, debilitating condition, usually affecting a limb and causes discomfort,
pain, heaviness, limited motion, unsatisfactory appearance and impacts on quality of life. However, there is a
paucity of prevalence data on this condition. This study aimed to determine the prevalence of lymphoedema
among persons attending wound management and vascular clinics in an acute tertiary referral hospital. Four
hundred and eighteen patients meeting the inclusion criteria were assessed. A prevalence rate of 2.63% (n =
11) was recorded. Thirty-six percent (n = 4) had history of cellulitis and broken skin, 64% (n = 7) had
history of broken skin and 36% (n = 4) had undergone treatment for venous leg ulcers. The most common
co-morbidities were hypertension 55% (n = 6), deep vein thrombosis (DVT) 27% (n = 3),
hypercholesterolemia 36% (n = 4) and type 2 diabetes 27% (n = 3). Quality of life scores identified that
physical functioning was the domain most affected among this group. This study has identified the need to
raise awareness of this condition among clinicians working in the area of wound management.
© 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
PMID: 21910829 [PubMed - as supplied by publisher]
September 19, 2011
BMJ. 2011 Sep 1;343:d5326. doi: 10.1136/bmj.d5326.
Effect of manual lymph drainage in addition to guidelines and exercise therapy on arm lymphoedema related
to breast cancer: randomised controlled trial.
Devoogdt N, Christiaens MR, Geraerts I, Truijen S, Smeets A, Leunen K, Neven P, Van Kampen M.
Source
Department of Rehabilitation Sciences, Katholieke Universiteit Leuven and Department of Physiotherapy,
University Hospitals Leuven, Leuven, Belgium.
Abstract
OBJECTIVE:
To determine the preventive effect of manual lymph drainage on the development of lymphoedema related to
breast cancer.
DESIGN:
Randomised single blinded controlled trial.
SETTING:
University Hospitals Leuven, Leuven, Belgium.
PARTICIPANTS:
160 consecutive patients with breast cancer and unilateral axillary lymph node dissection. The randomisation
was stratified for body mass index (BMI) and axillary irradiation and treatment allocation was concealed.
Randomisation was done independently from recruitment and treatment. Baseline characteristics were
comparable between the groups.
INTERVENTION:
For six months the intervention group (n=79) performed a treatment programme consisting of guidelines
about the prevention of lymphoedema, exercise therapy, and manual lymph drainage. The control group
(n=81) performed the same programme without manual lymph drainage.
MAIN OUTCOME MEASURES:
Cumulative incidence of arm lymphoedema and time to develop arm lymphoedema, defined as an increase in
arm volume of 200 mL or more in the value before surgery.
RESULTS:
Four patients in the intervention group and two in the control group were lost to follow-up. At 12 months
after surgery, the cumulative incidence rate for arm lymphoedema was comparable between the intervention
group (24%) and control group (19%) (odds ratio 1.3, 95% confidence interval 0.6 to 2.9; P=0.45). The
time to develop arm lymphoedema was comparable between the two group during the first year after
surgery (hazard ratio 1.3, 0.6 to 2.5; P=0.49). The sample size calculation was based on a presumed odds
ratio of 0.3, which is not included in the 95% confidence interval. This odds ratio was calculated as
(presumed cumulative incidence of lymphoedema in intervention group/presumed cumulative incidence of no
lymphoedema in intervention group)×(presumed cumulative incidence of no lymphoedema in control
group/presumed cumulative incidence of lymphoedema in control group) or (10/90)×(70/30).
CONCLUSION:
Manual lymph drainage in addition to guidelines and exercise therapy after axillary lymph node dissection for
breast cancer is unlikely to have a medium to large effect in reducing the incidence of arm lymphoedema in
the short term. Trial registration Netherlands Trial Register No NTR 1055.
PMID: 21885537 [PubMed - in process] PMCID: PMC3164214