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1.
Ann Plast Surg ; 90(2): 156-162, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36688859

RESUMO

INTRODUCTION: Complex traumatic injuries of the lower limb are increasingly being salvaged. The common long-term morbidity includes secondary lymphedema. The role of microvascular flaps is often discussed for lymph flow restoration. However, the differential effect of using muscle flap versus fasciocutaneous flap in the lower-limb trauma to avoid secondary lymphedema is not studied. METHODS: Forty patients who underwent microvascular flap reconstruction were reviewed retrospectively to obtain data regarding clinical demographics and surgical procedure. Assessment for presence of clinical lymphedema was done. The lymphatic drainage in all these patients was assessed by 99mTc lymphoscintigraphy. RESULTS: Of the 40 patients included in the study, group A (n = 23) underwent muscle-based free flap reconstruction, and group B (n = 17) had fasciocutaneous flaps. Clinical lymphedema was present in 21 patients, of which 18 were of group A and 3 of group B. On lymphoscintigraphy, 14 patients had either partial or complete obstruction in the reconstructed lower limb, 11 in group A and 3 in group B. All of them (n = 14) were found to have associated clinical lymphedema. The association of clinical lymphedema (P < 0.001) and obstructive pattern on lymphoscintigraphy (P < 0.05) with muscle flaps was found to be statistically significant. CONCLUSIONS: With the advancement in surgery and techniques, not only salvageability but also stable and morbidity free outcomes are the goals. Fasciocutaneous flaps may have better lymphatic outcomes than the muscle-based flaps, and the criteria for lower-limb reconstruction can be reformed to include simultaneous soft tissue and lymphatic reconstruction.


Assuntos
Retalhos de Tecido Biológico , Linfedema , Humanos , Estudos Retrospectivos , Retalhos Cirúrgicos , Extremidade Inferior/cirurgia , Linfedema/cirurgia , Músculos
2.
MMW Fortschr Med ; 165(1): 13-14, 2023 01.
Artigo em Alemão | MEDLINE | ID: mdl-36648645

Assuntos
Linfedema , Humanos
3.
J Plast Reconstr Aesthet Surg ; 76: 88-93, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36513015

RESUMO

INTRODUCTION: Indocyanine green (ICG) lymphography studies have identified that one in three to five patients with cancer-related lower extremity lymphoedema (LEL) demonstrated dermal backflow extending to the gluteal region. This study aimed to further characterize gluteal lymphoedema using contemporaneous magnetic resonance imaging (MRI). PATIENTS AND METHODS: Twenty-eight patients with unilateral advanced LEL who underwent both ICG lymphography and MRI prior to any surgical procedure were included in this study. The patients were divided into two groups with/without gluteal lymphoedema by the presence of dermal backflow on ICG lymphography. MRI was used to evaluate tissue changes. RESULTS: Ten patients demonstrated gluteal lymphoedema on ICG lymphography and had a higher incidence of skin hypertrophy in the gluteal region. However, no difference in excess leg volume was found between the two groups. A trend of increasing gluteal subcutaneous tissue in the affected side was identified in patients with gluteal lymphoedema with a median increase of 20% compared with an 11% increase in the non-gluteal lymphoedema group. The excess gluteal subcutaneous tissue was positively correlated to ipsilateral excess leg volume. CONCLUSION: The gluteal lymphoedema group on ICG lymphography had skin thickening in the gluteal region and was likely identified in the secondary cancer-related group. Surgical and conservative management options for gluteal lymphoedema need to be considered in advanced LEL.


Assuntos
Vasos Linfáticos , Linfedema , Neoplasias , Humanos , Verde de Indocianina , Linfografia/métodos , Estudos Retrospectivos , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Linfedema/cirurgia , Extremidade Inferior/diagnóstico por imagem
5.
Women Health ; 63(1): 27-34, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36514896

RESUMO

The aim was to investigate the relationship between lower extremity lymphedema and pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancer the effect of lymphedema severity on pelvic floor dysfunction (PFD), sleep quality, fear of movement, and body image in patients with lower extremity lymphedema after gynecologic cancer. A total of 103 patients (52 patients with lymphedema and 51 patients without lymphedema) after gynecologic cancer surgery were included in March-June 2022. Bilateral circumferential measurements were taken with a tape measure at different levels to create groups. These measurements determined limb volumes by summing segment volumes derived from the truncated cone formula. For data collection, all patients were presented with the Gynecologic Cancer Lymphedema Questionnaire (GCLQ), the Global Pelvic Floor Bother Questionnaire (GPFBQ), the Pittsburgh Sleep Quality Index (PSQI), the Tampa Scale of Kinesiophobia (TSK) and the Body Image Scale (BIS) one time. The severity of lymphedema symptoms was quite high in patients with lymphedema (GCLQ Total: 13.6) (p < .05). Patients with lymphedema had higher GCLQ total scores, GPFBQ1 (stress urinary incontinence), GPFBQ4 (urge urinary incontinence), GPFBQ8 (fecal incontinence), kinesiophobia and, body image scores than patients without lymphedema (p < .05). The sleep quality levels of patients with lymphedema and patients without lymphedema were similar (p > .05). A significant negative correlation was found between GLCQ total score and body image (p < .05). There was a positive correlation between kinesiophobia and pelvic floor symptoms and a negative correlation between kinesiophobia and body image (p < .05). In this study, it was observed that in patients who developed lymphedema after gynecologic cancer surgery, pelvic floor symptoms and kinesiophobia increased and the severity of lymphedema negatively affected body image. Reducing lymphedema in these patients may improve pelvic floor health, mobility, and body image.


Assuntos
Linfedema , Neoplasias , Humanos , Feminino , Diafragma da Pelve/diagnóstico por imagem , Imagem Corporal , Qualidade do Sono , Inquéritos e Questionários , Extremidade Inferior , Linfedema/diagnóstico , Qualidade de Vida
6.
FASEB J ; 37(1): e22674, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36520015

RESUMO

Secondary lymphedema is a debilitating disease characterized by abnormal soft tissue swelling and caused by lymphatic system dysfunction. Despite a high prevalence of secondary lymphedema after cancer treatments, current management is supportive and there are no approved therapeutic agents that can thwart disease progression. We have previously demonstrated that 9-cis-retinoic acid (9-cisRA) has the potential to be repurposed for lymphedema as it mitigates disease by promoting lymphangiogenesis at the site of lymphatic injury. Although the efficacy of 9-cisRA has been demonstrated in previous studies, the mechanism of action is not completely understood. In this study, we demonstrate that when RXRα is specifically deleted in lymphatic endothelial cells, 9-cisRA fails to induce lymphangiogenesis in vitro and prevent pathologic progression of postsurgical lymphedema in vivo. These findings demonstrate that downstream nuclear receptor RXRα plays a critical role in the therapeutic efficacy of 9-cisRA in postsurgical lymphedema.


Assuntos
Vasos Linfáticos , Linfedema , Humanos , Linfangiogênese , Alitretinoína/uso terapêutico , Células Endoteliais/patologia , Linfedema/etiologia , Linfedema/prevenção & controle , Linfedema/patologia , Vasos Linfáticos/patologia
7.
Plast Reconstr Surg ; 151(1): 217-224, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36576830

RESUMO

BACKGROUND: Previous studies have demonstrated racial disparities in breast cancer treatment and secondary lymphedema. However, no studies have yet examined the effects of race and socioeconomic status on physiological surgical treatment for lymphedema. The authors aimed to evaluate whether disparities exist within patients seeking physiological surgical lymphedema treatment. METHODS: A retrospective review was performed of patients presenting for physiological surgical treatment of lymphedema from 2013 to 2019. Data on demographics, medical history, socioeconomic factors, lymphedema, and treatments were collected. RESULTS: A total of 789 patients (712 women and 77 men) seeking physiological surgical treatment of lymphedema were selected. Their mean age was 54.4 ± 13.4 years. A total of 620 patients (78.5%) self-reported as White, 120 (15.2%) as Black, 17 (2.2%) as Asian, five (0.6%) as Hispanic, and eight (2.4%) as multiracial. A total of 566 patients (71.7%) met criteria for surgical candidacy. White race was associated with increased rates of surgical candidacy compared with Black race (46.6% versus 77.2%; P < 0.0001). Compared with White patients, Black patients presented with a longer symptom duration (11.07 versus 6.99 years; P < 0.001), had a higher body mass index (mean, 34.5 versus 28.1; P < 1 × 10 -10 ), had a higher International Society of Lymphology stage ( P < 0.05), and were less likely to have maximized medical treatment for lymphedema (30.8% versus 55.4%; P < 0.01). CONCLUSIONS: This study demonstrates racial disparities in patients seeking physiological surgical treatment for lymphedema. Black patients present later with more severe disease, receive less nonsurgical treatment before consultation, and are less likely to meet criteria for physiological surgery. Improved patient and provider education on lymphedema and appropriate diagnosis and nonsurgical treatment is of primary importance to address this disparity.


Assuntos
Linfedema , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Hispânico ou Latino , Grupos Raciais , Linfedema/cirurgia , Disparidades em Assistência à Saúde
8.
J Invest Surg ; 35(5): 978-983, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34545757

RESUMO

PURPOSE: While the risk of lower limb lymphedema (LLE) after radical surgery for gynecologic malignancies is multifactorial, the limited assessment of lymph nodes (LNs), such as sentinel LN biopsy, has been incorporated into a standard procedure. We assessed the relationship between the number of LNs retrieved from the hemipelvis and the incidence of ipsilateral LLE (iLLE). METHODS: This retrospective study included 103 women with gynecologic cancer who had LNs removed with minimally invasive surgery between January 2014 and December 2018. For early detection of LLE, the patients were followed up by a lymphedema specialist who complied with the International Society of Lymphedema criteria. Potential risk factors for LLE were collected, and the risk factors were further investigated according to the number of LNs removed in a side-specific manner. RESULTS: LLE was diagnosed in 32 (31.1%) patients, and most of them were diagnosed with unilateral (n = 22) LLE rather than bilateral (n = 10). The number of pelvic LNs removed (p = 0.018), no lymphatic mapping (p = 0.034), and radiation (p = 0.020) were associated with the development of one or both LLEs. A side-specific analysis revealed that the incidence of iLLE increased significantly when four or more LNs were removed from the hemipelvis compared with three or fewer LNs (22.9% vs. 8.3%, p = 0.048). CONCLUSIONS: The number of pelvic LNs retrieved was associated with the incidence of LLE in patients with early gynecologic cancer. We identified the cutoff number per hemipelvis through side-specific analysis that could minimize the risk of iLLE. Further studies are needed to validate our results.


Assuntos
Neoplasias dos Genitais Femininos , Linfedema , Feminino , Neoplasias dos Genitais Femininos/complicações , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Extremidade Inferior/cirurgia , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Linfonodos/cirurgia , Linfedema/epidemiologia , Linfedema/etiologia , Linfedema/cirurgia , Masculino , Estudos Retrospectivos
9.
Eur J Med Res ; 27(1): 274, 2022 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-36464689

RESUMO

BACKGROUND: The combined application of blue dye and radioisotopes is currently the primary mapping technique used for sentinel lymph node biopsy (SLNB) in breast cancer patients. However, radiocolloid techniques have not been widely adopted, especially in developing countries, given the strict restrictions on radioactive materials. Consequently, we carried out a retrospective study to evaluate the feasibility and accuracy of three-dimensional visualization technique (3DVT) based on computed tomography-lymphography (CT-LG) in endoscopic sentinel lymph node biopsy (ESLNB) for breast cancer. METHODS: From September 2018 to June 2020, 389 patients who underwent surgical treatment of breast cancer in our department were included in this study. The CT-LG data of these patients were reconstructed into digital 3D models and imported into Smart Vision Works V1.0 to locate the sentinel lymph node (SLN) and for visual simulation surgery. ESLNB and endoscopic axillary lymph node dissection were carried out based on this new technique; the accuracy and clinical value of 3DVT in ESLNB were analyzed. RESULTS: The reconstructed 3D models clearly displayed all the structures of breast and axilla, which favors the intraoperative detection of SLNs. The identification rate of biopsied SLNs was 100% (389/389). The accuracy, sensitivity, and false-negative rate were 93.83% (365/389), 93.43% (128/137), and 6.57% (9/137), respectively. Upper limb lymphedema occurred in one patient 3 months after surgery during the 12-month follow-up period. CONCLUSIONS: Our 3DVT based on CT-LG data combined with methylene blue in ESLNB ensures a high identification rate of SLNs with low false-negative rates. It, therefore, has the potential to serve as a new method for SLN biopsy in breast cancer cases.


Assuntos
Neoplasias da Mama , Linfedema , Humanos , Feminino , Biópsia de Linfonodo Sentinela , Linfografia , Azul de Metileno , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
10.
J Vis Exp ; (189)2022 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-36533826

RESUMO

Lymphedema is a common condition often associated with cancer and its treatment, which leads to damage to the lymphatic system, and current treatments are mostly palliative rather than curative. Its high incidence among oncologic patients indicates the need to study both normal lymphatic function and pathologic dysfunction. To reproduce chronic lymphedema, it is necessary to choose a suitable experimental animal. Attempts to establish animal models are limited by the regenerative capacity of the lymphatic system. Among the potential candidates, the rabbit hindlimb is easy to handle and extrapolate to the human clinical scenario, making it advantageous. In addition, the size of this species allows for better selection of lymphatic vessels for vascularized lymph node resection. In this study, we present a procedure of vascular lymph node resection in the rabbit hindlimb for inducing secondary lymphedema. Anesthetized animals were subjected to circumferential measurement, patent blue V infiltration, and indocyanine green lymphography (ICG-L) using real-time near-infrared fluorescence, a technique that allows the identification of single popliteal nodes and lymphatic channels. Access to the identified structures is achieved by excising the popliteal node and ligating the medial and lateral afferent lymphatics. Special care must be taken to ensure that any lymphatic vessel that joins the femoral lymphatic system within the thigh without entering the popliteal node can be identified and ligated. Postoperative evaluation was performed at 3, 6, and 12 months after induction using circumferential measurements of the hindlimb and ICG-L. As demonstrated during follow-up, the animals developed dermal backflow that was maintained until the 12th month, making this experimental animal useful for novel long-term evaluations in the management of lymphedema. In conclusion, the approach described here is feasible and reproducible. Additionally, during the time window presented, it can be representative of human lymphedema, thus providing a useful research tool.


Assuntos
Vasos Linfáticos , Linfedema , Animais , Humanos , Coelhos , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Linfedema/cirurgia , Linfografia/efeitos adversos , Linfografia/métodos , Excisão de Linfonodo , Linfonodos/patologia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Vasos Linfáticos/patologia , Membro Posterior/cirurgia , Membro Posterior/patologia , Verde de Indocianina
11.
Br J Community Nurs ; 27(12): 586-590, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36519461

RESUMO

Lymphoedema is more than 'swollen legs'; it is an unpleasant condition that affects approximately 260 000 people in the UK. This article briefly looks at what the lymphatic system is and what lymphoedema is. It then looks at compression wraps and argues for wider use with patients, as they can promote self-care in patients.


Assuntos
Linfedema , Doenças Vasculares , Humanos , Bandagens Compressivas , Linfedema/terapia , Edema , Autocuidado
12.
Support Care Cancer ; 31(1): 44, 2022 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-36525089

RESUMO

PURPOSE: The aim of this review is to establish the efficacy of aquatic therapeutic exercise in female breast cancer survivors for improving fatigue, pain, lymphedema, and quality of life. METHODS: A systematic literature review was conducted in PubMed, Web of Science, and Cochrane Library databases for articles published in the last 10 years. The review focuses on aquatic exercise-based rehabilitation in female breast cancer survivors, according to the PRISMA statement and using the PEDRO and Jadad scales. RESULTS: Ten randomized controlled trials with 606 participants were included. Two studies showed aquatic therapeutic exercise to be effective in reducing fatigue, three in reducing pain, and four in improving quality of life after intervention. Three of five studies obtained significant immediate changes in lymphedema volume, although this improvement was only maintained at 3 months in a single study. The methodological quality of all the studies was ≥ 7 on the PEDro scale and ≥ 3 on the Jadad scale. CONCLUSION: Aquatic therapeutic exercise is an effective strategy for improving fatigue, pain, and quality of life in breast cancer survivors, although the effects on lymphedema remain uncertain. Participants showed high adherence to treatment and no adverse effects after intervention were reported.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Linfedema , Feminino , Humanos , Neoplasias da Mama/reabilitação , Qualidade de Vida , Fadiga/etiologia , Fadiga/terapia , Terapia por Exercício , Linfedema/etiologia , Linfedema/terapia , Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Molecules ; 27(24)2022 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-36558195

RESUMO

Coumarin is an effective treatment for primary lymphoedema, as well as lymphoedema related to breast cancer radiotherapy or surgery. However, its clinical use is limited in several countries due to the possible occurrence of hepatotoxicity, mainly in the form of mild to moderate transaminase elevation. It is worth noting that only a few cases of severe hepatotoxicity have been described in the literature, with no reported cases of liver failure. Data available on coumarin absorption, distribution, metabolism, and excretion have been reviewed, focusing on hepatotoxicity studies carried out in vitro and in vivo. Finally, safety and tolerability data from clinical trials have been thoroughly discussed. Based on these data, coumarin-induced hepatotoxicity is restricted to a small subset of patients, probably due to the activation in these individuals of alternative metabolic pathways involving specific CYP450s isoforms. The aim of this work is to stimulate research to clearly identify patients at risk of developing hepatotoxicity following coumarin treatment. Early identification of this subset of patients could open the possibility of more safely exploiting the therapeutical properties of coumarin, allowing patients suffering from lymphoedema to benefit from the anti-oedematous activity of the treatment.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas , Linfedema , Humanos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Cumarínicos/efeitos adversos , Cumarínicos/metabolismo , Medição de Risco , Linfedema/induzido quimicamente
14.
Lymphat Res Biol ; 20(6): 579, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36537707
15.
Support Care Cancer ; 31(1): 9, 2022 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-36512157

RESUMO

PURPOSE: Postoperative complications of breast cancer (BC) seriously affect the quality of life (QOL) of survivors. Physical activity is related to prevention of complications and improvement of QOL. Follow-up can keep patients motivated to exercise. This study aimed to (1) compare the effect of three exercise programs on lymphedema, pain, and QOL in BC patients and (2) explore the effect of intensive follow-up on the outcomes of exercise programs. METHODS: A single-blind randomized parallel controlled trial with a 6-month intervention was carried out in China in 2021. The study sample included 200 women with BC. The patients were randomly divided into 4 groups. G0 (control group) was joint mobility exercise (JME) group; G1 was joint mobility exercise + intensive follow-up (IF) group; G2 was JME + aerobic exercise (AE) + IF group; and G3 was JME + progressive resistance exercise (PRE) + IF group. Outcome measures were evaluated at baseline (T1), 3 months post-intervention (T2), and 6 months post-intervention (T3). The following instruments and measurements were administered before and after the intervention: the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument, the numerical rating scale (NRS), and the relative volume change (RVC). Verificating aim 1 is by comparing the results of G1, G2, and G3, and verificating aim 2 is achieved by comparing G0 and G1. Differences before and after the intervention were determined by analysis of variance of repeated measures and Kruskal-Wallis nonparametric analysis of variance. RESULTS: Among the exercise programs, JME + PRE + IF resulted in the best improvement in QOL (T2: ΔG3-G0 = 13.032, P = 0.008; T2: ΔG3-G1 = 13.066, P < 0.001; ΔG3-G0 = 17.379, P < 0.001). For pain relief, JME + AE + IF had the best improvement (T3: ΔG2-G1 = - 0.931, P = 0.010; ΔG2-G0 = - 1.577, P < 0.001). For the prevention of lymphedema, JME + AE + IF (Z = 2.651, P = 0.048) and JME + PRE + IF (Z = 3.277, P = 0.006) had the similar effect, but JME + PRE + IF is better than JME + AE + IF. CONCLUSION: JME + PRE have the best effect in improving the QOL and preventing lymphedema after surgery. In improving pain, the effect of JME + AE appears earlier, and the overall effect of JME + PRE is better. In addition, long-term and planned monitoring and follow-up are also important.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Linfedema , Humanos , Feminino , Qualidade de Vida , Neoplasias da Mama/complicações , Seguimentos , Método Simples-Cego , Linfedema/etiologia , Linfedema/prevenção & controle , Sobreviventes , Exercício Físico , Dor/complicações , Terapia por Exercício/métodos
16.
Support Care Cancer ; 31(1): 18, 2022 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-36513801

RESUMO

PURPOSE: To review and update the incidence and risk factors for breast cancer-related lymphedema based on cohort studies. METHODS: The study was guided by the Joanna Briggs Institute methodology and the Cochrane handbook for systematic reviews. PubMed, EMBASE, CINAHL, Scopus, Web of Science, The Cochrane Library, CNKI, SinoMed, and Wan Fang Database were searched from inception to November 15, 2021. Cohort studies reported adjusted risk factors were selected. PRISMA guideline was followed. Study quality were evaluated using the Newcastle-Ottawa scale. Random-effects models were adopted. The robustness of pooled estimates was validated by meta-regression and subgroup analysis. Lymphedema incidence and adjusted risk factors in the multivariable analyses with hazard / odds ratios and 95% CIs were recorded. RESULTS: Eighty-four cohort studies involving 58,358 breast cancer patients were included. The pooled incidence of lymphedema was 21.9% (95% CI, 19.8-24.0%). Fourteen factors were identified including ethnicity (black vs. white), higher body mass index, higher weight increase, hypertension, higher cancer stage (III vs. I-II), larger tumor size, mastectomy (vs. breast conservation surgery), axillary lymph nodes dissection, more lymph nodes dissected, higher level of lymph nodes dissection, chemotherapy, radiotherapy, surgery complications, and higher relative volume increase postoperatively. Additionally, breast reconstruction surgery, and adequate finance were found to play a protective role. However, other variables such as age, number of positive lymph nodes, and exercise were not correlated with risk of lymphedema. CONCLUSION: Treatment-related factors still leading the development of breast cancer-related lymphedema. Other factors such as postoperative weight increase and finance status also play a part. Our findings suggest the need to shift the focus from treatment-related factors to modifiable psycho-social-behavioral factors.


Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Linfedema , Neoplasias Unilaterais da Mama , Humanos , Feminino , Mastectomia/efeitos adversos , Mastectomia/métodos , Neoplasias da Mama/patologia , Axila/patologia , Neoplasias Unilaterais da Mama/complicações , Neoplasias Unilaterais da Mama/cirurgia , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema/epidemiologia , Linfedema/etiologia , Linfedema/patologia , Excisão de Linfonodo/efeitos adversos , Fatores de Risco , Estudos de Coortes
17.
Support Care Cancer ; 31(1): 22, 2022 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-36513943

RESUMO

BACKGROUND: This study was performed to examine the effects of selfcare and selected factors on the quality of life in women with breast cancer-related lymphedema (BCRL). METHODS: The study was descriptive and cross-sectional and included 101 women with BCRL. Data were gathered with a descriptive characteristics questionnaire, the Lymphedema Quality of Life Scale-Arm and the Breast Cancer-Related Lymphedema Selfcare Scale. Obtained data were analyzed with numbers, percentages, mean, and multiple regression analysis. RESULTS: The lowest and the highest scores of the women with lymphedema (LE) on the Lymphedema Quality of Life Scale-Arm were 35 and 71 respectively with a mean of 52.63 ± 11.81. The lowest and the highest scores to be obtained from this scale are 20 and 80 respectively. The quality of life was predicted significantly and positively by time elapsing after the diagnosis of breast cancer and significantly and negatively by time elapsing after the diagnosis of LE and selfcare (p < 0.05). Other variables did not individually affect the quality of life (p > 0.05). CONCLUSION: Since selfcare influences the quality of life, patients with BCRL should be given education and support for selfcare, the quality of their lives should be regularly evaluated, and interventions that enhance the quality of their lives should be conducted.


Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Linfedema , Humanos , Feminino , Qualidade de Vida , Neoplasias da Mama/complicações , Estudos Transversais , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/terapia , Linfedema/etiologia , Linfedema/terapia , Linfedema/diagnóstico
18.
Lymphology ; 55(3): 110-116, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36446398

RESUMO

Lymphedema is a debilitating disease characterized by abnormal lymphatic drainage, either due to primary maldevelopment of the lymphatic system or to secondary injury. The clinical features of primary and secondary lymphedema differ, with primary lymphedema more often involving progressive bilateral lower extremity disease as compared to secondary lymphedema characteristically having more localized symptoms related to the origin of injury. This case presentation describes a patient who presented with bilateral lower extremity swelling, left greater than the right, with imaging results to support the diagnosis of lymphedema. During the time he was followed in our clinic, our team witnessed rapid progression of his lymphedema despite compliance with conservative management. We believe that the primary mechanism of systemic damage to our patient's lymphatic system is the lenalidomide and bortezomib therapy prescribed to treat multiple myeloma. This review explores the relationship between lenalidomide, bortezomib, and lymphedema in efforts of understanding this unique pathology of iatrogenic lymphedema mimicking primary nature.


Assuntos
Linfedema , Mieloma Múltiplo , Masculino , Humanos , Mieloma Múltiplo/tratamento farmacológico , Lenalidomida/efeitos adversos , Bortezomib/efeitos adversos , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Doença Iatrogênica
19.
Am Fam Physician ; 106(5): 557-564, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36379502

RESUMO

Edema is a common clinical sign that may indicate numerous pathologies. As a sequela of imbalanced capillary hemodynamics, edema is an accumulation of fluid in the interstitial compartment. The chronicity and laterality of the edema guide evaluation. Medications (e.g., antihypertensives, anti-inflammatory drugs, hormones) can contribute to edema. Evaluation should begin with obtaining a basic metabolic panel, liver function tests, thyroid function testing, brain natriuretic peptide levels, and a urine protein/creatinine ratio. Validated decision rules, such as the Wells and STOP-Bang (snoring, tired, observed, pressure, body mass index, age, neck size, gender) criteria, can guide decision-making regarding the possibility of venous thromboembolic disease and obstructive sleep apnea, respectively. Acute unilateral lower-extremity edema warrants immediate evaluation for deep venous thrombosis with a d-dimer test or compression ultrasonography. For patients with chronic bilateral lower-extremity edema, duplex ultrasonography with reflux can help diagnose chronic venous insufficiency. Patients with pulmonary edema or elevated brain natriuretic peptide levels should undergo echocardiography to assess for heart failure. Lymphedema is often a clinical diagnosis; lymphoscintigraphy can be performed if the diagnosis is unclear. Treatment of edema is specific to the etiology. Diuretics are effective but should be used only for systemic causes of edema. Ruscus extract and horse chestnut seed demonstrate moderate-quality evidence to improve edema from chronic venous insufficiency. Compression therapy is effective for most causes of edema.


Assuntos
Linfedema , Insuficiência Venosa , Humanos , Peptídeo Natriurético Encefálico , Edema/diagnóstico , Edema/etiologia , Edema/terapia , Insuficiência Venosa/complicações , Insuficiência Venosa/diagnóstico , Linfedema/etiologia , Atenção Primária à Saúde
20.
Pain Physician ; 25(8): E1269-E1277, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36375200

RESUMO

BACKGROUND: Although lower limb lymphedema (LLL) is more or equally as frequent and harmful as upper limb lymphedema after cancer treatment, there are only a few studies on this topic. Cancer-related secondary LLL not only has physical implications, but also affects quality of life among patients who underwent gynecological cancer treatment. Despite numerous studies of various therapies, the optimal treatment for cancer-related LLL is still unknown. OBJECTIVES: We aimed to investigate the efficacy of lumbar sympathetic ganglion block (LSGB) in patients with secondary LLL in the present study. STUDY DESIGN: This study is a retrospective study. SETTING: A single academic hospital, outpatient setting. METHODS: A total of 30 patients with secondary unilateral LLL and failed complex decongestive treatment,  from January 2017 through May 2021, were reviewed for inclusion in this study. The patients underwent fluoroscopy-guided LSGB 2 times with the help of digital subtraction angiography at 3-day intervals. Leg circumference was measured, and the volume of the leg was calculated before surgery, on the first day after the first surgery, on the first day after the second surgery, and on the seventh day after the second surgery. The World Health Organization Quality of Life Instrument Questionnaire scores were monitored before and after LSGB. RESULTS: The leg circumference and volume decreased significantly from baseline after the treatment (P < 0.001). One week after 2 rounds of LSGB, the physical health score, psychological score, and social relationships score were higher than those before treatment (all P < 0.05). There was no difference in the environmental health score (P = 0.2731). LIMITATIONS: This study was limited by its sample size and retrospective observational design. CONCLUSIONS: LSGB can be a safe and effective treatment option for patients with secondary LLL after gynecological cancer treatment.


Assuntos
Linfedema , Neoplasias , Humanos , Estudos Retrospectivos , Qualidade de Vida , Extremidade Inferior , Linfedema/psicologia , Linfedema/terapia , Gânglios Simpáticos
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