Prospective multicentre observational study of lymphedema therapy: POLIT study.

OBJECTIVE: Lymphedema treatment is based on Decongestive Lymphedema Therapy (DLT) with an intensive phase followed by a long-term maintenance phase. This study aimed to observe volume variation over the intensive phase and 6 months later. METHODS: Prospective multicentre observational study of patients with unilateral lymphedema. The primary objective was to assess lymphedema volume variation between baseline, the end of intensive phase and 6 months later. Secondary objectives were to assess the frequency of heaviness limiting limb function and treatments safety predictors for volume reduction. RESULTS: Three hundred and six patients (89.9% women; 59.9±14.3 years old) with upper/lower (n=184/122) limb lymphedema were included. At the end of the intensive phase, median excess lymphedema volume reduction was 31.0% (41.7-19.9) followed by a 16.5% (5.9-42.3) median increase over the 6-month maintenance period phase. Previous intensive treatment was the only significant predictor of this response. As compared to baseline, heaviness limiting limb use was much less frequently reported at the end of the reductive phase (75.5% versus 42.3% respectively), and was more frequent at the end of the maintenance phase (62.6%). The most frequent adverse events reported were skin redness and compression marks (18.4 and 15.7% of patients, respectively). Blisters requiring treatment stoppage were rare (1.4%). CONCLUSIONS: Intensive phase decreases lymphedema volume and heaviness limiting limb function. The benefit is partially abolished after the first 6 months of maintenance. There is a need to consider how to provide optimal patient care for the long-term control of lymphedema.

[Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the French Society for Vascular Medicine]. / Standards de qualité pour la pratique de l'examen écho-doppler dans l'étude des malformations et tumeurs vasculaires. Rapport de la Société française de médecine vasculaire (SFMV).

THE QUALITY STANDARDS OF THE FRENCH SOCIETY OF VASCULAR MEDICINE FOR THE ULTRASONOGRAPHIC ASSESSMENT OF VASCULAR MALFORMATIONS ARE BASED ON THE TWO FOLLOWING REQUIREMENTS: Technical know-how: mastering the use of ultrasound devices and the method of examination. Medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To achieve consistent practice, methods, glossary, and reporting. To provide good practice reference points, and promote a high-quality process. ITEMS OF THE QUALITY STANDARDS: The three levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Settings and use of ultrasound devices. Here, we discuss the methods of using ultrasonography for the assessment of peripheral vascular malformations and tumors.

Shaping quality: the use of performance polygons for multidimensional presentation and interpretation of qualitative performance data.

BACKGROUND: Measuring outcomes and quality in anaesthesia is challenging. In the UK, there is increased focus on these as a result of changes in Department of Health strategy and the imminent introduction of mandatory revalidation for all doctors. A definition of quality may differ according to the observer's standpoint and numerous performance measures may contribute to overall quality. Patients, surgeons, anaesthetic assistants, recovery nurses, managers, and anaesthetic peers are each likely to have their own perspective on 'anaesthetic quality' and would perhaps suggest different metrics to measure it. Speed, efficiency, cost, interpersonal skills, complication rates, patient recorded outcome measures, and satisfaction are all valid as quality measures, but none alone captures anaesthetic quality. Performance data are frequently presented as single-dimension measurements (e.g. pain, postoperative nausea and vomiting, patient satisfaction), but this does not address the fact that two or more domains may be closely related (e.g. use of regional anaesthesia and quality of analgesia) or in opposition (e.g. use of regional anaesthesia and speed). METHODS: We introduce the concept of a 'performance polygon' as a tool to represent multidimensional performance assessment. This method of data presentation encourages balanced appraisal of anaesthetic quality. RESULTS: Performance polygons may be used to compare individual performance with peers, published outcome norms, trends in performance over time, to explore aspects of team performance and potentially capture data that are required for medical revalidation. CONCLUSIONS: Performance polygons enable easy comparison with any relevant data set and are a visual tool that potentially has wider applications in healthcare quality improvement.

Lack of involvement of type 7 phosphodiesterase in an experimental model of asthma.

Type 7 phosphodiesterases (PDE7) are responsible for the decrease of intracellular cyclic AMP (cAMP) in many cells involved in allergic asthma by suppressing their potential to respond to many activating stimuli. The elevation of intracellular cAMP has been associated with immunosuppressive and anti-inflammatory activities and represents a potential treatment of asthma. Our aim was to evaluate the impact of the deletion of the murine phosphodiesterase (PDE)7B gene and then to evaluate the efficacy of a newly described selective PDE7A and -B inhibitor on an ovalbumin (OVA)-induced airway inflammation and airway hyperreactivity (AHR) model in mice. Inflammation was determined 72 h after single OVA challenge or 24 h after multiple challenges by the relative cell influx and cytokine content in bronchoalveolar lavage fluid. AHR and immunoglobulin E levels in serum were determined after multiple challenges. For the first time, we have demonstrated that the deletion of the PDE7B gene or the pharmacological inhibition of PDE7A and -B had no effect on all the parameters looked at in this model. These results highlight the absence of any implication of the PDE7 enzyme in our model.

[Renal functioning and human body liquids during 5-day dry immersion].

Renal function and body composition, including liquids, were investigated in 14 essentially healthy male subjects during simulation of some spaceflight effects by 5-d dry immersion (DI). Noninvasive measurement of water spaces of organism was performed with the methods of bio-impedance analysis (BIA). Increase of renal excretion of liquids and appearance of negative water balance were observed. BIA revealed reductions of total body and extracellular liquids and a decrease of circulating plasma volume. This means, that DI induced hypohydration of organism. In the post-DI period, the hydration status regained its baseline level fairly soon. Lean body mass slightly decreased; adipose mass, on the contrary, exceeded baseline values. Moreover, the experiment evidenced technical impossibility to obtain valid impedansimetry data in DI.

Cardiovascular deconditioning: From autonomic nervous system to microvascular dysfunctions.

Weightlessness induces an acute syndrome called the cardiovascular deconditioning, associating orthostatic intolerance with syncope, increase in resting heart rate and decrease in physical capability. Orthostatic intolerance occurs after short term and long term head down bed rest and after long term space flight. Both head down bed rest and space flight induce a significant decrease of the spontaneous baroreflex sensitivity. However, spontaneous baroreflex sensitivity only characterizes the cardiac baroreflex loop. To go further with the analysis of cardiovascular deconditioning we were interested in the microcirculation. As the endothelium plays a crucial role in the regulation of vascular homeostasis and local blood flow, we hypothesized that endothelial dysfunction is associated with bed rest induced changes. We investigated endothelial properties before and after 56 days of bed rest in 8 women of control group and in 8 women who regularly performed physical exercise as countermeasure. Our study shows that prolonged bed rest causes impairment of endothelium-dependent functions at the microcirculation level, along with an increase in circulating endothelial cells. Endothelium should be a target for countermeasures during periods of prolonged bed rest or exposure to weightlessness.

[Limb lymphedema: Diagnosis, explorations, complications. French Lymphology Society]. / Les lymphoedèmes des membres: diagnostic, explorations, complications.

Lymphedema results from impaired lymphatic transport with increased limb volume. Primary and secondary forms can be distinguished. Secondary lymphedema of the upper limb is the most frequent in France. A 2-cm difference on any segment of the limb confirms the diagnosis of lymphedema. Calculated lymphedema volume using the formula for a truncated cone is required to assess the efficacy of treatment and to monitor follow-up. Primary lymphedema is sporadic but rarely familial. Lymphoscintigraphy is useful in the primary form to evaluate precisely lymphatic function of the two limbs. Erysipelas is the main complication,but psychological or functional discomfort may occur throughout the course of lymphedema. Lipedema is the main differential diagnosis, defined as an abnormal accumulation of fat from hip to ankle and occurs almost exclusively in obese women.

[Genetics of lymphedema: from Milroy's disease to cancer investigations]. / La génétique du lymphoedème: de la maladie de Milroy aux applications en cancérologie.

New insight has recently been obtained into the molecular mechanisms regulating lymphatic development and function during embryogenesis. VEGF-C and D ligands have been shown to stimulate lymphangiogenesis and their lymphatic-specific receptor VEGFR-3 is linked to the human congenital and hereditary lymphedema in humans. Above all, new focus on lymphatic endothelial cells gives opportunities for developing innovative therapies for lymphedema and cancer metastasis.

[Physical therapy of lymphedema: Montpellier's experience]. / Physiothérapie des lymphoedèmes: l'expérience de Montpellier.

Authors have presented their experience for treatment of lymphedema during 5 consecutive days. After intensive phase of treatment at hospital, specific therapy is described to maintain results. Complex decongestive physiotherapy includes manual lymphatic drainage and bandage which are modified with original methods every day if necessary.

Acute diquat poisoning with intracerebral bleeding.

A case of severe diquat poisoning complicated by the development of aggressive behaviour, oliguric renal failure, and intracerebral bleeding is described. The patient was successfully managed and made a complete recovery. In this paper special attention has been given to the major clinical differences between diquat and paraquat intoxication.

[Manual lymphatic drainage]. / Drainage lymphatique manuel.

Manual physiotherapy of lymphoedema is the best treatment for chronic venous and lymphatic stasis of the lower limbs. It consists in handlings of the limb for the appeal and the resorption of the lymph but it cannot be used alone. It must be associated with other techniques: defibrosing, skin care, compressive bandages, muscular exercise. Contensive and compressive bandagings prolong the action of lymphatic drainage. The main indication of manual physiotherapy is primary or secondary lymphoedema but also chronic venous disease, and in some selected cases acute venous thrombosis and traumatic or post-traumatic pains.

Is a man's facial appearance predictive of how he will die?

The ability of a range of health professionals including an oncologist, a haematologist, a cardiologist, a general practitioner and a counsellor to predict the cause of death from facial appearance has been evaluated. Each participant was asked to predict the cause of death from facial photographs of 200 caucasian male doctors whose cause of death was known to be due to either arterial disease or neoplasia. Statistically significant concordance was found between the oncologist and both the GP and the counsellor in their predictions of cause of death, although the individual accuracy was no greater than would be expected by chance. This suggests that common judgments based on facial appearances may be shared among certain health professionals.

Warfarin treatment and migraine.

A patient suffering from migraine, whose symptoms were abolished by warfarin therapy, is reported. Warfarin was prescribed for deep vein thrombosis and the frequency of the patient's headache improved remarkably during the anticoagulant therapy. Because of the unusual nature of the response to anticoagulant therapy, warfarin was reintroduced on a double blind (versus placebo) basis and once again abolished the headaches.