Exercise induced muscle blood flow is decreased in Charcot-Marie-Tooth disease type 1 polyneuropathy: a power Doppler analysis.

BACKGROUND AND PURPOSE: Intramuscular blood flow increases during physical activity and may be quantified immediately following exercise using power Doppler sonography. Post-exercise intramuscular blood flow is reduced in patients with muscular dystrophy, associated with disease severity and degenerative changes. It is not known if intramuscular blood flow is reduced in patients with neuropathy, nor if it correlates with muscle strength and structural changes. The aim was to determine whether blood flow is reduced in patients with polyneuropathy due to Charcot-Marie-Tooth disease type 1 (CMT1) and to compare more affected distal to less affected proximal muscles. METHODS: This was a cross-sectional study including 21 healthy volunteers and 17 CMT patients. Power Doppler ultrasound was used to quantify post-exercise intramuscular blood flow in distal (gastrocnemius) and proximal (elbow flexor) muscles. Intramuscular blood flow was compared to muscle echo intensity, muscle strength, disease severity score, patient age and electromyography. RESULTS: Polyneuropathy patients showed reduced post-exercise blood flow in both gastrocnemius and elbow flexors compared to controls. A more prominent reduction was seen in the gastrocnemius (2.51% vs. 10.34%, p < 0.0001) than in elbow flexors (4.48% vs. 7.03%, p < 0.0001). Gastrocnemius intramuscular blood flow correlated with muscle strength, disease severity and age. Receiver operating characteristic analysis showed that quantification of intramuscular blood flow was superior to echo intensity for detecting impairment in the gastrocnemius (area under the curve 0.962 vs. 0.738, p = 0.0126). CONCLUSION: Post-exercise intramuscular blood flow is reduced in CMT1 polyneuropathy. This reduction is present in both impaired distal and minimally affected proximal muscles, indicating it as an early marker of muscle impairment due to neuropathy.

Risk factors for long-term arm morbidities following breast cancer treatments: A systematic review.

PURPOSE: To examine the risk factors for arm morbidity following breast cancer treatments, taking a broad view of all types of physical morbidity, including prolonged pain, lymphedema, decreased range of motion, and functional limitations. METHODS: A systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the risk factors for prolonged arm morbidity following breast cancer surgery and treatments were included. The studies were assessed independently according to pre-eligibility criteria, following data extraction and methodological quality assessment. RESULTS: 1,242 articles were identified. After removing duplicates, the full texts of 1,153 articles were examined. Sixty-nine of these articles met the criteria and were included in the review. These 69 articles identified 29 risk factors for arm morbidity following treatments for breast cancer. The risk of bias was evaluated using NIH study quality assessment tools. The studies reviewed were published between 2001 and 2021 and included a total of 22,886 patients who were followed up for between three months and 10 years. CONCLUSIONS: The main risk factors for long-term morbidity are removal of lymph nodes from the axilla, body mass index >30, having undergone a mastectomy, the stage of the disease, radiation therapy, chemotherapy, infection and trauma to the affected arm after surgery. An understanding of the risk factors for prolonged arm morbidity after surgery can help doctors and therapists in making personalized decisions about the need and timing of rehabilitation treatments.

Delineating neck targets for intensity- modulated radiation therapy of head and neck cancer. What we learned from marginal recurrences?

Delineation of the targets for intensity-modulated radiation therapy (IMRT) of the head and neck is a crucial step in treatment planning, determining the risks of marginal or out-of-field local/regional recurrences. Delineation of the gross tumor volumes needs to take into account both radiological (CT, MRI, PET) and clinical findings, discussed in this paper. In contrast, the delineation of the clinical target volumes depends solely on the physician's judgement and knowledge of the natural history and spread pattern of head and neck cancer. While much of this information exists in older literature, new information has been gained from the pattern of recurrences observed after IMRT of head and neck cancer. This review concentrates on this information and on the lessons gained from these recurrences at our institution.

Delineating neck targets for intensity-modulated radiation therapy of head and neck cancer.

Experience with intensity-modulated radiation therapy (IMRT) for head and neck cancer is building greater understanding of the requirements for therapy planning. Delineation of the lymphatic targets for IMRT of the head and neck is a crucial step in this planning, and often determines the risks of marginal or out-of-field local/regional tumor recurrence. Definition of the gross tumor volumes needs to take into account both radiological (CT, MRI, PET) and clinical findings. Understanding of the appropriate CTVs is developing based on: (a) established knowledge of the natural history and spread patterns of head and neck cancer, (b) the accruing experience of clinicians using IMRT, and (c) evaluations of patient outcomes following consistent treatment approaches as determined by institution practice patterns and prospective clinical studies. This chapter will outline the important steps in lymphatic target definition for head and neck cancer, and will discuss several special clinical concerns for these patients and their management.