Department of Cardiology, Naganoken Koseiren Shinonoi General Hospital, Japan. firstname.lastname@example.org
A 70-year-old man complained of right leg swelling due to right iliac vein stenosis. No mass was identified around the stenotic site, and the vessel wall had not become thickened. Self-expandable stents were positioned at the stenotic site. About two years later, chest CT revealed lung nodules. Pathology showed sarcoma. A mass that was considered to be the primary lesion was found around the stent in the right iliac vein. Although sarcoma of the iliac vein is very rare, it should be considered in the differential diagnosis of iliac vein stenosis, even if there are no suspicious findings from image studies.
Department of Neurology, Austin Health, 6 North, Austin Tower, 145 Studley Road, Heidelberg, Victoria 3084, Australia. email@example.com
Pramipexole is a non-ergot dopamine agonist that is used frequently as a single therapy or in combination for the management of Parkinson's disease. Common side effects are daytime drowsiness, hypotension, hallucinations and compulsive behaviour. We describe a patient who developed severe chronic and extensive lymphoedema after pramipexole was introduced and that resolved after its cessation.
Department of Internal Medicine, Wroclaw Medical University, Wroclaw, Poland.
Lymphangioleiomyomatosis (LAM) is a rare disease characterized by diffuse thin-walled cysts throughout the lungs on computed tomography and diffuse proliferation of abnormal smooth muscle-like cells (LAM cells) on lung biopsy. LAM affects women almost exclusively, predominantly in their reproductive age. The most typical presenting symptoms include dyspnea, spontaneous pneumothorax, cough and chylothorax. Abdominal findings represent less common initial manifestations of the disease and may pose diagnostic difficulties. The treatment of LAM has not been fully established. Recent studies report effectiveness of sirolimus in LAM patients. We report the case of a 45-year-old woman with sporadic LAM, successfully treated with sirolimus, in whom the first manifestation of the disease was chyloperitoneum and after three and nine years, respectively, lymphedema of the left lower extremity and right sided chylothorax occurred.
Traveling and Leg Lymphedema A lot of people withleg lymphedemahave questions regarding travel and leg lymphedema. More particular, the questions often involve leg lymphedema and airplane flights. This info is from one of my pages in the forum section ofLymphedema People: The longest flight I ever took was only ten hours and that was way back in the mid-seventies when I was (ugh) so much younger and my lymphedema was no where near as bad as it is now. My leg lymphedema has never had a problem due to air travel, whether it was a long or short flight. The great thing about longer flights like that is that the larger jets are generally used. In them you are much more able to stretch, move around and even take a short walk down the aisle.
There are a few pointers I would mention:
1.) Don't keep your legs at a 45 degree angle - try to stretch them out in front of you as much as possible. 2.) One thing I do periodically is to do stretch and flex exercises right there in the seat. You can flex the thigh muscle, lower leg muscles - even foot muscles while sitting. This is really helpful. 3.) Do try and get up for that short jaunt down the aisle (not like that aother really really long walk down the aisle) 4.) Some may not have to, but I do wear compression while on the flight too. The leg swelling, for me, just starts going up the second it is unwrapped or bandaged. This should help and should not interfere with circulation. 5.)My biggest nemisis is cellulitis, so whenever I take a trip, I make certain I take a prescription bottle of antibiotics with me. that way, if there is an emergency with infection, you can start on treatment while you find where to go to get medical help.
Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanxiao Street, Changhua 500, Taiwan. firstname.lastname@example.org
The aim of this study was to estimate the efficacy of an intensive CDP program, as well as to identify the predictors associated with lymphedemaseverity and response to CDP in lower limb lymphedema (LLL) after pelvic cancer therapy.
We performed a retrospective review of post-pelvic cancer LLL patients that were treated with a CDP program between January 2004 and March 2011.
Twenty-seven of the total 44 patients had cervical cancer, 9 had endometrial cancer, and 8 had ovarian cancer. The mean age was 62.2 years, 18 patients received radiotherapy and a mean of 12.6 sessions of daily CDP, and mean lymphedema duration was 34.8 months. The interval from pelvic cancer treatment to LLL development was 63.4 months. Lymphedema severity, baseline and post-CDP percentage of excess volume (PEV) were thirty-two percent plus-minus eighteen point four percent and eighteen point eight percent plus-minus sixteen point seven. Baseline PEV was not correlated with duration of lymphedema, number of CDP sessions, age or radiotherapy, and was significantly different to post-CDP PEV . CDP efficacy, percentage reduction of excess volume PREV, was minus fifty-five point one percent, and was correlated with baseline PEV, but not with the number of CDP sessions, duration of lymphedema, or age. PEV ) was the only predictive factor for CDP efficacy.
The key to predicting successful lymphedema treatment of LLL is the initial PEV. The intensive CDP program was effective and successful. We should encourage and refer patients to undergo treatment for LLL, even when the LLL is mild.
Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. email@example.com
Vascularized groin lymph node flaps have been successfully transferred to the wrist to treat postmastecomy upper limb lymphedema. This study investigated the anatomy, mechanism and outcome of a novel vascularized submental lymph node (VSLN) flap transfer for the treatment of lower limb lymphedema.
Bilateral regional submental flaps were dissected from three fresh adult cadavers for histological study. A unilateral submental flap was dissected in another six fresh cadavers after latex injection. The VSLN flap was transferred to the ankles of seven lower extremities in six patients with chronic lower extremity lymphedema. The mean patient age was 61 ± 9.4 years. The average duration of lymphedema symptoms was 71 ± 42.2 months.
There was a mean of 3.3 ± 1.5 lymph nodes around the submental artery typically at the junction with the facial artery, on the six cadaveric histological sections. Mean of 2.3 ± 0.8 sizable lymph nodes were dissected and supplied by the submental artery in six cadaveric latex-injected submental flaps. All seven VSLN flaps survived. One flap required re-exploration for venous congestion but was successfully salvaged. There was no donor site morbidity. At a mean follow-up of 8.7 ± 4.2 months, the mean reduction of the leg circumference was 64 ± 11.5% above the knee, 63.7 ± 34.3% below the knee and 67.3 ± 19.2% above the ankle.
The transfer of a vascularized submental lymph node flap to the ankle is a novel approach for the effective treatment of lower extremity lymphedema.
The Prevalence of Lymphedema Symptoms Among Survivors of Long-term Cancer with or at Risk for Lower Limb Lymphedema. Oct 2012 Brown JC, Chu CS, Cheville AL, Schmitz KH. Source From the Department of Clinical Epidemiology and Biostatistics (JCB, KHS) and the Department of Gynecologic Oncology (CSC), Perelman School of Medicine, and Abramson Cancer Center (CSC, KHS), University of Pennsylvania, Philadelphia; and the Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota (ALC). Abstract OBJECTIVE: The aim of this study was to identify commonly reported symptoms in the lower limbs among those with or at risk for developing lower limb lymphedema (LLL). DESIGN: The authors surveyed survivors of long-term cancer using the Pennsylvania State Cancer Registry. They inquired about demographics, cancer treatment history, knowledge about LLL, and symptoms experienced since completing cancer treatment. They invited all participants for an in-person clinical assessment to better identify and characterize the symptoms associated with LLL. RESULTS: The response rate to the study survey was 57.2%. Among the 107 participants who answered the study survey, 37 (34.5%) reported one or more symptoms associated with LLL. Many reported a combination of symptoms that included difficulty walking (n = 37; 100%), aching (n = 32; 86%), puffiness (n = 28; 76%), and pain (n = 27; 73%) on one side of the body since cancer treatment. The in-person clinical assessment among a subsample of 17 participants revealed 10 participants with no evidence of LLL and 5 and 2 participants with grade 1 and 2 LLL, respectively. The in-person clinical assessment identified three cases of previously undiagnosed LLL. CONCLUSIONS: One third of the survivors of cancer surveyed reported experiencing new symptoms in the lower limbs since cancer treatment. Cases of symptomatic, undiagnosed LLL may exist in the population. PubMed
Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan, 626-770, Republic of Korea.
The aims of this study were to investigate the long-term effect of complex decongestive therapy (CDT) onlymphedema volume reduction, especially considering the proximal and distal parts of the leg, and to evaluate the utility of pre-therapy lymphoscintigraphy in predicting the response to CDT in patients with lower-limb lymphedema after surgery for gynecologic cancer.
Medical records of 158 patients with secondary lymphedema of unilateral leg after surgery for gynecological cancer were reviewed retrospectively. They were treated with two weeks of CDT along with self-administered home therapy and were followed up for 24months. Whole, proximal and distal leg volume was serially measured by using an optoelectric volumeter prior to and immediately after therapy, and follow-up visits at months 3, 6, 12 and 24. Lymphoscintigraphy was performed prior to therapy.
The percent volume reduction was 22.1% in the whole leg, 30.9% in the distal leg and 18.4% in the proximal legimmediately after CDT. The volume reduction was maintained for 24months, but the distal leg was significantly well maintained better than the proximal leg. Extremity radioisotope uptake ratio (EUR) among lymphoscintigraphic findings could predict the improvement of lymphedema volume in the distal, proximal and whole leg.
CONCLUSION:This study suggests that the long-term edema reducing effects of CDT are better maintained in the distalleg than in the proximal part, and initial lymphoscintigraphic quantitative finding may usefully predict the short and long-term response to CDT.