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1.
Br J Community Nurs ; 25(Sup10): S12-S16, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33030379

RESUMO

The COVID-19 pandemic of 2020 has led to considerable changes in how healthcare is delivered, as it has pushed people to think outside the box technologically. Mobile working is becoming more widespread, useful and valuable in this innovative period in the NHS. Point-of-care (POC) technology encompasses mobile devices and systems that support health professionals in their daily activities of patient care. It allows the user to safely assess and diagnose individuals at the point of care, providing actionable information to allow rapid clinical decision-making. POC technology also has the ability to support and educate patients with health needs, encouraging patients and their carers to assume greater more control of and responsibility over their health. Providing patients individual care plans to maintain their health will help realise the future of self-care. This article describe the development of a mobile app-Juzo Care-designed to enhance the management of chronic oedema and lymphoedema in mobile working settings.


Assuntos
Enfermagem em Saúde Comunitária , Edema/enfermagem , Linfedema/enfermagem , Aplicativos Móveis , Educação de Pacientes como Assunto , Sistemas Automatizados de Assistência Junto ao Leito , Autocuidado , Betacoronavirus , Doença Crônica , Infecções por Coronavirus , Assistência à Saúde , Humanos , Pandemias , Pneumonia Viral , Guias de Prática Clínica como Assunto , Medicina Estatal , Reino Unido
6.
Plast Reconstr Surg ; 146(2): 402-407, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740596

RESUMO

BACKGROUND: Obesity is a risk factor for the development of secondary lymphedema after axillary lymphadenectomy and radiation therapy. The purpose of this study was to determine whether obesity influences the morbidity of lymphedema in patients who have the condition. METHODS: Two cohorts of patients were compared: group 1, normal weight (body mass index ≤25 kg/m); and group 2, obese (body mass index ≥30 kg/m). Inclusion criteria were patients aged 21 years or older with lymphedema confirmed by lymphoscintigraphy. Covariates included age, sex, lymphedema type (primary or secondary), location, comorbidities, lymph node dissection, radiation therapy, lymphoscintigram result, and disease duration. Outcome variables were infection, hospitalization, and degree of limb overgrowth. The cohorts were compared using the Mann-Whitney U test, Fisher's exact test, and multivariable logistic regression. RESULTS: Sixty-seven patients were included: group 1, n = 33; and group 2, n = 34. Disease duration did not differ between groups (p = 0.72). Group 2 was more likely to have an infection (59 percent), hospitalization (47 percent), and moderate or severe overgrowth (79 percent), compared to group 1 (18, 6, and 40 percent, respectively; p < 0.001). Multivariable logistic regression showed that obesity was an independent risk factor for infection (OR, 7.9; 95 percent CI, 2.5 to 26.3; p < 0.001), hospitalization (OR, 30.0; 95 percent CI, 3.6 to 150.8; p < 0.001), and moderate to severe limb overgrowth (OR, 6.7; 95 percent CI, 2.1 to 23.0; p = 0.003). CONCLUSIONS: Obesity negatively affects patients with established lymphedema. Obese individuals are more likely to have infections, hospitalizations, and larger extremities compared to subjects with a normal body mass index. Patients with lymphedema should be counseled about the negative effects of obesity on their condition. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Mastectomia/efeitos adversos , Obesidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Índice de Massa Corporal , Neoplasias da Mama/terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Radioterapia Adjuvante/efeitos adversos , Medição de Risco , Fatores de Risco , Adulto Jovem
7.
Medicine (Baltimore) ; 99(27): e20995, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629717

RESUMO

RATIONAL: Intestinal lymphangiectasia (IL) is a rare disease characterized by dilatation and rupture of intestinal lymphatic channels leading to protein-losing enteropathy. IL is classified as primary and secondary types. PATIENT CONCERNS: A 3-month-old girl born at term from vaginal delivery with an APGAR score of 10/10 and birth weight of 4.310 g (>97° percentile) was admitted to our hospital because of increasing abdominal tenderness and diarrhea. At first examination, she presented an abdominal circumference of 60 cm, edema of the lower extremities and vulva, and facial dysmorphisms (hypertelorism, flat nasal bridge, flat mid-face). DIAGNOSIS: Once admitted, ultrasonography showed a large amount of ascites, while blood laboratory investigations revealed severe hypoproteinemia, hypoalbuminemia and hypogammaglobulinemia. Lymphoscintigraphy with 99m-Tc-nanocolloid demonstrated abnormal leakage of the tracer in the abdomen as evidence of IL. To detect a possible secondary, exams were performed and demonstrated positive antibody titres for CMV-IgM and IgG in blood and CMV-DNA positivity in blood, urine, saliva, maternal milk, and gastric and duodenal biopsies. Genetic investigations identified the genomic variant c.472C>T of the CCBE1 gene, coding for a protein variant (p.Arg158Cys), in homozygosity. INTERVENTIONS: Total parenteral nutrition was started and continued for a total of 18 days, then gradually bridged by enteral nutrition with a special formula. In addition, antiviral therapy for CMV infection was added first with intravenous ganciclovir for 14 days, resulting in the disappearance of blood viral load after 7 days of therapy and then with valganciclovir per os for another 30 days. OUTCOMES: The clinical course of the child gradually improved. A few days after starting treatments, lower extremities and vulvar edema disappeared, and abdominal circumference gradually decreased to a stable value of 38 cm, without any ultrasonographic signs of ascites left. Moreover, serum albumin and IgG rose to normal values after 3 months (4.3 g/dL and 501 mg/dL, respectively). LESSONS: This case suggests that in presence of IL both primary and secondary causes should be evaluated. On the other hand, genetic diagnosis is crucial not only for diagnosis but also for prognosis in HS. Life expectancy and quality could deeply vary among different gene mutations and protein variants of the same gene. Further studies and case reports are needed to better understand the clinical meaning of these genetic results and the role of CMV as trigger of IL.


Assuntos
Anormalidades Craniofaciais/genética , Linfangiectasia Intestinal/genética , Linfedema/genética , Proteínas de Ligação ao Cálcio/genética , Anormalidades Craniofaciais/diagnóstico , Feminino , Humanos , Lactente , Linfangiectasia Intestinal/diagnóstico , Linfedema/diagnóstico , Mutação , Proteínas Supressoras de Tumor/genética
8.
PLoS One ; 15(7): e0235965, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701960

RESUMO

Secondary lymphedema (SL)is a frequent and devastating complication of modern oncological therapy and filarial infections. A lack of a reliable preclinical model to investigate the underlying mechanism of clinical stage progression has limited the development of new therapeutic strategies. Current first line treatment has shown to be merely symptomatic and relies on lifetime use of compression garments and decongestive physiotherapy. In this study, we present the development of a secondary lymphedema model in 35 rats using pre- and intraoperative fluorescence-guided mapping of the lymphatics and microsurgical induction. In contrast to the few models reported so far, we decided to avoid the use of radiation for lymphedema induction. It turned out, that the model is nearly free of complications and capable of generating a statistically significant limb volume increase by water displacement measurements, sustained for at least 48 days. A translational, accurate lymphatic dysfunction was visualized by a novel VIS-NIR X-ray ICG-Clearance-Capacity imaging technology. For the first-time SL stage progression was validated by characteristic histological alterations, such as subdermal mast cell infiltration, adipose tissue deposition, and fibrosis by increased skin collagen content. Immunofluorescence confocal microscopy analysis suggested that stage progression is related to the presence of a characteristic α SMA+/HSP-47+/vimentin+ fibroblast subpopulation phenotype. These findings demonstrate that the in-vivo model is a reliable and clinically relevant SL model for the development of further secondary lymphedema therapeutic strategies and the analysis of the veiled molecular mechanisms of lymphatic dysfunction.


Assuntos
Corantes Fluorescentes/química , Linfedema/patologia , Microcirurgia/efeitos adversos , Actinas/metabolismo , Animais , Colágeno/metabolismo , Modelos Animais de Doenças , Progressão da Doença , Feminino , Fibroblastos/citologia , Fibroblastos/metabolismo , Verde de Indocianina/química , Linfedema/etiologia , Microscopia de Fluorescência , Ratos , Ratos Endogâmicos Lew , Pele/patologia , Vimentina/metabolismo
9.
J Am Acad Orthop Surg ; 28(18): 737-741, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32618680

RESUMO

Lymphatic flow plays a notable role in the regulation of bone formation and remodeling. Chronic accumulation of the lymph fluid within tissues may lead to issues with proper bone healing after fractures, emphasizing the importance of proper management of lymphedema after trauma. Many associated risk factors place patients at risk for lymphedema, including previous surgery with nodal dissection, radiation therapy, infection, malignancy, family history of congenital lymphedema, and trauma. The benchmark imaging technique for the diagnosis of lymphedema is lymphoscintigraphy. Other modalities include duplex ultrasonography, CT, and MRI. First-line conservative treatment of lymphedema is compression. Complete decongestive therapy or complex physical therapy, also known as decongestive lymphatic therapy (DLT), has shown positive results in reducing lymphedema. Surgical interventions aim to either reconstruct and restore function of the lymphatic system or debulk and reduce tissues and fluids. Understanding the significance of lymphedema on bone healing and techniques available to recognize it are important factors in preventing delay in diagnosis and ensuring proper management of lymphedema after trauma.


Assuntos
Osso e Ossos/lesões , Fraturas Ósseas/complicações , Linfedema/etiologia , Linfedema/terapia , Osso e Ossos/fisiopatologia , Bandagens Compressivas , Tratamento Conservador/métodos , Diagnóstico por Imagem , Fraturas Ósseas/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/cirurgia , Procedimentos Ortopédicos/métodos , Modalidades de Fisioterapia , Cicatrização
10.
Health Qual Life Outcomes ; 18(1): 245, 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698883

RESUMO

BACKGROUND: Literature on the validity of outcome measurement in lymphedema and lipedema is very sparse. This study aimed to examine the convergent, divergent and discriminant validity of a set of 5 instruments in both conditions. METHODS: Cross-sectional outcome was measured by the generic Short Form 36 (SF-36), the lymphedema-specific Freiburg Quality of Life Assessment for lymphatic disorders, Short Version (FLQA-lk), the knee-specific Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), the Symptom Checklist-90-revised (SCL-90R), and the Six-Minute Walk Test (6 MWT). Construct convergent/divergent validity was quantified by bivariate correlations and multivariate factor analysis, and discriminant validity by standardized mean differences (SMDs). RESULTS: Health was consistently better in lymphedema (n = 107) than in lipedema (n = 96). The highest construct convergence was found for physical health between the SF-36 and KOS-ADL (bivariate correlations up to 0.78, factor loads up to 0.85, explained variance up to 56.8%). The second most important factor was mental health (bivariate correlations up to 0.79, factor loads up to 0.86, explained variance up to 13.3%). Discriminant validity was greatest for the FLQA-lk Physical complaints (adjusted SMD = 0.93) followed by the SF-36 Bodily pain (adjusted SMD = 0.83), KOS-ADL Function (adjusted SMD = 0.47) and SF-36 Vitality (adjusted SMD = 0.39). CONCLUSIONS: All five instruments have specific strengths and can be implemented according to the scope and aim of the outcome examination. A minimum measurement set should comprise: the SF-36 Bodily pain, SF-36 Vitality, FLQA-lk Physical complaints, FLQA-lk Social life, FLQA-lk Emotional well-being, FLQA-lk Health state, KOS-ADL Symptoms, KOS-ADL Function, and the SCL-90R Interpersonal sensitivity.


Assuntos
Lipedema/psicologia , Linfedema/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
12.
Medicine (Baltimore) ; 99(24): e20432, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541464

RESUMO

To ascertain the relationship between the perimetric differences obtained between the limbs and the type of fluoroscopic pattern observed by Indocyanine green (ICG) lymphography in patients with upper limb lymphedema.A correlational descriptive study was carried out in 19 patients with upper limb lymphedema secondary to breast cancer. The perimetric increase was recorded in 11 anatomical regions after ICG injection, fluoroscopic patterns were identified using an infrared camera. The ICG patterns were categorized into worse (stardust, diffuse) or better (linear, splash) patterns.The pattern coincidence between the anterior and posterior regions of the edematous extremities was 45%. At the wrist level, a difference of 2 cm was associated with the presence of a worse fluoroscopic pattern, whereas perimeter differences of 4.25 cm in the elbow and 2.25 cm in the arm (12 cm from the epicondyle) were associated with the presence of a better fluoroscopic pattern.The perimetric differences observed between the healthy and affected upper limbs in 4 specific anatomical areas allowed us to predict the type of fluoroscopic pattern. ICG lymphography has facilitated the study of the posterior regions of edema, which are difficult to visualize using other imaging techniques.


Assuntos
Verde de Indocianina/administração & dosagem , Vasos Linfáticos/diagnóstico por imagem , Linfedema/etiologia , Linfografia/métodos , Testes de Campo Visual/métodos , Adulto , Idoso , Neoplasias da Mama/complicações , Estudos de Casos e Controles , Estudos de Avaliação como Assunto , Feminino , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Humanos , Vasos Linfáticos/patologia , Linfedema/classificação , Linfedema/patologia , Pessoa de Meia-Idade , Espanha/epidemiologia , Extremidade Superior/anatomia & histologia , Extremidade Superior/diagnóstico por imagem
13.
15.
Gene ; 753: 144815, 2020 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-32479982

RESUMO

Lymphedema are characterized by interstitial edema leading to swelling of extremities. They can be divided into primary and secondary lymphedema. Developmental abnormalities of the lymphatic system are responsible for the primary form of lymphedema. The secondary form of lymphedema is caused by damage of the lymphatic system due to external factors. Lymphedema can rarely be observed in patients with tuberous sclerosis complex (TSC), which is a neurocutaneous syndrome caused by pathogenic variants in the genes TSC1 or TSC2. Patients with TSC usually present with neurological manifestations and the development of multiple benign tumors of ectodermal origin. Typical onset for several symptoms is during the first year of life and in some cases lesions can be detected prenatally. Epilepsy is one of the most common manifestations, affecting up to 90% of TSC patients, and is associated with developmental delay. Early pharmacotherapy improves long term patient outcome. Trio exome sequencing was performed in a 3 weeks old girl with congenital lymphedema of the right lower extremity. Using a filter for de novo variants, the heterozygous missense variant c.2524C>T, p.(Gln842Ter) in TSC1 (NM_000368.4) could be identified. After the first onset of infantile spams at age 7 months treatment with vigabatrin was started immediately. We propose to include TSC1 and TSC2 analysis in the diagnostic work-up of patients with (isolated) congenital lymphedema as early diagnosis facilitates consequent treatment strategies potentially improving the prognosis of TSC patients.


Assuntos
Linfedema/genética , Esclerose Tuberosa/genética , Esclerose Tuberosa/patologia , Deficiências do Desenvolvimento/complicações , Epilepsia/genética , Feminino , Humanos , Lactente , Linfedema/complicações , Linfedema/patologia , Mutação de Sentido Incorreto/genética , Prognóstico , Esclerose Tuberosa/complicações , Proteína 1 do Complexo Esclerose Tuberosa/genética , Proteína 2 do Complexo Esclerose Tuberosa/genética , Sequenciamento Completo do Exoma
18.
PLoS One ; 15(5): e0233395, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421740

RESUMO

OBJECTIVES: Tape measurement is a commonly used method in the clinical assessment of lymphedema. However, few studies have assessed the precision and reliability of tape measurement in assessing head and neck lymphedema. This study aimed to evaluate the reliability and precision of using tape measurement, performed by different evaluators, for the assessment of head and neck lymphedema. METHODS: This study was conducted at a tertiary care cancer hospital. Between January and December 2019, 50 patients with head and neck cancers and 50 normal subjects were enrolled. Each subject was examined using tape measurements for 7 point-to-point distances of facial landmarks, 3 circumferences of the neck (upper, middle, and lower), and 2 circumferences of the face (vertical and oblique) by 3 random examiners. Test precision and reliability were assessed with the within-subject standard deviation (Sw) and intra-class correlation coefficient (ICC), respectively. RESULTS: Overall, the standard deviation of the tape measurements varied in the range of 4.6 mm to 18.3 mm. The measurement of distance between the tragus and mouth angle (Sw: 4.6 mm) yielded the highest precision, but the reliability (ICC: 0.66) was moderate. The reliabilities of neck circumference measurements (ICC: 0.90-0.95) were good to excellent, but the precisions (Sw: 8.3-12.3 mm) were lower than those of point-to-point facial measurements (Sw: 4.6-8.8 mm). CONCLUSIONS: The different methods of tape measurements varied in precision and reliability. Thus, clinicians should not rely on a single measurement when evaluating head and neck lymphedema.


Assuntos
Antropometria/métodos , Pesos e Medidas Corporais/métodos , Linfedema/patologia , Adulto , Antropometria/instrumentação , Pesos e Medidas Corporais/instrumentação , Pesos e Medidas Corporais/normas , Precisão da Medição Dimensional , Feminino , Cabeça/patologia , Humanos , Linfedema/diagnóstico , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Reprodutibilidade dos Testes
19.
Cancer Sci ; 111(7): 2620-2634, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32412154

RESUMO

Secondary lymphedema often develops after cancer surgery, and over 250 million patients suffer from this complication. A major symptom of secondary lymphedema is swelling with fibrosis, which lowers the patient's quality of life, even if cancer does not recur. Nonetheless, the pathophysiology of secondary lymphedema remains unclear, with therapeutic approaches limited to physical or surgical therapy. There is no effective pharmacological therapy for secondary lymphedema. Notably, the lack of animal models that accurately mimic human secondary lymphedema has hindered pathophysiological investigations of the disease. Here, we developed a novel rat hindlimb model of secondary lymphedema and showed that our rat model mimics human secondary lymphedema from early to late stages in terms of cell proliferation, lymphatic fluid accumulation, and skin fibrosis. Using our animal model, we investigated the disease progression and found that transforming growth factor-beta 1 (TGFB1) was produced by macrophages in the acute phase and by fibroblasts in the chronic phase of the disease. TGFB1 promoted the transition of fibroblasts into myofibroblasts and accelerated collagen synthesis, resulting in fibrosis, which further indicates that myofibroblasts and TGFB1/Smad signaling play key roles in fibrotic diseases. Furthermore, the presence of myofibroblasts in skin samples from lymphedema patients after cancer surgery emphasizes the role of these cells in promoting fibrosis. Suppression of myofibroblast-dependent TGFB1 production may therefore represent an effective pharmacological treatment for inhibiting skin fibrosis in human secondary lymphedema after cancer surgery.


Assuntos
Linfedema/etiologia , Linfedema/metabolismo , Complicações Pós-Operatórias , Transdução de Sinais , Proteínas Smad/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Animais , Biomarcadores , Modelos Animais de Doenças , Fibroblastos/metabolismo , Fibrose , Humanos , Imuno-Histoquímica , Vasos Linfáticos/metabolismo , Vasos Linfáticos/patologia , Linfedema/diagnóstico por imagem , Linfedema/patologia , Macrófagos/metabolismo , Macrófagos/patologia , Ratos , Índice de Gravidade de Doença , Pele/metabolismo , Pele/patologia , Fator de Crescimento Transformador beta1/genética
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