Wednesday, November 4, 2009

Baby Kayden in Oklahoma

Baby Kayden in Oklahoma

Good Morning Everyone

I wanted to bring this to everyone’s attention and encourage anyone who can to help this little baby. Kayden has vascular Lymphedema and was just born on August 18, 2009…he’s got a long road ahead of him so let’s do anything we can for him and his family:

Baby Kayden

He’s a real little doll too!

Thanks Everyone!!!!!!!!!!!!!!!!!!!!

Pat

Wednesday, October 28, 2009

Understanding the Lymph System

Understanding the Lymph System

I thought it would be helpful for readers to understand the lymph system, the anatomy, what it does, and how it helps with immunity.

Listed below are information pages that should be quite helpful and each page has many additional links for more a more in depth study.

Anatomy of the Lymph System

Lymphatic System Functions

Lymphatic System and Immunity

Pathology of the Lymph Nodes and Lymphoma

Lymph Nodes

Lymph Fluid


Saturday, October 17, 2009

12th State of Georgia Lymphedema Awareness Programm

12th State of Georgia Lymphedema Awareness Program
.
.
THERE IS STILL TIME TO GET THOSE REGISTRATIONS IN
.
An educational and awareness conference for patients, caregivers and professionals!
.
Where?
.
Saint Joseph Hospital Auditorium 5665 Peachtree Dunwoody Road, NE Atlanta, GA 30342
.
When?
.
Saturday, October 24, 2009 7:30 am - 5:00 pm
.
.
Schedule
.
7:30-8:15am Registration – Continental Breakfast – Exhibits 8:15-8:30am Welcome .
Plenary Session:
.
8:30-10:00am Moderator: Elaine Gunter, MT (ASCP)
.
Nicole Stout, PT, MPT, CLT-LANA Will discuss her studies on early intervention for breast cancer including the anatomy, reconstruction, breast cancer surgeries, truncal and other upper extremity lymphedema
.
10:00-10:30am Break Exhibits
.
10:30-12:00 Charles McGarvey, PT, DPT, MS, FAPTA
.
Lymphedema Secondary to Pelvic Cancer Treatment: A Review of Literature and Clinical Practice
.
12:00 – 1:30pm Lunch Exhibits
.
1:00-2:15pm Teen (only) Networking -Parent Networking (parents of children with lymphedema)
.
Separate sessions
.
Plenary Session:
.
1:30-2:15pm Daniel Beless, MD, Director of Wound Care at Saint Joseph Hospital Wound Care and the lymphedema patient
.
2:15-3:00pm DeCourcy Squire, PT, CLT-LANA
Research updates from the International Society of Lymphology of Lymphedema Diagnosis and Treatment
.
3:00-3:30pm Break Exhibits
.
3:30-4:30pm Panel Discussion
All speakers will participate in this question and answer discussion
.
4:30-5:00pm Closing Remarks

Wednesday, October 14, 2009

New Lymphedema Treatment Clinic - Myrtle beach, Souther Carolina

It gives me great pleasure to announce a new lymphedema treatment clinic in the Myrtle Beach, Souther Carolina area:

Tom Kincheloe, OTR/L, CLT
Founder/Clinical Director
RIVERTOWN LYMPHEDEMA CLINIC AND REHAB, LLC.
100 Prather Park Drive, Suite A
Myrtle Beach, SC 29588-7910
Bus. Phone: (843) 742-5701
Bus. Fax: (843) 742-5704
Cell: (843) 957-2422
Email:
erivertownlymph@sc.rr.com

I know Tom personally and two things strike me about him.

First, is his real concern/compassion for his patients.

Secondly is his knowledge of lymphedema.


A winning combination! So if you live in his area and are looking for lymphedema help, give him a call.

Pat

Sunday, October 11, 2009

The contralateral rectus abdominis musculocutaneous flap for treatment of lower extremity lymphedema.

One of my desires is to bring all types of information relating to leg lymphedema to the readers. I must admit,
I really had to grit my teeth on this article.

The authors speak of a long term follow up time frame as 31 months. This is hardly adequate when you are
investigating long term possible complications. Indeed, I had the Thompson'sprocedure done in three surgeries
from 1971 through 1973. The first 31 months did see a reduction in leg size and a slight reduction in cellulitis
episodes.

However, long term should mean a 10, 20 or even longer time frame. After twenty years, I experienced horrific
complications from the surgery, not the least of all was mixed b-cell lymphoma.

Also, if the research proves to be correct about the possibilities that secondary lymphedema patients
are people who are already "at risk" for lymphedema, then the introduction of yet another area of surgery (abdomen)
could prove to be disasterous as well. Any type of surgery that would injury, damage or adversly effect the lymph
system in the abdomen can (as has been well documented) cause abdominal lymphedema.

Please do not consider the posting of this article as an endorsement of any kind and I would further discourage
lymphedema patients from having it.

Pat

The contralateral rectus abdominis musculocutaneous flap for treatment of lower extremity lymphedema.


Parrett BM, Sepic J., Pribaz JJ

Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115

Lymphedema is common after inguinal lymphadenectomy or resection of groin tumors. Animal studies have shown success using the rectus abdominis musculocutaneous (RAM) flap as a treatment for lymphedema. Four patients with acquired lower extremity lymphedema were treated with a contralateral RAM flap with an inferior cutaneous pedicle left intact to facilitate lymphatic drainage into the unaffected groin. One patient also had lymphaticovenous anastomoses performed during flap transfer. All flaps survived with no postoperative complications. With a mean follow-up of 31 months, the mean reduction in limb circumference from the preoperative excess was 81% at the thigh, 70% at the calf, and 71% at the ankle. None of the patients with recurrent cellulitis had further incidences of groin cellulitis. Two patients required future flap debulking. Lymphoscintigraphy was performed in 1 patient and demonstrated reconstitution of lymphatic flow from the affected leg through the flap. According to this preliminary study, transfer of a contralateral RAM flap to the groin of a lymphedematous leg improves lymphedema and decreases the incidence of cellulitis.


For further information on surgeries used for the treatment of lymphedema, please see:


and

Tuesday, September 29, 2009

Lighthouse Lymphedema Network

I wanted to make a special announcement that the Lighthouse Lymphedema Network
is now on Facebook.

You can join by going to: Lighthouse Facebook

There is also an area where you can post and participate.

AND - don't forget our upcoming program in October. We will be having both a
parenting network and a teen network this year....be there or be square!

see the details for that at:


Lighthouse Lymphedema Network

**yes, I'm on it too :-)

Pat

Monday, September 28, 2009

Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma.

Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma.

BMC Cancer. 2009 Feb

Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital,

Corresponding author.
Harue Tada: haru.ta@kuhp.kyoto-u.ac.jp; Satoshi Teramukai: steramu@kuhp.kyoto-u.ac.jp; Masanori Fukushima:mfukushi@kuhp.kyoto-u.ac.jp; Hiroshi Sasaki: hrssasaki@jikei.ac.jp

BACKGROUND: Lymph node dissection has proven prognostic benefits for patients with ovarian or uterine carcinoma; however, one of the complications associated with this procedure is lymphedema. We aimed to identify the factors that are associated with the occurrence of lymphedema after lymph node dissection for the treatment of ovarian or uterine carcinoma.

METHODS: A total of 694 patients with histologically confirmed ovarian (135 patients) or uterine cancer (258 with cervical cancer, 301 with endometrial cancer) who underwent lymph node dissection were studied retrospectively. Logistic regression analyses were used to identify the risk factors associated with occurrence of lymphedema.

RESULTS: Among ovarian and uterine cancer patients who underwent pelvic lymph node dissection, post-operative radiotherapy (odds ratio: 1.79; 95% confidence interval: 1.20-2.67; p = 0.006) was statistically significantly associated with occurrence of lymphedema.

CONCLUSION: There was no relationship between any surgical procedure and occurrence of lymphedema among patients undergoing pelvic lymphadenectomy. Our findings are supported by a sound biological rationale because they suggest that limb lymphedema is caused by pelvic lymph node dissection.

PubMedCentral

*Editor's note: It is rare that I openly place a note of disagreement on an article, but in this case, I think one is called for. The incident ratio of lower limb lymphedema from gynecological cancer is skyrocketing with survival rates increasing as well. It is well document that the removal of lymph nodes damages the lymph system and that a damaged lymph system can lead to lymphedema. I would suggest that they doctors involved in this study go back to their research. Pat

Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema

Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema

Clin Nucl Med. 2009 Jul

Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. pierre.bourgeois@bordet.be

PURPOSE: Angiomyomatous hamartoma (AH) of the lymph node is a rare vascular benign disease of unknown etiology with a predisposition for the lymph nodes of the inguinal area. Only 18 cases have been described up to now in the literature and the disorder was reported to be associated with lymphedema or swelling of the ipsilateral limb in 4 patients. However, scintigraphic investigation of the lymphatic system in these patients was reported in only 2 cases.

MATERIAL AND METHODS: Five patients where the biopsy of inguinal nodes for suspected lymphadenitis led to the diagnosis of angiomyomatous hamartoma were investigated using lymphoscintigraphic techniques (1 girl aged 15; 1 boy aged 9 at the time of first biopsy and 11 at the time of the second one; and 3 men aged 30, 50, and 57). The operated limb was lymphedematous in 3 and 1 developed lymphedema after biopsy. The fifth patient developed a contralateral lymphedema after his second nodal biopsy.

RESULTS: In all cases, lymphoscintigraphic investigation of the limbs showed extensive lymph node abnormalities on the operated side and in 4 cases on the opposite side.

CONCLUSIONS: These observations support not only the hypothesis that lymphatic disturbance was involved in the pathogenesis of these tumors but also the proposition that lymphoscintigraphy should be performed in cases of inguinal lymphadenitis of unknown origin to diagnose the underlying situation of latent lymphedema.

Clinical Nuclear Medicine


Elective amputation of the toes in severe lymphedema of the lower leg: rationale and indications

Elective amputation of the toes in severe lymphedema of the lower leg: rationale and indications


Department of Plastic Surgery, E-Da Hospital/I-Shou University, Taiwan.

Entry lesions at the toes interdigital spaces, in the setting of chronic lymphedema, are strongly associated with repetitive infective episodes which cause significant morbidity. A prospective study was designed to evaluate the outcome in 2 groups of patients affected by end stage III lymphedema of the lower extremity, treated with the Charles procedure with or without simultaneous amputation of the toes. At a mean 3 years of follow-up, 20% of the patients receiving elective toes amputation experienced recurrence of the infection and none required more proximal amputations. Among the patients not desiring elective toes amputation; 83% suffered multiples attacks of cellulitis and in 88% the toes were eventually amputated. The difference in the number of infective episodes between the 2 groups was highly significant. No cases of recurrent lymphedema were registered. Elective toes amputation in combination with the Charles procedure reduces recurrent cellulitis and long-term morbidity in stage III lymphedema of the lower leg.

Lippincott, Williams & Wilkins

Thursday, September 17, 2009

The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg

The outcomes of program based on complex decongestive physiotherapy for a patient with secondary lymphedema caused by infection on the leg
Fukuoka Igaku Zasshi. 2009 Jun

Nakao F, Furutani A, Yoshimura K, Hamano K, Kinoshita Y, Kawamoto R, Nakao H, Suzuki S.
Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.


Lymphedema is a chronic problem causing distress and loss of functions throughout the lifespan. Complex decongestive physiotherapy (CDP) is in common use in developed countries but has only recently been used in Japan for people in outpatient settings. CDP is a representative conservative treatment for lymphedema, conducted by combining four kinds of physical therapies: skin care, manual lymph drainage (MLD), bandage and exercise. This research project lead by a nurse is underway using CDP in an outpatient department. We report a case of secondary lymphedema caused by infection successfully treated by CDP. A 22-year-old man suffered from cellulitis of unknown origin when he was a high school student. After this event, he had been repeatedly admitted to hospital with infections as a result of the lymphedema. He underwent MLD once or twice monthly and received health education for skin care, self-massage and exercise, and was advised to wear compression stockings. Within 7 months the leg swelling had significantly reduced and his feelings of malaise and pain disappeared. Fourteen months later the circumferences of his knee and ankle had kept the sizes, and he has not re-entered hospital for infections. For this man, CDP had a positive outcome, as it has for many others around the world. Our experience has found it very important to establish adequate support systems for such people in outpatient and community settings. However, more research and knowledge sharing are required to understand the usefulness and effectiveness about this program as a primary treatment combined with health education in community settings in Japan.

PubMed

Friday, September 11, 2009

Georgia Lymphedema Education and Awareness Program

11th Annual Lymphedema Education & Awareness Program

An educational and awareness conference for patients, caregivers and professionals!

Where?

Piedmont Hospital

Piedmont Hospital

Richard H. Rich Auditorium

1968 Peachtree Road, NW, Building 77

Atlanta, Georgia

When?

Saturday, October 18, 20087:30 am - 5:30 pm

Program includes

What to expect of tissue after radiation?

What is the physiology response of radiation?

What does radiation do to the lymph nodes? - Peter Rossi, MD

How does vascular flow affect the lymphatics? - Ken Harper, MD

Expectations of surgery. - Christopher Hart, MD, FACSThe Lymphatic System, Wound Care,

Infections and Treatment - Paula Stewart, MDParent Networking

Aquatic Exercises

The Connection of obesity and increased swelling in people with lymphedema and lipedema.and more.

Additional information and registration form - Home website - Lighthouse Lymphedema Network

See you there - Pat

Thursday, June 11, 2009

Combined edema reducing therapy in the treatment of advanced lower limb lymphedema

Combined edema reducing therapy in the treatment of advanced lower limb lymphedema
Wiad Lek. 2008

Gabriel M, Sawlewicz P, Krüger A, Pawlaczyk K, Stanisić M, Majewski W.
Kliniki Chirurgii Ogólnej i Naczyń Uniwersytetu Medycznego w Poznaniu.
mgabriel@pro.onet.pl

Combined edema reducing therapy is a recognized method of lymphedema treatment. However such therapy can be difficult to implement from methodological and logistic point of view in cases of advanced forms of lymphedema. The aim of the study was the presentation and discussion of intensive phase of combined treatment in patient with advanced primary lymphedema.

MATERIAL AND METHODS: Therapy was conducted on 19 patients (27 limbs) with edema reducing therapy program. Procedures were conducted daily for 4-6 weeks in out-patient and in-wards conditions.

RESULTS: Intensive phase of treatment succeeded in 3870-15 330 ml edema reduction, consisting of 48-65% of initial status. Chronic leg ulcers were healed completely in 2 patients. Ten patients underwent minor adverse events (AE), such as superficial skin ulceration (n = 2), popliteal fossa skin maceration (n = 2), neuropathic foot pain (n = 3) and skin scratches (n = 3). Modification of the treatment allowed the complete healing of AEs within 2-7 days, but it produced significant delay in achievement of desired therapeutic result, In 2 cases it prolonged hospital stay for 7 days.

CONCLUSIONS: 1. Combined edema reducing therapy is very efficient form of treatment in advanced primary lymphedema. 2. Intensive, 4-6 week, phase of the treatment allows 3.8 to 15.3 1 edema reduction. 3. In our opinion this phase should be conducted only in specialized centers for proper final results achievement with adverse events minimization. 4. The main point of the therapy is a combination of appropriate forms of available treatment.

PubMed

Humanitarian rescue medical action for patient with advanced lower extremity lymphedema.

Humanitarian rescue medical action for patient with advanced lower extremity lymphedema.

Lymphology. 2008 Jun

Chen HC, Salgado CJ, Mardini S, Feng GM, Li TS.
E-Da Hospital/I-Shou University, Department of Plastic Surgery, Yan-Chau Shiang, Kaohsiung County, Taiwan.
salgado_plastics@hotmail.com

No clear data exists regarding the initiating process of medial care delivery in cases of humanitarian rescue for advanced and debilitating patient conditions. We report on the delivery of care from a hospital located in a rural area in Southern Taiwan to a desperate patient from a country across the world in Lima, Peru. The patient is a 45-year old woman with unilateral severe, progressive primary lymphedema of 26 years who was scheduled to undergo a high femoral amputation for infections, lymphatic leak, inability to ambulate, and symptomatic cardiomegaly. All arrangements for care, including dental restoration, were made by our hospital in collaboration with the government of Peru. Upon multi-departmental consultation, an 8-hour Charles procedure was performed removing 47 kg of lymphedematous thigh and leg tissue. Eleven months postoperatively the patient is healed and ambulating without assistance. Her weight dropped from 120 to 73 kg. This case of humanitarian action demonstrates intense collaboration and coordination between two governments with dialogue, diplomatic success, a lymphedema surgical feat, and ultimately a successful outcome for the patient.


PubMed

Anatomy of the subcutaneous lymph vascular network of the human leg in relation to the great saphenous vein.

Anatomy of the subcutaneous lymph vascular network of the human leg in relation to the great saphenous vein.

Anat Rec (Hoboken). 2009

Schacht V, Luedemann W, Abels C, Berens von Rautenfeld D.
Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany.
vivien.schacht@uniklinik-freiburg.de

The anatomical relationship between lymphatic collectors and veins is of clinical importance for preventing lymphedema secondary to lymphatic collector injury during surgical procedures. To identify areas at risk during surgical interventions, we performed an anatomical study of human legs. The lymphatic collectors of 42 legs of human cadavers were injected with Berlin Blue solution or contrast medium. After fixation, the collectors were dissected and their distances from the great saphenous vein were determined. We found that the lymphatic collectors on the dorsum of the foot ran in close parallel with the corium, whereas in the groin a greater number of lymphatic collectors clustered around the great saphenous vein. The ventromedial bundle that drains into the superficial inguinal nodes included 5-20 lymphatic collectors. The average width of the ventromedial bundle varied between 116 mm at the middle of the lower leg and 32 mm at the groin. Our study cannot confirm the previous observation of a bottleneck of the ventromedial bundle occurring at the knee, but does support the finding of an elongated bottleneck at the thigh and groin draining into the superficial inguinal lymph nodes. In addition, the idea of one sentinel lymph node for a specific region of the leg is not supported by these data. These observations will help surgeons to plan incisions and dissections with respect to lymphatic collectors, thereby minimizing damage to them and reducing complications resulting from unnecessary lymphatic excisions. Anat Rec, 2009.

PubMed

A 62-year-old woman with non-pitting leg oedema

A 62-year-old woman with non-pitting leg oedema

Tidsskr Nor Laegeforen. 2009 Apr

Bergersen TK, Mørk C.
kristin.bergersen@rikshospitalet.no

A patient presented with non-pitting lymphoedema of the legs and finger clubbing. A skin biopsy showed epidermal hyperkeratosis and abundant mucinous material (Alcian blue positive) in reticular dermis. Treatment (radioactive iodine) for Grave's disease (with exophthalmus) 20 years ago, raised suspicion of thyroid dermopathy. Together, these three extrathyroidal manifestations of Graves' disease are typical of the EMO syndrome. In addition, the patient had elevated serum concentrations of thyroid-stimulating hormone receptor autoantibodies. Autoimmune mechanisms are involved in the stimulation of fibroblasts and the production of large amounts of mucin. Pretibial myxoedema relates to scars, mechanical factors, and dependent position. Lack of steroid treatment during radioactive iodine therapy and smoking, may have exacerbated the thyroid dermopathy in this case. Awareness of pretibial myxoedema as a late autoimmune manifestation of Graves' disease, may contribute to earlier diagnosis and correct treatment.

Full Text Article

Monday, June 8, 2009

Chronic lower extremity lymphedema: A comparative study of high-resolution interstitial MR lymphangiography and heavily T2-weighted MRI.

Chronic lower extremity lymphedema: A comparative study of high-resolution interstitial MR lymphangiography and heavily T2-weighted MRI.
Eur J Radiol. 2008 Dec

Lu Q, Xu J, Liu N.
Department of Radiology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dong Fang Rd, Shanghai 200127, China.

PURPOSE: To assess the role of heavily T2-weighted image and interstitial MR lymphangiography (MRL) for the visualization of lymphatic vessels in patients with disorders of the lymphatic circulation.

METHODS: Forty lower extremities in 31 patients (9 bilateral and 22 unilateral) with primary lymphedema were examined by heavily T2-weighted image and indirect MRL. Maximum-intensity projection (MIP) was used to reconstruct the images of the lymphatic system. Two experienced radiologists analyzed the images with regard to the differences in image quality, number of lymphatic vessels, its maximum diameter and two other findings: accumulated lymph fluid in the tissue and honeycombing pattern.

RESULTS: The beaded appearance of the affected vessels in 73 leg segments of 40 lower extremities were present on both modalities 3D MIP. Larger amount of the dilated lymphatic vessels were visualized on heavily T2-weighted image than that on MRL (p=0.003) and the maximum diameter of it was 4.28+/-1.53mm on heavily T2-weighted image, whereas 3.41+/-1.05mm on MRL (p<0.01).>

CONCLUSION: The heavily T2-weighted imaging has greater sensitivity and the MRL image has higher legibility for detecting the pathologically modified lymphatic vessels and accompanying complications non-invasively. Combining these two MR techniques can accurately access the pathological changes in the lower extremity with lymphedema.

Elsevier