Fatigue and sleep quality improvement through complete decongestive therapy in postmastectomy lymphedema: An investigative analysis.

OBJECTIVE: To evaluate the effects of complete decongestive therapy (CDT) on cancer-related fatigue, sleep quality, and lymphedema-specific quality of life using validated and reliable questionnaires in cancer patients being commendable. MATERIAL AND METHODS: This prospective study includes 94 patients who had postmastectomy lymphedema syndrome. The demographic characteristics of the patients were recorded. The participants' stages of lymphedema (The International Society of Lymphology), Hirai Cancer Fatigue Scale (HCFS) score, Pittsburgh Sleep Quality Index (PSQI) Global score, lymphedema-specific quality of life questionnaire (LYMQOL-ARM) score, and Global health status were recorded before and after CDT. RESULTS: The mean age of the patients was 58.49 ± 10.96 years. Strong correlations were found between the severity of edema and global health status. There was a significant positive relationship between the HCFS score, PSQI Global score, LYMQOL-ARM score, and CDT. After decongestive physiotherapy, the majority of the lymphedema stages were downstaging (p < 0.05), respectively. There was also a trend toward improvement in general well-being (p < 0.05). CONCLUSION: Cancer-related fatigue and sleep disturbance can persist for years after surgery in women with breast cancer. This can negatively affect the patient physically, socially and cognitively. Our study, which is the first study to investigate the HCFS score in postmastectomy patients and the relationship between PSQI Global score and CDT. The findings identify the risk factors that affect these outcomes in women with lymphedema and can provide valuable insights for targeted interventions and improved patient care.

Self-reported arm and shoulder problems in breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes cohort study.

BACKGROUND: Arm and shoulder problems (ASP), including lymphedema, were common among women with breast cancer in high-income countries before sentinel lymph node biopsy became the standard of care. Although ASP impair quality of life, as they affect daily life activities, their frequency and determinants in Sub-Saharan Africa remain unclear. METHODS: All women newly diagnosed with breast cancer at the Namibian, Ugandan, Nigerian, and Zambian sites of the African Breast Cancer-Disparities in Outcomes (ABC-DO) cohort study were included. At each 3-month follow-up interview, women answered the EORTC-QLQ-Br23 questionnaire, including three ASP items: shoulder/arm pain, arm stiffness, and arm/hand swelling. We estimated the cumulative incidence of first self-reported ASP, overall and stratified by study and treatment status, with deaths treated as competing events. To identify determinants of ASP, we estimated cause-specific hazard ratios using Cox models stratified by study site. RESULTS: Among 1476 women, up to 4 years after diagnosis, 43% (95% CI 40-46), 36% (33-38) and 23% (20-25), respectively, self-reported having experienced arm/shoulder pain, stiffness and arm/hand swelling at least once. Although risks of self-reported ASP differed between sites, a more advanced breast cancer stage at diagnosis, having a lower socioeconomic position and receiving treatment increased the risk of reporting an ASP. CONCLUSION: ASP are very common in breast cancer survivors in Sub-Saharan Africa. They are influenced by different factors than those observed in high-income countries. There is a need to raise awareness and improve management of ASP within the African setting.

[Members lymphedema in CNHU-HKM of Cotonou: Results of the rehabilitation treatment]. / Lymphoedemesdes membres au CNHU-HKM de Cotonou : Resultats du traitement reeducatif.

AIM: To report results of patients followed in physical medicine and rehabilitation (PMR) in CNHU-HKM of Cotonou. PATIENTS AND METHODS: Retrospective, transversal study, aimed to be descriptive and analytical type. Were enrolled, 39 files of patients treated in PMR / CNHU-HKM, from 1st January 2014 to 31st December 2018, for unilateral lymphedema, who had done beginning and ending evaluations. Were excluded, venous, systemic or lipid edema. The severity and the result of the sessions were assessed taking into account the reports of perimeters of the member segments. Factors associated with the result were sought, by the Mann-Whitney test. RESULTS: The localization of lymphedema was in thoracic and pelvic limbs, respectively in 64.1 and 35.9%. Were associated with the oedema functional difficulties (61.54%), muscle paresis (33.33%) and joint stiffness (30.77%). Patients benefited from 5 to 20 physiotherapy sessions. Has been associated with physiotherapy, the use of compression stockings (58.97%). The results have been satisfactory, mainly influenced by the development time. CONCLUSION: Satisfactory results in the physiotherapy management of lymphedema have been noted in our context, especially in patients seen early.

BUT: Rapporter les résultats des patients suivis en médecine physique et de réadaptation (MPR) au CNHU-HKM de Cotonou. PATIENTS ET MÉTHODES: Etude rétrospective, transversale de type descriptif et analytique. Ont été enrôlés, 39 dossiers de patients traités en MPR/CNHU-HKM, du 1er Janvier 2014 au 31 Décembre 2018, pour un lymphoedème unilatéral, ayant eu des évaluations de début et de fin de séances. Ont été exclus, les cas d'œdème veineux, systémique ou lipidique. La sévérité et le résultat des séances ont été appréciés en tenant compte des rapports des périmétries des segments de membre. Les facteurs associés au résultat ont été recherchés, par le test de Mann-Whitney. RÉSULTATS: La localisation du lymphoedème a été aux membres thoracique(s) et pelvien(s), respectivement dans 64,1 et 35,9%. Y étaient associées, des difficultés fonctionnelles (61,54%), parésie musculaire (33,33%) et raideur articulaire (30,77%). Les patients ont bénéficié de 5 à 20 séances de kinésithérapie. A été associée à la kinésithérapie, l'utilisation de bas de contention (58,97%). Les résultats ont été satisfaisants, influencés essentiellement par le délai d'évolution. CONCLUSION: Des résultats satisfaisants de la prise en charge kinésithérapique du lymphoedème ont été notés dans notre contexte, surtout chez les patients vus tôt.

Clinical, haematological and biochemical profiling of podoconiosis lymphoedema patients prior to their involvement in a clinical trial in the Northwest Region of Cameroon.

BACKGROUND: Prior to carrying out clinical trials, it is important to assess the health status of the study participants to be able to interpret subsequent changes that may be related to the effects of the treatments during the follow-up of patients. This study presents the clinical, haematological and biochemical profiles of podoconiosis patients prior to their involvement in the PodoLEDoxy clinical trial. METHODS: All lower limb lymphoedema patients visiting the centre were screened and a podoconiosis diagnosis was based on clinical manifestation and detailed medical history. Patients who satisfied the eligibility criteria were enrolled in the study and their demographic data, vital signs and medical history were collected followed by biochemical and haematological examinations. RESULTS: Of the 222 participants enrolled in the study, 55.4% and 41.4% had either stage 3 or 2 podoconiosis as their highest stages, respectively. On physical examination, gastritis (46%) and poor vision (2.7%) were the most prevalent health issues identified. The majority of haematological and biochemical values were within the normal range except for mean platelet volume (47.7%), plateletcrit (58.1%), platelet distribution width (66.2%), mean corpuscular volume (67.6%) and red cell distribution width-standard deviation (79.3%), where >40% of the study participants had values out of the normal. CONCLUSION: The clinical, haematological and biochemical profiles of the study participants were largely within the normal range except for certain haematological parameters that might be worth investigating.

Lymph Node Fibrosis in a Case of Primary Lymphoedema- A Report of Two Cases.

Lymphoedema can be classified into primary and secondary. Primary lymphoedema arise in patients where the cause is not known. Secondary lymphoedema are those in which the lymph system has been damaged by some well recognised pathological process, such as extensive malignancy, filariasis, radiation etc. The changes may occur either in the lymph node, or in lymph vessels or both. The clinical evolution and the prognosis of the oedema in the limb involved will depend on the extension and evolution of these lesions. The degree of fibrosis and its distribution in lymph node play an important role on the prognosis, clinical course and treatment of the patient. Hence pathologist should be aware of the microscopic distribution and patterns of lymph node fibrosis in primary lymphoedema. We hereby report two cases- a 50-year-old male diabetic patient and a 35-year-old male patient presenting with varicose veins, lymphoedema showing lymph node fibrosis.

Early lipoedema diagnosis and the RCGP e-learning course.

Frequently misdiagnosed as obesity, lipoedema is chronic condition involving an abnormal build-up of fat cells in the legs, thighs and buttocks that cannot be shifted by exercise or dieting. Estimated to affect up to 11% of the female population, the condition is widely unknown by health professionals. This means women typically wait for many years before diagnosis. This allows the condition to progress unchecked, resulting in unnecessary deterioration and the development of associated comorbidities, as well as significant pain and mental anguish. A free, 30-minute Royal College of General Practitioners (RCGP) e-learning course created in partnership with Lipoedema UK aims to rectify this situation by educating nurses, GPs and other health professionals on how to diagnose and manage lipoedema in primary care. This article aims to describe the condition of lipoedema, how to recognise/diagnose it, current treatment options and the findings of a 240-patient survey carried out by Lipoedema UK in 2013 that included documenting the difficulties for patients in obtaining a diagnosis as well as the mental and physical effects of the condition.

Use of neutral plasma coagulation in groin node dissection for vulvar malignancy: a novel technique.

Vulvar cancer is an uncommon disease with approximately 1000 cases reported annually in the UK. Lymph node involvement is an important prognostic indicator. Vulvectomy and bilateral groin node dissection are the preferred surgical treatments for early disease and increase survival. However, significant morbidity with lymphocyst formation and wound breakdown has been reported in more than 50% of cases. We report the first case following use of the PlasmaJet(®) neutral argon coagulation system to reduce postoperative lymphocyst formation.