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Sample records for lymphedema prophylaxis utilizing

  1. Lymphedema Prophylaxis Utilizing Perloperative Education

    DTIC Science & Technology

    2005-09-01

    AD Award Number: DAMD17-00-1-0495 TITLE: Lymphedema Prophylaxis Utilizing Perloperative Education PRINCIPAL INVESTIGATOR: Mary Ann Kosir, M.D...NUMBER Lymphedema Prophylaxis Utilizing Perloperative Education 5b. GRANT NUMBER DAM D1 7-00-1-0495 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...perioperative training for lymphedema assessment and protection. The hypothesis is that structured perioperative training in lymphedema protection will

  2. Lymphedema Prophylaxis Utilizing Perioperative Education

    DTIC Science & Technology

    2006-09-01

    AD_________________ Award Number: DAMD17-00-1-0495 TITLE: Lymphedema Prophylaxis Utilizing...REPORT DATE 01-09-2006 2. REPORT TYPE Final 3. DATES COVERED 1 aug 2000 –1 aug 2006 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Lymphedema ...purpose is to evaluate perioperative training for lymphedema assessment and protection. The hypothesis is that structured perioperative training in

  3. Lymphedema Prophylaxis Utilizing Perioperative Education

    DTIC Science & Technology

    2003-09-01

    The purpose is to evaluate perioperative training for lymphedema assessment and protection. The hypothesis is that structured perioperative training...in lymphedema protection will decrease lymphedema , the episodes of infection, the time to detection of lymphedema and improve the QOL in patients...incidence of lymphedema and infection during the first three years after surgery among breast cancer patients who received perioperative training in

  4. Lymphedema Prophylaxis Utilizing Perioperative Education

    DTIC Science & Technology

    2004-09-01

    34Equality in Male Breast Cancer Care using Sentinel Lymph Node Biopsy", presented at the 2004 national meeting of the Association of VA Surgeons, Richmond... lymph node surgery and/or radiation therapy to the breast will be prospectively randomized to two groups. In addition to receiving standard care (i.e...variables were explanatory variables. From Table 5, the highest correlation with developing LE was with any lymph nodes positive or the number of

  5. Lymphedema

    MedlinePlus

    ... and Side Effects Managing Cancer-related Side Effects Lymphedema Lymphedema is a build-up of lymph fluid in ... edema), most often in the arms or legs. Lymphedema can result from surgery or radiation therapy to ...

  6. 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 ...

  7. Lymphedema

    MedlinePlus

    ... early if any changes are observed. When you go outside, put on a sun block, because sunburn can aggravate lymphedema. When you are working in the kitchen, be careful. When you’re in the garden, be careful, ... go, go. Just be careful. Falk Cardiovascular Research Center ...

  8. Lymphedema

    MedlinePlus

    ... MedlinePlus GO GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Lymphedema - self-care URL of this page: //medlineplus.gov/ency/patientinstructions/ ...

  9. A Prospective Cohort Study Defining Utilities Using Time Trade-Offs and the Euroqol-5D to Assess the Impact of Cancer-Related Lymphedema

    PubMed Central

    Cheville, Andrea L.; Almoza, Mously; Courmier, Janice N.; Basford, Jeffrey R.

    2013-01-01

    BACKGROUND The devastating impact of lymphedema on cancer survivors’ quality of life has prompted consideration of several changes in medical and surgical care. Unfortunately, our understanding of the benefits gained from these approaches relative to their cost remains limited. This study was designed to estimate utilities for lymphedema and characterize how utilities differ between subgroups defined by lymphedema etiology and distribution. METHODS A consecutive sample of 236 subjects with lymphedema seen at a lymphedema clinic completed both a time trade-off (TTO) exercise and the Euroqol 5D. Responses were adjusted in multivariate regression models for demographic factors, comorbidities, and lymphedema severity/location. RESULTS Most participants (167 of 236, 71%) had lymphedema as a consequence of cancer treatment; 123 with breast cancer and upper extremity involvement. Mean TTO utility estimates were consistently higher than Euroqol 5D estimates. Unadjusted TTO (0.85; standard deviation [SD], 0.21) and Euroqol 5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and patient body mass index (BMI). Adjusted utility scores were lowest in patients with cancer-related lower extremity lymphedema (TTO=0.82; SD, 0.04 and Euroqol 5D=0.80; SD, 0.03). Breast cancer patients also had lower adjusted Euroqol 5D scores (0.80; SD, 0.02). CONCLUSIONS Lymphedema-associated utilities are in the range of 0.80. Lower utilities are observed for patients with higher lymphedema stages, elevated BMI, and cancer-related lymphedema. Greater expenditures for the prevention and treatment of cancer-related lymphedema are warranted. PMID:20564063

  10. 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

  11. Lymphedema tarda.

    PubMed

    Majeski, J

    1986-08-01

    Lymphedema tarda is a rare form of primary lymphedema. Its cause is unknown; an autoimmune destruction of lymphatic channels can be hypothesized. A case of lymphedema tarda in which direct immunofluorescent studies of involved tissue showed no immune deposits is presented. The differential diagnosis of this condition is also discussed.

  12. Lymphedema (PDQ)

    MedlinePlus

    ... check for lymphangiosarcoma. Lymphangiosarcoma usually cannot be cured . Current Clinical Trials Check the list of NCI-supported ... This Summary This PDQ cancer information summary has current information about the causes and treatment of lymphedema. ...

  13. Lymphedema tarda.

    PubMed

    Segal, J; Turner, A F

    1976-05-03

    The clinical recognition and evaluation of congenital lymphedema of the lower extremities with abrupt onset in a 51-year-old man are reviewed. A rational, systematic approach is outlined and exemplifies the use of an interdisciplinary effort to achieve accurate diagnosis through readily available diagnostic procedures.

  14. [Classification of lymphedema].

    PubMed

    Lazareth, I

    2002-06-01

    Classification of lymphedema is debated, because authors don't agree with the disordered physiology. Kinmonth divided all cases into primary and secondary lymphedema. Three types of primary lymphedema have been recognized: congenital, precox and tarda. Secondary lymphedema develops as a consequence of disruption or obstruction of the lymphatic pathways. Iatrogenic lymphedema are caused by surgery and/or radiation therapy. Post-infectious lymphedema are mainly caused by filariasis in tropical areas, and by cellulitis in occidental areas. Neoplastic disease (breast, prostatic cancer, Kaposi's sarcoma) are a major cause of secondary lymphedema. Less frequent etiologies are rheumatoid lymphedema, pathomimic lymphedema, pretibial myxoedema. Reduced lymphatic drainage is associated with severe chronic venous insufficiency and contributes to the leg swelling and the risk of infection.

  15. Management of Extremity Lymphedema.

    PubMed

    Puleo; Luh

    1995-10-01

    Chronic lymphedema is almost always a permanent and often progressive condition. In most cases, neither medical nor surgical means can completely relieve the effects of lymphedema. Surgical management of chronic lymphedema has high morbidity and a success rate of only 30%, and many patients return to their presurgical limb girth within three to four years. Nonsurgical treatment of chronic lymphedema can decrease overall lymphatic edema. Sequential gradient compression systems, which compensate for impaired lymphatic flow, return protein-rich lymphatic fluid from the extracellular regions of the tissues back into the circulatory system where the fluid can be excreted.

  16. Lymphedema Risk Reduction Practices

    MedlinePlus

    ... now! Position Paper: Lymphedema Risk Reduction Practices Category: Position Papers Tags: Risks Archives Treatment risk reduction garments surgery obesity infection blood pressure trauma morbid obesity body weight ...

  17. Treatment of Lymphedema

    MedlinePlus

    ... check for lymphangiosarcoma. Lymphangiosarcoma usually cannot be cured . Current Clinical Trials Check the list of NCI-supported ... This Summary This PDQ cancer information summary has current information about the causes and treatment of lymphedema. ...

  18. 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 (174) FAQ's (6) Position Papers (9) LSAP Perspective (9) Click here to write ...

  19. Inflammatory Manifestations of Lymphedema

    PubMed Central

    Ly, Catherine L.; Kataru, Raghu P.; Mehrara, Babak J.

    2017-01-01

    Lymphedema results from lymphatic insufficiency leading to a progressive inflammatory process that ultimately manifests as discomfort, recurrent infections, and, at times, secondary malignancy. Collectively, these morbidities contribute to an overall poor quality of life. Although there have been recent advances in microsurgical interventions, a conservative palliative approach remains the mainstay of treatment for this disabling disease. The absence of a cure is due to an incomplete understanding of the pathophysiological changes that result in lymphedema. A histological hallmark of lymphedema is inflammatory cell infiltration and recent studies with animal models and clinical biopsy specimens have suggested that this response plays a key role in the pathology of the disease. The purpose of this report is to provide an overview of the ongoing research in and the current understanding of the inflammatory manifestations of lymphedema. PMID:28106728

  20. 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. |

  1. 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.

  2. Lymphedema secondary to filariasis.

    PubMed

    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.

  3. Predictors of Lymphedema Following Breast Cancer Surgery

    DTIC Science & Technology

    2006-09-01

    1-0738 TITLE: Predictors of Lymphedema Following Breast Cancer Surgery PRINCIPAL...2006 4. TITLE AND SUBTITLE Predictors of Lymphedema Following Breast Cancer Surgery 5a. CONTRACT NUMBER 5b. GRANT NUMBER DAMD17-03-1-0738...following axillary lymph node dissection (ALND) is upper-extremity lymphedema . The purpose of this study is to identify risk factors for lymphedema

  4. Predictors of Lymphedema Following Breast Cancer Surgery

    DTIC Science & Technology

    2007-09-01

    1-0738 TITLE: Predictors of Lymphedema Following Breast Cancer Surgery PRINCIPAL...2007 4. TITLE AND SUBTITLE Predictors of Lymphedema Following Breast Cancer Surgery 5a. CONTRACT NUMBER 5b. GRANT NUMBER DAMD17-03-1-0738...following axillary lymph node dissection (ALND) is upper-extremity lymphedema . The purpose of this study is to identify risk factors for lymphedema

  5. Lymphatic Reprogramming of Adult Endothelial Stem Cells for a Cell-Based Therapy for Lymphedema in Breast Cancer Patients

    DTIC Science & Technology

    2008-09-01

    Therapy for Lymphedema inBreast Cancer Patients PRINCIPAL INVESTIGATOR: Young Kwon Hong, Ph.D. CONTRACTING ORGANIZATION...5a. CONTRACT NUMBER 4. TITLE AND SUBTITLE Lymphatic Reprogramming of Adult Endothelial Stem Cells for a Cell-Based Therapy for Lymphedema in... lymphedema patients. The key significance of our proposal is to utilize the elusive circulating adult stem cells to avoid the ethical and immunological

  6. 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

  7. Kaposi sarcoma following postmastectomy lymphedema.

    PubMed

    Montero Pérez, Iria; Rodríguez-Pazos, Laura; Álvarez-Pérez, Adriana; Ferreirós, M Mercedes Pereiro; Aliste, Carlos; Suarez-Peñaranda, Jose Manuel; Toribio, Jaime

    2015-11-01

    Classical Kaposi sarcoma (KS) usually appears on lower extremities accompanied or preceded by local lymphedema. However, the development in areas of chronic lymphedema of the arms following mastectomy, mimicking a Stewart-Treves syndrome, has rarely been described. We report an 81-year-old woman who developed multiple, erythematous to purple tumors, located on areas of post mastectomy lymphedema. Histopathological examination evidenced several dermal nodules formed by spindle-shaped cells that delimitated slit-like vascular spaces with some red cell extravasation. Immunohistochemically, the human herpesvirus type 8 (HHV-8) latent nuclear antigen-1 was detected in the nuclei of most tumoral cells confirming the diagnosis of KS. Lymphedema could promote the development of certain tumors by altering immunocompetence. Although angiosarcoma (AS) is the most frequent neoplasia arising in the setting of chronic lymphedema, other tumors such as benign lymphangiomatous papules (BLAP) or KS can also develop in lymphedematous limbs. It is important to establish the difference between AS and KS because their prognosis and treatment are very different. Identification by immunohistochemistry of HHV-8 is useful for the distinction between KS and AS or BLAP.

  8. Isolated primary lymphedema tarda of the upper limb.

    PubMed

    Shariati, Farzaneh; Ravari, Hasan; Kazemzadeh, Gholamhossein; Sadeghi, Ramin

    2013-03-01

    Primary lymphedema tarda is considered as a congenital disease with late presentation. Primary lymphedema tarda usually affects lower limbs, and primary lymphedema tarda of the upper limbs usually accompanies lower limb lymphedema. In the current case report, we present an 80-year-old male patient with isolated left upper limb swelling that lymphoscintigraphy imaging proved to be lymphedema.

  9. Surgical treatment of recidivist lymphedema

    PubMed Central

    Ferrarese, Alessia; Moggia, Elisabetta; Francone, Elisa; Sagnelli, Carlo; Martino, Maria Di; de Franciscis, Stefano; Amato, Bruno; Grande, Raffaele; Butrico, Lucia; Amato, Maurizio; Serra, Raffaele; Martino, Valter; Berti, Stefano

    2016-01-01

    Abstract Lymphedema is a chronic disease with a progressively ingravescent evolvement and an appearance of recurrent complications of acute lymphangitic type; in nature it is mostly erysipeloid and responsible for a further rapid increase in the volume and consistency of edema. The purpose of this work is to present our experience in the minimally invasive treatment for recurrence of lymphedema; adapting techniques performed in the past which included large fasciotomy with devastating results cosmetically; but these techniques have been proposed again by the use of endoscopic equipment borrowed from the advanced laparoscopy surgery, which allows a monoskin access of about one cm.

  10. Lymphedema: What We Know | NIH MedlinePlus the Magazine

    MedlinePlus

    ... of this page please turn JavaScript on. Feature: Lymphedema Lymphedema: What We Know Past Issues / Fall 2016 Table ... Photo: NCI Who is at risk for getting lymphedema? Having lymph nodes removed during breast cancer surgery ...

  11. Predictors of Lymphedema Following Breast Cancer

    DTIC Science & Technology

    2005-09-01

    AD Award Number: DAMD17-03-1-0738 TITLE: Predictors of Lymphedema Following Breast Cancer PRINCIPAL INVESTIGATOR: Karen K. Swenson CONTRACTING...CONTRACT NUMBER Predictors of Lymphedema Following Breast Cancer 5b. GRANT NUMBER DAMD17-03-1-0738 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d...guides treatment decisions. Unfortunately, a relatively common side effect following axillary lymph node dissection is upper-extremity lymphedema . The

  12. 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

  13. Staged treatment of lymphedema praecox

    PubMed Central

    Tilley, A. R.; Douglas, L. G.

    1974-01-01

    Lymphedema of the lower extremities poses a challenging problem in management. Gross deformities may be encountered in patients with filarial infestation. This degree of involvement is rare in native North Americans suffering from primary lymphedema. A case is presented of a patient with changes similar to those seen in filariasis, due to several episodes of acute lymphangitis over a period of years. The involved tissue was excised and the defects skin-grafted, employing a modified Charles procedure. The magnitude of the excision was such that it was carried out in three widely spaced stages. The result was satisfactory from a functional viewpoint, and also represented a marked cosmetic improvement. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5FIG. 6 PMID:4590797

  14. Primary lower extremity lymphedema: CT diagnosis

    SciTech Connect

    Gamba, J.L.; Silverman, P.M.; Ling, D.; Dunnick, N.R.; Korobkin, M.

    1983-10-01

    The CT findings of two cases of primary lymphedema of the lower extremities are presented. CT showed a coarse, nonenhancing, reticular pattern in an enlarged subcutaneous compartment. CT excluded the diagnosis of secondary lymphedema from an obstructing mass by demonstrating a normal retroperitoneum and pelvis. The CT findings are correlated with pedal lymphangiograms.

  15. Resolution of Primary Lymphedema: A Case Report

    PubMed Central

    Goss, Jeremy A.; Maclellan, Reid A.; Beijnen, Usha E. A.

    2017-01-01

    Summary: Primary lymphedema is a rare, progressive disease that typically affects the lower extremity. The condition is not curable, and the limb enlarges over time because of subcutaneous fibroadipose deposition. We present a patient with clinical and radiographical evidence of resolution of primary lymphedema. This observation may provide greater insight into the pathophysiology of the disease. PMID:28280665

  16. [Clinical experiences in the use of lymphovenous anastomoses in secondary lymphedema].

    PubMed

    Ingianni, G; Holzmann, T

    1985-01-01

    Secondary lymphedema of the arm after therapy for breast cancer has a frequency of about 30% in the Federal Republic of Germany. Many authors have performed lympho-venous anastomoses to release lymphostatic edema, most using microsurgical technique. In this paper the authors present microlympho-venous anastomoses done in a telescope-like manner and using fibrin glue. First this technique was applied to dogs, later to patients. Measurement of the limb and of the limb volume at different levels were done pre- and postoperatively. Investigations with radionucleides were undertaken in some cases to measure lymphatic clearance. The operations were performed under local anaesthesia with perioperative antibiotic prophylaxis. The procedure was well tolerated by the patients, achieving a reduction of the swelling of about 30%. Despite the short follow-up of only six months and the limited number of cases we feel that this type of therapy should be offered to patients with secondary lymphedema.

  17. 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

  18. Purpura-associated congenital lymphedema.

    PubMed

    Berti, Samantha; Pieri, Alessandro; Lotti, Torello; Duranti, Alberto; Panelos, John; De Martino, Maurizio; Moretti, Silvia

    2009-01-01

    An 8-year-old girl referred to our Department for a two-month worsening of congenital primary lymphedema of the lower limb and for the appearance of several purpuric lesions on the right thigh and knee. We diagnosed a lichenoid pigmented purpura of Gougerot and Blum in a patient with Milroy disease, complicated by an insufficiency of anterior saphena. We treated the patient with topical steroids and compression stockings, until surgical intervention of phlebectomy. We report this case for the rarity of the disease, for the even more rare association with lichenoid pigmented purpura and for cutaneous immunopathological findings.

  19. Creation of distal canine limb lymphedema

    SciTech Connect

    Chen, H.C.; Pribaz, J.J.; O'Brien, B.M.; Knight, K.R.; Morrison, W.A.

    1989-06-01

    A canine model of distal limb lymphedema was established in order to study the treatment of this condition by lymph node transfer. This model was more difficult to establish than whole-limb lymphedema. Significant edema was achieved by a combination of preoperative irradiation and circumferential removal of skin from the irradiated areas followed by removal of the contents of the popliteal fossa. Despite these measures, it was not possible to produce lymphedema in every case, possibly because of the presence of lymphaticovenous shunts and panvascular compensation mechanisms.

  20. 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.

  1. Voices from the Shadows: Living with Lymphedema

    PubMed Central

    Ridner, Sheila H.; Bonner, Candace M.; Deng, Jie; Sinclair, Vaughn G.

    2011-01-01

    Background Breast cancer survivors with lymphedema face a lifetime of stressful physical and emotional symptoms and challenging self-care demands. An in-depth understanding of the perceptions and feelings surrounding life with lymphedema is critical to developing effective supportive care approaches. Objective To explore perceptions and feelings related to lymphedema in breast cancer survivors. Method The expressive writings of 39 individuals were evaluated for this descriptive qualitative study. Data were analyzed using conventional content analysis. Results Qualitative analyses produced four major themes: (1) marginalization and minimization; (2) multiplying losses; (3) yearning to return to normal; (4) uplifting resources. Sub-themes for each major theme were also identified. Conclusion The lymphedema experiences of breast cancer survivors reveal perceptions of marginalization from healthcare providers who are not well informed about lymphedema management and minimize its impact. Multiple distressing losses confront these patients on a daily basis, including body image disturbances, loss of functionality and control over time, permanent uncertainty, and adverse effects on relationships. The daily challenges of lymphedema often result in cumulative frustration and resentment that contribute to failure to perform self-care. Normalcy has been lost, never to return. These women find solace, encouragement and hope to meet the challenges of lymphedema through support from others and their spiritual beliefs. Implication for Practice Healthcare providers need greater awareness of the physical and psychosocial effects of lymphedema in breast cancer survivors. Nurses have unique opportunities to serve as advocates for reducing perceived marginalization and promoting effective self-care and other activities that promote psychological well-being and reduce physical deterioration. PMID:21558848

  2. Adrenomedullin Haploinsufficiency Predisposes to Secondary Lymphedema

    PubMed Central

    Nikitenko, Leonid L; Shimosawa, Tatsuo; Henderson, Stephen; Mäkinen, Taija; Shimosawa, Hiromi; Qureshi, Uzma; Pedley, R Barbara; Rees, Margaret C P; Fujita, Toshiro; Boshoff, Chris

    2013-01-01

    Secondary lymphedema is a debilitating condition, and genetic factors predisposing to its development remain largely unknown. Adrenomedullin (AM) is peptide encoded, together with proadrenomedullin N-terminal peptide (PAMP), by the Adm gene (adrenomedullin gene). AM and its putative receptor calcitonin receptor–like receptor (CLR) are implicated in angiogenesis and lymphangiogenesis during embryogenesis and wound healing, suggesting their possible involvement in secondary lymphedema. To investigate whether AM deficiency predisposes to secondary lymphedema, we used heterozygous adult mice with Adm gene-knockin stop mutation, which selectively abrogated AM, but preserved PAMP, expression (AdmAM+/Δ animals). After hind limb skin incision, Adm messenger RNA expression was upregulated in wounded tissue of both AdmAM+/+ and AdmAM+/Δ mice. However, only AdmAM+/Δ animals developed limb swelling and histopathological lymphedematous changes, including epidermal thickening, elevated collagen fiber density, and increased microvessel diameter. Secondary lymphedema was prevented when circulating AM levels in AdmAM+/Δ mice were restored by systemic peptide delivery. In human skin, CLR was expressed in tissue components affected by lymphedema, including epidermis, lymphatics, and blood vessels. Our study identified a previously unrecognized role for endogenous AM as a key factor in secondary lymphedema pathogenesis and provided experimental in vivo evidence of an underlying germ-line genetic predisposition to developing this disorder. PMID:23364478

  3. 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

  4. Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors

    DTIC Science & Technology

    2007-10-01

    AD_________________ Award Number: DAMD17-02-1-0387 TITLE: Modifiable Risk Factors for Lymphedema ...Final 3. DATES COVERED 1 Oct 2004 – 30 Sep 2007 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Modifiable Risk Factors for Lymphedema in Breast...axillary lymph nodes removed were followed for the development of arm lymphedema . Participants completed a baseline interview and subsequent

  5. Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors

    DTIC Science & Technology

    2006-10-01

    AD_________________ Award Number: DAMD17-02-1-0387 TITLE: Modifiable Risk Factors for Lymphedema ...Annual 3. DATES COVERED 1 Oct 2005 – 30 Sep 2006 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Modifiable Risk Factors for Lymphedema in Breast...Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Lymphedema of the arm is a consequence of breast cancer

  6. Lymphedema

    MedlinePlus

    ... treatment. It results from a blockage in your lymphatic system, which is part of your immune system. The ... persistent swelling in your arm or leg. Your lymphatic system is crucial to keeping your body healthy. It ...

  7. Assessing local tissue edema in postmastectomy lymphedema.

    PubMed

    Mayrovitz, H N

    2007-06-01

    Overall limb lymphedema can be assessed by several methods but none are suitable to determine local edema. Quantifying local edema could provide important information not previously available. Our goal was to determine the suitability of using the tissue dielectric constant (TDC) as and index of local tissue water to detect and quantify edema in postmastectomy patients with unilateral arm lymphedema. Segmental arm volume and TDC were measured in both arms of 18 women with unilateral lymphedema, and in 15 premenopausal and 15 postmenopausal controls. TDC was measured at a frequency of 300 MHz using open-ended coaxial probes with effective measuring depths of 0.5, 1.5, 2.5 and 5.0 mm. For patients and controls, absolute TDC depended on measurement depth but for any depth the TDC of lymphedematous segments was significantly greater than for non-affected contralateral arms (p<0.001). At a depth of 2.5 mm, the TDC ratio between arms for patients was 1.64+/-0.30 vs.1.04+/-0.04 for both control groups (p<0.001). No patient's TDC ratio was as low as 1.2 and no control subject's TDC ratio was as great as 1.2. Results suggest that this method is a good quantitative discriminator of the presence of lymphedema in patients with unilateral limb lymphedema.

  8. [Lymphedema--guidelines for evaluation and treatment].

    PubMed

    Heldenberg, Eitan; Bass, Arie

    2013-03-01

    Lymphedema is the "neglected vascular disease". A lot has been written about arterial and venous pathologies but our knowledge, as physicians, about the pathophysiology on the one hand and about the treatment, on the other hand, is scarce. Lymphedema is subdivided into primary and secondary disease. The primary lymphedema is further subdivided to congenital, praecox and tarda. Conservative treatment is the first line of therapy. Surgery has not been proven as a good solution for this disease, and furthermore, even when operations are being conducted, conservative treatment should be continued on a daily basis. It seems that further research about this "forgotten disease" should be designed in order to improve the treatment of these complicated patients.

  9. Low-level laser therapy in secondary lymphedema after breast cancer: systematic review.

    PubMed

    E Lima, Mariana Toledo Biscaia Raposo Mourão; E Lima, Januário Gomes Mourão; de Andrade, Mauro Figueiredo Carvalho; Bergmann, Anke

    2014-05-01

    Complex physical therapy is the main treatment for the secondary lymphedema after breast cancer. The low-level laser therapy (LLLT) has been used in order to stimulate lymphangiogenesis, encourage lymphatic motility, and reduce lymphostatic fibrosis. However, these factors could also favor the development of recurrence and metastasis. The objective of this study is to discuss the use of LLLT in the treatment of lymphedema after breast cancer. This study utilized a systematic review on the use of LLLT in the treatment of lymphedema after breast cancer. Evaluating quality of articles was conducted through the PEDro scale. Of the 41 articles identified, four were considered to be of high methodological quality (score ≥ 5). The low-level laser in the axillary region was performed in all studies. The control group was not similar across studies. The results presented showed that there was a reduction in limb volume in the group subjected to low-power laser when compared with other treatments. No studies have evaluated the risk of metastasis or relapse in the irradiated areas. Because no studies have included the complex physical therapy as the comparison group, we cannot claim that laser treatment is the best efficacy or effectiveness in lymphedema treatment after breast cancer. No studies have evaluated the hypothesis that the LLLT can increase the risk of recurrence or metastasis. Therefore, the questions about the safety of this procedure in cancer patients remain.

  10. With Lymphedema, Early Treatment is Key | NIH MedlinePlus the Magazine

    MedlinePlus

    ... of this page please turn JavaScript on. Feature: Lymphedema With Lymphedema, Early Treatment is Key Past Issues / Fall 2016 Table of Contents You may notice symptoms of lymphedema at the part of your body where you ...

  11. Airplane travel and lymphedema: a case study.

    PubMed

    Ward, L C; Battersby, K J; Kilbreath, S L

    2009-09-01

    A single subject prospective study of the relationship between air travel and lymphedema is reported. This proof of concept study was aimed at assessing the feasibility of using self-measured, inter-limb impedance ratios as a quantitative measure of lymphedema immediately prior to and following flying. The participant, a breast cancer survivor with lymphedema, measured whole arm impedance prior to and following air travel on 20 occasions, varying in duration of between 1 and 9 h, over a 12-month period. Although the inter-arm impedance ratio fluctuated over this time, it generally increased and worsened following flying. Impedance measurements were easily performed by the participant and could be obtained as close to the start and cessation of flying as is practicably possible. These data, when associated with self-assessment of lymphedema-related symptoms, could provide a comprehensive evidence base for an assessment of the risks associated with air travel and the provision of appropriate advice to prospective travelers. Further large-scale studies are recommended.

  12. Effectiveness of Decongestive Lymphatic Therapy in Patients with Lymphedema Resulting from Breast Cancer Treatment Regardless of Previous Lymphedema Treatment.

    PubMed

    Bozkurt, Mehtap; Palmer, Lynn J; Guo, Ying

    2017-03-01

    Decongestive lymphatic therapy (DLT) has gained wide acceptance as an effective treatment for patients with lymphedema resulting from breast cancer treatment. It is unclear whether DLT is effective for patients with lymphedema who have received lymphedema treatment previously. Our purpose was to compare the effectiveness of DLT in patients who had received lymphedema treatment previously with those who had never received treatment. We retrospectively reviewed the medical records of 98 patients who received outpatient lymphedema therapy for upper extremity lymphedema following surgery. Seventy-two eligible patients with a breast cancer diagnosis and complete medical records were divided into two groups: group 1; previously treated (PT) patients (n = 38, 53%) had previously received lymphedema treatment, while group 2 (no PT, n = 34, 47%) had never received lymphedema treatment. The primary outcome was the percent change in volume in the lymphedematous arm, measured by perometer, after DLT treatment. The two groups did not differ significantly in age, comorbidities, body mass index, and median time from surgery to current treatment, surgical procedure, previous radiation treatment, or history of cellulitis/lymphangitis. DLT significantly reduced arm volume in both groups (group 1, p < 0.001; group 2, p = 0.003). The mean percent volume reduction did not differ significantly between the groups (p = 0.619). This study is the first to show that, DLT reduce limb volume significantly with post-mastectomy lymphedema, regardless of previous lymphedema therapy.

  13. Topical tacrolimus for the treatment of secondary lymphedema

    PubMed Central

    Gardenier, Jason C.; Kataru, Raghu P.; Hespe, Geoffrey E.; Savetsky, Ira L.; Torrisi, Jeremy S.; Nores, Gabriela D. García; Jowhar, Dawit K.; Nitti, Matthew D.; Schofield, Ryan C.; Carlow, Dean C.; Mehrara, Babak J.

    2017-01-01

    Secondary lymphedema, a life-long complication of cancer treatment, currently has no cure. Lymphedema patients have decreased quality of life and recurrent infections with treatments limited to palliative measures. Accumulating evidence indicates that T cells play a key role in the pathology of lymphedema by promoting tissue fibrosis and inhibiting lymphangiogenesis. Here using mouse models, we show that topical therapy with tacrolimus, an anti-T-cell immunosuppressive drug, is highly effective in preventing lymphedema development and treating established lymphedema. This intervention markedly decreases swelling, T-cell infiltration and tissue fibrosis while significantly increasing formation of lymphatic collaterals with minimal systemic absorption. Animals treated with tacrolimus have markedly improved lymphatic function with increased collecting vessel contraction frequency and decreased dermal backflow. These results have profound implications for lymphedema treatment as topical tacrolimus is FDA-approved for other chronic skin conditions and has an established record of safety and tolerability. PMID:28186091

  14. A model for gene therapy of human hereditary lymphedema

    PubMed Central

    Karkkainen, Marika J.; Saaristo, Anne; Jussila, Lotta; Karila, Kaisa A.; Lawrence, Elizabeth C.; Pajusola, Katri; Bueler, Hansruedi; Eichmann, Anne; Kauppinen, Risto; Kettunen, Mikko I.; Ylä-Herttuala, Seppo; Finegold, David N.; Ferrell, Robert E.; Alitalo, Kari

    2001-01-01

    Primary human lymphedema (Milroy's disease), characterized by a chronic and disfiguring swelling of the extremities, is associated with heterozygous inactivating missense mutations of the gene encoding vascular endothelial growth factor C/D receptor (VEGFR-3). Here, we describe a mouse model and a possible treatment for primary lymphedema. Like the human patients, the lymphedema (Chy) mice have an inactivating Vegfr3 mutation in their germ line, and swelling of the limbs because of hypoplastic cutaneous, but not visceral, lymphatic vessels. Neuropilin (NRP)-2 bound VEGF-C and was expressed in the visceral, but not in the cutaneous, lymphatic endothelia, suggesting that it may participate in the pathogenesis of lymphedema. By using virus-mediated VEGF-C gene therapy, we were able to generate functional lymphatic vessels in the lymphedema mice. Our results suggest that growth factor gene therapy is applicable to human lymphedema and provide a paradigm for other diseases associated with mutant receptors. PMID:11592985

  15. Modifiable Risk Factors for Lymphedema in Breast Caner Survivors

    DTIC Science & Technology

    2005-10-01

    AD Award Number: DAMD17-02-1-0387 TITLE: Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors PRINCIPAL INVESTIGATOR: Mary Anne Rossing...2005 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors 5b. GRANT NUMBER DAMD17-02-1-0387 5c...Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Lymphedema of the arm is a consequence of breast cancer treatment that can result in substantial

  16. [Secondary lymphedema--the importance of a multidisciplinary team approach].

    PubMed

    Heldenberg, Eitan; Bass, Arie

    2013-03-01

    Secondary lymphedema is the most common type of lymphedema. Malignancy, mainly breast carcinoma, is the main cause of upper extremity lymphedema, while groin dissection, irradiation and trauma are the cause of lower extremity lymphedema. Early recognition of the pathology followed by early referral to a vascular surgeon, leading a multidisciplinary team, who takes care of those patients, can prevent a miserable Life from these patients. Lifelong commitment of the patients, prolonged financial support of the health insurance supplier, as well as team work of the group taking care of the patient, is the only way to help these patients.

  17. Primary Upper Limb Lymphedema: Case Report of a Rare Pathology

    PubMed Central

    McFarlane, Michael EC

    2017-01-01

    Introduction Lymphedema is characterized by a defect in the lymphatic system that causes limb swelling. Impaired uptake and transport of lymphatic fluid through lymphatic vessels causes accumulation of protein-rich fluid in the interstitial spaces, which leads to swelling of the limb. Primary lymphedema often presents at birth. The rare cases that arise after age 35 years are described as lymphedema tarda. The great majority of patients with lymphedema have swelling of the lower limbs—upper limb lymphedema is a rare disorder. Case Presentation An 84-year-old woman presented with a 3-year history of unilateral swelling of the right upper limb. There were no constitutional symptoms and no evidence of lymphadenopathy or systemic disease. Blood tests, carcinoembryonic antigen test, computed tomography scans, and venous Doppler ultrasound were all normal. The diagnosis was primary upper limb lymphedema. Discussion The swelling that occurs in upper limb lymphedema is permanent and usually extends to the hand. About one-third of patients with this condition also present with lower limb lymphedema. Thorough investigations are warranted in cases of unilateral upper limb lymphedema to rule out occult malignancy and systemic disease. PMID:28080951

  18. 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

  19. Lymphoscintigraphy in lymphedema: an aid to microsurgery

    SciTech Connect

    Vaqueiro, M.; Gloviczki, P.; Fisher, J.; Hollier, L.H.; Schirger, A.; Wahner, H.W.

    1986-07-01

    The role of lymphoscintigraphy, performed with /sup 99m/Tc-labeled antimony sulfur colloid, in the diagnosis of lymphedema and as a test for selection of patients for microvascular operation was evaluated in 32 patients with primary and secondary lymphedema and four patients with other causes of leg edema. Lymphoscintigraphy clearly demonstrated if edema was of lymphatic origin. Five different image patterns were identified; abnormal image patterns could not be predicted from clinical history or physical findings. Quantitative evaluation of removal of the radioactive colloid from the injection site and appearance in lymph node sites and liver was of limited usefulness. Nine patients underwent various surgical procedures before or after lymphoscintigraphy. Lympho-venous anastomoses were possible only in patients who had patent lymph channels visible on lymphoscintigrams. Based on initial experience, lymphoscintigraphy seems to be useful to select patients for microvascular operation.

  20. Scrotal Lymphedema Praecox: Disease and Treatment

    PubMed Central

    Anderson, Bernard B.; Cadogan, C.A. Mark

    1982-01-01

    Lymphedema of the scrotum and penis represents a debilitating but uncommon entity in countries spared of endemic filariasis. The clinical presentation and surgical management of one patient with idiopathic lymphedema praecox is discussed. A posterior based scrotal skin flap and a split thickness skin graft were used to reconstruct the scrotum and resurface the penis following radical excision of the edematous tissue. Limitation of the disease to the superficial tissues and relative sparing of the posterior scrotal skin represent the anatomic basis for success with this approach. The more deforming therapeutic alternative of excision of all lymphedematous tissue with transfer of the testes to the thigh and split thickness skin grafting to the exposed area would probably be best reserved for recurrence. ImagesFigure 1Figure 3 PMID:7120475

  1. Antimicrobial prophylaxis in adults.

    PubMed

    Enzler, Mark J; Berbari, Elie; Osmon, Douglas R

    2011-07-01

    Antimicrobial prophylaxis is commonly used by clinicians for the prevention of numerous infectious diseases, including herpes simplex infection, rheumatic fever, recurrent cellulitis, meningococcal disease, recurrent uncomplicated urinary tract infections in women, spontaneous bacterial peritonitis in patients with cirrhosis, influenza, infective endocarditis, pertussis, and acute necrotizing pancreatitis, as well as infections associated with open fractures, recent prosthetic joint placement, and bite wounds. Perioperative antimicrobial prophylaxis is recommended for various surgical procedures to prevent surgical site infections. Optimal antimicrobial agents for prophylaxis should be bactericidal, nontoxic, inexpensive, and active against the typical pathogens that can cause surgical site infection postoperatively. To maximize its effectiveness, intravenous perioperative prophylaxis should be administered within 30 to 60 minutes before the surgical incision. Antimicrobial prophylaxis should be of short duration to decrease toxicity and antimicrobial resistance and to reduce cost.

  2. Antibiotic prophylaxis and reflux: critical review and assessment

    PubMed Central

    Baquerizo, Bernarda Viteri

    2014-01-01

    The use of continuous antibiotic prophylaxis (CAP) was critical in the evolution of vesicoureteral reflux (VUR) from a condition in which surgery was the standard of treatment to its becoming a medically managed condition. The efficacy of antibiotic prophylaxis in the management of VUR has been challenged in recent years, and significant confusion exists as to its clinical value. This review summarizes the critical factors in the history, use, and investigation of antibiotic prophylaxis in VUR. This review provides suggestions for assessing the potential clinical utility of prophylaxis. PMID:25580258

  3. A case of fatal necrotizing fasciitis arising from chronic lymphedema.

    PubMed

    Jun, Young Joon; Kang, In Sook; Lee, Jung Ho; Kim, Sue Min; Kim, Young Jin

    2013-12-01

    Chronic lymphedema and lymphangitis are common adverse effects following treatment for gynecological cancer. Because the early symptoms of necrotizing fasciitis are similar to those of lymphangitis, fatal outcome can occur if patients or physicians underestimate this condition. Here, we present a case of necrotizing fasciitis in a patient with chronic lymphedema.

  4. Lymphedema of the upper extremity following circumferential burns.

    PubMed

    Balakrishnan, Chenicheri; Bradt, Lisa M; Khalil, Abdullah J; Trupiano, John M

    2004-01-01

    Lymphedema is characterized by edema of the extremity due to the inability of the lymphatic system to remove lymph into the circulation. This condition can result from destruction of the superficial lymphatics from burn injury and recurrent infection of the extremity. Due to its rare occurrence, two cases of upper extremity lymphedema following burns are reported.

  5. 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

  6. [Antimicrobial prophylaxis in surgery].

    PubMed

    Cisneros, José Miguel; Rodríguez-Baño, Jesús; Mensa, José; Trilla, Antoni; Cainzos, Miguel

    2002-01-01

    Antimicrobial prophylaxis in surgery refers to a very brief course of an antimicrobial agent initiated just before the start of the procedure. The efficacy of antimicrobials to prevent postoperative infection at the site of surgery (incisional superficial, incisional deep, or organ/space infection) has been demonstrated for many surgical procedures. Nevertheless, the majority of studies centering on the quality of preoperative prophylaxis have found that a high percentage of the antimicrobials used are inappropriate for this purpose. This work discusses the scientific basis for antimicrobial prophylaxis, provides general recommendations for its correct use and specific recommendations for various types of surgery. The guidelines for surgical antimicrobial prophylaxis are based on results from well-designed studies, whenever possible. These guidelines are focussed on reducing the incidence of infection at the surgical site while minimizing the contribution of preoperative administration of antimicrobials to the development of bacterial resistance.

  7. [Deep vein thrombosis prophylaxis.

    PubMed

    Sandoval-Chagoya, Gloria Alejandra; Laniado-Laborín, Rafael

    2013-01-01

    Background: despite the proven effectiveness of preventive therapy for deep vein thrombosis, a significant proportion of patients at risk for thromboembolism do not receive prophylaxis during hospitalization. Our objective was to determine the adherence to thrombosis prophylaxis guidelines in a general hospital as a quality control strategy. Methods: a random audit of clinical charts was conducted at the Tijuana General Hospital, Baja California, Mexico, to determine the degree of adherence to deep vein thrombosis prophylaxis guidelines. The instrument used was the Caprini's checklist for thrombosis risk assessment in adult patients. Results: the sample included 300 patient charts; 182 (60.7 %) were surgical patients and 118 were medical patients. Forty six patients (15.3 %) received deep vein thrombosis pharmacologic prophylaxis; 27.1 % of medical patients received deep vein thrombosis prophylaxis versus 8.3 % of surgical patients (p < 0.0001). Conclusions: our results show that adherence to DVT prophylaxis at our hospital is extremely low. Only 15.3 % of our patients at risk received treatment, and even patients with very high risk received treatment in less than 25 % of the cases. We have implemented strategies to increase compliance with clinical guidelines.

  8. 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.

  9. 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

  10. 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

  11. [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.

  12. Swelling among women who need education about leg lymphedema (SWELL): A descriptive study of lymphedema in women undergoing surgery for endometrial cancer

    PubMed Central

    Salani, Ritu; Preston, Megan M.; Hade, Erinn M.; Johns, Jessica; Fowler, Jeffrey M.; Paskett, Electra P.; Katz, Mira L.

    2014-01-01

    Objectives In addition to hysterectomy and bilateral salpingo-oophorectomy, comprehensive surgical staging for endometrial cancer includes pelvic and para-aortic lymphadenectomy. Clarifying and addressing the morbidity from these surgical procedures is imperative. The goal of this study was to assess the prevalence of lower extremity swelling following surgery for endometrial cancer. Methods/materials We performed a descriptive, cross-sectional survey study of women who underwent surgery for endometrial cancer at our institution from 2006–2008. Survey information included symptoms, management, and education regarding lymphedema. Demographic information such as race and education was collected in addition to clinical data such as body mass index (BMI) and age. Results Of the 482 patients identified, 440 were determined eligible and 305 (69.3%) responded to the survey with information on lower limb swelling (LLS). Of the 108 (35%) responders who reported swelling, only 68 (22%) participants reported a diagnosis of lower limb lymphedema (LLL). The most commonly experienced symptoms among those who reported LLS were tightness, pain/tenderness and heaviness. Among those with a diagnosis of LLL, a majority (60%) stated it affected their daily activities and noted exacerbating factors such as prolonged standing, heat, and walking. The most common therapies utilized to reduce symptoms included leg elevation (96%), compression stockings (65%), diuretics (46%), massage therapy (35%), and bandaging (25%). There was no association between LLS or LLL diagnosis and BMI, age, race, tobacco use. Only 8% of responders reported receiving preoperative education regarding risks for LLS and a desire for more comprehensive education was frequently noted. Conclusions The patient-reported incidence of LLS occurred in approximately 35% of survey participants who underwent surgery for endometrial cancer. However, only 22% reported a diagnosis of LLL. Efforts to obtain the true incidence

  13. The 5th world symposium for lymphedema surgery-Recent updates in lymphedema surgery and setting up of a global knowledge exchange platform.

    PubMed

    Loh, Charles Yuen Yung; Wu, Jerry Chih-Wei; Nguyen, Alexander; Dayan, Joseph; Smith, Mark; Masia, Jaume; Chang, David; Koshima, Isao; Cheng, Ming-Huei

    2017-01-01

    The successful completion of the 5th World Symposium for Lymphedema Surgery (WSLS) marks another milestone in the development and advancement of the management of lymphedema. We present our experience in organizing such a scientific lymphedema conference as well as a summary of seven variable live surgeries used for treating lymphedema. An update of current knowledge and determination of future direction in the treatment of lymphedema was made possible via WSLS 2016. J. Surg. Oncol. 2017;115:6-12. © 2016 Wiley Periodicals, Inc.

  14. Future Research Priorities for Morbidity Control of Lymphedema

    PubMed Central

    Narahari, S R; Aggithaya, Madhur Guruprasad; Moffatt, Christine; Ryan, T J; Keeley, Vaughan; Vijaya, B; Rajendran, P; Karalam, S B; Rajagopala, S; Kumar, N K; Bose, K S; Sushma, K V

    2017-01-01

    Background: Innovation in the treatment of lower extremity lymphedema has received low priority from the governments and pharmaceutical industry. Advancing lymphedema is irreversible and initiates fibrosis in the dermis, reactive changes in the epidermis and subcutis. Most medical treatments offered for lymphedema are either too demanding with a less than satisfactory response or patients have low concordance due to complex schedules. A priority setting partnership (PSP) was established to decide on the future priorities in lymphedema research. Methods: A table of abstracts following a literature search was published in workshop website. Stake holders were requested to upload their priorities. Their questions were listed, randomized, and sent to lymphologists for ranking. High ranked ten research priorities, obtained through median score, were presented in final prioritization work shop attended by invited stake holders. A free medical camp was organized during workshop to understand patients’ priorities. Results: One hundred research priorities were selected from priorities uploaded to website. Ten priorities were short listed through a peer review process involving 12 lymphologists, for final discussion. They were related to simplification of integrative treatment for lymphedema, cellular changes in lymphedema and mechanisms of its reversal, eliminating bacterial entry lesions to reduce cellulitis episodes, exploring evidence for therapies in traditional medicine, improving patient concordance to compression therapy, epidemiology of lymphatic filariasis (LF), and economic benefit of integrative treatments of lymphedema. Conclusion: A robust research priority setting process, organized as described in James Lind Alliance guidebook, identified seven priority areas to achieve effective morbidity control of lymphedema including LF. All stake holders including Department of Health Research, Government of India, participated in the PSP. PMID:28216723

  15. Post-Exposure Prophylaxis (PEP)

    MedlinePlus

    ... Pediatric OI Prevention and Treatment Guidelines Care for Disaster Displaced HIV-Infected Patients Guidelines on Care for HIV-Infected Residents Displaced from Disaster Areas Pre-exposure Prophylaxis Pre-exposure Prophylaxis (PrEP) ...

  16. A Leading Role in Lymphedema Awareness | NIH MedlinePlus the Magazine

    MedlinePlus

    ... developed lymphedema after surgery for breast cancer. When did you first experience symptoms? Was it diagnosed quickly? ... glossed over in a couple of hours. Why did you become an advocate for people with lymphedema? ...

  17. Primary lymphedema tarda in an 88-year-old African-American male.

    PubMed

    Aslam, Ahmed Faraz; Aslam, Ahmad Kamal; Qamar, Muhammad Umair R; Levey, Robert

    2005-07-01

    Primary lymphedema tarda is considered to be a congenital disease with delayed manifestations. We report a case of isolated lymphedema of the left upper extremity in an 88-year-old African-American male. The diagnosis of lymphedema was confirmed by lymphoscintigraphy, and appropriate diagnostic studies were done to rule out other known causes of lymphedema. Lymphoscintigraphic findings were consistent with idiopathic primary lymphedema. During the course of investigations, the patient was found to have adenocarcinoma in situ of the sigmoid colon with no evidence of metastatic spread. Based on the available data, we were unable to establish a causative relationship between colonic carcinoma and lymphedema in our patient. Therefore, this case can best be described as a case of Idiopathic primary lymphedema tarda. We emphasize the use of histopathologic examination in the diagnostic algorithm to rule out underlying malignant process only in patients with radionuclide findings suggestive of secondary lymphedema with no obvious etiology.

  18. Primary lymphedema tarda in an 88-year-old African-American male.

    PubMed Central

    Aslam, Ahmed Faraz; Aslam, Ahmad Kamal; Qamar, Muhammad Umair R.; Levey, Robert

    2005-01-01

    Primary lymphedema tarda is considered to be a congenital disease with delayed manifestations. We report a case of isolated lymphedema of the left upper extremity in an 88-year-old African-American male. The diagnosis of lymphedema was confirmed by lymphoscintigraphy, and appropriate diagnostic studies were done to rule out other known causes of lymphedema. Lymphoscintigraphic findings were consistent with idiopathic primary lymphedema. During the course of investigations, the patient was found to have adenocarcinoma in situ of the sigmoid colon with no evidence of metastatic spread. Based on the available data, we were unable to establish a causative relationship between colonic carcinoma and lymphedema in our patient. Therefore, this case can best be described as a case of Idiopathic primary lymphedema tarda. We emphasize the use of histopathologic examination in the diagnostic algorithm to rule out underlying malignant process only in patients with radionuclide findings suggestive of secondary lymphedema with no obvious etiology. Images Figure 1 Figure 2 PMID:16080675

  19. Compulsive masturbation and chronic penile lymphedema.

    PubMed

    Calabrò, Rocco Salvatore; Galì, Alessandro; Marino, Silvia; Bramanti, Placido

    2012-06-01

    Chronic penile lymphedema arises from the abnormal retention of lymphatic fluid in the subcutaneous tissues and may be secondary to local and systemic medical conditions such as sexually transmitted diseases, filariasis, malignancy, local radiotherapy, and surgery. This case report aims to consider compulsive masturbation as a possible cause of chronic penile edema. A 40-year-old man was referred to our institute for behavioral disturbance, including compulsive masturbation. Neuropsychiatric evaluation showed moderate mental retardation, mild dysarthria and limb incoordination, anxiety, depressed mood, and impulse dyscontrol. Brain MRI pointed out diffuse white matter lesions. Urogenital examination revealed an uncircumcised penis with non-tender edema of the shaft and prepuce with areas of lichenification. Since the most common local and systemic causes of edema were excluded, chronic penile edema due to compulsive masturbation was diagnosed and the compulsive behavior treated with an antidepressant and low-dose neuroleptics. Compulsive masturbation should be taken into account when counselling patients with penile edema.

  20. Post-Exposure Prophylaxis

    MedlinePlus

    ... is at Risk for HIV? Related Topics on AIDS.gov Pre-Exposure Prophylaxis (PrEP) Additional Resources CDC ... Prevent HIV Infection Last revised: 09/21/2015 AIDS.gov HIV/AIDS Basics • Federal Resources • Using New ...

  1. Lymphedema: Incidence, Time Course, and Etiology in Long-term Survivors of a Breast Cancer Cohort

    DTIC Science & Technology

    1997-03-01

    Barring recurrence, lymphedema is the most dreaded sequelae of breast cancer treatment. Nevertheless, there have been no cohort studies or... lymphedema in these long-term survivors was 27%, whereas 11 % had lymphedema causing a 2 inch greater circumference on the treated side. Of the 28...factors evaluated, only two were statistically significantly associated with lymphedema : the history of infection or injuries requiring antibiotics and

  2. 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.

  3. Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast Cancer

    DTIC Science & Technology

    2006-09-01

    AD_________________ Award Number: DAMD17-03-1-0622 TITLE: Assessment of Lymphedema Risk Following...10 Aug 2006 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for...13. SUPPLEMENTARY NOTES Original contains colored plates: ALL DTIC reproductions will be in black and white. 14. ABSTRACT Lymphedema

  4. Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast Cancer

    DTIC Science & Technology

    2005-09-01

    AD_________________ Award Number: DAMD17-03-1-0622 TITLE: Assessment of Lymphedema Risk...TITLE AND SUBTITLE Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation 5a. CONTRACT NUMBER Therapy for Primary Breast Cancer...ABSTRACT: Lymphedema is a common complication of primary breast cancer therapy. It is a chronic, insidiously progressive, and potentially

  5. Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast Cancer

    DTIC Science & Technology

    2010-09-01

    AD_________________ Award Number: DAMD17-03-1-0622 TITLE: Assessment of Lymphedema Risk Following...REPORT TYPE Annual Summary 3. DATES COVERED 11 August 2009 – 10 August 2010 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Assessment of Lymphedema ...STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Lymphedema is a common, chronic, and

  6. Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast Cancer

    DTIC Science & Technology

    2011-03-01

    AD_________________ Award Number: DAMD17-03-1-0622 TITLE: Assessment of Lymphedema Risk Following...TYPE Annual Summary 3. DATES COVERED 11 August 2003 – 10 February 2011 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Assessment of Lymphedema Risk...Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Lymphedema is a common, chronic, and potentially

  7. [Perioperative antibiotic prophylaxis in cancer surgery].

    PubMed

    Vilar-Compte, Diana; García-Pasquel, María José

    2011-01-01

    The effectiveness of perioperative antibiotic prophylaxis in reducing surgical site infections has been demonstrated. Its utility is recognized for clean-contaminated procedures and some clean surgeries. Prophylactic antibiotics are used as intended to cover the most common germs in the surgical site; first and second generation cephalosporins are the most used. For optimal prophylaxis, an antibiotic with a targeted spectrum should be administered at sufficiently high concentrations in serum, tissue, and the surgical wound during the time that the incision is open and risk of bacterial contamination. The infusion of the first dose of antimicrobial should begin within 60 min before surgical incision and should be discontinued within 24 h after the end of surgery The prolonged use of antibiotic prophylaxis leads to emergence of bacterial resistance and high costs. The principles of antimicrobial prophylaxis in cancer surgery are the same as those described for general surgery; it is recommended to follow and comply with the standard criteria. In mastectomies and clean head and neck surgery there are specific recommendations that differ from non-cancer surgery. In the case of very extensive surgeries, such as pelvic surgery or bone surgery with reconstruction, extension of antibiotics for 48-72 h should be considered.

  8. Upper limb swelling following mastectomy: lymphedema or not?

    PubMed

    Armer, Jane

    2007-04-01

    Having experienced an excisional biopsy, sentinel lymph node biopsy, and mastectomy, BH is at lifetime risk of developing post-breast cancer lymphedema in the arm on the side where her breast cancer was treated. She has two additional risk factors, among those documented in the literature: history of an infection (specifically a systemic infection, significant in that it required hospitalization for intravenous antibiotics) in the postsurgery period, and a moderate increase in bilateral limb volume and weight (body mass index) over the months and years following the breast cancer diagnosis. Further, the patient-reported transient hand swelling on the affected side and gradual weight increase are cues indicating a need for patient vigilance and careful monitoring by the health-care team. Preventing future infections, managing weight at an optimal level, and preventing trauma or injury to the affected arm and chest are important self-management precautions to reduce risk of chronic lymphedema development. BH needs continued support in reviewing evidence-based risk-reduction guidelines and understanding ways to apply them to her lifestyle. In the absence of preoperative baseline or contralateral limb measurements (with circumferences or perometry or water displacement), assessment of limb change at a level identified as diagnostic of lymphedema (commonly, 200-mL volume or 2-cm girth increase from baseline or as compared to the contralateral limb) is very challenging. Without bilateral preop limb measurements for baseline and contralateral limb comparisons, BH might have been diagnosed with lymphedema at postop or at 48 months, when both limbs increased symmetrically. Symptom assessment is also crucial, as symptom report of heaviness and swelling is found to be associated with limb volume changes indicative of lymphedema. Transient hand swelling may be evidence of latent lymphedema and cause for increased risk-reduction education and vigilance in assessment for

  9. Insights into the molecular pathogenesis and targeted treatment of lymphedema.

    PubMed

    Saaristo, Anne; Karkkainen, Marika J; Alitalo, Kari

    2002-12-01

    Abnormal function of the lymphatic vessels is associated with a variety of diseases, such as tumor metastasis and lymphedema. The development of strategies for local and controlled induction or inhibition of lymphangiogenesis would thus be of major importance for the treatment of such diseases. Two growth factors, vascular endothelial growth factor C (VEGF-C) and D (VEGF-D), have been found to be important in the proper formation and maintenance of the lymphatic network, through their receptor VEGFR-3. In patients with lymphedema, heterozygous inactivation of VEGFR-3 leads to primary lymphedema due to defective lymphatic drainage in the limbs. We have shown that VEGF-C gene transfer to the skin of mice with lymphedema induces regeneration of the cutaneous lymphatic vessel network. However, as is the case with VEGF, high levels of VEGF-C cause blood vessel growth and leakiness, resulting in tissue edema. Strategies to avoid these side-effects have also been developed. This new field of reseach has important implications for the development of new therapies for human lymphedema.

  10. 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

  11. Sexual partnerships and considerations for HIV antiretroviral pre-exposure prophylaxis utilization among high-risk substance using men who have sex with men.

    PubMed

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

    2014-01-01

    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 of HIV infection among MSM is use of "recreational" drugs that are highly associated with unprotected anal sex. Pre-exposure chemoprophylaxis (PrEP) is a novel biomedical HIV prevention 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.

  12. 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.

  13. 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.

  14. An easy method for diagnosis of lymphedema.

    PubMed

    Richards, T B; McBiles, M; Collins, P S

    1990-05-01

    Lymphoscintigraphy has been very useful in determination of lymphatic abnormalities. However, the radioactive isotopes used have been investigational and difficult obtain. The purpose of this study was to examine patients with extremity edema by lymphoscintigraphy using a radioactive colloid readily available in our nuclear pharmacy, Technetium 99m sulfur minicolloid. Forty limbs in 20 patients were evaluated using Technetium 99m sulfur minicolloid lymphoscintigraphy. All patients had lower extremity edema initially attributed to a venous or lymphatic etiology. There were 12 patients with normal bilateral studies. Seven patients exhibited unilateral obstruction to lymphatic flow, and one had unilateral enhanced flow of lymph. Those with normal studies included five patients with nonspecific edema, four with varicosities, and one patient each with acute deep vein thrombosis, chylous ascites, and excision of the greater saphenous vein for arterial bypass grafting. Five patients with obstructed patterns had previous arterial bypass procedures, one had trauma to the extremity, and one had lymphedema tarda. The one enhanced lymphoscintigraphic pattern was seen in a patient with acute cellulitis. All patients had Doppler venous examinations and other studies included strain gauge phlethysmography, venograms, computed tomography, magnetic resonance imaging, and ultrasound. As with other scintigraphic imaging agents used to study lymphatic flow, Technetium 99m provides clinically useful information in evaluating the swollen extremity noninvasively.

  15. 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

  16. Evaluation of azithromycin, trovafloxacin and grepafloxacin as prophylaxis for experimental murine melioidosis.

    PubMed

    Kenny, Dermot J; Sefton, Armine M; Brooks, Timothy J G; Laws, Thomas R; Simpson, Andrew J H; Atkins, Helen S

    2010-07-01

    The efficacies of the azalide azithromycin and the fluoroquinolones trovafloxacin and grepafloxacin for pre- and post-exposure prophylaxis of infection with high or low challenge doses of Burkholderia pseudomallei strain 576 were assessed in an experimental mouse model. Trovafloxacin and grepafloxacin afforded significant levels of protection, whereas azithromycin was ineffective and potentially detrimental. Overall, the data suggest that some fluoroquinolones may have potential utility in prophylaxis of melioidosis and suggest that azithromycin would not be effective in prophylaxis of B. pseudomallei infection.

  17. 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

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. Blocking of the Lymphatic Vessel in Lymphedema

    PubMed Central

    Mihara, Makoto

    2017-01-01

    Objective: In this case report, we present a case wherein we observed a blocking of lymphatic vessels in indocyanine green lymphography and found a shrunken lymphatic vessel intraoperatively. Methods: We performed indocyanine green lymphography and lymphaticovenous anastomosis on a 77-year-old woman. She had previously undergone right mastectomy and axillary lymph node dissection accompanied by radiotherapy and chemotherapy for right breast cancer. She noticed swelling in the right upper limb 22 years after the surgery and consulted our hospital. Although she started wearing elastic sleeve, there was still stiffness in the right upper limb, and we decided to perform lymphaticovenous anastomosis 5 months after the first consultation. Results: In the preoperative indocyanine green lymphography, we observed a linear pattern in the medial side of the right forearm, which suddenly blocked in the middle of the forearm. At that point, we observed dilated lymphatic vessels that were suddenly shrunken at the proximal side intraoperatively. We performed lymphaticovenous anastomosis with the dilated part of this lymphatic vessel. We also performed 4 additional lymphaticovenous anastomoses. The operation time was 2 hours 10 minutes, and the amount of bleeding was minimal. The right upper limb of the patient got softer, and she was satisfied with the result 3 months after the operation. The average circumference change at the 5 points in the right upper limb was −1.26 cm (range, −2.3 to −0.3 cm). Conclusions: There was a possibility that the blocking of the lymphatic vessels was a cause of lymphedema in the upper extremity.

  3. Rationale for a randomized controlled trial comparing two prophylaxis regimens in adults with severe hemophilia A: the Hemophilia Adult Prophylaxis Trial.

    PubMed

    Ragni, Margaret V

    2011-10-01

    A major goal of comprehensive hemophilia care is to prevent occurrence of bleeds by prophylaxis or regular preventive factor, one or more times weekly. Although prophylaxis is effective in reducing bleeding and joint damage in children, whether it is necessary to continue into adulthood is not known. The purpose of this article is to describe a Phase III randomized controlled trial to evaluate prophylaxis comparing two dose regimens in adults with severe hemophilia A. I hypothesize that adults with mature cartilage and joints are less susceptible to joint bleeds and joint damage, and that once-weekly recombinant factor VIII prophylaxis, with up to two rescue doses per week, is as effective as thrice-weekly prophylaxis in reducing bleeding frequency, but less costly and more acceptable, with higher quality of life. The ultimate goal of this project is to determine whether once-weekly prophylaxis is any worse than thrice-weekly prophylaxis in reducing joint bleeding frequency, while potentially utilizing less factor, at lower cost, leading to a better quality of life. This is an innovative concept, as it challenges the current paradigm of thrice-weekly prophylaxis in adults, which is based on dosing in children. Furthermore, this trial will assess interdose thrombin generation, a novel tissue factor-based assay of hemostasis, to determine if individualized thrombin generation can predict more individualized prophylaxis dosing, which would be practice changing.

  4. Lymphaticovenous Anastomosis Releases the Lower Extremity Lymphedema-associated Pain

    PubMed Central

    Hara, Hisako; Zhou, Han Peng; Tange, Shuichi; Kikuchi, Kazuki

    2017-01-01

    Background: We investigate the effectiveness of lymphaticovenous anastomosis (LVA) in releasing lymphedema-associated pain. Methods: We performed a retrospective analysis. Subjects of this study included lower extremity lymphedema patients who presented persistent and constant degrees of pain in their lower limbs. LVA was performed under local anesthesia. The preoperative lower extremity pain and postoperative lower extremity pain were surveyed using the visual analog scale on a score from 0 to 10. The circumferences of the limbs were also recorded. Results: A total of 8 patients (16 lower limbs) were included. The subjects included 1 man and 7 women, and their average age was 72 years. The average follow-up period was 17 months. The average preoperative and postoperative visual analog scale scores were 5.3 and 1.8, respectively. Moreover, 7 patients who had records of their lower extremity circumference observed an average changing rate of −4.7% in lower extremity lymphedema index after the surgery. Conclusion: LVA can release the pain in the affected limbs of lymphedema. PMID:28203506

  5. 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…

  6. 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

  7. Venous Thromboembolism Prophylaxis

    PubMed Central

    Laryea, Jonathan; Champagne, Bradley

    2013-01-01

    Venous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measure in most mandated quality initiatives. The measures for prevention of VTE include mechanical methods (graduated compression stockings and intermittent pneumatic compression devices) and pharmacologic agents. A combination of mechanical and pharmacologic methods produces the best results. Patients undergoing surgery should be stratified according to their risk of VTE based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prophylaxis should be commensurate with the risk of VTE based on the composite risk profile. PMID:24436666

  8. Venous thromboembolism prophylaxis.

    PubMed

    Laryea, Jonathan; Champagne, Bradley

    2013-09-01

    Venous thromboembolism (VTE) can occur after major general surgery. Pulmonary embolism is recognized as the most common identifiable cause of death in hospitalized patients in the United States. The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) is higher in colorectal surgical procedures compared with general surgical procedures. The incidence of venous thromboembolism in this population is estimated to be 0.2 to 0.3%. Prevention of VTE is considered a patient-safety measure in most mandated quality initiatives. The measures for prevention of VTE include mechanical methods (graduated compression stockings and intermittent pneumatic compression devices) and pharmacologic agents. A combination of mechanical and pharmacologic methods produces the best results. Patients undergoing surgery should be stratified according to their risk of VTE based on patient risk factors, disease-related risk factors, and procedure-related risk factors. The type of prophylaxis should be commensurate with the risk of VTE based on the composite risk profile.

  9. 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

  10. Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast Cancer

    DTIC Science & Technology

    2004-09-01

    AD_ Award Number: DAMD17-03-1-0622 TITLE: Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast...NUMBERS Assessment of Lymphedema Risk Following Lymph Node DAMDI7-03-1-0622 Dissection and Radiation Therapy for Primary Breast Cancer 6. AUThOR(S...axillary lymph nodes critical for upper extremity drainage predicts the development of lymphedema . In addition to funding this research project, the

  11. Lymphatic Regeneration Within Porous VEGF-C Hydrogels for Secondary Lymphedema

    DTIC Science & Technology

    2004-07-01

    AD Award Number: DAMD17-01-1-0152 TITLE: Lymphatic Regeneration Within Porous VEGF-C Hydrogels for Secondary Lymphedema PRINCIPAL INVESTIGATOR...Lymphatic Regeneration Within Porous VEGF-C Hydrogels for DAMD17-01-1-0152 Secondary Lymphedema 6. A UTHOR(S) Mauricio A. Contreras, M.D. 7. PERFORMING...ABSTRACT (Maximum 200 Words) Introduction: Lymphedema is an abnormal swelling, in which lymph production exceeds drainage capabilities. This occurs as a

  12. Lymphatic Regeneration within Porous VEGF-C Hydrogels for Secondary Lymphedema

    DTIC Science & Technology

    2006-01-01

    VEGF-C Hydrogels for Secondary Lymphedema PRINCIPAL INVESTIGATOR: Mauricio A. Contreras, M.D. CONTRACTING ORGANIZATION: Beth...for Secondary 5a. CONTRACT NUMBER Lymphedema 5b. GRANT NUMBER DAMD17-01-1-0152 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT... Lymphedema is an abnormal swelling, in which lymph production exceeds drainage capabilities. This occurs as a result of lymphatic vesdestruction during the

  13. Regulatory T cell transfer ameliorates lymphedema and promotes lymphatic vessel function

    PubMed Central

    Gousopoulos, Epameinondas; Proulx, Steven T.; Bachmann, Samia B.; Scholl, Jeannette; Dionyssiou, Dimitris; Demiri, Efterpi; Halin, Cornelia; Dieterich, Lothar C.

    2016-01-01

    Secondary lymphedema is a common postcancer treatment complication, but the underlying pathological processes are poorly understood and no curative treatment exists. To investigate lymphedema pathomechanisms, a top-down approach was applied, using genomic data and validating the role of a single target. RNA sequencing of lymphedematous mouse skin indicated upregulation of many T cell–related networks, and indeed depletion of CD4+ cells attenuated lymphedema. The significant upregulation of Foxp3, a transcription factor specifically expressed by regulatory T cells (Tregs), along with other Treg-related genes, implied a potential role of Tregs in lymphedema. Indeed, increased infiltration of Tregs was identified in mouse lymphedematous skin and in human lymphedema specimens. To investigate the role of Tregs during disease progression, loss-of-function and gain-of-function studies were performed. Depletion of Tregs in transgenic mice with Tregs expressing the primate diphtheria toxin receptor and green fluorescent protein (Foxp3-DTR-GFP) mice led to exacerbated edema, concomitant with increased infiltration of immune cells and a mixed TH1/TH2 cytokine profile. Conversely, expansion of Tregs using IL-2/anti–IL-2 mAb complexes significantly reduced lymphedema development. Therapeutic application of adoptively transferred Tregs upon lymphedema establishment reversed all of the major hallmarks of lymphedema, including edema, inflammation, and fibrosis, and also promoted lymphatic drainage function. Collectively, our results reveal that Treg application constitutes a potential new curative treatment modality for lymphedema. PMID:27734032

  14. [Levofloxacin prophylaxis in neutropenic patients].

    PubMed

    Carena, Alberto A; Jorge, Laura; Bonvehí, Pablo; Temporiti, Elena; Zárate, Mariela S; Herrera, Fabián

    2016-01-01

    Fluorquinolone-prophylaxis has proven useful in preventing infections in high risk neutropenic patients. The objective of this study was to describe the clinical, microbiological and therapeutic characteristics, and outcome of patients in the first episode of febrile neutropenia, comparing those who received levofloxacin prophylaxis with those who didn't. It was a prospective observational study that included all the episodes of inpatients with febrile neutropenia (February 1997- November 2014), also including the first episode in a same patient in different hospitalizations. Of 946 episodes here included, 821 presented high risk febrile neutropenia. A total of 264 cases (27.9%) received levofloxacin prophylaxis. This group consisted of a higher proportion of high risk febrile neutropenia (99.2% vs. 82.3%, p = 0.0001) and patients that had received an hematopoietic stem cell transplant (67.8% vs. 29.3%, p = 0.0001) compared to those who didn't receive prophylaxis. Those who received levofloxacin prophylaxis presented a similar frequency of clinically diagnosed but a lower proportion of microbiologically documented infections (28.8% vs. 37.5%, p = 0.012) than those who didn't receive prophylaxis. The episodes of bacteremia that occurred in the first group were more frequently caused by multidrug resistant bacteria (MDRB) (34.5% vs. 17.3%, p = 0.007) and by extended spectrum beta lactamase producing Enterobacteriaceae (19% vs. 3.8%, p = 0.0001). The group that received prophylaxis had a lower proportion of adequate empirical antibiotic treatment (69.7% vs. 83.7%, p = 0.009), with similar outcomes in both groups. We suggest that levofloxacin prophylaxis should be stopped whenever there is a rise in the frequency of MDRB infections in this population.

  15. Cognitive-Affective Predictors of the Uptake & Sustained Adherence to Lymphedema Symptom Minimization Practices in Breast Cancer Survivors

    DTIC Science & Technology

    2007-08-01

    Uptake of, & Sustained Adherence to Lymphedema Symptom Minimization Practices in Breast Cancer Survivors PRINCIPAL INVESTIGATOR: Suzanne M. Miller...SUBTITLE 5a. CONTRACT NUMBER Cognitive-Affective Predictors of the Uptake of, & Sustained Adherence to Lymphedema Symptom Minimization Practices in...SUPPLEMENTARY NOTES 14. ABSTRACT Approximately 20-30% of women develop lymphedema (LE) following breast cancer treatment. Effective symptom management

  16. Bacterial endocarditis prophylaxis.

    PubMed

    Blanco-Carrión, Andrés

    2004-01-01

    Bacterial endocarditis (BE) is a disease resulting from the association of morphological alterations of the heart and bacteraemia originating from different sources that at times can be indiscernible (infectious endocarditis). It is classified on the basis of the morphological alteration involved, depending on the clinical manifestations and course of illness, which varies according to the causative microorganism and host conditions (for example, it is characteristic in I.V. drug users). The most common microorganisms involved are: Streptococcus viridans (55%), Staphylococcus aureus (30%), Enterococcus (6%) and HACEK bacteria (corresponding to the initials: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella and Kingella), although on occasions it can also be caused by fungi. The oral microbiological flora plays a very important role in the aetiopathogenesis of BE, given that the condition may be of oral or dental origin. This paper will deal with the prevention of said bacteraemia. Prophylaxis will be undertaken using amoxicillin or clindamycin according to action protocols, with special emphasis placed on oral hygiene in patients with structural defects of the heart.

  17. Adaptive Immune Responses Regulate the Pathophysiology of Lymphedema

    DTIC Science & Technology

    2012-09-01

    ketoprofen ameliorates experimental lymphatic vascular insufficiency in mice. PLoS One 4: e8380. 40. Goldman j, Rutkowski J, Shields J, Pasquier M, Cui Y...using ketoprofen , a non-steroidal anti-inflammatory medication, markedly improves lymphatic function and decreases lymphedema in the mouse tail model...inflammatory pharmacotherapy with ketoprofen ameliorates experimental lymphatic vascular insufficiency in mice. PLoS One 4: e8380. 30. Winer S, Chan Y

  18. Acupuncture in the Treatment of Upper-Limb Lymphedema

    PubMed Central

    Cassileth, Barrie R; Van Zee, Kimberly J; Yeung, K Simon; Coleton, Marci I; Cohen, Sara; Chan, Yi H; Vickers, Andrew J; Sjoberg, Daniel D; Hudis, Clifford A

    2013-01-01

    BACKGROUND Current treatments for lymphedema after breast cancer treatment are expensive and require ongoing intervention. Clinical experience and our preliminary published results suggest that acupuncture is safe and potentially useful. This study evaluates the safety and potential efficacy of acupuncture on upper-limb circumference in women with lymphedema. METHODS Women with a clinical diagnosis of breast cancer−related lymphedema (BCRL) for 0.5-5 years and with affected arm circumference ≥2 cm larger than unaffected arm received acupuncture treatment twice weekly for 4 weeks. Affected and unaffected arm circumferences were measured before and after each acupuncture treatment. Response, defined as ≥30% reduction in circumference difference between affected/unaffected arms, was assessed. Monthly follow-up calls for 6 months thereafter were made to document any complications and self-reported lymphedema status. RESULTS Among 37 enrolled patients, 33 were evaluated; 4 discontinued due to time constraints. Mean reduction in arm circumference difference was 0.90 cm (95% CI, 0.72-1.07; P < .0005). Eleven patients (33%) exhibited a reduction of ≥30% after acupuncture treatment. Seventy-six percent of patients received all treatments; 21% missed 1 treatment, and another patient missed 2 treatments. During the treatment period, 14 of the 33 patients reported minor complaints, including mild local bruising or pain/tingling. There were no serious adverse events and no infections or severe exacerbations after 255 treatment sessions and 6 months of follow-up interviews. CONCLUSIONS Acupuncture for BCRL appears safe and may reduce arm circumference. Although these results await confirmation in a randomized trial, acupuncture can be considered for women with no other options for sustained arm circumference reduction. Cancer 2013;119:2455-2461. © 2013 American Cancer Society. PMID:23576267

  19. Relapse of Yellow Nail Syndrome with Pulmonary Lymphedema.

    PubMed

    Morimoto, Kozo; Saraya, Takeshi; Kurosaki, Atsuko; Yano, Ryozo; Sasaki, Yuka; Osawa, Takeshi; Kudoh, Shoji; Goto, Hajime

    2016-01-01

    Yellow nail syndrome (YNS) is a rare disorder characterized by the triad of yellow, thickened nails, lymphedema, and respiratory manifestations such as pleural effusions, bronchiectasis, and recurrent lower respiratory tract infections. We report a case of YNS showing pulmonary interlobular septal thickening on thoracic computed tomography, implying the presence of lymphatic edema. The patient showed both the remission and relapse of yellow nail with different lung treatments over a long clinical course.

  20. Lymphedema of the lower extremities: Evaluation by microcolloidal imaging

    SciTech Connect

    Intenzo, C.M.; Desai, A.G.; Kim, S.S.; Park, C.H.; Merli, G.J. )

    1989-02-01

    Contrast lymphangiography has been the traditional radiographic method for imaging the lymphatic system of the lower extremities. Because of the difficulty in performing the procedure and its potential side effects, radionuclide lymphangiography is a safe and reliable alternative. Technetium-99m labeled to antimony trisulfide colloid was used in nine patients presenting with lymphedema of the lower extremities. The procedure was relatively simple to perform, and no adverse effects were noted.

  1. Health care seeking behavior of Korean women with lymphedema.

    PubMed

    Cho, Myoung Ok

    2004-06-01

    The present biocultural study aimed to describe the health care use patterns of women with lymphedema. Data came from interviews and participant observations with eight key informants between February 2000 and February 2002. Analyzing the process of seeking health care, this paper explored how Korean women with lymphedema make use of all the available resources in the three sectors of the health care system: professional, folk and popular health. In these three sectors of the health care system, informants showed different patterns of behavior. In the professional health care sector, they behave based on scientific Western medicine and holistic herbal medical frameworks. Informants want scientific technological treatment from a Westernized doctor and perfect humanistic and holistic treatment from a herbal doctor. In the folk sector, informants' behavior is ruled by a pragmatic and supernatural framework. Informants seek religious healers who have strong spirituality and non-religious healers who have experience and skills. Informants complied with these healer's remedies based on efficacy and empirical healing evidence. In the popular sector of the health care system, informants behave based on their concept of illness and rules of daily life. They believe lymphedema comes from poor blood circulation and they want to be regarded as members of society, not as patients with lymphedema. Therefore, informants practised popular remedies that they believed were good for promoting blood circulation and keeping their social network active. This description about health care seeking behaviors being embedded in Korean socio-medical culture can serve to understand patients with other chronic health problems. With these results, we can put a bridge over the river of cultural conflict between health professionals and patients.

  2. Treating chronic lower limb lymphedema with the Charles procedure in a renal allograft recipient.

    PubMed

    Wu, Hsiao-Su; Cheng, Hsu-Tang; Chen, Hung-Chi

    2012-01-01

    We report our experience in applying the Charles procedure to a female renal allograft recipient for her left lower leg lymphedema. This is a rare comorbidity in limb lymphedema victims, and the use of the Charles procedure has not been reported in such an immunocompromised patient. After surgery, infection was well controlled, and there was minimal scar in the affected limb.

  3. 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

  4. [Antibiotic prophylaxis in colorectal surgery].

    PubMed

    Dellamonica, P; Bernard, E

    1994-01-01

    In elective colorectal surgery, the benefit of preoperative antibiotic prophylaxis is well established, with a reduction in wound infection rate to less than 10%. The antimicrobial agent used has to be active against aerobic and anaerobic pathogens such as Escheria coli and Bacteriodes fragilis. The efficacy of three schemes of administration: oral and/or parenteral prophylaxis associated with a mechanical preparation, has been demonstrated. Oral antibiotic administration is current practice in USA; the most widely used oral regimen is the combination of erythromycin and neomycin given the day before surgery. Parenteral prophylaxis with a cephalosporin active against Bacteriodes fragilis such as cefoxitin and cefotetan, is preferred in Europe. The issue of whether a systemic prophylaxis should be added to the oral regimen or not has not yet been resolved. However it seems that the association should be proposed in various situations: patients with a high risk factors score (rectal resection and operations lasting more than three hours), patients with incomplete mechanical preparation, delay of the onset of surgery after the last oral dose.

  5. Peripheral Polyneuropathy and Mefloquine Prophylaxis

    PubMed Central

    Chester, Alexander C.; Sandroni, Paola

    2011-01-01

    We describe a case of a woman who developed a peripheral polyneuropathy shortly after completing 4 weekly doses of mefloquine hydrochloride (250 mg) malaria prophylaxis. Although mefloquine-related central nervous system neuropathy is well described in the literature, peripheral polyneuropathy similar to this case has been documented only once before, to our knowledge. PMID:22144435

  6. 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

  7. 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.

  8. Skeletal Scintigraphy in Radiation-Induced Fibrosis With Lymphedema.

    PubMed

    Wang, Jieqi; Iranmanesh, Arya M; Oates, M Elizabeth

    2017-03-01

    Despite increasing reliance on CT, MRI, and FDG PET/CT for oncological imaging, whole-body skeletal scintigraphy remains a frontline modality for staging and surveillance of osseous metastatic disease. We present a 54-year-old woman with metastatic breast cancer who received palliative external-beam radiation to the left ilium. Serial follow-up Tc-MDP bone scans demonstrated progressive soft-tissue uptake in her left lower extremity, extending from thigh to leg, with associated enlargement and skin thickening, consistent with lymphedema related to radiation-induced fibrosis. Correlative abdominopelvic CT scans confirmed fibrotic changes in the left thigh.

  9. 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

  10. Severe lower limbs lymphedema of late onset revealing polysplenia syndrome--a case report.

    PubMed

    Granel, B; Serratrice, J; Juhan, V; Champsaur, P; Weiller-Merli, C; Pache, X; Swiader, L; Disdier, P; Weiller, P J

    2001-06-01

    Polysplenia syndrome includes a group of congenital abnormalities involving the spleen, gastrointestinal tract, liver, and cardiovascular system. A case of severe lower limbs lymphedema occurring in a young woman with polysplenia, azygous continuation of the inferior vena cava, short pancreas, and preduodenal portal vein is reported. Lower limb lymphedema could represent a new clinical manifestation associated with polysplenia syndrome. Lymphedema could be the result of a primary anomaly of the lymphatic system or be induced by high pressure in the venous system or by compression of the lymphatic circulation by the hypertrophic azygous vessels in the posterior mediastinum.

  11. 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

  12. 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

  13. Prophylaxis for the International Traveller

    PubMed Central

    MacPherson, D. W.

    1985-01-01

    Travellers should know as much as possible about the quality of food and drink in the areas of travel, and be prepared with safety measures if necessary. Routine immunization should be up to date; cholera and yellow fever vaccinations are required for travel to certain areas. Such prophylaxis should be sought, ideally, several months before departure. Resurgences of malaria are occurring in areas where the disease had previously been controlled, making prophylaxis essential for travel to endemic areas. Other mild disorders may be treated with medication appropriate to the type of travel and area. Patients may appreciate cautionary advice about behavior, to lessen the likelihood of physical or social harm. ImagesFig. 3Fig. 4 PMID:21274123

  14. Antifungal Prophylaxis in Immunocompromised Patients

    PubMed Central

    Vazquez, Lourdes

    2016-01-01

    Invasive fungal infections (IFIs) represent significant complications in patients with hematological malignancies. Chemoprevention of IFIs may be important in this setting, but most antifungal drugs have demonstrated poor efficacy, particularly in the prevention of invasive aspergillosis. Antifungal prophylaxis in hematological patients is currently regarded as the gold standard in situations with a high risk of infection, such as acute leukemia, myelodysplastic syndromes, and autologous or allogeneic hematopoietic stem cell transplantation. Over the years, various scientific societies have established a series of recommendations for antifungal prophylaxis based on prospective studies performed with different drugs. However, the prescription of each agent must be personalized, adapting its administration to the characteristics of individual patients and taking into account possible interactions with concomitant medication. PMID:27648203

  15. 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

    2016-04-20

    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.

  16. 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.

  17. Primary Congenital Lymphedema Complicated by Hydrops Fetalis: A Case Report and Review of the Literature

    PubMed Central

    Connell, Matthew

    2013-01-01

    Introduction. Primary congenital lymphedema is a rare disorder associated with insufficient development of lymphatic vessels. Usually most patients present with lower extremity edema seen sonographically. Rarely primary congenital lymphedema may be associated with severe lymphatic dysfunction resulting in hydrops fetalis. Case. A 27-year-old primigravida with a family history of leg swelling throughout multiple generations was diagnosed early in the third trimester with hydrops fetalis. Delivery was undertaken at 32 weeks for nonreassuring fetal status and the infant expired at approximately 45 minutes of life. Primary congenital lymphedema was confirmed via molecular testing of the vascular endothelial growth factor receptor-3 gene. Discussion. The diagnosis of PCL is suspected prenatally when ultrasound findings coincide with a positive family history of chronic lower limb lymphedema. Isolated PCL is rarely associated with significant complications. Rarely, however, widespread lymphatic dysplasia may occur, possibly resulting in nonimmune hydrops fetalis. PMID:23533860

  18. Assessment of Lymphedema Risk Following Lymph Node Dissection and Radiation Therapy for Primary Breast Cancer

    DTIC Science & Technology

    2007-09-01

    after sector resection and axillary dissection with or without postoperative radiotherapy in breast cancer stage I. Results from a randomized trial...distress after surgery for beast cancer. Can J Surg 1993;36:315-20. Meek, AG. Breast radiotherapy and lymphedema. Cancer. 1998 Dec 15;83(12 Suppl...However, SPECT/CT may have this capacity, allowing for contoured, LN sparing -radiation with minimal lymphedema risk. Methods: Prior to radiation

  19. Frequency of Early-Stage Lymphedema and Risk Factors in Postoperative Patients with Breast Cancer

    PubMed Central

    Soyder, Aykut; Taştaban, Engin; Özbaş, Serdar; Boylu, Şükrü; Özgün, Hedef

    2014-01-01

    Objective Lymphedema is a chronic major complication that is seen frequently post-operatively and has negative effects on quality of life. In our study, determining the early-stage postoperative lymphedema frequency and specifying the risk factors in its development has been aimed. Materials and Methods One hundred one cases that were operated on for breast cancer were evaluated regarding the 12-month control of their clinical specifications, histopathological specifications, and specifications related with the surgical intervention retrospectively. The data related to the parameters envisioned as risk factors were evaluated. Results Lymphedema development was found in 7 (6.9%) out of 101 cases constituting the study group. No significant difference (p>0.05) in terms of lymphedema development was determined among age, body mass index (BMI), chemotherapy (CT), postoperative seroma or infection, mastectomy with the dominant arm, and breast-conserving surgery (BCS), which were evaluated as risk factors. There was a significance (p<0.05) between the other risk factors, which were axillary dissection (AD), number of positive lymph nodes (LN), radiotherapy (RT), the tumor size (T), and lymphedema existence. In every case in which lymphedema was determined, it was seen that there was axillary LN involvement and 15≤LN were ablated in the dissection (p<0.05). Conclusion It is seen that AD, RT applied to the breast cancer patients, and T are important risk factors in early-stage lymphedema development. No early-stage lymphedema development was determined in any of the patients to whom sentinel lymph node dissection (SLND) was applied.

  20. Cognitive-Affective Predictors of the Uptake of, and Sustained Adherence to, Lymphedema Symptom Minimization Practices in Breast Cancer Survivors

    DTIC Science & Technology

    2005-08-01

    Adherence to, 5b. GRANT NUMBER Lymphedema Symptom Minimization Practices in Breast Cancer Survivors DAMD17-02-1-0382 5c. PROGRAM ELEMENT NUMBER 6...TERMS Breast cancer survivorship, Lymphedema , Prevention, Psychosocial Factors 16. SECURITY CLASSIFICATION OF: 17. LIMITATION 18. NUMBER 19a. NAME OF...Effective symptom management requires that women recognize early signs of lymphedema , and maintain precautionary practices over time.’ Data indicates

  1. Assessment of Risk Factors in Patients who presented to the Outpatient Clinic for Breast Cancer-Related Lymphedema

    PubMed Central

    Can, Aslı Gençay; Ekşioğlu, Emel; Bahtiyarca, Zeynep Tuba; Çakcı, Fatma Aytül

    2016-01-01

    Objective Lymphedema is one of the most debilitating outcomes of breast cancer treatment. We aimed to compare the demographic and clinical characteristics of breast cancer patients with and without lymphedema, to assess risk factors for lymphedema, and to evaluate treatment outcomes in lymphedema patients. Materials and Methods Demographic and clinical characteristics of 84 women with previous surgery for breast cancer who presented to the outpatient clinic between March 2014 and May 2015 were retrospectively extracted from patient records. Results Upper extremity lymphedema was detected in 34 of 84 patients (40.5%). The mean age, body mass index, the number of positive lymph nodes and the number of patients with postoperative radiotherapy were significantly higher among patients with lymphedema than those without (p<0.05). Educational level of patients with lymphedema was significantly lower than the other group (p<0.05). The correlation analysis revealed an association between age, educational level, body mass index, tumor stage, number of positive lymph nodes, postoperative radiotherapy and presence of lymphedema. Postoperative radiotherapy was detected as the only independent risk factor by logistic regression analysis. Fourteen out of 26 lymphedema patients were assigned to education, skin care, exercise and compression bandaging therapy. Upper extremity volumes and volume differences were significantly improved after treatment. Conclusion Advanced age, low educational level, obesity, tumor size, the number of positive lymph nodes and postoperative radiotherapy correlated with the development of lymphedema. Within these factors, postoperative radiotherapy was detected as an independent risk factor for the development of lymphedema. Patient education, skin care, exercise and compression bandage therapy are effective treatment options in breast cancer-related lymphedema. PMID:28331728

  2. Efficacy and safety of far infrared radiation in lymphedema treatment: clinical evaluation and laboratory analysis.

    PubMed

    Li, Ke; Zhang, Zheng; Liu, Ning Fei; Feng, Shao Qing; Tong, Yun; Zhang, Ju Fang; Constantinides, Joannis; Lazzeri, Davide; Grassetti, Luca; Nicoli, Fabio; Zhang, Yi Xin

    2017-01-26

    Swelling is the most common symptom of extremities lymphedema. Clinical evaluation and laboratory analysis were conducted after far infrared radiation (FIR) treatment on the main four components of lymphedema: fluid, fat, protein, and hyaluronan. Far infrared radiation is a kind of hyperthermia therapy with several and additional benefits as well as promoting microcirculation flow and improving collateral lymph circumfluence. Although FIR therapy has been applied for several years on thousands of lymphedema patients, there are still few studies that have reported the biological effects of FIR on lymphatic tissue. In this research, we investigate the effects of far infrared rays on the major components of lymphatic tissue. Then, we explore the effectiveness and safety of FIR as a promising treatment modality of lymphedema. A total of 32 patients affected by lymphedema in stage II and III were treated between January 2015 and January 2016 at our department. After therapy, a significant decrease of limb circumference measurements was noted and improving of quality of life was registered. Laboratory examination showed the treatment can also decrease the deposition of fluid, fat, hyaluronan, and protein, improving the swelling condition. We believe FIR treatment could be considered as both an alternative monotherapy and a useful adjunctive to the conservative or surgical lymphedema procedures. Furthermore, the real and significant biological effects of FIR represent possible future applications in wide range of the medical field.

  3. Diabetic Foot Ulcers Combination with Lower Limb Lymphedema Treated by Staged Charles Procedure: Case Report and Literature Review

    PubMed Central

    Lin, Chin-Ta; Ou, Kuang-Wen; Chang, Shun-Cheng

    2013-01-01

    Primary or secondary, lymphedema is lymphatic dysfunction which results in protein-rich interstitial fluid accumulated in the skin and subcutaneous tissue. In developed countries, surgical resection of regional lymph nodes or chronic inflammation process is the most common etiology of lymphedema instead of parasite infection seen in developing countries. Patients with lymphedema sustain either cosmetic or functional problems, and several studies have indicated the potential risk, though not high, transforming lymphedema to lymphangiosarcoma. Here we introduce a simple idea with staged Charles procedure by a case report to decrease the size of wound healing in each procedure and decreasing the rate of surgical complication. PMID:24353689

  4. "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.

  5. 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

  6. 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

  7. Hepatitis B reactivation and timing for prophylaxis

    PubMed Central

    Tuna, Nazan; Karabay, Oguz

    2015-01-01

    It is known that immunotherapy and cancer chemotherapy may cause hepatitis B virus (HBV) reactivation in hepatitis B surface antigen carriers and inactive chronic hepatitis B patients. Guidelines recommend antiviral prophylaxis regardless of HBV DNA levels to prevent reactivation. We read from the article written by Liu et al that Lamivudine was given inadequate time for antiviral prophylaxis. PMID:25717269

  8. 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

  9. 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

  10. [Antibiotic prophylaxis before kidney transplantation].

    PubMed

    Robles, N R; Gallego, E; Anaya, F; Franco, A; Valderrábano, F

    1990-02-01

    The effectiveness of antibiotic prophylaxis was evaluated in the immediate postoperative period of renal transplantation (RT). Before RT, the patients were randomly assigned to one of the following groups: 1) cefotaxime (intravenous infusion of 1 g one hour before the operation). 2) Ceftriaxone (1 g i.v. given in a similar way). 3) Control (without antibiotics). Patients who required antibiotic therapy during the first 3 postoperative weeks were excluded. 20 recipients of cadaveric renal grafts were included in each group. There were 39 males and 21 females with a mean age of 39.9 years. One patient from the cefotaxime group (5%), 2 from the ceftriaxone group (10%) and 2 from the control group (10%) developed infection of the surgical wound, all due to grampositive organisms. 19 patients had urinary tract infections: 7 from the control group (35%), 7 from the cefotaxime group (35%), and 5 from the ceftriaxone group (25%). The development of wound infection was not correlated with urea, creatinine, hemoglobin or total protein levels, or with urinary tract infection or fistula, diabetes or fever. The mean packed red cell volume of the patients who developed wound infection was 24.7 +/- 1.2 vs 28.6 +/- 6.6 in those who did not (p less than 0.01). All patients with visible hematoma and 3 of 10 with perirenal blood collection had wound infection. It was concluded that antibiotic prophylaxis for renal transplantation was useless in our patients.

  11. Animal Models of Secondary Lymphedema: New Approaches in the Search for Therapeutic Options.

    PubMed

    Hadrian, Rebecca; Palmes, Daniel

    2017-03-01

    Secondary lymphedema is still a worldwide problem. Symptomatic approaches to lymphedema therapy have been mainly used, with complete decongestive therapy as the cornerstone. Due to a lack of regenerative therapy, researchers have established various animal models to obtain insights into pathomechanisms and to reveal the best therapeutic option. Since the first reproducible and reliable animal model of lymphedema was reported in dogs, the technique of circumferential excision of lymphatic tissue has been translated mainly to rodents to induce secondary lymphedema. In these models, various promising pharmacological and surgical approaches have been investigated to improve secondary lymphedema therapy. Imaging modalities are crucial to detect the extent of lymphatic dysfunction and decide the best therapy. The gold standard of lymphoscintigraphy is currently limited by poor spatial resolution and lack of quantification. Animal models could help to bridge a gap in improving morphological correlation and quantifying lymphatic functionality. This review summarizes the animal models used in lymphatic research and focuses on new therapeutic options and requirements for imaging modalities to visualize the lymphatic system.

  12. Pneumatic compression devices for in-home management of lymphedema: two case reports

    PubMed Central

    2009-01-01

    The two patients in this case series had experienced long-term difficulty controlling lymphedema at home. Both patients had used numerous home therapies, including older-generation intermittent pneumatic compression devices, without success. The Flexitouch® system, an advanced pneumatic device, was prescribed to assist them with in-home efforts by providing therapy to their affected limbs in addition to the lower trunk area for the patient with lymphedema of the lower extremity; and the trunk, chest wall, and shoulder areas for the patient with lymphedema of the upper extremity. Both patients achieved successful home maintenance of lymphedema, as judged by limb volume, clinical observations, and subjective patient impressions, after incorporating the Flexitouch® system. Neither patient experienced the deleterious effects (worsening genital edema; fibrotic cuff development) that they had experienced with the older-generation intermittent pneumatic compression devices they had previously used. Incorporating the Flexitouch® system as part of maintenance may improve success for lymphedema patients who have previously struggled with in-home management. PMID:20184680

  13. Management of sacroiliac dysfunction and lower extremity lymphedema using a comprehensive treatment approach: a case report.

    PubMed

    Crane, Patricia

    2009-01-01

    Sacroiliac joint (SIJ) dysfunction, a common source of low back and buttock pain, can occur from cumulative shear or torsional forces during activities such as walking that require weight to transfer from one extremity to the other. Individuals with lower extremity lymphedema may also experience SIJ dysfunction. The purpose of this article was to describe the examination, diagnosis, and intervention for a patient with lower extremity lymphedema and sacroiliac joint dysfunction. The patient was a 50-year-old female with increased left lower extremity lymphedema and left buttock and groin pain that was previously treated unsuccessfully with physical therapy. SIJ dysfunction was attributable to an alteration in gait pattern caused by increased limb volume associated with lymphedema. The patient was treated for 19 visits over six weeks with complete decongestive therapy (CDT), muscle energy techniques, core stabilization, and the application of a pelvic support belt. Objective changes include decreased lymphedema, increased lower abdominal and lumbar extension strength, and decreased Oswetry Disability Index ratings. The patient was able to ambulate community distances without an assistive device and to resume unsupervised strength and conditioning without pain.

  14. Deep Vein Thrombosis Prophylaxis in Trauma Patients

    PubMed Central

    Toker, Serdar; Hak, David J.; Morgan, Steven J.

    2011-01-01

    Deep vein thrombosis (DVT) and pulmonary embolism (PE) are known collectively as venous thromboembolism (VTE). Venous thromboembolic events are common and potentially life-threatening complications following trauma with an incidence of 5 to 63%. DVT prophylaxis is essential in the management of trauma patients. Currently, the optimal VTE prophylaxis strategy for trauma patients is unknown. Traditionally, pelvic and lower extremity fractures, head injury, and prolonged immobilization have been considered risk factors for VTE; however it is unclear which combination of risk factors defines a high-risk group. Modalities available for trauma patient thromboprophylaxis are classified into pharmacologic anticoagulation, mechanical prophylaxis, and inferior vena cava (IVC) filters. The available pharmacologic agents include low-dose heparin (LDH), low molecular weight heparin (LMWH), and factor Xa inhibitors. Mechanical prophylaxis methods include graduated compression stockings (GCSs), pneumatic compression devices (PCDs), and A-V foot pumps. IVCs are traditionally used in high risk patients in whom pharmacological prophylaxis is contraindicated. Both EAST and ACCP guidelines recommend primary use of LMWHs in trauma patients; however there are still controversies regarding the definitive VTE prophylaxis in trauma patients. Large randomized prospective clinical studies would be required to provide level I evidence to define the optimal VTE prophylaxis in trauma patients. PMID:22084663

  15. Antibiotic prophylaxis in otolaryngologic surgery.

    PubMed

    Obeso, Sergio; Rodrigo, Juan P; Sánchez, Rafael; López, Fernando; Díaz, Juan P; Suárez, Carlos

    2010-01-01

    Since the beginning of the 80s, numerous clinical trials have shown a significant reduction in the incidence of infections in clean-contaminated upper respiratory tract surgery, due to perioperative use of antibiotics; however, there is no consensus about the best antibiotic protocol. Moreover, there are no universally accepted guidelines about flap reconstructive procedures. In otological and rhinological surgery, tonsillectomy, cochlear implant and laryngo-pharyngeal laser surgery, the use of antibiotics frequently depends on institutional or personal preferences rather than the evidence available. We reviewed clinical trials on different otorhinolaryngological procedures, assessing choice of antibiotic, length of treatment and administration route. There are no clinical trials for laryngo-pharyngeal laser surgery. Nor are there clinical trials on implant cochlear surgery or neurosurgical clean-contaminated procedures, but in these circumstances, antibiotic prophylaxis is recommended.

  16. Migraine headache prophylaxis in adolescents.

    PubMed

    Fantasia, Heidi Collins

    2014-01-01

    Migraine headache is estimated to affect up to 28 percent of adolescents, most of whom are female. Chronic migraine in this population has been associated with reduced quality of life and academic disruption due to missed school days. Historically, migraine headache was treated episodically as it occurred. In March 2014 the U.S. Food and Drug Administration approved an existing medication, topiramate (Topamax®), for migraine prophylaxis in adolescents between the ages of 12 and 17. This is the first FDA approval of a drug for migraine prevention in this population. There are several possible adverse effects of taking topiramate, some potentially serious, so adequate education for adolescents and their families on all the potential benefits and risks is imperative.

  17. Duration of venous thromboembolism prophylaxis after surgery.

    PubMed

    Kearon, Clive

    2003-12-01

    Venous thromboembolism (VTE) prophylaxis is indicated while in the hospital after major surgery. There is evidence that the prevalence of asymptomatic deep-vein thrombosis, detected by routine venography after major orthopedic surgery, is lower at hospital discharge in patients who have received 10 days rather than 5 days of prophylaxis. This observation supports the current American College of Chest Physicians (ACCP) recommendation for a minimum of 7 to 10 days of prophylaxis after hip and knee replacement, even if patients are discharged from the hospital within 7 days of surgery. As risk of VTE persists for up to 3 months after surgery, patients at high risk for postoperative VTE may benefit from extended prophylaxis (eg, an additional 3 weeks after the first 7 to 10 days). Extended prophylaxis with low-molecular-weight heparin (LMWH) reduces the frequency of postdischarge VTE by approximately two thirds after hip replacement; however, the resultant absolute reduction in the frequency of fatal pulmonary embolism is small (ie, estimated at 1 per 2,500 patients). Indirect evidence suggests that, compared with LMWH, efficacy of extended prophylaxis after hip replacement is greater with fondaparinux, similar with warfarin, and less with aspirin. Extended prophylaxis is expected to be of less benefit after knee than after hip replacement. In keeping with current ACCP recommendations, at a minimum, extended prophylaxis should be used after major orthopedic surgery in patients who have additional risk factors for VTE (eg, previous VTE, cancer). If anticoagulant drug therapy is stopped after 7 to 10 days, an additional month of prophylaxis with aspirin should be considered.

  18. Near-Infrared Fluorescence Lymphatic Imaging of a Toddler With Congenital Lymphedema.

    PubMed

    Greives, Matthew R; Aldrich, Melissa B; Sevick-Muraca, Eva M; Rasmussen, John C

    2017-03-29

    Primary lymphedema in the pediatric population remains poorly diagnosed and misunderstood due to a lack of information on the causation and underlying anatomy of the lymphatic system. Consequently, therapeutic protocols for pediatric patients remain sparse and with little evidence to support them. In an effort to better understand the causation of primary pediatric lymphedema and to better inform clinical care, we report the use of near-infrared fluorescence lymphatic imaging on the extremities of an alert, 21-month-old boy who presented with unilateral right arm and hand lymphedema at birth. The imaging results indicated an intact, apparently normal lymphatic anatomy with no obvious malformation, but with decreased lymphatic contractile function of the affected upper extremity relative to the contralateral and lower extremities. We hypothesized that the lack of contraction of the lymphatic vessels rather than an anatomic malformation was the source of the unilateral extremity swelling, and that compression and manual lymphatic drainage could be effective treatments.

  19. Lymphedema tarda after liver transplantation: a case report and review of the literature.

    PubMed

    Saab, Sammy; Nguyen, Stephen; Collins, James; Kunder, Gregg; Busuttil, Ronald W

    2006-12-01

    We present a patient with lymphedema that developed after orthotopic liver transplantation. The cause of the posttransplant lymphedema was likely related to a developmental abnormality of the lymphatic system that was exaggerated by refractory chylous ascites. A peritoneal fluid with a milky appearance, chylous ascites is rich in triglyceride and is caused by the obstruction or disruption of abdominal lymphatic channels. It is a rare complication that may develop after trauma or abdominal surgery or as a result of a malignant disease, and it is even more uncommon after liver transplantation. Therapy for chylous ascites involves treating its underlying cause. In the patient we describe, lymphedema tarda, which was diagnosed 6 months after liver transplantation, was likely caused by chylous ascites and a developmental abnormality of the lymphatic system.

  20. 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.

  1. 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.

  2. Pharmacological prophylaxis of venous thrombo-embolism.

    PubMed

    Flute, P T

    1976-02-07

    The pathogenesis of venous thrombosis is briefly discussed as a basis for the understanding of preventive measures used in this condition. Prophylaxis in venous thrombosis is then reviewed with emphasis on pharmacological treatment, and more particularly on heparin.

  3. Guideline for Antimicrobial Prophylaxis in Breast Surgery

    PubMed Central

    Bağhaki, Sema; Soybir, Gürsel Remzi; Soran, Atilla

    2014-01-01

    The American Society of Health-System Pharmacists (ASHP) published the 2012/2013 edition of the book entitled “Best Practices for Hospital & Health-System Pharmacy: Position and Guidance Documents of ASHP” with Bruce Hawkins as the editor. (ISSN: 15558975). Pages 582–667 of this book contain the section: “Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery”. This section includes current clinical developments, evidence and recommendations on the application of standard and effective antimicrobial prophylaxis in adult and pediatric patients, and has significant differences compared to the previous 1999 edition. On pages 632–633, antimicrobial prophylaxis in breast and plastic surgery practice is addressed in detail. This article contains a summary of the recommendations made in ASHP 2012/2013 Report regarding the antimicrobial prophylaxis in breast and plastic surgery applications.

  4. Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial

    PubMed Central

    Şener, Hülya Özlem; Malkoç, Mehtap; Ergin, Gülbin; Karadibak, Didem; Yavuzşen, Tuğba

    2017-01-01

    Objective The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment. Materials and Methods The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks. Results After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises. Conclusions Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs. PMID:28331763

  5. 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.

  6. Evaluation of azithromycin, trovafloxacin and grepafloxacin as prophylaxis against experimental murine Brucella melitensis infection.

    PubMed

    Atkins, Helen S; Spencer, Stephen; Brew, Simon D; Jenner, Dominic C; Sefton, Armine M; MacMillan, Alastair P; Brooks, Timothy J G; Simpson, Andrew J H

    2010-07-01

    The prophylactic potential of the azalide azithromycin as well as the fluoroquinolones trovafloxacin and grepafloxacin was assessed for the control of infection with Brucella melitensis in an experimental mouse model, determined by reduction in splenic bacterial burden. Trovafloxacin showed limited protective efficacy when administered 2h following a low-dose B. melitensis challenge, whereas grepafloxacin was ineffective. In comparison, azithromycin provided significant control of infection both following low- and high-dose challenges. Overall, the data confirm the potential utility of azithromycin in the prophylaxis of brucellosis and suggest that neither trovafloxacin nor grepafloxacin would likely be valuable for post-exposure prophylaxis of Brucella infection.

  7. [In search of the ideal surgical treatment for lymphedema. Report of 2nd European Conference on supermicrosurgery (Barcelona - March 2012)].

    PubMed

    Rausky, J; Robert, N; Binder, J-P; Revol, M

    2012-12-01

    Since more than 50 years, many surgeons all around the world try to find the perfect surgical technique to treat limb lymphedemas. Decongestive physiotherapy associated with the use of a compressive garment has been the primary choice for lymphedema treatment. Many different surgical techniques have been developed, however, to date, there is no consensus on surgical procedure. Most surgical experts of lymphedema met in the second European Conference on supermicrosurgery, organized on March 1st and 2nd 2012, in San Pau Hospital, Barcelona. Together they tried to clarify these different options and ideally a strategy for using these techniques.

  8. 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.

  9. Unravelling adherence to prophylaxis in haemophilia: a patients' perspective.

    PubMed

    Schrijvers, L H; Kars, M C; Beijlevelt-van der Zande, M; Peters, M; Schuurmans, M J; Fischer, K

    2015-09-01

    Given the lifelong therapy in haemophilia patients, insight in non-adherence behaviour from a patient perspective is important to understand patients' difficulties with the following treatment recommendations. The aim of this study was to clarify the process underlying adherence (behaviour) to prophylactic treatment, from a patients' perspective. To develop a grounded theory, a qualitative study using individual in-depth interviews was performed to understand experiences, perceptions and beliefs concerning adherence to prophylaxis. From two Dutch treatment centres, 21 adults with haemophilia using prophylaxis were interviewed. Patients were asked how they experience their task to administer prophylaxis and how they adhere to this. The interviews were transcribed, coded and analysed in an iterative process, leading to the development of the grounded theory. Adherence was determined by the position of prophylaxis in life. The position of prophylaxis was determined by the perception of prophylaxis and the ability to exert prophylaxis. Patients' perception was influenced by two main factors: acceptance of haemophilia and feeling/fearing symptoms. The ability to exert prophylaxis was influenced by understanding haemophilia and prophylaxis and planning/infusion skills. The combination of different perceptions and skills led to four main positions of prophylaxis in life: (i) prophylaxis integrated in life, (ii) prophylaxis according to doctors' advice, struggling with irregular situations, (iii) prophylaxis is too much to handle, (iv) prophylaxis is a confrontation with illness. The adherence level gradually decreased from position 1 to 4. This information can be used to design tailored interventions to promote adherence.

  10. Bioelectrical impedance for detecting and monitoring lymphedema in patients with breast cancer. Preliminary results of the florence nightingale breast study group.

    PubMed

    Erdogan Iyigun, Zeynep; Selamoglu, Derya; Alco, Gul; Pilancı, Kezban Nur; Ordu, Cetin; Agacayak, Filiz; Elbüken, Filiz; Bozdogan, Atilla; Ilgun, Serkan; Guler Uysal, Fusun; Ozmen, Vahit

    2015-03-01

    The aim of this study was to evaluate the efficacy of bioimpedance spectroscopy for the follow-up of patients with lymphedema in Turkey and its benefits in the diagnosis of stage 0, 1, and 2 lymphedema in patients who are under treatment for breast cancer. Thirty-seven female patients with breast cancer who underwent surgical procedures in our Breast Health Centre were followed up for lymphedema using bioimpedance, and clinical measurements were taken for a minimum period of 1 year at 3-month intervals. Patients who had been monitored regularly between November, 2011, and September, 2013, were enrolled to the study. In total, 8 patients developed lymphedema with an overall rate of 21.6%. Among the 8 patients who developed lymphedema, 4 had Stage 2, 1 had Stage 1, and 3 had Stage 0 lymphedema. Stage 0 lymphedema could not be detected with clinical measurements. During the patients' 1-year follow-up period using measurements of bioimpedance, a statistically significant relationship was observed between the occurrence of lymphedema and the disease characteristics. including the number of the extracted and remaining lymph nodes and the region of radiotherapy (p=0.042, p=0.024, p=0.040). Bioimpedance analysis seems to be a practical and reliable method for the early diagnosis of lymphedema. It is believed that regular monitoring of patients in the high-risk group using bioimpedance analyses increases the ability to treat lymphedema.

  11. 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

  12. MR imaging, proton MR spectroscopy, ultrasonographic, histologic findings in patients with chronic lymphedema.

    PubMed

    Fumiere, E; Leduc, O; Fourcade, S; Becker, C; Garbar, C; Demeure, R; Wilputte, F; Leduc, A; Delcour, C

    2007-12-01

    Lymphedema is a progressive disease with multiple alterations occurring in the dermis. We undertook this study using high-frequency ultrasonography (US), magnetic resonance imaging, proton MR spectroscopy and histology to examine structural changes occurring in the subcutaneous tissue and precisely describe the nature of intralobular changes in chronic lymphedema. Four cutaneous and subcutaneous tissue biopsies from patients with chronic lymphedema during lymphonodal transplantation were studied. We performed US with a 13.5 MHz transducer, TSE T1 and TSE T2 magnetic resonance images with and without fat-suppression, MR Chemical Shift Imaging Spectroscopy and histological evaluation on these biopsies. We found that normal subcutaneous septa are seen as hyperechogenic lines in US and hyposignal lines in MRI and that hyperechogenic subcutis in US can be due to interlobular and intralobular water accumulation and/or to interlobular and intralobular fibrosis. Our study also confirms the usefulness of MR spectroscopy to assess water or fat content of soft tissue. Thus, multiple imaging modalities may be necessary to precisely delineate the nature of tissue alterations in chronic lymphedema.

  13. Effects of yoga on arm volume among women with breast cancer related lymphedema: A pilot study.

    PubMed

    Fisher, Mary Insana; Donahoe-Fillmore, Betsy; Leach, Laura; O'Malley, Colleen; Paeplow, Cheryl; Prescott, Tess; Merriman, Harold

    2014-10-01

    Lymphedema affects 3-58% of survivors of breast cancer and can result in upper extremity impairments. Exercise can be beneficial in managing lymphedema. Yoga practice has been minimally studied for its effects on breast cancer related lymphedema (BCRL). The purpose of this study was to determine the effect of yoga on arm volume, quality of life (QOL), self-reported arm function, and hand grip strength in women with BCRL. Six women with BCRL participated in modified Hatha yoga 3×/week for 8 weeks. Compression sleeves were worn during yoga sessions. Arm volume, QOL, self-reported arm function, and hand grip strength were measured at baseline, half-way, and at the conclusion of yoga practice. Arm volume significantly decreased from baseline (2423.3 ml ± 597.2) to final measures (2370.8 ml ± 577.2) (p = .02). No significant changes in QOL (p = .12), self-reported arm function (p = .34), or hand grip strength (p = .26) were found. Yoga may be beneficial in the management of lymphedema.

  14. Otophyma: a case report and review of the literature of lymphedema (elephantiasis) of the ear.

    PubMed

    Carlson, J Andrew; Mazza, Jill; Kircher, Kenneth; Tran, Tien Anh

    2008-02-01

    Phymas (swellings, masses, or bulbs) are considered the end-stage of rosacea and mostly affect the nose (rhinophyma), and rarely involve the chin (gnatophyma), the cheek (metophyma), eyelids (blepharophyma), or ears (otophyma). Herein, we report the case of a 57-year-old man who developed unilateral enlargement of his left ear over 2 years. Biopsy revealed changes of rosaceous lymphedema associated with Demodex infestation. Corticosteroid and minocycline therapies resulted in partial reduction of the ear enlargement. Literature review examining for cases of lymphedema (elephantiasis) of the ear revealed that chronic inflammatory disorders (rosacea (most frequent), psoriasis, eczema), bacterial cellulitis (erysipelas), pediculosis, trauma, and primary (congenital) lymphedema can all lead to localized, lymphedematous enlargement of the ear. Depending on the severity, medical treatment directed at the inflammatory condition for mild, diffuse enlargement to surgical debulking for extensive diffuse enlargement or tumor formation can improve the signs and symptoms of otophyma. Decreased immune surveillance secondary to rosaceous lymphedema may explain why Demodex infestation is common in rosacea and support the suspicion that phymatous skin is predisposed to skin cancer development.

  15. 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…

  16. 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

  17. Long Term Results of Innovative Procedure in Surgical Management of Chronic Lymphedema

    PubMed Central

    Mousavi, Seyed R.

    2016-01-01

    Background: Lymphedema is the result of impaired lymphatic drainage by the affected organ. This abnormality can be primary or secondary. Different operative approaches have been introduced to treat chronic lymphedema. Materials and Methods: This retrospective study included 816 patients who were diagnosed with chronic lower extremity lymphedema and did not respond to non-operative management for at least six months. Data was collected over 25 years, between March 1987 and March 2013. Doppler ultrasonography of the deep venous system was routinely undertaken in all patients to confirm patency. The patients underwent surgery and their progress was followed for at least one year postoperatively. Results: All patients were operated by the suggested technique and long term fallow-up which is a modified form of the Homan’s technique. The outcome was excellent, and 89.2% of patients were free of complication and 2% had poor results. The most common complication was wound seroma and wound infection. Conclusion: The long term results and considering the difficulties associated with the treatment of chronic lymphedema and the variety of surgical options, our method achieved excellent results, and may be proposed for the standard operative procedure for treating intractable forms of this disease. PMID:27990192

  18. 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

  19. 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.

  20. Diphtheria toxin–mediated ablation of lymphatic endothelial cells results in progressive lymphedema

    PubMed Central

    Gardenier, Jason C.; Hespe, Geoffrey E.; Kataru, Raghu P.; Savetsky, Ira L.; Torrisi, Jeremy S.; Nores, Gabriela D. García; Dayan, Joseph J.; Chang, David; Zampell, Jamie; Martínez-Corral, Inés; Ortega, Sagrario; Mehrara, Babak J.

    2016-01-01

    Development of novel treatments for lymphedema has been limited by the fact that the pathophysiology of this disease is poorly understood. It remains unknown, for example, why limb swelling resulting from surgical injury resolves initially, but recurs in some cases months or years later. Finding answers for these basic questions has been hampered by the lack of adequate animal models. In the current study, we used Cre-lox mice that expressed the human diphtheria toxin receptor (DTR) driven by a lymphatic-specific promoter in order to noninvasively ablate the lymphatic system of the hind limb. Animals treated in this manner developed lymphedema that was indistinguishable from clinical lymphedema temporally, radiographically, and histologically. Using this model and clinical biopsy specimens, we show that the initial resolution of edema after injury is dependent on the formation of collateral capillary lymphatics and that this process is regulated by M2-polarized macrophages. In addition, we show that despite these initial improvements in lymphatic function, persistent accumulation of CD4+ cells inhibits lymphangiogenesis and promotes sclerosis of collecting lymphatics, resulting in late onset of edema and fibrosis. Our findings therefore provide strong evidence that inflammatory changes after lymphatic injury play a key role in the pathophysiology of lymphedema. PMID:27699240

  1. 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 |

  2. Is endocarditis prophylaxis for dental procedures necessary?

    PubMed Central

    Taubert, Kathryn A; Wilson, Walter

    2017-01-01

    Objectives Our purpose is to address whether antimicrobial prophylaxis is necessary before certain dental procedures for patients at increased risk for acquiring infective endocarditis (IE). Methods We reviewed recommendations for IE prophylaxis made by the American Heart Association (AHA) from 1995 to the present time. We also compared and contrasted the current recommendations from the AHA, European Society of Cardiology (ESC), United Kingdom’s National Institute for Health and Care Excellence (NICE) and a consortium of French organisations. We further reviewed recent papers that have observed the incidence of IE since these current recommendations were published. Results Beginning in the 1990s, questions were raised about the advisability of using antimicrobial prophylaxis before certain dental procedures to prevent IE. Various groups in Europe and the US were increasingly aware that there were not any clinical trials showing the effectiveness, or lack thereof, of such prophylaxis. In the early to mid-2000s, the AHA, ESC and French consortium published guidelines recommending restriction of prophylaxis before dental procedures to patients with highest risk for developing IE and/or the highest risk for an adverse outcome from IE. The NICE guidelines eliminated recommendations for prophylaxis before dental procedures. Studies published after these changes were instituted have generally shown that the incidence of IE has not changed, although two recent reports have observed some increased incidence (but not necessarily related to an antecedent dental procedure). Conclusion A multi-national randomised controlled clinical trial that would include individuals from both developed and developing countries around the world is needed to ultimately define whether there is a role for antibiotic prophylaxis administered before certain dental procedures to prevent IE. PMID:28321267

  3. 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

  4. 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.

  5. HIV postexposure prophylaxis after sexual assault.

    PubMed

    Stevens, L; Brown, M A

    2001-12-01

    Recent advances in the treatment of human immunodeficiency virus (HIV) disease have prompted health care providers to reexamine recommendations for prophylaxis of HIV infection. Parallels with occupational exposure through mucous membrane tissues spur consideration of HIV prophylaxis after sexual assault for several reasons. In both instances, exposure occurs at a single point in time and is unlikely to recur. Although the Centers for Disease Control and Prevention does not make definitive recommendations regarding postexposure prophylaxis after sexual assault, the reality is that as clinicians, we face situations in which we must consider treatment for prevention of HIV disease after sexual assault. Guidelines for treatment and how to create and implement a policy to ensure the best outcomes, and provide a high quality of patient care with the New York State guidelines as a model, are discussed.

  6. A Prospective Validation Study of Bioimpedance with Volume Displacement in Early-Stage Breast Cancer Patients at Risk for Lymphedema

    PubMed Central

    Barrio, Andrea V.; Eaton, Anne; Frazier, Thomas G.

    2015-01-01

    BACKGROUND Although volume displacement (VD) is considered the gold standard for diagnosing breast cancer (BC)-related lymphedema, it is inconvenient. We compared bioimpedance (L-Dex) and VD measurements in a prospective cohort of BC patients at risk for lymphedema. METHODS Between 2010–2014, 223 BC patients were enrolled. Following exclusions (n=37), 186 received baseline VD and L-Dex; follow-up measurements were performed at 3–6 month intervals for 3 years. At each visit, patients fit into one of three categories: normal (normal VD and L-Dex); abnormal L-Dex (L-Dex>10 or increase in 10 from baseline and normal VD); or lymphedema (relative arm volume difference of >10% by VD +/− abnormal L-Dex). Change in L-Dex was plotted against change in VD; correlation was assessed using Pearson correlation. RESULTS At a median follow-up of 18.2mos, 152 patients were normal; 25 had an abnormal L-Dex; and 9 developed lymphedema without a prior L-Dex abnormality. Of 25 abnormal L-Dex patients, 4 progressed to lymphedema for a total of 13 patients with lymphedema. Evaluating all time points, 186 patients had 829 follow-up measurements. Sensitivity and specificity of L-Dex compared to VD were 75% and 93%, respectively. There was no correlation between change in VD and change in L-Dex at 3mos (R=0.31) or 6mos (R=0.21). CONCLUSIONS VD and bioimpedance demonstrated poor correlation with inconsistent overlap of measurements considered abnormal. Of patients with an abnormal L-Dex, few progressed to lymphedema; most with lymphedema did not have a prior L-Dex abnormality. Further studies are needed to understand the clinical significance of bioimpedance. PMID:26085222

  7. Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India

    PubMed Central

    Stillwaggon, Eileen; Sawers, Larry; Rout, Jonathan; Addiss, David; Fox, LeAnne

    2016-01-01

    Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense. PMID:27573626

  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. Clinical effectiveness of itraconazole as antifungal prophylaxis in AML patients undergoing intensive chemotherapy in the modern era.

    PubMed

    Keighley, C L; Manii, P; Larsen, S R; van Hal, S

    2017-02-01

    Antifungal prophylaxis regimens vary between centres, informed by local epidemiology and antifungal stewardship practices. The advantages of itraconazole over posaconazole prophylaxis include maintaining the utility of azole therapy for suspected breakthrough invasive fungal infection (bIFI). We examined the effectiveness and tolerability of itraconazole as prophylaxis in acute myeloid leukaemia (AML) patients. We sought to determine the rate of probable and proven bIFI in the context of itraconazole prophylaxis in a real-life setting. Eighty-four patients corresponded to 175 episodes of primary antifungal prophylaxis with itraconazole solution (200 mg twice daily) as prophylaxis supported by a dedicated clinical pharmacist during induction, re-induction and consolidation chemotherapy for AML between January 2010 and January 2014. Assessment of clinical course included blinded review of all radiology scans. Episodes of bIFI were categorised according to consensus criteria. A low rate of bIFI (6/175, 3.4 %) occurred with the use of itraconazole. Tolerance was excellent with adverse events consisting predominantly of deranged liver function tests reported in 7/175 (4 %). Therapeutic drug monitoring performed at clinicians' discretion demonstrated appropriate levels in 12/14 (86 %). Persisting fever and suspicion of invasive fungal infection (IFI) led to empiric antifungal therapy with voriconazole or caspofungin in 33/175 episodes (19 %), ceased after a median of 5 days following investigation in 16/175 (9 %). In this setting, itraconazole is effective and well-tolerated as prophylaxis. An additional benefit was seen in empiric therapy of suspected bIFI with amphotericin formulations kept in reserve. Local epidemiology is vital in guiding prophylaxis strategy.

  10. 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 and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... agent and the user applies it to the teeth to remove debris. (b) Classification. Class I...

  11. 21 CFR 872.6290 - Prophylaxis cup.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prophylaxis cup. 872.6290 Section 872.6290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... agent and the user applies it to the teeth to remove debris. (b) Classification. Class I...

  12. 21 CFR 872.6290 - Prophylaxis cup.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prophylaxis cup. 872.6290 Section 872.6290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... agent and the user applies it to the teeth to remove debris. (b) Classification. Class I...

  13. 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 and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... agent and the user applies it to the teeth to remove debris. (b) Classification. Class I...

  14. 21 CFR 872.6290 - Prophylaxis cup.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prophylaxis cup. 872.6290 Section 872.6290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL... agent and the user applies it to the teeth to remove debris. (b) Classification. Class I...

  15. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery

    PubMed Central

    Tita, Alan T.N.; Szychowski, Jeff M.; Boggess, Kim; Saade, George; Longo, Sherri; Clark, Erin; Esplin, Sean; Cleary, Kirsten; Wapner, Ron; Letson, Kellett; Owens, Michelle; Abramovici, Adi; Ambalavanan, Namasivayam; Cutter, Gary; Andrews, William

    2016-01-01

    BACKGROUND The addition of azithromycin to standard regimens for antibiotic prophylaxis before cesarean delivery may further reduce the rate of postoperative infection. We evaluated the benefits and safety of azithromycin-based extended-spectrum prophylaxis in women undergoing nonelective cesarean section. METHODS In this trial conducted at 14 centers in the United States, we studied 2013 women who had a singleton pregnancy with a gestation of 24 weeks or more and who were undergoing cesarean delivery during labor or after membrane rupture. We randomly assigned 1019 to receive 500 mg of intravenous azithromycin and 994 to receive placebo. All the women were also scheduled to receive standard antibiotic prophylaxis. The primary outcome was a composite of endometritis, wound infection, or other infection occurring within 6 weeks. RESULTS The primary outcome occurred in 62 women (6.1%) who received azithromycin and in 119 (12.0%) who received placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; P<0.001). There were significant differences between the azithromycin group and the placebo group in rates of endometritis (3.8% vs. 6.1%, P = 0.02), wound infection (2.4% vs. 6.6%, P<0.001), and serious maternal adverse events (1.5% vs. 2.9%, P = 0.03). There was no significant between-group difference in a secondary neonatal composite outcome that included neonatal death and serious neonatal complications (14.3% vs. 13.6%, P = 0.63). CONCLUSIONS Among women undergoing nonelective cesarean delivery who were all receiving standard antibiotic prophylaxis, extended-spectrum prophylaxis with adjunctive azithromycin was more effective than placebo in reducing the risk of postoperative infection. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; C/SOAP ClinicalTrials.gov number, NCT01235546.) PMID:27682034

  16. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery.

    PubMed

    Tita, Alan T N; Szychowski, Jeff M; Boggess, Kim; Saade, George; Longo, Sherri; Clark, Erin; Esplin, Sean; Cleary, Kirsten; Wapner, Ron; Letson, Kellett; Owens, Michelle; Abramovici, Adi; Ambalavanan, Namasivayam; Cutter, Gary; Andrews, William

    2016-09-29

    Background The addition of azithromycin to standard regimens for antibiotic prophylaxis before cesarean delivery may further reduce the rate of postoperative infection. We evaluated the benefits and safety of azithromycin-based extended-spectrum prophylaxis in women undergoing nonelective cesarean section. Methods In this trial conducted at 14 centers in the United States, we studied 2013 women who had a singleton pregnancy with a gestation of 24 weeks or more and who were undergoing cesarean delivery during labor or after membrane rupture. We randomly assigned 1019 to receive 500 mg of intravenous azithromycin and 994 to receive placebo. All the women were also scheduled to receive standard antibiotic prophylaxis. The primary outcome was a composite of endometritis, wound infection, or other infection occurring within 6 weeks. Results The primary outcome occurred in 62 women (6.1%) who received azithromycin and in 119 (12.0%) who received placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; P<0.001). There were significant differences between the azithromycin group and the placebo group in rates of endometritis (3.8% vs. 6.1%, P=0.02), wound infection (2.4% vs. 6.6%, P<0.001), and serious maternal adverse events (1.5% vs. 2.9%, P=0.03). There was no significant between-group difference in a secondary neonatal composite outcome that included neonatal death and serious neonatal complications (14.3% vs. 13.6%, P=0.63). Conclusions Among women undergoing nonelective cesarean delivery who were all receiving standard antibiotic prophylaxis, extended-spectrum prophylaxis with adjunctive azithromycin was more effective than placebo in reducing the risk of postoperative infection. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; C/SOAP ClinicalTrials.gov number, NCT01235546 .).

  17. [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.

  18. Elephantiasis nostras verrucosa or "mossy foot lesions" in lymphedema praecox: report of a case.

    PubMed

    Duckworth, Amy L; Husain, Jugnoo; Deheer, Patrick

    2008-01-01

    Elephantiasis nostras verrucosa is a rare disorder that results from chronic obstructive lymphedema. It is characterized clinically by deforming, nonpitting edema; malodorous hyperkeratosis with generalized lichenification; cobblestoned papules; and verrucous changes, that often result in extreme enlargement of the involved body part. Although elephantiasis nostras verrucosa is striking in clinical appearance, biopsy reveals only moderately abnormal findings: pseudoepitheliomatous hyperplasia with dilated lymphatic spaces in the dermis, accompanied by chronic inflammation and fibroblast proliferation. The term elephantiasis nostras (nostras means "from our region") has traditionally been used to differentiate temperate zone disease from the classic disease process, elephantiasis tropica, which is defined by chronic filarial lymphatic obstruction caused by Wuchereria bancrofti, Wuchereria malayi, or Wuchereria pacifica. We present a case report of elephantiasis nostras verrucosa arising as a result of lymphedema praecox.

  19. A gene for lymphedema-distichiasis maps to 16q24.3.

    PubMed Central

    Mangion, J; Rahman, N; Mansour, S; Brice, G; Rosbotham, J; Child, A H; Murday, V A; Mortimer, P S; Barfoot, R; Sigurdsson, A; Edkins, S; Sarfarazi, M; Burnand, K; Evans, A L; Nunan, T O; Stratton, M R; Jeffery, S

    1999-01-01

    Lymphedema-distichiasis (LD) is a dominantly inherited syndrome with onset of lymphedema at or just after puberty. Most affected individuals have distichiasis-fine hairs arising inappropriately from the eyelid meibomian glands-which is evident from birth. A study of three families with LD has shown linkage to chromosome 16q24.3, and subsequent analysis of the region for recombinant genes places the locus between D16S422 and D16S3074, a distance of approximately 16 cM. Possible candidate genes in this interval include the N-proteinase for type 3 collagen, PCOLN3; the metalloprotease PRSM1; and the cell matrix-adhesion regulator, CMAR. PMID:10417285

  20. Lymph Node Transplantation Decreases Swelling and Restores Immune Responses in a Transgenic Model of Lymphedema

    PubMed Central

    Hespe, Geoffrey E.; García Nores, Gabriela D.; Kataru, Raghu P.; Martínez-Corral, Inés; Ortega, Sagrario; Mehrara, Babak J.

    2016-01-01

    Introduction Secondary lymphedema is a common complication of cancer treatment and recent studies have demonstrated that lymph node transplantation (LNT) can decrease swelling, as well as the incidence of infections. However, although these results are exciting, the mechanisms by which LNT improves these pathologic findings of lymphedema remain unknown. Using a transgenic mouse model of lymphedema, this study sought to analyze the effect of LNT on lymphatic regeneration and T cell-mediated immune responses. Methods We used a mouse model in which the expression of the human diphtheria toxin receptor is driven by the FLT4 promoter to enable the local ablation of the lymphatic system through subdermal hindlimb diphtheria toxin injections. Popliteal lymph node dissection was subsequently performed after a two-week recovery period, followed by either orthotopic LNT or sham surgery after an additional two weeks. Hindlimb swelling, lymphatic vessel regeneration, immune cell trafficking, and T cell-mediated immune responses were analyzed 10 weeks later. Results LNT resulted in a marked decrease in hindlimb swelling, fibroadipose tissue deposition, and decreased accumulation of perilymphatic inflammatory cells, as compared to controls. In addition, LNT induced a marked lymphangiogenic response in both capillary and collecting lymphatic vessels. Interestingly, the resultant regenerated lymphatics were abnormal in appearance on lymphangiography, but LNT also led to a notable increase in dendritic cell trafficking from the periphery to the inguinal lymph nodes and improved adaptive immune responses. Conclusions LNT decreases pathological changes of lymphedema and was shown to potently induce lymphangiogenesis. Lymphatic vessels induced by LNT were abnormal in appearance, but were functional and able to transport antigen-presenting cells. Animals treated with LNT have an increased ability to mount T cell-mediated immune responses when sensitized to antigens in the affected

  1. Role of CT in the diagnosis of primary lymphedema of the lower limb

    SciTech Connect

    Hadjis, N.S.; Carr, D.H.; Banks, L.; Pflug, J.J.

    1985-02-01

    Twelve patients with primary lymphedema of the lower limb were examined with computed tomography (CT). A characteristic honeycomb pattern of the subcutaneous compartment was seen in 10 of these patients. CT scans in nine other patients with swollen leg secondary to chronic venous disease or lipedema did not show this characteristic pattern. CT may be helpful in the differential diagnosis of a swollen leg, thus obviating venography or lymphangiography.

  2. Enhancing Supportive-Educative Nursing Systems to Reduce Risk of Post-Breast Cancer Lymphedema

    PubMed Central

    Armer, Jane M.; Shook, Robin P.; Schneider, Melanie K; Brooks, Constance W.; Peterson, Julie; Stewart, Bob R

    2010-01-01

    This study describes the use of data regarding self-care agency to enhance a supportive-educative nursing system for breast cancer survivors to reduce the risk of developing lymphedema post surgery. Impetus for this study came from the analysis of participant feedback from a parent study (Lance Armstrong Foundation pilot study) that sought to plan an educational program for nurses that will improve their supportive-educative nursing system when working with breast cancer survivors. The goal is to enable these women to reduce the risk of lymphedema post surgery. The parent study examined a bundled behavioral-educative intervention, which included standard lymphedema education coupled with Modified Manual Lymph Drainage (MMLD) to reduce the risk of developing lymphedema in newly-diagnosed breast cancer survivors. Based upon the feedback received from the parent study, the research team recognized that many of the participants were not fully following the recommendations of the intervention protocol. In order for nurses to help patients develop self-care agency (SCA) (Orem, 2001) to engage in actions that addressed the self-care requisites associated with post-breast cancer surgery, these nurses needed to refine their intervention skills. Prior to the development of a program for the nurses, the research team conducted a study to explore the state of power related to SCA of the study participants. The information obtained from this was then used in the development of an educational program for bundled intervention. Both motivational interviewing (Miller & Rollnick, 2002) and solution-focused therapy (Berg & DeJong, 1996) were incorporated into the educational program for the research nurse team to strengthen and improve supportive-educative nursing systems. Supportive-educative systems of care that integrate self-care deficit nursing theory, motivational interviewing, and solution-focused therapy can assist patients to develop and sustain self-care agency. PMID

  3. Assessment of Risk Reduction for Lymphedema Following Sentinel Lymph Noded Guided Surgery for Primary Breast Cancer

    DTIC Science & Technology

    2006-10-01

    study uses SPECT scanning to localize lymphatics critical for arm drainage after surgical removal of axillary lymph nodes. The study has established...allows precise quantification of radiation dosimetry delivered to lymph nodes critical for arm drainage . The study will test the hypothesis that...Conduct a prospective cohort study to estimate the risk of lymphedema associated with radiation dosimetry to lymph node critical for arm drainage . (Months

  4. Weight Lifting in Patients With Lower Extremity Lymphedema Secondary to Cancer: A Pilot and Feasibility Study

    PubMed Central

    Katz, Elana; Dugan, Nicole L; Cohn, Joy C.; Chu, Christina; Smith, Rebecca G.; Schmitz, Kathryn H.

    2010-01-01

    Objective To assess the feasibility of recruiting and retaining cancer survivors with lower limb lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety and efficacy of this intervention. We hypothesized that progressive weight training would not exacerbate leg swelling and that the intervention would improve functional mobility and quality of life. Design Before-after pilot study of 5 months duration. Setting University of Pennsylvania Participants Cancer survivors with a known diagnosis of lower limb lymphedema (N=10) were directly referred by University of Pennsylvania clinicians. All 10 participants completed the study. Intervention Twice weekly slowly progressive weight-lifting, supervised for 2 months, unsupervised for 3 months. Main Outcome Measures The primary outcome was interlimb volume differences as measured by optoelectronic perometry. Additional outcome measures included safety (adverse events), muscle strength, objective physical function, and quality of life. Results Interlimb volume differences were 44.4 and 45.3% at baseline and 5 months, respectively (pre-post comparison, p = 0.70). There were 2 unexpected incident cases of cellulitus within the first two months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months. Bench and leg press strength increased by 47% and 27% over 5 months (p = 0.001 and p = 0.07, respectively). Distance walked in 6 minutes increased by 7% in 5 months (p = 0.01). No improvement was noted in self-reported quality of life. Conclusions Recruitment of patients with lower limb lymphedema into an exercise program is feasible. Despite some indications that the intervention may be safe (e.g., a lack of clinically significant interlimb volume increases over 5 months), the unexpected finding of two cellulitic infections among the 10 participants suggests additional study is required before concluding lower extremity lymphedema patients can safely perform

  5. 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.

  6. Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes

    PubMed Central

    Cemal, Yeliz; Albornoz, Claudia; Klassen, Anne; Cano, Stefan; Sulimanoff, Isabel; Hernandez, Marisol; Massey, Marga; Cordeiro, Peter; Morrow, Monica; Mehrara, Babak

    2013-01-01

    Purpose Lymphedema following breast cancer surgery remains a common and feared treatment complication. Accurate information on health-related quality of life (HRQOL) outcomes among patients with lymphedema is critically needed to inform shared medical decision making and evidence-based practice in oncologic breast surgery. Our systematic review aimed to (1) identify studies describing HRQOL outcomes in breast cancer-related lymphedema (BCRL) patients, (2) assess the quality of these studies, and (3) assess the quality and appropriateness of the patient-reported outcome (PRO) instruments used. Methods Using the PRISMA statement, we performed a systematic review including studies describing HRQOL outcomes among BCRL patients. Studies were classified by levels of evidence and fulfillment of the Efficace criteria. PRO instruments were assessed using the COSMIN criteria. Results Thirty-nine studies met inclusion criteria, including 8 level I and 14 level II studies. Sixteen of 39 studies were compliant with the Efficace criteria. Seventeen HRQOL instruments were used, two specific to lymphedema patients. Exercise and complex decongestive therapy treatment interventions were associated with improved HRQOL. Conclusions High-quality data on HRQOL outcomes is required to inform surgical decisions for breast cancer management and survivors. Of the lymphedema-specific PRO instruments, the Upper Limb Lymphedema 27 (ULL-27) was found to have strong psychometric properties. Future studies should strive to use high-quality condition-specific PRO instruments, follow existing guidelines for HRQOL measurement and to consider economic burdens of BCRL. Implications for Cancer Survivors As lymphedema may develop many years after breast cancer surgery, the ULL-27 may offer greater content validity for use in survivorship research. PMID:23212603

  7. 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

  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. Acute Truncal Lymphedema Secondary to Axillary Metastatic Melanoma Presenting Like Cellulitis

    PubMed Central

    Kong, Benjamin Y.; Chou, Shaun; Wakade, Deepal; Carlino, Matteo S.; Fernandez-Penas, Pablo

    2017-01-01

    There are reported cases of diphencyprone used in treating cutaneous metastases of melanoma. Here, we report a patient with previous primary melanoma on his left back treated with surgical excision and lymphadenectomy, followed by radiotherapy for the recurrent tumor on the primary site. Despite radiotherapy and treatment with dabrafenib and trametinib, in-transit metastases have developed and topical diphencyprone was applied to these metastases. Six weeks later, the patient developed fever and a spreading erythematous tender indurated plaque covering the left side of the body including axillae, back, and flank, clinically suggestive of cellulitis. Systemic antibiotic therapy did not improve the condition and a biopsy showed sparse lymphocytic infiltrate. With the diagnosis of possible acute lymphedema, a CT scan was requested that showed significant axillary lymph node metastasis. The fever was considered secondary to dabrafenib and trametinib therapy. This case highlights that, in patients with lymphadenectomy, atypical forms of lymphedema on the body may appear. Truncal lymphedema is an infrequent event. PMID:28182109

  10. Aligned nanofibrillar collagen scaffolds – Guiding lymphangiogenesis for treatment of acquired lymphedema

    PubMed Central

    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.

    2016-01-01

    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

  11. 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

  12. Computed tomography-based quantitative assessment of lower extremity lymphedema following treatment for gynecologic cancer

    PubMed Central

    Chung, Seung Hyun; Kim, Young Jae; Kim, Kwang Gi; Hwang, Ji Hye

    2017-01-01

    Objective To develop an algorithmic quantitative skin and subcutaneous tissue volume measurement protocol for lower extremity lymphedema (LEL) patients using computed tomography (CT), to verify the usefulness of the measurement techniques in LEL patients, and to observe the structural characteristics of subcutaneous tissue according to the progression of LEL in gynecologic cancer. Methods A program for algorithmic quantitative analysis of lower extremity CT scans has been developed to measure the skin and subcutaneous volume, muscle compartment volume, and the extent of the peculiar trabecular area with a honeycombed pattern. The CT venographies of 50 lower extremities from 25 subjects were reviewed in two groups (acute and chronic lymphedema). Results A significant increase in the total volume, subcutaneous volume, and extent of peculiar trabecular area with a honeycombed pattern except quantitative muscle volume was identified in the more-affected limb. The correlation of CT-based total volume and subcutaneous volume measurements with volumetry measurement was strong (correlation coefficient: 0.747 and 0.749, respectively). The larger extent of peculiar trabecular area with a honeycombed pattern in the subcutaneous tissue was identified in the more-affected limb of chronic lymphedema group. Conclusion CT-based quantitative assessments could provide objective volume measurements and information about the structural characteristics of subcutaneous tissue in women with LEL following treatment for gynecologic cancer. PMID:28028991

  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.

  14. Primary lower limb lymphedema: a focus on its functional, social and emotional impact

    PubMed Central

    Symvoulakis, Emmanouil K; Anyfantakis, Dimitrios I; Lionis, Christos

    2010-01-01

    Primary lymphedema is a rare, chronic and distressing condition with negative effects on physical, social and emotional level. The purpose of these reports was to present and discuss two different cases of primary lower limb lymphedema with a focus on its physical and mental impact and on some qualitative aspects of patients' self-reported experiences. The patients were recruited as they used occasional services within the University Hospital of Heraklion (Crete, Greece). The functional and mental impact of primary lymphedema was measured using the generic Medical Outcome Study short form-36 questionnaire and open-ended questions led to give more emphasis to patients' experiences. The analysis of short form-36 results in the first patient disclosed a significant functional impairment with a minor impact of the condition on emotional and social domains. For the second patient quality of life scores in the emotional and social domains were affected. Our findings support further the statement that physicians should pay full attention to appraise the patient's physical and emotional condition. General practitioners have the opportunity to monitor the long-term impact of chronic disorders. Posing simple open-ended questions and assessing the level of physical and mental deficits in terms of well-being through the use of specific metric tools can effectively follow-up rare conditions in the community. PMID:20975845

  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. Final program evaluation methods and results of a National Lymphedema Management Program in Togo, West Africa.

    PubMed

    Ziperstein, Josh; Dorkenoo, Monique; Datagni, Michel; Drexler, Naomi; Murphy, Monica; Sodahlon, Yao; Mathieu, Els

    2014-06-01

    In order to eliminate Lymphatic Filariasis (LF) as a public health problem, the World Health Assembly recommends an approach which includes interruption of transmission of infection and the alleviation of morbidity. In 2000, the Togolese National Program to Eliminate Lymphatic Filariasis (PNELF) started the annual mass drug administrations and in 2007, the program added a morbidity component for the management of lymphedema. This manuscript describes the methods of an evaluation aimed at assessing the strengths and weaknesses of the Togolese National Lymphedema Morbidity Program. The evaluation was conducted through in-depth interviews with stakeholders at each programmatic level. Interviews focused on message dissemination, health provider training, patient self-care practices, social dynamics, and program impact. The evaluation demonstrated that the program strengths include the standardization and in-depth training of health staff, dissemination of the program's treatment message, a positive change in the community's perception of lymphedema, and successful patient recruitment and training in care techniques. The lessons learned from this evaluation helped to improve Togo's program, but may also provide guidance and strategies for other countries desiring to develop a morbidity program. The methods of program evaluation described in this paper can serve as a model for monitoring components of other decentralized national health programs in low resource settings.

  17. 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

  18. 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

  19. Kinesiology Taping reduces lymphedema of the upper extremity in women after breast cancer treatment: a pilot study

    PubMed Central

    Rosseger, Agnieszka; Hanuszkiewicz, Justyna; Woźniewski, Marek

    2014-01-01

    Introduction Secondary lymphedema affects approximately 40% of women treated for breast cancer and is recognized as a major problem associated with the therapy of malignant tumors. Consequently, new therapeutic methods are constantly being sought to effectively eliminate the condition. One of the new forms of edema management, especially in the initial stages of edematous development, is Kinesiology Taping (KT). Aim of the study The aim of the study was to assess the effects of KT applications on the extent of lymphedema of the upper extremity in women post cancer treatment. Material and methods The study group consisted of 28 women after axillary lymphadenectomy due to breast cancer. All the patients were diagnosed with grade I secondary lymphedema. Kinesiology Taping was applied to a total of 14 randomly selected women. The remaining 14 patients constituted a control group. The extent of lymphedema was measured using a centimeter tape and Limb Volumes Professional 5.0 software. Results A significant reduction in the extent of lymphedema (p = 0.0009) was achieved in the KT group between baseline and post-treatment assessments. No such reduction, however, was found in the control group (p = 0.36). Conclusions Kinesiology Taping applications are an effective method of early-stage edema management. Kinesiology Taping may be a safe new therapeutic option in patients who are contraindicated for the use of other methods. PMID:26327858

  20. Evaluation of the effectiveness of kinesio taping application in a patient with secondary lymphedema in breast cancer: a case report

    PubMed Central

    Halski, Tomasz; Zduńczyk, Małgorzata; Rajfur, Joanna; Pasternok, Małgorzata; Chmielewska, Daria; Piecha, Magdalena; Kwaśna, Krystyna; Skrzypulec-Plinta, Violetta

    2014-01-01

    Breast cancer-related lymphedema is one of the complications resulting from treatment. It is defined as arm oedema in the breast cancer patients caused by interruption of the flow of the axillary lymphatic system from surgery or radiation therapy, which results in the accumulation of fluid in the subcutaneous tissue of the arm, with a decrease in tissue distensibility around the joints and an increased weight of the extremity. Decongestive lymphatic therapy is common management for lymphedema. A program combining skin care, manual lymphatic drainage, exercise, and compression therapy (multilayer bandage or garment) is recognised as the best practice in lymphedema management. Kinesio taping (KT) for lymphatic drainage is a new choice in the field of physical therapy. The material and the original concept of the taping technique were introduced by Dr Kenso Kase in 1973. K-tape had been designed to allow 30-40% longitudinal stretch. It is composed of 100% cotton fibers and acrylic heat sensitive glue. Development of the technique for its administration is still ongoing. The paper discusses the case of a woman with breast cancer, in whom lymphedema occurred. The patient had three weeks of therapy. The treatment consisted of 12 manual lymphatic drainage, 12 pneumatic compressions and 3 applications of the KT method (due to the lack of standard multi-layer bandaging). During the measurement of oedema it was noted that KT had a significant effect on the reduction of lymphedema and accelerates healing effects compared to standard methods. PMID:26327833

  1. High-resolution 3D volumetry versus conventional measuring techniques for the assessment of experimental lymphedema in the mouse hindlimb

    PubMed Central

    Frueh, Florian S.; Körbel, Christina; Gassert, Laura; Müller, Andreas; Gousopoulos, Epameinondas; Lindenblatt, Nicole; Giovanoli, Pietro; Laschke, Matthias W.; Menger, Michael D.

    2016-01-01

    Secondary lymphedema is a common complication of cancer treatment characterized by chronic limb swelling with interstitial inflammation. The rodent hindlimb is a widely used model for the evaluation of novel lymphedema treatments. However, the assessment of limb volume in small animals is challenging. Recently, high-resolution three-dimensional (3D) imaging modalities have been introduced for rodent limb volumetry. In the present study we evaluated the validity of microcomputed tomography (μCT), magnetic resonance imaging (MRI) and ultrasound in comparison to conventional measuring techniques. For this purpose, acute lymphedema was induced in the mouse hindlimb by a modified popliteal lymphadenectomy. The 4-week course of this type of lymphedema was first assessed in 6 animals. In additional 12 animals, limb volumes were analyzed by μCT, 9.4 T MRI and 30 MHz ultrasound as well as by planimetry, circumferential length and paw thickness measurements. Interobserver correlation was high for all modalities, in particular for μCT analysis (r = 0.975, p < 0.001). Importantly, caliper-measured paw thickness correlated well with μCT (r = 0.861), MRI (r = 0.821) and ultrasound (r = 0.800). Because the assessment of paw thickness represents a time- and cost-effective approach, it may be ideally suited for the quantification of rodent hindlimb lymphedema. PMID:27698469

  2. Historical Review: Problematic Malaria Prophylaxis with Quinine.

    PubMed

    Shanks, G Dennis

    2016-08-03

    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.

  3. Secreted HSP Vaccine for Malaria Prophylaxis

    DTIC Science & Technology

    2014-10-01

    AWARD NUMBER: W81XWH-13-2-0098 TITLE: Secreted HSP Vaccine for Malaria Prophylaxis PRINCIPAL INVESTIGATOR: Dr. Eckhard R. Podack...1. REPORT DATE October 2014 2. REPORT TYPE ANNUAL 3. DATES COVERED 30 SEPT 2013 – 29 SEPT 2014 4. TITLE AND SUBTITLE Secreted HSP Vaccine for...SUPPLEMENTARY NOTES 14. ABSTRACT Proposed vaccine principle relies on secreted gp96-Ig chaperoning PfCSP and PfAMA1 sporozoite proteins that are efficiently

  4. [Prophylaxis of purulent complications in mechanical ileus].

    PubMed

    Tamm, T I; Nepomnyashchiy, V V; Shakalova, E A; Dvornik, I A

    2015-03-01

    In experiment, while simulating an acute ileus, the possibility of antibacterial preparations for prophylaxis of purulent--septic complications was studied. There was established, that while progressing purulent intestinal inflammation its wall already in 12 h losses a capacity to cumulate penicillines and aminoglycosides. In a phlegmon-like changed intestine during 48 h cephalosporins and fluorochinolons are accumulated in bactericidal concentration, making a destruction of intestinal wall and occurrence of purulent peritonitis by 6-12 h slower.

  5. Prophylaxis of endemic goitre in Mexico

    PubMed Central

    Stacpoole, Herbert H.

    1953-01-01

    The results of a survey carried out in eight States of Mexico are discussed by the author. The administrative, budgetary, and psychological difficulties encountered when attempting goitre prophylaxis by means of iodized salt are outlined. The author examines the efficacy of iodized sweets given to 50,000 schoolchildren in the Federal District and in the State of Morelos. Recent experiments in Mexico with iodated salt confirm previous statements concerning its stability. ImagesFIG. 1 PMID:13094516

  6. 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.

  7. Venous thromboembolism prophylaxis in colorectal surgery.

    PubMed

    Alizadeh, Kayvon; Hyman, Neil

    2005-01-01

    Patients who undergo colorectal surgery are at a substantially higher risk for deep vein thrombosis (DVT) than their general surgery counterparts. The incidence of DVT in colorectal surgery patients who do not receive prophylaxis is approximately 30%; a four-fold increase exists in the incidence of pulmonary embolism. The precise reasons for the increased risk are uncertain; likely, contributing factors are the need for pelvic dissection, patient positioning (eg, use of stirrups), and indications for surgery (eg, inflammatory bowel disease, cancer). Despite the clear evidence that supports the safety and efficacy of DVT prophylaxis, appropriate preventive measures are frequently not used. Heparin preparations and mechanical compression in combination likely represents the most appropriate prophylactic regimen in these high-risk patients. Standard heparin appears to be as effective as low-molecular-weight heparin and considerably less costly. In the presence of relatively poor adherence to consensus guidelines for prophylaxis, critical pathways or electronic alerts may be useful to facilitate compliance with appropriate preventive measures.

  8. Anticoagulant prophylaxis for placenta mediated pregnancy complications.

    PubMed

    Rodger, Marc A

    2011-02-01

    Thrombophilias are not yet established as a cause of the placenta-mediated pregnancy complications (pregnancy loss, pre-eclampsia, small for gestational age and placental abruption). A thrombophilia may be only one of many factors that lead to development of these complications. Our recent large systematic review of prospective cohort studies highlight that the association between thrombophilia and placenta mediated pregnancy complications is far from proven. The small step of previously describing an association in case control studies has led a large number of clinicians and opinion leaders to take the large leap of accepting this relationship as being causal and potentially treatable with anticoagulant interventions. Furthermore, while data in women with prior severe pre-eclpamsia, abruption and small for gestational age births without thrombophilia suggests some promise for anticoagulant prophylaxis to prevent complications in subsequent pregnancies in these women, in the absence of large well done and generalisable "no intervention" controlled studies adopting anticoagulant prophylaxis to prevent these complications is premature. The absence of strong evidence, coupled with the small potential for harm from anticoagulant prophylaxis suggests that these drugs should be considered experimental in thrombophilic and non-thrombophilic women with prior placenta mediated pregnancy complications.

  9. 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

  10. Older Breast Cancer Survivors: Factors Associated with Self-reported Symptoms of Persistent Lymphedema Over 7-years of Follow-up

    PubMed Central

    Clough-Gorr, Kerri M.; Ganz, Patricia A.; Silliman, Rebecca A.

    2009-01-01

    Introduction Lymphedema of the arm is a common complication of breast cancer with symptoms that can persist over long periods of time. For older women (over 50% of breast cancer cases) it means living with the potential for long-term complications of persistent lymphedema in conjunction with the common diseases and disabilities of aging over survivorship. Methods We identified women ≥65-years diagnosed with primary stage I-IIIA breast cancer. Data were collected over 7-years of follow-up from consenting patients’ medical records and telephone interviews. Data collected included self-reported symptoms of persistent lymphedema, breast cancer characteristics, and selected sociodemographic and health-related characteristics. Results The overall prevalence of symptoms of persistent lymphedema was 36% over 7-years of follow-up. Having stage II or III (OR=1.77, 95%CI 1.07–2.93) breast cancer and having a BMI>30 (OR=3.04, 95%CI 1.69–5.45) were statistically significantly predictive of symptoms of persistent lymphedema. Women ≥80-years were less likely to report symptoms of persistent lymphedema when compared to younger women (OR=0.44, 95%CI 0.18–0.95). Women with symptoms of persistent lymphedema consistently reported worse general mental health and physical function. Conclusion Symptoms of persistent lymphedema were common in this population of older breast cancer survivors and had a noticeable effect on both physical function and general mental health. Our findings provide evidence of the impact of symptoms of persistent lymphedema on the quality of survivorship of older women. Clinical and research efforts focused on risk factors for symptoms of persistent lymphedema in older breast cancer survivors may lead to preventative and therapeutic measures that help maintain their health and well-being over increasing periods of survivorship. PMID:19968661

  11. Penile and scrotal lymphedema as an unusual presentation of Crohn's disease: case report and review of the literature.

    PubMed

    Reitsma, W; Wiegman, M J; Damstra, R J

    2012-03-01

    Crohn's disease is an inflammatory intestinal disease that primarily causes abdominal pain and diarrhea. We report a male patient who presented with penile and scrotal lymphedema and inguinal fistulas as the first manifestations of Crohn's disease. Extraintestinal or metastatic Crohn's disease initially presenting as genital lymphedema with fistula formation is rare. Skin lesions in extraintestinal Crohn's disease typically show non-caseating, sarcoidal granulomas with numerous foreign body- and Langhans-type multinucleated giant cells, which are separated from intestinal involvement by normal skin. Treatment options are limited and include multi-immunosuppressant medications.

  12. Effects of Mobile Phone Usage in Supporting Leg Lymphedema Self-care

    PubMed Central

    Okutsu, Ayako; Koiyabashi, Kikuyo

    2014-01-01

    Objective: The aim of this study was to implement self-care support for leg lymphedema patients using mobile phones and to investigate the effects thereof. Patients and Methods: A total of 30 patients with lymphedema following female genital cancer surgery (stages I to II) who were referred from a nearby gynecologist were randomly divided into groups for routine self-care support (control group) and mobile telephone-assisted support (intervention group) and received the self-care support appropriate to their group. The (total) circumference of the leg with edema, FACT-G (cancer patient QOL), MHP (mental health status), and self-care self-assessment were comparatively investigated at three months after the initial interview. Results: No significant reduction in the (total) circumferences of legs with edema was confirmed in either the control or intervention group. The intervention group was significantly better than the control group in terms of the activity circumstances and FACT-G mental status at three months after the initial interview. The intervention group was also significantly better in psychological, social, and physical items in the MHP. The intervention group was significantly better than the control group in terms of circumstances of self-care implementation at three months after the initial interview. Additionally, comparison of the circumstances of implementation for different aspects of self-care content showed that the intervention group was significantly better at selecting shoes, observing edema, moisturizing, self-drainage, wearing compression garments, and implementing bandaging. Conclusion: Compared with routine self-care support, mobile telephone-assisted support is suggested to be effective for leg lymphedema patients’ QOL and mental health status as well as their self-care behaviors. PMID:25648778

  13. Role of physiotherapy and patient education in lymphedema control following breast cancer surgery

    PubMed Central

    Lu, Shiang-Ru; Hong, Rong-Bin; Chou, Willy; Hsiao, Pei-Chi

    2015-01-01

    Introduction This retrospective cohort study evaluated whether education in combination with physiotherapy can reduce the risk of breast cancer-related lymphedema (BCRL). Methods We analyzed 1,217 women diagnosed with unilateral breast cancer between January 2007 and December 2011 who underwent tumor resection and axillary lymph node dissection. The patients were divided into three groups: Group A (n=415), who received neither education nor physiotherapy postsurgery; Group B (n=672), who received an educational program on BCRL between Days 0 and 7 postsurgery; and Group C (n=130), who received an educational program on BCRL between Days 0 and 7 postsurgery, followed by a physiotherapy program. All patients were monitored until October 2013 to determine whether BCRL developed. BCRL risk factors were evaluated using Cox proportional hazards models. Results During the follow-up, 188 patients (15.4%) developed lymphedema, including 77 (18.6%) in Group A, 101 (15.0%) in Group B, and 10 (7.7%) in Group C (P=0.010). The median period from surgery to lymphedema was 0.54 years (interquartile range =0.18–1.78). The independent risk factors for BCRL included positive axillary lymph node invasion, a higher (>20) number of dissected axillary lymph nodes, and having undergone radiation therapy, whereas receiving an educational program followed by physiotherapy was a protective factor against BCRL (hazard ratio =0.35, 95% confidence interval =0.18–0.67, P=0.002). Conclusion Patient education that begins within the first week postsurgery and is followed by physiotherapy is effective in reducing the risk of BCRL in women with breast cancer. PMID:25750536

  14. Standardized Method for Quantification of Developing Lymphedema in Patients Treated for Breast Cancer

    SciTech Connect

    Ancukiewicz, Marek; Russell, Tara A.; Otoole, Jean; Specht, Michelle; Singer, Marybeth; Kelada, Alexandra; Murphy, Colleen D.; Pogachar, Jessica; Gioioso, Valeria; Patel, Megha; Skolny, Melissa; Smith, Barbara L.; Taghian, Alphonse G.

    2011-04-01

    Purpose: To develop a simple and practical formula for quantifying breast cancer-related lymphedema, accounting for both the asymmetry of upper extremities' volumes and their temporal changes. Methods and Materials: We analyzed bilateral perometer measurements of the upper extremity in a series of 677 women who prospectively underwent lymphedema screening during treatment for unilateral breast cancer at Massachusetts General Hospital between August 2005 and November 2008. Four sources of variation were analyzed: between repeated measurements on the same arm at the same session; between both arms at baseline (preoperative) visit; in follow-up measurements; and between patients. Effects of hand dominance, time since diagnosis and surgery, age, weight, and body mass index were also analyzed. Results: The statistical distribution of variation of measurements suggests that the ratio of volume ratios is most appropriate for quantification of both asymmetry and temporal changes. Therefore, we present the formula for relative volume change (RVC): RVC = (A{sub 2}U{sub 1})/(U{sub 2}A{sub 1}) - 1, where A{sub 1}, A{sub 2} are arm volumes on the side of the treated breast at two different time points, and U{sub 1}, U{sub 2} are volumes on the contralateral side. Relative volume change is not significantly associated with hand dominance, age, or time since diagnosis. Baseline weight correlates (p = 0.0074) with higher RVC; however, baseline body mass index or weight changes over time do not. Conclusions: We propose the use of the RVC formula to assess the presence and course of breast cancer-related lymphedema in clinical practice and research.

  15. A chronic and latent lymphatic insufficiency follows recovery from acute lymphedema in the rat foreleg

    PubMed Central

    Mendez, Uziel; Stroup, Emily M.; Lynch, Laura L.; Waller, Anna B.

    2012-01-01

    Secondary lymphedema in humans is a common consequence of axillary lymph node dissection (ALND) to treat breast cancer. Remarkably, secondary lymphedema generally first appears following a delay of over a year and can be triggered suddenly by an inflammatory insult. However, it remains unclear why the apparently functional lymphatic system is unable to accommodate an inflammatory trigger. To provide mechanistic insight into the delayed and rapid secondary lymphedema initiation, we compared the ability of the ALND-recovered rat foreleg lymphatic system to prevent edema during an inflammatory challenge with that of the uninjured lymphatic system. At 73 days postsurgery, the forelegs of ALND−- and ALND+-sensitized rats were exposed to the proinflammatory agent oxazolone, which was found to reduce fluid drainage and increase skin thickness in both ALND− and ALND+ forelegs (P < 0.05). However, drainage in the ALND-recovered forelegs was more severely impaired than ALND− forelegs, as visualized by indocyanine green lymphography and quantified by interstitial transport of fluid marker (P < 0.05). Although both ALND+ and ALND− forelegs experienced significant inflammation-induced edema with the oxazolone exposure (P < 0.05), the peak tissue swelling in the ALND+ group was significantly greater than that of the ALND− forelegs (arm area peaked at ∼13.4 vs. ∼5.7% swelling, respectively, P < 0.005; wrist diameter peaked at 9.7 vs. 2.2% swelling, respectively, P < 0.005). The findings demonstrate that outward recovery from ALND in the rat foreleg masks an ensuing chronic and latent lymphatic insufficiency, which reduces the ability of the foreleg lymphatic system to prevent edema during an acute inflammatory process. PMID:22942182

  16. Variation in seizure prophylaxis in severe pediatric traumatic brain injury.

    PubMed

    Ostahowski, Paige J; Kannan, Nithya; Wainwright, Mark S; Qiu, Qian; Mink, Richard B; Groner, Jonathan I; Bell, Michael J; Giza, Christopher C; Zatzick, Douglas F; Ellenbogen, Richard G; Boyle, Linda Ng; Mitchell, Pamela H; Vavilala, Monica S

    2016-10-01

    OBJECTIVE Posttraumatic seizure is a major complication following traumatic brain injury (TBI). The aim of this study was to determine the variation in seizure prophylaxis in select pediatric trauma centers. The authors hypothesized that there would be wide variation in seizure prophylaxis selection and use, within and between pediatric trauma centers. METHODS In this retrospective multicenter cohort study including 5 regional pediatric trauma centers affiliated with academic medical centers, the authors examined data from 236 children (age < 18 years) with severe TBI (admission Glasgow Coma Scale score ≤ 8, ICD-9 diagnosis codes of 800.0-801.9, 803.0-804.9, 850.0-854.1, 959.01, 950.1-950.3, 995.55, maximum head Abbreviated Injury Scale score ≥ 3) who received tracheal intubation for ≥ 48 hours in the ICU between 2007 and 2011. RESULTS Of 236 patients, 187 (79%) received seizure prophylaxis. In 2 of the 5 centers, 100% of the patients received seizure prophylaxis medication. Use of seizure prophylaxis was associated with younger patient age (p < 0.001), inflicted TBI (p < 0.001), subdural hematoma (p = 0.02), cerebral infarction (p < 0.001), and use of electroencephalography (p = 0.023), but not higher Injury Severity Score. In 63% cases in which seizure prophylaxis was used, the patients were given the first medication within 24 hours of injury, and 50% of the patients received the first dose in the prehospital or emergency department setting. Initial seizure prophylaxis was most commonly with fosphenytoin (47%), followed by phenytoin (40%). CONCLUSIONS While fosphenytoin was the most commonly used medication for seizure prophylaxis, there was large variation within and between trauma centers with respect to timing and choice of seizure prophylaxis in severe pediatric TBI. The heterogeneity in seizure prophylaxis use may explain the previously observed lack of relationship between seizure prophylaxis and outcomes.

  17. 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

  18. Localized bullous pemphigoid on sites of radiotherapy and lymphedema in the same patient

    PubMed Central

    Binitha, Manikoth P.; Vishnu, Veeravalli V.; Sreekanth, Sukumarakurup; Reena Mariyath, O. K.

    2014-01-01

    Bullous pemphigoid (BP) is a blistering disorder due to autoantibodies to the epidermal basement membrane zone. The triggering factor could be localized damage to the skin by physical or chemical agents. We report a case of a 68-year-old woman with a three year history of oral lesions of BP following radiotherapy for carcinoma of the hypopharynx, and a three month history of BP over lymphedematous sites on the right hand and right lower limb. Localized BP induced by radiotherapy or lymphedema is rare; both factors working simultaneously in the same patient is even rarer. PMID:25593794

  19. Systemic antibiotic prophylaxis and reconstructive ear surgery.

    PubMed

    Carlin, W V; Lesser, T H; John, D G; Fielder, C; Carrick, D G; Thomas, P L; Hill, S

    1987-12-01

    This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. Seventy-one individuals were clinically and bacteriologically assessed both preoperatively, and for a period of 8 weeks postoperatively. The results showed that antibiotic prophylaxis did not eradicate bacterial pathogens already present in preoperative ears, nor did it prevent their development during the postoperative period. The observation that an ear was wet or dry gave no indication of the actual presence or absence of pathogenic organisms.

  20. Local antimicrobial administration for prophylaxis of surgical site infections.

    PubMed

    Huiras, Paul; Logan, Jill K; Papadopoulos, Stella; Whitney, Dana

    2012-11-01

    Despite a lack of consensus guidelines, local antibiotic administration for prophylaxis of surgical site infections is used during many surgical procedures. The rationale behind this practice is to provide high antibiotic concentrations at the site of surgery while minimizing systemic exposure and adverse effects. Local antibiotic administration for surgical site prophylaxis has inherent limitations in that antibiotics are applied after the incision is made, rather than the current standard for surgical site prophylaxis that recommends providing adequate antibiotic concentrations at the site before the incision. The efficacy and safety of local application of antibiotics for surgical site prophylaxis have been assessed in different types of surgery with a variety of antibiotic agents and methods of application. We identified 22 prospective, randomized, controlled trials that evaluated local application of antibiotics for surgical site prophylaxis. These trials were subsequently divided and analyzed based on the type of surgical procedure: dermatologic, orthopedic, abdominal, colorectal, and cardiothoracic. Methods of local application analyzed included irrigations, powders, ointments, pastes, beads, sponges, and fleeces. Overall, there is a significant lack of level I evidence supporting this practice for any of the surgical genres evaluated. In addition, the literature spans several decades, and changes in surgical procedures, systemic antibiotic prophylaxis, and microbial flora make conclusions difficult to determine. Based on available data, the efficacy of local antibiotic administration for the prophylaxis of surgical site infections remains uncertain, and recommendations supporting this practice for surgical site prophylaxis cannot be made.

  1. Attitudes toward Infection Prophylaxis in Pediatric Oncology: A Qualitative Approach

    PubMed Central

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

    2012-01-01

    Background The risks and benefits of infection prophylaxis are uncertain in children with cancer and thus, preferences should be considered in decision making. The purpose of this report was to describe the attitudes of parents, children and healthcare professionals to infection prophylaxis in pediatric oncology. Methods The study was completed in three phases: 1) An initial qualitative pilot to identify the main attributes influencing the decision to use infection prophylaxis, which were then incorporated into a discrete choice experiment; 2) A think aloud during the discrete choice experiment in which preferences for infection prophylaxis were elicited quantitatively; and 3) In-depth follow up interviews. Interviews were recorded verbatim and analyzed using an iterative, thematic analysis. Final themes were selected using a consensus approach. Results A total of 35 parents, 22 children and 28 healthcare professionals participated. All three groups suggested that the most important factor influencing their decision making was the effect of prophylaxis on reducing the chance of death. Themes of importance to the three groups included antimicrobial resistance, side effects of medications, the financial impact of outpatient prophylaxis and the route and schedule of administration. Conclusion Effect of prophylaxis on risk of death was a key factor in decision making. Other identified factors were antimicrobial resistance, side effects of medication, financial impact and administration details. Better understanding of factors driving decision making for infection prophylaxis will help facilitate future implementation of prophylactic regiments. PMID:23112849

  2. Antimicrobial postexposure prophylaxis for anthrax: adverse events and adherence.

    PubMed

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

    2002-10-01

    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.

  3. Supplementary iron dose in pregnancy anemia prophylaxis.

    PubMed

    Reddaiah, V P; Raj, P P; Ramachandran, K; Nath, L M; Sood, S K; Madan, N; Rusia, U

    1989-01-01

    This study was conducted to determine the optimum dose of supplemental iron for prophylaxis against pregnancy anemia. One hundred and ten pregnant women were randomly allocated to three groups: Group A receiving equivalent of 60 mg, group B 120 mg and Group C 240 mg, elemental iron as ferrous sulphate daily; the content of folic acid was constant in all the three groups (0.5 mg). These women had at least consumed 90 tablets in 100 +/- 10 days. Blood was drawn at the beginning and at the end of the treatment. Fifty percent were anemic (less than 11 g/100 ml). The hemoglobin levels rose similarly in all groups and the differences were statistically not significant. Fifty-six percent had depleted iron stores (serum ferritin value less than 12 micrograms/l) at the beginning of the study. Following therapy a statistically significant increase in iron stores was observed in group B and C as compared to group A. The difference between group B and C was not significant. The side effects increased with increasing doses of iron; 32.4%, 40.3% and 72% in group A, B and C respectively. Based on these findings, the authors advocate that optimum dose of iron should be 120 mg instead of 60 mg as is currently being used in the National Nutritional Anemia Prophylaxis Programme.

  4. Effect of Kinesiology Taping on Breast Cancer-Related Lymphedema: A Randomized Single-Blind Controlled Pilot Study

    PubMed Central

    Trybulski, R.; Kucharzewski, M.; Kucio, C.; Mikusek, W.; Klakla, K.

    2013-01-01

    The aim of the study was to assess the efficacy of Kinesiology Taping (KT) for treating breast cancer-related lymphedema. Sixty-five women with unilateral stage II and III lymphedema were randomly grouped into the KT group (K-tapes, n = 20), the Quasi KT group (quasi K-tapes, n = 22), or the MCT group (multilayered compression therapy group, n = 23). Skin care, 45 min pneumatic compression therapy, 1 h manual lymphatic drainage, and application of K-tape/Quasi K-tapes/multilayered short-stretch bandages were given every treatment session, 3 times per week for 1 month. Patient evaluation items included limb size and percentage edema. Comparing the changes in K-tapes with quasi K-tapes changes, there were no significant differences (P > 0.05). The edema reduction of multilayered bandages was much better than in results observed in taping groups. The KT appeared to be ineffective at secondary lymphedema after breast cancer treatment. The single-blind, controlled pilot study results suggest that K-tape could not replace the bandage, and at this moment it must not be an alternative choice for the breast cancer-related lymphedema patient. The trial is registered with ACTRN12613001173785. PMID:24377096

  5. FOXC2 disease-mutations identified in lymphedema-distichiasis patients cause both loss and gain of protein function

    PubMed Central

    Tavian, Daniela; Missaglia, Sara; Maltese, Paolo E.; Michelini, Sandro; Fiorentino, Alessandro; Ricci, Maurizio; Serrani, Roberta; Walter, Michael A.; Bertelli, Matteo

    2016-01-01

    Dominant mutations in the FOXC2 gene cause a form of lymphedema primarily of the limbs that usually develops at or after puberty. In 90-95% of patients, lymphedema is accompanied by distichiasis. FOXC2 is a member of the forkhead/winged-helix family of transcription factors and plays essential roles in different developmental pathways and physiological processes. We previously described six unrelated families with primary lymphedema-distichiasis in which patients showed different FOXC2 mutations located outside of the forkhead domain. Of those, four were missense mutations, one a frameshift mutation, and the last a stop mutation. To assess their pathogenic potential, we have now examined the subcellular localization and the transactivation activity of the mutated FOXC2 proteins. All six FOXC2 mutant proteins were able to localize into the nucleus; however, the frameshift truncated protein appeared to be sequestered into nuclear aggregates. A reduction in the ability to activate FOXC1/FOXC2 response elements was detected in 50% of mutations, while the remaining ones caused an increase of protein transactivation activity. Our data reveal that either a complete loss or a significant gain of FOXC2 function can cause a perturbation of lymphatic vessel formation leading to lymphedema. PMID:27276711

  6. Efficacy of complete decongestive therapy and manual lymphatic drainage on treatment-related lymphedema in breast cancer

    SciTech Connect

    Koul, Rashmi . E-mail: rashmi.koul@cancercare.mb.ca; Dufan, Tarek; Russell, Catherine; Guenther, Wanda; Nugent, Zoan; Sun Xuyan; Cooke, Andrew L.

    2007-03-01

    Objective: To evaluate the results of combined decongestive therapy and manual lymphatic drainage in patients with breast cancer-related lymphedema. Methods and Materials: The data from 250 patients were reviewed. The pre- and posttreatment volumetric measurements were compared, and the correlation with age, body mass index, and type of surgery, chemotherapy, and radiotherapy was determined. The Spearman correlation coefficients and Wilcoxon two-sample test were used for statistical analysis. Results: Of the 250 patients, 138 were included in the final analysis. The mean age at presentation was 54.3 years. Patients were stratified on the basis of the treatment modality used for breast cancer management. Lymphedema was managed with combined decongestive therapy in 55%, manual lymphatic drainage alone in 32%, and the home program in 13%. The mean pretreatment volume of the affected and normal arms was 2929 and 2531 mL. At the end of 1 year, the posttreatment volume of the affected arm was 2741 mL. The absolute volume of the affected arm was reduced by a mean of 188 mL (p < 0.0001). The type of surgery (p = 0.0142), age (p = 0.0354), and body mass index (p < 0.0001) were related to the severity of lymphedema. Conclusion: Combined decongestive therapy and manual lymphatic drainage with exercises were associated with a significant reduction in the lymphedema volume.

  7. Effect of Kinesiology Taping on breast cancer-related lymphedema: a randomized single-blind controlled pilot study.

    PubMed

    Smykla, A; Walewicz, K; Trybulski, R; Halski, T; Kucharzewski, M; Kucio, C; Mikusek, W; Klakla, K; Taradaj, J

    2013-01-01

    The aim of the study was to assess the efficacy of Kinesiology Taping (KT) for treating breast cancer-related lymphedema. Sixty-five women with unilateral stage II and III lymphedema were randomly grouped into the KT group (K-tapes, n = 20), the Quasi KT group (quasi K-tapes, n = 22), or the MCT group (multilayered compression therapy group, n = 23). Skin care, 45 min pneumatic compression therapy, 1 h manual lymphatic drainage, and application of K-tape/Quasi K-tapes/multilayered short-stretch bandages were given every treatment session, 3 times per week for 1 month. Patient evaluation items included limb size and percentage edema. Comparing the changes in K-tapes with quasi K-tapes changes, there were no significant differences (P > 0.05). The edema reduction of multilayered bandages was much better than in results observed in taping groups. The KT appeared to be ineffective at secondary lymphedema after breast cancer treatment. The single-blind, controlled pilot study results suggest that K-tape could not replace the bandage, and at this moment it must not be an alternative choice for the breast cancer-related lymphedema patient. The trial is registered with ACTRN12613001173785.

  8. Venous thromboembolism prophylaxis after hospital discharge: transition to preventive care.

    PubMed

    Kaatz, Scott; Spyropoulos, Alex C

    2011-08-01

    Deep vein thrombosis and pulmonary embolism, the common clinical manifestations of venous thromboembolism (VTE), are among the most preventable complications of hospitalized patients. However, survey data repeatedly show poor rates of compliance with guideline-based preventive strategies. This has led the Centers for Medicare and Medicaid Services to deny reimbursement for hospital readmission for thromboembolic complications in patients undergoing total hip or knee arthroplasty. Multiple strategies and national initiatives have been developed to improve rates of VTE prophylaxis during hospitalization; however, most VTE occurs in the outpatient setting. Epidemiologic data suggest that recent surgery or hospitalization is a strong risk factor for the development of VTE and that this risk may persist for up to 6 months. These observations call into question whether VTE prophylaxis should be administered only during hospitalization or if this preventive strategy should be continued after hospital discharge. Many of the randomized trials showing efficacy of VTE prophylaxis have used longer durations of prophylaxis than are typical for current length of hospital stay, highlighting the issue of how long the duration of prophylaxis should be. Several patient groups have undergone formal testing to evaluate the risks and benefits of extended-duration VTE prophylaxis, but this issue is less clear for other categories of patients. Although there is clear consensus that most hospitalized patients should receive VTE prophylaxis, there is uncertainty about whether to continue VTE prophylaxis in the immediate post-hospital period or for an extended duration. The transition from inpatient to outpatient care is a key event in the coordination of continuity of care, but VTE-specific care transition guidance is limited. In this article, we review the evidence for both standard- and extended-duration VTE prophylaxis and discuss the difficulties in effectively maintaining VTE

  9. Pre-exposure rabies prophylaxis: a systematic review

    PubMed Central

    Recuenco, Sergio; Navarro-Vela, Ana Maria; Deray, Raffy; Vigilato, Marco; Ertl, Hildegund; Durrheim, David; Rees, Helen; Nel, Louis H; Abela-Ridder, Bernadette; Briggs, Deborah

    2017-01-01

    Abstract Objective To review the safety and immunogenicity of pre-exposure rabies prophylaxis (including accelerated schedules, co-administration with other vaccines and booster doses), its cost–effectiveness and recommendations for use, particularly in high-risk settings. Methods We searched the PubMed, Centre for Agriculture and Biosciences International, Cochrane Library and Web of Science databases for papers on pre-exposure rabies prophylaxis published between 2007 and 29 January 2016. We reviewed field data from pre-exposure prophylaxis campaigns in Peru and the Philippines. Findings Pre-exposure rabies prophylaxis was safe and immunogenic in children and adults, also when co-administered with routine childhood vaccinations and the Japanese encephalitis vaccine. The evidence available indicates that shorter regimens and regimens involving fewer doses are safe and immunogenic and that booster intervals could be extended up to 10 years. The few studies on cost suggest that, at current vaccine and delivery costs, pre-exposure prophylaxis campaigns would not be cost-effective in most situations. Although pre-exposure prophylaxis has been advocated for high-risk populations, only Peru and the Philippines have implemented appropriate national programmes. In the future, accelerated regimens and novel vaccines could simplify delivery and increase affordability. Conclusion Pre-exposure rabies prophylaxis is safe and immunogenic and should be considered: (i) where access to postexposure prophylaxis is limited or delayed; (ii) where the risk of exposure is high and may go unrecognized; and (iii) where controlling rabies in the animal reservoir is difficult. Pre-exposure prophylaxis should not distract from canine vaccination efforts, provision of postexposure prophylaxis or education to increase rabies awareness in local communities. PMID:28250534

  10. Shoulder Pain after Fall, Septic Shock, and Pyomyositis Associated with Breast Cancer Chemotherapy and Lymphedema

    PubMed Central

    Kitayama, Hiromitsu; Sugiyama, Junko; Hirayama, Michiaki; Onada, Yosihiro; Tsuji, Yasushi

    2016-01-01

    Background As a symptom of pyomyositis, sepsis usually follows local inflammation signs. Here, we report pyomyositis with lymphedema of upper extremity in which septic shock and poor local findings initially presented during chemotherapy for breast cancer. Case Report An 80-year-old woman presented with chronic right shoulder pain during chemotherapy for the recurrent disease. She had a history of postmastectomy lymphedema, diabetes mellitus, and repeated hyaluronic acid injections to the shoulder joint. The pain suddenly worsened with septic shock and no apparent local signs. Magnetic resonance imaging revealed myonecrosis, and no pus was yielded by ultrasound-guided needle aspiration. After 2 weeks of recovery by conservative medical management, surgical drainage was performed. Late formulated massive intramuscular pus showed severe neutrophil infiltration and myonecrosis. Conclusion Pyomyositis can develop into septic shock with poor local signs. Myelosuppression after chemotherapy can cause myonecrosis without macroabscess, and magnetic resonance imaging was useful for the diagnosis of this condition. When unspecified local pain appears during cancer chemotherapy we should consider this disease, too. PMID:27920709

  11. The impact of early detection and intervention of breast cancer-related lymphedema: a systematic review.

    PubMed

    Shah, Chirag; Arthur, Douglas W; Wazer, David; Khan, Atif; Ridner, Sheila; Vicini, Frank

    2016-06-01

    Breast cancer-related lymphedema (BCRL) has become an increasingly important clinical issue as noted by the recent update of the 2015 NCCN breast cancer guidelines which recommends to "educate, monitor, and refer for lymphedema management." The purpose of this review was to examine the literature regarding early detection and management of BCRL in order to (1) better characterize the benefit of proactive surveillance and intervention, (2) clarify the optimal monitoring techniques, and (3) help better define patient groups most likely to benefit from surveillance programs. A Medline search was conducted for the years 1992-2015 to identify articles addressing early detection and management of BCRL. After an initial search, 127 articles were identified, with 13 of these studies focused on early intervention (three randomized (level of evidence 1), four prospective (level of evidence 2-3), six retrospective trials (level of evidence 4)). Data from two, small (n = 185 cases), randomized trials with limited follow-up demonstrated a benefit to early intervention (physiotherapy, manual lymphatic drainage) with regard to reducing the rate of chronic BCRL (>50% reduction) with two additional studies underway (n = 1280). These findings were confirmed by larger prospective and retrospective series. Several studies were identified that demonstrate that newer diagnostic modalities (bioimpedance spectroscopy, perometry) have increased sensitivity allowing for the earlier detection of BCRL. Current data support the development of surveillance programs geared toward the early detection and management of BCRL in part due to newer, more sensitive diagnostic modalities.

  12. Information for patients with or at risk of cancer-related lymphedema.

    PubMed

    Dubois, Sylvie; Folch, Nathalie

    2013-10-01

    The Internet has great potential to provide information to patients with or at risk of developing cancer-related lymphedema (CRL), a complication of cancer treatment. To evaluate Web site structure (e.g., accreditation, design) and content (e.g., validity) for available Web sites on CRL, lymphedema, lymphoedema, cancer, and oncology were used with 10 search engines (five French and five English). The first page of each Web site was examined and the content was identified and classified using the evaluation model of the Science Panel on Interactive Communication and Health. The search strategy yielded 120 Web sites. Using inclusion and exclusion criteria, 19 Web sites were selected. The authors found that 79% of the Web sites focused exclusively on CRL and 74% were in English. Although information about each site's sponsor, goal, and target audience was readily available, content material was incomplete and evaluation of Web site impact and effectiveness was nonexistent. This review suggests that Web sites about CRL vary greatly in terms of structure and content.

  13. Compression therapy and liposuction of lower legs for bilateral hereditary primary lymphedema praecox.

    PubMed

    Espinosa-de-Los-Monteros, Antonio; Hinojosa, Carlos A; Abarca, Leonardo; Iglesias, Martín

    2009-01-01

    In this report, we describe a case of bilateral non-syndromic hereditary lymphedema praecox of lower legs. The patient was diagnosed at age 16. Ten years later, he was unable to ambulate due to increased bilateral lower leg volume, continuous pain, and recurrent episodes of cellulitis. He was treated at our tertiary-care center with compression therapy and circumferential liposuction of lower legs, ankles, and dorsum of feet in order to remove hypertrophic fat deposits, facilitate conservative therapy, and decrease further risk of cellulitis. No complications were seen and compression therapy was continued. Fourteen month follow-up reveals no increase in leg volume over time, absence of pain, and no further episodes of cellulitis with complete ability to ambulate and return to normal activities. Even when it does not eliminate the underlying cause of primary lymphedema, combined therapy consisting of compression and liposuction is safe and is able to achieve control, at least on a short term, of clinically disabling conditions associated with advanced stages.

  14. A retrospective study of the effects of the Lymphapress pump on lymphedema in a pediatric population.

    PubMed

    Hassall, A; Graveline, C; Hilliard, P

    2001-12-01

    We studied the effects of the Lymphapress pump (LP; Global Medical Imports, Digby, NS, Canada) retrospectively on 16 children with primary or secondary lymphedema of the upper or lower extremities by measuring the volume and circumference of the limbs before and after treatment. We reviewed medical charts for data on age, sex, length of disease process, grade of lymphedema, frequency and duration of treatment, and pump pressures used. We recorded changes in limb size before and after pumping in terms of the mean percentage difference between the affected and unaffected limb at both time points to allow for growth of the child and the extremity. On volumetric measures, thirteen (93%) of the subjects showed a clinical trend towards sustained maintenance or reduction in size of the lymphedematous limb(s). The reduction in the pump pressure at start of the treatment to that required to maintain the size of the limb was statistically significant (p = 0.0036). Fourteen (88%) of the subjects had no complications directly attributable to the pump, whereas two had complications that were probably unrelated to LP. Overall, there was a clinical trend towards reduction or maintenance of the lymphedematous limb size in children using LP without notable adverse sequelae.

  15. Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery.

    PubMed

    Goffman, Thomas E; Laronga, Christine; Wilson, Lori; Elkins, David

    2004-01-01

    The purpose of this study was to assess risk for lymphedema of the breast and arm in radiotherapy patients in an era of less extensive axillary surgery. Breast cancer patients treated for cure were reviewed, with a minimum follow-up of 1.5 years from the end of treatment. Clinical, surgical, and radiation-related variables were tested for statistical association with arm and breast lymphedema using regression analyses, t-tests, and chi-squared analyses. Between January 1998 and June 2001, 240 women received radiation for localized breast cancer in our center. The incidence of lymphedema of the ipsilateral breast, arm, and combined (breast and arm) was 9.6%, 7.6%, and 1.8%, respectively, with a median follow-up of 27 months. For breast edema, t-test and multivariate analysis showed body mass index (BMI) to be significant (p = 0.043, p = 0.0038), as was chi-squared and multivariate testing for site of tumor in the breast (p = 0.0043, p = 0.0035). For arm edema, t-test and multivariate analyses showed the number of nodes removed to be significant (p = 0.0040, p = 0.0458); the size of the tumor was also significant by multivariate analyses (p = 0.0027). Tumor size appeared significant because a number of very large cancers failed locally and caused cancer-related obstructive lymphedema. In our center, even modern, limited level 1-2 axillary dissection and tangential irradiation carries the risk of arm lymphedema that would argue in favor of sentinel node biopsy. For breast edema, disruption of draining lymphatics by surgery and radiation with boost to the upper outer quadrant increased risk, especially for the obese. Fortunately both breast and arm edema benefited from manual lymphatic drainage.

  16. Bioimpedance Spectroscopy in Detecting Lower-Extremity Lymphedema in Patients With Stage I, Stage II, Stage III, or Stage IV Vulvar Cancer Undergoing Surgery and Lymphadenectomy

    ClinicalTrials.gov

    2016-02-09

    Lymphedema; Perioperative/Postoperative Complications; Stage IA Vulvar Cancer; Stage IB Vulvar Cancer; Stage II Vulvar Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVA Vulvar Cancer; Stage IVB Vulvar Cancer

  17. Evidence for extended prophylaxis in the setting of orthopedic surgery.

    PubMed

    Dobesh, Paul P

    2004-07-01

    Patients undergoing orthopedic surgery represent one of the highest risk groups for the development of venous thromboembolism (VTE). Evidence shows that this risk extends beyond the period in which the patient is hospitalized, especially for patients undergoing hip surgery. Clinical trials have shown that extended prophylaxis with the low-molecular-weight heparins is effective in reducing the rate of total VTE, and a meta-analysis demonstrated a reduction in symptomatic VTE with extended prophylaxis after total hip replacement surgery. Based on these results, the American College of Chest Physicians gives a grade 2A recommendation for the use of extended prophylaxis after orthopedic surgery. Until recently, data evaluating the role of prophylaxis in patients undergoing hip fracture surgery were limited. Subsequently, a novel anticoagulant, fondaparinux, demonstrated significant benefit in these patients and has become the first and only agent approved by the United States Food and Drug Administration (FDA) for use in patients undergoing hip fracture surgery Despite the limitations of the older trials, their findings supported the need to evaluate extended prophylaxis in patients undergoing hip fracture surgery. In the first well-conducted trial of extended prophylaxis for hip fracture surgery, fondaparinux provided impressive results in reducing total and symptomatic VTE. The results of this trial have once again led to fondaparinux being the first and only agent to be granted FDA approval for the indication of extended prophylaxis in patients undergoing hip fracture surgery.

  18. Secondary prophylaxis for esophageal variceal bleeding.

    PubMed

    Albillos, Agustín; Tejedor, Marta

    2014-05-01

    Combination therapy with beta-blockers and endoscopic band ligation (EBL) is the standard prophylaxis of esophageal variceal rebleeding in cirrhosis. Beta-blockers are the backbone of combination therapy, since their benefit extend to other complications of portal hypertension. EBL carries the risk of post-banding ulcer bleeding, which explains why overall rebleeding is reduced when beta-blockers are added to EBL, and not when EBL is added to beta-blockers. TIPS is the rescue treatment, but it could be considered as first choice in patients that first bleed while on beta-blockers, those with contraindications to beta-blockers or with refractory ascites, and those with fundal varices.

  19. Current therapies and prophylaxis of malaria.

    PubMed

    Ehrich, R

    1994-09-01

    Malaria is a potentially life-threatening disease. Although not commonplace in the United States, malaria cases are occurring more frequently due to an influx of military personnel returning from duty in malarious areas, increased numbers of immigrants, and tourist and business travel to endemic areas. Careful history taking and proper laboratory diagnosis are essential in detecting malaria. Malaria should be considered in the differential diagnosis with any fever of unknown origin. Due to the increase in chloroquine resistant P. falciparum malaria worldwide it behooves the clinician to keep abreast of current therapies in the treatment and prophylaxis of malaria. The Centers for Disease Control and Prevention is one of the best resources for up-to-date recommended therapies.

  20. [Antibiotic prophylaxis with cephalosporins in heart surgery].

    PubMed

    Reichart, B; Klinner, W; Adam, D

    1981-08-13

    60 minutes after i.v. injection tissue levels of 7 different cephalosporins were obtained using biological assay. The following concentrations were measured: cephalothn 1.4 micrograms/g; cepharin 4.7 micrograms/g; cephacetrile 11.2 micrograms/g; cephradine 15.4 micrograms/g; cefazedone 26.9 micrograms/g; cefamandole 40.3 micrograms/g, and finally cefoxitin 43 micrograms/g. The high tissue levels of cefamandole and cefoxitin are especially remarkable as i.v. doses of both antibiotics had been 50 mg/kg body weight ( doses of all other cephalosporins 100 mg/kg body weight). Except cephalothin, all cephalosporins tested were suitable for antibiotic prophylaxis in cardiac surgery.

  1. [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.

  2. Prophylaxis therapy in haemophilia A: current situation in Spain.

    PubMed

    Lucía, J F; Aznar, J A; Abad-Franch, L; Escuin, R R; Jiménez-Yuste, V; Pérez, R; Batlle, J; Balda, I; Alperovich, G; Parra, R

    2011-01-01

    The Spanish Epidemiological Study in Haemophilia carried out in 2006 enrolled 2400 patients [2081-86.7% with haemophilia A (HA) and 319-13.3% with haemophilia B]; 465 of them (19.4%) were on prophylaxis. These rates were higher in patients with severe haemophilia (45.4%) and severe paediatric cases (72.5%). On the basis of information recorded in this study, we analysed the current situation of prophylaxis therapy administered to patients with HA in Spain, as well as their orthopaedic status. Prophylaxis was used in 399 (19.2%) patients with HA; such prophylaxis was primary (PP) in 20.3% and secondary (SP) in 75.9% of cases. Among severe HA patients, 313 (45.9%) were on prophylaxis (22.3% on PP and 74.7% on SP). Taking into account the patients' age, 34.7% of severe HA adults were on prophylaxis (6% PP and 92.1% SP), whereas 71.5% of severe HA paediatric patients (40.5% PP and 55.4% SP) received this kind of treatment. Established haemophilic arthropathy (EHA) was detected in 142 from 313 severe HA patients (45.3%) on prophylaxis, but only in 2.9% of patients under PP vs. 59% of patients receiving SP. There was no EHA in adult severe HA patient on PP, whereas 70.4% on SP had joint damage (P < 0.00001). Among paediatric severe HA patients, EHA was detected in 3.3% under PP and 37.8% under SP (P < 0.00001). In conclusion, our data suggest that an early initiation of prophylaxis avoids EHA in the long-term in patients with severe HA. We should emphasize the early onset of prophylaxis regimens.

  3. Congenital, low penetrance lymphedema of lower limbs maps to chromosome 6q16.2-q22.1 in an inbred Pakistani family.

    PubMed

    Malik, Sajid; Grzeschik, Karl-Heinz

    2008-03-01

    Hereditary lymphedema is a rare, lymphatic disorder resulting in the chronic swelling of the extremities. It shows wide inter- and intra-familial clinical heterogeneity as well as variability in the age of onset. There are more than four genetically distinct lymphedema conditions known and mutations in three genes have been discovered in families with lymphedema. However, many other familial lymphedemas do not show linkage with the known loci, suggesting genetic heterogeneity. Here, we describe a large inbred Pakistani family with congenital, progressive lymphedema confined to the lower limbs, which fades away at 40-45 years of age. This condition segregates in an autosomal dominant fashion with reduced penetrance. The features are close to primary lymphedema I, Nonne-Milory type (MIM 153100). We exclude this condition for linkage to the known loci for lymphedema by employing highly polymorphic microsatellite markers from these intervals. Then, through a genome-wide linkage study we show that the malformation in our family maps to chromosome 6q16.2-q22.1. The highest pair-wise LOD score (Z(max) = 3.19) was obtained with microsatellite marker D6S1671, and a multipoint score of 3.75 was obtained at 108 cM. Haplotype analysis indicated that the critical interval in this family flanks between markers D6S1716 and D6S303. Mutation analysis in FOXO3, a likely candidate within this interval, did not show any pathogenic change in the affected family subjects. Our study provides an evidence of a second locus for lymphedema type I. The discovery of the underlying gene could be helpful for the understanding of this heterogeneous hereditary condition.

  4. [Experience with the development of vaccinal prophylaxis in Perm Province].

    PubMed

    Lebedeva, T M; Fel'dblium, I V; Komkov, B D; Skovorodin, A N; Deviatkov, M Iu; Sarmometov, E V; Perminova, O A; Vorozhtsova, T N

    1999-01-01

    The results of the introduction of the system of epidemiological surveillance on vaccinal prophylaxis on the territory of Perm Province are presented. This system has permitted the realization of the principles of the regional tactics of immunization, while following the unified strategy acting on the territory of the Russian Federation. The optimization of the organizational foundations of vaccinal prophylaxis has made it possible to maintain the morbidity rates if infections, controlled by means of specific prophylaxis, on the levels below the average figures for the Federation and to preserve more stable tendencies to their decrease.

  5. A comparison of the quality of life in patients with primary and secondary lower-limb lymphedema: A mixed-methods study

    PubMed Central

    Stolldorf, Deonni P; Dietrich, Mary S.; Ridner, Sheila H.

    2016-01-01

    Patients with lower-limb lymphedema experience symptoms that may differ in intensity and distress. This mixed-methods study compares symptom intensity and distress and the impact of lymphedema on patients’ quality of life by primary and secondary (cancer and non-cancer) lymphedema groups. Individuals completed an online questionnaire (i.e., demographic form, Lymphedema Symptom Intensity and Distress Survey-Leg, and an open-ended question). Analyses included descriptive and inferential statistics (quantitative data) and content analysis (qualitative data). Participants differed statistically significantly by gender, employment status, and lymphedema location. Groups differed significantly in lack of self-confidence (χ2(df=2) =9.19; p=.010). Cancer patients reported higher intensity and distress scores for some symptoms, but these differences were not statistically significant. Patients reported lacking psychosocial well-being and resources and experiencing physical and functional impairments and treatment and care challenges. Patients with lower-limb lymphedema experience psychosocial impairments and problems with quality of and access to care. PMID:27151079

  6. Visual Attention in Children With Migraine: The Importance of Prophylaxis.

    PubMed

    Villa, Thaís Rodrigues; Agessi, Larissa M; Moutran, Andréa R C; Gabbai, Alberto A; Carvalho, Deusvenir de S

    2016-04-01

    This study aimed to compare the visual attention performance of children newly diagnosed with migraine, children undergoing migraine prophylaxis, and a healthy control group. Eighty-two children aged 8 to 12 years were divided into 3 groups: untreated migraine (n = 30), migraine prophylaxis (n = 22), and control (n = 30). All were subjected to a visual attention assessment with the Trail Making Test parts A and B, Letter-Cancellation Test, and the Brazilian Visual Attention Test 3rd edition. Although performance in attention tasks was within the normal range in all groups, children with untreated migraine performed significantly worse in some visual attention tests than did the control children or children undergoing migraine prophylaxis. The migraine prophylaxis group performed as well as the control group. The deregulation of the neurochemical mechanisms underlying the physiopathology of migraine might induce visual attention deficits, but an effective prophylactic treatment might reverse migraine symptoms.

  7. Sexual Assault: A Report on Human Immunodeficiency Virus Postexposure Prophylaxis

    PubMed Central

    Griffith, William F.; Ackerman, Gary E.; Zoellner, Cindy L.; Sheffield, Jeanne S.

    2010-01-01

    The objective of this report is to describe an urban county hospital human immunodeficiency virus (HIV) infection prevention protocol offering prophylactic combination antiretroviral medications to female victims of sexual assault. A retrospective chart review was conducted from June, 2007 through June, 2008 of 151 women who were prescribed antiretroviral prophylaxis by protocol. All women receiving HIV prophylaxis initially screened HIV seronegative. Of the 58 women who reported taking any HIV prophylaxis, 36 (62%) were HIV screened at 12 and/or 24 weeks and none had HIV seroconverted. Although the initiation of an HIV post exposure prophylaxis protocol for sexual assault in a county hospital population is feasible, patient follow-up for counseling and HIV serostatus evaluation is an identified barrier PMID:20706678

  8. Factitious lymphedema of the arm: case report and review of publications.

    PubMed

    De Fátima Guerreiro Godoy, M; Pereira De Godoy, J M

    2015-06-01

    The aim of this study was to report a case of factitious lymphedema of the arm and related lymphoscintigraphic aspects. The case of a 36-year-old patient is reported who started to present with pain, in the 3rd finger of the right hand three years prior to this report, which she associated with her work. Joint effusion was identified and treated using a splint that restricted blood flow leading to edema of the distal third of the forearm. Since then the patient was treated however her condition worsened resulting in edema of the entire arm. Subsequently she was referred to our service. A physical examination identified a restrictive band in the axillary region of the arm that delimited the edema. Volumetry and lymphoscintigraphic examinations of the limb were performed. The lymphoscintigraphy demonstrated acceleration of the flow in the affected limb and dermal reflux. Clinical treatment with removal of the restriction allowed a rapid reduction in the volume of the limb.

  9. Deep vein thrombosis/pulmonary embolism: prophylaxis, diagnosis, and management.

    PubMed

    Brunelli, Alessandro

    2012-02-01

    Thoracic surgery patients should be regarded at high risk for postoperative venous thromboembolism (VTE). VTE mechanical and pharmacologic prophylaxis with low molecular weight heparin, or low-dose unfractionated heparin or fondaparinux (Arixtra) is therefore strongly recommended. Pharmacologic prophylaxis should be extended to 4 weeks after major cancer surgery. Pulmonary embolism should be always managed with anticoagulation, in addition to thrombolytic therapy, in patients presenting with cardiogenic shock or persistent arterial hypotension.

  10. Conformity with guidelines for antimicrobial prophylaxis against bacterial endocarditis.

    PubMed

    Sagert, G; Austin, T W; Bombassaro, A M; Parbtani, A

    1994-10-01

    The extent to which prescribed antimicrobial prophylaxis against bacterial endocarditis conformed with American Heart Association (AHA) guidelines was determined and the frequency of nonconformity with specific elements of the guidelines was evaluated. Patients with conditions defined by AHA as placing them at risk for developing endocarditis were identified through medical records for a four-year period at an 850-bed hospital. Data about the procedures they underwent and prophylaxis prescribed were compared with the AHA guidelines. Conformity with the guidelines was evaluated according to whether prophylaxis was recommended, optional, or unnecessary; nonconformity with specific elements of the guidelines (indication, choice of antimicrobial, dose, dosage interval, timing, and duration) was also evaluated. The following variables were evaluated for possible association with nonconformity to the guidelines: patient's age and sex, penicillin allergy, use of a consultant, and whether the procedure was the first performed in the patient after identification of the cardiac condition. Of the 131 cases analyzed, 29 (22%) involved prophylaxis that conformed with the AHA guidelines. Conformity with the guidelines was significantly lower when prophylaxis was recommended or optional than when it was unnecessary. Nonconformity was most common with the following elements: indication, choice of antimicrobial, and dose. Recommended prophylaxis was given more often in children than in adults and more often before first procedures than before subsequent procedures. More of the regimens prescribed for children exceeded the recommended duration than those prescribed for adults. Unnecessary prophylaxis was given more often when a consultant was involved than when no consultant was involved. In hospitalized patients, conformity with AHA guidelines for antimicrobial prophylaxis against endocarditis was low.

  11. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    SciTech Connect

    Shah, Chirag; Vicini, Frank A.

    2011-11-15

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  12. Development of the short version of the Gynecologic Cancer Lymphedema Questionnaire: GCLQ-7

    PubMed Central

    Kim, Namjoo; Lee, Seonjoo; Lee, Sujung; Seo, Sang-Soo; Chung, Seung Hyun

    2017-01-01

    Objective The Gynecologic Cancer Lymphedema Questionnaire (GCLQ) was designed to identify gynecologic cancer patients with lower limb lymphedema (LLL). The questionnaire consists of 20 items distributed over 7 symptom clusters. The present study aimed to develop an abridged form of the GCLQ for simpler screening and more effective follow-up of LLL. Methods Data that had been collected for the development and validation of the Korean version of the GCLQ (GCLQ-K) were used in this study. Receiver-operating characteristic (ROC) curves were drawn according to the individual items of the GCLQ-K. Based on discrimination ability, the candidate items were selected in each symptom cluster. After combining the items, the best model was identified and named GCLQ-7. The area under the ROC curve (AUC) was compared between the GCLQ-7 and the original GCLQ-K. Results In total, 11 candidate items were selected from the original GCLQ-K. Among the models made with the candidate items, GCLQ-7, the best model, was constructed with 7 items as follows: 1) limited knee movement, 2) general swelling, 3) redness, 4) firmness/tightness, 5) groin swelling, 6) heaviness, and 7) aching. This model exhibited an AUC of 0.945 (95% confidence interval [CI], 0.900–0.991), which is comparable with that of the original GCLQ-K (AUC, 0.867; 95% CI, 0.779–0.956). The best cutoff value was 2 points, at which the sensitivity and specificity were 97.0% and 76.5%, respectively. Conclusion The newly developed short version model, GCLQ-7, showed acceptable discrimination ability as compared with the original GCLQ-K. PMID:27819411

  13. Cytomegalovirus Hyper Immunoglobulin for CMV Prophylaxis in Thoracic Transplantation.

    PubMed

    Rea, Federico; Potena, Luciano; Yonan, Nizar; Wagner, Florian; Calabrese, Fiorella

    2016-03-01

    Cytomegalovirus (CMV) infection negatively influences both short- and long-term outcomes after cardiothoracic transplantation. In heart transplantation, registry analyses have shown that CMV immunoglobulin (CMVIG) with or without virostatic prophylaxis is associated with a significant reduction in mortality and graft loss versus no prophylaxis, particularly in high-risk donor (D)+/recipient (R)- transplants. Randomized comparative trials are lacking but retrospective data suggest that addition of CMVIG to antiviral prophylaxis may reduce rates of CMV-related events after heart transplantation, including the incidence of acute rejection or chronic allograft vasculopathy. However, available data consistently indicate that when CMVIG is used, it should be administered with concomitant antiviral therapy, and that evidence concerning preemptive management with CMVIG is limited, but promising. In lung transplantation, CMVIG should again only be used with concomitant antiviral therapy. Retrospective studies have shown convincing evidence that addition of CMVIG to antiviral prophylaxis lowers CMV endpoints and mortality. The current balance of evidence suggests that CMVIG prophylaxis reduces the risk of bronchiolitis obliterans syndrome, but a controlled trial is awaited. Overall, the relatively limited current data set suggests that prophylaxis with CMVIG in combination with antiviral therapy appears effective in D+/R- heart transplant patients, whereas in lung transplantation, addition of CMVIG in recipients of a CMV-positive graft may offer an advantage in terms of CMV infection and disease.

  14. Pharmacokinetics of posaconazole prophylaxis of patients with acute myeloid leukemia.

    PubMed

    Mattiuzzi, Gloria; Yilmaz, Musa; Kantarjian, Hagop; Borthakur, Gautam; Konopleva, Marina; Jabbour, Elias; Brown, Yolanda; Pierce, Sherry; Cortes, Jorge

    2015-09-01

    Antifungal prophylaxis is routinely given to patients with hematologic malignancies at high risk for invasive fungal infections (IFI), yet breakthrough IFI may still occur. Posaconazole emerged as an excellent alternative for fungal prophylaxis in high-risk patients. There is limited data about pharmacokinetics and plasma concentrations of posaconazole when given as prophylaxis in patients with hematologic malignancies. We recruited 20 adult patients for prospective, open label trial of posaconazole given as a prophylaxis in patients with newly diagnosed acute myeloid leukemia (AML) undergoing induction chemotherapy or first salvage therapy. The median age of all patients was 65 years and received prophylaxis for a median of 38 days (range: 5-42 days).Ten patients (50%) completed 42 days on posaconazole prophylaxis. Median plasma posaconazole levels showed no statistical difference across gender, body surface area, patients developing IFI, and patients acquiring grade 3 or 4 elevation of liver enzymes. However, there was an overall trend for higher trough concentrations among patients with no IFI than those with IFI. Pharmacokinetics of posaconazole varies from patient to patient, and AML patients receiving induction chemotherapy who never develop IFI tend to have higher plasma concentrations after oral administration of posaconazole.

  15. 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…

  16. [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.

  17. Drug-coated balloons for restenosis prophylaxis.

    PubMed

    Speck, U; Scheller, B; Hamm, B

    2014-04-01

    Drug-coated balloons for restenosis prophylaxis provide a high local drug concentration with minimal or no systemic adverse effects. Their development was both delayed and facilitated by the introduction of drug-eluting stents: delayed because sustained release kinetics from stent platforms seemed to be essential and facilitated because prior experience with stents allowed selection of testing methods and drugs. Currently, a variety of drug-coated balloons are available, basically consisting of a coating containing paclitaxel at a dose of about 3 µg/mm² balloon surface, and different additives influencing the adherence and release of the drug, e. g., contrast agent, urea, or various amphiphilic compounds. The drug is almost completely released during a single inflation of 30 - 60 seconds. Studies in animals and several independent randomized clinical trials in coronary and peripheral arteries demonstrate effective reduction of neointimal proliferation, restenosis, and revascularization persisting for at least 2 years or 5 years according to one study in coronary arteries. Drug-coated balloons are preferably used for treating coronary in-stent restenosis and de novo and restenotic lesions in peripheral vessels. No coating-related adverse events have been observed in clinical trials. Persistent efficacy may be explained by the long residence time of paclitaxel in tissue or inhibition of an essential first step in the chain of events leading to neointimal proliferation.

  18. 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.

  19. Effects of proprioceptive neuromuscular facilitation stretching and deep-breathing exercises on upper extremity lymphedema in stroke patients

    PubMed Central

    Hwang, Woon Taek; Jeong, Yeon-Jae; Kim, Seong-Yeol; Jeong, Yeon-Gyu

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of deep-breathing and proprioceptive neuromuscular facilitation stretching exercises on upper limb lymphedema in stroke patients. [Subjects and Methods] The study consisted of 10 patients with lymphedema that had occurred after stroke. Neurodevelopmental treatment was applied in the same manner as that used for the existing treatment. The subjects performed deep-breathing and stretching exercises three times per week for 4 weeks (12 sessions total). Body water volume in the upper limbs was measured before and after exercise by using an InBody S10 analyzer. [Results] Performance of deep-breathing and stretching exercises significantly reduced body water volume in both the affected and unaffected arms. The extracellular-to-total cellular fluid volume ratio in the affected arm improved to 0.379 after exercise, although this change was not significant. [Conclusion] The results of the present study show that deep-breathing and proprioceptive neuromuscular facilitation stretching exercises reduce upper extremity lymphedema in stroke patients. PMID:28174433

  20. Predictive lymphatic mapping: a method for mapping lymphatic channels in patients with advanced unilateral lymphedema using indocyanine green lymphography.

    PubMed

    Mihara, Makoto; Seki, Yukio; Hara, Hisako; Iida, Takuya; Oka, Aiko; Kikuchi, Kazuki; Narushima, Mitsunaga; Haragi, Makiko; Furniss, Dominic; Hin-Lun, Lawrence; Mitsui, Kito; Murai, Noriyuki; Koshima, Isao

    2014-01-01

    In severe lymphedema, indocyanine green lymphography cannot be used to map lymphatic channels before lymphaticovenular anastomosis (LVA) because linear lymphatics cannot be detected in a severely affected leg. Here, we describe a new method, which we refer to as predictive lymphatic mapping, to predict the location of lymphatics for anastomosis in unilateral lymphedema, thereby improving surgical accuracy and efficiency. The approach consists of marking anatomical landmarks and joining selected landmarks with fixed lines. The distance from these fixed lines to lymphatic channels mapped by indocyanine green lymphography in the unaffected leg is then measured, scaled up based on the difference in circumference between the legs, and transposed to the affected leg. To date, we have used this method in 5 cases of unilateral or asymmetric lymphedema of the lower extremities. In no cases have we failed to find a lymphatic channel suitable for LVA within a 2-cm incision. These results suggest that predictive lymphatic mapping is a useful additional tool for surgeons performing LVA under local anesthesia, which will help to improve the accuracy of incisions and the efficiency of surgery.

  1. Effects of proprioceptive neuromuscular facilitation stretching and deep-breathing exercises on upper extremity lymphedema in stroke patients.

    PubMed

    Hwang, Woon Taek; Jeong, Yeon-Jae; Kim, Seong-Yeol; Jeong, Yeon-Gyu

    2016-12-01

    [Purpose] The purpose of this study was to determine the effects of deep-breathing and proprioceptive neuromuscular facilitation stretching exercises on upper limb lymphedema in stroke patients. [Subjects and Methods] The study consisted of 10 patients with lymphedema that had occurred after stroke. Neurodevelopmental treatment was applied in the same manner as that used for the existing treatment. The subjects performed deep-breathing and stretching exercises three times per week for 4 weeks (12 sessions total). Body water volume in the upper limbs was measured before and after exercise by using an InBody S10 analyzer. [Results] Performance of deep-breathing and stretching exercises significantly reduced body water volume in both the affected and unaffected arms. The extracellular-to-total cellular fluid volume ratio in the affected arm improved to 0.379 after exercise, although this change was not significant. [Conclusion] The results of the present study show that deep-breathing and proprioceptive neuromuscular facilitation stretching exercises reduce upper extremity lymphedema in stroke patients.

  2. Cervical Stimulation in the Treatment of Children with Lymphedema of All Four Extremities: A Case Report and Literature Review

    PubMed Central

    Pereira de Godoy, Livia Maria; Pereira de Godoy Capeletto, Paula

    2017-01-01

    Aim. The aim of this study is to report on the use of cervical stimulation as monotherapy to reduce swelling and normalize the size of limbs in two children with lymphedema of all four extremities. Case Presentation. One child also had hemifacial edema. In both cases, the mothers were trained to perform cervical stimulation under professional supervision. The cases of two girls, one of eight months and the other of six months, with primary congenital lymphedema are described. Outcome. After clinical diagnosis, the patients started treatment with cervical stimulation three times per week. The mothers were trained in cervical stimulation and, when the therapy team was confident about the mothers' ability to perform the technique, the children began to be treated at home. The Godoy & Godoy cervical stimulation technique consists of around 20 to 30 light stroking movements per minute in the cervical region which stimulate the lymphatics. Perimetric measurements were made of the feet, legs, and the hands. Only two points (3 and 6 cm) along the dorsum of the feet and hands and points at 5 cm intervals up the legs starting at the ankle were considered. Today, the children are 5 and 6 years of age, without edema and with a normal life, without limitations, except with respect to precautions against injuries to the limbs and against infections particularly erysipelas. Conclusion. Cervical Lymphatic Therapy as monotherapy is an option in the treatment of primary congenital lymphedema. PMID:28337356

  3. Arap3 is dysregulated in a mouse model of hypotrichosis-lymphedema-telangiectasia and regulates lymphatic vascular development.

    PubMed

    Kartopawiro, Joëlle; Bower, Neil I; Karnezis, Tara; Kazenwadel, Jan; Betterman, Kelly L; Lesieur, Emmanuelle; Koltowska, Katarzyna; Astin, Jonathan; Crosier, Philip; Vermeren, Sonja; Achen, Marc G; Stacker, Steven A; Smith, Kelly A; Harvey, Natasha L; François, Mathias; Hogan, Benjamin M

    2014-03-01

    Mutations in SOX18, VEGFC and Vascular Endothelial Growth Factor 3 underlie the hereditary lymphatic disorders hypotrichosis-lymphedema-telangiectasia (HLT), Milroy-like lymphedema and Milroy disease, respectively. Genes responsible for hereditary lymphedema are key regulators of lymphatic vascular development in the embryo. To identify novel modulators of lymphangiogenesis, we used a mouse model of HLT (Ragged Opossum) and performed gene expression profiling of aberrant dermal lymphatic vessels. Expression studies and functional analysis in zebrafish and mice revealed one candidate, ArfGAP with RhoGAP domain, Ankyrin repeat and PH domain 3 (ARAP3), which is down-regulated in HLT mouse lymphatic vessels and necessary for lymphatic vascular development in mice and zebrafish. We position this known regulator of cell behaviour during migration as a mediator of the cellular response to Vegfc signalling in lymphatic endothelial cells in vitro and in vivo. Our data refine common mechanisms that are likely to contribute during both development and the pathogenesis of lymphatic vascular disorders.

  4. In vitro study on the safety of near infrared laser therapy in its potential application as postmastectomy lymphedema treatment.

    PubMed

    Cialdai, Francesca; Landini, Ida; Capaccioli, Sergio; Nobili, Stefania; Mini, Enrico; Lulli, Matteo; Monici, Monica

    2015-10-01

    Clinical studies demonstrated the effectiveness of laser therapy in the management of postmastectomy lymphedema, a discomforting disease that can arise after surgery/radiotherapy and gets progressively worse and chronic. However, safety issues restrict the possibility to treat cancer patients with laser therapy, since the effects of laser radiation on cancer cell behavior are not completely known and the possibility of activating postmastectomy residual cancer cells must be considered. This paper reports the results of an in vitro study aimed to investigate the effect of a class IV, dual-wavelength (808 nm and 905 nm), NIR laser system on the behavior of two human breast adenocarcinoma cell lines (namely, MCF7 and MDA-MB361 cell lines), using human dermal fibroblasts as normal control. Cell viability, proliferation, apoptosis, cell cycle and ability to form colonies were analyzed in order to perform a cell-based safety testing of the laser treatment in view of its potential application in the management of postmastectomy lymphedema. The results showed that, limited to the laser source, treatment conditions and experimental models used, laser radiation did not significantly affect the behavior of human breast adenocarcinoma cells, including their clonogenic efficiency. Although these results do not show any significant laser-induced modification of cancer cell behavior, further studies are needed to assess the possibility of safely applying NIR laser therapy for the management of postmastectomy lymphedema.

  5. Low rate of lymphedema after extended pelvic lymphadenectomy followed by pelvic irradiation of node-positive prostate cancer

    PubMed Central

    2013-01-01

    Background The aim of the present study was to evaluate the prevalence and severity of lower limb lymphedema after pelvic lymphadenectomy and radiotherapy to the pelvic lymph nodes in patients with prostate cancer. Methods Twenty-six patients underwent combined treatment for high-risk node-positive prostate cancer at Skåne University Hospital between April 2008 and March 2011. The treatment consisted of extended pelvic lymphadenectomy followed by androgen deprivation therapy and radiotherapy. The pelvic lymphnodes, prostate and seminal vesicles were treated with external beam radiotherapy (EBRT) to an absorbed dose of 50 Gy followed by a brachytherapy (BT) boost of 2x10 Gy to the prostate only. Twenty-two patients accepted an invitation to a clinical examination with focus on lower limb swelling. The median time between the end of radiotherapy and examination was 2.2 years (range 1.2–4.1). Results Six patients (27%) experienced grade 1 lymphedema and two patients (9%) grade 2 while none had grade 3 or 4 according to the CTC Common Toxicity Criteria scale 4.0. Three patients required treatment with compression stockings. Conclusion Brachytherapy and pelvic EBRT have a low incidence of lymphedema (at median 2.2 y after treatment) in patients with high-risk node-positive prostate cancer that have undergone pelvic lymph node dissection. PMID:24252686

  6. Leg lymphedema caused by iliopectineal bursitis associated with destruction of a rheumatoid hip joint: A case report.

    PubMed

    Kuroyanagi, Gen; Yamada, Kunio; Imaizumi, Tsukasa; Mizutani, Jun; Wada, Ikuo; Kozawa, Osamu; Tokuda, Haruhiko; Otsuka, Takanobu

    2013-10-01

    The present study describes a case of leg lymphedema due to iliopectineal bursitis associated with rheumatoid arthritis (RA), which was satisfactorily controlled by surgery and combination therapy with methotrexate (MTX) and tacrolimus. A 68-year-old male, who had a six-year history of RA, developed an iliopectineal bursa associated with destruction of the hip joint. The mass gradually increased in size, and there was swelling in his right lower extremity. The patient was subsequently hospitalized with increasing right hip pain and leg edema. A colorless transparent lymph fluid leaked from his leg, and leg lymphedema was thus diagnosed. The patient also had a 20-year history of myelodysplastic syndrome. Therefore, the extensive or total resection of the bursa was considered to be too invasive, so a partial bursal excision was performed via an anterior approach. Following the partial bursal excision, total hip arthroplasty (THA) was performed using the Hardinge approach. The leg lymphedema disappeared following the surgery, and the iliopectineal bursa was no longer enlarged. MTX and tacrolimus were postoperatively administered to strictly control the RA. The RA was subsequently well controlled, without any increases in the levels of inflammatory markers, such as C-reactive protein and matrix metalloproteinase-3. This case demonstrated that iliopectineal bursitis was resolved following THA, without complete excision of the intrapelvic bursa, and that strict RA control led to a good clinical course without recurrent inflammation of the bursa. Similar procedures may be beneficial in other patients contraindicated for resection of the entire bursa.

  7. Allogeneic hematopoietic cell transplantation without fluconazole and fluoroquinolone prophylaxis.

    PubMed

    Heidenreich, D; Kreil, S; Nolte, F; Reinwald, M; Hofmann, W-K; Klein, S A

    2016-01-01

    Fluoroquinolone (FQ) and fluconazole prophylaxis is recommended for patients undergoing allogeneic hematopoietic cell transplantation (alloHCT). However, due to an uncertain scientific basis and the increasing emergence of resistant germs, this policy should be questioned. Therefore, FQ and fluconazole prophylaxis was omitted in alloHCT at our center. In this retrospective analysis, all consecutive patients (n = 63) who underwent first alloHCT at our institution from September 2010 to September 2013 were included. Patients neither received FQ nor fluconazole prophylaxis. Day 100 mortality, incidence of febrile neutropenia, bacterial infections, and invasive fungal diseases (IFD) were assessed. Sixteen patients who started conditioning under antimicrobial treatment/prophylaxis due to pre-existing neutropenia (3/16), IFD (12/16), or aortic valve replacement (1/16) were excluded from the analysis. Finally, 47 patients were transplanted without prophylaxis as intended. Day 100 mortality was 9 %. Febrile neutropenia occurred in 62 % (29/47); 17/47 patients (36 %) experienced a blood stream infection (BSI) with detection of Gram-positive bacteria in 14 patients, Gram-negative bacteria in five patients, and candida in one patient, respectively. Coagulase-negative staphylococci were the most frequently isolated Gram-positive bacteria; 12/21 isolated Gram-positive and 3/6 Gram-negative bacteria were FQ resistant. In 21 % (10/47) of the patients, IFD (1x proven, 1x probable, and 8x possible) were diagnosed. To conclude, all three criteria, day 100 mortality, the incidence of IFD, and BSI, are in the range of published data for patients transplanted with FQ and fluconazole prophylaxis. These data demonstrate that alloHCT is feasible without FQ and fluconazole prophylaxis.

  8. Results of a venous thromboembolism prophylaxis program for hospitalized patients

    PubMed Central

    Cardoso, Luiz Francisco; Krokoscz, Daniella Vianna C; de Paiva, Edison Ferreira; Furtado, Ilka Spinola; Mattar, Jorge; de Souza e Sá, Marcia Martiniano; de Lira, Antonio Carlos Onofre

    2016-01-01

    Introduction Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. Objective The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. Patients and methods This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel–Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05. Results With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033). Conclusion The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the

  9. Use of Probiotics as Prophylaxis for Postoperative Infections

    PubMed Central

    Jeppsson, Bengt; Mangell, Peter; Thorlacius, Henrik

    2011-01-01

    Postoperative bacterial infections are common despite prophylactic administration of antibiotics. The wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria. A restricted use of antibiotics must be followed in most clinical situations. In surgical patients there are several reasons for an altered microbial flora in the gut in combination with an altered barrier function leading to an enhanced inflammatory response to surgery. Several experimental and clinical studies have shown that probiotics (mainly lactobacilli) may reduce the number of potentially pathogenia bacteria (PPM) and restore a deranged barrier function. It is therefore of interest to test if these abilities of probiotics can be utilized in preoperative prophylaxis. These factors may be corrected by perioperative administration of probiotics in addition to antibiotics. Fourteen randomized clinical trials have been presented in which the effect of such regimens has been tested. It seems that in patients undergoing liver transplantation or elective surgery in the upper gastrointestinal tract prophylactic administration of different probiotic strains in combination with different fibers results in a three-fold reduction in postoperative infections. In parallel there seems to be a reduction in postoperative inflammation, although that has not been studied in a systematic way. The use of similar concepts in colorectal surgery has not been successful in reducing postoperative infections. Reasons for this difference are not obvious. It may be that higher doses of probiotics with longer duration are needed to influence microbiota in the lower gastrointestinal tract or that immune function in colorectal patients may not be as important as in transplantation or surgery in the upper gastrointestinal tract. The favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to elucidate potential mechanisms, impact on gut

  10. The Effect of Hygiene-Based Lymphedema Management in Lymphatic Filariasis-Endemic Areas: A Systematic Review and Meta-analysis

    PubMed Central

    Stocks, Meredith E.; Freeman, Matthew C.; Addiss, David G.

    2015-01-01

    Background Lymphedema of the leg and its advanced form, known as elephantiasis, are significant causes of disability and morbidity in areas endemic for lymphatic filariasis (LF), with an estimated 14 million persons affected worldwide. The twin goals of the World Health Organization’s Global Program to Eliminate Lymphatic Filariasis include interrupting transmission of the parasitic worms that cause LF and providing care to persons who suffer from its clinical manifestations, including lymphedema—so-called morbidity management and disability prevention (MMDP). Scaling up of MMDP has been slow, in part because of a lack of consensus about the effectiveness of recommended hygiene-based interventions for clinical lymphedema. Methods and Findings We conducted a systemic review and meta-analyses to estimate the effectiveness of hygiene-based interventions on LF-related lymphedema. We systematically searched PubMed, Embase, ISI Web of Knowledge, MedCarib, Lilacs, REPIDISCA, DESASTRES, and African Index Medicus databases through March 23, 2015 with no restriction on year of publication. Studies were eligible for inclusion if they (1) were conducted in an area endemic for LF, (2) involved hygiene-based interventions to manage lymphedema, and (3) assessed lymphedema-related morbidity. For clinical outcomes for which three or more studies assessed comparable interventions for lymphedema, we conducted random-effects meta-analyses. Twenty-two studies met the inclusion criteria and two meta-analyses were possible. To evaluate study quality, we developed a set of criteria derived from the GRADE methodology. Publication bias was assessed using funnel plots. Participation in hygiene-based lymphedema management was associated with a lower incidence of acute dermatolymphagioadenitis (ADLA), (Odds Ratio 0.32, 95% CI 0.25–0.40), as well as with a decreased percentage of patients reporting at least one episode of ADLA during follow-up (OR 0.29, 95% CI 0.12–0.47). Limitations

  11. [Pattern of injuries and prophylaxis in paragliding].

    PubMed

    Schulze, W; Hesse, B; Blatter, G; Schmidtler, B; Muhr, G

    2000-06-01

    This study will present trends and recommendations to increase active and passive safety in paragliding on the basis of current state-of-the-art equipment and typical patterns of injury. This German-Swiss teamwork presents data of 55 male and 9 female patients treated after paragliding accidents between 1994 to 1998 respectively 1996 to 1998. 43.7% of the pilots presented with multiple injuries, 62.5% suffered spinal fractures and 18.8% pelvic fractures. 28.4% of the injured pilots were admitted with injuries of the lower extremities mainly affecting the tarsus or the ankle joint. Only three patients with single injuries could be treated in an ambulatory setting. 54.0% of the injuries left the patients with lasting functional residues and complaints. Main causes of accidents were either pilot error in handling the paraglider or general lack of awareness about potential risk factors. 46.0% of injuries occurred during landing, 42.9% of injuries during the flight and another 11.1% of injuries during starting procedures. With noticeable enhanced performance sails of the beginners and intermediate level are increasingly popular. Protective helmets and sturdy footwear reaching above the ankle joint are indispensable pieces of equipment. The use of protective gloves is highly recommended. Back protection devices of the new generation provide the best passive prophylaxis for the pilot against pelvic and spinal cord injuries. This area hold the most promise for increasing safety and reducing risk of injury in future, apart from using beginners and intermediate wings. After acquisition of the pilot license performance and security training provide the best preparing to master unforeseeable situations.

  12. National Practice in Antibiotic Prophylaxis in Breast Cancer Surgery

    PubMed Central

    Eroglu, Aydan; Karasoy, Durdu; Kurt, Halil; Baskan, Semih

    2014-01-01

    Background Although breast cancer surgery is regarded as a “clean” surgery, surgical site infection (SSI) rates are higher than expected. There is no consensus regarding the use of antibiotic prophylaxis in elective breast surgery. The nationwide survey was conducted to determine the trend of antibiotic prophylaxis in breast cancer among Turkish surgeons. Methods The survey was sent to surgeons who are member of Turkish Surgical Association (TSA) via e-mail from TSA web address. A 15 item web-based survey consisted of surgeon demographics and the use of prophylactic antibiotic in patients with risk factors related to SSI. Results The number of completed questionnaires was 245. The most common antibiotic used was first generation of cephalosporins. A majority of respondents indicated that prophylaxis was preferred in patients with high risk of SSI including preoperative chemotherapy or radiotherapy, older age, diabetes mellitus, immunodeficiency, immediate reconstruction (P < 0.05). However, the use of drain did not significantly influence antibiotic prophylaxis (P = 0.091). Conclusions The use of prophylactic antibiotic was strongly dependent on the presence of some risk factors; however, the variation in current practice regarding antibiotic prophylaxis demonstrated a lack of its effect on preventing SSI after breast cancer surgery. PMID:24400029

  13. ANTIBIOTIC PROPHYLAXIS IN LAPAROSCOPIC CHOLECISTECTOMY: IS IT WORTH DOING?

    PubMed Central

    PASSOS, Márcio Alexandre Terra; PORTARI-FILHO, Pedro Eder

    2016-01-01

    ABSTRACT Background: Elective laparoscopic cholecystectomy has very low risk for infectious complications, ranging the infection rate from 0.4% to 1.1%. Many surgeons still use routine antibiotic prophylaxis Aim: Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients. Method: Prospective, randomized and double-blind study. Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy divided in two groups: group A (n=50), patients that received prophylaxis using intravenous Cephazolin (2 g) during anesthetic induction and group B (n=50), patients that didn't receive any antibiotic prophylaxis. The outcome evaluated were infeccious complications at surgical site. The patients were reviewed seven and 30 days after surgery. Results: There was incidence of 2% in infection complications in group A and 2% in group B. There was no statistical significant difference of infectious complications (p=0,05) between the groups. The groups were homogeneous and comparable. Conclusion: The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients doesn't provide any significant benefit in the decrease of surgical wound infection. PMID:27759780

  14. Prophylaxis of migraine: general principles and patient acceptance

    PubMed Central

    D’Amico, Domenico; Tepper, Stewart J

    2008-01-01

    Migraine is a chronic neurological condition with episodic exacerbations. Migraine is highly prevalent, and associated with significant pain, disability, and diminished quality of life. Migraine management is an important health care issue. Migraine management includes avoidance of trigger factors, lifestyle modifications, non-pharmacological therapies, and medications. Pharmacological treatment is traditionally divided into acute or symptomatic treatment, and preventive treatment or prophylaxis. Many migraine patients can be treated using only acute treatment. Patients with severe and/or frequent migraines require long-term preventive therapy. Prophylaxis requires daily administration of anti-migraine compounds with potential adverse events or contraindications, and may also interfere with other concurrent conditions and treatments. These problems may induce patients to reject the idea of a preventive treatment, leading to poor patient adherence. This paper reviews the main factors influencing patient acceptance of anti-migraine prophylaxis, providing practical suggestions to enhance patient willingness to accept pharmacological anti-migraine preventive therapy. We also provide information about the main clinical characteristics of migraine, and their negative consequences. The circumstances warranting prophylaxis in migraine patients as well as the main characteristics of the compounds currently used in migraine prophylaxis will also be briefly discussed, focusing on those aspects which can enhance patient acceptance and adherence. PMID:19337456

  15. Role of vaccinations and prophylaxis in rheumatic diseases.

    PubMed

    Papadopoulou, Despoina; Tsoulas, Christos; Tragiannidis, Athanassios; Sipsas, Nikolaos V

    2015-04-01

    Targeted strategies for reducing the increased risk of infection in patients with autoimmune rheumatic diseases include vaccinations as well as antibiotic prophylaxis in selected patients. However, there are still issues under debate: Is vaccination in patients with rheumatic diseases immunogenic? Is it safe? What is the impact of immunosuppressive drugs on vaccine immunogenicity and safety? Does vaccination cause disease flares? In which cases is prophylaxis against Pneumocystis jirovecii required? This review addresses these important questions to which clinicians and researchers still do not have definite answers. The first part includes immunization recommendations and reviews current data on vaccine efficacy and safety in patients with rheumatic diseases. The second part discusses prophylaxis for Pneumocystis pneumonia.

  16. Posaconazole prophylaxis in experimental azole-resistant invasive pulmonary aspergillosis.

    PubMed

    Seyedmousavi, Seyedmojtaba; Mouton, Johan W; Melchers, Willem J G; Verweij, Paul E

    2015-03-01

    We investigated the efficacy of posaconazole prophylaxis in preventing invasive aspergillosis due to azole-resistant Aspergillus fumigatus isolates. Using a neutropenic murine model of pulmonary infection, posaconazole prophylaxis was evaluated using three isogenic clinical isolates, with posaconazole MICs of 0.063 mg/liter (wild type), 0.5 mg/liter (F219I mutation), and 16 mg/liter. A fourth isolate harboring TR34/L98H (MIC of 0.5 mg/liter) was also tested. Posaconazole prophylaxis was effective in A. fumigatus with posaconazole MICs of ≤0.5 mg/liter, where 100% survival was reached. However, breakthrough infection was observed in mice infected with the isolate for which the posaconazole MIC was >16 mg/liter.

  17. [Malaria prophylaxis; advice for the individual traveller. The Working Group for Malaria Prophylaxis].

    PubMed

    1998-04-18

    Recently, the Dutch Working Group on Malaria Prophylaxis produced new national guidelines. The new approach takes the risk of malaria and of serious morbidity or mortality for the individual traveller as its point of departure. In large areas in the tropics, there is no malaria risk. In some areas with limited risk, proguanil is still an effective chemoprophylactic (mainly in Central America, the Near East, Central Asia and parts of Indonesia). However, multiple-drug resistant Plasmodium falciparum necessitates the use of mefloquine, despite disturbing side effects in some people, in Sub-Saharan Africa, major parts of South East Asia and the Amazone basin of South America. If mefloquine is contraindicated, alternatives advised are the combination of proguanil and chloroquine or (in South East Asia) doxycycline. For visits to transmission areas lasting 7 days or less, alternative prophylactic measures may be acceptable, but only if the traveller after the visit has easy access to adequate medical facilities. When exposure lasts not more than two nights, use of a mosquito net, repellents and protective clothing without chemoprophylaxis is acceptable, provided the traveller is well informed. To take along pocket treatment is only advised for some journeys lasting more than one month to areas with multiple-drug resistant falciparum malaria. When mefloquine prophylaxis is used, such stand-by treatment is only advocated for a few countries in South East Asia; when mefloquine cannot be given, also for other areas. The type of pocket treatment recommended depends on the chemoprophylaxis used and on whether contraindications exist. Drugs that can be used are: halofantrine (if no contraindications exist and an ECG shows no prolongation of the QT interval) or quinine, either alone (in pregnancy) or combined with doxycycline or clindamycine (the latter for children < 8 years). With the new individual approach advice may differ for different persons visiting similar tropical

  18. Case report: Manual lymphatic drainage and kinesio taping in the secondary malignant breast cancer-related lymphedema in an arm with arteriovenous (A-V) fistula for hemodialysis.

    PubMed

    Chou, Ya-Hui; Li, Shu-Hua; Liao, Su-Fen; Tang, Hao-Wei

    2013-08-01

    Lymphedema is a dreaded complication of breast cancer treatment. The standard care for lymphedema is complex decongestive physiotherapy, which includes manual lymphatic drainage (MLD), short stretch bandaging, exercise, and skin care. The Kinesio Taping could help to improve lymphatic uptake. We reported a patient with unilateral secondary malignant breast cancer-related lymphedema and arteriovenous (A-V) fistula for hemodialysis happened in the same arm, and used kinesio taping, MLD, and exercise to treat this patient because no pressure could be applied to the A-V fistula. The 12-session therapy created an excellent effect. We do not think the kinesio taping could replace short stretch bandaging, but it could be another choice for contraindicating pressure therapy patients, and we should pay attention to wounds induced by kinesio tape.

  19. Functional magnetic resonance evidence of cortical alterations in a case of reversible congenital lymphedema of the lower limb: a pilot study.

    PubMed

    Pardini, M; Bonzano, L; Roccatagliata, L; Boccardo, F; Mancardi, G; Campisi, C

    2007-03-01

    We report the first application of brain functional Magnetic Resonance Imaging (fMRI) to congenital peripheral lymphedema patients before and after microsurgical treatment. Our aim was to evaluate the effects of limb shape change on cortical organization of the motor system and how the cortical sensorimotor network restructures after microsurgical therapy. We acquired fMRI during active motor and motor imagery tasks before surgery and six months after surgery in a patient with congenital lymphedema of the left leg. fMRI data revealed activation differences in primary and secondary motor areas between the two scanning sessions for both tasks and also between the patient's and a healthy volunteer's activations. We suggest that these alterations could be related to changes in body schema representation due to the congenital lymphedema.

  20. Considerations in individualizing prophylaxis in patients with haemophilia A.

    PubMed

    Valentino, L A

    2014-09-01

    Prophylaxis is considered optimal care for children and adults with severe haemophilia A because of its proven ability to reduce joint and other bleeding episodes. However, a 'one size fits all' approach to prophylaxis is not ideal, potentially leading to over-treatment in some individuals and under-treatment in others. Moreover, a generic plan fails to take into account a patient's lifestyle and personal preferences. This article reviews the factors contributing to bleeding risk and joint damage and uses case studies to illustrate how these contributors can be weighed to individualize the prophylactic regimen, thereby increasing the likelihood of therapeutic success.

  1. Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment

    PubMed Central

    SARRI, ALMIR JOSÉ; MORIGUCHI, SONIA MARTA; DIAS, ROGÉRIO; PERES, STELA VERZINHASSE; DA SILVA, EDUARDO TINÓIS; KOGA, KÁTIA HIROMOTO; ZUCCA MATTHES, ÂNGELO GUSTAVO; DOS SANTOS, MARCELO JOSÉ; DA ROCHA, EUCLIDES TIMÓTEO; HAIKEL, RAPHAEL LUIZ

    2010-01-01

    The aim of this study was to confirm the effectiveness of early physiotherapeutic stimulation for lymphatic flow progression in patients with breast cancer undergoing axillary dissection. This was a randomized experimental study on 22 patients who underwent lymphoscintigraphy in their arms on two different occasions, firstly without stimulation and secondly after randomization into two groups: without physiotherapeutic stimulation (WOPS; n=10) and with physiotherapeutic stimulation (WPS; n=12). The lymphoscintigraphy scan was performed with 99mTc-phytate administered into the second interdigital space of the hand, ipsilaterally to the dissected axilla, in three phases: dynamic, static, and delayed whole body imaging. Physiotherapeutic stimulation was carried out using Földi's technique. In both groups, images from the two examinations of each patient were compared. Flow progression was considered positive when, on the second examination, the radiopharmaceutical reached areas more distant from the injection site. Statistical analysis was used to evaluate frequencies, percentages and central trend measurements, and non-parametric tests were conducted. Descriptive analysis showed that the WPS and WOPS groups were similar in terms of mean age, weight, height, body mass index and number of lymph nodes removed. There were statistically significant associations between physiotherapeutic stimulation and radiopharmaceutical progression at all three phases of the study (p<0.0001). Early physiotherapeutic stimulation in breast cancer patients undergoing radical axillary dissection is effective, and can therefore be indicated as a preventive measure against lymphedema. PMID:23136607

  2. Lipidomic Profiling of Adipose Tissue Reveals an Inflammatory Signature in Cancer-Related and Primary Lymphedema

    PubMed Central

    Sedger, Lisa M.; Tull, Dedreia L.; McConville, Malcolm J.; De Souza, David P.; Rupasinghe, Thusitha W. T.; Williams, Spencer J.; Dayalan, Saravanan; Lanzer, Daniel; Mackie, Helen; Lam, Thomas C.; Boyages, John

    2016-01-01

    Cancer-related and primary lymphedema (LE) are associated with the production of adipose tissue (AT). Nothing is known, however, about the lipid-based molecules that comprise LE AT. We therefore analyzed lipid molecules in lipoaspirates and serum obtained from LE patients, and compared them to lipoaspirates from cosmetic surgery patients and healthy control cohort serum. LE patient serum analysis demonstrated that triglycerides, HDL- and LDL-cholesterol and lipid transport molecules remained within the normal range, with no alterations in individual fatty acids. The lipidomic analysis also identified 275 lipid-based molecules, including triacylglycerides, diacylglycerides, fatty acids and phospholipids in AT oil and fat. Although the majority of lipid molecules were present in a similar abundance in LE and non-LE samples, there were several small changes: increased C20:5-containing triacylglycerides, reduced C10:0 caprinic and C24:1 nervonic acids. LE AT oil also contained a signature of increased cyclopropane-type fatty acids and inflammatory mediators arachidonic acid and ceramides. Interestingly C20:5 and C22:6 omega-3-type lipids are increased in LE AT, correlating with LE years. Hence, LE AT has a normal lipid profile containing a signature of inflammation and omega-3-lipids. It remains unclear, however, whether these differences reflect a small-scale global metabolic disturbance or effects within localised inflammatory foci. PMID:27182733

  3. The role of lymphovenous communication in the development of postmastectomy lymphedema

    SciTech Connect

    Aboul-Enein, A.; Eshmawy, I.; Arafa, S.; Abboud, A.

    1984-05-01

    Forty women were investigated 6 to 24 months after radical mastectomy for the presence of functioning lymphovenous communications in the arm; 20 cases were edematous and the rest were not. Ten normal volunteer women were also investigated and served as controls. Iodinated (I125) human serum albumin was injected intralymphatically in the arm, and samples of blood were taken from both basilic veins simultaneously at 5, 10, 15, 30, 45, and 60 minutes. The radioactivity of each sample was determined with a scintillation counter. Lymphangiography was performed in all cases 1 month after the isotopic studies and lymphangiograms were evaluated for the presence of lymphovenous shunts. In the volunteers and the edematous postmastectomy group, there was negligible lymphovenous shunting of labeled albumin. In the nonedematous postmastectomy group, there was an increased quantity of local lymphovenous transfer of iodinated albumin. Lymphovenous shunts were detected radiologically in two patients who did not have edema. On the basis of our observations, the incidence of postmastectomy lymphedema is predetermined and is a consequence of the lack of existence of lymphovenous communications that can allow adequate lymph flow drainage from the arm after radical dissection of axillary lymph nodes.

  4. Cardiorespiratory Fitness in Women with and without Lymphedema following Breast Cancer Treatment

    PubMed Central

    Smoot, Betty; Johnson, Morgan; Duda J, John; Krasnoff, Joanne; Dodd, Marylin

    2013-01-01

    Following breast cancer (BC) treatment, many women develop impairments that may impact cardiorespiratory (CR) fitness. The aims of this study were to 1) evaluate CR fitness in women following BC treatment, 2) evaluate differences in CR fitness in those with and without breast cancer-related lymphedema (BCRL) and compare these to age-matched norms, and 3) evaluate the contribution of predictor variables to CR fitness. 136 women post-BC treatment completed testing: 67 with BCRL, and 69 without. VO2 peak was lower in participants compared to published healthy age-matched norms. VO2 peak was statistically significantly lower in women with BCRL. Age, BMI, meeting recommended exercise criteria, and DASH scores explained 50% of the variance in VO2 peak (R=0.708, p<0.001). Following BC treatment CR fitness may be impaired, more-so in women with BCRL. This should be considered when providing rehabilitation for women following BC treatment as cardiorespiratory fitness has linked to improved health outcomes and survivorship. PMID:24058390

  5. Skin and Subcutaneous Tissue Ultrasonography Features in Breast Cancer-Related Lymphedema

    PubMed Central

    Morikage, Noriyasu; Yamashita, Osamu; Harada, Takasuke; Samura, Makoto; Takeuchi, Yuriko; Mizoguchi, Takahiro; Nakamura, Kaori; Hamano, Kimikazu

    2016-01-01

    Objective: To investigate skin, subepidermal low echogenic band (SELEB), and subcutaneous tissue (SCT) thickness as well as the degree of increase in subcutaneous echogenicity (SEG) and subcutaneous echo-free space (SEFS) in arms with lymphedema (LE). Materials and Methods: The skin and SCT of both arms of 30 patients with unilateral stage II breast cancer-related LE were scanned at five points (medial/lateral upper arm/forearm and dorsum of the hand). SEG and SEFS grades were determined according to severity (range: 0–2). Results: All measured parameters, except the SEFS in the medial upper arm, were significantly higher on the LE side than on the normal (N) side. The parameters differed most remarkably in the medial forearm (MFA; skin: LE 1.7 ± 0.8 mm vs. N 0.8 ± 0.2 mm; SELEB: LE 1.0 ± 0.6 mm vs. N 0.3 ± 0.1 mm; SCT: LE 8.7 ± 3.4 mm vs. N 3.8 ± 2.0 mm; SEG: LE 0.9 ± 0.5 vs. N 0.1 ± 0.3; and SEFS: LE 0.5 ± 0.7 vs. N 0). Conclusion: The differences in the thickness of the skin, SELEB, and SCT and the SEG and SEFS grades between the LE and N arms seemed most evident in the MFA. PMID:28018504

  6. Lower limb gigantism, lymphedema, and painful varicosities following a thigh vascular access graft.

    PubMed

    Thompson, Michael; Mathuram Thiyagarajan, Umasankar; Akoh, Jacob A

    2014-07-01

    Prosthetic arteriovenous grafts (AVGs) are associated with greater morbidity than autogenous arteriovenous fistulas (AVFs), but their use is indicated when AVF formation is not possible. This report adds to the literature a case of lower limb gigantism, painful varicosities, and lymphedema following long-term use of AVG in the upper thigh. The patient's past medical history included renal transplantation on the same side well before the AVG was inserted and right leg deep vein thrombosis. Suspicion of AVG thrombosis was excluded by Doppler ultrasound, which demonstrated an access flow of 1700 mL/min. A computed tomography (CT) scan of the abdomen and pelvis did not identify the cause of her symptoms. Whereas functional incompetence of the iliac vein valve might be responsible for the varicosities, the extent of hypertrophy in this case raises the suspicion of lymphatic blockage possibly secondary to groin dissection undertaken at the time of graft insertion, in addition to the previous dissection at the time of transplantation. This case highlights the need for minimal groin dissection during AVG insertion, particularly in patients with a history of previous abdominopelvic surgery.

  7. Randomized comparison of prophylaxis and on-demand regimens with FEIBA NF in the treatment of haemophilia A and B with inhibitors

    PubMed Central

    Antunes, S V; Tangada, S; Stasyshyn, O; Mamonov, V; Phillips, J; Guzman-Becerra, N; Grigorian, A; Ewenstein, B; Wong, W-Y

    2014-01-01

    Factor replacement therapy for the treatment of moderate to severe haemophilia A and B can be complicated by the production of inhibitory alloantibodies to factor VIII (FVIII) or factor IX. Treatment with the nanofiltered anti-inhibitor coagulant complex, Factor Eight Inhibitor Bypassing Activity (FEIBA NF), is a key therapeutic option for controlling acute haemorrhages in patients with high-titre inhibitors or low-titre inhibitors refractory to replacement therapy. Given the high risk for morbidity and mortality in haemophilia patients with inhibitors to FVIII or FIX, we conducted this Phase 3 prospective study to evaluate whether prophylaxis with FEIBA NF is a safe and effective treatment option. Over a 1-year period, 17 subjects were treated prophylactically (85 ± 15 U kg−1 every other day) while 19 subjects were treated on demand. The median (IQR) annualized bleeding rate (ABR) during prophylaxis was 7.9 (8.1), compared to 28.7 (32.3) during on-demand treatment, which amounts to a 72.5% reduction and a statistically significant difference in ABRs between arms (P = 0.0003). Three (17.6%) subjects (ITT) on prophylaxis experienced no bleeding episodes, whereas none treated on demand were bleeding episode-free. Total utilization of FEIBA NF for the treatment of bleeding episodes was significantly higher during on-demand therapy than prophylaxis (P = 0.0067). There were no differences in the rates of related adverse events between arms. This study demonstrates that FEIBA prophylaxis significantly reduces all types of bleeding compared with on-demand treatment, and the safety of prophylaxis is comparable to that of on-demand treatment. PMID:23910578

  8. Antiretrovirals for Primary HIV Prevention: The Current Status of Pre- and Post-Exposure Prophylaxis

    PubMed Central

    Krakower, Douglas S.; Jain, Sachin; Mayer, Kenneth H.

    2015-01-01

    In light of the 2 million HIV infections that occur globally each year, there is a need to optimize strategies that integrate biomedical and behavioral approaches to HIV prevention. Post-exposure prophylaxis (PEP) immediately after acute high-risk exposures and pre-exposure prophylaxis (PrEP) for those who engage in recurrent high-risk behaviors are promising bio-behavioral approaches to decreasing HIV transmission. Guidelines have recommended PEP for occupational and non-occupational exposures for over 15 years, but uptake of PEP has been limited, partly as a result of insufficient awareness of this intervention among persons at highest risk for acquiring HIV. However, since the publication of large randomized clinical trials demonstrating the efficacy of PrEP, and the dissemination of guidelines endorsing its use, there is a renewed focus on bio-behavioral prevention. Numerous studies have recently assessed the acceptability of bio-behavioral prevention programs among diverse populations or described experiences implementing these programs in “real-world” settings. As research and clinical data informing optimal utilization of PEP and PrEP are rapidly accumulating, this review provides a timely summary of recent progress in bio-behavioral prevention. By contextualizing the most noteworthy recent findings regarding PEP and PrEP, this review seeks to inform successful implementation of these promising prevention approaches. PMID:25600106

  9. Hospital-Based First Responder Mass Prophylaxis Plan

    DTIC Science & Technology

    2005-03-01

    Have you ever had any of the following medical conditions? Asthma/Emphysema/ COPD Yes No Diabetes...prophylaxis is a costly venture that includes regulatory, personal privacy considerations, and a strict adherence to medical guidelines, but the result of not

  10. Antibiotic prophylaxis against infective endocarditis in adult and child patients

    PubMed Central

    Al-Fouzan, Afnan F.; Al-Shinaiber, Rafif M.; Al-Baijan, Refal S.; Al-Balawi, Mohammed M.

    2015-01-01

    Objectives: To evaluate dentists’ knowledge regarding the prevention of infective endocarditis in Saudi Arabia and their implementation of the 2007 American Heart Association guidelines. Methods: In this cross-sectional study, in March 2014, 801 dentists who practice in different regions of Saudi Arabia completed a questionnaire regarding the need for antibiotic prophylaxis for specific cardiac conditions and specific dental procedures, prophylaxis regimens in adults and children, and recommendations for patients on chronic antibiotics, and in dental emergencies. The data were analyzed using one-way analyses of variance (ANOVAs) and independent t-tests, and a p-value <0.05 was considered statistically significant. Results: The total knowledge level regarding antibiotic prophylaxis among all participants was 52.2%, with a significant difference between dentists who graduated before and after 2007. Comparing the level of knowledge among different dental specialists, surgeons and periodontists had the highest level of knowledge regarding the use of antibiotic prophylaxis. Amoxicillin was prescribed as the drug of choice by 63.9% of the participants. Conclusion: This study emphasized the need for continuous education and for formal inclusion of the guidelines in the students’ curriculum, as well as for strategic placement of the guidelines in locations throughout dental clinics. PMID:25935175

  11. Respiratory-Related Hospitalizations following Prophylaxis in the Canadian Registry for Palivizumab (2005–2012) Compared to Other International Registries

    PubMed Central

    Mitchell, Ian; Lanctôt, Krista L.

    2013-01-01

    Respiratory syncytial virus (RSV) infection occurs commonly in infants aged ≤2 years, and severe infection results in hospitalization with accompanying morbidity and mortality. Palivizumab has been available for prophylaxis for the past 15 years. Prospective data on patients who received palivizumab from 2005 to 2012 has been assembled in the Canadian registry (CARESS) to document utilization, compliance, and health outcomes in both hospital and community settings. Long-term data is necessary to evaluate the impact of palivizumab on the incidence of RSV infections, minimize healthcare resources, and identify which infant subpopulations are receiving prophylaxis. A database search was also conducted for similar information from published registries, and hospitalization rates were compared to results from randomized clinical trials (RCTs).Overall hospitalization rates (percent; range) for respiratory-related illnesses and RSV-specific infection in infants who meet standard indications for prophylaxis were 6.6 (3.3–7.7) and 1.55 (0.3–2.06), respectively, in CARESS, which closely aligns with registry data from 4 other countries, despite the former comprising the largest cohort of complex patients internationally. Overall RSV-related hospitalization rates were lower across registries compared to equivalent patients in RCTs. Registry data provides valuable information regarding real-world experience with palivizumab, while facilitating the genesis of new research themes. PMID:23861694

  12. Respiratory-related hospitalizations following prophylaxis in the Canadian registry for palivizumab (2005-2012) compared to other international registries.

    PubMed

    Paes, Bosco; Mitchell, Ian; Li, Abby; Harimoto, Tetsuhiro; Lanctôt, Krista L

    2013-01-01

    Respiratory syncytial virus (RSV) infection occurs commonly in infants aged ≤2 years, and severe infection results in hospitalization with accompanying morbidity and mortality. Palivizumab has been available for prophylaxis for the past 15 years. Prospective data on patients who received palivizumab from 2005 to 2012 has been assembled in the Canadian registry (CARESS) to document utilization, compliance, and health outcomes in both hospital and community settings. Long-term data is necessary to evaluate the impact of palivizumab on the incidence of RSV infections, minimize healthcare resources, and identify which infant subpopulations are receiving prophylaxis. A database search was also conducted for similar information from published registries, and hospitalization rates were compared to results from randomized clinical trials (RCTs).Overall hospitalization rates (percent; range) for respiratory-related illnesses and RSV-specific infection in infants who meet standard indications for prophylaxis were 6.6 (3.3-7.7) and 1.55 (0.3-2.06), respectively, in CARESS, which closely aligns with registry data from 4 other countries, despite the former comprising the largest cohort of complex patients internationally. Overall RSV-related hospitalization rates were lower across registries compared to equivalent patients in RCTs. Registry data provides valuable information regarding real-world experience with palivizumab, while facilitating the genesis of new research themes.

  13. Temporal and spatial patterns of endogenous danger signal expression after wound healing and in response to lymphedema.

    PubMed

    Zampell, Jamie C; Yan, Alan; Avraham, Tomer; Andrade, Victor; Malliaris, Stephanie; Aschen, Seth; Rockson, Stanley G; Mehrara, Babak J

    2011-05-01

    While acute tissue injury potently induces endogenous danger signal expression, the role of these molecules in chronic wound healing and lymphedema is undefined. The purpose of this study was to determine the spatial and temporal expression patterns of the endogenous danger signals high-mobility group box 1 (HMGB1) and heat shock protein (HSP)70 during wound healing and chronic lymphatic fluid stasis. In a surgical mouse tail model of tissue injury and lymphedema, HMGB1 and HSP70 expression occurred along a spatial gradient relative to the site of injury, with peak expression at the wound and greater than twofold reduced expression within 5 mm (P < 0.05). Expression primarily occurred in cells native to injured tissue. In particular, HMGB1 was highly expressed by lymphatic endothelial cells (>40% positivity; twofold increase in chronic inflammation, P < 0.001). We found similar findings using a peritoneal inflammation model. Interestingly, upregulation of HMGB1 (2.2-fold), HSP70 (1.4-fold), and nuclear factor (NF)-κβ activation persisted at least 6 wk postoperatively only in lymphedematous tissues. Similarly, we found upregulation of endogenous danger signals in soft tissue of the arm after axillary lymphadenectomy in a mouse model and in matched biopsy samples obtained from patients with secondary lymphedema comparing normal to lymphedematous arms (2.4-fold increased HMGB1, 1.9-fold increased HSP70; P < 0.01). Finally, HMGB1 blockade significantly reduced inflammatory lymphangiogenesis within inflamed draining lymph nodes (35% reduction, P < 0.01). In conclusion, HMGB1 and HSP70 are expressed along spatial gradients and upregulated in chronic lymphatic fluid stasis. Furthermore, acute expression of endogenous danger signals may play a role in inflammatory lymphangiogenesis.

  14. Factors Associated With the Development of Breast Cancer-Related Lymphedema After Whole-Breast Irradiation

    SciTech Connect

    Shah, Chirag; Wilkinson, John Ben; Baschnagel, Andrew; Ghilezan, Mihai; Riutta, Justin; Dekhne, Nayana; Balaraman, Savitha; Mitchell, Christina; Wallace, Michelle; Vicini, Frank

    2012-07-15

    Purpose: To determine the rates of breast cancer-related lymphedema (BCRL) in patients undergoing whole-breast irradiation as part of breast-conserving therapy (BCT) and to identify clinical, pathologic, and treatment factors associated with its development. Methods and Materials: A total of 1,861 patients with breast cancer were treated at William Beaumont Hospital with whole-breast irradiation as part of their BCT from January 1980 to February 2006, with 1,497 patients available for analysis. Determination of BCRL was based on clinical assessment. Differences in clinical, pathologic, and treatment characteristics between patients with BCRL and those without BCRL were evaluated, and the actuarial rates of BCRL by regional irradiation technique were determined. Results: The actuarial rate of any BCRL was 7.4% for the entire cohort and 9.9%, 14.7%, and 8.3% for patients receiving a supraclavicular field, posterior axillary boost, and internal mammary irradiation, respectively. BCRL was more likely to develop in patients with advanced nodal status (11.4% vs. 6.3%, p = 0.001), those who had a greater number of lymph nodes removed (14 nodes) (9.5% vs. 6.0%, p = 0.01), those who had extracapsular extension (13.4% vs. 6.9%, p = 0.009), those with Grade II/III disease (10.8% vs. 2.9%, p < 0.001), and those who received adjuvant chemotherapy (10.5% vs. 6.7%, p = 0.02). Regional irradiation showed small increases in the rates of BCRL (p = not significant). Conclusions: These results suggest that clinically detectable BCRL will develop after traditional BCT in up to 10% of patients. High-risk subgroups include patients with advanced nodal status, those with more nodes removed, and those who receive chemotherapy, with patients receiving regional irradiation showing a trend toward increased rates.

  15. Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema

    NASA Astrophysics Data System (ADS)

    Tan, I.-Chih; Maus, Erik A.; Rasmussen, John C.; Marshall, Milton V.; Fife, Caroline E.; Smith, Latisha A.; Sevick-Muraca, Eva M.

    2011-03-01

    Treatment of lymphatic disease is complicated and controversial, due in part to the limited understanding of the lymphatic system. Lymphedema (LE) is a frequent complication after surgical resection and radiation treatment in cancer survivors, and is especially debilitating in regions where treatment options are limited. Although some extremity LE can be effectively treated with manual lymphatic drainage (MLD) therapy or compression devices to direct proximal lymph transport, head and neck LE is more challenging, due to complicated geometry and complex lymphatic structure in head and neck region. Herein, we describe the compassionate use of an investigatory technique of near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy and function, and to help direct MLD in a patient with head and neck LE. Immediately after 9 intradermal injections of 25 μg indocyanine green each around the face and neck region, NIR fluorescence images were collected using a custom-built imaging system with diffused excitation light illumination. These images were then used to direct MLD therapy. In addition, 3-dimensional (3D) surface profilometry was used to monitor response to therapy. NIR fluorescence images of functioning lymphatic vessels and abnormal structures were obtained. Precise geometries of facial structures were obtained using 3D profilometry, and detection of small changes in edema between therapy sessions was achieved. NIR fluorescence imaging provides a mapping of lymphatic architecture to direct MLD therapy and thus improve treatment efficacy in the head and neck LE, while 3D profilometry allowed longitudinal assessment of edema to evaluate the efficacy of therapy.

  16. Risk factors for cellulitis in patients with lymphedema: a case-controlled study.

    PubMed

    Teerachaisakul, M; Ekataksin, W; Durongwatana, S; Taneepanichskul, S

    2013-09-01

    Risk factors for cellulitis in lymphedema (LE) have never been evaluated in controlled studies. The objective of this study was to assess the risk factors for cellulitis in patients with LE using a case-controlled study method. Medical records of patients from November 2009 to September 2011 who met the following criteria were retrieved and analyzed: (a) clinical diagnosis of LE of the limb, (b) aged 18 or above, (c) no food allergy history and (d) no medical diagnosis of cancer metastasis. Overall, there were 179 cases of LE with cellulitis. Each case was matched by age (+/- 5 years) and gender with a patient with LE and without cellulitis for controls. Logistic regression with backward selection procedure was used to identify independent risk factors. The area under the receiver operating characteristics (ROC) curve of the final model was calculated. Independent risk factors for cellulitis in patients with LE were percentage difference in circumference of the limb (adjusted odds ratio (AOR)=1.07, 95% confidence interval (CI)=1.04-1.10), primary LE diagnosis (AOR=3.36, 95% CI=1.37-8.22), food-induced complication experiences (FIE: AOR=6.82, 95% CI=2.82-16.51) and systolic blood pressure (AOR=1.02, 95% CI=1.01-1.04). The area under the curve for the model was 0.80 (95% CI=0.75-0.85, p<0.001). No association was observed with hypertension, diabetes mellitus, body mass index and the duration of LE. This first case-controlled study highlights the important roles of dietary factors, percentage difference in circumference of the limb, and systolic blood pressure for developing cellulitis. The results suggest that controlling the percentage difference in circumference of the limb and systolic blood pressure together with restriction of fatty food and meat consumption may result in a decreased incidence of cellulitis among patients with LE.

  17. Does Axillary Boost Increase Lymphedema Compared With Supraclavicular Radiation Alone After Breast Conservation?

    SciTech Connect

    Hayes, Shelly B. Freedman, Gary M.; Li Tianyu; Anderson, Penny R.; Ross, Eric

    2008-12-01

    Purpose: To determine independent predictors of lymphedema (LE) after breast radiotherapy and to quantify added risks of LE from regional node irradiation (RNI). Materials and Methods: A total of 2,579 women with T1-2, N 0-3, M0 breast cancer treated with breast conservation between 1970 and 2005 were studied. A total of 2,169 patients (84%) received radiation to the breast (B), 226 (8.8%) to the breast and supraclavicular LNs (B+SC), and 184 (7.1%) to the breast, supraclavicular LNs, and a posterior axillary boost (B+SC+PAB). Median follow-up was 81 months (range, 3-271). Results: Eighteen percent of patients developed LE. LE risks were as follows: 16% (B), 23% (B+SC), and 31% (B+SC+PAB) (p < 0.0001). LE severity was greater in patients who had RNI (p = 0.0002). On multivariate analysis, RT field (p < 0.0001), obesity index (p = 0.0157), systemic therapy (p = 0.0013), and number of LNs dissected (p < 0.0001) independently predicted for LE. In N1 patients, the addition of a SC to tangents (p < 0.0001) and the addition of a PAB to tangents (p = 0.0017) conferred greater risks of LE, but adding a PAB to B+SC RT did not (p = 0.8002). In the N2 patients, adding a PAB increased the risk of LE 4.5-fold over B+SC RT (p = 0.0011). Conclusions: LE predictors included number of LNs dissected, RNI, obesity index, and systemic therapy. LE risk increased when a SC or PAB were added in the N1 subgroup. In the N2 patients, a PAB increased the risk over B+SC. The decision to boost the axilla must be weighed against the increased risk of LE that it imposes.

  18. The effect of migraine prophylaxis on migraine-related resource use and productivity.

    PubMed

    Láinez, Miguel J A

    2009-09-01

    In the US, it is estimated that up to 10% of men and 25% of women, particularly those aged 25-55 years, experience debilitating migraines, such that the condition presents an enormous economic burden for patients, health systems, employers and society. Migraine headache is a particularly prevalent condition associated with major reductions in patients' quality of life. From a payer perspective, the implementation of relevant programmes of migraine prophylaxis is highly desirable. Consistent evidence exists, from several randomized, controlled studies, of the efficacy of amitriptyline, divalproex sodium, propranolol, timolol and topiramate in migraine prophylaxis. Considering resource utilization, various studies suggest that migraine prophylaxis with antiepileptics, antidepressants, beta-blockers or calcium channel antagonists markedly reduces triptan use and visits to physician offices and emergency departments (EDs), without compromising quality of care or treatment outcomes. Over recent years, the effects of topiramate in reducing resource utilization in patients with migraine have been relatively widely studied. In US claims database analyses involving >4000 patients with migraine, topiramate significantly reduced triptan use by up to 20% in the 12-month period after starting treatment. Reductions were also noted in the numbers of ED visits, diagnostic procedures, hospital admissions and migraine-related hospitalization days. These long-term benefits of topiramate manifested without any increase in overall headache-related costs. Furthermore, in detailed modelling analyses based on UK and US data, topiramate-induced savings in acute medical services were estimated to offset about one-quarter of the monthly per patient cost of the topiramate regimen, which was shown to be a dominant cost-effective intervention relative to no preventive therapy: cost-effectiveness ratios were calculated as pound 5728 per quality-adjusted life-year (QALY) [2005 costings] and $US10

  19. Therapeutic Effects of Saireito (Chai-Ling-Tang), a Traditional Japanese Herbal Medicine, on Lymphedema Caused by Radiotherapy: A Case Series Study

    PubMed Central

    2013-01-01

    Despite the development of radiotherapy machines and technologies, a proportion of patients suffer from radiation-induced lymphedema. Saireito (SRT) is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in conditions such as nephritic disease. This study investigated the effect of SRT on lymphedema caused by radiotherapy. Four patients were treated with SRT at a dose of 9 g/day. The severity of lymphedema was evaluated using the Common Terminology Criteria for Adverse Events version 4 and Numerical Rating Scale before and after SRT treatment. After the treatment with SRT, 2 of 4 patients (50%) showed apparent improvement in lymphedema. One of the cases had difficulty in wearing the custom-made thermoplastic cast, but after SRT administration, he could wear the mask easily. One case decided to stop taking SRT 3 days after initiation because cough and fever appeared. In conclusion, it is important to control the side effects of radiotherapy, which leads to improved tumor control rates. Prospective randomized studies are necessary to confirm the findings of this case series study. PMID:23861700

  20. Elephantiasis, elastin, and chronic wound healing: 19th century and contemporary viewpoints relevant to hypotheses concerning lymphedema, leprosy, erysipelas, and psoriasis--review and reflections.

    PubMed

    Ryan, T J

    2009-03-01

    Both wound healing and lymphedema have fibrosis of the skin in common. They also share destruction of elastin by elastases from neutrophils as a significant feature. These are not new observations, and the writings of Unna and Kaposi are recalled. The contemporary observations on elastin by Gerli and his team are discussed in the light of these much earlier opinions.

  1. Supermicrosurgical anastomosis of superficial lymphatic vessel to deep lymphatic vessel for a patient with cellulitis-induced chronic localized leg lymphedema.

    PubMed

    Yamamoto, Takumi; Koshima, Isao

    2015-01-01

    Supermicrosurgical lymphaticovenular anastomosis (LVA) has been reported to be useful for the treatment of obstructive lymphedema. However, LVA has a potential risk of anastomosis site thrombosis. It is more physiological to use a lymphatic vessel as a recipient vessel of lymphatic bypass surgery, because there is no chance for blood to contact the anastomosis site. We report a chronic localized lower leg lymphedema case treated with supermicrosurgical superficial-to-deep lymphaticolymphatic anastomosis (LLA). A 66-year-old male with a 60-year history of cellulitis-induced left lower leg lymphedema suffered from very frequent episodes of cellulitis and underwent LLA under local infiltration anesthesia. LLA was performed at the dorsum of the left foot. A dilated superficial lymphatic vessel was found in the fat layer, and a nondilated intact deep lymphatic vessel was found along the dorsalis pedis artery below the deep fascia. The superficial lymphatic vessel was supermicrosurgically anastomosed to the deep lymphatic vessel in a side-to-end fashion. After the surgery, the patient had no episodes of cellulitis, and the left lower leg lymphedematous volume decreased. Superficial-to-deep LLA may be a useful option for the treatment of secondary lymphedema due to obstruction of only the superficial lymphatic system.

  2. Assessment of The Lymphatic System of the Genitalia Using Magnetic Resonance Lymphography Before and After Treatment of Male Genital Lymphedema

    PubMed Central

    Lu, Qing; Jiang, Zhaohua; Zhao, Zizhou; Wu, Lianming; Wu, Guangyu; Suo, Shiteng; Xu, Jianrong

    2016-01-01

    Abstract Treatment for chronic male genital lymphedema (GL) is limited. No standard treatment or validated instrument to assess GL is available. The aim of this study was to explore whether magnetic resonance lymphography (MRL) could be used to assess GL, select proper treatment for patients, and monitor postoperative progress. This is a retrospective analysis of a prospectively acquired cohort of men with GL presenting for MRL over a 7-year period. Thirty-six of 47 eligible men were included. All men were offered preoperative and postoperative MRL and assigned a morphology and function classification. Men with mild, moderate, and severe nodal dysfunction underwent complex decongestive physiotherapy (CDP), lymphoveneous microsurgery, and surgical excision, respectively. The volume reductions in the genitalia of patients with mild and moderate nodal dysfunction were recorded and compared using Student t test. The abnormal superficial and deep lymphatic vessels in the lymphedematous genitalia were detected by MRL, and inguinal lymph node dysfunction was classified by MRL. Seven patients with mild dysfunction who underwent CDP showed a more significant mean volume reduction in the genitalia than did 9 patients with moderate dysfunction. Three patients with hyperplasia and moderate dysfunction who underwent microsurgical operations and 17 patients with hypoplasia and moderate or severe nodal dysfunction who underwent surgical excision had excellent cosmetic results with no lymphedema at the 3- to 5-year follow-up. MRL can be used to assess morphological and functional lymphatic abnormalities in GL, preoperatively select appropriate treatment, and postoperatively evaluate treatment outcomes. PMID:27227943

  3. Physical, psychological, and social aspects of quality of life in filarial lymphedema patients in Colombo, Sri Lanka.

    PubMed

    Wijesinghe, Rushika S; Wickremasinghe, Ananda R

    2015-03-01

    Quality of life (QOL) was assessed in 141 filarial lymphedema patients and 128 healthy people in the Colombo district, Sri Lanka, by administering modified, translated, and validated (in Sri Lanka) versions of the Short Form 36 health survey questionnaire (SF-36) and the 30-item General Health questionnaire (GHQ-30). The GHQ-30 assesses the current mental health status. The SF-36 measures health on 8 multi-item dimensions covering functional state, well-being, and overall evaluation of health (physical functioning, role limitations resulting from physical health problems, role limitations resulting from emotional problems, energy/fatigue, emotional well-being, social functioning, pain and general health). By SF-36, patients experienced poorer physical functioning, more role limitations resulting from physical health conditions, less emotional well-being, poorer social functioning, and more pain than healthy individuals. By GHQ-30, mental well-being of healthy controls was significantly better than that of patients. The significant difference in the QOL as perceived by filarial lymphedema patients and healthy individuals reiterates the importance of morbidity control in patients affected by this disease.

  4. The aesthetic rationality of the popular expressive arts: Lifeworld communication among breast cancer survivors living with lymphedema

    PubMed Central

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

    2014-01-01

    The use of popular expressive arts as antidotes to the pathologies of the parallel processes of lifeworld colonization and cultural impoverishment has been under-theorized. This article enters the void with a project in which breast cancer survivors used collages and installations of everyday objects to solicit their authentic expression of the psycho-social impacts of lymphedema. The article enlists Jurgen Habermas' communicative action theory to explore the potential of these expressive arts to expand participants' meaningful engagement with their lifeworlds. The findings point to the unique non-linguistic discursivity of these non-institutional artistic forms as their liberating power to disclose silenced human needs: the images ‘spoke' for themselves for group members to recognize shared subjectivities. The authenticity claims inherent in the art forms fostered collective reflexivity and spontaneous, affective responses and compelled the group to create new collective understandings of the experience of living with lymphedema. The article contributes theoretical insights regarding the emancipatory potential of aesthetic-expressive rationality, an under-developed area of Habermasian theory of communicative action, and to the burgeoning literature on arts-based methods in social scientific research. PMID:25197263

  5. The aesthetic rationality of the popular expressive arts: Lifeworld communication among breast cancer survivors living with lymphedema.

    PubMed

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

    2014-08-01

    The use of popular expressive arts as antidotes to the pathologies of the parallel processes of lifeworld colonization and cultural impoverishment has been under-theorized. This article enters the void with a project in which breast cancer survivors used collages and installations of everyday objects to solicit their authentic expression of the psycho-social impacts of lymphedema. The article enlists Jurgen Habermas' communicative action theory to explore the potential of these expressive arts to expand participants' meaningful engagement with their lifeworlds. The findings point to the unique non-linguistic discursivity of these non-institutional artistic forms as their liberating power to disclose silenced human needs: the images 'spoke' for themselves for group members to recognize shared subjectivities. The authenticity claims inherent in the art forms fostered collective reflexivity and spontaneous, affective responses and compelled the group to create new collective understandings of the experience of living with lymphedema. The article contributes theoretical insights regarding the emancipatory potential of aesthetic-expressive rationality, an under-developed area of Habermasian theory of communicative action, and to the burgeoning literature on arts-based methods in social scientific research.

  6. A randomized clinical trial comparing advanced pneumatic truncal, chest, and arm treatment to arm treatment only in self-care of arm lymphedema.

    PubMed

    Ridner, Sheila H; Murphy, Barbara; Deng, Jie; Kidd, Nancy; Galford, Emily; Bonner, Candace; Bond, Stewart M; Dietrich, Mary S

    2012-01-01

    Treatment of the truncal lymphatics prior to treatment of the lymphedematous arm is an accepted, although not empirically tested, therapeutic intervention delivered during decongestive lymphatic therapy (DLT). Breast cancer survivors with arm lymphedema are encouraged to use these techniques when performing simple lymphatic drainage as part of their life-long lymphedema self-care. Self-massage is at times difficult and pneumatic compression devices are used by many patients to assist with self-care. One such device, the Flexitouch(®) System, replicates the techniques used during DLT; however, the need for application of pneumatic compression in unaffected truncal areas to improve self-care outcomes in arm only lymphedema is not established. The objective of this study was to compare the therapeutic benefit of truncal/chest/arm advanced pneumatic compression therapy (experimental group) verses arm only pneumatic compression (control group) in self-care for arm lymphedema without truncal involvement using the Flexitouch(®) System. Outcomes of interest were self-reported symptoms, function, arm impedance ratios, circumference, volume, and trunk circumference. Forty-two breast cancer survivors, (21 per group), with Stage II lymphedema completed 30 days of home self-care using the Flexitouch(®) System. Findings revealed a statistically significant reduction in both the number of symptoms and overall symptom burden within each group; however, there were no statistically significant differences in these outcomes between the groups. There was no statistically significant overall change or differential pattern of change between the groups in function. A statistically significant reduction in bioelectrical impedance and arm circumference within both of the groups was achieved; however, there was no statistically significant difference in reduction between groups. These findings indicate that both configurations are effective, but that there may be no added benefit to

  7. [Classical dengue transmission dynamics involving mechanical control and prophylaxis].

    PubMed

    Toro-Zapata, Hernán D; Restrepo, Leonardo D; Vergaño-Salazar, Juan G; Muñoz-Loaiza, Aníbal

    2010-12-01

    Dengue fever transmission dynamics were studied in an endemic region considering the use of preventative measures and mechanical control in reducing transmission of the disease. A system of ordinary differential equations was proposed, describing the dynamics and their evolution as determined by numerical simulation. Different mechanical control and prophylaxis strategies were compared to the situation without control. The basic reproduction number R₀ was determined R₀ to show that if R₀ > 1 there would be a risk of an epidemic and otherwise the disease would have low impact levels. The basic reproduction number helps determine the dynamics' future pattern and contrast the results so obtained with those obtained numerically. It was concluded that although prophylaxis and mechanical control alone provide effective results in controlling the disease, if both controls are combined then infection levels become significantly reduced. Around 60 % mechanical control and prevention levels are needed to provide suitable results in controlling dengue outbreaks.

  8. Phototoxic reaction associated with Malarone (atovaquone/proguanil) antimalarial prophylaxis.

    PubMed

    Amelot, Aymeric; Dupouy-Camet, Jean; Jeanmougin, Michel

    2014-04-01

    Phototoxic reaction has not been reported previously as an adverse reaction to the combination of atovaquone and proguanil (AP) (Malarone) used for antimalarial prophylaxis and therapy. We report here a 32-year-old patient treated with AP who presented with clinical manifestations of photosensitivity. AP-induced phototoxicity in this patient was further supported by phototesting. Malarone is not known to photosensitize and render the skin more susceptible to severe sunburn-like reactions. That it may do so, as in this case, is of importance especially as this drug is used predominantly by those travelling to sunnier climes. A notification of potential phototoxic effects of AP should be published for the choice of prophylaxis made by tourists traveling in malarial areas.

  9. Antifungal prophylaxis following reduced-intensity stem cell transplantation.

    PubMed

    Kami, M; Murashige, N; Tanaka, Y; Narimatsu, H

    2006-12-01

    Reduced-intensity stem cell transplantation (RIST) has been developed to be a novel curative option for advanced hematologic diseases. Its minimal toxicity allows for transplantation in patients with advanced age or with organ dysfunction. Young patients without comorbidity can undergo RIST as outpatients. However, fungal infection remains an important complication in RIST. Given the poor prognosis of fungal infection, prophylaxis is critical in its management. The prophylactic strategy is recently changing with the development of RIST. Hospital equipment is important for fungal prophylaxis; however, the median day for the development of fungal infection is day 100, when most RIST patients are followed as outpatients. The focus of fungal management after RIST needs to shift from in-hospital equipment to oral antifungals. Various antifungals have recently been developed and introduced for clinical use. A major change in antifungal management will probably occur within several years.

  10. Approaches to Improving Adherence to Secondary Prophylaxis for Rheumatic Fever and Rheumatic Heart Disease: A Literature Review with a Global Perspective.

    PubMed

    Rémond, Marc G W; Coyle, Meaghan E; Mills, Jane E; Maguire, Graeme P

    2016-01-01

    Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune conditions resulting from infection with group A streptococcus. Current management of these conditions includes secondary antibiotic prevention. This comprises regular 3 to 4 weekly long-acting intramuscular benzathine penicillin injections. Secondary antibiotic prevention aims to protect individuals against reinfection with group A streptococcus, thereby preventing recurrent ARF and the risk of further damage to the heart valves. However, utilization of benzathine penicillin can be poor leaving patients at risk of avoidable and progressive heart damage. This review utilizes the Chronic Care Model as a framework to discuss initiatives to enhance the delivery of secondary antibiotic prophylaxis for ARF and RHD. Results from the search strategy utilized revealed that there is limited pertinent published evidence. The evidence that is available suggests that register/recall systems, dedicated health teams for delivery of secondary antibiotic prophylaxis, education about ARF and RHD, linkages with the community (particularly between health services and schools), and strong staff-patient relationships may be important. However, it is difficult to generalize findings from individual studies to other settings and high quality studies are lacking. Although secondary antibiotic prophylaxis is an effective treatment for those with ARF or RHD, the difficulties in implementing effective programs that reduce the burden of ARF and RHD demonstrates the importance of ongoing work in developing and evaluating research translation initiatives.

  11. Posaconazole: Use in the Prophylaxis and Treatment of Fungal Infections.

    PubMed

    Clark, Nina M; Grim, Shellee A; Lynch, Joseph P

    2015-10-01

    Posaconazole, a fluorinated triazole antifungal drug, is approved by the U.S. Food and Drug Administration (FDA) for (1) prophylaxis against Aspergillus and Candida infections in immunocompromised patients at high risk for these infections and (2) oropharyngeal candidiasis (OPC), including cases refractory to fluconazole and/or itraconazole. The European Medicines Agency (EMA) has approved posaconazole for (1) treatment of aspergillosis, fusariosis, chromoblastomycosis, and coccidioidomycosis in patients who are refractory to or intolerant of other azoles or amphotericin B; (2) first-line therapy for OPC for severe disease or in those unlikely to respond to topical therapy; and (3) prophylaxis of invasive fungal infections in high-risk hematologic patients and stem cell transplant recipients. In addition to approved indications, posaconazole has been used with success as salvage therapy for invasive mold infections and endemic mycoses in patients who are refractory to or intolerant of other antifungal agents, and as prophylaxis or salvage therapy in children, for whom indications are more limited owing to a paucity of data. Posaconazole has potent in vitro activity against a broad range of fungi and molds, including Aspergillus, Candida, Cryptococcus, filamentous fungi, and endemic mycoses including coccidioidomycosis, histoplasmosis, and blastomycosis. Importantly, posaconazole is much more active than other azoles against many Mucorales species and the combination of posaconazole with other antifungal agents may be synergistic. Hence, posaconazole is a potential candidate as a single or combination agent for difficult-to-treat fungal infections. Posaconazole has an excellent safety profile; to date, serious side effects are rare, even with prolonged use. However, newer posaconazole formulations achieve higher blood levels and it remains to be seen whether this may lead to an increase in the rate of adverse effects. Currently, posaconazole is used predominantly

  12. Anti-Viral Prophylaxis Target Product Profile Guidelines

    DTIC Science & Technology

    2009-02-24

    pertain to vaccine development. The prophylaxis candidates will be used to prophylax patients who have been exposed to the pathogen, and are asymptomatic...FDA. uring exposure and for seven ro h laxis days after last exposure requency of therapy Once every six weeks Oral or topical, fast disintegrating...administration: • Objective: modeled from influenza (oseltamavir); • Threshold modeled from hepatitis A, rabies (immune serum globulin, rabies immune

  13. Current evidence of antifungal prophylaxis and therapy in pediatric patients

    PubMed Central

    Giacchino, Mareva; Milano, Giuseppe Maria; Carraro, Francesca; Bezzio, Stefania; Pegoraro, Anna; Aversa, Franco; Cesaro, Simone

    2011-01-01

    Invasive fungal infections (IFI) are an important complication in pediatric haematological and oncological patients who undergo intensive chemotherapy for leukemia, solid tumour at advanced stage or relapsed, and hematopoietic stem cell transplantation. The incidence of IFI is lower than bacterial infection but mortality rate remains high. This review is designed to help paediatric oncologists in choosing the appropriate anti-fungal strategy and agents for prophylaxis, empirical, pre-emptive and specific therapy on the basis of published evidence. PMID:21647279

  14. Current evidence of antifungal prophylaxis and therapy in pediatric patients.

    PubMed

    Giacchino, Mareva; Milano, Giuseppe Maria; Carraro, Francesca; Bezzio, Stefania; Pegoraro, Anna; Aversa, Franco; Cesaro, Simone

    2011-02-24

    Invasive fungal infections (IFI) are an important complication in pediatric haematological and oncological patients who undergo intensive chemotherapy for leukemia, solid tumour at advanced stage or relapsed, and hematopoietic stem cell transplantation. The incidence of IFI is lower than bacterial infection but mortality rate remains high. This review is designed to help paediatric oncologists in choosing the appropriate anti-fungal strategy and agents for prophylaxis, empirical, pre-emptive and specific therapy on the basis of published evidence.

  15. [Perioperative metronidazole-prophylaxis for cesarian section (author's transl].

    PubMed

    Gerstner, G; Kofler, E; Huber, J

    1980-12-01

    A prospective, randomized clinical trial was conducted in 103 patients undergoing cesarian section to assess the efficacy of prophylactic, intravenously administered Metronidazole on the infectious morbidity. A group of 53 patients with perioperative Metronidazol-prophylaxis was compared to a similar controll-group without prophylaxis. Bacteriologic swabs were taken from the cervix pre- and postoperatively, using anaerobic transport media. Prophylactic Metronidazole reduced postoperative fever of more than 38 degrees C on two subsequent days from 60% in the controll-group to 30,2% in the Metronidazole-group (p less than 0,01) wound infections were reduced from 18% without to 5,7% with prophylaxis (p less than 0,05) and Endometritis from 30% without to 13,2% with prophylaxis (p less than 0,05). An additional antibiotic therapy was necessary in 44% of the cases in the controllgroup, compared to 24,5% of the cases in the Metronidazolegroup (p less than 0,05). The mean duration of hospitalisation was reduced from 12,1 +/- 3,2 days in the controll-group to 11,2 +/- 2,1 in the Metronidazole-group (p less than 0,01). Anaerobic bacteria were isolated from the servical swabs in 60% preoperatively, with a still increasing incidence to 72% postoperatively, compared to 7% in the Metronidazole-group. Our results suggest, that prophylactic, intravenously administered Metronidazol reduces the infectious morbidity following cesarian section due to the reduction of the anaerobic flora at the female genital-tract.

  16. Prophylaxis in von Willebrand Disease: Coming of Age?

    PubMed

    Saccullo, Giorgia; Makris, Mike

    2016-07-01

    Although in most cases von Willebrand disease (VWD) is a mild disorder, a subgroup of patients experience frequent bleeding. In contrast to severe hemophilia in which prophylaxis is the accepted standard of care, this is less frequently used in VWD. Most type 1 VWD patients can be adequately managed with episodic desmopressin and tranexamic acid. In patients with more severe disease, especially those with type 3 VWD, joint bleeds, epistaxis, menorrhagia, and gastrointestinal bleeding are problematic and usually require treatment with von Willebrand factor/factor VIII (VWF/FVIII) concentrate. While in the past these patients were managed with on-demand VWF/FVIII concentrate, several recent reports have demonstrated the value of prophylactic treatment. Despite some uncertainties about the economic impact of treatment of severe VWD, prophylaxis with VWF concentrate should now be considered as the standard of care for the more severe end of the spectrum of affected individuals. The recent introduction of recombinant VWF concentrate is likely to improve the acceptability of prophylaxis in VWD.

  17. Current practice of antibiotic prophylaxis during elective laparoscopic cholecystectomy.

    PubMed

    Macano, Caw; Griffiths, E A; Vohra, R S

    2017-03-01

    INTRODUCTION Current guidelines do not recommend antibiotic prophylaxis in elective laparoscopic cholecystectomy. Despite this, there is wide variation in antibiotic prophylaxis during cholecystectomy in population-based studies. The aim of this survey was to establish the current rationale for antibiotic prophylaxis in elective laparoscopic cholecystectomy. METHODS A short questionnaire was designed and disseminated across collaborators for a population-based study investigating outcomes following cholecystectomy and via the Association of Upper Gastrointestinal Surgeons, Researchgate and Surginet membership. RESULTS Responses were received from 234 people; 50.9% had no written policy for the use of prophylactic antibiotics in elective cholecystectomy; 5.6% never used antibiotics, while 30.8% always did and 63.7% selectively used antibiotics. Contamination with bile, stones and pus were scenarios in which antibiotics were most commonly used in selective practices to reduce infective complications. Interestingly, 87% of respondents would be happy to participate in a trial investigating the effectiveness of antibiotics in elective laparoscopic cholecystectomy where contamination has occurred. CONCLUSIONS The disparity between current practice and guidelines appears to arise because of a lack of evidence to show that antibiotics reduce surgical site infection following elective laparoscopic cholecystectomy where contamination has occurred. This question needs to addressed before practice will change.

  18. Antibiotic prophylaxis for transurethral urological surgeries: Systematic review.

    PubMed

    Alsaywid, Basim S; Smith, Grahame H H

    2013-04-01

    The use of antibiotic prophylaxis to prevent urinary tract infection and bacteremia (sepsis) following endoscopic urologic procedures is a controversial topic. Evidence in the literature revealed that urological instrumentation is associated with increased incidence of urinary tract infection and bacteremia. The aim of this review is to evaluate the effectiveness of antibiotic prophylaxis in reducing the risk of urinary tract infection in patients who had transurethral urological surgeries. We have selected all RCTs of adult population who underwent all different types of transurethral urological surgery, including cystoscopy, transurethral resection of prostate and transurethral resection of bladder tumor, and received prophylactic antibiotics or placebo/no treatment. At first, more than 3000 references were identified and reviewed; of which 42 studies with a total of 7496 patients were included in the final analysis. All those trials were analyzing antibiotic prophylaxis versus placebo/no treatment, and they were significantly favoring antibiotic use in reducing all outcomes, including bacteriuria (RR 0.36, 95% CI 0.29 to 0.46, P < 0.0001) with moderate heterogeneity detected (I(2) 48%), symptomatic UTI (RR 0.38, 95% CI 0.28 to 0.51, P < 0.0001) with no significant heterogeneity was detected (I(2)= 17%), bacteremia (RR 0.43, 95% CI 0.23 to 0.82, P < 0.0001) with no noted heterogeneity (I(2) = 0%), and fever ≥38.5 Celsius (RR 0.41, 95% CI 0.23 to 0.73, P = 0.003); also, there was no noted heterogeneity (I(2) = 0%). However, using antibiotic prophylaxis did not reduce the incidence of low grade temperature (RR 0.82, 95% CI 0.61 to 1.11, P = 0.20) or in moderate grade temperature (RR 1.03, 95% CI 0.71 to 1.48, P = 0.89). Antibiotic prophylaxis appears to be an effective intervention in preventing urinary tract infections and its sequels following transurethral urological surgeries in patients with preoperative sterile urine.

  19. Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis

    PubMed Central

    İNAN, Nurten; İNAN, Levent E.; COŞKUN, Özlem; TUNÇ, Tuğba; İLHAN, Mustafa

    2016-01-01

    Introduction Peripheral nerve blocks have been used in primary headache treatment since a long time. In this study, we aimed to examine the efficiency of greater occipital nerve (GON) block in migraine prophylaxis. Methods Data from migraine without aura patients who had GON block were collected and divided into two groups: Group PGON (n=25), which included patients who were under medical prophylaxis and had GON block, and Group GON (n=53), which included patients who had only GON blocks. Migraine was diagnosed using International Headache Society (IHS) classification. Data of 78 patients were analyzed. Headache attack frequency, headache duration, and severity were compared between and within groups in a 3-month follow-up period. Results The decrease in headache parameters after GON block in both groups was significantly similar. Headache attack frequency decreased from 15.73±7.21 (pretreatment) to 4.52±3.61 (3rd month) in Group GON and from 13.76±8.07 to 3.28±2.15 in Group PGON (p<0.05). Headache duration decreased from 18.51±9.43 to 8.02±5.58 at 3rd month in Group GON and from 15.20±9.16 to 7.20±4.16 in Group PGON (p<0.05). Headache severity decreased from 8.26±1.32 to 5.16±2.64 in Group GON and from 8.08±0.90 to 5.96±1.20 in Group PGON (p<0.05). There was no statistically significant difference between the groups in 3rd month after treatment (p>0.05). Conclusion This study showed significant decreases in headache parameters in both groups. As GON blocks were performed in patients unresponsive to medical prophylaxis, a decrease in the headache parameters in Group PGON similar to that in Group GON can be attributed to GON blocks. Consequently, these results show that repeated GON blocks with local anesthetic can be an effective alternative treatment in migraine patients who are unresponsive to medical prophylaxis or who do not prefer to use medical prophylaxis. PMID:28360765

  20. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

    PubMed Central

    Smaill, Fiona M; Gyte, Gillian ML

    2014-01-01

    Background The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms. Objectives To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (May 2009). Selection criteria Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section. Data collection and analysis Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Main results We identified 86 studies involving over 13,000 women. Prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of febrile morbidity (average risk ratio (RR) 0.45; 95% confidence interval (CI) 0.39 to 0.51, 50 studies, 8141 women), wound infection (average RR 0.39; 95% CI 0.32 to 0.48, 77 studies, 11,961 women), endometritis (RR 0.38; 95% CI 0.34 to 0.42, 79 studies, 12,142 women) and serious maternal infectious complications (RR 0.31; 95% CI 0.19 to 0.48, 31 studies, 5047 women). No conclusions can be made about other maternal adverse effects from these studies (RR 2.43; 95% CI 1.00 to 5.90, 13 studies, 2131 women). None of the 86 studies reported infant adverse outcomes and in particular there was no assessment of infant oral thrush. There was no systematic collection of data on bacterial drug resistance. The findings were similar whether the cesarean section was elective or non elective, and whether the antibiotic was given before or after umbilical cord clamping. Overall, the methodological quality of the trials was unclear and in only a few studies was it obvious that potential other sources of bias had been

  1. No recurrence of Pneumocystis jirovecii Pneumonia after solid organ transplantation regardless of secondary prophylaxis.

    PubMed

    Kim, Tark; Sung, Heungsup; Lee, Yu-Mi; Hong, Hyo-Lim; Kim, Sung-Han; Choi, Sang-Ho; Woo, Jun Hee; Kim, Yang Soo; Lee, Sang-Oh

    2012-11-01

    There are no data on the efficacy of secondary prophylaxis against Pneumocystis pneumonia after solid organ transplantation. Therefore, we investigated the rate of recurrence of Pneumocystis pneumonia after solid organ transplantation in a retrospective cohort study. Between 2005 and 2011, a total of 41 recipients recovered from Pneumocystis pneumonia. Of these, 22 (53.7%) received secondary prophylaxis. None of the 41 recipients experienced recurrence of Pneumocystis pneumonia during the follow-up, regardless of secondary prophylaxis.

  2. Discontinuing early prophylaxis in severe haemophilia leads to deterioration of joint status despite low bleeding rates.

    PubMed

    Nijdam, Annelies; Foppen, Wouter; De Kleijn, Piet; Mauser-Bunschoten, Evelien P; Roosendaal, Goris; van Galen, Karin P M; Schutgens, Roger E G; van der Schouw, Yvonne T; Fischer, Kathelijn

    2016-05-02

    Prophylaxis is the recommended treatment for children with severe haemophilia A, but whether prophylaxis should be continued in adulthood is still under debate. Previous studies with limited follow-up have suggested that some patients may be able to stop prophylaxis in adulthood, while maintaining good joint health. This single-centre observational cohort study examined patients with severe haemophilia A born 1970-1988 without inhibitor development, and assessed the long-term consequences of discontinuing prophylaxis. Patient-initiated changes in prophylaxis, including all switches to on-demand treatment lasting a minimum of two consecutive weeks, were recorded from the time self-infusion began until the last evaluation. Sixty-six patients were evaluated at a median age of 32.4 years: 26 % of patients had stopped prophylaxis for a median of 10 years, 15 % had interrupted prophylaxis and 59 % had continued prophylaxis. Annual joint bleeding rate (AJBR), Haemophilia Joint Health Score (HJHS-2.1; 0-124 points), radiological Pettersson score (0-78 points) and Haemophilia Activities List score (HAL; 100-0 points) were compared between patients who stopped and patients who continued prophylaxis. Although self-reported bleeding rates and functional limitations were similar in both groups (AJBR: 1.5 vs 1.2 and HAL: 84 vs 84 for those who stopped and continued prophylaxis, respectively), objective assessment of joint status showed increased arthropathy after 10 years of on-demand treatment in patients who stopped prophylaxis compared with those who continued (HJHS: 23 vs. 14 and Pettersson: 16 vs 5, respectively; P< 0.01). These results support continuation of long-term prophylaxis in adults and demonstrate the need for objective monitoring of joint status.

  3. Universal fungal prophylaxis and risk of coccidioidomycosis in liver transplant recipients living in an endemic area.

    PubMed

    Kahn, Allon; Carey, Elizabeth J; Blair, Janis E

    2015-03-01

    Recipients of liver transplantation (LT) are at increased risk for symptomatic coccidioidomycosis, primarily because of chronic immunosuppression and impaired cellular immunity. Unfortunately, no consensus exists regarding optimal posttransplant prophylaxis. In a prior study at our institution, we observed both de novo and recurrent coccidioidomycosis despite targeted antifungal prophylaxis. In response, in February 2011, we instituted a universal prophylaxis program consisting of fluconazole (200 mg daily) for the first posttransplant year. In the current study, we retrospectively reviewed the medical records of all patients who underwent LT between the initiation of universal prophylaxis and July 11, 2013. Patients receiving a second transplant or dual-organ transplant and those who died or did not have follow-up in the 12-month post-LT period were excluded. Data from the universal prophylaxis cohort were compared with previously published data from the targeted prophylaxis era. Of the 160 patients undergoing LT during the study period, 143 met criteria for data analysis. When compared with the 349 patients in the targeted prophylaxis cohort, patients in the universal prophylaxis group were older and had higher rates of pre-LT coccidioidomycosis, asymptomatic coccidioidal seropositivity, posttransplant diabetes mellitus, and renal insufficiency. Fluconazole-related toxicity occurred in 13 of the universal prophylaxis patients, 7 of whom were required to discontinue use of the medication. Coccidioidomycosis developed in 10 of the 391 patients (2.6%) in the targeted prophylaxis cohort and in none of the patients in the universal prophylaxis group (P = 0.04). These data strongly support the use of a 1-year antifungal prophylaxis regimen for LT recipients in endemic regions.

  4. Fatal Breakthrough Mucormycosis in an Acute Myelogenous Leukemia Patient while on Posaconazole Prophylaxis.

    PubMed

    Kang, Seung Hun; Kim, Hyun Seon; Bae, Myoung Nam; Kim, Jihye; Yoo, Ji Yeon; Lee, Kwan Yong; Lee, Dong-Gun; Kim, Hee-Je

    2015-03-01

    Posaconazole is a new oral triazole with broad-spectrum antifungal activity. Posaconazole has also shown a significant advantage of preventing invasive fungal infection compared to fluconazole or itraconazole in patients with prolonged neutropenia. Indeed, posaconazole has been commonly used for antifungal prophylaxis in patients undergoing remission induction chemotherapy for acute myelogenous leukemia or myelodysplastic syndrome. We experienced a case of fatal mucormycosis despite posaconazole prophylaxis. To our knowledge, this is the first reported case of fatal breakthrough mucormycosis in a patient receiving posaconazole prophylaxis during remission induction chemotherapy in Korea. This case demonstrated that breakthrough fungal infection can occurs in patients receiving posaconazole prophylaxis because of its limited activity against some mucorales.

  5. Adherence To Malaria Prophylaxis Among Peace Corps Volunteers in the Africa Region, 2013

    PubMed Central

    Landman, Keren Z.; Tan, Kathrine R.; Arguin, Paul M.

    2016-01-01

    Background Although malaria can be prevented with prophylaxis, it is diagnosed in over 100 Africa-region Peace Corps Volunteers annually. This suggests that prophylaxis non-adherence is a problem in these non-immune travelers. Methods We investigated Volunteers’ knowledge, attitudes, and practices regarding prophylaxis using an internet-based survey during August 19–September 30, 2013. Adherence was defined as taking doxycycline or atovaquone-proguanil daily, or taking mefloquine doses no more than 8 days apart. Results The survey was sent to 3,248 Volunteers. Of 781 whose responses were analyzed, 514 (73%) reported adherence to prophylaxis. The most common reasons for non-adherence were forgetting (n=530, 90%); fear of long-term adverse effects (LTAEs; n=316, 54%); and experiencing adverse events that Volunteers attributed to prophylaxis (n=297, 51%). Two hundred fourteen (27%) Volunteers reported not worrying about malaria. On multivariate analysis controlling for sex and experiencing adverse events Volunteers attributed to prophylaxis, the factor most strongly associated with non-adherence was being prescribed mefloquine (OR 5.4, 95% confidence interval 3.2–9.0). Conclusions We found moderate adherence and a prevailing fear of LTAEs among Volunteers. Strategies to improve prophylaxis adherence may include medication reminders, increasing education about prophylaxis safety and malaria risk, and promoting prompt management of prophylaxis side effects. PMID:25534297

  6. 77 FR 10748 - Scientific Information Request on Mechanical Prophylaxis of Venous Thromboembolism (VTE)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ... effectiveness and safety of pharmacologic and mechanical strategies to prevent VTE in patients having bariatric surgery? Question 7 What is the comparative effectiveness and safety of pharmacologic prophylaxis...

  7. Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients. The ENDORSE Global Survey.

    PubMed

    Bergmann, Jean-Francois; Cohen, Alexander T; Tapson, Victor F; Goldhaber, Samuel Z; Kakkar, Ajay K; Deslandes, Bruno; Huang, Wei; Anderson, Frederick A

    2010-04-01

    Limited data are available regarding the risk for venous thromboembolism (VTE) and VTE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VTE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VTE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active non-infectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40-45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VTE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VTE risk and providing prophylaxis to hospitalised medical patients.

  8. Roughness of human enamel surface submitted to different prophylaxis methods.

    PubMed

    Castanho, Gisela Muassab; Arana-Chavez, Victor E; Fava, Marcelo

    2008-01-01

    The purpose of this in vitro study was to evaluate alterations in the surface roughness and micromorphology of human enamel submitted to three prophylaxis methods. Sixty-nine caries-free molars with exposed labial surfaces were divided into three groups. Group I was treated with a rotary instrument set at a low speed, rubber cup and a mixture of water and pumice; group II with a rotary instrument set at a low speed, rubber cup and prophylaxis paste Herjos-F (Vigodent S/A Indústria e Comércio, Rio de Janeiro, Brazil); and group III with sodium bicarbonate spray Profi II Ceramic (Dabi Atlante Indústrias Médico Odontológicas Ltda, Ribeirão Preto, Brazil). All procedures were performed by the same operator for 10 s, and samples were rinsed and stored in distilled water Pre and post-treatment surface evaluation was completed using a surface profilometer (Perthometer S8P, Marh, Perthen, Germany) in 54 samples. In addition, the other samples were coated with gold and examined in a scanning electron microscope (SEM). The results of this study were statistically analyzed with the paired t-test (Student), the Kruskal-Wallis test and the Dunn (5%) test. The sodium bicarbonate spray led to significantly rougher surfaces than the pumice paste. The use of prophylaxis paste showed no statistically significant difference when compared with the other methods. Based on SEM analysis, the sodium bicarbonate spray presented an irregular surface with granular material and erosions. Based on this study, it can be concluded that there was an increased enamel surface roughness when teeth were treated with sodium bicarbonate spray when compared with teeth treated with pumice paste.

  9. Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery

    PubMed Central

    2015-01-01

    IMPORTANCE Venous thromboembolism (VTE) is an important complication of colorectal surgery, but its incidence is unclear in the era of VTE prophylaxis. OBJECTIVE To describe the incidence of and risk factors associated with thromboembolic complications and contemporary VTE prophylaxis patterns following colorectal surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective data from the Washington State Surgical Care and Outcomes Assessment Program (SCOAP) linked to a statewide hospital discharge database. At 52 Washington State SCOAP hospitals, participants included consecutive patients undergoing colorectal surgery between January 1, 2006, and December 31, 2011. MAIN OUTCOMES AND MEASURES Venous thromboembolism complications in-hospital and up to 90 days after surgery. RESULTS Among 16 120 patients (mean age, 61.4 years; 54.5% female), the use of perioperative and in-hospital VTE chemoprophylaxis increased significantly from 31.6% to 86.4% and from 59.6% to 91.4%, respectively, by 2011 (P < .001 for trend for both). Overall, 10.6% (1399 of 13 230) were discharged on a chemoprophylaxis regimen. The incidence of VTE was 2.2% (360 of 16 120). Patients undergoing abdominal operations had higher rates of 90-day VTE compared with patients having pelvic operations (2.5% [246 of 9702] vs 1.8% [114 of 6413], P = .001). Those having an operation for cancer had a similar incidence of 90-day VTE compared with those having an operation for nonmalignant processes (2.1% [128 of 6213] vs 2.3% [232 of 9902], P = .24). On adjusted analysis, older age, nonelective surgery, history of VTE, and operations for inflammatory disease were associated with increased risk of 90-day VTE (P < .05 for all). There was no significant decrease in VTE over time. CONCLUSIONS AND RELEVANCE Venous thromboembolism rates are low and largely unchanged despite increases in perioperative and postoperative prophylaxis. These data should be considered in developing future guidelines. PMID:26060977

  10. Antibiotic prophylaxis in children with relapsing urinary tract infections: review.

    PubMed

    Mangiarotti, P; Pizzini, C; Fanos, V

    2000-04-01

    Recurrent urinary tract infections (UTIs) are observed in 30-50% of children after the first UTI. Of these, approximately 90% occur within 3 months of the initial episode. The basic aim of antibiotic prophylaxis in children with malformative uropathy and/or recurrent UTIs, is to reduce the frequency of UTIs. The bacteria most frequently responsible for UTI are gram-negative organisms, with Escherichia coli accounting for 80% of urinary tract pathogens. In children with recurrent UTIs and in those treated with antibiotic prophylaxis there is a greater incidence of UTI due to Proteus spp., Klebsiella spp. and Enterobacter spp., whereas Pseudomonas spp., Serratia spp. and Candida spp. are more frequent in children with urogenital abnormalities and/or undergoing invasive instrumental investigations. Several factors are involved in the pathogenesis of UTI, the main ones being circumcision, periurethral flora, micturition disorders, bowel disorders, local factors and hygienic measures. Several factors facilitate UTI relapse: malformative uropathies, particularly of the obstructive type; vesico-ureteric reflux (VUR); previous repeated episodes of cystitis and/or pyelonephritis (3 or more episodes a year), even in the absence of urinary tract abnormalities; a frequently catheterized neurogenic bladder; kidney transplant. The precise mechanism of action of low-dose antibiotics is not yet fully known. The characteristics of the ideal prophylactic agent are presented in this review, as well as indications, dosages, side effects, clinical data of all molecules. While inappropriate use of antibiotic prophylaxis encourages the emergence of microbial resistance, its proper use may be of great value in clinical practice, by reducing the frequency and clinical expression of UTIs and, in some cases such as VUR, significantly helping to resolve the underlying pathology.

  11. Nonadherence to Primary Prophylaxis against Pneumocystis jirovecii Pneumonia

    PubMed Central

    Heffelfinger, James D.; Voetsch, Andrew C.; Nakamura, Glenn V.; Sullivan, Patrick S.; McNaghten, A. D.; Huang, Laurence

    2009-01-01

    Background Despite the effectiveness of prophylaxis, Pneumocystis jirovecii pneumonia (PCP) continues to be the most common serious opportunistic infection among HIV-infected persons. We describe factors associated with nonadherence to primary PCP prophylaxis. Methodology/Principal Findings We used 2000–2004 data from the Supplement to HIV/AIDS Surveillance (SHAS) project, a cross-sectional interview project of HIV-infected persons ≥18 years conducted in 18 states. We limited the analysis to persons who denied having prior PCP, reported having a current prescription to prevent PCP, and answered the question “In the past 30 days, how often were you able to take the PCP medication(s) exactly the way your doctor told you to take them?” We used multivariable logistic regression to describe factors associated with nonadherence. Of 1,666 subjects prescribed PCP prophylaxis, 305 (18.3%) were nonadherent. Persons were more likely to be nonadherent if they reported using marijuana (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI] = 1.1–2.4), non-injection drugs other than marijuana (aOR = 1.5, 95% CI = 1.0–2.1), or injection drugs (aOR = 2.3, 95% CI = 1.3–4.1) in the past year; their mental health was “not good” for ≥1 day during the past month (aOR = 1.6, 95% CI = 1.2–2.2); their most recent CD4 count was <200 cells/μL (aOR = 1.6, 95% CI = 1.1–2.2); or taking ART usually (aOR = 9.6, 95% CI = 6.7–13.7) or sometimes/rarely/never (aOR = 18.4, 95% CI = 11.1–30.4), compared with always, as prescribed. Conclusion/Significance Providers should inquire about and promote strategies to improve adherence to PCP prophylaxis, particularly among persons who use illicit drugs, have mental health issues, and who are not compliant with ART to reduce the occurrence of PCP. PMID:19319199

  12. Acute Pharmacological DVT Prophylaxis after Spinal Cord Injury

    PubMed Central

    Thibault-Halman, Ginette; Casha, Steven

    2011-01-01

    Abstract A systematic review of the literature was performed to address pertinent clinical questions regarding deep vein thrombosis (DVT) prophylaxis in the setting of acute spinal cord injury (SCI). Deep vein thromboses are a common occurrence following SCI. Administration of low-molecular-weight heparin (LMWH) within 72 h of injury is recommended to minimize the occurrence of DVT. Furthermore, when surgical intervention is required, LMWH should be held the morning of surgery, and resumed within 24 h post-operatively. PMID:20795870

  13. From prophylaxis to atomic cocktail: circulation of radioiodine.

    PubMed

    Santesmases, María Jesús

    2009-01-01

    This paper is a history of iodine. To trace the trajectory of this element, goiter is used as a guideline for the articulation of a historical account, as a representation of thyroid disorders and of the spaces of knowledge and practices related to iodine. Iodine's journey from goiter treatment and prophylaxis in the late interwar period took on a new course after WWII by including the element's radioactive isotopes. I intend to show how the introduction of radioiodine contributed to stabilize the epistemic role of iodine, in both its non-radioactive and radioactive form, in thyroid gland studies and in the treatment of its disorders.

  14. Mapping of the Locus for Cholestasis-Lymphedema Syndrome (Aagenaes Syndrome) to a 6.6-cM Interval on Chromosome 15q

    PubMed Central

    Bull, Laura N.; Roche, Erin; Song, Eyun J.; Pedersen, Jan; Knisely, A. S.; van der Hagen, C. B.; Eiklid, Kristin; Aagenaes, Øystein; Freimer, Nelson B.

    2000-01-01

    Patients with cholestasis-lymphedema syndrome (CLS) suffer severe neonatal cholestasis that usually lessens during early childhood and becomes episodic; they also develop chronic severe lymphedema. The genetic cause of CLS is unknown. We performed a genome screen, using DNA from eight Norwegian patients with CLS and from seven unaffected relatives, all from an extended pedigree. Regions potentially shared identical by descent in patients were further characterized in a larger set of Norwegian patients. The patients manifest extensive allele and haplotype sharing over the 6.6-cM D15S979–D15S652 region: 30 (83.3%) of 36 chromosomes of affected individuals carry a six-marker haplotype not found on any of the 32 nontransmitted parental chromosomes. All Norwegian patients with CLS are likely homozygous for the same disease mutation, inherited from a shared ancestor. PMID:10968776

  15. 75 FR 32490 - Issues in the Development of Medical Products for the Prophylaxis and/or Treatment of Acute...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-08

    ... Prophylaxis and/or Treatment of Acute Antibody Mediated Rejection in Kidney Transplant Recipients; Public... prophylaxis and/or treatment of acute antibody mediated rejection (AMR) in kidney transplant recipients....

  16. ONE WEEK VERSUS FOUR WEEK HEPARIN PROPHYLAXIS AFTER LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER.

    ClinicalTrials.gov

    2012-04-28

    The Primary Study Objective is to Assess the Efficacy and; Safety of Extended 4-week Heparin Prophylaxis Compared to; Prophylaxis Given for 8±2 Days After Planned Laparoscopic; Surgery for Colorectal Cancer.; The Clinical Benefit Will be Evaluated as the Difference in; the Incidence of VTE or VTE-related Death Occurring Within 30 Days; From Surgery in the Two Study Groups.

  17. Pneumocystis carinii mutations associated with sulfa and sulfone prophylaxis failures in immunocompromised patients.

    PubMed

    Armstrong, W; Meshnick, S; Kazanjian, P

    2000-01-01

    Recent studies have shown that mutations in two amino acid positions of the Pneumocystis carinii dihydropteroate synthase gene are significantly more common in immunocompromised patients with P. carinii pneumonia who fail sulfa or sulfone prophylaxis. This paper reviews the studies that suggest that these mutations may be responsible for some failures of prophylaxis in P. carinii.

  18. Comparison between valganciclovir and aciclovir/valaciclovir for CMV prophylaxis in pediatric renal transplantation.

    PubMed

    Fila, M; Dechartes, A; Maisin, A; Dossier, C; Zhao, W; Deschênes, G; Baudouin, V

    2015-01-01

    Prophylaxis has dramatically decreased the occurrence of cytomegalovirus (CMV) infection after renal transplantation. Optimal regimens of treatment remain controversial, especially in pediatric recipients. The aim of this study was to evaluate the effectiveness of valganciclovir (VGC) versus aciclovir/valaciclovir (ACV) in a pediatric renal transplant population. Data from 101 renal transplantations were retrospectively analyzed. Except those with R-/Dstatus, all patients received prophylaxis either with ACV, n = 39 or VGC, n = 38. Incidences of positive CMV antigenemia and disease, as well as the delay in relation to the prophylaxis, were collected during at least 12 months after the end of treatment. Positive CMV antigenemia was reported in 34 patients (ACV: 16, VGC: 16, no prophylaxis: 2). CMV disease occurred in 15 patients (ACV: 5; VGC: 8) (ns). For the majority of patients under VGC, positive CMV antigenemia occurred within the year following the withdrawal of prophylaxis (VGC: 14; ACV: 5, P <0.05), whereas it occurred during prophylaxis in 11 patients under ACV versus two under VGC (P <0.05). The over-all incidence of positive CMV antigenemia was similar between ACV and VGC prophylaxis. However, VGC was more efficient to prevent early CMV infection while patients treated with ACV had less CMV infection or disease after the end of the prophylaxis.

  19. Verrucous lesions arising in lymphedema and diabetic neuropathy: Elephantiasis nostras verrucosa or verrucous skin lesions on the feet of patients with diabetic neuropathy?

    PubMed

    Hotta, Eri; Asai, Jun; Okuzawa, Yasutaro; Hanada, Keiji; Nomiyama, Tomoko; Takenaka, Hideya; Katoh, Norito

    2016-03-01

    Verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) develop in areas with sensory loss in diabetic patients. Although various types of chronic stimulation, such as pressure or friction, are considered an important factor in the development of such lesions, the precise pathogenesis of VSLDN remains obscure, and there is currently no established treatment for this disease. Here, we present a case of VSLDN on the dorsum of the right foot. However, because lymphedema was also observed at the same site, this lesion could also be diagnosed as elephantiasis nostras verrucosa arising in diabetic neuropathy. The lesion was successfully treated with a combination of elastic stocking and mixed killed bacterial suspension and hydrocortisone ointment, which suggested that VSLDN might have been exacerbated by the pre-existing lymphedema. Because various types of chronic stimulation can trigger VSLDN, treatment plans should be devised on a case-by-case basis. Therefore, it is important to investigate the presence of factors that can induce or exacerbate chronic inflammatory stimulation, such as lymphedema in our case, in each patient with VSLDN.

  20. Are compression corsets beneficial for the treatment of breast cancer-related lymphedema? New opportunities in physiotherapy treatment – a preliminary report

    PubMed Central

    Hansdorfer-Korzon, Rita; Teodorczyk, Jacek; Gruszecka, Agnieszka; Lass, Piotr

    2016-01-01

    Introduction Treatment of secondary lymphedema still remains an important medical issue. Treatment response is characterized by periodic remission rather than complete recovery. Compression methods currently used as part of complete decongestive therapy vary considerably in efficacy. Manual drainage, bandaging, and compression pumps are ineffective in everyday practice. Positive results have increasingly been reported where compression garments have been used as part of the treatment. This pilot study demonstrates a beneficial effect following the use of compression corsets in the treatment of edema in breast cancer-related lymphedema (BCRL). Material A total of 35 women with BCRL were enrolled. Of these, 29 patients completed the study. Methods Ultrasound (B-mode) was used to evaluate lymphedema in the side of the chest after mastectomy. This test was performed three times at a specific site on the operated side and symmetrically on the opposite side. Subsequently, patients were fit with an appropriate compression corset. The data were then statistically analyzed. Conclusion After the surgical treatment of breast cancer, lymphatic fluid reservoirs may form at the side of the chest. The use of carefully selected compression corsets is an effective treatment for BCRL. Corsets are an important item, which we recommend should be included in compression clothing sets. We anticipate this finding will form the foundation for further work on the use of modern compression garments for the treatment of BCRL as well as contribute to the limited number of published reports that exist on the subject. PMID:27103835

  1. Antibiotic prophylaxis in open inguinal hernia repair: a literature review and summary of current knowledge

    PubMed Central

    Makarewicz, Wojciech; Ropel, Jerzy; Bobowicz, Maciej; Kąkol, Michał; Śmietański, Maciej

    2016-01-01

    More than 1 million inguinal hernia repairs are performed in Europe and the US annually. Although antibiotic prophylaxis is not required in clean, elective procedures, the routine use of implants (90% of inguinal hernia repairs are performed with mesh) makes the topic controversial. The European Hernia Society does not recommend routine antibiotic prophylaxis for elective inguinal hernia repairs. However, the latest randomized controlled trial, published by Mazaki et al., indicates that the use of prophylaxis is effective for the prevention of surgical site infection. Unnecessary prophylaxis contributes to the development of bacterial resistance and significantly increases healthcare costs. This review documents clinical trials on inguinal hernia repairs with mesh and summarizes the current knowledge. It also tries to solve certain problems, namely: what constitutes a real risk factor, late-onset infection, and how the “surgical environment” impacts on the need to use antibiotic prophylaxis. PMID:27829934

  2. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City.

    PubMed

    Burke, J P

    2001-09-01

    Errors in antimicrobial prophylaxis for surgical patients remain one of the most frequent types of medication errors in hospitals. Failure to administer the first dose of antimicrobial prophylaxis within the 2-h window of time before incision is associated with 2- to 6-fold increases in rates of surgical site infection. Optimal use of antimicrobial prophylaxis includes proper case selection; use of appropriate agents; proper dosing, route of administration, timing, and duration; and intraoperative dosing when appropriate. Effective use of antimicrobial prophylaxis also requires monitoring of and feedback on patterns of use. Programs to improve antimicrobial prophylaxis should be multidisciplinary and should aim to improve use of medications, not simply to change physician practice patterns. The LDS Hospital experience demonstrates the clinical and financial benefits of such a program and also shows the pitfalls of and great difficulties associated with changing systems of care.

  3. Preliminary consultation on preferred product characteristics of benzathine penicillin G for secondary prophylaxis of rheumatic fever.

    PubMed

    Wyber, Rosemary; Boyd, Ben J; Colquhoun, Samantha; Currie, Bart J; Engel, Mark; Kado, Joseph; Karthikeyan, Ganesan; Sullivan, Mark; Saxena, Anita; Sheel, Meru; Steer, Andrew; Mucumbitsi, Joseph; Zühlke, Liesl; Carapetis, Jonathan

    2016-10-01

    Rheumatic fever is caused by an abnormal immune reaction to group A streptococcal infection. Secondary prophylaxis with antibiotics is recommended for people after their initial episode of rheumatic fever to prevent recurrent group A streptococcal infections, recurrences of rheumatic fever and progression to rheumatic heart disease. This secondary prophylaxis must be maintained for at least a decade after the last episode of rheumatic fever. Benzathine penicillin G is the first line antibiotic for secondary prophylaxis, delivered intramuscularly every 2 to 4 weeks. However, adherence to recommended secondary prophylaxis regimens is a global challenge. This paper outlines a consultation with global experts in rheumatic heart disease on the characteristics of benzathine penicillin G formulations which could be changed to improve adherence with secondary prophylaxis. Characteristics included dose interval, pain, administration mechanism, cold chain independence and cost. A sample target product profile for reformulated benzathine penicillin G is presented.

  4. Long term outcome of prophylaxis for febrile convulsions.

    PubMed Central

    Knudsen, F U; Paerregaard, A; Andersen, R; Andresen, J

    1996-01-01

    A cohort of 289 children with febrile convulsions who had been randomised in early childhood to either intermittent prophylaxis (diazepam at fever) or no prophylaxis (diazepam at seizures) was followed up 12 years later. The study focused on the occurrence of epilepsy and on neurological, motor, intellectual, cognitive, and scholastic achievements in the cohort. At follow up the two groups were of almost identical age (14.0 v 14.1 years), body weight (58.2 v 57.2 kg), height (168.2 v 167.7 cm), and head circumference (55.9 v 56.2 cm). The occurrence of epilepsy (0.7% v 0.8%), neurological examination, fine and gross motor development on the Stott motor test, intellectual performance on the Wechsler intelligence scale for children verbal IQ (105 v 105), performance IQ (114 v 111), and full scale IQ (110 v 108), cognitive abilities on a neuropsychological test battery, including short and long term, auditory and visual memory, visuomotor tempo, computer reaction time, reading test, and scholastic achievement were also very similar. Children with simple and complex febrile convulsions had the same benign outcome. The long term prognosis in terms of subsequent epilepsy, neurological, motor, intellectual, cognitive, and scholastic ability was not influenced by the type of treatment applied in early childhood. Preventing new febrile convulsions appears no better in the long run than abbreviating them. PMID:8660037

  5. Efficacy of Favipiravir (T-705) in Rabies Postexposure Prophylaxis.

    PubMed

    Yamada, Kentaro; Noguchi, Kazuko; Komeno, Takashi; Furuta, Yousuke; Nishizono, Akira

    2016-04-15

    Rabies is a fatal encephalitis caused by rabies virus (RABV), and no antiviral drugs for RABV are currently available. We report for the first time the efficacy of favipiravir (T-705) against RABV in vitro and in vivo. T-705 produced a significant, 3-4 log10 reduction in the multiplication of street and fixed RABV strains in mouse neuroblastoma Neuro-2a cells, with half-maximal inhibitory concentrations of 32.4 µM and 44.3 µM, respectively. T-705 significantly improved morbidity and mortality among RABV-infected mice when orally administered at a dose of 300 mg/kg/day for 7 days, beginning 1 hour after inoculation. T-705 significantly reduced the rate of virus positivity in the brain. Furthermore, the effectiveness of T-705 was comparable to that of equine rabies virus immunoglobulin for postexposure prophylaxis. Collectively, our results suggest that T-705 is active against RABV and may serve as a potential alternative to rabies immunoglobulin in rabies postexposure prophylaxis.

  6. Non-Antibiotic Prophylaxis for Urinary Tract Infections

    PubMed Central

    Beerepoot, Mariëlle; Geerlings, Suzanne

    2016-01-01

    Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs). Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in postmenopausal women, vaginal, but not oral, estrogens have been shown to restore the vagina lactobacilli flora, reduce vaginal colonization with Enterobacteriaceae, and reduce the number of UTIs compared to placebo. Different lactobacilli strains show different results in the prevention of recurrent UTIs. Intravaginal suppositories with Lactobacillus crispatus in premenopausal women and oral capsules with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in postmenopausal women are promising. Ascorbic acid (vitamin C) cannot be recommended for the prevention of UTIs. Cranberries are thought to contain proanthocyanidins that can inhibit adherence of P-fimbriated E. coli to the uroepithelial cell receptors. Cranberry products decreased UTI recurrences about 30%–40% in premenopausal women with recurrent UTIs, but are less effective than low-dose antimicrobial prophylaxis. However, the optimal dose of cranberry product has still to be determined. Initially OM-89, a vaccine with 18 heat-killed E. coli extracts, seemed promising, but this was not confirmed in a recently randomized trial. PMID:27092529

  7. [SELENIUM EFFICIENCY IN PROPHYLAXIS AND COMPLEX TREATMENT OF DIFFUSE GOITER].

    PubMed

    Osadtsiv, O I; Kravchenko, V I; Andrusyshyna, I M

    2014-01-01

    Efficiency of the combined prophylaxis and treatment of a diffuse goiter by preparations of sele- nium and iodine at 54 patients--men at the age of 41-50 years with the diagnosis of a diffuse goiter of 1st and 2nd degree was investigated. The diagnosis of a diffuse goiter was based on palpatory and ultrasonic research of the thyroid gland, which volume was compared with a body surface area. All surveyed have been divided into three groups. Patients of the first group accepted preparations of selenium and the iodine throughout three months, the second group--iodine preparations, in control group only dynamic supervision was spent. Thyroid gland volume at men who constantly used iodated salt and had no palpatory signs of a goiter was also measured for control. In the group which members accepted selenium and iodine preparations, at 11,8 % of patients was noted reduction of thyroid volume to normal and was revealed more expressed reduction of thyroid volume (for 2.15 sm3/M2 ± 0.07 sm3/M2), than at monotherapy by iodine preparations (for 0.92 sm3/M2 ± 0.17 sm3/M2). The conclusion was made that it is possible to recommend selenium preparations in a dose of 100 mkg a day together with preparations of iodine for prophylaxis and treatment of a diffuse goiter in conditions of the combined insufficiency in consumption of selenium and light deficiency of iodine.

  8. Pharmacologic Considerations for Preexposure Prophylaxis in Transgender Women

    PubMed Central

    Reirden, Daniel; Castillo-Mancilla, Jose

    2016-01-01

    Abstract: Studies of tenofovir disoproxil fumarate (TDF)-emtricitabine (FTC)–based preexposure prophylaxis (PrEP) have not focused on transgendered women who are at disproportionate risk of HIV acquisition. Concerns exist for drug interactions between cross-sex therapy (estradiol, progestins, and spironolactone) with tenofovir disoproxil fumarate–emtricitabine. This review assessed the experimental and theoretical risk for such drug interactions. It was found that none of these medications are implicated as major perpetrators of drug interactions, and the classes use different metabolic pathways for clearance, suggesting a low likelihood for interactions in either direction. Subanalyses of transgender women in Preexposure Prophylaxis Initiative suggested PrEP efficacy if adherence was high. Nevertheless, several research gaps were identified, particularly the need for controlled interaction studies in transgendered women, including effects on renal clearance, intracellular tenofovir diphosphate and emtricitabine triphosphate in target cells, as well as hormone effects on HIV susceptibility and immunity. PrEP should continue to be offered to transgender women while additional research is planned or pending. PMID:27429188

  9. Migraine prophylaxis, ischemic depolarizations and stroke outcomes in mice

    PubMed Central

    Eikermann-Haerter, Katharina; Lee, Jeong Hyun; Yalcin, Nilufer; Yu, Esther Sori; Daneshmand, Ali; Wei, Ying; Zheng, Yi; Can, Anil; Sengul, Buse; Ferrari, Michel D.; van den Maagdenberg, Arn M. J. M.; Ayata, Cenk

    2014-01-01

    Background and Purpose Migraine with aura is an established stroke risk factor, and excitatory mechanisms such as spreading depression are implicated in the pathogenesis of both migraine and stroke. Spontaneous spreading depression waves originate within the peri-infarct tissue and exacerbate the metabolic mismatch during focal cerebral ischemia. Genetically enhanced spreading depression susceptibility facilitates anoxic depolarizations and peri-infarct spreading depressions and accelerates infarct growth, suggesting that susceptibility to spreading depression is a critical determinant of vulnerability to ischemic injury. Because chronic treatment with migraine prophylactic drugs suppresses spreading depression susceptibility, we tested whether migraine prophylaxis can also suppress ischemic depolarizations and improve stroke outcome. Methods We measured the cortical susceptibility to spreading depression and ischemic depolarizations, and determined tissue and neurological outcome after middle cerebral artery occlusion in wild type and familial hemiplegic migraine type 1 knock-in mice treated with vehicle, topiramate or lamotrigine daily for 7 weeks or as a single dose shortly before testing. Results Chronic treatment with topiramate or lamotrigine reduces the susceptibility to KCl- or electrical stimulation-induced spreading depressions as well as ischemic depolarizations in both wild-type and familial hemiplegic migraine type 1 mutant mice. Consequently, both tissue and neurological outcomes are improved. Notably, treatment with a single dose of either drug is ineffective. Conclusions These data underscore the importance of hyperexcitability as a mechanism for increased stroke risk in migraineurs, and suggest that migraine prophylaxis may not only prevent migraine attacks but also protect migraineurs against ischemic injury. PMID:25424478

  10. Cost analyses of extended prophylaxis with enoxaparin after hip arthroplasty.

    PubMed

    Friedman, R J; Dunsworth, G A

    2000-01-01

    Venous thromboembolic complications occur in 50% to 70% of patients undergoing total hip arthroplasty if no prophylactic regimen is used. Because enoxaparin and warfarin are useful for extended outpatient prophylaxis, the objective of this study was to determine which of these agents is most cost effective in preventing venous thromboembolic complications. A decision tree analysis was developed to simulate a hypothetical cohort of patients with total hip arthroplasty. The analysis considered home health care services to perform monitoring and compliance verification. Accounting for prophylactic failures and treatment complications, results showed that enoxaparin maintained a cost effective advantage over warfarin for extended prophylaxis in the time after discharge and total hip arthroplasty ranging from 19 to 31 days after the patient was discharged from the hospital. The duration of cost effectiveness of enoxaparin was reduced to 14 to 17 days when home care services were excluded. These results indicated that approximately 3 weeks of outpatient therapy with enoxaparin is cost effective. With the cornerstone of managed care being cost efficiency in the provision of quality care, this conclusion warrants the development of integrated care strategies for the patient having orthopaedic surgery to achieve cost effective patient management.

  11. A New Approach to the Prophylaxis of Cyclic Vomiting: Topiramate

    PubMed Central

    Sezer, Oya B; Sezer, Taner

    2016-01-01

    Background/Aims The aim of this study was to compare the efficacy and tolerability of topiramate and propranolol in preventing pediatric cyclic vomiting syndrome. Methods A retrospective medical-record review of patients who underwent prophylaxis after receiving a diagnosis of cyclic vomiting syndrome was performed. Patients who completed at least 12 months of treatment were included in the analysis. Responder rate, and adverse-event rates were also calculated from all patients. Response to treatment was assessed as the total number of vomiting attacks per year. Patients in whom the frequency of vomiting attack reduced greater or equal to 50% were defined as responders, and the remaining patients were classified as nonresponders. Results A total of 38 patients who were treated prophylactically with either topiramate (16 patients) or propranolol (22 patients) were identified. Fifty-nine percent of the patients in the propranolol group and 81% of the patients in the topiramate group reported freedom from attacks. A decrease of more than 50% in attacks per year occurred in 23% of patients in the propranolol group and 13% of patients in the topiramate group. The responder rates were 81% for propranolol group and 94% for topiramate group (P = 0.001). Despite minor adverse effects (drowsiness, nervousness, and dizziness) observed in a few patients, the adverse event rates were not significantly different between the 2 groups (P = 0.240). Conclusions The efficacy of topiramate was superior to propranolol for the prophylaxis of pediatric cyclic vomiting syndrome. PMID:27302967

  12. The economics of hemodialysis catheter-related infection prophylaxis.

    PubMed

    Kosa, S Daisy; Lok, Charmaine E

    2013-01-01

    Hemodialysis central venous catheter (CVC) use is associated with the highest morbidity, mortality, and cost of all types of hemodialysis vascular access. CVC-related infection drives much of the cost associated with CVC use. The magnitude of the cost associated with CVC-related infection varies depending on the type and severity of that infection; however, estimates of the total direct and indirect costs associated with hospitalizations due to hemodialysis CVC-related infections range from 17,000 USD to 32,000 USD per episode. Thus, it is critically important, to not only have effective strategies to limit CVC-related infection but also evaluate whether these strategies are an efficient use of resources. Prophylactic strategies can be considered economically efficient only if the value of its implementation and the corresponding drop in infection rate offer greater value than standard care. The optimal CVC-related infection prophylaxis strategy should work to limit infection risk with minimal risk, inconvenience, and discomfort to the patient, and at minimal cost. The aim of this review was to examine the clinical and economic impact of some commonly described interventions used for CVC infection prophylaxis.

  13. A national audit of antibiotic prophylaxis in elective laparoscopic cholecystectomy

    PubMed Central

    Vasireddy, A; Nehra, D

    2014-01-01

    Introduction Laparoscopic surgeons in Great Britain and Ireland were surveyed to assess their use of antibiotic prophylaxis in elective laparoscopic cholecystectomy. This followed a Cochrane review that found no evidence to support the use of antibiotic prophylaxis in routine cases. Methods Data were collected on routine use of antibiotics in elective laparoscopic cholecystectomy, and how that was influenced by factors such as bile spillage, patient co-morbidities and surgeons’ experience. An online questionnaire was sent to 450 laparoscopic surgeons in December 2011. Results Data were received from 111 surgeons (87 consultants) representing over 7,000 cases per year. In routine cases without bile spillage, 64% of respondents gave no antibiotics and 36% gave a single dose. In cases with bile spillage, 11% gave no antibiotics. However, 80% gave one dose and 7% gave three doses. Co-amoxiclav was used by 75% of surgeons. Surgeons are more likely to give antibiotics when patients have risk factors for infective endocarditis. Conclusions This study suggests over 20,000 doses of antibiotics and over £100,000 could be saved annually if surgeons modified their practice to follow current guidelines. PMID:24992423

  14. Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic surgery: a comprehensive Canadian Delphi survey

    PubMed Central

    Agzarian, John; Linkins, Lori-Ann; Schneider, Laura; Hanna, Waël C.; Finley, Christian J.; Schieman, Colin; De Perrot, Marc; Crowther, Mark; Douketis, James

    2017-01-01

    Background The incidence of venous thromboembolic events (VTE) after resection of thoracic malignancies can reach 15%, but prophylaxis guidelines are yet to be established. We aimed to survey Canadian practitioners regarding perioperative risk factors for VTE, impact of those factors on extended prophylaxis selection, type of preferred prophylaxis, and timing of initiation and duration of thromboprophylaxis. Methods A modified Delphi survey was undertaken over three rounds with thoracic surgeons, thoracic anesthesiologists and thrombosis experts across Canada. Participants were asked to rate each parameter on a ten-point scale. Agreement was determined a priori as an item reaching a coefficient of variation of ≤30% (0.3), with the item then discontinued from later rounds. Results In total, 72, 57 and 50 respondents participated in three consecutive rounds, respectively. Consensus was reached on previous VTE, age, cancer diagnosis, thrombophilia, poor mobilization, extended resections, and pre-operative chemotherapy as risk factors. Consensus on risk factors impacting extended prophylaxis decisions was achieved on cancer diagnosis, obesity, previous VTE and poor mobilization. With respect to perioperative prophylaxis, once daily low-molecular-weight heparin (LMWH) was the only parameter that demonstrated agreement as a common practice pattern. No agreement was achieved regarding the role of mechanical prophylaxis, unfractionated heparin (UFH) or timing of initiation of peri-operative treatment. VTE prophylaxis until discharge reached agreement but there was substantial variability regarding the role of extended prophylaxis. Conclusions There is agreement between Canadian clinicians treating patients with thoracic malignancies regarding most risk factors for VTE, but there is no agreement on timing of initiation of prophylaxis, the agents used or factors mandating usage of extended prophylaxis. PMID:28203409

  15. Iranian Low-dose Escalating Prophylaxis Regimen in Children with Severe Hemophilia A and B.

    PubMed

    Eshghi, Peyman; Sadeghi, Elham; Tara, S Zahra; Habibpanah, Behnaz; Hantooshzadeh, Razieh

    2017-01-01

    Establishing an appropriate prophylaxis regimen for children with hemophilia is a critical challenge in developing countries. Barriers including availability and affordability, catheter-related complications, and inhibitor development risks have led to the introduction of new tailored prophylaxis regimens in different countries. This study emphasizes on the benefits of the Iranian low-dose escalating prophylaxis regimen in a Hemophilia Comprehensive Care Center in Iran. Referred patients with hemophilia less than 15 years of age, who were subject to prophylaxis regimen, are studied retrospectively. A once-weekly prophylaxis regimen of 25 IU/kg was started for the patients primarily. Their prophylaxis regimen was changed to 25 IU/kg twice a week and then 3 times a week when they experienced 3 joint bleedings, 4 soft tissue bleedings, or a 1 life-threatening bleed without a specific trauma history. Overall, 25 patients with severe hemophilia and at least 6-month history of on-demand (OD) treatment were studied. A mean of 1754 IU/kg/yr of coagulation factors, used for OD and prophylaxis purposes, was sufficient to decrease the mean annual bleeding rate (ABR) to 1.86 after prophylaxis. It also reduced the mean hospitalization days and the mean number of target joints to 0.24 and 0.16, respectively. Overall, 19 (76%) patients were continuing their once-weekly regimen at the end of the follow-up. None of the patients needed 3-times-a-week regimen or central venous catheterization and none developed inhibitors in the follow-up. Benefits of the Iranian low-dose escalating prophylaxis regimen prove equal to some of the previous 3-times-a-week prophylaxis regimens in reducing the ABR and hospitalizations.

  16. Clinical Feasibility of Noninvasive Visualization of Lymphatic Flow using Principles of Spin Labeling MRI: Implications for Lymphedema Assessment

    PubMed Central

    Rane, Swati; Donahue, Paula M. C.; Towse, Ted; Ridner, Sheila; Chappell, Michael; Jordi, John; Gore, John; Donahue, Manus J.

    2015-01-01

    Purpose To extend a commonly employed, noninvasive arterial spin labeling (ASL) MRI method for measuring blood flow to evaluate lymphatic flow. Materials and Methods All volunteers (n=12) provided informed consent in accordance with IRB and HIPAA regulations. Quantitative relaxation time (T1 and T2) measurements were made in extracted human lymphatic fluid at 3.0T. Guided by these parameters, an ASL MRI approach was adapted to measure lymphatic flow (flow-alternating-inversion-recovery lymphatic water labeling; 3×3×5 mm3) in healthy subjects (n=6; 30±1 yrs; recruitment duration=2 months). Lymphatic flow velocity was quantified by performing spin labeling measurements as a function of post-labeling delay time and measuring the time-to-peak of signal in axillary lymph nodes. Clinical feasibility was evaluated in Stage II lymphedema patients (n=3; 60yr/F, 43yr/F, 64yr/F) and control subjects with unilateral cuff-induced lymphatic stenosis (n=3; 31yr/M, 31yr/M, 35yr/F). Results T1 and T2 of lymphatic fluid at 3.0T were 3100±160 ms (range=2930-3210 ms; median=3200 ms) and 610±12 ms (range=598-618 ms; median=610 ms), respectively. Healthy lymphatic flow (afferent vessel to axillary node) velocity was found to be 0.61±0.13 cm/min (n=6). A reduction (P<0.005) in lymphatic flow velocity in the affected arms of patients and the affected arms of healthy subjects with manipulated cuff-induced flow reduction was observed. The ratio of unaffected to affected axilla lymphatic velocity (1.24±0.18) was significantly (P<0.005) higher than the Left/Right ratio in healthy subjects (0.91±0.18). Conclusion This work provides a foundation for clinical investigations whereby lymphedema etiogenesis and therapies may be interrogated without exogenous agents and with clinically available imaging equipment. PMID:23864103

  17. Pre-exposure prophylaxis in Southern Africa: feasible or not?

    PubMed Central

    Venter, Willem Daniel François; Cowan, Frances; Black, Vivian; Rebe, Kevin; Bekker, Linda-Gail

    2015-01-01

    Introduction Southern and Eastern Africa bear the brunt of the AIDS epidemic, and current prevention interventions remain inadequate. Antiretroviral-based pre-exposure prophylaxis (PrEP) is gaining momentum as an effective prevention intervention. Discussion Discussions have been started on how this strategy could be employed in Africa such that the populations most in need can be reached urgently for the greatest impact. This requires the selection of specific risk groups and service environments in which PrEP can be distributed safely and cost effectively while being mindful of any ethical issues. Conclusions Given the need for an integrated public health approach to this, a number of potential populations and opportunities for PrEP distribution exist and are discussed in this commentary. PMID:26198344

  18. Treatment and Prophylaxis in Pediatric Urinary Tract Infection

    PubMed Central

    Nickavar, Azar; Sotoudeh, Kambiz

    2011-01-01

    Urinary tract infection (UTI) is the most common serious bacterial infection in early life. Appropriate diagnosis and treatment prevent complications such as hypertension, proteinuria and end stage renal disease. A computerized search of MEDLINE, Embase and other databases was done to find the latest results about the treatment and prevention in pediatric UTI. Randomized control trials, systematic reviews and original articles were assessed. Search terms were “UTI, treatment, prophylaxis, prevention, and children”. All children with complicated or simple UTI were included in our search study from neonatal period to late childhood and medical aspects of treatment were reviewed. Recently, treatment approaches have been changed by simplification of drug administration. Oral treatment is recommended especially in older infants and children instead of strict intravenous treatment and patient admission. In addition, prophylactic treatment becomes easier and limited to certain cases. In this article, we review the recent information and approaches in this setting. PMID:21448397

  19. Indications of antibiotic prophylaxis in dental practice- Review

    PubMed Central

    Ramu, C; Padmanabhan, TV

    2012-01-01

    Antibiotics are frequently used in dental practice. Clinical and bacteriological epidemiological factors determine the indications of antibiotics in dentistry. Antibiotics are used in addition to appropriate treatment to aid the host defences in the elimination of remaining bacteria. It is indicated when there is evidence of clinical sign involvement and spread of infection. Antibiotics are prescribed in dental practice for treating odontoge nic infections, non-odontogenic infections, as prophylaxis against focal and local infection. Special care needs to be addressed to patients with organ transplants, poorly controlled diabetes and pregnancy. Antibiotics should be used only as an adjunct to dental treatment and never alone as the first line of care. The present paper reviews the indications of antibiotics in dental practice. PMID:23570007

  20. Human immunodeficiency virus postexposure prophylaxis at IBadan, Nigeria.

    PubMed

    Olowookere, Samuel A; Fatiregun, Akinola Ayoola

    2010-01-01

    HIV infection from occupational and nonoccupational exposures can be prevented through risk assessment and management with antiretroviral drug therapy (ART). This study sought to examine the pattern of presentation and outcome of clients who were given postexposure prophylaxis (PEP) at the University College Hospital, Ibadan, Nigeria. A retrospective review of case notes of clients presenting for HIV PEP from January 2005 to December 2006 was carried out. A total of 48 clients with a mean age of 27.9 +/- 12.3 years underwent PEP during the period under review. Rape constituted 50% of reasons for PEP, while needle pricks and blood splash into mucous membranes constituted 25% each. Among those who received therapy, 10 (23.8%) could not complete drug therapy because of side effects. Although no client was HIV positive after the recommended 6 months of follow-up, 8 (16.7%) clients did not complete attendance to the clinic during the period.

  1. A quantitative approach to recommendations on malaria prophylaxis

    PubMed Central

    Pappaioanou, M.; Lobel, H. O.; Campbell, C. C.

    1988-01-01

    In order to develop recommendations for malaria prophylaxis, a quantitative method is needed to balance the risk of Plasmodium falciparum malaria infections against the toxicity of antimalarial drugs. Using decision analysis, we estimated the expected mortality associated with three alternative regimens of prophylactic drugs for visitors to three areas with different risks of infection with chloroquine-resistant P. falciparum. The model used took into account the risks of malaria and of adverse reactions to antimalarial drugs. Estimates of the parameters used in the analysis were based on observations made on U.S. travellers. Reducing the risk of malaria infection was found to have a far greater impact on lowering the expected mortality than that of increasing the chemoprophylactic efficacy of the drugs used, thereby emphasizing the need for travellers to use anti-mosquito measures in malarious areas. The analytical method described can be used to define optimal malaria prevention strategies. PMID:3048761

  2. Assessment of Venous Thromboembolism Prophylaxis in Neurological Patients with Restricted Mobility – VTE-NEURO Study

    PubMed Central

    BAJENARU, Ovidiu; ANTOCHI, Florina; BALASA, Rodica; BURAGA, Ioan; PATRICHI, Sanda; SIMU, Mihaela; SZABOLCS, Szatmari; TIU, Cristina; ZAHARIA, Cornelia

    2014-01-01

    The authors present the data of a medical registry which evaluated if the physicians assess VTE risk in stroke patients, during hospitalization period and at hospital discharge and if the thromboprophylaxis is used according to National Guidelines for VTE Prophylaxis. 884 patients with acute ischemic stroke patients were enrolled between June 2010 and December 2011, from 62 centers, 51.4% male and 48.6% female with mean age 70.07 years (68.25 years in the male group and 71.92 years in the female one). There were two co-primary endpoints: the percentage of patients at risk for VTE at hospital admission assessed by the physician, and the percentage of patients with risk factors for VTE that persist at hospital discharge from the total number of patients hospitalized with ischemic stroke. The secondary endpoints were: the percentage of hospitalized patients receiving prophylaxis according to the National Guidelines of VTE Prophylaxis from the total number of patients at risk of VTE, the percentage of hospitalized patients with VTE risk receiving recommendation for thromboprophylaxis at discharge, the duration and the type of VTE prophylaxis in hospitalized patients, the duration and the type of VTE prophylaxis at discharge. Results: 879 (99.4%) of the total number of patients at risk of VTE have received prophylaxis during hospitalization. The most frequently types of prophylaxis used during hospitalisation were LMWH in 96.3% of the patients and mechanic method in 16.6% that were in accordance with the National Guidelines of VTE Prophylaxis recommendations. Conclusions: There is a clear improvement in both assessment and thromprophylaxis recommendation in acute stroke patients with restricted mobility at VTE risk and in our country. LMWH is preferred to unfractionated heparin for venous thromboembolism prophylaxis in this high-risk patient population in view of its better clinical benefits to risk ratio and convenience of once daily administration. PMID:25553119

  3. Is prophylaxis required for delivery in women with factor VII deficiency?

    PubMed Central

    Baumann Kreuziger, Lisa M.; Morton, Colleen T.; Reding, Mark T.

    2013-01-01

    Introduction Factor VII (fVII) deficiency is a rare congenital bleeding disorder in which fVII activity level and bleeding tendency do not completely correlate. Pregnancy and delivery present a significant hemostatic challenge to women with fVII deficiency. Treatment with recombinant factor VIIa (rfVIIa) carries a thrombotic risk and the literature is unclear whether prophylaxis is necessary prior to delivery. Aim To define management, hemorrhagic and thrombotic complications of pregnant women with fVII deficiency through a systematic review. Methods Medical databases (PubMed, MEDLINE, CINAHL, Academic Search Premier, Cochrane Library, Web of Science and Scopus) were searched using “factor VII deficiency” and “pregnancy” or “surgery.” Overall 34 articles, 4 abstracts, and 3 institutional cases were reviewed. Results Literature from 1953–2011 reported 94 live births from 62 women with fVII deficiency. The median fVII activity was 5.5%. Hemostatic prophylaxis was used in 32% of deliveries. Without prophylaxis, 40 vaginal deliveries and 16 cesarean sections were completed. The odds of receiving prophylaxis were 2.9 times higher in women undergoing cesarean section compared to vaginal delivery. Post-partum hemorrhage occurred in 10% of deliveries with prophylaxis and 13% of deliveries without prophylaxis. The fVII level did not significantly differ between women who did and did not receive prophylaxis. Conclusion We present the only systematic review of the management of pregnancy in fVII deficient women. No difference in post-partum hemorrhage was seen in deliveries with and without prophylaxis. Therefore we recommend that rfVIIa be available in the case of hemorrhage or surgical intervention, but not as mandatory prophylaxis. PMID:23607277

  4. Targeting viral dsRNA for antiviral prophylaxis

    PubMed Central

    Fei, Zhou; Liu, Yang; Yan, Zhen; Fan, Daiming; Alexander, Alice; Yang, Jing-Hua

    2011-01-01

    Double-stranded (ds)RNA in the infected cells is a trait shared by most if not all viruses. While humans have developed variable immune responses, viruses have also developed countermeasures to defeat dsRNA-induced antiviral strategies. Thus, we proposed a broad antiviral strategy to antagonize the countermeasures of viruses and bypass the dsRNA-induced signals that are readily defeated by viruses. By rewiring the dsRNA-binding proteins in the dsRNA complex and reconnecting them to apoptosis signaling, we created several dsRNA-dependent caspase recruiters, termed dsCAREs, to bypass dsRNA-induced antiviral signals that would otherwise be targeted by viruses. Adenovirus and vesicular stomatitis virus, representing viruses of the dsDNA and negative-stranded RNA viral groups, were used to infect HEK293 cells. The dsCARE chimera was added in medium to evaluate its antiviral activity. The truncated dsCAREs were used as controls. We demonstrate that dsCARE suppresses viral infection starting at 0.1 μg/ml and reaches the peak at 2 μg/ml. The EC50 was ∼0.2 μg/ml. However, it had an undetectable effect on uninfected cells. Further data show that both dsRNA binding and apoptosis activation of dsCARE are essential for its antiviral activity. We conclude that dsRNA is a practical virus-associated molecular pattern that can be targeted for broad and rapid antiviral prophylaxis.—Fei, Z., Liu, Y., Yan, Z., Fan, D., Alexander, A., Yang, J.-H. Targeting viral dsRNA for antiviral prophylaxis. PMID:19880628

  5. Topical azithromycin or ofloxacin for endophthalmitis prophylaxis after intravitreal injection

    PubMed Central

    Romero-Aroca, Pedro; Sararols, Laura; Arias, Lluis; Casaroli-Marano, Ricardo P; Bassaganyas, Francisca

    2012-01-01

    Background The number of patients who have undergone intravitreal injections has increased enormously in recent years, but a consensus is still lacking on prophylaxis for endophthalmitis. The aim of this prospective, observational study was to evaluate the prophylactic effect of azithromycin eye drops versus ofloxacin eye drops. Methods The study was conducted in five hospitals in Spain and included all patients undergoing intravitreal injections of triamcinolone, bevacizumab, ranibizumab, or pegaptanib over one year. Patients received azithromycin 15 mg/g eye drops (twice daily on the day prior to injection and for another 2 days) or ofloxacin 3 mg/g eye drops (every 6 hours on the day prior to injection and for another 7 days). Results In the azithromycin group, there were 4045 injections in 972 eyes of 701 patients. In the ofloxacin group, there were 4151 injections in 944 eyes of 682 patients. There were two cases of endophthalmitis (0.049%) in the azithromycin group and five (0.12%) in the ofloxacin group. The odds ratio of presenting with endophthalmitis in the ofloxacin group compared with the azithromycin group was 2.37 (95% confidence interval [CI] 1.32–3.72, P < 0.001). There were two cases of noninfectious uveitis after triamcinolone injection in the azithromycin group (0.049%) and two (0.048%) in the ofloxacin group; no significant differences were observed (odds ratio 0.902, 95% CI 0.622–1.407, P = 0.407). Conjunctival hyperemia was observed in 12 cases in the azithromycin group and none in the ofloxacin group. Conclusion The risk of endophthalmitis was significantly greater with ofloxacin than with azithromycin. These findings provide a valuable addition to the ever-increasing pool of information on endophthalmitis prophylaxis after intravitreal injection, although further large-scale studies are required to provide definitive conclusions. PMID:23109798

  6. Is DVT prophylaxis overemphasized? A randomized prospective study.

    PubMed

    Kosir, M A; Kozol, R A; Perales, A; McGee, K; Beleski, K; Lange, P; Dahn, M

    1996-02-01

    This study was designed to prospectively evaluate a previously published prognostic index for predicting deep venous thrombosis (DVT) in general surgical patients with conventional prophylaxis. Patients undergoing procedures of at least 1 hr duration (abdominal, thoracic, head and neck, inguinal) requiring general or spinal anesthetic were prospectively randomized into the following groups: Group 1, sequential pneumatic compression devices during surgery and 2 days postoperatively; Group 2, subcutaneous heparin (5000 U q 12 hr) starting 1 hr before surgery and for 7 days postop; Group 3, control group. All patients underwent duplex evaluation of bilateral lower extremity deep venous systems preoperatively and on postoperative Days 1, 3, and 30. In addition, a previously developed predictive DVT incidence indicator, the prognostic index (PI), was calculated for each patient. A total of 137 patients were entered into the study with 29 removed for patient/staff reasons. There were no differences in PI among the three groups at the 0.05 level (ANOVA). The distribution of risk factors for DVT including increased age, body size, hemoglobin (Hb), and colorectal procedures were distributed evenly among the groups. Additional factors such as diabetes, COPD, PVD, immobilization, and cancer were also evenly distributed among the groups. The PI predicted a 20% incidence of DVT. For Groups 1 (n = 25), 2 (n = 38), and 3 (n = 45) no DVTs were detected over the 30 days of study. During the study period, 8 DVTs were detected by duplex evaluation in general surgical patients not in the study (1.5%). In conclusion, in a prospective randomized study using sequential pneumatic compression devices, subcutaneous heparin or no prophylaxis in matched general surgical patients at moderate to high risk for thromboembolism, no DVTs occurred for up to 30 days. Furthermore, neither a PI nor other factors associated with DVT accurately predicted the incidence of DVT in this patient population.

  7. Labview utilities

    SciTech Connect

    Persaud, Arun

    2011-09-30

    The software package provides several utilities written in LabView. These utilities don't form independent programs, but rather can be used as a library or controls in other labview programs. The utilities include several new controls (xcontrols), VIs for input and output routines, as well as other 'helper'-functions not provided in the standard LabView environment.

  8. State of the science of adherence in pre-exposure prophylaxis and microbicide trials

    PubMed Central

    Muchomba, Felix M.; Gearing, Robin E.; Simoni, Jane M.; El-Bassel, Nabila

    2014-01-01

    For pre-exposure prophylaxis (PrEP) and microbicides to effectively prevent HIV, optimal treatment adherence is required. Adherence to these strategies, however, has not been sufficiently studied. This investigation systematically reviews oral PrEP and microbicide trials across 4 domains of adherence: 1) definition and measures used; 2) risks for non-adherence; 3) promotion strategies; and 4) effects on outcomes. Nineteen (n = 19) trials, with 47157 participants, published between 1987 and 2012 were identified. Reported mean adherence to microbicides was 79% and to oral PrEP 87%. Common risks for microbicide nonadherence were decreased motivation over time, sex with primary (noncommercial/casual) partners, and insufficient supply. Oral PrEP non-adherence risks were older age and medication side effects. Psychoeducation and outreach to participants and communities were frequently utilized promotion strategies. Most trials failed to systematically identify barriers and monitor and promote adherence, although adherence moderated outcomes. Recommendations for attending to adherence in future trials are provided. PMID:22932322

  9. The potential uses of preexposure prophylaxis for HIV prevention among people who inject drugs

    PubMed Central

    Baral, Stefan D.; Strömdahl, Susanne; Beyrer, Chris

    2013-01-01

    Purpose of review Oral preexposure prophylaxis (PrEP) has shown HIV preventive efficacy for several key populations at risk for HIV infection including MSM and heterosexual men and women in HIV serodiscordant relationships. An efficacy trial of daily oral tenofovir among people who inject drugs (IDU) is underway in Thailand. Recent findings Although efficacy data is pending, there is emerging biological and public health plausibility data suggesting the utility of PrEP as an effective component of combination HIV prevention for IDU. Drawing from studies characterizing adherence to antiretroviral therapy for IDU, there are a range of scientific and operational considerations for the potential use of PrEP for IDU. We review here the available literature on the potential use of PrEP for IDU, barriers to uptake and adherence, and potential implementation science questions, which could address, and potently increase, the effectiveness of this intervention. Summary IDU remain the most underserved population in the HIV response worldwide, and have a marked gap in prevention services, making PrEP a potentially promising addition to the prevention toolkit for people who use drugs and, for those already living with HIV infection, for their spouses and other sexual partners. PMID:23076122

  10. Hemophilia A and hemophilia B: focus on arthropathy and variables affecting bleeding severity and prophylaxis.

    PubMed

    Escobar, M; Sallah, S

    2013-08-01

    Hemophilia A (HA) and hemophilia B (HB) are X-linked, recessive disorders. Although their clinical manifestations are essentially indistinguishable, it has been suggested that bleeding episodes in patients with HA are generally more severe and occur at higher frequency than in patients with HB. Nevertheless, considerable debate remains regarding the relative severity of HA and HB. Based on the relative risk of undergoing joint arthroplasty, it appears that patients with HA have more severe joint deterioration compared with patients with HB. Although it is difficult to speculate on the factors that might modify bleeding severity in patients with hemophilia, recent observations indicate that other coagulation proteins, such as tissue factor pathway inhibitor or polymorphisms in coagulation factor genes and genetic defects associated with hypercoagulability may account for the variability in clinical phenotype among patients with hemophilia. Numerous studies have provided evidence supporting the clinical and social benefits of administration of clotting factor in prophylaxis. However, it is still unclear why this approach is more commonly utilized in patients with HA than in those with HB.

  11. [Prostate cancer prophylaxis by dietary supplements: more than just an illusion?].

    PubMed

    Merkle, W

    2014-11-01

    Prophylaxis of tumors of the prostate gland is theoretically simple but what makes it difficult is that no appropriate test methods are available. The topic of prostate cancer prophylaxis by dietary supplements remains difficult as there are still no really certain data. The psychological aspect of wanting and being able to actively contribute to success of a therapy oneself, is absolutely not an aspect to be ignored to accept such dietary supplements. There are also studies which show that a certain helpful effect seems to be present. From these considerations the question arises whether cancer prophylaxis could be developed from this. This article presents the state of the art in early 2014.

  12. Does Obesity Predispose Medical Intensive Care Unit Patients to Venous Thromboembolism despite Prophylaxis? A Retrospective Chart Review.

    PubMed

    Peters, Bradley J; Dierkhising, Ross A; Mara, Kristin C

    2016-01-01

    Background. Obesity is a significant issue in the critically ill population. There is little evidence directing the dosing of venous thromboembolism (VTE) prophylaxis within this population. We aimed to determine whether obesity predisposes medical intensive care unit patients to venous thromboembolism despite standard chemoprophylaxis with 5000 international units of subcutaneous heparin three times daily. Results. We found a 60% increased risk of venous thromboembolism in the body mass index (BMI) ≥ 30 kg/m(2) group compared to the BMI < 30 kg/m(2) group; however, this difference did not reach statistical significance. After further utilizing our risk model, neither obesity nor mechanical ventilation reached statistical significance; however, vasopressor administration was associated with a threefold risk. Conclusions. We can conclude that obesity did increase the rate of VTE, but not to a statistically significant level in this single center medical intensive care unit population.

  13. HIV Pre-Exposure Prophylaxis and Postexposure Prophylaxis in Japan: Context of Use and Directions for Future Research and Action.

    PubMed

    DiStefano, Anthony S; Takeda, Makiko

    2017-02-01

    Biomedical HIV prevention strategies are playing an increasingly prominent role in addressing HIV epidemics globally, but little is known about their use in Japan, where persistent HIV disparities and a recently stable, but not declining, national epidemic indicate the need for evolving approaches. We conducted an ethnographic study to determine the context of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) use and to identify directions for future research and action in Japan. We used data from observational fieldwork in the Kansai region and Tokyo Metropolitan Area (n = 178 persons observed), qualitative interviews (n = 32), documents and web-based data sources (n = 321), and email correspondences (n = 9) in the period 2013-2016. Drug approvals by Japan's regulatory agencies, insurance coverage for medications, and policies by healthcare institutions and government agencies were the main factors affecting PrEP and PEP legality, use, and awareness. Awareness and the observable presence of PrEP and PEP were very limited, particularly at the community level. PrEP and PEP held appeal for Japanese scientists and activists, and for study participants who represented various other stakeholder groups; however, significant concerns prevented open endorsements. Japanese health officials should prioritize a national discussion, weigh empirical evidence, and strongly consider formal approval of antiretroviral (ARV) medications for use in PrEP and both occupational and nonoccupational PEP. Once approved, social marketing campaigns can be used to advertise widely and increase awareness. Future research would benefit from theoretical grounding in a diffusion of innovations framework. These findings can inform current and future ARV-based prevention strategies at a critical time in the international conversation.

  14. Experiences of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India: An Analysis of Focus Group Discussions with Patients, Families, Community Members and Program Volunteers

    PubMed Central

    Cassidy, Tali; Worrell, Caitlin M.; Little, Kristen; Prakash, Aishya; Patra, Inakhi; Rout, Jonathan; Fox, LeAnne M.

    2016-01-01

    Background Globally 68 million people are infected with lymphatic filariasis (LF), 17 million of whom have lymphedema. This study explores the effects of a lymphedema management program in Odisha State, India on morbidity and psychosocial effects associated with lymphedema. Methodology/Principal Findings Focus groups were held with patients (eight groups, separated by gender), their family members (eight groups), community members (four groups) and program volunteers (four groups) who had participated in a lymphedema management program for the past three years. Significant social, physical, and economic difficulties were described by patients and family members, including marriageability, social stigma, and lost workdays. However, the positive impact of the lymphedema management program was also emphasized, and many family and community members indicated that community members were accepting of patients and had some improved understanding of the etiology of the disease. Program volunteers and community members stressed the role that the program had played in educating people, though interestingly, local explanations and treatments appear to coexist with knowledge of biomedical treatments and the mosquito vector. Conclusions/Significance Local and biomedical understandings of disease can co-exist and do not preclude individuals from participating in biomedical interventions, specifically lymphedema management for those with lymphatic filariasis. There is a continued need for gender-specific psychosocial support groups to address issues particular to men and women as well as a continued need for improved economic opportunities for LF-affected patients. There is an urgent need to scale up LF-related morbidity management programs to reduce the suffering of people affected by LF. PMID:26849126

  15. Illustrating the (in)visible: understanding the impact of loss in adults living with secondary lymphedema after cancer.

    PubMed

    Thomas, Roanne; Hamilton, Ryan

    2014-01-01

    Life with a disability is often riddled with paradoxes, one of which is being visibly marked, while personal experiences, losses, and challenges remain hidden. Our article draws attention to this paradox among people who live with secondary lymphedema after cancer (SLC). SLC is a relatively unfamiliar chronic condition within medical and lay discourses of cancer, which proves challenging for the many cancer survivors who are in search of information and understanding. Thirteen men and women with SLC were recruited from two research sites (Fredericton, NB, and Ottawa, ON, Canada) to participate in semi-structured interviews about the physical and psychosocial aspects of SLC. Using a methodology of interpretive description, our analysis of participant interviews reveals the complex ways in which men and women felt both visible and invisible within various contexts. We discuss three majors themes: (in)visibility and appearance related to material losses; (in)visibility and action connected to visible losses in function, as well as invisible struggles to care for oneself; and the loss of present and future well-being, as SLC renders some limitations visible while potentially obscuring a hopeful future indefinitely. Our research indicates that timely diagnosis of SLC would be an immediate first step in recognizing the physical and emotional dimensions of the condition. To accomplish this, increased awareness is needed. To enhance quality of life for those living with SLC, the development of new resources and psychosocial supports is also required.

  16. Antibiotic resistance in Enterobacteriaceae: what impact on the efficacy of antibiotic prophylaxis in colorectal surgery?

    PubMed

    Kirby, A; Santoni, N

    2015-04-01

    Antibiotic prophylaxis, introduced in the 1940s, brought in an era of relatively safe colorectal surgery. This was achieved in part due to the prevention of surgical site infections (SSIs) caused by Enterobacteriaceae. Since then, Enterobacteriaceae have become increasingly resistant to the antibiotics commonly used for prophylaxis. The impact of being colonized preoperatively with resistant Enterobacteriaceae on the efficacy of colorectal SSI prophylaxis, if any, is unknown. It is also difficult to predict the likely impact of resistance as the exposure‒response relationships have not been determined for antibiotic surgical prophylaxis. Neither is it known which test for resistance to use; the importance of the concentration of Enterobacteriaceae in the colon, the ability of different species of Enterobacteriaceae to cause SSIs, and the comparative ability of minimum inhibitory concentration or presence of a resistance mechanism in predicting SSI risk have yet to be established. Clinical research is urgently needed to answer these questions.

  17. Molecular Mechanisms of HIV Type 1 Prophylaxis Failure Revealed by Single-Genome Sequencing

    PubMed Central

    Li, Hui; Blair, Lily; Chen, Yalu; Learn, Gerald; Pfafferott, Katja; John, Mina; Bhattacharya, Tanmoy; Hahn, Beatrice H.; Mallal, Simon; Shaw, George M.; Bar, Katharine J.

    2013-01-01

    Trials of human immunodeficiency virus type 1 (HIV) pre- and postexposure prophylaxis show promise. Here, we describe a novel strategy for deciphering mechanisms of prophylaxis failure that could improve therapeutic outcomes. A healthcare worker began antiretroviral prophylaxis immediately after a high-risk needlestick injury but nonetheless became viremic 11 weeks later. Single-genome sequencing of plasma viral RNA identified 15 drug susceptible transmitted/founder HIV genomes responsible for productive infection. Sequences emanating from these genomes exhibited extremely low diversity, suggesting virus sequestration as opposed to low-level replication as the cause of breakthrough infection. Identification of transmitted/founder viruses allows for genome-wide assessment of molecular mechanisms of prophylaxis failure. PMID:24023257

  18. Molecular mechanisms of HIV type 1 prophylaxis failure revealed by single-genome sequencing.

    PubMed

    Li, Hui; Blair, Lily; Chen, Yalu; Learn, Gerald; Pfafferott, Katja; John, Mina; Bhattacharya, Tanmoy; Hahn, Beatrice H; Mallal, Simon; Shaw, George M; Bar, Katharine J

    2013-11-15

    Trials of human immunodeficiency virus type 1 (HIV) pre- and postexposure prophylaxis show promise. Here, we describe a novel strategy for deciphering mechanisms of prophylaxis failure that could improve therapeutic outcomes. A healthcare worker began antiretroviral prophylaxis immediately after a high-risk needlestick injury but nonetheless became viremic 11 weeks later. Single-genome sequencing of plasma viral RNA identified 15 drug susceptible transmitted/founder HIV genomes responsible for productive infection. Sequences emanating from these genomes exhibited extremely low diversity, suggesting virus sequestration as opposed to low-level replication as the cause of breakthrough infection. Identification of transmitted/founder viruses allows for genome-wide assessment of molecular mechanisms of prophylaxis failure.

  19. Glyburide - Novel Prophylaxis and Effective Treatment for Blast-Traumatic Brain Injury

    DTIC Science & Technology

    2013-10-01

    determine the safety of the SUR1 blocker , glyburide (glibenclamide), as it might be used as prophylaxis against blast-TBI. During the 4th year of...We completed evaluation of the prophylaxis treatment with SUR1 blocker , glyburide in the neurobehavioral outcome after blast-TBI (Obj. 1d, c...APP ( Beta -amyloid precursor protein) 64 qPCR Casp 3 (caspase 3) 28 Tissue hemoglobin detection SP1 (ischemic, hypoxic marker) 7 ED1

  20. Prophylaxis for Venous Thromboembolism Following Total Knee Arthroplasty: A Survey of Korean Knee Surgeons

    PubMed Central

    Kim, Nam Ki; Kim, Tae Kyun; Kim, Jong Min

    2016-01-01

    Purpose The purpose of this study is to provide information on the actual status and prevailing trend of prophylaxis for venous thromboembolism (VTE) following total knee arthroplasty (TKA) in South Korea. Materials and Methods The Korean Knee Society (KKS) developed a questionnaire with 6 clinical questions on VTE. The questionnaire was distributed to all members of KKS by both postal and online mail. Participants were asked to supply details on their specialty and to select methods of prophylaxis they employ. Of the total members of KKS, 27.9% participated in the survey. Results The percentage of surgeons who routinely performed prophylaxis for VTE was 60.4%; 19.4% performed prophylaxis depending on the patient's health condition; and the remaining 20.2% never implemented prophylaxis after surgery. The common prophylactic methods among the responders were compression stocking (72.9%), pneumatic leg compression (63.3%), perioral direct factor Xa inhibitor (46.9%), and low-molecular-weight heparin (39.5%). For the respondents who did not perform prophylaxis, the main reason (51.5%) was the low risk of postoperative VTE considering the low incidences in Asians. Conclusions The present study involving members of the KKS will help to comprehend the actual status of VTE prevention in South Korea. The results of this study may be useful to design VTE guidelines appropriate for Koreans in the future. PMID:27595074

  1. Novel concepts: emerging data and the role of extended prophylaxis following hip fracture surgery.

    PubMed

    Dobesh, Paul P

    2003-11-15

    The typical duration of hospitalization following major knee and hip surgeries may not provide adequate time for effective prophylaxis of venous thromboembolism (VTE) when inpatient therapy only is administered. Results from a clinical trial that extended the duration of VTE prophylaxis after hip fracture surgery are reviewed. The risk of VTE after major knee and hip arthroplasty has been demonstrated to extend into the outpatient period. Although extending the duration of VTE prophylaxis has been demonstrated to decrease the incidence of VTE following total hip replacement, no randomized, double-blinded assessment had demonstrated the effectiveness of this strategy following hip fracture surgery. A multicenter, randomized, placebo-controlled, double-blind trial was conducted to assess prolonged prophylaxis of VTE in patients undergoing surgery for fracture of the upper third of the femur. Patients received an initial 7 +/- 1 day open period of treatment with subcutaneous fondaparinux (2.5 mg once daily); 656 patients were subsequently randomized to receive a 21 +/- 2-day double-blind treatment period of either the same fondaparinux regimen or placebo. Fondaparinux treatment produced statistically significant reductions in the incidence of all VTE events (1.4% compared with placebo 35.0%); prolonged prophylaxis was associated with a 96% relative risk reduction for VTE (p < 0.001). Also, no differences were observed in the incidence of other major endpoints such as bleeding or death. These results indicate that extended prophylaxis with fondaparinux significantly reduces the risk of VTE without increasing the risk of major bleeding.

  2. Continuous antibiotic prophylaxis in the setting of prenatal hydronephrosis and vesicoureteral reflux

    PubMed Central

    Wong, Nathan C.; Koyle, Martin A.; Braga, Luis H.

    2017-01-01

    Continuous antibiotic prophylaxis (CAP) has traditionally been offered for children with recurrent urinary tract infections (UTIs) or those at risk, including children diagnosed with prenatal hydronephrosis (HN) and vesicoureteral reflux (VUR). However, indications for antibiotic prophylaxis are controversial, data on who should benefit from this therapy is conflicting and, thus, guidelines are unable to provide conclusive recommendations. In the setting of prenatal HN, although randomized trials are currently underway, most evidence is derived from low- to moderate-quality observational studies. Although there is no benefit in those with low-grade HN, a systematic review of the available studies showed that high-grade HN patients on prophylaxis experienced fewer infections with an estimated number needed to treat of 7. On the other hand, there are eight randomized trials that have investigated the use of antibiotic prophylaxis in the setting of VUR. Although four of the studies have demonstrated some value of prophylaxis and the other four have not, meta-analysis has shown an overall benefit of antibiotic prophylaxis in preventing infections. The observed differences are likely due to different inclusion criteria and study heterogeneity. Although generalizing results of meta-analyses to all children is tempting, an individualized approach, by determining which patients best behave like those of the included studies, is recommended. PMID:28265311

  3. Posaconazole prophylaxis--impact on incidence of invasive fungal disease and antifungal treatment in haematological patients.

    PubMed

    Peterson, Lisa; Ostermann, Julia; Rieger, Heidi; Ostermann, Helmut; Rieger, Christina Theresa

    2013-11-01

    Since two large-scale, randomised studies on posaconazole prophylaxis have demonstrated a clear benefit for patients at high risk for contracting invasive fungal disease (IFD), posaconazole prophylaxis has been adopted as standard of care for this patient collective. Several years on from implementation at our institution, we wanted to evaluate its impact on the incidence and use of empirical antifungal therapy in a real-life setting. We analysed retrospectively incidence and severity of IFD in high-risk patients with prophylaxis, using a historical cohort as comparator. A total of 200 patients had either received the extended spectrum triazole posaconazole in prophylactic dosage of 200 mg tid or empirical antifungal therapy. Disease events were analysed by application of the revised EORTC/MSG definitions for IFD. Before posaconazole prophylaxis, we recorded 57/100 cases of IFD which was reduced to 28/100 with prophylaxis. The empirical use of antifungal drugs was reduced to 41% from 91% in the non-prophylaxis cohort. Furthermore, we observed a shift in the categorisation of IFD according to EORTC/MSG criteria. Our data suggest that posaconazole was effective in reducing the rate and probability of invasive fungal disease in high-risk patients.

  4. Prophylaxis of bleeding episodes in patients with von Willebrand’s disease

    PubMed Central

    Federici, Augusto B.

    2008-01-01

    Patients with severe forms of von Willebrand’s disease (VWD) may have frequent haemarthroses, especially when factor VIII (FVIII) levels are below 10 U/dL, so that some of them develop target joints like patients with severe haemophilia A. Some patients have recurrent gastrointestinal bleeding, often without lesions in the gastrointestinal tract, and need treatment every day or every other day. Finally, there are children who have epistaxis frequently and severely enough to cause anaemia. In these frequent and severe bleeders, the optimal therapy may be secondary long-term prophylaxis with von Willebrand factor (VWF)/FVIII concentrates rather than on-demand treatment on the occasion of bleeding episodes. The largest experience on such prophylaxis in VWD has been in Sweden in 35 patients with severe forms of VWD. Long-term prophylaxis was also implemented in a cohort of Italian patients with VWD: prophylaxis was used in seven patients with types 3 (n=1), 2A (n=4), 2M (n=1) and type 1 (n=1) VWD because of recurrent gastrointestinal bleeds and in four patients with type 3 VWD because of joint bleeds. Prophylaxis prevented bleeding completely in eight patients and largely reduced hospitalisation for blood transfusions in the remaining three. The cost-effectiveness of these prophylaxis regimens versus on-demand therapy will now be investigated in one large international study. PMID:19105507

  5. Atovaquone for Prophylaxis of Toxoplasmosis after Allogeneic Hematopoietic Stem Cell Transplantation.

    PubMed

    Mendorf, Alexander; Klyuchnikov, Evgeny; Langebrake, Claudia; Rohde, Holger; Ayuk, Francis; Regier, Marc; Christopeit, Maximilian; Zabelina, Tatjana; Bacher, Adelbert; Stübig, Thomas; Wolschke, Christine; Bacher, Ulrike; Kröger, Nicolaus

    2015-01-01

    Toxoplasmosis and infections by other opportunistic agents such as Pneumocystis jirovecii constitute life-threatening risks for patients after allogeneic hematopoietic stem cell transplantation. Trimethoprim/sulfamethoxazole (TMP-SMX) has been well established for post-transplant toxoplasmosis and pneumocystis prophylaxis, but treatment may be limited due to toxicity. We explored atovaquone as an alternative and compared it with TMP-SMX regarding toxicity and efficacy during the first 100 days after transplantation in 155 consecutive adult stem cell recipients. Eight patients with a prior history of TMP-SMX intolerance received atovaquone as first-line prophylaxis. TMP-SMX was used for 141 patients as first-line strategy, but 13 patients (9.2%) were later switched to atovaquone due to TMP-SMX toxicity or gastrointestinal symptoms. No active toxoplasmosis or active P. jirovecii infection developed under continued prophylaxis with either TMP-SMX or atovaquone. However, for reasons of TMP-SMX and/or atovaquone toxicity, 7 patients were unable to tolerate any efficacious toxoplasmosis prophylaxis and therefore obtained inhalative pentamidine as P. jirovecii prophylaxis but no toxoplasmosis prophylaxis. Importantly, 2 of these patients developed severe toxoplasmosis. In summary, atovaquone appears as a valid alternative for at least some post-transplant patients who cannot tolerate TMP-SMX. This should be further confirmed by multicenter trials.

  6. Antibiotic prophylaxis for infective endocarditis: ethical care in the era of revised guidelines.

    PubMed

    Bach, David S

    Beginning in 1955, the American Heart Association recommended antibiotic prophylaxis among patients with certain structural heart diseases to decrease the likelihood of infective endocarditis (IE) following dental procedures. Over the ensuing 52 years, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines were revised to address gastrointestinal and genitourinary procedures and to modify the assessment of relative risks and specific regimens for prophylaxis. Throughout the various revisions, prophylaxis was recommended for individuals who were at increased risk of developing IE based on best evidence and consensus opinion, albeit in the absence of randomized controlled trials. In 2007, the AHA published a revised guideline statement dramatically restricting its recommendations for antibiotic prophylaxis against IE. In 2008, these views were incorporated in an ACC/AHA guideline update on the management of patients with heart valve disease. The revisions represent a dramatic shift in terms of the patients for whom antibiotic prophylaxis is recommended and the procedures for which it is recommended. What is striking about the new guidelines is that the change in recommendations was based not on new data, but on a change in philosophy despite the lack of new data. To some degree, the arguments for and against antibiotic prophylaxis become those of philosophy, ethics, and the role of evidence-based medicine. This manuscript attempts to briefly examine those arguments and discuss why the revised guidelines may fail to respect the ethical principles of beneficence and patient autonomy.

  7. Comparison of Chemical and Mechanical Prophylaxis of Venous Thromboembolism in Nonsurgical Mechanically Ventilated Patients

    PubMed Central

    Gaspard, Dany; Vito, Karen; Schorr, Christa; Hunter, Krystal; Gerber, David

    2015-01-01

    Background. Thromboembolic events are major causes of morbidity, and prevention is important. We aimed to compare chemical prophylaxis (CP) and mechanical prophylaxis (MP) as methods of prevention in nonsurgical patients on mechanical ventilation. Methods. We performed a retrospective study of adult patients admitted to the Cooper University Hospital ICU between 2002 and 2010. Patients on one modality of prophylaxis throughout their stay were included. The CP group comprised 329 patients and the MP group 419 patients. The primary outcome was incidence of thromboembolic events. Results. Acuity measured by APACHE II score was comparable between the two groups (p = 0.215). Univariate analysis showed 1 DVT/no PEs in the CP group and 12 DVTs/1 PE in the MP group (p = 0.005). Overall mortality was 34.3% and 50.6%, respectively. ICU LOS was similar. Hospital LOS was shorter in the MP group. Multivariate analysis showed a significantly higher incidence of events in the MP prophylaxis group (odds ratio 9.9). After excluding patients admitted for bleeding in both groups, repeat analysis showed again increased events in the MP group (odds ratio 2.9) but this result did not reach statistical significance. Conclusion. Chemical methods for DVT/PE prophylaxis seem superior to mechanical prophylaxis in nonsurgical patients on mechanical ventilation and should be used when possible. PMID:26682067

  8. Bacteriological studies of blood, tissue fluid, lymph and lymph nodes in patients with acute dermatolymphangioadenitis (DLA) in course of 'filarial' lymphedema.

    PubMed

    Olszewski, W L; Jamal, S; Manokaran, G; Pani, S; Kumaraswami, V; Kubicka, U; Lukomska, B; Tripathi, F M; Swoboda, E; Meisel-Mikolajczyk, F; Stelmach, E; Zaleska, M

    1999-10-15

    Filarial lymphedema is complicated by frequent episodes of dermatolymphangioadenitis (DLA). Severe systemic symptoms during attacks of DLA resemble those of septicemia. The question we asked was whether bacterial isolates can be found in the peripheral blood of patients during the episodes of DLA. Out of 100 patients referred to us with 'filarial' lymphedema 14 displayed acute and five subacute symptoms of DLA. All were on admission blood microfilariae negative but had a positive test in the past. Blood bacterial isolates were found in nine cases, four acute (21%) and five subacute (26%). In 10 acute cases blood cultures were found negative. Six blood isolates belonged to Bacilli, four to Cocci and one was Sarcina. To identify the sites of origin of bacterial dissemination, swabs taken from the calf skin biopsy wounds and tissue fluid, lymph and lymph node specimens were cultured. Swabs from the calf skin biopsy wound contained isolates in nine (47%) cases. They were Bacilli in nine, Cocci in three, Acinetobacter and Erwinia in two cases. Tissue fluid was collected from 10 patients and contained Bacilli in four (40%) and Staphylococci in three (30%). Lymph was drained in four patients and contained isolates in all samples (100%). They were Staphylococcus epidermis, xylosus and aureus, Acinetobacter, Bacillus subtilis and Sarcina. Three lymph nodes were biopsied and contained Staphylococcus chromogenes, xylosus, Enterococcus and Bacillus cereus. In six cases the same phenotypically defined species of bacteria were found in blood and limb tissues or fluids. In the 'control' group of patients with lymphedema without acute or subacute changes all blood cultures were negative. Interestingly, swabs from biopsy wound of these patients contained isolates in 80%, tissue fluid in 68%, lymph in 70% and lymph nodes in 58% of cases. In healthy controls, tissue fluid did not contain bacteria, and lymph isolates were found only in 12% of cases. This study demonstrates that

  9. Ciprofloxacin criteria in antimicrobial prophylaxis and bladder cancer recurrence.

    PubMed

    Gurtowska, Natalia; Kloskowski, Tomasz; Drewa, Tomasz

    2010-10-01

    Oral ciprofloxacin might achieve higher concentration in urine than in serum; theoretically, this drug might act as an anticancer drug against bladder cancer cells. Among fluoroquinolones, ciprofloxacin is distinguished by strong inhibition of topoisomerase II. A good correlation between cytotoxic activity of ciprofloxacin toward eukaryotic cells and its ability to induce the cleavable complexes topoisomerase II-DNA has been demonstrated. These data provide a basis for supposing that ciprofloxacin may act as anticancer drug. The efforts of evaluating ciprofloxacin's influence on human bladder cell lines have been shown by many authors. The cells were exposed to ciprofloxacin at various concentrations that are attainable in the urine after oral drug administration. Antiproliferative potential of the ciprofloxacin against human bladder cells varies according to drug concentration and time of incubation. It seems that ciprofloxacin can act as an anticancer drug in eukaryotic cells. Low urine pH can enhance the antitumor effect of ciprofloxacin. Ciprofloxacin enhances the effect of action of doxorubicin and epirubicin, which are used to prevent bladder cancer recurrence after transurethral resection of superficial bladder cancer. We think that ciprofloxacin might be used for antibacterial prophylaxis and as an anticancer agent in patients with superficial bladder cancer. This idea must be checked in future placebo controlled trials.

  10. Effectiveness of hepatitis A vaccination as post-exposure prophylaxis.

    PubMed

    Parrón, Ignasi; Planas, Caritat; Godoy, Pere; Manzanares-Laya, Sandra; Martínez, Ana; Sala, Maria Rosa; Minguell, Sofia; Torner, Nuria; Jané, Mireia; Domínguez, Angela

    2017-02-01

    Hepatitis A (HA) has been a vaccine-preventable disease since 1995. In Catalonia, a universal combined hepatitis A+B vaccination program of preadolescents was initiated at the end of 1998. However, outbreaks are reported each year and post-exposure prophylaxis (PEP) with hepatitis A virus (HAV) vaccine or immunoglobulin (IG) is recommended to avoid cases. The aim of this study was to assess the effectiveness of HAV vaccine and IG in preventing hepatitis A cases in susceptible exposed people. A retrospective cohort study of contacts of HA cases involved in outbreaks reported in Catalonia between January 2006 and December 2012 was made. The rate ratios and 95% confidence intervals (CI) of HA in susceptible contacts receiving HAV or IG versus those without PEP were calculated. There were 3550 exposed persons in the outbreaks studied: 2381 received one dose of HAV vaccine (Hepatitis A or hepatitis A+B), 190 received IG, and 611 received no PEP. 368 exposed subjects received one dose of HAV vaccine and IG simultaneously and were excluded from the study. The effectiveness of PEP was 97.6% (95% CI 96.2-98.6) for HAV vaccine and 98.3% (95% CI 91.3-99.9) for IG; the differences were not statistically significant (p = 0.36). The elevated effectiveness of HAV vaccination for PEP in HA outbreaks, similar to that of IG, and the long-term protection of active immunization, supports the preferential use of vaccination to avoid secondary cases.

  11. Acetazolamide in vestibular migraine prophylaxis: a retrospective study.

    PubMed

    Çelebisoy, Neşe; Gökçay, Figen; Karahan, Ceyda; Bilgen, Cem; Kirazlı, Tayfun; Karapolat, Hale; Köse, Timur

    2016-10-01

    The aim of this study is to check the efficacy of acetazolamide in the prophylaxis of vestibular migraine (VM). Treatment options in VM are mainly based on migraine guidelines. We tried to assess the efficacy of acetazolamide in these patients depending on clinical similarities with episodic ataxia type 2 and familial hemiplegic migraine responding to the drug. This is a retrospective cohort study. Among 50 patients with VM and prescribed acetazolamide 500 mg/day, 39 patients were studied as five had been lost on follow-up and six had stopped taking the drug due to side effects. Vertigo and headache frequency determined by number of attacks per month, and the severity determined by visual analog scales measured in centimeters from 0 to 10 were collected from the records. Initial reported figures for frequency and severity were compared with the results gathered after 3 months of treatment. The results were compared. Acetazolamide was effective in reducing both the frequency and severity of vertigo and headache attacks and this effect was more prominent for vertigo frequency and severity.

  12. [Abdominal cavity adhesions. Some issues of pathogenesis, prophylaxis and treatment].

    PubMed

    Tishchenko, V V

    2010-07-01

    The abdominal cavity adhesions (ACA) constitute frequent consequence of various abdominal cavity diseases and traumas and frequent cause of the abdominal adhesive disease and its complications. In spite of the known pathogenesis of ACA, the surgeons had failed throughout the decades of years to find out the measures and methods of its prophylaxis. There are several causes of such a situation and the main of them is that ACA in its origin constitutes a philogenetically developed defense biologic reaction of organism. Because of the fact, that an organism constitutes the self-regulated biological system, any external inputs (including the treatment), directed on qualitative or quantitative signs of these reactions, meet systemic counteraction and become annihilated. The forced overcome of such a counteraction may cause the development of severe systemic disorders in organism. The only prophylactic measures against ACA, which were already tested throughout the time, are the tactical and technical methods, promoting the reduction of severity of morphological changes in peritoneum and abdominal organs, thus causing reduction of natural reaction of organism. When the adhesions formation is inevitable it is necessary to apply surgical methods of governing such a process, and omentoparietopexy may constitutes one of such methods.

  13. Short-term antibiotic prophylaxis of mixed infections during hysterectomy.

    PubMed

    Moroni, M; Baccolo, M; Cavalli, G; Belloni, C; Ferrari, N; Sartor, V

    1979-01-01

    Surgical procedures on contaminated tissues, such as hysterectomy with opened vagina, are frequently followed by local or systemic infections. It seems that a prolonged antibiotic prophylaxis is not justified because of possible induction of resistant mutants or dysmicrobisms. The administration of antibiotics only in a short pre- and postsurgical period appears to be more rational. We have carried out a controlled clinical trial with the aim of evaluating the efficacy of this prophylactic practice. One hundred forty-five patients submitted to vaginal and two hundred seventy-five to abdominal hysterectomy entered this study (started September 1977). All patients received local nitrofurantoin treatment and were then subdivided into four randomized groups: control group, groups treated with thiamphenicol, cephazolin, thiamphenicol plus cephazolin, respectively. Each antibiotic was administered in the dose of 1 gm one hour before and five and 12 hours after surgery. Antibiotics were chosen taking into consideration the usual vaginal microbial flora, notoriously mixed (aerobic and anaerobic). The three treated groups presented a significant decrease in the incidence and severity of infectious complications. The use of antibiotics in the postoperative period resulted in significantly reduced morbidity in the treated groups. Thiamphenicol appears to be the most effective drug. Bacteriological studies showed that local treatment of the vagina decreased the bacteria charge, but never brought about sterilization.

  14. Respiratory syncytial virus prophylaxis--the story so far.

    PubMed

    Simoes, E A F; Groothuis, J R

    2002-04-01

    Respiratory syncytial virus (RSV) is a common and highly contagious pathogen that infects nearly all children by the age of 2 years. It is responsible for significant morbidity and mortality worldwide among certain high-risk paediatric populations. Therapy is sub-optimal for RSV, thus treatment focuses on ameliorating symptoms. Since discovery of the virus in the 1950s, efforts have been ongoing to develop a safe and effective vaccine. These efforts have met with serious obstacles. Passive immunoprophylaxis presents a viable alternative to active immunization. In 1998, the genetically engineered humanized monoclonal antibody (palivizumab) was granted FDA (Food and Drug Administration) approval for prophylaxis of high-risk children in the United States; EMEA (European Agency for the Evaluation of Medicinal Products) approval followed in 1999 for Europe. It is now approved in over 45 countries worldwide. Palivizumab was shown to significantly reduce RSV-related hospitalizations in North America and Europe with few adverse effects. Clinical trial and outcomes data documenting experience with palivizumab to date continue to extend the initial safety and efficacy observations.

  15. Use of quinocide in treatment and prophylaxis of vivax malaria

    PubMed Central

    Lysenko, A. Y.

    1960-01-01

    The discovery of antimalarial properties of derivatives of 8-aminoquinolines which combine high activity against the tissue stages of the malaria parasite with satisfactory tolerance by man can be said to have marked the final stage in the search for a radical cure of vivax malaria. Since its synthesis in the USSR in 1952, quinocide—an 8-aminoquinoline drug—has been subjected by Soviet workers to intensive research, an outline of which is presented in this paper. The results of their investigations, which ranged from laboratory and clinical studies of tolerance to the drug, through small-scale trials of its parasiticidal activity, to large-scale studies on the effectiveness of its mass administration are very encouraging. Both for anti-relapse treatment and for pre-epidemic prophylaxis, a short (10- or 14-day) course of quinocide proved as effective as a lengthy course of acriquine with plasmocide. Side-effects were infrequent, and most of those that occurred were transient and did not necessitate the suspension of treatment. It is suggested that the mass administration of quinocide would, in certain cases, be a useful adjunct to insecticidal measures in the clearance of malaria foci. PMID:14419205

  16. Aerosinusitis: pathophysiology, prophylaxis, and management in passengers and aircrew.

    PubMed

    Weitzel, Erik K; McMains, K Christopher; Rajapaksa, Suresh; Wormald, Peter-John

    2008-01-01

    Patients presenting before flight with an upper respiratory infection are at risk for aerosinusitis. Prophylaxis of this condition consists of an oral decongestant before flight and nasal decongestant spray during the flight just prior to descent. Evaluation of the patient presenting with aerosinusitis consists of a careful physical exam with emphasis on diagnosing treatable nasal and sinus pathology. Categorization of the patient into the Weissman classification is important for determining prognostic factors for recovery. Management of this condition is based on the Weissman stage. Stage I or II lesions are generally treated conservatively with a 1-wk course of topical sprays, analgesics, a tapering course of steroids, and oral decongestants. Use of antibiotics is reserved for those cases initiated by bacterial sinusitis. Additionally, antihistamines are reserved for cases where allergies were the inciting cause. Stage III lesions are rarely seen in civilian air travelers due to the relatively low fluctuations in ambient air pressure. Aircrew that suffer Stage III aerosinusitis are at risk for recurrent sinus barotrauma that may require an expertly performed functional endoscopic sinus surgery to successfully manage it.

  17. Defining the HIV pre-exposure prophylaxis care continuum

    PubMed Central

    Nunn, Amy S.; Brinkley-Rubinstein, Lauren; Oldenburg, Catherine E.; Mayer, Kenneth H.; Mimiaga, Matthew; Patel, Rupa; Chan, Philip A.

    2017-01-01

    Pre-exposure prophylaxis (PrEP) is an effective HIV prevention strategy. There is little scientific consensus about how to measure PrEP program implementation progress. We draw on several years of experience in implementing PrEP programs and propose a PrEP continuum of care that includes: (1) identifying individuals at highest risk for contracting HIV, (2) increasing HIV risk awareness among those individuals, (3) enhancing PrEP awareness, (4) facilitating PrEP access, (5) linking to PrEP care, (6) prescribing PrEP, (7) initiating PrEP, (8) adhering to PrEP, and (9) retaining individuals in PrEP care. We also propose four distinct categories of PrEP retention in care that include being: (1) indicated for PrEP and retained in PrEP care, (2) indicated for PrEP and not retained in PrEP care, (3) no longer indicated for PrEP, and (4) lost to follow-up for PrEP care. This continuum of PrEP care creates a framework that researchers and practitioners can use to measure PrEP awareness, uptake, adherence, and retention. Understanding each point along the proposed continuum of PrEP care is critical for developing effective PrEP interventions and for measuring public health progress in PrEP program implementation. PMID:28060019

  18. Host-based Prophylaxis Successfully Targets Liver Stage Malaria Parasites

    PubMed Central

    Douglass, Alyse N; Kain, Heather S; Abdullahi, Marian; Arang, Nadia; Austin, Laura S; Mikolajczak, Sebastian A; Billman, Zachary P; Hume, Jen C C; Murphy, Sean C; Kappe, Stefan H I; Kaushansky, Alexis

    2015-01-01

    Eliminating malaria parasites during the asymptomatic but obligate liver stages (LSs) of infection would stop disease and subsequent transmission. Unfortunately, only a single licensed drug that targets all LSs, Primaquine, is available. Targeting host proteins might significantly expand the repertoire of prophylactic drugs against malaria. Here, we demonstrate that both Bcl-2 inhibitors and P53 agonists dramatically reduce LS burden in a mouse malaria model in vitro and in vivo by altering the activity of key hepatocyte factors on which the parasite relies. Bcl-2 inhibitors act primarily by inducing apoptosis in infected hepatocytes, whereas P53 agonists eliminate parasites in an apoptosis-independent fashion. In combination, Bcl-2 inhibitors and P53 agonists act synergistically to delay, and in some cases completely prevent, the onset of blood stage disease. Both families of drugs are highly effective at doses that do not cause substantial hepatocyte cell death in vitro or liver damage in vivo. P53 agonists and Bcl-2 inhibitors were also effective when administered to humanized mice infected with Plasmodium falciparum. Our data demonstrate that host-based prophylaxis could be developed into an effective intervention strategy that eliminates LS parasites before the onset of clinical disease and thus opens a new avenue to prevent malaria. PMID:25648263

  19. Nonoccupational Postexposure Human Immunodeficiency Virus Prophylaxis: Acceptance Following Sexual Assault

    PubMed Central

    Draughon, Jessica E.; Hauda, William E.; Price, Bonnie; Sheridan, Daniel J.

    2015-01-01

    Background Nonoccupational postexposure prophylaxis (nPEP) for HIV following sexual assault may decrease the likelihood of HIV transmission. Objective The purpose of this exploratory chart review study was to examine factors associated with patients accepting postsexual assault nPEP at three forensic nurse examiner programs in urban settings. Methods Forensic nursing charts of patients presenting for acute, sexual assault care were reviewed as part of a mixed-methods study. Results Patients assaulted by more than one or an unknown number of assailants were over 12 times more likely to accept the offer of nPEP (aOR 12.66; 95%CI [2.77, 57.82]). In cases where no condom was used (aOR = 8.57; 95%CI [1.59, 46.10]), or when any injury to the anus or genitalia was noted (aOR = 4.10; 95%CI [1.57, 10.75]), patients were more likely to accept nPEP. Patients with any injury to the face or head were less likely to initiate nPEP (aOR = 0.32; 95%CI [0.11, 0.97]). Discussion This study is an important first step in understanding factors associated with nPEP acceptance after sexual assault. PMID:26657480

  20. Animal Bites and Rabies Prophylaxis in Rural Children: Indian Perspective

    PubMed Central

    Mondal, Rakesh; Shah, Ankit; Hazra, Avijit; Ray, Somosri; Dhar, Goutam; Biswas, Rupa; Sabui, Tapas Kumar; Raychaudhuri, Dibyendu; Chatterjee, Kaushani; Kundu, Chanchal; Sarkar, Sumantra

    2016-01-01

    A prospective observational study was conducted in a tertiary care hospital to study clinicoepidemiological profile of potentially rabid animal bite cases from rural India. Total of 308 children (median age 6 years) admitted to hospital, were recruited over 1 year and followed up till completion of antirabies vaccine course. Dog was the commonest (77.27%) offending animal. Of the exposures, 66.88% were scratches, 88.96% were unprovoked and 27.27% were categorized as Class III. The median times to wound toileting and reporting to health facility were 1 and 6 h, respectively. Majority received prompt PEP in hospital, and RIG was administered in 34.55% of Class II and 90.48% of Class III exposures. Compared with their older counterparts, children aged <5 years suffered more bites on face and trunk and more Class III exposures. The rabies prophylaxis scenario is encouraging, when compared with earlier studies, but there are gaps to be addressed. PMID:26510700

  1. Goitre studies in Tasmania. 16 Years' prophylaxis with iodide.

    PubMed

    Clements, F W; Gibson, H B; Howeler-Coy, J F

    1968-01-01

    The results of 16 years' prophylaxis against endemic goiter among children in Tasmania are given. A survey carried out in 1949 showed a relatively high prevalence of endemic goiter among children in most parts of the island, and in 1950, distribution of tablets containing 10 mg of potassium iodide to all school children was commenced. This distribution was gradually stopped during 1966 as legislation made it possible to add potassium iodate to all bread baked on the island. Periodic surveys showed that the prevalence of endemic goiter has fallen significantly but has not vanished entirely. Seasonal fluctuations in the prevalence found in some regions of the island decreased at the same time. Histopathological studies on goitrous tissue and iodine estimations on body fluids confirmed that the goiter in Tasmania is typical of endemic goiter, which is usually attributed to iodine deficiency. The effect of the treatment of established goiters in adolescent girls with thyroxine is described, as are results of the studies of the ability to taste phenylthiocarbamide, a property which may be genetically linked to a predisposition to goiter. (author's) (summary in ENG).

  2. Individualized prophylaxis for optimizing hemophilia care: can we apply this to both developed and developing nations?

    PubMed

    Poon, Man-Chiu; Lee, Adrienne

    2016-01-01

    Prophylaxis is considered optimal care for hemophilia patients to prevent bleeding and to preserve joint function thereby improving quality of life (QoL). The evidence for prophylaxis is irrefutable and is the standard of care in developed nations. Prophylaxis can be further individualized to improve outcomes and cost effectiveness. Individualization is best accomplished taking into account the bleeding phenotype, physical activity/lifestyle, joint status, and pharmacokinetic handling of specific clotting factor concentrates, all of which vary among individuals. Patient acceptance should also be considered. Assessment tools (e.g. joint status imaging and function studies/scores, QoL) for determining and monitoring risk factors and outcome, as well as population PK profiling have been developed to assist the individualization process. The determinants of optimal prophylaxis include (1) factor dose/dosing frequency, hence, cost/affordability (2) bleeding triggers (physical activity/lifestyle, chronic arthropathy and synovitis) and (3) bleeding rates. Altering one determinant results in adjustment of the other two. Thus, the trough level to protect from spontaneous bleeding can be increased in patients who have greater bleeding risks; and prophylaxis to achieve zero joint bleeds is achievable through optimal individualization. Prophylaxis in economically constrained nations is limited by the ill-affordability of clotting factor concentrates. However, at least 5 studies on children and adults from Thailand, China and India have shown superiority of low dose (~5-10 IU kg(-1) 2-3× per week) prophylaxis over episodic treatment in terms of bleed reduction, and quality of life, with improved physical activity, independent functioning, school attendance and community participation. In these nations, the prophylaxis goals should be for improved QoL rather than "zero bleeds" and perfect joints. Prophylaxis can still be individualized to affordability. Higher protective

  3. Rhabdomyolysis Following Initiation of Posaconazole Use for Antifungal Prophylaxis in a Patient With Relapsed Acute Myeloid Leukemia: A Case Report.

    PubMed

    Mody, Mayur D; Ravindranathan, Deepak; Gill, Harpaul S; Kota, Vamsi K

    2017-01-01

    Posaconazole is a commonly used medication for antifungal prophylaxis in patients with high-risk acute leukemia, such as acute myeloid leukemia. Despite clinical data that show that posaconazole is superior to other antifungal prophylaxis medications, posaconazole is known to have many side effects and drug-drug interactions. We present a patient who developed rhabdomyolysis after being started on posaconazole for prophylaxis in the setting of relapsed acute myeloid leukemia.

  4. Rhabdomyolysis Following Initiation of Posaconazole Use for Antifungal Prophylaxis in a Patient With Relapsed Acute Myeloid Leukemia

    PubMed Central

    Mody, Mayur D.; Ravindranathan, Deepak; Gill, Harpaul S.; Kota, Vamsi K.

    2017-01-01

    Posaconazole is a commonly used medication for antifungal prophylaxis in patients with high-risk acute leukemia, such as acute myeloid leukemia. Despite clinical data that show that posaconazole is superior to other antifungal prophylaxis medications, posaconazole is known to have many side effects and drug-drug interactions. We present a patient who developed rhabdomyolysis after being started on posaconazole for prophylaxis in the setting of relapsed acute myeloid leukemia. PMID:28203579

  5. The Johns Hopkins Venous Thromboembolism Collaborative: Multidisciplinary team approach to achieve perfect prophylaxis.

    PubMed

    Streiff, Michael B; Lau, Brandyn D; Hobson, Deborah B; Kraus, Peggy S; Shermock, Kenneth M; Shaffer, Dauryne L; Popoola, Victor O; Aboagye, Jonathan K; Farrow, Norma A; Horn, Paula J; Shihab, Hasan M; Pronovost, Peter J; Haut, Elliott R

    2016-12-01

    Venous thromboembolism (VTE) is an important cause of preventable harm in hospitalized patients. The critical steps in delivery of optimal VTE prevention care include (1) assessment of VTE and bleeding risk for each patient, (2) prescription of risk-appropriate VTE prophylaxis, (3) administration of risk-appropriate VTE prophylaxis in a patient-centered manner, and (4) continuously monitoring outcomes to identify new opportunities for learning and performance improvement. To ensure that every hospitalized patient receives VTE prophylaxis consistent with their individual risk level and personal care preferences, we organized a multidisciplinary task force, the Johns Hopkins VTE Collaborative. To achieve the goal of perfect prophylaxis for every patient, we developed evidence-based, specialty-specific computerized clinical decision support VTE prophylaxis order sets that assist providers in ordering risk-appropriate VTE prevention. We developed novel strategies to improve provider VTE prevention ordering practices including face-to-face performance reviews, pay for performance, and provider VTE scorecards. When we discovered that prescription of risk-appropriate VTE prophylaxis does not ensure its administration, our multidisciplinary research team conducted in-depth surveys of patients, nurses, and physicians to design a multidisciplinary patient-centered educational intervention to eliminate missed doses of pharmacologic VTE prophylaxis that has been funded by the Patient Centered Outcomes Research Institute. We expect that the studies currently underway will bring us closer to the goal of perfect VTE prevention care for every patient. Our learning journey to eliminate harm from VTE can be applied to other types of harm. Journal of Hospital Medicine 2016;11:S8-S14. © 2016 Society of Hospital Medicine.

  6. Prophylaxis and antibiotic therapy in management protocols of patients treated with oral and intravenous bisphosphonates

    PubMed Central

    Bermúdez-Bejarano, Elena-Beatriz; Serrera-Figallo, María-Ángeles; Gutiérrez-Corrales, Aida; Romero-Ruiz, Manuel-María; Castillo-de-Oyagüe, Raquel; Gutiérrez-Pérez, José-Luis

    2017-01-01

    Introduction Osteonecrosis of the jaw (MRONJ) linked to bisphosphonate treatment has specific characteristics that render its therapeutic management challenging for clinicians. Poor response to standard treatment makes it essential to take special precautions when treating this type of disease; therefore, antibiotic prophylaxis and/or antibiotic therapy have been proposed as effective and helpful tools in these situations. Objectives This article seeks to assess published evidence in order to evaluate the different protocols used for antibiotic prophylaxis and/or antibiotic therapy in the general context of patients treated with bisphosphonates. Material and Methods A literature review of the last 10 years was carried out in PubMed using the following keywords: “antibiotic prophylaxis and osteonecrosis,” “bisphosphonates AND osteonecrosis AND dental management,” “bisphosphonate AND osteonecrosis AND antibiotic prophylaxis AND oral surgery.” A total of 188 articles were obtained, of which 18 were ultimately selected. Results and Discussion In patients treated with oral and intravenous bisphosphonates without chemotherapy-associated osteonecrosis of the jaw, antibiotic prophylaxis prior to oral surgery is an important tool to avoid osteonecrosis and promote healing of the affected area. If the patient previously exhibited chemotherapy-associated osteonecrosis after tooth extraction, antibiotic prophylaxis is indicated to prevent recurrent osteonecrosis and promote healing of the extraction site. If chemotherapy-associated osteonecrosis is already present, antibiotic therapy is a vital part of conservative management to reduce the symptomatology of MRONJ and keep it from worsening. Finally, a lack of clinical data and randomized controlled trials makes it difficult to choose the most appropriate protocol for the various clinical situations studied. Key words:Bisphosphonates, antibiotic prophylaxis, maxillary osteonecrosis, antibiotic treatment. PMID

  7. No evidence of benefit from class-II compression stockings in the prevention of lower-limb lymphedema after inguinal lymph node dissection: results of a randomized controlled trial.

    PubMed

    Stuiver, M M; de Rooij, J D; Lucas, C; Nieweg, O E; Horenblas, S; van Geel, A N; van Beurden, M; Aaronson, N K

    2013-09-01

    Graduated compression stockings have been advocated for prevention of lymphedema after inguinal lymph node dissection (ILND) although scientific evidence of their efficacy in preventing lymphedema is lacking. The primary objective of this study was to assess the efficacy of class II compression stockings for the prevention of lymphedema in cancer patients following ILND. Secondary objectives were to investigate the influence of stockings on the occurrence of wound complications and genital edema, health-related quality of life (HRQoL) and body image. Eighty patients (45 with melanoma, 35 with urogenital tumors) who underwent ILND at two specialized cancer centers were randomly allocated to class II compression stocking use for six months or to a usual care control group. Lymphedema of the leg and genital area, wound complications, HRQoL, and body image were assessed at regular intervals prior to and up to 12 months after ILND. No significant differences were observed between groups in the incidence of edema, median time to the occurrence of edema, incidence of genital edema, frequency of complications, HRQoL, or body image. Based on the results of the current study, routine prescription of class II graduated compression stockings after ILND should be questioned and alternative prevention strategies should be considered.

  8. Palivizumab prophylaxis of respiratory syncytial virus disease in 2000-2001: results from The Palivizumab Outcomes Registry.

    PubMed

    Parnes, Curt; Guillermin, Judith; Habersang, Rolf; Nicholes, Peggy; Chawla, Vijay; Kelly, Tammy; Fishbein, Judith; McRae, Patty; Goessler, Mary; Gatti, Antoinette; Calcagno, John A; Eki, Cheryl; Harris, Kristen A; Joyave, Joseph; McFarland, Kathy; Protter, Paul; Sullivan, Mary; Stanford, Allan; Lovett, Nancy; Ortiz, Marisol; Rojas, Sharon; Cyrus, Scott; Cyrus, Janell; Cohen, Stuart; Buchin, Debbie; Riordan, Linda; Zuniga, Monica; Shah, Rupa; Minard, Carmen; Quintin, Arden; Douglas, Glenda; van Houten, John; Freutner, Sharyn; Chartrand, Stephen; Nowatzke, Patsy; Romero, Jose; Rhodes, Torunn; Benoit, Michelle; Walter, Emmanuel; Walker, Leslie; DeBonnett, Laurie; Cross, Mia; Free, Teresa; Martin, Sharman; Shank, Karen; Guedes, Ben; Atkinson, Lee Ann; Halpin, George J; Rouse, Kathy; Hand, Ivan; Geiss, Donna; Marshall, James R; Burleson, Lois; Boland, Jim; Seybold, Kelsey; Hunter, Vicki; Unfer, Susan; Schmucker, Jackie; Gley, Margaret; Marcus, Michael; Thompson, Patricia; Milla, Paulino; Young, Connie; Zanni, Robert; Zinno, Virginia; Fetter-Zarzeka, Alexandra; Busey, Amanda; Sokunbi, Modupe A; Airington, Sherrie; Richard, Nancy; Muraligopal, Vellore; Lewis, Stephanie; Weber, F Thomas; Giordano, Beverly P; Linehan, Denise; Roach, Jane; Davis, Randle; Rzepka, Andrew A; Booth, Teri; Smeltzer, David; Walsh, Jeanne; Arispe, Emilio; Rowley, Rhonda; Bolling, Christopher; Botts, Tanya; Haskett, Kateri; Raby, Deana; Batiz, Evelyn; Gelfand, Andrew; Farrell, Lynn; Butler, Stephen; Colby, Linda; Schochet, Peter; Bentler, Julie; Hirsch, David; Wilkinson, Lisa; Aaronson, Allen; Bennett, Eleanora; Wingate, Julie; Quinn, Dawn; Komendowski, Katherine; Deckard, Marcia; Frogel, Michael; Nerwen, Cliff; Copenhaver, Steven; Prater, Michele; Wolsztein, Jacob; Mackey, Kristine; Benbow, Marshall; Naranjo, Marisela; Hensley, Sandra; Hayes, Cindy; Sadeghi, Hossein; Lawson, Sally May; McCall, Mark; Combs, Karla; Ledbetter, Joel; Sarnosky, Karen; Swafford, Cathy; Speer, Michael; Barton, Wendy J; Mink, J W; Lemm, Dianne; Hudak, Mark; Case, Elizabeth; Rowen, Judith; Fuentes, Sandra; Pane, Carly; Richardson, Leslie; Chavarria, Cesar; Cassino, Deanne; Ghaffari, Kourosh; Carroll, Carol; Lee, Haesoon; Guclu, Lydia; Johnson, Christopher; Blum, Valerie; Boron, Marnie L; Sorrentino, Mark; Hirsch, Robert L; Van Veldhuisen, Paul C; Smith, Carol

    2003-06-01

    The objective of the Registry was to characterize the population of infants receiving prophylaxis for respiratory syncytial virus (RSV) disease by describing the patterns and scope of usage of palivizumab in a cross section of US infants. RSV hospitalization outcomes were also described. The Palivizumab (Synagis, MedImmune, Inc., 25 West Watkins Mill Road, Gaithersburg, MD 20878) Outcomes Registry was a prospective multicenter survey conducted at 63 sites. Demographics, injection history, and RSV hospitalization outcomes were collected on 2,116 infants receiving palivizumab. Infants were enrolled in the Registry between September 1, 2000-March 1, 2001, at the time of their first injection. Infants born at less than 32 weeks of gestation accounted for 47% of infants enrolled, and those between 32-35 weeks accounted for 45%; approximately 8% were greater than 35 weeks of gestation. Lower RSV hospitalization rates were observed in infants who had greater adherence to regularly scheduled injections. Nearly one-half of all hospitalizations occurred within the first and second injection intervals, suggesting the importance of early RSV protection. The confirmed RSV hospitalization rate of all infants in the Registry was 2.9%; the rate was 5.8% in infants with chronic lung disease of infancy, and 2.1% in premature infants without chronic lung disease. In conclusion, these data support the continued effectiveness of palivizumab prophylaxis for severe RSV lower respiratory tract disease in a large cohort of high-risk infants from geographically diverse pediatric offices and clinics. The Palivizumab Outcomes Registry provides an opportunity to assess palivizumab utilization and clinical effectiveness in the US.

  9. Measurement Issues in Anthropometric Measures of Limb Volume Change in Persons at Risk for and Living with Lymphedema: A Reliability Study.

    PubMed

    Tidhar, Dorit; Armer, Jane M; Deutscher, Daniel; Shyu, Chi-Ren; Azuri, Josef; Madsen, Richard

    2015-09-30

    Understanding whether a true change has occurred during the process of care is of utmost importance in lymphedema management secondary to cancer treatments. Decisions about when to order a garment, start an exercise program, and begin or end therapy are based primarily on measurements of limb volume, based on circumferences taken by physiotherapists using a flexible tape. This study aimed to assess intra-rater and inter-rater reliability of measurements taken by physiotherapists of legs and arms with and without lymphedema and to evaluate whether there is a difference in reliability when measuring a healthy versus a lymphedematous limb. The intra-rater reliability of arm and leg measurements by trained physiotherapist is very high (scaled standard error of measurements (SEMs) for an arm and a leg volume were 0.82% and 0.64%, respectively) and a cut-point of 1% scaled SEM may be recommended as a threshold for acceptable reliability. Physiotherapists can rely on the same error when assessing lymphedematous or healthy limbs. For those who work in teams and share patients, practice is needed in synchronizing the measurements and regularly monitoring their inter-rater reliability.

  10. The latissimus dorsi-groin-lymph node compound flap: A comprehensive technique with three features including skin coverage, restoration of motor function, and prevention of upper limb lymphedema.

    PubMed

    Nicoli, Fabio; Orfaniotis, Georgios; Lazzeri, Davide; Lim, Seong Yoon; Kiranantawat, Kidakorn; Chen, Pei-Yu; Ciudad, Pedro; Chilgar, Ram M; Sapountzis, Stamatis; Sacak, Bulent; Chen, Hung-Chi

    2016-11-01

    Reconstruction of complex upper extremity defects requires a need for multiple tissue components. The supercharged latissimus dorsi (LD)-groin compound flap is an option that can provide a large skin paddle with simultaneous functional muscle transfer. It is necessary to supercharge the flap with the superficial circumflex iliac pedicle to ensure the viability of its groin extension. In this report, we present a case of a supercharged LD-groin flap in combination with vascularized inguinal lymph nodes, which was used for upper limb reconstruction in a young male patient, following excision of high-grade liposarcoma. Resection resulted in a 28 cm × 15 cm skin defect extending from the upper arm to the proximal forearm, also involving the triceps muscle, a segment of the ulnar nerve and the axillary lymph nodes. Restoration of triceps function was achieved with transfer of the innervated LD muscle. Part of the ulnar nerve was resected and repaired with sural nerve grafts. Post-operatively, the flap survived fully with no partial necrosis, and no complications at both the recipient and donor sites. At 1-year follow up, the patient had a well-healed wound with good elbow extension (against resistance), no tumor recurrence, and no signs of lymphedema. We believe this comprehensive approach may represent a valuable technique, for not only the oncological reconstruction of upper extremity, but also for the prevention of lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:689-694, 2016.

  11. Pre-exposure prophylaxis to prevent HIV infection: current status, future opportunities and challenges.

    PubMed

    Krakower, Douglas S; Mayer, Kenneth H

    2015-02-01

    As the global incidence of HIV exceeds 2 million new infections annually, effective interventions to decrease HIV transmission are needed. Randomized, placebo-controlled studies have demonstrated that daily oral antiretroviral pre-exposure prophylaxis (PrEP) with a fixed-dose combination tablet containing tenofovir disoproxil fumarate and emtricitabine can significantly reduce HIV incidence among diverse at-risk populations. In these studies, the efficacy of PrEP was correlated with levels of adherence. Official guidelines recommend provision of PrEP to people at greatest risk of HIV acquisition, and demonstration projects suggest that high levels of uptake and adherence are possible outside of controlled studies. However, several potential barriers to implementing PrEP remain. These challenges include low awareness and utilization of PrEP by at-risk individuals, uncertainty about adherence in 'real-world' settings, the majority of healthcare providers being untrained in PrEP provision, limited data about potential adverse effects from long-term use of tenofovir-emtricitabine, high costs of PrEP medications, and stigma associated with PrEP use and the behaviors that would warrant PrEP. Innovative pharmacologic chemoprophylactic approaches could provide solutions to some of these challenges. Less-than-daily oral dosing regimens and long-acting injectable medications could reduce pill burdens and facilitate adherence, and local delivery of PrEP medications to genital compartments via gels, rings and films may limit systemic drug exposure and potential toxicities. As the portfolio of chemoprophylactic agents and delivery systems expands to meet the diverse sexual health needs and product preferences of individuals who may benefit from PrEP, it is hoped that antiretroviral chemoprophylaxis could become an acceptable, feasible, and highly effective addition to existing HIV prevention strategies.

  12. Reducing Cost of Rabies Post Exposure Prophylaxis: Experience of a Tertiary Care Hospital in Pakistan

    PubMed Central

    Salahuddin, Naseem; Gohar, M. Aftab; Baig-Ansari, Naila

    2016-01-01

    Background Rabies is a uniformly fatal disease, but preventable by timely and correct use of post exposure prophylaxis (PEP). Unfortunately, many health care facilities in Pakistan do not carry modern life-saving vaccines and rabies immunoglobulin (RIG), assuming them to be prohibitively expensive and unsafe. Consequently, Emergency Department (ED) health care professionals remain untrained in its application and refer patients out to other hospitals. The conventional Essen regimen requires five vials of cell culture vaccine (CCV) per patient, whereas Thai Red Cross intradermal (TRC-id) regimen requires only one vial per patient, and gives equal seroconversion as compared with Essen regimen. Methodology/Principal Findings This study documents the cost savings in using the Thai Red Cross intradermal regimen with cell culture vaccine instead of the customary 5-dose Essen intramuscular regimen for eligible bite victims. All patients presenting to the Indus Hospital ED between July 2013 to June 2014 with animal bites received WHO recommended PEP. WHO Category 2 bites received intradermal vaccine alone, while Category 3 victims received vaccine plus wound infiltration with Equine RIG. Patients were counseled, and subsequent doses of the vaccine administered on days 3, 7 and 28. Throughput of cases, consumption utilization of vaccine and ERIG and the cost per patient were recorded. Conclusions/Significance Government hospitals in Pakistan are generally underfinanced and cannot afford treatment of the enormous burden of dog bite victims. Hence, patients are either not treated at all, or asked to purchase their own vaccine, which most cannot afford, resulting in neglect and high incidence of rabies deaths. TRC-id regimen reduced the cost of vaccine to 1/5th of Essen regimen and is strongly recommended for institutions with large throughput. Training ED staff would save lives through a safe, effective and affordable technique. PMID:26919606

  13. AIDS Vaccines and Preexposure Prophylaxis: Is Synergy Possible?

    PubMed Central

    Excler, Jean-Louis; Rida, Wasima; Priddy, Frances; Gilmour, Jill; McDermott, Adrian B.; Kamali, Anatoli; Anzala, Omu; Mutua, Gaudensia; Sanders, Eduard J.; Koff, Wayne; Berkley, Seth

    2011-01-01

    Abstract While the long-term goal is to develop highly effective AIDS vaccines, first generation vaccines may be only partially effective. Other HIV prevention modalities such as preexposure prophylaxis with antiretrovirals (PrEP) may have limited efficacy as well. The combined administration of vaccine and PrEP (VAXPREP), however, may have a synergistic effect leading to an overall benefit that is greater than the sum of the individual effects. We propose two test-of-concept trial designs for an AIDS vaccine plus oral or topical ARV. In one design, evidence that PrEP reduces the risk of HIV acquisition is assumed to justify offering it to all participants. A two-arm study comparing PrEP alone to VAXPREP is proposed in which 30 to 60 incident infections are observed to assess the additional benefit of vaccination on risk of infection and setpoint viral load. The demonstrated superiority of VAXPREP does not imply vaccine alone is efficacious. Similarly, the lack of superiority does not imply vaccine alone is ineffective, as antagonism could exist between vaccine and PrEP. In the other design, PrEP is assumed not to be in general use. A 2 × 2 factorial design is proposed in which high-risk individuals are randomized to one of four arms: placebo vaccine given with placebo PrEP, placebo vaccine given with PrEP, vaccine given with placebo PrEP, or VAXPREP. Between 60 and 210 infections are required to detect a benefit of vaccination with or without PrEP on risk of HIV acquisition or setpoint viral load, with fewer infections needed when synergy is present. PMID:21043994

  14. Single-dose antibiotic prophylaxis during cesarean section.

    PubMed

    Gugino; Cimino; Wactawski-Wende

    1998-07-01

    Objective: To compare single-dose antibiotic prophylaxis (cefotetan 1 g vs cefoxitin 2 g) in various subpopulations based upon risk factors for postsurgical infection following cesarean section.Methods: Patients undergoing cesarean section from April 1993 through March 1994 were included in a retrospective analysis if either of the above antibiotics were administered, surgery was non-emergent, gestational age was less than 32 weeks, absence of fever or prior antibiotics therapy within 72 hours, and no history of organ transplantation or HIV. Cases classified as high risk for infection: IDDM, obesity, autoimmune disease, sickle cell disease, or corticosteroid use. Cases classified as high risk for endometritis (any 2 factors): labor >12 hours, >4 vaginal examinations, ruptured membranes >9 hours, and internal fetal monitor. Cases were separated into 4 groups: elective vs non-elective, low vs high surgical risk. A chi(2) analysis was used to test for differences in infection rates between groups (P <.05).Results: Of 1383 cesarean sections, 385 met criteria for inclusion. Non-elective cases accounted for 77% of cases. Postsurgical infection rate was greater in non-elective cases, 7.4%, vs elective cases, 3.0% (P =.056) as was the rate of endometritis (3.2% vs 1.2%, P =.185). No differences were noted based on antibiotic regimen. Postsurgical infection rate was greater for 28 cases at high risk for both surgical infection and endometritis (17.9%) when compared to all 357 other cases (4.5%), P =.003. No difference was noted for endometritis. Of the 28 cases 28.6% of patients treated with cefoxitin and 7.1% of cases treated with cefotetan developed postsurgical infection (P =.13).Conclusion: Overall cefoxitin and cefotetan provided equivalent clinical outcome. A small subset of patients with multiple risk factors for infection may benefit from cefotetan.

  15. Transgender Women in Clinical Trials of Pre-Exposure Prophylaxis

    PubMed Central

    Sevelius, Jae M.; Guanira, Juan V.; Aguilar, Jana Villayzan; Chariyalertsak, Suwat; Deutsch, Madeline B.

    2016-01-01

    Abstract: Lessons were learned with trans women who participated (as volunteers and investigators) in trials of HIV pre-exposure prophylaxis (PrEP). Trans women are not men. Compared with men who have sex with men, trans women trial participants were more likely to be involved with transactional sex, had more sexual partners, and were less likely to have PrEP medications detected in blood. Trans women define themselves differently in different cultures. One best practice is to ask at least 2 gender questions: sex assigned at birth and current gender. More information is needed to fully situate PrEP efficacy for trans women, including analysis of drug–drug interactions between PrEP medications and feminizing hormones and PrEP drug penetration into neovaginal tissues. Including trans women in studies is helpful only if their participation is specifically reported, as could occur in a table of baseline characteristics of the enrolled cohort. Gender-affirming care is important to foster appropriate uptake and use of PrEP. Such care includes use of preferred pronouns and names, safety to use the bathroom of choice, and access to gender-affirming hormone therapy and surgery. The consistent finding that PrEP works when taken across diverse populations having diverse practices related to gender, sexual intercourse, and hormone use provides a basis for offering PrEP to people at substantial risk of acquiring HIV although some subgroups may not have been fully represented in trials. Nonetheless, specific PrEP implementation science for trans women (and men) is essential to develop best practices for PrEP delivery and use. PMID:27429187

  16. Prophylaxis of early ventricular fibrillation by inhibition of acylcarnitine accumulation.

    PubMed Central

    Corr, P B; Creer, M H; Yamada, K A; Saffitz, J E; Sobel, B E

    1989-01-01

    Hypoxia in isolated myocytes results in accumulation of long-chain acylcarnitines (LCA) in sarcolemma. Inhibition of carnitine acyltransferase I (CAT-I) with sodium 2-[5-(4-chlorophenyl)-pentyl]-oxirane-2-carboxylate (POCA) prevents both the accumulation of LCA in the sarcolemma and the initial electrophysiologic derangements associated with hypoxia. Another amphiphilic metabolite, lysophosphatidylcholine (LPC), accumulates in the ischemic heart in vivo, in part because of inhibition of its catabolism by accumulating LCA. It induces electrophysiologic alterations in vitro analogous to early changes induced by ischemia in vivo. The present study was performed to determine whether POCA could prevent accumulation of both LCA and LPC induced by ischemia in vivo and if so, whether attenuation of early arrhythmogenesis would result. LAD coronary artery occlusions were induced for 5 min in chloralose-anesthetized cats. Coronary occlusion in untreated control animals elicited prompt, threefold increases of LCA (73 +/- 8 to 286 +/- 60 pmol/mg protein) and twofold increase of LPC (3.3 +/- 0.4 to 7.5 +/- 0.9 nmol/mg protein) selectively in the ischemic zone, associated with ventricular tachycardia (VT) or ventricular fibrillation (VF) occurring within the 5-min interval before acquisition of myocardial samples in 64% of the animals. POCA prevented the increase of both LCA and LPC. It also prevented the early occurrence of VT or VF (within 5 min of occlusion) in all animals studied. The antiarrhythmic effect of POCA was not attributable to favorable hemodynamic changes or to changes in myocardial perfusion measured with radiolabeled microspheres. Thus, inhibition of CAT-I effectively reduced the incidence of lethal arrhythmias induced early after the onset of ischemia. Accordingly, pharmacologic inhibition of this enzyme provides a promising approach for prophylaxis of sudden cardiac death, that typically occurs very soon after the onset of acute ischemia, in man. PMID:2921326

  17. EFFECT OF DIFFERENT PROPHYLAXIS METHODS ON SOUND AND DEMINERALIZED ENAMEL

    PubMed Central

    Honório, Heitor Marques; Rios, Daniela; Abdo, Ruy César Camargo; Machado, Maria Aparecida de Andrade Moreira

    2006-01-01

    Considering the importance of professional plaque control for caries prevention, this study comprised an in vitro evaluation of wear by two prophylaxis methods (sodium bicarbonate jet – Profident and pumice and brush) on sound bovine enamel and with artificial carious lesions. Sixty enamel fragments were employed (4x4mm), which were divided into 4 groups: GI – 15 sound blocks treated with pumice and brush; GII – 15 sound blocks treated with Profident; GIII – 15 demineralized blocks treated with pumice and brush, and GIV – 15 demineralized blocks treated with Profident. In the fragments of Groups III and IV, artificial carious lesions were simulated by immersion in 0.05M acetic acid solution 50% saturated with bovine enamel powder at 37oC for 16h. The specimens were submitted to the prophylactic treatments for 10 seconds. Wear analysis was performed by profilometer and revealed the following results: 0.91μm – GI; 0.42μm – GII; 1.6μm – GIII, and 0.94μm – GIV. The two-way ANOVA and Tukey's test (p<0.05) revealed significant difference between all groups. Scanning electron microscopy images were employed to illustrate the wear pattern, with observation of larger alteration on the demineralized enamel surface (GIII; GIV), round-shaped wear on GI and GIII and blasted aspect on GII and GIV. The study indicated that the demineralized enamel presented more wear than the sound enamel, and the brush led to larger wear when compared to Profident. PMID:19089042

  18. Transgender Women in Clinical Trials of Pre-Exposure Prophylaxis.

    PubMed

    Grant, Robert M; Sevelius, Jae M; Guanira, Juan V; Aguilar, Jana Villayzan; Chariyalertsak, Suwat; Deutsch, Madeline B

    2016-08-15

    Lessons were learned with trans women who participated (as volunteers and investigators) in trials of HIV pre-exposure prophylaxis (PrEP). Trans women are not men. Compared with men who have sex with men, trans women trial participants were more likely to be involved with transactional sex, had more sexual partners, and were less likely to have PrEP medications detected in blood. Trans women define themselves differently in different cultures. One best practice is to ask at least 2 gender questions: sex assigned at birth and current gender. More information is needed to fully situate PrEP efficacy for trans women, including analysis of drug-drug interactions between PrEP medications and feminizing hormones and PrEP drug penetration into neovaginal tissues. Including trans women in studies is helpful only if their participation is specifically reported, as could occur in a table of baseline characteristics of the enrolled cohort. Gender-affirming care is important to foster appropriate uptake and use of PrEP. Such care includes use of preferred pronouns and names, safety to use the bathroom of choice, and access to gender-affirming hormone therapy and surgery. The consistent finding that PrEP works when taken across diverse populations having diverse practices related to gender, sexual intercourse, and hormone use provides a basis for offering PrEP to people at substantial risk of acquiring HIV although some subgroups may not have been fully represented in trials. Nonetheless, specific PrEP implementation science for trans women (and men) is essential to develop best practices for PrEP delivery and use.

  19. Parsonage-Turner syndrome following post-exposure prophylaxis

    PubMed Central

    2014-01-01

    Background The ‘Parsonage-Turner syndrome’ (PTS) is a rare but distinct disorder with an abrupt onset of shoulder pain, followed by weakness and atrophy of the upper extremity musculature, and a slow recovery requiring months to years. To our best knowledge, this is the first case describing symptoms and signs of PTS following the administration of a post-exposure prophylaxis (PEP) regimen against possible human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. Case presentation A 25-year-old Caucasian man presented with pain and unilateral scapular winging following PEP against possible HIV and HBV infection. Although atrophy and weakness were observed for the right supraspinatus muscle, a full range of motion was achievable. Neurological examination, plain radiography of the right shoulder and electromyography showed no additional abnormalities. The patient was diagnosed with post-vaccination PTS and treated non-operatively. During the following 15 months the scapular winging receded and full muscle strength was regained. Conclusion Parsonage-Turner syndrome is a rare clinical diagnosis. The precise pathophysiological mechanism of PTS remains unclear, but it seems to involve an interaction between genetic predisposition, mechanical vulnerability and an autoimmune trigger. An immunological event, such as – in this case – a vaccination as part of PEP treatment, can trigger the onset of PTS. The clinical presentation is distinctive with acute severe pain followed by patchy paresis, atrophy and sensory symptoms that persist for months to years. No currently available tests can provide a definite confirmation or exclusion of PTS. Routine blood examination, electromyography (EMG), and computed tomography (CT) or magnetic resonance imaging (MRI) serve mainly to exclude other disorders. The recovery can be quite lengthy, non-operative treatment is the accepted practice. Supplementary administration of oral prednisolone could shorten the

  20. [Successful discontinuation of antifungal secondary prophylaxis in AIDS-related cryptococcosis].

    PubMed

    Negroni, R; Helou, S H; López Daneri, G; Robles, A M; Arechavala, A I; Bianchi, M H

    2004-01-01

    The clinical and laboratory data of 22 patients with AIDS related cryptococcosis who were able to interrupt antifungal secondary prophylaxis after HAART administration, are presented. They were 14 males and 8 females, between 15 and 50 years old (X: 34 years old). All patients presented fever and severe deterioration of their general health status, and 19 exhibited a meningeal syndrome. At the start of antifungal treatment, 59% of the cases presented < 50 CD4+ cells/microl, the median viral burden was 134,804 RNA copies/ml and the median titer of serum cryptococcal antigen was 1/3,000. Amphotericin B by intravenous route, (0.7 mg/kg/day) or fluconazole (600 to 800 mg/day) were given as a treatment of the initial episode, up to CSF cultures negativization. Oral fluconazole (200 mg/day) or intravenous amphotericin B, 50 mg twice a week, were given as a secondary prophylaxis. The secondary prophylaxis was interrupted when the patients had received HAART for an average lapse of 19 months (6 to 36 months) and the median CD4+ cell count was 249/microl. The follow up after secondary prophylaxis discontinuation lasted for a median lapse of 22 months. These data seem to show that secondary prophylaxis is not necessary when the patient are clinically asymptomatic and the CD4+ cell counts are above 150/microl.

  1. Effect of pumice prophylaxis on the bond strength of orthodontic brackets.

    PubMed

    Lindauer, S J; Browning, H; Shroff, B; Marshall, F; Anderson, R H; Moon, P C

    1997-06-01

    Pumice prophylaxis has long been accepted as a prerequisite for achieving adequate enamel etching during orthodontic bonding procedures. Three methods were used in this study to examine the effects of pumice prophylaxis on the bond strength of orthodontic brackets: (1) shear bond strength of brackets that were bonded to extracted premolars after surface preparation procedures, which either included or did not include prior pumice prophylaxis, was evaluated; (2) scanning electron microscopy (SEM) was used to examine the surface characteristics of teeth that had been etched with and without prior pumice prophylaxis; and (3) rate of bracket failure in patients who had had brackets bonded with and without prior pumice prophylaxis was recorded during an average treatment time of 18 months. No significant differences were noted in bond strength, general etched enamel surface characteristics, or bracket retention rates. Some specific differences, however, were noted on SEM in localized areas of the etched enamel surfaces, although these did not appear to affect the bond strength or bracket retention rates ultimately attained.

  2. Voriconazole versus itraconazole for antifungal prophylaxis following allogeneic haematopoietic stem-cell transplantation

    PubMed Central

    Marks, David I; Pagliuca, Antonio; Kibbler, Christopher C; Glasmacher, Axel; Heussel, Claus-Peter; Kantecki, Michal; Miller, Paul JS; Ribaud, Patricia; Schlamm, Haran T; Solano, Carlos; Cook, Gordon

    2011-01-01

    Antifungal prophylaxis for allogeneic haematopoietic stem-cell transplant (alloHCT) recipients should prevent invasive mould and yeast infections (IFIs) and be well tolerated. This prospective, randomized, open-label, multicentre study compared the efficacy and safety of voriconazole (234 patients) versus itraconazole (255 patients) in alloHCT recipients. The primary composite endpoint, success of prophylaxis, incorporated ability to tolerate study drug for ≥100 d (with ≤14 d interruption) with survival to day 180 without proven/probable IFI. Success of prophylaxis was significantly higher with voriconazole than itraconazole (48·7% vs. 33·2%, P <0·01); more voriconazole patients tolerated prophylaxis for 100 d (53·6% vs. 39·0%, P<0·01; median total duration 96 vs. 68 d). The most common (>10%) treatment-related adverse events were vomiting (16·6%), nausea (15·8%) and diarrhoea (10·4%) for itraconazole, and hepatotoxicity/liver function abnormality (12·9%) for voriconazole. More itraconazole patients received other systemic antifungals (41·9% vs. 29·9%, P<0·01). There was no difference in incidence of proven/probable IFI (1·3% vs. 2·1%) or survival to day 180 (81·9% vs. 80·9%) for voriconazole and itraconazole respectively. Voriconazole was superior to itraconazole as antifungal prophylaxis after alloHCT, based on differences in the primary composite endpoint. Voriconazole could be given for significantly longer durations, with less need for other systemic antifungals. PMID:21880032

  3. Pneumococcal septicemia despite pneumococcal vaccine and prescription of penicillin prophylaxis in children with sickle cell anemia.

    PubMed

    Buchanan, G R; Smith, S J

    1986-05-01

    Although polyvalent pneumococcal vaccine and prophylactic penicillin are used to prevent overwhelming Streptococcus pneumoniae septicemia in infants and young children with sickle cell anemia, infection rates remain high. We have reviewed our seven-year experience with a regimen of twice daily oral penicillin V potassium prophylaxis in 88 affected children. The median age at the start of prophylaxis was 10 months, and the median duration of prophylaxis was 29 months (range, three months to seven years). The total period of observation of patients who were prescribed penicillin was 248 person-years. Most patients also received one or two doses of polyvalent pneumococcal vaccine. Despite penicillin prophylaxis and pneumococcal vaccine, eight episodes of S pneumoniae septicemia have occurred and three have been fatal. Four episodes were in children older than 3 years. Suboptimal compliance with the prescribed oral penicillin regimen was usually apparent. With one possible exception, the infections occurred when penicillin had not been taken during the previous 24 hours. The S pneumoniae septicemia rate in this patient population, 3.2 per 100 person-years, is somewhat less than that described in previous reports of children not receiving penicillin but is still unacceptably high. Vigorous advocacy of a penicillin prophylaxis regimen does not eliminate the risk of pneumococcal septicema in this patient population.

  4. What do women know about breast cancer prophylaxis and a healthy style of life?

    PubMed Central

    Sielska, Jolanta; Matecka, Monika; Dąbrowska, Eliza; Jakubek, Ewa; Urbaniak, Monika

    2015-01-01

    Aim The aim of the study was to determine the factors influencing women's knowledge concerning breast cancer prophylaxis and find out the sources of the knowledge. Background In the Greater Poland region, breast cancer has been the most frequently detected tumour for years. The percentage of breast cancer cases has increased by 31% in the last decade. Materials and methods The study encompassed 337 women aged 40–59 who participated in the mammographic examinations. An original research tool was used which assessed the level of knowledge concerning breast cancer prophylaxis, the knowledge of health-oriented behaviour in this regard and the influence of the medical personnel on women's education. Results Age is a factor diversifying the knowledge of the breast self-examination method. Doctors and nurses were rarely indicated as a source of knowledge concerning breast cancer prophylaxis. The subjects presented a high level of knowledge of the factors increasing the risk of developing cancer. Conclusions A correlation between the level of education and the knowledge of one's own breast to a degree which enables a woman to detect even a slight change was observed. Vital findings also concern the sources of knowledge concerning breast cancer prophylaxis. The results of the studies indicated little informative support on the part of the medical personnel; therefore, one should call for supplementing training courses for doctors and nurses focusing on the issues of prophylaxis, including the method of breast self-examination. PMID:26549989

  5. Venous thromboembolism prophylaxis after total hip or knee arthroplasty: a survey of Canadian orthopedic surgeons

    PubMed Central

    Gross, Michael; Anderson, David R.; Nagpal, Seema; O’Brien, Bernie

    1999-01-01

    Objective To determine the pharmacologic and physical modalities used by orthopedic surgeons in Canada to prevent venous thromboembolism (deep venous thrombosis and pulmonary embolism) after total hip or knee arthroplasty. Design Mail survey sent to all members of the Canadian Orthopaedic Association. Setting A nation-wide study. Methods A total of 828 questionnaires, designed to identify the type and frequency of prophylaxis against venous thromboembolism that were used after hip and knee arthroplasty were mailed to orthopedic surgeons. Outcome measures Demographic data and the frequency and type of thromboprophylaxis. Results Of the 828 surveys mailed 445 (54%) were returned, and 397 were included in this analysis. Of the respondents, 97% used prophylaxis routinely for patients who undergo total hip or knee arthroplasty. Three of the 397 (0.8%) did not use any method of prophylaxis. Warfarin was the most common agent used (46%), followed by low-molecular-weight heparin (LMWH) (36%). Combination therapy with both mechanical and pharmacologic methods were used in 39% of patients. Objective screening tests were not frequently performed before discharge. Extended prophylaxis beyond the duration of hospitalization was used by 36% of physicians. Conclusion Prophylaxis for venous thromboembolism with warfarin or LMWH has become standard care after total hip or knee arthroplasty in Canada. PMID:10593248

  6. Primary prophylaxis of disseminated histoplasmosis in HIV patients in French Guiana: arguments for cost effectiveness.

    PubMed

    Nacher, Mathieu; Adenis, Antoine; Basurko, Celia; Vantilcke, Vincent; Blanchet, Denis; Aznar, Christine; Carme, Bernard; Couppié, Pierre

    2013-12-01

    Histoplasmosis is the first cause of acquired immunodeficiency syndrome (AIDS) and AIDS-related deaths in French Guiana. Cohort data were used to determine whether primary prophylaxis with 100 mg itraconazole for patients with CD4 counts < 150/mm(3) was cost-effective with different scenarios. For a scenario where 12% of patients died, 60% were aware of their human immunodeficiency virus (HIV) infection and adherence was only 50%, primary prophylaxis would prevent 1 death and 9 cases of histoplasmosis for a cost of 36,792 Euros per averted death, 1,533 per life-year saved, 4,415 Euros per averted case, when only counting the costs of itraconazole prophylaxis. Taking into account the total costs of hospitalization showed that primary prophylaxis would allow a savings of 185,178 Euros per year. Even in a scenario of low adherence, primary prophylaxis would be cost-effective in French Guiana, and presumably in the rest of the Guianas and the Amazon.

  7. Central nervous system prophylaxis in diffuse large B-cell lymphoma.

    PubMed

    Zahid, Mohammad Faizan; Khan, Nadia; Hashmi, Shahrukh K; Kizilbash, Sani Haider; Barta, Stefan K

    2016-08-01

    Central nervous system (CNS) involvement with diffuse large B-cell lymphoma (DLBCL) is a relatively uncommon manifestation; with most cases of CNS involvement occuring during relapse after primary therapy. CNS dissemination typically occurs early in the disease course and is most likely present subclinically at the time of diagnosis in many patients who later relapse in the CNS. CNS relapse in these patients is associated with poor outcomes. Based on a CNS relapse rate of 5% in DLBCL and weighing the benefits against the toxicities, universal application of CNS prophylaxis is not justified. The introduction of rituximab has significantly reduced the incidence of CNS relapse in DLBCL. Different studies have employed other agents for CNS prophylaxis, such as intrathecal chemotherapy and high-dose systemic agents with sufficient CNS penetration. If CNS prophylaxis is to be given, it should be preferably administered during primary chemotherapy. However, there is no strong evidence that supports any single approach for CNS prophylaxis. In this review, we outline different strategies of administering CNS prophylaxis in DLBCL patients reported in literature and discuss their advantages and drawbacks.

  8. [Prophylaxis and health promotion--whether and for whom they provide profit?].

    PubMed

    Szozda, Ryszard J

    2002-01-01

    The subject of this article is employee and his family, employer, the state in all aspects and health as a profit and a lack of health as a loss. Healthy employee brings a profit to himself, to the employer and to the state. Up to these times nobody has thought about the health value. Work is a commodity. Prophylaxis and health promotion are work. Health can be sold as each commodity. Prophylaxis and health promotion incur expenses but they must be compared with illness results expenses (including immeasurable ones). Having analysed the literature the author claims that the thesis is right so it means that the effects of prophylaxis and health promotion determine the profit to employees and their families, to employers and to the state--which means to all of us.

  9. Pneumocystis pneumonia in a non-HIV patient on chronic corticosteroid therapy: a question of prophylaxis.

    PubMed

    Plakke, Michael J; Jalota, Leena; Lloyd, Benjamin J

    2013-03-01

    A man in his late 50s with a history of membranoproliferative glomerulonephritis presented with fever and mild dyspnoea. He was HIV-negative and had been on corticosteroids as immunosuppression for 6 months prior to tapering them off 1 week before presentation. He was not taking prophylaxis for Pneumocystis jirovecii pneumonia. After unsuccessful treatment for community-acquired pneumonia, his condition worsened and he required intubation and mechanical ventilation. Full respiratory workup including bronchoscopy revealed P jirovecii as a source for the patient's infection. He was treated successfully with a 21-day course of trimethoprim-sulfamethoxazole  and eventually weaned off the ventilator. He has had no complications to date. In our review of this case and the existing literature, we believe that proper utilisation of prophylaxis for pneumocystis pneumonia may have prevented our patient's transfer to intensive care unit. In our article, we discuss this issue and explore current evidence for prophylaxis.

  10. Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: Prophylaxis and treatment controversies.

    PubMed

    Cheuk, Daniel Kl

    2012-04-24

    Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome, is a major complication of hematopoietic stem cell transplantation and it carries a high mortality. Prophylaxis for hepatic VOD is commonly given to transplant recipients from the start of conditioning through the early weeks of transplant. However, high quality evidence from randomized controlled trials is scarce with small sample sizes and the trials yielded conflicting results. Although various treatment options for hepatic VOD are available, most have not undergone stringent evaluation with randomized controlled trial and therefore it remains uncertain which treatment offers real benefit. It remains controversial whether VOD prophylaxis should be given, which prophylactic therapy should be given, who should receive prophylaxis, and what treatment should be offered once VOD is established.

  11. An audit of intermittent pneumatic compression (IPC) in the prophylaxis of asymptomatic deep vein thrombosis (DVT).

    PubMed

    Illingworth, Clare; Timmons, Stephen

    2007-11-01

    This paper reports a prospective audit, against an existing baseline standard, for intermittent pneumatic compression (IPC) in the prophylaxis of asymptomatic deep vein thrombosis (DVT). This was done via a structured questionnaire, using the methodology of total population sampling, encapsulating all theatre staff within one NHS trust. With regards to the standard, performance is good, as IPC is DVT prophylaxis of choice in the perioperative area and is used frequently on most patients. The findings of the audit do, however, highlight the need for appropriate local DVT risk assessment guidelines, essential to ensure that prophylaxis is administered to the correct at risk groups, as prevention may be unjustified in low risk groups and possibly inappropriate for the same regimen to be used for all patients.

  12. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy

    PubMed Central

    Gafter-Gvili, Anat; Fraser, Abigail; Paul, Mical; Vidal, Liat; Lawrie, Theresa A; van de Wetering, Marianne D; Kremer, Leontien CM; Leibovici, Leonard

    2014-01-01

    Background Bacterial infections are a major cause of morbidity and mortality in patients who are neutropenic following chemotherapy for malignancy. Trials have shown the efficacy of antibiotic prophylaxis in reducing the incidence of bacterial infections but not in reducing mortality rates. Our systematic review from 2006 also showed a reduction in mortality. Objectives This updated review aimed to evaluate whether there is still a benefit of reduction in mortality when compared to placebo or no intervention. Search methods We searched the Cochrane Cancer Network Register of Trials (2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), abstracts of conference proceedings and the references of identified studies. Selection criteria Randomised controlled trials (RCTs) or quasi-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention, or another antibiotic, to prevent bacterial infections in afebrile neutropenic patients. Data collection and analysis Two authors independently appraised the quality of each trial and extracted data from the included trials. Analyses were performed using RevMan 5.1 software. Main results One-hundred and nine trials (involving 13,579 patients) that were conducted between the years 1973 to 2010 met the inclusion criteria. When compared with placebo or no intervention, antibiotic prophylaxis significantly reduced the risk of death from all causes (46 trials, 5635 participants; risk ratio (RR) 0.66, 95% CI 0.55 to 0.79) and the risk of infection-related death (43 trials, 5777 participants; RR 0.61, 95% CI 0.48 to 0.77). The estimated number needed to treat (NNT) to prevent one death was 34 (all-cause mortality) and 48 (infection-related mortality). Prophylaxis also significantly reduced the occurrence of fever (54 trials, 6658 participants; RR 0.80, 95% CI 0.74 to 0.87), clinically documented infection

  13. Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis

    SciTech Connect

    Balboni, Tracy A.; Gobezie, Reuben; Mamon, Harvey J. . E-mail: hmamon@partners.org

    2006-08-01

    Heterotopic ossification (HO) is a benign condition of abnormal formation of bone in soft tissue. HO is frequently asymptomatic, though when it is more severe it typically manifests as decreased range of motion at a nearby joint. HO has been recognized to occur in three distinct contexts-trauma, neurologic injury, and genetic abnormalities. The etiology of HO is incompletely understood. A posited theory is that HO results from the presence of osteoprogenitor cells pathologically induced by an imbalance in local or systemic factors. Individuals at high risk for HO development frequently undergo prophylaxis to prevent HO formation. The two most commonly employed modalities for prophylaxis are nonsteroidal anti-inflammatory drugs and radiation therapy. This review discusses HO pathophysiology, clinical features, and the role of radiotherapy for prophylaxis.

  14. Lack of doxycycline antimalarial prophylaxis impact on Staphylococcus aureus tetracycline resistance.

    PubMed

    Mende, Katrin; Beckius, Miriam L; Zera, Wendy C; Yu, Xin; Li, Ping; Tribble, David R; Murray, Clinton K

    2016-10-01

    There is concern that susceptibility of Staphylococcus aureus to tetracyclines may decrease due to use of antimalarial prophylaxis (doxycycline). We examined characteristics related to tetracycline resistance, including doxycycline exposure, in S. aureus isolates collected via admission surveillance swabs and inpatient clinical cultures from United States military personnel injured during deployment (June 2009-January 2012). Tetracycline class resistance was determined using antimicrobial susceptibility testing. The first S. aureus isolate from 168 patients were analyzed, of which 38 (23%) isolates were resistant to tetracyclines (class). Tetracycline-resistant isolates had a higher proportion of resistance to clindamycin (P=0.019) compared to susceptible isolates. There was no significant difference in tetracycline resistance between isolates collected from patients with and without antimalarial prophylaxis; however, significantly more isolates had tet(M) resistance genes in the doxycycline exposure group (P=0.031). Despite 55% of the patients receiving doxycycline as antimalarial prophylaxis, there was no association with resistance to tetracyclines.

  15. Perspectives on HIV Prevention Among Urban Black Women: A Potential Role for HIV Pre-Exposure Prophylaxis

    PubMed Central

    Stone, Valerie E.; Mitty, Jennifer A.; Mimiaga, Matthew J.; Hall, Kathryn T.; Krakower, Douglas; Mayer, Kenneth H.

    2014-01-01

    Abstract Limited data exist regarding attitudes and acceptability of topical and oral HIV pre-exposure prophylaxis (PrEP) among US black women. This investigation explored interest in HIV chemoprophylaxis and modes of use. Five focus groups enrolled 26 black women recruited from an inner-city community health center and affiliated HIV testing sites. Thematic analysis utilized Atlas.ti. Most women expressed interest in PrEP, as many reported condom failure concerns. Most women preferred a pill formulation to intravaginal gel because of greater perceived privacy and concerns about vaginal side effects and gel leakage. Women who had taken pills previously advocated daily dosing and indicated adherence concerns about episodic or post-coital PrEP. Many women desired prophylactic strategies that included partner testing. Urban black women are interested in utilizing PrEP; however, misgivings exist about gel inconvenience and potential side effects for themselves and their partners. Most women preferred oral PrEP, dosed daily. PMID:25295393

  16. Editorial Commentary: The Efficacy of Nonsteroidal Anti-inflammatory Drugs for Prophylaxis of Heterotopic Ossification in Hip Arthroscopy--Do We Treat Patients or X-rays?

    PubMed

    Miller, G Klaud

    2016-03-01

    A systematic review of 5 series comparing the incidence of heterotopic ossification after hip arthroscopy with and without nonsteroidal anti-inflammatory drug prophylaxis showed a statistically significant improvement with the use of prophylaxis.

  17. Effectiveness and outcome predictors of long-term lithium prophylaxis in unipolar major depressive disorder

    PubMed Central

    Baethge, Christopher; Gruschka, Philipp; Smolka, Michael N.; Berghöfer, Anne; Bschor, Tom; Müller-Oerlinghausen, Bruno; Bauer, Michael

    2003-01-01

    Objective To determine the effectiveness of lithium prophylaxis in unipolar major depressive disorder (MDD) and to identify predictors of outcome including comedication. Methods In this long-term naturalistic study, clinical data from 55 patients with MDD (DSM-III-R) were collected prospectively in an outpatient clinic specializing in the treatment of affective disorders. Outcome measures Change in hospital admission rate (number and duration) during prophylaxis compared with the period before prophylaxis, Morbidity-Index during prophylaxis and time to first recurrence after initiation of lithium treatment. Results During an average follow-up period of 6.7 years, a significant decline in the number of days spent in hospital (p < 0.001; 52 d/yr less; 95; CI 31–73 d) and a low Morbidity-Index (mean 0.07) was observed. Only in 6 patients did medication have to be changed because of side-effects (n = 4) or a lack of efficacy (n = 2). None of the independent variables we analyzed proved to be important in predicting the outcome of lithium prophylaxis. Comedication was necessary in 21 patients. The overall outcome of their prophylactic treatment, however, did not differ from the group that did not receive comedication in the symptom-free intervals. Conclusions The results of this study, with its long observation period and the inclusion of comedication as a confounding variable, indicate that lithium is a potent prophylactic agent for unipolar MDD in a naturalistic setting. In contrast to the findings of others, age was not associated with the outcome of prophylaxis, and latency did not predict outcome. Contrary to doubts that have been raised in recent years with regard to the effectiveness of lithium in everyday clinical practice, lithium appears to be a safe and potent alternative to antidepressants. PMID:14517579

  18. Cost effectiveness of venous thromboembolism pharmacological prophylaxis in total hip and knee replacement: a systematic review.

    PubMed

    Kapoor, Alok; Chuang, Warren; Radhakrishnan, Nila; Smith, Kenneth J; Berlowitz, Dan; Segal, Jodi B; Katz, Jeffrey N; Losina, Elena

    2010-01-01

    Total hip and knee replacements (THR and TKR) are high-risk settings for venous thromboembolism (VTE). This review summarizes the cost effectiveness of VTE prophylaxis regimens for THR and TKR. We searched MEDLINE (January 1997 to October 2009), EMBASE (January 1997 to June 2009) and the UK NHS Economic Evaluation Database (1997 to October 2009). We analysed recent cost-effectiveness studies examining five categories of comparisons: (i) anticoagulants (warfarin, low-molecular-weight heparin [LMWH] or fondaparinux) versus acetylsalicylic acid (aspirin); (ii) LMWH versus warfarin; (iii) fondaparinux versus LMWH; (iv) comparisons with new oral anticoagulants; and (v) extended-duration (> or =3 weeks) versus short-duration (<3 weeks) prophylaxis. We abstracted information on cost and effectiveness for each prophylaxis regimen in order to calculate an incremental cost-effectiveness ratio. Because of variations in effectiveness units reported and horizon length analysed, we calculated two cost-effectiveness ratios, one for the number of symptomatic VTE events avoided at 90 days and the other for QALYs at the 1-year mark or beyond. Our search identified 33 studies with 67 comparisons. After standardization, comparisons between LMWH and warfarin were inconclusive, whereas fondaparinux dominated LMWH in nearly every comparison. The latter results were derived from radiographic VTE rates. Extended-duration prophylaxis after THR was generally cost effective. Small numbers prohibit conclusions about aspirin, new oral anticoagulants or extended-duration prophylaxis after TKR. Fondaparinux after both THR and TKR and extended-duration LMWH after THR appear to be cost-effective prophylaxis regimens. Small numbers for other comparisons and absence of trials reporting symptomatic endpoints prohibit comprehensive conclusions.

  19. Standard or extended-duration prophylaxis in medical patients? A review of the evidence.

    PubMed

    Stark, J E; Smith, W J

    2011-10-01

    Acutely ill medical patients are at significant risk of venous thromboembolism (VTE). Thromboprophylaxis can substantially reduce the incidence of VTE, but to be optimally effective must consist of the correct choice of agent, at an appropriate dose, and for sufficient duration. Increasing evidence suggests that VTE risk persists beyond the standard period of prophylaxis. Although there is evidence that extended-duration prophylaxis is beneficial in preventing late VTE complications in high-risk surgical patients, few data exist in medical patients. The recent EXCLAIM study demonstrated that, subsequent to a standard prophylaxis regimen of 10 ± 4 days with enoxaparin 40 mg once daily, extended-duration prophylaxis (28 ± 4 days) with enoxaparin reduced total VTE events compared with placebo: 2.5% versus 4.0%; (absolute risk difference -1.53%; 95.8% confidence interval [CI] -2.54 to -0.52), with parallel increases in major bleeding rates (0.8% vs. 0.3%; absolute risk difference 0.51%; 95% CI 0.12-0.89%). The reduction in total VTE was principally driven by a decrease in symptomatic deep-vein thrombosis (absolute risk difference -0.60%; 95.8% CI -1.00 to -0.19%). Favorable benefit-to-risk ratios were observed in certain high-risk patient groups: level 1 immobility, women, and age >75 years. In addition to their underlying medical condition, medical patients often have multiple risk factors, placing them at sustained risk of VTE. Extended-duration prophylaxis might be most relevant in such patients. The development of appropriate risk assessment tools could help identify medical patients at greatest risk of late VTE events who might benefit most from extended-duration prophylaxis.

  20. Polarised press reporting about HIV prevention: Social representations of pre-exposure prophylaxis in the UK press.

    PubMed

    Jaspal, Rusi; Nerlich, Brigitte

    2016-05-22

    Pre-exposure prophylaxis is a novel biomedical HIV prevention option for individuals at high risk of HIV acquisition. Although pre-exposure prophylaxis has yielded encouraging results in various clinical trials, opponents argue that pre-exposure prophylaxis poses a number of risks to human health and to sexually transmitted infection prevention efforts. Using qualitative thematic analysis and social representation theory, this article explores coverage of pre-exposure prophylaxis in the UK print media between 2008 and 2015 in order to chart the emerging social representations of this novel HIV prevention strategy. The analysis revealed two competing social representations of pre-exposure prophylaxis: (1) as a positive development in the 'battle' against HIV (the hope representation) and (2) as a medical, social and psychological setback in this battle, particularly for gay/bisexual men (the risk representation). These social representations map onto the themes of pre-exposure prophylaxis as a superlatively positive development; pre-exposure prophylaxis as a weapon in the battle against HIV/AIDS; and risk, uncertainty and fear in relation to pre-exposure prophylaxis. The hope representation focuses on taking (individual and collective) responsibility, while the risk representation focuses on attributing (individual and collective) blame. The implications for policy and practice are discussed.

  1. Radiation Therapy Risk Factors for Development of Lymphedema in Patients Treated With Regional Lymph Node Irradiation for Breast Cancer

    SciTech Connect

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

    2015-03-15

    Purpose: We previously evaluated the risk of breast cancer-related lymphedema (LE) with the addition of regional lymph node irradiation (RLNR) and found an increased risk when RLNR is used. Here we analyze the association of technical radiation therapy (RT) factors in RLNR patients with the risk of LE development. Methods and Materials: From 2005 to 2012, we prospectively screened 1476 women for LE who underwent surgery for breast cancer. Among 1507 breasts treated, 172 received RLNR and had complete technical data for analysis. RLNR was delivered as supraclavicular (SC) irradiation (69% [118 of 172 patients]) or SC plus posterior axillary boost (PAB) (31% [54 of 172]). Bilateral arm volume measurements were performed pre- and postoperatively. Patients' RT plans were analyzed for SC field lateral border (relative to the humeral head), total dose to SC, RT fraction size, beam energy, and type of tangent (normal vs wide). Cox proportional hazards models were used to analyze associated risk factors for LE. Results: Median postoperative follow-up was 29.3 months (range: 4.9-74.1 months). The 2-year cumulative incidence of LE was 22% (95% confidence interval [CI]: 15%-32%) for SC and 20% (95% CI: 11%-37%) for SC plus PAB (SC+PAB). None of the analyzed variables was significantly associated with LE risk (extent of humeral head: P=.74 for <1/3 vs >2/3, P=.41 for 1/3 to 2/3 vs >2/3; P=.40 for fraction size of 1.8 Gy vs 2.0 Gy; P=.57 for beam energy 6 MV vs 10 MV; P=.74 for tangent type wide vs regular; P=.66 for SC vs SC+PAB). Only pretreatment body mass index (hazard ratio [HR]: 1.09; 95% CI: 1.04-1.15, P=.0007) and the use of axillary lymph node dissection (HR: 7.08, 95% CI: 0.98-51.40, P=.05) were associated with risk of subsequent LE development. Conclusions: Of the RT parameters tested, none was associated with an increased risk of LE development. This study underscores the need for future work investigating alternative RLNR risk factors for LE.

  2. Echinocandin Resistance, Susceptibility Testing and Prophylaxis: Implications for Patient Management

    PubMed Central

    Perlin, David S.

    2014-01-01

    become drug tolerant and can form stable drug resistant FKS mutations with continued drug exposure. A major concern for resistance detection is that classical broth microdilution techniques show significant variability among clinical microbiology laboratories for certain echinocandin drugs and Candida species. The consequence is that susceptible strains are misclassified according to established clinical breakpoints, and this has led to confusion in the field. Clinical factors that appear to promote echinocandin resistance include the expanding use of antifungal agents for empiric therapy and prophylaxis. Furthermore, host reservoirs such as biofilms in the gastrointestinal tract or intra-abdominal infections can seed development of resistant organisms during therapy. A fundamental understanding of the primary molecular resistance mechanism, along with cellular and clinical factors that promote resistance emergence, is critical to develop better diagnostic tools and therapeutic strategies to overcome and prevent echinocandin resistance. PMID:25255923

  3. [Deep Vein Thrombosis Prophylaxis in Patients with Traumatic Brain Injury].

    PubMed

    Silva, Vinícius Trindade Gomes da; Iglesio, Ricardo; Paiva, Wellingson Silva; Siqueira, Mario Gilberto; Teixeira, Manoel Jacobsen

    2015-01-01

    Introdução: O risco de trombose venosa profunda encontra-se aumentado em doentes vítimas de traumatismo cranioencefálico, mas a profilaxia da trombose venosa profunda se confronta com o possível risco de piora de lesões hemorrágicas relacionados ao traumatismo cranioencefálico. Neste artigo apresentamos uma revisão crítica do tema e propomos um protocolo de profilaxia para estes doentes.Material e Métodos: Foi realizada uma pesquisa na base de dados Medline/PubMed, Cochrane, e Scielo de janeiro de 1998 a janeiro de 2014 com a expressão de busca âÄúdeep venous thrombosis and prophylaxis and traumatic brain injuryâÄù. Foram encontrados 44 artigos usando os termos MeSH definidos. Destes foram selecionados 23 artigos, usando como critérios: publicação em inglês ou português, fase aguda do traumatismo cranioencefálico moderado e grave, profilaxia mecânica não invasiva ou química.Resultados: O traumatismo cranioencefálico é um fator de risco para trombose venosa profunda e tromboembolismo pulmonar. A chance de trombose venosa profunda é 2,59 vezes maior em doentes com traumatismo cranioencefálico. A prevalência de trombose venosa profunda e embolia pulmonar em doentes que sofreram traumatismo cranioencefálico é de 20%, podendo atingir 30% dos doentes em alguns estudos.Discussão e Conclusão: As diversas formas de traumatismo de forma isolada constituem fator de risco para trombose venosa profunda e tromboembolismo pulmonar. Ensaios clínicos são necessários para estabelecer a eficácia da profilaxia e o melhor momento de iniciar medicação para trombose venosa profunda em doentes com traumatismo craniencefálico.

  4. Lack of extended venous thromboembolism prophylaxis in high-risk patients undergoing major orthopaedic or major cancer surgery. Electronic Assessment of VTE Prophylaxis in High-Risk Surgical Patients at Discharge from Swiss Hospitals (ESSENTIAL).

    PubMed

    Kalka, Christoph; Spirk, David; Siebenrock, Klaus-Arno; Metzger, Urs; Tuor, Philipp; Sterzing, Daniel; Oehy, Kurt; Wondberg, Daniela; Mouhsine, El Yazid; Gautier, Emanuel; Kucher, Nils

    2009-07-01

    Extended pharmacological venous thromboembolism (VTE) prophylaxis beyond discharge is recommended for patients undergoing high-risk surgery. We prospectively investigated prophylaxis in 1,046 consecutive patients undergoing major orthopaedic (70%) or major cancer surgery (30%) in 14 Swiss hospitals. Appropriate in-hospital prophylaxis was used in 1,003 (96%) patients. At discharge, 638 (61%) patients received prescription for extended pharmacological prophylaxis: 564 (77%) after orthopaedic surgery, and 74 (23%) after cancer surgery (p < 0.001). Patients with knee replacement (94%), hip replacement (81%), major trauma (80%), and curative arthroscopy (73%) had the highest prescription rates for extended VTE prophylaxis; the lowest rates were found in patients undergoing major surgery for thoracic (7%), gastrointestinal (19%), and hepatobiliary (33%) cancer. The median duration of prescribed extended prophylaxis was longer in patients with orthopaedic surgery (32 days, interquartile range 14-40 days) than in patients with cancer surgery (23 days, interquartile range 11-30 days; p<0.001). Among the 278 patients with an extended prophylaxis order after hip replacement, knee replacement, or hip fracture surgery, 120 (43%) received a prescription for at least 35 days, and among the 74 patients with an extended prophylaxis order after major cancer surgery, 20 (27%) received a prescription for at least 28 days. In conclusion, approximately one quarter of the patients with major orthopaedic surgery and more than three quarters of the patients with major cancer surgery did not receive prescription for extended VTE prophylaxis. Future effort should focus on the improvement of extended VTE prophylaxis, particularly in patients undergoing major cancer surgery.

  5. Methemoglobinemia in a Pediatric Oncology Patient Receiving Sulfamethoxazole/Trimethoprim Prophylaxis.

    PubMed

    Carroll, Timothy G; Carroll, Megan G

    2016-07-18

    BACKGROUND Methemoglobinemia due to the administration of sulfamethoxazole/trimethoprim has been documented in a series of case reports. However, all of these reports are on adult patients, and all patients received at least daily administration of sulfamethoxazole/trimethoprim for the treatment of active or suspected infection. CASE REPORT Herein we report the development of methemoglobinemia in a pediatric patient receiving sulfamethoxazole/trimethoprim three times weekly for the prophylaxis of opportunistic infections. CONCLUSIONS The clinician should always consider sulfamethoxazole/trimethoprim, even when administered for opportunistic infection prophylaxis at reduced doses and intervals, as a possible cause of methemoglobinemia.

  6. Cefixime for the prophylaxis of urinary tract infections in children with malformative uropathies: an open study.

    PubMed

    Stranieri, G; Zampogna, S; Ielapi, V; Defilippo, R G; Defilippo, V; Cristofaro, G; Galiano, R; Capillo, S; Madonna, L; Cifalà, S; Ferro, V; Rubino, R

    2003-01-01

    Urinary tract infections are often associated with urinary anomalies. An appropriate pharmacologic treatment may prevent, or may at least limit, any kidney damage due to pyelonephritis. The antibiotic prophylaxis plays a role as significant as early surgical therapy, taking into consideration also the present limitative trend for a softer therapeutic regimen. In the past few years a greater bacterial resistance has emerged against some commonly administered antibiotics. Cefixime (3rd generation cephalosporin) has been used on a wide series of patients suffering from urinary infections associated with urinary tract anomalies. A few significative results emerge from the present study. In conclusion, cefixime's effectiveness long-term prophylaxis of urinary infections associated with anomalies.

  7. Physical Therapy Intervention to Augment Outcomes Of Lymph Node Transfer Surgery for a Breast Cancer Survivor with Secondary Upper Extremity Lymphedema: A Case Report

    PubMed Central

    McKey, Katelyn P; Alappattu, Meryl J

    2016-01-01

    Background and purpose Lymphedema is an incurable complication of breast cancer treatment that affects roughly 20 percent of women. It is often managed via complete decongestive therapy, which includes manual lymph drainage, therapeutic compression, skin care, and exercise. Lymph node transfer is a new and expensive surgical intervention that uses one’s own lymph nodes and implants them in the affected upper extremity. Previous research has investigated augmenting lymph node transfer surgery with complete decongestive therapy, but there is a lack of evidence regarding the success of focusing lymph drainage against the normal pressure gradient toward a surgical flap located on the wrist. The patient’s main motivation for the surgical intervention was to alleviate her daily burden of complete decongestive therapy. The purpose of this case report was to compare the methods and results of pre-surgical complete decongestive physical therapy to a post-operation modified approach that directed lymph fluid away from the major lymphatic ducts and instead toward a surgical flap on the wrist of a patient with lymphedema. Case Description A 65-year-old female presented with secondary upper extremity lymphedema following breast cancer treatment. Her circumferential measurements and L-Dex score corroborated this diagnosis, and she had functional deficits in upper extremity range of motion. She was seen for 10 visits of traditional complete decongestive therapy prior to her lymph node transfer surgery and 24 treatments of modified complete decongestive therapy over the course of six months following surgery. Outcomes At six months, the patient had minor improvements in the Functional Assessment of Chronic Illness Therapy-Fatigue, Disabilities of the Arm, Shoulder and Hand questionnaire, range of motion, and upper extremity strength. However, her circumferential measurements and L-Dex scores showed a meaningful increase in limb girth. Discussion The patient’s smallest upper

  8. Is selective prenatal iron prophylaxis better than routine prophylaxis: final results of a trial (PROFEG) in Maputo, Mozambique

    PubMed Central

    Hemminki, Elina; Nwaru, Bright I; Salomé, Graca; Parkkali, Saara; Abacassamo, Fatima; Augusto, Orvalho; Cliff, Julie; Regushevskaya, Elena; Dgedge, Martinho; Sousa, Cesar; Chilundo, Baltazar

    2016-01-01

    Objective To compare routine versus selective (ie, screening and treatment for anaemia) prenatal iron prophylaxis in a malaria-endemic and HIV-prevalent setting, an extended analysis including previously missing data. Design A pragmatic randomised controlled clinical trial. Setting 2 health centres in Maputo, Mozambique. Participants Pregnant women (≥18 years old; non-high-risk pregnancy) were randomly allocated to routine iron (n=2184) and selective iron (n=2142) groups. Interventions In the routine group, women received 60 mg ferrous sulfate plus 400 μg folic acid daily. In the selective group, women received 1 mg of folic acid daily and haemoglobin (Hb) screening at each visit; with low Hb (cut-off 9 g/dL) treatment (120 mg+800 μg of folic acid daily) for a month. Outcome measures Primary outcomes: preterm birth, low birth weight; secondary outcomes: self-reported malaria, labour complications, caesarean section, perinatal death, woman's death. Nurses collected pregnancy data. Birth data were abstracted from hospital records for 52% of women and traced using various methods and linked with probabilistic matching for 24%. Women's deaths were collected from death registers. Results Birth data were available for 3301 (76%) of the women. Outcomes were similar in the two groups: preterm births (27.1% in the selective vs 25.3% in the routine group), low birthweight infants (11.0% vs 11.7%), perinatal deaths (2.4% vs 2.4%) and caesarean sections (4.0% vs 4.5%). Women's deaths during pregnancy or <42 days postpartum were more common in the selective group (0.8% among the two best matched women) than in the routine group (0.4%). Extra deaths could not be explained by the cause of death, Hb level or HIV status at recruitment. Conclusions Birth outcomes were similar in the two iron groups. There might have been more women's deaths in the selective iron group, but it is unclear whether this was due to the intervention, other factors or chance finding

  9. Thrombin generation and low-molecular-weight heparin prophylaxis in pregnant women with thrombophilia.

    PubMed

    Selmeczi, Anna; Roach, Rachel E J; Móré, Csaba; Batta, Zoltán; Hársfalvi, Jolán; van der Bom, Johanna G; Boda, Zoltán; Oláh, Zsolt

    2015-02-01

    Pregnancy is associated with increased risk of venous thromboembolism, especially in the presence of thrombophilia. However, there is no consensus on the optimal approach for thromboprophylaxis in this population. Recent evidence suggests that thrombin generation correlates with the overall procoagulant state of the plasma. Our aim was to evaluate thrombin generation in a prospective cohort of thrombophilic pregnant women, and investigate the effectiveness of low-molecular-weight heparin (LMWH) prophylaxis in pregnancy. Women with severe (n=8), mild (n=47) and no (n=15) thrombophilia were followed throughout their pregnancies. Thrombin generation was evaluated in each trimester as well as five days and eight weeks postpartum (as a reference category). In women undergoing LMWH prophylaxis, thrombin generation and anti-Factor-Xa activity were measured just before and 4 hours after administration (peak effect). Thrombin generation was determined using Technothrombin TGA assay system. For the analysis, median peak thrombin and endogenous thrombin potential were used. Peak thrombin and endogenous thrombin potential were increased during pregnancy compared to the non-pregnant state with the highest results in the severe thrombophilia group. In women receiving LMWH prophylaxis a decrease was observed in thrombin generation at peak effect but over the progression of pregnancy the extent of this decrease reduced in a stepwise fashion. Our results show that thrombin generation demonstrates the hypercoagulable state in thrombophilic pregnancies. In addition, we found the effect of LMWH prophylaxis to progressively decrease with advancing stages of pregnancy.

  10. Low molecular weight heparins as extended prophylaxis against recurrent thrombosis in cancer patients.

    PubMed

    Engman, Cocav A; Zacharski, Leo R

    2008-08-01

    Cancer has been shown to be an independent risk factor for the development of venous thromboembolism (VTE; deep vein thrombosis and pulmonary embolism). Thromboprophylaxis reduces the incidence of VTE in patients with cancer; however, active cancer places patients at high risk for recurrent VTE, necessitating extended prophylactic regimens. Extended prophylaxis in patients with cancer can be problematic because of increased risk for bleeding. Oral anticoagulants, such as warfarin, have been the standard of care for extended prophylaxis, but maintaining a clinically effective level of anticoagulation can be difficult because of a wide range of drug interactions, a narrow therapeutic window, and an increased risk of bleeding complications, particularly in patients with cancer. Recent evidence indicates that long-term prophylaxis with low-molecular-weight heparins (LMWHs) is an effective and safe alternative to oral anticoagulation in patients with VTE and cancer, reducing the risk for recurrent VTE by up to 52%. LMWHs can also be seen as cost-effective for long-term prophylaxis, because higher drug acquisition costs are offset by the potential for reduced hospital stays, reduced need for coagulation monitoring, and fewer bleeding complications. Some studies suggest that LMWHs may also have direct antitumor effects and improve survival rates, most notably in patients with non-metastatic disease. Further clinical research is needed to evaluate the potential survival benefits of LMWH therapy in patients with cancer.

  11. Streptococcus mutans infective endocarditis complicated by vertebral discitis following dental treatment without antibiotic prophylaxis.

    PubMed

    Biswas, Sujata; Bowler, Ian C J W; Bunch, Christopher; Prendergast, Bernard; Webster, Daniel P

    2010-10-01

    We report what we believe is the first reported case of Streptococcus mutans endocarditis complicated by vertebral discitis. The case is particularly interesting and topical as it occurred in a patient with pre-existing cardiac valvular disease who had recently had a dental procedure without antibiotic prophylaxis following a dramatic shift in the UK guidelines.

  12. Pneumocystis carinii mutations are associated with duration of sulfa or sulfone prophylaxis exposure in AIDS patients.

    PubMed

    Kazanjian, P; Armstrong, W; Hossler, P A; Burman, W; Richardson, J; Lee, C H; Crane, L; Katz, J; Meshnick, S R

    2000-08-01

    This study was conducted to determine whether Pneumocystis carinii dyhydropteroate synthase (DHPS) gene mutations in AIDS patients with P. carinii pneumonia (PCP) are affected by duration of sulfa or sulfone prophylaxis and influence response to sulfa or sulfone therapy. The P. carinii DHPS genes from 97 AIDS patients with PCP between 1991 and 1999 from 4 medical centers were amplified, using polymerase chain reaction (PCR), and sequenced. Mutations were observed in 76% of isolates from patients exposed to sulfa or sulfone prophylaxis compared with 23% of isolates from patients not exposed (P=.001). Duration of prophylaxis increased the risk of mutations (relative risk [RR] for each exposure month, 1.06; P=.02). Twenty-eight percent of patients with mutations failed sulfa or sulfone treatment; mutations increased the risk of sulfa or sulfone treatment failure (RR, 2.1; P=0.01). Thus, an increased duration of sulfa or sulfone prophylaxis increases the chance of developing a P. carinii mutation. The majority of patients with mutations respond to sulfa or sulfone therapy.

  13. [Prophylaxis of thromboembolism in atrial fibrillation: new oral anticoagulants and left atrial appendage closure].

    PubMed

    Zeus, Tobias; Kelm, Malte; Bode, Christoph

    2015-08-01

    Thrombo-embolic prophylaxis is a key element within the therapy of atrial fibrillation/atrial flutter. Besides new oral anticoagulants the concept of left atrial appendage occlusion has approved to be a good alternative option, especially in patients with increased risk of bleeding.

  14. Efficacy of clarithromycin versus that of clindamycin for single-dose prophylaxis of experimental streptococcal endocarditis.

    PubMed Central

    Vermot, D; Entenza, J M; Vouillamoz, J; Glauser, M P; Moreillon, P

    1996-01-01

    Clarithromycin is compared with clindamycin for single-dose prophylaxis of streptococcal endocarditis in rats. Human-like kinetics of the two antibiotics prevented endocarditis in animals challenged with both small and large amounts of bacterial inocula. Clarithromycin was marginally superior to clindamycin against small amounts of inocula. Clarithromycin may be considered for endocarditis chemoprophylaxis in human. PMID:8851620

  15. Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin - review of the literature

    PubMed Central

    2011-01-01

    Major progress for the management of invasive aspergillosis has come from the introduction of new antifungals since the late 1990s. Although mortality of invasive aspergillosis remains as high as 30-50%. Backbone of management are prophylaxis, early diagnosis and early initiation of antifungals for reduction of invasive aspergillosis related mortality. Randomized trials have been undertaken for the prophylaxis as well as treatment of invasive aspergillosis in the last two decades. Posaconazole is recommended for prophylaxis against aspergillosis in patients treated for acute myelogenous leukemia, myelodysplastic syndrome or patients with graft versus host disease after allogeneic transplantation. Efficacy has been shown for first-line therapy of invasive aspergillosis with voriconazole and liposomal amphotericin B. Gastrointestinal resorption for the azoles posaconazole, voriconazole and itraconazole differ considerably. While oral voriconazole resportion is reduced when taken with food, posaconazole has to be taken with fatty food for optimal intestinal resorption. Beside all advances in the management of invasive aspergillosis important questions remain unresolved. This article reviews the current state of prophylaxis and treatment of invasive aspergillosis and points out clinicians unmet needs. PMID:21486728

  16. Treatment of febrile neutropenia and prophylaxis in hematologic malignancies: a critical review and update.

    PubMed

    Villafuerte-Gutierrez, Paola; Villalon, Lucia; Losa, Juan E; Henriquez-Camacho, Cesar

    2014-01-01

    Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis.

  17. Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update

    PubMed Central

    Villafuerte-Gutierrez, Paola; Villalon, Lucia; Losa, Juan E.; Henriquez-Camacho, Cesar

    2014-01-01

    Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis. PMID:25525436

  18. Absence of VOD in paediatric thalassaemic HSCT recipients using defibrotide prophylaxis and intravenous Busulphan.

    PubMed

    Cappelli, Barbara; Chiesa, Robert; Evangelio, Costanza; Biffi, Alessandra; Roccia, Tito; Frugnoli, Ilaria; Biral, Erika; Noè, Anna; Fossati, Marco; Finizio, Valentina; Miniero, Roberto; Napolitano, Sara; Ferrua, Francesca; Soliman, Clara; Ciceri, Fabio; Roncarolo, Maria G; Marktel, Sarah

    2009-11-01

    Hepatic veno-occlusive disease (VOD) is a common complication of haematopoietic stem cell transplantation (HSCT), with reported incidences of 5-40% in children. Recently, defibrotide (DF) has been successfully used as prophylaxis and treatment of VOD. This study reports data on 63 human leucocyte antigen-matched HSCT performed in 57 children affected by beta thalassemia at very high risk for developing VOD (liver fibrosis, iron overload, hepatitis C virus infections, busulphan-based conditioning, methotraexate + ciclosporine). All patients received a busulphan-based conditioning regimen, either orally (four HSCT) or intravenously (59 HSCT). All patients received oral DF (40 mg/kg per day, final dose) as VOD prophylaxis from median day -9 to median day +29. In order to overcome the lack of oral paediatric formulations, a galenic formulation was administered. DF was well tolerated. Only one patient fulfilled Seattle Criteria for VOD diagnosis. This patient had discontinued DF 6 d prior to VOD onset, due to high risk of haemorrhage. We concluded that oral defibrotide prophylaxis and i.v. busulphan safely abated VOD incidence in high-risk patients who had undergone HSCT. A galenic preparation of oral DF also permits this treatment in low-weight patients. Costs of DF prophylaxis are acceptable considering the reduced incidence of VOD.

  19. Neuropsychological sequelae of central nervous system prophylaxis in survivors of childhood acute lymphoblastic leukemia

    SciTech Connect

    Said, J.A.; Waters, B.G.; Cousens, P.; Stevens, M.M.

    1989-04-01

    We assessed neuropsychologically 106 children with acute lymphoblastic leukemia (ALL) who had all received cranial irradiation for the prevention of central nervous system (CNS) leukemia 1-13 years previously. Children were assessed for adverse late effects of their therapy, using age-appropriate Wechsler measures of overall intellectual ability and supplementary tests. Forty-five siblings near in age to the patients were tested as controls. The patients who had had the most intensive central nervous system (CNS) prophylaxis were found to have a WISC-R Full Scale IQ 17 points lower than the sibling control group. Performance IQ was more affected than verbal IQ. The patients were more easily distracted and less able to concentrate. The severity of the aftereffects was related to younger age at the time of CNS prophylaxis and to a higher dose of cranial irradiation but not to time since CNS prophylaxis. CNS prophylaxis using a combination of cranial irradiation and intrathecal methotrexate has lowered the incidence of CNS relapse in childhood ALL but is associated with considerable long-term morbidity in survivors.

  20. Antibiotic surgical prophylaxis increases nasal carriage of antibiotic-resistant staphylococci.

    PubMed

    McMurray, Claire L; Hardy, Katherine J; Verlander, Neville Q; Hawkey, Peter M

    2015-12-01

    Staphylococci are a significant cause of hospital-acquired infection. Nasal carriage of Staphylococcus aureus is an important risk factor for infection in surgical patients and coagulase-negative staphylococci (CNS) are a major cause of prosthetic joint infections. The impact that antibiotic surgical prophylaxis has on the nasal carriage of staphylococci has not been studied. Daily nasal swabs were taken from 63 patients who received antibiotic surgical prophylaxis and 16 patients who received no antibiotics. Total aerobic bacterial count, S. aureus and CNS were enumerated by culture from nasal swabs. Representative isolates were typed by staphylococcal interspersed repeat units (SIRU) typing and PFGE, and MICs to nine antibiotics were determined. After antibiotic administration, there was a reduction in S. aureus counts (median - 2.3 log(10)c.f.u. ml(- 1)) in 64.0 % of S. aureus carriers, compared with only a 0.89 log(10)c.f.u. ml(- 1) reduction in 75.0 % of S. aureus carriers who did not receive antibiotics. A greater increase in the nasal carriage rate of meticillin-resistant CNS was observed after antibiotic surgical prophylaxis compared with hospitalization alone, with increases of 16.4 and 4.6 %, respectively. Antibiotic-resistant S. epidermidis carriage rate increased by 16.6 % after antibiotic administration compared with 7.5 % with hospitalization alone. Antibiotic surgical prophylaxis impacts the nasal carriage of both S. aureus and CNS.

  1. Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin: review of the literature.

    PubMed

    Karthaus, M

    2011-04-28

    Major progress for the management of invasive aspergillosis has come from the introduction of new antifungals since the late 1990s. Although mortality of invasive aspergillosis remains as high as 30-50%. Backbone of management are prophylaxis, early diagnosis and early initiation of antifungals for reduction of invasive aspergillosis related mortality. Randomized trials have been undertaken for the prophylaxis as well as treatment of invasive aspergillosis in the last two decades. Posaconazole is recommended for prophylaxis against aspergillosis in patients treated for acute myelogenous leukemia, myelodysplastic syndrome or patients with graft versus host disease after allogeneic transplantation. Efficacy has been shown for first-line therapy of invasive aspergillosis with voriconazole and liposomal amphotericin B. Gastrointestinal resorption for the azoles posaconazole, voriconazole and itraconazole differ considerably. While oral voriconazole resportion is reduced when taken with food, posaconazole has to be taken with fatty food for optimal intestinal resorption. Beside all advances in the management of invasive aspergillosis important questions remain unresolved. This article reviews the current state of prophylaxis and treatment of invasive aspergillosis and points out clinicians unmet needs.

  2. Risk-assessment algorithm and recommendations for venous thromboembolism prophylaxis in medical patients

    PubMed Central

    T Rocha, Ana; F Paiva, Edison; Lichtenstein, Arnaldo; Milani, Rodolfo; Cavalheiro-Filho, Cyrillo; H Maffei, Francisco

    2007-01-01

    The risk for venous thromboembolism (VTE) in medical patients is high, but risk assessment is rarely performed because there is not yet a good method to identify candidates for prophylaxis. Purpose To perform a systematic review about VTE risk factors (RFs) in hospitalized medical patients and generate recommendations (RECs) for prophylaxis that can be implemented into practice. Data sources A multidisciplinary group of experts from 12 Brazilian Medical Societies searched MEDLINE, Cochrane, and LILACS. Study selection Two experts independently classified the evidence for each RF by its scientific quality in a standardized manner. A risk-assessment algorithm was created based on the results of the review. Data synthesis Several VTE RFs have enough evidence to support RECs for prophylaxis in hospitalized medical patients (eg, increasing age, heart failure, and stroke). Other factors are considered adjuncts of risk (eg, varices, obesity, and infections). According to the algorithm, hospitalized medical patients ≥40 years-old with decreased mobility, and ≥1 RFs should receive chemoprophylaxis with heparin, provided they don’t have contraindications. High prophylactic doses of unfractionated heparin or low-molecular-weight-heparin must be administered and maintained for 6–14 days. Conclusions A multidisciplinary group generated evidence-based RECs and an easy-to-use algorithm to facilitate VTE prophylaxis in medical patients. PMID:17969384

  3. Venous thromboembolism prophylaxis for hospitalized medical patients, current status and strategies to improve

    PubMed Central

    Abdel-Razeq, Hikmat

    2010-01-01

    Venous thromboembolism (VTE), comprising life-threatening pulmonary embolism (PE) and its precursor deep-vein thrombosis (DVT), is commonly encountered problem. Although most patients survive DVT, they often develop serious and costly long-term complications. Both unfractionated heparin and low molecular weight heparins significantly reduce the incidence of VTE and its associated complications. Despite the evidence demonstrating significant benefit of VTE prophylaxis in acutely ill medical patients, several registries have shown significant underutilization. This underutilization indicates the need for educational and audit programs in order to increase the number of medical patients receiving appropriate prophylaxis. Many health advocacy groups and policy makers are paying more attention to VTE prophylaxis; the National Quality Forum and the Joint Commission recently endorsed strict VTE risk assessment evaluation for each patient upon admission and regularly thereafter. In the article, all major studies addressing this issue in medical patients have been reviewed from the PubMed. The current status of VTE prophylaxis in hospitalized medical patients is addressed and some improvement strategies are discussed. PMID:20981179

  4. Prophylaxis against Organophosphorous Nerve Agents - State of the Art (profylaxe tegen organofosfaat zenuwgassen - stand van zaken)

    DTIC Science & Technology

    2005-12-01

    exposure studies an exponent of the LD5 0 value is mostly used. For carbamate (prophylaxis) dosages the level of AChE inhibition is used. However, the most...residues essential for human paraoxonase (PONI) arylesterase/organophosphatase activities. Biochemistry 38, 2816-2825, 1999. Keeler JR, Hurst CG

  5. Comparison of flunarizine and topiramate for the prophylaxis of pediatric migraines.

    PubMed

    Kim, Hunmin; Byun, Sung Hwan; Kim, Jon Soo; Lim, Byung Chan; Chae, Jong-Hee; Choi, Jieun; Kim, Ki Joong; Hwang, Yong Seung; Hwang, Hee

    2013-01-01

    The purpose of this study was to compare the efficacy and tolerability of topiramate and flunarizine for the prophylaxis of pediatric migraines. A retrospective medical-record review of patients who underwent prophylaxis after receiving a diagnosis of migraine with aura and without aura was performed. Only patients who completed at least 3 months of treatment were included in the analysis. Response to treatment was assessed as the total number of headache days/month. Patients with more than 50% reduction in headache days/month were classified as responders. Responder rate, retention rate, and adverse-event rates were also calculated from all patients who started on the prophylaxis. Further analyses were performed using different patient groups with a cut-off age of 12 years. The responder rate was 80% (89/111 patients) for flunarizine and 81% (122/150 patients) for topiramate, based on a comparison among 261 patients. The retention rate was 67% for flunarizine and 63% for topiramate and the adverse-event rate was 6% for flunarizine and 10% for topiramate. The responder rate, the retention rate, and the adverse-event rate were not significantly different between flunarizine and topiramate. These findings were concordant between the preadolescent (6-12 years old) and adolescent (13-18 years old) groups. The efficacy and tolerability of topiramate were not inferior to those of flunarizine for the prophylaxis of pediatric migraines. These findings were observed in preadolescent and adolescent patients.

  6. Community-based, nurse-led post-exposure prophylaxis: results and implications.

    PubMed

    O'Byrne, Patrick; MacPherson, Paul; Roy, Marie; Orser, Lauren

    2017-04-01

    HIV medications can be used as post-exposure prophylaxis to efficaciously prevent an HIV-negative person who has come into contact with HIV from becoming HIV-positive. Traditionally, these medications have been available in emergency departments, which have constituted a barrier for the members of many minority groups who are greatly affected by HIV transmission (i.e. gay, bisexual and other men who have sex with men, and persons who use injection drugs). From 5 September 2013 through 4 September 2015, we sought to increase the use of HIV post-exposure prophylaxis by having registered nurses provide these medications, when indicated, in community clinics in Ottawa, Canada. We undertook a chart review of patients who accessed services for HIV post-exposure prophylaxis in this period. Over the two years of data collection, 112 persons requested HIV post-exposure prophylaxis and 64% (n = 72) initiated these medications. Most (93%, or n = 67, of the 72 initiations) were among men, with 88% (n = 59) of these men reporting same sex sexual partners. Among these 58 men, 31% (n = 18) had sexual contact with other men known to be HIV-positive. Among women (n = 8), five initiated post-exposure prophylaxis: three after needle-sharing contact or sexual contact with a male partner who reportedly shared needles, and two after unprotected vaginal sex with a male partner known to be HIV-positive. Overall, no one was diagnosed with HIV at the four-month HIV testing follow-up, although six persons were diagnosed with HIV from the baseline HIV testing, and an additional four were diagnosed with HIV during routine HIV testing one year after completing post-exposure prophylaxis. In total, nine persons in our sample were thus diagnosed with HIV during the study period, which accounted for 9.4% (n = 10 of 106) of all reported HIV diagnoses in Ottawa during this time. We conclude that nurse-initiated HIV post-exposure prophylaxis can be an effective way to provide

  7. [WHO recommended pre-exposure prophylaxis for rabies using Japanese rabies vaccine].

    PubMed

    Yanagisawa, Naoki; Takayama, Naohide; Suganuma, Akihiko

    2008-09-01

    After severe exposure to suspected rabid animal, WHO recommends a complete vaccine series using a potent effective vaccine that meets WHO criteria, and administration of rabies immunoglobulin (RIG). RIG is not available globally, and is not marketed in Japan. If pre-exposure prophylaxis for rabies is given, RIG is unnecessary even after severe exposure. It is thus important to give pre-exposure prophylaxis for rabies to people who plan to go to rabies-endemic areas. In Japan, pre-exposure prophylaxis for rabies consists of 3 doses of cell-culture rabies vaccine. The first two doses are given 4 weeks apart, and the third dose is given 6-12 months after the first dose, all of which are injected subcutaneously (standard regimen). People who plan to travel abroad to rabies-endemic areas may know of their destinations only 1 or 2 months in advance at best. Therefore, it is virtually impossible to complete the 3 dose regimen for rabies in Japan. Pre-exposure prophylaxis recommended by WHO consists of 3 doses given intramuscularly on days 0, 7, and 28, making it possible to complete pre-exposure prophylaxis in one month. This WHO recommended pre-exposure prophylaxis using Japanese cell-cultured rabies vaccine (PCEC-K) has not been studied, so we elected to fill the gap using PCEC-K, administered based on the WHO recommendation and examined its efficacy and safety. Subjects were 26 healthy volunteers with no previous rabies vaccination giving oral and written consent. Vaccine was administered on days 0, 7, and 28, and rabies antibody levels were tested on days 7, 28, and 42. On day 7, every antibody level was negative. On day 28, antibody levels were between 0.7-3.5 EU/ mL, with the exception of 3 cases still negative. On day 42, all cases, including the 3 negative cases, exceeded 1.6 EU/mL, providing sufficient protection against rabies. This result was not inferior compared to the standard regimen. Local adverse effects such as erythema and pain were noted, but none were

  8. Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever

    PubMed Central

    2010-01-01

    Background More than 15 million people worldwide have rheumatic fever (RF) and rheumatic heart disease due to RF. Secondary prophylaxis is a critical cost-effective intervention for preventing morbidity and mortality related to RF. Ensuring adequate adherence to secondary prophylaxis for RF is a challenging task. This study aimed to describe the rates of recurrent episodes of RF, quantify adherence to secondary prophylaxis, and examine the effects of medication adherence to the rates of RF in a cohort of Brazilian children and adolescents with RF. Methods This retrospective study took place in the Pediatric Rheumatology outpatient clinic at a tertiary care hospital (Instituto de Puericultura e Pediatria Martagão Gesteira) in Rio de Janeiro, Brazil, and included patients with a diagnosis of RF from 1985 to 2005. Results 536 patients with RF comprised the study sample. Recurrent episodes of RF occurred in 88 of 536 patients (16.5%). Patients with a recurrent episode of RF were younger (p < 0.0001), more frequently males (p = 0.003), and less adherent (p < 0.0001) to secondary prophylaxis than patients without RF recurrence. Non-adherence to medication at any time during follow-up was detected in 35% of patients. Rates of non-adherence were higher in the group of patients that were lost to follow-up (42%) than in the group of patients still in follow-up (32%) (p = 0.027). Appointment frequency was inadequate in 10% of patients. Higher rates of inadequate appointment frequency were observed among patients who were eventually lost to follow-up (14.5%) than in patients who were successfully followed-up (8%) (p = 0.022). 180 patients (33.5%) were lost to follow up at some point in time. Conclusions We recommend implementation of a registry, and a system of active search of missing patients in every service responsible for the follow-up of RF patients. Measures to increase adherence to secondary prophylaxis need to be implemented formally, once non-adherence to secondary

  9. Intravenous pentamidine for Pneumocystis carinii/jiroveci pneumonia prophylaxis in pediatric transplant patients.

    PubMed

    Clark, Abigail; Hemmelgarn, Trina; Danziger-Isakov, Lara; Teusink, Ashley

    2015-05-01

    SMX/TMP is the current gold standard for prophylaxis against PCP in immunocompromised pediatric patients. Currently, there are several second-line options for prophylaxis but many, including intravenous (IV) pentamidine, have not been reported to be as effective or as safe as SMX/TMP in the pediatric transplant population. This study is to determine the efficacy and safety of IV pentamidine in preventing PCP in pediatric transplant patients. A retrospective chart review was conducted to evaluate all transplant patients that received at least one dose of IV pentamidine from January 2010 to July 2013. The primary outcome, IV pentamidine efficacy, was evaluated by the incidence of PCP diagnosis for 28 days after the last dose of IV pentamidine if patient was transitioned to another agent for PCP prophylaxis. Patients on IV pentamidine for entire course of PCP prophylaxis were followed at least six months after discontinuation of IV pentamidine. The safety of IV pentamidine was assessed by the incidence of adverse events leading to pentamidine discontinuation. All data were analyzed using descriptive statistics. All transplant patients at CCHMC who had received IV pentamidine were reviewed, and 333 patients met inclusion criteria. The overall incidence of PCP was found to be 0.3% for pediatric transplant patients on pentamidine. Pentamidine was found to be safe, and the incidence of adverse events leading to discontinuation was 6% with the most common reason being tachycardia 2.1%. IV pentamidine is safe and effective as PCP prophylaxis in pediatric transplant patients with a PCP breakthrough rate of 0.3% (1 of 333 patients), and only 20 adverse events led to discontinuation. We recommend that IV pentamidine be considered as a second-line option in pediatric transplant patients who cannot tolerate SMX/TMP.

  10. Veno-occlusive disease prophylaxis with fresh frozen plasma and heparin in bone marrow transplantation.

    PubMed

    Batsis, Ioannis; Yannaki, Evangelia; Kaloyannidis, Panayotis; Sakellari, Ioanna; Smias, Christos; Georgoulis, Ioannis; Fassas, Athanasios; Anagnostopoulos, Achilles

    2006-01-01

    Fresh frozen plasma (FFP) contains natural anticoagulants, such as antithrombin (AT) and Protein C (Prot-C). We hypothesized that FFP given in addition to heparin, could potentially replace the consumption of endogenous anticoagulants occurring during conditioning and moreover, corrected AT levels could augment heparin's anticoagulant function. This could therefore result in an effective anti-VOD prophylaxis. In this study, we retrospectively analyzed the incidence of hepatic VOD in 403 consecutive bone marrow transplants (BMTs) comparing 2 prophylactic regimens and no prophylaxis. Patients received no prophylaxis (70/403), heparin-only (27/403) or heparin+2FFP daily during conditioning (306/403). VOD was significantly lower in the heparin+FFP group (5.9%) compared to heparin (20%) and no prophylaxis group (15.7%) [p<0.01]. Day 8 AT and Prot-C levels, were lower in the VOD- compared to the non-VOD group (AT: 69+/-26% vs. 89+/-19%, Prot-C:68+/-26% vs. 91+/-29%, respectively, p=0.001). In a multivariate logistic regression, risk factors for developing VOD were: the administration of >2 hepato-nephrotoxic drugs, previous history of hepatitis B or C and number of BMT. Multivariate analysis in a subset of 198 patients (all having recorded AT, Prot-C), demonstrated as VOD-related factors, the low day 8 Prot-C, number of BMT>1 and prior abdominal radiotherapy. Our study implies that FFP during conditioning, in addition to heparin, potentially has an anti-VOD prophylactic effect, presumably by minimizing the drop of natural anticoagulants around day 8. In order to evaluate if there truely is a beneficial effect of heparin+FFP in VOD prophylaxis, we have initiated a prospective randomized trial.

  11. Prophylaxis on gout flares after the initiation of urate-lowering therapy: a retrospective research

    PubMed Central

    Feng, Xin; Li, Yao; Gao, Wei

    2015-01-01

    The objective of this study was to evaluate the efficacy and safety associated with treatment available to prevent an acute attack of gout when initiating a urate-lowering therapy (ULT). We retrospectively reviewed patients who were diagnosed with gout and treated with ULT during the period from January 2000 to January 2014. They were divided into three groups, 75 patients without prophylaxis treatment, 103 patients treated with etoricoxib, and 129 patients with colchicine treatment. Both demographic and clinical characteristics associated with gout were analyzed. At baseline, demographic and clinical characteristics were generally similar in three groups. SU target level was achieved in 49.3% of the patients without prophylaxis treatment, 66.4% in the etoricoxib group and 65.1% in colchicine group, respectively. During the first 16 weeks, patients without prophylaxis treatment exhibited higher flare rates than patients in other two groups. However, no statistically significant difference was observed between patients in etoricoxib group and colchicine group. In the 16-24 weeks, the proportion of patients who reported flares were all decreased similarly in three groups. The mean number of acute gout flares per patient and gout flare days per patient was significantly higher in patients without prophylaxis treatment than patients in other groups. The mean number of acute gout flares was lower (4.2±2.3 vs 3.2±1.8) in patients with etoricoxib treatment than that in patients with colchicine treatment. Gout flare days per patient were significantly higher in patients without prophylaxis treatment. Compared to colchicine group, gout flare days per patient in etoricoxib were lower (1.2±0.5 vs 2.6±0.6). In term of AEs, patients receiving colchicine had higher rates of gastrointestinal AEs than those who received etoricoxib. In summary, our survey revealed that etoricoxib was more effective and safe than colchicine in preventing acute attack during ULT. PMID:26885092

  12. Antifungal prophylaxis in liver transplantation: a systematic review and network meta-analysis.

    PubMed

    Evans, J D W; Morris, P J; Knight, S R

    2014-12-01

    Invasive fungal infections (IFIs) cause significant morbidity and mortality in liver transplant recipients, but the need and best agent for prophylaxis is uncertain. A comprehensive literature search was performed to identify randomized controlled trials comparing regimens for antifungal prophylaxis in liver transplant recipients. Direct comparisons were made between treatments using random-effects meta-analysis and a Bayesian network meta-analysis was performed for the primary end point of proven IFI. Fourteen studies met inclusion criteria, reporting comparisons of fluconazole, liposomal amphotericin B (L-AmB), itraconazole, micafungin and placebo. Overall, antifungal prophylaxis reduced the rate of proven IFI (odds ratio [OR] 0.37, confidence interval [CI] 0.19-0.72, p = 0.003), suspected or proven IFI (OR 0.40, CI 0.25-0.66, p = 0.0003) and mortality due to IFI (OR 0.32, CI 0.10-0.83, p = 0.02) when compared to placebo. All-cause mortality was not significantly affected. There was no difference in risk of adverse events requiring cessation of prophylaxis (OR 1.11, 95% CI 0.48-2.55, p = 0.81). In the network meta-analysis an equivalent reduction in the rate of IFI was seen with fluconazole (OR 0.21, CI 0.06-0.57) and L-AmB (OR 0.21, CI 0.05-0.71) compared with placebo. Routine prophylaxis with fluconazole or L-AmB reduces the incidence of IFI following liver transplantation, and the available evidence suggests that the two are equivalent in efficacy.

  13. Hepatitis B-related serological events in hematopoietic stem cell transplant patients and efficacy of lamivudine prophylaxis against reactivation.

    PubMed

    Gupta, Alok; Punatar, Sachin; Gawande, Jayant; Bagal, Bhausaheb; Mathew, Libin; Bhat, Vivek; Kannan, Sadhana; Khattry, Navin

    2016-09-01

    Reactivation of remote hepatitis B infection (RHBI) is an important cause of morbidity in hematopoietic cell transplant (HCT) patients. We analyzed the prevalence of RHBI in 205 patients who underwent HCT in our centre, serological events related to hepatitis B virus (HBV) reactivation and role of lamivudine prophylaxis in HCT patients with RHBI. The prevalence of RHBI was 14% (28/205 patients). Of these 28 patients, 15 received lamivudine prophylaxis (14 anti-HBcIgG positive and 1 only anti-HBs positive) while 13 did not receive lamivudine prophylaxis (12 anti-HBs positive and 1 anti-HBcIgG positive). None in prophylaxis group developed HBV reactivation while 12 of 13 in no-prophylaxis group reactivated (P < 0.001). The rate of HBV reactivation was 10% (21/205 patients), which included 9 patients with no evidence of RHBI pre-transplant. We conclude that lamivudine prophylaxis protects against HBV reactivation in HCT patients with evidence of RHBI. Lamivudine prophylaxis should be used not only in patients with anti-HBcIgG positivity but also in those with isolated anti-HBs positivity pre-transplant given the high rate of HBV reactivation in these patients. HBV serology cannot identify all cases with RHBI and therefore does not preclude HBV reactivation post-transplant. Copyright © 2015 John Wiley & Sons, Ltd.

  14. [How to implement a guideline from theory to practice: the example of the venous thromboembolism prophylaxis].

    PubMed

    Paiva, Edison F; Rocha, Ana T C

    2009-01-01

    The objective of this manuscript is to discuss the existing barriers for the dissemination of medical guidelines, and to present strategies that facilitate the adaptation of the recommendations into clinical practice. The literature shows that it usually takes several years until new scientific evidence is adopted in current practice, even when there is obvious impact in patients' morbidity and mortality. There are some examples where more than thirty years have elapsed since the first case reports about the use of a effective therapy were published until its utilization became routine. That is the case of fibrinolysis for the treatment of acute myocardial infarction. Some of the main barriers for the implementation of new recommendations are: the lack of knowledge of a new guideline, personal resistance to changes, uncertainty about the efficacy of the proposed recommendation, fear of potential side-effects, difficulties in remembering the recommendations, inexistence of institutional policies reinforcing the recommendation and even economical restrains. In order to overcome these barriers a strategy that involves a program with multiple tools is always the best. That must include the implementation of easy-to-use algorithms, continuous medical education materials and lectures, electronic or paper alerts, tools to facilitate evaluation and prescription, and periodic audits to show results to the practitioners involved in the process. It is also fundamental that the medical societies involved with the specific medical issue support the program for its scientific and ethical soundness. The creation of multidisciplinary committees in each institution and the inclusion of opinion leaders that have pro-active and lasting attitudes are the key-points for the program's success. In this manuscript we use as an example the implementation of a guideline for venous thromboembolism prophylaxis, but the concepts described here can be easily applied to any other guideline

  15. Predicting HIV Pre-exposure Prophylaxis Efficacy for Women using a Preclinical Pharmacokinetic-Pharmacodynamic In Vivo Model

    PubMed Central

    Wahl, Angela; Ho, Phong T.; Denton, Paul W.; Garrett, Katy L.; Hudgens, Michael G.; Swartz, Glenn; O’Neill, Cynthia; Veronese, Fulvia; Kashuba, Angela D.; Garcia, J. Victor

    2017-01-01

    The efficacy of HIV pre-exposure prophylaxis (PrEP) relies on adherence and may also depend on the route of HIV acquisition. Clinical studies of systemic tenofovir disoproxil fumarate (TDF) PrEP revealed reduced efficacy in women compared to men with similar degrees of adherence. To select the most effective PrEP strategies, preclinical studies are critically needed to establish correlations between drug concentrations (pharmacokinetics [PK]) and protective efficacy (pharmacodynamics [PD]). We utilized an in vivo preclinical model to perform a PK-PD analysis of systemic TDF PrEP for vaginal HIV acquisition. TDF PrEP prevented vaginal HIV acquisition in a dose-dependent manner. PK-PD modeling of tenofovir (TFV) in plasma, female reproductive tract tissue, cervicovaginal lavage fluid and its intracellular metabolite (TFV diphosphate) revealed that TDF PrEP efficacy was best described by plasma TFV levels. When administered at 50 mg/kg, TDF achieved plasma TFV concentrations (370 ng/ml) that closely mimicked those observed in humans and demonstrated the same risk reduction (70%) previously attained in women with high adherence. This PK-PD model mimics the human condition and can be applied to other PrEP approaches and routes of HIV acquisition, accelerating clinical implementation of the most efficacious PrEP strategies. PMID:28145472

  16. Flexitouch® Home Maintenance Therapy or Standard Home Maintenance Therapy in Treating Patients With Lower-Extremity Lymphedema Caused by Treatment for Cervical Cancer, Vulvar Cancer, or Endometrial Cancer

    ClinicalTrials.gov

    2014-12-29

    Lymphedema; Stage 0 Cervical Cancer; Stage 0 Uterine Corpus Cancer; Stage 0 Vulvar Cancer; Stage I Uterine Corpus Cancer; Stage I Vulvar Cancer; Stage IA Cervical Cancer; Stage IB Cervical Cancer; Stage II Uterine Corpus Cancer; Stage II Vulvar Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage III Uterine Corpus Cancer; Stage III Vulvar Cancer; Stage IV Uterine Corpus Cancer; Stage IVA Cervical Cancer; Stage IVB Cervical Cancer; Stage IVB Vulvar Cancer

  17. Preferences for HIV pre-exposure prophylaxis (PrEP) information among men-who-have-sex-with-men (MSM) at community outreach settings

    PubMed Central

    Merchant, Roland C.; Corner, David; Garza, Eduardo; Guan, Wentao; Mayer, Kenneth H.; Brown, Larry; Chan, Philip A

    2016-01-01

    Community outreach efforts to increase HIV pre-exposure prophylaxis (PrEP) utilization by at risk men-who-have-sex-with-men (MSM) first need to elucidate preferences for learning about PrEP and linking to PrEP resources. In this pilot study, we observed that among MSM recruited through community outreach, HIV sexual risk-taking was significant, yet self-perceived PrEP knowledge was low and interest in learning more about PrEP was moderate. Most preferred learning about PrEP and being provided local PrEP clinic information through electronic media. However, receipt of PrEP information alone did not appear to motivate these men into presenting to a local clinic for PrEP evaluation. PMID:27076865

  18. Guide to Understanding Lymphedema

    MedlinePlus

    ... Therapy Acupuncture Art Therapy Expressive Writing Guided Imagery Hypnosis Massage Therapy Mindfulness-Based Stress Reduction Yoga and ... Help Donate Donate Now Gift in Honor or Memory Of Matching Gifts Planned Giving Stock Gifts Workplace ...

  19. Correlation of antibiotic prophylaxis and difficulty of extraction with postoperative inflammatory complications in the lower third molar surgery.

    PubMed

    Lee, J Y; Do, H S; Lim, J H; Jang, H S; Rim, J S; Kwon, J J; Lee, E S

    2014-01-01

    Our aim was to investigate the correlation among antibiotic prophylaxis, difficulty of extraction, and postoperative complications in the removal of lower 3rd molars. A total of 1222 such extractions in 890 patients between January 2010 and January 2012 were analysed retrospectively. The difficulty of extraction measured by Pederson's index, antibiotic prophylaxis with cefditoren, and postoperative complications were recorded. The difficulty of extraction was significantly associated with postoperative complications (p=0.03). There were no significant associations between antibiotic prophylaxis and postoperative complications in groups of equal difficulty ("easy" group (class I) p=1.00; "moderate" group (class II) p=1.00; and "difficult" group (class III) p=0.65). There was a small but insignificant increase in the number of dry sockets and infections in class III cases. In conclusion, this study provides further evidence that antibiotic prophylaxis for the prevention of postoperative inflammatory complications is unnecessary for extraction of 3rd molars.

  20. Clinical consequences and cost of limiting use of vancomycin for perioperative prophylaxis: example of coronary artery bypass surgery.

    PubMed Central

    Zanetti, G.; Goldie, S. J.; Platt, R.

    2001-01-01

    Routine us of vancomycin for perioperative prophylaxis is discouraged, principally to minimize microbial resistance to it. However, outcomes and costs of this recommendation have not been assessed. We used decision-analytic models to compare clinical results and cost-effectiveness of no prophylaxis, cefazolin, and vancomycin, in coronary artery bypass graft surgery. In the base case, vancomycin resulted in 7% fewer surgical site infections and 1% lower all-cause mortality and saved $117 per procedure, compared with cefazolin. Cefazolin, in turn, resulted in substantially fewer infections and deaths and lower costs than no prophylaxis. We conclude that perioperative antibiotic prophylaxis with vancomycin is usually more effective and less expensive than cefazolin. Data on vancomycin's impact on resistance are needed to quantify the trade-off between individual patients' improved clinical outcomes and lower costs and the future long-term consequences to society. PMID:11747694