ABSTRACT
BACKGROUND: Lymphoedema of the arm is a common problem after mastectomy and radiotherapy of mammary cancer. In a prospective 5-year follow-up study we investigated the development of arm oedema and the effect of conservative compression treatment. METHODS: Two hundred and twenty-six patients who had undergone mastectomy were investigated. Oedema formation was estimated by recording displaced water volume of both arms preoperatively and six times post-operatively. One hundred fifty-seven patients (70%) could be followed for five years. An inter-arm difference of 100 ml or more was defined as oedema. Three types of treatment were given: (1) Compression with stockings in 28 patients, (2) intermittent compression (Flowtron) in 8 and (3) intermittent compression (Lympha-Press) and compression sleeves in 19 patients. RESULTS: A total of 46 patients (20%) developed post-operative oedema, 17 within six months and 29 one year postoperatively. The average oedema volume was 418 ml. Most patients with a moderate or severe oedema had irradiation therapy. Severe lymphoedema (750 ml or more) occurred in patients with irradiation postoperatively and lymph node engagement. There was no correlation between patient age and oedema formation. Compression therapy with stockings reduced oedema in 15 out of 28 patients (54%) and prevented further swelling. Therapy with stockings and Lympha Press reduced the arm volume in 13 out of 19 patients (68%). Four out of eight patients treated with Flowtron showed oedema reduction. In most patients cessation of treatment resulted in relapse of swelling to the same degree as before. CONCLUSIONS: Compression therapy is beneficial to control postmastectomy arm swelling. This applies to different modalities and prolonged periods of treatment are required to check progression. Application of stockings is the simplest way to treat postoperative oedema. In most cases postoperative oedema appeared during the first year after surgery and the most severe cases occurred after irradiation.
Subject(s)
Lymphedema/therapy , Mastectomy, Modified Radical , Postoperative Complications/therapy , Adult , Aged , Arm , Female , Follow-Up Studies , Humans , Lymphedema/epidemiology , Lymphedema/etiology , Middle Aged , Postoperative Complications/epidemiology , Prospective Studies , Time Factors , Treatment OutcomeABSTRACT
A case of ruptured aortic aneurysm in connection with an operation for gastric cancer is described. Risk factors for ruptures are discussed. An active approach even in serious concomitant disease in elderly people is recommended.
Subject(s)
Adenocarcinoma/complications , Aortic Aneurysm, Abdominal/complications , Aortic Rupture/complications , Stomach Neoplasms/complications , Adenocarcinoma/surgery , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , Fatal Outcome , Female , Humans , Patient Care Team , Stomach Neoplasms/surgerySubject(s)
Muscle, Smooth/physiopathology , Varicose Veins/physiopathology , Veins/physiopathology , Elasticity , Electric Stimulation , Female , Foot/blood supply , Histamine/pharmacology , Humans , Leg/blood supply , Male , Muscle, Smooth/drug effects , Norepinephrine/pharmacology , Potentiometry , Saphenous Vein/physiopathology , Serotonin/pharmacology , Thigh/blood supply , Varicose Veins/etiology , Veins/drug effectsSubject(s)
Arm/blood supply , Arteriosclerosis/diagnosis , Blood Pressure Determination , Leg/blood supply , Ultrasonography , Adult , Aged , Blood Flow Velocity , Female , Humans , Middle AgedSubject(s)
Foot/blood supply , Venous Insufficiency/therapy , Clothing , Elasticity , Female , Humans , Male , Middle Aged , Pressure , Regional Blood FlowSubject(s)
Edema/diagnosis , Foot/blood supply , Venous Insufficiency/diagnosis , Central Venous Pressure , Humans , Methods , PlethysmographySubject(s)
Dihydroergotamine/therapeutic use , Venous Insufficiency/drug therapy , Adult , Aged , Female , Humans , Male , Middle Aged , Varicose Veins/drug therapySubject(s)
Arteriosclerosis Obliterans/physiopathology , Leg/blood supply , Sympathetic Nervous System/physiopathology , Thromboangiitis Obliterans/physiopathology , Aged , Arteriosclerosis Obliterans/therapy , Blood Pressure , Body Temperature Regulation , Collateral Circulation , Hemodynamics , Humans , Mepivacaine , Middle Aged , Nerve Block , Skin Temperature , Spinal Nerves , Sympathectomy , Thromboangiitis Obliterans/therapy , Toes/blood supply , Toes/physiopathology , Vascular ResistanceSubject(s)
Sclerosing Solutions/therapeutic use , Varicose Veins/drug therapy , Varicose Veins/surgery , Adult , Female , Humans , MaleABSTRACT
In 63 patients with severe symptoms of thoracic outlet syndrome, transaxillary rib resection was performed. The series was re-evaluated after a mean postoperative observation time of 2.5 years. Complete relief of all symptoms was obtained in 64% of the patients and marked improvement in 17%. The result was classified as fair in 12%. In 7% of the series no improvement of symptoms was obtained.
Subject(s)
Thoracic Outlet Syndrome/surgery , Adolescent , Adult , Female , Humans , Male , Middle Aged , Postoperative Complications , Ribs/surgery , Thoracic Outlet Syndrome/pathologyABSTRACT
The effect of stretch and storage of isolated human blood vessels was studied in vitro. The following observations were made. 1. Umbilical vessel preparations exhibited spontaneous rhythmic activity whereas other vessels showed this only after storage. Amplitude but not frequency of this activity increased after stretching. 2. Innervated vessel preparations showed increased sensitivity and maximal response to noradrenaline after storage. This can probably be explained by denervation supersensitivity and receptor upregulation and the rhythmic responses after storage may reflect unstable membrane potentials and prostaglandin synthesis.