Pelvic lymphedema in rectal cancer: a magnetic resonance feasibility study: a preliminary report.
Apr 2013
Vannelli A, Basilico V, Zanardo M, Caizzone A, Rossi F, Battaglia L, Scaramuzza
D.
Source
Division of Gastrointestinal and Surgical Oncology, Ospedale Valduce, Como,Italy. info@albertovannelli.it.
Abstract
BACKGROUND:
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.
RESULTS:
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.
CONCLUSIONS:
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.
PubMed
Saturday, May 4, 2013
Wednesday, April 10, 2013
I have not been well as soon as I am I will again be posting 04/10/13
I have not been well as soon as I am I will again be posting 04/10/13
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.
Mar 2013
Source
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: sakita-chiba@umin.ac.jp.
Abstract
BACKGROUND:
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.
METHODS:
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.
RESULTS:
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.
CONCLUSION:
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.
The Impact of Living With Severe Lower Extremity Lymphedema: A Utility Outcomes Score Assessment.
March 2013
Source
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.
Abstract
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.
METHODS:
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).
CONCLUSIONS:
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 lymphedema of filarial origin: a very rare etiology of cutaneous lymphangiosarcoma.
Chronic lymphedema of filarial origin: a very rare etiology of cutaneous lymphangiosarcoma.
Jan 2013
Source
Department of Pathology, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India.
Abstract
Lymphedema-associated angiosarcoma also known as lymphangiosarcoma is the commonest type of cutaneous angiosarcoma. Post-mastectomy lymphedema is the most frequent cause, while chronic filarial lymphedema is one of the most uncommon etiology for development of lymphangiosarcoma. We report a case of a 50 year old male suffering from chronic filarial lymphedema of right lower extremity, presented with brownish nodules on the right leg, which were diagnosed histopathologically as lymphangiosarcoma.
See Also:
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 lymphoedema of the lower limb: can it end the suffering? Report of four cases with review of literatures.
Feb 2013
Source
Department of Surgery, Ninava Medical College, Mosul University, Mosul, Iraq.
Abstract
We report our experience of four cases of long-standing unilateral, secondary lymphoedema of the lower limb, for which conservative treatment has failed, that were treated in our centre using pedicled omental flap. The four patients were followed for a period of 1 year after the procedures and frequent measurements of the circumference of the affected limb revealed a reduction in the circumference ranging between 50% in the first patient to 75% in the fourth patient together with an excellent functional improvement in terms of resuming walking, daily activities, sports and work. We think that pedicled omental flap is an important, relatively easy and safe option that deserves consideration in refractory cases of lymphoedema of the lower limb.
***Please Note: This is for informational purposes only. Not to be construed as an endorsement of this procedure. Personally, I feel much more research is imperative including long term and very long term results and potential complications. Pat***
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 Edema in Women with Morbid Obesity After Bariatric Surgery: A Randomized Controlled Trial.
Jan 2013
Source
From the College of Health Science, Methodist University of Piracicaba, São Paulo, Brazil.
Abstract
OBJECTIVE:
The aim of this study was to evaluate the effects of postural drainage (PD) and manual lymphatic drainage (MLD) techniques on edema in the lower limbs of women with morbid obesity submitted to bariatric surgery.
DESIGN:
A total of 47 women between 20 and 40 yrs old with a body mass index of 40 kg/m or higher were randomly placed in three groups: control group (n = 15), PD group (PDG, n = 16), and MLD group (n = 16). Lower limb perimetry was carried out in the first and third days of the postoperative period. All patients underwent six sessions of conventional physical therapy, plus additional six sessions of PD for the PDG or six sessions of MLD for the MLD group.
RESULTS:
Intragroup analysis showed volume reductions in the PDG and the MLD group after the treatment protocol. Comparison of the pretreatment and posttreatment deltas among the groups showed a larger change in volume for the PDG compared with the control group and a larger change in volume for the MLD group compared with the control group or the PDG.
CONCLUSIONS:
The treatment protocols promoted reductions in volume values, suggesting that both techniques could be used to help reduce lower limb edema among this population. Nevertheless, the best results were obtained with MLD.
Wednesday, January 30, 2013
Primary lower limb lymphedema: a focus on its functional, social and emotional impact
Primary lower limb lymphedema: a focus on its functional, social and emotional impact
**This is actually an older article that has recently become available through PubMed. It was written in 2010 and after you read this, you will be thinking "three years later and almost no progress has been made!. It speaks of quality of life. Sad and very frustrating. Pat**
Int J Med Sci. 2010; 7(6): 353–357.
Published online 2010 October 22.
![[env]](http://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcents/x2709.gif)
and
Abstract
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.
Full text article:
Tuesday, January 22, 2013
Lower-Limb Drainage Mapping for Lymphedema Risk Reduction After Pelvic Lymphadenectomy for Endometrial Cancer.
Lower-Limb Drainage Mapping for Lymphedema Risk Reduction After Pelvic Lymphadenectomy for Endometrial Cancer.
Jan 2013
Source
Department of Medicine and.
Abstract
Objectives
Pelvic lymphadenectomy is associated with a significant risk of lower-limb lymphedema. In this proof-of-concept study, we evaluated the feasibility of identifying the lower-limb drainage nodes (LLDNs) during pelvic lymphadenectomy for endometrial cancer. Secondary objectives were to map lower-limb drainage and to assess the diagnostic value of our mapping technique.
Methods
This prospective study included patients with endometrial cancer requiring pelvic lymphadenectomy, without neoadjuvant radiotherapy or chemotherapy and without history of lower-limb surgery. A radio pharmaceutical was injected into both feet on the day before surgery. LLDNs were identified using preoperative lymphoscintigraphy and intraoperative isotopic probe detection, then removed before complete pelvic lymphadenectomy. LLDNs and pelvic lymphadenectomy specimens underwent separate histological analysis.
Results
Of the 12 patients with early-stage endometrial cancer, 10 underwent preoperative lymphoscintigraphy, which consistently identified inguinal, femoral, and pelvic LLDNs (detection rate: 100%). The intraoperative detection rate was 83% (10/12). Median number of hot nodes per patient was 5 nodes (range: 3-7) on the right and 3 nodes (range: 2-6) on the left. Of 107 LLDNs, 106 were in the external iliac area, including 38 in the lateral group and 45 in the intermediate and medial
Monday, January 21, 2013
A case report: elephantiasis
A case report: elephantiasis
2012
[Article in Turkish]
Source
Gülhane Askeri Tıp Akademisi Haydarpaşa Eğitim Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Servisi, İstanbul, Türkiye. drgkara@gmail.com
Abstract
Klippel-Trenaunay syndrome (KTS) is a rare disease and a syndrome that is characterized by the triad of congenital port wine stains, venous malformations with or without varicose veins, bone or soft tissue hypertrophy. Lymphatic filariasis is a filarial disease which usually occurs with genital anomalies, pathologies associated with lymphedema or elephantiasis caused by a filarial infectious agent. In this case report, a 20-year-old male patient admitted to our clinic for diagnosis and treatment with right leg edema and lesions compatible with dermatological manifestations. In the list of differential diagnosis, filarial elephantiasis was also thought, consequently KTS was diagnosed. (Turkiye Parazitol Derg 2012; 36: 188-90).
Sunday, January 13, 2013
Development and Validation of a Self-Report Lower-Extremity Lymphedema Screening Questionnaire in Women.
Development and Validation of a Self-Report Lower-Extremity Lymphedema Screening Questionnaire in Women.
Jan 2013
Source
K.J. Yost, Department of Health Sciences Research, Mayo Clinic, 200 First St W, Rochester, MN 55905 (USA).
Abstract
BACKGROUND:
Patient-reported signs and symptoms are often the first indication of clinically relevant lymphedema.
OBJECTIVE:
Develop and assess the diagnostic accuracy of a screening questionnaire to detect lower extremity lymphedema (LEL) among normal weight and obese women.
DESIGN:
Cross-sectional survey study.
METHODS:
We reviewed existing questionnaires assessing upper extremity lymphedema (UEL) for potential questions and worked with content experts to generate new items. A draft questionnaire with 59 items was reviewed by 5 physicians and 5 physical therapists specialized in lymphedema management and 5 female patients with clinically confirmed secondary LEL. A revised questionnaire with 45 items was administered by mail (n=186) or in a lymphedema clinic waiting area (n=28) to women with clinically confirmed LEL (cases, n=116) or UEL (controls, n=70). A parsimonious subset of items that best discriminated patients with and without LEL was identified using chi-square tests and logistic regression. Sensitivity and specificity for detecting LEL were estimated for the entire sample and for subsamples defined by obesity (BMI ≥30 versus < 30), which may confound the accurate diagnosis of LEL.
RESULTS:
Questionnaires were completed by 127 women (LEL n=88; UEL n=39). A sum of 13 items (score range 0-52) was the most discriminating. Using a cutoff score of ≥5 points, the sensitivity and specificity for detecting LEL among all participants were 95.5% and 86.5%, respectively and 94.8% and 76.5% for obese participants.
LIMITATIONS:
By enumerating a sample with a high prevalence of LEL, we may have introduced spectrum bias, which may affect the accuracy of our screening questionnaire.
CONCLUSIONS:
Our brief, 13-item self-report questionnaire is a sensitive and specific tool for detecting clinically relevant LEL among women, including those with BMI ≥30.
Monday, January 7, 2013
Caring for the lymphedema foot
Caring for the lymphedema foot
January 2013
January 2013
Most people who have leg lymphedema also will have foot involvment. Thus, taking care of our feet becomes even more critical for lymphedema patients.
Feet that have damaged skin, cuts, scrapes or any open areas become entry foci for bacterial infections associated with lymphedema infections. Feet with unhealthy skin can become an open door for foot fungal infections. Both can cause further complications and worsening of our lymphedema.
Keith Smiley
The National Lymphedema Network (NLN) has been flooded with questions regarding foot and ankle care for patients with lower extremity lymphedema. Dr. Joseph Hewitson, a San Francisco Podiatrist, who has worked with many lymphedema patients, provided NLN a list of guidelines and suggestions for proper foot care for people suffering from lower extremity lymphedema. These guidlelines are excerpted from The July NLN newsletter.
Wear shoes.
I love going barefoot, but with lymphedema, this can be downright dangerous and can give bacteria a splendid opening for an infection. Resist that temptation to go barefoot.
Make sure you don't provide an opportunity in your shoes for bacteria or fungus spores to hide and grow. I personally use an antifungal powder in even my street shoes.
Nail Care
Be sure to trim your toenails, but not necessarily straight across. If the corners have grown into the skin, trim the offending border.
Be sure to trim your toenails, but not necessarily straight across. If the corners have grown into the skin, trim the offending border.
If you get an infection, you should remove that side of the nail to resolve the infection. Antibiotics often will not work because an abscess (walled off infection) has occurred. Soaking may only provide temporary relief.
A lymphedema patient should never undergo a chemical matrisectomy (destroying root growth matrix with a chemical to permanently remove nail).
Fungal nails are common in lymphedema patients and should be soaked in 1:1 vinegar/water solution for 20 minutes, with antifungal solution applied afterwards.
Routine foot care every three months with a podiatrist if possible or your physician.
Meticulous nail care decreases the chance for inflammation and infection.
Taking Care of your Toes
The inner spaces between your toes need to be kept clean and dry.
Soaking in a 1:1 vinegar/water solution for 20 minutes at least once a week and running a piece of gauze between your toes to remove any debris will help keep your web spaces clean.
Using a drying agent/antifungal solution like Castelani's Paint decrease chances of irritation and infection.
Applying lambs wool (see your pharmacist) between the toes allows the web greater breathability.
Open toed compression garments will also allow greater breathability, as will breathable footwear that is fitted correctly.
Dr. Hewitson says that proper footwear is very important. He says always buy your shoes at the time of day when your foot is most swollen (usually the end of the day). If you wear a compression garment, make sure you fit your shoes to accommodate this. Good athletic shoes are excellent to wear because they are more supportive, and more breathable. For very large feet, a Velcro strap shoe is usually more accommodating.
If you have painful corns and calluses, they should be routinely trimmed by a podiatrist or practitioner. Never use any callous removal pads, because they can cause burns and infections.
Dr. Hewitson also says to always work with reputable practitioners who are willing to further educate themselves on lymphedema. He adds, you may be their best and only teacher.
Simple measures which will promote healthy skin:
1. Inspect the skin daily for any crack, cuts or dry areas. Check carefully areas with reduced sensation or where there are skin folds.
2. Clean skin daily with non-perfumed soap
3. Dry skin completely, especially the area between the toes
4. Keep skin supple. Use a Iow pH lotion as Eucerin to keep the skin moist and pliable.
5. Check fingernails and toenails for any signs of infection, cracks, fungus, or hangnails. Do not cut nails or cuticles. Use an emery board.
6. Call your doctor at the first signs of any infection, redness or high temperature.
For Further Information on the skin, skin care, foot care, possible complications and infections, please see the below listed pages:
Wrapping Lymphedema Toes - illustrated
Wrapping the Lower Limb (Leg) with Lymphedema - illustrated
Tuesday, January 1, 2013
Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-year Experience of One Surgeon/One Center.
Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-year Experience of One Surgeon/One Center.
Dec 2012
Source
Department of Surgical Research & Transplantology, Medical Research Center, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland. Electronic address: wlo@cmdik.pal.pl.
Abstract
RATIONALE:
The use of microsurgical lymphovenous shunts is one of the generally accepted treatments for limb lymphedema.
AIM:
The 45-year personal experience of one surgeon in indications, technique and results of lymphovenous shunt operations in lower limb lymphedema of varying etiology is presented.
MATERIAL:
One thousand three hundred patients were followed up in the period 1966-2011. Patients were classified into groups according to the etiology of lymphedema as postinflammatory/posttraumatic, postsurgical, idiopathic and hyperplastic. Decrease in limb circumference, heaviness and pain, and increase in joint flexing were evaluated.
RESULTS:
The most satisfactory results, reaching 80-100% improvement, were obtained in the congenital non-hereditary hyperplastic lymphedema group, with large lymphatics not previously damaged by infection. Results were also satisfactory in the group of cancer patients after iliac lymphadenectomy, reaching 80%. A less satisfactory outcome was observed in the postinflammatory group, not exceeding 30-40%. In idiopathic lymphedema results were satisfactory in only a few cases.
CONCLUSIONS:
Patients with lymphedema with local segmental obstruction but still partly patent distal lymphatics and without an active inflammatory process in the skin, subcutaneous tissue and lymph vessels present satisfactory results.
**Editor's note: Please understand this procedure while showing great promise is still classified as experimental. Also, note the particular "types" of lymphedema and patients that appear to have the best results. See RESULTS - Pat**
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