Pelvic lymphedema in rectal cancer: a magnetic resonance feasibility study: a preliminary report.
Vannelli A, Basilico V, Zanardo M, Caizzone A, Rossi F, Battaglia L, Scaramuzza
Division of Gastrointestinal and Surgical Oncology, Ospedale Valduce, Como,Italy. firstname.lastname@example.org.
Functional pelvic disorders in patients undergoing conservative surgical approach for rectal cancer are considered a major public health issue and
represent one third of cost of colorectal cancer. We investigated the hypothesis that lymphadenectomy, involves the pelvic floor results in a localized hides or
silent pelvic lymphedema characterized by symptoms without signs.
PATIENTS AND METHODS:
We examined 13 colo-rectal cancer patients: five intra-peritoneal adenocarcinoma: 1 sigmoid and 4 upper third rectal cancer (1 male and 3 female)and 9 extra-peritoneal adenocarcinoma: 3 middle and 5 lower third rectal
cancer (4 male and 5 female) using 1.5-T magnetic resonance, one week before and twelve months after discharged from hospital.
Lymphedema was discovered on post-operative magnetic resonance imaging of all 9 patients with extra-pertitoneal cancer, whereas preoperative magnetic resonance
imaging as well as a post-operative examination of 4 intra-peritoneal adenocarcinoma, revealed no evidence of lymphedema. Unlike the common clinical skin signs that typify all other sites of lymphedema, pelvic lymphedema is hides or silent, with no skin changes or any single symptom manifested. Magnetic resonance imaging showed that pelvic illness alone is accompanied by lymphedema related exclusively to venous congestion, and accumulation of liquid in adipose
tissue or lipedema.
Alteration of the pelvic lymphatic network during pelvic surgery can lead to lymphedema and, pelvic floor disease. Patients should be routinely examined for
the possibility of developing this post-surgical syndrome and further studies are needed to establish diagnosis and to evaluate treatment preferences.
Saturday, May 4, 2013
Wednesday, April 10, 2013
Friday, March 29, 2013
Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphoedema.
Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphedema.
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: email@example.com.
Lymphoscintigraphy is the gold-standard examination for extremity lymphoedema. Indocyanine green lymphography may be useful for diagnosis as well. We compared the utility of these two examination methods for patients with suspected extremity lymphoedema and for those in whom surgical treatment of lymphoedema was under consideration.
A total of 169 extremities with lymphoedema secondary to lymph node dissection and 65 extremities with idiopathic oedema (suspected primary lymphoedema) were evaluated; the utility of indocyanine green lymphography for diagnosis was compared with lymphoscintigraphy. Regression analysis between lymphoscintigraphy type and indocyanine green lymphography stage was conducted in the secondary lymphoedema group.
In secondary oedema, the sensitivity of indocyanine green lymphography, compared with lymphoscintigraphy, was 0.972, the specificity was 0.548 and the accuracy was 0.816. When patients with lymphoscintigraphy type I and indocyanine green lymphography stage I were regarded as negative, the sensitivity of the indocyanine green lymphography was 0.978, the specificity was 0.925 and the accuracy was 0.953. There was a significant positive correlation between the lymphoscintigraphy type and the indocyanine green lymphography stage. In idiopathic oedema, the sensitivity of indocyanine green lymphography was 0.974, the specificity was 0.778 and the accuracy was 0.892.
In secondary lymphoedema, earlier and less severe dysfunction could be detected by indocyanine green lymphography. Indocyanine green lymphography is recommended to determine patients' suitability for lymphaticovenular anastomosis, because the diagnostic ability of the test and its evaluation capability for disease severity is similar to lymphoscintigraphy but with less invasiveness and a lower cost. To detect primary lymphoedema, indocyanine green lymphography should be used first as a screening examination; when the results are positive, lymphoscintigraphy is useful to obtain further information.
The Impact of Living With Severe Lower Extremity Lymphedema: A Utility Outcomes Score Assessment.
From the *Division of Plastic and Reconstructive Surgery, Montreal General Hospital, †Faculty of Medicine, McGill University, Montreal, Quebec, Canada; and ‡Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
BACKGROUND: Debilitating lower extremity lymphedema can be either congenital or acquired. Utility scores are an objective measure used in medicine to quantify degrees of impact on an individual's life. Using standardized utility outcome measures, we aimed to quantify the health state of living with severe unilateral lower extremity lymphedema.
A utility outcomes assessment using visual analog scale, time trade-off, and standard gamble was used for lower extremity lymphedema, monocular blindness, and binocular blindness from a sample of the general population and medical students. Average utility scores were compared using a paired t test. Linear regression was performed using age, race, and education as independent predictors.
RESULTS: A total of 144 prospective participants were included. All measures [visual analog scale, time trade-off, and standard gamble; expressed as mean (SD)] for unilateral lower extremity lymphedema± 0.22, and 0.76 ± respectively) were significantly different from the corresponding scores for monocular blindness (0.64 ± 0.18, 0.84 ± 0.16, and 0.83 ± 0.17, respectively) and binocular blindness and 0.62 ± 0.26, respectively).
We found that a sample of the general population and medical students, if faced with severe lymphedema, is willing to theoretically trade 8.64 life-years and undergo a procedure with a 24% risk of mortality to restore limb appearance and function to normal. These findings provide a frame of reference regarding the meaning of a diagnosis of severe lower extremity lymphedema to a patient and will allow objective comparison with other health states.
Sunday, February 24, 2013
Chronic of filarial origin: a very rare etiology of cutaneous lymphangiosarcoma.
Tuesday, February 12, 2013
Omental flap for treatment of long standing lymphedema of the lower limb: can it end the suffering? Report of four cases with review of literatures.
Omental flap for treatment of long standing of the lower limb: can it end the suffering? Report of four cases with review of literatures.
Saturday, February 2, 2013
Postural Drainage and Manual Lymphatic Drainage for Lower Limb Edema in Women with Morbid Obesity After Bariatric Surgery: A Randomized Controlled Trial.
Postural Drainage and Manual Lymphatic Drainage for Lower Limb in Women with Morbid Obesity After Bariatric Surgery: A Randomized Controlled Trial.