Science.gov

Sample records for lymphedema prophylaxis utilizing

  1. Lymphedema

    MedlinePlus

    ... due to lymphedema is known as complete decongestive physiotherapy that involves a combination of therapeutic massage (known ... lymphedema that has not responded to complete decongestive physiotherapy and compression therapy. It is very unusual for ...

  2. Lymphedema

    MedlinePlus

    Lymphedema is the name of a type of swelling. It happens when lymph builds up in your ... happens in the arms or legs. Causes of lymphedema include Infection Cancer Scar tissue from radiation therapy ...

  3. Lymphedema

    MedlinePlus

    ... water. Put a clean, dry bandage over the burn. Call your provider right away if you have an infection. Living with lymphedema can be hard. Ask your ... 2015. www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq . Accessed March 22, 2016. Read ... Breast radiation - discharge Chest radiation - discharge Surgical ...

  4. Lymphedema

    MedlinePlus

    ... burn for 15 minutes. Then wash gently with soap and water. Put a clean, dry bandage over the burn. Call your doctor right away if you have an infection. Living with lymphedema can be hard. Ask your doctor about visiting a physical therapist ...

  5. Estimates of utility weights in hemophilia: implications for cost-utility analysis of clotting factor prophylaxis

    PubMed Central

    Grosse, Scott D; Chaugule, Shraddha S; Hay, Joel W

    2015-01-01

    Estimates of preference-weighted health outcomes or health state utilities are needed to assess improvements in health in terms of quality-adjusted life-years. Gains in quality-adjusted life-years are used to assess the cost–effectiveness of prophylactic use of clotting factor compared with on-demand treatment among people with hemophilia, a congenital bleeding disorder. Published estimates of health utilities for people with hemophilia vary, contributing to uncertainty in the estimates of cost–effectiveness of prophylaxis. Challenges in estimating utility weights for the purpose of evaluating hemophilia treatment include selection bias in observational data, difficulty in adjusting for predictors of health-related quality of life and lack of preference-based data comparing adults with lifetime or primary prophylaxis versus no prophylaxis living within the same country and healthcare system. PMID:25585817

  6. Management of moderate lymphedema.

    PubMed

    Shumacker, H B

    1981-08-01

    Moderate chronic lymphedema generally requires a different program of management than mild or massive lymphedema. It responds well to a special management regimen based on home use of an intermittent limb compressor and utilization of proper compression support when the patient is not in the recumbent position. PMID:7259517

  7. Cost–utility analysis of prophylaxis versus treatment on demand in severe hemophilia A

    PubMed Central

    Colombo, Giorgio L; Di Matteo, Sergio; Mancuso, Maria Elisa; Santagostino, Elena

    2011-01-01

    Background: Individuals with severe hemophilia A have reduced blood levels of clotting factor VIII (FVIII) leading to recurrent bleeding into joints and muscles. Primary prophylaxis with clotting factor concentrates started early in childhood prevents joint bleeds, thus avoiding joint damage and improving people’s quality of life. There remain significant differences in the implementation of primary prophylaxis worldwide mainly due to the cost of prophylaxis compared with treatment on demand. Objective: To evaluate the cost-effectiveness of primary prophylaxis with FVIII concentrates versus secondary prophylaxis, versus treatment on demand, and versus a “hybrid” (primary prophylaxis followed by on-demand treatment in adults) in individuals with severe hemophilia A. Methods: A Markov model was developed and run using different sources of clinical, cost, and utility data. The model was populated with a hypothetical cohort of 100 individuals with severe hemophilia A. The perspective of the Italian National Health System was used. Results: The baseline results showed that primary and secondary prophylaxis is cost-effective compared both with treatment on demand and with a hybrid strategy. The incremental costs per quality-adjusted life-year gained for individuals with hemophilia A receiving primary and secondary prophylaxis were €40,229 to €40,236 versus an on-demand strategy. However, the sensitivity analyses performed showed that the results were sensitive to the unit cost of clotting FVIII, bleeding frequency, and the discount rate. Conclusion: Although primary prophylaxis is a costly treatment, our results show that it is cost-effective compared with treatment on demand. PMID:21935333

  8. Treatment for life for severe haemophilia A- A cost-utility model for prophylaxis vs. on-demand treatment.

    PubMed

    Farrugia, A; Cassar, J; Kimber, M C; Bansal, M; Fischer, K; Auserswald, G; O'Mahony, B; Tolley, K; Noone, D; Balboni, S

    2013-07-01

    Prophylaxis has been established as the treatment of choice in children with haemophilia and its continuation into the adult years has been shown to decrease morbidity throughout life. The cost of factor therapy has made the option questionable in cost-effectiveness studies. The role of prophylaxis in pharmacokinetic dosage and tolerization against inhibitor formation were used to model the cost utility of prophylaxis vs. on-demand (OD) therapy over a lifetime horizon in severe haemophilia A. The model was applied to a single provider national health system exemplified by the United Kingdom's National Health Service and a third party provider in the United States. The incremental cost-effectiveness ratio (ICER) was estimated and compared to threshold values used by payer agencies to guide reimbursement decisions. A cost per quality-adjusted life year (QALY) was also estimated for Sweden. Prophylaxis was dominant over OD treatment in the UK. The model resulted in an ICER - $68 000 - within the range of treatments reimbursed in the USA. In Sweden, a cost/QALY of SEK 1.1 million was also within the range of reimbursed treatments in that country. Dosage- and treatment-induced inhibitor incidence were the most important variables in the model. Subject to continuing clinical evidence of the effectiveness of pharmacokinetic dosage and the role of prophylaxis in decreasing inhibitor incidence, treatment for life with prophylaxis is a cost-effective therapy, using current criteria for the reimbursement of health care technologies in a number of countries. PMID:23534877

  9. Lymphedema Risk Reduction Practices

    MedlinePlus

    ... and foot hygiene maintained. For arm lymphedema, good hand hygiene and softening the cuticles with proper cuticle moisturizer ... For people at-risk for arm lymphedema, good hand hygiene and softening the cuticles with proper cuticle moisturizer ...

  10. Primary Lymphedema of the Lower Limb: The Clinical Utility of Single Photon Emission Computed Tomography/CT

    PubMed Central

    Baumeister, Ruediger G.H.; Frick, Andreas; Wallmichrath, Jens; Bartenstein, Peter; Rominger, Axel

    2015-01-01

    Objective The aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb. Materials and Methods For a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65). Results In comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%). Conclusion As an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema. PMID:25598689

  11. The grading of lymphedema in oncology clinical trials.

    PubMed

    Cheville, Andrea L; McGarvey, Charles L; Petrek, Jeanne A; Russo, Sandra A; Thiadens, Saskia R J; Taylor, Marie E

    2003-07-01

    Lymphedema is a common late toxicity of cancer therapy. This article describes the rationale and process utilized by the Lymphedema Working Group for the revision and expansion of the Common Toxicity Criteria version 2 (CTC v2.0) lymphedema criteria to produce the CTC v3.0 lymphedema criteria. Established clinician-based rating scales and quantitative instruments are reviewed in this article. None of the extant rating scales have been formally validated, nor has their reliability been assessed. Drawbacks of current scales were considered in formulating CTC v3.0 criteria. Most rely exclusively on volume to diagnose and grade lymphedema. This imposes significant clinical limitations, particularly in the assessment of toxicity in oncology clinical trials. Volume-based rating scales are of little value in rating the severity of bilateral limb and nonlimb edema. Problems with nonvolumetric staging systems (eg, CTC v2.0) include insufficient detail to permit useful discrimination of severity among the majority of lymphedema patients. Technologies for objectively quantifying lymphedema have been developed and validated. Although these are briefly reviewed, it is recognized that cost and access issues limit their widespread clinical utility and, as such, were not considered in developing the CTC v3.0 criteria. The CTC v3.0 lymphedema criteria adopted several innovations. Principle among these was the decision to generate separate criteria for volumetric increase, dermal changes, and subcutaneous fibrosis. We anticipate the use of the new CTC v3.0 lymphedema criteria to begin in mid-2003 for grading the key clinical features of this disorder in oncology clinical trials. The purpose of this article is to familiarize the reader with (1) background on the clinical features of lymphedema, (2) information on established lymphedema rating systems, (3) the consensus process and rationale of the Lymphedema Working Group, (4) the new CTC v3.0, and (5) quantitative techniques for

  12. Clinical Utility of Antithrombotic Prophylaxis in ART Procedures: An Italian Experience

    PubMed Central

    Grandone, Elvira; Villani, Michela; Tiscia, Giovanni L.; Dentali, Francesco; Colaizzo, Donatella; Cappucci, Filomena; Fischetti, Lucia; Ageno, Walter; Margaglione, Maurizio

    2014-01-01

    Background The usefulness of antithrombotic prophylaxis in management of Assisted Reproductive Technologies (ART) is questionable. Objectives We prospectively examined the contribution of an antithrombotic prophylaxis in influencing clinical pregnancy and live-birth in an unselected cohort of women approaching ART. Patients/Methods 1107 women with fertility problems and a valid indication for ART were recruited. Baseline and follow-up information of obstetric outcomes and antithrombotic treatment were collected. Results and Conclusions Median follow-up time was 34.5 months (range: 2–143). During the follow-up period, 595 (53.8%) women underwent ART (total 1234 cycles); 202 (33.9%) women achieved a pregnancy for a total of 255 clinical pregnancies. The concomitant use of LMWH and aspirin was significantly associated with a higher rate of clinical pregnancies (p: 0.003, OR: 4.9, 95% CI: 1.7–14.2). The pregnancy rate was also significantly increased by the use of LMWH alone (p: 0.005, OR: 2.6, 95% CI: 1.3–5.0). Carriership of inherited or acquired thrombophilia did not affect clinical outcomes of the ART. The efficacy of antithrombotic treatment was confirmed when the outcome “ live-birth” was considered. Present data suggest a potential benefit of antithrombotic prophylaxis during ART in improving the number of live-births. PMID:24870449

  13. Lymphatic mapping and lymphedema surgery in the breast cancer patient

    PubMed Central

    Manrique, Oscar; Sosin, Michael; Hashmi, Mahjabeen Aftab; Poysophon, Poysophon; Henderson, Robert

    2015-01-01

    Upper limb lymphedema can be an unfortunate sequela following the oncologic treatment of breast cancer. The surgical treatment of lymphedema has had a recent renewed clinical interest paralleling innovative descriptions of surgical techniques and imaging modalities. In addition, an improved understanding of the physiology and pathophysiology of lymphedema has allowed improved translation to the clinical condition. Various surgical options exist to decrease the symptom-burden of upper limb lymphedema, including vascularized lymph node (VLN) transfer, lymphovenous bypass (LVB), liposuction, lymphatic grafting, and excisional procedures. Modern imaging techniques help to improve the consistency and accuracy of these surgical treatment options. A multi-modal treatment plan utilizing non-operative and surgical therapies has the potential to improve various factors related to overall patient quality of life. This review details all of the current operative treatment strategies and modern imaging modalities used in the treatment of lymphedema. PMID:26161309

  14. National Lymphedema Network

    MedlinePlus

    ... Stage 3 Infection and Other Complications NLN Position Papers Lymphedema Awareness Campaign Education Kits Educational Videos What ... Patients (8) LymphLink Articles (175) FAQ's (6) Position Papers (9) LSAP Perspective (9) Click here to write ...

  15. Antibiotic Prophylaxis for Gynecologic Procedures prior to and during the Utilization of Assisted Reproductive Technologies: A Systematic Review

    PubMed Central

    Hutchinson, Anne P.; Lekovich, Jovana P.; Hobeika, Elie; Elias, Rony T.

    2016-01-01

    The use of assisted reproductive technologies (ART) has increased steadily. There has been a corresponding increase in the number of ART-related procedures such as hysterosalpingography (HSG), saline infusion sonography (SIS), hysteroscopy, laparoscopy, oocyte retrieval, and embryo transfer (ET). While performing these procedures, the abdomen, upper vagina, and endocervix are breached, leading to the possibility of seeding pelvic structures with microorganisms. Antibiotic prophylaxis is therefore important to prevent or treat any procedure-related infections. After careful review of the published literature, it is evident that routine antibiotic prophylaxis is generally not recommended for the majority of ART-related procedures. For transcervical procedures such as HSG, SIS, hysteroscopy, ET, and chromotubation, patients at risk for pelvic infections should be screened and treated prior to the procedure. Patients with a history of pelvic inflammatory disease (PID) or dilated fallopian tubes are at high risk for postprocedural infections and should be given antibiotic prophylaxis during procedures such as HSG, SIS, or chromotubation. Antibiotic prophylaxis is recommended prior to oocyte retrieval in patients with a history of endometriosis, PID, ruptured appendicitis, or multiple prior pelvic surgeries. PMID:27047692

  16. The Lymphedema and Gynecologic Cancer (LEG) Study: Incidence, Risk Factors, and | Division of Cancer Prevention

    Cancer.gov

    DESCRIPTION (provided by applicant): The proposed study, "Lymphedema and Gynecologic cancer (LEG): Incidence, Risk Factors and Impact", will innovatively utilize the cooperative group setting of the GOG (Gynecologic Oncology Group) to prospectively study 1300 women newly diagnosed with cervical, endometrial, or vulvar cancer to determine the incidence and impact of lower extremity lymphedema following surgical treatment of these diseases. |

  17. Lymphedema secondary to breast cancer: how choice of measure influences diagnosis, prevalence, and identifiable risk factors.

    PubMed

    Hayes, S; Janda, M; Cornish, B; Battistutta, D; Newman, B

    2008-03-01

    Research on secondary lymphedema primarily uses indirect methods for diagnosis. This paper compares prevalence and cumulative burden following breast cancer surgery, as well as personal, treatment, and behavioral characteristics associated with lymphedema, using different assessment techniques. Lymphedema status was assessed at three-monthly intervals between six- and 18-months post-surgery in a population-based sample of Australian women with recently diagnosed, unilateral, invasive breast cancer, using three methods: bioimpedance spectroscopy (BIS), difference between sum of arm circumferences (SOAC) and self-report. Depending on the method, point prevalence ranged between 8 to 28%, with 1 in 5 to 2 in 5 women experiencing lymphedema at some point in time. Of those with lymphedema defined by BIS, almost 40%-60% went undetected, and 40%-12% were misclassified as having lymphedema, based on self-report and SOAC, respectively. The choice of measure also had significant implications for identified risk factors. Over 10 characteristics were associated with lymphedema, however only one, experiencing other upper-body symptoms at baseline, influenced odds of lymphedema across all three methods. These findings highlight that secondary lymphedema poses a significant public health problem. Utilizing the most accurate and reliable method for assessment is crucial to advance our understanding of preventive and treatment strategies. PMID:18581955

  18. Lymphedema secondary to filariasis

    SciTech Connect

    Leonard, J.C.; Humphrey, G.B.; Basmadjian, G.

    1985-03-01

    A 1-year-old immunodeficient boy developed brawny edema of the left foot. Lymphoscintigraphy revealed no evidence of left inguinal activity following pedal injection of Tc-99m-Sn phosphate. Over the next two months, the patient developed lymphedema on the right and repeat scintigraphy demonstrated no movement of isotope from the dorsum of either foot. Subsequent studies identified microfilaria in a nocturnal blood smear, which were thought to represent Brugia beaveri acquired by mosquito transmission in Oklahoma.

  19. Cost of a lymphedema treatment mandate-10 years of experience in the Commonwealth of Virginia.

    PubMed

    Weiss, Robert

    2016-12-01

    Treatment of chronic illness accounts for over 90 % of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. The author knows of no open source of lymphedema treatment cost data based on population coverage or claims. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters' estimations of expected claim costs for a larger general population with a range of severities, or for legislators' evaluations of the costs of proposed mandates to cover treatment of lymphedema according to current medical standards. These data are of interest to providers, advocates and legislators in Canada, Australia and England as well as the U.S.The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004-2013, representing 80 % of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate. The average actual annual lymphedema claim cost was $1.59 per individual contract and $3.24 per group contract for the years reported, representing 0.053 and 0.089 % of average total claims. The estimated premium impact ranged 0.00-0.64 % of total average premium for all mandated coverage contracts. In this study actual costs are compared with pre-mandate state mandate commission estimates for proposed lymphedema mandates from Virginia, Massachusetts and California.Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that

  20. Predictors of practice patterns for lymphedema care among oncology advanced practice nurses.

    PubMed

    Ryan, Joanne C; Cleland, Charles M; Fu, Mei R

    2012-09-01

    Lymphedema, a debilitating and chronic condition, is considered to be one of the most distressing adverse effects of cancer treatment. The purpose of this study was to understand the practice patterns in lymphedema care and identify predictors influencing those patterns among oncology nurses, with a focus on advanced practice nurses. Random and purposive sampling was utilized to recruit 238 oncology nurses who completed the Web-based study. Participants included advanced practice nurses (nurse practitioners and clinical nurse specialists), nurse navigators/case managers, staff nurses, and directors/managers/coordinators. Data focused on perceived knowledge of and perceived competence in risk reduction, treatment, and self-management of lymphedema and practice patterns in lymphedema care. Actual knowledge of lymphedema care was evaluated. Descriptive, comparative, and regression analyses were performed. The study showed that perceived knowledge and perceived competence were highly correlated. Perceived competence was a predictor of practicing lymphedema care. Advanced practice nurses scored in the midrange for perceived knowledge and perceived competence in risk reduction and self-management, but obtained lower scores in perceived knowledge and perceived competence for treatment. The odds of advanced practice nurses delivering lymphedema care were less than those of staff nurses. This study identifies gaps and opportunities for advanced practice nurses to play an important role in providing lymphedema care, an essential aspect of cancer survivorship. PMID:25031960

  1. Predictors of Practice Patterns for Lymphedema Care Among Oncology Advanced Practice Nurses

    PubMed Central

    Ryan, Joanne C.; Cleland, Charles M.; Fu, Mei R.

    2012-01-01

    Lymphedema, a debilitating and chronic condition, is considered to be one of the most distressing adverse effects of cancer treatment. The purpose of this study was to understand the practice patterns in lymphedema care and identify predictors influencing those patterns among oncology nurses, with a focus on advanced practice nurses. Random and purposive sampling was utilized to recruit 238 oncology nurses who completed the Web-based study. Participants included advanced practice nurses (nurse practitioners and clinical nurse specialists), nurse navigators/case managers, staff nurses, and directors/managers/coordinators. Data focused on perceived knowledge of and perceived competence in risk reduction, treatment, and self-management of lymphedema and practice patterns in lymphedema care. Actual knowledge of lymphedema care was evaluated. Descriptive, comparative, and regression analyses were performed. The study showed that perceived knowledge and perceived competence were highly correlated. Perceived competence was a predictor of practicing lymphedema care. Advanced practice nurses scored in the midrange for perceived knowledge and perceived competence in risk reduction and self-management, but obtained lower scores in perceived knowledge and perceived competence for treatment. The odds of advanced practice nurses delivering lymphedema care were less than those of staff nurses. This study identifies gaps and opportunities for advanced practice nurses to play an important role in providing lymphedema care, an essential aspect of cancer survivorship. PMID:25031960

  2. A Woman with Unilateral Rash and Fever: Cellulitis in the Setting of Lymphedema

    PubMed Central

    Joseph, Melissa; Camilon, Marissa; Kang, Tarina

    2015-01-01

    Cellulitis in the setting of lymphedema is an uncommon but clinically important presentation to the emergency department. Stagnant lymph is an ideal medium for bacterial growth and progression can be rapid due to decreased ability to fight infection in the affected area. Infections are commonly caused by gram-positive cocci, though blood cultures are often negative. Treatment should be aimed at rapid initiation of antibiotics targeting these species. There may be a role for antibiotic prophylaxis in recurrent cases. PMID:26171259

  3. A Woman with Unilateral Rash and Fever: Cellulitis in the Setting of Lymphedema.

    PubMed

    Joseph, Melissa; Camilon, Marissa; Kang, Tarina

    2015-01-01

    Cellulitis in the setting of lymphedema is an uncommon but clinically important presentation to the emergency department. Stagnant lymph is an ideal medium for bacterial growth and progression can be rapid due to decreased ability to fight infection in the affected area. Infections are commonly caused by gram-positive cocci, though blood cultures are often negative. Treatment should be aimed at rapid initiation of antibiotics targeting these species. There may be a role for antibiotic prophylaxis in recurrent cases. PMID:26171259

  4. Update on Post-mastectomy Lymphedema Management.

    PubMed

    Doscher, Matthew E; Schreiber, Jillian E; Weichman, Katie E; Garfein, Evan S

    2016-09-01

    Lymphedema is a chronic, progressive condition caused by an imbalance of lymphatic flow. Upper extremity lymphedema has been reported in 16-40% of breast cancer patients following axillary lymph node dissection. Furthermore, lymphedema following sentinel lymph node biopsy alone has been reported in 3.5% of patients. While the disease process is not new, there has been significant progress in the surgical care of lymphedema that can offer alternatives and improvements in management. The purpose of this review is to provide a comprehensive update and overview of the current advances and surgical treatment options for upper extremity lymphedema. PMID:27375223

  5. Lymphedema Characteristics and the Efficacy of Complex Decongestive Physiotherapy in Malignant Lymphedema.

    PubMed

    Liao, Su-Fen

    2016-08-01

    The aim of this study is to identify the lymphedema characteristics and the efficacy of complex decongestive physiotherapy (CDP) in 29 patients with malignant lymphedema. After CDP, total decreased volume of lymphedema was 306 mL, percentage of excess volume (PEV) changed from 43.4% to 22.7%, and lymphedema severity improved from severe to moderate status. The CDP efficacy-percentage reduction in excess volume (PREV) was 46.6%. The stage of lymphedema (P = .004), range of motion (P < .001), pain, heaviness, and tension scores (P < .001) were significantly improved after CDP. This shows that CDP is efficacious and useful in malignant lymphedema. PMID:25995325

  6. Under-Utilization of Implantable Cardioverter Defibrillators in Patients with Heart Failure - The Current State of Sudden Cardiac Death Prophylaxis

    PubMed Central

    Pillarisetti, Jayasree; Emert, Martin; Biria, Mazda; Chotia, Rashaad; Guda, Rajeshwer; Bommana, Sudharani; Pimentel, Rhea; Vacek, James; Dendi, Raghuveer; Berenbom, Loren; Dawn, Buddhadeb; Lakkireddy, Dhanunjaya

    2016-01-01

    Background Despite ACC/AHA guidelines indicating implantable cardioverter defibrillator (ICD) as class I therapy for primary prevention of sudden cardiac death in patients with EF≤35%, ICD utilization rates in real world practice have been low. Objective To determine the rate of ICD implantation at a tertiary care academic center and to assess the reasons for under-utilization of the same. Methods Review of a prospectively collected database which included all patients diagnosed with an EF≤35% was performed to assess the rate of ICD implantation and mortality. Reasons for non-implantation of ICD were then assessed from detailed chart review. Results A total of 707 patients (age 69.4 ± 14.1 years) with mean EF of 26±7% were analyzed. Only 28% (200/707) of patients had ICDs implanted. Mortality was lower in the group with ICD (25% vs 37%, p=0.004). When patients who either died or were lost to follow-up prior to 2005 were excluded, ICD utilization rate was still low at 37.6%. The most common reason for non-implantation of ICD was physicians not discussing this option with their patients. Patient refusal was the second most common reason. Conclusions ICD Implantation rates for primary prevention of SCD in patients with EF≤35% is low. Physician and patient education should be addressed to improve the utilization rates. PMID:25852239

  7. Prophylaxis for infective endocarditis.

    PubMed

    Gray, J D

    1987-04-01

    Although antibiotic prophylaxis for patients at risk for bacterial endocarditis has never been scientifcally tested, it is now an accepted practice in medicine. Patients at risk include all individuals with prosthetic valves, congenital or rheumatic heart disease, previous endocarditis, idiopathic hypertrophic subaortic stenosis (IHSS), and mitral valve prolapse with a holosytolic murmur. Dental, upper respiratory tract, genitourinary and gastrointestinal procedures associated with bacteremia are reviewed. New antibiotic regimens utilizing oral agents for shorter periods have recently been published and are outlined here. Patients at high risk of endocarditis (especially those with prosthetic valves) should continue to receive prophylactic antibiotics by the parenteral route. PMID:21263914

  8. Prophylaxis for Infective Endocarditis

    PubMed Central

    Gray, Jean D.

    1987-01-01

    Although antibiotic prophylaxis for patients at risk for bacterial endocarditis has never been scientifcally tested, it is now an accepted practice in medicine. Patients at risk include all individuals with prosthetic valves, congenital or rheumatic heart disease, previous endocarditis, idiopathic hypertrophic subaortic stenosis (IHSS), and mitral valve prolapse with a holosytolic murmur. Dental, upper respiratory tract, genitourinary and gastrointestinal procedures associated with bacteremia are reviewed. New antibiotic regimens utilizing oral agents for shorter periods have recently been published and are outlined here. Patients at high risk of endocarditis (especially those with prosthetic valves) should continue to receive prophylactic antibiotics by the parenteral route. PMID:21263914

  9. Lymphedema in China--experiences and prospects.

    PubMed

    Liu, N F

    2007-12-01

    The history of prevention and treatment of lymphedema in China is long. Filarial lymphedema was the most common type of the disease in the past with 5 million patients countrywide in the 1950's. Great efforts have gone into controlling filariasis during the past 50 years, and China now has essentially eliminated filariasis. In contrast to the reduction in filarial lymphedema, there has been a trend of increase in secondary lymphedema cases after malignant tumor surgery. Although there are no precise figures on the incidence of lymphedema nationwide, physicians and therapists are in great clinical demand. Traditional Chinese medicine has shown effectiveness for prevention and treatment of inflammation and alleviating swelling. The combination with Western medicine may offer improved methods for lymphedema treatment. PMID:18365528

  10. Gigantic Suprapubic Lymphedema: A Case Study

    PubMed Central

    Tanhaeivash, Roozbeh; Franiel, Tobias; Grimm, Marc-Oliver

    2016-01-01

    We present the first case study of idiopathic gigantic suprapubic lymphedema and buried penis treated with puboscrotal reconstruction in a patient with initial extreme obesity after an extensive weight reduction (120 kg). Massive localized lymphedema of the suprapubic region should be differentiated from the scrotal type. Severe lymphedema could not resolve on its own and weight reduction does not seem to be helpful in such cases. PMID:27574599

  11. Gigantic Suprapubic Lymphedema: A Case Study.

    PubMed

    Tanhaeivash, Roozbeh; Franiel, Tobias; Grimm, Marc-Oliver; Horstmann, Marcus

    2016-08-01

    We present the first case study of idiopathic gigantic suprapubic lymphedema and buried penis treated with puboscrotal reconstruction in a patient with initial extreme obesity after an extensive weight reduction (120 kg). Massive localized lymphedema of the suprapubic region should be differentiated from the scrotal type. Severe lymphedema could not resolve on its own and weight reduction does not seem to be helpful in such cases. PMID:27574599

  12. Association between Lymphedema Self-Care Adherence and Lymphedema Outcomes among Women with Breast Cancer-Related Lymphedema

    PubMed Central

    Brown, Justin C.; Kumar, Anagha; Cheville, Andrea L.; Tchou, Julia C.; Troxel, Andrea B.; Harris, Susan R.; Schmitz, Kathryn H.

    2014-01-01

    Objective To determine if adherence to self-care modalities for breast cancer-related lymphedema (BCRL) predicts BCRL outcomes among 128 breast cancer (BrCa) survivors who participated in the 12-month physical activity and lymphedema (PAL) trial. Design This was a prospective cohort study. Adherence to 10 BCRL self-care modalities, as recommended in the clinical practice guidelines for the management of BCRL was assessed by questionnaire at baseline. BCRL outcomes assessed at baseline and 12-months included volumetry, circumferences, bioimpedence spectroscopy, the Norman lymphedema survey, and clinician-defined lymphedema exacerbations requiring treatment. Generalized linear models were used to estimate the relationship between adherence to BCRL self-care modalities and the likelihood of experiencing a BCRL outcome. Results Adherence to BCRL self-care activities did not predict experiencing any BCRL outcomes at 12-months. Levels of adherence to BCRL self-care modalities did not predict a ≥5% decrease in interlimb volume (Ptrend=0.79), ≥5% decrease in the sum of interlimb arm circumferences (Ptrend=0.47), ≥10% decrease in bioimpedence spectroscopy (Ptrend=0.83), ≥1 decrease in self-reported lymphedema symptoms (Ptrend=0.91), or clinician-defined lymphedema exacerbation requiring treatment (Ptrend=0.84). Conclusions Our findings suggest levels of BCRL self-care adherence do not predict BCRL outcomes among BrCa survivors with stable lymphedema who were followed for 12-months. PMID:25171662

  13. Psychosocial Impact of Lymphedema: A Systematic Review of Literature from 2004–2011

    PubMed Central

    Fu, Mei R.; Ridner, Sheila H.; Hu, Sophia H.; Stewart, Bob R.; Cormier, Janice N.; Armer, Jane M.

    2014-01-01

    Objective This systematic review aimed to evaluate the level of evidence of contemporary peer-reviewed literature published from 2004–2011 on the psychosocial impact of lymphedema. Methods Eleven electronic databases were searched and 1,311 articles retrieved; 23 met inclusion criteria. Twelve articles utilized qualitative methodology and 11 employed quantitative methodology. An established quality assessment tool was used to assess the quality of the included studies. Results The overall quality of the 23 included studies was adequate. A critical limitation of current literature is the lack of conceptual or operational definitions for the concept of psychosocial impact. Quantitative studies showed statistically significant poorer social well-being in persons with lymphedema, including perceptions related to body image, appearance, sexuality, and social barriers. No statistically significant differences were found between persons with and without lymphedema in the domains of emotional well-being (happy or sad) and psychological distress (depression and anxiety). All 12 of the qualitative studies consistently described negative psychological impact (negative self-identity, emotional disturbance, psychological distress) and negative social impact (marginalization, financial burden, perceived diminished sexuality, social isolation, perceived social abandonment, public insensitivity, non-supportive work environment). Factors associated with psychosocial impact were also identified. Conclusions Lymphedema has a negative psychosocial impact on affected individuals. The current review sheds light on the conceptualization and operationalization of the definitions of psychosocial impact with respect to lymphedema. Development of a lymphedema-specific instrument is needed to better characterize the impact of lymphedema and to examine the factors contributing to these outcomes in cancer and non-cancer-related populations. PMID:23044512

  14. DESCRIBING LYMPHEDEMA IN FEMALES WITH TURNER SYNDROME.

    PubMed

    Rothbauer, J; Driver, S; Callender, L

    2015-09-01

    Turner syndrome (TS) is a chromosomal condition affecting an estimated 1 in 2,500 girls where the second X chromosome is missing, or partially formed. This abnormality affects multiple body systems and can lead to short stature, cardiac, neural, and renal abnormalities. Due to the chronic, non-life threatening nature of lymphedema in comparison to other symptoms of TS, it is often ignored by girls and women with TS and their physicians. Consequently, little is known about how lymphedema affects girls and women with TS across the lifespan. Therefore, the objective of the study was to deliver an online survey for females with TS and caregivers in the US, UK, and Canada to provide a worldwide perspective on their current experience with lymphedema within the spectrum of TS. There were 219 participants who completed the survey, and we were able to identify incidence and characteristics of lymphedema across the lifespan. In addition, we found that females with 45,X karyotyping were more likely to report lymphedema symptoms. Lymphedema is not the most significant concern of females with TS, but education, physician evaluation, and assistance with referrals for treatment and management would improve the ease of managing lymphedema in girls and women with TS. PMID:26939161

  15. Topiramate for migraine prophylaxis.

    PubMed

    2006-08-01

    About 14% of adults in the UK have migraines. Drugs used in migraine prophylaxis include beta-blockers (e.g. propranolol), 5HT antagonists (e.g. pizotifen), antidepressants (e.g. amitriptyline), antiepileptics (e.g. sodium valproate) and NSAIDs. The antiepileptic topiramate (Topamax-Janssen-Cilag) is licensed for the prophylaxis of migraine headache in patients aged over 16 years. Here we discuss the place of topiramate in migraine prophylaxis. PMID:16903488

  16. Prophylaxis of Malaria

    PubMed Central

    Schwartz, Eli

    2012-01-01

    Malaria prevention in travelers to endemic areas remains dependent principally on chemoprophylaxis. Although malaria chemoprophylaxis refers to all malaria species, a distinction should be drawn between falciparum malaria prophylaxis and the prophylaxis of the relapsing malaria species (vivax & ovale). While the emergence of drug resistant strains, as well as the costs and adverse reactions to medications, complicate falciparum prophylaxis use, there are virtually no drugs available for vivax prophylaxis, beside of primaquine. Based on traveler’s malaria data, a revised recommendation for using chemoprophylaxis in low risk areas should be considered. PMID:22811794

  17. Angiosarcoma after excisional surgery for chronic lymphedema.

    PubMed

    Joh, Jin Hyun; Lee, Byung-Boong; Chun, Young Soo; Chung, Weon Kuu; Lee, Ha Yeon

    2016-07-01

    Angiosarcoma is a rare soft tissue sarcoma of endothelial cell origin. It can arise from the endothelium of lymphatics (lymphangiosarcoma) or blood vessels (hemangiosarcoma). Chronic lymphedema of any origin is associated with its development. Few cases have been reported after surgical procedures for lymphedema. Here, we report one case of angiosarcoma that developed 15 months after excisional surgery for lymphedema. In spite of radical surgery and adjuvant chemoradiotherapy, the patient died of multiple lung metastases and pleural effusion 13 months later. PMID:27318054

  18. Lymphedema as a Cancer Treatment Side Effect

    MedlinePlus

    ... infections or drugs to relieve pain when necessary. Physical therapy. If you have trouble swallowing or other issues ... of the head and neck, you may need physical therapy. Reducing your risk of lymphedema Research continues to ...

  19. Lymphedema (PDQ®)—Health Professional Version

    Cancer.gov

    Expert-reviewed information summary about the anatomy, pathophysiology, clinical manifestations, diagnosis, and treatment of cancer-related lymphedema, a condition in which lymph fluid builds up in tissues and causes swelling.

  20. [Antimicrobial prophylaxis in surgery].

    PubMed

    Stastník, Miloslav

    2004-04-01

    Antimicrobial prophylaxis is an important factor influencing the risk of infection at the spot of surgical interventions (SSI). SSIs are the most important nosocomial infections of hospitalized surgical patients; they are responsible for increases of 10 to 20 % in the total costs of treatment. The efficacy of antimicrobial prophylaxis hinges on four basic factors. The first is a correctly indicated prophylaxis (in surgical operations with a confirmed reduction of SSI risk after prophylaxis and/or in cases of surgical operations, where a possible early or organ SSI could have tragic consequences). The second factor is the choice of the best possible antimicrobial for a specific indication. The third factor is the best possible time for the administration of prophylaxis (in most indications at the beginning of anaesthesia). The fourth factor influencing the efficacy of prophylaxis is its administration for only the absolutely minimum time period necessary (in most indications best is a single administration, possibly including a second peroperative ATB dose). The high rate of errors in the actual practice of prophylaxis and the confirmed efficacy of implementing local recommendations indicate that it is absolutely necessary to define national and local recommendations for antimicrobial prophylaxis, to ensure that surgeons adhere to these recommendations and to initiate SSI surveillance in the Czech Republic. PMID:15146385

  1. Lymphedema: What Every Woman with Breast Cancer Should Know

    MedlinePlus

    ... fluid, which can trigger or worsen lymphedema. Good hygiene and careful skin care may reduce your risk of lymphedema by helping you avoid infections. Follow these tips to care for the hand and arm on the side of your body ...

  2. Understanding Lymphedema (For Cancers Other Than Breast Cancer)

    MedlinePlus

    ... My ACS » Understanding Lymphedema: For Cancers Other Than Breast Cancer Download Printable Version [PDF] » Lymphedema can be caused ... News About Cancer Expert Voices Blog Programs & Services Breast Cancer Support TLC Hair Loss & Mastectomy Products Hope Lodge® ...

  3. Lymphedema: What Every Woman with Breast Cancer Should Know

    MedlinePlus

    ... Articles » My ACS » Lymphedema: What Every Woman With Breast Cancer Should Know Download Printable Version [PDF] » ( En español ) Women who have been treated for breast cancer may be at risk for lymphedema in the ...

  4. Symptom report in detecting breast cancer-related lymphedema

    PubMed Central

    Fu, Mei R; Axelrod, Deborah; Cleland, Charles M; Qiu, Zeyuan; Guth, Amber A; Kleinman, Robin; Scagliola, Joan; Haber, Judith

    2015-01-01

    Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors’ limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema

  5. Factors Predicting Adherence to Risk Management Behaviors of Women at Increased Risk for Developing Lymphedema

    PubMed Central

    Sherman, Kerry A.; Miller, Suzanne M.; Roussi, Pagona; Taylor, Alan

    2014-01-01

    Purpose Lymphedema affects 20-30% of women following breast cancer treatment. However, even when women are informed, they do not necessarily adhere to recommended lymphedema self-management regimens. Utilizing the Cognitive-Social Health Information Processing framework, we assessed cognitive and emotional factors influencing adherence to lymphedema risk management. Methods Women with breast cancer who had undergone breast and lymph node surgery were recruited through the Fox Chase Cancer Centre breast clinic. Participants (N=103) completed measures of lymphedema-related perceived risk, beliefs and expectancies, distress, self-regulatory ability to manage distress, knowledge, and adherence to risk management behaviors. They then received the American Cancer Society publication “Lymphedema: What Every Woman with Breast Cancer Should Know”. Cognitive and affective variables were reassessed at 6- and 12-months post-baseline. Results Maximum likelihood multilevel model analyses indicated that overall adherence increased over time, with significant differences between baseline and 6- and 12- month assessments. Adherence to wearing gloves was significantly lower than that for all other behaviors except electric razor use. Distress significantly decreased, and knowledge significantly increased, over time. Greater knowledge, higher self-efficacy to enact behaviors, lower distress, and higher self-regulatory ability to manage distress were associated with increased adherence. Conclusions Women who understand lymphedema risk management and feel confident in managing this risk are more likely to adhere to recommended strategies. These factors should be rigorously assessed as part of routine care to ensure that women have the self-efficacy to seek treatment and the self-regulatory skills to manage distress, which may undermine attempts to seek medical assistance. PMID:24970542

  6. [Antibiotical prophylaxy in gynecology].

    PubMed

    Záhumenský, J; Menzlová, E; Zmrhal, J; Kučera, E

    2013-08-01

    Gynecological surgery is considered to be clear with possible contamination by gram-positive cocci from the skin, gram-negatives from the perineum or groins or polymicrobial biocenosis from vagina, depending on the surgical approach. Antibiotical prophylaxy enforces the natural mechanisms of immunity and helps to exclude present infection. There were presented many studies comparing useful effect of prophylaxis in gynecological surgery. The benefits of antibiotical prophylaxy before IUD insertion, before the cervical surgery and before hysteroscopies were not verified. On the other hand the prophylaxy of vaginal surgery including vaginal hysterectomy decreases the number of postoperative febrile complications. The positive influence of prophylaxis before the simple laparoscopy and laparoscopy without bowel injury or the opening of the vagina was not evidently verified. In abdominal hysterectomy the antibiotical prophylaxy decreases the incidence of postoperative complications significantly. The administration of 2 g of cefazolin can be recommended. In procedures taking more than 3 hours the repeated administration of cefazolin is suitable. New urogynecological procedures, using mesh implants, were not sufficiently evaluated as for postoperative infections and the posible antibiotical effect. The presence of implant in possibly non sterile area should be considered as high risc of postoperative complications. PMID:24040985

  7. Impact of dose and volume on lymphedema.

    PubMed

    Nardone, Luigia; Palazzoni, Giovanni; D'Angelo, Elisa; Deodato, Francesco; Gambacorta, M Antonietta; Miccichè, Francesco; Morganti, Alessio G

    2005-01-01

    Lymphedema represents one of the major problem of morbidity in breast cancer therapy. Approximately 15-30% of patients show more or less severe lymphedema of the arm, following cancer therapy. Main pathogenetic mechanisms, risk factors, main grading criteria and scales as LENT-SOMA, CTCv2, CTCAE v3 are presented. A close correlation has been documented between the extent of axillary dissection and the association with radiotherapy in determining an increased risk of lymphedema. Details of surgery and radiotherapy are relevant in the definition of the risk of edema of the arm. Because the axillary area does not correspond to an organ, evaluable parameters as V20 and Dmean available for other organs are not applicable. There is some evidence of a correlation between the irradiation volume and the development of lymphedema. Data of the impact of the dose and its fractionation on the development of lymphedema are contrasting. The monitoring system of late toxicity used by the authors is presented. PMID:16294908

  8. [Management of secondary lymphedema in patients with cancer].

    PubMed

    Wenczl, Enikő

    2016-03-27

    Due to the increased number of cancer patients and the progress in cancer treatment, there are more cases with cancer-related lymphedema. Lymphedema treatment became part of oncological patients' care. Basic therapy for lymphedema is the complex decongestive therapy, which should be embedded into the patient's comprehensive medical care and should always be determined individually. Results of therapy are influenced by the experience of the doctor and the physiotherapist in lymphedema care, patient's complience, tumor behavior and the accompanying diseases. Lymphedema is a chronic disease, requires lifelong follow-up and treatment. For prevention and better care, it would be important to inform patients about lymphedema risk and appropriate life-style (e.g. weight control) preoperatively and during oncological follow-up. Early diagnosis is important. Lymphedema treatment should be integrated into palliative programmes. If therapy is started in time, complications may be avoided, healthcare costs may be reduced and better quality of life may be achieved. PMID:26996895

  9. Systematic review: conservative treatments for secondary lymphedema

    PubMed Central

    2012-01-01

    Background Several conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for secondary lymphedema. The optimal treatment is unknown. We examined the effectiveness of conservative treatments for secondary lymphedema, as well as harms related to these treatments. Methods We searched MEDLINE®, EMBASE®, Cochrane Central Register of Controlled Trials®, AMED, and CINAHL from 1990 to January 19, 2010. We obtained English- and non-English-language randomized controlled trials or observational studies (with comparison groups) that reported primary effectiveness data on conservative treatments for secondary lymphedema. For English-language studies, we extracted data in tabular form and summarized the tables descriptively. For non-English-language studies, we summarized the results descriptively and discussed similarities with the English-language studies. Results Thirty-six English-language and eight non-English-language studies were included in the review. Most of these studies involved upper-limb lymphedema secondary to breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most studies were under 6 months. Many trial reports contained inadequate descriptions of randomization, blinding, and methods to assess harms. Most observational studies did not control for confounding. Many studies showed that active treatments reduced the size of lymphatic limbs, although extensive between-study heterogeneity in areas such as treatment comparisons and protocols, and outcome measures, prevented us from assessing whether any one treatment was superior. This heterogeneity also precluded us from statistically pooling results. Harms were rare (< 1% incidence) and mostly minor (e.g., headache, arm pain). Conclusions The literature contains no evidence to suggest the most effective treatment for secondary lymphedema. Harms are few and unlikely to cause major clinical problems. PMID:22216837

  10. Lymphedema following cancer therapy in Slovenia: a frequently overlooked condition?

    PubMed Central

    Rucigaj, Tanja Planinsek; Leskovec, Nada Kecelj; Zunter, Vesna Tlaker

    2010-01-01

    Introduction Secondary lymphedema following cancer therapy is a frequent, often painful, quality of life disturbing condition, reducing the patients’ mobility and predisposing them to complications, e.g. infections and malignancies. The critical aspect of lymphedema therapy is to start as soon as possible to prevent the irreversible tissue damage. Patients and methods We performed a retrospective study of patients with lymphedema, treated at the Department of Dermatovenereology, University Medical Center Ljubljana, from January 2002 to June 2010. The patients’ demographic and medical data were collected, including type of cancer, type and stage of lymphedema, and time to first therapy of lymphedema. The number of referred patients with lymphedema following the therapy of melanoma, breast cancer, and uterine/cervical cancer, was compared to the number of patients expected to experience lymphedema following cancer therapy, calculated from the incidence reported in the literature. Results In the period of 8.5 years, 543 patients (432 females, 112 males) with lymphedema were treated. The results show that probably many Slovenian patients with secondary lymphedema following cancer therapy remain unrecognized and untreated or undertreated. In the majority of our patients, the management of lymphedema was delayed; on average, the patients first received therapy for lymphedema 3.6 years after the first signs of lymphedema. Conclusions To avoid a delay in diagnosis and therapy, and the complications of lymphedema following cancer therapy, the physician should actively look for signs or symptoms of lymphedema during the follow-up period, and promptly manage or refer the patients developing problems. PMID:22933923

  11. Severe lymphedema caused by repeated self-injury.

    PubMed

    Mihara, M; Hara, H; Murai, N; Todokoro, T; Iida, T; Narushima, M; Koshima, I

    2011-12-01

    Lymphedema is divided into primary and secondary forms. Primary lymphedema often develops in young people and may be caused by lymphvascular aplasia, hypoplasia, and hyperplasia. The most frequent cause of secondary lymphedema after lymphatic filariasis is regional lymph node dissection for treatment of a malignant tumor, and this complication occurs most frequently in middle aged or older patients. Here, we describe a relatively young patient (27 years old) in whom collecting lymph vessels in the upper limb were disrupted by repeated self-injury, with resultant lymphedema. There have been very few reports on lymphedema caused by self-induced trauma. This case report illustrates that secondary lymphedema should also be considered and evaluated appropriately when diagnosed in a relatively young patient without a history of cancer or infection. PMID:22458120

  12. A multimodal physical therapy approach to the management of a patient with temporomandibular dysfunction and head and neck lymphedema: a case report

    PubMed Central

    Crane, Patricia; Feinberg, Lauren; Morris, John

    2015-01-01

    Objective and importance: There is a paucity of research that investigates therapeutic interventions of patients with concurrent head and neck lymphedema and temporomandibular dysfunction (TMD). The purpose of this case report is to describe the management and outcomes of a patient with head and neck lymphedema and TMD using a multimodal physical therapy approach. Clinical presentation: A 74-year-old male with a past medical history of head and neck lymphedema and TMD was referred to physical therapy with chief complaints of inability to open his mouth in order to eat solid food, increased neck lymphedema, temporomadibular joint pain, and inability to speak for prolonged periods of time. Interventions: The patient was treated for three visits over 4 weeks. Treatment included complete decongestive therapy (CDT), manual therapy, therapeutic exercise, and a home exercise program. Upon discharge, the patient had improved mandibular depression, decreased head and neck lymphedema, improved deep neck flexor endurance, decreased pain, and improved function on the Patient Specific Functional Scale (PSFS). Conclusion: Utilization of a multimodal physical therapy approach to treat a patient with a complex presentation yielded positive outcomes. Further research on outcomes and treatment approaches in patients with TMD and head and neck lymphedema is warranted. PMID:26309380

  13. Proteomic profiling of lymphedema development in mouse model.

    PubMed

    Lee, Joomin; Song, Haeun; Roh, Kangsan; Cho, Sungrae; Lee, Sukchan; Yeom, Chang-Hwan; Park, Seyeon

    2016-07-01

    The lymphatic vascular system plays an important role in tissue fluid homeostasis. Lymphedema is a chronic, progressive, and incurable condition that leads to lymphatic fluid retention; it may be primary (heritable) or secondary (acquired) in nature. Although there is a growing understanding of lymphedema, methods for the prevention and treatment of lymphedema are still limited. In this study, we investigated differential protein expressions in sham-operated and lymphedema-operated mice for 3 days, using two-dimensional gel electrophoresis (2-DE) and mass spectrometry analysis. Male improved methodology for culturing noninbred (ICR) mice developed lymphedema in the right hindlimb. Twenty functional proteins were found to be differentially expressed between lymphedema induced-right leg tissue and normal left leg tissue. Out of these proteins, the protein levels of apolipoprotein A-1 preprotein, alpha-actinin-3, mCG21744, parkinson disease, serum amyloid P-component precursor, annexin A8, mKIAA0098 protein, and fibrinogen beta chain precursor were differentially upregulated in the lymphedema mice compared with the sham-operated group. Western blotting analysis was used to validate the proteomics results. Our results showing differential up-regulation of serum amyloid P-component precursor, parkinson disease, and apolipoprotein A-1 preprotein in lymphedema model over sham-operated model suggest important insights into pathophysiological target for lymphedema. Copyright © 2016 John Wiley & Sons, Ltd. PMID:27151289

  14. [Conservative lymphedema therapy - lymphological rehabilitation treatment].

    PubMed

    Apich, Gert

    2013-04-01

    The most important column in the conservative lymphedema therapy still represents the complex decongestive physical therapy/KPE.This is a multimodal therapy, which consists of four components. (1) skin restoration and/or skin care, (2) manual lymphatic drainage, (3) compression therapy and (4) decongestive exercises. The KPE is also divided into two phases. Phase 1-the decongestion-serves primarily the mobilization and transporting away the banked protein-rich oedema fluid and seamless transition into the Phase 2-the maintenance phase, which serves to preserve the achieved treatment success. The implementation of the KPE should be stage-adjusted, but depends also on the location (genital, head, face), and on co-existing comorbidities (congestive heart failure, diabetes mellitus, obesity, muscular-skeletal disorders, mental illness, etc.). It should be modified for children, elderly persons and for patients with malignant lymphedema. PMID:23645412

  15. Possible Genetic Predisposition to Lymphedema after Breast Cancer

    PubMed Central

    Newman, Beth; Lose, Felicity; Kedda, Mary-Anne; Francois, Mathias; Ferguson, Kaltin; Janda, Monika; Yates, Patsy; Spurdle, Amanda B.

    2012-01-01

    Abstract Background Known risk factors for secondary lymphedema only partially explain who develops lymphedema following cancer, suggesting that inherited genetic susceptibility may influence risk. Moreover, identification of molecular signatures could facilitate lymphedema risk prediction prior to surgery or lead to effective drug therapies for prevention or treatment. Recent advances in the molecular biology underlying development of the lymphatic system and related congenital disorders implicate a number of potential candidate genes to explore in relation to secondary lymphedema. Methods and Results We undertook a nested case-control study, with participants who had developed lymphedema after surgical intervention within the first 18 months of their breast cancer diagnosis serving as cases (n=22) and those without lymphedema serving as controls (n=98), identified from a prospective, population-based, cohort study in Queensland, Australia. TagSNPs that covered all known genetic variation in the genes SOX18, VEGFC, VEGFD, VEGFR2, VEGFR3, RORC, FOXC2, LYVE1, ADM, and PROX1 were selected for genotyping. Multiple SNPs within three receptor genes, VEGFR2, VEGFR3, and RORC, were associated with lymphedema defined by statistical significance (p<0.05) or extreme risk estimates (OR <0.5 or >2.0). Conclusions These provocative, albeit preliminary, findings regarding possible genetic predisposition to secondary lymphedema following breast cancer treatment warrant further attention for potential replication using larger datasets. PMID:22404826

  16. Antibiotic prophylaxis in otolaryngologic surgery

    PubMed Central

    Ottoline, Ana Carolina Xavier; Tomita, Shiro; Marques, Marise da Penha Costa; Felix, Felippe; Ferraiolo, Priscila Novaes; Laurindo, Roberta Silveira Santos

    2013-01-01

    Summary Aim: Antibiotic prophylaxis aims to prevent infection of surgical sites before contamination or infection occurs. Prolonged antibiotic prophylaxis does not enhance the prevention of surgical infection and is associated with higher rates of antibiotic-resistant microorganisms. This review of the literature concerning antibiotic prophylaxis, with an emphasis on otolaryngologic surgery, aims to develop a guide for the use of antibiotic prophylaxis in otolaryngologic surgery in order to reduce the numbers of complications stemming from the indiscriminate use of antibiotics. PMID:25991999

  17. Sodium selenite and cancer related lymphedema: Biological and pharmacological effects.

    PubMed

    Pfister, Christina; Dawzcynski, Horst; Schingale, Franz-Josef

    2016-09-01

    A significant percentage of cancer patients develop secondary lymphedema after surgery or radiotherapy. The preferred treatment of secondary lymphedema is complex physical therapy. Pharmacotherapy, for example with diuretics, has received little attention, because they were not effective and only offered short-term solutions. Sodium selenite showed promise as a cost-effective, nontoxic anti-inflammatory agent. Treatment with sodium selenite lowers reactive oxygen species (ROS) production, causes a spontaneous reduction in lymphedema volume, increases the efficacy of physical therapy for lymphedema, and reduces the incidence of erysipelas infections in patients with chronic lymphedema. Besides biological effects in reducing excessive production of ROS, sodium selenite also displays various pharmacological effects. So far the exact mechanisms of these pharmacological effects are mostly unknown, but probably include inhibition of adhesion protein expression. PMID:27267968

  18. Breast and gynecologic cancer-related extremity lymphedema: a review of diagnostic modalities and management options

    PubMed Central

    2013-01-01

    Lymphedema remains a poorly understood entity that can occur after lymphadenectomy. Herein, we will review the pathogenesis of lymphedema, diagnostic modalities and the natural history of extremity involvement. We will review the incidence of upper extremity lymphedema in patients treated for breast malignancies and lower extremity lymphedema in those treated for gynecologic malignancy. Finally, we will review traditional treatment modalities for lymphedema, as well as introduce new surgical treatment modalities that are under active investigation. PMID:24053624

  19. Sexual Partnerships and Considerations for HIV Antiretroviral Pre-Exposure Prophylaxis Utilization Among High-Risk Substance Using Men Who Have Sex with Men

    PubMed Central

    Mimiaga, Matthew J.; Closson, Elizabeth F.; Kothary, Vishesh; Mitty, Jennifer A.

    2015-01-01

    Men who have sex with men (MSM) remain at great risk of HIV in the United States, representing 65 % of incident HIV infections. One factor contributing to the high rate ofHIV infectionamongMSM isuse of“recreational”drugsthat are highly associated with unprotected anal sex. Pre-exposure chemoprophylaxis(PrEP)isanovelbiomedicalHIVprevention strategy that has the potential to reduce HIV transmission in MSM. Main and casual sex partners play a role in HIV prevention efforts for MSM. The study aimed to qualitatively explore the perceived influences of sexual relationships on promoting and inhibiting PrEP use among high-risk MSM who report regular drug use. Semi-structured qualitative interviews were conducted with 40 participants recruited in Boston, Massachusetts. Data were analyzed using descriptive qualitative analysis. Casual partners presented a distinct set of concerns from primary partnerships. MSM generally viewed main partners as a potential source of support for taking PrEP. Given their informal and often temporary nature, PrEP disclosure to casual partners was considered unnecessary. HIV-related stigma and substance use were also perceived as barriers to discussing PrEP use with casual partners. MSM articulated a high degree of personal agency regarding their ability to take PrEP. Findings suggest that behavioral interventions to improve PrEP utilization and adherence for high-risk MSM should be tailored to sex partner type and the parameters established between sex partners. Approaches to PrEP disclosure and partner engagement should be informed by the relative benefits and limitations characterized by these different types of relationships. PMID:24243002

  20. Lymphoscintigraphy to confirm the clinical diagnosis of lymphedema

    SciTech Connect

    Golueke, P.J.; Montgomery, R.A.; Petronis, J.D.; Minken, S.L.; Perler, B.A.; Williams, G.M. )

    1989-09-01

    Confirmation of the diagnosis of lymphedema often requires lymphangiography, a procedure that is painful for the patient and technically demanding. Radioisotope lymphoscintigraphy is a relatively new technique that uses technetium 99 m antimony trisulfide colloid to produce a diagnostic image similar to a lymphangiogram. The procedure requires a single subcutaneous injection in the involved extremity, and images are obtained 3 hours later. It is technically easy to perform, produces minimal discomfort for the patient, and has no adverse effects. We have recently used radioisotope lymphoscintigraphy to evaluate 17 patients with extremity edema. These patients initially had a presumed diagnosis of lymphedema involving the upper or lower extremity. Lymphoscintigraphy confirmed the diagnosis of lymphedema in 12 (70.6%) patients. In five of the 17 patients (29.4%) the clinical impression of lymphedema was not supported by lymphoscintigraphy, leading to alternative diagnoses such as lipomatosis, venous insufficiency (two patients), congestive heart failure, and disuse edema. In all patients with secondary lymphedema the lymphatic system in the involved extremity could be partially visualized. Conversely, three of four patients with primary lymphedema had no ascent of the tracer from the foot and no lymphatic channels could be visualized. Lymphoscintigraphy is relatively easy to perform, safe, minimally invasive, and not uncomfortable for the patient. It is useful in differentiating lymphedema from other causes of extremity edema, allowing institution of appropriate therapy.

  1. A Lymphedema Self-Management Programme: Report on 30 Cases

    PubMed Central

    Hodgson, Pamela; Shay, Carol; Towers, Anna

    2014-01-01

    ABSTRACT Purpose: Compression therapy is the most important element in the treatment and long-term management of moderate and severe lymphedema, but it is not universally accessible in Canada. For those unable to access private lymphedema treatment, physiotherapists at the McGill University Health Centre (MUHC) Lymphedema Clinic began teaching patients and caregivers how to use compression bandages safely and effectively. Methods: A retrospective chart review was combined with structured telephone or in-person interviews with 30 people who had attended a self-bandaging clinic in the MUHC Lymphedema Clinic between 2011 and 2012. Patients were monitored weekly until limb volume plateaued, and a compression garment was then fitted for ongoing maintenance. Monthly or quarterly surveillance continued for 1 year. Follow-up interviews were conducted 3 to 18 months after patients had received their garments. Results: The majority of participants had moderate to severe lymphedema; all achieved reduction of edema in the range of 48% to 92%. More than three-quarters of participants reported a global rate of change (GRC) of ≥80%. Themes derived from the interviews included the importance of bandaging, the feeling of being in control, and difficulties with compression garments. Participants spontaneously expressed satisfaction about having tools to manage their condition themselves. Conclusion: For selected patients with lymphedema, a self-bandaging programme can be a route to lymphedema reduction, independence, and self-efficacy. PMID:25922562

  2. [Lymphangion in health and in lymphedema].

    PubMed

    Borisov, A V; Anichkov, N M

    1992-01-01

    Comparative analysis of lymphangion construction in different organs and sites of human body is performed. Quantitative parameters of lymphangions (length, width, volume) are found to have age and site peculiarities. Myo-myocyte contacts of the nexus type and fascicular-reticular organizational principle of the cells underly myocyte association into functional syncytium. The valve consists of a muscleless fold and valvular bolster containing muscles. Restructuring of lymphangions in lower limb lymphedema are observed. In the course of the disease progression myocyte atrophy occurs which is followed by lymphangion wall collagenization. The alterations in lower limb lymphangions are proportional to the gravity of the disease. PMID:1296566

  3. Giant scrotal lymphedema of unclear etiology: a case report

    PubMed Central

    2009-01-01

    Introduction Scrotal lymphedema is common in the tropics and subtropics. The giant variants can cause a lot of physical disability and psychological disturbances. Case presentation We present a 25-year-old Nigerian male with giant scrotal lymphedema with severe debilitating symptoms, immobility and emotional disturbance. He benefited from a modified Charles' procedure and reconstruction of the penile shaft using a split-thickness skin graft. Conclusion Giant scrotal lymphedema related to poverty, ignorance and neglect, is amenable to surgery. Surgery provides a cosmetically acceptable and functionally satisfying outcome. PMID:19830170

  4. [Surgical treatment of penile lymphedema associated with hidradenitis suppurativa].

    PubMed

    García-Tutor, E; Botellé del Hierro, J; San Martín Maya, A; Castro García, J; España, A; Fernández Montero, J; Robles García, J E

    2005-05-01

    Penoscrotal lymphedema is a rare disease in the developed countries, although it is relatively frequent in tropical countries. The most common cause is filariasis, although in our practice usually is associate to neoplasic and inflammatory processes, surgery, radiotherapy, hidroelectrolitic disbalances and idiopathic. We present a 22 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa. After unsuccessful medical treatment, was performed a total excision of the penile skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. Even medical management of penoscrotal lymphedema is not effective for most patients, surgery is a safe and effective procedure that gives excellent functional and cosmetic results. PMID:16013800

  5. Recent Progress in Cancer-Related Lymphedema Treatment and Prevention

    PubMed Central

    Shaitelman, Simona F.; Cromwell, Kate D.; Rasmussen, John C.; Stout, Nicole L.; Armer, Jane M.; Lasinski, Bonnie B.; Cormier, Janice N.

    2016-01-01

    This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema. PMID:25410402

  6. 21 CFR 872.6290 - Prophylaxis cup.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prophylaxis cup. 872.6290 Section 872.6290 Food... DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6290 Prophylaxis cup. (a) Identification. A prophylaxis... agents during prophylaxis (cleaning). The dental handpiece spins the rubber cup holding the...

  7. [Drugs for migraine prophylaxis].

    PubMed

    Takeshima, Takao

    2012-01-01

    Migraine is a prevalent and disabling neurologic disorder. The aims of migraine management are lifting the burden of migraine and improvement of quality of life (QOL) of the sufferers. Chronification of episodic migraine would introduce refractory chronic migraine or medication overuse headache. The prevention of chronification of migraine is one of the major roles of prophylactic medication. There are some classes of prophylactic drugs against migraine headache. The calcium blocker (lomeridine, verapamil), anti-epileptic drugs (valproate), beta-blockers (propranorol), and anti-depressant (amytriptyline) have high quality evidence in migraine prophylaxis. Migraine has varied cormorbid disorders, such as hypertension, cardiac diseases, cerebrovascular diseases, psychiatric disorders, epilepsy, and allergic disorders. Upon choosing preventive drug, neurologists should consider the comorbid disorders. Recent studies revealed possible association of migraine and cerebrovascular diseases, especially in migraine with aura and in young women. Not only headache expert but every neurologist should have broad knowledge concerning migraine management. PMID:23196487

  8. Prospective Lymphedema Surveillance in a Clinic Setting.

    PubMed

    Chance-Hetzler, Janet; Armer, Jane; Van Loo, Maggie; Anderson, Blake; Harris, Robin; Ewing, Rebecca; Stewart, Bob

    2015-01-01

    The potential impact of breast cancer-related lymphedema (LE) is quite extensive, yet it often remains under-diagnosed until the later stages. This project examines the effectiveness of prospective surveillance in post-surgical breast cancer patients. A retrospective analysis of 49 out of 100 patients enrolled in a longitudinal prospective study at a Midwestern breast center evaluates: (1) time required for completion of bilateral limb measurements and Lymphedema Breast Cancer Questionnaire (LBCQ); (2) referral to LE management with limb volume increase (LVI) and/or LBCQ symptoms; and (3) cost of LE management at lower LVI (≥5%-≤10%) versus traditional (≥10%). Findings revealed a visit timeframe mean of 40.3 min (range = 25-60); 43.6% of visits were ≤30-min timeframe. Visit and measurement times decreased as clinic staff gained measurement experience; measurement time mean was 17.9 min (range = 16.9-18.9). LBCQ symptoms and LVI were significantly (p < 0.001) correlated to LE referral; six of the nine patients referred (67%) displayed both LBCQ symptoms/LVI. Visits with no symptoms reported did not result in referral, demonstrating the importance of using both indicators when assessing early LE. Lower threshold referral provides compelling evidence of potential cost savings over traditional threshold referral with reported costs of: $3755.00 and $6353.00, respectively (40.9% savings). PMID:26308061

  9. Utility of the clinical practice of administering thrombophilic screening and antithrombotic prophylaxis with low-molecular-weight heparin to healthy donors treated with G-CSF for mobilization of peripheral blood stem cells.

    PubMed

    Martino, Massimo; Luise, Francesca; Oriana, Vincenzo; Console, Giuseppe; Moscato, Tiziana; Mammì, Corrado; Messina, Giuseppe; Massara, Elisabetta; Irrera, Giuseppe; Piromalli, Angela; Lombardo, Vincenzo Trapani; Laganà, Carmelo; Iacopino, Pasquale

    2007-01-01

    The aim of the study was to verify the utility of the clinical practice of administering thrombophilic screening and antithrombotic prophylaxis with low-molecular-weight heparin to healthy donors receiving granulocyte colony-stimulating factor to mobilize peripheral blood stem cells. Thrombophilia screening comprised of testing for factor V Leiden G1691A, prothrombin G20210A, the thermolabile variant (C677T) of the methylene tetrahydrofolate reductase gene, protein C, protein S, factor VIII and homocysteine plasmatic levels, antithrombin III activity, and acquired activated protein C resistance. We investigated prospectively 72 white Italian healthy donors, 39 men and 33 women, with a median age of 42 years (range, 18-65). Five donors (6.9%) were heterozygous carriers of Factor V Leiden G1691A; two healthy donors had the heterozygous prothrombin G20210A gene mutation; C677T mutation in the methylene tetrahydrofolate reductase gene was present in 34 (47.2%) donors in heterozygous and in 7 donors (9.7%) in homozygous. Acquired activated protein C resistance was revealed in 8 donors of the study (11.1%). The protein C plasmatic level was decreased in 3 donors (4.2%); the protein S level was decreased in 7 donors (9.7%). An elevated factor VIII dosage was shown in 10 donors (13.9%) and hyperhomocysteinemia in 9 donors (12.5%). Concentration of antithrombin III was in the normal range for all study group donors. The factor V Leiden mutation was combined with the heterozygous prothrombin G20210A in 2 cases and with protein S deficiency in one case; 2 healthy donors presented an associated deficiency of protein C and protein S. Although none of these healthy subjects had a previous history of thrombosis, low-molecular-weight heparin was administered to all donors during granulocyte colony-stimulating factor administration to prevent thrombotic events. No donor experienced short or long-term thrombotic diseases after a median follow-up of 29.2 months. Our data do not

  10. AA amyloidosis as a complication of primary lymphedema.

    PubMed

    Beloncle, François; Sayegh, Johnny; Eymerit-Morin, Caroline; Duveau, Agnès; Augusto, Jean-François

    2014-03-01

    Primary lymphedema is a rare disease caused by a disorder of lymphangiogenesis. Clinical presentation and age at onset are variable. AA amyloidosis is usually due to chronic inflammatory diseases, malignant tumors or less frequently chronic infectious diseases. We report here the first two cases of AA amyloidosis present with renal failure and nephrotic syndrome in patients with primary lymphedema-induced chronic leg ulcers. The first patient was a 62-year-old female who presented with chronic untreated leg ulcers for 8 years secondary to primary lymphedema. A kidney biopsy done for nephrotic syndrome allowed the diagnosis of AA amyloidosis. The second patient was a 54-year-old male who presented with hereditary lymphedema and elephantiasis since the age of 12. A salivary gland biopsy allowed the diagnosis of AA amyloidosis. Renal function deteriorated progressively needing chronic haemodialysis. Chronic leg ulcers have been rarely reported to induce AA amyloidosis. Only five other cases have been reported in the literature, but none of them with chronic lymphedema. We believe that the relation between lymphedema, chronic leg ulcers and AA amyloidosis is underestimated. PMID:23964754

  11. Lymphedema Outcomes in Patients with Head and Neck Cancer

    PubMed Central

    Little, Leila G.; Skoracki, Roman J.; Rosenthal, David I.; Lai, Stephen Y.; Lewin, Jan S.

    2015-01-01

    Objective We sought to describe the presentation of external head and neck lymphedema in patients treated for head and neck cancer and examine their initial response to complete decongestive therapy. Study Design Case series with chart review. Setting MD Anderson Cancer Center, Houston, TX. Subjects and Methods Patients evaluated for head and neck cancer at MD Anderson Cancer Center after treatment 01/2007-01/2013 were retrospectively reviewed. Response to complete decongestive therapy was evaluated per changes in lymphedema severity rating or surface tape measures. Predictors of therapy response were examined using regression models. Results 1,202 patients were evaluated. Most patients (62%) had soft, reversible pitting edema (MDACC Stage 1b). Treatment response was evaluated in 733 patients after receiving therapy; 439 (60%) improved after complete decongestive therapy. Treatment adherence independently predicted complete decongestive therapy response (p<0.001). Conclusions These data support the effectiveness of a head and neck cancer-specific regimen of lymphedema therapy for cancer patients with external head and neck lymphedema. Our findings suggest that head and neck lymphedema is distinct from lymphedema that affects other sites, requiring adaptations in traditional methods of management and measurement. PMID:25389318

  12. Factors Associated With External and Internal Lymphedema in Patients With Head-and-Neck Cancer

    SciTech Connect

    Deng Jie; Ridner, Sheila H.; Dietrich, Mary S.; Wells, Nancy; Wallston, Kenneth A.; Sinard, Robert J.; Cmelak, Anthony J.; Murphy, Barbara A.

    2012-11-01

    Purpose: The purpose of this study was to examine factors associated with the presence of secondary external and internal lymphedema in patients with head-and-neck cancer (HNC). Methods and Materials: The sample included 81 patients {>=}3 months after HNC treatment. Physical and endoscopic examinations were conducted to determine if participants had external, internal, and/or combined head-and-neck lymphedema. Logistic regression analysis was used to examine the factors associated with the presence of lymphedema. Results: The following factors were statistically significantly associated with presence of lymphedema: (1) location of tumor associated with presence of external (P=.009) and combined lymphedema (P=.032); (2) time since end of HNC treatment associated with presence of external (P=.004) and combined lymphedema (P=.005); (3) total dosage of radiation therapy (P=.010) and days of radiation (P=.017) associated with the presence of combined lymphedema; (4) radiation status of surgical bed was associated with the presence of internal lymphedema, including surgery with postoperative radiation (P=.030) and (salvage) surgery in the irradiated field (P=.008); and (5) number of treatment modalities associated with external (P=.002), internal (P=.039), and combined lymphedema (P=.004). No demographic, health behavior-related, or comorbidity factors were associated with the presence of lymphedema in the sample. Conclusions: Select tumor and treatment parameters are associated with increased occurrence of lymphedema in patients with HNC. Larger and longitudinal studies are needed to identify adjusted effects and causative risk factors contributing to the development of lymphedema in patients with HNC.

  13. Proactive Approach to Lymphedema Risk Reduction: A Prospective Study

    PubMed Central

    Fu, Mei R.; Axelrod, Deborah; Guth, Amber A.; Cartwright, Francis; Qiu, Zeyuan; Goldberg, Judith D.; Kim, June; Scagliola, Joan; Kleinman, Robin; Haber, Judith

    2014-01-01

    Background Advances in cancer treatments continue to reduce the incidence of lymphedema. Yet, many breast cancer survivors still face long-term post-operative challenges as a result of developing lymphedema. The purpose of this study was to preliminarily evaluate The-Optimal-Lymph-Flow program, a patient-centered education and behavioral program focusing on self-care strategies to enhance lymphedema risk reduction by promoting lymph flow and optimize body mass index. Methods A prospective, longitudinal, quasi-experimental design with repeated-measures was used. The study outcomes included lymph volume changes by infra-red perometer and body mass index by a bioimpedance device at pre-surgery baseline, 2-4 weeks after surgery, 6-month, and 12-month follow-up. A total of 140 patients were recruited and participated in The-Optimal-Lymph-Flow program; 134 patients completed the study with 4% attrition rate. Results Fifty-eight percent patients had axillary node dissection and 42% had sentinel lymph node biopsy. The majority (97%) of patients maintained and improved their preoperative limb volume and body mass index at the study endpoint of 12 months following cancer surgery. Cumulatively, 2 patients with sentinel lymph node biopsy and 2 patients with the axillary lymph node dissection had measurable lymphedema (>10% limb volume change). At 12-month follow-up, among the 4 patients with measurable lymphedema, 2 patients' limb volume returned to pre-operative level without compression therapy but by maintaining The-Optimal-Lymph-Flow exercises to promote daily lymph flow. Conclusions This educational and behavioral program is effective to enhance lymphedema risk reduction. The study provided initial evidence for emerging change in lymphedema care from treatment-focus to proactive risk reduction. PMID:24809302

  14. [Beta blockers in migraine prophylaxis].

    PubMed

    Shimizu, Toshihiko

    2009-10-01

    Beta blockers (beta-adrenoceptor blockers) are known to be used for the prophylactic treatment of migraine. The improvement of migraine in the patients who recieved propranolol for angina pectoris revealed the effectiveness of propranolol in migraine prophylaxis. Many clinical trials have confirmed that propranolol is effective in the prophylactic treatment of migraine. Other beta-blocking drugs, namely nadolol, metoprolol, atenolol, timolol and bisoprolol, have also been demonstrated to be effective in the prophylaxis of migraine. In contrast, several beta blockers with intrinsic sympathetic activity (ISA), such as alprenolol, oxprenolol, pindolol and acebutolol, have not been demonstrated to be effective in migraine prophylaxis. In this review, we have descrived the pharmacologic background and pharmacokinetics of the beta blockers that demonstrated a prophylactic effect for migraine will be described. We have also reviewed the results of clinical trials of beta-blocking drugs for migraine. PMID:19882938

  15. The Multicomponent Medication Lymphomyosot Improves the Outcome of Experimental Lymphedema

    PubMed Central

    Keim, Alex P.; Slis, Justin R.; Mendez, Uziel; Stroup, Emily M.; Burmeister, Yvonne; Tsolaki, Natalie; Gailing, Oliver

    2013-01-01

    Abstract Background Secondary lymphedema is a life-long disease of painful tissue swelling that often follows axillary lymph node dissection to treat breast cancer. It is hypothesized that poor lymphatic regeneration across the obstructive scar tissue during the wound healing process may predispose the tissue to swell at a later date. Treatment for lymphedema remains suboptimal and is in most cases palliative. The purpose of this study was to evaluate the ability of Lymphomyosot to treat tissue swelling and promote lymphangiogenesis in experimental models of murine lymphedema. Methods Experimental models of mouse lymphedema were injected with varied amounts of Lymphomyosot and saline as control. Measurements of tail swelling and wound closure were taken and compared amongst the groups. Three separate groups of mice were analyzed for lymphatic capillary migration, lymphatic vessel regeneration, and macrophage recruitment. Results Lymphomyosot significantly reduced swelling and increased the rate of surgical wound closure. Lymphomyosot did not increase the migration of lymph capillaries in a mouse tail skin regeneration model or regeneration of lymph vessels following murine axillary lymph node dissection. Conclusions Lymphomyosot may act through inflammatory and wound repair pathways to reduce experimental lymphedema. Its ability to regulate inflammation as well as assist in tissue repair and extracellular formation may allow for the production of a scar-free matrix bridge through which migrating cells and accumulated interstitial fluid can freely spread. PMID:23725444

  16. Putting evidence into practice: cancer-related lymphedema.

    PubMed

    Fu, Mei R; Deng, Jie; Armer, Jane M

    2014-01-01

    Cancer-related lymphedema is a progressive and chronic syndrome of abnormal swelling and multiple symptoms resulting from cancer treatment. Even with modern medical advances, lymphedema remains a major health problem affecting thousands of cancer survivors. To provide healthcare professionals with evidence-based clinical practice guidelines for lymphedema treatment and management, a systematic review was conducted to evaluate 75 selected articles from 2009-2014 by the Oncology Nursing Society Putting Evidence Into Practice lymphedema team. Findings of the systematic review support complete decongestive therapy, compression bandages, and compression garments with highest evidence for best clinical practice. Weight management, full-body exercise, information provision, prevention, and early intervention protocols are likely to be effective for clinical practice. Historic recommendations for activity restriction and avoidance of aerobic and resistive exercises that limit cancer survivors' daily lives have been challenged with more evidence. Cancer survivors may not need to restrict activities such as resistive or aerobic exercises and weightlifting with gradual exercise progression. Future research should focus on providing high-level evidence using randomized clinical trials with larger samples and studying lymphedema beyond breast cancer. PMID:25427610

  17. Pediatric lymphedema caused by diffuse cervical lymphadenopathy: A case report and review of the literature.

    PubMed

    Gitomer, Sarah A; Giannoni, Carla M; Cañadas, Karina T

    2016-08-01

    Pediatric head and neck lymphedema is rare and there have not been any reported cases in children. Here we discuss severe, diffuse head and neck lymphedema in a child caused by compression of the internal jugular veins by lymphadenopathy from Kawasaki's disease. With steroid and intravenous immunoglobulin treatment, the lymphadenopathy improved and facial edema slowly resolved. In review of the literature, complications of head and neck lymphedema including airway obstruction and blindness are discussed. This case highlights the importance of the pediatric otolaryngologist considering lymphedema as a cause for facial swelling and monitoring for complications of lymphedema. PMID:27368445

  18. 21 CFR 872.6290 - Prophylaxis cup.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prophylaxis cup. 872.6290 Section 872.6290 Food... DEVICES DENTAL DEVICES Miscellaneous Devices § 872.6290 Prophylaxis cup. (a) Identification. A prophylaxis cup is a device made of rubber intended to be held by a dental handpiece and used to apply...

  19. Time Course of Mild Arm Lymphedema After Breast Conservation Treatment for Early-Stage Breast Cancer

    SciTech Connect

    Bar Ad, Voichita; Cheville, Andrea; Solin, Lawrence J.; Dutta, Pinaki; Both, Stefan; Harris, Eleanor

    2010-01-15

    Purpose: Arm lymphedema is a potential consequence of the treatment for breast carcinoma. The objective of this retrospective study was to characterize the progression of mild arm lymphedema after breast conservation treatment for breast cancer. Methods and Materials: The study cohort was drawn from 1,713 consecutive Stage I or II breast cancer patients who underwent breast conservation therapy, including axillary staging followed by radiation. Arm lymphedema was documented in 266 (16%) of 1,713 patients. One hundred nine patients, 6% of the overall group and 40% of the patients with arm lymphedema, presented with mild arm lymphedema, defined as a difference of 2 cm or less between the measured circumferences of the affected and unaffected arms. Results: Among the 109 patients with mild arm lymphedema at the time of arm lymphedema diagnosis, the rate of freedom from progression to more severe lymphedema was 79% at 1 year, 66% at 3 years, and 52% at 5 years. The patients who were morbidly obese, had positive axillary lymph nodes, or received supraclavicular irradiation at the time of breast cancer treatment were at higher risk of progression from mild arm lymphedema to more severe edema. Conclusions: Mild arm lymphedema, generally considered to be a minor complication after breast conservation treatment for breast cancer, was associated with a risk of progression to a more severe grade of arm lymphedema in a substantial fraction of patients.

  20. Inter-Changeability of Impedance Devices for Lymphedema Assessment.

    PubMed

    van Zanten, Malou; Piller, Neil; Ward, Leigh C

    2016-06-01

    Impedance technology is a popular technique for the early detection of lymphedema. The preferred approach is to use bioimpedance spectroscopy (BIS), with measurements being made with the subject lying supine, although attempts have been made to use single or multiple frequency impedance measurements obtained while the subject is standing. The aim of the present study was to determine the equivalence of these different approaches. Impedance measurements of the individual limbs of 37 healthy individuals were determined using both a stand-on, multi-frequency impedance device and a supine impedance spectroscopy instrument. Significant differences were found between the instruments in both absolute impedance values and, importantly, inter-limb impedance ratios. Since impedance ratios in healthy individuals provide the reference standard for detection of lymphedema, these data indicate that the methods are not interchangeable. Consideration of the errors associated with each method indicates that the BIS remains the preferred method for lymphedema detection. PMID:26574711

  1. Management of secondary lymphedema related to breast cancer

    PubMed Central

    Cheifetz, Oren; Haley, Louise

    2010-01-01

    Abstract OBJECTIVE To review recent literature on the management of secondary lymphedema following breast cancer. QUALITY OF EVIDENCE MEDLINE, EMBASE, AMED, PubMed, and the Internet were searched for articles published between 2005 and 2009. Articles were evaluated using Sackett’s levels of evidence. The literature search focused on primary research and systematic reviews. MAIN MESSAGE Secondary lymphedema related to breast cancer is an ongoing challenge. Evidence suggests that there are several safe and beneficial treatments, including complex decongestive therapy, physiotherapy, and exercise. Furthermore, resistive exercises, previously contraindicated on the affected side, have been found to be both beneficial and safe with careful progression and monitoring. Exercise guidelines and patient education topics are presented with a comprehensive reference list for further reading. CONCLUSION Advances in cancer treatment, cancer and exercise research, and lymphedema management require that physicians have a basic understanding of the current evidence to provide appropriate patient education and referral. PMID:21375063

  2. Lymphedema-related angiogenic tumors and other malignancies.

    PubMed

    Lee, Robert; Saardi, Karl M; Schwartz, Robert A

    2014-01-01

    Chronic lymphedema has a permissive effect with certain types of malignancies, particularly angiosarcomas, in what is known as Stewart-Treves syndrome. The presumed mechanism of this effect is an immunocompromised district of the affected area. Most other cutaneous malignancies have also been described in lymphedematous areas, including basal cell carcinoma, squamous cell carcinoma, melanoma, Kaposi sarcoma, Merkel cell carcinoma, and several cutaneous lymphomas. The occurrence of such malignancies suggests a more general immunosuppression within the skin. The formation of collateral lymphatic and vascular vessels in response to lymphedema produces an environment rich in growth factors, which may also play a role. In addition to infection and other general skin care issues, regions affected by lymphedema should be monitored for malignant changes not limited to angiosarcomas. PMID:25160102

  3. Barcelona Lymphedema Algorithm for Surgical Treatment in Breast Cancer-Related Lymphedema.

    PubMed

    Masià, Jaume; Pons, Gemma; Rodríguez-Bauzà, Elena

    2016-06-01

    Background Breast cancer-related lymphedema is a prevalent condition that has a major impact on quality of life. Surgical treatment has become an alternative to help affected patients with good results. However, there is no consensus on surgical procedure and protocol. Methods We analyzed our data in two periods: from June 2007 to December 2011 and from January 2012 to June 2014. Data included the analysis of the limb circumferences and the subjective symptoms felt by patients. Results Of the 200 patients treated in the study, 81 had lymphaticovenous anastomosis, 7 had autologous lymph node transfer, 16 had total breast anatomy restoration, 52 had vibroliposuction, and 44 had combined reconstructive procedures. In the first period, the circumference of the superior limb showed a decrease of 0.9 to 6.1 cm (average 2.75 cm). In the second period, the circumference of the superior limb showed a decrease of 2.9 to 6.1 cm (average 3.85 cm). Clinical results and data from the questionnaires confirmed the improvement and subjective benefits. Conclusion We have obtained considerable improvements in results of limb circumferences and subjective symptoms after incorporating several modifications into our surgical strategy for lymphedema treatment. A detailed preoperative assessment should be performed to determine whether reconstructive surgery or palliative surgery is indicated. PMID:26975564

  4. Breast Cancer–Related Lymphedema: Comparing Direct Costs of a Prospective Surveillance Model and a Traditional Model of Care

    PubMed Central

    Pfalzer, Lucinda A.; Springer, Barbara; Levy, Ellen; McGarvey, Charles L.; Danoff, Jerome V.; Gerber, Lynn H.; Soballe, Peter W.

    2012-01-01

    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 may 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

  5. Breast Cancer Survivors’ Experiences of Lymphedema-Related Symptoms

    PubMed Central

    Fu, Mei Rosemary; Rosedale, Mary

    2009-01-01

    The purpose of this study was to explore and describe breast cancer survivors’ lymphedema-related symptom experiences. As a serious chronic condition from breast cancer treatment, lymphedema, or persistent swelling, is caused by chronic accumulation of lymph fluid in the interstitial spaces of the affected limb or surrounding areas. While significant prevalence of ongoing multiple symptoms have been reported, little is known about how survivors with lymphedema perceive and respond to lymphedema-related symptoms in their daily lives. This study employed a descriptive phenomenological method. Thirty-four participants were recruited in the US. Three in-depth interviews were conducted with each participant; a total of 102 interviews were completed, audio-taped, and transcribed. Interview transcripts and field notes were the data sources for this analysis, which was part of three larger studies. Data were analyzed to identify the essential themes within and across cases. Four essential themes were revealed: living with perpetual discomfort; confronting the unexpected; losing pre-lymphedema being; and feeling handicapped. Participants experienced multiple symptoms on a daily basis. Distress was heightened when women expected symptoms to disappear but instead they remained as a “perpetual discomfort.” Moreover, distress was intensified when symptoms evoked unexpected situations or when symptoms elicited emotional responses powerful enough to change perceived personal identity. Findings suggest that symptom distress may encompass temporal, situational and attributive dimensions. Prospective studies are needed to examine lymphedema-related symptom distress in terms of these dimensions so that more specific interventions can be developed to target distress occurring in each dimension. PMID:19819668

  6. Transnodal Lymphangiography in the Diagnosis and Treatment of Genital Lymphedema

    SciTech Connect

    Gomez, F. M. Martinez-Rodrigo, J.; Marti-Bonmati, L.; Santos, E.; Forner, I.; Lloret, M.; Perez-Enguix, D.; Garcia-Marcos, R.

    2012-12-15

    Purpose: To report the success of groin nodal lymphography in the diagnosis and treatment of genital lymphedema. Methods and Materials: We present one female (8 years old [patient no. 1]) and two male (69 and [patient no. 2] 31 years old [patient no. 3], respectively) patients with genital lymphedema in whom conservative treatment failed. The girl also had lymphorrhagia. Genital lymphedema was caused by radical cystectomy (patient no. 2), lymphatic hyperplasia (patient no. 1), and idiopathic lymphangitis (patient no. 3). All of them underwent ultrasound-guided bilateral groin lymph node puncture. Afterward, 4-8 ml Lipiodol Ultra-Fluide (Guerbet) were injected at a rate of 0.2 ml/s. Lipiodol progression was assessed by fluoroscopy. Computed tomography scan of the abdomen and pelvis was performed immediately after and again at 24 h after the procedure to confirm the leak. The follow-up period was 15, 13, and 9 months, respectively. Technical success was considered as bilateral pelvic and abdominal filling of lymphatic vessels. Therapeutic success was considered as improvement or disappearance of genital lymphedema and/or lymphorrhagia. Results: Lipiodol leak to the scrotum was observed in patients no. 2 and 3. Lymphaticopelvic fistula and genital lymphatic hyperplasia were seen in patient no. 1. Genital lymphedema diminished within 1 week and almost disappeared in two cases (patients no. 1 and 3) or significantly improved (patient no. 2). lymphorrhagia also resolved in patient no. 1. No recurrence or worsening was detected during follow-up. Conclusion: Therapeutic lymphangiography by lymph node injection seems to be effective to treat genital lymphedema. Lymph node puncture lymphangiography is feasible and less cumbersome than pedal lymphangiography.

  7. The Psychosocial Impact of Lymphedema-related Distress among Breast Cancer Survivors in the WHEL Study

    PubMed Central

    Dominick, Sally A.; Natarajan, Loki; Pierce, John P.; Madanat, Hala; Madlensky, Lisa

    2014-01-01

    Objective Lymphedema is a distressing and chronic condition affecting up to 30% of breast cancer survivors. Using a cross-sectional study design, we examined the impact of self-reported lymphedema-related distress on psychosocial functioning among breast cancer survivors in the Women’s Healthy Eating and Living (WHEL) Study. The WHEL Study has a dataset that includes self-report data on lymphedema status, symptoms and distress. Methods Chi-square tests and binary logistic regression models were used to examine how specific participant characteristics, including lymphedema-related distress, were associated with physical health and mental health as measured by the SF-36 and depressive symptoms assessed by the CES-Dsf. Results Of the 2,431 participants included in the current study population, 692 (28.5%) self-reported ever having lymphedema. A total of 335 (48.9%) women reported moderate to extreme distress as a result of their lymphedema and were classified as having lymphedema-related distress. The logistic regression models showed that women with lymphedema-related distress had 50% higher odds of reporting poor physical health (p=0.01) and 73% higher odds of having poor mental health (p<0.01) when compared to women without lymphedema. In contrast, even though lymphedema-related distress was significantly associated (p=0.03) with elevated depressive symptoms in the bivariate analyses, it was not significant in the logistic regression models. Conclusion Breast cancer survivors with lymphedema-related distress had worse physical and mental health outcomes than women with lymphedema who were not distressed and women with no lymphedema. Our findings provide further evidence of the relationship between lymphedema and psychosocial outcomes in breast cancer survivors. PMID:24615880

  8. Giant lymphedema of the penis and scrotum: a case report

    PubMed Central

    Vives, Franklin; Ocampo-Flórez, Ginna Marcela

    2016-01-01

    Lymphedema of the penis and scrotum is a rare entity characterized by enlargement of the skin and subcutaneous tissue of the genital region due to lymphatic drainage impairment. This clinical condition is more frequent in tropical countries due to a higher incidence of filariasis, which, in turn, is the main etiology. We describe the case of a 33-year-old man with large lymphedema of the scrotum and penis due to an acute and chronic inflammatory process, foreign body granuloma, and marked hyalinization. Four consecutive surgical interventions were necessary to remove the great part of the affected tissue, which enabled satisfactory results and improved the patient's quality of life. PMID:27284543

  9. Angiosarcoma in a patient with congenital nonhereditary lymphedema.

    PubMed

    Shon, Wonwoo; Wada, David A; Folpe, Andrew L; Pittelkow, Mark R

    2012-11-01

    Angiosarcoma is an uncommon but aggressive tumor of endothelial origin that may occur in the upper extremities of patients with postmastectomy lymphedema (Stewart-Treves syndrome) as well as in other regions. We present an unusual case of angiosarcoma associated with congenital nonhereditary lymphedema in an 18-year-old man. Our case underscores the need for a careful clinical examination and shows the importance of appropriate sampling and thorough pathologic examination of suspicious areas to exclude the presence of a malignant process. PMID:23270196

  10. Giant lymphedema of the penis and scrotum: a case report.

    PubMed

    Vives, Franklin; García-Perdomo, Herney Andrés; Ocampo-Flórez, Ginna Marcela

    2016-01-01

    Lymphedema of the penis and scrotum is a rare entity characterized by enlargement of the skin and subcutaneous tissue of the genital region due to lymphatic drainage impairment. This clinical condition is more frequent in tropical countries due to a higher incidence of filariasis, which, in turn, is the main etiology. We describe the case of a 33-year-old man with large lymphedema of the scrotum and penis due to an acute and chronic inflammatory process, foreign body granuloma, and marked hyalinization. Four consecutive surgical interventions were necessary to remove the great part of the affected tissue, which enabled satisfactory results and improved the patient's quality of life. PMID:27284543

  11. Lymphedema surgery: Patient selection and an overview of surgical techniques.

    PubMed

    Allen, Robert J; Cheng, Ming-Huei

    2016-06-01

    Evaluation of the lymphedema patients with appropriate staging is fundamental for further treatment. Treatment includes compressive decongestive therapy for stage 0 and 1 patients, lymphovenous anastomosis for stage 1 and 2 patients, vascularized lymph node transfer for stage 2 and above patients. Wedge resection, liposuction, and the Charles procedure are alternatives or additions to physiological procedures. The selection of donor lymph node flap and recipient site depends on the patient's lymphedema status and surgeon's expertise. J. Surg. Oncol. 2016;113:923-931. © 2016 Wiley Periodicals, Inc. PMID:26846615

  12. Treatment of Lymphedema Praecox through Low Level Laser Therapy (LLLT)

    PubMed Central

    Mahram, Manoochehr; Rajabi, Majid

    2011-01-01

    A 15-year-old girl with right lower extremity lymphedema praecox was treated through Low Level Laser Therapy (LLLT), by means of a GaAs and GaAlAs diodes laser-therapy device. Treatment sessions were totally 24, each cycle containing 12 every other day 15-minute sessions, and one month free between the cycles. The treatment was achieved to decrease the edema and no significant increase in circumference of involved leg was found following three months after the course of treatment. Although LLLT can be considered a beneficial treatment for Lymphedema Praecox, any definite statement around its effectiveness needs more studies on more cases. PMID:22091317

  13. Th2 differentiation is necessary for soft tissue fibrosis and lymphatic dysfunction resulting from lymphedema

    PubMed Central

    Avraham, Tomer; Zampell, Jamie C.; Yan, Alan; Elhadad, Sonia; Weitman, Evan S.; Rockson, Stanley G.; Bromberg, Jacqueline; Mehrara, Babak J.

    2013-01-01

    Lymphedema is a dreaded complication of cancer treatment. However, despite the fact that >5 million Americans are affected by this disorder, the development of effective treatments is limited by the fact that the pathology of lymphedema remains unknown. The purpose of these studies was to determine the role of inflammatory responses in lymphedema pathology. Using mouse models of lymphedema, as well as clinical lymphedema specimens, we show that lymphatic stasis results in a CD4+ T-cell inflammation and T-helper 2 (Th2) differentiation. Using mice deficient in T cells or CD4+ cells, we show that this inflammatory response is necessary for the pathological changes of lymphedema, including fibrosis, adipose deposition, and lymphatic dysfunction. Further, we show that inhibition of Th2 differentiation using interleukin-4 (IL-4) or IL-13 blockade prevents initiation and progression of lymphedema by decreasing tissue fibrosis and significantly improving lymphatic function, independent of lymphangiogenic growth factors. We show that CD4+ inflammation is a critical regulator of tissue fibrosis and lymphatic dysfunction in lymphedema and that inhibition of Th2 differentiation markedly improves lymphatic function independent of lymphangiogenic cytokine expression. Notably, preventing and/or reversing the development of pathological tissue changes that occur in lymphedema may be a viable treatment strategy for this disorder.—Avraham, T., Zampell, J. C., Yan, A., Elhadad, S., Weitman, E. S., Rockson, S. G., Bromberg, J., Mehrara, B. J. Th2 differentiation is necessary for soft tissue fibrosis and lymphatic dysfunction resulting from lymphedema. PMID:23193171

  14. Lymphedema Precautions: Time to Abandon Old Practices?

    PubMed

    Ahn, Soojin; Port, Elisa R

    2016-03-01

    The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 46-year-old premenopausal woman with a body mass index of 21 was found on screening mammography to have a new, approximately 1-cm spiculated mass with associated calcifications in the upper outer quadrant of the left breast. Stereotactic core biopsy showed a focus of invasive duct carcinoma, strongly positive for estrogen and progesterone receptors and negative for human epidermal growth factor receptor 2, with associated ductal carcinoma in situ. Clinical examination revealed no palpable mass or axillary lymphadenopathy. She underwent a left lumpectomy with seed localization and sentinel lymph node biopsy. Final pathology revealed an 8-mm well-differentiated invasive carcinoma without lymphovascular invasion and intermediate grade ductal carcinoma in situ. The margins were clear, and three sentinel lymph nodes were negative for metastasis. The 21-gene recurrence score was 10, suggesting a 7% risk of 10-year distant recurrence with adjuvant endocrine treatment. After the completion of adjuvant radiotherapy (42.50 Gy in 16 fractions to the breast), the patient has returned for a follow-up visit. She is a professional violinist and would like to know what she can do to prevent lymphedema on her upcoming flight to Vienna. PMID:26712226

  15. Lymphedema fat graft: an ideal filler for facial rejuvenation.

    PubMed

    Nicoli, Fabio; Chilgar, Ram M; Sapountzis, Stamatis; Lazzeri, Davide; Sze Wei, Matthew Yeo; Ciudad, Pedro; Nicoli, Marzia; Lim, Seong Yoon; Chen, Pei-Yu; Constantinides, Joannis; Chen, Hung-Chi

    2014-09-01

    Lymphedema is a chronic disorder characterized by lymph stasis in the subcutaneous tissue. Lymphatic fluid contains several components including hyaluronic acid and has many important properties. Over the past few years, significant research has been performed to identify an ideal tissue to implant as a filler. Because of its unique composition, fat harvested from the lymphedema tissue is an interesting topic for investigation and has significant potential for application as a filler, particularly in facial rejuvenation. Over a 36-month period, we treated and assessed 8 patients with lymphedematous limbs who concurrently underwent facial rejuvenation with lymphedema fat (LF). We conducted a pre- and post-operative satisfaction questionnaire survey and a histological assessment of the harvested LF fat. The overall mean general appearance score at an average of 6 months after the procedure was 7.2±0.5, demonstrating great improvement. Patients reported significant improvement in their skin texture with a reading of 8.5±0.7 and an improvement in their self-esteem. This study demonstrates that LF as an ideal autologous injectable filler is clinically applicable and easily available in patients with lymphedema. We recommend the further study and clinical use of this tissue as it exhibits important properties and qualities for future applications and research. PMID:25276654

  16. Breast Cancer-Related Lymphedema: Implications for Family Leisure Participation

    ERIC Educational Resources Information Center

    Radina, M. Elise

    2009-01-01

    An estimated 20% of breast cancer survivors face the chronic condition of breast cancer-related lymphedema. This study explored the ways in which women with this condition experienced changes in their participation in family leisure as one indicator of family functioning. Participants (N = 27) were interviewed regarding lifestyles before and after…

  17. Lymphatic capillary pressure in patients with primary lymphedema.

    PubMed

    Zaugg-Vesti, B; Dörffler-Melly, J; Spiegel, M; Wen, S; Franzeck, U K; Bollinger, A

    1993-09-01

    Flow and pressure dynamics in minute human lymphatics are unexplored. Lymphatic capillary pressure was measured by the servo-nulling technique at the foot dorsum of 14 patients with primary lymphedema and 15 healthy controls. Glass micropipettes (7-9 microns) were inserted under microscopic control into lymphatic microvessels previously stained by fluorescence microlymphography (FITC-Dextran 150,000). Mean lymphatic capillary pressure was 7.9 +/- 3.4 mm Hg in the controls and 15.0 +/- 5.1 mm Hg in the patients. The difference was significant at the P < 0.001 level. In about half of the patients and control subjects studied pressure fluctuated by more than 3 mm Hg. The mean intralymphatic pressure of lymphedema patients was slightly below mean interstitial pressure measured by J. T. Christensen, N. J. Shaw, M. M. Hamas and H. K. Al Hassan (1985, Microcirc., Endothelium, Lymphatics 2, 267-384) (17.9 mm Hg) in lower leg lymphedema. Microlymphatic hypertension present in patients with primary lymphedema is probably an important factor for edema formation. PMID:8246814

  18. Return of lymphatic function after flap transfer for acute lymphedema.

    PubMed Central

    Slavin, S A; Van den Abbeele, A D; Losken, A; Swartz, M A; Jain, R K

    1999-01-01

    OBJECTIVE: The goals of this work were to develop animal models of lymphedema and tissue flap transfer, and to observe physiologic changes in lymphatic function that occur in these models over time, both systemically with lymphoscintigraphy (LS) and locally using fluorescence microlymphangiography (FM). SUMMARY BACKGROUND DATA: Although lymphedema has been managed by a combination of medical and surgical approaches, no effective long-term cure exists. Surgical attempts aimed at reconnecting impaired lymphatic channels or bypassing obstructed areas have failed. METHODS: The tails of rats (A groups) and mice (B groups) were used because of their different features. Lymphedema was created by ligation of the lymphatics at the tail base and quantified by diameter measurements there. In the experimental group, rectus abdominis myocutaneous flap was transferred across the ligation. In addition to the ligation (A1 and B1) and ligation + flap (A2 and B2) groups, three control groups were included: sham flap with ligation (B4), sham flap alone (B5), and normal (A3 and B3) animals. Observations were made at weekly time points for lymphatic function and continuity. RESULTS: Lymphedema was successfully created in the mouse ligation groups (B1 and B4) and sustained for the entire length of observation (up to 14 weeks). Lymphatic continuity was restored in those animals with transferred flaps across the ligation site (A2 and B2), as seen both by LS and FM. Sham flaps did not visibly affect lymphatic function nor did they cause any visible swelling in the tail. CONCLUSIONS: Acute lymphedema developing after ligation of tail lymphatics in mice can be prevented by myocutaneous flap transfer. Restored lymphatic continuity and function were demonstrable using lymphoscintigraphy and fluorescence microlymphangiography. Images Figure 2. Figure 4. Figure 5. PMID:10077056

  19. Godoy & Godoy technique in the treatment of lymphedema for under-privileged populations

    PubMed Central

    de Godoy, José Maria Pereira; de Godoy, Maria de Fátima Guerreiro

    2010-01-01

    The aim of this paper is to report new options in the treatment of lymphedema for under-privileged populations. Several articles and books have been published reporting recent advances and contributions. A new technique of manual lymph drainage, mechanisms of compression, development of active and passive exercising apparatuses and the adaptation of myolymphokinetic activities have been developed for the treatment of lymphedema. This novel approach can be adapted for the treatment of lymphedema in mass. PMID:20428336

  20. A prospective study of breast lymphedema: frequency, symptoms, and quality of life.

    PubMed

    Degnim, Amy C; Miller, Joyce; Hoskin, Tanya L; Boughey, Judy C; Loprinzi, Margie; Thomsen, Kristine; Maloney, Shaun; Baddour, Larry M; Cheville, Andrea L

    2012-08-01

    Although lymphedema of the arm is a well-known complication of breast and axillary surgery, breast lymphedema has received scant attention. We sought to prospectively characterize breast lymphedema's incidence, associated symptoms, clinical course, and impact on quality of life. Subjects were enrolled prospectively from a consecutive sample of patients undergoing non-mastectomy breast procedures (excisional biopsy or wide local excision ± lymph node removal) and followed for signs and symptoms of lymphedema in the operated breast. Symptoms and distress were serially assessed with 11-point linear analog scales. Breast lymphedema was diagnosed independent of symptoms, based on the distribution and degree of edema and erythema. One hundred twenty-four women were followed for a median of 11 months, and breast lymphedema was diagnosed in 38 (31%) women. Breast lymphedema was more frequent after breast surgery with axillary node removal (49%) compared to breast surgery alone (0%), p < 0.0001. Breast lymphedema involved multiple quadrants in most women and was characterized by edema in 100% and erythema in 79%. Patients with breast lymphedema were significantly more likely than women without breast lymphedema to report symptoms of breast heaviness (65% vs 22%, p < 0.0001), redness (62% vs 29%, p = 0.0006), and swelling (59% vs 22%, p < 0.0001), but symptom-associated distress was low overall. Three of 32 breast lymphedema patients with clinical follow-up developed chronic edema. Breast lymphedema occurs in approximately one-half of women who undergo breast surgery with axillary node removal. The condition is characterized by diffuse skin edema and erythema as well as self-reported symptoms with a low level of distress. PMID:22415476

  1. Primary prophylaxis of variceal bleeding.

    PubMed

    Ilyas, Jawad A; Kanwal, Fasiha

    2014-12-01

    Gastroesophageal varices are present in almost half of patients with cirrhosis at the time of initial diagnosis. Variceal bleeding occurs in 25% to 35% of patients with cirrhosis. Effective and timely care can prevent variceal bleeding (primary prophylaxis). For example, clinical studies demonstrate that both beta-blockers and endoscopic variceal ligation are effective in preventing a first episode of variceal bleeding. The major challenge is to screen patients in a timely manner and institute a form of therapy that has the highest chance of success in terms of patient compliance and effectiveness. PMID:25440925

  2. PROPHYLAXIS OF VENOUS THROMBOEMBOLISM IN ORTHOPAEDIC SURGERY

    PubMed Central

    Leme, Luiz Eugênio Garcez; Sguizzatto, Guilherme Turolla

    2015-01-01

    The relevance of prophylaxis of venous thromboembolism and its complications in orthopedic surgery is increasingly significant. This review discusses the pathophysiology of thrombus formation in general and orthopedic surgery, its incidence, predisposing factors and complications. It also presents an updated presentation and critique of prophylaxis currently available in our environment. PMID:27047885

  3. [Secondary malignant lymphedema in head and neck tumors].

    PubMed

    Hammerl, Bernhard; Döller, Walter

    2008-01-01

    The occurrence of edema is a serious problem of patients suffering from cancer and may have various causes. Particularly, the secondary malignant lymphedema poses a special threat to patients. In some cases, it indicates the progression of illness, and in fact also results in mutilating physical changes, which add to the already existing impairments caused by the cancer disease. So far therapeutic interventions are limited. Current management consists of physical therapy and pharmacological interventions. There are few powerful studies concerning the efficiency and hardly any concerning combined or comparative treatment in the literature. Most of them focus on the management of lymphedema in breast cancer patients. Preventive measures and supportive therapy are rarely being discussed. In this case report, we describe the successful use of Selen and Sandostatin in treating a facial edema of a patient with advanced head-neck cancer. PMID:19165449

  4. GENITAL LYMPHEDEMA: A NEW TECHNIQUE OF CORRECTION SURGERY.

    PubMed

    Kumar, K Leela Praveen; Manokaran, G

    2015-09-01

    Genital lymphedema is a common problem seen by lymphology surgeons in India due to filarial infections. We have developed an innovative operative technique to correct this issue using native skin and have found the results in the first fifteen patients to be encouraging. Gross debulking procedures reduced the size and using native skin allowed a better cosmetic appearance. The patients also reported almost normal sensation and good sexualfunction. This technique deserves further testing with more patients and at additional centers. PMID:26939162

  5. Combined Lymphedema and Capillary Malformation of the Lower Extremity

    PubMed Central

    Maclellan, Reid A.; Chaudry, Gulraiz

    2016-01-01

    Background: Primary lymphedema and capillary malformation are independent vascular malformations that can cause overgrowth of the lower extremity. We report a series of patients who had both types of malformations affecting the same leg. The condition is unique but may be confused with other types of vascular malformation overgrowth conditions (eg, Klippel–Trenaunay and Parkes Weber). Methods: Our Vascular Anomalies Center and Lymphedema Program databases were searched for patients with both capillary malformation and lymphedema. Diagnosis of lymphedema–capillary malformation was made by history, physical examination, and imaging studies. Because lymphedema–capillary malformation has phenotypical overlap with other conditions, only patients who had imaging confirming their diagnosis were included in the analysis. Clinical and radiological features, morbidity, and treatment were recorded. Results: Eight patients (4 females and 4 males) had confirmed lymphedema–capillary malformation. Referring diagnosis was Klippel–Trenaunay syndrome (n = 4), diffuse capillary malformation with overgrowth (n = 3), or lymphatic malformation (n = 1). The condition was unilateral (n = 6) or bilateral (n = 2). Morbidity included infection (n = 6), difficulty fitting clothes (n = 6), bleeding or leaking vesicles (n = 5), leg length discrepancy (n = 4), and difficulty ambulating (n = 3). All patients were managed with compression regimens. Operative management was liposuction (n = 3), treatment of phlebectatic veins (n = 3), staged skin/subcutaneous excision (n = 1), and/or epiphysiodesis (n = 1). Conclusions: Lymphedema and capillary malformation can occur together in the same extremity. Both conditions independently cause limb overgrowth primarily because of subcutaneous adipose deposition. Compression garments and suction-assisted lipectomy can improve the condition. Lymphedema–capillary malformation should not be confused with other vascular malformation overgrowth

  6. The European preexposure prophylaxis revolution

    PubMed Central

    Cairns, Gus; McCormack, Sheena; Molina, Jean-Michel

    2016-01-01

    Purpose of review The review describes the European epidemic and the challenges in moving from clinical trials of preexposure prophylaxis (PrEP) to routine practice. Recent findings Two European trials conducted in gay and other MSM and transgender women reported a high and consistent reduction in HIV incidence using oral PrEP with tenofovir/emtricitabine (TDF/FTC). The incidence of HIV infection in the control group was much higher than anticipated, based on routine surveillance data in MSM, in spite of the highest standard of HIV prevention available. Summary Recent results have highlighted the urgent need to make PrEP available to key populations in Europe as an additional prevention tool. Gilead has not yet submitted an application to use TDF/FTC as PrEP in Europe. Although regulatory approval would accelerate implementation, countries are already dispensing TDF/FTC as postexposure prophylaxis without this. Services for prevention are diverse across countries ranging from free, walk-in services for the diagnosis and treatment of HIV and other sexually transmitted infections, to insurance-dependent reimbursement of private clinical services. Momentum is gathering in Europe with PrEP demonstration projects in MSM and a growing demand from community organizations. Each Member State urgently needs to identify their key populations and determine the service best placed to provide this new prevention strategy within a comprehensive prevention package. PMID:26599164

  7. Pathophysiological basis of migraine prophylaxis.

    PubMed

    Galletti, Francesca; Cupini, Letizia Maria; Corbelli, Ilenia; Calabresi, Paolo; Sarchielli, Paola

    2009-10-01

    Several cellular and molecular mechanisms have been implicated in migraine pathophysiology including abnormal neuronal excitability and vascular events. Drugs from different pharmacological classes are used for migraine prophylaxis. These agents may normalize neuronal excitability by modulating distinct ionic channels and various neurotransmitter systems. They can also block cortical spreading depression, prevent peripheral and/or central pain sensitization, and normalize brainstem function. Most of the drugs recently used in migraine prophylaxis have been identified by serendipidy and they have been originally approved for other indications. Subsequently, their use has been extended to migraine prevention, according to their putative mechanisms of action. More recently, trials on adequate samples of migraine patients have been conducted for several drugs. In the present review, we will present and discuss the pathophysiological bases for the use of antidepressants, beta-adrenergic blockers, calcium channel blockers and antiepileptic drugs in migraine prevention. Currently, the major classes of conventional migraine preventive drugs include the antidepressant amitriptyline, the beta-adrenergic blocker propranolol, and the antiepileptic drugs topiramate and valproic acid. Promising results have recently been obtained for angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers. Some limited clinical findings have also been reported for atypical antipsychotic agents, nutritional supplements and also botulinum toxin. Targets of migraine preventive treatment are to reduce frequency and intensity of attacks and to decrease disability related to chronic headache. PMID:19654035

  8. Preexposure Prophylaxis and Patient Centeredness

    PubMed Central

    Snowden, Jonathan M.; Rodriguez, Maria I.; Jackson, Skyler D.; Marcus, Julia L.

    2016-01-01

    Preexposure prophylaxis has transformed HIV prevention, becoming widespread in communities of gay and bisexual men in the developed world in a short time. There is a broad concern that preexposure prophylaxis will discourage condom use among gay men (i.e., “risk compensation”). This commentary argues for broadening the focus on gay men’s health beyond sexual health to address the holistic health and well-being of gay men. Gay men may benefit from being offered candid, nonjudgmental health promotion/HIV prevention messages not requiring condom use for anal sex. Lessons can be drawn from the family planning movement, which has undergone a similar shift in focus. The principle of patient centeredness supports such a shift in gay men’s health toward the goal of providing men with the knowledge to evaluate various prevention approaches according to the specifics of their life circumstances and health needs. Bringing more nuance to discussions of sexual risk and sexual pleasure could facilitate more universally healthy attitudes regarding sex among gay men, in turn enabling healthier decisions more compatible with men’s own values and preferences. PMID:27387042

  9. Lymphedema-lymphangiectasia-mental retardation (Hennekam) syndrome: a review.

    PubMed

    Van Balkom, Inge D C; Alders, Mariel; Allanson, Judith; Bellini, Carlo; Frank, Ulrich; De Jong, Greetje; Kolbe, Ingeborg; Lacombe, Didier; Rockson, Stan; Rowe, Peter; Wijburg, Frits; Hennekam, Raoul C M

    2002-11-01

    The Hennekam syndrome is an infrequently reported heritable entity characterized by lymphedema, lymphangiectasia, and developmental delay. Here we add an additional 8 patients, and compare their findings to the 16 cases from the literature. The lymphedema is usually congenital, can be markedly asymmetrical, and, often, gradually progressive. Complications such as erysipelas are common. The lymphangiectasias are present in the intestines, but have also been found in the pleura, pericardium, thyroid gland, and kidney. Several patients have demonstrated congenital cardiac and blood vessel anomalies, pointing to a disturbance of angiogenesis in at least some of the patients. Facial features are variable, and are chiefly characterized, in a typical patient, by a flat face, flat and broad nasal bridge, and hypertelorism. Facial features are thought to mirror the extent of intrauterine facial lymphedema, or may be caused by lymphatic obstruction that affects the early migration of neural crest tissue. Other anomalies have included glaucoma, dental anomalies, hearing loss, and renal anomalies. The psychomotor development varies widely, even within a single family, from almost normal development to severe mental retardation. Convulsions are common. The existence of 10 familial cases, equal sex ratio, increased parental consanguinity rate (4/20 families), and absence of vertical transmission are consistent with an autosomal recessive pattern of inheritance. It seems likely that most (but not all) manifestations of the entity can be explained as sequences of impaired prenatal and postnatal lymphatic flow, suggesting that the causative gene(s) should have a major function in lymphangiogenesis. PMID:12376947

  10. [Update on special surgical approaches in the therapy for lymphedemas].

    PubMed

    Wallmichrath, J; Baumeister, R; Giunta, R E; Notohamiprodjo, M; Frick, A

    2012-12-01

    Despite recent medical progress primary and secondary lymphedemas still represent a therapeutic challenge and they often lead to a significant reduction in quality of life. Lymphedemas usually develop in the extremities, the male external genitals as well as the female breast as a consequence to the axial alignment of the lymphatic collectors. Early stages are characterized by an excess of lymph fluid increasing the volume of the affected part of the body whereas later stages represent an increasing amount of solid tissue. Thus therapeutic efforts can focus on the reduction of the surplus of liquid and/or solid components. Generally there are conservative and operative strategies. Conservative measures mainly focus on the improvement of fluid mobilization and drainage and comprise compression garments, manual lymphatic drainage, and apparative intermittent compression. Operative approaches comprise procedures for surgical tissue reduction (symptomatic/ablative approaches) and/or procedures with the intention of enhancing lymphatic transport (causal approaches). Surgical tissue reduction can be performed by open resection and/or liposuction. Traditional surgical causal techniques such as transposition of local flaps aim at leading lymph away from the congested region of the body. Modern microsurgical causal approaches contain methods of reconstruction of interrupted lymphatic pathways as well as techniques for the conduction of lymph into local veins. In this review we depict and discuss the features of the multiform spectrum of the surgical therapy of lymphedemas on the basis of literature as well as our own clinical and experimental experience. PMID:23093446

  11. Microcephaly-lymphedema syndrome: report of a family with short stature as additional manifestation.

    PubMed

    Strenge, S; Froster, U G

    1998-12-28

    Patients with the rare autosomal dominant microcephaly-lymphedema syndrome have apparently normal intelligence. We report on a boy with microcephaly, lymphedema, and short stature as an additional manifestation. The family history of our patient suggests autosomal dominant inheritance with reduced penetrance and variable expressivity. However, X-linked inheritance cannot be excluded. PMID:9880217

  12. Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection

    PubMed Central

    Cook, Kyung Hoon; Park, Myong Chul; Lim, Seong Yoon; Jung, Yong Sik

    2016-01-01

    Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation. PMID:27064862

  13. Vascularized Free Lymph Node Flap Transfer in Advanced Lymphedema Patient after Axillary Lymph Node Dissection.

    PubMed

    Cook, Kyung Hoon; Park, Myong Chul; Lee, Il Jae; Lim, Seong Yoon; Jung, Yong Sik

    2016-03-01

    Lymphedema is a condition characterized by tissue swelling caused by localized fluid retention. Advanced lymphedema is characterized by irreversible skin fibrosis (stage IIIb) and nonpitting edema, with leather-like skin, skin crypts, and ulcers with or without involvement of the toes (stage IVa and IVb, respectively). Recently, surgical treatment of advanced lymphedema has been a challenging reconstructive modality. Microvascular techniques such as lymphaticovenous anastomosis and vascularized lymph node flap transfer are effective for early stage lymphedema. In this study, we performed a two-stage operation in an advanced lymphedema patient. First, a debulking procedure was performed using liposuction. A vascularized free lymph node flap transfer was then conducted 10 weeks after the first operation. In this case, good results were obtained, with reduced circumferences in various parts of the upper extremity noted immediately postoperation. PMID:27064862

  14. New developments in migraine prophylaxis.

    PubMed

    Bigal, Marcelo E; Krymchantowski, Abouch V; Rapoport, Alan M

    2003-04-01

    Migraine is a common neurological disorder that afflicts > or = 12% of the adult US population. Severe, frequent and disabling attacks require effective prophylaxis. Traditional preventive drugs such as beta-blockers, antidepressants and calcium antagonists, despite their documented efficacy, fail to offer relief for a significant proportion of migraine sufferers. Multiple threads of research over the last 15 years have led to the concept that migraine is generated from a hyperexcitable brain. This opens new perspectives in terms of preventive options, especially regarding the anticonvulsants agents. Additionally, different groups of substances, some of which nominated as non-orthodox agents, have been recently subjected to clinical trials and found to be effective. The aim of this review is to present and discuss the new options for migraine prevention. PMID:12667107

  15. Prevalence and Epidemiological Factors Involved in Cellulitis in Korean Patients With Lymphedema

    PubMed Central

    Park, Sae In; Yang, Eun Joo; Kim, Dong Kyu; Jeong, Ho Joong; Kim, Ghi Chan

    2016-01-01

    Objective To evaluate the prevalence and associated factors involved in cellulitis with lymphangitis among a group of Korean patients who were being treated for lymphedema. We present our epidemiologic research and we also report a systematic review of these types of cases. Methods This was a retrospective medical record study among 1,246 patients diagnosed with lymphedema. The study was carried out between January 2006 and December 2012 at the Kosin University Gospel Hospital and Seoul National University Bundang Hospital. Cases were examined for onset time, affected site, seasonal trend, and recurrence pattern of lymphedema, lymphangitis, and cellulitis. We also evaluated the history of blood-cell culture and antibiotic use. Results Ninety-nine lymphedema patients experienced complications such as cellulitis with accompanying lymphangitis. Forty-nine patients had more than two recurrences of cellulitis with lymphangitis. The incidence and recurrence of cellulitis with lymphangitis were significantly higher in the patients with lower-extremity lymphedema. There was a significant trend toward higher cellulitis prevalence in the lower-extremity lymphedema group according to the time of lymphedema onset. Among the cellulitis with lymphangitis cases, 62 cases were diagnosed through blood-cell culture; 8 of these 62 cultures were positive for β-hemolytic streptococci. Conclusion The prevalence rate of cellulitis with lymphangitis in patients with lymphedema was 7.95%, and the prevalence of recurrent episodes was 3.93%. Especially, there was high risk of cellulitis with lymphangitis after occurrence of lower-extremity lymphedema with passage of time. Lymphedema patients should be fully briefed about the associated risks of cellulitis before treatment, and physicians should be prepared to provide appropriate preventive education. PMID:27152284

  16. Assessment and measurement of head and neck lymphedema: state-of-the-science and future directions.

    PubMed

    Deng, Jie; Ridner, Sheila H; Aulino, Joseph M; Murphy, Barbara A

    2015-05-01

    Currently, assessment and measurement of lymphedema in head and neck cancer patients is difficult. The aims of this report are to examine the current state of science regarding available measurement of head and neck lymphedema, to identify gaps in clinical evaluation of head and neck lymphedema, and to propose future research directions for advancing the assessment of head and neck lymphedema. The authors conducted a comprehensive literature review based on PubMed, CINAHL, Cochrane database, EMBASE, and PsycINFO from 1989 to 2014. Primary search terms included head and/or neck cancer, head and/or neck and/or face, lymphedema, edema, swelling, fibrosis, measurement, assessment, and evaluation. The authors also reviewed information from the Oncology Nursing Society, National Lymphedema Network, National Cancer Institute, American Cancer Society, and other related healthcare professional association web sites. Based on the nature/characteristics of measurement reported in the literature, methods for assessment of head and neck lymphedema can be categorized into: (1) patient-reported outcome (PRO) measures (e.g., symptom tool), (2) clinician-reported outcome (CRO) measures based on clinical grading criteria via a clinical exam (external lymphedema evaluation by physical examination and internal edema examination via endoscopy), and (3) technical capacity/measurement techniques (e.g., imaging techniques). Although a number of measures have been reported in the literature, clinically useful PRO and CRO measures, and reliable and sensitive measurement techniques need to be validated to address gaps in assessment of head and neck lymphedema, and to be easily used in early identification of lymphedema and assessment of treatment/interventional effects. PMID:25703799

  17. EFFECTS OF COMPRESSION ON LYMPHEDEMA DURING RESISTANCE EXERCISE IN WOMEN WITH BREAST CANCER-RELATED LYMPHEDEMA: A RANDOMIZED, CROSS-OVER TRIAL.

    PubMed

    Singh, B; Newton, R U; Cormie, P; Galvao, D A; Cornish, B; Reul-Hirche, H; Smith, C; Nosaka, K; Hayes, S C

    2015-06-01

    The use of compression garments during exercise is recommended for women with breast cancer-related lymphedema, but the evidence behind this clinical recommendation is unclear. The aim of this randomized, cross-over trial was to compare the acute effects of wearing versus not wearing compression during a single bout of moderate-load resistance exercise on lymphedema status and its associated symptoms in women with breast cancer-related lymphedema (BCRL). Twenty-five women with clinically diagnosed, stable unilateral breast cancer-related lymphedema completed two resistance exercise sessions, one with compression and one without, in a randomized order separated by a minimum 6 day wash-out period. The resistance exercise session consisted of six upper-body exercises, with each exercise performed for three sets at a moderate-load (10-12 repetition maximum). Primary outcome was lymphedema, assessed using bioimpedance spectroscopy (L-Dex score). Secondary outcomes were lymphedema as assessed by arm circumferences (percent inter-limb difference and sum-of-circumferences), and symptom severity for pain, heaviness and tightness, measured using visual analogue scales. Measurements were taken pre-, immediately post- and 24 hours post-exercise. There was no difference in lymphedema status (i.e., L-Dex scores) pre- and post-exercise sessions or between the compression and non-compression condition [Mean (SD) for compression pre-, immediately post- and 24 hours post-exercise: 17.7 (21.5), 12.7 (16.2) and 14.1 (16.7), respectively; no compression: 15.3 (18.3), 15.3 (17.8), and 13.4 (16.1), respectively]. Circumference values and symptom severity were stable across time and treatment condition. An acute bout of moderate-load, upper-body resistance exercise performed in the absence of compression does not exacerbate lymphedema in women with BCRL. PMID:26714372

  18. Discrete Choice Experiment to Evaluate Factors That Influence Preferences for Antibiotic Prophylaxis in Pediatric Oncology

    PubMed Central

    Regier, Dean A.; Diorio, Caroline; Ethier, Marie-Chantal; Alli, Amanda; Alexander, Sarah; Boydell, Katherine M.; Gassas, Adam; Taylor, Jonathan; Kellow, Charis; Mills, Denise; Sung, Lillian

    2012-01-01

    Background Bacterial and fungal infections in pediatric oncology patients cause morbidity and mortality. The clinical utility of antimicrobial prophylaxis in children is uncertain and the personal utility of these agents is disputed. Objectives were to use a discrete choice experiment to: (1) describe the importance of attributes to parents and healthcare providers when deciding between use and non-use of antibacterial and antifungal prophylaxis; and (2) estimate willingness-to-pay for prophylactic strategies. Methods Attributes were chances of infection, death and side effects, route of administration and cost of pharmacotherapy. Respondents were randomized to a discrete choice experiment outlining hypothetical treatment options to prevent antibacterial or antifungal infections. Each respondent was presented 16 choice tasks and was asked to choose between two unlabeled treatment options and an opt-out alternative (no prophylaxis). Results 102 parents and 60 healthcare providers participated. For the antibacterial discrete choice experiment, frequency of administration was significantly associated with utility for parents but not for healthcare providers. Increasing chances of infection, death, side effects and cost were all significantly associated with decreased utility for parents and healthcare providers in both the antibacterial and antifungal discrete choice experiment. Parental willingness-to-pay was higher than healthcare providers for both strategies. Conclusion Chances of infection, death, side effects and costs were all significantly associated with utility. Parents have higher willingness-to-pay for these strategies compared with healthcare providers. This knowledge can help to develop prophylaxis programs. PMID:23082169

  19. Adolescent Onset of Localized Papillomatosis, Lymphedema, and Multiple Beta-Papillomavirus Infection: Epidermal Nevus, Segmental Lymphedema Praecox, or Verrucosis? A Case Report and Case Series of Epidermal Nevi

    PubMed Central

    Kadam, Pooja; Rand, Janne; Rady, Peter; Tyring, Stephen; Stehlik, Jan; Sedivcova, Monica; Kazakov, Dmitry V.; Ray, Kathy; Hill, Jerome; Agag, Richard; Carlson, J. Andrew

    2014-01-01

    Herein, we report the case of a 12-year-old female who noted the recent onset of an oval, circumscribed, 10-cm papillomatous plaque affecting the thigh and vulva that showed histologic signs of lymphedema without evidence of secondary lymphedema. The sequencing of genes associated with a delayed onset of lymphedema or epidermal nevi (EN) – GATA2 and GJC2, and HRAS and KRAS, respectively – showed wild-type alleles. Polymerase chain reaction for human papillomavirus (HPV) DNA demonstrated infections with 15 HPV genotypes. Evidence of productive HPV infection, HPV capsid expression, and cytopathic changes was detected. At the 6-month follow-up, no evidence of recurrence was found after complete excision. The analysis of a consecutive series of 91 EN excision specimens revealed that 76% exhibited histologic evidence of lymphostasis. Notably, multiple acrochordon-like EN, which most closely resembled this case, showed similar signs of localized lymphedema. The late onset and evidence of lymphedema favors the diagnosis of congenital unisegmental lymphedema. However, the clinical findings and epidermal changes point to the diagnosis of EN. Moreover, localized verrucosis also accurately describes this patient's cutaneous findings. Based on the above evidence, we postulate that an abnormal development of lymphatics may play a primary role in the pathogenesis of some types of EN and facilitate productive HPV infection. PMID:27047923

  20. Yoga protocol for treatment of breast cancer-related lymphedema

    PubMed Central

    Narahari, SR; Aggithaya, Madhur Guruprasad; Thernoe, Liselotte; Bose, Kuthaje S; Ryan, Terence J

    2016-01-01

    Introduction: Vaqas and Ryan (2003) advocated yoga and breathing exercises for lymphedema. Narahari et al. (2007) developed an integrative medicine protocol for lower-limb lymphedema using yoga. Studies have hypothesized that yoga plays a similar role as that of central manual lymph drainage of Foldi's technique. This study explains how we have used yoga and breathing as a self-care intervention for breast cancer-related lymphedema (BCRL). Methods: The study outcome was to create a yoga protocol for BCRL. Selection of yoga was based on the actions of muscles on joints, anatomical areas associated with different groups of lymph nodes, stretching of skin, and method of breathing in each yoga. The protocol was piloted in eight BCRL patients, observed its difficulties by interacting with patients. A literature search was conducted in PubMed and Cochrane library to identify the yoga protocols for BCRL. Results: Twenty yoga and 5 breathing exercises were adopted. They have slow, methodical joint movements which helped patients to tolerate pain. Breathing was long and diaphragmatic. Flexion of joints was coordinated with exhalation and extension with inhalation. Alternate yoga was introduced to facilitate patients to perform complex movements. Yoga's joint movements, initial positions, and mode of breathing were compared to two other protocols. The volume reduced from 2.4 to 1.2 L in eight patients after continuous practice of yoga and compression at home for 3 months. There was improvement in the range of movement and intensity of pain. Discussion: Yoga exercises were selected on the basis of their role in chest expansion, maximizing range of movements: flexion of large muscles, maximum stretch of skin, and thus part-by-part lymph drainage from center and periphery. This protocol addressed functional, volume, and movement issues of BCRL and was found to be superior to other BCRL yoga protocols. However, this protocol needs to be tested in centers routinely managing BCRL

  1. Sotos syndrome: An unusual presentation with intrauterine growth restriction, generalized lymphedema, and intention tremor.

    PubMed

    McClelland, Jessie; Burgess, Bronwyn; Crock, Patricia; Goel, Himanshu

    2016-04-01

    Sotos syndrome is a childhood overgrowth syndrome characterized clinically by a distinctive facial gestalt, advanced bone age, childhood overgrowth, and non-progressive developmental delay; and genetically by haploinsufficiency of the Nuclear receptor binding SET Domain 1 (NSD1) gene. Generalized lymphedema has not previously been associated with Sotos syndrome. Generalized lymphedema has been associated with mutations in several genes including FLT4. This gene is involved in the regulation of VEGFR3, a key governor of lymphatic-endothelial cell development and function. We report on a 28-year-old Caucasian female with a de novo NSD1 intragenic mutation, c.5841_5848dup: p.Leu1950Serfs*22, who presented with characteristic clinical features of Sotos syndrome. Unusually this case includes atypical features of intrauterine growth retardation and post-pubertal onset of primary lymphedema. To our knowledge, no link between Sotos syndrome and generalized lymphedema has previously been described in the literature. We propose a mechanism by which disruptions in NSD1 gene may lead to generalized lymphedema. Aberrations of the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK)-signaling pathway has been identified in both Sotos syndrome and lymphedema. This finding extends the known phenotype of Sotos syndrome through the inclusion of lymphedema. This case also indicates that presence of low birth weight does not exclude the possibility of Sotos syndrome. © 2016 Wiley Periodicals, Inc. PMID:26738611

  2. Excess Lymphangiogenesis Cooperatively Induced by Macrophages and CD4(+) T Cells Drives the Pathogenesis of Lymphedema.

    PubMed

    Ogata, Fusa; Fujiu, Katsuhito; Matsumoto, Sahohime; Nakayama, Yukiteru; Shibata, Munehiko; Oike, Yuichi; Koshima, Isao; Watabe, Tetsuro; Nagai, Ryozo; Manabe, Ichiro

    2016-03-01

    Lymphedema is a debilitating progressive condition that severely restricts quality of life and is frequently observed after cancer surgery. The mechanism underlying lymphedema development remains poorly understood, and no effective pharmacological means to prevent or alleviate the ailment is currently available. Using a mouse model of lymphedema, we show here that excessive generation of immature lymphatic vessels is essential for initial edema development and that this early process is also important for later development of lymphedema pathology. We found that CD4(+) T cells interact with macrophages to promote lymphangiogenesis, and that both lymphangiogenesis and edema were greatly reduced in macrophage-depleted mice, lymphocyte-deficient Rag2(?/?) mice or CD4(+) T-cell-deficient mice. Mechanistically, T helper type 1 and T helper type 17 cells activate lesional macrophages to produce vascular endothelial growth factor-C, which promotes lymphangiogenesis, and inhibition of this mechanism suppressed not only early lymphangiogenesis, but also later development of lymphedema. Finally, we show that atorvastatin suppresses excessive lymphangiogenesis and lymphedema by inhibiting T helper type 1 and T helper type 17 cell activation. These results demonstrate that the interaction between CD4(+) T cells and macrophages is a potential therapeutic target for prevention of lymphedema after surgery. PMID:27015456

  3. Rhesus monkey is a new model of secondary lymphedema in the upper limb

    PubMed Central

    Wu, Guojun; Xu, Hao; Zhou, Wenhong; Yuan, Xianshun; Yang, Zhe; Yang, Qing; Ding, Feng; Meng, Zhigang; Liang, Weili; Geng, Chong; Gao, Ling; Tian, Xingsong

    2014-01-01

    Objective: This study is to establish the rhesus monkey model of lymphedema in the upper limbs, and assess the suitability of this model. Methods: An animal model of lymphedema was established by the combined irradiation and surgical techniques in the upper limbs of these rhesus monkeys. Physical examination, high-resolution MR lymphangiography, bioelectrical impedance analysis (BIA), and immunohistochemical staining were performed to determine the severity of the edema in the upper limbs of the animal model. Results: Our results from physical examination indicated that the rhesus monkey model present with typical appearance and features of lymphedema. MR lymphangiography further demonstrated pathologically modified lymphatic vessels in our rhesus monkey model. BIA revealed increased water content in the upper limb in these rhesus monkeys, which was in line with the pathology of lymphedema. Immunohistochemical staining showed the curvature of the lymphatic vessels in the rhesus monkey model, typical pathological changes in lymphedema. Conclusion: Rhesus monkey lymphedema model provides a more consistent background to elucidate the pathophysiology of the disease. This new model would help to increase our understanding of acquired upper limb lymphedema, and promote the development of new treatments for this intractable disorder. PMID:25337207

  4. Lymphedema following breast cancer treatment and impact on quality of life: a review.

    PubMed

    Taghian, Nadine R; Miller, Cynthia L; Jammallo, Lauren S; O'Toole, Jean; Skolny, Melissa N

    2014-12-01

    Lymphedema resulting from breast cancer treatment is a chronic condition which can significantly compromise quality of life. We sought to review various aspects of breast-cancer related lymphedema including measurement techniques, definitions, risk factors, and specifically, impact on physical, psychological, and emotional well-being of women treated for breast cancer. For the purpose of this review, we performed a literature search using PubMed for articles on lymphedema secondary to breast cancer treatment published since 1997. While improvements in breast cancer therapy have contributed to a decrease in the incidence of lymphedema, the overall negative impact the condition has on patients and survivors has remained unchanged. The development of lymphedema results in physical impairments including compromised function, diminished strength, fatigue, and pain in the affected arm. Affected women may have decreased self-confidence resulting from a distorted body image. Negative emotions reported by women with lymphedema include anxiety, frustration, sadness, anger, fear, and increased self-consciousness. Lymphedema secondary to breast cancer treatment remains a significant quality of life issue, with known consequences related to a woman's physical, psychological, and emotional well-being. PMID:25085806

  5. Magnetic resonance lymphography demonstrates spontaneous lymphatic disruption and regeneration in obstructive lymphedema.

    PubMed

    Liu, N-F; Yan, Z-X; Wu, X-F; Luo, Y

    2013-06-01

    The present study was aimed at observing both the damage and change process undergone in lymphatic collectors in obstructive extremity lymphedema. Forty-five patients with obstructive extremity lymphedema who had been examined with magnetic resonance lymphangiography (MRL) were enrolled in the study. Among this group, 36 were diagnosed with secondary lymphedema of the lower extremity and 9 exhibited upper extremity lymphedema after mastectomy. Morphological damage as a result of obstruction of collecting lymph vessels was recorded and analyzed. Obvious damage to the lymph vessels was found in all of the 36 lower extremity lymphedema cases with different lengths of history, including vessel disruption in 21 and lymphatic regeneration in 15. Lymphatic damage occurred in the anterior tibial area of the lower leg in almost every case. In 9 cases with upper extremity lymphedema, collecting lymphatic disruption and lymph tracer leakage was seen in multiple patterns. Imaging displayed that ruptured lymph collectors healed spontaneously or regenerated into a segment of the lymphatic network. The present study provided real-time images of collecting lymphatic vessels in obstructive lymphedema. These were seen to have undergone disruption, displayed lymphorrhoea, and/or lymphatic regeneration. In addition, the images suggest that the anterior tibial lymphatic is the weak point of the lymphatic pathway in the lower limb. PMID:24354104

  6. Massive localized lymphedema: A case series and literature review.

    PubMed

    Evans, Robin James; Scilley, Chris

    2011-01-01

    A large, deep, soft tissue mass is often malignant in nature; however, a recent study described a large soft tissue mass present in morbidly obese patients that was found to be benign. Massive localized lymphedema (MLL) is a large pedunculated lymphadematous mass found in the lower extremity of morbidly obese patients. MLL often enlarges over many years and may interfere with mobility. Although histologically similar to well-differentiated liposarcoma, MLL has recently emerged as a separate, benign clinical entity. The pathophysiology of MLL is yet to be understood. A literature review, and the authors' experiences are discussed to assist in clinical decision making. PMID:22942667

  7. Penoscrotal lymphedema associated with metastatic renal cell carcinoma.

    PubMed

    Crawley, David; Haddock, Peter; Jackson, Max; Kamradt, Jeffrey; Kesler, Stuart

    2015-08-01

    A 64-year-old male presented with lower back pain, radiating in a sciatic-type distribution, swelling in his lower abdomen and right leg, and edema of the scrotum and penile shaft. A sonogram and CT imaging indicated an enhancing mass in the right kidney and a spinal metastasis. The right lower extremity and penoscrotal lymphedema was caused by lymphatic obstruction due to a sacral metastasis of renal cell carcinoma. He was treated with cytoreductive nephrectomy, radiation and a systemic tyrosine kinase inhibitor. Pelvic imaging is suggested to determine whether malignant lymphatic obstruction is present when presented with idiopathic penoscrotal edema. PMID:26267035

  8. Ethnodrama: An Innovative Knowledge Translation Tool in the Management of Lymphedema

    PubMed Central

    Ahmed, Shahid; Quinlan, Elizabeth; McMullen, Linda; Thomas, Roanne; Fichtner, Pam; Block, Janice

    2015-01-01

    Background: Lymphedema can cause significant physical impairment and quality-of-life issues. Yet there is a gap in knowledge about lymphedema among breast cancer survivors (BCS), and health care professionals (HCP). Ethnodrama is an innovative knowledge translation strategy that uses theatrical performances for dissemination of research results. We evaluated the impact of live ethnodrama on HCP' and BCS' awareness and attitudes in relation to impact of lymphedema on BCS' lives. Methods: Ethnodrama performances were developed by script writers and a theatre director in collaboration with the investigators and BCS using data from published research and pre-performances workshops. Six interactive live performances were given to audiences of BCS, HCP, and community members in four cities across Canada. After watching these live performances, members of the audiences were asked to complete a paper-based questionnaire regarding their knowledge of lymphedema, and their attitudes and practices toward lymphedema. Results: Of 238 audience members who participated in the survey, 55 (23%) were BCS and 85 (37.5%) were HCP. Most members rated the performances as very effective in changing their (84%) or other people's (93%) understanding of lymphedema; 96% reported being motivated to seek additional information on lymphedema, and 72% of HCP anticipated changes in their practices related to lymphedema screening. Overall no significant differences were noted in responses to ethnodrama between BCS and HCP. Open-ended responses were supportive of the findings from the closed-ended questions. Conclusions: Our results indicate that ethnodrama performances effectively convey information and positively affecting changes in HCP' and BCS' attitudes toward lymphedema. PMID:26284137

  9. Treatment of Lymphedema with Saam Acupuncture in Patients with Breast Cancer: A Pilot Study

    PubMed Central

    Jeong, Young Ju; Kwon, Hyo Jung; Park, Young Sun; Kwon, Oh Chang; Shin, Im Hee

    2015-01-01

    Abstract Background: Lymphedema is a troublesome complication affecting quality of life (QoL) in many women after breast-cancer treatment. Recent studies have suggested that acupuncture can reduce symptoms of lymphedema in breast-cancer survivors. Objectives: This was a pilot study. It was designed to assess the feasibility and the safety of acupuncture with the Saam acupuncture method for treating lymphedema in Korean patients after surgical therapy for breast cancer. Materials and Methods: This was a prospective, single-arm, observational pilot study using before and after measurements. The study was conducted at the East-West Medical Center at the Daegu Catholic University Medical Center, in Daegu, Korea. The subjects were 9 patients with breast cancer who presented with lymphedema of the upper limb ipsilateral to surgery. Saam acupuncture was administered 3 times per week for 6 consecutive weeks, for 30±5 minutes at each session.The primary outcome measure was severity of lymphedema as assessed by stages of lymphedema, a visual analogue scale (VAS), and by circumferential measurements of the upper extremity. The secondary outcome measure was QoL, which was assessed by a self-administered questionnaire using the Short Form–36 questionnaire. Results: Acupuncture reduced severity of lymphedema significantly, as assessed by the VAS (P<0.001) as well as by circumferential measurements of the upper extremity. Four weeks after the final treatment, symptoms were not aggravated. SF-36 scores remained significant for health status at the end of treatment. Conclusions: The Saam acupuncture method appeared to provide reduction of lymphedema among women after they had undergone surgery for breast cancer. A randomized, controlled prospective study with a larger sample size is required to clarify the role of acupuncture for managing lymphedema in patients with breast cancer. PMID:26155321

  10. Risk Factors Associated with Breast Cancer-Related Lymphedema in the WHEL Study

    PubMed Central

    Dominick, Sally A.; Madlensky, Lisa; Natarajan, Loki; Pierce, John P.

    2012-01-01

    Introduction Lymphedema is a significant health problem faced by a large percentage of breast cancer survivors. The Women’s Healthy Eating and Living (WHEL) Study has a unique data set collected after the completion of breast cancer treatment, which allowed a focused analysis of risk factors for breast cancer-related lymphedema. Methods Participant characteristics, treatment modalities, and health behaviors were examined as potential predictors of lymphedema among breast cancer survivors with univariate analyses and multivariate logistic regression. Results Lymphedema status was assessed for 83% of the study cohort (2431 of the 2917 WHEL participants). Among these respondents, 692 (28.5%) women reported yes to either a physician’s diagnosis of lymphedema or a question on arm/hand swelling. When compared to other participants, women with lymphedema were diagnosed at a younger age, more likely to have a higher body mass index, had a larger tumor size, had more lymph nodes removed, more likely to have a mastectomy with radiation therapy, and more likely to have chemotherapy. In the final multivariate-adjusted model, body mass index greater than 25 kg/m2 (p<0.01), the removal of 11 or more lymph nodes (p<0.01), and breast cancer surgery plus radiation therapy (p<0.01) showed a strong independent association with developing breast cancer-related lymphedema. Conclusions The results of this study highlight the importance of educating breast cancer survivors about the modifiable risk factors (e.g., body mass index) associated with the development of lymphedema. Implications for Cancer Survivors Breast cancer survivors at risk for lymphedema may benefit from interventions aimed at achieving or maintaining a healthy body weight. PMID:23212606

  11. LITHIUM PROPHYLAXIS IN AFFECTIVE DISORDER

    PubMed Central

    Rao, A. Venkoba; Hariharasubramanian, N.; Devi, S. Parvathi; Sugumar, A.; Srinivasan, V.

    1982-01-01

    SUMMARY Out of 108 patients on the rolls in the Lithium clinic, Madurai Medical College and Govt. Rajaji Hospital, Madurai, India, 47 patients suffering from affective disorders receiving lithium continuously for more than three years were analysed with a view to study the recurrences. Thirteen suffered no relapses while on lithium while nineteen experienced them while on lithium. Four were free from recurrences after lithium was withdrawn- Seven defaulted but suffered recurrences while in four the drug was withdrawn and in both the groups remission was achieved with re-administration of lithium. The study reveals that lithium besides averting the recurrences can reduce the frequency, number, duration, intensity of episodes and improve the amenability to drugs. Among the symptoms, suicidal ideas and behaviour and insight were found to be influenced favourably by lithium. Among the factors that help favourable response to lithium were a positive family history of affective disorder, in the first degree relatives and lesser frequency and number of episodes in the pre-lithium period. A reappraisal of the natural history of the illness is called for in the light of lithium prophylaxis of manic depressive psychosis. PMID:21965880

  12. Preexposure Prophylaxis for HIV Prevention

    PubMed Central

    Kelesidis, Theodoros; Landovitz, Raphael J.

    2012-01-01

    Reducing the incidence of HIV remains one of our greatest public health challenges. However, there is growing optimism that preexposure prophylaxis (PrEP) could have a major impact on preventing incident HIV infection. Recently presented data on the use of oral PrEP in men who have sex with men (MSM) have provided proof-of-principle for this strategy. Additional clinical trials are evaluating whether PrEP provides similar protection to risk groups other than MSM, such as heterosexual persons and injection drug users. Still unanswered questions include optimal dosing strategies, long-term safety, maximizing adherence and minimizing costs, addressing drug resistance in the face of PrEP failure, optimizing access, and assessing effects on risk behavior. Future implementation will be guided by the results of clinical trials in progress. This article provides a review of the data on the potential strengths and limitations of PrEP as an HIV prevention strategy, identifies challenges to implementation of this approach, and outlines knowledge gaps. PMID:21465112

  13. Mechanical methods for thrombosis prophylaxis.

    PubMed

    Caprini, Joseph A

    2010-12-01

    Prevention of venous thromboembolism (VTE) remains the number one preventable cause of death in hospitalized patients. The pathogenesis of thrombosis involves the triad of venous stasis, dilatation of the leg veins, and changes in coagulability of the blood. These changes can be modified by the use of intermittent pneumatic compression devices (IPC) and, to a much lesser extent, by graduated compression hose (GCS). Studies have shown the effectiveness of GCS in preventing deep vein thrombosis (DVT) compared to placebo, but there is no evidence that they reduce the incidence of pulmonary emboli (PE). No venographic data are available regarding the efficacy of GCS; however, IPC have shown excellent efficacy in several venographic studies over the past 25 years. Mechanical methods are important to use in situations where the risk of bleeding exists, thereby making the use of anticoagulants hazardous. One of the key uses for mechanical methods is in combination with anticoagulants in patients at the highest risk of developing VTE. Chest consensus guidelines assigns a 2A recommendation for the use of combination prophylaxis in the highest risk patients. Unfortunately, studies to show which type of leg compression device is optimal for DVT prevention are not available, so individual preference, ease of use, and company support are the determining factors at the present time. Finally, compliance using these devices is a major problem, and until systems have been developed to easily monitor and ensure compliance, these methods will enjoy only limited use. PMID:19850588

  14. Primary amyloidosis of the mesentery and the retroperitoneum presenting with lymphedema.

    PubMed

    Halm, U; Berr, F; Tannapfel, A; Klöppel, R; Secknus, R; Mössner, J

    1998-11-01

    We report the case of a 57-yr-old woman presenting with moderate weight loss, abdominal distension, and lymphedema of the legs and vulva. Computed tomography of the abdomen revealed massive thickening of the rectal wall, mesentery, and retroperitoneum. Primary amyloidosis was diagnosed by immunohistochemistry from the rectum and duodenum. To our knowledge, lymphedema due to primary amyloidosis has not yet been reported. The diagnosis should be presumed in the case of retroperitoneal thickening and lymphedema and can be established by immunohistochemistry. PMID:9820426

  15. Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India

    PubMed Central

    Walsh, Victoria; Little, Kristen; Wiegand, Ryan; Rout, Jonathan; Fox, LeAnne M.

    2016-01-01

    Background Over 1.1 billion people worldwide are at risk for lymphatic filariasis (LF), and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor. Methodology/Principal Findings A house-to-house morbidity census was conducted to assess the burden and severity of lymphedema in a population of 1,298,576 persons living in the LF-endemic district of Khurda in Odisha State, India. The burden of lymphedema in Khurda is widespread geographically, and 1.3% (17,036) of the total population report lymphedema. 51.3% of the patients reporting lymphedema were female, mean age 49.4 years (1–99). Early lymphedema (Dreyer stages 1 & 2) was reported in two-thirds of the patients. Poisson regression analysis was conducted in order to determine risk factors for advanced lymphedema (Dreyer stages 4–7). Increasing age was significantly associated with advanced lymphedema, and persons 70 years and older had a prevalence three times greater than individuals ages 15–29 (aPR: 3.21, 95% CI 2.45, 4.21). The number of adenolymphangitis (ADL) episodes reported in the previous year was also significantly associated with advanced lymphedema (aPR 4.65, 95% CI 2.97–7.30). This analysis is one of the first to look at potential risk factors for advanced lymphedema using morbidity census data from an entire district in Odisha State, India. Significance These data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions. PMID:27548382

  16. Antimicrobial prophylaxis in caesarean section delivery

    PubMed Central

    Liu, Ronghua; Lin, Lin; Wang, Dujuan

    2016-01-01

    Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section. One of the most important risk factors for postpartum infection is caesarean delivery. Caesarean section shows a higher incidence of infection than vaginal delivery. It is complicated by surgical site infections, endometritis or urinary tract infection. The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital. A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics. Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients. The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20–35 years. The highest proportion of patients were primigravida 72%. Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days. In total, 27% of patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes. Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes. Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern. PMID:27446303

  17. Tissue-engineered lymphatic graft for the treatment of lymphedema

    PubMed Central

    Kanapathy, Muholan; Patel, Nikhil M.; Kalaskar, Deepak M.; Mosahebi, Afshin; Mehrara, Babak J.; Seifalian, Alexander M.

    2015-01-01

    Background Lymphedema is a chronic debilitating condition and curative treatment is yet to be found. Tissue engineering approach, which combines cellular components, scaffold, and molecular signals hold great potential in the treatment of secondary lymphedema with the advent of lymphatic graft to reconstruct damaged collecting lymphatic vessel. This review highlights the ideal characteristics of lymphatic graft, the limitation and challenges faced, and the approaches in developing tissue-engineered lymphatic graft. Methods Literature on tissue engineering of lymphatic system and lymphatic tissue biology was reviewed. Results The prime challenge in the design and manufacturing of this graft is producing endothelialized conduit with intraluminal valves. Suitable scaffold material is needed to ensure stability and functionality of the construct. Endothelialization of the construct can be enhanced via biofunctionalization and nanotopography, which mimics extracellular matrix. Nanocomposite polymers with improved performance over existing biomaterials are likely to benefit the development of lymphatic graft. Conclusions With the in-depth understanding of tissue engineering, nanotechnology, and improved knowledge on the biology of lymphatic regeneration, the aspiration to develop successful lymphatic graft is well achievable. PMID:25248852

  18. Treatment and prophylaxis of melioidosis

    PubMed Central

    Dance, David

    2014-01-01

    Melioidosis, infection with Burkholderia pseudomallei, is being recognised with increasing frequency and is probably more common than currently appreciated. Treatment recommendations are based on a series of clinical trials conducted in Thailand over the past 25 years. Treatment is usually divided into two phases: in the first, or acute phase, parenteral drugs are given for ≥10 days with the aim of preventing death from overwhelming sepsis; in the second, or eradication phase, oral drugs are given, usually to complete a total of 20 weeks, with the aim of preventing relapse. Specific treatment for individual patients needs to be tailored according to clinical manifestations and response, and there remain many unanswered questions. Some patients with very mild infections can probably be cured by oral agents alone. Ceftazidime is the mainstay of acute-phase treatment, with carbapenems reserved for severe infections or treatment failures and amoxicillin/clavulanic acid (co-amoxiclav) as second-line therapy. Trimethoprim/sulfamethoxazole (co-trimoxazole) is preferred for the eradication phase, with the alternative of co-amoxiclav. In addition, the best available supportive care is needed, along with drainage of abscesses whenever possible. Treatment for melioidosis is unaffordable for many in endemic areas of the developing world, but the relative costs have reduced over the past decade. Unfortunately there is no likelihood of any new or cheaper options becoming available in the immediate future. Recommendations for prophylaxis following exposure to B. pseudomallei have been made, but the evidence suggests that they would probably only delay rather than prevent the development of infection. PMID:24613038

  19. Chronic Lymphedema of the Lower Limb: A Rare Cause of Dislocation of Total Hip Arthroplasty

    PubMed Central

    Vaishya, Raju; Gupta, Nishint; Vijay, Vipul

    2016-01-01

    Total hip arthroplasty (THA) in a patient with chronic lymphedema of both lower limbs is rarely reported in the literature. Chronic lymphedema is a challenging condition associated with various complications especially in a patient with THA. However, dislocation of the total hip prosthesis due to acute exacerbation of lower limb swelling in the postoperative period is an extremely rare complication. The cause that led to the dislocation of the prosthesis is intricate and difficult to assess, as this has not been discussed in the literature yet. We believe that the excessive weight of the limb due to chronic lymphedema had a deleterious effect on the biomechanics of total hip prosthesis, thereby increasing the tendency for dislocation. This case illustrates that chronic lymphedema of the lower limb should be dealt with aggressively using various modalities like intermittent pneumatic compression pumps and compression stockings after THA in such patients. PMID:27226940

  20. Chronic Lymphedema of the Lower Limb: A Rare Cause of Dislocation of Total Hip Arthroplasty.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Gupta, Nishint; Vijay, Vipul

    2016-01-01

    Total hip arthroplasty (THA) in a patient with chronic lymphedema of both lower limbs is rarely reported in the literature. Chronic lymphedema is a challenging condition associated with various complications especially in a patient with THA. However, dislocation of the total hip prosthesis due to acute exacerbation of lower limb swelling in the postoperative period is an extremely rare complication. The cause that led to the dislocation of the prosthesis is intricate and difficult to assess, as this has not been discussed in the literature yet. We believe that the excessive weight of the limb due to chronic lymphedema had a deleterious effect on the biomechanics of total hip prosthesis, thereby increasing the tendency for dislocation. This case illustrates that chronic lymphedema of the lower limb should be dealt with aggressively using various modalities like intermittent pneumatic compression pumps and compression stockings after THA in such patients. PMID:27226940

  1. Indocyanine Green Lymphographic Signs of Lymphatic Collateral Formation in Lower Extremity Lymphedema After Cancer Resection.

    PubMed

    Tashiro, Kensuke; Shibata, Takashi; Mito, Daisuke; Ishiura, Ryohei; Kato, Motoi; Yamashita, Shuji; Narushima, Mitsunaga; Iida, Takuya; Koshima, Isao

    2016-08-01

    Indocyanine green lymphography has recently been used to assess lymphatic vessel function in lymphedema patients. Postoperative collateral lymphatic vessels toward ipsilateral axillary lymph nodes are rarely seen above the umbilical level in lower lymphedema patients. Between January 2012 and December 2014, we performed indocyanine green lymphography of 192 limbs in 96 lower extremity lymphedema cases. As a result, dermal back flow appeared in 95 cases, with 38 in the lower abdominal area and 31 in the genital area. We confirmed 3 cases of superficial lymphatic collateral ways extending above the umbilical level to the axillary lymph nodes. All 3 cases had similarity in lower abdominal edema, so excessive lymphatic fluid in the lower abdomen was assumed to be the cause. Lymphatic collateral ways from abdomen to axillary lymph nodes in this study was likely to be designed to prevent the progress of lymphedema. PMID:26418772

  2. A comprehensive review of the natural lymphaticovenous communications and their role in lymphedema surgery.

    PubMed

    Miranda Garcés, María; Mirapeix, Rosa; Pons, Gemma; Sadri, Amir; Masià, Jaume

    2016-03-01

    Cancer-related lymphedema is a progressive, chronic condition that impairs quality of life. Its pathophysiology and the mechanisms of action of current reconstructive surgical treatments are not fully understood but lymphaticovenous communications may play a key role. We review the available literature on lymphaticovenous communications and their implications in lymphedema surgery, and propose a subclassification of lymphaticovenous communications. J. Surg. Oncol. 2016;113:374-380. © 2016 Wiley Periodicals, Inc. PMID:26780968

  3. Intermittent local prophylaxis against recurrent vaginal candidosis.

    PubMed Central

    Bushell, T E; Evans, E G; Meaden, J D; Milne, J D; Warnock, D W

    1988-01-01

    Women with recurrent vaginal candidosis were treated until the infection cleared and were then given one clotrimazole 500 mg vaginal tablet a month or an identical placebo as prophylaxis. Of 21 women who received placebo, 16 developed symptoms or signs within three months, compared with nine of 17 women given active treatment. Women who relapsed were treated and then given active prophylaxis once a month. Of 30 women given such treatment, 13 relapsed within three months. Women who relapsed were treated and then given two clotrimazole 500 mg vaginal tablets a month. Of 17 women given prophylaxis twice a month, four developed symptoms or signs within three months, but 10 remained clear for 12 months. No appreciable difference was seen in the incidence of mycological recurrence between the different regimens; within three months over half the women in all treatment groups had become recolonised. PMID:3060424

  4. Squamous cell carcinoma of the penis and scrotum in a patient with chronic scrotal and penile lymphedema.

    PubMed

    Abhyankar, Suhas V; Kulkarni, Ananta; Kulkarni, Madhuri; Agarwal, Naveen Kumar

    2010-10-01

    Squamous cell carcinoma arising from tissue affected by chronic lymphedema is rare, though it is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema. We describe, a case of scrotal and penile squamous cell carcinoma arising in a patient with a history of chronic scrotal and penile lymphedema of filarial origin. We here discuss the management and possible etiology of this unusual case. PMID:21430898

  5. Peri-portal lymphedema in association with an acute adrenal insufficiency: case report

    PubMed Central

    2014-01-01

    Introduction We report the case of a patient with peri-portal lymphedema in association with severe adrenal insufficiency. To the best of our knowledge, this association was not previously reported in the literature. Peri-portal lymphedema is usually seen in cases such as blunt abdominal trauma, hepatic congestion and post–liver transplantation. Case presentation We present the case of a 28-year-old Indian man who presented to our hospital with adrenal crisis and was treated accordingly. Computed tomography of his abdomen showed evidence of peri-portal lymphedema (edema) with some free fluid collection. We excluded other causes of this pathology and followed the patient’s condition after steroid replacement therapy. We found no other contributing factors to the patient’s peri-portal lymphedema apart from the adrenal crisis, which was more consolidated when we followed the patient after steroid replacement therapy, during which follow-up computed tomography showed complete resolution of the pathology. Conclusions We conclude following an extensive MEDLINE® search that this is the first case to be reported for the association between peri-portal lymphedema and adrenal insufficiency, after having excluded all other causes of peri-portal lymphedema. This signifies reporting of this case as the first one in the medical literature. PMID:24661563

  6. Lymphaticovenous Bypass Decreases Pathologic Skin Changes in Upper Extremity Breast Cancer-Related Lymphedema

    PubMed Central

    Torrisi, Jeremy S.; Joseph, Walter J.; Ghanta, Swapna; Cuzzone, Daniel A.; Albano, Nicholas J.; Savetsky, Ira L.; Gardenier, Jason C.; Skoracki, Roman; Chang, David

    2015-01-01

    Abstract Introduction: Recent advances in microsurgery such as lymphaticovenous bypass (LVB) have been shown to decrease limb volumes and improve subjective symptoms in patients with lymphedema. However, to date, it remains unknown if these procedures can reverse the pathological tissue changes associated with lymphedema. Therefore, the purpose of this study was to analyze skin tissue changes in patients before and after LVB. Methods and Results: Matched skin biopsy samples were collected from normal and lymphedematous limbs of 6 patients with unilateral breast cancer-related upper extremity lymphedema before and 6 months after LVB. Biopsy specimens were fixed and analyzed for inflammation, fibrosis, hyperkeratosis, and lymphangiogenesis. Six months following LVB, 83% of patients had symptomatic improvement in their lymphedema. Histological analysis at this time demonstrated a significant decrease in tissue CD4+ cell inflammation in lymphedematous limb (but not normal limb) biopsies (p<0.01). These changes were associated with significantly decreased tissue fibrosis as demonstrated by decreased collagen type I deposition and TGF-β1 expression (all p<0.01). In addition, we found a significant decrease in epidermal thickness, decreased numbers of proliferating basal keratinocytes, and decreased number of LYVE-1+ lymphatic vessels in lymphedematous limbs after LVB. Conclusions: We have shown, for the first time, that microsurgical LVB not only improves symptomatology of lymphedema but also helps to improve pathologic changes in the skin. These findings suggest that the some of the pathologic changes of lymphedema are reversible and may be related to lymphatic fluid stasis. PMID:25521197

  7. Self-Care for Management of Secondary Lymphedema: A Systematic Review

    PubMed Central

    Graves, Patricia; Gordon, Susan

    2016-01-01

    Background Lymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local community. This review was conducted to evaluate the evidence for effective lymphedema self-care strategies that might be applicable to management of all types of secondary lymphedema. Methodology/Principal Findings Searches were conducted in Medline, CINAHL and Scopus databases in March 2015. Included studies reported before and after measures of lymphedema status or frequency of acute infections. The methodological quality was assessed using the appropriate Critical Appraisal Skills Program checklist. Descriptive synthesis and meta-analysis were used to evaluate effectiveness of the outcomes reported. Twenty-eight papers were included; two RCTs were found to have strong methodology, and overall 57% of studies were rated as methodologically weak. Evidence from filariasis-related lymphedema (FR-LE) studies indicated that hygiene-centred self-care reduced the frequency and duration of acute episodes by 54%, and in cancer-related lymphedema (CR-LE) home-based exercise including deep breathing delivered significant volume reductions over standard self-care alone. Intensity of training in self-care practices and frequency of monitoring improved outcomes. Cultural and economic factors and access to health care services influenced the type of intervention delivered and how outcomes were measured. Conclusions/Significance There is evidence to support the adoption of remedial exercises in the management of FR-LE and for a greater emphasis on self-treatment practices for people

  8. Analysis of the duration of migraine prophylaxis.

    PubMed

    Silva-Néto, Raimundo Pereira; Almeida, Kelson James; Bernardino, Silvya Neri

    2014-02-15

    To determine the minimum duration of migraine prophylaxis, after patients become pain-free. Migraine patients diagnosed according to criteria of International Classification of Headache Disorders-2 were treated prophylactically. After becoming pain-free, they were divided into two equal groups: in group 1, prophylaxis was maintained for another 12 months and in group 2, for 24 months. Each group was followed for more three years after prophylaxis period. Of the 50 patients, 39 (78%) were female and 11 (22%) were male. The age ranged from 18 to 50 years. Before treatment, the attack frequency for groups 1 and 2 was, respectively, 16.3 ± 12.8 and 16.4 ± 11.8 days per month (p = 0.769). Patients in groups 1 and 2 have become pain-free, respectively, with 21.4 ± 11.2 and 16.8 ± 9.9 months (p = 0.161). During three years without treatment, groups 1 and 2 maintained an annual frequency of respectively 3.2 and 0.5 headache days. Of the patients in group 2, 76.0% (19/25) remained pain-free during follow-up, versus 44.0% (11/25) of group 1, with a significant difference (p=0.001). The best results were obtained when migraine prophylaxis was maintained for 24 months after patients became pain-free. PMID:24308946

  9. Levetiracetam for Pediatric Posttraumatic Seizure Prophylaxis.

    PubMed

    Nita, Dragos A; Hahn, Cecil D

    2016-03-01

    Investigators from Nationwide Children's Hospital performed an observational cohort study of early post-traumatic seizures (EPTS) among 34 children with moderate to severe traumatic brain injury (TBI) who received levetiracetam (LEV) prophylaxis following admission to their pediatric intensive care unit. PMID:27396956

  10. Migraine prophylaxis: who, why, and how.

    PubMed

    Loj, Jadwiga; Solomon, Glen D

    2006-09-01

    If a patient has frequent, severely debilitating migraine headaches, prophylactic treatment may help. Beta-blockers, tricyclic antidepressants, and anticonvulsants have the best evidence of efficacy; calcium channel blockers and nonsteroidal anti-inflammatory drugs are also popular because they are well tolerated and inexpensive. We review migraine treatment with emphasis on prophylaxis. PMID:16970133

  11. Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors

    PubMed Central

    Karadibak, Didem; Yavuzşen, Tuğba; Demirbüken, İlkşan

    2014-01-01

    Aim of the study There is little known about any change in postural balance caused by asymmetrical volume increase due to unilateral upper extremity lymphedema in patients who underwent breast surgery. The aim of this study was to determine whether there is a change in postural balance by measuring postural sway velocity (PSV), center of gravity (CoG) displacement and directional control (DCL) in patients with unilateral upper extremity lymphedema in breast cancer survivors. Material and methods Eighteen females 38–60 (M = 53) years old diagnosed with upper extremity lymphedema due to breast cancer surgery, and 18 healthy females with similar ages (M = 52.5) were assessed using the Balance Master system (Neuro Com, Clackamas, USA). Unilateral stance (US) and bilateral stance (BS) tests in eyes open and closed conditions and the limit of stability (LOS) test were applied to quantify postural sway velocity (PSV), CoG displacement, and directional control (DCL). Results The lymphedema group showed a significant increase in PSV in the US test on the ipsilateral leg with eyes open (p = 0.02) and eyes closed (p = 0.005) as well as on the contralateral leg with eyes open (p = 0.004) and eyes closed (p = 0.0001). Average displacement and position of the CoG were 25% of LOS (p = 0.0001) towards the lymphedema side and 60.6 degrees respectively. DCL in the lymphedema group was significantly lower in forward (p = 0.0001), back (p = 0.003), ipsilateral (p = 0.002), and contralateral (p = 0.03) directions. Conclusions These findings suggest that unilateral upper extremity lymphedema may have challenging effects on postural balance. PMID:25258587

  12. Upper extremity impairments in women with or without lymphedema following breast cancer treatment

    PubMed Central

    Wong, Josephine; Cooper, Bruce; Wanek, Linda; Topp, Kimberly; Byl, Nancy; Dodd, Marylin

    2010-01-01

    Introduction Breast-cancer-related lymphedema affects ∼25% of breast cancer (BC) survivors and may impact use of the upper limb during activity. The purpose of this study is to compare upper extremity (UE) impairment and activity between women with and without lymphedema after BC treatment. Methods 144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective measures included Purdue pegboard, finger-tapper, Semmes-Weinstein monofilaments, vibration perception threshold, strength, range of motion (ROM), and volume. Results Women with lymphedema had more lymph nodes removed (p < .001), more UE symptoms (p < .001), higher BMI (p = .041), and higher DASH scores (greater limitation) (p < .001). For all participants there was less strength (elbow flexion, wrist flexion, grip), less shoulder ROM, and decreased sensation at the medial upper arm (p < .05) in the affected UE. These differences were greater in women with lymphedema, particularly in shoulder abduction ROM (p < .05). Women with lymphedema had bilaterally less elbow flexion strength and shoulder ROM (p < .05). Past diagnosis of lymphedema, grip strength, shoulder abduction ROM, and number of comorbidities contributed to the variance in DASH scores (R2 of 0.463, p < .001). Implications for cancer survivors UE impairments are found in women following treatment for BC. Women with lymphedema have greater UE impairment and limitation in activities than women without. Many of these impairments are amenable to prevention measures or treatment, so early detection by health care providers is essential. PMID:20373044

  13. Lymphedema in a 7-year-old boy infected with Wuchereria bancrofti in Sierra Leone: a case report.

    PubMed

    Dome, Mackenzie; Ansumana, Rashid; Covington, Andrea L; Rebollo, Maria P; Sesay, Santigie; Jacobsen, Kathryn H; de Souza, Dziedzom K; Koudou, Benjamin G; Michael, Edwin; Bockarie, Moses J

    2014-06-01

    We present a case of congenital lymphedema in a 7-year-old boy in Sierra Leone with active filarial infection and penile edema. The genital edema with onset at 6 months of age may have been due to a congenital abnormality in lymphatic drainage. Other possible causes of childhood lymphedema, including Milroy's disease, are discussed. PMID:24561072

  14. Diagnosis and Treatment of Lymphedema Following Breast Cancer: A Population-based Study

    PubMed Central

    Sayko, Oksana; Pezzin, Liliana E.; Yen, Tina W.F.; Nattinger, Ann B.

    2013-01-01

    Objective To examine factors associated with variations in diagnosis and rehabilitation treatments received by women with self-reported lymphedema secondary to breast cancer care. Design Population-based, prospective study. Setting California, Florida, Illinois, New York. Participants Elderly (65+) women identified from Medicare claims as having had an incident breast cancer surgery in 2003. Interventions N.A. Main Outcome Measures Self-reported incidence of lymphedema symptoms, formal lymphedema diagnosis; treatments for lymphedema. Results Of the 450 breast cancer survivors with lymphedema who participated in the study, 290 (64.4%) were formally diagnosed with the condition by a physician. An additional 160 (35.6%) reported symptoms consistent with lymphedema (arm swelling on the side of surgery that is absent on the contralateral arm) but were not formally diagnosed. Of those reporting as being diagnosed by a physician, 39 (13.4%) received the comprehensive decongestive therapy (CDT) that included multiple components of treatment (manual lymphatic drainage (MLD), bandaging with short stretch bandages, using compression sleeves, skin care and remedial exercises), 24 (8.3%) received MLD only, 162 (55.9%) used bandages, compression garments or a pneumatic pump only, 8 (2.8%) relied solely on skin care or exercise to relieve symptoms and 65 (22.4%) received no treatment at all. Multivariate regressions revealed that race (African American), lower income, and lower levels of social support increased a woman’s probability of having undiagnosed lymphedema. Even when formally diagnosed, African American women were more likely to receive no treatment or to be treated with bandages/compression only, rather than to receive the multi-modality, comprehensive decongestive therapy. Conclusions Lymphedema is a disabling chronic condition related to breast cancer treatment. Our results suggest that a substantial proportion of those reporting symptoms were not formally

  15. [Successes and failures in rhesus-prophylaxis].

    PubMed

    Speiser, P

    1983-12-31

    The medical history of hemolytic disease of the newborn (h. d. n.) due to Rh is reviewed from 1928-1963 and a very common and widespread error in the international literature on statistical data of h. d. n. has been critically analysed and corrected on the basis of the Viennese material over a period of 25 years. It is shown the first time that the morbidity is not as high as 6 to 7 in 1000 newborns but approximately 3 to 4 taking into account the origin of their mothers. The frequency of h. d. n. in Vienna is strongly influenced by mothers who come from abroad with and without foreign citizenship. In 13,34% of h. d. n. the women produce Rh antibodies during pregnancy, and therefore the Rh prophylaxis given after birth is not able to prevent the immunization which means that 0,55 per thousand of the h. d. n. rate of 4,1 per thousand is caused by Rh antibodies developed intra graviditatem and 3,55 per thousand post partum. These figures are derived from observations between 1948 and 1971 in the Pre-Prophylaxis-Time. The success of the Anti-D-IgG application dropped the h. d. n. rate from 4,1 per thousand to 1,7 per thousand in 1981. If the figure of 0,55 per thousand is taken into account as a wrong "failure" of the post partum prophylaxis, 1,15 per thousand (1,7-0,55) of h. d. n. have to be noted as true failures. There are many causes possible for the high rate of failure in the post partum prophylaxis which is to be eliminated before one could think of a systematic ante partum Rh prophylaxis. In our population 17% are Rh negative, 10% of all mothers are Rh negative giving birth to a Rh positive child and 3,5 per thousand of mothers of h. d. n. develop Rh antibodies post partum, 0,55 per thousand before. Out of 1000 Anti-D-IgG injections given after birth 965 are without any consequence and therefore only 35 are effective. Making use of the ante partum prophylaxis (mother Rh negative, baby's Rh factor unknown) 17% of all pregnant women have to be treated for

  16. Unilateral lower limb lymphedema resulting from a heart surgery performed 50 years prior

    PubMed Central

    Onoda, Satoshi; Miura, Yuki; Sugiyama, Narushi

    2015-01-01

    Introduction Lymphedema is classified into two main types: secondary lymphedema accompanied by lymph node excision surgery or radiotherapy; and idiopathic lymphedema. Here we experienced a very rare case of lymphatic edema resulting from cardiac surgery that the patient underwent 50 years previously. Presentation of case A 62-year-old woman experienced progressive unilateral lower leg lymphedema for recent years. After undergoing cardiac surgery at another hospital at the age of 12 years, she gradually developed left lower leg edema. The cause of the edema was unclear and it remained untreated. Her edema symptoms gradually worsened in recent years, so she consulted the plastic surgery division of our hospital. Discusssion Perhaps the lymphatic structures of affected individuals differ prior to disease onset. If the mechanism of lymphatic edema outbreak is elucidated, patients needing conservative and surgical therapy might be more easily identified. Knowing the outbreak mechanism of lymphatic edema would definitely ease the investigation of an unconventional case like this one. Conservative treatments for lymphedema, such as self-massage and compression therapy using garments, were immediately started. With these treatments, the leg volume and edema symptoms reduced. Conclusion The research on the cause of this case may be important step for elucidating the source of secondary lymphatic edema. PMID:26719996

  17. [Post-therapeutic lymphedema of the arm--possibilities and limits of diagnosis and therapy].

    PubMed

    Döller, W

    1999-01-01

    The post-therapeutical secondary arm lymphedema is the most frequent complication after a curatively treated cancer of mamma. For the diagnosis and therapy the knowledge of physiology and pathophysiology of lymphedema and of specific anatomy are necessary. The diagnosis facilities are essentially limited to a basic diagnosis (anamnesis, inspection, palpation, sonography, functional-diagnosis). Specific apparative diagnostics like lab, sonography, CT, MRI and PTE have to be applied especially at an early stage of the secondary arm lymphedema for the differential diagnosis between the secondary malign and secondary benign arm lymphedema. Specific apparative examinations like lymphscintigraphy and lymphography are limited and solely indicated for special questions. As a therapy possibility of the secondary arm-lymph edema, a conservative therapy, that is, the complex two-stage-decongestive physiotherapy (CDP) is recommended as first choice. Surgical therapies such as autologous lympho-lymphostatic anastomoses and lymphovenous anastomoses are only recommended in selected individual cases. The secondary malignant arm lymphedema must be primarily treated oncologically; lymphological therapy measures have to be postponed. Diagnosis and therapy are limited through lymphological incompetence and insufficient patient compliance. In this respect the provision of financial resources through National Health policy ist regarded as utterly important. PMID:10378339

  18. The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema

    PubMed Central

    Jang, Dae-Hyun; Kim, Min-Wook; Oh, Se-Jeong; Kim, Jae Min

    2015-01-01

    Purpose To evaluate the pathological effect of the duration of arm swelling on the shoulder pathology in patients with breast cancer-related lymphedema. Methods Forty seven breast cancer patients with unilateral arm lymphedema were assessed. The duration of the arm swelling and shoulder pain were recorded. Ultrasound examination of the shoulder joint was performed in all patients to detect any lesions. Results Abnormalities were detected by ultrasound in 41/47 (87.2%) study participants. Subacromial subdeltoid bursal thickening was found in 26/47 (55.3%) participants, distension of the biceps brachii tendon sheath was found in 14/47 (29.8%) and a supraspinatus tendon tear was found in 13/47 (27.7%). Patients with a supraspinatus tendon tear were found to have a significantly longer duration of lymphedema (1310 days vs. 398 days, p = 0.032). Conclusions The duration of arm lymphedema has a progressive pathological effect on rotator cuff. Clinicians should adopt an early management approach of shoulder pain in patients with breast cancer-related lymphedema. PMID:26571274

  19. Prominent Lymphatic Vessel Hyperplasia with Progressive Dysfunction and Distinct Immune Cell Infiltration in Lymphedema.

    PubMed

    Gousopoulos, Epameinondas; Proulx, Steven T; Scholl, Jeannette; Uecker, Maja; Detmar, Michael

    2016-08-01

    Lymphedema is a common complication that occurs after breast cancer treatment in up to 30% of the patients undergoing surgical lymph node excision. It is associated with tissue swelling, fibrosis, increased risk of infection, and impaired wound healing. Despite the pronounced clinical manifestations of the disease, little is known about the morphological and functional characteristics of the lymphatic vasculature during the course of lymphedema progression. We used an experimental murine tail lymphedema model where sustained fluid stasis was generated on disruption of lymphatic flow, resulting in chronic edema formation with fibrosis and adipose tissue deposition. Morphological analysis of the lymphatic vessels revealed a dramatic expansion during the course of the disease, with active proliferation of lymphatic endothelial cells at the early stages of lymphedema. The lymphatic capillaries exhibited progressively impaired tracer filling and retrograde flow near the surgery site, whereas the collecting lymphatic vessels showed a gradually decreasing contraction amplitude with unchanged contraction frequency, leading to lymphatic contraction arrest at the later stages of the disease. Lymphedema onset was associated with pronounced infiltration by immune cells, predominantly Ly6G(+) and CD4(+) cells, which have been linked to impaired lymphatic vessel function. PMID:27315777

  20. WATER EXERCISE COMPARED TO LAND EXERCISE OR STANDARD CARE IN FEMALE CANCER SURVIVORS WITH SECONDARY LYMPHEDEMA.

    PubMed

    Lindquist, H; Enblom, A; Dunberger, G; Nyberg, T; Bergmark, K

    2015-06-01

    There are few studies showing that physical exercise can improve secondary lymphedema. We hypothesized that water exercise would be more effective than land exercise in reducing limb volume. Secondary objectives were joint movement, BMI, daily function, well-being, and body image. Limb volume was measured with circumference or was volumetric. Well-being and body image were measured with a study-specific questionnaire and daily function with DASH and HOOS questionnaires. Eighty-eight eligible patients with secondary lymphedema after breast or gynecological cancer participated in this controlled clinical intervention study. There was a higher proportion of women who participated in water exercises who reduced their secondary arm limb volume (p = 0.029), and there were also significant differences for BMI (p = 0.047) and self-reported frequency of swelling (p = 0.031) in the water exercise group after intervention. Women with arm lymphedema in the land exercise group improved DASH scores (p = 0.047) and outer rotation in the shoulder (p = 0.001). Our results suggest that to reduce objective and self-reported swelling, lymphedema patients may be offered water exercise training while to improve daily shoulder function, land exercises are preferred. To guide female cancer survivors with lymphedema to effective exercise resulting in reduced limb volume and improved function, adequate evidenced-based programs are needed. PMID:26714371

  1. A Pilot Study Using the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) as a Clinical Care Tool to Identify Lower Extremity Lymphedema in Gynecologic Cancer Survivors

    PubMed Central

    Carter, Jeanne; Raviv, Leigh; Appollo, Kathleen; Baser, Raymond E.; Iasonos, Alexia; Barakat, Richard R.

    2016-01-01

    Objective To determine the feasibility and efficacy of using the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) as a symptom scale for lymphedema of the lower extremity (LLE). Methods Twenty-eight gynecologic cancer survivors with documented LLE and 30 without a history or presence of lymphedema completed the GCLQ and provided feedback about their satisfaction with and feasibility of using the GCLQ at their oncology follow-ups. The study survey took approximately 5–10 minutes to complete, and it was easily understood by the majority of the sample. Results Participants had a mean age of 59.6 years (range, 28–80 years). Twenty-eight women (48%) had LLE and 30 (52%) had no history or presence of LLE (confirmed by limb volume [LV] measurements at assessment). Type of cancer history included: endometrial, 38 (66%); cervical, 13 (22%); and vulvar, 7 (12%). GCLQ scores differed significantly by lymphedema diagnosis; LLE patients had higher scores (P<0.01). The large area under the curve (AUC) of 0.95 (95% CI: 0.90–1.000) suggests that the GCLQ can distinguish between patients with and without LLE. Although all 28 (100%) of the LLE patients were aware of their LLE diagnosis, only 23 (82%) underwent treatment. The GCLQ was easily understood by most (55/58, 95%); and overall, patients showed a high willingness (56/58, 96%) to complete the questionnaire at future appointments. Twenty-five (88%) of the LLE patients found the GCLQ to be helpful in identifying symptoms of lymphedema. Conclusions The GCLQ effectively distinguished between gynecologic cancer survivors with and those without LLE, with good sensitivity and specificity. The patients, particularly those with LLE, showed high confidence in the GCLQ’s ability to detect LLE symptoms. PMID:20163847

  2. Cryptic Bacteria of Lower Limb Deep Tissues as a Possible Cause of Inflammatory and Necrotic Changes in Ischemia, Venous Stasis and Varices, and Lymphedema

    PubMed Central

    Zaleska, Marzanna; Stelmach, Ewa; Swoboda-Kopec, Ewa; Jain, Pradeep; Agrawal, Karoon; Gogia, Sashi; Gogia, Arun; Andziak, Piotr; Durlik, Marek

    2015-01-01

    Abstract Background: Infections and inflammation of the lower limb skin, soft tissues, and vessels are more common than in other body regions. The aim was to determine whether cryptic bacteria dwelling in deep tissues are the cause. Methods: We performed bacteriologic studies of specimens harvested from arteries of amputated ischemic legs, leg varices, and tissue fluid/lymph and lymphatics in lymphedema. Results: Calf arteries contained isolates in 61% and femoral arteries in 36%, whereas normal cadaveric organ donors' arteries in 11%. Bacterial deoxyribonucleic acid (DNA) was detected in 70%. The majority of isolates belonged to the coagulase-negative staphylococci and Staphylococcus aureus; however, highly pathogenic bacteria were also detected. All were sensitive to all antibiotics except penicillin. Saphenous vein varices contained bacterial cells in 40% and controls 4%; bacterial DNA was found in 69%. The majority of bacteria were S. epidermidis and S. aureus susceptible to all antibiotics except penicillin, Lymph and epifascial lymphatics limb contained bacteria in 60% and 33% samples, respectively and controls in 7%. Most were S. epidermidis susceptible to all antibiotics except penicillin. Conclusion: Cryptic bacteria are present in lower limb tissues and may play a pathologic role in surgical site infections. Proper antibacterial prophylaxis should be considered when planning surgical interventions. PMID:26046245

  3. A prospective pilot study on the incidence of post-operative lymphedema in women with endometrial cancer

    PubMed Central

    Hopp, Elizabeth E.; Osborne, Janet L.; Schneider, Deborah K.; Bojar, Claudia J.; Uyar, Denise S.

    2015-01-01

    To determine the incidence of lower-extremity lymphedema after surgical therapy including lymphadenectomy in endometrial cancer patients using standardized leg measurements. Also, to determine additional risk factors for the development of lymphedema and to study the effect of lymphedema on one's quality of life. In this prospective cohort study, patients with the diagnosis of endometrial cancer who were to undergo definitive surgical management were evaluated pre-operatively and followed post-operatively over the course of two years. Standardized leg measurements were performed by the same individuals at six time-points. Subjects also completed a standardized quality-of-life survey at each time-point. The incidence of lymphedema in 39 women with endometrial cancer using a standardized leg measurement protocol was 12.8% with lymphedema defined as a 20% increase in post-operative leg measurements. There was no significant association between the development of lymphedema and the number of pelvic or para-aortic lymph nodes removed, medical comorbidities, or surgical approach (p > 0.05). Of the five patients who met criteria for lymphedema, only one had worsening quality-of-life concerns post-operatively on the FACT-En, version 4, survey. This is the first prospective study using standardized leg measurements to calculate the incidence of post-operative lymphedema in endometrial cancer. Medical comorbidities, surgical approach, number of lymph nodes removed, and location of lymph nodes removed did not appear to affect the development of lymphedema in this cohort. A prospective, multicenter trial is needed to confirm these findings and to further assess the impact of lymphedema on one's quality of life. PMID:26937484

  4. A prospective pilot study on the incidence of post-operative lymphedema in women with endometrial cancer.

    PubMed

    Hopp, Elizabeth E; Osborne, Janet L; Schneider, Deborah K; Bojar, Claudia J; Uyar, Denise S

    2016-01-01

    To determine the incidence of lower-extremity lymphedema after surgical therapy including lymphadenectomy in endometrial cancer patients using standardized leg measurements. Also, to determine additional risk factors for the development of lymphedema and to study the effect of lymphedema on one's quality of life. In this prospective cohort study, patients with the diagnosis of endometrial cancer who were to undergo definitive surgical management were evaluated pre-operatively and followed post-operatively over the course of two years. Standardized leg measurements were performed by the same individuals at six time-points. Subjects also completed a standardized quality-of-life survey at each time-point. The incidence of lymphedema in 39 women with endometrial cancer using a standardized leg measurement protocol was 12.8% with lymphedema defined as a 20% increase in post-operative leg measurements. There was no significant association between the development of lymphedema and the number of pelvic or para-aortic lymph nodes removed, medical comorbidities, or surgical approach (p > 0.05). Of the five patients who met criteria for lymphedema, only one had worsening quality-of-life concerns post-operatively on the FACT-En, version 4, survey. This is the first prospective study using standardized leg measurements to calculate the incidence of post-operative lymphedema in endometrial cancer. Medical comorbidities, surgical approach, number of lymph nodes removed, and location of lymph nodes removed did not appear to affect the development of lymphedema in this cohort. A prospective, multicenter trial is needed to confirm these findings and to further assess the impact of lymphedema on one's quality of life. PMID:26937484

  5. [PROPHYLAXIS OF AN ACUTE ADHESIVE ILEUS RECURRENCE].

    PubMed

    Evtushenko, D A

    2015-10-01

    The results of treatment of 56 patients were studied, in whom for adhesive abdominal disease, complicated by an acute adhesive ileus (AAI), the adhesiolysis with intraabdominal introduction of antiadhesive measures, named Mezogel, Defensal were conducted, as well as in 42 patients, operated on in emergency for AAI, using a routine method. Application of videolaparoscopy gives a possibility to control the adhesive process in the early postoperative period, what is necessary for prophylaxis of the adhesive disease occurence. Application of the apparatus, we have elaborated, permitted to conduct a precisional viscerolysis due to good visualization of organs, pathologically changed and healthy tissues. Application of the procedures elaborated for prophylaxis of the AAI recurrence have promoted the reduction of risk for the AAI occurence down to 1.8%, and of disorders of the gut contents transit in terms up to 1 yr - to 3.6%. PMID:26946653

  6. Prophylaxis of Human Hydrophobia in South Korea

    PubMed Central

    2014-01-01

    Domestic human hydrophobia has not been reported since the one case of 2004 in South Korea, but still a few animal rabies occur persistently since the reemerging stage of rabies from 1993. The government has made efforts to control animal rabies in many aspects, but whether prophylactic strategy for human hydrophobia is performed adequately is in question. The rate of proper post-exposure prophylaxis for animal bite case in 'high-risk region' of rabies is very low with 20% between 2011 and 2013. The National Animal Bite Patient Surveillance targeting 'high-risk region' is missing out animal bite cases who visit directly to hospitals in 'suspect-risk region' of rabies. Little data seems to exist for pre-exposure prophylaxis of domestic hydrophobia. Danger of reoccurrence of human hydrophobia always remain in South Korea. The medical personnel needs to have greater interest on the matter and the government strengthen the management system. PMID:25298903

  7. Historical Review: Problematic Malaria Prophylaxis with Quinine.

    PubMed

    Shanks, G Dennis

    2016-08-01

    Quinine, a bitter-tasting, short-acting alkaloid drug extracted from cinchona bark, was the first drug used widely for malaria chemoprophylaxis from the 19th century. Compliance was difficult to enforce even in organized groups such as the military, and its prophylaxis potential was often questioned. Severe adverse events such as blackwater fever occurred rarely, but its relationship to quinine remains uncertain. Quinine prophylaxis was often counterproductive from a public health viewpoint as it left large numbers of persons with suppressed infections producing gametocytes infective for mosquitoes. Quinine was supplied by the first global pharmaceutical cartel which discouraged competition resulting in a near monopoly of cinchona plantations on the island of Java which were closed to Allied use when the Japanese Imperial Army captured Indonesia in 1942. The problems with quinine as a chemoprophylactic drug illustrate the difficulties with medications used for prevention and the acute need for improved compounds. PMID:27185766

  8. Antibiotic prophylaxis is unnecessary in clean surgery.

    PubMed

    Hasan, G Z; Saleh, F M; Hossain, M Z; Amin, M R; Siddiqui, T H; Islam, M D; Chakraborty, S

    2013-04-01

    A significant number of paediatric surgical patients undergone clean surgical procedures. Most of the paediatric surgeon use perioperative prophylactic antibiotic in this clean procedure because of undue fear of infection in their mind. The objective of this study is to evaluate whether the use of perioperative prophylactic antibiotics have an effect to prevent post operative wound infection in clean operation in paediatric surgical patients. This study was conducted in the paediatric surgery department of Bangabandhu Sheikh Mujib Medical University and some private clinics of Dhaka city from January 2009 to December 2009. Two hundred patients who were undergone clean elective surgical procedure on day case basis were included in this study. They were divided into two equal groups (Group A and Group B). The patients of Group A were given intransverse Cephradine 30 minutes before incision and then oral Cephradine was advised postoperatively for 7 days. The patients of Group B were not given any perioperative antibiotic. All the patients of both groups were advised to come on 3rd, 6th and 10th postoperative day for examination of wound. In Group A (With chemo prophylaxis), five patients (5%) developed postoperative wound infection and in Group B (without chemo prophylaxis), three patients (3%) developed postoperative wound infection. Thus the rate of postoperative wound infection is slightly more in patients with chemo prophylaxis but it was not statistically significant by chi-square test. Based on the result of this study, it may be concluded that the antibiotic prophylaxis is not necessary in clean surgery in paediatric age group. PMID:23715359

  9. Antimicrobial prophylaxis in minor and major surgery.

    PubMed

    Bassetti, M; Righi, E; Astilean, A; Corcione, S; Petrolo, A; Farina, E C; De Rosa, F G

    2015-01-01

    Surgical site infections (SSIs) are a frequent cause of morbidity following surgical procedures. Gram-positive cocci, particularly staphylococci, cause many of these infections, although Gram-negative organisms are also frequently involved. The risk of developing a SSI is associated with a number of factors, including aspects of the operative procedure itself, such as wound classification, and patient-related variables, such as preexisting medical conditions. Antimicrobial prophylaxis (AP) plays an important role in reducing SSIs, especially if patient-related risk factors for SSIs are present. The main components of antimicrobial prophylaxis are: timing, selection of drugs and patients, duration and costs. Compliance with these generally accepted preventive principles may lead to overall decreases in the incidence of these infections. Ideally the administration of the prophylactic agent should start within 30 minutes from the surgical incision. The duration of the AP should not exceed 24 hours for the majority of surgical procedures. The shortest effective period of prophylactic antimicrobial administration is not known and studies have demonstrated that post-surgical antibiotic administration is unnecessary. Furthermore, there were no proven benefits in multiple dose regimens when compared to single-dose regimens. The choice of an appropriate prophylactic antimicrobial agent should be based primarily on efficacy and safety. Broad spectrum antibiotics should be avoided due to the risk of promoting bacterial resistance. Cephalosporins are the most commonly used antibiotics in surgical prophylaxis; specifically, cefazolin or cefuroxime are mainly used in the prophylaxis regimens for cardio-thoracic surgery, vascular surgery, hip or knee arthroplasty surgery, neurosurgical procedures and gynecologic and obstetric procedures. A review of the prophylactic regimens regarding the main surgical procedures is presented. PMID:24561611

  10. [Organizational principles in prophylaxis of stroke].

    PubMed

    Shappo, V V; Simonenko, V B; Shirokov, E A; Denishchuk, I S

    2008-05-01

    Modern system of insult prophylaxis intends development of 2 directions: population strategy and individual tactics. The effectiveness of population strategy depends on quality of health survey and of sanitarian-educational work. The effectiveness of individual tactics depends on intensity of clinical, laboratorial and instrumental checkup and elaborating an adequate correction of representative syndromes. Model of an individual prophylaxis of insult exists in the 2nd Central Military Clinical Hospital of P.V. Mandryka more then 15 years. According to the result of yearly health survey, therapist, in cooperation with cardiologist and neurologist, elaborates a "plan of health", which intends decrease of negative factor's influence and using medicinal substances, correcting the representative syndromes. High-technological algorithms of checkup include ultrasonics surveys of brachycephaly vessel and of the heart, an entire-day electrocardiogram monitoring or loading test, large bio-chemistry tests, directed to finding hyper-coagulation and dislipidemia. The experience of work demonstrates large capabilities in increasing of effectiveness of prophylaxis programs. These capabilities permit decrease sickness rate of insult--to the 30% during latter years. PMID:18589695

  11. Self-assessment of striae gravidarum prophylaxis

    PubMed Central

    Sobczak, Małgorzata; Kasielska-Trojan, Anna

    2015-01-01

    Introduction Striae are the most frequently occurring pathology of connective tissue during pregnancy. According to the statistical data, 70–90% of women suffer from striae gravidarum. Aim To assess effectiveness of topical products and massage used by pregnant women in striae gravidarum prophylaxis. Material and methods The questionnaire study was conducted among 299 women who were maximum 6 months after delivery at term. The questionnaire included questions concerning age, occurrence of striae gravidarum during pregnancy, their location, week of gestation when the lesions appeared and used striae prophylaxis as well as its effectiveness in respondents’ opinion. Results Analysis of the correlation between striae gravidarum occurrence and use of different types of cosmetics showed that this kind of prophylaxis is effective when applied at least twice a day (63.7% vs. 77.6%). No correlation between the type of cosmetics and presence of striae was observed (p > 0.05). Conclusions Use of prophylactic measures like skin emollients and oils with the appropriate frequency significantly reduces the risk of striae gravidarum occurrence. PMID:26755911

  12. New compression mechanism in penile-scrotal lymphedema and sexual rehabilitation

    PubMed Central

    de Godoy, Jose Maria Pereira; Facio, Fernando Nestor; de Carvalho, Eleni Cássia Matias; Godoy, Maria de Fatima Guerreiro

    2014-01-01

    The objective of this study is to describe a new compression mechanism in the treatment of lymphedema of the penis and scrotum and the ensuing sexual rehabilitation. The patient, a 58-year-old man, had edema of the penile and scrotal region as a result of surgery of the pancreas and spleen and chemotherapy. The patient complained of pain, discomfort, and difficulties to walk and urinate. A clinical diagnosis of lymphedema of the penis and scrotum was reached. Treatment involved the continuous use of a cotton-polyester compression garment for the region together with thorough hygiene skin care. The swelling reduced significantly within a week to almost a normal aspect which was accompanied by clinical improvements of the symptoms. The reduction in penile edema allowed sexual rehabilitation even though erectile dysfunction required the use of a specific medication (sildenafil). In conclusion, simple and low-cost options can improve lymphedema of the penis and scrotum and allow sexual rehabilitation. PMID:24669133

  13. Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema.

    PubMed

    Pyszel, A; Malyszczak, K; Pyszel, K; Andrzejak, R; Szuba, A

    2006-12-01

    The aim of this study was to assess disability, psychological distress and quality of life in Polish breast cancer survivors with arm lymphedema. One thousand sets of questionnaires consisting of WHO-DAS II, GHQ-30, EORTC QLQ-C30 and QLQ-BR23 were sent to members of the Polish Federation of Breast Cancer Survivors Clubs "Amazonki." The response rate was 28.3% of whom 31.70% reported arm lymphedema. The WHO-DAS II survey showed that patients with arm lymphedema had a higher overall disability score (45.04 versus 38.80 in group without arm lymphedema; p=0.01) and higher mean values in the scales of understanding and communicating, getting around, life activities at home, getting along with people, participating in society. The EORTC QLQ-C30 survey showed that patients with lymphedema had lower mean values in physical (0.55 versus 0.65; p=0.001), emotional (0.47 versus 0.57; p=0.01), social (0.59 versus 0. 73; p=0.002), cognitive and role functioning, increased fatigue, pain, insomnia, dyspnea, nausealvomiting and financial problems. The EORTC QLQ-BR23 data demonstrated worse future perspectives and an increase in breast and arm symptoms, and the GHQ-30 survey produced higher psychological distress (scores 15.18 versus 11.24; p=0.004). In conclusion, breast cancer survivors with arm lymphedema were more disabled, experienced a poorer quality of life and had increased psychological distress in comparison to survivors without this condition. PMID:17319631

  14. Functional Lymphatic Collectors in Breast Cancer-Related Lymphedema Arm

    PubMed Central

    Wang, Bing-shun

    2014-01-01

    Abstract Background: The pathophysiology of breast cancer-related lymphedema (BCRL) is poorly understood. The present study evaluated the lymphatic collectors in the arms of patients with BCRL. Methods and Results: In total, 123 patients with ipsilateral BCRL who had undergone magnetic resonance lymphangiography using gadobenate dimeglumine as a contrast agent were enrolled in this study. Morphological changes and the numbers of collecting lymphatic vessels were recorded. Associations between the number of visualized lymphatic collectors and edema accumulation, subcutis thickness, and the BCRL duration and latency were analyzed. Tortuous and significantly dilated lymphatic collectors were visualized in the lymphedematous arms of 104 patients (85%). The median number of visualized lymphatic collectors was four. The duration of BCRL was weakly but significantly correlated with the number of lymphatic collectors (rs=0.2054, p=0.0226). The differences in the tissue water content and thickness of the subcutis between the bilateral arms demonstrated moderate correlations with the number of collecting lymphatics (rs=0.31 and 0.35, respectively; p<0.01). More lymphatic collectors tended to be seen in more advanced cases. There was no statistical difference in the amount of lymphatic vessels among different breast cancer treatment methods. Conclusions: The number of functional remaining lymphatic collectors increases with the prolongation and severity of BCRL. This may imply persistent reactions of lymphatic collectors in response to lymphostasis. PMID:25495381

  15. Phototherapeutic treatment of lymphedema and other complications after mastectomy

    NASA Astrophysics Data System (ADS)

    Zharov, Vladimir P.; Kalinin, Konstantin L.; Borisov, Andrei A.; Velsher, Leonid Z.; Stakhanov, Mikhail L.; Eskin, Vadim G.; Savin, Alexei A.; Shihkerimov, Raphiz K.

    2000-05-01

    One of the possible consequences of mastectomy is lymphedema of soft tissues of upper extremities on the side of ablated breast as result of cutting and trauma of multiple nerves, lymphatic and blood vessels. This phenomenon is often accompanied by deterioration of blood and lymphatic microcirculation, increasing of stagnation and aggregation ability of thrombocities, limitation of humeral and ulnar joint activity, severe pain and decreasing of myotonus. The developing of new phototherapeutic method based on using of light-emitting diodes (LED) arrays is attempted. This method is just directed on improvement of patient's condition in combination with other traditional methods such as drug therapy, pressure bandaging etc. The main parameters of LED arrays fixed inside cylindrical tube covering pathology region are: wavelength -- 660 nm, intensity range -- 0.5 mW/sm2. To control and study efficiency of phototreatment ultrasonic dopplerography, thermography, electromyography and viscosimetry have been used. During clinical trials in oncology department of Moscow State University of Medicine and Dentistry 128 patients have been treated with following results: patients felt complete disappearance of pain and weightiness sensation in arm, restoration of skin sensitivity and muscle strength. There were statistically proved amelioration of excitation spreading velocity on radial nerve, decreasing of blood viscosity, increasing of blood velocity in main arteries of shoulder and symmetry of temperature distribution.

  16. Microcephaly/lymphedema and terminal deletion of the long arm of chromosome 13

    SciTech Connect

    Fryns, J.P.

    1995-07-03

    Recently, we examined a 2-year-old boy with the association of microcephaly and significant pedal edema that extended to the distal parts of the legs. Prometaphase chromosome studies showed a small terminal deletion in the long arm of chromosome 13 of band 13q34, karyotype 46,XY,del(13)(q34{yields}qter). The present finding of a small terminal 13q34 deletion in this young boy with microcephaly/lymphedema is a first indication that the lymphedema/microcephaly association can be due to a small terminal 13q deletion. 2 refs.

  17. Vascularized lymph node transfer and lymphovenous bypass: Novel treatment strategies for symptomatic lymphedema.

    PubMed

    Silva, Amanda K; Chang, David W

    2016-06-01

    Lymphedema is a debilitating disease that is commonly caused by cancer and it is treatments in the developed world. Surgery is an option for refractory disease. Lymphovenous bypass and vascularized lymph node transfer are newer modalities that show great promise. Further work is necessary to determine proper patient selection and ensure minimum donor site morbidity. Liposuction and direct excision still have a role, especially in advanced cases. Further investigations into prevention of iatrogenic lymphedema are underway. J. Surg. Oncol. 2016;113:932-939. © 2016 Wiley Periodicals, Inc. PMID:26846735

  18. Limb Differences in the Therapeutic Effects of Complex Decongestive Therapy on Edema, Quality of Life, and Satisfaction in Lymphedema Patients

    PubMed Central

    Noh, Sujin; Yoon, Tae Hee; Chang, Hyun Ju; Chu, In Ho; Kim, Jung Hyun

    2015-01-01

    Objective To investigate the changing patterns of edema, quality of life (QOL), and patient-satisfaction after complex decongestive therapy (CDT) in three trajectories: arm lymphedema (AL), secondary leg lymphedema (LL) and primary leg lymphedema (PL). Methods Candidates for AL (n=35), LL (n=35) and PL (n=14) were identified from prospective databases. The patients were treated with CDT for 2 weeks, and lymphedema volume was measured before and immediately following the therapy. Patients then self-administered home therapy for 3 months and presented for a follow-up visit. The Korean version of Short Form-36 (SF-36) was used to assess QOL, and we administered a study-specific satisfaction survey. Results There was no significant difference in the volume reductions between the 3 groups. There were no significant differences in all of the measures between PL and LL. Overall initial QOL was significantly lower in patients with LL than in patients with AL. SF-36 scores post-CDT did not differ significantly between AL and LL. Clinically significant differences were noted between AL and LL in the mean values of the satisfaction survey. Conclusion AL, LL, and PL may have different longitudinal courses. We suggest that lower extremity lymphedema patients present more favorable outcomes after CDT with respect to QOL and satisfaction than upper extremity lymphedema patients. Clinicians should approach patients with different therapeutic considerations specific to each type or region of lymphedema before using CDT in clinical practice. PMID:26161340

  19. The Impact of Radiation Therapy on the Risk of Lymphedema After Treatment for Breast Cancer: A Prospective Cohort Study

    SciTech Connect

    Warren, Laura E.G.; Miller, Cynthia L.; Horick, Nora; Skolny, Melissa N.; Jammallo, Lauren S.; Sadek, Betro T.; Shenouda, Mina N.; O'Toole, Jean A.; MacDonald, Shannon M.; Specht, Michelle C.; Taghian, Alphonse G.

    2014-03-01

    Purpose/Objective: Lymphedema after breast cancer treatment can be an irreversible condition with a negative impact on quality of life. The goal of this study was to identify radiation therapy-related risk factors for lymphedema. Methods and Materials: From 2005 to 2012, we prospectively performed arm volume measurements on 1476 breast cancer patients at our institution using a Perometer. Treating each breast individually, 1099 of 1501 patients (73%) received radiation therapy. Arm measurements were performed preoperatively and postoperatively. Lymphedema was defined as ≥10% arm volume increase occurring >3 months postoperatively. Univariate and multivariate Cox proportional hazard models were used to evaluate risk factors for lymphedema. Results: At a median follow-up time of 25.4 months (range, 3.4-82.6 months), the 2-year cumulative incidence of lymphedema was 6.8%. Cumulative incidence by radiation therapy type was as follows: 3.0% no radiation therapy, 3.1% breast or chest wall alone, 21.9% supraclavicular (SC), and 21.1% SC and posterior axillary boost (PAB). On multivariate analysis, the hazard ratio for regional lymph node radiation (RLNR) (SC ± PAB) was 1.7 (P=.025) compared with breast/chest wall radiation alone. There was no difference in lymphedema risk between SC and SC + PAB (P=.96). Other independent risk factors included early postoperative swelling (P<.0001), higher body mass index (P<.0001), greater number of lymph nodes dissected (P=.018), and axillary lymph node dissection (P=.0001). Conclusions: In a large cohort of breast cancer patients prospectively screened for lymphedema, RLNR significantly increased the risk of lymphedema compared with breast/chest wall radiation alone. When considering use of RLNR, clinicians should weigh the potential benefit of RLNR for control of disease against the increased risk of lymphedema.

  20. Excision of Elephantiasis Nostras Verrucosa Lesions in a Patient With Hereditary Lymphedema: Case Report and Review of the Literature.

    PubMed

    Pitcher, Austin A; Pagan, Carlos A; Small, Kevin; Otterburn, David M

    2015-01-01

    Elephantiasis nostras verrucosa (ENV) is a rare cutaneous sequela of chronic lymphedema. Treatment of ENV remains poorly elucidated but has historically involved conservative management aimed at relieving the underlying lymphedema, with a few cases managed by surgical intervention. We report a case of a 27-year-old male with primary lymphedema complicated by large painful ENV lesions on his left foot that we excised surgically with good functional and cosmetic results as validated by the patient. To our knowledge, this is the first report of a case of ENV with a pedunculated morphology and the presence of a deep invasive stalk. PMID:25441846

  1. Antifungal prophylaxis during neutropenia and immunodeficiency.

    PubMed Central

    Lortholary, O; Dupont, B

    1997-01-01

    Fungal infections represent a major source of morbidity and mortality in patients with almost all types of immunodeficiencies. These infections may be nosocomial (aspergillosis) or community acquired (cryptococcosis), or both (candidiasis). Endemic mycoses such as histoplasmosis, coccidioidomycosis, and penicilliosis may infect many immunocompromised hosts in some geographic areas and thereby create major public health problems. With the wide availability of oral azoles, antifungal prophylactic strategies have been extensively developed. However, only a few well-designed studies involving strict criteria have been performed, mostly in patients with hematological malignancies or AIDS. In these situations, the best dose and duration of administration of the antifungal drug often remain to be determined. In high-risk neutropenic or bone marrow transplant patients, fluconazole is effective for the prevention of superficial and/or systemic candidal infections but is not always able to prolong overall survival and potentially selects less susceptible or resistant Candida spp. Primary prophylaxis against aspergillosis remains investigative. At present, no standard general recommendation for primary antifungal prophylaxis can be proposed for AIDS patients or transplant recipients. However, for persistently immunocompromised patients who previously experienced a noncandidal systemic fungal infection, prolonged suppressive antifungal therapy is often indicated to prevent a relapse. Better strategies for controlling immune deficiencies should also help to avoid some potentially life-threatening deep mycoses. When prescribing antifungal prophylaxis, physicians should be aware of the potential emergence of resistant strains, drug-drug interactions, and the cost. Well-designed, randomized, multicenter clinical trials in high-risk immunocompromised hosts are urgently needed to better define how to prevent severe invasive mycoses. PMID:9227863

  2. [Radiation therapy for heterotopic ossification prophylaxis].

    PubMed

    Utzon, Henrik; Skov, Ole; Johansen, Jørgen

    2014-06-01

    Heterotopic ossification (HO) is a well-known condition of bone formation in soft tissues due to trauma (e.g. surgery) or neurological injury, but the exact aetiology is unknown. In most cases, HO is asymptomatic, but it may cause pain, reduced mobility of joints, and loss of functioning. Various patient groups have a significant risk of developing HO after surgery and should be offered prophylactic treatment. Nonsteroidal anti-inflammatory drugs and radiotherapy are internationally accepted treatments. This review discusses the potential for radiotherapy as prophylaxis against HO. PMID:25352198

  3. The prophylaxis of nonindustrial urothelial tumours

    PubMed Central

    Mount, Balfour M.

    1973-01-01

    Present knowledge concerning carcinogenesis and the natural history of urothelial tumours precludes firm conclusions relative to nonindustrial prophylaxis. However, a number of measures are consistent with current data and may be instituted for those patients with a demonstrated propensity to urothelial tumours. Their acceptability is based on the lack of associated toxicity for the patient. These measures include the elimination of significant infection, cigarettes, artificial sweeteners, analgesic abuse and coffee, the administration of vitamins C and B6, and in selected cases, the use of thiotepa. It is emphasized that the merit of these steps in altering the natural history of urothelial tumours is uncertain. PMID:4197537

  4. [Postoperative pulmonary complications: prophylaxis after noncardiac surgery].

    PubMed

    Hofer, S; Plachky, J; Fantl, R; Schmidt, J; Bardenheuer, H J; Weigand, M A

    2006-04-01

    Postoperative pulmonary complications are a major problem after upper abdominal or thoracoabdominal surgery. They lead to a prolonged ICU stay as well as increased costs and are one of the main causes of early postoperative mortality. Even after uncomplicated operations, postoperative hypoxemia occurs in 30-50% of patients. Acute respiratory failure involves a disturbance in gas exchange. The mortality ranges from 10 to 60% according to the severity of respiratory failure. The most important complications are interstitial and alveolar pulmonary edema, atelectasis, postoperative pneumonia, hypoventilation, and aspiration. Preoperative optimization, postoperative prophylaxis according to a stepwise approach, and early mobilization decrease the rate of complications. PMID:16575614

  5. Complexities of Adherence and Post-Cancer Lymphedema Management

    PubMed Central

    Ostby, Pamela L.; Armer, Jane M.

    2015-01-01

    Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL), a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005–2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens. PMID:26580657

  6. Complexities of Adherence and Post-Cancer Lymphedema Management.

    PubMed

    Ostby, Pamela L; Armer, Jane M

    2015-01-01

    Breast cancer survivors are at increased risk for breast cancer-related lymphedema (BCRL), a chronic, debilitating, condition that is progressive and requires lifelong self-management. Up to 40% of 3 million breast cancer survivors in the US will develop BCRL, which has no cure, is irreversible, and requires self-management with regimens that may include multiple components. The complexities of treatment can negatively affect adherence to BCRL self-management which is critical to preventing progressive swelling and infection. The aim of this review of contemporary literature published from 2005-2015 is to examine the complexities of BCRL self-management, to identify adherence-focused studies relevant to BCRL, and to summarize barriers to self-management of BCRL. Six electronic indices were searched from which 120 articles were retrieved; 17 were BCRL-focused; and eight met inclusion criteria. Seventeen of 120 articles identified barriers to self-management of BCRL such as complexities of treatment regimens, symptom burden, balance of time for treatment and life demands, and lack of education and support; however, only eight studies included outcome measures of adherence to BCRL treatment regimens with a subsequent improvement in reduced limb volumes and/or perceptions of self-efficacy and self-regulation. A major limitation is the few number of rigorously developed outcome measures of BCRL adherence. In addition, randomized studies are needed with larger sample sizes to establish adequate levels of evidence for establishing best practice standards for improving adherence to BCRL self-management treatment regimens. PMID:26580657

  7. Breast Cancer–Related Lymphedema after Neoadjuvant Chemotherapy

    PubMed Central

    Kim, Myungsoo; Park, In Hae; Lee, Keun Seok; Ro, Jungsil; Jung, So-Youn; Lee, Seeyoun; Kang, Han-Sung; Lee, Eun Sook; Kim, Tae Hyun; Cho, Kwan Ho; Shin, Kyung Hwan

    2015-01-01

    Purpose The risk for lymphedema (LE) after neoadjuvant chemotherapy (NCT) in breast cancer patients has not been fully understood thus far. This study is conducted to investigate the incidence and time course of LE after NCT. Materials and Methods A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database. Results At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were grade 3. The overall 5-year cumulative incidence of LE was 42%. LE first occurred within 6 months after surgery in 62%; 1 year in 77%; 2 years in 91%; and 3 years in 96%. In a multivariate analysis, age (hazard ratio [HR], 1.66; p < 0.01) and the number of dissected ALNs (HR, 1.68; p < 0.01) were independent risk factors for LE. Patients with both of these risk factors showed a significantly higher 5-year cumulative incidence of LE compared with patients with no or one risk factor (61% and 37%, respectively; p < 0.001). The addition of adjuvant chemotherapy did not significantly correlate with LE. Conclusion LE after NCT, surgery, and SCRT developed early after treatment, and with a high incidence rate. More frequent surveillance of arm swelling may be necessary in patients after NCT, especially during the first few years of follow-up. PMID:25544575

  8. Effects of matrix rhythm therapy on primary lymphedema: a case report

    PubMed Central

    Narin, Ayse Neriman; Alpozgen, Ayse Zengin; Kulli, Hilal Denizoglu

    2016-01-01

    [Purpose] Primary lymphedema occurs because of genetic predisposition and developmental insufficiency of the lymphatic system. Matrix Rhythm Therapy was developed as an external and dynamic method that supplies rhythmic mobilization of the fluids in tissues. The aim of the study was to investigate the effects of Matrix Rhythm Therapy in primary lymphedema. [Subject and Methods] A 36-year-old female with left lower limb lymphedema was evaluated. Leg circumference was measured before and at the end of treatment, and 1 and 3 months later. The circumferences were converted to volumetric values. Twenty sessions of Matrix Rhythm Therapy (5 days/week) were applied to the affected leg, spine, and abdominal regions. Patient satisfaction was assessed with the Global Rating of Change scale. [Results] Volumetric values were 1,573.28 ml before treatment, 1,573.13 ml at the end of treatment, 1,516.70 ml 1 month later, and 1,441.61 ml 3 months later. At the end of treatment, the volumetric reduction was not significant; however, when compared with baseline, measurements at 1 and 3 months decreased by 3.59% and 8.36%, respectively. The Global Rating of Change score was 2. [Conclusion] Matrix Rhythm Therapy could not reduce lymphedema when used alone, but long-term treatment may show positive effects.

  9. Lymphedema After Surgery in Patients With Endometrial Cancer, Cervical Cancer, or Vulvar Cancer

    ClinicalTrials.gov

    2014-12-23

    Lymphedema; Stage IA Cervical Cancer; Stage IA Uterine Corpus Cancer; Stage IA Vulvar Cancer; Stage IB Cervical Cancer; Stage IB Uterine Corpus Cancer; Stage IB Vulvar Cancer; Stage II Uterine Corpus Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVB Vulvar Cancer

  10. Severe cheek and lower eyelid lymphedema after resection of oropharyngeal tumor and radiation.

    PubMed

    Silverman, Adam T; Hoffman, Ryan; Cohen, Mimis; Garza, Rebecca

    2010-03-01

    Facial lymphedema, a rare condition with poorly understood pathogenesis, is commonly associated with previous infection, radiation therapy, local tumor growth, or previous surgery in the head and neck region. Few cases of isolated facial lymphedema have been reported in the literature. Surgical excision has emerged as the mainstay of therapy in such cases, although the long-term efficacy and recurrence rate after excision remain unknown. We present a unique case of a patient with severe unilateral facial lymphedema, which manifested many years after extirpation of a floor-of-the-mouth squamous cell carcinoma, bilateral supraomohyoid neck dissections, and radiation therapy. The massive cheek and eyelid lymphedema, which extended from the patient's left lower eyelid to patient's oral commissure measured 11 x 15 cm with a thickened, brawny, lobulated, and bosselated skin surface. This mass interfered with activities of daily life, caused poor oral intake, and contributed to the patient's severe kyphosis. Because the mass did not clinically or radiologically appear to be malignant, we decided to perform a salvage procedure consisting of wide excision of the massive lymphedematous mass and immediate coverage with a split-thickness skin grafting. Temporary tarsorraphy sutures were also used to provide support to the lower eyelid. The patient tolerated the procedure well, with no complications and with full take of the skin graft. Postoperatively, he was very grateful to be relieved of his debilitating symptoms. PMID:20489462

  11. Adipose veno-lymphatic transfer for management of post-radiation lymphedema

    SciTech Connect

    Pho, R.W.; Bayon, P.; Tan, L.

    1989-01-01

    In a patient who had post-radiation lymphedema after excision of liposarcoma, a method is described that is called adipose veno-lymphatic transfer. The technique involves transferring adipose tissue containing lymphatic vessels that surround the long saphenous vein, from the normal, healthy leg to the irradiated leg, with the creation of an arteriovenous fistula.

  12. Intermittent Pneumatic Compression Enhances Formation of Edema Tissue Fluid Channels in Lymphedema of Lower Limbs

    PubMed Central

    Zaleska, Marzanna; Cakala, Marta; Cwikla, Jaroslaw; Budlewski, Tadeusz

    2015-01-01

    Abstract Background: In lymphedema, tissue fluid steadily accumulates in the subcutaneous space containing loose connective tissue. We documented previously that deformation of the structure of subcutaneous collagen bundles and fat by excess fluid leads to formation of “lakes” and interconnected channels with irregular shape. Since there is no force that could mobilize and propel stagnant fluid to the regions where lymphatics absorb and contract, this task should be taken over by external massage. The most effective in this respect seems to be the sequential intermittent pneumatic compression (IPC). Aim: The aim of the study was to observe whether IPC would enhance and accelerate formation of tissue fluid channels. Methods: Together with the Biocompression Systems (Moonachie, NJ), we designed a high pressure intermittent compression device and used in it our therapy protocol for patients with obstructive lymphedema of lower limbs. The study was carried out on 18 patients with lymphedema stages II–IV. The IPC was applied daily for 1–2 hours. The follow up time was 24–36 months. Lymphoscintigraphy and immunohistopathology of tissue biopsies were used for evaluation of channel formation process. Results: The forced fluid flow brought about increase of the area of fluid channels in the thigh and groin, with a decrease in the calf. Concomitantly, with decrease of channel area in the calf, there was a decrease of calf circumference. No new lymphatic collectors were observed. Conclusions: Compression of limb lymphedema tissues leads to formation of tissue channels as pathways for evacuation of edema fluid. PMID:25748341

  13. Breast Cancer Survivors Coping with Lymphedema: What All Counselors Need to Know

    ERIC Educational Resources Information Center

    Heppner, P. Paul; Tierney, Candece Glauser; Wang, Yu-Wei; Armer, Jane M.; Whitlow, Natalie M.; Reynolds, Alysia

    2009-01-01

    The purpose of this study was to promote greater understanding among counselors and other helping professionals regarding the stressors associated with lymphedema, how women cope with the stressors, and the role of social support. An intensive qualitative study was conducted; data were analyzed using a consensual qualitative research approach. The…

  14. Biomarker and Phenotypic Risk Factors for Breast Cancer Lymphedema | Division of Cancer Prevention

    Cancer.gov

     DESCRIPTION (provided by applicant): Lymphedema (LE) following treatment for breast cancer is the most common form of secondary LE in the industrialized world. It occurs in 20% to 87% of patients following treatment for breast cancer and results in significant disability. At the |

  15. Primary malignant lymphoma arising in postmastectomy lymphedema. Another facet of the Stewart-Treves syndrome.

    PubMed

    d'Amore, E S; Wick, M R; Geisinger, K R; Frizzera, G

    1990-05-01

    In rare cases, primary malignant lymphomas may arise in the soft tissues. Only one previous case has arisen in the context of chronic lymphedema. Because of the clinical appearance of such lesions, which resemble violaceous nodular or plaquelike tumors, they may be confused clinically with lymphedema-associated angiosarcomas occurring after radical mastectomy (Stewart-Treves syndrome). Furthermore, the histologic appearance of some lymphomas and angiosarcomas may also be similar. We studied two women with primary postmastectomy lymphedema-related malignant lymphoma in the soft tissues of the upper arm. These tumors arose 11 and 30 years, respectively, after radical removal of ductal mammary carcinomas. Histologically, one neoplasm mimicked metastatic carcinoma or epithelioid angiosarcoma; whereas the other was initially confused with a variety of pathologic entities, including vasculitis, epithelioid hemangioma, and malignant fibrous histiocytoma. The lymphoid nature of both lesions was confirmed by immunoreactivity for leukocyte common antigen in addition to the B-lymphocyte marker, L26. Conversely, vascular and epithelial determinants were absent. One patient's disease pursued an indolent course; she died of unknown causes but with no evidence of lymphoma at last follow-up. The second patient is currently in remission on chemotherapy. Awareness of the existence of lymphedema-related malignant lymphoma and familiarity with methods used for its distinction from epithelioid vascular sarcomas should prevent unnecessary surgery. PMID:2327551

  16. HIV post exposure prophylaxis induced bicytopenia: a case report

    PubMed Central

    2014-01-01

    Long and short term side effects of antiretroviral drugs are not fully understood yet. Here a case of reversible blood count changes following post exposure prophylaxis with tenofovir/emtricitabin and lopinavir/ritonavir is reported. We propose that antiretroviral drugs used in post exposure prophylaxis may have a significant impact on hematopoiesis. PMID:24506969

  17. Use of Postexposure Prophylaxis After Occupational Exposure to Zaire ebolavirus.

    PubMed

    Wong, Karen K; Davey, Richard T; Hewlett, Angela L; Kraft, Colleen S; Mehta, Aneesh K; Mulligan, Mark J; Beck, Allison; Dorman, William; Kratochvil, Christopher J; Lai, Lilin; Palmore, Tara N; Rogers, Susan; Smith, Philip W; Suffredini, Anthony F; Wolcott, Mark; Ströher, Ute; Uyeki, Timothy M

    2016-08-01

    From September 2014 to April 2015, 6 persons who had occupational exposures to Zaire ebolavirus in West Africa received investigational agent rVSV-ZEBOV or TKM-100802 for postexposure prophylaxis and were monitored in the United States. All patients experienced self-limited symptoms after postexposure prophylaxis; none developed Ebola virus disease. PMID:27118786

  18. Antimicrobial Postexposure Prophylaxis for Anthrax: Adverse Events and Adherence

    PubMed Central

    Soriano-Gabarro, Montse; Zell, Elizabeth R.; Hayslett, James; Lukacs, Susan; Goldstein, Susan; Factor, Stephanie; Jones, Joshua; Ridzon, Renee; Williams, Ian; Rosenstein, Nancy

    2002-01-01

    We collected data during postexposure antimicrobial prophylaxis campaigns and from a prophylaxis program evaluation 60 days after start of antimicrobial prophylaxis involving persons from six U.S. sites where Bacillus anthracis exposures occurred. Adverse events associated with antimicrobial prophylaxis to prevent anthrax were commonly reported, but hospitalizations and serious adverse events as defined by Food and Drug Administration criteria were rare. Overall adherence during 60 days of antimicrobial prophylaxis was poor (44%), ranging from 21% of persons exposed in the Morgan postal facility in New York City to 64% of persons exposed at the Brentwood postal facility in Washington, D.C. Adherence was highest among participants in an investigational new drug protocol to receive additional antibiotics with or without anthrax vaccine—a likely surrogate for anthrax risk perception. Adherence of <60 days was not consistently associated with adverse events. PMID:12396927

  19. Current perspectives on rabies postexposure prophylaxis.

    PubMed

    Blaise, Agathe; Gautret, Philippe

    2015-01-01

    Rabies is a zoonose affecting wild and domestic animals and transmitted to humans through bites or scratches, causing over 60,000 human deaths, annually. The disease results from the transmission of a neurotropic virus leading to invariably deadly encephalitis. The post-exposure prophylaxis consists of careful washing and disinfection of the wound, antibiotherapy and tetanus prophylaxis when needed. Furthermore, rabies vaccine and rabies immunoglobulin [RIG] administration should be applied according to the type of wound, and the animal involved, according to the WHO protocols that are regularly updated. Unfortunately it is sometimes difficult to obtain RIG in some countries due to their high cost, leading to suboptimal treatment and possible death. Also, observance can be weak, due to the number of repeated visits required with protocols [up to five visits over 28 days]. These limitations justify research on new vaccines which were not conclusive at the moment. New RIGs are under development, including a monoclonal antibody cocktail which is more promising in a near future. Finally, vaccination protocols are in the way of being shortened in given conditions. Further studies are needed to validate these new practices. PMID:25809623

  20. Guidelines on prophylaxis to prevent infective endocarditis.

    PubMed

    Thornhill, M H; Dayer, M; Lockhart, P B; McGurk, M; Shanson, D; Prendergast, B; Chambers, J B

    2016-01-22

    Infective endocarditis is a devastating disease with high morbidity and mortality. The link to oral bacteria has been known for many decades and has caused ongoing concern for dentists, patients and cardiologists. Since 2008, the UK has been out of step with the rest of the world where antibiotic prophylaxis is recommended for high-risk patients undergoing invasive dental procedures. Recent evidence that identified an increase in endocarditis incidence prompted a guideline review by NICE and the European Society for Cardiology--which produces guidance for the whole of Europe. Despite reviewing the same evidence they reached completely opposing conclusions. The resulting conflict of opinions and guidance is confusing and poses difficulties for dentists, cardiologists and their patients. Recent changes in the law on consent, however, may provide a patient-centred and pragmatic solution to these problems. This Opinion piece examines the evidence and opposing guidance on antibiotic prophylaxis in the context of the recent changes in the law on consent and provides a framework for how patients at risk of endocarditis might be managed in practice. PMID:26794105

  1. HIV Prevention by Oral Preexposure Prophylaxis

    PubMed Central

    Heneine, Walid; Kashuba, Angela

    2012-01-01

    The impressive advances in antiretroviral (ARV) therapy of chronic human immunodeficiency virus (HIV) infections during the last decade and the availability of potent ARV drugs have fueled interest in using chemoprophylaxis as a novel HIV prevention strategy. Preexposure prophylaxis (PrEP) refers to the use of ARV drugs in HIV-negative persons to prevent HIV infection. The rationale for PrEP builds on the success of ARV prophylaxis in preventing mother-to-child transmission of HIV and on a large body of animal studies that show the efficacy of PrEP against mucosal and parenteral infection. We focus on oral administration of ARV drugs for prevention of HIV infection. Identifying an effective prophylactic pill that individuals can take outside the setting of sexual intercourse precludes the necessity to disclose such use to their partners, thereby empowering those who might not be in a position to negotiate with their partners. Several human clinical trials evaluating the efficacy of daily regimens of the HIV reverse-transcriptase (RT) inhibitors tenofovir disoproxil fumarate (TDF) or Truvada (TDF and emtricitabine [FTC]) are under way among high-risk populations. The results of one trial among men who have sex with men showed that daily Truvada was safe and effective, providing the first support for oral PrEP as a prevention strategy. Here we outline the preclinical and clinical research on oral PrEP, pharmacologic considerations, and future directions and challenges. PMID:22393535

  2. French Oak Wood (Quercus robur) Extract (Robuvit) in Primary Lymphedema: A Supplement, Pilot, Registry Evaluation.

    PubMed

    Belcaro, Gianni; Dugall, Mark; Hu, Shu; Ledda, Andrea; Ippolito, Edmondo

    2015-03-01

    The aim of this pilot supplement study was the evaluation of an oak wood extract (Robuvit, Quercus robur [QR], Horphag Research) in an 8-week registry study on lymphatic signs in primary lymphedema. Subjects with primary lymphedema confined to a single leg without skin changes or ulcerations were followed for at least 8 weeks. Lymphedema was mainly present distally (below the knee). Three groups were formed: one group used only the standard management for lymphedema; one used the same management plus 300 mg Robuvit; and one used the standard management plus 600 mg of Robuvit. The three groups were comparable. After 8 weeks the variation in leg volume was on average -6.2% with standard management, -15% in the QR 300 mg group, and -18.9% in the 600 mg group. The edema score was also significantly lower at 8 weeks in the two QR groups. The variation in proteins in the interstitial fluid in comparison with initial values was -14.8% in controls in comparison with -29.9% in QR 300 mg group and -36.9% in QR 600 mg group. Skin flux significantly improved (increased) in the two QR groups. Ultrasound pretibial skin thickness was decreased on average 6% in controls versus 10.3% in the low-dose QR group and 11.8% in the higher dose group. Perimalleolar thickness was decreased 7% in controls and more in the two QR groups. Ankle circumference was decreased 4.4% in controls and more in the two supplement groups. This pilot registry indicates that Robuvit can be effective in the management of primary lymphedema. More patients and longer evaluation periods are needed. PMID:25780327

  3. French Oak Wood (Quercus robur) Extract (Robuvit) in Primary Lymphedema: A Supplement, Pilot, Registry Evaluation

    PubMed Central

    Belcaro, Gianni; Dugall, Mark; Hu, Shu; Ledda, Andrea; Ippolito, Edmondo

    2014-01-01

    The aim of this pilot supplement study was the evaluation of an oak wood extract (Robuvit, Quercus robur [QR], Horphag Research) in an 8-week registry study on lymphatic signs in primary lymphedema. Subjects with primary lymphedema confined to a single leg without skin changes or ulcerations were followed for at least 8 weeks. Lymphedema was mainly present distally (below the knee). Three groups were formed: one group used only the standard management for lymphedema; one used the same management plus 300 mg Robuvit; and one used the standard management plus 600 mg of Robuvit. The three groups were comparable. After 8 weeks the variation in leg volume was on average −6.2% with standard management, −15% in the QR 300 mg group, and −18.9% in the 600 mg group. The edema score was also significantly lower at 8 weeks in the two QR groups. The variation in proteins in the interstitial fluid in comparison with initial values was −14.8% in controls in comparison with −29.9% in QR 300 mg group and −36.9% in QR 600 mg group. Skin flux significantly improved (increased) in the two QR groups. Ultrasound pretibial skin thickness was decreased on average 6% in controls versus 10.3% in the low-dose QR group and 11.8% in the higher dose group. Perimalleolar thickness was decreased 7% in controls and more in the two QR groups. Ankle circumference was decreased 4.4% in controls and more in the two supplement groups. This pilot registry indicates that Robuvit can be effective in the management of primary lymphedema. More patients and longer evaluation periods are needed. PMID:25780327

  4. Congenital segmental lymphedema in tuberous sclerosis complex with associated subependymal giant cell astrocytomas treated with Mammalian target of rapamycin inhibitors.

    PubMed

    Prato, Giulia; Mancardi, Maria Margherita; Baglietto, Maria Giuseppina; Janis, Sara; Vercellino, Nadia; Rossi, Andrea; Consales, Alessandro; Raso, Alessandro; Garrè, Maria Luisa

    2014-09-01

    Tuberous sclerosis complex is a genetic, multisystemic disorder characterized by circumscribed benign lesions (hamartomas) in several organs, including brain. This is the result of defects in the TSC1 and/or TSC2 tumor suppressor genes, encoding the hamartin-tuberin complex that inhibits the mammalian target of rapamycin pathway. Specific inhibitors of this pathway have been shown to reduce the volume of subependymal giant cell astrocytomas associated with tuberous sclerosis. Congenital lymphedema is rarely seen in association with tuberous sclerosis, with only a few reported cases. Although this association can be coincidental, the dysgenetic lymphatic system can represent a hamartia as a consequence of gene mutation. We describe a child with congenital lymphedema in tuberous sclerosis and associated subependymal giant cell astrocytoma who experienced lymphangitis under treatment with mammalian target of rapamycin inhibitors. Because our patient did not show worsening of lymphedema, congenital lymphedema does not seem to be a contraindication for this therapy. PMID:24056156

  5. Profilometry and subsurface imaging in point of care diagnosis in ocular disease and lymphedema after breast cancer treatment

    NASA Astrophysics Data System (ADS)

    Sayegh, Samir I.; Taghian, Alphonse

    2013-02-01

    Breast cancer-related lymphedema (BCRL) can be irreversible with profound negative impact on patients' quality of life. Programs that provide screening and active surveillance for BCRL are essential to determine whether early detection and intervention influences the course of lymphedema development. Established methods of quantitatively assessing lymphedema at early stages include "volume" methods such as perometry and bioimpedance spectroscopy. Here we demonstrate 1) Use of topographical techniques analogous to those used in corneal topography 2) Development of point-of-care lymphedema detection and characterization based on off-the-shelf hardward 3) The role of subsurface imaging 4) Multimodal diagnostics and integration yielding higher sensitivity/ specificity.

  6. A Pilot Randomized Trial Evaluating Lymphedema Self-Measurement with Bioelectrical Impedance, Self-Care Adherence, and Health Outcomes

    PubMed Central

    Shih, Ya-Chen Tina; Doersam, Jennifer K.; Rhoten, Bethany Andrews; Schultze, Benjamin S.; Dietrich, Mary S.

    2014-01-01

    Abstract Background: Less than half of breast cancer survivors with lymphedema perform self-care as directed. Effective lymphedema self-care is required to obtain acceptable health outcomes. Self-Regulation Theory suggests that objective self-measurement of physiological conditions is necessary to promote self-regulation/self-care. Bioelectric Impedance Spectroscopy (BIS) represents a potential self-measurement method for arm lymphedema. The purpose of this pilot study was to examine the impact of arm self-measurement on daily self-care activities and health outcomes in breast cancer survivors with lymphedema. Methods and Results: A pilot randomized clinical trial compared outcomes between breast cancer survivors with lymphedema who self-monitored for 3 months and breast cancer survivors with lymphedema who did not self-monitor. Data were collected at baseline, months 1, 2, 3, and 4. Eighty-six women with lymphedema were screened: 62 were eligible, 50 were enrolled, 10 withdrew, and 1 had incomplete data, thus N=39. No between group differences were noted in participant characteristics. The self-monitored group had higher days of garment use (p=0.005) that remained stable after self-monitoring stopped. The median number of days of simple manual lymphatic drainage increased in the intervention group (p=0.004) with a downward trend after self-monitoring ceased. Conclusions: Objective self-monitoring of arms using BIS is possible. Self-monitoring may positively impact self-care behaviors. Highly symptomatic patients may require coaching or other psychological support to improve their self-care. Studies that combine a cognitive behavioral therapy component along with self-measurement should be considered as potential interventions to impact lymphedema self-care. Other applications of self-monitoring warrant investigation. PMID:25412401

  7. EFFECTS OF RESISTANCE EXERCISES AND COMPLEX DECONGESTIVE THERAPY ON ARM FUNCTION AND MUSCULAR STRENGTH IN BREAST CANCER RELATED LYMPHEDEMA.

    PubMed

    Do, J H; Kim, W; Cho, Y K; Lee, J; Song, E J; Chun, Y M; Jeon, J Y

    2015-12-01

    The incorporation of resistance exercises into the lifestyle of patients with lymphedema is understudied and an emerging interest. We investigated the effectiveness and results of adding a moderate intensity resistance exercise program for 8 weeks in conjunction with intensive CDT for 1 or 2 weeks (depending on severity) on arm volume, arm function, QOL, and muscular strength in patients with breast cancer-related lymphedema. This prospective, pilot trial included forty-four patients with a history of breast cancer who were beginning complex decongestive therapy for lymphedema. They were assigned to either the intervention (n = 22) or control (n = 22). groups. The intervention comprised of resis- tance band exercises 5 times a week for 8 weeks. These were initially supervised during the intensive lymphedema treatment, but performed independently during the study period. Limb volume, muscular strength, and the European Organization for Research and Treatment of Cancer QOL Questionnaire C30 (EORTC QLQ-C30), EORTC-Breast Cancer-Specific QOL Questionnaire (EORTC QLQ-BR23), and Disabilities of Arm, Shoulder, and Hand (DASH) questionnaires were assessed at baseline and at 8 weeks. After 8 weeks, the intervention group demonstrated statistically significant differences (p < 0.05) in the DASH score and muscular strength compared to the control group. Our results indicate that upper body resistance exercise demonstrates a positive effect on arm function and muscular strength without increasing arm volume in breast cancer related lymphedema during and shortly post intensive CDT lymphedema treatment. PMID:27164764

  8. Physical Activity and Lymphedema (The PAL Trial): Assessing the safety of progressive strength training in breast cancer survivors

    PubMed Central

    Schmitz, Kathryn H.; Troxel, Andrea B.; Cheville, Andrea; Grant, Lorita L.; Bryan, Cathy J.; Gross, Cynthia; Lytle, Leslie A.; Ahmed, Rehana L.

    2009-01-01

    Lymphedema is a chronic and progressive long-term adverse effect of breast cancer treatment commonly defined by swelling of the affected arm. Current clinical guidelines indicate that women with and at risk for lymphedema should protect the affected arm from overuse. In clinical practice, this often translates into risk aversive guidance to avoid using the arm. This could lead to a disuse pattern that may increase the likelihood of injury from common activities of daily living. Further, such guidance poses an additional barrier to staying physically active, potentially translating to weight gain, which has been shown to be associated with worse clinical course for women with lymphedema. We hypothesize that a program of slowly progressive strength training with no upper limit on the amount of weight that may be lifted would gradually increase the physiologic capacity of the arm so that common activities represent a decreasing percentage of maximal capacity. Theoretically, this increased capacity should decrease the risk that daily activities put stress on the lymphatic system of the affected side. The Physical Activity and Lymphedema (PAL) Trial is a recently completed randomized controlled exercise intervention trial that recruited 295 breast cancer survivors (141 with lymphedema at study entry, 154 at risk for lymphedema at study entry). The purpose of this report is to provide detail regarding the study design, statistical design, and protocol of the PAL trial. PMID:19171204

  9. Perioperative Pharmacologic Prophylaxis for Venous Thromboembolism in Colorectal Surgery

    PubMed Central

    Kwon, Steve; Meissner, Mark; Symons, Rebecca; Steele, Scott; Thirlby, Richard; Billingham, Rick; Flum, David

    2011-01-01

    Background To determine the effectiveness of pharmacologic prophylaxis on preventing clinically relevant venothromboembolic (VTE) events and deaths after surgery. Surgical Care Improvement Project recommends that VTE pharmacologic prophylaxis be given within 24 hours of the operation. The bulk of evidence supporting this recommendation uses radiographic endpoints. Study Design The Surgical Care and Outcomes Assessment Program (SCOAP) is a Washington State quality improvement initiative with data linked to hospital admission/discharge and vital status records. We compared the rates of death, clinically relevant VTE and a composite adverse event (CAE) in the 90-days after elective, colon/rectal resections, based on the receipt of pharmacologic prophylaxis (within 24 hours of surgery) at 36 SCOAP hospitals (2005-2009). Results Of 4,195 (61.1±15.6 yrs; 54.1% women) patients, 56.5% received pharmacologic prophylaxis. 90-day death (2.5% vs. 1.6%, p-value=0.03), VTE (1.8% vs. 1.1%, p-value=0.04), and CAE (4.2% vs. 2.5%, p-value=0.002) were lower in those who received pharmacologic prophylaxis. After adjustment for patient and procedure characteristics, the odds were 36% lower for CAE (OR 0.64, 95% CI 0.44-0.93) with pharmacologic prophylaxis. In any given quarter, hospitals where patients more often received pharmacologic prophylaxis (highest tertile of use) had the lowest rates of CAE (2.3% vs. 3.6%, p=0.05) compared to hospitals in the lowest tertile. Conclusions Using clinical endpoints this study demonstrates the effectiveness of VTE pharmacologic prophylaxis in patients having elective colorectal surgery. Hospitals that used pharmacologic prophylaxis more often had the lowest rates of adverse events. PMID:21871823

  10. HIV pre-exposure prophylaxis for women.

    PubMed

    Sheth, Anandi N; Rolle, Charlotte P; Gandhi, Monica

    2016-01-01

    Women and girls comprise nearly half of HIV-infected individuals globally and 20% of new infections in the United States, indicating an urgent need to optimise HIV prevention options in this population. HIV pre-exposure prophylaxis (PrEP) - where antiretrovirals are administered to HIV-non-infected individuals at risk of HIV acquisition - is a promising, female-controlled HIV prevention strategy but has so far been underutilised in women. Clinical trial data demonstrate efficacy of daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for reduction of HIV acquisition among women when used consistently. Limited HIV risk perception and suboptimal PrEP awareness among women and healthcare personnel are among the challenges with PrEP delivery for women. Future research into the development of new drugs and delivery systems, and integrating PrEP delivery with reproductive healthcare services, provide opportunities to optimise this prevention strategy for women. PMID:27482454

  11. [Aerosinusitis: part 1: Fundamentals, pathophysiology and prophylaxis].

    PubMed

    Weber, R; Kühnel, T; Graf, J; Hosemann, W

    2014-01-01

    The relevance of aerosinusitis stems from the high number of flight passengers and the impaired fitness for work of the flight personnel. The frontal sinus is more frequently affected than the maxillary sinus and the condition generally occurs during descent. Sinonasal diseases and anatomic variations leading to obstruction of paranasal sinus ventilation favor the development of aerosinusitis. This Continuing Medical Education (CME) article is based on selective literature searches of the PubMed database (search terms: "aerosinusitis", "barosinusitis", "barotrauma" AND "sinus", "barotrauma" AND "sinusitis", "sinusitis" AND "flying" OR "aviator"). Additionally, currently available monographs and further articles that could be identified based on the publication reviews were also included. Part 1 presents the pathophysiology, symptoms, risk factors, epidemiology and prophylaxis of aerosinusitis. In part 2, diagnosis, conservative and surgical treatment will be discussed. PMID:24337391

  12. Migraine prophylaxis: what is new and what we need?

    PubMed

    Barbanti, P; Aurilia, C; Egeo, G; Fofi, L

    2011-05-01

    A wide array of options are now available for migraine prophylaxis. Conventional treatments include beta-blockers, anticonvulsants, antidepressants, calcium antagonists and antiserotoninergic drugs. Emerging medications such as ACE inhibitors, sartans and nutritional supplements are gaining favour for migraine prophylaxis. Botulinum toxin type A is a promising therapeutic tool for chronic migraine. Tonabersat is likely to be a step forward for the treatment of migraine with aura. However, much work is needed to identify predictive clinical features of successful responsiveness and to better define the duration of prophylaxis. PMID:21533725

  13. [Antibiotic prophylaxis with ++vancomycin in corrective surgery with alloplastic material].

    PubMed

    Massaioli, N; Marchesa, P; Bacino, A; Galliano, R; Borello, G; Bonatti, L; Lorenzini, L

    1995-09-01

    The authors report a controlled series of 40 patients treated for recidivating inguinal hernia and laparocele with the implant of alloplastic material. Short-term prophylaxis with vancomycin was performed in all cases. The antibiotic was found to be well tolerated at the doses used and this was associated with a good clinical success rate. The use of vancomycin in prophylaxis for this type of surgery is considered a rational choice and the use of short-term prophylaxis reduces the risks linked to possible collateral effects. PMID:8587722

  14. Massive localized lymphedema: a clinicopathologic study of 46 patients with an enrichment for multiplicity.

    PubMed

    Kurt, Habibe; Arnold, Christina A; Payne, Jason E; Miller, Michael J; Skoracki, Roman J; Iwenofu, O Hans

    2016-01-01

    Massive localized lymphedema is a monstrous tumefactive pseudosarcoma seen in middle-aged morbidly obese adults. Since its initial description in 1998, the etiology remains unknown, although associations with trauma, surgeries, and hypothyroidism have been reported. Herein, we report the largest study of massive localized lymphedema and expand upon its clinicopathologic features. Fifty-four cases from 46 patients were retrospectively identified from the institutional archives of The Ohio State University Wexner Medical Center between 2002 and 2015. Forty-six patients (21 males and 25 females, mean age 50 years) presented with large masses developing over a 5-60-month period. The majority of patients were Caucasian (n=39). All patients were obese with a mean weight of 384.7 lb and a mean body mass index of 59.6 kg/m(2). Thirty-six patients had a history of atherosclerotic cardiovascular disease and diabetes mellitus type 2 was present in 22 patients. Eight patients had multifocal massive localized lymphedema. The sites included thigh (n=33), abdomen (n=17), suprapubic region (n=1), mons pubis (n=6), scrotum (n=2), perianal region (n=1), and right flank (n=1). Mostly, the clinical impression was benign processes, including pannus or lymphedema pseudotumor. Grossly, the mean weight was 8237 g and the mean size was 53.2 cm. Histologically, eight cases showed a unique pattern of dystrophic calcifications mimicking hyperchromatic, atypical nuclei that might lead to misdiagnosis of liposarcoma, four cases showed focal metaplastic ossification, and three cases showed multinucleated cells in addition to prototypic features of massive localized lymphedema. We report that this is the largest series of massive localized lymphedema. This is a lesion mostly seen in morbidly obese patients and the thigh is the most common site of involvement. We note a marked racial predilection for Caucasians and a tendency towards multiplicity. We suggest that obesity itself and the

  15. Perioperative antibiotic prophylaxis in elective surgeries in Iran

    PubMed Central

    Foroutan, Behzad; Foroutan, Reza

    2014-01-01

    Background: The use of antibiotic prior to surgery is widely accepted. The WHO has recommended the use of ATC/DDD (Anatomical Therapeutic Chemical / Defined Daily Dose) for the analysis of drug utilization. The aims of the present study are 1) to analyze the assessment of prophylactic antibiotic usage prior to surgery, 2) to assess the drug administration based on antibiograms and 3) to compare the results with the national and international standards. Methods: The present study used ATC/DDD, in a retrospective manner. Cefazolin, ceftazidime, gentamicin, ciprofloxacin, metronidazole, vancomycin, imipenem and penicillin G from 21st March to 21st June 2011 were analyzed in a hospital. Out of 516 medical records, 384 patients had received prophylactic antibiotics. Results: In comparison, the orthopaedic ward had used more antibiotics. The results showed that antibiotics were not selected based on the antibiogram antibiotic programs. Patients in the age range of 20-30 years were the most recipients of the antibiotics. Men had received more antibiotic in comparison with women. About 75% (384 out of 516) of patients in the study received antibiotics as prophylaxis. Cefazolin was the most frequently prescribed antibiotic. Conclusion: Our findings showed differences in comparison with national and international studies, but insignificant differences. Data on in-hospital antibiotic usage are varying widely not only due to different antibiotic policies but also due to different methods of mesurement. These differences make the comparison difficult. PMID:25405131

  16. Antifungal Prophylaxis in Pediatric Hematology/Oncology: New Choices & New Data

    PubMed Central

    Dvorak, Christopher C.; Fisher, Brian T.; Sung, Lillian; Steinbach, William J.; Nieder, Michael; Alexander, Sarah; Zaoutis, Theoklis E.

    2012-01-01

    A severe complication of the treatment of pediatric cancers is the development of an invasive fungal infection (IFI). The data to support antifungal prophylaxis in pediatric oncology patients derive primarily from adult patients, and thus the optimal agent to utilize is not clear. Fluconazole has been a standard option, but agents with antimold activity are now available, each with limitations. Pediatric dosing for voriconazole and posaconazole is uncertain and multiple drug interactions exist. The echinocandins are well-tolerated, but only available in intravenous form. Ultimately, studies demonstrating biologic risk factors for the development of IFI may lead to personalized prophylactic strategies. PMID:22102607

  17. A change in the NICE guidelines on antibiotic prophylaxis.

    PubMed

    Thornhill, M H; Dayer, M; Lockhart, P B; McGurk, M; Shanson, D; Prendergast, B; Chambers, J B

    2016-08-12

    Since 2008, NICE clinical guidelines have stated: 'Antibiotic prophylaxis against infective endocarditis is not recommended for people undergoing dental procedures'. This put UK guidance at odds with guidance in the rest of the world, where antibiotic prophylaxis is recommended for patients at high-risk of infective endocarditis undergoing invasive dental procedures. Many dentists also felt this wording prohibited the use of antibiotic prophylaxis, regardless of the wishes of the patient or their personal risk of infective endocarditis and made it difficult for them to use their clinical judgment to deliver individualised care in the best interests of their patients. NICE have now changed this guidance to 'Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.' This article examines the implications of this small but important change. PMID:27514339

  18. The use of preexposure treatments for HIV prophylaxis

    PubMed Central

    Majid, Adrian; Redfield, Robert R; Gilliam, Bruce L

    2012-01-01

    Infection with human immunodeficiency virus remains a global concern with a significant number of incident infections still reported worldwide. The use of prophylaxis prior to exposure to the virus to prevent infection has been a growing area of recent research. Results in nonhuman primates and clinical trials in high-risk patient populations using preexposure prophylaxis have shown promising results in terms of efficacy and safety, especially relating to oral preexposure prophylaxis. The potential use of oral antiretroviral agents traditionally used for human immunodeficiency virus treatment as prophylaxis raises interesting considerations, such as the best agents available for such a role, long-term safety in healthy individuals, and the potential development of resistance to these agents should infection occur. From a public health perspective, the cost-effectiveness of implementing this preventive strategy has not been fully defined at this point in time. PMID:22347807

  19. Screening and Prophylaxis for Varices in Children with Liver Disease.

    PubMed

    Bozic, Molly A; Puri, Kanika; Molleston, Jean P

    2015-07-01

    Esophageal varices in children with portal hypertension are quite common. Bleeding from these varices frequently occurs. Prophylactic measures to prevent such bleeding can be undertaken either before ("primary," prompted by a screening endoscopy) or after ("secondary") an initial variceal bleed. There are no clear pediatric guidelines for primary or secondary prophylaxis of esophageal varices. Adult studies clearly support the use of pharmacologic (beta blockers) and endoscopic (endoscopic band ligation, EBL) management for both primary and secondary prophylaxis of esophageal varices in patients with portal hypertension. Pediatric studies are limited. There are inadequate data to recommend use of beta blockers to prevent variceal bleeding or rebleeding in children with portal hypertension. There is very limited support for EBL for primary prophylaxis in children and more compelling support for EBL for secondary prophylaxis. Further randomized controlled studies are needed but are difficult to implement in this vulnerable population. PMID:26122248

  20. [Current wound care in patients with elephantiasis--third-stage lymphedema].

    PubMed

    Rucigaj, Tanja Planinsek; Slana, Ana; Leskovec, Nada Kecelj

    2012-10-01

    Lymphedema resulting from fluid accumulation due to impairment in the lymphatic system drainage leads to enlargement of the body part involved. If left untreated, in its third stage it results in elephantiasis. Elephantiasis is frequently accompanied by papillomatosis and lymphocutaneous fistulas with lymphorrhoea, erosions and ulcers, frequently with the loss of function in the respective part of the body. Unlike other chronic wounds, wound healing in lymphedema is highly dependent on the use of combined therapies because local treatment with modern supportive dressings and compression therapy with adhesive and non-adhesive short-stretch systems is only part of the complete treatment. This treatment also includes sub-bandage foamy materials, kinesitherapy with tapes (kinesiotaping), intermittent local application of high-pressure oxygen, breathing exercise, and manual lymph drainage and exercises. PMID:23193819

  1. [Filamentous fungal infections in immunosuppressed patients: prophylaxis and treatment].

    PubMed

    Ruiz-Camps, Isabel; Peghin, Maddalena

    2015-09-01

    Although the incidence of invasive aspergillosis has decreased in haematologic patients and solid organ transplant recipients due to the use of prophylaxis; aspergillosis has emerged in other populations undergoing immunosuppressive drugs where prophylaxis is not well defined presenting different clinical patterns. Voriconazole is the gold standard in the treatment of aspergillosis and probably combined therapy, with voriconazole plus anidulafungin, could have a role in the initial management of the infection. PMID:26365733

  2. Manual lymphatic drainage for lymphedema following breast cancer treatment

    PubMed Central

    Ezzo, Jeanette; Manheimer, Eric; McNeely, Margaret L; Howell, Doris M; Weiss, Robert; Johansson, Karin I; Bao, Ting; Bily, Linda; Tuppo, Catherine M; Williams, Anne F; Karadibak, Didem

    2016-01-01

    Background More than one in five patients who undergo treatment for breast cancer will develop breast cancer-related lymphedema (BCRL). BCRL can occur as a result of breast cancer surgery and/or radiation therapy. BCRL can negatively impact comfort, function, and quality of life (QoL). Manual lymphatic drainage (MLD), a type of hands-on therapy, is frequently used for BCRL and often as part of complex decongestive therapy (CDT). CDT is a fourfold conservative treatment which includes MLD, compression therapy (consisting of compression bandages, compression sleeves, or other types of compression garments), skin care, and lymph-reducing exercises (LREs). Phase 1 of CDT is to reduce swelling; Phase 2 is to maintain the reduced swelling. Objectives To assess the efficacy and safety of MLD in treating BCRL. Search methods We searched Medline, EMBASE, CENTRAL, WHO ICTRP (World Health Organization’s International Clinical Trial Registry Platform), and Cochrane Breast Cancer Group’s Specialised Register from root to 24 May 2013. No language restrictions were applied. Selection criteria We included randomized controlled trials (RCTs) or quasi-RCTs of women with BCRL. The intervention was MLD. The primary outcomes were (1) volumetric changes, (2) adverse events. Secondary outcomes were (1) function, (2) subjective sensations, (3) QoL, (4) cost of care. Data collection and analysis We collected data on three volumetric outcomes. (1) LE (lymphedema) volume was defined as the amount of excess fluid left in the arm after treatment, calculated as volume in mL of affected arm post-treatment minus unaffected arm post-treatment. (2) Volume reduction was defined as the amount of fluid reduction in mL from before to after treatment calculated as the pretreatment LE volume of the affected arm minus the post-treatment LE volume of the affected arm. (3) Per cent reduction was defined as the proportion of fluid reduced relative to the baseline excess volume, calculated as volume

  3. Breast Cancer-Related Lymphedema and Resistance Exercise: A Systematic Review.

    PubMed

    Nelson, Nicole L

    2016-09-01

    Nelson, NL. Breast cancer-related lymphedema and resistance exercise: a systematic review. J Strength Cond Res 30(9): 2656-2665, 2016-Breast cancer-related lymphedema (BCRL) is characterized by the accumulation of fluid in the interstitial tissues in the arm, shoulder, neck, or torso and attributed to the damage of lymph nodes during breast cancer treatments involving radiation and axillary node dissection. Resistance exercise training (RET) has recently shown promise in the management of BCRL. The aims of this review were twofold: (a) To summarize the results of recent randomized controlled trials (RCTs) investigating the effect of resistance exercise in those with, or at risk for, BCRL. (b) To determine whether breast cancer survivors can perform RET at sufficient intensities to elicit gains in strength without causing BCRL flare-up or incidence. A search was performed on the electronic databases PubMed, MEDLINE, SPORT Discus, and Science Direct, up to July 10, 2015, using the following keywords: breast cancer-related lymphedema, strength training, resistance training, systematic review, and breast cancer. Manual searches of references were also conducted for additional relevant studies. A total of 6 RCTs, involving 805 breast cancer survivors, met the inclusion criteria and corresponded to the aims of this review. The methodological quality of included RCTs was good, with a mean score 6.8 on the 10-point PEDro scale. The results of this review indicate that breast cancer survivors can perform RET at high-enough intensities to elicit strength gains without triggering changes to lymphedema status. There is strong evidence indicating that RET produces significant gains in muscular strength without provoking BCRL. PMID:26840439

  4. The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema.

    PubMed

    Sun, Fangdi; Skolny, Melissa N; Swaroop, Meyha N; Rawal, Bhupendra; Catalano, Paul J; Brunelle, Cheryl L; Miller, Cynthia L; Taghian, Alphonse G

    2016-06-01

    Breast cancer-related lymphedema (BCRL) is a feared outcome of breast cancer treatment, yet the push for early screening is hampered by a lack of standardized quantification. We sought to determine the necessity of preoperative baseline in accounting for temporal changes of upper extremity volume. 1028 women with unilateral breast cancer were prospectively screened for lymphedema by perometry. Thresholds were defined: relative volume change (RVC) ≥10 % for clinically significant lymphedema and ≥5 % including subclinical lymphedema. The first postoperative measurement (pseudo-baseline) simulated the case of no baseline. McNemar's test and binomial logistic regression models were used to analyze BCRL misdiagnoses. Preoperatively, 28.3 and 2.9 % of patients had arm asymmetry of ≥5 and 10 %, respectively. Without baseline, 41.6 % of patients were underdiagnosed and 40.1 % overdiagnosed at RVC ≥ 5 %, increasing to 50.0 and 54.8 % at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, increased weight change between baselines, hormonal therapy, dominant use of contralateral arm, and not receiving axillary lymph node dissection (ALND) were associated with increased risk of underdiagnosis at RVC ≥ 5 %; not receiving regional lymph node radiation was significant at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, not receiving ALND, and dominant use of ipsilateral arm were associated with overdiagnosis at RVC ≥ 5 %; increased pseudo-baseline asymmetry and not receiving ALND were significant at RVC ≥ 10 %. The use of a postoperative proxy even early after treatment results in poor sensitivity for identifying BCRL. Providers with access to patients before surgery should consider the consequent need for proper baseline, with specific strategy tailored by institution. PMID:27154787

  5. Axillary evaluation and lymphedema in women with ductal carcinoma in situ.

    PubMed

    Coromilas, Ellie J; Wright, Jason D; Huang, Yongmei; Feldman, Sheldon; Neugut, Alfred I; Hillyer, Grace Clarke; Chen, Ling; Hershman, Dawn L

    2016-07-01

    Axillary evaluation in women with ductal carcinoma in situ (DCIS) is increasing; however, this may introduce additional morbidity with unclear benefit. Our objective was to examine the morbidity and mortality associated with axillary evaluation in DCIS. We conducted a retrospective cohort study of 10,504 women aged 65-90 years with DCIS who underwent breast conserving surgery between 2002 and 2012 using SEER-Medicare database. Patients were categorized by receipt of axillary evaluation with either sentinel lymph node biopsy (SLNB) or axillary node dissection (ALND). We determined the incidence of lymphedema treatment as defined by diagnostic and procedural codes, as well as 10-year breast cancer-specific and all-cause mortality. 18.3 % of those treated with BCS and 69.4 % of those treated with mastectomy had an axillary evaluation. One year after treatment, 8.2 % of women who had an axillary evaluation developed lymphedema, compared to 5.9 % of those who did not. In a multivariable Cox proportional hazard model, the incidence of lymphedema was higher among those who underwent axillary evaluation (HR 1.22, 95 % CI 1.04-1.45). Overall 10-year breast cancer-specific survival was similar between both groups (HR 0.83, 95 % CI 0.40-1.74). Only 44 (0.40 %) women died of breast cancer; receipt of axillary evaluation did not alter overall survival. Axillary evaluation is commonly performed in women with DCIS, especially those undergoing mastectomy. However, women who receive an axillary evaluation have higher rates of lymphedema, without breast cancer-specific or overall survival benefit. Efforts should be made to determine the population of women with DCIS who benefit from this procedure. PMID:27365080

  6. Lymphedema Prevalence and Treatment Benefits in Cancer: Impact of a Therapeutic Intervention on Health Outcomes and Costs

    PubMed Central

    Brayton, Kimberly M.; Hirsch, Alan T.; O′Brien, Patricia J.; Cheville, Andrea; Karaca-Mandic, Pinar; Rockson, Stanley G.

    2014-01-01

    Background Lymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. The objective of this study was to examine lymphedema prevalence among cancer survivors and to characterize changes in clinical outcomes and costs associated with a defined therapeutic intervention (use of a pneumatic compression devices [PCD]) in a representative, privately insured population. Methods and Findings Retrospective analysis of de-identified health claims data from a large national insurer for calendar years 2007 through 2013. Patients were required to have 12 months of continuous insurance coverage prior to PCD receipt (baseline), as well as a 12-month follow-up period. Analyses were performed for individuals with cancer-related lymphedema (n = 1,065). Lymphedema prevalence was calculated: number of patients with a lymphedema claim in a calendar year divided by total number of enrollees. The impact of PCD use was evaluated by comparing rates of a pre-specified set of health outcomes and costs for the 12 months before and after, respectively, PCD receipt. Lymphedema prevalence among cancer survivors increased from 0.95% in 2007 to 1.24% in 2013. PCD use was associated with decreases in rates of hospitalizations (45% to 32%, p<0.0001), outpatient hospital visits (95% to 90%, p<0.0001), cellulitis diagnoses (28% to 22%, p = 0.003), and physical therapy use (50% to 41%, p<0.0001). The average baseline health care costs were high ($53,422) but decreased in the year after PCD acquisition (−$11,833, p<0.0001). Conclusions Lymphedema is a prevalent medical condition that is often a defining attribute of cancer survivorship. The problem is associated with high health care costs; Treatment (in this instance, use of PCD) is associated with significant decreases in adverse clinical outcomes and costs. PMID:25470383

  7. Surveillance recommendations in reducing risk of and optimally managing breast cancer-related lymphedema.

    PubMed

    Ostby, Pamela L; Armer, Jane M; Dale, Paul S; Van Loo, Margaret J; Wilbanks, Cassie L; Stewart, Bob R

    2014-01-01

    Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL), a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes. Ongoing surveillance, beginning with pre-operative assessment, has been effective in identifying subclinical lymphedema (LE). A prospective model for surveillance is necessary in order to detect BCRL at an early stage when there is the best chance to reduce risk or slow progression. Physical methods for monitoring and assessment, such as circumferential arm measures, perometry, bioimpedance; exercise programs; prophylactic and early-intervention compression garments; and referral for complete decongestive therapy are all interventions to consider in the development of a BCRL surveillance program. In addition, supportive-educative programs and interactive engagement for symptom self-management should also be implemented. The importance of interdisciplinary collaboration is integral to the success of an effective personalized medicine program in breast cancer-related lymphedema surveillance. PMID:25563360

  8. Surveillance Recommendations in Reducing Risk of and Optimally Managing Breast Cancer-Related Lymphedema

    PubMed Central

    Ostby, Pamela L.; Armer, Jane M.; Dale, Paul S.; Van Loo, Margaret J.; Wilbanks, Cassie L.; Stewart, Bob R.

    2014-01-01

    Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL), a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes. Ongoing surveillance, beginning with pre-operative assessment, has been effective in identifying subclinical lymphedema (LE). A prospective model for surveillance is necessary in order to detect BCRL at an early stage when there is the best chance to reduce risk or slow progression. Physical methods for monitoring and assessment, such as circumferential arm measures, perometry, bioimpedance; exercise programs; prophylactic and early-intervention compression garments; and referral for complete decongestive therapy are all interventions to consider in the development of a BCRL surveillance program. In addition, supportive-educative programs and interactive engagement for symptom self-management should also be implemented. The importance of interdisciplinary collaboration is integral to the success of an effective personalized medicine program in breast cancer-related lymphedema surveillance. PMID:25563360

  9. Immediate Changes to Skin and Subcutaneous Tissue Strains Following Manual Lymph Drainage in Legs with Lymphedema

    PubMed Central

    Kakutani, Hiromi; Nakamura, Kaori; Morikage, Noriyasu; Yamashita, Osamu; Harada, Takasuke; Ueda, Koshiro; Samura, Makoto; Tanaka, Yuya; Takeuchi, Yuriko; Hamano, Kimikazu

    2016-01-01

    Objectives: To study the immediate impact of manual lymph drainage (MLD) on skin and subcutaneous tissue strains in legs with lymphedema using free-hand real-time tissue elastography (RTE). Methods: Skin and subcutaneous tissue strain measurements were taken at the middle of the inner thigh and calf by RTE in 20 legs with lymphedema of 18 patients (stage II: 11, late stage II: 7, stage III: 2) and in 70 legs of 35 normal subjects. In patients with lymphedema, the same measurements were repeated immediately following MLD. Results: Significant negative correlations were found between pre-MLD strains and the MLD-induced changes in thigh and calf skin strains (thigh skin: p <0.01, calf skin: p = 0.05), but not in subcutaneous tissue strains. Pre-MLD intercepts of these regression lines were closer to normal values as compared to mean pre-MLD values (normal thigh skin: 0.54% ± 0.30%, calf skin: 0.25% ± 0.18%, Pre-MLD thigh skin: 0.39% ± 0.20%, calf skin: 0.17% ± 0.12%, Pre-MLD intercept of thigh skin: 0.48%, Pre-MLD intercept of calf skin: 0.31%). Conclusions: It appears that MLD did not simply soften the skin, but rather normalized it in terms of strain. However, this was not confirmed in the subcutaneous tissue. PMID:27087870

  10. Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment.

    PubMed

    Lawenda, Brian D; Mondry, Tammy E; Johnstone, Peter A S

    2009-01-01

    The primary goals of oncologic therapy are the compassionate care of cancer patients, eradication of disease, and palliation of symptoms. Advances in various targeted therapies such as highly conformal and image-guided radiotherapy techniques, sentinel lymph node dissection, and molecularly targeted agents hold the promise of allowing those goals to be reached with fewer treatment-related complications. Unfortunately, certain side effects remain problematic due to the inability to completely avoid injuring normal tissues. Lymphedema, a chronic condition that occurs as a result of the body's inability to drain lymph fluid from the tissues, is a common treatment-related side effect experienced by cancer patients. In this review, many of the important aspects of lymphedema with which clinicians who treat cancer patients should be familiar are outlined, including the anatomy, pathophysiology, diagnosis, and management of this condition. The authors also identify some of the resources available both to cancer patients with lymphedema and to the clinicians who treat them. It is hoped that this review will convey the importance of the early identification and management of this incurable disorder because this is essential to minimizing its complications. PMID:19147865

  11. Aligned nanofibrillar collagen scaffolds - Guiding lymphangiogenesis for treatment of acquired lymphedema.

    PubMed

    Hadamitzky, Catarina; Zaitseva, Tatiana S; Bazalova-Carter, Magdalena; Paukshto, Michael V; Hou, Luqia; Strassberg, Zachary; Ferguson, James; Matsuura, Yuka; Dash, Rajesh; Yang, Phillip C; Kretchetov, Shura; Vogt, Peter M; Rockson, Stanley G; Cooke, John P; Huang, Ngan F

    2016-09-01

    Secondary lymphedema is a common disorder associated with acquired functional impairment of the lymphatic system. The goal of this study was to evaluate the therapeutic efficacy of aligned nanofibrillar collagen scaffolds (BioBridge) positioned across the area of lymphatic obstruction in guiding lymphatic regeneration. In a porcine model of acquired lymphedema, animals were treated with BioBridge scaffolds, alone or in conjunction with autologous lymph node transfer as a source of endogenous lymphatic growth factor. They were compared with a surgical control group and a second control group in which the implanted BioBridge was supplemented with exogenous vascular endothelial growth factor-C (VEGF-C). Three months after implantation, immunofluorescence staining of lymphatic vessels demonstrated a significant increase in lymphatic collectors within close proximity to the scaffolds. To quantify the functional impact of scaffold implantation, bioimpedance was used as an early indicator of extracellular fluid accumulation. In comparison to the levels prior to implantation, the bioimpedance ratio was significantly improved only in the experimental BioBridge recipients with or without lymph node transfer, suggesting restoration of functional lymphatic drainage. These results further correlated with quantifiable lymphatic collectors, as visualized by contrast-enhanced computed tomography. They demonstrate the therapeutic potential of BioBridge scaffolds in secondary lymphedema. PMID:27348849

  12. Lymphedema in Klippel-Trenaunay Syndrome: Is It Possible to Normalize?

    PubMed Central

    Río, Angela; Domingo Garcia, Paloma; de Fatima Guerreiro Godoy, Maria

    2016-01-01

    The aim of this study is to report the results of intensive therapy of lymphedema associated with Klippel-Trenaunay syndrome. A 24-year-old female patient reported that her family had observed edema in her right leg and port wine stains from birth. For ten years, they consulted with different specialists in the region but the prognosis did not change and no specific treatment was found. In 2014, at the age of 24, with massive lymphedema, a leg ulcer, and recurrent infections, she started treatment at the Clínica Godoy in São José do Rio Preto. She was evaluated by clinical history, physical examination, water displacement volumetry, and bioimpedance. Intensive therapy (8 hours daily) was proposed using Manual Lymphatic Therapy (Godoy & Godoy), Cervical Stimulation Therapy, Mechanical Lymphatic Therapy, a grosgrain stocking adjusted several times a day, and the use of Unna boot in the region of the ulcer. The volume of edema was reduced by about 44% within the first week with further reductions in the following weeks and healing of the ulcer. Subsequently, it was possible to control and maintain the reduction in swelling with less intense treatment. It is possible to reduce and maintain the treatment results of lymphedema associated with Klippel-Trenaunay syndrome. PMID:27529050

  13. Massive localized lymphedema of the male external genitalia: a clinicopathologic study of 6 cases.

    PubMed

    Lee, Stephen; Han, Jeong S; Ross, Hillary M; Epstein, Jonathan I

    2013-02-01

    Massive localized lymphedema is a reactive pseudotumor strongly associated with obesity. The tumor most commonly presents as pendulous masses in the lower limbs with only 3 reported cases involving external male genitalia. In this study, we report an additional 6 cases localized to the external male genitalia. The cases were retrospectively identified from the surgical pathology database of the Johns Hopkins Hospital. All 6 patients were obese (5 presented with diffuse scrotal edema and 1 with a penile mass). In all cases, the clinical impression was of a benign chronic process developing over 3 months to 1 year. All 3 cases from outside institutions were referred with benign pathologic diagnoses. The lesions ranged in size from 4 to 55 cm. Microscopically, all cases exhibited stromal fibrosis and edema, multinucleated stromal cells, perivascular chronic inflammation, and lymphangiectasia. Entrapped fat was a minor feature and seen in only 3 cases. Variable hyperplasia and hypertrophy of dartos muscle were noted in 6 lesions. Three cases showed prominent microvascular proliferation around the edge of individual dartos muscle bundles. In summary, diagnosis of massive localized lymphedema requires appropriate correlation between clinical and microscopic findings. Lesions in the male external genitalia share many microscopic findings with massive localized lymphedema at other sites, although entrapped adipose tissue is not prominent. Additional, although not specific, findings include variably hyperplastic and hypertrophic dartos muscle and capillary neoangiogenesis at the interface between smooth muscle bundles and stroma. PMID:22995331

  14. Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema.

    PubMed

    Buragadda, Syamala; Alhusaini, Adel A; Melam, Ganeswara Rao; Arora, Nisha

    2015-09-01

    [Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema. PMID:26504284

  15. Evaluation of kinesthetic sense and hand function in women with breast cancer-related lymphedema

    PubMed Central

    Karadibak, Didem; Yavuzsen, Tugba

    2015-01-01

    [Purpose] This study evaluated the functional ability and kinesthetic sense of the hands of women with breast cancer-related lymphedema. [Subjects and Methods] Fifty-seven women experiencing lymphedema after breast surgery and adjuvant radiotherapy were included. The patients were divided into two groups: women with hand edema (HE+, n = 29) and without hand edema (HE−, n = 28) after breast cancer treatment. Arm edema severity, hand size, functional mobility and kinesthetic sense of the hand, and daily living skills were evaluated. [Results] The mean age of the patients was 55.8 years. In both groups, functional mobility, kinesthetic sense, and daily living skills decreased significantly with increasing edema severity. However, there was no significant difference between groups with respect to functional mobility or daily living skills. The kinesthetic sense of the hand was better in the HE− group than the HE+ group. There was a significant negative relationship between the severity of edema and hand function. [Conclusion] Breast cancer-related lymphedema can negatively impact women’s functional mobility and kinesthetic sense of the hands as well as daily living skills. PMID:26180295

  16. Mapping of primary congenital lymphedema to the 5q35.3 region.

    PubMed Central

    Evans, A L; Brice, G; Sotirova, V; Mortimer, P; Beninson, J; Burnand, K; Rosbotham, J; Child, A; Sarfarazi, M

    1999-01-01

    Primary lymphedema is a chronic tissue swelling, most frequently of the lower limbs, resulting from deficient lymphatic drainage. The variability of the affected phenotype, incomplete penetrance, lack of large families, and possible genetic heterogeneity have hampered the identification of causative genes until now. We carried out a genomewide search, using a four-generation North American family with dominantly inherited primary congenital lymphedema (PCL), otherwise known as "Milroy disease," or "hereditary lymphedema type I" (MIM 153100). Linkage to markers from the 5q35.3 region in this and four additional, British families was established. A minimum of 79 directly scorable haplotypes (37 affected) in five families conspicuously segregated with the most telomeric region of 5q35.3, thus suggesting a major locus for PCL in this vicinity. No recombination was observed with D5S408 (Z = 10.03) and D5S2006 (Z = 8.46) with a combined multipoint score of 16.55. While D5S2073 and WIAF-2213 defined the upper centromeric boundary, no recombinants were obtained for the last telomeric marker of D5S2006. Four unaffected subjects were identified as gene carriers and provided an estimated penetrance ratio of.84 for this condition. A few of the positionally mapped genes in the 5q35 region that may potentially be involved in the etiology of this condition are CANX, FGFR4, HK3, and hnRPH1. PMID:9973292

  17. Quality of life following liposuction and conservative treatment of arm lymphedema.

    PubMed

    Brorson, H; Ohlin, K; Olsson, G; Långström, G; Wiklund, I; Svensson, H

    2006-03-01

    Arm lymphedema can produce an additional burden from a psychosocial point of view. Although edema reduction through treatment can be an advantage in terms of reduced weight of the arm and simplified clothing needs, the purpose of the present study was to register changes in psychosocial parameters during one year after treatment. Thirty-five patients underwent liposuction combined with postoperative CCT (Controlled Compression Therapy), while 14 received CCT alone. Edema volume and range of motion in the shoulder joint were measured and effects on quality of life were assessed with various questionnaires. Liposuction+CCT removed the arm lymphedema completely, whereas CCT alone reduced it by half. The treatments improved range of motion in the shoulder joint and patients' quality of life in relationship to the volume reduction. Liposuction+CCT improves patients' quality of life, particularly qualities related to the volume reduction and hence qualities associated with everyday activities. CCT is beneficial too, but the effect is less obvious than when combined with surgery, probably because the edema reduction is less. The consequences of arm lymphedema for more psychologically oriented qualities and social life in general seem to be less serious and we found few notable effects of treatment in these domains. PMID:16724506

  18. Effect of complete decongestive therapy and a home program for patients with post mastectomy lymphedema

    PubMed Central

    Buragadda, Syamala; Alhusaini, Adel A; Melam, Ganeswara Rao; Arora, Nisha

    2015-01-01

    [Purpose] Post mastectomy lymphedema is common among breast cancer survivors. It leads to physical discomfort and functional impairment. Rehabilitation forms the mainstay of treatment and is multidisciplinary. [Subjects and Methods] Sixty post mastectomy patients were allocated randomly and assigned to either a conventional treatment group (n=30) or a complete decongestive therapy (CDT) group (n=30). The conventional treatment group received manual lymphatic drainage, wore a low elastic compression garment, received glenohumeral mobilization, and performed deep breathing exercises, and the complete decongestive therapy group received CDT from a trained physiotherapist and a daily home program along with the conventional treatment, 5 days a week for 6 weeks. [Results] Arm circumference measurements were taken at five levels: the wrist, mid forearm, elbow, mid-upper arm, and axilla. The upper extremity function was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and pain was assessed using the visual analogue scale. Measurements were taken at baseline, and at 4th and 6th weeks after the start of intervention. Within and between group comparisons showed significant improvements in the CDT group. [Conclusion] Complete decongestive therapy and a home program assists breast cancer related lymphedema survivors in regaining their lost functions. It also helps to improve their independence in daily activities, reduce their need for caregivers, and thereby improving their quality of life. Therefore, the results of this study showed that the CDT with a home program is an effective treatment for reducing post mastectomy lymphedema. PMID:26504284

  19. HIV Post-Exposure Prophylaxis for Child Rape Survivors in KwaZulu-Natal, South Africa: Who Qualifies and Who Complies?

    ERIC Educational Resources Information Center

    Collings, Steven J.; Bugwandeen, Shikaar R.; Wiles, Wendy A.

    2008-01-01

    Objective: Our objective was to audit the provision and utilization of HIV post-exposure prophylaxis (PEP) to child rape survivors in the Province of KwaZulu-Natal, South Africa. Methods: A prospective design was used to collect data from a convenience sample of 200 consecutive cases of child rape referred for medico-legal assessment to a state…

  20. Update on the prophylaxis of migraine.

    PubMed

    Schürks, Markus; Diener, Hans-Christoph; Goadsby, Peter

    2008-01-01

    Migraine prophylaxis is a stepwise procedure with lifestyle advice followed by consideration of medications. Patients should be advised to try to maintain a regular lifestyle, with regular sleep, meals, exercise, and management of stress, perhaps through relaxation techniques or other ways that are sensible for them. If this regimen does not adequately control their migraines, preventatives are indicated. Patients can choose between evidence-based nutraceuticals such as riboflavin, feverfew, butterbur, or coenzyme Q10, or more traditional pharmacotherapeutics. Medicine choices are somewhat limited by what is available in each country, but from the full range, the medicines of first choice are beta-adrenoceptor blockers, flunarizine, topiramate, and valproic acid. Beta-adrenoceptor blockers are particularly useful in patients also suffering from hypertension or tachycardia. Following recent studies, topiramate has become a first choice for episodic as well as chronic migraine. It is the only prophylactic drug that may lead to weight loss, but it is sometimes associated with adverse cognitive effects. Valproic acid and flunarizine also have very good prophylactic properties. However, valproic acid is often associated with adverse effects, and flunarizine is unavailable in many countries, including the United States. If sequential monotherapies are ineffective, combinations of first-line drugs should be tried before advancing to drugs of second choice, which are associated with more adverse effects or have less well-established prophylactic properties. Amitriptyline should be used carefully because of its anticholinergic effects, although it is useful in comorbid tension-type headache, depression, and sleep disorders. Methysergide is very effective, but it has been supplanted or even made unavailable in many countries because of its well-described association with retroperitoneal fibrosis. Pizotifen has a slightly better safety profile but is unavailable in the United

  1. "You're naked, you're vulnerable": Sexual well-being and body image of women with lower limb lymphedema.

    PubMed

    Winch, Caleb J; Sherman, Kerry A; Smith, Katriona M; Koelmeyer, Louise A; Mackie, Helen; Boyages, John

    2016-09-01

    Lower-limb lymphedema is an incurable illness manifesting as visible swelling enlarging the leg(s) and/or feet, buttocks, and genitals. This study used semi-structured interviews and thematic analysis to explore sexual well-being among women with primary (congenital) lymphedema (n=11) or secondary lymphedema associated with gynecological cancer (n=8). Five themes (subthemes) summarized women's responses, with Attractiveness and Confidence (Publicly Unattractive, Privately Unconfident, Lymphedema or Aging?) describing women's central concern. These body image-related concerns accounted for sexual well-being in association with Partner Support (Availability of Support, Languages of Support, Fears About Support) and the degree of Functional Interruptions (Lymphedema in Context, Enduring Impacts, Overcoming Interruptions). Successful Lymphedema Coping (Control, Acceptance) and self-perceived ability to fulfill a valued Sexual Role also affected sexual well-being. Few differences between women with primary versus secondary lymphedema were evident. Lymphedema clinicians should screen for sexual concerns and have referral options available. PMID:27434105

  2. The Long-term Risk of Upper-extremity Lymphedema is Two-fold Higher in Breast Cancer Patients than in Melanoma Patients

    PubMed Central

    Voss, Rachel K.; Cromwell, Kate D.; Chiang, Yi-Ju; Armer, Jane M.; Ross, Merrick I.; Lee, Jeffrey E.; Gershenwald, Jeffrey E.; Stewart, Bob R.; Shaitelman, Simona F.; Cormier, Janice N.

    2015-01-01

    Background and Objectives We assessed the cumulative incidence, symptoms, and risk factors for upper-extremity lymphedema in breast cancer and melanoma patients undergoing sentinel lymph node biopsy or axillary lymph node dissection. Methods Patients were recruited preoperatively (time 0) and assessed at 6, 12, and 18 months postoperatively. Limb volume change (LVC) was measured by perometry. Lymphedema was categorized as none, mild (LVC 5–9.9%), or moderate/severe (LVC≥10%). Symptoms were assessed with a validated lymphedema instrument. Longitudinal logistic regression analyses were conducted to identify risk factors associated with moderate/severe lymphedema. Results Among 205 breast cancer and 144 melanoma patients, the cumulative incidence of moderate/severe lymphedema at 18 months was 36.5% and 35.0, respectively. However, in adjusted analyses, factors associated with moderate/severe lymphedema were breast cancer (OR 2.0, p=0.03), body mass index ≥30 kg/m2 (OR 1.6, p=0.04), greater number of lymph nodes removed (OR 1.05, p<0.01), and longer interval since surgery (OR 2.33 at 18 months, p<0.01). Conclusions: Lymphedema incidence increased over time in both cohorts. However, the adjusted risk of moderate/severe lymphedema was two-fold higher in breast cancer patients. These results may be attributed to surgical treatment of the primary tumor in the breast and more frequent use of radiation. PMID:26477877

  3. Peripartum Primary Prophylaxis Inferior Vena Cava Filter Placement in a Patient with Stage IV B-Cell Lymphoma Presenting with a Pathologic Femur Fracture

    PubMed Central

    Sherer, David M.; Dalloul, Mudar; Behar, Henry James; Salame, Ghadir; Holland, Roy; Zinn, Harry; Abulafia, Ovadia

    2015-01-01

    Background Pulmonary embolus (PE) remains a leading etiology of maternal mortality in the developed world. Increasing utilization of retrievable inferior vena cava (IVC) filter placement currently includes pregnant patients. Case A 22-year-old woman at 27 weeks' gestation was diagnosed with Stage IV high-grade malignant B cell lymphoma following pathologic femur fracture. Significant risk factors for PE led to placement of primary prophylaxis IVC filter before cesarean delivery, open reduction and internal fixation of the fractured femur, and chemotherapy. Conclusion This case supports that primary prophylaxis placement of IVC filters in highly selected pregnant patients may assist in decreasing PE-associated maternal mortality. PMID:26495170

  4. The Health Deviation of Post-Breast Cancer Lymphedema: Symptom Assessment and Impact on Self-Care Agency.

    PubMed

    Armer, Jane M; Henggeler, Mary H; Brooks, Constance W; Zagar, Eris A; Homan, Sherri; Stewart, Bob R

    2008-01-01

    Breast cancer is the leading cancer among women world-wide, affecting 1 of 8 women during their lifetimes. In the US alone, some 2 million breast cancer survivors comprise 20% of all cancer survivors. Conservatively, it is estimated that some 20-40% of all breast cancer survivors will develop the health deviation of lymphedema or treatment-related limb swelling over their lifetimes. This chronic accumulation of protein-rich fluid predisposes to infection, leads to difficulties in fitting clothing and carrying out activities of daily living, and impacts self-esteem, self-concept, and quality of life. Lymphedema is associated with self-care deficits (SCD) and negatively impacts self-care agency (SCA) and physiological and psychosocial well-being. Objectives of this report are two-fold: (1) to explore four approaches of assessing and diagnosing breast cancer lymphedema, including self-report of symptoms and the impact of health deviations on SCA; and (2) to propose the development of a clinical research program for lymphedema based on the concepts of Self-Care Deficit Nursing Theory (SCDNT). Anthropometric and symptom data from a National-Institutes-of-Health-funded prospective longitudinal study were examined using survival analysis to compare four definitions of lymphedema over 24 months post-breast cancer surgery among 140 of 300 participants (all who had passed the 24-month measurement). The four definitions included differences of 200 ml, 10% volume, and 2 cm circumference between pre-op baseline and/or contralateral limbs, and symptom self-report of limb heaviness and swelling. Symptoms, SCA, and SCD were assessed by interviews using a validated tool. Estimates of lymphedema occurrence varied by definition and time since surgery. The 2 cm girth change provided the highest estimation of lymphedema (82% at 24 months), followed by 200 ml volume change (57% at 24 months). The 10% limb volume change converged with symptom report of heaviness and swelling at 24 months

  5. The Health Deviation of Post-Breast Cancer Lymphedema: Symptom Assessment and Impact on Self-Care Agency

    PubMed Central

    Armer, Jane M.; Henggeler, Mary H; Brooks, Constance W.; Zagar, Eris A.; Homan, Sherri; Stewart, Bob R.

    2010-01-01

    Breast cancer is the leading cancer among women world-wide, affecting 1 of 8 women during their lifetimes. In the US alone, some 2 million breast cancer survivors comprise 20% of all cancer survivors. Conservatively, it is estimated that some 20-40% of all breast cancer survivors will develop the health deviation of lymphedema or treatment-related limb swelling over their lifetimes. This chronic accumulation of protein-rich fluid predisposes to infection, leads to difficulties in fitting clothing and carrying out activities of daily living, and impacts self-esteem, self-concept, and quality of life. Lymphedema is associated with self-care deficits (SCD) and negatively impacts self-care agency (SCA) and physiological and psychosocial well-being. Objectives of this report are two-fold: (1) to explore four approaches of assessing and diagnosing breast cancer lymphedema, including self-report of symptoms and the impact of health deviations on SCA; and (2) to propose the development of a clinical research program for lymphedema based on the concepts of Self-Care Deficit Nursing Theory (SCDNT). Anthropometric and symptom data from a National-Institutes-of-Health-funded prospective longitudinal study were examined using survival analysis to compare four definitions of lymphedema over 24 months post-breast cancer surgery among 140 of 300 participants (all who had passed the 24-month measurement). The four definitions included differences of 200 ml, 10% volume, and 2 cm circumference between pre-op baseline and/or contralateral limbs, and symptom self-report of limb heaviness and swelling. Symptoms, SCA, and SCD were assessed by interviews using a validated tool. Estimates of lymphedema occurrence varied by definition and time since surgery. The 2 cm girth change provided the highest estimation of lymphedema (82% at 24 months), followed by 200 ml volume change (57% at 24 months). The 10% limb volume change converged with symptom report of heaviness and swelling at 24 months

  6. Anthrax prophylaxis: recent advances and future directions.

    PubMed

    Williamson, E Diane; Dyson, Edward Hugh

    2015-01-01

    Anthrax is a serious, potentially fatal disease that can present in four distinct clinical patterns depending on the route of infection (cutaneous, gastrointestinal, pneumonic, or injectional); effective strategies for prophylaxis and therapy are therefore required. This review addresses the complex mechanisms of pathogenesis employed by the bacterium and describes how, as understanding of these has developed over many years, so too have current strategies for vaccination and therapy. It covers the clinical and veterinary use of live attenuated strains of anthrax and the subsequent identification of protein sub-units for incorporation into vaccines, as well as combinations of protein sub-units with spore or other components. It also addresses the application of these vaccines for conventional prophylactic use, as well as post-exposure use in conjunction with antibiotics. It describes the licensed acellular vaccines AVA and AVP and discusses the prospects for a next generation of recombinant sub-unit vaccines for anthrax, balancing the regulatory requirement and current drive for highly defined vaccines, against the risk of losing the "danger" signals required to induce protective immunity in the vaccinee. It considers novel approaches to reduce time to immunity by means of combining, for example, dendritic cell vaccination with conventional approaches and considers current opportunities for the immunotherapy of anthrax. PMID:26441934

  7. [Prophylaxis of Pulmonary Aspiration during General Anesthesia].

    PubMed

    Mori, Yosuke; Sumikura, Hiroyuki

    2016-01-01

    Pulmonary aspiration of gastric or esophageal contents is uncommon; however, it is one of the most severe complications in the perioperative period. The aspiration is associated with possible clinical outcomes, ranging from mild asymptomatic limited episodes of bronchial injury up to the development of a severe acute respiratory distress syndrome. To reduce the incidence of pulmonary aspiration, rapid sequence induction and intubation and awake tracheal intubation are commonly chosen anesthetic techniques for the management of patients at risk of aspiration of gastric or esophageal contents. Although there have been innumerable reports that describe prophylaxis of pulmonary aspiration, currently, there is insufficient evidence to prevent passive regurgitation in at-risk anesthetized patients. Some techniques to prevent pulmonary aspiration entered medical practice on a limited evidence base, but with common sense supporting its use. Properly applied techniques are probably effective at preventing regurgitation in the perioperative period although more randomized controlled trials are awaited to confirm this. Pulmonary aspiration should be prevented using multidisciplinary techniques and considerations that have been shown to improve effectiveness of prophylaxes. However, further research is necessary to support this strategy. PMID:27004384

  8. Prophylaxis of migraine in children and adolescents.

    PubMed

    Kacperski, Joanne

    2015-06-01

    While it has been established that headaches in the pediatric age group are relatively common, the characterization of headache disorders and their treatment in this group has historically been limited. Due to the paucity of controlled studies on prophylaxis of the primary headache disorders in children, the diagnosis of migraine often rests on criteria similar to those used in adults. Data from adult studies are often extrapolated and applied to the pediatric patient. Although it appears that many prophylactic agents are safe, well tolerated and efficacious in children, currently only topiramate is FDA-approved for use in patients 12 years and over. As a result, despite often experiencing significant disability, many children who present to their physician with migraines do not receive preventive therapy. One-third of adolescents meet the criteria for warranting prophylactic therapy, yet few are offered a preventative medication. Moreover, controlled clinical trials investigating the use of both abortive and prophylactic medications in children have suffered from high placebo response rates. A diverse group of medications are used to prevent migraine attacks, including antidepressants, antiepileptics, antihistamines and antihypertensive agents, yet there still remains a serious lack of controlled studies on the pharmacological treatment of pediatric migraine. PMID:25792525

  9. Antibiotic prophylaxis in pediatric odontology. An update.

    PubMed

    Planells del Pozo, Paloma; Barra Soto, Ma José; Santa Eulalia Troisfontaines, Eva

    2006-07-01

    Most orofacial infections are of odontogenic origin, and are of a self-limiting nature, characterized by spontaneous drainage. The causal bacteria are generally saprophytes. On the other hand, invasive dental interventions give rise to transient bacteremia. When an oral lesion is contaminated by extrinsic bacteria, the required antibiotic treatment should be provided as soon as possible. In the case of pulpitis, such treatment is usually not indicated if the infection only reaches the pulp tissue or the immediately adjacent tissues. In the event of dental avulsion, local antibiotic application is advised, in addition to the provision of systemic antibiotics. The dental professional must know the severity of the infection and the general condition of the child in order to decide referral to a medical center. Prophylaxis is required in all immunocompromised patients, as well as in individuals with cardiac problems associated with endocarditis, vascular catheters or prostheses. Penicillin V associated to clavulanic acid and administered via the oral route is known to be effective against odontogenic infections. In the case of allergies to penicillin, an alternative drug is clindamycin. Most acute infections are resolved within 3-7 days. In recent years, the tendency is to reduce general antibiotic use for preventive or therapeutic purposes. PMID:16816822

  10. [Lyme disease: prophylaxis after tick bite].

    PubMed

    Patey, O

    2007-01-01

    Lyme disease is a bacterial infection caused by Borrelia burgdorferi, which is transmitted by infected ticks. The transmission depends on several factors, especially on the duration of the tick's presence in the host body (the nymph which is smaller than the adults and thus less visible, is in this case the most frequently involved) and on whether the tick is infected or not. The interpretation of results in the few available studies is made difficult by the lack of information obtained (due to difficulty to collect information and examination costs). The comparison is made even more difficult by the difference between Borrelia ticks species in various regions. Today, the best methods are preventive: protective clothing, tick repellents, checking and removal of ticks after a journey in an endemic zone, and in case of tick bite, regular examination of the bite site during the following weeks in order to initiate an early curative treatment if ECM is diagnosed. The currently available data seems to be insufficient to suggest systematic antimicrobial prophylaxis in case of tick bite. PMID:17399928