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1.
BMC Health Serv Res ; 21(1): 1065, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625080

RESUMO

BACKGROUND: Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis (LF) and leprosy mainly affect communities in low resource settings. These diseases are associated with physical disability due to lymphoedema as well as poor mental health and psychosocial outcomes. Integration of care across these NTDs at primary health care level, which includes mental health and psychosocial care alongside physical health care, is increasingly recommended. METHODS: A holistic integrated care package was developed and piloted as part of the EnDPoINT project in Gusha district, Awi zone, Ethiopia. The intervention was conducted at the health care organization, health facility and community levels. To assess the impact of the care package in terms of acceptability, scalability, sustainability and barriers to implementation, a qualitative study was conducted in January 2020. This included four focus group discussions (29 participants) and ten key informant interviews with decision makers, health professionals, patients, and community representatives. RESULTS: The integrated lymphoedema care package was found to be efficient compared to vertical programs in saving time and resources. It also resulted in improved awareness of the causes, treatment and prevention of lymphoedema, in marked improvements in the lymphoedema, and in reduced stigma and discrimination. The care package was found to be acceptable to patients, health professionals and decision makers. The barriers to integrated care were unrealistic patient expectations, inadequate dissemination across health workers, and poor transportation access. Health professionals, decision makers and patients believed the integrated lymphoedema care package to be scalable and sustainable. CONCLUSION: The integrated holistic care package was found to be acceptable to patients, health professionals and decision makers. We recommend its scale-up to other endemic districts.


Assuntos
Elefantíase , Linfedema , Atenção à Saúde , Etiópia , Humanos , Linfedema/terapia , Projetos Piloto
2.
Clin Plast Surg ; 48(4): 607-616, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503721

RESUMO

Melanoma tumor thickness and ulceration are the strongest predictors of nodal spread. The recommendations for sentinel lymph node biopsy (SLNB) have been updated in recent American Joint Committee on Cancer and National Comprehensive Cancer Network guidelines to include tumor thickness ≥0.8 mm or any ulcerated melanoma. Mitotic rate is no longer considered an indicator for determining T category. Improvements in disease-specific survival conferred from SLNB were demonstrated through level I data in the Multicenter Selective Lymphadenectomy Trial (MSLT) I. The role for completion lymph node dissection has evolved to less surgery in lieu of recent domestic (MSLT II) and international (Dermatologic Cooperative Oncology Group Selective Lymphadenectomy Trial [DeCOG-SLT]) level I data having similar melanoma-specific survival. Treatment options for the prevention of treatment of lymphedema have progressed to include immediate lymphatic reconstruction, lymphovenous anastomosis, and vascularized lymph node transfer.


Assuntos
Linfedema , Melanoma , Neoplasias Cutâneas , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Metástase Linfática , Linfedema/cirurgia , Melanoma/cirurgia , Estudos Multicêntricos como Assunto , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia
3.
Br J Community Nurs ; 26(Sup10): S30-S35, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542312

RESUMO

During the second wave of the COVID-19 pandemic, district nursing teams were overwhelmed with their caseload due to the palliative care needs of their patients. This led to patients with wet legs and chronic wounds deteriorating due to staffing levels. Therefore, the Swansea Bay University Health Board and Lymphoedema Network Wales teams redeployed two working time equivalents (WTE) into the community to take over the management of these patients with chronic wounds for 4 months. The clinicians came from a variety of different backgrounds, including nursing, physiotherapy, emergency medicine and occupational therapy. Between the teams, 866 visits were carried out over the 4-month period, where patients' compression therapy was altered to promote healing and reduce oedema. At the end of the 4-month period, 21% of the patients were discharged off the district nursing caseload completely, while of the 60% who were still active caseload patients, 35% were in increased compression and 20% had reduced need for visits.


Assuntos
COVID-19 , Enfermagem em Saúde Comunitária , Linfedema , Pandemias , COVID-19/epidemiologia , Enfermagem em Saúde Comunitária/organização & administração , Humanos , Linfedema/enfermagem , Reino Unido/epidemiologia
4.
Br J Community Nurs ; 26(Sup10): S6-S15, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542313

RESUMO

Management of secondary head and neck lymphoedema has undergone little research investigation. Its treatment is time and labour intensive and involves multiple therapeutic modalities without a clear understanding of which is most effective. This study aimed to determine the feasibility of a randomised controlled trial comparing two therapeutic modalities to manage head and neck lymphoedema. The secondary objective was to evaluate the clinical effects of these treatments. Participants were randomised to receive treatment with manual lymphatic drainage or compression over 6 weeks, with the primary outcome-percentage tissue water-measured 12 weeks after treatment. Six participants were recruited until the study was ceased due to restrictions imposed by the COVID-19 pandemic. Some 86% of required attendances were completed. Percentage tissue water increased in all participants at 12 weeks. No consistent trends were identified between internal and external lymphoedema. The small number of people recruited to this study informs its feasibility outcomes but limits any conclusions about clinical implications.


Assuntos
COVID-19 , Linfedema , Pesquisa em Enfermagem , Pandemias , COVID-19/epidemiologia , Bandagens Compressivas , Estudos de Viabilidade , Cabeça , Humanos , Linfedema/enfermagem , Drenagem Linfática Manual , Pescoço , Pesquisa em Enfermagem/organização & administração , Resultado do Tratamento , Reino Unido/epidemiologia
5.
Br J Community Nurs ; 26(Sup10): S16-S21, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542314

RESUMO

Reticence to apply compression therapy has been widely observed in clinical practice, compounded by an absence of evidenced-based pathways for application of prompt compression prior to measuring ankle brachial pressure index (ABPI). Importantly, delaying compression therapy for patients with chronic oedema and lymphorrhoea causes many avoidable complications. In 2017, Lymphoedema Network Wales (LNW) developed an evidenced-based pathway to improve the management of chronic oedema and wet legs (lymphorrhoea) for community nurses. During the past 4 years, the Chronic Oedema Wet Leg Pathway has been presented, published and used internationally, as well as being translated into different languages. It is commonly used in community nursing Teams as an evidenced-based document. However, like all documents and guidelines, when more evidence becomes available, the pathway needs updating. Therefore, this clinical focus article will present the new and enhanced Chronic Oedema Wet Leg Pathway, introducing a new level four compression section, which increases the layers of compression bandaging for patients with venous insufficiency or who are morbidly obese.


Assuntos
Procedimentos Clínicos , Linfedema , Doença Crônica , Humanos , Perna (Membro) , Linfedema/enfermagem , País de Gales
6.
Br J Community Nurs ; 26(Sup10): S22-S28, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34542317

RESUMO

The use of compression therapy to treat chronic oedema of the lower limbs can be a challenge, especially when this is undertaken by clinicians who have limited experience and knowledge of the theoretical principles which underpin its use in clinical practice. This articles aims to discuss the reasoning which underpins the use of compression hosiery in the management of lymphoedema and how this understanding can improve treatment outcomes and reduce the burden of disease on patients and clinical resources.


Assuntos
Linfedema , Meias de Compressão , Doença Crônica , Humanos , Extremidade Inferior , Linfedema/enfermagem , Resultado do Tratamento
7.
Ann Ital Chir ; 92: 452-459, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34524114

RESUMO

PURPOSE: The aim of this study is to compare two dynamic imaging modalities employed to study peripheral lymphatic system, Magnetic Resonance Lymphangiography (MRL) and Indocyanine Green Lymphangiography (ICGL), evaluating their role for planning lymphaticovenular anastomosis (LVA) or other surgical-nonsurgical treatments in patients with lymphedema of the extremities. MATERIALS AND METHODS: We conducted a retrospective study of 32 patients (26 women) with a mean age of 38 years (range 18-73) enrolled from January 2014 to December 2018; 20 out of 32 were affected by lower limb lymphedema with 6 cases of primary lymphedema; all of them had stage II disease. All the patient underwent ICGL and MRL within a month of one another, by injecting different contrast medium into interdigital web spaces. In each patient we rated the number of lymphatic vessels visualized, considering the wrist for the upper limb and the ankle for the lower limb. Student's t-test was applied. RESULTS: All patients completed both the diagnostic examinations without any significant complications. A statistically significant difference (p < 0.05) was found between the number of lymphatic vessels identified on the wrist/ankle (34 on ICGL vs 70 on MRL and 82 on ICGL vs 26 on MRL, considering affected and healthy limbs respectively). In particular, dermal backflow in advanced lymphedema seems to hinder lymphatic vessels detection on ICGL. Conversely, on healthy limbs, MRL hardly identifies lymphatics, because of their fast lymphatic flow and almost virtual lumen. CONCLUSIONS: Both MRL and ICGL are dynamic diagnostic modalities that permit an effective evaluation of lymphatic vessels anatomical and functional status in extremities lymphedema these diagnostic procedures may be considered complementary because they show different aspects of lymphatic system. KEY WORDS: Indocyanine green, MR lymphangiography.


Assuntos
Verde de Indocianina , Linfedema , Adolescente , Adulto , Idoso , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Linfografia , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
8.
Integr Cancer Ther ; 20: 15347354211044107, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34521235

RESUMO

OBJECTIVE: The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effects of acupuncture and moxibustion (AM) in women with breast cancer-related lymphedema (BCRL). METHODS: We retrieved RCTs published before January 24, 2021, from the MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP), and Wanfang databases. RCTs that compared acupuncture and/or moxibustion intervention with other treatments were included. A random effects or fixed effects model was used based on the heterogeneity findings. Study quality was evaluated using the Cochrane risk of bias tool. RESULTS: We included 14 RCTs in the analyses, of which 4 RCTs adopted acupuncture, 4 RCTs used moxibustion, and the rest used both. AM significantly reduced arm circumference at the elbow crease compared to routine care (Mean deviation (MD) = -7.26, 95% confidence interval (CI) = -8.30 to -6.21, P < .00001). There was a significant difference between AM and diosmin tablets in the effective index for upper limb lymphedema (MD = 24.68, 95% CI = 24.82-30.53, P < .00001), the range of motion of the shoulder during protraction (MD = 6.77, 95% CI = 2.81-10.73, P = .0008), and adduction (MD = 4.17, 95% CI = 1.02-7.32, P = .01). There was a significant difference between moxibustion and pneumatic circulation (MD = -0.51, 95% CI = -0.85 to -0.17, P = .003) in the visual analog score (VAS) for swelling. Finally, compared to the blank control, acupuncture reduced the VAS for pain (MD = -1.33, 95% CI = -1.52 to -1.15, P < .00001; heterogeneity (I2) = 0%, P = .57). CONCLUSION: Our results suggest that AM is effective in the treatment of BCRL. AM may reduce arm circumference at the elbow crease (compared to routine care), increase effective index for upper limb lymphedema (compared to oral diosmin tablets), improve the range of motion of the shoulder during protraction and adduction (compared to oral diosmin tablets), and decrease the VAS for both swelling (compared to pneumatic circulation) and pain (compared to blank control).


Assuntos
Terapia por Acupuntura , Neoplasias da Mama , Linfedema , Moxibustão , Neoplasias da Mama/complicações , Feminino , Humanos , Linfedema/etiologia , Linfedema/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Integr Cancer Ther ; 20: 15347354211046192, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34541909

RESUMO

BACKGROUND: Among the different cancers found in women, breast cancer is the most common. Breast cancer-related lymphedema is a serious health complication affecting the quality of life and sleep quality. This study evaluates the quality of life and sleep quality among Saudi women with different stages of lymphedema following the treatment of breast cancer. METHODS: This cross-sectional correlational study included 163 Saudi women with breast cancer-related lymphedema (Stages I-III), aged 28 to 56 years. From the patients identified for this study, women who suffered from mental and psychological dysfunctions or other malignant disorders were excluded. Copies of structured questionnaires were given to each participant during their visits to outpatient physiotherapy clinics. Quality of life was assessed using a valid questionnaire (EORTC QLQ-C30), while sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The differences between the different lymphedema stages have been assessed. RESULTS: Of the total number of participants 27 women had been diagnosed with stage I lymphedema, 84 women had been diagnosed with stage II lymphedema, and 52 women had been diagnosed with stage III lymphedema. All participants have shown low scores on both EORTC QLQ-C30 and PSQI. While analyzing the differences between the 3 stages of lymphedema with the Kruskal-Wallis test, noteworthy statistical differences between the 3 stages of lymphedema (P < .05) have been found. The Stage III lymphedema patients have been shown the lowest quality of life values in all scales when compared with the stage I and stage II lymphedema patients. For PSQI scores, the stage III lymphedema patients worse values than the stage I and stage II lymphedema patients (P < .05). CONCLUSION AND RECOMMENDATIONS: Both quality of life and quality of sleep have significantly decreased in Saudi women with different stages of breast cancer-related lymphedema. Quality of life and quality of sleep are the worst in stage III lymphedema patients. Future research should consider repeat and enlarge these results as well as assess the risk factors that affect the quality of life and quality of sleep among Saudi women suffering from breast cancer-related lymphedema.


Assuntos
Neoplasias da Mama , Linfedema , Neoplasias da Mama/complicações , Estudos Transversais , Feminino , Humanos , Linfedema/epidemiologia , Linfedema/etiologia , Qualidade de Vida , Arábia Saudita/epidemiologia , Sono
10.
BMJ Case Rep ; 14(9)2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535495

RESUMO

Primary lymphoedema is a rare disorder. Often presents at a young age with asymptomatic limb oedema with gradual progression. We present a 16-year-old woman who presented with a history of swelling of the left lower limb for 6 years. There was the presence of isolated left lower limb oedema, which was a non-pitting type. The patient underwent imaging studies and was diagnosed to have primary lymphoedema. The patient was managed conservatively as the patient did not have any other problems other than the left lower limb oedema.


Assuntos
Linfedema , Doenças Raras , Adolescente , Feminino , Humanos , Extremidade Inferior , Linfedema/complicações , Linfedema/diagnóstico
11.
BMC Cancer ; 21(1): 1019, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521359

RESUMO

BACKGROUND: Patients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an under-recognized postsurgical complication which can result in shoulder morbidity and functional impairment. Emerging studies have indicated that AWS may persist beyond the first few months after surgery, although few studies have assessed the prevalence and association of AWS beyond a year after diagnosis. Therefore, the aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery. METHODS: This cross sectional observational study was conducted at a community-based cancer rehabilitation center. Patients were evaluated for the presence of AWS via physical examination. Disease-related data was obtained from clinical review and medical records. Descriptive statistics were utilized to illustrate patient demographics and clinical characteristics. Logistic regression analyses were used to determine associations of AWS. RESULTS: There were 111 Asian women who were recruited, who had undergone breast surgery and were referred to a national outpatient rehabilitation center. The prevalence of AWS in this population was 28.9%. In the multivariate regression model, significant factors were age < 50 years (OR = 3.51; 95% CI = 1.12-11.0; p = 0.031) and ALND (OR = 6.54; 95% CI = 1.36-31.3; p = 0.019). There was reduced shoulder flexion ROM (p < 0.001) in patients with AWS compared to patients without AWS. CONCLUSIONS: A high prevalence of AWS was reported in breast cancer survivors even at 3 years after breast surgery. Our findings highlight the need to identify breast cancer survivors with AWS even in the survivorship phase, and develop strategies to raise awareness and minimize functional impairment in these patients.


Assuntos
Grupo com Ancestrais do Continente Asiático , Neoplasias da Mama/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Fatores Etários , Axila , Neoplasias da Mama/etnologia , Neoplasias da Mama/reabilitação , Métodos Epidemiológicos , Feminino , Humanos , Linfedema/diagnóstico , Pessoa de Meia-Idade , Exame Físico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etnologia , Amplitude de Movimento Articular , Centros de Reabilitação , Articulação do Ombro , Dor de Ombro/epidemiologia , Dor de Ombro/etnologia , Síndrome , Fatores de Tempo
12.
Front Cell Infect Microbiol ; 11: 680832, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485170

RESUMO

CD8+ T cells are crucial for the clearance of viral infections, and current research begins to highlight their importance in parasitic diseases too. In-depth research about characteristics of CD8+ T-cell subsets and exhaustion remains uncertain, especially during filariasis, a chronic helminth infection. Lymphatic filariasis, elicited by Wuchereria bancrofti, remains a serious health problem in endemic areas in Ghana, especially in those suffering from morbidity due to lymphedema (LE). In this observational study, the characteristics and profiles of CD8+ T cells were compared between asymptomatic Wuchereria bancrofti-infected individuals, uninfected endemic normals, and those with LE (grades 2-6). Focusing on exhausted memory (CD8+exmem: CD8+ T-betdimEomeshi) and effector (CD8+exeff: CD8+T-bethiEomesdim) CD8+ T-cell subsets, advanced flow cytometry revealed that LE individuals presented reduced frequencies of IFN-γ+CD8+exmem T cells expressing Tim-3 or LAG-3 which negatively correlated to the presence of LE. Moreover, the LE cohort further showed significantly higher frequencies of IL-10+CD8+exeff T cells expressing either Tim-3, LAG-3, CD39, KLRG-1, or PD-1, all associated markers of exhaustion, and that these frequencies positively correlated with the presence of LE. In summary, this study shows that distinct exhausted CD8+ T-cell subsets are prominent in individuals suffering from LE, suggesting that enhanced inflammation and constant immune activation might drive exhaustion of CD8+ T cells. Since T-cell exhaustion is known to be associated with insufficient control of persisting antigen, the data presented here reveals that these CD8+ T-cell exhaustion patterns in filarial LE should be taken into consideration for prevention and control management of LE.


Assuntos
Linfócitos T CD8-Positivos , Linfedema , Antígenos , Receptor Celular 2 do Vírus da Hepatite A , Humanos , Subpopulações de Linfócitos T
13.
Ann Surg Oncol ; 28(10): 5742-5751, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34333706

RESUMO

BACKGROUND: In 2017, the American Society of Breast Surgeons (ASBrS) published expert panel recommendations for patients at risk for breast cancer-related lymphedema (BCRL) and those affected by BCRL. This study sought to determine BCRL practice patterns. METHODS: A survey was sent to 2975 ASBrS members. Questions evaluated members' clinical practice type, practice duration, and familiarity with BCRL recommendations. Descriptive statistics, the chi-square test, and Fisher's exact test were used. RESULTS: Of the ASBrS members surveyed, 390 (13.1%) responded. Most of the breast surgeons (58.5%, 228/390) indicated unfamiliarity with recommendations. Nearly all respondents (98.7%, 385/390) educate at-risk patients. Most (60.2%, 234/389) instruct patients to avoid venipuncture, injection or blood pressure measurements in the at-risk arm, and 35.6% (138/388) recommend prophylactic compression sleeve use during air travel. Nearly all (97.7%, 380/389) encourage those at-risk to exercise, including resistance exercise (86.2%, 331/384). Most do not perform axillary reverse mapping (ARM) (67.9%, 264/389) or a lymphatic preventive healing approach (LYMPHA) (84.9%, 331/390). Most (76.1%, 296/389) screen at-risk patients for BCRL. The most frequently used screening tools include self-reported symptoms (81%, 255/315), circumferential tape measure (54%, 170/315) and bioimpedance spectroscopy (27.3%, 86/315). After a BCRL diagnosis, most (90%, 351/390) refer management to a lymphedema-certified physical therapist. For affected patients, nearly all encourage exercise (98.7%, 384/389). Many (49%, 191/390) refer affected patients for consideration of lymphovenous bypass or lymph node transfer. CONCLUSION: Most respondents were unfamiliar with the ASBrS expert panel recommendations for patients at risk for BCRL and those affected by BCRL. Opportunities exist to increase awareness of best practices and to acquire ARM and LYMPHA technical expertise.


Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Linfedema , Cirurgiões , Linfedema Relacionado a Câncer de Mama/etiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/cirurgia , Feminino , Humanos , Linfonodos , Linfedema/etiologia , Linfedema/prevenção & controle , Estados Unidos
14.
Ann Surg Oncol ; 28(10): 5775-5787, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34365563

RESUMO

BACKGROUND: Breast cancer-related lymphedema (BCRL) is a source of postoperative morbidity for breast cancer survivors. Lymphatic microsurgical preventive healing approach (LYMPHA) is a technique used to prevent BCRL at the time of axillary lymph node dissection (ALND). We report the 5-year experience of a breast surgeon trained in LYMPHA and investigate the outcomes of patients who underwent LYMPHA following ALND for treatment of cT1-4N1-3M0 breast cancer. METHODS: A retrospective review of patients with cT1-4N1-3M0 breast cancer was performed in patients who underwent ALND with and without LYMPHA. Diagnosis of BCRL was made by certified lymphedema therapists. Descriptive statistics and lymphedema surveillance data were analyzed using results of Fisher's exact or Wilcoxon rank-sum tests. Logistic regression and propensity matching were performed to assess the reduction of BCRL occurrence following LYMPHA. RESULTS: In a 5-year period, 132 patients met inclusion criteria with 76 patients undergoing LYMPHA at the time of ALND and 56 patients undergoing ALND alone. Patients who underwent LYMPHA at the time of ALND were significantly less likely to develop BCRL than those who underwent ALND alone (p = 0.045). Risk factors associated with BCRL development were increased patient age (p = 0.007), body mass index (BMI) (p = 0.003), and, in patients undergoing LYMPHA, number of positive nodes (p = 0.026). CONCLUSIONS: LYMPHA may be successfully employed by breast surgeons trained in lymphatic-venous anastomosis at the time of ALND. While research efforts should continue to focus on prevention and surveillance of BCRL, LYMPHA remains an option to reduce BCRL and improve patient quality of life.


Assuntos
Neoplasias da Mama , Linfedema , Cirurgiões , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Linfedema/etiologia , Linfedema/prevenção & controle , Linfedema/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela
15.
J Bodyw Mov Ther ; 27: 307-313, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391250

RESUMO

INTRODUCTION: Breast cancer affects women of different ages, and comorbidities resulting from treatment can affect postural stability. The study aimed to evaluate the influence of age and lymphedema on the postural balance of women undergoing breast cancer treatment. METHODS: The study included 77 women undergoing breast cancer treatment, divided into different groups: 37 young adult women divided into 17 with lymphedema (GYL) and 20 young adults without lymphedema (GY); 40 elderly women, 20 elderly women with lymphedema (GEL) and 20 elderly women without lymphedema (GE). Mini Balance Evaluation Systems Test (Mini BESTest) and Falls Efficacy Scale - International (FES-I) were used. RESULTS: Mini BESTest and FES-I between the groups showed that GE and GEL had a significant difference to GY. Mini BESTest Total and Time Up and Go TUG-Double Task showed that GE has a significant difference to GYL, with GE and GEL having lower scores. Moderate negative correlation in the GEL between FES-I and Mini BESTest. In the age correlation between the Mini BESTest, FES-I, TUG, and double task TUG, a moderate positive correlation was observed for TUG. GEL showed a moderate positive correlation for FES-I and double-task TUG, strong for TUG, and moderate negative correlation with Mini BESTest. Correlation of the volume difference between the limb affected and not affected by lymphedema and the FES-I, Mini BESTest, TUG, and TUG double task, GYL showed moderate negative correlation for TUG. CONCLUSION: Age and lymphedema influenced the dynamic postural balance of women undergoing breast cancer treatment.


Assuntos
Neoplasias da Mama , Linfedema , Acidentes por Quedas , Idoso , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Avaliação da Deficiência , Feminino , Humanos , Equilíbrio Postural , Psicometria , Reprodutibilidade dos Testes
16.
S D Med ; 74(8): 368-371, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34461002

RESUMO

Yellow nail syndrome (YNS) has traditionally been thought of as a triad of exudative pleural effusion, yellow nails, and lymphedema. More recently, in addition to the hallmark yellowish nail discoloration, the diagnostic criteria required an associated lymphedema and/or chronic respiratory manifestations including pleural effusions, bronchiectasis or chronic sinusitis. Etiology remains unknown and treatment is supportive and directed towards patient's specific complaints. While described alongside multiple endocrine, lymphatic and autoimmune disorders, its most ominous association is malignancy, raising YNS as a possible paraneoplastic condition. Here we present the case of an 80 years-old female with worsening restrictive airway disease and acquired yellow nails, with development of dyspnea, cough and leg edema. Recurrent exudative lymphocyte predominant pleural effusion was treated definitively with pleurodesis. Her leg edema and yellow nails were treated conservatively. We describe previous case reports and series in the literature, outline therapeutic options and discuss prognosis.


Assuntos
Bronquiectasia , Linfedema , Derrame Pleural , Sinusite , Síndrome das Unhas Amareladas , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfedema/diagnóstico , Linfedema/terapia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/terapia , Síndrome das Unhas Amareladas/complicações , Síndrome das Unhas Amareladas/diagnóstico , Síndrome das Unhas Amareladas/terapia
17.
Eur J Med Genet ; 64(10): 104295, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34371190

RESUMO

Defects in the PIEZO1 gene cause lymphatic dysplasia in an autosomal recessive manner, mostly by loss-of-function variants. Moreover, since 2019, the role of PIEZO1 in bone formation has been established, but there have been no PIEZO1-related cases presenting definite skeletal involvement to date. A 21-year-old male with primary lymphatic dysplasia had some other distinctive clinical features, including multiple fracture history during infancy, thoracolumbar scoliosis, short stature, and left-sided facial bone hypoplasia. We analyzed the whole exome of the patient and found two novel pathogenic variants of PIEZO1 in trans: a 93.7 kb heterozygous deletion (chr16:88,782,477-88,876,207; exon 1-50) and c.2858G>A (p.Arg953His). Sanger sequencing validated the deletion with breakpoints, and each variant was inherited from a different parent. This study presented an extremely rare case of a patient with lymphatic dysplasia caused by compound heterozygous variants of PIEZO1, along with additional clinical manifestations including several skeletal phenotypes.


Assuntos
Anormalidades Craniofaciais/genética , Fraturas Ósseas/genética , Canais Iônicos/genética , Linfangiectasia Intestinal/genética , Linfedema/genética , Mutação , Fenótipo , Escoliose/genética , Anormalidades Craniofaciais/patologia , Fraturas Ósseas/patologia , Heterozigoto , Humanos , Linfangiectasia Intestinal/patologia , Linfedema/patologia , Masculino , Escoliose/patologia , Adulto Jovem
18.
Integr Cancer Ther ; 20: 15347354211037938, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34387119

RESUMO

PURPOSE: Lymphedema is a common debilitating late effect among patients post-head and neck cancer (HNC) treatment. Head and neck lymphedema was associated with symptom burden, functional impairment, and decreased quality of life. The objective of this study was to determine the feasibility and potential efficacy of the use of photobiomodulation (PBM) therapy for head and neck lymphedema, symptom burden, and neck range of motion among HNC survivors. METHODS: This was a single-arm, pre- and post-design clinical trial. Eligible patients included those with lymphedema after completion of complete decongestive therapy (CDT) and 3 to 18 months after completion of cancer therapy. The intervention included PBM therapy 2 times a week for 6 weeks for a total of 12 treatments. Lymphedema, symptom burden, and neck range of motion were measured at baseline, end-of-intervention, and 4-week post-intervention. RESULTS: Of the 12 patients enrolled in the study, 91.7% (n = 11) completed the study intervention and assessment visits, and no adverse events were reported. When comparing the baseline to 4-week post-intervention, we found statistically significant improvements in the severity of external lymphedema, symptom burden, and neck range of motion (all P < .05). CONCLUSION: PBM therapy was feasible and potentially effective for the treatment of head and neck lymphedema. Future randomized controlled trials are warranted to examine the efficacy of PBM therapy for HNC-related lymphedema. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: ClinicalTrials.gov Identifier: NCT03738332; date of registration: November 13, 2018.


Assuntos
Neoplasias de Cabeça e Pescoço , Terapia com Luz de Baixa Intensidade , Linfedema , Estudos de Viabilidade , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Linfedema/etiologia , Linfedema/terapia , Qualidade de Vida
19.
Nurs Womens Health ; 25(5): 377-383, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34461070

RESUMO

OBJECTIVE: To examine the effects of manual lymphatic drainage (MLD) on reducing the risk of and managing breast cancer-related lymphedema (BCRL). DATA SOURCES: The electronic databases ScienceDirect, Scopus, PubMed, and CINAHL were searched for articles published in the English language from January 2000 to June 2020. STUDY SELECTION: A total of 518 articles were retrieved. After the removal of duplicates, 472 articles remained, 433 of which were excluded based on title and abstract consideration. Thereafter, 39 studies were further inspected, and 27 articles were excluded because they were not randomized controlled trials, did not measure BCRL, and/or were an incomplete study. Ten studies were included for the final review. DATA EXTRACTION: Data from the 10 studies were extracted and compiled into a summary table. DATA SYNTHESIS: Based on the results of this systematic review, it cannot be concluded that MLD helps reduce the risk of BCRL for women after breast surgery. Regarding the effect of MLD on managing BCRL, the findings indicate that MLD alone or MLD combined with other treatments was likely to give similar benefits in terms of reducing arm volume for women diagnosed with BCRL. CONCLUSION: Scientific evidence to support the benefits of MLD on preventing or reducing BCRL remains unclear. More rigorous studies to confirm findings on the effectiveness of MLD are needed.


Assuntos
Neoplasias da Mama/cirurgia , Drenagem/métodos , Linfedema/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Neoplasias da Mama/complicações , Bases de Dados Factuais , Feminino , Humanos , Linfedema/etiologia
20.
Ann Surg Oncol ; 28(9): 5166-5182, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34224044

RESUMO

BACKGROUND: A multiphased mixed-methods study was performed to develop and validate a comprehensive patient-reported outcome measure (PROM) for arm lymphedema in women with breast cancer (i.e., the LYMPH-Q Upper Extremity Module). METHODS: Qualitative interviews (January 2017 and June 2018) were performed with 15 women to elicit concepts specific to arm lymphedema after breast cancer treatment. Data were audio-recorded, transcribed, and coded. Scales were refined through cognitive interviews (October and Decemeber 2018) with 16 patients and input from 12 clinical experts. The scales were field-tested (October 2019 and January 2020) with an international sample of 3222 women in the United States and Denmark. Rasch measurement theory (RMT) analysis was used to examine reliability and validity. RESULTS: The qualitative phase resulted in six independently functioning scales that measure arm symptoms, function, appearance, psychological function, and satisfaction with information and with arm sleeves. In the RMT analysis, all items in each scale had ordered thresholds and nonsignificant chi-square p values. For all the scales, the reliability statistics with and without extremes for the Person Separation Index were 0.80 or higher, Cronbach's alpha was 0.89 or higher, and the Intraclass Correlation Coefficients were 0.92 or higher. Lower (worse) scores on the LYMPH-Q Upper Extremity scales were associated with reporting of more severe arm swelling, an arm problem caused by cancer and/or its treatment, and wearing of an arm sleeve in the past 12 months. CONCLUSIONS: The LYMPH-Q Upper Extremity Module can be used to measure outcomes that matter to women with upper extremity lymphedema. This new PROM was designed using a modern psychometric approach and, as such, can be used in research and in clinical care.


Assuntos
Braço , Linfedema , Feminino , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários , Extremidade Superior
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