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1.
Clin Nucl Med ; 44(8): 669-673, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274620

RESUMO

Stress-lymphoscintigraphy evaluates the effects of exercise on lymph drainage. Results may predict outcomes of complex physical therapy as a first-line lymphedema treatment. Microsurgical approaches are best in patients with lymphangectasia or dermal backflow. Lymphatic pathway mapping helps plan lympho-venous anastomoses. For improved lymphatic visualization, we suggest a scan at rest, after a quick exercise (stepping or weight lifting for 2 min) and delayed scanning after prolonged symptom limited exercise (walking or hand squeezing for 30-40 min). In advanced lymphedema, identification of lymph pathways and residual regional lymph nodes might be difficult. In these patients, lymph node transplant is suggested.


Assuntos
Linfedema/diagnóstico por imagem , Linfocintigrafia/métodos , Idoso , Gerenciamento Clínico , Diagnóstico Precoce , Teste de Esforço/métodos , Feminino , Humanos , Linfedema/terapia , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 98(30): e16563, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348280

RESUMO

BACKGROUND: Many studies were performed to explore the correlation between taxane-based chemotherapy and the risk of breast cancer-related lymphedema (BCRL), however, with inconsistent results. Hence, the purpose of this study is to evaluate whether taxane-based chemotherapy is a risk factor for BCRL. METHODS: A comprehensive systematic search of clinical trials published in the PubMed, Embase and the Cochrane Library databases will be conducted to identify eligible studies up to the date of December 31, 2018. We will employ risk ratios with 95% confidence intervals (95% CIs) to estimate the correlations between taxane-based chemotherapy and BCRL. Meta-analysis will be performed using Stata SE version 12.0 software. RESULTS: The results of this systematic review and meta-analysis will provide a high-quality synthesis of existing evidence of the correlations between taxane-based chemotherapy and the risk of BCRL. CONCLUSION: The protocol will provide updated evidence for the use of taxane-based chemotherapy in postoperative breast cancer patients. ETHICS AND DISSEMINATION: It is not necessary for ethical approval because it is based on published studies. The protocol will be disseminated in a peer-reviewed journal or presented at a topic-related conference. TRIAL REGISTRATION: This systematic review protocol has been registered with a number of CRD42019123989.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Hidrocarbonetos Aromáticos com Pontes/efeitos adversos , Linfedema/induzido quimicamente , Taxoides/efeitos adversos , Feminino , Humanos , Metanálise como Assunto , Projetos de Pesquisa , Fatores de Risco , Revisão Sistemática como Assunto
3.
Zhonghua Shao Shang Za Zhi ; 35(4): 277-283, 2019 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-31060175

RESUMO

Objective: To explore the clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction. Methods: From October 2014 to December 2016, 10 female patients, aged 37-60 (48±8) years, who had lymphedema in the upper limb after radical mastectomy, were admitted to Department of Oncology Plastic Surgery of Hunan Cancer Hospital. Three patients suffered recurrent erysipelas infections, and 4 patients suffered consistent neuropathic pain in the upper limb. Free deep inferior epigastric perforator flap carrying lymphatic groin flap was used for breast reconstruction and lymphedema treatment. Operation was performed by 2 surgeon groups including recipient site prepare group and flap harvest group. In the 10 patients, the length of the flaps was (26.2±0.3) cm, the width of the flaps was (13.4±0.4) cm, and the thickness of the flaps was (3.4±0.3) cm. All the donor sites in the abdomen were closed directly. The choices of vascular pedicles and vessels in the recipient sites, operation time, complications, operation effects, and follow-up were recorded. Results: (1) Bilateral vascular pedicle was adopted in flaps of 5 patients. Unilateral vascular pedicle was adopted in flaps of 5 patients. The recipient vessels were proximal and distal ends of internal thoracic vessels in 4 cases, the proximal end of thoracodorsal vessels in 3 cases, the proximal end of internal thoracic vessels in 2 cases, and the proximal end of internal thoracic vessels and thoracodorsal vessels in 1 case. (2) The operation time of the patients was 330-480 (406±55) min. (3) Subcutaneous edema was observed in flaps of 2 patients and donor site of 1 patient, which were all healed by dressing change therapy. The other flaps survived successfully. The reconstructed breasts were in good shape and elasticity. Nine patients had different degrees of relief in lymphedema in the upper limb. All 10 patients were followed up for 6 to 28 months, no one had recurrent erysipelas infections, and neuropathic pain in the upper limb was relieved in 2 patients. Only linear scar was left in the donor sites of 10 patients, and the function of abdomen was not affected without related complications. Conclusions: Free deep inferior epigastric perforator flap carrying lymphatic groin flap can simultaneously accomplish breast reconstruction and upper limb lymphedema treatment, which is worthwhile to be popularized in clinic.


Assuntos
Neoplasias da Mama/cirurgia , Artérias Epigástricas/cirurgia , Linfedema/cirurgia , Mamoplastia/métodos , Mastectomia , Retalho Perfurante/irrigação sanguínea , Extremidade Superior/patologia , Adulto , Linfedema Relacionado a Câncer de Mama/reabilitação , Linfedema Relacionado a Câncer de Mama/cirurgia , Artérias Epigástricas/transplante , Feminino , Retalhos de Tecido Biológico/transplante , Virilha , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
4.
J Surg Oncol ; 120(2): 160-167, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31144329

RESUMO

BACKGROUND: A lymphedema (LE) prevention surgery (LPS) paradigm for patients undergoing axillary lymphadenectomy (ALND) was developed to protect against LE through enhanced lymphatic visualization during axillary reverse mapping (ARM) and refinement in decision making during lymphaticovenous bypass (LVB). METHODS: A retrospective analysis of a prospective database was performed evaluating patients with breast cancer who underwent ALND, ARM, and LVB from September 2016 to December 2018. Patient and tumor characteristics, oncologic and reconstructive operative details, complications and LE development were analyzed. RESULTS: LPS was completed in 58 patients with a mean age of 51.7 years. An average of 14 lymph nodes (LN) were removed during ALND. An average of 2.1 blue lymphatic channels were visualized with an average of 1.4 LVBs performed per patient. End to end anastomosis was performed in 37 patients and a multiple lymphatic intussusception technique in 21. Patency was confirmed 96.5% of patients. Adjuvant radiation was administered to 89% of patients. Two patients developed LE with a median follow-up of 11.8 months. CONCLUSION: We report on our experience using a unique LPS technique. Refinements in ARM and a systematic approach to LVB allows for maximal preservation of lymphatic continuity, identification of transected lymphatics, and reestablishment of upper extremity lymphatic drainage pathways.


Assuntos
Neoplasias da Mama/cirurgia , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/prevenção & controle , Adulto , Idoso , Axila , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Corantes , Feminino , Humanos , Verde de Indocianina , Linfedema/etiologia , Linfografia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
BMC Infect Dis ; 19(1): 442, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109288

RESUMO

BACKGROUND: Lymphatic Filariasis (LF) is a vector-borne neglected tropical disease caused by the filarial nematode parasites that can lead to the disfiguring swelling of the limbs (lymphedema or elephantiasis for late stage) and/or genitalia (hydrocele) in men. Growing evidence suggests that not only are filarial lymphedema patients confronted with huge societal stigma and discrimination, but also experience acute filarial attacks accompanied by swelling of the affected part(s), fever, wounds and peeling of the skin of affected limbs(s). However, the extent to which seasonal variation influence filarial attacks among people with lymphedema was highly speculated without empirical evidence and was thus investigated. METHODS: In light of this, a cross-sectional study where 142 (70.4% females and 29.6% males) lymphedema patients were recruited from 8 established Wuchereria bancrofti endemic communities in the Ahanta West District, Ghana was carried out to investigate the prevalence and seasonal variation (rainy/wet and dry seasons) of acute filarial attacks. Chi-square test was used to test for association between frequency of attacks and seasonality. The STROBE guidelines for reporting cross-sectional studies was adopted. RESULTS: The average lymphedema leg stage was 2.37 and 2.33 for left and right legs, respectively, while mossy lesions, sores and ulcers were observed among 33.1% of patients with late stage disease (elephantiasis). It was found that 97 (68.3%) of the study participants experience filarial attacks during the wet season and 36 (25.4%) reported the incidence of filarial attacks during both seasons (wet and dry) while 9 (6.3%) of the study participants did not experience any attack at all. CONCLUSIONS: Findings from the present study show compelling evidence that the frequency and the prevalence of filarial attacks is significantly increased during wet seasons compared to the dry season.


Assuntos
Filariose Linfática/diagnóstico , Linfedema/patologia , Adulto , Idoso , Animais , Estudos Transversais , Filariose Linfática/epidemiologia , Filariose Linfática/parasitologia , Feminino , Gana/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estações do Ano , Índice de Gravidade de Doença , Wuchereria bancrofti/isolamento & purificação
6.
BMC Infect Dis ; 19(1): 332, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014256

RESUMO

BACKGROUND: Lymphatic filariasis (LF) is a mosquito-borne parasitic disease and a major cause of disability worldwide. To effectively plan morbidity management programmes, it is important to estimate disease burden and evaluate the needs of patients. This study aimed to estimate patient numbers and characterise the physical, social and economic impact of LF in in rural Nigeria. METHODS: This is a matched cross-sectional study which identified lymphedema and hydrocele patients with the help of district health officers and community-directed distributors of mass drug administration programmes. A total of 52 cases were identified and matched to 52 apparently disease-free controls, selected from the same communities and matched by age and sex. Questionnaires and narrative interviews were used to characterise the physical, social and economic impact of lymphedema and hydrocele. RESULTS: Forty-eight cases with various stages of lower limb lymphedema, and 4 with hydrocele were identified. 40% of all cases reported feeling stigma and were 36 times (95% CI: 5.18-1564.69) more likely to avoid forms of social participation. Although most cases engaged in some form of income-generating activity, these were low paid employment, and on average cases spent significantly less time than controls working. The economic effects of lower income were exacerbated by increased healthcare spending, as cases were 86 times (95% CI: 17.48-874.90) more likely to spend over US $125 on their last healthcare payment. CONCLUSION: This study highlights the importance of patient-search as a means of estimating the burden of LF morbidity in rural settings. Findings from this work also confirm that LF causes considerable psychosocial and economic suffering, all of which adversely affect the mental health of patients. It is therefore important to incorporate mental health care as a major component of morbidity management programmes.


Assuntos
Filariose Linfática/patologia , Linfedema/patologia , Adulto , Estudos Transversais , Filariose Linfática/tratamento farmacológico , Filariose Linfática/economia , Feminino , Humanos , Renda , Entrevistas como Assunto , Linfedema/tratamento farmacológico , Linfedema/economia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Nigéria , População Rural , Índice de Gravidade de Doença , Estigma Social , Inquéritos e Questionários , Adulto Jovem
7.
Turk J Med Sci ; 49(2): 610-616, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30997976

RESUMO

Background/aim: The aim of this study is to present the results of modified combined decongestive therapy (CDT) in patients with lower extremity lymphedema (LEL). Materials and methods: We retrospectively reviewed 95 patients aged 55.84 ± 15.70 years who had been diagnosed with LEL between May 2015 and May 2017. The patients were treated for 4 weeks with modified CDT, including self-manual lymphatic drainage, self-bandaging, decongestive exercises, and skin care. Results: The mean reduction amounts of edema volume before and after treatment were 296.05, 784.92, and 1038.50 mL for stages 1, 2, and 3 respectively (P = 0.001). There were significant differences between the values before and after treatment in excess extremity volume (EEV) at all stages (P = 0.001). The EEV percentages of the secondary LEL patients were higher than those of the primary LEL patients (P = 0.04). There was no correlation between BMI and treatment response in terms of EEV percentages (r = ­0.99; P = 0.36). Conclusion: Our results revealed that home-based modified CDT is more effective in reducing extremity edema volume in secondary LEL than primary LEL. It should be an available method for self-management of LEL at all stages.


Assuntos
Terapia Combinada/métodos , Terapia por Exercício/métodos , Extremidade Inferior/fisiopatologia , Linfedema/reabilitação , Drenagem Linfática Manual/métodos , Modalidades de Fisioterapia , Higiene da Pele , Adulto , Bandagens Compressivas , Feminino , Humanos , Linfedema/fisiopatologia , Masculino , Massagem , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Estudos Retrospectivos , Resultado do Tratamento
8.
Rev. argent. salud publica ; 10(38): 34-37, Abril 2019.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-996478

RESUMO

El linfedema es una acumulación de linfa y tejido fibroadiposo anormal en los miembros. Su origen más habitual, en Argentina, es el tratamiento del cáncer de mama. El manejo incluye múltiples intervenciones, que van desde terapias no invasivas hasta técnicas quirúrgicas específicas. El objetivo de este informe fue evaluar la eficacia y seguridad de intervenciones destinadas al manejo del linfedema mediante la revisión de la evidencia científica disponible, con el fin de orientar la toma de decisiones de cobertura. Se realizó una búsqueda bibliográfica y se utilizó la lista de cotejo de PRISMA para la evaluación de revisiones sistemáticas. En caso de discrepancias, se consultó a un tercer revisor. Se recuperaron 141 trabajos a través de las distintas estrategias de búsqueda, 45 fueron evaluados mediante resumen o texto completo. Finalmente se incluyeron 10 revisiones sistemáticas. La evidencia para las intervenciones evaluadas resultó de baja confianza, principalmente por la presencia de estudios con escaso número de pacientes, comparadores distintos del manejo habitual, heterogeneidad en las intervenciones y tiempos acotados de seguimien


Assuntos
Humanos , Radioterapia , Cirurgia Geral , Terapêutica , Linfedema , Neoplasias
9.
Clin Nucl Med ; 44(6): 501-503, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30932981

RESUMO

Prostate-specific membrane antigen (PSMA) is overexpressed in a majority of prostate cancer cells, which has led to the development of radiolabeled small-molecule inhibitors of PSMA for molecular imaging and targeted radioligand therapy. Lu-labeled PSMA, with therapeutic ß-emission and concomitant γ radiation, permits posttherapy imaging for the assessment of biodistribution and uptake in tumors and normal organs, as well as dosimetry. We report a patient with prostate cancer and metastatic lymph nodes-related lower extremity lymphedema, who presented with dermal backflow and soft-tissue uptake in the lower extremity on posttherapeutic whole body scan after intravenous Lu-PSMA treatment.


Assuntos
Dipeptídeos/farmacocinética , Compostos Heterocíclicos com 1 Anel/farmacocinética , Extremidade Inferior/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Compostos Radiofarmacêuticos/farmacocinética , Idoso de 80 Anos ou mais , Humanos , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Imagem Corporal Total
14.
Clin Nucl Med ; 44(6): 439-445, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985414

RESUMO

PURPOSE: This study was designed to investigate the role of Ga-NOTA-Evans Blue (NEB) time-of-flight (TOF) PET/MR in evaluating lower limb lymphedema by visual analysis and novel parameters. METHODS: Thirteen patients with unilateral lower limb lymphedema were divided into 3 groups according to the clinical severity: minimal (4 patients), moderate (5 patients), and severe (4 patients). All patients underwent Ga-NEB TOF PET/MR lymphoscintigraphy. The ratio of the standardized uptake value (SUV) of superficial lymphatic vessel (SLV) versus SUV of deep lymphatic vessel (DVL) (SUVslv/dlv) was designed to assess the level of lymphedema severity. The correlation between lymphedema severity and lymphoscintigraphy findings was determined using 1-way analysis of variance, the t test, and Pearson correlation analysis. RESULTS: There was a significant difference in the SUVslv between the affected limbs and normal limbs in all subjects (affected limbs: 0.57 ± 0.32, normal limbs: 1.86 ± 1.43; P < 0.05), which was not found in the SUVdlv (affected limbs: 0.64 ± 0.39, normal limbs: 0.63 ± 0.31; P > 0.1). The SUVslv/dlv of the affected limbs showed statistical differences within the 3 groups (P < 0.05) (minimal group: 1.91 ± 0.45; moderate group: 0.84 ± 0.16; severe group: 0.42 ± 0.11). The statistical analysis revealed a negative correlation between SUVslv/dlv and the severity of lymphedema (r = -0.899; P < 0.01). CONCLUSIONS: Ga-NEB TOF PET/MR lymphoscintigraphy can provide anatomical and functional information of lymphatic vessels to guide surgery plans. SUVslv/dlv was well correlated with clinical lymphedema severity and might be potential in evaluating bilateral lower limb lymphedema.


Assuntos
Vasos Linfáticos/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfocintigrafia/métodos , Adulto , Azul Evans , Feminino , Radioisótopos de Gálio , Compostos Heterocíclicos com 1 Anel , Humanos , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons
15.
Work ; 63(1): 21-31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31033476

RESUMO

BACKGROUND: Lymphedema is one of the major complications following breast cancer treatment. The majority of women who develop breast cancer are in their years of employment. Occupational functioning and employment are issues of significant concern among women with breast cancer-related lymphedema (BCRL). We present a single-case study of a nurse living with BCRL for more than two decades in the Midwestern United States, as an exemplar to explore the 'return-to-work' phenomenon. METHODS: A sixty-minute, semi-structured interview was conducted with a selected single case ("Linda"), following a pre-interview survey. Themes and sub-concepts were generated through constant-comparison of evidence within the case. RESULTS: Themes included: the feeling of being lost, functional impairments related to BCRL and bandaging, being limited yet not being limited, and experiencing different challenges with different jobs. Overall, returning to work with BCRL was a complex phenomenon involving interactions of the disease process, the work activity, the individual, and an array of contextual factors. CONCLUSIONS: Linda's struggles, efforts, and adaptations at different career points were revealing and exemplified how individuals navigate the journey of returning to work with BCRL.


Assuntos
Neoplasias da Mama/complicações , Linfedema/complicações , Enfermeiras e Enfermeiros/psicologia , Neoplasias da Mama/psicologia , Feminino , Humanos , Linfedema/etiologia , Linfedema/psicologia , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Complicações Pós-Operatórias/psicologia , Pesquisa Qualitativa , Inquéritos e Questionários , Sobreviventes/psicologia
16.
Transl Res ; 209: 68-76, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31022376

RESUMO

Secondary lymphedema is a common complication of cancer treatment resulting in progressive fibroadipose tissue deposition, increased risk of infections, and, in rare cases, secondary malignancies. Until recently, the pathophysiology of secondary lymphedema was thought to be related to impaired collateral lymphatic formation after surgical injury. However, more recent studies have shown that chronic inflammation-induced fibrosis plays a key role in the pathophysiology of this disease. In this review, we will discuss the evidence supporting this hypothesis and summarize recent publications demonstrating that lymphatic injury activates chronic immune responses that promote fibrosis and lymphatic leakiness, decrease collecting lymphatic pumping, and impair collateral lymphatic formation. We will review how chronic mixed T-helper cell inflammatory reactions regulate this process and how this response may be used to design novel therapies for lymphedema.


Assuntos
Vasos Linfáticos/patologia , Linfedema/patologia , Fibrose , Humanos , Vasos Linfáticos/lesões , Linfedema/imunologia , Ativação Linfocitária/imunologia , Modelos Biológicos , Linfócitos T/imunologia
17.
Gynecol Oncol ; 153(2): 399-404, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30879878

RESUMO

OBJECTIVE: The primary aim of this study was to pilot the use of an objective measurement technique to prospectively evaluate the incidence of lower extremity lymphedema (LEL) after minimally invasive staging surgery for endometrial cancer. Secondary objectives included observation of changes in lower extremity function and quality of life in this patient population. METHODS: A prospective evaluation of LEL was performed in 97 women who underwent minimally invasive staging surgery for endometrial cancer using comparative circumferential volume measurements. Postoperative changes in lower extremity function and global quality of life were also assessed using patient-reported outcome measures. RESULTS: Ninety-seven patients were included for lymphedema analysis. The rate of LEL was 25% at 4-6 weeks, 19% at 6-9 months, and 27% at 12-18 months postoperatively. The presence of LEL was associated with a significant worsening from baseline Lower Extremity Functional Scale (LEFS) scores at 4-6 weeks (-27.0% vs -3.7%, p = 0.02) and 6-9 months (-13.0% vs 0%, p = 0.01). LEL was not associated with a change in patient-reported global quality of life. CONCLUSIONS: Up to one in four women experience lymphedema following surgical staging for endometrial cancer, and its presence is associated with diminished lower extremity function. Larger, prospective trials using the objective methodology piloted in this study should better clarify risk factors and long-term outcomes of this morbidity.


Assuntos
Neoplasias do Endométrio/cirurgia , Perna (Membro)/fisiopatologia , Linfedema/etnologia , Linfedema/fisiopatologia , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/fisiopatologia , Feminino , Humanos , Estudos Longitudinais , Linfedema/etiologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Estadiamento de Neoplasias , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida
18.
Int Angiol ; 38(1): 70-75, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30860343

RESUMO

BACKGROUND: Lower extremity edema occurs in many conditions including congestive heart failure, lymphedema, diabetes-related, kidney and liver disease, chronic venous insufficiency with venous hypertension. Clinical edema assessment methods are often subjective and variable. Our goals were to introduce a simple noninvasive measurement procedure potentially useful to characterize lower extremity edema by providing normative values from which edema thresholds might emerge. METHODS: Tissue dielectric constant (TDC) values, as indices of skin-to-fat tissue water, were measured on foot dorsum, lower medial leg and anterior forearm of 88 adults (44 female) with ages ranging from 19-77 years with BMI ranging from 18.3-40.6 kg/m2. From these direct measurements lower-to-upper extremity TDC ratios (foot/arm and leg/arm) were determined for each gender. Possible edema threshold ratios were calculated as the mean lower-to-upper ratio to which was added two standard deviations of the overall ratio thereby providing initial thresholds for future testing. RESULTS: Results showed that at each anatomical site absolute TDC values for males significantly exceed those of females (P<0.001). Male vs. female TDC values were 33.0±5.4 vs. 27.7±4.0 for the forearm, 34.8±6.5 vs. 27.5±4.6 for the leg, and 32.5±6.5 vs. 28.7±5.1 for the foot. In contrast, the foot/arm and leg/arm ratios were similar between genders ranging 0.990±0.144 to 1.063±0.170. Corresponding lower extremity to upper extremity threshold ratios ranged from 1.278 for foot/arm to 1.403 for leg/arm. The composite ratios considering both gender ration (N.=88) yielded a composite threshold foot/arm ratio of 1.387 and a leg/arm threshold ratio of 1.324. CONCLUSIONS: This assessment method together with the normative ratios and calculated thresholds may aid in rapid detection of lower extremity edema in patients and possibly as a way to quantitatively track changes in edema status with time or treatment. However, the suitability of these thresholds is subject to future validation in persons with clearly defined lower extremity edema for which this report's findings serve as an initial quantitative starting point.


Assuntos
Água Corporal , Edema/diagnóstico , Impedância Elétrica , Extremidade Inferior , Pele , Extremidade Superior , Idoso , Feminino , , Antebraço , Voluntários Saudáveis , Humanos , Perna (Membro) , Linfedema/diagnóstico , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valores de Referência
19.
Eur J Surg Oncol ; 45(4): 650-658, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30910053

RESUMO

OBJECTIVE: The purpose of this study was to assess the postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer and to determine risk factors of severe perioperative morbidity. METHODS: Data of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II) were analysed. Patients having a radical hysterectomy were included between 2005 and 2012 from 25 French oncologic centers. Postoperative complications were prospectively recorded in a pre-specified analysis. RESULTS: 248 patients met the inclusion criteria. The median age was 44.5 years [25-85]. 88.7% of patients had a stage IB1 disease. There were 71.4% epidermoid carcinomas and 25% adenocarcinomas. 125 patients (50.4%) had a laparoscopic-assisted vaginal RH, 88 patients (35.5%) had a total laparoscopic RH, 26 patients (10.5%) had an open RH and 9 patients (3.6%) had a robotic-assisted RH. Sixteen patients (6.4%) had intraoperative complications. On a multivariate analysis, intraoperative complications were significantly associated with BMI >30 kg/m2. The urinary, lymphovascular and neurologic complications rates were respectively 34.3%, 20.6% and 19.8%. 31 patients (12.5%) had severe postoperative complications (Clavien-Dindo ≥ 3 or CTCAE ≥ 3). On multivariate analysis, severe postoperative complications were associated with parametrial involvement, preoperative brachytherapy and inclusion in low surgical skills center. CONCLUSIONS: This study based on prospective data showed that RH has low severe postoperative complications. The main complications were urinary infections and lower limb lymphedema. Patients with early-stage cervical cancer should be referred to expert center to ensure best surgical outcomes.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Histerectomia Vaginal/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Complicações Pós-Operatórias/etiologia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Braquiterapia , Carcinoma de Células Escamosas/patologia , Intervalo Livre de Doença , Feminino , França , Humanos , Complicações Intraoperatórias/etiologia , Laparoscopia/efeitos adversos , Linfedema/etiologia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Traumatismos dos Nervos Periféricos/etiologia , Estudos Prospectivos , Radioterapia Adjuvante , Fatores de Risco , Taxa de Sobrevida , Doenças Urológicas/etiologia , Neoplasias do Colo do Útero/patologia
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