Pelvic lymphedema in rectal cancer: a magnetic resonance feasibility study: a preliminary report.

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

I have not been well as soon as I am I will again be posting 04/10/13

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

Akita S, Mitsukawa N, Kazama T, Kuriyama M, Kubota Y, Omori N, Koizumi T, Kosaka K, Uno T, Satoh K.

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.

PubMed

The Impact of Living With Severe Lower Extremity Lymphedema: A Utility Outcomes Score Assessment.

March 2013

Sinno H, Izadpanah A, Tahiri Y, Christodoulou G, Thibaudeau S, Williams HB, Slavin SA, Lin SJ.

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.

PubMed

Chronic lymphedema of filarial origin: a very rare etiology of cutaneous lymphangiosarcoma.

Jan 2013

Agale SV, Khan WA, Chawlani K.

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.

NIH Indian Journal of Dermatology

See Also:

Stewart Treves Syndrome

Lymphangiosarcoma

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

Attash SM, Al-Sheikh MY.

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***

PubMed

Postural Drainage and Manual Lymphatic Drainage for Lower Limb Edema in Women with Morbid Obesity After Bariatric Surgery: A Randomized Controlled Trial.

Jan 2013

Bertelli DF, de Oliveira P, Gimenes AS, Moreno MA.

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.

PubMed