An exploratory study of the efficacy of medical illustration detail for delivering cancer information.

Medical illustrations are an effective means of conveying complex information about cancer to patients and laypersons. However, there are no standard criteria for creating these illustrations. This study used online exploratory research focussed on laypersons to identify the aspects of an illustration that convey the optimal degree of detail and understand these findings. Six illustrations depicting pancreatic cancer and nine depicting cervical cancer, with high, medium, and low levels of detail, were created. A total of 420 participants (male = 210, female = 210, aged 20 years and above) answered an online questionnaire about these illustrations. The results indicated that female participants tended to prefer the same illustration level that they also found most comprehensible. Younger participants (under 40 years) tended to prefer illustrations with a medium level of detail for both cancers. Older participants (40 years and above) tended to prefer illustrations with a high level of detail for both cancers. This study was unable to determine the reasons behind these preferences. However, the researchers hypothesise that older people's preference for higher levels of detail may be due to their greater concerns about cancer and because they find the illustrations to be more effective in conveying relevant information.

Questionnaire survey of a mock jury on their impressions of medical-legal illustrations aimed at reducing trauma and PTSD of jurors.

Gruesome graphic evidence such as autopsy photographs and damaged corpses in criminal cases may affect some individuals involved in the trial. Specifically, individuals may suffer from psychological health issues, such as secondary traumatic stress and PTSD, and they may also be susceptible to punitive verdict bias owing to graphic evidence that often elicits a negative emotional response. In this study, we adopt medical-legal illustrations as an alternative for graphic images. The illustrations differed in the amount of detail portrayed (Realistic and inclusive of main Characteristics) and colouring (black and white or colour). Mock jurors (n = 37) were surveyed to determine which is the most suitable approach to describe graphic scenes in three cases. Emotions were assessed. In all three cases, mock jurors chose Characteristics illustrations as the most suitable - a level of detail that exaggerated some details and simplified others. Specialist forensic doctors agreed with this conclusion. Schematics and Realistic (including background information) illustrations were chosen as the most unsuitable. Realistic (including background information) illustrations in particular generated a higher emotional score than the other types.

Interviewing forensic specialists regarding medical-legal illustration methods to replace gruesome graphic evidence.

Jurors are often subject to psychological health issues like secondary trauma and post-traumatic stress disorder (PTSD) due to exposure to gruesome graphic evidence. Against this background, the current study investigated the usefulness of medical-legal illustrations that include important details on the victim, including nature and position of wounds and cause of death. However, there have been no attempts to establish an effective format for medical-legal illustrations to facilitate the delivery of accurate information while also minimising traumatic stress or PTSD symptoms. We interviewed forensic doctors to determine the most suitable representational format for conveying relevant information. We concluded that the degree of detail (realistic and inclusive of characteristics) and colouring were important factors in determining the effectiveness of illustrations' representational format.

Investigation of suitable illustrations in medical care.

Visual representation methods have long been used as tools to communicate information in health education settings, and their effect on improving health literacy has been investigated. The question arises: How should an illustration function in relation to the textual information it illustrates? Medical illustrations are likely to be featured in media such as brochures and textbooks. If the textual information in such materials is so complex, what function should illustrations play? We reviewed the sociological literature on illustrations to obtain findings potentially applicable to health education and the improvement of health literacy. We then evaluated these tools to determine the types of illustrations that are suitable for the information. Of the three topics for which we developed the materials-cancer, food allergies and HEV light-only for the HEV light topic were earlier findings replicated. One key factor behind this result was that the illustrations for the HEV topic underwent a more thorough deliberative process than those for the other two topics. The results of our study also highlight the importance of third-party opinion in the illustration design process.

Modified lymph vessel flap transplantation for the treatment of refractory lymphedema: A case report.

Lymph vessel flap transplantation (LFT), lymphaticovenous anastomosis (LVA), or lymph node flap transfer are sometimes used to treat lymphedema that is resistant to conservative treatment. LFT harvested from the contralateral limb has been reported for the treatment of lymphedema. Here we report the use of modified LFT from the abdominal wall for the treatment of refractory lymphedema. Our patient was a 57-year-old patient with secondary lower limb lymphedema was previously treated with conservative therapy and lymphaticovenous anastomosis. We first examined the lymphatic function of the lower abdominal region in the patient using indocyanine green (ICG) lymphography. After confirming the good lymphatic function in the right abdominal region, we harvested the pedicled abdominal adiposal flap containing multiple abdominal lymph vessels and transferred it to the left groin region. The flap (20 × 10 cm2 ) was based on the superficial circumflex iliac artery perforator. We anastomosed one lymph vessel in the flap to that in the recipient site. We also performed multiple fibrotripsy using a 3-mm-diameter stainless steel stick inserted into small incisions. The postoperative course was uneventful. The circumference measurement was decreased by 2.2-13.5 cm at 1 year after the operation. The lower abdominal region has many lymph vessel networks and is thought to be a less risky donor site in patients with lymphedema than the lower limbs. Thus, LFT may be an option for the treatment of chronic lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:695-699, 2016.

Indocyanine green lymphography and lymphaticovenous anastomosis for generalized lymphatic dysplasia with pleural effusion and ascites in neonates.

BACKGROUND: The fatality rate of generalized lymphatic dysplasia (GLD) with chylous pleural effusion and ascites is particularly high when it persists over a prolonged period. The purpose of this report was to determine the utility of indocyanine green (ICG) lymphography and lymphaticovenous anastomosis (LVA) in GLD with chylous pleural effusion and ascites in neonates. METHODS: We tested the lymphatic function in the 4 extremities for 8 GLD neonate patients using ICG lymphography, and on the basis of the results, we performed LVA for 5 of them. LVA was performed at the extremities under general anesthesia using incisions <1 cm in length. The outcome of LVA was evaluated with the amount of ascites discharged from thoracostomy tube or abdominal tube, except for 1 patient who had no drainage tube. RESULTS: In all cases, ICG lymphography showed varying degrees of dermal backflow in the limbs with lymphostasis. After LVA surgery, effusion stopped in 2 cases and decreased in 1 case. In the cases where effusion stopped, backflow as observed with ICG lymphography was minimal, and in the case where effusion decreased but did not stop, backflow was moderate. CONCLUSIONS: The application of ICG and LVA could possibly be used to diagnose and treat lymphatic pleural effusion or ascites.

Case report: a new hybrid surgical approach for treating mosaic pattern secondary lymphedema in the lower extremities.

Two of the most common surgical lymph reconstructive interventions for the treatment of secondary lymphedema today are lymphaticovenous anastomosis (LVA) and lymph node transplant. However, neither of these approaches has proven enough evidence to be considered as an effective treatment measure. In this case report, we will introduce a "hybrid method" where combinations of these two conventional methods are used in treating a 52-year-old female patient who displays a mosaic pattern of aggravating secondary lymphedema. Preoperative indocyanine green lymphography assessment was used to identify the different stages of lymphedema within the symptomatic limbs. The application of the hybrid method has resulted in a faster improvement in limb circumference and tissue tenderness compared with when only LVA is performed and has resulted in successful recovery from lymphedema in our case. The hybrid method allows surgeons to select the most appropriate surgical approach for each region displaying a different severity staging of lymphedema, establishing a new order-made remedy for chronic secondary lymphedema patients.

Predictive lymphatic mapping: a method for mapping lymphatic channels in patients with advanced unilateral lymphedema using indocyanine green lymphography.

In severe lymphedema, indocyanine green lymphography cannot be used to map lymphatic channels before lymphaticovenular anastomosis (LVA) because linear lymphatics cannot be detected in a severely affected leg. Here, we describe a new method, which we refer to as predictive lymphatic mapping, to predict the location of lymphatics for anastomosis in unilateral lymphedema, thereby improving surgical accuracy and efficiency. The approach consists of marking anatomical landmarks and joining selected landmarks with fixed lines. The distance from these fixed lines to lymphatic channels mapped by indocyanine green lymphography in the unaffected leg is then measured, scaled up based on the difference in circumference between the legs, and transposed to the affected leg. To date, we have used this method in 5 cases of unilateral or asymmetric lymphedema of the lower extremities. In no cases have we failed to find a lymphatic channel suitable for LVA within a 2-cm incision. These results suggest that predictive lymphatic mapping is a useful additional tool for surgeons performing LVA under local anesthesia, which will help to improve the accuracy of incisions and the efficiency of surgery.